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Biomedical subjects

J M Fitzpatrick

Publications and source records attributed to J M Fitzpatrick.

At least 109 records · Page 6Linked to original sources

An evaluation of predisposing factors for testis cancer in Ireland.

All testis cancer in Ireland (1980-1985) was analysed (n = 240). Incidence was highest in young adults (5.8/10(5)/year in those aged 25-34 years) with a moderate level in the elderly (1.8/10(5)/year in those over 75 years). Associations elsewhere with maldescent and social class were confirmed but cryptorchidism (12%) was more common than expected. Significant infertility was not identified. Associations with urban domicile (77%, p = 0.001), mental handicap (2.8%, p less than 0.05), recent vasectomy (1.2%, p = 0.009) and certain occupations were observed.

Adult

Non-seminomatous germ cell testis cancer in Ireland (1980-1985). Management, results and prognostic variables with relevance to national management protocols.

All non-seminomatous germ cell testis cancer in Ireland (1980-1985) was analysed (n = 131) and 3-year survival was: stage I = 95% (n = 58), stage II = 54% (n = 36), stages III and IV = 24% (n = 34). Countrywide results were not as favourable as those achieved in specialist units and this supports the development of a national strategy to maximise disease control. No management protocols existed during this study and the variety of approaches helped to identify the most suitable types of treatment in this broad context.

Clinical Protocols

Physician-dependent prognostic variables in the management of testicular cancer.

A study of 246 cases of germ cell testicular cancer in Ireland between 1980 and 1985 confirmed that the personnel and the manner of management can significantly influence the outcome. Inadequate staging by omitting marker assays or CT scan reduced prognosis. Failure to use standard chemotherapy (PVB, BEP, POMBACE, VAB) or a reduced dosage diminished survival. Regular investigations are necessary during treatment, including marker assays, chest X-ray and CT scan. Frequent monitoring is important in later follow-up. Management by a urologist improved survival, especially if he was involved from the outset. The results also favoured the concept of combined management by a urologist and an oncologist.

Antineoplastic Combined Chemotherapy Protocols

Primary non-obstructive megaureter in adults.

Primary non-obstructive megaureter is rarely first diagnosed in adult life. The clinical and radiographic findings in 11 adults presenting with this condition are reviewed. The commonest complaint was pain. In all cases the diagnosis was suggested by intravenous urography, which was usually the initial diagnostic test. Confirmation was aided chiefly by micturating cystography and retrograde pyelography. Cystoscopy was normal. The radiologist can make an early diagnosis in this condition, which requires no treatment, in the absence of complications.

Adult

Ureteral meatotomy by Sachse urethrotome in the management of lower ureteral stones.

From January 1981 to June 1985 inclusive 170 patients were hospitalized for transurethral ureteral stone manipulation. A meatotomy with the Sachse urethrotome was done in 46 of these patients because the stone was impacted in the intramural ureter or the basket containing the stone became impacted. This method resulted in successful endoscopic removal of the stones in 43 patients.

Adult

Partial ureteric obstruction: a new variable canine experimental model.

An experimental model of ureteric obstruction should be accurate and persistent, and allow variation of the degree of obstruction. A model was tested in 28 dogs consisting of insertion of an obstructing stent into the left ureter, and the degree of obstruction was varied by altering the internal diameter of the stents. The effects of such an obstruction on the following features were studied: renal intrapelvic pressure, intravenous urography, creatinine clearance, vascular casts, and both gross and histological examination. The procedure was well tolerated and caused a persistent, unchanging degree of partial ureteric obstruction. Pathological changes of obstructive uropathy were produced. This model can be used for further pathophysiological studies.

Animals

Patients' delay in the presentation of testis cancer in Ireland.

A study of 217 cases of testis cancer in Ireland revealed a longer duration of symptoms (median 2.8 months, mean 10 months) than elsewhere: 32% of patients waited at least 6 months before seeking medical advice. Delay was associated with metastases (P = 0.001), diminished prospects of cure (P = 0.001) and increased mortality (P = 0.002) but not with marker status or complexity of treatment required. Eleven per cent did not notice a detectable swelling and 25% waited at least 3 months after such a discovery. These facts and the incidence of maldescent (12%, with more than two-thirds untreated) highlight the need for better health education in this area.

Attitude to Health

Surgical approach to inferior vena caval extension of renal carcinoma.

Between 1979 and 1985, 10 patients were treated for renal carcinoma with extension into the inferior vena cava but without evidence of disseminated disease. Two of these had tumour thrombus extension up to the level of the hepatic veins and in four the extension was above the level of the diaphragm, two of which entered the atrium. Thrombus was removed en bloc at radical nephrectomy. Six patients are still alive, with a mean survival of 22 months. There was no correlation between the level of tumour thrombus and perinephric extension or indeed any correlation between tumour thrombus level and overall survival. It is suggested that tumour thrombus in the inferior vena cava, in the absence of metastatic disease, should be managed by radical surgery.

Adult

The canine kidney in haemorrhagic shock: effect of verapamil.

Recent evidence suggests that verapamil administration reduces myocardial and small intestinal damage in canine haemorrhagic shock, and verapamil has also been shown to reduce renal dysfunction in clamp models in post-ischaemic renal failure. The effects of high-dose verapamil and hypovolaemia on renal haemodynamics and function in a canine haemorrhagic shock model were studied. Anaesthetized mongrel dogs were divided into three groups. Animals of group I (n = 5) were not subjected to shock but given a 90-min verapamil infusion (2.28 micrograms/kg); animals of group II (n = 5) were subjected to shock (mean blood pressure 40 mm Hg) for 2 h and given a 90-min 0.9% saline infusion, and animals of group III (n = 7) were both subjected to a 2-hour shock and given verapamil. The electrocardiograph was monitored, and general haemodynamic parameters were measured before shock (period 1), at the end of shock (period 2), after reinfusion of shed blood (period 3) and 1 h after shock (period 4). Total renal and cortical zonal blood flow was estimated by radioactively labelled microsphere injection during each period. Creatinine and osmolar clearance were estimated before and after shock. Verapamil administration caused heart block in groups I and III which lowered heart rate and blood pressure and exacerbated the haemodynamic effects of shock in group III. Despite this, no measurable difference in renal function was recorded between groups II and III. Total renal blood flow fell during shock, and this was exacerbated in animals given verapamil, suggesting a cumulative deleterious effect of shock and verapamil in renal blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Prostate cancer.

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Humans