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Biomedical subjects

R F Deane

Publications and source records attributed to R F Deane.

At least 19 recordsLinked to original sources
PubMed1994

Nephrectomy: changing indications, 1960-1990.

OBJECTIVE: To review the indications for nephrectomy over the period 1960-1990. PATIENTS AND METHODS: A total of 1470 nephrectomies were performed (excluding transplant-related nephrectomies) over this period. Data were collected by means of a pathology report review and the indications were classified according to aetiology. RESULTS: The total number of nephrectomies performed has not significantly changed over this 31-year period. There was a significant decrease in the number of partial nephrectomies performed and an increase in the number of nephrectomies performed for tumour. This change was equally distributed between both renal adenocarcinomas and transitional cell tumours. The number of nephrectomies for chronic pyelonephritis decreased over this period. The change seen was not as great as might have been anticipated in view of the advent of modern antibiotics. Nephrectomies performed for tuberculosis decreased, although this change was not established until the 1980s. In the 1960s and early 1970s, most tuberculous nephrectomies were performed in patients from the native community. By the 1980s, most patients in this category were from the ethnic Asian immigrant community. Nephrectomy rates for polycystic kidney and trauma remained unchanged. CONCLUSIONS: Despite changes in the investigation and management of renal tract pathologies, which contributed to a change in the indications for nephrectomy, the overall number of nephrectomies performed has remained constant over a 31-year period.

Humans↗
PubMed1992

Effect of percutaneous nephrolithotomy on thermoregulation.

Hypothermia is a well recognised complication of open surgery. We had observed hypothermia, occasionally followed by rebound hyperthermia in the early post-operative period, in patients undergoing percutaneous nephrolithotomy, and therefore decided to monitor patients undergoing this procedure more closely. During a 12-month period, 32 patients were monitored during 38 percutaneous nephrolithotomies; 12 procedures were performed using irrigation fluid at room temperature (22 degrees C) and 26 with fluid warmed to 37 degrees C. Although no statistically significant differences between temperature changes were seen, the most profound temperature falls occurred in patients who received fluid at room temperature. The recovery ward staff observed improved post-operative recovery in patients who had received warmed fluid. Three of the 5 patients who underwent more than 1 percutaneous procedure received fluid at 22 degrees C and fluid at 37 degrees C on separate occasions. In each patient a more profound temperature fall occurred when the cold fluid was used. Only 1 patient, who received cold fluid, developed rebound hyperthermia in the early post-operative period. Warming of irrigation fluid and close monitoring of core temperature may prevent unnecessary morbidity in patients undergoing percutaneous nephrolithotomy.

Adult↗
PubMed1992

Chronic testicular pain following vasectomy.

The incidence of chronic testicular pain following vasectomy has not been previously assessed. We have carried out a survey by postal questionnaire and telephone interview of 172 patients 4 years after vasectomy to assess the incidence of chronic testicular pain. Significant early post-operative complications occurred in 6 patients (3.5%): 2 infection, 3 haematoma and 1 orchitis. Chronic testicular discomfort was present in 56 patients (33%), considered by 26 (15%) to be troublesome but not by the other 30 (17%). Testicular discomfort related to sexual intercourse occurred in 9 cases (5%). Of the 9 patients who had sought further medical help only 2 had had further surgery (1 an epididymectomy and 1 excision of a hydrocele). Only 3 patients regretted having had the vasectomy because of chronic pain. On ultrasound examination, epididymal cysts were a common finding on both asymptomatic and symptomatic patients following vasectomy. Prior to vasectomy, all patients should be counselled with regard to the risk of chronic testicular pain.

Adult↗
PubMed1992

Is there still a place for prolonged bladder distension?

Over a 2-year period, 31 patients underwent prolonged hydrostatic bladder distension for benign and malignant bladder disease in this unit. Of these, 29 patients had benign functional disorders or bladder contracture, and in 2 patients hydrodistension was performed for complications of treatment for bladder neoplasia. Of the 29 patients with benign disease, 6 observed marked improvement and 8 some improvement in their symptoms, and 12 received no benefit. Patients with detrusor hypersensitivity fared better than those with detrusor instability or interstitial cystitis. A patient with malignant bladder disease died soon after the procedure as a result of a myocardial infarction. Problems attributed to the hydrostatic balloon catheter were responsible for 2 failures. The regional anaesthetic technique failed to provide adequate anaesthesia for hydrodistension in 9 procedures and limited the duration to 2 h in 13 others. Following recall of the perished balloon catheters by the manufacturer, and the introduction of continuous spinal anaesthesia, the number of technical failures has been reduced. This technique still has an important role to play in the relief of severe symptoms unresponsive to medical treatment, but it is important that ideal conditions are provided for hydrodistension in order to ensure maximum success, particularly when the alternative is major surgery.

Adolescent↗
PubMed1992

Is indoramin an effective alternative to prostatectomy?

Alpha-1-adrenergic antagonists are recommended for symptomatic treatment of patients awaiting prostatic surgery. Their efficacy has been confirmed in placebo controlled clinical trials, but to date no comparison of their effects with the results of subsequent prostatectomy has been made. Fifty-five patients awaiting prostatectomy were assessed (by symptom scores and peak urinary flow rates) prior to treatment, on indoramin 20 mg bd, and 2 months following prostatectomy. Side effects while taking indoramin were experienced by 36% of patients. Despite an overall improvement in mean symptom scores, 26% of patients with obstructive and 30% of those with irritative symptoms who were assessed while taking indoramin failed to experience any improvement. Of the 31 patients assessed while on indoramin and again following surgery, prostatectomy produced a greater symptomatic relief than indoramin. The increase in peak flow rate following prostatectomy was 11.7 ml/s compared with 3.2 ml/s on indoramin. However, 5 patients preferred to continue taking indoramin rather than proceeding to surgery. Indoramin is no substitute for prostatectomy. Although some patients might benefit from treatment while awaiting surgery, significant side effects may severely restrict its use for this purpose. The response to indoramin cannot be used as an accurate predictor of response to prostatectomy.

Humans↗
PubMed1990

Silent testicular metastasis from carcinoma of the prostate.

Secondary testicular tumours are rare, but metastasis of prostatic carcinoma to the testis is being reported more frequently. While this may not reflect a true increased incidence, more cases are detected by bilateral orchiectomy. Of 916 patients with carcinoma of the prostate diagnosed and treated over a period of 10 years, 124 underwent bilateral orchiectomy. Three patients were found to have testicular metastasis, 1 being bilateral. The route of spread seems to be through the lumen and/or lymphatics of the vas deferens. Although it is a sign of advanced disease, the prognostic significance is undetermined.

Aged↗
PubMed1989

Urothelial tumours of the upper urinary tract.

We present a retrospective 10 year analysis of 76 patients with urothelial tumours of the upper urinary tract. Patients older than 65 years, and female patients, presented with more advanced stages and had a worse prognosis. The grade and stage of the tumour has the greatest impact on survival. No conclusions can be drawn on the efficacy of various types of surgery, but simple nephrectomy gave a 5-year survival of 68%, with a stump recurrence rate of 15%. We observed that patients with urothelial tumours had 4 fold increased chance of developing gastrointestinal cancer.

Actuarial Analysis↗
PubMed1988

Blood groups and transitional cell carcinoma of the upper urinary tract.

A retrospective analysis of the blood groups of 74 patients with transitional cell carcinoma of the upper urinary tract is presented. The blood group distribution of the patients reflected that of the general population. No relationship was found between blood groups and stage and grade of the tumour or patient survival. Nor were blood groups predictive of bladder tumour recurrence and stump recurrence in patients who had undergone simple nephrectomy.

Adult↗
PubMed1986

Urinary tract lymphoma.

Urinary tract involvement by non-Hodgkin's lymphoma is uncommon and whilst extranodal disease may be the first manifestation of NHL in 15% of patients, the primary site of origin of NHL in the urinary tract is very rare. At the time of diagnosis, apparently primary urogenital lymphoma is often widely disseminated, with a correspondingly poor prognosis.

Adult↗
PubMed1984

The treatment of advanced bladder cancer with methotrexate and cis-platinum--a pharmacokinetic study.

As part of a phase III study in advanced bladder cancer, 5 patients received methotrexate (MTX) 50 mg/m2 as a single agent every 2 weeks, and with every alternate dose of MTX (i.e. every 4 weeks) cis-platinum (CDDP) 50 mg/m2 was given simultaneously, together with saline hydration and diuresis. The clearance of MTX was measured in a total of 12 courses by serial serum sampling for up to 72 hr following injection. In 4 patients (with a mean pretreatment creatinine clearance of 97 ml/min) there was no significant difference between the clearance of MTX when given alone [mean t1/2 (beta) 3.2 hr] and when given 2 weeks later with concurrent CDDP [mean t1/2 (beta) 2.9 hr]. In 1 patient with a pretreatment creatinine clearance of 52 ml/min the clearance of MTX when given alone (without hydration) was significantly delayed compared with the clearance of MTX when given 2 weeks later concurrently with CDDP and saline hydration [t1/2 (beta) 19 and 4.5 hr respectively]. Of the 5 patients so far treated with MTX-CDDP, 2 have had a partial objective response and 3 have had stable disease (including 2 with a marked subjective response). These data indicate that in patients with satisfactory renal function, low-dose MTX and CDDP may be given concurrently without risk of enhanced drug toxicity.

Aged↗
PubMed1975

Ultrasound in the staging of bladder tumours.

The ultrasonic features of 162 bladder tumours are described. Comparing clinical staging by the TNM system and the ultrasonic appearances, there is a high degree of accuracy in staging by ultrasound. The use of this painless non-invasive technique is assessed and should be used in staging bladder tumours only in conjunction with other established methods, and not in isolation.

Cystoscopy↗
PubMed1972

Renal transplantation: an analysis of 33 cases.

Thirty-three patients with end-stage renal failure have had transplants over a three-year period, four patients receiving kidneys from siblings and the remainder cadaver organs. Twenty-seven kidneys survived with stable function for periods of six months to three years. Graft survival at one year was 85% and at two years 82%. One patient died and five were returned to dialysis. Complications included rejection episodes, technical problems, respiratory and wound infections, gastrointestinal disorders, and side effects of steroids.

Acute Kidney Injury↗