Biomedical subjects

G Jakse

Publications and source records attributed to G Jakse.

At least 127 records · Page 7Linked to original sources

PubMed1995

Evaluation of patients with diseases of the prostate using prostate-specific antigen density.

OBJECTIVE: To compare the efficacy of two tests, prostatic-specific antigen (PSA) and the PSA/prostate volume ratio (PSAD), as diagnostic and staging markers to discriminate patients with benign prostatic hyperplasia (BPH) from patients with cancer of the prostate (CaP). PATIENTS AND METHODS: Prostate gland volumes were estimated in 60 patients with BPH and 88 patients with clinically organ-confined CaP by performing transrectal ultrasonography (TRUS) and using the prolate ellipse formula. Serum PSA concentration was determined using an enzyme immunoassay. In patients with BPH, the prostates were removed either by transurethral resection or retropubic prostatectomy. Patients with CaP underwent laparoscopic pelvic lymphadenectomy followed by radical perineal prostatectomy. PSAD was calculated by relating the serum PSA level to the TRUS-estimated prostate volume. RESULTS: The median PSA level was 4.4 ng/mL in patients with BPH, 9.3 ng/mL in patients with CaP-NO disease and 24 ng/mL in those with CaP-N+ disease. However, imposing a PSA limit of 4 ng/mL for the diagnosis of CaP gave a positive predictive value of only 64.8%, whereas a limit of 10 ng/mL gave a positive predictive value of 71.4%. In contrast, the median PSAD was 0.086 ng/mL/cm3 in patients with BPH, but was 0.295 ng/mL/cm3 in patients with NO-disease and 0.775 ng/mL/cm3 in those with N(+)-disease. With a limit of 0.15 ng/mL/cm3 the positive predictive value of PSAD was 81%. Furthermore, a limit of 0.6 ng/mL/cm3 revealed a positive predictive value of 81% for the diagnosis of metastatic lymph node involvement. CONCLUSIONS: There was a considerable overlap of PSA concentrations in patients with BPH and CaP, and PSA was not sufficiently accurate to distinguish between them. In contrast, PSAD enhanced the discrimination between BPH and CaP and may provide additional information about the status of the lymph nodes in patients with CaP.

Aged↗

PubMed1995

Second in situ extracorporeal shock wave lithotripsy in not disintegrated ureteral stones is preferred to retrograde manipulation.

In this study we tried to determine the optimal treatment of upper ureteral stones which are not disintegrated by the first extracorporeal shock wave lithotripsy (ESWL) and to analyze the cost-benefit ratio of retrograde manipulation into the renal pelvis. 180 patients with an upper ureteral stone were treated by ESWL in situ. 40 patients needed a retreatment and were randomized for retrograde manipulation before ESWL or ESWL in situ without a prior manipulation. In both the in situ group and in the push-and-smash group, the stone-free rate was 75%. In stones < 8 mm, the disintegration rate was higher after retrograde manipulation into the renal pelvis and inserting a DJ catheter. In conclusion, ESWL in situ is the optimal treatment for all patients with upper ureteral stones. We reserve retrograde manipulation before a second ESWL for stones < 8 mm. Routinely employed auxiliary procedures such as placement of a DJ catheter increase the costs significantly, without improving the results.

Cost-Benefit Analysis↗

PubMed1995

Spontaneous kidney rupture--symptom of renal tumors.

Spontaneous ruptures of the kidney frequently require an emergency surgical intervention and the underlying pathology often only becomes clear intraoperatively. On the basis of our own cases the clinical management of the symptom 'rupture of the kidney' is discussed particularly referring to renal tumors.

Adenoma, Oxyphilic↗

PubMed1995

Management of rectal injury during perineal prostatectomy.

109 patients with locally confined prostate cancer underwent radical perineal prostatectomy. In 12 (11%) patients a rectal laceration was noted intraoperatively and closed in two layers. No patient had complications or prolonged hospital stay associated with the laceration.

Aged↗

PubMed1995

Determination of prostate gland volume by transrectal ultrasound: correlation with radical prostatectomy specimens.

Estimation of the prostate gland volume employing transrectal ultrasound provides important additional information in patients with benign and malignant diseases of the prostate. Twenty-five patients underwent transrectal ultrasound of the prostate prior to radical prostatectomy for organ-confined cancer of the prostate. The prostate gland volume was calculated employing two different methods. The prostate specimen weights were compared with the results of each of the volume estimation method. The prolate ellipse formula, widely used as an alternative to planimetry, demonstrated a correlation coefficient of r2 = 0.831. However, a variation of the prolate ellipse formula expressed as (width x width x height) x pi/6, which is easier to perform as described by Terris and Stamey, exhibited a correlation coefficient of r2 = 0.829. It appears to be a reliable means of estimating prostate gland volume, especially in cases in whom the original formula is difficult to apply.

Aged↗

PubMed1995

Computed tomography for detection and staging of transitional cell carcinoma of the upper urinary tract.

A total of 91 patients were treated for upper tract urothelial tumors between 1981 and 1991. Preoperative computed tomography (CT) scans and nephroureterectomy for treatment of transitional cell carcinoma were performed in 26 patients. At pathological examination, 28 tumors were diagnosed of which 19 were in the renal pelvis and 7 were in the ureter. Intravenous pyelogram, retrograde and antegrade pyelogram detected 26 of 28 tumors (93%). CT detected 24 of 28 tumors (86%). However, CT is still the best current method for staging of upper urinary tract urothelial tumors, although staging was correct in only 5 of 9 T3 and T4 tumors.

Adult↗

PubMed1995

Multiinstitutional home-therapy trial of recombinant human interleukin-2 and interferon alfa-2 in progressive metastatic renal cell carcinoma.

PURPOSE: In a phase II multiinstitutional outpatient trial, patients with progressive metastatic renal cell carcinoma were treated with a combination of subcutaneous (SC) recombinant interleukin-2 (rIL-2) and recombinant interferon alfa-2 (rIFN alpha 2). PATIENTS AND METHODS: One hundred fifty-two patients with metastatic renal cell carcinoma were treated. Treatment courses consisted of SC rIL-2 at 20 x 10(6) IU/m2 three times per week in weeks 1 and 4, and at 5 x 10(6) IU/m2 three times per week in weeks 2, 3, 5, and 6. Additionally, patients received SC rIFN alpha 2 6 x 10(6) U/m2 once per week in weeks 1 and 4, and three times per week in weeks 2, 3, 5, and 6. RESULTS: There were nine (6%) complete responses (CRs) and 29 (19%) partial responses (PRs), for an overall response rate of 25% (95% confidence interval, 19% to 32%). The median duration of responses for CRs and PRs was 16+ and 9 months, respectively. Additionally, 55 patients (36%) had stable disease (SD). Fifty-nine patients (39%) had continued disease progression (PD) despite treatment, or went off study after less than 4 weeks of therapy. The majority of patients treated experienced fever, chills, malaise, nausea, vomiting, and anorexia, side effects that were mostly limited to World Health Organization (WHO) grade 1 and 2. However, one patient developed grade 4 CNS toxicity with extended somnolence. On cessation of therapy, the neurologic symptoms in this patient were fully reversible, with no neurologic deficiency. CONCLUSION: In summary, this multiinstitutional home-therapy setting of SC rIL-2 and SC rIFN alpha 2 in patients with progressive metastatic renal cell carcinoma demonstrated drastically reduced systemic toxicity, while it confirmed the therapeutic efficacy of the low-dose SC immunotherapy combination schedule.

Adult↗

PubMed1995

Visual laser ablation of the prostate (VLAP): an effective alternative treatment of benign prostatic hyperplasia.

A total of 75 patients suffering from benign prostatic hyperplasia (BHP) were treated with visual laser ablation of the prostate (VLAP) using the Nd-Yag laser. Preoperative evaluation consisted in determination of urinary flow and residual urine, assessment of voiding symptoms and urodynamic evaluation. Postoperatively, the same evaluation was performed at 3 and at 6 months. VLAP is a relatively simple technique with a low perioperative morbidity and short time results are comparable to classical transurethral resection of the prostate. Therefore VLAP seems to be an effective alternative treatment method for BPH which may replace classical transureteral resection of the prostate in a selected number of cases.

Aged↗

PubMed1995

Biofeedback in the treatment of voiding disorders in childhood.

Voiding disorders are a common problem in pediatric urology. Biofeedback is a non-invasive method in the treatment of voiding disorders in childhood. Biofeedback takes aim at the learning or relearning of influencing involuntary functions. We report about our preliminary results of biofeedback training in the treatment of the enuretic syndrome in children. Out of 26 children with pseudo-detrusor-sphincter-dyssynergy 17 could be completely cured and 5 improved considerably. Out of 21 children with motor urgency 9 could be completely cured and 7 children improved. Biofeedback is a successful method to treat children with the enuretic syndrome.

Biofeedback, Psychology↗

PubMed1995

[Visual laser ablation of the prostate--a prospective study].

Since february 1993 90 patients with BPH were treated with VLAP. Preoperatively determined parameters, WHO Prostate Symptom Score, uroflow, residual urine and obstruction grade were reevaluated 3, 6 and 9 months after operation. After dividing the whole collective into two groups (prostate size < 50 ml, prostate size > 50 ml), we could conclude, that VLAP in smaller prostate glands is similarly effective as transurethral resection, but in larger glands by obstructive symptoms can be improved by VLAP without removing the urodynamically proved obstruction.

Aged↗

PubMed1994

Measurement of BBN-induced alterations in rat urothelium by electron microscopic X-ray microanalysis.

The aim of this study was to analyse N-butyl-n-butanol-4-nitrosamine (BBN)-induced alterations of the urothelium in rats concerning its content of phosphorus, sulphur, chlorine, potassium and calcium using electron microscopic X-ray microanalysis (REM analysis). The following histopathological findings of the bladder mucosa were discovered after exposure to BBN: normal urothelium (n = 36); focal epithelial proliferations (n = 12) following 6-12 week's exposure; epithelial hyperplasia (n = 8) after urothelial carcinoma (n = 4) following 12 weeks' exposure. The observed phosphorus/sulphur and phosphorus/calcium ratios based on REM analysis did not show any statistical correlation with the morphological changes classified by light microscopy. Our data do not support the hypothesis raised by other investigators that an increase in phosphorus content or phosphorus/sulphur or phosphorus/calcium ratio could indicate early neoplastic transformations of urothelial cells as "tumor markers".

Animals↗

PubMed1994

The latissimus dorsi muscle for detrusor assistance: functional recovery after nerve division and repair.

The treatment of choice for bladder atonia is clean intermittent catheterization. To eliminate the catheter-related morbidity and increase the quality of life for patients with an atonic bladder, the restoration of bladder contractility would be desirable. Based on our hypothesis that skeletal muscle might augment bladder contractility, we designed the present study to examine the ability of the latissimus dorsi muscle in situ to empty a bladder-like reservoir and to regenerate after division and repair of the supplying motor nerve. In 4 dogs, the left latissimus dorsi muscle was dissected, mobilized and wrapped around a bladder substitute (100-ml. silicone reservoir). Stimulation of the thoracodorsal nerve resulted in the evacuation of 63.8 +/- 6.2% of the reservoir's volume and a maximum pressure of 109.5 +/- 18.6 cm. H2O. Four months later, the thoracodorsal nerve supplying motor control to the muscle was transected and microsurgically reanastomosed. Using transcutaneous stimulation, we recorded the pressure generation and resulting evacuation at regular intervals for 8 months (that is, 12 months after the initial surgery). At the end of this period, the pressure was 79.3 +/- 12.1 cm. H2O (72.4% of the initial value), expelling 48.3 +/- 6.7% of total volume. This long-term study demonstrates: (1) the ability of the transposed latissimus dorsi muscle to evacuate a bladder-like reservoir; and (2) the regenerative potential of muscle and nerve after nerve transsection and repair. Use of skeletal muscle, which can be readily stimulated, may serve to facilitate bladder emptying and provide a treatment alternative to intermittent catheterization in the future.

Animals↗

PubMed1994

Intra-urethral ultrasound in women with stress incontinence.

OBJECTIVE: To investigate whether the sphincter area in women can be seen and quantified with intra-urethral ultrasound (IUUS). Currently, sphincter capacity in women is determined by clinical tests, vaginal palpation, urodynamics and urethral pressure profile. PATIENTS AND METHODS: A pilot study using IUUS was carried out in 32 stress incontinent and 12 healthy women to enable the urethra and para-urethral tissue to be visualized. Round-tipped miniature transducer-containing (20 MHz) catheters (6 and 9 F) were tested. Both provided 15 frames per second. Real-time 360 degrees cross-sectional ultrasound images were obtained by using a standard intraluminal ultrasound system. The external urethral sphincter was visualized and its circumference and area were measured. RESULTS: IUUS provided high resolution imaging of the urethra and surrounding tissues. The whole length of the urethra was visualized. The external sphincter was easily recognized as an oval-shaped, hypoechoic structure. Examination of 44 stress incontinent and healthy women revealed a negative correlation between the external urethral sphincter (area and circumference) and the grade of stress incontinence (P < 0.01). In no patient with normal urinary continence was the sphincter reduced in size (< 2.8 cm circumference). CONCLUSION: IUUS is a useful technique in the diagnosis of incontinence, as conventional methods provide little information on the sphincter itself. The evaluation of sphincter size and morphology could help in the choice of therapy.

Female↗

PubMed1994

Spontaneous bladder rupture following enterocystoplasty can be treated conservatively.

Spontaneous bladder rupture following enterocystoplasty has been reported recently. The etiology remains unclear but appears to be multifactorial. Common factors are a high outlet resistance with total urinary continence and the presence of an augmented, dysfunctional native bladder, which may result in the development of high intravesical pressures or increased wall tension. We present a case of spontaneous bladder rupture 4 weeks following enterocystoplasty in which a segment of detubularized ileum was used to augment a contracted bladder. Our patient was treated by continuous bladder drainage for 21 days, antibiotics and appropriate supportive care.

Aged↗

PubMed1994

DNA aneuploidy in G1-urothelial carcinomas of the urinary bladder.

Thirty G1-urothelial carcinomas of the bladder were investigated using DNA cytophotometry. Specimens obtained by tumour resection and quadrantic biopsy were first fixed in formalin and then embedded in paraffin. The cells were then separated using the method developed by Hedley. The DNA content was established after Feulgen staining using a TV-based image analysis system. DNA aneuploidy, a marker for neoplasia, was investigated using the so-called stemline interpretation developed by Böcking. This method compares the DNA content of the G0/1 tumour cells in the cell population to be analysed with the reference cell population, using the Kolmogoroff-Smirnow test (p < 0.001). On this basis, 23 tumours (76.6%) were DNA aneuploid, whereas if DNA aneuploidy is defined (as conventionally) as a DNA content of > 2.2c, only 17 tumours (56.6%) were found to be DNA aneuploid. The mean stemline value was 2.4c (range 1.85-3.96). By using a more precise TV-based image analysis system and this new DNA stemline interpretation, the rate of detection of DNA aneuploidy was improved by 20%. The diagnosis of G1-urothelial carcinomas by DNA cytophotometry is at least 25% more sensitive than that using conventional cytology (20-50%). We suggest that modified DNA cytophotometry could be a useful, additional diagnostic tool in examining doubtful urinary samples.

Adult↗

PubMed1994

Retinoblastoma and p53 genes as prognostic indicators in urological oncology.

Recent studies of the malignant phenotype have suggested that cumulative genetic changes are necessary for a malignant cell to develop. Alterations in particular genes associated with cell growth and division have been identified and two main classes of genes have been characterized. Oncogenes are those genes which when mutated promote tumour growth, whereas tumour suppressor genes (antioncogenes) inhibit tumour growth. Oncogenes have been investigated in some depth, but relatively little is known about tumour suppressor genes. Recent studies have shown that inactivation of normal tumour suppressor genes is a common mechanism in cancer progression and this may be of prognostic value. The present review focuses on the potential of tumour suppressor genes as prognostic markers in urological cancers.

Biomarkers, Tumor↗

PubMed1994

In situ extracorporeal shockwave lithotripsy of distal ureteral stones: parameters for therapeutic success.

Between January and December 1989, 123 patients with distal ureteral stones were treated with in situ extracorporeal shockwave lithotripsy (ESWL) using a modified HM3 Dornier lithotriptor. One hundred and three patients (83.7%) were stone-free, 20 patients (16.3%) had small residual stones (< 1 mm2) that passed spontaneously. In situ ESWL treatment alone was successful in 88 of the 103 stone-free patients (85.4%). Fifty-six (54.4%) needed 1 ESWL session, 26 (25.2%) needed 2 ESWL sessions. Nineteen of the 123 patients (15.4%) needed auxiliary endourological measures. The results of ESWL treatment were correlated to pretherapeutically identified parameters such as stone size, radiopacity, outer contour, shape, inner structure, biochemical analysis of the stones and grade of dilatation of the upper urinary tract. The results prove that size (> or = 75 mm2), radiopacity and grade of dilatation have a direct correlation to the difficulty to disintegrate ureteral stones.

Female↗

PubMed1994

Differentiation of benign prostatic hyperplasia and prostate cancer employing prostatic-specific antigen density.

To enhance the ability of prostate-specific antigen (PSA) to distinguish benign prostatic hyperplasia (BPH) from cancer of the prostate (CaP) Benson et al. defined a new parameter, PSA density (PSAD), which is the ratio of the serum PSA concentration to the volume of the prostate. We have employed this parameter in a prospective study of 28 patients with clinically localised CaP and 57 patients with BPH. Mean PSAD was 0.116 for the BPH patients and 0.46 for the CaP patients (p < 0.005). The authors conclude that the information provided by PSAD is superior to absolute PSA values in the differentiation between BPH and CaP.

Biomarkers, Tumor↗