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R A Kane

Publications and source records attributed to R A Kane.

At least 19 recordsLinked to original sources
PubMed1992

Prostate-specific antigen levels in 1695 men without evidence of prostate cancer. Findings of the American Cancer Society National Prostate Cancer Detection Project.

The American Cancer Society National Prostate Cancer Detection Project is a prospective, multidisciplinary, and multicenter trial to assess the potential for early detection of prostate cancer by transrectal ultrasonography (TRUS), digital rectal examination (DRE), and serum prostate-specific antigen assay (PSA). By November 1990, 2805 men between the ages of 55 and 70 years with no known signs or symptoms of prostate cancer were enrolled in the study, which is planned to run for 5 years. Annual TRUS, DRE, and PSA tests were done on these subjects, and biopsies were recommended for suspicious lesions when detected. To study the performance of PSA testing in presumed normal subjects, all men were eliminated who had (1) prostate cancer detected on their initial examinations and proven by biopsy or (2) cancer detected during the year or subsequent examinations. Additionally, all men with TRUS or DRE findings that were interpreted as suspicious for cancer but who are being followed and have not yet had biopsies done were removed from this series. This left a unique, extensively screened group of 1695 men who were free of prostate cancer, as far as could be determined. Analyses of the PSA levels in this large population in the appropriate age range for increasing risk of prostate cancer revealed several important findings. First, there was a direct relationship between serum PSA levels and estimated prostate volume for both the currently available monoclonal and polyclonal PSA assays. Individuals with benign prostatic hyperplasia and larger gland volume have a higher normal limit of PSA than men with normal gland volume. Second, analyses showed no relationship between age and PSA levels or between symptoms of prostatism and PSA levels independent of gland enlargement. It was concluded that volume-adjusted upper limits of normal PSA can be determined for different levels of specificity desired. This information may be applicable to the use of PSA in men not already suspected of having prostate cancer and may increase its effectiveness as a tool for early detection.

Age Factors↗
PubMed1992

Correlative imaging of malignant liver tumors.

Radiologists play a vital role in the management of malignant liver disease, both by providing accurate data regarding extent and segmental localization of lesions as well as demonstrating their relationship to major vascular structures. The interrelationship between the major cross-sectional imaging modalities (ultrasound, CT, and MRI) must be understood in order to use each modality effectively and efficiently. Characteristic behavior of certain tumors (such as venous invasion by hepatomas) can help in recognition of tumor type and may have a major impact on decisions regarding resectability. Pitfalls in liver imaging (such as the presence of benign conditions that may mimic malignant lesions) must be well understood in order to avoid errors in diagnosis. Difficulties may arise in underdetection of tumors arising in chronically diseased livers and overstatement of the extent of tumors in livers with coexistent benign and malignant lesions. The appearances and behavior of primary and metastatic liver cancer is reviewed, emphasizing the features listed previously.

Humans↗
PubMed1992

Noninvasive liver imaging: new techniques and practical strategies.

The goals and expectations of liver imaging have expanded as the treatment options for a range of liver diseases have advanced. Unfortunately, no single modality can yet achieve all the goals that an ideal imaging modality should satisfy. Currently available liver imaging techniques should be considered complementary rather than competitive in their roles, and appropriate utilization of the expanding technical capabilities of cross-sectional imaging depends on many considerations, including patient factors, referring physician expectations and biases, experience and bias of the radiologist, and the availability of state-of-the-art technical capabilities for each modality. This article reviews the advantages, limitations, and roles of fast CT and fast MR liver imaging techniques as well as the complimentary role of ultrasound, and the future of new imaging considerations including the role of contrast agents.

Humans↗
PubMed1992

Case management in long-term care: it can be ethical and efficacious.

The present-day concept of case management combines two opposing functions, advocacy and gatekeeping, which creates an ethical tension. To maintain a balance between these activities and thus avoid untenable ethical situations, long-term-care programs must at the very least have sufficient dollars to provide required services, those dollars must be committed to the program and not subject to allocation elsewhere, and the services must be distributed fairly among those who need them. Various case management models attempt to separate the advocacy and gatekeeping functions with varying degrees of success.

Aged↗
PubMed1991

Psychosocial issues. Psychological and social issues for older people with cancer.

Elderly people vary from one another and from earlier generations, making generalizations about psychosocial issues for older patients with cancer risky. Social issues for older people with cancer include multiple losses, the reactions of others, arranging for their own care, and meeting responsibilities for others. Older persons with cancer may be primary family caregivers for other relatives. Psychological issues include learned helplessness and loss of control. Routine assessment of psychological and social factors, including patients' preferences, should be done through direct queries to patients. A detailed psychosocial research agenda is proposed. When possible, psychosocial studies should be linked to studies of the disease and its treatment.

Aged↗
PubMed1991

Cancer control and the older person. Psychosocial issues.

Three major areas related to psychosocial issues pertinent to the provision of cancer control services to older people have been delineated. These are values and medical decision making, psychosocial barriers to screening and access to care and services, and quality of life, including rehabilitation. These areas are explored, salient issues are defined, and specific questions and areas for consideration in future research are identified at the macro and micro levels.

Age Factors↗
PubMed1991

Determination of prostate volume with transrectal US for cancer screening. Part I. Comparison with prostate-specific antigen assays.

To investigate whether radiologists can objectively define a high-risk group for prostate cancer, the researchers measured gland volume and compared it with results of a screening blood test, prostate-specific antigen (PSA) assay. A total of 768 men, aged 55-71 years, were self-referred to two prostate cancer screening programs using transrectal ultrasound (US) and digital rectal examination. In patients with no evidence of cancer, statistically significant increases in mean PSA values were noted with increasing gland volume ranges (P less than .05). PSA values in patients with cancer were more likely to exceed the volume-adjusted 95th percentile (mean + [1.65.standard deviation]) than those in patients with negative biopsy results (P less than .005). Patients with PSA values above the volume-adjusted 95th percentile have an estimated risk for prostate cancer up to nine times that of the general screening population. The researchers conclude that knowledge of transrectal US gland volume and prostate-specific antigen assay type are important objective variables for future prostate cancer screening programs. The volume-adjusted 95th percentiles presented may help guide cost-effective management of current early detection efforts.

Aged↗
PubMed1991

Liver transplantation: MR angiography with surgical validation.

Thirty patients (mean age, 45 years) were evaluated with magnetic resonance (MR) angiography before liver transplantation to assess the accuracy of MR angiography. A series of breath-hold, two-dimensional images were acquired and subsequently processed to form three-dimensional projection angiograms. Graphic information on blood flow in the portal vein was acquired by using presaturation bolus tracking. Correlative duplex ultrasound (US) was performed in 28 patients, and surgical or autopsy correlation was available in all cases. MR angiography demonstrated patency of the portal vein in 26 (96%) of 27 patients, made possible the diagnosis of portal venous occlusion in three of three patients, depicted reversed portal flow in one patient, and provided clear delineation of the extent of varices and specific portosystemic collateral vessels. When duplex US was successful, there was full agreement with MR angiographic results in assessing portal vein patency and flow direction. All of the MR findings were corroborated at surgical exploration or autopsy. The authors conclude that MR angiography is very accurate in the portal system and is valuable in preoperative assessment for liver transplantation.

Abdomen↗
PubMed1991

Determination of prostate volume with transrectal US for cancer screening. Part II. Accuracy of in vitro and in vivo techniques.

Improved diagnostic information is obtained when prostate volume is correlated with results of prostate-specific antigen assays for early detection of prostate cancer. Three commonly used prostate volume measurement techniques were analyzed: planimetry, prolate ellipse volume calculation (HWL), and an ellipsoid volume measurement technique. For in vitro volume measurement, the declining order of accuracy was planimetry, HWL, and ellipsoid techniques. At the 95% confidence level, inverse prediction produced full-range values for a 40-cm3 model of 5.7, 16.0, 28.8, and 32.8 cm3 for planimetry, HWL, and the two ellipsoid techniques, respectively. Despite its superior accuracy, planimetry is not available on most ultrasound units, increases estimated clinical scanning time, requires additional equipment, and is difficult for a sole operator to perform. Although less accurate than planimetry, HWL is a rapid volume measurement technique that appears to be more accurate than ellipsoid software packages; its universal availability makes it practical for routine clinical use.

Humans↗
PubMed1991

Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?

BACKGROUND: In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS: In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS: On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS: Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC.

Aged↗
PubMed1990

Development of cloned DNA probes for the identification of snail intermediate hosts within the genus Bulinus.

DNA fragments have been isolated from Bulinus cernicus and cloned in Escherichia coli strain JM109 using pUC18 as the vector. Four recombinant plasmids designated pBC123, pBC126, pBC127 and pBC134 were selected for further analysis and were shown by both dot and Southern blot hybridisations to have different specificities to species representing the four species groups of Bulinus. Non-specific hybridisation occurred with pBC126 whereas pBC123 and pBC134 hybridised only to B. cernicus. Partial restriction maps of the inserts revealed sequence differences between pBC123 and pBC134. Intermediate specificity was shown by pBC127 as this probe hybridised only to DNA from snails of the B. forskalii group and B. truncatus of the B. truncatus/tropicus complex. The results demonstrate the potential of DNA probes for the identification and characterisation of intermediate hosts of schistosomes.

Animals↗
PubMed1989

Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors.

A prospective evaluation of the accuracy of preoperative computed tomography (CT), ultrasonography (US), and angiography was performed in 54 patients undergoing resection of hepatic neoplasms. The results were compared with surgical findings and intraoperative ultrasonography (IOUS). A total of 167 lesions was seen by means of IOUS, of which preoperative US enabled detection of 127 (76%). In 48 patients CT allowed detection of 91 of 150 lesions (61%), and in 35 patients angiography showed 56 of 107 lesions (52%). When the detection rate is analyzed according to hepatic segment, the greater overall accuracy of preoperative US may be attributed to a markedly better detection rate in lateral segment of the left lobe of the liver. Lesion size also represented a factor, with preoperative US allowing detection of a greater number of small (less than 2 cm) lesions compared with CT. In patients studied with both CT and US, the combined lesion-detection rate increased to 81% in the right lobe and 76% in the left lobe. Because of this we recommend that preoperative assessment include both CT and US evaluation of the liver. IOUS showed 25% to 35% additional lesions compared with preoperative US and CT. More importantly, 40% of the lesions demonstrated by IOUS were neither visible nor palpable at surgery. We recommend that IOUS be considered in all patients in whom resection of hepatic neoplasm is planned.

Angiography↗