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Biomedical subjects

D Jocham

Publications and source records attributed to D Jocham.

At least 91 records · Page 5Linked to original sources
PubMed1997

[Complications with portable ESWL--a multicenter study].

An increasing number of urological departments are taking advantage of portable lithotripsy units if a system is not available in their clinic or purchase does not seem feasible; however, infrequent application of ESWL in such a setting should not increase the rate of complications. From 1993 to 1995, up to 54 urological departments using mobile lithotripsy units collected data concerning all major complications. A total of 12,901 treatments were performed which led to 85 major complications (0.66%). Of them 64 were intrarenal or perirenal hematomas. There was no fatal complication. In three patients nephrectomy had to be performed subsequently. The probability of complications can be calculated according to these data. Overall, less frequent application of ESWL does not yield higher complication rates than those at ESWL centers where larger numbers of treatments are performed.

Equipment Design↗
PubMed1997

Effects of colony-stimulating factors on cellular cytotoxicity.

Colony-stimulating factors (CSF) are used clinically in the treatment of chemotherapy-induced myelosuppression and in support of bone marrow transplantation. As CSF are known to have pleiotropic functions, their effects on cellular cytotoxicity were analysed in vitro against bladder carcinoma cell lines. By means of an L-[3H]methionine-release assay, the cytotoxicity of peripheral blood mononuclear cells against the natural-killer(NK)-cell-resistant bladder carcinoma cell lines BT-A and SBC-7 was measured using different effector/target-cell ratios. Costimulatory effects of granulocyte-colony-stimulating factor (G-CSF), granulocyte/macrophage colony-stimulating factor (GM-CSF), interleukin-3 (IL-3) and stem cell factor (SCF) on the generation of lymphokine-activated killer (LAK), bacillus Calmette-Guérin-activated killer (BAK) and natural killer (NK) cell cytotoxicity were investigated in this assay. Furthermore, the effect of CSF on proliferation of urothelial tumor cells in vitro was determined by a [3H]thymidine DNA-labelling technique. GM-CSF, but not G-CSF, IL-3 or SCF, was able to increase NK, BAK and LAK cytotoxicity in a dose-dependent manner. No acceleration of carcinoma cell proliferation was evident under the conditions of our assay. These data indicate the costimulatory effect of GM-CSF on cellular cytotoxicity, which might be used for immunotherapeutic purposes.

Cell Division↗
PubMed1997

Laparoscopic nephropexy: 3-year experience.

PURPOSE: Operative treatment of nephroptosis is rarely performed and is indicated only in select patients. Postoperatively approach related symptoms and morbidity often limit therapeutic success. We evaluated the technique and outcome of laparoscopic nephropexy in patients with symptomatic nephroptosis. For comparison the records of patients who underwent open nephropexy were reviewed. MATERIALS AND METHODS: Since 1993, 22 women and 1 man 16 to 56 years old (mean age 29) underwent laparoscopic nephropexy at our hospital. Preoperatively excretory urography and radioisotope renography were performed with the patient supine and erect, and careful pain evaluation was also done. For laparoscopic nephropexy the transperitoneal approach was used in all patients. The kidney was completely mobilized by dissection of the perirenal fat. The upper pole and convexity of the kidney were fixed to the muscle using single nonabsorbable sutures and an extracorporeal technique for tying. Between 1984 and 1994, 12 patients underwent open nephropexy at our hospital. The results of this group were reviewed and compared with those treated by laparoscopy. RESULTS: Mean operative time in the laparoscopy and control groups was 61 (range 40 to 85) and 49 minutes (range 28 to 70), respectively. In patients who underwent laparoscopic nephropexy mean analgesic use was 15 mg. morphine equivalent intravenously and 550 mg. ibuprofen orally. Postoperatively 3 minor complications (13%) were noted. Hospital stay was 3.7 days (range 2 to 9) and patients returned to work after 19 days (range 4 to 30). Six weeks after nephropexy excretory urography showed a correctly positioned kidney. At a mean 13-month followup pain intensity had improved in 21 patients (91%). According to these parameters laparoscopic nephropexy was superior to the open approach except for operative time. CONCLUSIONS: Laparoscopic nephropexy is safe and effective in the select group of patients in whom nephropexy is indicated.

Adolescent↗
PubMed1997

Laparoscopic bilateral nephrectomy: results in 11 renal transplant patients.

PURPOSE: We report our experience with bilateral laparoscopic nephrectomy after renal transplantation. MATERIALS AND METHODS: Between August 1994 and October 1995, 11 patients who had previously undergone renal transplantation underwent bilateral laparoscopic nephrectomy at our hospital due to poorly controlled hypertension. The records of 10 patients undergoing bilateral open nephrectomy were reviewed for comparison. RESULTS: Mean operative time in the laparoscopy group was 195 minutes (range 125 to 270). Mean blood loss was 345 ml. and 1 patient required conversion to an open operation. Oral intake and mobilization were begun 1 day postoperatively. Mean postoperative morphine equivalent consumption was 14 mg., mean hospital stay was 4.2 days (range 3 to 6) and mean return to normal activities was 14 days. At a mean followup of 10.4 months blood pressure had improved significantly in 8 patients (73%). Mean operative time in the open surgery group was 145 minutes (range 115 to 170) and mean postoperative morphine equivalent required was 44 mg. Compared to the laparoscopy group the interval to resumption of oral intake (3.5 days), duration of hospital stay (10.7 days) and return to normal activities (36 days) were prolonged in the open surgery group. CONCLUSIONS: According to our results, bilateral laparoscopic nephrectomy could be an effective alternative for the treatment of severe hypertension after renal transplantation. Compared to open nephrectomy most patients benefit from the laparoscopic approach.

Adult↗
PubMed1997

Laparoscopy in renal transplant patients.

OBJECTIVES: To evaluate the use of laparoscopic techniques in patients with a renal transplant. METHODS: Since 1992, 358 patients have undergone urologic laparoscopy at our hospital. Among these, 37 procedures (10.4%) were performed in patients with a renal transplant: 14 bilateral nephrectomies for severe drug-resistant hypertension, 9 marsupializations of symptomatic lymphoceles, 6 renal allograft biopsies in patients with clotting abnormalities, 6 unilateral nephrectomies, and 2 nephroureterectomies for recurrent episodes of pyelonephritis and symptomatic vesicoureteral reflux, respectively. RESULTS: Five complications (14%) and three conversions (8%) occurred. Patients who underwent successful laparoscopic operations began mobilization and oral intake on the day after the operation. The hospital stay ranged from 1 to 6 days. In the nephrectomy groups, perioperative urine outputs remained stable and post-operative urine outputs were increased as compared with those in the perioperative period (P < 0.05). Post-operatively, serum creatinine remained stable or improved in patients who underwent nephrectomy or marsupialization of lymphocele. CONCLUSIONS: Our results indicate that laparoscopic techniques are safe and effective in the treatment of patients with a renal transplant. Renal allograft function apparently is not affected by laparoscopic procedures.

Adult↗
PubMed1996

Clinical study results of the new formulation leuprorelin acetate three-month depot for the treatment of advanced prostate carcinoma.

Androgen suppression, using gonadotrophin-releasing hormone analogues (leuprorelin), is being developed as an effective treatment of advanced prostate carcinoma. Treatment with leuprorelin acetate 1-month depot is already well established all over the world. In order to increase patients' acceptability of this treatment, by reducing frequency of administration, a 3-month depot formulation has been developed in Takeda's research laboratories. A single-shot pharmacokinetic study was conducted to confirm efficacy in terms of hormone suppression and safety of the 3-month depot formulation. Thereafter, a parallel-group, open-labelled, randomized trial was performed to compare clinical efficacy and safety profiles of the 1- and 3-month depot formulations. Patients with a histologically and/or cytologically confirmed advanced prostate carcinoma, without prior hormonal or surgical androgen deprivation, are included. According to 1:2 randomization, patients are treated with either the 1- or 3-month depot for 9 months. To prevent initial flare-up, a concomitant antiandrogen therapy might be administered within 2 weeks prior to first injection and continued for up to 3 weeks. The clinical efficacy of the formulations is assessed by both objective response, EORTC and NPCTG response criteria, and subjective response by using WHO performance status. In addition, the level of prostate-specific antigen is determined every 3 months. The efficacy of the two formulations is also evaluated by determination of serum testosterone, dihydrotestosterone, luteinizing hormone and follicle stimulating hormone. To date, 106 patients have been treated with the 3-month depot and 53 patients with the 1-month depot. Preliminary evaluation shows a satisfying level of testosterone suppression with both the 3- and 1-month depot formulations. Therapeutic equivalence was assumed. The 3-month depot is tolerated as well as the 1-month depot.

Aged↗
PubMed1996

The effect of lubricants on viability of bacillus Calmette-Guerin for intravesical immunotherapy against bladder carcinoma.

PURPOSE: The viability of bacillus Calmette-Guerin (BCG) is crucial for induction of a local immune response and for effective therapy of recurrent superficial bladder carcinoma. During intravesical instillation of BCG lubricants are administered to assist catheterization, which contain bacteriostatic components that may interfere with the viability of mycobacteria. To verify this assumption, 5 commercially available lubricants were analyzed with regard to inhibition of viable BCG growth. MATERIALS AND METHODS: Five different lubricants and their components were co-incubated with Connaught strain BCG and the resultant growth of BCG was assessed. To prove the significant passage of lubricants into the bladder, fluid was recovered from the bladder after catheterization, analyzed with regard to the bacteriostatic effect and compared to normal urine of different acidity. RESULTS: Significant impairment of BCG viability, dependent on dosage and time of co-incubation, was noted with all lubricants analyzed. Several components, namely lidocaine hydrochloride, glyceryl stearate, propyl-4-hydroxy-benzoate and chlorhexidine digluconate, were identified as responsible for this inhibition. Fluid recovered from the bladder after lubricant assisted catheterization also showed an inhibitory effect, indicating significant mixture of the instillate with lubricants. CONCLUSIONS: Generous use of lubricants to assist catheterization during intravesical BCG therapy will result in a clinically significant decrease in the number of intravesically instilled viable mycobacteria. For this reason, during intravesical immunotherapy with BCG only small amounts of lubricants should be used for urethral catheterization, and use of catheters not requiring lubricants should be considered.

Adjuvants, Immunologic↗
PubMed1996

The quality of life during intravesical bacillus Calmette-Guerin therapy.

PURPOSE: In the treatment of cancer the subjective evaluation of therapy induced side effects and quality of life must be considered. Adjuvant intravesical bacillus Calmette-Guerin (BCG) immunotherapy is regarded as highly effective but associated with significant side effects. To clarify whether these side effects significantly impact on patient satisfaction with life, a prospective survey of the health related quality of life and side effects was performed during an intravesical BCG treatment course. MATERIALS AND METHODS: Symptoms and side effects were recorded daily during the 6-week instillation period in 30 patients. The quality of life was determined before, during and after intravesical therapy with the assistance of a self-reported questionnaire. RESULTS: Due to a detailed subjective assessment of side effects, the course of local symptoms could be characterized with great reliability. Although side effects occurred, satisfaction with life in the patients studied was high and was not impaired during the treatment. The incidence of side effects correlated well with patient subjective evaluation of quality of life. CONCLUSIONS: Assessment of side effects and quality of life, as presented in this pilot study, can assist in the quantification of localized symptoms in intravesical therapy could contribute to the comparability of clinical studies. With regard to intravesical BCG immunotherapy, our results suggest that the specific side effects do not seriously impair satisfaction with life in these patients.

Adjuvants, Immunologic↗
PubMed1995

[Ureterorenoscopy in children].

Ureterolithiasis is rare in children. Although ureterorenoscopy is needed only in few cases, because of the small number of children who suffer from ureteral stones, the development of small-calibre semi-flexible instruments for the treatment of any ureteral stones can be seen as a useful extension of the range of therapeutic options. The established technique used in adults can also be applied in children. It is recommended that endoscopic stone treatment should be carried out in children only by operators who can draw on a wide experience of such procedures in adults. The small-calibre instruments must be used and extreme caution is still required. We report on our experience with ureterorenoscopy in 12 children.

Adolescent↗
PubMed1994

Specific binding of bacillus Calmette-Guérin to urothelial tumor cells in vitro.

Intravesical immunotherapy with bacillus Calmette-Guérin (BCG) against recurrences of superficial bladder cancer and carcinoma in situ is a highly effective regimen in urology. Despite intensive efforts to clarify the immunological mechanisms of the most successful immunotherapy known today, the cellular mechanism of its antitumor activity remains unknown. In our approach to elucidate the way of action of intravesical BCG, we applied an in vitro adhesion assay to investigate the interaction of radiolabeled BCG with urothelial bladder-tumor cells. We demonstrated a BCG dose-dependent binding to bladder-tumor cell lines derived from tumors of different gradings. The binding of BCG is apparently specific, since competition experiments showed an inhibition by nonradioactive BCG but not by Escherichia coli. We also found that there was no difference between the binding of living or heat-killed mycobacteria. Control experiments showed only a low affinity of BCG for fibroblasts, smooth-muscle cells, and endothelial cells in comparison with the tumor cells. Furthermore, we investigated the role of fibronectin as an adhesion molecule that is also present in the bladder wall. We demonstrated that BCG was capable of binding to fibronectin-coated surfaces in a dose-dependent manner. However, competitive binding assays failed to reveal an inhibition of the binding of BCG to bladder-tumor cells by anti-fibronectin. Furthermore, binding was not influenced by soluble fibronectin. These data suggest that the in vitro attachment of BCG to bladder-tumor cells appears not to be mediated by fibronectin. In electron microscope studies an adhesion of BCG to bladder-tumor cells was observed after an incubation period of ony 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)

BCG Vaccine↗
PubMed1994

On the mode of action of intravesical bacillus Calmette-Guérin: in vitro characterization of BCG-activated killer cells.

Previously we had shown that, upon activation with viable bacillus Calmette-Guérin (BCG), peripheral blood mononuclear cells (PBMNC) could be rendered cytotoxic against otherwise insensitive natural killer (NK)-resistant bladder cancer cell lines. This phenomenon had been termed the BCG-activated killer (BAK) cell phenomenon. By means of depletion and enrichment procedures of mononuclear cell subpopulations derived from BCG-activated PBMNC we further characterized the cytolytic BAK effector cells functionally in an in vitro cytotoxicity assay against the bladder carcinoma cell line BT-A and phenotypically in their pathway of activation. Neither macrophages nor CD4+ T-helper/inducer cells exerted cytotoxic BAK activity. This cytotoxicity was restricted to the CD8+CD56+ subpopulation of T-cytotoxic/NK cells. Furthermore, activation of BAK cells via interferon gamma (IFN-gamma) was evidenced by the complete inhibition of BAK cell generation with an IFN-gamma antibody.

Administration, Intravesical↗
PubMed1994

[Current status of extracorporeal shockwave lithotripsy].

Extracorporeal shockwave lithotripsy has become an established standard procedure for the treatment of nephrolithiasis. Almost 100 lithotripters are installed in large and medium-sized urological departments in Germany. The number of treatments per year averages 660 ESWL sessions per hospital. Multifunctional use and non-urological ESWL therapy ensure maximum utilization of the lithotripter units. In additional hospitals mobile lithotripsy is provided. At present there is a trend toward ambulatory ESWL treatment.

Ambulatory Care↗
PubMed1994

[Photodynamic procedures in urology].

Photodynamic therapy (PDT) has been demonstrated to be an effective therapy for carcinoma in situ of the urinary bladder. The data recorded in the various pilot studies are not comparable, because different photosensitizers, various irradiation modalities and different doses of photosensitizers have been used. Present activities include basic research on principles of action of PDT, the development of photosensitizers with better tumor selectivity, optimization of irradiation modalities, and prospective randomized clinical trials, e.g. in superficial bladder cancer. Photodynamic fluorescence diagnosis (PDD) can be performed easily in clinical conditions with the use of the topically applicable fluorescent marker delta amino levulinic acid (ALA). There is a need for controlled clinical trials to check the efficacy suggested for PDD by the very promising data yielded by pilot studies.

Carcinoma in Situ↗