Biomedical subjects

K S Ford

Publications and source records attributed to K S Ford.

8 recordsLinked to original sources

PubMed1998

Olanzapine in the treatment of hallucinosis in idiopathic Parkinson's disease: a cautionary note.

BACKGROUND: Hallucinosis is a dopaminergic dose limiting complication of the treatment of idiopathic Parkinson's disease. Typical neuroleptic medications cannot be used for suppressing hallucinosis because the extrapyramidal side effects worsen parkinsonian motor control. Olanzapine is a novel atypical antipsychotic drug with few reported extrapyramidal side effects which may be more suitable for controlling hallucinosis in these patients. METHODS: Olanzapine was given to five patients with idiopathic Parkinson's disease and the dosage was titrated until a clinically meaningful reduction in hallucinosis was achieved. The commercially available 5 mg, 7.5 mg and 10 mg tablets were used. RESULTS: After an initial 9 days of treatment, hallucinosis frequency was significantly reduced, an effect which was maintained with continued treatment. However, during this early phase of treatment, parkinsonian motor disability increased, which resulted in two of the patients discontinuing medication. CONCLUSIONS: Olanzapine is effective in the suppression of hallucinosis in patients with idiopathic Parkinson's disease but the currently available dose increments may result in an unacceptable exacerbation of motor disability.

Aged↗

PubMed1985

Buserelin as primary therapy in advanced prostatic carcinoma.

The effectiveness of buserelin, a luteinizing hormone-releasing hormone agonist, was tested in 28 patients with Stages C or D adenocarcinoma of the prostate. Of 24 evaluable patients, there were 13 partial responses (54%) by National Prostatic Cancer Project criteria, median duration greater than 6 months. Nine patients had stable disease (38%), median duration greater than 5 months, and only two patients progressed. Performance status improved in 38%, patient-scored pain improved in 46%, and quality of life improved in 57%. Symptoms occurring during treatment consisted of hot flashes, loss of libido, and impotence. A flare of symptoms was observed in only one patient, despite a transient 25% increase in testosterone in 36% of patients. Buserelin is an effective treatment for inducing frequent and meaningful remissions in advanced prostatic cancer.

Adult↗

PubMed1985

Radical cystectomy and adjuvant chemotherapy.

Seventy-one radical cystectomies were performed at the University of Tennessee from June, 1976, through December, 1983. The operative mortality rate was 1.5 per cent. The early and late complication rate was 21 and 15 per cent, respectively. Single agent cisplatin was used as adjuvant chemotherapy in patients at high risk for development of metastatic disease and did not alter the poor survival of this group of patients.

Adult↗

PubMed1984

Urinary cytology and bladder cancer. The cellular features of transitional cell neoplasms.

Urinary cytology is increasingly accepted as a diagnostic tool in the detection and follow-up of patients with bladder cancer. Its potential value has been reduced, however, by the relative inexperience of most pathologists in the examination of urinary specimens, and by the lack of cellular criteria specifically reflecting the morphology of low-grade papillary and flat lesions of bladder epithelium. The cytologic features of urothelial lesions, including papillary transitional cell carcinomas and flat urothelial dysplasias have been studied in both experimental systems and clinical situations and their application to a selected patient population is presented. Overall, the cytohistologic correlation for patients with bladder cancer was 92%. Positive cells reflecting the morphology of the tumor occurred in 62% of patients with grade I transitional cell carcinomas, and cells suspicious for malignancy were identified in an additional 14% of these individuals. Using the criteria presented, a positive cytology can correlate with a papillary grade I bladder tumor, and should not necessarily indicate the presence of another neoplasm. Dysplastic cells in cytologic specimens are often identified in patients having urothelial dysplasia as the most serious bladder lesion, but the cytologic diagnosis of dysplasia may represent an under-interpretation of a low-grade papillary bladder tumor. The cells of urothelial neoplasms, including low-grade transitional cell carcinomas and dysplasias, differ morphologically both from normal and reactive/reparative elements, and can be detected in cytologic samples. The changes are often subtle and require experience and a cautious approach for accurate interpretation.

Biopsy↗

PubMed1984

Surveillance of stage O, grade I bladder cancer by cytology alone--is it acceptable?

Although the high incidence of subsequent tumors is well established there is accumulating evidence that few cases of low grade, low stage transitional cell carcinomas will progress in stage. Since the purpose of intensive endoscopic monitoring following initial tumor resection is to detect potentially lethal new tumors as soon as possible, we reviewed retrospectively the course of 36 patients with an initial grade I, stage O (Ta) transitional cell carcinoma to determine whether cytology was capable of achieving this goal. Of these patients 10 (28 per cent) had a subsequent tumor of a higher grade or stage. Cytology performed at or before recurrence was positive in 8 patients (80 per cent) and 2 (20 per cent) had grade II, noninvasive transitional cell carcinoma with negative cytology. Subsequent tumors in these 2 patients have been grade I. All 36 patients are alive. Given the patient inconvenience, expense and risk of infection of cystoscopy compared to cytology, this retrospective review suggests that when an experienced cytopathologist is available patients with grade I, noninvasive transitional cell carcinoma may be monitored primarily by urinary cytology with less frequent endoscopy. A prospective study must be performed to confirm this approach.

Aged↗

PubMed1983

Invasive bladder cancer: support for screening.

Of 297 patients with bladder cancer treated between 1975 and 1981, 90 (30 per cent) had histologic documentation of muscle invasion, 82 of whom (91 per cent) had invasion into the muscle at the time of presentation. Of these 82 patients 51 (62 per cent) had tumor localized to the bladder after clinical staging. Of 36 patients undergoing radical cystectomy 9 (25 per cent) had microscopic pelvic lymph node involvement. Nine patients underwent urinary diversion alone and 31 presented with perivesical or pelvic nodal tumor extension, or distant metastases. Only 8 of the 90 patients (9 per cent) had prior superficial bladder cancer. The mean survival for patients with stage B to C disease at diagnosis was 23 months and for those with stage D tumor it was 11 months. This experience indicates that the majority of patients with advanced bladder cancer are not identified at a stage when definitive therapy offers an excellent prognosis. More resources must be devoted to earlier detection.

Adult↗

PubMed1983

Subsequent tumor analysis of 36 patients who have received intravesical mitomycin C for superficial bladder cancer.

We studied 36 patients with stages O and A (Tis, Ta and T1) bladder cancer who had received 8 weekly doses of 30 or 40 mg. mitomycin C as definitive therapy. Of this group 16 had failed thiotepa therapy and 13 had grade III tumors (6 multifocal carcinoma in situ). The complete response rate at 12 weeks was 45 per cent (negative biopsy and cytology), while an additional 33 per cent had a partial response. Response did not correlate with tumor grade or stage. Patients who had failed thiotepa therapy were less likely to have a complete response, although the over-all response rate was identical to patients who had either not received prior chemotherapy or were not clear thiotepa failures. Followup of these patients indicates that the complete responders were benefited by this regimen since the subsequent recurrence rate was reduced when compared prior to initiation of mitomycin C. Most of these patients received monthly maintenance therapy.

Adult↗

PubMed1983

Thiotepa-induced myelosuppression: review of 670 bladder instillations.

Intravesical chemotherapy is an integral part of the therapeutic strategy for patients with superficial bladder cancer. Despite the introduction of new agents thiotepa currently is used most owing to its low cost and moderate effectiveness. Myelosuppression is a side effect caused by absorption of the drug through the bladder mucosa. A review of 670 instillations of thiotepa in 72 patients at our medical center revealed a decrease in the white blood or platelet count below normal in 18 per cent of the patients (3.9 per cent of the instillations). In no case did this decrease lead to any problem other than a delay in therapy.

Adult↗