Ruf C.G.,Armed Forces Hospital Hamburg |
Gnoss A.,Albertinen Krankenhaus Hamburg |
Hartmann M.,University of Hamburg |
Matthies C.,Armed Forces Hospital Hamburg |
And 4 more authors.
Andrology | Year: 2015
The precursor of testicular germ cell tumours (GCTs), called testicular intra-epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular biopsies are utilized poorly. The patterns of care regarding the use of biopsies remain unknown. Uncertainty exists about the prevalence and specific treatment of TIN/CIS. We asked clinical urologists in Germany whether or not they employed contralateral biopsies in GCT patients. We evaluated the prevalence of contralateral TIN/CIS in a retrospective analysis of 780 consecutive GCT patients. All had contralateral double biopsies. Discordance of TIN/CIS findings among biopsy pairs as well as age, histology of the primary tumour and clinical stage was noted. Evaluation of data comprised descriptive statistical methods. To evaluate treatment options for TIN/CIS, we performed a literature search. 52.1% of German urologists always perform the biopsy, 17% do it mostly, 27.3% in select cases, 3.5% never. Curiously, there was a geographic north-south gradient regarding biopsy use. Contralateral TIN/CIS was found in 5%. The median ages of patients with TIN/CIS and those without were 31.8 and 34.9 years respectively (p = 0.02). The discordance rate among biopsy pairs was of 33%. Two-site biopsies provide a 17% gain in diagnostic sensitivity. Local radiotherapy with 20 Gy is the safest treatment of TIN/CIS failing in 2%. Chemotherapy has significantly lower efficacy. Contralateral testicular biopsies in GCT patients are well accepted among German urologists. The prevalence of contralateral TIN/CIS found in this series is in accordance with previous reports. Double biopsies should be the diagnostic standard because of their diagnostic superiority. Local radiotherapy with 20 Gy is the safest way of eradicating TIN/CIS. Failures occur in only 2%, usually many years after irradiation. Cisplatin-based chemotherapy is dose dependent and less effective. © 2014 American Society of Andrology and European Academy of Andrology.
Oldenburg J.,Akershus University Hospital |
Oldenburg J.,University of Oslo |
Dieckmann K.-P.,Albertinen Krankenhaus Hamburg
World Journal of Urology | Year: 2016
Introduction: In 1979, the Copenhagen group around Dr. Skakkebaek introduced contralateral biopsy in patients with testicular germ cell tumour (GCT) as a means of early diagnosing a contralateral testicular tumour (Berthelsen et al. in Br Med J 2(6186):363–364, 1). Although the rationale of contralateral biopsies is based on much of scientific evidence, no issue regarding the management of GCTs has been more controversial than the issue of contralateral biopsies (Heidenreich in BJU Int 104(9 Pt B):1346–1350, 2; Grigor and Rorth in Eur Urol 23(1):129–135, 3). A poll conducted during the GCT Consensus Meeting in Berlin 2011 revealed that 43 % of 60 leading experts would not recommend a contralateral biopsy and only 13.7 % would do the biopsy in all cases with GCT (Beyer et al. in Ann Oncol 24(4):878–888, 4). Likewise, the European Association of Urology and the European Society of Medical Oncology offer only weak recommendations with respect to contralateral biopsies in their guidelines of testicular cancer (Albers et al. in Eur Urol 68(6):1054–1068, 5; Oldenburg et al. in Ann Oncol 24(Suppl 6):vi125–vi132, 6). Conclusion: This review summarizes contemporary knowledge regarding contralateral biopsies to provide professionals caring for GCT patients with sufficient information to decide for or against the procedure in clinical practice. © 2016 Springer-Verlag Berlin Heidelberg
Dieckmann K.-P.,Albertinen Krankenhaus Hamburg |
Gerl A.,Onkologische Schwerpunktpraxis Munich |
Witt J.,Albertinen Krankenhaus Hamburg |
Hartmann J.-T.,Universitatsklinik Tubingen
Annals of Oncology | Year: 2010
Background: Chronic vascular morbidity resulting from chemotherapy for testicular germ-cell cancer (TGCC) is recognized. Cardiovascular events (CVEs) occurring early during chemotherapy are less understood. We evaluated the incidence and clinical features of CVEs associated with chemotherapy of TGCC. Patients and methods: A questionnaire was sent to 355 institutions in Germany to explore for early CVEs occurring during 1996-2008. To assess the relative incidence of CVEs, the number of events was put into relation to the total number of patients treated during the time span (n = 8233, calculated from national database). The response rate was 79%. Results: Twenty cases with myocardial infarction (MI), 3 with cerebral stroke, and 2 with arterial thrombosis were recorded. The estimated incidence of MI and of all CVEs during chemotherapy is 0.24% [95% confidence intervals (CIs) 0.137% to 0.349%] and 0.30% (95% CI 0.188% to 0.423%), respectively. This estimate represents a minimum figure because the calculation is on the basis of simplifications. Six MI patients had no risk factors. Coronary angiography was indicative of thromboembolic rather than atherosclerotic origin of MI. Conclusions: There is a small but definite risk of major early CVE associated with chemotherapy of TGCC. Physicians caring for TGCC patients must be aware of this hazard. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Diegeler A.,Herz und Gefass Klinik Bad Neustadt |
Borgermann J.,Herz und Diabeteszentrum Bad Oeynhausen |
Kappert U.,Herzzentrum Dresden |
Breuer M.,Universitatsklinik Jena |
And 11 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: The benefits of coronary-artery bypass grafting (CABG) without cardiopulmonary bypass in the elderly are still undetermined. METHODS: We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery. RESULTS: A total of 2539 patients underwent randomization. At 30 days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P = 0.74) or four of the components (death, stroke, myocardial infarction, or new renal-replacement therapy). Repeat revascularization occurred more frequently after off-pump CABG than after on-pump CABG (1.3% vs. 0.4%; odds ratio, 2.42; 95% CI, 1.03 to 5.72; P = 0.04). At 12 months, there was no significant between-group difference in the composite end point (13.1% vs. 14.0%; hazard ratio, 0.93; 95% CI, 0.76 to 1.16; P = 0.48) or in any of the individual components. Similar results were obtained in a per-protocol analysis that excluded the 177 patients who crossed over from the assigned treatment to the other treatment. CONCLUSIONS: In patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery. (Funded by Maquet; GOPCABE ClinicalTrials.gov number, NCT00719667). Copyright © 2013 Massachusetts Medical Society.
Dieckmann K.-P.,Albertinen Krankenhaus Hamburg |
Struss W.J.,Albertinen Krankenhaus Hamburg |
Budde U.,Medilys Laborgemeinschaft mbH
Anticancer Research | Year: 2011
Background: Acute early vascular toxicity of chemotherapy for germ cell tumour (GCT) is poorly understood. To explore the pathogenesis of this complication we evaluated laboratory parameters associated with vascular disease. Patients and Methods: In 33 GCT patients the following parameters were investigated with routine laboratory methods before and after chemotherapy: von Willebrand factor antigen (vWF:AG), collagen binding capacity (vWF:CB), lipoprotein (a), homocysteine, plasminogen activator inhibitor I, total cholesterol, high density lipoprotein, low density lipoprotein, troponine I. Statistical evaluation involved descriptive analysis and the Wilcoxon signed rank test. Results: Levels of vWF:AG and vWF:CB increased significantly upon therapy (p=0.002). All other parameters remained unchanged. Upon late measurement, vWF:AG and vWF:CB were normalised. Conclusion: As von Willebrand factor is released from endothelial cells upon damage, we postulate that early vascular toxicity of chemotherapy is caused by direct damage of the vascular endothelium. Long-term vascular complications of chemotherapy appear to be different, pathogenetically.
PubMed | Universitatsklinikum Eppendorf Hamburg, Bundeswehr Krankenhaus Hamburg, Saarland University, Albertinen Krankenhaus Hamburg and 3 more.
Type: Journal Article | Journal: Journal of cancer research and clinical oncology | Year: 2016
Clinical stage 1 (CS1) testicular seminoma involves an almost 100% disease-specific survival in controlled clinical trials. We aimed to find out whether these results can be matched in patients managed on the routine care level.In total, 725 patients with seminoma CS1 were prospectively enrolled from 130 institutions. Adjuvant management as decided by local physicians involved surveillance (n=256), radiotherapy (41), 1 Carboplatin (362), and 2 Carboplatin (66). We registered type of management, age, duration of follow-up (F/U), relapse, rete testis invasion (RTI), and tumor size. Actuarial relapse-free survival curves were calculated for treatment modalities and stratified for tumor sizes and RTI. A Cox regression model was calculated to explore for factors influencing relapses.Disease-specific survival was 100%. Crude relapse rates were 8.2, 2.4, 5.0, and 1.5% for surveillance, radiotherapy, 1 Carboplatin, and 2 Carboplatin after a median F/U of 30months. RTI and tumor size were not associated with progression in surveillance patients. One course Carboplatin caused relapses in 6.8% in tumor sizes >4cm and 9.3% (actuarial 13%) in sizes >5cm. The Cox model revealed the association of tumor size with recurrence in the entire seminoma population (Hazard ratio 1.17; 95% confidence intervals 1.03-1.33).The overall outcome of CS1 seminoma managed on the routine care level mirrors that of controlled trials. Unexpectedly, the risk factors in surveillance patients were not confirmed, but tumor size proved to be a risk indicator in the entire group of seminoma. Importantly, one course Carboplatin involved low efficacy to control the disease in large tumors.
PubMed | Albertinen Krankenhaus Hamburg and Akershus University Hospital
Type: | Journal: World journal of urology | Year: 2016
In 1979, the Copenhagen group around Dr. Skakkebaek introduced contralateral biopsy in patients with testicular germ cell tumour (GCT) as a means of early diagnosing a contralateral testicular tumour (Berthelsen et al. in Br Med J 2(6186):363-364, 1). Although the rationale of contralateral biopsies is based on much of scientific evidence, no issue regarding the management of GCTs has been more controversial than the issue of contralateral biopsies (Heidenreich in BJU Int 104(9 Pt B):1346-1350, 2; Grigor and Rorth in Eur Urol 23(1):129-135, 3). A poll conducted during the GCT Consensus Meeting in Berlin 2011 revealed that 43% of 60 leading experts would not recommend a contralateral biopsy and only 13.7% would do the biopsy in all cases with GCT (Beyer et al. in Ann Oncol 24(4):878-888, 4). Likewise, the European Association of Urology and the European Society of Medical Oncology offer only weak recommendations with respect to contralateral biopsies in their guidelines of testicular cancer (Albers et al. in Eur Urol 68(6):1054-1068, 5; Oldenburg et al. in Ann Oncol 24(Suppl 6):vi125-vi132, 6).This review summarizes contemporary knowledge regarding contralateral biopsies to provide professionals caring for GCT patients with sufficient information to decide for or against the procedure in clinical practice.
PubMed | Albertinen Krankenhaus Hamburg, Universitatsklinikum Eppendorf and Bundeswehrkrankenhaus Hamburg
Type: | Journal: BMC urology | Year: 2015
The loss of a testicle to cancer involves much emotional impact to young males. Little is known about the number of patients with testicular germ cell tumour (GCT) who would accept a testicular prosthesis. Also, knowledge about the satisfaction of implant recipients with the device is limited.A retrospective chart analysis was performed on 475 consecutive GCT patients. Prior to orchiectomy, all patients were offered prosthesis insertion. Acceptance of implant was noted along with age, clinical stage, histology and year of surgery. 171 implant recipients were interviewed using an 18 item questionnaire to analyze satisfaction with the prosthesis. Statistical analysis involved calculating proportions and 95% confidence intervals. Multivariate analysis was performed to look for interrelations between the various items of satisfaction with the implant.26.9% of the patients accepted a prosthesis. The acceptance rate was significantly higher in younger men. Over-all satisfaction with the implant was very high and high in 31.1% and 52.4%, respectively. 86% would decide again to have a prosthesis. Particular items of dis-satisfaction were: implant too firm (52.4%), shape inconvenient (15.4%), implant too small (23.8%), position too high (30.3%). Living with a permanent partner had no influence on patient ratings. Multivariate analysis disclosed numerous inter-relations between the particular items of satisfaction.More than one quarter of GCT patients wish to have a testicular prosthesis. Over-all satisfaction with implants is high in more than 80% of patients. Thus, all patients undergoing surgery for GCT should be offered a testicular prosthesis. However, surgeons should be aware of specific items of dis-satisfaction, particularly shape, size and consistency of the implant and inconvenient high position of the implant within the scrotum. Appropriate preoperative counselling is paramount.
PubMed | Albertinen Krankenhaus Hamburg
Type: Journal Article | Journal: Urology | Year: 2011
To evaluate the feasibility of contrast-enhanced ultrasound (CEUS) in the diagnosis of testicular masses.A total of 51 consecutive patients with testicular masses detected by clinical examination and gray-scale ultrasound were examined with CEUS (2.4 mL of intravenous Sonovue [Bracco]) before surgery. Characteristics of contrast enhancement were correlated with intraoperative and histologic findings.In 50/51 patients, bubbles of the contrast media were clearly visualized in the testicles 21 5.5 seconds after injection. Of the patients, 43 had a neoplastic lesion, histologically (29 seminoma, 9 nonseminomatous testicular tumor, 4 Leydig cell tumor, and 1 non-Hodgkin lymphoma). In 39 of 51 patients (76.5%), testicular masses showed a clear early hyperenhancement compared with the surrounding tissue. Of these 39 masses, 38 proved to be neoplastic; 1 patient had focal suppurative epididymo-orchitis. Hyperenhancement of a testicular lesion had a positive predictive value of 97.4% (95% CI = 84.9-99.9%) for neoplasia. Hyperenhancement was not found in 7 of 8 lesions proved to be nonneoplastic (1 epidermoid cyst, 3 necrosis/atrophy, 1 incarcerated inguinal hernia, 1 hematoma, and 1 tubular ectasia of the rete testis).CEUS allows visualization of testicular microvascularization and may thus aid in the preoperative assessment of testicular lesions with hypervascularization as an important feature in the diagnosis of malignancy. It may be particularly valuable in the assessment of small intratesticular masses where color-coded ultrasound comes to its limits.
PubMed | Albertinen Krankenhaus Hamburg
Type: Journal Article | Journal: Urologia internationalis | Year: 2016
microRNAs (miRs)-371-3 are suggested to be novel biomarkers of germ cell tumors (GCTs), but their specificity is unresolved. We aimed at clarifying the origin of miR 371a-3p by measuring this miR in peripheral vein blood, and in fluids present in the vicinity of GCTs.miR-371a-3p levels were measured by quantitative PCR in 9 tumor surrounding hydroceles and in cubital vein blood (CVB) and testicular vein blood (TVB) of 64 GCT patients, 51 with clinical stage (CS) 1, 13 with CS2-3. Thirty three CS1 cases had also postoperative CVB measurement. TVB miR levels were compared with those of CVB. Associations with clinical factors were analyzed statistically.TVB miR levels were 294-fold, 80-fold and 4.6-fold higher than those in CVB of CS1 patients, CS2-3 patients and controls, respectively. Neoplastic hydrocele fluid comprised of very high miR levels. In CS1, miR levels dropped to normal postoperatively. Statistically, CVB miR levels are significantly associated with tumor size (p = 0.0211) and testis length (p = 0.0493). TVB miR levels are associated with testis length (p = 0.0129).This study provides evidence for the origin of circulating miR 371a-3p molecules from GCT cells. miR-371a-3p represents a specific serum biomarker for germ cell cancer.