Clinical characteristics of African-American men with hereditary prostate cancer: the AAHPC Study.

INTRODUCTION: The African-American Hereditary Prostate Cancer (AAHPC) Study was designed to recruit African-American families fulfilling very stringent criteria of four or more members diagnosed with prostate cancer at a combined age at diagnosis of 65 years or less. This report describes the clinical characteristics of a sample of affected AAHPC family members. METHODS: In all, 92 African-American families were recruited into the study between 1998 and 2002. Complete clinical data including age and PSA at diagnosis, number of affected per family, stage, grade, and primary treatment were available on 154 affected males. Nonparametric Wilcoxon two-sample tests and Fisher's exact test (two-tailed), were performed to compare families with 4-6 and >6 affected males with respect to clinical characteristics. RESULTS: The mean number of affected men per family was 5.5, with a mean age at diagnosis of 61.0 (+/-8.4) years. Age at diagnosis, PSA and Gleason score did not show significant differences between the two groups of families. Based on the Gleason score, 77.2% of affected males had favorable histology. Significantly, there were marked differences between the two groups in the frequency of node-positive disease (P=0.01) and distant metastases (P=0.0001). Radical prostatectomy was the preferred primary therapy for 66.2% of all affected men followed by 20.8% who chose radiation therapy. CONCLUSIONS: Our findings suggest that affected males who carry the highest load of genetic factors are at the highest risk for early dissemination of disease, thus efforts at early diagnosis and aggressive therapeutic approaches may be warranted in these families. Since the primary therapy choices in our study favored definitive treatment (87.0%) when compared to the 1983 and 1995 SEER data in which 28 and 64% received definitive treatment, respectively, it appears that affected African-American men in multiplex families may be demonstrating the reported psycho-social impact of family history on screening practices and treatment decisions for prostate cancer.

Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire.

OBJECTIVES: To assess the efficacy and safety of Viagra (sildenafil citrate) in male outpatients with erectile dysfunction and patient and partner satisfaction with treatment using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). METHODS: A total of 247 patients with erectile dysfunction of broad-spectrum etiology were treated in a randomized, double-blind, parallel-group, multicenter study conducted at outpatient clinics. Patients receiving oral sildenafil (25, 50, and 100 mg) were compared with patients receiving placebo during a 12-week period. The principal efficacy measures were responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) on the International Index of Erectile Function and three global efficacy questions. Patient and partner satisfaction with treatment were assessed, for the first time, using the EDITS questionnaire. RESULTS: Efficacy scores for the International Index of Erectile Function questions and the global efficacy questions were significantly higher for patients receiving sildenafil than for those receiving placebo (P <0.001). Both patients and partners receiving sildenafil also had significantly higher EDITS scores than those receiving placebo (P <0.001). Adverse events were chiefly mild or moderate. Two patients receiving sildenafil and none receiving placebo discontinued treatment because of adverse events. CONCLUSIONS: Sildenafil was an effective, well-tolerated treatment for erectile dysfunction in an outpatient setting. Partner evaluations corroborated patient assessments. The results from the EDITS questionnaire indicated that after 12 weeks of receiving sildenafil both patients and partners reported higher levels of treatment satisfaction relative to placebo.

African-American heredity prostate cancer study: a model for genetic research.

A genome-wide scan of high-risk prostate cancer families in North America has demonstrated linkage of a particular marker to Chromosome 1q (HPC1). An even greater proportion of African-American families have shown linkage to HPC1. Therefore, investigators at the National Human Genome Research Institute (NHGRI) in collaboration with Howard University and a predominantly African-American group of urologists established the African-American Hereditary Prostate Cancer (AAHPC) Study Network to confirm the suggested linkage of HPC in African Americans with a gene on Chromosome 1. Blood samples from recruited families were sent to Howard University for extraction of DNA. The DNA was sent to NHGRI at NIH where the genotyping and genetic sequence analysis was conducted. Genotype data are merged with pedigree information so that statistical analysis can be performed to establish potential linkage. From March 1, 1998, to June 1, 1999, a total of 40 African-American families have been recruited who met the study criteria. Preliminary results suggest that racial/ethnicity grouping may affect the incidence and extent of linkage of prostate cancer to specific loci. The importance of these findings lays in the future treatment of genetic-based diseases.

African-American heredity prostate cancer study: a model for genetic research.

A genome-wide scan of high-risk prostate cancer families in North America has demonstrated linkage of a particular marker to Chromosome Iq (HPC11. An even greater proportion of African-American families have shown linkage to HPC 1. Therefore, investigators at the National Human Genome Research Institute [NHGRI] in collaboration with Howard University and a predominantly African-American group of urologists established the African-American Hereditary Prostate Cancer (AAHPC) Study Network to confirm the suggested linkage of HPC in African Americans with a gene on Chromosome 1. Blood samples from recruited families were sent to Howard University for extraction of DNA. The DNA was sent to NHGRI at NIH where the genotyping and genetic sequence analysis was conducted. Genotype data are merged with pedigree information so that statistical analysis can be performed to establish potential linkage. From March 1, 1998, to June 1, 1999, a total of 40 African-American families have been recruited who met the study criteria. Preliminary results suggest that racial/ethnicity grouping may affect the incidence and extent of linkage of prostate cancer to specific loci. The importance of these findings lays in the future treatment of genetic-based diseases.

Recruitment experience in the first phase of the African American Hereditary Prostate Cancer (AAHPC) study.

The African American Hereditary Prostate Cancer (AAHPC) Study is an ongoing multicenter genetic linkage study organized by Howard University and the National Human Genome Research Institute (NHGRI), with support from the Office for Research on Minority Health and the National Cancer Institute. The goals of the study are to: (i) look for evidence of involvement of chromosome 1q24-25 (HPC1) in African American men with hereditary prostate cancer (HPC) and (ii) conduct a genome-wide search for other loci associated with HPC in African American men. To accomplish these goals, a network has been established including Howard University, the NHGRI, and six Collaborative Recruitment Centers (CRCs). The CRCs are responsible for the identification and enrollment of 100 African American families. To date, 43 families have been enrolled. Recruitment strategies have included mass media campaigns, physician referrals, community health-fairs/prostate cancer screenings, support groups, tumor registries, as well as visits to churches, barber shops, and universities. By far, the most productive recruitment mechanisms have been physician referrals and tumor registries, yielding a total of 35 (81%) families. Approximately 41% (n = 3400) of probands initially contacted by phone or mail expressed interest in participating; the families of 2% of these met the eligibility criteria, and 75% of those families have been enrolled in the study, indicating a 0.5% recruitment yield (ratio of participants to contacts). As the first large-scale genetic linkage study of African Americans, on a common disease, the challenges and successes of the recruitment process for the AAHPC Study should serve to inform future efforts to involve this population in similar studies.

Transparenchymal suture fixation and testicular histology in a prepubertal rat model.

We evaluate the effect on testicular histology when fine suture materials are used for transparenchymal suture fixation of the testis during orchiopexy in immature Sprague-Dawley rats. Significant inflammatory reactions were observed in all groups of animals with suture fixation regardless of suture size and material. Only 5% of the animals in the dartos pouch control group had an inflammatory response and no inflammation was noted in the nonoperative controls. Although these findings have not been documented in humans, this evidence raises concerns about the impact of surgical technique on the future reproductive capabilities of these testes. Alternatives to transparenchymal suture fixation of the testis should be considered in patients with cryptorchidism and testicular torsion. Sutureless dartos pouch placement may provide adequate fixation during most orchiopexies without risking injury to testicular structure and function.

Renal tumors in young adults.

Primary renal malignancies are relatively rare in young adults. Eighteen patients between the ages of twenty and forty years underwent nephrectomy for renal tumors at our institution between 1947 and 1989. Data were reviewed in this group regarding method of presentation, duration of symptoms, tumor histology, pathologic stage, and survival. Tumor histology parallels that of older patients, the majority being adenocarcinoma (78%). The duration of symptoms prior to seeking medical attention was long, averaging eighty-four weeks. The overall survival rate, excluding nontumor deaths, was 50 percent. No patient with nodal or distant metastases survived, regardless of histology.

Complete urinary obstruction following periurethral polytetrafluoroethylene injection for urinary incontinence.

We report a unique case of foreign body granulomatous reaction after periurethral polytetrafluoroethylene injection causing complete urinary obstruction. Urinary obstruction in the immediate postoperative period and granuloma formation following polytetrafluoroethylene injection are not unusual. To our knowledge delayed complete urinary obstruction after polytetrafluoroethylene injection has not been described previously in the urological literature.

Experimental evidence of a strategy for a beat swing prior to a kip.

Throughout a beat swinging motion prior to a kip the gymnast changes the relative orientation of his legs and head-torso with respect to his arms. It was observed that if these changes occurred in a correct order he could rapidly increase his swing with his limited strength. If changes in orientation of the body parts did not take place in a correct phase, the person would immediately begin to lose any height gained. Previous measurements of the filmed motion of a gymnast performing this motion and his anthropometric dimension and were used to compute from the Dempster-Hanavan model the gymnast's center-of-mass (CM) and polar moment-of-inertia (I) at each instant throughout the maneuver. A simple mechanical model should be able to reproduce the time history of the CM. This model provides some insight into what might be required to increase one's swing. From filmed motion of "good" and "bad" beat swings leading to a kip and this simple model a simple strategy was devised. Graphs are presented which show that the simple strategy is related to the gymnast's radius-of-gyration. The simple strategy is only for the swinging motion. It was concluded that the strategy of the final, small segment of the kip was not the same as that during the swinging segment but a complex one of largely utilizing the accumulated angular momentum.

Personalized, electro-kinematic, neuromuscular model of a human forearm.

Electromyography, the recording of muscular activity, is of importance in industrial, biomechanical, and sports research as well as in medical diagnoses. When a muscle is activated, an electric potential in the order of microvolts (muV) is generated. This potential can be picked up, amplified, and displayed on an oscilloscope or strip chart recorder. Researchers have developed ways of analyzing these signals in terms of their characteristics. A numerical index, which reflects the basic characteristics of the electromyogram, mainly amplitude, frequency, and duration, can be used to provide quantitative information. The method used in this work for EMG processing consisted of filtering, rectification, and integration over very small intervals of time. Both analog and digital filtering proved necessary. Angular accelerometer and rotational potentiometer data were used in conjunction with limb inertia parameters obtained from existing biochemical models for the individual tested for obtaining the torques as a function of time. A system parameter identification method was used to determine the muscle parameters, such as occur in the single muscle Hill model, of four muscle groups for a human arm. The main results consist of personalized arm muscle group models. It was concluded that the method provided excellent (fit) personalized arm muscle group models under dynamic conditions. This method could lead to fundamental scientific information about a living muscle group from experiments in vivo.