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Autoimmunphanomene bei hamatologischen malignen Grunderkrankungen zeigen ein komplexes klinisches Erscheinungsbild und konnen zunachst zu der Diagnose einer Autoimmunerkrankung fuhren, ohne dass die hamatologische Diagnose gestellt wird. Dies kann zu einer Therapieverzogerung der hamatologischen Neoplasie fuhren, was die Prognose des Patienten potentiell verschlechtern kann. Deshalb ist es essentiell, bei bestimmten klinischen Merkmalen und laborchemischen Konstellationen eine zugrunde liegende hamatologische Erkrankung auszuschliesen. Haufige hamatologische Neoplasien als Ursache fur Autoimmunphanomene sind Lymphome (Non-Hodgkin-Lymphome, Hodgkin-Lymphome) und myelodysplastische sowie myeloproliferative Erkrankungen.

The use of total nodal irradiation (TNI) has been reported as an immunomodulatory therapy for different diseases including chronic graft-versus-host disease (cGVHD).We retrospectively analyzed 13 patients with treatment-refractory cGVHD receiving TNI with 1×1Gy from 2001 to 2014. In 10 of 13 patients immunomodulatory effects of TNI were measured.At time of TNI all patients had severe cGVHD (involving the skin: n=12), fascia (n=6), oral mucosa (n=8), eye (n=8), and lung (n=5). Nine of 13 patients had corticosteroid-refractory cGVHD. In 7 of 13 patients (54%) a partial response (PR) could be achieved. In 3 patients (23%) cGVHD manifestations remained stable, 2 patients progressed. One patient was not evaluable due to follow-up1 month. At 3 months after TNI, best responses could be achieved in skin, and oral involvement including steroid sparing activity. TNI was well tolerated with adverse effects limited to reversible thrombocytopenia and neutropenia. Immunomodulatory effects on peripheral blood cells could be demonstrated including an increase of CD4+ T cells in the group of responders.TNI represents an effective immunomodulating therapy in treatment-refractory cGVHD.

With improved outcome of allogeneic stem cell transplantation (allo-SCT) for hematologic malignancies, long-term complications gain greater importance. Skeletal complications such as osteoporosis or avascular necrosis (AVN) occur frequently in allogeneic recipients with a cumulative incidence of diminished bone mineral density of 24-50% between 2 and 12 months after allo-SCT and a cumulative incidence of AVN in as many as 19% of patients 3 years after allo-SCT. Here, we present a review as part of the German, Austrian, and Swiss Consensus Conference on clinical practice in chronic graft-versus-host disease, held 2009 in Regensburg. The Consensus Conference aimed to achieve a consensus on the current evidence of diagnosis, prevention, and therapeutic options of late complications after allo-SCT summarizing and discussing the literature on these topics. In this report, we provide recommendations for metabolic bone diseases agreed upon by the working party. This includes guidelines for diagnosis, prevention, and therapeutic options in patients with low bone mass or AVN.

Background The results of post–radical cystectomy (RC) erectile function are notoriously disappointing, except when a prostate-sparing technique is used. However, valid concerns regarding oncologic safety still predominate, and protocols for patient selection and technique are not well defined. Objective We describe a new technique for nerve-sparing RC and orthotopic diversion with preservation of the vasa deferentia, seminal vesicles, and neurovascular bundles (NVB). No prostatic tissue is left behind, thus eliminating the risk of local recurrence from bladder cancer (BCa) as well as de novo prostate cancer. Design, setting, participants Between March 2008 and October 2009, nine patients with intact erectile function and non–muscle-invasive bladder cancer (NMIBC) or stage ≤pT3a away from the trigone underwent this type of procedure. Prostatic carcinoma was excluded by normal digital rectal examination (DRE) and transurethral ultrasound (TRUS), a prostate-specific antigen (PSA) value ≤4.0 ng/ml, and a free-to-total PSA ratio >20%. Intervention The procedure starts as a standard nerve-sparing radical prostatectomy (RP). After transection of the urethra with Denonvillier's fascia still intact, vasa deferentia and seminal vesicles are transected at the base of the prostate, and the trigone is undermined to the space of Douglas. The cystectomy is completed in ascending or preferably descending fashion. Measurements Patients were evaluated pre- and postoperatively using the International Index of Erectile Function (IIEF) questionnaire. Patients were followed up regularly at 2 mo, 6 mo, and 12 mo. Results and limitations Four out of nine patients maintained spontaneous complete tumescence, and five patients had partial tumescence using sildenafil as a successful erectogenic aid. PSA was Conclusion With correct patient selection, excellent functional results can be obtained.

The heterogeneity of bladder tumors in their ability to invade and metastasize and their frequent recurrence pose a challenge for physicians who treat bladder cancer patients and for the researchers who work on bladder cancer diagnosis, recurrence, and treatment-related areas. For most new bladder cancer cases, investigation begins when patients are symptomatic (i.e., hematuria or irritative voiding). This mode of detection is often inadequate for nearly 15-30% of these new cases with high-grade bladder cancer, since the tumor is already in the invasive stage at the time of diagnosis. Bladder cancer patients are on a mandatory 3-month to 6-month surveillance schedule because bladder tumors frequently recur. The current mode of detecting bladder cancer involves cystoscopy, which is an invasive and relatively expensive procedure. Voided urine cytology, the standard noninvasive marker, is highly tumor specific and has good sensitivity for detecting high-grade tumors. However, its sensitivity for detecting low-grade tumors is low; its accuracy depends on the examiner’s expertise; and it is not available everywhere. Marker systems are readily available for use in practice. Their utility remains under discussion.

A 57-year-old man with an HIV infection, diagnosed a year ago, complained of fever and cough. The haemoglobin level was 7.5 g/dl, white cell count 3800/microliters, T-helper cell count 60/microliters and the CD4-CD8 ratio 0.1. Erythrocyte sedimentation rate was raised to 21/39 mm. Bacteriological tests were at first negative. The chest radiograph showed slight widening of the upper mediastinum which further increased over the next 10 days, at which time it also revealed a shadow in the right upper lobe. Computed tomography suggested necrotizing mediastinal lymph-nodes. Treatment was begun with rifampicin (600 mg daily) ethambutol (1.2 g daily), pyrazinamide (1.5 g daily) and ciprofloxacin (500 mg twice daily). Oesophagoduodenoscopy, performed after 3 weeks, revealed several fistulae which, after ingestion of contrast medium, were demonstrated to communicate with the mediastinum, presumably as a result of lymph-node liquefaction. Mycobacterium tuberculosis was demonstrated in gastric juice, sputum and stool only after tuberculostatic drugs had been started.

Das Prostatakarzinom (PCA) ist die haufigste Krebserkrankung des Mannes in Zentral- und Westeuropa. Jahrlich erkranken etwa 202.000 Manner in Europa neu an diesem Tumor. Die kurative Behandlung des PCA per Brachytherapie gewinnt zunehmend an Bedeutung (20–30% Anteil an kurativen Behandlungen). Von auserordentlicher Bedeutung ist das initiale Staging und damit die pratherapeutische Einteilung in Risikogruppen. Die Low-dose-rate- (LDR-)Brachytherapie (SEED Implantation) unterscheidet sich bezuglich des Verfahrens, sowie der Indikation von der High-dose-rate- (HDR-)Brachytherapie (Afterloading Verfahren). Beide Verfahren finden sowohl als Monotherapie als auch kombiniert mit externer Bestrahlung Anwendung. Bei der LDR-Monotherapie wird im Bereich der Low-risk-Tumoren im 10-Jahres-Follow-up uber eine biochemische Rezidivfreiheit von bis zu 90% berichtet. Bei der kombinierten HDR-Tele- und Brachytherapie wird in Langzeitverlaufen bezuglich der Intermediate- und High-risk-Tumoren uber biochemische Rezidivfreiheiten von 80–90% berichtet. Randomisierte Studien fehlen, aber aus Anwendungsbeobachtungen und Kohortenstudien lassen sich die folgenden Anwendungsalgorithmen ableiten. Die Anwendung der LDR-Monobrachytherapie muss auf Low-risk-Tumoren beschrankt bleiben. Die kombinierte HDR-Tele- und Brachytherapie kann im Bereich der Intermediate- und High-risk-Tumoren erfolgversprechend angewendet werden. Das Outcome hangt initial entscheidend vom pratherapeutischen PSA-Wert und Gleason-Score ab. Posttherapeutisch hat der Nadir die groste Aussagekraft bezuglich der biochemischen Rezidivfreiheit.

Die nichtinvasive Diagnostik durch Blasentumormarker hat in den letzten Jahren eine Vielzahl von experimentellen wie kommerziellen Verfahren hervor gebracht. Vergleichende Untersuchungen einzelner Marker zur Diagnostik, Nachsorge oder Rezidiverkennung beim Blasenkarzinom laufen sowohl retrospektiv wie prospektiv sowie uni- und multizentrisch. Unsere Arbeitsgruppe hat eine Analyse von multizentrischen Arbeiten an grosen Patientenkollektiven im Vergleich zur eigenen Tumorbank aufgearbeitet. Aus der Kieler Tumorbank wurden prospektiv 106 konsekutive Blasentumorpatienten aus dem Jahr 2006 fur diesen Vergleich herangezogen. Besondere Bedeutung kommen dabei der Urinzytologie als Referenztest sowie der Durchfuhrung des NMP 22 bladder chek® als kommerziell erhaltlichem Test zu. In der exemplarischen Analyse des NMP 22 bladder chek® konnte eine Gesamtsensitivitat aller Tumorgrade und -stadien von 69% bei einer Spezifitat von 76% ermittelt werden. Der Vergleich zu den multizentrischen Analysen mit einer Gesamtsensitivitat von 75% bei einer Spezifitat von 73% zeigte mit der Literatur vergleichbare Ergebnisse. Die Urinzytologie zeigte vergleichbare Daten mit einer Gesamtsensitivitat von 73% bei einer Spezifitat von 80%. Eine Vielzahl nichtinvasiver Testverfahren mit hoher Sensitivitat und vernunftiger Spezifitat kann insbesondere in der Blasentumornachsorge eingesetzt werden. Aufgrund der immer noch begrenzten Datenlage kann zum jetzigen Zeitpunkt keiner der verfugbaren Marker im Blasentumorscreening allein empfohlen werden.

Vor 30 Jahren pragte Cabanas erstmals in der Urologie den Begriff des Sentinel-Lymphknotens (SLN). Diese Definition des Schildwachterlymphknotens basierte auf typischen anatomischen Mustern und wurde somit einer individuellen Variation des Lymphabflusses nicht gerecht. Aufgrund der daraus resultierenden falsch-negativen Untersuchungen wurde dieses Konzept jedoch weitestgehend verlassen. Erst die Einfuhrung der Farbmarkierung der drainierenden Lymphknoten durch Farbinjektion in das tumortragende Areal beim malignen Melanom fuhrte zur Wiederbelebung des Sentinel-Konzepts beim Peniskarzinom Mitte der 1990er Jahre. Durch permanente Verfeinerungen der Methodik konnte die Rate an falsch-negativen Untersuchungen von 22% auf 4,8% gesenkt werden. Die Methodik erfordert eine enge interdisziplinare Zusammenarbeit zwischen Urologen, Nukearmedizinern und Pathologen und stellt hohe Anforderungen hinsichtlich der Qualitatssicherung.

Mit der Einfuhrung des 80-W-KTP-Lasers steht eine neue und viel versprechende Therapieoption in der Behandlung der benignen Prostatahyperplasie (BPH) zur Verfugung. Das Verfahren zeichnet sich durch gute hamostatische Eigenschaften, sichere Anwendbarkeit und hohe Effizienz aus. Ziel der vorliegenden Studie ist die prospektive Bewertung der funktionellen Ergebnisse nach KTP-Laservaporisation der Prostata. Bislang wurden seit September 2005 123 Patienten mit BPH operiert. Davon waren im Vorfeld 40 Patienten im Alter von 67,26 (55–82) Jahren bereit an der Studie teilzunehmen. Anhand einer praoperativen, urodynamischen Messung wurden der jeweilige Obstruktionsgrad, sowie die Miktionssituation evaluiert. Zur Bewertung der Symptomatologie und Sexualfunktion wurde der IPSS-Score respektive der IIEF herangezogen. Neben der Erfassung des stationaren Verlaufs erfolgten die Nachuntersuchungen nach 3 Monaten gemas praoperativem Standard einschlieslich einer erneuten Druck-Fluss-Messung. In allen Fallen konnte praoperativ eine deutliche Obstruktion nachgewiesen werden. Nach einer postoperativen Verweildauer von 4,9 (3-10) Tagen betrug der maximale Uroflow 20,2 (8-56)ml/s bei Restharnbildung von durchschnittlich 17,0 (0-100) ml. Die Katheterliegezeit war gemas Studienprotokoll

Mesonephroid adenocarcinoma of the bladder may be a malignant form of nephrogenic adenoma or nephroid metaplasia. The lesion is extremely rare in the urinary bladder, and to our knowledge 19 cases have been reported in the literature. We report two cases of mesonephroid adenocarcinoma of the bladder which were treated by radical cystectomy.

Das Nierenzellkarzinom stellt jedes Jahr die hochste tumorassoziierte Todesursache bezogen auf alle urologischen Tumoren dar. Ursprunglich als Karzinosarkom bezeichnet, ist die sarkomatoide Differenzierung verantwortlich fur eine hohe Aggressivitat in allen moglichen Subtypen des Nierenzellkarzinoms mit einer Haufigkeit von ca. 1%. Das lokal auserst aggressive sarkomatoide Nierenzellkarzinom zeichnet sich typischerweise durch ein fortgeschrittenes Tumorstadium und niedrigen Differenzierungsgrad aus, welcher verantwortlich ist fur eine „explosionsartige“ Progression und die schlechte Uberlebensrate der betroffenen Patienten mit einem mittleren Uberleben von

Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. TIO is usually induced by small, slowly growing tumors of mesenchymal origin (phosphaturic mesenchymal tumor mixed connective tissue variant [PMTMCT]). Nonspecific symptoms including fatigue, bone pain, and musculoskeletal weakness make the diagnosis elusive and often lead to a delay in treatment. The prognosis of TIO is excellent following complete resection of the neoplasm, which leads to the rapid and complete reversal of all symptoms. If the tumor cannot be detected, treatment relies on supplementation with phosphate and active vitamin D compounds. Subsequent radiotherapy in case of incompletely resected tumors or definitive radiotherapy in unresectable tumors is an important treatment option to avoid recurrence or metastasis even though this occurs rarely. Due to the risk of recurrence or late metastases, long-term monitoring is required even in TIO patients diagnosed with a benign tumor.

Hintergrund Das therapeutische Vorgehen bei Patienten mit einem T1-Peniskarzinom insbesondere bei unauffalligen Leistenlymphknoten wird kontrovers diskutiert. Die Datenlage fur Lymphknotenmetastasen (LKM) ist widerspruchlich. Ziel dieser Studie war es, das Metastasierungsrisiko des T1-Karzinoms naher zu charakterisieren und mit dem des T2-Karzinoms zu vergleichen.

Radical cystectomy and various techniques of urinary diversion are gold standard treatments for invasive bladder cancer. However, postoperative hydronephrosis is a common complication in these patients. A special focus was placed on the type of ureteroileal anastomosis used with 2 different techniques performed at 1 institution.Between 1995 and 2003 a total of 106 consecutive patients with bladder cancer underwent cystectomy followed by construction of an ileal neobladder. The nonrefluxing technique of ureter tunneling described by LeDuc and the refluxing chimney technique used for ureter implantation into the ileum-neobladder were compared. Hydronephrosis due to ureteral strictures was studied immediately following surgery and up to 5 years after surgery.A total of 204 RU were included in the study. The LeDuc technique was used in 132 RU (64%) and the chimney technique was used in 72 RU (36%). Hydronephrosis rate of 2% were found in each of the 2 groups after 5 years of followup.Postoperative hydronephrosis due to ureteral strictures is observed at the same rate during long-term followup with the LeDuc and chimney techniques. We favor the chimney technique compared to the LeDuc tunnel due to easier technical preparation and a better chance to identify the ureters endoscopically at a later time. The chimney does give extra length to reach the ureteral stump, especially in cases of distal ureteral carcinoma in situ.

Contains fulltext : 47839schalken.pdf (Publisher’s version ) (Closed access) This is the first of 2 articles that summarize the findings of the International Consensus Panel on cytology and bladder tumor markers. The objectives of our panel were to reach a consensus on the areas where markers are needed, to define the attributes of an ideal tumor marker, and to identify which marker(s) would be suitable for diagnosis and/or surveillance of bladder cancer. Our panel consisted of urologists and researchers from Europe, Asia, and the United States who reviewed original articles, reviews, and book chapters on individual bladder tumor markers published in the English language mainly using the PubMed search engine. Panel members also met during 3 international meetings to write recommendations regarding bladder tumor markers. The panel found that the most practical use of noninvasive tests is to monitor bladder cancer recurrence, thereby reducing the number of surveillance cystoscopies performed each year. Markers also may be useful in the screening of high-risk individuals for early detection of bladder cancer. However, more prospective studies are needed to strengthen this argument. Case-control and cohort studies show that several markers have a higher sensitivity to detect bladder cancer. However, cytology is the superior marker in terms of specificity, although some markers in limited numbers of studies have shown specificity equivalent to that of cytology. Our panel believes that several bladder tumor markers are more accurate in detecting bladder cancer than prostate-specific antigen (PSA) is in detecting prostate cancer. However, bladder tumor markers are held to a higher standard than PSA. Therefore, use of bladder tumor markers in the management of patients with bladder cancer will require the willingness of both urologists and clinicians to accept them.

Pulmonary involvement in ulcerative colitis may manifest as a variety of disorders. Ulcerative colitis-related interstitial lung disease is exceedingly rare and has been reported to be steroid-responsive. We describe the first case of a patient with acute exacerbation of ulcerative colitis-induced usual interstitial pneumonia, who did not respond to corticosteroid therapy and died 12 weeks after the onset of pulmonary symptoms. Early recognition of pulmonary disease in patients with ulcerative colitis is necessary to initiate further diagnostic work-up and may aid treatment decisions.

A cystectomy for indications other than transitional cell cancer of the bladder or general bladder cancer is frequently performed in cooperation with other surgical specialties such as general surgery or gynecology. In these cases the urological procedure as well as the oncological and surgical concepts of other specialties have to be combined. We studied our cystectomy patients who had undergone such a combined procedure for a non-urothelial indication concerning perioperative and postoperative complications.A total of 204 cystectomies were performed by the Department of Urology at the University of Hamburg, Germany between 1995 and 2003. Bladder cancer was the indication for cystectomy in 162 patients, but 42 patients had a non-urothelial indication for this procedure. These patients included 12 cases of advanced rectal cancer, 9 cases of advanced cervical cancer, 6 cases of advanced sigmoid cancer, 4 cases of advanced prostate cancer, 1 case of prostate sarcoma, 5 cases of complex vesicointestinal fistulae, 2 cases of urachal cancer, 1 leiomyosarcoma, 1 rhabdomyoma, and 1 rhabdomyosarcoma, respectively. Perioperative and postoperative complications of those patients were compared to patients who underwent cystectomy for transitional cell cancer of the bladder.Those 42 patients who underwent cystectomy for non-urothelial indications included 14 male and 28 female patients. The mean age was 58.2 years with a range of 3-78 years. For urinary diversion 30 ileum conduits, 4 sigma conduits, and 8 ileum neobladders were used. The mean operative time was 6.25 h. The mean blood loss was 2200 ml. An average of four red blood cell concentrates (RBC) had to be given. Postoperative hydronephrosis had to be treated in three (7%) patients unilaterally and in two (5%) patients bilaterally with a temporary nephrostomy. Postoperative urinary leakage lasting more than 30 days was found in two (5%) patients. A deep vein thrombosis as well as an ileus was found in five (12%) patients each, respectively. There was no perioperative mortality in this study. When comparing the complications of those patients with the 162 patients who underwent cystectomy for bladder cancer, the only significant difference ( p=0.033, chi-square test) was a higher ileus rate in the patients with cystectomy for a non-urothelial indication. Complications with cystectomy for non-urothelial indications are in large comparable to those for transitional cell carcinoma of the bladder. The higher ileus rate in non-urothelial patients can be explained by the more radical procedures in this group of patients. Even though the group of patients undergoing cystectomy for indications other than bladder cancer was small in this trial, the procedure is standardized in combination with other specialties. Larger patient numbers and a longer follow-up will lead to more data in this special group of patients.

Introduction: The treatment of small distal ureteral stones smaller or equal to 5 mm in size is still highly controversial. In distal ureteral stones larger than 5 mm in size, ureteroscopy (URS) has been shown in many studies to be superior to shockwave lithotripsy (SWL). The objective was to analyze the stone-free rate after treatment of distal ureteral stones with in situ SWL or URS. Materials and Methods: A total of 3,857 SWL treatments were performed at our institution between 1996 and 2001. During this period 45 in situ SWL procedures were performed with the Dornier MFL 5000 lithotripter on distal ureteral stones regardless of the stone size. A total of 262 URS treatments were performed on distal ureteral stones. URS for small (5 mm or less) distal ureteral stones was performed in 110 cases. Results: Distal ureteral stones smaller or equal to 5 mm in size were treated successfully stone free in 78% in one SWL session. Patients required a second SWL in 14% of the cases and 8% of the patients required a third SWL session. URS patients were successfully stone free after the procedure in 97% of the cases. Failed URS that needed an additional URS were performed in 2 and 1% of the patients had one SWL in situ treatment. Conclusions: URS treatment has shown to be the therapy of choice for distal ureteral stones. It is more effective than SWL treatment in this stone location. In experienced hands URS is a safe though even more invasive procedure than SWL. This can be expected as urologists perform more than 40 URS procedures per year.

Die nichtinvasive Diagnostik des Urothelkarzinoms der Harnblase ist und bleibt eine Herausforderung an die klinische urologische Forschung. Zielsetzung der vorliegenden Arbeit ist der prospektive Vergleich des BTAstat-Tests und des NMP-22-Tests mit den Immunzytologien gegen 486p3/12 und gegen das Lewis-X-Antigen (mAb BG7). Zusatzlich sollte die klinische Relevanz falsch-positiver Tests untersucht werden.

Study objectives: Assessment of the therapeutic potential of tracheobronchial stenting for obstructive tracheobronchial disease, i in-vivo comparison of different stent types and development of . helpful criteria for choosing the suitable stent type. Material and Methods: Prospective case analysis. Between 1993 and 1999 53 stents were implanted into the tracheobronchial system of 39 consecutive patients with benign or malignant airway obstruction. Every single stent (26 Strecker Stents, 18 Wallstents, 6 Accuflex Nitinolstents, 1 Dumon-, 1 Rusch- and 1 Palmazstent) was recorded in an unified database. Analysis comprised clinical effectiveness, lung function if possible, relevant complications and radiologic follow-up parameters. The probability of their remaining within the tracheobronchial system, of their remaining undislocated and uncompressed was calculated using KaplanMeier analysis for three stent types. Results: Stent placement proved itself to be an effective treatment in 86% of the patients. Resistance could be normalized in 9/9 patients. Kaplan-Meier analysis clearly revealed a higher probability for the Wall- and Nitinolstent to remain within the tracheobronchial system and to remain uncompressed. Dislocation also occurred more rarely. Explantation of the Wallstent, however, if desired, was much more difficult compared to the Strecker stent. The Wallstent also occasionally led to the formation of granulation tissue especially at the proximal stent end and, as such, required reintervention. Conclusion: Any of the 3 stent types proved to be an effective therapeutic option in the management of obstructive tracheobronchial disease. Choise of the stent type should be determined through definition of the therapeutic intention. It is useful to distinguish between (a) benign stenosis, (b) malignant stenosis but curative therapeutic situation and (c) malignant stenosis in a palliative therapeutic situation with limited life expectancy. In spite of its superior mechanical properties the Wallstent is rather suited for a palliative situation because explantation may be difficult. The Strecker Stent requires more reinterventions but removal is easy to perform. The Nitinolstent possibly represents a reasonable copromise.

The noninvasive detection of urothelial carcinoma remains challenging. We prospectively evaluated urine markers for bladder carcinoma. We compared the NMP22 (Matritech, Cambridge, Massachusetts) and BTA Stat (Bard Diagnostics, Redmond, Washington) tests with immunocytology using mAbs 486p3/12 and BG7 against Lewis X antigen.The NMP22 and BTA Stat tests were performed in urine samples and immunocytology with mAbs 486p3/12 and BG7 staining were performed in bladder washing specimens in 146 samples of 115 patients undergoing transurethral resection for suspected bladder carcinoma (70) or 45 undergoing followup cystoscopy for a history of bladder carcinoma (76). Bladder carcinoma was detected in 54 patients, including stages pTa in 25, pT1 in 20, pT2 in 8 and carcinoma in situ in 1, while 61 had no evidence of bladder carcinoma. The cutoff was 10 units per ml. for the NMP22, 30% positive cells for 486p3/12 and 5% positive cells for the Lewis X tests.BTA Stat was positive in 65 samples (44.5%) and NMP22 was positive in 69 (47.3%). Immunocytology with mAbs 486p3/12 and BG7 against Lewis X was positive in 52 (35.6%) and 109 (74.7%) samples, respectively. Sensitivity was 70.3% for BTA Stat, 68.5% for NMP22, 68.5% for 486p3/12 and 94.4% for Lewis X. Specificity was 70.6% for BTA Stat, 65.2% for NMP22, 83.6% for 486p3/12 and 36.9% for Lewis X. Area under the receiver operating characteristics curve was 0.6804 for NMP22, 0.7226 for Lewis X and 0.8002 for 486p3/12. False-positive results on BTA Stat in 2 of 22 patients (9%), on NMP22 in 2 of 25 (8%), on 486p3/12 in 3 of 11 (27%) and on Lewis X in 4 of 43 (9.3%) were associated with tumor recurrence. Furthermore, negative results on BTA Stat in 2 of 39 patients (2%), on NMP22 in 2 of 36 (0.5%), on Lewis X in 0 of 18 (0%) and on 486p3/12 in 1 of 50 (2%) was associated with tumor recurrence during followup.Immunocytology with mAbs against Lewis X showed higher sensitivity than all commercially available tests evaluated. Because of its high sensitivity and high negative predictive value, it may be useful for screening in a high risk population. Patients with a false-positive 486p3/12 test results are at increased risk for tumor recurrence compared with those with negative results.

BACKGROUND One of the goals of a noninvasive test for bladder carcinoma screening would be to reduce surveillance cystoscopies among patients with a history of bladder carcinoma. In addition, an accurate bladder carcinoma marker could be used to screen a high-risk population. The authors examined the efficacy of the hyaluronic acid–hyaluronidase (HA-HAase) and BTA-Stat tests to detect and predict bladder carcinoma recurrence and tested their specificity for bladder carcinoma screening. METHODS Over a four year period, the authors prospectively collected 225 urine specimens from 70 bladder carcinoma patients and analyzed them by the HA-HAase test. Tumors were identified during 178 visits, and in 47 specimens there was no evidence of disease (NED). Twenty six of these 70 patients were randomly selected to have the BTA-Stat test (111 surveillance visits). In a separate study, 401 former Department of Energy (DOE) workers, who are likely to be at a higher risk for bladder carcinoma, were screened by the HA-HAase and BTA-Stat urine tests. RESULTS The HA-HAase test had an approximately 91.0% sensitivity, 70% specificity, 87% accuracy, 92% positive predictive value (PPV), and 67% negative predictive value (NPV) in the 70 bladder carcinoma patients. There were 14 false-positives; however, 6 of these had recurred in approximately 5 months. Only 4 out of 33 NED cases recurred in that time period (chi-square = 5.43; degrees of freedom [DF] = 1; P = 0.0198). Thus, a false-positive HA-HAase test carried a significant risk of recurrence within five months (relative risk [RR] = 3.5; odds ratio [OR] = 5.44). In a direct comparison, the HA-HAase and BTA-Stat had 94% and 61% sensitivity, 63% and 74% specificity, 87% and 64% accuracy, 89% and 88% PPV, and 77% and 38% NPV, respectively. While 6 of the 10 false-positive on the HA-HAase test recurred in 5 months (chi-square = 9.6; DF = 1; P = 0.004), only 1 of the 7 false-positives on the BTA-Stat test recurred in that time period (chi-square = 0.096; DF = 1; P = 0.756). The RR and OR for the HA-HAase test were 10.2 and 24, and for the BTA-Stat, 1.4 and 1.5, respectively. In the DOE worker screening study, the HA-HAase and BTA-Stat had 14% (56 out of 401) and 16.7% (67 out of 401) positive rates, respectively. Sixty three percent of the positives on the BTA-Stat test, but only 25% of the positives on the HA-HAase test, had benign urologic conditions. None of the biomarker positive cases with clinical follow-up (n = 29) had evidence of bladder carcinoma. CONCLUSIONS The HA-HAase test is efficient and superior to the BTA-Stat for detecting and predicting bladder carcinoma recurrence. Noninvasive tests with low false positive rates could be used for bladder carcinoma screening in high-risk populations (e.g., those with occupational exposure to carcinogens or smokers). Cancer 2002;95:61–72. © 2002 American Cancer Society. DOI 10.1002/cncr.10652

We examined the expression of 2 bladder tumor markers, hyaluronic acid (HA) and hyaluronidase (HAase), in bladder tissues and correlated tissue staining with the inferences of the HA-HAase urine test, which detects bladder cancer.A biotinylated HA binding protein and an antiHYAL1 antibody were used to localize HA and HYAL1 type HAase, respectively, in 83 bladder tissues. Immunoblot analysis was performed using an antiHYAL1 antibody to detect HYAL1.A total of 12 normal bladder tissues showed no (66%) to 1+ (34%) HA staining and 0 (83%) to 1+ (17%) HYAL1 staining. The staining intensity of HA and HYAL1 increased in 71 bladder tumor specimens on chi-square analysis (p0.001). Grade 1 tumors demonstrated 1+ (50%) to 2+ (50%) staining for HA and 1+ to 3+ staining for HYAL1 (37%, 37% and 26%, respectively). Grades 2 and 3 tumors showed 2+ to 3+ HA (94%) and HYAL1 (79%) staining. HA was expressed in tumor associated stroma and in tumor cells, whereas only tumor cells expressed HYAL1. In bladder tumor tissues HYAL1 expression was confirmed by immunoblot analysis. In 33 of the 34 patients (97%) with bladder cancer from whom urine and tumor tissue specimens were obtained at the same time 2+ to 3+ staining of HA and/or HYAL1 in 12 and 21, respectively, constituted a positive HA-HAase urine test (kappa = 0.945).To our knowledge this is the first report of HA localization in bladder tissues and of HYAL1 in any normal or tumor tissue. A close correlation of elevated HA and HYAL1 levels in tumor tissues with a positive HA-HAase urine test indicates that in patients with bladder cancer tumor associated HA and HYAL1 are secreted in urine, causing the HA-HAase test to be positive.

The heterogeneity of bladder cancer concerning progress of recurrence is an essential characteristic of this disease. Hyaluronic acid (HA) and its degrading enzyme hyaluronidase (HAase) are intricately associated with bladder cancer angiogenesis and metastasis. Tumor-associated HA and HAase are secreted in urine. In 513 urine specimens (261 bladder cancer patients, 252 patients without bladder cancer) and 83 bladder tissue specimens (71 bladder tumors, 12 normal bladder tissues), the accuracy of HA and HAase as tumor markers was studied. Elevated urinary HA levels (> or = 500 ng/ml), indicating a positive HA test, suggest the presence of bladder cancer regardless of tumor grade. Elevated urinary HAase levels (> or = 10 mU/mg) indicate high-grade (G2/G3) bladder cancer. The combined HA-HAase urine test showed 91% sensitivity and 84% specificity to detect bladder cancer. The HA-HAase test is equally sensitive for monitoring tumor recurrence. Immunohistochemistry (IHC) staining of HA and HAase in the G1 and G2/G3 bladder cancer specimens was significantly (p < 0.001) higher than in normal bladder tissue. HA and HAase appear to be useful markers in the diagnosis of bladder cancer. When compared with other noninvasive tests, the HA-HAase urine test may be less expensive and more accurate.

Background: Maximal inspiratory mouth pressures are suitable for non-invasive evaluation of respiratory muscle function. Different studies on PIMAX give predicted normal values and their relation to anthropometric data. Due to a large inter-subject variation of PIMAX, predicted values, however, maximal inspiratory mouth pressures are not suitable to define the individual expected normal PIMAX. What is the lower limit of the normal range?Methods: PIMAX has been prospectively measured in a representative sample of 504 healthy volunteers (248 males and 256 females) between 18 and 82 years of age with normal lung function. Age, height, weight, body mass index (BMI) and smoking status were recorded and incorporated stepwise in a multiple regression analysis to determine prediction equations. Lower limits of the normal range were defined as the fifth percentile of the residuals derived from the regression model.Results: Mean values of PIMAX were 9·95 kPa for men and 7·43 kPa for women. Significant correlations were found with height, weight, BMI, FEV1, PEF and FVC (P

In our case, a 45-year-old male patient had multiple fractures accompanied by hypophosphatemia. FGF-23 levels were significantly increased, and total body magnetic resonance imaging (MRI) revealed a tumor mass located at the distal tibia leading to the diagnosis of tumor-induced osteomalacia (TIO). After resection of the tumor, hypophosphatemia and the increased levels of FGF-23 normalized within a few days. Subsequent microscopic examination and immunohistochemical analysis revealed a phosphaturic mesenchymal tumor mixed connective tissue variant (PMTMCT) showing a positive expression of somatostatin receptor 2A (SSTR2A), CD68, and Periostin. Electron microscopy demonstrated a poorly differentiated mesenchymal tumor with a multifocal giant cell component and evidence of neurosecretory-granules. However, the resected margins showed no tumor-free tissue, and therefore a subsequent postoperative radiotherapy was performed. The patient is still in complete remission after 34 months. Tumor resection of PMTMCTs is the therapy of choice. Subsequent radiotherapy in case of incompletely resected tumors can be an important option to avoid recurrence or metastasis even though this occurs rarely. The prognostic value of expression of Periostin has to be evaluated more precisely in a larger series of patients with TIO.

The purpose of this study was to determine the effectiveness and toxicity of local continuous immunotherapy of prostatic cancer. A group of 60 young male Copenhagen rats with Dunning adenocarcinoma of the prostate, implanted subcutaneously into both flanks, after proven tumor growth, were treated with either human interleukin-2 (IL-2) depot preparations (n = 30) or albumin (placebo) depot preparations (n = 30) implanted directly into one tumor site. IL-2 depots released IL-2 reliably for more than 24 days. The rat serum was tested during treatment for human IL-2, possibly absorbed from depots, and for rat interferon gamma. IL-2 treatment reduced tumor growth significantly (P0.001) compared with albumin-treated sites or untreated contralateral sites. No toxicity was observed during treatment. Neither human IL-2 nor rat interferon gamma was detected in the serum, which indicates an exclusively local IL-2 effect. IL-2 depot preparations reduce tumor growth in Dunning adenocarcinoma of the prostate significantly without toxicity.

Uber die moderate Wirksamkeit systemischer Chemotherapeutika zur Behandlung des Urothelkarzinoms wird seit >30 Jahren berichtet. Eine potentielle Heilbarkeit auch fortgeschrittener Erkrankungsstadien in dieser Tumorentitat wurde ab Mitte der 80er Jahre erst mit der Kombination verschiedener Einzelsubstanzen postuliert. Bezuglich der Therapieeffektivitat einer „Second-line-Chemotherapie“ beim metastasierten Urothelkarzinom des Nierenbeckens liegen aufgrund der geringen Fallzahl und der schlechten Prognose bislang keine aussagekraftigen Daten vor. Wir berichten uber den bemerkenswerten Verlauf eines 59-jahrigen Patienten mit pulmonal, lymphogen und ossar metastasiertem Transitionalzellkarzinom des Nierenbeckens, der nach 2 Kursen Gemcitabin/Paclitaxel im Rahmen einer „Second-line-Therapie“ eine partielle Remission erreichte, nachdem er sich zuvor uber 24 Kurse Gemcitabin/Cisplatin im „stable disease“ befand, mit jeweils rezidivierender Progression in den therapiefreien Intervallen.

In this retrospective analysis, 30 patients with acute GVHD (aGVHD) and 32 patients with chronic GVHD (cGVHD) treated with extracorporeal photopheresis (ECP) performed by the COBE Spectra System were evaluated. After 3 months of ECP treatment, a CR and PR were observed in 9 (30%) and 6 (20%) patients with aGVHD and in 2 (6%) and 12 (38%) patients with cGVHD. In 16 (53%) patients with aGVHD and 9 (28%) with cGVHD ECP treatment was already stopped after 3 months. One (3%) patient with aGVHD and 7 (22%) patients with cGVHD received new additional immunosuppressive therapy started during the first 3 months of ECP treatment and were classified as 'nonresponder' with regard to ECP. Of these patients a PR was achieved in one patient with aGVHD and in three patients with cGVHD. Steroids could be tapered by 50 in 83% of patients with aGVHD and in 29% of patients with cGVHD after 3 months of ECP treatment. Patients with aGVHD achieving a CR or PR showed a significant improved OS after allo-SCT (P=0.019). ECP is associated with significant response rates and successful reduction of steroids in patients with GVHD.

Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Leiomyomas are benign tumors that can arise in the smooth muscle and can appear practically everywhere; hence, they must be taken into consideration as a rare possibility in the differential diagnosis of numerous tumors. While leiomyomas of the peripheral vessels are a relatively common finding, they are rarely found in the central vessels. Only a few cases of leiomyomas in the vena cava are known. In contrast to malignant leiomyosarcomas, leiomyomas usually grow towards the lumen. We report on the rare case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. Therefore, transperitoneal extirpation of the site was undertaken. It was only during surgery that a tumor emanating from the vessel wall became apparent. Thus, after an initial laparoscopic approach it became necessary to change to open resection of the tumor with cavotomy and resection of the vessel wall. The histopathological work-up revealed a benign leiomyoma and further imaging diagnostics gave no indication for the presence of metastases.

Flexible bronchoscopy is a standard examination today and is conducted not only in nearly every hospital but also in privately owned practices. The vast majority of patients want sedation for this examination. Such a procedure is nearly always necessary in complex and interventional procedures, irrespective of the patient's wish. The recommendation at hand to use sedation measures for flexible bronchoscopy is based on the results of numerous clinical studies and also takes account of individual experiences in this area. The structural and procedural requirements and the requirements for staff training are defined and should describe the minimum standard when it comes to conducting a bronchoscopy under sedation. Furthermore the drugs recommended for sedation are discussed and their methods of application shown. Finally the recommendations also include suggestions for patient clarification, monitoring and discharge. They should provide the examiner with concrete operating options and therefore above all increase patient safety.

Bronchoscopic training courses are an essential part of the education in bronchoscopy for all kinds of specialisations and professions performing such investigations. All aspects of the application should be mentioned during a course. These recommendations are necessary because the number of bronchoscopies performed in the last years has increased due to the increasing number of patients, improved equipment and better availability. Courses should provide the basic knowledge including main points of indications, preconditions for the procedure and decisions of consequence after bronchoscopy. Participants should be trained in the skills of correct handling and performing flexible bronchoscopies in training dummies. Necessary competence requirements on the course instructor are adequate professional qualifications, paedagogic skills and the availability of appropriate teaching material. Quality assurance of the course should be achieved by consequent evaluation. A widely spread field of bronchoscopic applications can improve patient care in many medical specialisations.

Immunomodulation by IFN-γ in patients with resistant infections and accompanying bronchiolitis obliterans following allo-SCT

OBJECTIVE To evaluate the effect of low-dose sildenafil for rehabilitating erectile function after nerve-sparing radical prostatectomy (NSRP), as the delay to recovery of erectile function after NSRP remains under debate. PATIENTS AND METHODS Forty-three sexually active patients had a NSRP; at 7–14 days after surgery they had a Rigiscan® (Dacomed Corporation, Minneapolis, MN, USA) measurement of nocturnal penile tumescence and rigidity (NPTR). To support the recovery of spontaneous erectile function, 23 patients with preserved nocturnal erections received sildenafil 25 mg/day at night. A control group of 18 patients were then followed but had no phosphodiesterase-5 inhibitors. The International Index of Erectile Function (IIEF)-5 questionnaire was completed 6, 12, 24, 36 and 52 weeks after NSRP. RESULTS Of the 43 patients, 41 (95%) had one to five erections during the first night after catheter removal. In the group using daily sildenafil the mean IIEF-5 score decreased from 20.8 before NSRP to 3.6, 3.8, 5.9, 9.6 and 14.1 at 6, 12, 24, 36 and 52 weeks after NSRP, respectively. In the control group the respective scores were 21.2, decreasing to 2.4, 3.8, 5.3, 6.4 and 9.3. There was a significant difference in IIEF-5 score and time to recovery of erectile function between the groups (P

Staging of bronchial carcinoma presents a diagnostic challenge. In addition to CT scans, endobronchial ultrasound is used. The aim of this study was to compare the diagnostic accuracy of high-resolution multidetector CT (MSCT) with that of endobronchial ultrasound with respect of detection and extension of the bronchial lesions.24 patients with lesions in the central bronchial area were examined using both EBUS and MSCT. Multiplanar reconstructions (MPR) as well as virtual endoscopy (VE) were used as adjuncts in this investigation of the comparative diagnostic accuracy of MSCT and EBUS in the imaging of bronchial lesions.No significant difference could be established between EBUS and MSCT in detecting and extension of bronchial lesions. With both procedures, the use of supplementary techniques may be advantageous and helpful in individual cases.When compared with EBUS, MSCT with post-processing has equally high sensitivity with regard to the visualization of malign endobronchial lesions.