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Biomedical subjects

T S O'Brien

Publications and source records attributed to T S O'Brien.

29 records · Page 2Linked to original sources
PubMed1995

Temporary reappearance of sperm 12 months after vasectomy clearance.

OBJECTIVES: To determine the incidence of positive semen analysis 12 months after vasectomy clearance. SUBJECTS AND METHODS: A prospective study was undertaken, starting in 1990, of men undergoing vasectomy. Azoospermia was confirmed by two successive semen analyses 16 weeks after vasectomy. One year later a further sample was analysed for the presence of sperm. RESULTS: Of 1000 men who provided a sample for analysis, six men (0.6%) have had positive semen analyses 1 year after the initial tests showed azoospermia. In all six the sperm count was <10,000 per mL. Five of the six men produced a repeat sample 1 month later which, in all five cases, showed azoospermia. No pregnancies have been reported to date. CONCLUSION: Transitory reappearance of sperm following successful vasectomy occurs in about 0.6% of men. This incidence is 18 times greater than the reported pregnancy rate following successful vasectomy.

Humans↗
PubMed1995

Efficiency in the outpatient department: the lessons from urology.

To determine the scope for improvements in efficiency in the outpatient management of urological patients, a retrospective analysis was undertaken of outpatient records from one consultant's practice in a regional teaching hospital. Two hundred consecutive patients referred between March and May 1992 were studied for 1 year after referral. Each outpatient visit was judged to be unavoidable or potentially avoidable. Of referrals, 72% were in one of four diagnostic categories (bladder outflow obstruction; haematuria; scrotal disorders; frequency/dysuria syndromes). Of these patients, 90% were seen only once or twice for each episode of illness. Of the visits, 150/347 (42%) were potentially avoidable. Patients with suspected bladder outflow obstruction, haematuria and scrotal disorders should undergo imaging of the relevant anatomy before referral. Patients with haematuria should be referred directly for a flexible cystoscopy after imaging. Urologists need to educate general practitioners more clearly about the indications for the treatment of scrotal swellings in elderly men and mild bladder outflow obstruction in middle-aged men. Patients need not be reviewed routinely after transurethral resection of the prostate for benign prostatic hypertrophy or after investigations for haematuria have revealed no serious abnormality.

Efficiency, Organizational↗
PubMed1993

Calf vessel preservation in peripheral vascular disease--angiography versus pulse generated run-off.

Previous angiographic and radiological studies have suggested that the peroneal artery is the best preserved of the calf vessels in peripheral vascular disease and should be a site of preference for a femorodistal bypass graft. Calf vessel run-off assessed by pulse generated run-off (PGR) provides a more accurate prediction of graft success or failure than angiography and may therefore give a better functional picture of vessel patency than angiography. This study compares the presence and degree of preservation of the three calf vessels in patients with severe peripheral vascular disease using both intra-arterial digital subtraction angiography (IADSA) and PGR. Thirty-four limbs in patients with either ischaemic rest pain, ulceration or gangrene were studied and the results were scored according to the extent and severity of disease in the peroneal, posterior tibial and anterior tibial arteries. On IADSA, the peroneal artery was patent significantly more often (79%) than the posterior tibial artery (47%) or the anterior tibial artery (38%). Conversely, PGR examination showed no difference in patency between the three vessels (peroneal 91%, posterior tibial 88%, anterior tibial 79%). The peroneal artery was also significantly better preserved on IADSA (65%) compared to the posterior tibial artery (38%) and the anterior tibial artery (23%). PGR studies again showed no difference in the best preserved vessel between peroneal (47%), posterior tibial (50%) and anterior tibial (50%) arteries. Thus, the peroneal artery appears the better preserved vessel on angiography but this appearance may be misleading because the more functional PGR studies show no significant difference in the patency or degree of preservation of the three calf vessels.

Angiography, Digital Subtraction↗
PubMed1993

Lower limb ischaemia in the octogenarian: is limb salvage surgery worthwhile?

Vascular surgeons are being asked to manage vascular disease in an increasingly elderly population, and advanced age may be considered a relative contraindication to limb salvage surgery with an amputation seeming the preferred option. We present a review of 50 patients over the age of 80 years, presenting with ischaemic rest pain, ulceration or gangrene of the lower extremity. Six patients were treated conservatively, four of whom died during the same admission. Only two patients proved suitable for transluminal angioplasty as the sole curative procedure. Twelve patients (24%) underwent primary amputation with a perioperative mortality of 3/12 (25%). Five patients (10%) had an iliac bypass procedure, and 25 patients (50%) were considered suitable for infrainguinal bypass. Of the latter group 14 had femoropopliteal bypasses, and 11 had femorodistal bypasses with an overall perioperative mortality of 3/25 (12%). Mortality at 6 months was high (33%) and was similar in both the grafted and amputation groups. Patients having reconstruction fared well in terms of independent mobility, use of long-term care, and length of hospital stay. Patients over 80 years of age with critical ischaemia should not be denied the opportunity of vascular reconstruction.

Age Factors↗
PubMed1990

Loss of true blue labelling from the medial septum following transection of the fimbria-fornix: evidence for the death of cholinergic and non-cholinergic neurons.

Many neurons in the medial septal nucleus lose their transmitter-associated enzyme staining following axotomy in the proximal fimbria-fornix (FF), but it is not clear if these neurons have died or persist in a shrunken and subfunctional state. To investigate this further, septal neurons projecting through the FF were labelled with the fluorescent dye, True blue, by retrograde transport from multiple bilateral injection sites in the hippocampus. True blue-labelled neurons and cholinergic neurons immunohistochemically stained for choline acetyltransferase (ChAT) were then quantitatively compared in neighbouring sections through the medial septum 28 days after complete unilateral transections of the proximal FF. The number of True blue and ChAT positive cells ipsilateral to the FF lesion showed significant (P less than 0.001) declines of 51.4% and 71.1%, respectively, relative to the unlesioned side. Cell loss was considerably more severe among large neurons, such that 78.0% and 92.7% of True blue and ChAT labelled cells larger than the normal mean, but only 40.1% and 68.0% of True blue and ChAT labelled cells smaller than the normal mean size were lost. This indicates either that larger neurons were more prone to cell loss, or that some (but not all) large neurons persisted in a shrunken form. Histograms showed no increase in cell number in any of the smaller size categories and a substantial decrease in most cases, indicating that shrinkage alone could not account for the loss of all large neurons. Since True blue can remain present in brainstem cholinergic neurons surviving for over 365 days after axotomy, loss of True blue suggests breakdown of membrane integrity and cell death.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Nerve growth factor receptor immunoreactivity in the rat suprachiasmatic nucleus.

Using a monoclonal antibody, nerve growth factor receptor has been immunohistochemically identified within the suprachiasmatic nucleus of adult rats. Labelling was most intense in the ventral, lateral and caudal portions of the nucleus and appeared primarily associated with fibers and terminals. These were among the most intensely labelled fibers and terminals in the forebrain.

Animals↗
PubMedDate not supplied

Fluorescence diagnosis of bladder cancer.

Standard management of newly presenting superficial bladder tumours is to remove the tumour endoscopically and to administer a single dose of a chemotherapeutic agent into the bladder postoperatively. However, between 20-40% of patients will develop a tumour in the bladder again within 12 months (Herr, 1997). There is controversy about whether these tumours are genuine recurrences or previously undetected tumours. Photodynamic diagnosis is currently the subject of clinical trials for detection and surveillance of bladder cancer. A solution is administered into the bladder preoperatively which is absorbed by the cancer cells. These areas within the bladder then fluoresce under blue light, aiding the surgeon to detect tumours that may not have been visible to the naked eye. The authors present a review of this developing technique and their early experiences of photodynamic diagnosis in clinical trials which appear to be clinically relevant in decreasing recurrent bladder tumours.

Aminolevulinic Acid↗
PubMedDate not supplied

Primary pneumococcal peritonitis.

Primary pneumococcal peritonitis is an uncommon condition which in the preantibiotic era was associated with a high mortality rate. We present two cases and discuss the aetiology, clinical features and management of this condition.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging in congenital dysplasia of the hip.

This study was designed to determine the usefulness of magnetic resonance imaging (MRI) in managing congenital hip dysplasia and dislocation. We compared various hip parameters using bony and cartilaginous landmarks. MRI determined that the bony acetabular index (AI) accurately reflects the cartilaginous AI. Bony acetabular indices greater than 30 degrees indicated hip dysplasia, subluxation, or dislocation. MRI demonstrates qualitative information not available on plain films; however, it does not provide further quantitative data, so we do not recommend its routine use in the evaluation of congenital hip dysplasia. The true benefit of MRI may be its ability to identify a group of patients with bone dysplasia but normal cartilaginous growth potential.

Child↗