Biomedical subjects

M Stöckle

Publications and source records attributed to M Stöckle.

At least 73 records · Page 4Linked to original sources

PubMed1995

Maximum androgen deprivation prior to radical retropubic prostatectomy in patients with stage T3 adenocarcinoma of the prostate.

Eighty-two patients with stage T3 carcinoma of the prostate were treated for 3 months prior to radical retropubic prostatectomy with a luteinizing-hormone-releasing hormone analogue and an antiandrogen. Based on digital rectal examination (DRE), reduction of prostate and tumor size was noted in all cases. Ultrasound demonstrated a decrease in prostatic volume between 0 and 62.5% (median 32%). Prostate-specific antigen levels (PSA, Hybritech) decreased substantially (mean PSA of 29.5 ng/ml before to a mean PSA of 1.3 ng/ml after hormonal treatment). Pathologically, only 15 patients (18.3%) had organ-confined disease (stage pT2), 44 (53.7%) had stage pT3 tumors and 22 (26.8%) had positive lymph nodes. In 1 surgical specimen (1.2%), no residual tumor was identified. In 5 patients with nodal metastasis and 13 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Compared to the preoperative needle biopsy, a decrease in the histological grade was found in only 7 tumors, while an increase was noted in 26. DRE, ultrasound and PSA suggest a downstaging of stage T3 prostate cancer after 3 months of maximum androgen deprivation. This cannot be confirmed pathologically. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.

Adenocarcinoma↗

PubMed1995

Urinary diversion in bladder exstrophy and incontinent epispadias: 25 years of experience.

PURPOSE: To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex we reviewed the records of patients treated at our institution. MATERIALS AND METHODS: From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated of whom followup was available for 104 and 2 died of causes unrelated to urinary diversion. Mean followup is 16.7 years. In 43 of the 102 patients surgery was primarily performed at our institution (urinary diversion in 39, a modified Young-Dees procedure in 1 and sling plasty in 3). In another 59 patients urinary diversion was done secondarily after therapy elsewhere (bladder closure/bladder neck reconstruction in 34 and failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in 7 and genital reconstruction alone in 3. RESULTS: The present continence rates are 96% for the rectal reservoir, 97% for the Mainz pouch I and 67% for the modified Young-Dees augmentation. Upper tracts have remained stable and no bowel neoplasms have developed. CONCLUSIONS: Rectal reservoirs represent our urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed and when the upper tract has deteriorated a colon conduit is created.

Bladder Exstrophy↗

PubMed1995

[The continent ileocecal pouch. The Mainz pouch I].

Since 1993 to July 1994, 374 patients underwent a Mainz Pouch procedure in their hospital. The follow up is between 4.2 +/- 2.6 years. The authors used this technique as well for bladder augmentation, bladder substitution as continent diversion. If possible, the appendix will be used for creating the continence system.

Adolescent↗

PubMed1995

Clinical experience with nephron-sparing surgery in the presence of a normal contralateral kidney.

Since 1981, 110 patients have undergone a nephron-sparing surgery for renal cell carcinoma in the presence of normal contralateral kidney (elective indication) at our institution. The majority of these tumors were incidental findings with a mean tumor diameter of 3.3 cm (range 1 to 7 cm). After a mean follow-up period of 50.6 months, 1 patient died of metastatic disease, 5 died of tumor-unrelated causes, 2 are alive with systemic progression, and 102 are alive with no evidence of disease, resulting in a 5-year cancer specific survival rate of 98%. During the follow-up period, local tumor recurrence occurred in 3 patients (2.7%) without evidence of systemic progression at the time of diagnosis. A repeated nephron-sparing surgery (1 patient) or total excision of the renal remnant (2 patients) was possible in all these cases. Our results suggest that nephron-sparing surgery provides effective curative treatment for patients with small, unilateral, single, and localized renal cell carcinoma.

Aged↗

PubMed1995

[3-dimensional reconstruction for planning surgical reconstruction of tumors in the single kidney].

Organ-sparing renal surgery for renal cell carcinoma has greatly increased in importance over the last few years owing to the widespread application of ultrasound examination. When a normal contralateral kidney is present the indications for organ-sparing surgery are very strict. Our patient presented with a large tumour in a single kidney and, though fully informed about all the risks involved, insisted upon an organ-sparing operation. In planning and execution of the operation we were much assisted by the use of a three-dimensional reconstruction made from the CT scan carried out preoperatively, because this showed the exact position and size of the tumour. We report on the course of the patient's illness and present a simple three-dimensional reconstruction technique.

Carcinoma, Renal Cell↗

PubMed1994

Cellular immune response to human renal-cell carcinomas: definition of a common antigen recognized by HLA-A2-restricted cytotoxic T-lymphocyte (CTL) clones.

Cytotoxic T lymphocyte (CTL) clones directed against autologous renal-cell carcinoma (RCC) cell lines were generated by mixed lymphocyte/tumor-cell culture (MLTC) using peripheral blood lymphocytes (PBL). A CD8+, CD4- CTL clone MZ1257-CTL 5/30 with high cytolytic activity for the autologous tumor cell line MZ1257-RCC was established. No lysis of the autologous EBV-transformed B lymphocytes (EBV-B) or K562 cells was observed. A panel of HLA-A2-matched allogeneic RCC lines was recognized by CTL 5/30. Further specificity analysis showed a cross-reactivity with HLA-A2-matched allogeneic tumor cells of various origins, especially melanoma. CTL 5/30 was also cross-reactive with several HLA-A2-positive allogeneic normal kidney cells in culture. The restriction element identified for CTL 5/30 was HLA-A2, as shown by blocking of cytotoxicity using an anti-HLA-A2 monoclonal antibody (MAb) and by resistance of an HLA-A2-negative melanoma variant SK29-MEL. 1.22 against lysis by CTL 5/30. In this report we demonstrate HLA-A2-restricted recognition of a T-cell-defined antigen on autologous renal-cancer cells. This antigen is also expressed and recognized in association with HLA-A2 on normal kidney cells in culture and other HLA-A2-positive tumor cells. It may therefore be a normal differentiation antigen to which tolerance is incomplete in the renal-cell cancer system investigated.

Antibodies, Monoclonal↗

PubMed1994

Factors influencing survival after resection of pancreatic cancer. A DNA analysis and a histomorphologic study.

BACKGROUND: The influence of DNA content on prognosis in stomach cancer has been investigated rarely, and the results are controversial. METHOD: The prognostic relevance of the DNA content and histomorphologic parameters was evaluated in 41 patients after resection of pancreatic cancer. RESULTS: In the univariate analysis, the DNA content, tumor size, lymph node status, tumor stage, nuclear grade, and type of resection had a statistically significant influence on the prognosis. No association was found between the DNA content and the histomorphologic features. Apart from the operative procedure, the DNA content was the strongest indicator of prognosis in the multivariate analysis. CONCLUSIONS: Further investigations are necessary to find out if DNA analysis can be performed preoperatively on material obtained by fine-needle aspiration.

Cell Nucleus↗

PubMed1994

Hormone therapy prior to radical prostatectomy in patients with clinical stage C prostate cancer.

Seventy patients with clinical stage C carcinoma of the prostate were treated for 3 months with the gonadotropin-releasing hormone analog, goserelin acetate (Zoladex; Zeneca Pharmaceuticals, Macclesfield, UK) plus an antiandrogen (flutamide). Based on digital rectal examination (DRE), reductions of the size of the prostate and the tumor were noted in 91.4% of patients. Ultrasound demonstrated a decrease in prostatic volume between 0% and 62.5% (median 31%). Prostate-specific antigen (PSA) levels (Hybritech) decreased substantially (mean PSA of 31.3 ng/ml before, to a mean PSA of 1.4 ng/ml after hormonal treatment). A total of 64 patients subsequently underwent radical retropubic prostatectomy. Pathologically, only 9 patients (14.1%) had organ-confined disease (stage B), 34 (53.1%) had stage C tumors, and 21 (32.8%) had positive lymph nodes (stage D1). In 5 patients with nodal metastasis and 7 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Maximal androgen blockade for a period of 3 months in clinical stage C prostate cancer induces a notable reduction in prostate size ("downsizing"). A "downstaging" effect, as suggested by DRE, ultrasound, and PSA, was not observed. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.

Chemotherapy, Adjuvant↗

PubMed1994

Automated image analysis DNA cytometry in testicular cancer.

The value of automated DNA cytometry for differentiation of testis cancer was evaluated in 54 seminomas, 13 HCG-positive seminomas, and 48 embryonal carcinomas. Slices of paraffin embedded tissue were enzymatically digested and stained with Feulgen SITS after fixation on glass slides. Automated DNA cytometry was performed with a Modular Image Analysis Computer (MIAC). DNA histogram phenotpye and computed DNA indices were correlated with the different tumor types. The ratio of hypertriploid to hypotriploid increased from HCG-positive seminoma over embryonal carcinoma to seminoma. The following mathematical DNA indices were found to correlate with tumor type: mean ploidy, 2c deviation index, 5c exceeding rate, variation coefficient of the GO/1 fraction and DNA nucleus diameter correlation.

Carcinoma, Embryonal↗

PubMed1994

Low-dose gamma-interferon therapy is ineffective in renal cell carcinoma patients with large tumour burden.

The efficacy and immunomodulatory effects of low-dose gamma-interferon (gamma IFN) were investigated in an unselected population of patients with metastasising renal cell carcinoma. 36 patients suffering from metastasising renal cell carcinoma with a performance status exceeding Karnofsky index of 50 were entered into the open phase I/II trial. The majority of the patients recruited displayed a large tumour burden, and 28 patients (78%) had metastases involving two to six organ sites. Treatment was started with a 2-week cycle of either daily or weekly subcutaneous administration of either 100, 200 or 400 micrograms gamma IFN. After a therapy-free interval of 2 weeks treatment was switched to the alternate mode of administration. Subsequently, treatment was continued with the same dose applied once a week for a minimum of 3 months. Serum levels of neopterin and beta-2-microglobulin, as well as flow cytometric analyses of peripheral blood mononuclear cells, were used for the assessment of biological response. Minimal antitumour activity was observed in this high-risk patient group and only 1 patient experienced a partial response (PR) lasting 36 + months. Comparison of the patients' characteristics to those of other low-dose gamma IFN trials revealed a highly significant difference in the tumour burden and clinical response. We conclude that patient selection is a decisive parameter for the outcome of treatment with low-dose gamma IFN, and that patients with poor prognostic features and a large tumour burden are not likely to respond to this almost atoxic treatment.

Adult↗

PubMed1994

Multifocal renal cell tumors: a retrospective analysis of 56 patients treated with radical nephrectomy.

In this retrospective analysis of 56 patients with multifocal renal cell tumors the effect of secondary tumors on the prognosis was examined and the incidence of tumors in the contralateral kidney was evaluated. All of the primary tumors were renal cell carcinomas, the majority of which had a local tumor stage of pT2 (31 cases, 55.3%) and a cytological grading of 1 (23 cases, 41%). The mean size of the secondary tumors was 1.0 cm. An additional tumor was diagnosed in 23 patients (41%), 2 to 5 secondary tumors in 23 (41%) and more than 5 additional tumors in 10 (18%). The overall 5-year survival rates were 69.4%, 72.2% and 40%, respectively (p = 0.313). Histopathological differentiation of the additional lesions revealed 23.2% renal cell carcinomas, 71.4% adenomas and 5.3% renal tumors of "doubtful dignity," with overall 5-year survival rates of 67.2% for adenomas, and 60.6% for carcinomas and renal tumors of "doubtful dignity" (p = 0.546). After a mean followup of 60 months 33 patients (58.9%) were alive without evidence of disease, 1 (1.7%) was alive with tumor progression, 8 (14.2%) died of the disease and 14 (25%) died of other causes; only 1 patient presented with a tumor in the contralateral kidney (incidence 1.7%). Thus, the overall 5-year survival rate for the entire group was 66.0% and the histopathological parameters of the additional tumors had no effect on the prognosis of the patients.

Adenoma↗

PubMed1994

The fate of the adult exstrophy patient.

Between 1968 and 1993, 101 patients with bladder exstrophy or incontinent epispadias underwent surgery at our hospital. The standard procedure was ureterosigmoidostomy and additional genital reconstruction. Of the 56 patients who have reached adulthood 45 could be interviewed regarding social integration, sexuality and fertility. All patients have a functioning urinary diversion. Of the 45 patients questioned 41 have completed vocational training or are currently in training, 3 are unemployed and 1 lives at a therapeutic center. Among the patients 29 are married or have a steady partner. All women engage in sexual intercourse and 2 have delivered 3 children by cesarean section. All men achieve erection. Of the 28 men who underwent reconstruction of the external genitalia 11 have a penile deviation, which is distressing in only 2. Only 3 of the men are dissatisfied with the cosmetic result and 33% had epididymitis, necessitating 2 orchiectomies and 3 vasectomies. No patient with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas all 5 who did not undergo genital reconstruction had normal ejaculation and 2 have fathered children. Male patients with genital reconstruction and closure of the urethra have a high risk of infertility. Our patients demonstrate that the cosmetic results after genital reconstruction are satisfactory. However, in male patients, surgery is performed at the expense of fertility. Because this corrective procedure is usually performed during childhood, the parents must be informed of these consequences before surgical correction.

Adolescent↗

PubMed1994

[Adjuvant polychemotherapy after radical cystectomy of metastatic bladder cancer].

The aim of adjuvant polychemotherapy after radical cystectomy for patients with a high risk of tumor progression is to improve cure rates or at least prolong survival. So far, three prospectively randomized and several retrospective studies analyzing the benefit of adjuvant polychemotherapy have been performed. All have revealed longer survival times after adjuvant chemotherapy. The up-dated data from our own study increasingly suggest that a significant improvement of tumor-free survival rates is also possible, which is in accordance with the retrospective studies published so far. The extension of lymph node involvement, however, seems to be the most important independent prognostic variable. Further studies are necessary to define therapy-specific risk groups and the potential therapeutic benefit in the different groups. The optimal chemotherapy combination and the optimal dosage also remain to be defined.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1994

[The value of quantitative DNA analysis in evaluating the prognosis of differentiated thyroid cancer].

In this study we analyzed DNA ploidy as a potential prognostic parameter in differentiated thyroid carcinoma. In the case of papillary cancer the depth of tumor infiltration, a micro- or macroinvasive tumor growth, an invasion of vessels and the ploidy had an influence on prognosis. In the case of follicular cancer depth of tumor infiltration, the presence of distant metastasis, grading, uni- or multifocal tumor growth and the ploidie had an influence on prognosis. In the case of papillary cancer the multivariate analysis for the ploidy shows a strong and independent influence on the prognosis. Even when comparing with tumor stage, EORTC score and AGES score the ploidy allows an additional prognostic differentiation. In follicular carcinomas a multivariate analysis was not possible due to the strong associations of the prognostic parameters.

Adenocarcinoma, Follicular↗

PubMed1993

Prognostic value of DNA analysis in colorectal carcinoma.

BACKGROUND: Reported experiences regarding the prognostic significance of DNA content in colorectal carcinoma have been a matter of controversy. METHODS: DNA analysis with image cytometry was performed in 137 patients with colorectal cancer. Only patients who had resection without tumor residual and who did not die postoperatively as a consequence of the operation were entered in the study. At the time of DNA analysis, neither the histomorphologic data nor the relapse-free survival time of the patients were known. RESULTS: In this investigation the DNA content of tumor cells had no univariate or multivariate influence on the relapse-free survival time. The prognosis was dependent on the tumor localization, depth of tumor infiltration, lymph node metastasis, and grade. CONCLUSIONS: DNA content provides no additional prognostic information in colorectal carcinoma.

Adult↗

PubMed1993

Image analysis DNA cytometry of bladder cancer.

In a retrospective analysis, the DNA histograms of 65 paraffin-embedded bladder carcinomas from radical cystectomy specimens (stage pT1-pT4a, pN0, pN1, pN2) were analyzed using an automated image analysis system (Leytas 2). Automated image analysis was able to characterize invasive bladder carcinoma as being either diploid, polyploid, or aneuploid. Within the group of aneuploid tumors, the DNA content of the stem-cell line allowed further subtyping of the tumors; hypotriploid, hypertriploid, hypertetraploid, and even hyperpentaploid tumors could be distinguished. Comparing different sites of identical tumors, the DNA histogram was found to be a stable and reproducible tumor characteristic. The various tumor types differed significantly in prognosis. This technique can also be applied to smears of urine sediment or transurethrally resected tumor chips. In the case of superficial tumors, DNA cytometry defines those tumors which are potentially invasive, requiring careful follow-up and/or early aggressive treatment.

DNA, Neoplasm↗

PubMed1993

Pathologic parameters and flow cytometric ploidy analysis in predicting recurrence in carcinoma of the prostate.

Recurrence of prostate cancer following radical prostatectomy is determined by the extent of local disease. Tumor volume and grade have improved our ability to predict extraprostatic extension, but tumors of intermediate volume and grade vary in their biologic behavior. To assess the prognostic significance of DNA ploidy, we performed flow cytometry in 85 patients with prostate cancer volumes > 4 cm3. Post-radical prostatectomy serum prostate-specific antigen was used to prove recurrence of cancer. Mean follow-up was 35 months (median 31 months). 26 patients (30%) had diploid histograms, 55 (65%) non-diploid histograms. In 4 cases (5%) the histograms were uninterpretable. Tumor volume and percent of Gleason grades 4 or 5 separated the recurrent from nonrecurrent groups in a highly significant manner (p < 0.001). When tested alone, ploidy had no ability to predict recurrence (p = 0.26). However, in a subset of patients with 4-8 cm3 of cancer with < 30% Gleason grade 4 or 5 tumor, ploidy conferred significant additional prognostic information (p < 0.005).

DNA, Neoplasm↗

PubMed1993

[The role of M-VAC polychemotherapy in the treatment of advanced urothelial carcinoma of the bladder].

Over the last seven years, M-VAC combination chemotherapy has been used for: the treatment of transitional cell carcinoma with metastases (palliative indication) or to reduce operable T4a tumours (inductive, initial or preliminary indication), or before or after t for bladder cancers (neoadjuvant and adjuvant indications). The authors present their experience of 17 cases of stage T4a transitional cell carcinoma transformed into an operable stage by M-VAC. Those patients with regression of the tumour to a non-invasive stage at operation (patients with a good response) had a good prognosis. In contrast those patients with residual invasive tumour all died from their disease. A prospective comparative study was performed between total cystectomy alone and cystectomy completed by adjuvant M-VAC in patients with a worrying histology. This study was based on 49 cases up until December 1990. A significant improvement in the prognosis was observed in patients receiving adjuvant M-VAC. The recurrence-free survival was considerably prolonged in this second group (study suspended in November 1992). When metastases developed, palliative M-VAC only rarely prolonged survival.

Adult↗