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C Doehn

Publications and source records attributed to C Doehn.

At least 19 recordsLinked to original sources
PubMed2002

[Urologic laparoscopy in marginal patients].

This paper describes the use of urological laparoscopy in borderline patients, focussing on geriatric patients and those with renal failure. Laparoscopy must not only be feasible but also at least as effective concerning operative and postoperative parameters when compared to standard open surgery. For laparoscopic nephrectomy most of these factors have tested positive. However, only a few papers have been published concerning borderline patients. In some cases the pneumoperitoneum may not be suitable for borderline patients and open operative techniques are preferred. Apart from this, the current literature supports the effectiveness of laparoscopy even when certain risk factors are present. Especially borderline patients can benefit from the laparoscopic approach for nephrectomy. Although data are scarce concerning other laparoscopic procedures in borderline patients, the results of laparoscopic nephrectomy should probably apply to other laparoscopic procedures.

Aged↗
PubMed2001

Laparoscopic fenestration of posttransplant lymphoceles.

BACKGROUND: A lymphocele is a common finding after renal transplantation and occurs in up to 20% of patients. The majority of patients are asymptomatic. However, once a lymphocele has become symptomatic (e.g., through transplant dysfunction) this condition has to be treated. We report our 9-year experience with laparoscopic lymphocele fenestration and discuss the current management options for posttransplant lymphoceles. METHODS: Since 1993, 19 patients (11 males and 8 females; median age 56 years, range 22-68 years) of a total of 31 patients with a symptomatic posttransplant lymphocele have undergone laparoscopic fenestration of their lymphocele at a median of 66 days (range, 19-111 days) following successful renal transplantation in our department. As a first-line treatment, a percutaneous pigtail drainage catheter was inserted in all patients. In case of failure in resolving the fluid collection, the next step included sclerotherapy by instillation of tetracycline or ethanol into the lymphocele cavity in some cases. In patients with a persistent lymphocele, a laparoscopic lymphocele fenestration via a transabdominal approach was undertaken to achieve adequate drainage. RESULTS: Primary laparoscopic lymphocele fenestration was successful in all except two patients, who required a conversion. The median operating time was 36 min (range, 20-70 min). Following the procedure, renal transplant function remained stable or returned to individually normal levels in all patients. Median duration of hospital stay was 4 days (range, 1-13 days). At median follow-up of 27 months, all patients were alive with a functioning transplant. CONCLUSIONS: Laparoscopic lymphocele fenestration is reserved for patients in whom temporary drainage with or without sclerotherapy failed to resolve the fluid collection. In these cases the laparoscopic approach offers obvious technical and clinical advantages compared to open operative techniques.

Adult↗
PubMed2001

[Surgical therapy of penis carcinoma].

Primary therapy of penile cancer (carcinoma in situ/T1 tumors) consists of circumcision, microsurgical excision, application of 5-fluorouracil cream, radiation, or laser treatment. In cases of larger T1 tumors or T2 and distal T3 tumors, partial penectomy with a 2-cm margin of clearance is mandatory. Secondary therapy includes inguinal lymphadenectomy 4-6 weeks after primary treatment and antibiotic prophylaxis. Independent prognostic factors for the presence of lymph node metastases are T stage and grading. Only patients with noninvasive G1 or G2 tumors and nonpalpable inguinal lymph nodes are candidates for surveillance with careful follow-up. Inguinal lymphadenectomy is performed in a radical or modified (Catalona) manner. Sentinel biopsy (Cabanas) may regain importance with the use of gamma probes. Complication rates of inguinal lymphadenectomy correlate to the extent of the procedure and must be weighed against the possibility of cure with lymphadenectomy. In cases of inguinal lymph node metastasis, removal of the iliac lymph nodes (one- or two-step procedure) is necessary.

Aged↗
PubMed2001

[Radiotherapy of penis carcinoma].

Penile cancer is rare. Thus, there are no therapeutic recommendations fulfilling the requirements of evidence-based medicine. The empirically based therapeutic approach consists of local excision, laser therapy, or radiotherapy with comparable local control rates. Radiation is delivered by external beam radiotherapy or as brachytherapy. After radiotherapy, 5-year survival rates of 66-92% and organ preservation in 55-84% are reported. Serious long-term sequelae are necrosis (3-23%) and urethral stenosis (6-45%) requiring surgery. In the adjuvant treatment of the locoregional lymph nodes, lymphadenectomy and radiotherapy of both inguinal regions are therapeutic options. Inguinal lymph node metastases may be irradiated pre- or postoperatively to reduce the local recurrence rates. In addition, palliative radiotherapy of the primary tumor, lymph node, or distant metastases is of use for incurable patients. New combined therapies, e.g., radiochemothermotherapy, are currently under clinical evaluation and may offer a curative and organ-preserving therapeutic option to patients with locally advanced tumors.

Brachytherapy↗
PubMed2001

[Radiochemotherapy of penis carcinoma].

Some authors report successful use of radiochemotherapy in patients with penile cancer. The most promising chemotherapeutic agents in penile cancer are cisplatin, methotrexate, bleomycin, vinblastine, and vincristine. There are different protocols for the use of chemotherapeutic agents such as mono- or polychemotherapy in combination with radiotherapy. Operative treatment is still the primary approach in patients with penile cancer. However, in some patients with relevant co-morbidity who wish to receive organ-sparing therapy, radiochemotherapy may be applied when low-stage tumors (carcinoma in situ or T1) are present. There is no chemotherapeutic agent of choice to be recommended. The results of radiochemotherapy in patients with T2 tumors or higher are not satisfactory because local tumor control often cannot be achieved.

Antineoplastic Agents↗
PubMed2001

Laparoscopic nephroureterectomy to exclude upper urinary tract malignancy associated with analgesic nephropathy.

BACKGROUND AND PURPOSE: Analgesic abuse is a potential cause of end-stage renal disease. Such patients bear an elevated risk of developing malignancies, predominantly transitional-cell carcinoma. We report our experience with laparoscopic nephroureterectomy carried out in patients with analgesic nephropathy to exclude upper urinary tract malignancy. All patients were scheduled to be put on the waiting list for cadaveric renal transplantation. PATIENTS AND METHODS: Since 1996, nine women and two men with a long-term history of analgesic abuse have undergone laparoscopic nephroureterectomy at our hospital. The median age was 63 years (range 51-70 years). All patients had developed end-stage renal failure secondary to heavy analgesic abuse with a median duration of 14 years (range 7-40 years). The median interval from the beginning of hemodialysis to laparoscopic nephroureterectomy was 36 months (range 6-76 months). RESULTS: The median operative time was 99 minutes (range 55-170 minutes). There were no conversions to open surgery. Two complications occurred, and three patients required blood transfusions. The median hospital stay lasted 5 days (range 2-12 days), and the median convalescence was 20 days (range 6-44 days). In seven patients, histopathologic examination of the kidney revealed changes attributable to analgesic abuse. None of the patients had a transitional-cell carcinoma, but in two patients, a renal-cell carcinoma stage pT1cN0cM0 grade 2 was detected. CONCLUSION: Patients with analgesic nephropathy bear an elevated risk for the development of transitional-cell or renal-cell carcinoma. In these patients, laparoscopic nephroureterectomy combines minimally operative invasiveness with a maximum of diagnostic safety.

Aged↗
PubMed2001

Laparoscopic nephrectomy in young-old, old-old, and oldest-old adults.

BACKGROUND: This study reports findings for laparoscopic nephrectomy in comparison with open nephrectomy in geriatric patients. METHODS: Since 1993, a total of 249 patients have undergone nephrectomy for benign disease at the Medical University of Lübeck, Germany. In 11 patients older than 65 years, a laparoscopic nephrectomy was performed (in the majority via a transperitoneal approach), and 42 patients older than 65 years underwent an open-flank nephrectomy. Clinical parameters were evaluated in comparison with both groups and stratified according to age groups. RESULTS: With respect to operative results (operative duration and pre- and postoperative hemoglobin levels), no relevant differences were observed between the laparoscopy group and the open-nephrectomy group, even when stratified according to patient age. However, patients in the laparoscopy group demonstrated a significant advantage concerning blood loss and the number of required blood transfusions, regardless of age. In addition, patients after laparoscopy showed advantages in the postoperative course. Benefits were proven for the analgesic consumption, hospital stay, and convalescence parameters. Although complication rates were comparable in both groups, an increase was observed in both groups for patients aged between 75 and 84 years. CONCLUSIONS: Laparoscopic nephrectomy offers comparable operative results (with reduced blood loss and less need for blood transfusions) when compared with open surgery. Significant advantages can be demonstrated in the postoperative course, and especially geriatric patients benefit from these aspects of the minimally invasive approach. Laparoscopy should be regarded as the primary therapeutic option for nephrectomy for benign disease in these patients.

Age Factors↗
PubMed2001

Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease.

OBJECTIVES: We report the results from a nonrandomized comparison of open flank versus laparoscopic nephrectomy in patients with benign renal disease. METHODS: From January 1993 to December 1997, 249 nephrectomies for benign renal disease were performed at our institution. There were 118 patients in the open flank nephrectomy group (median age 58.5, range 8-89 years) and 131 patients in the laparoscopic nephrectomy group (median age 40, range 16-73 years). Clinical parameters such as operative times, blood loss, transfusion rates, conversion and complication rates, start of oral intake, analgesic consumption, duration of hospitalization and convalescence and short-term mortality were compared among both groups. RESULTS: Median operative time in the open flank nephrectomy group was 90 (range 30-240) min and also 90 (range 41-210) min in the laparoscopic nephrectomy group. In the laparoscopy group 8 patients were converted to open surgery (6.1%). There were 27 complications (20.6%) in the laparoscopic nephrectomy group compared to 30 complications (25.4%) in the open flank nephrectomy group. Postoperatively, patients in the laparoscopic nephrectomy group required less morphine sulfate equivalent (12 vs. 20 mg) for pain control and they had a shorter hospital stay (4 vs. 10 days) and convalescence (24 vs. 36 days). The postoperative parameters are given as medians and reached statistically significant differences in favor of laparoscopic nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. As a matter of fact laparoscopy in urology is still a center-related procedure and even in these centers only a minority of urologists practice laparoscopy. However, in experienced centers the laparoscopic technique should be offered to patients with benign renal disease who are scheduled for elective nephrectomy.

Adolescent↗
PubMed2001

Value of acute-phase proteins in the differential diagnosis of acute scrotum.

OBJECTIVES: The evaluation of patients with an acute scrotum is primarily based on physical examination, imaging studies, as well as blood and urine tests. However, the differential diagnosis may be difficult in some cases. In a retrospective study, we investigated the value of acutephase proteins in serum and plasma from patients with an acute scrotum. METHODS: A total of 104 patients (epididymitis n=52, testicular tumor n=17, testicular torsion n = 11, other conditions n = 24) with an acute scrotum were included in this study. In all patients the acute-phase proteins C-reactive protein (CRP), haptoglobin, alpha1-acid glycoprotein and transferrin in serum as well as fibrinogen in plasma were determined by turbidimetric analysis. The results were compared to the clinical findings, routine blood and urine tests and ultrasound. RESULTS: Patients with an epididymitis showed at least a 4-fold elevation of CRP except for 2 cases (median 63.2 mg/l). In these patients, the sensitivity of CRP was 96.2%, the specificity 94.2%, the negative predictive value 94.2% and the positive predictive value 94.3%. Patients with a testicular tumor had no significant elevation of CRP (median 9 mg/l) as well as those with a testicular torsion (median 5 mg/l) except for 1 patient. The difference between patients with epididymitis and those with noninflammatory conditions was statistically significant (p<0.001, Kruskal-Wallis test and Tukey-Kramer test). The remaining parameters (haptoglobin, fibrinogen, a1-acid glycoprotein, transferrin, white blood count, body temperature and ultrasound) were less sensitive and specific. CONCLUSIONS: Acute-phase proteins (especially C-reactive protein) are helpful in differentiating epididymitis from noninflammatory conditions like testicular torsion or tumor. Turbidimetric analysis of these proteins is rapid, easy and inexpensive.

Acute Disease↗
PubMed2001

Technology evaluation: CV-787, Calydon Inc.

CV-787 is a recombinant adenovirus that replicates only in prostate-specific antigen (PSA)-producing cells, which is being developed by Calydon Inc for the treatment of prostate cancer [339621]. This attenuated replication-competent virus (ARCA) only replicates in and destroys PSA-producing cells. By engineering the prostate-specific enhancer (PSE) control element into the adenovirus, Calydon has established both a means for delivery and the mechanism for killing prostate cancer cells [339621]. In October 1999, Calydon began treating patients with biopsy-proven, prostate-confined cancer with CV-787 in a phase I/II multi-center, open-label, dose-finding study [362188], [344731]. In September 2000, Calydon initiated a a phase I/II multi-center, open-label, dose-finding trial of an intravenous formulation of CV-787 in men with metastatic prostate cancer [384039]. The trial was designed to enrol 48, and enrollment was continuing in April 2001. The study is being conducted at three medical centers: University of California at San Francisco; Johns Hopkins Oncology Center in Baltimore; and, University of Wisconsin at Madison. The primary objectives of this trial are to determine the safety, tolerability, and PSA efficacy of CV-787 administered intravenously to patients with end-stage prostate cancer [384039].

Adenoviruses, Human↗
PubMed2001

Wrong ECG leads.

Explore the source record for details and available documents.

Electrocardiography↗
PubMed2000

[Laparoscopic nephrectomy in geriatric patients: comparison with conventional nephrectomy].

INTRODUCTION: We report our experience with laparoscopic nephrectomy in comparison to open nephrectomy in geriatric patients. The laparoscopic technique is presented and the results are discussed with respect to the data from the current literature. MATERIAL AND METHODS: Since 1993, a total of 249 patient have undergone a nephrectomy for benign renal disease. In 131 patients a laparoscopic nephrectomy (in most cases via a transperitoneal approach) was performed and in 118 patients an open nephrectomy via a flank incision. Clinical parameters were compared between both groups as well as with respect to different age groups. RESULTS: There were no differences in terms of operative results (operative time, pre- and postoperative hemoglobin) between the laparoscopy group and open nephrectomy group as well as among the different age groups. Patients in the laparoscopy group demonstrated significant advantages with respect to blood loss, transfusion rate, analgesic consumption, hospital stay, and convalescence. These advantages were not related to patient age. The complication rate was comparable for both groups; however, both groups showed an elevation of the complication rate in the age groups 75 to 84 years. The mortality rate within the first 30 days after nephrectomy was 1.7% in the open nephrectomy group. CONCLUSIONS: The laparoscopic nephrectomy offers comparable operative results (with less blood loss and a lower transfusion rate) when compared to open nephrectomy. In terms of postoperative parameters, patients in the laparoscopy group have significant advantages. Especially geriatric patients benefit from these advantages and, therefore, the laparoscopic approach should be the preferred technique for a nephrectomy in these patients.

Aged↗
PubMed2000

Why is urological laparoscopy minimally invasive?

OBJECTIVES: Laparoscopic procedures have been developed and established with the view that a similar operative effect can be achieved with less traumatization, especially as far as systemic stress response is concerned. We report a prospective, controlled, nonrandomized animal and patient study to determine the systemic response to laparoscopic and open surgical procedures. METHODS: In the animal study, 26 female pigs underwent either a laparoscopic bilateral varix ligation followed by bilateral nephrectomy (group I), sole introduction of trocars (group II) or sole establishment of an open surgical approach (group III). In the patient study, 145 patients underwent various laparoscopic procedures (nephrectomy, renal cyst marsupialization, varix ligation), open surgical procedures (nephrectomy, inguinal orchiectomy) or extracorporeal shockwave lithotripsy (ESWL). The serum parameters interleukin (IL)-6, IL-10 and C-reactive protein (CRP) were measured before, during and after the operative procedure. RESULTS: In animals and patients, laparoscopy resulted in significantly lower serum levels of CRP during and after the operative procedure. Animals in group I showed a 5-fold elevation, in group II a 3-fold elevation and in group III a 9-fold elevation of CRP. In patients, the increase of CRP was twice as high after open unilateral nephrectomy than after laparoscopic unilateral or bilateral nephrectomy. IL-6 showed less marked elevation during laparoscopy, ESWL and minor operative procedures like laparoscopic varix ligation or inguinal orchiectomy when compared to an open unilateral nephrectomy. The parameter IL-10 showed no significant differences among the patient groups. CONCLUSIONS: The extent of the acute phase reaction to the operative trauma correlates much more convincingly to the approach than to the extent of the procedure. Only larger operations like nephrectomy trigger a systemic acute phase reaction, which can be limited by the laparoscopic access. For minor operative procedures like varix ligation or exploration of cryptorchidism, laparoscopy offers technical advantages rather than minimal invasiveness.

Acute-Phase Reaction↗
PubMed2000

Fatal basilar artery thrombosis after chemotherapy for testicular cancer.

We report a 31-year-old patient with a pT3N2M1 seminoma who received cisplatin-based chemotherapy. During the second course of chemotherapy, the patient suffered a thrombosis of the basilar artery. He died 14 h after hospital admission. Cerebrovascular events related to cisplatin-based chemotherapy are rare, however, these potentially fatal events should be kept in mind when treating patients with testicular cancer.

Adult↗
PubMed2000

Technology evaluation: TG-1031, Transgene SA.

Tumor-associated antigens have considerable promise not only as diagnostic or prognostic markers but also as targets for active or passive immunotherapy. The epithelial mucin MUC1 is a transmembrane molecule which is expressed by most glandular epithelial cells. Transgene has developed VV-MUC1-IL-2 (TG-1031), an antigen-specific therapy, involving the tumor antigen MUC1 and the cytokine IL-2 combined with a vaccinia virus vector. Vaccinia virus vectors have been shown to stimulate a strong immune response to encoded antigens in vivo. This therapy has potential for the treatment of breast cancer, prostate cancer and other adenocarcinomas and is currently under investigation in phase I and II trials.

Animals↗
PubMed2000

Technology evaluation: CN-706, Calydon Inc.

CN-706, an engineered adenovirus containing the prostate tissue-specific enhancer (PSE) gene is under development by Calydon as a potential treatment for prostate cancer. The company is collaborating with the Johns Hopkins Hospital, which has agreed to sponsor clinical trials [274956]. Phase I trials in patients with advanced and recurring prostate cancer began during 1998 at the Johns Hopkins Brady Urological Institute and the Oncology Center [283946], [296857], and the results of phase I/II trials were reported in 2000 [386879]. The US Patent Office issued three patents in October 1998 [301251] related to Calydon's technology for engineering viruses to replicate and kill prostate cancer cells [US-05648478], [US-05698443], [US-05783435]. In June 1999, Calydon was issued two further patents [US-05871726], [US-05830686], [327511].

Adenoviridae↗
PubMed2000

Technology evaluation: Abarelix, Praecis pharmaceuticals.

Abarelix (PPI-149) is a luteinizing hormone-releasing hormone (LHRH) receptor antagonist under development by Praecis, Amgen and Sanofi-Synthelabo for the potential treatment of prostate cancer, breast cancer and hormone-related disorders [285672,328910]. Abarelix has entered phase III clinical trials for hormonally responsive prostate cancer [311887], and a sustained-release formulation is in a phase I/II clinical trial for endometriosis [317822]. In June 1997, Praecis entered into a collaboration with Sanofi-Synthelabo for the continued development and future marketing of Abarelix for the treatment of prostate cancer and other hormone-related disorders in Europe [248307]. In June 1998, Roche gained marketing rights in the US and elsewhere, under a joint development agreement [289677], which was later terminated. In March 1999, Amgen gained rights to develop Abarelix in the US, Canada, Australia, Asia and other secondary markets [317822]. Sanofi-Synthelabo expects to launch the compound in Europe in 2001 [345341,346302]. In March 1999, Merrill Lynch predicted sales in 2001 of US$75 million, with peak sales of up to US$400 million [336561]. In October 1999, Merrill Lynch predicted sales in 2003 of EUR 100 million [346209] and Lehman Brothers predicted sales of US$50 million in 2002 rising to a peak of US$150 million in 2010 [346267].

Animals↗