Biomedical subjects
Publications and source records attributed to P Olbert.
We present a rare case of cystitis emphysematosa in an 85-year-old female patient in whom the typical risk factors were present: diabetes of long standing, neurogenic bladder and urinary infection with E.coli. Thanks to early diagnosis by cystoscopy and abdominal CT, after antibiotic treatment, appropriate insulin therapy and continuous bladder drainage the course was uneventful. The patient was fit to leave hospital after 14 days.
PURPOSE: On the basis of promising first-line data we have evaluated the safety and efficacy of a combination therapy comprising interleukin-2 (IL-2) and thalidomide in patients with metastatic renal cell carcinoma (RCC) refractory to both immuno- and chemotherapy. PATIENTS AND METHODS: 14 patients with progressive metastatic RCC, in whom prior immunochemotherapy had failed but who desired further active therapy, were enrolled in this study. Oral thalidomide was started at 200 mg/d and escalated after two days to 400 mg/d at week 0. IL-2 at 7 MIU/m (2) was given by subcutaneous injection, starting at week 1, days 1 to 5, weeks 1 to 4, with no IL-2 at weeks 5 and 6. The response was assessed every other therapy cycle. RESULTS: 12 patients were evaluable for response. There was no objective response; 4 patients showed stable disease for 21, 15, 13 and 9 months, respectively. Toxicities were predominantly grade 1 - 3 and included somnolence and constipation, as well as flu-like symptoms associated with IL-2. However, one patient developed serious constipation which led to a paralytic ileus and discontinuation of treatment. Another patient left the study after seven weeks due to increasing confusion. 11 patients required IL-2 dose reduction. Time on therapy ranged from 3 - 44 weeks (median, 19 weeks). Median overall survival was 22 months. Up to date, all patients have discontinued treatment. CONCLUSIONS: We conclude that outpatient administration of thalidomide/IL-2 is feasible in patients with heavily pretreated and progressive RCC who desire further active treatment. However, toxicity and costs are considerable and the clinical benefit is uncertain. Therefore thalidomide/IL-2 may not represent a promising therapeutic approach for this subgroup of patients.
OBJECTIVES: Renal cell carcinoma is an aggressive malignancy with a high propensity for both early and metachronous regional and distant metastasis. While surgical resection is the mainstay of therapy for patients with localized disease, the prognosis for patients with distant metastasis is poor with a 5-year survival rate of less than 10%. Response rates to first-line immunotherapy or immunochemotherapy range from 10-35%; responses achieved are predominantly partial remissions of short duration. Until today, there is no standard therapeutic procedure for the growing number of patients who relapse following first-line therapy and desire further active treatment. MATERIALS AND METHODS: This article reviews classic and recent publications about second- and third-line approaches, their potential efficacy and toxicity. RESULTS: Several novel approaches have raised well-founded hope. Especially the application of monoclonal antibodies targeting VEGF signalling as well as different receptor tyrosine kinase inhibitors have the potential to change the face of second-line treatment of patients with metastatic RCC. Both groups of agents are focused in current phase III trials, either as mono- and/or combination therapy. CONCLUSIONS: Until today, second-line treatment of patients with metastatic RCC progressing under therapy with biological response modifiers remains an unresolved issue. The results of ongoing clinical trials evaluating novel targeted approaches can be expected with suspense.
Bacillus Calmette-Guérin is established in the prophylaxis of recurrent intermediate and high-risk superficial bladder cancer and induces an unspecific, Th1-biased local immune response. Small CpG oligonucleotides (CpG ODN) containing a central unmethylated CpG motif are able to mimic the immunostimulatory activity of bacterial DNA. The purpose of the present study was to evaluate the antineoplastic properties of intravesically administered CpG ODN in an orthotopic murine bladder cancer model. MB49 tumor cell suspension was instilled transurethrally in female C57/BL6 mice on day 0. Mice were divided in three groups of 12 animals. Four mice in each group received either stimulative CpG ODN, non-stimulative GpC ODN or PBS intravesically: group I on day 3, group II on day 5, group III on day 7. After sacrifice 7 days after treatment, bladders were removed and histological examinations were performed. Single instillation of CpG ODN revealed antineoplastic effects in every group demonstrated by significantly lower bladder weight compared with non-stimulative GpC ODN- and PBS-treated mice. Histological examination showed extensive infiltration of macrophages and lymphocytes in CpG ODN-treated mice, whereas PBS- and GpC ODN-treated mice showed solid tumor growth with only few leucocytes. Intravesically applied immunostimulative DNA demonstrated antitumoral activity in an orthotopic murine bladder cancer model. A single instillation seems to be sufficient to reduce tumor load.
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Tumors of the spermatic cord are rare. Up to 20% are malignant and usually located in the paratesticular region. We report the rare case of an inguinal fibrolipoma of the spermatic cord with discrepancies between clinical and histopathological findings.
Complete dissociation of testis and epididymis is rare. An isolated torsion of the epididymis has not been reported so far. We report two cases: a 6-month-old boy who was admitted with fever and swollen hemiscrotum and an 18-year-old youth with acute onset of pain in the left hemiscrotum. Immediate inguinal surgical exploration of the baby showed a complete infarction of the epididymis due to an isolated epididymal torsion with dissociation of testis and epididymis. Epididymectomy was carried out and the testis was sutured down. In the case of the youth, the surgical exploration also showed an isolated epididymal torsion due to dissociation of testis and epididymis. The epididymis could be rescued by raising the torsion. The isolated torsion of the epididymis should be included in the differential diagnosis of acute scrotum in childhood.
Diagnosis and treatment of chronic testicular pain (CTP) has been a difficult and often unrewarding clinical situation. Success rates of conservative and surgical measures rarely exceed 55% to 73% and 10% to 40%, respectively. We report on our experience with microsurgical testicular denervation as therapeutic option in CTP. Following an extensive preoperative work-up and a positive response to spermatic cord block, 25 patients underwent microsurgical testicular denervation. After a mean follow-up of 31.5 months 24/25 patients are painfree; no intra- or postoperative complications were encountered. In none of the cases testicular atrophy or testicular hydrocele was observed during postoperative follow-up. Microsurgical testicular denervation produces reliable and reproducible excellent therapeutic success rates and should be integrated in the management of CTP at an early stage. High success rates, however, require adequate and meticulous diagnostic workup of the patients with the spermatic cord block using saline and different local anaesthetics being an initial diagnostic armentarium predicting postoperative outcome.
OBJECTIVES: A new lithotriptor for intracorporeal lithotripsy was developed combining the two most effective lithotriptors. A combination of the mechanically driven Lithoclast Master and a new ultrasonic device was constructed. Efficacy was tested in standardized model stones and in patient treatment. MATERIAL: The new lithotriptor is composed of a Lithoclast Master and an ultrasonic device (EMS, Nyon, Switzerland). The 1.0 mm Lithoclast probe is advanced off-center through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. Five different artificial stones of defined hardness and density were used as model stones for disintegration. Time until first fragmentation and complete fragmentation (particles smaller than 2.2 mm to fit through the ultrasonic probe), percent disintegration after 1 min and time until 50% disintegration were determined for the new device as well as lithoclast and ultrasound alone. A total of 68 patients were treated by percutaneous nephrolitholapaxy (PNL) with the new device from February 1999 to August 2001. Lithotripsy was performed after fluoroscopically guided puncture of the lower calix and dilatation of the nephrostomy tract with coaxial bougies. Thirty-five patients had complete and 33 patients partial staghorn calculi. RESULTS: First fragmentation was reached 25-200 times faster with the combination as with either mode alone. Disintegrated stone mass after 1 min was 1.5-4 times larger in combined lithotripsy and 50% disintegration time 30-50% shorter. Clinically, complete stone free rate (KUB and ultrasound) was 66% after the first PNL. Sixteen out of 68 patients had a second look PNL with an overall stone free rate of 89.7% by dismission. Stone composition was calcium-oxalate-monohydrate in 13%, Ca-ox-monohydrate/uric acid in 35%, apatite in 20% and cystine in 11%. CONCLUSION: In in vitro experiments and clinically the new lithotriptor provides easy handling and high effectivity in fragmentation of all stones regardless of their composition.
OBJECTIVE: To assess a new lithotripter for intracorporal lithotripsy, which combines the mechanically driven pneumatic LithoClast (Electro-Medical Systems, Nyon, Switzerland) and a new ultrasonic device (Electro-Medical Systems), for use in percutaneous nephrolitholapaxy (PNL). PATIENTS AND METHODS: The new lithotripter consists of a LithoClast Master with 12 Hz repetition rate and a new ultrasonic device. The 1.0 mm LithoClast probe is advanced off-centre through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. A new irrigation system with a pinch valve compressing the irrigation tube, a foot-switch for activating the ultrasound, the LithoClast and both together, and a stone bucket at the outlet tube are new features. Between February 1999 and August 2001, 68 patients were treated by PNL with the new device; 35 had complete and 33 had partial staghorn calculi. PNL was administered under fluoroscopic control and with the patient prone. RESULTS: The mean (range) duration of surgery was 61 (42-119) min. The complete stone-free rate was 66% after the first PNL; of the 68 patients, 16 received a second PNL, giving a final stone-free rate of 76% and 80%. The stone was composed of calcium oxalate monohydrate (COM) in 13%, COM with uric acid in 35%, apatite in 20% and cystine in 11%. Clinically the new lithotripter was very effective, producing smaller stone particles and thus fewer residual stone fragments after PNL than with the LithoClast or ultrasonic fragmentation alone. CONCLUSION: The new lithotripter provides easily managed and highly effective stone fragmentation of all stones, regardless of their composition.
A case of an unusually large, proximal urethral calculus located very close to the external sphincter and caused by recurrent urethral stricture is presented.
There are no reliable serologic tumor markers for transitional cell carcinoma (TCC) of the urinary bladder and noninvasive urine investigations are inadequate. We used fluorescent microsatellite analysis (MSA) to detect serum DNA and urine-sediment DNA alterations in patients with bladder cancer and prospectively collected fresh tumor, peripheral blood, serum and spontaneous urine specimens from 39 consecutive patients treated for TCC of the bladder to obtain the corresponding DNA. Fluorescent MSA was performed with 17 polymorphic markers from the chromosomal regions 5q, 8p, 9p, 9q, 13q, 14q, 17p, 17q and 20q in the 39 cancer patients and in 10 healthy controls. Serum DNA alterations were identified in 84.5% (33 of 39 patients) and tumor-specific urine DNA alterations indicating the diagnosis were present in 72% (27 of 39 patients) of cases. None of the healthy controls displayed serum DNA alterations. The highest frequency of serum DNA aberrations (56%) was detected for chromosomal region 8p. The most frequent alterations in urine-sediment DNA, 36% and 26%, were detected in chromosomal regions 8p and 9p, respectively. Identification of serum DNA and urine-sediment DNA alterations was not related to stage of disease or grade of tumor (p > 0.05). Thus, MSA offers a highly sensitive and specific method for serum- and urine-bound diagnosis of bladder TCC.
Severe acute inflammation in chronic inflammatory bowel disease is associated with large wound areas and ulcerations that show spontaneous hemorrhage or marked friability. Therefore, an enormous potential of hemostasis and wound healing is required. Coagulation studies demonstrate a deficiency of factor XIII that is important for both clot formation and wound healing. Consequently, the substitution of factor XIII may be beneficial; the first case reports present favorable clinical results. In a prospective pilot study, we treated 12 patients with therapy-resistant ulcerative colitis. The colitis activity index (CAI) and the endoscopic score (ES) according to Rachmilewitz were elevated; all patients suffered from hematochezia. After substitution therapy with factor XIII concentrate (1,250 U/d) the stool frequency dropped and no further hematochezia was detected. The CAI and the ES declined highly significantly. Because of these encouraging results two placebo-controlled multicenter trials have been initiated. In the first study, patients with acute stage of ulcerative colitis associated with severe intestinal blood loss are treated with two different dosages of factor XIII concentrate (1,250 and 500 U/d, respectively) or placebo for 10 days. In the second trial, patients with therapy-resistant ulcerative colitis with a lack of remission in spite of a consequent therapy for 2 weeks are included; factor XIII concentrate or placebo is administered for 10 days. The aim of both trials is an end of intestinal bleeding and the fostering of a more effective wound-healing process.
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