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Biomedical subjects

J A Vale

Publications and source records attributed to J A Vale.

At least 73 records · Page 4Linked to original sources
PubMed1993

Predicting the outcome of radical radiotherapy for invasive bladder cancer.

The correlation between T stage, histological grade, the presence of squamous metaplasia, and nuclear morphometry scores and response to radiotherapy and survival was investigated in 60 patients with muscle invasive transitional cell carcinomas of the bladder. Patients with T2 tumours showed a complete response significantly more often than those with T3 lesions. Multivariate analysis showed that T stage and initial response to radiotherapy were very strong predictors of survival though they were not independent variables. Histological grade, the presence of squamous metaplasia, and nuclear morphometry scores were not found to have any predictive value.

Aged↗
PubMed1993

Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men.

280 patients (aged 28 to 74 years, mean 57) with erectile failure (EF) underwent colour Doppler and duplex ultrasound imaging (CDI) following intracorporeal papaverine. After achieving a full, or nearly full, erection visual inspection and palpation revealed plaques and/or constriction or deformity of the penis in 55 (20%) cases. 10 (4%) were known to have Peyronie's plaques prior to referral. Of these 55 patients ultrasound showed focal echogenic plaques in 14 (25%) and diffuse thickening of the tunica albuginea in 41 (75%). CDI diagnosed arteriogenic EF in 20 (36%) of these patients, venous leak in 10 (18%), arterial and venous in two (4%) and a normal response in 23 (42%). In 11 (20%) patients (seven with arteriogenic EF and four with venous leak) the plaque was seen to be affecting vessels. These results indicate that abnormalities of the tunica albuginea are far more common in patients presenting with erectile failure than previously thought. We believe that the diffuse thickening is a form of Peyronie's which is only recognized after pharmacological induction of penile erection.

Adult↗
PubMed1993

Balloon dilatation of the prostate--should it have a place in the urologist's armamentarium?

Transurethral balloon dilatation of the prostate is a safe method of treating benign prostatic hyperplasia; it has been largely free of complications, and does not produce retrograde ejaculation. However doubts remain over its efficacy. We have performed balloon dilatation on 28 patients using balloons of diameter 30 mm (90F), and one year follow-up data is now available on 20 patients. Nine patients were satisfied with the outcome of treatment and reported reductions in their symptom score by a mean of 8.8 points. In addition, eight of these patients showed a reduction in their ultrasound residual volume by a mean volume of 75 ml. However urinary flow rate was only improved in four. Of the remaining 11 patients, two showed some initial improvement but then relapsed and nine derived no benefit from the procedure. We conclude that balloon dilatation may be of value in younger patients wishing to avoid or delay TURP, but is unlikely to achieve wider application.

Catheterization↗
PubMed1992

Finasteride in the treatment of benign prostatic hyperplasia. A urodynamic evaluation.

A group of 69 men with bladder outflow obstruction due to benign prostatic hyperplasia (BPH) were treated in a double-blind, placebo-controlled study with finasteride (Proscar, MK-906), a 5-alpha reductase inhibitor, 5 mg or 10 mg/day or placebo for 3 months; subsequently, 20 patients received finasteride 5 mg/day for a further 9 months in an open extension study. In treated patients dihydrotestosterone declined by over 60%, remaining unchanged with placebo. Symptom scores fell significantly in all 3 groups. Mean maximum flow rates fell slightly in placebo-treated patients but improved by 1.5 ml/s in the 10 mg group and by 3.3 ml/s in the 5 mg group. After 1 year's treatment, the reduction in symptom score and increase in flow rate were well maintained; the mean prostate volume was reduced by 14% and prostatic specific antigen declined by 28%. It was concluded that finasteride shows some efficacy in the treatment of BPH, with minimal toxicity, but 12 months of therapy or longer may be necessary to achieve maximal effect.

Aged↗
PubMed1992

[Primary decontamination: vomiting, gastric irrigation or only medicinal charcoal?].

Procedures to reduce the absorption of ingested poisons have been employed widely for decades in the management of intoxicated patients. However, evidence of substantial clinical benefit to the majority of patients undergoing such treatments is lacking. Volunteer studies suggest that activated charcoal is generally more effective than either syrup of ipecacuanha or gastric lavage, though lavage may be more effective than syrup of ipecacuanha. Studies in poisoned patients have shown that although lavage is more effective than syrup of ipecacuanha, it led to a better outcome in comatose patients only if performed less than one hour after overdose. Syrup of ipecacuanha did not alter the outcome beneficially in those who were alert on presentation and is known to produce significantly more complications than charcoal alone even in patients who are awake with a gag reflex. A recent study suggests that activated charcoal may be superior both to lavage and syrup of ipecacuanha. Based on these studies it would seem reasonable to recommend that 50 to 100 g activated charcoal be administered to patients who have taken a substantial amount of a toxic substance less than one hour previously. This may be done conveniently by using an orogastric tube, which would also allow lavage to be undertaken with possible additional benefit.

Charcoal↗
PubMed1992

Endometrioid carcinoma of the prostate: a misnomer?

The origin of this unusual variant of carcinoma of the prostate has provoked discussion ever since its first description in 1967. This is of both embryological interest and therapeutic importance. Four cases have been reviewed, and all have demonstrated immunohistochemical features consistent with an origin from prostatic tissue. In addition, three had evidence of disseminated disease which responded well to androgen ablation. It is concluded that the term endometrioid carcinoma is of descriptive value only, and these tumours are a variant of primary duct prostatic carcinoma. Patients should be treated by androgen ablation when metastases are present.

Adenocarcinoma↗
PubMed1991

Diagnostic and surgical aspects of renal carcinoma with involvement of the inferior vena cava.

Over the past 10 years, 13 patients presented with operable renal carcinoma and tumour extension within the inferior vena cava. This was diagnosed accurately in all but 1 patient, using ultrasound. Radical nephrectomy with removal of tumour within the inferior vena cava was performed in all 13 cases, 2 requiring cardiac bypass. There were no operative deaths and 6 patients remain alive and well with a mean follow-up of 2 years. The presence and level of vena caval extension did not appear to have an adverse affect on prognosis.

Adult↗