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Biomedical subjects

R A Hurley

Publications and source records attributed to R A Hurley.

At least 19 recordsLinked to original sources
PubMed2000

Functional neuroanatomy of the frontal lobe circuits.

This article summarizes the current theories regarding the locations and functions of the three primary frontal lobe circuits. It forms the framework for structuring functional magnetic resonance imaging investigations. It can be used to assist in (a) detecting subtle lesions of the frontal circuits and (b) applying the current theories of neuropsychiatry to assess prognosis and to plan rehabilitation.

Brain Diseases↗
PubMed1999

Carcinoma of the larynx treated with hypofractionated radiation and hyperbaric oxygen: long-term tumor control and complications.

PURPOSE: To evaluate the long-term outcome with respect to local control, survival, and complications in a cohort of patients with locally advanced laryngeal carcinoma treated with hypofractionated radiation and hyperbaric oxygen at 4 atmospheres of pressure (HBO-4). METHODS AND MATERIALS: Between January 1970 and August 1982, 45 patients with locally advanced carcinoma of the larynx were treated with primary radiation using a unique hypofractionated schedule of 2 fractions of 11 Gy separated by 21 days, with concomitant HBO-4 during each radiotherapy session. To avoid seizures, discomfort and other complications of HBO-4, each session was performed under general anesthesia. All patients had pathologically confirmed squamous cell carcinoma of the glottic (23) or supraglottic larynx (22) and were staged as follows: T2-5, T3-24, T-4-16; N0-26, N1-4, N2-13, N3-1. Patients were treated with opposed lateral wedged fields of 4-6 MV photons, with a median field size of 5.5 x 9.75 to a total median dose of 22.5 Gy. RESULTS: As of February 1998, follow-up was complete on all but one patient, who relocated to another country after 8 years. Complete clinical responses were observed in 39 (87%) of the cases. The 10-year local control rate for all 45 patients was 58%, and local control for the complete responders was 69%. Three patients underwent laryngectomy for complications and were found to have no pathological evidence of disease in the laryngectomy specimen. The 10-year survival of the overall population was 27%. The 10-year voice preservation rate for the the 39 complete responders was 55%. Acute mucosal and skin reactions were modest and acceptable. Significant late complications occurred in 14 patients consisting of severe fibrosis, necrosis, pharyngeal fistula, with 3 patients requiring laryngectomy for complications. The actuarial rate of severe complications at 5 years was 42%. CONCLUSIONS: The response rate and long-term tumor control rate obtained with this treatment program were comparable to more protracted radiation schedules with or without systemic chemotherapy. The complication rate was high resulting in an adverse therapeutic ratio. The radiobiologic interpretation of this clinical data, and implications for hypoxia directed therapy, are discussed.

Adult↗
PubMed1995

Clozapine for acute and maintenance treatment of psychosis in Parkinson's disease.

In a prospective, open-label study, 12 patients manifesting psychosis associated with Parkinson's disease were treated with clozapine. Cognitive functioning and type of psychotic symptoms were measured prior to treatment, and changes in psychiatric and behavioral symptoms were studied by using the Behave-AD Scale. Significant resolution in psychotic symptoms was found and improvement in global behavioral status observed in all cases, with 10 patients maintaining improvement at follow-up. Careful initiation and titration of the drug resulted in few side effects, and dementia was not found to be a contraindication to such treatment.

Aged↗
PubMed1993

Clozapine use in diffuse Lewy body disease.

Diffuse Lewy body disease, a severely disabling neuropsychiatric disease, presents with progressive dementia, psychotic symptoms, depression, and parkinsonian symptoms. The authors report a case illustrating that clozapine, a novel neuroleptic drug, has special efficacy in treating psychotic symptoms in these patients.

Clozapine↗
PubMed1989

The effect of selective therapy on malignant obstructive jaundice.

To determine the impact and use of alternative treatment methods of draining malignant obstructive jaundice, a review of 41 patients who were managed by a surgical hepatobiliary service, in which non-surgical (endoscopic and radiological) treatment modalities were available equally, was performed. Of the 41 patients, 39 patients experienced 45 attempted treatments with ultimate success in 35 (90%) patients. The non-operative management of the high-risk patients did not result in a higher mortality at 9% and 25% for endoscopic and radiological management, respectively, than that of 15% which was achieved in the operative series. As a result of treatment selection, the non-operative groups survived for a shorter time (eight weeks) than did those who underwent operation (survival, 30 weeks). This shorter survival time resulted in a similar readmission rate for the non-operative and operative groups; patients did not survive long enough in the non-operative group to develop stent complications. Even if surgery is the chosen treatment modality, preoperative endoscopic retrograde cholangiopancreatography is recommended in planning that surgery. We conclude that in patients with malignant obstructive jaundice, surgical treatment has the advantage of fewer late complications, while non-surgical treatment has the advantage of less initial morbidity or mortality. If the aim is to optimize palliation not only in the short term, but also in the longer term, then the selection of patients for treatment on the basis of pretreatment imaging results, the operative risk and the predicted duration of survival, will result in operative and non-operative methods of treatment being used approximately equally.

Aged↗
PubMed1985

Recurrent nasopharyngeal carcinoma--two long term disease-free remissions with non-cisplatinum based combination chemotherapy.

Two cases of locally recurrent nasopharyngeal carcinoma following maximal radiotherapy are presented. Both patients had complete resolution of disease with outpatient combination chemotherapy using Vincristine, Adriamycin and Cyclophosphamide (VAC), and are disease free, and working full time, 3 and 4 years later, respectively. The significant relapse rate of nasopharyngeal carcinoma after initial radiotherapy is outlined, and the reported limitations of radiotherapy and chemotherapy in this situation are discussed. The survival curve for this disease appears to plateau at 2-3 years. This appears to be the first reported outpatient combination chemotherapy programme to produce long term disease-free remission in recurrent disease.

Adult↗