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R E Hautmann

Publications and source records attributed to R E Hautmann.

At least 37 records · Page 2Linked to original sources
PubMed2004

Comparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients.

INTRODUCTION: Treatment options for lymph node positive prostate cancer are limited. We retrospectively compared patients who underwent external radiotherapy (ERT) to patients treated by radical prostatectomy (RPX). MATERIALS AND METHODS: A total of 102 lymph node positive patients from the RPX series at Ulm University were evaluated. In all, 76 patients received adjuvant androgen withdrawal as part of their primary treatment. In the ERT group, 44 patients were treated at the University of Michigan using a fractionated regimen. Of these, 21 patients received early adjuvant hormonal therapy. Patients with neoadjuvant therapy before RPX or ERT were excluded. RESULTS: In the RPX group, PSA nadir (nadir < or = 0.2 vs > 0.2 ng/ml) showed a strong association with outcome. In the ERT group, pretreatment PSA was an independent predictor of outcome (P = 0.04) and patients with adjuvant hormonal therapy had a significant longer recurrence-free interval compared to patients without adjuvant therapy (P = 0.004). Comparing only patients with adjuvant hormonal treatment after cancer-specific therapy, the ERT-treated patients had a borderline longer PSA recurrence-free survival time compared to the RPX-treated patients (P = 0.05). CONCLUSIONS: In case of positive lymph nodes, RPX and ERT might be considered and need to be explained to the patient. For future treatment decisions, the presented findings and a potential survival benefit need to be evaluated in a larger prospective setting.

Aged↗
PubMed2003

[Remarks on the introduction of the German Diagnosis-Related Groups (DRGs) for the specialty of urology].

In January 2003 a new system to charge inpatient treatment was established in Germany: the G-DRGs. This system is based on the thought that equal medical service causes equal costs all over Germany. Hospitals offering a broad spectrum of diagnostics and therapies and being unable to select their patients according to economical aspects are put at disadvantage: Despite a perfect documentation the G-DRGs reflect their medical service only in an insufficient way. Tools for an optimized coding must be a coding manual created for the specific needs of urologists and an infrastructure that allows a permanent quality control for all persons involved.

Diagnosis-Related Groups↗
PubMed2003

[Familial versus sporadic prostate cancer in the German population. Clinical and pathological characteristics in patients after radical prostatectomy].

Family history is one of the strongest epidemiological risk factors for the development of prostate cancer. The impact on the clinical presentation and prognosis, however, is controversial. In the present study, we analyzed 464 familial and 492 sporadic prostate cancer patients following radical prostatectomy. The average age at onset was 62.1 years in the familial group and 64.2 years in the sporadic controls (p<0.001). The screening attitude, DRE findings and the PSA values at diagnosis the pT- and pN-stages, and the tumor grade did not differ between both groups. With a median follow-up of 3.3 years, the 5- and 10-year progression-free survival rates were 76.2% and 56.5% in familial and 70.8% and 55.5% in sporadic patients, respectively (n.s.). A multiple logistic regression analysis revealed that family history did not have an influence on disease recurrence. In our population there was no association between a familial predisposition and clinical features or clinical course of the disease. Whether hereditary prostate cancer is distinct from sporadic forms cannot be determined before the underlying genetic alterations are identified.

Adult↗
PubMed2003

[Chemotherapy of bladder cancer. Systemic therapy with reduced toxicity].

For many years, MVAC chemotherapy has been the standard treatment for patients with advanced bladder cancer. Since only a small proportion of patients with advanced disease may be cured by chemotherapy, the expected toxicity profile has to be balanced against the clinical benefit. It is of importance to select patients who may probably respond to chemotherapy. The treatment-associated toxicity needs to be considered especially in unfit and elderly patients. The introduction of innovative new compounds and combinations for the treatment of advanced bladder cancer has opened new avenues. In particular, the good activity of the synthetic nucleoside analogue gemcitabine has improved chemotherapeutic approaches for older patients. For this group of patients, monotherapy with gemcitabine or paclitaxel as well as combinations with cisplatin, carboplatin, or methotrexate is feasible with acceptable side effects.

Aged↗
PubMed2003

Association between the clinical presentation and epidemiological features of familial prostate cancer in patients selected for radical prostatectomy.

OBJECTIVE: We evaluated if epidemiological features of familial prostate cancer are associated with certain clinical or histopathological characteristics of the disease. METHODS: 463 German patients with familial prostate cancer who underwent radical prostatectomy were stratified according to several epidemiological criteria: (1). the apparent mode of disease transmission, (2). the average age of onset and (3). number of affected relatives/family, (4). whether or not they met the Johns Hopkins criteria of hereditary prostate cancer. The variables analysed included the Prostate Specific Antigen (PSA) and the digital rectal examination at diagnosis, histopathological characteristics of the prostatectomy specimen and relapse free 5-year survival rates. These characteristics were compared within the subsets of familial patients and compared to 492 control patients with sporadic prostate cancer. RESULTS: Age of onset was the only clinical parameter differentiating familial and sporadic prostate cancer. Otherwise there was no association between epidemiological features of familial predisposition and the clinical presentation or outcome of the disease. CONCLUSIONS: Familial and sporadic prostate cancer seem to be the same disease. Alternatively it may be concluded that the common epidemiological features of familial prostate cancer are not useful to tell tumours that are based on inherited susceptibility apart from those that are not. Whether hereditary prostate cancer is clinically distinct from sporadic forms cannot be determined before the underlying genetic alterations are identified.

Age of Onset↗
PubMed2002

[Preventing prostate carcinoma in men with familial disposition].

A family history is one of the strongest risk factors for prostate cancer (PC). We evaluated the detection rate of PC in relatives of 119 German PC families that took part in ongoing linkage analyses. Brothers of patients with sporadic prostate cancer aged < 55 years at onset were included as well. Responses were received from 120/196 (61.2%) individuals of the familial and 67/120 (55.8%) of the sporadic group. Findings (DRE, TRUS, PSA) were more often suspicious for carcinoma in the PC families. Prostate cancer was diagnosed in 6 (5.0%) and 2 (2.99%) participants of the familial and the sporadic group, respectively. These detection rates tended to be higher than that of an age-matched subgroup of an unselected population in other European screening studies. The most important risk factor for the diagnosis of PC was a low average age at onset within the family. These data imply that prostate cancer screening in the high-risk group of men with familial predisposition cannot be assessed by population-based studies and should be evaluated separately.

Adult↗
PubMed2002

[Familial prostate carcinoma in Germany].

Epidemiologic studies have shown that hereditary forms account for approximately 10% of all prostate cancers. The identification of several susceptibility loci harboring predisposing genes indicates the genetic heterogeneity of prostate cancer. The conflicting results of different linkage analyses may be explained by a varying contribution of each locus within different family collections and reflect differences of allele frequencies across different populations. In the present study we recorded the incidence of familial prostate cancer in Germany and performed descriptive analysis of the epidemiological data. In spite of a significant ascertainment bias, only 19% of all prostate cancers were familial. In 94% of families there were three affected relatives at most. Large prostate cancer families with at least five affected persons were rare (2%). Descriptive analysis revealed that only 42% of all pedigrees followed an autosomal-dominant pattern of transmission; the other pedigrees showed an X-chromosomal or recessive mode of inheritance. These data confirm the genetic heterogeneity of hereditary prostate cancer and imply that previously published epidemiological data cannot be transferred to the German population.

Adult↗
PubMed2001

[15 years experience with the ileal neobladder. What have we learned?].

During the past 15 years, orthotopic bladder reconstruction has evolved from experimental surgery over "standard of care at larger medical centers" to become the preferred method of urinary diversion in both sexes. The paradigm for choosing a urinary diversion has changed substantially over that time. In 2001, all cystectomy patients are candidates for a neobladder, and we should identify those patients in whom orthotopic reconstruction may be less ideal, noting that the percentage of patients receiving a neobladder today averages 60 to 70 percent. Relative contraindications and comorbidity now play a smaller role in choosing the neobladder option. Patient selection criteria include both patient factors and cancer factors. The primary patient factor being the patient's desire for a neobladder. The psychologically damaging stigma to the patient who enters surgery expecting a neobladder but awakens with a stoma now plays an increasing role. Nevertheless, there are patients who are better served with a conduit. Among that are patients whose main motivation is to "get out of the hospital as soon as possible", and patients who will be happy to resume a normal, relatively sedentary life and who have no concerns about body image. Two important criteria that must be maintained when contemplating a neobladder procedure--the urethral sphincter must remain intact and the cancer operation must not be compromised. However, increasing experience has forced less restrictiveness as far as tumor stage is concerned. A recent study of 435 bladder cancer patients who had bladder replacements after cystectomy, experienced a local recurrence rate of 10 percent. Interference of the local recurrence with the neobladder occurred in just 11 patients--infiltration in six, and obstruction in five. Survival was limited despite multimodality therapy. The option of a neobladder reduced the physician and patient reluctance to perform cystectomy early in the disease process, thereby increasing the survival rate, and patients can anticipate normal neobladder function until time of death. It can be concluded that a neobladder for locally advanced cancer and positive nodes is no more problematic than a conduit. The structural and ultrastructural changes which occur in neobladder mucosa are biphasic. The early phase is inflammatory, showing an infiltration of the lamina propria and a reduction in microvilli. After one year the late regressive phase starts, ending up in a flat mucosa and a stratified epithelium. The structure and response of the implanted ileum change to a detrusor-type: response. The structural and ultrastructural changes an ileal mucosa lead to a primitive surface and glandular epithelium similar to urothelium. This transformation of the ileal mucosa minimizes the risk of metabolic complications. We conclude that mother nature engineers a new bladder almost as good as the one given by God initially. The risk of obstruction of non refluxing techniques is at least twice that following a direct anastomosis. There is no longer a justification of any antireflux mechanism. Ileum seems to be clearly superial to colon when continence rates, metabolic safety and surgeons's issues are considered.

Female↗
PubMed2001

Chorioallantoic membrane assay: vascularized 3-dimensional cell culture system for human prostate cancer cells as an animal substitute model.

PURPOSE: Chorioallantoic membranes have been used as a reliable biomedical assay system for many years. Chicken eggs in the early phase of breeding are between in vitro and in vivo systems but may provide an immunodeficient, vascularized test environment. We tested this model as an in vivo system for prostate cancer research. MATERIALS AND METHODS: Single cell suspensions of LNCaP, PC-3 and Tsu-Pr1 human prostatic cancer cell lines as well as 2 immortalized normal human prostate epithelial cell lines were inoculated on the chorioallantoic membrane of fertilized chicken eggs on day 5 or 6 of breeding. Tumor growth and viability of the embryo was evaluated by stereo microscopy. At day 10 the membranes were removed and embedded in paraffin. Cell morphology was assessed after hematoxylin and eosin staining. Cellular expression of cytokeratin, prostate specific antigen and androgen receptor as well as apoptosis induction was confirmed by immunohistochemistry. RESULTS: Three days after tumor cell inoculation on the extraembryonic vascular system of the chorioallantoic membrane cell growth and formation of 3-dimensional tumors became apparent in 100% of inoculated membranes. Strong neo-angiogenesis was detected next to the established tumors and tumor cells invading the stroma of the chorioallantoic membrane. Cytokeratin expression as well as prostate specific antigen and androgen receptor in LNCaP cells confirmed the human prostate tumor origin. Assessment of quantitative in vivo apoptosis induction in LNCaP cells after intravenous injection of the phorbol ester 12-O-tetradecanoylphorbol-13-acetate confirmed the model as a versatile in vivo system. CONCLUSIONS: The well vascularized chorioallantoic membrane of bred chicken eggs is a suitable system for early in vivo cancer research. Reliable growth of prostate cancer cell lines is feasible and allows the evaluation of proliferation and apoptosis induction after intravascular or topic application of anticancer drugs. Exploitation of this assay enables a substantial reduction in or substitution for subsequent animal experiments.

Allantois↗
PubMed2001

Significance of high-grade prostatic intraepithelial neoplasia in needle biopsy specimens.

OBJECTIVES: To examine the significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in biopsy specimens. METHODS: We performed sextant biopsies on a series of 83 cystoprostatectomy specimens removed for bladder cancer. For each case the number of foci and volume of both HGPIN and prostate cancer were assessed in the prostatectomy specimens and compared with the number of biopsy specimens involved by HGPIN. RESULTS: We identified HGPIN in 82 (99%) of 83 prostatic glands, whereas prostate cancer was found in 41 cases (49%). Corresponding sextant biopsies harbored both HGPIN and prostate cancer in 6 cases (7%), whereas only HGPIN was diagnosed in 29 sextant biopsies (35%). There was a positive correlation between the number of biopsy specimens containing HGPIN and the volume and multifocality of HGPIN in the corresponding prostatic glands. Prostates with HGPIN on sextant biopsy contained prostate cancer significantly more often when compared to cases with no HGPIN on sextant biopsy. Frequency of concurrent prostate cancer was higher in cases with two or more biopsy specimens containing HGPIN than in cases with only one such biopsy specimen, but case numbers of these categories were too small to render this difference statistically significant. CONCLUSIONS: The presence of HGPIN in sextant biopsies is a significant predictor of concurrent prostate cancer. Multifocality of HGPIN is a useful parameter in assessing the extent of HGPIN in the corresponding prostates. Its value in predicting a significantly increased risk of concurrent prostate cancer needs to be further investigated in larger case studies.

Adult↗
PubMed2001

New-generation lithotripters for treatment of patients with implantable cardioverter defibrillator: experimental approach and review of literature.

PURPOSE: The influence of shockwaves applied during extracorporeal shockwave lithotripsy on the function of implantable cardioverter defibrillators was evaluated. Mechanical influences as well as proper electrical function were tested in an experimental approach. MATERIALS AND METHODS: Two implantable defibrillators (Ventak Mini 1743 and AVII 1821) were exposed to the shockwaves of a new-generation lithotripter. Each of the antidysrhythmic devices was tested at several distances from and within the focus of the lithotripter. All studies were performed with maximum energy and the number of shockwaves used for stone treatment. The devices were connected to an ECG simulator, and continuous recording of a surface ECG, a shock ECG, and marker channel was performed. RESULTS: No macroscopic and microscopic mechanical damage was observed. The detection function of the implantable defibrillators was not altered by any electromagnetic artifacts even when brought into the focus of the shockwaves. All induced ventricular dysrhythmias were terminated properly regarding artifact sensing. However, after defibrillation, the pacing function of the Ventak Mini cardioverter defibrillator, which was programmed into the demand mode, failed. In this case, there was no post-shock pacing in the period of post-defibrillation asystole. The failure was caused by artifact oversensing. CONCLUSION: In patients with implanted cardiac devices undergoing treatment with a new-generation lithotripter, deactivation of the defibrillator is not mandatory. For safety reasons, continuous ECG recording is recommended. To avoid pacing failure by artifact oversensing, the shockwaves should be applied in a R-wave synchronous mode.

Artifacts↗
PubMed2000

Tributyrin induces differentiation, growth arrest and apoptosis in androgen-sensitive and androgen-resistant human prostate cancer cell lines.

Progression to androgen independence remains the main problem that impacts on survival and quality of life in prostate cancer patients. We have investigated the potency of tributyrin, an orally available prodrug of butyrate, to induce growth arrest, differentiation and apoptosis in LNCaP, PC-3 and TSU-PR1 human prostate cancer cell lines. Cells were treated with 0.1 to 5 mM tributyrin or sodium butyrate. Growth inhibition, cell cycle arrest and apoptosis induction was assessed using standard methods. Both agents induced a more differentiated, fibroblast-like phenotype in androgen-sensitive as well as androgen-resistant cell lines. Expression of prostate-specific antigen was increased in LNCaP cells by tributyrin as a indicator of differentiation. The IC(50) for sodium butyrate was 2.5 mM in PC-3 and TSU-PR1 cells. LNCaP cells exhibited <50% growth inhibition at 5 mM sodium butyrate. However, the IC(50) for tributyrin was 0.8 mM in PC-3 cells, 1.2 mM in TSU-PR1 cells and 3.1 mM in LNCaP cells. Flow cytometry revealed a strong G1-arrest after exposure to tributyrin or sodium butyrate. Both agents resulted in a strong increase of apoptosis rates compared with mock-treated cells. Overall, tributyrin had a 2.5- to 3-fold growth inhibitory and apoptosis-inducing potency compared with equimolar concentrations of sodium butyrate. Our results demonstrate that tributyrin is more potent than butyrate in regard to cell growth inhibition and apoptosis induction at pharmacologically relevant concentrations. Hence, tributyrin may be a promising candidate for clinical protocols in prostate cancer.

Androgens↗
PubMed2000

Orthotopic ileal neobladder in females: impact of the urethral resection line on functional results.

We present our functional experience with orthotopic bladder replacement in female patients dependent on the urethral resection line. Between November 1986 and July 1998 42 women underwent orthotopic urinary tract reconstruction with an ileal neobladder at our institution: 26 patients underwent radical cystectomy (RCx) with subsequent ileal anastomosis to the urethra, and 16 underwent simple cystectomy (SCx) with preservation of the bladder neck. Fourteen of 22 patients following RCx and 3 of 14 patients following bladder neck-sparing cystectomy void naturally. Clean intermittent catheterization is necessary in 8 of 22 and 11 of 14 patients, respectively. Perfect continence with no pads at 1 year postoperatively was achieved in 15 of 18 evaluable patients following RCx and 10 of 11 patients following bladder neck sparing. Incontinence requiring one or more pads is present in 3 of 18 patients and 1 of 11 patients, respectively. Subjectively satisfactory continence was achieved in 16 of 18 patients following RCx and in all patients following bladder neck-sparing surgery. Our conclusions are that radical cystectomy as well as a bladder neck-sparing cystectomy does provide satisfactory functional results in the majority of patients. However, the urethral resection line does slightly influence the rate of incontinence as well as the requirement for intermittent catheterization. RCx does translate into a lesser requirement for CIC, whereas bladder neck sparing results in slightly better continence rates.

Adolescent↗
PubMed2000

Which patients with transitional cell carcinoma of the bladder or prostatic urethra are candidates for an orthotopic neobladder?

Bladder replacement has become a standard method of urinary diversion in adults undergoing cystectomy. When faced with a treatment decision, the patient and urologist are most comfortable if information is available on short- and long-term possible outcomes of the proposed intervention and on the magnitude of the expected effect. This article presents and discusses absolute and relative contraindications for orthotopic neobladders that may help optimize the clinical results with these procedures. As our own series has progressed, so has our philosophy regarding patients who are candidates for an orthotopic reconstruction. All men who require radical cystectomy as treatment for bladder cancer are initially thought to be appropriate candidates for orthotopic lower urinary tract reconstruction. Given the criteria presented in this article approximately, 80% of men are considered acceptable candidates for a neobladder. By these criteria, 65% of women are adequate candidates for an orthotopic bladder.

Carcinoma, Transitional Cell↗
PubMed2000

Bladder reconstruction: a critical reappraisal.

The operative management of muscle invasive bladder cancer has been dramatically advanced by the advent of orthotopic reconstruction. Several studies reported during the past year have further demonstrated the utility of this form of urinary diversion. The long-term safety and efficacy of bladder replacement with respect to both surgical and metabolic complications has been demonstrated. As series include more patients with sufficient follow up, we are gaining a better appreciation of the results of treatment that patients and urologists can expect in terms of function and risk of complications. Taken together, published studies have made the following important points. Exenterative surgery as currently performed alters pelvic floor/urethral physiology. Early reports of complications in studies with short periods of follow up are not meaningful. When basic principles and complication rates are established for a procedure in the long term, sufficient follow up is required before it can be established that a modification to that procedure really is better. The occurrence of retention in a female patient with orthotopic bladder continues to be poorly understood.

Cystectomy↗