Biomedical subjects

C Ogden

Publications and source records attributed to C Ogden.

8 recordsLinked to original sources

PubMed2000

Imaging with prostate-specific membrane antigen (PSMA) in prostate cancer.

Radioimmunoscintigraphy using a radio-labelled antibody to prostate-specific membrane antigen (PSMA) has growing applications as a means of tissue-specific imaging based on functional characteristics and complements traditional staging investigations. Clinical applications in men with carcinoma of the prostate are being refined, and this study reports outcomes with this technique in our practice. Prostatic immunoscintigraphy scans were performed with In-111 CYT 356 in 49 men with carcinoma of the prostate, obtaining sequential images in two and three dimensions at 10 min, 24 and 48 h. Of the 49 men, 36 had clinically localized cancer, 10 had recurrent disease after radical radiotherapy or radical prostatectomy and three had rising PSA after primary endocrine treatment. Scan findings are discussed in the context of clinical management. Of the 36 men with clinically localized cancer, seven had increased uptake in regional and distant lymph nodes. Of these seven, three were treated with hormone manipulation, two by radical prostatectomy and two by radical radiotherapy. Among 10 patients who had recurrence after radical treatment of the primary tumour, scans showed local recurrence alone in four, and six had regional or distant metastases. Three patients treated with primary hormone manipulation had scans for rising PSA, and of these one had a positive regional node and two had distant soft tissue and bone metastases. In conclusion, prostatic radio-immunoscintigraphy scans highlight tissues involved by prostate cancer, including the prostate, lymph nodes, soft tissues and bone metastases as well as pelvic recurrence. Results may contribute to the clinical management of individual patients, although histological confirmation may be appropriate when considering alternative treatment. Prostate Cancer and Prostatic Diseases (2000) 3, 47-52

Journal Article↗

PubMed1997

Multiple frequent recurrences in superficial transitional cell carcinoma of the bladder: is survival compromised by a conservative management strategy?

OBJECTIVE: To examine whether a strategy of bladder conservation is reasonable in patients with multiple frequent superficial recurrences of transitional cell carcinoma (TCC) of the bladder. PATIENTS AND METHODS: Fifty-four patients with pTa/pT1. G1/G2 tumours at diagnosis, with five or more recurrences at two or more cystoscopies within 2 years of diagnosis and a minimum follow-up of 4 years were identified. The patients were categorized according to outcome, i.e. disease settled, continuing high-activity disease and disease progression. RESULTS: Forty-four patients did not progress, of whom 16 continued to have high-activity disease and 28 settled to a lower disease activity. One patient had a cystectomy for superficial disease. Nine patients progressed, six with muscle invasion in the bladder and three elsewhere in the urinary tract. Neither grade nor stage were predictive of recurrence. All but one of the patients with progression had both multicentric tumours at diagnosis and a positive cystoscopy at 3 months. Three patients died from their bladder cancer. CONCLUSION: A policy of endoscopic resections and intravesical chemotherapy or bacille-Calmette-Guèrin, with cystectomy reserved until muscle-invasive disease develops, does not significantly compromise survival in patients with high-activity superficial TCC. Cystectomy for superficial disease is rarely necessary.

Administration, Intravesical↗

PubMed1996

A 12-month study of the placebo effect in transurethral microwave thermotherapy.

OBJECTIVE: To determine the placebo effect of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic enlargement (BPE). PATIENTS AND METHODS: A prospective, randomized sham-controlled study in 93 patients (mean age 65, range 50-88) was conducted at two centres comparing TUMT or a sham treatment. Patients randomized to receive sham treatment underwent the same initial procedure as for TUMT, but the complete procedure was simulated on the visual display with no application of microwave energy. If the patient's condition had not improved after 3 months, a second genuine TUMT treatment was given at the patient's request. RESULTS: After 3 months there were significant clinical and statistical differences in efficacy between the groups; 62% and 18% of patients had a > 50% improvement in symptom score in the treated and sham groups, respectively (P = 0.001). The corresponding changes in flow rate were 36% and 11% (P = 0.002), respectively. After 1 year, 63 patients were divided into those that had TUMT initially, those that had sham initially but subsequently had TUMT and those whose sham procedure had led to sufficient clinical improvement to require no further treatment. The two treated groups had a significant improvement over the sham group. CONCLUSION: The benefit from TUMT cannot be due to a placebo effect alone.

Aged↗

PubMed1995

The prediction of clinical outcome from transurethral microwave thermotherapy by pressure-flow analysis: a European multicenter study.

A total of 100 patients treated with a single session of microwave thermotherapy at 4 European centers was stratified according to 2 different types of obstruction (constrictive and compressive) and compared to clinical outcome at 6 months. Patients had a Madsen-Iversen score of 8 or more, maximum flow rate of 15 ml. per second or less and residual urine volume of 300 ml. or less at entry. The change in Madsen-Iversen score was the same in the 2 groups. Maximum flow rate increased from 8.71 +/- 2.62 to 14.73 +/- 4.04 ml. per second in the constrictive group, and from 8.54 +/- 2.26 to 10.41 +/- 4.52 in the compressive group (p < or = 0.0001). Residual urine decreased from 96.00 +/- 72.85 to 40.34 +/- 56.33 ml. in the constrictive group and from 109.86 +/- 67.09 to 84.65 +/- 81.45 ml. in the compressive group (p < or = 0.0001). Success, as defined by an increase of 50% or more in maximum flow rate and Madsen-Iversen score, was noted in 68% of the constrictive but only 15% of the compressive groups (p < or = 0.0001 chi-square test for trend). Selection by pressure-flow criteria for patients being considered for thermotherapy should improve the overall clinical results.

Diathermy↗

PubMed1994

Patient and staff needs drive changes on a postsurgical unit.

In response to a dynamic health care environment and influenced by fiscal pressures, "business as usual" on the postsurgical unit at University of Nebraska Medical Center required examination. Both internal and external factors prompted a staff-driven task force to plan and implement changes. The task force consisted of representatives from staff and management to redesign current practices collaboratively. Issues addressed were nursing workload, responsibilities, scheduling, patient satisfaction, job satisfaction, and professional development. Expected outcomes of changes in the work design on the unit centered on increased efficiency of nursing time, cost effectiveness, and increased satisfaction of patients and nursing staff. The task force proposed and implemented innovative changes in the report and documentation system, utilization of nonprofessional staff, and redesign of work hours. The article presents these changes in the work environment and focuses on a written report system and a clearly defined role for nonprofessional staff.

Academic Medical Centers↗

PubMed1993

Clinical response to transurethral microwave thermotherapy is thermal dose dependent.

Transurethral microwave thermotherapy of the prostate was used to treat men with symptomatic benign prostatic hypertrophy. Three treatment protocols delivering increasing thermal doses (Prostasoft T-A > Prostasoft II > Prostasoft I) were evaluated. The results show a dose-dependent response. Histological changes induced by microwave heating were dependent on the temperature achieved in the tissue. Thermocoagulation is obtained above 45 degrees C and thermoablation above 60 degrees C. Using Prostasoft II in a long-term follow-up study, the Madsen symptom score decreased by 66% and peak flow rates increased by 41% over a period of more than 18 months. Using Prostasoft T-A (thermoablation) in 28 patients, a cavity was obtained inside the prostate without major complication. The symptoms and obstruction caused by benign prostatic hypertrophy can be treated by transurethral thermotherapy in a single, anesthesia-free 1-hour session on an ambulatory basis.

Follow-Up Studies↗

PubMed1991

An evaluation of pulse oximetry in prehospital care.

STUDY OBJECTIVES: We performed this study to evaluate the accuracy of pulse oximetry oxygen saturation (SpO2) against direct measurements of arterial oxygen saturation (SaO2) in the field. DESIGN: Prospective, cross-sectional, paired measurements of SpO2 against SaO2. SETTING: This evaluation was done in the prehospital setting. INTERVENTIONS: A pulse oximeter with digital probe was used to measure SpO2 in 30 patients. Arterial blood gases were drawn in the field while the pulse oximeter was in use, and oxygen saturation (HbO2) was measured by CO-oximetry. MAIN RESULTS: There was no significant difference between SpO2 (94.6 +/- 5.4%) and HbO2 (94.9 +/- 5.1%) (P = .495, beta less than .2). There was a strong correlation between SpO2 and HbO2 (r = .898). The bias between SpO2 and HbO2 was -0.3, with a precision of 2.4. When SpO2 was 88% or more, HbO2 was 90% or more in every case. Mean carboxyhemoglobin was 1.3 +/- 0.9%, and mean methemoglobin was 0.9 +/- 0.3%. There was no significant difference between the pulse oximeter heart rate and the ECG heart rate (P = .223, beta less than .2). CONCLUSION: We conclude that pulse oximetry is sufficiently accurate to be useful in the field when SpO2 is more than 88%. It is potentially useful in patients with clinical signs of acute hypoxemia and in patients receiving interventions that may produce acute hypoxemia. Further work is needed to evaluate the accuracy of pulse oximetry in the settings of elevated carboxyhemoglobin, methemoglobin, and very low saturations.

Aged↗

PubMed1980

Ultrasound in early thyroid orbitopathy.

Fourteen patients with unilateral exophthalmos were found on A-scan ultrasound examination to have enlarged extraocular muscles. Thyroid dysfunction later was documented in 12 patients (86%) by laboratory tests and subsequent clinical examination. The suspicion of endocrine orbitopathy was based on the presence of enlarged extraocular muscles in both orbits and on the difference in thickness between corresponding muscles. A-scan orbital examination including specific muscle measurements is a simple and apparently reliable method of diagnosing early thyroid orbitopathy.

Adult↗