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Biomedical subjects

I M Thompson

Publications and source records attributed to I M Thompson.

At least 19 recordsLinked to original sources
PubMed1995

Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection.

OBJECTIVES: The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a segment of patients for whom pelvic lymph node dissection (PLND) may be omitted. This study was conducted to develop a method to select patients for whom PLND could be omitted. METHODS: We analyzed serum prostate-specific antigen (PSA), clinical stage, biopsy Gleason score, and final pathologic stage in 481 men with clinically localized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes. RESULTS: Logistic regression analysis determined that combining all three variables provided the best determination of final pathologic stage. A series of probability curves have been created to estimate the risk of positive lymph nodes in a given patient. Based on the distribution of patients in this study and using these probability functions, PLND could be avoided in up to 50% of patients with localized prostate cancer diagnosed by contemporary methods. CONCLUSIONS: In properly selected patients, pelvic lymphadenectomy can be omitted in the staging and treatment of localized prostate cancer.

Humans↗
PubMed1995

Protection of the germinal epithelium in the rat from the cytotoxic effects of chemotherapy by a luteinizing hormone-releasing hormone agonist and antiandrogen therapy.

OBJECTIVES: The protection of spermatogenesis during chemotherapy using an antiandrogen and a luteinizing hormone-releasing hormone (LHRH) agonist was examined in the rat. Previous studies using LHRH agonists alone have been inconclusive, as both protective and deleterious effects on the germinal epithelium have been reported. Flutamide has not previously been used in this manner but theoretically should protect the germinal epithelium, since flutamide rapidly blocks testosterone at the cellular level and also minimizes the testosterone "flare" when LHRH agonist therapy is initiated. METHODS: Mature Sprague-Dawley rats were pretreated with flutamide, sustained-release goserelin acetate (Zoladex), or a combination of flutamide and sustained-release goserelin acetate for 14 days before 4 weekly doses of procarbazine were initiated. The seminiferous tubules were evaluated histologically after a 90-day regeneration period using the stem cell assay test. RESULTS: After treatment with procarbazine alone, only 43% of the seminiferous tubules were active; however, 80% were active if protected with flutamide, 91% if protected with sustained-release goserelin acetate, and 95% if protected with both flutamide and goserelin acetate. CONCLUSION: Flutamide, sustained-release goserelin acetate, and a combination of these agents were effective in protecting the germinal epithelium of the rat during chemotherapy. A combination of flutamide and goserelin acetate provided the best protection. This study demonstrates for the first time the protective effect of flutamide and flutamide with goserelin acetate on the germinal epithelium during chemotherapy.

Animals↗
PubMed1995

Balloon dilation of the prostate: correlation with magnetic resonance imaging and transrectal ultrasound findings.

Alternative treatments for benign prostatic hyperplasia are under intense scrutiny. Initial reports on balloon dilation therapy showed success rates of 60% to 90%, although follow-up was brief. We present a prospective non-blinded study assessing the efficacy of an investigational balloon dilatation catheter (105 Fr at 3 atm) as well as the MRI findings preoperatively and postoperatively. Twenty-seven men underwent balloon dilation and have been followed for at least 1 year. Twelve patients (44%) ultimately required definitive transurethral prostatectomy during follow-up. A mild improvement was noted in the symptom score and flow rate in the responder group. Fracture of the anterior commissure was accomplished in only 5 patients (18%) despite diligent efforts. The MRI scans showed no change in the prostate in any patients. Intraoperative transrectal ultrasound scanning suggested that proximal balloon migration can occur. Our experience with this balloon system leads us to recommend that it remain an investigational procedure.

Aged↗
PubMed1995

Delayed development of mid-ileal conduit stenosis: the importance of life-long urologic follow-up.

Mid-ileal conduit stenosis is an unusual yet morbid complication following ileal conduit urinary diversion. We report the cases of four patients who developed mid-ileal stenosis at an average interval of 19.5 years after urinary diversion, with the longest interval being 25 years. This series emphasizes the importance of life-long follow-up of patients who have had urinary-intestinal diversion.

Adolescent↗
PubMed1995

Economic impact of urolithiasis in the United States.

PURPOSE: We determined the economic costs to individuals in 1993 for the evaluation and treatment of upper urinary tract calculi. MATERIALS AND METHODS: Hospital discharge statistics, prevalence data for urolithiasis and the relative frequency of surgical treatments from Civilian Health and Medical Program of the Uniformed Services claims data were assessed. RESULTS: The total charges for evaluation, hospitalization and treatment were estimated to be $1.23 billion per year. Professional charges for those who were hospitalized were estimated to be $183 million. Outpatient evaluation of urolithiasis was expected to cost $278 million. Indirect costs for lost wages were estimated to be $139 million. CONCLUSIONS: The total annual cost for urolithiasis in the United States is estimated to be $1.83 billion.

Cost of Illness↗
PubMed1995

Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association.

PURPOSE: The American Urological Association convened the Prostate Cancer Clinical Guidelines Panel to analyze the literature regarding available methods for treating locally confined prostate cancer, and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1966 to 1993 on stage T2 (B) prostate cancer and systematically analyzed outcomes data for radical prostatectomy, radiation therapy and surveillance as treatment alternatives. Outcomes considered most important were survival at 5, 10 and 15 years, progression at 5, 10 and 15 years, and treatment complications. RESULTS: The panel found the outcomes data inadequate for valid comparisons of treatments. Differences were too great among treatment series with regard to such significant characteristics as age, tumor grade and pelvic lymph node status. The panel elected to display, in tabular form and graphically, the ranges in outcomes data reported for each treatment alternative. CONCLUSIONS: In making its recommendations, the panel presented treatment alternatives as options, identifying the advantages and disadvantages of each, and recommended as a standard that patients with newly diagnosed, clinically localized prostate cancer should be informed of all commonly accepted treatment options.

Humans↗
PubMed1995

Congenital diaphragmatic hernia with or without extracorporeal membrane oxygenation: are we making progress?

BACKGROUND: Congenital diaphragmatic hernia (CDH) continues to have a high mortality rate (24 to 57 percent) despite changing management schemes, which include extracorporeal membrane oxygenation (ECMO) for treatment of associated persistent pulmonary hypertension of the newborn. STUDY DESIGN: The medical records of 123 acutely symptomatic newborns with CDH treated from 1972 to 1994 were retrospectively reviewed. Patients were divided into three groups to compare historical treatment modalities: group 1, no ECMO available; group 2, postoperative ECMO if necessary; and group 3, delayed repair with preoperative ECMO if necessary. The blood gas values, alveolar-arterial oxygen gradient (A-aDO2), mean airway pressure (MAP), and oxygenation (OI) and ventilation indices (VI) prior to treatment were compared between survivors and nonsurvivors. Chi-square and Student's t tests were used to determine statistical significance. RESULTS: The overall survival rate was 41 percent: 27 percent in group 1, 45 percent in group 2, and 39 percent in groups 3. If those who were not candidates for ECMO were excluded from analysis, the survival rate improved to 35 percent in group 1, 51 percent in group 2, and 50 percent in group 3. No published prognostic scoring system, such as arterial blood gas values, A-aDO2 gradient, MAP, OI, or VI consistently distinguished survivors from nonsurvivors. Extracorporeal membrane oxygenation decreased the mortality rate of patients having large defects. CONCLUSIONS: Prognostic scoring systems do not predict which patients with CDH should be treated. Extracorporeal membrane oxygenation has improved survival in newborns with CDH who present in early respiratory distress. There is no advantage or disadvantage to using ECMO prior to repair of CDH.

Extracorporeal Membrane Oxygenation↗
PubMed1995

Should renal ultrasound be performed in the patient with microscopic hematuria and a normal excretory urogram?

PURPOSE: We determine what additional information would be detected by renal ultrasonography that was not identified by a normal excretory urogram (IVP) performed for the evaluation of microscopic hematuria. MATERIALS AND METHODS: A retrospective review was done of 101 patients with microscopic hematuria and a normal IVP who underwent renal ultrasonography. RESULTS: Of the 101 patients with microscopic hematuria and a normal IVP, renal ultrasonography was abnormal in 20%. All findings were ultimately proved to be of no clinical significance, although 6 of 21 patients required a total of 10 additional studies, including 9 computerized tomography scans and 1 renal arteriogram. CONCLUSIONS: These data demonstrate that renal ultrasonography is unnecessary in a patient with microscopic hematuria and a normal IVP.

Adolescent↗
PubMed1995

Is ultrasound guidance necessary for transrectal prostate biopsy?

PURPOSE: The relatively simultaneous development of spring-loaded biopsy devices and the proliferation of transrectal ultrasonography for transrectal guidance of biopsy needles have led to the general use of both technologies for transrectal prostate biopsy. This review was done because the incremental cost of ultrasonographic guidance is considerable and the marginal improvement of sensitivity over digital guidance alone is unknown. MATERIALS AND METHODS: A total of 200 consecutive men underwent prostate biopsy with digital and ultrasound guidance. RESULTS: Biopsy sensitivity was superior for ultrasound guidance in all categories of tumors studied, with an overall sensitivity of 88% compared to 74% for digital guidance. Nevertheless, 12% of the tumors were detected with digital rectal examination guidance alone. CONCLUSIONS: These data suggest that the optimal method of prostate biopsy may include ultrasound and digital guidance.

Adult↗
PubMed1992

The natural history of adenocarcinoma of the prostate.

All analyses of the efficacy of therapy for prostate cancer must control for the natural history of the disease. Over the past years, several long-term series involving several hundred patients have helped to describe the results of untreated disease. In general, most patients will not die of their disease, although approximately half of the patients will develop disease progression within 10 years. Predictors of progression include tumor stage, grade, and ploidy status.

Adenocarcinoma↗
PubMed1992

When is intervention warranted?

A chemoprevention trial in prostate cancer would be a formidable but potentially rewarding study. The current status of knowledge of drug interactions with, biomarkers of, and even the natural history of prostate cancer is insufficient to study all levels of men at risk. Currently, the most promising group to study is group I--those men with a high probability of developing prostate cancer but who do not currently have evidence of the disease. This could be a placebo-controlled, prospective and randomized study with the endpoint being clinically-detected prostate cancer. In addition, much may be gained from short-term pilot studies of "chemo-active" agents on morphologic and other biomarkers of prostate cancer initiated immediately before surgical removal. It is hoped that such studies may provide rationale for future efforts directed at preventing progression of premalignant or early prostate cancer lesions.

Anticarcinogenic Agents↗
PubMed1992

Multivariate case-control study of survival following transurethral resection of prostate.

Although prevalence of perioperative mortality following transurethral resection of the prostate (TURP) has steadily declined as reported in several review studies, it has been suggested that with extended follow-up after TURP, mortality exceeds that of an age-matched population. The sample selected for this study was drawn from a data base of 2,005 men who entered a urologic health-screening program. The sample included a group of 25 patients who underwent TURP and a group of 50 age-matched control patients with symptoms of prostatism. Patients were followed for six years, a total of 450 observed person-years. Multivariate analyses based on a general linear model approach for the dependent variable of survival were used to assess gains in predictive efficiency due to combinations of TURP versus control, time, and patient variables. F-ratio hypothesis tests of coefficients of multiple determination for the models indicated that TURP did account for a significant amount of the variability of survival but only after five years of follow-up. However, a far larger proportion of the variance in survival was explained by other patient variables of age, preoperative risk, comorbidity factors, and postoperative urinary disease after all effects due to TURP, follow-up years, and operation cohort years were held constant in the survival prediction equation.

Aged↗
PubMed1992

Renal tumors in young adults.

Primary renal malignancies are relatively rare in young adults. Eighteen patients between the ages of twenty and forty years underwent nephrectomy for renal tumors at our institution between 1947 and 1989. Data were reviewed in this group regarding method of presentation, duration of symptoms, tumor histology, pathologic stage, and survival. Tumor histology parallels that of older patients, the majority being adenocarcinoma (78%). The duration of symptoms prior to seeking medical attention was long, averaging eighty-four weeks. The overall survival rate, excluding nontumor deaths, was 50 percent. No patient with nodal or distant metastases survived, regardless of histology.

Adult↗
PubMed1992

Current urological practice: routine urological examination and early detection of carcinoma of the prostate.

With the increasing incidence of carcinoma of the prostate, the interest in early diagnosis through screening has dramatically increased. Several organizations, including the American Urological Association (AUA) and the American Cancer Society, have promulgated recommendations on suggested early detection methods. To determine the current practice patterns of United States urologists, a survey was sent to a random sample of 10% of all urologist members of the AUA. The survey was designed to determine what are current recommendations for an annual urological checkup for older men, what tests should be included in screening for carcinoma of the prostate and what age groups of men should undergo prostate cancer screening. A total of 562 surveys was returned, constituting a 4.7% sample of all urologist members of the AUA. The use of digital rectal examination was unanimously recommended for the urological examination as well as for prostate cancer detection. Prostate specific antigen was recommended by a majority of respondents for both situations. Screening was recommended for men ages 50 to 80 years. Demographic factors had a significant role in clinical recommendations by urologists.

Adult↗
PubMed1992

The fate of buried vaginal epithelium.

A new technique in the treatment of stress urinary incontinence utilizes a sling fashioned from a rectangular island of buried vaginal epithelium. We developed a model to study the natural history of vaginal wall covered by an epithelial flap in 12 rabbits sacrificed at intervals to 26 weeks. Histopathologic examination demonstrated an immediate acute inflammatory reaction. This early response was followed by formation of an epithelial lining of the potential space overlying the buried vaginal tissue. Acute inflammatory cells continued to enter this lumen until week 20, when granulomas were first detected. Histopathologic examination at twenty-six weeks showed stratified squamous epithelium lining the lumen. No deleterious inflammatory sequelae were detected, and no dysplastic or malignant changes were identified. These results suggest that buried vaginal epithelium is a safe (short term) tissue alternative for sling creation.

Animals↗
PubMed1992

Surgical treatment of carcinoma of the male urethra.

Despite the distinct rarity of carcinoma of the male urethra, the eventual outcome for a significant proportion of patients presenting with this process hinges on the selection and proper accomplishment of surgical therapy. Lesions of the posterior urethra seem to have a worse prognosis and may warrant aggressive therapy. Close attention must be given to the evaluation and treatment of the regional lymph nodes in all cases. The authors review the nuances of the various surgical options for these cancers.

Carcinoma, Squamous Cell↗