Biomedical subjects

Peter Rehak

Publications and source records attributed to Peter Rehak.

At least 37 records · Page 2Linked to original sources

PubMed2004

Prognostic value of keratin subtyping in transitional cell carcinoma of the upper urinary tract.

To investigate the prognostic value of keratin subtyping in invasive transitional cell carcinomas (TCCs), we performed a systematic study applying 15 different monoclonal keratin antibodies on 53 upper urinary tract TCCs using a tissue microarray technique. Immunoreactivity was correlated with pT stages and tumour grades using the Fisher's exact test. Impact on disease-free survival was analysed using the Kaplan-Meier method and compared by the log-rank test. Immunoreactivity for keratins 5/6, 6, 7, 8, 13, 14, 17, 18, 19, 20, low molecular weight (LMW) keratins (8, 18) and high molecular weight (HMW) keratins (1, 5, 10, 14) was detected in varying quantities. Regarding semi-quantitative assessment, a prognostic impact was found for keratins 5/6, 7, 8, 13, 17, 20 and HMW keratins, with reduced expression or loss of immunoreactivity being significantly associated with disease progression. With respect to analysis of staining patterns, the retention of a basally accentuated labelling for keratin 5/6 and HMW keratin as well as a superficially accentuated labelling for keratin 20 was significantly associated with a favourable outcome. In conclusion, this investigation is the first to demonstrate a possible prognostic value for keratin subtyping in invasive (upper urinary tract) TCCs with respect to metastasis-free survival. Further studies, however, are needed to substantiate our results.

Adult↗

PubMed2004

Pilot study on the effect of parenteral vitamin E on ischemia and reperfusion induced liver injury: a double blind, randomized, placebo-controlled trial.

BACKGROUND AND AIMS: Liver surgery usually involves ischemia and reperfusion (I/R) which results in oxidative stress and cell damage. The administration of antioxidants should diminish or prevent this damage. The purpose of this study was to investigate the effect of the antioxidant vitamin E on I/R injury. METHODS: We carried out a placebo-controlled double-blind study on 68 patients undergoing elective, tumor-related, partial liver resection. 47 patients were qualified for the per protocol population based evaluation. The patients were randomly assigned to two groups. The day before surgery one group received three infusions containing vitamin E (600 IU=540 mg vitamin E emulsion). The other group received three infusions of placebo. RESULTS: Length of stay in the intensive care unit (ICU) was significantly shorter in the verum group than in the placebo group (P<0.05). There were signs of improvement for AUC AST (P<0.05), ALT and GLDH in the verum group after surgery. Serum vitamin E concentration increased after administration of vitamin E infusion and declined in both treatment groups after surgery (P<0.01). In the verum group vitamin E deficiency was prevented while vitamin E concentration remained low in the placebo group (P<0.01). CONCLUSIONS: The findings from this study indicate that preoperative administration of vitamin E is safe and that this treatment may have beneficial effects by reducing the impact of I/R injury in liver surgery.

Adult↗

PubMed2004

Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events.

BACKGROUND: The eustachian valve (EV) (valvula venae cavae inferioris) is a remnant of the embryonic right valve of the sinus venosus. Embryologically, the EV directs oxygenated blood from the inferior vena cava across the patent foramen ovale (PFO) into the systemic circulation. Transthoracic echocardiography shows the EV in the majority of newborns, but the prevalence of EV in adults studied with transesophageal echocardiography is unknown. We studied whether the presence of an EV is associated with PFO or with cryptogenic stroke. METHODS: The frequency and size of the EV was studied in 211 consecutive patients undergoing transesophageal echocardiography after a cryptogenic stroke and in 95 consecutive patients without cerebrovascular events. In all 306 patients, the presence of a PFO was studied with 2-dimensional transesophageal echocardiographic, color Doppler, and contrast echocardiographic studies. RESULTS: An EV was seen in 174 of 306 patients overall (57%). The mean size was 1.0 +/- 0.4 cm (range: 0.5-2.0); 70% of patients with an EV had a PFO (Cohen's kappa = 0.75; P <.001). This relationship was not significantly influenced by a cryptogenic stroke. The prevalence of PFO was 30% in the control group and 61% for those with presumed paradoxical embolism (P <.001). Thus, an EV was more common for patients with presumed paradoxical embolism than in control patients (143 of 211 68% vs 31 of 95 33%, respectively, P <.001). There was no significant difference in the size of the EV between the 2 groups (1.1 vs 1.0 cm; P =.24). CONCLUSION: A persisting EV is a frequent finding in patients with a PFO. By directing the blood from the inferior cava to the interatrial septum, a persisting EV may prevent spontaneous closure of PFO after birth and may, therefore, indirectly predispose to paradoxical embolism.

Adolescent↗

PubMed2004

Austrian survey of treating heart failure--AUSTRIA.

BACKGROUND: Treatment of chronic heart failure is based on the results of large clinical trials, which form the basis of treatment guidelines, such as those from the European Society of Cardiology (ESC). The aim of this study was to record treatment-modalities and the implementation of guidelines of chronic heart failure in clinical practice in Austria. METHODS: Overall 96 general physicians, specialists for internal medicine in private practice or in hospital outpatient departments participated in the survey. Physicians were asked to prospectively document 30 consecutive patients with chronic heart failure. RESULTS: 1880 patients were documented. The majority of patients were treated by general physicians (57%). Coronary artery disease was the most frequent aetiology for heart failure (47%). The most frequently used drugs were blockers of the renin-angiotensin-system (RAS-blocker including ACE-inhibitors and angiotensin-receptor-blockers, 78%), diuretics (76%) and beta-blockers (49%). Other drugs like digitalis and spironolactone were used infrequently. Average doses of ACE-inhibitors were approximately 90% of those recommended by the ESC, average doses of beta-blockers were approximately 50% of those recommended. Treatment among the three classes of physicians differed with respect to RAS-blockers and beta-blockers, which were used infrequently by general practitioners. Both groups of drugs were given more frequently to younger patients (<70 years) while digitalis was given more often to elderly patients. CONCLUSIONS: Results from this survey suggest that Austrian physicians treating patients with heart failure use the appropriate drugs in dosages that are suggested by recently published guidelines (ACE-inhibitors and beta-blockers). However, dosages of spironolactone clearly differed from current recommendations.

Adrenergic beta-Antagonists↗

PubMed2004

Value of p53 as a prognostic marker in histologic subtypes of renal cell carcinoma: a systematic analysis of primary and metastatic tumor tissue.

OBJECTIVES: To investigate the histologic subtypes of renal cell carcinoma (RCC) with respect to differences in immunoreactivity for p53 and its impact on prognosis. The prognostic significance of p53 in RCC remains to be defined. METHODS: A total of 188 primary RCC and 58 RCC metastasis specimens were stained immunohistochemically for p53 overexpression using a tissue microarray technique. p53 overexpression was analyzed semiquantitatively with respect to its association with pT stage, grade, histologic subtype, and sex using the chi-square test or Fisher's exact test. The impact on metastasis-free survival was analyzed using the Kaplan-Meier method and log-rank test. For conventional RCC, a multivariate analysis, including pT stage, grade, and p53 immunoreactivity was performed. RESULTS: Sufficient tumor tissue was present in 184 (97.9%) of 188 primary and 56 (96.6%) of 58 metastatic cases. p53 overexpression was found in 42 (22.8%) of 184 primary RCC specimens and in 29 (51.8%) of 56 metastasis specimens (P = 0.0001). p53 overexpression for papillary, chromophobe, and conventional RCC was 70.0%, 27.3%, and 11.9%, respectively (P <0.0001). No association of p53 immunoreactivity with the other parameters investigated was found. Regarding prognosis, a statistically significant difference in metastasis-free survival between p53-positive and p53-negative tumors was found only for conventional RCC (P = 0.0005) and not for the other subtypes (P = 0.19). Multivariate analysis proved grade (P <0.0001), pT stage (P = 0.01), and p53 overexpression (P = 0.01) to be independent prognostic factors for conventional RCC. CONCLUSIONS: p53 overexpression was significantly more frequent in "nonconventional" RCC subtypes, especially papillary RCC, compared with conventional RCC in our study. However, p53 immunoreactivity is a prognostic marker only for conventional RCC.

Adult↗

PubMed2004

Selenium levels of patients with newly diagnosed prostate cancer compared with control group.

OBJECTIVES: To compare the toenail selenium level of patients with prostate cancer with that of controls. A tumor-protective effect of selenium has been discussed for many years. Published data about the influence of the selenium level in the plasma and toenails are controversial. METHODS: Our prospective study included 150 patients. Of these, 70 patients had recently diagnosed prostate cancer (cancer group) and 80 patients had no evidence of prostate cancer (negative digital rectal examination and prostate-specific antigen level within age-specific range or negative biopsies) or any other malignant disease (control group). Toenail clippings exhibit selenium levels for up to 1 year. Both groups were compared by assessing their selenium levels using inductively coupled plasma dynamic reaction cell mass spectrometry after microwave-assisted closed vessel digestion. The results of the selenium levels in both groups were statistically compared using the Wilcoxon test. Possible correlations between the selenium level and age, body mass index, smoking habits, and prostate cancer were analyzed by multiple regression analysis. RESULTS: The median age of the cancer and control group was 65 and 69 years, respectively. The median toenail selenium level in the cancer and control group was 528 ng/g (range 393 to 4274) and 502 ng/g (range 201 to 831), respectively (P value not statistically significant). Furthermore, no correlation was found between selenium level and age, body mass index, or smoking status. CONCLUSIONS: The patients in our study with newly diagnosed and not yet treated prostate cancer did not have different toenail selenium levels than controls. Body selenium levels may not influence prostate cancer incidence. A protective effect of selenium for prostate cancer seems questionable.

Aged↗

PubMed2004

Prognostic impact of p63 and p53 expression in upper urinary tract transitional cell carcinoma.

OBJECTIVES: To analyze p63 and p53 immunoreactivity of upper urinary tract transitional cell carcinoma with respect to prognosis. p63 is required for the differentiation of normal urothelium and is expressed in both non-neoplastic urothelium and transitional cell carcinoma of the bladder. METHODS: A total of 53 upper urinary tract transitional cell carcinoma specimens were investigated immunohistochemically using a tissue microarray technique. p63 and p53 immunoreactivity was analyzed digitally with respect to associations with pT stage and grade and impact on disease-free survival. RESULTS: p63 expression was detected in 51 (96.2%) of 53 cases. Normal expression (greater than 90% of tumor cell nuclei) was observed in 1 (4.5%) of 22 Stage pT3 compared with 13 (41.9%) of 31 Stage pT1-T2 tumors (P = 0.003) and 4 (16%) of 25 G3 compared with 10 (35.7%) of 28 G2 tumors (P = 0.13). p53 overexpression (more than 10% of tumor cell nuclei) was found in 10 (18.9%) of 53 cases, including 2 (6.5%) of 31 Stage pT1-T2 and 8 (36.4%) of 22 Stage pT3 (P = 0.011) and 0 of 28 G2 and 10 (40%) of 25 G3 tumors (P <0.001). Metastatic disease was observed in 14 (26.4%) of 53 patients, including none of 14 with normal p63 expression compared with 14 (35.9%) of 39 with decreased (less than 90% of tumor cell nuclei) p63 expression (P = 0.02) and 5 (50%) of 10 patients with p53 overexpression compared with 9 (20.9%) of 43 patients with p53-negative tumors (P = 0.01). Multivariate analysis proved Stage pT3 was the only independent prognostic factor. CONCLUSIONS: Decreased p63 immunoreactivity and p53 overexpression were significantly associated with advanced tumor stages and poor prognosis. However, neither parameter was an independent prognostic factor in multivariate analysis.

Adult↗

PubMed2004

Phytoestrogen tissue levels in benign prostatic hyperplasia and prostate cancer and their association with prostatic diseases.

OBJECTIVES: To compare phytoestrogen tissue levels in men with small-volume benign prostatic hyperplasia (BPH), large-volume BPH, and prostate cancer (PCa). METHODS: Prostatic tissue samples of men consuming a Western diet who underwent surgery for BPH (n = 63) or PCa (n = 31) were collected and frozen at -40 degrees C. In the tissue samples, the enterolactone and genistein levels were determined in duplicate by monoclonal antibody-based immunoassays. We subsequently compared the tissue levels in patients with BPH and PCa and studied the impact of enterolactone and genistein on prostate volume. RESULTS: The enterolactone tissue levels were comparable in patients with BPH and PCa and revealed no correlation to prostate volume. The genistein tissue levels tended to be lower in patients with PCa (median 8.4 ng/g dry weight) compared with the entire BPH group (11.0 ng/g dry weight; P = 0.072). In addition, the genistein tissue levels were significantly greater in men with small-volume BPH (median 20.9 ng/g dry weight) compared with those with large-volume BPH (8.8 ng/g dry weight; P = 0.023). CONCLUSIONS: Our data suggest an involvement of genistein in the pathogenesis of BPH and, possibly, of PCa. The impact of enterolactone is currently unknown.

4-Butyrolactone↗

PubMed2004

Expression of p27 and its ubiquitin ligase subunit Skp2 in upper urinary tract transitional cell carcinoma.

OBJECTIVES: To analyze p27 and S-phase kinase-associated protein 2 (Skp2) expression in upper urinary tract transitional cell carcinoma (TCC) with respect to biologic significance. p27 (p27/kip1) is involved in cell cycle control, and loss of p27 protein expression may result in tumor development and/or progression. The association of p27 with the ubiquitin ligase subunit Skp2 targets p27 for degradation. METHODS: A total of 53 upper urinary tract TCC specimens were investigated immunohistochemically using a tissue microarray technique. The immunoreactivity of p27 and Skp2 was analyzed with respect to associations with pT stage, grade, and prognosis. RESULTS: Non-neoplastic renal tissue showed p27 immunoreactivity in tubule epithelium and pelvic urothelium, but lacked immunoreactivity for Skp2. In the TCC specimens, p27 immunoreactivity was noted in 47 (89%) of 53 cases. High p27 expression (50% or greater of tumor cell nuclei) tended to decrease with rising tumor stage (14 [45%] of 31 with pT1-pT2 versus 4 [18%] of 22 with pT3; P = 0.076), but was independent of tumor grade (11 [39%] of 28 grade 2 versus 7 [28%] of 25 grade 3-4; P = 0.56). Skp2 immunoreactivity was noted in 32 (60%) of 53 tumors. Skp2 expression increased with rising tumor stage (9 [41%] of 22 pT1 versus 23 [74%] of 31 pT2-pT3; P = 0.023) and tumor grade (12 [43%] of 28 grade 2 versus 20 [80%] of 25 grade 3; P = 0.043) and was associated with angioinvasion (P = 0.017). In multivariate analysis, tumor stage proved to be the only independent prognostic factor regarding disease-free survival. CONCLUSIONS: p27 and Skp2 are additional biomarkers in urogenital pathologic findings. The statistically significant association of Skp2 expression with high-grade TCC, as well as the lack of expression in non-neoplastic tissue, suggests that Skp2 could be a promising target for future cancer therapy strategies.

Adult↗

PubMed2004

Expression of MUC1 (EMA) and E-cadherin in renal cell carcinoma: a systematic immunohistochemical analysis of 188 cases.

MUC1 (epithelial membrane antigen) is a membrane-associated mucin known to interfere with both cell-cell and cell-matrix adhesions. Overexpression has been associated with poor prognosis in a variety of cancers. We investigated the expression of MUC1 (using two different antibodies, MA695 and E29) and E-cadherin in renal cell carcinomas (137 conventional, 23 chromophobe, 20 papillary, and eight unclassified tumors) with respect to diagnostic and prognostic significance using a tissue microarray technique. Immunoreactivity was correlated with histological subtype, pT-stage, and grade using the chi2 test or the Fisher's exact test, respectively. Impact on disease-free survival was analyzed using the Kaplan-Meier method and the log-rank test. Immunoreactivity of more than 10% of cancer cells with MA695, E 29, and E-cadherin antibodies was found in 112/133 (84%), 86/133 (65%), and 7/131 (5%) conventional, 20/22 (91%), 19/22 (86%), and 21/22 (95%) chromophobe, 13/20 (65%), 8/20 (40%), and 3/20 (15%) papillary as well as 5/8 (63%), 5/8 (63%), and 4/8 (50%) unclassified carcinomas, respectively. The two different MUC1 antibodies yielded comparable staining results. A diffuse cytoplasmic staining pattern for MUC1 was found exclusively in chromophobe carcinomas, whereas conventional and papillary subtypes showed predominantly membranous staining (P<0.0001). Regarding papillary carcinomas, MUC1 was predominantly associated with type 1 (P=0.0001), and E-cadherin with type 2 (P=0.049) tumors. The cellular staining pattern of MUC1 in conventional tumors was related to pT-stage (P=0.002) and tumor grade (P=0.001): Low-stage (pT1/pT2) and grade (G1/G2) tumors showed a predominantly apical membranous staining, high-stage (pT3a/pT3b) and grade (G3/G4) tumors a predominantly circumferential membranous staining (with or without additional diffuse cytoplasmic immunoreactivity), which, in the conventional subtype, was associated with poor prognosis (P<0.0001). In conclusion, MUC1 and E-cadherin are diagnostically and prognostically useful markers in renal tumor pathology, especially when cellular staining patterns are considered.

Adult↗

PubMed2004

The accuracy of ultrasound for measurement of mobile- bearing motion.

After anterior cruciate ligament-sacrificing total knee replacement, mobile bearings sometimes have paradoxic movement but the implications of such movement on function, wear, and implant survival are not known. To study this potential problem accurate, reliable, and widely available inexpensive tools for in vivo mobile-bearing motion analyses are needed. We developed a method using an 8-MHz ultrasound to analyze mobile-bearing motion and ascertained accuracy, precision, and reliability compared with plain and standard digital radiographs. The anterior rim of the mobile bearing was the target for all methods. The radiographs were taken in a horizontal plane at neutral rotation and incremental external and internal rotations. Five investigators examined four positions of the mobile bearing with all three methods. The accuracy and precision were: ultrasound, 0.7 mm and 0.2 mm; digital radiograph, 0.4 mm and 0.2 mm; and plain radiographs, 0.7 mm and 0.3 mm. The interrater and intrarater reliability ranged between 0.3 to 0.4 mm and 0.1 to 0.2 mm, respectively. The difference between the methods was not significant for neutral rotation but ultrasound was significantly more accurate than any one degree of rotation or higher. Ultrasound of 8 MHz provides an accuracy and reliability that is suitable for evaluation of in vivo meniscal bearing motion. Whether this method or others are sufficiently accurate to detect motion leading to abnormal wear is not known.

Arthroplasty, Replacement, Knee↗

PubMed2004

Steroid hormone receptor expression in renal cell carcinoma: an immunohistochemical analysis of 182 tumors.

PURPOSE: Steroid hormone receptor expression has an essential role in cancer of the prostate and breast but there is only limited experience with renal cell carcinoma (RCC), especially regarding prognostic and therapeutic impact. MATERIALS AND METHODS: A total of 188 cases of RCC were stained immunohistochemically for the expression of estrogen (ER), progesterone (PR) and androgen (AR) receptors using a tissue microarray technique. Nuclear steroid hormone receptor immunoreactivities were analyzed semiquantitatively with respect to associations with histological subtype, pT stage, grading and gender using Fisher's exact test. Impact on disease-free survival was analyzed using the Kaplan-Meier method. RESULTS: Sufficient tumor tissue was present in 182 of the 188 RCCs. AR expression was found in 27 of 182 tumors (14.8%) in 24 male and 3 female patients. AR expression was significantly associated with stage pT1 compared with pT3 (p <0.0001), and grades 1 and 2 compared with grade 3 (p = 0.0005). Regarding progression-free survival, AR positive RCCs showed a significantly better prognosis than AR negative cases (log rank test, p = 0.027). No difference of AR immunoreactivity could be detected between histological subtypes. Only 2 of the 182 cases (1.1%) showed ER and PR immunoreactivity in less than 10% of tumor cell nuclei. CONCLUSIONS: While ER and PR expression was the exception, AR expression was found in almost 15% of the tumors and it was significantly associated with low stage, well or moderately differentiated tumors and a favorable outcome, decreasing with tumor growth and dedifferentiation. However, these results do not support a potential role of hormonal therapy for metastatic RCC.

Adult↗

PubMed2004

Analysis of insulin-like growth factors and insulin-like growth factor I receptor expression in renal cell carcinoma.

The expression of insulin-like growth factors I (IGF-I) and II (IGF-II) and insulin-like growth factor-I receptor (IGF-IR) was studied in 137 clear cell, 23 chromophobe, and 20 papillary renal cell carcinomas (RCCs) using a tissue microarray technique. IGF-I immunoreactivity was detected in 110 (82.1%) of 134 clear cell, 8 (36%) of 22 chromophobe, and 3 (15%) of 20 papillary RCCs (P < .001). IGF-IR immunoreactivity was detected in 39 (29.5%) of 132 clear cell, 9 (41%) of 22 chromophobe, and 19 (95%) of 20 papillary RCCs (P < .001). In contrast, all tumors lacked IGF-II expression. Expression of IGF-I and IGF-IR was not related to tumor stage, grade, or prognosis. The IGF system is expressed differentially among different tumor types. The expression of IGF-I together with its receptor, IGF-IR, provides evidence for the existence of an autocrine-paracrine loop of tumor cell stimulation in RCC and makes this type of cancer a candidate for therapeutic strategies aimed to interfere with the IGF pathway.

Adult↗

PubMed2004

The influence of an anterior-posterior gliding mobile bearing on range of motion after total knee arthroplasty. A prospective, randomized, double-blinded study.

BACKGROUND: Range of motion is a crucial measure of outcome after total knee arthroplasty. In order for maximum flexion to occur, the femur must progressively shift posteriorly on the tibia, a movement that is known as femoral rollback. Mobile bearings with free anterior-posterior translation could improve knee flexion by allowing such motion. The purpose of the present study was to determine the influence of an anterior-posterior gliding mobile bearing on the postoperative range of knee motion in patients with an intact posterior cruciate ligament. METHODS: We performed a prospective, randomized clinical trial of fifty consecutive total knee arthroplasties that were performed with use of the LCS-Universal prosthesis. Participants were randomized to receive either a deep-dish rotating platform or a mobile bearing that allowed additional anterior-posterior translation, the latter of which requires an intact posterior cruciate ligament. The ranges of motion of the knees were assessed to detect a 15 degrees difference in the active non-weight-bearing range of motion with a power (1 - beta) of 20% and with the level of significance (alpha) set at 0.05. The translation of the mobile bearing was measured with use of a standardized ultrasound technique and was correlated with maximum knee flexion. The participants and the assessor were blinded throughout the study. RESULTS: At the time of the one-year follow-up evaluation, forty-eight knees were available for an intention-to-treat analysis. The mean active non-weight-bearing range of motion at one year was 113 degrees (95% confidence interval, 108 degrees to 118 degrees ) in the twenty-six knees that had received a rotating platform and 111 degrees (95% confidence interval, 115 degrees to 125 degrees ) in the twenty-two knees that had received an anterior-posterior gliding bearing (p = 0.57). In the latter group, a continuous rollback occurred in two knees. There was no significant correlation between knee flexion and anterior-posterior translation (r(2) = 0.015). CONCLUSIONS: The use of a mobile bearing that allowed free anterior-posterior translation did not regularly restore femoral rollback and did not improve range of motion after total knee arthroplasty compared with the findings seen in association with the use of a rotating platform.

Adult↗

PubMed2003

Early fluoxetine treatment of post-stroke depression--a three-month double-blind placebo-controlled study with an open-label long-term follow up.

OBJECTIVE: Poststroke depression is a frequent psychiatric complication after stroke that may have strong negative impact on rehabilitation therapy and functional recovery. This study was conducted to show the efficacy and safety of early treatment with the selective serotonin reuptake inhibitor fluoxetine in post-stroke depressed patients. METHODS: This double-blind, randomized placebo-controlled study was of patients within two weeks after stroke. Moderate to severe depressed patients (determined by Hamilton Depression Scale (HDS) > 15, the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI) Scale) were randomized to receive either 20 mg/d fluoxetine or placebo for 3 months. Beside the psychiatric assessment, patients were evaluated by use of the Scandinavian Stroke Scale (SSS), the Mini-Mental-State-Examination (MMSE) and the Barthel-Index (BI). An open-label long-term follow up was done 18 months after the initial assessment. RESULTS: 54 depressed patients of an inpatient population of 242 consecutive stroke patients aged 25 to 85 years entered the trial within the first two weeks post-stroke. 50 patients completed the trial per-protocol. The initial severity of depression was comparable in the two groups (mean baseline HDS score 32.8 in the fluoxetine vs. 30.3 in the placebo group), as were neurological symptom severity and demographic parameters. Significant improvement was seen in both groups within 4 weeks of treatment, whereas no advantages of fluoxetine could be observed at this time. This indicates a high degree of spontaneous recovery during early rehabilitation therapy. BDI scores of patients treated with fluoxetine further decreased until the follow-up at 12 weeks, whereas the scores increased again in the placebo group. This depressive relapse of the placebo patients after the end of most rehabilitation efforts was evident at a long-term follow-up 18 months after inclusion, when patients who had been treated with fluoxetine were significantly less depressed. No side effects of fluoxetine treatment were detected. CONCLUSIONS: The advantages of fluoxetine were obvious at the follow-up 18 months after inclusion, but could not be demonstrated within the first three months of controlled treatment. The multitude of therapeutic efforts that take place in the early phase of rehabilitation might have facilitated spontaneous recovery from depression and might have hindered benefits of antidepressant treatment to become obvious. Fluoxetine treatment was well tolerated and safe.

Activities of Daily Living↗

PubMed2003

Detection of prostate cancer by TURP or open surgery in patients with previously negative transrectal prostate biopsies.

OBJECTIVES: To evaluate retrospectively the effectiveness of transurethral resection of the prostate (TURP) in diagnosing prostate cancer in patients with obstructive voiding symptoms and a history of negative transrectal prostate biopsy but elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). METHODS: In 1189 consecutive patients undergoing TURP or open prostatectomy between 1994 and 2000 for obstructive voiding symptoms, we identified 445 patients (37.4%) with at least one previous set of transrectal prostate biopsies because of an elevated PSA level and/or abnormal DRE findings. The probability to detect prostate cancer by TURP (n = 423; 95%) or open surgery (n = 22; 5%) was investigated overall, as well as related to patient age, PSA level, DRE findings, number of previous biopsies, time from biopsy to surgery, and weight of resected tissue. RESULTS: The mean number of preoperative negative biopsies per patient was 1.6 (range 1 to 8). The mean patient age was 69 years (range 48 to 89). The median PSA level and resection weight was 8.64 ng/mL and 32 g, respectively. Ninety-seven patients (21.8%) had abnormal DRE findings. Overall, prostate cancer was detected in 35 patients (7.9%). The cancer incidence was 5.5% (19 of 348) in patients with a normal DRE compared with 16.5% (16 of 97) in patients with an abnormal DRE (P <0.001; Fisher's exact test). The cancer rate was also related to age; other subgroups showed no statistically significant differences regarding cancer incidence. CONCLUSIONS: In patients with previously negative biopsies, the diagnostic yield of TURP is low. Therefore, TURP for diagnostic purposes only cannot be recommended. However, in patients with an abnormal DRE and obstructive symptoms, surgery should be preferred over alternative treatment options.

Adenocarcinoma↗

PubMed2003

Impact of tumor-associated symptoms on the prognosis of patients with renal cell carcinoma: a single-center experience of 683 patients.

OBJECTIVES: To evaluate the impact of cancer-associated symptoms present at the diagnosis of renal cell carcinoma (RCC) on the prognosis of patients. Increasing numbers of RCC are currently detected incidentally by routine ultrasonography. METHODS: From January 1994 to December 2000, 693 operations for RCC in 683 consecutive patients have been performed at our institution. Overall, tumor-specific, and progression-free survival were investigated using the Kaplan-Meier method. For multivariate analysis regarding tumor-specific survival, the Cox regression model, including risk ratios, was used. A receiver operating characteristics curve regarding the sensitivity and specificity for the association between tumor size and symptoms was used. RESULTS: Of the 683 patients, 417 patients were male and 266 female. The mean patient age was 62 years (range 16 to 88). Of the 683 patients, 141 (20.8%) presented with symptoms suspicious for cancer. The 5-year overall, progression-free, and cancer-specific survival rates were 82%, 79%, and 86%, respectively, for asymptomatic patients compared with 60%, 55%, and 65%, respectively, for patients with symptoms at diagnosis (P <0.0001, log-rank test). The cutoff value of 5 cm for the tumor diameter to result in symptoms was chosen on the receiver operating characteristic curve. Multivariate analysis found tumor grade (P = 0.001), tumor stage (P = 0.001), presence of symptoms (P = 0.013), and tumor diameter (P = 0.005) to be independent prognostic parameters for cancer-specific survival. CONCLUSIONS: Tumors larger than 5 cm were significantly more likely to cause symptoms compared with smaller tumors in our series. In multivariate analysis, patients presenting with symptoms suspicious for cancer at the diagnosis of RCC had a 1.8-fold greater risk of dying of cancer compared with patients without symptoms.

Adolescent↗

PubMed2003

Angiotensin-converting enzyme polymorphisms and their potential impact on left ventricular myocardial geometry after aortic valve surgery.

BACKGROUND AND AIM OF THE STUDY: Genetic variants of the angiotensin-converting enzyme (ACE) cascade may influence left ventricular myocardial mass (LVMM) regression after aortic valve surgery. Postoperative long-term changes in LV indices were investigated in patients with asymptomatic aortic regurgitation (AR) and symptomatic aortic stenosis (AS) and related to alleles of ACE polymorphisms. METHODS: A total of 96 patients was included in the study, 21 with class IIa AR (22%) and 75 with class I AS (78%) recommendations for surgery. Patients were evaluated for demographic risk factors and underwent a thorough clinical examination including 3-D cardiac imaging by ultrafast-computed tomography. Genomic DNA was isolated for genotyping. RESULTS: AR patients were younger (55.8 +/- 8.9 versus 64 +/- 9.1 years, p = 0.0014), had a larger body surface area (1.92 +/- 0.21 versus 1.82 +/- 0.19 m2, p = 0.039), and were more likely to be asymptomatic (myocardial infarction, p = 0.04; syncope, p = 0.0099; thromboembolism, p = 0.03; NYHA class IV, p = 0.04). Postoperatively, the reduction in absolute LVMM (from 297.1 +/- 52.6 to 190.1 +/- 57.1 g versus 214.4 +/- 55.7 to 143.8 +/- 40.0 g; pT = 0.0000001) and indexed LVMM (from 156.0 +/- 31.7 to 99.3 +/- 28.4 g/m2 versus 118.7 +/- 28.3 to 79.3 +/- 20.6 g/m; pT = 0.0000001) over time was more significant in AR patients, but never reached normal values. Enforced ACE inhibitor medication resulted in significantly higher postoperative indexed LVMM differences in homozygote DD patients compared to AR patients with II/ID alleles of ACE 16 ins/del polymorphism. CONCLUSION: AR patients showed a statistically significant decrease in absolute/indexed LVMM during follow up, but never achieved LV mass recovery compared to standard values or to values in patients undergoing aortic valve replacement for AS. The benefits of ACE inhibitors were observed among AR patients with homozygote DD alleles of ACE 16 ins/del polymorphism.

Aged↗