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Reichert M, Schüler P, Stepniewski A, Felmerer G, Trojan L, von Knobloch HC. [Closure of persisting rectourethral fistula after suprasymphyseal adenoma enucleation of the prostate by combining the Bressel-Naujox and gracilis flap procedure]. Urologie 2023; 62:295-298. [PMID: 36066612 PMCID: PMC9998548 DOI: 10.1007/s00120-022-01924-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
When taking into consideration the basic principles of fistula surgery, numerous options are available for the surgical repair of rectourethral fistulas. However, there is no standard regarding which surgical method should be used under which circumstances-due to the heterogeneity of this disease. This case report describes the individual adaptation of a surgical technique that is used for the treatment of vesicovaginal fistulas to treat a rectourethral fistula in a patient who had already undergone an unsuccessful fistula closure attempt. Successful closure of the fistula was achieved on the basis of an established method using tissue interposition.
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Affiliation(s)
- M Reichert
- Klinik für Urologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - P Schüler
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - A Stepniewski
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - G Felmerer
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - L Trojan
- Klinik für Urologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - H C von Knobloch
- Klinik für Urologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Klümper N, Ralser D, Zarbl R, Schlack K, Schrader A, Rehlinghaus M, Hoffmann M, Niegisch G, Uhlig A, Trojan L, Steinestel J, Steinestel K, Wirtz R, Kristiansen G, Toma M, Hölzel M, Ritter M, Strieth S, Ellinger J, Dietrich D. PDCD1 methylation predicts response to anti–PD-1 based immunotherapy in advanced and metastatic renal cell carcinoma. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO, Lotz J, Schildhaus HU, Trojan L, Sahlmann CO. Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography. Prostate 2015; 75:1934-40. [PMID: 26356236 DOI: 10.1002/pros.23091] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The first evaluation of pelvic extended lymph node dissection (pLND) in oligometastatic prostate cancer (PCa) detected by (68)Ga-PSMA PET/CT. METHODS Retrospective analysis of 35 PCa patients underwent (68)Ga-PSMA PET/CT affected by biochemical recurrence (BCR) after curative treatment (n = 23) or before primary therapy of high-risk PCa (n = 12). We performed pLND associated with pathologic imaging in 17 men with nodal oligometastatic PCa. RESULTS Indicative lesions for PCa in PET/CT were detected in 91.4% (32 of 35) of patients. Nodal, bone, visceral (pulmonary), and within the prostate suspected disease were detected in 72% (23 of 32), 16% (5 of 32), 6% (2 of 32), and 47% (15 of 32) of patients, respectively. Median serum PSA in patients with pathological radiotracer uptake in recurrent and high-risk PCa patients was 2.9 ng/ml (range 0.18-30) and 19.5 ng/ml (range 6-90), respectively. The median number of removed lymph nodes with pLND in recurrent and high-risk PCa was 10 (range 4-17) and 12 (range 8-29) per patient and the median number of positive lymph nodes was 1 (range 1-2) and 3 (2-3) per patient, respectively. In total, two false positive and one false-negative lymph node were found. Diagnostic accuracies per nodal lesion in total of 213 removed nodes: sensitivity, 94%; specificity, 99%; positive predictive value (PPV), 89%, and negative predictive value (NPV), 99.5%. After pLND, 53% (9 of 17) of patients received androgen deprivation therapy and/or radiation therapy and hormonal therapy, while 47% (8 of 17) of patients remained free of any post-surgery therapy. Follow-up PSA remained less than 0.2 ng/ml in 82% (14 of 17) of patients. After pLND, immediate BCR (PSA never measured less than 0.2 ng/ml) in 18% (3 of 17) of patients was recorded. CONCLUSIONS This represents the first study of pLND in the setting of nodal oligometastatic PCa detected by (68)Ga-PSMA PET/CT. The use of (68)Ga-PSMA PET/CT could be to improve the accuracy for the detection of nodal micrometastases. These promising findings need validation in larger studies.
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Affiliation(s)
- S Hijazi
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - B Meller
- Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - C Leitsmann
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - A Strauss
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - J Meller
- Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - C O Ritter
- Department of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - J Lotz
- Department of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - H-U Schildhaus
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - L Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - C O Sahlmann
- Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany
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Zemličková H, Dědičová D, Jakubů V, Mach J, Kolínská R, Malíková E, Urbášková P, Adámková V, Bartoniková N, Bártová M, Bendová E, Bergerová T, Bohunová Z, Čápová E, Dovalová M, Glasnák M, Hanslianová M, Hásková H, Heinigeová B, Hermanová N, Horníková M, Horová B, Chmelařová E, Janečková J, Ježek P, Jindrák V, Kohnová I, Kolářová L, Krčková D, Kůrková V, Linhart P, Machučová M, Miklová J, Niemczyková J, Nyč O, Ochvatová B, Ouertani A, Paterová P, Pokorná Z, Pomykal J, Sekáčová A, Scharfen J, Skačáni H, Steinerová A, Šimečková E, Štolbová M, Tejkalová R, Trojan L, Uhlířová E, Vašková L, Vesela E, Zálabská E, Zamazalová D, Záruba R, Železná J. [Antibiotic resistance in nontyphoidal salmonellae serovars in the Czech Republic]. Epidemiol Mikrobiol Imunol 2013; 62:43-49. [PMID: 23964964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
STUDY AIM To determine antibiotic resistance and incidence of multidrug resistance among Nontyphoidal salmonellae serovars isolated from humans. MATERIAL AND METHODS Consecutive Salmonella isolates from patients, recovered in 48 microbiology laboratories in May 2012, were analyzed in the respective reference laboratories at the National Institute of Public Health. Strains were re-identified and differentiated into serovars. Their minimum inhibitory concentrations (MICs) to 11 antibiotics were determined by the microdilution method. RESULTS Of 25 serovars identified among 637 strains of Salmonella enterica, the most frequent were Enteritidis (87.0 %), Typhimurium (4.9 %), and monophasic Typhimurium 4,[5],12:i:- (2.0 %) and Mbandaka (0.6 %); other serovars were rare. Altogether 558 strains (87.6 %) were susceptible to all antibiotics tested and the remaining 79 strains were resistant to one or more antibiotics. The prevalence rates of resistance to individual antibiotics among 637 study strains were as follows: ampicillin 8.5%, tetracycline 5.7%, sulfamethoxazole 5.2%, cipro-floxacin 3.8%, and chloramphenicol 2.5%. Resistance to gentamicin, trimethoprim, and third and fourth generation cephalosporins was rare ( 0.5%) and none of the study strains showed resistance to meropenem. Three producers of extended spectrum beta-lactamase were multidrug resistant and two of them recovered from twins exhibited a different pattern of resistance. Resistant strains were most often assigned to the following serovars: Enteritidis (49.4%), Typhimurium (26.6%), and monophasic Typhimurium (15.2%). While only 7% (39 of 554 strains) of Enteritidis strains were resistant, the serovars Typhimurium and its monophasic variant 4,[5],12:i:- showed high rates of resistance, i.e. 66.7 and 92.3%, respectively. Furthermore, resistance was revealed in all strains of the serovars Virchow (n = 3), Kentucky (n = 1), and Newport (n = 1), in two of three strains of the serovar Infantis, and in one of two strains of the serovar Stanley. All five blood isolates were assigned to the serovar Enteritidis and one of them showed resistance to ciprofloxacin. Of 79 resistant strains, 26.6% showed resistance to ampicillin only and 24.1% to ciprofloxacin only, with multidrug resistance, i.e. resistance to three or more antibiotics, confirmed in 43.0% of strains. CONCLUSION Despite a relatively low prevalence of resistance to the antibiotics tested among 637 study strains, the following alarming findings were made: Detection of Salmonella enterica strains resistant to ciprofloxacin as the drug of choice or to higher generation cephalosporins and multidrug resistance revealed in two thirds of the strains of the serovar Typhimurium and in all but one strains of its monophasic variant 4,[5],12:i:-.
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Buchner A, May M, Burger M, Bolenz C, Herrmann E, Fritsche HM, Ellinger J, Höfner T, Nuhn P, Gratzke C, Brookman-May S, Melchior S, Peter J, Moritz R, Tilki D, Gilfrich C, Roigas J, Zacharias M, Hohenfellner M, Haferkamp A, Trojan L, Wieland W, Müller S, Stief C, Bastian P. Prediction of outcome in patients with urothelial carcinoma of the bladder following radical cystectomy using artificial neural networks. Eur J Surg Oncol 2013; 39:372-9. [DOI: 10.1016/j.ejso.2013.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/14/2013] [Accepted: 02/01/2013] [Indexed: 10/27/2022] Open
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Heinrich E, Probst K, Michel M, Trojan L. UP-02.087 Gastrin-Releasing Peptide: Novel Predictor of Castration-Resistant Prostate Cancer? Urology 2011. [DOI: 10.1016/j.urology.2011.07.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Heinrich E, Ferber A, Schoen G, Schiefelbein F, Trojan L, Egner T. MP-13.05 Five Years' Experience with High-Intensity Focused Ultrasonography for Prostate Cancer Treatment: A Mid-Term Follow Up. Urology 2011. [DOI: 10.1016/j.urology.2011.07.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kübler H, Maurer T, Stenzl A, Feyerabend S, Steiner U, Schostak M, Schultze-Seemann W, vom Dorp F, Pilla L, Viatali G, Hampel C, Wedel S, Trojan L, Hiller K, Sommerauer M, Jocham D, Scheel B, Lander T, Kallen K, Miller K. Final analysis of a phase I/IIa study with CV9103, an intradermally administered prostate cancer immunotherapy based on self-adjuvanted mRNA. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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May M, Fritsche HM, Brookman-May S, Burger M, Bolenz C, Trojan L, Herrmann E, Michel MS, Wülfing C, Tiemann A, Müller SC, Ellinger J, Buchner A, Stief CG, Tilki D, Wieland WF, Gilfrich C, Höfner T, Hohenfellner M, Haferkamp A, Roigas J, Zacharias M, Gunia S, Bastian PJ. [Patients with bladder cancer in clinical stage T2 : survival benefit of downstaging in comparison to patients with confirmed muscle invasion in cystectomy specimens]. Urologe A 2011; 49:1508-15. [PMID: 20922515 DOI: 10.1007/s00120-010-2424-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few and partially contradictory data are available regarding the prognostic signature of downstaging of muscle-invasive clinical tumour stages in patients treated with radical cystectomy. MATERIALS AND METHODS Clinicopathological parameters of 1,643 patients (study group, SG) treated with radical cystectomy due to muscle-invasive urothelial bladder cancer were summarized in a multi-institutional database. Patients of the SG fulfilled the following conditions: clinical tumour stage T2 N0 M0 and no administration of neoadjuvant radiation or chemotherapy. Cancer-specific survival (CSS) rates were calculated referring to pathological tumour stages in cystectomy specimens (<pT2, pT2, >pT2) (mean follow-up: 51 months). Furthermore, a multivariable model integrating clinical information was developed in order to predict the probability of downstaging. RESULTS A total of 173 patients (10.5%) of the SG presented with downstaging in pathological tumour stages (pT0: 4.8%, pTa: 0.4%, pTis: 1.3%, pT1: 4.1%); 12 of these patients had positive lymph nodes (7%, in comparison with 21% pN+ of pT2 tumours and 43% of >pT2 tumours). Patients with tumour stages <pT2, pT2 and >pT2 had CSS rates after 5 years of 89, 69 and 46%, respectively (p<0.001). In a multivariable Cox model the presence of pathological downstaging resulted in a significant reduction of cancer-specific mortality (HR 0.30; 95% CI 0.18-0.50). By logistic regression analysis the date of TURB (benefit for more recent operations) was identified as the only independent predictor for downstaging of muscle-invasive clinical tumour stages. Age, gender, grading and associated Tis in the TURB did not reveal any significant influence. CONCLUSION Patients with muscle-invasive clinical tumour stages and downstaging in cystectomy specimens represent a subgroup with significantly enhanced CSS rates. Further trials that integrate the parameters tumour size, stages cT2a vs cT2b and focality are required in order to define the independent prognostic signature of downstaging of tumour stages more precisely.
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Affiliation(s)
- M May
- Urologische Klinik, St. Elisabeth-Klinikum Straubing, St. Elisabeth-Straße 23, 94315, Straubing, Deutschland.
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Martinschek A, Heinrich E, Ritter M, Michel M, Trojan L. 40 CLINICAL APPLICATION OF ENDOSEW® - REPORT ON A NEW DEVICE FOR RUNNING SUTURES. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1569-9056(11)60045-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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May M, Fritsche HM, Gilfrich C, Brookman-May S, Burger M, Otto W, Bolenz C, Trojan L, Herrmann E, Michel M, Wülfing C, Tiemann A, Müller S, Ellinger J, Buchner A, Stief C, Tilki D, Wieland W, Höfner T, Hohenfellner M, Haferkamp A, Roigas J, Müller O, Bretschneider-Ehrenberg P, Zacharias M, Gunia S, Bastian P. Einfluss des Alters auf das karzinomspezifische Überleben nach radikaler Zystektomie. Urologe A 2011; 50:821-9. [DOI: 10.1007/s00120-011-2507-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buse S, Höfner T, Mueller S, Bolenz C, Trojan L, Michel MS, Hermann E, Wuelfing C, Tiemann A, Fritsche HM, Burger M, Wieland W, Tilki D, Buchner A, Stief C, Bastian P, Hohenfellner M, Haferkamp A. 1830 CHARACTERIZATION AND RISK STRATIFICATION OF PROSTATIC MALIGNANCY IN PATIENTS UNDERGOING RADICAL CYSTOPROSTATECTOMY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wulfing C, Herrmann E, Trojan L, Schrader A, Becker F, Stähler M, Haferkamp A, Legal W, Brenner W, Hartmann A. Independent validation of the 2002 UICC TNM staging system for papillary renal cell carcinoma in a multicenter cohort. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5092 Background: Papillary renal cell carcinoma (pRCC) is the second most malignant histologic subtype in nephrectomy specimens. To date, the most recognized staging system to stratify renal cancer patients is the 2002 UICC TNM classification system. Its accuracy for predicting patient outcome for pRCC is unknown. Methods: From ten urologic institutions in Germany follow-up data on 675 patients with pRCC were collected. In most cases histologic slides were available and central pathologic review was performed. The Kaplan-Meier method was used to derive the cumulative cancer-specific survival. For multivariate analysis of prognostic factors, a Cox regression analysis was performed. Results: 498 (74.1%) patients had organ-confined tumor stages (≤pT2). Synchronous distant metastases in the entire group occurred in 58 (8.7%) patients and 69 (11.2%) others developed metastatic disease during follow-up. Cancer-specific survival (CSS) was significantly related to TNM stage and histologic grading in univariate as well as in multivariate analysis (all p < 0.0001). 5-year CSS in pT1b tumors (90.0%) was significantly shorter compared to pT1a tumors (98.3%) (p = 0.017). Patients with ≥pT3 were at high risk for metastases (50.6%), while metastatic disease associated with ≤pT2 tumors occurred in 7.8% (p < 0.0001). Once metastatic disease was present, prognosis was poor (5-year CSS: 7.2%). Age was associated with a worse prognosis in the subgroup of ≥pT3 tumors in univariate (p = 0.026), but not in multivariate analysis. Conclusions: The 2002 UICC TNM staging system is applicable for pRCC. Clinical and radiologic follow-ups should be offered in frequent intervals to patients with venous thrombus and/or locally advanced disease. The role of age remains unclear, but should not be underestimated at risk stratification after tumor resection. No significant financial relationships to disclose.
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Affiliation(s)
- C. Wulfing
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - E. Herrmann
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - L. Trojan
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - A. Schrader
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - F. Becker
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - M. Stähler
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - A. Haferkamp
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - W. Legal
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - W. Brenner
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
| | - A. Hartmann
- University of Munster, Munster, Germany; University of Mannheim, Mannheim, Germany; University of Marburg, Marburg, Germany; University of Homburg, Homburg Saar, Germany; University of Munich (LMU), Munich, Germany; University of Heidelberg, Heidelberg, Germany; University of Erlangen, Erlangen, Germany; University of Mainz, Mainz, Germany; German Papillary Renal Cancer Study Group
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Verhoef MJ, Trojan L, Armitage GD, Carlson L, Hilsden RJ. Complementary therapies for cancer patients: assessing information use and needs. Chronic Dis Can 2009; 29:80-88. [PMID: 19281693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Many cancer patients seek complementary therapies (CTs) for cancer management; however, relatively little is known about patients' CT information seeking behaviour. Therefore, we assessed: 1) cancer patients' use of the types and sources of CT information; 2) their information preferences; and 3) their understanding of the phrase "scientific evidence or proof that a therapy works." We collected data from 404 patients attending the Tom Baker Cancer Centre (TBCC) in Calgary and 303 patients calling the Cancer Information Service (CIS) helpline. In most cases, patients wanted information on the safety of CTs, how CTs work and their potential side effects. Physicians and conventional cancer centres were the most desired sources of CT information, but relatively few patients obtained information via these sources. Although patients were aware of the meaning of scientific evidence, they often used information based on non-scientific evidence, such as patient testimonials. The creation of a supportive care environment in conventional cancer treatment centres, by providing CT information, may help address cancer patients' concerns and alleviate some of the stress that may have been caused by the cancer diagnosis.
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Affiliation(s)
- M J Verhoef
- Departments of Community Health Sciences and Medicine, University of Calgary, Alberta, Canada
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Bolenz C, Trojan L, Honeck P, Schöppler G, Herrmann E, Alken P, Michel M, Häcker A. [Medical treatment of metastatic renal cell carcinoma after the approval and market entry of multitargeted tyrosine kinase inhibitors in Germany]. Aktuelle Urol 2009; 40:31-6. [PMID: 19177319 DOI: 10.1055/s-2008-1038176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the current use and administration of multitargeted tyrosine kinase inhibitors (sunitinib and sorafenib) in the management of metastatic renal cell carcinoma (RCC) and to characterise frequent adverse events. MATERIALS AND METHODS A questionnaire was sent to 104 urologists and medical oncologists having their own practice. The common use of medical treatment with sunitinib and sorafenib in patients with metastatic RCC was recorded. Data on the most frequent drug-associated adverse events were registered and described in a preliminary patient cohort. RESULTS Medical oncologists in private practice treat over twice as many patients with metastatic RCC (8/year) as established urologists. Most medical oncologists but not urologists already use multitargeted tyrosine kinase inhibitors. For the initiation of treatment, most urologists admit patients to a hospital, whereas medical oncologists start and carry out medical treatment themselves. In all patients adverse events occurred due to medical treatment, leading to therapy stop or pause in 53% of patients. The most frequent adverse events were abnormal fatigue, arterial hypertension, diarrhoea and the hand-foot skin syndrome. CONCLUSIONS Multitargeted tyrosine kinase inhibitor therapy in Germany is currently done predominantly by medical oncologists rather than urologists. Adverse events caused by sunitinib and sorafenib frequently required medical care, and in our initial series of patients prompted physicians to pause treatment.
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Abstract
Many cancer patients seek complementary therapies (CTs) for cancer management; however, relatively little is known about patients’ CT information seeking behaviour. Therefore, we assessed: 1) cancer patients’ use of the types and sources of CT information; 2) their information preferences; and 3) their understanding of the phrase “scientific evidence or proof that a therapy works.” We collected data from 404 patients attending the Tom Baker Cancer Centre (TBCC) in Calgary and 303 patients calling the Cancer Information Service (CIS) helpline. In most cases, patients wanted information on the safety of CTs, how CTs work and their potential side effects. Physicians and conventional cancer centres were the most desired sources of CT information, but relatively few patients obtained information via these sources. Although patients were aware of the meaning of scientific evidence, they often used information based on non‑scientific evidence, such as patient testimonials. The creation of a supportive care environment in conventional cancer treatment centres, by providing CT information, may help address cancer patients’ concerns and alleviate some of the stress that may have been caused by the cancer diagnosis.
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Affiliation(s)
- M.J. Verhoef
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L. Trojan
- Health Systems and Workforce Research Unit, Calgary Health Region, Calgary, Alberta, Canada
| | - G.D. Armitage
- Health Systems and Workforce Research Unit, Calgary Health Region, Calgary, Alberta, Canada
| | - L. Carlson
- Departments of Oncology and Psychology, University of Calgary, Calgary, Alberta, Canada
| | - R.J. Hilsden
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
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Trojan L, Harrer K, Schäfer J, Voss M, Welzel G, Bolenz C, Wenz F, Alken P, Michel MS. Komplikationen und Nebenwirkungen der LDR-Brachytherapie beim Prostatakarzinom. Urologe A 2007; 46:1542-7. [PMID: 17622506 DOI: 10.1007/s00120-007-1369-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brachytherapy (BT) is an established treatment option for low risk prostate cancer. The aim of this study was to determine the long-term complications and side effects of the procedure in an up to 13 year long single center follow-up analysis. MATERIAL A total of 505 patients were treated by BT for prostate cancer between May 1991 and August 2005. Cohort I (n=412; May 1991 to November 2003) was evaluated by written questionnaire (modified ICS male) and patient chart evaluation in terms of side effects and secondary interventions. In cohort II (n=148; January 2002 to August 2005) perioperative complications were investigated. RESULTS The mean follow-up was 5.5 years. Perioperative complications were present in 5.4% of patients. Transurethral resection of the prostate was a common secondary intervention, performed in 7% of cases. The rate of incontinence was 6.3% in the long-term follow-up, the rate of potency was 43.5% in those patients who were potent before BT and no hormonal manipulation was performed at any time. CONCLUSION BT is a minimally invasive procedure for the treatment of localised "low risk" prostate cancer. Perioperative complications are rare, secondary intervention may be necessary and the patient has to be informed of possible impotence, incontinence and lack of ejaculation.
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Affiliation(s)
- L Trojan
- Urologische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Michel MS, Trojan L, Melchior S, Thüroff J, Alken P. Versorgung von Patienten mit Hormonrefraktären Prostatakarzinomen im Deutschen Gesundheitssystem: Eine Bestandsanalyse. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Michel MS, Trojan L, Iyazaliev K, Grobholz R, Alken P. Aktueller Stellenwert der R1-Situation nach radikaler Prostatovesikulektomie in Hinblick auf das Auftreten eines biochemischen Rezidives. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bolenz C, Ikinger EM, Trojan L, Fernández M, Grobholz R, Alken P, Michel MS. Ein neues Langzeit-3D-Gewebekulturmodell für normales Urothel und das Urothelkarzinom mit Evaluierung einer topischen Chemotherapie in vitro. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bolenz C, Cao Y, Wenzel M, Fernández M, Trojan L, Alken P, Michel MS. Erste Erfahrungen mit einem neu entwickelten Mini-Cystoskop an der Nacktratte: Ein neues orthotopes Modell für das Urothelkarzinom der Harnblase. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Honeck P, Michel MS, Trojan L, Alken P. Das Mannheim-Ventil – Eine einfache Methode zur Konstruktion eines Kontinenz-Ventils bei kontinenter Harnableitung. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trojan L, Harrer K, Bolenz C, Schäfer J, Wenz F, Alken P, Michel MS. Komplikationen und funktionelle Ergebnisse der Brachytherapie beim Prostatakarzinom: 14 Jahre Erfahrung in Mannheim. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trojan L, Zechmann C, Delorme S, Grobholz R, Bolenz C, Alken P, Michel MS. Konventionelle, dynamisch-kontrastmittelverstärkte MRT und MR-Spektroskopie in der Diagnostik des Prostatakarzinoms: Erste Erfahrungen. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schaefer J, Welzel G, Trojan L, Harrer K, Eppler N, Michel M, Alken P, Wenz F. Long-Term Health-Related Quality of Life in Men Treated with 125I Prostate Brachytherapy for Clinically Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND NE tumor cells are present in virtually all prostatic adenocarcinomas. As they express no androgen receptor they are hormone independent. During anti-androgenic therapy their number increases. Their prognostic value is controversial. MATERIAL AND METHODS In 233 patients with prostatic carcinoma the NE differentiation was determined in a hot spot (7.9 mm(2)) with maximum CgA positive cell density. A high NE differentiation (HNE) was defined by a least 30 NE tumor cells, while less means a low NE differentiation (LNE). In addition the occurrence of NE tumor cells was defined as solitary or clustered (> or =5 NE tumor cells in close proximity). RESULTS In advanced and high grade tumors more and clustered NE tumor cells could be found than in low grade and organ confined tumors. Moreover HNE tumors and occurrence of NE clusters resulted in a significant shorter progression-free interval. CONCLUSIONS Besides the quantity of NE differentiation the quality of the growth pattern of NE tumor cells is of relevance in prostatic carcinoma.
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Affiliation(s)
- C G Sauer
- Pathologisches Institut, Universitätsklinikum Mannheim der Universität Heidelberg
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Zechmann CZ, Baudendistel K, Aftab K, Trojan L, Delorme S, Michel MS, Kauczor HU. Prostata-MRT: Vergleich von T1-Dynamik und Spektroskopie bei gesichertem Prostatakarzinom. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trojan L, Steidler A, Haak M, Knoll T, Gretz N, Alken P, Michel M. 80 Identification of metastasis-associated genes in prostate cancer by genetic profiling of human prostate cancer cell lines. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1569-9056(05)80090-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
More than 30 % of all admissions to an urologic clinic are for the treatment of urinary stones. In almost all cases, the treatment is minimally invasive employing extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL). Technical advances in endourology and a growing expertise in ESWL led to a decline in ESWL and an increase in endoscopic techniques. In comparison with ESWL, the endoscopic techniques are more invasive but in most cases achieve a stone free state faster. With the introduction of diagnosis related groups (DRG), the economic aspect of stone therapy is gaining in importance. Stone prevention leads to a cost reduction in the health care system, justifying the use of an appropriate stone metaphylaxis. This review article presents the current recommendations for interventional urinary stone therapy and lists the options of conducting both medical and economically rational therapy.
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Affiliation(s)
- T Knoll
- Urologische Klinik, Universitätsklinikum Mannheim.
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Abstract
New approaches to treat prostate cancer (PCA) are utilizing gene therapy and aim to correct the disease at the genetic level. Getting a gene efficiently into the target cell is the subject of much interest. We used a holmium laser for transfecting rat PCA cells with the reporter gene pEGFP. By FACS analysis and fluorescence microscopy, we could demonstrate that cellular delivery of plasmid DNA was possible with high efficiencies up to 41.3%. Therefore, transfection of PCA cells by holmium laser might offer a promising new gene transfer strategy to PCA with minimal invasiveness.
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Affiliation(s)
- S Sagi
- Department of Urology, University Hospital Mannheim, Germany
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Knoll T, Trojan L, Haecker A, Michel M, Köhrmann K, Alken P. Interventionelle Therapie von Harnsteinen - Indikationen, Erfolgsraten und Komplikationen. ACTA ACUST UNITED AC 2004. [DOI: 10.1055/s-2003-815703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Grobholz R, Griebe M, Michel M, Trojan L, Bleyl U. Influence of the neuroendocrine tumor differentiation on proliferation in prostate cancer. Pathol Res Pract 2004. [DOI: 10.1016/s0344-0338(04)80437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Michel MS, Erben P, Trojan L, Knoll T, Alken P. Prostate cancer transfection by acoustic energy using pEGFP-N1 as reporter gene in the solid Dunning R-3327-MatLu tumor. Prostate Cancer Prostatic Dis 2003; 6:290-3. [PMID: 14663469 DOI: 10.1038/sj.pcan.4500667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gene therapy is expected to play a major role in medical treatment in the future. Several different methods for DNA transfection exist. We evaluated the efficacy and effects of transfection by acoustic energy in a standardized prostate cancer model. METHODS Subcutaneous implantation of Dunning tumors was followed by injection of pEGFP-DNA plasmid. Tumors were treated by acoustic energy with different parameter settings and the transfection rate was assessed by FACScan. RESULTS Standardized experimental conditions resulted in minor intragroup deviations. Intratumoral injection resulted in a transfection rate of 0.3% (control group). The statistically significant increase of 4.6% in cell transfection rate was gained by applying acoustic energy. CONCLUSIONS DNA transfection of solid tumors can be mediated by the application of acoustic energy. Achieved transfection rates are encouraging and imply therapeutical levels. Prodrug activation or suicide gene therapy are possible fields of investigation in the treatment of prostate cancer.
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Affiliation(s)
- M S Michel
- Department of Urology, University Hospital Mannheim, Germany.
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Abstract
Open surgery was the standard therapy for urinary calculi up to about 30 years ago. This changed upon introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980, a procedure that is now the primary therapy for 70 % of the patients in western countries. Simultaneously, endourological procedures like ureterorenoscopy (URS) and percutaneous nephrolithotripsy (PCNL) have been improved, and now, modern small diameter and highly efficient instruments offer an ideal alternative to shockwave lithotripsy. Today, minimally-invasive stone treatment has replaced open stone surgery almost completely. This article introduces ESWL, URS and PCNL and discusses indications, outcomes and limitations.
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Affiliation(s)
- T Knoll
- Urologische Klinik, Universitätsklinikum Mannheim.
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Kiessling F, Lichy M, Grobholz R, Farhan N, Heilmann M, Michel MS, Trojan L, Werner A, Rabe J, Delorme S, Kauczor HU, Schlemmer HP. [Detection of prostate carcinomas with T1-weighted dynamic contrast-enhanced MRI. Value of two-compartment model]. Radiologe 2003; 43:474-80. [PMID: 12827262 DOI: 10.1007/s00117-003-0911-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The suitability of dynamic parameters of the two-compartment model for detecting prostate carcinomas and its correlation with tumor microvascular density were evaluated. METHODS The study included 43 patients with biopsy-proven prostate carcinoma: 28 were examined by 1.0-T MRI (Turbo-FLASH) and 15 by 1.5-T MRI (FLASH) with infusion of 0.1 mmol/kg Gd-DTPA. Signal time curves were parametrized with an open two-compartment model in amplitude and exchange rate constants (k(ep)). The microvascular density of resected prostate carcinomas was determined. RESULTS The microvascular density in the tumors was significantly higher than in the adjacent healthy prostate tissue and correlated in both sequences with k(ep). Prostate carcinomas of the peripheral zone were demarcated by amplitude and k(ep). In the Turbo-FLASH sequence there was a significant difference between the tumor tissue and healthy peripheral zone in terms of k(ep) and in the FLASH sequence in terms of amplitude. CONCLUSION Prostate carcinomas can be visualized with dynamic T1-weighted MR sequences using a two-compartment model. Moreover, the parameter k(ep) reveals the microvascular density in the tumor and can thus provide valuable clinical information for characterizing the tumors.
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Affiliation(s)
- F Kiessling
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum (DKFZ) Heidelberg.
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Abstract
The surgical and medical management of carcinoma of the prostate is a central issue in urology. Radical prostatectomy is the standard procedure in the curative therapy of locally confined carcinoma of the prostate. Recently, alternative minimally invasive options such as brachytherapy and the still experimental focused ultrasound and cryotherapy have gained in interest. Further palliative schemes such as hormonal ablation and chemotherapy have become established in the management of locally advanced and generalized carcinoma or elderly patients. It was our objective to give an account of these established and new urological therapy options in the management of carcinoma of the prostate.
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Affiliation(s)
- M S Michel
- Urologische Klinik, Universitätsklinikum Mannheim.
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Back W, Schweyer S, Grobholz R, Schulze G, Corinth C, Trojan L, Zwergel T, Sauer C, Gröne HJ. Tumours of Testis and Prostate, Abstract 81–89, Posters. Pathol Res Pract 2003. [DOI: 10.1078/0344-0338-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Knoll T, Michel MS, Trojan L, Bross S, Alken P, Köhrmann KU. [Long-term follow-up of interstitial laser coagulation in the treatment of benign prostatic hyperplasia]. Aktuelle Urol 2003; 34:48-51. [PMID: 14566701 DOI: 10.1055/s-2003-37559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Besides standard open or transurethreal adenoma resection, less morbid interstitial laser coagulation (ILC) is an alternative therapeutical option that could reduce lower urinary tract symptoms, especially in high-risk patients. Although short-term results indicate effectiveness, reliable long-term statistics are still lacking. Therefore, to assess long-term satisfaction and overall success rate, we re-evaluated patients with a mean follow-up of 7 years after laser treatment. METHODS A total of 72 patients had been included in our ILC programme between 1993 and 1995. Mean age was 74 years. About 45 % of the patients had since died of other causes. In all, 23 patients were evaluated by telephone questionnaire, International Prostate Symptom Score (IPSS), Quality of Life (QoL), second surgical interventions or medical therapy. Our patient group was treated with interstitial Nd:YAG laser coagulation (mediLas fibertom). A perineal (34 %), transurethral (23 %) or combined (43 %) approach was chosen, depending on the preoperative volume of the prostate (range 40 - 100 ml; mean 59.3 ml). RESULTS 68.4 % of the patients were satisfied with their current urological situation. Mean IPSS was 8.8 vs. 18.8 preoperatively mean QoL 1.5 vs. 3.3. 15.8 % had undergone conventional transurethral prostatic resection in the interim; one patient uses a urine catheter. 15.8 % receive medical treatment for lower urinary tract symptoms. CONCLUSIONS Although the results of standard TUR or open surgery imply higher success, the long-term results of ILC demonstrate effectiveness. Further follow-up studies on a larger number of patients are advisable. The low morbidity of ILC makes this procedure an interesting alternative option in the treatment of high risk patients.
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Affiliation(s)
- T Knoll
- Urologische Klinik. Klinikum Mannheim gGmbH, Universitätsklinikum, Mannheim.
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Abstract
OBJECTIVE To report the results and long-term follow-up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany). PATIENTS AND METHODS Most endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high-frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years. RESULTS During resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality-of-life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow-up. CONCLUSION The Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization.
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Affiliation(s)
- M S Michel
- Department of Urology, University Hospital, Mannheim, Germany.
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Upegui-Gonzalez LC, Ly A, Sierzega M, Jarocki P, Trojan L, Duc HT, Pan Y, Shevelev A, Henin D, Anthony D, Nowak W, Popiela T, Trojan J. IGF-I triple helix strategy in hepatoma treatment. Hepatogastroenterology 2001; 48:660-6. [PMID: 11462897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND/AIMS To investigate the effect of gene therapy for hepatocellular carcinoma based on inhibition of cellular IGF-I expression, the technique of IGF-I triple helix was investigated in mice developing programmed hepatoma. METHODOLOGY mhAT1F1 mouse hepatoma cell line was transfected in vitro with IGF-I triple helix expression vector (pMT-AG-TH) or with IGF-I antisense expression vector (pMT-Anti-IGF-I). 10 x 10(6) transfected cells of either triple helix or antisense type were inoculated intraperitonealy into transgenic ATIIITB6 mice developing genetically programmed hepatoma (mice die between the age of 6 and 7 months). In parallel, human cell cultures established from surgically removed hepatomas were investigated. RESULTS mhAT1F1 and human primary cell cultures, transfected with pMT-AG-TH or pMT-Anti-IGF-I vectors resulted in total inhibition of IGF-I demonstrated by immunocytochemical and Northern blot techniques. Transfected cells changed their phenotype and recovered major histocompatibility complex I expression showed by fluorescence-activated cell sorting analysis and Western blot. Moreover, two phenomena were observed in IGF-I "antisense" or "triple helix" transfected cells: 1) the apoptosis, demonstrated by TUNEL technique; 2) the presence of IL-6 simultaneously with disappearance of tumor necrosis factor-alpha and IL-10, investigated by reverse transcriptase-polymerase chain reaction technique. In in vivo experiments, injection of murine transfected cells into mice in terminal-phase prolonged their survival 3-4 months in 100% of cases, as well in "antisense" group (8/8) as in "triple helix" group (10/10). CONCLUSIONS Injection of hepatoma cells transfected with IGF-I triple helix expression vector, and showing immunogenic and apoptotic characteristics, can constitute an effective cellular therapy against hepatocellular carcinoma.
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Yonge O, Krahn H, Trojan L, Reid D. Through the eyes of the preceptor. Can J Nurs Adm 1997; 10:65-85. [PMID: 9450413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study highlights some of the issues for preceptors and assists in clarifying the role of preceptors, students and nurse educators. Through a survey of 295 nursing preceptors in the province of Alberta, it was found that most preceptors rated their orientation to their role as adequate to very adequate, the greatest advantage was re-examining their knowledge and the most common problem was having a student with poor nursing skills. Only 30 percent used nursing frameworks. The implications are: nursing educators need to take more responsibility in the areas of preceptor and student orientation, assess the student, preceptor and agency prior to placement, and understand that the preceptor may not be using a nursing framework. Nurses working as preceptors do have the advantage of knowledge since working with students can be a form of continuing education. This study highlights some of the issues for preceptors and assists in clarifying the role responsibilities of preceptors, students and nurse educators.
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Affiliation(s)
- O Yonge
- Faculty of Nursing, University of Alberta
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Yonge O, Krahn H, Trojan L, Reid D. Preceptors evaluating nursing students. Can J Nurs Adm 1997; 10:77-95. [PMID: 9384017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this exploratory, descriptive survey of 295 nursing preceptors it was found that 98.3 per cent had evaluated nursing students. They cited numerous reasons as to why they should be involved in the evaluation process. Only 28.8 per cent had been taught to evaluate and 5.4 per cent had failed students. There is a discrepancy between how little preceptors are prepared for the evaluation role and how frequently they are expected to do so. Consequently, there is an onus on nurse educators to prepare clear evaluation forms, to assess students for suitability for preceptorship experiences, and to recognize evaluation as part of the preceptor's professional relationship with the student.
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Affiliation(s)
- O Yonge
- Faculty of Nursing, University of Alberta
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Trojan L, Marck P, Gray C, Rodger GL. A framework for planned change: achieving a funded PhD program in nursing. Can J Nurs Adm 1996; 9:71-86. [PMID: 8695610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This paper describes a process of planned change undertaken by a group of graduate nursing students of the University of Alberta. Their goal, a funded PhD program in Nursing, was realized fourteen months after their initial meeting. The message of their story is a simple yet significant one for all nurses who wish to influence their environment: Using a framework of planned change, a group of people who organize and commit themselves to a clear goal can become impossible to ignore. In the complexities and uncertainties of today's health care system, many nursing leaders wonder how to effectively insert themselves into the changes occurring in their environments. In this paper, the process of planned change is described through the story of one group of nurses who deliberately set out to reach a desired goal: a funded PhD Program in Nursing at the University of Alberta. Fourteen months later on December 21, 1990, a funded PhD Program in Nursing became a reality. In the early 1980's, several nurses attempted to establish doctoral education for nurses in Canada. The need was for nurse researchers and leaders with doctoral qualifications within the Canadian context. By 1986, the collaboration of nursing faculties at the University of Alberta in Edmonton and the University of Calgary was well under way. The work of Dr. Shirley Stinson, Dr. Janetta McPhail, and Dr. Margaret Scott-Wright with their colleagues resulted in academic approval for the first PhD Program in Nursing in Canada, at the University of Alberta in Edmonton. The starting date of the program, however, was subject to the availability of funding. Funding remained elusive for the next three years, and in the fall of 1989, the Nursing Graduate Student Association decided to form a committee to obtain funding for the doctoral nursing program. Nineteen graduate nursing students from the University of Alberta and the University of Calgary banded together to create the "Nursing PhD Program a Reality" group (NPPR). The group used a framework of planned change based on concepts found in the literature on power, politics, and political action.
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Abstract
Educators commonly discuss the need to reward nurse preceptors. A survey of 295 preceptors teaching nursing students found 118 nurses (36.6%) did not feel a reward was appropriate, while the remainder felt it was. When asked if they had enough support, 68 (22.9%) reported "no" and 213 (73%) reported "yes." Recommendations stemming from this research include: the need to redefine "reward" to be more congruent with the preceptor's perceptions; to provide acknowledgment to preceptors reflective of their educational and professional role; and to recognize that the ongoing communication and feedback with nursing faculty is a crucial factor in preceptors' perceptions of support.
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Yonge O, Krahn H, Trojan L. Perceptions of preceptors toward preceptorship in nursing undergraduate education programs. AARN News Lett 1994; 50:14-6. [PMID: 7856422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
Trusting as an area of research has not been critically examined in nursing research literature. In this study, nurses working in home care and elderly clients were interviewed to ascertain the process of developing a trusting relationship. Data were obtained from seven home care nurses and six elderly clients who were interviewed from one to three times. The data were analysed using grounded theory methodology and sorted using Microsoft Word software on a Macintosh computer. The core category which was identified in the data was labelled 'trusting, caring relationships'. This core category encompassed trusting which is developed and the caring which the nurses provide. Home care nurses and elderly clients moved through four phases: initial trusting; connecting; negotiating; and helping. The findings have implications for novice nurses working with elderly people, as well as for programme development and education. More research needs to be done on trust in different contexts to assist all nurses in establishing nurse-client relationships.
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Affiliation(s)
- L Trojan
- Health and Welfare Canada, Hobbema, Alberta
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