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Biomedical subjects

W Thurston

Publications and source records attributed to W Thurston.

8 recordsLinked to original sources
PubMed2000

The natural history of small renal masses.

PURPOSE: Ultrasound, computerized tomography and magnetic resonance imaging are widely available. Incidentally discovered small renal masses are reported more frequently. Most of these masses are low stage renal cell carcinomas. To understand better the natural history of these lesions and offer appropriate management, we followed prospectively a series of patients with this type of lesion. MATERIALS AND METHODS: A total of 13 patients with radiologically detected solitary small renal masses who were unfit for or refused surgery were followed with abdominal imaging for a median of 42 months. Median patient age was 69 years and mean lesion volume at diagnosis was 13.6 cm.3 or 2.95 cm. in diameter. Growth rate was calculated based on tumor volume rather than bi-dimensional diameter. Individual slopes of tumor size in time were calculated. RESULTS: Of the 13 patients 5 underwent surgery following a period of surveillance because of apparent tumor enlargement or new onset of symptoms. Pathological evaluation revealed renal cell carcinoma in all 5. No patient had metastases. Only 2 tumors were fast growing and these were the only 2 cases in which symptoms developed. When these patients were excluded from analysis, average growth rate was 1.32 cm.3 per year (p = 0.5, 95% confidence interval -3.00 to 5.76 cm.3 per year), which was not statistically significantly different from 0 slope or no growth. CONCLUSIONS: These results demonstrate that the growth rate of small renal tumors is variable, tumors that are destined to grow and possibly metastasize do so early and most small tumors grow at a low rate or not at all.

Aged↗
PubMed1994

Percutaneous fluoroscopically guided removal of dysfunctioning ureteral stents.

PURPOSE: To present the authors' experience with fluoroscopically guided percutaneous removal of dysfunctioning ureteral stents and to discuss the technique and instrumentation used. MATERIALS AND METHODS: Over 6 years, stent or stent fragment extraction procedures were performed in 20 patients. Indications included stent misplacement or migration, stent fracture, difficult retrograde exchange, stent occlusion, and removal prior to percutaneous ureteroscopy. Twelve extractions were performed as two-stage procedures and eight as one-stage procedures. A rigid forceps passed through a 12-F sheath was the preferred instrument for extraction. Other instruments used successfully included snares and flexible forceps. RESULTS: Seventeen procedures were successful: Eight stents were removed with rigid forceps, seven with flexible forceps, and two with snares. Three procedures were unsuccessful: In two, the stent could not be grasped because there was intervening renal pelvic mucosa, and in one, clotted blood surrounded the stent. There were no undue complications. CONCLUSION: This procedure is highly successful when appropriate technique and instruments are used.

Adult↗
PubMed1993

Transrectal drainage of deep pelvic collections under fluoroscopic guidance.

Although transrectal drainage of pelvic fluid collections, guided by fluoroscopy, computed tomography (CT) and ultrasonography (US), has been reported, the cumulative experience is small. The authors describe a technique for fluoroscopically guided transrectal drainage and present the results obtained for 13 patients. Each patient underwent diagnostic CT and then fluoroscopically guided drainage. A barium enema tube assembly, consisting of an enema tube, a Lunderquist PTC (percutaneous transhepatic cholangiogram) needle and a small portion of a red rubber catheter, was used to facilitate insertion of the drainage catheter. The procedure was defined as successful if complete clearance occurred after drainage, as temporizing if partial drainage was achieved and clinical improvement occurred, and as failed if the collection showed no response to drainage. Twelve of the patients had abscesses, 9 of which were successfully treated by drainage alone; one drainage was temporizing and two failed. The collection in the last patient represented a hematoma, which did not respond to drainage. The authors conclude that the technique they describe is suitable for draining moderate to large pelvic abscesses. The procedure is safe and can easily be performed in both male and female patients.

Abscess↗
PubMedDate not supplied

The utility of the Transtheoretical Model of behavior change for HIV risk reduction in injection drug users.

The spread of HIV among injection drug users (IDUs) is the second most common mode of transmission next to sexual contact. Although HIV infections can be prevented by changing high-risk behaviors such as needle sharing, these high-risk behaviors are highly complex. Initially developed for smoking cessation, Prochaska's Transtheoretical Model (TTM) is well-suited to the IDU population because it recognizes that chronic behavior patterns are usually under some combination of biological, social, and self-control. The objective of this article is to examine the utility of the TTM for promoting risk reduction behaviors among IDUs. This article will outline (a) the challenges of applying the TTM to IDU behaviors with respect to HIV prevention, (b) the four major components of the TTM as they relate to IDUs, (c) how risk reduction practitioners are currently using the TTM, and (d) current and future research using the TTM.

Attitude to Health↗