Search PubMed⌕ Search

Biomedical subjects

M Goepel

Publications and source records attributed to M Goepel.

70 records · Page 4Linked to original sources
PubMed1994

Surgical management of Wilms tumor with intracardiac neoplastic extension.

In the management of Wilms tumor (nephroblastoma) with intracardiac extension (ICE) an interdisciplinary approach is mandatory. The three cases reported here reflect the impressive improvements of both diagnostic facilities and surgical strategies over the last 16 years as evidenced in the literature. Nowadays, prerequisite for a well-planned, safe, and successful operation is the exact delineation of the intravasal tumor extension and the use of the combined techniques of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). In the first child (1976) only tumor nephrectomy was performed. Under chemotherapy fatal massive pulmonary embolism occurred. In the second child (1980) ICE was removed after tumor nephrectomy on an emergency basis using CPB. The third child (1987) was operated on electively using the concepts of CPB+DHCA. Now, both children are doing well without evidence of disease 13 years (case 2: stage III) and 6 years (case 3: stage IV) after an aggressive adjuvant-therapy regimen of multiagent chemotherapy and radiation. In conclusion, in children with nephroblastoma and ICE an aggressive surgical approach and subsequent multiagent chemotherapy are advocated.

Chemotherapy, Adjuvant↗
PubMed1994

Wilms tumor with intracardiac neoplastic extension.

A rare case of a Wilms tumor with intracardiac neoplastic extension is presented. The good prognosis of even extensive nephroblastoma is the reason for attempting a radical surgical approach to patients with intracardiac tumor thrombus. The exact preoperative delineation of the intracasal tumor extension is essential for a safe and successful operation. Ultrasonography in combination with echocardiography is the preferred modality for detecting intracardiac extension.

Child, Preschool↗
PubMed1993

E-cadherin: a marker for differentiation and invasiveness in prostatic carcinoma.

Considerable controversy exists concerning the value of histomorphological data in the assessment of the malignant potential of prostatic carcinomas. We investigated the expression pattern of E-cadherin in human prostate at the translational level. E-cadherin is a specific epithelial cell-cell adhesion molecule which has previously been found to be expressed in well-differentiated non-invasive carcinoma cell lines but is lost in many poorly differentiated invasive cell lines. The E-cadherin expression pattern in the prostate samples was correlated with histopathological findings in the same specimens. We found strong E-cadherin expression in normal prostate and benign prostatic hyperplasia. A decrease in or loss of E-cadherin was seen in 13 of 14 locally advanced and in 8 of 9 poorly differentiated prostatic carcinomas. We conclude that downregulation of E-cadherin expression plays a role in prostate carcinogenesis and invasiveness.

Adult↗
PubMed1993

[Delayed retroperitoneal lymph node excision in treatment of advanced non-seminomatous germinal cell tumors. I. Intraoperative findings in marker converted tumor].

Retroperitoneal lymphadenectomy was performed in 462 patients with testicular cancer. A total of 142 patients with advanced non-seminomatous germ cell tumours underwent retroperitoneal lymphadenectomy following cisplatin-based polychemotherapy. After inductive chemotherapy all of the patients described (108/142) showed seroconversion of tumour markers. Histology following RLA revealed vital tumour in 41% and teratoma in 12%. It was not possible to distinguish preoperatively between non-malignant residual tissue and vital tumour. In addition, sonography, computed tomography, and the tumour marker results did not correlate significantly with the intraoperative histopathological findings. Although histopathological confirmed complete remission was achieved in 47% of the patients with chemotherapy alone, subsequent retroperitoneal lymphadenectomy remains mandatory in cases with residual retroperitoneal lesions and pathological partial remission.

Adult↗
PubMed1993

[Observations on the course of ejaculation in the posterior urethra].

Nine patients underwent retroperitoneal nerve-sparing lymph node dissection for bilateral nonseminomatous testicular tumours (path. St. I disease). While the isolated lumbar nerves L1, L2, L3 were electrostimulated (30 Hz, 5-20 V), the activity of these seminal vesicles, bladder neck and posterior urethra was recorded by way of suprapubic transvesical sonography and/or endoscopy. Emission started simultaneously on three different levels: contraction of the seminal vesicles in the periphery, bladder neck closure, and opening of the paracollicular space. Contraction of the seminal vesicles extends to the midline; the prostatic urethra closes, starting at the bladder neck. Secretion from the ductuli prostatici (milky) and from the ductucli ejaculatorii (transparent) follow. It was confirmed by the detection of PSA (11,000-21,000 ng/ml) in the ejaculate that prostatic secretion is also present in it. The significance of the postganglionic nerves for emission increased from L1 to L3. In three patients with salvage lymph node dissection the above-mentioned ultrasound monitoring allowed differentiate nerves relevant to emission from those not involved, allowing more comprehensive retroperitoneal resection.

Adolescent↗
PubMed1992

Extensive retroperitoneal hematoma following extracorporeal shock wave lithotripsy with second generation lithotriptor.

A patient with extensive retroperitoneal hematoma after extracorporeal shock wave lithotripsy (ESWL) with a second generation lithotriptor is presented. Apart from bilateral ESWL for renal calculi in 1987 the patient had a negative history of previous renal disease or risk factors associated with hemorrhage following ESWL. Ultimately surgery was required to control bleeding from a capsular artery. The kidney could be salvaged. The shock wave characteristics of the different lithotriptors are discussed and the cases of subcapsular hemorrhage after ESWL reviewed.

Adult↗
PubMed1992

The forgotten double J stent. Case report of a multifractured ureter stent.

An 81-year-old male patient was admitted to hospital because of macrohematuria. The clinical examination revealed a multifractured double J stent which had been placed 17 months before in another clinic because of hydronephrosis. In the reported case, a combined endoscopic and open surgical management was necessary to remove all fragments from the renal pelvis, the ureter and the bladder. Occlusion, encrustration and migration are among the most frequent risks of ureter stenting. The breakage of the stent, however, is a rare but severe complication. Therefore, patients should generally be controlled by sonography every 2 months and when malfunction of the stent is suspected, a cystogram should follow. In general, a stent exchange should be performed after 12 months.

Aged↗
PubMed1991

[TNM-oriented therapy planning in bladder cancer].

The standard diagnostic procedures for bladder carcinoma include transurethral resection, bimanual palpation of the bladder under general anaesthesia, ultrasound examination and CT scan of the abdominal and pelvic regions. An IVP is additionally carried out for the detection of concomitant upper urinary tract tumours. Preoperative urinary cytology is also performed, as in 10% of all patients the degree of malignancy of bladder cancer according to the TNM system is revealed more exactly by cytology than by histology. New computerized examination techniques have been designed in attempts to improve the accuracy of the diagnostic process. Therapeutic modalities according to the classification of bladder carcinoma in the TNM system have to be based on the different efficacies of the diagnostic procedure: In superficial low-grade tumours the diagnostic efficacy is quite high, so that transurethral resection remains the treatment of choice. Superficial high-grade tumours are attended by reduced 5-year survival rates, and patients with such tumours must therefore be regarded as a high-risk group. In muscle-invasive bladder carcinoma reduced diagnostic efficacy and unsatisfactory treatment results are seen, so that in this condition cystectomy at an early stage is indicated.

Biomarkers, Tumor↗
PubMedDate not supplied

Management of nephroblastoma with intracardiac extension: three case reports and review of the literature.

A single institution's experience of three patients with nephroblastoma extending via the inferior vena cava to the right heart is described. The case reports and the pertinent literature illustrate that preoperative failure to detect the intracardial extension increases the risk of right outflow obstruction and pulmonary embolism during or after surgery. Simultaneous thoraco-abdominal surgery with total circulatory arrest is advocated to remove the cardiac and caval tumor together with the primary tumor in order to prevent sudden hemodynamic and embolic complications. Noninvasive diagnostic methods usually suffice to detect this rare complication of nephroblastoma and to plan an interdisciplinary surgical procedure. The presence of this complication should not worsen the stage- and histology-related prognosis of the patient.

Child, Preschool↗