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Biomedical subjects

M C Bishop

Publications and source records attributed to M C Bishop.

At least 19 recordsLinked to original sources
PubMed1991

Clam enterocystoplasty in general urological practice.

A series of 45 patients (31 female) underwent clam enterocystoplasty for urgency and incontinence. The majority had detrusor instability. Prolonged conservative treatment had failed in all cases. Improvement occurred in 71% and those younger than 30 years had better overall results; 29% remained incontinent, with 9% requiring a urinary diversion. Many patients did not achieve maximum benefit until 9 months post-operatively. Surgery had no statistically significant effect on any urodynamic parameter and post-operative complications were common. The operation was performed in either the coronal (19) or the sagittal plane (26); this did not influence results. In general, surgery was found to be technically simpler in the sagittal group and it is recommended that this becomes the standard procedure. We feel that this operation involves major surgery and should only be offered with reluctance.

Adult↗
PubMed1991

Effect of milk ingestion on pulmonary function in healthy and asthmatic subjects.

Since Maimonides, it has been common in folk medicine to proscribe milk for asthmatics because its putative stimulation of mucus production can exacerbate asthma symptoms. A literature review, however, failed to reveal any data supporting this notion. We, therefore, compared the effects of ingesting 16 oz. of whole milk (16 g lipid), skim milk (2 g lipid), and water (each on a separate day) on: (1) forced expiratory volume in 1 second (FEV1), (2) forced expiratory flow at 50% of vital capacity (V50), and (3) pulmonary diffusing capacity (DLCO) in 11 asthmatic and 10 nonasthmatic subjects. Measurements were taken at 30 minute intervals for 3 hours. The two milk types did not significantly change FEV1 or V50 in either group, indicating that the amount ingested did not change airway resistance sufficiently to alter airflow parameters. In the asthmatic group, however, DLCO decreased progressively over the 3 hours by 6.8 +/- 1.4% (mean +/- SE) per hour after whole milk (maximum reduction = 21 +/- 1.4%) but not after water or skim milk. In the nonasthmatic group, no significant effects were observed on DLCO after any of the liquids. These data suggest that milk lipids can disturb gas exchange in asthmatic patients.

Adult↗
PubMed1990

The dangers of a long urological waiting list.

Statistics on urological waiting lists suggest that there is considerable regional variation in delay before treatment. This clearly depends on many factors but is unlikely to indicate significant variation in morbidity either at presentation or during subsequent admission for surgery. Managers and politicians should be extremely wary if encouraged to base major changes in distribution of funding and equipment on a casual examination of waiting list figures. It is doubtful if delay in diagnosis or treatment seriously influences morbidity and mortality from urological illness.

Appointments and Schedules↗
PubMed1989

Oestrogen dosage in prostatic cancer: the threshold effect?

We present the results of a prospective randomised trial of Estradurin, a long-acting oestrogen preparation (polyoestradiol phosphate), 160 mg per month, compared with bilateral orchiectomy in patients with advanced prostatic carcinoma (T3M1; T4MO/M1). The dose was lower than that usually recommended to induce a consistent fall in serial plasma testosterone levels to within the castrate range. Most patients treated with oestrogen showed an initial clinical and biochemical response equal to that obtained for patients undergoing orchiectomy. The inevitable relapse in hormone sensitivity sometimes occurred very soon after the start of oestrogen treatment. Many patients had poorly suppressed plasma testosterone expressed as a mean of monthly serial measurements, but then responded to secondary orchiectomy. These data only suggest that, in the treatment of hormone-sensitive prostatic carcinoma, it may be necessary to reduce plasma testosterone to midway between castrate and normal ranges. The data support the theory that response to androgen withdrawal is qualitative rather than quantative. The effective dose of oestrogen may therefore be reduced and the risk of thrombo-embolic complications minimised.

Delayed-Action Preparations↗
PubMed1988

Use of older patients as cadaveric kidney donors.

We have no fixed upper age limit for cadaveric kidney donors and donors over the age of 50 provided kidneys for 22 per cent of our adult transplant recipients between 1983 and 1986. Immediate function following transplantation occurred in 17 per cent of these kidneys compared with 58 per cent for kidneys from donors under the age of 50. The 1-year actuarial graft survival rate for transplants from donors over 50 was 52 per cent, compared with 70 per cent for transplants from donors under 50 (P less than 0.05). Thus kidneys from older donors make an important contribution to the total pool of organs available for transplantation, but their use leads to inferior results in comparison with kidneys from younger donors.

Adolescent↗
PubMed1988

Haematuria in an adolescent due to bladder carcinoma.

A 14-year-old boy had a 6 month history of recurrent macroscopic haematuria. A papillary non-invasive transitional cell carcinoma of the bladder was found at cystoscopy and treated by transurethral resection. In comparison to adults, bladder carcinoma is a rare cause of haematuria in children who appear to have a favourable prognosis.

Adolescent↗
PubMed1987

Ureteric stone surgery in practice.

From 1983 to 1986 140 patients underwent surgery for ureteric calculus. In approximately 30% "blind" basket extraction was considered appropriate and continued to be effective. Increasing expertise with the rigid ureterorenoscope led to a considerable reduction in open ureterolithotomy (15% in 1985-86), the majority following failed ureteroscopic extraction. In the same year both "blind" basket extraction and ureteroscopy were successful in 82 and 86% of attempts respectively. Electrohydraulic and ultrasonic lithotripsy were used in 12 patients to reduce large impacted calculi. The commonest complication of ureteroscopic stone surgery was perforation; this occurred in 14% of cases, though it was usually trivial and near the vesicoureteric junction. Perforations higher in the ureter tended to follow endoscopic lithotripsy and were often associated with urinary extravasation. Extra-ureteric stone fragments were also occasionally observed in such cases. There were no serious sequelae, although the in-patient stay was prolonged beyond the 48 h customary for uncomplicated extraction. The results suggest that ureteroscopic stone extraction, which can be conveniently introduced into urological practice, should become a standard endoscopic procedure.

Endoscopy↗
PubMed1986

Removal and replacement of Tenckhoff catheter at a single operation: successful treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis.

8 episodes of persistent and 4 of recurrent bacterial peritonitis in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) were treated successfully by the removal and immediate replacement of the Tenckhoff catheter. Intraperitoneal antibiotics, which had previously failed to produce clinical resolution of the peritonitis, were continued unchanged. Dialysate culture yielded Staphylococcus epidermidis (3 cases), Staphylococcus aureus (1 case), pseudomonas species (5 cases), acinetobacter (1 case), and no growth in 2 cases. Clinical and microbiological resolution was achieved in all 12 cases within 36 h. CAPD continued uninterrupted in 10 cases. 1 patient required temporary haemodialysis for 6 weeks because of dialysate leakage and later restarted CAPD. 1 patient chose haemodialysis as his long-term treatment when his new catheter failed mechanically on the second postoperative day. Replacement of the Tenckhoff catheter at a single operation without interrupting CAPD reduces the demand which temporary haemodialysis of these patients makes on centre dialysis facilities and may preserve the peritoneal cavity for dialysis by preventing the formation of adhesions.

Adult↗
PubMed1985

Bacteriology and ultrastructure of the bladder in patients with urinary tract infections.

Tissue obtained by biopsy of the bladder from 33 patients with various urinary tract symptoms was studied by conventional bacteriological techniques and by scanning electron microscopy (SEM). All the patients had recurrent urinary tract symptoms which had not completely responded to antibiotic therapy. Eleven of the patients had greater than or equal to 10(8) colony-forming units (CFU) of bacteria/1 urine; six had between 10(6) and 10(7) CFU/1, and 16 were abacteruric. Bacteria were isolated, however, from the tissue obtained by biopsy from eight of the 16 patients with sterile urine and bacteria were seen on the uro-epithelium in 14 of these patients. By comparison, in all samples of tissue obtained from the 11 patients with greater than or equal to 10(8) CFU/1 of urine bacteria were seen on the uro-epithelium and from nine of these, bacteria were subsequently grown. Fastidious organisms were not isolated from any of the patients. The uro-epithelium of all those studied was also shown to be grossly disrupted with increased disturbance and loss of the epithelial cells when compared with tissue obtained from uninfected patients. The degree of uro-epithelial disturbance was greatest in patients with histories of urinary tract infections lasting more than 4 months. The findings suggest that bacteriological examination of the urine does not always reflect bacterial infection on the bladder surface nor disruption of the uro-epithelium. The changes on the bladder surface may explain the patients' symptoms. In view of the results, a scheme is proposed that explains the development of symptoms in patients with urinary tract and bladder infections.

Adult↗
PubMed1985

Plasma hormone levels in patients with prostatic carcinoma treated with diethylstilboestrol and estramustine.

Plasma testosterone, oestradiol, luteinising hormone (LH) growth hormone and prolactin were measured serially in 140 patients with advanced prostatic carcinoma (T3, T4, MI and MO) randomised in a trial of diethylstilboestrol 3 mg/day against estramustine 560 mg/day. Both drugs suppressed plasma testosterone and LH and increased plasma growth hormone and prolactin, though estramustine induced a greater rise in prolactin. Oestradiol levels fell on stilboestrol but were considerably elevated on estramustine. Initial hormone levels reflected neither the extent of disease nor the response to treatment. The data also showed that close attention should be given to plasma LH in identifying patients who are unreliable, since intermittent hormone dosage caused an exaggerated rise even when plasma testosterone remained at castrate levels.

Aged↗
PubMed1985

Serial prostatic histology. A valid marker of response to hormone treatment.

Serial transrectal needle biopsies were taken from 146 patients (657 specimens) with advanced prostatic cancer (T3/T4, M1/MO) admitted to a trial of two forms of oestrogen therapy. Histological grading by Gleason and Mostofi techniques on the initial biopsy showed no correlation either with extent of disease or its eventual outcome on treatment. Change in grade was dissociated from the response of bone metastases to hormone treatment and did not appear to influence survival. However, the prognosis of 16 patients showing clearance of tumour from their serial biopsies was generally good.

Aged↗