Biomedical subjects

J Flamm

Publications and source records attributed to J Flamm.

At least 37 records · Page 2Linked to original sources

PubMed1989

The significance of bladder quadrant biopsies in patients with primary superficial bladder carcinoma.

The prognostic significance of dysplasia (D I-III, Tis) based on bladder quadrant biopsies was established in 216 patients with primary urothelial carcinoma of the bladder (stage pTaGI-pTGIII). Collectively within the study, 51 of the 216 patients biopsied (24%) were found with abnormal urothelium. Twelve (6%) have coexistent Tis, and 30 (18%) were found with dysplastic changes D I-III. Further concerns included the incidence of dysplastic changes associated with tumor invasion, tumor dedifferentiation, and the presence of primary multifocal disease. The collective recurrence rate was 43%. However, with inclusion of quadrant biopsies, the predictability of positive biopsy results increased to 63% and the negative rate decreased to 37%.

Adult↗

PubMed1989

[Short-term versus long-term chemoprevention of recurrence with Epodyl following transurethral resection of superficial urinary bladder cancer].

This investigation compares the short and long-term administration of intravesical Epodyl (etoglucid), following transurethral bladder tumor resection. This chemoprophylactic agent was used specifically in the treatment of bladder tumors that displayed different associated tumor risk factors: solitary versus multiple tumors, grade(s) I-III, primary versus recurrent tumors, and the presence of associated dysplasia. Within this study, 114 patients with carcinoma of the bladder underwent primary transurethral resection (TUR), followed in 10 days by short-term intravesical therapy (STIT) or long-term intravesical therapy (LTIT). Short-term intravesical therapy was administered to 56 patients. The therapy consisted of a 1% solution of Epodyl, which was given once per week for 6 weeks. Long-term intravesical therapy was given to 58 patients. This consisted of the short-term intravesical therapy protocol, followed by an additional dose once a month during an observation period of 2 years. The follow-up in both groups was for a minimum of 2 years. When the total number of recurrences in patients receiving (STIT) or (LTIT) was compared, no marked differences were noted (39% vs 38%). However, there was a difference when the individual tumor risk features were compared, e.g. for solitary tumors, the recurrence rate was 67% within the (STIT) group and 43% within the (LTIT). These results demonstrate that the decision of whether superficial bladder carcinomas are to be treated with short- or long-term Epodyl should be based on tumor-associated risk factors. Furthermore, if multiple tumor risk factors are present, maximal therapy is require; in the absence of risk factors TUR alone may be sufficient.

Administration, Intravesical↗

PubMed1988

The Escherichia coli biotin biosynthetic enzyme sequences predicted from the nucleotide sequence of the bio operon.

The nucleotide sequence of the biotin (bio) biosynthetic operon of Escherichia coli has been determined. The 5.8-kilobase region contains the five biotin operon genes, bioA, B, F, C, and D. and an open reading frame of unknown function. The operon is negatively regulated and divergently transcribed from a control region between the bioA and bioB genes. The product of the bioA gene, 7,8-diaminopelargonic acid aminotransferase, was discovered to be related to ornithine aminotransferase. The product of the bioF gene, 7-keto-8-aminopelargonic acid synthetase, was found to be similar to 5-aminolevulinic acid synthetase.

5-Aminolevulinate Synthetase↗

PubMed1988

[Complete androgen blockade (orchiectomy + flutamide) versus androgen blockade with cytostasis (orchiectomy + estramustine) in the treatment of virginal advanced prostate cancer].

The results of orchiectomy + flutamide (n = 28) versus orchiectomy + estramustine (n = 27) in the initial therapy of advanced prostatic cancer were compared in a prospective randomized study. The minimum observation period was one year. In the group orchiectomy + flutamide the incidence of side effects was 25%, the response rate (complete + partial remission) was 28% and the progression rate was 18%. 5 patients (18%) died within the first year. In the group orchiectomy + estramustine the incidence of side effects was 22%, the response rate (complete + partial remission) was 29% and the progression rate was 33%. 2 patients (7%) died within 1 year of treatment. There is no significant difference either in the response rate or the progression rate between the two groups.

Aged↗

PubMed1988

[Radical prostatectomy in the treatment of prostatic cancer. Perineal and transpubic methods].

This paper presents a report on 49 patients with prostatic cancer stages A-C (pT1NxMo-pT3Nx-1Mo) treated by radical prostatectomy. 32 patients were operated on perineally without preliminary lymph staging and 17 patients by the transpubic method after pelvic lymph staging. No death occurred perioperationaly in either group. Early complications were seen in 22% of cases after the perineal method and in 12% after the transpubic method; the incidence of late complications was virtually the same in both groups (22% and 23%) and the rate of incontinence was also similar (22% and 18%). The 5 year survival rate was 92% and the 10 year survival rate was 67%. On the basis of these results we feel that radical prostatectomy, especially incorporating the most recent modifications to retain continence and potency, represents the treatment of choice in early stages of prostatic cancer and, indeed, even in stage C cases.

Aged↗

PubMed1988

[Therapy of advanced prostatic cancer].

Prostate cancer is a polyclonal tumor. There are about 70 bis 75% responders after hormone therapy among previously untreated patients in EORTC trials. Therefore 25 to 30% of the tumors are resistant to androgen. Surgical and hormonal castration show similar results. After progression under hormone therapy response can be reached with antiandrogenic therapy in 30 to 38%. All this leads to the conclusion that it is necessary to base treatment on tumor adaptation and selection. Cell clones insensitive to androgen therefore need cytostatic chemotherapy. It is not yet proofed whether polychemotherapy really shows better results than monotherapy does. Following the thesis of a polyclonal tumor, therapy of advanced prostate cancer must be based on hormone therapy and cytostatic chemotherapy. Prostate specific antigen is a marker for an early recognition of progression.

Antineoplastic Agents↗

PubMed1988

The influence of medroxyprogesterone acetate (MPA) on hormone parameters in prostatic carcinoma patients.

In ten patients suffering from previously untreated, advanced, non-metastatic prostatic carcinoma, the effect of MPA on the hormonal parameters of testosterone and luteinizing hormone (LH) was examined. The dosage of MPA amounted to 500 mg i.m. daily for a week. Thereafter 1000 mg i.m. every four weeks were applied. Full castration could be achieved in all patients, and this effect could be kept up during the time of observation. The tolerance was good, there were no side effects.

Aged↗

PubMed1988

[High dosage ketoconazole therapy in the treatment of advanced prostatic cancer].

This paper reports on oral high-dose ketoconazole treatment (3 x 400 mg/die) in 38 patients with advanced (pT3-4NXMOGIII - n = 9), metastasizing (Ml - n = 23) prostatic cancers that had been treated previously (n = 23) or untreated (n = 15). The primary response rate was 66% with 37% remissions. After 1 year, the response rate was 40% with 8% remissions and 8% progressive tumours. There was drop-out rate of 34% because of adverse experience and a very high rate of side-effects for 74%. During treatment there was a significant reduction in testosterone, cortisol and acid phosphatase blood levels. There was a transient rise in liver enzymes (gamma-GT, GOT, GPT, LDH and bilirubin) above the limit. There was no change registered in the renal parameters (BUN, creatinine) or in the calcium and phosphorus blood levels. There was no difference in the response rate between patients who had been treated previously and those with no treatment. There was also no difference in the outcome of tumours that had metastasized and those that had not.

Aged↗

PubMed1987

[Status of surgery in the treatment of metastatic renal cell carcinoma].

A report is presented on 78 patients with metastatic renal cell carcinoma (RCC, Robson III and IV). The average survival time was 2.1 years after nephrectomy, 1.1 years after embolization and only 0.65 years in the patients who underwent no surgery at all. As there is still not known effective systemic cytostatic therapy for this type of tumour, there is no doubt about the priority of nephrectomy. The indication for nephrectomy is limited by the feasibility of total removal of the metastases. An extension of this indication limit has not improved the survival rate. There is no difference in survival rate between patients with removable local, as opposed to operable distant metastases. In those cases where nephrectomy was not possible the patients did better after embolization than with no surgery at all.

Aged↗

PubMed1987

[High-dosage medroxyprogesterone acetate treatment in advanced prostatic cancer].

32 patients suffering from previously untreated, advanced metastatic or non-metastatic prostatic carcinoma, were studied in an assessment of the effect of high-dose medroxyprogesterone acetate (MPA) on the hormonal parameters testosterone and the luteinizing hormone (LH). The dose used was 500 mg intramuscularly daily for a week, followed by 1000 mg monthly until progression or for a minimal period of 12 months. Full castration was achieved and this effect was maintained during the observation period. Stable disease was seen in 20 patients (63%) whilst progression of disease was found in 12 patients (37%). 4 patients were non-responders. The incidence of side effects was 31%.

Aged↗

PubMed1987

[Long-term intravesical treatment with adriamycin in chemoprevention of recurrence of transurethrally resected urinary bladder cancers].

64 patients with a histologically verified urothelial tumour of the urinary bladder were given intravesical Adriamycin-instillations after transurethral resection of their tumours. 34 patients received 50 mg Adriamycin once weekly for a period of 6 weeks. 30 patients, after undergoing this initial treatment, were treated with 50 mg Adriamycin once a month over a period of 2 years. After 1 year we found a relapse rate in the group with a long term therapy as compared with the first group a relapse rate of 32%. After 2 years of observation the relapse rate was practically the same in both groups (41% and 40%).

Administration, Intravesical↗

PubMed1987

[Cutaneous uretero-ileostomy].

A report is presented on 95 ileal conduit operations. Of these cases 16 had either neurogenic bladder disorders or shrunken bladder after radiation therapy and 79 had carcinomas of the bladder without radiotherapy. 19 of the latter patients were treated palliatively with an ileal conduit without cystectomy, whereas the remaining 60 patients underwent ileal conduit including total cystectomy. Early complications were seen in 42% and late complications in 27% of the patients. The 5-year survival rate for all stages of carcinoma was 34% and the 10 years survival rate was 18%. There is a definite relationship between reduced survival rates in cases of increased tumour staging and grading.

Aged↗

PubMed1987

[Palliative ileal conduit in inoperable cancer of the urinary bladder].

A retrospective study is presented of 19 patients with inoperable urinary bladder carcinoma in which urinary diversion was performed by ileal conduit without cystectomy. The postoperative mortality rate was 10.5% and the incidence of complications was 16%. The average time of survival was 5.1 months and varied from between one and 23 months. According to the literature these results are no better than those in patients undergoing no therapy at all. It is, thus, our opinion that palliative ileal conduit should not be considered a suitable method for urinary diversion in patients with advanced carcinoma of the urinary bladder.

Aged↗

PubMed1987

[Prognostic significance of dysplastic urothelial changes for the rate of recurrence in superficial urinary bladder cancer].

In 54 patients with a superficial transitional cell carcinoma of the bladder urinary (pTa/pTl) apart from a differentiated TUR a quadrant biopsy was investigated in relation to other tumour parameters and the rate of recidivations. Altogether dysplastic changes were to be found in the margin of the tumour in 14 tumours (30%), a positive quadrant biopsy in 20 tumours (37%). Dysplasias in the margin of the tumour without atypias of the remaining mucous membrane were found only in 4 tumours (7%). Dysplasias increase with increasing degree G from 17% in G I tumours to 50% in G III tumours. The rate of recidivations in a control period of 2 years and a chemorecidivation prophylaxis with adriamycin was 14/20 (70%) in positive quadrant biopsy and 6/34 (18%) in negative quadrant biopsy.

Aged↗

PubMed1987

[Radical prostatectomy in stage C prostatic cancer].

This is a study on 38 patients with carcinoma of the prostate stage C. Radical perineal or transpubic surgery was performed on 20 of the patients. The 5 years survival rate was 95% and the 10 year survival rate was 46%. 18 of the patients had either palliative or not treatment at all. The 5 year survival rate here was 76%, and the 10 year survival rate was 22%. Local tumor recurrency after radical surgery occurred in 10% of the cases, whereas a progression of the tumor after palliative treatment only occurred in 72%. After radical surgery 1/8 (12.5%) of the patients died as a result of the carcinoma, whereas having undergone palliative treatment 6/11 (54.5%) died as a result of their tumor.

Aged↗

PubMed1987

[Conservative treatment of staghorn calculi].

On the basis of the examination of 24 patients with unilateral or bilateral staghorn calculus, who could not be operated for internal reasons, is reported on the course of the lithiasis. The observation time is between 2 and 9 years. In all patients an infection of the urinary tract was present. During the observation time in no patient a growth of the calculi could be stated. 6 patients who died of the lithiasis and uraemia already when the diagnosis was made had a functionless kidney greatly restricted global renal function. In the living patients no progression or exacerbation of the infection was revealed. The suggestion that a staghorn calculus necessarily leads to the loss of the renal function cannot be confirmed on the basis of the literature and the own results. Though there is no doubt about the advantage of the operation, in an increased risk an expectant attitude with conservative therapy seems to be justified. An infection of the urinary tract cannot be treated conservatively.

Aged↗

PubMed1986

[Unilateral atrophy of the kidney].

We considered and discussed the case histories in comparison with the clinical symptoms and the consequent therapy of 47 urological patients with unilaterally shrunken kidney. In 43% of the patients their main symptom was high blood pressure, 53% of the patients were then clinically proven to suffer from albuminuria. In 34% of the patients there was a case history of nephrolithiasis and in 32% of the patients nephrolithiasis would be clinically proven. In 20 patients nephrectomy was performed. After this procedure all the patients were freed from urinary infections and in 75% of them the high blood pressure could be considerably lowered.

Atrophy↗

PubMed1986

[Tumor-associated mononuclear cell infiltrate and recurrence rate in the superficial urothelial carcinoma of the urinary bladder].

Investigation on the absence or presence of malignancy-associated mononuclear cell infiltration in correlation to the recurrence rate after topic adriamycin chemotherapy was made in 53 patients with a superficial urothelial carcinoma of the urinary bladder after transurethral resection. The tumor recurrence rate, after an average observation period of 2.8 years, was 55%. Malignancy-associated mononuclear cell infiltration was found in 18 cases (34%) and of these, 6 (33%) showed recurrence. Absence of cell infiltration was found in 35 cases (66%) and of these, 23 (66%) showed recurrence. In those tumors which showed recurrence, cell infiltration was absent in 83%, whereas it was absent in only 46% of the tumors without recurrence.

Aged↗