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F Steinbach

Publications and source records attributed to F Steinbach.

At least 37 records · Page 2Linked to original sources
PubMed1997

Long-term survival after surgical revascularization for atherosclerotic renal artery disease.

PURPOSE: We analyzed the long-term clinical outcome and survival after surgical revascularization for atherosclerotic renal artery stenosis. MATERIALS AND METHODS: The study group comprised 222 patients who underwent surgical revascularization for atherosclerotic renal artery stenosis between 1974 and 1987. The indications for performing surgical revascularization were treatment of hypertension in 60 patients, preservation of renal function in 12, and control of hypertension and preservation of renal function in 148. Postoperative blood pressure, renal function and survival data were analyzed during a mean followup of 7.4 years. RESULTS: There were 5 operative deaths (2.2%) and postoperative thrombosis or stenosis of the repaired renal artery occurred in 16 patients (7.3%). Long-term cure or improvement of renovascular hypertension was achieved in 72.4% of patients. Preoperative renal function correlated significantly with a favorable blood pressure response to surgical revascularization (p = 0.013). Long-term improvement or stabilization of renal function was achieved in 71.3% of patients. Preoperative renal function (p = 0.034) and bilateral atherosclerotic renal artery stenosis (p = 0.04) correlated significantly with a favorable renal function result after surgical revascularization. Actuarial 5 and 10-year survivals for the entire series from the time of surgical revascularization were 81 and 53%, respectively. The expected 5 and 10-year survivals for a comparable healthy population are 89 and 77%, respectively. Using a multivariate analysis, factors correlating with diminished long-term survival were age older than 60 years (p = 0.002), coronary artery disease (p = 0.031), and previous vascular operations (p = 0.001). CONCLUSIONS: These data support the long-term therapeutic efficacy of surgical revascularization in patients with atherosclerotic renal artery stenosis. The merits of newer forms of therapy, such as percutaneous transluminal angioplasty and endovascular stenting, must ultimately be weighed against these results.

Actuarial Analysis↗
PubMed1996

Intraoperative evaluation of renal cell carcinoma: a prospective study of the role of ultrasonography and histopathological frozen sections.

PURPOSE: Nephron sparing surgery is being performed increasingly for treatment of renal cell carcinoma, including in select patients with a normal contralateral kidney. The number of tumors in the involved kidney (single versus multiple) and presence or absence of perinephric fat involvement (pathological stage T1 to 2 versus T3A) are important prognostic factors. In a prospective study we evaluated the accuracy of intraoperative histopathological frozen section analysis of renal capsular biopsies for assessing local tumor stage, and the accuracy of intraoperative ultrasonography for assessing tumor focality. MATERIALS AND METHODS: Intraoperative frozen section biopsies and ultrasonography were compared with information obtained from preoperative computerized tomography (CT), intraoperative inspection of the kidney by the surgeon and permanent histopathological specimens. RESULTS: We evaluated 99 patients (102 kidneys) with localized sold renal masses undergoing either radical nephrectomy (48) or nephron sparing surgery (54). Final pathological analysis revealed 95 renal cell carcinomas (stage T3A in 24), 6 oncocytomas and 1 angiomyolipoma. Multiple tumors were detected in 18 of 102 kidneys overall. Frozen section analysis identified 87% of the stage T3A lesions with no false-positive results, compared to CT, which only identified 67%. Ultrasonography identified 14 of 18 multifocal tumors (78%) and was not more accurate than the combination of CT and intraoperative inspection. However, during nephron sparing surgery ultrasonography was useful to localize the intrarenal extent of tumors (17 cases). CONCLUSIONS: Our results clarify the role of intraoperative ultrasonography and frozen section analysis in patients undergoing nephron sparing surgery for renal cell carcinoma. Frozen section analysis may be useful in select patients with small peripheral tumors who are under consideration for elective nephron sparing surgery.

Carcinoma, Renal Cell↗
PubMed1996

The influence of cytokines on the adhesion of renal cancer cells to endothelium.

PURPOSE: The development of tumor metastasis requires direct adhesive interactions between tumor cells and vascular endothelium. We examined the adherence of renal cell carcinoma (RCC) lines to endothelium after stimulation with different cytokines that induce expression of the vascular adhesion molecules endothelial leukocyte adhesion molecule (ELAM)-1, vascular cell adhesion molecule (VCAM)-1 and intercellular adhesion molecule (ICAM)-1, MATERIALS AND METHODS: Human umbilical vein endothelial cells (HUVEC) were used to determine the adhesion of the RCC lines CCF-RC1, 2 and 7 to endothelium. Expression of cell adhesion molecules (CAM) on HUVEC and RCC lines was measured with immunoflowcytometry. RESULTS: Stimulation of HUVEC with rIl-1 beta, rTNF-alpha, or PMA resulted in a time-dependent 1.4- to 2.9-fold increase of RCC adhesion to HUVEC. Significant increased tumor cell binding was observed after 4 hours and paralleled the time-dependent induction of ELAM-1 and VCAM-1. Immunocytometry demonstrated the presence of the ligands sialyl Lewis X and VLA-4 on RCC, and blocking studies with monoclonal antibodies directed against tumor cell-endothelial interactions mediated by VCAM-1/VLA-4 and ELAM-1/sialyl Lewis X demonstrated marked inhibition of tumor cell adherence to cytokine-stimulated HUVEC. CONCLUSIONS: This study demonstrates that cytokine-induced increases in RCC adherence to HUVEC are mediated in part by VCAM-1/VLA-4 and ELAM-1/sialyl Lewis X interactions and suggest that these molecules may play an important role in the ability of RCC to metastasize.

Carcinoma, Renal Cell↗
PubMed1995

Current controversies in nephron-sparing surgery for renal-cell carcinoma.

The role of nephron-sparing surgery for renal cell carcinoma is well established in patients with an anatomical or functional solitary kidney (imperative indication) in which a radical nephrectomy would render the patient anephric with subsequent need for hemodialysis. This also encompasses patients with a unilateral renal cell carcinoma and a functioning contralateral kidney when the opposite renal unit is affected by a disease that might threaten its future function, such as renal artery stenosis, chronic pyelonephritis, stone disease or systemic conditions such as diabetes. A functioning renal remant of at least 20% of normal renal parenchyma seems to be necessary to avoid end-stage renal failure in these patients [16]. There have been several reports in the literature of excellent 5-year cancer-specific survival rates of over 80% in such circumstances [12, 15]. These results were confirmed in our institution, with a 5-year cancer-specific survival rate of 83% in over 70 patients with an imperative indication for nephron-sparing surgery. Thereby the prognosis was significantly influenced by the local tumor stage and the grade of malignancy. These data support the efficacy of nephron-sparing surgery in this clinical situation.

Carcinoma, Renal Cell↗
PubMed1995

Expression of cell adhesion molecules in an established and characterized new human renal cell cancer line, CCF-RC7.

In order to investigate the importance of cell adhesion molecules (CAMs) in renal cell carcinoma (RCC), a cell line, designated as CCF-RC7, was established from a human RCC of the clear cell type. CCF-RC7 was passaged over 50 times in vitro for 3 1/2 years. The cell line has an epithelial morphology and a doubling time of 30 h, forming colonies in soft agar with an average efficiency of 10.4% and producing clear cell tumors in athymic nude mice. CCF-RC7 cells have an aneuploid-hypotetraploid karyotype with a modal chromosome number of 82 and rearrangements in chromosomes 9, 12 and 14. Immunohistochemical and flow immunocytometric analyses revealed high expression of ICAM-1 (CD54), and Hermes antigen (CD44), which was significantly upregulated by cytokine and PMA treatment. VLA-4 was expressed on approximately 20% of tumor cells and could not be altered by cytokine or PMA stimulation. High expression of sialyl Lewis X was also demonstrated by immunohistological examination. This newly characterized cell line will serve as a useful model for the study of CAMs during hematogenous metastasis and host defense mechanisms in human RCC.

Adult↗
PubMed1995

Borna disease virus genome transcribed and expressed in psychiatric patients.

Borna disease virus (BDV) is a neurotropic, negative and single-stranded enveloped RNA virus that persistently infects various domestic animal species. Infection causes disturbances in behaviour and cognitive functions, but can also lead to a fatal neurologic disease. Human infections seemed likely, since serum antibodies were detected in neuropsychiatric patients. Further proof came from our discovery that peripheral blood monocytes carry viral antigens. Here, we present the first data on different viral genomic transcripts in such patients' cells as well as sequence data of transcripts. Both viral markers seem to coincide with acute episodes of mood disorders, thus pointing to a new human virus infection possibly threatening mental health.

Acute Disease↗
PubMed1995

Treatment of renal cell carcinoma in von Hippel-Lindau disease: a multicenter study.

A total of 65 patients with von Hippel-Lindau disease underwent surgery for renal cell carcinoma (54 bilaterally and 11 unilaterally) at 8 medical centers. Only 1 patient presented with metastatic disease. Radical nephrectomy and nephron sparing surgery were performed in 16 and 49 patients, respectively. Mean posttreatment followup was 68 months. The 5 and 10-year cancer-specific survival rates for all patients were 95% and 77%, respectively. The corresponding rates for patients treated with nephron sparing surgery were 100% and 81%, respectively. Of the latter patients 25 (51%) had postoperative local tumor recurrence but only 2 had concomitant metastatic disease. Survival free of local recurrence was 71% at 5 years but only 15% at 10 years. End stage renal failure occurred in 15 patients (23%): 6 underwent renal transplantation (5 are alive with satisfactory renal function and no evidence of malignancy) and 9 were treated with chronic dialysis (6 are free of tumor). Our results indicate that nephron sparing surgery can provide effective initial treatment for patients with renal cell carcinoma and von Hippel-Lindau disease. These patients must be followed closely, since most will eventually have locally recurrent renal cell carcinoma. When removal of all renal tissue is necessary to achieve control of malignancy, renal transplantation can provide satisfactory replacement therapy for end stage renal disease.

Adolescent↗
PubMed1995

Clinical experience with nephron-sparing surgery in the presence of a normal contralateral kidney.

Since 1981, 110 patients have undergone a nephron-sparing surgery for renal cell carcinoma in the presence of normal contralateral kidney (elective indication) at our institution. The majority of these tumors were incidental findings with a mean tumor diameter of 3.3 cm (range 1 to 7 cm). After a mean follow-up period of 50.6 months, 1 patient died of metastatic disease, 5 died of tumor-unrelated causes, 2 are alive with systemic progression, and 102 are alive with no evidence of disease, resulting in a 5-year cancer specific survival rate of 98%. During the follow-up period, local tumor recurrence occurred in 3 patients (2.7%) without evidence of systemic progression at the time of diagnosis. A repeated nephron-sparing surgery (1 patient) or total excision of the renal remnant (2 patients) was possible in all these cases. Our results suggest that nephron-sparing surgery provides effective curative treatment for patients with small, unilateral, single, and localized renal cell carcinoma.

Aged↗
PubMed1994

Phenotypic investigation of mononuclear phagocytes by flow cytometry.

A simple and rapid method for the phenotypic analysis of mononuclear phagocytes is described. Using flow cytometry, surface markers, as well as intracellular antigens and DNA content of peripheral blood monocytes, or differentiated monocytic cells could be analysed. Furthermore, the method has been of use in several species and is therefore not restricted to applications in humans. Different modes of data acquisition and analysis were compared and are discussed.

Antibodies, Monoclonal↗
PubMed1994

Dextran sulphate induces a PKC and actin independent internalisation of CD4.

Internalisation of CD4 is a well-known phenomenon. It occurs in the presence of phorbol myristate acetate (PMA), TPA or gangliosides and is usually completed within 30 min. Here, we describe an internalisation of CD4 molecules induced by low concentrations of high molecular weight dextran sulfate (M(r) 500 kDa) which differs from the classical mode in several ways. Internalisation is demonstrated by flow cytometry after simultaneous and consecutive staining of extracellular and internalised CD4 molecules and by visualisation by electron micrographs. A simple blockage of antibody binding sites on the CD4 molecule (epitope masking) by DS500, as widely believed, is definitely not responsible for the observed effects. DS500-mediated internalisation is a slow and energy-dependent process, where CD4 but not CD 2, 3, 8, 16, 56 and HLA-DR molecules are involved. The reaction reveals a characteristic time and concentration dependency. It does not require activation of protein kinase C (PKC) and cannot be inhibited by cytochalasin D. These results provide some more insight in the behavior of CD4 on lymphoid cell surfaces in response to high molecular weight polyanions such as dextran sulfate.

Actins↗
PubMed1994

Low-dose gamma-interferon therapy is ineffective in renal cell carcinoma patients with large tumour burden.

The efficacy and immunomodulatory effects of low-dose gamma-interferon (gamma IFN) were investigated in an unselected population of patients with metastasising renal cell carcinoma. 36 patients suffering from metastasising renal cell carcinoma with a performance status exceeding Karnofsky index of 50 were entered into the open phase I/II trial. The majority of the patients recruited displayed a large tumour burden, and 28 patients (78%) had metastases involving two to six organ sites. Treatment was started with a 2-week cycle of either daily or weekly subcutaneous administration of either 100, 200 or 400 micrograms gamma IFN. After a therapy-free interval of 2 weeks treatment was switched to the alternate mode of administration. Subsequently, treatment was continued with the same dose applied once a week for a minimum of 3 months. Serum levels of neopterin and beta-2-microglobulin, as well as flow cytometric analyses of peripheral blood mononuclear cells, were used for the assessment of biological response. Minimal antitumour activity was observed in this high-risk patient group and only 1 patient experienced a partial response (PR) lasting 36 + months. Comparison of the patients' characteristics to those of other low-dose gamma IFN trials revealed a highly significant difference in the tumour burden and clinical response. We conclude that patient selection is a decisive parameter for the outcome of treatment with low-dose gamma IFN, and that patients with poor prognostic features and a large tumour burden are not likely to respond to this almost atoxic treatment.

Adult↗
PubMed1994

Multifocal renal cell tumors: a retrospective analysis of 56 patients treated with radical nephrectomy.

In this retrospective analysis of 56 patients with multifocal renal cell tumors the effect of secondary tumors on the prognosis was examined and the incidence of tumors in the contralateral kidney was evaluated. All of the primary tumors were renal cell carcinomas, the majority of which had a local tumor stage of pT2 (31 cases, 55.3%) and a cytological grading of 1 (23 cases, 41%). The mean size of the secondary tumors was 1.0 cm. An additional tumor was diagnosed in 23 patients (41%), 2 to 5 secondary tumors in 23 (41%) and more than 5 additional tumors in 10 (18%). The overall 5-year survival rates were 69.4%, 72.2% and 40%, respectively (p = 0.313). Histopathological differentiation of the additional lesions revealed 23.2% renal cell carcinomas, 71.4% adenomas and 5.3% renal tumors of "doubtful dignity," with overall 5-year survival rates of 67.2% for adenomas, and 60.6% for carcinomas and renal tumors of "doubtful dignity" (p = 0.546). After a mean followup of 60 months 33 patients (58.9%) were alive without evidence of disease, 1 (1.7%) was alive with tumor progression, 8 (14.2%) died of the disease and 14 (25%) died of other causes; only 1 patient presented with a tumor in the contralateral kidney (incidence 1.7%). Thus, the overall 5-year survival rate for the entire group was 66.0% and the histopathological parameters of the additional tumors had no effect on the prognosis of the patients.

Adenoma↗
PubMed1994

Renal transplantation in patients with renal cell carcinoma and von Hippel-Lindau disease.

This study reviewed the management and outcome of patients with von Hippel-Lindau disease (VHLD) who underwent renal transplantation after being rendered anephric to treat multifocal bilateral renal cell carcinoma (RCC). Five patients with bilateral RCC and VHLD underwent renal transplantation at our hospital. Initial treatment of RCC consisted of bilateral nephrectomy in 2 patients and unilateral nephron-sparing surgery with contralateral nephrectomy in 3 patients. All of the latter 3 patients experienced isolated tumor recurrence in the renal remnant at 48, 64, and 66 months postoperatively; this was managed by complete excision of the renal remnant. Renal transplantation was performed 11 to 24 months after initiation of dialysis. Postoperatively, all of the allografts functioned well with no further requirement for dialysis. Currently, 4 patients are alive at a mean post-transplant follow-up interval of 26 months (range, 7 to 66 months) with excellent graft function and no evidence of malignancy. One patient died 17 months following transplantation due to metastatic disease. Renal transplantation can provide satisfactory replacement therapy for patients with end-stage renal disease with VHLD and treated RCC.

Adult↗
PubMed1994

[Computed tomography of the kidneys following tumor enucleation].

Two weeks to 120 months after enucleation of renal tumours the postoperative defects were correctly localized by renal computed tomography in 34 patients. Typical defect morphology was either wedge-shaped or concave. No dependence on tumour localization, tumour size, operative technique or a certain surgeon was observed. The cortical defects were smaller (mean 2.0 cm) than the original, prominent tumours (mean 3.4 cm). In small defects without tension suture of the capsule is sufficient, leading to minor defects. Larger defects were closed with a retroperitoneal or free peritoneal fat flap resulting in larger residual defects. In case of intra- or postoperative bleeding, CT could demonstrate parenchymatous or perirenal haematomas or delayed perfusion of adjacent parenchyma. In one patient a recurrent tumour was correctly diagnosed, different postoperative complications (such as abscesses) were not observed.

Adenoma, Oxyphilic↗