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Biomedical subjects

M Marberger

Publications and source records attributed to M Marberger.

At least 163 records · Page 9Linked to original sources
PubMed1995

[Minimally invasive therapy of benign prostatic hyperplasia with focussed ultrasound].

To determine the morphologic impact and safety of high-intensity focused ultrasound (HIFU) administered transrectally for tissue ablation, a total of 22 prostates were treated in vivo with transrectal HIFU prior to surgical removal. Location and size of the tissue lesions correlated well with the predefined target area and revealed sharply delineated coagulative necrosis in all cases. In a subsequent phase II clinical trial the clinical effectiveness of transrectal HIFU as a minimally invasive treatment modality for patients with symptomatic benign prostatic hyperplasia (BPH; n = 50) was studied. The maximum urinary flow rate (Qmax, ml/s) increased from 8.9 +/- 0.6 (n = 50; mean +/- SEM) to 12.8 +/- 0.9 (3 months, n = 46), 11.9 +/- 0.9 (6 months, n = 44) and 12.2 +/- 1.0 (12 months, n = 32). Within the same time period, the post-voiding residual volume (ml) decreased from 113 +/- 17 (mean +/- SEM) to 47 +/- 6, 57 +/- 7, and 49 +/- 6. These data demonstrate that transrectal HIFU can induce intraprostatic coagulative necrosis. The phase-II clinical data presented in this paper reveal that transrectal HIFU is an effective and safe minimally invasive treatment option for BPH. Nevertheless, a randomised phase-III trial comparing HIFU and TURP is mandatory to define the definitive role of transrectal HIFU in BPH, and is presently planned.

Adult↗
PubMed1995

High expression of a CD38-like molecule in normal prostatic epithelium and its differential loss in benign and malignant disease.

PURPOSE: We characterize an undescribed antigen on prostatic epithelial cells, which is recognized by anti-CD38. MATERIALS AND METHODS: Normal (3 cases), benign hyperplastic (10) and carcinomatous (10) prostatic tissues were analyzed using immunohistochemistry, immuno-electron microscopy and the Western blot test. RESULTS: Comparison of prostatic and lymphatic CD38 antigen revealed identical bands at 45 kD. Electron microscopy demonstrated anti-CD38 reactivity on the cytoplasmic membrane and within the secretory vacuoles. Double labeling with anti-cytokeratin types 5/15 and 8/18 confirmed that basal and secretory normal prostatic epithelial cells express CD38. By contrast, a complete loss was found in malignant (52.8%), tumor-surrounding nonmalignant (16.3%) and benign prostatic hyperplasia derived glands (3.7%). CONCLUSIONS: CD38 is a novel prostatic antigen. Its role in intracellular calcium mobilization may contribute to smooth muscle cell contraction and/or sperm motility.

ADP-ribosyl Cyclase↗
PubMed1995

[Current status and future developments in noninvasive treatment of urinary calculi with extracorporeal shockwave lithotripsy (ESWL)].

Being a highly effective and minimally invasive treatment modality, extracorporeal shock wave lithotriopsy (ESWL) has come to be the therapy of choice in more than 80% of urinary stones. Apart from pregnancy and untreated coagulopathy as contraindications, generally accepted limiting factors are a stone size of > 2.5 cm and the presence of anatomical draining barriers. In such cases endourological procedures are indicated from the outset. Modern urinary stone therapy requires both extracorporeal and intracorporeal procedures of lithotripsy as indispensable complementary techniques. Third-generation lithotriptors are characterized by a dual stone location system (ultrasound and X-ray) and painless treatment without any need for analgesia. The current rapid development of lithotriptors is mainly driven by economic aspects and market requirements like multipurpose or mobile applicability. The "ideal" lithotriptor enabling even more effective, safer, and more comfortable treatment has yet to be developed.

Equipment Design↗
PubMed1994

Serum neopterin as a parameter for monitoring the course of renal cell carcinoma during interferon-gamma therapy.

Serum analyses were performed regularly over 1 year of therapy with bioactive doses of recombinant interferon-gamma (mean 200 micrograms) in eight patients with advanced renal cell carcinoma in order to assess the usefulness of neopterin in monitoring the course of disease. The baseline level calculated from repeated measurements before treatment (2.87 + 0.59 nmol/liter) did not correlate with the extent of metastatic spread. All patients did show significant increases in serum neopterin concentrations 48 hr after IFN application (7.09 +/- 1.99 nmol/liter, P < 0.05, t test) in accordance with a temporary IFN-gamma-induced reinforcement of macrophage activity. However, no difference was observable when comparing the baseline values to those obtained 1 week after the last IFN application (3.05 +/- 1.16 nmol/liter). There was no correlation with the course of disease, i.e., neither with response (n = 1) nor with progression (n = 7). In contrast to previous studies, the present report shows that although serum neopterin is an appropriate marker for IFN-gamma-induced reinforcement of monocyte/macrophage activity, it is not suitable for monitoring the course of metastatic renal cell carcinoma.

Aged↗
PubMed1994

Nitinol urethral stents: long-term results in dogs.

No information has been available to date on the long-term behavior of nitinol (nickel-titanium alloy) urethral stents. In the present study, prostheses of this type were implanted in 18 German shepherd dogs in order to evaluate the reaction of the mucosa, muscles and periurethral tissue. Follow-up examinations performed after 1 week, and 1, 3, 6, 12 and 18 months included urine, macroscopic, radiologic, histologic and scanning electron microscopic analyses. Despite the excellent biocompatibility of the material, with no evidence of foreign body reactions or corrosion, there were no complete incorporations of the stent by epithelialization. Clinical application therefore appears to be problematic.

Alloys↗
PubMed1994

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

In a phase I clinical trial the morphological impact and safety of high intensity focused ultrasound administered transrectally for tissue ablation in prostates from 22 patients undergoing subsequent prostatectomy were evaluated. Location and size of the tissue lesions correlated well with the predefined target area and revealed sharply delineated coagulative necrosis in all cases. Intervening tissues, such as the rectal wall and posterior prostate capsule, were invariably intact. In a subsequent phase II clinical trial the effectiveness of transrectal high intensity focused ultrasound as a novel minimally invasive treatment modality for 50 patients with symptomatic benign prostatic hyperplasia was determined. The maximum urinary flow rate (ml. per second) increased from 8.9 +/- 4.1 to 12.7 +/- 6.4 at 3 months in 44 patients, 12.4 +/- 5.6 at 6 months in 33 and 13.1 +/- 6.5 at 12 months in 20. During the same period the post-void residual volume (ml) decreased from 131 +/- 120 to 48 +/- 41, 59 +/- 42 and 35 +/- 30, respectively, and the American Urological Association symptom score (points) decreased from 24.5 +/- 4.7 to 13.3 +/- 4.4, 13.4 +/- 4.7 and 10.8 +/- 2.5, respectively. These data demonstrate that transrectal high intensity focused ultrasound is capable of inducing coagulative necrosis in the human prostate via a transrectal approach while preserving intervening and adjacent tissue. A 47% (+4.2 ml. per second) improvement in uroflowmetry and a 53% (-13.7 points) decrease in the American Urological Association symptom score 1 year after treatment clearly prove that transrectal high intensity focused ultrasound is a novel and safe minimally invasive treatment option for benign prostatic hyperplasia.

Aged↗
PubMed1994

Phenotype and function of peripheral and prostatic lymphocytes in patients with benign prostatic hyperplasia.

In a previous report, we demonstrated intense lymphocytic infiltration of all benign prostatic hypertrophy (BPH) tissues analyzed in conjunction with HLA-DR expression on normally MHC-class-II-negative prostate epithelial cells. The composition of these infiltrates (70 to 80% CD3+ T-cells, but no granulocytes) resembles the situation seen in immune responses against altered self or self rather than against foreign antigens (infection). In the present study, phenotypic and functional immunoassays were used in order to investigate whether T-cells in BPH are indeed activated, and whether this activation is systemic or restricted locally to the prostate. Analysis of T-cell activation marker expression and proliferation requirements provided substantial evidence that these infiltrating lymphocytes, in contrast to their peripheral counterparts, are chronically activated. Since local accumulation of activated lymphocytes can cause tissue destruction, high concentrations of cytokines, and consequently tissue rebuilding, this process might contribute to the pathogenesis of BPH.

Adult↗
PubMed1994

Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis--a prospective randomized study.

OBJECTIVE: To assess the efficacy of alkali citrate therapy in patients suffering from recurrent idiopathic calcium oxalate stone formation. PATIENTS AND METHODS: Fifty patients suffering from active stone formation who had had at least one stone annually over the previous 3 years were recruited and randomly divided into two groups. They were given either general prophylactic instructions, i.e. abundant liquid intake and dietary restrictions (group I, n = 25)--or were additionally treated with alkali citrate (group II, n = 25). RESULTS: In group I, the rate of stone formation was reduced from 1.8 to 0.7 stones per patient per year. Similar results were obtained for group II, the corresponding figures being 2.1 and 0.9. There was a statistically significant higher urinary citrate excretion in group II than in group I. No difference was seen between the two groups regarding recurrent stone formation (Student's t-test). Stone formation decreased in both groups (group I 27%, group II 31%). Subjectively, 56% of group II patients, all of whom had previously experienced severe colic, reported spontaneous stone elimination to be painless, whereas in group I all but one patient suffered pain. CONCLUSION: An objective benefit of alkali citrate could not be established.

Adult↗
PubMed1994

Management of ureteric stones.

Based on experience with over 2,000 patients, the treatment of ureteric stones today relies on extracorporeal shock wave lithotripsy (ESWL) in situ and ureteroscopy with semirigid, ultrathin ureteroscopes combined with pneumatic or laser lithotripsy. All stones in the upper and larger stones in the distal third of the ureter are preferably treated by ESWL in situ, whereas smaller stones in the distal ureter are better treated by endoscopy. Midureteric stones continue to be the domain of primary ureteroscopy; in cases of moderate obstruction in asymptomatic patients, 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. Manipulation of the stone back into the kidney and treating it by ESWL there (push back/ESWL) offers no advantage over ESWL in situ, as results are not better yet morbidity is higher. 'Blind' instrumentation has lost all justification, and incisional ureteric lithotomy is no longer indicated but in exceptional cases.

Endoscopy↗
PubMed1994

The 'stone clinic effect': myth or reality?

Sixty-six active recurrent stone formers (RSF), i.e., with at least one stone annually over 3 years prior to the first examination at our stone clinic, were retrospectively evaluated. All received specific drug metaphylaxis which was discontinued after 5.5 +/- 2.1 years (period 1). They were reclassified according to the above definition into active and inactive RSF and were then left on a general metaphylactic regimen with regular urological follow-up every 6 months (period 2). 32 patients observed these recommendations for 5.7 +/- 2.6 years (group 1), 34 did not. 20 of these 34 could be reexamined after 6.3 +/- 2.2 years (group 2). Group 1 comprised 10 active and 22 inactive, group 2 comprised 1 active and 19 inactive RSF. While the recurrence rates among the inactive RSF of groups 1 and 2 decreased significantly during period 2, a statistically significant difference between them was not observed. Conversely, there was only a slight reduction of the recurrence rate in the active RSF. Both findings argue against a stone clinic effect. Interviews of the patients showed that stone formation was periodical for a mean of 12 +/- 8 years, after which it gradually faded out. This period is termed 'phase of regular stone formation' and appears to be an autonomous process that cannot usually be influenced by metaphylactic measures. This could explain the wide variability of reported success rates for the various metaphylactic regimens, as they would merely reflect the number of stone formers who are in their phase of regular stone formation.

Adult↗
PubMed1993

ESWL in situ or ureteroscopy for ureteric stones?

As documented by follow-up data on ureteric stones in 1259 ureteric units treated, ESWL in situ on advanced lithotriptors with stone location by ultrasonography and fluoroscopy was successful without any retrograde ureteric manipulation in 98% of stones in the upper, 71% in the iliac, and 84% in the distal ureter; 85% of the units were stone-free within 3 months: ancillary measures were needed in 11% and the stone-free state was reached after a median of 39 days. The results obtained with treatment after manipulation of the stone from the upper and mid-ureter by retrograde instrumentation were similar, but ancillary measures were needed in 20% of cases. Endoscopic management with rod-lens ureteroscopes was highly efficient in the distal and mid-ureter, but involved a complication rate of about 11% and required general anaesthesia. In the upper ureter it was abandoned in favour of the two former methods. Endoscopic stone removal has been greatly facilitated by the development of ultrathin, semirigid ureteroscopes 6.2-9 F in diameter, as well as by laser and pneumatic lithotriptors that operate through their minute working ports. Of the stones impacted in 127 ureteric units, 97% were successfully managed at the first attempt, involving an overall complication rate of 6%.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopy↗
PubMed1993

Color flow Doppler sonography for extracorporeal shock wave lithotripsy.

This report documents the usefulness of color Doppler sonography for early verification of urinary stone fragmentation during extracorporeal shock wave lithotripsy with ultrasonographic focusing. In the experimental study lithotripsy was performed on human urinary stones placed in pig kidneys. Increasing color flow within the stone mass created by movement of small fragments indicated fragmentation earlier than pixel movement on the standard gray scale sonogram. The success of treatment was demonstrated macroscopically. In the clinical study 25 patients with radiopaque kidney stones were treated by color Doppler guided shock wave lithotripsy and compared to a control group of 32 patients with similar stone characteristics in whom the end point of treatment was chosen based on B-mode sonography alone. The amount of color flow within the stone reflex determined the end point of treatment. The degree of fragmentation was confirmed by fluoroscopy immediately after treatment. Disintegration was successful in all cases and fragments passed spontaneously. Color Doppler imaging during shock wave lithotripsy provides reliable information on the spatial and temporal characteristics of stone fragmentation, and is superior to B-mode sonography by providing more immediate, objective information on stone fragmentation and allowing better evaluation of the focal zone. With the help of this technique, the number of applied shock waves could be reduced by 20% compared with the control group.

Animals↗
PubMed1993

Epidermoid cysts of the testis: organ-preserving surgery following diagnosis by ultrasonography.

Epidermoid cysts of the testes are rare, benign tumours that can be visualised by high frequency ultrasonographic transducers. Their echo patterns are characteristic but not pathognomonic, so that inguinal exposure of the testis is required to confirm the diagnosis. However, sonography facilitates the planning of surgery, since excision of the tumour can be performed in an organ-preserving manner. In 6 patients with epidermoid cysts treated in this way between 1986 and 1989, no recurrence was seen during a mean follow-up period of 37 months.

Adolescent↗
PubMed1993

Is transrectal ultrasonography needed to rule out prostatic cancer with normal findings at digital rectal examination and normal serum prostate-specific antigen?

In a prospective study, 288 consecutive patients without evidence for prostatic carcinoma at digital rectal examination (DRE) and scheduled for prostatectomy because of benign prostatic hyperplasia (BPH) were examined by transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) measurement prior to surgery. 46 patients were found to have a carcinoma at histological examination of the surgical specimens. 14 carcinomas were detected preoperatively by TRUS and biopsy (10 pT1, 3 pT2, 1 pT3) of 32 patients with suspicious, i.e., hypoechoic, lesions at TRUS. Among the remaining 256 patients with normal findings at TRUS, another 32 carcinomas were found at histological examination of the surgical specimen. Of the 14 carcinomas detected by TRUS, 13 were found within a group of 57 patients with PSA levels > 7 ng/ml corresponding to a cancer detection rate of 22.8% in this group. In 231 patients with PSA < 7 ng/ml, the use of TRUS was successful in detecting only 1 carcinoma (cancer detection rate 0.4%). These results suggest that the use of TRUS is dispensible in 80% of palpably normal patients without affecting the cancer detection rate.

Aged↗