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Biomedical subjects

J Rassweiler

Publications and source records attributed to J Rassweiler.

At least 91 records · Page 5Linked to original sources
PubMed1988

New generator for low pressure lithotripsy with the Dornier HM3: preliminary experience of 2 centers.

The technical innovation of a low pressure generator with a standard ellipsoid installed into the Dornier HM3 lithotriptor leads to a decrease in pressure at the second focus by 30 per cent. The preliminary experience with 273 patients treated at 2 centers is presented. The success rate in terms of stone disintegration was similar compared to the old generator (96 versus 97 per cent). However, the rate of secondary treatments increased from 8 to 15.5 per cent, respectively. Owing to the lower peak pressures at the second focus, an additional 700 impulses per session were necessary. The method of anesthesia was changed to a combination of an anxiolytic and analgesic drug in the majority of the patients. Treatment was judged as free of pain or with easily tolerable pain in 93 and 88 per cent of the patients, respectively.

Anesthesia, Epidural↗
PubMed1988

[Value of commercial enzyme immunoassays in the determination of prostatic acid phosphatase].

In 261 non-selected patients (190 prostate adenoma, 71 carcinoma of prostate) prostatic acid phosphatase (PAP) was measured prior to treatment using three different commercial enzyme immuno assays. According to the normal values given by the manufacturers we found different specificities (ranging from 0.61-0.88) and sensitivities (0.45-0.75). However, the receiver-operating-characteristics-curves (ROC) for each of the tests were similar. Since we observed a considerable overlapping of PAP-activity measured in patients with prostatic adenoma and carcinoma we tried to optimize the specificity of the three assays. The actual cut-off value was determined by use of a tangent with the "a posteriori prevalence" (adenoma:carcinoma = 190:71 = 2.6) on each ROC-curve. With this method we found a similar range of sensitivity (0.38-0.48) and specificity (0.96-0.97). The use of a cut-off-value according to the "a posteriori prevalence" results in optimizing of sensitivity and specificity by taking into account the specific long term distribution of prostate adenoma/carcinoma in the respective material.

Acid Phosphatase↗
PubMed1988

[Use of electronic data processing in the urologic clinic and practice--possibilities and perspectives].

The development, present status and future trends in the use of computers in urology in the Federal Republic of Germany are reviewed. The hardware, software required for hospital and private practice and the staff needed are discussed. Proposals are given for the installation and stepwise upgrading of computer systems, from simple text processing units to complex hospital communication systems. Finally new technologies that might considerably change the use of computers in urology are presented.

Computers↗
PubMed1986

[Persistent varicocele following high ligation of the internal spermatic vein. Phlebography and vaso-occlusion with ethibloc].

The importance of phlebography and vaso-occlusion using ethibloc in diagnosis and treatment of the persistent varicocele following ligation ("Bernardis' technique") is demonstrated. We performed 280 surgical ligations of the internal spermatic vein. In 30 patients persistence of the varicocele was found. In 9 patients following phlebography embolisation of a long segment including smaller collaterals was performed using ethibloc. The other 21 patients were treated surgically because of unusual draining of the collaterals into renal capsular veins, into the hemiazygos vein and into renal segmental veins. In all cases following embolisation complete resolution of the varicocele was observed within 3 months.

Diatrizoate↗
PubMed1986

Experimental basis of angioinfarction for the treatment of renal hypertension.

Collateral circulation and recanalization represent the main problems of organ-ablating renal embolization. Different animal models were used to study the influence of central, peripheral, and capillary occlusion on organ necrosis. The first laboratory experiments were performed to optimize transcatheteral application of the embolization media tested (Gelfoam powder, Histoacryl, Ethibloc). Experiments with the model of a normal rat kidney (n = 400) showed that only capillary embolization homogeneously occluding the entire arterial system resulted in complete organ necrosis, while following central (renal artery ligation) or peripheral (Gelfoam powder) occlusion, areas of intact parenchyma remained. Ethibloc/glucose proved to be the embolization medium best suited for capillary embolization (radiopaque, inert, slow resorption). Studies with the model of unilateral renal hypertension of the rat (n = 146) demonstrated the equivalent therapeutic efficiency on blood pressure of Ethibloc embolization (57% cured, 21% improved) compared to surgical nephrectomy (50% cured, 29% improved), whereas renal artery ligation (85% failed) resulted in minor improvement only. In order to adapt capillary embolization with Ethibloc/glucose to clinical angiographic techniques, we performed angioinfarction of canine kidneys (n = 15): the use of a balloon catheter is mandatory. This guarantees blood stasis during the embolization procedure and avoids embolic reflux. Possible clinical indications of capillary embolization in renal hypertension as a less invasive method are, e.g.: malignant nephrosclerosis; renovascular or glomerulonephritic contracted kidneys, and renal dysplasia. Indications for super-selective vaso-occlusion are renal aneurysms, a-v malformations, and segmental hypoplasia.

Angioplasty, Balloon↗
PubMed1986

Multimodal treatment (extracorporeal shock wave lithotripsy and endourology) of complicated renal stone disease.

From October 1983, (installation of the extracorporeal shock wave lithotripsy unit) to August 1985, 207 patients presented at the Katharinenhospital Stuttgart with complicated renal stone disease (70 borderline stones, 77 partial and 60 complete staghorn calculi). 197 patients were treated with the new technology for urinary stone therapy, i.e. extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCN), and ureterorenoscopy. The combination of PCN and ESWL proved to be the optimal therapeutic approach in the majority of cases (44%), particularly for partial and complete staghorns, whereas PCN or ESWL monotherapy are indicated for borderline stones (51% ESWL, 26% PCN, 20% combination, 3% surgery) and selected cases of staghorn calculi only. Based on this treatment policy (minimal invasiveness and morbidity), 75 patients with partial staghorn (21% ESWL, 28 PCN, 44% combination, 7% surgery) and 52 cases of complete staghorn stone (2% ESWL, 13% PCN, 74% combination, 11% surgery) have been treated successfully. The rate of major complications was low (2.5% septicemia, 2% major renal hemorrhage, 0.5% mortality). With this new concept of multimodal therapy (ESWL and endourology), even cases of malignant stone formation ('stone cancer') may be treatable, since these methods can be applied repeatedly without damaging the renal parenchyma.

Adolescent↗
PubMed1986

Efficacy of in situ extracorporeal shock wave lithotripsy for upper ureteral calculi.

In contrast to the majority of renal calculi, in situ extracorporeal shock wave lithotripsy (ESWL) for upper ureteral stones is still controversial. Some centers recommend retrograde mobilization of the calculus into the renal pelvis prior to ESWL as a routine procedure (UC + ESWL). To evaluate the efficiency of in situ ESWL for upper ureteric stones, we initiated a prospective clinical trial. From July 1985 to January 1986, 122 patients presented with upper ureteral calculi, necessitating a total of 146 different procedures: 88 in situ ESWL; 31 UC + ESWL; 15 antegrade ureteroscopies (URS); 6 retrograde URS; 2 open surgery (ureterolithotomy, nephrectomy), and 4 patients were managed conservatively. Of all 99 patients treated at the lithotripter, 80 patients received in situ ESWL (no emergency case, no location problems): in 60 patients (75%) the stone could be disintegrated in one session; 8 patients (10%) required a second ESWL session due to partial fragmentation. Retrograde mobilization using a ureteral catheter or URS was necessary in 9 patients due to failure of in situ ESWL (11%) and, in only 3 patients, we had to remove the stone by antegrade URS (4%). In conclusion, 96% of all upper ureteric stones suitable for primary ESWL could be treated by a noninvasive (in situ ESWL) or minimally invasive (UC + ESWL) procedure. Therefore we recommend in situ ESWL for these calculi. Primary retrograde mobilization is only indicated in case of location problems (stone close to the spine, obesity, skeleton deformation) or emergency cases (colic, hydronephrosis). Antegrade URS should be performed if retrograde mobilization fails or in emergency cases (acute pyelonephritis, following percutaneous nephrostomy, after clinical stabilization). The rate of open surgery is below 2%.

Clinical Trials as Topic↗
PubMed1985

Morphologic contribution on gross hematuria in mild mesangioproliferative glomerulonephritis without crescents.

In order to clarify the pathogenesis of gross hematuria in mild forms of mesangioproliferative glomerulonephritis without crescents, systematic light microscopic, immunohistologic, electron microscopic, and some scanning electron microscopic investigations were carried out on 17 cases of this disease, in part on serial sections. The investigations produced the following results: In gross hematuria, erythrocytes pass into Bowman's space in the area of basement membrane ruptures. The basement membrane ruptures occur at sites where the basement membrane is infiltrated in its entire width by aggregated immune complexes. This occurs when these immune complexes are detached from the basement membrane by lysosomal digestion. As a working hypothesis, it is furthermore considered possible that in diseases accompanied by increased IgA production, circulating IgA is deposited at a higher rate in the glomerular filtration barrier and it is there degraded by an excessive reaction of local cells before morphologically identifiable immune complexes appear. In this process the basement membrane undergoes local destruction. It is also assumed that in gross hematuria, immune complexes other than IgA or hitherto unknown substances enter the basement membrane during the filtration process and trigger frustrane phagocytosis at the basement membrane by their presence, with consecutive basement membrane destruction. It is pointed out that gross hematuria occurs most often in mild forms of mesangioproliferative glomerulonephritis with IgA and C3 deposits in the mesangium and sometimes also in the capillary periphery. It could be shown that in mild forms of mesangioproliferative glomerulonephritis, hematuria occurs more often in the male sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Extracorporeal shock-wave lithotripsy: one-year experience with the Dornier lithotripter.

Extracorporeal shock-wave lithotripsy (ESWL) has now been in clinical use for more than 4 years. In October 1983, the second kidney lithotripter in the world was installed in our department and, from then until October 1984, 800 treatments were performed on 733 patients. Our results confirm the promising reports published by the Munich group. Furthermore, it was possible to extend the range of indications by combining ESWL with percutaneous procedures, such as percutaneous nephrolithotomy and ureteroscopy. As a result only 7% of all patients who were referred to our hospital with urinary stones (4% of renal stone patients and 15% of those with ureteral stones) had to undergo open surgery.

Combined Modality Therapy↗
PubMed1984

[Experimental conditions for embolization treatment of renal hypertension].

An experimental study was carried out on 146 rats with hypertension in order to determine whether the intensive collateral circulation which develops in reno-vascular hypertension is responsible for the high failure rate following clinical embolisation. Ethibloc embolisation, which fills the capillaries, is as effective as nephrectomy, whereas ligature of the renal artery fails to affect the hypertension.

Animals↗
PubMed1984

Financial analysis, personnel planning and organizational requirements for the installation of a kidney lithotripter in a urologic department.

The first clinical experiences with extracorporeal shockwave lithotripsy (ESWL)--the method of choice in noninvasive treatment of renal calculi--were so encouraging that more ESWL units are now being installed and a still larger number can be predicted. A cost-efficiency analysis shows that, in spite of high investment costs, a net saving of about DM 4,599 (deutsche marks) can be figured for each 'ESWL patient' compared to the expenses of an open operation. This benefit is due to the reduction of disability time, hospital stay and dialysis cases. For the management of an ESWL unit a trained team of urologists and anesthesiologists, as well as a clinic with an 'operative background' is necessary.

Cost-Benefit Analysis↗
PubMed1984

[Kidney tumor embolization. Progress, experiences and complications].

Indications for preoperative and palliative embolization of renal tumors have been restricted due to the failures caused by insufficient tumor blockage. Personal experiences using a variety of materials (balloon n = 18, gelfoam n = 10, ethibloc1 /glucose n = 23) and their effectiveness are presented. special emphasis is placed on the influence of parasitic collaterals and the complication rate on the various procedures. Clinical results corroborate those obtained from our own animal experiments: only a capillary embolization that is based on the tumor volume exhausts the current possibilities of therapeutic vascular occlusion of tumors.

Diatrizoate↗
PubMed1983

[Blunt kidney injuries - operative or conservative therapy? A contribution to classification].

There is consensus concerning the management of minor (Grade I) and critical (Grade III) renal trauma, while the management of Grade II-lesions is contradictory. 48 consecutive cases of renal trauma were evaluated in order to define more exactly the indications of operative and non-operative therapy. As a diagnostic approach sonography and computerized tomography were added to urine examinations and intravenous pyelography, while angiography is only used when surgical intervention is expected. As therapeutic regimen for the intermediate group of Grade II b-lesions we recommend expectant management with "delayed urgency". This concept is based on a more differentiated classification particularly of major injuries (modified from Hodges and Lutzeyer). The importance of short-time clinical, sonographic and CT-control is underlined. Deterioration of clinical condition, associated injuries or pre-existent renal anomalies are indicating delayed operation. Emphasizing the intermediate group within major injuries between expectant conservative and operative management (about 5-10%) the main controversial issues are presented.

Adult↗
PubMed1981

[Capillary embolization. Part II. Occlusion of the entire arterial system of experimentally induced renal tumors ].

221 renal rat tumors (induced by Dimethylnitrosamine) are embolized by gelfoam powder, IBC/Lipiodol and Ethibloc/Glucose. The effect of those embolization media is compared to ligation and glucose perfusion. Recurrencies and rate of surviving tumor tissue are dependent on the stage of the neoplasm, sufficient capillary propagation of the medium, and exact volume-dependent embolization. It could be proven that large areas of renal rat tumors are equally supplied by the main artery and parasitary collaterals. Only homogeneous distribution and complete downstream propagation of the embolization medium from the main artery to the capillaries will achieve breakdown of this parasitary supply. Glucose governed Ethibloc embolization achieves in 80% of tumors with a 6 fold renal volume and in 50% of larger tumors complete necrosis. It has the lowest complication rate of all tested materials.

Animals↗