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Biomedical subjects

J A Vale

Publications and source records attributed to J A Vale.

At least 19 recordsLinked to original sources
PubMed1992

Finasteride in the treatment of benign prostatic hyperplasia. A urodynamic evaluation.

A group of 69 men with bladder outflow obstruction due to benign prostatic hyperplasia (BPH) were treated in a double-blind, placebo-controlled study with finasteride (Proscar, MK-906), a 5-alpha reductase inhibitor, 5 mg or 10 mg/day or placebo for 3 months; subsequently, 20 patients received finasteride 5 mg/day for a further 9 months in an open extension study. In treated patients dihydrotestosterone declined by over 60%, remaining unchanged with placebo. Symptom scores fell significantly in all 3 groups. Mean maximum flow rates fell slightly in placebo-treated patients but improved by 1.5 ml/s in the 10 mg group and by 3.3 ml/s in the 5 mg group. After 1 year's treatment, the reduction in symptom score and increase in flow rate were well maintained; the mean prostate volume was reduced by 14% and prostatic specific antigen declined by 28%. It was concluded that finasteride shows some efficacy in the treatment of BPH, with minimal toxicity, but 12 months of therapy or longer may be necessary to achieve maximal effect.

Aged↗
PubMed1992

[Primary decontamination: vomiting, gastric irrigation or only medicinal charcoal?].

Procedures to reduce the absorption of ingested poisons have been employed widely for decades in the management of intoxicated patients. However, evidence of substantial clinical benefit to the majority of patients undergoing such treatments is lacking. Volunteer studies suggest that activated charcoal is generally more effective than either syrup of ipecacuanha or gastric lavage, though lavage may be more effective than syrup of ipecacuanha. Studies in poisoned patients have shown that although lavage is more effective than syrup of ipecacuanha, it led to a better outcome in comatose patients only if performed less than one hour after overdose. Syrup of ipecacuanha did not alter the outcome beneficially in those who were alert on presentation and is known to produce significantly more complications than charcoal alone even in patients who are awake with a gag reflex. A recent study suggests that activated charcoal may be superior both to lavage and syrup of ipecacuanha. Based on these studies it would seem reasonable to recommend that 50 to 100 g activated charcoal be administered to patients who have taken a substantial amount of a toxic substance less than one hour previously. This may be done conveniently by using an orogastric tube, which would also allow lavage to be undertaken with possible additional benefit.

Charcoal↗
PubMed1992

Endometrioid carcinoma of the prostate: a misnomer?

The origin of this unusual variant of carcinoma of the prostate has provoked discussion ever since its first description in 1967. This is of both embryological interest and therapeutic importance. Four cases have been reviewed, and all have demonstrated immunohistochemical features consistent with an origin from prostatic tissue. In addition, three had evidence of disseminated disease which responded well to androgen ablation. It is concluded that the term endometrioid carcinoma is of descriptive value only, and these tumours are a variant of primary duct prostatic carcinoma. Patients should be treated by androgen ablation when metastases are present.

Adenocarcinoma↗
PubMed1991

Diagnostic and surgical aspects of renal carcinoma with involvement of the inferior vena cava.

Over the past 10 years, 13 patients presented with operable renal carcinoma and tumour extension within the inferior vena cava. This was diagnosed accurately in all but 1 patient, using ultrasound. Radical nephrectomy with removal of tumour within the inferior vena cava was performed in all 13 cases, 2 requiring cardiac bypass. There were no operative deaths and 6 patients remain alive and well with a mean follow-up of 2 years. The presence and level of vena caval extension did not appear to have an adverse affect on prognosis.

Adult↗
PubMed1989

Hypophosphataemia and phosphaturia in paracetamol poisoning.

To find out whether the hypophosphataemia in paracetamol poisoning is due to renal loss of phosphate, serum phosphate concentrations were correlated with indices of hepatotoxicity in 273 patients who had taken an overdose of paracetamol, and the renal handling of phosphate was examined in another 40 patients. Hypophosphataemia was a feature of paracetamol poisoning, whether hepatotoxicity was present or not. It correlated with the degree of hepatic damage and was not influenced by glucose infusions. Serum phosphate correlated with renal threshold phosphate concentration, so renal loss rather than intracellular redistribution of phosphate seems to be the reason for the hypophosphataemia in paracetamol overdose, and it correlates well with other indices of severity of poisoning.

Acetaminophen↗
PubMed1989

Biofilms, bacteria and bladder catheters. A clinical study.

Biofilms were present on 16 of 33 urethral catheters examined. In 11 cases the catheter carried a different microbial flora from that of the bladder urine. The length of time the catheter was in situ did not influence biofilm formation, and all types of materials tested supported biofilm growth. Biofilms were seen on 2 of the 7 catheters where prophylactic antibiotics had been used.

Bacteria↗
PubMed1987

Who needs molar units for drugs?

The standardisation of units for drug concentration measurement in clinical medicine is an urgent necessity. The obvious choice is mass units based on the litre. A change to molar units for drug concentrations would make no sense unless drugs were also prescribed in moles, which would cause disruption and inconvenience. There would be considerable danger to patients and the change would be expensive. Most importantly, molar units for drugs will not benefit doctors or their patients. Mass units should be retained and proposals for the adoption of molar units should be abandoned.

Humans↗