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Biomedical subjects

G Jakse

Publications and source records attributed to G Jakse.

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

Determination of local tumour extension in cases of carcinoma of the prostate.

OBJECTIVE: Since most cases of carcinoma of the prostate (CaP) are still diagnosed at a time when the tumour has already spread beyond the prostatic capsula and therefore is incurable, recent impetus has been given to early detection with the chance of curative therapy. METHODS: This paper reviews of the literature concerning the ability of prostate-specific antigen (PSA), digital rectal examination (DRE), transrectal ultrasonography (TRUS), TRUS directed sextant biopsies, computerized tomography (CT) and magnetic resonance imaging (MRI) to determine the pathological stage of clinically organ-confined CaP. RESULTS: The combination of PSA, DRE, TRUS and TRUS directed sextant biopsies yield the best information about the pathological extent of clinically organ-confined CaP. However, while this is true for a cohort of patients, the individual patient may still suffer from locally advanced disease that was unpredictable preoperatively by applying these tests. Positive surgical margins after radical prostatectomy are a logical consequence of advanced disease and therefore will be seen as long as no better clinical staging is available to the urologist and as long as CaP does not get diagnosed earlier in the course of the disease. CONCLUSION: At the present time the determination by PSA, DRE, TRUS and TRUS directed sextant biopsies are the diagnostic procedures of choice for the clinical staging of patients with potentially organ-confined CaP, CT and MRI are unable to markedly enhance the accuracy of clinical staging in this disease.

Biomarkers, Tumor↗
PubMed1997

Seizures associated with cisplatin administration.

A 50-year-old patient with a diagnosis of a primary extragonadal germ cell tumor received cisplatin-containing polychemotherapy and developed seizures after the first course of drug administration. We discuss this very rare toxic side effect of cisplatin and present a review of the literature concerning the experience with neurotoxic effects exerted by this agent.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

5-Fluorouracil versus folinic acid and 5-fluorouracil in advanced, hormone-resistant prostate cancer: a prospective randomized pilot trial.

OBJECTIVES: Results of cytotoxic chemotherapy for hormone-resistant prostate cancer are not impressive. One of the substances which seems to have a therapeutic benefit is 5-fluorouracil (5-FU). The effect of 5-FU can be modulated by addition of folinic acid (FA). We tested in a prospective, randomized phase II trial monotherapy with 5-FU versus the combination of 5-FU and high-dose FA. METHODS: 25 patients received 600 mg/m2 5-FU, and 24 patients 400 mg/m2 FA plus 600 or 400 mg/m2 5-FU. They were treated for two cycles for 5 days in a 21-day interval followed by a weekly single-day application until progression occurred. Pain remission, toxicity, time to progression and survival were evaluated. RESULTS: Both regimens led to a pain remission in nearly 70% of the patients. Mucosal side effects like diarrhea and stomatitis occurred more often in the combination arm, whereas leukopenias were more frequent in the monotherapy are. We observed no statistically significant difference between the two treatment arms regarding time to progression and survival. CONCLUSIONS: Although both regimens led to a pain remission, side effects are too severe to recommend these protocols for standard treatment of hormone-resistant prostate cancer.

Aged↗
PubMed1997

Long-term follow-up after primary extracorporeal shockwave lithotripsy monotherapy of staghorn calculi: results after more than 6 years.

OBJECTIVE: We retrospectively investigated 58 patients suffering from 60 staghorn calculi, who were treated with primary extracorporeal shockwave lithotripsy (ESWL) monotherapy, in order to determine long-term results and the fate of the residual stones. MATERIAL AND METHODS: Mean follow-up was 72.4 months. There were 49 partial staghorn calculi (C4) and 11 complete C5 stones according to Rocco's classification. The mean number of ESWL sessions needed for disintegration was 3.6. The mean amount of shockwaves was 10,244. ESWL monotherapy alone was performed in 26 staghorn calculi (43.3%). In treating the other 34 staghorn calculi 56 auxiliary procedures were necessary. RESULTS: At discharge 28.3% of the patients were free of stones. Fifty-five percent had small remnant particles (< 4 mm) and 16.7% had rest-fragments (> 4 mm). After a mean follow-up period of 72.4 months 36 patients were free of stones (60%). Twenty-four patients still have residual stones. The fragments in 2 patients did not change in size, in 14 patients fragments became bigger and 8 patients had a real recurrence (13.3%). CONCLUSIONS: Primary ESWL monotherapy of staghorn calculi is justified because of the comparable results with open surgery and percutaneous nephrolithotomy (PCNL). Prognostic good factors are small stone mass with most of the stone mass in the upper and middle calices, the absence of dilatation and the absence of anatomical anomalies.

Adult↗
PubMed1996

[Laparoscopic lymphadenectomy in prostate carcinoma. Experiences with 120 patients].

Laparoscopic pelvic lymph node dissection was performed in 120 patients scheduled to undergo either radical perineal prostatectomy or radiation therapy. On average 13 lymph nodes were resected in each patient, and 21 patients were found to have metastatic disease in 1-9 lymph nodes. After an initial learning curve, mean operative time was reduced significantly, allowing laparoscopic lymph node dissection and radical prostatectomy to be performed as a one-stage procedure. The overall complication rate was 10%; open revisions were necessary in only 2 of 120 patients. Postoperative hospital stay was 2 days in patients undergoing laparoscopic lymph node dissection only. This minimally invasive procedure is particularly beneficial to patients with lymph node metastases not undergoing radical prostatectomy, as well as to patients planned to be treated by radiation therapy. The combination of laparoscopic lymph node dissection and radical perineal prostatectomy avoids an abdominal incision and thus shortens both the hospital stay and the period of convalescence.

Adenocarcinoma↗
PubMed1996

Oculo-bulbar myasthenia gravis induced by cytokine treatment of a patient with metastasized renal cell carcinoma.

OBJECTIVE: The occurrence of autoimmune diseases or deterioration of pre-existing disorders has recently been described after cytokine treatment. The present report gives evidence for acquired myasthenia gravis induced by externally administered interferon-alpha and interleukin-2 in a patient with metastasized renal cell carcinoma. Electromyographic investigations did not reveal generalised myasthenia gravis. However, a highly elevated titre of antibodies against the human acetylcholine receptor and a significant improvement in clinical symptoms during therapy with anticholinesterase drugs, combined with a decremental response in electronystagmography, indicated an intermittent mainly oculo-bulbar form of myasthenia gravis.

Carcinoma, Renal Cell↗
PubMed1996

Gemcitabine: a phase II study in patients with advanced renal cancer.

Gemcitabine is a fluorine-substituted cytarabine analog with broad experimental antitumor activity. It's activity was explored in chemotherapy-naive patients with advanced progressive renal-cell carcinoma. A total of 39 patients were included in the study, of whom 37 were fully evaluable. In five patients the primary tumor remained in situ. Gemcitabine at 800 mg/m2 was given as a weekly 30-min infusion for 3 consecutive weeks followed by 1 week of rest. One complete response and two partial responses were observed giving a response rate of 8.1% [95% confidence interval (CI), 2-22%]. The duration of the responses is currently 32, 15, and 19 months, respectively. The median survival for all patients was 12.3 months. Gemacitabine was generally well tolerated, with nausea and vomiting (20.5% grade III) and neutropenia (5.3% grade III) being the most significant side effects. Gemcitabine given at this dose level and on this schedule has only limited activity in advanced renal-cell carcinoma.

Adult↗
PubMed1996

Free-to-total prostate-specific antigen serum concentrations in patients with prostate cancer and benign prostatic hyperplasia.

OBJECTIVE: To determine whether the proportion of total serum prostate-specific antigen (tPSA) which is unbound or free (free PSA) offers a better discriminant for the detection of patients with prostate cancer (CaP) and those with benign prostatic hyperplasia (BPH) than does serum tPSA alone. PATIENTS AND METHODS: In a retrospective analysis, the proportion of free PSA was determined in the sera of 60 patients with histologically confirmed localized (n = 39; pT1-3NoMo) and metastatic (n = 21; T2-4NxM+) CaP and 45 patients with BPH. Forty patients with urolithiasis served as a control group. Serum levels of free and total PSA were determined using a chemiluminescent enzyme immunoassay. RESULTS: Patients with CaP had a lower percentage of free PSA (localized CaP median 8.8%; metastatic CaP median 7.1%) than patients with BPH (median 19.5%) and those with urolithiasis (median 18.8%: P < 0.001). The percentage of free PSA did not differ significantly between patients with clinically localized and metastatic disease. CONCLUSION: The determination of the proportion of free PSA enhanced the discrimination between BPH and CaP and may reduce the number of unnecessary biopsies in patients with an elevated PSA. The results warrant further investigations in a broader population to improve the clinical use of serum PSA as a tumour marker for discriminating patients with an early, potentially curable CaP from men with BPH.

Aged↗
PubMed1996

The continent sigmoid urinary reservoir--an experimental study in pigs.

OBJECTIVE: To evaluate the function of a continence mechanism in combination with a colonic urinary reservoir in a pig model. MATERIALS AND METHODS: A colonic urinary reservoir was constructed as a bladder augmentation in six domestic pigs. The pouch was connected to a narrowed and tunnelled ileal tube as a continence mechanism. The closure pressure was measured intra-operatively and 3 months post-operatively. RESULTS: The mean difference between the pressure in the continence mechanism and in the reservoir was 74 cmH2O (range 50-100). Continence was complete both intra-operatively and 3 months post-operatively. CONCLUSION: The modified narrowed and tunnelled ileal tube is a safe continence mechanism when combined with a colonic urinary pouch.

Animals↗
PubMed1996

Role of lasertripsy in the management of ureteral calculi: experience with alexandrite laser system in 232 patients.

In 232 patients with ureteral stones, lasertripsy was used as primary treatment or as second-line therapy after extracorporeal shockwave lithotripsy (SWL). In all patients, a semirigid 6.5F ureteroscope or a flexible 6F ureteroscope was used. Lithotripsy was performed employing an alexandrite laser with an energy of 50 to 65 mJ. The immediate success rate was 67.5% for stones in the upper ureter, 86.1% for those in the midureter, and 94.5% for those in the distal ureter. In 16.5% of the treatments, it was necessary to insert a double-J stent. A perforation of the ureter happened in two patients (0.9%), but no laser-related complications were seen. Stone fragmentation was not dependent on stone composition or size. Using small semirigid or flexible ureteroscopes, lasertripsy of ureteral stones is a minimally invasive treatment with an insignificant complication rate. In case of midureteral stones, our results revealed a higher immediate stone-free rate than is reported in the literature after treatment by SWL, and we can therefore recommend lasertripsy as primary treatment. For upper ureteral stones, lasertripsy can be recommended as a helpful auxillary procedure. Furthermore, in cases of distal ureteral stones, lasertripsy challenges SWL as the primary treatment.

Adolescent↗
PubMed1996

Early detection of infected ureteral obstruction after SWL employing C-reactive protein.

Infection of the obstructed upper urinary tract is a severe complication of stone disease. Early detection and therapy is crucial to prevent septicemia. The authors investigated prospectively whether C-reactive protein (CRP) might act as a marker for the early detection of infected upper urinary tract obstruction. The serum concentration of CRP was compared with the classic markers of inflammation--white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and temperature--in the follow-up of 85 patients undergoing 173 extracorporeal shockwave lithotripsy (SWL) treatments. Post-SWL, 69% of the patients showed dilation of the upper tract on ultrasonography and 16.5% became symptomatic and required intervention. In this group, the mean CRP value was increased 18-fold, whereas the WBC count, ESR, and temperature were not markedly raised. In contrast, patients with no need for additional treatment showed no more than a 2-fold increase in CRP. C-Reactive protein seems to be a useful indicator for the early detection of infected upper urinary tract obstruction.

Adult↗
PubMed1996

Laparoscopic bilateral ureterolysis in Ormond's disease.

We report a case of retroperitoneal fibrosis with dilation of the upper urinary tract on both sides and impaired renal function in a 66-year-old female. The patient was successfully treated by laparoscopic ureterolysis and intraperitonealization of both ureters with subsequent immunosuppressive medication. Due to intraoperative subcutaneous emphysema, surgical therapy had to be performed as a two-step procedure but postoperative morbidity was minimal with quick recovery. Laparoscopic ureterolysis is a reconstructive procedure and the ureters are accessible in full length either transperitoneally or retroperitoneally.

Aged↗
PubMed1996

Prostate-specific antigen as a marker of bone metastasis in patients with prostate cancer.

OBJECTIVE: Staging in patients with newly diagnosed untreated cancer of the prostate has significant ramifications on the management of the disease. Currently measurement of the serum prostate-specific antigen (PSA) concentration and radionuclide bone scan are two important procedures in the metastatic workup of these patients. We retrospectively evaluated the efficacy of PSA as a staging marker to discriminate prostate cancer patients with bone metastases from those without bone metastases. MATERIALS AND METHODS: In a retrospective study 158 prostate cancer patients with (n = 21) and without (n = 137) bone metastases were analyzed. In all patients the initial PSA measurement as well as the radionuclide bone scan were evaluated. RESULTS: Patients with bone metastases demonstrated a median serum PSA concentration of 151 ng/ml and only 1 patient revealed a serum PSA concentration of <10 ng/ml. This resulted in a negative predictive value of 98%. In addition 67% of these patients demonstrated a serum PSA concentration of >100 ng/ml, which resulted in a positive predictive value of 74% and an overall accuracy of 92%. CONCLUSION: The serum PSA concentration seems to provide useful information with regard to the presence of bone metastasis in patients with newly diagnosed cancer of the prostate. A serum PSA value of <10 ng/ml nearly excludes bone metastases, whereas a serum PSA value of> 100 ng/ml is highly predictive of bone metastases.

Adult↗
PubMed1996

Prostate-specific antigen: insufficient discrimination between benign prostatic hyperplasia and organ-confined prostate cancer.

OBJECTIVE: Discrimination of patients with benign prostatic hyperplasia (BPH) from those with cancer of the prostate (CaP) is crucial to the management of these diseases. At present, a number of new treatment modalities for symptomatic BPH, which include various nonsurgical treatment modalities, are being discussed. Prior to treatment, it is important to exclude those patients with CaP. In the present study we examined retrospectively the serum prostatic-specific-antigen (PSA) values in both patient groups in order to determine whether serum PSA identifies those patients harboring organ-confined CaP. PATIENTS AND METHODS: Group 1 consisted of 121 patients with histologically confirmed BPH as determined from pathological analysis of the surgically removed specimens. Group 2 included 69 patients with organ-confined CaP, confirmed pathologically from the analysis of the radical prostatectomy specimens. PSA serum concentration was analyzed in both groups. RESULTS: The median PSA level was 3.96 ng/ml (range: 0.5-31.2 ng/ml) in the BPH group and 7.8 ng/ml (range: 0.7-37.7 ng/ml) in the CaP group. In spite of a statistically significant difference (p = 0.0001), serum PSA values overlapped considerably in both groups. CONCLUSIONS: Serum PSA demonstrated only a limited ability to discriminate between BPH and organ-confined CaP. Therefore some patients with symptomatic BPH undergoing nonsurgical treatment may harbor clinically significant CaP despite "normal' serum PSA values. Furthermore, PSA-based screening may overlook a significant percentage of patients in whom a rectal digital examination would detect CaP.

Aged↗
PubMed1996

The choice of continence mechanism in continent (supra)vesical urinary diversion.

By creating continent supravesical diversions or continent vesicostomies, various methods of continence mechanism can be distinguished. They all are based on the principle that the pressure in the conduit is higher than in the reservoir. Twenty-eight patients with various urinary diversions and different continence mechanisms were followed up by clinical investigation, questioning and urodynamic evaluation. The latter showed similar results with regard to efferent loop pressure. The best results concerning easy catheterization and safe continence are reached by appendix stoma and tapered ileum.

Adolescent↗
PubMed1996

Skeletal alkaline phosphatase in the metastatic workup of patients with prostate cancer.

OBJECTIVE: To compare the efficacy of two tests, prostate-specific antigen (PSA) and skeletal alkaline phosphatase (SAP) as staging markers to discriminate patients with cancer of the prostate (CaP) with bone metastases (M+) from those without bone metastases (M0). METHODS: Thirty-nine untreated patients with CaP M0 (n = 22) and CaP M+ (n = 17) along with 10 patients with benign prostatic hyperplasia, who served as controls, were entered in this study. Serum concentrations for SAP and PSA were determined using two immunoassays. Receiver operating characteristic (ROC) curves were constructed to compare the ability of SAP and PSA to discriminate patients with CaP M+ from CaP M0. RESULTS: None of the M0 patients but 65% of the M+ patients exhibited an SAP value above the reference range (< 19 ng/ml). A corresponding cutoff point of 100 ng/ml for PSA demonstrated that 27% of M0 patients and only 65% of the M+ patients exhibited a value > 100 ng/ml. This resulted in a sensitivity of 65% for both markers. However, SAP revealed a higher specificity than PSA (100 vs. 73%). The ROC curve comparing SAP and PSA demonstrated the superiority of SAP as a marker for bone metastases. CONCLUSION: Our findings suggest that SAP could become a useful marker in the evaluation of patients with newly diagnosed CaP as it seems to provide additional information concerning the skeletal status of these patients.

Adult↗