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Sharon Smith

Publications and source records attributed to Sharon Smith.

15 recordsLinked to original sources
PubMed2006

Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided high dose rate brachytherapy boost.

PURPOSE: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. MATERIALS AND METHODS: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise >35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. RESULTS: Median follow-up was 24 months (range 18-36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. CONCLUSION: We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.

Aged↗
PubMed2006

Intrarectal amifostine suspension may protect against acute proctitis during radiation therapy for prostate cancer: a pilot study.

PURPOSE: Our goal was to test the ability of intrarectal amifostine to limit symptoms of radiation proctitis. METHODS AND MATERIALS: The first 18 patients received 1 g of intrarectal amifostine suspension placed 30-45 min before each radiation treatment. The following 12 patients received 2 g of amifostine. Total dose prescribed ranged from 66 to 76 Gy. All patients were treated with three-dimensional conformal radiation therapy. The suspension remained intrarectal during treatment and was expelled after treatment. For gastrointestinal symptoms, during treatment and follow-up, all patients had a Radiation Therapy Oncology Group (RTOG) grade recorded. RESULTS: Median follow-up was 18 months (range, 6-24 months). With 2 g vs. 1 g amifostine, there was a nearly significant decrease in RTOG Grade 2 acute rectal toxicity. Seven weeks after the start of radiation therapy, the incidence of Grade 2 toxicity was 33% in the 1-g group (6/18) compared with 0% (0/12) in the 2-g group (p=0.06). No Grade 3 toxicity or greater occurred in this study. CONCLUSION: This trial suggests greater rectal radioprotection from acute effects with 2 g vs. 1 g amifostine suspension. Further studies should be conducted in populations at higher risk for developing symptomatic acute and late proctitis.

Administration, Rectal↗
PubMed2006

The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To present nationally representative data on the prevalence, correlates, and comorbidity of DSM-IV panic disorder (PAN), including the differentiation between panic with agoraphobia (PDA) and without agoraphobia (PDWA) and agoraphobia without a history of panic disorder (AG). METHOD: The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Prevalence, correlates, and comorbidity of PAN, PDA, and PDWA with Axis I and II disorders were determined. RESULTS: Prevalences of 12-month and lifetime PAN were 2.1% and 5.1%. Rates of 12-month and lifetime PDWA were 1.6% and 4.0%, exceeding those of 12-month (0.6%) and lifetime (1.1%) PDA. Rates of 12-month and lifetime AG were extremely low, 0.05% and 0.17%. Being female, Native American, middle-aged, widowed/ separated/divorced, and of low income increased risk, while being Asian, Hispanic, or black decreased risk for PAN, PDA, and PDWA. Individuals with PDA were more likely to seek treatment and had earlier ages at onset and first treatment, longer episodes, and more severe disability, impairment, panic symptomatology, and Axis I and II comorbidity than those with PDWA. CONCLUSION: PDA may be a more severe variant of PAN. Overrepresentation of PDA in treatment settings reflects increased treatment seeking and the severity of PDA relative to PDWA. The very low prevalence of AG leaves open questions about the meaning of the disorder as a distinct clinical entity as defined in the DSM-IV.

Adolescent↗
PubMed2005

Comparing measures of acute bowel toxicity in patients with prostate cancer treated with external beam radiation therapy.

PURPOSE: This study strives to compare early measures of bowel toxicity in patients with prostate cancer receiving definitive or adjuvant 3D conformal external beam radiation therapy and concurrent daily endorectal application of amifostine. METHODS: Eighteen patients were enrolled in the clinical study with a median follow-up of 12 months. Prescription doses ranged from 66 Gy to 76 Gy with a daily fractionation of 2 Gy. Acute bowel toxicity was measured at baseline, at Weeks 5 and 7 of radiotherapy, and at 1 and 3 months after the completion of therapy. Measures of acute bowel toxicity included the Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring criteria, Expanded Prostate Cancer Index Composite (EPIC) self-assessment questionnaires, and proctoscopic examinations. RESULTS: The mean EPIC bowel scores changed significantly through the course of therapy and follow-up (p < 0.0001), with a progressive decrease in scores at Weeks 5 and 7 of treatment, a partial recovery at 3 months, and a correlation to the gold standard RTOG grade (p = 0.004). Proctoscopic toxicity scores were low, did not vary over time, and did not correlate with either EPIC or RTOG scores. CONCLUSION: The EPIC questionnaire measurements are most sensitive to changes in acute bowel toxicity through a course of radiotherapy and correlate with RTOG acute toxicity scores. Endoscopic examination of the rectal mucosa at the end and immediate follow-up of a course of therapy does not seem to be informative or reproducible between observers in the acute setting.

Aged↗
PubMed2005

Co-occurring DSM-IV drug abuse in DSM-IV drug dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

The extent to which dependence occurs with or without abuse is important because of the potential for underestimation and biased estimates of drug dependence in surveys that rely on abuse as a screening method for dependence. The purpose of this paper was to present the prevalence of DSM-IV drug dependence with and without drug abuse in a nationally representative sample, as well as in subgroups defined by sex, age and race/ethnicity. Among all respondents with current drug dependence, 22.0% did not additionally meet criteria for abuse (19.5% among males and 27.8% among females). Current drug dependence without abuse was especially common among females age 45-64 (52.6% of all cases). Among those with lifetime diagnoses of drug dependence, a small proportion overall, 5.0% had no symptoms of abuse, with the highest proportion again found among females aged 45-64 (19.5% of all cases). The use of drug abuse as a screening method for drug dependence in large epidemiologic studies will differentially underestimate the prevalence of dependence by subgroup, affecting many types of research. Dependence with and without abuse may represent heterogeneous phenotypes for genetic and gene-environment research, which should be explored.

Adolescent↗
PubMed2005

Comparison of continuous interleaved sampling and simultaneous analog stimulation speech processing strategies in newly implanted adults with a Clarion 1.2 cochlear implant.

OBJECTIVE: This study consisted of a within-subjects comparison of speech recognition and patient preference when subjects used two different cochlear implant speech processing strategies with a Clarion 1.2 (enhanced bipolar) device: Simultaneous Analog Stimulation (SAS), and Continuous Interleaved Sampling (CIS). These two strategies used two different electrode configurations: the SAS strategy used bipolar stimulation, whereas the CIS strategy used monopolar stimulation. STUDY DESIGN: This was a multicenter study that used a within-subjects balanced crossover design. Experience with the two strategies was replicated in each subject using an ABAB design. Order of strategy use was balanced across all subjects. SETTING: The study was carried out at several cochlear implant centers affiliated with tertiary medical centers. PATIENTS: Subjects consisted of 25 postlingually deafened adults who received a Clarion cochlear implant. INTERVENTIONS: Total involvement by each subject was 14 weeks. Speech perception testing and sound quality assessments were performed after use with each strategy. MAIN OUTCOME MEASURES: Primary outcome measures include speech perception data and patient responses to questionnaires regarding speech and sound quality. RESULTS: Analyses revealed that performance did not differ significantly by the strategy encountered first as relative to the strategy encountered second and that the order in which a strategy was used did not appear to affect subjects' eventual preference for a particular strategy. Although speech recognition scores tended to be higher for CIS for most of the test measures at most of the test intervals, the analysis of variance to evaluate differences in strategy did not reveal a significant effect of strategy. Further analysis of scores obtained at the replication interval, however, revealed that scores obtained with CIS were significantly higher than scores obtained with SAS on the Hearing in Noise Test sentences in quiet and noise. In addition, significantly more patients indicated a final preference for the CIS strategy than for the SAS strategy. Importantly, both the analysis evaluating order and the analysis evaluating strategy revealed significant effects of evaluation period, indicating that time/experience with the implant had a significant effect on scores for each strategy, regardless of the order in which it was used (first or second). CONCLUSIONS: This study demonstrates that important learning occurs during the first several weeks of cochlear implant use, making it difficult to adequately compare performance with different speech processing strategies. However, the finding that patients often prefer the strategy they understand speech the best with supports the clinical practice of letting adult patients select their preferred strategy without formally evaluating speech perception with each available strategy.

Aged↗
PubMed2005

The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To present nationally representative data on 12-month and lifetime prevalence, correlates and comorbidity of social anxiety disorder (SAD) among adults in the United States as determined by the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. DESIGN: Face-to-face survey. SETTING: The United States. PARTICIPANTS: Adults (aged 18 and over) residing in households and group quarters (N = 43,093). MAIN OUTCOME MEASURES: Prevalence and associations of SAD with sociodemographic and psychiatric correlates and Axis I and II disorders. RESULTS: The prevalence of 12-month and lifetime DSM-IV SAD was 2.8% (95% CI = 2.5 to 3.1) and 5.0% (95% CI = 4.6 to 5.4), respectively. Being Native American, being young, or having low income increased risk, while being male, being of Asian, Hispanic, or black race/ethnicity, or living in urban or more populated regions reduced risk. Mean age at onset of SAD was 15.1 years, with a mean duration of 16.3 years. Over 80% of individuals with SAD received no treatment, and the mean age at first treatment was 27.2 years. Current and lifetime SAD were significantly related to other specific psychiatric disorders, most notably generalized anxiety, bipolar I, and avoidant and dependent personality disorders. The mean number of feared social situations among individuals with SAD was 7.0, with the majority reporting anxiety in performance situations. CONCLUSIONS: Social anxiety disorder was associated with substantial unremitting course and extremely early age at onset. Social anxiety disorder often goes untreated, underscoring the need for health care initiatives geared toward increasing recognition and treatment. Comprehensive evaluation of patients with SAD should include a systematic assessment of comorbid disorders, and novel approaches to the treatment of comorbid SAD are needed.

Adolescent↗
PubMed2005

Cochlear implantation in severe traumatic brain-injury and paranoid schizophrenia: two case studies.

In view of the demanding instruction and training requirements associated with cochlear implantation;,patients with cognitive impairments have typically been considered to be poor candidates for this procedure. This presumption persists in part because experience and research in this area are limited. We describe our experience with implanting cochlear devices in 2 patients who had significant psychological impairments; 1 patient had experienced a severe brain injury, and the other had paranoid schizophrenia. Nevertheless, both patients were able to follow the implant training program, and they experienced different degrees of improvement in their hearing. We discuss our preoperative evaluations of these patients and the key factors that led to our decision to proceed with surgery.

Adult↗
PubMed2004

MRI-guided HDR prostate brachytherapy in standard 1.5T scanner.

PURPOSE: Magnetic resonance imaging (MRI) provides superior visualization of the prostate and surrounding anatomy, making it the modality of choice for imaging the prostate gland. This pilot study was performed to determine the feasibility and dosimetric quality achieved when placing high-dose-rate prostate brachytherapy catheters under MRI guidance in a standard "closed-bore" 1.5T scanner. METHODS AND MATERIALS: Patients with intermediate-risk and high-risk localized prostate cancer received MRI-guided high-dose-rate brachytherapy boosts before and after a course of external beam radiotherapy. Using a custom visualization and targeting program, the brachytherapy catheters were placed and adjusted under MRI guidance until satisfactory implant geometry was achieved. Inverse treatment planning was performed using high-resolution T(2)-weighted MRI. RESULTS: Ten brachytherapy procedures were performed on 5 patients. The median percentage of volume receiving 100% of prescribed minimal peripheral dose (V(100)) achieved was 94% (mean, 92%; 95% confidence interval, 89-95%). The urethral V(125) ranged from 0% to 18% (median, 5%), and the rectal V(75) ranged from 0% to 3.1% (median, 0.3%). In all cases, lesions highly suspicious for malignancy could be visualized on the procedural MRI, and extracapsular disease was identified in 2 patients. CONCLUSION: High-dose-rate prostate brachytherapy in a standard 1.5T MRI scanner is feasible and achieves favorable dosimetry within a reasonable period with high-quality image guidance. Although the procedure was well tolerated in the acute setting, additional follow-up is required to determine the long-term safety and efficacy of this approach.

Aged↗
PubMed2004

Nonoccupational physical activity by degree of urbanization and U.S. geographic region.

PURPOSE: To estimate levels of nonoccupational leisure-time physical activity (LTPA) by degree of urbanization and geographic region of the United States. METHODS: Participants were respondents to the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 (N = 137,359). Moderate- and vigorous-intensity LTPA was categorized as meeting recommended levels, insufficient, or inactive. The U.S. Department of Agriculture rural-urban continuum codes were used to describe degrees of urbanization (metro, large urban, small urban, and rural). Geographic regions were defined by the U.S. Bureau of the Census (Northeast, Midwest, South, and West). Prevalence estimates were calculated using sample weights to account for the design of the BRFSS. Multivariate logistic regression analyses examined regional differences in the odds of physical inactivity (physically inactive vs insufficient or meets) by degree of urbanization after adjustment for sex, age, race, BMI, education, and occupational physical activity. RESULTS: Large urban areas (49.0%) and the western United States (49.0%) had the highest prevalence of recommended levels of LTPA. Rural areas (24.1%) and the southern United States (17.4%) had the highest prevalence of inactivity. Adults living in the four urbanization categories of the midwestern (metro (OR = 1.47, 95% CI = 1.31, 1.65), large urban (OR = 1.83, 95% CI = 1.51, 2.23), small urban (OR = 1.99, 95% CI = 1.65, 2.40), and rural (OR = 2.59, 95% CI = 1.35, 4.97)); and southern (metro (OR = 1.70, 95% CI = 1.53, 1.88), large urban (OR = 2.04, 95% CI = 1.72, 2.41), small urban (OR = 2.32, 95% CI = 2.02, 2.67), and rural (OR = 5.49, 95% CI = 2.82, 10.68)) U.S. regions were more likely to be inactive than adults living in similar areas of the western United States. Adults in northeast metro and large urban areas (OR = 1.62, 95% CI = 1.45, 1.81; and OR = 1.37, 95% CI = 1.08, 1.74, respectively) were more likely to be inactive than those residing in western metro and large urban areas. CONCLUSION: The prevalence of physical inactivity varies by degree of urbanization and geographic region of the United States.

Activities of Daily Living↗
PubMed2003

Resolution of facial stimulation in otosclerotic cochlear implants.

OBJECTIVES: We examined the incidence of facial nerve stimulation in a population of patients with otosclerosis implanted with the Nucleus 22, Clarion 1.2, or Clarion High Focus (CHF) device. STUDY DESIGN AND SETTING: A retrospective chart review was used for 147 patients who had been implanted with electronic cochlear devices at the University of Minnesota between June 1986 and February 2001. Seventy-four patients were implanted with the Nucleus 22, 41 patients were implanted with the Clarion 1.2 (without a positioner), and 32 patients were implanted with the CHF I or II. RESULTS: Eleven (14.9%) of the 74 patients implanted with the Nucleus 22 device had facial stimulation. There were 9 patients with otosclerosis. Seven (78%) of the 9 patients with otosclerosis had facial stimulation. One (2.4%) of the 41 patients implanted with the Clarion 1.2 device (without a positioner) had facial stimulation and that 1 (100%) patient in the group had otosclerosis. There were 4 patients in the CHF group with otosclerosis. One patient experienced stimulation, but it was possible to decrease maximum current levels and still use the electrode pair. CONCLUSION: Facial stimulation appears to be less problematic in patients with otosclerosis implanted with the CHF devices.

Adult↗
PubMed2003

Clinical trial of endorectal amifostine for radioprotection in patients with prostate cancer: rationale and early results.

Tolerance of the normal rectal mucosa to radiation injury limits the dose that can be safely delivered to the prostate gland with definitive external beam radiation therapy. The radioprotective agent amifostine (Ethyol; MedImmune, Inc, Gaithersburg, MD) is approved for intravenous use. Laboratory studies indicate that rectal administration results in preferential accumulation of amifostine in the rectal mucosa, and in clinical studies, neither free parent compound nor free active metabolite has been detected in the systemic circulation. This trial evaluates the rates of early and late rectal toxicities in patients with prostate cancer receiving definitive or adjuvant three-dimensional conformal external beam radiation therapy and concurrent daily endorectal applications of amifostine. Endpoints include Radiation Therapy Oncology Group acute and late toxicity gradings, Expanded Prostate Cancer Index Composite self-assessment questionnaires, and proctoscopic examinations with scoring of mucosal damage measured before, during, and after treatment. Eleven patients have been enrolled to date; 10 have completed radiotherapy and three have been followed-up to 6 months. Two patients received 66 Gy to the prostatic bed post-prostatectomy; five patients received 74 Gy and three received 76 Gy to the prostate gland. In all patients, daily fractionation was 2 Gy, and 1 g of amifostine (50 mg/mL in 20 mL reconstituted saline) was administered endorectally 40 minutes before radiation delivery. Daily endorectal administration was well tolerated. To date, six patients have experienced grade 2 (Radiation Therapy Oncology Group) acute toxicities, all but one because of frequent bowel movements relieved by loperamide. The initial trial will proceed until 18 patients are accrued, at which time an interval evaluation of both early and late toxicity endpoints will be conducted.

Adenocarcinoma↗
PubMed2003

Phase I evaluation of sequential topoisomerase targeting with irinotecan/cisplatin followed by etoposide in patients with advanced malignancy.

PURPOSE: To investigate pharmacologically guided addition of etoposide to a weekly irinotecan/cisplatin chemotherapy. PATIENTS AND METHODS: Patients with advanced nonhematologic malignancies were eligible. Treatment consisted of i.v. administration of 50 mg/m(2) irinotecan and 20 mg/m(2) cisplatin on days 1, 8, 15, and 22 of a 42-day cycle or on days 1 and 8 of a 21-day cycle. Etoposide was administered in a dose-escalating fashion 2 days after each dose of irinotecan/cisplatin, either i.v. as a single dose or p.o. as two doses administered 12 h apart. Pharmacologic analyses included measurement of plasma concentrations of irinotecan, SN-38, and SN-38 glucuronide, as well as quantitation of topoisomerase protein levels in peripheral blood mononuclear cells (PBMNCs). RESULTS: A total of 40 patients with a variety of malignancies received 122 cycles of therapy. Dose-limiting toxicities included neutropenia and diarrhea, with the 21-day cycle tolerated better than the 42-day cycle. For the 21-day cycle, the maximum tolerated dose was 75 mg/m(2) for i.v. etoposide and 85 mg/m(2) for oral etoposide. Objective responses were observed in four patients with previously treated mesothelioma, gastric, breast, and ovarian cancer, respectively. PBMNC levels of topoisomerase IIalpha were increased at the time of etoposide administration in two patients, with these patients having the highest SN-38 glucuronide peak-plasma-concentration and area-under-the-curve values among 15 patients with available pharmacokinetic data. One of these patients had a partial response to therapy. CONCLUSIONS: Pharmacologically guided administration of etoposide in combination with irinotecan/cisplatin using a 21-day cycle is associated with acceptable toxicity and significant antitumor activity. The finding that PBMNC topoisomerase IIalpha protein levels increased after irinotecan/cisplatin treatment in two of six patients supports the continued development of sequential topoisomerase targeting in the treatment of malignancy.

Adult↗
PubMed2003

Sequencing topotecan and etoposide plus cisplatin to overcome topoisomerase I and II resistance: a pharmacodynamically based Phase I trial.

PURPOSE: Resistance to topoisomerase (TOP) 1 and 2 inhibitors is a potentially important reason for treatment failure, and may be related, in part, to a down-regulation of the specific TOP target. Investigators in our laboratories previously noted such a down-regulation of the target, along with a reciprocal up-regulation of the alternate TOP. Therefore, sequencing TOP inhibitors may provide a means for overcoming resistance to the TOP I and II inhibitors. Furthermore, point mutations in TOP I, which confer resistance to TOP I inhibitors, were associated with collateral sensitivity to cisplatin. EXPERIMENTAL DESIGN: A dose escalating Phase I trial of topotecan (at doses of 0.75 to 1.0 mg/m(2)/day) on days 1 to 3 with etoposide (70-80 mg/m(2)/day) and cisplatin (20-25 mg/m(2)/day) on days 8 to 10. The timing of the drug sequence was based on the prior Phase I pharmacokinetic and pharmacodynamic studies of camptothecin and etoposide, and the level of the TOP targets in peripheral blood monocytes. RESULTS: Fifteen patients (7 males and 8 females) received 40 courses of therapy across three dose levels. The median age was 56 (range, 39-77), and the median performance status was 1 (range, 0-2). The diagnoses included: non-small cell lung cancer (7), head and neck cancer (2), cancer of unknown primary (2), and 1 each of ovarian cancer, prostate cancer, gastric cancer, and renal cancer. Level 1 (topotecan 1.0 mg/m(2)/day; etoposide 80 mg/m(2)/day; and cisplatin 25 mg/m(2)/day) produced severe and prolonged febrile neutropenia in the first patient treated, and the subsequent patients were then entered onto a reduced dose level (cohort 2: topotecan 0.75 mg/m(2)/day; etoposide 70 mg/m(2)/day; and cisplatin 20 mg/m(2)/day). Three of 6 patients on cohort 2 experienced grade IV neutropenia >5 days, and a decision was then made to add filgrastim at 5 micro g/kg rather than additionally reduce the dosages (cohort 3). Eight patients were then treated on cohort 3, and 1 of the 8 patients experienced a grade 4 neutropenia. Thus, cohort level three was considered the recommended dose for Phase II studies. Twelve of the 15 patients had disease assessable for response to therapy. Seven achieved stable disease for >/==" BORDER="0">2 months, whereas 5 showed continued progression of their disease. CONCLUSIONS: These data show that sequencing TOP 1 and 2 inhibitors is feasible, and topotecan 0.75 mg/m(2)/day days 1-3; etoposide 70 mg/m(2)/day days 8-10; and cisplatin 20 mg/m(2)/day days 8-10 with filgrastim at 5 micro g/kg is an appropriate dose and schedule to test the concept of modulating TOP levels by sequencing the administration of the respective TOP inhibitors.

Adult↗