ABSTRACT
BACKGROUND: In localized low-risk prostate cancer (PCa), there is a therapeutic dilemma between possible overtreatment by one of the standard therapies and potentially insufficient cancer control by active surveillance (AS). Focal therapy (FT) provides an alternative therapeutic option as it aims to preserve the organ and to eliminate the cancer focus at the same time. METHODS: In this article the current state of FT for localized low-risk prostate carcinoma in Germany is described. In addition, criteria that should be used to select patients for FT are proposed. RESULTS: Currently, the effectiveness of FT is under evaluation by two multicenter, prospective studies in Germany: TOOKAD and HEMI. However, localized low-risk prostate carcinoma remains a diagnostic challenge: Multiparametric MRI as well as histopathological second opinion are considered mandatory in addition to transrectal biospy. CONCLUSION: The oncological outcome of both the TOOKAD and HEMI study will be crucial for any form of FT for prostate carcinoma in Germany in the future. However, there is a remarkably high acceptance of FT among patients.
Subject(s)
Minimally Invasive Surgical Procedures/methods , Organ Sparing Treatments/methods , Prostatectomy/methods , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Radiotherapy, Conformal/methods , Evidence-Based Medicine , Germany , Humans , Male , Prognosis , Risk Assessment/methods , Treatment Outcome , Watchful Waiting/methodsABSTRACT
Liver parenchymal cells (hepatocytes) of human organ donors were isolated using a two-step collagenase perfusion technique. The average viability of the freshly isolated liver parenchymal cells, as judged by trypan blue exclusion, was 82% (SD = 7%; n = 6). The inter-individual differences in the determined enzyme activities were less than a factor of 7.5, despite the different sexes and ages of the donors. Freshly isolated parenchymal cells (PC) were cryopreserved using a computer-controlled freezing protocol. After thawing, cryopreserved cells had a mean viability of 57% (SD = 18%; n = 6). The activities of xenobiotic metabolizing enzymes in freshly isolated and cryopreserved cells were compared using PC from two donors. The enzyme activities of phenol sulfotransferase, 1-naphthol UDP-glucuronosyltransferase and microsomal epoxide hydrolase were well maintained after thawing (87-117% of activities in freshly isolated cells), whereas the activities of glutathione S-transferase, monitored with the broad spectrum substrate 1-chloro-2,4-dinitrobenzene, and the major broad spectrum cytosolic epoxide hydrolase were moderately but markedly reduced after cryopreservation (34-64% and 45-89% of levels in fresh cells, respectively). The decrease of both activities was dependent on the viability after thawing. When cryopreserved cells were purified by a Percoll centrifugation after thawing, the viability was increased from 62 to 92% for cells from one of the donors and from 88 to 98% for PC for the other donor. Subsequently the activity of glutathione S-transferase in Percoll-purified PC from the two donors was increased to 71 and 96% of levels in freshly isolated cells. It is concluded that the use of cryopreserved liver parenchymal cells of humans and other species represents a valuable tool in predicting which animal species best represents humans in hepatic metabolism and therefore should be the preferred species for investigations of metabolism and metabolism-dependent toxicities.
ABSTRACT
In 105 patients CT studies were done prospectively after renal ESWL with a second generation lithotripter. 33 (31%) of the patients had renal oedema (n = 8), renal (n = 20) or extrarenal (n = 31) bleeding. Three of the 23 patients who had a three year follow-up had chronic renal changes, 10 had renal stones. As blunt renal trauma can be the cause of renal hypertension a longterm follow-up is necessary in ESWL patients, particularly if there was renal bleeding after treatment. Further studies are needed to determine the exact risk of renal hypertension after ESWL.
Subject(s)
Hypertension, Renal/etiology , Kidney Calculi/therapy , Lithotripsy/adverse effects , Technetium Tc 99m Mertiatide , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Hypertension, Renal/diagnostic imaging , Kidney Calculi/epidemiology , Male , Middle Aged , Prospective Studies , Radionuclide ImagingABSTRACT
Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for urinary calculi. 117 patients were studied prospectively with 99mTc mercaptoacetyltriglycine (MAG3) before and after ESWL. 79 (66%) of the 119 kidneys treated had abnormal findings. Of these 63/119 (53%) had abnormal scans. 41 (65%) had focal lesions with a delayed intrarenal transport. The remaining 22 had a diffuse delay of intrarenal transport. A loss of relative renal function of 3% and more compared to the pretreatment values was observed in 50/119 (42%) patients. 99mTc MAG3 should be done routinely together with radiologic tests (CT or MRI) before and after ESWL to select the patients at risk for post ESWL hypertension.
