Biomedical subjects
Publications and source records attributed to A Sigel.
An experimental study demonstrates the feasibility of local renal hypothermia by transvenous perfusion. The method is technically simple and provides continuous renal cooling within a range of 15-19 degrees C, optimally protecting the ischemic kidney. Thromobosis at the site of venous puncture was not observed.
On the basis of satisfactory results with a new magnetic stoma seal in colostomy patients, this seal, consisting of a magnetic ring and cap, was used in an experimental study to convert the colonic conduit into a continent reservoir. The aim of the study, involving 16 dogs, was to find a method of ring implantation that would avoid infection of the ring and yield complete continence in a higher percentage than had been achieved so far in patients. Complete continence was obtained in all animals but there was a 75% incidence of immediate and delayed infection of the magnetic ring when the ring was inserted transcutaneously. In contrast, all rings were well accepted by the tissue when the procedure was staged with the ring being implanted transperitoneally several weeks prior to fashioning of the conduit. The general problems arising from the colonic conduit when used as continent reservoir are known from the results of colocystoplasty, coloprostatoplasty and colourethroplasty, which are reviewed and compared with our observations. Residual urine was low due to an ideal energy-balance pattern. Coloureteric reflux was successfully prevented in all cases operated on by a long-tunnel modification of the Leadbetter-Clarke technique. Hyperchloremic acidosis and renal function deterioration were not observed. All conduits were infected.
Urine oxalate was determined by the enzymatic method, quality criteria were established, and 24h oxalate excretion measured in healthy control subjects and in patients suffering from calcium urolithiasis. The technique is highly reliable and can be practiced in every conventional clinical laboratory. There is no increase in 24h urine oxalate in calcium urolithiasis when related to body weight or lean body mass.
In an experimental study involving ten dogs, the feasibility of transvenous perfusion cooling of the kidney is proven. The theoretical basis of this new method of regional renal hypothermia is presented; the technique is easy to perform and requires cannulation of the renal vein. The perfusate leaves the kidney either via the capsular veins which have been divided during renal exposure, or through the proposed nephrotomy. Renal vein thrombosis or tearing of the venous vasculature was not observed. The only complication encountered in one instance was hemorrhage from the puncture site of the renal vein.
The disturbance of miction after general surgical operations has three causes. They exist individually and combined. The first cause is a relative trauma of anaesthesiological remedies. They have a central site of action in the brain stem and a peripheral one in the parasympathetic and sympathetic ganglian of the urinary bladder. The second cause is an operative trauma of the abdomino-pelvic initial reflex of the miction. The two traumata, the vegetative and the mechanical one, decompensate an imminent neuropathic or obstructive reduction of the urinary bladder. The two traumata are prolonged by abdominal, pulmonary and cerebral insufficiency. The third cause is a direct lesion of the sacral plexus pelvicus. - The postoperative disturbance of miction concerns about 25% of all operated persons. Children are specifically rarely concerned. Operations on the lower half of the body cause the disturbance of miction by far more frequently than operations on the upper half of the body or on extremities. The therapy consists of a rational, liberal and differentiated use of the catheter, further in parasympathomimetic and sympatholytic medication, in the obstructively or neuropathically decompensated cases in transurethral operative correction of the outlet of the urinary bladder.
Indications, selection of donor and recipient, medical and surgical management and complications, problems of organ procurement. Renal transplantation has become routine therapy. Organs are predominantly obtained from cadavers, transplantations from living donors are rarely indicated. Advances in preservation methods have improved organ quality and prolonged storage time. Selection of the most suitable recipient is based on histocompatibility matching. Blood transfusions before transplantation seem to improve the results. Recognition of a rejection crisis is primarily based on clinical symptoms. Persistent rejection calls for prompt explantation and the patient has to return to dialysis. Infections, serum-hepatitis and gastro-intestinal bleeding are the most common complications. Late complicatons are diabetes mellitus, cirrhosis of the liver, osteopathy, recurring glomerulonephritis, and, rarely, malignomas. Transplantation frequency in the Federal Republic of Germany could be increased by more awareness of physicians and a better knowledge of the general public about the need for cadaver donors.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Impaired micturition after general surgical operations can be due to three causes, which occur individually or in combination. The first comprises side effects of anesthetics upon the autonomic nervous system. Inhibition of the abdominopelvic reflex, initiating micturition, due to the operative trauma represents the scond cause. Both the vegetative and the mechanical traumas, lead to decompensation of the urinary bladder, whose function is impaired by neuropathic factors and outflow obstruction. Pulmonary, cerebral, and abdominal insufficiency prolong the effects of both traumas. The third cause is direct operative injury of the sacroplexus pelvus.--Approximately 25% of all patients undergoing surgery will shown voiding disturbances in the postoperative period. The treatment consists sympatholytic therapy. In cases of neuropathic and obstructed bladders, the treatment of choice is transurethral correction of the bladder outlet.
In advanced stages, the three most common inflammatory bowel diseases - colonic diverticulitis, Crohn's disease and ulcerative colitis - cause, in some 10% of cases, secondary urological pathology involving either bladder or ureter. Colovesical fistula is found more frequently in diverticulitis and less often in Crohn's disease, which penetrates predominantly from the ileum into the bladder. On the other hand, if uretic stenosis develops it will be caused on the right side by Crohn's disease and on the left by ulcerative colitis. Vesico-intestinal fistulae will close without sequelae after resection of the diseased bowel segment. On the other hand, retroperitoneal ureteric stenosis - despite bowel resection and ureterolysis - will often require nephrectomy if operation is not carried out early enough. Frequent re-checks with infusion excretory urography will help to prevent this. Nephrolithiasis, amyloidosis and contracted bladder are other, though less common, complications of chronic inflammatory diseases of the bowel.
The three most common inflammatory diseases of the bowel, colonic diverticulitis, regional enteritis and ulcerative colitis, involve the bladder or ureter in the advanced stage in about 10%. The colovesical fistula is found more frequently with diverticulitis and less often with regional enteritis, which penetrates predominantly from the ileum into the bladder. On the other hand, if an ureteric stenosis develops, it will be caused on the right side mainly by regional enteritis and on the other side by ulcerative colitis. The vesicointestinal fistulae will close without sequelae after resection of the involved bowel segment. However, the ureteric stenosis will often be followed by nephrectomy despite bowel resection and ureterolysis, if the operation is not undertaken early enough. Frequent rechecks with infusion urography should help to prevent this. Nephrolithiasis, amyloidosis, and a contracted bladder are futher, yet less common complications of chronic inflammatory disease of the bowel.
With a uniform pathohistological technique of investigation the frequency of histological verified lymph node metastases in tumor nephrectomy depends on the surgical approach. Lymph node metastases were seen twice (6%) in 33 cases of lumbar nephrectomy, 22 times (17%) in 132 cases of abdomino-paracolic operations without systematic lymphadenectomy, 11 times (37%) in 30 abdomino-transplical nephrectomies with systematic lymphadenectomy. Primarily, one can expect lymph node metastases in case of infiltration of capsula adiposa, macroscopic invasion of veins, histologic grade 3 of malignancy, and/or if the tumor exceeds a size of 10 cm. Metastases are also possible in not enlarged and macroscopic normal lymph nodes. Without systematic dissection of the regional abdominal lymph nodes unknown regional lymph node metastases are likely to remain. Therefore, the treatment of choice in renal cell cancer is abdominal transplical nephrectomy with systematic lymphadenomectomy.
Explore the source record for details and available documents.
After surgical removal of renal cell cancers we can compare and contrast 3 prognostically differing groups by combining staging after Robson and histologic grading of malignancy. Good cancers (grade 1, stage I or II) have an (uncorrected) 5-year-survival rate of 93%, bad cancers (grade 3, Robson stage II or III) one of 35%. The remaining tumors (intermediate cancers) have a 5-year-survival rate of 64%. Classification in 3 groups is also advisable for future comparison of end result reports.
Out of 188 operatively removed renal cell carcinomas 49% showed macroscopic evidence of vein invasion and in 28% of the cases only histologically provable vein invasion. The uncorrected 5-year survival rates amounted to 40.8% in macroscopic vein invasion, 60.6% in histologically provable vein invasion and 75.6% in the absence of vein invasion. The term 'vein invasion' should therefore always be defined more precisely. Hence suggest to modify the V classification of 1974 of the UICC.
The Erlangen system of histologic grading of the malignancy of renal cell cancers is described in detail. It takes into consideration the type of cell and pattern of the tumor and differentiates between grades 1, 2, and 3. Grade 1 was observed in 10%, grade 2 in 51%, and grade 3 in 39% of the cases. The difference in the 5-year survival rates between tumors of grade 3 and those of tumors of grades 1 and 2 is statistically significant.
In rats fed with various diets as regard contents of magnesium, cholesterin, neutral fat, carbohydrates and proteins, urinary thyroxine (U-T4) appears low in general when compared with control chow, whereas renal calcifications and stones are absent only with the latter and the carbohydrate-rich diet. Normalization of U-T4 is hampered by differences in urinary creatinine excretion and in individual weight gain. In male renal calcium stone patients (20--40 years) U-T4 also is lower than in age-matched controls, but in other groups no abnormality could be detected.
Explore the source record for details and available documents.