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Biomedical subjects

Wiking Månsson

Publications and source records attributed to Wiking Månsson.

11 recordsLinked to original sources
PubMed2006

Mucosal host responses to bacteriuria in colonic and ileal neobladders.

OBJECTIVE: To study the local host response in patients with colonic and ileal neobladders, with or without bacteriuria. METHODS: Twenty-three patients with colonic neobladders and 19 with ileal neobladders were included. Eleven radical prostatectomy patients and seven healthy male volunteers were used as controls. Six urine samples were obtained from all patients and controls over a six-month period. The samples were cultured semiquantitatively, and the number of neutrophils and concentrations of the inflammatory mediators interleukin 6 and 8 (IL-6, IL-8) in the urine were determined. RESULTS: The prostatectomy patients and healthy volunteers had sterile urine, and concentrations of IL-6 and IL-8 were below the detection limit. Most (>70%) of the urine samples from patients with colonic and ileal neobladders showed anaerobic or aerobic bacterial growth, and uropathogens were identified in about 45% of the samples. The local host response was minimal or undetectable in the sterile urine samples. However, the host response was markedly induced by uropathogenic strains in the urine, but not by urinary carriage of nonpathogenic or anaerobic strains. IL-8, but not IL-6, was increased in colonic neobladders, which corresponds to the mucosal host responses in patients with intact lower urinary tracts and asymptomatic bacteriuria. In ileal neobladders, the IL-8 responses were higher, and levels of IL-6 were significantly increased. CONCLUSION: Neobladders exhibit a significant local host response to colonization with bacterial uropathogens. This reaction is more pronounced and includes IL-6 activation in ileal neobladders than in colonic neobladders.

Aged↗
PubMed2006

Working capacity and well-being after radical cystectomy with continent cutaneous diversion.

OBJECTIVES: The primary aim was to compare the working capacity in patients with continent urinary diversion with a control group. Secondary aims were to assess the changes in electrolyte and acid-base homeostasis and the functional status during strenuous physical activity, and finally, the well-being in the two groups. METHODS: Eleven patients who had undergone radical cystectomy and continent cutaneous diversion using an ileocolonic segment participated. The control group consisted of 12 men, matched for age and activity level. Working capacity was assessed by ergospirometry on an exercise bicycle. Venous blood samples were taken before the test, when the expiratory exchange ratio (RER) was about 1.0 and immediately after completion of the test. SF-36 was used to evaluate the subject's functional status and well-being. RESULTS: The median working capacity in the patient group was 155 (85-190) W and 155 (125-215) W in the control group (n.s.) corresponding to 72 (43-97) % and 80 (59-97) % respectively of predicted values. Peak oxygen uptake was somewhat low in both groups when compared to P-O Astrands norms. Blood tests revealed that patients developed a slight metabolic hyperchloremic acidosis, not seen in the control group. There were no differences between the groups as assessed with SF-36. CONCLUSION: Patients with a continent urinary diversion have a working capacity equal to a control group despite a slight metabolic hyperchloremic acidosis. Quality of life was similar in the two groups and corresponded well with the norms for the general Swedish population aged 65 to 74.

Acid-Base Equilibrium↗
PubMed2006

Intraoperative sentinel node detection improves nodal staging in invasive bladder cancer.

PURPOSE: We evaluated intraoperative SN detection in patients with invasive bladder cancer during radical cystectomy in conjunction with extended lymphadenectomy. MATERIALS AND METHODS: A total of 75 patients with invasive bladder cancer underwent radical cystectomy with extended lymphadenectomy. SNs were identified by preoperative lymphoscintigraphy, intraoperative dynamic lymphoscintigraphy and blue dye detection. An isotope (70 MBq (99m)Tc-nanocolloid) and Patent Blue(R) blue dye were injected peritumorally via a cystoscope. Excised lymph nodes were examined ex vivo using a handheld gamma probe. Identified SNs were evaluated by extended serial sectioning, hematoxylin and eosin staining, and immunohistochemistry. RESULTS: At lymphadenectomy an average of 40 nodes (range 8 to 67) were removed. Of 75 patients 32 (43%) were lymph node positive, of whom 13 (41%) had all lymph node metastases located only outside of the obturator spaces. An SN was identified in 65 of 75 patients (87%). In 7 patients an SN was recognized when the nodal basins were assessed with the gamma probe after lymphadenectomy and cystectomy. Of the 32 lymph node positive cases 26 (81%) had a positive (metastatic) SN. Thus, the false-negative rate was 6 of 32 cases (19%). Five false-negative cases had macrometastases and/or perivesical metastases. In 9 patients (14%) the SN contained micrometastases (less than 2 mm), in 5 of whom the micrometastasis was the only metastatic deposit. CONCLUSIONS: SN detection is feasible in invasive bladder cancer, although the false- negative rate was 19% in this study. Extended serial sectioning and immunohistochemistry revealed micrometastases in SNs in 9 patients and radio guided surgery after the completion of lymphadenectomy identified SNs in an additional 7. We believe that the technique that we used in this study improved nodal staging in these 16 of 65 patients (25%).

Aged↗
PubMed2005

Lymph node metastasis in bladder cancer.

OBJECTIVE: We reviewed the literature on nodal staging in patients with bladder cancer treated with radical cystectomy and lymphadenectomy. RESULTS: Fractionating the lymph node specimen significantly increases the node count, whereas results are contradictory as to whether that increase improves detection of positive nodes. Pathoanatomic data indicate that extending lymph node dissection to the aortic bifurcation improves nodal staging. That approach might be beneficial, especially in cases of T3/T4a tumours, which more often have lymph node metastases above the iliac bifurcation as compared to less advanced tumours. In node-negative patients, extended lymph node dissection probably removes undetected micrometastases and thereby increases disease-free survival. Four studies suggested that a minimum of 8, 10, 10-14, and 16 nodes must be removed, to improve survival, and in another investigation aortic bifurcation was proposed as the upper limit for dissection. Some patients with positive nodes can be cured by surgery alone, even those with gross adenopathy. There is no evidence that extended lymphadenectomy increases surgery-related morbidity. The TNM classification is apparently insufficient for stratifying node-positive patients because several larger cystectomy series could not verify differences in survival between N groups. CONCLUSIONS: Fractionating the lymphadenectomy specimen increases the lymph node count. In node-negative patients, more meticulous and extended lymph node dissection (8-16 nodes or to the aortic bifurcation) probably improves disease-free survival by removing undetected micrometastases. Patients with positive lymph nodes should also be offered radical cystectomy.

Humans↗
PubMed2005

Quality of life after cystectomy and urinary diversion: an evidence based analysis.

PURPOSE: We critically examined the evidence supporting the widely accepted notion that patients undergoing continent urinary tract reconstruction after cystectomy experience superior quality of life outcomes than patients receiving a conduit. MATERIALS AND METHODS: Based on a comprehensive MEDLINE literature search we retrieved and evaluated all full-length articles published in the English, French, German, Italian and Spanish languages comparing conduit diversion with continent cutaneous diversion and/or orthotopic bladder substitution with respect to quality of life or similar concepts. All studies were rated according to the International Consultation on Urological Diseases modification of Oxford Center for Evidence-Based Medicine levels of evidence. RESULTS: The literature on quality of life after radical cystectomy for bladder cancer was rather extensive but generally of questionable quality. The main problems were flaws in the patient materials and methodologies used. To our knowledge not a single randomized, controlled study exists in the field. Because only few articles achieved a level of evidence better than III, the International Consultation on Urological Diseases rating system does not allow further differentiation among studies. Most studies showed that overall quality of life after cystectomy remained good in most patients irrespective of urinary diversion type. CONCLUSIONS: Existing studies are unable to prove that continent reconstruction after radical cystectomy is superior to conduit diversion. This review emphasizes the importance of performing well designed studies in the future.

Adaptation, Physiological↗
PubMed2005

Treatment delay and prognosis in invasive bladder cancer.

PURPOSE: We studied treatment delay, and the impact on disease specific survival and stage progression in a series of patients who had undergone cystectomy. MATERIALS AND METHODS: All 141 patients underwent radical cystectomy between 1990 and 1997 due to locally advanced bladder cancer. Treatment delay was defined as time from pathological confirmation of invasive disease to performance of cystectomy, and was registered retrospectively from the patient charts. Two patients received neoadjuvant chemotherapy and were excluded from further analyses. Followup continued until April 2003 with death due to bladder cancer as the end point. Causes of death were retrieved from the Swedish Cause of Death Registry. RESULTS: The median treatment delay was 49 days, but was significantly longer for the 71 cases who were referred from other hospitals (63 vs 41 days, p < 0.001). Treatment delay did not influence cumulative incidence of death from bladder cancer. Considering all cases, there was no significant correlation between treatment delay and stage progression. For clinical stage T2 tumors, median treatment delay was 76 days among patients with stage progression compared to 41 and 48 days for those with stage regression and stage equivalence, respectively (p = 0.20). CONCLUSIONS: Treatment delay was not found to influence disease specific survival in the present study. Furthermore, treatment delay was not significantly longer in cases that progressed compared to those with equal or lower pathological stage in the cystectomy specimen.

Adult↗
PubMed2004

Microbial flora in ileal and colonic neobladders.

OBJECTIVE: To describe bacterial colonization in patients with ileal and colonic neobladders. METHODS: Twenty-three patients with right colon neobladders, 30 with ileal neobladders, 11 who had undergone radical prostatectomy, and 6 healthy controls were included. Culture of clean-catch, midstream urine specimens was done weekly for 3 weeks, and this was repeated after 6 months. Residual urine was measured, and the patients were interviewed about leakage. All patients and controls were antibiotic free during the study except for 13 of the ileal neobladder patients, who were treated with trimethoprim 100mg daily. RESULTS: Urine cultures from controls and prostatectomy patients were negative for bacteria, whereas 67% of the specimens from patients with neobladders, not on antibiotic therapy, were culture positive, and half of these contained uropathogenic species, such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis. Bacterial colonization (including uropathogenic strains) was strongly correlated with residual urine (p<0.005), but not with leakage. Anaerobic strains were found more frequently (p=0.04) in urine from ileal neobladders than in urine from colonic neobladders. The 13 patients with ileal neobladders and on prophylactic antibiotic therapy carried bacteriuria in 80% of the samples, the majority being anaerobic strains. Uropathogenic strains, mainly Enterecoccus faecalis was revealed in 30% of the samples. CONCLUSIONS: The lower urinary tract of patients with ileal or colonic neobladders is heavily colonized with potentially uropathogenic and anaerobic bacteria. Complete bladder emptying reduces the bacterial burden. Anaerobic colonization is increased in neobladders reconstructed from ileum. Prophylactic antibiotic therapy does not seem to reduce the bacterial burden, but interferes with the bacterial composition.

Aged↗
PubMed2003

Diagnostic delay and prognosis in invasive bladder cancer.

OBJECTIVES: To study diagnostic delay in invasive bladder cancer in a population-based material with long-term follow-up, and to evaluate whether delay in diagnosis affects the risk of bladder cancer death. MATERIAL AND METHODS: In a previous study, 177 patients with invasive bladder cancer (T1-T4) diagnosed in 1988 were investigated with regard to diagnostic delay. A review of all available clinical records was performed. In the present study, causes of death for these patients were registered over a 12-year follow-up period, and the impact of diagnostic delay on bladder cancer death was studied by means of survival analysis. RESULTS: The median diagnostic delay in the material was 144 days. When the patients were stratified into groups with diagnostic delays of 0-3, 3-6, 6-12 and >12 months, those with T1 tumours in the two groups with a diagnostic delay of <6 months showed a trend towards a decreased risk of bladder cancer death. In contrast, in patients with muscle-invasive disease, a significantly increased risk of bladder cancer death was noted for those with a diagnostic delay of <6 months. CONCLUSION: A trend towards better prognosis was found for patients with T1 tumours with a shorter diagnostic delay. The poor prognosis of patients with muscle-invasive disease and a short diagnostic delay suggests aggressive behaviour of the tumour and may explain the worse prognosis in these patients.

Age Distribution↗
PubMedDate not supplied

Quality of life in patients with bladder cancer.

The objective of this review is to examine the published data regarding quality of life (QOL) in patients with bladder cancer. Not a single, randomized controlled trial exists. Most studies are retrospective, cross-sectional, and have serious methodological flaws. There is no single QOL tool preferably used in bladder cancer. While there is no long-term data after therapy for superficial cancer, most investigations compared the impact of different forms of urinary diversion on QOL. In contrast to the prevailing notion that patients who underwent cystectomy undergoing continent urinary reconstruction have superior QOL than those receiving a conduit, existing reports fail to show significant advantages of one technique over the other.

Cross-Sectional Studies↗