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Biomedical subjects

E J Milroy

Publications and source records attributed to E J Milroy.

At least 73 records · Page 4Linked to original sources
PubMed1983

Reoperative parathyroid surgery.

The increasing recognition of hypercalcaemia caused by primary hyperparathyroidism has led to a rise in the number of failed parathyroid exploration. We report a series of 37 parathyroid re-explorations on 33 patients with persistent hypercalcaemia following the failure of their previous parathyroid surgery. Of these patients, 27 have been cured of their hypercalcaemia but 7 are permanently hypocalcaemic. The results of the parathyroid localization tests used in this series are described, and the difficulties of reoperative parathyroid surgery are discussed. The reasons for failure of the original operations are analysed. Many are avoidable. Based on our experience strategies are described for parathyroid localization and reoperative surgery.

Adenoma↗
PubMed1983

The structure of the bladder neck in male bladder neck obstruction.

A light microscope and neurohistochemical study is presented of full thickness biopsies from the bladder neck of 10 middle-aged males with urodynamically proven bladder neck obstruction. Apart from varying degrees of collagen deposition in seven cases, no abnormality was present in the detrusor and pre-prostatic components of the bladder neck muscles or in the distribution of cholinergic nerve fibres. The normal noradrenergic innervation to the pre-prostatic sphincter was absent in all specimens; this may be age-related.

Adult↗
PubMed1983

Non-obstructive detrusor failure. A urodynamic, electromyographic, neurohistochemical and autonomic study.

Twenty-eight patients presenting with persistent loss of the voiding reflex have been evaluated. Those with cauda equina lesions or pelvic nerve injury were distinguished from a group with idiopathic detrusor failure by their abnormal urethral behaviour during filling, and by urethral sphincter electromyography (EMG). Bladder muscle biopsies revealed the presence of presumptive cholinergic fibres in all three groups, indistinguishable in quantity and distribution from normal controls. The implications of these findings for the diagnosis and management of these patients is discussed.

Adult↗
PubMed1982

The synthesis of 3H labelled steroid-nitrogen mustard derivatives and studies on their action in rat and human prostate.

Tissue receptor proteins are thought to be a key factor in selective retention and nuclear translocation of steroid hormones in their target tissues. Steroid-cytotoxic derivatives with high affinity for these receptor proteins may, therefore, be useful as site directed agents in the treatment of hormone dependent cancers. The prostatic retention and subcellular localisation of estramustine and a 17 beta nitrogen mustard derivative of 5 alpha-dihydrotestosterone have been compared since the latter compound has higher androgen receptor binding affinity than the former. The 5 alpha-dihydrotestosterone derivative was not retained more avidly than estramustine by either human or rat ventral prostatic tissue. Nuclear localisation could not be detected with either compound. The cytotoxic action of these compounds requires the liberation of the nitrogen mustard moiety. The cleavage rate of both compounds was low but similar in both benign and malignant prostatic tissues. We conclude that steroids are unlikely to be suitable agents for directing cytotoxic compounds to prostatic tissue particularly if the steroid-cytotoxic derivative requires metabolism for the expression of the cytotoxic activity.

Animals↗
PubMed1982

Urothelial abnormalities in the obstructed bladder.

Bladder mucosa from patients undergoing prostatectomy was examined histologically for evidence of pre-malignant change. The mucosal appearances were compared with tissue taken from control patients without bladder outlet obstruction. The appearances in patients with uncomplicated obstruction and in control patients were found to be similar and dysplastic change was uncommon. However, dysplasia was found relatively frequently in patients with bladder outlet obstruction complicated by the presence of infection, catheters or stones. In all, 10 out of 74 patients were found to have dysplasia and 7 of these agreed to have a further cystoscopy and biopsy taken at an interval of between 10 and 28 months after the first examination. Persistent dysplasia was found in all 7 cases and in 3 of these it had progressed from mild to moderate in severity. The significance of these findings is discussed.

Adult↗
PubMed1982

Electrical anal stimulation and the prediction of bladder stability after surgical relief of male outflow obstruction.

In an attempt to predict which unstable bladders in males with outflow obstruction would convert to stability following surgery, we performed functional electrical stimulation (FES) of the anus during pre-operative rapid fill cystometry in 13 patients with benign prostatic hypertrophy (BPH) and 5 patients with bladder neck obstruction (BNO), all of whom had associated instability. Instability was suppressed in only 2 patients with BPH. Although suppression was achieved in 4 patients with BNO, no correlation was found with either post-operative stability or symptomatology in this group or the patients with BPH and we conclude that FES has no predictive value in this context.

Adult↗
PubMed1981

Radiological trabeculation for the male bladder--a clinical and urodynamic assessment.

Two hundred and fifty patients have been studied by synchronous cine/pressure/flow cystometry to assess the relationship between radiological trabeculation and the urodynamic findings. There is a strong association between detrusor instability and trabeculation. Trabeculation, however, may also occur in the presence of high pressure outflow obstruction, usually at prostate level, in the absence of instability. It is suggested that frequent uninitiated detrusor contraction against a voluntarily closed sphincter is a likely cause of the more prominent varieties of trabeculation. However, the presence of minor degrees of trabeculation noted at cystoscopic examination in the absence of detrusor instability is not disputed.

Adult↗
PubMed1981

Unheralded urinary tract infection in the male. A clinical and urodynamic assessment.

Fifty adult males presenting with unheralded single or recurrent urinary tract infections, but without prior urinary symptoms or disorders, were investigated by appropriate urodynamic techniques. Pressure/flow videocystography revealed significant underlying lower urinary tract abnormalities in 40 cases (80%) compared with only 11 (22%) whose abnormalities were also demonstrated by standard intravenous urography or endoscopy. We suggest that videocystography is the most efficient diagnostic procedure for these cases in a specialist unit but recommended the intravenous urodynamogram as a simpler screening test for general use.

Adolescent↗
PubMed1979

The intravenous urodynamogram.

Modifications to the intravenous urogram are described. It is suggested that the time has come to rationalise the standard procedure. If an evaluation of the lower urinary tract is required, the voiding films may be modified to provide an intranvenous urodynamogram. If an evaluation of the upper urinary tract is directed at a specific question, then the number of spot-films can often be reduced.

Adult↗
PubMed1978

The nuclear uptake of androgen by human benign prostate in vitro: action of antiandrogens.

An in vitro test system suitable to assess the potency of putative antiandrogens has been developed, using the human benign prostatic tissue obtained at operation. The system circumvents some problems associated with using human tissue, such as the presence of endogenous steroid and contamination with plasma proteins (particularly sex hormone binding globulin). Slices of tissue were incubated in the presence of 3H-testosterone and the uptake into nuclei was determined. The nature of the nuclear radioactivity and the steroid specificity indicates a mechanism similar to the established in the rat ventral prostate. The action of antiandrogens (cyproterone acetate, diethylstilbestrol, flutamide, hydroxylated flutamide and gestonorone capronate) has been studied at various concentrations.

Androgen Antagonists↗
PubMed1978

Results of prolonged bladder distension as treatment for detrusor instability.

Forty-six patients with urinary symptoms associated with unstable (uninhibitable) detrusor contractions have been treated by a total of 58 bladder distensions; 43 of these were fully re-evaluated urodynamically thereafter and none showed conversion from unstable to stable detrusor behaviour. Four patients with unstable bladders were symptomatically improved but 5 patients reported symptomatic deterioration. We have concluded that while over-distension may sometimes improve a patient's symptoms, it did not result in the abolition of detrusor contractions or the reversal of unstable detrusor behaviour.

Adolescent↗
PubMed1975

A urodynamic view of bladder outflow obstruction in the female: factors influencing the results of treatment.

169 female patients with outlet obstruction have been studied urodynamically. The results of treatment of the outlet obstruction in 102 patients have been analysed and the reason for the failures discussed. Patients with stable detrusors and those with symptoms of recurrent urinary tract infection responded well to treatment, provided this relieved the obstruction adequately; symptomatic relief was less common in patients with unstable detrusors, despite adequate outflow readjustment.

Adolescent↗