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J Peabody

Publications and source records attributed to J Peabody.

12 recordsLinked to original sources
PubMed2005

pT1 substaging in renal cell carcinoma: validation of the 2002 TNM staging modification of malignant renal epithelial tumors.

PURPOSE: Tumor size has been used as one of the criteria to stratify renal cell carcinoma (RCC) into different pathological stages (pT). The recent 2002 UICC/TNM classification of malignant epithelial renal tumors is modified to substratify pT1 RCC into pT1a (less than 4.0 cm) and pT1b (greater than 4.0 but less than 7.0 cm). In this study we ascertained if this stage modification has prognostic relevance. MATERIALS AND METHODS: A total of 259 consecutive radical nephrectomy specimens of organ confined RCC from 1970 to 1997 at 1 institution, including 153 of conventional RCC (CRCC), 71 of papillary RCC, 28 of chromophobe RCC, 1 of collecting duct carcinoma and 6 of RCC not otherwise specified, with a mean clinical followup of 7.5 years (median 6.4) were included in the study. RESULTS: There were 115 pT1a (44.4%), 95 pT1b (36.7%) and 49 pT2 tumors (18.9%). Disease recurrences (DR) and disease specific death occurred in 2 (1.7%) and 0 cases (0%) of pT1a, 7 (7.3%) and 5 (5.3%) of pT1b, and 16 (32.6%) and 12 (24.5%) of pT2. DR for pT1b was higher compared with pT1a (all histological subtypes RR 3.68), although this difference was not statistically significant (p = 0.106). If only CRCCs were analyzed, DR in the pT1b group was statistically higher compared with pT1a (RR 8.54, p = 0.047). Disease specific survival in pT1a could not be evaluated because no deaths occurred in this subgroup. DR and disease specific survival were significantly different between pT1b and pT2 tumors for all histological subtypes (RR 5.51, p = 0.001 and 5.49, p = 0.001) and for the CRCC subtype (RR 5.50, p = 0.001 and 5.18, p = 0.005, respectively). Using size as a continuous variable the logarithmic change in tumor size was a significant predictor of DR (RR 8.82, p = 0.001). All statistical analyses were adjusted for age and sex. CONCLUSIONS: Substaging RCC into pT1a and pT1b yields prognostically important information, validating the 2002 TNM modification for malignant renal epithelial malignancies. The substratification of pT1 is particularly useful in tumors with CRCC histology.

Adult↗
PubMed2001

Home apnea monitor use in preterm infants discharged from newborn intensive care units.

PURPOSE: To identify current factors associated with home apnea monitor use in preterm infants and to determine whether home monitor use was associated with a shorter length of hospital stay. SETTING: We evaluated neonates who were < or =34 weeks' estimated gestational age and admitted for neonatal intensive care. We excluded neonates with congenital anomalies, neonates transferred out before discharge, and neonates who died. METHODS: Using a database created with a computer-assisted tool that generates hospital notes, we reviewed the epidemiology of monitor use. Differences between neonates sent home with an apnea monitor and those who were not were evaluated by using stepwise logistic regression analysis to identify which factors were independently associated with a neonate being discharged with a monitor. RESULTS: We studied 14,532 neonates; 1588 (11%) were sent home with monitors and 12,944 (89%) were not. The most important variables associated with being discharged with a monitor were site of care and a diagnosis of apnea. Site variation remained significant when adjusted for gestational age, diagnosis of apnea, and a history of use of methylxanthines. When corrected for gestational age, monitor use was not associated with shorter hospital stays. CONCLUSION: The data suggest that monitor use is more dependent on physician preference than medical indication and is not associated with earlier hospital discharge.

Apgar Score↗
PubMed2001

Are very low birth weight infants born at high altitude at greater risk for adverse outcomes?

OBJECTIVE: To determine if neonatal intensive care at higher altitudes was associated with any variation in mortality or morbidity. METHODS: We reviewed demographic and outcome data on 5450 neonates with birth weights between 500 and 1500 g cared for in 76 different level II and III neonatal intensive care units (NICUs). The altitude break point of 4300 feet was prospectively chosen. Care was provided at 63 NICUs located below 4300 feet, "low-altitude," (n = 4534 neonates) and at 13 NICUs at or above 4300 feet, "high-altitude" (n = 916 neonates). RESULTS: Compared with neonates cared for at low altitude, neonates cared for at high altitude were more often non-Hispanic white and exposed to prenatal steroids. Neonates born at high altitude were more often treated with surfactant (60% vs 53%, P <.01). At 28 days of age, neonates cared for at high altitude were less often in room air (33% vs 50%, P <.01) compared with neonates cared for at low altitude. However, when corrected for barometric pressure, the calculated partial pressure of inspired oxygen at 28 days of age was lower for neonates cared for at high altitude compared with low altitude (165 +/- 80 vs 183 +/- 57, P <.01). There were no differences in the rates of mortality, severe intraventricular hemorrhage (grades 3 and 4), severe retinopathy of prematurity (stages 3 and 4), or necrotizing enterocolitis requiring surgical treatment. CONCLUSIONS: Being cared for at NICUs located above 4300 feet above sea level was not associated with any increase in adverse events compared with NICUs located below 4300 feet.

Altitude↗
PubMed2001

A comparison of the outcomes of neonates treated with two different natural surfactants.

OBJECTIVE: Our purpose was to determine whether there exists a mortality difference between neonates treated with Infasurf (surfactant A [SA], ONY, Inc, Amherst, NY) and Survanta (surfactant B [SB], Ross Products Division, Abbott Laboratories, Columbus, OH). METHODS: We evaluated 114 different neonatal units' records, between January 1, 2000, and December 31, 2000, of neonates < or = 36 weeks' estimated gestational age who were admitted for neonatal intensive care and reported to have been treated with SA or SB. We used stepwise logistic regression analysis to determine whether the type of surfactant was associated with increased incidence of neonatal death, severe intraventricular hemorrhage, or necrotizing enterocolitis independent of estimated gestational age, birth weight, sex, method of delivery, use of antenatal steroids, or place of birth. RESULTS: We studied the records of 5169 neonates; 1115 (22%) received SA and 4054 (78%) received SB. The most important variables associated with neonatal death, intraventricular hemorrhage and necrotizing enterocolitis were birth weight and estimated gestational age. Logistic regression showed that the type of surfactant did not significantly influence any of these 3 outcomes. Neither overall mortality (8.3% vs 8.5%) or birth weight-specific mortality was different between the 2 groups. CONCLUSION: The differences in mortality previously reported are not present in a larger, more contemporary data set.

Biological Products↗
PubMed2001

Predictive modeling techniques in prostate cancer.

A number of new predictive modeling techniques have emerged in the past several years. These methods can be used independently or in combination with traditional modeling techniques to produce useful tools for the management of prostate cancer. Investigators should be aware of these techniques and avail themselves of their potentially useful properties. This review outlines selected predictive methods that can be used to develop models that may be useful to patients and clinicians for prostate cancer management.

Humans↗
PubMed2001

Genetic adaptive neural network to predict biochemical failure after radical prostatectomy: a multi-institutional study.

BACKGROUND AND PURPOSE: Despite many new procedures, radical prostatectomy remains one of the commonest methods of treating clinically localized prostate cancer. Both from the physician's and the patient's point of view, it is important to have objective estimation of the likelihood of recurrence, which forms the foundation for treatment selection for an individual patient. Currently, it is difficult to predict the probability of biochemical recurrence (rising serum prostate specific antigen [PSA] concentration) in an individual patient, and approximately 30% of the patients do experience recurrence. Tools predicting the recurrence will be of immense practical utility in the treatment selection and planning follow up. We have utilized preoperative parameters through a computer based genetic adaptive neural network model to predict recurrence in such patients, which can help primary care physicians and urologists in making management recommendations. PATIENTS AND METHODS: Fourteen hundred patients who underwent radical prostatectomy at participating institutions form the subjects of this study. Demographic data such as age, race, preoperative PSA, systemic biopsy based staging and Gleason scores were used to construct a neural network model. This model simulated the functioning of a trained human mind and learned from the database. Once trained, it was used to predict the outcomes in new patients. RESULTS: The patients in this comprehensive database were representative of the average prostate cancer patients as seen in USA. Their mean age was 68.4 years, the mean PSA concentration before surgery was 11.6 ng/mL, and 67% patients had a Gleason sum of 5 to 7. The mean length of follow-up was 41.5 months. Eighty percent of the cancers were clinical stage T2 and 5% T3. In our series, 64% of patients had pathologically organ-confined cancer, 33% positive margins, and 14% had seminal vesicle invasion. Lymph node positive patients were not included in this series. Progression as judged by serum PSA was noted in 30.6%. With entry of a few routinely used parameters, the model could correctly predict recurrence in 76% of the patients in the validation set. The area under the curve was 0.831. The sensitivity was 85%, the specificity 74%, the positive predictive value 77%, and the negative predictive value of 83%. CONCLUSION: It was possible to predict PSA recurrence with a high accuracy (76%). Physicians desiring objective treatment counseling can use this model, and significant cost savings are anticipated because of appropriate treatment selection and patient-specific follow-up protocols. This technology can be extended to other treatments such as watchful waiting, external-beam radiation, and brachytherapy.

Aged↗
PubMed2000

A new look at intrauterine growth and the impact of race, altitude, and gender.

BACKGROUND: Growth curves described in the 1960s are used to classify neonate intrauterine growth as normal or abnormal. Our objective was to determine whether continued use of these curves is appropriate. METHODS: From 1996 to 1998, we collected birth weight, length, head circumference, estimated gestational age (EGA), gender, race, and place of birth (<4,000 feet or >/=4,000 feet) on 27 229 neonates to evaluate the effects of each on intrauterine growth and the diagnoses of small for gestational age (SGA) and large for gestational age (LGA). We compared the gestation-specific growth parameters derived from our sample with those reported in 1966 and 1969. RESULTS: Gestational age had the largest influence on each growth parameter. Race and gender both had effects on birth weight. Female neonates were smaller than male neonates, and black neonates were smaller than Hispanic and white neonates at each EGA. For neonates with an EGA <30 weeks, our data had a smaller variance and lower average weights, lengths, and head circumferences than those reported in 1966 and in 1969. For neonates >36 weeks, the variance was similar, but our curves showed that neonates in our sample were larger and heavier. Use of the older growth curves to classify neonates as SGA, LGA, and appropriate for gestational age (AGA) led to significantly different rates of each by gender and race. CONCLUSIONS: Intrauterine growth patterns previously described and commonly used to classify neonates as AGA are inaccurate for use in current populations and lead to gender- and race-specific diagnoses of SGA and LGA that are misleading. neonates, growth, race, gender.

Birth Weight↗
PubMed1994

Cortical hyperostosis: a complication of prolonged prostaglandin infusion in infants awaiting cardiac transplantation.

BACKGROUND: Infants awaiting heart transplantation for congenital heart disease frequently require prostaglandin E1 (PGE1) infusion for prolonged periods. As a result, complications of prolonged PGE1 infusion, such as cortical hyperostosis, are being encountered more commonly. OBJECTIVE: To determine the incidence and severity of cortical hyperostosis in newborns requiring prolonged PGE1 infusion. METHODS: Chest radiographs of 86 infants receiving PGE1 infusion awaiting heart transplantation were reviewed. The chest radiographs were graded for the severity of cortical hyperostosis (no bony changes, minimal hyperostosis, or severe hyperostosis). Duration of PGE1 infusion, total PGE1 dose, and highest alkaline phosphatase were recorded for each patient. Infants were arbitrarily divided into three groups according to the duration of PGE1 infusion (< 30 days, 30 to 60 days, > 60 days). RESULTS: Fifty-three of the 86 infants (62%) had radiologic evidence of cortical hyperostosis. Forty-two of 80 infants (53%) had elevated alkaline phosphatase. The percentage of infants with hyperostosis increased with increasing duration of PGE1 infusion (42% at < 30 days; 87% at 30 to 60 days; 100% at > 60 days). The incidence and severity of cortical hyperostosis were related (by Kruskal-Wallis) to the duration of PGE1 infusion (P < .0001) and the total dose of PGE1 received (P < .0001). The highest alkaline phosphatase levels were observed in infants with the most severe grades of hyperostosis (P < .0001). The percentage of infants with elevated alkaline phosphatase increased with greater severity of hyperostosis (26% of infants with no bony changes, 59% with minimal changes, and 85% with severe changes). Two infants had symptomatic bone tenderness or swelling mimicking osteomyelitis. CONCLUSION: It is concluded that cortical hyperostosis is a frequent, often asymptomatic, side effect of prolonged PGE1 infusion that should be evaluated in any infant on long-term PGE1 therapy. When symptoms occur in infants awaiting transplantation, osteomyelitis must be excluded rapidly to avoid an unnecessary delay in transplantation.

Alprostadil↗
PubMed1986

Pulmonary vascular occlusion and fibrosing mediastinitis.

Patients with fibrosing mediastinitis causing obstruction of pulmonary veins and arteries may present with many of the historic, physical, and laboratory findings of patients with pulmonary hypertension due to chronic thrombotic obstruction of major pulmonary arteries. Because the latter is subject to surgical correction, and the former is not, it is important to differentiate between the two and to be aware of the similarities in presentation. Three patients with pulmonary hypertension due to compression of pulmonary veins and the right pulmonary artery by fibrosing mediastinitis are presented who illustrate these points. A review of the literature documents other instances in which vascular involvement due to fibrosing mediastinitis has mimicked other types of pulmonary hypertension.

Adult↗
PubMed1979

The role of thoracotomy in the management of pulmonary metastases from malignant melanoma.

Thirty-three patients over a 21-year period underwent thoracotomy for resection of suspected pulmonary metastases from malignant melanoma. Eleven patients were found to have nonmalignant disease (Group 1); 10 were found to have unresectable disease (Group 2); and 12 were rendered disease-free (Group 3). Of the patients found to have melanoma, 20 of 22 received post-operative chemotherapy. The median survival of the patients in Group 2 was 10.5 months (3 to 20 months); in Group 3 it was 12 months (3 to 35 months). There were no 5-year survivors. No factors distinguished the three groups preoperatively. Surgical resection still offers the greatest chance for long-term survival, based on reports of patients in the literature who have survived longer than 5 years following resection of pulmonary metastases from melanoma. Thoracotomy is especially useful for staging purposes in those patients found to have no metastatic disease.

Follow-Up Studies↗
PubMed1975

Primary adenoid cystic carcinoma of the esophagus. Report of a case and review of the literature.

A case of primary adenoid cystic carcinoma of the esophagus is reported and a total of 15 cases was reviewed. There were 9 men, although earlier reports indicated the disease was more common in women. The lesion was located in the middle third of the esophagus in 10 cases. The possibility of tumor development from embryonal rests of the tracheobronchial tree in the esophagus is discussed. The prognosis of adenoid cystic carcinomas is not well known, but the treatment and prognosis appear similar to those of epidermoid carcinomas of the esophagus.

Aged↗