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Biomedical subjects

H G Frohmüller

Publications and source records attributed to H G Frohmüller.

At least 19 recordsLinked to original sources
PubMed1997

Cyclic interferon alpha treatment in metastatic renal cell carcinoma: results of a phase II study and review of the literature.

In a phase II clinical trial 23 patients with metastatic renal cell carcinoma were treated with a cyclic regimen of interferon alpha-2b (IFN-alpha). To these 23 patients IFN-alpha at a dose of 10 MU/m2 body surface was applied subcutaneously on 5 consecutive days every 4 weeks. In 12 out of these 23 patients tumor nephrectomy preceded this treatment. The mean follow-up period was 13.6 (range 2-36) months. No complete remission was achieved in any of the patients. One patient with lung metastases revealed a partial response for 19 months. Stable disease lasting 4 to > 36 (mean: 18.7) months was seen in 7 cases. Progressive disease was observed in 15 patients. Only slight side effects were noted, consisting of a maximum toxicity of grades II (n = 20) and III (n = 3) according to the WHO classification. Five out of 8 patients with partial responses or stable disease showed a long-lasting stabilization (> 12 months) of the disease with a good quality of life. In summary, in advanced renal cell carcinoma patients, the objective response rate of a cyclic treatment with IFN-alpha is rather low. However, a long-lasting stabilization of the disease including a good quality of life can be expected in a modest proportion of the patients.

Antineoplastic Agents↗
PubMed1996

Immunochemotherapy for metastatic renal cell carcinoma using a regimen of interleukin-2, interferon-alpha and 5-fluorouracil.

PURPOSE: Promising results of recent clinical trials with a triple drug bio-chemotherapy regimen encouraged its use in patients with renal cell carcinoma. MATERIALS AND METHODS: In a phase II study of patients with metastatic renal cell carcinoma the efficacy and toxicity of a treatment regimen were evaluated using interleukin-2 and interferon-alpha 2 subcutaneously in combination with intravenous 5-fluorouracil. The treatment protocol consisted of an 8-week cycle given on an outpatient basis, with 6 to 9 MU/m2. interferon-alpha given 1 to 3 times a week during the 8 weeks, and sequentially combined with 5 to 20 MU/m2. interleukin-2, 3 times a week for 4 weeks and 750 mg./m.2 5-fluorouracil once a week for 4 weeks. RESULTS: Among 25 consecutive men and 9 women treated 3 (9%) had a complete and 10 (29%) had a partial remission (overall objective response rate 38%). Median response duration (complete plus partial) was 12.5 months (range 3 to 20+). Stable disease lasting 3 to 24+ months was noted in 12 patients (35%). There were only minor side effects, for a maximum toxicity grade of I in 3 patients, II in 25 and III in 6 according to the World Health Organization classification. There were no dose limiting toxicities and no treatment related deaths. CONCLUSIONS: Triple drug immunochemotherapy resulted in a significant clinical effect comparable to an aggressive intravenous interleukin-2 treatment regimen but without significant toxicity.

Adult↗
PubMed1995

Significance of conventional and new prognostic factors for locally confined renal cell carcinoma.

BACKGROUND: The prognosis of patients with locally confined renal cell carcinoma is variable. To improve the prognostic knowledge and select patients at high risk, additional prognostic parameters are needed. METHODS: The significance with respect to survival and tumor recurrence of "classic" and "new" prognostic parameters has been examined by following 41 patients with locally confined renal cell carcinoma after nephrectomy (mean follow-up, 5.2 years). The significance of histologic grade, tumor stage, Ki-67 index, proliferating cell nuclear antigen index, 3H-thymidine labeling index, tumor ploidy status, and tumor growth after xenotransplantation into nude mice (GAX range) was tested using the Kaplan-Meier plots by the log rank test or Tarone's test and also by the Cox multiple hazard regression analysis. RESULTS: Tumor stage (P < 0.0025), histologic grade (P < 0.005), Ki-67 index (P < 0.006), and GAX range (P < 0.00004) were found to be significant prognostic parameters for survival and tumor recurrence using single-factor analysis. Applying the multivariate analysis, the combination of the "new" factors, GAX range and Ki-67 index, resulted in even a higher prognostic relevance than the combination of the "classic" prognostic factors, tumor stage and histologic grade. The calculated prognostic index based on the results of the Cox analysis, which, except for stage and grade, included the Ki-67 index, was shown to be highly correlated with survival (P = 0.00002) and tumor recurrence (P = 0.0004). Its prognostic validity was studied with the receiver operating characteristics procedure and was found to be considerably superior to that of the two conventional prognosticators. CONCLUSIONS: The additional determination of the Ki-67 labeling index increases the prognostic assessment of patients with locally confined renal cell carcinoma.

Animals↗
PubMed1995

Prognostic significance of capsular invasion and capsular penetration in patients with clinically localized prostate cancer undergoing radical prostatectomy.

One hundred thirty patients with an observed follow-up of more than 10 years after radical prostatectomy were restaged with regard to local extent of the tumor in relation to the prostate capsule. Of 112 patients with surgically staged negative pelvic lymph nodes, 62 had a tumor-free prostate capsule, 24 had capsular invasion without penetration, and 26 had tumors extending through the capsule of the prostate. Observed overall and disease-free 10-year-survival rates were 79% and 69.4%, respectively, in patients with absence of capsular involvement and 70.8% and 66.7%, respectively, in patients with capsular invasion alone. In patients with capsular penetration, however, the survival rates significantly decreased to 57.7% (P = 0.018) and to 38.5 (P = 0.017), respectively. The overall progression rate was found to be significantly higher in patients with tumors extending through the prostatic capsule (46.2%), as compared to those with absence of capsular involvement (21%; P = 0.014) as well as to those with capsular invasion alone without penetration (25%; P = 0.034). Thus, in contrast to capsular invasion alone, capsular penetration means a poor prognostic indicator, which accounts for a reduced survival expectancy and a higher progression rate following radical prostatectomy. Therefore, tumors with capsular invasion and those with capsular penetration should not be grouped together in the same tumor stage as done in the 1987 edition of the TNM tumor classification system.

Adult↗
PubMed1995

Radical prostatectomy in the management of localized prostate cancer.

No data from prospective randomized studies comparing radical prostatectomy, radiotherapy and deferred treatment for localized prostatic cancer are currently available. Comparison of retrospective series, however, strongly suggests a clear superiority of radical prostatectomy over other attempts to cure prostate cancer, and especially over the 'watchful waiting' strategy. This concerns survival data as well as quality of life and psychological aspects. In 1994, the Department of Veterans Affairs and The National Cancer Institute in the United States initiated a randomized controlled study comparing radical prostatectomy vs expectant management for the treatment of localized prostate cancer, the 'Prostate Cancer Intervention vs Observation Trial (PIVOT)'. Until the results of this study become available, the decision on how to manage a patient with a newly-diagnosed clinically localized prostate cancer has to be based on current knowledge. The current knowledge is that localized prostate cancer can be cured by radical prostatectomy with acceptable treatment-related morbidity. Therefore, the chance of receiving curative treatment should be offered to every man with localized prostate cancer and a life expectancy of 10 or more years.

Aged↗
PubMed1995

Primary non-Hodgkin's lymphoma of the male urethra. A case report and review of the literature.

Approximately 15-25% of malignant non-Hodgkin's lymphomas (NHLs) are primarily extranodal and only 2.7% of these are located in the genitourinary tract. Only a few particular cases of primary manifestation of NHL in the urethra have been described, most of them in female patients, whereas a secondary involvement occurs more frequently. In the present case a high-grade malignant NHL of the B-cell type was located in the urethra of a 29-year-old male patient. No other manifestations of NHL could be found. After surgical removal of the urethral neoplasm the patient was treated with combined chemotherapy (6 cycles of the CHOP scheme). Thereafter, reconstruction of the urethra by the island flap method of Duckett was carried out. Two years after diagnosis the patient is alive and in complete remission with good functional and cosmetic results of surgery and a normal sexual life.

Adult↗
PubMed1995

Survival and quality of life of patients with stage D1 (T1-3 pN1-2 M0) prostate cancer. Radical prostatectomy plus androgen deprivation versus androgen deprivation alone.

A series of 139 patients with histologically proven stage D1 (T1-3 pN1-2 M0) prostate cancer was reviewed in order to determine the influence of radical surgery in addition to hormonal treatment on long-term outcome with respect to survival and quality of life. In all 139 patients a pelvic lymphadenectomy was performed. In 87 patients, lymphadenectomy was followed by androgen deprivation alone (group 1). Fifty-two patients underwent additional radical prostatectomy (group 2). The actuarial 10-year nonprogression rates were 14.6% in group 1 and 35.8% in group 2, respectively (p = 0.0016). The overall and disease-specific 10-year survival rates were found to be 29.7 and 32.1%, respectively, for group 1 and 50.8 and 70.7%, respectively, for group 2. Local progression as the main parameter influencing quality of life occurred in 60 of the 87 patients (69%) not subjected to radical prostatectomy. Transurethral resection of the prostate was required in 29 of these patients. In contrast, following radical prostatectomy, only 4 of the 52 patients (8%) had local progression and only 1 patient (2%) needed a dilatation of the vesicourethral anastomosis for relief of infravesical obstruction. Thus, radical prostatectomy plus androgen deprivation for patients with stage D1 prostate cancer appeared to be superior to androgen deprivation alone with respect to survival expectancy and quality of life. Prospective randomized trials, however, have to be undertaken to verify these results.

Biopsy↗
PubMed1995

Fournier's gangrene in a patient with erectile dysfunction following use of a mechanical erection aid device.

A case of Fournier's gangrene is presented following the use of a constriction ring in a patient with erectile dysfunction. The necrotizing inflammation started at the skin of the penile shaft and spread over the entire scrotal area. Total scrotectomy and excision of the skin of the penile shaft were necessary. This case demonstrates that mechanical constriction devices applied to create or maintain a penile erection are not as free of adverse affects as they are generally believed to be. Physicians who treat patients using these devices should be aware of such severe complications.

Constriction↗
PubMed1994

DNA-ploidy, G2M-fractions and prognosis of stages B and C prostate carcinoma.

Paraffin embedded tissue of 49 stage C and 27 stage B prostate adenocarcinomas was investigated by flow cytometry. All patients were treated by radical prostatectomy with pelvic lymphadenectomy and followed up for 5-10 years. The tumour was separated from the benign tissue to increase the proportion of tumour cells. Ten stage C and seven stage B carcinomas had to be excluded because of poor fixation. Six of the 39 (15%) stage C and 1/20 (5%) stage B carcinomas were aneuploid. Cell cycle analysis was done with correction for sliced nuclei and background subtraction. The threshold between carcinomas with low and with increased ("tetraploid") G2M-fraction was determined by comparing carcinomas with and without tumour progression. Sixty-seven percent of the patients with non-euploid stage C carcinomas and 11% of those with euploid carcinomas suffered from tumour progression (P < 0.01). The respective values for the stage B carcinomas were 67% and 6% (P < 0.01). These results demonstrate the strong prognostic impact of DNA-ploidy and G2M-fractions for each individual patient.

Adult↗
PubMed1994

[Surgical interventions of the adrenal gland. Diagnosis and results of treatment].

From 1982 to 1992, 33 patients underwent adrenalectomy for disease of the adrenal gland: 18 patients with adrenal cortex adenoma or hyperplasia (Cushing's syndrome n = 11, Conn's syndrome n = 6, adrenogenital syndrome n = 1), 3 with pituitary-dependent Cushing's disease, 7 with pheochromocytoma (malignant n = 1), 2 with a metastasis of lung cancer and 1 with cystic adrenal necrosis. Multiple endocrine neoplasia existed in four cases. Various preoperative symptoms were noted, including complaints typical of the respective syndromes and general abdominal symptoms. Other patients were symptom-free with incidental findings. An intercostal approach was used in 30 cases, a transabdominal approach in 3 cases. In 6 cases bilateral and in 27 cases unilateral adrenalectomy was performed. In two cases additional nephrectomy became necessary because of extensive adhesions. Intraoperatively, one patient suffered a blood pressure crisis. 31 patients are still alive and symptom-free after a mean follow-up of 5.4 years (range 1-11 years). Two patients have died (one with benign pheochromocytoma and one with a metastasis of lung cancer). Detailed preoperative hormone analysis and adequate preoperative medication substantially lowers the risk involved in adrenal surgery. However, the indications for surgical treatment of hormonally inactive, symptom-free adrenal tumors that are found incidentally remain controversial, and surgery should perhaps be restricted to large tumors.

Adolescent↗
PubMed1994

[Treatment of advanced renal cell carcinoma with subcutaneous administration of interleukin 2 and interferon-alpha].

Twenty-three patients with advanced renal cell carcinoma were treated with subcutaneous injections of interleukin-2 (IL-2) and interferon-alpha (IFN-alpha). IFN-alpha (5-10(6) U/m2) was injected on day 1 of the 1st week of a treatment cycle of 6 weeks and high doses of IL-2 (20.10(6) IU/m2) on days 3, 4 and 5. In the 2nd and 3rd week IFN-alpha (dose as above) and low doses of IL-2 (5.10(6) IU/m2) were injected on days 1, 3 and 5. The treatment from the 4th to the 6th week corresponded to that of the 1st to 3rd week. In cases of remission or stable disease the treatment schedule was repeated as a rule once or twice. In 12 of the 23 cases nephrectomy had been carried out previously. Complete remission lasting 4 + months and partial remission lasting 2 months were achieved in two patients with lung and skeletal metastases. A stable state of the disease lasting 1-7 + months was observed in 11 cases. Ten patients showed progression of the disease after the first treatment cycle. Thus, the overall objective response rate was 9%. The side effects were only slight and corresponded to WHO toxicity grade I (n = 8) and grade II (n = 15). In two cases the first treatment cycle could not be finished.

Adult↗
PubMed1993

Extracorporeal shock wave lithotripsy in patients with renal malformations.

Twenty-four consecutive patients with malformed kidneys (21 horseshoe kidneys, 2 crossed ectopic and 1 pelvic kidney) underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis between 1984 and 1990. No serious complications occurred either during or after treatment. Urinary obstruction was accompanied by fever in 3 patients and by renal colic in 4. Auxiliary measures were required in only 2 cases. Patients with renal anomalies remained in hospital longer than patients with normal kidneys. Fifteen patients were free of stones 3 months after ESWL and 16 after 1 year. Six patients required further ESWL less than 1 year after their first treatment as a result of stone recurrence or regrowth. ESWL is a safe and successful non-invasive procedure for the treatment of nephrolithiasis in patients with malformed kidneys. However, the higher frequency of stone recurrence and regrowth means that these patients must undergo careful monitoring.

Adult↗
PubMed1993

[Value of transrectal ultrasound in determining the T-stage of prostate cancer].

Accurate preoperative staging of prostate adenocarcinoma is especially important before radical prostatectomy. The purpose of this prospective study was to investigate the staging accuracy of transrectal ultrasonography in prostatic adenocarcinoma. The results of the preoperative staging evaluation in 126 patients with endorectal ultrasound were compared with the histopathologic findings after radical prostatectomy. Correct staging by transrectal sonography was possible in 82 of 126 patients (65%). For stage pT3 tumors, sensitivity, specificity and positive predictive value were 69%, 51% and 82% respectively.

Adult↗
PubMed1993

[Results of low dosage cyclic interferon-gamma therapy of metastatic renal cell carcinoma].

A total of 24 patients with metastatic renal cell carcinoma were treated with a low-dose cyclic regimen of interferon-gamma (IFN-gamma). The dosage was 50 micrograms IFN-gamma s.c. per day for 5 days every 4 weeks. In 16 of the 24 patients nephrectomy had preceded this treatment. Another immunotherapy had already been performed in 13 of the 24 cases. No complete remission was achieved in any of the patients, all of whom were evaluable. One patient with pulmonary metastases achieved partial response. Stable disease lasting 2 to 12+ months was seen in 5 cases. Tumour progression was observed in 18 patients. Only slight side-effects were noted. Patient selection could be one reason for the wide range of response rates reported for IFN-gamma treatment in the literature.

Adult↗
PubMed1992

Primary extracorporeal shock wave lithotripsy of staghorn renal calculi.

186 patients with partial and 55 patients with complete renal staghorn calculi were treated with primary extracorporeal shock wave lithotripsy (ESWL) at the Department of Urology, University of Würzburg Medical School. Partial staghorn calculi required an average of 1.4, complete staghorn calculi an average of 2.2 treatment sessions using the Dornier HM 3 lithotriptor. 55% of all patients and 46% of the patients with complete staghorn calculi were rendered stone-free within 1 year after ESWL. Pretreatment urinary tract infections present in 50.6% of all patients could be reduced to 22.5% 1 year after ESWL. The most frequent complications after ESWL were ureteral obstruction caused by 'steinstrasse' (41.4%), fever (38.4%), and renal colics (29.4%). Severe complications needing open operative procedures or blood transfusions did not occur. 50% of all patients underwent auxiliary procedures (e.g. insertion of indwelling ureteral stents: 25.3%, percutaneous nephrostomy: 20.3%, percutaneous nephrolithotripsy: 2.9%). Pretreatment insertion of an indwelling ureteral stent was found to reduce posttreatment complications as well as the need for percutaneous nephrostomy only in patients with partial staghorn calculi. The data presented in this study demonstrate that primary ESWL therapy can be safely and successfully performed in the majority of patients with renal staghorn calculi. In patients requiring complete removal of all stone fragments, a percutaneous lithotripsy can be performed following ESWL.

Adult↗