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Biomedical subjects

A D Smith

Publications and source records attributed to A D Smith.

At least 91 records · Page 5Linked to original sources
PubMed2000

Transurethral microwave thermotherapy for the treatment of prostatitis.

The lethal action of microwaves on various microorganisms is well established and has been exploited in various clinical settings. Transurethral microwave thermotherapy (TUMT) has become a recognized modality for the treatment of prostatic diseases. Recently, it has been applied for the treatment of patients with nonbacterial prostatitis unresponsive to traditional therapeutic schemes. We review the current literature and present our recent encouraging experience with the in vitro bactericidal effect of microwaves on bacteria considered possible etiologic agents of prostatitis. Thus, we may consider the application of TUMT in patients with chronic bacterial prostatitis.

Bacterial Infections↗
PubMed2000

Tissue expansion: a promising trend for reconstruction in urology.

To evaluate the role of the tissue expansion concept in reconstructive urology, the contemporary literature was reviewed, together with our own results with tissue expansion. The principle of tissue expansion has been applied in cases of bladder augmentation, ureteral dilation for the generation of indigenous tissue and subsequent ureterocystoplasties, ureteral elongation, and dilation of the renal pelvis, producing native tissue for the reconstruction of defects or strictures of the upper ureter. Even though the exact mechanism of action of mechanical strain in different tissues is not known, tissue expansion is a well-accepted technique that can amplify the armamentarium of reconstructive urologists for the management of defects along the urinary tract.

Humans↗
PubMed2000

Excision of the submandibular gland by an intraoral approach.

To improve the outcome in patients with benign diseases of the submandibular gland, we have developed an entirely intraoral technique for excision of the submandibular gland. This procedure is anatomically safe and can be performed with minimal morbidity. We believe the essential surgical steps are as follows: (1) infiltration with Xylocaine plus epinephrine with an adequate waiting period for hemostasis; (2) careful identification of the submandibular duct/lingual nerve relationship; (3) anterior retraction of the mylohyoid muscle to expose the superficial lobe; (4) superiorly directed, extraoral, manipulation of the submandibular gland; and (5) close and blunt dissection to the gland laterally to avoid injury to the facial artery and vein.

Adult↗
PubMed2000

Offence characteristics of psychotic men who sexually assault women.

Very little is known about the nature of serious sex offences against women by psychotic men. This study aimed to examine such offences by carrying out a search of Home Office records for all 80 male restricted hospital order in-patients with schizophrenia, resident in any hospital in England and Wales during May 1997, with an index conviction for a contact sex offence against a woman, committed whilst psychotic. Offences peaked in the afternoon, but were proportionally distributed according to day and month. Most (47/59%) offences occurred indoors, with over half of these in the victim's home. Assailants were strangers in 49 (61%) offences. Offences involving strangers were more likely to occur outdoors and without any preceding social interaction compared to those involving assailants known to their victims. Offenders' speech tended to be impersonal, with little attempt at intimacy. Offence sexual behaviours were: breast/genital fondling 63 (79%), vaginal intercourse 42 (52%), fellatio eight (10%), anal intercourse seven (9%), and cunnilingus six (8%). Excessive violence or bizarre behaviour occurred in a minority of offences. The findings are discussed with reference to the literature on sex offences by men without mental illness. The data do not support anecdotal or popular images that most psychotic sex attackers behave in an exceptionally violent or bizarre manner.

Adolescent↗
PubMed2000

Sources of error in comparing functional magnetic resonance imaging and invasive electrophysiological recordings.

OBJECT: Several authors have recently reported studies in which they aim to validate functional magnetic resonance (fMR) imaging against the accepted gold standard of invasive electrophysiological monitoring. The authors have conducted a similar study, and in this paper they identify and quantify two characteristics of these data that can make such a comparison problematic. METHODS: Eight patients in whom surgery for epilepsy was performed and five healthy volunteers underwent fMR imaging to localize the part of the sensorimotor cortex responsible for hand movement. In the patient group subdural electrode mats were subsequently implanted to identify eloquent regions of the brain and the epileptogenic zone. The fMR imaging data were processed to correct for motion during the study and then registered with a postimplantation computerized tomography (CT) scan on which the electrodes were visible. The motion during imaging in the two groups studied, and the deformation of the brain between the preoperative images and postoperative scans were measured. The patients who underwent epilepsy surgery moved significantly more during fMR imaging experiments than healthy volunteers performing the same motor task. This motion had a particularly increased out-of-plane component and was significantly more correlated with the stimulus than in the volunteers. This motion was especially increased when the patients were performing a task on the side affected by the lesion. The additional motion is hard to correct and substantially degrades the quality of the resulting fMR images, making it a much less reliable technique for use in these patients than in others. Also, the authors found that after electrode implantation, the brain surface can shift more than 10 mm relative to the skull compared with its preoperative location, substantially degrading the accuracy of the comparison of electrophysiological measurements made in the deformed brain and fMR studies obtained preoperatively. CONCLUSIONS: These two findings indicate that studies of this sort are currently of limited use for validating fMR imaging and should be interpreted with care. Additional image analysis research is necessary to solve the problems caused by patients' motion and brain deformation.

Cerebral Cortex↗
PubMed2000

Hypermnesia: age-related differences between young and older adults.

Hypermnesia is a net improvement in memory performance that occurs across tests in a multitest paradigm with only one study session. Our goal was to identify possible age-related differences in hypermnesic recall. We observed hypermnesia for young adults using verbal (Experiment 1) as well as pictorial (Experiment 2) material, but no hypermnesia for older adults in either experiment. We found no age-related difference in reminiscence (Experiments 1 and 2), though there was a substantial difference in intertest forgetting (Experiments 1 and 2). Older, relative to young, adults produced more forgetting, most of which occurred between Tests 1 and 2 (Experiments 1 and 2). Furthermore, older, relative to young, adults produced more intrusions. We failed to identify a relationship between intrusions and intertest forgetting. We suggest that the age-related difference in intertest forgetting may be due to less efficient reinstatement of cues at test by older adults. The present findings reveal that intertest forgetting plays a critical role in hypermnesic recall, particularly for older adults.

Adolescent↗
PubMed2000

Percutaneous management of grade II upper urinary tract transitional cell carcinoma: the long-term outcome.

PURPOSE: We report the long-term outcome of our experience with percutaneous treatment of grade II upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS: A total of 61 patients with transitional cell carcinoma of the upper urinary tract were treated percutaneously between 1984 and 1998. Of the patients 24 (39%) had grade II disease. Immediate nephroureterectomy was performed due to muscle invasive disease in 2 patients, bleeding in 1 and inability to resect the whole tumor in 1. Percutaneous resection was the actual treatment in 15 patients with stage Ta and 5 with stage T1 disease. RESULTS: Recurrence was noted in 5 patients (25%), including 3 (20%) with stage Ta tumors and 2 (40%) with stage T1 disease after a median followup of 48 months (range 9 months to 12 years). All stage Ta disease recurrences were superficial. In 1 patient with a stage T1 tumor invasive and metastatic disease developed. Disease specific survival was 95% overall, and 100% for stage Ta and 80% for stage T1 disease. No tumor seeding was detected along the percutaneous tract. CONCLUSIONS: Percutaneous surgery has proved safe and effective in treating superficial grade II upper tract transitional cell carcinoma. Offering an endoscopic approach electively to healthy individuals with a normal contralateral kidney seems viable.

Adult↗
PubMed2000

Caliceal diverticular calculi: is there a role for metabolic evaluation?

PURPOSE: We report our experience with the treatment and incidence of metabolic abnormalities in patients presenting with caliceal diverticular stones. MATERIALS AND METHODS: We retrospectively evaluated 49 patients with caliceal diverticular stones (group 1) and 44 with simple renal stones (group 2). Each group successfully underwent percutaneous treatment. Mean stone size was 1.7 and 2.5 cm. in groups 1 and 2, respectively. Metabolic evaluation was available in 25 group 1 and 22 group 2 patients. Mean followup was 73.2 and 70. 8 months, respectively. RESULTS: We achieved a stone-free rate of 95. 9% in group 1 and 100% in group 2. There was no metabolic abnormality in 75% of the group 1 patients, while 12% had type II absorptive hypercalciuria, 8% hyperuricosuric hypercalciuria and 4% hyperoxaluria. There were no metabolic abnormalities in 22.7% of the group 2 patients, while 9%, 18% and 9% had types I to III absorptive hypercalciuria, respectively, 13.6% hyperuricosuric hypercalciuria, 13.6% hyperoxaluria, 4.5% hypocitruria and 9% type II absorptive hypercalciuria associated with hypocitruria. CONCLUSIONS: Our results reveal a low incidence of associated metabolic abnormalities in patients with caliceal diverticular stones. Thus, we believe that metabolic abnormalities do not promote caliceal diverticular calculous formation.

Adolescent↗
PubMed2000

[Percutaneous treatment of calculosis in caliceal diverticulosis: 13-year experience].

We report our experience with the composition and management of caliceal diverticular stones for the past 13 years at our institution. Fourty patients with caliceal diverticular stones were treated percutaneously at Long Island Jewish Medical Center. The size of the diverticula ranged from 1 to 4.8 cm, with a mean size of 2.27 cm. The stone size ranged from 0.2 to 4.5 cm in diameter with an average of 1.7 cm. Twenty patients underwent a metabolic evaluation. Follow-up ranged from 8 months to 140 months with a mean of 72.5 months. We achieved a stone free rate of 95%. All 40 patients were free of pain and infection. The chemical composition of stones was identified in 38 patients. Twelve patients were found to have mainly calcium phosphate stones, 16 mainly calcium oxalate stones, 7 mainly uric acid stones and 3 were found with milk of calcium in their diverticulum. Thirty-five patients had complete resolution of their diverticula with normal urograms. The remaining 5 patients had at least 50% diminution of the diverticulum size. No one of the latter patients was found to have stone recurrence. Metabolic evaluation of the 40 patients showed in the 75% of the cases any metabolic abnormality, an absorptive hypercalciuria type II in two patients (10%), hyperuricosuric hypercalciuria in two cases (10%) and hyperoxaluria in one (5%). Percutaneous management of caliceal diverticular stones is a safe and effective modality compared to the existing alternative procedures reported in the literature.

Adolescent↗
PubMed2000

[Endourologic treatment of transitional cell carcinoma of the upper urinary tract].

Nephrourete-rectomy with excision of a bladder cuff has been the standard treatment of the upper urinary tract transitional cell carcinoma. The very indolent behavior (GI, II, Ta, T1) of more than 50% and up to 82% of the upper urinary tract tumors treated with nephroureterectomy in different series in conjunction with the advent of sophisticated endourological techniques have permitted in certain cases alternative treatments using a conservative approach with either ureteropyeloscopy or percutaneous access. Ureteroscopy is reserved for ureteral tumors and small, simple tumors of the renal pelvis (< 1.5 cm) while large or multiple tumors of the renal pelvis are approached in a percutaneous way. During 14 years 64 patients with transitional cell carcinoma of the upper urinary tract were treated percutaneously at our department at Long Island Jewish Medical Center, 15 (23.5%) with grade I, 26 (40.6%) with grade II and 23 (35.9%) with grade III and IV. After a mean follow-up of 51 months, percutaneously treated patients had a tumor specific survival of 85.6%, being 100% for GI tumors, 96.1% for GII and 60.8% for GIII. Recurrence of grade I tumors were observed in 20%, 26.9% for grade II and 56.5% for Grade III. In conclusion, with a rigorous follow-up transitional cell carcinoma of the upper tract with low and moderate grades (GI, GII, Ta, T1) can be treated endorologically even in the presence of a normal contralateral kidney with low morbility and a long term efficiency comparable to a nephroureterectomy. An elective endorologic management for GIII tumors is not recommended. Endoscopic conservative surgery can be offered when the criteria of good prognosis are found for Ta (such as absence of carcinoma in situ, presence of diploidy, low p53 expression and a single tumor) and in the cases of a solitary kidney or chronic renal insufficiency or for poor surgical candidates for T1. Patients with stage T2-T3 should be offered a nephroureterectomy.

Carcinoma, Transitional Cell↗
PubMed1999

Expression of interleukin-4 and interferon-gamma in the small bowel of patients with dermatitis herpetiformis and isolated gluten-sensitive enteropathy.

Although possessing a morphologically similar small bowel abnormality to patients with isolated gluten-sensitive enteropathy (GSE), patients with dermatitis herpetiformis (DH) have few gastrointestinal symptoms and exhibit blistering skin lesions and cutaneous IgA deposits. To determine whether clinical discrepancies between these gluten-sensitive conditions might be the result of different patterns of small bowel cytokine expression, duodenal biopsies were obtained from eight DH patients and nine isolated GSE patients. Biopsies were evaluated for interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) expression by reverse-transcriptase polymerase chain reaction (message) and immunohistochemistry (protein). In DH patients, most of whom had no gut symptoms, IFN-gamma mRNA expression was significantly less than in isolated GSE patients with symptomatic gut disease. Conversely, IL-4 mRNA expression in DH patients was greater than that found among isolated GSE patients. These findings suggest that the different clinical phenotypes of gluten sensitivity may be caused by variation in cytokine expression in the small bowel response to gluten.

Biopsy↗
PubMed1999

Species-dependent effects of adenosine receptor agonists on contractile responses of vas deferens to ATP.

1. Experiments were carried out to examine the postjunctional actions of adenosine receptor agonists on the smooth muscle of the vas deferens of the guinea-pig and rabbit. 2. Although they produced neither contraction nor relaxation by themselves, adenosine analogues enhanced contractions of the guinea-pig vas deferens induced by 10 microm ATP. The rank order of potency was N6-cyclopentyladenosine (CPA) > 5'-N-ethylcarboxamidoadenosine (NECA) > adenosine > CGS 21680. Dose-response curves for NECA were shifted to the right by the nonselective adenosine receptor antagonist 8(p-sulphophenyl)theophylline (8-SPT; 100 microM) and by the selective A1-receptor antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX; 1 mM). 3. In the rabbit vas deferens, contractions induced by ATP (1 mM) were inhibited rather than facilitated by NECA. Neither CPA, R(-)-N6-(2-phenyl isopropyl)-adenosine (R-PIA) nor CGS 21680 had any effect. 4. The results indicate that the smooth muscle of the guinea-pig vas deferens expresses facilitatory adenosine A1 receptors but not adenosine A2 receptors. In contrast, in rabbit there are postjunctional inhibitory adenosine A2A receptors but not adenosine A1 receptors.

Adenosine↗