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Biomedical subjects

D G Arkell

Publications and source records attributed to D G Arkell.

At least 19 recordsLinked to original sources
PubMed1992

Phase III randomised study of zoladex versus stilboestrol in the treatment of advanced prostate cancer.

An open randomised Phase III trial was conducted of the depot GnRH analogue goserelin (Zoladex) versus stilboestrol (3 mg/day) in patients with advanced or metastatic prostate cancer. The study included 250 patients and the median follow-up was 43 months. In the Zoladex arm the time to first response was achieved earlier and more patients reported an improvement in symptoms. There was no statistically significant difference between the Zoladex and the stilboestrol arms with regard to survival and time to treatment failure. A major reason for treatment failure was the preponderance of adverse events in patients receiving stilboestrol. It is suggested that stilboestrol should no longer be used for prostate cancer when equally effective alternative treatments are available.

Aged↗
PubMed1989

The fragmented staghorn calculus: a radiological sign of pyonephrosis.

Staghorn calculi may cause several complications, particularly important being the development of pyonephrosis due to long-standing infection. We describe four patients who presented with either a marked systemic illness or a loin mass due to pyonephrosis. In each patient, the plain abdominal radiograph showed a fragmented staghorn calculus, which is suggested as a radiological sign of pyonephrosis and indicative of the need for surgical attention.

Aged↗
PubMed1988

Installation and use of a neodymium-YAG laser in a urology department.

We report our experience in setting up a urological laser unit. An operating theatre was upgraded to include the required safety features and a neodymium-YAG laser was installed. A preliminary study using cadaver bladders was performed to establish the technique of cystoscopic laser application. We treated 55 bladder tumours in 12 patients by laser coagulation, with total destruction of 54 tumours and no serious complications; 6 patients developed recurrent tumours. Twenty-one patients underwent surgery with the contact laser scalpel. The instrument proved slow but effective, with excellent haemostasis and almost painless wounds. Healing was delayed in 2 cases but there were no wound infections. All wounds healed with good cosmetic scars. The neodymium-YAG laser is an effective means of destroying superficial non-invasive bladder tumours endoscopically and can also be used in conjunction with a laser scalpel for open surgery.

Aged↗
PubMed1987

Ureteropyelostomy: a simple and effective treatment for symptomatic ureteroureteric reflux.

Partial ureteric duplication may cause delayed drainage of urine from the upper tracts because of ureteroureteric "see-saw" reflux. This can be eliminated by the procedure of ureteropyelostomy, in which the partially duplicated ureter is converted into a bifid renal pelvis. This operation leaves a short anastomotic suture line and has a low complication rate. We report seven patients who have undergone ureteropyelostomy for symptomatic ureteroureteric reflux. All remain symptom-free after follow-up for a minimum of 1 year.

Anastomosis, Surgical↗
PubMed1987

Phase II study of Zoladex depot in advanced prostatic cancer with special reference to criteria of response and survival.

Zoladex is a potent decapeptide analogue of luteinising hormone releasing hormone (LHRH). The drug is formulated as a 3.6 mg depot dispersed in a matrix of d,l-lactide-glycolide copolymer, which is totally biodegradable. This formula releases drug continuously for at least 28 days and reliably suppresses serum testosterone into the castrate range. The effect of the depot was studied in 29 patients with locally advanced or metastatic carcinoma of the prostate. Average age at entry was 71 years (range 52-87) and follow-up was from 13.5 to 34.5 months (median 23). Endocrine studies showed that medical castration was maintained in all cases. Three patients experienced bone pain in the first month of treatment and two others had temporary nephrostomies for worsening ureteric obstruction. Subjective improvement was seen in 23/28 cases (82%). There were no complete responses, but partial response was seen in 24/28 (85.7%) using our own criteria, 24/28 (85.7%) using the criteria recommended by the British Prostate Group (BPG) and 15/28 (53.6%) using NPCP criteria. Stable disease was seen in 3/28 patients (10.7%) by our own or BPG criteria, and in 12/28 patients (42.9%) according to NPCP criteria. Progression of disease was measurable in 21 patients (72.4%) whatever criteria were applied; 11/29 (37.9%) have died, giving a median survival of 10 months (range 2.4-26). Following these encouraging results, a multicentre randomised comparative study with stilboestrol 3 mg daily is being undertaken.

Aged↗
PubMed1986

Pharmacokinetic and endocrinological parameters of a slow-release depot preparation of the GnRH analogue ICI 118630 (zoladex) compared with a subcutaneous bolus and continuous subcutaneous infusion of the same drug in patients with prostatic cancer.

Seventeen patients with advanced prostatic cancer were treated with the gonadotrophin-releasing hormone analogue DSer (tBU)6 AzaGly 10 GnRH (ICI 118630), either as a constant SC infusion, or in the form of a monthly SC slowrelease depot formulation, in which case patients were randomised to receive one of three doses. Six of these patients also received a 250-microgram SC bolus of ICI 118630, for pharmacokinetic studies, before starting the infusion or the depot. Drug levels were measured using a double-antibody radioimmunoassay. In contrast to the SC infusion, which gave a smooth serum 118630 level profile, drug release from the depot preparation was not constant, levels varying in a predictable manner throughout each 28-day period, reaching a peak proportional to the dose of ICI 118630 received, between days 15 and 18 of each cycle. With all methods of administration there was an initial rise in LH, usually followed by a rise in testosterone, after which the SC infusion and the depot were both effective in reducing serum LH to basal levels and testosterone into the castrate range within 1 month. It is too early to make any assessment of clinical response; however, depot treatment was well tolerated: Four patients experienced an initial flare in bone pain, probably related to the initial rise in testosterone, and twelve patients experienced flushing; one patient with pre-existing hydronephrosis and hydroureter developed renal failure, possibly related to a tumour flare reaction. No patients have experienced cardiovascular side effects or local reaction.

Buserelin↗
PubMed1986

The association of hypertension, the Ask-Upmark kidney and other congenital abnormalities.

We report 2 cases of hypertension with segmental renal hypoplasia (Ask-Upmark kidney) and other anomalies in the absence of vesicoureteral reflux. These cases support the view that the Ask-Upmark kidney is a defect of renal development rather than acquired as a consequence of vesicoureteral reflux. In 1 patient the abnormal renal vein renin ratio suggested that the renin-angiotensin system may have had a part in the pathogenesis of the hypertension.

Abnormalities, Multiple↗
PubMed1984

A symptomatic and cystometric comparison of terodiline with emepronium in the treatment of women with frequency, urgency and incontinence.

Terodiline has been compared with emepronium in the treatment of 20 women suffering with frequency, urgency and incontinence in a double-blind, two-way cross-over study with fixed placebo as wash-out. A significant number of patients preferred terodiline treatment and a closer correlation between symptomatic and cystometric improvement has been seen during treatment with this drug. Regression analyses indicate that patients with high micturition frequencies (12 to 15 per 24 hours) benefit more from treatment than those with lower frequencies do.

Adult↗
PubMed1983

Leiomyosarcoma of the spermatic cord.

Leiomyosarcoma of the spermatic cord is extremely rare. We report a case associated with recurrent papillary bladder tumours and benign hyperplasia of the prostate. The use of adjuvant chemotherapy is described for the first time in the management of this condition.

Genital Neoplasms, Male↗
PubMed1983

Urodynamic investigation in a district general hospital.

In patients with disorders of micturition there is a poor correlation between clinical diagnosis and urodynamic findings. Thirty-three out of 82 patients studied in a Urodynamic Unit had their treatment plan altered as a result of the investigation.

Adolescent↗