PubMed Health⌕ Search

Biomedical subjects

M J Stower

Publications and source records attributed to M J Stower.

At least 19 recordsLinked to original sources
PubMed2005

The role of percutaneous nephrostomy in malignant ureteric obstruction.

OBJECTIVES: Uraemia as a result of malignant ureteric obstruction is a recognised event in those with advanced malignancy, usually of pelvic origin, which, if left untreated, is quickly a terminal event. Palliative decompression of the obstructed urinary system, either by percutaneous nephrostomy (PCN), ureteric stent or a combination of both is a recognised method of improving renal function, with presumed low morbidity. The aims of the study were to assess whether PCN placement in malignant ureteric obstruction provided any additional survival benefit or patient morbidity. PATIENTS AND METHODS: The case notes of 32 patients with a mean age of 68.1 years (16 male, 16 female) who underwent PCN drainage for malignant ureteric obstruction were retrospectively analysed. Data on the site of primary malignancy, mode of presentation, improvement in renal function, median survival, conversion to internal ureteric stents and intervention-related complications were collected for analysis. RESULTS: The median survival following PCN insertion was 87 days and was unrelated to the patient's age and renal function. Those patients with primary underlying gynaecological malignancies appeared to survive almost 4 times as long as those with underlying primary bladder cancer. Renal function took a mean of 16.8 days to reach a nadir. Almost 79% of patients were able to be discharged from hospital--each patient, however, being re-admitted back to hospital on average 1.6 times prior to their death through PCN or internal ureteric stent related events. Retrospective "useful quality of life" was seen in less than half of the patient cohort. CONCLUSIONS: In the presence of malignant ureteric obstruction, palliative percutaneous urinary diversion may be performed and is effective in improving renal function. However, long-term survival is limited and should, therefore, be performed only when the views and wishes of the patient and carers are taken into account and if there is a definitive treatment plan available for the patient as quality of life can be suboptimal.

Aged↗
PubMed2004

The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000.

OBJECTIVES: Transurethral resection of the prostate (TURP) is considered by many to be the 'gold standard' treatment for benign prostatic enlargement. However, with the relatively recent introduction of pharmacological and other surgical treatment modalities, the performance of TURP appears to be in decline. METHODS: A retrospective casenote analysis of 200 patients who underwent TURP in 1990 and the year 2000 with the aim of identifying changes in the incidence and practice of TURP. RESULTS: There was a decline in the number of TURPs performed of 31.6% over the 10-year period, with more being carried out because of urinary retention. In 2000, the patient was older and the operative procedure took statistically longer than 10-years earlier, but the weight of prostate tissue resected, patient satisfaction and complication rates were similar. CONCLUSIONS: At present, TURP is in decline, with urinary retention being the commonest indication. The population at present is older but this does not carry additional co-morbidity. The weight of resection has not altered, although surgery currently takes longer to perform.

Acute Disease↗
PubMed2001

Experimental prostate epithelial morphogenesis in response to stroma and three-dimensional matrigel culture.

To reproduce the structural and functional differentiation of human prostatic acini in vivo, prostatic epithelial and stromal cells derived from human primary cultures were cocultured in Matrigel. In the absence of stroma and serum, epithelial spheroids composed of solid masses of stratified and cuboidal cells formed. Outer cells of the spheroid expressed cytokeratins 1, 5, 10, and 14, whereas the inner cells expressed cytokeratin 18. The addition of 2% serum induced formation of a lumen surrounded by a layer of one or two cuboidal and columnar epithelial cells. The further addition of stromal cultures, dihydrotestosterone, and estrogen induced polarization of the epithelium and increased spheroid-forming efficiency. Epithelium expressed either cytokeratin 18 alone or additionally cytokeratins 1, 5, 14, and 10. All spheroid epithelium expressed prostate-specific antigen and prostate-specific membrane antigen. Androgen receptor was only detected in the presence of stroma, serum, and hormones. Thus, development of a functional and morphologically correct prostate gland in vitro is dependent on extracellular matrix, steroid hormones, and factors from stromal cells and serum.

Animals↗
PubMed1997

A hot spot for p53 mutation in transitional cell carcinoma of the bladder: clues to the etiology of bladder cancer.

Twenty-eight transitional cell carcinomas of the bladder, grade 2 or 3, were analyzed for the presence of p53 mutations. Thirteen tumors were found to contain 14 mutations. These were all base substitution mutations, of which nine were GC-->AT transitions (three at CpG sites). The remaining five mutations were transversions (three GC-->CG, one GC-->TA, and one AT-->TA). Four of the mutations were found at codon 280. A comparison with other studies of bladder tumors reveals that a region encompassing codons 280 and 285 represents a hot spot for p53 mutation in bladder cancer. The 280/285 hot spot lies within two purine-rich sequences that may provide some clues to the identity of potential bladder carcinogens. A comparison of mutations from bladder tumors of smokers and nonsmokers reveals no significant differences.

Adult↗
PubMed1996

Molecular screening of multifocal transitional cell carcinoma of the bladder using p53 mutations as biomarkers.

Thirteen of 28 patients (46%) with grade 2-3 multifocal transitional cell carcinoma (TCC) of the bladder were found to have p53 mutations using DNA sequence analysis. These were subsequently utilized as tumor-specific biomarkers. Analysis of 17 episodes of recurrence from five of the patients revealed that all but one carried the identical mutation to the primary tumor. Thirty urine samples were collected, at initial diagnosis and during follow-up screening, from eight patients with mutations over a period of 24 months. Sequence analysis of PCR products generated from DNA extracted from the urine sediments was carried out. The p53 mutation seen in the primary tumors was detectable in 24 of 30 urine samples. The remaining six cases coincided with a negative cystoscopic examination. Interestingly, 6 of the 24 urine samples in which mutations were detectable also coincided with negative cystoscopy. The results are consistent with: (a) monoclonality of multifocal TCC; (b) the spread of TCC through a seeding mechanism; and (c) the long-term persistence of tumor cell clones (up to 97 months) within the bladder, even in the absence of obvious tumor growth.

Biomarkers↗
PubMed1990

Quantification of prostatic cancer metastatic disease using prostate-specific antigen.

The serum prostate-specific antigen (PSA) of 58 men with benign prostatic hypertrophy (BPH) and 17 men with carcinoma of the prostate (CaP) was correlated with the weight of prostatic tissue resected at transurethral prostatectomy (TURP). A significant correlation was identified between the weight of resected BPH tissue and the serum PSA (p less than or equal to 0.001; r = 0.54). No such correlation was seen in the CaP patients. By arbitrarily dividing the serum PSA by the prostate weight, it was possible to devise an index. This index corrected PSA in relation to prostatic size and unlike PSA in isolation did not differ significantly between normal controls and those with BPH. The index in CaP was significantly greater than that of either controls or BPH (p less than or equal to 0.001). Furthermore the index of metastatic CaP (M1) was significantly higher than that of nonmetastatic disease (MO) (p = 0.05). The higher index found in CaP would seem to be related to the bulk metastatic tumor, either manifest or occult. Comparing the index of CaPs to that found in normal and benign disease (a constant) offers a possible means of estimating the extent of local and metastatic tumor mass.

Antigens, Neoplasm↗
PubMed1990

Inverted papilloma of the ureter with malignant change.

Three patients with inverted papilloma of the ureter are described. A range of histological features was seen, including one showing malignant change. This condition, which is probably more common than previously thought, can be successfully treated by conservative surgery and close follow-up.

Carcinoma, Transitional Cell↗
PubMed1990

Life with urostomy.

The quality of life of urostomy patients was assessed by direct interview. Specific problems, such as urine leakage, were documented and the size, site and quality of the stoma were assessed. The study included 41 patients; 83% noted an improvement in the quality of life since their urinary diversion and 90% were still able to work or continue to perform household duties. Urine leakage was the commonest problem and this was unrelated to the length of the stoma or the build of the patient. More important factors were the correct siting of the stoma and the avoidance of parastomal herniation. All patients emphasised the importance of the stoma therapist.

Adolescent↗
PubMed1989

Urethral closure in management of urinary incontinence.

Urethral closure with suprapubic catheterization has been used in 50 patients with urethral destruction due to an indwelling catheter. Thirty-seven of the patients were dry after the initial operation. Long-term complications were seen in 33 patients. Those that did occur were not life threatening. This relatively minor procedure offers a good alternative to formal diversion in this group of severely disabled patients.

Adult↗
PubMed1989

Prostatectomy in the over 80-year-old.

With an ageing population the demand for prostatectomy in the over 80-year-olds is increasing. This study assesses the place of prostatectomy in this age group. All patients over the age of 80 who underwent prostatectomy in a 2-year period were studied retrospectively; 90 such patients underwent 94 operations, 90 of which were TURPs. Serious concomitant disease was found in 64 patients (71%) and 11 (12%) had had a previous prostatectomy at least 1 year before. The mean weight of tissue removed was 24.8 g. In 18 men histology showed malignant change. Two men died from cardiovascular disease immediately after surgery (2.1%); a further 5 patients (7.8%) died within 6 months. Post-operative morbidity was high, with 64 patients (71%) developing complications. These were related to pre-operative urinary tract infections and uraemia. Nevertheless, at 6 weeks 72 patients (80%) were considered to have had a satisfactory result. Prostatectomy in the over 80-year-old has a good long-term outcome. Although the morbidity rate is high, these patients should be considered for operation provided they undergo careful pre-operative assessment.

Aged↗
PubMed1988

Bacteriuria and bacteraemia in patients with long-term indwelling catheters--a domiciliary study.

Men with indwelling catheters and men and women with suprapubic catheters were studied in their homes. Urine and blood were cultured and body temperature recorded after every catheter change. Nearly all patients had infected urine after 4 weeks of catheterisation, and all had bacteriuria after longer periods, usually with a mixture of organisms. Culture on selective media revealed a wider range of organisms than was detected on routine C.L.E.D. and blood agar with antibiotic sensitivity disks, but routine culture gave adequate information for clinical purposes. Bacteraemia was demonstrated after 20 of 197 changes of urethral catheter and after one of 19 changes of suprapubic catheter; but no patient had pyrexia or other symptoms. However, two had rigors on other occasions. When assessing "risk factors" for blood-stream infection in catheterised patients, it is important to record the total incidence of bacteraemia, asymptomatic as well as symptomatic.

Bacteria↗
PubMed1988

The effects of transurethral prostatectomy on serum prostate specific antigen.

Serum prostate specific antigen (PSA) was recorded in 75 patients immediately before and after transurethral resection of the prostate (TURP). Fifty-eight patients had benign prostatic hypertrophy (BPH) and 17 had prostatic carcinoma (CaP). In patients with BPH there was a statistically significant rise in PSA immediately following TURP. No such rise was seen in patients with prostatic carcinoma. A statistically significant correlation was identified between the weight of the benign hypertrophic prostate and the baseline pre-operative serum PSA. Because of the effects of TURP on serum PSA it is important to avoid PSA estimations immediately following such surgery. The failure of the malignant prostate to release PSA in significant amounts during TURP suggests that the elevated levels of PSA found in patients with prostatic carcinoma arise not from the local disease but from its metastases.

Antigens, Neoplasm↗
PubMed1988

Urethral strictures in childhood.

Thirty-six children have been treated for a non-hypospadiac urethral stricture. Of 12 patients with meatal or submeatal stenosis, 10 had undergone circumcision for balanitis xerotica obliterans. The strictures were successfully treated by meatoplasty or meatal dilatation. Twenty-four children had a more proximal urethral stricture: 16 were caused by urethral catheterisation, 4 were post-traumatic, 2 were congenital and 2 were idiopathic. Sixteen children were treated by visual urethrotomy; this was successful in 12 after a maximum of 2 urethrotomies. Two children required 4 or more urethrotomies and 2 required urethroplasty for restricturing. Seven children were treated by a formal urethroplasty. There were no complications. Two patients died of unrelated medical conditions. Follow-up was for a mean of 2 years.

Child↗
PubMed1986

The effect of ritodrine and glucagon on the acutely obstructed canine ureter.

The effects of 22 micrograms/kg/h glucagon and 240 micrograms/kg/h ritodrine infusions on the electrical activity and the intraluminal pressure of an acutely obstructed canine ureter have been studied. Acute obstruction of the ureter increased the rate of peristalsis from 7.05 (+/- 0.61) to 19.87 (+/- 0.47) per minute and the intraluminal pressure rose to a maximum of 124 cm water. Glucagon and ritodrine infusions reduced the rate of peristalsis to 6.32 (+/- 0.73) and 5.83 (+/- 0.84) respectively, whilst the intraluminal pressure was reduced by 43% during the glucagon infusion and 51% during the ritodrine infusion. The effect of ritodrine was more prolonged than that of glucagon.

Animals↗