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Biomedical subjects

S M Marcus

Publications and source records attributed to S M Marcus.

At least 19 recordsLinked to original sources
PubMed1999

Adherence by African American men to prostate cancer education and early detection.

BACKGROUND: This study was designed to identify factors that predict adherence by African American men to prostate cancer education and early detection. METHODS: In the spring of 1995, the authors identified 548 African American men who were patients at the University Health Services of the University of Chicago, were ages 40-70 years, and did not have a personal history of prostate cancer. Baseline telephone survey data were collected from 413 men (75%). Participants were randomly assigned to either a minimal or an enhanced intervention group. Men in the former group were mailed a letter and a reminder that invited them to a urology clinic for prostate cancer education and early detection. Men in the enhanced intervention group were sent the same correspondence and were also given print material and telephone contacts, which were tailored to each recipient. RESULTS: Adherence was significantly higher (OR = 2.6, CI: 1.7-3.9) in the enhanced intervention group than in the minimal intervention group (51% and 29%, respectively). Men who were age 50 years or older (OR = 1.7, CI: 1.1-2.8), were married (OR = 1.8, CI: 1.2-2.9), believed that prostate cancer early detection examination should be performed in the absence of symptoms (OR = 2.3, CI: 1.3-4.0), and self-reported an intention to have an early detection examination (OR = 1.9, CI: 1.2-2.9) were also more likely to adhere. CONCLUSIONS: A tailored behavioral intervention can influence adherence to prostate cancer early detection among African American men. Individual background and cognitive and psychosocial characteristics may also affect behavior. Future studies should assess the impact of this type of intervention on cognitive and psychologic correlates of decision-making and behavior along the continuum of prostate cancer care. [See editorial on pages 1-2, this issue.]

Adult↗
PubMed1998

Treatment of superficial basal cell carcinoma and squamous cell carcinoma in situ with a high-energy pulsed carbon dioxide laser.

BACKGROUND: High-energy pulsed carbon dioxide (CO2) lasers have been used extensively to resurface wrinkled and photodamaged skin with a low risk of scarring. Results of histological studies demonstrate precise ablation depths in treated skin with minimal thermal damage to underlying tissue. Our objective was to determine if a pulsed CO2 laser could effectively ablate superficial malignant cutaneous neoplasms (superficial multifocal basal cell carcinoma [BCC] and squamous cell carcinoma [SCC] in situ). OBSERVATIONS: Thirty superficial neoplasms (17 BCCs and 13 SCCs) and their surrounding 3-mm margins were treated with either 2 or 3 passes of a pulsed CO2 laser (500 mJ, 2-4 W) using a 3-mm collimated handpiece. The treated areas were subsequently excised and evaluated histologically by serial sectioning at 5-micron intervals for residual tumor at the deep and lateral margins. Average patient age was greater for those with SCCs than for those with BCCs (76.5 vs 56.7 years; P = .001). The average tumor thickness of SCC in situ was significantly greater than that of superficial BCC (0.57 vs 0.34 mm; P = .01). All (9 of 9 patients) BCCs were completely ablated with 3 passes, and residual tumor in the deep margins was seen in 5 of 8 patients treated with 2 passes of the pulsed CO2 laser (P = .005). Incomplete vaporization of the SCC depth was seen in 3 of 7 patients treated with 3 passes and in 2 of 6 patients treated with 2 passes. Those SCCs incompletely treated were significantly thicker than those completely ablated (0.65 vs 0.41 mm; P = .01). Positive lateral margins were seen in 1 BCC and 3 SCC specimens. CONCLUSIONS: Pulsed CO2 laser treatment can be effective in ablating superficial BCC. Treatment of the neoplasm and a minimum of 4-mm margins with 3 passes (500 mJ, 2-4 W) is recommended for complete vaporization using this laser system. Because 3 passes did not completely ablate all SCC in situ, use of this modality alone is not recommended for treatment of thick or keratotic lesions. No direct comparison of efficacy can be made with other destructive modalities that have not been evaluated with comparably sensitive histological techniques. Further study is needed to establish any cosmetic advantage of pulsed CO2 lasers over other destructive modalities for treatment of superficial malignant neoplasms and long-term cure rates.

Adult↗
PubMed1998

Does surgical approach affect the incidence of inflatable penile prosthesis infection?

OBJECTIVES: To review retrospectively the rate of infection in 380 consecutive organically impotent men implanted with a Mentor Alpha I inflatable penile prosthesis, stratified by surgical approach (scrotal or infrapubic). METHODS: Data were obtained from review of medical records. One hundred percent of cases were available for a minimum postoperative follow-up of 6 months. RESULTS: Twenty patients had a prior penile prosthetic operation and were excluded, leaving 360 primary implants for review. Overall, 6 patients (1.7%) developed periprosthetic infection. Four of these 6 patients were diabetic. Four of 139 infrapubic cases (2.9%) and 2 of 221 scrotal cases (0.9%) developed periprosthetic infection. This difference was not statistically significant (P = 0.15). Equal proportions of the infrapubic (39.6%) and scrotal cases (40.3%) were diabetic patients. The infection rate in patients with and without diabetes was 4 of 144 (2.8%) and 2 of 216 (0.9%), respectively. This difference was not statistically significant (P = 0.18). CONCLUSIONS: This study indicates that there is no statistically significant difference in the infection rate when the scrotal and infrapubic approaches to inflatable penile prosthesis insertion are compared.

Adult↗
PubMed1998

Should we adjust for covariates in nonlinear regression analyses of randomized trials?

The analyses of the primary objectives of randomized clinical trials often are not adjusted for covariates, except possibly for stratification variables. For analyses with linear models, adjustment is a precision issue only. We review the literature regarding logistic and Cox (proportional hazards) regression models. For these nonlinear analyses, omitting covariates from the analysis of randomized trials leads to a loss of efficiency as well as a change in the treatment effect being estimated. We recommend that the primary analyses adjust for important prognostic covariates in order to come as close as possible to the clinically most relevant subject-specific measure of treatment effect. Additional benefits would be an increase in efficiency of tests for no treatment effect and improved external validity. The latter is particularly relevant to meta-analyses.

Bias↗
PubMed1997

Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in the year 2000?

BACKGROUND: There has been a dramatic increase in the diagnosis of primary lymphoma of the brain during the past decade, prompting speculation that it may become the most frequently diagnosed tumor of the central nervous system by the year 2000. The current analysis drew from the updated Surveillance, Epidemiology, and End Results (SEER) database to establish projections for the incidence of brain lymphoma. The study also attempted to determine whether increased incidence rates are attributable to the increasing incidence of acquired immunodeficiency syndrome (AIDS) and whether there is gender or age dependence. METHODS: Primary brain lymphoma case data and population census data for calculating incidence rates for the period 1973-1992 were obtained from the SEER program. In an attempt to determine the contribution of AIDS to the increasing incidence of the disease, separate analyses were performed with and without the inclusion of never married men (a high risk group for the development of AIDS). Separate analyses were also performed within the San Francisco SEER registry because a higher incidence of AIDS-related cancers has been documented in this geographic region. Finally, a piece-wise linear model (using one regression line until 1982 and another regression line from 1982 onward) was used to predict incidence rates for the year 2000. RESULTS: During the period of study, the incidence rates of brain lymphoma increased more than 10-fold, from 2.5 cases per 10 million population in 1973 to 30 in 1991-1992 (chi-square trend, 17.76: P < 0.0001). These increased incidence rates were independent of age and gender. The incidence rates of primary brain lymphoma did not differ significantly when comparing the San Francisco registry with the remainder of the SEER database for any comparison that excluded never married males. However, when the analysis included never married males, a statistically significantly higher incidence rate of primary central nervous system lymphoma was observed among San Franciscans compared with age-matched controls from the remainder of the SEER database. In the year 2000, the projected incidence rate of brain lymphoma would reach 51.1 per 10 million population and 118.2 per 10 million population, with never married men excluded and included, respectively. These incidence rates would still fall below the corresponding projections for glioma and glioblastoma multiforme. CONCLUSIONS: There continues to be a significantly increasing incidence of brain lymphoma that is independent of age and gender. Indirect evidence implicates the AIDS epidemic as a contributor to this trend. Although the rate of increase in the incidence of non-Hodgkin's lymphoma of the brain is higher than for peripheral non-Hodgkin's lymphoma and other glial tumors, brain lymphoma is not projected to surpass glial tumors as the most frequently diagnosed intracranial malignancy by the year 2000.

Age Factors↗
PubMed1997

Assessing non-consent bias with parallel randomized and nonrandomized clinical trials.

In some randomized clinical trials, a large proportion of patients eligible for randomization may withhold consent to be randomized. When the subjects in the randomized trial differ from the eligible population with respect to characteristics that are associated with the magnitude of the treatment effect, there may be non-consent bias, i.e., the treatment effect for those in the randomized trial may not reflect the treatment effect for the eligible population. In response to this problem, some investigators have conducted, in addition to the randomized trial, a separate nonrandomized but otherwise identical trial consisting of those patients who are eligible for randomization, but instead choose their own treatment. Observed baseline covariate data can be used to adjust for differences between the randomized population and the eligible population when estimating the treatment effect for the eligible population. After adjusting, different outcomes for the randomized versus nonrandomized treated groups and/or the randomized versus nonrandomized control groups reflect the presence of hidden non-consent bias resulting from differences between the trial population and the eligible population with respect to unobserved covariates. A sensitivity analysis can display how hidden non-consent bias can account for an imbalance in the treatment groups with respect to an unobserved covariate. A parallel randomized and nonrandomized trial which compares adenoidectomy versus medical treatment for children with recurrent otitis media [Paradise et al. Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. J Am Med Assoc 1990; 263: 2066-2073] is used as an illustration.

Adenoidectomy↗
PubMed1996

Phenylpropanolamine and associated myocardial injury.

We report the cases of two patients without significant past medical history in whom developed myocardial injury attributed to the use of anorectic agents containing phenylpropanolamine. The pharmacologic properties of phenylpropanolamine and the current management of common adverse reactions to phenylpropanolamine are briefly reviewed.

Adolescent↗
PubMed1992

Use of succimer.

Explore the source record for details and available documents.

Drug Industry↗
PubMed1986

Adjunctive therapy of phenytoin overdose--a case report using plasmaphoresis.

Phenytoin is widely used as an anticonvulsant. In overdose situations phenytoin demonstrates saturable metabolic kinetics making treatment difficult. Phenytoin's high protein binding makes it a poor candidate for hemodialysis or hemoperfusion. We report a case of an attempted suicide in which plasmaphoresis was used in an attempt to lower plasma levels and reduce toxicity. A review of the use of plasmaphoresis in acute intoxications is included.

Adult↗
PubMed1985

Oven-cleaner pads: new risk for corrosive injury.

Over a six-month period, the New Jersey Poison Information System received 61 calls related to exposures to alkaline corrosives. Seven of these calls related to a new oven-cleaner product, oven-cleaner pads. These pads are sealed in a protective plastic wrap and contain lye in excess of 5%. Use of these products requires careful opening of the seal and caution in application. Five of the callers sustained injuries from their exposure, and three of these sustained burns, one in the oral cavity and one in the eye. None suffered permanent sequelae, but the potential for such is considerable. The method of application, concentration of base, and prolonged exposure to a widely covered area may make this product particularly hazardous.

Adult↗