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Biomedical subjects

H J Mensink

Publications and source records attributed to H J Mensink.

At least 19 recordsLinked to original sources
PubMed2003

[Surprises during urological interventions due to incomplete medical histories].

Two men, aged 37 and 47 years old, visited the urologist because of secondary infertility. These underwent an examination whilst under general anaesthesia; the examination was converted to a vasovasostomy, as in both cases it was found that a vasectomy had previously been performed. A third man, 56 years old, wished to undergo vasovasostomy; a few months later he appeared to have pre-existent retrograde ejaculation after an earlier bladder neck incision. For various reasons, no adequate information about the psychosocial and medical history was available. These case histories stress the importance of all of the patient records being available prior to an intervention.

Adult↗
PubMed2003

[The use of corticosteroid cream to treat phimosis].

Many of the boys diagnosed with 'phimosis', who are referred for circumcision, do not have a dermatopathology and thus there is no indication for surgery. If an unretractable prepuce causes hygienic problems, and also in the case of dermatopathology, topical corticosteroid application may be an effective alternative to circumcision. In a literature search 13 studies were found on the effectiveness and the safety of topical steroid application for phimosis. Three of the studies were placebo controlled. A total of 1121 boys with an unretractable prepuce were treated with a topical corticosteroid, which was mostly applied twice daily. After a treatment duration of 4 to 8 weeks, about 75% of the patients achieved complete retractability of the prepuce. In the studies evaluated, local or systemic adverse effects were not noted. Different types of corticosteroids gave similar results. Topical corticosteroid application for the treatment of unretractable prepuce complaints seems to be effective and safe, and is therefore recommended before surgical intervention is considered.

Administration, Topical↗
PubMed2001

[Adenocarcinoma of prostate in men younger than 50--rectal palpation mandatory with micturition problems].

In three men, aged 44, 47, and 48 years, prostatic carcinoma was diagnosed after a long delay, more than eight months after the onset of symptoms (obstructive and irritative micturition problems, erectile dysfunction, and haemospermia). The cancer was suspected on eventually performed rectal palpation and confirmed in biopsies. The serum prostate-specific antigen (PSA) levels were moderately increased. All were treated with goserelin and flutamide and radiotherapy on the emerging metastases (two patients). Two patients died, the third one, who had received antibiotic treatment for three months because at first prostatitis was suspected, was still in remission at the last follow up. Prostate cancer in young men is rare and may demonstrate aggressive biological behaviour. The age group less than 50 years of age accounts for 0.8% to 1.1% of all patients with prostate cancer. This form of the disease responds poorly to radiation or hormonal therapy and is often already too advanced for surgery. The symptoms at presentation of prostate cancer in young men are quite similar to those in prostate cancer patients beyond the fifth decade. When carcinoma grows beyond the margins of the prostate the prognosis is poor. In all men with micturition problems, rectal palpation of the prostate should be carried out as a routine.

Adenocarcinoma↗
PubMed2001

Pretreatment levels of urinary deoxypyridinoline as a potential marker in patients with prostate cancer with or without bone metastasis.

OBJECTIVE: To assess the predictive role of the bone markers alkaline phosphatase (ALP) and urinary deoxypyridinoline (DPD), as indicators of bone turnover, at baseline in patients with prostate cancer. PATIENTS, SUBJECTS AND METHODS: Urinary DPD, serum ALP and prostate-specific antigen (PSA) were evaluated in 23 patients with benign prostatic hyperplasia (BPH), 115 with prostatic carcinoma, of whom 21 had bone metastasis, and in 16 age-matched control subjects. RESULTS: Patients with newly diagnosed prostate cancer and bone metastasis had a higher urinary excretion of DPD, and a higher serum PSA and ALP than had patients with BPH and those with prostate cancer but no metastasis. Receiver operating curve analysis for PSA, ALP and DPD showed a significant discriminating ability for positive and negative bone scans (P = 0.0684). However, from logistic regression of the combinations, only serum ALP was a significant independent predictor of bone metastasis in patients with prostate cancer. CONCLUSION: Serum ALP or urinary DPD are the best predictors of bone metastasis in patients with prostate cancer; further studies with more patients are required.

Adult↗
PubMed2001

Routine bone scans in patients with prostate cancer related to serum prostate-specific antigen and alkaline phosphatase.

OBJECTIVE: To evaluate the need for a bone scan as a routine staging procedure in patients with newly diagnosed prostate cancer in relation to serum prostate-specific antigen (PSA) and alkaline phosphatase (ALP) levels, and thus determine whether a reduction of the use of this staging method is possible in patients with a low probability of osseous metastasis. PATIENTS AND METHODS: The results of bone scans were related retrospectively to levels of serum PSA and ALP in 363 patients with prostate cancer newly diagnosed between 1989 and 1997. RESULTS: Of 363 consecutive patients, 111 had a positive bone scan. In 19 of 144 (13%, "missed diagnosis") patients with a PSA level of < 20 ng/mL the bone scan was positive. In 125 patients (49%, "false-positives") with a PSA level of > 20 ng/mL the bone scan was negative. A threshold level of 100 U/L for ALP gave a better balance for the number of "false-positives" and "missed diagnosis". ALP values correlated better with an abnormal bone scan than did PSA levels; ALP levels of > 90 U/L indicated a 60% chance for the presence of bone metastases. CONCLUSION: Patients with newly diagnosed and untreated prostate cancer should undergo bone scintigraphy if there is bone pain or if ALP levels are > 90 U/L. Recent reports discourage the routine use of a bone scan when the serum PSA level is <20 ng/mL. However, the present series suggests there is a greater chance of a positive bone scan in patients with low PSA levels; these findings need further confirmation.

Aged↗
PubMed2000

Telomerase activity in needle biopsies from prostate cancer and benign prostates.

BACKGROUND: Telomerase activation is thought to be essential for the immortality of cancer cells. It may be a prognostic factor in small volume well differentiated prostate cancers and hence a guide for the aggressiveness of the approach. The length of the chromosome tips (telomeres) are maintained by a specific enzyme (telomerase) independently of the normal cell division cycle. Although telomerase is not expressed in most normal human tissues, it is expressed in most human tumours. For the detection of telomerase in small prostate needle biopsy samples a recently developed telomeric repeat amplification protocol (TRAP) assay was used. The aim of the present study was: to measure telomerase activity in human prostate samples, and to evaluate the applicability of this assay on specimens from a prostate biopsy. MATERIALS AND METHODS: From 36 patients referred for lower urinary tract symptoms (LUTS) or suspicion of having prostate cancer a total of 288 prostate biopsy samples were obtained (8 in each patient). When the digital rectal examination was abnormal and/or when the PSA level was elevated in L.U.T.S., or asymptomatic patients' tissue samples were obtained by transrectal ultrasound (TRUS) guided biopsies. Samples were tested for telomerase activity by a modified TRAP and forwarded for histology. RESULTS: In 19 out of 36 patients prostate cancer was diagnosed on histology. In 11 of these 19 tumours substantial telomerase activity was detected, whereas only very low telomerase activity existed in 2 of 17 samples from benign prostatic hypertrophy (BPH) patients. In this small series the relative telomerase activity in prostate cancer correlated with histopathological grade. CONCLUSIONS: Our results show the applicability of a TRAP assay to measure telomerase activity in small needle biopsied prostate samples. In poorly differentiated and metastatic cancer we observed that levels of telomerase activity were high. To establish accuracy and to distinguish the 'relative good from the ugly' further study is needed.

Biomarkers, Tumor↗
PubMed2000

Clinical implications of free-to-total immunoreactive prostate-specific antigen ratios.

OBJECTIVE: A study was performed to evaluate the free-to-total prostate-specific antigen (PSA) ratio for discriminating benign prostatic hyperplasia (BPH) or prostate cancer in the intermediate PSA range (2.0-10.0 microg/l) in patients referred for prostate evaluation. In addition, the relationship of free-to-total PSA ratio and tumor grade in prostatic cancer cases, implying a higher concentration of complex PSA in poorly differentiated cancer, was assessed for its predictive value of tumor aggressiveness at the time of diagnosis. PATIENTS AND METHODS: Seven hundred and sixteen patients referred to the out-patient clinics of two urological departments were included in this prospective study. Blood samples were taken for total immunoreactive and free PSA (IMMULITE) determinations prior to any manipulation. The patients were grouped according to their PSA levels: 2.0-4.0 microg/l, 4.0-10.0 microg/l, 10.0-20.0 microg/l and > or = 20.0 microg/l. All patients were categorized, after histological confirmation, as having BPH (n = 423) or prostate cancer (n = 293). In patients with cancer the tumor grade was also assessed. RESULTS: In patients with serum immunoreactive PSA levels in the 2.0-4.0 microg/l range, a free-to-total PSA ratio lower than 22% predicted the presence of prostate cancer with a sensitivity of 67% and a specificity of 63%. The positive- and negative-predictive values were 29% and 90% respectively. Receiver-operating characteristic curve analysis indicated a free-to-total PSA ratio of 22% to be the optimum discriminatory level in this low PSA range. For patients with a serum PSA level between 4.0 and 10.0 microg/l, the threshold ratio of 18% gave a sensitivity of 70%, a specificity of 70%, a positive-predictive value of 46% and a negative-predictive value of 87%. Men with a well differentiated grade of prostate cancer had higher free-to-total PSA ratios than those with less differentiated tumors (p = 0.01). CONCLUSIONS: Our data indicate that the free-to-total PSA ratio, in patients with prostatic disease and with PSA levels in the 2.0-10.0 microg/l range, gives a significant improvement in prediction of cancer over the total immunoreactive PSA value alone. Because of the correlation between a higher tumor grade and a lower free-to-total PSA ratio, this ratio may be helpful in assessing the risk of a poorly differentiated cancer.

Diagnosis, Differential↗
PubMed2000

Increase in incidental renal cell carcinoma in the northern part of the Netherlands.

OBJECTIVES: Evaluating in a retrospective survey the incidence of incidental and symptomatic renal cell carcinoma (RCC) between 1977 and 1994 in the northern part of the Netherlands and the mode of their detection. PATIENTS AND METHODS: Retrospectively, 173 patients surgically treated for RCC were divided into two groups according to the period of detection, 1977-1987 (n = 87) and 1987-1994 (n = 86). Because of the increase in abdominal ultrasound in 1987, this year was used as the cutoff date. In both periods the patients were grouped according to whether the tumor was found incidentally or whether the tumor was suspected. The mode of detection was recorded together with the tumor stage at presentation and survival. RESULTS: The incidental detection rate was 33% (29/87) in the 1977-1987 group and 49% (42/86) in the 1987-1994 group, showing a significant difference (p = 0.038). In the 1977-1987 group incidental tumors were detected with ultrasound in 83% and symptomatic tumors with ultrasound in 36%. Of the cases in the 1987-1994 group this percentage was 91 and 43%, respectively. Disease-free survival rates after a mean follow-up of 10 years were 63% in the incidental RCC group and 37% in the symptomatic RCC group (p = 0.0159). CONCLUSIONS: There is an increase in incidental tumors in this part of the Netherlands with ultrasound as the mode of detection. The disease-free survival is significantly better in the incidental tumor group.

Carcinoma, Renal Cell↗
PubMed2000

Reliability analysis of first and second generation PSA assays.

PURPOSE: To assess the reliability of first and second generation PSA assays. MATERIALS AND METHODS: In the present investigation we sought to compare pretreatment serum PSA levels determined by a first (IMx) and a second (IMMULITE) generation PSA assays to determine whether there were differences. Sera from 545 men were investigated in the range > 0 - 5330 microg/L, and prostatic histology was known, based on either transrectal ultrasound (TRUS), guided systematic needle biopsies, or transurethral resection or prostatectomy. RESULTS: Over the entire range there was an excellent correlation (r > 0.97) between the IMx and the IMMULITE PSA assays. When analyzed according to histology, there was an equivalent slope in the PSA ranges for patients with benign prostatic hyperplasia compared with prostate cancer patients. The area under the ROC curve for the IMx for the total PSA range was 0.7860, and for the IMMULITE assay the area under the ROC curve was 0.7810, a striking resemblance and not different significantly (p=0.87). CONCLUSION: For the majority of men, the first (IMx) and second (IMMULITE) generation PSA assays are equivalent. Small differences between both assays will not be of clinical significance for most men, but should be considered when comparing results of different assays in sequential determinations for a specific man.

Humans↗
PubMed1999

[Fournier's gangrene].

Fournier's gangrene is a rapidly progressive, necrotizing fasciitis of the perineal, genital or perianal regions. Despite increasing knowledge about aetiology, diagnostic procedures and treatment, the gangrene is still a destructive and potentially lethal disease. In two patients, men aged 54 and 63 years, Fournier's gangrene was diagnosed. The first one died of septic shock 12 hours after admission. Surgical débridement had been performed immediately. He had a latent promyelocytic leukaemia. The second patient recovered fully after extensive surgical and antimicrobial therapy. Fournier's gangrene appears to be caused by the synergistic pathogenic action of various individually non-pathogenic commensal bacteria. Virtually all patients have an underlying systemic disorder, mainly chronic alcoholism or diabetes mellitus. Immunosupression is a predisposing factor. The gangrene requires an aggressive approach, treatment being based on the combination of haemodynamic stabilisation, antibiotic triple therapy and radical surgical débridement.

Aged↗
PubMed1999

[Uncommon initial symptoms of metastasized carcinoma of the prostate].

Four patients, men aged 81, 65, 69 and 52 years, presented with painless lymphomas, pain in the lower back and legs, venous thrombosis in an arm, and headache, vomiting and other neurological complaints, respectively. They were found to have carcinoma of the prostate with metastases. After antiandrogen therapy the symptoms resolved; 2 men died after 2 years and 2 are still alive, 2 and 5 years later. In men with unexplained complaints, it is advisable to perform a thorough physical examination, including digital rectal examination and a prostate specific antigen determination.

Aged↗
PubMed1999

[Prostate-specific antigen as a tumor marker of prostate carcinoma].

Prostate specific antigen (PSA) is currently the tumour marker of choice for prostatic carcinoma. Various indices of PSA have been developed in an attempt to refine its sensitivity and improve its clinical value. These include the ratio of serum PSA level and prostate volume, the rate of change of the PSA level with time, age-referenced PSA, and the proportion of free PSA in serum relative to total PSA (free to total PSA ratio). The free to total PSA ratio is lower in patients with prostate cancer than in those with elevated PSA levels due to benign prostatic hyperplasia.

Biomarkers, Tumor↗
PubMed1999

[A strontium-89 injection: a simple treatment of painful bone metastases in patients with prostate cancer unresponsive to hormonal treatment].

Four patients (men aged 75, 67, 65 and 69 years) with painful osseous metastases from prostate cancer were treated by intravenous radionuclide therapy using Strontium-89. All had secondary progression after initially successful hormonal treatment. Three of these four had good responses lasting from 5 to 9 months. One patient with rapidly progressive disease did not respond. Second and third injections were successful in two patients. Mild bone marrow suppression was observed in all, but was not clinically significant. The 70-80% chance of long-lasting pain alleviation through a single injection of Strontium-89 is a valuable addition in the treatment of painful bone metastases from prostate cancer, and probably also in such metastases from breast cancer.

Aged↗
PubMed1999

Erectile dysfunction due to a 'hidden' penis after pelvic trauma.

We describe a twenty-six year old patient who presented us with a dorsally retracted 'hidden' penis, which was entrapped in scar tissue and prevesical fat, 20y after a pelvic fracture with symphysiolysis. Penile 'lengthening' was performed by V-Y plasty, removal of fatty tissue, dissection of the entrapped corpora cavernosa followed by ventral fixation.

Adult↗
PubMed1999

Objective and subjective effects of treatment for testicular cancer on sexual function.

OBJECTIVE: To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction. PATIENTS AND METHODS: Ten patients treated with BEP were compared with 11 undergoing orchidectomy alone followed by surveillance. Sex hormone levels were analysed and cavernosal artery duplex ultrasonography performed before orchidectomy and at 6 and 12 months afterward. Patients were questioned about their sexual function. After 1 year, a visual erotic stimulation (VES) test was performed to assess penile rigidity. RESULTS: In contrast to the surveillance group, BEP-treated patients had higher follicle-stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L) at 6 months than at baseline. At 1 year, most patients had compensated hypergonadotrophic eugonadism, but Leydig cell function had recovered. Changes in cavernosal artery peak flow velocities induced by local injection with papaverine/phentolamine showed no difference between the groups before and 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP-treated patients. However, 1 year after treatment, most reported a satisfying sex life and VES resulted in a rigid erection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood flow velocities. CONCLUSIONS: After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP induces transient testicular dysfunction but this recovers. Although BEP is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal VES-evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.

Adult↗
PubMed1998

Genetic analysis of 2 cases of clear cell renal cancer in 2 sisters.

Two sisters affected with renal cell carcinoma (RCC) is an extremely rare finding, and may indicate a hereditary pattern or the presence of other predisposing factors. We describe here 2 sisters presenting with clear cell renal cell cancer. Examination for von Hippel-Lindau (VHL)-related features and tuberous sclerosis (M. Bourneville) was negative and both had a normal constitutional karyotype. Cytogenetic analysis of the tumor tissue of both patients showed a translocation involving chromosomes 3 and 5, resulting in loss of 3p sequences and gain of part of 5q. The 5q breakpoints were similar, but the breakpoints at 3p appeared to differ. Allelic imbalance analysis supported our observations. Microsatellite analysis revealed that both sisters inherited different chromosome 3 parental alleles. For chromosome 5, 3 different haplotypes could be deduced, but the chromosome 5 alleles overrepresented in the different tumor tissues were from different parental origin. The development of the 2 RCCs in these 2 sisters thus cannot be explained by the inheritance of a mutated VHL gene located at 3p25, nor by the inheritance of other gene defects at chromosomes 3p or 5q. Although the chance that 2 sisters develop sporadic RCC is very low, in the presented case it is probably coincidental or related to another genetic predisposition.

Carcinoma, Renal Cell↗
PubMed1998

Comparison of the Danish Prostatic Symptom Score with the International Prostatic Symptom Score, the Madsen-Iversen and Boyarsky symptom indexes. ALFECH Study Group.

OBJECTIVE: To compare the Danish Prostatic Symptom Score (DAN-PSS) with the International Prostatic Symptom Score (IPSS). Madsen-Iversen and Boyarsky symptom indexes in a clinical setting, and to evaluate the potential significance of any differences in information obtained from these questionnaires. PATIENTS AND METHODS: The study comprised two substudies: in the first, 205 patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), a Madsen-Iversen score > 6 and a maximum flow rate of < 10 mL/s were randomized to receive either placebo or alfuzosin in a double-blind study of 16 weeks. The symptoms were assessed using the Madsen-Iversen, DAN-PSS and the IPSS questionnaires. In the second, 138 patients with LUTS suggestive of BOO were selected for treatment with transurethral microwave thermotherapy (TUMT, 52 degrees C for 60 min, microwave energy 200 kJ) and their symptoms assessed using the Boyarsky and the DAN-PSS questionnaires. Patients were then followed for one year. Rank correlation coefficients and regression lines were calculated using Spearman's non-parametric test. The relative changes, i.e. responsiveness, calculated for the DAN-PSS, IPSS and Boyarsky indexes were compared pairwise using the Wilcoxon-Pratt test. RESULTS: The DAN-PSS, IPSS and Madsen-Iversen indexes were correlated on a pairwise basis. The DAN-PSS and IPSS indexes have significant construct validity in terms of correlation with the Madsen-Iversen system (Spearman's correlation coefficient, rs = 0.51 and rs = 0.45, respectively). The DAN-PSS and the IPSS indexes were correlated (rs = 0.61). The DAN-PSS was more sensitive than the IPSS to changes after pharmacological treatment, with scores decreasing 70% and 29% (P < 0.05), respectively, after treatment with an alpha-blocker for 4 months, and 50% and 29% (P < 0.05), respectively, after 4 months on placebo treatment. Finally, the responsiveness of the Boyarsky and DAN-PSS indexes to TUMT showed that the DAN-PSS system was significantly more responsive than the Boyarsky index, with scores decreasing 57% and 15% (P < 0.05), respectively, after one year. CONCLUSIONS: The DAN-PSS index is more sensitive than the IPSS, Madsen-Iversen and Boyarsky symptom indexes, incorporates important outcome events, includes a patient-weighting of each symptom, thereby reflecting better the patients' global assessment of outcome.

Adrenergic alpha-Antagonists↗