Biomedical subjects
Publications and source records attributed to J A Jacobs.
Issues surrounding posttreatment follow-up research are examined in terms of internal and external validity. Because of the problems involved in other types of follow-up research, recidivism is proposed as the most reliable methodology for follow-up research. Problems and solutions in recidivism research, as well as implications for aftercare, are discussed.
Therapy for prolonged renal bleeding related to sickle cell disease can be challenging. We review the treatment of a woman with a 4-week history of renal bleeding thought to be due to sickle cell trait. The hemorrhage ceased immediately following irrigation of the involved kidney with oxychlorosene. Before radical surgery is performed for this problem this relatively simple approach should be considered. Further documentation of the efficacy and safety is necessary before advocating this modality for routine use.
We recently established a multidisciplinary center for the evaluation and treatment of male sexual dysfunction. The patients are seen in a single day by the endocrinologist, psychiatrist, psychologist, neurophysiologist and urologist. Laboratory studies include chemical and hormonal profiles, pudendal nerve latency testing and determination of the penile blood pressure. Nocturnal penile tumescence studies are done in selected cases. A diagnosis was made in 95 of 106 patients (90 per cent). The problem was psychogenic in 42 per cent of the patients, vascular and neurologic in 34 per cent, hormonal in 15 per cent, urologic in 7 per cent and medication-related in 2 per cent. The interdisciplinary approach to this problem allows for a more comprehensive and accurate evaluation, while providing a convenient service to the patient.
We evaluated 31 male diabetics for sexual dysfunction. Patients were examined by an endocrinologist, psychologist or psychiatrist, urologist and neurophysiologist. Evaluation was done by penile blood pressure, pudendal nerve latency, psychologic testing and laboratory tests, including serum testosterone levels. Mean patient age was 53 years and the average onset of sexual dysfunction was 6 years after the diagnosis of diabetes. Results showed that 68 per cent of the patients had evidence of vascular occlusion, 26 per cent had neurologic abnormalities, 19 per cent had low plasma testosterone levels and 38 per cent had relevant psychological problems, although the condition was considered primarily psychogenic in only 19 per cent. Of those patients with abnormal nerve latencies 86 per cent had abnormal Doppler penile systolic pressures, while only 28 per cent of the patients with abnormal penile pressures had abnormal neurologic findings. These data suggest that vascular occlusion is the most prevalent abnormality in impotent diabetics and may predate neurologic abnormalities. The diabetics were divided into 2 groups, insulin-dependent and insulin-nondependent patients. A higher incidence of vascular lesions was found in insulin-dependent diabetics (83 versus 57 per cent), suggesting that vascular pathological conditions are related to severity of the diabetes. Although most diabetics have a vascular etiology for impotence one must remember that other causes may be present and that a thorough investigation is necessary.
While fluid collections within the scrotum are not uncommon, an uncomplicated cyst attached to or within the various components of the scrotum is unusual. We report a case of a rare simple cyst of the testicle, which was diagnosed accurately by preoperative ultrasound examination.
News about health research findings, especially regarding controversial topics, can seem confusing and conflicting to students and the general public. Many people eventually develop a "turned-off" attitude toward all health news. Yet medical information is one of the key factors involved in health decision-making, because it influences a person's judgment about the potential health impact of a behavior choice. As part of their health education, youngsters need to learn skills to better understand and evaluate reports of research news, so the information available for health decision-making will be more complete and accurate. Such news is already abundant in television, radio, newspaper and magazine reports and will continue to increase as research advances, knowledge expands and health "facts" are revised. This article outlines concepts and skills to help teachers and students understand the changes and controversies in health news. To most effectively use new information generated by medical research, students need to: 1) understand basic concepts about the nature of research and the research process; 2) apply critical thinking approaches to health news; and 3) locate additional health information resources. Generating ways to address these needs is a high priority of the school health education work at the National Heart, Lung and Blood Institute. Comments are invited on this approach.
Two patients with stage D transitional cell carcinoma of the kidney presented with recurrent massive hematuria. Both had prompt cessation of bleeding following renal infarction. Another patient had malignant hypercalcemia related to metastatic renal cell carcinoma and became normocalcemic after renal infarction. Angiographic renal infarction offers a rational alternative to conventional therapy in the management of these 2 problems.
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Our experience with pre-cystectomy radiation for carcinoma of the bladder from July 1959 through June 1976 is presented. Pre-cystectomy radiation would appear to be beneficial in the management of patients with invasive bladder cancer. There is an impressive improvement in survival rates in those patients demonstrating reduction in staging after radiation. Our experience correlates well with other comparative series. Based on this 17-year experience guide lines are outlines for the subsequent management of patients with bladder cancer.
Complications of radiation therapy for prostatic carcinoma are frequent but usually minor. A patient is described in whom localized ureteral fibrosis developed following curative radiation therapy, which subsequently required a reconstructive operation. An analogous situation regarding patients with carcinoma of the cervix is examined and possible etiologies are discussed. This complication should be recognized so that proper management can be instituted.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Sexually dysfunctional diabetic and nondiabetic males were compared with a group of normal controls using different endocrinological, psychophysiological, and psychological parameters. One hundred male subjects participated in this study: 47 diabetics with sexual dysfunction (DD), 31 nondiabetics with sexual dysfunction (NDD), and 22 normal controls (C). They were evaluated by an internist (physical examination and medical history), a psychologist (psychological and sexual functioning tests), a psychiatrist (psychiatric history and mental status examination), a urologist (genitourinary physical examination), and an endocrine biochemist (evaluation of endocrine factors). Additionally, subjects were evaluated for nocturnal penile tumescence (NPT) during three nights in the sleep laboratory to obtain a differential diagnosis of impotence, that is, psychogenic vs. organic. Both sexually dysfunctional groups showed significant differences on several measures in the psychological and psychophysiological evaluations. There were also significant differences between these two groups and the control group. Plasma levels of total testosterone and serum levels of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) showed no significant differences among the three groups, but there were some significant correlations between the endocrine and psychological measures. No significant correlations were found between the endocrine and psychophysiological measures.