Der Stellenwert von Bisphosphonaten in der Therapie des Prostatakarzinoms

Skeletal complications of bone metastases or secondary osteoporosis are a frequent event in patients with prostate cancer. Bisphosphonates have been widely used for both indications because of their capacity to prevent bone loss, to reduce pain and to inhibit metastatic growth. Possible side effects include acute phase reactions, osteonecrosis of the jaw and renal impairment. Therefore, the risks and benefits of therapy should be considered and informed consent obtained from the patient. Given current evidence the guidelines only allow a recommendation for use in patients with metastatic prostate cancer.     

108. Der Stellenwert des Gastrografin-Einlaufs in der Ileusdiagnostik

Zusammenfassung Von 1978–1984 wurden bei 421 Patienten eine Colonkontrastuntersuchung mit Gastrografin durchgeführt. In 246 Fällen wurde die Untersuchung wegen eines unklaren Abdomens vorgenommen, bei 172 Patienten lagen postoperative Fragestellungen vor, 3 Patienten hatten eine gastrointestinale Blutung. Unter 236 pathologischen Befunden befanden sich 81 Patienten mit einem Dickdarmileus, davon wurden 58 Patienten operiert. Ursache des Dickdarmileus waren Colontumoren, extraluminäre Tumoren sowie Perforationen und Entzündungen. In 55 Fällen wurde durch den Operationsbefund die Diagnose des Gastrografineinlaufs bestätigt, je einmal war ein falschnegativer, unsicherer und falschpositiver Befund vorhanden. Die Treffsicherheit der Befunde lag somit bei 96%.     

113. Der Stellenwert der Chirurgie in der Behandlung des kleinzelligen Bronchialcarcinoms

Zusammenfassung In enger Kooperation von Chirurgen, Chemotherapeuten und Strahlentherapeuten wurde in den letzten 9 Jahren folgendes Therapiekonzept zur Behandlung des kleinzelligen Bronchialcarcinoms (limited disease) entwickelt. Stadium I, II: 1) Radikale Resektion. 2) Chemotherapie. 3) Cerebrale Bestrahlungsprophylaxe. 4) Lokale Radiotherapie. Stadium III: 1) Chemotherapie. 2) cerebrale Prophylaxe. 3) Radikale Operation im Ausmaß der ursprünglichen Tumorausdehnung. 4) Lokale Bestrahlung. Die bisherigen Ergebnisse bei 15 Patienten sind ermutigend.     

Der Stellenwert der Arthroskopie in der Behandlung der Arthrose des oberen Sprunggelenks

ZusammenfassungFragestellung: Ziel der retrospektiven Studie war die Evaluation der Arthroskopie in der Therapie der Arthrose des oberen Sprunggelenks (OSG).Methodik: Im 10-Jahres-Zeitraum 1988–1997 wurden insgesamt 358 Arthroskopien des OSG durchgeführt — in 178 Fällen indiziert durch eine Arthrose. Von 132 erreichbaren Patienten beantworteten 124 einen Fragebogen. Davon wurden 90 (73%) Patienten 94 (37–152) Monate nach der Arthroskopie nachuntersucht und entsprechend dem Score nach Evanski und Waugh bewertet. Alle Arthroskopien erfolgten unter Flüssigkeitsfüllung über einen anterolateralen und anteromedialen Zugang. Lediglich in 5 Fällen wurde das posteriore Kompartment zusätzlich gespiegelt. Generell wurde sowohl auf Blutsperren als auch auf mechanische Gelenkdistraktion verzichtet.Ergebnisse: Von insgesamt 12 (6,7%) Komplikationen waren lediglich 3 Hämatome (1,7%) revisionsbedürftig, eines davon mit arteriovenöser (AV-)Fistel. 5 Sensibilitätsstörungen waren passager, Infektionen traten nicht auf. Von den 124 Patienten der Fragebogengruppe bewerteten 11% das Ergebnis nach der Arthroskopie als sehr gut, 46% als gut, 22% als befriedigend und 21% als schlecht. 22% der Patienten wurden in der Folgezeit erneut am OSG operiert, davon waren 9% arthroskopische Revisionen, 3% Arthrodesen und 10% Denervierungen. Der gesamte Bewegungsumfang vergrößerte sich um 15% von präoperativ 10/0/40° Extension/Flexion auf 15/0/44° zum Zeitpunkt der Nachuntersuchung. Der Evanski-Score verbesserte sich statistisch hoch signifikant (p<0,001) von 41 auf 76 Punkte.Schlussfolgerungen: Aufgrund der geringen Invasivität und Komplikationsrate empfiehlt sich u. E. die Arthroskopie bei folgenden Indikationen: fokale Arthrosen, Bewegungseinschränkungen bei Osteophyten, Impingement, freien Gelenkkörpern und Begleitsynovitis. Schweregrad und Ausdehnung der OSG-Arthrose, Bewegungsumfang des Gelenks, Schmerzhaftigkeit, lokale Knochen- und Weichteilqualität sowie Patientenalter, -aktivität und -compliance entscheiden u. a. über das individuell angepasste Therapiekonzept. In Abhängigkeit davon werden therapeutische Alternativen wie Denervierung, Distraktionsarthroplastik, Korrekturosteotomien, Arthrodese und endoprothetischer Gelenkersatz diskutiert.     

Der Stellenwert der Tageted-Therapie beim Peniskarzinom

With an incidence of 0.1-0.9/100,000 men/year, penile cancer is a rare cancer of the urogenital tract in Western Europe. At the time of initial diagnosis up to 45% of the patients already demonstrate metastatic disease and need some type of systemic treatment. Objective remission rates and 3-year survival rates of 30 and < 10%, respectively, are depressingly low. Identification of molecular targets for the introduction of molecular triggered therapies such as monoclonal antibodies and tyrosine kinase inhibitors might improve the poor prognosis and could replace non-targeted systemic chemotherapies with a less toxic targeted therapy.However, a MEDLINE search does not identify any current clinical trial with regard to targeted therapeutic approaches in penile cancer. Based on a systematic review of the molecular events involved in the metastatic process of penile cancer, therapeutic approaches with bevacizumab or COX-2 inhibitors appear to have the greatest potential to improve the prognosis. In order to perform a prospective clinical phase 2/3 trial in such a low frequency cancer, international cooperative structures have to be established.     

Der Stellenwert der Targeted-Therapie beim Prostatakarzinom

Prostate cancer is the most frequent malignancy of the male population. Every year in Germany approximately 12,000 patients die of their hormone-refractory prostate cancer even though early detection is able to find more curable prostate cancers. In a hormone-refractory stage we only have limited options for treatment. Although docetaxel is currently the standard of care in most hormone-refractory prostate cancers, it is not the magic therapy that will dramatically change the patient's poor survival. This drug provides an overall survival advantage of 2 months. During recent years, significant progress has been made in the field of molecular therapy in urologic oncology. Targeted therapy leads to an inhibition of angiogenesis and proliferation in malignant tumors. Even if there is a great theoretical potential, mono- and combination therapies with target substances are not relevant in the clinical routine.     

Stellenwert genetischer Untersuchungen beim Management des thorakalen Aortenaneurysmas (TAAD)

Background

Thoracic aortic aneurysms are characterized by a dilatation of the ascending aorta and a disposition to dissection of the ascending or descending aorta (thoracic aortic aneurysms and dissections, TAAD). Up to 20?% of cases are familial and as a rule follow an autosomal dominant pattern of inheritance.

Objectives

Heritability of TAAD is not always obvious, thus genetic tests have a high diagnostic value. This is primarily true for the non-syndromic, isolated cases of TAAD but also for syndromic cases, such as Marfan syndrome and Loeys-Dietz syndrome genetic testing should be performed.

Results

For the patient with manifest disease, the genetic differential diagnostics contribute to estimating the prognosis, planning of therapy and future management, such as timing of a prophylactic aorta replacement. Family members can benefit from predictive genetic testing with subsequent initiation of preventive options. The psychological relief ensuing from a negative genetic test result is often underestimated and the same is true for the cost savings for the healthcare system caused by a justifiable renouncement of possible lifelong follow-up preventive measures.

     

Der Stellenwert der Targeted-Therapie beim Nierenzellkarzinom

Therapeutic approaches based solely on cytokine are meanwhile no longer recommended without restrictions as the primary therapy for metastatic renal cancer due to the reduced clinical response and the promising available data regarding molecular therapy. Several randomized controlled studies have been performed since the introduction of the so-called targeted therapies for metastatic renal cancer. Substantial data relevant for drug approval are available for the multikinase inhibitors sorafenib (Nexavar) and sunitinib (Sutent), the mTOR inhibitor temsirolimus (Torisel), and the monoclonal antibody bevacizumab (Avastin) in combination with interferon-alpha. Sunitinib, temsirolimus, and bevacizumab are approved for first-line treatment, whereas sorafenib was approved for second-line treatment in Germany.Clinical trials are currently investigating the questions of optimal timing, value of neoadjuvant or adjuvant treatment, form, and sequence of the molecular targeted therapy. Experimental investigations for a better understanding of signaling pathways will preferably allow preselecting patients for an individualized therapy in metastatic renal cell cancer (RCC). The aim of the present paper is to address and to critically discuss the clinical data that are currently available regarding"targeted" therapeutics during the treatment of metastatic RCC.     

Der Stellenwert der Targeted-Therapie beim Hodentumor

Due to the introduction of tyrosine kinase-inhibitors in the treatment of metastatic renal cell cancer, targeted therapy raises hopes for other urological tumors as well. Even if excellent cure rates, achieved by standardization of diagnosis und therapy, have made testicular cancer a curable disease, up to 6% of young patients still die from tumors refractory to therapy. The quality of life of patients in advanced stages needing aggressive treatment should be improved by new therapies with reduced side effects. The role of tyrosine kinase inhibitors and angiogenesis inhibitors as well as intervention in the cell cycle and induction of apoptosis are discussed.     

Der Stellenwert der Lymphknotenchirurgie beim Nierenzellkarzinom

There are as yet no common standards regarding lymph node dissection during tumor nephrectomy. In order to assess prognoses and survival rates and ensure early detection of kidney tumors, a pathohistological staging following lymphadenopathy and new adjuvant therapies in metastatic disease have to be established in the future. The aims of lymph node dissection are – as far as the morbidity and performance status of the patient are concerned – accurate staging and a decrease in risk of tumor recurrence, particularly in organ-confined cancer disease.     

Der Stellenwert der Lymphknotenchirurgie beim Peniskarzinom

Inguinal lymphadenectomy is performed according to the clinical features as well as the risk factors of the primary tumor. In cases involving more than two positive lymph nodes or extranodal growth as well as positive imaging, pelvic lymphadenectomy is indicated. Large or fixed inguinal nodes as well as iliac lymph nodes seen on computed tomography scanning are a good indication for neoadjuvant rather than adjuvant chemotherapy.     

Stellenwert der Arthroskopie des Ellbogengelenks

Trauma und Berufskrankheit - Zusammenfassung Die Arthroskopie am Ellbogengelenk ist mit 2% aller Arthroskopien ein noch wenig geübtes Verfahren. Sie bringt dennoch eine klare...     

Der Stellenwert der Galvanotherapie beim lokal begrenzten Prostatakarzinom

In recent years electrotherapy has become an accepted treatment option in several medical subfields such as defibrillation during cardiopulmonary resuscitation, electroconvulsive shock treatment (ECT) in conjunction with antidepressant therapy, pain management and physical therapy [transcutaneous electrical nerve stimulation (TENS), diathermia, Stanger bath therapy, etc.]. In recent years several groups, especially from Asia, have investigated the therapeutic effect of electricity in the treatment of malignant tumours. They determined basic principles of electrotherapy and developed different theories of tumour destruction. They postulated a multifactorial tissue effect of continuous current based on tumour cell necrosis due to pH shifting and alteration of membrane potential. In clinical trials similar oncological results of electrotherapy in several malignant tumours compared to established therapeutic methods were observed, whereas clinical trial designs to some extent were not consistent with internationally accepted scientific standards. Regarding electrotherapy of localised prostate cancer only limited data with a few cases and controversial study designs were published. According to EAU guidelines electrotherapy of localised prostate cancer as an alternative treatment option is not recommended and is still an experimental method. For this procedure well-designed clinical trials and a longer follow-up are mandatory to assess the true role of electrotherapy in the management of prostate cancer.     

Stellenwert des Ultraschalls in der Urologie

Ultrasound is of great importance in the diagnosis of acute and chronic diseases in urology, such as kidney colic, testicular torsion, low-grade kidney trauma or for follow-up of vesicoureteral reflux, evaluation of infertility, measurement of residual urinary volume and the detection of cancer. An ultrasound examination is time and cost-effective without exposure to ionizing radiation and is routinely performed by practitioners as well as in the clinical daily routine. With technical innovations, such as contrast-enhanced ultrasound or real time elastography, it would for instance be possible to extend the application field of ultrasound. However, in some fields of investigation ultrasound still lacks accuracy and despite its many advantages the validity of ultrasound findings sometimes has to be verified with computed tomography (CT) or magnetic resonance imaging (MRI).