Biomedical subjects

R Waidelich

Publications and source records attributed to R Waidelich.

12 recordsLinked to original sources

PubMed2003

Fluorescence diagnosis: a novel method to guide radical inguinal lymph node dissection in penile cancer.

In penile cancer there is still a diagnostic dilemma between over treatment of lymph node-negative patients and the missing of occult metastases by watchful waiting. In the current study the value of fluorescence diagnosis during radical inguinal lymph node dissection was evaluated. Five patients with penile cancer were elected to undergo groin dissection. All patients received 5-aminolevulinic acid (5-ALA) orally before the operation for fluorescence diagnosis. Intraoperatively, fluorescence detection of the lymph nodes was performed by visual detection and spectroscopy. Two of the five patients had positive inguinal lymph nodes. Fluorescence in tumor-bearing tissue was detectable in the exposed lymph nodes. Protoporphyrin IX (PPIX) is accumulated in tumor-positive lymph nodes, making fluorescence diagnosis in penile cancer possible. More studies with higher patient numbers are necessary to evaluate optimal dosage and excitation conditions to detect tumor-bearing nodes in vivo.

Fluorescence↗

PubMed2003

Whole bladder photodynamic therapy with 5-aminolevulinic acid using a white light source.

OBJECTIVES: To determine whether whole bladder photodynamic therapy after intravesical administration of 5-aminolevulinic acid using a white light source would destroy urothelial carcinoma. We sought to define the optimal target group of patients for this therapy. The side effects of treatment were also assessed. METHODS: We performed whole bladder photodynamic therapy with 100 J/cm(2) white light 2 to 4.5 hours after intravesical administration of 17% 5-aminolevulinic acid in 12 patients with recurring, multifocal, Stage pTa, grade I to III, urothelial tumors of the bladder and carcinoma in situ. RESULTS: Immediately after whole bladder irradiation, histologic examination of biopsies taken from flat suspicious lesions showed no viable cells; remnants of malignant cells were found in papillary tumors. Of the 12 patients, 11 returned for follow-up examination. At a median follow-up of 18 months (range 3 to 25), 3 of the 7 patients with carcinoma in situ and 2 of the 4 patients with papillary tumors were free of disease. In all patients, urinary frequency and urgency subsided within 3 weeks. No decreased bladder capacity or systemic side effects were observed. CONCLUSIONS: Our preliminary data show that whole bladder photodynamic therapy with intravesically applied 5-aminolevulinic acid using a white light source is effective in destroying flat malignant lesions of the bladder such as carcinoma in situ. The procedure is easy to perform and is not associated with any major side effects. The findings warrant long-term and multicenter studies.

Administration, Intravesical↗

PubMed2002

Penile carcinoma. Is Nd:YAG laser therapy radical enough?

PURPOSE: Penile carcinoma is a difficult disease to treat due to its aggressive nature and the psychological effects of amputation, which is often the recommended therapy. Outcome data from the last 13 years on patients with penile carcinoma treated with Nd:YAG laser coagulation were evaluated and compared with outcome data on conventional organ sparing techniques. MATERIALS AND METHODS: For the last 13 years 29 patients were treated with Nd:YAG laser coagulation, including 17 with carcinoma in situ, and 10 with stage T1 and 2 with T2 cancer. Mean patient age was 55.1 years and mean followup was 46.7 months. RESULTS: All patients are alive. Disease recurred in 1 patient with T1 tumor and 1 with carcinoma in situ. All patients were satisfied with the cosmetic and functional result. CONCLUSIONS: Recurrence rates after Nd:YAG laser treatment for T1 tumors are comparable to those after partial amputation. Excellent cosmetic and functional results can be achieved without compromising oncological principles. For patients with metastasis prognosis is limited by the distant disease and, therefore, amputation is only necessary to achieve local control.

Adult↗

PubMed2001

[Fluorescence cytology of the urinary bladder].

5-aminolevulinic acid induced fluorescence cystoscopy is invaluable for diagnosing urinary bladder carcinoma and its precursors. Because neoplastic cells of the urinary bladder possess striking fluorescent properties due to protoporphyrin IX, we initiated a study to evaluate the use of fluorescence microscopy in urinary sediments. In 27 patients suspected of having bladder carcinomas, we instilled 5-aminolevulinic acid into their urinary bladders before transurethral therapy and compared thereafter our studies of standard cytological sediments with those made under fluorescence microscopy. The results of fluorescence cystoscopy and those using urinary sediments for neoplastic cells under fluorescence microscopy correlated extremely well. In this pilot study using fluorescence microscopy, we found that we could diagnose with precision urinary neoplasms of different grades of differentiation. Accordingly, we regard fluorescence microscopy as a valuable complement for standard urinary cytology, especially since with fluorescence microscopy we can readily recognize fluorescing cells of highly differentiated urinary tumors and flat premalignant dysplasias.

Aminolevulinic Acid↗

PubMed2001

Clinical experience with 5-aminolevulinic acid and photodynamic therapy for refractory superficial bladder cancer.

PURPOSE: We determined whether photodynamic therapy after the oral administration of 5-aminolevulinic acid in patients with superficial bladder cancer that cannot be controlled by transurethral resection and intravesical bacillus Calmette-Guerin (BCG) immunotherapy would preserve the bladder, while stopping tumor progression. Side effects of treatment were also assessed. MATERIALS AND METHODS: We performed photodynamic therapy after the oral administration of 5-aminolevulinic acid in 24 patients with rapidly recurring, multifocal, BCG refractory superficial pTa-pT1 transitional cell carcinoma of the bladder and carcinoma in situ. RESULTS: At a median followup of 36 months (range 12 to 51) 3 of the 5 patients with carcinoma in situ and 4 of the 19 with papillary tumors were free of recurrence. Three patients were rendered disease-free by repeat photodynamic therapy with 5-aminolevulinic acid and 3 underwent cystectomy. Tumor progression was stopped in 20 of our 24 cases. Immediately after the oral administration of 5-aminolevulinic acid hypotension and tachycardia occurred in 19 and 10 patients, respectively, with previously known severe cardiovascular disease. No phototoxic skin reaction or decreased bladder capacity was observed. CONCLUSIONS: These initial clinical results suggest that photodynamic therapy with orally administered 5-aminolevulinic acid is effective as an organ preserving procedure for treating superficial bladder cancer even in patients with bacillus Calmette-Guerin refractory carcinoma. One should be aware of hemodynamic instability after the oral administration of 5-aminolevulinic acid, particularly in patients with cardiovascular co-morbidity.

Adult↗

PubMed1998

Breathhold MR urography: comparison between HASTE and RARE in healthy volunteers.

The purpose of our study was to determine relative values of rapid acquisition relaxation enhancement (RARE) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences in breathhold magnetic resonance (MR) urography in healthy volunteers under nonobstructive conditions of the urinary tract. A total of 20 healthy volunteers underwent MR urography with breathhold RARE and HASTE sequences at 1.5 T. For evaluation, the urinary tract was divided into nine segments on each side. Visualization of segments and artifacts was scored and the intensity ratios (InR) were determined. The upper five urinary segments were sufficiently visualized with RARE and significantly better with HASTE (renal calices, p = 0.002-0.037). The middle and lower ureter was sufficiently delineated both with RARE and HASTE, but HASTE images were statistically superior (p = 0.009-0.041). Both in RARE and HASTE images, the lower ureter was frequently superimposed by bowel contents and bowel motion. Superimposition of genital organs degraded image quality in eight of ten female volunteers. InRs were superior with HASTE in the kidney and ureter (p = 0.0003-0.0125). RARE InRs were higher in the bladder (p = 0.0008-0.014). We concluded that neither the RARE nor the HASTE sequences allowed the evaluation of the entire urinary tract under nonobstructive conditions. Although it cannot entirely replace intravenous urography, MR urography seems to lend itself to combination with other MR techniques, particularly in the investigation of pelvic or retroperitoneal disease.

Adult↗

PubMed1998

Early clinical experience with 5-aminolevulinic acid for the photodynamic therapy of upper tract urothelial tumors.

PURPOSE: Photodynamic therapy is effective in the treatment of superficial urothelial cancer of the bladder. We report our experience with photodynamic therapy for the treatment of upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS: Photodynamic therapy after oral administration of 5-aminolevulinic acid was performed in 4 patients with widespread superficial papillary tumors of the upper urinary tract. RESULTS: Complete remission occurred in 2 patients who remained free of local recurrence at 7 and 17 months of followup. In the other 2 patients residual tiny papillary tumors were found in the distal ureter after photodynamic therapy. These tumors were coagulated with neodymium:YAG laser irradiation. Both patients are disease-free at 24-month followup. CONCLUSIONS: Photodynamic therapy with 5-aminolevulinic acid is a minimally invasive approach for organ preserving treatment of multifocal superficial transitional cell carcinoma of the upper urinary tract.

Aged↗

PubMed1998

A study of reflux in patients with an ileal orthotopic bladder.

OBJECTIVE: To determine whether there is vesico-ureteric reflux during voiding in patients who had undergone an ileal bladder substitution after cystectomy. PATIENTS AND METHODS: The study comprised 15 patients (13 men and two women) who had undergone radical cystectomy and construction of a Studer ileal neobladder. At 1-24 months (median 4) after the operation indirect radionuclide cystography (IRC) was performed after isotopic renography (using 99m-technetium mercapto-acetyltriglycine) and voiding cysto-urethrography (VCUG). RESULTS: None of the patients had reflux during voiding, either on IRC or on VCUG. Renal function and morphology remained stable in all patients. Despite bacteriuria occurring in four patients, no episode of pyelonephritis was reported. CONCLUSION: There was no vesico-ureteric reflux during voiding in patients with a Studer ileal bladder substitution. However, long-term follow-up is needed to finally determine whether an antirefluxive ureteric implantation is required to protect the upper urinary tract in patients with ileal low-pressure bladder substitutions.

Adult↗

PubMed1996

Early clinical experience with 5-aminolevulinic acid for the photodynamic therapy of superficial bladder cancer.

OBJECTIVE: To report clinical experience with intravesical instillations of 5-aminolevulinic acid (ALA) for the photodynamic therapy of superficial bladder cancer and to assess any side-effects of the treatment. PATIENTS AND METHODS: Ten patients (six men and four women, mean age 62.3 years, range 42-73) with refractory superficial bladder cancer were treated with photodynamic therapy using 5 g of ALA dissolved in 30 mL sodium bicarbonate instilled intravesically. After a mean retention of 5.1 h, the bladder interior was illuminated transurethrally at radiation integrals of 15, 30 or 60 J/cm2. At integrals of 15 or 30 J/cm2 red light (635 nm) was used and at 60 J/cm2, green light (514 nm, 40 J/cm2) was combined with a subsequent application of red light (635 nm, 20 J/cm2). RESULTS: After 10-12 weeks, four patients had a complete remission, two a partial remission, there was no change in three and one had progressive disease. Of those patients responding, the bladder was preserved in five after a mean follow-up of 15 months (range 6-27). There were no photodermatoses or bladder shrinkage in any patient. CONCLUSIONS: Photodynamic therapy with intravesically applied ALA is effective in destroying superficial urothelial carcinomas of the bladder. There were no serious side-effects which could preclude further clinical testing.

Administration, Intravesical↗

PubMed1995

Integral photodynamic treatment of refractory superficial bladder cancer.

PURPOSE: Cystectomy is indicated after unsuccessful transurethral resection and intravesical treatment of superficial bladder cancer. As an alternative, whole bladder photodynamic therapy was done. MATERIALS AND METHODS: In 21 patients the bladder was irradiated with laser light at a wavelength of 630 nm. after intravenous injection of a synthetic porphyrin mixture. RESULTS: Of the 21 patients 12 attained complete remission with a mean disease-free interval of 18.0 months (range 3 to 42), 3 with partial remission were rendered disease-free with transurethral resection or neodymium:YAG laser coagulation and 6 underwent cystectomy. CONCLUSIONS: In patients with refractory superficial bladder cancer the bladder can be preserved by use of photodynamic therapy.

Aged↗

PubMed1994

[Photodynamic therapy of superficial bladder cancer. An alternative to radical cystectomy?].

If transurethral resection and intravesical treatment with BCG or chemotherapeutic agents are unsuccessful in recurrent flat multifocal superficial bladder cancer, cystectomy is considered to be indicated. A whole-bladder photodynamic therapy (PDT) was carried out in 23 patients in this worst-case situation, in 19 of whom minimum follow-up of 3 months has been possible. In 5 patients with carcinoma in situ and in 14 patients with flat papillary tumors covering nearly the whole bladder, Photofrin or Photosan-3 was applied intravesically. Irradiation of the bladder followed about 48 h, later with a light dose of 15 J/cm2 or 30 J/cm2 at a wave length of 630 nm. In 12 patients complete remission was achieved; 7 patients showed no evidence of disease over a follow-up period of 3-31 months (median 16.3 months). One patient was lost to follow-up. In 7 patients recurrent disease or residual tumor was observed following PDT, but these were easily managed by transurethral resection or Nd:YAG laser coagulation. In 4 patients PDT failed and cystectomy was carried out. Systemic progression was not observed. PDT has to be regarded as an alternative to cystectomy in the treatment of refractory superficial bladder cancer.

Aged↗

PubMedDate not supplied

Screening for prostatic carcinoma with prostate specific antigen.

The usefulness of prostate specific antigen (PSA) in screening for prostatic carcinoma was studied in 262 inpatients of the department of internal medicine. All patients underwent a rectal digital examination and determination of PSA by the Tandem-E method (Hybritech). The plan was to perform biopsies if there were suspicious findings on the rectal examination or if the PSA value was more than 10 ng/ml. The PSA values were < or = 4 ng/ml in 219 patients (83.6%), > 4 to 10 ng/ml in 27 patients (10.3%) and > 10 ng/ml in 16 men (6.1%). In consideration of the severity of disease which limited life expectancy we did not perform a biopsy on 37.5% of the patients with PSA > 10 ng/ml. 7 patients with prostatic carcinoma were found. Their PSA values varied between 11.2 and 875 ng/ml. The cancer detection rate was highest for the combination of a suspicious rectal examination and a PSA value > 10 ng/ml (70%).

Aged↗