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Biomedical subjects

S K Wilson

Publications and source records attributed to S K Wilson.

At least 19 recordsLinked to original sources
PubMed2005

Ectopic placement of AMS 800 urinary control system pressure-regulating balloon.

OBJECTIVES: The AMS 800 sphincter urinary control system (artificial urinary sphincter) is frequently placed in patients with scarred retroperitoneal spaces. Placement of the pressure-regulating balloon (PRB) requires a second abdominal incision in the traditional perineal surgical technique. In the new transverse scrotal incision method of sphincter placement, the transversalis fascia is pierced to place the PRB in the space of Retzius. We present a novel technique of ectopic PRB placement requiring neither a second incision nor piercing the fascia. TECHNICAL CONSIDERATIONS: Nineteen patients underwent ectopic PRB placement during artificial urinary sphincter placement. Most patients (n = 17) were incontinent after radical prostatectomy, two were incontinent after transurethral resection of the prostate. Cuff placement was through a scrotal (n = 10) or perineal (n = 9) incision. In all patients, the incision was displaced toward either inguinal ring. A finger was passed through the ring forcibly cephalad and a space developed anterior to the transversalis fascia but beneath the abdominal muscles. The PRB was passed into this space. CONCLUSIONS: The results of our study have shown that ectopic placement is easier and quicker. The PRB is usually not palpable. Two PRB hernias into the upper scrotum were noted after vigorous coughing. Two patients developed urethral atrophy under the cuff at 3 and 5.5 years. No erosions, infections, or mechanical failures were noted. Early outcomes with ectopic PRB placement seemed similar to that of traditional locations.

Atrophy↗
PubMed2002

Management of Peyronie's disease with penile prostheses.

Peyronie's disease is a common malady affecting men mostly between the ages of 40 and 60. When penile curvature and erectile softening are present and the erectile dysfunction does not respond to Viagra a penile implant will strengthen and usually straighten the penis. If curvature persists after implant placement 'modeling' the erect penis will successfully achieve straightening in most patients. Plaque incision and grafting or a Nesbit procedure are rarely necessary to straighten the penis but will afford excellent results when employed. A thorough explanation of the pathogenesis of Peyronie's disease and effects of the disease and treatment on penile size will help avoid some of the disappointment seen when a shorter erection occurs.

Humans↗
PubMed2001

Reservoir herniation as a complication of three-piece penile prosthesis insertion.

OBJECTIVES: To obtain data concerning the incidence and management of reservoir herniation in inflatable penile prosthesis surgery in a clinical investigation. Reservoir herniation after scrotal placement of inflatable penile prosthesis is an unusual complication, and a review of the published medical reports reveals only anecdotal reports and no definitive articles. METHODS: A multi-item self-addressed questionnaire was mailed to the members of the Society for the Study of Impotence questioning the occurrence of reservoir migration from the prevesical space to the inguinal canal or scrotum. In addition, the database of one of us was reviewed to determine the incidence of reservoir migration in a large series of 1206 three-piece penile prostheses. RESULTS: The response rate was 38%. A minority of respondents (28%) were familiar with the problem. Of those who had experienced this complication, the occurrence was very rare and usually appeared in the immediate postoperative period, often in association with vigorous coughing spells or vomiting. The responders also indicated that imperfect surgical technique might have been implicated in some cases. Management usually consisted of reservoir replacement or repositioning through an inguinal incision with repair of the defect. Alternatively, several surgeons used the existing scrotal incision if the patient presented in the immediate postoperative period. The incidence of reservoir herniation was 0.7%. CONCLUSIONS: Reservoir herniation is a rare complication of inflatable penile prosthesis surgery that occurs almost exclusively in penoscrotally placed prostheses. Familiarity with various approaches to the management of this complication is clinically useful to urologists performing penile prosthesis surgery.

Foreign-Body Migration↗
PubMed2001

High-level expression of a synthetic red-shifted GFP coding region incorporated into transgenic chloroplasts.

We describe here a synthetic red-shifted variant of GFP that can be introduced into tobacco plastid genomes and is highly expressed in regenerated plants that appear normal and fertile. The variant contains the S65G and S72A mutations which shift the absorption maximum from the 395 nm of wild-type GFP closer to 488 nm, a wavelength emitted by a laser commonly used in confocal microscopy. In addition to enhanced fluorescence, the removal of significant absorption below 450 nm will potentially facilitate double-labelling experiments. The variant GFP encoded by the synthetic gene can be expressed at a high level, forming approximately 5% of total leaf protein.

Amino Acid Sequence↗
PubMed2001

Long-term outcomes of inflatable penile implants: reliability, patient satisfaction and complication management.

Despite the revolutionary introduction of oral erectogenic agents for the treatment of erectile dysfunction, there will always be patients who do not respond to conservative therapy. Penile prosthetic surgery remains an important option for these patients. Mechanical reliability and patient satisfaction have improved significantly throughout the years. This review focuses on the most recent and important updates regarding product enhancements, patient satisfaction studies, and management of intra- and postoperative problems.

Erectile Dysfunction↗
PubMed2001

Neonatal thermal care, part I: Survey of temperature probe practices.

PURPOSE: To determine nurses' practices regarding skin temperature probes. DESIGN: Data were collected using an anonymous questionnaire, which was returned by mail. Questionnaires were distributed by volunteer neonatal nurses. Items included frequency of probe change, position of probe, use of probes in skin and air servocontrolled incubators and radiant warmers, as well as demographic data. SAMPLE: Eighty-three neonatal nurses. RESULTS: Nurses reported that skin servocontrolled incubators are used widely, but generally only for infants less than 28 weeks gestational age; a high proportion of respondents reported using continuous monitoring of skin temperature in air servocontrol incubators. Although most nurses reported positioning infants to prevent their lying on the probe, 21 percent reported using the same probe site regardless of infant position. Routine changing of the probe cover was reported by a number of nurses. Practices were influenced by individual knowledge, beliefs, and experience as well as by unit protocols, which varied widely.

Attitude of Health Personnel↗
PubMed2001

Neonatal thermal care, part II: Microbial growth under temperature probe covers.

PURPOSE: To determine if temperature probe covers contribute to nosocomial infections by providing an environment for skin microbe colonization. DESIGN: Descriptive, comparative design with infants randomized into two groups: foam probe cover and hydrogel probe cover. Skin cultures were obtained 72 hours after cover placement. Bacterial growth was quantified after 24 and 48 hours. Skin integrity was assessed using visual irritations scores (VIS) every 5 minutes for 30 minutes following cover removal. ANOVA and ANOVA-RM were used to compare amounts of microbes and VIS scores between groups. SAMPLE: Twenty-six medically stable infants, 29 to 34 weeks gestational age, less than 10 days postbirth, and in an incubator. MAIN OUTCOME VARIABLE: Microbial growth and VIS. RESULTS: There were no statistically significant differences in microbial growth and VIS scores between groups (p > .05). Clinical significance was noted in VIS scores. Infants who had foam covers had more sustained irritation scores.

Analysis of Variance↗
PubMed2001

Neonatal thermal care, part III: The effect of infant position and temperature probe placement.

PURPOSE: Accurate management of infant temperature requires appropriate placement of temperature monitoring probes. Currently, there is a lack of consensus regarding placement of skin temperature probes and the effect on temperature monitoring of the infant's lying on the probe. The objective of this study was to compare abdomen and back skin temperatures when infants were positioned supine and prone. DESIGN: A quasi-experimental design was used to randomize infants to prone or supine position. Infant back, abdomen, and axillary temperatures were measured at one-minute intervals with small disposable thermocouples over a one-hour period. SAMPLE: Twenty-three infants, weight 820-2,400 gm, gestational age 27-37 weeks, postnatal age three to ten days. MAIN OUTCOME VARIABLE: Gradient between abdomen and back temperature. RESULTS: Both mean abdomen and mean back temperatures differed significantly by position (t-test, p = .003 and .028, respectively). Weight and postnatal age did not have an effect on the mean difference between abdomen and back temperature. Results indicate that probe placement and infant positioning are important factors altering measurement of skin temperature.

Abdomen↗
PubMed2001

Long-term followup of treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis.

PURPOSE: We originally reported inflatable penile implants used to treat impotence in patients with Peyronie's disease in 1993. We now present a historical prospective study of 104 patients in whom the modeling procedure was used to correct Peyronie's curvature after implantation with the Mentor Alpha 1dagger and AMS 700CXdouble dagger penile prostheses. We compared revision-free survival experience of these implants with 905 similar implants in men with nonPeyronie's disease. MATERIALS AND METHODS: The reasons for revision were classified as mechanical failure, patient dissatisfaction, infection and medical causes, including reoperation for straightening. Overall and cause specific revision-free survival in the 2 study cohorts was compared. Maximum followup was more than 12 years and average followup was more than 5. RESULTS: No significant difference in device survival was observed in the 2 study cohorts in 5 years. Similarly each prosthesis provided the same permanent straightening without the need for revision. In Peyronie's disease cases mechanical survival of the Mentor Alpha 1 was superior to that of the AMS 700CX (p = 0.0270). There was no significant difference in mechanical reliability of the devices in nonPeyronie's disease cases. CONCLUSIONS: Implantation and modeling appear to provide permanent straightening without an increase in revisions. In the nonmodeled group there was no significant difference in mechanical reliability of the AMS 700CX or Mentor Alpha 1. In modeled cases the Mentor Alpha 1 appeared less likely to fail mechanically than the AMS 700CX when followed more than 5 years. Based on this single series modeling may predispose the AMS 700CX to earlier mechanical failure.

Adult↗
PubMed2001

Treating symptoms of female sexual arousal disorder with the Eros-Clitoral Therapy Device.

OBJECTIVE: The aim of this study was to determine the effect of the Eros-Clitoral Therapy Device (Eros-CTD) on the sexual function of women with and without symptoms of female sexual arousal disorder (FSAD). DESIGN: Periodic survey of sexual function in women using the Eros-CTD over a six-week period. SUBJECTS: A total of 19 women participated in the study--10 with symptoms of FSAD and nine without symptoms of FSAD--ranging in age from 28 to 65 years, with a mean age of 45.2 years. METHODS: Ten patients with symptoms of FSAD and 10 without symptoms were instructed in the use of the small, portable vacuum device, Eros-CTD. One woman without symptoms of FSAD withdrew early in the study for personal reasons. The patients were instructed in the correct use of the device and were asked to complete one Female Intervention Efficacy Index (FIEI) each week. The patients also kept diaries of their use of the device, noting the frequency, length, and strength of vacuum. RESULTS: There was a significant improvement in all symptoms of FSAD (P < .05), including increased sensation, improved vaginal lubrication, enhanced ability to orgasm, and greater overall satisfaction. Patients without FSAD also reported similar changes in sensation, lubrication, ability to orgasm, and overall satisfaction. LIMITATIONS: This study was done on a small sample of self-selected patients, was of limited duration, and had no long-term follow-up. All of these factors should be considered in interpreting the data. CONCLUSION: The Eros-CTD was safe and effective in improving symptoms of FSAD in this group of women. Further studies on the efficacy of the Eros-CTD are indicated.

Adult↗
PubMed2000

Historical advances in penile prostheses.

In the 25 y since their introduction, semi-rigid and inflatable penile implants have become remarkably dependable mechanical instruments associated with high patient satisfaction. This report attempts to quantify the historical milestones of significance pertaining to these devices. As with any historical 'best of ' list, there will be controversy and omissions. Three broad topics contributing to the advancement of penile prosthetic surgery, devices and techniques are discussed: (1) Prosthetic design changes contributing to freedom from revision: distention controlled cylinders, Bioflex cylinders, connectionless systems and reservoir lockout valves; (2) Instrument innovations to facilitate prosthetic surgery: Scott retractor, Furlow inserter, Brooks dilators, Carrion-Rossello cavernotomes; (3) Clever surgical applications: SST repair, transverse scrotal incision, modeling for Peyronie's disease, salvage for infection and natural tissue repair. International Journal of Impotence Research (2000) 12, Suppl 4, S101-S107.

Erectile Dysfunction↗
PubMed1999

Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome.

PURPOSE: Implantation of penile prosthetic cylinders into scarred corpora remains a challenge in the field of prosthetic urology. We describe a new penile cavernotome, which allows for easier dilation of fibrotic corpora cavernosa and facilitates inflatable penile prosthesis cylinder insertion. MATERIALS AND METHODS: A set of 5 cavernotomes between 6 and 13 mm. in diameter are used to drill a space in fibrotic corpora with controlled 1 mm. cuts. The cavernotomes are advanced in an oscillating fashion and also allow shaving of severely stenotic areas for easier cavity development. They were used in 16 patients with fibrotic corpora secondary to different etiologies. A high transverse scrotal incision was used in all cases. Of the 16 patients 14 received downsized cylinders. RESULTS: Implantation of both cylinders of an inflatable 3-piece device was successful in all cases. Proximal crural perforation occurred intraoperatively in 5 patients and was corrected by attaching the rear tip extender to the tunica with nonabsorbable suture. Postoperatively, distal tunical perforation of the corpora in 4 patients was repaired with natural tissue. Operative time was reduced compared to our previous experience with implantation in cases of corporeal fibrosis using extensive corporotomies or the Carrion-Rossello cavernotomes. In no case was the procedure terminated for urethral laceration or inadequate dilation for cylinder insertion. No grafting materials were necessary to close the corporotomy. CONCLUSIONS: The new cavernotomes along with the high transverse scrotal incision and downsized prostheses resulted in successful implantation in all of our cases. Dilation of fibrotic corpora was easier and quicker with the new cavernotomes because extensive corporeal resection was not necessary. Complications were acceptable for these difficult cases and prosthesis survival is 100% to date.

Equipment Design↗
PubMed1999

Comparison of mechanical reliability of original and enhanced Mentor Alpha I penile prosthesis.

PURPOSE: We report the results of a prospective study of 1,381 Mentor Alpha I penile prostheses implanted to treat impotence, and compare original and enhanced penile prosthesis mechanical reliability. MATERIALS AND METHODS: The study consisted of 410 original models manufactured before November 1992 and 971 enhanced models manufactured since December 1992. Implants were further stratified as first time (virgin) or replacements of a previous implant. Mechanical failure-free survival rates for the original prosthetic and enhanced models were compared. RESULTS: The 5-year survival rate increased from 75.3% for the original to 92.6% for the enhanced model overall (log rank p<0.0001), and from 75.3 to 93.6%, respectively, for the virgin implants only (log rank p<0.0001). The estimated failure rate of approximately 5.6% for the original model was fairly consistent during followup, while the significantly lower failure rate of 1.3% for the enhanced model was not. The failure rate of the enhanced model implants was about 0.8% per year during the first 3.5 years and increased to approximately 3.1% per year thereafter. CONCLUSIONS: Our results strongly support the premise that mechanical reliability is superior with the enhanced compared to the original model.

Adult↗
PubMed1998

Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin.

PURPOSE: Elevation of glycosylated hemoglobin above levels of 11.5 mg.% has been considered a contraindication to penile prosthesis implantation in diabetic patients. We determine the predictive value of glycosylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion. MATERIALS AND METHODS: We conducted a 2-year prospective study of 389 patients, including 114 diabetics, who underwent 3-piece penile prosthesis implantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C level. Risk of infection was statistically analyzed for diabetics versus nondiabetics, glycosylated hemoglobin A1C values above and below 11.5 mg.%, insulin dependent versus oral medication diabetics, and fasting blood sugars above and below 180 mg.%. RESULTS: Prosthesis infections developed in 10 diabetics (8.7%) and 11 nondiabetics (4.0%). No increased infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increased infection risk with increased levels of glycosylated hemoglobin A1C among all patients or among only the diabetics. In fact, there was no meaningful difference in the median or mean level of glycosylated hemoglobin A1C in the infected and noninfected patients regardless of diabetes. CONCLUSIONS: Use of glycosylated hemoglobin A1C values to identify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin dependence also does not increase risk of infection in diabetics undergoing prosthesis implantation.

Diabetes Complications↗
PubMed1998

Death following minor head trauma in two adult individuals with the Chiari I deformity.

Reports of sudden death associated with minor head trauma in adults with the Chiari I malformation are rare. We describe two such cases, occurring in a 71-year-old individual and in a 22-year-old individual. In both cases, postmortem examination revealed prominent cerebellar tonsillar herniation and, in one, associated tonsillar sclerosis and hydrocephalus. Evidence of trauma was minimal in both, and was not sufficient to explain these fatalities. We describe the neuropathologic findings and discuss the differential diagnostic considerations in these cases of sudden death. The implications regarding manner of death are also emphasized.

Adult↗
PubMed1997

Multiple maltreatment experiences and adolescent behavior problems: adolescents' perspectives.

By adolescence, appraisal of one's past life experience becomes critical to the stage-salient issue of identity formation. This study examined adolescents' perceptions of their maltreatment experiences. It scrutinized the combined and unique contribution of five maltreatment types (i.e., physical abuse, sexual abuse, psychological abuse, neglect, and exposure to family violence) to variance in adolescent adjustment. It was predicted that these maltreatment types would account for significant variance in adjustment when controlling for the context variables of age, sex, socioeconomic status, IQ, and stressful life events. Adolescents (N = 160, aged 11-17) were randomly selected from the open caseload of a child protection agency. Participants completed global severity ratings regarding their experiences of the five types of maltreatment, as well as a battery of measures assessing self- and caretaker-reported externalizing and internalizing symptomatology. The youths' maltreatment ratings significantly predicted self-reported adjustment, even when controlling for all context variables. Psychological maltreatment was the most predictively potent maltreatment type, and enhanced the predictive utility of other maltreatment types. Significant sex differences in the sequelae of perceived maltreatment were evident. Also, interactions between youths' ratings and those obtained from CPS files were detected. The findings were consistent with recent research in child maltreatment, and contribute to our understanding of developmental psychopathology among adolescents.

Adolescent↗
PubMed1996

Ultrex cylinders: problems with uncontrolled lengthening (the S-shaped deformity).

PURPOSE: We investigated whether the AMS Ultrex cylinder, developed to provide cylinder lengthening while controlling girth expansion, acted as a tissue expander and, thus, promoted penile lengthening. MATERIALS AND METHODS: Between December 1990 and January 1992, 59 AMS Ultrex prostheses were implanted. Cylinder length corresponded to intracorporeal measurements. The results of lengthening and occurrence of an S-shaped deformity were statistically analyzed. RESULTS: No penile lengthening occurred. In 19 patients (32%) cylinder replacement was required for the S-shaped deformity. CONCLUSIONS: Ultrex cylinders should be downsized and prolonged inflation should be avoided. They should not be implanted in cases of Peyronie's disease, or to replace malleable or self-contained inflatable implants.

Erectile Dysfunction↗