Search PubMed⌕ Search

Biomedical subjects

M Marberger

Publications and source records attributed to M Marberger.

At least 145 records · Page 8Linked to original sources
PubMed1997

Proliferating cell nuclear antigen and MIB-1. An alternative to classic prognostic indicators in renal cell carcinomas?

Tumor progression and clinical outcome for patients with renal cell carcinomas (RCCs) cannot be predicted based solely on tumor staging and grading. In a retrospective study we have therefore attempted to analyze the capacity of proliferation markers to provide additional prognostic information. One hundred seven cases of RCC were investigated by immunohistochemical analysis using two different monoclonal antibodies: PC10, which recognizes a proliferating cell nuclear antigen (PCNA), and MIB-1, which identifies the Ki-67 antigen in formalin-fixed, paraffin-embedded material. PCNA frequency ranged from 0% to 71% (mean, 17%), and MIB-1 expression, from 0% to 43% (mean, 11%). PCNA scores correlated significantly with MIB-1 immunoreactivity. PCNA and MIB-1 immunoreactivity showed a significant correlation with tumor grade. A strong correlation was also observed for T-component of stage and MIB-1 scores, but no correlation was found between PCNA and T-component of stage. In univariate analysis, PCNA immunoreactivity and MIB-1 scores were significant predictors of survival. Multivariate analysis, using a Cox proportional hazard model, showed PCNA index, N-component of stage, and tumor grade to be independent predictors of tumor progression, which is not the case for MIB-1 index.

Adult↗
PubMed1997

The early postoperative morbidity of transurethral resection of the prostate and of 4 minimally invasive treatment alternatives.

PURPOSE: We compared the early postoperative morbidity of transurethral resection of the prostate to minimally invasive treatment alternatives with respect to the objective rate of complications and subjective morbidity assessed by a patient addressed diary-type questionnaire. MATERIALS AND METHODS: Parameters evaluated preoperatively were the International Prostate Symptom Score (I-PSS), free flow study, post-void residual, transrectal ultrasonography and a pressure-flow study. The patients underwent transurethral resection (28), transrectal high intensity focused ultrasound (20), visual laser ablation (15), transurethral needle ablation (15) and transurethral electrosurgical vaporization (17) of the prostate. On the day of hospital discharge the patients received the questionnaire and were asked to answer daily 7 questions concerning micturition status. After 6 weeks the questionnaire was returned and an I-PSS, uroflowmetry and post-void residual were obtained. RESULTS: Preoperatively, there was no statistically significant difference regarding the I-PSS, peak flow rate, prostate volume and degree of bladder outlet obstruction. After 6 weeks the peak flow rate improved most prominently after transurethral electrosurgical vaporization (+ 13.2 ml. per second), transurethral resection of the prostate (+ 12.3 ml. per second) and visual laser ablation (+ 11.1 ml. per second). The I-PSS decreased most significantly after transurethral resection (-14.1) and transurethral electrosurgical vaporization (-8.4). There was no difference regarding the rate of adverse events within the first 6 weeks postoperatively in the 5 treatment arms. Mean duration of catheter drainage plus or minus standard deviation was 3.7 +/- 1.2 days after transurethral resection of the prostate, 6.8 +/- 1.7 days after high intensity focused ultrasound, 7.8 +/- 1.5 days after visual laser ablation, 2.0 +/- 0.4 days after transurethral needle ablation and 3.3 +/- 0.8 days after transurethral electrosurgical vaporization. Analysis of the questionnaire revealed that the daytime frequency, degree of hematuria and incontinence were comparable for all 5 procedures within the first 6 weeks postoperatively. Postoperative dysuria was greatest after visual laser ablation and transurethral electrosurgical vaporization. Regarding the degree of nocturia, there was no improvement after visual laser ablation, while the remaining 4 procedures yielded a significant and comparable decrease. The most significant subjective improvement in uroflowmetry was reported after transurethral resection of the prostate and transurethral electrosurgical vaporization. Regarding the global quality of life question, the patients were generally more worried after visual laser ablation and transurethral needle ablation compared to the other 3 procedures. CONCLUSIONS: The overall morbidity of transurethral resection of the prostate within the first 6 weeks postoperatively is equivalent to that of the 4 minimally invasive treatment alternatives evaluated in our study. When comparing the 4 minimally invasive procedures, no dramatic differences were notable, although visual laser ablation seems to be associated with a greater degree of morbidity as assessed by this questionnaire.

Aged↗
PubMed1997

Tumor markers in hydrocele fluids of patients with benign and malignant scrotal diseases.

PURPOSE: We evaluated the presence of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and a panel of other tumor markers in the compartment next to the tumor (that is, the malignant hydrocele fluid). MATERIALS AND METHODS: We measured hCG, AFP, neuron-specific enolase, carcinoembryonic antigen and cytokeratin-19 fragments in cubital vein sera and in hydrocele fluids of patients with testicular cancer. Results were compared with those obtained from hydrocele fluids of patients with benign disease. RESULTS: All tumor markers remained under the respective cutoff values in benign hydroceles. In patients with pure seminomas, hCG levels were elevated in 66% of hydroceles but only once in peripheral sera, whereas AFP remained low in both compartments. Furthermore, of 11 cases of nonseminomatous germ cell tumor hydrocele fluids, 3 with negative peripheral tumor marker values had to be reclassified marker positive, of which 2 showed elevated hCG levels and 1 had increased levels of AFP. Significant changes of neuron-specific enolase and carcinoembryonic antigen concentrations could not be observed. However, a cytokeratin-19 fragment measured by Cyfra 21-1 assay was elevated in 2 of 3 seminomatous and in 4 of 8 nonseminomatous hydroceles. CONCLUSIONS: These data give a new insight into the in vivo secretion pattern of testicular germ cell neoplasms, which demonstrates that the term "marker negative" should be restricted to selected cases of testicular cancer. Analysis of tumor markers in hydrocele fluids may be a helpful tool in patients with scrotal swelling if clinical and sonographic results remain uncertain.

Adolescent↗
PubMed1997

Prostate specific antigen density of the transition zone: a new effective parameter for prostate cancer prediction.

PURPOSE: Use of prostate specific antigen (PSA) density to enhance the predictive value of detecting prostate cancer at intermediate PSA levels has been limited due to contradictory results in large scale studies. Most PSA leakage from the benign prostate into the serum comes from the transition zone. Therefore, in patients with benign prostatic hyperplasia (BPH) and prostate cancer with a serum PSA of less than 10 ng/ml. we studied and compared the values of PSA density of the total prostate and the transition zone. We examined the ability of PSA density of the transition zone to enhance prostate cancer detection in patients with intermediate PSA levels. MATERIALS AND METHODS: The volumes of the entire prostate and of the transition zone were determined by transrectal ultrasound. PSA density for both regions was calculated in 88 patients with histologically confirmed prostate cancer (radical prostatectomy), and 74 with BPH and histologically proved benign disease. RESULTS: Average total prostate PSA density plus or minus standard deviation was 0.12 +/- 0.07 and 0.22 +/- 0.12 ng./ml./cc in patients with BPH and prostate cancer, respectively, while average PSA density of the transition zone was 0.21 +/- 0.13 and 1.02 +/- 0.70 ng./ml./cc, respectively (p < 0.0001). If a total prostate PSA density of 0.15 had been chosen, the cancer would have been missed in 34% of the patients compared to 10% if a cutoff value of 0.35 for PSA density of the transition zone had been chosen (p < 0.001). Overall, in patients with a PSA of 0.25 to 10.0 ng./ml. the sensitivity and specificity of PSA density of the transition zone for predicting prostate cancer at a 0.35 cutoff value were 90 and 93%, respectively, compared to 94 and 89%, respectively, for those with a PSA of 4 to 10 ng./ml. CONCLUSIONS: In our study PSA density of the transition zone was much more accurate in predicting prostate cancer than was total prostate PSA density for PSA levels of less than 10 ng./ml. With respect to the high sensitivity and specificity, if confirmed in large prospective studies, including patients seen for early diagnosis, PSA density of the transition zone could become a routine tool for urologists in the prediction of prostate cancer in men with a PSA of 4 to 10 ng./ml.

Aged↗
PubMed1997

Fluorescence in situ hybridization identifies more aggressive types of primarily noninvasive (stage pTa) bladder cancer.

PURPOSE: We evaluated the genetic changes in cytological specimens of bladder cancer by fluorescence in situ hybridization, and related them to stage and grade of the tumor, ploidy, p53 and Ki-67 expression, and clinical outcome to determine a simple method to identify tumors with a poorer prognosis. MATERIALS AND METHODS: Using fluorescence in situ hybridization the numerical aberrations of chromosomes 7, 9 and 17 in barbotages and imprints of 50 patients with transitional cell cancer of the bladder were determined. Of the patients 29 had a primary stage pTa tumor, while 21 with stage pT1 or greater disease formed the control group. Data were compared to ploidy status, and Ki-67 and p53 immunoreactivity. RESULTS: Repeated monosomy 9 and haploid or diploid status on static ploidy determination were found in patients with primary stage pTa tumors without recurrence. Immunoreactivity of p53 was negative in all of these patients, while there was a low percentage of positive staining for Ki-67. Patients with recurrent and progressive disease had a high incidence of trisomy 7 and 17, aneuploid status and high positivity for both immunological markers. For chromosomes 7 and 17, and ploidy status bivariate analysis showed a significant difference. CONCLUSIONS: The evaluation of chromosomal aberrations in barbotage and imprint specimens clearly establishes a relationship between chromosomal defects and aggressiveness of the tumor. The majority of nonaggressive stage pTa transitional cell carcinomas can be distinguished from potentially lethal cases by fluorescence in situ hybridization at a diagnostic point when the grading is not yet prognostic.

Adult↗
PubMed1997

[PSA level of the transitional zone: a new marker especially reliable for the detection of prostatic cancer].

The extensive use of serum prostate specific antigen in early PCa diagnosis has been limited by the far from perfect sensibility and specificity of this test. The value of prostate specific antigen density (PSAD) to enhance prostate cancer detection in patients with PSA serum levels below 10 ng/ml is limited due to controversial results. We have compared the value of PSAD of the transition zone (PSA-T) dividing serum PSA by transition zone volume to the PSAD for early prostate cancer prediction in patients with PSA levels under 10 ng/ml. PSAD and PSA-TZ were calculated in patients with histologically proved located prostate cancer or with benign histology. We have defined a cut-off value of 0.35 ng/ml/cc for PSA-TZ with both a sensitivity and a specificity in predicting prostate cancer of nearly 90%. For PSAD around 0.15 ng/ml/cm3, PSA-TZ value was significant in prostate cancer. This study showed that PSA-TZ could be a new accurate parameter for prostate cancer prediction in patients with PSA below 10 ng/ml.

Aged↗
PubMed1997

Serial tissue polypeptide specific antigen determination in the followup of hormone treated carcinoma of the prostate.

PURPOSE: We determined the impact of serum cytokeratin-18-related tissue polypeptide specific antigen (TPS) in monitoring hormone treated carcinoma of the prostate. MATERIALS AND METHODS: From 1991 to 1996, serial TPS and prostate specific antigen (PSA) determinations (3,882) in 443 hormone treated prostate carcinoma patients were correlated with the clinical course for a mean of 22 months. RESULTS: Elevated TPS levels were significantly associated with disease progression in hormone treated stage M1 carcinoma of the prostate (p = 0.001), even in high grade, PSA negative tumors. Post-therapy TPS declines following second line therapy in hormone refractory prostate cancer patients (92) correlated significantly with subjective response (p = 0.001, PSA p = 0.02) and progression-free survival time (r(s) = -0.76, PSA r(s) = -0.32). A TPS decrease of more than 50% coincided with palliation in 90% of patients (PSA 64%) and predicted the best chance of a longer progression of free survival (p < 0.00005, PSA p = 0.036). Vice versa, rising TPS levels (more than 20%) coincided with subjective response in only 1 of 37 patients (PSA 9 of 33). CONCLUSIONS: TPS may be a useful adjunct to PSA in monitoring hormone refractory, metastasized prostate cancer.

Aged↗
PubMed1996

Molecular characterization of a tissue-polypeptide-specific-antigen epitope and its relationship to human cytokeratin 18.

Tissue-polypeptide-specific antigen (TPS) from the human colon adenocarcinoma cell line WiDr was purified using the monoclonal antibody M3 as a probe. Upon SDS/polyacrylamide gradient gel electrophoresis, several TPS-positive bands were detected (corresponding to 13 kDa, 22 kDa and a doublet at 42 kDa). The 13-kDa moiety was purified about 30,000-fold by a 5-step protocol. The electro-phoretically homogeneous component was obtained in a 7% yield of the total TPS activity of the crude extract. N-terminal sequence analysis showed the presence of an N-terminally truncated molecule and identified the 13-kDa TPS component as a fragment of human cytokeratin 18, with a major from starting at position 284 of the parent molecule. Laser-desorption mass spectrometry showed the presence of one major component with a molecular mass corresponding to a C-terminal end close to position 396 (which gives 12776 Da for the form with non-truncated N-terminus). The M3 antibody was also used to screen a human prostate cDNA lambda gt11 library. Four identical phage clones were detected, each producing a fusion protein with beta-galactosidase and the M3-positive component. PCR amplification showed the presence of an approximately 1200-bp insert, and sequence analysis revealed it to contain a 996-nucleotide fragment corresponding to residues 103-429 of human cytokeratin 18 (plus a non-coding human desmin artifact fragment). Smaller fragments, engineered by PCR and expressed as fusion proteins using the pET3xc vector in Escherichia coli, showed that the M3 epitope is localized to cytokeratin 18, residues 322-340. Two other TPS-active monoclonal antibodies were localized to cytokeratin 18 with similar techniques, ascribing an epitope (to M21) to residues 414-429 and another (to M24) to residues 139-297. Combined, the results demonstrate that TPS reactivity is derived from specific epitopes of human cytokeratin 18.

Antibodies, Monoclonal↗
PubMed1996

Circulating immune markers in advanced renal cell carcinoma during immunotherapy with interferon gamma.

Circulating immune markers sICAM-1, sELAM-1, sMHC-I, beta 2-MG, sCD4 and sCD8 were evaluated prior to and during immunotherapy with biologically active doses of interferon gamma (IFN-gamma) in 16 patients with advanced renal cell carcinoma (RCC) over a period of 12 months. Compared to 20 healthy controls, significantly (P < 0.01) elevated baseline levels of circulating adhesion molecules sICAM-1 (mean 1166 vs 230 ng/ml) and sELAM-1 (70 vs 17 ng/ml) were found in all patients. Compared to responders (n = 2) or patients with stable disease (n = 2), progressive disease during therapy (n = 12) was associated with significantly (P < 0.05) higher mean concentrations of sICAM-1 (1574 vs 962 ng/ml) and sELAM-1 (86 vs 46 ng/ml). Pretherapeutic and intratherapeutic levels of sMHC-I among the RCC patients were significantly (P < 0.05) lower than among the controls (0.41 vs 0.8 ng/ml). sCD4 levels clearly showed the same tendency (24 vs 33 U/l). sCD8 baseline levels, by contrast, were significantly (P < 0.05) elevated (564 vs 336 U/l), reflecting either activation of the NK-cell subset or increased synthesis of CD8+ T-suppressor cells. Again, significantly (P < 0.05) higher intratherapeutic sCD8 concentrations were observable with progressive disease than with response to therapy or stable disease (721 vs 355 U/l). Interestingly, although the biologically active dose of IFN-gamma was defined by an increase in beta 2-MG release of at least 30% within 48 h after injection, none of the other markers showed any significant alteration following IFN-gamma administration, suggesting that IFN-gamma in vivo does not produce changes in circulating markers of activation that might be expected on the basis of its effects in vitro. The finding of significantly elevated concentrations of sICAM-1, sELAM-1 and sCD8 in the presence of low sCD4 and sMHC-I levels might be of clinical significance for indicating ongoing tumor progression.

Adult↗
PubMed1996

Microfilarial clearance in loiasis involves elevation of Th1 and Th2 products and emergence of a specific pattern of T-cell populations.

Diethylcarbamazine (DEC) induced clearance of microfilaraemia in loiasis is associated with severe posttreatment reactions. To define the switch from hypo- to hyper-responsiveness associated with DEC treatment, phenotypic alterations of T-lymphocytes, characterized by flow cytometry, and cytokines, determined by enzyme linked immunosorbent assay, were monitored in a microfilaraemic patient. In contrast to reports on onchocerciasis and lymphatic filariases, no elevation of interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha was observed. The most severe side effects coincided with an elevation of interferon (IFN)-gamma on day 3, followed by IL-10, transforming growth factor (TGF)-beta 2 and macrophage inflammatory protein-1 alpha (MIP-1 alpha) peaking on day 5. Phenotypically, T-cell activation markers CD38, CD54 and CD25 were significantly expressed before treatment, with high CD38 expression still existing one year after clearance of microfilaraemia. Treatment-related increases were observed with anti-CD122, anti-HLA-DR and anti-CD69. CD28 was expressed before treatment on almost 100% of CD4+ and CD8+ T cells and dropped to 20% by day 5, reaching again baseline levels on day 21. Furthermore, there emerged 20% TCR alpha beta+/CD3+ T cells and 10% anti-beta V5(c)+ T cells, altogether indicating a specific pattern of T-helper (Th) 1 and Th2 cytokines as well as expansion of certain pauciclonal T-cell populations in response to microfilarial clearance.

Adult↗
PubMed1996

Cytophotometry in the monitoring of bladder cancer under intravesical chemotherapy.

OBJECTIVE: We evaluated the DNA cytophotometry in 446 bladder washing samples from 64 patients under mitomycin C after superficial bladder cancer during an observation period of up to 5 years. The aim of the study was to identify patients at high risk of recurrence despite chemotherapy-induced atypical, hence noninformative cytology. METHODS: The prognostic value of cytology and ploidy during chemotherapy was compared with regard to recurrence rates and the median time to recurrence. RESULTS: Aneuploidy identified 8 of 10 patients recurring within 12 months out of 17 patients with atypia at first presentation after surgery, whereas no recurrence was seen after atypia and diploid histograms (p = 0.005, mean follow-up period 62 months). Aneuploidy was the most accurate indicator of short-time recurrence (p < 0.001 by multivariate analysis). Follow-up data showed a relative risk of recurrence of 12.7 following histogram shifts towards aneuploidy and of 1.6 for positive shifts in cytology. CONCLUSION: Cytophotometry is superior to cytology in predicting the outcome in patients under chemotherapy for superficial transitional cell cancer of the bladder.

Administration, Intravesical↗
PubMed1996

Tissue polypeptide-specific antigen in renal cell carcinoma.

OBJECTIVES: The usefulness of serum tissue polypeptide-specific antigen (TPS), a cytokeratin 18-associated marker, in renal cell carcinoma (RCC) was assessed in vitro and in vivo. METHODS: Indirect immunoperoxidase staining for TPS expression was performed on frozen sections of normal renal tissue and RCC specimens. By using a monoclonal TPS immunoradiometric assay, serum TPS concentrations were analyzed in 82 healthy controls, in 20 patients with locoregional RCC before and after surgery and in 18 patients with advanced disease following surgery receiving immunotherapy with interferon-gamma. RESULTS: Using immunohistochemistry, TPS was found to be expressed by both normal and cancerous renal epithelial cells. The mean TPS concentrations in 82 healthy controls was 56 +/- 49 U/1 with a 95% percentile of 78.5 U/1. Out of 20 patients with locoregional RCC, 8 presented with elevated values (mean 168 +/- 82 U/1) above the cut-off level (78.5 U/1, sensitivity 40%) which dropped to normal within 2 weeks after surgery. During a follow-up period of 1 year, none of the patients presented with tumor recurrence and TPS concentrations remained low (mean 52 +/- 36 U/1). In 18 patients receiving interferon-gamma therapy, serum TPS concentrations were monitored over a period of 12 months. In 5/18 patients, baseline levels were within the normal range (mean 37 +/- 21 U/1); interestingly, these at the same time were the only responders to immunotherapy (n = 2) or at least showed stable disease (n = 3). Response to therapy was reflected by low serum TPS levels (mean 28 +/- 23 U/1) over the entire observation period. Thirteen patients suffered progressive disease during therapy, all of them exhibiting significantly elevated (p < 0.005) pretherapeutic TPS concentrations (mean 186 +/- 124 U/1) that remained equally elevated throughout therapy (mean 192 +/- 102 U/1), reflecting tumor progression. CONCLUSIONS: TPS might have some clinical value as prognostic marker in RCC, possibly by reflecting the proliferative tendency of the tumor.

Adult↗
PubMed1996

The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.

OBJECTIVES: The aim of this study was to determine the urodynamic impact of transrectal high-intensity focused ultrasound (HIFU), which is presently evaluated as a minimally invasive treatment option for benign prostatic hyperplasia (BPH), on bladder outflow obstruction by means of pressure flow analyses. METHODS: A total number of 30 patients suffering from symptomatic BPH underwent pressure flow studies before and after transrectal HIFU (mean time interval: 4.5 months; range: 3-6 months). In parallel, the international prostate symptom score (IPSS), free flow and postvoid residual volume were determined at regular time intervals postoperatively. RESULTS: The IPSS decreased from preoperatively 15.8 +/- 5.9 (n = 30; mean +/- SD) to 6.9 +/- 4.4 at 3 months (n = 30) and 7.2 +/- 5 at 6 months (n = 30). Within the same time period the maximum uroflow (Qmax; ml/s) increased from 8.8 +/- 2.2 to 11.3 +/- 3.4 (3 months) and 12.1 +/- 3.6 (6 months) and the postvoid residual volume (ml) declined from 100 +/- 47 to 44 +/- 33 and 55 +/- 50, respectively. Pressure flow studies revealed a reduction of the minimal voiding pressure (cm H2O) from preoperatively 70 +/- 23 (mean +/- SD) to 51 +/- 22 (p < 0.005) postoperatively and a decline of the detrusor pressure at maximum flow (cm H2O) from 74.2 +/- 24 to 57 +/- 15 (p < 0.005). The linear passive urethral resistance relations (linear PURR) dropped from 3.7 +/- 1.1 to 2.2 +/- 1.2 (p < 0.005). According to the Abrams-Griffiths nomogram, 24 (80%) patients were classified preoperatively as obstructed, the remaining 20% as being in equivocal zone. Postoperatively, 13% were obstructed, 50% in the equivocal zone and 37% of patients were rated as obstructed. CONCLUSION: Transrectal HIFU is capable of improving objective and subjective BPH parameters as well as of decreasing the degree of bladder outflow obstruction.

Aged↗
PubMed1996

[Minimal invasive therapy of benign prostatic hyperplasia].

Within the past decade, a number of minimally invasive treatment alternatives to transurethral resection of the prostate (TUR/P) have been developed. The majority of these techniques make use of the therapeutic effect of heat with a close correlation of therapeutic heat and clinical efficacy, yet also postoperative morbidity. Therapeutic temperatures below 45 to 47 degrees C ("hyperthermia") do not induce irreversible tissue destruction and are therefore obsolet. Temperatures in the range of 47 and 60 degrees C ("thermotherapy") lead to irreversible tissue destruction. Between 60 and 200 degrees C ("thermoablation") cystic cavities, comparable to post-TUR/P effects, can be seen. Even higher temperatures lead to tissue vaporisation and are used for laser-prostatectomy and electrovaporisation of the prostate. Although randomised phase-III clinical trials are available for some of these techniques, it is too early to make a definitive judgement concerning their future role in the armentarium for BPH-treatment. Finally, it needs to be emphasized that the golden standard for BPH-therapy is TUR/P.

Aged↗
PubMed1996

Age related urodynamic changes in patients with benign prostatic hyperplasia.

PURPOSE: We determined age related urodynamic changes in patients with untreated symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 222 patients (mean age 67.3 years, range 45 to 90) with the clinical diagnosis of symptomatic BPH was entered into a prospective protocol evaluating the international prostate symptom score (I-PSS), prostate volume, noninvasive uroflowmetry, residual volume and a pressure-flow study. To obtain a homogeneous study population only patients with a noninvasive maximum flow rate of 15 ml. per second or less and an I-PSS of 7 or more were eligible. RESULTS: There was no correlation between age and I-PSS (p > 0.05) but there was a statistically significant decrease in maximum flow rate (p = 0.045) and voided volume (p = 0.0013) with age. Prostate volume increased constantly from 31.3 to 64.4 ml. in patients 45 to 50 and older than 80 years, respectively (p < 0.0001). Pressure-flow studies revealed an age related decrease in cystometric bladder capacity (p = 0.0003) and invasive maximum flow rate (p = 0.0057) but no changes in detrusor pressure at maximum flow rate (p > 0.05), maximum detrusor pressure (p > 0.05) and linear passive urethral resistance relation (p > 0.05). The incidence of urodynamically proved bladder instability increased from 20 to 47% in men 45 to 50 and older than 80 years, respectively. CONCLUSIONS: The well established age related decrease in maximum flow rate and voided volume in patients with prostatism cannot be attributed to an increase in bladder outflow obstruction or impaired detrusor function. Because 60% of all men older than 80 years did not have urodynamic obstruction despite a decreased maximum flow rate of 10 to 15 ml. per second, all patients meeting these criteria and having symptoms bothersome enough to justify surgery should undergo pressure-flow studies before surgical intervention.

Age Factors↗
PubMed1995

Effect of high-intensity focused ultrasound on human prostate cancer in vivo.

Transrectal high-intensity focused ultrasound (HIFU) was recently established as a highly effective means of inducing contact and irradiation-free intraprostatic coagulative necrosis. This technique, therefore, appears potentially useful for treating localized prostate cancer (PC). To evaluate this issue, a total of 29 human prostates with localized cancer was subjected to HIFU treatment in vivo before radical retropubic prostatectomy. HIFU therapy was performed with the use of HIFU transducers with focal lengths of 3.0 cm (n = 3), 3.5 cm (n = 19), and 4.0 cm (n = 7), and the site intensity was varied from 1260 to 2000 W/cm2. The extent of intraprostatic necrosis was determined by planimetrical analysis of whole mount prostatic sections. Transrectal HIFU consistently induced sharply delineated intraprostatic coagulative necrosis within the target area, whereas alterations of perioprostatic structures were never observed. The cross-sectional area of necrosis increased from 1.1 +/- 0.7 cm2 (SD; n = 3; 3.0-cm focal length; 1428 W/cm2) to 1.2 +/- 0.7 cm2 (n = 2; 3.5-cm focal length; 1428 W/cm2), 1.8 +/- 0.17 cm2 (n = 8; 3.5-cm focal length; 1680 W/cm2), 2.8 +/- 0.32 cm2 (n = 9; 3.5-cm focal length; 2000 W/cm2) and 3.8 +/- 0.4 cm2 (n = 7; 4.0 cm focal length; 1260 W/cm2). HIFU beam transmission and the therapeutic effect were comparable in benign and malignant prostatic tissue. Interstitial thermometry (n = 6) revealed maximum intraprostatic temperatures in the focal zone up to 98.6 degrees C. Outside the focal zone and on the rectal wall, no significant temperature rises were noted. Subsequently, HIFU was applied to unilateral histologically proven T2a/T2b PC (n = 10) in an attempt to destroy all cancer before radical retropubic prostatectomy. PC was always correctly targeted. In 7 individuals, PC was partially (mean, 53%; range, 38-77%) destroyed; in the remaining 3 cases the entire tumor was ablated. Although these histological data permit no definitive conclusion on the clinical efficacy of this approach, transrectal HIFU seems to be an attractive novel minimally invasive treatment option for localized PC.

Aged↗
PubMed1995

Electrohydraulic versus pneumatic disintegration in the treatment of ureteral stones: a randomized, prospective trial.

The efficacy and safety of electrohydraulic versus pneumatic lithotripsy in the treatment of ureteral stones were evaluated in a prospective, randomized study. A total of 72 patients with stones not capable of passing spontaneously and unsuitable for extracorporeal shock wave lithotripsy was randomized to either method (34 to electrohydraulic lithotripsy and 38 to pneumatic lithotripsy). While both techniques were equivalent in efficacy (85.3% for electrohydraulic and 89.5% for pneumatic lithotripsy), the perforation rates were significantly different (17.6 versus 2.6%, respectively). Although the long-term results revealed no significant differences, pneumatic lithotripsy, as the markedly safer and easier to handle technique, is currently the method of choice at our stone center for ureteral calculi requiring treatment but not suitable for extracorporeal shock wave lithotripsy.

Adult↗