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Biomedical subjects

E W Ramsey

Publications and source records attributed to E W Ramsey.

At least 19 recordsLinked to original sources
PubMed1999

Impact of a shared decision-making program on patients with benign prostatic hyperplasia.

OBJECTIVES: To determine patient views about the Shared Decision-Making Program (SDP), an interactive videodisk program designed to inform patients with benign prostatic hyperplasia (BPH) about their condition and treatment options and to determine its impact on perceived knowledge and treatment preference. METHODS: Six hundred seventy-eight patients with symptomatic BPH from eight Canadian centers viewed the SDP. Before and after viewing the video, patients answered questionnaires designed to assess treatment preference, knowledge gained, and satisfaction with this educational format. A 1-year follow-up survey was also conducted. RESULTS: Most patients showed a high desire for information and high satisfaction with the SDP; this satisfaction persisted at 1 year. Patients' self-reported knowledge increased significantly (P <0.0001). However, the SDP did not alter initial treatment preferences among those with already formed preferences, although it aided almost half of those initially undecided in forming a preference. Viewing the SDP also appeared to enhance the physician-patient relationship. CONCLUSIONS: Patients saw the SDP as an effective method for teaching patients about BPH and the risks and benefits of various treatments, clarifying particular areas about which many patients appear to have a desire for more information than is often provided. Patients were enthusiastic about the educational value of the program, and their active participation in the decision-making process may actually enhance the physician-patient relationship. Contrary to other studies, we found no significant alterations in treatment preferences. Problems relating to the cost and timely updating of the software need to be addressed for these kinds of programs to realize their full potential.

Aged↗
PubMed1998

Prostate cancer: 6. Surgical treatment of localized disease.

A 65-year-old man undergoes a routine checkup before retiring. His wife has urged him to have his prostate examined, because she has read about testing for prostate cancer and a friend has just died of this disease. During the rectal examination, the man's physician discovers some firmness in the right lobe of the prostate gland. The patient has had no urinary symptoms and is in excellent general health. Sexual function is normal. There is no history of prostate cancer; his father died of a stroke at age 86 years. Testing shows that the patient's prostate-specific antigen level is 9.3 ng/mL, and he is referred to a urologist. Transrectal ultrasound-guided needle biopsy reveals adenocarcinoma with a Gleason score of 7 (intermediate grade). At a follow-up meeting with his physician, the patient says, "I have been doing some research, and it appears that I should have treatment. However, what is less clear to me is what form of therapy is best--surgery or radiation treatment. Please tell me what you can about the state of the art with respect to surgery."

Adenocarcinoma↗
PubMed1998

Office treatment of benign prostatic hyperplasia.

The less invasive procedures described herein are suitable for use in the office setting. Improvement in symptoms and quality of life are similar to that achieved with TURP. With the exception of TUIP, flow rate improvement is less than with TURP. TURP, however, tends to produce a "super normal" flow rate, which may be unnecessary. Patients are concerned regarding symptoms and quality of life and the avoidance of complications. In regard to decreased complications, less invasive procedures have an advantage. The main concern with these new treatments, with the exception of TUIP, is durability. Treatment failure may lead to other treatments, thereby increasing overall management costs. In this regard, it must be remembered that there is a significant treatment failure rate with TURP. Although patients failing less invasive treatments are likely to be offered other treatments, this is less likely after an adequate TURP. Therefore, when results are compared, it may be more appropriate to evaluate failure rates based on symptoms and quality of life rather than on the use of additional treatments. More patient follow-up for a longer period of time will be required before a definite answer is available on durability. All of the procedures described herein can be performed to a variable extent using topical anesthesia. TUNA has been performed using topical lidocaine alone but frequently requires intravenous sedation/analgesia and, in some instances, a regional block. If the patient can tolerate rigid cystoscopy fairly well, topical anesthesia alone may suffice. Similar requirements for anesthesia apply to ILC with the Nd:YAG or indigo systems. Using the Targis (T3) microwave device, Peterson and co-workers reported that 60% of patients were treated with topical urethral lidocaine alone, whereas 40% also received oral Toradol. Djavan (personal communication) using the Targis (T3) device randomized patients to topical urethral anesthesia alone or combined with intravenous sedoanalgesia. Pain was evaluated using a 0 to 10 visual analog scale score. At the commencement of treatment, the mean score was 1.4 in the topical anesthesia alone group and 1.3 in the sedoanalgesia group. During therapy, the score increased to a peak at 30 minutes of 2.2 and 2.0 in the topical and sedoanalgesia groups, respectively. After this, the visual analog score declined, falling to 0.2 and 0.1, respectively, by 1 hour following treatment. This study shows that microwave treatment with the Targis (T3) system is well-tolerated using topical urethral anesthesia alone. No difference was observed between outcomes in the two groups. Capital and operating costs as well as reimbursement issues are important in the introduction of these treatments into the office; however, until more information is available on the durability of results, the cost-effectiveness of these newer treatments remains unclear.

Diathermy↗
PubMed1997

A novel transurethral microwave thermal ablation system to treat benign prostatic hyperplasia: results of a prospective multicenter clinical trial.

PURPOSE: We evaluated the efficacy, safety and impact on quality of life of a newly designed microwave thermal ablation system in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Microwave thermal ablation was administered to 154 BPH patients at 3 centers in Canada and the United Kingdom during a single 1 to 2-hour office or clinic procedure without general or regional anesthesia and without need for potent medications necessitating intensive patient monitoring. Various measures of symptoms, voiding function and patient quality of life were assessed at baseline, 6 weeks, and-3, 6, 9 and 12 months after treatment. RESULTS: Mean American Urological Association symptom score 12 months after treatment (8.8, 95% confidence interval 7.7 to 10.0) was significantly lower (p < 0.05) by 56% than that at baseline (20.1, 95% confidence interval 19.1 to 21.0). The incidence of mild symptoms increased from 0 to 57%, while that of severe symptoms decreased from 49 to 8%. There was a significant increase (p < 0.05) in peak flow rate of 45% from 9.3 ml. per second (95% confidence interval 8.8 to 9.7) at baseline to 13.4 ml. per second (95% confidence interval 12.5 to 14.4) at 12 months. Similar symptomatic and urodynamic improvements occurred in all prostate volume categories. Convalescence was rapid after treatment with little or no need for home bed rest or restriction of usual activities. Patients expressed a high level of satisfaction with treatment and found the prostate symptoms to be significantly more tolerable. Adverse events were infrequent, transient and readily managed. CONCLUSIONS: Microwave thermal ablation proved to be safe and effective for treatment of BPH with a significant positive impact on patient quality of life.

Aged↗
PubMed1996

A multicenter, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of terazosin in the treatment of benign prostatic hyperplasia.

OBJECTIVES: This study was designed to evaluate the safety and efficacy of the selective alpha 1-adrenoceptor blocker terazosin in the treatment of benign prostatic hyperplasia (BPH). METHODS: Two hundred twenty-four patients aged 50 to 80 years, who had a diagnosis of BPH based on medical history, physical examination, and digital palpation, were recruited from 11 different sites between January 1992 and January 1994. The study consisted of a screening phase, a placebo phase, a double-blind dose-titration phase, and a double-blind maintenance phase. RESULTS: Of the patients recruited, 164 entered the double-blind phase and of these 134 were evaluable. Only 11 patients withdrew because of an adverse event, 7 in the terazosin and 4 in the placebo group. Compared to placebo, terazosin significantly increased peak and mean urine flow rates without significantly affecting voided volume or postvoid residual volume. It significantly improved both the obstructive and irritative symptoms associated with BPH. Fifty-one patients from the terazosin group reported a total of 120 adverse events compared with 83 reported by 42 patients in the placebo group. The majority of these events were mild to moderate. Seventeen terazosin-treated patients reported hypotension-related adverse events and 4 withdrew from the study. However, concurrent treatment with antihypertensive agents did not affect the blood pressure response of the terazosin group. CONCLUSIONS: Overall, this study showed terazosin to be safe and effective in relieving the signs and symptoms of BPH and should be considered as a treatment alternative.

Adrenergic alpha-Antagonists↗
PubMed1996

Renal autotransplantation in patients with loin pain-hematuria syndrome.

OBJECTIVE: To determine if renal autotransplantation is an effective treatment for the loin pain-hematuria syndrome. DESIGN: Retrospective chart review. SETTING: Tertiary care referral centre in Manitoba. PATIENTS: Four patients referred for diagnosis and management of loin pain-hematuria syndrome. Follow-up for each of the four was 2, 24, 29 and 48 months. INTERVENTION: Renal autotransplantation. MAIN OUTCOME MEASURES: Relief of pain with preservation of renal function and blood pressure. RESULTS: All four patients experienced relief of the pain of loin pain-hematuria syndrome. Renal function was preserved and blood pressure maintained. Narcotic analgesia was discontinued in all cases. CONCLUSION: Renal autotransplantation appears to be an effective treatment for patients with loin pain-hematuria syndrome.

Adult↗
PubMed1995

N,N-diethyl-2-[4-(phenylmethyl)phenoxy]ethanamine in combination with cyclophosphamide: an active, low-toxicity regimen for metastatic hormonally unresponsive prostate cancer.

PURPOSE: The intracellular histamine antagonist, N,N-diethyl-2-[4-(phenylmethyl)phenoxy]ethanamine. HCl (DPPE), potentiates chemotherapy cytotoxicity to malignant cells but protects normal tissue, including bone marrow, gut, and hair. We assessed the response to and clinical toxicity of DPPE/cyclophosphamide therapy in 20 patients with advanced hormonally unresponsive prostate cancer, 19 of whom were symptomatic. PATIENTS AND METHODS: Subjects received a maximally tolerated dose of DPPE (6 mg/kg) intravenously (IV) over 80 minutes. Cyclophosphamide (600 to 800 mg/m2; maximum dose, 1,500 mg) was administered over the last 20 minutes of DPPE infusion. Treatments (usually outpatient) were given once weekly for 4 weeks, followed by a 1-week delay, and then 2 of every 3 weeks as long as the patient was deemed to benefit. RESULTS: Five of seven patients (71%) with measurable soft tissue disease had a partial remission (PR). Three of 16 (19%) with assessable bone disease responded (one complete remission [CR] and two PRs). Nine of 18 (50%) with an elevated serum level of prostate-specific antigen (PSA) had more than a 50% (mean +/- SD, 78% +/- 14%) decrease. Eleven of 13 (85%) with bone pain had partial or complete resolution of this symptom; the PSA level and bone scan improved in six and two of these subjects, respectively. Acute treatment toxicity consisted of nausea/vomiting (six of 20) and ataxia (20 of 20), which correlated with peak serum levels of DPPE. Delayed effects (24 to 48 hours) consisted mainly of tiredness and mild nausea; one patient developed hemorrhagic cystitis. Bone marrow and hair follicle toxicity was negligible in 14 and 15 patients, respectively. CONCLUSION: DPPE/cyclophosphamide appears to be an active regimen for metastatic prostate cancer, with the added benefit of relatively low toxicity.

Aged↗
PubMed1991

Total androgen ablation: Canadian experience.

A multicenter randomized, double-blind trial comparing total androgen blockade obtained by the use of castration with a pure anti-androgen (nilutamide) with simple castration was begun. One hundred and five patients received the combined treatment and 103 the orchiectomy plus placebo. Several features were used to evaluate the efficacy. Bone pain responded better to combined treatment at 6 months (P = 0.042). The number of favorable responses, as evaluated by the NPCP criteria, was 61% with simple castration and 78% with the combined treatment (P = 0.013). There was no statistically significant difference between the two groups in time to progression (logrank test P = 0.462) or survival (logrank test P = 0.137) despite an increase in median survival of 5.4 months. All other measures showed no difference between the two treatments. With total androgen blockade, 50% of the patients had disease progression at 1 year, and 45% were dead at 2 years. A review of the results of similar reported studies suggests no improvement or very modest improvement with total androgen blockade over testicular androgen ablation alone.

Adult↗
PubMed1990

A controlled trial of castration with and without nilutamide in metastatic prostatic carcinoma.

A randomized double-blind trial in patients with disseminated, previously untreated prostate cancer (Stage D2) was conducted in eight Canadian centers. All 203 patients enrolled in this study underwent bilateral orchiectomy and were randomized to receive either the nonsteroidal anti-androgen nilutamide or a placebo. Patient responses were graded according to the criteria of the National Prostatic Cancer Project (NPCP). Patients treated with nilutamide had a significantly greater number of positive objective responses (partial and complete regression) than did the patients treated with castration alone (46% versus 20%, P = 0.001). Progression-free survival was improved initially in the nilutamide group, but the median time to progression was 12 months for both groups. Despite an increase in the median length of survival from 18.9 to 24.3 months with the nilutamide, the survival time was not significantly longer in the nilutamide group (log = rank test, P = 0.048). Although minor side effects were frequent, adverse effects related to the medication and leading to discontinuation of treatment were observed in 9% of cases. These results suggest some benefit of the combined treatment (orchiectomy + nilutamide) over orchiectomy alone in the treatment of metastatic prostatic carcinoma.

Adult↗
PubMed1988

The excretory urogram bowel preparation--is it necessary?

A prospective randomized study was undertaken to determine whether prior bowel preparation improves the diagnostic quality of the excretory urogram. From August 1986 to May 1987, 107 outpatients having an excretory urogram on an elective basis were randomized into 3 groups: group 1 received castor oil, group 2 received x-ray preparation and group 3 received clear fluids 24 hours before the study. The quality of the bowel preparation and the excretory urogram was graded separately on a scale of 1 to 5. More than 71 per cent of the bowel preparations were graded as 4 (very good) or 5 (excellent) and more than 91 per cent of the films were graded as 4 or 5 in all 3 groups. The quality of the excretory urogram was graded as 5/5 in a greater number of group 3 cases. Patients reported a high incidence of side effects from both bowel preparations, while no adverse effects were reported from those in group 3. The administration of a bowel preparation compared to that of clear fluids alone made no difference to either the quality of the bowel preparation or the diagnostic quality of the film.

Adolescent↗
PubMed1988

Total androgen blockade for metastatic cancer of the prostate.

This randomized, double-blind study comparing orchiectomy plus placebo to orchiectomy plus a nonsteroid antiandrogen (Anandron) shows that total androgen blockade for metastatic cancer of the prostate provides a significantly better early objective response when compared to castration alone. This response, however, is less apparent at 18 months. The study also suggests a longer survival for the patients with total androgen blockade.

Androgen Antagonists↗
PubMed1988

Megestrol acetate plus minidose diethylstilbestrol in the treatment of carcinoma of the prostate.

A multicenter randomized trial comparing megestrol acetate 120 mg/d, plus diethylstilbestrol (DES) 0.1 to 3 mg/d in patients with stage D2 prostate cancer was undertaken to compare the efficacy and toxicity of these two regimens. Pretreatment characteristics, including pathologic grade, performance status, age, and disease-related symptoms were similar in the two groups. Of 81 patients who have been entered in the study, 77 are evaluable for response and toxicity at a mean follow-up of 13.3 months. Using National Prostate Cancer Project (NPCP) criteria, no difference in response rate is noted (73% v 76%) or in disease-free survival and overall survival. The ability to suppress serum testosterone to castration levels and to maintain this suppression is equivalent in both treatment groups. However, treatment-related toxicity, including edema, hypertension, and gynecomastia, occurred at a significantly greater frequency, severity, and after a shorter treatment period in the DES-treated group. No difference in major cardiovascular events was noted. Since megestrol acetate plus minidose DES is equivalent to DES in achieving treatment responses in patients with carcinoma of the prostate, it is a preferable treatment because of its improved side-effect profile.

Aged↗
PubMed1987

A population-based study of prostatectomy: outcomes associated with differing surgical approaches.

Data from the universal health insurance system in Manitoba, Canada were used to describe the short-term (2 years) and long-term (8 years) outcomes associated with prostatectomy for nonmalignant conditions (all 2,699 procedures were performed from 1974 to 1976). In a system with high quality urological care (more than 90 per cent of the procedures were performed by urologists) no superior operative results for transurethral procedures were found. Postoperative mortality rates following transurethral prostatectomy were similar to or higher than rates for open procedures, and the rate of repeat prostatectomy, was considerably higher following transurethral resection. Dilation for urethral stricture was most common after suprapubic prostatectomy and least common after retropubic prostatectomy. Patients were followed for 8 years and those who underwent transurethral prostatectomy required an additional prostatic operation at a constant rate (2 per cent per year). By the end of the followup period 16.8 per cent of the transurethral prostatectomy patients had undergone a second prostatectomy compared to 7 per cent or less of those who initially underwent an open procedure.

Adult↗
PubMed1987

Haematuria following a marathon run: source and significance.

Urine specimens were obtained from 98 runners before and immediately after running a half (21 km) or full (42 km) marathon. Specimens were examined for the presence of proteinuria, haematuria and whether the erythrocytes were normomorphic or dysmorphic as determined by phase contrast microscopy. Proteinuria occurred in 35% of those running the half and 69% running the full marathon. Haematuria with or without proteinuria occurred in 21% running the half and 22% running the full marathon. In runners with haematuria, dysmorphic erythrocytes were found in 30% of the half and 81% of the full marathon group. No urinary abnormalities were found on repeat examination 4 to 12 weeks after the run. These results suggest that non-glomerular bleeding, possibly from bladder contusions, predominates at shorter distances. With greater distances glomerular bleeding occurs. These abnormalities disappear with rest and do not appear to signify underlying urinary tract disease.

Erythrocytes↗