Search PubMed⌕ Search

Biomedical subjects

T D Moon

Publications and source records attributed to T D Moon.

At least 37 records · Page 2Linked to original sources
PubMed1997

Acquired immunodeficiency syndrome in Alabama: special concerns for black women.

BACKGROUND: Among AIDS case reports from rural and small town areas of the United States, rates are higher in the South than in any other part of the country. METHODS: For this study, we analyzed AIDS surveillance statistics from the state of Alabama for trends, distributions, and populations affected. We aggregated Alabama AIDS surveillance data in 5-year intervals--1981 to 1985, 1986 to 1990, 1991 to 1995--and made comparisons based on geographic area of residence of people diagnosed with AIDS. RESULTS: Of the 3,558 cases of AIDS reported in Alabama in the period 1981 to 1995, 86% were men and 14% were women. Among women, 69.7% were black and 29.1% were white. Among men, 48.4% were black and 50.9% were white. We compared these figures with 1995 Alabama population estimates of 26.2% black, 73.7% white, and < 1% another race. The rates for black women and white women increased 170-fold and 23-fold, respectively, from the 1981 to 1985 period to the 1991 to 1995 period. For the same periods, case rates for black men and white men increased more than 80-fold and 50-fold, respectively. Black women showed a rise per 100,000 population-from 0.3 (1981 to 1985) in both northern and southern Alabama to 37 in northern Alabama and 64 in southern Alabama (1991 to 1995). CONCLUSIONS: Black women are at disproportionately high risk, particularly in the southern counties of Alabama. HIV is increasingly prevalent in rural and small town communities in Alabama and is more often transmitted heterosexually than it has been previously.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Rise in sexually transmitted diseases during democratization and economic crisis in Mongolia.

In 1990, democratic changes and loss of Soviet economic subsidies led to enormous social upheaval in Mongolia. The objective of this study is to map sexually transmitted disease (STD) trends in Mongolia from 1983-1995 and review human immunodeficiency virus (HIV) surveillance data since 1987. Data for syphilis show a decreasing trend from 1983-1993 with a decline in cases from 70 to 18/100,000 population, followed by a rise in cases to 32/100,000 population in 1995. Data suggest a 1.5-3.0 fold higher rate of syphilis for ages 15-24 than for any other group. Data for gonorrhoea show an upward trend in the rate of cases, from 51/100,000 population in 1983 to 142/100,000 in 1995. The majority of cases are aged 15-44. Trichomonas rates also show an upward trend in the number of cases, from 47/100,000 population in 1983 to 155/100,000 cases in 1995. Like gonorrhoea the majority of cases are in the 15-44 year age range. For children aged 0-14, the 1983-1993 rate remained below 4.5/100,000; however, in 1994 and 1995 the rate increased reaching 53 and 48/100,000 respectively. Since 1987, more than 176,000 HIV tests have been done with only one confirmed positive result. Rises in STD rates coincide with deterioration in STD services and reduced active surveillance, suggesting that these data reflect a minimum estimation of the problem. Changes in business and social circumstances may have resulted in increasing HIV and STD risk behaviour.

Adolescent↗
PubMed1997

Hand-assisted laparoscopic nephrectomy: technical considerations.

PURPOSE: Laparoscopic nephrectomy can be technically difficult and associated with lengthy operative times because of the limitations imposed by working with long instruments rotating about a fixed site on the abdominal wall, and without direct manual contact with the tissue. Hand-assisted laparoscopy is an option that addresses these problems. Herein we report our initial technique for hand-assisted laparoscopic nephrectomy. TECHNIQUE: After obtaining pneumoperitoneum and placing a 12-mm cannula lateral to the rectus muscle, a 7- to 8-cm incision is made in the upper midline. A commercially available wound protector and occlusive sleeve are inserted. Once an arm strap has been secured, the surgeon can operate with one hand in the abdomen while maintaining pneumoperitoneum. Using instruments placed through one or two additional laparoscopic ports, the nephrectomy is completed and the specimen is removed through the upper midline incision. Our continued experience with 10 hand-assisted laparoscopic nephrectomies to date has been favorable. CONCLUSION: Hand-assisted laparoscopic nephrectomy may facilitate the laparoscopic management of demanding pathologies, such as severely inflamed kidneys and larger tumors. It is particularly advantageous when intact specimens are required. Although more experience is required to define the role of hand-assisted urologic laparoscopy, we are encouraged by our initial technique and results.

Humans↗
PubMed1996

Bropirimine immunotherapy of upper urinary tract carcinoma in situ.

OBJECTIVES: Bropirimine has been shown to be effective in treating approximately 50% of patients with carcinoma in situ (CIS) of the bladder in recent clinical trials. Patients with upper tract CIS were treated with bropirimine to determine whether this oral drug might be effective in that setting. METHODS: Twenty-four patients with negative radiographic findings and positive cytologic evidence for upper tract CIS in one or both ureters received bropirimine (3.0 g/day orally) for 3 consecutive days each week for up to 1 year. Ureteral collection of urine or barbotage for cytologic analysis was performed quarterly thereafter. RESULTS: Ten (48%) of 21 evaluable patients had a negative ureteral cytologic analysis after 12 weeks (5 patients) or 24 weeks (5 patients). Of these 10 patients, 8 continue to have negative cytology for a period of 3 to 30 months (median, more than 9 months). In 2 patients, negative cytology reverted to positive at 6 and 9 months, respectively, during therapy. Twelve (50%) of the 24 patients reported no toxicity. Three patients stopped treatment at 2, 3, and 3 weeks due to pruritic rash, nausea and vomiting, and severe bone pain, respectively. Therapy was stopped in 1 additional patient between 4 and 5 months because of transient liver enzyme elevations, yet this patient has had a continuous negative cytologic analysis for more than 9 months. CONCLUSIONS: Orally administered bropirimine may be effective therapy for CIS of the ureter or renal pelvis, with acceptable toxicity in most patients. Further efforts to better define this activity as well as the possible need for maintenance or intermittent long-term therapy are warranted.

Adjuvants, Immunologic↗
PubMed1996

Oral bropirimine immunotherapy of carcinoma in situ of the bladder: results of a phase II trial.

OBJECTIVES: Bropirimine is an orally administered immunostimulant that has been shown to have activity against carcinoma in situ (CIS) of the bladder. To further assess this potential activity, bropirimine was administered to 42 patients for bladder CIS in a Phase II trial. METHODS: Patients were treated with bropirimine 3.0 g/day by mouth for 3 consecutive days each week up to 1 year. Cystoscopy with biopsies and bladder wash cytology were performed quarterly. RESULTS: Twenty (61%) of 33 evaluable patients converted malignant biopsies and bladder wash cytology to negative, including 6 (50%) of 12 who failed prior bacillus Calmette-Guérin (BCG) immunotherapy, 14 (67%) of 21 who had not received prior BCG therapy, and 12 (80%) of 15 with primary CIS. Median response duration exceeds 21 months. Four of the 20 responders did have a papillary tumor recurrence at 3 to 15 months, all Stage Ta or T1. Mild toxicity (grade I or II) suggestive to interferon induction or administration occurred in one third of patients. Headache, transient hepatic enzyme elevations, skin rash, and arthralgias each occurred in 5% to 14% of the patients, with nausea or emesis in 21%. Grade 1 tachycardia/palpitations or chest pain each were noted in 5%. CONCLUSIONS: Oral bropirimine can induce remission of bladder CIS with acceptable toxicity at 3.0 g/day. Bropirimine may be a valuable alternative to cystectomy for some failures of BCG therapy and may have the potential to replace BCG as front-line therapy because of its ease of administration.

Adjuvants, Immunologic↗
PubMed1995

Living related and unrelated donors for kidney transplantation. A 28-year experience.

OBJECTIVE: The objective of this study was to analyze a single center's 28-year experience with 1000 living donor transplants. SUMMARY BACKGROUND DATA: The number of potential renal transplant recipients far exceeds the number of cadaveric donors. For this reason, living related donors (LRDs) and, more recently, living unrelated donors (LURDs) have been used to decrease the cadaveric donor shortage. METHODS: From November 15, 1966, until August 5, 1994, 1000 living donor transplants were performed; 906 were living related and 94 were living unrelated transplants. Results were divided into precyclosporine (1966-1986, era I) and cyclosporine (1986-1994, era II) eras. Patient and graft survivals were compared between diabetic and nondiabetic recipients, between LRDs and LURDs, and according to human leukocyte antigen (HLA) matching. Donor mortality, morbidity, and postoperative renal function were also analyzed. RESULTS: The 5-, 10-, and 20-year graft survivals were 78.8%, 64.8%, and 43.4%, respectively. Patient and graft survival improved in era II (patient = 87.0% vs. 81.7%, p = 0.03; graft = 72.9% vs. 67.7%, p = 0.04). Nondiabetic patient and graft survivals were better than diabetic patient survivals in both eras. However, diabetic patient survival improved in era II (78.0% vs. 66.9%, p = 0.04). In era II, HLA-identical recipients had better graft survival than haploidentical or mismatched recipients (91.7% vs. 67.3% and 66.1%, p = 0.01). No difference between haploidentical LRDs and LURDs was seen. One donor death occurred in 1970, and 17% of donors developed postoperative complications. CONCLUSION: Living related and unrelated renal donation continues to be an important source of kidneys for patients with end-stage renal disease.

Adult↗
PubMed1994

Use of terazosin in prostatodynia and validation of a symptom score questionnaire.

OBJECTIVE: The purpose of this trial was to study the use of terazosin in nonbacterial prostatitis/prostatodynia, and to evaluate a new symptom score sheet for this disease. METHODS: Twenty-five patients who presented with lower urinary tract symptoms suggestive of prostatitis were evaluated for evidence of bacterial infection by Meares-Stamey criteria and found to be negative. They were then treated with the alpha-blocking drug terazosin in doses from 1 to 10 mg. A symptom score index for prostatitis was developed, tested in these patients, and validated against patients with benign prostatic hyperplasia. Normal control patients, who presented for vasectomy, were studied as well. RESULTS: Nineteen patients (76%) responded to one month's therapy, with 11 (58%) remaining asymptomatic three months later. The symptom score index, as measured by Cronbach's alpha measure of index reliability, was excellent at 0.78 and logistic regression analysis demonstrated each prostatitis question to have independent validity (P < 0.001) but not to the extent of the combined score. CONCLUSIONS: Terazosin appears effective in treating patients with nonbacterial prostatitis/prostatodynia. This new symptom score is one way to evaluate and track patients with this disease. A randomized, placebo-controlled clinical trial has been initiated to study this.

Adrenergic alpha-Antagonists↗
PubMed1994

Effect of age, educational status, ethnicity and geographic location on prostate symptom scores.

We evaluated the effect of patient age, educational status, ethnicity and geographic location upon the American Urological Association benign prostatic hyperplasia symptom scores. Using patients attending Prostate Cancer Awareness Week, we collected additional data on the symptom score and also on education received. A total of 2,245 records was obtained from 4 different centers. Of the population 72% were white and 13% were black. Regression analysis of patient age versus symptom score demonstrated an increase with patient age from 4.59 at age 40 years to 8.17 at age 70 years. Analysis of covariance revealed significant differences in age-adjusted scores between sites from 6.24 in New Orleans, Louisiana to 8.58 in Madison, Wisconsin. No effect was noted for education or ethnicity on symptom scores.

Adult↗
PubMed1992

Prostate specific antigen and prostatitis. I. Effect of prostatitis on serum PSA in the human and nonhuman primate.

Prostate specific antigen (PSA) has become a mainstay in the diagnosis and management of patients with prostate cancer. We have found, as have others, that it may be elevated in patients with prostatic inflammation. Ten patients had clinical evidence of prostatitis and elevated PSA levels. Six of these had persistently elevated levels after antibiotic treatment. After transrectal ultrasonography and biopsy, two had findings of adenocarcinoma, and the rest had a pathologic diagnosis of acute or chronic prostatitis. We studied this process in an experimental model of prostatitis using a nonhuman primate. We infected six cynomolgus monkeys and followed their PSA levels until resolution of the infection. The PSA peaked between 5 and 7 days after inoculation and gradually returned to baseline in 8 weeks. The dramatically elevated serum PSA levels in bacterial prostatitis can cause confusion in the diagnosis of prostatic carcinoma.

Adult↗
PubMed1992

Prostate specific antigen and prostatitis. II. PSA production and release kinetics in vitro.

Elevations in serum prostate specific antigen (PSA) levels in patients with prostatitis are well known, but the pathophysiologic mechanisms involved with this phenomenon are poorly understood. We have recently evaluated the effect of prostatitis on PSA levels in primates. This data demonstrated a rapid rise in PSA, which subsequently fell along the biological decay curve. This suggested a release of sequestered PSA. We evaluated the effect of infection upon PSA production for the prostatic adenocarcinoma cell line LNCaP. The cell line was determined to produce 9.6 +/- 2.7 fg/cell/hr PSA with essentially linear kinetics. No effect was seen with dead bacteria, bacterial supernatant or complement upon the PSA production. Live E. coli had no effect for 4-8 hours at which time the cells sloughed and PSA production ceased. No release of stored PSA was seen. These data do not elucidate the reasons for increased serum PSA levels found with acute bacterial prostatitis, but indicate that it is not a storage phenomenon.

Antigens, Neoplasm↗
PubMed1992

Phase 1 trial of oral bropirimine in superficial bladder cancer.

A total of 34 patients with measurable superficial transitional cell cancer of the bladder entered into a phase 1, nonrandomized, noncomparative trial to assess the toxicity of the oral interferon inducer bropirimine. Of the patients 26 were also evaluable for response. The toxicity of bropirimine was minimal. At the 3-month evaluation 6 patients had experienced complete regression of tumor and had negative cytology studies, and 2 had partial responses. The majority of complete responses were in patients with carcinoma in situ only, with most responses seen at higher dose levels. One patient with papillary tumor and carcinoma in situ had a complete response. Some early responses appear to be durable. Most importantly, a high rate of complete response was noted at higher dose levels among patients who had failed prior therapy with bacillus Calmette-Guerin. Further clinical trials of bropirimine in bladder cancer appear warranted.

Administration, Oral↗
PubMed1992

Prostate cancer.

Clinically, prostate cancer (prostatic adenocarcinoma) is now the most frequently diagnosed cancer in males and the second leading cause of mortality due to cancer in the United States. However, because 75% of histologic prostate cancers remain functionally benign (will not metastasize and kill the patient), mass screening of the male population for the disease has become a hotly debated issue among urologists. The real challenge in the upcoming decade for geriatricians, though, will be to diagnose earlier in their course the prostate cancers which, if not treated, will metastasize and kill the patient and thus allow this subgroup of patients the opportunity to be treated more effectively. This review briefly discusses the etiology of prostate cancer, ways the disease may present, current treatments, depending on disease stage, screening in the diagnosis of prostate cancer, and quality of life issues important to patients confronted with the disease.

Adenocarcinoma↗
PubMed1991

Squamous cell carcinoma of prostate.

A primary squamous cell carcinoma occurring in the prostate of a sixty-nine-year-old man is described. A radical excision that included cystoprostatectomy, total penectomy, scrotectomy, pubic symphysiectomy, and abdominoperineal resection of rectum was done. The patient died of systemic metastases six months after diagnosis. Review of the literature suggests that such a cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therapy. Histogenesis of this tumor remains controversial; however, it probably does not originate from the prostatic acinar cells.

Aged↗
PubMed1991

Quantitative fluorescence image analysis of deoxyribonucleic acid ploidy in urine from normal children.

Quantitative fluorescence image analysis incorporates the 2 diagnostic techniques of cytological analysis with quantitation of deoxyribonucleic acid (DNA). Exfoliated urinary cells are ideal for analysis by this method, which allows the identification of "rare event" abnormal cells. We evaluated the urine from 50 children who had undergone cystoscopy or were catheterized for other reasons. The urine was free of infection by urinalysis. Cytological analysis demonstrated normal or atypical cells in all patients. Of the patients 1 (2%) had greater than 2 of 500 cells analyzed with greater than 5C DNA and 4 (8%) had greater than 2 of 500 cells with greater than 5C double stranded nucleic acid. These data suggest that it may be "normal" for urine to contain "rare event" abnormal cells. The significance of this finding is unclear at present.

Adolescent↗
PubMed1991

Prostate cancer screening in younger men: prostate-specific antigen and public awareness.

The American Cancer Society recommends annual digital rectal examination for men over forty years of age. We evaluated 414 men between forty and fifty-nine years of age with a questionnaire, digital rectal examination (DRE), and prostate-specific antigen (PSA) determination. One hundred ninety were forty to forty-nine years old, and 224 were fifty to fifty-nine years old. Four patients in the forty to forty-nine age group had elevated PSA determinations, and 7 had abnormal findings on DRE. Using prostate ultrasound and biopsy, no cases of prostate cancer were diagnosed. Ten patients in the fifty to fifty-nine age group had elevated PSA determinations, and 5 were diagnosed to have prostate cancer. These data suggest that PSA may have utility in detecting cancer in younger men.

Adenocarcinoma↗