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Biomedical subjects

R Kirby

Publications and source records attributed to R Kirby.

At least 73 records · Page 4Linked to original sources
PubMed1995

Prospective observational study to assess value of prostate specific antigen as screening test for prostate cancer.

OBJECTIVE: To evaluate measurement of serum prostate specific antigen as a potential screening test for future clinical prostate cancer among healthy men. DESIGN: Nested case-control study with stored serum samples collected from 49,261 men with follow up using national death and cancer registration systems. SUBJECTS: 265 asymptomatic men who subsequently developed clinical prostate cancer and 1055 controls matched for age, study centre, and duration of storage of samples. MAIN OUTCOME MEASURES: Distribution of concentrations of the antigen in men who developed prostate cancer and in controls. RESULTS: Prostate specific antigen concentrations were significantly higher in men who subsequently developed prostate cancer than in controls. In the first three years after blood collection the median concentration was 23 times greater in cases than in controls of the same age at the same centre (that is, 23 multiples of the median). A smaller difference persisted thereafter; 4.0 multiples of the median 3-6 years after blood collection, 3.6 6-10 years, and 1.8 after 10 years. In the first three years the proportion of men who developed prostate cancer and had raised levels of the antigen (> or = 12 multiples of the median) (detection rate or sensitivity) was 81% (95% confidence interval 54% to 96%). The proportion of men who did not develop prostate cancer but had levels this high (false positive rate) was only 0.5%. CONCLUSION: Prostate specific antigen measurement is a highly discriminatory screening test for prostate cancer among healthy men. In the general population, 60-74 year old men who had > or = 12 times the normal median level would have about a 50% chance of developing clinical prostate cancer in the next three years. Measurement of this antigen is a good enough screening test to justify a randomised controlled trial to determine any reduction in mortality from prostate cancer.

Aged↗
PubMed1995

A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate.

OBJECTIVES: To assess the safety and efficacy of endoscopic laser ablation of the prostate (ELAP), performed with the Urolase fiber and the neodymium:yttrium-aluminum-garnet laser, compared to transurethral resection of the prostate (TURP) in patients with bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: In this multicenter, prospective, randomized study, a total of 151 patients were treated (ELAP, 76; TURP, 75) of whom 137 completed 1 year follow-up (ELAP, 67; TURP, 70). Safety parameters included measurement of preoperative and 24-hour postoperative sodium, hematocrit, and hemoglobin values and careful monitoring of adverse events. Efficacy was assessed with the American Urological Association symptom score (6), urinary flow rates, and residual urinary volume measurements. RESULTS: There was 1 death in each group during the study period unrelated to the treatment procedure. There was a clinically significant improvement in all efficacy parameters in both groups. Between group comparisons favored TURP in maximum flow rate, residual urinary volume, and symptom score. ELAP had a better safety profile than TURP in the defined safety parameters of drop in hemoglobin and hematocrit values. In 16% of patients, a blood transfusion was required after TURP compared with no transfusions in the ELAP group. Urinary tract infections and dysuria were more frequent in the ELAP group. CONCLUSIONS: ELAP performed with the Urolase fiber is a useful alternative therapy to TURP in patients presenting with bladder outflow obstruction secondary to BPH.

Aged↗
PubMed1995

Transfusion therapy in emergency and critical care medicine.

The administration of blood or its components can provide the life-saving element for a critically ill small animal patient. Shock from acute massive hemorrhage produces catastrophic cardiovascular changes requiring rapid, accurate resuscitation techniques for survival. Bleeding that occurs more slowly allows for the opportunity to discover and treat the inciting cause and to administer specific blood component.

Animals↗
PubMed1995

Cost-effective, clinically relevant method for rapid identification of beta-hemolytic streptococci and enterococci.

Currently popular agglutination and coagglutination methods for the identification of beta-hemolytic streptococci, although rapid and simple to perform, are costly. Furthermore, they fail to distinguish between clinically relevant species and normal flora of the same serogroup. We investigated the use of a series of four physiologic tests to differentiate beta-hemolytic streptococci and enterococci into five clinically relevant groups. We also investigated the use of a new product, Visi-Spot, and evaluated an alternate method for the detection of beta-D-glucuronidase production. Our results suggest that for most routine processing of beta-hemolytic streptococci, physiologic tests are sufficiently rapid, more accurate, and far less costly to perform than serologic methods. The facility of our scheme is enhanced by the use of the Visi-Spot test and the substitution of a commercially available product for more traditional methods of detecting beta-D-glucuronidase.

Agglutination Tests↗
PubMed1994

Hypovolemic shock and resuscitation.

Hypovolemic shock is the manifestation of hypoperfusion from inadequate intravascular volume resulting in cellular hypoxia. Early, effective treatment tailored to the individual patient will minimize morbidity and mortality. The causes and end-organ responses can differ with each patient, requiring an understanding of the underlying physiology and pathophysiology. Treatment always consists of oxygen and isotonic crystalloids and may require the use of colloids, corticosteroids, antibiotics, and vasomotor drugs.

Animals↗
PubMed1994

Systemic inflammatory response syndrome: septic shock.

The systemic inflammatory response syndrome (SIRS) is the body's response to a multitude of chemical mediators. Conditions inciting the release of these mediators include bacterial sepsis, viremia, pancreatitis, trauma, neoplasia, heat stroke, and many others. The key to the successful management of SIRS lies in anticipation and not reaction. Resuscitation of the patient to supranormal levels, coupled with aggressive monitoring and support of target organs are essential.

Animals↗
PubMed1994

A generalist physician-based model for a rural geriatric collaborative practice.

This article describes a geriatric collaborative practice model in which primary care physicians (family practice and internal medicine) and nurse case managers are key members of a multidisciplinary team providing care to elderly rural patients in east central Illinois. Client characteristics, nursing case management roles, and the strengths and benefits associated with this geriatric collaborative model are presented.

Aged↗
PubMed1993

Complete nucleotide sequence of sugarcane streak Monogeminivirus.

The complete nucleotide sequence of the genome of the Monogeminivirus sugarcane streak virus (SSV) was determined from cloned replicative form DNA. The genome is contained in one DNA circle of 2,758 nucleotides, and has four open reading frames with the potential to encode proteins of MW > 10 kDa: two in the viral (+) sense and two in the complementary (-) sense. Each open reading frame has a counterpart among the open reading frames reported for other Monogeminiviruses. A potential binding site for a DNA replication primer and potential transcriptional control sequences were identified on the (+) strand, and a possible intron on the (-) strand. Phylogenetic analysis of coat protein and replication-associated protein sequences of SSV and other grass-infecting geminiviruses indicate that SSV, although distinct from any other virus, is part of an "African streak virus subgroup" of Monogeminiviruses.

Base Sequence↗
PubMed1993

A role for mitochondrial DNA in the pathogenesis of radiation-induced myelodysplasia and secondary leukemia.

The onset of acute myeloid leukemia following ionizing radiation or alkylating agent exposure is antedated months to years by the development of 'preleukemia', or secondary myelodysplastic syndrome (sMDS). Mitochondrial abnormalities induced by chloramphenicol and clonal deletions of mitochondrial DNA (mt DNA) in the bone marrow create hematological defects similar to sMDS, and abnormal dimers of mt DNA are observed in acute leukemia. This suggests a role for mt DNA in the pathogenesis of sMDS and secondary leukemia. We outline disparate experimental evidence to support this concept and suggest a role for select protease inhibitors in the clinical management of this disorder.

Bone Marrow↗
PubMed1993

Coming of age with diabetes: patients' views of a clinic for under-25 year olds.

This study is both an evaluation of patients' perceptions of a diabetes clinic for under-25 year olds, and an assessment of experiences in transferring from a paediatric clinic. Sixty-nine patients with Type 1 diabetes (74% of the total clinic), including 41 females, completed evaluations of the clinic and recall of experiences in transfer. Mean age on transferring clinic was 15.9 (range 12-20) years. Paediatricians were perceived to emphasise family and social life, school or work progress; adult physicians tended to stress the risk of long-term complications, importance of exercise and need to maintain strict levels of glycaemic control. Our data suggest that transition to adult care can generally be achieved non-traumatically, but patients may perceive some difficulty because of different emphases and treatment advice favoured by paediatricians and adult physicians.

Adolescent↗
PubMed1993

The incidence of inducible macrolide-lincosamide-streptogramin B resistance in methicillin-resistant staphylococci in clinical isolates from the Eastern Cape area of South Africa.

The incidence of inducible macrolide-lincosamide-streptogramin B resistance in methicillin-resistant staphylococci in clinical isolates from the Eastern Cape area of South Africa is shown to be higher than might be expected. A significant difference in the frequency between different hospital and different population groups was identified. RAPD fingerprinting of the strains suggests that this difference is mirrored in the presence of different Staphylococcus aureus strains in the different hospitals. It is proposed that the significantly higher level of overcrowding in certain hospitals in worsening the problem of multiple antibiotic resistance in the Eastern Cape.

Anti-Bacterial Agents↗
PubMed1993

Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men.

280 patients (aged 28 to 74 years, mean 57) with erectile failure (EF) underwent colour Doppler and duplex ultrasound imaging (CDI) following intracorporeal papaverine. After achieving a full, or nearly full, erection visual inspection and palpation revealed plaques and/or constriction or deformity of the penis in 55 (20%) cases. 10 (4%) were known to have Peyronie's plaques prior to referral. Of these 55 patients ultrasound showed focal echogenic plaques in 14 (25%) and diffuse thickening of the tunica albuginea in 41 (75%). CDI diagnosed arteriogenic EF in 20 (36%) of these patients, venous leak in 10 (18%), arterial and venous in two (4%) and a normal response in 23 (42%). In 11 (20%) patients (seven with arteriogenic EF and four with venous leak) the plaque was seen to be affecting vessels. These results indicate that abnormalities of the tunica albuginea are far more common in patients presenting with erectile failure than previously thought. We believe that the diffuse thickening is a form of Peyronie's which is only recognized after pharmacological induction of penile erection.

Adult↗