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F M Debruyne

Publications and source records attributed to F M Debruyne.

At least 235 records · Page 13Linked to original sources
PubMed1994

Prognostic factors in pTa-pT1 superficial bladder tumours treated with intravesical instillations. The Dutch South-Eastern Urological Collaborative Group.

OBJECTIVE: To identify prognostic factors that enable patients with superficial bladder cancer to be divided into groups who will probably respond to therapy and those who will not. PATIENTS AND METHODS: In a prospective randomized study 387 patients with pTa-pT1 superficial bladder carcinoma received, after transurethral resection, intravesical instillations with immuno- or chemotherapy. A simultaneous computerized analysis of factors predicting the recurrence-free interval was performed. All these patients had negative random biopsies. Pretreatment factors analysed for recurrence were gender, age, history (primary or recurrent disease), location of tumour, number of tumours, pT-stage and grade. RESULTS MEDIAN: Follow-up was 27 months (range 12-56). During the follow-up period 37.2% of the patients had recurrence and eight patients (2.2%) had progression into muscle invasive disease. After a univariate analysis the number of tumours and location of the tumour in the bladder appeared to be a significant influence on the recurrence-free interval. Location of at least one of the tumours in the prostatic urethra, bladder neck, posterior wall, and trigone area was significantly related to a shorter recurrence-free interval; these areas were defined as high risk. Tumour stage showed borderline significance. By using multivariate methods to assess the relative importance of these factors, location of tumour in the high risk region was related especially to a short recurrence-free interval. The factor found to be of significance for the prognosis for recurrence was tumour multiplicity. Gender, age, history of recurrent disease, size of the largest tumour, tumour stage or grade gave no additional information about the risk of recurrence. CONCLUSION: Prognostic factor analysis, as an auxiliary study of trials of patients treated for superficial bladder tumours, is mandatory. The prognostic factors related to recurrence-free interval found in this study, location of the tumour and multiplicity, may be of use in the stratification necessary for current protocol design.

Administration, Intravesical↗
PubMed1994

Laser ablation of the prostate: experience with an ultrasound guided technique and a procedure under direct vision.

Twenty-four patients with benign prostatic hyperplasia were treated with the Nd:YAG laser. We review our experience with two different techniques: the ultrasound-guided transurethral laser-induced prostatectomy (TULIP) and the visual laser ablation of the prostate (VLAP). Our experience with these two different laser systems shows that the treatment is relatively simple, speedy and performed with virtually no blood loss. The results, of both the TULIP and VLAP procedures, are excellent. The symptom scores decrease from 43 to 19 (TULIP) and 48 to 9 (VLAP). Furthermore, there is a marked increase in average uroflow from 7.9 to 18.6 ml/s (TULIP) and from 8.1 to 18.0 ml/s (VLAP). The patients with the TULIP procedure, however had more pronounced posttreatment complaints. These patients more often received antibiotics. Laser therapy of the prostate, although still in its infancy, gives excellent results and has substantial advantages over conventional transurethral resection of the prostate (TURP). Laser therapy may replace TURP within several years.

Humans↗
PubMed1994

Pain sensation in transurethral microwave thermotherapy for benign prostatic hyperplasia: the rationale for prophylactic sedation.

Transurethral microwave thermotherapy (TUMT) can be painful. Pain sensation limits treatment tolerance and consequently also treatment efficacy. Of our population of patients treated with TUMT, 22% (63/288) needed intravenous analgesia and, nevertheless, 6% (17/288) needed definitive treatment interruption. The aim of this study was to identify the mechanism of pain sensation during TUMT and to verify whether the prophylactic use of a sedative drug would improve treatment tolerance. Eighty-three patients undergoing TUMT treatment for benign prostatic hyperplasia at our department entered a prospective, randomized, single-blinded study. Thirty minutes before treatment, 40 patients (group A) received 960 mg cotrimoxazole orally while 43 patients (group B) received 960 mg cotrimoxazole and 10 mg oxazepam, both orally. Statistically significant improvement in treatment tolerance in group B in comparison with group A was found. Pain sensation during TUMT seemed to be mostly due to anxiety. It is concluded that the prophylactic use of a sedative drug is advisable in patients undergoing TUMT in order to improve treatment tolerance.

Analgesia↗
PubMed1994

Imaging in BPH patients.

Benign prostatic hyperplasia is one of the most common pathological processes to afflict men. Strikingly, there is a large variety of methods of evaluation and therapeutic strategies for BPH in various countries. Before adequate treatment is possible, the process of benign adenomatous hyperplasia has to be distinguished from malignant or inflammatory prostatic disease. Furthermore, secondary alterations of the bladder and upper urinary tract have to be evaluated. A wide range of imaging techniques of the lower and upper urinary tract have evolved over the years. The specific benefits and restrictions of each of them are discussed. Finally, the recent developments and possibilities of computer-aided tissue characterisation and volume determination are outlined. The development of imaging techniques for BPH has just begun...

Humans↗
PubMed1994

Cytogenetics of prostate cancer. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

This report summarizes the current knowledge with respect to genetic changes associated with the development of prostate cancer. The relation between the occurrence of these changes and the stage of the disease is by far not clear yet, albeit that some tendencies become more or less evident. In Fig. 2 these are summarized. Whereas changes on 7q and loss or gain of the X chromosome are not consistently found by either RFLP or ISH analysis, other changes are (8p-, 10p-, 10q, 16q-, and 18q-). Clearly the picture is far from complete and even more the relevant genes on these chromosomes are not defined. E-cadherin was considered a good candidate and indeed the value as progression marker is great. However, the studies so far indicate that E-cadherin does not behave as a classical type I suppressor gene and the relation with 16q loss remains to be established. The data available to date regarding chromosomal changes in prostate cancer are limited. Many studies have to be pursued to identify the consistent changes, and moreover, to map the relevant loci harbouring the genes that are implicated in the development of this disease. This knowledge will be critical in the design of appropriate diagnostic methods and possibly clues towards therapy.

Cadherins↗
PubMed1994

Karyometric analysis of intra-tumour heterogeneity in prostate adenocarcinoma.

The intra-tumour heterogeneity in different locations in the prostate was determined by karyometric image analysis and compared with local tumour progression in a retrospective analysis of 65 patients with localized adenocarcinoma of the prostate. In these 65 radical prostatectomy specimens 290 tumour locations were documented. In each location tumour volume was estimated and Gleason grade determined. Quantitative image analysis of nuclear size, shape and chromatin pattern was performed. Differences in Gleason grade and karyometric feature values were evaluated as measures for intra-tumour heterogeneity. Moreover, the location within the prostate was documented for each tumour area. Gleason grade and karyometric features varied widely in the prostate. Tumour locations in the apex (n = 92) had significantly larger and more irregularly shaped nuclei (P < 0.005) compared with basally located tumours (n = 49). Significant differences in nuclear shape were also found in different locations in the equatorial plane of the organ. Tumour heterogeneity in chromatin pattern features was found to correlate with local extension (seminal vesical invasion, extracapsular tumour growth, positive resection margins) and lymph node metastases. This correlation was even stronger when more pathological features were present. In view of the observed tumour heterogeneity, (karyometric) analysis of multiple tumour areas in the prostate is advisable for optimal evaluation of prostate carcinoma.

Adenocarcinoma↗
PubMed1993

Increased expression of high mobility group protein I(Y) in high grade prostatic cancer determined by in situ hybridization.

In a previous study using the Dunning rat prostate cancer model, we found high mobility group protein I-(Y) [HMG-I(Y)] to be overexpressed in metastatic tumor lines when compared to nonmetastatic lines. Hence, overexpression of this 12-kDa non-histone chromosomal protein may be associated with tumor progression. Firstly, by Northern analysis we showed that HMG-I(Y) expression increases in high grade prostate tumors. These studies, however, required fresh material, and clinical follow-up was limited. To overcome this problem paraffin-embedded material must be made amenable for determination of HMG-I(Y) expression in retrospective studies. RNA in situ hybridization enables the evaluation of mRNA levels in such material. We studied tumors from 71 patients with prostate cancer. The microscopic analysis of each sample included: (a) hybridization on sections with sense HMG-I(Y) and (b) 28S rRNA probes (nonspecific signal); (c) hybridization with antisense 28S rRNA (RNA preservation); (d) hybridization with an antisense HMG-I(Y) probe [quantification of HMG-I(Y) mRNA in the expressing areas]. Data were quantified using an image analysis system. High expression of HMG-I(Y) was observed in regions with high Gleason grade (4 and 5); whereas in lesions of Gleason grade 3, both weak and no expression was observed. In areas of grade 1 and 2, as well as in normal glands, low or no expression was found. We conclude that HMG-I(Y) expression assessed by RNA in situ hybridization is related to tumor differentiation in prostate cancer. These findings indicate that HMG-I(Y) expression may be a marker in prostate cancer diagnosis, and the possible clinical implication of expression of this gene in malignancy is discussed in this report.

Carcinoma↗
PubMed1993

Prognostic value of karyometric and clinical characteristics in renal cell carcinoma. Quantitative assessment of tumor heterogeneity.

BACKGROUND: The variation in tumor cell differentiation within one renal cell carcinoma, also termed tumor heterogeneity, renders visual tumor grading of these carcinomas difficult. Karyometric analysis enables description of nuclear characteristics of multiple tumor areas. Hence, karyometric analysis can be used to quantify tumor heterogeneity and thus may aid in a more objective grading of renal cell carcinoma. METHODS: In 121 patients with renal cell carcinoma (tumors in International Union Against Cancer [UICC] stages I [5 cases], II [23 cases], III [33 cases], and IV [60 cases]), clinical and karyometric features were studied to obtain routinely applicable prognostic factors. Several parts of the tumor were analyzed to obtain a measure of tumor heterogeneity. Univariate and multivariate Cox regression analyses were used to determine the predictive value of karyometric features independent of tumor stage and other clinical characteristics. RESULTS: The Cox univariate regression analysis showed correlation of several clinical and karyometric characteristics with survival. Of the clinical characteristics, TNM stage, tumor size, weight reduction, and performance status were significantly associated with survival. The karyometric features, especially those measurements associated with tumor heterogeneity (e.g. differences in nuclear size or chromatin texture between tumor subpopulations) were of value in predicting prognosis. In the Cox multivariate regression analysis, the Robson and UICC stages proved to be the most powerful predictors of survival (P < 0.0001). Of the clinical features, weight reduction and performance score were the only characteristics offering additional information regarding tumor stage (P < 0.0001). From the karyometric analysis quantification of anisokaryosis in the tumor at time of diagnosis offered additional prognostic information. Moreover, the differences of karyometric features within the tumor presumably associated with tumor heterogeneity correlated with survival. Using the features from the multivariate analysis, prognostic groups could be defined. CONCLUSION: We conclude that karyometric analysis offers a useful means for quantifying tumor heterogeneity. Multivariate Cox analysis revealed additional value of a grading system based on karyometric analysis to tumor stage. Karyometric analysis can be a useful tool for stratification of patient populations.

Adult↗
PubMed1993

Decreased E-cadherin immunoreactivity correlates with poor survival in patients with bladder tumors.

E-cadherin, an intercellular adhesion molecule, has been shown to behave like an invasion suppressor gene in vitro. This may explain the inverse relation between expression of E-cadherin and tumor grade that was found in certain cancers. We therefore examined E-cadherin expression in bladder cancer samples from patients with known clinical follow-up. Forty-nine snap-frozen specimens (24 superficial and 25 invasive tumors) and 4 samples of normal urothelium were retrospectively analyzed with anti-E-cadherin monoclonal antibodies. In normal urothelium E-cadherin is expressed homogeneously with a typical membranous staining at cell-cell borders. Decreased expression is found in 5 of 24 superficial tumors and in 19 of 25 invasive cancers. Completely negative tumors are infrequent (4 cases). Most of the time a heterogeneous staining, which may correspond to an unstable E-cadherin expression during tumor development, is seen. Decreased E-cadherin expression correlates with both increased grade and stage (chi 2 = 9.5, P < 0.01, and chi 2 = 14.9, P < 0.005, respectively). More importantly, abnormal E-cadherin expression correlates with shorter survival (log rank test: chi 2 = 16.5, P < 0.001). In keeping with its in vitro invasion suppressor function, decreased E-cadherin expression correlates with the clinical aggressiveness of bladder tumors. This is the first report of E-cadherin as a marker with prognostic value. This parameter must now be tested in a large prospective study to assess its precise clinical relevance.

Adult↗
PubMed1993

[Diagnostic laparoscopy in non-palpable testis].

In this article we present our experience with diagnostic laparoscopies in 45 patients with a total of 48 impalpable testes. Laparoscopy was performed before surgical exploration, in the same operative set-up. No complications were seen. One laparoscopy was a technical failure. In six children and one adult no testis, no deferent duct or spermatic vessels were found. The diagnosis of testicular absence was made. In 14 children no testis was found. In 13 cases atrophic spermatic vessels were seen, in one case histologically proven testicular tissue was found. In one case a blind-ending deferent duct was seen. In 27 patients an intra-abdominal testis was found, mostly 2-3 cm before the internal annulus. We performed an orchidectomy 10 times, an orchidopexy 3 times and an autotransplantation of the testis 9 times. Laparoscopy proved to be an easy, safe and reliable method to localise an impalpable testis. It is the method of choice in our clinic.

Adolescent↗