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Biomedical subjects

G Janetschek

Publications and source records attributed to G Janetschek.

107 records · Page 6Linked to original sources
PubMed1988

Urinary diversion in gynecologic malignancies.

A variety of methods for urinary diversion are employed in patients with gynecologic malignancies depending on whether there is an obstruction or fistula formation due to either tumor growth or radiotherapeutic injury. Percutaneous nephrostomy (PCN) has a low complication rate and is a good method for palliative urinary diversion or may precede some form of permanent diversion to restore the kidney function first. Indication for palliative diversion in tumor obstruction depends on many individual factors. A relative contraindication is tumor progression during therapy. 6-month survival was about 70% in patients with previously untreated tumors or recurrences. This rate is far better than reported in earlier studies, so that a palliative diversion has to be considered for these patients. Also a high rate of recanalization after therapy could be observed in the untreated group, allowing the PCN to be removed. However, this has not been shown to be a prognostic factor. In the individual patient some other aspects, such as quality of life and social status, have to be taken into account before a final decision can be made. Ureteral obstruction after radiotherapy is a rare finding and often mistaken for a more likely recurrence. Different methods to restore the urinary tract, such as reimplantation of the ureter, should be used as a first choice. When the stenosis is due to radiocystitis, enterocytoplasty will often be indicated. Diversion has then to be omitted. The poor quality of life because of permanent incontinence due to fistula formation makes diversion mandatory even if life expectancy is very short. Surgical closure of a large radiogenic fistula is rarely successful. In this situation, ileal conduit has proven its efficacy for long-term urinary diversion.

Female↗
PubMed1988

[Intrarenal percutaneous surgery in calyceal stones, infundibular stones, calyceal diverticuli and stenosis of the ureteropelvic junction].

Percutaneous intrarenal surgery makes it possible to treat calculi and an underlying outlet obstruction in a one-step procedure. We performed percutaneous repair in ten patients with infundibular stenosis, three with calyceal diverticula, and ten patients with recurrent ureteropelvic-junction obstruction. In six patients, it proved possible to remove otherwise inaccessible stones after incision of a parenchymal bridge. Our patients included four children. The operative techniques used are presented. There is a certain risk of injuring an artery, which can be greatly reduced when the renal anatomy is borne in mind. Access above the 12th rib was used frequently. The long-term results demonstrate the efficacy of percutaneous surgery.

Adult↗
PubMed1988

[Arterial blood supply of horseshoe kidneys with special reference to percutaneous lithotripsy].

The arterial blood supply of six horseshoe kidneys has been examined in respect to percutaneous lithotripsy, i.e. puncture of the renal pelvis in its dorsolateral aspect including nephroscopic extraction of renal calculi. The blood supply of horseshoe kidneys is presupposed by evolution. Besides the definitive renal arteries there are accessory arteries which may be regarded as persistent mesonephric arteries. We distinguish between proper accessory arteries entering the horseshoe kidney at its hilum and aberrant accessory arteries which reach either the upper extremities or the zone of fusion. The latter derive form the abdominal aorta or the bifurcation respectively, the common iliac arteries, the left renal artery, the inferior mesenteric artery or the median sacral artery. Despite the variability of the renal arteries we didn't find any larger vessels in the area of puncture. The anatomical investigations showed that there is no increased risk of hemorrhage performing percutaneous lithotripsy on horseshoe kidneys. During the last two years 8 patients with horseshoe kidneys have been operated because of relapsing calculi using this method, showing no intra- or postoperative complications.

Humans↗
PubMed1987

Hemodynamic effects of experimental testicular torsion.

Experimental testicular torsion must be used for certain studies of clinical relevance, but most experimental models either do not provide hemodynamic alteration comparable to the clinical situation or cannot guarantee reproducibility. Using a rat model arterial perfusion and hemorrhagic infarction were correlated to the degree of both intra- and extravaginal testicular torsion. Arterial inflow was measured sequentially with radiolabelled microspheres, hemorrhagic infarction was judged by the increase of testicular weight. Maximal hemorrhagic infarction and reproducible values were found when the spermatic cord was twisted together with the tunica vaginalis for 360 degrees-540 degrees.

Animals↗
PubMed1987

Unilateral testicular disease: effect on the contralateral testis (morphometric study).

Unilateral testicular disease has been reported to damage the contralateral testis. In order to find out whether this detrimental influence is permanent in nature or can be avoided by therapeutic measures, and furthermore to quantify the damage, the following experiments were performed. Seventy-five rats were classified into the following five groups: I) testicular torsion persisting for eight hours; II) ipsilateral semicastration after torsion persisting for eight hours; III) semicastration; IV) sham operation as control; V) immunosuppression with azathioprine after torsion persisting for eight hours. The contralateral testes were removed two months later and perfused with fixative via the testicular artery. Stereologic techniques were employed to obtain quantitative morphologic data. Serum hormone levels were determined. The volume density of the contralateral germinal epithelium was not decreased two months after torsion for eight hours, torsion following by semicastration or torsion followed by immunosuppression. The same was true of the total volume of germinal epithelium per rat testis. The hormone levels remained essentially unchanged.

Animals↗
PubMed1984

Prenatal diagnosis of neuroblastoma by sonography.

Herein we report the first case in the literature in which a neuroblastoma in a fetus was recognized before birth and its growth could be observed. The diagnosis was made by ultrasonography. Other helpful diagnostic procedures in prenatal diagnosis are: determination of catecholamines, sonographic examination of the placenta, and search for metastases. As more and more centers perform ultrasound examinations routinely in pregnancy, similar findings such as fetal tumors or congenital malformations are to be expected more frequently.

Adrenal Gland Neoplasms↗
PubMed1983

[Replacement of a dislodged nephrostomy catheter].

A common complication of percutaneous nephrostomy is accidental withdrawal of the catheter. Opacification of the nephrostomy tract demonstrates an intact passage to the collecting system. First one should try to negotiate the tract with a probe under fluoroscopy. If the pelvocalyceal system cannot be entered by probing alone, a puncture is done next. The Seldinger-needle together with a 22-gauge needle and a mandrin allows to combine probing, puncture and fluoroscopy of the nephrostomy tract.

Humans↗
PubMed1982

[Chromosomal findings in patients with oligospermia and azoospermia (author's transl)].

A cytogenetical study has been conducted in patients with impaired spermatogenesis and reduced fertility or complete sterility to investigate the frequency of chromosomal aberrations in this condition. 78 patients with azoospermia and 74 patients with a sperm count of below 20 million/ml have been studied cytogenetically and endocrinologically between 1977 and 1981. Numerical or structural chromosomal aberrations were found in 27 out of the 152 patients. In two phenotypically normal males hitherto-undescribed balanced autosomal translocations were detected.

Chromosome Aberrations↗
PubMed1982

The effects of chlorotrianisene (Tace) of kinetics of 3H-testosterone metabolism in patients with carcinoma of the prostate.

Alterations in the metabolism of testosterone and plasma levels of testosterone, luteinising hormone (LH), follicle stimulating hormone (FSH), prolactin and oestradiol were studied in 6 patients with newly diagnosed prostatic carcinoma before and during treatment with chlorotrianisene at a daily dosage of 48 mg for 14 days. Parameters of plasma kinetics were determined according to the single injection technique and the 2-compartment model, and the plasma hormones by radioimmunoassay. Chlorotrianisene altered neither plasma levels of testosterone, gonadotrophins, prolactin and oestradiol, nor metabolic clearance rate, production rate and other kinetic parameters of testosterone. Thus the beneficial effects which have been reported previously cannot be explained by suppression of peripheral testosterone metabolism.

Aged↗
PubMed1981

In vivo studies on the antiandrogenic effects of cimetidine versus cyproterone acetate in rats.

To investigate the antiandrogenic action of cimetidine in vivo, prostatic androgen uptake and metabolism, spermatogenesis, morphology of the prostate and testes, and plasma hormone levels were studied using Sprague-Dawley rats, and the results were compared with the effects of cyproterone acetate or castration. Cimetidine and cyproterone acetate caused significant reduction in the weights of the ventral prostate and testes. The changes of ventral prostate were accompanied by a dose-related epithelial atrophy. No adverse effect on spermatogenesis was observed after treatment with cimetidine at daily doses of 50 mg/kg or cyproterone acetate of 10 mg/kg. Although cimetidine treatment induced a significant decrease in plasma testosterone levels, the uptake of testosterone-3H and its conversion to DHT of the ventral prostate were not inhibited by cimetidine.

Androgen Antagonists↗
PubMed1980

[Percutaneous nephrostomy in ureteric fistulas following antireflux operations (author's transl)].

Ureteric fistulae after reflux operations are rare. The percutaneous nephrostomy is a minor procedure and best suited for temporary urinary diversion. The interval before further surgery is about two months. The area of the ureteric fistula is not to be opened and the ureteric defect is bridged by the psoas hitch technique. A spontaneous closure of the fistula during urinary diversion can be observed.

Child↗
PubMedDate not supplied

Pheochromocytoma and sub-clinical Cushing's syndrome during pregnancy: diagnosis, medical pre-treatment and cure by laparoscopic unilateral adrenalectomy.

The coexistence of pheochromocytoma and primary adrenal Cushing's syndrome of the same adrenal gland has rarely been reported. We describe here the case of a female patient presenting with mild Cushing's stigmata, hypertension and diabetes mellitus in whom we diagnosed a pheochromocytoma of the left adrenal gland with coexisting non-ACTH-dependent cortisol hypersecretion. While hormonal work-up was still in progress, the patient became pregnant and wanted to carry her pregnancy to full-term. A laparoscopic adrenalectomy in the 17th week of gestation was decided upon and the patient accordingly prepared for surgery by pre-treatment with phenoxybenzamine. Successful surgery--the first ever reported laparoscopic resection of a pheochromocytoma in pregnancy--without perioperative complications was performed under general anesthesia, with the patient receiving peri- and post-operative hydrocortisone substitution. Pathohistological examination revealed a pheochromocytoma with positive immunostaining for interleukin-6 (IL-6) and negative immunostaining for ACTH, vasoactive intestinal polypeptide (VIP) and cytochrome P450, and with no signs of malignancy. A paracrine stimulation of the ipsilateral adrenal cortex by IL-6 produced by the pheochromocytoma, leading to cortical hyperplasia and subclinical Cushing's syndrome, is suggested by the positive immunostaining for IL-6 and the MRI findings. Post-operatively, secondary adrenal insufficiency ensued, necessitating continuing hydrocortisone replacement over 12 months. Hypertension resolved after surgery, and diabetes after the uncomplicated vaginal delivery at term.

Adrenal Gland Neoplasms↗