Biomedical subjects
Publications and source records attributed to J Steffens.
Epidermoid cysts are rare, benign tumors of the testis or, less frequently, the inguinal cord. Generally, they affect males between 10 and 39 years. In newborns they are rare. We report on a newborn with an epidermoid cyst of the right testis that had been diagnosed in utero and was removed with preservation of the testicle.
In recent years, mumps orchitis has become a rarely reported disease. However, since October 1994 a clear increase in the incidence of this disease has been observed. At four hospitals in the Saarland, Germany, 45 cases of mumps orchitis in adolescents and adults were diagnosed in this period. In addition to the case history and clinical findings, the diagnosis was confirmed by an increased IgM titer. None of the patients had been previously vaccinated. The main reason for this was a lack of parental knowledge of the necessity for this vaccination, one which has almost no side effects. The goal of this study is to describe the disease, present our own results, and indicate the need for vaccination. In addition to providing information, a further aim of the study is to increase the motivation of adolescents and adults for vaccination. Although many treatments for mumps have been published in recent years, the most successful therapy is still prophylactic vaccination.
Unilateral or bilateral suprarenal abscesses are rare in the neonate. We describe 2 cases, an 8-week-old Syrian female with a right, and a 6-week-old white female infant with a left adrenal abscess, both following adrenal hemorrhage. The etiology and treatment are discussed.
Cystic lymphangiomas are rare, benign tumors, which are mainly located in the neck or axilla. The fourteenth reported case in the literature of a pediatric retroperitoneal cystic lymphangioma is described. Symptoms, diagnostic procedure and therapy are reported and discussed.
Leydig cell tumors are the most common tumors of the gonadal stroma. They account for 3% of all testicular tumors. Whereas in 10% of adult cases malignancy occurs, the clinical course in children is benign. During childhood the tumor presents with precocious pseudopuberty, in adults with testicular swelling and gynecomastia. We report on 17 cases of Leydig cell tumor, paying special attention to clinical and morphological aspects.
Velocity-encoded cine-magnetic resonance imaging (VEC-MRI) is a new method for quantitation of blood flow with the potential to measure high-velocity jets across stenotic valves. The objective of this study was to evaluate the ability of VEC-MRI to measure transmitral velocity in patients with mitral stenosis. Sixteen patients with known mitral stenosis were studied. A 1.5 Tesla superconducting magnet was used to obtain velocity-encoded images in the left ventricular short-axis plane. Images were obtained throughout the cardiac cycle at 3 consecutive slices beginning proximal to the mitral coaptation point. To determine the optimal slice thickness for MRI imaging, both 10 mm and 5 mm thicknesses were used. Echocardiography including continuous-wave Doppler was performed on every patient within 2 hours of MRI imaging. Peak velocity was determined for both VEC-MRI and Doppler-echo images. Two observers independently measured the VEC-MRI mitral inflow velocities. Of the 16 patients, imaged data were incomplete in only 1 study, and all images were adequate for analysis. Strong correlations were found for measurements of mitral valve gradient for both 10 mm (peak r = 0.89, mean r = 0.84) and 5 mm (peak r = 0.82, mean r = 0.95) slice thicknesses. Measurements of peak velocity with VEC-MRI (10 mm) agreed well with Doppler: mean 1.46 m/s, mean of differences (Doppler MRI) 0.38 m/s, standard deviation of differences 0.2 m/s. These findings suggest that VEC-MRI can noninvasively determine the severity of mitral stenosis.
The increased sympathetic neurotransmission in benign prostatic hyperplasia (BPH) results in a alpha 1C-adrenoceptor-mediated increase in prostatic smooth muscle tone which seems to be responsible for the dynamic infravesical obstruction occurring in BPH. The prostatic smooth muscle contractions evoked by norepinephrine can be efficiently blocked by alpha 1-adrenoceptor blockers. Moreover, an impressive number of clinical trials illustrated the beneficial results of alpha 1-adrenoceptor blockers in the treatment of BPH. However, despite knowledge of alpha 1-adrenergic neurotransmission and the clinical application of its blockade by selective alpha 1-adrenoceptor antagonists, very little is known about the intracellular pathways involved in the regulation of prostatic smooth muscle contractility. To study the intracellular mechanism of the alpha 1C-adrenoceptor-induced prostatic smooth muscle contraction, the patch-clamp technique in the whole-cell configuration mode combined with the Fura-II fluorescence technique was used in human, enzymatically isolated smooth muscle cells obtained from patients undergoing transurethral resection of the prostate because of symptomatic BPH. Furthermore changes in prostatic smooth muscle contractility were registered in organ bath experiments. Application of the selective alpha 1-adrenoceptor agonist phenylephrine (PE) increased the L-type Ca(2+)-channel current (ICa) dose dependently from 8 up to 18.5 microA/cm2, simultaneously elevating the free cytoplasmic Ca2+ concentration ([Ca2+]i) up to 1.9 microM. Pretreating the myocytes with pertussis toxin, an exotoxin of Bordetella pertussis which inactivates GTP-binding proteins (G proteins) of the Gi and G(o) family by ADP ribosylation, reduced the PE-induced ICa stimulation by 71.5 +/- 5.6% (n = 21). Dialysis of the cytosol with the second messenger inositol-1,4,5-trisphosphate (IP3), which releases Ca2+ from intracellular non-mitochondrial, IP3-sensitive Ca2+ pools, imitated the PE-evoked responses. Pretreating the myocytes with the Ca(2+)-release blockers ryanodine (10-100 microM, n = 8), thapsigargin (0.1 microM, n = 11) or low-molecular weight heparin (n = 14) largely attenuated the PE-evoked responses. The experimental results suggest a coupling of alpha 1-adrenoceptors to phospholipase C-converting phosphoinositol-4,5-bisphosphate into diacylglycerol, an endogenous activator of the protein kinase C and IP3 which releases Ca2+ from intracellular stores stimulating ICa via Ca(2+)-calmodulin-dependent protein kinase induced phosphorylation of voltage-dependent Ca2+ channels. This knowledge could be of interest for conservative treatment in symptomatic BPH.
We report a case of primary renal osteosarcoma diagnosed during the patient's life. A review of the literature revealed only 10 cases of primary osteogenic renal sarcoma. Differential diagnoses and possible treatment are discussed.
A man in whom urinary diversion (colon conduit) was performed after 2 unsuccessful implantations of artificial urethral sphincters for treatment of iatrogenic incontinence became continent again after implantation of an alloplastic sling. Three months later the patient underwent urinary undiversion with augmentation cystoplasty. After 3 years ureteroneocystostomy was necessary due to distal ureteral stenoses. At 7-year followup the patient is continent. He has good bladder capacity, bladder emptying and a normal upper urinary tract.
A total of 659 consecutive patients underwent venography for the evaluation of idiopathic left varicocele before sclerotherapy. In 484 cases no valves of the left spermatic vein could be demonstrated, while 172 patients demonstrated competent valves or absent insertions of the left spermatic vein at the typical point on the left renal vein plus retrograde flow over persistent intercardinal anastomoses. Stenosis of the renal vein occurred in 103 patients (15.7%). In only 3 patients was stenosis observed in the course of the left iliac vein, suggestive of the so-called distal nutcracker phenomenon. We propose that during embryogenesis disturbances in the development of the secondary venous system may result in the idiopathic left varicocele.
A rare case of postnephrectomy arteriovenous fistula of the right renal pedicle of a 6-year-old boy is reported. The diagnosis was made by clinical signs and confirmed by colored duplex sonography and angiography. Successful treatment was achieved by percutaneous transcatheter embolization using coils.
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Ossifying renal tumor of infancy is a rare but distinctive tumor that presents as a mass in the pelvicaliceal system. It is usually suspected to be a calculus until surgical exploration reveals dense tumor attachment to the renal parenchyma. The histogenesis of this lesion has not been established. We present a case of this unusual neoplasm. A renal sparing procedure was performed on this biologically benign tumor. Followup after 20 months showed no evidence of recurrence.
The lack of circadian rhythmicity of plasma arginine vasopressin (AVP) in primary nocturnal enuresis (PNE) in some children is known. The original test protocol is time-consuming and needs excellent compliance by children and parents. The goals of the presented study are the introduction of a simple screening test and the evaluation of the response of treatment using intranasal synthetic vasopressin. Fifty-five children (aged 8.2 +/- 3.1 years) with PNE and 15 children (aged 7.9 +/- 2.4 years) of a control group were investigated. Using a standardized protocol, AVP levels were measured by radioimmunoassay (RIA) under controlled water intake 3 times per day over a period of 72 h. Fourteen of 55 tested children (25.5%) with PNE had a significant decrease in nocturnal AVP when compared to the control group. We measured also an increased nocturnal urine volume and a lower urine osmolality in this enuretic group. Eight of 14 patients (57.1%) with plasma AVP deficiency (AVPD) also had bladder instability. Nine of 14 patients (64.3%) with AVPD with or without concomitant bladder instability were totally dry during desmopressin treatment, but only 2 (14.3%) remained dry after discontinuation of treatment. Our data suggest that nocturnal urine osmolality measurement may reflect AVPD and predict a positive treatment outcome.