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Biomedical subjects

J E Altwein

Publications and source records attributed to J E Altwein.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Systematic program for the differentiation of cystic and solid lesions of the kidney].

Renal cysts are found in up to 50% of the population beyond 50 years. The coexistence of a renal cyst and a tumor is observed in 0.3% to 2.9% and may appear in 5 different types, of which type 2, the cysticly degenerated renal cell carcinoma, is most commonly found since 10% of the renal cell carcinomas reveal this phenomenon. Type 1, a renal cyst close to a renal tumor, is found in the literature in 5%; while the intracystic tumors (type 3 and 4) are rare with only 50 cases reported so far. The diagnostic procedures should reliably exclude malignant tumor. A differentiation between a simple renal cyst and malignancy is possible by intravenous pyelography and tomography alone in only 50%, while Catscan and angiography increase the accuracy to 93%. The sensitivity and specificity of ultrasonic examination is found to be 90%, whereas the combination of sonography and percutaneous cyst aspiration reaches an accuracy of 97%. A diagnostic exploration should be done only if the previous procedures are unclear.

Biopsy, Needle↗
PubMed1984

[Penile revascularization surgery in vascular impotence].

The application of objective diagnostic methods to patients complaining of erectile dysfunctions has proved that 30 to 40% are based on pathologic changes of the penile vascular system. The most important diagnostic procedures (NPT, Doppler, BCR-latency time, dynamic cavernosography with simultaneous passive erection, penile angiography) are emphasized and possible pitfalls with reference to misinterpretation of the diagnostic findings are discussed. Technique and results of current revascularization procedures (epigastricopenile anastomosis, revascularization of cavernous and dorsal arteries using vein grafts, deep dorsal vein arterialization) are discussed and first own experiences with aforementioned techniques presented.

Angiography↗
PubMed1984

[Erection and ejaculation disorders following retroperitoneal lymphadenectomy in non-seminomatous testicular tumors].

From 38 patients, who had undergone retroperitoneal lymphadenectomy in the period between April 1980 and October 1983, reliable statements were obtained referring to pre- and postoperative erectile and ejaculatory abilities. The thoracolumbar outflow (Th12-L3) of the centers for emission and psychogenic erection is usually damaged in this procedure. About 12% of the radically lymph node dissected patients complained of permanent erectile disturbances; 85% of the radically lymph node dissected patients revealed ejaculatory disorders, 58% of them with a total loss of ejaculation. About 50% of them showed a considerable psychic involvement. In 12 patients a modified lymph node dissection procedure was performed with the intention to preserve ejaculatory capability. Nevertheless 6 (50%) of them revealed postoperative ejaculatory failure, 3 of them with a total loss of ejaculation. Thus our own experiences and a review of the literature indicate that this modified lymph node dissection often fails in its purpose and can not always be considered a valuable procedure for preservation of ejaculation. The administration of sympathomimetic drugs and/or imipramine is a promising approach in the treatment of ejaculatory failure.

Ejaculation↗
PubMed1984

[Late results following sclerotherapy of varicocele].

Between May 1981 and December 1982 244 patients with varicocele were scheduled for percutaneous sclerotherapy which is performed as an out-patient procedure. In around 80% of the patients sclerotherapy was possible. Failures were due to anatomical and technical factors. Three months after treatment a persisting varicocele was observed in 3.3% as evidenced by control phlebography; 3.9% of our patients developed a painful induration of the plexus pampiniformis which necessitated a 3-day hospitalization. Six months after sclerotherapy spermiography was repeated and compared to the pretreatment results: in 50% of the patients the sperm density was significantly improved, however, sperm morphology and mobility remained virtually unchanged. The sclerotherapy of varicoceles can be recommended as an alternative procedure to surgery. The effect on sperm quality of both therapies is equal, but the sclerotherapy is performed as an outpatient procedure (sick-leave 2 days), is cheaper, better tolerated and has a lower rate of persisting varicoceles than surgical repair.

Adult↗
PubMed1983

Primary lymphadenectomy or primary chemotherapy in advanced metastatic testicular tumor?

The treatment of advanced metastasized germ cell tumor consists in a combination of chemotherapy and surgical tumor resection. The sequence of treatment measures is still not uniform. 55 patients with clinically apparent retroperitoneal metastases ('bulky disease') and/or extensive parenchymal metastases are reported. Chemotherapy was performed initially in 40 cases with subsequent resection of the retroperitoneal or parenchymal residues. Of 28 patients with the finding of necrosis/fibrosis or mature teratoma in the dissection preparation, 23 b1e alive and free of tumors. Of 14 patients with the finding of highly malignant tumor, 9 died. In 15 cases, we carried out 'surgical debulking' before chemotherapy: 5 of these patients died as a result of progression in the further course. The advantages and disadvantages of the two treatment modalities are described and discussed. Advanced stages of germ cell tumor with distant metastases should initially be treated with inductive chemotherapy and the tumor residues should subsequently be removed by delayed resection. The sequence in the case of a retroperitoneal 'bulky tumor' without distant metastases is a matter of further discussion and needs a prospective randomized study.

Castration↗
PubMed1981

Selective partial kidney resection. The transsinusal approach.

Partial kidney resection by a combined anterior and posterior transsinusal approach was performed in 8 patients with various kinds of kidney pathology. The technique uses the secondary branches of the renal artery as guidelines to adopt the size of the resected parenchyma as closely as possible to that of the lesion, thereby minimizing the loss of normal parenchyma.

Humans↗
PubMed1981

[Current aspects of hormonal therapy in prostate cancer].

The following endocrine treatment modalities have been used in advanced prostatic carcinoma: 1. orchiectomy plus estrogens; 2. primary orchiectomy with delayed estrogen employment; 3. initial estrogen therapy with delayed orchiectomy; 4. initial cyproterone acetate or medroxyprogesterone acetate; 5. a combination treatment: estramustine phosphate, cyproterone acetate or estrogens plus bromocriptine. The application of phase-III studies permits the subsequent conclusions: Simultaneous orchiectomy is to no advantage (exception: urinary stasis). Cyproterone acetate does neither yield better nor worse results regarding survival than estrogen alone, but has fewer side effects. Estrogens and cyproterone acetate produce a rise of serum prolactin justifying the use of bromocriptine (or lisuride). Estramustine phosphate should be reserved for relapsing prostatic cancer.

Antineoplastic Agents↗
PubMed1980

Treatment of advanced prostatic cancer with parenteral cyproterone acetate: a phase III randomised trial.

Forty-two patients with previously untreated T3/4 N1-4 MO/1 prostatic adenocarcinoma were treated with either cyproterone acetate (n = 21; 300 mg intramuscularly per week) or oestradiol undecylate (n = 21; 100 mg intramuscularly per month) after extensive staging which included open skeletal biopsy and pelvic lymphadenectomy in some cases. Subjective and objective parameters as well as signs of drug toxicity were recorded regularly. Evaluation after 6 months showed cyproterone acetate to be more effective in the following respects: (1) the significantly different castration effect as judged by plasma testosterone, (2) the objective voiding pattern and tumour response, with regression of palpable and histologically evaluable local tumour in 16 of 21 patients, and (3) side effects and untoward reactions. Thus cyproterone acetate is suggested as a valuable alternative in the treatment of advanced prostatic cancer.

Adenocarcinoma↗
PubMed1980

[Androgen metabolism in prostate cancer: 3-hydroxysteroid dehydrogenase in relation to the grade of tumor differentiation (author's transl)].

The peripheral zone of the prostate behaves as an androgen target organ, whereas the periurethral glands are under estrogenic stimulation. This anatomical-physiological situation explained in the past the endocrine dependence of prostatic carcinoma. Biochemical studies by Prout, however, showed that the response of prostate cancer to contrasexual measures correlates well with the activity of androgen-converting enzymes and with the grade of tumor differentiation. In this study the in vitro activity of 3-hydroxysteroid dehydrogenase (formation of androstanediols from dihydrotestosterone) was assessed in biopsy material of 8 highly differentiated adenocarcinomas and of 14 poorly differentiated tumors by a microassay technique. The results were compared with the enzyme activities obtained earlier from benign prostatic hyperplasia and normal prostatic tissue. In the different cell fractions (cytosol, microsomes) and with various cofactor supplementation, the enzyme activities in highly differentiated tumors strongly resembled those of adenomatous or normal prostate tissues, whereas a relative enzyme deficiency was present in poorly differentiated lesions. The pathophysiological and eventual clinical implications of these findings are discussed.

3-Hydroxysteroid Dehydrogenases↗
PubMed1980

[Renal adenoma: dignity and management (author's transl)].

At the Department of Urology, University of Mainz Medical School, 286 patients were operated between 1967 and 1976 for alleged renal cell carcinoma. In 7 patients (2.4%) a renal adenoma was diagnosed. A search in the pertinent literature revealed among patients treated for renal tumors an incidence between 0.21 and 4.4%. There is no reliable preoperative test to distinguish clinically between renal cell carcinoma and adenoma. Even intraoperative frozen section does not safely rule out the possibility of malignant degeneration. Thus, tumor-nephrectomy remains the treatment of choice. Partial resection is warranted only in solitary kidneys, as supported by 2 own cases. Eventually, malignant change and dissemination occurs. Histologically, the renal adenomas are therefore classified as G0 tumors.

Adenocarcinoma↗
PubMed1980

Adjunct bromocriptine treatment as palliation for prostate cancer: experimental and clinical evaluation.

Bromocriptine, a potent antiprolactin, in conjunction with low dose polyestradiolphosphate or cyproterone acetate resulted in a response rate of 28 out of 42 patients. The longest response with pain free and physical as well as sexual, full activity was 15 months until relapse occurred. There was a clear cut prevention of gynecomaesia in 11 out of 13 patients. This is a second report on treatment for prostatic cancer with bromocriptine.

Bromocriptine↗
PubMed1980

[Hormone therapy of prostatic cancer (author's transl)].

64% of all patients with newly diagnosed prostatic carcinoma present with metastases. Hormone application with or without orchiectomy appears to be the adequate form of primary treatment. The most common therapeutic modality is estrogen administration, which has, however distinct disadvantages: The patient is protected up to 5 years only, there is a 27% cardiovascular mortality, it induces a prolactin surge, and is immunosuppressive. Phase III-studies of the EORTC and VACURG have demonstrated that medroxyprogesterone acetate and cyproterone acetate parallel the effectiveness of estrogens. In a phase II-trial adjunctive bromocriptine was found to be necessary to suppress estrogen or antiandrogen induced hyperprolactinemia. The following concept is derived: In disseminated untreated prostatic cancer estrogens or antiandrogens in combination with bromocriptine or high dose injectable gestagens are effective means of primary treatment. Distinct clinical parameters determine the "hormone of first choice". Orchiectomy is reserved for patients with ureteral compression or progressing disease.

Hormones↗
PubMed1980

[Radical extirpation of a left-sided hypernephroma with tumor thrombus in the vena cava inferior (author's transl)].

A radical nephrectomy of a left-sided renal cell carcinoma with extension of the tumor thrombus into the vena cava as far up as the right atrium is described. The right kidney has no venous collateral system, therefore ligation of the right renal vein and resection of the tumor-invaded vena cava is not possible. A left radical extended nephrectomy, if necessary, with interposition of a vessel prosthesis, increases the prognosis and must be considered the therapy of choice.

Adenocarcinoma↗