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Biomedical subjects

J E Wickham

Publications and source records attributed to J E Wickham.

At least 19 recordsLinked to original sources
PubMed1992

Indomethacin and postprandial gallbladder emptying.

Patients with gallstone disease commonly have impaired gallbladder emptying. To see whether non-steroidal anti-inflammatory drugs (NSAIDs) prevent gallstone formation by improving gallbladder emptying, we assessed the effect of indomethacin on postprandial emptying in healthy subjects and in patients with gallstone disease. Subjects received indomethacin 25 mg three times a day for a week and matching placebo for another week. Compared with placebo, indomethacin improved postprandial gallbladder emptying in all 7 patients with gallstone disease. This finding was not recorded in healthy subjects with normal gallbladders. The prevention of gallstone formation associated with ingestion of NSAIDs may be due mainly to a prokinetic effect on the gallbladder since there is no evidence to suggest that these drugs affect cholesterol crystal nucleation at ordinary therapeutic doses in man or animals.

Adult↗
PubMed1992

Effect of oral erythromycin on gallbladder motility in normal subjects and subjects with gallstones.

The action of the motilin receptor agonist erythromycin on human gallbladder contraction, measured by ultrasound, both in normal subjects and those with gallstone disease was studied. In 17 normal subjects, oral erythromycin administration (500 mg; vs. placebo) reduced fasting gallbladder volume at 2 hours (26.2 vs. 19.0 mL; P less than 0.001), and postprandial residual gallbladder volume (9.0 vs. 4.4 mL; P less than 0.001) and the rate constant of gallbladder emptying following the meal was significantly increased. Erythromycin also reduced fasting and residual gallbladder volumes in 13 patients with gallstone disease: in 6 who underwent cholecystolithotomy, fasting volume was 29.5 vs. 22.3 mL (P less than 0.05) and residual volume was 17.7 vs. 6.5 mL (P less than 0.05), and in 7 with gallstones in situ, fasting volume was 23.8 vs. 14.3 mL (P less than 0.05) and residual volume was 17.2 vs. 5.0 mL (P less than 0.05). In 7 of 8 subjects with gallstones and impaired gallbladder emptying, the gallbladder emptied normally following administration of erythromycin, and in 3 of the other 5 gallstone subjects gallbladder emptying was increased. In 6 normal subjects given erythromycin three times weekly for 1 month, the effect was maintained (fasting volume, 18.8 mL, P less than 0.001; residual volume, 3.7 mL, P less than 0.001). Oral erythromycin significantly reduces fasting and postprandial residual gallbladder volumes in both normal subjects and subjects with gallstones and reverses the gallbladder motility defect found in a proportion of subjects with gallstones. This effect is maintained for a month in normal subjects.

Administration, Oral↗
PubMed1991

Extrusion of calculi from upper urinary tract into perinephric and periureteric tissues during endourologic stone surgery.

We report on 11 patients in whom fragments of calculi were extruded into the perinephric or periureteric tissues at the time of endourologic stone surgery. All patients have been managed conservatively. In 2 patients ureteric strictures developed, but these were probably secondary to an electrical injury as a result of electrohydraulic lithopaxy. The remaining 9 patients have not experienced serious sequelae as a result of the calculus extrusion.

Humans↗
PubMed1991

Percutaneous nephrolithotomy and the solitary kidney.

We reviewed 53 patients with stones in a solitary kidney who had undergone percutaneous nephrolithotomy. Previous surgery on that kidney had been performed in 35.8%, and 50.9% had other medical conditions including 26.4% who had impaired renal function. Staghorn or partial staghorn calculi were present in 52.9% and an additional 18.8% had multiple stones. Postoperative complications in 18.8% of the patients included sepsis, the need for transfusion and 1 death of bronchopneumonia. Percutaneous nephrolithotomy alone resulted in a 77.3% rate free of stone or fragments of 2 mm, or less. This rate increased to 86.8% with the addition of extracorporeal shock wave lithotripsy, ureteroscopy or open surgery (2 patients). Only 1 patient suffered long-term deterioration in renal function. Percutaneous nephrolithotomy is a safe procedure in the solitary kidney. It should be considered in those patients with complex stone burdens and impaired renal function when reduction in stone bulk and improved renal function may allow other treatment modalities to be used.

Female↗
PubMed1991

Percutaneous nephrolithotomy for calculi in horseshoe kidneys.

Between 1983 and 1988, 15 patients (18 kidneys) underwent percutaneous nephrolithotomy at this unit for calculi in horseshoe kidneys. A standard 1-stage percutaneous access technique with minor modifications was used. In situ disintegration with ultrasound or electrohydraulic lithotripsy was necessary in 15 moieties (83.3%) and nephrostomy drainage was required in 12 (66.7%). Percutaneous access was not a problem and there were minimal perioperative problems. Blood transfusion was required postoperatively in 2 patients. A total of 14 kidneys (77.8%) were rendered free of stone with percutaneous nephrolithotomy alone and 2 kidneys were left with asymptomatic stone fragments of 2 mm. or less. Another 2 kidneys became free of stone after extracorporeal shock wave lithotripsy, thus giving an over-all stone clearance rate of 88.8%. We conclude that percutaneous nephrolithotomy is an acceptable treatment for stones in horseshoe kidneys and it is the treatment of choice for patients in whom imaging is difficult or impossible.

Adult↗
PubMed1991

A user's guide to flexible cystoscopes.

This survey, carried out on behalf of the BAUS Instruments Committee, aims to assist the urologist in choosing a flexible cystoscope. The 5 most commonly available flexible cystoscopes (from ACMI, Olympus, Pentax, Storz and Wolf) were assessed in a clinical setting for handling, image quality and user satisfaction. Several technical characteristics, including deflection range, irrigant flow rate and optics, were tested in the laboratory. Whilst all instruments were satisfactory, the favourite of our testing panel was the Olympus CYF-2, which also came out best in the technical assessment and has the most comprehensive service support. The cheaper Storz instrument also performed well.

Cystoscopes↗
PubMed1991

The development of a surgeon robot for prostatectomies.

The removal of prostatic tissue through transurethral resection of the prostate (TURP) is an operation that can require considerable skill from a surgeon as well as being a lengthy procedure. The potential for using robotic techniques was investigated in a preliminary feasibility study using a standard six axis 'Puma' robot. This led to the construction of a manually operated 'safety frame' which has been shown to be effective through clinical trials on 30 patients. A special-purpose robot, based on the design of the manual frame, has now been constructed. Some of the safety issues are discussed which make this procedure an ideal candidate for a robotic device.

Equipment Design↗
PubMed1991

[Development of an instrument for endoscopic liquefaction of the prostate].

Although the concept of prostate liquefaction had been proposed by Wickham 15 years ago, its clinical application has been delayed by various technical problems. The authors report on the investigative procedures that have been undertaken to design and develop the ELSA (Endoscopic Liquidiser and Surgical Aspirator) prototype which has been utilized in the clinical setting with promising results.

Aged↗
PubMed1990

Percutaneous cholecystolithotomy: the first 60 patients.

OBJECTIVE: To assess the feasibility and possible complications of percutaneous removal of gall stones. DESIGN: Prospective study of the first 60 patients treated. SETTING: The London Clinic. PATIENTS: 60 Consecutive patients with symptomatic gall stones who agreed to have them removed percutaneously. RESULTS: 56 Patients had stones successfully removed percutaneously. In four patients failure of access necessitated a cholecystectomy under the same anaesthetic. Two patients had an empyema of the gall bladder drained initially, followed by a second operation to remove the stones one week later. Seven patients had postoperative complications, and two had recurrences of biliary calculi. CONCLUSIONS: The techniques and instruments used in percutaneous nephrolithotomy can successfully be adapted for percutaneous removal of gall stones. The procedure is suitable for a wider range of patients than other techniques that leave the gall bladder intact.

Adult↗
PubMed1990

The changing practice of percutaneous stone surgery. Review of 1000 cases 1981-1988.

A review was carried out on 1000 cases of percutaneous nephrolithotomy (PCNL), Group 1 (500), 1981-1985, being compared with Group 2 (500), 1985-1988. Previous renal surgery had been performed in 17.4% of patients in Group 1 and 36% in Group 2. There were 17.2% complicated patients in Group 1 and 51% in Group 2. The stone burden included 30.2% multiple, partial staghorn and staghorn calculi in Group 1 and 47.2% in Group 2. The use of in situ stone disintegration increased from 22.2% in Group 1 to 73.4% in Group 2 and nephrostomy drainage was necessary in 29.6% compared with 75%. Post-operative complications increased from 13.6 to 24%. Stone-free rates decreased from 92 to 51%, but the addition of other methods of treatment and the inclusion of patients with stone fragments of 2 mm or less increased these figures to 98% in Group 1 and 83% in Group 2. More complicated patients with complex stones are now being referred for PCNL. These patients require multiple treatments, including extracorporeal shock wave lithotripsy (ESWL) and percutaneous surgery, in combination with other endoscopic and radiological procedures.

Adolescent↗
PubMed1989

Integrated cystoscope: first rigid multipurpose operating cystoscope for local anesthetic endoscopy.

The Miller Integrated Cystoscope is the first small-diameter (17 Ch), rigid, multipurpose, operating cystoscope (biopsy, urethrotomy, ureteric catheterization, cutting, retrieval of stones and foreign bodies, and injection) designed with patient comfort in mind. Despite a small outside diameter, the 8.7-Ch instrument channel conducts a 7.5-Ch accessory including the unique rigid Endoknife, which converts it into an optical urethrotome and rigid Endoneedle which can deliver local anesthetic and other pharmacologic agents into the bladder, prostate, and urethra of both male and female patients. The simplicity of design has dispensed with the need for more costly and conventional instrumentation (e.g., optical urethrotome, Albarron lever) at a fraction of the cost. The urologist can not only inspect the lower urinary tract (Cf fiberscopes) but also perform endoscopic procedures short of a full transurethral prostatectomy with maximum patient comfort.

Ambulatory Surgical Procedures↗
PubMed1989

Clinical experience using the Wolf Piezolith device at 2 British stone centers.

Machines using the principle of piezoelectric extracorporeal shock wave lithotripsy have been developed. This has allowed the prospect of painless treatment for renal and ureteral calculi. The experience with use of 2 Wolf Piezolith machines for 1 year is presented. Different second generation lithotriptors have varying techniques of production of shock waves and different imaging methods. The Wolf Piezolith device uses ultrasound imaging and piezoelectric crystals for shock wave generation. Between June 1987 and May 1988, 545 patients 5 to 84 years old were treated with the Wolf Piezolith device. Of these patients 2-month followup data are available for 367 (398 renal units). Outpatient treatment was used routinely. For renal calculi complete fragmentation (into particles less than 2 mm. in size) was achieved in 94 per cent of the patients, with 53 per cent being completely free of stone at 2 months. For ureteral stones treated in situ the best results were obtained in the upper and lower ureter. Over-all, 62 per cent of the patients required more than 1 treatment, with the number of treatment sessions required increasing with the size of the stone treated. Morbidity was low. Ultrasound imaging has proved to be as effective as x-ray imaging. Compared to Dornier HM-3 lithotripsy, installation and running costs were low. The machine offers a favorable alternative to first generation lithotriptors.

Adolescent↗
PubMed1989

Percutaneous cholecystolithotomy.

A single-stage method of percutaneous removal of gallstones is presented which was adapted from our experience with percutaneous nephrolithotomy. It is performed under general anesthesia using ultrasound and fluoroscopic control. The overall success rate of 90 per cent and the fact that any stone, irrespective of its size or composition may be treated, firmly establishes this method as an important addition to the modern methods of treating gallstones.

Cholelithiasis↗
PubMed1989

Radionuclide imaging of ureteric peristalsis.

Dynamic renal scintigraphy is a successful and minimally invasive technique for evaluating renal function. An extension to the basic technique involving fast-frame acquisition and a modified analysis is described which enables ureteric function to be examined. Ureteric peristalsis was assessed in 32 patients using this technique. The results from 5 representative studies are described in detail. Normally functioning ureters exhibit peristaltic contractions at a frequency of up to 3/min. Hyperperistalsis that exceeds 4 contractions/min is associated with obstruction. Peristaltic behaviour in 9 patients examined before and after ESWL was not altered.

Adult↗