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Biomedical subjects

L Hertle

Publications and source records attributed to L Hertle.

At least 73 records · Page 4Linked to original sources
PubMed1996

Continent cutaneous urinary diversion using the full-thickness bowel flap tube as continence mechanism: a simplified tunneling technique.

PURPOSE: We present a time and labor saving embedding technique for a full-thickness bowel flap tube used as a continent outlet. MATERIALS AND METHODS: In 17 patients the bowel flap tube was extramurally embedded instead of being submucosally tunneled. The reservoir was attached to the abdominal wall to reinforce the continence mechanism and prevent the tunnel from opening. RESULTS: All 17 patients are completely continent and 14 of 16 evacuate urine easily with a 14F catheter. Due to recurrent stomal stenosis 1 patient with severe diabetes has undergone incontinent diversion. CONCLUSIONS: Our described tunneling procedure for the full-thickness bowel flap tube is easy to perform and provides excellent continence.

Follow-Up Studies↗
PubMed1996

Discordance of assay methods creates pitfalls for the interpretation of prostate-specific antigen values.

The availability of numerous different assays for the determination of prostate-specific antigen (PSA) has created substantial problems in the interpretation of PSA concentrations. Currently over 60 assays are commercially offered on the European market. The majority of the recently marketed assays are based on the commonly used reference range (< 4 ng/ml), although this rarely has been verified. Some manufacturers avoid specifying the range altogether, while others derive the data from very small collectives. Reference ranges established with sera of young males or even with an unspecified proportion of sera of females are not suitable for assessing the specificity of PSA assays for detecting prostate cancer among males older than age 50 years. Most manufacturers recommend that their assays not be used for diagnostic purposes but only for following up patients previously diagnosed with prostate cancer. Usually the physician remains unaware of this warning as well as of the name of the assay used. Since PSA concentrations may vary in identical samples by a factor of two depending on the assay used, the clinician in charge of interpreting the results needs to be aware of the method used and must have detailed information on the assay-specific reference range.

Humans↗
PubMed1995

Immunocytochemical localisation of some lysosomal hydrolases, their presence in luminal fluid and their directional secretion by human epididymal cells in culture.

The way in which the human epididymis modifies spermatozoa during their sojourn in this structure might be clarified by knowledge of the nature of its secretions. We have examined the presence of several lysosomal hydrolases in human epididymal tissue and fluids, and their synthesis and secretion by monolayer cultures. Tissues were obtained from men undergoing orchidectomy for prostatic carcinoma. The enzymes cathepsin D and acid alpha-glucosidase were localised in the lysosomes of epithelial cells from the corpus epididymidis, by an immunocytochemical technique. Cathepsin D was also found in epithelial cells of the efferent ducts within lysosomes, apical vesicles and multivesicular bodies. No immunolocalisation of acid glucosidase in the efferent ducts or on the microvilli of the corpus was demonstrable. Cathepsin D, beta-hexosaminidase (N-acetylglucosaminidase) and alpha-glucosidase were measurable in the luminal fluid from the human corpus epididymidis; beta-hexosaminidase was secreted into the culture medium by confluent monolayers of epididymal and efferent duct cells. Immunoprecipitation of cell extracts and culture medium of these cultures incubated with 35S-methionine revealed that the precursors of cathepsin D and beta-hexosaminidase were synthesized and secreted by such monolayers. Thus, active lytic enzymes are secreted by the human epididymis and could modify sperm membranes.

Adult↗
PubMed1995

Treatment of varicocele: counselling as effective as occlusion of the vena spermatica.

Occlusion of the spermatic vein by surgical or angiographic techniques is generally accepted as the treatment of choice in infertile patients with varicocele. We have recently demonstrated that surgical ligation and radiological embolization are equally effective in terms of pregnancies following treatment. Since, however, it remains unclear whether any treatment is more effective than no treatment, we initiated a controlled, randomized prospective study to address this question. Infertile patients with varicocele were investigated twice using Doppler sonography, ultrasonography of the scrotal contents, semen analysis according to World Health Organization guidelines and serum follicle stimulating hormone, luteinizing hormone and testosterone measurements. Other causes of male infertility were excluded. The patients' wives were free of obvious causes of infertility such as anovulation or tubal blockage. Subjects fulfilling the admission criteria were randomly allocated to groups receiving ligation, embolization or no treatment. Thereafter, all patients were investigated and counselled every 3 months for a period of 1 year. In all, 47 couples in the treatment group (23 ligations and 24 embolizations) and 48 in the non-treatment group concluded the study. When entering the study, there were no significant differences in semen analysis and hormonal parameters between the two groups, nor between the subgroups undergoing treatment. While no significant changes in semen parameters occurred in the non-treatment group, the sperm concentration increased significantly (P = 0.008) in the treated patients from 16.5 +/- 2.5 x 10(6)/ml (mean +/- SE) before to 25.1 +/- 4.1 x 10(6)/ml at the end of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Improved focusing for extracorporeal shock wave lithotripsy of ureteral calculi.

Extracorporeal shock wave lithotripsy of ureteral calculi, which is usually performed with the patient in the prone position, may be difficult or even impossible under certain conditions because x-ray visibility is poor or the calculus is out of range of the shock wave focus. Treatment conditions can be improved by a simple change in the positioning of the patient, using the shock wave head from the contralateral side. This method is applicable for the common Siemens Lithostar device.

Humans↗
PubMed1995

Surgical management of renal cell cancer with extension into the vena cava: usefulness of intra-operative sonography.

Intracaval tumour extension represents a significant surgical problem in patients with renal cell carcinoma. Although pre-operative imaging techniques provide sufficient visualization for the planning of the majority of operative procedures, intra-operative ultrasound is nonetheless beneficial in some cases. In 3 patients, the procedure has given an accurate evaluation of the extent of the tumour thrombus. It has allowed safe placement of instruments which had lessened the risk of thrombus dislodgement. Intra-operative sonography is simple to perform and can be considered a valuable new adjunct in the evaluation and management of renal cell carcinoma with intracaval tumour extension. New technological advances may eventually improve the quality of intra-operative imaging.

Carcinoma, Renal Cell↗
PubMed1995

[Can the tumor stage of prostate carcinoma be determined with the aid of prostate-specific antigen?].

Prostate-specific antigen (PSA) is known to correlate with tumor grading, tumor volume, and lymph node and osseous metastases. If PSA concentrations exceed 20 ng/ml, the risk of extracapsular tumor extension increases greatly, and above 50 ng/ml organ-confined disease is extremely rare. Due to a considerable overlap in PSA concentrations between various tumor stages, the prediction of tumor stage with PSA alone is barely possible. In combination with other preoperative diagnostic findings, e.g. digital rectal examination or histological grade in multiple biopsies, the predictive value of PSA in terms of tumor stage determination can be increased to a large extent.

Biomarkers, Tumor↗
PubMed1995

[Different determination methods make interpretation of prostate-specific antigen more difficult].

The availability of numerous different assays for the determination of prostate-specific antigen (PSA) hs created substantial problems in the interpretation of PSA concentrations. Presently more than 40 assays are commercially promoted within the German market. The majority of the recently released assays claim the commonly used reference range (< 4 ng/ml) although this has no always been verified. Some companies entirely avoid the specification of reference ranges, others derive the data from very small cohorts. Reference ranges established with sera of young males or even with an unknown proportion of female sera are not valid in assessing the specificity of PSA assays to detect prostate cancer among male individuals between 50 and 80 years of age. Some companies recommend not to apply their assay for diagnostic purposes limit its use to the follow-up of patients previously diagnosed but to as having prostate cancer. This warning usually remains just as unknown to the urologist as the name of the assay used. Since PSA concentrations may vary in identical samples by a factor of 2, depending on the assay used, the clinician interpreting the results needs to be aware of the method applied and must have detailed information about the assay-specific reference range. Without this information, PSA loses its valuable diagnostic and prognostic features. Apart from avoidable worries on the patient's part, evidence of prostate cancer may be missed or unnecessary biopsies may be performed.

Aged↗
PubMed1995

Risk of bowel dysfunction with diarrhea after continent urinary diversion with ileal and ileocecal segments.

PURPOSE: In a retrospective study we evaluated the risk of diarrhea after continent urinary diversion using ileal and ileocecal segments. MATERIALS AND METHODS: We interviewed 100 patients of whom 65 underwent ileal and 35 underwent ileocecal resection. RESULTS: Of the 65 patients who underwent ileal resection 7 (11%) and of the 35 who underwent ileocecal resection 8 (23%) reported chronic diarrhea of greater than 6 months in duration, which subsided spontaneously in 2 patients in each group. In each group 3 patients responded well to cholestyramine treatment and 3 responded to loperamid or psyllium. Two patients with ileocecal resection failed to respond to drug therapy. CONCLUSIONS: The risk of diarrhea after ileocecal resection seems to be twice as high as after ileal resection. Most patients responded to symptomatic drug therapy. Alternative surgical therapies should be considered when risk factors are present.

Cecum↗
PubMed1994

The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal.

Penile insensitivity is a symptom commonly observed after traumatic or iatrogenic nerve lesions, or in association with neurological or vascular diseases. In contrast, we report 2 cases of intermittent genital hypesthesia that occurred in cyclists after long-term bicycle riding. Anatomical studies show that this condition was probably caused by an irritation of the pudendal nerve during its course through the Alcock canal as reported in the literature. No pathological findings were demonstrated on extensive physical examinations, medical history and all medical imagings (sonography of abdomen, prostate and testes, and magnetic resonance imaging of the pelvis and lumbar spine) as well as radiodiagnostics and Doppler sonography, nor was there evidence of other neurological disturbances. The symptoms in the 2 patients spontaneously resolved after 4 and 7 weeks, respectively, without specific medical therapy.

Bicycling↗
PubMed1994

Prostate-specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ-confined prostatic cancer.

OBJECTIVE: To determine whether the ratio of PSA and prostate volume provides additional useful information for the discrimination of benign prostatic hyperplasia from prostatic carcinoma. PATIENTS AND METHODS: Since 1989, a prospective study has been in progress involving 229 patients (49 with locally confined prostatic carcinoma, 180 with benign prostatic hyperplasia) to establish whether the ratio of prostate-specific antigen (PSA) and prostate volume, determined by transrectal ultrasound (longitudinal x anterior-posterior x transverse diameter x 0.52), allows a better differentiation than the absolute PSA values. RESULTS: In this population of patients with prostatic disease, the positive predictive value for diagnosis of a prostatic carcinoma was 26% with an absolute PSA threshold value of 4.0 ng/ml, and 36% at a threshold value of 10 ng/ml. With a threshold value of the PSA/prostate volume ratio of 0.25 ng/(ml x cm3), the positive predictive value was 56% compared with 93% for a threshold value of 0.4 ng/(ml x cm3). CONCLUSION: The ratio PSA/prostate volume is a superior method for the diagnosis of prostatic carcinoma both with regard to its sensitivity and its specificity in patients with absolute PSA values in excess of 4 ng/ml.

Diagnosis, Differential↗
PubMed1994

Epithelial monolayers from human epididymal and efferent duct tubules; testosterone metabolism and effects of culture conditions on cell height and confluence.

Corpus epididymal and efferent duct epithelial cells on permeable supports formed confluent monolayers that resisted hydrodynamic equilibrium and created electrical resistance. Monolayers were formed sooner and were of better quality when fetal bovine serum (FBS), rather than bovine serum albumin (BSA), was present in glucose-free, rather than glucose-containing, media. Testosterone was converted to androstenedione by both cell types and conversion of both steroids to 5 alpha-reduced metabolites was higher in cells from the corpus epididymidis than from efferent ducts. Addition of heat-treated human spermatocoele fluid (similar to rete testis fluid) to the apical aspects of the cells increased cell heights when they were initially low, but some cytoplasmic damage was observed. New serum-free media (especially those designed for keratinocytes and mammary epithelial cells) could maintain cultured cells at heights found in situ.

Aged↗