Totale prostatektomie: geschiedenis en resultaten van een controversiele operatie

Rede, uitgesproken bij de aanvaarding van het ambt van gewoon Hoogleraar in de Urologie aan de Erasmus Universiteit Rotterdam, op 21 september 197

Screening, early detection, and treatment of prostate cancer: A European view

Powerful tests are now available for the detection of prostate cancer, both more frequently and at an earlier and usually more curable stage. In some countries of the world, mainly the United States and some European countries, serum prostate-specific antigen (PSA) and rectal examination-based screening is routinely applied to men at risk. In other countries, particularly in Northern Europe, routine application of screening procedures for prostate cancer is not accepted for a number of reasons: knowledge about the natural history of early lesions suggests that indiscriminate use of these tests will lead to overdiagnosis and overtreatment, information on the effectiveness of treatment from randomized trials is unavailable, and no evidence exists that early diagnosis and treatment will lead to an improvement of disease-related and overall mortality. In this article a number of critical and controversial issues of screening for prostate cancer are reviewed. This includes the risk of prostate cancer to patients, the efficacy and acceptability of the screening tests, the issue of overdiagnosis in relation to the natural history, evidence concerning the effectiveness of treatment, and the chances that early treatment may lead to an improvement of prostate cancer mortality. In relation to these points it is concluded that prostate cancer is a frequent cause of death in men and that at present the possibility of early diagnosis and treatment represents the only possibility of cure. The question whether cure is necessary in every identified case or in identifiable subgroups remains unanswered at this time. Although the individual positive predictive value of the screening tests is low, a combination offers higher positive predictive values that are in the range of 70–80%. With proper streamlining of the screening tests, it may be possible in the future to detect one cancer in 2.5–3.0 biopsies. The most efficient use of the screening tests in the general population still remains to be determined. Estimates related to the amount of overdiagnosis are made. Depending on the definition used, overdiagnosis with one round of screening for prostate cancer is probably in the range two to threefold. The effectiveness of available treatment modalities compared with delayed management has not been studied in a prospective randomized manner. There is, however, indirect evidence, especially relating to the long-term survival of grade 3 patients and to the long-term normalization of serum PSA values after radical prostatectomy, that at least this treatment is effective. In conclusion, the use of the screening tests cannot be withheld from symptomatic men and those who wish to be examined for the presence of prostate cancer. Application to the general population should depend, however, on the result of a prospective randomized study that shows that early detection and treatment will decrease prostate cancer mortality

Dialogues and Dynamics – Interculturality in Theology and Religious Studies

This volume contains the texts from the symposium on the occasion of the 10th Anniversary of the M.A. Programme Intercultural Theology. The contributions address the challenges and consequences of an intercultural approach in academics as well as in the churches and in society. Since globalisation has significantly changed the face of contemporary Christianity in the 21st century, the task of doing theology has become more complex. The cultural, geographic and denominational varieties of Christianity worldwide challenge the traditional Western face of academic Christian theology and demand new and global forms of theological thinking across lines. Intercultural Theology seeks to embrace these dynamics with a constructive dialogue, opening up new spaces of collaborative thinking and academic reflection

Критерии формы поперечного сечения взрывной скважины

Предложены критерии оценки форм поперечного сечения скважины, полностью заполненной удлиненным зарядом взрывчатого вещества. Критерии рассмотрены с точки зрения эффективности взрывного воздействия на горную породу и могут быть использованы при создании и обосновании конструкций бурового инструмента. Анализ геометрических форм поперечных сечений взрывной полости в виде правильных фигур показал, что имеется взаимосвязь критериев, конкретное значение которых может быть определено для имеющихся конструкций бурового инструмента.Proposed criteria for the assessment of the bag of cross-section of the borehole is completely filled elongated explosive charge. Criteria considered from the point of view of the ability to influence the result of the explosive impact and can be used to create and justify the constructions of the drilling tool. The analysis of geometrical forms of cross sections of the explosive borehole in the form of correct figures have shown that there is a relationship of the considered criteria, however, a specific value can be determined for the existing designs of drilling tools

Treatment of benign prostatic hyperplasia by transurethral ultrasound- guided laser-induced prostatectomy (TULIP): Effects on urodynamic parameters and symptoms

Objectives This prospective study was undertaken to evaluate the effects oftransurethral ultrasound-guided laser-induced prostatectomy (TULIP) on urodynamic, symptomatic, and prostate volume parameters as well as serum prostate-specific antigen. Methods The TULIP procedure was performed in 33 patients with benign prostatic hyperplasia with a mean age of 66 years. Patients were evaluated by pressure—flow studies, prostate volume measurement by transrectal ultrasound, and the American Urological Association (AUA) symptom score. Results At 3-month follow-up, laser prostatectomy has resulted in an increased maximum flow rate from 6.6±0.5 to 11.2±0.6 mL/s and in an objectively proven relief of the urodynamic obstruction, as is evident by a decrease of the average value of the urethral resistance parameter URA and the detrusor pressure at maximum flow rate from 38.3 ± 2.7 to 21.3 ± 1.3 cm water and from 62.7 ±4 to 38.9 ± 2.1 cm water, respectively. Symptomatic improvement is evident from a decrease in the AUA symptom score from 20.4 at baseline to 8.8 at 6-month follow-up. Although the total symptom score did not change significantly between 6 months and 1 year follow-up, the score of the symptom “weak stream” was significantly higher again at 12 months follow-up. Conclusions The TULIP procedure is a urodynamically and symptomatically effectivetreatment. Conclusions about the durability of this treatment modality should be made with reser