Search PubMed⌕ Search

Biomedical subjects

E Schick

Publications and source records attributed to E Schick.

At least 19 recordsLinked to original sources
PubMed2005

Multicenter randomized clinical trial comparing surgery and collagen injections for treatment of female stress urinary incontinence.

OBJECTIVES: To compare, in a multicenter, randomized clinical trial, collagen injections versus surgery with regard to efficacy, quality of life, satisfaction, and complications. METHODS: Of 133 women with stress urinary incontinence, 66 were randomized to collagen injection and 67 to surgery (6 needle bladder neck suspensions, 19 Burch, and 29 slings). After randomization, 15 women refused their allocated treatment. "Intent-to-treat" and "per protocol" analyses were applied. Women assigned to collagen injection could receive up to three injections before it was considered a failure. A "top-up" injection was allowed within 3 months after cure. Success as the primary outcome at 12 months was defined as a dry 24-hour pad test (2.5 g or less of urine) after having received only the allocated intervention. RESULTS: The per protocol analysis showed that the success rate 12 months after collagen injections (53.1%) was much lower than that after surgery (72.2%). The difference was 19.1% (95% confidence interval -36.2% to -2%). The general and disease-specific quality-of-life scores measured by the Rand Medical Outcomes Study 36-item Health Survey and Incontinence Impact Questionnaire were similar in the two groups (P = 0.306). Women treated by surgery were, on average, more satisfied (79.6%) than those treated by collagen injection (67.2%), but the difference was not significant (P = 0.228). Finally, complications were less frequent and severe with collagen injection: 36 events in 23 subjects for collagen injection versus 84 events in 34 subjects for surgery (P = 0.03). CONCLUSIONS: One year after intervention, the success rate of collagen injection as a treatment for stress urinary incontinence was about 19% lower than that after surgery. This has to be tempered by the similar changes in quality of life and satisfaction in both groups and that the number and severity of complications were much greater after surgery than after collagen injection. The results of this study indicate that collagen injections might be a worthwhile alternative to surgery for the treatment of stress urinary incontinence.

Collagen↗
PubMed1999

Burch colposuspension: long-term results and review of published reports.

OBJECTIVES: To review our long-term results with the Burch colpocystourethropexy, compare our results with those in recently published reports, and define factors that may influence the long-term outcome of this procedure. METHODS: A group of 79 patients who underwent Burch colposuspension as modified by Tanagho between January 1985 and January 1991 were studied retrospectively. Preoperative investigation consisted of clinical history, physical examination, cystourethroscopy, multichannel urodynamic evaluation, including pressure-flow studies, and static and dynamic urethral pressure profile analysis. A postal survey was sent to all patients to evaluate their symptoms and the impact on their quality of life. RESULTS: The mean follow-up was 7.6 years (range 5.3 to 10.8). Forty-four percent of patients were considered cured (responders), 25% significantly improved (partial responders), and 31% failures (nonresponders). The success rate was higher among patients who had not undergone previous continence surgery (75%) or hysterectomy (78%) than among those who had previously undergone continence surgery (59%) or hysterectomy (65%). Seventy-five percent of the patients were responders or partial responders if the bladder was stable preoperatively, as opposed to 70% when the bladder was unstable before surgery. Analysis of the postal questionnaire indicated a statistically significant difference in terms of irritative symptoms between the responder and partial responder groups combined and the nonresponder group. CONCLUSIONS: More than two thirds (69.6%) of our patients who underwent a Burch-Tanagho colpocystourethropexy had a favorable long-term outcome (mean 7.6 years). Previously failed continence procedures, unstable bladder preoperatively, and previous or concomitant hysterectomy had a negative influence on the final outcome in the long term from the clinical point of view, even if, statistically, the difference was not significant. The incidence of irritative symptoms and nocturia were significantly higher among nonresponders than among responders and partial responders. More attention paid to these symptoms during the post-operative follow-up should increase the perception of success by the patient after retropubic colpocystourethropexy.

Adult↗
PubMed1998

Primary renal mucormycosis.

Primary renal mucormycosis is a rare infection capable of acute illness with sepsis. Few cases have been reported. We report a case of an acute primary renal mucormycosis and review the published reports. The incidence of primary renal mucormycosis has risen in recent years. The most frequently reported underlying predisposing disorders are human immunodeficiency virus infection, intravenous drug abuse, and diabetes mellitus. Primary renal mucormycosis should be suspected in patients with an immunocompromising illness or particular risk factors, when persistent flank pain and fever with sterile urine not responding to appropriate antibiotics are associated with enlarged heterogeneous kidneys.

Acute Disease↗
PubMed1998

Functional immobilization of biomembrane fragments on planar waveguides for the investigation of side-directed ligand binding by surface-confined fluorescence.

A method for the functional immobilization of Na,K-ATPase-rich membrane fragments on planar metal oxide waveguides has been developed. A novel optical technique based on the highly sensitive detection of surface-confined fluorescence in the evanescent field of the waveguide allowed us to investigate the interactions of the immobilized protein with cations and ligands. For specific binding studies, a FITC-Na,K-ATPase was used, which had been labelled covalently within the ATP-binding domain of the protein. Fluorophore labels of the surface-bound enzyme can be selectively excited in the evanescent field. A preserved functional activity of the immobilized enzyme was only found when a phospholipid monolayer was preassembled onto the hydrophobic chip surface to form a gentle, biocompatible interface. In situ atomic force microscopy (AFM) was used to examine and optimize the conditions for the lipid and membrane fragment assembly and the quality of the formed layers. The enzyme's functional activity was tested by selective K+ cation binding, interaction with anti-fluorescein antibody 4-4-20, phosphorylation of the protein and binding of inhibitory ligand ouabain. The comparison with corresponding fluorescence intensity changes found in bulk solution provides information about the side-directed surface binding of the Na,K-ATPase membrane fragments. The affinity constants of K+ ions to the Na,K-ATPase was the same for the immobilized and the non-immobilized enzyme, providing evidence for the highly native environment on the surface. The method for the functional immobilization of membrane fragments on waveguide surfaces will be the basis for future applications in pharmaceutical research where advanced methods for exploring the molecular mechanisms of membrane receptor targets and drug screening are required.

Animals↗
PubMed1998

[FPSUND: a pan-Canadian evaluation of a clinical classification of urinary incontinence].

Historically, urinary incontinence is divided into 3 subtypes: stress, urge and mixed. This latter group, which according to many studies can account for up to 50% of the patients, is very heterogenous. For this same reason, the reports of treatments of urinary incontinence are very difficult to analyse using this simple classification. In a attempt to clarify this situation and to help the acquisition of useful clinical information relating to urinary incontinence, were have developed a clinical classification of urinary incontinence (FPSUND) in which 6 symptoms are graded in severity from 0 to 3. In this acronym, the F stands for frequency, the P for the use of protection, the S for stress-related complaints, the U for urge-related complaints, the N for nocturia and the D for the number of daily micturitions. Urologists across Canada were sent the French or English version of the classification and used it to evaluate 148 female patients aged from 18 to 70, suffering from urinary incontinence. A second, independent evaluation, was also performed on the same patients by registered nurses or urodynamic technicians. Reproducibility between observers, as assessed by the weighted Kappa score ranged from 0.47 and 0.74 (p < 0.05), was very good. Generally, the users of the classification found it very easy to use. In summary, we propose the FPSUND clinical classification of urinary incontinence as a useful and accurate tool to classify urinary incontinence and as a means to assess treatment outcome.

Adolescent↗
PubMed1997

Retropubic cystourethropexy: is it an obstructive procedure?

PURPOSE: We sought to establish whether colpocystourethropexy creates bladder outlet obstruction, as evaluated by pressure-flow studies. MATERIALS AND METHODS: We retrospectively analyzed the records of 50 women. Preoperative evaluation included a detailed questionnaire, physical examination, urine culture, cystourethroscopy and multichannel urodynamic testing. Every patient underwent retropubic colpocystourethropexy according to the Tanagho modification of the original Burch technique. An average of 3 months after the operation clinical evaluation and identical multichannel urodynamic testing were repeated. Preoperative and postoperative urodynamic parameters were compared for each patient and statistical differences were established using Student's 2-tailed t test. RESULTS: No statistically significant difference was demonstrated in static urethral pressure profile parameters and in parameters during the filling phase of the cystometrogram except for cystometric capacity, which decreased after surgery (p = 0.02). In contrast, all 5 pressure-flow parameters analyzed (minimum urethral opening pressure, detrusor pressure at maximum flow, maximum flow, theoretical cross-sectional area and theoretical diameter of the flow rate controlling zone) showed statistically significant differences induced by surgery. Pressure-flow data reported on Schäfer's diagram and on the Abrams-Griffiths nomogram failed to demonstrate urodynamically significant obstruction created by surgery. CONCLUSIONS: Our data suggest that colpocystourethropexy does not create obstruction but, rather, restores pressure-flow conditions to a normal or nearly normal level.

Adult↗
PubMed1997

Nonlinear dynamics of intracellular methylene blue during light activation of cell cultures.

Methylene blue (MB+) is a well-known dye in medicine and has been discussed as an easily applicable drug for topical treatment in photodynamic therapy (PDT). Methylene blue can potentially be used as a redox indicator to detect the important redox reactions that are induced during PDT. The kinetics of this process was analyzed on a subcellular level with confocal laser scanning microscopy. BKEz-7 endothelial cells were incubated 4 h with 1 microM MB+. The fluorescence dynamics of MB+ during irradiation with 633 nm light was observed with subcellular resolution. Images were acquired at 0.5 s intervals (frame rate 1 image/0.5 s). Fluorescence was observed in the red channel of the laser scanning microscope. Synchronously, the phase-contrast image was visualized with the green channel. Morphological changes could therefore be correlated with the dynamics of MB+. In addition, the light-dose-dependent phototoxicity at 633 nm irradiation was determined by viable cell counting. After an induction period (phase I), fast fluorescent spikes could be observed in the whole cytoplasm, which decayed with a time constant of about 20 s (phase II), followed by a period of nearly constant fluorescence intensity (phase III) and exponential photobleaching (phase IV). Phase II exhibits highly nonlinear kinetics, which is hypothesized to correlate probably with a nonlinear quantal production of reactive oxygen species (ROS). Morphological cell changes were not observed during phase II. During phase III, a pycnotic cell nucleus developed. From the determination of viable cells we can conclude that a light dose applied within phase II was only sublethal in correlation with morphological observations. Overproduction of ROS leading finally to cell killing during phases III and IV is discussed.

Animals↗
PubMed1997

Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-'BPH' Study. International Continence Society--Benign Prostatic Hyperplasia.

OBJECTIVE: To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. PATIENTS AND METHODS: The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. RESULTS: The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF-36 and the EuroQol. CONCLUSION: ICSQoL items may be used individually or as a group in research studies or in clinical practice.

Aged↗
PubMed1996

A multicenter, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of terazosin in the treatment of benign prostatic hyperplasia.

OBJECTIVES: This study was designed to evaluate the safety and efficacy of the selective alpha 1-adrenoceptor blocker terazosin in the treatment of benign prostatic hyperplasia (BPH). METHODS: Two hundred twenty-four patients aged 50 to 80 years, who had a diagnosis of BPH based on medical history, physical examination, and digital palpation, were recruited from 11 different sites between January 1992 and January 1994. The study consisted of a screening phase, a placebo phase, a double-blind dose-titration phase, and a double-blind maintenance phase. RESULTS: Of the patients recruited, 164 entered the double-blind phase and of these 134 were evaluable. Only 11 patients withdrew because of an adverse event, 7 in the terazosin and 4 in the placebo group. Compared to placebo, terazosin significantly increased peak and mean urine flow rates without significantly affecting voided volume or postvoid residual volume. It significantly improved both the obstructive and irritative symptoms associated with BPH. Fifty-one patients from the terazosin group reported a total of 120 adverse events compared with 83 reported by 42 patients in the placebo group. The majority of these events were mild to moderate. Seventeen terazosin-treated patients reported hypotension-related adverse events and 4 withdrew from the study. However, concurrent treatment with antihypertensive agents did not affect the blood pressure response of the terazosin group. CONCLUSIONS: Overall, this study showed terazosin to be safe and effective in relieving the signs and symptoms of BPH and should be considered as a treatment alternative.

Adrenergic alpha-Antagonists↗
PubMed1995

[Dermatomyositis-like skin changes with long-term hydroxyurea (Litalir) therapy].

We report on dermatomyositis-like adverse cutaneous reactions following long-term maintenance therapy with hydroxyurea in two patients suffering from chronic myelogenous leukaemia (CML). In addition to non-specific side effects, such as xerosis, pruritus and hyperpigmentation, both patients presented with more specific skin changes, i.e. erythematous lesions, scaling, and partially atrophic areas distributed in a linear fashion on the dorsal aspects of the hands and fingers. In addition, teleangiectatic erythema of the face was present in both patients, and this was associated with oedema of the eyelids in one patient. Despite these dermatomyositis-like features there were no clinical signs of muscular involvement, and muscle-specific enzymes were within normal ranges. Skin biopsy specimens revealed an interface dermatitis characterized by a lichenoid cell infiltrate, vacuolar alteration of basal cells, necrotic keratinocytes within the spinous zone, focal hypergranulosis, ortho-hyperkeratosis and telangiectases in the upper part of the dermis. Analogous histopathological findings have been documented in lichen planus-like skin changes on the hands following hydroxyurea therapy. It seems doubtful whether there are actually any major differences between those skin changes described as dermatomyositis-like and those interpreted as lichen planus-like in patients receiving long-term hydroxyurea therapy.

Aged↗
PubMed1995

Influence of activation and differentiation of cells on the effectiveness of photodynamic therapy.

Photodynamic therapy combines photosensitizers absorbing light in the red spectral region and irradiation with light of the corresponding wavelength. To analyse the influence of cell differentiation on susceptibility to photodynamic therapy, we compared the proliferation inhibition induced by photodynamic therapy on normal human keratinocytes, spontaneously transformed human keratinocyte cell line HaCat and on squamous cell carcinoma lines. Cells were irradiated with polychromatic methylene blue as well as the precursor of protoporphyrin, 5-aminolevulinic acid. When incubated with Photosan-3, normal human keratinocytes exhibited and ED50 about 10-fold lower than the other cell lines studied. When methylene blue and 5-aminolevulinic acid were used, photodynamic therapy had comparable effects on all cell types. Stimulation of normal human keratinocytes with either EGF-alpha or IFN-gamma resulted in an increase susceptibility to photodynamic therapy when 5-aminolevulinic acid was used. This effect was more pronounced in the case of EGF-alpha. Our experiments suggest that activation and differentiation are two important parameters determining susceptibility to photodynamic therapy.

Aminolevulinic Acid↗
PubMed1995

[The importance and significance of post-micturitional bladder residue in the evaluation of prostatism].

The presence of a significant post-voiding residue is often considered to be secondary to bladder neck obstruction and frequently constitutes the main indication for transurethral resection of the prostate. In order to validate this approach, the files of 350 patients presenting with symptoms of prostatism and assessed by urodynamic studies were analysed retrospectively. The results of the study demonstrated that, regardless of the value of the residue, approximately 30% of patients were not obstructed despite a high post-voiding residue (PVR), while approximately 70% of patients with minimal or no PVR were considered to be obstructed on the basis of urodynamic criteria. These results therefore demonstrate that the presence of a post-voiding residue is not indicative of bladder neck, but reflects a lesion of the detrusor. Considered alone, it therefore should not constitute an indication for transurethral resection of the prostate.

Humans↗
PubMed1993

Frequency-volume chart pattern in a healthy female population.

Very few data are available on what should be considered a normal frequency-volume chart. To establish baseline figures we studied the voiding diaries of 33 normal women. A computer program was developed using 12 parameters. A normal pattern was established for young and middle-aged women. These data may be used as a reference when analysing the charts of patients with voiding dysfunction.

Adult↗
PubMed1992

Agreement between clinical methods of measurement of urinary frequency and functional bladder capacity.

We assessed the agreement between 2 methods of data gathering of particular interest in urology: patient questionnaire and examination vs. frequency-volume charts. One hundred consecutive patients consulting our out-patient clinic were chosen for this study; 88 completed the study. Urinary frequency and bladder capacity were evaluated in each patient by using the above methods. The agreement between different methods of measurement was assessed by determining whether the 2 methods were interchangeable, a condition occurring if results of both methods fall within predetermined limits of variability. The results showed poor agreement between subjectively estimated urinary frequency and chart-determined urinary frequency. Moreover, different methods of measuring bladder capacity (endoscopic vs. chart) gave different results. Since chart-determined data are probably a more valid indication of urinary habits, we suggest that frequency-volume charts should be used more often in the investigation and follow-up of patients with micturition disorders.

Circadian Rhythm↗