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Biomedical subjects

M Hehir

Publications and source records attributed to M Hehir.

At least 19 recordsLinked to original sources
PubMed2003

Transurethral vaporisation of the prostate and irrigating fluid absorption.

Transurethral vaporisation of the prostate gland (TUVP) is an emerging surgical alternative to conventional electroresection (TURP). This study examined vesical pressure and fluid absorption during TUVP in 35 patients with benign prostatic hypertrophy. The irrigating fluid was a solution of glycine 1.5% and ethanol 1%. Intraoperative intravesical pressure was monitored continuously and absorption of irrigating fluid was detected by ethanol analysis in expired breath. The incidence of absorption during TUVP was 34%. Intravesical pressures were higher amongst patients who went on to absorb than amongst patients who did not. Combining data from the current study and from 35 patients in our previous investigation into TURP (Gray et al.: Anaesthesia 2001; 56: 461-4), urological trainees operated at higher mean pressure and for longer than their consultant colleagues and their resections were significantly more likely to result in absorption. The incidence of irrigating fluid absorption during trainees' operations appeared to be less using TUVP than using conventional TURP.

Absorption↗
PubMed2003

Clinical and psychological outcome from a randomized controlled trial of patient-initiated direct-access hospital follow-up for rheumatoid arthritis extended to 4 years.

BACKGROUND: Patients with rheumatoid arthritis (RA) are traditionally seen regularly as out-patients, irrespective of whether it is appropriate or timely to see them. A randomized controlled trial has shown that over 2 yr, seeing patients only when they or their general practitioner (GP) request a review saves time and resources and is more convenient. This study aimed to assess clinical and psychological outcomes when the trial was extended to 4 yr. METHOD: A total of 209 patients were randomized into either 'routine review' (control) or 'no routine follow-up' but access to rapid review on request (direct access). Clinical and psychological status and patient satisfaction and confidence were reviewed after 24 and 48 months. RESULTS: Mean age at entry was 56 yr and mean disease duration 11 yr, and 134 patients remained in the study after 48 months. There were no differences between the groups, nor between those who completed the study and those who did not. There were no major differences in clinical or psychological status between the groups at 24 or 48 months. However, self-efficacy for function was stronger at 48 months for direct access patients (mean 64.0 vs 52.0, P=0.005), as was self-efficacy for other symptoms (mean 67.8 vs 59.3, P=0.009). Satisfaction at 48 months was increased in direct access compared with control (mean 8.7 vs 7.6, P=0.01) as was confidence in the system (8.9 vs 7.6, P<0.01). CONCLUSION: It is effective for patients with rheumatoid arthritis to have no regular follow-up, provided they have access to rapid review when they or their GP request it. Patients using a self-referral system of care had higher self-efficacy and greater satisfaction and confidence than those using the traditional system.

Adult↗
PubMed2002

The CAG trinucleotide repeat length in the androgen receptor does not predict the early onset of prostate cancer.

OBJECTIVE: To relate the repeat length of the androgen-receptor CAG trinucleotide to the age of onset of prostate cancer, stage and grade of disease. PATIENTS AND METHODS: After obtaining ethical approval, 265 patients with locally confined or locally advanced/metastatic prostate cancer were identified and evaluated for age at diagnosis (< 65 years and > 75 years). DNA was extracted from peripheral blood lymphocytes and 1 micro g aliquots subjected to polymerase chain reaction using fluorescently labelled primers. Samples were then run on an ABI 377 gene scan analysis gel with an internal molecular weight marker. The length of the CAG repeat was determined by comparing the gene scan product size to samples where the CAG repeat length had been quantified using direct sequencing. The Kruskal-Wallis, Mann-Whitney and Wilcoxon two sample tests were used to analyse the data. RESULTS: The mean (range) length of the CAG repeat in the androgen receptor was 22.2 (10-31) in the younger and 22.5 (16-32) in the older group, and was not statistically different. There was no significant association between the CAG repeat length and the age of onset of prostate cancer (P = 0.568) or with stage (P = 0.577) and grade (P = 0.891) of prostate cancer. CONCLUSION: These results suggest that there is no correlation between the androgen receptor CAG repeat length and the age of onset, stage and grade of prostate cancer, confirming recent doubts from other similar studies of a suggested correlation between shorter androgen receptor CAG repeat and early onset and aggressiveness of prostate cancer.

Age of Onset↗
PubMed2002

Prediction of successful application for disability benefits for people with arthritis using the Health Assessment Questionnaire.

BACKGROUND: Many eligible people with arthritis do not receive disability benefits. Application forms are lengthy and complex, and doctors and nurses are often unsure which patients would qualify. AIM: To investigate how severe disability on the Health Assessment Questionnaire (HAQ) relates to successful application for disability benefits by people with osteoarthritis (OA) and rheumatoid arthritis (RA). METHOD: RA patients attending a hospital out-patient rheumatology clinic and patients with OA or RA in two general practices completed an HAQ and were asked about receipt of disability benefits. Those scoring 2 or more on the HAQ (severe disability) and not in receipt of benefits were offered professional help to complete applications for Disability Living Allowance (DLA) or Attendance Allowance (AA). RESULTS: Eighty per cent of patients with an HAQ score of 2 or more were already in receipt of benefits. Seventy-nine per cent of the new applicants applied successfully, the average benefit being in excess of 2580 pounds per annum. CONCLUSION: This initial study suggests that people who score 2 or more on the HAQ should be encouraged to apply for disability benefits. A test of the generalizability of these findings and the success rate associated with lower HAQ scores should be undertaken.

Adult↗
PubMed2001

Intravesical pressure and the TUR syndrome.

Intravesical pressure was measured continuously during 35 transurethral prostate resections using a fine suprapubic catheter. Absorption of irrigating fluid was detected by tagging it with ethanol and sampling the expired breath using an alcohol meter. Higher mean (SD) intravesical pressure was demonstrated in those patients who absorbed irrigating fluid (19.1 (7.7) mmHg) than in those who did not (12.4 (6.5) mmHg; p = 0.00004). Higher peak pressures were also demonstrated among absorbing patients. Traditional risk factors for fluid absorption, such as operator experience and resectate mass, were found to correlate with pressure exposure over time. Exposure to supranormal bladder pressure over time is the final common path for all causes of absorption. Vesical pressure monitoring may be a valuable feedback tool during difficult resections or operator training.

Absorption↗
PubMed2000

Hospital readmissions. We'll meet again.

A 12-month study of emergency medical admissions at one trust suggests most readmissions could not be avoided. The re-admission rate within 28 days was 10 per cent, of which 5 per cent were found to be preventable. Readmissions were higher among smokers, men and people living in hostels. The study found no evidence of increased readmissions in winter.

Adolescent↗
PubMed2000

General practitioners miss disability and anxiety as well as depression in their patients with osteoarthritis.

BACKGROUND: General practitioners (GPs) integrate physical, psychological, and social factors when assessing patients, particularly those with chronic diseases. Recently, the emphasis has been on assessment of depression but not of other factors. AIM: To determine functional disability, psychological morbidity, social situation, and use of health and social services in patients with osteoarthritis and examine GP knowledge of these factors. METHOD: Two hundred patients completed a validated postal questionnaire about functional disability (Health Assessment Questionnaire [HAQ]), mood (Hospital Anxiety and Depression Scale [HAD]), employment status, who they lived with, welfare benefits received, and use of health and social services. A similar questionnaire was completed by the patient's GP, including a HAQ. However, a three-point scale was used to assess depression and anxiety. RESULTS: Forty-seven per cent of patients were moderately or severely disabled (HAQ > 1). GPs underestimated functional disability: mean patient HAQ = 1.04 (95% confidence interval [CI] = 0.92-1.16), mean GP HAQ = 0.74 (95% CI = 0.65-0.83), and there was low correlation between patient and GP scores (kappa = 0.24). There was moderate prevalence of depression and high prevalence of anxiety, which the GP often did not recognise: patient depression = 8.3% (95% CI = 4.1%-12.8%), GP depression = 6.0% (95% CI = 2.4%-9.6%), kappa = 0.11; patient anxiety = 24.4% (95% CI = 17.8%-31.0%), GP anxiety = 11.9% (95% CI = 6.9%-16.9%), kappa = 0.19. Only 46% of severely disabled patients (HAQ > 2) were receiving disability welfare benefits. GPs were often unaware of welfare benefits received or the involvement of other professionals. CONCLUSION: GPs frequently lack knowledge about functional disability, social factors, and anxiety as well as depression in their patients with osteoarthritis.

Adult↗
PubMed1997

Myofibroblastoma of the breast.

Myofibroblastoma of the breast is an uncommon stromal tumor most often found in older men. It usually presents as a solitary well-circumscribed breast lesion consisting of slender bipolar spindle cells and broad bands of hyalinised collagen. This is the first documented case of myofibroblastoma of the breast in Australia. Found in a 71-year-old man, this case demonstrates many of the typical features of this entity. A history of previous trauma to the chest wall was present in this case, a finding only rarely associated with this lesion.

Aged↗
PubMed1996

A review of radical prostatectomy from three centres in the UK: clinical presentation and outcome.

OBJECTIVE: To examine critically the clinical presentation, pathological stage and outcome in patients selected for radical prostatectomy combining data from three centres where the operation has been carried out routinely for more than 5 years. Comparisons were made between impalpable tumours presenting at transurethral resection of the prostate (TURP) for clinically benign disease, tumours diagnosed at needle biopsy performed because the serum prostate-specific antigen (PSA) was elevated, and palpable, clinically localized cancer detected by digital rectal examination (DRE). PATIENTS AND METHODS: Clinical and pathological findings recorded in the hospital notes of 183 patients who had undergone exploration for radical prostatectomy at St Bartholomew's Hospital, London, Southmead Hospital, Bristol, and the Royal Infirmary, Stirling, between 1987 and 1994 were transcribed onto a proforma and analysed. Patients were categorized by clinical stage and the relationships between clinical presentation, serum PSA level, pathological stage, tumour grade and outcome were examined. RESULTS: The pathological extent of clinically unsuspected cancer identified at TURP was highly variable. Well-differentiated tumours occupying < 5% of the TURP specimen were generally found to be less extensive at subsequent radical prostatectomy than either impalpable malignancy diagnosed by needle biopsy performed because PSA levels were raised or palpable tumours associated with a unilateral abnormality on DRE. Unsuspected tumours diagnosed at TURP that were less than well differentiated or occupied > 5% of the surgical specimen were more commonly associated with extra-prostatic invasion or metastatic disease than were tumours detected by raised PSA levels or an abnormal DRE. Serum PSA did not reliably predict either clinical stage or pathological extent, but no patient with nodal metastases had a PSA level of < 12 ng/mL. Similarly, pathological stage could not be predicted confidently from the whole-tumour grade ascertained after surgery. The extent of malignancy in patients referred because of lower urinary tract symptoms was not significantly different from that among patients referred specifically because the PSA level was raised or the DRE was abnormal. However, there was a trend for patients found to have cancer in specific screening programmes to have a malignancy that was less extensive and therefore more frequently confined to the gland than in those not identified by screening. CONCLUSION: Among patients with unsuspected malignancy diagnosed at TURP, those with well differentiated tumours in < 5% of the specimen had significantly less advanced disease than men found to have less differentiated or more extensive malignancy in the resected specimen. Impalpable cancer associated with a raised PSA level diagnosed by needle biopsy represented an intermediate group comparable to those with unilateral palpable malignancy. This suggests that needle biopsies may be worthwhile in some patients with an apparently benign prostate and raised PSA level with a view to identifying clinically significant but potentially curable cancer. Screening may detect less extensive tumours, but the natural history of these cancers is unknown and observed survival will be subject to lead-time and length bias when compared to symptomatic disease. Prospective randomized studies of both screening and treatment modalities, including surgery and radiotherapy, are required to define the impact of radical prostatectomy on disease-specific survival in men with early stage prostate cancer.

Adult↗
PubMed1995

Reproducibility and observer variability of transrectal ultrasound measurements of prostatic volume.

Transrectal ultrasound (TRUS) is an established investigation in benign and malignant prostatic disease though the level of reproducibility of TRUS volume measurements is not known. A group of observers in the UK and the USA who were participating in linked prospective studies of benign prostatic hyperplasia each carried out measurements during real-time scanning and on a series of static TRUS images. Results demonstrated good reproducibility for measurements of antero-posterior, transverse, and longitudinal dimensions of the prostate by an experienced UK urologist; only a minor degree of interobserver variation occurred in measurements made between experienced UK and USA observers. Using static images, USA observers obtained results that were in good agreement, whereas the UK observers, only two of whom used TRUS regularly, were in poor agreement with each other. This study demonstrates a high level of reproducibility for TRUS volume measurements performed by experienced observers.

Adult↗
PubMed1994

Predicted and actual change in serum PSA following prostatectomy for BPH.

OBJECTIVE: To determine the relationship between prostatic adenoma volume and serum prostate-specific antigen (PSA) levels in patients with benign prostatic hyperplasia (BPH), and to compare the predicted change in serum PSA following prostatectomy with the actual change observed. METHODS: Transrectal ultrasound (TRUS) estimation of prostatic adenoma (transition zone) and total gland volumes were calculated in 96 patients prior to prostatectomy. BPH was confirmed histologically following transurethral prostatectomy (in 86) and open prostatectomy (in 10). Serum PSA was measured preoperatively in all patients and post-operatively in 87 patients. RESULTS: Correlation coefficients of 0.607 and 0.614 were observed between PSA and adenoma and total gland volumes, respectively. The geometric mean ratio of PSA to adenoma volume was 0.120 micrograms/L/cc with 95% CI (0.104, 0.139) and to total gland volume was 0.068 micrograms/L/cc with 95% CI (0.058, 0.078). TRUS-determined adenoma and total gland volumes correlated well (r = 0.915), as did TRUS-determined adenoma volume and resected weight (r = 0.878). The mean ratio of change in PSA to resected weight was -0.096 micrograms/L/g with 95% CI (-0.128, -0.064). Neither total gland volume nor operation type affected the relationship between change in serum PSA and resected weight. CONCLUSIONS: The adenoma should be the main determinant of serum PSA levels in patients with BPH. TRUS adenoma volume measurement is therefore the most appropriate preoperative measure when one is interpreting elevated levels of serum PSA in men thought clinically to have BPH.

Aged↗
PubMed1993

A study of benign prostatic hyperplasia--a challenge to British urology.

A community study to determine the prevalence and natural history of benign prostatic hyperplasia (BPH) in a typical Scottish community has been undertaken in men from 40 to 79 years of age. From 2497 eligible men, 1627 (65%) agreed to take part and after screening by symptom score and urinary flow rate 561 were offered a full investigation including transrectal ultrasonography; 492 (87.7%) attended and 415 were found to have BPH, which was defined as a prostate > or = 20 g. Following urological consultation, 3 groups of patients with BPH were recognised: those requiring no therapy (39.5%), those in whom therapy options were considered (50.5%) and those where operation was advised (10%). Seventeen patients with prostatic carcinoma were found, 4 of whom were treated by radical prostatectomy. A total of 67 operations for BPH resulted from the study in patients not previously referred to our urological unit, the majority of whom had not consulted their GP for symptoms of prostatism. This represents a serious challenge to British urology.

Adult↗
PubMed1993

Relationship between prostate specific antigen, prostate volume and age in the benign prostate.

The relationship between prostate specific antigen (PSA) levels, prostate volume and age was examined in 472 men who underwent PSA assay (Hybritech), digital rectal examination (DRE) and transrectal ultrasound (TRUS) as part of a community survey of benign prostatic hyperplasia following exclusion of men with prostate cancer. The mean age of the study population was 60 years (range 40-79). The mean PSA was 2.4 ng/ml and 85% of the men had levels < 4 ng/ml. There was a modest correlation between PSA and both age and prostate volume. The mean prostate and adenoma volumes were 32 ml (SD 13.4) and 15 ml (SD 10.7) respectively. Prostate volume increased with age. Linear regression analysis revealed an independent association between PSA and age when controlling for volume. The mean ratio of PSA per unit of prostate volume was 0.072 ng/ml. This ratio also increased with age. Age and prostate volume influences PSA levels independently. The sensitivity and specificity of PSA adjusted for volume and age in the diagnosis of prostate cancer need to be evaluated in association with DRE and TRUS.

Adult↗
PubMed1993

Ultrasonically determined patterns of enlargement in benign prostatic hyperplasia.

A series of 430 men aged 40 to 79 years underwent transrectal ultrasonography (TRUS) as part of a community survey of benign prostatic hyperplasia (BPH). We describe a reproducible method of prostate volume estimation and discuss the implications of prostate dimension changes in BPH. The mean prostate and adenoma volumes for the group were 32 ml (SD 14) and 15 ml (SD 11) respectively. The antero-posterior dimension of the prostate (APD) had the strongest correlation with gland volume compared with the transverse dimension (TD) and length (L). The mean ratio of adenoma volume to prostate volume was 0.45 (SD 0.13) and this increased with increasing gland volume. There was a modest correlation between the ratio and prostate volume. BPH is characterised by a proportionally greater increase in the APD compared with L and TD and by an increasing adenoma/prostate ratio. TRUS is useful in assessing the type and extent of adenoma and prostate enlargement in BPH.

Adult↗