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Biomedical subjects

J McLoughlin

Publications and source records attributed to J McLoughlin.

At least 19 recordsLinked to original sources
PubMed1992

Markers of the metastatic phenotype in prostate cancer.

Metastatic malignant disease is the single most common cause of treatment failure and subsequent mortality of most human malignancies, including prostate cancer. Presently, cells expressing the metastatic phenotype cannot be identified within a primary tumor population. Hence, accurate assessment of the likely behavior of an individual primary malignancy cannot be made at the time of diagnosis. The studies now reported have been aimed at identifying some of the features that may be associated with the metastatic phenotype of prostatic cancer. Insight into those factors that may be involved in prostate cancer metastasis has been gained from a variety of experimental approaches as well as study of intact human prostate cancers.

Animals↗
PubMed1992

Cerebellar manifestations of prostatic carcinoma.

We present two patients known to have prostate cancer who presented with acute cerebellar signs. The neurological deficit of the first patient was due to a paraneoplastic cerebellar manifestation and progressed, despite evidence of response of the primary prostate tumour to hormonal manipulation. The second case, resulting from a solitary cerebellar metastasis, was amenable to surgical intervention and subsequent hormonal manipulation. This latter patient has experienced no recurrent neurological signs after a period of 7 years follow-up. This is the first report of a paraneoplastic cerebellar deficit and, to our knowledge, only the sixth case of parenchymatous cerebellar metastasis of prostatic origin to appear in the literature.

Acute Disease↗
PubMed1992

Impact of short-term oral steroid use upon children's school achievement and behavior.

Physicians need clarification of whether the temporary use of adrenal corticosteroids to abort acute asthma can adversely effect school achievement and behavior problems. Nineteen nonsteroid-dependent asthmatic children were given prednisone orally while all other medications were kept constant. Five days later, when they were seen in the physician's office, an academic achievement test was administered to the child; and the child, a parent, and a teacher completed behavior rating surveys. After 2 weeks off the steroids the child returned to the physician's office and the achievement test and rating scales were completed again. There was no significant difference between the achievement test scores and behavior ratings in school or at home under the two conditions. Short-term use of oral steroids does not impair children's basic academic skills nor their behavior at school or home.

Administration, Oral↗
PubMed1991

Decrease in luteal gonadotropin concentration in conception cycles after in vitro fertilization/gamete intrafallopian transfer.

The concentrations of the gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured in the luteal phase of the cycle in patients undergoing ovarian hyperstimulation. In nonconception cycles, FSH and LH were increased in the late luteal phase compared with conception cycles in which both gonadotropins were suppressed. Estradiol (E2) and progesterone concentrations increased in pregnancy cycles and may be the sole cause for the decreased gonadotropin concentrations as shown by equivalent concentrations of LH and FSH in both pregnancy and nonpregnancy cycles after matching for E2 concentrations. Subjects who subsequently had twin pregnancy or a spontaneous abortion were compared with those with a successful ongoing singleton conception. There were no significant differences relative to LH and FSH between the three groups, although in twin pregnancy FSH tended to be lower at day 16 from oocyte recovery. It is concluded that suppression of LH and FSH in hyperstimulated pregnancy cycles occurs after the time of the rising human chorionic gonadotropin concentrations in plasma.

Abortion, Spontaneous↗
PubMed1991

Serum and urinary levels of beta human chorionic gonadotrophin in patients with transitional cell carcinoma.

Serum and early morning urine specimens were obtained from 62 patients. The levels of beta human chorionic gonadotrophin (BhCG) in both serum and urine were estimated simultaneously in all cases. At the time of estimation 43 patients had transitional cell carcinoma of the bladder, one had transitional cell carcinoma of the renal pelvis and three had carcinoma in situ (two of whom also had overt carcinoma). Raised serum and urinary levels were found in only three patients, all of whom had poorly differentiated or metastatic transitional cell carcinoma of the bladder. This observation is in accordance with previous studies. In one of these patients, who underwent transurethral resection of her bladder tumour, the urinary levels returned to within normal limits post resection. An additional three patients had elevations of serum BhCG. Two of these three patients had poorly differentiated transitional cell carcinoma present at the time of estimation and one had no sign of recurrence. Using immunoperoxidase staining a retrospective study was undertaken to stain all available sections belonging to patients studied to observe whether BhCG was being produced by the respective tumours. Twelve well differentiated, nine moderately well differentiated and seven poorly differentiated specimens were available. In no case was evidence of BhCG production demonstrated in these tumours despite its presence being demonstrable in positive controls. We confirm the production of BhCG associated with bladder tumours, a feature correlated with poorer differentiation. Studies employing larger patient numbers are necessary to clarify the role of this tumor marker in patients with well differentiated bladder tumours.

Carcinoma, Transitional Cell↗
PubMed1991

Dilatation of the prostatic urethra with 35 mm balloon.

A series of 54 men, 25 with acute urinary retention and 29 with cytometrically proven bladder outflow obstruction (BOO), underwent dilatation of the prostatic urethra using a 35 mm fixed diameter, low compliance balloon. In 42 patients this was performed under cystoscopic guidance and in 12 patients under fluoroscopic control. Three months following dilatation, 13/27 patients (48%) with BOO who returned for review were rendered unobstructed and 19/27 (70%) were symptomatically improved. By 6 months only 3 remained unobstructed but 15 remained symptomatically improved. Nine months after dilatation 14 patients retained symptomatic improvement but only 2 remained unobstructed. Of the 25 patients treated for acute retention only 6 voided spontaneously, 1 of these relapsing into retention at 2 months and another at 4 months. No patient was rendered unobstructed but 2 patients (who declined prostatectomy) noted an improvement in their obstructive symptoms at both 3 and 6 months. No patient developed retrograde ejaculation following dilatation. Balloon dilatation to 35 mm has no role in acute urinary retention but may have a role in younger men with BOO who wish to avoid prostatectomy and the risk of retrograde ejaculation. In these patients careful follow-up is required.

Aged↗
PubMed1990

The embryo freezing programme at Groote Schuur Hospital. First results.

'Surplus' embryos from 28 patients on the in vitro fertilisation programme at Groote Schuur Hospital were frozen for transfer in later cycles. Depending on the stage of the embryos, either propanediol or glycerol was used as a cryoprotectant. In 20 patients embryos survived the thawing procedure and were transferred. Five pregnancies resulted, 2 twin and 3 singleton. The pregnancy rate per embryo transfer in this group of patients in thus 25%. The pregnancy rate per freezing procedure is 19.2%.

Cryopreservation↗
PubMed1990

Wallstent endoprostheses for the relief of prostatic urethral obstruction in high risk patients.

Twenty-one patients with prostatic urethral obstruction who were unfit for surgery were treated with self-expandable stainless steel endoprostheses inserted under fluoroscopic guidance. The procedure was technically successful in all patients, although in one case a second stent was required 2 months later. One patient developed a urethral stricture in the 12-16 month follow up period. One case of epididymoorchitis and one case of septicaemia after stenting were treated successfully with antibiotics. Endoprostheses represent a satisfactory alternative to prostatectomy in high-risk patients.

Aged↗
PubMed1990

Alternatives to prostatectomy.

The danger of the treatments described are that patients may be treated without referral to a urologist. Investigations to determine whether genuine obstruction is the cause of their symptoms may not be performed and follow-up to exclude the side effects of their outflow obstruction or indeed their treatment may not be carried out. In addition, in cases where digital palpation does not alert the clinician to the possibility of prostatic malignancy, the loss of specimens for histological interpretation may lead to missed diagnoses. In summary, the alternatives to prostatectomy are still limited. Hormonal manipulation, hyperthermia and prostatic dilatation using the smaller balloons have no role at present in symptomatic patients. The role of larger balloons has still to be determined. Alpha blockade, while achieving relief in the short-term, still requires long-term objective follow-up studies in patients with urodynamically proven obstruction to assess patient compliance and the effects of treatment before it can be recommended as a long-term alternative. Similar information is also required before the efficacy of hyperthermia in patients with retention can be determined. For high risk patients with a limited life expectancy who present with retention of urine, prostatic stents may have a role, but once again long-term follow-up data are required before this treatment can be advocated in fitter or symptomatic patients.

Adrenergic alpha-Antagonists↗
PubMed1990

Visual analogue scales distinguish between low urinary flow rates due to impaired detrusor contractility and those due to bladder outflow obstruction.

In patients with symptoms suggestive of bladder outflow obstruction and a free flow rate less than 12 ml/s a visual analogue scale was used to measure the response to the question "Compared to 5 years ago, how thick is your stream when you pass urine?". The visual analogue scale compared favourably with cystometry in distinguishing between low flow rates resulting from impaired detrusor contractility and low flow rates due to bladder outflow obstruction. A visual analogue scale may serve to alert the surgeon to the presence of impaired detrusor contractility and the need for a fuller urodynamic assessment in patients with a low urinary flow rate prior to consideration for prostatectomy.

Aged↗
PubMed1990

The use of prostatic stents in patients with urinary retention who are unfit for surgery. An interim report.

Under local anaesthesia, 19 patients (18 with acute and 1 with chronic urinary retention) underwent insertion of an expandable stainless steel tubular "stent" into their prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. The 18 patients with acute retention voided spontaneously following the initial stent procedure, but the patient with chronic retention required a period of suprapubic catheterisation. Following the endoscopic insertion of an additional stent this patient also voided spontaneously. During a follow-up period of 3 to 7 months (mean 4), 4 patients were lost to follow-up. The remaining 15 patients all void spontaneously. Recurrent asymptomatic urinary tract infections were seen in all but 1 patient initially, but none of those who were followed up for over 5 months had evidence of infection. Although the follow-up period is limited, the results to date demonstrate that the insertion of an expandable prostatic stent is a safe and reliable method of treating acute urinary retention in patients unfit for surgery. Further follow-up is required to assess long-term safety and to exclude late complications.

Aged↗
PubMed1990

Symptoms versus flow rates versus urodynamics in the selection of patients for prostatectomy.

Many prostatectomies are performed on the basis of symptoms alone; 39% of patients referred by their family doctors and 23% of patients who were on waiting lists for prostatectomy of other hospitals, but who had not undergone any urodynamic investigations, were found to be unobstructed on urodynamic criteria. A screening peak urinary flow rate of 12 ml/s or less was associated with urodynamic evidence of obstruction in 95% of cases; 35% of patients with symptoms of outflow obstruction and a flow rate greater than 12 ml/s were also found to be obstructed. One year post-operatively, 84% of patients who were selected for surgery on combined symptomatic and urodynamic criteria were pleased symptomatically with their result. The failure of detrusor instability to resolve following prostatectomy was associated with symptomatic failure of treatment. Residual obstruction was demonstrated in 5 patients who had undergone prostatectomy and were asymptomatic at this time. This study illustrates that objective measures are necessary in the assessment of patients prior to prostatectomy in order to select only patients who are obstructed. The importance of a screening flow rate is emphasised. All patients who underwent surgery had cystometric evidence of obstruction but the symptomatic results of surgery were no better than the results in patients who had been assessed according to non-urodynamic selection criteria. We have thus failed to identify a need for routine cystometry in the pre-operative assessment of these patients. Cystometry does, however, have a role in assessing patients with pre-operative flow rates greater than 12 ml/s and in those who remain symptomatic following prostatectomy.

Humans↗
PubMed1990

Prostatic stents and balloon dilatation.

Prostatic obstruction of urinary flow is a common age-related event resulting in both troublesome symptoms and retention of urine. There have been recent developments in the management of such patients by inserting metallic stents or by balloon dilatation of the prostatic urethra. The role of these treatments as alternatives to surgery is evaluated and some of the difficulties encountered in their usage are described in this article.

Aged↗
PubMed1990

The normal IVU: a trap for the unwary.

Intravenous urography (IVU) is considered to be a reliable means of investigating the urinary tract for renal pathology. We present two cases of patients who were investigated for loin pains. In both patients the IVU appearances were normal but the final diagnosis, as obtained by ultrasound, was renal cell carcinoma of the upper pole of the right kidney.

Carcinoma, Renal Cell↗