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Biomedical subjects

U E Studer

Publications and source records attributed to U E Studer.

At least 19 recordsLinked to original sources
PubMed1992

Carcinosarcoma of the urinary bladder: a distinct variant characterized by small cell undifferentiated carcinoma with neuroendocrine features.

The clinicopathological features of two carcinosarcomas of the urinary bladder are reported. The tumours occurred in a 64- and a 66-year-old patient presenting with haematuria and both were polypoid. The epithelial component was consistent with small cell undifferentiated carcinoma with neuroendocrine differentiation, whereas the sarcomatous component did not display specific features. The carcinomatous component showed immunohistochemical reactivity for different epithelial markers as well as for chromogranin and neuron specific enolase. Conversely, the sarcomatous cells stained strongly for vimentin and in one case for muscle actin and smooth muscle actin. The differential diagnosis of biphasic tumours of the bladder is discussed and the literature reviewed.

Actins↗
PubMed1992

Cystadenoma of the seminal vesicle: case report and literature review.

A benign fibroepithelial and cystic tumor of the seminal vesicle is described in a 63-year-old man. The symptoms, macroscopic appearance, microscopic characteristics, immunophenotype prognosis and complications of this rare benign tumor are discussed, and 9 previously reported cases are reviewed. Several terms have been used to describe benign fibroepithelial tumors of the seminal vesicle. We suggest that the term cystadenoma is the most appropriate.

Cystadenoma↗
PubMed1992

[Intracavernous self-injection in impotence].

On the basis of new diagnostic methods, 50 to 80% of impotent men show organic changes which are potentially responsible for erectile dysfunction. In our institution 409 consecutive patients have been submitted to the programme of intracavernous self-injection of papaverine. In 11% of the patients erectile function was normalized after a series of self-injections. 25% use papaverine regularly at home, and 64% discontinued the self-injections. Many of these patients did not accept this form of therapy. Side effects are rare and harmless. Early information about the intracavernous self-injection therapy by the physician can help to avoid unnecessary investigations.

Adult↗
PubMed1991

Ileal bladder substitute: antireflux nipple or afferent tubular segment?

Spheroidal bladder substitutes made from double-folded ileal segments, similar to Goodwin's cup-patch technique, are devoid of major coordinated wall contractions. This, together with the reservoir's direct anastomosis to the membranous urethra, prevents major intraluminal pressure peaks and assures a residue-free voiding of sterile urine. In order to determine whether, under these conditions, an afferent tubular isoperistaltic ileal segment of 20-cm length protects the upper urinary tract as efficiently as an antireflux nipple, 60 male patients who were subjected to radical cystectomy were prospectively randomised to groups in which a bladder substitute was formed together with either of these 2 antireflux devices. An analysis of the results obtained in 20 patients from each group who could be followed for more than 1 year (median observation time 30 and 36 months) showed no differences between the groups in metabolic disturbances, kidney size, reservoir capacity, diurnal and nocturnal urinary continence, the incidence of urinary tract infection or episodes of acute pyelonephritis. Later than 1 year postoperatively, intravenous urograms of the renoureteral units of 25% of the patients with antireflux nipples showed persistent but generally slight dilatation of the upper urinary tracts. This observation was significantly more frequent than it was in patients with afferent tubular segments. Urodynamic and radiographic studies showed that the competence of the antireflux nipples was secured by the raised surrounding intravesical pressure. This, however, also resulted in a transient functional obstruction, and a gradual rise of the basal pressure in the upper urinary tracts was recorded. In patients with afferent ileal tubular segments, contrast medium could be forced upwards into the renal pelvis when the bladder substitutes were overfilled. However, despite raised intravesical pressures, peristalsis in the isoperistaltic afferent tubular segment gradually returned contrast medium back to the reservoir. Our results suggest that the combination of an ileal low-pressure reservoir together with an afferent tubular isoperistaltic limb is at least as good as an antireflux nipple valve. Moreover, the use of the afferent ileal limb makes it possible to resect the distal and often diseased ureters together with the paraureteric lymphatics at a safe distance from the bladder tumor. This avoids also distal ischemic ureteric stenosis and makes possible a simple end-to-side ureterointestinal anastomosis with a small complication rate.

Anastomosis, Surgical↗
PubMed1991

Neutrophil-activating peptide-1/interleukin-8 detection in human urine during acute bladder inflammation caused by transurethral resection of superficial cancer and bacillus Calmette-Guérin administration.

Neutrophil-activating peptide-1/interleukin-8 (NAP-1/IL-8), secreted by monocytes, macrophages and a number of other cells, acts as a chemoattractant for neutrophil leukocytes and stimulates them to produce a series of responses such as shape change, adherence, exocytosis and respiratory burst, events that are of importance in inflammation. To study the release of NAP-1/IL-8, two human models of inflammation were chosen: transurethral resection of superficial bladder cancer and the subsequent instillation of bacillus Calmette-Guérin (BCG), performed in order to reduce the recurrence rate of papillary bladder tumors. As the secretions of the bladder wall are retained in the urine, patients' urine was collected during 4-hour periods. These urine samples were chromatographed on phosphocellulose. In the elution fractions NAP-1/IL-8 was quantified by a bioassay that measured the elastase release by human neutrophils. The neutrophil-stimulating activity was further purified by reverse phase high performance liquid chromatography. Although no NAP-1/IL-8 activity could be detected in normal individuals, formation of this inflammatory cytokine was observed in patients after transurethral resection and after BCG treatment. The significance and possible use of this secretion are discussed.

Administration, Intravesical↗
PubMed1991

[Bladder substitution using the double-folded ileum technic (Goodwin's cup-patch technic)].

An internal urinary diversion after radical cystoprostatectomy has been performed in 70 male patients. The bladder substitute was made from an ileal segment, opened along its antimesenteric border and folded twice, according to Goodwin's "cup-patch technique". After an observation time of 6 months to 6 years, the results are in general good: The initial capacity of the pouch made from only 40 cm of ileum (in order to avoid metabolic disturbances) increases to a functional capacity of 500 ml within the first postoperative weeks. The increase of the bladder substitute's capacity is parallel to the improvement of urinary continence. In general, the latter is achieved after 1-3 months during the day, and after 3-6 months during the night. However, loss of a few drops of urine may occur, reason why half of our patients wear a safety pad later than 6 months after surgery, at least during the night. There was no significant difference between those patients with an antireflux nipple and those patients having an ileal tubular afferent segment.

Adult↗
PubMed1991

[The potential hormonal therapy of prostatic carcinoma].

Hormonal manipulation is still the most effective systemic treatment for prostate cancer. The alternatives to orchiectomy are discussed: estrogens, with their known cardiovascular side-effects, and the expensive LH-RH analogues and/or antiandrogens, the success of which depends heavily on the patient's compliance. With more intensive health care and more sensitive methods of diagnosis, not only is the overall number of prostate carcinomas diagnosed increasing, but also the percentage that need not be fatal. The timing of hormonal treatment and selection of patients are increasing in importance.

Aged↗
PubMed1991

[Replacement bladder constructed with the aid of a folded ileum segment].

An internal urinary diversion after radical cystoprostatectomy has been performed in 70 male patients. The bladder substitute was made from an ileal segment, opened along its antimesenteric border and folded twice, according to Goodwin's "cup-patch technique". After an observation time of 6 months to 6 years, the results are in general good: The initial capacity of the pouch made from only 40 cm of ileum (in order to avoid metabolic disturbances) increases to a functional capacity of 500 ml within the first postoperative weeks. The increase of the bladder substitute's capacity is parallel to the improvement of urinary continence. In general, the latter is achieved after 1-3 months during the day, and after 3-6 months during the night. However, loss of a few drops of urine may occur, reason why half of our patients wear a safety pad later than 6 months after surgery, at least during the night. There was no significant difference between those patients with an antireflux nipple and those patients having an ileal tubular afferent segment.

Adult↗
PubMed1990

[Hormonal therapy (medical orchiectomy) in prostatic carcinoma].

Hormonal therapy of prostate cancer is still the most effective systemic treatment. Possible alternatives to subcapsular orchiectomy are discussed, comprising the estrogens with their known cardiovascular side effects, the expensive LH-RH analogues, and/or the antiandrogens, which depend on the patient's compliance. Due to more intensive health care and more sensitive diagnostic methods, there is now an increase not only in the overall number of diagnosed prostate carcinomas, but also in the percentage of those which do not need treatment. The question when, and in which patient hormonal treatment should be started becomes increasingly important.

Androgen Antagonists↗
PubMed1990

Enlargement of regional lymph nodes in renal cell carcinoma is often not due to metastases.

Preoperative axial computerized tomography scans in 163 patients with renal cell carcinoma were reviewed to assess the predictive value for the diagnosis of regional lymph node metastases. Computerized tomography was falsely negative in 5 patients: 2 had metastatic lymph nodes in the renal hilus adjacent to the primary tumor measuring 2 and 2.5 cm., and 3 had micrometastases in nodes of less than 1 cm. In 43 patients enlarged lymph nodes with a diameter of 1 to 2.2 cm. (median 1.4 cm.) were diagnosed on the preoperative scan and this was confirmed at nephrectomy and pathologically. In 18 of these 43 patients (42%) histological study showed metastases of the renal cell carcinoma in the enlarged lymph nodes. In the other 25 patients (58%) the enlarged nodes showed only inflammatory changes and/or follicular hyperplasia. This finding was significantly more frequent in patients with tumor involvement of the renal vein and tumor necrosis (p = 0.0044). We conclude that the sensitivity of preoperative computerized tomography is good for the detection of enlarged lymph nodes in patients with renal cell cancer (95%). However, significant lymph node enlargement frequently may be caused by inflammatory changes, especially in the presence of tumor necrosis. This radiological finding should not be misinterpreted as metastatic disease, unless it has been proved cytologically by fine needle aspiration.

Carcinoma, Renal Cell↗
PubMed1990

Ultrasonography of testicular tumors.

From 1984 to 1989, 62 patients with palpable testicular tumor were examined with ultrasound before surgical exploration. The ultrasonographic morphology was compared with the histological diagnosis of the tumor. The radiologist's interpretation regarding the type of tumor (seminoma versus nonseminomatous tumor) was correct in 70%. The typical sonography of the seminoma comprises homogeneous, hypoechogenic and sharply delineated masses, but nonseminomatous tumors are inhomogeneous, hypoechogenic, normoechogenic and hyperechogenic masses with cysts and calcifications. The tumor stage could be predicted in precisely 44% of the seminomas and in only 8% of the nonseminomatous tumors. Nevertheless, the ultrasonogram of the testis may provide a false-positive tumor diagnosis. We conclude that ultrasonography may help us in the differential diagnosis of malignant tumors of the testis, but cannot replace surgical and histological exploration of the testis.

Dysgerminoma↗
PubMed1989

Percutaneous bacillus Calmette-Guerin perfusion of the upper urinary tract for carcinoma in situ.

Ten pyeloureteral systems in 8 patients (mean age 74 years) with cytologically proved ureteral carcinoma in situ (1 combined with ureteral papillary tumors) were perfused with bacillus Calmette-Guerin via a percutaneous nephrostomy tube. In 4 patients cytology results remained negative after 1 treatment course during an observation time of 18 to 28 months. In 1 patient a papillary tumor persisted while cytology results became negative for carcinoma in situ. Two patients with bilateral disease had repeated perfusion of bacillus Calmette-Guerin until cytology results became negative and they remained negative during observation for 18 months in 1. The other patient had a multifocal recurrence of carcinoma in situ, combined with a stage T1, grade 3 urothelial cancer in the bladder after 12 months and a recurrence of carcinoma in situ in 1 ureter after 24 months. In 1 patient treatment was stopped prematurely after severe septicemia. Although our short-term results are promising, percutaneous perfusion of bacillus Calmette-Guerin for carcinoma in situ of the upper urinary tract should be considered as an investigational treatment modality until long-term results are available.

Administration, Cutaneous↗
PubMed1989

Three years' experience with an ileal low pressure bladder substitute.

At the beginning of this century it was realised that peristalsis would cause incontinence if bowel was used for augmentation or substitution of the bladder. Trans-section of the antimesenteric border and cross-folding of the intestinal segments (Goodwin's cup-patch technique) is an efficient means of solving this problem and has been successfully used in the Kock pouch. We anastomosed the ileal low pressure reservoir to the membranous urethra in 22 male patients following radical cystoprostatectomy for bladder cancer. The mean observation time was 16 months (range 3-36). The capacity of the bladder substitute increased with time, the average being 450 ml after 6 months. In the first 4 patients with a short (2-5 cm) intestinal segment between the pouch and the urethra, micturition was prolonged, residual urine varied from 50 to 300 ml and bacteriuria was found. Occasional expulsions of several ml of urine were caused by peristalsis within this short tubular segment. In the following 18 patients, the low pressure reservoir was anastomosed directly to the membranous urethra. Micturition was good, with no notable residual urine, no bacteriuria and no paroxysmal urinary incontinence. However, a safety pad is used by half of the patients because once or twice a week, mainly at night, a few ml of urine may be lost. No significant changes in serum electrolytes, bicarbonate or creatinine were noted. With the three different antireflux techniques used, no obstructive or inflammatory changes in the upper urinary tracts were found, although no long-term antibiotic prophylaxis was given.

Aged↗