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Biomedical subjects

R deVere White

Publications and source records attributed to R deVere White.

At least 19 recordsLinked to original sources
PubMed1999

Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. PLESS Study Group.

OBJECTIVES: To determine whether baseline prostate-specific antigen (PSA), in addition to prostate volume, is associated with long-term changes in symptoms and urinary flow rate. METHODS: Three thousand forty men with benign prostatic hyperplasia enrolled in the PLESS trial were randomly assigned to finasteride 5 mg or placebo for 4 years. Symptoms and flow rate were assessed every 4 months, and data were analyzed by dividing the patients into three groups by baseline PSA tertiles (0 to 1.3, 1.4 to 3.2, and 3.3 ng/mL or greater) and baseline prostate volume tertiles (14 to 41, 42 to 57, and 58 to 1 50 mL). RESULTS: After the initial placebo effect, a slow deterioration in symptoms over time was observed in the placebo-treated men with a baseline PSA 1.4 ng/mL or greater. However, placebo-treated men in the lowest PSA tertile (less than 1.4 ng/mL) had sustained symptomatic improvement that was not seen in placebo-treated men in the higher tertiles (P<0.001). In all finasteride-treated groups, there was initial improvement followed by maintenance or continued symptom improvement over time (approximately 3 to 3.5 points by the end of 4 years). The differences in symptom score improvement between placebo and finasteride were marginal for men with baseline PSA levels less than 1.4 ng/mL (P = 0.128) but were highly significant for men with PSA levels 1.4 ng/mL or greater (P<0.001). Urinary flow rate results were similar to those observed for symptoms. Analysis of symptom and flow rate data by prostate volume tertiles in a 10% subset of men yielded similar results, namely a deterioration of symptoms and flow rate in the two higher tertiles treated with placebo (greater than 41 mL) and a sustained improvement in all three groups of finasteride-treated patients. CONCLUSIONS: Baseline PSA and prostate volume are good predictors of long-term symptomatic and flow rate changes. Baseline PSA levels of 1.4 ng/mL or greater and enlarged prostate glands predict the best long-term response to finasteride compared with placebo.

Enzyme Inhibitors↗
PubMed1997

Improved detection of recurrent bladder cancer using the Bard BTA stat Test.

OBJECTIVES: To evaluate the BTA stat Test in the detection of recurrent bladder cancer. METHODS: Sensitivity and specificity were determined using frozen voided urine samples from patients with recurrent bladder cancer, volunteers, patients with nonurologic conditions, and patients with a history of bladder cancer but free of disease. Results of cytology and the original BTA Test were compared with the sensitivity of the BTA stat Test in a large subgroup of the patients with cancer. RESULTS: The BTA stat Test detected 147 (67%) of 220 recurrent cancers. For those urine samples with previous cytologic and BTA Test results available, cytology had a sensitivity of 23%, the BTA Test 44%, and the BTA stat Test 58% for detection of recurrent cancer (P < 0.001, stat versus cytology). The specificity of the BTA stat Test was 72% for benign genitourinary disease and 95% in healthy volunteers. CONCLUSIONS: The BTA stat Test has high sensitivity and is significantly superior to voided urine cytologic analysis in the detection of recurrent bladder cancer.

Aged↗
PubMed1993

Color flow sonographic mapping of intravascular extension of malignant renal tumors.

The purpose of this study was to evaluate the possible role of CDFI in identifying malignant renal tumor thrombus in the renal vein or the IVC. This study involved 24 tumors in 23 patients, including 19 renal cell carcinomas, four Wilms' tumors, and one rhabdoid tumor. CDFI had an overall sensitivity of 95% in predicting combined renal vein and IVC tumor involvement but was more sensitive in the renal vein alone (100%) than in the IVC alone (89%). Specificity of CDFI was nearly equal for both renal vein and IVC thrombus at 85%. The main limitation of CDFI was its inability to predict venous tumor extension in large or bulky tumors. We would recommend CDFI as a method of detecting renal vein or IVC thrombus at the time of initial real-time sonographic detection of tumor. When CT or MR imaging is equivocal, CDFI may be used to predict tumor thrombus in the renal vein or IVC.

Adult↗
PubMed1990

Neobladders: clinical management and considerations for patients receiving chemotherapy.

Continent catheterizable urinary reservoirs and orthotopic bladder substitutes are complex surgical endeavors. The goal is preservation of renal function, reliable continence, and storage intervals acceptable to the patient. The construction requires familiarity with bowel segments and may increase operative time for radical cystoprostatectomy by 30% to 50%. Patients with continent reservoirs have improved body image, work habits, and sexual and interpersonal relationships. Experience with patients with dysfunctional neurogenic bladders previously converted to Bricker urostomies now undiverted to continent reservoirs indicates an overall increase in physical activity and self-satisfaction. These patients are tolerant of reoperations to maintain independence from wet urostomies. Undoubtedly, the expectations of bladder cancer patients will differ from those of young adults with neurogenic bladder, but we have found that when all options are presented patients will seek out therapy that least alters their body image. Therefore, patient selection becomes an important factor in determining the success of continent reservoirs. Patients must have the dexterity and motivation to catheterize the urinary reservoir, irrigate for mucus and, in cases of orthotopic bladder replacement to urethra, accept the need for artificial sphincter placement in 30% to 40% of cases. Management of the neo-bladders requires additional consideration of several practical and theoretic points for both the surgeon and medical oncologist: 1. Patients with diffuse carcinoma in situ or transitional cell carcinoma at the bladder neck or prostatic urethra should undergo simultaneous urethrectomy excluding orthotopic bladder replacement. 2. Ten percent to 40% of patients undergoing radical cystoprostatectomy for transitional cell cancer will have concomitant underdiagnosed adenocarcinoma of the prostate; patient prognosis will remain defined by the stage and grade of the bladder cancer. 3. Patients may have a tendency toward dehydration because of increased loss of free water through bowel transit. 4. Absorption of chloride, ammonium, and hydrogen ions may cause hyperchloremic acidosis, especially in face of imparied renal function. 5. Because of the potential for drug absorption across reservoir mucosa, patients receiving chemotherapy may require Foley catheterization with irrigation in addition to intravenous hydration. 6. Creatinine clearance is unsuitable for studying the renal function of reservoir patients because urine passes through the intestinal segment where creatinine is absorbed; glomerular filtration is better estimated by nuclear scanning with the reservoir emptied. 7. Most reservoirs will remain colonized with bacteria. 8. Antibiotic prophylaxis for the patient with temporary impairment of immune function during chemotherapy may be necessary. 9. Mucus may entrap bacteria serving as a host defense; its production may diminish with time from construction. All patients should be capable of performing reservoir irrigations to manage mucus obstruction.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Agents↗
PubMed1988

Characterization of urinary keratin number 18 using a new assay.

The levels of the low-molecular weight keratin 18 appearing in the voided urine of 130 healthy volunteers was studied using a new immunoradiometric assay for keratin 18 (IRMAK-18). Keratin 18 was detected in 79 urines with an average level of 2.5 +/- 4.7 ng./ml. The assay does not detect complex epidermal keratins or non-keratin intermediate filaments. Only 50% of the purified keratin added to urine could be recovered. The recovered keratin had the same molecular weight as the input molecules, implying that substances in the urine physically inhibited the assay rather than destroyed the keratin. The independent variables of cell count, dead cells, and protein concentration were not found to be important in evaluating the results. However, the urine concentration, as measured by creatinine, might be an important consideration for assessing the levels of keratin detected.

Adult↗
PubMed1988

Quantitative analysis of keratin 18 in the urine of patients with bladder cancer.

The level of urinary keratin was compared in patients with and without bladder cancer using the newly developed IRMAK-18. Patients with bladder cancer had higher levels of keratin (74.6 +/- 146.9) than normals (2.5 +/- 4.7). When the upper limit of normal was set at keratin less than 20 ng./ml., the test was highly specific (98%) for bladder cancer but had a sensitivity of only 46%. Adjusting to keratin less than 10 ng./ml. increased the sensitivity to 57% but decreased the specificity to 91%. Elevated keratins were associated with stage and grade, aneuploidy and disease history. The IRMAK-18 assay for keratin may be useful for monitoring the clinical progress of some patients.

Adult↗
PubMed1988

The limited usefulness of external beam radiotherapy in the control of superficial bladder cancer.

Thirty-seven patients with superficial bladder cancer (Ta, T1) who failed local control were treated with external beam radiotherapy: 22 received full dose radiotherapy without interval cystoscopic monitoring and 15 followed a protocol in an attempt to select a subgroup of radiosensitive tumours. Both the unselected and protocol treated patients demonstrated the limited usefulness of external beam radiotherapy in the treatment of superficial bladder cancer.

Dose-Response Relationship, Radiation↗
PubMed1985

The influence of cytoreductive surgery on the response to chemotherapy of a rat renal cancer.

The potential ability of cytoreductive surgery to increase the effectiveness of chemotherapy (vindesine) was tested utilizing male Wistar Lewis rats transplanted simultaneously with intraperitoneal and flank implants of a spontaneously arising renal adenocarcinoma. Cytoreduction was accomplished in some animals by removing the flank tumor 5-7 weeks following implantation; all animals received vindesine (IP injection of 0.5 mg/kg on two successive weeks). While vindesine reduced tumor growth, in no case did the addition of cytoreductive surgery enhance the effect of chemotherapy. The addition of cytoreductive surgery to marginally effective chemotherapy was found to be ineffective or even detrimental.

Animals↗
PubMed1985

Primary transitional cell carcinoma of prostatic periurethral ducts.

Primary transitional cell carcinoma of the prostatic periurethral ducts is a distinct histologic variety of prostate carcinoma. Traditional methods of therapy for adenocarcinoma of the prostate are ineffective. A review of the literature suggests that appropriate radical surgical therapy should be considered for early control of this disease.

Adenocarcinoma↗
PubMed1984

Comparison of histologic and flow cytometric evaluation of cyclophosphamide-induced testicular damage.

This study evaluates the ability of DNA histograms obtained by flow cytometry to detect and quantify reversible alterations in spermatogenesis induced by cyclophosphamide, a known inhibitor of spermatogenesis. Evaluation of per cent of cells in each of the haploid (lc), diploid (2c), and tetraploid peaks (4c) as determined by flow cytometry in treated and control Balb/C mice over a six-week period, and comparison with routine histologic evaluation have led us to conclude that DNA histogram evaluation is a rapid and accurate means of identifying testicular damage and recovery. This technique may be useful in sequential monitoring of the effects of malignancy and/or treatments applied on spermatogenesis in young men.

Animals↗
PubMed1984

Testicular torsion: temporal considerations.

Unilateral testicular torsion may result in contralateral testicular alterations which appear immunologically mediated and avoidable by immunosuppression or orchiectomy of the twisted testicle within 24 hours. This study was instituted to assess three temporal aspects of these observations: (1) The effect of prepubertal torsion was studied. It was found that after prepubertal torsion, the contralateral testicle underwent normal development. (2) The duration of torsion necessary to result in contralateral testicular alterations in adult rats was studied. Deoxyribonucleic acid (DNA) histograms were utilized to assess disturbed spermatogenesis. After greater than 8 hours of torsion, detorsion offered no protection to the contralateral testicle. Marked alterations occurred in DNA histograms of 60% to 80% of the animals. (3) The duration and significance of these alterations were assessed. The alterations persisted in the contralateral testis 6 months, and the fertility rates were significantly lower than for control animals.

Animals↗
PubMed1984

Familial idiopathic priapism: a case report.

Idiopathic priapism is a diagnosis made by exclusion of identifiable etiologies and is found in 43 to 58 per cent of the cases. We report a case of priapism that was investigated exhaustively and classified as idiopathic. In addition, 3 brothers also reported similar episodes of priapism. Although a common abnormality exists presumably, we were unable to define an etiology. Therefore, this case was designated as familial idiopathic priapism.

Adult↗
PubMed1984

Removal of renal cell carcinoma extending into the right atrium using cardiopulmonary bypass, profound hypothermia and circulatory arrest.

An operation is indicated in patients with renal cancer growing into the inferior vena cava and right atrium because the tumor in the right atrium presents an immediate risk to life if acute obstruction of the tricuspid valve or pulmonary emboli occur. In addition, patients treated by such an operation may enjoy reasonable survivals. We believe that the best technique for operative management includes cardiopulmonary bypass, profound hypothermia and total circulatory arrest. Although perhaps seemingly complicated, it is the only technique that simplifies the operative dissection and permits as complete removal as possible of the cancer without the risk of tumor embolization or uncontrollable hemorrhage.

Adenocarcinoma↗
PubMed1984

Nonsurgical management of patients with stage D1 adenocarcinoma of prostate: risks vs benefits.

Within two years of diagnosis, 50 per cent of patients with Stage D1 prostatic adenocarcinoma will have clinically overt metastatic disease. Any purely local therapy (e.g., radical prostatectomy) appears to offer little in terms of the risk:benefit ratio. However, some form of local therapy is appropriate, since the untreated primary may continue to act as a source of metastases. 125I implantation with concomitant systemic therapy is an excellent therapeutic option for the majority of these patients. If one accepts the premise that local therapy is of limited value in metastatic disease, systemic treatment at the time of initial diagnosis should be considered. According to the data presented by the Mayo Clinic Group, immediate orchiectomy may be the best form of therapy. An alternative to orchiectomy is estrogen therapy or the more recently introduced GnRH analogues. Finally, the issue of identifiable tumor characteristics is addressed. The course of treatment may well be influenced by the identification of biologically aggressive tumors, using indicators such as elevated acid phosphatase. It is still undetermined whether stereology or flow cytometric analysis will further identify slower growing tumors from the more aggressive ones.

Adenocarcinoma↗
PubMed1983

Keyhole-limpet haemocyanin (KLH) immunotherapy of murine transitional cell carcinoma.

The antigenicity of transitional cell carcinoma of the bladder has stimulated the search for effective immunotherapeutic agents in the treatment of this disease. Non-specific immunotherapy with local (intravesical/intralesional) and systemic Keyhole Limpet Haemocyanin (KLH) in a FANFT induced murine bladder tumor model was studied. Results showed no difference between control or treated groups in either tumor growth or animal survival.

Animals↗
PubMed1983

Adjuvant chemotherapy for stage D1 adenocarcinoma of prostate.

In a series of 112 patients undergoing pelvic lymphadenectomy for clinically localized prostate cancer, 37 were found to have pelvic lymph node metastases. After prostatic irradiation, these 37 patients were divided into groups receiving adjunctive chemotherapy versus no additional treatment. The patients were followed for a period ranging from twelve to sixty-five months for evidence of disease progression. Of the 12 patients administered chemotherapy, disease progression was documented in 4 (average time to progression was fifteen months). In contrast, of the 25 patients receiving no additional treatment, 12 exhibited evidence of gross metastatic disease within an average interval of 11.6 months. One death has been recorded in the chemotherapy group at twenty-nine months after diagnosis; 4 deaths have occurred in patients receiving no systemic therapy (average time to death was eighteen months).

Adenocarcinoma↗