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Biomedical subjects

K Anson

Publications and source records attributed to K Anson.

17 recordsLinked to original sources
PubMed2005

Multicentre audit of the treatment of uncomplicated urinary tract infection in South Thames.

A regional audit report on the management of uncomplicated urinary tract infections (UTIs) in genitourinary (GU) medicine clinics in the UK in South Thames (South London, Kent, Surrey and Sussex). The majority of centres use trimethoprim as first-line treatment for uncomplicated UTIs. The incidence of trimethoprim resistance was 22.6%. The group has therefore recommended that cephalexin should be the first choice antibiotic for suspected UTIs within GU medicine.

Anti-Bacterial Agents↗
PubMed2000

Does endoscopic laser ablation of the prostate stand the test of time? Five-year results from a multicentre randomized controlled trial of endoscopic laser ablation against transurethral resection of the prostate.

OBJECTIVE: To determine the long-term objective and subjective outcome of patients with benign prostatic enlargement (BPE) treated by endoscopic laser ablation of the prostate (ELAP), as part of a multicentre randomized controlled trial of ELAP against TURP. PATIENTS AND METHODS: Initially, 151 patients with BPE were randomized to undergo either ELAP or TURP, starting in March 1992. ELAP was performed using the Urolasetrade mark fibre (Bard, Covington, GA, USA) in conjunction with a Nd:YAG laser source. All patients who had originally participated in the study were approached 5 years later to obtain a urological history, American Urological Association (AUA) symptom score and two measurements of urinary flow rate, with an ultrasonographic assessment of the postvoid residual urine volume (PVR). RESULTS: The mean duration of follow-up was 61 months; 109 patients were traced, comprising 69 who were alive and well, and had undergone no further bladder outlet surgery, 26 who had required revision surgery, 12 who were dead or terminally ill and three who had dementia. Both ELAP and TURP produced sustained improvements in mean AUA score, maximum flow rate and PVR, with respective values at 5 years of 6.3, 17.8 mL/s and 76 mL, and 6.5, 20.0 mL/s and 55 mL. Eighteen of 47 ELAP patients (38%) and eight of 51 (16%) TURP patients underwent revision surgery within the follow-up. CONCLUSION: ELAP and TURP produced similar subjective and objective outcomes at 5 years. The re-operation rate after ELAP was more than double that after TURP and suggests that ELAP should not be used routinely in the management of men with BPE.

Endoscopy↗
PubMed1996

Alteration of laser-tissue interaction with the 805 nm diode laser using indocyanine green in the canine prostate.

BACKGROUND AND OBJECTIVE: Research interests in laser prostatectomy continue to evaluate a variety of wavelengths and treatment parameters in an effort to optimize treatment. Recently, a semiconductor diode laser with a wavelength of 805 nm has become available for clinical use; however, free-beam noncontact applications were limited by the low power output (25 W). In this study in the canine prostate, the possible potentiating effects of intravenously administered indocyanine green (ICG) were evaluated with the 805 nm diode laser. STUDY DESIGN/MATERIALS AND METHODS: A total of 16 fixed position, free-beam lasings were performed at 25 W for 60 sec in four dogs with eight lasings before and eight lasings after ICG administration. Endoscopic observations and measurements of lesion volumes were used to evaluate the laser-tissue interactions. RESULTS: Prior to ICG administration, we observed that side fire irradiation produced primarily small coagulative lesions. Following ICG administration, however, immediate and more noticeable tissue vaporization occurred, although total lesion size was not increased. Pathologic review demonstrated less coagulation and hyperemia, but a larger vaporized cavity in the ICG treated tissue. CONCLUSION: These findings suggest intravenous ICG alters laser-tissue interaction with the 805 nm diode laser in the canine prostate. The use of the 805 nm diode laser with enhancing chromophores deserves further investigation.

Animals↗
PubMed1995

A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate.

OBJECTIVES: To assess the safety and efficacy of endoscopic laser ablation of the prostate (ELAP), performed with the Urolase fiber and the neodymium:yttrium-aluminum-garnet laser, compared to transurethral resection of the prostate (TURP) in patients with bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: In this multicenter, prospective, randomized study, a total of 151 patients were treated (ELAP, 76; TURP, 75) of whom 137 completed 1 year follow-up (ELAP, 67; TURP, 70). Safety parameters included measurement of preoperative and 24-hour postoperative sodium, hematocrit, and hemoglobin values and careful monitoring of adverse events. Efficacy was assessed with the American Urological Association symptom score (6), urinary flow rates, and residual urinary volume measurements. RESULTS: There was 1 death in each group during the study period unrelated to the treatment procedure. There was a clinically significant improvement in all efficacy parameters in both groups. Between group comparisons favored TURP in maximum flow rate, residual urinary volume, and symptom score. ELAP had a better safety profile than TURP in the defined safety parameters of drop in hemoglobin and hematocrit values. In 16% of patients, a blood transfusion was required after TURP compared with no transfusions in the ELAP group. Urinary tract infections and dysuria were more frequent in the ELAP group. CONCLUSIONS: ELAP performed with the Urolase fiber is a useful alternative therapy to TURP in patients presenting with bladder outflow obstruction secondary to BPH.

Aged↗
PubMed1995

Perpetuation of ageist attitudes among present and future health care personnel: implications for elder care.

The population of the western world is greying rapidly. By the year 2025, people over the age of 65 will make up 20% of the population of the USA. By the year 2000, one-half of elderly people in the United Kingdom (UK) will be over the age of 75. The increasing numbers of elderly people will be spending from 18% (males) to 27% (females) of their added years as impaired, disabled and frail individuals. The purposes of this comparative descriptive study were to: (a) describe and compare the attitudes of registered nurses (RNs) and health career work study students (HCS) who work with elderly people in the clinical setting; and (b) determine whether relevant demographic variables of the two groups were related to their attitudes. A convenience sample of 82 RNs and 68 HCSs were asked to complete Kogan's (1961) Attitudes Toward Old People Scale (KOP). Response to the survey was 91% and 74% for the HCS and RN groups respectively. There was a significant difference between the group mean scores with students holding less favourable attitudes toward elderly people on the KOP-negative scale. No significant difference was found on the KOP-positive scale. Point-biserial correlations between demographic variables and attitude scores revealed that gender and ethnicity were significantly related to RNs attitudes--males and blacks and Asians expressed more unfavourable attitudes. Educational level and primary area of clinical work were significantly associated with students' scores on the KOP-negative scale, while years of clinical experience was significantly related to KOP-positive scale scores. While both groups held attitudes that were more favourable than unfavourable, RNs and HCSs expressed stereotypical views about old people in general. Recommendations for nursing education and nursing service are proposed to prevent the negative impact on future care elderly people that the findings suggest.

Aged↗
PubMed1995

A comparative optical analysis of laser side-firing devices: a guide to treatment.

OBJECTIVE: To compare the optical characteristics of five different laser side-firing fibres used to perform deep laser coagulation of the prostate. MATERIALS AND METHODS: The intensity profile, angle of exit and beam divergence from the launch fibre were measured underwater (to simulate endoscopic conditions) for each fibre using both the Helium Neon(633 nm) and Nd:YAG(1064 nm) lasers. RESULTS: The intensity profiles and spot sizes varied among fibres but broadly fell within two groups characterized by large and small footprints (low and high power density). There was a maximum 5.5 fold difference in average power densities between the fibres. CONCLUSIONS: Not all side-firing devices are the same. Variations in the power density profiles among the fibres suggest that the choice of fibre is of critical importance in determining the type of laser tissue interaction (i.e. coagulation or vaporization) that will follow the use of that fibre.

Laser Coagulation↗
PubMed1994

Laser prostatectomy: which way forward?

A number of endoscopic laser strategies have been employed in the treatment of symptomatic benign prostatic hyperplasia at our hospital. The post-operative results in 102 patients are presented. Sidefiring fibres were coupled with the Nd:YAG laser to produce a deep coagulative necrosis within the prostatic adenoma. This approach was associated with a short operative time and a delay of up to three months before treatment effect. Contact laser techniques (with both the 1064 nm and 805 nm lasers) were used to vaporize prostatic tissue in an attempt to produce a defect similar to that following TURP. This provided an immediate treatment effect with early removal of catheters. The operative time, however, was long and this limited the procedure to glands of less than 40 ccs. The hybrid approach (combining laser prostatotomies with coagulation) provided an immediate relief of obstruction with an additional delayed effect as the coagulated cavity matured. All approaches were associated with minimal haemorrhage and limited morbidity with encouraging improvements in both symptom scores and uroflowmetry. The various advantages and disadvantages of each endoscopic laser strategy are discussed.

Follow-Up Studies↗
PubMed1990

The role of midazolam and flumazenil in urology.

The effects of midazolam (3-10 mg i.m.) and their reversal by flumazenil were studied in transurethral endoscopic procedures performed using topical analgesia. In one randomised study, patients (n = 84) received either no medication or flumazenil (0.5 mg i.v.) on completion of endoscopy. Recovery was assessed subjectively. Within 15 min, 83% of those receiving flumazenil were considered ready for discharge compared with only 24% of the control group (P less than 0.001). In a second randomised, double-blind, placebo-controlled trial of 44 patients, post-operative recovery was assessed using five objective psychomotor tests. Whereas the placebo group took up to 2 h to recover, those receiving flumazenil recovered fully or returned to near control values within 15 min. Sedoanalgesia--a technique combining adequate local anaesthesia with sedation (using midazolam)--has wide application in urology, and the introduction of flumazenil has major implications for the practice of day-case surgery.

Adult↗