Renal cell carcinoma in a transplanted kidney.
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Carcinoma, Renal Cell↗
Biomedical subjects
B Fallon
Publications and source records attributed to B Fallon.
Reassessing the efficacy of the Dornier MFL-5000 lithotriptor.
PURPOSE: The Dornier MFL-5000* is a multifunctional lithotriptor unit that has been purported to be highly efficacious for treating stones. Our experience led us to believe that the actual success rates are not as high as those reported by others. We objectively reexamined the efficacy of this device and factors contributing to treatment success or failure. MATERIALS AND METHODS: We retrospectively reviewed the records and x-rays of 105 consecutive patients treated with extracorporeal shock wave lithotripsy (ESWL*) using the MFL-5000 during an 18-month period from September 1997 to March 1999. One patient was excluded from study due to a stone within a caliceal diverticulum. Patients were divided evenly by gender and stone laterality. In 70% of cases a stent was placed preoperatively to relieve obstruction and/or facilitate the passage of calculous fragments. The majority of stones (70%) were 10 mm. or less. Treatment success was determined by examining x-rays done preoperatively and at a median of 4 weeks postoperatively. RESULTS: ESWL was successful in only 47% of our patients, defined as residual stone fragments 2 mm. or less. A secondary procedure was required in 27% of the patients, including repeat ESWL in 6, ureteroscopic stone manipulation in 14, percutaneous tube placement in 1 and percutaneous nephrolithotripsy in 7. Factors contributing to secondary procedures and poor stone clearance were a stone burden of greater than 100 mm.2 and mid pole location (p = 0.0242 and 0.016, respectively). Poor stone fragmentation and clearance were noted despite significantly more shocks delivered (p = 0.0122). Only a small stone burden of 50 mm.2 or less responded well to ESWL (p = 0. 0142). CONCLUSIONS: These results compel us to reconsider the effectiveness of the Dornier MFL-5000 lithotriptor. We encourage groups at other institutions to reexamine and report their success rates. We recommend the use of this lithotriptor only for a stone burden of 50 mm.2 or less.
Adolescent↗
Infection control in outpatient unicomponent penile prosthesis surgery.
The aim of this work is evaluate the efficacy of infection control measures with unicomponent penile implants in two ambulatory surgery units in Cairo and Jeddah. This was a retrospective study of 117 consecutive cases. A patient selection and infection control protocol was followed to implant 12 hydraulic, 53 mechanical and 52 malleable prostheses under local bupivacaine penile ring anesthesia and intravenous propofol. No infection occurred that required prosthesis removal, none required hospitalization or urinary catheterization, one crural and two septal perforations were managed intraoperatively; one case was reoperated upon for mechanical failure, two for oversizing and one for undersizing the girth. We conclude that implantation of unicomponent penile implants under triple antibiotic coverage in an ambulatory surgery setting, with rigid infection control measures appears to be effective in preventing infection.
Adult↗
The autonomy of mood disorders among cocaine-using methadone patients.
This study uses an algorithm to determine whether patients dually diagnosed with a mood disorder and cocaine dependence have either (a) an autonomous mood disorder (onset of mood disorder prior to substance use disorder (SUD) or mood disorder symptoms persist during periods of abstinence or (b) a nonautonomous mood disorder (onset of SUD preceded mood disorder and mood disorder symptoms remit during periods of abstinence). The relationship among autonomy, patient characteristics, and treatment completion is examined. The sample included 67 methadone patients with a mood disorder (87% major depression, 13% bipolar) who were enrolling in a 6-month psychosocial treatment for cocaine use. Of these subjects, 27% were rated as having an autonomous mood disorder and 73% a nonautonomous mood disorder. Mean age was 37 years; 55% were female and 82% were Hispanic or African-American. All subjects had been stabilized on methadone (mean = 70 mg). During the 30 days prior to study intake, subjects with an autonomous mood disorder, compared to subjects with a nonautonomous mood disorder, reported fewer days using cocaine (12.5 versus 21.1) and fewer days drinking four or more drinks of alcohol (1.1 versus 6. 1). Treatment completion was associated with less cocaine use, autonomy, and African-American ethnicity. However, when these variables were controlled using logistic regression, only autonomous mood disorder and ethnicity predicted treatment completion. These results suggest that autonomy may be a useful construct to measure, and that subjects with nonautonomous mood disorders may need special efforts to ensure treatment retention.
Adult↗
Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome.
BACKGROUND: This article presents results of the acute treatment phase of a 2-site study comparing cognitive behavioral group therapy (CBGT) and treatment with the monoamine oxidase inhibitor phenelzine sulfate for social phobia. METHODS: One hundred thirty-three patients from 2 sites received 12 weeks of CBGT, phenelzine therapy, pill placebo administration, or educational-supportive group therapy (an attention-placebo treatment of equal credibility to CBGT). The "allegiance effect," ie, the tendency for treatments to seem most efficacious in settings of similar theoretical orientation and less efficacious in theoretically divergent settings, was also examined by comparing responses to the treatment conditions at both sites: 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment. RESULTS: After 12 weeks, phenelzine therapy and CBGT led to superior response rates and greater change on dimensional measures than did either control condition. However, response to phenelzine therapy was more evident after 6 weeks, and phenelzine therapy was also superior to CBGT after 12 weeks on some measures. There were few differences between sites, suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances. CONCLUSIONS: After 12 weeks, both phenelzine therapy and CBGT were associated with marked positive response. Although phenelzine therapy was superior to CBGT on some measures, both were more efficacious than the control conditions. More extended cognitive behavioral treatment and the combination of modalities may enhance treatment effect.
Adult↗
Fournier's gangrene with an unusual urologic etiology.
Fournier's gangrene is a necrotizing infection affecting the male genitalia and perineum, caused by synergistic aerobic and anaerobic organisms. We report on a previously undescribed upper urinary tract etiology for this life-threatening infection.
Fournier Gangrene↗
Hepatic phenylalanine hydroxylase of Clethrionomys glareolus Schreber as a bioindicator of pollution.
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Animals↗
Treatment level progress and time spent in treatment in the prediction of outcomes following drug-free therapeutic community treatment.
UNLABELLED: Previous research has suggested that time spent in treatment is the most important predictor of therapeutic community treatment outcomes. Although level divisions or treatment stages represent the basic structure for segmenting responsibility and authority within traditional therapeutic communities, the relationship of this treatment component to treatment outcome has not previously been investigated. AIM: To test the hypothesis that higher treatment level attainment, more time spent in treatment and additional time spent within a treatment level has a linear association with improvements at outcome. DESIGN: Retrospective quasi-experimental. PARTICIPANTS: Four hundred and twenty-seven ex-residents, stratified according to their highest level of treatment in the Melbourne Odyssey House therapeutic community between 1984 and 1988 were targeted for follow-up and 60% were successfully located and interviewed an average of 5.6 years after their first Odyssey entry. Analysis of official records of methadone treatment, convictions and incarcerations demonstrated no post-treatment differences comparing those interviewed with those not interviewed. MEASUREMENTS: Drug use, criminal involvement and employment. FINDINGS. Although both level attainment and time spent in treatment had a linear relationship to improved outcomes, level attainment was a better predictor of outcomes at treatment exit. An unexpected finding was that those who had spent the median time or longer in particular levels demonstrated worse outcomes on official conviction records and on self-reports of employment compared to those remaining for less than the median time. CONCLUSION: The results suggest that it may be level progress rather than simply time spent in treatment that best explains improved functioning following exit from the therapeutic community.
Adult↗
Placebo-controlled trial of moclobemide in social phobia.
BACKGROUND: Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia. METHOD: Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight weeks. RESULTS: Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated. CONCLUSIONS: Moclobemide may have efficacy in the treatment of social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small.
Adolescent↗
Ondansetron in the treatment of panic disorder.
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Administration, Oral↗
Intracavernous injection therapy for male erectile dysfunction.
Intracavernosal injection therapy has consistently produced erections in 60% to 70% of patients in whom it is tried. About 70% of patients enter long-term therapy and there is a dropout rate of 20% to 50% within the first year. The most effective current regimen is a mixture of papaverine-phentolamine and prostaglandin E1, that also seems to have a relatively low incidence of priapism and fibrous nodule formation. Patient education is vitally important to the success of a program. Patient satisfaction rates are high.
Drug Therapy, Combination↗
Conservative surgical therapy of localized renal cell carcinoma in von Hippel-Lindau disease.
BACKGROUND: Renal cell carcinoma is a frequent cause of morbidity and mortality in patients with von Hippel-Lindau disease. METHODS: A review was conducted of 10 patients with von Hippel-Lindau disease and localized renal tumors, who underwent renal parenchyma-sparing surgery. Four patients had recurrences, requiring a total of 16 operations. Patients were followed for recurrence by computed tomography. RESULTS: The mean follow-up for these patients was 62 months (range, 11-118 months). Seventy-two tumors were resected, including 36 tumors not seen by preoperative imaging studies. This was accomplished primarily by enucleation or partial nephrectomy when anatomically feasible. No patient required dialysis, and the mean serum creatinine at follow-up was 1.2 mg/dl (range, 0.9-1.7). Of the 10 patients, 2 died, one of primary lung cancer with recurrent renal cell carcinoma found at autopsy, and one of metastatic renal cell carcinoma. Another patient with probable recurrent tumor was being observed at the time of this writing. The other seven patients were alive and without evidence of renal cancer. CONCLUSION: Although the risk of recurrence is high, these patients may be treated with parenchyma-sparing renal surgery and enjoy a prolonged survival, and avoid the complications of dialysis or transplantation.
Adult↗
Teamwork achieves success ... benefits of IMS membership.
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Humans↗
Laparoscopic nephrectomy in crossed fused renal ectopia.
Operative laparoscopy offers the patient a minimally invasive alternative to open surgery. We have recently performed a laparoscopic nephrectomy of the upper moiety of a crossed fused renal ectopia. The procedure lasted approximately six hours, and the patient was discharged on postoperative day 3. He was able to resume normal physical activity in one week. This case demonstrates the advantages of minimally invasive surgery.
Adult↗
Alpidem in the treatment of panic disorder.
Alpidem, an imidazopyridine that acts at the gamma-aminobutyric acid/benzodiazepine receptor complex, has been reported to be an effective anxiolytic with a more favorable side effect profile than benzodiazepines. The effect of alpidem was investigated in an 8-week, open, clinical trial in 13 patients with panic disorder, with or without agoraphobia. Three patients were responders (much improved or very much improved), five patients were nonresponders, and five patients dropped out after less than 6 weeks of treatment. Significant improvement was seen in the sample as a whole for spontaneous panic attacks, phobic avoidance, and anticipatory anxiety. Most improvement occurred during the first 4 weeks of treatment, and responders had milder panic disorder at baseline. Adverse effects were generally mild. After 8 weeks of treatment, taper of medication over 2 weeks occurred without significant worsening of panic disorder symptoms. The efficacy of alpidem in the treatment of panic disorder remains uncertain and requires assessment in a controlled trial.
Adolescent↗
A phase I study of an outpatient regimen of recombinant human interleukin-2 and alpha-2a-interferon in patients with solid tumors.
This study was undertaken to define the maximum tolerated dose (MTD) of recombinant interleukin-2 (IL-2) that could be combined with a fixed dose of alpha-2a-interferon (alpha-IFN) in an outpatient setting. The schedule called for IL-2 to be given by a 2-hour intravenous infusion 5 days a week for 4 weeks. The alpha-IFN was given at a dose of 6 x 10(6) U/m2/d intramuscularly 3 days per week (Monday, Wednesday, and Friday). The IL-2 dose was escalated in four dose levels from 1 to 4 x 10(6) U/m2/d. The MTD in this study of 17 patients was at the fourth dose level of IL-2 (4 x 10(6) U/m2/d). In addition to the usual IL-2 toxicities, debilitating fatigue limited outpatient administration of this dose. Although the response rate was low, with partial responses seen in only 1 of 15 patients, 2 of 5 patients with melanoma treated at the higher dose levels had objective tumor shrinkage with one partial and one minor response. Thus, an IL-2 dose of 3 x 10(6) U/m2/d combined with a recombinant alpha-2a-IFN dose of 6 x 10(6) U/m2/d is recommended for Phase II studies.
Adult↗
Two new uses of 8-F feeding tube in performing injecting urethrograms.
A modification of a previously described method for visualizing the urethrovesical junction is described. This modification is easier to perform, less messy, and obtains superior images to the method now used. A new method for outlining urethral strictures is also described. Both methods use an 8-F feeding tube.
Catheterization↗
A phase I study of recombinant human interleukin-2 and alpha-interferon-2a in patients with renal cell cancer, colorectal cancer, and malignant melanoma.
Preclinical data suggest synergy of interleukin-2 (IL-2) combined with alpha-interferon (IFN). In addition, toxicities of IL-2 may be decreased by intermittent continuous infusion. The purpose of this trial was to determine the maximum tolerated dose (MTD) of recombinant IL-2 combined with alpha-IFN in patients with renal cancer, colon cancer, melanoma, and malignant B-cell disease. IL-2 was given by continuous i.v. infusion at an initial dose of 5 X 10(5) units (U)/m2/d for 4 days plus IFN at 6 X 10(6) U/m2/d intramuscularly days 1 and 4 weekly for 4 weeks. Patients who achieved a response or stable disease received an additional 4 weeks of therapy. IL-2 doses were increased to 1, 2, 3, 5, and 7 X 10(6) U/m2/d with three to eight patients at each dose level, at each of the two participating institutions. The dose of IFN was 6 X 10(6) U/m2 days 1 and 4 for all but five patients whose IFN dose was doubled to 12 X 10(6) U/m2/d. Forty-three patients were entered on this study with 34 completing at least 4 weeks of therapy. Six patients were taken off study because of Grades III or IV pulmonary, neurologic, or cardiac toxicity; one for progressive disease; one for CNS metastases, and one for personal reasons. All of the toxicities were reversible. Chills and fever were universal, especially on days 1 and 4. Mild and moderate nausea, vomiting, diarrhea, anorexia, malaise, and cutaneous erythema were present in most patients. Fluid retention and occasional pleural effusions were observed at the higher IL-2 doses but were not dose-limiting. Significant hypotension associated with oliguria was seen, and these patients were treated with vasopressors and colloids. None of the patients required ICU admission. Thirty-four patients were evaluable for response. There were 4/18 (22%) renal cell patients who experienced a partial response. No responses were seen in patients with melanoma, lymphoma, or colorectal cancer. The combined debilitating symptoms of fatigue, diarrhea, hypotension, fluid retention, and anorexia defined the MTD as 5 X 10(6) U/m2/d of IL-2 and 6 X 10(6) U/m2 of alpha-IFN.
Adult↗