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A Reissigl

Publications and source records attributed to A Reissigl.

33 records · Page 2Linked to original sources
PubMed1996

Usefulness of the ratio free/total prostate-specific antigen in addition to total PSA levels in prostate cancer screening.

OBJECTIVES: Two different studies were performed. The aim of the first study was to define whether the measurement of the ratio between free and total prostate-specific antigen (f/t PSA) in serum may enhance the ability of PSA-based screening for early detection of prostate cancer in men with elevated serum PSA levels. A second study was undertaken to investigate the value of f/t PSA ratio in serum to improve the specificity of prostate cancer screening in men with serum PSA levels between 2.5 and 10.0 ng/mL. METHODS: In a retrospective study of 266 men with elevated PSA levels and proven biopsy results, f/t PSA levels were measured using deep frozen serum samples. In a second study we enrolled 158 men with elevated PSA levels according to age reference ranges apparent from our current PSA screening study with additional measurement of the f/t PSA ratio. All study volunteers with a free f/t PSA ratio cutoff point of < or = 22% underwent digital rectal examination, transrectal ultrasonography, and biopsy of the prostate. Free and total PSA levels were measured with the Delfia PSA dual label f/t PSA kit (Wallac Oy Turku, Finland). RESULTS: 106 of 158 men with elevated total PSA values between 2.5 and 10.0 ng/mL (group 1) have been further evaluated and 37 prostate cancers were detected. Mean percentage of free PSA was 10% in men with cancer and 22% in men with benign prostatic hyperplasia. Using a f/t PSA ratio of < or = 22% as a biopsy criterion 30% of the negative biopsies could be eliminated while still detecting 98% carcinomas. CONCLUSIONS: Measurement of f/t PSA reduces the number of unnecessary biopsies in PSA screening without missing many cancers.

Aged↗
PubMed1996

Prostate zones in three-dimensional transrectal ultrasound.

OBJECTIVES: This study was undertaken to evaluate the efficacy of three-dimensional transrectal ultrasound to identify and measure the prostate zones. METHODS: In an anatomic-sonographic study, eight specimens were investigated by means of three-dimensional transrectal ultrasound. Subsequently, the volumes of the prostate and the transition zone were measured by means of a special planimetric program; the images and results obtained were compared with anatomic sections and water displacement volume measurement. Then two groups of patients were investigated by means of three-dimensional transrectal ultrasound; the first group included 90 patients ranging in age from 55 to 85 years who presented with benign prostatic hyperplasia (BPH), which was verified by means of histologic examination. Three-dimensional transrectal ultrasound was performed prior to ultrasound-guided biopsies of the prostate. The second group comprised 10 patients aged between 17 and 30 years whose prostates were free of disease. RESULTS: Three-dimensional transrectal sonography is the first imaging technique that can simultaneously demonstrate relevant structures in three planes; apart from the sagittal and the horizontal (or axial) plane, the region of interest can be examined in the coronal plane as well. The structural differences of the prostatic zones in BPH and the juvenile gland can be clearly identified with the help of three-dimensional transrectal ultrasound. The coronal plane provides important additional information; the central zone and the enlarged transition zone can be identified best in this third plane. CONCLUSIONS: The prostate zones, their interrelations, and, in particular, the hyperplasia of the transition zone in BPH are clearly demonstrable. Furthermore, the size of the enlarged transition zone can be exactly measured.

Adolescent↗
PubMed1996

[Laparoscopic spermatic vein ligation].

Between December 1991 and November 1995 a total of 231 patients underwent laparoscopic varix ligation in our department. The laparoscopic varicocelectomy offers a lower rate of morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. The spermatic arteries were identified by using a laparoscopic vascular Doppler probe. Any laparoscopic procedure carries some risk of injury to intra-abdominal organs when placing the primary trocar. Therefore, a new extraperitoneal approach has been developed to avoid these risks.

Adult↗
PubMed1995

Comparison of different prostate-specific antigen cutpoints for early detection of prostate cancer: results of a large screening study.

OBJECTIVES: This study was designed to compare the usefulness of the normal prostate-specific antigen (PSA) level and the age-referenced PSA level in a large screening study for early detection of prostate cancer. METHODS: A total of 21,078 subjects (aged 45 to 75 years) were participants in a 1-year prostate cancer screening project with PSA as the initial test. Of the volunteers, 1618 (8%) showed an elevated PSA level according to age-specific reference ranges, and using the normal PSA cutoff point (4.0 ng/mL), 1872 (9%) had elevated PSA levels between 4.0 and 6.5 ng/mL. RESULTS: Biopsies in both groups were performed if the PSA level was elevated. We evaluated the effect on biopsy rate and cancer detection. A PSA cutoff point of 2.5 ng/mL in men 45 to 49 years old and a PSA cutoff point of 3.5 ng/mL in men 50 to 59 years old with normal digital rectal examination findings resulted in an 8% increase in the number of biopsies (66 of 778) and an 8% increase in organ-confined cancer detection. An increasing cutoff of 4.5 ng/mL in men 60 to 69 years old and 6.5 ng/mL in men 70 to 75 years old resulted in 21% fewer biopsies (205 of 983) and would have missed 4% of organ-confined tumors (8 of 220). CONCLUSIONS: We conclude that the use of PSA age-specific reference ranges increases the detection of clinically important and organ-confined cancers in young men and decreases the number of biopsies in older men.

Aged↗
PubMed1995

Renal cell carcinoma extending into the vena cava: surgical approach, technique and results.

OBJECTIVE: To describe the technique and results of a thoraco-abdominal approach to removing the caval thombi in patients with renal cell carcinoma extending into the vena cava. PATIENTS AND METHODS: Between 1970 and 1990 35 patients presenting with renal cell carcinoma extending into the vena cava were treated at the Department of Urology, Innsbruck. Twenty-three of these patients underwent radical tumour nephrectomy including cavotomy and thrombectomy or caval resection. A transabdominal approach had been used in this department for radical tumour nephrectomy including cavotomy and thrombectomy or caval resection until 1987. Since 1988, a thoraco-abdominal approach has been employed. In group I patients the approach was via the seventh intercostal space, whereas in group II and III patients the thoraco-abdominal incision was made through the fifth intercostal space. In the present study the anatomy of the thoraco-abdominal approach is described. RESULTS: Tumour staging and grading yielded stage T3b in 15 patients (grade I, 1; grade II, 6; grade III, 8); another eight patients with stage T3b were found to have metastatic disease (N1, 6; N2, 2; M1, 3). On the basis of the extension of the caval thrombus the patients were classified as follows: group I, 16; group II, 3; group III, 4. In T3b N0 M0 patients the 5-year-survival rate was 62.5%, while in patients with positive lymph nodes the mean survival rate was 15.5 months. CONCLUSION: Our results suggest that the thoracoa-abdominal approach is the method of choice for the safe removal of renal cell carcinomas associated with caval thombi. If resection of the caval tumour is complete, prognosis is dependent on known factors, such as tumour invasion, nodal involvement and distant metastases rather than the extension of the tumour thrombus. An aggressive approach is not warranted in patients with nodal involvement and/or distant metastases, as it does not improve survival.

Carcinoma, Renal Cell↗
PubMed1995

Diagnostic laparoscopic retroperitoneal lymph node dissection for non seminomatous testicular tumor.

Retroperitoneal lymph node dissection for nonseminomatous testicular tumor. A modified retroperitoneal lymph node dissection for stage I testicular tumor has been described by Weissbach. We have developed a two-step procedure for performing laparoscopic retroperitoneal lymph-adenectomy within these boundaries. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised, and the borders of the dissection are defined. Removal of retroaortic and retrocaval nodal tissue is technically not feasible via the ventral approach. Therefore, in the second step, a lateral approach is employed, which is the key to success since it permits easy transection of the lumbar vessels. Thus complete lymph node dissection can be achieved. Between August 1992 and March 1994 this procedure was performed in 15 patients. In nine patients, the tumor was on the right side and in six on the left. Conversion to open surgery was necessary in two patients because of uncontrollable bleeding and a large metastasis, respectively. Microscopic metastases were detected in two other patients. Apart from the above-mentioned bleeding no major complications occurred; no blood transfusion were required. The results obtained so far demonstrate that this procedure is technically feasible. Therefore, we have decided to perform laparoscopic retroperitoneal lymphadenectomy also in patients with stage II B tumors who have received chemotherapy; to date one patient with a left-sided stage II B tumor has been operated on successfully.

Adult↗
PubMed1994

Androgen signal transduction and prostatic carcinoma.

In the prostate, androgen action affects the growth of the gland, its morphology, and regulation of protein expression. Endocrine therapy of non-organ-confined tumors is based on the androgen dependence of the vast majority of prostatic carcinomas. Although initial response rates are high, this therapy is only temporarily effective. Critical molecular changes ultimately resulting in androgen independence of tumor cells are unknown at this time. The androgen signal-transduction cascade and its central element, the androgen receptor (AR), are possible targets for such changes. Immunohistological analysis using anti-AR antibodies has revealed the presence of AR in a vast majority of therapy-responsive as well as therapy-unresponsive prostatic carcinomas, indicating that loss of AR expression is not the reason for androgen independence. On the other hand, molecular-biology studies have revealed qualitative and quantitative impairment of AR expression in prostatic tumor cell lines that represent very late stages of prostatic carcinoma development. Mutant ARs were detected in the prostatic tumor cell line LNCaP and in two specimens from primary prostatic tumors. The LNCaP mutant AR as well as mutant AR715met, one of the mutant receptors detected in tumor tissue, show a gain of function as compared with the wild-type receptor. In addition to androgens, the natural activators of the AR, the LNCaP receptor is activated also by progestagenic and estrogenic steroids and by the nonsteroidal antiandrogen flutamide. AR715met is activated by adrenal androgens and progesterone in addition to androgens.(ABSTRACT TRUNCATED AT 250 WORDS)

Androgens↗
PubMed1994

Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular tumor.

OBJECTIVES: An appropriate laparoscopic technique for diagnostic retroperitoneal lymph node dissection in clinical Stage I testicular tumors is presented and its efficiency and morbidity are evaluated. METHODS: A two-step procedure has been developed. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised and the borders of dissection are defined. Via the ventral approach removal of retroaortic and retrocaval nodal tissue is technically not feasible. Therefore, in the second step, a lateral approach is used, which is the key to success because it permits straightforward transection of the lumbar vessels. Thus, complete lymph node dissection within the boundaries described by Weissbach can be achieved. Between August 1992 and March 1994, this procedure was performed in 15 patients. In 9 patients, the tumor was on the right side and in 6 it was on the left. RESULTS: Conversion to open surgery was necessary in 2 patients because of uncontrollable bleeding and a large metastasis. Microscopic metastasis were detected in 2 other patients. Apart from the bleeding just mentioned, no major complications occurred; no blood transfusions were required. CONCLUSIONS: The results obtained so far demonstrate that the technique is feasible and decreases postoperative morbidity. It therefore warrants further consideration.

Adult↗
PubMed1994

Laparoscopic repair of pediatric hydroceles.

An open processus vaginalis presenting as hydrocele was transected by means of laparoscopy in four boys aged between 2 and 5 years. In one boy, the internal ring was narrowed with one interrupted suture. In another, an asymptomatic indirect hernia was detected during laparoscopy, and herniorrhaphy was performed by suturing the internal oblique muscle to the inguinal ligament.

Child, Preschool↗
PubMed1994

[Laparoscopic interventions in pediatric urology].

Between January 1992 and June 1993 a total of 36 children underwent laparoscopic surgery in our department. On account of its superior validity, diagnostic laparoscopic surgery for nonpalpable testicles has become a viable alternative to the currently available imaging techniques. Furthermore, diagnostic laparoscopy has the benefit of enabling the surgeon to proceed directly with adequate therapy. Our results gained in 29 pediatric laparoscopic procedures for varicoceles show that it is a very efficient technique that entails few complications. The varicocele persisted in only 1 of the 29 children. In 2 patients laparoscopic nephrectomy was performed, which in technical terms turned out to be less complicated than in adults. Postoperatively, 1 patient developed an incarcerated hernia at the site of trocar insertion. In 2 patients a laparoscopic Lich-Gregoir procedure was performed for vesicoureteral reflux, which, however, cannot yet be considered a viable alternative to the conventional operative techniques.

Adolescent↗
PubMed1994

[Laparoscopic retroperitoneal lymph node excision in clinical stage I non-seminomatous testicular cancer].

Modified retroperitoneal lymph node dissection for stage I testicular tumors has been described by Weissbach. For performing laparoscopic retroperitoneal lymphadenectomy within these boundaries, we have developed a two-step procedure. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised, and the borders of dissection are defined. Removal of retroaortic and retrocaval nodal tissue is technically not feasible from the ventral approach. Therefore, in the second step, a lateral approach is employed, which is the key to success since it allows for easy transection of the lumbar vessels. Thus complete lymph node dissection can be realized. Between August 1992 and June 1993 this procedure was performed in 11 patients. In 7 patients, the tumor was on the right side and in 4 on the left. Conversion to open surgery was necessary in two patients because of uncontrollable bleeding and a large metastasis, respectively. Microscopic metastases were detected in two other patients. No major complications occurred; no blood transfusions were required. So far, the results have been encouraging.

Adult↗
PubMed1993

Laparoscopic retroperitoneal lymphadenectomy in the pig: initial report.

The value of retroperitoneal lymphadenectomy in the management of nonseminomatous testicular tumors is still a matter of controversy. Lymphadenectomy doubtlessly has great advantages but is somewhat down-graded by the considerable associated morbidity. Our experimental study in six pigs has shown that retroperitoneal lymphadenectomy by means of laparoscopic techniques is feasible. Clinical trials will follow. Should they prove successful, the role of retroperitoneal lymphadenectomy in the management of testicular tumors has to be reassessed.

Animals↗
PubMed1993

Left-sided laparoscopic adrenalectomy.

Laparoscopic transperitoneal adrenalectomy was performed in a 42-year-old female with a left adrenocortical adenoma causing Conn's syndrome. No technical problems occurred during surgery and the patient recovered quickly.

Adrenal Cortex Neoplasms↗
PubMed1991

Megalourethra.

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Humans↗