Manifestation of metabolic risk factors after renal transplantation: III. Impact on cerebrocardiovascular complications.
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Adult↗
Biomedical subjects
D Heimbach
Publications and source records attributed to D Heimbach.
Are auxiliary methods necessary prior to ESWL in patients with a solitary kidney?
Between January 1985 and October 1991, 54 patients with calculi in a solitary kidney were treated by ESWL using the Dornier HM-3 lithotriptor. The mean age of the patients was 53.9 years (range 24-77 years). In 51.9% of the cases the stones measured > 1 cm in diameter, in 42.6% between 0.4 and 1 cm, and in 5.5% < 0.4 cm in diameter. In 39 of the 54 patients (72.2%) the calculi could be disintegrated by a single ESWL treatment. In 12 patients (22.2%) 2 ESWL treatments were necessary, and another 3 patients (5.6%) needed 3 ESWL treatments. In 6 cases (11.1%) percutaneous nephrostomy (PCN) was needed, and in 8 other patients ureteric stents were inserted prior to ESWL because of obstruction of the upper urinary tract, causing impending urosepsis in 8 of these 14 cases. Following ESWL, PCN was performed in 4 cases (7.4%) and a ureteric stent was inserted in 2 patients (3.7%) because of urinary obstruction. At discharge from the hospital 15 of the 54 patients (27.8%) were stone-free and 34 patients (63.0%) had small residual fragments of < 0.4 cm in diameter. One year after treatment, 42 patients could be evaluated at a control examination. 37 of these 42 patients (88.1%) were stone-free and 3 patients (7.1%) showed residual fragments of < 0.4 cm. In conclusion, our results demonstrate that, if there is no ureteric obstruction present prior to ESWL, the majority of patients with a solitary kidney do not present extraordinary problems and do not need auxiliary procedures.
Adult↗
[Surgical interventions of the adrenal gland. Diagnosis and results of treatment].
From 1982 to 1992, 33 patients underwent adrenalectomy for disease of the adrenal gland: 18 patients with adrenal cortex adenoma or hyperplasia (Cushing's syndrome n = 11, Conn's syndrome n = 6, adrenogenital syndrome n = 1), 3 with pituitary-dependent Cushing's disease, 7 with pheochromocytoma (malignant n = 1), 2 with a metastasis of lung cancer and 1 with cystic adrenal necrosis. Multiple endocrine neoplasia existed in four cases. Various preoperative symptoms were noted, including complaints typical of the respective syndromes and general abdominal symptoms. Other patients were symptom-free with incidental findings. An intercostal approach was used in 30 cases, a transabdominal approach in 3 cases. In 6 cases bilateral and in 27 cases unilateral adrenalectomy was performed. In two cases additional nephrectomy became necessary because of extensive adhesions. Intraoperatively, one patient suffered a blood pressure crisis. 31 patients are still alive and symptom-free after a mean follow-up of 5.4 years (range 1-11 years). Two patients have died (one with benign pheochromocytoma and one with a metastasis of lung cancer). Detailed preoperative hormone analysis and adequate preoperative medication substantially lowers the risk involved in adrenal surgery. However, the indications for surgical treatment of hormonally inactive, symptom-free adrenal tumors that are found incidentally remain controversial, and surgery should perhaps be restricted to large tumors.
Adolescent↗
Treatment of a human renal cell carcinoma in nude mice with recombinant human tumor necrosis factor alpha and etoposide.
The effect of treating a human renal cell adenocarcinoma xenografted into Balb/c-nu/nu (nude) mice with recombinant human tumor necrosis factor alpha (TNF alpha) and the cytostatic agent etoposide (ETP) as monotherapy or combination has been studied. Antitumor effects were evaluated by determining growth of the tumor implants by external caliper measurements and tumor cell proliferation by determining the labelling index (LI) after pulse labelling with 3H-thymidine. The toxicity of the treatment with TNF alpha and/or ETP was also studied by measuring the animal weight. Monotherapy with TNF alpha had no effect on tumor growth or proliferation. Treatment with ETP as a single agent, TNF alpha plus ETP applied concurrently and TNF alpha plus ETP two days later led to a slight inhibition of tumor growth and also to a slight decrease of the LI. In contrast to a monotherapy with TNF alpha, all therapeutic modalities containing ETP showed an increased toxic effect on the animals represented by a distinct weight loss. This suggests that the minute efficacy of the treatment observed could well be due solely to its toxicity. In contrast to two other studies, no additive or synergistic effect of the antineoplastic activity of TNF alpha and/or ETP was found. The intertumoral variation of human renal cell carcinomas could be one reason for the different results with this therapeutic regimen.
Animals↗
Value of prostate-specific antigen as a tumor marker.
Prostate-specific antigen (PSA) is the most important tumor marker for prostate cancer. However, the diagnostic limits of PSA have to be taken into consideration because PSA is also secreted by normal prostate tissue and, with benign prostatic hyperplasia, false positives are possible. Although there is a direct correlation between the serum PSA concentration and the clinical stage of the tumor, PSA is not sufficiently reliable to determine the stage of the disease on an individual basis. Low serum PSA concentrations (less than 20 ng/ml) in patients with previously untreated prostate cancer seem to be predictive for a negative bone scan. Serum PSA values also reflect the prognosis of the patient. With respect to monitoring patients after definitive therapy, PSA is a very sensitive tumor marker. However, in a small number of patients PSA-negative tumor recurrences occur.
Humans↗
[Synchronous growth of a mixed mesodermal tumor and an adenocarcinoma of the urinary bladder].
The case of synchronous growth of a mesodermal mixed tumour and an adenocarcinoma in the bladder is presented. This is a rare phenomenon. Mesodermal mixed tumours are malignancies with both epithelial (carcinoma) and mesenchymal (sarcoma) differentiation. The term carcinosarcoma is frequently used in the literature. In most cases the prognosis of mesodermal mixed tumours, which depends mainly on the high rate of local recurrences, is poor. Therefore, cystectomy with suprapubic urinary diversion is the treatment of choice. However, results reported in the literature show that transurethral resection of the tumour may be adequate when there is only superficial growth of mesodermal mixed tumours. Short follow-up intervals are absolutely essential for patients treated this way.
Adenocarcinoma, Papillary↗
[Pneumoscrotum. Case report and review of the literature].
The rare case of a pneumopenis and pneumoscrotum after a thoracic operation is reported. Two subtypes--pneumatocele and subcutaneous emphysema of the scrotum--are differentiated on the basis of anatomy. The cases reported in the literature so far are reviewed. A therapeutic regimen is recommended.
Diagnosis, Differential↗
[Results of low dosage cyclic interferon-gamma therapy of metastatic renal cell carcinoma].
A total of 24 patients with metastatic renal cell carcinoma were treated with a low-dose cyclic regimen of interferon-gamma (IFN-gamma). The dosage was 50 micrograms IFN-gamma s.c. per day for 5 days every 4 weeks. In 16 of the 24 patients nephrectomy had preceded this treatment. Another immunotherapy had already been performed in 13 of the 24 cases. No complete remission was achieved in any of the patients, all of whom were evaluable. One patient with pulmonary metastases achieved partial response. Stable disease lasting 2 to 12+ months was seen in 5 cases. Tumour progression was observed in 18 patients. Only slight side-effects were noted. Patient selection could be one reason for the wide range of response rates reported for IFN-gamma treatment in the literature.
Adult↗
[The use of alpha-receptor blockers in urological diseases].
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Adrenergic alpha-Antagonists↗
M-VAC versus CisCA--chemotherapy in the treatment of advanced bladder cancer.
The results of this study do not demonstrate a superiority of M-VAC chemotherapy over a modified CisCA regimen chemotherapy. M-VAC, however, proved less toxic than CisCA in terms of side effects. Neither CisCA nor M-VAC was effective as a curative treatment for patients with distant metastases. A durable complete remission of 22.5 months was seen in only 2 of the 12 patients with locally advanced tumors without distant metastases treated with M-VAC, and one of 35 months was observed in only 1 of the 6 cases with locally advanced tumors treated with CisCA chemotherapy.
Antineoplastic Combined Chemotherapy Protocols↗
[Chemotherapy in metastasizing prostate carcinoma].
Seventeen patients with metastasized hormone-resistant prostate cancer were treated between January 1986 and October 1989 with combination chemotherapy at the Department of Urology, University of Würzburg Medical School. In 1 of the 17 patients a complete remission lasting 4 months was observed. In 3 patients a partial remission was noted, and in 5 others stable disease for an average of 6.8 months occurred. Tumor progression was seen in 7 patients. In all 16 evaluable cases palliation of tumor pain was achieved with this kind of treatment. The role of chemotherapy in the treatment of metastasized prostate cancer is discussed.
Aged↗
[Ectopic splenic tissue in connection with the testis].
A case of ectopic splenic tissue in the testicle is reported. This congenital anomaly has only ever been seen in the left scrotal compartment. The ectopic splenic tissue is separated from the testicle by a fibrotic capsule. When accessory splenic tissue is suspected on examination of a testicular biopsy a frozen section should be performed; orchiectomy can then often be avoided.
Adult↗
Results of a multicenter outpatient burn study on the safety and efficacy of Dimac-SSD, a new delivery system for silver sulfadiazine.
Dimac with silver sulfadiazine (Dimac-SSD), a new silver sulfadiazine delivery system, was evaluated prospectively in a multicenter study for the treatment of outpatient burn injuries. The goal of this study was to evaluate the effect of Dimac-SSD on the microbiology of the burn wounds and to quantitate its clinical safety and efficacy. A total of 197 patients were evaluated. Eight (4%) of these patients did not complete the study. Six patients withdrew because of local discomfort caused by the Dimac-SSD and two patients were terminated because of technical problems. The mean +/- SD duration of treatment with Dimac-SSD was 12 +/- 8.5 days, during which time the mean number of dressing changes was 2.9 per patient. During treatment with Dimac-SSD, the burn wound bacterial flora remained stable and overgrowth with Pseudomonas species or Gram-negative bacilli did not occur. Only four (2%) patients developed clinical infections; thus the Dimac-SSD appeared to have good antimicrobial effectiveness. This dressing was not associated with any organ system or metabolic side-effects and patient discomfort during application and removal was minimal. Thus this new delivery system for silver sulfadiazine was associated with excellent wound healing, a low incidence of wound infections, reduced frequency for dressing changes, and excellent patient compliance.
Acrylates↗
Artificial dermis for major burns. A multi-center randomized clinical trial.
This communication presents an 11-center prospective randomized trial using the artificial dermis invented by Burke and Yannas. Patients with life-threatening burns who underwent primary excision and grafting within 7 days of injury had comparable sites randomized to receive either the artificial dermis (study site) or the investigator's usual skin grafting material (control site). Control materials were autograft, allograft, xenograft, or a synthetic dressing. Epidermal grafts were applied to the study site during a second operation, and surviving patients were followed for 1 year after grafting. One hundred thirty-nine sites on 106 patients were studied. Mean burn size was 46.5 +/- 15% mean total body surface (TBSA). Overall mortality was 13%, and mean hospital stay was 68 +/- 45 days. Median artificial dermis take was 80% compared with 95% for all comparative sites, but the take was equivalent to that of all nonautograft control materials. Results with the artificial dermis improved slightly as the investigators became more familiar with the material. Donor site thickness for the study site averaged .006'' +/- .002'' compared to .013'' +/- .018'' for control (p less than .0001) and the epidermal donor site healed an average of 4 days sooner (10 +/- 6 vs. 14 +/- 8 days) (p less than .0001). As the wounds matured during the first year, both patients and surgeons felt that both sites became more comparable in appearance and function. At the completion of the study, there was less hypertrophic scarring of the artificial dermis, and more patients preferred the artificial dermis to the control graft. Artificial dermis with an epidermal graft provides a permanent cover that is at least as satisfactory as currently available skin grafting techniques, and uses donor grafts that are thinner and donor sites that heal faster.
Adolescent↗
Pulmonary microembolism: a cause of lung injury.
Microthrombi found in the pulmonary capillaries in patients dying with post-traumatic pulmonary insufficiency suggests that pulmonary microembolism (PME) may be etiologically important, but a temporal relationship has not been demonstrated. We used a modified Lim-Blaisdell model of PME to cause a severe ischemic soft tissue injury in dogs. The appearance of microaggregates (MA) in the venous circulation was measured using a laser optical scanning technique. The effect of MA on pulmonary physiologic and histologic parameters was measured and compared to control animals. In the ischemic soft tissue injury group, following restoration of local circulation, the platelet count dropped by 72% (P less than 0.00002), the number of MA increased by 800% (P less than 0.00002), the mean pulmonary artery pressure (PA) increased from 15.6 to 32 mm Hg (P less than 0.00002), and electron micrographs of lung obtained at 4 hr after ischemic insult revealed PM with severe lung injury that was consistent with a capillary membrane leak. The control group never demonstrated a significant change in platelets, MA, PA, or histologic lung injury. These findings imply that MA found in the pulmonary microcirculation are temporally related to the development of physiologic and anatomic lung abnormalities.
Animals↗
Contact burns of the hand.
Contact burns of the hand in children present difficult management questions. Because visual inspection of the acute wound often fails to distinguish major burns requiring inpatient treatment from minor burns amenable to outpatient therapy, we sought to identify characteristics of patients that would aid in decision making at the time the burn patient is seen. During the 5-year period, 1980 to 1984, 32 children less than 14 years of age were admitted to our medical center with contact burns of the hand. Patients were divided into two groups: those with major burns requiring greater than or equal to seven days of hospitalization (n = 16) and those with minor burns requiring less than seven days of hospitalization (n = 16). Compared with patients in the minor burn group, patients in the major burn group were hospitalized longer (16.9 v 2.8 days), were more likely to require surgical excision and grafting (63% v 0%), and had more extensive follow-up (5.3 v 2.5 visits). There were no significant differences between the two groups with regard to percentage of area burned, age, sex, primary admission v referral, and cause of burn. These data support the recommendation that all such burns be managed initially on an inpatient basis.
Burns↗
Meperidine disposition in burn patients.
Limited information is available describing the pharmacokinetics of hepatically-cleared drugs in burn patients. Based on the hypothesis that after burn injury, plasma meperidine clearance should increase in response to the postburn increase in hepatic blood flow, we examined the kinetics of intravenous meperidine in eleven patients about one week after burn injury (acute study) and in five of these patients about six weeks postburn (convalescent study). The meperidine steady-state distribution volume (about 2 1/kg) during both the acute and the convalescent studies was about half the distribution volume reported in the literature for meperidine in healthy subjects. The meperidine clearance in burn patients (acute, 420 ml/min and convalescent, 600 ml/min) was lower than would be anticipated in the presence of known marked increases in hepatic blood flow in burn patients.
Adolescent↗