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Biomedical subjects

N T Galloway

Publications and source records attributed to N T Galloway.

At least 19 recordsLinked to original sources
PubMed1995

Normal range prostate-specific antigen versus age-specific prostate-specific antigen in screening prostate adenocarcinoma.

OBJECTIVES: Prostate-specific antigen (PSA) has become the most useful serum tumor marker in the diagnosis and screening of prostate adenocarcinoma. The currently cited reference range of normal (0 to 4.0 ng/mL monoclonal) lacks both the sensitivity and specificity to be universally accepted as a screening test, and alternatives to serum PSA have been proposed, such as PSA density, PSA velocity, and age-adjusted PSA. Age-adjusted PSA takes into account the facts that as men grow older the prostate enlarges and that screening should have maximum sensitivity in younger men and maximum specificity in older men. METHODS: A population of 4,710 men with no known history of prostate adenocarcinoma underwent 5,629 examinations by transrectal ultrasound of the prostate (TRUS) from 1987 to 1994. This population consists of Mobile Urology Group, Mobile, Alabama, and Emory University, Atlanta, Georgia, patient databases. We have examined our data to determine the sensitivity, specificity, and positive predictive values for normal range PSA (0 to 4 ng/mL) versus age-specific PSA values. RESULTS: A total of 2040 patients had an abnormal digital rectal examination (DRE) and 3581 procedures were performed for an elevated PSA and a normal DRE. Biopsies were performed in 2,657 patients with 945 (35.6%) positive for cancer. Criteria for biopsy included elevated PSA (more than 4 mg/mL), PSA density more than 0.15 abnormal DRE, or suspicious TRUS. Patients were grouped according to decade: group 1 (ages 40 to 49 years, n = 183), group 2 (ages 50 to 59 years, n = 1018), group 3 (ages 60 to 69 years, n = 2358), and group 4 (ages 70 to 79 years, n = 1687). CONCLUSIONS: Use of the age-specific range for PSA increases the sensitivity in younger men more likely to benefit from treatment, and decreases the biopsy rate in older patients who may not be candidates for aggressive treatment. Age-adjusted PSA is the most valuable for patients over the age of 70 years of whom 22% would be spared TRUS with biopsy.

Adenocarcinoma↗
PubMed1994

The gastric augment single pedicle tube catheterizable stoma: a useful adjunct to reconstruction of the urinary tract.

Since 1990 we have used stomach for bladder augmentation and continent urinary diversions in 73 patients, of whom 15 received a gastric tube catheterizable stoma and are the subject of this report. The gastric tube receives its blood supply from the same vascular pedicle as the gastric patch and, therefore, it can be moved anywhere along with the patch. The tube is then reimplanted in the reservoir or bladder following the Mitrofanoff principle and brought to the skin as a catheterizable stoma. Patient age ranged from 12 to 60 years. Three patients underwent augmentation cystoplasty and 12 received a composite gastrointestinal continent reservoir (in 10 a prior bowel conduit was detubularized and used as part of the reservoir). The appendix was either previously removed (10 patients) or not suitable as a catheterizable limb (4). All patients are continent. Catheters used to empty the reservoir varied from 12F to 18F. Complications included an early traumatic perforation of the tube in 1 patient, distal stenosis in 1 and mucosal redundancy in 1. Of these patients 2 required revision. Two patients had mild peristomal skin irritation without ulceration. Anatomical and technical aspects of this procedure are presented. In summary, we believe the gastric augment single pedicle tube to be a useful tool for the reconstructive urologist, which in select cases may obviate the need for additional bowel anastomosis to create a tapered intestinal catheterizable limb.

Adolescent↗
PubMed1994

Surgical management of interstitial cystitis.

For most urologists the decision to operate on a patient with interstitial cystitis is made with extreme caution. The knowledge that this is a nonmalignant disease, that it poses little risk to overall health (although most patients would differ with this assertion), and that surgical intervention may be accompanied by additional complications has relegated open surgical procedures to last on the list of treatments for interstitial cystitis. This reluctance to operate until late in the course of the disease is clearly unsatisfactory. If a successful surgical procedure can performed, it ought to be employed early in the course of the patient's management and not withheld after the unfortunate patient has been subjected to a host of unsatisfactory conservative treatments. There is a need for balance between timidity and surgical aggression in the management of this dreadful condition. There is a need to identify the appropriate patients for surgical treatment and to select the most successful procedure. We should not expect to have to move through a series of different procedures for each patient, but rather select the right one the first time. There is an obvious need for a better understanding of the precise cause and pathogenesis of the condition so that alternative forms of treatment may be investigated. Surgery can provide significant relief for many patients with incapacitating symptoms. Cystectomy, either supratrigonal or total, is best reserved for those patients with markedly reduced bladder capacities.

Cystectomy↗
PubMed1993

Abnormal pedal thermoregulation in interstitial cystitis.

Isolated cold stress tests were used to evaluate the thermoregulatory capacity in the feet of 19 patients with interstitial cystitis (IC) and of 11 healthy volunteer control subjects. Mean pedal skin temperature fell more rapidly in the IC group as compared with controls; significant differences were found at 10-min (P = 0.002) and 20-min (P = 0.0008) cooling. Mean skin temperature remained lower in the IC group throughout the study. Sixteen feet (42%) in the IC group and five (22%) of the control feet failed to return to within 2 degrees C of baseline temperature during the 20-min recovery period. These findings may reflect abnormal vasomotor control in the IC group and, if so, may be indicative of increased spinal sympathetic activity in interstitial cystitis.

Adult↗
PubMed1993

Impaired bladder perfusion in interstitial cystitis: a study of blood supply using laser Doppler flowmetry.

Laser doppler flowmetry was used to study bladder blood flow in 16 patients with interstitial cystitis and in 18 control subjects. All studies were performed at cystoscopy under general anesthesia. Interstitial cystitis patients conformed to the diagnostic criteria of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Blood flow measurements were made at four specific sites in the bladder at a capacity of 100 ml. and at full capacity. The mean maximum capacity under anesthesia was 828 cc for the control group and 562 cc for the IC group. Blood flow at low capacity was similar in the two groups. When the bladder was filled to capacity, blood flow increased by a mean of 9.05 LDF units in the control group but only by 0.06 LDF units in the IC group (p = 0.007). Vault perfusion increased considerably more in the control group compared to the IC group (p = 0.002). The mean ratio of vault to trigonal perfusion was similar in both groups and was not affected by the overall blood flow changes which accompanied distension. Although the mean bladder capacity under anesthesia was greater in the control group, covariant analysis showed that the significant differences in perfusion between the two groups occurred independently of changes in capacity. It is concluded that bladder perfusion at capacity is significantly impaired in interstitial cystitis.

Cystitis↗
PubMed1993

Lumbar epidural blockade for management of pain in interstitial cystitis.

Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18-month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain. Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure. Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.

Adult↗
PubMed1992

The development of a technique to estimate the number of motor units in the urethral sphincter.

An electromyographic technique is presented that has been developed in an effort to quantitate the number of motor units in the urinary sphincter. Sphincter contraction was provoked by electrical stimulation and recorded with a catheter mounted electrode. Incremental stimulation produced corresponding increments of sphincter contraction that were recorded as the magnitude of the sphincter electromyogram. Estimates of the number of motor units in the sphincter were made by analysis of variance of a Poisson distribution. Using this method, the mean number of motor units in the sphincter of five dogs was estimated to be 129 with values ranging from 80 to 182. Anatomical correlation was sought by infiltrating this sphincter with horseradish peroxidase, which is taken up by axonal transport to stain the motor neurons in the spinal cord. The mean number of motor neurons was 229 with values ranging from 116 to 358. There are technical and physiologic explanations for the observed differences between the predicted and the actual number of motor neurons stained and this is addressed in the discussion.

Animals↗
PubMed1991

An objective score to predict upper tract deterioration in myelodysplasia.

Bladder dysfunction in myelodysplasia may present a significant hazard to the upper tract and a threat to kidney function. Urodynamic features of high leak pressure and detrusor-sphincter dyssynergia have been associated with an increased risk. We have developed an objective score to describe urodynamic findings in myelodysplasia. The score includes consideration of bladder compliance, detrusor contractility and reflux, in addition to leak pressure and sphincter behavior. In 171 myelodysplastic patients a significant correlation was demonstrated between the score and upper tract studies at the time of urodynamics and the score and the management decision. Of 73 myelodysplasia patients with normal upper tracts at the first urodynamics study hydronephrosis later developed in 14. The score was a potent predictor of outcome (p = 0.0006).

Child, Preschool↗
PubMed1987

Sacral reflex latency in acute retention in female patients.

Neurophysiological measurements of the innervation of the lower urinary tract were performed on 14 female patients presenting with unexplained acute urinary retention. The method consisted of (a) static electromyography (EMG) of the anal and urethral sphincter with the patient relaxed, coughing and gripping, (b) the study of sensory thresholds on the dorsal nerve of the clitoris and in the urethra, (c) the measurement of sacral reflex latencies (SRL) from the dorsal nerve of the clitoris to the anus and urethra and from the urethra to the anus. The results showed that all 14 patients had significant defects in the innervation of their lower urinary tract. These findings suggest that a neurological explanation for acute retention in women should always be sought before making any other diagnosis.

Acute Disease↗
PubMed1987

An assessment of the complications of the Brantley Scott artificial sphincter.

A Brantley Scott artificial sphincter has been inserted into 95 patients since 1981; more than half of the patients had lower urinary tract neuropathy and most of the others post-TUR incontinence. The main problem with the device has been cuff failure (12), which should be resolved by the new "dipped" cuffs. The major surgical complication has been erosion (10), usually associated with infection. Twenty-four patients had variable degrees of incontinence but the artificial sphincter remains the cornerstone of continence control when other methods have failed or are inappropriate.

Female↗
PubMed1987

The complications of colposuspension.

Fifty patients with stress incontinence treated by a colposuspension procedure were reviewed symptomatically and urodynamically before and after surgery and followed up for 1 to 6 years (mean 4.5). Although 84% were continent post-operatively, only 63% of those previously operated on for incontinence were dry, and only 44% were dry and complication-free in the long term.

Adult↗
PubMed1987

The longer-term results of undiversion.

Thirty patients have been undiverted over the past 7 years. All but six were originally diverted for neuropathic problems of incontinence and/or upper tract compromise. Eighteen were undiverted because of deteriorating renal function. Only two were reconstructed for purely social reasons. Twenty-eight patients have stable renal function, though three are enuretic and two have persistent Pseudomonas infection. Ureteric "failure" remains the most difficult problem.

Colon, Sigmoid↗
PubMed1986

Effect of a blood transfusion protocol and low dose steroid regime on renal transplant survival.

The effects of introduction of a low steroid regime and pre-transplant blood transfusion were evaluated. The kidney and patient survival rates for the period before such a policy was adopted were compared with the period after this policy. There has been a highly significant rise in patient survival rates to the present level of 95 per cent at three years. There was a similar rise in three year graft survival rates from less than 40 per cent to 66 per cent.

Actuarial Analysis↗
PubMed1985

Patterns and significance of the sacral evoked response (the urologist's knee jerk).

Neurological examination may fail to demonstrate any abnormality in patients who have neurogenic bladder dysfunction. Standard clinical methods will include full examination of segmental nerves to the level of S1 but will not include the lower sacral segments which control sphincter function. We describe a simple method of measuring the integrity and function of these segments of the cord. The method and the common patterns of response are described. The stimulus is physiological (not supramaximal), the response is measured with surface mounted electrodes at the urethral and anal sphincters and each measurement is the average response after 100 stimuli.

Anal Canal↗
PubMed1985

Minor defects of the sacrum and neurogenic bladder dysfunction.

Minor defects of the sacrum are common and often dismissed as normal. The radiographs of 100 patients with urinary incontinence revealed sacral abnormalities in 43. Sacral evoked responses were measured and compared independently with the radiological findings. Patients who had defective closure of the dorsal neural arches of S1 or S2 all had abnormal nerve studies. We suggest that incomplete development of the bones of the dorsal neural arches of the upper sacrum may be a marker of incomplete neurogenesis of the sacral nerves. The sacral neurological deficit is subtle and difficult to demonstrate, but it is real and may be important in the pathogenesis of incontinence.

Adolescent↗