Biomedical subjects
Publications and source records attributed to B Fallon.
The use of autologous human dura mater as a graft material in 7 cases of Peyronie disease is described. In 3 cases, preoperative erectile ability was thought to be inadequate, and a penile prosthesis was simultaneously inserted. No complications occurred related to the graft material although 1 patient has inadequate erections postoperatively and another appears to have recurrent Peyronie disease.
The pathologic specimens of 64 patients who underwent radical prostatectomy for clinical Stage A or B carcinoma of the prostate were reviewed retrospectively for surgical margin involvement with cancer. Fourteen of the operations were performed by the radical transperineal method, 30 by the standard radical retropubic approach, and 20 by the nerve-sparing radical retropubic technique. Seventy-eight percent of the radical transperineal group had resection margin involvement, as opposed to 30 percent of the standard radical retropubic cases, and 45 percent of the nerve-sparing radical retropubic cases. The average tumor burden of the transperineal group was larger than that of the other two groups. Resection margin involvement in all groups was associated with a higher Gleason histologic score. No significant difference was noted between the two retropubic groups in terms of resection margin involvement (P = 0.28), suggesting that nerve-sparing radical retropubic prostatectomy does not compromise the surgical goal of radical prostatectomy for carcinoma over that of the standard radical retropubic prostatectomy.
Some forms of anxiety and affective disorder, such as panic disorder and major depression, appear distinct, while other forms, such as generalized anxiety disorder and chronic depression or dysthymia, may lie on a continuum and blend with each other. However, even panic disorder and major depression have many common features. Moreover, for reasons not yet clear, they occur together frequently, and their combined occurrence in the same patient has been associated with greater severity and chronicity, decreased treatment responsiveness, and, possibly, increased familial prevalence of anxiety and/or depression. Finally, studies of primary care patients suggest the frequent occurrence of a mixed anxiety-depressive disorder that may often be subsyndromal by DSM-III-R criteria but is nevertheless associated with prominent distress and/or impairment.
In addition to being effective in depressive disorders, monoamine oxidase inhibitors (MAOIs) have been shown to be effective in controlled studies of patient with panic disorder with agoraphobia, social phobia, atypical depression or mixed anxiety and depression, bulimia, posttraumatic stress disorder (PTSD) and borderline personality disorder. Uncontrolled case reports have noted MAOI efficacy in obsessive-compulsive disorder (OCD), trichotillomania, dysmorphophobia and avoidant personality disorder. Reversible inhibitors of MAO-A (RIMAs) appear safer than the classical irreversible MAOIs since they have less potential to increase blood pressure. They have not been studied as yet, however, in most of the conditions responsive to MAOIs. If RIMAs are found effective in these disorders, they would probably achieve wider use than MAOIs because they are safer and tend to cause fewer side effects.
Eight patients with depersonalization disorder or with depersonalization symptoms in association with obsessive-compulsive and panic disorders were treated with serotonin reuptake blockers. There was clinical overlap of depersonalization disorder with obsessive-compulsive disorder, and the co-occurrence of obsessive-compulsive and panic features with depersonalization in these patients was associated with a favorable treatment outcome. The chronicity of illness and lack of prior response to a variety of treatments in these patients highlights the positive outcome with this treatment. In addition, issues are raised regarding the current hierarchical exclusion of depersonalization disorder in the presence of obsessive-compulsive and panic disorders.
The evaluation of clinical stage C prostatic cancer has been enhanced by advances in staging modalities over the past 15 years. Better staging of the local lesion is possible with transrectal ultrasound-guided multiple biopsies of the prostate and its vicinity. Biopsies of suspect pelvic lymph nodes guided by CT (or lymphangiography) may obviate pelvic lymphadenectomy, particularly in patients with high-grade stage C lesions. Advances in the understanding of serum markers have supplemented other staging information. No single therapeutic modality is appropriate for all cases of clinical stage C cancer. In C1 lesions, radical prostatectomy with adjunctive radiation or hormonal therapy seems to produce the best 5- and 10-year survival rates. External-beam radiation alone, or in combination with interstitial radiation, may have equivalent success. In clinical stage C2 disease, external-beam radiotherapy seems at present to be the best therapeutic modality. Interstitial radiation as a sole method of management in stage C disease carries a high local recurrence rate and a significant risk of metastatic progression. Transurethral prostatectomy and hormonal treatment continue to have a place in the management of selected poor-risk patients. The current results with surgery or radiation therapy alone are less than ideal. It is recommended that aggressive combination treatment be compared with monotherapy in randomized clinical trials monitored jointly by radiation and urologic oncologists.
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We evaluated the survival rate and time to recurrence for 114 patients in whom an initial histological diagnosis of stage B1 or B2 bladder tumor was made between 1974 and 1983. The 5-year survival rates for stages B1 and B2 disease, respectively, were 63 and 38 per cent in 43 patients treated by transurethral resection alone, 48 and 54 per cent in 40 treated by preoperative radiation and radical cystectomy, 33 and 25 per cent in 15 treated by radical cystectomy alone, and 53 and 11 per cent in 16 treated by definitive radiation therapy alone. Similar results were found among the groups with regard to time to development of metastases. The distribution of stage, grade and number of tumors was not significantly different among the treatment groups. Patients in the transurethral resection group were older, and had smaller tumors and more medical problems. Comparing transurethral resection of muscle invasive bladder tumors to standard radical surgery with or without radiotherapy yielded comparable long-term survival and time to distant recurrence.
To survive in an increasingly competitive industry, many healthcare organizations are struggling to strengthen their performance and position. However, many providers find they lack the internal ability to systematically collect and analyze market and industry information. By using a competitive analysis process, hospitals can examine current and future market information which includes insights on industry potential, competition among hospitals with similar characteristics, and the individual hospital's performance. By competitively assessing the industry and themselves, hospitals can establish a position for themselves in fresh markets and predict their likely success.
Hypertensive reactions occurred without obvious cause in two patients receiving monoamine oxidase inhibitors (MAOIs) while being monitored in a hospital. These patients appear to have experienced "spontaneous" hypertensive episodes temporally related to the ingestion of the MAOIs. Similar occurrences in outpatients reported in the literature are reviewed.
The clinical, light and ultrastructural features of three renal neoplasms demonstrating a sarcomatous appearance on light microscopic examination are reported. At the time of radical nephrectomy, all three tumors displayed aggressive features with capsular invasion and either metastases or invasion of adjacent organs. Ultrastructural examination revealed epithelial features in a pure spindle cell tumor and in a malignant fibrous histiocytoma-like tumor (sarcomatoid renal carcinoma) and smooth muscle differentiation (leiomyosarcoma) in a lesion showing features of malignant fibrous histiocytoma. All three patients died from 1 to 9 months after nephrectomy. Renal tumors with a sarcomatous histologic appearance are aggressive neoplasms that cannot be classified accurately solely by employing light microscopic criteria.
At the Dana-Farber Cancer Institute Head and Neck Cancer Clinic, 114 previously untreated patients with advanced squamous cell carcinoma of the head and neck (17% stage III; 83% stage IV) were managed with induction chemotherapy using cis-platinum, bleomycin, and methotrexate, followed by definitive extirpative surgery and/or radiation therapy. The present report evaluates this group from a surgical and surgical pathology standpoint. The following aspects are evaluated: predictability of, and conversion to, resectability during induction chemotherapy; ease of surgical technique and intraoperative assessment; patterns of pre-op and post-op risks and complications; gross and histopathologic observations of the extent and character of residual primary and nodal disease, particularly after a response to chemotherapy; patterns of locoregional control or failure related to treatment variables. The issues subsequently addressed include: how does chemotherapy affect the operative candidacy and resectability of proposed surgical patients? Could, or should surgery be eliminated in the management of some patients treated with induction chemotherapy? Can less radical surgery be contemplated in patients significantly "downstaged" by prior chemotherapy treatment? Is increased locoregional or distant metastatic control observed in these patients? What is the role of surgery in the responder to chemotherapy?
Two patients who underwent radical nephrectomy for renal cell carcinoma developed local recurrence with lumbar vertebral involvement and intractable pain. Both patients were treated with a combination of radiation therapy and selective lumbar vertebral artery embolization with complete resolution of pain and no evidence of recurrence of disease after 3 years.
Sixty-four patients who had unilateral or bilateral orchiopexy for cryptorchism between 1950 and 1960 responded to a questionnaire. Marriage rates were the same as in a control group. Unilaterally cryptorchid patients had normal paternity rates and sperm concentrations on semen analysis. Only 2 of 15 bilaterally cryptorchid patients had fathered children, while severe oligospermia was present in all 10 who had semen analysis performed. Thirty per cent of pexed testes had a cosmetically poor result.
A case is presented of a thirty-seven-year-old woman with bilateral renal masses interpreted as abscesses on computerized tomography (CT) scan. Subsequent renal exploration revealed metastatic cervical carcinoma, which is a relatively rare entity.
Since 1969 cryosurgical perineal destruction of the prostate has been developed at the University of Iowa for treatment of patients with prostatic cancer. The technique of this procedure has been the subject of previous reviews. This is a summary of our experience of patient survival and the effect on local prostatic cancer growth in those patients with various stages of the disease subjected to perineal cryosurgical destruction of their cancer. We also report briefly on our experience in the laboratory where the Dunning tumor model is used to study the effect of cryosurgery as well as combinations of immunological modifications.
An inflatable penile prosthesis was implanted in 95 patients between 1977 and 1983. The patients were divided into 3 groups with roughly equal numbers studied during 2-year intervals. Of the prostheses 48 per cent have been revised or removed, or have failed during followup. The complication rate increased with the duration of followup.
Of 10 patients with familial or nonfamilial visceral myopathy studied for urological manifestations only 3 had symptoms of urinary retention. Excretory urography revealed megacystis in all 3 symptomatic patients, while the 7 asymptomatic patients had normal-sized bladders. Cystometrograms performed in 4 asymptomatic patients also were normal. Bladder tissue from 5 patients was studied. Of 3 autopsy cystectomy specimens 2 were dilated severely and thin-walled without trabeculations or diverticula suggestive of mechanical obstruction. Microscopic sections showed segmental intrafascicular fibrosis in 4 patients, which was associated with elastosis in 3. Electron microscopy of leiomyocytes in abnormal fascicles revealed myofilament disorganization, lipid accumulation and increased numbers of cytoplasmic organelles. We conclude that pathological changes in the bladder occur commonly but urinary symptoms occur in less than half of the patients with visceral myopathy available for study. An abnormal excretory urogram was seen in only patients who had symptoms suggestive of lower urinary tract dysfunction.