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R Klän

Publications and source records attributed to R Klän.

At least 19 recordsLinked to original sources
PubMed1998

Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: results in 143 patients.

Although extracorporeal shockwave lithotripsy (SWL) is a successful treatment for ureteral calculi, introduction of miniureteroscopes has advanced endoscopic management. We combined the use of a semirigid ureteroscope with a pneumatic lithotripter (Swiss Lithoclast) for the treatment of ureteral calculi. From January 1992 to August 1994, 143 patients (87 male, 56 female; mean age 48.7 years; age range 22-74 years) with urolithiasis underwent endoscopic lithotripsy with the Swiss Lithoclast under general anesthesia. The 0.8 = mm probe was inserted through the deflected working channel (3.4F) of the Micro-6L ureteroscope (tip diameter 6.9F). The calculi were in the distal (N = 96; 67.1%), mid (N = 34; 23.8%), and proximal part (N = 13; 9.1%) of the ureter. The mean stone size was 6.8 mm (range 5-26 mm). Of the 137 patients whose stones we could access adequately, 70 (51.1%) were stone free immediately after the procedure, and another 31 (22.6%) had residual fragments <3 mm that passed spontaneously. The remaining 36 patients underwent another 50 procedures; 30 SWL sessions in 26 patients (19%), 17 further endoscopic lithotripsies in 14 (10.2%), and open surgery in 3. Application of the Swiss Lithoclast through semirigid miniureteroscopes is highly effective for endoscopic lithotripsy, regardless of stone composition. Deflection of the probe up to 30 degrees did not impair the disintegration rate. Because of the high migration rate of mid and proximal ureteral stones, the Swiss Lithoclast is not recommended in these cases as a primary procedure. Low capital cost and simple and safe handling are the device's major advantages over laser lithotripsy.

Adolescent↗
PubMed1997

Is routine excretory urography necessary at first diagnosis of bladder cancer?

PURPOSE: We determined whether routine excretory urography (IVP) at initial diagnosis of bladder cancer is useful in screening the upper urinary tract for clinically inapparent urothelial tumors. MATERIALS AND METHODS: IVPs and ultrasound findings of 314 patients with bladder cancer were reviewed retrospectively. RESULTS: Only 1 silent upper urinary tract tumor was detected with IVP (0.3%), resulting in nephroureterectomy. IVP had no further therapeutic consequences except for destruction of an asymptomatic prevesical stone. IVP was followed by ureterorenoscopy in 5 patients with negative results. Upper urinary tract obstruction could be documented equally well by sonography in all cases. CONCLUSIONS: Routine IVP at first diagnosis of bladder cancer is unnecessary.

Adult↗
PubMed1996

Transplantation in autosomal dominant polycystic kidney disease without nephrectomy.

Some transplantation centers still suggest nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) before kidney transplantation at least in selected cases. We wanted to learn whether prior nephrectomy is beneficial. The outcome of kidney transplantation in 47 consecutive ADPKD patients without prior nephrectomy was compared with that in matched controls with respect to complications of ADPKD. Although ADPKD patients were older than controls (mean, 50.1 vs. 40.3 years), there was no statistically significant difference in 1- and 5-year allograft survival between ADPKD patients and controls: 76.6 and 68.0%, respectively, in ADPKD patients, and 83.9 and 56.3% in controls. After a mean follow-up of 66.5 months 3 patients with ADPKD had cyst infections and were managed with antibiotics. Two patients had episodes of hematuria; neither required invasive therapy. There was no renal malignancy and clinical sign of urolithiasis in any patient. No posttransplantation nephrectomy was required. With only few indications remaining, there is no rationale for routine pretransplantation nephrectomy in patients with ADPKD.

Adult↗
PubMed1996

Evaluation of acute scrotal pain by color-coded duplex sonography.

In light of the high sensitivity of color-coded duplex sonography (CCDS), we analyzed a group of patients with acute scrotal pain to evaluate the use of CCDS in routine clinical examination. During March 1988 through April 1991, CCDS was used in 31 patients with acute scrotal pain before they underweight surgery in our department. In 15 patients, the structural and perfusion changes of the scrotal contents were such that a definitive diagnosis was possible. In the rest of the patients, the pathologic changes seen with CCDS were more complex, and the correct interpretation needed more expertise; this was especially true in patients with partial torsion, posttorsion status, and torsion of hydatids. CCDS with the simultaneous display of anatomic scrotal structures and blood flow over the entire scan field is an excellent method for evaluating patients with acute scrotal pain. However, apart from the classical case of no perfusion (as in testicular torsion) and increased perfusion (as in inflammation), more complex changes are more difficult to interpret. The correct diagnosis in the latter cases requires considerable experience and evaluation of all facts, including clinical history, results of palpation, and structural and perfusion changes of the scrotal contents.

Acute Disease↗
PubMed1995

Nitric oxide donor, linsidomine chlorhydrate (SIN-1), in the diagnosis and treatment of erectile dysfunction: critical appraisal and review of the literature.

Recent experimental work has demonstrated that nitric oxide (NO) is the neutrotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO-donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have come to conflicting results ranging from highest praise to complete dismissal. We reviewed all published studies on the use of SIN-1 for intracorporeal injection in erectile failure including our own. To this date, 3 groups published their data. Only the uncontrolled data from Hannover claim good results. The controlled data from Hamburg and Berlin on patients with erectile failure due to venous leakage, to a mixed aetiology in a double-blind fashion and to mixed aetiology with drug increase (1 mg versus 2 mg of SIN-1) showed a significantly worse performance of SIN-1 compared to the standard drug for penile injection, prostaglandin E1. We conclude that there is no place for linsidomine chlorhydrate in either the diagnosis or the treatment of erectile dysfunction.

Animals↗
PubMed1995

Long-term monitoring of 486P 3/12 antigen pattern (quantitative immunocytology) before, during, and after mitomycin C prophylaxis in patients with superficial bladder cancer.

OBJECTIVES: Quantitative pattern of 486p 3/12 antigenicity in urine cytologies (Quic) of patients with superficial bladder carcinoma during operation and chemoprophylaxis was evaluated to determine the duration of prophylaxis on an individual patient-oriented basis. METHODS: Thirty-six patients with superficial bladder carcinoma during chemoprophylaxis (43 [range, 3 to 90] weeks of mitomycin C) have been evaluated monthly for 99 (range, 36 to 141) weeks. RESULTS: Only 6 of 36 patients (16.7%) had tumor recurrence after mean follow-up of 67.5 weeks. During mitomycin instillations, only 5 patients converted from positive to repeated negative Quic. None of them developed tumor. Thirty-one did not convert and only 6 of them developed recurrent tumor. CONCLUSIONS: Quic seems not to be a reliable marker during mitomycin prophylaxis. After mitomycin prophylaxis, a repeated positive Quic, however, was associated with a high risk of recurrence occurring in 3 of 8 Quic-positive patients. A repeated negative or alternating Quic identified a lower risk group, showing 3 recurrent tumors in 28 patients only. We conclude that Quic cannot be used during, but after, prophylaxis to identify risk patients requiring further treatment. During prophylaxis, its value is limited to a subgroup of patients developing negative Quic, for whom prophylaxis can be stopped individually.

Adult↗
PubMed1995

Laparoscopic pelvic lymphadenectomy in prostatic cancer: an analysis of seventy consecutive cases.

From July 1992 to April 1994, 70 patients with prostatic cancer underwent laparoscopic pelvic lymph-node dissection (LPLD) before retropubic radical prostatectomy or afterloading therapy in our clinic. After an initial learning phase, the accuracy of LPLD was excellent, with only 3.0% residual nodes and no false-negative results due to LPLD. The rate of severe complications was 5.7% (4/70). No transfusions were required due to LPLD. If patients with positive nodes (D1) were excluded from local therapy, the benefits of LPLD were estimated as 12 patients with positive nodes avoiding open surgery (17.1%); 15 patients undergoing afterloading therapy and avoiding open surgery (21.4%); 1 patient with high preoperative prostate-specific antigen having a chance of surgical cure (1.4%) - a total of 28 of 70 patients (40.0%). We conclude that, depending on the therapeutic concept applied, LPLD is beneficial for patients with prostatic cancer, it opens the door for other curative procedures like after-loading therapy, and reappraisal of perineal prostatectomy.

Adult↗
PubMed1995

Efficacy of linsidomine chlorhydrate, a direct nitric oxide donor, in the treatment of human erectile dysfunction: results of a double-blind cross over trial.

Recent experimental work has demonstrated that nitric oxide (NO) is the neurotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO-donor SIN-1 (linsidomine chlorhydrate) in patients with erectile dysfunction have come to conflicting results. We have performed a double-blind cross over trial in 40 patients with erectile dysfunction of mixed etiology comparing SIN-1, SIN-1 plus the alpha-blocker Urapidil, and prostaglandin E1 (PGE1) in order to determine the effectiveness of SIN-1. PGE1 achieved the best response, the combination of SIN-1 and Urapidil performed slightly, statistically insignificantly poorer with significantly increased side effects. SIN-1 alone performed statistically significantly (p < 0.0068) worse. SIN-1 is not a useful alternative to PGE1. The combination of SIN-1 and Urapidil performs equally as good as PGE1 but cannot be recommended due to intolerable side effects.

Adult↗
PubMed1994

Bladder cancer following prostate cancer--an analysis of risk factors.

Between 1969 and 1988, 1421 men had been treated for primary adenocarcinoma of the prostate. In 14 cases subsequent primary bladder cancer was observed, as compared to 5.98 cases to be expected, thus constituting a relative risk of 2.34. Seven of these cases developed synchronously (within 6 months), with a range of up to 10 years. Aetiologically, cigarette smoking was detected as the single most important denominator, whereas family history was positive for malignancy in only two cases.

Adenocarcinoma↗
PubMed1994

Rescue of renal transplants with distal ureteral complications by pyelo-pyelostomy.

Secondary ureteroneocystostomy is the procedure most commonly used for repair of ureteral stenosis or necrosis in renal transplant patients. However, when the transplant ureter available for reconstruction is too short, ureteropyelostomy is the standard procedure. Another option is pyelo-pyelostomy, which has been used infrequently to date. Between 1979 and 1988 we managed 6 patients (4 men and 2 women 42 to 62 years old) with renal allografts who required repair of the transplant ureter for long segmented ureteral necrosis (3), long segmented ureteral stenosis (2) and an iatrogenic lesion of the ureter (1) with pyelo-pyelostomy. Of the 6 patients 2 had undergone previous rescue operations. Pyelo-pyelostomy with the renal pelvis of the graft was performed as first described by Gil-Vernet and Caralps in 1968. Median followup was 6 years (range 3 to 12 years). Two patients died of chronic rejection and pulmonary embolism, respectively. Four patients are still alive with functioning transplants and serum creatinine levels of less than 210 mumol/l. According to our experiences with 6 patients, we believe that pyelo-pyelostomy is a promising rescue maneuver that is worth consideration in cases of total or subtotal ureteral necrosis and long segmented ureteral stenosis after renal transplantation.

Adult↗
PubMed1994

Prostaglandin E1 versus linsidomine chlorhydrate in erectile dysfunction.

Recent experimental work has demonstrated that nitric oxide (NO) is the neurotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have had conflicting results. We performed a single-blind cross-over trial in 20 patients with erectile dysfunction of mixed etiology comparing prostaglandin E1 (PGE1) to SIN-1 at two different dosages (1 and 2 mg, respectively) in order to determine the effectiveness of SIN-1. PGE1 always achieved the best response, SIN-1 performed statistically significantly poorer irrespective of the dosage used. There were only a few side effects with no significant difference. SIN-1 is not a useful alternative to PGE1 in the treatment of erectile dysfunction.

Adult↗
PubMed1994

[Laparoscopic vs. open surgical lymphadenectomy in prostate cancer. Methodological comparison].

Bilateral laparoscopic pelvic lymph node dissection was performed in 27 consecutive patients with stage B prostatic carcinoma. The first 5 operations (learning phase) were compared with the next 22 procedures and with a group of 20 patients who had undergone conventional open lymphadenectomy previously. Retropubic radical prostatectomy was done in 22 patients with negative nodes. All residual lymphatic tissue was removed. During the learning phase the average operating time was 3 h 40 min. The mean number of laparoscopically removed nodes was 5.8 on both sides. At open operation we found 1.5 residual nodes on the right side and 5.3 residual nodes on the left. In one case one of the residual nodes was positive for tumor. Operating time in the next 22 patients was 2 h 20 min. The number of nodes removed laparoscopically was 8.3 on the right and 7.0 on the left. Residual nodes were found in only 3 patients. None of these nodes was positive for tumor. In both groups the number of nodes removed was greater than in the group of patients who underwent open lymphadenectomy. In one of the first 5 patients immediate open surgery was required because of bleeding. In 1 patient's nodes evidence of Hodgkin disease was found. This was the only patient to develop a lymphatic fistula. There were no lymphoceles. We feel that laparoscopic pelvic lymphadenectomy has a definite learning curve but is a safe staging procedure for prostatic cancer with results equivalent to those of the open operation.

Adult↗
PubMed1993

Acetylsalicylic acid inhibition of n-butyl-(4-hydroxybutyl)nitrosamine-induced bladder carcinogenesis in rats.

We examined the effect of acetylsalicylic acid (ASA) on n-butyl-(4-hydroxybutyl)nitrosamine (BHBN)-induced bladder carcinogenesis in male Wistar rats. Of 29 rats that received 0.05% BHBN in their drinking water for 9 weeks, 8 developed bladder cancer. Only 1 out of 29 rats that received 0.1% ASA in their diet for 20 weeks, including the period of BHBN consumption, developed a tumor. That difference is statistically significant. Bladder weight was significantly higher in rats given BHBN than in controls and in rats given both BHBN and ASA. We conclude that ASA inhibits BHBN-induced bladder carcinogenesis.

Animals↗
PubMed1993

[Endoscopic lithotripsy with pneumatic shockwave (Swiss Lithoclast) using a mini-ureteroscope].

We performed endoscopic lithotripsy for 23 urinary stones (21 ureteral and 2 bladder stones) with a pneumatic shockwave unit (Swiss Lithoclast; EMS, Angiomed), for the first time applying the probe through the tangential working channel of a semirigid 6.9-Fr ureteroscope (Circon, ACMI). Disintegration was successful in all stones (5-24 mm). Immediately after treatment, the 2 patients with bladder calculi and 10 of the patients with ureteral stones (47.6%) were stone free, while another 5 had residual fragments < 3 mm. Migration of fragments in 4 patients (19%) led to subsequent extracorporeal shock wave lithotripsy. There were no ureteral perforations in this series. Routine application of double-J stents avoided any serious postoperative complications. Endoscopic lithotripsy with the pneumatic shockwave unit was shown to be highly effective regardless of stone composition. The ltihotripsy probe is easily applied through mini-ureteroscopes.

Adolescent↗
PubMed1992

[Polychemotherapy in advanced bladder cancer. Practicality and clinical results].

From 1987 to 1990 a consecutive series of 172 patients were treated for advanced bladder cancer, in our clinic, 48 of whom underwent radical cystectomy. In 80 of the remaining 124 patients polychemotherapy was not possible, because of impaired renal function, poor performance status, cardiovascular disease, second malignancy or other problems. There were 11 patients who refused further treatment and 13 patients with tumor restricted to the pelvis who underwent radiochemotherapy. Thus, 20 patients received polychemotherapy with either methotrexate, vinblastine, Adriamycin and cisplatin (M-VAC) or cisplatin, methotrexate and vinblastine (CMV). In 90% of the M-VAC cycles and 34% of the CMV cycles dose reduction was necessary. Median survival was 10 months. We achieved 2 complete responses lasting 6 months and 19 months and 4 partial responses. The authors conclude that patients who cannot undergo radical surgery for bladder cancer are not good candidates for polychemotherapy either. Only patients with measurable remission of the tumour have a longer survival. New regimens with lower toxicity, and especially with lower renal toxicity, must be developed.

Adult↗
PubMed1991

Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder.

When a second transurethral resection was routinely performed 8 to 14 days after the initial transurethral resection in 46 patients for stage T1 bladder tumors residual disease was found in 20 despite the surgical report of complete resection in 40. In only 13 patients was residual tumor noted at repeat resection by the senior urologist performing the operation and residual tumor was confirmed histologically in 10 of them. The extent of the lesion is easily misjudged even by experienced surgeons. Early cystoscopy cannot exclude residual tumor. Residual tumor is an important cause of early recurrence and repeat resection of stage T1 lesions is recommended.

Carcinoma, Transitional Cell↗
PubMed1991

Sensitivity of urinary quantitative immunocytology with monoclonal antibody 486 P3/12 in 241 unselected patients with bladder carcinoma.

We investigated the sensitivity of quantitative immunocytology with our monoclonal antibody 486 P3/12 in 241 unselected patients with transitional cell carcinoma. Immunocytology yielded a sensitivity of 91.8%, 89.4% and 92.9% for grade 1, 2 and 3 tumors, respectively. Standard cytology was positive in 59.2%, 63.8% and 84.7%, respectively. Deoxyribonucleic acid flow cytometry, used in the first 69 patients, was positive in only 27.7%, 48.6% and 57.1%, respectively.

Antibodies, Monoclonal↗