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R Hartung

Publications and source records attributed to R Hartung.

At least 55 records · Page 3Linked to original sources
PubMed2000

New technologies in transurethral resection of the prostate.

Different ablative treatments are in clinical use to lower perioperative morbidity and to maintain efficacy of transurethral resection of the prostate. Modifications to electrodes or high frequency units, or both, as well as improvements in laser technology have been tried. Transurethral resection is performed with a modified high frequency generator. The technique of 'coagulating intermittent cutting' allows reduction in morbidity and maintains the advantages of classical transurethral resection.

Humans↗
PubMed2000

Value of free prostate-specific antigen (Hybritech Tandem-R) in symptomatic patients consulting the urologist.

INTRODUCTION: Prostate-specific antigen (PSA) is a widely used tumor marker in the detection and follow-up of adenocarcinoma of the prostate. Selection of candidates for prostate biopsies is hampered by the lack of specificity resulting in a large number of unnecessary biopsies. The intention of our study was to compare the percent free PSA (f-PSA; Hybritech Tandem-R) with total PSA and age-specific PSA reference values to evaluate the clinical benefit in detecting patients with prostate cancer (PC) in a selected group of patients consulting the urologist. The question was whether cutoff points are influenced by this selection of patients. METHODS: A total of 188 patients, 114 with benign prostate hyperplasia (BPH) and 74 with PC were selected. It is a selected group of patients consulting the urologist. Diagnosis was confirmed in the BPH and PC groups by either ultrasound-guided biopsy or transurethral resection of the prostate or suprapubic adenomectomy or cystoprostatectomy. Total PSA (t-PSA) and f-PSA of all patients were measured before any manipulation by Tandem-R assay for f-PSA and Tandem-E assay for t-PSA (Hybritech). Mean values of age, prostate volume, t-PSA, f-PSA, percent f-PSA were compared in patients with BPH and PC by Mann-Whitney U test. The sensitivity and specificity of t-PSA and age-specific PSA were compared to the sensitivities and specificities of different cutoff points of percent f-PSA. RESULTS: The mean value of t-PSA, f-PSA and percent f-PSA in patients with BPH (n = 114) and PC (n = 74) were statistically significantly different. At PSA levels between 4 and 10 ng/ml 19% of negative biopsies could be avoided by the use of percent f-PSA (cutoff point 25%). There was no additional benefit of age-specific PSA. At a PSA of <4 ng/ml 6 of 7 PCs could be diagnosed by percent f-PSA (cutoff point 25%), whereas only 1 patient would be diagnosed by age-specific PSA. CONCLUSION: Percent f-PSA seems to decrease the biopsy rate at PSA levels from 4 to 10 ng/ml without missing a relevant number of cancers and to increase the detection rate at PSA <4 ng/ml. Our data indicate that it might be necessary to choose high cutoff points (25%; Tandem-E and R assay, Hybritech) in a selected study population consulting the urologist with large glands and a high prevalence of disease. However, this situation is not comparable to testing of screening populations. No benefit of age-specific PSA could be observed in this study.

Aged↗
PubMed1999

[Coagulating intermittent cutting. Improved high-frequency surgery in transurethral prostatectomy].

In spite of the high and lasting efficiency of transurethral prostatectomy, intraoperative blood loss results in increased morbidity in this procedure. This led to the development of many alternative treatment modalities in the last years. To minimize the risk of bleeding, we improved the high-frequency technology in several steps. To achieve this, the output signals of commercially available high-frequency generators were modulated to the effect that each cut results in an efficient coagulation zone in the tissue at excellent cutting quality. Laboratory and in vitro studies using porcine kidneys as well as clinical trials showed good cutting characteristics accompanied by a significant reduction of bleeding. As a result, blood transfusions were less necessary, the transurethral catheter could be removed earlier in the postoperative period, and hospitalization time was significantly reduced. In conclusion, the improved high-frequency technology in form of the "coagulating intermittent cutting" results in a blood-sparing tissue resection with a consecutive reduction of morbidity.

Animals↗
PubMed1999

Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for the detection of local recurrence after radical prostatectomy.

OBJECTIVE: After radical retropubic prostatectomy a rise of the prostate-specific antigen (PSA) indicates a local recurrent or metastatic disease. If the bone scan shows no apparent bone metastasis, morphological imaging methods like x-ray computed tomography, magnetic resonance imaging or transrectal ultrasound often cannot distinguish between postoperative scar and local recurrence. Therefore we investigated the feasibility of fluorine-18-fluorodeoxyglucose positron emission tomography (F-18 FDG PET) for metabolic characterization of prostatic cancer, especially for differentiation of scar or recurrent prostate cancer after radical prostatectomy. METHODS: Dynamic PET with 370 MBq F-18 deoxyglucose (F-18 FDG) up to 60 min p.i. was performed in 2 patients with biopsy-proven benign prostatic hyperplasia, in 11 patients with a histologically proven prostate cancer prior to radical retropubic prostatectomy (RRP) and 7 patients with suspected local recurrence (with negative bone scan) after RRP prior to biopsy of anastomosis (3 local recurrence, 4 postoperative scar). RESULTS: Prostate cancer showed a very low F-18 FDG uptake. The placement of regions of interest was only possible by the use of other imaging methods. There was not difference between the F-18 FDG uptake of benign prostate hyperplasia, prostate carcinoma, postoperative scar or local recurrence after radical prostatectomy. CONCLUSION: F-18 FDG seems not to be useful to distinguish between postoperative scar and local recurrence after radical prostatectomy.

Adenocarcinoma↗
PubMed1999

[Intraoperative ERCP for therapy of common bile duct stones during laparoscopic cholecystectomy].

The data of 166 patients that underwent laparoscopic cholecystectomy between November 1989 and December 1997 are given. In all cases intraoperative ERC and extraction of bile duct stones within the laparoscopic surgery were performed. The results show that by intraoperative simultaneous ERC bile duct stones can be removed with a success rate of 98.8% and a mortality rate of 0%. Intraoperative ERC is a secure and economic kind of treatment, especially the patient profits from this minimal invasive procedure.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

[Treatment of progressive, locally advanced prostate carcinoma].

Due to the lack of randomized and controlled trials comparing treatment options for locally advanced prostate cancer no clear cut therapeutical advise can be given. Currently, external beam radiotherapy is the form of treatment most often applied to which other therapeutic modalities have to be compared. Radical prostatectomy alone does not improve survival at this stage. The combination of local treatment modalities with neoadjuvant androgen deprivation seems to be a promising approach which has to be a promising approach which has to be evaluated in prospective clinical trials.

Androgen Antagonists↗
PubMed1998

[What does the urologist expect and hope for from the pathologist in diagnosis of prostate carcinoma].

Prostate cancer has become the most common cancer in males in Western countries. In the United States 317,000 men were newly diagnosed with this disease in 1996. Screening efforts will identify increasing numbers of men who will be scheduled for prostate biopsy. Since the progression of prostate cancer varies widely from rapid tumor growth with early distant metastases to slow growth with good prognosis, it is of utmost importance that prognostic parameters be identified which allow the course of the disease to be predicted. Thus, the correct pathohistological staging, the evaluation of different grading systems, and the biological impact of positive surgical margins after radical prostatectomy requires collaboration between urologists and pathologists.

Biopsy↗
PubMed1998

Dysfunctional voiding in women: which muscles are responsible?

OBJECTIVE: To analyse the striated external urethral sphincter (EUS) and pelvic floor muscles using two different electromyography (EMG) techniques in women with dysfunctional voiding and/or urinary retention. PATIENTS AND METHODS: Fifteen women (mean age 38.2 years, range 18-61) with dysfunctional voiding and/or unexplained voiding dysfunction associated with urinary retention were examined neurologically and urologically; urodynamics and kinesiological EMG of the bilateral pubococcygeal and external urethral striated sphincter muscles were obtained. In an additional neurophysiological session, concentric-needle EMG of the external urethral sphincter was performed. RESULTS: Kinesiological EMG recordings revealed inappropriate pelvic floor muscle activation during voiding in 11 and EUS activation in four women. Concentric needle EMG of the EUS revealed complex repetitive discharges in the four women with inappropriate urethral sphincter activation recorded by kinesiological EMG during voiding. Biofeedback training led to improvement in women with inappropriate pubococcygeal activation but not in those with urethral sphincter complex repetitive discharges. CONCLUSION: Urodynamic examinations in combination with kinesiological EMG examination of the pubococcygeal and external urethral sphincter muscles revealed two groups of women with dysfunctional voiding. Further diagnostic evaluation of such patients with concentric-needle EMG is mandatory. The differentiation of the two groups is therapeutically relevant.

Adolescent↗
PubMed1997

Iridium 192 high-dose-rate brachytherapy--a useful alternative therapy for localized prostate cancer?

We report on a novel protocol involving iridium 192 high-dose-rate brachytherapy and follow-up of up to 130 months in patients with prostatic carcinoma. Using regional anesthesia, five to seven hollow needles are placed within the prostate by perineal puncture under ultrasound guidance. A 9-Gy prostate dose is applied followed by 30 min of hyperthermia (since 1991). This treatment is repeated once after 7 days; 2 weeks later, 18 x 2-Gy external beam radiation (small-field prostate) is added as percutaneous dose saturation. Since 1984 we have treated 40 patients with this protocol. Local tumor control was achieved by means of prostatic biopsy at 18 months after therapy and determination of prostate-specific antigen (PSA) values in about 70% of the patients; after a mean follow-up period of more than 6 years (16-130 months), 80% of the patients show either no evidence of disease or stable disease. We therefore conclude that iridium 192 high-dose-rate brachytherapy is a useful alternative in the treatment of localized prostate cancer in patients who are not eligible for radical prostatectomy.

Adult↗
PubMed1997

Diagnostic value of additional systematic prostate biopsies in patients undergoing transurethral resection of the prostate.

OBJECTIVES: There are patients with obstructive voiding symptoms and suspicious screening parameters in whom prostate cancer (PC) cannot be excluded prior to transurethral resection of the prostate (TURP). The goal of our study was to assess the diagnostic value of systematic biopsies of the peripheral zone of the prostate performed during TURP. METHODS: Between 1990 and 1995, 132 patients (average age 69.5 +/- 7.4 years) with at least one suspicious screening parameter underwent a TURP and additional systematic prostate biopsies. Pathology reports were reviewed to verify whether PC was present in the TURP chips or in the biopsy cores. RESULTS: Histologic examination found benign prostatic hyperplasia in 52, prostatitis in 53, and PC in 27 patients. PC was detected only with TURP in 11 patients (40.8%). In 15 patients (55.6%), both TURP and prostate biopsies showed PC. There was only 1 patient (3.7%) with a positive biopsy in whom the examination of the resection chips did not detect PC. In patients with negative digital rectal examination and intermediate prostate-specific antigen levels, prostate-specific antigen density was not able to differentiate between benign and cancerous lesions. CONCLUSIONS: There seems to be a subgroup of patients where systematic and repeated prostate biopsies fail to detect PC prior to TURP. Although the increase in the detection rate through additional prostate biopsies of the peripheral zone is limited, we would recommend these biopsies in addition to TURP, especially if patients are eligible for further curative treatment options.

Adult↗
PubMed1997

Predictors of subjective well-being among older, community-dwelling persons with schizophrenia.

This study tests a theoretical model of subjective well-being (SWB) for community-dwelling older persons with schizophrenia. The sample consisted of 117 persons age 55 and over (mean age = 63 years) who developed schizophrenia before age 45. With the use of bivariate analyses and then logistic regression, five variables attained significance as predictors of SWB: male gender, absence of loneliness, older age, reliable social contacts, and fewer perceived life difficulties. Although a comparison with their age-peers in the general population indicated that the sample was worse on several objective indicators of well-being, for example, income, clinical depression, physical limitations, and social network size, none of these variables was predictive of SWB. Rather, the data largely supported the "judgment" theory of SWB, which proposes that SWB is based on beliefs about oneself and others.

Age Distribution↗
PubMed1997

Updated patient information for treatment of benign prostatic hyperplasia: a permanent challenge.

Ideally, a decision analysis should be performed in order to provide patient information and enhance decision-making procedures in benign prostatic hyperplasia (BPH). The steps associated with a decision analysis include creating a decision tree, identifying decision alternatives, quantifying the potential outcomes and weighing the potential outcomes according to the patients' requirements. However, doctors have their own individual experience and information on treatment from a wide variety of sources e.g. journals, conferences, the industry etc. Patients, in contrast, are informed by the popular media, friends and relatives etc. Updated patient information for the treatment of BPH therefore remains a permanent challenge. Each patient also has an individual acceptance of his symptoms, an individual tolerance to therapy according to his performance status, and an individual approach to medication or to surgery, whilst the doctor has novel experience with new drugs and instrumental procedures, his own individual availability of treatment options, and must always take the cost-effectiveness of a treatment into consideration.

Cost-Benefit Analysis↗
PubMed1997

5-Fluorouracil versus folinic acid and 5-fluorouracil in advanced, hormone-resistant prostate cancer: a prospective randomized pilot trial.

OBJECTIVES: Results of cytotoxic chemotherapy for hormone-resistant prostate cancer are not impressive. One of the substances which seems to have a therapeutic benefit is 5-fluorouracil (5-FU). The effect of 5-FU can be modulated by addition of folinic acid (FA). We tested in a prospective, randomized phase II trial monotherapy with 5-FU versus the combination of 5-FU and high-dose FA. METHODS: 25 patients received 600 mg/m2 5-FU, and 24 patients 400 mg/m2 FA plus 600 or 400 mg/m2 5-FU. They were treated for two cycles for 5 days in a 21-day interval followed by a weekly single-day application until progression occurred. Pain remission, toxicity, time to progression and survival were evaluated. RESULTS: Both regimens led to a pain remission in nearly 70% of the patients. Mucosal side effects like diarrhea and stomatitis occurred more often in the combination arm, whereas leukopenias were more frequent in the monotherapy are. We observed no statistically significant difference between the two treatment arms regarding time to progression and survival. CONCLUSIONS: Although both regimens led to a pain remission, side effects are too severe to recommend these protocols for standard treatment of hormone-resistant prostate cancer.

Aged↗
PubMed1996

Clinical relevance of urokinase plasminogen activator, its receptor, and its inhibitor in patients with renal cell carcinoma.

BACKGROUND: Urokinase plasminogen activator (u-PA) plays a key role in the metastatic process by promoting plasmin mediated tissue degradation. Metastatic cell invasion requires localized proteolysis, which may be directed by u-PA receptor. The binding of u-PA and PAI-1 to the u-PA-receptor may cause internalization of the trimeric complex into the cell and activate a tyrosine-kinase. In a prospective study the u-PA, u-PA-R, and PAI-1 content in patients with renal cell carcinoma (RCC) and benign renal tissue were correlated with traditional prognostic factors such as the TNM staging, histologic grading, ploidy, and the clinical outcome of the patients. METHODS: One hundred fifty-two patients who underwent transperitoneal tumor nephrectomy for RCC were followed up for a mean of 23.9 months. u-PA, u-PA-R, and PAI-1 from the tumor tissue and corresponding benign renal tissue were quantified from detergent extracted tissue samples (1% Trinton-X-100 in triethanolamine-buffered saline) and measured with an enzyme-linked immunoadsorbent assay. RESULTS: PAI-1 significantly correlated with the prevalence of distant metastasis (M0: 10.04 vs. M1 23.79, P=0.02) and the development of new metastasis postoperatively (M0: 10.85 vs. M1 27.36, P=0.001). A cut-off level of 12 ng/mg protein for PAI-1 selected a group of patients at high risk for relapse. Forty-one patients had PAI-1 > 12 ng/mg with 6 relapses compared with 55 patients with PAI-1 < 12 ng/mg with 1 relapse during the follow-up. Content of mu-PA correlated with the development of distant metastases (log rank 4.32, P=0.037). A cut-off value of 0.84 ng/mg selected 2 groups: a group at high risk for metastasizing (u-PA > 0.84, n=11 with 9 events and a group at low risk (u-PA < 0.84 with 94 patients and 5 events). Applying a cut-off value of 0.85 for u-PA-R 2 groups could be discriminated: 31 patients had no relapse with u-PA-R < 0.85 and 18 had 3 recurrences with u-PA-R > 0.85 g/ml. CONCLUSIONS: u-PA, u-PA-R, and PAI-1 are strong and independent prognostic factors for predicting early relapse for RCC. Especially with PAI-1, a high and low risk group for disease free survival can be discriminated.

Biomarkers, Tumor↗
PubMed1996

Enhancement of 5-fluorouracil cytotoxicity by folinic acid in different cell-lines of human renal cell carcinoma.

Results of cytotoxic chemotherapy in metastatic renal cell carcinoma are not impressive. Remission rates range between 0 and 20%. One of the substances which show a marginal effect is 5-fluorouracil (5-FU). The cytotoxicity of 5-FU can be modulated by combination with folinic acid as shown in various cell lines and clinical trials. We were interested to see whether such a biomodulation also occurs in renal cell cancer. The antiproliferative effect of 5-fluorouracil on two human cell lines of RCC and its potentiation by folinic acid was investigated in a monolayer proliferation assay. It could be shown that folinic acid enhanced the cytotoxic potential of 5-FU 6-8-fold. Our results indicate that the combination of these two drugs in the treatment of metastatic renal cell cancer might lead to better response rates.

Carcinoma, Renal Cell↗