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Biomedical subjects

D Jocham

Publications and source records attributed to D Jocham.

At least 127 records · Page 7Linked to original sources

[The current status and place of open surgery in treating urolithiasis].

Within the concept of treatment of urinary calculosis, open surgery still occupies a firm place. At present, however, the indications for open surgical interventions have been considerably narrowed, and only a small group of patients with urinary calculosis are subject of open surgery, which requires experienced operators and special instruments for optimally sparing performance of the operation. Often intraoperative echography makes useless the application of intraoperative hypothermia and intraoperative X-ray diagnosis.

Endoscopy↗

[Photodynamic destruction of in vitro cultivated squamous cell carcinoma cells of the head and neck area].

Hematoporphyrin derivatives are retained in higher concentrations in proliferating tumor tissues than in normal tissues causing a defined photosensitization. Laser light irradiation of photosensitized cells results in photobiological, non-thermal cell destruction. These photodynamic reactions were analyzed with in vitro cultured squamous cell carcinoma lines of the head and neck. As a light source we used an argon-ion-pumped-dye laser (630 nm wavelength), and for photosensitization we employed a mixture of dihematoporphyrinester and -ether (DHE). The photodynamic reaction on squamous carcinoma cells was proportional to the DHE concentration, the DHE incubation time, and the light exposure. Maximal tumor cell destruction in comparison to DHE free controls was observed with DHE concentrations of 5-10 micrograms/ml medium and a light exposure of 2-4 Joule/cm2. Based on these dose effect relations for DHE sensitized squamous carcinoma cells, photodynamic therapy for destruction of head and neck cancer can be applied in animal tumor models.

Carcinoma, Squamous Cell↗

Application of fibrin adhesive in the urinary bladder.

The investigations on rats and pigs showed that the transuretheral haemostasis of the urinary bladder damaged by radiotherapy is possible by means of fibrin adhesion. The spraying procedure has to be carried out by means of a special balloon-catheter in a bladder filled with CO2. During spraying the bladder must be kept constantly free of pressure.

Animals↗

Cytologic regression grading of hormone-treated prostatic cancer.

Aspiration cytology during hormone treatment of prostatic cancer has been regularly performed at the University of Munich for 13 years and gives direct information on the primary tumor. To analyse its value in clinical practice, 919 biopsies of 187 patients were reviewed without knowledge of clinical data and the charts were analysed retrospectively. Each biopsy was classified as having good, medium, or poor therapeutic response depending on the regressive changes of the cells. Agreement between two independent observers was 89%. All but 39 of these patients have died and the surviving patients have a minimum observation period of 5.6 years. A poor therapeutic response was seen cytologically in 72 patients (38.5%) at variable times after treatment began. These patients have a statistically significant worse survival in comparison to all other patients. Forty-seven of these 72 patients had deterioration, but clinical signs developed later in 23 cases (mean 1.1 years); in 21 patients cytology and clinical signs were simultaneous and in only three cases clinical deterioration preceded aspiration cytology (mean 4.8 months). In 25 cases there was a cytologically poor therapeutic response, but no clinical signs of deterioration. These patients had the same survival rate as with good or medium treatment response. Serial aspiration cytology is a very valuable parameter in treatment monitoring and is often the early warning sign of endocrine treatment failure.

Aged↗

Extracorporeal shock wave lithotripsy.

Urolithiasis represents the symptomatic manifestation of various metabolic disturbances which persist after elimination of the immediate problem, i.e., urinary stones, and may lead to the development of recurrent stones. Invasive surgical removal of recurrent stones is sometimes associated with considerable problems. Against this backdrop it is not surprising that after development (1974-1980) and clinical testing (1980-1982) at the Department of Urology of the Ludwig Maximilian University in Munich, a meanwhile clinically proven method of totally noninvasive extracorporeal lithotripsy (ESWL) has disseminated within a relatively short time (from October 1983), first in West Germany (April 1986: 20 ESWL centers) and later all over the world (April 1986: 133 ESWL centers). With the advent of ESWL and semiinvasive techniques of stone extraction (percutaneous lithotripsy, ureterorenoscopy) a transformation of the therapeutic strategy for urolithiasis has been ushered in.

Adolescent↗

Integral laser-photodynamic treatment of multifocal bladder carcinoma photosensitized by hematoporphyrin derivative.

Intravenously administered hematoporphyrin derivative photosensitizes tumorous bladder tissue which can then be destroyed selectively by irradiation with red laser light (630 nm). After experimentally developing a concept since 1978 (light diffusion medium, special bladder catheter) to expose the bladder to the therapeutically effective red laser light, the integral photodynamic therapy is meanwhile performed clinically. The experience gained so far demonstrates that especially the multifocal carcinoma in situ up till now difficult to be detected endoscopically represents a new domain for the integral photodynamic therapy.

Carcinoma in Situ↗

Experimental models of bladder cancer: a critical review.

We have reviewed critically the available models of bladder cancer, and have attempted to compare their strengths and weaknesses where appropriate data are available. Further direct comparisons of the applications of each model will be needed in order to rank them, and to identify areas of research where each model will predominate. Furthermore, more information will be needed to validate each model in the context of human disease. With the increasing range and sophistication of the tools of molecular biology, a very important future direction will be the characterisation of animal and human bladder cancer, and in particular the study of the changes from normal to neoplastic urothelium: tumor markers, chromosomal patterns and oncogenes that are associated with specific biological functions, such as invasion, metastasis and ultimate prognosis. The transfection of normal tissues by oncogenes to yield transformed or immortalised lines may be of critical importance in identifying the nature of neoplastic transformation. The use of animal tumors and xenografts, each with the availability of a physiological internal milieu (although different from human metabolic conditions) may yield useful systems for the testing of new therapeutic approaches. However, of the utmost importance is the continuing need to characterise and validate each model, to avoid multiple publications and nomenclatures pertaining to common lines, and to recognise the limitations of the heavily adapted long term cell lines in vivo and in vitro. The major deficiencies of the available lines continue to be found in the method of their application to basic research, rather than being inherent in themselves. Although there are many theoretical and practical applications of these models, it should not be forgotten that the direct study of human bladder cancer, including the appropriate processing of biopsy specimens, will remain integral to understanding the biology of this disease.

Animals↗

The use of neodymium-YAG lasers in urology: indications, technique and critical assessment.

After development and experimental approval of suitable equipment for endoscopic and external use, the neodymium-YAG laser has been used routinely to treat tumors of the bladder and external genitalia in our department. A 2-year followup of 60 patients revealed a significant decrease in local bladder tumor recurrence (5 per cent). Successful laser therapy also was applied in cases of stage T1/T2 penile carcinomas, female urethral carcinomas and condylomata acuminata. Laser application offers an additional useful therapeutic procedure in the treatment of urological malignancies.

Animals↗

DNA grading of malignancy and tumor regression in prostatic carcinoma under hormone therapy.

The prognostic value of the DNA malignancy grade (DNA-MG) and of the DNA regression index (DNA-RI) for survival was tested in 19 patients with prostatic carcinoma under hormone therapy. Measurements were performed on repeated Feulgen-stained transrectal aspiration biopsy smears by DNA image cytometry. The DNA-MG was demonstrated to be an objective scalar index of high prognostic value for the individual patient. The prospective tumor response to hormone therapy could be predicted from the DNA-MG. Independently of the DNA-MG, the DNA-RI provided additional prognostic information concerning tumor regression and survival of prostatic cancer patients under conservative therapy. The determination of DNA-RI allows the early identification of an ineffective conservative therapy.

Aged↗

[Integral photodynamic therapy of multifocal bladder cancer. Initial clinical experiences].

Experimental results and initial clinical experience indicates that even carcinoma in situ can be destroyed by integral photodynamic therapy of multifocal bladder carcinoma following tumor-selective photosensitization with a hematoporphyrin derivative. The employment of a light-scattering medium in combination with a special bladder catheter and photodynamically effective red laser light (630 nm) guarantees homogeneous irradiation of the bladder, which thus reaches all tumor foci. The complications observed were transitional dysurias and, in a particular case, regressive shrinkage of the bladder.

Carcinoma in Situ↗