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Biomedical subjects

H Zincke

Publications and source records attributed to H Zincke.

At least 199 records · Page 11Linked to original sources
PubMed1984

Failure of inosine to prevent ischemic damage in the canine and rat kidney models.

Intravenous, renal artery, and intraperitoneal administration of inosine at dosages of 100 to 200 mg/kg, 160 mg/kg, and 200 mg/kg, respectively, in the dog and rat was used to test its efficacy in preventing ischemic damage after 60 min of warm ischemia in an in situ solitary renal model. No improvement of renal function as compared with a control and a conventional mannitol/furosemide treatment group was detected. Rather, inosine at dosages of greater than or equal to 160 mg/kg resulted in significantly impaired renal function in the experimental groups of the dog model; no improvement was observed in the rat model. These results suggest that the use of inosine in human renal surgery and preservation should be approached cautiously.

Animals↗
PubMed1984

Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for Stage C adenocarcinoma of prostate.

A series of 105 patients with surgical Stage C adenocarcinoma of the prostate underwent pelvic lymphadenectomy and radical retropubic prostatectomy and were followed up from one and one-half to fifteen years; 33 (31%) of the 105 had clinical Stage C disease. Of the 105 patients, 92 were at risk for greater than or equal to two years, 42 for greater than or equal to five years, and 12 for greater than or equal to ten years. Survival and disease progression were related to tumor grade (Mayo grades 1 through 4) and tumor bulk (less than 3, 3 to 10, greater than 10 cm3) but not to seminal vesicle involvement. Twenty-seven patients received adjuvant treatment (orchiectomy, DES, radiation, or combinations of these); it was administered to patients with higher tumor grades, larger tumor bulk, and/or residual cancer. Overall actuarial survival at five and ten years was 85 per cent and 72 per cent, respectively; five-year nonprogression rate was 64 per cent. Local recurrence was noted in only 8 patients (7.6%). Radical surgical treatment for nonbulky Stage C disease of the prostate is associated with favorable survival results and good local control. Adjuvant treatment may favorably affect disease outcome. Clinical seminal vesicle involvement with negative urethrocystoscopy should not necessarily deter the surgeon from planning radical prostatectomy. Prospective adjuvant treatment protocols need to be developed to identify the value of adjuvant hormone and/or radiation therapy.

Adenocarcinoma↗
PubMed1984

Observations on surgical management of carcinoma of prostate with limited nodal metastases.

One hundred patients with surgical Stage D1 (TXN + M0) adenocarcinoma of the prostate underwent pelvic lymphadenectomy and radical retropubic prostatectomy and were followed up for one-half to fifteen and one-half years. Forty-eight patients received "adjuvant" hormonal or radiation (or both) treatment; all patients were treated ("delayed") hormonally on disease progression, when this treatment had not been administered initially. Tumor grade (Mayo 1 through 4), tumor bulk (measured in cm3), or seminal vesicle involvement alone and when considered with number of positive nodes was not related to survival or disease progression. Only number of positive nodes and bilateral orchiectomy as "adjuvant" treatment affected survival and progression. For the 52 patients without "adjuvant" orchiectomy, the overall five-year rate for nonprogression was only 18.5 per cent, and the five-year rates for nonprogression were, respectively, 26, 0, and 0 per cent when 1, 2, and greater than or equal to 3 positive nodes were considered. However, for the 37 patients who received "adjuvant" orchiectomy, the overall five-year rate for nonprogression was 95 per cent, and the five-year rates for nonprogression were, respectively, 100, 100, and 80 per cent when 1, 2, and greater than or equal to 3 positive nodes were considered. Prostatic cancer with positive pelvic lymph nodes treated by pelvic lymphadenectomy and radical retropubic prostatectomy alone leads to rapid disease progression. "Adjuvant" bilateral orchiectomy is associated with projected five- and ten-year survival rates of 94 per cent and 80 per cent, respectively. Recommendation of other treatment modalities for patients with Stage D1 cancer of the prostate should be considered with reference to the results presented herein.

Adenocarcinoma↗
PubMed1984

Upper urinary tract transitional cell cancer after radical cystectomy for bladder cancer.

We studied 425 patients who had undergone radical cystectomy for transitional cell cancer of the bladder and were followed for 5 years or more, or until death. Upper urinary tract urothelial cancer developed in 14 patients (3.3 per cent), 3 of whom had bilateral disease: 2 synchronous and 1 asynchronous. The interval between cystectomy and emergence of the upper tract tumor ranged from 8 to 100 months (mean 40 months). There was a declining incidence of upper tract cancer relative to cystectomy P stage for carcinoma in situ (9.1 per cent), papillary stages O and A (3.6 per cent), stages B1, C and D1 (2.6 per cent) and no residual cancer (0 per cent). Of the 14 patients 8 (57 per cent) had features of multifocal carcinoma in situ in the cystectomy specimens. In 4 of the 14 patients (29 per cent) ipsilateral disease developed when the distal ureteral margins were involved with cancer at cystectomy. Only 3 of the 14 patients (21.4 per cent), all with stage I disease, were alive at the time of this report.

Adult↗
PubMed1984

Risk of local urethral recurrence after radical cystectomy for bladder cancer.

Radical cystectomy and urinary diversion were performed on 349 patients with transitional cell cancer of the bladder. Followup for 4 to 13 years revealed that 91 and 83 per cent of the patients were free of urethral recurrence 5 and 10 years after cystectomy, respectively. Statistical elimination of urethral recurrences did not improve the over-all survival rate significantly. It appears that supplementation of cystectomy with simultaneous urethrectomy may not be justified if the urethra is not involved by the cancer.

Adult↗
PubMed1984

Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for adenocarcinoma confined to the prostate.

A total of 519 patients with clinical stage B disease underwent radical prostatectomy from 1966 to 1981: 65 (12.5 per cent) had pathologic stage D1, 72 (14.0 per cent) pathologic stage C and 382 (73.5 per cent) pathologic stage B disease. Of the 519 patients 320 with pathologic stage B1 (239) or B2 (81) adenocarcinoma of the prostate and no prior hormonal or radiation therapy underwent complete pelvic lymphadenectomy and radical retropubic prostatectomy. Stage, grade and size of tumor were associated significantly with interval to disease progression but not with survival. The probable explanation for this observation is that only 2 per cent of 186 patients who were followed for 5 years and 2 per cent of 46 who were followed for 10 years died of prostatic carcinoma within these intervals. The over-all survival of patients who had intracapsular prostatic carcinoma was not different from that of an age-matched surgical control group (men undergoing total hip arthroplasty during the same interval). These observations suggest that although morbidity from alternative therapies may vary no other treatment modality offers survival superior to that observed for pelvic lymphadenectomy and radical retropubic prostatectomy in patients with pathologic intracapsular prostatic cancer.

Adenocarcinoma↗
PubMed1984

Meclofenamate treatment of recurrent idiopathic nephrotic syndrome with focal segmental glomerulosclerosis after renal transplantation.

Recurrent corticosteroid-resistant nephrotic syndrome with focal segmental glomerulosclerosis (FSGS) caused the failure of a first renal allograft in a 41-year-old man. Recurrence of the nephrotic syndrome in the second renal allograft was successfully controlled by the administration of meclofenamate, and the renal function has remained stable for 2 1/2 years. No accepted treatment is available for corticosteroid-resistant nephrotic syndrome with FSGS. This report suggests that administration of meclofenamate might be beneficial in some patients with corticosteroid-resistant nephrotic syndrome and FSGS. Because of the potential side effects, however, careful supervision of this therapy is of the utmost importance.

Adult↗
PubMed1984

Results of treatment of renal failure by means of home hemodialysis.

Of 630 patients who began hemodialysis treatment for chronic renal failure between 1965 and 1977, 147 successfully completed training for home hemodialysis. Patient compliance was satisfactory, as reflected by the results of monthly blood chemical values, hematocrits, and weight gain between dialysis. Although only 15 patients had previous myocardial infarctions and 4 had had strokes before beginning dialysis, 9 patients subsequently experienced acute myocardial infarctions and 14 had strokes. Of the 45 patients who died while being maintained by hemodialysis, 24 had cardiopulmonary complications and 6 had strokes. Despite such complications, 70 patients were gainfully employed and 32 were active at home or at school, whereas 29 were totally disabled. At last follow-up, 74 remained on home hemodialysis, 53 had functioning renal allografts, and the rest of the patients were being maintained in our dialysis center, had transferred elsewhere, or were being maintained by peritoneal dialysis. The overall estimated 5-year survival rate was 56%, whereas the estimated 5-year survival rate for those maintained by home hemodialysis alone was 52%.

Adolescent↗
PubMed1984

Improving results in primary diabetic renal transplantation.

One hundred seventeen patients with renal failure resulting from insulin-dependent diabetes mellitus received primary renal allografts from June 1970 to April 1983. Factors significantly associated with improved graft and patient survival were LRD sources (in particular, HLA-identical) and splenectomy. Variables such as transfusions, age, sex, and the administration of ALG were not significantly associated with transplant outcome. However, survival of patients and grafts has improved in recent years and continues to compare favorably with hemodialysis results. Although splenectomy might be the most important variable responsible for the improvement of our recent results, the use of ALG for rejection episodes might have contributed substantially to the improvement. Early transplantation, not analyzed in this study, might prove to be the most significant variable in the outcome of transplantation in patients with diabetic renal failure.

Adult↗
PubMed1984

Feasibility of conservative surgery for transitional cell cancer of the upper urinary tract.

The controversy between the proponents of radical surgery for treatment of transitional cell cancer of the upper urinary tract (total nephroureterectomy) and those of conservative surgery (segmental resection) continues. In an in-depth analysis of a large group of patients presented in this article, an attempt has been made to rationalize a conservative surgical treatment approach for certain upper-tract tumors.

Adult↗
PubMed1984

Value of excretory cystography in the diagnosis of bladder tumours.

The value of excretory cystography in diagnosing bladder tumours was assessed in a randomised study. The 10-min, 20-min, and post-voiding films of intravenous urograms of 75 patients with biopsy-proved bladder tumours and of 25 patients with proved normal bladders were randomly reviewed. Overall, 60 of 75 bladder tumours (80%) were correctly diagnosed by review of the roentgenograms. Specificity and sensitivity were comparable (94 and 96% respectively) for patients with papillary tumours greater than or equal to 0.5 cm in diameter, but specificity was low (23%) for those with tumours smaller than 0.5 cm. It is concluded that excretory cystography makes a considerable contribution to the establishment of the diagnosis of papillary bladder tumours greater than or equal to 0.5 cm in diameter.

Carcinoma in Situ↗
PubMed1984

Perioperative complications of pelvic lymphadenectomy and radical retropubic prostatectomy for Stages C and D1 prostate cancer.

The complications experienced by 205 consecutive patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for surgical Stages C and D1 prostate cancer were analyzed. One hundred five patients had pathologic Stage C disease, and 100 patients had pathologic Stage D1 disease. Seven patients had thromboembolic complications. Wound or pelvic hematomas developed in 6 patients. Only two lymphoceles were detected. Rectal injuries occurred in 6 patients, of whom 4 required colostomies. The overall incidence of perioperative complications was 17 per cent. There was one postoperative death.

Adult↗
PubMed1983

Primary and secondary renal transplantation in diabetic patients.

A total of 117 (101 primary and 16 secondary) renal transplants were performed on 101 diabetic patients. The mean duration of diabetes mellitus to the onset of end-stage renal disease was 17.5 years. After primary transplantation, overall one- and five-year patient survival was 77% and 55%, respectively; for grafts, it was 58% and 45%, respectively. One- and five-year living-related donor graft survival was 66% and 53%, respectively; for cadaveric kidneys, it was 45% and 33, respectively. One- and five-year graft survival for 20 HLA-identical living-related donor kidneys was 85% and 77%, respectively. Among the 16 recipients of secondary grafts, patient survival at one and five years was 65% and 29%, respectively; graft survival at one year was 24%. Acceptable patient and graft survival continues with primary renal transplantation. In view of the poor results with secondary transplantation in the diabetic patient, however, its continued application should be questioned.

Adult↗
PubMed1983

A comparative study of several agents alone and combined in protection of the rodent kidney from warm ischaemia: methylprednisolone, propranolol, furosemide, mannitol, and adenosine triphosphate-magnesium chloride.

The effect of 60 min of in situ warm ischaemia (37 degrees C) on renal function was investigated in the rat model. In addition, the effect of pretreatment with intravenously administered furosemide, mannitol, propranolol, methylprednisolone, and adenosine triphosphate-magnesium chloride (ATP-MgCl2), singly or in combination, was studied. The ischaemic kidney was effectively protected by the administration of methylprednisolone alone but not by furosemide, mannitol, ATP-MgCl2, or propranolol singly or in combination. These results demonstrate that rat kidneys subjected to 60 min of warm ischaemia can be safely protected with methylprednisolone pretreatment (3 mg/100 g of body weight) 30 min before warm ischaemia.

Adenosine Triphosphate↗
PubMed1983

Splenectomy in high-risk primary renal transplant recipients.

One hundred sixty-five high-risk patients who were either 50 years of age or older or had diabetes mellitus, or both underwent primary renal transplantation. One hundred eight had splenectomy and 57 did not. Graft and patient survival were analyzed in regard to whether splenectomy had been performed at all and whether it had been performed 30 days or more before transplantation, less than 30 days before, or at the time of transplantation. Also, the influence of age, diabetes, blood transfusions, blood type, donor type, HLA mismatch, pretransplantation dialysis, and percentage of performed antibodies were analyzed, as were complications and causes of death. Differences in patient survival were not significant in any one of these categories, although survival in the splenectomized group was generally better. The incidence of infection and sepsis was comparable in both groups and was responsible for death in 34 percent of the patients who underwent splenectomy compared with 22 percent of those who did not (no significant difference). Splenectomy improved cadaver donor renal allograft survival (p = 0.001) in the diabetic patients (p = 0.015) and in those 50 years of age or older (p = 0.026) but it did not improve survival in those who received living related donor kidneys. No significant differences were detectable in regard to the timing of splenectomy. The effect of splenectomy was significant in the patients who had not received transfusions (p = 0.003). It also improved survival in the transfused patients. Splenectomy in high-risk diabetic patients and patients 50 years of age or older does not seem to be associated with increased mortality.

Adult↗
PubMed1983

Hormonal treatment at time of radical retropubic prostatectomy for stage D1 prostate cancer.

We classified 70 prostatic cancers as stage D1 at the time of pelvic lymphadenectomy and radical prostatectomy. For retrospective analysis after 1 to 14 years of followup, the patients were divided into 32 in whom endocrine therapy had been given immediately postoperatively and 38 in whom it had not. These 2 groups did not differ substantially in patient age, Gleason grade, pathologic stage, tumor volume or seminal vesicle involvement. The mean number of involved nodes per patient was higher in the hormone-treated group (2.9 versus 1.8). According to Kaplan-Meier projections 88 per cent of such patients without hormonal treatment will have progression within 5 years, compared to only 14 per cent of those given hormonal treatment immediately. However, projected survival differed little between the groups, most likely since 17 of the 18 patients with progression in the nontreated group were given hormonal treatment as soon as progression was substantiated. Definitive assessment of the impact of the timing of endocrine therapy on patient survival and time to disease progression awaits a randomized trial with long-term followup.

Adenocarcinoma↗
PubMed1983

Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind, controlled trial.

The influence of the instillation of thiotepa or doxorubicin hydrochloride into the bladder at the end of transurethral surgical treatment on the recurrence of bladder cancer was evaluated. We studied in a randomized, double-blind, controlled fashion 89 patients with transitional cell epithelioma (carcinoma in situ or papillary carcinoma) whose tumors were considered to have been completely removed. Of these patients 28 (the control group) received a placebo (sterile water), 30 received thiotepa and 31 received doxorubicin. By 3 to 4 months postoperatively 71 per cent of the control group, and 30 and 32 per cent, respectively, of the patients treated with thiotepa and doxorubicin had recurrences (p less than 0.01). Additional treatment during the followup interval was ineffective in all groups. Patients studied also were classified according to grade, histological findings, multiplicity of tumors and history of bladder tumor. Treatment was most effective in reducing recurrence in patients with low grade, papillary or multiple tumors and in patients with a history of bladder cancer. No effect was observed in patients with single tumors and only modest effects were found in those with high grade tumors, carcinoma in situ or new tumors. The results support the concept that recurrences may arise from tumor cell implantation at the time of transurethral management of bladder tumors and may be reduced effectively by concomitant intravesical chemotherapy.

Adult↗