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Biomedical subjects

D Costello

Publications and source records attributed to D Costello.

At least 19 recordsLinked to original sources
PubMed2000

Surgical management of primary melanoma.

A significant proportion of the general population is diagnosed with malignant melanoma each year, and more people die of melanoma now than at any time in the past. Consequently, treatment of melanoma at all stages of development is an important clinical issue. A variety of management options are discussed here, including biopsy techniques and treatment of the primary melanoma. The latter include lymphatic mapping and sentinel lymph node biopsy, hyperthermic isolated limb perfusion, and surgery for stage IV melanoma patients. Procedure-associated benefits and possible complications associated with each modality are also summarized.

Biopsy↗
PubMed2000

Tailgut cyst.

Explore the source record for details and available documents.

Cysts↗
PubMed1999

Lymphatic mapping in breast cancer.

The most accurate predictor of survival in breast cancer is the presence or absence of lymph node metastases. Lymphatic mapping with sentinel node biopsy is a new technique that provides more accurate nodal staging compared with routine histology for women with breast cancer, but without the morbidity of a complete lymph node dissection. Sentinel lymph node (SLN) biopsy is a more conservative approach to the axilla that requires close collaboration from the surgical team, nuclear medicine, and pathology. National trials are investigating the clinical relevance of the upstaging that occurs with a more intense examination of the SLN. As is the case with breast preservation as a viable alternative to mastectomy for the definitive treatment of the primary node, selective lymphadenectomy has the ability to decrease morbidity without compromising patient care.

Breast Neoplasms↗
PubMed1999

Lymphatic mapping for melanomas of the upper extremity.

Over a period of 4 years, 127 consecutive patients with upper extremity melanomas were identified from a prospectively accrued database. A protocol consisting of preoperative lymphoscintigraphy and intraoperative lymphatic mapping and with a vital blue dye and radiocolloid was used; the protocol had a 98% success rate of identifying the sentinel lymph node (SLN). Preoperative lymphoscintigraphy identified unpredictable cutaneous lymphatic flow in 15 (12%) of the patients. These discordant areas would not have been included in classic regional node dissection and possible sites of metastatic disease would not have been identified. Metastatic disease was identified within the SLNs in 12 (9%) of the patients. Of the 12 patients with a positive SLN, 2 (17%) were found on complete node dissection to have metastatic disease in higher nodes in the regional basin. The SLN was the only site of disease in 10 of these 12 patients with documented metastases in the regional basin. Patients with a negative SLN biopsy can be spared the morbidity and expense of a complete lymph node dissection.

Arm↗
PubMed1999

Radioguided surgery for melanoma.

The advent of lymphatic mapping and sentinel lymph node biopsy provides an effective and less morbid procedure for staging patients with malignant melanoma. There is considerable variation on this technique. This article describes the technique that was developed and is currently in application at the H. Lee Moffitt Cancer Center and Research Institute. Understanding all the steps and paying close attention to all details are important to ensure successful mapping.

Biopsy↗
PubMed1999

Minimally invasive radioguided parathyroidectomy.

The last decade has been characterized by an emphasis on minimizing interventional techniques, hospital stays, and overall costs of patient care. It is clear that most patients with sporadic HPT do not require a complete neck exploration. We now know that a minimal approach is appropriate for this disease. Importantly, the MIRP technique can be applied to most patients with sporadic HPT and can be performed by surgeons with modest advanced training. The use of a gamma probe as a surgical tool converts the sestamibi to a functional and anatomical scan eliminating the need for any other preoperative localizing study. Quantification of the radioactivity within the removed gland eliminates the need for routine frozen section histologic examination and obviates the need for costly intraoperative parathyroid hormone measurements. This radioguided technique allows the benefit of local anesthesia, dramatically reduces operative times, eliminates postoperative blood tests, provides a smaller scar, requires minimal time spent in the hospital, and almost assures a rapid, near pain-free recovery. This combination is beneficial to the patient whereas helping achieve a reduction in overall costs.

Adenoma↗
PubMed1998

Two- to six-year controlled-trial stuttering outcomes for children and adolescents.

This research is a long-term follow-up of a previously published, controlled trial on the effectiveness of 3 stuttering treatments (intensive smooth speech, parent-home smooth speech, and intensive electromyography feedback) for children and adolescents, aged 11 to 18 years, who stutter. The previous controlled trial showed all 3 treatments to be effective compared to nontreatment after 12 months. This paper reports on the treatment effectiveness after an average of 4 years post-treatment. Results demonstrate that treatment gains were maintained in the long term, with rates of stuttering similar to the 1-year postoutcomes. There were no significant differences among the 3 treatments in long-term effectiveness. This controlled study substantiates the claim that the treatments investigated will more than likely have substantial long-term benefits for the fluency and personality of children and adolescents who stutter.

Adolescent↗
PubMed1998

Efficacy of Nicardipine for Long-Term Therapy of Chronic Stable Angina.

BACKGROUND: Although angina is a chronic disease, most clinical trials evaluating antianginal therapy are of a few weeks or months in duration. METHODS AND RESULTS: To evaluate the effects of nicardipine, a second-generation dihydro-pyridine calcium channel blocker, as long-term therapy, patients with chronic stable angina were treated for 1 year with open-label nicardipine. Anginal symptoms were controlled with 20 mg tid in 24%, 30 mg tid in 34%, and 40 mg tid in 42%. Of 72 patients completing the 1-year trial, only 14 (19%) had required the addition of long-acting nitrates for control of symptoms. The remaining 57 patients, who had anginal symptoms controlled with nicardipine alone, were continued into the 3-week, double-blind period and were randomized to continue their usual dose of nicardipine or placebo. Throughout the 1-year, open-label treatment period, the number of anginal episodes and exercise parameters of angina were significantly reduced with nicardipine. CONCLUSIONS: During the double-blind period, the patients who continued on nicardipine had significantly greater exercise time and time to onset of angina than patients who were randomized to placebo. The exercise parameters in the patients randomized to placebo were improved over baseline after 1 year of therapy; however, the improvement with nicardipine was significantly greater.

Journal Article↗
PubMed1996

A controlled clinical trial for stuttering in persons aged 9 to 14 years.

This paper presents the results of a controlled trial of child stuttering treatment. The aim of the study was, first, to compare the effectiveness of three viable treatments, and, second, to compare these three treatments to a no-treatment control composed of children who stuttered of a similar age and sex ratio who were on treatment waiting lists. The three treatments investigated included intensive smooth speech, intensive electromyography feedback, and home-based smooth speech. The children/adolescents were assessed across three speaking contexts on measures of percentage syllables stuttered (% SS) and syllables spoken per minute (SPM) and outcomes were assessed 12 months later. Repeated measures analyses of variance demonstrated significant differences between the control group and all three treatment groups across time on conversations in the clinic, on the telephone, and at home (although home measures were not taken for the intensive smooth speech group). Although the controls' stuttering did not change across time, the treatment groups' stuttering was decreased to very low levels posttreatment (less than 1% syllables stuttered on average), with mean improvement in stuttering frequency of at least 85% to 90% across all assessment contexts. Stuttering did not increase significantly up to 3 months and one year posttreatment in the experimental groups, although levels did rise across time (less than 3% syllables stuttered on average). Speech naturalness results showed increasing naturalness across time as rated by the clinician and parent. This was not the case for the controls. The children were also less anxious across time following treatment. The results suggest that all three treatments for children aged 9-14 who stutter were very successful in the long term for over 70% of the group, though the EMG feedback and home-based treatments were superior when percentages falling below a cutoff point (2%SS) were used to discriminate between groups. Implications for child/adolescent treatment in the community are discussed. Long-term outcomes will be assessed up to 5 years after the treatment.

Adolescent↗
PubMed1993

Intrathecal sufentanil labor analgesia: the effects of adding morphine or epinephrine.

Intrathecal opioids can provide labor analgesia. We attempted to prolong the duration of intrathecal sufentanil analgesia by adding epinephrine or morphine. Forty-one healthy, term nulliparae with cervical dilation < 5 cm participated in this double-blind, randomized protocol. Using a combined spinal and epidural technique, we gave intrathecal injections of either sufentanil 10 micrograms, sufentanil 10 micrograms plus epinephrine 200 micrograms, or sufentanil 10 micrograms plus morphine 250 micrograms. At baseline and every 5 min for 30 min thereafter, we recorded arterial blood pressure and asked the patients to rate their pain, nausea, and pruritus on visual analog scales. The women continued to rate these variables every 30 min until they requested additional analgesia. They then received 10 mL of 0.25% bupivacaine via the epidural catheter, and rated the above variables every 30 min until they requested additional epidural drug injection. Both morphine and epinephrine prolonged the duration of sufentanil analgesia. Only morphine prolonged analgesia after the first dose of epidural bupivacaine. However, because women in the morphine group experienced significantly more side effects throughout the study period, we do not recommend intrathecal morphine for labor analgesia.

Adult↗
PubMed1989

Muscarinic receptors: relationships among phosphoinositide breakdown, adenylate cyclase inhibition, in vitro detrusor muscle contractions and in vivo cystometrogram studies in guinea pig bladder.

The relationships between activation of muscarinic receptors in guinea pig bladder measured as carbachol-stimulated inositol phosphate (IP) accumulation, oxotremorine-induced adenylate cyclase (AC) inhibition and bladder detrusor smooth muscle contraction determined in vitro as well as in vivo in the slow filling cystometrogram (CMG), were analyzed from the potencies of a number of muscarinic antagonists to block these responses. Significant positive linear correlations were found among the inhibitory potencies of 10 muscarinic antagonists to inhibit phosphoinositide (PI) turnover and both detrusor muscle contraction in vitro, as well as peak intravesical bladder pressure in vivo in the CMG (r = 0.8, P less than .01). In contrast, there was no significant correlation between the potency of antagonists to block the AC inhibitory response and either in vitro or in vivo guinea pig bladder contractions (P greater than .05). Muscarinic agonists inhibited basal AC activity to a maximum of 20% in a GTP-dependent, Na+-sensitive manner and dose dependently stimulated both PI breakdown (3- to 4-fold) and isolated detrusor contractions. Again, a significant correlation (r = 0.9, P less than .01) was calculated among the potencies of seven muscarinic agonists to elicit PI turnover and in vitro muscle contraction, whereas no significant correlation was observed between their potencies to inhibit AC activity and contractile responses in vitro. Collectively, the data suggest that IP accumulation and presumably IP-induced Ca++ release may function as the transducing mechanism for cholinergic contraction of the urinary bladder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylyl Cyclase Inhibitors↗
PubMed1988

Selective agents for muscarinic receptors linked to phosphoinositide breakdown.

We examined the effects of several muscarinic agonists and antagonists on phosphoinositide breakdown (PI) and adenylate cyclase (AC) inhibition in rat cerebral cortex and heart, respectively. Acetylcholine, carbachol and methacholine behaved as full agonists in both systems. In contrast, oxotremorine and arecoline failed to stimulate PI turnover but were potent and efficacious at inhibiting AC. Among the antagonists, pirenzepine, dicyclomine, telenzepine and (R)-QNA were both potent (Ki approximately 0.5-7.5 nM) and selective (90- to 8,500-fold) for the PI-linked (putatively M1) brain receptor. In contrast, the cardioselective and ileal-selective M2 antagonists, AF-DX 116 and hexahydrosiladifenidol, were equipotent, competitive inhibitors of both responses. The selectivity of these drugs in terms of their biochemical responses is described.

Adenylyl Cyclases↗