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Biomedical subjects

G Janetschek

Publications and source records attributed to G Janetschek.

At least 91 records · Page 5Linked to original sources
PubMed1993

Laparoscopic retroperitoneal lymphadenectomy in the pig: initial report.

The value of retroperitoneal lymphadenectomy in the management of nonseminomatous testicular tumors is still a matter of controversy. Lymphadenectomy doubtlessly has great advantages but is somewhat down-graded by the considerable associated morbidity. Our experimental study in six pigs has shown that retroperitoneal lymphadenectomy by means of laparoscopic techniques is feasible. Clinical trials will follow. Should they prove successful, the role of retroperitoneal lymphadenectomy in the management of testicular tumors has to be reassessed.

Animals↗
PubMed1993

Modified retroperitoneal lymphadenectomy for testicular tumor: anatomical approach, operative technique and results.

Between January 1988 and June 1992, 56 patients underwent nerve-preserving retroperitoneal lymphadenectomy at the Department of Urology, University of Innsbruck. In 23 patients stage I, and in 33 patients stage II testicular tumors were found (staging according to the criteria recommended in Lugano 1979). Orchiectomy and subsequent lymphadenectomy within the boundaries described by Weissbach's group were performed for stage I tumors. In patients presenting with stage IIa or IIb tumors modified retroperitoneal lymphadenectomy within the boundaries suggested by Colleselli's group was performed. In stage IIc patients the residual tumor was resected after three cycles of polychemotherapy. If possible, nerve-sparing lymphadenectomy was performed. By adapting the operative technique to the respective tumor stage antegrade ejaculation could be preserved in 47 of these 56 patients. Semen analysis was carried out in 22 patients. The results in patients with stages I and IIa tumors were excellent, while in stages IIb and IIc patients' exocrine testicular function was considerably worse due to inductive polychemotherapy. None of the patients had a retroperitoneal recurrence. Of all 56 patients only one had a relapse in the lung (1.7%). The average follow-up period was 29 months.

Adolescent↗
PubMed1993

Left-sided laparoscopic adrenalectomy.

Laparoscopic transperitoneal adrenalectomy was performed in a 42-year-old female with a left adrenocortical adenoma causing Conn's syndrome. No technical problems occurred during surgery and the patient recovered quickly.

Adrenal Cortex Neoplasms↗
PubMed1993

[Antibacterial chemotherapy of "septic kidney"].

In the present retrospective study we report on antibacterial chemotherapy in patients suffering from a septic kidney. The results were documented in a course table, in which the septic parameters were divided into scores from 0 to 4 allowing to follow each patient's course with respect to the indicated scores. Two antibacterial substances were applied as short infusions with intervals of 4-6 hours between the administration of the different substances (Innsbruck scheme of chemotherapy). In all cases within 6 days from the onset of this therapy the septic parameters turned to normal values. None of the 24 patients suffering from a severe course of urosepsis, all treated at the University Hospital of Urology in Innsbruck between 1980 and 1990, died.

Adolescent↗
PubMed1993

[Modified retroperitoneal lymph node excision in testicular tumors. Anatomy, surgical technique and results].

Between January 1988 and June 1992, 56 patients suffering from malignant testicular tumors underwent nerve-preserving retroperitoneal lymphadenectomy at the University Hospital in Innsbruck. The tumors were staged according to the nomenclature recommended by the Workshop for Staging and Treatment of Testicular Cancer (Lugano 1979). According to this nomenclature 23 patients had stage I and 33 patients stage II. Thirty-nine patients presented with malignant teratoma, 3 with seminoma and 14 with teratoma and seminoma. The patients with stage I tumors were treated after orchiectomy with nerve-preserving retroperitoneal lymphadenectomy according to the dissection fields of Weissbach et al. In cases of nodal involvement in the retroperitoneum (stage IIa and IIb) a retroperitoneal modified lymphadenectomy according to the margins of Colleselli et al was performed. Patients with stage IIc tumors were treated with three cycles of polychemotherapy. Subsequently, the residual tumor was removed and, if possible, a nerve-sparing lymphadenectomy was performed. Since the nerve-preserving technique was modified in accordance with the tumor stage, antegrade ejaculation could be preserved in 47 of the 56 patients. In 22 patients exocrine testicular function was assessed by sperm analysis. The findings for the patients with stage I and IIa were considerable. The patients who had undergone induction chemotherapy for stage IIb and IIc had poor exocrine testicular function. The follow-up time was 29 months. At follow-up none of the patients presented with recurrent retroperitoneal tumor. Only one patient was found to have tumor progression (solitary pulmonary metastasis 1.7%). These results show that nerve-preserving retroperitoneal lymphadenectomy is the treatment of choice in stage I non-seminomatous testicular tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Uretero-iliac fistula--a rare cause of hematuria. Case report.

Fistulation between the ureter and iliac artery is a rare cause of hematuria. Like our case, most of the cases reported so far, originate from traumatic or iatrogenic lesions. This condition should be considered in patients with massive hematuria and underlying predisposing factors.

Aged↗
PubMed1992

[Urethral rupture--primary repair and reconstruction].

Whether the posterior urethra can successfully be reconstructed depends mainly on the primary care, especially in the case of strictures secondary to trauma. Prior to surgery, primary care of the lesion is mandatory, including open suprapubic fistula, drainage of the cavum retii and of the perineal space, repositioning of the urethra and immediate stabilization of the pelvic ring by means of elastic procedures. In a second step, between 1978 and 1990 we performed bulbo-prostatic surgery in 27 patients with traumatic rupture of the posterior urethra. Based on extensive anatomic be studies on the relationship of the membranous urethra to the pelvic floor and to the arteries, veins and nerves, an operative approach via the perineal body was developed. Of 18 patients followed up, only 4 had flow rates of less than 15 ml/s. Retrograde urethrograms and micturition cystograms showed good results.

Adolescent↗
PubMed1992

[Fibroepithelial polyp of the ureter].

We report on a woman with a long ureteral fibroepithelial polyp prolapsing into the bladder. After endoscopic excision, in a second stage enbloc resection of the tumor-bearing segment and ureteral end-to-end-anastomosis was performed. Optimum management of these lesions includes precise diagnostic work-up followed by conservative surgical approaches.

Cystoscopy↗
PubMed1991

[Percutaneous drainage of complicated infections of the upper urinary tract].

Acute pyelonephritis associated with obstruction may result in urosepsis and septic shock. Besides the administration of antimicrobial agents, quick removal of the obstruction is the essential part of the therapeutic regimen. In 43 patients with urosepsis the obstruction which was mainly due to urinary calculi was removed by percutaneous nephrostomy. Nephrostomy drainage was the only therapeutic measure required in all but 3 patients in whom nephrectomy had to be performed. 1 patient died after nephrectomy; no death occurred after percutaneous nephrostomy. Once diuresis has started after drainage, the patient will improve. If the kidney does not produce urine immediately after drainage the decision has to be made as soon as possible whether nephrectomy has to be performed for survival or whether it is justified to wait. Perfusion studies with radioisotopes have proven to be very helpful in such decisions. If there is no perfusion, immediate nephrectomy is mandatory; however, if perfusion can be demonstrated, recovery of the kidney can be expected. 21 patients with pyonephrosis were drained percutaneously. In 2 patients the infection could be controlled by nephrectomy only. The rate of secondary nephrectomy because of a non-functioning kidney was 50%. Percutaneous drainage has proven to be very effective in 6 patients with infected renal cysts, 7 patients with intrarenal abscesses and 4 patients with perinephric abscesses. There was only 1 patient presenting with intrarenal abscess in whom percutaneous drainage was insufficient and surgical intervention became necessary.

Abscess↗
PubMed1991

[Approach to radical cystoprostatectomy].

A new possibility of using a standardized surgical approach is demonstrated by specific topographic-anatomical paintings. The operation, in this case radical cystoprostatectomy and lymphadenectomy in the man is demonstrated in the cadaver, from the incision of the skin to the excision of prostate and bladder. The significant surgical steps are documented in paintings, which allow exact documentation of the anatomical approach.

Cystectomy↗
PubMed1991

[Therapeutic concept of complicated ureterocele in childhood].

Because of the varied pathological manifestations of complicated ureteroceles, it is difficult to formulate a standardized management schedule. In a retrospective analysis of the methods of treatment appued in recent years, we try to determine the best procedure. Incision of the ureterocele is obsolete. Ureteroceles are often combined with renal duplication. Therefore, in small children we prefer staged surgical management with primary heminephrectomy and partial ureterectomy, with the option of avoiding later excision of the ureterocele. In older children it is advisable to perform all the treatment of the urinary tract in a single stage.

Abnormalities, Multiple↗
PubMed1989

Percutaneous nephrostomy tube with perirenal balloon fixation.

Despite a variety of available systems the fixation of nephrostomy catheters has not been solved satisfactorily so far. Secure and comfortable fixation of the presented nephrostomy tube is provided by its inflatable balloon which is placed in the perinephric space so that the abdominal wall will retain it.

Drainage↗
PubMed1989

Combined percutaneous and transurethral approach to stenoses of the ureteral meatus after transurethral resection for bladder tumor.

A stenosis of the ureteral meatus may result from transurethral resection (TUR) for bladder tumor. Open reconstructive surgery is not recommended because of possible tumor implantation. Preservation of the renal function is the main goal, particularly when chemotherapy with nephrotoxic drugs is planned. Moreover, the patency of the vesicoureteral junction has to be preserved to allow regular inspection of the upper urinary tract for urothelial tumor. The first measure is decompression by nephrostomy. After antegrade cannulation of the stenotic ureteral meatus, a ureteral stent is left for several weeks prior to transurethral meatotomy, which is also followed by stenting for 6 weeks. The retrograde approach will fail more frequently. Sixteen ureteral meatal stenoses were treated in 11 patients. The vesicoureteral junction was permanently restored in about 50%, even when it had not only been injured by one or several TURs, but also by the preceding radio- and chemotherapy.

Aged↗
PubMed1988

Experimental testicular torsion: effect on endocrine and exocrine function and contralateral testicular histology.

In order to investigate whether unilateral testicular torsion exerts a negative influence on the previously undisturbed contralateral side, exocrine and endocrine testicular function were evaluated before and two months after torsion. A rat model with 6 hours', 12 hours' or permanent extravaginal 540 degrees torsion of the right testis was used; a sham operated group of animals served as controls. Ejaculates were collected by electrostimulation; LH, FSH and testosterone serum levels were determined by radioimmunoassays. Eight weeks after torsion sperm output had decreased by half in the experimental groups, and LH levels increased significantly, whereas the other hormone levels, as well as the controls, remained unchanged. Morphometry of the contralateral testis revealed no alterations except a significant increase of the Leydig cells and interstitial cells in some subgroups. All observed changes correlate with the functional loss of one testis; definite evidence for contralateral damage was not observed.

Animals↗
PubMed1988

Percutaneous nephrolithotomy in horseshoe kidneys. Applied anatomy and clinical experience.

The arterial supply of horseshoe kidneys was studied in 6 anatomical specimens to establish whether there is a risk of haemorrhage when performing percutaneous nephrolithotomy. The anatomy of the collecting system was studied on patients' X-rays, taken in different planes to obtain a three-dimensional view. It was found that there is no increased risk of arterial bleeding in horseshoe kidneys compared with normal kidneys. The orientation of the collecting system offers good access. Eight patients with horseshoe kidneys and 1 with a malrotated kidney were treated with percutaneous nephrolithotomy because of solitary or multiple renal pelvic and caliceal stones and 1 ureteric stone. Four patients had had previous operations for calculi. All of the stones were removed without complications.

Adolescent↗