Search PubMed⌕ Search

Biomedical subjects

H Zincke

Publications and source records attributed to H Zincke.

At least 181 records · Page 10Linked to original sources
PubMed1987

Renal cell carcinoma in von Hippel-Lindau syndrome.

Thirty-seven cases of von Hippel-Lindau syndrome are reported. The urinary tract was studied in 23 patients; 15 of them had the renal lesions. Eight of these 15 patients had renal cell carcinoma, which was bilateral in six. Because 80 percent of these patients are seen initially by neurologists or ophthalmologists, the potential for the development of renal cell carcinoma in these patients, the familial nature of the disorder, and the need for early urologic investigations and subsequent close follow-up are emphasized.

Adolescent↗
PubMed1987

Treatment options for patients with stage D1 (T0-3,N1-2,M0) adenocarcinoma of prostate.

Three hundred six patients with adenocarcinoma of the prostate underwent pelvic lymphadenectomy and had Stage D1 (T0-3,N1-2,M0) disease; 171 patients underwent radical retropubic prostatectomy with or without immediate adjuvant therapy (hormonal or radiation or both) or conservative (hormonal or radiation or both) treatment alone (n = 135). Follow-up was one-half to eighteen and one-half years (mean, 5 yrs). Immediate adjuvant orchiectomy significantly (P = 0.01) improved survival (87.4% at 10 years) and nonprogression rates for patients who underwent radical prostatectomy, but not for those who had lymphadenectomy. Overall patient survival was significantly better (P = 0.005) after prostatectomy than lymphadenectomy. Residual disease (n = 43) in patients who underwent prostatectomy and received adjuvant treatment (orchiectomy or radiation or both) did not affect disease outcome. Bilateral pelvic lymphadenectomy and radical prostatectomy with immediate adjuvant orchiectomy provided survival comparable to the expected survival; conservative treatment alone was associated with rapid disease progression and poor survival and significantly (P = 0.02) higher local morbidity.

Adenocarcinoma↗
PubMed1987

Renal transplantation in patients with indwelling continuous ambulatory peritoneal dialysis catheters.

Controversy exists regarding management of the continuous ambulatory peritoneal dialysis catheter in patients undergoing renal transplantation. We performed 30 transplants (23 cadaveric and 7 living related) in 27 patients with indwelling continuous ambulatory peritoneal dialysis catheters. Dialysis was necessary in the immediate post-transplantation period in 9 of 30 patients (30 per cent). Of these 9 patients 3 had temporary hemodialysis and 6 resumed continuous ambulatory peritoneal dialysis with the indwelling catheter. Two postoperative complications clearly were related to the continuous ambulatory peritoneal dialysis catheter: 1 patient required abdominal exploration for control of bleeding related to disruption of peritoneal adhesions at the time the continuous ambulatory peritoneal dialysis catheter was removed and 1 suffered an abscess at the catheter site 1 month after the catheter was removed. No patient experienced peritonitis during immunosuppression after transplantation. We support leaving the continuous ambulatory peritoneal dialysis catheter during and after transplantation to simplify pre-transplantation patient care and to avoid the possible need for temporary post-transplantation hemodialysis in many patients.

Abscess↗
PubMed1987

Surgical treatment of renal cancer with vena cava extension.

Fifty-four patients with renal cancer and vena cava tumour thrombus underwent radical nephrectomy and removal of the thrombus; the operative mortality rate was 9.3% (5 patients). The extent of the vena cava thrombus did not affect survival. Of 36 patients with no known pre-operative metastases and complete (29 patients) and incomplete (7 patients) removal of the vena cava tumour thrombus, the 5-year survival rate was 68 and 17%, respectively (P = 0.01). Thirteen patients (45%) who underwent complete removal of the vena cava tumour thrombus are alive and free of disease, with a mean follow-up of 51.2 months (range 4-144); three died without disease 110, 31 and 23 months after operation. The 2-year and 5-year survival rates of 18 patients with known pre-operative metastases was 37.5 and 12.5% respectively; 14 died between 1 and 27 months post-operatively (mean 11.6) of metastatic disease. Two of these 18 patients experienced long-term remission: one died of unrelated causes 151 months after operation; the other was lost to follow-up 219 months after operation, with no evidence of disease. Of 14 patients with positive regional nodes, the mean survival in those with metastases compared with those without metastases was 7.5 versus 15 months, respectively; only one patient survived at 14 months. Operative intervention in patients without metastatic disease (systemic or regional) and complete removal of the vena cava thrombus achieved a 5-year survival rate of 68%. Variables which significantly decreased survival and may be considered contraindications for operation were systemic metastasis, regional lymph node involvement and incomplete removal of the vena cava thrombus.

Adult↗
PubMed1986

Significance of serum protein and lipid-bound sialic acid as a marker for genitourinary malignancies.

A prospective study was done to evaluate the roles of serum N-acetylneuraminic acid (NANA) and the lipid-bound subfraction of sialic acid (LSA) concentrations in the detection and staging of cancer, and the follow-up of treatment in patients with genitourinary malignancies. Multiple determinations were obtained in 177 subjects: 90 normal volunteers, 38 patients with prostate cancer, 20 patients with bladder cancer, 15 patients with renal cell cancer, and 14 patients with benign urologic diseases. The results showed a low incidence of elevated values in patients with early stages of cancer and a high incidence of false-positive values with serum NANA concentrations in patients with benign urologic diseases, especially prostatitis. Serum NANA and LSA concentrations were highly correlated with the stage and grade in patients with advanced urologic cancer, and may be used as markers of tumor activity during follow-up under treatment; currently, however, they are not useful in the screening of patients for urologic cancer. Their usefulness in prostatic cancer is at least comparable to that of acid phosphatase determinations by the enzymatic and radioimmunoassay methods, which were elevated in a smaller percentage of patients with prostate cancer than were the NANA or LSA concentrations.

Adult↗
PubMed1986

Long-term followup of young patients with stage A adenocarcinoma of the prostate.

A total of 23 men less than 60 years old with stage A adenocarcinoma of the prostate who were managed expectantly (that is untreated) and were at risk for 10 to 25 years form the basis of this study. The original amount of tissue obtained at transurethral resection, number of chips involved and examined, and tumor grade (Mayo grades 1 to 4) were recorded and compared in an in-depth analysis whereby the entire tissue removed was examined without knowledge of previous grading attempts. On the basis of volume estimation of the amount of cancer present 8 patients were reclassified as having stage A2 disease. Of these 8 patients 2 had disease progression and 1 died of metastatic adenocarcinoma of the prostate. At review 15 patients remained with stage A1 disease and 4 had disease progression (3 systemically and 1 locally) an average of 10.2 years after diagnosis. Because of longer life expectancy the young patient with stage A1 disease is at increased risk for local and/or systemic disease progression. Therefore, when incidental adenocarcinoma of the prostate is found in young patients consideration should be given to examination of all tissue resected, and to repeat transurethral resection and biopsy to ensure accurate staging. Lifelong careful followup is mandatory not only to detect local recurrence owing to heterogeneous adenocarcinoma of the prostate but also to detect a possible secondary clinical lesion.

Adenocarcinoma↗
PubMed1986

Surgical enucleation for renal cell carcinoma.

The results of an enucleative operation in 33 patients with renal carcinoma present bilaterally or in a solitary kidney are reviewed. All of the excised tumors were low grade and the majority of the patients had pathological stage I renal carcinoma. Postoperative followup ranged from 9 to 156 months (mean 45 months). The 3-year actuarial survival rate was 90 per cent. Tumor recurred locally in 2 patients (6 per cent). We conclude that enucleation is a safe technique that can yield excellent tumor control in selected patients with renal carcinoma.

Adult↗
PubMed1986

Bilateral pelvic lymphadenectomy and radical prostatectomy for clinical stage C prostatic cancer: role of adjuvant treatment for residual cancer and in disease progression.

A total of 101 patients with limited but unequivocal clinical stage C adenocarcinoma of the prostate underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. At operation 49 patients had pathological stage C and 52 had stage D1 disease. Followup ranged from 0.5 to 17 years (mean 4.9 years). The 5 and 10-year observed survival rates for patients with stages C and D1 disease were similar to the expected survival. Sixteen patients had residual cancer postoperatively but only 2 had local progression: 1 had received no adjuvant therapy, and 1 had received diethylstilbestrol and radiation. None of the others, having received adjuvant radiation and/or orchiectomy, suffered local recurrence. Over-all, local progression occurred in 17 patients, only 4 of whom had received adjuvant treatment initially (diethylstilbestrol, 1 also received radiation). Local progression occurred in 13 of 47 patients (28 per cent) without adjuvant treatment. Thus, in all patients immediate adjuvant bilateral orchiectomy or radiation (except for 1 patient) prevented local progression. In patients with pathological stage D1 disease bilateral orchiectomy significantly reduced disease progression (p less than 0.0001). Therefore, limited clinical stage C adenocarcinoma of the prostate can be successfully treated surgically (with low morbidity) when supplemented with appropriate immediate adjuvant treatment.

Adenocarcinoma↗
PubMed1986

Current status of renal transplantation--1986.

During the course of 3 decades, and particularly during the past 5 years, clinical renal transplantation has improved to become a safe mode of therapy for end-stage renal disease. Currently, more than 95% 1-year survival can be expected, both in patients who receive allografts from living-related donors and in those who receive cadaver kidneys. One-year living-related donor graft survival is 98%, and 1-year cadaver graft survival is 87%. Cyclosporine has been an important adjunctive immunosuppressive agent not only because of improved results but also because it has shortened hospitalization time.

Antilymphocyte Serum↗
PubMed1985

Acute toxicity and preliminary therapeutic results of pelvic lymphadenectomy combined with transperineal interstitial implantation of 192IR and external beam radiotherapy for locally advanced prostate cancer.

We have developed a combined modality approach for treatment of locally advanced prostate cancer consisting of: surgical staging with lymphadenectomy; transperineal placement of afterloading needles for a course of 192Ir brachytherapy; and a course of moderate-dose external beam irradiation to tight prostatic fields. The flexibility of the treatment permits adaptation of the dose to any tumor configuration. A total of 23 patients have been treated to date; 18 are available for treatment review and 14 for acute toxicity analysis. Significant morbidity has occurred in only 2 patients, 1 with a pelvic hematoma and 1 with hematoma in the wound. Local tumor response has been excellent in all but 1 patient. A good degree of symptomatic improvement was observed at the three-month follow-up. This approach appears to be safe and effective at this time. A brief review of the technique and the rationale for its use are also presented.

Adenocarcinoma↗
PubMed1985

Intravesical thiotepa and mitomycin C treatment immediately after transurethral resection and later for superficial (stages Ta and Tis) bladder cancer: a prospective, randomized, stratified study with crossover design.

In a prospective, randomized, stratified study with crossover design the effect of thiotepa was compared to that of mitomycin C when each was instilled intravesically immediately at the end of complete removal of superficial bladder cancer (stages Ta and Tis) and later on tumor recurrence. The 3-month and 1-year rates free of recurrence were 93 and 78 per cent, respectively, for thiotepa (41 patients), and 97.6 and 67.1 per cent, respectively, for mitomycin C (42 patients) (p equals 0.6). On crossover (5 patients to thiotepa and 9 to mitomycin C) at 1 year 60 per cent of the patients receiving thiotepa secondarily and 51.9 per cent of those receiving mitomycin C secondarily were free of recurrence (p equals 0.52). Therefore, both drugs are equally effective in reducing bladder tumor recurrence. Future comparative studies should continue to include thiotepa as a standard by which the efficacies of other agents are judged.

Adult↗
PubMed1985

Long-term results with transpubic urethroplasty.

From 1973 to 1982, 44 patients underwent transpubic urethroplasty for traumatic prostatomembranous strictures and were followed for 1 to 10 years. The most frequent late sequelae were permanent erectile dysfunction (22 patients) and progressive erectile dysfunction (4 patients). Of the 44 patients 6 (14 per cent) had significant primary urinary incontinence that necessitated placement of a genitourinary sphincter and 2 (4.5 per cent) had incontinence after secondary transurethral procedures because of involvement of the remaining voluntary sphincter mechanism. Prosthetic devices may be useful in correcting erectile dysfunction and urinary incontinence in this difficult patient population. Of 13 patients with post-urethroplasty strictures 10 required dilation.

Adult↗
PubMed1985

Adaptation of existing cutaneous ureterostomy for urinary drainage after renal transplantation.

We adapted existing cutaneous ureterostomies for urinary drainage in 3 patients who underwent renal transplantation. Careful preoperative radiological evaluation of the ureteral anatomy and appropriate preoperative planning are necessary for such patients. The concentration of serum creatinine was 0.9, 1.3 and 1.5 mg. per dl. at 2 months, 3 years and 10 years, respectively, after transplantation. All 3 patients have had bacteriuria that necessitated therapy with chronic suppressive antibiotics but clinical pyelonephritis has not occurred.

Adolescent↗
PubMed1985

Treatment of renal cell carcinoma by in situ partial nephrectomy and extracorporeal operation with autotransplantation.

During a 10-year period, 33 patients underwent in situ enucleation, in situ partial nephrectomy, or an extracorporeal operation for low-grade (1 or 2), low-stage (I or II), bilateral or solitary renal cell carcinoma. Only one patient (3%) (who had undergone in situ partial nephrectomy) had local recurrence; the projected 5-year rates of nonprogression of disease and survival from death due to cancer only were 76% and 87%, respectively. A group of patients who were closely matched for grade and stage of renal cell cancer underwent traditional transabdominal radical nephrectomy during the same time interval and had rates of nonprogression and survival similar to those of the conservative surgical group. Thus, in selected patients with low-grade, low-stage renal cell cancer, conservative surgical treatment (that is, renal parenchyma-saving procedures) can produce favorable results without the side effects (such as renal failure) associated with ablative renal operations.

Adult↗
PubMed1985

Pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder with pelvic nodal disease.

Past and present methods of treatment for patients with stage D1 (T1-4 N+ MO) transitional cell cancer of the urinary bladder have proved to be largely ineffective. This report on 57 patients with stage D1 disease confirms this impression and demonstrates that radical operation alone is associated with a 5-year survival rate of only 10%. Survival is related to tumour grade and to the number of pelvic lymph nodes involved; furthermore, complete lymphadenectomy may contribute to improved patient survival. Effective treatment programmes for stage D1 bladder cancer are lacking and efforts should be directed toward developing treatment protocols that combine radical cystectomy and meticulous pelvic node dissection with an effective adjuvant systemic treatment programme.

Adult↗
PubMed1985

Use of radiographically abnormal kidneys in living-related donor renal transplantation.

A retrospective study was undertaken to evaluate the significance of anatomic variants in living-related donor kidneys, when used in renal transplantation. 301 arteriograms were performed in the evaluation of such potential living donors over an 8-year period. 51 (16.9%) were found to have one or more radiographic abnormalities. 20 of the 51 patients (39%) were judged as not suitable for transplantation because of radiographic abnormalities. 7 of 31 patients who were accepted as organ donors declined for personal reasons. The remaining 24 patients underwent donor nephrectomy with the abnormal kidney utilized as the donor organ. In follow-up, none of the kidneys were lost because of their primary radiographic abnormality, and allograft survival of abnormal kidneys was the same as for normal kidneys transplanted under parallel circumstances. We conclude, in properly selected living donors, kidneys with anatomic variants without pathological significance can be used safely in renal allotransplantation. We do not recommend, however, transplanting kidneys with the potential for the development of progressive disease.

Adult↗
PubMed1985

Review of Mayo Clinic experience with carcinoma in situ.

Experience with carcinoma in situ (CIS) of the urinary bladder during a twenty-year period at the Mayo Clinic is reviewed. The most important clinical clues for diagnosis of this disease continue to be irritative bladder symptoms in the absence of infection in elderly men and a history of transurethral resection of the prostate. The most reliable method of diagnosis is urinary cytology. When not modified by treatment, CIS is the precursor of most invasive cancers, originating probably from an area of atypical hyperplasia into CIS and, finally, into invasion. Among patients considered to have CIS who undergo cystectomy, 34 per cent may already have microinvasion. CIS has the potential to involve the entire urothelium. Prudence should guide the use of intravesical chemotherapy (mitomycin or thiotepa or doxorubicin), which may control the disease for extended periods in many patients. If primary treatment fails, immediate second-line treatment should include BCG or hematoporphyrin derivative (HpD) phototherapy or both. If such therapy fails, delay of radical cystectomy seems inadvisable. Monitoring of the prostatic urethra during intravesical treatment is mandatory; a radical surgical procedure should be performed once the prostatic urethra is involved. Results of treatment for secondary prostatic and upper urinary tract cancer are dismal. Conversely, secondary urethral disease, although it occurs frequently beyond five years, may be associated with a good prognosis.

Administration, Topical↗