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Biomedical subjects

P Abrams

Publications and source records attributed to P Abrams.

At least 19 recordsLinked to original sources
PubMed1992

Stamey-Martius procedure for severe genuine stress incontinence.

There are few options now available to treat patients with severe genuine stress incontinence caused by urethral failure. These patients usually have a low maximum urethral closure pressure (less than 20 cm of water) and anterior vaginal wall scarring caused by previous surgery. In 32 such patients we used the Martius fat pad insertion procedure, in addition to the Stamey procedure, and achieved a 91% symptomatic success rate over a mean 13-month follow-up period. Because of its simplicity, reliability and low morbidity, we recommend this procedure in this difficult group of patients before performing a sling procedure or insertion of an artificial urinary sphincter.

Adipose Tissue↗
PubMed1992

Personal computers and urological research.

The value of a computer in urological research depends not only upon an appropriate and informed choice of hardware, but also the purchase of software programs which will facilitate input, manipulation and transfer of relevant data. Acquaintance with the Data Protection Act is essential, as is registration as a data user in most cases.

Computer Literacy↗
PubMed1992

Urological audit: the role for an aggressive approach to high grade superficial bladder tumours.

A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.

Adult↗
PubMed1992

Surgical treatment and complications of urinary incontinence.

Numerous surgical approaches to the management of incontinence, particularly genuine stress incontinence, have been reported. No single operation is a panacea for the condition, and many factors must be taken into account before deciding which procedure is best tailored to an individual's needs. The procedures vary in their results, morbidity, and associated complications. Awareness of these previous complications encourages their avoidance and permits better management should they occur.

Female↗
PubMed1991

Pilot study of screening for prostate cancer in general practice.

The success of a screening programme for cancer depends on the sensitivity of the tests used and on the proportion of the target population that comes forward for screening. To assess the value of digital rectal screening and prostate-specific antigen (PSA) measurement as screening measures, the 814 men in a city general practice aged between 55 and 70 were recruited in one of five different ways. Men with a palpably suspicious prostate or a serum PSA greater than 4 ng/ml were referred for transrectal ultrasonography and, if indicated, biopsy. 472 men (58%) were screened; of these 68 underwent transrectal ultrasonography and 29 biopsy. In 7 the biopsy specimen showed carcinoma. Serum PSA was better than digital examination as a screening test--all men with prostate cancer had raised concentrations of serum PSA, whereas only 1 had a palpably abnormal prostate. All 7 had localised disease, and 5 underwent radical prostatectomy. The best methods of patient recruitment were to send an appointment for screening and to "tag" the patient's notes.

Aged↗
PubMed1991

Urodynamic morbidity and dysuria prophylaxis.

A group of 324 patients received prophylactic treatment with either sodium bicarbonate, potassium citrate or a glucose placebo following urodynamic studies. Urine was screened for infection both before and after testing and the incidence of dysuria assessed by postal questionnaire; 63% of patients experienced some degree of dysuria and this was severe and prolonged in 6.3%, the majority of whom were male. Neither sodium bicarbonate nor potassium citrate was any more effective in preventing dysuria than placebo. The presence of severe prolonged dysuria was not associated with a urinary tract infection or with any particular urodynamic diagnosis.

Bacteriuria↗
PubMed1991

Indoramin in the treatment of prostatic bladder outflow obstruction.

A series of 40 patients took part in a double-blind, placebo-controlled trial of indoramin in prostatic bladder outflow obstruction. Patients were assessed clinically and urodynamically before and after 4 weeks' treatment. Significant improvement was seen in nocturia, volume voided, flow rates and residual urine. The drug was well tolerated, although 7 patients on treatment and 7 on placebo noted side effects. These results suggest that indoramin may be a useful agent in the symptomatic management of bladder outflow obstruction.

Double-Blind Method↗
PubMed1991

Para-urethral collagen implantation for female stress incontinence.

A series of 25 women with genuine stress incontinence were treated by para-urethral injection of glutaraldehyde cross-linked collagen. The technique was simple and associated with few complications. Follow-up at 3 months revealed 20 patients (80%) to have been symptomatically improved or cured. An increase in urethral closure pressure together with a decrease in urine flow rate and increase in detrusor pressure was found post-operatively. The success rate was significantly higher (90%) in patients who had undergone previous surgery for urinary incontinence when compared with those who had had no previous surgery (73%).

Adult↗
PubMed1991

Immunoconjugates of Pseudomonas exotoxin A: evaluation in mice, monkeys, and man.

Immunotoxins of PE were constructed with stable thioether linkages using two monoclonal antibodies to ovarian cancer, OVB-3 and NR-LU-10. Antigens recognized by both antibodies have limited normal tissue distribution and are expressed on virtually all ovarian cancers. Both antibodies form highly potent conjugates (ID50 = 100 pg/ml) with high selectivity (greater than or equal to 4 logs) and can eliminate greater than or equal to 5 logs of tumor cells in vitro. The conjugates have been evaluated for efficacy in both ovarian and colon carcinoma ascites xenografts. In the ovarian model, the conjugates produce an increase in life span (ILS) of 200 to 300 with some cures against established but low tumor burden ascites. Increasing the tumor burden decreases efficacy and duration of responses. A lower ILS of 150 to 200 is achieved in the more aggressive colon model. However, the combination of immunotoxin with chemotherapy, which is ineffective on its own, demonstrated enhanced activity (ILS = 300). Toxicity of the conjugates is hepatic and easily monitored by liver function tests (LDH). Antitoxin responses are highly variable, but typically have a rapid onset and appear to be predicted by preexisting levels. Pilot clinical evaluation in ovarian cancer (intraperitoneal) is ongoing.

ADP Ribose Transferases↗
PubMed1990

The perineal artificial sphincter for acquired incontinence--a cut and dried solution?

Sixteen males with stress incontinence due to sphincter damage were investigated with videourodynamic studies after implantation of a perineal artificial urinary sphincter. Twelve patients were rendered dry; 4 remained incontinent, all of whom were shown by cystometry to have incontinence from detrusor instability. Of these, 2 also had stress incontinence proven by videourography. Detrusor instability was present in 9 patients before implantation; the instability worsened considerably in 2 patients and new instability was shown in another 2 patients. The limitations of the artificial urinary sphincter and the implications of detrusor instability in patients with an artificial sphincter are discussed. The artificial urinary sphincter is an extremely successful device for the treatment of acquired stress incontinence.

Humans↗
PubMed1989

Terodiline: a dose titrated, multicenter study of the treatment of idiopathic detrusor instability in women.

Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes. Treatment initially is conservative and often includes drug therapy. Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects. Theoretically, by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents. A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol. Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation, standardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial. Terodiline has been demonstrated to be a safe, well tolerated and effective drug in the treatment of idiopathic detrusor instability. Drug treatment led to significant decreases in urinary frequency and incontinence episodes. Pre-micturition symptoms, such as urgency, were markedly reduced and the voided volume was significantly increased. Although there were consistent trends towards greater improvement in the urodynamic measurements, when the terodiline and placebo groups were compared these did not reach statistical significance, partly due to a large improvement in the placebo group. Nevertheless, terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability.

Adult↗
PubMed1989

Technetium-99m labeled monoclonal antibodies in the detection of metastatic melanoma.

Twenty-six stage II/III malignant melanoma patients with 321 measurable metastatic lesions were imaged using Fab fragments of an IgG murine monoclonal antibody labeled specifically with 10-30 mCi Tc-99m with a bi-functional chelating method (NeoRx, Seattle, WA). There were no side effects or adverse reactions. Immunoscintigraphy demonstrated 66.6% of lesions larger than 1 cm and 92.5% of lesions larger than 3 cm. Most frequently detected metastases were in lymph nodes, subcutaneous areas, and bone. Of lesions less than 1 cm, 23.6% were detected if superficial cutaneous lesions were excluded. The smallest detectable lesion was 4 mm. Twenty-one additional clinically unsuspected sites were visualized in 12 of the 26 patients studied. Of these, 56% were confirmed as metastasis by other tests. There were apparent nonspecific localizations owing to other causes, including fracture, varicosities, skin abscess and pneumonitis. Increased experience in image analysis facilitates correct interpretation of these localizations. This study demonstrates that imaging with Tc-99m labeled antibody fragments detects melanoma lesions in organs routinely surveyed and in other areas not routinely assessed by other imaging techniques. The procedure is readily performed and safe. The principal advantage of the test is its ability to survey the entire body and all organs with a single test. Its principal limitation, in common with other diagnostic imaging procedures, is its poor sensitivity for detecting lesions less than 1 cm.

Adult↗