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Biomedical subjects

J Gschwend

Publications and source records attributed to J Gschwend.

At least 19 recordsLinked to original sources
PubMed2006

The role of radical prostatectomy in patients with clinically localized prostate cancer and a prostate-specific antigen level >20 ng/ml.

OBJECTIVES: To determine the outcome of patients with a serum prostate-specific antigen (PSA) level >20 ng/ml that underwent radical prostatectomy (RP). METHODS: We retrospectively reviewed the medical records of 147 patients who underwent RP for clinically localized prostate cancer with a pre-treatment PSA (PSApt) >20 ng/ml. Fifty-two patients had positive pelvic lymph nodes and were excluded from analysis. Of 95 patients remaining, 15 were lost to follow-up. Therefore, the study group included 80 patients. The end points for this analysis were biochemical relapse-free survival (bRFS), surgical and post-operative complications and urinary continence. PSApt, pathological grade, surgical margin status, age, clinical stage and immediate androgen ablation were evaluated in a multivariate analysis regarding bRFS. RESULTS: Forty-nine resected specimens (61.2%) were pathologically classified as pT3 or pT4. After a mean follow-up of 64 months, the estimated 5-year bRFS rate was 58% for the overall group. Immediate androgen ablation was the only independent prognostic factor for biochemical relapse (P=0.001). Concerning the 21 patients who received an immediate androgen ablation after RP, the estimated 5-year bRFS rate was 92%. Complete urinary continence was achieved in 76.5% of patients. Early complications occurred in 13 patients (16.2%). CONCLUSIONS: Clinically localized prostate cancer with a PSApt >20 ng/ml is considered as having a poor prognosis. However, RP performed in these patients led to an acceptable morbidity and good functional results. Immediate adjuvant hormonal therapy seems mandatory in this setting to improve bRFS.

Carcinoma↗
PubMed2006

[Translational research in renal cell cancer. Illustrated by the example of the vascular endothelial growth factor pathway].

For patients with metastatic renal cell cancer (RCC), therapeutic options after cytokine failure are rather limited. There is a considerable need to identify new substances for systemic therapy. Due to upregulation after the loss of a functional von Hippel Lindau gene product, the vascular endothelial growth factor (VEGF) pathway is a promising target for a molecular based therapy. Over the last few years, therapeutic agents have been developed which inhibit this pathway at various levels. Here, we provide an overview of the molecular background and currently used drugs which have entered clinical trials in the setting of metastatic RCC disease. Until now, the results from early clinical trials are very promising, however, the best schedule, dosage, potential combination regimens, as well as long time efficacy, are still to be determined.

Angiogenesis Inhibitors↗
PubMed2006

[Structured quality report of urologic clinics according to section 137 SGB V. Useful information for the patient, marketing tool of the hospitals, leverage wielded by the health insurance companies, or junk data?].

In 2005, German hospitals were legally obliged to publish a structured quality report on their data of 2004 including the top 10 diagnosis-related groups, top 10 diagnoses, and top 10 procedures for every specialty. The aim was to increase the transparency for patients, doctors, and health insurance companies. Comparing the quality reports of 248 departments of urology revealed very uniform distributions of diagnoses and diagnosis-related groups. There was a large variety of top 10 procedures, resulting from different interpretations of the coding system, leading to diminished accuracy. The quality reports provide coding specialists with important data, but for patients and nonspecialized doctors, this system is not helpful in improving transparency.

Data Collection↗
PubMed2001

[The new uretero-ileal anastomosis technique in Hautmann ileal neobladder].

OBJECTIVE: Hautmann neobladder is one of the most widely bladder replacement techniques in the two sexes. The uretero-ileal stenosis rate is estimated to be 11% with the initial CAMEY-LE DUC technique. A new anastomosis technique is presented in order to improve this postoperative complication. MATERIALS AND METHODS: Two 5 to 10 cm ileal segments are prepared at the two extremities of the W of the neobladder to receive the largely spatulated ureters. The anastomosis is performed directly on the ileal resection margin, in a strictly retroperitoneal position. Between December 1996 and December 1998, the technique was performed in 89 patients including 19 women. One hundred and sixty six renal units (RU) were analysed by preoperative renal ultrasound, repeated after 1, 3 and 6 months and then every 6 months. Urine culture was performed monthly for 6 months. RESULTS: Thirteen RU were dilated (grade II and III) preoperatively (7.8%). No secondary anastomotic stenosis was observed with a mean follow-up of 5.8 +/- 7.6 months. Of the 166 RU examined, 129 were normal, 13 preoperative dilatations were improved and 24 RU presented minimal postoperative dilatation (grade I). Ileo-ureteric reflux was observed on the postoperative retrograde cystography in two cases. The only complication was acute pyelonephritis (1.1%) at 1 month. 90% of urine cultures were sterile after 6 months. CONCLUSION: Modification of uretero-ileal anastomosis by the "double chimney" technique is performed without tension by placing the two ureters in an anatomical position without plication or torsion. Preservation of the ureteric blood supply contributes to the low complication rate and a decreased risk of stenosis. However, the technique needs to be validated by analysis of the results with a longer follow-up.

Adult↗
PubMed1999

Altered expression of extracellular matrix in human-cytomegalovirus-infected cells and a human artery organ culture model to study its biological relevance.

The influence of human cytomegalovirus (HCMV) on the transcription of 11 selected, representative extracellular matrix genes was investigated in cell culture. Northern blot hybridization indicated the downregulation of all mRNAs investigated. Based on our results and the known repression of other extracellular matrix transcripts and the beta-actin transcription during HCMV infection, we suggest that one molecular mechanism contributing to the cytopathic effect may be the transcriptional downregulation of genes encoding proteins involved in cell structure and intercellular connection. To further study the biological relevance of this and other pathogenetic mechanisms, we established a human renal artery organ culture system and characterized this new infection model for HCMV. Our model is a new suitable system for the investigation of molecular as well as functional consequences of HCMV infection in a more physiological microenvironment.

Cells, Cultured↗
PubMed1999

[The Dornier Compact: one year experience with a new generation mobile unit lithotriptor for the treatment of renal and ureteral calculi].

OBJECTIVES: To evaluate the clinical results after one year's experience with a new generation lithotriptor, the Dornier Compact Delta. MATERIAL AND METHODS: The authors treated 278 patients between the ages of 7 and 88 years, presenting with ureteral stones in 49% of cases. The mean stone diameter was 10.5 (range: 3 to 50 mm). The Compact Delta is equipped with a fixed or induced frequency electromagnetic shock wave generator. Stones are visualized by digital fluoroscopy and/or ultrasound scanning. Therapeutic centering is performed by isocentric displacement of the patient. Corrections can be easily made during treatment. An average of 3,202 (range: 500-5,800) shock waves were applied with a mean energy level of 4.5 (range: 1-6). Treatment was performed without premedication. RESULTS: A feeling of discomfort or even pain was reported in 75% of cases and treated with intravenous analgesic. Ninety-five per cent of patients were discharged with no residual stones or with residual fragments in the process of spontaneous evacuation. This result was obtained with one treatment session in 66% of cases and two sessions in 25% of cases. Five per cent of patients required a postoperative complementary manipulation. CONCLUSION: The combination of digital fluoroscopic and ultrasound stone detection ensures rapid and reliable localization. The Compact Delta is efficient and does not induce any complications. The preliminary results with this new mobile system show an equivalent efficacy to that of the fixed system with greater flexibility and improved comfort of use.

Adolescent↗
PubMed1996

[Minimally invasive treatment of stress urinary incontinence by collagen administration. Comparison between endosonography controlled and transurethral submucous collagen injection].

For many years, injectable substances have been in use for the treatment of incontinence. We examined different methods of injecting glutaraldehyde cross-linked bovine collagen injection for their effectiveness in treatment of genuine stress incontinence. In the first group of patients collagen injection was done under endo-ultrasound guidance. In the second group an endoscopic system was used. There was no major difference in patient selection for the two groups. Incontinence symptoms became less severe in only 5 of 15 (33%) patients in the endo-ultrasound group, who then had moderate stress incontinence. Endoscopic collagen treatment resulted in social continence in 15 of the 22 (68.2%) patients. We conclude that endoscopic collagen is superior to endo-ultrasound-guided collagen injection in the treatment of incontinence.

Adult↗
PubMed1995

[Initial experiences with the Memotherm Stent in treatment of benign prostatic hyperplasia].

We report our experience with a new thermosensitive stent (Memotherm), which has been invented recently as an alternative method for treatment of benign prostatic hyperplasia. The wall of this stent is a thermoreactive mesh made of nitinol, which reaches its maximum force of expansion at body temperature. Its high degree of flexibility allows the Memotherm stent to fit the natural course of the prostatic urethra. This stent is available in different sizes between 2 and 8 cm to meet the demand for different lengths of prostatic urethra. Furthermore, the meshed structure of this stent allows its atraumatic removal. From April 1992 to September 1993, 54 consecutive patients with benign prostatic hyperplasia and Memotherm stents inserted. The mean patient age was 76.1 years (range 61-98 years). Patients were considered suitable for treatment with the Memotherm stent when they presented with a poor operative risk. Mean prostatic volume was 51.9 +/- 25 ml (20-150 ml), and on average a stent measured 32.3 +/- 9.5 mm (20-70 mm). Preoperatively, only 14 patients (26%) were able to void, and 40 patients (74%) had had a transurethral or suprapubic catheter placed. After placement of the Memotherm stent, 53 of 54 patients were able to void. In the patients who were able to void preoperatively, the mean maximum flow rate increased from 4.5 ml/s to 15.8 ml/s within the first 6 months after treatment. Within the same period of time, the mean residual urine volume decreased from 194.4 ml to 11.8 ml, and the AUA 6-Symptom Score improved from 24 to 3.5 points. All differences are statistically significant (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Thermosensitive stent (Memotherm) for the treatment of benign prostatic hyperplasia.

Recently, more and more alternative therapeutic methods have been used for the treatment of benign prostatic hyperplasia (BPH). We will report on therapeutic results with a new thermosensitive stent system (Memotherm). This wire mesh stent has been designed especially for urological purposes. It is made of Nitinol, a thermoreactive material, and gains its maximum expansion force al body temperature. Due to the properties of the material the stent is flexible and can adapt to the anatomical conditions of the prostatic part of the urethra. Because of individual variations in the length of the prostatic part of the urethra, the system is available in lengths from 2 to 8 cm. The knitted structure for the first time allows atraumatic removal. Between April, 1992, and September, 1993, we treated a total of 54 BPH patients with the stent system. Mean patient age was 76.1 +/- 7.6 years (61-98). Mean prostatic volume was 51.9 +/- 25 ml (20-150), and the length of the applicated stents was 32.3 +/- 9.5 mm (20-70). Patient selection for stent treatment was carried out with regard to the preoperative risk status of this patient group. Fourteen (26%) of the patients treated were able to micturate before operation; in 40 (74%) urinary drainage was accomplished by means of an indwelling catheter. Following stent application, 53 out of 54 patients were able to micturate. With the first group (preoperative voiding ability), maximum flow had increased from 4.5 ml/s to a mean of 15.8 ml/s, while residual urine volume had decreased from 194.4 ml to 11.8 ml and the AUA 6 Symptoms Score had improved from 24 points to 3.5 points 6 months after stent application. All differences were statistically significant (P < 0.02). With the second group (no preoperative voiding ability), the AUA 6 Symptoms Score had improved from 25 points to 3.9 points (P < 0.02) 6 months after the operation, at which time the mean maximum flow rate was 14.8 ml/s and residual urine volume 14.8 ml. There was no statistically significant difference between the patients who were able and those who were unable to micturate before operation. One case of epididymitis was the only major complication observed after stent placement. Frequent urgency symptoms (30 out of 54 patients; 55.5%) subsided after a mean period of 1 week. The Memotherm stent offers an interesting therapeutic alternative for BPH risk patients.

Aged↗
PubMed1994

[Venous tumor invasion by renal cell carcinoma. Surgical technique, complications and survival rate].

Renal cell carcinoma invades the vena cava in 4-10% of cases. Another 10% of patients present with invasion of the renal vein. The surgical approach, complications and long-term outcome of 95 patients were investigated. Intraoperative complications occurred in 1 of 73 patients with involvement of the renal vein and 5 of 22 patients with vena cava thrombus. One patient in each group died due to pulmonary emboli in the perioperative period. Minor renal insufficiency occurred in 39 (54.2%) and 11 (50%) of the patients respectively. The rates of minor complications such as wound infections, haematoma and pneumonia were similar in the two groups. The mean intra-operative blood loss of 780 ml in patients undergoing tumour nephrectomy was significantly lower than the blood loss of 1485 ml in patients with tumour thrombus extension into the vena cava. The 5-year survival rate of patients with V1 tumours (71%) is comparable to that of patients without venous involvement. Tumour extension into the vena cava (V2) influences the 5-year survival rate significantly, decreasing it to 56.7%. In conclusion, long-term survival can be achieved for patients with renal cell carcinoma and venous involvement, though for patients with lymph node metastases or distant metastases only short-term palliation can be achieved. However, the potential benefits should be carefully weighed against the possible complications, the surgical morbidity and the resources expended in vena cava resection.

Adult↗
PubMed1993

[The biofragmentable Valtrac ring--a reliable concept for enteral anastomosis?].

In a retrospective investigation, 54 patients with 55 enteric anastomoses performed with the new biofragmentable Valtrac ring were examined. In 45 patients with disease of the colon partial resection of the large bowel had been performed. In 9 patients undergoing urinary diversion an end-to-end ileostomy was performed. The most important advantage of this device is that its use is achieved by way of a safe and quick technique which is easy to learn. Bowel stenosis, bleeding and other complications independent of anastomotic technique, such as wound infection, were no more frequent than after conventional suture anastomosis. In 3 patients an anastomotic leakage appeared. In 1 of these cases conservative management for a colocutaneous fistula was successful, but the other 2 patients had to undergo a second operation. In our opinion, the Valtrac system offers a convincing and reproducible alternative to conventional anastomotic techniques and it is easy to learn how to apply it.

Adult↗
PubMed1993

[Combined ultrasound and roentgen localization in ESWL. Initial clinical experiences].

Interdisciplinary use of extracorporeal shock-wave lithotripsy with sonographic or fluoroscopic guidance has become a routine procedure in clinical practice, for both urolithiasis and cholecystolithiasis. Therefore, newly developed systems with combined locating devices are gaining in importance. A primary sonographically guided lithotripter was extended by a mobile X-ray system. The results were compared with those obtained with a first-generation lithotripter. The results show that sufficient disintegration of stones throughout the urinary tract is possible with both systems. The retreatment rate with both lithotripters was 30% when stone size was comparable. No essential differences in treatment time, shockwave energy and pain were found. The easy localisation of radiolucent stones, convenient positioning of the patient and successful localisation of ureteral stones near to the spine are advantages of the MPL 9000 X. On the other hand, the technically simpler fluoroscopy system and greater ease of electrode changing are advantages of the HM3 Lithotripter. Altogether, differences in the application of the two systems are slight and insignificant except in special cases.

Adult↗
PubMed1991

[Radiologic study of the ileum-neobladder after radical cystoprostatectomy].

The study reports on radiographic findings obtained from 70 male patients in whom, following radical cystoprostatectomy for carcinoma, an ileum neobladder was created. Morphological appearance and postoperative complications of this continent type of bladder replacement were documented by means of cystography, excretory urography, retrograde urethrography and CT. Specific complications rarely arose from suture insufficiencies of the neobladder itself (n = 3) or from the ileourethral anastomosis (n = 2). Stenoses occurred at the site of the ileourethral (n = 9) and the ureteroileal anastomosis (n = 2). Transient dilatation of the upper urinary tract was observed in the majority of patients. Non-specific complications included pelvic abscesses (n = 2), haematomas (n = 2), lymphoceles (n = 3), and ileus (n = 2).

Adult↗
PubMed1991

[Experience with ultrasound-guided ESWL].

The ESWL treatment of gallstones has led to the development of ultrasound-guided lithotripters. The interdisciplinary use of these new ESWL systems by urologists, general surgeons and gastroenterologists means that different requirements have to be met. As a result of this development, ultrasound in urology is gaining even more significance. While ESWL treatment of renal calculi under ultrasound guidance has quickly become a routine method, the in situ treatment of ureteral calculi is much more problematic. In our study the validity of diagnostic ultrasound for the localization of ureteral stones was investigated. In an unselected preliminary series only 30% of ureteral calculi could be located by ultrasound. The success rates were 39% for distal stones and 16% for proximal calculi. The treatment results of renal calculi are on a par with those previously obtained under fluoroscopic guidance. Once exact localization is obtained by ultrasound, disintegration rates for ureteral calculi are fully comparable to those performed under fluoroscopic guidance. However, 60% of ureteral stones can not be located by ultrasound. Therefore, retrograde manipulation and ureteroscopic stone disintegration gains more importance in interdisciplinary shock wave centers equipped with ultrasound-guided machines. A real alternative to second-generation lithotripters in the treatment of ureteral stones will thus only be obtained if an X-ray device can be added to the locating system if necessary. With this combination device the treatment of most ureteral calculi will thus be possible.

Endoscopes↗
PubMed1990

[Experimental results and initial clinical experiences with the alexandrite laser lithotripter].

Although extracorporeal shock wave lithotripsy has become the standard therapy for urolithiasis, there are still indications for endoscopic stone treatment. Laser lithotripsy in association with flexible or semirigid "miniscopes" has become increasingly important for this form of therapy. So far the Nd: YAG and the pulsed dye laser have been used for laser lithotripsy in clinical applications. Since each system has its specific drawbacks, the new solid state alexandrite laser was developed to combine the advantages of the two existing systems. In order to evaluate the lithotriptic potential of the alexandrite laser, a stone model and eight human calculi were exposed to the laser in an experimental setting. Results with the stone model were comparable to those obtained with a reference Nd: YAG system. Adequate destruction was possible in all the human calculi except for one monohydrate stone. In the second part of the study, bladder and ureteric wall were exposed to the laser in ten female pigs, with different numbers of shock waves at various energy levels. While there was a relatively high incidence of early changes, late histological specimens 4-5 weeks after the exposure did not reveal any significant pathology. There was no stricture-formation in the ureter. Finally 12 patients were treated with ureteroscopical laser lithotripsy, and 8 of these were evaluatable. All were stone free without any additional lithotripsy and did not develop any secondary changes in the ureter. The alexandrite laser can therefore be expected to become a safe, reliable and cost-effective alternative for endoscopic stone treatment.

Adult↗