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Biomedical subjects

M Duchek

Publications and source records attributed to M Duchek.

At least 19 recordsLinked to original sources
PubMed2000

The effect of isoniazid on BCG-induced toxicity in patients with superficial bladder cancer.

The use of bacillus Calmette-Guérin in the treatment of transitional cell cancer of the bladder has caused concern because of its associated adverse effects. We conducted a randomized prospective, double-blind, multicentre study to determine whether isoniazid prophylaxis could reduce BCG-induced toxicity without compromising its immunotherapeutic effects. Patients (n = 160) with histologically documented urothelial cancer (pTa-T1, pTis, G1-3) were treated with 6 weekly instillations of BCG Connaught strain, 81 mg, administered concomitantly with a 3-day course of isoniazid (300 mg o.d.) or placebo. Side-effects were recorded with each treatment and at follow-up. Of the patients treated with isoniazid, 19% remained free from side-effects, compared with 16% of the placebo group. Local side-effects confined to the bladder were significantly lower among those receiving isoniazid (35% vs. 48%, p < 0.01). Local side-effects together with systemic adverse effects such as fever, nausea or skin rash were experienced by 30% of patients in each arm. There were no differences in tumour recurrence between the two patient groups. Concomitant isoniazid reduces the local, but not the systemic side-effects of topically applied BCG without compromising the antitumour effect on superficial, transitional cell cancer of the bladder during a follow-up period that now exceeds 2 years.

Administration, Intravesical↗
PubMed1998

Informed consent in clinical training--patient experiences and motives for participating.

The purpose of this study was to assess patients' attitudes to and experiences of participating in the clinical training of medical students. Samples of patients (n = 582) selected at random from six different departments (gynaecology, psychiatry, internal medicine, paediatrics, urology and a health care centre with general practitioners) were interviewed by means of a questionnaire. The patients were selected from those who had consulted the actual departments in the last six months of 1995. Four hundred and forty-one patients (76%) answered the questionnaire. Seventy-one per cent of all patients had experience of participating; of these 41% had estimated that they had once or several times participated without being informed. Eighty per cent felt aggrieved if they were not informed. On average 88% were, in principle, positive to participating. Of those who were, in principle, negative a majority had negative experiences of participating. Elderly patients tended to accept participating more often without being informed. Almost all patients seemed to be positive to participating in the education of medical students, although a silent precondition might be that patients should be informed and given the opportunity to abstain.

Adult↗
PubMed1998

Radical nephrectomy is still preferable in the treatment of localized renal cell carcinoma. A long-term follow-up study.

OBJECTIVES: Due to the advances of radiological methods, an increased number of incidentally detected renal cell carcinomas is diagnosed. The reported excellent results of nephron-sparing surgery have promoted its application in patients with a normal contralateral kidney. However, the risk of local tumor recurrence and surgical complications after nephron-sparing surgery might be higher compared with radical nephrectomy. METHODS: In 89 patients with localized renal cell carcinoma treated with radical nephrectomy, long-term renal function, morbidity, and survival were evaluated. The renal function was followed up regularly with serum creatinine measurements. RESULTS: The cause-specific 5-year survival rate was 91.6%. There was neither local nor contralateral kidney tumor recurrence in any patient. Surgical complications were observed in 3% of the patients. Mean serum creatinine after the nephrectomy was 123 mumol/l without further increase during 10 years of follow-up. CONCLUSIONS: Radical nephrectomy of localized renal cell carcinoma has low morbidity, excellent local tumor control, and a high survival rate. For patients with a normally functioning contralateral kidney the long-term renal function remained adequate. Based on these data, there is no convincing evidence justifying nephron-sparing surgery to be used routinely for patients with a normally functioning contralateral kidney.

Adult↗
PubMed1996

Translabial sonography in evaluating the lower female urogenital tract.

Transvaginal sonography has become an invaluable technique for examining the uterus, adnexa, and other nongynecologic structures in the pelvis because it provides better spatial resolution than transabdominal sonography [1]. Transvaginal sonography is a technique that complements manometric urodynamic examination by permitting a precise study of periurethral soft tissue. However, the principal disadvantage of transvaginal sonography is the distortion it provokes in vesicourethral anatomy [2]. Furthermore, transvaginal sonography cannot be used in small girls, virgins, and women with narrow vaginas, nor can it be used in assessing incontinence and other voiding dysfunctions because of direct effects on the physiology of the urinary tract caused by the probe itself [3]. Translabial sonography, which we have routinely used since 1990 [4], is an excellent alternative means of examination for these patients and for disorders of the lower urogenital tract. We have used translabial sonography in different types of incontinence. To learn more about the physiology of micturition, using translabial sonography, we let patients micturate not only in a recumbent position but also standing while straining and coughing. The latter position simulates a provocative cystometry. In this paper, we describe the translabial sonographic technique and some of the disorders we have encountered.

Adult↗
PubMed1996

Predictive value of DNA ploidy in bladder cancer treated with preoperative radiation therapy and cystectomy.

The predictive value of flow cytometric DNA analysis of cells from bladder washings was evaluated in 43 patients with muscle-invasive or recurrent superficial bladder cancer treated with preoperative radiotherapy and cystectomy. There was no correlation between ploidy status of the primary tumour and survival, neither was there any correlation between ploidy and the occurrence of residual tumour in the cystectomy specimens. Patients without residual tumours in the cystectomy specimen had significantly longer survival time than those with residual tumours. Concomitant carcinoma in situ was correlated with better survival, which is surprising, considering the malignant potential of this lesion. In this study DNA ploidy did not predict tumour response to radiotherapy nor was it of any prognostic significance.

Carcinoma in Situ↗
PubMed1994

Translabial ultrasonography with pulsed colour-Doppler in the diagnosis of female urethral diverticula.

Urethral diverticulum in female can be easy to detect by physical examination but sometimes the diagnosis can be difficult. The classical radiographic diagnosis has traditionally been based on urethrography. Ultrasonographic approach is gaining more acceptance for the diagnosis of female diverticula. Transabdominal (1977), transrectal, transperineal and transvaginal techniques were described earlier. We here present a new and improved technique: i.e. the translabial ultrasonographic approach in combination with pulsed colour-doppler examination. An endovaginal 5 MHz probe was used. The transducer was placed directly against labia minora and the urethral orifice. The character of the diverticula and it's spatial relationship to the urethra could be described in 5 women. There was no need for other radiological examination preoperatively. The advantages of translabial sonographic technique are absence of ionizing radiation, reduced risk of infection, noninvasivity and comfortability. It is also a quick and reliable technique.

Adult↗
PubMed1993

Carcinoma of the penis. Treatment by surgery or combined bleomycin and radiation therapy.

Forty-four patients with squamous cell carcinoma of the penis stage T1-T2, N0 were either treated surgically (n = 19) or with a combination of irradiation and bleomycin (n = 25). The overall actuarial survival rate was 80% at 3 years, 77% at 5 years and 60% at 10 years. The result of irradiation treatment combined with bleomycin was in stage N0 equivalent to that of surgical therapy. The non-surgical treatment had the advantage of preserved sexual ability.

Adult↗
PubMed1992

Screening of patients with hereditary spastic paraparesis and Addison's disease for adrenoleukodystrophy/adrenomyeloneuropathy.

X-linked adrenoleukodystrophy/adrenomyeloneuropathy presents a wide variation of clinical manifestations and may mimic several diseases. A screening investigation by measuring plasma saturated very long-chain fatty acids was performed in two groups of patients. Among six patients with hereditary spastic paraparesis one woman was detected to be a heterozygous gene carrier. However, in a group of eleven adult men with idiopathic Addison's disease the plasma concentrations of very long-chain fatty acids were all within normal limits. We conclude that X-linked adrenoleukodystrophy and symptomatic heterozygous females should be considered in cases of progressive spastic paraparesis.

Addison Disease↗
PubMed1991

Painful testicular lithiasis.

Testicular pain both acute and chronic is quite common and may result from many different diseases located both in and outside of the testis. Diffuse testicular microlithiasis is a rarely encountered problem in urology and up to now a unique sonographic appearance. We here report a case with combination of both signs and give a short review of the literature.

Adult↗
PubMed1989

Gonadotropins, testosterone and prolactin in men with abnormal semen findings and an evaluation of the hormone profile.

Over a 4-year period, 259 men were investigated regarding primary (86.5%) or secondary (13.5%) infertility. Men with azoospermia had significantly higher concentrations of FSH and LH and lower concentrations of testosterone than those with spermatozoa. High concentrations of FSH and LH in serum were found in case of low sperm density. Men with low testicular volume had high concentrations of FSH and LH and low concentrations of testosterone. FSH was closely correlated with LH and also with total testicular volume. A negative correlation was found between both gonadotropins and testosterone. The correlation between LH and testosterone was stronger in axoospermic men than in those with spermatozoa in semen. Serum concentrations of prolactin were higher in men with high sperm motility than among men with low motility of spermatozoa. Otherwise, prolactin concentrations were not correlated either with sperm density or with the morphology of spermatozoa or total testicular volume. A 'hormone profile' of FSH, LH and testosterone concentrations is suggested useful in the routine investigation of the infertile man, as more information is given by this profile than by FSH concentrations alone.

Adult↗
PubMed1989

A prognostic score for subfertile men based on anamnestic data and semen variables.

Over a 4-year period, 259 men were investigated for primary (86%) or secondary (14%) infertility. Some 3-5 years after the initial investigation, 200 of these men were followed up and the conception rate of their partners assessed. Their age at investigation, total testicular volume, sperm density, sperm motility, percentage morphologically normal sperm and the duration of infertility all gave information about the prospects of conception. A stepwise discriminant analysis showed that the age of the men at investigation, sperm density, sperm motility and the duration of infertility all had a strong discriminant bearing on future conception. A score based on these four variables for the estimation of prognosis in 'subfertile' men has been devised and would seem to be clinically useful.

Adult↗
PubMed1989

Tamoxifen treatment of idiopathic oligozoospermia: effect on hCG-induced testicular steroidogenesis and semen variables.

The mechanisms behind the effects of antioestrogens on semen variables and steroidogenesis in patients with oligozoospermia are unknown. In order to further elucidate this, the steroidogenic response to acute hCG-stimulation was studied in patients with idiopathic oligozoospermia before and during treatment with the antioestrogen Tamoxifen. Also an evaluation of semen variables in these patients was performed. During Tamoxifen treatment serum concentrations of LH, FSH, progesterone, 17 alpha-progesterone, testosterone and oestradiol-17 beta increased whereas no effect was observed on prolactin and SHBG concentrations. A similar pattern in steroidogenic response to hCG-stimulation was observed before and during Tamoxifen treatment. Sperm density, motility and morphology all improved after Tamoxifen treatment. The present results are discussed in relation to the possible mechanism of action of antioestrogens in patients with oligozoospermia.

Adult↗
PubMed1989

Conception rate for infertile couples. The importance of anamnesis and signs of genital disease in men with abnormal semen findings.

During a 4-year period, 259 men were investigated for primary (86%) or secondary (14%) infertility. Some 3-5 years after the initial investigation, a follow-up study of conception rate, was performed in 200 of these cases. Conception had occurred in 79 couples (39%). Sperm density was lower among men with a history of genital disease(s) than amongst men without such a history, but conception rate was not influenced by a positive history. Men with signs of genital disease(s) had lower sperm density, a smaller proportion of morphologically normal spermatozoa and lower sperm motility, than men with a normal finding at physical examination. Men with such signs had the same conception rate as men with normal physical findings. The only subgroup, in which conception rate was lower than in men with no physical abnormalities, was men with palpatory abnormal epididymis(des).

Female↗
PubMed1988

Renal cell carcinoma in a solitary kidney: late nephrectomy after 35 years and analysis of tumor deoxyribonucleic acid content.

We report a case of renal cell carcinoma in a solitary kidney, which was palpable for 35 years and verified histopathologically 31 years before nephrectomy. Deoxyribonucleic acid analysis of paraffin embedded and new surgical samples showed a similar aneuploid deoxyribonucleic acid content with an index of 1.3. The unusually long survival of this patient is discussed.

Aged↗
PubMed1987

Inverted papilloma with intussusception of the ureter. Case report.

A case of inverted papilloma with intussusception of the ureter is reported. The patient is followed up 5 years after conservative treatment by partial resection of the ureter. No signs of urothelial tumor in the upper urinary tract or urinary bladder were revealed.

Adult↗