Educational benefits of audit.
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Education, Medical↗
Biomedical subjects
J B Roberts
Publications and source records attributed to J B Roberts.
Jail suicide and legal redress.
Suicide is the leading cause of death in jails. Especially at risk are pretrial detainees. This paper provides clinicians who serve as consultants to jails with an overview of legal precedent concerning liability for jail suicide on the federal appellate, federal district, and state levels. Liability on the federal level is based upon actions involving deliberate indifference or gross negligence. A table is provided granting a summary view of appellate-level decisions on liability for jail suicide. Liability on the state level involves lesser standards of negligence. The paper concludes with several liability-generating scenarios.
Civil Rights↗
Prostatectomy in the over 80-year-old.
With an ageing population the demand for prostatectomy in the over 80-year-olds is increasing. This study assesses the place of prostatectomy in this age group. All patients over the age of 80 who underwent prostatectomy in a 2-year period were studied retrospectively; 90 such patients underwent 94 operations, 90 of which were TURPs. Serious concomitant disease was found in 64 patients (71%) and 11 (12%) had had a previous prostatectomy at least 1 year before. The mean weight of tissue removed was 24.8 g. In 18 men histology showed malignant change. Two men died from cardiovascular disease immediately after surgery (2.1%); a further 5 patients (7.8%) died within 6 months. Post-operative morbidity was high, with 64 patients (71%) developing complications. These were related to pre-operative urinary tract infections and uraemia. Nevertheless, at 6 weeks 72 patients (80%) were considered to have had a satisfactory result. Prostatectomy in the over 80-year-old has a good long-term outcome. Although the morbidity rate is high, these patients should be considered for operation provided they undergo careful pre-operative assessment.
Aged↗
Treatment of prostatic cancer.
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Delayed-Action Preparations↗
Tumour markers in prostatic carcinoma. A comparison of prostate-specific antigen with acid phosphatase.
A study was performed on 130 men to compare the level of serum prostate-specific antigen (PSA) in controls, patients with benign prostatic hyperplasia (BPH) and patients with prostatic carcinoma. The results showed that all 30 normal controls below 40 years of age had values less than 10 ng/ml. Of the 40 patients with BPH, all aged over 40 years, 13 (32.5%) had raised levels above 10 ng/ml. In the 60 patients with prostatic carcinoma, all over 40 years, 24 had localised disease (MO) and 36 had metastatic spread (M1), as judged by isotope bone scan. In patients with MO disease, 16 (66.6%) had raised PSA levels compared with 34 (94.5%) of those with M1 disease. The corresponding figures for raised prostatic acid phosphatase (PAP) values were 4% in the MO group and 52.7% in the M1 group. PSA levels reflected neither the histological grade nor the local stage of the tumour and were of no value in estimating tumour burden. PSA was found to be a valuable index in the management of prostatic cancer because of this sensitivity. Stable disease not requiring hormonal manipulation was reflected by unchanging levels of PSA, whereas progressive disease requiring hormonal therapy was reflected by an alteration in the PSA levels corresponding to the patients' response. The same group of progressive disease patients showed only a 50% rise in serum PAP levels, confirming the greater sensitivity of PSA as a measure of prostate cancer. PSA measurements should be included in any further trials on prostatic carcinoma and should be regarded as a standard marker for evaluating response to therapy.
Acid Phosphatase↗
Identification of the poor risk patient with "prostatism" and detrusor failure.
Twenty-five patients with "prostatism" and chronic retention of urine have been followed up for 4 years to determine the natural history of the disorder and results of elective treatment. Twenty-one patients with low pressure during bladder filling maintained normal upper tracts and renal function; they were subdivided by micturition pressure into two groups which differed significantly in terms of both total bladder capacity and variance of capacity. Patients with good voiding pressures had a very satisfactory outcome following surgery, with almost complete relief of symptoms, but patients with poor voiding pressures obtained a poor symptomatic and urodynamic result from repeated surgical procedures. Four patients declined operation and the subsequent course of the disorder is described. Four patients had painless retention associated with high pressure bladder filling, hydronephrosis and uraemia. Operation was successful in reversing these potentially terminal complications. None of the 25 patients developed acute retention. Men with "prostatism" do not constitute a homogeneous population. Identification of specific patient groups enables an accurate prediction of the consequences of both conservative and operative management.
Adult↗
Treatment of bladder carcinoma with tumor-immune pig lymph node cells. Phase I study.
A total of 77 patients with invasive TCC of the urinary bladder each received a single arterial injection of tumor-immune pig lymph node cells (LNC), into the tumor blood supply. The patients were divided into 4 groups: those receiving pig LNC as the only treatment (16 patients); those who received pig LNC on relapse (judged by EUA cystoscopy and biopsy) following radical radiotherapy, 5,500 cGy (34 patients); those who received pig LNC followed after an interval of six weeks by radiotherapy, 4,000 cGy (10 patients); as in Group 3 but with the dose of radiotherapy increased to 5,500 cGy (17 patients). Complete remission was characterized by complete disappearance of the tumor (for a varying time) following treatment. Partial remission was defined as: a reduction in the level of symptoms and a decrease in tumor size on EUA and/or cystoscopy. There were 1 complete and 3 partial remissions among the patients in Group 1, 5 complete and 7 partial in Group 2, 6 complete and 2 partial in Group 3, and 8 complete and 1 partial in Group 4. Of the 20 patients showing complete remission, 7 lived for more than five years after treatment.
Animals↗
Primary malignant melanoma of the penis. Two cases and a review of the literature.
Two cases of primary malignant melanoma of the penis are reported and 35 cases from the world literature are reviewed. The tumour most commonly started in the glans penis and less frequently from the prepuce. The microscopic appearances were identical with those of tumours arising elsewhere in the skin. A comparison is made between the incidence of melanoma of the penis and melanoma occurring elsewhere on the body surface. Evaluation of the best treatment was difficult because the total number of cases was small and the methods of treatment and results so variable. It would seem that the prognosis of malignant melanoma of the penis is generally poor, although there are sufficient examples of long-term survival after total amputation in Stage I disease to suggest that this radical treatment is justified.
Adult↗
The long-term results of ileal conduit urinary diversion in children.
Sixty-seven children undergoing urinary diversion by ileal conduit tolerated this procedure well. The initial results were most satisfying, but late complications occurred in 55 children (82%), and this is a cause for concern. Even when the surgical complications were avoided, it seemed important to consider carefully the psychological problems that these children with ileal loop diversion could develop as they advanced into adult life.
Adolescent↗
Vesicoplication in the management of chronic urinary retention.
Eighteen patients have been treated by vesicoplication for low tension chronic urinary retention. The clinical presentation, operative technique and results in these 18 patients are discussed. Vesicoplication is shown to be a simple, safe and effective method of relieving symptoms in this group of patients.
Chronic Disease↗
Nephroplasty in the management of hydronephrosis.
Seventeen patients with hydronephrosis were treated by nephroplasty and pyeloplasty. This combination proved to be a simple and effective way of reducing intrarenal dilatation and encouraging dependent drainage from the lower pole calices.
Adolescent↗
Benign tumours developing at the site of ureterosigmoidostomy.
Two cases of benign tumours complicating ureterosigmoidostomy are described. The latent period between diversion and the development of tumour is long and careful follow-up of patients with ureterosigmoidostomy is recommended. It would seem highly probable that adenomatous polyps developing at the site of anastomosis may, if undetected, undergo malignant change to adenocarcinoma. All of the tumours recorded following ureterosigmoid diversion have been associated with a nipple type ureterocolic anastomosis and mucosa-to-mucosa anastomosis may possibly prevent this complication.
Adenocarcinoma↗
The surgical treatment of heterotopic ossification at the elbow following long-term coma.
Nine cases of heterotopic ossification at the elbow in seven patients who had a cerebral injury and prolonged coma were treated by excision of the extra-articular bone bridge from the humerus to the ulna. The bridge was either anterior or posterior, and did not involve the radius. The articular cartilage in all elbows showed no significant evidence of degeneration in spite of the prolonged immobility of the joints during the period of coma. Two of the patients also had resection of heterotopic bone about the hip joint which resulted in rapid reformation of bone. In all patients there was restoration of satisfactory function in the elbow operated on without reformation of bone. Follow-up was from ten months to 8.7 years.
Adolescent↗
Transfer of adoptive immunity by intra-arterial injection of tumor-immune pig lymph node cells: treatment of recurrent urinary bladder carcinoma after radical radiotherapy.
Twenty-four patients with invasive transitional cell carcinoma of the urinary bladder, recurrent after radiotherapy, were treated by intra-arterial infusion of tumor-immune pig lymph node cells. In 11 patients there was a remission of the disease process, and 3 patients remain alive and free of disease in excess of one year after treatment.
Aged↗
Coagulum pyelolithotomy.
In 25 patients undergoing pyelolithotomy a supplementary coagulum technique has been used. Initial difficulties were found in the preparation, instillation and extraction of the coagulum, but with experience a satisfactory technique has been developed. The type of stone situation most likely to benefit from coagulum pyelolithotomy would seem to be where there is a small, mobile stone or stone fragment lying in a calix or in a wide renal pelvis.
Fibrinogen↗
Adoptive immunotherapy and radiotherapy in the treatment of urinary bladder cancer.
Thirty-one patients with invasive transitional cell carcinoma of the urinary bladder were treated either by infusion of tumour immune pig mesenteric lymph node cells into the tumour blood supply, followed 6 weeks later by 5500 rad, or by radiotherapy alone. The patients were paired prior to treatment, using 4 criteria: age (nearest decade), sex, clinical stage (T3 or T4) and histological grade (average or high). The first patient in each pair then received combined treatment and the second radiotherapy alone. Administration of pig cells before radiotherapy offered no advantage to the patient in terms of the incidence of remission or the length of survival after treatment.
Animals↗
Late results of skin inlay urethroplasty.
Sixty-two patients undergoing either one-stage or two-stage skin inlay urethroplasty for stricture of the urethra have been reviewed. The success rate and incidence of complications are discussed. The technique of skin inlay urethroplasty requires a considerable degree of surgical expertise and a similar skill in clinical evaluation is required in the selection of patients for this procedure.
Adolescent↗
Interstitial cystitis, treated by prolonged bladder distension.
25 patients with interstitial cystitis were treated by prolonged bladder distension. 16 patients are symptom-free, but 5 of these have had 1 or more previous prolonged bladder distensions. 6 patients are improved, whilst 3 remain symptomatically unchanged. Prolonged bladder distension can be repeated successfully when symptoms return. These results suggest that prolonged bladder distension has a place in the treatment of interstitial cystitis.
Adult↗