Biomedical subjects

Richard D Sowery

Publications and source records attributed to Richard D Sowery.

4 recordsLinked to original sources

PubMed2006

Parameters affecting urologic complications after major joint replacement surgery.

INTRODUCTION AND OBJECTIVES: Peri-operative bladder management after major arthroplasty procedures remains controversial. The purpose of this study was to assess the risk of urological complications in those patients undergoing hip or knee joint replacement. As well, we identified those factors that may affect the likelihood of developing complications. METHODS: Two hundred and twenty-one consecutive patients receiving a total knee or hip arthroplasty were reviewed. The outcomes measured were prolonged urinary retention, as well as urinary tract infections and the development of a septic prosthesis. Statistical significance of any predisposing factors identified was determined using a two-tailed Fisher exact test. RESULTS: Urological complications in the cohort were common at 47%, with patients having hip arthroplasty being at higher risk (p < 0.03). Despite this there was a low incidence of documented infections. Increased rates of urinary retention were identified in those who received intrathecal narcotics (p < 0.02), as well as those who suffered from hypertension (p < 0.05). Gender and anesthetic techniques (general or regional) did not affect the rate of complications. There was a decrease in urological complications when bladder management included peri-operative catheterization rather than expectant management. CONCLUSIONS: Bladder management is a significant problem for patients after hip and knee arthroplasty as urinary retention was identified in almost half of the patients. Parameters that may identify those with higher risks include patients with hypertension and those who receive intrathecal narcotics. In high-risk patients, the practice of utilizing a catheter peri-operatively may decrease the risk of multiple post-operative catheterizations without increasing the rate of infections.

Arthroplasty, Replacement, Hip↗

PubMed2005

Experimental intraprostatic injection of bacillus Calmette-Guerin: a feasibility and safety study.

PURPOSE: We investigated the feasibility and safety of intraprostatic administration of bacillus Calmette-Guerin (BCG) and determined the histological changes induced by this approach. MATERIALS AND METHODS: A total of 36 healthy male beagle dogs 2.2 to 3.6 years old weighing 10.0 to 14.8 kg were randomly assigned to 6 experimental groups. Four groups were given intradermal BCG vaccination and 6 weeks later they were given 0 (group 1), 10 (group 2), 5 x 10 (group 3) or 10 (group 4) BCG organisms intraprostatically. An additional group received prevaccination, followed 6 weeks later by a dose of 10 BCG organisms intraprostatically and then 6 weeks of antibiotics (group 5). Another group receiving no prevaccination and 5 x 10 BCG organisms intraprostatically at week 6 were included (group 6). RESULTS: Adverse reactions (ARs) were seen in 12 dogs, including inguinal lymphadenopathy in 3, an anal lesion in 5, constipation in 7 and dysuria in 3. There was a trend toward an increased incidence of ARs in high dose groups 3 and 4, fewer ARs in group 5 and no ARs in group 6. There was minimal evidence of systemic dissemination of BCG in any group. Post-necropsy histological analysis indicated higher inflammation as well as glandular destruction in high dose groups 3 and 4. Antibiotics did not seem to lessen the histological response to intraprostatic BCG injection (group 5). Interestingly in nonvaccinated group 6 the level of inflammation as well as glandular destruction was higher. CONCLUSIONS: Our results indicate that intraprostatic BCG administration in dogs is a safe and well tolerated procedure. It is free of major or long lasting serious complications.

Adjuvants, Immunologic↗

PubMed2004

Long-term penile incarceration by a metal ring resulting in urethral erosion and chronic lymphedema.

A patient presented with a metal ring around the base of his penis. The ring had been placed 3 years prior to presentation. Intra-operative findings revealed a ventral erosion with complete transection of the urethra and massive fixed lymphedema of the penile skin distal to the ring. Treatment consisted of removal of the ring with metal shears and bolt cutters. Small reduction of the edema was seen 3 months following removal, and the patient refused further treatment. The most interesting part of the outcome was the preservation of penile urethral voiding although intromission was not possible.

Aged↗

PubMed2004

Growth characteristics of renal cortical tumors in patients managed by watchful waiting.

OBJECTIVE: To characterize tumor growth of patients managed conservatively for renal cell carcinoma. METHODS: Patients electing conservative management of radiographically determined renal cell carcinomas were referred to a surveillance database. Exclusion criteria consisted of locally advanced disease (>T2) and those with metastatic disease. Clinical follow-up included renal imaging with ultrasound or computed tomography at least every 6 months. RESULTS: Twenty-two patients were originally managed conservatively, two of whom subsequently underwent nephrectomy because of rapid tumor growth. Mean follow-up was 26 months. Mean tumor volume and diameter at presentation was 62.4 cc and 4.08 cm respectively. Overall tumor growth was 24 cc/year by volume or .86 cm/year diameter. CONCLUSIONS: Given the stage migration of incidentally detected renal masses, the natural history of these tumors remains incomplete. Overall tumor growth in selected populations appear to be slow even in those diagnosed with larger masses. These data may be useful in counseling patients and directing further trials on conservative therapy for renal cell carcinoma.

Aged↗