Biomedical subjects

Heiko Wunderlich

Publications and source records attributed to Heiko Wunderlich.

10 recordsLinked to original sources

PubMed2006

Radical cystectomy with ultrasound-guided partial prostatectomy for bladder cancer: a complication-preventing concept.

OBJECTIVES: Radical cystectomy has been the reference standard for the treatment of muscle-invasive bladder cancer. However, this kind of therapy does have an impact on the patient's quality of life. For this reason, we performed prostate-sparing surgery during radical cystectomy without compromising the oncologic outcome. METHODS: From December 2003 to August 2005, 31 patients with a mean age of 63.6 +/- 8 years (range 48 to 79) underwent apex-sparing radical cystoprostatectomy for invasive bladder cancer. All patients underwent transurethral biopsy in the prostatic urethra to exclude urothelial tumor and transrectal ultrasound-guided biopsy of the prostate to diagnose concomitant prostate cancer. Patients with a prostate-specific antigen level greater than 4 ng/mL were excluded from prostate-sparing cystectomy. The mean follow-up period was 12 months. RESULTS: The postoperative pathologic stage was pTis in 2 patients, pTa in 1, pT1 in 3, pT2 in 20, pT3 in 5, and pN+ in 4 patients. We found no prostate cancer on histopathologic evaluation. Except for 4 patients, no patient had deterioration of sexual function. Except for 2 patients, all patients were fully continent. CONCLUSIONS: Radical cystectomy with prostate-sparing surgery in patients with invasive bladder cancer resulted in improved continence and improved erectile function. Additionally, with apex-sparing radical cystoprostatectomy, we were able to create a wide neovesicourethral anastomosis to prevent strictures, urinary retention, and mucous retention. It is absolutely necessary that this procedure be restricted to highly selected patients.

Aged↗

PubMed2006

Differential expression of tenascin-C splicing domains in urothelial carcinomas of the urinary bladder.

PURPOSE: Through alternative splicing of the extracellular matrix protein tenascin-C (Tn-C) primary transcript nine type III homology repeats can be independently included or omitted. Large, low spliced Tn-C variants (Tn-C(L)) are preferentially expressed during tissue remodelling processes like tumour invasion to modulate cell migration. The study was aimed to evaluate the differential expression of Tn-C splicing domains in urinary bladder carcinoma with respect to the invasive behaviour. METHODS: The deposition and synthesis of the Tn-C splicing domains A1-D was analysed in 34 urinary bladder carcinomas by semiquantitative immunohistochemistry using domain specific antibodies and by RT-PCR. Results were correlated to tumour stage and grade. RESULTS: There is a significant increase of Tn-C(L) with higher tumour stage and grade. Immunohistochemistry revealed a more restricted distribution pattern of A1, B, and/or D domain containing Tn-C variants to invasive tumours, tumour vessels, and to destructed muscle. The mRNA expression patterns of the domains A1-A3 are similar among the different carcinomas. Stronger differences exist in the region from the B to D domain. In general, the domains AD1/C are rarely expressed. AD1 domain expression seems to be connected with compact invasion pattern. CONCLUSION: In urinary bladder carcinoma a differential expression of Tn-C splicing variants exists in dependence of tumour type, vascularization, and invasive behaviour. Therefore, the detection of different Tn-C splicing domains could be useful for assessment of muscle invasion, tumour surveillance, as well as target structures for antibody based tumour detection and therapy.

Aged↗

PubMed2006

Case report: primary carcinoid tumor of the testicle without metastases in combination with testicular atrophy and testosterone deficiency.

The first case of testicular carcinoid was represented as an element of a benign cystic teratoma by Simon et al. J Urol 1954; 72: 892-894. It is a rare disease accounting for less than 1% of all testicular neoplasms. We report a case of carcinoid of the testis without carcinoid syndrome and metastasis but with testosterone deficiency based on a bilateral testicular atrophy, which has not been previously reported.

Adult↗

PubMed2006

Prediction of renal allograft rejection by urinary protein analysis using ProteinChip Arrays (surface-enhanced laser desorption/ionization time-of-flight mass spectrometry).

OBJECTIVES: To develop a noninvasive method for the detection of renal transplant rejection using ProteinChip Arrays (surface-enhanced laser desorption/ionization time-of-flight mass spectrometry). METHODS: A total of 23 urine samples were collected from 13 patients showing biopsy-proven renal allograft rejection and from 10 patients without histologic signs of rejection. All 23 patients had clinical symptoms and signs of acute allograft rejection and underwent renal biopsy. Samples were centrifuged, and supernatants were directly spotted onto the ProteinChip arrays with different chromatographic surfaces. The obtained spectra in a range from 2 to 200 kDa were subjected to bioinformatic analysis using the method of Fuzzy c-means, followed by the establishment of rule bases and evaluation using the relevance index according to Kiendl. RESULTS: Several protein peaks were identified allowing differentiation between rejection and no rejection. Using two different ProteinChip surfaces, we found two biomarkers at 25.71 kDa and 28.13 kDa that gave a diagnostic sensitivity of 90% and 93% and a specificity of 80% (SAX2) and 85% (CM10), respectively. CONCLUSIONS: Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry appears to be a promising new diagnostic tool for distinguishing renal transplant patients with no rejection from those with acute rejection.

Graft Rejection↗

PubMed2005

The accuracy of 250 fine needle biopsies of renal tumors.

PURPOSE: In some cases of uncertain lesions in the kidney it would be helpful to perform biopsies for preoperative histopathological evaluation. In this study we evaluated the accuracy of and the impact on tumor management of core biopsy for histopathological evaluation of small solid renal masses. MATERIALS AND METHODS: After radical or partial nephrectomy 250 renal tumor biopsies were performed in 50 patients. All biopsies were performed by 1 urologist after preparation of the kidney ex situ on back table visually guided. Formalin fixed paraffin embedded biopsies were evaluated by 1 pathologist. RESULTS: In 49 of 50 cases (98%) we could define the malignant behavior of the tumor when performing 1 central and 4 peripheral biopsies of each tumor. In 85.2% the grading was correctly defined. A benign lesion was revealed in 4 cases (8%, all oncocytoma). In renal tumors 4 cm or smaller in diameter the accuracy of 1 central and 1 peripheral biopsy each regarding definition of tumor origin, tumor grading and cell type/growth pattern was 96% and 95.5%, 84% and 84.4%, and 87.5% and 89.5%, respectively. In renal tumors more than 4 cm in diameter the accuracy was 100% and 98.1%, 85% and 94.3%, and 71.4% and 88.7%, respectively. CONCLUSIONS: Core biopsy of renal lesions is accurate enough for histopathological evaluation and determination of therapeutic procedure. Additionally, biopsy could be used for identifying benign renal lesion for observation.

Biopsy, Needle↗

PubMed2004

mRNA expression and protein distribution of the unspliced tenascin-C isoform in prostatic adenocarcinoma.

The inclusion or omission of the alternatively spliced region in the tenascin-C (Tn-C) mRNA gives rise to the large (Tn-C(L)) or small (Tn-C(S)) variant, respectively. Tn-C(L) is thought to be a typical component of provisional extracellular matrices (ECMs) and is expressed during tumour stroma remodelling in cancer. Tn-C(L) mRNA expression and protein distribution have been studied in 44 prostatic adenocarcinomas using RNA/RNA in situ hybridization supplemented by reverse transcriptase-polymerase chain reaction (RT-PCR), and immunohistochemistry (clone BC-2). While the Tn-C(L) protein was demonstrated within tumour stroma, Tn-C(L) mRNA expression was mainly observed in carcinoma cells, regardless of the histological grade of the tumour. Carcinoma cells containing Tn-C(L) mRNA were particularly localized at the tumour invasion front. Tn-C(L) mRNA was also identified in benign prostatic hyperplasia, where it was present exclusively in the basal cell layer, and in prostatic intraepithelial neoplasia in which there was partial loss of positive basal cells and increasing positivity of luminal cells. Furthermore, newly formed tumour blood vessels and inflammatory and stromal cells take part in the expression of Tn-C(L) and are involved in the formation of a provisional tumour matrix. It is concluded that deposits of Tn-C(L) indicate rebuilding processes in non-neoplastic as well as in neoplastic prostatic tissues. In respect of the Tn-C(L) synthesis in budding prostatic carcinoma cells, the results demonstrate that tumour cells can directly produce the ECM components of carcinoma stroma, creating conditions that facilitate the process of invasion.

Adenocarcinoma↗

PubMed2004

Pubovaginal cutaneous fascial sling procedure for stress urinary incontinence: 10 years' experience.

OBJECTIVES: There is a considerable lack of consensus regarding indications and long-term efficacy of the many techniques for treating urinary stress incontinence. We report the long-term results of a modified pubovaginal sling procedure. METHODS: From 1989 to 1998, 129 consecutive patients underwent a pubovaginal sling by two urologists. 86 of the subjects (67%) replied to a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. During surgery we performed a modified sling procedure using a cutaneous strip strengthened by rectus fascia and placed with almost no tension. Special care was taken not to lacerate or damage but support the urethral musculature. We routinely did an anterior vaginoplasty, and posterior vaginoplasty if necessary. RESULTS: Mean patient age was 56.8 years, mean follow-up 39 months, mean parity 2.1, previous surgery 0.4. Improvement rates were determined as follows ('Are you satisfied with the operation?'): Significantly reduced incontinence (i.e. 50-100% improvement) was found in 65.2%, slight reduction (10-40% improvement) in 15.2%, no change in 17.4% and worsening in 2.2% of all 103 cases. The majority of all complications were wound infections. CONCLUSION: Despite the considerable failure rate, the substantial improvement in the quality of life of almost two thirds of the patients during a 3-year follow-up recommends a pubovaginal sling as a treatment option for urinary incontinence.

Fasciotomy↗

PubMed2003

Immunohistochemical demonstration of the gamma2 chain of laminin-5 in urinary bladder urothelial carcinoma. Impact for diagnosis and prognosis.

The heterotrimeric molecule laminin-5 (Ln-5) represents a main protein of the epithelial adhesions complex. It links the basement membrane (BM) with the hemidesmosomes of the basal urothelial cells. The study was aimed to evaluate invasion associated changes of the epithelial adhesion complex in urothelial carcinoma (UC) monitored by immunohistochemical demonstration of the Ln-5 gamma2 chain. For correlation to UC phenotype and patients outcome, a semiquantitative immunohistochemical analysis of 100 routinely processed paraffin embedded samples (non-invasive and invasive UC) using the antibody D4B5 specific for the Ln-5 gamma2 chain was performed. An increased risk of death is associated with an increased Ln-5 loss from BM (P=0.001), an increase of stroma deposition (P=0.001), as well as an increase of cellular retention of Ln-5 protein (P=0.001) (Kruskal-Wallis test). As shown in multivariate analysis, in addition to tumor stage the cellular retention of Ln-5 is the most important prognostic parameter. In consequence, the modulation of Ln-5 is recommended as a diagnostic marker of invasive UC phenotype.

Adult↗

PubMed2003

Bladder dysfunction and end stage renal disease.

INTRODUCTION AND OBJECTIVES: Evaluation of lower urinary tract function in patients with end-stage renal disease and lower urinary tract symptoms. Patients were screened before entering a renal transplantation program. MATERIALS AND METHODS: A diagnostic work-up including urodynamics was performed on 52 patients (14 women, 38 men) suffering from renal failure due to chronic glomerulonephritis (n = 25), diabetic nephropathy (n = 15), chronic pyelonephritis/stone disease (n = 9) and polycystic kidney disease (n = 3). RESULTS: Abnormalities in lower urinary tract function of different degrees were found in 40 patients (77%). Major problems are bladder hypersensitivity (n = 31%), poor bladder compliance (38%), detrusor instability (25%) and detrusor-sphincter dyssynergia (33%). CONCLUSIONS: There is a high incidence of bladder dysfunction of different degrees in patients with renal failure. The clinical significance, especially in the long term, needs to be evaluated. However, a urodynamic assessment before renal transplantation is recommended in all patients reporting symptoms of dysfunctional voiding and/or bladder storage problems in order to avoid allograft dysfunction due to chronic bladder dysfunction and related complications. Depending on the degree of bladder dysfunction an urodynamic follow-up after transplantation is necessary. If there are no symptoms and no history of lower urinary tract dysfunction an urodynamic assessment is not necessary.

Adolescent↗

PubMed2003

How reliable is conventional urinary cytology in post-transplant patients?

INTRODUCTION AND OBJECTIVES: Factors like cold, flushing solutions, ischemia and reperfusion may alter the microscopic appearance of transitional cells leading to falsely positive results of urinary cytology in patients after kidney transplantation. After seeing 1 patient presenting with two consecutive highly suspicious cytology specimens 3 days after transplantation and no sign of urothelial tumor at retrograde urography, we analyzed the cytological picture of transitional cells in post-transplant patients. MATERIAL AND METHODS: We investigated 31 urine specimens of 11 patients undergoing kidney transplantation preoperatively (if possible) and on days 1, 3 and 9 postoperatively. Microscopic cytology was performed by using Papanicolaou's criteria: 0 - no cytology possible (no cells), I+II - negative cytology, III - doubtful, IV - suspicious for tumor, V - tumor cells. All microscopic examinations were performed by one experienced senior pathologist. RESULTS: Mean patient age was 55.8 (+/- 17.5) years, mean residual diuresis 856 (+/- 636) ml, mean cold ischemia time 13.6 (+/- 6.4) h, mean creatinine level on day 1: 582 microM/l, day 3: 533 microM/l and day 9: 259 microM/l. None of the urinary cytology results were suspicious for malignant transformation (Papanicolaou I+II). No patient presented signs of urothelial malignancy after a mean follow-up of 3 months. CONCLUSION: Although microscopic urinary cytology may be falsely positive in 1-12% of non-transplanted patients due to urothelia atypia, inflammation or radiation/chemotherapy, the present study suggests that conventional microscopic cytology examinations in post-transplant patients are not heavily altered and do not lead to an increased false-positive rate.

Carcinoma, Transitional Cell↗