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Biomedical subjects

G Jakse

Publications and source records attributed to G Jakse.

At least 109 records · Page 6Linked to original sources
PubMed1996

Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.

OBJECTIVE: To determine the efficacy of visual laser ablation of the prostate (VLAP) in comparison to conventional transurethral resection of the prostate (TURP). MATERIAL AND METHODS: 133 patients with benign hyperplasia of the prostate (BPH) were treated by VLAP (n = 90) or TURP (n = 43). International prostate symptom score (IPSS), uroflow, residual urine and grade of obstruction determined by pressure flow studies were evaluated before and after treatment. The VLAP was performed by means of a side firing laser fiber under visual control and using a Nd:YAG laser as energy source. RESULTS: VLAP could improve IPSS, uroflow and residual urine in all patients. However, the obstruction grade was lowered to normal only in patients with prostates smaller than 50 ml, whereas TURP was able to eliminate the obstruction in all patients. CONCLUSION: VLAP can be offered as an alternative to TURP in patients with BPH as long as the prostate volume is not bigger than 50 ml.

Aged↗
PubMed1996

Clinical use of prostate-specific antigen and prostate-specific antigen density in the staging of patients with cancer of the prostate.

OBJECTIVE: To examine the efficacy of prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in staging patients undergoing radical prostatectomy for clinically localized prostate cancer (CaP). PATIENTS AND METHODS: Prostate gland volumes were estimated in patients with clinically localized CaP (n = 119) performing transrectal ultrasound and employing the prolate ellipse formula. PSA was determined using an enzyme immunoassay. All patients underwent laparoscopic pelvic lymphadenectomy followed by radical perineal prostatectomy in No disease. The PSA density was calculated relating the Serum PSA to the sonographically estimated prostate volume. RESULTS: The pathological examination of the prostatectomy specimens revealed a pT2 tumor in 52 cases (43.7%) and a pT3 tumor in 41 cases (34.5%). In 26 patients (21.8%) the histological examination demonstrated metastases to the lymph nodes. Patients with a pT2No CaP demonstrated a median PSA level of 8.95 ng/ml and a median PSAD of 0.3, those with a pT3No CaP demonstrated a median PSA level of 12.3 ng/ml and a median PSAD of 0.38 and those with a T2-3pN + revealed a median PSA level of 22.9 ng/ml and a median PSAD of 0.7. CONCLUSIONS: Both marker, serum PSA as well as PSAD, did not sufficiently distinguish patients with organ-confined cancer from those with extracapsular tumor extension. In contrast, PSAD levels seem to provide useful additional information in the staging of patients with clinically localized CaP with regard to the lymph node status.

Aged↗
PubMed1996

Laparoscopical marsupialization of symptomatic post-transplant lymphoceles.

Post-transplant lymphoceles after kidney transplantations occur with an incidence between 2 and 15%. In the last two years we observed four patients with symptomatic lymphoceles. After an infection or urinoma had been ruled out all cases were operated on laparascopically. All goals of open surgery in lymphoceles were achieved by this minimally invasive technique within an operating time between 40 and 70 min. No complications or recurrences occurred during a mean follow-up period of 17.8 months. Symptomatic post-transplant lymphocele is a rare event and represents an ideal indication for laparoscopic marsupialization.

Adult↗
PubMed1996

Diagnostic and therapeutic laparoscopy of the nonpalpable testis.

We report about laparoscopic examination and treatment of 19 patients with 25 non-palpable testes. Thirteen patients presented with unilateral and six patients with bilateral absent testes, respectively. In all cases of non-palpable testes laparoscopy was able to determine the exact localization and supported the surgical approach. Six testicles were treated by open orchiectomy after diagnostic laparoscopy; three testes were fixed by laparoscopically assisted orchiopexy. Three patients (three testicles) were treated by standard orchiopexy after laparoscopy and in three cases microvascular autotransplantation was performed. Laparoscopically, five aplastic testicles without vas and vessels were diagnosed. Three testes were considered as vanishing and in two patients (two testes) due to previous surgical exploration elsewhere testicular remnants were totally atrophic and were resected with the adjacent vas. All laparoscopic findings except the vanishing testis syndrome were proven either by open surgery or by laparoscopic preparation of the internal inguinal ring.

Child↗
PubMed1996

The influence of LCD shutter glasses on spatial perception in stereoscopic visualization.

For a general establishment of stereoscopic visualisation systems in clinical routine a fundamental analysis of the influence of technical, optical and physiological parameters onto visual spatial perception seems to be necessary to achieve an optimisation of the existing devices. As one important component of these systems we perform studies on the influence of LCD Shutter glasses on the individual binocular perception. The developed shutter system, the initial experiments and their results are presented.

Computer Simulation↗
PubMed1996

Using human factor analysis and VR simulation techniques for the optimization of the surgical worksystem.

The introduction of minimal invasive operating techniques into the conventional surgical worksystem, requires a fundamental analysis of the resulting problems. Based on ergonomic investigations, concerning working postures, static holding work and task sequence analysis, bottlenecks of workplace design can be demonstrated. As a contribution to the optimization of workplace design, the development of a CAD-based VR simulation environment with an integrated anthropometric man-model, as a very useful tool for anthropometric system design is presented.

Computer Simulation↗
PubMed1996

Three-dimensional versus two-dimensional video endoscopy. A clinical field study in laparoscopic application.

Stereoscopic visualisation systems are available for the medical application in clinical routine, especially in the field of endoscopic or minimal invasive surgery. As we have shown in laboratory studies in 1991 the use of stereoscopic visualisation systems leads to a significant improvement of endoscopic manipulation. A broader diffusion of these systems in clinical routine will be based on quantitative evaluation of the influence of stereoscopic visualisation systems on the intervention. As a first approach we performed a clinical field study to compare 2D and 3D video endoscopy in laparoscopic interventions in urological surgery.

Computer Simulation↗
PubMed1996

Metabolic imaging of untreated prostate cancer by positron emission tomography with 18fluorine-labeled deoxyglucose.

PURPOSE: We evaluated positron emission tomograph (PET) with 18fluorine (18F)-labeled deoxyglucose for metabolic grading of untreated primary prostate cancer, and differentiation of benign and malignant prostatic disease. MATERIALS AND METHODS: A total of 48 patients with untreated prostate cancer of different stages and 16 with histologically confirmed benign prostatic hyperplasia (BPH) underwent static PET after intravenous injection of 150 to 300 MBq. 18F-deoxyglucose. 18F-deoxyglucose accumulation was quantitated by calculating differential uptake ratios and prostate-to-skeletal muscle ratios. RESULTS: Low 18F-deoxyglucose uptake was noted in the majority of primary tumors (81%). 18F-deoxyglucose accumulation did not correlate with increasing tumor grade or stage. There was a significant overlap in uptake values in BPH and malignant prostatic disease. A trend towards statistical significance was noted with lower prostate-to-skeletal muscle ratios in patients with BPH (p < 0.07). Increased 18F-deoxyglucose accumulation was detected in some patients with BPH and malignant prostatic disease, as well as in those with lymph node and bone metastases of prostate cancer. CONCLUSIONS: 18F-deoxyglucose PET does not allow for metabolic labeling in the majority of untreated primary prostate cancers. BPH and primary prostate cancer cannot be reliably differentiated on the basis of PET. Increased 18F-deoxyglucose accumulation occurs in some primary prostate tumors and in metastatic deposits of prostate cancer.

Antimetabolites↗
PubMed1996

[Interdisciplinary concepts of surgical sex transformation in transsexual patients].

From the introduction of the law on recognition of transsexuals (TSG) in 1980, over 1400 decisions were made by German regional district judges up to 1990. In over 90% of the cases the desired gender was accepted and attested officially. In the near future, a growing number of requests has to be expected. Generally, transsexual patients desire surgery to achieve a complete sex change. Since the foundation of an interdisciplinary gender dysphoria identity committee at our institution in 1989, we have developed criteria on indications, operative techniques and follow-up, which would overtax a urology department, but which can be managed by an interdisciplinary team. Operative techniques may be regarded as well standardized in male-to-female transsexuals and may be performed by the urologist alone; in female-to-male transsexuals sex transformation remains complex interdisciplinary challenge to urologists and plastic surgeons, mainly due to urethral complications. Continuous psychiatric guidance and endocrinological monitoring of the patients facilitates indications for surgery and perioperative management.

Adult↗
PubMed1996

Prostate specific antigen in the diagnosis and staging of prostate cancer.

Prostate Specific Antigen (PSA) has revolutionized our approach to managing patients with an established diagnosis of cancer of the prostate (CaP). Moreover, its use in early detection and screening has resulted in the most sensitive method of detecting CaP. Furthermore it is regarded as the most important tumour marker in tumour biology. This article will discuss some important advances in the application of PSA.

Aged↗
PubMed1996

Bellini duct carcinoma: a rare variant of renal cell carcinoma.

Bellini Duct Carcinoma (BDC) or collecting duct carcinoma is a rare but very aggressive renal neoplasm which originates from the epithelium of the ducts of Bellini in the distal tubule. This tumour often occurs in a young population and has a bad prognosis. Histomorphological differentiation from the more common renal cell carcinoma of the proximal tubuli is difficult. Immunohistochemic and cytogenetic characterisation can lead to the correct diagnosis.

Adult↗
PubMed1996

DNA-aneuploidy as marker for neoplasia in G1-urothelial carcinomas.

Biopsies from 60 grade-1 urothelial carcinomas and 50 normal bladder mucosae have been investigated by DNA-image-cytometry after enzymatic cell separation to determine the diagnostic sensitivity of DNA-aneuploidy for the identification of low grade urothelial neoplasia. Two different modes to detect DNA-aneuploidy were compared: the conventional application of a threshold at 2.2c for the modal DNA value and the use of the Kolmogoroff-Smirnow (KS) test to compare GO/1 phase fractions of the cells under analysis and the internal reference cells. Whereas the specificity for both types of analysis was 100%, the sentitivity of the latter method was 73.3% compared to 48.3% of the conventional procedure. Therefore, the application of the KS-test for the identification of DNA- stemlines as aneuploid results in an increased detection rate was compared with the conventional threshold procedure. The high prevalence of DNA- stemline aneuploidy even in low grade urothelial cancers may qualify this marker as a possible aid in the cytologic evaluation of urine and bladder washings.

Aneuploidy↗
PubMed1996

Laparoscopic ureterolysis in retroperitoneal fibrosis.

We reported on 5 patients with retroperitoneal fibrosis with dilatation of the upper urinary tract. All patients were operated on laparoscopically. Surgery consisted of complete ascending ureterolysis from the pelvis up to the renal pelvis, biopsy of periureteral tissue, intraperitonealisation and/or preparing an omental flap to separate the ureters from the retroperitoneal vessels. Operating time was reduced from 4 hours in a unilateral case down to 5 hours in a bilateral case by performing three-dimensional video endoscopy. In case of Ormond's disease postoperative immunosuppressive medication was given. Ureterolysis in Ormond's disease is a rare but reasonable indication for reconstructive laparoscopic surgery. Both ureters are accessible in full length either transperitoneal or retroperitoneal. Provided all goals of open surgery can be achieved by the laparoscopic technique, patients will benefit from the minimal access.

Adult↗
PubMed1995

Biomodulation of 5-Fu cytotoxicity by folinic acid and its stereoisomers: in vitro experiments with different cell lines of prostatic cancer.

The results of cytotoxic chemotherapy for advanced, hormone-escaped prostate cancer have been disappointing. Evaluation of the effect of new drugs or new combinations with already known ones is required. The antimetabolite 5-fluorouracil (5-FU) has been shown to be active in prostate cancer, acting via inhibition of thymidylate synthase, an essential enzyme in DNA de novo synthesis. Experiments with cell lines of different tumors have shown that 5-FU activity can be modulated by addition of the coenzyme tetrahydrofolic acid (folinic acid). We investigated the effect of folinic acid and its stereoisomers on 5-FU action in different cell lines of prostate cancer. It was found that addition of non-toxic folinic acid led to a two- to fourfold better antiproliferative effect of 5-FU. The unnatural 6R isomer, which is a compound of chemically synthesized folinic acid, inhibited the modulatory effect of the natural 6S isomer. Our results indicated that a combination of folinic acid and 5-FU may result in a better response of patients with hormone-resistant prostate cancer than of patients treated with 5-FU alone.

Antineoplastic Agents↗
PubMed1995

Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device.

OBJECTIVES: To determine the efficacy and possible beneficial effects of the Catalyst vacuum device (VD) in the treatment of impotence, the ischaemic state of the penis after application of a constriction ring and the origin of the blood in the corpus cavernosum after application of the VD. PATIENTS AND METHODS: Thirty men (mean age 62 years; range 46-76) suffering from erectile dysfunction were selected for the trial after using the VD for 2 weeks at home. Changes in penile tumescence and rigidity before, during and after the VD were assessed using the Rigiscan monitor. Blood gas analysis (BGA) was performed in selected patients whilst using the VD, allowing calculation of the proportional contribution of venous and arterial blood to the increase in penile volume. The efficacy of the VD was also assessed by questionnaires completed before treatment and at the 6 month follow-up. RESULTS: Four patients were lost to follow-up but the 26 impotent men who used the VD for 6 months were able to have sexual intercourse after using the VD. The average rigidity measured at the base and tip of the penis after application of the VD was > 80%. The duration and extent of nocturnal penile tumescence and rigidity at the start and the end of the study improved, although only one variable increased significantly. Patients reporting spontaneous morning erections showed significant improvements in total erection-time, erection-phase and plateau-phase duration, effective rigidity and tumescence increase. BGA determined 30 min after applying a constriction ring showed ischaemia of the penile blood and the mean contribution of arterial and venous blood to penile blood volume was by 58 and 42%, respectively. CONCLUSION: The efficacy of the Catalyst vacuum device was objectively determined and the quality of the nocturnal erections improved in some patients. After application of a constriction ring an ischaemia of the penis developed. In contrast to previous reports, the increased penis volume during the application of the VD is caused not only by arterial inflow but also by venous backflow.

Aged↗
PubMed1995

Non-traumatic rupture of the urinary tract during pregnancy.

OBJECTIVE: To review published cases of rupture of the urinary tract during pregnancy and illustrate the clinical manifestations of this serious complication of pregnancy. METHODS: Reported cases of urinary tract rupture were reviewed and a new case described. RESULTS: Spontaneous rupture of the urinary tract during pregnancy is rare; a review of the literature revealed only 24 cases, most commonly occurring in diseased kidneys. In the majority of cases the rupture was associated with underlying diseases of the kidney, the most common being renal tumours. Of the 25 cases examined, 12 had ruptures of the collecting system and 13 had ruptures of the renal parenchyma: 21 were diagnosed during pregnancy in the second and third trimester and four within the first 24 h postpartum. CONCLUSION: Pregnancy-induced changes in the urinary tract exaggerate any weakness of the parenchyma or collecting system. Pregnant patients with overdistension of the upper urinary tract should undergo routine ultrasonography and be observed carefully for infection or haematuria.

Adult↗