Changes in radical prostatectomy and radiation therapy rates for African Americans and whites.

There are racial differences in prostate cancer outcomes. One variable influencing end results is treatment for cure: either radical prostatectomy (RP) or radiation therapy (RT). The purpose of this report is to determine changes in diagnosis rates of localized prostate cancer between the years before prostate-specific antigen (PSA) use (1973-1988) and the years after PSA use (1989-1996), to evaluate differences in RP and RT rates between the pre-PSA and post-PSA eras, to assess differences in RP and RT rates between African Americans and whites between these intervals. The Surveillance, Epidemiology, and End Results (SEER) data were used and evaluated. Both African Americans and whites had statistically increased rates of localized prostate cancer diagnosed (70.4 and 49.0 in 1973 through 1988 and 123.1 and 84.9 in 1989 through 1996, respectively [p < 0.05]). The differences between the pre-PSA and post-PSA eras for African Americans and whites for RP (3.6 vs. 44.3 and 5.0 vs. 44.9, respectively) and RT (23.6 vs. 61.6 and 17.0 vs. 38.1, respectively) were all significant (p < 0.05). Both African Americans and whites had increased rates of RP from 3.6 and 5.0 to 44.3 and 44.9, respectively, and RT from 23.6 and 17.0 to 61.6 and 38.1 during the pre- and post-PSA years.

Urethroplasty following total phallic reconstruction.

PURPOSE: Total phallic reconstruction is often complicated by recalcitrant strictures particularly at the native-to-neourethral anastomosis, which may ultimately require definitive repair. Presumably these strictures form as a result of relative ischemia at the anastomosis of tissues of native urethra to fasciocutaneous tube flap, which is exacerbated by kinking at the neophallus base. The traditional approaches to urethroplasty, such as end-to-end anastomosis, and penile or preputial skin grafts and flaps, are not available for this population. Therefore, extragenital grafts and flaps become important for managing repair of urethral strictures in the neophallus. In addition, an unusual recipient bed of fat and fascia complicates the repair of these strictures. We review our experience with 15 patients who underwent penile reconstruction. MATERIALS AND METHODS: A total of 15 patients 17 to 50 years old had a radial forearm flap except 1 who had a fibula based flap. Nine urethroplasties were performed on 8 patients who were followed for a mean of 31.8 months. The approaches comprised 3, 2-stage mesh graft urethroplasties, 1 full-thickness skin tube graft, 1 bladder mucosa tube graft, 1 vagina labial pedicle tube flap and, most recently, 3 buccal mucosa onlay grafts. The length of strictures ranged from 3 to 12 cm. Urethroplasty was performed 2 to 34 months after phallic construction. RESULTS: Urinary flow rates in patients with buccal mucosa urethroplasty averaged 18 cc per second and no strictures recurred. These results are superior to those of other urethroplasty techniques in this patient population. CONCLUSIONS: A full array of surgical options must be available to the reconstructive surgeon but buccal mucosa grafting seems to be a promising approach to strictures in this patient population.

Treatment of subclinical intraurethral human papilloma virus infection with interferon alfa-2b.

OBJECTIVES: Anogenital human papilloma virus (HPV) infection represents a growing concern among physicians in the United States. An intraurethral reservoir of the virus has been suggested as a possible source for reinfection between sexual partners, and may contribute to the increase in the number of affected individuals. Treatment reports of intraurethral HPV infection with adequate follow-up have been lacking. Our goals in this study were to identify the patients with cytologic evidence of HPV intraurethral infection, and to attempt treatment with intraurethral instillations of interferon alfa-2b. METHODS: Eighty-nine men with anogenital lesions or known exposure to HPV underwent cytologic examination using a urethral swab after all visible disease was adequately treated. Sixteen patients with positive cytology results were treated with weekly instillations of 25 million U of interferon alfa-2b solution for 6 weeks. Urethral cytology was monitored at 2 and 6 weeks post-treatment, as well as every 3 months thereafter up to a year. Those who had a recurrence during the study were retreated with a 6-week course using 50 million U per instillation. Patients were monitored for possible side effects. RESULTS: Seventeen (19%) of 89 patients who entered the study had urethral cytology positive for HPV infection with no evidence of visible disease. Seven (41%) of these 17 patients did not show external (meatal or skin) manifestations of the disease. Fourteen of 16 (88%) men who underwent the therapy were followed for an average of 11.8 months. Nine of those 14 (64%) remained disease free throughout the follow-up. Of the 5 who had a recurrence, 3 were successfully retreated, with a mean of 7.2 months of disease-free follow-up after the second course. No adverse effects of the treatment were noted by blood testing, semen analysis, and patient report. CONCLUSIONS: The urethra is a significant HPV reservoir and should be investigated in patients exposed to the virus. Interferon is a potentially safe and effective treatment option for intraurethral HPV.

Stratospheric aerosol measurements with implications for global climate.

In this paper we present measurement results obtained in New Mexico with bistatic optical probing of the atmosphere using a searchlight beam. The data yield vertical profiles of the aerosol attenuation coefficient. Because they approximate proportionality to aerosol concentration, these profiles provide information concerning the aerosol layer structure and its parameters. During a 9-day period in October and November 1970, a series of forty-one such profiles was obtained which includes altitudes 12-25 km, selected for study because of the relatively high aerosol content of this stratospheric region and its relation to global climate. The mean stratospheric aerosol distribution for this period is double layered with maxima at 15.6 km and 19.3 km. An early phase of volcanic dust incursion is examined. A chronology of stratospheric aerosol concentration levels is developed based on measurements with the same instrumentation at the same sites since February 1963. The chronology shows that the particulate background level of a nonvolcanic, nonpolluted stratosphere is represented by an aerosol optical thickness Tau(p)(O.55 micro) = 2.0 x 10(-2). A calculation with this background level is included, which indicates feasibility of a laser-satellite method for acquiring data related to global climate. The Appendix introduces an original method of numerical integration (used in the calculations), which is suited to radiative transfer studies.

Relationships between vertical attenuation and surface meteorological range.

An examination of the haze regime, used in the sense of diminished surface meteorological range, shows that the lower and upper limits can be defined by meteorological ranges 1.2 km and 15 km, respectively. In order to develop relationships between surface haze and vertical attenuation, eight meteorological ranges are selected from within these limits; then, vertical aerosol attenuation parameters are computed by deriving an aerosol scale height for each meteorological range. A sample tabulation for one of twenty wavelengths in the uv, visible, and ir is presented and combined with previously published attenuation parameters (aerosols, molecules, and ozone) to the 5O-km altitude.

Features of tropospheric and stratospheric dust.

A series of 119 profiles obtained over New Mexico comprise aerosol attenuation coefficients vs altitude to about 35 km. These profiles show the existence of several features. A surface convective dust layer extending up to about 5 km is seasonally dependent. Also, a turbidity maximum exists below the tropopause. The altitude of an aerosol maximum in the lower stratosphere is located just below that of the minimum temperature. The colder the minimum temperature, the greater is the aerosol content of the layer. This relationship suggests that the 20-km dust layer is due to convection in tropical air and advection to higher latitudes. Computed averages of optical thickness show that abatement of stratospheric dust from the Mt. Agung eruption became evident in April 1964. Results based on seventy-nine profiles characterizing volcanic dust abatement indicate that above 26 km, the aerosol scale height averages 3.75 km. Extrapolating with this scale height, tabulations are developed for uv, visible, and ir attenuation to 50 km. Optical mixing ratios are used to examine the aerosol concentrations at various altitudes, including a layer at 26 km having an optical thickness 10(-3) for 0.55-micro wavelength.

Aerosol measurements in the troposphere and stratosphere.

Light scattering measurements from a searchlight beam were carried out in New Mexico to determine the aerosol properties of the atmosphere. Although data were acquired to an altitude of about 70 km, the results show the aerosol attenuation parameters to be significant to about 35 km. The expression for the aerosol attenuation coefficient is derived based on the field geometry in conjunction with Rayleigh and aerosol scattering considerations. The results are categorized into moderate-structured, medium-structured and full-structured aerosol profiles. Examples of each are discussed and measurements presented which show variation over a 6-h period. A quantitative examination is made of the 20-km aerosol layer. Also, a medium-structured profile is selected and treated more extensively to provide preliminary information pertaining to atmospheric scattering and transmission. Ultimately, the data accumulated will provide a substantial number of profiles that will form a basis for various atmospheric studies.