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Biomedical subjects

J N Nacey

Publications and source records attributed to J N Nacey.

At least 19 recordsLinked to original sources
PubMed1992

The efficacy of serum prostate specific antigen as a tumour marker in prostatic carcinoma: a comparison with serum acid phosphatase.

AIMS: To assess the efficacy of serum prostate specific antigen (PSA) in the diagnosis of prostatic cancer. To compare this tumour marker with serum acid phosphatase (ACP) in order to define the more effective diagnostic test. METHODS: Serum samples from 349 patients attending a urology department were assayed for PSA and ACP. Histological assessment of prostatic biopsy samples was used as the standard by which the diagnostic effectiveness of the tumour markers was determined. RESULTS: Mean serum PSA results from patients with prostatic carcinoma (159 (SEM 35) ng/mL) were significantly different to those from patients with benign prostatic hyperplasia (4.0 (0.53) ng/mL). As there was considerable overlap of results, test sensitivities and specificities were calculated for various decision points. The sensitivity and specificity of PSA at a level of 10 ng/mL were 61.2% and 93.0% respectively, while for ACP at a level of 0.8 U/L they were 47.6% and 89.9%. The areas beneath receiver-operator curves (0.81 for PSA and 0.72 for ACP) indicated that PSA gives better diagnostic information than ACP. For a stated incidence of cancer, posttest probabilities following a given PSA result have been calculated. CONCLUSIONS: PSA is a more effective serum marker for prostatic carcinoma than ACP. We present a table so that for similar patient groups posttest probabilities for prostatic cancer can be assessed for a given serum PSA level.

Acid Phosphatase↗
PubMed1992

Wilms' tumour in New Zealand 1960-1986.

Between 1960 and 1986, 177 cases of Wilms' tumour were reported to the New Zealand National Cancer Registry. There was an equal sex distribution and 93.2% of patients were in the paediatric age group with a mean age of 3.4 years. The mean symptom interval was 2.0 months and the majority of patients presented with localised disease, although the incidence of advanced disease was greater than that reported from other series. The 5-year survival rate for all cases was 52.5%. Data were divided into patients presenting before and after the publication of the first National Wilms' Tumour Study (NWTS) in the United States in 1976. In patients presenting after 1976 the diagnosis was based on histology in 100%, compared to 58.6% in patients before 1977. Treatment was considered curative in a greater proportion of the post-1976 group. Treatment modalities reflected the recommendations of the NWTS and the 5-year survival rate of this group was 78.3%, this being similar to that reported from the NWTS. Multivariate analysis showed patient age, symptom interval, tumour stage and treatment (pre- and post-NWTS) to be independent predictors of survival.

Adolescent↗
PubMed1991

The value of early diagnosis in the treatment of patients with testicular cancer.

A study of 79 patients treated at Wellington Hospital for testicular cancer showed that those presenting with a short history (time from tumour recognition to surgery) had no better prognosis than those with a longer history (chi 2 = 1.857, p = 0.173). Tumour size was significantly related to this time interval such that those patients with a short history were more likely to have smaller tumours (rp = 0.651, p = 0.001). The data suggests that testicular tumours are currently being recognised too late in their development to allow any improvement in survival to be gained from reducing the interval from recognition to treatment. However, earlier recognition of the tumour by the patient may allow diagnosis and treatment in an earlier stage. The advantages of diagnosis in early stage disease are substantial and the need for a public education programme involving testicular self examination to allow early diagnosis is discussed.

Adult↗
PubMed1991

Nucleolar organizer regions and prognosis in renal cell carcinoma.

The prognostic significance of nucleolar organizer regions (NORs) in renal cell carcinoma (RCC) was evaluated. NORs were quantified in a series of 182 cases of RCC using the silver-colloid method. The cases were staged according to Robson's method (48 stage I, 26 stage II, 33 stage III, 75 stage IV) and mean NOR numbers for each tumour were correlated with survival over a 5-year period. Localized tumours (stages I and II) with low NOR numbers had an almost 100 per cent 5-year survival. Those patients with clinical evidence of metastases at presentation showed a high mortality, although those with low numbers of NORs had a significantly increased disease-free interval. Statistical analysis using the log rank test indicated NORs to be a significant predictor of survival over the whole series (P = 0.0001) and within each of Robson's stages (P = 0.0008 stage I, P = 0.0154 stage II, P = 0.0009 stage III, P = 0.0001 stage IV). Analysis of data using Cox's proportional hazard model showed mean NOR numbers to be independent of stage as a predictor of survival.

Carcinoma, Renal Cell↗
PubMed1991

Giant sclerosing leiomyoma of bladder presenting as chronic renal failure.

The clinical and pathologic features of a case of giant sclerosing leiomyoma of the bladder in a male Polynesian patient are reported. The presenting complication of chronic renal failure due to tumor envelopment of both ureters and consequent bilateral renal obstruction appears to be unique in the literature.

Adult↗
PubMed1991

Effect of abdominal straining on urinary flow rate in normal males.

The measurement of urinary flow rate by uroflowmetry and its relationship to voided volume and age have been extensively studied. It is well recognised that some men void with abdominal straining, but any effect of this on the urinary flow rate is usually not taken into account in urological practice. The aim of this study was to determine whether abdominal straining had any significant influence on the urinary flow rate. Three male volunteers performed multiple voidings either with or without abdominal straining. Statistical transformation of the data and the use of co-variant analysis allowed a comparison between "normal" or passive voiding and voiding with abdominal straining. The results showed that abdominal straining caused a significant improvement in both the average and maximum urinary flow rate. If the effect of abdominal straining is not taken into account during the interpretation of uroflowmetry results, incorrect conclusions may be made which could influence subsequent management. It is suggested that the method of voiding should be standardised by instructing patients, if possible, to avoid abdominal straining during uroflowmetry assessment.

Abdomen↗
PubMed1991

Toxicity study of first and second generation hydrogel-coated latex urinary catheters.

The hydrogel-coated urinary catheter is a novel formulation in which the coating hydrogel polymer is claimed to reduce the level of cytotoxicity frequently associated with the use of latex catheters. This study was undertaken to measure cytotoxicity using in vivo techniques. Twelve first generation and 5 second generation hydrogel-coated latex catheters were evaluated in vivo using canine urethras. The results showed all catheters to cause minimal inflammatory changes of the urethral mucosa (toxicity score 0-1.2/6).

Animals↗
PubMed1990

Wilms' tumour: a 30 year experience at Wellington Hospital.

Over the 30 year period from 1958-88, 20 cases of Wilms' tumour have been treated at Wellington Hospital. All eight patients presenting prior to 1976 have died. The 12 patients presenting after 1976 were treated according to the guidelines of the National Wilms' Tumour Study Group and ten of these are alive (mean follow up seven years). Four of the patients received preoperative chemotherapy and this was found to facilitate surgical removal of the tumour. The concept of partial nephrectomy in the management of Wilms' tumour is discussed. Retrospective analysis of this series has shown that this would have been a feasible management option in four of the cases reviewed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Testicular germ cell tumor with pineal metastases.

A patient with a mixed testicular germ cell tumor (choriocarcinoma, teratocarcinoma and embryonal carcinoma) that had metastasized to the lungs, cerebrum, and pineal gland is presented. The metastases had resulted in localized neurological signs and initially, on clinical grounds, a primary intracranial lesion could not be excluded. The occurrence of tumor metastases to the pineal gland is discussed and the literature is reviewed.

Adult↗
PubMed1990

Ischaemic necrosis of the glans penis: a complication of urethral catheterization in a diabetic man.

Ischaemic necrosis of the glans penis is rare. Diabetic patients commonly have small vessel disease which may affect the penis. We report the case of a man with extensive diabetic vascular disease, in whom partial penectomy was necessary for ischaemia of the glans penis, following urethral catheterization. The decision to use a urethral catheter in diabetics, particularly those with evidence of vascular disease, must be made with the knowledge that internal compression caused by the catheter may cause irreversible ischaemic changes. In such patients, a suprapubic catheter should be considered as an alternative.

Catheterization↗
PubMed1990

Foley catheter balloon puncture and the risk of free fragment formation.

The incidence of free fragment formation following balloon puncture or spontaneous bursting was examined in 294 Foley catheters immersed for 48 h in urine. The catheters were divided into 3 groups: 100 were inflated to the manufacturer's recommended volume, 100 to twice the volume and 94 to 3 times the recommended volume. The catheter balloons were punctured by pricking with a hypodermic needle. The overall incidence of free fragment formation was 27.3%. For both types of catheter examined, increasing balloon volume was not associated with an increased risk of free fragment formation following puncture. However, increasing volume was associated with increased free fragment formation when the balloon burst spontaneously. In view of the high risk of free fragment formation, cystoscopy should be performed in all cases of spontaneous catheter balloon rupture or after percutaneous balloon puncture.

Catheters, Indwelling↗