Impact of preoperative antiandrogen medication and nerve-sparing surgery on the outcome of radical prostatectomy.

OBJECTIVES: Radical prostatectomy in antiandrogen-medicated patients, as well as nerve-sparing surgery, has increased within recent years. We investigated the impact of antiandrogen medication on loss of blood and of nerve-sparing surgery on continence and potency. METHODS: A total of 401 men who underwent radical prostatectomy between January 1995 and September 1999 at our clinic were asked about antiandrogenic medication prior to radical prostatectomy and about daily life activities, overall satisfaction, voiding ability, and sexual activities. Consumption of erythrocyte concentrates and cryoprecipitated plasma was taken from the records. RESULTS: The average follow-up was 36 months. Seventy-two percent (n = 289) of our patients replied. Sixty-seven men (23%) who replied to our questionnaire had received antiandrogen medication prior to radical prostatectomy. In 53 (18%) of the men, the nerve-sparing technique was used. In antiandrogen-medicated patients, we observed a significantly elevated consumption of erythrocyte concentrates (antiandrogen-medicated 0.93, not antiandrogen-medicated 0.44; P = 0.013) and of cryoprecipitated plasma (antiandrogen-medicated 0.39, not antiandrogen-medicated 0.08; P = 0.010). Patients who underwent the nerve-sparing technique reported better results in daily life activities, general health status, International Prostate Symptom Score (IPSS), and continence. CONCLUSION: Our results point to a higher quality of life in patients who had undergone nerve-sparing surgery.

[Analgesia with acupuncture in extracorporeal shock wave lithotripsy of kidney stones--first results]. / Akupunktur während der ESWL von Nierensteinen--erste Ergebnisse.

INTRODUCTION: To date, extracorporeal shock wave lithotripsy (ESWL) has been successfully used with awake anaesthesia. The aim of this study was to investigate whether acupuncture at certain acupuncture points can lower or even substitute the demand for analgesics. SUBJECTS AND METHODS: ESWL treatments were selected for the two groups using the registration number for randomisation. Both groups rated pain sensation prior to the ESWL treatment using a numeric pain scale. The subjects in the analgesic group received 50 mg pethidine and 10 mg diazepam whereas the subjects in the acupuncture group received acupuncture at the points colon 4 bilateral, liver 3 bilateral, urinary bladder 23 bilateral, gall bladder 25 contralateral to the stone, circulation 6 bilateral, and Ren Mai. Every minute till 21 min after starting the therapy and 10 min after termination, the pain sensation was rated. Analgesics were intravenously applied in all subjects reporting a pain sensation higher than 5. Additionally, the pain management was rated with a non-evaluated questionnaire. RESULTS: In the present study on 102 patients, analgesia by acupuncture was successfully applied to patients who underwent ESWL. The analgesic effect of acupuncture was significantly superior to the analgesic effect of analgesics. In the group treated by acupuncture, 20 subjects received additionally analgesics. In general, these subjects presented bigger kidney stones and were younger. Subjects with left-sided kidney stones required more frequently analgesics. The results were not significant.

[Retroperitoneal leiomyosarcoma. A rare differential diagnosis of an adrenal tumor]. / Retroperitoneales Leiomyosarkom. Eine seltene Differentialdiagnose des Nebennierentumors.

A pararenal mass is a clinical finding that cannot be explored preoperatively regarding its parent organ even nowadays. We report in the following about a patient who was admitted with dull pain located in the flank and upper abdomen. Ultrasound investigation at admission showed a solid homogeneous mass close to the upper pole of the left kidney. Urinalysis and catecholamine levels were normal. Intraoperatively, a sarcoma infiltrating the renal capsule and renal vein was observed. In the case of a mass located in the area of the adrenal gland, an extra-adrenal tumor must be considered especially if there are normal findings for urinalysis and catecholamine levels even if modern imaging techniques had been applied.

[Vacuum sealing of extensive wound healing disorders after kidney transplantation]. / Vakuumversieglung bei ausgeprägten Wundheilungsstörungen nach Nierentransplantation.

With the introduction of mycophenolate mofetil (MMF) in renal transplantation, acute rejection episodes diminished and short-term graft survival improved. Better graft outcome, however, is followed by several surgical complications attributed to MMF. Patients with risk factors (adiposity, diabetes mellitus, advanced age) show an increased rate of healing by second intention. We treated two patients with the vacuum sealing technique so that after 15 days a secondary suture became possible in each case. To date the vacuum sealing technique has been used mainly in traumatology, abdominal surgery, surgery for acute infections of soft tissue and bone, and problem wounds with reduced wound-healing capacity (chronic leg ulcer). This article presents two cases of successful application of the vacuum sealing technique in renal transplantation after prolonged wound healing.

[Quality of life following radical prostatectomy]. / Lebensqualität nach radikaler Prostatektomie.

PURPOSE: To investigate quality of life in prostate cancer patients after radical retropubic prostatectomy. MATERIALS AND METHODS: 401 men who underwent radical prostatectomy between January 1995 and September 1999 at our clinic were asked for information concerning daily life activities, overall satisfaction, voiding ability and sexual activity in standardized questionnaire. RESULTS: The average follow-up was 36 months, 72 % (n = 289) of our patients replied. In 53 (18%) of the men who replied to our questionnaire, the nerve-sparing technique had been used. At the time our patients were questioned, 202 (70%) did not use any pads, and 211 (73%) were satisfied or very satisfied with the outcome. Of these patients 98% would undergo a radical prostatectomy again. 13% (n = 37) of our patients reported limited satisfaction, 14% (n = 41) were not satisfied with their postoperative status. However, 69% of this latter group would nevertheless decide to have a radical prostatectomy again. Of the patients who underwent the nerve-sparing technique, 68% (n = 36) reported sufficient erections for sexual intercourse, four of them under medication with sildenafil. Patients who underwent the nerve-sparing technique reported better results in daily life activities, general health status, IPSS-score and continence. While age at the time of radical prostatectomy did not influence life quality, we found substantial correlation with the postoperative tumor stage. CONCLUSIONS: Our results underline the importance of early prostate cancer detection, not only regarding a lower recurrence rate, but also because of a better postoperative quality of life.

Methylation specific PCR to characterize methylation of the promoter of deoxycytidine kinase.

Deoxycytidine kinase (dCK) is essential for phosphorylation of natural deoxynucleosides and analogs, such as gemcitabine and cytarabine, two widely used anticancer compounds. We hypothesized that DNA methylation of SP1 binding sites in the dCK promoter region might affect dCK expression. Using methylation specific PCR (MSP), methylation was detected in one of the SP1 binding sites of the dCK promoter, in most tested cancer cell lines and in patient samples from brain tumors and leukemia. This SP1 site is a 3'GC box, which upon hypomethylation negatively regulates dCK mRNA expression. In conclusion, we developed a new MSP method showing methylation of the 3' GC-box in the dCK promoter region in tumor cells and patient samples. Methylation might therefore regulate transcription of dCK, and should be studied further to understand its role in influencing gemcitabine and cytarabine activity.