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Biomedical subjects

S S Carter

Publications and source records attributed to S S Carter.

36 records · Page 2Linked to original sources
PubMed1991

Abdominal wall tenderness: a useful sign in chronic abdominal pain.

The outcome in 72 patients with obscure abdominal pain and a positive Carnett's (abdominal wall tenderness) test, seen in one firm's surgical outpatient clinic between 1975 and 1983, was sought by a combination of hospital note retrieval and general practitioner questionnaire. Full follow-up data to date or death were available for 58 (81 per cent) patients and partial follow-up for 14 patients. The study showed that the patients generated a good deal of investigation and a number of surgical procedures but that seldom were their symptoms attributable to serious pathology. Familiarity with the test, taken in the context of a proper history and examination, has been found helpful in assessing such patients and saves the inconvenience, expense and occasional hazard of investigation, and even surgery.

Abdominal Muscles↗
PubMed1989

Radionuclide imaging of ureteric peristalsis.

Dynamic renal scintigraphy is a successful and minimally invasive technique for evaluating renal function. An extension to the basic technique involving fast-frame acquisition and a modified analysis is described which enables ureteric function to be examined. Ureteric peristalsis was assessed in 32 patients using this technique. The results from 5 representative studies are described in detail. Normally functioning ureters exhibit peristaltic contractions at a frequency of up to 3/min. Hyperperistalsis that exceeds 4 contractions/min is associated with obstruction. Peristaltic behaviour in 9 patients examined before and after ESWL was not altered.

Adult↗
PubMed1989

Pathologic basis of the sonographic appearance of the normal and malignant prostate.

The hypoechoic nature of prostatic cancer is now well recognized. In fact, not all cancers are purely hypoechoic; many are isoechoic, and some have a mixed echogenicity. Rarely, we have seen a cancer that was predominantly hyperechoic. Other signs of disturbance of the normal internal anatomy of the prostate may suggest the diagnosis of prostate cancer and are particularly valuable in assessing patients with more advanced disease. Approximately one third of early-stage cancers detected by palpation or transurethral resection are isoechoic. These tumors are anteriorly located, small, and well differentiated and infiltrate among normal glands or are composed of malignant glands similar in size to normal acini. Not all hypoechoic areas within the prostate are cancer; both normal anatomic structures and various benign conditions may appear less echogenic than the normal prostatic parenchyma. A comprehensive understanding of normal prostatic anatomy and the morphology of prostate cancer is essential to the accurate interpretation of the sonogram. Precise interpretation of prostatic sonograms requires detailed correlations of high-quality images with pathologic examinations of the whole prostate. The development of accurate criteria for the sonographic diagnosis of both malignant and benign prostatic diseases can be achieved only by such studies. As the possibilities and limitations of transrectal ultrasonography become apparent from pathologic correlation, the role of ultrasound in the diagnosis of prostate cancer will be placed on a more rational basis.

Diagnosis, Differential↗
PubMed1989

Staging of prostate cancer. Value of ultrasonography.

Clinical staging is the attempt to determine the pathologic extent of a cancer by clinical tests (Whitmore). Traditionally, staging of prostate cancer has relied on the digital rectal examination, but ultrasonography, which provides an unprecedented picture of the gland, has become a valuable adjunct. The overall sonographic pattern helps to classify a tumor as "localized" or "extensive." A more detailed analysis yields information about the volume and location of the primary tumor; the presence, location, and extent of extracapsular extension; and the presence of seminal vesicle invasion. Comparison of sonograms with corresponding sections of radical prostatectomy specimens demonstrates that ultrasound complements the digital examination in determining by clinical tests the pathologic extent of a cancer.

Humans↗
PubMed1989

Ultrasonographic changes in the normal and malignant prostate after definitive radiotherapy.

As treatments for early localized prostate cancer come under closer scrutiny, the fundamental problem of documenting the success of radiotherapy becomes more obvious. Currently, no satisfactory method exists to determine tumor viability after radiotherapy. Transrectal ultrasonography is particularly valuable for monitoring the response of prostate cancer to radiotherapy. Persistent cancer retains its hypoechoic appearance after definitive radiotherapy. Hypoechoic lesions greater than 5 mm in diameter found more than 12 months after radiotherapy should be suspected of representing persistent local disease. In our study, albeit in a selected group of patients undergoing salvage radical prostatectomy, 92 per cent of such findings were associated with what we interpreted as viable tumor by light microscopy. Ultrasound-guided biopsy should be considered in such circumstances. The persistence of hypoechoic lesions in more than 65 per cent of patients 12 to 36 months after radiotherapy also suggests that local treatment failure may be underestimated by digital rectal examination and random digitally guided biopsy. Serial measurement of the diameter of hypoechoic lesions may provide a valuable indicator of progress in an individual patient. Patients with enlarging foci of tumor within the prostate after radiotherapy might be selected for biopsy and further treatment. If such a policy is employed, it is likely that a higher incidence of persistent cancer will be found after radiotherapy than has previously been discovered by random digitally guided biopsy.

Humans↗
PubMed1989

Ultrasound-guided implantation techniques in treatment of prostate cancer.

Percutaneous ultrasound-guided interstitial radiotherapy is an attractive and elegant technique for the administration of high-dose local radiotherapy to the prostate. The complications of seed implantation are those associated with the radiation rather than with the technique of implantation. However, radiotherapy has not provided impressive local control of the disease or prolonged survival. The poor disease control was not attributed to poor seed placement, but rather to the inadequacy of 125I in controlling the cancer. The essence of nonsurgical treatment for prostate cancer is the use of effective imaging. Experience in the field of minimally invasive surgery has shown that ultrasound is the ideal imaging system for targeting treatments because of its ease of use and the absence of adverse effects. As the newer techniques of implantation come to be accepted, it is hoped that the complications of rectal and bladder radiation injury will decrease and the therapeutic benefits increase. The clinical trials required to define the precise role of each of the modalities of treatment must take nodal staging into account and must be compared with the gold standard of radical prostatectomy in the treatment of early confined disease.

Brachytherapy↗
PubMed1989

Ultrasonographic findings in prostatitis.

Transrectal prostatic ultrasound is a minimally invasive, painless investigation that provides objective data on the topography of the prostate. Prostatitis is a condition difficult to diagnose in view of its varied symptomatology and lack of physical signs. The diagnosis currently rests on the finding of excessive numbers of leukocytes in the prostatic secretion obtained during the Stamey localization procedure. Seven ultrasound features having a significant correlation with a diagnosis of prostatitis have been identified: high-density and mid-range echoes, echo-lucent zones, capsular irregularity and thickening, ejaculatory duct echoes, and periurethral-zone irregularity. Ultrasonography confirms the focal nature and frequent peripheral-zone location of inflammatory prostate disease. Follow-up ultrasound studies over a short period showed that the echo-lucent zones may resolve to normal, mid-range, or high-density echoes in conjunction with a fall in the leukocyte count in expressed prostatic secretions. The ability to place a biopsy needle accurately under ultrasound control has enabled histologic assessment of the parenchymal features. The high-density echoes represent corpora amylacea; the mid-range echoes, inflammation, fibrosis, or both; and the echo-lucent zones, inflammation. The low specificity of mid-range and high-density echoes (51.9 and 40.7 per cent) and the low sensitivity (range 30.8 to 62.3 per cent) of the remaining five ultrasound features of prostatitis preclude identification of any one feature as being diagnostic of this condition. A possible exception may be the finding of echo-lucent zones, which may also prove useful in the monitoring of response to treatment. The detection of several signs within an individual's prostate suggests a diagnosis of chronic prostatitis, whereas a normal scan in a patient with symptoms of prostatitis is highly suggestive of prostatodynia.

Adult↗
PubMed1989

Transrectal ultrasonography in disorders of the seminal vesicles and ejaculatory ducts.

Ultrasonography is an inexpensive, noninvasive, and reliable means of evaluating the integrity of the distal seminal tract. A variety of rare congenital anomalies can be demonstrated by ultrasound applied either transabdominally or by the transrectal route. Ultrasonography provides a unique insight into the function and pathology of ejaculation that may affect fertility and may well produce new diagnostic criteria to explain some of the more unusual symptoms encountered by urologists in general practice.

Constriction, Pathologic↗
PubMed1988

Suprapubic endoscopy: a percutaneous approach.

We have assessed whether suprapubic endoscopic surgery can be helpful in situations where transurethral access is inadequate, difficult or likely to be associated with urethral damage and have applied a modified version of the well known techniques for creating and dilating a track for percutaneous renal access to the bladder. This method has been used in a series of clinical cases and in certain experimental studies. Assessment of the techniques has allowed their modification and the development of a specially designed access cannula--the St Peter's Hospital cannula.

Endoscopy↗
PubMed1988

YAG laser treatment of early carcinoma of the prostate.

We describe our initial experience of a method which develops the role of endoscopic surgery in the treatment of early prostatic carcinoma. An "extended" transurethral resection of the prostate (TURP) under ultrasound control reduces the prostatic tissue to a thin residual capsule suitable for subsequent transmural coagulation by endoscopic YAG laser. Twenty patients with early disease were entered into the pilot study. Three were excluded after staging (2 T0a and 1 with positive nodes on pelvioscopy-T2 N1 M0); 17 received a full course of treatment. Mean follow-up was 6 months (range 1-14). Two early patients with excessive residual tissue had initially positive biopsies and underwent second treatments with subsequently negative biopsies. Two patients continue to have positive biopsies and the rest are negative. No tumour has progressed and complications have been minimal. One patient experienced reduced frequency of erections and 1 required bladder neck incision for symptomatic bladder neck stenosis at routine follow-up endoscopy. There were no other effects on either potency or continence.

Adult↗
PubMed1987

Tissue effects of an ultrasonic scalpel for clinical surgical use.

The effects of a new ultrasonic scalpel were studied in laboratory animals. Tissue heat conduction from the tip of the ultrasonic blade was measured. Tissue damage was assessed by light microscopy of histochemically stained sections. The ultrasonic scalpel incised nonfibrous tissue effectively, with minimal heat conduction, and the incisions healed with no evidence of fibrosis nor of tissue destruction.

Animals↗
PubMed1986

On-table lavage to achieve safe restorative rectal and emergency left colonic resection without covering colostomy.

On table orthograde colonic lavage has been used in a nearly consecutive series of 122 cases of restorative rectal resection (16 for acutely obstructing rectosigmoid lesions), and in a further 4 cases of acutely obstructing left colonic carcinoma, with the aim of both achieving safer anastomoses in these adverse circumstances and avoiding a covering colostomy. The technique was found to be safe and to be effective, only five temporary colostomies being required for management of anastomotic leakage. The incidence of clinical anastomotic leakage was 4.8 per cent.

Adult↗
PubMed1986

Complications associated with ureteroscopy.

A review of 125 ureteroscopies in 111 patients is reported. Eight per cent suffered major complications of perforation or stricture formation and 3% required ureteric reimplantation. Clinical follow-up and imaging studies performed more than a year after ureteroscopy produced no evidence that late complications arise.

Adult↗
PubMed1985

The da Silva method of incisional hernia repair.

A technique of incisional hernia repair originally devised by da Silva is described. The operation was performed on 30 patients and no recurrence was found in the 27 cases examined 1 to 4.5 (mean 2.5) years later.

Abdominal Muscles↗
PubMed1983

The indwelling ureteric stent--the Bristol experience.

Indwelling ureteric stents have been used for upper urinary tract drainage in 17 patients. The advantages over traditional methods in terms of endoscopic insertion, avoidance of external diversion and potentially lengthy periods of drainage are described. Patients requiring ureteric splintage following open procedures can also benefit from internal stenting rather than external drainage. Withdrawal is performed as a minor out-patient endoscopic procedure.

Adult↗
PubMed1981

Aortic and lower extremity arterial aneurysms.

A sonographic survey of 100 patients with suspected abdominal aortic, femoral, or popliteal arterial aneurysms was conducted over a period of 2 yr. Patients referred for suspected abdominal aortic aneurysms had a low incidence of associated lower extremity arterial aneurysms. Those patients referred for possible femoral or popliteal artery aneurysms frequently had multiple other peripheral arterial aneurysms. The authors recommend a survey scanning protocol in this subgroup with lower extremity aneurysms to rule out the presence of other aneurysms.

Adult↗