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Biomedical subjects

I M Thompson

Publications and source records attributed to I M Thompson.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1995

An overview cost-utility analysis of prostate cancer screening.

The value of prostate cancer screening remains controversial because of the high prevalence of the disease and the fact that many tumors detected through screening are not destined to lead to morbidity or mortality, rendering treatment unnecessary. An ongoing NCI-sponsored screening trial may eventually put an end to the controversy. However, in the meantime, cost-utility estimates suggest that the cost per crude and quality-adjusted life year gained from prostate cancer screening and treatment ranges from $8,400 to $23,100 (with an estimated 1 to 2.68 QALYs gained from screening and treatment), and that these estimates are actually lower than, or well within the range of, the costs of many commonly accepted medical interventions, including screening mammography in women under age 50 ($232,000) and treatment of hypertension with captopril ($82,600) or hydrochlorothiazide ($23,500). Thus, we conclude that prostate cancer screening may indeed be cost effective and should be offered to men in the at-risk age range.

Costs and Cost Analysis↗
PubMed1994

Testicular cancer in blacks. A multicenter experience.

BACKGROUND: The rarity of testis tumor in black patients has made the study of a large series difficult. Much of the epidemiologic and clinical information regarding this neoplasm in this population is in dispute, including data on incidence, prognosis, histologic distribution, age and stage at presentation, and side distribution. METHODS: A retrospective review of 66 blacks with testicular tumors from seven military medical centers was performed. RESULTS: Similar results were found for blacks with testis tumor to those of the general testis cancer population regarding prognosis, side distribution, and age of onset for nonseminoma and interstitial tumors. There is a slight increase in the expected number of interstitial tumors in blacks, but the distribution between seminoma and nonseminoma is similar to the general population. The mean age of presentation for seminoma in blacks was younger than that of the general testis cancer population. For testis tumor treated at the same institution, there was an increased delay of diagnosis in blacks compared with whites. The number of new cases of testicular cancer between 1979 and 1991 at one major center was increased for whites but not for blacks. The availability of cisplatin-based combination chemotherapy has resulted in an improved prognosis for blacks, as has already been demonstrated for white populations. CONCLUSIONS: Testis tumor in blacks behaves similarly to testis tumor in the general population except that in blacks there are more interstitial tumors and the mean age of presentation for seminoma is younger. Further, there is an increased delay in diagnosis for blacks compared with whites, but the incidence of this tumor in this population does not appear to be increasing. Cisplatin-based chemotherapy has significantly improved survival in this population.

Adult↗
PubMed1994

Coumarin (1,2-benzopyrone) for the treatment of prostatic carcinoma.

The unavailability of effective treatment for metastatic hormone-refractory and clinically localized but pathologically unfavorable prostatic carcinoma warrants trial of new and promising treatments. Preliminary studies in patients with metastatic disease have shown (a) subjective but no objective responses to 100 mg coumarin and cimetidine daily; (b) objective responses in 3 of 40 patients treated with 3 g coumarin daily, all of whom had normal performance status and 1 of whom remains with three resolved bone metastases and stable prostate-specific antigen levels after 4 years; (c) toxicity only in bedridden patients. We recently initiated two multi-center trials of 1 g coumarin daily. Metastatic prostatic carcinoma patients of normal performance status were treated in a phase II trial. Patients who had been treated by radical prostatectomy, but had surgical margin, seminal vesicle or lymph node involvement or detectable prostate-specific antigen after radical prostatectomy, were randomized to coumarin or placebo.

Aged↗
PubMed1994

Chemoprevention of prostate cancer.

Primary prevention of prostate cancer is a relatively new concept. Through large-scale studies it is possible that we may be able to define better the risk for prostate cancer and identify those who would benefit from an intervention to lower their risk of disease. As risk for prostate cancer is better defined, a number of interventions may eventually be tested. Several interventions are sufficiently mature that they can be implemented in large-scale trials. Diet modification is an intervention that is ready for evaluation. It may also have additional benefits by decreasing mortality from other malignancies and cardiac disease. 5 alpha-reductase inhibitors are also ready for testing. The National Cancer Institute and its clinical cooperative groups have begun a large trial to assess finasteride in the prevention of prostate cancer.

5-alpha Reductase Inhibitors↗
PubMed1994

Observation alone in the management of localized prostate cancer: the natural history of untreated disease.

OBJECTIVE: To review the data from a series of patients with localized prostate cancer managed with observation alone. When available, cancer-specific survival was analyzed. Predictive factors for disease outcome were reviewed. METHODS: Series of patients with localized prostate cancer managed with observation alone were reviewed. When available, cancer-specific survival was analyzed. Predictive factors for disease outcome are reviewed. RESULTS: In published trials of observation alone, ten-year cancer-specific survivals of 80-90 percent are realized. Adverse predictors of outcome include higher stage and grade as well as aneuploid tumors. Although tumor progression is more common in patients with adverse predictive factors, adverse outcomes can occur in the larger group of patients with intermediate grade, stage, or tumor volume. CONCLUSIONS: Based on a small number of studies of patients with localized prostate cancer managed with observation alone, it appears that this option is reasonable for patients with good predictive factors and for patients with shorter life expectancies. The principal advantage of observation is the avoidance of treatment-related morbidity, but for the patient whose disease progresses during follow-up, disease-related morbidity can occasionally occur.

Aged↗
PubMed1994

Meta-analysis of the literature: guideline development for prostate cancer treatment. American Urological Association Prostate Cancer Guideline Panel.

Medical interventions are identified to be in need of practice guidelines based on several criteria, including uncertainty of therapeutic benefit, economic impact, variation in practice patterns and lack of objective data for new developments. Treatment of localized adenocarcinoma of the prostate meets these criteria and has been identified as an issue in need of practice guideline development. The American Urological Association began working toward establishing prostate cancer treatment guidelines in 1989. An explicit method based on collection of scientific data was adopted, which requires complete review of the literature and analysis of the evidence collected. An update on the progress toward this data analysis and guideline document is presented.

Adenocarcinoma↗