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Biomedical subjects

J E Altwein

Publications and source records attributed to J E Altwein.

At least 73 records · Page 4Linked to original sources
PubMed1988

Late results after sclerotherapy of varicocele.

Percutaneous sclerotherapy is technically feasible in about 80% of patients with idiopathic varicocele. Persistence must be reckoned with in 3-5% of the cases. Sclerotherapy is a low-risk technique which can be applied on an outpatient basis in the vast majority of cases. In about 40% of the cases, an improvement of the fertility can be attained by raising the spermatozoal density; the total motility and morphology of the spermatozoa can only be slightly improved by this therapy. Percutaneous sclerotherapy is to be recommended as an alternative to surgery since it provides equally good results, is cheaper and causes hardly any complications.

Adult↗
PubMed1988

Benign testicular tumors: a case for testis preservation?

Between June 1980 and June 1986, 345 inguinal explorations for intrascrotal space-occupying lesions were performed. In 47 patients benign testicular tumors were diagnosed (13.5%). In 32 of the 47 tumors (68%), the testis could be preserved by excision or enucleation of the tumor. In the remaining 15 patients a high semicastration was carried out: in 12 cases macroscopic examination or frozen section revealed doubtful benignity (6 Leydig cells tumors, 5 dermoid cysts and 1 epidermoid cyst), in 3 patients because of extensive involvement of the testis. In a follow-up period of 1-7 years none of the patients has shown evidence of tumor recurrence or metastasis. Changing the concept of not incising the parietal tunica of the testis and regarding clear-cut macroscopic and histological criteria of benignity on frozen section will safely lower the testicular loss rate from up to 80% to about 30% when benign tumors are encountered.

Dermoid Cyst↗
PubMed1988

[Local chemolysis of occluding uric acid calculi].

Between 1984 and 1986 nineteen patients (20 renal units) were admitted with obstructing uric acid calculi. Seventy-eight percent of all patients with urolithiasis were treated endourologically: 8 kidneys were infected, 8 kidneys were non-functioning and 3 kidneys caused a status colicus. Sodium bicarbonate was used for percutaneous irrigation and all 20 kidneys were cleared within 4 to 18 days. The technique is a valuable adjunct to the ESWL.

Aged↗
PubMed1988

[Open multicenter study of the differential diagnosis of erectile dysfunction with a papaverine-phentolamine combination (BY023)].

We report the results of an open multicenter clinical trial with 115 patients. The results of a pharmacological test using intracavernously applied mixture of papaverine and phentolamine were compared with the results of a multidisciplinary evaluation of erectile dysfunction. Sensitivity and specificity of our test were determined. The injection of our drug solution caused an increase in tumescence and/or rigidity in all patients. The evaluation of the dose dependent erectile response makes it possible to distinguish between the three main pathogenetic principles: non-vascular, arterial and venous etiology of erectile dysfunction. The pharmacological test requires one to four intracavernous injections of 0.5-3.0 ml of the drug solution (7.5-45 mg papaverine hydrochloride, 0.25-1.5 mg phentolamine mesylate).

Adolescent↗
PubMed1987

[Erectile dysfunction: a multidisciplinary approach].

In 1985, a multidisciplinary investigation was carried out on 134 patients suffering from erectile dysfunction (mean age 37.5 years). The study comprised medical and sexual history, physical examination, laboratory tests, psychological interview and psychometrics, nocturnal penile-tumescence (NPT) measurements, bulbocavernosus-reflex (BCR) latency, and penile Doppler sonography. If indicated, we performed additional autoinjection of the corpus cavernosum (CCAT) with vasoactive agents, dynamic cavernosography, and bilateral selective pudendal arteriography. Thus we found an organic cause in 85% of the cases, revealing a vascular disease in 76%.

Adult↗
PubMed1987

Management and early reconstruction of urinary tract abnormalities detected in utero.

Pre-natal detection of urinary tract anomalies by ultrasound prevents delay in post-natal diagnosis and enables appropriate treatment to be instituted for potentially destructive uropathies. Over a 3-year period 42 cases (60 renoureteric units) of fetal urinary tract abnormality were diagnosed by maternal ultrasound. Sixteen of the 35 survivors underwent corrective urological surgery during the first months of life. Follow-up studies indicate that this early management results in satisfactory preservation of renal function.

Female↗
PubMed1987

[Position of surveillance therapy in clinical stage I testicular non-seminoma].

Since the initiation of a 'surveillance' therapy the role of retroperitoneal lymph node dissection as standard treatment in the management of patients with clinical stage I nonseminomatous germ cell testicular tumor (NSGCTT) continues to be debated. Noninvasive staging techniques (CT scans, lymphography, ultrasound and serologic tumor markers) help to identify more accurately patients with distant metastases. 'Surveillance' alone as a possible treatment modality following orchidectomy in selected patients with clinical stage I NSGCTT requires cooperative and reliable patients. In our urological clinic surveillance alone is not justified any longer because of a noncompliance rate of 10% and a relapse rate of 30%, although the early detection of small-volume metastatic disease, lymphadenectomy and polychemotherapy result in a high rate of cure. Any patient should be excluded from 'wait and see' protocols if metastatic prognostic factors such as vascular infiltration of the primary tumor or local tumor stage greater than pT1 are identified.

Biomarkers, Tumor↗
PubMed1987

[Venous insufficiency of the corpora cavernosa as (additional) cause of erectile dysfunction].

In 25-30% of the patients with erectile dysfunction, venous insufficiency is the (additional) reason for the erectile failure. Surgical procedures and prognosis depend largely on the precise localisation of the pathological drainage. The venous leakage is proven and exactly localized by a multiprojectional cavernosography, measurement of the maintainance flow and intracavernous pressure monitoring. The most reliable screening test for venous erectile dysfunction is the intracavernous application of a standardised vasoactive drug combination.

Erectile Dysfunction↗
PubMed1987

[Intravascular pressure measurements and phlebography of the renal vein: a contribution to the etiology of varicocele].

Phlebography of the left renal vein was performed in 80 patients with left-sided varicocele demonstrating the nutcracker phenomenon. In 39 cases we could prove a compression of the left renal vein. In 10 varicocele patients additional intravascular pressure measurements were studied in both renal veins in the supine and erect position. We found no significant difference between the pressure in the left and right renal vein in the supine position: values varied with respiration. Changing from the supine to the erect position one can note a significantly elevated pressure, higher on the left side than on the right side due to the longer excursion of the left kidney. Urine investigations were done in 153 patients before and in 191 after sclerotherapy to detect protein or blood. Only in 4 patients we found proteinuria but no microhematuria. The results suggest that the aetiology of the varicocele formation is not the nutcracker phenomenon or renal vein hypertension; the predominant cause is a congenital incompetence of the valves in the left testicular vein. The driving force for the retrograde blood flow from the left renal vein into the testicular vein was the increase in pressure: in the supine position caused by respiration, the continuous reflux in the erect position caused by the hydrostatic pressure. The varicocele does not cause a congested kidney with hematuria and proteinuria.

Humans↗
PubMed1987

[Advanced prostate cancer--a therapeutic dilemma?].

The number of approaches available for the management of metastasizing prostatic carcinoma is overwhelming. If due attention is paid to prognostic factors, however, patients can be effectively treated in the urological practice. Once the condition has been diagnosed the first-line treatment carried out should be orchiectomy. Adjuvant drug therapies with such agents as progestogens and estrogens seem to be of little value. Data are not yet available from prospective studies performed to assess the value of complete androgen blockade. In addition, there is so far only experimental evidence that the effect of endocrine therapy is enhanced by an initial adjuvant chemotherapy in untreated prostatic carcinoma, and this should be investigated in randomized clinical trials. In the case of tumor progression estrogens or antiandrogens can be administered to relieve the symptoms; good effects have been achieved especially with estramustine phosphate. Further progression demands chemotherapy, which should be selected with reference to Berry's parameters. There is no agent or combination generally accepted as the chemotherapeutic agent of choice.

Antineoplastic Agents↗
PubMed1986

[Corpus cavernosum autoinjection therapy: initial experiences in erectile dysfunction].

The cause of erectile dysfunction was evaluated by a multidisciplinary approach in 120 impotent patients. Out of these, the CCAT was proposed to 20 patients with vasculogenic erectile dysfunction, 19 of them accepted this therapy. The dosage of phentolamine mesylate-papaverin hydrochloride injection required was determined in each patient individually. Usually we injected initially 1 cc in one corpus cavernosum. Eighteen patients followed the regimen successfully at home. In 2 patients prolonged erections were observed, which were successfully relieved by simple corpus puncture, however, discontinuation of therapy was not necessary. CCAT failed in 1/19 patients with a severe venous leak. Follow up was carried out weekly.

Drug Therapy, Combination↗
PubMed1986

[Metaraminol--an antidote in corpus cavernosum autoinjection therapy-induced prolonged erection].

Up to now 65 patients with erectile dysfunction were treated by means of corpus cavernosum-autoinjection-therapy (CAT). The only side effect observed were 6 prolonged erections, which could successfully be treated in 3 cases by puncture and aspiration of the corpora cavernosa. In another 3 cases prolonged erection subsided after an intracavernous injection of 2 mg metaraminol. Erection induced by CAT was immediately interrupted by metaraminol in 10 other patients.

Adult↗
PubMed1986

[Nonbulky nonseminomas: N-staging value of image-producing study procedures with reference to possible surveillance management].

In a retrospective study 72 patients with non-bulky nonseminomas were investigated in order to determine the value of computed tomography, sonography and lymphography in the detection of lymph node metastases. The diagnostic results were compared with the histological findings of the retroperitoneal lymph node dissection. In our evaluation computed tomography (n = 48) had an accuracy of 0.77, a sensitivity of 0.62 and a specificity of 0.89; sonography (n = 40) had an accuracy of 0.66, a sensitivity of 0.47 and a specificity of 0.81; lymphography (n = 54) had an accuracy of 0.56, a sensitivity of 0.59 and a specificity of 0.53. Our own results were compared with the results published elsewhere.

Humans↗
PubMed1986

[Preliminary results of the treatment of erectile impotence by intracavernous self administration of vasoactive substances].

From a group of 120 patients with erectile deficiency, 43 cases with arterial disorders with or without associated nervous, psychologic or venous causes were selected for treatment. Mean age of group was 44.5 years. A preliminary series of test was performed during hospital stay, consisting of injection of phentolamine and papaverine into corpus cavernosum. This allowed determination of the minimal effective dose for maintaining erection, and 41 patients accepted to continue treatment at home by auto-injection of products. Regular review showed that all had erections, considered to be complete in 95%. The initially determined dose was usually reduced, probably due to sexual stimulation. The erections appeared earlier (8 min) and lasted longer (140 min), ejaculation provoking only minimal detumescence. Patients responding poorly had venous losses. During initial tests, 2 patients had abnormally prolonged erections requiring puncture of corpus cavernosum. Incidents or habit-forming did not develop and patients and partners did not present psychological problems.

Adult↗
PubMed1985

Dynamic cavernosography: venous outflow studies of cavernous bodies.

Based on dynamic cavernosography studies in 15 patients, including 8 with simultaneous passive erection, we present more precise details of the venous drainage of the penis. The venous drainage is comprised of 3 different systems. The superficial dorsal vein drains mainly the penile skin and prepuce, and empties via the external pudendal veins into the femoral vein. The deep dorsal vein, located between the tunica albuginea and Buck's fascia, drains the glans and all 3 corpora. The venae profundae penis emerge from each crus of the corpora cavernosa and drain only the corpora themselves. Considerable individual differences were found regarding further drainage via the pelvic venous system, including the prostatovesical plexus and internal pudendal veins. Passive erection was tried in 11 patients and was successful immediately after cavernosography in 8. The flow rates to induce an erection averaged 111 ml. per minute (range 55 to 160 ml. per minute), while the rate to maintain the erection was 48 ml. per minute (range 12 to 90 ml. per minute).

Adolescent↗