PubMed Health⌕ Search

Biomedical subjects

M J Coptcoat

Publications and source records attributed to M J Coptcoat.

At least 37 records · Page 2Linked to original sources
PubMed1995

Extraperitoneal pelvic and para-aortic lymphadenectomy.

Many laparoscopic surgeons, particularly in urology, have been performing a laparoscopic transperitoneal pelvic and para-aortic lymphadenectomy for prostatic and germ cell cancers respectively with great success. The transperitoneal route has been superceded by an extraperitoneal approach. Although the working space is sometimes a little more restricted and orientation more difficult, the ultimate result is a procedure associated with much less post-operative pain.

Ambulatory Surgical Procedures↗
PubMed1994

Laparoscopic nephrectomy results in better postoperative pulmonary function.

The pulmonary response to nephrectomy was studied in 16 patients undergoing laparoscopic (n = 8) or open (n = 8) nephrectomy using a standardized anesthetic technique. Although there was no significant difference between the two groups at 24 hours, postoperative pulmonary function measures (P = 0.02-0.03) and oxygenation (P = 0.03) were significantly better in the laparoscopic surgery group at 48 hours. The median opiate analgesic requirement (P = 0.02) and the number of nights spent in the hospital (P = 0.003) also were significantly lower in this group. The results of this study suggest that laparoscopic nephrectomy offers a real biological advantage in terms of postoperative preservation of lung function and that this might therefore be the safest technique for nephrectomy in patients with limited respiratory reserves.

Adolescent↗
PubMed1994

Superficial bladder cancer: the response of a marker tumour to a single intravesical instillation of epirubicin.

OBJECTIVE: To determine the response of a marker tumour to a single instillation of intravesical epirubicin. PATIENTS AND METHODS: Eighty-one patients (54 men, 27 women) with a mean age of 69.3 years (range 36-92) with superficial bladder cancer were randomized to receive a single instillation of intravesical epirubicin. At the initial cystoscopy all but one papillary marker tumour was resected. Subsequently the patients were randomized to receive either intravesical epirubicin at a concentration of 1 mg/ml (n = 40) or 2 mg/ml (n = 41) in 50 ml of saline for 1 h. The response of the marker tumour was determined at 3 months (first check cystoscopy). The toxicity associated with both treatments was also recorded. RESULTS: A complete response (no visible or microscopic bladder carcinoma) was observed in 46% (95% confidence interval (CI) 35-57%) of patients. No patient experienced systemic side-effects. Chemical cystitis and bladder irritability were the most frequent local side-effects, occurring in 15% (95% CI 8-24%) of the patients. CONCLUSIONS: A single instillation of intravesical epirubicin has a demonstrable effect in superficial bladder cancer. The results compare favourably with more onerous regimes. Side-effects were minimal at 1 mg/ml and acceptable at 2 mg/ml.

Administration, Intravesical↗
PubMed1993

Transperitoneal laparoscopic nephrectomy: training, technique, and results.

Transperitoneal laparoscopic nephrectomy was integrated into our daily routine within a 6-month period by means of a step-by-step training program progressing from a pelvic trainer to animal studies (N = 15) to laptent-assisted surgery. The pneumoperitoneum is created with the patient in the flank position, enabling insertion of three trocars: 10-mm periumbilical (Port I), 5/12-mm subcostal (Port II), and 12/5-mm above the iliac spine (Port III). After medial mobilization of the colon, two additional 5-mm trocars (Ports IV and V) are inserted into the lateral abdominal wall parallel to Ports II and III. Once clipping and dissection of the ovarian (spermatic) vein has been carried out, the ureter is identified and dissected. Retraction of the proximal ureter exposes the renal hilum, allowing dissection of the renal vessels. The renal vein is dissected using an endoscopic stapling device, while accessory veins and the renal artery are clipped. Organ retrieval is achieved with a specially designed tissue pouch (Lapsac) and digital fragmentation of the kidney within the organ bag. Using this technique, we have treated 24 patients with benign (N = 20) and malignant (N = 4, including adrenalectomy) renal disease. The mean operative time was 239 (115-300) minutes. In four cases, open surgery was required because of bleeding (N = 2), severe perinephric inflammation (N = 1), or bowel injury (N = 1). For relief of wound pain, an average of 1.15 vials of analgesic (morphine derivatives)/patient were administered for 2.4 days. The postoperative hospital stay averaged 6.2 (4-10) days.

Animals↗
PubMed1993

Ultrasound in renal carcinoma: an essential in follow-up.

A total of 115 patients underwent radical nephrectomy for renal carcinoma in this hospital between 1983 and 1990. Follow-up was available in 113 cases (mean 27 months, range 0-93). The overall actuarial survival was 66% at 2 years and 53% at 5 years. Fifty-three patients have been followed up with annual abdominal ultrasound over the last 2 years. Abnormal ultrasound scans were reported in 6 patients (11%) on follow-up. Two had para-aortic lymph node recurrence amenable to further surgery. One patient developed a metachronous tumour and a partial nephrectomy was carried out. Three patients had local recurrence not amenable to further surgery. Ultrasound and computed tomography have found an invaluable place in the pre-operative diagnosis and staging of renal carcinoma. Sixteen of 113 tumours were diagnosed by ultrasound or intravenous urography carried out for some other purpose; 8 were less than 5 cm in diameter and 12 were T category N0M0V0. The 2-year survival rate in this group was 85% (mean 30 months, range 19-67). We consider the routine follow-up of renal carcinoma with clinical examination and annual chest X-ray to be inadequate. The application of ultrasound in the follow-up of these patients has provided a valuable adjunct to our clinical practice. It has allowed the prompt diagnosis of lymph node recurrence or metachronous tumour amenable to secondary surgery with the potential for improved survival in this group of patients. We consider this to be the logical extension of the value of ultrasound in the pre-operative diagnosis of renal carcinoma.

Adult↗
PubMed1993

A consumer's guide to laparoscopic equipment for urology.

The ever increasing amount of laparoscopic instrumentation and the lack of any objective comparison make choosing the most appropriate equipment a difficult task for the urological neo-laparoscopist. All major manufacturers of laparoscopic equipment were invited to submit as much of their equipment as possible for inspection. A selection of ports, hand instruments, haemostatic devices and imaging systems was then tested in a laboratory and clinical setting. Costings are provided for evaluated ports, hand instruments and imaging systems. Vessels with a diameter greater than 7 mm, such as renal artery and vein, should be secured with a linear stapler-cutter. The optics of the Olympus OTV-S4, CLV-10 light source, Olympus light cable and A5254A telescope are superior to the other imaging systems tested. Laparoscopic equipment is diverse in specification, performance and cost. Due consideration must be given to these factors when purchasing equipment to avoid disappointment and wastage of resources, particularly with regard to disposable instruments and imaging systems.

Humans↗
PubMed1993

Bromodeoxyuridine labelling of transitional cell carcinoma of the bladder--an index of recurrence?

Nineteen patients with newly diagnosed transitional cell carcinoma of the bladder consented to receive an intravenous bolus of bromodeoxyuridine (BrdUrd) 3 to 6 h prior to transurethral resection of bladder tumour. Routine paraffin embedded sections were stained with anti-BrdUrd monoclonal antibody in order to determine the S phase fraction of the bladder tumours and to correlate this with tumour grade, category and the development of recurrence during follow-up. BrdUrd labelling of nuclei was reliably detected in 100% of the tumours. The mean labelling index of Ta tumours (n = 8) was 3.14%; in T1 tumours (n = 7) it was 8.6% and in T2-3 tumours (n = 4) it was 16.4%. A similar correlation was found in association with tumour grade. The patients were followed up for a mean of 23 months (range 18-30). Seven of the 15 superficial tumours recurred during the period of follow-up. These tumours had a mean labelling index (at diagnosis) of 8.4%, whereas the tumours that did not recur had a mean labelling index of 3.4%. The in vivo determination of BrdUrd uptake in transitional cell carcinoma of the bladder may be useful in predicting which superficial tumours are likely to recur following resection and so rationalise both the time to follow-up and intravesical chemoprophylaxis.

Aged↗
PubMed1992

Acute urinary retention secondary to carcinoma of the prostate. Is initial channel TURP beneficial?

Over a 2-year period patients presenting with acute urinary retention secondary to locally advanced prostate carcinoma (stage T3/T4) were randomized to one of two treatments. Ten patients underwent channel transurethral resection of prostate (TURP) and bilateral orchidectomy, 12 patients underwent bilateral orchidectomy alone. Treatment by channel TURP and bilateral orchidectomy was complicated by difficulties in voiding in four patients, one requiring a further TURP. Ten of the 12 patients were voiding well one month following bilateral orchidectomy alone. Only two patients in this group required TURP. In patients with acute urinary retention secondary to prostate carcinoma, in whom hormonal manipulation is thought appropriate due to bulk of local tumour or metastatic disease, channel TURP may confer extra morbidity and therefore be held in reserve for those patients unable to void after hormonal manipulation.

Acute Disease↗
PubMed1991

[Development of an instrument for endoscopic liquefaction of the prostate].

Although the concept of prostate liquefaction had been proposed by Wickham 15 years ago, its clinical application has been delayed by various technical problems. The authors report on the investigative procedures that have been undertaken to design and develop the ELSA (Endoscopic Liquidiser and Surgical Aspirator) prototype which has been utilized in the clinical setting with promising results.

Aged↗
PubMed1990

A comparison of danazol and placebo in the treatment of adult idiopathic gynaecomastia: results of a prospective study in 55 patients.

In an attempt to define the efficacy of danazol in the treatment of idiopathic gynaecomastia, 55 patients were enrolled into a randomised double-blind comparison of danazol 200 mg twice daily for 3 months against placebo. The results of 52 patients were evaluated, three patients being excluded because of protocol violations. Danazol improved breast tenderness to a significantly greater degree than did placebo (P = 0.022, danazol vs placebo) and was associated with statistically significant improvement in the degree of gynaecomastia and in its measured size (P less than 0.05). The intended management of patients who had received danazol was less likely to be surgery compared to the placebo group when assessed at the end of treatment (27% vs 50%). Minor side effects were common in both groups, but significant weight gain was noted in the danazol group alone. If there is no urgent need for rapid resolution of gynaecomastia, danazol 200 mg twice daily can provide effective control of symptoms and may obviate the need for surgery.

Adolescent↗
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

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

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↗