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H Lipsky

Publications and source records attributed to H Lipsky.

At least 19 recordsLinked to original sources
PubMed2001

Twelve-year experience with two courses of adjuvant single-agent carboplatin therapy for clinical stage I seminoma.

PURPOSE: During the past 30 years, radiation therapy with 28 to 30 Gy for para-aortic and ipsilateral iliac node areas was the standard adjuvant treatment for clinical stage I seminoma after orchiectomy. However, late effects of radiotherapy prompted a search for alternative adjuvant treatment approaches, including surveillance and application of carboplatin. In this retrospective analysis, we evaluated the efficacy and toxicity of two adjuvant single-agent carboplatin courses in 107 patients who were diagnosed with clinical stage I seminoma at our study centers between 1988 and 1999. PATIENTS AND METHODS: All 107 patients (median age, 39 years; range, 24 to 63 years) received two postoperative adjuvant cycles of carboplatin (400 mg/m(2)). The pathologic tumor stage was pT1 in 84 patients, pT2 in 18 patients, and pT3 in five patients. Whole blood count and serum chemistry were evaluated weekly during treatment to assess hematologic and nonhematologic toxicity. RESULTS: Six patients died from tumor-unrelated causes. The remaining 101 patients are currently alive and free of disease after a median follow-up of 74 months (range, 5 to 145 months). A detailed analysis of hematologic toxicity showed only World Health Organization (WHO) grade 1 leukocytopenia in 10.7% of all cycles and WHO grade 2 leukocytopenia in 2.1% of all cycles. CONCLUSION: Regarding the absence of tumor recurrences in our retrospective analysis and the favorable toxicity profile with no episodes of long-term toxicity, we suggest that two adjuvant courses of single-agent carboplatin for clinical stage I seminoma patients might be equivalent to radiotherapy.

Adult↗
PubMed2000

[Long-term outcome of endoscopic treatment of vesicoureteral reflux].

For more than 10 years VUR has been treated by endoscopic injections with biocompatible substances. This study presents the results of this procedure with bovine collagen (Zyplast) in 42 children with 66 refluxing ureters. The follow-up period comprises an average time of 6.5 years (2-10 years). In 16 ureters a second and in 4 a third injection was given. In 5 kidneys scarring occurred during the years of follow up. Growth, kidney function and blood pressure remained normal in all children. 6 ureters were reimplanted because of recurrences, in 13 ureters (23%) the reflux improved and since no infection recurred no further management became necessary. In 36 (65.4%) ureters reflux was cured and in further 11 this was supposedly the case. However this was not proven by MCU, because parents refused this investigation. Earlier MCU have shown no reflux. We think that the endoscopic injection with collagen is a excellent option in management of VUR grade I-IV.

Biocompatible Materials↗
PubMed1998

[Carboplatin monotherapy in clinical stage I of seminoma. An acceptable alternative?].

Between 1/1990-8/1997 two courses of single agent Carboplatin had been given to 36 patients with clinical stage I seminoma. Within an median follow up period of 52 months (17-88) 29 out of 34 patients were analyzed retrospectively. During this period no recurrences had been noted and nobody of our patients died (0% relapsrate, 100% survival-rate). The Carboplatin-therapy was well tolerated. Myelosuppression after chemotherapy was mild (WHO grade I). The experienced acute toxic side effects (max. grade II WHO) during and after chemotherapy had been nausea (37%), vomiting (14%) and mild hairloss (11%). Until now no long term side effects were noticed. A standardized questionnaire had been used to evaluate the impairment of quality life after single agent carboplatin therapy. After a minimum of one year follow up averagly 79% (62-92%) of the asked patients showed no impairment of their quality of life, whereas 19% (8-38%) of the people experienced mild impairment of their quality of life. Because of the shown low recurrence rate, the minimal toxicity and no relevant impairment of the quality of life single agent carboplatin therapy will be an alternative approach for clinical stage I seminoma.

Adult↗
PubMed1997

[Calculation of lavage volume in transurethral prostate resection (TURP)].

PURPOSE: Evaluation of the relationship between ethanol concentration in expired air and the amount of absorbed irrigation fluid in patients who undergo a transurethral resection of the prostate. METHODS: 76 patients were evaluated in a prospective study. The irrigation fluid contained 1.92 w/w% of ethanol. The ethanol concentration in breath was measured at least every 10 minutes with a Alcotest 7410 (Dräger) or a Biomed 3010 (Biotest). Documented values: breath ethanol concentration, mean arterial pressure, heart rate, haemoglobin concentration, serum sodium concentration, the amount of irrigation fluid, the time of operation, special events, therapeutic interventions. A modification of the Widmark formula was used for calculating the amount of absorbed irrigation fluid from the breath ethanol concentration. RESULTS: A rise of the ethanol level above 0.2/1000 was observed in 10 patients. No clinically significant difference in heart rate and blood pressure during surgery between the 24 patients with no alcohol in breath and the 10 patients with more than 0.2/1000 was observed. Prolonged duration of resection and greater amount of used irrigation fluid correlated with higher ethanol concentration in breath. During the study period no patient developed the clinical features of a transurethral resection syndrome. CONCLUSIONS: If 2 w/w% of ethanol is added to the irrigation fluid, breath ethanol concentration under 0.2/1000 may be considered harmless, while values above 0.2/1000 are predictors of massive absorption of irrigation fluid. In our patients, the addition of ethanol to the irrigation fluid has been a suitable and easy way to monitor the absorption of irrigation fluid, if the ethanol concentration in the breath is measured every ten minutes. If 2 w/w% of ethanol have been added to the irrigation fluid, the absorbed volume (E) can be estimated using the formula: E = 37.5 x body weight (kg) x ethanol concentration (/1000).

Aged↗
PubMed1996

[Psoas abscess].

Psoas abscess is a rare infection, which can present a diagnostic challenge. The classical symptoms are fever, rigor and pain in the loin, lower abdomen, groin or hip, as well as a characteristic limp, but these symptoms can vary. The general health can deteriorate with delayed diagnosis and anemia, weight loss and anorexia can develop. CT is the best diagnostic method to demonstrate the localization and extent of the abscess and also possible sources of infection in the neighbourhood. 14 cases of psoas abscess, which were largely diagnosed and treated in the urological department, are presented and the clinical spectrum of this infection is discussed.

Adult↗
PubMed1995

Laparoscopic varicocele ligation: a recommendable standard procedure with good long-term results.

In the last 2 years we have performed 100 laparoscopic varicocele ligations. The indications for surgery were pain, a small testicle or prevention of subfertility. 4 patients had undergone previous embolization therapy or open operation and developed recurrences. 5 patients had bilateral varicocele. No severe intraoperative complications occurred. Postoperative complications were of low morbidity and were managed conservatively. The follow-up time was 3-30 months. The overall persistence and recurrence rate was 8%. Laparoscopic varicocele ligation is safe and can be recommended.

Adolescent↗
PubMed1995

[Is orthotopic ileal neobladder an acceptable form of urinary diversion from the viewpoint of the patient?].

In 19 patients with bladder cancer who required cystectomy, an orthotopic ileal bladder was created. The patients were followed up for an average of 36 months (12-60 months). In this study we present the early and late postoperative complications, the survival data, quality of life assessment, data from urodynamic investigations, metabolic changes and the situation in the upper tracts. Postoperative complications requiring reoperation occurred in 11% in the early postoperative and in 27.7% in the late postoperative phase. Two of 19 patients died from cancer 18 and 26 months after cystectomy. A further patient had an urethral recurrence and the cancer is progressing further. Questionnaires showed that 80% of our patients were satisfied with their new bladder. Eighty percent were continent during the day and at night. Stress incontinence (II-III) occurred in only 2 patients (12%). All patients were impotent, but in 5 SCAT therapy made intercourse possible. The metabolic acidosis required oral alkalization in 60%. Dilatation of the upper urinary tract was seen in 6% of the renal units. We conclude from our experience that an orthotopic ileal neobladder is an excellent method of urinary diversion after cystectomy.

Aged↗
PubMed1993

Laparoscopic treatment of an upper ureteral stone.

Extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous lithotripsy have become standard procedures for treatment of ureteral stones. Often, open surgery becomes necessary. A case of bilateral ureteral stones with chronic obstruction is presented in which the successful treatment with laparoscopic ureterolithotomy on one side is described. Laparoscopic ureterolithotomy can be used as an alternative method for stone removal in the upper and middle ureter.

Female↗
PubMed1993

Endoscopic treatment of vesicoureteric reflux with collagen. Five years' experience.

Submucosal injections of bovine collagen (Zyplast) were administered to 67 children and 7 adults with 115 refluxing ureters. Reflux was grade I in 14 ureters, grade II in 54, grade III in 38 and grade IV in 9. All patients had a history of recurrent urinary infection. One year after treatment 70 ureters showed no reflux, 20 were grade I and 25 showed a complete recurrence. The cure rate was 81% if grade I recurrence is included. In all, 68 ureters were followed up for 2 to 4 years. In 19 ureters a second injection was given, 47 showed no reflux, 19 had grade I reflux and 2 had a recurrence. In 5 ureters reflux grade I disappeared without a second injection. The cure rate was 97%. Renal scarring was seen in 4 kidneys. Collagen injections are an adequate method of treatment for reflux grades I-III.

Adolescent↗
PubMed1992

[Urethral stricture after TURP and transvesical prostatectomy].

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

Catheters, Indwelling↗
PubMed1992

[Incidental prostatic cancer--"wait and see" or radical prostatectomy?].

In a comparative and retrospective study, outcome was examined in two groups of patients with incidental carcinoma of the prostate (stage T1a). In the 47 patients in the first group the carcinoma was kept under observation for 2-10 years without the administration of any treatment. During the mean follow-up of 5 years, the disease progressed in 11 (23.4%) of these patients, and 4 of them died. The other group was made up of 20 patients who underwent radical prostatectomy. The clinical and pathological staging were quite different in this group than in the other: more advanced stages and higher grades were seen in 10 patients, and the specimens taken from 6 were found not to contain any tumour. After a mean follow-up period of 4.5 years, all these 20 patients are alive with no evidence of disease. The management of patients with T1a tumour is still a problem. Observation only will be followed by progression in 23% of cases, while radical prostatectomy actually constitutes overtreatment in 30%. In conclusion, we prefer to perform prostatectomy in all patients with T1a carcinoma who are young and have a good life expectancy.

Aged↗
PubMed1990

Dietary fiber for reducing blood cholesterol.

Soluble dietary fiber, including psyllium, has been shown to have mild to modest cholesterol lowering properties. Psyllium hydrophilic mucilloid (Metamucil, Procter and Gamble, Cincinnati, OH), a bulk laxative, when used as a dietary supplement in combination with a low fat diet, can lower total serum cholesterol and low-density lipoprotein (LDL) cholesterol, and raise high-density lipoprotein (HDL) cholesterol in hypercholesterolemic patients. The cholesterol lowering effects of psyllium are much less evident than those observed with cholestyramine and the HMG-CoA reductase inhibitors. The mechanism for the cholesterol lowering effect of psyllium is not known. The substance is well tolerated with long-term use.

Cholesterol↗
PubMed1990

Endoscopic treatment of vesicoureteric reflux with bovine collagen.

A submucosal injection with bovine collagen (Zyplast) was performed in 45 female patients with 70 refluxing ureters. 4 ureters showed reflux grade IV, while the others had reflux grade I-III. All patients suffered from recurrent urinary tract infections. In 18 ureters, a second injection was given. As a result of this treatment, reflux was cured in 85.8% of the ureters. Only 13 patients had urinary tract infections during the follow-up period (6-24 months). 5 patients had antireflux surgery and collagen was excised. The histology of the specimen did not show an inflammatory reaction. Collagen injections could gain great importance in the management of vesicoureteral reflux.

Adult↗
PubMed1989

Management of patients with localized prostatic carcinoma.

Three groups of patients with localized prostatic carcinoma are presented. One group of 42 patients was treated with radiation therapy. The second group of 43 patients was subjected to radical prostatectomy. The third group consisted of 42 elderly men with focal, incidental carcinoma who received no therapy. The preliminary results of management and observation are presented. Comparison of the two forms of management shows that radical prostatectomy gives better results than radiation in terms of cure, survival and disease progression. The probability of recurrence or metastases is very high in T3 lesions, despite radical surgery. In the group with incidental untreated carcinoma, a high incidence of progression was seen. It is concluded that these patients are at a certain risk despite old age and focal disease.

Age Factors↗