Biomedical subjects

Keith L Lee

Publications and source records attributed to Keith L Lee.

6 recordsLinked to original sources

PubMed2005

Positive family history of prostate cancer not associated with worse outcomes after radical prostatectomy.

OBJECTIVES: To determine the clinical outcomes in men with (FH) and without (NFH) a family history of prostate cancer after radical prostatectomy. METHODS: We performed a retrospective analysis of 557 men with localized prostate cancer treated by radical prostatectomy between 1989 and 2000. We defined a positive FH as having one or more first-degree relatives such as a father or brother with prostate cancer. The clinical and pathologic features, as well as biochemical disease-free survival, defined as an undetectable prostate-specific antigen level (less than 0.2 ng/mL), were compared between the FH and NFH groups. RESULTS: Compared with the NFH group, the FH men were younger at surgery (median 62 years versus 64 years, P = 0.01), had a lower median preoperative prostate-specific antigen level (7.2 ng/mL versus 7.8 ng/mL, P = 0.05), and were more likely to have only low-grade disease at the final pathologic evaluation (26.2% versus 17.8%, P = 0.05). At a median follow-up of 7.5 years (mean 7.6 +/- 2.9 years), 17% of the FH group had biochemical disease recurrence compared with 30% in the NFH group. The actuarial disease-free survival rate at 5 and 10 years for the two groups was 86% and 80% compared with 73% and 66%, respectively (P = 0.01). When controlled for pathologic variables in a multivariate analysis, FH was not an independent predictor of disease-free survival. CONCLUSIONS: The association of improved disease-free survival in the FH patients may have been driven by an earlier age at diagnosis and more favorable pathologic features.

Actuarial Analysis↗

PubMed2004

Gender differences in radical cystectomy: complications and blood loss.

OBJECTIVES: To review the impact of gender on blood loss, transfusions, and complications. Radical cystectomy is technically different between men and women. Unique to women, dissection of the anterior vaginal wall can be associated with added blood loss. METHODS: We analyzed the records of 262 consecutive patients who underwent radical cystectomy for urothelial carcinoma from March 1993 to March 2003. The perioperative variables, amount of blood loss, transfusion requirements, need for intensive care, length of hospitalization, and 30-day complications were examined. RESULTS: Women accounted for 24% (n = 63) of this series and had a median operative blood loss of 1.4 L compared with 0.5 L in men (P = 0.001). The transfusion rate was 82% in women and 55% in men (P = 0.001), with the median number of units transfused greater in women (3 U versus 2 U, P = 0.043). Also, 31% of women needed intensive care compared with 15% of men (P = 0.004). The median postoperative stay was similar at 9 days for women and 8 days for men (P = 0.099). The incidence of complications was not significantly different statistically between the gender groups, occurring in 43% of women and 33% of men (P = 0.161). Major complications occurred in 8% of women and 7.5% of men, and the most common minor complication was ileus, reported in 19% of women and 14% of men. CONCLUSIONS: Although the overall complications and length of hospital stay were similar between the gender groups, radical cystectomy in women was associated with greater blood loss, transfusion requirements, and intensive care needs.

Aged↗

PubMed2004

Molecular and cellular pathogenesis of benign prostatic hyperplasia.

PURPOSE: Symptomatic benign prostatic hyperplasia (BPH) is one of the most common ailments seen by the urologist. Significant advances have occurred in medical and surgical therapy, and in the understanding of the biology of this disease. However, the basic science literature is often conflicting and confusing, without a unified voice. We report the current state of knowledge of the molecular and cellular basis of BPH. MATERIALS AND METHODS: We compiled and interpreted basic science studies relevant to BPH pathogenesis. RESULTS: Cellular alterations that include changes in proliferation, differentiation, apoptosis and senescence in the epithelium and stroma are implicated in BPH pathogenesis. Molecular analyses have yielded numerous candidate genes important in disease progression. Differential expression of cytokines and growth factors in BPH tissue suggests roles for inflammation and hypoxia. Through the use of cell culture models the complex regulatory mechanisms of growth control in BPH are becoming defined. CONCLUSIONS: The scientific endeavor has resulted in great strides in our understanding of BPH on a molecular and cellular level. It is hopeful that basic science and translational research will improve treatment and prevention strategies for this common disease of elderly men.

Apoptosis↗

PubMed2003

Luteinizing hormone-releasing hormone agonists and meningioma: a treatment dilemma.

The relative contraindication of hormonal therapy for patients with prostate cancer and a history of meningioma has not been widely emphasized. Using immunohistochemistry to determine the presence of hormone receptors in meningioma specimens proved potentially valuable in 2 patients with biochemical recurrence after prostatectomy who were being considered for androgen deprivation therapy. These cases also highlight the need for caution against assuming that skull-based intracranial growths in patients receiving hormonal therapy for prostate cancer are metastatic lesions rather than hormonally induced primary tumors.

Aged↗

PubMed2003

Neuroblastoma: management, recurrence, and follow-up.

The clinical use of N-myc amplification in neuroblastoma management has served as a paradigm for "bench to bedside" medicine. It is hoped that the quest for molecular markers such as neurotrophin, TrkA, and TrkB will continue to advance the understanding of neuroblastoma. In addition, animal models of neuroblastoma (N-myc transgenic mice, and neuroblastoma xenografts) have been established to assess the efficacy of novel treatments. These advances are likely to improve clinical practice in the future.

Animals↗

PubMed2002

Survey of urological laparoscopic practices in the state of California.

PURPOSE: In the interest of maintaining our surgical domain we performed a survey aimed at establishing laparoscopic practice patterns as they pertain to urological disease. MATERIALS AND METHODS: Surveys were mailed to 2,902 surgeons in California who were listed with the American College of Surgeons, including 2,175 general surgeons, 510 urologists and 217 obstetricians-gynecologists. RESULTS: A total of 442 complete responses (15.2%) were tallied. Of urologists and of nonurologists 54% and 11% performed no laparoscopy, while 12% and 80%, respectively, devoted at least 5% of their time to laparoscopic surgery. Urologists and nonurologists performing no laparoscopy were older than those performing a significant volume (p < 0.05). Of urologists 16% thought that they were trained adequately during residency to perform laparoscopic surgery compared with 30% of nonurologists. Of the urologists who performed hand assisted laparoscopy, 50% tended to use it as a means of gaining familiarity with these techniques. These urologists performed more laparoscopic surgery than other urologists. While 80% of laparoscopy cases were community based, academic urologists are actively interested in laparoscopic surgery. The 2 most important reasons cited for performing laparoscopy were more rapid recovery and decreased morbidity. The leading laparoscopic procedures according to incidence for urologists performing laparoscopic surgery were diagnostic procedures (12.9%), varicocelectomy (12.1%), adrenalectomy (9.7%), pelvic lymphadenectomy (8.9%), and simple nephrectomy and renal cyst decortication (8.1% each). The leading laparoscopic cases according to the number of available cases per urologist were colposuspension-bladder neck suspension (1.06), donor nephrectomy (0.77), pelvic lymphadenectomy (0.52), varicocelectomy (0.48) and orchiopexy (0.45). Urologists performed more urological laparoscopy cases than nonurologists. CONCLUSIONS: Urological laparoscopic practice in California remains in its infancy. It is imperative that exposure should be increased in residency training programs.

California↗