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Biomedical subjects

J Hofbauer

Publications and source records attributed to J Hofbauer.

At least 37 records · Page 2Linked to original sources

Mutation load and mutation-selection-balance in quantitative genetic traits.

Haldane (1937) showed that the reduction of equilibrium mean fitness in an infinite population due to recurrent deleterious mutations depends only on the mutation rate but not on the harmfulness of mutants. His analysis, as well as more recent ones (cf. Crow 1970), ignored back mutation. The purpose of the present paper is to extend these results to arbitrary mutation patterns among alleles and to quantitative genetic traits. We derive first-order approximations for the equilibrium mean fitness (and the mutation load) and determine the order of the error term. For a metric trait under mutation-stabilizing-selection balance our result differs qualitatively from that of Crow and Kimura (1964), whose analysis is based on a Gaussian assumption. Our general approach also yields a mathematical proof that the variance under the usual mutation-stabilizing-selection model is, to first order, micro/s (the house-of cards approximation) as micro/s tends to zero. This holds for arbitrary mutant distributions and does not require that the population mean coincide with the optimum. We show how the mutant distribution determines the order of the error term, and thus the accuracy of the house-of-cards approximation. Upper and lower bounds to the equilibrium variance are derived that deviate only to second order as micro/s tends to zero. The multilocus case is treated under the assumption of global linkage equilibrium.

Alleles↗

Results of excimer laser photorefractive keratectomy for the correction of myopia.

PURPOSE: This report summarizes the authors' 3-year experience with excimer laser photorefractive keratectomy on 240 eyes of 161 patients. METHODS: With constant laser emission parameters, nitrogen flow across the cornea was used on 79 eyes, whereas 161 eyes had no nitrogen flow. Of the 240 eyes, 74 were operated on without suction ring fixation. Postoperative pain management included patching and oral analgesics in 77 eyes and the use of topical diclofenac or ketorolac and a therapeutic soft contact lens in 163 eyes. Follow-up ranged from 1 month (206 eyes) to 36 months (10 eyes). RESULTS: At 3 months, 88% (144 eyes) had uncorrected visual acuity of 20/40 or better; 86% (151 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and 10% (17 eyes) lost two or more lines of best-corrected visual acuity. At 12 months, 89% (122 eyes) achieved uncorrected visual acuity of 20/40 or better, 79% (115 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and 4% (6 eyes) lost two or more lines of best-corrected visual acuity. At 24 months, 92% (44 of 48 eyes) had uncorrected visual acuity of 20/40 or better, 86% (44 of 51 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and 5% (2 eyes) lost two or more lines of best-corrected visual acuity. At 36 months, 90% (9 eyes) achieved an uncorrected visual acuity of 20/40 or better, 90% (9 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and no eyes lost two or more lines of best-corrected visual acuity. CONCLUSIONS: The results obtained with one procedure are within accepted standards of accuracy for refractive surgery, and there is the potential for refinement of the final optical correction. Complication rates are low and are not vision threatening. They included increased intraocular pressure, epithelial "map dot" changes, and recurrent corneal erosion syndrome, "central islands," and others. Photorefractive keratectomy appears to be a safe procedure over the short and medium term.

Adult↗

[Ultrasound diagnosis of persistent varicocele after sclerotherapy].

252 consecutive patients with left-sided idiopathic varicocele were admitted into this prospective study. 30 patients did not receive a transcatheter sclerotherapy on account of their venous morphology on the selective phlebogram. Ultrasound examinations including Doppler sonography were performed before and 1, 3, and 6 to 12 (average 10) months after transcatheter sclerotherapy of the varicocele. For evaluation of therapeutic success the maximal diameter of the pampiniform plexus, the maximal diameter of the largest vein of the plexus, and, by means of Doppler ultrasound, reflux were measured. A continual decrease of these parameters was observed approximately one year after sclerotherapy. 9% of patients (20 patients) had a persisting varicocele. A premature decision for repeat sclerotherapy or operative correction of possibly persisting varicoceles can be avoided by employing a sonographical follow-up of more than 10 months.

Adolescent↗

Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis--a prospective randomized study.

OBJECTIVE: To assess the efficacy of alkali citrate therapy in patients suffering from recurrent idiopathic calcium oxalate stone formation. PATIENTS AND METHODS: Fifty patients suffering from active stone formation who had had at least one stone annually over the previous 3 years were recruited and randomly divided into two groups. They were given either general prophylactic instructions, i.e. abundant liquid intake and dietary restrictions (group I, n = 25)--or were additionally treated with alkali citrate (group II, n = 25). RESULTS: In group I, the rate of stone formation was reduced from 1.8 to 0.7 stones per patient per year. Similar results were obtained for group II, the corresponding figures being 2.1 and 0.9. There was a statistically significant higher urinary citrate excretion in group II than in group I. No difference was seen between the two groups regarding recurrent stone formation (Student's t-test). Stone formation decreased in both groups (group I 27%, group II 31%). Subjectively, 56% of group II patients, all of whom had previously experienced severe colic, reported spontaneous stone elimination to be painless, whereas in group I all but one patient suffered pain. CONCLUSION: An objective benefit of alkali citrate could not be established.

Adult↗

Management of ureteric stones.

Based on experience with over 2,000 patients, the treatment of ureteric stones today relies on extracorporeal shock wave lithotripsy (ESWL) in situ and ureteroscopy with semirigid, ultrathin ureteroscopes combined with pneumatic or laser lithotripsy. All stones in the upper and larger stones in the distal third of the ureter are preferably treated by ESWL in situ, whereas smaller stones in the distal ureter are better treated by endoscopy. Midureteric stones continue to be the domain of primary ureteroscopy; in cases of moderate obstruction in asymptomatic patients, it may also be acceptable to wait for the stone to pass into the distal ureter spontaneously to be treated by ESWL in situ there. Manipulation of the stone back into the kidney and treating it by ESWL there (push back/ESWL) offers no advantage over ESWL in situ, as results are not better yet morbidity is higher. 'Blind' instrumentation has lost all justification, and incisional ureteric lithotomy is no longer indicated but in exceptional cases.

Endoscopy↗

The 'stone clinic effect': myth or reality?

Sixty-six active recurrent stone formers (RSF), i.e., with at least one stone annually over 3 years prior to the first examination at our stone clinic, were retrospectively evaluated. All received specific drug metaphylaxis which was discontinued after 5.5 +/- 2.1 years (period 1). They were reclassified according to the above definition into active and inactive RSF and were then left on a general metaphylactic regimen with regular urological follow-up every 6 months (period 2). 32 patients observed these recommendations for 5.7 +/- 2.6 years (group 1), 34 did not. 20 of these 34 could be reexamined after 6.3 +/- 2.2 years (group 2). Group 1 comprised 10 active and 22 inactive, group 2 comprised 1 active and 19 inactive RSF. While the recurrence rates among the inactive RSF of groups 1 and 2 decreased significantly during period 2, a statistically significant difference between them was not observed. Conversely, there was only a slight reduction of the recurrence rate in the active RSF. Both findings argue against a stone clinic effect. Interviews of the patients showed that stone formation was periodical for a mean of 12 +/- 8 years, after which it gradually faded out. This period is termed 'phase of regular stone formation' and appears to be an autonomous process that cannot usually be influenced by metaphylactic measures. This could explain the wide variability of reported success rates for the various metaphylactic regimens, as they would merely reflect the number of stone formers who are in their phase of regular stone formation.

Adult↗

ESWL in situ or ureteroscopy for ureteric stones?

As documented by follow-up data on ureteric stones in 1259 ureteric units treated, ESWL in situ on advanced lithotriptors with stone location by ultrasonography and fluoroscopy was successful without any retrograde ureteric manipulation in 98% of stones in the upper, 71% in the iliac, and 84% in the distal ureter; 85% of the units were stone-free within 3 months: ancillary measures were needed in 11% and the stone-free state was reached after a median of 39 days. The results obtained with treatment after manipulation of the stone from the upper and mid-ureter by retrograde instrumentation were similar, but ancillary measures were needed in 20% of cases. Endoscopic management with rod-lens ureteroscopes was highly efficient in the distal and mid-ureter, but involved a complication rate of about 11% and required general anaesthesia. In the upper ureter it was abandoned in favour of the two former methods. Endoscopic stone removal has been greatly facilitated by the development of ultrathin, semirigid ureteroscopes 6.2-9 F in diameter, as well as by laser and pneumatic lithotriptors that operate through their minute working ports. Of the stones impacted in 127 ureteric units, 97% were successfully managed at the first attempt, involving an overall complication rate of 6%.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopy↗

Rare-earth elements in urinary calculi.

In vitro studies have demonstrated that trace elements have inhibitory as well as stimulatory effects on the crystallization of urinary stones. Little is known about the activities of rare-earth elements (REEs) in the human body. Although their physiological role is unclear, an effect on calcium transport mechanisms is discussed. In the present study, ten kidney stones (six oxalate and four phosphate stones) were analyzed by neutron-activation analysis for their REE patterns. Urinary stones are capable of concentrating these elements, and some fractionation into light and heavy REEs appears to take place during deposition. Significantly elevated concentrations of heavy REEs such as europium, terbium, and lutetium were detected in phosphate stones as compared with oxalate stones (P < 0.005).

Calcium Oxalate↗

Color flow Doppler sonography for extracorporeal shock wave lithotripsy.

This report documents the usefulness of color Doppler sonography for early verification of urinary stone fragmentation during extracorporeal shock wave lithotripsy with ultrasonographic focusing. In the experimental study lithotripsy was performed on human urinary stones placed in pig kidneys. Increasing color flow within the stone mass created by movement of small fragments indicated fragmentation earlier than pixel movement on the standard gray scale sonogram. The success of treatment was demonstrated macroscopically. In the clinical study 25 patients with radiopaque kidney stones were treated by color Doppler guided shock wave lithotripsy and compared to a control group of 32 patients with similar stone characteristics in whom the end point of treatment was chosen based on B-mode sonography alone. The amount of color flow within the stone reflex determined the end point of treatment. The degree of fragmentation was confirmed by fluoroscopy immediately after treatment. Disintegration was successful in all cases and fragments passed spontaneously. Color Doppler imaging during shock wave lithotripsy provides reliable information on the spatial and temporal characteristics of stone fragmentation, and is superior to B-mode sonography by providing more immediate, objective information on stone fragmentation and allowing better evaluation of the focal zone. With the help of this technique, the number of applied shock waves could be reduced by 20% compared with the control group.

Animals↗

Plasma sialic acid in patients with prostate cancer.

Serum sialic acid (N-acetylneuraminic acid) was evaluated as a tumour marker for prostate cancer and compared with serum prostate specific antigen (PSA). The records of 35 patients suffering from prostate cancer (9 with bone metastases) were analysed and compared with those of 21 healthy individuals. Total serum sialic acid was significantly elevated among the cancer patients. Levels in patients with distant metastases were significantly higher than in those with locally restricted disease and normal individuals, whereas no such difference was seen between the latter 2 groups. A direct association between serum sialic acid and tumour T category and grade could not be established. The difference between the cancer and the control groups was reflected more significantly by PSA. As sialic acid lacks tumour specificity, it is not helpful in screening for prostate cancer, yet might contribute towards the early detection of tumour progression and metastases during both therapy and follow-up.

Aged↗

Primary small cell carcinoma of the urinary bladder. Report of a case with immunohistochemical analyses.

A case of primary small cell carcinoma of the urinary bladder is reported. The light-microscopic diagnosis was supported by immunoreactivity for HISL-19 (marker for peptide-hormone-producing cells) and for neuron-specific enolase (NSE), demonstrating the neuroendocrine differentiation of this rare bladder tumor. Serum NSE, which was significantly elevated, can be a marker for disease extent and response to therapy.

Antibodies, Monoclonal↗

Management of ureteric calculi (minimally invasive therapy of ureteric stones).

As documented with results obtained in 1685 patients the treatment of ureteric stones is today based on ESWL in situ and ureteroscopy with semirigid, ultrathin ureteroscopes and laser lithotripsy. All stones in the upper third of the ureter and larger stones in the distal third of the ureter are preferably treated with ESWL in situ whereas smaller stones in the distal ureter are better treated endoscopically. Midureteric stones remain the domain of primary ureteroscopy; with moderate obstruction in the asymptomatic patient it may also be acceptable to wait for the stone to pass into the distal ureter spontaneously to be treated by ESWL in situ there. Manipulating stones back into the kidney and treating them by ESWL there (pushback/ESWL) offers no advantage over ESWL in situ, as the results are similar, yet morbidity is higher. Blind instrumentation and open surgery have lost all justification.

Endoscopy↗

Trace elements and urinary stone formation: new aspects of the pathological mechanism of urinary stone formation.

The urinary stone, serum and 24-hour urine concentrations of 14 trace elements were determined in urinary stone patients by inductively coupled plasma atomic-emission spectroscopy. The data obtained for 25 active stone patients and 32 whose last stone episode had occurred at least 12 months previously were compared with those of 25 healthy individuals. Urinary nickel, manganese and lithium excretion, and serum nickel, manganese and cadmium concentrations were statistically significantly lower for active stone patients compared to those with previous stone episodes and healthy individuals. No difference in the concentrations of trace elements could be found, however, for patients with previous stone episodes and healthy individuals. Nickel, manganese, lithium and cadmium could be of significance in the pathological mechanism of stone formation, not from mineralogical or crystallographic viewpoints but for the smooth flow of enzymatic reactions in biological systems.

Adult↗

Malignant hemangiopericytoma of the pelvis. Report of a case with urological implications and immunohistochemical analysis.

A case of a malignant hemangiopericytoma located in the pelvic fossa of a 50-year old man is reported. The tumor displaced the urinary bladder and caused bilateral hydronephrosis. Light microscopic diagnosis was followed by immunohistochemistry. After surgery the patient was successfully treated by chemotherapy and irradiation. This paper reviews clinicopathological features in respect of prognosis and a possible treatment.

Abdominal Pain↗

Value of routine citrate analysis and calcium/citrate ratio in calcium urolithiasis.

24-hour urinary citrate excretion was measured in 176 calcium oxalate stone formers and 100 normal controls. A statistically significant difference (p less than 0.03) could be found between the two groups. When stone formers were divided into a group of 69 patients with recurrent calcium urolithiasis (RCU) and a group of 106 patients with a single stone episode, the latter did not differ from the control group, while in RCU a significantly lower citrate excretion compared with controls (p less than 0.005) could be found. Thus, patients with RCU could benefit from alkali citrate prophylaxis. A female-male difference in citrate excretion could not be found in either the control group or stone formers. Recurrent stone formers presented a significantly higher calcium/citrate ratio compared with controls, which would indicate an increased risk for stone formation. The value of routine citrate analysis is limited, however, by the great, variability of citrate levels in stone formers and controls.

Adult↗

Multiple limit cycles for predator-prey models.

We construct a Gause-type predator-prey model with concave prey isocline and (at least) two limit cycles. This serves as a counter-example to the global stability criterion of Hsu [Math. Biosci. 39:1-10 (1978)].

Animals↗

[The significance of citrate excretion and calcium/citrate quotients in urine in patients with calcium calculi].

In 111 patient suffering from calcium oxalate lithiasis more than 168 citrate and calcium analyses have been performed in 24 hour urine. In 69 patients with a single stone episode no significant difference of citrate concentration was found in comparison with 63 healthy volunteers. However, in 42 recurrent stone formers was the citrate concentration significantly diminished (p less than 0.005). The calcium/citrate ratio was in recurrent stone formers markedly higher (5.19 +/- 8.6) than in patients with a single stone episode (3.34 +/- 4.9). However, because great deviation of citrate values the calcium/citrate ratio may not be suitable for evaluation of stone formation risk.

Calcium↗