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Biomedical subjects

H Huland

Publications and source records attributed to H Huland.

At least 109 records · Page 6Linked to original sources
PubMed1998

Microsatellite alterations at chromosomes 9p, 13q, and 17p in nonmuscle-invasive transitional cell carcinomas of the urinary bladder.

The clinical behavior of bladder cancer is difficult to predict and prognostic markers applicable to routinely processed tumor specimens clearly are needed. We screened 40 primary Ta and T1 bladder cancers for microsatellite alterations at 9p, 13q, and 17p with PCR, using nine polymorphic microsatellite markers. DNA was prepared after microdissection of paraffin-embedded transurethral resection specimens. PCR products were separated on sequencing gels, and allelic loss as well as band shifts was assessed by comparing alleles of control and tumor tissue. The results were correlated with grade, stage, and clinically documented tumor recurrence. Overall, allelic loss at 9p, 13q, and 17p was present in 35.1%, 25%, and 27.5% of cases, respectively. Whereas the frequency of allelic loss at 9p was nearly equally distributed throughout all tumor grades and stages, the occurrence of allelic loss at 13q and 17p correlated statistically significantly with higher grades and stage. Band shifts were observed in three cases. Of the 40 patients, 16 had tumor recurrence during a follow-up period of 3-49 months (median, 23 months). Kaplan-Meier analysis did not show any statistically significant correlation between allelic loss at either locus and tumor recurrence. The results confirm the role of alterations at 13q and 17p in the progression of bladder cancer. Allelic loss at 9p seems to be an early event in tumor development. However, the detection of alterations at the three chromosomal loci studied did not have any prognostic value regarding tumor recurrence in this group of patients.

Aged↗
PubMed1997

Surgical therapy for localized prostatic carcinoma.

The intraoperative, immediate postoperative, and late postoperative morbidity and prostate-specific antigen (PSA) levels in 511 consecutive patients with clinical T1b, T1c, and T2 tumors, who underwent anatomical radical retropubic prostatectomy, have been discussed. Between 1988 and 1995, prostatic cancer was diagnosed in 511 patients on the basis of PSA and prostate biopsy, when life expectancy was more than 10 years and frozen sections of obturator lymph nodes were negative. All specimens were cut into 3 mm sections by the step-section technique, after the surgical margin had been inked with formalin-resistant dye to identify the margin status. The mean age of the 511 patients was 63.4 years. Blood loss during the operation decreased to 986 ml in the last 2 years. Of the patients, 4.3% had intraoperative rectal perforation; only 5 required a second operation, which was done with a simple rectal approach. Ureteral injury occurred in 1.4% and this was repaired during the operation; 11% had prolonged lymphocele; all were treated conservatively. Deep-venous thromboses were seen in 3.7%; 5 patients (1%) had pulmonary embolism, which was lethal in 3 patients (0.6% of the whole group). There were no intraoperative deaths. No patient death was observed in the last 3 years, when all lymphoceles were diagnosed with thorough ultrasonographic evaluation and drained immediately. Complete continence after 1 year was achieved in 92% of the patients; 5.8% of the patients had anastomotic stricture; most were treated with a single calibration. Twelve months after the operation, 80% of the patients had no measurable PSA. There was a clear correlation of PSA negativity to tumor stage. Anatomical radical prostatectomy is safe and can cure about 70% of patients with clinical T1b, T1c, and T2 prostatic tumors.

Adult↗
PubMed1997

[Experiences with local collagen injection in male stress incontinence].

Nineteen men with post-prostatectomy urinary incontinence grade II and III (mean follow-up 12.7 months) underwent periurethral injections of collagen. In all, 37 procedures were performed; 58% of the patients underwent the procedure at least twice. A mean of 16 ml collagen was injected. The results were successful directly after injections, leaving all patients continent; however, after 3 months the treatment failed and all patients returned to their incontinence status as seen preoperatively. No perioperative complications were noted. Despite the simple and safe nature of this procedure, men with severe postoperative stress incontinence do not benefit from periurethral collagen injections.

Aged↗
PubMed1997

[Occurrence of lymphoceles after allogeneic kidney transplantation and their therapy].

We conducted a prospective evaluation of 301 consecutive renal transplants to define the prevalence and therapy of lymphoceles following renal transplantation. Using a management scheme, we identified in 52 patients (17.3%) perirenal fluid collections. Using this management scheme, we treated 47/52 patients conservatively. Only 5 (1.7%) patients required internal marsupialization. We conclude that groin lympho cysts after renal transplantation can be successfully treated with conservative methods.

Adolescent↗
PubMed1997

[Long-term results of Stamey bladder neck suspension. Effect of data analysis technique on surgical result].

The methodology used to assess postoperative continence has a significant effect on the outcome of incontinence surgery. Retrospective chart review studies consistently report higher success rates than patient questionnaire-based outcome analyses. The purpose of this study was to evaluate the true long-term results of the Stamey bladder neck suspension procedure using an anonymous patient questionnaire. Of 172 consecutive patients, 138 (80.2%) returned a questionnaire on long-term continence, complications and subjective satisfaction with the operative result. With a mean follow-up of 66 months, 65 of 130 evaluable patients (50.0%) remained completely continent while 15 (11.5%) never became continent and 50 (38.5%) had recurrent incontinence 6-90 months postoperatively. Almost two-thirds of the patients felt either cured or substantially improved more than 5 years after surgery. Stamey bladder neck suspension leads to a persistently improved quality of life despite a considerable failure rate. Our study demonstrates the advantages of patient questionnaires for outcome analyses and emphasizes the need for standardisation and validation to allow comparisons between the results of different incontinence procedure in the future.

Adult↗
PubMed1997

[Urodynamic changes after radical prostatectomy].

Urodynamic examinations were performed in 82 patients with clinically localized prostate cancer before and after radical prostatectomy. A significant decrease in bladder capacity (396 ml to 331.9 ml), urethral closure pressure (89.6 cm H2O to 65.2 cm H2O) and functional profile length (61 mm to 25.9 mm) was noted. The continence rate after radical prostatectomy was 33.4% after 1 month, 69.4% after 3 months, 84.7% after 6 months, and 90.9% after 12 months, respectively. A correlation was found between urethral closure pressure and functional profile length and continence. A second urodynamic examination was performed 6 months after radical prostatectomy. Functional profile length and urethral closure pressure increased. These data suggest that restoration of continence is based on sphincteric parameters.

Adult↗
PubMed1997

Intratumoral depot interleukin-2 therapy inhibits tumor growth in Dunning adenocarcinoma of the prostate implanted subcutaneously in rats.

The purpose of this study was to determine the effectiveness and toxicity of local continuous immunotherapy of prostatic cancer. A group of 60 young male Copenhagen rats with Dunning adenocarcinoma of the prostate, implanted subcutaneously into both flanks, after proven tumor growth, were treated with either human interleukin-2 (IL-2) depot preparations (n = 30) or albumin (placebo) depot preparations (n = 30) implanted directly into one tumor site. IL-2 depots released IL-2 reliably for more than 24 days. The rat serum was tested during treatment for human IL-2, possibly absorbed from depots, and for rat interferon gamma. IL-2 treatment reduced tumor growth significantly (P < 0.001) compared with albumin-treated sites or untreated contralateral sites. No toxicity was observed during treatment. Neither human IL-2 nor rat interferon gamma was detected in the serum, which indicates an exclusively local IL-2 effect. IL-2 depot preparations reduce tumor growth in Dunning adenocarcinoma of the prostate significantly without toxicity.

Adenocarcinoma↗
PubMed1997

Prostatic volume and ratio of free-to-total prostate specific antigen in patients with prostatic cancer or benign prostatic hyperplasia.

PURPOSE: We correlated prostatic volume with the ratio of free-to-total prostate specific antigen (PSA) in serum from patients with prostatic cancer or benign prostatic hyperplasia (BPH) to evaluate how prostatic volume influences the ratio. MATERIALS AND METHODS: We evaluated sera from 395 patients (mean age 65 years, range 45 to 88) with prostate cancer (239) or BPH (156) for total PSA, free PSA and ratio of free-to-total PSA. For detection of total and free PSA we used an Immulite free and total PSA assay. Prostatic volume was determined with transrectal ultrasonography. Prostatic volume in BPH and prostate cancer patients was divided into 10 ml. groups, and mean ratio of free-to-total PSA was calculated for each volume group and both diseases. For statistical analysis Mann-Whitney U and Kruskal-Wallis tests were performed in addition to calculation of sensitivity and specificity, and receiver operator curves for prostates 60 ml. or less and greater than 60 ml. RESULTS: For BPH patients the mean ratio of free-to-total PSA was 14.64 to 25.14% without a close relation to prostatic volume. In prostate cancer patients a proportional increase from 8.45 to 19.37% in the ratio of free-to-total PSA with volume was found. Mann-Whitney U analysis revealed significant differences in prostate cancer versus BPH only in patients with prostates of 60 ml. or smaller (p = 0.0008 to 0.029). No significant differences were seen when prostate cancer and BPH patients with prostates larger than 60 ml. were compared (p = 0.082 to 0.868). Kruskal-Wallis test confirmed independence of the ratio of free-to-total PSA from prostatic volume in BPH patients (p = 0.285) but dependence in prostate cancer patients (p <0.0001). Sensitivity was higher in patients with prostates 60 ml. or smaller (86.72%) than in patients with prostates larger than 60 ml. (66%), and specificity was lower at 45.78 and 56.16%, respectively. CONCLUSIONS: We have shown that the ratio of free-to-total PSA is influenced by prostatic volume in patients with prostate cancer. The ratio of free-to-total PSA provides useful information for differentiate BPH from prostate cancer in patients with small prostates but it is less useful in patients with larger prostates, probably because of the larger proportion of benign hypertrophic tissue.

Aged↗
PubMed1997

Early complication of anatomical radical retropubic prostatectomy: lessons from a single-center experience.

OBJECTIVES: The purpose of this study is to report the rate of early complications in 316 of 600 patients who underwent anatomical radical retropubic prostatectomy for localized prostatic cancer from June 1988 to July 1996 and to measure the effect of increasing experience in a single institution. METHODS: From January 1992 to August 1995, 316 patients with prostatic cancer underwent anatomical radical retropubic prostatectomy at our medical institution. Early complications were recorded prospectively and the rate of complications of the first 166 patients was compared with the rate in the next 150 patients. RESULTS: Comparison of the 2 groups showed a significant decrease in blood loss with time (mean 1,397 vs. 967 cm3, p = 0.0011). The rates of anastomotic urinary leakage (21.7 vs. 10%, p = 0.0056), lymphoceles (22.3 vs. 2%, p < 0.0001), rectal injury (7.8 vs. 2%, p = 0.02), reoperation (10.2 vs. 4%, p = 0.049), and thromboembolic complications (7.8 vs. 2.7%, p = 0.0479) also decreased significantly. Only ureteral transsection showed an increase in the later group (0 vs. 4.7%, p = 0.005). CONCLUSIONS: The low percentage of early complications suggests that anatomical retropubic radical prostatectomy is a safe approach. Our single-center study showed a learning pattern that appears unavoidable when this operation is as radical as possible so as to keep the percentage of positive margins low especially in patients with advanced tumors (> pT2).

Adult↗
PubMed1997

Long-term follow-up of cytostatic intravesical instillation in patients with superficial bladder carcinoma. Is short-term, intensive instillation better than maintenance therapy?

OBJECTIVES: Comparisons of two 3-year protocols, one 20-week protocol of mitomycin C instillation and one 3-year protocol of doxorubicin instillation for the prevention of recurrent tumors and progression in patients whose superficial bladder tumors had been removed by transurethral resection. METHODS: A prospective, randomized parallel group multicenter trial was conducted. 419 patients were evaluated after a median follow-up of 57 months. Cox proportional hazards analysis was performed. RESULTS: An overall recurrence rate of 22.7% and an overall progression rate of 9.8% was found. For time to progression a significant overall treatment effect was detected dependent on the recurrence status before entry into the study (p = 0.0059). Pairwise comparisons showed the mitomycin protocol with short-term intensive (weekly) combined with long-term maintenance instillation to have a highly beneficial effect compared to long-term maintenance instillation only especially for patients entering the study with recurrent tumors (RR = 0.06, 95% CI: [0.008, 0.506]. CONCLUSION: These results show that intensive therapeutic instillation may have an advantage over less intensive, prophylactic regimens.

Administration, Intravesical↗
PubMed1997

Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy.

PURPOSE: Urodynamic evaluations were done in patients before and after radical prostatectomy to obtain more information about the factors that affect continence. MATERIALS AND METHODS: Urodynamic testing was done in 82 patients before, and 6 to 8 weeks and 6 months (9 cases) after radical prostatectomy. Evaluation included measurement of cystometric bladder capacity, compliance, functional profile length, maximal urethral closure pressure, maximal urethral closure pressure during voluntary contraction of the external sphincter, residual urine, maximal flow rate and bladder instability. RESULTS: The continence rate was 33.4, 69.4, 84.7 and 90.9% at 1, 3, 6 and 12 months after radical prostatectomy, respectively. Mean functional urethral length decreased from 61 mm. preoperatively to 25.9 mm. postoperatively, maximal urethral pressure from 89.6 to 65.2 cm. water and bladder capacity from 338.7 to 278.8 ml. Bladder instability was found in 17 and 41% of cases before and directly after radical prostatectomy, respectively. There was a statistically significant difference in maximal urethral closure pressure (68.1 versus 53.1 cm. water) as well as functional urethral length (27.6 versus 20.5 mm.) in continent versus incontinent patients, respectively. Urodynamic examination 6 months after prostatectomy showed an increase in functional profile length and maximal urethral pressure, while bladder measurements did not change significantly. CONCLUSIONS: After radical prostatectomy significant changes in bladder and sphincter measurements are noted. Urethral closure pressure, functional urethral length and bladder stability are significant urodynamic factors that influence continence after radical prostatectomy.

Adult↗
PubMed1997

Tumor-associated antigens in normal mucosa of patients with superficial transitional cell carcinoma of the bladder.

PURPOSE: We identified premalignant lesions in tumor-surrounding histologically normal bladder mucosa from patients with superficial and muscle-invasive bladder cancer to look for "premalignant" lesions as the source of tumor recurrence. MATERIALS AND METHODS: Tumor-associated antigen expression in histologically normal bladder mucosa in 23 patients with superficial bladder cancer was studied. Histologically normal bladder specimens from 21 patients with muscle-invasive bladder cancer and from 30 prostatic cancer patients served as controls. Tumor-related antigens 486p 3/12, LBS8, 19A211 and M344 were mapped quantitatively with monoclonal antibodies and immunohistological techniques. RESULTS: Expression of all four bladder tumor-associated antigens was significantly enhanced and more than two antigens were expressed simultaneously in histologically normal mucosa from both bladder-cancer groups, compared with histologically normal bladder mucosa of prostatic carcinoma patients (p < 0.05). CONCLUSIONS: The results suggest the existence of early malignantly transformed cells in the benign-looking and morphologically normal bladder mucosa of superficial bladder carcinoma patients, which possibly is the source of recurrent bladder cancer. This approach models the mapping of histopathologic premalignant lesions of the bladder to predict risk.

Aged↗
PubMed1997

Long-term results of the Stamey bladder neck suspension procedure: a patient questionnaire based outcome analysis.

PURPOSE: Reported success rates of the Stamey bladder neck suspension procedure vary from 39 to 91%. The disparity is substantially influenced by the methods used to assess the surgical outcome, with best results being found consistently in retrospective chart review studies. We assessed the true long-term outcome of the Stamey bladder neck suspension with a patient questionnaire based outcome analysis using strict definitions for cure and recurrence. MATERIALS AND METHODS: Of 172 consecutive patients 138 (80.2%) returned a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. To our knowledge we report the longest mean followup for this procedure (66 months). RESULTS: Of 130 evaluable patients with hypermobility or intrinsic sphincter deficiency leading to urinary stress incontinence 65 (50.0%) remained completely continent, 15 (11.5%) never became continent and 50 (38.5%) had recurrence 6 to 90 months after initial operative success. However, approximately two-thirds of the patients believed they were cured or substantially improved more than 5 years postoperatively. CONCLUSIONS: Despite the considerable failure rate, the substantial improvement in the quality of life of almost two-thirds of the patients during long-term followup and the lack of superior techniques qualify the Stamey bladder neck suspension as a treatment of choice for urinary stress incontinence in women. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontinence surgery.

Adult↗
PubMed1997

Numerical chromosomal aberrations in transition-zone carcinomas of the prostate.

PURPOSE: Prostatic carcinomas arising in the transition zone (TZ) are thought to differ from the more frequent cancers of the peripheral zone (PZ) with regard to morphology and biologic behavior. It is unclear, however, whether the differences are reflected in genetic alterations. MATERIALS AND METHODS: We assessed numerical aberrations of chromosomes 7, 8, 10, 17, and X with interphase cytogenetics in 10 radical-prostatectomy specimens containing exclusively TZ cancers larger than 0.5 cm.3 and in 10 additional specimens containing both TZ and PZ cancers larger than 0.5 cm.3 each. RESULTS: Of the 20 TZ carcinomas, 9 were completely disomic, 5 were at least focally tetrasomic but not aneusomic, and 6 were focally aneusomic. Ploidy correlated well with tumor volume (p = 0.0083), grade (p = 0.0064) and surgical margins (p = 0.0141) but not with preoperative prostate-specific antigen. A strong correlation was observed between the presence of low grade tumor (Gleason grade 4 or 5) and a nondiploid chromosomal status (p = 0.0001). In 10 cases there were also foci of PZ cancer larger than 0.5 cm.3, of which 4 were disomic, 3 were tetrasomic at the most, and 3 were aneusomic. The mean tumor volumes of disomic and aneusomic cancers differed significantly between TZ and PZ carcinomas (p = 0.0336 and 0.0476, respectively). CONCLUSIONS: Numerical chromosomal instability parallels tumor progression in TZ carcinomas of the prostate. However, our results indicate that PZ and TZ cancers differ in that the latter can reach larger volumes before histological dedifferentiation and aneusomy occur.

Aged↗
PubMed1997

Inhaled interleukin-2 therapy in pulmonary metastatic renal cell carcinoma: six years of experience.

PURPOSE: Patients with advanced metastatic renal cell carcinoma often cannot or do not want to tolerate high-dose systemic interleukin-2 (IL-2) therapy and the toxicity associated with it. To reduce toxicity and still maintain or even increase effectiveness, we developed a method to deliver IL-2 locally for the treatment of pulmonary and mediastinal metastases in metastatic renal cell carcinoma patients. PATIENTS AND METHODS: We report here 6 years of experience treating 116 metastatic renal cell carcinoma patients who had pulmonary or mediastinal metastases with inhaled IL-2. We have utilized three different IL-2 preparations (natural human IL-2 purified from the supernatants of mitogen-activated peripheral blood lymphocytes, glycosylated recombinant IL-2 produced by Chinese hamster ovary cells, and non-glycosylated recombinant IL-2 produced by bacteria). All protocols used high-dose inhalation of IL-2, either exclusively (11%), with coadministration of low-dose systemic IL-2 (33%), or with coadministration of low-dose systemic IL-2 and interferon-alpha (56%). RESULTS: Maximal toxicity per total treatment time was mild (median treatment time, 7.2 months); there was a low incidence (16%) of World Health Organization grade 3 toxicity. Toxicity associated with exclusive inhalation of IL-2 was local and consisted mainly of cough. Thus, patients who could not tolerate high-dose systemic IL-2 were able to tolerate inhalation IL-2 therapy. Progressive pulmonary metastases responded in 15% of patients for a median of 15.5 months (range, 4.1-33 months) and were stabilized in 55% of patients for a median of 6.6 months (range, 3-51.7 months). The overall response rate was 16%; disease was stabilized in 49% of patients and disease progressed in 35% of patients. The overall median response duration was 9.6 months. Median survival was 11.8 months (range, 1.7-68.8 months); expected survival according to risk analysis was 5.3 months. CONCLUSIONS: Inhalation of IL-2 is a nontoxic and effective treatment for patients with progressive pulmonary and mediastinal metastases. Inhaled IL-2 effectively prevented progress of pulmonary metastases in 70% of patients. Furthermore, patients could be treated as outpatients and remain employed. Local administration of IL-2 increases therapeutic effectiveness with little or no toxicity.

Administration, Inhalation↗