Heinz Koelbl

Transurethral injection of silicone microimplants for intrinsic urethral sphincter deficiency.

Objective To assess the short-term efficacy of transurethral injection of silicone microimplants in women with intrinsic sphincter deficiency. Methods During January 1995 and December 1996, 32 women (mean age 64.3 years, range 39-85 years) with type III stress incontinence (intrinsic sphincter deficiency) underwent transurethral injection of silicone microimplants under general anesthesia. Twenty-eight had undergone previous continence surgery. Subjective and urodynamic assessments were made at 6 and 12 months after injection to evaluate success and short-term effects. Results Objective and subjective success rates were 75% and 59% at 6 and 12 months, respectively. Injections of silicone microimplants significantly increased maximum urethral closure pressure (maximum urethral pressure at rest: 34.40 ± 16.46 cm H2O, 95% confidence interval [CI] 28.55, 40.25 versus 25.35 ± 10.78 cm H2O, 95% CI 21.52, 29.18; P = .027). There were no complications after surgery up to 1 year. Conclusion Transurethral silicone injections were effective in 60% of cases of intrinsic sphincter deficiency, although there was a time-dependent decrease.

Prognostic value of immunohistochemically detected HER-2/neu oncoprotein in endometrial cancer

HER-2/neu (c-erbB-2) oncoprotein is a transmembrane glycoprotein and may function as a growth factor receptor being involved in the regulation of cell growth and cell transformation. We performed an analysis of 100 patients with endometrial cancer stage FIGO I to IV using an immunoperoxidase technique on formalin-fixed, paraffin-embedded tissue samples in order to determine HER-2/neu oncoprotein expression. HER-2/neu oncoprotein was expressed in the tumors of 21 patients (21%). Clinical stage, histologic stage, histologic grade and death of invasion did not correlate with HER-2/neu oncoprotein expression. We found HER-2/neu oncoprotein in all clinical stages and therefore it does not seem to be a late event in the natural history of endometrial cancer. HER-2/neu oncoprotein expression was associated with poor overall survival (log-rank P-value 0.04).

IMAGING OF THE LOWER URINARY TRACT

Review of the current literature indicates that the application of various ultrasound techniques plays the most important role in research of imaging of the lower urinary tract. Whereas sonographic urethrocystography by perineal, introital, or vaginal ultrasound has replaced radiography in routine clinical use, more detailed information about the urethra and periurethral tissues has been obtained by three-dimensional sonography and intraluminal high frequency ultrasound. Magnetic resonance imaging is emerging as the newest technique in this field, and has the potential to expand our knowledge of interactions of the lower urinary tract and the pelvic floor.

Serum CD44 splice variants in cervical cancer patients

Aberrant expression of the cell adhesion molecule CD44 has been detected in human tumours and has been shown to be associated with metastasis and poor prognosis in human malignancies. We evaluated serum levels of different soluble CD44 molecules (CD44 standard form and CD44 splice variants v5 and v6) in cervical cancer patients stage IB to IIIB. Two-hundred three serum samples were analysed. Serum levels of CD44st and CD44v5 showed no significant correlation with the presence or absence of cervical cancer. The splice variant CD44v6 showed a mean concentration of 227.3 +/- 90.9 (minimum 71.4, maximum 543.9) ng/ml when tumour was present and a mean concentration of 198.7 +/- 135.4 (minimum 67.2, maximum 696.3) ng/ml in cases of complete remission (P-value = 0.0001). However, in this preliminary study the sensitivity/specificity characteristic of CD44v6 was poor.

Differential diagnosis of detrusor instability and stress‐incontinence by patient history: The Gaudenz‐Incontinence‐Questionnaire revisited

Objective. To evaluate the validity of the Gaudenz‐Incontinence‐Questionnaire in the differential diagnosis of genuine stress‐incontinence and detrusor instability.

Prognostic value of immunohistochemically detected CD44 expression in patients with carcinoma of the vulva

Overexpression of alternatively spliced CD44 isoforms has been reported to correlate with poor prognosis in several human malignancies. To the authors knowledge, there are no studies concerning the prognostic value of CD44 isoform overexpression in patients with squamous cell carcinoma of the vulva.

Tissue polypeptide specific antigen in the follow-up of ovarian and cervical cancer patients

This retrospective study includes 425 serological examinations of 40 patients with epithelial ovarian cancer and 356 serological examinations of 33 patients with squamous cell cervical cancer. The serum levels of the tumor markers tissue polypeptide specific antigen (TPS), carbohydrate antigen 125 (CA 125) and squamous cell carcinoma antigen (SCC) were determined. Cutoff values of 93 U/l for TPS, 3 μg/l for SCC and 37 U/ml for CA 125 were selected according to the 95th percentile of serum concentrations measured in healthy control patients. For ovarian cancer sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TPS were 67%, 84%, 59% and 90%, respectively. In 27 patients with recurrent ovarian cancer, CA 125 and TPS showed lead time effects in 8 and 11 cases, respectively. The combination of CA 125 and TPS provided lead time in 14 cases of recurrent disease with a time range from 1 to 23 months (median 3.9 months). In cervical cancer, TPS showed a sensitivity, specificity, PPV and NPV of 64%, 90%, 85% and 68%, respectively. In 16 patients with recurrent cervical cancer, SCC and TPS showed lead time effects in 7 and 8 cases, respectively. The combination of SCC and TPS provided lead time effects in 12 cases with a time range from 0.5 to 6 months (median 3.5 months). Our data indicate that TPS is a valuable tool in the follow‐up of patients with ovarian or cervical cancer. However, TPS does not appear to be adequate to replace tumor markers CA 125 and SCC. Int. J. Cancer (Pred. Oncol.) 79:241–244, 1998.© 1998 Wiley‐Liss, Inc.

Quantification of uPA receptor expression in human breast cancer cell lines by cRT-PCR

The conversion of plasminogen to active plasmin is thought to be a crucial step in the process of extracellular matrix degradation associated with metastatic spread. Activation of plasminogen is initiated by urokinase plasminogen activator (uPA). The binding of uPA to the uPA cell surface receptor (uPA-R) accelerates plasmin generation from plasminogen and localizes uPA activity to the cell surface.We investigated the mRNA-expression of uPA-R in 19 different human breast cancer cell lines. In a competitive reverse transcription polymerase chain reaction (cRT-PCR) we simultaneously co-amplified two different RNA templates bearing the same primer recognition sequences, the cell line RNA and a known amount of anin vitro synthesized uPA-R-RNA internal standard. We analyzed the two PCR products differing 50 bp in size by agarose gel electrophoresis and calculated the initial uPA-R-RNA template concentration from the relative intensities of the bands quantified by video densitometry.We grouped the investigated cell lines according to theirin vitro invasiveness according to literature. Cell lines with a high potential of invasiveness showed a higher expression of uPA-R compared to those with a low potential of invasiveness (Students t-test,p 0.04). In addition to that we compared the uPA-R mRNA levels with uPA-R, uPA, and PAI-1 protein levels in culture supernatants and cell lysates. The obtained results in breast cancer cell lines with different invasiveness and in benign epithelial cell lines revealed the complex cooperation of the urokinase type proteolytic pathway.uPA, uPA-R, and PAI-1 are to be considered as a diagnostic tool rather than assaying a particular molecule alone. Our findings support the hypothesis that the urokinase proteolytic pathway plays a central role in the acquisition of an invasive phenotype and favors its potential use as a prognostic marker in patients with breast cancer.

Value of urethral pressure profilometry in the female incontinent patient: a prospective trial with an 8-channel urethral catheter

OBJECTIVESnTo measure the pressure profiles at different positions of the urethral circumference simultaneously.nnnMETHODSnTwenty-two women with symptoms of genuine stress incontinence underwent urogynecologic assessment and multichannel urethral pressure profilometry (UPP) at rest with a specially designed 8-channel urethral catheter with radial openings.nnnRESULTSnThe distribution pattern of maximum urethral closure pressure (MUCP) and functional urethral length (FUL) values were significantly different (P=0.004 and P=0.0004, respectively). Most of the highest MUCP values per patient were found between channels 2 and 4 (P=0.015); most of the greatest FUL values per patient were found between channels 3 and 4 (P=0.15).nnnCONCLUSIONSnThe data of our study substantiate asymmetric radial pressure distribution within the urethra and underline the necessity of cautious interpretation of results of conventional single-channel UPP, which might vary because of transducer orientation.

Preoperative evaluation of tumor extension in patients with recurrent cervical cancer.

Background. Pelvic exenteration is an option in the treatment of locally recurrent cervical cancer. Various preoperative diagnostic procedures in the estimation of tumor invasion of the bladder and rectum or lymphonodal involvement were evaluated.