[Renal cell carcinoma].
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Carcinoma, Renal Cell↗
Biomedical subjects
J Pannek
Publications and source records attributed to J Pannek.
Urodynamically controlled management of spinal cord injury in children.
Spinal cord injuries in children are relatively uncommon. However, infants with cervical spine injury have an especially high risk of renal damage. Six patients, 4 of them tetraplegic, aged 15 months to 8 years, were primarily treated by oral anticholinergic medication and intermittent catheterization. With this concept, satisfactory results were achieved in 4 of 6 children for a mean follow-up of 17.7 months. Mean bladder capacity increased by 128% and intravesical pressure was reduced by 35%. While all patients initially presented with a detrusor leak point pressure above 40 cm H2O, in 4 patients detrusor leak point pressure could be sufficiently reduced by initial treatment. One patient required intravesical instillation of oxybutynin; in another patient sphincterotomy was performed. No patient had signs of renal damage. In summary, even in tetraplegic infants, oral anticholinergic medication and intermittent catheterization is a safe and well-tolerated treatment.
Bacterial Infections↗
Quality of life of patients with renal cell carcinoma or prostate cancer after radical surgery.
OBJECTIVES: To study the impact of radical tumour surgery in prostate and renal cell cancer patients on quality of life (QOL). METHODS: In 38 male patients suffering from organ-confined prostate or renal cell cancer, a prospective study was performed. For the evaluation of QOL, we used the EMPK (Erfassung multipler psychischer Konstrukte). Urologic symptoms were evaluated with a specially designed symptom score. The test instrument was filled out the day before surgery and one year after operation. RESULTS: The EMPK was able to detect and describe significant changes in certain aspects of QOL in renal cell cancer and prostate cancer patients. Moreover, there seems to be a difference between the two groups. A direct relation between QOL and the different quality and quantity of operation-related symptoms, however, could not be proven. CONCLUSIONS: In this pilot study, radical surgical therapy did not significantly change QOL in prostate cancer patients, but seemed to have a positive influence on the QOL of renal cell cancer patients.
Aged↗
Detection of intact prostate cancer cells in the blood of men with prostate cancer.
OBJECTIVES: To develop a procedure to be used to find, identify, and characterize the living prostate cancer cells in the blood of patients with prostate cancer. METHODS: The procedure is based on a negative selection approach that removes most of the blood cells and collects the remaining prostate cancer cells, which are identified and characterized by fluorescent in situ hybridization with deoxyribonucleic acid probes and by indirect fluorescent immunocytochemical staining. The blood cells are removed via density gradient centrifugation. RESULTS: Using the prostate cancer LNCaP cells as a model, the recovery rate of the added prostate cancer cells to 10 mL of blood was about 85%, with a dilution of 1 LNCaP cell to 10,000 white blood cells or more. Blood samples varying from 9 to 27 mL were collected and analyzed from 8 men aged 54 to 79 years who had varying levels of PSA in serum. In one blood sample, prostate cancer cells were not found; in the seven other samples, the number of prostate cancer cells found per milliliter of blood varied from 1 to 20. Prostate cancer cells were not found in 7.5 to 15-mL blood samples from 3 healthy younger men. The prostate cells were found to be aneuploid for chromosomes 7 and 8, highly suggestive that these cells were cancerous. CONCLUSIONS: Using a negative selection approach, prostate cells can be found in the blood of patients with prostate cancer, as identified by prostate cell-specific probes and antibodies. These cells were found to be aneuploid.
Adult↗
Molecular forms of prostate-specific antigen and human kallikrein 2 (hK2) in urine are not clinically useful for early detection and staging of prostate cancer.
OBJECTIVES: Prostate-specific antigen (PSA), a member of the human kallikrein (hK) family, is the most important tumor marker for early detection, staging, and monitoring of men with prostate cancer today. However, the sensitivity of serum PSA is not sufficient to be used alone for prostate cancer screening. Recently, it was reported that the serum-to-urinary total PSA ratio improves the detection of men with prostate cancer, especially in men with a serum total PSA level between 4.0 and 10.0 ng/mL. We tested this hypothesis by evaluating the clinical usefulness of this PSA ratio as well as the use of the different molecular forms of PSA and human kallikrein 2 (hK2) in urine for detection and staging of prostate cancer. METHODS: One hundred ten fresh, midstream urine specimens (prostate cancer 62, benign prostatic hyperplasia [BPH] 38, healthy male control 5, women 5) were collected. Serum total PSA, urine total PSA, urinary free PSA, urinary alpha 1-antichymotrypsin-bound PSA, and urinary hK2 levels were determined by monoclonal antibody assays (Hybritech Inc.). The serum-to-urinary total PSA ratio was calculated. RESULTS: The serum-to-urinary total PSA ratio did not accurately distinguish between men with BPH and men with prostate cancer. There was no significant difference between the urinary levels of any of the molecular forms of PSA or hK2 between men with prostate cancer and men with BPH. Among men with prostate cancer, neither urinary hK2 nor urinary levels of any of the molecular forms of PSA correlated with age, pathologic stage, or Gleason grade. CONCLUSIONS: In our study, the serum-to-urinary total PSA ratio did not improve the detection of men with prostate cancer. Furthermore, measurement of the molecular forms of PSA and hK2 in urine did not improve the detection or staging of prostate cancer over serum PSA alone.
Aged↗
Glans hyperemia after penile revascularization: a late complication following alpha-1-receptor blockade for benign prostatic hyperplasia.
Surgical revascularization of the penile vessels is one treatment choice for patients with vasculogenic impotence. Hyperemia of the glans is a rare but severe complication which usually occurs early. We report a patient who developed this complication more than 3.5 years after surgery following onset of medical treatment of benign prostatic hyperplasia with a vasodilating alpha 1-receptor blocker.
Adrenergic alpha-Antagonists↗
Orchitis due to vasculitis in autoimmune diseases.
Autoimmune diseases can affect the blood vessels, causing systemic vasculitis. Although testicular manifestation of some autoimmune diseases is not uncommon, only a few cases of acute orchitis are described in the literature. The underlying pathological condition in testicular manifestations of autoimmune diseases is severe vasculitis causing inflammation and infarction. In patients with recurrent episodes of scrotal swelling and pain, testicular vasculitis as the first sign of a systemic disease should be taken into consideration.
Acute Disease↗
Transurethral resection of the prostate with microprocessor controlled electrosurgical unit.
PURPOSE: We analyzed the efficacy and side effects of a microprocessor controlled high frequency unit for transurethral resection of the prostate. MATERIALS AND METHODS: A high frequency device with microprocessor control was used in 934 consecutive patients undergoing transurethral resection of the prostate. Indications for transurethral resection, medical history, preoperative findings, operative parameters, operative and immediate postoperative complications, and postoperative peak flow rate and residual urine were evaluated. RESULTS: Postoperative peak flow rate and residual urine were comparable to those with standard transurethral resection of the prostate. One patient died on postoperative day 1 for a mortality rate of 0.1%. The immediate morbidity rate was 6.9%. CONCLUSIONS: Morbidity and mortality in this study were lower than those in previous series on transurethral resection of the prostate.
Aged↗
Prostate-specific antigen: what's new in 1997.
When used alone, prostate-specific antigen (PSA) is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity, PSA density, and age-related PSA values were developed. Although PSA velocity provides excellent results, its determination requires three PSA values over a 2-year period. The value of PSA density rests on the accurate determination of prostatic volume by transurethral ultrasound (TRUS), which is examiner-dependent. Age-specific reference ranges appear to be more sensitive in men under age 60 than in those over 60. The molecular forms of PSA, especially the percentage of free PSA, seem to be useful tools for the detection of prostate cancer in men with slightly elevated total PSA. New molecular techniques, such as the reverse transcriptase-polymerase chain reaction (RT-PCR), enable the detection of minimal amounts of PSA messenger RNA (mRNA). Human kallikrein 2 (hK2), a serine protease closely related to PSA that also is expressed predominantly in the prostate, may be a new marker for prostate cancer.
Biomarkers, Tumor↗
[Kidney colic caused by allergy to contrast media--the limits of diagnosis].
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Adult↗
Fear of risks of cure in the treatment of a giant germ cell tumour. A case report.
A delay of treatment of a giant germ cell tumour because of fear of therapy and lacking knowledge of prognosis is presented. Based on this case, the possible pitfalls and limitations of self-detection programmes are discussed and recommendations for the improvement of general knowledge of testicular tumours are given.
Adult↗
The role of free/total prostate-specific antigen ratio in the prediction of final pathologic stage for men with clinically localized prostate cancer.
OBJECTIVES: The combined use of total prostate-specific antigen (PSA), clinical stage, and Gleason score accurately predicts final pathologic stage for men with clinically localized prostate cancer. Recently, the free/ total PSA ratio has been proposed as an adjunct for early detection of prostate cancer. We examined the association between free/total PSA and pathologic stage. METHODS: In a prospective study, 301 consecutive men with clinically localized prostate cancer (average age 58.8 years, range 45-72) underwent a staging pelvic lymphadenectomy and radical prostatectomy. Total PSA and free PSA were measured from preoperative sera. Pathologic stage was determined as organ-confined (OC, n = 169), capsular penetration (CP+, n = 108), seminal vesicle involvement (SV+, n = 13) and lymph node involvement (LN+, n = 11). RESULTS: Overall, 292/301 (97%) of the free/total PSA values were < 25%, and thus suspicious for prostate cancer. Combination of total PSA, Gleason score, and clinical stage predicted well OC (P = 0.00001) and LN+ (P = 0.023); whereas, replacing total PSA with free/total PSA ratio did not improve the prediction of OC (P = 0.0007) nor LN+ (P = 0.03). CONCLUSIONS: The free/total PSA ratio cutoff point of 25% had high sensitivity for prostate cancer among a group of men with clinically localized disease. The free/total PSA ratio did not significantly improve the prediction of pathologic stage provided by total PSA when used alone or in combination with Gleason score and clinical stage. These preliminary data demonstrate that free/total PSA levels provide no additional information for pathologic stage prediction when combined with Gleason score and clinical stage in men with clinically localized prostate cancer.
Aged↗
In vitro comparison of two ballistic systems for endoscopic stone disintegration.
Endoscopic stone disintegration can be performed with various lithotripsy techniques. We compared two ballistic systems in vitro: the Swiss Lithoclast and the Combilith (Olympus). Measurements of the probe movement; i.e., maximum velocity and displacement, were performed using an optical high-speed technique based on a frame transfer camera. The Lithoclast and Combilith both achieve excellent probe velocities. However, the Lithoclast achieves equal velocity with less probe displacement.
Lithotripsy↗
Cyproterone acetate in the treatment of advanced prostatic cancer: retrospective analysis of liver toxicity in the long-term follow-up of 89 patients.
Cyproterone acetate (CPA) was the first steroidal antiandrogen used for the treatment of prostatic cancer. In recent studies CPA has been linked with DNA adduct formation and increased DNA repair synthesis in vitro, suggesting an increased risk for the development of hepatic malignancies. To assess liver-toxic and carcinogenic effects, 89 patients who received CPA 50 mg/day p.o. over 4 (range 2-152 months) years for prostatic cancer treatment were retrospectively evaluated. 22 patients (28.2%) showed elevated liver enzyme concentrations. In none of the 89 patients alpha-fetoprotein serum levels were elevated. In no case hepatocellular carcinoma has been observed, and in no case CPA administration was discontinued due to side effects. Considering the life expectancy of patients with advanced prostatic cancer and the long-term and high-dose exposure to CPA necessary to possibly induce liver tumors, it appears highly unlikely that CPA treatment may account for a substantial number of liver carcinomas in such patients.
Aged↗
Aging--a potential pitfall of continent urinary diversions.
We report three cases of patients with Kock-pouches, who developed late complications related to old age. Based on these findings, the fate of aging patients with continent urinary diversions is discussed.
Aged↗
Urodynamic and rectomanometric findings in urinary incontinence.
To investigate the correlation of urinary and fecal incontinence, 52 patients with urinary incontinence underwent cystometry and rectomanometry. Twenty-five patients suffered from stress, 20 from urge and 7 from overflow urinary incontinence. The rectomanometry showed normal results in 29 patients, 5 presented with a compensated and 18 with a partially compensated sphincter incompetence. Whereas 18 of 20 urge incontinent patients had a normal rectal sphincter function, in contrast 16 of 25 stress incontinent patients suffered from rectal sphincter incompetence. In conclusion, there is a marked correlation between stress urinary incontinence and rectal sphincter incompetence. This supports the general thesis that a weakness of the entire pelvic floor is one of the characteristic features of urinary incontinence.
Adult↗
Influence of continent ileal urinary diversion on vitamin B12 absorption.
PURPOSE: Because vitamin B12 is mainly absorbed in the terminal ileum, we evaluated potential absorption deficiencies in continent ileal reservoirs. MATERIALS AND METHODS: Eight to 25 months (mean 13) after surgery we evaluated 25 patients with a Kock pouch and 29 with an ileal neobladder. A Schilling test and red blood count were done, and serum levels of vitamin B12 and folic acid were determined. RESULTS: Absorptive capacity was decreased in 20 of the 25 Kock pouch patients but none of the 29 ileal neobladder patients. Four patients in each group had low vitamin B12 levels. No patient had megaloblastic anemia. Folic acid levels were normal in all patients. CONCLUSIONS: A loss of 50 cm. of terminal ileum seems to be the critical margin sufficient vitamin B12 absorption.
Female↗
Transurethral ultrasound-guided laser-induced prostatectomy: clinical outcome and data analysis.
OBJECTIVES: To analyze efficacy and side effects of the transurethral ultrasound-guided laser-induced prostatectomy (TULIP) procedure for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Based on the results obtained so far, the influence of preoperative and intraoperative parameters on clinical outcome is analyzed. METHODS: Between May 1991 and March 1994, 89 men with symptomatic and obstructive BPH underwent a TULIP procedure and were followed after 3 and 6 weeks, and 3, 6, and 12 months postoperatively. RESULTS: On average, mean urinary peak flow increased from 7 to 15 mL/s, postvoidal residual urine decreased from 215 to 40 mL and symptoms (assessed by modified Boyarsky score) decreased from 17 to 5 at 12 months after TULIP: In about half of the patients peak flow increased to more than 20 mL/s on average, and approximately 85% of all men reported that their symptoms improved on average 80% during this time. Because of insufficient micturition, 7 patients subsequently underwent conventional transurethral resection of the prostate (TURP) and 1 had an open prostatectomy. Either partial or complete retrograde ejaculation was reported by 13 of 58 sexually active men. No blood transfusion was required and no post-transurethral resection syndrome occurred in any case. Analyses of preoperative and intraoperative parameters and clinical outcome with respect to prostate volume, urinary retention, type of BPH enlargement, sleeve size, and good and poor responders did not reveal any significant influence of any factor. There is, however, a trend toward a lower laser energy delivered in patients who failed or may be considered to be poor responders. CONCLUSIONS: In this unselected group of patients with BPH, who otherwise would have been TURP candidates, the TULIP procedure demonstrated the efficacy of this technique to relieve bladder outlet obstruction. Compared with TURP, the TULIP procedure proved to be advantageous in regard to less blood loss and rate of retrograde ejaculation. In addition, TULIP can be performed under analgesic sedation, which is especially advantageous in high-risk patients. Disadvantages, however, are that it takes a considerably longer time to obtain substantial improvements in subjective and objective symptoms and there are more irritative symptoms in the early postoperative phase.
Aged↗