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Biomedical subjects

I M Thompson

Publications and source records attributed to I M Thompson.

At least 19 recordsLinked to original sources
PubMed1992

The natural history of adenocarcinoma of the prostate.

All analyses of the efficacy of therapy for prostate cancer must control for the natural history of the disease. Over the past years, several long-term series involving several hundred patients have helped to describe the results of untreated disease. In general, most patients will not die of their disease, although approximately half of the patients will develop disease progression within 10 years. Predictors of progression include tumor stage, grade, and ploidy status.

Adenocarcinoma↗
PubMed1992

When is intervention warranted?

A chemoprevention trial in prostate cancer would be a formidable but potentially rewarding study. The current status of knowledge of drug interactions with, biomarkers of, and even the natural history of prostate cancer is insufficient to study all levels of men at risk. Currently, the most promising group to study is group I--those men with a high probability of developing prostate cancer but who do not currently have evidence of the disease. This could be a placebo-controlled, prospective and randomized study with the endpoint being clinically-detected prostate cancer. In addition, much may be gained from short-term pilot studies of "chemo-active" agents on morphologic and other biomarkers of prostate cancer initiated immediately before surgical removal. It is hoped that such studies may provide rationale for future efforts directed at preventing progression of premalignant or early prostate cancer lesions.

Anticarcinogenic Agents↗
PubMed1992

Multivariate case-control study of survival following transurethral resection of prostate.

Although prevalence of perioperative mortality following transurethral resection of the prostate (TURP) has steadily declined as reported in several review studies, it has been suggested that with extended follow-up after TURP, mortality exceeds that of an age-matched population. The sample selected for this study was drawn from a data base of 2,005 men who entered a urologic health-screening program. The sample included a group of 25 patients who underwent TURP and a group of 50 age-matched control patients with symptoms of prostatism. Patients were followed for six years, a total of 450 observed person-years. Multivariate analyses based on a general linear model approach for the dependent variable of survival were used to assess gains in predictive efficiency due to combinations of TURP versus control, time, and patient variables. F-ratio hypothesis tests of coefficients of multiple determination for the models indicated that TURP did account for a significant amount of the variability of survival but only after five years of follow-up. However, a far larger proportion of the variance in survival was explained by other patient variables of age, preoperative risk, comorbidity factors, and postoperative urinary disease after all effects due to TURP, follow-up years, and operation cohort years were held constant in the survival prediction equation.

Aged↗
PubMed1992

Renal tumors in young adults.

Primary renal malignancies are relatively rare in young adults. Eighteen patients between the ages of twenty and forty years underwent nephrectomy for renal tumors at our institution between 1947 and 1989. Data were reviewed in this group regarding method of presentation, duration of symptoms, tumor histology, pathologic stage, and survival. Tumor histology parallels that of older patients, the majority being adenocarcinoma (78%). The duration of symptoms prior to seeking medical attention was long, averaging eighty-four weeks. The overall survival rate, excluding nontumor deaths, was 50 percent. No patient with nodal or distant metastases survived, regardless of histology.

Adult↗
PubMed1992

Current urological practice: routine urological examination and early detection of carcinoma of the prostate.

With the increasing incidence of carcinoma of the prostate, the interest in early diagnosis through screening has dramatically increased. Several organizations, including the American Urological Association (AUA) and the American Cancer Society, have promulgated recommendations on suggested early detection methods. To determine the current practice patterns of United States urologists, a survey was sent to a random sample of 10% of all urologist members of the AUA. The survey was designed to determine what are current recommendations for an annual urological checkup for older men, what tests should be included in screening for carcinoma of the prostate and what age groups of men should undergo prostate cancer screening. A total of 562 surveys was returned, constituting a 4.7% sample of all urologist members of the AUA. The use of digital rectal examination was unanimously recommended for the urological examination as well as for prostate cancer detection. Prostate specific antigen was recommended by a majority of respondents for both situations. Screening was recommended for men ages 50 to 80 years. Demographic factors had a significant role in clinical recommendations by urologists.

Adult↗
PubMed1992

The fate of buried vaginal epithelium.

A new technique in the treatment of stress urinary incontinence utilizes a sling fashioned from a rectangular island of buried vaginal epithelium. We developed a model to study the natural history of vaginal wall covered by an epithelial flap in 12 rabbits sacrificed at intervals to 26 weeks. Histopathologic examination demonstrated an immediate acute inflammatory reaction. This early response was followed by formation of an epithelial lining of the potential space overlying the buried vaginal tissue. Acute inflammatory cells continued to enter this lumen until week 20, when granulomas were first detected. Histopathologic examination at twenty-six weeks showed stratified squamous epithelium lining the lumen. No deleterious inflammatory sequelae were detected, and no dysplastic or malignant changes were identified. These results suggest that buried vaginal epithelium is a safe (short term) tissue alternative for sling creation.

Animals↗
PubMed1992

Surgical treatment of carcinoma of the male urethra.

Despite the distinct rarity of carcinoma of the male urethra, the eventual outcome for a significant proportion of patients presenting with this process hinges on the selection and proper accomplishment of surgical therapy. Lesions of the posterior urethra seem to have a worse prognosis and may warrant aggressive therapy. Close attention must be given to the evaluation and treatment of the regional lymph nodes in all cases. The authors review the nuances of the various surgical options for these cancers.

Carcinoma, Squamous Cell↗
PubMed1991

Expectant management of localized prostatic cancer.

Seventy-five patients with clinical Stage B histologically proven prostatic cancer accumulated over a 40-year period and receiving no therapy for at least 1 year after histologic diagnosis were retrospectively reviewed. Twenty-nine patients had Stage B1 lesions, 37 had B2, and nine had B3 lesions; median follow-up for these patients was 124, 120, and 96 months, respectively. Five ultimately received pelvic lymph node dissection with iodine-125 implantation, 23 had transurethral resection of the prostate, and 18 had endocrine therapy. Of those tumors which progressed, 18 of 19 (95%) B1, 26 of 29 (90%) B2, and four of four (100%) B3 lesions demonstrated local progression first. Six of 29 (21%) B1, 17 of 37 (46%) B2, and two of nine (22%) B3 tumors developed recognized distant metastasis. Actuarial survival at 15 years was 67%, 39%, and 63% for patients with B1, B2, and B3 lesions, respectively. These data indicate the varied and potentially protracted course of patients with clinical Stage B prostatic cancer.

Adenocarcinoma↗
PubMed1991

Efficacy and morbidity of "channel" TURP.

Transurethral resection of the prostate (TURP) is necessary in a significant proportion of men with a diagnosis of carcinoma of the prostate. Often, "channel" TURP (resection of visually obstructing tissue without extension to the prostatic capsule in a patient with metastatic or locally advanced disease to improve voiding symptoms) is required. Although several theoretical concerns regarding the efficacy and morbidity of this procedure have been voiced, data to support these contentions are lacking. In a review of 41 patients undergoing channel TURP, all were able to void following the procedure. Two patients in whom the resection was carried through the external urinary sphincter, which had been invaded by tumor, were incontinent postoperatively. Two patients had mild stress incontinence. There were no perioperative deaths. These data suggest that incontinence is higher than expected with TURP for benign disease but that results may be acceptable to the patient with significant outlet obstructive symptoms.

Aged↗
PubMed1991

Management of ultrasonically detected nonpalpable testis masses.

As testicular ultrasound has evolved, nonpalpable masses have been detected for which an evaluation and treatment protocol has not been established. Our experience with nonpalpable testis masses detected only by ultrasound in 5 patients is presented, with all patients found to have nonmalignant lesions. We recommend that such cases with negative serum tumor markers and normal chest radiographs be followed with serial ultrasounds. Benign masses will resolve completely, while stable or enlarging masses can be locally excised and inguinal orchiectomy completed only if cancer is found by frozen section. A modified staging system to follow these patients is proposed to determine these patients' prognoses: Stage Ia for inguinally removed nonpalpable cancers, Stage Ib for excised nonpalpable cancers without orchiectomy (false-negative frozen section), and Stage Ic for inguinally removed palpable cancers.

Adolescent↗
PubMed1991

A prospective comparison of thromboembolic stockings, external sequential pneumatic compression stockings and heparin sodium/dihydroergotamine mesylate for the prevention of thromboembolic complications in urological surgery.

Deep venous thrombosis and pulmonary emboli are reported to occur in up to 66% of the patients undergoing a major urological operation. Thromboembolic stockings, external sequential pneumatic compression stockings and anticoagulant agents, such as heparin sodium plus dihydroergotamine mesylate, have been suggested to decrease the risk of deep venous thrombosis and pulmonary emboli. A total of 74 evaluable patients undergoing a major urological operation was randomized to receive either thromboembolic stockings, external sequential pneumatic compression stockings, or heparin plus dihydroergotamine as prophylaxis against deep venous thrombosis and pulmonary emboli. 111Indium-labeled platelet scans, performed preoperatively and on days 1, 3 and 6 postoperatively, were used to diagnose deep venous thrombosis and pulmonary emboli. Mean patient age was 63 years and all but 1 operation was performed for neoplastic disease. Deep venous thrombosis was detected in 5 of 25 patients (20%) with thromboembolic stockings, 3 of 24 (12.5%) with external sequential pneumatic compression stockings and 2 of 25 (8%) with heparin plus dihydroergotamine. There was no difference in blood loss or complications among the groups. Although statistical significance among the treatment groups was not reached in this study, the trend to a decrease in deep venous thrombosis and pulmonary emboli with external sequential pneumatic compression stockings and heparin plus dihydroergotamine, and an absence of an increase in morbidity in these groups supports the use of these modalities to decrease the morbidity and mortality of deep venous thrombosis and pulmonary emboli.

Adult↗
PubMed1991

Presentation and clinical course of patients ultimately succumbing to carcinoma of the prostate.

Ninety-six patients who expired due to carcinoma of the prostate were identified within the primary treatment area of Brooke Army Medical Center between the years of 1981 and 1988. Although 71 patients were noted to have abnormal prostate examinations at the time of diagnosis, 11 had been noted to have a palpably normal prostate within three years of tumor diagnosis. Twenty-four patients had a palpably normal prostate at the time of diagnosis. Fifteen patients had been previously noted to have an abnormal prostate but biopsy in 11 of these had been benign. These data suggest that digital rectal examination of the prostate will not detect a number of patients who will ultimately die of carcinoma of the prostate.

Biopsy↗
PubMed1991

Digital rectal examination and carcinoma of the prostate.

Urologists have considered themselves to be the experts in the use of digital rectal examination for the evaluation of diseases of the prostate. However, without close attention to the teaching of this examination, it probably is inaccurate and unreliable. Moreover, many patients who are destined to die of prostate cancer never develop a palpable abnormality. In patients with prostate cancer, a palpable abnormality usually indicates the presence of carcinoma, but the majority of patients will be upstaged by pathologic examination. In patients undergoing a digitally guided biopsy, it appears critical that those with a negative biopsy be followed closely, as they have a measurable risk of developing overt carcinoma. It is unclear how transrectal ultrasound will interface with digital rectal examination because of the multiple echo patterns this disease can exhibit.

Humans↗
PubMed1990

Conservative therapy of rectourethral fistula: five-year follow-up.

A case of rectourethral fistula is described, occurring after radical prostatectomy and adjuvant radiotherapy for pathologic Stage C carcinoma of the prostate. Urethral instrumentation for stricture disease immediately preceded development of the stricture. Conservative management for five years has resulted in the development of osteomyelitis of the pubis, but with antibiotic suppression the patient remains active and asymptomatic. Predisposing factors for the development of rectourethral fistula following radical prostatectomy may include adjuvant radiotherapy and recurrent urethral instrumentation. Most patients will require definitive repair but occasionally a patient may be managed conservatively.

Adenocarcinoma↗
PubMed1990

Experience with Duraphase penile prosthesis: its use as replacement device.

The Duraphase Penile Prosthesis is a new, articulating type of semirigid prosthesis which appears to have several advantages over other semirigid penile prostheses. This series describes the experience with this prosthesis in 12 patients and highlights the experience in 4 patients who underwent removal of other types of prostheses due to mechanical or functional problems and replacement with the Duraphase prosthesis. The device has been mechanically reliable during short follow-up, and there has been excellent patient satisfaction.

Aged↗
PubMed1990

Sudden death due to disease flare with luteinizing hormone-releasing hormone agonist therapy for carcinoma of the prostate.

Luteinizing hormone-releasing hormone agonist therapy for prostate cancer is a new method of management for metastatic disease. During the initial 1 to 2-week period of administration an increase in serum testosterone concentration can lead to an exacerbation of clinical symptoms (flare phenomenon). Two patients are summarized who received luteinizing hormone-releasing hormone agonist therapy without flare blockade and died suddenly during month 1 of therapy. A review of 765 patients in 9 series found 10.9% who suffered disease flare and 15 who died during disease flare. Of these 17 patients 12 were similar to our 2. These data suggest that any patient placed on luteinizing hormone-releasing hormone agonist therapy for prostate cancer merits some form of flare blockade during the initial 1 or 2 months of therapy.

Adenocarcinoma↗
PubMed1990

Economics of screening for carcinoma of the prostate.

The proposition of whether to adopt a system of mass screening for carcinoma of the prostate in the U.S. is well suited to the clinical decision analysis approach. The authors demonstrate this by using available data, which suggest that offering a screening program to all men ages 50 to 70 would be prohibitively expensive. The method also permits calculation of the eventual morbidity of screening and its costs. This analysis demonstrates the importance of attempting to predict ultimate patient outcomes before implementing any health care strategy as standard.

Acid Phosphatase↗