Biomedical subjects
Publications and source records attributed to G Jakse.
Spontaneous rupture of the kidney is an uncommon entity. In most cases the non-traumatic rupture is associated with underlying diseases of the kidney, the most frequent being renal tumours. We report the case of a spontaneous kidney rupture due to a renal metastasis from an adenocarcinoma of the colon.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We describe the clinical course in a patient with a primary testicular chondrosarcoma. The way of metastasizing and cytogenetic analysis proved the germ cell origin of this tumour. After unilateral orchiectomy four cycles of chemotherapy with cisplatin, etoposide and bleomycin and one cycle of vinblastine, ifophosphamide and cisplatin were given. Even though the retroperitoneal metastases continued to grow, a radical retroperitoneal lymph node dissection was performed. Five years after surgery the patient is still in remission.
This paper highlights the surgical aspects of continent vesicostomy. The cases of 6 patients are described to illustrate the indications for vesicostomy, and experience with the techniques of Benchekroun, Kock and Mitrofanoff is presented.
We analyzed our first 41 patients with localized prostate cancer treated with laparoscopic pelvic lymph node dissection (LPLND) as staging procedure followed either by radical perineal prostatectomy or interstitial radiotherapy. 7/41 patients (17%) had pelvic lymph node metastases and received endocrine therapy. Overall complication rate was low (7.5%) and no major complication occurred. LPLND is minimally invasive and provides staging accuracy in prostate cancer.
Over a period of 15 years selective embolization of the renal artery was performed in 22 patients (15 men, 7 women; mean age 47.5 [5-73] years), using a percutaneously introduced coaxial technique with a 3F catheter. Tissue glue (N-butyl-2-cyanoacrylate) was employed in 18 cases, spiral wire in two, detachable balloon in three and gel-foam in one case. The bleeding had been iatrogenic in 20 cases, in one it was the result of a traffic accident, while in another the bleeding was from an angioma. The procedure was successful at the first attempt in 21 patients, permanently arresting bleeding in 18. There were three complications, transitory and not requiring treatment in two. In one patient gel-foam embolization went to a wrong site and a nephrectomy had to be performed.--This form of selective embolization is the treatment of choice in traumatic injury to a renal vessel.
The purpose of our study was to detect somatic changes in renal cell carcinoma by multilocus fingerprinting. DNA fingerprints were generated from the DNA of normal and malignant renal tissue samples of 29 patients with nonhereditary kidney carcinoma by using oligonucleotide probes specific for simple repeat motifs such as (GTG)5, (CA)8, (GACA)4, or (TTAGGG)3. Each probe rendered a typical fingerprint pattern, because it is specific with respect to the target regions recognized in the genome. The restriction enzymes used were HinfI and HaeIII. Changed banding patterns were detected by using (GTG)5 in 20% of the tumors, in 20% for (CA)8 after HinfI digestion, and in 10% after HaeIII digestion. Even more informative probes were (GACA)4, showing 70% changes after HaeIII digestion, and (TTAGGG)3, with 80% changes after digestion with either enzyme. Since the simple repeat motifs recognized by (GACA)4 are localized on the short arms of the acrocentric chromosomes (13, 14, 15, 21, and 22), it is possible that sequences important for renal carcinogenesis are present in these regions. The observation of changes in regions to which (TTAGGG)3 hybridizes points to an involvement of DNA elements in telomeric sequence related regions in human kidney tumor formation.
Explore the source record for details and available documents.
Recent publications report increased cardiovascular morbidity and mortality after transurethral prostatic resection (TURP). Repeated breath-ethanol monitoring with a new infrared device permits a highly sensitive peroperative registration of fluid absorption. A prospective study in 52 patients revealed surprisingly high rates of intravascular fluid loads without clinical manifestations. Only 4 patients developed clinical signs of the TUR syndrome. Immunological work-up in 41 patients demonstrated circulating endotoxins and significant rise of endogenous tumour necrosis factor (TNF) in 3 of these patients. In 11 patients transient endotoxins could be detected during resection under prophylactic parenteral antibiosis. In the face of less invasive approaches to benign prostatic hyperplasia, close intraoperative monitoring and antibiotic coverage should be demanded as a routine procedure during TURP. Elective surgery should be delayed until appropriate antibiotic therapy has been given.
The anatomy of urinary incontinence and the underlying pathology is still under discussion. We examined 24 stress incontinent patients and 6 healthy volunteers. Magnetic resonance imaging (MRI) clearly shows that the urethra is not connected to the levator ani. The urethra is not fixed to deep perineal muscle layers. In stress incontinence the sharp angulation of the levator ani of healthy volunteers is lost in 65%. MRI shows degeneration of the levator ani muscle in 45% of stress incontinent patients. The extent of damage to the levator can clearly be identified with the aid of MRI.
The results of immunoscintigraphy of haematopoetic bone marrow were compared with those of conventional bone scanning in 141 patients with malignant diseases. Marrow scans showed more metastatic lesions than bone scanning in all patient subgroups, resulting in a significantly more extended skeletal involvement. CT was concordant in 83.3% of 323 skeletal regions with bone marrow scanning. Bone marrow scans of 30 control patients with benign disease were abnormal only in 7 of 2135 skeletal regions in 3 patients. In malignant lymphoma, bone marrow histology or aspiration cytology was concordantly positive in 14 or negative in 17 patients. Immunoscintigraphy of haematopoetic bone marrow provides a reliable, sensitive and safe novel approach towards the non-invasive evaluation of metastatic spread to the skeleton.
The release of mediator substances of the arachidonic acid cascade is closely related to the functional state of the endothelium. A significant lower prostacyclin/thromboxane A2 ratio in penile plasma of organogenic impotent patients in comparison to patients with psychogenic erectile dysfunction has been described in the literature. We observed the time-related liberation of prostacyclin, thromboxane A2 and the vasoactive peptide endothelin for 16 minutes of a drug-induced erection. We compared kinetics of patients with penile deviation and transsexualism, to patients suffering from severe organogenic impotence. We assessed the usefulness of the prostacyclin-to-thromboxane A2 ratio as a possible indicator of corporal degeneration. An animal model has been created to observe differences between rabbits under 100 days of standard diet alimentation, rabbits under cholesterol enriched diet and rabbits with hereditary hyperlipidemia type II A. Hyperlipidemia is suspected to be one possible factor causing organogenic impotence. Enzyme-immuno-assays were used for the determination of all substances. The systemic prostacyclin-to-thromboxane A2 ratio differed significantly between control rabbits and rabbits with hyperlipidemia. Prostacyclin, thromboxane A2 and endothelin in corpus cavernosum plasma showed a typical profile during spontaneous and drug-induced erection. A significant difference between groups of patients suffering from organogenic or psychogenic impotence could not be found. The value of the determination of the studied substances in differential diagnosis seems to be dubious.
78 patients (pts.) with erectile dysfunction (ED) underwent conventional diagnostic evaluation including NPTR monitoring with the Rigiscan, intracavernous drug testing, dynamic cavernosometry, doppler evaluation, pharmaco-angiography and neurologic tests. Only erections of the best rigidity recorded over three nights served for classification into three classes of rigidity. Patients with neurogenic impotence showed significantly poorer and fewer erectile events per hour than vasculogenic impotent men. Patients with arteriogenic ED had better erections than patients with venogenic or mixed arterio-venogenic ED. Severity of organic ED during conventional diagnostic work-up correlated to loss of rigidity during NPTR recordings, but no differential diagnosis between arteriogenic, venogenic or neurogenic impotence could be made with NPTR data alone. The presented criteria for NPTR evaluation permit a time-saving, examiner-independent analysis.
A specific heterogeneous enzyme-linked immunosorbent assay (ELISA) has been established in order to determine levels of low-molecular-weight epidermal growth factor (EGF) in the urine of patients with renal cell carcinoma who had undergone unilateral radical nephrectomy. Urine specimens, i.e., 20 pre- and postsurgical specimens from a group of patients and 22 from a control group, were assayed after the urine had been freed from high-molecular-weight proteins (greater than 30 kDa) and salts. EGF levels were expressed as urinary EGF/creatinine ratios, and a highly significant decrease (alpha = 0.0005 by Student's t-test) of urinary EGF was found in the patient group prior to surgery. The cancer patients also showed an additional loss of urinary EGF after unilateral nephrectomy (alpha = 0.0005 by Student's t-test). These data correlate with our previous findings that pro-EGF gene expression is decreased in human renal carcinoma and support the concept that low-molecular-weight urinary EGF is derived from high-molecular-weight kidney pro-EGF.
Explore the source record for details and available documents.
Bacillus Calmette-Guérin (BCG) is the most effective intravesical therapy of carcinoma in situ of the urinary bladder. Six, weekly instillations of BCG result in a complete remission in about 70-80% of patients. The optimal dose however has still to be defined, and the value of maintenance therapy is also a matter of debate. Recurrent tumours after complete remission occur mainly in the distal ureter and prostatic urethra. In these patients, cystectomy may be required. In about 60-80% of patients, local (e.g. cystitis) and/or systemic (e.g. fever, malaise) side effects are observed. The occurrence of cystitis is associated with the number of instillations, BCG dose and a positive skin test. Systemic side effects are connected with pre-existing dysuria or bacterial cystitis and with traumatic catheterization. Severe toxicity occurs in about 5% of the patients. Prognostic parameters indicating complete remission have yet to be determined, but there is evidence that cytokines detected in the urine and immune-cell infiltration into the bladder wall revealed by immunohistochemistry, can be of value in this respect.
Explore the source record for details and available documents.