Prostatorectal fistula 14 years following brachytherapy for prostate cancer.
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Brachytherapy↗
Biomedical subjects
J W Davis
Publications and source records attributed to J W Davis.
Influenza vaccination, hospitalizations, and costs among members of a Medicare managed care plan.
OBJECTIVE: To evaluate the effectiveness and possible cost savings of influenza vaccination. SUBJECTS: Members age 65 and older in a Medicare managed care plan during the 1994-1995, 1995-1996, and 1996-1997 influenza seasons. RESEARCH DESIGN: The study examined administrative data on influenza vaccination and subsequent hospitalizations. Outcomes included hospitalization with pneumonia or influenza, with any respiratory condition, and with congestive heart failure (CHF). RESULTS: Vaccinated subjects experienced fewer hospitalizations with respiratory conditions or CHF than had unvaccinated subjects (OR=0.8 (95% CI, 0.7, 0.9) in analyses adjusted for age, sex, pneumococcal vaccination, health utilization, and morbidity). Analyses adjusted in addition for ethnicity obtained similar results among the subgroup of members whose ethnicity was known. Subjects without major disease in the previous 12 months had lower odds ratios for vaccination than subjects with major disease (OR values of 0.5 [95% CI, 0.4, 0.7] and 0.9 [95% CI, 0.8, 1.1], respectively). Subjects ages 65 to 79 had lower odds ratios for vaccination than subjects ages 80 and older (OR values of 0.7 [95% CI, 0.6, 0.9] and 0.9 [95% CI, 0.8, 1.1], respectively). Estimated cost savings averaged about $80 per vaccinated subject. CONCLUSIONS: Subjects ages 65 to 79 who had received influenza vaccination experienced fewer hospitalizations and had lower costs than had unvaccinated subjects. Associations were weaker for subjects age 80 and older. The results, consistent with recommendations for the use of influenza vaccine, suggest that people ages 65 to 79 should be heavily targeted for vaccination.
Acute Disease↗
Comparison of performance-based measures among native Japanese, Japanese-Americans in Hawaii and Caucasian women in the United States, ages 65 years and over: a cross-sectional study.
BACKGROUND: Japanese (both in Japan and Hawaii) have a lower incidence of falls and of hip fracture than North American and European Caucasians, but the reasons for these differences are not clear. SUBJECTS AND METHODS: A cross-sectional study. We compared neuromuscular risk factors for falls using performance-based measures (chair stand time, usual and rapid walking speed, and grip strength) among 163 Japanese women in Japan, 681 Japanese-American women in Hawaii and 9403 Caucasian women in the United States aged 65 years and over. RESULTS: After adjusting for age, the Caucasian women required about 40% more time to complete 5 chair stands than either group of Japanese. Walking speed was about 10% slower among Caucasians than native Japanese, whereas Japanese-American women in Hawaii walked about 11% faster than native Japanese. Grip strength was greatest in Japan, which may reflect the rural farming district that this sample was drawn from. Additional adjustment for height, weight or body mass index increased the adjusted means of chair stand time and grip strength among Japanese, but the differences remained significant. CONCLUSIONS: Both native Japanese and Japanese-American women in Hawaii performed better than Caucasians on chair stand time and walking speed tests, and native Japanese had greater grip strength than Japanese in Hawaii and Caucasians. The biological implications of these differences in performance are uncertain, but may be useful in planning future comparisons between populations.
Journal Article↗
Quality of life after treatment for localized prostate cancer: differences based on treatment modality.
PURPOSE: Brachytherapy with 103palladium (103Pd) is an increasingly administered treatment modality for localized prostate cancer. We compared general and disease specific health related quality of life after 103Pd treatment, radical prostatectomy and external beam radiation therapy given during the same time frame. MATERIALS AND METHODS: We performed a retrospective cross-sectional survey study of patients treated at a single community medical center between 1995 and 1999. We mailed 5 validated health related quality of life survey instruments to 269, 142 and 222 men who underwent radical prostatectomy, 103Pd treatment and external beam radiation therapy, respectively, with a response rate of greater than 80% in all groups. RESULTS: General health related quality of life assessed by the SF-36 showed the same scores in patients who underwent prostatectomy and 103Pd treatment. The University of California-Los Angeles Prostate Cancer Index was used to assess bowel, urinary and sexual function/bothersomeness. External beam radiation therapy reported was associated with worse bowel function and greater bowel bothersomeness. Prostatectomy was associated with worse urinary function compared to 103Pd and external beam radiation therapy. Prostatectomy was associated with worse sexual function than 103Pd or external beam radiation therapy, although nerve sparing surgery and erectile aids minimized the difference. American Urological Association symptom scores were initially higher for 103Pd but became equal to those in the other groups in patients treated greater than 12 months from survey time. Disease-free men who underwent prostatectomy and 103Pd brachytherapy were equally confident that cancer would not recur in the future. Satisfaction rates were equivalent and biochemical failure significantly decreased satisfaction in all groups. CONCLUSIONS: While general health related quality of life was mostly unaffected by the 3 most common treatments for prostate cancer, there were differences in bowel, urinary and sexual function. This information may aid patients in the decision making process.
Aged↗
Domestic violence and the trauma surgeon: results of a study on knowledge and education.
BACKGROUND: Despite the frequency of domestic violence in trauma patients, little emphasis has been placed on this subject in the education of surgeons and emergency medicine physicians. The 1997 Advanced Trauma Life Support (ATLS) course included, for the first time, education about domestic violence. This study was done to test the hypothesis that baseline knowledge about domestic violence in trauma care providers is poor and is not improved by the 1997 ATLS course. STUDY DESIGN: A study on domestic violence was designed using attending general surgeons, general surgery and emergency medicine residents, and medical students as test subjects. An educational lecture and pre- and post-tests were developed using the Eastern Association for the Surgery of Trauma position paper on domestic violence and other peer-reviewed literature as information sources. Data collected included level of training, date ATLS course was taken, and pre- and post-test scores. Statistical analysis was performed with ANOVA, with significance attributed to p < 0.05. RESULTS: Ninety-two subjects attended the lecture and completed the pre- and post-tests. The overall mean pre-test score was 54 +/- 1. There was no difference in scores for the 1997 ATLS cohort (with domestic violence material) versus the group with earlier ATLS courses (52 +/- 2 versus 51 +/- 1). The group that had never taken ATLS scored significantly better on the pre-test than the other groups (58 +/- 2, p < 0.05). All groups had significantly increased scores on the post-test (mean 77 < 1, p < 0.001 versus pre-test). CONCLUSIONS: Baseline knowledge about domestic violence among surgeons and emergency medicine physicians was poor and was not improved by participation in the 1997 ATLS course. This study strongly supports the need for expanded domestic violence education for trauma care providers.
Adult↗
2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) inhibits growth factor withdrawal-induced apoptosis in the human mammary epithelial cell line, MCF-10A.
Previous studies have demonstrated that 2,3,7, 8-tetrachlorodibenzo-p-dioxin (TCDD) increases cell recovery in the human mammary epithelial cell line MCF-10A grown under growth factor-restricted conditions. TCDD was also found to mimic growth factor signaling pathways by stimulating the tyrosine phosphorylation of numerous effector molecules, and increased phosphatidylinositol 3-kinase (PI3K) activity in the absence of exogenously added growth factors. In the present studies, we have expanded on these initial results to show that TCDD (3-30 nM) increases cell recovery on days 2-6 by as much as 80% when insulin or epidermal growth factor (EGF) was removed from the media. The mechanism for this effect appears to be complex as TCDD inhibited apoptosis stimulated by EGF, or EGF and insulin, withdrawal by almost 80% as determined by Annexin V binding. However, withdrawal of insulin alone did not induce apoptosis even though TCDD did increase cell number in its absence. These results were corroborated by immunoblot analysis of poly(ADP-ribose) polymerase cleavage. Since TCDD stimulates PI3K activity, the phosphorylation status of Akt, a serine/threonine kinase that mediates PI3K-dependent inhibition of apoptosis, was examined. Immunoblot analysis revealed that TCDD causes a transient increase in the phosphorylated form of Akt that peaks at 6 h and disappears by 12 h. It appears that EGF stimulates an anti-apoptotic pathway, while insulin signals a pro-mitogenic pathway. By stimulating or mimicking one or both of these pathways TCDD may alter tightly regulated growth pathways in the MCF-10A cell line.
Apoptosis↗
Relation between body composition and biochemical markers of bone turnover among early postmenopausal women.
We studied the associations between body composition and biochemical markers of bone formation and resorption among 1600 postmenopausal women, ages 45-59. Multiple regression analyses were performed to examine the independent associations of fat mass, muscle strength (quadriceps strength), height, and whole body bone mineral content (BMC) with biochemical markers of bone formation (serum osteocalcin) and resorption (urinary type I collagen crosslinked N-telopeptides [NTX]). Per interquartile range (IQR) (the difference between 75th and 25th percentiles) increase in fat mass and whole body BMC, the mean levels of osteocalcin decreased by 3% and 13%, respectively; NTX decreased by 5 and 21%. Fat mass and whole-body BMC were also significantly associated with decreases in the average of osteocalcin and NTX Z-scores. By contrast, the mean levels of serum osteocalcin increased by 2 and 11%, respectively, per IQR increase in muscle strength and height; NTX increased by 4 (not significant) and 14%, respectively. Both muscle strength and height were significantly associated with increases in the average Z-scores. These exploratory analyses suggest that fat mass and whole-body BMC were associated with decreased bone turnover, while muscle strength and height were associated with increased bone turnover.
Adipose Tissue↗
Are we ready for genetics?
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Ethics, Medical↗
Alendronate and estrogen-progestin in the long-term prevention of bone loss: four-year results from the early postmenopausal intervention cohort study. A randomized, controlled trial.
BACKGROUND: Up to 3 years of treatment with alendronate, 5 mg/d, prevents postmenopausal bone loss. OBJECTIVE: To determine whether the effect of alendronate is sustained at 4 years of treatment and persists after treatment is discontinued. DESIGN: Randomized, controlled trial. SETTING: United States and Europe. PARTICIPANTS: 1609 postmenopausal women 45 to 59 years of age. INTERVENTION: Participants were randomly assigned to receive oral alendronate, 5 mg/d or 2.5 mg/d; placebo; or open-label estrogen-progestin. Women in the alendronate groups received alendronate for the first 2 years of the study. Treatment was then continued without change or replaced with placebo for the last 2 years of the study. MEASUREMENTS: Annual measurement of bone mineral density. RESULTS: By year 4, the bone mineral density of participants in the placebo group had decreased by 1% to 6% (P < 0.001). Four years of treatment with 5 mg of alendronate per day increased bone mineral density at the spine (mean change [+/-SE], 3.8%+/-0.3%), hip (mean, 2.9%+/-0.2%), and total body (mean, 0.9%+/-0.2%) (P < 0.001 overall). By year 4, bone mineral density at most skeletal sites was greater in participants who switched from alendronate to placebo than in those who continuously received placebo. In years 3 and 4, bone loss in participants who switched from alendronate to placebo was similar to that seen during years 1 and 2 in those who continuously received placebo. Compared with 5 mg of alendronate per day, estrogen-medroxyprogesterone acetate produced similar increases in bone mineral density and estradiol-norethisterone acetate produced increases that were substantially greater. CONCLUSIONS: Four years of treatment with alendronate or estrogen-progestin prevented postmenopausal bone loss. A residual effect was seen 2 years after alendronate therapy was stopped; however, continuous alendronate treatment was more effective in preventing postmenopausal bone loss than 2 years of alendronate followed by 2 years of placebo.
Alendronate↗
Ethnic, anthropometric, and lifestyle associations with regional variations in peak bone mass.
The study investigated the ability of ethnicity and anthropometric and lifestyle factors to account for differences within subjects in bone mass at different skeletal sites. The subjects were young, adult, Japanese, Filipino, Hawaiian, and white women ages 25-34. In the preliminary analyses, they were divided into thirds based on their BMD z-scores. Thirty-five percent exhibited high variability in bone mass: they were in the upper third at one or more bone sites and in the lower third at one or more sites. Other women had more generalized low bone mass: 25% were in the lowest third for two or more sites, and there were no sites with low bone mass in the upper third. In subsequent analyses, ethnicity, anthropometry, and lifestyle influences were examined as possible predictors of differences in bone mineral content (BMC) between bone sites in bone-size adjusted models. White women had greater BMC at the proximal radius and calcaneus than at the distal radius compared with other ethnic groups. This may be explained by the fact that they had exceptionally wide bone widths at the distal radius. Of the anthropometric variables, fat mass was associated with higher bone mass at sites with higher proportions of cancellous tissue (calcaneus > spine > radius sites). Muscle mass was associated with greater bone mass at the calcaneus and proximal radius than at the spine. For the lifestyle variables, women with greater milk consumption between the ages of 10-24 years had higher spine bone mass than expected from their measurements at the proximal radius. Women 12-17 years of age who had been more active in sports had higher calcaneous bone mass than expected from their spine measurements. As the study participants were still young women, the results suggest that regional differences in bone mass may partly derive from anthropometric and lifestyle influences during skeletal maturation.
Absorptiometry, Photon↗
Conservative surgical therapy for penile and urethral carcinoma.
OBJECTIVES: Invasive penile and urethral tumors are traditionally treated with aggressive excision that requires involved organ and adjacent organ sacrifice. An alternative approach seeks to completely excise the tumor with adequate margins while preserving form and function of the organ. We present 6 patients who underwent such organ-sparing surgery. METHODS: Six selected cases (4 penile and 2 urethral) are presented with operative photographs and pertinent data. RESULTS: Three distal tumors of the penis were treated with excision limited to the glans with histopathologic findings of verrucous carcinoma, melanoma, and angiosarcoma. One patient with squamous cell carcinoma of the distal shaft refused partial penectomy and underwent a local wedge resection. A patient with locally advanced bulbourethral transitional cell carcinoma (TCC) refused cystourethrectomy and underwent an anterior urethrectomy and perineal urethrostomy. A 48-year-old woman with an adenocarcinoma contained in a very distal urethral diverticulum underwent simple diverticulectomy and excision of distal urethra. Postoperative voiding and sexual function were well preserved. Follow-up was 12 to 48 months. The patient with angiosarcoma died of lung metastases at 48 months with no local disease, and the patient with bulbourethral TCC developed pelvic disease at 12 months with no local recurrence and died of metastases at 25 months. CONCLUSIONS: Organ-sparing surgery is appropriate in selected patients on the basis of stage and location, high risk of distant failure, and patient disposition. Close follow-up is necessary. Comanagement with reconstructive and oncologic specialists optimizes results and outcomes.
Adult↗
Means for load variation during echocardiographic assessment of the Frank-Starling relationship.
Because minimally invasive methods of preload variation are not validated for load-insensitive indexes of cardiac performance, intravenous nitroglycerin (NTG), phenylephrine, and saline solution (VOL) boluses were used in blocked and intact autonomic states to alter load and were compared with vena caval occlusion in the assessment of preload recruitable stroke work relationships between stroke work and left ventricular end-diastolic volume in dogs. In both autonomic states NTG and VOL produced comparable linear relationships. NTG and saline solution were combined with noninvasive measurements of left ventricular pressure and volume to construct echocardiographic relationships between stroke work and left ventricular end-diastolic cross-sectional area; NTG produced linear relationships similar to vena caval occlusion. Therefore NTG and VOL reliably alter load in constructing preload recruitable stroke work relationships, and NTG may be used with noninvasive measurements to provide load-insensitive estimates of cardiac function in a minimally invasive manner.
Analysis of Variance↗
Spatial relationships between prevalent and incident spine fractures.
Women with prevalent fractures have an increased risk of developing additional, incident fractures. This article examines the relation between the location of prevalent fractures within the spine and the risk of subsequent vertebral fractures. The subjects were 721 Japanese-American women of mean age 69.5 +/- 5.3 (SD) years. For the analyses, the spine was categorized into three regions: an upper region, vertebrae T3-11; a middle region, vertebrae T-12 and L-1; and a lower region, vertebrae L2-5. Initial analyses were limited to women with, at most, one prevalent fracture. Compared to women without fracture, women with a prevalent fracture had odds ratios of 2-5 for developing an incident fracture outside the prevalent region. Subsequent analyses included women with multiple prevalent fractures. Women having two or three prevalent fractures had odds ratios of 7-9 for developing an incident fracture outside the prevalent region. The results suggest that the increased fracture risk of women with prevalent fractures extends beyond nearby vertebrae, and can affect vertebrae both above and below the prevalent fracture.
Aged↗
Differences in health characteristics between native Japanese and Japanese-Americans.
Health characteristics were compared among 1193 Japanese in Hiroshima, and 2306 Japanese-Americans in Hawaii. Japanese women experienced later menarche, earlier menopause, and a shorter interval between menarche and menopause than Japanese-Americans. Japanese men and women were shorter and lighter and the men bad lower body mass index than Japanese-Americans. Differences between populations were also found for the prevalence of artificial menopause, number of live births, lactation period, smoking, and alcohol consumption. Within one or both populations, significant trends with birth year were found for age at menarche, age at menopause, interval between menarche and menopause, lactation period, height, weight, and body mass index, suggesting the existence of cohort effects. Some of these trends may also reflect age-related changes. Environmental factors likely contribute to the differences in physique and reproductive factors, which may explain differences in frequency of osteoporosis, cardiovascular diseases, and cancer between the two populations.
Journal Article↗
A cross-cultural comparison of neuromuscular performance, functional status, and falls between Japanese and white women.
BACKGROUND: Previous studies have reported that the incidence of falls among Japanese women is about half that of white women. The difference in incidence might result from differences in neuromuscular performance, such as muscle strength, mobility, and balance. This hypothesis was tested by comparing two community-dwelling populations: Japanese women in the Hawaii Osteoporosis Study, and Caucasian women in the Study of Osteoporotic Fractures. METHODS: Neuromuscular performance was assessed for women in the two cohorts using standardized procedures. Falls were monitored longitudinally, using surveys mailed at 4-month intervals. RESULTS: The Japanese and white women differed substantially in their neuromuscular performance. The Japanese women had faster walking speeds and chair stands, and performed better on a series of balance tests. The white women had greater strength, particularly at the quadriceps, and faster hand and foot reaction times. The white women also reported fewer functional disabilities, including fewer difficulties in climbing steps, doing heavy housework, and shopping for groceries. In age-adjusted analyses, the risk of falls was greater for the white women [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.6, 2.0]. After adjusting for the neuromuscular test results and the number of functional disabilities, the odds ratio for the risk of falls remained essentially the same (OR = 1.8; 95% CI = 1.5, 2.1). CONCLUSIONS: The Japanese and white women had different advantages and limitations in neuromuscular performance. These differences, however, did not explain the lower risk of falls among Japanese women.
Accidental Falls↗
Endoluminal stent placement for the treatment of traumatic carotid artery pseudoaneurysm: case report and review of the literature.
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Adult↗
Blunt ureteropelvic junction disruption.
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Abdominal Injuries↗
The durability of external beam radiation therapy for prostate cancer: can it be identified?
PURPOSE: We establish criteria to identify a durable response to external beam radiation therapy by calculation of biochemical progression-free probability for patients who attained and maintained defined nadir prostate specific antigen (PSA) levels more than 5 years after treatment. MATERIALS AND METHODS: A total of 460 patients were treated with external beam radiation monotherapy from 1976 to 1995. Patients with PSA less than 0.5 (group 1) or 0.5 to 1.0 (group 2) ng./ml. more than 5 years after treatment were identified. Treatment failure was defined as 3 consecutive increases in PSA after nadir. Progression-free probability after 60 months was calculated for each group. A comparison was also made to patients achieving the same nadir levels anytime after treatment. RESULTS: Failure occurred at 133 months in 1 of 26 group 1 patients (4%) and at a median of 76 months in 5 of 26 group 2 patients (19%). At 10 years progression-free probability was 91% for group 1 compared to 72% for group 2 (p = 0.0575). These same nadir levels anytime after treatment were associated with higher failure rates of 55% for group 1 and 72% for group 2. CONCLUSIONS: If a PSA nadir of less than 0.5 ng./ml. was maintained 5 years after therapy, subsequent failure was rare. Although statistical significance was not reached (p = 0.0575), a higher failure rate was noted if the nadir PSA was 0.5 to 1.0 ng./ml. at 5 years. Thus, patients with PSA 0.5 to 1.0 ng./ml. require careful continued surveillance. Nadir levels less than 1.0 ng./ml. anytime before 5 years were associated with a substantial risk of subsequent progression.
Disease Progression↗