Transplant surgery often requires an effective preoperative treatment which allows to reduce the ... more Transplant surgery often requires an effective preoperative treatment which allows to reduce the risk of bleeding caused by platelet aggregation inhibitors without major delay. The use of recombinant activated coagulation factor VIIa (rFVIIa) may be a future treatment option in such patients. Five patients with end-stage renal disease on treatment with platelet aggregation inhibitors (ASA, Plavix, Aggrenox), who were scheduled for renal transplantation and received a preoperative bolus of recombinant factor VIIa (rFVIIa, NovoSeven) in a dose of 3 kIU/kg (60 microg/kg), were retrospectively analyzed. Parameters of plasmatic coagulation as well as bleeding time were determined before as well as after the administration of rFVIIa. The initial median bleeding time was 7.3 min (range 6.2-14.6); after administration of rFVIIa it fell to 2.8 min (range 1.8-3.2). All patients had a good intraoperative hemostasis. None of the patients developed a hematoma requiring surgical treatment. The graft of all patients was homogeneously and well perfused, with a sufficient postoperative diuresis. The administration of rFVIIa prior to renal transplantation in patients on treatment with platelet aggregation inhibitors was effective and without major complications. Further studies should be performed in order to confirm our observations.
The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma o... more The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma of the prostate has been a controversial method. Materials and methods: The results determined visually from whole capillary blood were compared with the PSA values obtained from serum through quantitative assay and their correspondence was evaluated. PSA values <4 ng/ml obtained through quantitative assay were regarded and as negative results and PSA > or = 4 ng/ml as positive results. Results: Of 371 usable assays, 100 quantitatively obtained PSA values were positive and 271 negative. Seven test strips showed false-negative and 49 false-positive results. In comparison with the quantitative assay, this is equivalent to a sensitivity of 93% and a specificity of 82%. Comparing the distinction between PSA >4 and <4 ng/ml only, there was no significant difference between the results of the quick test and the quantitative assay (Fischer exact test, p < 0.000). Considering the PSA values between 4 and 10 ng/ml, 10.3% of the results of both methods differed. Conclusion: Our series of experiments ascertained a relatively high rate of false-positive PSA test strip results. In practice this can lead to an unpredictable increase of costs, as every positive result requires a quantitative assay. Even more alarming is the loss of sensitivity in the PSA "between 4 and 10 ng/ml" range, which gives false-negative results leading to a delay of diagnosis and therapy.
Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously ... more Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). Materials and Methods: Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. Results: Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 (p = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. Conclusion: We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer ... more Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer cells.• lacking nuclear beta-catenin translocation indicated an actively abrogated Wnt signaling.• elevated expression of the Wnt antagonist DKK1 in HPV-positive penile cancer cells.• DKK1-driven autocrine Wnt pathway inhibition in penile cancer cells.• DKK1+ penile cancers are with a higher frequency HPV+, less differentiated and grow more aggressively.
The advent of complexed PSA (cPSA) raised great expectations concerning the role of this paramete... more The advent of complexed PSA (cPSA) raised great expectations concerning the role of this parameter for improving the early detection of prostate cancer. Materials and methods: Total PSA (tPSA), free PSA (fPSA) and cPSA were evaluated from the serum of 178 of our clinic's patients (74 patients with prostate carcinoma, 104 patients with benign prostate illness) prior to prostate histology. ROC curves were calculated for all of these parameters as well as for the ratios fit-PSA, c/t-PSA and f/c-PSA. Results: The ROC analysis for the whole examined PSA area and PSA levels of 4 to 10 ng/ml showed a statistically significant difference between the AUCs of the ratios on the one hand and the cPSA and tPSA parameters on the other hand. However, there was no difference between these parameters in PSA levels of up to 6 ng/ml. In the comparison of specificities at PSA levels of 4 to 10 ng/ml, the best results were achieved for the c/tPSA ratio. Neither in the PSA level area between 4 and 10 nglml, nor in the whole examined PSA area, could a difference between the cPSA and tPSA parameters be detected. Conclusion: Firm conclusions regarding low PSA concentrations cannot be drawn because of the small number of cases included in our study. However, 5 out of 13 patients with prostate carcinoma, whose tPSA values were still in the employed method's reference area, would have been identified as carcinoma-suspicious and brought to further diagnosis by determining the cPSA value with a recommended cut-off of 2.5 ng/ml.
Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga... more Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga-Marie Schaefer; Bastian Gunawan; László Füzesi; Manfred Blech; Josef Frasunek; Hagen Loertzer. Journal Home, Register or Login: Password: Auto-Login [Reminder]. ...
Transplant surgery often requires an effective preoperative treatment which allows to reduce the ... more Transplant surgery often requires an effective preoperative treatment which allows to reduce the risk of bleeding caused by platelet aggregation inhibitors without major delay. The use of recombinant activated coagulation factor VIIa (rFVIIa) may be a future treatment option in such patients. Five patients with end-stage renal disease on treatment with platelet aggregation inhibitors (ASA, Plavix, Aggrenox), who were scheduled for renal transplantation and received a preoperative bolus of recombinant factor VIIa (rFVIIa, NovoSeven) in a dose of 3 kIU/kg (60 microg/kg), were retrospectively analyzed. Parameters of plasmatic coagulation as well as bleeding time were determined before as well as after the administration of rFVIIa. The initial median bleeding time was 7.3 min (range 6.2-14.6); after administration of rFVIIa it fell to 2.8 min (range 1.8-3.2). All patients had a good intraoperative hemostasis. None of the patients developed a hematoma requiring surgical treatment. The graft of all patients was homogeneously and well perfused, with a sufficient postoperative diuresis. The administration of rFVIIa prior to renal transplantation in patients on treatment with platelet aggregation inhibitors was effective and without major complications. Further studies should be performed in order to confirm our observations.
The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma o... more The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma of the prostate has been a controversial method. Materials and methods: The results determined visually from whole capillary blood were compared with the PSA values obtained from serum through quantitative assay and their correspondence was evaluated. PSA values <4 ng/ml obtained through quantitative assay were regarded and as negative results and PSA > or = 4 ng/ml as positive results. Results: Of 371 usable assays, 100 quantitatively obtained PSA values were positive and 271 negative. Seven test strips showed false-negative and 49 false-positive results. In comparison with the quantitative assay, this is equivalent to a sensitivity of 93% and a specificity of 82%. Comparing the distinction between PSA >4 and <4 ng/ml only, there was no significant difference between the results of the quick test and the quantitative assay (Fischer exact test, p < 0.000). Considering the PSA values between 4 and 10 ng/ml, 10.3% of the results of both methods differed. Conclusion: Our series of experiments ascertained a relatively high rate of false-positive PSA test strip results. In practice this can lead to an unpredictable increase of costs, as every positive result requires a quantitative assay. Even more alarming is the loss of sensitivity in the PSA "between 4 and 10 ng/ml" range, which gives false-negative results leading to a delay of diagnosis and therapy.
Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously ... more Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). Materials and Methods: Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. Results: Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 (p = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. Conclusion: We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer ... more Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer cells.• lacking nuclear beta-catenin translocation indicated an actively abrogated Wnt signaling.• elevated expression of the Wnt antagonist DKK1 in HPV-positive penile cancer cells.• DKK1-driven autocrine Wnt pathway inhibition in penile cancer cells.• DKK1+ penile cancers are with a higher frequency HPV+, less differentiated and grow more aggressively.
The advent of complexed PSA (cPSA) raised great expectations concerning the role of this paramete... more The advent of complexed PSA (cPSA) raised great expectations concerning the role of this parameter for improving the early detection of prostate cancer. Materials and methods: Total PSA (tPSA), free PSA (fPSA) and cPSA were evaluated from the serum of 178 of our clinic's patients (74 patients with prostate carcinoma, 104 patients with benign prostate illness) prior to prostate histology. ROC curves were calculated for all of these parameters as well as for the ratios fit-PSA, c/t-PSA and f/c-PSA. Results: The ROC analysis for the whole examined PSA area and PSA levels of 4 to 10 ng/ml showed a statistically significant difference between the AUCs of the ratios on the one hand and the cPSA and tPSA parameters on the other hand. However, there was no difference between these parameters in PSA levels of up to 6 ng/ml. In the comparison of specificities at PSA levels of 4 to 10 ng/ml, the best results were achieved for the c/tPSA ratio. Neither in the PSA level area between 4 and 10 nglml, nor in the whole examined PSA area, could a difference between the cPSA and tPSA parameters be detected. Conclusion: Firm conclusions regarding low PSA concentrations cannot be drawn because of the small number of cases included in our study. However, 5 out of 13 patients with prostate carcinoma, whose tPSA values were still in the employed method's reference area, would have been identified as carcinoma-suspicious and brought to further diagnosis by determining the cPSA value with a recommended cut-off of 2.5 ng/ml.
Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga... more Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga-Marie Schaefer; Bastian Gunawan; László Füzesi; Manfred Blech; Josef Frasunek; Hagen Loertzer. Journal Home, Register or Login: Password: Auto-Login [Reminder]. ...
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