Search PubMed⌕ Search

Biomedical subjects

R Hohenfellner

Publications and source records attributed to R Hohenfellner.

At least 181 records · Page 10Linked to original sources
PubMed1989

Extent of surgery in rhabdomyosarcoma of urogenital structures.

After high inguinal semicastration in group-1 paratesticular rhabdomyosarcoma (RMS), the patient having undergone chemotherapy can be followed closely by CT scanning without retroperitoneal lymphadenectomy. In contrast, retroperitoneal RMS should be operated on as radically as possible after downstaging the tumor mass. In RMS of the female genitalia locally limited organ-preserving surgery is the method of choice. The prognosis is excellent with adjuvant chemotherapy. Only 20% of all bladder RMS arise from the bladder dome or the movable part of the bladder, where primary partial resection including a safety margin of 3 cm of healthy tissue is possible. The majority, however, arising from the submucous tissue of the bladder base, trigonal area and bladder neck, infiltrates the prostatic urethra and the surrounding pelvic fascia. Therefore differentiation between primary bladder or prostate RMS is often doubtful. The current strategy of downstaging by chemotherapy or chemo-radiotherapy followed either by limited organ-preserving surgery or by a wait-and-see policy includes the high risk of residual tumor or local tumor recurrence, which has proved to have the worst prognosis of all. As organ-preserving therapy was recommended as the method of choice, mainly to avoid anterior pelvic exenteration and urinary diversion, the question of advantages in comparison to the risk of tumor recurrence is still open. The routine use of chemoradiotherapy and increasing follow-up has called attention to a variety of chronic sequelae, such as contracted bladders with reduced capacity and upper urinary tract deterioration, which subsequently require secondary urinary diversion. Progress in continent urinary diversion may be an alternative procedure for better life quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Long-term follow-up of children with surgically treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension.

With a mean follow-up of 10.8 years, 160 female and 29 male patients were investigated after successful correction of vesicoureterorenal reflux. All patients suffered from urinary tract infection (UTI) preoperatively, while postoperatively 42% of the patients developed further UTIs but with a significantly diminished rate of febrile infections. In comparison to a group of patients without postoperative UTI (n = 16), the uroepithelial cells of those patients with a high infection rate after reflux correction showed a significantly lower bacterial growth suppression (n = 37). Renal scars were found in 22% of the investigated renal units with operated ureters (n = 211). Of the preoperatively unscarred kidneys, 3.4% developed new scars during the observation period, mainly within the first 2 years after operation. In 7 (11.5%) of the 61 patients with renal scars, moderate arterial hypertension was found.

Child↗
PubMed1989

[Urethral tumor recurrence following radical cystoprostatectomy--an indication for primary cystoprostato-urethrectomy?].

A total of 273 male patients underwent radical cystoprostatectomy between 1967 and 1987, 22 of them being regarded as at risk for urethral tumor recurrence. In these 22 primary simultaneous urethrectomy was performed or urethrectomy followed shortly after cystectomy because of the histology of the cystectomy specimen. Of the remaining 251 patients, a urethral tumor recurrence was observed in 23 (9.2%). Another patient with a urethral recurrence had originally been operated on in another hospital. The first urethral tumor recurrence was observed in 1977, but between October 1987 and May 1988, 7 patients were treated for urethral recurrence or rerecurrence, suggesting that this problem will be recorded increasingly often with improved survival rates from the original bladder tumor and longer follow-up of these patients. In 21 of the 24 patients with recurrence, multifocal tumor growth (multiple primary tumors, multifocal carcinoma in situ, unifocal primary tumor with concomitant carcinoma in situ or severe dysplasia) was found in their primary cystectomy specimen. Two had unifocal tumors. The original histology of the patient operated on elsewhere is not known. The data suggest that primary simultaneous urethrectomy should be performed in all patients undergoing cystoprostatectomy for multifocal bladder tumors. All patients in whom the urethra is left in place need regular washout cytologies of the urethra for the rest of their lives to ensure early diagnosis of any urethral tumor recurrences.

Aged↗
PubMed1988

Urology.

Explore the source record for details and available documents.

Animals↗
PubMed1988

Urology.

Explore the source record for details and available documents.

Bladder Exstrophy↗
PubMed1988

Treatment of iatrogenic functional or morphologic bladder loss.

From 1984 to 1986, six children from 4 to 13 years of age, received a bladder augmentation by ileocecal cystoplasty (Mainz-pouch technique) because of an iatrogenic functional or morphologic bladder loss. Indications for operation were incontinence due to the low bladder capacity or threat to the upper urinary tract due to ureteral obstruction or vesicorenal reflux. Two of the children had already undergone supravesical urinary diversion by sigmoid conduit. After a follow-up period of 2 to 19 months, (mean 11 months), five of the six children are completely continent. One boy with a known weak sphincter still has slight, but decreasing, enuresis nocturna in periods of complete filling of the pouch, 1 month after the operation. All children are able to void their augmented bladders without residual urine.

Cecum↗
PubMed1988

100 cases of Mainz pouch: continuing experience and evolution.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz pouch procedure since 1983: 34 for bladder augmentation, 15 for total bladder substitution after cystoprostatectomy and 51 for continent urinary diversion. In the bladder augmentation group 1 patient underwent conversion to a continent stoma, 1 has urge and frequency, and the remaining 32 are completely dry day and night. These patients empty the bladder at normal intervals spontaneously except for 3 who rely on intermittent catheterization. In the bladder substitution group 1 patient has grade 1 stress incontinence and the remainder are completely dry during the day. However, at night 4 patients have leakage and they use a condom urinal. In the urinary diversion group all but 2 patients are completely dry and are on intermittent catheterization. The main problem of the initial series was prolapse of the continence nipple, which has been solved by staple fixation of the nipple to the bowel wall and to the ileocecal valve.

Adolescent↗
PubMed1988

Spontaneous perirenal hematoma due to a small perihilar renal cell carcinoma.

Spontaneous renal rupture is an infrequent event and is usually caused by a predisposing factor. Up to 178 cases have been published. We present a case of a large spontaneous perirenal hematoma caused by a perihilar renal cell carcinoma of a 1-cm diameter. Reviewing the literature, a classification of the condition is given according to the underlying pathology and mechanism of rupture. The need for explorative surgery in cases which cannot be clarified by noninvasive diagnostic tools is discussed.

Adult↗
PubMed1988

Local shock-wave lithotripsy of distal ureteral calculi.

Since the initiation of the clinical trial utilizing a second-generation lithotripor (Lithostar, Siemens, Erlangen, FRG), 96 patients with distal ureteral calculi (i.e. calculi below the pelvic brim) underwent local shock-wave lithotripsy. Routine treatment was conducted under intravenous sedation and light analgesia only. Complete stone disintegration was achieved in 84 patients (87.5%), 11 requiring two sessions and 1 patient, three. In 7 patients ureteroscopy became necessary after unsuccessful local shock-wave treatment. In 2 of these patients a 9-french flexible ureteroscope and the Storz Q-switched neodymium-YAG laser was used for stone disintegration. In 3 cases loop extraction and in 2 cases open surgery had to be performed for definitive stone removal. All pre- and postoperative manipulations (except open surgery) were done on the Lithostar. Local shock-wave lithotripsy is a highly successful, noninvasive, time-saving and easily applicable technique. It has become our primary approach in the treatment of distal ureteral calculi.

Clinical Trials as Topic↗
PubMed1988

Karyotype analysis and marker chromosomes of renal cell carcinoma.

Karyotyping was performed in 46 human renal cell carcinomas of various histological grades. Controls included chromosome analysis of normal renal parenchymal cells from the same patients. Various numerical chromosome aberrations were found as well as marker chromosomes. They are specific of the individual tumor but no single marker was identified occurring in all tumors tested. Only trisomy 3 was found in different tumors (31%), suggesting a more general character of this aberration. Histological dedifferentiation and large tumor size correlate with focusing of the karyotype towards distinct chromosomal modes indicative of distinct tumor cell subclones within these tumors. Their rapid growth, reflecting biological aggressiveness, is most probably responsible for the patients' poor prognosis.

Carcinoma, Renal Cell↗
PubMed1988

Tumor-specific antigen for human renal cell carcinoma. Ultrastructural localization of the antigen by immunoelectron microscopy.

Hybridoma technology enabled the production of tumor-specific monoclonal antibodies reactive exclusively with human renal cell carcinoma. Intracellular localization of the antigen was undertaken in order to gain understanding of its possible physiological role in cellular metabolism and to investigate its future clinical applicability for immunoscintigraphy in tumor localization. For immunoelectron microscopy a special paraformaldehyde-periodate fixation process (PLP fixation) had to be employed, in order to preserve the cell's ultrastructure without destruction of the antibody-binding epitope. The antigen was found to be strictly intracytoplasmic in close correlation to the glycogen particles characteristic for human renal cell carcinoma. These findings suggest that this antigen may be involved in the pathological glycogen synthesis, explaining the specific staining pattern of these monoclonal antibodies.

Antibodies, Monoclonal↗
PubMed1988

Endocrine and clinical evaluation of 107 patients with advanced prostatic carcinoma under long-term pernasal buserelin or intramuscular decapeptyl depot treatment.

Three major assumptions emerged from these clinical and endocrine long-term studies. First, buserelin, given pernasally in the conventional doses, and Decapeptyl microcapsules administered intramuscularly in 5-week intervals are equally effective in terms of their long-term castration effect in previously untreated patients with prostatic carcinoma. However, Decapeptyl causes complete LH and subsequent testosterone down-regulation 1 week earlier than buserelin. Furthermore, this treatment is more convenient, and the compliance is better. Both LHRH analogues are equally well tolerated. Second, in groups of prostate cancer patients with far advanced disease treated with palliative intention, only true subjective or objective remission should be considered a positive treatment response. Third, our results comparing PAP and PSA as the two most useful tumor markers with the corresponding testosterone levels suggest a close correlation.

Adenocarcinoma↗
PubMed1988

[Importance of early cystectomy for the prognosis of cancer of bladder].

Between 1967 and 1985, 246 cystectomies were performed for the treatment of urothelial carcinoma of the bladder. Surgery-related mortality, initially 15%, was equal to 0% in 1985. Preoperative radiation therapy was not given. Despite strictly comparable T and N stages, prognosis was markedly better in patients who had undergone cystectomy as soon as the diagnosis of invasive cancer of the bladder was established than in patients who had undergone cystectomy after one or more recurrences of invasive carcinoma of the bladder and after transurethral resection. Twenty-six patients, undergoing cystectomy because of recurrence after curative radiation therapy, were the group with the worst 5--years survival--less than 10%. These results allow us to conclude that for the prognosis of carcinoma after total cystectomy, it is of the utmost importance to differentiate between an initially invasive tumor and a recurrence of an invasive carcinoma after transurethral resection. If performed immediately after infiltration has been demonstrated, cystectomy may greatly contribute to improving the long-term prognosis. As soon as the tumor extends to the lamina propria (pT1), one can no longer expect transurethral electroresection to suffice as reliable curative treatment of carcinoma of the bladder. As for the argument that the procedure is mutilating, one can counter with the increasing success in the last few years, of urinary derivation with continence, including bladder replacement or even total cystoprostatectomy, which does not result in impotence.

Carcinoma, Transitional Cell↗
PubMed1988

[Importance of the DNA content for the prognosis of invasive carcinoma of the bladder. Determination by photocytometry].

In a retrospective study, a DNA histogram was established from specimens obtained by cystectomy in 65 carcinomas of the bladder (stages pT1 to pT4, pN0, pN1 and pN2). Flow cytometry and automated photocytometry were systematically compared. Automated photocytometry makes it possible to differentiate between diploid, polyploid and aneuploid tumors. Among aneuploid tumors, the DNA content of tumor stem cells make it possible to identify another subgroup. The analysis of various tumor sections showed that the DNA histogram obtained by photocytometry was a stable and reproducible characteristic of the tumor. The subgroups of carcinoma of the bladder, determined by topology, have markedly different long-term prognoses. In contrast to automated photocytometry, flow cytometry did not allow for reproducible determination of the biologic characteristics of carcinoma of the bladder.

Cytophotometry↗