Biomedical subjects

W Whitmore

Publications and source records attributed to W Whitmore.

16 recordsLinked to original sources

PubMed1998

Microwave thermotherapy for benign prostatic hyperplasia with the Dornier Urowave: results of a randomized, double-blind, multicenter, sham-controlled trial.

OBJECTIVES: To study the efficacy and safety of a new transurethral microwave thermotherapy device (the Urowave) in the treatment of men with clinical benign prostatic hyperplasia (BPH) in a randomized, double-blind, sham-controlled trial. METHODS: A total of 220 patients (mean age 66.2 years) with clinical BPH, an American Urological Association symptom index (AUA SI) of 13 points or more, and a peak flow rate of 12 mL/s or less were enrolled and randomized 2:1 for active versus sham treatment. All treatments were conducted as an outpatient procedure under local anesthesia, with oral sedation and analgesia only. Patients were followed up at 1 week and 1, 3, and 6 months after treatment. RESULTS: The treatments were well tolerated, and no patient received general or spinal anesthesia. The AUA SI dropped from 23.6 to 12.7 points at 6 months (P < 0.05) in the active group and from 23.9 to 18.0 points in the sham-treated group (P < 0.05, between-group difference). Statistically significant improvements were also noted for peak flow rate (7.7 to 10.7 mL/s at 6 months for active treatment, 8.1 to 9.8 mL/s for sham treatment, P < 0.05, between-group difference) and for average flow rate. A decrease in AUA SI of more than 30% was achieved in 72% versus 38% of patients (active versus sham treatment, respectively) and more than 50% in 50% versus 19% of patients. In general, active Urowave-treated patients perceived "a lot" of improvement, whereas sham-treated patients perceived "a little" to "some" improvement. More of the actively treated patients had dysuria and urgency after treatment, and ejaculatory dysfunction (e.g., hematospermia) was more common in actively treated patients as well. Secondary urinary retention after removal of the catheter occurred in 8 patients (5.4%). CONCLUSIONS: The Dornier Urowave transurethral microwave thermotherapy device for treatment of clinical BPH is effective in decreasing symptoms and bother and improving quality of life and flow rate and is superior to sham treatment. Patients perceive a great deal of improvement, independent of their baseline symptom severity. Adverse events are in general transient and mild in nature. Extended follow-up is necessary to document long-term durability of improvements.

Aged↗

PubMed1997

Effect of prebreeding maintenance diet on subsequent reproduction by artificial insemination in alpine and Saanen goats.

The objective of this study was to investigate the effect of 2 levels of prebreeding nutrition on reproduction in yearling does artificially inseminated (AI) by the intrauterine laparoscopic method. Forty-two does (Alpine = 22 and Saanen = 20) were randomly penned in groups of 7 and were fed 1 of 2 diets. The diets contained 3.2 Mcal DE/d (MAINT) or 3.5 Meal DE/d (HIGH), which was 10 and 20% higher than the National Research Council recommendations for maintenance requirements. The does were on the 2 feed treatments for 8 wk, after which the MAINT group was switched to the HIGH group diet. A week later, they were fitted with Veramix sponges to synchronize estrus. The sponges were removed from 22, 10 and 10 randomly picked does after 17, 22 and 23 d, respectively. All the does showed estrus within 48 h of removing the sponges. Previously frozen Alpine or Saanen semen (0.5 ml) was deposited into the uterus of does exhibiting standing estrus after anesthetizing them with zylazine and ketamine. Pure breeding was practiced. All the does lost weight prior to breeding. Seventeen does (41%) conceived and kidded by AI while the rest returned to estrus about 23 d later. A significant difference (P < 0.05) in the kidding percentage was observed between the 2 breeds (Alpine = 64% and Saanen = 16%), while the kidding percentage between the 2 diets did not differ (P > 0.05). Of the does that kidded, seven (41%) had singletons, eight (47%) had twins, one had triplets and one had quadruplets. Average litter size (kids/doe kidding) by AI was 1.76. Although the does lost weight prior to breeding, this did not affect their reproduction.

Journal Article↗

PubMed1993

Modeling the development of metastases from primary and locally recurrent tumors: comparison with a clinical data base for prostatic cancer.

For many types of cancer, patients who relapse locally following localized treatment such as surgery or radiation therapy are found to have a higher incidence of distant metastases than those who are locally controlled. In this study we developed a mathematical model to investigate whether the excess distant metastases arise mainly from the local recurrence or whether the primary tumors in this group of patients have an intrinsically higher metastatic potential than those of locally controlled patients of the same clinical stage. The parameters of the model were chosen to be representative of prostate cancer and the calculated results were compared with published clinical data for carcinoma of the prostate. The best agreement with the data was seen for parameters which imply somewhat more "aggressive" primary tumors for locally relapsing patients, yielding relatively high rates of micrometastatic dissemination prior to initial diagnosis. However, the model calculations indicate that more than half of the metastases in such patients originated in association with the development of a local recurrence. Therefore, achieving local control in this group of patients would be beneficial in improving long term survival.

Computer Simulation↗

PubMed1991

An improved method for computerized tomography-planned transperineal 125iodine prostate implants.

Transperineal 125iodine implants of the prostate can be performed with ultrasound guidance, a simple technique that has met with widespread acceptance. However, ultrasound does not allow good visualization of the pubic bones in relation to the pelvic outlet, and the pubic bones may interfere with needle placement in the anterior peripheral aspect of the prostate. Adequate irradiation of the entire periphery of the prostate is important to assure tumor control, since most tumors are multicentric and may involve the anterior aspect of the prostate. A computerized tomography-based treatment planning procedure that allows for angulation of transperineal needles to avoid the pubic bones and still reaches the most peripheral aspects of the gland is described. The technique also allows for the use of transrectal ultrasound and fluoroscopy to verify correct needle placement in the prostate at the procedure. Early treatment results, based on prostate specific antigen and regression of palpable tumors, are encouraging.

Antigens, Neoplasm↗

PubMed1987

Residual mass: an indication for further therapy in patients with advanced seminoma following systemic chemotherapy.

Forty-one advanced seminoma patients with normal biochemical markers and a complete or partial radiographic response after cisplatin-based chemotherapy had a complete reevaluation of all known sites of disease. Twenty-three patients had a residual mass, and in 14 the mass was greater than or equal to 3 cm. Nineteen patients with a residual mass, including 13 with a mass greater than or equal to 3 cm in diameter, had surgical excision or biopsy. Four patients had viable seminoma and one patient had teratoma; all five of these patients had residual masses greater than or equal to 3 cm. Four patients with a residual mass were observed without surgery. One patient with a residual mass greater than or equal to 3 cm progressed with biopsy-proven seminoma. Therefore, six of 14 patients (42%) with a residual mass greater than or equal to 3 cm had viable residual tumor. Eighteen patients had no residual mass after chemotherapy. Ten of these patients had surgery or biopsy; none had viable tumor, but two have relapsed. Eight patients were observed and none have relapsed. Advanced seminoma patients with a residual mass greater than or equal to 3 cm after chemotherapy are at high risk for residual viable tumor. Additional therapy is indicated for these patients. For patients with normal imaging studies or a residual mass less than 3 cm, close observation without surgery is generally possible.

Adult↗

PubMed1986

Surgical treatment of spinal cord compression in kidney cancer.

Forty-three patients with renal-cell carcinoma underwent treatment for spinal cord compression over a 7-year period. Of these, 32 patients underwent surgery, while 11 patients underwent radiation alone. Before operation, 25 patients had relapsed following prior radiation, while seven others received postoperative radiation. A more aggressive surgical approach, tailored to the site of compression within the spinal canal, was used with the majority undergoing gross total tumor resection by an anterior approach. Immediate stability of the spine was achieved with methyl-methacrylate reconstruction of the resected segments. Preoperative spinal angiography with embolization of hypervascular tumors was carried out in eight patients. Patient parameters in the surgical and irradiated groups were comparable, except that a greater proportion of the radiation alone group had more than one organ system involved (64% v 44%). The median survival of the surgically treated patients was 13 months, compared with 3 months for those treated by radiation alone. In addition, a greater proportion of the surgically treated patients were benefitted neurologically (70%) compared with those treated by radiation (45%). With the development of effective surgical treatment for spinal metastases, early consideration for surgical treatment (before radiation) should be considered in selected patients. Preoperative spinal angiography and embolization are recommended whenever feasible to minimize intraoperative blood loss.

Adult↗

PubMed1985

Role of etoposide-based chemotherapy in the treatment of patients with refractory or relapsing germ cell tumors.

Forty-nine patients with metastatic germ cell tumors were treated with etoposide 100 mg/m2 and cisplatin 20 mg/m2 intravenously each day for five days as "salvage" chemotherapy. Forty-seven patients had received standard induction regimens for metastatic germ cell tumors before receiving etoposide and cisplatin. Four patients were treated after surgical resection of a single site of relapse (Group I). Forty-five patients had measurable or evaluable disease at the time of treatment. In 17 patients with evaluable disease who had either achieved a prior complete remission or received no prior cisplatin (Group II), eight (47 percent) complete and four (24 percent) partial remission were observed. In 28 patients who had never achieved a prior complete remission (Group III), no complete and five (18 percent) partial responses were observed. Seven of 21 patients in Groups I and II and none of 28 patients in Group III remain alive and free of disease. Assuming prior treatment with cisplatin-based chemotherapy, these data and a review of the published experience with similar salvage regimens for patients with relapsing or refractory germ cell tumors suggest that combination chemotherapy based on etoposide and cisplatin is effective primarily in those patients who achieved a prior complete remission. Such therapy is ineffective in the absence of a prior complete remission probably because the patients have tumors that are largely resistant to cisplatin. Observed responses are probably due to etoposide alone. Investigational therapies should be pursued in those patients whose disease is refractory to current induction regimens.

Agranulocytosis↗

PubMed1985

Postnatal methyl mercury exposure: effects on ontogeny of renal and hepatic ornithine decarboxylase responses to trophic stimuli.

The effects of postnatal methyl mercury exposure on the ontogeny of renal and hepatic responsiveness to trophic stimuli were examined. Increased ornithine decarboxylase (ODC) activity was used as an index of tissue stimulation. In the rat, renal ODC responsiveness to growth hormone, angiotensin, vasopressin, isoproterenol, and serotonin was absent at birth and matured 3 to 4 weeks later. However, pups exposed to methyl mercury showed marked, ODC responses to these same agents as early as 10 to 19 days of postnatal age, accompanied by a significant renal hypertrophy. In contrast to the kidney, the liver of normally developing rats was responsive to trophic factors even in the neonate. In this tissue, there was no consistent effect of neonatal methyl mercury treatment on ODC responses at any developmental stage tested; although absolute liver weights were reduced, liver/body weight ratio was not affected. These results demonstrate that postnatal methyl mercury exposure causes a precocious onset of ODC responses to trophic agents specifically in the kidney. Altered responsiveness may mediate some of the effects of this organomercurial on overall renal development and function.

Animals↗

PubMed1985

The results of chemotherapy for extragonadal germ-cell tumors in the cisplatin era: the Memorial Sloan-Kettering Cancer Center experience (1975 to 1982).

Thirty-eight patients with extragonadal germ-cell tumors treated at Memorial Sloan-Kettering Cancer Center (New York) between 1975 and 1982 received high-dose cisplatin-based chemotherapy. Complete response was achieved in 89% of patients with pure seminoma and all complete responders are alive without evidence of disease (median follow-up time, 29+ months). Complete response was achieved in only 41% (12 of 29) of patients with extragonadal nonseminomatous germ-cell tumors; only four patients are alive and free of disease (median survival time, 18 months). Although patients with extragonadal seminoma respond well with current cisplatin-based chemotherapy, minimal improvement in CR rates has been achieved in patients with extragonadal nonseminomatous tumors. Patients with extragonadal nonseminomatous germ-cell tumors have a relatively poor prognosis when compared to patients with primary testicular tumors and investigational trials of innovative therapy should be considered.

Adolescent↗

PubMed1984

Phase II trial of doxorubicin in bidimensionally measurable prostatic adenocarcinoma.

Intravenous doxorubicin (30 to 60 mg. per m.2 every 3 weeks) was administered to 52 patients with metastatic adenocarcinoma of the prostate, including 41 with bidimensionally measurable soft tissue lesions. Prior therapy in the measurable disease group included hormonal manipulation in 39 cases, irradiation in 39 and cytotoxic drugs in 19. In 39 of 41 adequately treated patients with soft tissue lesions only 2 (5 per cent, 95 per cent confidence limits 0 to 12 per cent) achieved a partial remission for 12 and 6 months, respectively, 3 had a minor response for 5, 4 and 3 months, respectively, and 1 had stabilization of disease for 4 months. Survival in this group was 16 months versus 5 months for patients with a mixed response and progression of disease. Of 11 patients with evaluable parameters only 1 had stabilization and 5 showed subjective improvement. Recognizing the patient selection bias and treatment schedule in this study, we believe that doxorubicin has marginal activity in soft tissue lesions in patients with advanced prostatic cancer.

Adenocarcinoma↗

PubMed1983

Interrelationships of histopathology and other clinical variables in patients with germ cell tumors of the testis.

Possible relationships between histopathologic cell type and several clinical variables were examined in 253 patients with Stage III nonseminomatous germ cell tumors of the testis. No statistically significant associations were found between cell type and either the side of primary tumor or cryptorchidism. The presence of elements of choriocarcinoma was associated with the presence of retroperitoneal tumor (P less than 0.03) but no other association between cell type and site of metastasis was encountered. Elevated serum levels of human chorionic gonadotropin were found in patients with elements of choriocarcinoma but serum levels of alphafetoprotein, lactate dehydrogenase and carcinoembryonic antigen were not correlated with a specific cell type. No statistically significant association was found between cell type and either complete response to combined modality therapy or survival. These results would indicate that cell type is probably not an important prognostic variable in patients with Stage III nonseminomatous tumors of the testis.

Carcinoembryonic Antigen↗

PubMed1983

Impact of symptomatic interval on prognosis of patients with stage III testicular cancer.

In patients with testicular cancer, the interval from the onset of symptoms to histologic diagnosis has been correlated with extent of disease. To determine whether or not the symptomatic interval was related to response to chemotherapy and extent of disease in patients presenting with metastatic disease, the charts of 253 patients treated with chemotherapy were reviewed. In the 123 patients presenting with metastatic disease, for whom the symptomatic interval was known, complete response was significantly associated with the symptomatic interval (P = 0.039). A trend was noted between the symptomatic interval and the extent of retroperitoneal metastases (P = 0.065). The survival of patients with testicular cancer in all stages may be improved by heightening public awareness through educational programs.

Antineoplastic Agents↗

PubMed1981

Randomized trial of standard therapy with or without poly I:C in patients with superficial bladder cancer.

Thirty-two patients with superficial urinary bladder tumors were stratified for four variables and randomized after complete transurethral resection and/or fulguration of tumor to receive standard therapy with or without intravenous Poly I:C. Cystoscopies were performed at three- to four-month intervals for up to 48 months. While there was no statistically significant difference in the tumor recurrence rates in the two groups during the first year, a significant increase (P = 0.003) in survival at four years was observed between the Poly I:C group and the control group. The difficulties in evaluating the efficacy of anti-neoplastic agents in the treatment of superficial bladder tumors are discussed.

Aged↗

PubMed1981

Adjuvant chemotherapy with VAB-3 of stage II-B testicular cancer.

A recent report from the Memorial Sloan-Kettering Cancer Center has indicated that patients with resected Stage IIB (N-2B and N-3) testicular cancer are at significant risk for relapse. Of patients with resected Stage IIB disease (N-2B, 19%; N-3, 54%), 34% relapsed after having undergone relatively mild adjuvant chemotherapy consisting of vinblastine, actinomycin D, bleomycin, and chlorambucil (VAB). In this study, 29 patients with resected Stage IIB testicular cancer underwent treatment with adjuvant VAB-3 which has been used as primary treatment for Stage III disease. All patients have remained in complete remission with a median follow-up time of 24 months. Three patients received broad spectrum antibiotics when fever and leukopenia developed. No patient experienced renal failure. The results of this study demonstrate the capability of aggressive adjuvant chemotherapy to prevent recurrence in the high-risk setting of resected Stage II (N-2B and N-3) disease. Optimal adjuvant treatment remains to be defined.

Antineoplastic Agents↗

PubMed1976

Chemotherapy of germ cell tumors of the testis. I. Induction of remissions with vinblastine, actinomycin D, and bleomycin.

Patients with disseminated testicular carcinoma were treated with the combination of vinblastine, actinomycin D, and bleomycin in an attempt to induce remission. Of 47 patients receiving an initial adequate trial of this regimen, 34% achieved a complete or partial remission; in the 18 patients with either no prior nonsurgical treatment or treatment with actinomycin D alone, the response rate was 61%. Those who attained complete response status enjoyed significant prolongation of life compared with the nonresponders or partial responders. Responses were seen in all histologic categories and were not related to the performance status of the patient at the start of the trial, to the total dose of drug in the first mouth of therapy, or the extent of hematologic toxicity produced by the drugs. Responders had a higher incidence of stomatitis than nonresponders.

Adolescent↗

PubMed1976

Therapeutic trial of aniline mustard in patients with advanced cancer. Comparison of therapeutic response with cytochemical assessment of tumor cell beta-glucuronidase activity.

Seventy-eight patients with advanced cancer received an adequate therapeutic trial with aniline mustard (NSC 18429). Significant anticancer activity with clinical benefit was demonstrated in five patients with cancer of the prostate and one patient with renal cancer. beta-glucuronidase levels in aspirate and imprint preparations of tumor cells were assessed by a timed cytochemical technique. A partial correlation appeared to exist between very intense glucuronidase staining and tumor regression in prostate and kidney lesions; however, these high levels were observed only rarely. Sequential observations in two patients demonstrated loss of enzymatic activity concomitant with development of clinical relapse.

Aniline Mustard↗