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S Deger

Publications and source records attributed to S Deger.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Laparoscopic radical cystectomy with intracorporeal creation of a continent urinary diversion. Future or present?].

Once laparoscopic radical prostatectomy has been mastered, the step to performing a radical cystectomy is not that far. The challenge is to create the urinary diversion by laparoscopy. In this report we describe our experience with 11 laparoscopic radical cystectomies and intracorporeal construction of a continent urinary diversion (Mainz pouch II) as a treatment option in patients with muscle-invading bladder cancer. All 11 procedures could be performed successfully. A conversion to open surgery was not required in any case. The mean surgery time was 6.7 h. Except for two pouch fistulas we did not observe any intra- or postoperative complications. The functional as well as the oncological results are convincing. Less morbidity and faster recovery are the main advantages of this minimally invasive procedure. In addition, the low levels of blood loss, fluid shifts, and electrolyte loss considerably reduce cardiovascular stress. Radical cystectomy and construction of a continent urinary diversion represent the limit of technically feasible laparoscopy and should be done exclusively in specialized centers.

Aged↗
PubMed2002

[Radical prostatectomy in clinically localized prostate carcinoma. Pro laparoscopic approach].

Systematic development of laparoscopy during the last decade has led to establishing laparoscopic radical prostatectomy (LRP) as a surgical procedure. On the basis of extensive experience at our center, the advantages of the minimally invasive method are described as well as the problems still in existence. Reduced trauma caused by laparoscopic access in combination with clearly reduced blood loss has resulted in less morbidity after laparoscopic procedures. This is reflected in a shorter postoperative stay in hospital and faster convalescence. LRP as an ambitious and complex procedure has an average complication rate of 12%, which shows that the method has surpassed the stage of experimental surgery. By direct comparison, the costs of LRP are higher than for the open surgical procedure, but on the whole this is economically balanced by the lower morbidity, shorter hospital stay, and faster convalescence. The progress in technology to be expected in the field of laparoscopy will further increase quality, precision, and safety of LRP and thus contribute to the establishment of laparoscopic radical prostatectomy as a surgical method of choice.

Adult↗
PubMed2002

Short communication serum copper, zinc, and calcium concentrations in lice-infested sheep.

The purpose of this study was to investigate changes in serum concentration of copper, zinc, and calcium in sheep naturally infested with lice (Bovicola caprae, Linognathus africanus, Linognatus ovillus, and Linognattus pedalis). Twenty sheep naturally infested with lice and 20 healthy sheep were used as subjects. Blood samples were collected from the sheep before and 8 and 15 d after treatment with Avermectin, a veterinary antiparasitic drug. The samples were analyzed for their serum copper, zinc, and calcium concentrations by atomic absorption spectrometry. The concentrations of these elements in the infested animals were lower than in the healthy controls, mainly because the general condition of the affected sheep was poor. When the infested animals were treated with an ectoparasitic drug, the serum levels of the studied elements rose to normal ranges while the health of the animals improved.

Animals↗
PubMed2001

[Brachytherapy of local prostatic carcinoma].

Brachytherapy of prostate cancer has become attractive in recent years in Germany. There are several radioactive sources available, which are physically different. Some of them are used as permanent or temporary implants. The permanent sources most frequently used are iodine 125, palladium 103, and gold 198. Iridium is a temporary implant. The techniques used in Germany are low-dose rate (LDR) and high-dose rate brachytherapy, which differ in dose distribution and patient population. The success of prostate cancer brachytherapy depends on patient selection and choosing the right source for the technique used. Best suited for LDR monotherapy is the low-risk patient with a prostate-specific antigen (PSA) level below 10 ng/ml, maximal tumor stage T2b, and a Gleason score of less than 7.

Brachytherapy↗
PubMed2001

[Thermoradiotherapy with interstitial thermoseeds in treatment of local prostatic carcinoma. Initial results of a phase II study].

Several experimental data are available regarding the efficacy of the combination of interstitial hyperthermia and conformal radiation therapy. We planned a phase II trial as a member of the special hyperthermia research group of the Deutsche Forschungsgemeinschaft (German Research Society) to determine the efficacy of thermoradiotherapy using interstitial cobalt-palladium thermoseeds in the treatment of patients with localized prostate cancer. Forty-one patients with localized prostate cancer were enrolled in the study between July 1997 and April 2000. The interstitial hyperthermia induced in a magnetic field was applied in six sessions once a week. Conformal three-dimensional radiation therapy was given simultaneously in daily fractions of 1.8 Gy with a total dose of 68.4 Gy. We measured intraprostatic temperatures between 42 degrees and 46 degrees C. No major side effects were observed during the hyperthermia session. The median level of prostate-specific antigen (PSA) decreased from 11.25 ng/ml to 0.88 ng/ml 3 months after treatment and to 0.38 ng/ml 12 months after treatment with a median follow-up of 10 months. The mean prostate volume decreased from 32.6 ml to 26 ml after 3 months of treatment and to 18.5 ml after 12 months. Interstitial hyperthermia is a feasible, well-tolerated procedure in prostate cancer therapy. A significant PSA decrease was observed. Longer follow-up is necessary to determine the efficacy.

Aged↗
PubMed2001

Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: the initial 5 cases.

PURPOSE: We present our experience with the first 5 patients who underwent radical cystectomy with bilateral pelvic lymphadenectomy and continent urinary diversion (rectal sigmoid pouch) performed with an intracorporeal laparoscopic technique at our center. MATERIALS AND METHODS: There were 3 males and 2 females 59 to 65 years old with organ confined, muscle invasive transitional cell carcinoma of the bladder who underwent surgery. The procedure included pelvic lymph node dissection, radical cystectomy with prostate or uterus and tubal structures, creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch. Freehand laparoscopic suturing and in situ knot tying techniques were used exclusively. The mobilized specimens were removed in an endoscopy bag via the rectum or vagina. Laparotomy was not required. RESULTS: Operating time was 6.9 to 7.9 hours (median 7.4) and blood loss was 190 to 300 ml. (median 245). None of the 5 patients none needed blood transfusion. Oral intake was started on hospital day 3, ureteral stents were removed on day 8 and the pouch catheter was removed on day 9. The hospital stay was 10 days for all cases. Histopathological examination of the specimens revealed stage pT1 G3 urothelial carcinoma in case 1, pT2b G2 in cases 2 and 3, pT3a G2 in case 4 and pT3aG3 in case 5. The lymph nodes and resection margins were tumor-free. No intraoperative or postoperative complications were observed. CONCLUSIONS: To our knowledge, this is the first series of laparoscopic radical cystectomy with intracorporeal continent urinary diversion (rectal sigmoid pouch), and our results are promising. With more experience and improvement of the surgical technique, laparoscopic radical cystectomy with continent urinary diversion may become an alternative surgical method for treating select patients with localized muscle invasive bladder cancer.

Carcinoma, Transitional Cell↗
PubMed2001

Laparoscopic radical prostatectomy. Technical aspects and experience with 125 cases.

PURPOSE: The laparoscopic access for radical prostatectomy offers an alternative to the open surgical procedure with less morbidity. We report on our experience with 125 laparoscopic prostatectomies, especially with respect to making the laparoscopic approach a routine procedure and with a view to the oncological and functional results. MATERIAL AND METHODS: From June 1999 to September 2000, we performed 125 laparoscopic prostatectomies. These included only patients with cancer stages T1 or T2. The mean PSA concentration was 10.5 ng/ml. Forty-four percent of the patients had undergone previous abdominal and 19% previous transurethral surgery. For our laparoscopic prostatectomies we used the descending technique. Free-hand laparoscopic suturing and in situ knot-tying technique were used for the urethrovesical anastomosis. The mobilized specimens were removed in an endobag via a muscle splitting incision. RESULTS: All 125 procedures could be completed successfully. No case required conversion to open surgery. The average operating time was 255 min, the last 40 procedures taking 200 min only. Mean blood loss was 185 ml. Two patients (2%) required postoperative blood transfusion. After an initial learning curve, catheter remained in place for an average of 5.5 days, and the average postoperative stay in hospital was 8 days. Intraoperative complications were seen in 5 patients (4%). In 13 patients (10.4%) postoperative complications were observed. 86% of the patients are continent 6 months postoperatively. Preservation of the neurovascular bundle and sexual potency is possible. CONCLUSION: Laparoscopic radical prostatectomy is an ambitious procedure with a steep learning curve, especially for the laparoscopic dissecting and suturing technique. The excellent sight for dissection results in a reduced blood loss and faster convalescence with an overall lower morbidity. Also with regard to oncological and functional (continence) results the minimally invasive access is at least equivalent to the open procedure. In our opinion, laparoscopic prostatectomy will be the future method of choice for radical prostatectomy.

Adult↗
PubMed2001

Complete laparoscopic approach for radical cystectomy and continent urinary diversion (sigma rectum pouch).

Technical and manual progress made in recent years now enables large uro-oncological procedures to be performed by means of laparoscopy. We report the first successful radical laparoscopic cystectomy and laparoscopic construction of a continent urinary diversion. Laparotomy can be avoided completely. The advantages are clear reduction of blood loss and postoperative morbidity with faster convalescence.

Cystectomy↗
PubMed2000

[Value of radiotherapy in urology].

Radiotherapy of patients with prostate cancer offers an alternative to radical prostatectomy in early stages (T1-T2). In locally advanced prostate cancer a high dose or combined radiotherapy is more effective than radical surgery with concurrent lower morbidity and mortality. Recent developments in linear accelerator technique, the progress in dose calculation and planning techniques provide the means to apply higher doses to a given tumor volume while effectively protecting the surrounding normal tissue at the same time. These improvements may possibly reduce the rate of therapy related side effects or complications significantly. The combination of external beam radiotherapy and interstitial brachytherapy as well as the combination of hormone therapy and external beam radiotherapy are most likely more effective than percutaneous irradiation alone. In special cases with a very low risk of recurrent tumor an interstitial permanent brachytherapy alone is indicated. Future developments (i.e. intensity modulated radiotherapy-IMRT, combined thermo-radiotherapy, proton- or neutrontherapy) may further increase the rate of curative treatments in patients with prostate cancer.

Brachytherapy↗
PubMed2000

[MRI of the prostate after combined radiotherapy (afterloading and percutaneous): histopathologic correlation].

AIM: To identify the MRI changes of the prostate after combined (high-dose rate interstitial with external beam) radiotherapy for, localized prostate cancer and to correlate the findings with histology in order to determine the value of MR imaging in the follow-up of these patients. MATERIAL AND METHODS: Twenty-three patients underwent MR imaging at 1.5 T between 6 and 24 months after completion of combined radiotherapy. The prostate was imaged with axial and coronal T2-weighted sequences and axial T1-weighted sequences before and after intravenous administration of Gd-DTPA. Quadrant or sextant biopsy was performed in all cases and three patients with proven persistence of the tumor underwent salvage prostatectomy. The MRI findings were compared with the biopsy results or the large-area sections. RESULTS: On T2-weighted images the fibrotically changed peripheral zone was hypointense while persistent tumor tissue showed hyperintensity. Solid tumors were depicted when they had a diameter of 1 cm or more. Persistent tumors of the diffuse multifocal type escaped detection. Contrast-enhanced T1-weighted imaging yielded no additional information. The accuracy in detecting persistent tumor was 74%. CONCLUSIONS: Histopathologic changes seen after combined radiotherapy correlate with the findings on T2-weighted MR images. MR imaging cannot replace follow-up by routine biopsy. Its only role is assessing local operability in cases found to have increasing PSA levels during follow-up. Further studies are needed to determine the role of MR imaging in this patient population.

Adult↗
PubMed1998

High-dose rate interstitial with external beam irradiation for localized prostate cancer--results of a prospective trial.

PURPOSE: A prospective phase II trial was carried out to test the feasibility and effectiveness of a combined interstitial with external beam radiotherapy approach for localized prostate cancer. MATERIALS AND METHODS: Between October 1992 and December 1994, 82 evaluable patients were treated. T2 and T3 tumours, according to the AJCC classification system of 1992, were found in 21 and 61 cases, respectively. The median follow-up was 24 months; three patients were lost during follow-up. All of the patients were pathologically proven to be node-negative by laparoscopic node dissection of the fossa obturatoria region. A dose of 9 Gy a week was prescribed during the first and second weeks of treatment (10 Gy each week from October 1992 to December 1993) interstitially with high-dose rate Iridium-192 brachytherapy to the prostate and tumour extension beyond the capsule. External beam four-field box irradiation was then given to the prostate to a dose of 45 Gy/25 fractions (40 Gy/20 fractions from October 1992 to December 1993). RESULTS: Before starting treatment, a PSA value of > or =10 ng/ml was found in 64.6% (53/82) of patients with a median PSA of 14.0 ng/ml. The median PSA 3, 12 and 24 months after completion of therapy was 1.20, 0.78 and 0.70 ng/ml, respectively. The PSA value was < 1.0 ng/ ml in 52.9% of patients at 2 years. Negative punch biopsies 12 and 24 months after therapy were observed in 69.8% (44/63) and 73. 1% (38/ 52) of patients, respectively. A positive biopsy combined with a PSA value of > 1.0 ng/ml was considered as local failure. The local tumour control rate was 79.5% at 2 years. Acute side-effects were not increased relative to external beam irradiation alone. Severe side-effects were observed in three patients (two of the three patients had additional risk factors (colitis ulcerosa and diabetes mellitus)); they developed rectourethral fistulae requiring colostomy after biopsies from the anterior rectal wall. CONCLUSION: The described method is feasible and well tolerable. The three complications observed were not caused by irradiation alone. Biopsies from the anterior rectal wall after definitive high-dose radiotherapy for prostate cancer have to be seen as obsolete. The rate of negative prostate biopsies of 73.1% after 24 months represents an encouraging result.

Adenocarcinoma↗
PubMed1998

Laparoscopic ureterolithotomy.

We report about the successful laparoscopic removal of ureteral stones. Since July 1993, 21 patients with large ureteral calculi have undergone laparoscopic ureterolithotomy. In 19 of 21 patients, laparoscopic ureterolithotomy was successful. The mean operating time was 90 minutes. The postoperative inhospital stay was 1 to 4 days. Laparoscopic ureterolithotomy offers an alternative to open surgery in patients with large ureteral stones or when less invasive measures fail.

Adult↗
PubMed1997

Status of the tick-borne diseases in sheep and goats in Turkey.

A serological survey using Indirect Fluorescent Antibody Test (IFAT) for Babesia ovis infection of sheep has been carried out in different geographical regions of Turkey. The results indicated that 71.6% of 141 sheep in Black Sea region, 70.9% of 93 sheep in central Anatolia, 80.2% of 96 sheep in Aegean region and 55.7% of 122 sheep in eastern Anatolia were seropositive. This means that B. ovis infection is endemic throughout Turkey. In addition, occurrence of B. ovis, B. motasi, Theileria hirci, T. recondita and Anaplasma ovis infections in sheep and goats has been reported previously in Turkey as well. However further studies are needed to obtain more information about the agents to keep the infection under control.

Animals↗
PubMed1997

High-dose rate iridium192 afterloading therapy in combination with external beam irradiation for localized prostate cancer.

Development of afterloading techniques in combination with external radiotherapy allows for curative therapy modality for stage C prostate cancer. Between 10/92 and 12/95 128 patients were treated. Stage B and C tumors were found in 36 and 89 cases, respectively. All patients were pathologically proven to be node-negative by laparoscopic node dissection of the fossa obturatoria region. 9 Gy a week was applied during the first and second weeks of treatment (10/92-12/93: 10 Gy each week) interstitially with high-dose rate iridium192 brachytherapy to the prostate. After this, a four-field box of external beam radiation therapy was given to the prostate to a dose of 45 Gy/25 fractions (10/92-12/93: 40 Gy/20 fractions). Before starting treatment median PSA was 13.8 ng/ml. The median PSA 3, 12, and 24 months after completion of therapy was 1.2, 0.78, and 0.75 ng/ml, respectively. Negative biopsies 12 and 24 months after therapy were observed in 56% (49/87) and 72% (31/43), respectively.

Adenocarcinoma↗
PubMed1996

[Complications of laparoscopic interventions in urology].

From April 1987 to November 1995, we performed 741 laparoscopic procedures, in which we observed 14 major complications (1.9% complication rate). The complication rate was 4% in the first 100 procedures--more than twice as many as in the following 631 procedures, which had a complication rate of 1.6%. Although between 1987 and 1990 laparoscopy was mainly used for the diagnosis of cryptorchidism, we then progressed to therapeutic measures with the help of the laparoscopic technique. After performing laparoscopic orchiectomy (1990), we introduced fenestration of lymphoceles (1991), varicocelectomy (1991), pelvic staging lymphadenectomy (1992), nephrectomy (1992), and adrenalectomy (1994) into clinical practice, in addition to other, more rarely occurring procedures. The complications we observed demonstrate a clear learning curve and show that critical, gradual practice of the laparoscopic technique is necessary.

Female↗