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Biomedical subjects

S J Foley

Publications and source records attributed to S J Foley.

At least 19 recordsLinked to original sources
PubMed2000

Microvessel density in prostatic hyperplasia.

OBJECTIVES: To examine the prostates from patients with haematuria associated with benign prostatic hyperplasia (BPH) to determine their microvascular anatomy and thus assess histopathological differences in patients with significant haematuria. PATIENTS AND METHODS: Prospectively, 11 patients with BPH and haematuria (mean age 70 years) and 19 control patients with BPH alone (mean age 72 years) were identified. Neither group had received hormone manipulation or had been catheterized. The sub-urothelial compartment of the prostatic urethra in subsequent specimens from transurethral resection was examined using factor VIII/CD-34 immuno-histochemistry. The microvessel density (MVD) was calculated by counting vascular cross-sectional profiles within a 0.81-mm2 grid. The pathologist studying the specimens was unaware of the patients' symptoms. RESULTS: The median (range) MVD in the haematuria group was 64 (28-137) and in the controls was 27 (14-39) (P < 0.001). CONCLUSION: The MVD was significantly greater in the patients with haematuria, suggesting that suburothelial microvessel proliferation may play an important role in mediating haematuria associated with BPH. This is the first time that a difference has been shown at the cellular level in patients with haematuria and could form an important foundation for subsequent research.

Aged↗
PubMed2000

A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride.

PURPOSE: We prospectively studied the effect of finasteride on chronic hematuria associated with benign prostatic hyperplasia. MATERIALS AND METHODS: We prospectively evaluated 57 patients with chronic intermittent hematuria who were randomized to a finasteride treated or a control arm. RESULTS: In the untreated control group hematuria recurred in 17 patients (63%) within a year but in only 4 (14%) in the finasteride group, which was a statistically significant difference (p <0.05). Surgery was required for bleeding in 7 controls (26%), while no patient on finasteride required surgery. CONCLUSIONS: Hematuria secondary to prostatic bleeding may be significant if not treated. Finasteride appears to be effective for suppressing hematuria caused by benign prostatic hyperplasia and should be considered as treatment.

Aged↗
PubMed1998

Histological changes associated with long-term urethral stents.

OBJECTIVE: To assess the histological changes found in patients with long-term external sphincter, prostatic and urethral stents. PATIENTS AND METHODS: Eighteen patients with long-term stents (mean time since insertion 3.5 years) were investigated. Three had external sphincter stents for detrusor-sphincter dyssynergia secondary to spinal injury, eight had prostatic stents for obstruction secondary to benign prostatic hyperplasia and seven had urethral stents for recurrent strictures. Nine stents were occluded at investigation, of which seven were entirely removed. The mucosae overlying the remaining two were biopsied, as were mucosae over the nine patent stents, at urethroscopy. RESULTS: The changes observed included polypoid hyperplasia (11 of 18 patients) between and around the stent mesh wires, nonkeratinizing squamous metaplasia (two) or hyperkeratotic squamous metaplasia (seven), chronic inflammation (15) with prominent plasma cell infiltrates (11), variable foreign-body granuloma (two) and microabscess formation (five), usually associated with clefts formed around the stent wires (three of five). CONCLUSION: Stents become incorporated into the urethral wall by a process of polypoid hyperplasia through the stent mesh, with at least focal covering of the stent in most cases, and with variable inflammatory infiltrates, most of which are rich in plasma cells. The urothelial and connective tissue proliferation resulted in obstruction of the stent lumen in nine of the patients studied. Further long-term study is necessary to exclude the development of carcinoma in patients with keratinizing squamous metaplasia, although no malignancy was seen in this study.

Adult↗
PubMed1998

Bladder cancer recurrence by implantation of exfoliated cells: is gamma-linolenic acid an effective tumoricidal agent?

OBJECTIVE: To compare the tumoricidal efficacy of meglumine gamma-linolenic acid (MeGLA), mitomycin C, epirubicin and water on two urothelial cell lines, and to establish the effect of serum protein levels derived from bladder cancer resection craters on the action of these agents. MATERIALS AND METHODS: The human urothelial cell lines MGHU-1 and RT112 and their drug-resistant variants were exposed to short pulses of aqueous MeGLA, mitomycin, epirubicin and water. Both adherent and suspended cells were exposed to these agents. The MTT viable biomass assay and a clonogenic assay were used to establish tumoricidal efficacy. These experiments were then repeated to assess the effect of added serum proteins on the test results. Estimates of protein in the waste irrigation fluid from 10 patients undergoing transurethral resection of bladder tumour (TURBT) were used to select the quantity of protein used in the study, to establish the clinical relevance. RESULTS: MeGLA caused > 95% reduction in the residual viable biomass of adherent cells, compared with < 50% reduction with any other agent. Both epirubicin and mitomycin were as effective as MeGLA in preventing colony formation from suspended drug-sensitive (parental) cells. However, using multidrug-resistant (MDR) cell lines, only MeGLA prevented any colony formation, although counts were greatly reduced by mitomycin and epirubicin. Water was least effective as a tumoricidal agent on both adherent and suspended cells. On the latter, water was markedly inactivated by adding 5% serum. TURBT waste irrigation fluid was found frequently to contain such quantities of serous fluid contamination, as shown by albumin estimates in waste fluid from 10 consecutive patients undergoing this procedure. CONCLUSION: MeGLA is an effective tumoricidal agent against both parental and MDR cell lines. Its efficacy is maintained in the presence of clinically relevant serum contamination.

Antibiotics, Antineoplastic↗
PubMed1997

Balloon dilatation of the external urethral sphincter in the treatment of detrusor-sphincter dyssynergia.

Balloon dilatation of the external urethral sphincter was introduced in our unit in 1990 as an alternative to sphincterotomy in the surgical management of detrusor-sphincter dyssynergia in spinally injured patients. The initial results with the technique looked promising. We performed 14 balloon dilatations in the period 1990-1993, and these patients have been followed up for 8-68 months (mean 55.5). The procedure was effective in relieving symptoms and had a low morbidity. Sphincter activity assessed at cystoscopy was initially abolished in all patients. Vesicoureteric reflux present in one patient pre-operatively resolved after the procedure. However the long-term results are disappointing, with an 85% failure rate (62% within 1 year). Balloon dilatation in our series has a lower success rate than both sphincterotomy and sphincter stenting and cannot be recommended for the treatment of detrusor-sphincter dyssynergia.

Catheterization↗
PubMed1997

Vesico-ureteric reflux in adult patients with spinal injury.

OBJECTIVES: To review the incidence, aetiology, treatment and prognosis of vesico-ureteric reflux (VUR) in patients in a regional spinal injuries centre. PATIENTS AND METHODS: A retrospective review of radiological investigations revealed 34 of 447 (8%) patients with VUR on at least one study. The notes of these patients were examined to determine their management and outcome. RESULTS: Most patients developed VUR within 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients resolved completely and in three patients there was some improvement. Renal function deteriorated in three patients as assessed by isotopic scanning. Two patients were transferred to our unit in end-stage renal failure associated with VUR and died within one year. CONCLUSIONS: VUR continues to be a problem in patients with spinal injury and remains potentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of the combination of VUR and high intravesical pressure. No single aetiological factor for VUR was found. With active early treatment, the incidence of VUR can be minimized and long-term complications avoided.

Adolescent↗
PubMed1997

Acute suppression of idiopathic detrusor instability with magnetic stimulation of the sacral nerve roots.

OBJECTIVE: To assess the effect of magnetic stimulation of the S3 nerve root on unstable contractions in patients with idiopathic detrusor instability. PATIENTS AND METHODS: Twelve patients with idiopathic instability were studied. The S3 nerve root was localized by mapping the response of the toe flexor muscles and anal sphincter to magnetic stimulation at different sites. Unstable contractions were provoked by rapidly infusing saline into the bladder and the effect of magnetic stimulation of S3 on contractions was assessed. RESULTS: Magnetic stimulation relieved the sensation of urinary urgency and reduced the duration and amplitude of provoked contractions in all patients. Stimulation reduced the area under the pressure/time curve by 80-98%. In some patients there was a shortlived residual suppressive effect lasting up to 90 s. CONCLUSIONS: Magnetic stimulation of S3 acutely abolishes unstable contractions in patients with idiopathic detrusor instability.

Electromyography↗
PubMed1997

Use of Memokath temporary urethral stent in treatment of detrusor-sphincter dyssynergia.

In spinal-injured patients, detrusor-sphincter dyssynergia (DSD) can lead to high intravesical pressures, upper tract dilation, and recurrent infections. The standard treatment for DSD is sphincterotomy and, more recently, permanent sphincter stenting. Many spinal-injury patients would prefer a reversible treatment because of concern about fertility or because they are awaiting a "miracle cure." There is also concern over the theoretical long-term risk of squamous carcinoma after permanent stenting. In view of this, the Memokath, a thermosensitive temporary stent, has been undergoing trials at our center to determine which patients could benefit. Fourteen Memokath stents have been inserted in spinal-injured patients with DSD at our center, and they have been followed up for as long as 2 years. Stents were placed under cystoscopic guidance as a day case procedure. The stents were inserted either through the sphincter alone (short [4-cm] stents; 3 patients) or through the sphincter and bladder neck (long [5-7-cm] stents; 11 patients). There were no complications during surgery in either placement or removal of these stents. There was a significant (p < 0.001) reduction in the residual urine volume after stenting. Preoperative hydronephrosis and attacks of autonomic dysreflexia noted in some patients also resolved after stenting. Short stents that bridge the external urethral sphincter were ineffective in emptying the neuropathic bladder. Therefore, we advise that only long stents that lie across both the bladder neck and the external sphincter be used. Because of its easily reversible nature, the Memokath should be adopted for use in patients who are unsure about their preferred option of bladder management and those involved in a fertility program.

Adult↗
PubMed1996

Endoscopic treatment of vesicoureteric reflux in adults with a neuropathic bladder.

The injection of submeatal paste to treat vesicoureteric reflux is well documented in paediatric patients but there is little documentation on this treatment for adults, especially with secondary reflux. We present our experience of treatment of five adults with neuropathic bladders, consisting of eight refluxing ureters. 63% showed complete resolution of reflux and all showed improvement with no complications. The high degree of success, ease of the procedure and the lack of complications suggests that this could be the treatment of choice for adults with a neuropathic bladder and vesicoureteric reflux.

Adolescent↗
PubMed1996

Long-term outcome of permanent urethral stents in the treatment of detrusor-sphincter dyssynergia.

OBJECTIVES: To evaluate the long-term efficacy of a permanently implanted urethral stent in the treatment of spinally injured patients with detrusor-sphincter dyssynergia. PATIENTS AND METHODS: Twelve patients underwent external sphincter stenting in our institution between 1988 and 1990. They were reviewed at least annually and investigated with serial urodynamic and ultrasonographic studies. RESULTS: Ten patients were followed for at least 5 years. Two patients required stent removal and five patients developed bladder neck obstruction requiring surgical intervention. There were no problems with stent migration, ulceration or infection. CONCLUSION: Stenting is an effective alternative to sphincterotomy in the long-term, although secondary bladder neck obstruction is a frequent problem.

Adult↗
PubMed1995

Metastatic squamous cell carcinoma of the hand and review of the literature.

New cases of cancer amongst medical workers arising as a result of X-ray exposure are now rare. We record a case of a dentist who presented 11 years ago with a radiation induced squamous cell carcinoma of the ring finger of his left hand with massive axillary lymphadenopathy. Repeated exposure of his hands to diagnostic dental irradiation in his surgery had lead 16 years previously to a troublesome radiodermatitis which had been mistakenly diagnosed and had itself been treated with radiotherapy without effect. Management by amputation of the distal phalanx of the ring finger, debulking of the axillary lymphadenopathy with adjunctive radiotherapy to the axilla and chemotherapy, have been successful in achieving a prolonged disease free interval and satisfactory hand function.

Carcinoma, Squamous Cell↗