Case report: renal adenocarcinoma with ultrasonographic appearances suggestive of angiomyolipoma.
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Adenocarcinoma↗
Biomedical subjects
J A Webb
Publications and source records attributed to J A Webb.
Breast cancer screening: racial/ethnic differences in behaviors and beliefs.
Racial/ethnic differences in breast cancer screening behaviors and beliefs were examined in 259 asymptomatic women, 50 years old or older, who participated in a no-cost worksite breast cancer screening program. Hispanics were more likely than African Americans to report having had mammography in the past year. Caucasians and Hispanics were more likely than African Americans to report having had a clinical breast examination in the past year. African Americans to report having had a clinical breast examination in the past year. African Americans and Hispanics were more likely to practice monthly breast self-examination than were Caucasians. African Americans were more likely to report cancer-related fears and worries as barriers to mammography, whereas Caucasians were more likely to report being too busy, inconvenience, and procrastination as barriers. African Americans also were more likely to evaluate their physicians and other health professionals positively than were Caucasians. These results suggest a need to make a special effort to address cancer-related fears as barriers to screening among African Americans, and time-related barriers to screening among Caucasians.
Black or African American↗
Development of a risk profile for intentions to use alcohol among fifth and sixth graders.
OBJECTIVE: The relationship between intentions to use alcohol and risk factors was examined among fifth and sixth graders. METHOD: Subjects completed a questionnaire that assessed intentions to use alcohol and eight risk factors. Risk factors included peer and parental use and attitudes toward use, sensation seeking, tolerance of deviance, rejection of parental authority, and family cohesion. RESULTS: Multivariate analyses showed that the risk factors were able to discriminate between those who intended to use alcohol and those who did not. Family factors showed stronger relationships to intentions among fifth graders, and peer factors were more strongly related to intentions among sixth graders. CONCLUSIONS: Risk factors can be used to target preadolescents who may be at risk for early alcohol use, and programs that attempt to prevent early initiation of alcohol use among adolescents can be designed.
Adolescent↗
Career satisfaction among psychiatrists in Texas.
We examined present and anticipated future levels of career satisfaction among psychiatrists in the greater Houston area. We gathered data by means of an anonymous questionnaire. The strongest univariate correlations between background variables and current and anticipated future levels of career satisfaction were found with age, years in practice, and source of professional income. Major threats to the quality of psychiatric practice were identified as changes in third-party reimbursement/managed care, competition from nonphysician mental health practitioners, and the national economy. Psychiatrists least satisfied with their current careers and most pessimistic about the future were found to be older with more years' experience and deriving their professional income chiefly from private practice. Much of their dissatisfaction appeared to relate to changes in third-party reimbursement/managed care and increasing competition from nonphysician mental health professionals.
Career Choice↗
Post-operative serial prostate-specific antigen and transrectal ultrasound for staging incidental carcinoma of the prostate.
OBJECTIVES: To examine the value of post-operative serum prostate-specific antigen (PSA), PSA density, incremental change in serial serum PSA (PSA slope) and transrectal ultrasound (TRUS) in the assessment of residual malignancy after the diagnosis of clinically unsuspected prostatic adenocarcinoma at transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Forty-eight untreated patients with incidental carcinoma of the prostate, demonstrated at TURP for a clinically benign gland, were evaluated post-operatively with serum PSA and TRUS with multiple systematic prostatic biopsies. Prostatic volume was determined from TRUS measurements and PSA density was defined as serum PSA divided by gland volume. Those patients who did not undergo further treatment were monitored with serial PSA levels, and PSA slope was calculated as the overall annual percentage increase in serum PSA. RESULTS: Among 36 patients staged T1A (A1), 11 (31%) had histologically proven residual carcinoma, and five of the 12 patients (42%) with T1B (A2) disease had no residual disease on biopsy. Serum PSA levels following TURP were greater in those patients with residual disease than those without (P = 0.001), but at a cut-off of 4.0 ng/mL--providing a sensitivity of 89%--the specificity of PSA alone was 57%. PSA density had an 83% sensitivity and a 67% specificity with a cut-off of 0.15 ng/mL/cm3. TRUS had a sensitivity of 63% and a specificity of 52%. An incremental rise in PSA exceeding 20% per year in untreated patients gave a sensitivity of 90% and specificity of 79% for biopsy proven residual malignancy. CONCLUSION: This study demonstrates the inaccuracy of staging incidental prostatic malignancy by TURP. Although the performance of PSA density is better than that of PSA alone, the reliability of both are limited by the lack of specificity, and TRUS imaging lacks both sensitivity and specificity. The PSA slope has sufficient sensitivity and specificity to distinguish reliably most patients with biopsy proven residual malignancy. Although ultrasound-guided systematic biopsies provide a means for confirming residual malignancy, they may not be indicated in all patients with incidental carcinoma: for such patients, PSA progression may provide a rational basis for subsequent treatment.
Aged↗
Screening in general practice.
Screening for prostate cancer in a general practice setting seems to be technically feasible and generally acceptable. In our study, 14 cancers were diagnosed among the 568 men screened, giving an overall detection rate of 2%; five of these were either locally advanced or associated with metastatic disease. Although these results may reflect our somewhat conservative biopsy rate, there is a considerable false positive rate in the PSA range of 4-10 ng/ml, particularly among men with clinical evidence of benign prostatic hyperplasia. A large scale prospective controlled study will be necessary to establish the true benefit of screening.
Aged↗
The role of ultrasonography in the diagnosis of intrinsic renal disease.
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Humans↗
What is the value of measuring renal parenchymal thickness before renal biopsy?
Reduced renal length is widely used to diagnose chronicity in patients with renal impairment. A length of 9 cm or less measured ultrasonographically is considered to indicate irreversible disease. However, some patients with normal renal length have thin parenchyma. The aim of this study was to determine the relationship between ultrasonographically measured parenchymal thickness and renal length and to correlate parenchymal thickness with the histology obtained at renal biopsy. Sixty-four patients, aged 16-74 years, who had had a renal biopsy were evaluated retrospectively. Histology was considered in five categories: I, interstitial nephritis (n = 13); II, glomerulonephritis (28); III, diabetes mellitus/metabolic/other (8); IV, chronic renal disease (CRD) (11); V, hypertension/vascular disease (4). There was a good linear correlation between renal length and renal parenchymal thickness (r = 0.64, P < 0.001). Both were reduced most in patients with CRD. Sixty-four per cent of patients with CRD had renal parenchymal thickness 1.5 cm or less, compared to 38% in group I, 25% in groups II and V, and 7% in group II. Although 11/37 (30%) of patients whose serum creatinine had increased 3 months post-biopsy had parenchymal thickness 1.5 cm or less, so did 6/27 (23%) whose creatinine decreased. Like renal length, parenchymal thickness gives an indication of the chronicity of renal failure. However, some patients with parenchymal thickness 1.5 cm or less still have potential for improvement. This measurement alone should not be used to obviate renal biopsy.
Adolescent↗
Anxiety in medical situations and chemotherapy-related problems among cancer patients.
Relationships between anxiety in medical situations and age, gender, duration of illness, and communication problems with friends or relatives were examined in a heterogeneous sample of 117 adult cancer patients. The relationships between the same demographic, medical, and psychosocial variables and chemotherapy-related problems in a subsample of 79 patients receiving chemotherapy also were examined. Results indicated that females and patients who reported more communication problems with friends or relatives reported more anxiety in medical situations. Female patients and patients who reported more communication problems with friends or relatives also reported more chemotherapy-related problems. Duration of illness was not related significantly to either dependent measure. Clinical implications of these results are discussed.
Adult↗
Screening for carcinoma of the prostate: a GP based study.
OBJECTIVE: To examine the feasibility and acceptability of screening for cancer of the prostate by digital rectal examination (DRE), prostate specific antigen (PSA) determination and subsequent transrectal ultrasound (TRUS) in selected patients in a single general practice in Hertfordshire. SUBJECTS AND METHODS: A total of 568 of 856 men aged 55 to 70 accepted an invitation for a health check which included screening for prostate cancer. Of these, 80 individuals with either a raised PSA level or an abnormal DRE underwent TRUS. In 29 individuals biopsies were taken, 11 of which confirmed the presence of adenocarcinoma of the prostate giving an overall detected prevalence of 2%. Of the 11 tumours identified by screening, two were T1M0, four were T2M0, two were T3M0 and three were T3M1. RESULTS: To assess the acceptability of the screening exercise a postal questionnaire was sent to all 568 participants: 83% replied and 69% reported no concern. Of the 67 individuals who had undergone TRUS, 69% reported discomfort. A total of 448 (95%) of respondents declared that they would be prepared to undergo the screening exercise again. CONCLUSION: Screening for prostate cancer would seem to be technically feasible and generally acceptable. However, there is a considerable false positive rate in the PSA range 4 ng/ml to 10 ng/ml, particularly among men with clinical evidence of benign prostatic hyperplasia. To establish the true benefit of screening a large-scale prospective controlled study will be necessary.
Adenocarcinoma↗
Premigratory expectations and mental health symptomatology in a group of Vietnamese Amerasian youth.
This paper reports on the first phase of a prospective longitudinal evaluation of the relationship between premigratory expectations for life in the United States and postmigratory symptoms of anxiety and depression in a group of Vietnamese Amerasian youth. Premigratory expectations, as measured by an expectations questionnaire, are correlated with concurrent symptomatology assessed utilizing the General Health Questionnaire, Hopkins Symptom Checklist-25, and Vietnamese Depression Scale. Those with higher premigratory expectations tended to report fewer symptoms of anxiety and depression. Implications of these findings for future research defining the relationship between premigratory expectations and postmigratory symptoms are discussed.
Adolescent↗
Long-term effects of maternal loss on Vietnamese Amerasians.
OBJECTIVE: The objective of this study was to investigate the differential effects of maternal, single surrogate, and multiple surrogate caregiving on psychological and educational outcomes in a group of Vietnamese Amerasians. METHOD: Subjects were assessed in Vietnam using several measures of affective and behavioral symptomatology as well as a detailed psychosocial history. RESULTS: Amerasians who lived continuously with their biological mothers had fewer symptoms of psychological distress than did either group raised by surrogate caregivers. In addition, those living continuously with either their mothers or a single surrogate had better educational outcomes and experienced fewer geographic relocations than did those raised by multiple surrogates. CONCLUSIONS: Amerasians who remained continuously with their biological mothers had better overall outcomes than did those raised by surrogate caregivers. Continuous surrogate caregiving appeared to offer some, but not complete, protection from the adverse effects of maternal loss. The clinical significance of these findings for those assessing and treating Amerasians, as well as for those assisting immigration officials with relocation decisions, is discussed.
Adolescent↗
Complications of ultrasound-guided transperineal prostate biopsy. A prospective study.
A prospective study of the complications of transperineal prostate biopsy was undertaken in 171 patients; 150 (88%) returned a questionnaire 1 week after biopsy. The incidence of serious complications was low, with 1 patient requiring admission for presumed septicaemia and another developing acute retention of urine. Many patients had minor complications, with 42% having haematuria, 13% haemospermia and 31% pain. Only 18% needed analgesia following biopsy. Since transperineal prostate biopsy has such a low incidence of infective complications, we suggest that it should be considered in frail or elderly patients in whom septicaemia may be especially hazardous.
Biopsy, Needle↗
Long-term urodynamic effects of finasteride in benign prostatic hyperplasia: a pilot study.
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), a 5 alpha-reductase inhibitor, 5 mg or 10 mg/day, or an identical placebo for 3 months; subsequently, 20 patients received finasteride 5 mg/day in an open extension study. Ten of these patients have now completed 3 years of therapy and have been reevaluated with pressure/flow urodynamics. In finasteride-treated patients dihydrotestosterone (DHT) declined by over 60%, remaining unchanged with placebo. Symptom scores fell in both groups of patients, maximum flow rate values decreased on placebo but improved by a mean of 1.5 ml/s in the 10-mg group and 3.3 ml/s in the 5-mg group. After 1 year of therapy, the reduction in symptom score was well maintained and the flow rate had increased by a mean of 2.7 ml/s; the mean prostate volume was reduced by 14% and prostate-specific antigen (PSA) had declined by 28%. In the 10 patients treated for 3 years who consented to further urodynamic study, the maximum urinary flow rate had improved from a mean baseline value of 8.7 ml/s to a mean of 13.8 ml/s, while maximum subtracted voiding pressure had decreased from a mean baseline value of 72 cm H2O to an unobstructed mean value of 44 cm H2O. Side effects were minimal and reversible on stopping the medication.(ABSTRACT TRUNCATED AT 250 WORDS)
5-alpha Reductase Inhibitors↗
Premigratory risk factors in Vietnamese Amerasians.
OBJECTIVE: The study's goal was to determine the ability of risk factors determined before migration to predict future levels of anxiety and depression in a group of Vietnamese Amerasian immigrants. METHOD: In a cohort of 161 randomly selected Vietnamese Amerasian youth in Vietnam awaiting placement, risk factors for psychological distress were identified with Felsman's 35-item Personal Information Form and the Hopkins Symptom Checklist-25 (HSCL-25). Ninety-five members of the original cohort were subsequently reevaluated, again with the HSCL-25, at a Philippine refugee center during their 6-month stay there awaiting placement in the United States. RESULTS: A statistically significant relationship was found between greater numbers of risk factors identified in Vietnam and higher total symptom levels in the Philippines. The strongest relationship was between greater numbers of risk factors and higher levels of depression. The relationship between number of risk factors and levels of anxiety was not significant. CONCLUSIONS: This study demonstrates the ability of risk factors determined prior to departure in Vietnam to predict future levels of psychological distress in a group of Vietnamese Amerasian immigrants.
Adolescent↗
A risk profile predicting psychological distress in Vietnamese Amerasian youth.
The relationship between risk factors and psychological distress was examined in 161 Vietnamese Amerasian youth. Background factors such as a history of missing school, frequent hospitalizations, and previous refugee camp experience distinguished those with higher levels of anxiety and depression. This study provides support for attempts to link specific risk factors with increased levels of psychological distress in immigrant populations. Confirmation of the predictive power of these risk factors awaits completion of a longitudinal study following the Ameriasians as they resettle in the United States.
Adolescent↗
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↗
Risk factors and their relation to initiation of alcohol use among early adolescents.
This study examined the relationship between risk factors and initiation of alcohol use over a 15-month period among a cohort of 7th graders who were abstainers at the time of initial testing. The relationship between risk factors and alcohol use was examined using a discriminant function analysis. At the univariate level, rejection of parental authority, deviant behavior, and sensation seeking were statistically significant. The discriminant function retained only three of the risk factors: rejection of parental authority, deviant behavior, and religious commitment. Implications for school-based prevention programs are discussed, particularly the need to target primary prevention programs based upon adolescents' risk.
Adolescent↗