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Biomedical subjects

U Jonas

Publications and source records attributed to U Jonas.

At least 109 records · Page 6Linked to original sources
PubMed1999

Max Brödel (1870-1941) and Howard A. Kelly (1858-1943)--urogynecology and the birth of modern medical illustration.

In 1894 the German artist Max Brödel came to America and started work with the famous gynecologist Howard A. Kelly. By developing a profound medical knowledge especially in the field of gynecology, and creating new artistic techniques for medical illustration, Brödel revolutionized the appearance of medical literature and founded the profession of medical artist and illustrator. In 1911, Brödel became head of the first 'Department of Art as Applied to Medicine' in the world. The ingenious cooperation of the artist Brödel and the gynecologist Kelly and their influence on modem medical illustration is reflected in this historical article.

Female↗
PubMed1999

Direct electrospray-ionization mass spectrometric analysis of the major ganglioside from crucian carp liver after thin layer chromatography.

Ganglioside patterns from crucian carp brain, muscle, and liver as well as liver gangliosides of roach, carp, the cichlid Oreochromis mossambicus, pigeon, dwarf hamster, and calf were comparatively analyzed by high performance thin layer chromatography (HPTLC). To achieve a rapid estimation on potentially interesting ganglioside compounds, electrospray-ionization mass spectrometry (MS) was directly applied to a chloroform/methanol extract of the major TLC band of crucian carp liver. The spectrum, obtained from a few micrograms of this crude biological sample, revealed a series of peaks corresponding to GM4-like monosialoganglioside species. GC-MS analysis revealed hydroxylated fatty acids ranging from 2 h 20 min:0 to 2 h 26 min:0 for the [M'H]- ions of m/z 1061-1145. Collision induced dissociation tandem MS/MS of the major peak with a [M'H]- ion of m/z 1117 demonstrated the presence of N-acetylneuraminic acid as sialic acid compound. The sugar composition was confirmed by GLC as galactose and sialic acid in a 1:1 molar ratio. Thus, the structure of the ion at m/z 1117 is N-acetylneuraminylgalactosylceramide (NeuAc-Gal-Cer) with the long chain base d18:1 and the hydroxylated fatty acid 2 h 24 min:0. The results demonstrate for the first time unambiguously that NeuAc-Gal-Cer is the main ganglioside fraction in fish liver and that electrospray ionization-mass spectrometry (ESI-MS) can be used to elucidate the chemical composition of a ganglioside fraction obtained by convenient extraction of a HPTLC band.

Animals↗
PubMed1999

Predictive value of decreased p27Kip1 protein expression for the recurrence-free and long-term survival of prostate cancer patients.

The p27Kip1 gene has been identified as inductor of cell cycle arrest at the G1 checkpoint to prevent entry of somatic cells into the S phase of the cell cycle when substantial DNA damage has occurred. It has been suggested that decreased expression of the p27Kip1 protein may contribute to the development of human malignancies due to loss of critical antiproliferative mechanisms. In the present study, 95 specimens (T1-T4) from 95 randomly selected patients undergoing radical prostatectomy at the Urological Department of Hannover University (82 patients) as well as in the Josef Hospital Regensburg (13 patients) between 1981 and 1992 for whom tissue blocks for immunohistochemical investigation were available, were investigated for different biological and clinical characteristics as possible predictors for recurrence-free and long-term survival: age, depth of tumour infiltration, histological grade, lymph node status, as well as decreased expression of the p27Kip1 protein. After a median follow-up up of 56 months (24-151 months), seven of 21 (33%) patients (Group 1) with loss of p27Kip1 protein expression or a relative amount of <10% of positively stained tumour cells developed recurrent disease in contrast to 17 of 74 (23%) patients (Group 2) with retained p27Kip1 protein expression (> or =10% of positively stained tumour cells). The median recurrence-free survival was 14 months (5-40 months) for patients from Group 1 and 31 months (7-133 months) for Group 2 patients (P = 0.02). In multivariate analysis, loss of p27Kip1 protein expression was identified as the only independent prognostic parameter for recurrence-free survival. In contrast, neither the univariate nor the multivariate analysis showed a correlation between loss of p27Kip1 protein expression and the long-term survival of the patients. Prospective studies are urgently needed to confirm the independent prognostic value of decreased p27Kip1 protein expression together with overexpression of the p53 tumour suppressor protein in patients with localized prostate cancer. The availability of more refined prognostically important biological variables in addition to established prognostic factors like tumour stage or Gleason score might help decision making in patients at high risk for the development of local recurrence or systemic tumour progression.

Adenocarcinoma↗
PubMed1999

Petroleum jelly is an ideal contact medium for pain reduction and successful treatment with extracorporeal shock wave lithotripsy.

PURPOSE: Various minimally invasive approaches to reduce pain during extracorporeal shock wave lithotripsy (ESWL) have been described. We compared petroleum jelly (Vaselinet) and ultrasound gel in vitro as a contact medium based on the stone fragmentation rate. The analgesic effect of cutaneous petroleum jelly was tested against eutectic mixture of local anesthesia. We also evaluated the outcome of ESWL in a large group of patients treated with petroleum jelly. MATERIALS AND METHODS: In vitro 3 artificial stones were completely fragmented with a MFL 5000* lithotriptor using petroleum jelly or ultrasound gel as a contact medium. A total of 110 patients (group 1) received petroleum jelly before treatment with the same lithotriptor. After retrospective analysis of group 1 we matched 32 patients (group 2) receiving cutaneous eutectic mixture of local anesthesia. Because of the favorable results with petroleum jelly, we used it in another 148 patients, for a total of 258 patients (group V). Treatment dependent pain was scored using a questionnaire as 1--no, 2--minor, 3--tolerable and 4--intolerable. ESWL without additional analgesics had a pain score of 1 to 3. RESULTS: In vitro petroleum jelly had a superior fragmentation rate compared to ultrasound gel. Our long-term experience with the lithotriptor indicated that only 30% of patients required no additional analgesics with cutaneous ultrasound gel. In contrast, no additional analgesics were needed in only 38% of group 2 compared to 81.8% of group V. The stone fragmentation rate did not differ statistically between groups. CONCLUSIONS: Cutaneous petroleum jelly offers a noninvasive, highly effective, inexpensive treatment modality with no side effects and significant reduction in pain. This ointment is our contact medium of choice.

Anesthetics, Local↗
PubMed1999

Tamsulosin: 3-year long-term efficacy and safety in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction: analysis of a European, multinational, multicenter, open-label study. European Tamsulosin Study Group.

OBJECTIVE: This open-label extension study evaluated the efficacy and safety of tamsulosin (0.4 mg as a modified release formulation) once daily in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) treated for up to 3 years. METHODS: Patients were enrolled from two European, 12-week, placebo-controlled trials. This analysis reports on 355 patients randomized originally to tamsulosin (n = 244) or placebo (n = 111) in the two placebo-controlled trials with follow-up data for up to 3 years. RESULTS: The significant improvements in the primary efficacy parameters, maximum urinary flow rate (Q(max)) and total Boyarsky symptom score that were observed during the placebo-controlled trials were sustained throughout the long-term extension study for up to 3 years in patients who remained on therapy. Mean Q(max) increased from baseline (range 0.7-1.8 ml/s; p < 0.05 vs. baseline) and remained between 11.5 and 12 ml/s during the entire follow-up period. Total Boyarsky symptom score also improved from baseline (range -3.7 to -4.1 (or -39 to -44%); p < 0.001 vs. baseline). Similarly, the percentage of treatment responders, defined as an increase in Q(max) of >/=30% or a decrease in total symptom score of >/=25%, remained constant throughout the 3-year period. The number of patients who had a clinically significant total Boyarsky symptom score response ranged between 69 and 80%. During the 3-year study period, 95 patients (27%) experienced an adverse event considered to be possibly or probably related to study medication, the most common of which (occurring in </=6% of patients) were dizziness and abnormal ejaculation. There were no clinically significant changes in blood pressure or pulse rate during the study. CONCLUSION: Long-term tamsulosin therapy is safe, well-tolerated and improvements in urinary flow and symptoms are maintained in patients with LUTS suggestive of BPO who remain on treatment for up to 3 years.

Administration, Oral↗
PubMed1999

Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group.

PURPOSE: A prospective, randomized study was performed to evaluate sacral nerve stimulation for the treatment of refractory urinary urge incontinence. MATERIALS AND METHODS: Primary outcome variables were obtained from voiding diaries. After baseline evaluation candidates who satisfied inclusion criteria were enrolled into the study. Test stimulation results determined eligibility for randomization into a stimulation (treatment) or delay (control) group. The stimulation group included 34 patients who underwent implantation and were followed for 6 months. The delay group comprised 42 patients who received standard medical therapy for 6 months and then were offered implantation. The stimulation group completed a therapy evaluation test (on versus off) after 6 months. RESULTS: At 6 months the number of daily incontinence episodes, severity of episodes and absorbent pads or diapers replaced daily due to incontinence were significantly reduced in the stimulation compared to the delay group (all p<0.0001). Of the 34 stimulation group patients 16 (47%) were completely dry and an additional 10 (29%) demonstrated a greater than 50% reduction in incontinence episodes 6 months after implantation. Efficacy appeared to be sustained for 18 months. During the therapy evaluation test the group returned to baseline levels of incontinence when stimulation was inactivated. Urodynamic testing confirmed that sacral nerve stimulation did not adversely affect voiding function. Complications included implantable pulse generator site pain in 15.9% of the patients, implant site pain in 19.1% and lead migration in 7.0%. Surgical revision was required in 32.5% of patients with implants to resolve a complication. There were no reports of permanent injury or nerve damage. CONCLUSIONS: Sacral nerve stimulation is safe and effective in treating refractory urinary urge incontinence.

Adult↗
PubMed1998

Differential involvement of gangliosides versus phospholipids in the process of temperature adaptation in vertebrates. A comparative phenomenological and physicochemical study.

The data presented support the idea that gangliosides are involved in thermal adaptation of neuronal membranes. Brain ganglioside patterns from cold-blooded vertebrate species living in different climates and from mammals during ontogenetical or seasonal changes in their body temperature were compared. The general rule "the lower the environmental temperature the more polar is the composition of brain gangliosides" as derived from these data was confirmed by the changes in ganglioside patterns evoked by experimentally induced cold acclimation of fish. To assess whether gangliosides are able to modulate the temperature-dependent properties of membranes, artificial mono- and bilayer membrane model systems were used. Incorporation of gangliosides in the model bilayer membranes evoked drastic changes in the dynamics of a peptide channel, suggesting that gangliosides are able to modulate basic membrane properties. In addition, data on thermosensitivity of ganglioside-calcium interactions and on surface behavior of gangliosides in monolayers are reviewed.

Acclimatization↗
PubMed1998

[Prognostic relevance of vena cava thrombosis in renal cell carcinoma].

The independent prognostic value of neoplastic extension of renal cell cancer (RCC) into the vena cava inferior has been the subject of several investigations reported to date. However, the use of vena cava thrombosis as an independent prognosticator of a patient's long-term survival is still debated. We have therefore correlated the clinical course of 53 patients with RCC and vena cava thrombosis with a control group consisting of 47 patients with renal cell tumors without vena cava thrombosis (follow-up: 1-154 months). The median long-term survival of patients with and without vena cava thrombosis was 32 and 35 months, respectively. Neither the propagation of the tumor into the vena cava (P = 0.391) nor the cranial extension of the thrombosis (P = 0.158)--even in case of propagation into the right atrium--could be identified as parameters of any prognostic value during univariate or multivariate statistical analysis.

Adult↗
PubMed1998

[Percutaneous bladder neck suspension with osseous fixation. Surgical technique and initial results in 26 patients].

A modification of percutaneous needle suspension using a bone anchor system for fixation of the suture to the pubic bone is presented. After a follow-up of 3-11 months (mean 6,8) the postoperative success-rate in 26 patients is 73.1% (n = 19). A removal of bone anchor and suture was necessary in 2 patients because of bacterial infection or soft tissue granuloma. We can not reinforce the very optimistic results of the first reports published in the recent years. Therefore it is still questionable whether percutaneous needle bladder neck suspension should be a first line procedure for the treatment of female urinary stress incontinence.

Adult↗
PubMed1998

[Pharmacological therapy of erectile dysfunction].

Pharmacotherapy of erectile dysfunction comprises oral and local application of drugs. Today, Yohimbin is the only drug listed for this indication. Yohimbin acts via central alpha-receptor blockade and showed a significant effect in a recent double blind study compared to placebo. The centrally acting substances Apomorphin and Trazodone were also tested for their potential use with Apomorphin showing promising results. The orally active phosphodiesterase-V inhibitor Sildenafil acts predominantly on the peripheral side; broad clinical studies demonstrated a significant effect of the drugs compared to placebo. For local use, intraurethral (MUSE) and intracavernous applications are available with PGE1 being the drug the most widely used for the moment. Since many different drugs with various modes of action and different modes of application are being developed at the moment, future pharmacological treatments will allow a more refined approach towards an individually adapted regimen.

Adrenergic alpha-Antagonists↗
PubMed1998

Urodynamics and transurethral microwave thermotherapy.

In this paper the role and value of urodynamic measurements in symptomatic benign prostatic hyperplasia (BPH) patients selected for transurethral microwave thermotherapy (TUMT) reviewed. Although pressure-flow studies alone can diagnose benign prostatic obstruction, the level of acceptance of urodynamic investigations in BPH remains low, reportedly due to their cost and to their invasive and time-consuming nature. Furthermore, the observation that extremely different treatment modalities in BPH have nearly the same symptomatic outcome, independently of their influence on obstruction, has played a part in raising doubt as to the value of baseline urodynamics as a predictor of clinical success. Pre- and posttherapy urodynamic investigations in TUMT-treated patients have shown that urodynamic algorithms must be capable of distinguishing between compressive and constrictive types of obstruction to document the limited effects of low-energy TUMT on obstruction. Furthermore, it has been shown that urodynamics evaluated in this way seems to be the only predictor of the clinical success of TUMT when improvements in the objective parameters Qmax (peak uroflow) and residual urine are included in the definition of outcome.

Diathermy↗
PubMed1998

Recent strategies for the use of paclitaxel in the treatment of urological malignancies.

Paclitaxel, a natural anticancer drug, has gained widespread acceptance as an active broad-spectrum antitumor agent, including its use in urological malignancies, particularly urothelial tract cancer and testicular cancer. The mechanism of action, based on the premature stabilization of the microtubule assembly with disruption of the cytoskeletal framework, is completely different from those of DNA-damaging agents, e.g., cisplatin and ifosfamide. As a single agent, paclitaxel is one of the most active drugs in metastatic bladder cancer, with an overall response rate of 40-50% being obtained in previously untreated patients. These promising single-agent results have prompted the use of combination regimens including, in particular, cisplatin and paclitaxel. A high degree of activity for the cisplatin-paclitaxel combination as reflected by responses in 50-80% of patients, including a substantial number of complete responses (> 30%), has been identified. The role of other agents such as vinorelbine, methotrexate, 5-fluorouracil, or ifosfamide as additions to this two-drug combination currently remains open. The combination of paclitaxel plus ifosfamide or vinorelbine in the absence of a platinum derivative has yielded rather disappointing results. Of particular interest may be the combination of paclitaxel and carboplatin. Both drugs can be given to patients with impaired renal function. Overall response rates of 45-60% have been reported in phase II studies. The so-called platelet-sparing effect of paclitaxel given in combination with carboplatin has resulted in a surprisingly low frequency of myelotoxicity, particularly thrombocytopenia. The combination of paclitaxel with carboplatin is being compared in an ongoing trial against the current standard MVAC regimen (methotrexate/vinblastine/Adriamycin/cisplatin) in patients with metastatic disease. Furthermore, the activity of paclitaxel-based combinations is currently being explored in the neoadjuvant setting in phase II studies, and the potential for the combination with the other new promising agent--gemcitabine--will be evaluated in a phase I setting. In prostate cancer, estramustine phosphate is widely used as palliative treatment for patients with hormone-refractory disease. In vitro synergistic activity has been observed between estramustine and paclitaxel in prostate-cancer cell lines, although paclitaxel has not demonstrated single-agent activity in patients with hormone-refractory prostate cancer. In clinical trials the combination of the two agents was associated with increased gastrointestinal toxicity. The addition of etoposide as a third drug has yielded prostate-specific antigen (PSA)-response rates of > 50%, but data on quality of life and survival time have not been reported for these combinations. A true clinical role for paclitaxel in prostate cancer has therefore not been established. Paclitaxel has finally demonstrated single-agent activity in relapsed and/or cisplatin-refractory testicular cancer in recent phase II trials, indicating different mechanisms of resistance to cisplatin and paclitaxel. These results have formed the rationale for the introduction of paclitaxel as part of combination chemotherapy regimens in patients with relapsed but chemosensitive testicular cancer. Preliminary results demonstrate that paclitaxel can be safely included into these conventional-dose combination regimens. When it is used prior to high-dose chemotherapy, sufficient numbers of peripheral blood stem cells (PBSCs) for high-dose therapy can be collected. The final role of paclitaxel in risk-adapted chemotherapeutic strategies in testicular cancer is not defined, but it appears that paclitaxel-based combinations can achieve a substantial response rate in patients with relapsed disease.

Antineoplastic Agents, Phytogenic↗
PubMed1998

The effect of the specific phosphodiesterase-IV-inhibitor rolipram on the ureteral peristalsis of the rabbit in vitro and in vivo.

PURPOSE: Cyclic nucleotide phosphodiesterases (PDE's) are intracellular key enzymes in the regulation of the tone in smooth muscle cells. There are 5 different isoenzyme families that show a specific organ and species distribution pattern. The aim of our study was to examine possible selective ureteral relaxation by the specific PDE-IV-inhibitor rolipram in the rabbit. MATERIALS AND METHODS: For in vitro studies ureters were taken from 12 patients who underwent radical nephrectomy and from 4 rabbits which were sacrificed. For the in vivo study 23 rabbits received intravenous administration of papaverine (300 microg./kg. b.w., n = 2), scopolamine (667 microg./kg. b.w., n = 2), theophylline (5 mg./kg. b.w., n = 2) and rolipram (5 and 20 microg./kg. b.w., n = 9 and n = 8). Ureteral dynamic parameters (frequency, amplitude, tonus) and systemic blood pressure were continuously monitored 40 minutes before and at least 60 minutes after injection of the drugs. RESULTS: Scopolamine had no effect on ureteral peristalsis, but significant effects on systemic blood pressure were observed. Papaverine and theophylline showed short-lasting ureteral relaxations, but were accompanied by severe circulatory side effects. Rolipram showed pronounced ureteral relaxation with minimal circulatory effects. CONCLUSION: Our results show that intravenous administration of the specific PDE-IV-inhibitor rolipram relaxes the rabbit ureter without significant circulatory side effects. Because human and rabbit ureter show similar relaxation results in vitro, this pharmacological approach seems promising for the treatment of ureteral colic and the facilitation of urinary stone passage in humans.

Animals↗