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Biomedical subjects

H Zincke

Publications and source records attributed to H Zincke.

At least 235 records · Page 13Linked to original sources
PubMed1981

Radical retropubic prostatectomy and pelvic lymphadenectomy for high-stage cancer of the prostate.

A series of 340 patients with adenocarcinoma of the prostate treated by bilateral pelvic lymphadenectomy and radical retropubic prostatectomy was reviewed to determine the factors that influence survival and time to progression of disease. Follow-up ranged from 1-12 1/2 years. Factors evaluated were grade, stage, and bulk of tumor; influence of seminal vesical involvement and number of pelvic nodes involved; age of patient; and year of surgery. Tumor grade was the only factor related significantly to patient survival. However, grade, stage, and bulk of tumor were all significantly associated with interval between surgery and disease progression. Furthermore, in Stage C disease, seminal vesical involvement (C+) was an adverse factor for disease progression, particularly among patients with low-grade tumor. This is in contrast to the finding that, among patients with Stage D1 disease, those with seminal vesical involvement experienced more favorable survival times and times to progression of disease when compared with patients without seminal vesical involvement. Overall, patient survival compared favorably with an age-matched control group for all stages, A through D1. Patients with few pelvic nodes involved had a survival experience nearly comparable with that of an age-matched control group. This suggests that pelvic lymphadenectomy might have a therapeutic value and that patients with pelvic nodal disease only, without evidence for metastatic disease, should not be denied radical surgery. The influence of concomitant hormonal manipulation or radiotherapy (or both) on patient survival and disease progression is not conclusively answered in this report.

Adult↗
PubMed1981

Factors influencing outcome of kidney allografts from pretreated cadaveric donors.

A five-year retrospective analysis of patient and graft survival after initial cadaveric kidney transplantation showed that recipients of kidneys from cadaveric donors pretreated with cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) had better graft survival than those patients who received nonpretreated kidneys. In patients not receiving transfusions, transplantation of a pretreated kidney improved the chances of success, with graft survival equivalent to that for patients receiving transfusions. Splenectomy was beneficial for graft survival and did not affect overall patient survival. The effect of splenectomy could not be clearly separated fro the effect of donor pretreatment.

Adolescent↗
PubMed1981

Management of high grade transitional cell cancer of the upper urinary tract.

A total of 175 patients was operated on for grade 2, 3 or 4 transitional cell epithelioma of the upper urinary tract. Followup was between 5 and 26 years. The operations involved total nephroureterectomy, simple nephrectomy and local resection. Patient survival correlated well with tumor stage and, particularly, with tumor grade, and, consistently, was inferior to that of an age and sex-matched control group. The correlation of survival and ipsilateral tumor recurrence with the type of operation suggests that patients with grade 2 tumors may benefit from total nephroureterectomy. The incidence of ipsilateral tumor recurrence (28 per cent) was high in this group. The radical procedure seems to be of no benefit to patients with grade 3 or 4 tumors. The incidence of subsequent bladder tumor was 30 per cent in patients with grades 2 and 3 tumors. The latent period ranged from 2 months to 10 years (average 23 months); 82 per cent of the tumors occurred within 3 years of treatment of the upper tract tumor.

Adult↗
PubMed1981

Estrogen secretion in a renal allograft population.

Four pregnancies after renal transplantation, during which estrogen metabolism was monitored, were reviewed. Urinary estrogen levels were obtained in all four pregnancies, and all values were low. This phenomenon has been ascribed to suppression via the fetal pituitary of the fetal adrenal glands by exogenously administered corticosteroids. However, definitive data substantiating this theory are lacking. Serum or amniotic fluid estrogen levels were measured concomitantly, and in each instance the levels were below normal for the period of gestation. This finding suggests that the mechanism producing low levels of urinary estrogens is related to the suppressed synthesis of estrogen rather than to altered renal excretion of estrogen.

Amniotic Fluid↗
PubMed1981

Renal transplantation after failure of a first graft.

Renal transplantation in the nondiabetic patient can be achieved with a graft survival comparable with the over-all survival of the cadaveric first graft. The utilization of immunologic donor pretreatment in second cadaveric renal transplantation was of no benefit to graft survival. The second graft survived significantly longer than the first graft when the survival in the same patients was evaluated in a paired fashion. In our experience, retransplantation in the patient with juvenile-onset diabetes using a cadaveric graft gives disastrous results. Of pretreatment, splenectomy, transfusion, preformed antibodies, antigens mismatched, course and time of first-graft loss, diabetes, age and donor source analyzed in this study, only diabetes was found to have a significant effect upon the survival of the second graft.

Adult↗
PubMed1980

Renal transplantation: its use in a patient with systemic lupus erythematosus and complete occlusion of inferior vena cava.

A 22-year-old woman with systemic lupus erythematosus and complete occlusion of the inferior vena cava underwent a living related donor renal transplantation, with the kidney placed in the standard pelvic extraperitoneal position. If adequate collateral circulation bypassing the impedance of vena caval obstruction can be demonstrated, there is no need for orthotopic renal transplantation.

Adult↗
PubMed1980

Urinary tract reconstruction in renal transplantation. Mayo Clinic experience and review of literature.

Althrough rejection remains the most frequent cause of renal allograft failure, technical problems have contributed and continue to contribute to graft loss. Urologic complications may be caused by technical errors in the donor nephrectomy or in urinary tract reconstruction. During the past decade, however, with advances in medical and surgical management, the reported incidence of urologic complications in renal transplantation has declined steadily. This may be due to (1) more extensive donor and recipient preparation and evaluation for surgery, (2) improvement of surgical technique with increasing experience in donor and recipient, and (3) more refined diagnosis and treatment of urologic and infectious complications.

Adolescent↗
PubMed1980

Radical prostatectomy after radiotherapy for prostatic cancer.

We report on 18 patients with clinical stages B and C carcinoma of the prostate who underwent radiotherapy to the prostate, followed by radical retropubic prostatectomy and pelvic lymphadenectomy. Of the 18 patients only 2 (1 with grade 1 and 1 with grade 4 disease) had no residual local cancer at operation. Surgical morbidity was minimal in the 18 patients and only 3 patients had spread of the disease after the combined treatment. Radical retropubic prostatectomy after radiation therapy appears to be safe and effective treatment.

Adenocarcinoma↗
PubMed1980

Definitive radiation therapy for prostatic carcinoma: Mayo clinic experience.

Primary radiation therapy for clinically localized prostatic cancer is effective and safe. Of our 147 patients treated between 1964 and 1973, 144 were evaluated 5 years after the initial date of radiation therapy. At 5 years the over-all survival rate was 80 per cent and the rate of survival free of disease was 63 per cent. More than 70 per cent of the patients were free of progression 5 years after the date of the first radiation treatment. Analysis revealed a highly significant association between tumor grade and patient survival (p less than 0.001), and between tumor grade and the interval free of disease (p less than 0.002). The relationship between tumor stage and time to progression of disease also was significant (p approximately equal to 0.01) but there was no relationship between lower stage and longer survival. Of the 142 patients who completed treatment only 20 (14 per cent) had local recurrence of the prostatic cancer after radiation therapy, representing a local control rate of 86 per cent 5 years after treatment. A few of the patients underwent post-treatment prostatic biopsy after radiation therapy. If a biopsy is done for increased prostatic induration and the results are positive adjuvant treatment is recommended. In the absence of urologic symptoms of progressive induration of the prostate gland biopsy is not instrumental in predicting the course of the cancer.

Adenocarcinoma↗
PubMed1980

Primary grade 1 transitional cell carcinoma of the renal pelvis and ureter.

During a 22-year period 224 patients were seen for treatment of transitional cell carcinoma of the renal pelvis or ureter. Of these patients 49 (22 per cent) had grade 1 lesions. Followup ranged from 5 to 25 years. The most common symptom was hematuria. In only 54 per cent of the 49 patients was a filling defect noted on excretory urography. Forty-seven patients (96 per cent) had stage I disease. Treatment included total nephroureterectomy, nephrectomy or segmental resection. In 11 patients (23 per cent) evidence of bladder tumor developed 8 months to 12 years (average 4 years) after the diagnosis of tumor of the upper urinary tract and 73 per cent of these recurrences were noted within the first 3 years. In 1 patient a tumor developed in the opposite upper urinary tract. In only 1 of 15 patients who had had partial ureterectomy or local excision tumor developed in the ipsilateral ureter. Patient survival time was identical to that in an age-matched control group. We conclude that the most significant findings are the subsequent high incidence (23 per cent) of bladder tumor and the comparable survival in these pateints and in an age-matched control group. Furthermore, these results suggest that operations preserving the renal parenchyma, that is segmental resection, should be used more frequently.

Carcinoma, Transitional Cell↗
PubMed1980

Mixed lymphocyte culture, phytohemagglutinin stimulation, and matching grade: clinical relevance in renal transplantation from living related donors.

Mixed lymphocyte cultures (MLC), including phytohemagglutinin (PHA) stimulation and HLA-A and HLA-B loci typing of donor and recipient, were performed on 70 renal allograft recipients and relevant family members. Graft survival was correlated retrospectively with matchnd PHA response index (PHARI), in order to assess the clinical relevance of each variable singly or jointly. Overall graft survival was significantly associated with SI (log10) (P less than 0.001) and matching grade (P = 0.027). No significant association with either PHARI or II was detected (P greater than 0.10). In addition, the product of the last two indices--the lymphocyte response index (LRI)--was not found to be related to graft survival (P greater than 0.10). Survival of grafts with one-haplotype identity was significantly associated with SI (P = 0.002). Survival in this group was not found to be related to II, PHARI, or LRI, considered either alone or jointly (P greater than 0.10). Grafts with two-allele-identical grafts, whereas PHARI did not differ. SI and matching grade were related significantly to graft survival and appeared to be the most important variables.

Cell Division↗
PubMed1980

In vitro alteration of canine renal allograft immunogenicity.

Significant prolongation of renal allograft survival was demonstrated in a controlled canine model with the host suboptimally immunosuppressed when grafts were perfused for 24 hr with cryoprecipitated plasma (CPP) that had been obtained from plasma of dogs "pretreated" with i.v. cyclophosphamide (80 mg/kg for 5 1/2 hr) and i.v. methylprednisolone (60 mg/kg for 2 1/2 hr). The active metabolites of these drugs within the pretreated plasma may have modified the graft immunogenicity in vitro. However, the use of pretreated kidneys in combination with 24 hr of perfusion with CPP did not result in prolonged graft survival. Furthermore, 24-hr perfusion of pretreated kidneys with their own pretreated CPP did not improve graft survival. This suggests that the pretreated canine kidney does not tolerate pulsatile preservation with CPP; this is in contrast to the human experience and may be attributable to a species difference.

Animals↗
PubMed1980

Open-lung biopsy in the renal transplant recipient.

In 22 renal transplant recipients, 23 open-lung biopsy procedures were performed. There were two (8.7%) biopsy-related complications (hemorrhage and pneumothorax) and five deaths (22.7%), although the deaths could not be definitely related to the biopsy procedure itself. Seventeen biopsy specimens yielded specific diagnoses, and six were nonspecific. The mortality rate for the patients with specific diagnoses was not significantly different from that of patients with nonspecific diagnoses (25% vs. 16.7%). Other factors analyzed, such as age, diabetes, hypoxia, leukopenia, and donor source, did not affect the result of biopsy. We conclude that the patient's underlying disease and added immunosuppressive therapy are the factors most responsible for the clinical outcome. We suggest that without early treatment of the infectious agents, the mortality rate of the group with specific diagnoses would likely have been higher.

Adult↗
PubMed1979

Primary carcinoma in situ of the ureter and renal pelvis.

Primary carcinoma in situ of the ureter or renal pelvis is rare. We describe 3 patients, each of whom had a different mode of presentation. When malignant cells in the urine from the upper urinary tract are associated with urographic evidence of an appropriate lesion, aggressive surgical therapy is indicated. In the absence of such a urographic abnormality patients with positive cytologic examinations should be followed closely because the exfoliated cells usually are from poorly differentiated neoplasms.

Aged↗