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Biomedical subjects

F Eisenberger

Publications and source records attributed to F Eisenberger.

At least 19 recordsLinked to original sources
PubMed1996

The Dornier-Lithotripter U30. First clinical experience.

OBJECTIVE: It can be claimed that ESWL is an optimal alternative for ablation of calculi by external shock waves. The new developments in ESWL have focussed more on the economic aspects of treatment rather than enhancing its efficacy or reducing the side effects. Since August 1993, the prototype of the Dornier Lithotripter U-30 was used at the Department of Urology of the Katharinen hospital in Stuttgart. METHODS/RESULTS: In 16 months, 1092 stones were treated requiring 1533 sessions. Complete disintegration was achieved in 84%; after 3 months' follow-up, 85.5% of the patients were stone free. CONCLUSION: The Dornier Lithotripter U-30 provides easy handling and a short learning curve and a sufficient disintegration of the stones. The device is suitable for safe and effective treatment of all urinary calculi, with special respect to in situ treatment of ureteral stones.

Equipment Design↗
PubMed1995

The Dornier Lithotripter U 30: first clinical experience.

Since August 1993, the Dornier Lithotripter U 30 has been used at the Department of Urology of the Katharinenhospital in Stuttgart. The machine consists of an endourologic table with an X-ray unit mounted on a C-arm and an electromagnetic shockwave source equipped with an inline ultrasound scanner and oblique shockwave coupling with a water cushion. Stone location can be performed with fluoroscopy or simultaneous ultrasound scanning. Until December 1994, 1092 stones had been treated, requiring 1533 sessions: 497 stones (45.5%) were situated in a calix, 426 (39%) in the renal pelvis, 130 (11.9%) in the upper ureter, and 39 (3.6%) in the distal ureter. Auxiliary measures were necessary before SWL in 245 patients (16%): double-J stent placement in 184 patients (12%), percutaneous lithotripsy in 43 patients (2.8%), and percutaneous nephrostomy in 15 patients (1%). The mean number of shockwaves was 3018, ranging from 250 to 3750. The time needed for positioning ranged from 1 to 10 minutes (mean 3 minutes). The mean treatment time was 30.5 minutes (range 10-50 minutes). There were 26 treatments (1.7%) performed without analgetic medication. In 1359 cases (88.6%), analgetics were utilized, and in 108 cases (7.0%), a sedative was added. In 40 patients (2.6%), general anesthesia was necessary. Complete stone disintegration was achieved in 94%. Auxiliary measures after SWL were ureteroscopy in 8.4% and percutaneous nephrostomy in 1.3%. Perirenal hematomas were found in 10 patients (0.6%). Colic pain necessitating analgetic medication was reported by 247 patients (16.1%). Body temperature above 38 degrees C occurred after 20 treatments (1.3%). At 3 months' follow-up, 110 patients of 128 patients (85.9%) were stone free. The Dornier Lithotripter U 30 has proven highly effective for SWL of renal and ureteral stones, radiolucent and radiopaque, and can be used as a full endourologic work-station.

Follow-Up Studies↗
PubMed1994

Role of human chorionic gonadotropin in patients with pure seminoma.

Human chorionic gonadotropin (beta-hCG) and alpha-fetoprotein (AFP) are widely established specific and sensitive tumor markers for nonseminomatous testicular cancer. In 106 patients with pure seminoma, a highly sensitive method detected beta-hCG both before and repeatedly during therapy. The low detection limit of the test (0.3 IU/l) coincided with the 95 percentile of a group of 60 healthy blood donors. Its 100 percentile of < 1.0 IU/l was applied as the upper limit of the normal range. In 30.2% of our patients with pure seminoma, elevated beta-hCG levels were noted prior to orchiectomy. The levels returned to normal in 76% of these patients thereafter, and in 34% after additional irradiation or chemotherapy. During an observation period of 2-84 months, all beta-hCG-positive patients were in complete remission. Prior to semicastration, 1 patient showed extremely high beta-hCG levels, while in another patient, beta-hCG and AFP were elevated simultaneously. In both cases, tumor marker levels did not seem to agree with the histology of 'pure seminoma' and rather suggested the presence of nonseminomatous tumor cells. Increased AFP levels contradict the presence of a pure seminoma and indicate a nonseminomatous testicular tumor. The same holds true for strongly elevated beta-hCG levels, whereas levels of up to 200 IU/l correlate with the diagnosis of pure seminoma.

Adult↗
PubMed1994

[Bilateral ureteral rupture in a child after blunt trauma].

We report a case of bilateral subpelvic ureteral disruption in a child following blunt trauma sustained during a road traffic accident. This case illustrates the importance of coordinated interdisciplinary management in the primary diagnosis of patients with blunt abdominal trauma. The pathomechanism of traumatic ureteral avulsion is also discussed.

Abdominal Injuries↗
PubMed1994

[Current status of extracorporeal shockwave lithotripsy].

Extracorporeal shockwave lithotripsy has become an established standard procedure for the treatment of nephrolithiasis. Almost 100 lithotripters are installed in large and medium-sized urological departments in Germany. The number of treatments per year averages 660 ESWL sessions per hospital. Multifunctional use and non-urological ESWL therapy ensure maximum utilization of the lithotripter units. In additional hospitals mobile lithotripsy is provided. At present there is a trend toward ambulatory ESWL treatment.

Ambulatory Care↗
PubMed1993

ESWL and the future of stone management.

Based on optimal efficacy regarding disintegration and stone clearance, combined with minimal invasiveness, extracorporeal shockwave lithotripsy (ESWL) represents the first choice therapy for urolithiasis. Further developments in ESWL have related more to economic aspects than to improvement of disintegration efficacy or reduction of side effects. Routine indications for ESWL are well known and widely accepted. Its limitations are also well established: silent calyceal stones, calyceal diverticula stones, nephrolithiasis in horse-shoe kidneys, medullary sponge kidney, and residual fragments after ESWL. Although endourology provides new, less invasive and traumatic means of stone retrieval or disintegration, including laser lithotripsy, small ureteroscopes and actively deflectable uretero- and pyeloscopes, indications for an aggressive approach in such cases are limited to those who are symptomatic. In the case of distal ureteral calculi ureteroscopy in traureteral laser-induced shockwave lithotripsy open up new and interesting possibilities for the future.

Animals↗
PubMed1993

Lasertripsy of ureteral calculi using pulsed-dye laser with automatic shut-off after tissue contact.

Since June 1991, 54 patients with ureteral calculi (13 upper, 18 middle, and 23 distal) have been treated in our department using a flashlamp-pumped tunable-dye (rhodamine 6G) laser with a wavelength of 594 nm with an energy at the distal fiber tip between 30 and 120 mJ. The fiber core diameters were 200 and 300 microns. By spectral analysis of the reflected light, immediate shut-off of the laser was obtained after tissue contact. In average, 1599 impulses at a mean energy of 76.4 mJ were applied. In 32 cases (59%), complete disintegration was achieved. In 22 cases (41%), partial disintegration was noted, leading to retrograde mobilization of the fragments followed by SWL in 16 patients. Ureteroscopic extraction of fragments was performed in six patients. All patients were rendered stone free after 6 weeks. Because of the ureteroscopic manipulation, mucosal lesions were found in five patients, but no trauma attributable to the action of the laser was seen. In 42 patients, a double-J stent was placed after the procedure. Lasertripsy using a pulsed-dye laser with automatic shut-off after tissue contact is a safe and effective approach that offers a new aspect in the noninvasive treatment of recalcitrant ureteral calculi in our department.

Automation↗
PubMed1993

Intra- and perivesical tumor growth in preoperative staging of bladder cancer: the role of transrectal ultrasonography and high resolution magnetic resonance imaging.

Bladder tumors were staged preoperatively before and/or after M-VEC poly-chemotherapy using transrectal ultrasonography and magnetic resonance imaging in 46 patients. The resultant findings were each compared with histomorphologic results. The sensitivity of both methods compared with pathohistology was 88%. Using this technique, the degree of tumor invasion of the bladder wall could be evaluated and the appropriate therapy selected. Further applications included the monitoring of transurethral resection determine its adequacy as a treatment modality.

Adenocarcinoma↗
PubMed1992

Tissue polypeptide antigen for monitoring of advanced bladder cancer after MVEC chemotherapy.

58 patients with advanced bladder cancer were treated with MVEC chemotherapy (methotrexate, vinblastine, epirubicin and cisplatinum). 22 patients suffered from locally advanced disease (pT3-4 M0 N0), in 20 patients regional lymph node metastases were found (pT3-4 N1-3 M0). In 16 patients distant metastases were noted (pT1-4 N0-1 M1). In 89% transitional cell and in 11% squamous cell cancer or anaplastic carcinoma was seen. Complete response was noted in 45%, partial response in 23% and no response in 32%. Tissue polypeptide antigen (TPA) was registered before each course of chemotherapy and 3 months after the last application. The sensitivity for (pT3-4 N0 M0) tumors was 90.9%, for (pT3-4 N1-3 M0) 100% and for tumors with distant metastases 100% also, overall 96.6%. No statistically significant different values between each tumor group were found. In 85.7% a concordant reaction of TPA values and clinical status was notable. In conclusion, TPA has been proven as a valuable and a reliable marker for monitoring therapeutic efficacy of chemotherapy for advanced bladder cancer.

Aged↗
PubMed1990

Minimally invasive treatment of ureteric calculi using modern techniques.

Between July 1985 and July 1986, 226 upper and 62 distal ureteric calculi were treated. In situ extracorporeal shockwave lithotripsy (ESWL) is the treatment of choice for upper and distal ureteric calculi, with success rates of 81 and 76% respectively. Retrograde manipulation of the calculus was undertaken only when in situ ESWL was impossible because of difficulty in localisation. Although ESWL after successful mobilisation was successful in 95% of patients, retrograde mobilisation was possible in only 80%. Antegrade ureterorenoscopy via a percutaneous nephrostomy was performed to avoid open surgery if retrograde mobilisation was not feasible, and was successful in 90%. Two second generation lithotripters, the modified Dornier HM3+ and the Wolf Piezolith 2200, both suitable for treatment without anaesthesia, were compared in terms of efficacy. In situ ESWL of upper ureteric calculi was successful in 70.6% with the HM3+ and 37.2% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2200 because of inadequate ultrasound localisation. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. We report our experience of ESWL using the prone position for iliac ureteric calculi; 8 of 10 patients were treated successfully in situ.

Humans↗
PubMed1990

ESWL for ureteral calculi. Using the Dornier HM 3, HM 3+ and Wolf Piezolith 2,200.

In a one year period from July 1985 to July 1986 226 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76% respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of the anesthesia, the modified Dornier HM 3- and the Wolf Piezolith 2,200 were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful with the Piezolith 2,200. In situ ESWL of middle ureteric calculi was successful 81.8% with modified HM 3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2,200 due to insufficient localization with ultrasound of middle ureteric calculi were treated successfully in 71.4% with the modified Dornier HM 3+ and in 64% with the Piezolith 2,200. First clinical experience of ESWL in prone position for iliac ureteric calculi was reported. 8 of 10 cases were treated successfully in situ.

Humans↗
PubMed1990

Minimal invasive therapy of ureteral calculi using modern techniques.

In a one year period from July 1985 to July 1986, 224 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76%, respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of anesthesia, the modified Dornier HM3+ and the Wolf Piezolith 2200, were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful for upper ureter calculi in 70.7% with the HM3+ and 37.9% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the piezolith 2200 due to insufficient localization of middle ureteric calculi with ultrasound. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. Our initial clinical experience with ESWL in the prone position for iliac ureteric calculi is reported. Eight of 10 cases were treated successfully in situ.

Humans↗
PubMed1989

[Extracorporeal shockwave lithotripsy. Current status in treatment of kidney calculus disease].

The introduction of extracorporal shock wave lithotripsy has led to a revolution in stone management. After five years of clinical experience with increasing use of second generation lithotripters, the following conclusions can be drawn: There is an increasing tendency to employ ESWL for ureteral calculi, although only 60% of those can be located by ultrasound. In the case of staghorn stones, a differentiated approach is adopted (ESWL-, PCNL-monotherapy or a combination of the two) depending on stone size, localisation, chemical composition, radiodensity, and the state of the collecting system. With almost all second generation lithotripters, ESWL can be performed under i.v.-analgesia. Some machines with a large-aperture shock wave source (i.e. Wolf Piezolith, Edap LT 01, Dornier MPL 9000) even permit painfree treatment without the need for analgesia. However, this is associated with a 30% increase in retreatment rate. Further development of low-cost lithotripters and increasing use of ESWL for biliary stones make it necessary for ever more hospitals to face the question of installing such a machine. In this situation, the choice must be based on the local situation (i.e. number of patients, interdisciplinary use of ESWL).

Humans↗
PubMed1989

Wolf Piezolith 2200 versus the modified Dornier HM3. Efficacy and range of indications.

From February to September 1987, a prospective study was performed at two clinics to compare the Piezolith and the Dornier HM3+ lithotripters. Based on the same clinical indications for extracorporeal shock wave lithotripsy, 334 patients were treated with the Dornier HM3+ and 378 patients with the Piezolith. Whereas stone size was similar in both groups, more ureteral calculi were treated with the Dornier HM3+ (31.1 versus 23%). The rate of successful disintegration and total number of auxiliary measures were similar in both groups. However, the mean number of impulses (HM3+ 1,997 versus Piezolith 2,855) and number of secondary ESWL treatments (HM3+ 15.5% versus Piezolith 45%) differed significantly. According to the locating systems, the success of in situ treatment was similar for renal calculi; however, fewer ureteric stones could be treated in situ at the Piezolith (HM3+ upper ureter 70.6%, middle ureter 82%, distal ureter 71.4% versus Piezolith upper ureter 37.5%, middle ureter 0%, distal ureter 62.8%). The stone-free rate at discharge and after 3 months did not differ in both centers (HM3+ 75% versus Piezolith 72%).

Child↗
PubMed1989

Technical considerations using a pulsed neodym-YAG laser for endoscopic shock wave lithotripsy.

First clinical experience with the use of a Q-switched pulsed Neodym-YAG Laser showed promising results. This paper focuses on two problems with respect to the optimal use of this laser: (1) is there any need for a special iron (Fe3+)-enriched irrigant, and (2) what is the best frequency for laser lithotripsy? To answer these questions, we used an in vitro model, measuring the laser-induced breakdown (LIB) photographically utilizing sodium chloride as an irrigant enriched with different amounts of Fe3+ ions. The disintegrative efficacy of the laser was tested utilizing a standard stone model (plaster cube) and working at different frequencies (1, 10, 40 Hz). The addition of Fe3+ ions resulted in significant improvement of LIB. However, in the presence of a test stone no difference between sodium chloride and Fe3+-enriched irrigants was noted. The use of lower frequencies (1, 10 Hz) lead to a remarkable improvement in the disintegrative efficacy of the laser compared to the standard frequencies (40, 50 Hz). For clinical use, addition of Fe3+ ions seems only necessary if optical breakdown (LIB) is insufficient despite the increase in generator voltage. In such a situation, we recommend the addition of an 1-ml Fe3+ solution to 10 liters of sodium chloride irrigant (= 0.5 mg Fe3+/dl). Moreover, the standard frequency for laser-induced intracorporeal lithotripsy should be 1-10 Hz.

Ferric Compounds↗