In 1972, a prospective, randomized, multi-institutional, cooperative clinical trial was begun to evaluate the efficacy of prolonged 1-phenylalanine mustard (L-PAM) administration following operation in lengthening the disease free interval of patients with primary breast cancer. That protocol using a single agent was the first of a series directed toward evaluating successively more complex chemotherapeutic regimens in an attempt to define subsets of patients which might be responsive to less therapy than others. When it was observed that L-PAM prolonged the disease free interval, particularly of premenopausal patients, findings were reported and a new evaluation comparing L-PAM with L-PAM plus 5-fluorouracil (5-FU) was begun. Upon completion of patient accrual in that protocol, an additional trial comparing L-PAM and 5-FU with L-PAM, 5-FU and Methotrexate was implemented. The present report updates findings from the initial study and presents those from the second. It compares results across the first two protocols as well as between groups within a protocol. While insufficient time has elapsed for determining the ultimate worth of the modalities employed, findings from the second protocol confirm those previously reported indicating that L-PAM lengthens the disease free interval following mastectomy. The combination of L-PAM with 5-FU resulted in a reduction of treatment failure at 12 months which is as good or better than that observed with L-PAM in the first protocol lending further credibility to the earlier findings. While at the end of the first year following mastectomy there was alomst a 50% reduction in treatment failures in patients aged 50 or over (post-menopausal), by 18 months the reduction was 23% and at two years, based on small numbers of patients, only 5%. Examination of results from the first protocol (placebo vs L-PAM) after two years reveals a most highly significant effect of L-PAM in pre-menopausal women with one to three positive nodes. There is an 89% redqction of treatment failures. A similar but less striking effect is noted for those under 50 with 2four positive nodes. In older patients in both nodal categories, the early observed effect for L-PAM has decreased with time. Inter-protocol comparisons relative to survival are premature. At two years survival in L-PAM patients is 36% greater than in those receiving placebo. It is somewhat better in every subgroup for those receiving L-PAM. Information relative to the effect of these agents on patient toxicity and loco-regional treatment failures is presented. All of the findings stress the ~
A non-steroidal antiandrogen (flutamide) was used to treat 17 patients with advanced prostatic cancer. Twelve of 14 patients who had already failed to respond to conventional hormone therapy were dead within 12 months of starting flutamide therapy and there was a high incidence of side effects. Of three patients who had not received prior hormone therapy, two showed an early partial response and one showed no evidence of response to therapy.
Introduction: General Medical Council (GMC) guidelines and the Ayling report recommend that a chaperone should be offered to all patients for every intimate examination. We wanted to establish whether these guidelines reflect men's preferences and urologists' current practice in intimate examination. Methods: All male patients attending urology outpatient clinics over a 3 month period at two hospitals were asked to fill in a preference questionnaire. A separate questionnaire was sent to all urologists in Scotland to establish the current practice.Results: 315 patients returned evaluable questionnaires. While 227 patients (73%) felt that a chaperone should be offered, only 45 patients (14.3%) wanted a chaperone. Of these, only 15 patients (4.8%) would not have been comfortable to ask for a chaperone. 64 (75.3%) Scottish urologists responded and only 3 (4.7%) urologists offered a chaperone to all male patients. 47 (73.4%) urologists did not routinely counsel patients about intimate examination under anaesthesia as part of transurethral surgery. Conclusion: Most men do not wish a chaperone to be present. Recommended best practice will protect the small minority of patients who want to have a chaperone. This involves the offer of a chaperone to all patients and accurate record keeping in the patient's case note.
The initial investigation and diagnosis in 28 patients with posterior urethral trauma are presented. Twenty-five patients underwent either primary realignment for complete rupture or cystostomy alone for partial rupture. The results of their management are reported.
Varicella Zoster affecting the sacral dermatomes is a rare but well recognised cause of urinary retention. Only one case of erectile dysfunction associated with Varicella Zoster has previously been described, which was longstanding, but no cases of transient erectile dysfunction following Zoster infection are recorded. We present one such case.
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