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Biomedical subjects

H Hedelin

Publications and source records attributed to H Hedelin.

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

Analysis of the local control in lymph-node staged localized prostate cancer treated by external beam radiotherapy, assessed by digital rectal examination, serum prostate-specific antigen and biopsy.

OBJECTIVE: To describe local disease control after radical external beam radiotherapy of prostatic carcinoma, as judged by digital rectal examination (DRE), transrectal ultrasonography (TRUS)-guided biopsies and estimates of serum prostate-specific antigen (PSA). PATIENTS AND METHODS: The study comprised 175 patients (mean age 67.5 years, range 49-82; > 90% aged > or = 60 years) with localized prostatic carcinoma (T1-T3C, N0, M0) who underwent external beam radiation therapy (70 Gy), and were then regularly followed with a DRE, measurements of serum PSA and TRUS-guided biopsies to determine the outcome. RESULTS: The DRE revealed four patients with evidence of residual cancer in the prostate and biopsies showed no evidence of residual cancer in 131 (75%) of the patients. There was no correlation of residual cancer with tumour stage or grade but tumour size, as estimated by TRUS, correlated with the results of the biopsy. The nadir serum PSA level was < or = 1.0 ng/mL in 116 (66%) of the patients, of whom 76 (43%) had a nadir serum PSA level of < or = 0.5 ng/mL. The median time to the nadir level was 11 months. Serum PSA progression (> 4.0 ng/mL) at the latest PSA measurement after reaching the nadir occurred in 13% of the patients with a nadir PSA of < or = 0.5 ng/mL and in 25 of the 29 (86%) patients with a nadir serum PSA > 2.0 ng/mL. Cox regression analysis showed that tumour size and rectal irradiation dose were the most important factors for local control. CONCLUSIONS: Radiotherapy is effective in achieving local control in small prostate cancer tumours but less effective in large tumours. Tumour size and dorsal extension of the irradiated target, the rectal dose, were the two important factors for local control. A serum PSA level of < or = 1.0 ng/mL was associated with a higher chance of prolonged disease control.

Aged↗
PubMed1997

Palliative effect of intravesical bacillus Calmette-Guerin in elderly patients with advanced bladder carcinoma.

PURPOSE: Intravesical bacillus Calmette-Guerin (BCG) was used to palliate severe local symptoms in patients with invasive carcinoma. MATERIALS AND METHODS: Four patients with unresectable bladder carcinoma who were unfit for radical cystectomy because of age and poor performance status were treated with a 6-week course of BCG followed by monthly instillations. RESULTS: Urgency and frequency were reduced in 3 patients and the improvement lasted for 9 to 19 months. All 4 patients ultimately died of bladder carcinoma. CONCLUSIONS: The results of palliative BCG treatment were encouraging, but further experience is necessary.

Adjuvants, Immunologic↗
PubMed1997

[Outpatient treatment of bladder cancer--lower cost and satisfied patients].

Transurethral resection of bladder tumours and recurrences accounts for a substantial part of the workload at a urology unit. With the aim of reducing costs, since 1992 we have performed transurethral resection as an out-patient procedure if possible. Transurethral resection as day surgery in selected patients has been enabled by the use of extirpation and fulguration under cover of intravesical lignocaine (lidocaine) anaesthesia or submucosal lignocaine injection. Before the introduction of the out-patient treatment policy, around 270 transurethral resections of bladder tumours were performed annually at a cost of SEK 5.7 million. During 1994 and 1995, almost half of the procedures could be performed in an out-patient setting, with minimal complications and a very high level of patient acceptance, the respective reductions in costs being SEK 2.4 million and SEK 3.2 million.

Ambulatory Surgical Procedures↗
PubMed1997

Long-term followup of a bladder carcinoma cohort: questionable value of radical radiotherapy.

PURPOSE: We studied the outcome of radical radiotherapy for bladder carcinoma in all patients from a well-defined region. MATERIALS AND METHODS: All 701 cases with a new bladder carcinoma between 1987 and 1988 in Western Sweden were prospectively documented and followed until 1994. Between 1987 and 1994, 74 of the 701 patients (mean age 73 years, range 54 to 88) were treated with external beam radiotherapy (60 Gy. or more). RESULTS: At least 84% of the patients had persistent tumor, a local recurrence or a symptomatic contracted bladder after external beam radiotherapy. Seven patients (9.5%) died of early or late treatment related complications. Of only 8 long-term survivors 6 had undergone radical transurethral resection before external beam radiotherapy. CONCLUSIONS: Full dose external beam radiotherapy in patients with bladder carcinoma was associated with high local recurrence and serious complication rates. It must be questioned whether elderly patients actually benefit from full dose radiotherapy.

Aged↗
PubMed1997

Long-term followup of all patients with muscle invasive (stages T2, T3 and T4) bladder carcinoma in a geographical region.

PURPOSE: We studied the relationship between long-term survival and treatment of stages T2, T3 and T4 bladder carcinoma in an unselected patient population. MATERIALS AND METHODS: A total of 680 patients with the initial diagnosis of bladder carcinoma in 1987 to 1988 in Western Sweden was prospectively registered and followed until 1994. Of these patients 107 had stage T2 to T3 and 41 had stage T4 disease. RESULTS: Of the patients with stage T2 to T3 disease 30 (mean age 66) underwent radical cystectomy, 33 (mean age 75) full dose radiotherapy and 44 (mean age 81) nonradical therapy (mainly transurethral resection of the bladder). The 5-year crude survival rates were 33, 15 and 14%, respectively. Of the patients with stage T4 disease 6 (mean age 61) underwent radical cystectomy, 9 (mean age 73) full dose radiotherapy and 26 (mean age 81) nonradical therapy (mainly transurethral resection of the bladder). All except 1 patient died of disease within 4 years. CONCLUSIONS: More than 60% of the patients in the cohort were considered unsuitable for radical cystectomy and their survival was poor, whether treated with full dose radiotherapy or transurethral resection of the bladder alone.

Aged↗
PubMed1996

Concrement formation and urease-induced crystallization in urine from patients with continent ileal reservoirs.

OBJECTIVES: To study the relationship between urinary tract infection, urine composition and concrement formation in patients with continent ileal reservoirs for urinary diversion. PATIENTS AND METHODS: The study comprised 27 patients (seven men and 20 women, mean age 47 years, range 23-76) with continent ileal reservoirs who were followed for a mean of 67 months (range 13-146) by annual reservoiroscopy, intravenous urography and urine culture; at the final follow-up, a sample of their morning urine was analysed for a range of compounds and the number and size of any particles present or produced in response to incubation with urease. RESULTS: The presence of urease-producing bacteria was associated with the formation of concrement. However, a few patients in whom an infection with urease-producing organisms was not detected also formed concrement. Urine from those patients forming stones tended to have a high calcium and a low citrate concentration. After incubation with urease, significantly more and larger particles were formed in the urine from stone formers. There was a strong correlation (r = 0.8) between urinary calcium content and urinary pH when the urease-induced precipitation commenced, and between urinary calcium and the size and volume of the crystals developed (r = 0.9) after 4 h of incubation. CONCLUSIONS: There are many factors which might influence the formation of concrement, e.g. outflow conditions, the presence of staples or infection in the reservoir, and the composition of the urine is also important. It thus appears appropriate to determine if measures to reduce urinary calcium and increase urinary citrate can decrease the episodes of stone formation in those patients with continent ileal reservoirs for urinary diversion who frequently form stones.

Adult↗
PubMed1995

Effect of indomethacin on N-[4-(5-nitro-2-furyl)-2-thiazolyl]formamide-induced urinary tract carcinogenesis.

The effects of indomethacin on the urinary bladder and renal pelvis in rats treated with N-[4-(5-nitro-2-furyl)-2-thiazolyl]formamide (FANFT) were studied. Two hundred female Sprague-Dawley rats were divided into four groups. Group 1 received control diet without added chemicals. Group 2 was treated with indomethacin (1 mg/kg per day) in the drinking water throughout the experiment. Groups 3 and 4 received 0.2% FANFT in the diet for seven weeks followed by control diet. In addition to FANFT, Group 4 received indomethacin, 1 mg/kg per day, for the entire experiment. The rats were sacrificed after 92 weeks. There were no urothelial tumors in the control group, one renal pelvic tumor in the indomethacin group, 4 tumors in the FANFT group and 10 urothelial tumors in the FANFT + indomethacin group. The difference between Groups 3 and 4 was statistically significant (P < 0.05). Moderate and severe hyperplasia of the renal pelvic and papillary epithelium was found in 15 of 48 rats in Group 2 (indomethacin only) as compared with 6 of 49 control rats (P < 0.05). Moderate and severe hyperplasia was equally frequent in Groups 3 and 4 (14 and 17 animals in each group, respectively). Twenty-four rats in Group 2 had mammary tumors as compared to 12 animals in Group 1 (P < 0.01). Five of the tumors in Group 2 were adenocarcinomas. There was no difference between the number of mammary tumors in Groups 3 and 4 (36 and 32 animals in each group, respectively). The results suggest that indomethacin enhances FANFT-induced urinary tract carcinogenesis. Indomethacin also seems to exert some tumorigenic activity in the mammary gland.

Animals↗
PubMed1995

Laparoscopic obturator lymph node dissection in patients with prostatic cancer.

The result of 33 laparoscopic obturator lymph node dissections in patients with locally confined prostatic cancer are presented and compared with open surgery dissections. The hospitalization time was 3 days with the laparoscopic technique, a reduction by 50% compared with open surgery. The operation time was increased from 60 to 100 minutes. No serious complications were encountered. The postoperative recovery was fast and uneventful. The number of glands dissected out was slightly lower than that at open surgery. Obturator lymph node metastases were found in 15% of the patients in the laparoscopic series.

Aged↗
PubMed1995

The relationship among multiple recurrences, progression and prognosis of patients with stages Ta and T1 transitional cell cancer of the bladder followed for at least 20 years.

A retrospective study was done on 176 patients with primary stages Ta and T1 bladder cancer treated between 1963 and 1972. One patient was lost to followup after 6 years, while the remainder were followed to death or for at least 20 years. In 1993, 13 patients had no evidence of disease, 39 died of bladder cancer and 123 died of intercurrent disease. Of 77 patients with a primary noninfiltrating tumor and 99 with a primary lamina propria invasive tumor 9 (11%) and 30 (30%), respectively, died of bladder cancer. Recurrences were noted on 10 or more cystoscopic studies in 16 patients and 10 died of bladder cancer 3.5 to 19 years after the primary transurethral resection. A total of 14 patients received repeated thiotepa instillations, all continued to have recurrences and 10 subsequently died of bladder cancer. Only 1 upper tract tumor was diagnosed on routine followup excretory urography. Invasive transitional cell carcinoma of the bladder developed in only 1 of 59 patients who had been tumor-free for 5 years. The results indicate that patients with recurrences on 10 or more cystoscopic studies will continue to have recurrences until death or cystectomy. Recurrence more than 4 years after the primary tumor operation is another ominous sign. Repeated thiotepa instillations did not influence the course of the disease in patients with a history of multiple recurrences. Followup cystoscopy may be discontinued 5 to 10 years after the last recurrence, at least in patients with a solitary low grade primary tumor. Routine followup urographic studies are neither cost-effective, clinically indicated nor justified in patients with superficial bladder cancer.

Carcinoma, Transitional Cell↗
PubMed1995

[Antibiotic prophylaxis in diagnostic and therapeutic urological interventions].

An enquiry into the use of antibiotic prophylaxis in conjunction with diagnostic or therapeutic urological procedures at hospitals in four Scandinavian countries showed manifest national differences to exist for most procedures. In transurethral resection, for instance, antibiotic cover was used at 79 percent of Finnish hospitals, but at only nine percent of Danish hospitals. Not only were dosage regimens characterized by wide national variation, but also the spectrum of antibiotics used, quinolones being most frequently used in Sweden, but ampicillin and pivampicillin in Denmark. For some procedures policy was more uniform in all countries, antibiotic cover rarely being used in connection with ureterocystoscopy (5 percent of hospitals), but often in conjunction with percutaneous stone surgery (72 per cent). In certain procedures where there is strong evidence suggesting the necessity of antibiotic prophylaxis, it was not always used-e.g., in transrectal prostate biopsy where it was used at only 62 per cent of hospitals. The interpretation of published findings and clinical experience would appear to differ markedly, and local traditions would seem to be strong determinants of clinical routines. The wide variation suggests that all patients do not receive optimal treatment. To improve routines, our knowledge of antibiotic preparations needs to be expanded by well executed studies, followed by general implementation of the results at the various centres. A series of consensus conferences should be arranged and the recommendations published as a first step toward a more uniform and probably better use of antibiotic prophylaxis in conjunction with diagnostic and therapeutic urological procedures.

Anti-Bacterial Agents↗
PubMed1994

Long-term studies of urease-induced crystallization in human urine.

Urine samples were inoculated with viable Proteus mirabilis or purified Jack bean urease. The subsequent pH increase and crystallization were followed for 2 weeks. Particle formation was detected much earlier and at a lower pH in urines inoculated with Proteus, in which a higher end pH was also reached. The crystal configuration in bacteria and urease inoculated samples was different. Crystal aggregation was also much more pronounced in the Proteus mirabilis inoculated samples. The total precipitation was markedly increased in the Proteus mirabilis inoculated samples. The presence of live Proteus mirabilis thus has a profound influence on urease-induced crystallization in human urine. Despite the formation of rather large crystal aggregates in the Proteus-inoculated urines, no firm aggregates of a "prestone" type were observed.

Crystallization↗
PubMed1994

The effects of sodium citrate and oral potassium citrate on urease-induced crystallization.

OBJECTIVES: To study the effects of citrate on urease-induced crystallization in human urine. MATERIALS AND METHODS: Urine samples were collected from seven healthy volunteers with no history of urinary tract infection or stone disease. Citrate was removed from the urine samples by decomposition with citrate lyase. Citrate was then added to the urine in increasing concentrations. Oral potassium citrate was given to the volunteers and their urine was collected. The samples were incubated with urease and the crystallization induced was observed by the Coulter counter technique, by using an optical microscope and by precipitated material analysis. RESULTS: The initiation of crystallization was markedly delayed by both the addition of citrate to the urine and after the ingestion of citrate. Crystal growth and the resulting precipitation of both calcium and magnesium showed a concentration-dependent reduction when citrate was added up to a concentration of 4 mM. Crystal growth and precipitation of calcium and magnesium were also significantly decreased by oral citrate intake. CONCLUSION: Citrate added to the urine or taken orally markedly delays urease-induced crystallization in human urine.

Administration, Oral↗
PubMed1994

Multiple bladder biopsies under intravesical lignocaine anaesthesia.

OBJECTIVE: To study biopsy quality, complications and patient acceptance when urinary bladder biopsies were taken under local anaesthesia. PATIENTS AND METHODS: Multiple large cold-cup urinary bladder biopsies were taken under topical lignocaine anaesthesia in 20 patients who had previously undergone transurethral resection for superficial bladder cancer. RESULTS: The procedures were carried out at the outpatient clinic with 0.5-2 h post-operative observation. Patient acceptance was very high and complications were minimal. The quality of the biopsies was consistently high and influenced treatment in the majority of the patients. CONCLUSION: In our department multiple bladder biopsies (mapping) have previously always been performed as a transurethral resection under general or spinal anaesthesia. Operation under intravesical lignocaine anaesthesia with 2 h post-operative observation reduced the costs by 70%.

Aged↗
PubMed1994

Extirpation and fulguration of multiple superficial bladder tumour recurrences under intravesical lignocaine anaesthesia.

OBJECTIVE: To register the results, complications and patient acceptance of bladder tumour operations under local anaesthesia. PATIENTS AND METHODS: Intravesical lignocaine was the anaesthesia used in 30 patients with multiple bladder tumour recurrences. The largest tumour was extirpated with large flexible biopsy forceps and the others were fulgurated. RESULTS: All visible tumours were extirpated or fulgurated except in one patient, where the operation had to be terminated due to unsatisfactory anaesthesia. All left the hospital within 2 h of surgery. Complications were minor and patient acceptance was very high. CONCLUSION: These operations have previously been performed under spinal anaesthesia in this department and the present modification reduced costs by approximately 70%. Patients who had only minor discomfort associated with routine cystoscopy under urethral anaesthesia were well suited for extirpation and fulguration of multiple small tumours under intravesical lignocaine.

Administration, Intravesical↗
PubMed1994

Unique ability of the Proteus mirabilis capsule to enhance mineral growth in infectious urinary calculi.

Struvite (MgNH4PO4.6H2O) calculi are a common complication of Proteus mirabilis urinary tract infections. Although urease is a major virulence factor in calculus formation, the polysaccharide capsule (CPS) of this organism also enhances struvite crystallization and growth in vitro (L. Clapham, R. J. C. McLean, J. C. Nickel, J. Downey, and J. W. Costerton, J. Crystal Growth 104:475-484, 1990). We obtained purified CPS, of known structure and varying anionic character, from P. mirabilis ATCC 49565 and several other organisms. Artificial urine was added to CPS, and the pH was elevated from 5.8 to 8.5 by the addition of urease or titration with 0.25 M NH4OH to induce struvite crystallization. Crystallization was measured by particle counting (Coulter counter), and the morphology (crystal habit) was examined by phase-contrast microscopy. In the presence of partially anionic P. mirabilis CPS, struvite formation occurred at a lower pH than in the absence of CPS or in the presence of other neutral, partially anionic, or anionic CPS. At pH 7.5 to 8.0, significantly more struvite crystals formed in the presence of P. mirabilis CPS than under other experimental conditions. With the exception of one polymer (curdlan) which did not bind Mg2+, enhancement of struvite formation by CPS polymers was inversely proportional to their Mg2+ binding ability. We speculate that the structure and partial anionic nature of P. mirabilis CPS enable it to enhance struvite formation by weakly concentrating Mg2+ ions during struvite crystal formation. This illustrates a new virulence aspect of bacterial CPS during infection.

Bacterial Capsules↗
PubMed1994

Laparoscopic ligature of the spermatic veins. A comparison between outpatient and hospitalised treatment.

The preferable operation for varicocele is ligation of all venous trunks of the spermatic vein above the internal orifice of the inguinal canal, traditionally performed by a retroperitoneal approach. An alternative method is laparoscopic ligature of the spermatic veins. To evaluate this procedure and to see if it can be done on an outpatient basis, 24 patients were operated upon laparoscopically. The patients were allocated to two series, one scheduled to be operated upon on an outpatient basis and one hospitalised. In 22 out of 24 patients the varicocele had disappeared completely at follow-up 1-3 months after the operation. Three of the patients operated upon late during the day in the outpatient group had to stay overnight. No complications occurred. The costs were more than 50% lower in the outpatient group. Laparoscopic ligature of the spermatic veins seems to be an attractive way to treat varicoceles, with good postoperative results and, if performed on an outpatient basis, with a substantial reduction of costs.

Adult↗