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Biomedical subjects

A Steg

Publications and source records attributed to A Steg.

At least 55 records · Page 3Linked to original sources

Immunohistochemical markers defined by monoclonal antibodies and response to bacillus Calmette-Guérin endovesical immunotherapy for superficial bladder tumors.

As bacillus Calmette-Guérin (BCG) immunotherapy is highly effective for most but not all superficial bladder tumors, there is a need to define predictors of response to this mode of treatment. We have investigated a panel of markers defined by monoclonal antibodies, directed against tumor-associated transitional cell carcinoma antigen (G4 and E7), epidermal growth factor receptor, cytokeratin (CK) 18 and blood group antigens A, B and H, using an indirect immunoperoxidase staining on paraffin sections. Twenty superficial bladder tumors (T1) treated with intravesical BCG therapy (10 responders and 10 nonresponders) were tested with this panel. Among the responders, expression of CK18 antigen was positive in 7 and negative in 3, whereas in the nonresponder group it was positive in 2 and negative in 8. The difference was statistically significant (p less than 0.05). Loss of expression of CK18 antigenicity was associated with recurrence or progression of superficial bladder tumors following BCG therapy, indicating that changes in CK patterns should be investigated as potential predictive markers for response to BCG.

Administration, Intravesical↗

Epidemiology of prostatic cancer.

The worldwide incidence of prostatic cancer derived from data published by the Union Internationale contre le Cancer and the International Red Cross Committee has been estimated to be 200,000 new cases each year. Cases occur predominantly in the USA (75 per 100,000) and in northern Europe (40 per 100,000), whereas the incidence is low in Asia. Comparison of clinical series and autopsies confirms the high incidence of cancer in older age groups, although not all cases are seen clinically. Mortality increases more slowly than the incidence of the disease, indicating that diagnosis and treatment are increasingly effective. Aetiological factors remain the subject of much discussion, without any criteria appearing to be dominant.

Africa↗

Laser lithotripsy of ureteral calculi: initial experience with a new pulsed dye laser.

Thirty-two patients with ureteral calculi ranging in size from 5 x 5 to 12 x 18 mm underwent lithotripsy with a new pulsed dye laser (Pulsolith, TMI). In 24 cases, the patients were entirely free of stones following laser lithotripsy alone, or with adjunctive stone basket removal. There were three instances of equipment failure and five calcium oxalate monohydrate stones that did not respond to laser energy.

Calcium Oxalate↗

[Treatment of prostatic obstruction using localized hyperthermia. A preliminary study].

The LDMWH (Promeditech 2000), a hyperthermia apparatus emitting microwaves with a frequency of 915 MHz, has been used since July 1988 in the Urology Department of Hôpital Cochin and the Polyclinic of Montreuil for the treatment of prostatic obstructions. Patients are selected on the basis of objective criteria (flowmetry, post-micturating residue) and subjective criteria (standard clinical history). Only patients with objective obstruction are treated by localized hyperthermia, which constitutes a real alternative to surgery. Treatment is performed as an outpatient procedure without anaesthesia as one one-hour session per week for a period of six weeks. The results are evaluated one and three months after completion of treatment by assessing the same objective and subjective criteria as before treatment. The results of the first 26 patients with sufficient follow-up reveals 45% good objective results and 65% good subjective results.

Aged↗

[Palliative diversion using an autostatic ureteral stent after endoscopic resection of the ureteral meatus in T4 pelvic tumors].

Seven patients with renal failure secondary to bilateral ureteric obstruction by pelvic carcinoma underwent palliative urinary diversion. In 3 cases, an autostatic ureteric stent was inserted after endoscopic resection of the trigone invaded by the tumour in the presumed zone of the ureteric meatus, and retrograde catheterisation of the ureter. This method has very limited indications, but may improve the comfort of survival of certain patients.

Adenocarcinoma↗

[Ureteral endometriosis].

Endometriosis, initially believed to be a gynecologic disease, occasionally involves the urinary bladder, and less frequently the ureters. Use of ureteral stents with an appropriate hormonal treatment can obviate the need for open surgery.

Adult↗

[Treatment of traumatic rupture of the urethra. Apropos of 30 patients].

Thirty patients with traumatic rupture of the urethra were treated in the Urology Department of Cochin Hospital between 1975 and 1985: 11 as an emergency procedure, 7 for an early complication and 12 for a late complication. In the patients treated early, urethrorrhaphy or one-stage urethroplasty gave the best results. Two stage urethroplasty constituted best treatment for patients with a complication of earlier treatment. In patients with late complications, endoscopic urethrotomy is rarely sufficient on its own and two-stage urethroplasty is generally indicated.

Adult↗

[Benign prostatic hypertrophy. Treatment using local hyperthermia].

The authors have used local hyperthermia in the treatment of benign prostatic hypertrophy (BPH). The "Promeditech" device consists of a computer-controlled microwave hyperthermia system which warms up the prostate through a probe inserted into the rectum. Forty-three patients aged from 57 to 81 years were treated. All presented with severe voiding symptoms and were considered for surgery. Treatment was applied once a weeks for 5 weeks without anaesthesia and on an out-patient basis. At each session, hyperthermia was maintained at 42.5 to 43.5 degrees C for 60 minutes. Objective and subjective criteria for treatment were: post-voiding residual volume, voided volume, maximum flow rate and frequency, urgency, dysuria and nocturia respectively. These parameters were determined for all patients before and after treatment. Results were evaluated at 3 months and 6 months. Objective improvement was observed in 45 p. 100 of the patients, and subjective improvement in 58 p. 100. In 4 out of 5 patients fitted with an in-dwelling catheter for more than 3 months, it was possible to remove the catheter. This procedure must be more widely tested, but it seems to be particularly appropriate for two kinds of patients: those who do not accept retrograde ejaculation and those who are considered poor surgical risks.

Aged↗

[Treatment of epidermoid carcinoma of the penis].

Epidermoid carcinoma of the penis is a rare type of cancer. Treatment of the primary lesion consists of amputation, although curietherapy can be effective in some cases as a conservative treatment. The prognosis is determined by the presence of absence of lymph node invasion, but the therapeutic strategy to be used when invaded lymph nodes are present remains controversial. Lymph node dissection is the only effective treatment of metastatic adenopathy, but its high morbidity rate limits its indications.

Adult↗

Systemic bacillus Calmette-Guérin infection, 'BCGitis', in patients treated by intravesical bacillus Calmette-Guérin therapy for bladder cancer.

Among 169 patients treated for supeficial bladder tumor with 150 mg Pasteur-strain bacillus Calmette-Guérin (BCG) intravesical instillation, 5 cases of 'BCGitis' were observed, i.e. a severe systemic BCG infection with bronchopulmonary lesions and granulomatous hepatitis. In 4 cases, the complications appeared at the early stage of treatment (after the 3rd, 6th, 6th and 8th instillations, respectively). In 1 case, treated with monthly maintenance therapy for 2 years, BCGitis appeared 6 months after treatment had been completed and, in addition to pulmonary basal infiltrate and granulomatous hepatitis, intramedullary granulomatosis was observed. In 3 patients, trauma must be taken into consideration as BCGitis appeared after traumatic instillation with bleeding. All patients were cured by treatment with rifampicin, isoniazid and prednisone.

Administration, Intravesical↗

Management of the urethra in patients undergoing radical cystectomy for bladder carcinoma.

Urethral carcinoma recurrence after radical cystectomy for bladder carcinoma is a rare but devastating condition. Among 140 male patients submitted to radical cystectomy, urethral carcinoma recurrence occurred in 11. Nine of whom died. Nine other patients underwent urethrectomy at the time of cystectomy or shortly afterwards. Five are alive with no evidence of disease, 4 died of local recurrence or distant metastasis. Prophylactic urethrectomy should be performed in the presence of carcinoma in situ in the prostatic urethra or involvement of the prostatic urethra from the bladder tumor. These criteria should be considered as an absolute contraindication for substitution enteroplasty.

Aged↗

Delayed nonurothelial metastatic lesions to the penis: a report of two cases.

Metastatic lesions to the penis are uncommon and originate most often from other genitourinary primaries. Diagnosis is usually easy, as the primary is already known in most cases. The metastases can very rarely be isolated and delayed for several years after the treatment of the primary tumor. We report two cases of penile metastases from nonurothelial primary lesions. A sigmoid adenocarcinoma was the primary in one case, a renal adenocarcinoma in the other. These two cases were distinctly unusual, as the metastases were delayed for several years after the treatment of the primary. Treatment was palliative with early death in both cases.

Adenocarcinoma↗

Bladder tumors invading the lamina propria (stage A/T1): influence of endovesical bacillus Calmette-Guérin therapy on recurrence and progression.

47 patients with transitional cell bladder carcinoma invading the lamina propria (stage A/T1) were treated from 1984 to 1986 by complete transurethral resection followed by 1-3 cycles of endovesical bacillus Calmette-Guérin instillations, and followed 14-64 months by cytology, endoscopy and bladder biopsies, 64% achieved a complete response, 36% recurred (recurrence rate/100 months/patient 2.2), 21% progressed to muscle invasion. Duration of treatment, tumor size or type (solid vs. papillary), presence of carcinoma in situ bore no relation to the final result. The preceding history of T1 bladder tumor appeared associated with a higher risk of progression although not reaching statistical significance. The results were compared to those obtained by transurethral resection in a similar group of 50 patients treated from 1982 to 1984 and followed up 12-100 months, 90% recurred and 34% progressed to muscle invasion with a recurrence rate/100 months/patient of 9.22. Keeping in mind the limits of a nonrandomized historical comparison, it appears that endovesical bacillus Calmette-Guérin therapy alters favorably the recurrence pattern of T1 bladder cancer.

Adult↗

[Does rectal examination modify the blood level of specific prostatic antigen? A study of 40 cases].

Prostatic specific antigen has become an essential laboratory parameter in prostatic cancer; it may rise transiently after various manipulations of prostatic tissue. We decided to investigate a possible modification in PSA after rectal examination. The PSA level, studied before and after rectal examination in 40 patients, confirmed the almost constant rise in PSA after thorough rectal examination. The biokinetic features of PSA are also discussed as they are important to determine the time of PSA assay after a transient rise.

Aged↗