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Biomedical subjects

R Hautmann

Publications and source records attributed to R Hautmann.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Is retrograde ureteropyelography necessary before kidney pelvis-plasty in childhood?].

For routine evaluation of ureteropelvic junction obstruction in children, sonography, voiding cystogram, IV pyelogram and a renal scan in combination with administration of furosemide are available. Furthermore, often preoperative antegrade or retrograde ureteropyelography is performed. However, the significance of retrograde ureteropyelography in the world literature remains controversial. Therefore, we reviewed the records of 41 children who underwent a pyeloplasty in our department. In 9 children the ureter was visualized by IV pyelogram, voiding cystogram or antegrade ureteropyelography; a retrograde examination of the ureter was performed in 21 children before pyeloplasty in the OR. In 11 children the ureter was not visualized preoperatively. Retrograde ureterography neither gave additional information in any patient nor did it change the operative technique. In the children where the ureter was not visualized preoperatively, no ureteric abnormality was found in association with ureteropelvic junction obstruction. Hence, we conclude that retrograde ureteropyelography before pyeloplasty in children is not necessary, provided that sonography does not show ureteral dilatation.

Adolescent↗
PubMed1997

[Transurethral collagen injection for treatment of urinary stress incontinence].

Minimally invasive treatment of urinary incontinence has become a subject of major interest in recent years. We examined the use of transurethral collagen injection for incontinence treatment. A total of 48 patients were selected for this procedure from April 1993 to February 1997-26 male patients (19 post-RPX incontinence and 7 post-TUR incontinence) and 22 female patients (all after previous incontinence surgery) were treated by injection of collagen into the continence region. The whole group underwent an average of 1.8 sessions, and a mean collagen injection volume of 14.5 ml was delivered per session. Mean follow-up was 9.2 months. Of the female population, 68.2% were cured or greatly improved. In the male population only 47.3% of the post-RPX patients and 6/7 of the post-TUR patients benefited from the procedure. In males, treatment outcome depends on the degree of pretreatment incontinence, because all grade III incontinence patients did worse. Therefore we conclude: transurethral collagen injection is an interesting method in the treatment of urinary incontinence if proper patient selection is assured.

Aged↗
PubMed1996

Aminolevulinic acid for photodynamic therapy of bladder carcinoma cells.

A new concept in photosensitizing tumor cells is photosensitizer synthesis in situ. Aminolevulinic acid (ALA) is a precursor of protoporphyrin IX (PP IX), a potent photosensitizer. The goal of our study was to examine dark toxicity, phototoxic potential, metabolism of ALA and morphological alterations in Waf bladder cancer cells. Dark toxicity of Waf cells was observed after incubation with ALA, beginning at a concentration of 15 mM. Photodynamic treatment with ALA at concentrations of 1, 5 and 10 mM showed a drug- and light-dose-dependent cell survival rate in comparison to a control group. Two incubation times of 3.5 and 5.5 h were compared for cell survival. After a longer incubation time of 5.5 h, cell survival was decreased in all experiments; this is consistent with our extraction data where higher fluorescence was found after 5.5 than after 3.5 h. The results show that ALA-induced photosensitization has a high potential for photodynamic therapy (PDT) of superficial bladder carcinoma.

Aminolevulinic Acid↗
PubMed1996

The ileal neobladder--updated experience with 306 patients.

From April 1986 through May 1995, 306 men with primary urothelial carcinoma underwent radical cystoprostatectomy and orthotopic bladder substitution via the ileal neobladder. Altogether, 7.5% of the patients suffered general early complications, including thrombosis, embolism, wound infection, and pneumonia. Specific early complications directly related to formation of the neobladder and requiring surgery included ileus (4%), abscess drainage (2%), and leakage of the ileal anastomosis (0.5%). The early reoperation rate was 6.5%. Early complications that required temporary percutaneous drainage were lymphocele formation (3%) or ureteral obstruction (6%). In all, 9% of our patients required prolonged catheter drainage for leakage of the ileouretheral anastomosis. Late complications requiring reoperation were ileus (2%), abscess drainage (1%), neobladder fistula to the colon (1.5%), ureteral reimplantation because of obstruction (3.6%), and nephrectomy for hydronephrosis (1%). A transurethral incision of the ileouretheral anastomosis was necessary in 7% of cases. Continence was separately addressed by sending each patient and his home physician a detailed questionnaire: Using our criteria (no diapers, no awakenings) the night and day continence rate increased from 67% at 6 months, to 72% at 1 year to 85% at 2 years, finally reacting 90% after 4 years. In part II of this presentation we address the question as to whether the option of orthotopic bladder replacement has any impact on the patient's and physician's decision toward earlier cystectomy. We compared our ileal neobladder cohort with a group of 137 patients that had been operated on during the same time span by the same group of surgeons. There was no negative selection with regard of the tumor stage of our patients. However, as compared with the conduit group, the neobladder cohort had a significantly improved survival rate. This phenomenon is explainable by the significantly lower number of previous transurethral resections of the bladder (TUR-Bs) performed in the neobladder group. The time span between primary diagnosis and cystectomy was 10 months in the neobladder group as compared with 18 months in the conduit patients. These data reinforce our belief that orthotopic bladder replacement using the ileal neobladder yields an extraordinary functional result that can be accomplished with a high degree of patient satisfaction and minimal complication. The availability of orthotopic bladder replacement does indeed stimulate the physicians and patients decision toward earlier cystectomy.

Aged↗
PubMed1996

[Positron emission tomography in diagnosis of renal cell carcinoma].

PET is a new method for staging malignant tumors; the metabolism is examined and not the morphology. In this study the staging of renal cell carcinoma (RCC) by PET was investigated. In 29 patients PET with fluorodeoxyglucose (FDG) was carried out preoperatively; the PET results were compared to the histology of the OR specimen. In 26 patients a RCC was found histologically, which was diagnosed correctly by PET in 20 patients; in 6 patients a false-negative PET result was obtained. An angiomyolipoma, a pericytoma and a pheochromocytoma showed a false-positive PET result. For lymph-node staging positive nodes were found in 3 patients which was correct; no false-negative result was obtained. In 25 patients the PET result was true-positive; once a false-positive finding occurred. In conclusion, PET offers the advantage that no allergy to FDG is known and a pacemaker or metal implants are not contraindications; in diagnosing RCC, according to our results there is no further advantage of FDG-PET in comparison to standard methods; for lymph-node staging the results are equivalent

Blood Glucose↗
PubMed1996

[Ileal neobladder with anastomosis to the female urethra].

Orthotopic reconstruction to the native urethra has revolutionized urinary diversion, allowing patients to void per the urethra. This form of urinary diversion was initially performed solely in male patients after cystectomy. More recently, however, with a better understanding of the female continence mechanism, including the urethral/vaginal support mechanism, and the ability to select appropriate female candidates properly for this type of surgery, orthotopic reconstruction has become a viable option in women. Since November 1986, 24 women aged 53 years (range 17-76) have undergone orthotopic reconstruction using the ileal neobladder. Indications for cystectomy included transitional cell carcinoma of the bladder (8), fibrotic radiated bladder (4), interstitial cystitis (5), tuberculotic bladder (2), urge incontinence (2), neurogenic fibrotic bladder (2), and fibrotic bladder of unknown etiology (1). Nineteen patients are available with a median follow-up of 48 months (range 3 to 109 months). There were no perioperative deaths, with few early and late complications. Two women previously irradiated developed a neovesicovaginal fistula and had to be diverted by an ileal loop. Three patients from the far East are no longer available for follow-up. Ten years of experience with 24 patients have led to a nerve- and urethral-support-sparing cystectomy technique with the ileal neobladder anastomosed to the proximal urethra. However, even then, retention in 20% of the patients rather than the expected incontinence is the critical issue. Incontinence has never been a problem. The advent of orthotopic lower urinary reconstruction in women is a major achievement in the evolution of urinary diversion. With our increasing understanding of the continence mechanism in women and with increasing evidence that the female urethra can be safely preserved after cystectomy, orthotopic lower urinary tract reconstruction by the ileal neobladder can now be offered safely not only to males, but also to female patients undergoing cystectomy, and the functional results are superb.

Adolescent↗
PubMed1995

Photodynamic efficiency of liposome-administered tetramethyl hematoporphyrin in two human bladder cancer cell lines.

The main problems presented by superficial bladder carcinoma, its high recurrence rate and multifocal appearance, require treatment of the bladder as a whole. Photodynamic therapy (PDT) is one such experimental treatment for superficial bladder carcinoma, involving the administration of a photosensitizer that accumulates in the tumor tissue, and subsequent irradiation of the tumor with light. Since the photosensitizers used in PDT suffer from several drawbacks, new photosensitizers are being sought. Drug delivery systems are also being investigated for the administration of hydrophobic photosensitizers and enhancement of photodynamic efficiency and tumor selectivity. In this study we examined a new photosensitizer, tetramethyl hematoporphyrin (TMHP), in two human bladder cancer cell lines. In the first pair of the experiments, TMHP was bound to unilamellar liposomes. Cellular uptake, dark toxicity and photodynamic efficiency were then studied. Fluorescence microscopy showed TMHP localization in the cytoplasm in a perinuclear region, sparing the nucleus. Dark toxicity occurred after incubation of cells with TMHP above a concentration of 20 micrograms/ml. Irradiation was carried out using an argon-pumped dye laser emitting a wavelength of 630 nm at a fluence of 3.6 and 7.2 J/cm2. Before irradiation, cells were incubated with TMHP at concentrations of 2.5 and 5 micrograms/ml for 1 h. Cell survival rates after incubation with 5 micrograms/ml TMHP and irradiation at 7.2 J/cm2 were 15.7% of control cells for Rec and 4.5% for Waf cells. Uptake studies showed a higher intracellular TMHP concentration in Waf than in Rec cells. This correlates with the higher PDT efficiency seen in Waf cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Transitional Cell↗
PubMed1995

Minimal invasive therapy of prostatic abscess by transrectal ultrasound-guided perineal drainage.

Prostatic abscess is a rare but severe disease. Conventional therapy is transurethral resection of the prostatic abscess. Since the advent of transrectal ultrasound (TRUS) a minimal-invasive treatment of prostatic abscess by TRUS-guided perineal drainage under local anesthesia is available. We report on our experience in 6 patients with prostatic abscess. TRUS is a simple, rapid, easily accessible, and accurate method for diagnosis, therapy and follow-up of a prostatic abscess. TRUS-guided perineal drainage of a prostatic abscess is an effective, minimal-invasive and cost-effective treatment without adverse side effects.

Abscess↗
PubMed1995

[Initial experiences with the Memotherm Stent in treatment of benign prostatic hyperplasia].

We report our experience with a new thermosensitive stent (Memotherm), which has been invented recently as an alternative method for treatment of benign prostatic hyperplasia. The wall of this stent is a thermoreactive mesh made of nitinol, which reaches its maximum force of expansion at body temperature. Its high degree of flexibility allows the Memotherm stent to fit the natural course of the prostatic urethra. This stent is available in different sizes between 2 and 8 cm to meet the demand for different lengths of prostatic urethra. Furthermore, the meshed structure of this stent allows its atraumatic removal. From April 1992 to September 1993, 54 consecutive patients with benign prostatic hyperplasia and Memotherm stents inserted. The mean patient age was 76.1 years (range 61-98 years). Patients were considered suitable for treatment with the Memotherm stent when they presented with a poor operative risk. Mean prostatic volume was 51.9 +/- 25 ml (20-150 ml), and on average a stent measured 32.3 +/- 9.5 mm (20-70 mm). Preoperatively, only 14 patients (26%) were able to void, and 40 patients (74%) had had a transurethral or suprapubic catheter placed. After placement of the Memotherm stent, 53 of 54 patients were able to void. In the patients who were able to void preoperatively, the mean maximum flow rate increased from 4.5 ml/s to 15.8 ml/s within the first 6 months after treatment. Within the same period of time, the mean residual urine volume decreased from 194.4 ml to 11.8 ml, and the AUA 6-Symptom Score improved from 24 to 3.5 points. All differences are statistically significant (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Uptake and phototoxic effects of aluminum-chlorophthalocyanine (AlSPc) in human bladder carcinoma cells.

In vitro experiments were performed on human bladder carcinoma cells to evaluate the uptake of aluminum-chlorophthalocyanine (AISPc) and the subcellular target of phototoxicity. In order to quantify the correlation of intracellular uptake and incubation time and to identify the primary subcellular target of phototoxicity, fluorescence and absorption measurements have been carried out as well as electron microscopic studies. Absorption and fluorescence measurements showed the largest value after 24 h of incubation time. Fluorescence microscopic studies suggested the sensitizer to be located in a brighter patch within cytoplasm. Electron microscopic studies using DAB (3,3' diaminobenzidine) staining showed that the mitochondria are the primary target of phototoxic activity of AlSPc and that the majority of vacuoles of treated cells were originally mitochondria.

Carcinoma, Transitional Cell↗
PubMed1994

Comparison of two routes of photosensitizer administration for photodynamic therapy of bladder cancer.

Photodynamic therapy (PDT) consists in administration of a photosensitizer and subsequent irradiation of the tumor with visible light. Routinely the photosensitizer is given intravenously (i.v.). The goal of our study was to examine whether intravesical (i.b.) instillation of the photosensitizer for PDT of bladder cancer might be feasible. Therefore, the uptake of chlor-aluminum-sulfonated phthalocyanine (CASPc) in bladder, bladder tumor, skin, and muscle in a rat bladder cancer model after i.v. injection and i.b. instillation was compared. The efficacy of PDT after either method of administration was also evaluated. The CASPc concentration in bladder tumor after i.v. injection was approximately 1.5-fold that after i.b. instillation. The ratio of CASPc concentration between bladder tumor and normal bladder was approximately 2:1 after administration by either route. There was no systemic absorption of CASPc after i.b. instillation; hence no systemic side effects are expected. PDT showed similar effects on bladder tumor after either method of administration, but less side effects on normal bladder wall after i.b. instillation. Our results demonstrate that i.b. instillation of CASPc for PDT of superficial bladder cancer seems to have advantages over i.v. injection.

Administration, Intravesical↗
PubMed1994

Photodynamic therapy of human bladder carcinoma cells in vitro with pH-sensitive liposomes as carriers for 9-acetoxy-tetra-n-propylporphycene.

In vitro experiments were performed on human bladder carcinoma cells to evaluate the efficiency of the recently synthesized photosensitizer 9-acetoxy-tetra-n-propylporphycene (ATPPn) for photodynamic therapy. To improve cytoplasmic delivery of this hydrophobic compound, we prepared pH-sensitive liposomes composed of phosphatidylethanolamine (PE) and cholesteryl hemisuccinate (CHEMS) in comparison with pH-insensitive liposomes consisting of phosphatidylcholine (PC) and CHEMS. Dynamic light scattering measurements were used to monitor the acid-induced liposome destabilization. After incubation with liposome-bound ATPPn, bladder carcinoma cells were irradiated by a dye laser with increasing light fluence rates from 1 to 48 J/cm2. The photodynamic effects were then assessed from cell survival curves. No dark or phospholipid toxicity was measured for 2 micrograms ATPPn/1.5 ml medium. Qualitative cellular uptake of ATPPn was determined by fluorescence microscopy, while photodamage was elucidated by transmission and scanning electron microscopy. Absorption spectra performed up to 42 days revealed changes in shape for the pH-sensitive liposomes after storage at room temperature. ATPPn was proved to be an encouraging photosensitizer, capable of reducing cell survival to 0.1% after short-term incubation of 60 min with a drug dose of 2 micrograms ATPPn/1.5 ml medium. Although pH-sensitive PE/CHEMS liposomes showed significantly (P < 0.05) more photokilling effects at 24 J/cm2 and 48 J/cm2, no further advantages over non-pH-sensitive PC/CHEMS liposomes were found.

Carcinoma↗