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Biomedical subjects

S D Graham

Publications and source records attributed to S D Graham.

At least 55 records · Page 3Linked to original sources
PubMed1990

Enucleation of tumor versus partial nephrectomy as conservative treatment of renal cell carcinoma.

In patients with renal insufficiency, solitary kidney, or bilateral renal malignancies, conservative surgery for renal cell carcinoma has been suggested. The authors treated 17 such patients with either enucleation of tumor or partial nephrectomy. Overall survival from disease in this series was 58.8%. Seventy percent of patients undergoing enucleation and 42.9% undergoing partial nephrectomy survived with a mean follow-up period of 5 years. Survival or local recurrence rate after enucleative surgery is an effective treatment of renal carcinoma in selected patients, and despite concerns about tumor invasion of the pseudocapsule, the clinical data do not indicate any difference in survival. There was no significant difference between enucleation of tumor and partial nephrectomy regarding morbidity, mortality, or recurrence rate.

Adult↗
PubMed1990

A competitive ELISA for the detection of group-specific antibodies to African horse sickness virus.

A competition enzyme-linked immunosorbent assay (ELISA) has been developed for the rapid identification and quantification of antibodies against African horse sickness (AHS) in sera from solipeds. The data showed the ELISA to be sensitive, specific and reliable. More than 1600 sera from 37 different countries were examined and results compared with those obtained by agar gel immuno-diffusion (AGID) tests. In no case did any of 775 sera from countries where AHS has never been reported and where AHS vaccines are not used, record an ELISA titre greater than 4. A titre equal to or greater than 8 was considered positive. Using this criterion, 96.3% of sera tested in both assays were in agreement. Doubtful results by AGID (1.7%) were clearly defined in terms of positivity and negativity by ELISA. This ELISA is suited for the rapid laboratory confirmation of AHS and should be considered as a replacement for the traditional AGID test.

African Horse Sickness↗
PubMed1990

Preliminary report on adrenal-brain transplantation for parkinsonism in man.

The attempt to restore lost neurological function through grafting of catecholaminergic tissue into the striatum is a dramatic new experimental treatment approach for parkinsonism. We have grafted autologous adrenal medullary tissue into the right caudate nucleus in 12 patients with advanced Parkinson's disease (10 males, 2 females, mean age 53 years, mean Hoehn and Yahr stage 'off' medications 4.2) applying a transcortical technique similar to that of Madrazo as modified by Allen using right adrenalectomy performed via a flank approach. There have been no deaths, surgical complications, or serious postoperative morbidity. Modified Columbia Parkinson's disease ratings of patients off all dopaminergic agents for 72 h revealed 22% improvement (p less than 0.01) 3-6 months postoperatively (n = 10) and 22% improvement (p less than 0.01) 7-12 months later (n = 9). Postoperative dyskinesias necessitated reduction of L-dopa by 11% and of carbidopa by 29%. Analysis of lumbar cerebrospinal fluid biogenic amine metabolites following a 4-day 'drug holiday' revealed that homovanillic acid increased to 159% of preoperative levels (p less than 0.01) 3-6 months (n = 9) and to 197% of preoperative levels (p less than 0.02) 7-12 months postoperatively (n = 5). We have observed a mild to moderate improvement persisting up to 1 year with this therapeutic approach, but further study is needed.

Adrenal Medulla↗
PubMed1990

Changes in endocrine function after adrenal medullary transplantation to the central nervous system.

Ten patients were studied before and after autologous adrenal medullary transplantation to the central nervous system for Parkinson's disease to determine if the presence of new catecholamine-producing tissue near the hypothalamus would alter hypothalamic or pituitary function, mineralocorticoid levels, or catecholamine production. No clinically apparent ill effects occurred. Changes in endocrine function were largely short-term and transient: at 7-10 days after surgery, urinary catecholamine levels were significantly increased, PRL levels were significantly elevated despite markedly increased serum dopamine levels, and gonadal steroid levels (estradiol and testosterone) were significantly lower despite unchanged basal and stimulated levels of gonadotropins. Dehydroepiandrosterone sulfate was significantly reduced at 7-10 days after surgery and remained low at 3-6 months. Other changes at 3-6 months after surgery included increased stimulated corticotropin levels and reduced serum aldosterone response to upright posture. The changes at 7-10 days were probably due to stress or unilateral adrenalectomy or both; the changes at 3-6 months were likely due to unilateral adrenalectomy. We conclude that unilateral adrenalectomy and autologous adrenal medullary transplantation to the central nervous system does not produce clinically important changes in endocrine function; however, possible adverse consequences of long-term reduction of dehydroepiandrosterone sulfate levels cannot be excluded.

Adrenal Medulla↗
PubMed1989

Use of limited retroperitoneal lymphadenectomy in nonseminomatous germ cell tumors.

In an attempt to prevent ejaculatory dysfunction associated with retroperitoneal lymphadenectomy, the dissection has been modified to stay above the inferior mesenteric artery. Using this approach, there has been no adverse impact on survival (at least 18 months follow-up) in 18 patients with nonseminomatous germ cell tumors.

Ejaculation↗
PubMed1989

Cardiac hypertrophy induced by thyroid hormone is independent of loading conditions and beta adrenoceptor blockade.

This study was designed to determine whether thyroid hormone (T4) produces cardiac hypertrophy and alters ventricular function by direct effects on the heart or by alterations in adrenergic stimulation or changes in the peripheral circulation. Rats were treated with captopril (4 mg/ml of drinking water), propranolol (0.5 mg/ml of drinking water), hydralazine (80 mg/l of drinking water) or the combination of captopril and propranolol with and without T4 (15 micrograms/100 g b.w. i.p.). After 10 days, T4 increased (P less than .01) heart rate, left ventricular (LV) dP/dt and LV weight/body weight, but did not alter LV systolic pressure (SP) or enddiastolic pressure (EDP). Compared to treatment with T4 alone, captopril plus T4 decreased LV SP (P less than .05) and LV EDP (P less than .01); however, heart rate, LV dP/dt and LV weight/body weight were unchanged. Treatment with T4 plus propranolol decreased heart rate and LV EDP (P less than .05) compared to T4 alone; however, LV SP, LV dP/dt and LV weight/body weight were unchanged (P greater than .05). Hydralazine did not alter (P greater than .05) heart rate, LV SP, LV EDP or prevent the development of increased LV weight/body weight when given with T4; however, LV dP/dt was slightly decreased (P less than .05). Treatment with the combination of captopril and propranolol did not alter (P greater than .05) heart rate, LV SP, LV EDP or LV dP/dt and also failed to prevent the development of increased LV weight/body weight and LV dP/dt when given with T4.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Immunotherapy of renal cell carcinoma.

Metastatic renal cell carcinoma remains a frustrating disease to treat. Although there is significant evidence that this tumor is responsive to alterations in the immune system, a complete understanding of the antitumor immune response is still elusive. The early trials have been aimed primarily at nonspecific methods for stimulation of the immune system, with the equal possibility that aside from stimulation of the effector cells responsible for tumor containment, there may be stimulation of other mechanisms that will inhibit this response. The better responses in some cases appear to be in the treatments that produce the most toxicities, though even these treatments only have a 20% to 30% response in most trials. Although the prior trials of immunotherapy have yielded modest results, they have provided a better understanding of the immune system in the oncologic setting. Newer trials are now being directed at combinations of lymphokines, which is the beginning of the application of basic science in the clinical setting. With a better appreciation of the basic science behind the immune response, the current factors available will be put into better therapeutic perspective, and newer factors, including various growth factors, may play an important role in future therapy. Also, the addition of antisuppressor regimens to stimulation trials is a sign of recognition of the complexity of the immune response. Aside from suppressor cells, investigators are beginning to realize that there are circulating proteins probably generated either by the tumor or in response to the tumor that are immunosuppressive (eg, circulating IL-2 receptors). Inhibition of these proteins by pheresis or other methods may provide increased immunoreactivity to the tumors, as has already been shown in a small series. Monoclonal antibodies offer the promise of the most specificity; however, the technology is still far from making this therapy imminently available. Only through additional laboratory and clinical investigation, will significant advances be made.

Adjuvants, Immunologic↗
PubMed1988

Pelvic fibrous mesothelioma with obstructive symptoms.

A case report of a fifty-eight-year-old man with complaints of urinary obstructive symptoms and constipation is presented. At laparotomy the patient was found to have a large pelvic mass elevating the bladder and prostate which proved to be a fibrous mesothelioma. A review of peritoneal mesotheliomas is presented.

Constipation↗
PubMed1988

Significance of lipid-associated sialic acid and CA 19-9 as tumor markers for renal cell carcinoma.

Numerous neoplasms, including colonic, lung, stomach, and prostate, have been found to have increased concentrations of lipid-associated sialic acid (LASA). CA 19-9 is a carbohydrate antigen found on the membrane surface of pancreatic, gastric, and colonic cancers. A prospective study involving 25 patients (15 males, 10 females) with renal cell carcinoma (RCC) was undertaken to examine the clinical value of these two markers. Patients' ages ranged from twenty-five to seventy-seven years (mean 56 years). The group consisted of 9 Stage I, 1 Stage II, 5 Stage III, and 10 Stage IV patients. Twenty three of the 25 had known disease present when tested. Eleven patients with no known tumor were used as an age-matched control group. Sixteen of the 23 patients with known disease (70%) had elevated LASA values. Nine of the 11 control patients (82%) had normal LASA values. Three of 7 patients with values obtained pre- and post-nephrectomy showed levels returned to normal after nephrectomy; 3 had persistent LASA elevation and were found to have either metastatic or recurrent disease, and 1 had a persistent elevation of his LASA value without known metastatic or recurrent disease. When the 23 patients with known disease were compared according to stage, 62 percent of Stages I and II, 80 percent of Stage III, and 70 percent of Stage IV had elevated LASA values. There was no statistically significant difference between LASA values and tumor stage. CA 19-9 values obtained in 15 of 25 patients with RCC were within normal range.

Adult↗
PubMed1987

Cystitis cystica: an electron and immunofluorescence microscopic study.

Cystitis cystica was studied with the aid of electron and immunofluorescence microscopy. By electron microscopy, the epithelium demonstrated morphologic features suggestive of an active metabolism. Secretory-type granules were seen in the cytoplasm just beneath the luminal membrane of surface columnar cells. Microvilli of the plasma membrane also were seen at the luminal surface. Rough endoplasmic reticulum and Golgi apparatuses were present. The cells were rich in mitochondria. By immunofluorescence microscopy, IgA, secretory piece and IgM were localized in the epithelial cells, especially at the luminal surfaces. IgG was occasionally found. These findings contrast markedly with the transitional cells and their relatively scanty content of secretory-type organelles. In addition, they may explain the large amounts of IgA in the urine of patients with cystitis cystica.

Adult↗
PubMed1986

Beta-2-microglobulins as a differentiation marker in bladder cancer.

The transformation of a normal cell through dysplasia to the malignant state usually is associated with changes at the molecular level within the nucleus, cytoplasm and cell surface. These changes can be monitored by the loss of normal cell surface antigens, such as the blood group antigen ABO(H) and major histocompatibility complex antigens, which in the human correlate with the histocompatibility locus antigens. A group of patients with bladder biopsy and diagnosis ranging from normal through severe dysplasia to papillary transitional cell carcinoma, invasive transitional cell carcinoma and carcinoma in situ were evaluated for the presence or absence of beta-2-microglobulin. This 11,000 molecular weight protein was used as an indirect marker for the major histocompatibility complex antigens on the cell surface. With immunoperoxidase as a marker, the presence of beta-2-microglobulin was seen in all patients with normal epithelium as well as benign disease. However, with progression through dysplasia to carcinoma there was progressive deletion of the beta-2-microglobulin. Carcinoma in situ exhibited minimal expression of the beta-2-microglobulin. The use of beta-2-microglobulin as a marker for major histocompatibility complex antigens on the cell surface may prove to be useful for monitoring transitional cell carcinoma.

Aged↗
PubMed1985

Antibiotic treatment of complicated urologic infections. Six selected case studies.

The use of aminoglycosides in urology is limited primarily either to preoperative prophylaxis or to acutely ill patients. Frequently in this latter group, there is little margin for error, and the appropriate drug(s) must be given at the outset. In addition to receiving antibiotics, patients in distress should be resuscitated with fluids, evaluated to determine the cause of their sepsis, and promptly and definitively treated. It is important early in the course of therapy to drain the site of obstruction or abscess, remove foreign bodies, or debride necrotic areas if medical measures are to be successful. The rationale for selection of an aminoglycoside and treatment in these patients is discussed, using six case studies as illustrations.

Adult↗
PubMed1985

CT-guided adrenal biopsy: accuracy, safety, and indications.

Fifty-eight percutaneous needle biopsies of adrenal masses were performed in 53 patients. The technique was initially successful in 44 (83%) of 53 patients. Five patients had second procedures because of initial failure or the possibility of sampling error. Fourteen biopsies were performed in nononcologic patients and 39 in patients with a known malignancy. None of the adrenal masses in nononcologic patients were malignant. Only 18 (46.1%) of the 39 masses in oncologic patients were metastases; the rest represented a variety of nonneoplastic conditions. Seven minor complications occurred in six patients. Two of these patients required transfusions for hypotension or decreases in hematocrit. No correlation was noted between needle size and complications. There were no pneumothoraces. The procedure is an accurate and safe alternative to surgical biopsy.

Adrenal Gland Diseases↗
PubMed1983

CT diagnosis of renal metastases.

Antemortum detection of renal metastases can be made by computed tomography (CT), particularly if the known primary malignancy is in a late stage. The CT scans of 10 oncologic patients with focal renal metastases were reviewed (confirmation by surgery in four, follow-up CT demonstrating new lesions or lesion growth in two). Five of our cases had only renal metastases and five patients had other areas of metastases. Renal metastases are well circumscribed, rarely enhance, and have density measurements of 25-70 Hounsfield units. Ways of differentiating these lesions from other renal masses are discussed.

Aged↗