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Biomedical subjects

S H Stokes

Publications and source records attributed to S H Stokes.

15 recordsLinked to original sources
PubMed2000

Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation.

PURPOSE: This retrospective study compares the long-term biochemical disease-free survival for patients undergoing radical prostatectomy, transperineal ultrasound-guided (125)Iodine implantation, or external beam irradiation alone in a tertiary referral community-based hospital. METHODS AND MATERIALS: Five hundred forty patients were available for evaluation, which included: external beam, 132; (125)I, 186; and radical prostatectomy, 222. For the 318 patients referred to the Department of Radiation Oncology, those with T3 disease underwent external beam irradiation while patients with T1 or T2 underwent (125) 0.2 ng/mL or if they had three consecutive increases in their PSA or an increase in their postoperative PSA warranting intervention with androgen ablation or external beam irradiation to the pelvis. RESULTS: Patients were stratified by pretreatment risk groups predicting for post-treatment PSA recurrence. Patients were considered to be at a low or intermediate risk for recurrence if their clinical stage was T1c, T2a, T2b, pretreatment PSA level was </= 20 or their biopsy. Gleason score was </= 6, Patients were considered to be at high risk for failure if they were clinically stage T2c, T3, PSA at diagnosis > 20, or Gleason score was >/= 7. For 132 patients undergoing external beam irradiation, 28 of 37 low or intermediate risk obtained a 1 year nadir PSA of < 1 (76%) while 40% of high risk patients obtained nadir < 1. Of 186 patients undergoing (125)I, 112 of 147 low or intermediate risk (76%) obtained a nadir PSA < 1. Twenty of 39 (51%) high risk obtained a nadir PSA < 1. Of the 222 patients undergoing prostatectomy, 83 of 88 (94%) low or intermediate risk had undetectable levels of PSA at 1 year. One hundred seventeen of 134 (86%) were high risk and had undetectable levels of PSA at 1 year. The biochemical disease-free survival for patients with low or intermediate risk at 5 years is approximately 70% with no significant difference between those patients treated with radical prostatectomy, external beam, or (125)I. For those patients with high risk factors for recurrence, there is no significant difference between ultrasound-guided implant or external beam, but there is a significant improvement in biochemical disease-free survival with radical prostatectomy. CONCLUSION: For patients with low or intermediate risk disease, external beam, ultrasound-guided (125)I, or a radical prostatectomy give comparable long-term biochemical disease-free survival. For patients with high risk disease, a radical prostatectomy provides a significantly improved biochemical disease-free survival. Our current protocols utilize androgen ablation in combination with conformal three-dimensional external beam irradiation or androgen ablation in conjunction with external beam irradiation and (103)Pd seed implantation for patients at high risk for extra capsular disease. It is too early to determine if this combination therapy will give results comparable to radical prostatectomy. For patients who obtain a 1 year nadir PSA of < 1, the biochemical disease-free survival is durable with little risk of subsequent recurrence.

Aged↗
PubMed1997

Transperineal ultrasound-guided radioactive seed implantation for organ-confined carcinoma of the prostate.

PURPOSE: This retrospective study was undertaken to: (a) determine the prognostic significance of pretreatment and 1-year nadir serum prostate specific antigen (PSA) levels in organ-confined carcinoma of the prostate treated with ultrasound-guided radioactive 125I seed implantation; (b) determine the factors associated with postimplant morbidity and whether modification of the technique would reduce morbidity; (c) evaluate the local control rate and disease-free survival of patients undergoing seed implantation. METHODS AND MATERIALS: From October 1988 through December 1992, 142 patients with organ-confined adenocarcinoma of the prostate and a Gleason score < or = 7 underwent ultrasound-guided radioactive 125I seed implantation as an alternative to radical prostatectomy. Patients were considered to have persistent or progressive disease if there was evidence of local progression on digital exam, or if there were two consecutive increases in the PSA level. Patients suspected of persistent or progressive disease underwent restaging to include CT scan of the pelvis, bone scan, and ultrasound-guided prostate biopsy. Patients with increasing PSA levels in which active disease could not be confirmed were considered biochemical failures with occult systemic disease and were offered hormone ablation. RESULTS: With 1-6-year follow-up, median 30 months, the relapse patterns were prostate 4 (2.8%), bone 4 (2.8%), rising PSA 16 (11%). Pretreatment PSA level correlated with subsequent recurrence; pretreatment PSA < or = 4 (0), 4.1 to 10 (14%), 10.1 to 20 (21%), 20.1 to 50 (58%). Disease free survival at 2 years was 90% and at 5 years 76%. Nadir PSA (nPSA) at 1 year also correlated with recurrence: nPSA < or = 1 (3%), nPSA 1 < or = 4 (50%), and nPSA > or = 4 (100%). Seed implantation was well tolerated with 31% of patients experiencing RTOG morbidity > or = Grade 2, which typically consisted of transient radiation urethritis, which resolved with conservative measures. Eleven (8%) experienced RTOG morbidity > or = Grade 3. There was no correlation between number of seeds or total millicuries implanted and subsequent morbidity. However, reduction in the periurethral seed intensity reduced > or = Grade 3 morbidity from 11 to 4%. CONCLUSION: Ultrasound-guided radioactive seed implantation provides excellent local control of 97%, with a median 30 month follow-up. Morbidity is comparable to other curative modalities and by modifying Blasko's technique to reduce radioactive seed strength in the periurethral area, significant morbidity is rare. Pretreatment PSA and the nadir PSA at 1 year are important predictors of subsequent disease outcome. With a liberal definition of systemic recurrence as two consecutive increases in PSA levels, the 5-year disease-free survival is 76%.

Aged↗
PubMed1989

Intraluminal irradiation for inoperable obstructing endobronchial carcinoma of the lung.

Between April 1, 1987 and August 31, 1988, 31 patients with inoperable symptomatic obstructing carcinoma of the lung underwent 79 intraluminal irradiation sessions in an effort to re-establish patency of the airway. Palliation was excellent, 74% of the patients had complete relief of atelectasis, while two patients with extensive tracheal disease experienced little objective response. There was little morbidity, other than that associated with bronchoscopy. Overall, survival at 6 months was 55% with 22% of patients at risk for 18 months surviving. This compares favorably with the more complicated technique of laser resection for relieving malignant airway obstruction.

Airway Obstruction↗
PubMed1985

Angiofollicular lymph node hyperplasia (Castleman's disease) associated with vertebral destruction.

A 45-year-old man presented with lower thoracic pain, proteinuria, and destruction of thoracic vertebra from an adjacent unresectable paraspinal mass which, on biopsy, demonstrated angiofollicular lymph node hyperplasia (AFLNH). The patient received 3939 rad in 22 fractions to the mass and associated area of vertebral destruction. The patient is currently asymptomatic without recurrence of pain or progression of neurologic symptoms 5 years after radiotherapy. There has been resolution of the previous proteinuria. Serial computerized tomography scans and x-rays show no change in the paraspinal mass nor resolution of the vertebral destruction adjacent to the mass. A search of the English literature has failed to identify any previous association of AFLNH and bone destruction.

Humans↗
PubMed1984

Stage IV-S neuroblastoma. Results with definitive therapy.

The results of management of 14 patients with Stage IV-S neuroblastoma are reported. The treatment policy, although not consistent over this time span, in general used a combination of radiotherapy and chemotherapy or infrequently one modality alone. Twelve of 14 (86%) survived more than 6 years. One patient, with a solitary mediastinal primary tumor, died of rapidly progressive disease at three months. The other death occurred in a 4.5-year-old presenting with hepatomegaly at diagnosis followed by skeletal dissemination 2.5 years later. Thirteen of the patients were younger than 1 year of age. Of the 11 patients that received radiotherapy, 4 experienced mild asymptomatic scoliosis or kyphoscoliosis at 3 to 12 years after initial therapy. A review of the literature indicates that spontaneous regression in this tumor is very frequent; therefore, it is recommended that for the common presentation of massive hepatomegaly in an infant, close observation is warranted, unless life threatening complications occur. However, initial therapeutic intervention may be indicated in those patients with life threatening presentations. This data did not substantiate the necessity for complete surgical excision of the primary tumor, as has been suggested by others.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Microcomputer based information storage on burned patients.

The paper describes a package of programmes designed to store, retrieve and search simple descriptive data on burn patients. The computer system used is a Commodore Pet 8032 with 8050 disk drive and compatible printer. The programmes also have the ability to produce summary tables of certain patient characteristics either on a yearly or cumulative basis.

Burns↗
PubMed1983

Pathologic fracture after radiation therapy for primary non-Hodgkin's malignant lymphoma of bone.

Between 1963 and 1981, 32 patients with biopsy proven non-Hodgkin's lymphoma involving bone were treated at the Mallinckrodt Institute of Radiology either with radiation alone or in conjunction with chemotherapy. An unexpectedly high rate of fracture at the site of the tumor was observed. Six patients were excluded because they survived less than six months after the completion of radiotherapy or were lost to follow-up within six months. There were 15 appendicular and 17 axial sites treated. Local control was achieved in 30 of 32. There were 10 patients with appendicular lesions of which seven suffered a fracture. Of the seven patients with lesions in a weight bearing bone, six suffered fractures. Twenty-six sites of involvement received less than 5000 rad. Five sites of involvement with diffuse histiocytic lymphoma (DHL) involving the appendicular skeleton received 5000 to 6000 rad. One site with DHL involving the axial skeleton received 5000 rad. Of the six patients receiving high dose, two presented with pathologic fractures of the femur requiring surgical stabilization and the remaining four patients suffered subsequent fractures 7 to 30 months after completion of therapy. Two of these six had local recurrence of disease. It appears that involvement of the appendicular skeleton by lymphoma frequently results in fracture. Doses of 5000 rad or greater do not increase the probability of local control but may contribute to the risk of fracture following radiotherapy.

Adult↗
PubMed1982

Heat inactivation of gamma-glutamyltransferase in homogenates of human kidney.

The properties of gamma-glutamyltransferase in homogenates of human kidney were investigated by measuring its susceptibility to inactivation by heating at 56 degree C. In freshly prepared homogenates, or after short storage at -20 degree C, the enzyme was observed to be relatively heat-stable. However, it could be transformed into a heat-labile form by treatment with thiol compounds or the proteolytic enzymes trypsin and papain. This process was not necessarily accompanied by solubilisation of the enzyme from the particulate fraction of the homogenate. The addition of 1 mmol/1 glutathione during the heating step completely protected the enzyme against heat inactivation in either the relatively heat-stable form or the heat-labile form produced as a result of prior treatment with enzymes or thiol reagent. The observation that glutathione concentrations lower than the apparent Km for glutathione as a substrate fully protect the enzyme against heat inactivation suggests that the enzyme contains a second binding site for glutathione. This second site would be of higher affinity for glutathione than the substrate-binding site but would not itself participate in the enzyme reaction.

Glutathione↗
PubMed1980

Superoxide and inflammation: a mechanism for the anti-inflammatory activity of superoxide dismutase.

Several models of inflammation induced in laboratory animals were markedly inhibited by intravenous administration of the enzyme superoxide dismutase. In most cases, the enzyme required chemical modification to increase its circulating lifetime. In all cases, histological examination of the sites of the potential lesions revealed that treatment with superoxide dismutase prevented the accumulation of inflammatory cells. Experiments in vitro demonstrated the existence of a plasma factor which reacts with superoxide to become a potent chemotactic factor for neutrophils. The factor apparently serves to call increasing numbers of neutrophils to the inflammatory locus in response to the superoxide produced by the first cells to encounter the stimulus.

Animals↗