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Biomedical subjects

M Theiss

Publications and source records attributed to M Theiss.

At least 19 recordsLinked to original sources
PubMed1997

[Immunochemotherapy of metastatic renal cell carcinoma with interleukin 2, interferon-alpha and 5-fluorouracil].

Interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) were both administered subcutaneously (SC) in combination with intravenously (IV) applied 5-fluorouracil (5-FU) for the treatment of patients with metastasized renal cell carcinoma (RCC). The therapy protocol consisted of a treatment cycle of 8 weeks, which could be carried out in an outpatient regimen. The IFN-alpha was given in each of the 8 weeks (6-9 MU/m2 once to three times weekly SC) combined sequentially with IL-2 (5-20 MU/m2 three times weekly SC for 4 weeks) and 5-FU (750 mg/m2 IV weekly for 4 weeks). Among the 30 consecutive patients treated, in 2 cases a complete, and in 9 cases a partial, remission was achieved in patients with mostly lung and skeletal metastases, with an overall objective response rate of 37%. Mean response duration was 8 months (range 3-18 months). A stable state of the disease lasting 3-18 months was observed in 10 cases. The side effects were only slight and corresponded to toxicity grade I (n = 2), grade II (n = 22) and grade III (n = 6), according to the WHO classification. In conclusion, this triple-drug biochemotherapy demonstrated significant clinical effectiveness comparable with that of an aggressive IL-2 treatment regimen (applied IV), but without its high toxicity.

Adult↗
PubMed1997

[Radical prostatectomy as primary monotherapy in capsule penetrating prostatic carcinoma. 15 years outcome].

Twenty-five patients with locally advanced prostate cancer (stage pT3pN0) underwent pelvic lymphadenectomy and radical prostatectomy and were followed up thereafter for at least 15 years. No hormonal treatment was given prior to tumor progression. Overall and disease-free 15-year survival rates were observed to be 44 and 24%, respectively. These data suggest that a cure from prostate cancer by radical prostatectomy can be expected in a quarter of patients with capsular penetration. From our results, no justification can be derived to exclude radical prostatectomy from the spectrum of treatment options for patients with capsular penetration of prostate cancer. More detailed analysis of the results depending on the local extent of the tumor and histological grade revealed distinct differences with respect to the risk of progression. Histological grade was the single most predictive parameter of progression. Out of all subgroups of patients with capsular penetration of prostate cancer, those with a poorly differentiated tumor showed the shortest progression-free interval after surgery, the highest level of overall progression and the largest proportion of tumor-related deaths. By contrast, the prognosis was only slightly influenced by the presence or absence of seminal vesicle involvement. The role of adjuvant treatment after radical prostatectomy for patients with stage pT3pN0 prostate cancer or for subgroups of them remains to be determined within the scope of prospective randomized trials.

Follow-Up Studies↗
PubMed1997

Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis.

OBJECTIVE: We investigated the disease-specific and metastasis-free survival rates in men with locally advanced (clinical stage T3) prostate cancer who were treated surgically. METHODS: A retrospective, multi-institutional pooled analysis of the results of surgical treatment in 345 men with clinical stage T3 disease was performed. Survival curves were generated using the Kaplan-Meier method. RESULTS: Among 298 evaluable patients, pelvic lymphadenectomy alone was performed in 56 men (19%), while 242 men (81%) underwent node dissection and radical prostatectomy. In total, 122 of 298 patients (41%) had nodal metastases and/or seminal vesicle tumor spread. Pathologically organ-confined disease was noted in 27 men (9%). The actuarial 10-year disease-specific and metastasis-free survival rates for all patients managed surgically were 57 and 32%, respectively. For patients with well, moderately and poorly differentiated tumors, cancer-specific survival rates at 10 years were 73, 67 and 29%, respectively. CONCLUSIONS: A large number of men with clinical stage T3 prostate cancer have advanced disease and are unlikely to achieve improved long-term survival with surgery alone. Although there may be a role for radical prostatectomy in selected patients with low to intermediate grade tumors, such treatment appears unlikely to result in long-term survival in men with high grade disease. A prospective study is necessary to determine the optimal treatment approach in men with locally advanced prostate cancer.

Adult↗
PubMed1996

Atypical findings in a patient with a renal milk-of-calcium cyst.

A case of an atypical renal milk-of-calcium cyst is presented. Although this cyst contained a colloidal suspension of calcium crystals, other signs and findings typical for a milk-of-calcium cyst were lacking. No connection of the cyst to the collecting system could be identified, no "half moon" phenomenon was found on upright and cross-sectional radiography, and the biopsies taken from the wall of the cyst showed sclerosis instead of urothelium. From the present case it was concluded that renal milk-of-calcium cysts may sometimes occur in the absence of findings that are typical of this particular entity. Therefore, this disease should be considered in the differential diagnosis of renal calcifications of unknown origin.

Adult↗
PubMed1996

Chemotherapy in advanced seminoma and the role of postcytostatic retroperitoneal lymph node dissection.

Between 1979 and 1992, 79 patients with seminoma were treated at our institution. Nineteen of these patients with advanced seminoma were treated with cisplatin-based chemotherapy (stage IIA, n = 2; stage IIB, n = 6; stage IIC, n = 2; stage III, n = 5 [2 with primary extragonadal tumor site]; relapse, n = 5 [1 with previously stage III seminoma]). One patient died of progressive disease 3 months after treatment with chemotherapy and retroperitoneal lymph node dissection (RPLND) which had led initially to a complete clinical response. Another patient (62 years old) died of an acute heart failure due to a sepsis caused by chemotherapy. Treatment of the other 17 patients was successful. Ten patients with a residual retroperitoneal mass after inductive chemotherapy underwent a RPLND. In 1 case viable seminoma (diameter of the residual mass 5 cm), in 4 cases necrotic tumor tissue, and in 5 cases fibrosis was diagnosed histopathologically. The 2 patients with extragonadal seminoma showed complete responses after surgery and chemotherapy. In conclusion, in patients with advanced seminoma, inductive cytostatic therapy seems to be the best treatment regimen. Residual retroperitoneal masses after chemotherapy with a diameter of > 3 cm should be treated with RPLND.

Adult↗
PubMed1996

Immunochemotherapy for metastatic renal cell carcinoma using a regimen of interleukin-2, interferon-alpha and 5-fluorouracil.

PURPOSE: Promising results of recent clinical trials with a triple drug bio-chemotherapy regimen encouraged its use in patients with renal cell carcinoma. MATERIALS AND METHODS: In a phase II study of patients with metastatic renal cell carcinoma the efficacy and toxicity of a treatment regimen were evaluated using interleukin-2 and interferon-alpha 2 subcutaneously in combination with intravenous 5-fluorouracil. The treatment protocol consisted of an 8-week cycle given on an outpatient basis, with 6 to 9 MU/m2. interferon-alpha given 1 to 3 times a week during the 8 weeks, and sequentially combined with 5 to 20 MU/m2. interleukin-2, 3 times a week for 4 weeks and 750 mg./m.2 5-fluorouracil once a week for 4 weeks. RESULTS: Among 25 consecutive men and 9 women treated 3 (9%) had a complete and 10 (29%) had a partial remission (overall objective response rate 38%). Median response duration (complete plus partial) was 12.5 months (range 3 to 20+). Stable disease lasting 3 to 24+ months was noted in 12 patients (35%). There were only minor side effects, for a maximum toxicity grade of I in 3 patients, II in 25 and III in 6 according to the World Health Organization classification. There were no dose limiting toxicities and no treatment related deaths. CONCLUSIONS: Triple drug immunochemotherapy resulted in a significant clinical effect comparable to an aggressive intravenous interleukin-2 treatment regimen but without significant toxicity.

Adult↗
PubMed1996

[Cosmetic and functional long-term outcome after operation of Fournier gangrene].

The study documents the long-term cosmetical and functional sequelae in 12 patients treated for Fournier's gangrene after an average of 5 years follow-up. Only 50% of the patients were free of pain. In the majority of cases, the sexual function was impaired by penile deviation or penile torsion as well as by a loss of sensitivity of the penile skin or pain during erection. Two patients suffered from temporary stool incontinence. Despite major complaints due to extensive scarring, most (10 of 12) patients considered their cosmetic result as well as their quality of life to be satisfactory.

Adult↗
PubMed1996

[Fournier gangrene].

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Anti-Bacterial Agents↗
PubMed1995

Prognostic significance of capsular invasion and capsular penetration in patients with clinically localized prostate cancer undergoing radical prostatectomy.

One hundred thirty patients with an observed follow-up of more than 10 years after radical prostatectomy were restaged with regard to local extent of the tumor in relation to the prostate capsule. Of 112 patients with surgically staged negative pelvic lymph nodes, 62 had a tumor-free prostate capsule, 24 had capsular invasion without penetration, and 26 had tumors extending through the capsule of the prostate. Observed overall and disease-free 10-year-survival rates were 79% and 69.4%, respectively, in patients with absence of capsular involvement and 70.8% and 66.7%, respectively, in patients with capsular invasion alone. In patients with capsular penetration, however, the survival rates significantly decreased to 57.7% (P = 0.018) and to 38.5 (P = 0.017), respectively. The overall progression rate was found to be significantly higher in patients with tumors extending through the prostatic capsule (46.2%), as compared to those with absence of capsular involvement (21%; P = 0.014) as well as to those with capsular invasion alone without penetration (25%; P = 0.034). Thus, in contrast to capsular invasion alone, capsular penetration means a poor prognostic indicator, which accounts for a reduced survival expectancy and a higher progression rate following radical prostatectomy. Therefore, tumors with capsular invasion and those with capsular penetration should not be grouped together in the same tumor stage as done in the 1987 edition of the TNM tumor classification system.

Adult↗
PubMed1995

Radical prostatectomy in the management of localized prostate cancer.

No data from prospective randomized studies comparing radical prostatectomy, radiotherapy and deferred treatment for localized prostatic cancer are currently available. Comparison of retrospective series, however, strongly suggests a clear superiority of radical prostatectomy over other attempts to cure prostate cancer, and especially over the 'watchful waiting' strategy. This concerns survival data as well as quality of life and psychological aspects. In 1994, the Department of Veterans Affairs and The National Cancer Institute in the United States initiated a randomized controlled study comparing radical prostatectomy vs expectant management for the treatment of localized prostate cancer, the 'Prostate Cancer Intervention vs Observation Trial (PIVOT)'. Until the results of this study become available, the decision on how to manage a patient with a newly-diagnosed clinically localized prostate cancer has to be based on current knowledge. The current knowledge is that localized prostate cancer can be cured by radical prostatectomy with acceptable treatment-related morbidity. Therefore, the chance of receiving curative treatment should be offered to every man with localized prostate cancer and a life expectancy of 10 or more years.

Aged↗
PubMed1995

Survival and quality of life of patients with stage D1 (T1-3 pN1-2 M0) prostate cancer. Radical prostatectomy plus androgen deprivation versus androgen deprivation alone.

A series of 139 patients with histologically proven stage D1 (T1-3 pN1-2 M0) prostate cancer was reviewed in order to determine the influence of radical surgery in addition to hormonal treatment on long-term outcome with respect to survival and quality of life. In all 139 patients a pelvic lymphadenectomy was performed. In 87 patients, lymphadenectomy was followed by androgen deprivation alone (group 1). Fifty-two patients underwent additional radical prostatectomy (group 2). The actuarial 10-year nonprogression rates were 14.6% in group 1 and 35.8% in group 2, respectively (p = 0.0016). The overall and disease-specific 10-year survival rates were found to be 29.7 and 32.1%, respectively, for group 1 and 50.8 and 70.7%, respectively, for group 2. Local progression as the main parameter influencing quality of life occurred in 60 of the 87 patients (69%) not subjected to radical prostatectomy. Transurethral resection of the prostate was required in 29 of these patients. In contrast, following radical prostatectomy, only 4 of the 52 patients (8%) had local progression and only 1 patient (2%) needed a dilatation of the vesicourethral anastomosis for relief of infravesical obstruction. Thus, radical prostatectomy plus androgen deprivation for patients with stage D1 prostate cancer appeared to be superior to androgen deprivation alone with respect to survival expectancy and quality of life. Prospective randomized trials, however, have to be undertaken to verify these results.

Biopsy↗
PubMed1995

[Results of 15 years of radical prostatectomy].

From July 1969 to May 1994, radical prostatectomy was performed in 630 patients with clinically localized prostate cancer at the Department of Urology, University of Würzburg Medical School. These included 74 patients subsequently followed up for 15 years or more 15 years (15-23 years, mean 17.5 years), who were the subjects of the present study. Of these 74 patients 59 had pT2 tumors and 10 had pT3 tumors according to the staging criteria of the 1992 edition of the UICC TNM classification. The remaining 5 patients had microscopic lymph node metastases detected at staging pelvic lymphadenectomy (stage pT2-3pN1-2). Patients with lymph node involvement were treated by immediate orchiectomy. All other patients received no further treatment until progression occurred. The overall 15-year survival rate actually observed the 74 patients was 50% (37/74) and the disease-free survival rate was 43.2% (32/74 pts). Stage-related overall and disease-free survival rates were found to be 54.2% and 49.1%, respectively, for patients with pT2 tumors, 40% and 30% for those with pT3 tumors, and 20% and 0 for patients with lymph node metastases. Progression (either local recurrence or distant metastatic spread) was noted in 22 of the 74 patients (29.7%) within the 15-year period following radical prostatectomy. Mean time to progression was 7.9 years (3 months to 17 years). Within the follow-up period, 17 patients (23%) died of prostate cancer. These actual 15-year follow-up data show radical prostatectomy to be the most effective means of achieving long-term disease-free survival, if not cure, in patients with clinically localized prostate cancer.

Adult↗
PubMed1995

Fournier's gangrene in a patient with erectile dysfunction following use of a mechanical erection aid device.

A case of Fournier's gangrene is presented following the use of a constriction ring in a patient with erectile dysfunction. The necrotizing inflammation started at the skin of the penile shaft and spread over the entire scrotal area. Total scrotectomy and excision of the skin of the penile shaft were necessary. This case demonstrates that mechanical constriction devices applied to create or maintain a penile erection are not as free of adverse affects as they are generally believed to be. Physicians who treat patients using these devices should be aware of such severe complications.

Constriction↗
PubMed1995

[Indications].

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Cost-Benefit Analysis↗
PubMed1994

[Bilateral massive macronodular adrenal gland hyperplasia. A rare cause of Cushing's syndrome].

A 46-year-old man with known arterial hypertension for 10 years had, over the last two years, developed increasing obesity, particularly of the trunk, with other symptoms typical of Cushing's syndrome. Hormone analysis demonstrated hypercortisolism and decreased plasma ACTH concentration. The dexamethasone inhibition test failed to show any significant suppression of serum cortisol. Plasma ACTH was not increased in the corticotrophin-releasing hormone and the metyrapone tests. In the short ACTH test there was an excessive cortisol increase. Abdominal computed tomography revealed both adrenals to be enlarged (6 x 4 cm) and coarsely nodular. Adrenolytic treatment with ketoconazole (400 mg daily) caused symptoms of adrenal insufficiency, but a reduced dosage of 200 mg daily lowered the cortisol level to between 5 and 11 micrograms/dl and normalized the blood pressure and clinical signs of Cushing's syndrome disappeared. Subsequent bilateral adrenalectomy confirmed the diagnosis of massive macronodular adrenal hyperplasia. Substitution treatment with twice daily 25 mg cortisone acetate and 0.05 mg fludrocortisone was started postoperatively.

Adrenal Gland Diseases↗
PubMed1994

Radical prostatectomy in patients with incidental prostate carcinoma.

Radical prostatectomy was carried out in 30 patients with an incidental carcinoma of the prostate. A tumor stage T1a (A1) was present in 7 cases and a tumor stage T1b (A2) in 23 cases. None of the 30 patients died postoperatively. As intraoperative complication, a rectum perforation occurred in 1 case. In the 23 patients with a T1b tumor, a pT2pN0M0 lesion was found in 10 cases and pT3pN0M0 lesion in 11 cases on pathohistological examination after radical prostatectomy. In 5 out of 30 patients the carcinoma could no longer be detected in the radical prostatectomy specimen. In 1 patient with a T1a tumor, pelvic lymphadenectomy revealed a single lymph node metastasis. Tumor progression did not occur in any of the 7 patients with a T1a tumor after an observation period of 9 months up to 16 years (average 4.6 years). The percentage of progression-free patients in stage T1b was calculated as 81.4% 10 years after surgery. The calculated overall survival time of patients in stage T1b was 76.3% after 10 years and the tumor-related survival was 87.5%.

Actuarial Analysis↗
PubMed1994

[Treatment of advanced renal cell carcinoma with subcutaneous administration of interleukin 2 and interferon-alpha].

Twenty-three patients with advanced renal cell carcinoma were treated with subcutaneous injections of interleukin-2 (IL-2) and interferon-alpha (IFN-alpha). IFN-alpha (5-10(6) U/m2) was injected on day 1 of the 1st week of a treatment cycle of 6 weeks and high doses of IL-2 (20.10(6) IU/m2) on days 3, 4 and 5. In the 2nd and 3rd week IFN-alpha (dose as above) and low doses of IL-2 (5.10(6) IU/m2) were injected on days 1, 3 and 5. The treatment from the 4th to the 6th week corresponded to that of the 1st to 3rd week. In cases of remission or stable disease the treatment schedule was repeated as a rule once or twice. In 12 of the 23 cases nephrectomy had been carried out previously. Complete remission lasting 4 + months and partial remission lasting 2 months were achieved in two patients with lung and skeletal metastases. A stable state of the disease lasting 1-7 + months was observed in 11 cases. Ten patients showed progression of the disease after the first treatment cycle. Thus, the overall objective response rate was 9%. The side effects were only slight and corresponded to WHO toxicity grade I (n = 8) and grade II (n = 15). In two cases the first treatment cycle could not be finished.

Adult↗