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Biomedical subjects

G Staehler

Publications and source records attributed to G Staehler.

At least 37 records · Page 2Linked to original sources
PubMed1989

Significance of salvage lymphadenectomy in the therapeutical concept of advanced nonseminomatous germ cell tumors.

A retrospective study reports 65 patients with metastatic disease from nonseminomatous germ cell testicular tumors who underwent a salvage lymphadenectomy either to remove a residual mass or to confirm a complete clinical response after polychemotherapy. Scarring was found in 23 patients (35%), differentiated teratoma in 25 patients (39%) and residual cancer in 17 patients (26%). Of the 12 patients staged as complete responders 2 were found to have cancer, 4 teratoma and 6 fibrosis. Neither tumor markers nor CT scan could accurately predict which patients with residual masses would have cancer, mature teratoma or necrosis. Thus needle biopsy or limited resection is inadequate in its ability to detect persistent vital tumor. After a follow-up of 10-106 months 49 patients (75%) are living with no evidence of disease. 12 patients (19%) died of tumor progress. The most critical prognostic determinant was the nature of the tissue resected. 21 (91%) of 23 patients with only fibrous or necrotic elements are living with no evidence of disease. However, of 17 patients with persistent cancer in the resected tissue only 8 patients (47%) fared well. Our experience confirms the original concept which called for postchemotherapeutic tumor surgery in all patients who demonstrated either a partial or complete clinical response.

Adult↗
PubMed1989

Intracavernous self-injection of prostaglandin E1 in the therapy of erectile dysfunction.

The efficacy of intracavernous autoinjection therapy with prostaglandin E1 was investigated over a period of up to six months in 187 patients with long-term erectile dysfunction. All patients had to undergo an investigation program consisting of routine laboratory tests, directional doppler sonography of the penile arteries, measurements of the BCR-latencies, as well as intracuvernum drug testing with PGE1. Six months follow-up results are available so far in 115 patients. The mean injection dose was 13.5 mcg PGE1 at the beginning of therapy and 12.8 mcg PGE1 at the end of therapy. An average of 24 prostaglandin E1 injections per patient was given. In 16.6% of the 187 patients slight to moderate pain occurred at the injection site, not influencing sexual intercourse. No priapisms lasting more than six hours were observed. A significant improvement of the blood flow in the deep and dorsal penile arteries was shown by penile doppler sonography after 6 months treatment. The efficacy and tolerability of the therapy were designated as very good to good in 91% respectively in 98% of the patients. 94% of the patients would like to continue the therapy. The results indicate that PGE1 due to its erectile potency and great tolerability will occupy an important position in the therapy of the erectile dysfunction.

Adult↗
PubMed1988

[Autologous retransfusion of washed erythrocytes in transurethral resection of prostatic adenomas. Preliminary report].

Red blood cells were concentrated from the irrigation fluid used during prostatic resection in 30 patients by means of a cell saver system. The resulting units of packed red cells were analysed for quality and possible contamination. Average blood loss during the procedure was 645 ml, and an average of 580 ml of packed red cells was harvested and retransfused in 25 patients. Retransfusion was well tolerated and no adverse reactions were seen. Our positive clinical experience with the method and the ease of application suggest that it can probably be recommended as a routine procedure during transurethral resection of the prostate.

Aged↗
PubMed1988

[Metaraminol in therapy of various forms of priapism].

A total of 19 patients (aged 17-66 years) with priapism received primarily conservative treatment in the form of aspiration of blood from the cavernous bodies and subsequent intracavernous (i.c.) administration of the alpha-adrenergic drug metaraminol. In 15 patients the priapism was due to i.c. injection of vasoactive agents; 1 patient each it had developed after hemodialysis, during oral prazosin medication, and in conjunction with Fabry's disease; and in 1 patient the etiopathogenesis was unknown. Treatment of priapism with metaraminol was successful in the first 15 patients and in 2 patients with priapism due to hemodialysis and oral prazosin medication. Therapy failed in long-lasting priapism associated with Fabry's disease and in priapism of unknown etiopathogenesis. Penile detumescence took place in the first 15 patients 3 min to 2.5 h after the injection of 2-4 mg metaraminol. Hemodialysis- and prazosin-linked priapism was treated with 5 and 2 mg metaraminol, respectively; in these patients erection subsided within 15 and 4 min after onset of therapy. In a further 2 patients in whom therapy had failed Al-Ghorab shunts were constructed, with the subsequent postoperative complication of erectile impotence. Injection of metaraminol must be carried out under strict supervision of the patient's circulatory system: doses of 4 mg metaraminol or more led to an increase in blood pressure and heart rate. In 15 patients with priapism induced by i.c. application of vasoactive agents, the analysis of blood gas parameters demonstrated a severe hypercapnia (70.3 +/- 10.0 mm Hg) and acidosis (pH 7.08 +/- 0.08) 5-10 h after the onset of erection, but severe hypoxia (37.0 +/- 16.6 mm Hg) was not found until erection had lasted for more than 10 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1987

[Kidney cancer with invasion of the vena cava: classification, surgical strategy and results of treatment].

A new classification of vena caval tumor thrombi is recommended from our experience with 37 cases. For advanced tumor thrombi a surgical technique with routinely performed thoracotomy, inserting a Sarns-catheter and preparing the cardiopulmonary bypass is mandatory. If metastases are absent the prognosis of the renal carcinoma is nearly as good as in cases without tumor extension into the vena cava. The total 2-year-survival rate in our series is 47%, for the cases without metastases it is 65%. The total 5-year-survival rate is 25% and for patients without metastases 57%.

Adult↗
PubMed1986

Cytologic regression grading of hormone-treated prostatic cancer.

Aspiration cytology during hormone treatment of prostatic cancer has been regularly performed at the University of Munich for 13 years and gives direct information on the primary tumor. To analyse its value in clinical practice, 919 biopsies of 187 patients were reviewed without knowledge of clinical data and the charts were analysed retrospectively. Each biopsy was classified as having good, medium, or poor therapeutic response depending on the regressive changes of the cells. Agreement between two independent observers was 89%. All but 39 of these patients have died and the surviving patients have a minimum observation period of 5.6 years. A poor therapeutic response was seen cytologically in 72 patients (38.5%) at variable times after treatment began. These patients have a statistically significant worse survival in comparison to all other patients. Forty-seven of these 72 patients had deterioration, but clinical signs developed later in 23 cases (mean 1.1 years); in 21 patients cytology and clinical signs were simultaneous and in only three cases clinical deterioration preceded aspiration cytology (mean 4.8 months). In 25 cases there was a cytologically poor therapeutic response, but no clinical signs of deterioration. These patients had the same survival rate as with good or medium treatment response. Serial aspiration cytology is a very valuable parameter in treatment monitoring and is often the early warning sign of endocrine treatment failure.

Aged↗
PubMed1985

Analysis of proliferative compartments in human tumors. II. Seminoma.

Growth pattern and cell kinetics of 12 human seminomas were determined by means of vascular organ perfusion after orchiectomy. The arteria testicularis of the tumor-bearing testis was perfused up to 5 hours with dextran-diluted blood under normothermic and normotonic, simulated physiologic conditions. At defined periods, the specimen was exposed to tritiated and/or carbon 14-labeled thymidine. Autoradiograms prepared of whole tumor sections revealed a dependence of growth pattern on the stage of development. A homogeneous distribution of DNA synthesizing seminoma cells was found in small tumor foci. With increasing size, the zone of proliferation shifted to the periphery of the nodule giving rise to nodular subpopulations of high proliferative activity. In nodules of a diameter of more than about 2 cm the growth compartment consists of a highly proliferating invading cell layer at the edge of the tumor and intratumoral patches of proliferating cells near the vascular stroma. The largest part of the tumor remains at this stage in a quiescent state (G0). The mean labeling index of the seminoma cells was 11.6 +/- 1.4%, with the highest values found immediately adjacent to tumor vessels. High mitotic activity in an anaplastic seminoma was coupled with maximum labeling indices up to 41.9%. DNA synthesis time ts was 15.9 +/- 2.0 hours. The potential population doubling time for the proliferating fraction was in the range of 5 days. Lymphocytic infiltration reduced the proliferative activity in some parts, but was without effect in other areas of the seminoma. The seminoma is an example of a malignant human tumor with a rather regular growth pattern: The distribution of the proliferating compartment appears less dependent on cytologic or histologic structure, but more on tumor geometry and size.

Adult↗
PubMed1985

The use of neodymium-YAG lasers in urology: indications, technique and critical assessment.

After development and experimental approval of suitable equipment for endoscopic and external use, the neodymium-YAG laser has been used routinely to treat tumors of the bladder and external genitalia in our department. A 2-year followup of 60 patients revealed a significant decrease in local bladder tumor recurrence (5 per cent). Successful laser therapy also was applied in cases of stage T1/T2 penile carcinomas, female urethral carcinomas and condylomata acuminata. Laser application offers an additional useful therapeutic procedure in the treatment of urological malignancies.

Animals↗
PubMed1985

[Urologic complications following radiotherapy of cancers of the corpus uteri].

Patients with endometrial carcinomas who have undergone only radiation therapy represent a negative selection, because of the many concomitant diseases. In the author's group of 134 cases such patients were on average 7 years older than those who had undergone surgery. Even with computer-calculated opposing-field therapy with intracavity packing, radiation damage to the urinary tract must be expected. Of the 134 patients, 75 (55.9%) had pathologic urological findings following radiation therapy. The most commonly affected organ was the bladder (55.2%), followed by the kidneys (21.6%) and the ureter (7.5%). Radiation damage to the urethra could not be verified. The urological complications were hardly affected by the stage of the tumor, but considerably so by the time interval: the rate of urological complications was 68.9% higher after 5 years than after 1 year. Therefore, accurate statements concerning urological complications following primary radiation therapy for endometrial carcinoma cannot be made until 5 years have elapsed.

Female↗
PubMed1985

[NMR tomography in urology. Principles--technics--risks--areas of use].

NMR tomography is a new imaging method based on nuclear magnetic resonance. It is possible to obtain sectional views of the human body in all three planes without ionizing radiation. NMR can differentiate soft tissue better than CT, and large blood vessels can be simultaneously evaluated without using contrast medium. The pathological process could be imaged exactly in every examination. Due to the lack of image clarity caused by breathing movement, NMR is not superior to CT when using contrast medium in the epigastrium. Calculation of relaxation times T1 and 2 shows clear differences between tumor and normal tissue. However, contrary to initial expectations. NMR did not permit a type-specific diagnosis to be made. Three-dimensional images improve the process of staging tumors, especially in the retroperitoneal space and in the pelvis. As with CT, metastatic lymph nodes can only be demonstrated when they have reached a size of at least 1 cm. Further studies will be necessary to evaluate the validity of this new imaging method.

Contrast Media↗
PubMed1985

[Potential danger to pacemaker patients during transurethral operations. Clinical and experimental studies].

The high sensitivity of modern demand pacemakers to HF-currents, as used for the TUR, could be shown by an in vitro model, animal experiments and clinical investigations. It was possible to characterise the type specific HF-sensitivity by means of individual functions. Furthermore, it could be proven that almost every external HF-signal could be blocked by switching the demand pacemaker to its fixed magnet frequency, a most important procedure in order to maintain patient safety during a transurethral resection.

Animals↗
PubMed1985

[Integral photodynamic therapy of multifocal bladder cancer. Initial clinical experiences].

Experimental results and initial clinical experience indicates that even carcinoma in situ can be destroyed by integral photodynamic therapy of multifocal bladder carcinoma following tumor-selective photosensitization with a hematoporphyrin derivative. The employment of a light-scattering medium in combination with a special bladder catheter and photodynamically effective red laser light (630 nm) guarantees homogeneous irradiation of the bladder, which thus reaches all tumor foci. The complications observed were transitional dysurias and, in a particular case, regressive shrinkage of the bladder.

Carcinoma in Situ↗
PubMed1985

[Experimental studies on the regeneration capability and prognosis of hydronephrosis].

There are conflicting opinions regarding the ability of kidneys to return to normal functioning following removal of an obstruction. Opinions also differ on the precision of radioactive iodine for the measurement of functional ability in obstructed kidneys. We tried to assess the value of nuclear medical methods in comparison to the classical physiological clearance methods. Furthermore, we tried to answer the following questions: how long can an obstruction be present before total recovery becomes impossible and when is it no longer worthwhile to perform conservative surgery?

Animals↗
PubMed1985

[Organ-sparing operative therapy of kidney tumors].

In 24 (4.8%) of 503 patients with renal tumors, the growth was located in solitary or residual kidneys, and the overall renal function was diminished. This was the indication used for tumor enucleation or partial nephrectomy. Of the patients with renal cell carcinoma, 75% were free of tumor after a mean follow-up of 27 months (8-65). There were 18 patients with stage 1 (T1, T2, N0, M0) and 2 with stage 2 tumors. Three patients had a angiomyolipoma and one underwent nephrectomy because of a late postoperative complication. This outcome compares favorably with the results of radical nephrectomy in cases with normal kidney function. In conclusion, enucleation or partial nephrectomy is justified in patients with impaired renal function and may be considered in patients with T1, G1 tumors in normal functioning kidneys.

Female↗