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Biomedical subjects

M J Barry

Publications and source records attributed to M J Barry.

At least 73 records · Page 4Linked to original sources
PubMed1997

Spontaneous mediastinal hemorrhage: a case report with a review of the literature.

A patient on chronic hemodialysis presenting with shortness of breath and dysphagia was found to have massive hemomediastinum. A review of the world's literature prompted by this case reveals that this rare entity can be classified into three general groups: (1) hemomediastinum secondary to underlying bleeding disorder, (2) hemomediastinum secondary to hemorrhage into a mediastinal organ or gland, without underlying bleeding disorder and (3) idiopathic hemomediastinum, without underlying bleeding disorder. Therapy depends upon the underlying etiology and the severity of symptoms.

Acute Disease↗
PubMed1996

Controversies in prostate cancer screening. Analogies to the early lung cancer screening debate.

The current debate regarding early detection and aggressive treatment of prostate cancer is fueled by the absence of controlled studies defining the risks and benefits of prostate cancer screening, and by the lack of adequately powered trials demonstrating the benefit of curative treatment for early-stage prostate cancer. Pending the results of clinical trials in 10 to 15 years, advocates of early detection of prostate cancer with digital rectal examination and prostate-specific antigen have compared prostate cancer screening with the effective strategy of breast cancer screening, implying that prostate cancer screening should similarly reduce cancer mortality. They have also cited the high burden of disease, the acceptable operating characteristics of digital rectal examination and prostate-specific antigen, a stage shift among cases detected by screening, and the theoretical curability of early-stage disease as sufficient reasons to proceed with screening. These arguments, however, are reminiscent of earlier arguments in favor of lung cancer screening with chest x-ray examination and sputum cytology, a practice ultimately proven ineffective in clinical trials. We reviewed published articles on lung and prostate cancer screening and identified many parallels. While prostate cancer screening may one day prove effective, analogies between the current prostate cancer screening controversy and the older lung cancer screening debate should inject some caution regarding widespread dissemination of prostate cancer screening without experimental evidence that such screening does more good than harm.

Clinical Trials as Topic↗
PubMed1996

The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group.

BACKGROUND: Men with benign prostatic hyperplasia can be treated with alpha 1-adrenergic-antagonist drugs that relax prostatic smooth muscle or with drugs that inhibit 5 alpha-reductase and therefore reduce tissue androgen concentrations. However, the effects of the two types of drugs have not been compared. METHODS: We compared the safety and efficacy of placebo, terazosin (10 mg daily), finasteride (5 mg daily), and the combination of both drugs in 1229 men with benign prostatic hyperplasia. American Urological Association symptom scores and peak urinary-flow rates were determined at base line and periodically for one year. RESULTS: The mean changes from base line in the symptom scores in the placebo, finasteride, terazosin, and combination-therapy groups at one year were decreases of 2.6, 3.2, 6.1, and 6.2 points, respectively (P<0.001 for the comparisons of both terazosin and combination therapy with finasteride and with placebo). The mean changes at one year in the peak urinary-flow rates were increases of 1.4, 1.6, 2.7, and 3.2 ml per second, respectively (P<0.001 for the comparisons of both terazosin and combination therapy with finasteride and with placebo). Finasteride had no more effect on either measure than placebo. In the placebo group, 1.6 percent of the men discontinued the study because of adverse effects, as did 4.8 to 7.8 percent of the men in the other three groups. CONCLUSIONS: In men with benign prostatic hyperplasia, terazosin was effective therapy, whereas finasteride was not, and the combination of terazosin and finasteride was no more effective than terazosin alone.

Adrenergic alpha-Antagonists↗
PubMed1996

Follow-up prostate cancer treatments after radical prostatectomy: a population-based study.

BACKGROUND: Radical prostatectomy is one of the most commonly used curative procedures for the treatment of localized prostate cancer. The probability that a patient will undergo additional cancer therapy after this procedure is largely unknown. PURPOSE: The objective was to determine the likelihood of additional cancer therapy after radical prostatectomy. METHODS: Data for this study were derived from a linked dataset that combined information from the Surveillance, Epidemiology, and End Results Program and Medicare hospital and physician claims. Records were included in this study if patient histories met the following criteria: (a) residing in Connecticut, Washington (Seattle-Puget Sound), or Georgia (Metropolitan Atlanta); (b) having been diagnosed with prostate cancer during the period from January 1, 1985, through December 31, 1991; (c) undergoing radical prostatectomy by December 31, 1992; and (d) having no evidence of other types of cancer. Patients were considered to have had additional cancer therapy if they had had radiation therapy, orchiectomy, and/or androgen-deprivation therapy by injection after radical prostatectomy. The interval between the initial treatment and any follow-up treatment was calculated from the date of radical prostatectomy to the 1st day of the follow-up cancer therapy. All presented probabilities are based on Kaplan-Meier estimates. RESULTS: The study population consisted of 3494 Medicare patients, 3173 of whom underwent radical prostatectomy within 3 months of prostate cancer diagnosis. Although radical prostatectomy is often reserved for localized cancer, less than 60% (1934) of patients whose records were included in this study had organ-confined disease, according to final surgical pathology. Overall, the 5-year cumulative incidence of having any additional cancer treatment after radical prostatectomy reached 34.9% (95% confidence interval [CI] = 31.5%-38.5%). For patients with pathologically organ-confined cancer, the 5-year cumulative incidence was 24.3% (95% CI = 20.0%-29.3%) overall and ranged from 15.6% (95% CI = 9.7%-24.5%) for well-differentiated cancer (Gleason scores 2-4) to 41.5% (95% CI = 27.9%-58.4%) for poorly differentiated cancer (Gleason scores 8-10). The corresponding figures for pathologically regional cancer were 22.7% (95% CI = 12.0%-40.5%) and 68.1% (95% CI = 58.7%-77.1%). CONCLUSION: Further treatment of prostate cancer was done in about one third of patients who had had a radical prostatectomy with curative intent and in about one quarter of patients who were found to have organ-confined disease. IMPLICATIONS: Given the common requirement for follow-up cancer treatments after radical prostatectomy and the uncertainties about the effectiveness of the various follow-up treatment strategies, further investigation of these treatments is warranted.

Aged↗
PubMed1996

Effects of an organochlorine pesticide on different levels of biological organization in Daphnia.

The toxicity of the organochlorine pesticide, endosulfan, to Daphnia carinata was measured at three levels of biological organization: allocation of resources to reproduction, growth and reproductive rates, and population dynamics. The mechanisms by which responses at one level of organization manifest at higher levels are discussed. Two experiments were performed: in the first experiment, groups of Daphnia were exposed to endosulfan at one of three concentrations (0, 40, or 80 microg/liter) and two algal food levels (Selanastrum capricornatum) (1 x 10(5) or 5 x 10(4) cells/ml). Animals were subsampled daily and length, dry weight, egg number, total egg mass, mean egg weight, and timing of reproduction measured. The fraction of available resources that were allocated to reproduction was calculated. In the second experiment, 12 populations of Daphnia were established in flowthrough culture systems. Populations were allowed to grow for 45 days before addition of endosulfan at 0, 40, 80, or 160 microg/liter. Population density, the number of egg-bearing females, and the chlorophyll a concentration in each culture were measured at weekly intervals. The effects of endosulfan on length, dry weight, brood size, and total egg mass were greater at the high food level; however, the timing of reproduction was significantly delayed for the low-food endosulfan-exposed animals. A model is proposed whereby the low-food animals increased the intermolt period to partially offset the costs of endosulfan toxicity. The fraction of available resources allocated to reproduction increased with each instar, although no endosulfan-induced changes could be detected. Daphnia population densities fluctuated in a cyclic manner. Chlorophyll a concentration also fluctuated with peaks coinciding with depressions in the daphnid population density. The effect of endosulfan was to dampen the amplitude of the cycles.

Analysis of Variance↗
PubMed1996

Comparative acute and chronic toxicity of diethylenetriamine pentaacetic acid (DTPA) and ferric-complexed DTPA to Daphnia carinata.

The acute and chronic toxicity of diethylenetriamine pentaacetic acid (DTPA) and ferric complexed DTPA (Fe[III]-DTPA) to Daphnia carinata were compared, while the effects of DTPA exposure prior to and/or during 1st brood embryogenesis were also assessed. For chronic exposures, daphnids were exposed to DTPA at high or low food levels, or to Fe(III)-DTPA at high food level until the 6th reproductive instar. The 48 h LC50S of DTPA and Fe(III)-DTPA to D. carinata were 245 mg/L and > 1,000 mg/L, respectively. Chronic exposure to 10 mg/L DTPA resulted in a significant reduction in all individual brood sizes, while it increased the age at each reproductive instar. Ten mg/L DTPA also significantly decreased the cumulative number of offspring per adult at high and low food level from 161.3 +/- 14.6 to 11.3 +/- 4.9 offspring, and 56.4 +/- 1.8 to 0 +/- 0 offspring, respectively, while a similar effect was observed for the number of offspring per adult per day. Both the 3rd and 5th brood sizes were also significantly reduced at 1 mg/L DTPA, but only at high food level, from 39.0 +/- 2.9 to 27.6 +/- 3.8 offspring, and 49.3 +/- 5.0 to 39.9 +/- 4.2 offspring, respectively. Chronic exposure to Fe(III)-DTPA had little effect on D. carinata, but there was a significant negative relationship between Fe(III)-DTPA and the number of offspring per adult per day (y = -0.024x + 14.048, r2 = 0.20, n = 26, P < 0.02). This was due to a 25% reduction in reproduction at 134 mg/L Fe(III)-DTPA, the highest test concentration, compared to controls. The no-observed-effect concentrations (NOEC) and lowest-observed-effect concentrations (LOEC) for DTPA and Fe(III)-DTPA following chronic exposure to D. carinata were 1.0 and 10 mg/L, and 67 and 134 mg/L, respectively, although the possibility of effects occurring below 10 mg/L DTPA could not be discounted. Exposure to DTPA prior to 1st brood embryogenesis significantly decreased the 1st brood size but did not affect the 2nd brood size, while exposure during 1st brood embryogenesis significantly decreased the 2nd brood size, but did not affect the 1st brood size, indicating the reproductive impairment was due to maternally-mediated factors and not direct toxicity to the eggs. The decrease in DTPA toxicity when complexed with Fe(III) was attributed to preferential binding with that metal, thereby limiting any further chelating ability. Concentrations of DTPA in receiving waters are unlikely to be toxic to D. carinata.

Animals↗
PubMed1996

Interpreting results of prostate-specific antigen testing for early detection of prostate cancer.

OBJECTIVE: Calculation of likelihood ratios for serum prostate-specific antigen (PSA) levels to discriminate potentially curable prostate cancer in men selected for having benign prostatic hyperplasia (BPH) or in randomly selected men. DESIGN: Retrospective analysis of prospectively measured PSA levels. SETTING: A tertiary referral center, a multicenter randomized controlled trial, and a community-based study, all providing PSA data. PATIENTS: We used PSA measurements from four groups of men aged 50 to 79 years: 276 men with organ-confined prostate cancer treated with radical prostatectomy, 305 randomly selected men without clinical evidence of prostate cancer or a history of surgery for BPH recruited for a community study, 173 men without cancer but with BPH coming to prostatectomy, and 770 men without cancer and with symptoms of BPH enrolled in the North American finasteride clinical trial. MEASUREMENTS AND MAIN RESULTS: Age-standardized, stratum-specific likelihood ratios for organ-confined prostate cancer were calculated separately for unselected men in the community sample and for selected men with BPH (pooling both BPH populations). Likelihood ratios ranged from 0.2 for PSA between 0.0 and 2.0 ng/mL to 54.8 for a PSA level of 10.1 ng/mL or higher in unselected men, but rose to only 2.9 for PSA values of 10.1 ng/mL or higher in men with BPH. Forty percent of the men in the community study had moderate to severe lower urinary tract symptoms. In these men, likelihood ratios ranged from 0.2 for PSA values between 0.0 and 2.0 ng/mL to 17.2 for PSA values of 6.1 ng/mL or higher, while in men with no or mild symptoms, likelihood ratios rose to 26.9 for PSA values of 6.1 ng/mL or higher. CONCLUSIONS: Likelihood ratios for PSA test results allow stratification of men along a continuum of risk for prostate cancer. Likelihood ratios demonstrate that the ability of the PSA test to discriminate potentially curable prostate cancer from BPH is dramatically lower in men selected with lower urinary tract symptoms than in randomly selected men.

Aged↗
PubMed1996

Continuous intrathecal baclofen infusion for symptomatic generalized dystonia.

Five patients with generalized dystonia who were refractory to oral medications were treated by continuous intrathecal baclofen infusion. Dystonia was related to cerebral palsy in three patients and to Hallervorden-Spatz disease in two. Responsiveness to intrathecally administered baclofen was evaluated after bolus injections in one patient and during continuous infusions via an external micropump in four. Patients who responded to trial injections were subsequently implanted with a programmable pump for continuous infusion of baclofen. Dystonia in the three patients were cerebral palsy was substantially improved by continuous intrathecal baclofen infusion in doses of 500 to 800 micrograms/d. Benefit has persisted for > 19 months of continuous infusion. Dystonia in the two patients with Hallervorden-Spatz disease was not improved, although the screening trial was limited by side effects in one patient and by meningitis in the other. We conclude that continuous intrathecal baclofen infusion is beneficial therapy for some patients with generalized dystonia and that additional investigations are indicated.

Adolescent↗
PubMed1996

Physical therapy interventions for patients with movement disorders due to cerebral palsy.

The purpose of this paper is to present evidence of the efficacy of physical therapy interventions for patients with cerebral palsy and identify goals for these patients. Studies suggest that neurodevelopmental treatment and Vojta techniques improve postural control. Little evidence supports the efficacy of early intervention, but researchers have not yet studied effects on the family. Strengthening, electrical stimulation, the use of orthoses, and seating show positive effects in studies of small numbers of subjects. For severely involved children, ease of care and comfort are important goals, as well as prevention of deformity, which is important for all children. To the extent possible, therapy should prepare a child for independent adult life. In early intervention through school age, therapy focuses on promoting communication, self-care, and mobility. Independence is a key issue for adolescents transitioning into adulthood. The rehabilitation and health needs of adults with cerebral palsy need to be addressed. Research needs to determine the effects of physical therapy not only on impairment but also on function and disability.

Adolescent↗
PubMed1996

Measurement of overall and disease-specific health status: does the order of questionnaires make a difference?

OBJECTIVES: This study was designed to detect any effect of order when modules on disease-specific and overall health status are combined in an outcomes research questionnaire. METHODS: Men with symptomatic benign prostatic hyperplasia (BPH) were prospectively enrolled in a clinical trial of an educational intervention in Group Health Cooperative of Puget Sound, a prepaid group practice. Within the trial, 392 consecutive men were randomized to one of two versions of a baseline questionnaire. One had a 38-item module on BPH-specific health status first, followed by a 30-item module on overall health status; the other had the modules in reverse order. Scores were compared for three BPH-specific scales and eight scales measuring overall health. Data were collected in the form of self-administered questionnaires. RESULTS: Comparing the groups assigned the two versions of the questionnaire, no significant differences in scores on any of the health status scales were found. CONCLUSIONS: In this dataset, we could find no evidence of an order effect when modules on BPH-specific and overall health status were combined in different sequences.

Group Practice, Prepaid↗
PubMed1996

Outcomes of external-beam radiation therapy for prostate cancer: a study of Medicare beneficiaries in three surveillance, epidemiology, and end results areas.

PURPOSE: This study was designed to obtain representative estimates of the quality of life and probabilities of possible adverse effects among Medicare-age patients treated with external-beam radiation therapy for prostate cancer. METHODS: Patients treated for local or regional prostate cancer with high-energy external-beam radiation between 1989 and 1991 were sampled from a claims data base of the Surveillance, Epidemiology, and End Results (SEER) program from three regions. Patients were surveyed primarily by mail, with telephone follow-up evaluation of non-respondents. There were 621 respondents (83% response rate). The results were compared with data from a previously published national survey of Medicare-age men who had undergone radical prostatectomy. RESULTS: Although they were older at the time of treatment, radiation patients were less likely than surgical patients to wear pads for wetness (7% v 32%) and had a lower rate of impotence (23% v 56% for men < 70 years), while they were more likely to report problems with bowel dysfunction (10% v 4%). Both groups reported generally positive feelings about their treatments. Radiation and surgical patients reported similar rates of additional subsequent treatment (24% v 26% at 3 years after primary treatment). However, radiation patients were less likely to say they were cancer-free, and they reported more worry about cancer than did surgical patients. CONCLUSION: The health-related quality of life of radiation and surgical patients, on average, is similar, but the pattern of experience with adverse consequences of treatment differs by treatment.

Aged↗
PubMed1995

Toxicity of DTPA to Daphnia carinata as modified by oxygen stress and food limitation.

First-instar Daphnia carinata were exposed to one of four or five sublethal concentrations of the industrial chelating agent diethylenetriamine pentaacetic acid (DTPA) either alone, or in conjunction with, high (90-100%) or low (10-25%) oxygen saturation and high (2 x 10(5) cells/ml) or low (2 x 10(4) cells/ml) food conditions for 6 to 7 days, in a series of three experiments. Survival, growth, reproduction, and hemoglobin (Hb) content were assessed. Mortality increased significantly from 6.5 +/- 4.2 to 38.9 +/- 5.2%, and mean length was significantly reduced from 2.73 +/- 0.02 to 1.37 +/- 0.01 mm at 100 mg/liter DTPA in experiment 1. Mean length was also significantly reduced from 2.64 +/- 0.12 to 1.9 +/- 0.1 mm at 50 mg/liter DTPA in experiment 3. This was attributed to an indirect effect via the food supply in the third experiment. There was a significant decrease in the mean number of first-brood eggs at 10 mg/liter DTPA in all three experiments. Hemoglobin concentration was significantly increased under low oxygen conditions from 27.6 +/- 1.7 to 65.5 +/- 4.6 mg Hb/g Daphnia dry wt, and 23.0 +/- 1.8 to 49.4 +/- 3.5 mg Hb/g Daphnia dry wt in experiments 2 and 3, respectively. However, DTPA had no effect on hemoglobin concentration in any experiment. DTPA toxicity to D. carinata was not significantly altered by oxygen stress or food limitation and could not be attributed to an inhibition of Hb synthesis. Increased exposure times may result in further reproductive effects and also an indirect effect on hemoglobin concentration via the gradual depletion of iron stores. The no-observed effect concentration and the lowest observed effect concentration for D. carinata in this study were 1.0 and 10 mg/liter DTPA, respectively, based on reproduction, giving an estimated threshold concentration of 3.2 mg/liter DTPA.

Analysis of Variance↗
PubMed1995

Effect of algal food concentration on toxicity of two agricultural pesticides to Daphnia carinata.

The effects of algal concentration (Selanastrum capricornatum) on the toxicity of the organochlorine pesticide endosulfan and the synthetic pyrethroid esfenvalerate to Daphnia carinata was investigated. The study progressed through four stages: (1) A dose-response experiment on the effects of endosulfan and esfenvalerate on the survival, growth, and reproduction of D. carinata at a single nonlimiting food level. (2) An experiment to investigate the effects of five different food concentrations on survival, growth, and reproduction of D. carinata at sublethal concentrations of endosulfan and esfenvalerate compared with nonexposed controls. (3) An experiment to investigate the effects of route of exposure (water, food-borne, or water+food-borne exposure) on the toxicity of endosulfan to D. carinata. (4) An experiment to investigate the effects of algal concentration on persistence of endosulfan in the water column and on the relative toxicity of the alpha and beta isomers and of endosulfan sulfate to D. carinata. In the first experiment all daphnids exposed to 500 ng/liter esfenvalerate died within 3 days. There was a significant effect of esfenvalerate on reproduction at 50 ng/liter by the second brood. Endosulfan did not cause significant mortality to daphnids but brood size was reduced at 320 micrograms/liter. In the second experiment the toxicity of esfenvalerate increased significantly with decreasing food concentration. In contrast, the toxicity of endosulfan to D. carinata was greatest at the higher food concentrations. Direct water-borne exposure to endosulfan was the most toxic route of exposure and the presence of algae decreased toxicity of this pesticide. The total amount of endosulfan (alpha + beta + endosulfan sulfate) persisting in the water column after 24 hr was greater at high food levels, suggesting that this may be one mechanism for increased toxicity at high food concentrations. The 48-hr LC50s of technical endosulfan, endosulfan sulfate, alpha-endosulfan, beta-endosulfan, and a 50:50 mixture of alpha, and beta endosulfan were 478, 756, 249, 205, and 234 micrograms/liter, respectively.

Analysis of Variance↗
PubMed1995

Benign prostatic hyperplasia specific health status measures in clinical research: how much change in the American Urological Association symptom index and the benign prostatic hyperplasia impact index is perceptible to patients?

PURPOSE: We assessed the relationship between changes in scores for the American Urological Association (AUA) symptom index and benign prostatic hyperplasia (BPH) impact index with patient global ratings of improvement in a large Veterans Affairs trial comparing different pharmacological therapies for BPH. MATERIALS AND METHODS: The primary analyses compared absolute score changes from baseline with global ratings of improvement at 13 weeks for 1,218 men. RESULTS: Subjects who rated themselves as being slightly improved had a mean decrease in AUA symptom index and BPH impact index scores of 3.1 and 0.4 points, respectively. However, the baseline scores strongly influenced this relationship. CONCLUSIONS: These data provide guidance for investigators using the AUA symptom index and BPH impact index as outcome measures.

Health Status↗
PubMed1995

The American Urological Association symptom index: does mode of administration affect its psychometric properties?

PURPOSE: We determine whether self-administration and interviewer administration of the American Urological Association (AUA) symptom index are equivalent. MATERIALS AND METHODS: The AUA symptom index was administered twice to 41 visually impaired or illiterate men. Men who were able were randomized to self-administration first and then interviewer administration (43) or the reverse (40). RESULTS: The scores in each group were reliable. However, because we could not reject a differential carryover effect, the nonsignificant test of mode effect in the crossover design may have been invalid. At time 1 there was no significant difference between group mean scores for randomized patients (p = 0.13). CONCLUSIONS: Although the AUA symptom index should be self-administered when possible, interviewer administration appears to be acceptable.

Aged↗
PubMed1995

Effect of radical prostatectomy for prostate cancer on patient quality of life: results from a Medicare survey.

OBJECTIVES: To assess patient responses to radical prostatectomy and its effects. METHODS: A national sample was taken of 1072 Medicare patients who underwent radical prostatectomy for prostate cancer (1988 through 1990) by mail, telephone, and personal interviews. The effects of the surgery and its complications on these patients' lives were studied through: (1) patient ratings of the extent to which sexual and urinary dysfunctions were "problems" in their lives; (2) two general measures of quality of life, the Mental Health Index and the General Health Index; (3) patient reports of how they felt about the results of treatment and whether they would choose surgery again. RESULTS: On average, dripping urine, particularly to the point where subjects were wearing pads, had a more significant effect on patients than loss of sexual function; incontinence had significant adverse effects on the measures of quality of life and self-reported results of surgery. Overall, postsurgical patients scored comparatively high on the quality of life measures (similar to a cohort of patients with benigh prostatic hyperplasia who had undergone transurethral resection of the prostate), reported feeling positive about the results (81%), and would choose surgical treatment again (89%). Nonetheless, there was variability in patient response to the effects of surgery. CONCLUSIONS: The results demonstrate the ability of many Medicare patients to adapt to adverse outcomes, such as loss of sexual function and incontinence. They also provide evidence of the variability of individual patients' responses to surgical results and reinforce the importance of individualized decision making for patients facing a decision about radical prostatectomy for prostate cancer.

Aged↗