PubMed Health⌕ Search

Biomedical subjects

J E Wickham

Publications and source records attributed to J E Wickham.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1988

Percutaneous cholecystolithotomy.

A percutaneous method was used to remove stones from otherwise normal gall bladders, as assessed by cholecystography and ultrasonography. The procedure was performed in a single stage under general anaesthesia, adopting the method and instruments used for one stage percutaneous nephrolithotomy. A Foley catheter was left in the gall bladder and the system checked with contrast at 10 days to ensure free drainage and exclude residual calculi. Seven out of eight patients had a successful percutaneous cholecystolithotomy. An adequate track could not be secured in one man; he had an uneventful cholecystectomy under the same anaesthetic. Follow up at three months of the seven patients showed no calculi and no complications. Percutaneous cholecystolithotomy may prove complementary to extracorporeal shockwave lithotripsy in patients in whom there is difficulty focusing the shock waves on the gall bladder or who have had incomplete disintegration of stones.

Adult↗
PubMed1988

Tethered ureteric stents--a clinical assessment.

The acceptability and complications of tethered double-J stents were assessed in 17 patients. The study showed tethered ureteric stents to be safe, well tolerated and easy to remove. The technique avoids unnecessary ureteral instrumentation and general anaesthesia and has benefits for both patients and hospital resources.

Adolescent↗
PubMed1988

Lasertripsy for ureteric stones in 120 cases: lessons learned.

The pulsed dye laser has proved to be an effective and safe method of treating ureteric stones; 120 patients have been treated. Ureteroscopic lasertripsy (107 cases) had an overall success rate of 84%. The failures were due to mobile stones inadvertently flushed back into the kidney (14%) and 2% of patients required open ureterolithotomy after failure of two ureteroscopic procedures. "Blind" lasertripsy (13 cases) was safe but not as efficient, the success rate being only 23%.

Female↗
PubMed1988

YAG laser treatment of early carcinoma of the prostate.

We describe our initial experience of a method which develops the role of endoscopic surgery in the treatment of early prostatic carcinoma. An "extended" transurethral resection of the prostate (TURP) under ultrasound control reduces the prostatic tissue to a thin residual capsule suitable for subsequent transmural coagulation by endoscopic YAG laser. Twenty patients with early disease were entered into the pilot study. Three were excluded after staging (2 T0a and 1 with positive nodes on pelvioscopy-T2 N1 M0); 17 received a full course of treatment. Mean follow-up was 6 months (range 1-14). Two early patients with excessive residual tissue had initially positive biopsies and underwent second treatments with subsequently negative biopsies. Two patients continue to have positive biopsies and the rest are negative. No tumour has progressed and complications have been minimal. One patient experienced reduced frequency of erections and 1 required bladder neck incision for symptomatic bladder neck stenosis at routine follow-up endoscopy. There were no other effects on either potency or continence.

Adult↗
PubMed1988

The steinstrasse: a legacy of extracorporeal lithotripsy?

32 steinstrasse formations in the first 600 extracorporeal shockwave lithotripsy treatments required intervention. Their radiological appearance has been classified into 3 types and the aetiology of each type is discussed. 24 cases received a primary needle nephrostomy to relieve obstruction and of these 18 passed spontaneously, 5 required ureteroscopic manipulation and 1 underwent open surgery. Primary ureteroscopic removal was successful in 3 out of 5 cases. 3 upper ureteric steinstrassen were removed by a percutaneous intrarenal approach. A suggested plan of management for complicated steinstrassen is outlined.

Adult↗
PubMed1988

Effective intubation for percutaneous pyelolysis.

The pelvi-ureteric incision carried out during percutaneous pyelolysis has been intubated with a tapered 14-french catheter in 20 patients. This catheter provided both internal and external pelvic drainage and proved efficient in decompressing the upper ureter when drained externally. This catheter provided optimal conditions for pelvi-ureteric healing and allowed splintage of a sufficient diameter to enlarge the upper ureter and improve drainage from the obstructed renal pelvis.

Catheterization↗