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Biomedical subjects

M Goepel

Publications and source records attributed to M Goepel.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Therapy with mitomycin C, folic acid and 5-fluorouracil in treatment of metastatic, refractory urinary bladder carcinoma--phase II study].

We performed a phase II trial with second-line chemotherapy in patients with refractory, metastatic cancer of the bladder. Second-line therapy consists of 2.6 cycles of mitomycin-C, 5-fluorouracil and folic acid. Two patients suffered from WHO grade III side effects (nephrotoxicity, leukocytopenia). We did not find any complete or partial remission. Four patients had a stable disease; 3.3 months after therapy, patients developed tumor progression with a median survival of 9 months. Four patients reported an improvement in quality of life. Since all patients received supportive care, improvement in quality of life cannot be related to chemotherapy alone. In conclusion, second-line chemotherapy with mitomycin-C, 5-fluorouracil and folic acid has no effect on refractory, metastatic cancer of the bladder and is no alternative for cisplatin and methotrexate-based chemotherapy.

Aged↗
PubMed1997

[Long-term outcome of surgical therapy of metastatic non-seminomatous germ cell tumor in advanced tumor stages].

We present long-term results (minimum follow-up 5 years) in 145 patients with advanced non-seminomatous germ cell tumours, who underwent radical retroperitoneal lymphadenectomy (RPLA) after chemotherapy. We correlated patients' outcomes (death of disease) to different kinds of chemotherapy and to intraoperative findings. We found that patients who were treated by a modified Einhorn scheme with cisplatin, etoposide and bleomycin have a good prognosis. In all, 90% showed no evidence of disease (NED). The NED rate was significantly lower in patients who were treated by sequential alternative chemotherapy (DOD = 37%). We determined the following prognostic factors which predict a poor outcome: salvage RPLA in the case of progressive disease or tumour marker increase during chemotherapy (DOD = 89%, P < 0.0001) residual tumour in multiple-organ systems (DOD = 41%, P = 0.0006) vital tumour in RPLA specimen (DOD = 53%, P < 0.0001) residual tumour mass > 5 cm (DOD = 41%, P = 0.0188). We found that histopathological findings of the primary tumour and tumour stage IIc-IIIc according to the Lugano classification have no prognostic significance for death of disease.

Adult↗
PubMed1997

Management of neurogenic fecal incontinence in myelodysplastic children by a modified continent appendiceal stoma and antegrade colonic enema.

OBJECTIVES: Antegrade colonic enemas for neurogenic fecal incontinence via reverse reimplanted appendices (Mitrofanoff principle) have been primarily reported by Malone and coworkers in 1990. We used a modification of the described surgical technique and treated the first 10 patients with neurogenic fecal incontinence due to spina bifida. The surgical procedure and the results are reported. METHODS: Since November 1991, we have used a surgical procedure similar to the appendiceal continence mechanism in urinary diversion to establish a continent colonic cutaneous stoma for antegrade enemas in 10 myelodysplastic patients (4 females, 6 males; median age 13.2 years [range 6 to 26]) with severe neurogenic fecal incontinence. The average follow-up is now 26.4 months (range 12.5 to 50). All patients had neurogenic bladder dysfunction successfully managed by clean intermittent catheterization, anticholinergic drugs, or artificial sphincter implantation. The surgical technique for fecal incontinence included the partial orthotopic submucosal imbedding of the appendix into a cecal tenia and the fixation of the ileocecal region at the inner side of the abdominal wall after creation of an appendicocutaneous catheterizable stoma. RESULTS: All patients reached fecal continence for at least 38 hours (median 45.3) by using antegrade colonic enemas with 1.5% saline solution (n = 9) or GoLYTELY solution (n = 1), 0.5 to 1.5 L every 2 to 3 days. All other therapies (diet, oral medication, rectal purgative, or enema) to reach fecal continence had previously failed. There were only two complications seen at the follow-up. One boy with an artificial urinary sphincter presented with infection of the sphincter system, which led to explantation. Another boy presented 15 months after creation of the colonic appendiceal stoma with saline intoxication possibly due to a homemade saline solution. CONCLUSIONS: We conclude that the antegrade colonic enema via an orthotopic continent appendiceal stoma is a safe and highly effective treatment modality for fecal incontinence in patients with neurogenic bowel dysfunction if nonsurgical management has failed.

Adolescent↗
PubMed1997

Bladder autoaugmentation in adult patients with neurogenic voiding dysfunction.

Bladder autoaugmentation offers an alternative to enterocystoplasties for patients with low capacity high pressure bladders caused by non-malignant pathology. In particular for patients with neuropathic hyperreflexive bladders, refractory to less invasive therapy, bladder autoaugmentation will attain comparable results with less impact on life quality compared to other bladder augmentation procedures. The procedure does not preclude later enterocystoplasty or deafferentations. Over the last 7 years, 50 patients were treated by this method, some of them for other than neurogenic voiding dysfunction. Substantial increase of bladder capacity and compliance resulted, at the cost of increased residual urine and the need for intermittent catheterisation in most patients. Some patients are able to perform complete voiding at will. The time lapse between surgery and functional rehabilitation of the bladder (substantial increase of capacity and detrusor compliance) cannot be predicted yet. In most patients this amelioration was observed 1-6 months after surgery, but in some the effect was equivocal for a year or longer. Low-dose anticholinergics appear to speed up the therapeutic effect. One patient had enterocystoplasty and one deafferentation later, one had rupture of the bladder, probably from the use of an artificial sphincter, and two are rated as failures because of psychogenic bladder-centred problems. Bladder autoaugmentation is a favourable treatment for patients who are motivated to wait possibly longer for functional changes to occur and are willing to perform intermittent catheterisation afterwards.

Adolescent↗
PubMed1997

Phase II study: adjuvant single-agent carboplatin therapy for clinical stage I seminoma.

OBJECTIVE: Though para-aortal and ipsilateral iliacal radiation is the established adjuvant treatment for clinical stage I seminoma, promising results have been reported on adjuvant single-agent carboplatin therapy. PATIENTS AND METHODS: We treated 43 patients with clinical stage I seminoma according to this option. They received 2 courses of single-agent carboplatin (400 mg/m2) at an intervall of 3 weeks. Therapy could be performed on an outpatient basis within 2 h. RESULTS: Therapy was well tolerated. Apart from minor gastrointestinal disorders and mild myelosuppression, no adverse reactions were observed. The median follow-up is 28 months. Up to now no recurrences have been noted. CONCLUSIONS: If the recurrence rate remains as low as after adjuvant radiotherapy, which should be proved in a phase III study, single-agent carboplatin therapy will be an alternative adjuvant approach for clinical stage I seminoma.

Adult↗
PubMed1996

An intra-operative seminal and prostate emission test as a control for nerve-sparing procedures in primary and secondary retroperitoneal lymphadenectomy.

OBJECTIVE: To determine the value of an intra-operative electrostimulatory test of post-ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph-node dissection (RLND). PATIENTS AND METHODS: Between 1991 and 1994, 21 patients with non-seminomatous testicular cancer of clinical stage A and 15 patients with bulky or clinical stage C disease underwent primary or secondary RLND, respectively. During surgery, post-ganglionic nerves were electrostimulated at 30 Hz and up to 20 V, for 3-10 s. Emissions were recorded simultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethra (in 11 patients). RESULTS: A positive intra-operative emission test in 15 pathological stage A (with bilateral nerve-sparing) and six pathological stage B (with contralateral nerve-sparing) patients predicted the post-operative preservation of antegrade ejaculation. In the group undergoing secondary RLND, the test allowed the identification and sparing of the emission-related nerves in four of 15 patients with a residual mass consisting of necrosis/fibrosis, and preserved antegrade ejaculation after surgery. CONCLUSIONS: A positive result in the seminal emission test predicted the preservation of antegrade ejaculation after surgery. The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the residual mass consists of necrosis or fibrosis, then electrostimulation during secondary RLND can help to identify important nerve structures when their origin is unknown initially. However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission-relevant nerves while the retroperitoneal space is removed radically. The test may also give additional information about the physiology of emission.

Ejaculation↗
PubMed1996

Results of postchemotherapy adjunctive retroperitoneal lymph node dissection in non-seminomatous germ cell cancer patients.

Cisplatin-based chemotherapy is highly effective in non-seminomatous testicular cancer. Patients with advanced disease receive two to four cycles of polychemotherapy. Residual retroperitoneal masses after chemotherapy are suspected to contain active tumour tissue as well as mature teratoma. Therefore, a delayed retroperitoneal lymph node dissection remains necessary. A total of 123 patients with advanced non-seminomatous germ cell cancer underwent retroperitoneal surgery after two different regimes of cisplatin-based chemotherapy. The first group (n = 55) received a sequential alternating chemotherapy with Adriamycin/cisplatin and bleomycin/vinblastine (8.5 +/- 5 cycles, 1979-1985), the second group (n = 60) got a standard PEB scheme (cisplatinum /etoposide/bleomycin; 5.7 +/- 2.1 cycles, 1985-1991). Eight patients got other cisplatin-based combinations. All patients received adjunctive retroperitoneal surgery. After a mean follow-up period of 72 months, the patients treated with the sequential alternating scheme showed a survival rate of 50% (27/54, 1 patient lost to follow-up). After the PEB scheme a survival rate of 79% (46/58, 2 patients lost to follow-up) was found. 86% of the patients with retroperitoneal necrosis after retroperitoneal lymph node dissection (RPLND; n = 58) survived with no evidence of disease, as well as 82% of the patients with adult teratoma (n = 18). Only 47% of the patients with residual active carcinoma after RPLND (n = 47) survived within a follow-up period of (median) 72 months, despite further chemotherapy after RPLND. Residual tumor burden and type of histology after RPLND can partially predict the clinical outcome. A necrotic specimen in RPLND could not be predicted by any means, so that surgical removal of a residual retroperitoneal mass after chemotherapy remains necessary. Standard PEB chemotherapy is superior to sequential alternating chemotherapy.

Adult↗
PubMed1996

Recent considerations for hypospadias repair: results of 252 operations from 1985 to 1990.

OBJECTIVES AND METHODS: 252 hypospadias operations were performed at our department from 1985 to 1990. We conducted 173 primary repairs and 79 reoperations. In distal hypospadias (n = 98), we used the meatoplasty and granuloplasty procedure as well as the Mathieu technique. In penile hypospadias (n = 40), a tubularized dorsal preputial flap (Duckett procedure) was performed. Proximal and scrotal hypospadias (n = 23) were operated using a combination of Duckett's tube and the Thiersch-Duplay procedure. RESULTS: We saw a 15% complication rate in distal hypospadias, 36% in penile hypospadias, and 27% in proximal hypospadias. CONCLUSION: The Mathieu technique gave a complication rate of 35.5% in our hands, and so it was replaced by the island onlay flap technique as described by Duckett.

Adolescent↗
PubMed1996

Phase II study of interferon-gamma versus interleukin-2 and interferon-alpha 2b in metastatic renal cell carcinoma.

PURPOSE: In a randomized phase II study we evaluated response, survival and side effects of low dose recombinant interferon-gamma in 30 patients (group 1) versus recombinant interleukin-2 and interferon-alpha 2b in 30 (group 2) with metastatic renal cell carcinoma. MATERIALS AND METHODS: Group 1 received 200 micrograms interferon-gamma subcutaneously once a week. Group 2 received 4 x 4.8 x 10(6) IU/m.2 interleukin-2 subcutaneously on days 1 and 22, 2 x 4.8 x 10(6) IU/m.2 on days 2 and 23, and 2 x 2.4 x 10(6) IU/m.2 combined with interferon-alpha 2b subcutaneously at 3 x 10(6) IU/m.2 on days 3, 5, 24 and 26, and 6 x 10(6) IU/m.2 3 times weekly for 6 weeks. RESULTS: Toxicity grades 2 and 3 (World Health Organization) were observed in group 2 only. After followup of 13 months there was no remission in group 1 compared to 7 remissions in group 2, with 23 cases of progressive disease detected. CONCLUSIONS: Combination therapy showed an objective response rate of 23% (p = 0.01). Although survival was not a primary aim of the study, there was a tendency toward no significant difference in survival when evaluating these relatively small groups (p = 0.49).

Adult↗
PubMed1996

[Therapy of hormone refractory prostate carcinoma with mitoxantrone. A clinical phase II study].

So far, no curative treatment is available for hormone-refractory prostate carcinoma. Therapy is thus focused on alleviating symptomatic tumor progression with the aim of improving quality of life. Therefore, anthracyclin-derived mitoxantrone was administered to 25 patients with hormone-refractory prostate carcinoma and symptomatic progressive disease. After a median treatment of 13 weeks, a median of 4 cycles and a follow-up of 14 months, 48% of the patients (12/25) reported improvement in tumor-related pain; in 60% (15/25) there was improvement of the self-assessment symptom score and 32% of the patients (8/25) gained weight. Additionally, partial tumor response with regression of lymph-node metastases occurred in 3/25 patients (12%). In 10/25 patients the serum level of prostate-specific antigen (PSA) decreased as well as the alkaline phosphatase (AP) in 7/25 patients. Side effects subsequent to chemotherapy were leucopenia WHO grade III in 25% of the patients and thrombocytopenia WHO grade III in 3/25 and grade V (treatment-related death) in 1/25 patients. Non-hematological toxicity occurred in 2 patients (cardiotoxicity n = 1, nephrotoxicity n = 1, WHO grade II each).

Aged↗
PubMed1996

[Pediatric ureteral ureteral outlet obstruction and obstructive megaureter: observation or operation?].

Stenosis of the ureteropelvic junction and obstructive megaureter are still a diagnostic and therapeutic problems. So far, there is no reliable prognostic factor to predict the outcome of a primary dilated upper urinary tract under the "wait and see" strategy and to decide which child must be operated upon and which should not. In practice, basic diagnostic evaluation with sonography, possibly i.v.-pyelography and voiding cystography is accompanied by quantifying isotope-based procedures such as DMSA-uptake or diuretic renography. The Whitaker test has become less important. Based on the investigation by Koff et al., it seems to be possible to follow the "wait and see" procedure in more than 85% of the children without any loss of renal function of the dilated kidney.

Child↗
PubMed1996

[Use of digital luminescence radiography in voiding cystourethrography].

PURPOSE: Optimization of image quality by use of digital luminescence radiography (DLR) in voiding cystoureterography (VCU) instead of a conventional screen film system. PATIENTS AND METHODS: 53 patients with a suspected vesicouretral reflux were examined with a VCU in analogous and digital technique. The X-rays were taken in a sitting position while simultaneously measuring the bladder pressure. An intraindividual comparison was omitted for X-ray saving reasons. In the follow-up 3 patients were examined with the other system. Two radiologists and two urologists compared 60 VCU of 53 patients--30 VCU in conventional screen film and 30 in DLR technique presented in standard and edge-enhanced images--with regard to image quality according to 3-step score (A--good image quality, B--sufficient image quality, C--insufficient image quality). RESULTS: The 59 conventional films were scored 72 times with an A, 76 times with a B, and 72 times with a C, whereas the DLR films were scored 116 times with an A, 72 times with a B, and only 8 times with a C. Hereby the edge-enhanced images were the most useful for distinguishing the bladder shadow from the soft tissue of the thigh and for detecting reflux. Furthermore, the exposure dose when applying DLR could be decreased to 75% in grown-ups and to 57% in children without any significant loss of information. CONCLUSION: The DLR is highly superior to the conventional film screen system because of its relatively high tolerance towards wrong exposures, especially with respect of the sitting position during MCU. With the DLR we obtained 96% and with the conventional system only 63% films usable for diagnosis.

Adolescent↗
PubMed1996

[Are their individual decisions for urinary diversion? Indications and results of 200 consecutive patients].

During the past 20 years many continent urinary diversions have been established. The indications includes pelvic tumors, especially bladder cancer, and structural and functional disorders of the lower urinary tract with irreversible damage of storage or continence function. Given the variety of surgical diversion techniques, it seems feasible to consider the patient's individual pathoanatomical situation as well as his/her personal wishes. We report on 200 consecutive patients with supravesical urinary diversion. The analysis includes indications surgical technique, intra-and postoperative complications and patients' quality of life. The peri- and postoperative morbidity rate was 18.5%. Complications mainly comprised infections and obstruction of the urinary tract. The mortality rate was 4.5% and causes of death included bleeding, infection, urinary extravasation and bowel atonia. Patients with malignant disease and only palliative treatment showed disappointing results after on operation including continent urinary diversion: 30% of them had early complications. Several female patients with a catherizable continent urinary diversion could not handle the catheterization of the pouch, although the function of the urinary diversion was excellent. Therefore an indwelling catheter was placed in all these patients. Our analysis shows that the choice of urinary diversion has to consider the patient's pathoanatomical situation, as well as his/her age, general condition, mental and manual skills. In addition, renal function, the metabolic situation and previous therapies may influence the decision regarding supravesical urinary diversion in an individual case.

Adult↗
PubMed1995

Prognostic factors for bladder cancer.

Cancer of the urinary bladder is the fifth most common cancer in men and the second most urological malignancy in Western society [17], with an incidence rate per year of 29.8/100,000 males. Bladder tumors are distinguished as either invasive or superficial: invasive tumors are generally associated with poor prognosis, while 20-30% of superficial carcinomas recur and progress to become invasive and metastic [26, 27]. The most common prognostic factors for classification of urothelial cancer are staging and grading, which are based on morphological criteria. In the past decade, however, other criteria have been developed as a possible prognostic aid to better disease management, such as expression of specific cell surface antigens, DNA content, chromosomal aberrations, gene rearrangements and point mutations [26, 7]. Since most tumors of the bladder are carcinomas and are associated with dedifferentiation and high metastatic capability, we investigated whether reduced expression of so-called differentiation factors in combination with increased cell motility might be correlated with tumor progression.

Cell Adhesion↗
PubMed1995

Laparoscopic dismembered pyeloplasty: preliminary report.

As a reconstructive laparoscopic procedure, dismembered pyeloplasty was done in 5 patients: the laparoscopic procedure was completed in 4 and converted to an open operation in 1. Within this series operative time decreased from 390 to 190 minutes. The main operating time was devoted to laparoscopic suturing of the anastomosis. Spreading the renal pelvis by either pulling the sutures transcutaneously or with intra-abdominal stay sutures improved visualization and facilitated the anastomosis. Mean postoperative hospitalization was 8 days (range 7 to 10). After a mean followup of 9 months (range 6 to 15) excretory urography and renal scintigraphy revealed significant radiographic improvement and no obstruction in 4 patients. Compared to open pyeloplasty and endo-pyelotomy, laparoscopic pyeloplasty may combine the advantages of open surgery (excision of the stenosis and reduction of the renal pelvis) with those of minimally invasive surgery (minimal postoperative morbidity), provided the operative time can be shortened and the technique simplified.

Adult↗
PubMed1995

[Cytokine therapy of metastatic renal cell carcinoma].

Cytokine therapy of metastatic renal cell carcinoma reveals a remission rate of about 25% regarding to the different patients selection criteria, i.e. age, performance status, site of metastasis, tumour load. Remission is not correlated to patient's survival. Adjuvant or neoadjuvant immunotherapy is not a treatment option. Nephrectomy has no influence on distant metastases and should be limited to symptomatic primary tumours. In conclusion, cytokine therapy is not a standard treatment. Its value has to be evaluated in randomized trials.

Carcinoma, Renal Cell↗
PubMed1995

[Principles of tumor invasion and metastasis].

Histopathological and clinical parameters are of limited value in characterization of the individual course of disease in bladder cancer patients. Down-regulation of E-cadherin, an intercellular adhesion molecule, and upregulation of autocrine motility factor receptor (AMFR) expression have been shown to play a part in tumour cell invasion and metastasis. In a retrospective analysis concerning 95 different bladder specimens and a prospective study in 100 bladder cancer patients, reduction in E-cadherin concomitantly with an increase in AMFR expression was associated with a poor prognosis. The dual use of these two antigens may improve early diagnosis of high-risk bladder cancer patients and influence treatment decisions.

Cadherins↗