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J Schubert

Publications and source records attributed to J Schubert.

At least 109 records · Page 6Linked to original sources
PubMed2000

[Modern follow-up strategies for the treatment of patients with superficial bladder carcinoma].

In this retrospective study the efficacy of tumor dispensaire in patients with superficial transitional cell carcinoma of the bladder was investigated in a population of 246 patients. Special attention was payed to follow up cystoscopy. Furthermore our goal was to identify and confirm prognostic factors relevant to recurrence rate and tumor progression. After transurethral resection 241 patients suffering from superficial bladder cancer were enclosed. The first of them were diagnosed in 1984 with a mean follow up range of 6.1 years and a minimum of 1 year. The evaluation was closed in 1995. The 1-year recurrence free rate of all cases amounts to 60%, whereas 42% of patients with a pT1-primary tumor and 45% with a pTa-primum developed a relapse within 2 years after the first diagnosis. All in all more than 50% of all recurrent tumors occurred within the first two years if illness. Patients with pTa and pT1 tumor are progressed in 10.7% and 18%. In 8% we saw lymphogen metastases in patients with pT1 carcinoma. 149 patients (62%) were followed up exactly (+/- 1 cystoscopy) according to the investigation schedule. More than +/- 3 aberrant cystoscopies contrary to the follow up instructions happened very seldom. Prognostic factors to be found of significance for tumor progression and recurrence risk are: tumor staging and grading, multiplicity in occurrence, period of time between first diagnosis and first relapse, associated dysplasia or carcinoma in situ. Chest X-ray and urography should be performed in accordance to the patients individual clinical situation, not routinely (2 cases of pulmonary metastasis occurred after pT1G2-3 tumor progression in 496 regular chest X-rays and 1 ureter tumor was diagnosed by routine urography). As a main result of our investigation we defined two groups of patients with superficial bladder cancer: a "low risk" group (pTa, G1-2, late recurrence (> 2 yrs.) and a "high risk" group (pT1, G3, early recurrence (< 2 yrs.), multifocal occurrence). Group 1 ("low risk") should be followed up for 5 years and group 2 ("high risk") for 10 years. Cystoscopic investigations are scheduled with regard to the group risk of recurrence and tumor progression. For patients of both groups the need of chest X-ray and urography should be evaluated individually.

Follow-Up Studies↗
PubMed1999

Molecular characterization and genome organization of 7SL RNA genes from hop (Humulus lupulus L.).

A wide spectrum of hop 7SL RNA-encoding sequences was detected by temperature gradient-gel electrophoresis. Four hop 7SL RNA genes were cloned and characterized. A new subvariant of the upstream sequence element (USE) 5'TCCCACATGG 3' and two distinct variants of TATA signal were found at positions characteristic for RNA polymerase III-driven transcription in plants. In addition, a more distant conserved sequence element 5' CATGTATAAACTTTCTGC 3' was present in all cloned genes, about 160 bp upstream of the 7SL RNA coding sequence. Consensus secondary structures calculated for hop 7SL RNAs revealed characteristic features, although some structure differences from formerly published models were predicted. Specific in-vitro transcription of plant 7SL RNA genes was observed in a heterologous system (HeLa extract). This in-vitro transcription assay showed significant differences among individual clones in transcription rates, suggesting the requirement of complexity of 7SL RNA sequence for its efficient transcription in HeLa extract. Southern blot analysis of hop DNA revealed 12 7SL-specific signals corresponding to HindIII fragments ranging from 0.45 to 7.8 kb. Several 7SL RNA-encoding sequences and various intergenic spacers were amplified from the individual HindIII fragments of about 1.3 and 2.8 kb. These facts suggest that at least some of the hop 7SL RNA genes are organized in genomic clusters.

Base Sequence↗
PubMed1999

[Immunotesting--a conditio sine qua non for therapeutic BCG instillation in bladder neck carcinoma?].

The intravesical instillation of BCG (Bacillus Calmette-Guérin) in cases of relapsed superficial bladder cancer is an acknowledged kind of prophylaxis. It is uncertainly up to now whether a verification of the immune systems competence is necessary. The recommendations in this problem are very different. In conclusion to the recent literature we think that a verification of the immune system before BCG installation in the urinary bladder has not a prognostic value. Additionally, the legal obligingness of this immunotest is doubtful.

Administration, Intravesical↗
PubMed1999

[An unusual case of genital tuberculosis. A case report].

We represent and discuss etiology, diagnosis as well as differential diagnoses of tuberculous orchtitis referring to an actual case of this rare disease. In the least of all cases one can conclude from the clinical symptoms on the tuberculous origin of the disease. Other differential diagnoses will set more frequently due to rarity of this disease. Quite a lot of cases a bacterial superinfection veils the sterile leucocyturia as main characteristic of genitourinary tuberculosis. Imaging diagnostics frequently fails to give indications of tuberculous origin of the lesion. As before the evidence of Mycobacteria tuberculosis is the most important parameter to proof a tuberculosis. Despite required microbiological cultivation to make a resistogram the polymerase chain reaction is a high sensitive and comparable fast method for detection of Mycobacteria even from tissue. In such dubious cases we recommend to perform an operative denudation due to frequently difficult delimitation from malignant testicular tumours.

Antitubercular Agents↗
PubMed1999

[Increased incidence of renal cell carcinoma in central Europe. Does diagnostic increase reflect a true increase in incidence?].

In the last years the incidence of renal cell carcinoma diagnosis increased about 15-20%. The main aim of this study was to analyse the reason of the increase of incidence. In the present autopsy series comprising 23,801 autopsies the percentage of patients who died of renal cell carcinoma is 1.77% in Jena and 1.55% in Königgrätz (200,000 inhabitants each). Over this time the incidence of renal cell carcinoma in autopsies has increased. In spite of the increased amount of incidentally found renal cell carcinomas since beginning widespread use of ultrasonography the percentage of clinically recognized renal cell carcinomas on the total of all found renal cell carcinomas in autopsies is nearly constant about the 12-year period in Jena and 10-year period in Königgrätz. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of renal cell carcinoma seems to be real.

Carcinoma, Renal Cell↗
PubMed1999

[Strategy for informed consent before a planned live kidney donation].

It has been observed an increasing discrepancy between the supply and demand of cadaveric organs for transplantation for a few years, particularly in renal transplantation. For this living organ donation will occupy an lasting place also in Germany. The new regulation organ donation and transplantation in Germany provides a legal protection and prohibits all forms of organ trading. First of all the transplant team have to take into consideration medical and psychological aspects of donor and recipient but a detailed enlightenment of the pair concerning risks, complications and long term outcome is important as well. In this paper is introduced the enlightenment procedure and the common declaration of donor and recipient of the transplant center Jena. The authors conclude, that living organ donation is not a problem after intensive preparation and enlightenment of donor and recipient with the new Transplant Law in the background.

Documentation↗
PubMed1999

[Limits for organ-preserving surgery in renal cell carcinoma].

The indication for elective organ-preserving surgery in renal cell carcinoma is under discussion. The statements about the maximum tumor size, which could be considered for this surgical procedure, differ in the literature. In a series of 281 consecutive radical tumor nephrectomies we compared the results of preoperative ultrasound and computerized tomography regarding to tumor size and multifocality with the results of the postoperative systematically section of the removed kidneys. Further we analysed the results of 14.793 autopsies regarding to tumor size and multifocality. Serial section of the 281 nephrectomy specimens revealed a total of 64 multifocal tumors in 48 kidneys ( = 17,1 %). The correlation between tumor size and multifocality showed only in tumors up to 20 mm no additional lesions, whereas in the higher tumor categories the incidence was up to 23 %. These clinical investigations were confirmed by the results of the autopsies. In summery of the results we conclude, that the elective organ-preserving surgery of renal cell carcinoma is only indicated in tumors with a maximum diameter of 20 mm.

Carcinoma, Renal Cell↗
PubMed1999

Effective analgesia for extracorporeal shock wave lithotripsy: transcutaneous electrical nerve stimulation.

OBJECTIVES: Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the treatment of urinary stone disease. However, the most appropriate analgesia offering pain-free treatment, minimal side effects, and adequate cost effectiveness remains to be established. This prospective study was performed to evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) during ESWL using third-generation lithotripters. METHODS: Two pairs of stimulator electrodes were placed paravertebrally at L1 and near the lithotripter shock tube before ESWL. Treatment was carried out as follows: (a) shock wave administration was begun (no current = sham TENS); (b) in the case of severe pain, TENS was begun; and (c) if patients experienced no pain relief, analgesic drugs were given intravenously. RESULTS: Of 149 patients, 92 (62%) did not need any analgesia (neither TENS nor medication). In 42 (72%) of the remaining 57 patients, a TENS-related, pain-relieving response was observed. ESWL-induced pain could be reduced by 39.2%. The degree of fragmentation assessed by two urologists was found to be 90% for patients receiving TENS compared with a retrospectively analyzed control group (94%, n = 100). CONCLUSIONS: Two different theories explaining TENS-related analgesia are known: segmental (spinal) and supraspinal (central) inhibition. Since we did not observe any analgesic effect in patients having both pairs of electrodes attached around the shock tube (n = 30), supraspinal inhibition obviously accounts for the abovementioned pain relief. We conclude that TENS is a noninvasive, cost-effective method to achieve side-effect-free analgesia in ESWL using third-generation lithotripters.

Adolescent↗
PubMed1999

Telomerase activity and telomere lengths: alterations in renal cell carcinomas.

Detection of telomerase activity in renal cell carcinomas may be a key to understanding the loss of growth control in tumor cells. This enzyme forms the end of most chromosomal DNAs (that is, telomeres) found in renal tumors. When activated, the telomeres shorten with every cell cycle and then there is a compensatory lengthening of the cells, which then proliferate and eventually become immortal and metastasize. This complex multigenetic process may prove to be a useful marker of tumor progression and patient outcome.

Carcinoma, Renal Cell↗
PubMed1999

Determination of telomerase activity for differential analysis of multifocal renal cell carcinomas.

Secondary tumors are found in approximately 12 to 22% of all renal cell carcinoma, and their origin is currently unknown. To determine their potential for malignancy, we examined the telomerase activity of primary tumors and secondary lesions, and found that 86% of the lesions had an identical telomerase status as the related primary tumors, and thus probably share their malignancy potential.

Adenocarcinoma, Clear Cell↗
PubMed1999

Genetic characterization of multifocal tumor growth in renal cell carcinoma.

The primary cancer found in the kidney is renal cell carcinoma (RCC), which does not as yet have a delineation of the types of lesions that progress to tumor malignancy. We studied tissues from primary tumors and secondary lesions, and compared it with the surrounding normal kidney tissue using comparative genomic hybridization to determine their potential for malignancy. Although our sample size was small, we found that small multifocal tumors have the same potential as primary carcinoma to lead to RCC malignancy. Further genetic studies in a larger sample of patients is necessary before the risk of different lesions to remain benign or progress to RCC can be defined absolutely.

Carcinoma, Renal Cell↗
PubMed1999

Finite-element-analysis of different screw-diameters in the sagittal split osteotomy of the mandible.

A three dimensional finite element model of the mandible was developed to simulate and study the biomechanical loads of osteosynthesis screws in bilateral sagittal osteotomy. Using the finite-element method clinical conditions were simulated. Different bicortical screw configurations and diameters were evaluated. When bite forces were applied, the most stable configuration was found to be a triangular one. This confirms the results found in the literature. A mini screw of 2.0 mm diameter can provide sufficient stability at the osteotomy site after ramus split osteotomy. Even screws with a diameter of 1.5 mm would withstand forces up to 89.5 N, which would not normally be reached by patients after ramus split osteotomy in the early period of healing. Forces exerted by patients after bilateral ramus split osteotomy do not exceed these values. The finite-element analysis appears to be an adequate method to evaluate this clinical question of interest. It might well replace mechanical models and the results are comparable with those reported in the International literature.

Biomechanical Phenomena↗
PubMed1999

[The observed and chance-corrected agreement of the computed tomographic and histological staging results in renal-cell carcinoma].

PURPOSE: To assess the diagnostic value of abdominal computed tomography in the preoperative staging of renal cell carcinoma. METHODS: Computed tomograms of 87 renal cell carcinomas were classified according to the TNM-System. The results were correlated with the histopathological categories. The usual parameters for diagnostic tests were calculated and chance correction of the observed agreement was performed using Cohen's Kappa (kappa) test. RESULTS: T-category staging showed an overall accuracy of 60% (kappa = 0.44). The pT1 category was correctly predicted in all cases. For perirenal invasion, an accuracy of 60% (kappa = 0.27), a sensitivity of 90.5%, and a specificity of 51% were found. For venous involvement, accuracy was 92% (kappa = 0.59), sensitivity 86%, and specificity 92%. All inconspicuous adrenals on CT were histologically normal as well. An accuracy of 80% for lymphadenopathy staging was attributable to chance (kappa = 0.04). 7 distant metastases were detected in the scanned volume. CONCLUSIONS: Good CT staging results are obtained with discrimination between T1 tumors and higher categories, the assessment of venous invasion, the exclusion of adrenal involvement, and the detection of metastatic spread to abdominal organs. Insufficient results are seen with lymphadenopathy staging and the distinction of organ-confined and invasive tumors.

Adult↗
PubMed1999

Real indications for adrenalectomy in renal cell carcinoma.

OBJECTIVES: Adrenalectomy is a part of radical nephrectomy because of the surgical oncology principle of a 'wide margin beyond the malignancy' and due to concern over possible metastases to the ipsilateral adrenal gland, especially in upper pole tumors. But, neither the frequency, predisposing factors of the renal cell carcinoma nor mechanisms of involvement of the adrenal gland are well defined. We assessed the ipsilateral adrenal involvement in renal cell carcinoma to determine whether ipsilateral adrenalectomy during radical nephrectomy is essential. MATERIAL AND METHOD: In a series of 15,347 autopsies in Jena from 1985 through 1996, 272 renal cell carcinoma with 24 adrenal metastases were found. In the same period 9 adrenal metastases were found in 639 radical nephrectomies. Contralateral and bilateral metastases were seen in 15 cases of the autopsy series and in 2 cases of the operative series. RESULTS: The risk of adrenal metastases correlated with multifocal tumors, pleomorphic cell type, anaplastic growth pattern and tumors that were larger than 2.5 cm. Of the 24 renal cell carcinomas with adrenal metastases in the autopsy series, 23 had evidence of widespread disease and 22 had lymph node metastases. A preoperative abdominal computerized tomography was performed in all 9 patients of the operative series with renal cell carcinoma and adrenal involvement. The adrenal gland was considered abnormal in 8 of the 9 cases (88.9%). Only in 1 patient was the computerized tomography incorrectly interpreted as negative. CONCLUSION: We think adrenalectomy should only be performed if there is radiographic evidence of metastases in the adrenal gland or adrenal infiltration by a large upper-pole tumor is possible. Macroscopically normal adrenal glands should not be removed during tumor nephrectomy because the need and benefit of routine adrenalectomy are extremely limited.

Adrenal Gland Neoplasms↗