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Biomedical subjects

L Baert

Publications and source records attributed to L Baert.

At least 73 records · Page 4Linked to original sources
PubMed1997

Adenocarcinoma of the prostate: innovations in management.

Adenocarcinoma of the prostate (CaP) in the Western world has become the most common noncutaneous human tumor. CaP is also the second most important cause of cancer deaths among the male population in the United States. Major progress was made in the past decade in better understanding this disease process, as well as in improved diagnostic accuracy. This improved diagnostic accuracy was due to wide application of prostate-specific antigen (PSA), use of transrectal ultrasound (TRUS), and greater awareness among clinicians of CaP. The use of PSA in clinical practice has resulted in a sharp increase in the number of patients diagnosed with capsule-confined tumors. The optimal treatment for capsule-confined CaP is in the process of being defined. Radical prostatectomy in the United States is currently the most commonly applied treatment for younger patients. Excellent treatment results with a 10-year actuarial survival > 80% are readily obtainable in properly selected patients. Nerve-sparing procedures helped reduce the high incidence of impotence that occurs in patients after radical retropubic prostatectomy. Radiotherapy remains the other curative treatment method in the management of CaP patients, with long-term survival rates similar to those reported in surgical series. Due to the problem of frequent preoperative tumor understaging, a routine use of postoperative irradiation to the prostatic fossa produces an excellent (> 95%) incidence of local tumor control. Management of patients with metastatic disease has undergone a considerable evolution with the development of modern hormonal management and treatment with strontium-89 to control intractable bone pain. Newer treatment methods such as hyperthermia are currently being investigated. Major efforts are directed toward the reduction of short- and long-term treatment toxicity associated with surgery, radiotherapy, and hormonal management, thus improving patient quality of life.

Adenocarcinoma↗
PubMed1997

Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma.

PURPOSE: Although many factors have been considered to predict the outcome after radical nephrectomy, renal cell carcinoma continues to behave unpredictably. In a retrospective study the correlation between microvascular tumor invasion and disease-free survival after surgery for renal cell carcinoma was analyzed. MATERIALS AND METHODS: Between 1980 and 1993, 180 patients (mean age 60 years) were followed for a mean of 52 months after radical or partial nephrectomy for clinically localized renal cell carcinoma. The relevance of microscopic vascular invasion was compared to classical tumor staging, grade and tumor diameter. RESULTS: Microscopic vascular invasion was found in 51 patients (28.3%), including 20 (39.2%) with progression (mean interval to progression 72 months). Of 129 patients with no pathological evidence of microscopic vascular invasion only 8 (6.2%) showed progression at a mean interval of more than 160 months. The difference in disease-free survival as a function of microvascular invasion was statistically highly significant (log rank p < 0.00001) and on multivariate analysis this parameter was by far the most relevant predictor of progression. CONCLUSIONS: In patients who underwent radical nephrectomy for clinically nonmetastatic renal cell carcinoma with microvascular invasion but without lymph node involvement or macroscopic vascular invasion the chance of disease progression is estimated at 45% within 1 year. Microvascular invasion is the single most relevant prognosticator after presumed curative radical nephrectomy for renal cell carcinoma.

Adolescent↗
PubMed1997

Maximal androgen blockade versus total androgen suppression.

As long as advanced prostate cancer remains androgen-dependent, it can be treated by castration in combination with anti-androgens. When despite maximal androgen blockade (MAB), progression occurs, the anti-androgen withdrawal can result in partial remission. Otherwise corticosteroids can be used in low doses in order to suppress the androgens originating from the adrenal gland: total androgen suppression (TAS). The minimal side effects and the low cost price of this treatment are important advantages, given the fact that only few efficient cytostatic agents are actually available for hormone-escaped prostate cancer. About 30% of the patients with advanced prostate cancer that became androgen independent will show a secondary remission under low doses hydrocortisone or prednisone.

Adenocarcinoma↗
PubMed1997

Contemporary non-imaging methods in diagnosis of bladder cancer: a review.

The early diagnosis of bladder cancer is central to the effective treatment of the disease. Presently, the detection of bladder tumors relies on cystoscopy and there are no methods available to easily and specifically identify the presence of bladder cancer cells. A variety of new technologies and potential tumor markers are being studied in bladder cancer and some are being translated into clinical use. It is important to realise that all available results on the diagnostic value of tumor markers do not allow firm clinical recommendations, but tests based on biomarkers will undoubtedly influence the management of bladder cancer in the near future.

Antigens, Neoplasm↗
PubMed1997

Tamsulosin 0.4 mg once daily: tolerability in older and younger patients with lower urinary tract symptoms suggestive of benign prostatic obstruction (symptomatic BPH). The European Tamsulosin Study Group.

OBJECTIVES: To compare the safety and tolerability of tamsulosin 0.4 mg once daily in younger (< 65 years) and older (> or = 65 years) patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). METHODS: In a retrospective analysis of two European double-blind, randomized, placebo-controlled trials, safety was assessed in 574 younger or older patients treated with tamsulosin or placebo for 12 weeks. RESULTS: The incidence of adverse events, drug-related adverse events, serious adverse events and discontinuations due to adverse events was similar in older and younger tamsulosin-treated patients and was not significantly different from placebo. Although abnormal ejaculation was slightly more common in younger than older men receiving tamsulosin, the difference was not statistically significant from the placebo groups in both age groups. The incidence of adverse events possibly associated with vasodilation in tamsulosin-treated younger and older patients was 8.4 and 4.2%, respectively; these were comparable with the values for placebo-treated patients: 7.5 and 6%, respectively. Baseline systolic blood pressure was higher in older than younger patients, but there were minimal changes in blood pressure or pulse rate in tamsulosin- or placebo-treated patients in either age group. CONCLUSIONS: Tamsulosin is well tolerated and suitable for use in older and younger patients with LUTS suggestive of BPO (symptomatic BPH).

Adrenergic alpha-Antagonists↗
PubMed1997

[Etiology and treatment of secondary lesions of the urethra: unusual complication of a combined kidney-pancreas transplantation].

The pancreaticoduodenocystostomy has become the most acquired technique to perform a combined pancreas-kidney-transplantation. This operation shows some disadvantages. There sometimes are urological problems. In this article, we describe two patients, who showed urethral problems due to this operation. At the same time, we would like to describe the possible causes and the preferable treatment of this rare complication. We advise to start with a conservative treatment and, if problems persist, to consider an intestinal conversion.

Adult↗
PubMed1997

Urinary incontinence following transurethral, transvesical and radical prostatectomy. Retrospective study of 489 patients.

Urinary incontinence following prostate surgery was evaluated in 489 consecutive patients: 216 patients underwent a transurethral resection, 98 patients a transvesical prostatectomy for benign prostatic hyperplasia and 175 patients a radical prostatectomy for localized prostate cancer. In the first group incontinence was present in 19% of the patients immediately after catheter withdrawal, 16% after 1 month, 8% after 3 months, 3% and 2% after 6 and 9 months, 1.5% after 1 year and 0.5% after 15 months. In the second group incontinence was present in 15% immediately after catheter withdrawal, 12% after 1 month, 5% after 3 months, 2% after 6 months and 1% after 9, 12 and 15 months. In the last group the incontinence rate was higher, 66% were incontinent immediately after catheter withdrawal, 53% after 1 month, 33% after 3 months, 12% after 6 months, 8% after 9 months. After 12 and 15 months still 2% had problems with persistent incontinence. These results compare favourably with the results from the literature. The fact that a rehabilitation program was introduced for the patients with post-operative incontinence, may have been a contributing factor.

Aged↗
PubMed1997

Sarcomatoid renal cell carcinoma: case report and review of the literature.

Sarcomatoid renal cell carcinoma (SRCC) is an uncommon tumor of the renal parenchyma, representing one to five percent of all primary kidney tumors. The major symptoms are the same as in the classic renal cell carcinoma: haematuria and flank pain. The tumor consists of a bimorph feature of clear cells with areas of spindle cells and giant cells, resembling a sarcoma. Immunohistochemistry and electronmicroscopy are often necessary to prove the epithelial origin of these spindle cells. Therapy is essentially surgical but in some cases there can be a benefit of chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Cytogenetic investigation of synchronous bilateral renal tumors.

Cytogenetic investigations on synchronous bilateral renal tumors are scarce. We report our findings on 13 renal tumors from 5 patients and review the literature. In bilateral as well as in solitary tumors, cytogenetic findings in each tumor correlated with the histological patterns, i.e. combinations of trisomies for papillary renal cell carcinoma, loss of 3p-material for non-papillary renal cell carcinoma, and coincident loss of the Y chromosome and chromosome 1 in oncocytomas. Bilateral multifocal renal cell carcinomas were always of the papillary type and the karyotypes showed more or less the same numerical anomalies, with trisomies in different combinations in tumors within the same kidney as well as in both kidneys. Structural changes, in contrast, were different from tumor to tumor.

Aged↗
PubMed1996

The t(1;12)(p36;q13) in a renal oncocytoma.

A new chromosome rearrangement, t(1;12)(p36;q13), is added to the cytogenetic changes found in renal oncocytomas. The breakpoint in 12q is cytogenetically different from those of the MAR region, and molecularly HMGIC located in 12q15 on the basis of 3' RACE experiments does not seem to be directly involved.

Adenoma, Oxyphilic↗
PubMed1996

Ultrasonic velocities of concentric laminated uric acid stones.

In concentric laminated uric acid samples two different sound velocities are observed with very different values, the one in the organic matrix varies from 670 to 1170 m s(-1), the other in the crystalline layers between 3200 and 5300 m s(-1). This large difference illustrates the importance of the internal stone structure on the fracture behaviour of urinary stones and reveals the weakness of the actual disintegration models, attributing the destructive effect of shock waves on the differences in acoustical impedance at the water/stone interface and not on the differences in acoustical impedance at the matrix/crystalline interfaces inside the urinary calculus.

Acoustics↗
PubMed1996

The new generation Siemens Multiline lithotripter tube "M": early results in ureteral calculi.

The Siemens electromagnetic Lithostar tube "C" and the new multiline tube "M" lithotripters were compared for the in situ treatment of ureteral calculi. A series of 248 patients with a calcium oxalate ureteral stone (proven by stone analysis) more than 4 mm in diameter were treated between December 1994 and September 1995 with the tube M Multiline lithotripter. The results were compared with those of 462 patients treated in prior years with tube C. High energy levels were obtained without sedation in 11% of patients with tube C and in 61% with tube M. The proportion of patients needing additional analgetics was 11% and 6%, respectively. The percentages of patients reporting no pain at all were 7 and 77. In proximal calculi, stone-free status was achieved in 63 of 79 patients (80%) with tube C and in 82 of 91 patients (90%) with tube M (p = 0.057). In distal calculi, stone-free status was achieved in 124 of 173 patients (72%) with tube C and in 134 of 157 patients (85%) with tube M (p = 0.0027). The evacuation rate for distal ureteral stones was significantly higher with tube M, which implies that the new shock head can enable the operator to apply higher energy without sedation because of the better tolerance.

Humans↗
PubMed1996

Renal fibromuscular dysplasia treated with partial nephrectomy.

Renovascular hypertension, caused by fibromuscular dysplasia, mainly affects young women in the third decade of life. Percutaneous transluminal angioplasty is the treatment of choice for solitary lesions with a complete functional result in 40-50% of the cases. Multiple stenoses, involving intrarenal arterioles, cannot be treated by dilatation and are mostly treated by nephrectomy. Nevertheless, those vascular stenoses are often limited to a particular renal segment so that unaffected segments could be spared. Two patients were treated with a partial nephrectomy. The short-term results are promising. We suggest that this treatment modality could be offered as a rational and effective solution to well-selected cases, with multiple, regionally limited arterial stenoses.

Adolescent↗
PubMed1996

The case against fine-needle aspiration cytology for small solid kidney tumors.

Conservative renal cell cancer surgery in elective conditions can be applied if the tumor is solitary and well delineated on the CT scan and easily resectable within a rim of healthy parenchyma. A number of solid tumors will prove not to be malignant on definite pathological examination. The radiological preoperative differential diagnosis of a small renal mass is not always obvious. The efficacy of fine-needle aspiration cytology in recognizing the pathology of the tumor before surgery is limited and major complications have been reported. Moreover, it can render a conservative surgical procedure less safe. Thus fineneedle aspiration cytology is not recommended if conservative surgery is planned, unless renal involvement by metastasis or lymphoma is suspected.

Biopsy, Needle↗
PubMed1996

Initial evaluation of the bladder tumor antigen test in superficial bladder cancer.

PURPOSE: We analyzed the value of the Bard bladder tumor antigen (BTA*) test for the diagnosis of stage Ta superficial bladder cancer and carcinoma in situ, and compared it to the highly sensitive bladder washing cytology. MATERIALS AND METHODS: The BTA test is a latex agglutination test that qualitatively detects the presence of basement membrane complexes in the urine. A total of 60 patients with superficial bladder cancer underwent voided urine BTA analysis and bladder washing cytologies. RESULTS: Of the patients 65% were correctly diagnosed with the BTA test compared to 32% with bladder washings, which is statistically significant (p < 0.001). CONCLUSIONS: The BTA test is a noninvasive diagnostic tool that is superior to bladder washing cytology for diagnosing superficial bladder cancer.

Adult↗
PubMed1996

Symptomatic adrenal pseudocyst.

A case of symptomatic adrenal pseudocyst due to recurrent hemorrhage is presented. Because of the hemorrhages, the cyst-like lesion had unusual appearances at US, CT and MRI, resembling a malignant cystic tumor.

Adrenal Gland Diseases↗
PubMed1996

Nephrectomy for metastatic renal cell carcinoma and surgery for distant metastases.

Renal cell carcinoma has a very heterogeneous behavior. Nearly 30% of the patients are metastatic at the time of diagnosis and approximately 50% of the patients will develop metastases or recurrence after nephrectomy for an apparently localized disease. No prognostic factor is at the moment absolutely reliable in predicting the outcome for an individual patient. Nephrectomy in the presence of metastases is often performed by urologic surgeons in an attempt to prolong life or to improve the quality of life. Induction of spontaneous regression of metastases is very rare and it is still not proven that nephrectomy enhances the response to any systemic therapy. The resection of a solitary metastasis can be beneficial to a few patients although cure remains uncommon. Since no other effective treatment is actually available, metastasectomy can be advocated in a selected group of patients.

Carcinoma, Renal Cell↗