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Biomedical subjects

S Levitt

Publications and source records attributed to S Levitt.

At least 19 recordsLinked to original sources
PubMed2006

High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: technical and methodological aspects.

The aim of this study was to focus on certain characteristic problems associated with Iridium-192 high dose-rate brachytherapy (Ir-192 HDR-BT) in combination with external beam radiation therapy (EBRT) in the treatment of patients with localised prostate cancer. Over a period of 16 years, >2,000 patients with prostate cancer have been treated in Sweden with a combination of two fractions of 10 Gy Ir-192 HDR-BT and 50 Gy of fractionated EBRT. Although this treatment is usually well tolerated, there are biological and technical factors to be considered before and during the treatment of the patient to avoid side effects or under-treatment of the target volume. Some of the problems facing the doctors are transducer stability, needle deviation, target definition, target motion, pubic arch interference, concomitant diseases and tolerance doses for different organs at risk. These problems are discussed and possible solutions are presented in this study.

Brachytherapy↗
PubMed2000

Long-term cardiac mortality following radiation therapy for Hodgkin's disease: analysis with the relative seriality model.

PURPOSE: (a) To assess the increased risk of death due to ischemic heart disease (IHD) in a group of patients treated for Hodgkin's disease (HD) with radiation therapy (RT) as the primary treatment. (b) To quantify the dose response of IHD using a biophysical model. MATERIALS AND METHODS: Patient material consisted of 157 patients diagnosed for HD between 1972 and 1985 who received RT as the primary treatment at Radiumhemmet, Karolinska Hospital. The general population formed the control group. The RT treatments were reconstructed based on the individual treatment data and simulator films. Individual clinical and dosimetrical data were analyzed with the relative seriality model. The material was also analyzed grouping the material according to dose-volume constraints. RESULTS: Of the 157 patients, 13 (8.3%) died due to IHD. The standardized mortality ratio (SMR) was 5.0 (95% CI, 2.7-8.6). Analysis of dose-volume histograms (DVH) showed an increasing risk with increasing dose to a larger volume fraction. The observed individual clinical complication data could not be modeled unambiguously. The group analysis resulted in the dose-response parameters: D(50)=71 Gy, gamma=0.96 and s=1.0. CONCLUSIONS: A significantly increased risk of death due to IHD following RT for HD was found. The risk was found to increase with higher dose and larger volume fraction irradiated.

Adolescent↗
PubMed1998

Rectal cancer following colectomy and ileorectal anastomosis for familial adenomatous polyposis.

BACKGROUND: Familial adenomatous polyposis (FAP) has historically been treated by colectomy and ileorectal anastomosis (IRA). Preservation of the rectum allows the subsequent development of cancer in the rectum. The risk of rectal cancer following ileorectal anastomosis in the Australian population has not been published to date. METHODS: An audit of the Familial Adenomatous Polyposis Registry of Western Australia was undertaken to assess patients who had undergone colectomy and ileorectal anastomosis. Fifty-five patients ranging in age from 13 to 65 years were studied. RESULTS: Seven patients (13%) developed cancer of the rectum with a median follow-up of 10 years (range: 1-31 years). Median interval to diagnosis of carcinoma of the rectum following colectomy and IRA was 10 years. All patients who developed cancer in the retained rectum had rectal polyps. Colon cancer was present in the initial colectomy specimen in 13 patients (of these, five patients developed rectal cancer). Flat polyps were noted in five patients. Four patients with flat polyps developed cancer of the rectum. CONCLUSIONS: Total colectomy and IRA should be considered as part 1 of a staged procedure in the patient with FAP. With the exception of the patient with no evidence of rectal polyps, completion proctectomy should be undertaken within 10 years of the initial colectomy.

Adenomatous Polyposis Coli↗
PubMed1996

Is contralateral exploration of the kidney necessary in patients with Wilms tumor?

PURPOSE: Surgical exploration of the contralateral kidney in patients with Wilms tumor is standard practice. The introduction of modern imaging techniques (ultrasound, computerized tomography and magnetic resonance imaging) in place of excretory urography has led to a more accurate definition of intrarenal pathology. Is contralateral kidney exploration still necessary in patients with Wilms tumor? MATERIALS AND METHODS: We reviewed the records of 75 patients from 3 medical centers who were evaluated and treated for Wilms tumor in the last 14 years. All children underwent preoperative excretory urography, computerized tomography, ultrasound and/or magnetic resonance imaging. RESULTS: Seven bilateral Wilms tumors were diagnosed preoperatively and confirmed surgically, whereas extensive operative exploration of the contralateral kidney in the other 69 patients revealed no additional pathological condition. This concurred with preoperative radiological findings with 100% sensitivity and specificity. Furthermore, 1 month to 12 years of followup (mean 4.3 years) revealed no tumor in the contralateral kidney. The major postoperative complication was small bowel obstruction in 5 patients 15 to 180 days (mean 77.2) after explorative laparotomy. CONCLUSIONS: In all patients preoperative radiological investigation was accurate in excluding bilaterality. With modern imaging techniques and effective chemotherapy extensive contralateral renal exploration may no longer be mandatory for managing Wilms tumor.

Adolescent↗
PubMed1996

Department of Transportation 1995 regulations for alcohol testing: policy changes and compliance issues.

1. The Omnibus Employees Testing Act of 1991 (part of the Department of Transportation and Related Agencies Act of 1992) mandated rules and regulations on drug and alcohol testing for employees in "safety sensitive" positions. 2. Employees in "safety sensitive" positions who misuse alcohol jeopardize themselves and others. As a noninvasive, relatively quick method for testing alcohol misuse. Evidential Breath Testing allows an employer to test, and if the results are positive, to immediately remove an employee from a "safety sensitive" position. 3. Occupational health nurses play an important role in the commercial drivers' license screening process; therefore, they can assist employers' understanding of and compliance with these federally mandated regulations.

Alcoholism↗
PubMed1995

Genetic counselling and gene mutation analysis in familial adenomatous polyposis in Western Australia.

OBJECTIVE: To assess the provision of accurate pre-symptomatic genetic testing with DNA analysis and appropriate counselling for individuals and families known to be at high risk of developing familial adenomatous polyposis coli (FAP). PATIENTS AND METHODS: Thirty-one families with clinically and pathologically documented FAP were ascertained from the Western Australian Polyposis Registry. DNA was collected from over 200 individuals in these families to establish their genetic risk status for FAP, either by direct mutation analysis, or by linkage analysis. Individuals undergoing DNA testing were given intensive psychosocial support and counselling. RESULTS: In 19 families DNA-based counselling could not be offered because either the adenomatous polyposis coli (APC) gene mutation could not be detected or there were insufficient family members for linkage analysis. Gene testing yielded mutations of the APC gene in 87 individuals from 12 families; by gene tracking (or linkage analysis) in three families and by mutation analysis in the remaining nine (four of which had only one affected individual). DNA results conformed with a definite clinicopathological diagnosis in 27 FAP patients and, of the remaining 60 high-risk subjects tested, 14 had inherited the mutated APC gene. CONCLUSIONS: DNA analysis allowed accurate genetic counselling for 12 of 31 families affected by FAP, thus improving the medical and personal management in asymptomatic people who would otherwise be subjected to the uncertainty of long term surveillance and repeated colonic examinations. In future a superior biomolecular approach to gene mutation analysis, such as the protein truncation test, will facilitate management for most FAP individuals and families.

Adenomatous Polyposis Coli↗
PubMed1993

Genitourinary malformations associated with agenesis of the corpus callosum.

Agenesis of the corpus callosum is an infrequent congenital anomaly that occurs in partial or complete forms, and is frequently associated with other craniofacial and skeletal abnormalities. An increased association with genitourinary abnormalities has not been previously defined. We reviewed the records of 22 boys and 11 girls with agenesis of the corpus callosum. Of the patients 18 had complete radiological or necroscopic evaluation and 15 had physical examinations as the sole means of evaluation. Renal anomalies were the most frequent genitourinary abnormalities identified in these children, although ureteral, genital and bladder abnormalities were also encountered. There was an exceptionally high incidence of undescended testes (23%), approximately 20-fold greater than the frequency in the normal population, possibly resulting from hypothalamic insufficiency associated with midline cranial defects. We suggest, therefore, that all patients with agenesis of the corpus callosum should be thoroughly evaluated with bladder and renal ultrasound studies to rule out any genitourinary abnormalities. Male patients with agenesis of the corpus callosum and undescended testes should undergo hypothalamic/pituitary axis testing.

Abnormalities, Multiple↗
PubMed1991

Nd:YAG laser therapy for colorectal polyps.

Adenomatous polyps are the precursors of most colonic cancers and should be removed and recovered for histological analysis. Removal by endoscopic laser photocoagulation offers a safe alternative to surgery. We report our experience of managing selected colonic polyps by neodymium:yttrium aluminum garnet (Nd:YAG) laser.

Adolescent↗
PubMed1991

Duodenal necrosis and intramural haematoma complicating acute pancreatitis.

Although segmental bowel necrosis is a recognized complication of pancreatitis, the duodenum is rarely involved. We report a unique case of acute duodenal obstruction characterized by transmural necrosis and intramural duodenal haematoma in a young man with acute alcohol-induced pancreatitis. The patient recovered following pancreaticoduodenectomy.

Acute Disease↗
PubMed1990

Juvenile polyposis: a premalignant condition?

This is the case report of a 20 year old man with juvenile polyposis who developed adenocarcinoma of the duodenum. Patients with juvenile polyposis and their families have an increased risk of developing gastrointestinal malignancies. Such patients require endoscopic monitoring.

Adenocarcinoma↗
PubMed1989

The Western Australian Familial Polyposis Registry.

The Western Australian Familial Polyposis Registry was established in 1985 by the Cancer Foundation of Western Australia in conjunction with the Health Department of Western Australia. The primary aim of the Registry is the prevention of colorectal cancer in a group of persons at high risk of the disease. Families are notified to the Registry by medical practitioners throughout the State and, at the request of family members and medical practitioners, the project officer for the Registry will arrange for the collection of data, counselling and reminders for follow-up examinations for both cases and family members who are at risk of developing the disease. A total of 44 families with familial adenomatous polyposis is known to the Registry. The crude incidence of polyposis in Western Australia was 0.24 cases per 100,000 persons over the three-year period 1986-1988. The prevalence of the condition in 1988 was 2.59 cases per 100,000 persons. There are 188 family members in Western Australia who are at a 50% risk of developing familial adenomatous polyposis. Registry data indicate that regular follow-up and early treatment reduce the risk of the development of bowel cancer.

Adenomatous Polyposis Coli↗
PubMed1989

Significance of epididymal and ductal anomalies associated with testicular maldescent.

Epididymal abnormalities have long been found in conjunction with cryptorchid testicles. The aim of this study was to document the different types of epididymal and ductal anomalies in relation to the position of the cryptorchid testis and to determine their clinical significance. Exploration was performed on 187 cryptorchid testes in 174 boys. The position of the testis and the epididymal and ductal anomalies were documented at operation. A biopsy was taken from the testis or atretic spermatic cord structures for light microscopy. Epididymal, ductal and/or testicular anomalies were detected in 43 per cent of the 187 testes, including anomalies of ductal fusion, anomalies of ductal suspension and anomalies associated with absent or vanishing testes. Biopsy of the testes with severe anomalies of ductal fusion showed preservation of germ cells in 69 per cent and diminished germ cells in 31 per cent. The higher the arrest of testicular descent, the more grossly abnormal was the associated ductal system. Early successful orchiopexy alone may not ensure subsequent fertility despite the presence of normal germ cells.

Biopsy↗
PubMed1989

Needle biopsy in the diagnosis of testicular leukemia in children.

Aggressive chemotherapy in patients with acute lymphoblastic leukemia has resulted in a marked upsurge in patient survival. In the course of their management, testicular biopsy and rebiopsy have an important role. We evaluated the histological findings in 50 sets of open wedge and simultaneous needle core biopsy specimens from 44 testes of children with acute lymphoblastic leukemia to determine the accuracy of the needle biopsy technique in the evaluation of testis involvement in acute lymphoblastic leukemia. We conclude that needle biopsy of the testis in acute lymphoblastic leukemia is highly accurate and correlates well with the conventional open wedge biopsy, and it may have a role in the management of children with acute lymphoblastic leukemia.

Biopsy, Needle↗
PubMed1989

The changing role of radiation therapy in the treatment of primary breast cancer.

The role of radiation in the management of breast cancer has seen extraordinary change in the past 15 years. The primary treatment of early breast cancer once required mastectomy. Today, a local tumor excision followed by postoperative radiation is an established alternative of equal efficacy. Postoperative chest wall and/or lymphatic irradiation was once nearly routine following mastectomy; later, as adjuvant chemotherapy came into widespread use, its usage declined markedly. Today however, evidence is mounting that the addition of postoperative radiation to adjuvant chemotherapy and surgery can improve local-regional control and survival in selected subsets of these patients. In unresectable breast cancer, radiation was once the primary modality of treatment. Today it is part of a combined modality approach attempting to reduce these patients' high rates of both distant and local-regional failure.

Antineoplastic Agents↗
PubMed1988

The dilated urinary tract in children. Prospective analysis with correlation of radiological, isotope, pressure perfusion and surgical findings.

Moderate and even severe dilatation of the urinary tract in the absence of vesicoureteric reflux may remain stable or show spontaneous resolution. Two such cases are described. Twenty-five children with dilated urinary systems were studied to correlate the radiological, isotope, pressure perfusion and surgical findings. A positive Whitaker test correlated well with the surgical findings and post-operative improvement in renal function in all patients with pelviureteric junction (PUJ) and vesicoureteric junction (VUJ) obstruction. High flow rates of 8.6 and 12 ml are required even in neonates and infants in order to demonstrate obstruction by Whitaker testing.

Adolescent↗
PubMed1988

Radiation therapy as adjuvant treatment after radical prostatectomy.

Between 1977 and 1984, adjuvant radiation therapy was administered after radical prostatectomy to 71 patients at high risk for recurrence of carcinoma of the prostate. In 35 patients, tumor remained at the surgical margin (stage C2 disease) and/or the disease had invaded the seminal vesicles (stage C3). Thirty-six patients had microscopic metastases in the pelvic lymph nodes (stage D1a). Radiation therapy was administered only after full recovery from surgery, which included full recovery of continence. The average period between surgery and initiation of radiation therapy was 3 months. Serious or long-term complications attributable to irradiation occurred in 7% of the patients. Tumor recurred locally in only 2 patients. Five-year actuarial survival, disease-related survival, and disease-free survival for patients with stage C2 and C3 disease were 86%, 96%, and 80%, respectively. These survival values for patients with stage D1a disease were 74%, 90%, and 69%, respectively. Our results suggest a greater therapeutic benefit from radical prostatectomy and adjuvant radiation therapy than from radical prostatectomy alone for stages C2 and C3 disease or from radical prostatectomy alone or radiation therapy alone for stage D1a disease; however, the length of follow-up, number of patients treated, and problems in comparing our results with those from historical controls do not allow us to draw firm conclusions about the benefits of this combined therapy. Controlled, randomized studies clearly are required. The serum levels of prostate-specific antigen, but not prostatic acid phosphatase, were invariably elevated in patients at the time of clinical detection of disease recurrence and predicted recurrence up to 4 years before the event.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1987

Xanthogranulomatous pyelonephritis in children.

We report on a child with xanthogranulomatous pyelonephritis--an uncommon entity in children. A review of the literature revealed that in only 18 per cent was the diagnosis made correctly preoperatively. In children the disease is of a focal nature rather than a diffuse one, suggesting that possibly radical surgery would be less necessary for adequate treatment.

Child, Preschool↗