Biomedical subjects

L K Lloyd

Publications and source records attributed to L K Lloyd.

At least 19 recordsLinked to original sources

PubMed2001

Treatment of intrinsic sphincter deficiency using autologous ear chondrocytes as a bulking agent.

Intrinsic sphincter deficiency (ISD) is frequently treated with collagen bulking at the bladder neck. The standard material used, Contigen, biodegrades over 3-19 months requiring repeated injections to maintain efficacy. The study objective was to evaluate use of autologous ear chondrocytes for treatment of ISD. Women with documented ISD had harvest of auricular cartilage. Chondrocytes were isolated from the cartilage and expanded in culture and formulated with calcium alginate to form an injectable gel. Thirty-two patients received a single outpatient injection just distal to the bladder neck. Outcome measures included voiding diary, quality-of-life scores, incontinence severity grading, and pad weight testing. Incontinence grading indicated 16 patients dry, and 10 improved at 12 months for a total of 26 of 32 (81.3%) dry and improved after one treatment. Only four patients had a 12-month pad weight test over 2.2 g. Quality-of-life scores improved significantly after treatment. There was a decrease in incontinence impact scores in all categories. The urogenital distress inventory declined for all categories except bladder emptying and lower abdominal pain. Endoscopic treatment of ISD with autologous chondrocytes is safe, effective, and durable with 50 % of patients dry 12 months after one injection. Twenty-six of 32 patients dry or improved at 3 months after the injection maintained the effect at the 12-month visit.

Adult↗

PubMed2001

Bladder stone incidence in persons with spinal cord injury: determinants and trends, 1973-1996.

OBJECTIVES: To examine the current trend in the incidence of an initial bladder stone and the potential contributing factors among persons with spinal cord injury. METHODS: A longitudinal cohort of 1336 patients with spinal cord injury who were injured between 1973 and 1996 and followed up on a yearly basis up to 1999 in a single institution was used to estimate bladder stone incidence. Multivariable analysis was performed to identify risk factors for an initial bladder stone. RESULTS: During the study period, 229 incident bladder stone cases were documented. It is estimated that for those injured in 1973 to 1979, 1980 to 1984, 1985 to 1989, and 1990 to 1996, the 5-year cumulative incidence rate of an initial bladder stone was 29%, 23%, 14%, and 8%, respectively (P <0.0001). This decreasing trend was consistent for various demographic and clinical characteristics. During the first year after injury only, the bladder stone risk increased with decreasing age (P <0.0001) and was greater for whites. A neurologically complete lesion was associated with an increased bladder stone risk in later years (P = 0.008). Males and persons with indwelling and intermittent catheters had a higher risk during all the years after the injury. CONCLUSIONS: With improvement in urologic rehabilitation, bladder stone incidence has declined during the past several decades. The study results, however, suggest that new strategic interventions may be required to further prevent stone occurrence in individuals with spinal cord injury and a complete neurologic lesion who are using indwelling catheterization, because these patients are still at a relatively higher risk.

Adolescent↗

PubMed1999

The effect of physical activity and fitness on specific antibody production in college students.

BACKGROUND: The purpose of this study was to determine the effect of moderate physical activity/fitness on the immune response to a defined antigen, in particular, the hemagglutinin-inhibition response to the H1 (A/Texas/36/91) and H3 (A/Johannesburg/33/94) components of the 1995-96 Influenza virus vaccine. METHODS: Sixty-seven volunteers 18-30 years of age (mean 21.1 + 2.3) participated in the study. Physical activity was assessed using the Stanford 7-Day Recall Questionnaire, physical fitness (VO2max) was predicted based on graded submaximal cycle ergometry. Participants were divided into six groups (lower-active/fit, moderate active/fit, and higher active/fit), based on their scores on the 7-Day Recall Questionnaire or predicted VO2max, respectively. Plasma samples were collected prior to, one, two, four, and six weeks post vaccination. A total of four separate repeated measures ANOVA were utilized to evaluate the effect of physical fitness and physical activity on the immune response to the H1 and H3 components of the vaccine. RESULTS: As expected, for both antigens, titers significantly increased after vaccination, with the highest titers found on week four (H1) and week six (H3), respectively. However, for both antigens, there was no difference between groups and no significant interaction. CONCLUSIONS: The results of this study showed no significant effect of physical fitness or physical activity on the production of specific antibody in the range of physical fitness and physical activity found within this group of college students.

Adolescent↗

PubMed1997

Comparison of long-term renal function after spinal cord injury using different urinary management methods.

OBJECTIVE: To determine the effect of different bladder management methods on long-term renal function in persons with spinal cord injury (SCI). DESIGN: Cohort study. SETTING: Model SCI care system within a large teaching hospital. PATIENTS: Consecutive sample of 1,114 persons with SCI who were injured between 1969 and 1994. MAIN OUTCOME MEASURE: Total and individual kidney effective renal plasma flow (ERPF). RESULTS: ERPF was generally lower in persons with cervical injuries or kidneys that had a renal stone, older persons, and women. Overall, there was very little change in renal function as time postinjury increased, and there were no clinically meaningful differences in the change in renal function over time among persons using different bladder management methods. CONCLUSION: Renal function was adequately preserved in the great majority of persons and did not appear to be influenced to any great extent by method of bladder management.

Adolescent↗

PubMed1997

Nephron-sparing surgery compared with radical nephrectomy for renal tumors: current indications and results.

BACKGROUND: Small asymptomatic solid renal masses are being found more often through the frequent use of abdominal ultrasonography and computed tomography. Nephron-sparing renal surgery is being done more often to treat these small lesions. A retrospective review was done to determine the effectiveness of this treatment. METHODS: Patients who had nephron-sparing renal surgery (group 1-35 patients) were compared with those who had radical nephrectomy (group 2-71 patients) for renal cell carcinoma smaller than 5 cm. RESULTS: The two groups had only small differences in fall in hematocrit, transfusion rates, operative time, and hospital stay. Major surgical complications were more frequent in group 1. After a median follow-up of 3.1 years, there has been no recurrence of tumor and there were no surgery-related or cancer-related deaths in either group. CONCLUSION: Nephron-sparing renal surgery appears to be a safe and effective alternative to radical nephrectomy for localized small renal tumors.

Adult↗

PubMed1996

The Hytrin Community Assessment Trial study: a one-year study of terazosin versus placebo in the treatment of men with symptomatic benign prostatic hyperplasia. HYCAT Investigator Group.

OBJECTIVES: To determine the clinical effectiveness and safety of alpha(1)-blockade therapy versus placebo in the treatment of men with moderate to severe symptoms of prostatism in a community-based population under usual care conditions. METHODS: The Hytrin Community Assessment Trial is a prospective, placebo-controlled, randomized, double-blinded, 1-year clinical trial, conducted at 15 academic medical centers (regional sites) and 141 private urology practices (satellite sites). A total of 2084 men at least 55 years old with moderate to severe symptoms of benign prostatic hyperplasia (BPH) as determined by an American Urological Association (AUA) Symptom Score (AUA-SS) of 13 or more points and a bother score (AUA-BS) of 8 or more were enrolled. Randomized patients at regional sites were required to have a peak urinary flow rate less that 15 mL/s with voided volume of at least 150 mL. Treatment with terazosin was initiated with 1 mg daily for 3 days, followed by 2 mg daily for 25 days. Thereafter, patients were titrated stepwise to 5 or 10 mg if they failed to achieve a 35% or greater improvement in the AUA-SS. Primary outcome measures were AUA-SS, AUA-BS, BPH Impact Index (BII), disease-specific quality of life (QQL) score, and treatment failure as defined as discontinuation due to persistent or worsening symptoms or need for surgical intervention for BPH. Secondary outcome measures were peak urinary flow rate and postvoid residual urine volume. RESULTS: AUA-SS (0 to 35 point scale) improved from a baseline mean of 20.1 points by 37.8% during terazosin (n=976) and by 18.4% during placebo (n=973) treatment (P<0.001). Similarly, statistically superior improvements were observed in regard to the AUA-BS, BII, and the QQL score in the terazosin-treated patients. Peak urinary flow rate improved from a baseline of 9.6 mL/s (both regional treatment groups) by 2.2 mL/s in the terazosin group (n=137) and by 0.7 mL/s in the placebo group (n=140) (P< or = 0.05). Treatment failure occurred in 11.2% of terazosin- and 25.4% of placebo-treated patients (P<0.001; Kaplan-Meier adjusted withdrawal rates of 365 days). Withdrawal from study drug treatment due to adverse events occurred in 19.7% of terazosin- and 15.2% of placebo-treated patients (P<0.001). CONCLUSIONS: Terazosin given once daily in a dose ranging from 2 to 10 mg in community-based urology practices under conditions simulating usual care is effective in reducing the symptoms, perception of bother, and the impairment of QQL due to urinary symptoms in men with moderate to severe symptoms of prostatism. This effect is superior to placebo and maintained over 12 months of follow-up. Clinical research outcome studies in BPH can be conducted in community-based practices, thus simulating as closely as possible "usual care" conditions.

Adrenergic alpha-Antagonists↗

PubMed1995

Compliance with annual urologic evaluations and preservation of renal function in persons with spinal cord injury.

We located 59 persons with spinal cord injury (SCI) who had not been examined for 3-15 years and paid them to undergo evaluation and comparison with 101 controls examined on an annual basis. Renal function during the first year post-injury and at follow-up was measured by radioisotopic scanning to determine effective renal plasma flow (ERPF) and information was obtained regarding occurrence of specific secondary complications. Subjects and controls were alike with respect to demographic characteristics, injury-related variables and occurrence of specific secondary complications. Mean initial and follow-up ERPF values adjusted for increasing age were not significantly different for subjects and controls, nor was there significant change within individuals over time. Although serial examination of the urinary tract following SCI is important, after the first few years it may be acceptable to lengthen the periods between examinations or substitute less expensive, noninvasive diagnostic techniques. SCI care centers should carefully evaluate recommendations regarding follow-up urologic examinations in persons with SCI in order to provide the most cost-effective program while maintaining optimum patient care.

Adolescent↗

PubMed1994

Review of 333 living donor nephrectomies.

We reviewed the operative complications in 333 living related donor nephrectomies done at our institution over the past 12 years. The overall complication rate was 17.1%; only three patients (0.9%) had major complications, and none died. The major complications were a delayed splenectomy because of bleeding, an adrenalectomy, and acute renal failure in one patient in the immediate postoperative period. We concluded that donor nephrectomy done through a flank incision results in minimal morbidity.

Adolescent↗

PubMed1992

Factors predicting efficacy of phentolamine-papaverine intracorporeal injection for treatment of erectile dysfunction in diabetic male.

Thirty-three diabetic men were instructed in the use of phentolamine-papaverine injections for the treatment of erectile dysfunction over a two-year period. Of these, 12 reported a satisfactory response and 21 reported a nonsatisfactory response. The responders and the nonresponders were retrospectively studied to identify characteristics that would predict a satisfactory response. No difference was found between the two groups in the duration of diabetes, the presence of retinopathy, neuropathy, nephropathy, peripheral vascular disease, or ischemic heart disease. The utilization of insulin, the prevalence of type II diabetes, or the use of drugs which would cause impotence, did not differ between the two groups. There was no difference in the serum testosterone levels between the two groups. Age was the only predictive factor. Only 1 of 14 patients over age sixty had a satisfactory response to treatment while 11 of 19 patients under age sixty had a satisfactory response. Five of the responders and 2 of the nonresponders proceeded to penile implant surgery and reported satisfactory results. While older diabetic men may choose a trial of intracorporeal injections, they should be counselled regarding the high failure rate and alternative forms of therapy.

Age Factors↗

PubMed1992

Retrospective review of sexual and marital satisfaction of spinal cord injury and diabetic males post penile injection or implant.

This study compares sexual activity and sexual and marital satisfaction in spinal-cord-injured (SCI) and diabetic men who had received either a penile prosthesis or papaverine/phentolamine injections for the treatment of impotence. Questionnaires were used retrospectively to assess changes pre- and post-procedure in 30 SCI and 26 diabetic males. Regardless of whether they received a penile prosthesis or injections, both diabetic and SCI males reported increases in diversity and frequency of sexual activities and satisfaction with sexual activities post-implant/injection. When compared with a normative sample, both diabetic and SCI males were found to have poorer body image post-implant/injection. They also reported more disagreement with their partners but engaged in more activities together.

Adult↗

PubMed1992

Complications of intracavernous injections and penile prostheses in spinal cord injured men.

Erectile dysfunction is a common complication in men who have had spinal cord injury (SCI). This retrospective study focuses on the complications encountered at our institution with both penile prostheses and intracavernous injections in men with SCI. Seventy-two men with SCI were treated with intracavernous injections for erectile dysfunction, and 30 penile prostheses were implanted in 19 men with SCI. Twenty-two of the 72 patients in the intracavernous injection program had adverse effects; none were severe. Prolonged erections lasting four to six hours and ecchymosis were the most common complications. No complication required discontinuation of treatment. There were 23 inflatable prostheses and seven semirigid rods. Mechanical failures occurred in 15 instances, infection occurred in nine, and late erosion occurred in three. Although multiple revisions and replacements were necessary, 14 of the 19 patients had satisfactorily functioning implants at their last outpatient visit. Patients were selected carefully for penile implant placement and yet significant complications and expense were incurred to obtain satisfactory results. Although follow-up has been relatively short, the intracavernous injections of vasoactive medications appear to be a more attractive initial means of treating the erectile dysfunction in men with SCI. The complications are relatively minor and the incidence of prolonged erections has decreased with increased experience. Furthermore, the cost of treatment will be considerably less than that with implant surgery, particularly in view of the high drop-out rate. Although improved implants have decreased the occurrences of mechanical failure, it seems likely that infection and extrusion will continue to be significant problems among men with SCI.

Adult↗

PubMed1991

Short-term and long-term changes in renal function after donor nephrectomy.

We retrospectively examined the effect of nephrectomy on renal function in 55 living related donors. Renal function was measured with 131iodine-orthoiodohippurate scans. All patients were studied preoperatively, and 1 week and 1 year postoperatively. In 20 patients 10-year followup was available. Compensatory hypertrophy was complete 1 week postoperatively: effective renal plasma flow of the remaining kidney was 32.5% higher than preoperatively. The increase remained stable for at least a year. The degree of compensatory hypertrophy was significantly greater in male patients (46.9% after 1 week) than in female patients (26.7%). Compensatory hypertrophy occurred in all age groups studied and it was most pronounced in patients less than 30 years old. In the patients followed for 10 years effective renal plasma flow decreased from 387.7 ml. per minute 1 week after nephrectomy to 367.4 ml. per minute at 10 years. This result is similar to the decrease seen in the normal population. According to our results, renal donation by living related persons does not lead to long-term decrease in renal function.

Adaptation, Physiological↗

PubMed1991

Neurogenic urinary tract infection.

Even though renal failure secondary to the urologic complications of chronic or recurrent urinary tract infection has decreased markedly due to advances in diagnostic, preventive, and therapeutic measures, infection and its sequelae continue to be major problems in patients with spinal cord injury regardless of the bladder emptying method employed. Although lower urinary tract complications have decreased with intermittent catheterization, the effects of increased intravesicular pressure, inflammation, and chronic bacterial colonization or invasion of the urinary tract on long-term renal function are still undetermined. Thorough evaluation of the urologic status on a regular basis in all patients with spinal cord injury is encouraged. Treatment of urinary tract infection should be guided by scientific data and drug susceptibilities of etiologic bacteria. The general consensus is that the presence of asymptomatic bacteriuria, particularly in the absence of pyuria, usually does not warrant antibiotic treatment, and that prophylaxis or suppression of infection with systemic antibiotics is not effective for any considerable length of time. Preservation of renal function is the ultimate goal of all bladder management strategies.

Humans↗

PubMed1990

Duraphase penile prosthesis--results of clinical trials in 63 patients.

The Duraphase penile prosthesis was implanted in 63 patients at 4 investigative sites during clinical trials. This device is a semirigid rod that is bendable and provides good support to the erection. Mechanical complications included 4 instances of cable breakage rendering the device nonfunctional. Of 57 patients questioned 55 were pleased with the results after 4 months. Ease of insertion and exceptional bendability are other features that make this device attractive.

Adult↗

PubMed1989

Intracavernous pharmacotherapy for management of erectile dysfunction in spinal cord injury.

Sexual dysfunction due to inadequate or poorly sustained erections is a common problem among patients with spinal cord injury (SCI). While penile prostheses have provided adequate treatment for many patients, the complication rate in spinal cord injured patients remains high and they have not received widespread acceptance among SCI patients or the physicians treating them. Recently, intracavernous injections of vasoactive medications have proved beneficial for treating patients with erectile dysfunction. In the current study, we evaluated 40 SCI patients and 116 patients with vascular based impotence who had been followed for a minimum of 1 month while utilising intracavernous injections of phentolamine and papaverine. SCI patients with neurogenic based erectile dysfunction are significantly different from vascular impaired patients. SCI patients are younger and have been impotent for a longer period of time when treatment is sought. Furthermore, the dose of medication required is significantly less for SCI patients. The time of erection is longer and the quality of erection is better in neurogenic based impotence. Results with this treatment in SCI appear to be quite good with short term followup and long term evaluation of this methodology in SCI appears warranted.

Adult↗

PubMed1989

Urinary tract infection in spinal cord injury.

Loss of normal bladder function results in increased risk of developing urinary tract infection. Recurrent bacteriuria continues to be a problem in most spinal cord injured persons regardless of the bladder emptying method used. Lower urinary tract complications have decreased with intermittent catheterization, but the effect of increased intravesical pressure and presence of bacteriuria on renal function are still undetermined. Current methods of neurogenic bladder management are often based on professional or institutional presuppositions rather than scientific data. Although there are many unanswered questions about the role of urinary tract infection in spinal cord injury patients, treatment should be based on scientific knowledge, even though the knowledge base is still limited. Preservation of renal function is the ultimate goal of any method of neurogenic bladder management. Although a person with spinal cord injury is described, the material covered is applicable to other neurogenic bladder disturbances.

Humans↗

PubMed1988

Estimation of extracellular fluid volume from plasma clearance on technetium-99m DTPA by a single-injection, two-sample method.

A simple method is presented for estimating extracellular fluid volume from the plasma clearance of [99mTc])DTPA or [169Yb]DTPA. Two plasma samples are required, at 1 and 3 hr, following a single intravenous injection. (The same plasma samples can be used for measurement of glomerular filtration rate.) Using the complete plasma clearance curve as a reference (eight samples at 10 to 240 min), the error of the two-sample method in 40 patients was 1.5 I for [99mTc]DTPA, 2.1 I for [169Yb]DTPA (residual standard deviation).

Extracellular Space↗

PubMed1987

Prediction of pyelocaliectasis in follow-up of patients with spinal cord injury.

Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis. The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow. This study suggests that the presence of these risk factors warrants careful monitoring of renal function in these patients and appropriate management of bladder dysfunction.

Dilatation, Pathologic↗