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Biomedical subjects

W Höltl

Publications and source records attributed to W Höltl.

At least 19 recordsLinked to original sources
PubMed1997

Clinical usefulness of percentage of free serum prostate specific antigen.

Serum concentrations of total and free prostate specific antigen were measured retrospectively in 268 patients, in order to test the usefulness of percentage of free prostate specific antigen in distinguishing between cancer and benign hyperplasia of the prostate and to improve the specificity of cancer screening. Four groups were investigated: 94 urologic patients without prostate disease (controls), 98 patients with a histologically confirmed benign hyperplasia, 76 with histologically established prostatic adenocarcinoma, 18 of them after radical prostatectomy. Total and free prostate specific antigen concentrations were measured in frozen serum, in a retrospective mode, by using an equimolar monoclonal antibody immunoassay. Median percentage of free prostate specific antigen was 20.48% in controls, 17.75% in patients with hyperplasia, 10.52% in patients with cancer and 33.03% in patients after prostatectomy. Median percentage of free prostate specific antigen was significantly lower in men with cancer than in patients with benign hyperplasia (P < 0.0001). The percentage of free prostate specific antigen increased the specificity of cancer screening: a cut-off of 23.6% detected at least 90% of cancers and would have eliminated 34.7% of biopsies in benign hyperplasias. A prospective study is ongoing to confirm these results.

Adenocarcinoma↗
PubMed1997

Testis-preserving surgery in bilateral testicular germ cell tumours.

OBJECTIVE: To evaluate the indications, techniques and outcome of organ-preserving tumour enucleation in patients with bilateral testicular germ cell tumours (BTGCT) rather than standard bilateral radical orchidectomy which results in loss of fertility and a lifelong requirement for androgen replacement. PATIENTS AND METHODS: In 13 patients with BTGCT of 6-30 mm in diameter, the tumours were enucleated under cold ischaemia after inguinal testicular exploration, and biopsies of the tumour bed and the peripheral parenchyma were taken. Histology of the orchidectomy specimen revealed a seminoma in four cases, an embryonal carcinoma in three, a teratocarcinoma and a mixed-germ cell tumour in two each, and a mature teratoma in one. Histology of the enucleated tumours showed a seminoma in seven cases, an embryonal carcinoma in five and a mature teratoma in one. Six of the 13 patients underwent testicular radiation (20 Gy) for carcinoma in situ (CIS) and five patients had adjuvant local therapy. Six months postoperatively a testicular biopsy was taken to determine the success of therapy. RESULTS: The median follow-up was 62 months (range 14-163) and the 13 patients are currently free of disease; one patient had local recurrence 9 months after tumour enucleation but after orchidectomy the patient is free of disease after a follow-up of 156 months. Serum concentrations of luteinizing hormone and testosterone were within the normal range in all patients and no androgen substitution was necessary. A testicular biopsy taken 6 months post-operatively revealed Sertoli cells only in all patients who had received radiation therapy. CONCLUSIONS: These results suggest that organ-sparing surgery in patients with BTGCT represents a new therapeutic approach with endocrinological and psychological advantages. In our experience, enucleation resection of testicular tumours is possible with certain prerequisites, i.e. the tumour is organ-confined with no infiltration of the rete testis, multiple biopsies of the tumour bed and peripheral parenchyma should be taken, any associated CIS treated by radiation therapy, and patients must be followed closely.

Carcinoma in Situ↗
PubMed1996

Adrenalectomy--still a must in radical renal surgery?

OBJECTIVE: To investigate the incidence of adrenal involvement and survival in patients with renal cell carcinoma. PATIENTS AND METHODS: A retrospective, multicentre trial was initiated by the Austrian Association of Urologic Oncology (AUO); between January 1980 and December 1984, 225 patients were eligible for the study. All patients had unilateral renal tumours and nephrectomies were performed either with (group A, 109 patients) or without (group B, 116 patients) adrenalectomy. The two groups were matched for sex, age, laterality and nodal status. The mean follow-up time was 78 months. RESULTS: The location of the intrarenal tumour had no significant effect on adrenal involvement. By univariate and multivariate analysis (Cox's proportional hazards model) significant differences in outcome were found only for pT stages. The mean survival times of patients in group A were 122.9 months in those with stage pT1/2, 76.6 months with stage pT3 and 75.3 months with stage pT4. In group B, survival times were 109 months in those with stage pT1/2 (not significant) and 111 months in stage pT3 (P = 0.0076). Eight patients had adrenal involvement and died from their tumours after a median of 15.3 months (range 4-63). The slightly longer survival of patients in group B with stage T1/2 tumours and the significantly better survival of patients with stage T3 disease may be attributable to statistical bias, but there was no benefit from adrenalectomy. CONCLUSION: The effect of adrenalectomy on the prognosis was at best comparable to that of lymphadenectomy and no curative effect was demonstrated. The removal of a healthy adrenal may be detrimental and cause subsequent problems in those patients requiring hormone replacement.

Adrenalectomy↗
PubMed1996

Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial.

PURPOSE: To assess the impact of short-term adjuvant chemotherapy on relapse rates, treatment-related morbidity, and long-term toxicity in patients with clinical stage I nonseminomatous testicular germ cell tumor (NSGCT I) who carry a high risk of relapse, ie, who show blood-vessel invasion (VI) by the primary tumor. PATIENTS AND METHODS: From January 1985 to January 1995, 42 NSGCT I patients with VI were treated with two courses of cisplatin, etoposide, and bleomycin (PEB) after orchidectomy. Of these, 29 patients with a follow-up time of more than 2 years are the subject of this report. NSGCT I patients without VI were assigned to a surveillance program and served as controls for the assessment of long-term toxicity. RESULTS: During a median follow-up time of 79 months (range, 27 to 119), two patients relapsed. One developed fully differentiated mature teratoma; the other was a true chemotherapy failure and again developed embryonal carcinoma. Twenty-seven patients (93%) are alive without evidence of disease; one patient (3%) died of progressive testicular cancer and another of lung cancer. The two courses of PEB did not cause any severe acute adverse reactions. The assessment of late sequels of adjuvant chemotherapy based on clinical and laboratory evidence of cardiovascular and pulmonary disease, fertility, and secondary neoplasms, as well as on a psychosocial questionnaire, did not show any significant disadvantages versus the control group. CONCLUSION: Adjuvant chemotherapy with two courses of PEB is an effective and reasonable treatment option for patients with clinical stage I NSGCT who carry a high risk of relapse. No adverse late sequelae were detected within a median follow-up time of more than 6 years.

Adolescent↗
PubMed1995

Basic research.

Basic research is currently investigating the molecular cascade associated with bladder cancer development. Many new findings are potential leads towards the improvement of the diagnosis and prognosis of this disease. Special care, however, should be taken in the design of protocols for clinical evaluation of the value of these markers. Some initial guidelines have been put forward in this report.

Alleles↗
PubMed1994

[Topical immunotherapy (KLH) vs. chemotherapy (Ethoglucid) in prevention of recurrence of superficial bladder cancer. A prospective randomized study].

A prospective randomized controlled study on the effect of KLH (keyhole limpet hemocyanin) versus etoglucid in the prevention of recurrences in primary and recurrent superficial transitional cell carcinoma of the bladder (stage pTa-pT1, grades 1-3 according to the recommendations of UICC and WHO) after complete transurethral resection of the tumor started in 198. Patients in group 1 (n = 76) were immunized with 1 mg KLH intracutaneously, after which they received bladder instillations of 30 mg (30 ml) KLH weekly for 6 weeks and then monthly for 1 year. Patients in group 2 (n = 85) received weekly bladder instillations of 0.565 g etoglucid (50 ml 1% solution) for 6 weeks and then monthly for 1 year. The percentage of recurrences, recurrence rate, disease-free interval and tumor progression rate were evaluated for both treatment groups. The end-point of the study was progression in stage or grade or more than two recurrences during the observation period. The shortest follow-up was 12 months, the mean follow-up, 27.5 months. No statistically significant differences were found between the two groups in percentage of recurrences (43.4% KLH-53.9% etoglucid), recurrence rate (4.4 KLH-3.9 etoglucid), mean disease-free interval (12.1 months KLH-13.6 months etoglucid) or progression rate (6.5% KLH-9.4% etoglucid).

Adjuvants, Immunologic↗
PubMed1991

Lord's procedure--the best operation for hydrocele?

A prospective study was carried out to compare Lord's hydrocele operation with traditional surgical procedures. The groups of patients investigated were comparable in terms of age, period of observation, number of previous aspirations and size of hydrocele. The incidence of isolated hydrocele of the spermatic cord, as well as epididymal cysts, was lower in the patients who underwent Lord's procedure (7.2 versus 15.8%), as was the percentage of patients reporting post-operative pain for more than 3 days (4.3 versus 15.8%, p less than 0.05).

Adolescent↗
PubMed1991

Complete androgen deprivation prior to radical prostatectomy in patients with stage T3 cancer of the prostate.

Twenty-one patients with stage T3 cancer of the prostate underwent complete androgen deprivation (LH-RH agonist and flutamide) for 3 months prior to radical prostatectomy. Two problems were to be dealt with: the decrease in the volume of the prostate, and the possibility of downstaging (= pT less than pT3 according to the UICC 1987 classification) of the prostatic cancer. A decrease in the volume was noted in each case. A downstaging effect (pT in comparison to T stage) was noted in 33% of the patients. The downstaging effect was noted in 75% of grade 1 tumor, in 31% of grade 2 tumors, but not in grade 3 tumors.

Aged↗
PubMed1990

Recurrent superficial transitional cell carcinoma of the bladder: adjuvant topical chemotherapy versus immunotherapy. A prospective randomized trial.

A multicenter, prospective, randomized controlled study was begun in 1985 on the effect of ethoglucid and keyhole-limpet hemocyanin in the prevention of recurrent superficial transitional cell carcinoma of the bladder (stages pTa to pT1, grades 1 to 3 according to the recommendation of the International Union Against Cancer and the World Health Organization). The study was performed on a selected group of patients at high risk for further recurrences. All of these patients were pre-treated with different chemotherapeutic agents (doxorubicin or mitomycin C) and still had recurrent superficial transitional cell carcinoma. All tumors were removed by transurethral resection and all patients were presumed to be free of tumor at initiation of the prophylactic instillations. Patients in the ethoglucid group received 0.565 gm. (solution of 1%) ethoglucid weekly for 6 weeks and then monthly for 1 year. Patients in the keyhole-limpet hemocyanin group were immunized with 1 mg. keyhole-limpet hemocyanin intracutaneously, and then weekly bladder instillations of 30 mg. were given for 6 weeks and then monthly for 1 year. The percentage of recurrences, recurrence rate, interval free of disease, tumor progression and effect on downstaging were evaluated for both therapeutic arms. The percentage of recurrences (60.9% in the ethoglucid group versus 55.3% in the keyhole-limpet hemocyanin group) and the comparison of interval to recurrence for all patients showed no statistical significant difference (p = 0.808, Mantel-Cox test). A comparison of the interval to recurrence in patients with recurrent tumors only showed a mean interval free of disease of 8.8 months for patients given ethoglucid versus 5.5 months for those given keyhole-limpet hemocyanin (p = 0.006, Wilcoxon test). Recurrence rate (4.8 versus 6.5, respectively) and tumor progression rate (21.7 versus 21.1%, respectively) showed no statistically significant difference (p greater than 0.1).

Administration, Intravesical↗
PubMed1990

Incidental carcinoma of the prostate: an improved modality for early detection.

In a prospective study 140 unselected patients with clinical evidence of benign adenoma of the prostate were resected via a transurethral approach. Pathohistological analysis was done according to selective criteria for tissue sampling. 16 incidental carcinomas (T0; 11.4%) were detected. In a retrospective analysis 244 patients were operated on by the same method compared with 326 patients with conventional transurethral resection. T0 tumors were found in 11.5 versus 5.2% of the patients. The increase in the incidence of T0 tumors was significant (p less than 0.004). We recommend this modality as a simple method to optimize early detection of T0 tumors in the transurethral resection specimens.

Biopsy↗
PubMed1990

Organ-preserving surgery in patients with urothelial tumors of the upper urinary tract.

The Austrian Urological Oncology Group reports on 55 organ-preserving operations in 52 patients with tumors of the upper urinary tract epithelium. The data were gathered from 12 urological departments in the country. There was no evidence of distant metastases in any of the patients at the time of surgery. The observation period ranged from 0.5 to 12 years. 69.2% (36 of 52) of the patients were alive and recurrence-free at the time of data collection, after a mean observation period of 41.4 months. 9.6% died for reasons other than cancer after an average of 18.8 months, and 21.2% were still alive with or had died due to recurrent tumors. The recurrence rate after open surgery was similar in tumors of the upper ureter or pelvis (15.3%) as in tumors of the lower ureter (17.6%). After endoscopic treatment 4 of 9 patients showed recurrences. 92% (22 of 24) of the patients with no compelling indication for organ-preserving therapy were alive and recurrence-free or had died due to other causes. Therefore organ-preserving surgery appears to be appropriate in tumors of the upper urinary tract epithelium.

Aged↗
PubMed1990

Risk-adapted treatment choice in stage I nonseminomatous testicular germ cell cancer by regarding vascular invasion in the primary tumor: a prospective trial.

Based on the results of a retrospective study, which found blood vessel invasion to be the most important prognostic factor in clinical stage I nonseminomatous testicular germ cell cancer (NSTGCC I), a prospective study was started in 1985 which assigned NSTGCC I patients without evidence of vascular invasion to surveillance and patients with vascular invasion to two cycles of adjuvant chemotherapy with cisplatin, etoposide, and bleomycin. Twenty-two patients entered the surveillance group and 18 patients received adjuvant chemotherapy. Median follow-up is 30 months (3 to 50 months). Relapses occurred in three patients (7.5%), one in the surveillance group (4.5%), two in the chemotherapy group (11%). Thirty-eight patients (95%) are alive and without evidence of disease. Two patients of the adjuvant-treated group died, one of progressive germ cell cancer and one of lung cancer. We conclude that low- and high-risk NSTGCC I patients can be identified by considering blood vessel invasion. The presence of embryonal carcinoma and vascular invasion seem to be interrelated prognostic factors, because in 94% of vessel invasion the invading element was embryonal carcinoma. The exclusion of patients with vascular invasion from surveillance decreases relapse rates remarkably. Adjuvant chemotherapy diminishes relapse rates in high-risk patients but does not entirely prevent relapse.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

The microvasculature of the guinea pig ureter. A scanning electron microscopic investigation.

In 24 albinotic guinea pigs (Cavia porcellus) the gross vasculature and the microvascular architecture of the ureter were studied by light microscopy of tissue blocks and by scanning electron microscopy of vascular casts. The guinea pig ureter is supplied by the renal artery proximally, by the aorta and the internal iliac artery in its mid-segment, and by the uterine and prostatic as well as by the vesical arteries distally. The main arterial trunks run alongside the ureter before they branch to send perforating arterioles to the muscular coat and the mucosal lining. The draining venules are found on both sides of the ureter and form transverse anastomoses. Communications between the arterioles are also located on both sides, but longitudinally arranged. The capillary network of the mucosal lining shows an undulating pattern with tortuous vessels and lies just below the epithelium. The muscular coat and the adventitia have no prominent capillaries of their own. Large arteries are embedded in the adventitia, large veins in the lamina propria. In analogy to human anatomy the vascular arrangement found suggests that, if the ureters are excised in transplant surgery, a lateral incision should be used for the abdominal portion, while the pelvic portion is best approached by a medial incision.

Animals↗
PubMed1987

[Is lymphadenectomy in stage I of non-seminomatous testicular cancer still justified?].

Testicular cancer is the tumour of the male genital tract which is most easily and successfully treated today. This very circumstance dictates that for ethical reasons we are more bound than ever to prevent unnecessary diagnostic and therapeutic procedures in these young patients. They should receive only the maximum necessary and not the maximum possible therapy. The difference between these two critical concepts determines the extent of treatment morbidity. Retroperitoneal lymphadenectomy (RLA) is only a diagnostic procedure in approximately 85% of cases. This is the reason for critically reviewing the necessity of this investigation in early non-seminomatous cancer of the testes. The prognostic impact of vascular invasion by the primary tumour is demonstrated in a retrospective study of 86 pathohistological specimens of germ cell tumours. We suggest the inclusion of vascular invasion basically as criterion for any prospective "wait and see" protocol in early non-seminomatous germ cell tumours.

Combined Modality Therapy↗
PubMed1984

[Testicular tumor staging: the ranking of CT and ultrasonic diagnosis].

In a retrospective study 79 patients suffering from a tumour of the testis were analysed between March 1977 and March 1983. Of these, 31 patients were examined via CT. The radiologist's task was the staging of these cases. The results show the superiority of CT diagnosis, which led to only one false-negative report. For the evaluation of stage II ultrasonography is useful, too, even though small lymphomas might be overlooked. If CT is not available, sonography, which is less costly, might be a good substitute. With regard to cooperative therapy, staging together with the histology of the primary tumour and determination of tumour markers are of essential importance.

Adolescent↗