PubMed Health⌕ Search

Biomedical subjects

E P Allhoff

Publications and source records attributed to E P Allhoff.

At least 19 recordsLinked to original sources
PubMed2006

Perioperative immunomodulation with interleukin-2 in patients with renal cell carcinoma: results of a controlled phase II trial.

We conducted a non-randomised controlled phase II trial to investigate the role of preoperative administration of interleukin-2 (IL-2) in patients with renal cell carcinoma undergoing tumour nephrectomy. A total of 120 consecutive patients were allocated alternately to the two study groups: perioperative immunomodulation with IL-2 (IL-2 group; n=60) and perioperative immunomonitoring without immunomodulation (control group; n=60). Patients from the IL-2 group received four doses of 10 x 10(6) IU m(-2) twice daily subcutaneously a week before operation followed by a daily maintenance dose of 3 x 10(6) IU m(-2) subcutaneously until a day before the operation. Parameters of cellular and humoral immunity (leucocytes, T-cell markers CD3, CD4, and CD8, B-cell marker CD19, monocyte marker CD14, natural killer (NK) cell markers CD16, CD56, and CD57, activation markers CD6, CD25, CD28, and CD69, progenitor cell marker CD34, as well as IL-2, IL-6, IL-10, soluble IL-2 receptor, IL-1 receptor antagonist, transforming growth factor-beta1, and vascular endothelial growth factor) were measured in peripheral venous blood at various intervals. Interleukin-2-related toxicity was WHO grade 1 (24%), 2 (67%), and 3 (9%). In the postoperative period, T-cell markers, activation markers, and NK cell markers decreased, and IL-6 and IL-10 increased. However, all these alterations were significantly less accentuated in patients who had been pretreated with IL-2. Median follow-up was 40 months. Tumour-specific survival in the IL-2 group and the control group was 98 vs 81% after 1 year and 86 vs 73% after 5 years (P=0.04). A similar effect was found for progression-free survival. We conclude that IL-2 can be safely administered in the perioperative period and modulates immunological parameters. However, to validate the survival data, a larger randomised phase III trial is needed.

Adult↗
PubMed2006

[Radionuclide bone scan in patients with newly diagnosed prostate cancer. Clinical aspects and cost analysis].

BACKGROUND: The indication for a radionuclide bone scan in patients with newly diagnosed, untreated prostate cancer remains controversial. PATIENTS AND METHODS: In this retrospective study we examined 406 patients who had received a staging bone scan irrespective of their PSA serum level and histology. We evaluated different guidelines and recommendations with respect to their usefulness. The costs were calculated according to EBM and GOA. We evaluated the classification systems of bone metastases according to Soloway, Crawford, and Rigaud. RESULTS: The bone scan was positive in 41 (10%) of 406 patients. The EAU guidelines turned out to be useful with respect to both clinical value and cost efficiency. The Rigaud classification of bone metastases predicted outcome better than the Soloway or Crawford classification. CONCLUSIONS: The EAU guidelines from 2005 are a useful tool to decide whether to perform a bone scan in patients with newly diagnosed, untreated prostate cancer. A bone scan should be performed if PSA levels exceed 20 ng/ml in patients with a G1/G2 histology, and in patients with G3 histology and locally advanced disease irrespective of PSA level. Bone scan metastases should be classified according to Rigaud.

Bone Neoplasms↗
PubMed2006

[Idiopathic retroperitoneal fibrosis (Ormond's disease)].

INTRODUCTION: Idiopathic retroperitoneal fibrosis (RPF) represents a rare inflammatory disease, which leads to extensive fibrosis of the retroperitoneal space. In the course of the progressive fibrosis, fibrous tissue compresses the retroperitoneal structures with the development of consecutive ureteral obstruction. Because of the unknown aetiology, no consensus between conservative and surgical treatment exists. CASE REPORT: A 60-year-old patient was admitted to hospital with left-sided flank pain, hydronephrosis, and retroperitoneal tumour. A CT scan-guided biopsy revealed RPF. The hydronephrosis was treated by endoluminal urinary diversion. Under simultaneous administration of steroids, an almost complete regression of the RPF was noted. CONCLUSIONS: First goal in the treatment of RPF is urinary diversion to protect the renal function. A simultaneous therapy with steroids can cause a complete regression of the RPF. Surgical intervention is only recommended in refractory cases.

Adrenal Cortex Hormones↗
PubMed2004

Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study.

PURPOSE: Previous studies demonstrate a positive correlation between postoperative survival and the extent of pelvic lymphadenectomies in patients with bladder cancer. However, the distribution of nodal metastases has not been examined in sufficient detail. Therefore, we conducted a comprehensive prospective analysis of lymph node metastases to obtain precise knowledge about the pattern of lymphatic tumor spread. MATERIALS AND METHODS: Between 1999 and 2002 we performed 290 radical cystectomies and extended lymphadenectomies. Cranial border of the lymphadenectomy was the level of the inferior mesenteric artery, lateral border was the genitofemoral nerve and caudal border was the pelvic floor. We made every effort to excise and examine microscopically all lymph nodes from 12 well-defined anatomical locations. RESULTS: Mean total number and standard deviation of lymph nodes removed was 43.1 +/- 16.1. Nodal metastases were present in 27.9% of patients. The percentage of metastases at different sites ranged from 14.1% (right obturator nodes) to 2.9% (right paracaval nodes above the aortic bifurcation). By studying cases of unilateral primary tumors or with only 1 metastasis we observed a preferred pattern of metastatic spread. However, there were many exceptions to the rule and we did not identify a well-defined sentinel lymph node. CONCLUSIONS: We strongly recommend extended radical lymphadenectomy to all patients undergoing radical cystectomy for bladder cancer to remove all metastatic tumor deposits completely. The operation can be conducted in routine clinical practice and our data may serve as a guideline for future standardization and quality control of the procedure.

Adult↗
PubMed2003

[Ambulatory vasectomy. Risks and complications].

Vasectomy is the simplest and most effective method of permanent sterilization in men. In most cases, the surgical technique includes conventional vasoresection with incision of the scrotal skin or no-scalpel vasectomy as a minimally invasive method. The most important complications following surgery are haemorrhage and haematoma (1.2%), infection (3.5%), epididymitis/epididymo-orchitis (2.1%), sperm granuloma (2-70%), and chronic pain (3-8%). No long-term negative organic effects have been proven in clinical studies. The surgeon's experience and the technique applied are essential for the postoperative course, whereas performing vasectomy either on an in-patient or out-patient basis does not seem to have an influence. To evaluate the success of the vasectomy, follow-up spermiograms are obligatory. If immotile spermatozoa are present further follow-ups are necessary. Vasectomy needs to be reperformed if motile spermatozoa are detected. The chance of an unsuccessful vasectomy is below 1%. Unprotected intercourse must not be performed before two consecutive spermiograms show azoospermia.

Ambulatory Surgical Procedures↗
PubMed2003

[Virtual cystoscopy with reduced tube current: an alternative to cystoscopy?].

PURPOSE: Virtual cystoscopy at different mAs settings in patients with tumors of the bladder in comparison with cystoscopy and axial CT. MATERIALS AND METHODS: The study included 28 patients with bladder tumors and 28 patients without tumors as control group. The bladder was distended with air and scanned at two different mAs settings (protocol 1 and 2). The radiation exposure was reduced by 82 % for protocol 2 in comparison with protocol 1. Three readers compared virtual cystoscopy with cystoscopy and axial CT as to tumor location and size. Sensitivity, specificity and accuracy were calculated. RESULTS: Of the 47 tumors seen at cystoscopy, all readers detected 45 tumors by virtual cystoscopy using protocol 1 and 44 tumors using protocol 2, with p > 0.05 in comparison with cystoscopy. Virtual cystoscopy showed higher sensitivity than axial CT (97.2 % vs. 86.5 % for protocol 1) and (96.5 % vs. 86.5 % for protocol 2) with the same specificity (100 %). The accuracy was 0.982 for protocol 1 and 0.978 for protocol 2. In comparison with virtual cystoscopy, axial CT shoved more often over- and underestimation of the tumor size. CONCLUSION: Virtual cystoscopy at reduced mAs setting is a modality suitable for the detection of polypoid tumors, but does not provide data of the mucosa and thus cannot replace cystoscopy yet.

Adult↗
PubMed2003

[Perioperative immune modulation in renal cell carcinoma--review of the current situation].

Surgery and immunotherapy are the mainstay in the treatment of renal cell carcinoma. Surgery, however, is associated with considerable perioperative immunodysfunction. This immunodysfunction can be modulated by pretreatment with Interleukin-2 (IL-2), which appears to prolong tumour-specific survival. Perioperative immunomodulation could help close the therapeutic gap between neoadjuvant and adjuvant immunotherapy. This article reviews recent literature and presents original data of 63 patients.

Antineoplastic Agents↗
PubMed2003

[Ranking of pelvic lymphadenectomy in therapy and prognosis of carcinoma of the bladder].

PURPOSE: Due to the absence of internationally recognised guidelines on the necessary extent of lymphatic node removal in carcinoma of the bladder, we are still not sure as to which procedure is most favourable to therapeutic success. Hence, we checked retrospectively on the influence exercised by radical surgery on prognosis. MATERIAL AND METHOD: 506 patients were analysed retrospectively after radical cystectomy and pelvic lymphadenectomy with regard to the influence exercised on prognosis by clinical and histopathological variables. RESULTS: Statistically significant influential factors in univariate analysis were in the retrospective examination: the pT category (p < 0.0001), lymphatic node status (p < 0.0001), grading (p = 0.0145), proof of uronephrosis (p = 0.0007), number of performed transurethral resections (p = 0.0043), surgeon (p = 0.0033) and number of resected lymph nodes (p = 0.0012). There was a significant difference between surgeons at a median number of 14.3 removed lymphatic nodes (range 1 - 46) in respect of radicality (p = 0.001) and prognosis (p < 0.0049). Independent influential factors in multivariate analysis were: pT category (p = 0.003), pN category (p < 0.001) and the number of surgically removed lymphatic nodes (p = 0.038). CONCLUSION: In our retrospectively examined group of patients extensive lymphadenectomy significantly improved the prognosis and was thus a potentially curative procedure. Basing on these results, prospective studies will have to clarify the level of the standard applicable to pelvic lymphadenectomy and also the advantages and prospects of radical surgery in respect of possible patient survival.

Adult↗
PubMed2003

Pretreatment with interleukin-2 modulates perioperative immunodysfunction in patients with renal cell carcinoma.

Complex perioperative immunodysfunction occurs in patients with renal cell carcinoma undergoing nephrectomy. Here, the effect of pretreatment with IL-2 is addressed. Of 63 patients who underwent tumour nephrectomy, 26 patients received four doses of 10 Mio IE/m2 IL-2 b.d. s.c. (i.e. a total of 40 Mio IE/m2) a week before operation, 37 did not. Parameters of cellular and humoral immunity (differential blood count, T-cell markers CD2, CD3, CD4, and CD8, B-cell markers CD19 and CD20, monocyte markers CD13 and CD14, NK-cell marker CD16, activation markers CD25, CD26, CD69 and HLA-DR, and cytokines IL-1-receptor antagonist (IL-1RA), IL-2, soluble IL-2-receptor (sIL-2R), IL-6, IL-10, and TGFbeta) were measured in peripheral venous blood. Blood was drawn before IL-2, one day before and immediately after the operation, and on the 1st, 3rd, 5th, and 10th postoperative day. All patients showed postoperatively elevated leukocyte and granulocyte counts, and elevated serum levels of cytokines IL-6 and IL-10. T-cell and activation markers were decreased. However, all these alterations were less accentuated in patients who had been pretreated with IL-2. Monocyte counts and IL-2 and TGFbeta levels were decreased, but IL-1RA and sIL-2R levels were elevated in pretreated patients. IL-2-related toxicity was WHO grade I-II in all patients, grade III in one patient. The anaesthetic regimen had no measurable effect. IL-6 concentrations were higher in renal venous than in venous pool blood, indicating IL-6 production in the tumour in vivo. Tumour-specific survival was better in pretreated patients with tumours extending beyond the kidney. Pretreatment with IL-2 modulates perioperative immunodysfunction in patients undergoing tumour nephrectomy. This affects in particular T-cell-mediated immunity and levels of cytokines IL-10 and IL-6. The IL-2 application scheme used here was followed by distinct counter regulation including monocytes, IL-2, sIL-2R, IL-1RA and TGFbeta. Taken together, pretreatment with IL-2 may complement surgery in the treatment of patients with renal cell carcinoma, and may help close the therapeutic gap between neo-adjuvant and adjuvant immunotherapy.

Adult↗
PubMed2002

Diagnostic potential of virtual cystoscopy of the bladder: MRI vs CT. Preliminary report.

The aim of the study was to evaluate the diagnostic potential of the half-Fourier acquired single-shot turbo spin echo (HASTE) sequence for MRI cystoscopy compared with CT cystoscopy and the gold standard conventional cystoscopy. The MRI- and CT cystoscopy was performed in 29 patients with bladder tumors documented at cystoscopy and a control group using a 1.5-T unit (6-mm slice thickness) and a helical CT (3-mm collimation, pitch 1) after filling the bladder with air. Axial MRI and CT images were transferred to a workstation for application of virtual cystoscopy and compared with routine cystoscopy. Axial images and virtual cystoscopies were read by three readers for size and location of tumors. Forty-seven tumors were diagnosed at cystoscopy (12<1 cm, 35>/=1 cm). The sensitivity for detection of tumors smaller than 1 cm was 88.9% at MRI cystoscopy and 100% for tumors of 1 cm or larger. These results were not statistically different from the other modalities. Three tumors smaller than 1 cm were not detected at CT cystoscopy, four not all identical at MRI cystoscopy. One tumor with a wall thickening was detected on axial CT and MR images and CT cystoscopy by all observers, but only by two at MRI cystoscopy. The MRI cystoscopy is a diagnostic modality with results comparable to conventional and CT cystoscopy.

Aged↗
PubMed2002

Pretreatment with interleukin-2 modulates peri-operative immuno-dysfunction in patients with renal cell carcinoma.

OBJECTIVE: Complex peri-operative immuno-dysfunction occurs in patients with renal cell carcinoma undergoing nephrectomy. Here, the effect of pretreatment with interleukin-2 (IL-2) is addressed. METHODS: Of 63 patients who underwent tumor nephrectomy, 26 patients received 4 doses of 10 Mio IE/m(2) IL-2 b.d. s.c. (i.e. a total of 40 Mio IE/m(2)) a week before operation, 37 did not. Parameters of cellular and humoral immunity (differential blood count, T-cell markers CD2, CD3, CD4, and CD8, B-cell markers CD19 and CD20, monocyte markers CD13 and CD14, NK (natural killer)-cell marker CD16, activation markers CD25, CD26, CD69, and HLA-DR, and cytokines IL-1-receptor antagonist (IL-1RA), IL-2, soluble IL-2-receptor (sIL-2R), IL-6, IL-10, and TGFbeta) were measured in venous blood. Blood was drawn before IL-2, 1 day before and immediately after the operation, and on the 1st, 3rd, 5th, and 10th postoperative day. RESULTS: All patients showed postoperatively elevated leukocyte and granulocyte counts, and elevated serum levels of cytokines IL-6 and IL-10. T-cell and activation markers were decreased. However, all these alterations were less accentuated in patients who had been pretreated with IL-2. Monocyte counts and IL-2 and TGFbeta levels were decreased, but IL-1RA and sIL-2R levels were elevated in pretreated patients. IL-2 related toxicity was WHO grades I-II in all patients, grade III in one patient. The anesthetic regimen had no measurable effect. IL-6 concentrations were higher in renal venous than in venous pool blood, indicating IL-6 production in the tumor in vivo. CONCLUSIONS: Pretreatment with IL-2 modulates peri-operative immuno-dysfunction in patients undergoing tumor nephrectomy. This affects in particular T-cell-mediated immunity and levels of cytokines IL-10 and IL-6. The IL-2 administration scheme used here was followed by distinct counter-regulation including monocytes, IL-2, sIL-2R, IL-1RA and TGFbeta.

Adult↗
PubMed2002

[Significance of pelvic lymphadenectomy for the prognosis after radical cystectomy].

OBJECTIVE: In contrast to other carcinomas such as breast or colon cancer, there are no guidelines regarding the number and location of lymph nodes to be removed during radical surgery in patients with invasive bladder carcinoma. The therapeutic effect of pelvic lymphadenectomy and its influence on tumour staging has not been documented yet. METHODS: Here we present an evaluation of pelvic lymph nodes from 484 patients who underwent radical cystectomy with curative intention between 1986 and 1999. The number of lymph nodes was correlated with the depth of invasion of the primary tumour, occurrence of nodal metastases, clinical outcome, the operating surgeon, and the pathologist. RESULTS: There were 484 patients with a mean age of 62.7 years. Clinical follow up was available from 321 patients with a mean follow up period of 35.9 months. The average number of lymph nodes removed was 14.3 (range: 1-46). The number of lymph nodes removed varied significantly between different surgeons and did not correlate with the pathologists. There was a significant correlation between the number of lymph nodes removed and the tumour-free survival in pT2 or pT3 tumours and in patients without lymph node metastases. Multivariate analysis revealed that pT-category (p < 0.01), pN-category (p < 0.01), and the total number of lymph nodes removed (p = 0.04) were the most important factors affecting survival. CONCLUSION: The more extensive lymphadenectomy significantly improved the prognosis of patients with invasive bladder cancer and therefore, represents a potentially curative procedure. The results indicate a need for a standardised lymph node dissection.

Adult↗
PubMed2001

The pelvic plexus and antireflux surgery: topographical findings and clinical consequences.

PURPOSE: Voiding dysfunction and urinary retention are rare complications of antireflux surgery. As mainly reported after bilateral antireflux surgery with extravesical technique, bladder insufficiency has been suspected to be caused by intraoperative damage to neural structures. We studied the topography of the pelvic plexus and assessed the injury to the plexus resulting from antireflux surgery. MATERIALS AND METHODS: Human cadavers fixed with Thiel solution were used for dissection. The superior hypogastric plexus and hypogastric nerves were identified as the pathway to the pelvic plexus. After dissecting the surrounding fatty tissue the S2 to S4 nerves and efferent nerve bundles from the pelvic plexus were identified. RESULTS: The main portion of the pelvic plexus was located about 1.5 cm. dorsal and medial to the ureterovesical junction. The bundles of the pelvic plexus ended at the distal ureter, trigone and rectum. When simulating an antireflux procedure, there was a high risk of injury to the pelvic plexus and its efferent nerves if dissection was performed distal to the ureter and dorsal trigone. CONCLUSIONS: Careful dissection close to the ureter avoids inadvertent injury to the pelvic plexus. To minimize the risk of voiding dysfunction bilateral antireflux surgery should be performed at 2 sessions unless the operative technique allows preservation of the neural structures.

Aged↗
PubMed2001

Inguinovaginal sling procedure for female stress incontinence: introduction of a minimally invasive technique.

PURPOSE: The inguinovaginal sling procedure is well accepted for surgical treatment of female stress urinary incontinence. Although the functional results are excellent, the operative trauma is higher compared to that of more recently used minimally invasive techniques. MATERIALS AND METHODS: A modified inguinovaginal sling procedure was performed in 15 patients with urodynamically diagnosed intrinsic sphincter deficiency. With the assistance of a laparoscope, two fascial strips were dissected using two small suprapubic skin incisions. The pullthrough maneuver of the fascial slings was facilitated by opening the perivesical space with an inflatable balloon. RESULTS: There were no intraoperative or postoperative complications. Mean follow-up of 7.7 months (range 4 to 11) was available in all patients. Stress incontinence was cured in 14 patients; only one woman reported using one pad per day. All patients were able to void spontaneously after a mean of 8 days (range 6 to 10). CONCLUSIONS: The laparoscopically assisted inguinovaginal sling procedure is less invasive than the original technique. Good long-term results are known from the original inguinovaginal sling procedure, and there is no need for allografts or synthetic material.

Aged↗
PubMed2001

Complex perioperative immuno-dysfunction in patients with renal cell carcinoma.

PURPOSE: Patients with renal cell carcinoma have an impaired function of the immune system, which is the basis for different approaches of immunotherapy. We address perioperative changes of several parameters of the immune system in these patients. MATERIALS AND METHODS: Parameters of cellular and humoral immunity, including differential blood count, T cell markers CD2, 3, 4 and 8, B cell markers CD19 and 20, monocyte markers CD13 and 14, natural killer cell marker CD16, activation markers CD25, CD26 and HLA-DR, and cytokines interleukin-1 (IL-1) receptor antagonist, IL-2, soluble IL-2 receptor, IL-6, IL-10 and transforming growth factor-beta, were measured in the venous blood of patients who underwent renal surgery extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia). Patients were grouped and age matched, and 37 underwent tumor nephrectomy, 20 open renal surgery for nonmalignant reasons and 24 ESWL. A group consisting of 39 controls received no treatment. RESULTS: Little change was detected in controls and those patients who received ESWL. Patients who underwent open renal surgery had increased leukocyte and granulocyte counts until postoperative day 3 but had low T cell counts. The postoperative decrease in CD25 expressing cells corresponded to an increase in the soluble IL-2-receptor. Cytokines IL-6 and 10, which also have immunosuppressive properties, were markedly increased postoperatively. These changes were more noted (p <0.01) in those patients who underwent tumor nephrectomy than open renal surgery for nonmalignant reasons and remained detectable when paired patients with similar surgical trauma were compared. In tumor nephrectomy cases renal venous IL-6 was higher than peripheral venous levels. CONCLUSIONS: Patients with renal cell carcinoma suffer from selective immuno-dysfunction, indicating a rationale for perioperative immunomodulation.

Adult↗
PubMed2000

[Surgery of metastases in renal cell carcinoma].

Renal cell carcinomas (RCC) are endowed with impressive metastatic potential. Patients with RCC who present with apparently solitary metastatic lesions represent a small cohort. Due to the different long-term results achieved with surgical resection of metastatic RCC lesions, a generally accepted judgement about this treatment modality is not possible. Several studies suggest that aggressive surgical management can provide an effective treatment, especially in patients with solitary pulmonary metastases. Most noteworthy is the fact that because of the organ distribution of RCC metastases, surgical therapy is dominated by general and thoracic surgeons, neurosurgeons, and orthopaedic surgeons. Therefore, an interdisciplinary approach is one of the most important key points for a successful outcome in these patients.

Carcinoma, Renal Cell↗