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Biomedical subjects

W M O'Brien

Publications and source records attributed to W M O'Brien.

At least 37 records · Page 2Linked to original sources
PubMed1987

Adrenal metastases by renal cell carcinoma. Incidence at nephrectomy.

Recently, there have been questions raised as to the results and feasibility of performing renal-sparing procedures for localized renal cell carcinoma. We reviewed the records of 72 patients treated with standard radical nephrectomy to determine the incidence of adrenal involvement and to determine if adrenal lesions were detectable by radiographic methods preoperatively. Four patients had evidence of adrenal involvement for an overall incidence of 5.5 per cent. All had upper pole lesions. Adrenal involvement in each case was apparent at surgery or on preoperative imaging studies. For patients with middle and lower pole localized renal cell carcinoma who have normal findings on preoperative computerized tomography scans, modified radical nephrectomy sparing the adrenal gland may be a surgical alternative to radical nephrectomy.

Adrenal Gland Neoplasms↗
PubMed1987

Thrombosis of the inferior vena cava by seminoma.

We report a case of metastatic seminoma that caused thrombosis and obstruction of the inferior vena cava. The pathogenesis of this rare clinical entity is discussed. The diagnostic studies for detection of vena caval thrombosis and clinical management strategies are reviewed.

Adult↗
PubMed1987

New approaches in the treatment of renal calculi.

Indications for intervention in patients with renal stone disease include persistent pain or bleeding, obstruction, infection and the presence of stones that are too large to pass spontaneously. Extracorporeal shock wave lithotripsy has revolutionized the surgical treatment of kidney stones. Contraindications include anticoagulation, bleeding diathesis, sepsis and renal malignancy. Stones in the renal pelvis and upper ureter are treated with shock wave lithotripsy; those in the lower ureter are best approached with the ureteroscope.

Endoscopy↗
PubMed1986

Invasion of the inferior vena cava by testicular seminoma: demonstration by computed tomography and venography.

Involvement of the inferior vena cava (IVC) by testicular neoplasms is unusual and often clinically unsuspected. We present a patient with testicular seminoma that involved the IVC secondarily and caused multiple pulmonary emboli requiring the placement of a caval filter. The radiographic features of this phenomenon are presented with special emphasis on the computed tomographic (CT) appearance of caval thrombosis and pulmonary embolus. The characteristically low density lymphadenopathy of seminoma may obscure the diagnosis of caval thrombosis on CT. Although the findings are nonspecific, tumor invasion of the IVC should be suspected in all patients with testicular neoplasms who demonstrate caval thrombosis radiographically.

Adult↗
PubMed1986

Radiological evaluation of erosions: a quantitative method for assessing long-term remittive therapy in rheumatoid arthritis.

1 The most reliable method for evaluating possible remission-inducing properties in a drug is to measure how well it prevents the appearance of new erosions in serial X-rays of the hands. 2 I have reviewed the literature on the development, over the last 25 years, of a standard method for quantitatively assessing the progress of erosions radiologically. 3 The only drugs thus far shown to be genuinely remission-inducing are cyclophosphamide, high-dose penicillamine, and (most consistently over several decades) gold-thiols, all drugs with life-threatening toxicity. 4 The search for a non-steroidal drug with remission-inducing properties is crucial in our efforts to find a safe drug to control the progression of rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1985

Rare adverse reactions to nonsteroidal antiinflammatory drugs.

Excluding the most frequent kinds of problems seen with the nonsteroidal antiinflammatory drugs (NSAID)--gastritis, peptic ulceration and renal effects--published reports indicate that these drugs may cause a wide variety of rare adverse reactions. The most serious of these are hypersensitivity reactions: blood dyscrasias (aplastic anemia, thrombocytopenia, agranulocytosis, hemolytic anemia), erythema multiforme and hepatitis. Aseptic meningitis and anaphylactoid reactions may strike patients with underlying immunologic abnormalities; urticaria, bronchospasm and proctocolitis may affect aspirin-sensitive patients. Other unusual reactions include several kinds of bullous dermatitis, febrile reactions, pneumonitis, esophageal ulceration, parotitis, pancreatitis and neurological or psychological effects.

Anti-Inflammatory Agents↗
PubMed1984

Radiographic evaluation of erosion in rheumatoid arthritis: double blind study of auranofin vs placebo.

PA radiographs of hands and wrists from a randomized 6 month study of auranofin (AF) vs placebo followed by 6 months of open AF were scored for progression of erosive disease by 2 independent readers. The readers were blinded both to treatment and sequence (month 0 vs month 12) of the films. The results of our study demonstrate a reduction in the advancement of erosive disease during AF therapy compared to placebo.

Adult↗
PubMed1983

Pharmacology of nonsteroidal anti-inflammatory drugs. Practical review for clinicians.

Aspirin and the newer nonsteroidal anti-inflammatory drugs are the mainstay of basic therapy in rheumatoid arthritis and the other rheumatic diseases. Despite its many years of clinical use, the pharmacologic actions of aspirin are still not fully understood; those of many of the newer nonsteroidals may offer significant advantages in terms of long-term safety. Studies in animals and normal human volunteers, as well as clinical trials, provide useful information about the absorption, metabolism, excretion, efficacy, appropriate dosage, and safety of a given nonsteroidal agent. Because all of the newer agents have been developed using the same basic animal tests of efficacy, they all closely resemble indomethacin. Differences in half-life, however, may be important in determining the relative safety of a nonsteroidal, especially in older patients. Most of the nonsteroidals bind only to albumin, and therefore have a kind of built-in safety mechanism: once the albumin binding sites are saturated, free drug is rapidly excreted by the kidney and drug accumulation is prevented. Despite this fact, the clinician must be concerned about two frequent sorts of problems that may arise from the prostaglandin-inhibiting effects of the nonsteroidals. Gastrointestinal side effects may include minor symptoms; diffuse gastritis; small erosions of the gastric mucosa, visible only by endoscope; and frank ulceration, which may rarely be life-threatening. Animal studies, various tests in normal volunteers, and pre-marketing clinical studies may all shed light on the relative ulcerogenicity of a given nonsteroidal agent. Long-term clinical experience especially helps indicate which agents appear to be more ulcerogenic than average and which appear to be less than average. Renal effects of the nonsteroidals are also related to their inhibition of prostaglandin synthesis. The most serious of these--a characteristic kind of interstitial nephritis, renal papillary necrosis, and hyperkalemia--are fortunately rare, but some classes of patients--the elderly, those with impaired renal function, and those receiving diuretics--are at increased risk. For these patients, any nonsteroidal anti-inflammatory drug should be prescribed with caution and appropriate monitoring of renal function.

Animals↗
PubMed1983

Decreased complement mediated binding of antibody/3H-dsDNA immune complexes to the red blood cells of patients with systemic lupus erythematosus, rheumatoid arthritis, and hematologic malignancies.

The complement mediated binding of prepared antibody/3H-dsDNA immune complexes to the red blood cells obtained from a number of patient populations has been investigated. Patients with solid tumors have binding activity similar to that seen in a normal group of individuals. However, a significant fraction of patients with systemic lupus erythematosus, rheumatoid arthritis, and hematologic malignancies have lowered binding activity compared with normal subjects. Quantitative studies indicate the lowered activity probably arises due to a decrease in complement receptors on the respective red blood cells. The potential importance and implications of these findings are briefly discussed.

Adolescent↗
PubMed1983

Long-term efficacy and safety of tolmetin sodium in treatment of geriatric patients with rheumatoid arthritis and osteoarthritis: a retrospective study.

In order to evaluate the effectiveness and safety of tolmetin sodium in the treatment of both rheumatoid arthritis (RA) and osteoarthritis in geriatric patients, a retrospective study was made of patients 65 years and older who participated in long-term, controlled, double-blind and open trials during both the investigational period and since marketing of the drug. Standard entrance criteria, methods of evaluating disease activity, and statistical methods were used in the study of both arthritic diseases. A total of 847 geriatric patients were studied for periods of up to one year; 171 had RA, while 676 had osteoarthritis of large or small joints. Average daily dose of tolmetin sodium was 1141 mg for patients with RA and 953 mg for patients with osteoarthritis. The results of this retrospective study of both RA and osteoarthritis patients show that tolmetin was as effective in geriatric patients as in nongeriatric patients. Symptoms responded rapidly to treatment with tolmetin, and both the inflammatory symptoms of RA and the joint pain and functional parameters of osteoarthritis showed improvement that was both statistically and clinically significant throughout the major course of therapy. Tolmetin was also found to be safe and well tolerated by the elderly patient population. The major complaints were gastrointestinal, but serious or limiting side effects occurred in few patients. The dropout rates due to adverse effects during the entire year of therapy were 15.8 per cent in the RA population and 15.4 per cent in osteoarthritis patients. This retrospective evaluation of tolmetin therapy shows significant relief of the symptoms of both RA and osteoarthritis in a geriatric population and fails to reveal any unusual or serious conditions which would contraindicate its use in the elderly patient. Tolmetin, which is an antiinflammatory agent with a short half-life, can provide adequate, safe therapy in the geriatric population.

Aged↗