Biomedical subjects

Hendrik Van Poppel

Publications and source records attributed to Hendrik Van Poppel.

9 recordsLinked to original sources

PubMed2006

A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.

OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS: 541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS: This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS: NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.

Aged↗

PubMed2006

Current status of minimally invasive ablative techniques in the treatment of small renal tumours.

OBJECTIVES: In the current era, minimally invasive surgery using ablative techniques for the treatment of small renal tumours has become a more common and feasible treatment option. In this review, we present recent data regarding the utility of needle ablative techniques in the experimental and clinical settings. METHODS: We performed a comprehensive evaluation of available published data from 1997 to 2006 that were identified with PubMed. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS: Two main thermoablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), represent the current available minimally invasive treatments for renal cell carcinoma (RCC). CA has been more extensively studied and has gained acceptance from patients and physicians. The procedure is well tolerated by patients even with serious concomitant diseases. RFA is delivered with a monopolar alternating current. Morbidity rates for this modality remain slightly higher than those for cryotherapy. Both techniques are associated with highly successful cancer control rates at short-to-medium follow-up in patients with tumour size <3 cm. Multiple lesions can be treated simultaneously and the procedures can be repeated. However, long-term follow-up data are still lacking. CONCLUSION: Minimally invasive ablative approaches seem to represent an attractive alternative to extirpative surgery for the treatment of small renal neoplasms in select patients. Potential developments include concepts to improve the accuracy of thermal ablation using novel imaging modalities with reduction in side-effects and optimised selection and follow-up of patients to provide at least equivalent cancer control to conventional surgery.

Catheter Ablation↗

PubMed2006

Metanephric adenoma during pregnancy: clinical presentation, histology, and cytogenetics.

Metanephric adenoma is a rare benign tumor of the kidney. It is considered to be derived from embryonic renal tissue and to be the benign counterpart of the Wilms tumor. Although its imaging findings and immunohistochemistry are nonspecific, it has a typical microscopic morphology. We describe a case of a 24-year-old primigravida who presented in the 28th week of pregnancy with lower back pain, fever, malaise, and anemia. At renal ultrasonography and magnetic resonance imaging, a hemorrhagic tumor of 10 cm in diameter originating from the right kidney was seen. Based on the imaging findings, the diagnosis of a cystic renal cell carcinoma with recent hemorrhage was suggested, and a radical nephrectomy was performed. Pathologic examination concluded to a metanephric adenoma. The further pregnancy went on well. The karyotype of the tumor was 46,XX,t(1;22)(q22;q13),t(15;16)(q21;p13). To our knowledge, this is the first report on these chromosomal abnormalities in metanephric adenoma.

Adenoma↗

PubMed2006

The role of whole pelvic radiotherapy in locally advanced prostate cancer.

Routine PSA testing has led to diagnosis and treatment of prostate cancer at earlier stages than previously. Earlier and technically-improved treatment, together with escalation of dose has enhanced cure rates. Although, the incidence of nodal metastases is now lower than in pre-PSA days, more extended pelvic lymphadenectomies have shown the actual rate of lymph node involvement to be higher than had been determined from standard radical prostate surgery. As in cancers in other sites, especially in their earlier stages, lymph node metastases may exist in the absence of haematogenous dissemination. This, together with the improved rates of control of the primary prostate tumour, suggests that elective irradiation of early-stage lymph nodes from prostate cancer should enhance survival in a manner analogous to improvements seen with this approach in other cancers. Although, the absolute incidence of positive nodes in locally advanced prostate cancer warrants elective radiotherapy, it is relatively low and the modest improvements to be expected may be undetected in the results of a small trial.

Adenocarcinoma↗

PubMed2006

Urachal carcinoma during pregnancy.

We report a case of Stage T4aN2M0 urachal carcinoma that was diagnosed early in pregnancy. Because positive pelvic lymph nodes and uterine involvement were present, surgical resection, including hysterectomy with termination of the pregnancy, and postoperative radiotherapy were performed. The treatment options, which largely depend on the duration of the pregnancy, the tumor stage, and the patient's desire to continue the pregnancy, are discussed.

Adenocarcinoma↗

PubMed2005

Gastrointestinal stromal tumor of the prostate.

We present a unique case of an atypical prostate tumor in a 49-year-old man with acute urinary retention. Digital rectal examination revealed a large prostate with a parenchymal mass on the left side. Radiologic imaging showed a 14.2 x 9.6 x 14.0-cm prostatic mass and multiple liver metastases. A pathologic diagnosis of a prostatic gastrointestinal stromal tumor was made and was confirmed by molecular analysis. Therapy consisted of a tyrosine kinase inhibitor, resulting in prostate mass reduction. After 100 weeks, the patient was in good physical condition with a continuing partial response with a reduced mass volume and liver nodules.

Acute Disease↗

PubMed2005

Hemorrhagic complications after nephron-sparing surgery: angiographic diagnosis and management by transcatheter embolization.

OBJECTIVE: Nephron-sparing surgery has become an accepted treatment technique for renal cell carcinoma in properly selected patients. Although rare, major postoperative hemorrhage can occur and is usually accompanied by gross hematuria with or without acute flank pain at the site of prior surgery. In this retrospective study, the immediate radiologic and clinical success and the long-term follow-up of transcatheter embolization are evaluated. CONCLUSION: Transcatheter selective embolization is a safe and effective technique for appropriate management of this postoperative vascular complication.

Adult↗

PubMed2005

Enhancing the photodynamic effect of hypericin in tumour spheroids by fractionated light delivery in combination with hyperoxygenation.

The aim of this study was to explore the hypothesis of oxygen depletion during light irradiation as a possible explanation for the incomplete response seen after hypericin-mediated photodynamic therapy (PDT) under specific conditions. To investigate this, we performed PDT experiments using transitional cell carcinoma spheroids with fractionated light irradiation and hyperoxygenation. After 2-h incubation with 3 different hypericin concentrations, spheroids were irradiated either continuously or with fractionated light delivery. The effect of hyperoxygenation was investigated by bubbling normobaric oxygen in the solution surrounding the spheroids before continuous irradiation or during the dark interval of light fractionation. The PDT efficacy was evaluated with an MTT antiproliferation assay and apoptotic cells were visualized after PDT by DAPI staining. Our results show that fractionated light delivery with dark intervals ranging from 1 to 10 min does not enhance the PDT efficacy in spheroids at all, whereas hyperoxygenation, using appropriate hypericin concentrations and oxygenation intervals, results in a virtually complete malignant cell killing through apoptosis. This study suggests that oxygen depletion is the major source of relative treatment failure in hypericin-mediated PDT with spheroids, which can only be overcome with hyperoxygenation. Therefore, whole bladder wall PDT with hypericin is likely to become a very efficient antitumoural treatment against superficial bladder cancer, on the condition that instillation fluids are hyperoxygenated during light irradiation.

Anthracenes↗

PubMed2003

Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation.

BACKGROUND AND PURPOSE: Only a few investigators have described the involvement of the perineal muscles in the process of human erection. The aim of this research was to evaluate a re-education program for men with erection problems of different etiologies. SUBJECTS AND METHODS: Fifty-one patients with erectile dysfunction were treated with pelvic-floor exercises, biofeedback, and electrical stimulation. RESULTS: The results of the interventions can be summarized as follows: 24 patients (47%) regained a normal erection, 12 patients (24%) improved, and 6 patients (12%) did not make any progress. Nine patients (18%) did not complete the therapy. On the basis of several variables, a prediction equation was generated to determine the factors that would predict the effect of the interventions. The outcome was most favorable in men with venous-occlusive dysfunction. DISCUSSION AND CONCLUSION: Comparison of the results of the physical therapy protocol reported here with those obtained for other interventions reported in the literature shows that a pelvic-floor muscle program may be a noninvasive alternative for the treatment of patients with erectile dysfunction caused by venous occlusion.

Adult↗