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Biomedical subjects

R J Honey

Publications and source records attributed to R J Honey.

18 recordsLinked to original sources
PubMed2002

Health-related quality of life after laparoscopic and open nephrectomy.

BACKGROUND: Postoperative recovery often is assessed with parameters (pain and return to work) susceptible to bias. This study sought objectively to compare postoperative health-related quality of life (HRQL) after laparoscopic and open nephrectomy with the Postoperative Recovery (PRS) (a validated questionnaire designed to assess pain), activities of daily living (ADL), and HRQL in postoperative patients. METHODS: Patients undergoing contemporaneous laparoscopic and open nephrectomy received the PRS pre- and postoperatively. The results were analyzed with analysis of covariance (ANCOV) and survival analysis. RESULTS: The 33 open nephrectomy and 38 laparoscopic patients in this study were comparable in age, gender, body mass index (BMI) and employment. Laparoscopic operative time was longer (p = 0.015), and the hospital stay was shorter (p<0.001). Laparoscopic patients had higher HRQL scores from postoperative days 3 to 365 (p<0.001), and they returned to preoperative HRQL faster (p<0.001). CONCLUSIONS: An objective HRQL instrument confirms that laparoscopic nephrectomy patients recover faster and with a higher HRQL than open surgery patients. The PRS can be modified for use after other abdominal procedures, and may prove useful for comparisons of other minimally invasive surgical techniques.

Activities of Daily Living↗
PubMed2001

Electrode performance beyond the manufacturer's recommended lifespan using the Dornier MFL 5000 lithotripter.

BACKGROUND AND PURPOSE: Electrodes used by the Dornier MFL 500 lithotripter have a specified lifespan, after which, the manufacturer recommends replacing the electrode before continuing the treatment. The aim of this study was to investigate whether electrodes continue to function effectively beyond 100% consumption by measuring the pressure output of electrodes up to 300% consumption or until electrode failure. MATERIALS AND METHODS: We assessed new, refurbished, and twice-refurbished electrodes to compare their respective performances. RESULTS: Rather than a decrease, there was a trend toward increased pressure output beyond 100% electrode consumption, with no drop in pressure prior to 300% consumption or electrode failure. All three types of electrodes functioned adequately above 100% consumption. CONCLUSION: These observations suggest that discarding the electrode before the completion of the treatment or electrode failure is not warranted. Using a single electrode rather than multiple electrodes to complete a treatment has the potential to save both time and cost.

Electrodes↗
PubMed2001

Thoracoscopy-assisted high intercostal percutaneous renal access.

PURPOSE: We describe a technique for safely accessing an upper pole calix through a 9th or 10th intercostal puncture. PATIENTS AND METHODS: A 9th or 10th intercostal access was used for percutaneous nephrolithotomy (PCNL) in nine patients. Thoracoscopy via the 5th or 6th intercostal space was used to ensure safe passage of the nephrostomy needle. RESULTS: Access was obtained in all patients without visceral injury. Seven patients were stone free after PCNL; the initial two required sandwich therapy to become so. Chest tubes were inserted routinely in the first eight cases. They were removed on postoperative day three and did not affect the length of hospital stay. CONCLUSIONS: Access through the 9th or 10th intercostal space is occasionally necessary and is ideal in certain circumstances. Thoracoscopy-assisted percutaneous renal access allows access under direct vision, thus preventing pulmonary injury.

Humans↗
PubMed2001

A comparison of patient-controlled sedation using either remifentanil or remifentanil-propofol for shock wave lithotripsy.

UNLABELLED: Patient-controlled sedation (PCS) has been used for extracorporeal shock wave lithotripsy (SWL) because it allows for rapid individualized titration of anesthetics. Because of its sedating effects, the addition of propofol to remifentanil may improve patient tolerance of SWL with PCS. One hundred twenty patients were randomly assigned to receive remifentanil 10 microg or remifentanil 10 microg plus propofol 5 mg for PCS with zero-lockout interval. Nine patients in the Remifentanil group and three patients in the Remifentanil-Propofol group required additional sedatives to complete their SWL (P = 0.128). Compared with the Remifentanil group, the Remifentanil-Propofol group required less remifentanil, had a decreased incidence of postoperative nausea and vomiting, and had a better overall satisfaction level. However, they had an increased incidence of transient apnea and oxygen desaturation. The incidence of apnea was 15% in the Remifentanil group and 52% in the Remifentanil-Propofol group (P < 0.001). All patients were able to move themselves to the stretcher at the end of SWL, and median time to home discharge was <70 min in both groups. Both remifentanil and remifentanil-propofol were useful for PCS during SWL. IMPLICATIONS: The addition of propofol to remifentanil improves patient satisfaction and decreases postoperative nausea and vomiting. However, it causes more respiratory depression than remifentanil alone. When remifentanil-propofol is used with patient-controlled sedation, appropriate monitoring and a minimum 1-2 min lockout interval is required.

Adolescent↗
PubMed2000

Shockwave frequency affects fragmentation in a kidney stone model.

PURPOSE: To study the effect of altering shockwave frequency on the efficiency of stone fragmentation using the MFL 5000 spark-gap lithotripter. MATERIALS AND METHODS: Standardized solid plaster stones, 12.0 +/- 0.5 mm in diameter, were fragmented at an energy setting of 20 kV. The shockwave frequencies tested were 60, 80, and 117 per minute. Stones were fragmented throughout the entire lifespan of the electrode, from 0 to >100% consumption, at each frequency tested. Electrode pressure output was studied for each frequency. RESULTS: A greater number of shocks was required to fragment the plaster balls at higher frequencies (regression coefficient 1.93; p < 0.003). An inverse relation was found between the number of shocks necessary to break the stones and electrode consumption (regression coefficient -2.16; p < 0.001). The analysis of delivered pressure from the electrode failed to demonstrate a linear relation with frequency (regression coefficient -0.40; p < 0.728) or consumption (regression coefficient -1.11; p < 0.158). CONCLUSIONS: The number of shocks required to fragment a stone is influenced in part by the frequency at which the shockwaves are delivered. Increasing the shockwave frequency from 60 to 117 per minute in this study caused a significant rise in the number of shocks required to break the stone. The pressure output of the electrode was similar at the frequencies tested, thus making the difference in stone fragmentation secondary to the mechanism of stone disintegration and not the function of the electrode.

Dose-Response Relationship, Radiation↗
PubMed2000

Variation in clinical outcome following shock wave lithotripsy.

PURPOSE: We measure and compare operator specific success rates of extracorporeal shock wave lithotripsy (ESWL) performed by 12 urologists in 1 unit to determine interoperator variation. MATERIALS AND METHODS: From January 1, 1994 to September 1, 1997 a total of 5,769 renal and ureteral stones received 9,607 ESWL treatments by 15 urologists with a Dornier MFL 5000 lithotriptor. The 3-month followup data are available for 4,409 stones. Outcome measures consisted of patient demographics, stone characteristics, technical details of lithotripsy, and stone-free and success rates by treating urologists. RESULTS: Treatment results were analyzed for 12 urologists (surgeons A to L) who treated more than 100 stones each, totaling 4,244 with followup information available. Mean stone-free and success rates were 50.6% and 72.3%, respectively. Surgeon A had significantly higher stone-free and success rates of 56.2% and 76.7%, respectively (p<0.05), with treatment results from 877 stones, which was a significantly higher number than others (p<0.05). Significant differences existed in mean number of shocks delivered among urologists (p = 0.0001), with surgeons A and J delivering the highest mean numbers (2,317 and 2,801, respectively). There was no difference in treatment duration (p = 0.75) but variation existed among urologists in terms of mean maximum treatment voltage (p = 0.0001). Mean fluoroscopy time at 4.1 minutes was higher for surgeon A than others (p<0.05). Mean complication rate following ESWL was 4.9% with no difference among urologists (p = 0.175). Re-treatment was required in 21.7% of cases and surgeon A had the lowest rate (15.9%, p<0.05). CONCLUSIONS: We demonstrated clinically and statistically significant intra-institutional differences in success rates following ESWL. The best results were obtained by the urologist who treated the greatest number of patients, used a high number of shocks and had the longest fluoroscopy time. Accurate targeting is crucial when using a lithotriptor, such as the Dornier MFL 5000, with a narrow focal zone of 6.5 mm. in diameter. Other centers should be encouraged to develop similar programs of outcome analysis in an attempt to improve performance.

Adolescent↗
PubMed2000

Higher urinary potassium is associated with decreased stone growth after shock wave lithotripsy.

PURPOSE: We correlated serum and urinary biochemical parameters with radiological evidence of stone growth after shock wave lithotripsy. MATERIALS AND METHODS: Biochemical parameters in serum and 24-hour urine collections of 359 patients were correlated with stone growth for 2 years after shock wave lithotripsy. Each patient underwent a minimum of 2 radiological studies at 3 and 12 months and plain abdominal x-ray at 24 months. The presence and size of stones were documented by a radiologist in blinded fashion. Stone growth was defined as measurable growth of a preexisting stone or new stone formation. RESULTS: A total of 209 patients remained stone-free or had no existing stone growth, while stone size decreased in 30. Of the remaining 120 patients with stone growth 72 had new growth and 48 had growth of preexisting stones. Urinary excretion of potassium was significantly higher in those without than with stone growth (mean 24-hour urine collection plus or minus standard deviation 62 +/- 27 versus 54 +/- 23 mmol., p = 0.009). The only parameter significantly associated with stone growth was urinary potassium. Linear regression revealed that for each 10 unit increase in urinary potassium there was a corresponding 2 mm. decrease in stone growth (p = 0.013). CONCLUSIONS: Our results indicate that increased urinary potassium excretion correlates with a decreased risk of stone growth up to 2 years after shock wave lithotripsy, implying that a high potassium diet may be beneficial for preventing stone growth. The effect of potassium supplementation on stone formation and growth must be investigated further.

Dietary Supplements↗
PubMed2000

Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment.

PURPOSE: We determined the number of shock wave lithotripsy treatments that should be given for a single ureteral stone before alternate modalities are used. MATERIALS AND METHODS: We compared the stone-free rate of initial shock wave lithotripsy for ureteral calculi with that of subsequent treatments. We evaluated 1,593 ureteral stones treated with the Dornier MFL 5000 lithotriptor* from January 1, 1994 to September 1, 1999 using various parameters associated with treatment outcome. RESULTS: The stone-free rate after initial treatment was 68% (1,086 of 1,593 stones), which decreased to 46% (126 of 273) after re-treatment 1. We observed a further decrease in the stone-free rate after re-treatment 2 to 31% (19 of 61 stones, p = 0.001). The cumulative stone-free rate increased to 76% (1,212 of 1,593 stones) after 2 treatments and to 77% (1,231 of 1593) after 3. The stone-free rate for stones 10 mm. or less was significantly better than that of stones 11 to 20 mm. initially (64% versus 43%) and after re-treatment (49% versus 37%). A ureteral stent decreased the stone-free rate of initial treatment and re-treatment 1 by 12% and 14%, respectively (p = 0.001). After initial treatment the stone-free rate of the upper and mid ureter was significantly higher than that of the lower ureter. Patient weight had no significant impact on success in either group. CONCLUSIONS: The stone-free rate of re-treating ureteral calculi with shock wave lithotripsy decreases significantly after the initial treatment. These findings imply that ureteroscopic management of ureteral stones may be better than shock wave lithotripsy after initial shock wave lithotripsy fails.

Adolescent↗
PubMed1998

Assessment of a new tipless nitinol stone basket and comparison with an existing flat-wire basket.

Flexible nephroscopes and ureteroscopes make it possible to see calculi in remote calices, but it is often impossible to remove these with existing technology. Flat-wire baskets impede deflection and can traumatize the papilla. This study compares the performance of a new 3.2F tipless nickel-titanium (Nitinol) basket with that of an existing 3.0F flat-wire basket. Specifications were compared using a 15F nephroscope and a 7.5F flexible ureteroscope in a pig kidney model. A calculus was placed in a calix, and the author and two residents were timed while using both baskets to retrieve the stone. To open fully, the flat-wire basket needed to protrude 1.2 cm further than the tipless basket. The tipless basket did not restrict deflection of the nephroscope, whereas the flat-wire basket limited flexion by 24 degrees and extension by 28 degrees. The tipless basket did not restrict extension of the 7.5F ureteroscope but limited flexion by 10 degrees. The flat-wire basket limited flexion by 79 degrees and extension by 72 degrees. Using the pig kidney model, the three operators took a mean of 5.3, 11.8, and 6.4 seconds to catch the stone with the tipless basket. Using the flat-wire basket, the mean times were 15.3, 34.5, and 28.9 seconds (combined data: 8.2 seconds for the tipless basket and 27.8 seconds with the flat-wire basket; P = 0.0001). Only the flat-wire basket was seen to traumatize the papilla. The Nitinol tipless basket has significant advantages over the flat-wire basket.

Alloys↗
PubMed1998

A randomized controlled trial to assess the incidence of new onset hypertension in patients after shock wave lithotripsy for asymptomatic renal calculi.

PURPOSE: To answer the question of whether extracorporeal shock wave lithotripsy (ESWL*) induces hypertension, a prospective, randomized controlled trial of normotensive patients with asymptomatic renal calculi was designed. MATERIALS AND METHODS: Patients were randomized to receive immediate ESWL versus observation, reserving ESWL for the onset of symptoms. The rates of new onset hypertension were evaluated for both groups. RESULTS: There was no observed difference in the incidence of hypertension between the treatment and observation groups. CONCLUSIONS: The risk of hypertension in patients undergoing ESWL therapy is similar to that of a control cohort of initially observed asymptomatic patients.

Adult↗
PubMed1995

Diagnosis and management of urethral sarcoidosis.

We report on a woman with urethral sarcoidosis with obstructive urinary symptoms and previously known systemic sarcoidosis. The diagnosis of this rare lesion and management are discussed, and the genitourinary manifestations of sarcoidosis are reviewed.

Dilatation↗
PubMed1994

Testicular seminoma presenting with features of androgen excess.

A 32-year-old white man presented with worsening acne and noticeable increase in muscle bulk. On examination, a firmer area with a granular consistency was noted in the right testis. A right radical orchiectomy was performed and the histologic findings were those of a typical seminoma associated with marked Leydig cell hyperplasia. A solitary right iliac lymph node metastasis, but not the primary seminoma, contained human chorionic gonadotrophin- (HCG) producing syncytiotrophoblast, which was regarded as the hormonal stimulus for Leydig cell hyperplasia and elevated serum testosterone. This seems to be the first report of testicular seminoma presenting with symptoms of androgen excess.

Adult↗
PubMed1992

The use of an abdominal compression belt to reduce stone movement during extracorporeal shock wave lithotripsy.

We used an abdominal compression belt in 50 patients undergoing extracorporeal shock wave lithotripsy with the Siemens Lithostar lithotriptor to limit diaphragmatic excursion and, therefore, renal calculus movement. Stone movement was measured on the monitor with and without the compression belt. Abdominal compression was found to decrease the range of stone movement by an average of 32% (-4 to 63%). This technique was less effective in patients with limited chest expansion. Abdominal compression was also found to be useful during treatment of renal and upper ureteral stones in reducing overall patient movement. The decreased stone movement during extracorporeal shock wave lithotripsy with abdominal compression may increase stone fragmentation and may decrease the number of shocks per treatment.

Humans↗
PubMed1992

Aluminum toxicity and death following intravesical alum irrigation in a patient with renal impairment.

Intravesical alum irrigation is the safest and most effective method of treatment for intractable hematuria. Systemic absorption is reported to be minimal and there have been no reported deaths following its use. We describe an elderly man with compromised renal function (serum creatinine 420 mumol./l.) who was treated with 1% alum irrigation for 48 hours for hematuria due to inoperable bladder cancer. He received a total of 9.6 l. during 48 hours, which controlled the bleeding. After cessation of the alum he became lethargic, suffered respiratory depression and died the next day. Laboratory data showed mild metabolic acidosis and increasing daily aluminum levels that peaked at 7,014 nmol./l. (toxic greater than 2,000) beginning on the day after treatment was commenced. The efficacy and safety profile of alum irrigation is discussed.

Aged↗
PubMed1991

A randomized comparative study of the prophylactic use of trimethoprim-sulfamethoxazole versus netilmycin-metronidazole in transrectal prostatic biopsy.

An open randomized study was done to compare the prophylactic value of single doses of netilmycin-metronidazole versus trimethoprim-sulfamethoxazole in the prevention of postoperative infections associated with transrectal prostatic biopsy. Of 117 patients enrolled in the study 101 were evaluated and of these patients 47 received netilmycin-metronidazole and 54 received trimethoprim-sulfamethoxazole. The bacteremia rate in the netilmycin-metronidazole group was 28% (13 of 47 patients) with a 95% confidence interval of 18 to 42% and in the trimethoprim-sulfamethoxazole group it was 37% (20 of 54) with a confidence interval of 26 to 50% (p = 0.43). None of the patients with bacteremia was symptomatic. Urinary tract infection rates were greater in the netilmycin-metronidazole group: 17% (8 of 47 patients) versus 2% (1 of 54) in the trimethoprim-sulfamethoxazole group, p = 0.01. Trimethoprim-sulfamethoxazole (cotrimoxazole) is a better choice as an antimicrobial prophylaxis for patients undergoing transrectal prostatic biopsy.

Aged↗
PubMed1977

Tuberose sclerosis and bilateral renal carcinoma.

A case report is presented of an 18-year-old girl of normal intellect with tuberose sclerosis and multiple bilateral renal carcinomas. These tumours were successfully treated surgically by right nephrectomy and left partial nephrectomy. The usual renal lesion in these patients is the angiomyolipoma, which is a hamartoma. Renal carcinoma associated with tuberose sclerosis is extremely rare, and the mode of behaviour of these tumours may be unusual.

Adolescent↗