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Biomedical subjects

F Recker

Publications and source records attributed to F Recker.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Prostate-specific antigen in the diagnosis of organ-confined treatable prostate carcinoma].

Prostate cancer is now the most common cancer and the second most common cause of death from cancer among men. Several studies have shown a frequency of autopsy-detected cancer of 40% in men over 50 years of age. In contrast, the lifetime probability of prostate cancer being diagnosed clinically is only 8%. Thus histologically documented prostate cancer only becomes clinically relevant if the tumors are > 0.5 cm3 and the life expectancy exceeds 10 years. Therapy with curative intention is only possible for organ confined disease. Because disease specific survival is about 80-90% after 10 years for conservative treatment of organ confined disease, early detection of prostate cancer is useful for patients with a life expectancy > 10 years. Organ confined prostate cancer is usually asymptomatic. The use of prostate specific antigen (PSA) combined with digital rectal examination (DRE) results in a 2-3 fold increase in prostatic carcinoma detection rate, especially of organ confined disease, by PSA. In men with a minimally elevated PSA-value of 4-10 ng/ml (Hybritech Assays), 25% will have a prostatic carcinoma regardless of the finding of the DRE, which would have reached clinical significance in the follow-up. The indication for biopsy should be established at an early date. There is no support for the common opinion that early detection programs detect clinically unimportant cancers. 95% of tumor volumes are > 0.5 cm3. Furthermore only 3-5% of subjects show prostate cancer in detection programs though 8% will develop clinical symptoms of prostate cancer during their lifetime. This difference is a reason for longitudinal programs with PSA and DRE control once a year, as proposed by the American Cancer Society and the American and Canadian Urological Association, in contrast to other health care organizations, which would wait with general screening until data from prospective randomized trials with beneficial effects of screening are available. To introduce prostate cancer therapy with curative intention for symptomatic patients as well, the cancer should be detected below a PSA level of 10 ng/ml. Insufficient specificity of PSA (2-4 patients have to undergo biopsies to detect one cancer patient) is still an unsolved problem.

Aged↗
PubMed1996

An intra-operative seminal and prostate emission test as a control for nerve-sparing procedures in primary and secondary retroperitoneal lymphadenectomy.

OBJECTIVE: To determine the value of an intra-operative electrostimulatory test of post-ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph-node dissection (RLND). PATIENTS AND METHODS: Between 1991 and 1994, 21 patients with non-seminomatous testicular cancer of clinical stage A and 15 patients with bulky or clinical stage C disease underwent primary or secondary RLND, respectively. During surgery, post-ganglionic nerves were electrostimulated at 30 Hz and up to 20 V, for 3-10 s. Emissions were recorded simultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethra (in 11 patients). RESULTS: A positive intra-operative emission test in 15 pathological stage A (with bilateral nerve-sparing) and six pathological stage B (with contralateral nerve-sparing) patients predicted the post-operative preservation of antegrade ejaculation. In the group undergoing secondary RLND, the test allowed the identification and sparing of the emission-related nerves in four of 15 patients with a residual mass consisting of necrosis/fibrosis, and preserved antegrade ejaculation after surgery. CONCLUSIONS: A positive result in the seminal emission test predicted the preservation of antegrade ejaculation after surgery. The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the residual mass consists of necrosis or fibrosis, then electrostimulation during secondary RLND can help to identify important nerve structures when their origin is unknown initially. However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission-relevant nerves while the retroperitoneal space is removed radically. The test may also give additional information about the physiology of emission.

Ejaculation↗
PubMed1996

Results of postchemotherapy adjunctive retroperitoneal lymph node dissection in non-seminomatous germ cell cancer patients.

Cisplatin-based chemotherapy is highly effective in non-seminomatous testicular cancer. Patients with advanced disease receive two to four cycles of polychemotherapy. Residual retroperitoneal masses after chemotherapy are suspected to contain active tumour tissue as well as mature teratoma. Therefore, a delayed retroperitoneal lymph node dissection remains necessary. A total of 123 patients with advanced non-seminomatous germ cell cancer underwent retroperitoneal surgery after two different regimes of cisplatin-based chemotherapy. The first group (n = 55) received a sequential alternating chemotherapy with Adriamycin/cisplatin and bleomycin/vinblastine (8.5 +/- 5 cycles, 1979-1985), the second group (n = 60) got a standard PEB scheme (cisplatinum /etoposide/bleomycin; 5.7 +/- 2.1 cycles, 1985-1991). Eight patients got other cisplatin-based combinations. All patients received adjunctive retroperitoneal surgery. After a mean follow-up period of 72 months, the patients treated with the sequential alternating scheme showed a survival rate of 50% (27/54, 1 patient lost to follow-up). After the PEB scheme a survival rate of 79% (46/58, 2 patients lost to follow-up) was found. 86% of the patients with retroperitoneal necrosis after retroperitoneal lymph node dissection (RPLND; n = 58) survived with no evidence of disease, as well as 82% of the patients with adult teratoma (n = 18). Only 47% of the patients with residual active carcinoma after RPLND (n = 47) survived within a follow-up period of (median) 72 months, despite further chemotherapy after RPLND. Residual tumor burden and type of histology after RPLND can partially predict the clinical outcome. A necrotic specimen in RPLND could not be predicted by any means, so that surgical removal of a residual retroperitoneal mass after chemotherapy remains necessary. Standard PEB chemotherapy is superior to sequential alternating chemotherapy.

Adult↗
PubMed1995

Laparoscopic dismembered pyeloplasty: preliminary report.

As a reconstructive laparoscopic procedure, dismembered pyeloplasty was done in 5 patients: the laparoscopic procedure was completed in 4 and converted to an open operation in 1. Within this series operative time decreased from 390 to 190 minutes. The main operating time was devoted to laparoscopic suturing of the anastomosis. Spreading the renal pelvis by either pulling the sutures transcutaneously or with intra-abdominal stay sutures improved visualization and facilitated the anastomosis. Mean postoperative hospitalization was 8 days (range 7 to 10). After a mean followup of 9 months (range 6 to 15) excretory urography and renal scintigraphy revealed significant radiographic improvement and no obstruction in 4 patients. Compared to open pyeloplasty and endo-pyelotomy, laparoscopic pyeloplasty may combine the advantages of open surgery (excision of the stenosis and reduction of the renal pelvis) with those of minimally invasive surgery (minimal postoperative morbidity), provided the operative time can be shortened and the technique simplified.

Adult↗
PubMed1995

Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests.

In an attempt to assess the impotence rate secondary to transurethral resection of the prostate more objectively than by merely interviewing patients, potency was evaluated with the Snap-Gauge test. The test was used preoperatively to recruit patients with intact potency. The 98 patients studied underwent transurethral resection of the prostate and were retested during postoperative night 4. Of the 98 patients 64 remained potent while 34 did not. These 34 men were retested 3 months later, and 26 were potent and 8 were impotent. Therefore, 8 of 98 patients (8.3%) became impotent as a consequence of transurethral resection of the prostate. The risk specific to subgroups in cases of small (less than 10 gm. resectable tissue) and larger adenomas is 11.1% and 7.7%, respectively, for men older than 65 years, and 7.1% and 0%, respectively, for men younger than 65 years. A selective indication taking into account patient age and prostatic size might further lower the already low impotence risk of transurethral resection of the prostate.

Aged↗
PubMed1995

[Principles of tumor invasion and metastasis].

Histopathological and clinical parameters are of limited value in characterization of the individual course of disease in bladder cancer patients. Down-regulation of E-cadherin, an intercellular adhesion molecule, and upregulation of autocrine motility factor receptor (AMFR) expression have been shown to play a part in tumour cell invasion and metastasis. In a retrospective analysis concerning 95 different bladder specimens and a prospective study in 100 bladder cancer patients, reduction in E-cadherin concomitantly with an increase in AMFR expression was associated with a poor prognosis. The dual use of these two antigens may improve early diagnosis of high-risk bladder cancer patients and influence treatment decisions.

Cadherins↗
PubMed1993

[Initial experience with surgical uro-laparoscopy].

Preliminary experience with uro-laparoscopy was retrospectively analyzed to determine whether patients profited from the laparoscopic procedure. Between August 1991 und July 1993 we performed 53 operations laparoscopically. Four more began in this way but ended in open surgery. 29 varicocele procedures were carried out. A reduced postoperative morbidity, and hence a benefit, were obvious in 3/29 patients with bilateral varicocele, but probably not in the remaining 26/29 patients affected only on the left side. 13 pelvic lymphadenectomies in patients with prostatic carcinoma T1-3, elevated prostatic acid phosphatase, a PSA > 30 ng/ml and/or a suspected N+ on CT, served to identify 10 pN0 and 3 pN1 patients. Four of the pN0 patients with a T3 tumor were given radiotherapy. Six with a T2 tumor underwent radical prostatectomy, four with margin-negative specimens benefited from laparoscopic lymphadenectomy by securing a curative operation which according to established rules would otherwise have been withheld. Two patients with margin-positive specimens suffered harm from laparoscopic lymphadenectomy, which had led to a needless operation. Another lymphadenectomy performed on one more patient suffering from deep venous thrombosis of the left leg associated with pelvic lymphadenopathy established the benign histology of the enlarged lymph nodes with minimal morbidity. 10 nephrectomies were carried out for benign, clinically relevant lesions of the kidney, which are rare. They produced a clear-cut benefit for all patients as the postoperative morbidity was minimal. We conclude that the present indications for uro-laparoscopic procedures are either disputable or rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Monitoring of emission as direct intraoperative control for nerve sparing retroperitoneal lymphadenectomy.

An intraoperative test to identify emission relevant lumbar postganglionic nerves during nerve sparing retroperitoneal lymph node dissection is presented. The neurophysiological course of the ejaculation into the posterior urethra, the emission, is described. A retroperitoneal nerve sparing procedure was done for nonseminomatous testicular tumors bilaterally in 7 patients with pathological stage I disease and unilaterally in 4 with pathological stage IIa disease. While the isolated lumbar nerves were electrostimulated, the seminal vesicles and bladder neck were monitored by suprapubic transvesical sonography. Simultaneously, endoscopy of the posterior urethra was performed and time code was registered. Emission began with bladder neck closure, propulsive contraction of the seminal vesicles in the periphery and opening of the paracollicular region. Then, complete contraction of the seminal vesicles was associated with closure of the prostatic urethra and ended in the separate secretion from the ductuli prostatici and ejaculatorii. Descending from nerve L1 to L3, their importance for emission usually increased. For intraoperative monitoring of emission transvesical sonography alone is sufficient. In 2 patients this method allowed us to identify the relevant nerves within the retroperitoneal residual mass (fibrosis) after chemotherapy.

Adolescent↗
PubMed1993

[Balloon dilatation vs. prostatic transurethral resection in stages I-II prostatic adenoma].

Thirty consecutive patients with benign prostatic hypertrophy St. I-II (adenom weight < 25g) were treated either by balloon dilatation (Group I) or transurethral resection (group II). Peak flow, residual urine and voided urine did not improve after balloon dilatation in a follow-up of 9 months. In contrast peak flow enhanced after TUR-P from 10.4 ml/sec. to 21.9 ml/sec. Residual urine reduced from 65 ml to 30. In group I obstructive symptom score (6.1 > 4.5) and irritative symptom score (5.5 > 3.6) decreased after 9 months, TUR-P resulted in a greater reduction of obstructive score (7.4 > 1.6) and irritative score (6.0 > 2.4). This study with selected patients does not support indications for balloon dilatation.

Aged↗
PubMed1993

[Observations on the course of ejaculation in the posterior urethra].

Nine patients underwent retroperitoneal nerve-sparing lymph node dissection for bilateral nonseminomatous testicular tumours (path. St. I disease). While the isolated lumbar nerves L1, L2, L3 were electrostimulated (30 Hz, 5-20 V), the activity of these seminal vesicles, bladder neck and posterior urethra was recorded by way of suprapubic transvesical sonography and/or endoscopy. Emission started simultaneously on three different levels: contraction of the seminal vesicles in the periphery, bladder neck closure, and opening of the paracollicular space. Contraction of the seminal vesicles extends to the midline; the prostatic urethra closes, starting at the bladder neck. Secretion from the ductuli prostatici (milky) and from the ductucli ejaculatorii (transparent) follow. It was confirmed by the detection of PSA (11,000-21,000 ng/ml) in the ejaculate that prostatic secretion is also present in it. The significance of the postganglionic nerves for emission increased from L1 to L3. In three patients with salvage lymph node dissection the above-mentioned ultrasound monitoring allowed differentiate nerves relevant to emission from those not involved, allowing more comprehensive retroperitoneal resection.

Adolescent↗
PubMed1992

Quantitative determination of urinary marker proteins: a model to detect intrarenal bioeffects after extracorporeal lithotripsy.

To detect the source of relevant acute intrarenal side effects after extracorporeal piezoelectric lithotripsy and its impact on repeat treatment, urinary excretion of highly specific marker proteins was determined before (day-1) and after (days 0, 1, 4, 7, 14 and 21) treatment. Marker proteins included high molecular weight alpha-2-macroglobulin, immunoglobulin G, albumin, alpha-1-microglobulin as well as the enzyme N-acetyl-beta-glucosaminidase. Of 50 patients who underwent 4,000 shock waves to caliceal stones (group 1) 15 were identically retreated after 5 (group 2) or 15 (group 3) days, respectively, to determine the shortest safe interval to repeat extracorporeal piezoelectric lithotripsy. The course of lithotripsy damage was also evaluated in 15 pre-damaged kidneys (group 4). The alpha-2-macroglobulin enhancement found in all groups on day 0 (p less than 0.005 to p less than 0.05) documented intrarenal bleeding from ruptured vessels. Ratios of alpha-2-macroglobulin/albumin greater than 2.00 on days 0 and 1 exclude a glomerular source of gross hematuria (groups 1 to 4). There was only slight acute tubular damage after extracorporeal piezoelectric lithotripsy (N-acetyl-beta-glucosaminidase increase, p less than 0.05 for groups 1 to 4). Retreatment after 5 days did not enhance the amount of proteinuria compared to the same patients from group 1 (statistically significant at p less than 0.45 to p less than 0.10). Group 3 also showed a similar elevation of proteinuria as the identical patients pretreated 15 days previously. Thus, the data seem to suggest that early repeat sessions of extracorporeal piezoelectric lithotripsy are as safe as delayed retreatments. The course of proteinuria in group 4 did not suggest enhancement of extracorporeal piezoelectric lithotripsy damage in pre-injured kidneys. The urinary marker alpha-2-macroglobulin detects intrarenal vessel ruptures, which are responsible for intrarenal hematomas, as evidenced by animal and human histology. A model is offered to understand and detect the most important parenchymal bioeffects to minimize the risk of injury.

Acetylglucosaminidase↗
PubMed1992

Lectins in diagnosis of bladder carcinoma.

With the purpose of studying changes in the expression of glycoconjugate structures in nonmalignant and cancerous lesions of urothelium the lectins ConA, TKA, PNA, DBA, STA, LFA, UEA, MPA, RCA, LCA, GSA1, SBA, GSA2, WGA, PHA and Lot were tested in formalin-fixed, paraffin-embedded tissue sections of (1) cold biopsies from normal urothelium and bladder cancer of different grades (G1-G3) in humans, (2) normal transitional epithelium and N-butyl-N(4-hydroxybutyl)nitrosamine (BBN)-induced bladder cancer in animal experiments (Wistar rat), and (3) human transitional cancer cell line HT 1376. In human urothelium TKA and SBA were positive markers demonstrating positive staining reactions in all tumor grades without binding to normal epithelium. They stained also the human transitional carcinoma cell line HT 1376 (G3). In Wistar rats DBA, ConA, LCA, SBA, GSA2 and WGA had a specific affinity to BBN-induced carcinoma. Findings of positive lectin marker in transitional cell cancer may offer progress in diagnostics and therapy.

Animals↗
PubMed1991

Accuracy of magnetic resonance imaging compared to computerized tomography and renal selective angiography in preoperatively staging renal cell carcinoma.

During 1986 and 1987, 47 patients with renal cell carcinoma were evaluated preoperatively with CT, angiography and MRI. The preoperative tumor stage (T), lymph node metastases and venous involvement determined with the three methods were compared to the operative and histopathological findings. For T stage, angiography proved less accurate (54%) than CT (64%) or MRI (63%). MRI was found to be superior to CT in assessing lymph nodes, with an overall accuracy of 89% and sensitivity of 100% compared to 77 and 60%, respectively, of CT. For venous involvement CT was overall more accurate (74%) than angiography (65%) or MRI (63%). All three methods expressed a low sensitivity (between 31 and 41%) and a high specificity (between 95 and 100%) for detecting venous involvement. The minimal advantages of MRI compared to its high cost do not justify its routine use. CT remains the method of choice in staging preoperatively renal cell carcinoma.

Angiography↗
PubMed1991

[Animal experiment aspects of bladder cancer].

Many aspects of bladder cancer remain obscure under clinical conditions. The natural course of the illness is seldom known in human patients, in whom only the treated natural history is subject to investigation. Cancer research in animals can complement clinical investigations. The following experimental set-ups are of importance; chemically induced bladder cancer; transplantation of human urothelial carcinoma in immunodeficient nude mice (xenograft model); transplantation of clinically induced bladder cancer in syngenetic animals (syngenetic model). These models are used for tumour induction and the development of immunotherapy, chemotherapy and new techniques. The extrapolation of these experimental results to clinical situations is being discussed. Some experimental results are of interest for practising urologists, e.g. increased incidence of tumour development in dilated upper urinary tract or in the bowel segment after urinary diversion; new therapeutic approaches such as breakdown of multidrug resistance to chemotherapy or administration of photodynamic therapy; planning of intravesical therapy relating to aspects of cell proliferation.

Animals↗
PubMed1990

Magnetic resonance imaging of acute and long-term alterations following extracorporeal shock wave lithotripsy in rats.

The kidneys of 30 rats were treated by extracorporeal shock wave lithotripsy (ESWL) with different doses of extracorporeal shock waves: 500, 1,000 and 2,000. The animals were sacrificed after 24 h, 7, 14 or 35 days. Magnetic resonance (MR) imaging at 1.5T was used to evaluate the effects of ESWL on T1- and T2-weighted (spin echo 600/22, 1,600-2,000/90) images compared to histology and macroscopy. The severity of pathologic changes correlated dose dependently with the number of shock waves given (500-2,000). The MR findings following ESWL in 50 kidneys included diffuse loss of the corticomedullary junction (n = 20), perirenal and subcapsular fluid (n = 23), intrarenal foci of increased (n = 16) or decreased (n = 8) signal intensity, and loss of distinction between renal, splenic or hepatic contours (n = 7), detected macroscopically as adhesions. Subcapsular and intrarenal findings corresponded to acute hematomas and organized fibrotic tissue morphologically. In long-term groups MR revealed fibrotic shrinkage of the renal convexity as indentation of the kidney surface (n = 12). MR imaging is a sensitive method for the detection of specific alterations following ESWL, especially intrarenal changes, which are important for possible long-term lesions after ESWL.

Animals↗
PubMed1990

[Does extracorporeal shock wave lithotripsy injure the female reproductive tract?].

Female reproductive tract lies near the distal ureter where extracorporeal shock wave lithotripsy (ESWL) of calculi is performed. The question whether ESWL may induce morphological changes in ovary, tube or uterus should be investigated in animal experiments. The female reproductive system of 28 Wistar rats was exposed to 600 or 1200 shock waves. After 24 hours or 35 days the animals were sacrificed and examined by light microscopy and scanning electron microscopy (SEM). Acute after ESWL 2/14 rats revealed minimal subcapsular bleeding in the ovaries. SEM showed a desquamation of superficial cells and a loss in microvilli. In long-term groups there was no morphological lesion. Besides the correlation between healthy and atretic follicles were unchanged. In animal experiment no sign of long lasting changes in female reproductive tract after ESWL could be observed.

Animals↗
PubMed1989

Cyclosporine A impairs wound healing of ureterocystoneostomy in rats. Scanning electron microscopic examination.

The effect of cyclosporine A (CsA), an immunosuppressive agent used in transplantation, on wound healing following microsurgical neoimplantation of a ureter in the bladder of 63 SIV ZUR rats was examined morphologically using the light and scanning electron microscopes and functionally by radiography. Following ureterocystoneostomy (UCN) on the right side, the animals in Group I (control group) received 1.0 ml CsA solvent (0.1 g ethanol and 0.3 g intralipid) per day. Group II received 12.5 mg/kg/day CsA and Group III 17.5 mg/kg/day CsA. All drugs were administered i.p. A third of the animals in each group were reoperated 7, 14 or 28 days after UCN. At these time intervals, there were no radiologically demonstrable differences in the operated side. Examination under the scanning electron microscope indicated delayed restitution of epithelium in the bladder for rats which had received CsA as compared to the control group. In the area of the UCN, CsA caused dose-independent retardation of the regenerative hyperplasia associated with wound healing (Group I: max. 7 days after UCN: Group II and Group III, max. 14 days after UCN). Hyperplastic areas had ropy microridges and uniform short microvilli. Where the hyperplasia exhibited nodular and papillary formation, also histologically more evident under CsA, occasional epithelial cells had pleomorphic microvilli on their luminal surface. Unlike other known premalignant changes of this kind, the frequent occurrence of pleomorphic microvilli under CsA was reversible. In general, CsA led to dose-unrelated protraction of UCN wound healing with no lasting functional disturbance in rats.

Animals↗