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Biomedical subjects

F J Allen

Publications and source records attributed to F J Allen.

At least 19 recordsLinked to original sources
PubMed1999

Influence of local tumour stage and grade on reliability of serum prostate-specific antigen in predicting skeletal metastases in patients with adenocarcinoma of the prostate.

OBJECTIVE: To determine whether serum prostate-specific antigen (PSA) can be reliably used to predict the absence or presence of skeletal metastases on the bone scan in patients with adenocarcinoma of the prostate. METHODS: We studied 450 consecutive men presenting with adenocarcinoma of the prostate between 1991 and 1995. Serum PSA was measured by the Hybritech Tandem-R monoclonal immunoradiometric assay and bone scanning was performed with 99m-technetium-labelled methylene diphosphonate. In total, 46 patients were excluded for one or more of the following reasons: serum PSA not available; radionuclide bone scan inconclusive; histology of the prostate other than adenocarcinoma; hormonal or other therapy given prior to obtaining the serum PSA and/or bone scan. RESULTS: Of the 404 patients included, 43% had poorly differentiated (grade 3), 74% had locally advanced (stages T3-4) tumours and 50% had skeletal metastases. The mean and median serum PSA were 348 and 52 ng/ml, respectively, and 77% of the patients had a serum PSA >20 ng/ml. The negative predictive value (for the absence of metastases on bone scan) of a serum PSA <20 ng/ml was 87% for the whole group of patients, 92, 94 and 70% for grade 1, 2 and 3 tumours, and 95, 83 and 50% for stage T1-2, T3 and T4 tumours, respectively. The positive predictive value (for the presence of metastases on bone scan) of a serum PSA >100 ng/ml was 80% for the whole group of patients. CONCLUSIONS: In patients presenting with adenocarcinoma of the prostate, serum PSA alone is not sufficiently reliable to predict the absence or presence of metastases on the radionuclide bone scan. In patients with grade 3 and clinical stage T3-4 tumours, a bone scan should be obtained for accurate staging, regardless of the serum PSA value.

Adenocarcinoma↗
PubMed1997

Carcinoma of the penis--appraisal of a modified tumour-staging system.

OBJECTIVE: To evaluate variables for the prediction of lymph node metastases in carcinoma of the penis, using a recently proposed modified tumour-staging system that combines the histological degree of differentiation and extent of local invasion of the primary tumour. PATIENTS AND METHODS: Thirty-five patients with squamous carcinoma of the penis and histo- or cytological staging of the inguinal lymph nodes were reviewed. A clinical TNM staging system was used in which the size (diameter) of the primary tumour and the clinical extent of invasion were considered. Subsequently, the tumours were also staged according to a modified T-system in which the histological degree of differentiation and pathological extent of tumour invasion were combined. RESULTS: Penectomy was performed in 34 patients (partial amputation in 20 and radical penectomy in 17). Inguinal lymphadenectomy was performed in 31 patients and in four the presence of lymph node metastases was confirmed by aspiration cytology. Using the clinical TNM staging system, lymph node metastases were histo- or cytologically present in no patients with T1, in five of 19 with T2, in 10 of 13 with T3 and in both patients with T4 tumours. Lymph node metastases were present in two of eight patients without clinically palpable inguinal nodes, in three of 14 with nodes clinically thought to be infective and in 11 of 12 nodes clinically considered to be malignant. Lymph node metastases were present in five of 17 patients with grade 1, in nine of 13 with grade 2 and in three of five with grade 3 tumours. Using the modified histological T-staging system (T1 = grade 1-2, invasive through dermis; T2 = any grade, invasion of corpus spongiosum or cavernosum; T3 = any grade, invasion of urethra; T4 = grade 3, regardless of invasion) lymph node metastases were present in one of nine patients with T1, in eight of 16 with T2, in all five with T3 and in three of five with T4 tumours. CONCLUSION: The modified T-staging system, which combines histological differentiation with pathological extent of invasion, provided the best predictive distinction between T1 and T2-4 tumours, indicating that lymphadenectomy can be avoided in T1 tumours, but should be performed in all patients with T2-4 tumours. We recommend bilateral inguinal lymphadenectomy 6-8 weeks after penectomy in such patients.

Adult↗
PubMed1997

Cancer of the penis--a review of 50 patients.

We reviewed the management of 50 patients with cancer of the penis treated between November 1983 and April 1995 at Tygerberg Hospital. The mean patient age was 54 years. The race of the patient was mixed in 40, white in 8 and black in 2 cases. Serological tests were positive for syphilis in 8/18 (44%), and for human immunodeficiency virus (HIV) in 2/11 patients (18%) who were tested. Only 1 patient had been circumcised (at puberty). Penectomy was performed in 45 patients--partial amputation in 29 cases and radical penectomy in 20 (in 4 of these after previous partial penectomy with positive margins). Complications of penectomy occurred in 9 patients (20%). The histology of the primary lesion was squamous carcinoma in 46, verrucous carcinoma in 3 and melanoma in 1 patient. Differentiation of the tumour was good in 24, moderate in 15 and poor in 8; the grade was not recorded in 3 cases. The pathological T stage was Tis in 1 patient, T1 in 5, T2 in 24, T3 in 17 and T4 in 3 cases. Inguinal lymphadenectomy was performed in 34 patients at a median interval of 72 days after penectomy. Complications after lymphadenectomy occurred in 26 of the 34 patients (76%), but a second operation was required in only 5 cases (15%). In patients without clinically palpable inguinal nodes, cancer was present in 2/8 (25%) specimens. In patients with clinically palpable inguinal nodes, metastases were present in 16/29 (55%)--in 4/16 (25%) of nodes clinically thought to be infective, and in 12/13 (92%) of nodes considered to be malignant. Lymph node metastases were present in 0/2 patients with T1, in 5/19 (26%) with T2, in 12/15 (80%) with T3 and in 3/3 (100%) with T4 tumours. At a mean follow-up of 22 months in 39 patients 62% were alive without evidence of disease, 23% were alive with carcinoma and 15% were dead. Death and recurrence or metastases were significantly more common in patients with T3-4 compared with T1-2 tumours, and in those with N1-3 compared to NO disease, but tumour grade had no significant effect on outcome. Death and recurrence or metastases were also more common in cases where the surgical margin at penectomy was involved with tumour. In conclusion, our patients presented at a relatively young age with locally advanced tumours and a high incidence of inguinal lymph node metastases. In patients with locally advanced tumours we recommend ablative surgery with bilateral inguinal lymphadenectomy 6-8 weeks after penectomy. We avoid pelvic lymph node dissection, since this does not improve the prognosis, while increasing the risk of complications, especially lower limb oedema.

Adult↗
PubMed1996

Oral surgery at St. Mary's Hospital, Chapelizod. A quarter century experience of day-case oral surgery.

To mark the first quarter century of the existence of the Oral Surgery unit at St. Mary's Hospital, Chapelizod, an audit was undertaken. Twenty-nine thousand, three hundred and seventy-four (29,374) entries in the operations register were analysed, examining annual totals, categories of operation, the changing patterns of anaesthesia, including cancellations on the day, and the evolution of a true day-case service. The results showed a decline in total numbers and in some operation categories. The most striking reductions were in extractions of carious teeth and in preprosthetic surgery. The most marked increase was in surgery for impacted teeth. While general anaesthesia remains the most commonly used form of anaesthesia, there has been an increased utilisation of sedation. Since the earlier years the number of patients requiring admission post-operatively has steadily decreased but more patients have been cancelled on the day of operation. Most of the changes described reflect the influence of health care economics and the effects of fluoridation.

Ambulatory Surgical Procedures↗
PubMed1995

Are neuroendocrine cells of practical value as an independent prognostic parameter in prostate cancer?

OBJECTIVE: To assess whether the presence of neuroendocrine (NE) cells is of value as an independent indicator of poor prognosis in patients with prostate carcinoma. PATIENTS AND METHODS: A series of 160 consecutive patients with prostate carcinoma was studied retrospectively. In 120 there was sufficient tissue for review and to perform immunoperoxidase stains for neuron specific enolase (NSE) and chromogranin A (CGA). All patients had a potential follow-up of at least 5 years. RESULTS: Five-year survival was poorer for patients with a high tumour grade and stage at presentation compared to those with a lower grade and stage. NE cells were more common in higher grade and stage disease, but 5-year survival did not differ significantly between patients with NE cell positive and negative tumours. CONCLUSION: NE cells are of no practical value as an independent prognostic indicator in patients with prostatic adenocarcinoma.

Adenocarcinoma↗
PubMed1993

Leydig cell tumor of intra-abdominal testis.

A patient with bilateral cryptorchidism and gynecomastia due to Leydig cell tumor involving the left intra-abdominal testis is described. Raised serum estrogen, low serum testosterone, and ultrasonic demonstration of a tumor in the left testis allowed the diagnosis to be suspected preoperatively. The relevant literature is reviewed.

Adult↗
PubMed1993

Genito-urinary tuberculosis--experience with 52 urology inpatients.

The current trend in South African health services is toward primary care. Pulmonary tuberculosis is well understood by the majority of primary care doctors and nurses, whereas genito-urinary tuberculosis may not be as easy to diagnose and treat. We reviewed our experience with this condition in 52 patients, who represented 0.74% of urology admissions between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involvement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting complaints were urinary frequency and haematuria, although flank and scortal pain were also reported by a number of patients. Physical examination seldom helped to suggest the diagnosis. On microscopic examination and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform organism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosis drugs, but 58% also required some form of surgery; nephrectomy was the commonest operation. Ureteral strictures developed in over 50% of cases with renal involvement. We conclude that the diagnosis of genito-urinary tuberculosis is not simple, and that treatment must include regular follow-up at a specialist institution.

Adolescent↗
PubMed1992

Intravenous urography in patients with transitional cell carcinoma of the bladder. The incidence and implications of ureteral obstruction.

In order to study the value of excretory urography in the diagnosis of transitional cell carcinoma of the bladder, and also the incidence and implications of ureteral obstruction, 100 consecutive patients were studied. Of 73 patients with superficial tumours (stages Tis, Ta, T1) only 1 (1,4%) had hydronephrosis as a result of the bladder tumour. However, 2 further patients had hydronephrosis secondary to synchronous ureteral tumours. Of the 27 patients with muscle-invasive tumours, 10 (37%) had hydronephrosis at the time of diagnosis. Four patients who had normal upper tracts initially, developed hydronephrosis during follow-up: 1 due to progression of a superficial tumour to stage T3, 1 due to the development of an ureteral tumour, and 2 due to fibrosis of the intramural ureter after transurethral resection of superficial tumours. The presence of ureteral obstruction at the time of diagnosis most often implies a muscle-invasive tumour, but the possibility of a synchronous ureteral tumour must also be considered. Fibrous strictures of the distal ureter can occur after transurethral resection of superficial bladder tumours.

Carcinoma, Transitional Cell↗
PubMed1991

Prostate carcinoma--the value of T stage and grade in predicting metastases and prognosis. A cost-effective approach to clinical staging.

In order to evaluate the initial T stage and tumour grade as predictors of metastatic disease and prognosis in adenocarcinoma of the prostate, 963 patients were reviewed. Of the patients, 41% presented with metastatic disease. Stage T4 tumours were associated with a consistently poor prognosis, and 70% of such patients had demonstrable distant metastases. No patient with TOf local disease had metastases or died of prostate cancer during follow-up. The incidence of metastases was also low in stages T1 and T2. High tumour grade correlated strongly with more advanced disease. Using this information a more cost-effective approach to the staging of prostate carcinoma is proposed.

Adenocarcinoma↗
PubMed1990

A case of adult mesoblastic nephroma: ultrastructure and discussion of histogenesis.

A benign fibromyomatous kidney tumor with deep seated tubular structures in a 20-year-old woman is reported as a case of adult mesoblastic nephroma. Ultrastructural examination confirmed the fibromyomatous nature of the stroma and the tubules appeared to be an integral part of the tumor. The histogenetic relationship to congenital mesoblastic nephroma, Wilms tumor and other tumors is discussed. Radical nephrectomy was performed and the patient remained well 1 year later.

Actin Cytoskeleton↗
PubMed1990

Immunosuppressive therapy for pemphigus vulgaris complicated by malakoplakia of the bladder.

Pemphigus vulgaris is an uncommon auto-immune disease which responds well to treatment with corticosteroids and azathioprine. Malakoplakia is a rare granulomatous disease associated with coliform infections and an altered cellular immune response. We report a 68-year-old female patient with pemphigus vulgaris who, after 2 years on maintenance prednisone and azathioprine immunotherapy, developed malakoplakia of the bladder associated with chronic E. coli urinary-tract infection. The malakoplakia responded well to treatment with cotrimoxazole, bethanechol chloride and ascorbic acid, combined with tapering of the corticosteroid dosage. Our patient presents an uncommon but interesting complication of long-term immunosuppressive therapy for pemphigus vulgaris.

Aged↗
PubMed1989

Guidelines for the treatment of urethral strictures.

Over a period of 12 years 467 patients with urethral stricture were treated surgically at Tygerberg Hospital. The following surgical guidelines were developed: visual cold-knife urethrotomy should be the first line of treatment; urethroplasty is indicated when urethrotomy fails or is unfeasible; the urethroplasty of choice should be a single-stage operation; and staged procedures should be reserved for complicated cases.

Adolescent↗