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Biomedical subjects

A Y Smith

Publications and source records attributed to A Y Smith.

29 records · Page 2Linked to original sources
PubMed1990

Combined versus sequential chemo-endocrine therapy in advanced prostate cancer: final results of a randomized Southwest Oncology Group study.

Cytotoxic chemotherapy has not provided survival benefit in metastatic prostate cancer, although it has been used most frequently in patients with far-advanced, refractory disease. To evaluate the effects of chemotherapy given earlier in the course of the disease, the Southwest Oncology Group (SWOG) performed a randomized trial between September 1982 and October 1986 comparing endocrine therapy (diethylstilbestrol [DES] or orchiectomy) alone followed by cyclophosphamide-Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) chemotherapy at progression versus initial combined chemo-endocrine therapy. One hundred forty-three patients were registered, and only six were declared ineligible. Patients on the combined chemo-endocrine therapy arm had a slightly higher response rate (63%) compared with endocrine therapy alone (48%). A log-linear model of tumor response and treatment arm adjusted for the stratification factors favored the combination arm (P = .059). Only three of 27 patients on the endocrine therapy alone arm had an objective partial response when crossed over to chemotherapy, while two others had stable disease. Despite the difference in initial response rate, time to treatment failure and survival were identical in the two treatment arms. Seventy-seven percent of patients on the initial endocrine therapy alone arm have died (median survival, 25.6 months) compared with 78% on the chemo-endocrine therapy arm (median survival, 22.0 months). No significant effect of treatment on survival was observed even after adjustment for the stratification variables in a Cox regression model. Exploratory survival analyses with patients on both arms combined did show a marginally significant time to treatment failure and survival advantage for patients treated with DES rather than orchiectomy as initial endocrine therapy. Eighty-six percent of patients treated by orchiectomy have died compared with only 65% of those treated with DES. These data do not support the addition of cytotoxic chemotherapy to initial endocrine therapy in patients with metastatic prostate cancer.

Adult↗
PubMed1989

Benign conditions of the external genitalia.

Benign mass lesions of the scrotum include spermatocele, hydrocele, varicocele, sperm granuloma after vasectomy, tuberculous masses, and epididymitis. A careful history and physical examination are paramount in making the diagnosis of a scrotal mass. Referral to a urologist is indicated for masses that do not transilluminate, are solid or fixed to the testicle, or for epididymitis that does not respond to antibiotics. Hydroceles associated with significant symptoms or with hernia and varicoceles with symptoms or associated infertility are also reasons for referral. After a sexual history is obtained, lesions of the anogenital area should be carefully inspected. Male partners of women with cervical dysplasia should be examined for evidence of human papillomavirus infection. Treatment of anogenital lesions resulting from a sexually transmitted disease involves both partners.

Anus Diseases↗
PubMed1988

Urodynamic evaluation of patients with spinal stenosis.

Spinal stenosis, which may be congenital/developmental or acquired in origin, is a narrowing of the spinal canal, nerve root canals, or intervertebral foramina. Compression of the spinal cord or nerve roots may lead to structural neuronal damage, neuronal ischemia or edema, and axonal transport block. The most frequent symptom in patients with spinal stenosis is back pain and some have classic neurogenic claudication. We have performed urodynamic evaluations in 2 patients with combined cervical and lumbar spinal stenosis. A girl with achondroplastic dwarfism had urgency incontinence and detrusor hyperreflexia. An adult man with acquired degenerative spinal stenosis had difficulty voiding and findings compatible with the cauda equina syndrome.

Adult↗
PubMed1988

Short-term and long-term function of cadaveric kidneys from pediatric donors in recipients treated with cyclosporine.

Short and long-term renal function of 67 cyclosporine-prednisone (CsA-Pred)-treated recipients of pediatric cadaveric donor kidneys followed for up to 68 months (mean 16 months) were compared with 67 recipients of adult kidneys (group 3), who were demographically matched for recipient age, sex, race, cause of disease, HLA compatibility, ABO blood type, and retransplant status. Thirty-seven of the pediatric kidneys came from donors less than or equal to 10 years old (group 1) and 30 from donors 11-16 years old (group 2). Group 1 displayed impaired short-term graft function: a significantly higher mean value of the nadir serum creatinine (SCr; 2.35 versus 1.63 mg/dl), a lower maximal creatinine clearance during the first 30 days (50.3 versus 65.7 ng/dl/1.73 m2), and a longer time to achieve the nadir creatinine (22.1 versus 17.2 days). Group 1 transplants also had a higher mean nadir creatinine at 3 months and a lower mean creatinine clearance (CCl) at 3 and 6 months. By 12 months the values in the group 1 pediatric kidneys were similar to those using the group 3 adult grafts. Therefore, CsA therapy did not preclude compensatory graft function. Group 2 grafts showed intermediate short-term function relative to groups 1 and 3. Mean SCr and CCl showed progressive improvement over time, significantly better than adult kidneys at two years. Graft loss was significantly greater at two years in pediatric compared with adult grafts, but significantly better than our historical controls using azathioprine-prednisone immunosuppression.

Adolescent↗
PubMed1987

Treatment of superficial papillary transitional cell carcinoma of the ureter by vesicoureteral reflux of mitomycin C.

We report 2 cases of recurrent superficial papillary transitional cell carcinoma of the bladder with right vesicoureteral reflux in which superficial papillary transitional cell carcinoma developed in the distal ureter with reflux. Both patients received intravesical mitomycin C that was delivered by the vesicoureteral reflux to the tumor sites. Diagnosis and management were facilitated through the use of ureteroscopy, which allowed for accurate pathological staging and surveillance. No systemic toxicity or change in renal function was noted in either patient and both have remained free of recurrent tumor for more than 2 years.

Administration, Intravesical↗
PubMed1987

Primary psoas abscess.

Infectious processes in the retroperitoneal space often involve the psoas muscle. These infections usually are secondary to other intra-abdominal or intrapelvic inflammatory processes but rarely they will arise primarily within the retroperitoneum. These primary infections occur most often in younger patients and usually will demonstrate a chronic illness in which the diagnosis often is missed. We describe a 22-year-old man with a 2-year history of symptoms before the diagnosis was confirmed. The clinical presentation of the process and pathophysiology are discussed briefly.

Abscess↗
PubMed1987

Factors determining renal transplant outcome at the University of Texas at Houston.

CsA-Pred therapy yields equivalently good patient survival for LRD and 2 degrees CAD versus 1 degree CAD transplants. There is a long-term graft survival advantage for LRD versus 1 degree CAD transplants (5 years; 83% vs 58%). 2 degrees CAD transplants have inferior graft survival when compared with 1 degree CAD grafts (one year; 78% vs 67%). Multiple donor factors adversely affecting graft outcome include increased warm and cold ischemia times, pulsatile perfusion, use of pressors or diuretics in the donor, donor age less than 10 years, donor blood transfusions, and kidneys shipped from other centers. Recipient factors adversely affecting graft outcome include retransplantation and CMV infection as well as noncompliance with therapy. HLA-matching and pretransplant blood transfusions have not contributed in a statistically significant way to graft outcome although they may affect the quality of graft function at this center. Immunosuppressive therapy with CsA-Pred must be tailored to the individual patient. Continuous IV CsA infusion in the preoperative period and slow steroid taper impact favorably on graft outcome. The complications of CsA therapy include neuroectodermal toxicity, hepatotoxicity, and most importantly, nephrotoxicity. Other problems unique to CsA-Pred therapy include hypertension, delayed graft thrombosis, and de novo hemolytic uremic syndrome. Hepatotoxicity may eventuate in biliary and pancreatic complications necessitating surgical therapy. The overall incidence of infection and neoplasm remains low with CsA-Pred therapy. The use of therapeutic trough CsA level monitoring, as well as pharmacokinetic and pharmacodynamic analyses may assist in clinical decision making regarding administered doses, dosing interval, and discrimination between rejection and nephrotoxicity.

Adolescent↗