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Biomedical subjects

M Marberger

Publications and source records attributed to M Marberger.

At least 181 records · Page 10Linked to original sources
PubMed1993

Morphology of tissue destruction induced by focused ultrasound.

The effect of high-intensity focused ultrasound (HIFU) ablation on the morphology of prostatic, renal and testicular tissue was studied by light and electron microscopy. Specimens were obtained in 21 patients 1 h to 10 weeks after lesioning. Histological findings showed consistent coagulative necrosis with precisely defined, sharp margins to normal tissue. Lesion size and position correlated well with the assumed target zones, suggesting that HIFU permits therapeutic tissue ablation.

Humans↗
PubMed1993

Tissue ablation in benign prostatic hyperplasia with high-intensity focused ultrasound.

The safety and effectiveness of tissue ablation by coagulative necrosis with high-intensity focused ultrasound (HIFU) applied through a rectal probe to 36 patients with symptomatic benign prostatic hyperplasia (BPH) was investigated in a phase II clinical trial. Overall, HIFU treatment was well tolerated, the mean hospital stay being 1.1 days. Negative side effects were transient urinary retention in 32/36 patients, hematuria in 2 patients and hematospermia resolving after 3-4 weeks (n = 15). After 3 months the maximum flow rate/s (Qmax) increased from 9.0 +/- 3.9 to 14.4 +/- 7.0 ml/s, the median flow rate/s (QM90) from 4.9 +/- 2.4 to 7.6 +/- 4.17 ml/s; the postvoid residual volume decreased from 128 +/- 88 to 57 +/- 35 ml and the AUA symptom score from 25.5 +/- 5 to 13.2 +/- 4.4. In conclusion, it was shown that tissue ablation in patients with symptomatic BPH using HIFU is safe and dramatically reduces both obstructive and irritative symptoms and leads to a significant increase in uroflow and a decrease in postvoid residual volume.

Feasibility Studies↗
PubMed1992

Extracorporeal shock wave lithotripsy retreatment ("stir-up") promotes discharge of persistent caliceal stone fragments after primary extracorporeal shock wave lithotripsy.

A prospective randomized study was performed to compare the results of piezoelectric extracorporeal shock wave lithotripsy (ESWL) retreatment versus surveillance only in 50 patients with persistent caliceal stone fragments after primary ESWL for renal calculi. After a 3-month followup significant decreases in residual debris were observed in the retreated group, while changes in the control group were negligible. Considering the low morbidity of outpatient ESWL with a pain-free, second generation lithotriptor, ESWL retreatment of completely fragmented but persistent stone debris appears to be justified to render the kidney stone-free.

Adult↗
PubMed1992

Treatment decision for stage I non-seminomatous germ cell tumours based on the risk factor "vascular invasion".

Surveillance has become an alternative treatment modality for stage I non-seminomatous germ cell tumours with reported relapse rates of up to 30% in retrospective studies. Results obtained in our retrospective study showed vascular invasion in primary tumours to be the risk factor with the highest negative predictive value. Since January 1985 patients with stage I non-seminomatous germ cell tumours have been stratified by the presence or absence of vascular invasion in the primary tumour: those without vascular invasion (n = 26; group A) were subjected to a rigorous surveillance programme, while those with vascular invasion (n = 22; group B) were given 2 chemotherapy courses of bleomycin, etoposide and platinum in the hope of preventing progression. Relapse rates were 3.8% and 9% in groups A and B, respectively. The pooled relapse rate for both groups A and B (n = 48) was 6.2% (3/48). After a mean follow-up time of 36 months 95.8% (46/48) of the patients were without evidence of disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Colorectal cancer involving the urinary tract.

The survival rate among patients with colorectal cancer classified as Dukes' B or C who underwent extended resection due to infiltration of neighboring structures is significantly lower than among patients in the same Dukes' stage without infiltration of adjacent structures. Seventy-one patients with rectosigmoid cancer (37 primary and 34 recurrent tumors) involving the urogenital tract were retrospectively analyzed. Patients with primary tumors had a markedly higher mean survival rate after radical surgery (60.7 months) than after palliative procedures (28.2 months), while no such difference was seen among patients with recurrent tumors (17.6 or 14.1 months, respectively). From the urologic point of view, radical intervention is mandatory in cases of primary rectosigmoid carcinoma involving the urogenital tract. Aggressive surgery for recurrent tumors appears questionable, however; in these cases, priority should be given to improving the quality of life, recommending palliative surgery as the preferable approach.

Adult↗
PubMed1992

Topical chemoprophylaxis of superficial bladder cancer with mitomycin C and adjuvant hyaluronidase.

The effect of intravesical instillation of 200,000 IU hyaluronidase in addition to mitomycin C as chemoprophylaxis of superficial bladder cancer was evaluated. Based on our result of a previous study that this approach results in a significantly reduced recurrence rate (7.1 versus 32.1%), 43 patients undergoing transurethral resection of Ta-T1 tumors were retrospectively analyzed after a mean observation period of 48.5 months. During the 2 years of prophylactic therapy, tumor recurrence was seen in 6 patients (13.9%). Of the 37 patients who remained recurrence-free under treatment, 5 (13.5%) had recurrent tumors later during a mean observation period of 24.5 (18-42) months after treatment. These values are significantly lower than those obtained previously from a group of 63 patients treated with mitomycin alone, with recurrence rates of 33.3% during chemoprophylaxis and 26.2% thereafter (mean observation period 50.4 months). It appears that additive hyaluronidase enhances the local effect of mitomycin C in the intravesical chemoprophylaxis of bladder cancer, presumably by improving diffusion into the bladder mucosa and catalyzing the breakdown of a hyaluronic acid contained in a protective halo around malignant urothelial cells.

Administration, Intravesical↗
PubMed1992

Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia.

This study for the first time elaborates on cells of the immune system present in benign prostatic hyperplasia (BPH). Compared with normal prostate, all BPH-derived specimens revealed a marked increase of CD45+ leukocytes, characterization of which demonstrated three major cell types, i.e., CD3+ T lymphocytes, CD11c+ macrophages and CD20+ B lymphocytes. Frequencies of CD3+ cells/mm2 of cryocut sections were increased at least 10 times in BPH specimens, and the CD8+:CD4+ T suppressor/cytotoxic:T helper cell ratio was reversed. The infiltrating leukocytes predominantly populate the interstitium and accumulate around epithelial ducts which, however, were found to be invaded and/or destroyed only in a number of cases. Phenotypic alterations of surface antigen expression on prostate epithelial cells in BPH that might be due to the presence of lymphocytes were examined by using monoclonal antibodies (mAb) directed against human leukocyte antigens (HLA). Whereas anti-HLA-DR reactivity in normal prostate is restricted to small numbers of macrophages and includes neither prostate epithelial cells nor prostate T cells, it was found to be dramatically increased in BPH, comprising CD45+ cells and prostate epithelial cells as demonstrated by double-staining with anti-cytokeratin or anti-prostate-specific antigen. A mean of 40% of analyzed epithelial glands in BPH reacted with anti-HLA-DR, but not with anti-DQ or -DP monoclonal antibodies. A new method for the enrichment of prostate-derived lymphocytes was established to facilitate phenotypic analysis by flow cytometry, demonstrating 70 to 80% of enriched CD45+ cells to stain for CD3, approximately 60% thereof for CD4, 30% for CD8, and the remaining 10% with anti-CD20, a pan-B-cell marker. Flow cytometry showed that, in contrast to peripheral T cells, both CD4+ and CD8+ prostatic T cells were positive for the T cell activation markers HLA-DR and interleukin-2-receptor.

Antibodies, Monoclonal↗
PubMed1992

Management of ureteric calculi (minimally invasive therapy of ureteric stones).

As documented with results obtained in 1685 patients the treatment of ureteric stones is today based on ESWL in situ and ureteroscopy with semirigid, ultrathin ureteroscopes and laser lithotripsy. All stones in the upper third of the ureter and larger stones in the distal third of the ureter are preferably treated with ESWL in situ whereas smaller stones in the distal ureter are better treated endoscopically. Midureteric stones remain the domain of primary ureteroscopy; with moderate obstruction in the asymptomatic patient it may also be acceptable to wait for the stone to pass into the distal ureter spontaneously to be treated by ESWL in situ there. Manipulating stones back into the kidney and treating them by ESWL there (pushback/ESWL) offers no advantage over ESWL in situ, as the results are similar, yet morbidity is higher. Blind instrumentation and open surgery have lost all justification.

Endoscopy↗
PubMed1991

How effective is topical alpha-2b interferon in preventing recurrence of superficial bladder cancer?

A total of 44 patients with low and intermediate grade superficial urothelial bladder cancer Ta and T1 were randomised into a controlled, long-term, phase III trial on topical instillation therapy with high dose alpha-2b interferon (100 x 10(6) IU versus low dose alpha-2b interferon (10 x 10(6) IU) versus ethoglucid. Thirteen patients in the low dose group, 11 in the high dose group and 10 in the ethoglucid group completing the trial were evaluable (median follow-up 36.5 months) and were followed up for 3 years. They were treated weekly for 10 weeks and then monthly for a total of 1 year. The aim of the trial was to establish the prophylactic efficacy and the toxic side effects, if any, of alpha-2b interferon in the topical treatment of superficial bladder cancer. Recurrence rate and disease-free survival were chosen as study end-points. The recurrence rate was 4.4 in the low dose interferon group, 2.76 in the high dose interferon group and 3.08 in the ethoglucid group. In the low dose interferon group the time to the first recurrence was 22.23 months versus 22.36 in the high dose group and 21.76 months in the ethoglucid group. No differences of statistical significance were noted between the 3 groups. Progression occurred in 5 patients on interferon but was not seen in those on ethoglucid. Neither systemic nor local side effects were seen in the interferon groups, but 3 patients had to be taken off ethoglucid because of severe chemocystitis. In superficial bladder cancer, topical instillation therapy with interferon is as effective as conventional chemotherapy and has no side effects.

Administration, Intravesical↗
PubMed1990

Incidental carcinoma of the prostate: an improved modality for early detection.

In a prospective study 140 unselected patients with clinical evidence of benign adenoma of the prostate were resected via a transurethral approach. Pathohistological analysis was done according to selective criteria for tissue sampling. 16 incidental carcinomas (T0; 11.4%) were detected. In a retrospective analysis 244 patients were operated on by the same method compared with 326 patients with conventional transurethral resection. T0 tumors were found in 11.5 versus 5.2% of the patients. The increase in the incidence of T0 tumors was significant (p less than 0.004). We recommend this modality as a simple method to optimize early detection of T0 tumors in the transurethral resection specimens.

Biopsy↗
PubMed1990

ESWL and endourology on the same table: a feasible concept?

Within 26 months a total of 4,126 procedures were performed on the ESWL multipurpose table. Forty percent of the procedures were comprised of endourology, 25% functional urinary tract radiology, and 37% ESWL therapy. Biplane fluoroscopy is an extraordinary help for percutaneous interventions. A further advantage is the possibility to perform endourology and ESWL in one session without having to transport the patient. This has facilitated pre- and post-operative ancillary measures in a total of 35.3%. Seventy-six percent of stones greater than 15 mm were managed via indwelling stents. In situ ESWL for ureteral stones has become the therapy of choice in more than 80% of patients due to the availability of radiological localization systems and a complication and failure rate of 20% for the push-and-smash procedure. The multipurpose table is equally successful as the piezoelectric system for ESWL therapy. Drawbacks include operational inconvenience with percutaneous interventions and the necessity to change patient position during ureterorenoscopy and retrograde pyelography. The multipurpose unit used is a valid compromise for ESWL and percutaneous endourology. For purely diagnostic interventions, a standard x-ray table is preferred.

Adolescent↗
PubMed1989

[Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].

Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.

Aged↗
PubMed1989

Piezoelectric extracorporeal shock wave lithotripsy in children.

Piezoelectric lithotriptors have by far the smallest focal zone of all lithotriptors. By pinpointing this high pressure zone onto the stone with continuous visualization by ultrasonography throughout treatment, the volume of the kidney exposed to potentially harmful pressures is minimized and radiation hazards are avoided. We treated in this manner 33 renal and 8 ureteral stones in 25 renoureteral units of 22 children 4 months to 14 years old. No child required any other type of primary stone treatment during this period. Piezoelectric lithotripsy is painless and anesthesia was needed in only 11 children too young to cooperate. With a retreatment rate of 40 per cent, all stones were fragmented completely. After treatment only 48 per cent of the children had transient hematuria, which always subsided within 24 hours. Of the children 14 per cent required analgesics and 5 per cent had fever in the postoperative period. One child needed temporary nephrostomy drainage. Otherwise, the passage of stone debris was remarkably smooth and after 3 months 96 per cent of the renoureteral units were free of calculi. Evidence of soft tissue damage, such as skin ecchymosis, perirenal hematoma or retardation of renal growth, was not observed.

Child↗
PubMed1989

Percutaneous endoscopic cholecystolithotripsy. Work in progress.

In spite of long-term adjunctive oral dissolution therapy, residual gallstones have been reported in up to 50% of gallstone patients 3 months after extracorporeal shock-wave lithotripsy. Six women and five men, aged 31-75 years, underwent percutaneous endoscopic cholecystolithotripsy between April 1988 and October 1988. The gallbladder was punctured by means of an anterior transperitoneal approach. The tract was dilated, and gallstones were removed with a modified 21-F cholecystoscope under direct visual inspection. Calculi too large for extraction were disintegrated with ultrasound or electrohydraulic lithotripsy. Eight patients were stone-free and two had small residual stones 3 months later; nine were stone-free 6 months after the procedure. Although more invasive than shock-wave lithotripsy, percutaneous endoscopic cholecystolithotripsy has the advantage of immediate removal of more calculi, causes less pain, necessitates less postoperative immobilization, and allows patients to leave the hospital sooner.

Adult↗
PubMed1989

Stonebearing gallbladders: CT anatomy as the key to safe percutaneous lithotripsy. Work in progress.

Percutaneous cholecystolithotripsy can be performed with a transhepatic or transperitoneal approach. Because the anatomy of the gallbladder varies from person to person, the authors began a study to evaluate the position of the gallbladder with computed tomographic scans of 100 patients known to have stones in their gallbladders. Four variations in the relationship of the gallbladder to the liver and anterior abdominal wall were noted: completely intrahepatic gallbladders (39%) (type I), gallbladders bulging anterior to the anterior rim at least in part (35%) (type II), gallbladders completely anterior to the liver (17%) (type III), and gallbladders in a lateral position (9%) (type IV). In 51%, the colon was in direct contact with the gallbladder, and in 13% it was positioned between the abdominal wall and gallbladder. A safe percutaneous puncture was not possible in 34% of the patients (nine type IV gallbladders, 23 type I organs, and two type III gallbladders with anterior interposition of the colon).

Adult↗