PubMed Health⌕ Search

Biomedical subjects

R Appell

Publications and source records attributed to R Appell.

10 recordsLinked to original sources
PubMed2000

Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. The Ditropan XL Study Group.

OBJECTIVE: To compare the efficacy and safety of controlled-release oxybutynin with conventional, immediate-release oxybutynin and determine rates of dry mouth. METHODS: Patients (n = 226) who were known to be responsive to anticholinergic therapy and who had seven or more urge incontinence episodes per week were randomized to receive controlled-release oxybutynin or immediate-release oxybutynin. After an initial placebo run-in period, dosing in each began at 5 mg per day and increased weekly by 5 mg per day to a maximum of 20 mg per day or when a balance between improvement of incontinence symptoms and tolerability of side effects was achieved. Rates of urge incontinence and dry mouth were compared. Post hoc Kaplan-Meier survival analysis was used to describe elimination of incontinence episodes by dose and to analyze dry mouth risk by dose. RESULTS: Reductions in urge urinary incontinence episodes from baseline to the end of treatment were 18.6 to 2.9 per week (83% mean decrease) and 19.8 to 4.4 per week (76% mean decrease) in the controlled- and immediate-release oxybutynin groups (P =.36), respectively. At equal doses, comparable proportions of patients in both groups reported the absence of urge incontinence (P =.85). The incidence of dry mouth increased with dose in both groups, but there was no difference in dry mouth rates between the groups: 47.7% and 59.1% for the controlled- and immediate-release oxybutynin (P =.09), respectively. However, Kaplan-Meier analysis to examine first report of dry mouth at a given dose revealed that a significantly lower proportion of patients taking controlled-release oxybutynin had moderate to severe dry mouth (P =.007) or any dry mouth (P =.003) compared with those taking immediate-release oxybutynin. CONCLUSION: At the same daily dose, controlled- and immediate-release oxybutynin demonstrated comparable efficacy in reduction of urge incontinence episodes. The incidence of dry mouth was dose dependent but equal in both groups; first report of moderate to severe dry mouth was significantly lower in the controlled-release group.

Chemistry, Pharmaceutical↗
PubMed1999

Immunoregulatory potential of urothelium: characterization of NF-kappaB signal transduction.

PURPOSE: To characterize the basal and activated form of nuclear factor-kappaB (NF-kappaB) complex in normal urothelial cell cultures after stimulation with tumor necrosis factor-alpha (TNF-alpha), lipopolysaccharide (LPS), and double-stranded ribonucleic acid (dsRNA). MATERIALS AND METHODS: Human urothelial cells cultured from normal bladder specimens underwent immunohistochemical staining and cellular extracts were prepared for Electrophoretic Mobility Shift Assays (EMSA), Western blot analyses, RNA isolation and Northern Blot analyses before and after stimulation with TNF-alpha, LPS, and dsRNA. RESULTS: In normal human urothelial cells, activation of the NF-kappaB complex in response to stimulation with TNF-alpha, LPS, and dsRNA was detected by immunohistochemical methods and EMSA. Depending on the stimulus, a specific NF-kappaB complex was activated as seen by supershift experiments in EMSA. By Western blot, the inhibitor of NF-kappaB complex, IkappaB-alpha, degraded in response to stimulation. Northern blot analysis from total RNA revealed subsequent inducible interleukin-8 (IL-8) mRNA expression of normal urothelial cells when treated with TNF-alpha, LPS, and dsRNA. CONCLUSIONS: Normal human urothelial cells contain basal NF-kappaB complexes in an inactivated state. When these cells are challenged by different agents such as TNF-alpha, LPS, and dsRNA, the cells respond by activation of the NF-kappaB signal transduction pathway, degradation of its inhibitor, IkappaB-alpha, and translocation of this primary factor into the nucleus to induce specific genetic responses such as IL-8 expression.

Cells, Cultured↗
PubMed1996

Percutaneous bladder neck suspension.

The early results after PBNS are extremely encouraging. The procedure is easy to learn, is performed rapidly on an outpatient basis under local anesthesia if desired, and has minimal postoperative morbidity. Continued objective follow up is critical to define the long-term efficacy of this promising technique.

Female↗
PubMed1995

Periurethral injection of collagen in the treatment of intrinsic sphincteric deficiency in the female patient.

In properly selected patients, the periurethral injection of collagen is a safe and effective form of management for females with intrinsic sphincteric dysfunction. Performed under local anesthesia, this procedure allows for the treatment of patients who may not be suitable candidates for anesthesia and formal surgery. In female patients, excellent treatment results are obtained, which appear durable for greater than 2 years; these results are obtained usually within three treatment sessions. Periurethral collagen injection has been shown to elicit only a minimal inflammatory reaction and there have been no adverse immunogenic effects, foreign-body reaction, or migration of the injected material. Adverse events associated with the periurethral injection of collagen are rare. Collagen has proven to be a highly efficacious substance for use in periurethral injections for the treatment of intrinsic sphincteric dysfunction.

Collagen↗
PubMed1992

Treatment of urinary incontinence in the elderly.

Urinary incontinence affects millions of American men and women. Treatment consists of drug therapy, exercises, mechanical devices, surgery, and injection therapy. This article reviews the advantages and disadvantages of all treatment modalities for this common medical problem.

Female↗
PubMed1981

[Bone metastases in Wilms' tumor in relation to histologic grading (author's transl)].

86 patients with Wilms' tumor were treated in Heidelberg between 1951 and 1980. Using the histopathologic grading according to Hardwick and Stowens the sarcomatous tumor type has an unfavorable prognosis. All the patients in stage III to V developed metastases. In contrast to other types of Wilms' tumor these sarcomatous tumors do metastasize to bones, not primarily to the lung. Boys up to 5 years are mostly affected by the tumor. These were "cold" lesions in bone scan using different radionuclides on skeletal osteolytic metastases, which is limiting the application of scans to detect bone metastases in Wilms' tumor. A more aggressive chemotherapy should be given to improve prognosis of the sarcomatous type of Wilms' tumor.

Bone Neoplasms↗
PubMed1980

Renal angiomyolipoma: diagnosis and management.

Renal angiomyolipoma is a benign tumor. Use of excretory urography, plain tomography, arteriography, ultrasound, and computerized tomography can usually provide the diagnosis. Appropriate operative or nonoperative management can then be determined for the individual patient.

Adult↗
PubMed1978

Radioiodine treated hyperthyroidism and thyroid carcinoma.

External irradiation of the head and neck has been shown to increase the incidence of thyroid carcinoma. Fourteen cases have also been reported of thyroid cancer developing in individuals treated with radioiodine for hyperthyroidism. Another patient's case is reported here to emphasize the possible role of I131 on the genesis of thyroid malignancy and the importance of surgery in the treatment of hyperthyroidism.

Adenocarcinoma, Papillary↗