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H Rübben

Publications and source records attributed to H Rübben.

At least 163 records · Page 9Linked to original sources
PubMed1993

E-cadherin: a marker for differentiation and invasiveness in prostatic carcinoma.

Considerable controversy exists concerning the value of histomorphological data in the assessment of the malignant potential of prostatic carcinomas. We investigated the expression pattern of E-cadherin in human prostate at the translational level. E-cadherin is a specific epithelial cell-cell adhesion molecule which has previously been found to be expressed in well-differentiated non-invasive carcinoma cell lines but is lost in many poorly differentiated invasive cell lines. The E-cadherin expression pattern in the prostate samples was correlated with histopathological findings in the same specimens. We found strong E-cadherin expression in normal prostate and benign prostatic hyperplasia. A decrease in or loss of E-cadherin was seen in 13 of 14 locally advanced and in 8 of 9 poorly differentiated prostatic carcinomas. We conclude that downregulation of E-cadherin expression plays a role in prostate carcinogenesis and invasiveness.

Adult↗
PubMed1993

[Therapeutic strategies in patients with bladder tumors according to histopathological findings].

The therapeutic strategy in patients with bladder carcinoma depends on general conditions, i.e. age of the patient, history, i.e. primary tumor versus recurrent tumor and on the histopathological finding according to the transurethral resection. Exophytic tumor, tumor burden as well as deep muscle layer have to be investigated combined with urinary cytology. Independent prognostic factors are depth of infiltration, differentiation grade, concomitant carcinoma in situ (TIS), lymph node metastases or distant metastases. Carcinoma in situ is characterized by an intraepithelial growth, poorly differentiated tumor cells and an completely disturbed growth pattern (Fig. 1). Those histopathological findings are of great importance for further therapy. Patients with poorly differentiated superficial bladder carcinoma or patients with carcinoma in situ are treated by adjuvant chemo- or immunotherapy. Radical cystectomy is indicated in all cases of recurrent T1 G3 carcinoma or persistent carcinoma in situ. The histopathological investigation of regional lymph nodes is of great prognostic value and influences the therapeutic strategy. Patients with positive lymph nodes (N2-N3) should not be considered for radical cystectomy because these patients will have no survival benefit. Histopathological examination of distant metastases are without prognostic or therapeutic value because these patients are normally treated by systemic chemotherapy.

Carcinoma in Situ↗
PubMed1993

[Delayed retroperitoneal lymph node excision in treatment of advanced non-seminomatous germinal cell tumors. I. Intraoperative findings in marker converted tumor].

Retroperitoneal lymphadenectomy was performed in 462 patients with testicular cancer. A total of 142 patients with advanced non-seminomatous germ cell tumours underwent retroperitoneal lymphadenectomy following cisplatin-based polychemotherapy. After inductive chemotherapy all of the patients described (108/142) showed seroconversion of tumour markers. Histology following RLA revealed vital tumour in 41% and teratoma in 12%. It was not possible to distinguish preoperatively between non-malignant residual tissue and vital tumour. In addition, sonography, computed tomography, and the tumour marker results did not correlate significantly with the intraoperative histopathological findings. Although histopathological confirmed complete remission was achieved in 47% of the patients with chemotherapy alone, subsequent retroperitoneal lymphadenectomy remains mandatory in cases with residual retroperitoneal lesions and pathological partial remission.

Adult↗
PubMed1993

[Is risk-oriented therapy in stage I non-seminoma tumor advisable?].

For a long time the usual regimen for patients with a non-seminomatous testicular tumor, clinical stage I, was an orchiectomy and retroperitoneal lymphadenectomy. Because of the possible loss of ejaculation as a aggravating consequence for the patient, one must think about alternatives. One of those is the wait-and-see strategy. Recurrences, which occur in 30% of the patients, 15% retroperitoneal and 15% pulmonary, can be cured with chemotherapy. Unfortunately, the recurrence is often discovered late because the uncertainty of radiological diagnostic procedures. Then several courses of inductive chemotherapy are necessary. Thus, it is worthwhile to consider primary adjuvant chemotherapy. There have been only a few reports about this strategy, but all are very hopeful. The advantages and disadvantages of the different strategies are discussed in the following paper.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

[Diagnosis of urine transport disorders. Diuresis renography].

Congenital urinary tract malformations are frequently the cause of urinary transport disturbances. However, not all the malformations or obstructions presenting sonographically as hydronephrosis have to be treated surgically. The Whitaker test, an invasive diagnostic procedure to establish the urodynamic relevance of an obstruction, does not provide a reliable estimate of prognosis; spontaneous cures in cases of obstruction have been reported. Diuresis renography offers several advantages as compared with the Whitaker test, for example a more physiological basis, less observer dependency, better reproducibility and--last but not least--non-invasiveness. However, diuresis renography has to be carried out according to a strictly standardized protocol. Sufficient hydration (20 mg/kg body weight) and bladder catheterization (to rule our reflectory transport disturbances) are mandatory. Today, 123I-OIH or 99mTc-MAG3 are the radiopharmaceuticals of choice; the activity for children has to be reduced in relation to body surface. To stimulate diuresis, furosemide (0.5-1 mg/kg of body weight) has to be given. For the evaluation of diuresis renography, sequential scintigrams as well as functional curves have to be used. It is strongly recommended that diuresis renography be combined with clearance determinations separately for the two kidneys. The interpretation of diuresis renography should not rely only on quantitative curve parameters but--above all--on visual analysis of the functional curves. However, in cases of proven obstruction, diuresis renography--like the Whitaker test--cannot accurately predict the prognosis in any individual case. If renal function is normal and there is no difference between the left and the right kidney, a wait-and-see attitude seems to be justified.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

Lectins in diagnosis of bladder carcinoma.

With the purpose of studying changes in the expression of glycoconjugate structures in nonmalignant and cancerous lesions of urothelium the lectins ConA, TKA, PNA, DBA, STA, LFA, UEA, MPA, RCA, LCA, GSA1, SBA, GSA2, WGA, PHA and Lot were tested in formalin-fixed, paraffin-embedded tissue sections of (1) cold biopsies from normal urothelium and bladder cancer of different grades (G1-G3) in humans, (2) normal transitional epithelium and N-butyl-N(4-hydroxybutyl)nitrosamine (BBN)-induced bladder cancer in animal experiments (Wistar rat), and (3) human transitional cancer cell line HT 1376. In human urothelium TKA and SBA were positive markers demonstrating positive staining reactions in all tumor grades without binding to normal epithelium. They stained also the human transitional carcinoma cell line HT 1376 (G3). In Wistar rats DBA, ConA, LCA, SBA, GSA2 and WGA had a specific affinity to BBN-induced carcinoma. Findings of positive lectin marker in transitional cell cancer may offer progress in diagnostics and therapy.

Animals↗
PubMed1992

A system for focal intracavitary irradiation of bladder cancer with remote iridium-192 afterloading.

An afterloading system for remote-control focal intracavitary irradiation of bladder cancer is presented. With 192Ir as radiation source, we demonstrated the practicability of the method in 23 chinchilla rabbits. A system for focal intracavitary irradiation of bladder cancer in humans was developed. A guiding tube with an inflatable balloon led to a reproducible vesical diameter. The intravesical part of the tube was shielded with lead and had a slit for focal radiation exposure. Three variant guiding tubes with different positions of the slit were designed to allow irradiation of any part of the bladder. The application is planned in patients with locally advanced tumors who refuse radical cystectomy or who are medically inoperable.

Animals↗
PubMed1992

[Hypospadias--current surgical procedures].

The treatment of hypospadias has developed over the years from a disabling intervention to a surgical procedure devised with due consideration for the needs of paediatric patient. The operation is timed to fit in with the child's psychological development, being performed early in life before it becomes too traumatic for the child. Resection of the chordee and creation of the neourethra in a single session is increasingly superseding the two-stage procedure usual earlier, especially for distal and medial hypospadias. However, when the surgeon is sufficiently experienced even proximal hypospadias can be corrected in a single session, for example by a combination of a Thiersch and a free island flap or by free bladder mucosal flaps or grafts. The use of suitably fine instruments and suture material should be a matter of course, as should the use of magnifying lenses. Urinary diversion is still obligatory in most centres, and, like the sort of dressing used, it depends on the individual experience and judgement of the surgeon. The incidence of postoperative complications should be below 10% regardless of the degree of hypospadias.

Child↗
PubMed1991

[TNM-oriented therapy planning in bladder cancer].

The standard diagnostic procedures for bladder carcinoma include transurethral resection, bimanual palpation of the bladder under general anaesthesia, ultrasound examination and CT scan of the abdominal and pelvic regions. An IVP is additionally carried out for the detection of concomitant upper urinary tract tumours. Preoperative urinary cytology is also performed, as in 10% of all patients the degree of malignancy of bladder cancer according to the TNM system is revealed more exactly by cytology than by histology. New computerized examination techniques have been designed in attempts to improve the accuracy of the diagnostic process. Therapeutic modalities according to the classification of bladder carcinoma in the TNM system have to be based on the different efficacies of the diagnostic procedure: In superficial low-grade tumours the diagnostic efficacy is quite high, so that transurethral resection remains the treatment of choice. Superficial high-grade tumours are attended by reduced 5-year survival rates, and patients with such tumours must therefore be regarded as a high-risk group. In muscle-invasive bladder carcinoma reduced diagnostic efficacy and unsatisfactory treatment results are seen, so that in this condition cystectomy at an early stage is indicated.

Biomarkers, Tumor↗
PubMed1991

[Carcinoma in situ of the urinary bladder--definition and status of treatment].

Carcinoma in situ is a noninvasive intraepithelial disease without papillary growth. Anaplasia and a disarranged growth form of the epithelium are histopathological characteristics. Carcinoma in situ can appear as a secondary disease combined with a papillary tumour or after transurethral resection of a papillary tumour. On the other hand, primary carcinoma in situ is also known to appear without a papillary tumour. Symptoms of cystitis are often seen. Sometimes, however, the disease does not cause any symptoms. Urinary cytology is the most important noninvasive investigation, followed by biopsy of the bladder epithelium. Treatments commonly applied at present are intravesical immunotherapy with BCG and intravesical chemotherapy. Photodynamic laser therapy is presently being investigated. Carcinoma in situ is very significant as a prognostic factor. The progression rate is up to 83%, and progression signifies development of a poorly differentiated invasive bladder cancer. The treatment of choice for inefficiently treated carcinoma in situ is cystectomy. The urinary diversion selected in men depends on the histopathological findings in the prostatic urethra; an ileum neobladder, the standard diversion in men, cannot be performed if carcinoma in situ has been found in the prostatic urethra.

Administration, Intravesical↗
PubMed1991

[Therapy of superficial bladder carcinoma].

Topical therapy is administered after transurethral resection (TUR) for superficial cancer to reduce the frequency of recurrence, to avoid local tumor progression and to increase the survival rate. However, the results of prospective randomized studies on topical chemotherapy show that successful reduction of tumor recurrence is limited to a small group of patients. Topical immunotherapy with BCG seems to be more efficient, but prospective multicenter studies have not confirmed the superiority of BCG treatment. At present neither chemotherapy nor immunotherapy can influence progression or survival rate. It therefore seems advisable to continue to enroll patients with superficial bladder tumors in prospective studies to obtain more information on treatment schedules and their side-effects and therapeutic activity. The following information may be helpful in deciding on individual treatment schedules for patients with superficial bladder cancer: (1) Carcinoma in situ is the only therapeutic indication for topical therapy, and BCG may be more potent than chemotherapy. (2) Patients with pTaG1 tumor should be excluded from topical therapy. (3) Topical therapy may not be indicated at all for pT1G3 tumors. The rate of local progression and distant metastasis is high and cannot be influenced by this form of adjuvant treatment. (4) At present no drug of first choice is known. (5) Early application of intravesical chemotherapy immediately after TUR has no advantage over delayed treatment. (6) Long-term chemoprophylaxis is equivalent to short-term prophylaxis (6-24 months) in effect. (7) Immunotherapy with BCG can be limited to a period of 6 months.

Administration, Intravesical↗
PubMed1990

Adjuvant systemic chemotherapy after complete transurethral resection of superficially invasive bladder carcinoma (T1 G3-4 and T2 G2-4).

A prospective multicenter phase-two study was initiated in 1983 to evaluate the effect of systemic chemotherapy after complete resection of T1 G3-4 and T2 bladder carcinomas. Chemotherapy consisted of three cycles of cisplatin alone, a modified MVAC scheme or the combination of cisplatin and methotrexate. 52 patients entered the study. After a medium follow-up of 36 months 11 patients developed progression of the disease; cystectomy had been performed in 8 patients and 6 patients died due to progressive bladder carcinoma. These encouraging results should be the base for a randomized trial with the aim to improve survival and avoid cystectomy in selected patients with superficially invasive bladder cancer.

Antineoplastic Combined Chemotherapy Protocols↗