Showing papers by "Richard M. Hoffman published in 2000"

How common are various causes of dizziness? A critical review.

Abstract: Background.Although dizziness is a common symptom in both primary care and referral practices, the relative frequency of various causes has not been well delineated.Methods.A MEDLINE search identified 12 articles containing original data on the etiology of dizziness in consecutive patients.

Laser prostatectomy for benign prostatic obstruction.

Abstract: Background Symptomatic benign prostatic obstruction is a common problem for older men. The gold standard treatment, transurethral resection of the prostate (TURP), significantly improves urinary symptoms and urinary flow. However, TURP has up to a 20% morbidity. Currently, there are a number of minimally invasive procedures that may be safe, effective alternatives to TURP. One promising surgical technique is laser prostatectomy. Objectives To assess the therapeutic efficacy and safety of laser prostatectomy techniques for treating men with symptomatic benign prostatic obstruction. Search strategy Randomized controlled trials were identified from the Cochrane Collaboration Library, MEDLINE, EMBASE, bibliographies of retrieved articles and reviews, and contacting expert relevant trialists and laser manufacturers. Selection criteria All randomized controlled trials evaluating laser prostatectomy treatment for men with symptomatic BPH. Trials were eligible if they (1) were randomized comparisons of a laser technique with TURP, (2) included at least 10 men with BPO in each treatment arm, (3) provided at least 6-months follow-up, and (4) included clinical outcomes such as urologic symptom scales or urodynamic measurements. Data collection and analysis Data extraction and assessment of methodologic quality was performed independently by two reviewers. Information on study design, subject and treatment characteristics, adverse events, urinary symptoms, and urinary flow were extracted using a standard form. Main results 20 studies involving 1898 subjects were evaluated, including studies 4 with multiple comparisons. We found 8 comparisons of TURP with contact lasers, 8 with non-contact lasers, 4 with hybrid techniques, and one with interstitial laser coagulation (ILC). Two studies compared transurethral electrovaporization (TUVP) with contact lasers, one study compared interstitial laser coagulation with transurethral microwave thermotherapy (TUMT), and one study compared holmium contact lasers (HoLRP) with open prostatectomy. Among the studies comparing laser prostatectomy with TURP, follow-up duration ranged from 6 to 36 months. Mean age (67.2 yrs), mean baseline symptom score (20.2), and mean baseline peak urinary flow (9.2 ml/s) did not differ by treatment group. The pooled percentage improvements for mean urinary symptoms ranged from 59% to 68% with lasers and 63% to 77% with TURP. The improvements for mean peak urinary flow ranged from 56% to 119% with lasers and 96% to 127% with TURP. Overall, laser subjects were less likely to receive transfusions or develop strictures and their hospitalizations were shorter. Non-contact laser subjects were more likely to have dysuria, urinary tract infection, and retention. Re-operation occurred more often following laser procedures. Reviewer's conclusions Laser techniques are a useful alternative to TURP for treating BPO. Small sample sizes and differences in study design limit any definitive conclusions regarding the preferred type of laser technique. Data were insufficient to compare laser techniques with other minimally invasive procedures.

Using the Free-to-total Prostate-specific Antigen Ratio to Detect Prostate Cancer in Men with Nonspecific Elevations of Prostate-specific Antigen Levels

Abstract: BACKGROUND: Prostate-specific antigen (PSA) levels between 4.0 to 10.0 ng/ml have poor specificity in prostate cancer screening, leading to unnecessary biopsies.

Patient and tumor characteristics of colon cancers with microsatellite instability: a population-based study.

Abstract: Molecular screening for microsatellite instability (MSI) in colon cancers has been proposed to identify individuals with hereditary nonpolyposis colorectal cancer. To date, most reports of MSI in colorectal cancer have been based on studies of clinical case series or high-risk families. We examined the proportion of incident colon cancers in the general population that exhibit MSI by patient and tumor characteristics. We interviewed 201 colon cancer cases ascertained by the New Mexico Tumor Registry in the metropolitan Albuquerque area for demographic information, lifestyle factors, medical history, and family cancer history. Paired normal and tumor tissue specimens were obtained for each case. Three microsatellite markers were used; instability was defined as observed alteration at two or more loci. Overall, 37 of 201 (18%) colon cancers exhibited instability. MSI was more common among cases >70 years (26%) and most common among cases >80 years (38%). MSI was significantly associated with tumors in the proximal colon and with later stage and poor differentiation among cases >70 years. MSI was not associated with a history of polyps. Family history of colorectal cancer was associated with MSI only among cases <50 years. When all factors were analyzed jointly in a regression model, proximal subsite and poor differentiation remained significantly associated with MSI. One patient, whose tumor exhibited MSI, fulfilled the Amsterdam Criteria for hereditary nonpolyposis colorectal cancer. Our study provides a population-based estimate of MSI in colon tumors and a representative estimate of the proportion of colorectal cancer patients in the general population who consent to be interviewed for family cancer history and to have biological samples analyzed.

Vitamin E did not reduce myocardial infarction, death, or stroke in adults at high risk for cardiovascular events

Abstract: (2000) N Engl J Med 342, 154. The Heart Outcomes Prevention Evaluation Study Investigators. . Vitamin E supplementation and cardiovascular events in high-risk patients. . Jan 20; . : . –60 . [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTION: In adults who have a high risk for cardiovascular events, do vitamin E supplements improve cardiovascular outcomes? Randomised {allocation concealed*}†, blinded {patients, clinicians, and outcome assessors}‡,* placebo controlled trial with a 2 × 2 factorial design and a mean follow up of 4.5 years (Heart Outcomes Prevention Evaluation [HOPE] study). {161 centers in North America, 76 in 14 western European countries, and 30 in Argentina and Brazil.}‡ 9541 patients (mean age 66 y, 73% men) who were {≥55 years of age and had a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes and ≥1 other cardiovascular disease risk factor. Exclusion criteria were heart failure, ejection … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DThe%2BHeart%2BOutcomes%2BPrevention%2BEvaluation%2BStudy%2BInv%26rft.auinit1%253D%2B%26rft.volume%253D342%26rft.issue%253D3%26rft.spage%253D154%26rft.epage%253D160%26rft.atitle%253DVitamin%2BE%2BSupplementation%2Band%2BCardiovascular%2BEvents%2Bin%2BHigh-Risk%2BPatients%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJM200001203420302%26rft_id%253Dinfo%253Apmid%252F10639540%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJM200001203420302&link_type=DOI [3]: /lookup/external-ref?access_num=10639540&link_type=MED&atom=%2Febmed%2F5%2F5%2F137.atom [4]: /lookup/external-ref?access_num=000084851700002&link_type=ISI