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Biomedical subjects

D M Wilbert

Publications and source records attributed to D M Wilbert.

At least 37 records · Page 2Linked to original sources
PubMed1993

Protective effect of verapamil on shock wave induced renal tubular dysfunction.

In a prospective randomized study, the effects of the calcium entry blocker verapamil on shock wave induced tubular impairment were examined. A total of 24 patients with renal pelvis or caliceal stones undergoing anesthesia-free extracorporeal shock wave lithotripsy (ESWL*) without auxiliary measures was randomly assigned to the verapamil group (12) or the control group (12). Four doses of verapamil (80 mg. each) were given orally starting the night before ESWL. Controls received no medication. To assess renal tubular function the urinary excretion of alpha 1-microglobulin, N-acetyl-beta-glucosaminidase and Tamm-Horsfall protein were determined before, immediately, and 12 and 24 hours after ESWL. After ESWL there was an increase in urinary alpha 1-microglobulin and N-acetyl-beta-glucosaminidase, which was significantly higher in the control than in the verapamil group. Tamm-Horsfall protein, a glycoprotein synthesized by the distal tubules, decreased significantly less in the verapamil group compared to the controls. Our results indicate that verapamil exhibits a protective effect on shock wave induced tubular damage. The underlying mechanisms are not elucidated yet, and direct actions on tubular cells and interference with renal hemodynamics are to be discussed.

Acetylglucosaminidase↗
PubMed1993

Evaluation of the acute scrotum by color-coded Doppler ultrasonography.

Color-coded Doppler ultrasonography is a combination of real-time sonography and duplex sonography for noninvasive imaging of arterial and venous blood vessels. In 40 patients with acute onset of scrotal pain this diagnostic procedure was correlated with the findings at surgical exploration: 11 had testicular torsion, 4 hydatid torsion, 13 spontaneous detorsion, 2 blunt scrotal trauma and 10 epididymitis. For testicular torsion color-coded Doppler ultrasonography had a sensitivity of 82% and a specificity of 100%, and for epididymitis the sensitivity was 70% and specificity was 88%. Color-coded ultrasonography readily demonstrates testicular perfusion. In cases of incomplete or early torsion some residual perfusion may be detected leading to false-negative results. Despite this fact, color-coded Doppler ultrasonography currently is the most valuable diagnostic modality in the evaluation of the acute scrotum.

Acute Disease↗
PubMed1993

Influence of transrectal hyperthermia on prostate-specific antigen in prostatic cancer and benign prostatic hyperplasia.

The prostate-specific antigen (PSA) is a glycoprotein synthesized exclusively by the prostate. Since manipulations on the prostate can increase PSA serum levels, we investigated the effects of transrectal hyperthermia on PSA levels in prostate cancer (PC) and benign prostatic hyperplasia (BPH). Patients and treatments were the following: group 1a, PC St.D (n = 12): 8 hyperthermia sessions (twice a week) and LHRH-agonists plus flutamide; group 1b, PC St.D (hormone resistant; n = 10): 8 hyperthermia sessions (once a week) and epirubicin (50 mg intravenously, once a week); group 1c, PC St.C (n = 5): 6 hyperthermia sessions (once a week) and radiotherapy (60 Gy); group 2, BPH (n = 10): 8 sessions (twice a week). PSA levels were determined before, during (immediately before each hyperthermia session) and 1 week after therapy. Apart from hormone-/hyperthermia-treated patients, who showed a continuous decrease in PSA during therapy, all the other groups revealed a transient increase in PSA during the hyperthermia treatment. This effect is attributed to manipulations on the prostate and hyperthermia-specific effects on prostatic cells. The decrease in PSA on hormone/hyperthermia therapy can be explained by the tremendous effect of androgen deprivation on PSA levels overshadowing the hyperthermia effect.

Aged↗
PubMed1991

Angiodynography (color-coded duplex sonography) in the evaluation of vasculogenic impotence.

The penile arteries of 18 men with erectile dysfunction were examined by angiodynography (color-coded duplex sonography). Blood flow velocity was measured before and after intracavernous injection of papaverine/phentolamine. The angiodynographic findings were compared to arteriography. Normal values of peak flow velocity (after injection) were obtained from 6 men with normal arteriographic findings (deep artery greater than 25 cm/s, superficial artery greater than 30 cm/s). Angiodynography enables good imaging of the four penile arteries superior to duplex sonography. A strong correlation with the arteriographic findings could be found. Thus noninvasive angiodynography may replace penile arteriography for the routine evaluation of impotence.

Adult↗
PubMed1991

[Local hyperthermia in prostate cancer].

We conducted a clinical trial evaluating the effects of hyperthermia in patients with carcinoma of the prostate, treating 20 patients with newly diagnosed carcinoma of the prostate with local microwave hyperthermia (915 MHz). Histological examination revealed hypoeremic effects and diffuse oedema with interstitial lymphoplasmatic cellular infiltration. However, necrotic tumour cells were not found in any of specimens. A second series consisted of 10 patients with metastasizing carcinoma of the prostate (n = 4 untreated; n = 6 hormone-resistant). For 8 weeks, epirubicin was administered once weekly, followed each time by local microwave hyperthermia 1 h later. The efficacy was evaluated according to the EORTC criteria. In 4 patients with untreated carcinoma no change was found in the size of the prostate or metastases. In 3 of the 6 patients with hormone-resistant carcinoma progressive disease was found, while the other 3 had stable disease. Only in 2 of the 10 patients did the grading of tumour regression reveal any improvement. Cytophotometric studies showed no change of DNA ploidy. Currently we consider hyperthermia unsuitable as monotherapy for carcinoma of the prostate, and the combination of epirubicin and hyperthermia is no more favourable than monotherapy with epirubicin alone. Further studies are necessary to evaluate other cytotoxic regimens and various patterns of application for hyperthermia.

Adenocarcinoma↗
PubMed1990

Damaging effects of high energy shock waves on cultured Madin Darby canine kidney (MDCK) cells.

Shock wave lithotripsy (ESWL) has become an almost non-invasive standard treatment modality for urolithiasis. Several investigations, however, demonstrated that ESWL is not completely free of side effects. Among others alteration of renal tubular function has been reported. To study the effect of shock waves on tubular cells directly an in-vitro model with cultured Madin Darby Canine Kidney (MDCK) cells was established. Suspensions of MDCK cells (7 groups of 6 containers each) were exposed to 0, 16, 32, 64, 128, 256 shock waves (Dornier HM4, 18 kV). Before and 0, 1, 3, 6, 9, 12, 24 h after ESWL the following parameters were measured in the nutrient medium: lactate dehydroxygenase (LDH), glutamate oxalacetate transaminase (GOT), electrolytes. LDH and GOT increased depending on the number of shock waves indicating a membrane damage of MDCK cells. The MDCK model seems suitable for further studies on the effect of shock waves on renal tubular cells.

Animals↗
PubMed1990

Alveolar echinococcosis with involvement of the ureter and testis.

Alveolar echinococcosis is a rare disease of the liver, and occasionally of the lungs and brain, that is endemic across areas of Central Europe, the Soviet Union and Alaska. We describe a case of alveolar echinococcosis with involvement of the ureter and testis overshadowing the liver manifestation. The unusual presentation and nondemonstrable exposure to the organism caused misinterpretation of the histological findings and an initial misdiagnosis of tuberculosis.

Adult↗
PubMed1990

Local microwave hyperthermia of benign prostatic hyperplasia.

Recently, hyperthermia has been used for treatment of benign prostatic hyperplasia. The preliminary results reported were promising. However, apart from patients with total urinary retention, objective voiding parameters have not been reported in detail for patients with prostatism. In a phase II study we treated 30 patients with benign prostatic hyperplasia by local microwave hyperthermia (915 MHz.). The prostate was heated transrectally to 42 to 43C, with the treatment consisting of 8 sessions of 60 minutes each given twice a week. To assess the results of treatment several parameters were determined before and 4 weeks after hyperthermia therapy, including transrectal ultrasound of the prostate with volumetry, urinary flow rate and residual volume. Of the patients 28 could be evaluated and only 2 showed a relevant improvement. Neither the voiding parameters nor the size of the prostate could be changed significantly by hyperthermia. The success rate of 7.1% is even lower than the spontaneous temporary regression rate of benign prostatic hyperplasia. Thus, we believe that hyperthermia cannot be regarded as an effective treatment for benign prostatic hyperplasia comparable to transurethral resection.

Aged↗
PubMed1989

Tumor volume, CT scan, lymphography, sonography, intravenous pyelography, and tumor markers in testis tumors.

Correlation of tumor volume to tumor stage in 134 patients with nonseminomatous testicular tumors, which were classified according to the TNM system, revealed similar tumor load for N0 and N1 patients. CT scans (n = 92), lymphangiography (n = 47), intravenous pyelography (IVP) (n = 134), sonography (n = 118) and serial tumor markers (n = 82) were evaluated for sensitivity, specificity and accuracy, both separately and in different combinations. The best individual results were obtained by lymphangiography (sensitivity 0.77, specificity 0.73, accuracy 0.75) and CT scan (sensitivity 0.52, specificity 0.91, accuracy 0.70). In combination CT scan and lymphangiography were the most valuable diagnostic tools (accuracy 0.79) with high sensitivity (0.88) and specificity (0.77). For patients with negative CT scans, subsequent lymphangiography is recommended for accurate staging, as seems mandatory in stage 1 patients entering surveillance programs.

Adult↗
PubMed1989

[Therapy of interstitial and radiogenic cystitis with D-glucosamine].

Twelve patients with interstitial or radiation cystitis were treated by D-glucosamine, a precursor of glycosaminoglycans. D-glucosamine was given for 3 months (500 mg t.i.d. orally). Urinary glycosaminoglycans which were low before the treatment could be increased significantly by D-glucosamine. Endoscopic findings and subjective symptoms could be markedly improved. D-glucosamine may be a new treatment modality in interstitial and radiation cystitis.

Administration, Oral↗
PubMed1988

Treatment of paediatric urolithiasis by extracorporeal shock-wave lithotripsy.

Non-surgical removal of renal and ureteral stones has proven successful in adults. In this study, 21 paediatric patients have been treated with the first generation extracorporeal shock-wave lithotriptor and an additional 13 children with a second generation local shock-wave lithotriptor. A total of 47 stones was treated. Treatment-related complications such as colics (17%/18.8%) or fever (8.3%/6.2%) were minimal. Stone passage occurred in 93% and 100%, respectively of each group. Open surgery is still the treatment of choice for large staghorn calculi. Extracorporeal shock-wave lithotripsy can be performed successfully in paediatric nephrolithiasis with stones of limited size.

Adolescent↗
PubMed1988

Local shock-wave lithotripsy of distal ureteral calculi.

Since the initiation of the clinical trial utilizing a second-generation lithotripor (Lithostar, Siemens, Erlangen, FRG), 96 patients with distal ureteral calculi (i.e. calculi below the pelvic brim) underwent local shock-wave lithotripsy. Routine treatment was conducted under intravenous sedation and light analgesia only. Complete stone disintegration was achieved in 84 patients (87.5%), 11 requiring two sessions and 1 patient, three. In 7 patients ureteroscopy became necessary after unsuccessful local shock-wave treatment. In 2 of these patients a 9-french flexible ureteroscope and the Storz Q-switched neodymium-YAG laser was used for stone disintegration. In 3 cases loop extraction and in 2 cases open surgery had to be performed for definitive stone removal. All pre- and postoperative manipulations (except open surgery) were done on the Lithostar. Local shock-wave lithotripsy is a highly successful, noninvasive, time-saving and easily applicable technique. It has become our primary approach in the treatment of distal ureteral calculi.

Clinical Trials as Topic↗
PubMed1987

New generation shock wave lithotripsy.

Extracorporeal shock wave lithotripsy has been clinically successful for more than 5 years. Currently, several devices commonly termed second generation lithotriptors are under experimental or clinical trials. We present a prototype multifunctional urological table that uses a new mode of shock wave generation along with local coupling to the patient. The results of the first 400 treatments are presented after a brief description of pre-clinical experiments. The prototype has been in operation since March 1986. Particular attention is paid to adjuvant endourological measures, which all have been performed on the same table.

Animals↗
PubMed1987

[Extracorporeal shockwave lithotripsy of the ureteral calculus--clinical results with local shockwave lithotripsy].

Second generation local shockwave lithotripsy appliances (Lithostar) were used for the treatment of upper and lower ureteral stones in 199 patients, 145 of whom had upper ureteral stones. In 78 patients the calculi were pushed back and all but one disintegrated. In 33 patients a catheter was inserted past the stone, which resulted of primary disintegration in 66%. In 19 of 34 patients (56%) in whom the stones could not be moved, primary disintegration was achieved. Distal ureteral stones were present in 54 patients and these were treated successfully by ESWL alone in 83.3%. Auxiliary measures (total 10%) included ureteroscopy, percutaneous extraction and ureterolithotomy. The results are discussed under the aspects of 'in situ' versus 'push-and-smash' procedures.

Combined Modality Therapy↗