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Biomedical subjects

L Hertle

Publications and source records attributed to L Hertle.

103 records · Page 6Linked to original sources
PubMed1984

[Effect of Baralgin on isolated preparations of the upper urinary tract in man].

The effects of the constituents of Baralgin ( metamizole , fenpiverinium , and pitofenone ) on mechanical activity were studied in isolated human preparations of the upper urinary tract. Metamizole in concentrations up to 10(-3) mol/l did influence neither spontaneous phasic activity nor activation by high external potassium, norepinephrine, or acetylcholine. Fenpiverinium blocked the increase in frequency of phasic-rhythmic contractions and the tonic tension development induced by acetylcholine. Fenpiverinium did influence neither spontaneous phasic activity nor activation by high potassium or norepinephrine. Pitofenone (10(-3)mol/l) antagonized completely spontaneous phasic-rhythmic as well as norepinephrine- or acetylcholine-induced phasic activity. The tonic activation induced by norepinephrine and acetylcholine was nearly completely inhibited. Pitofenone (10(-6) to 10(-3) mol/l) antagonized the high potassium-induced activation in a concentration-dependent way. The EC50 of pitofenone amounted to 2 X 10(-4) mol/l. Uptake measurements of 14C- pitofenone (2 X 10(-4) mol/l) in isolated ureteral segments showed the drug to be accumulated in the ureteral tissue; a tissue/medium ratio of about 3 was found at an exposure time of 60 min. The accumulation of the drug was reversible after washing in drug-free solution, indicated by the loss of radioactivity increasing with longer washing times. The results show that pitofenone has a direct relaxant effect on smooth muscle of the upper urinary tract, whereas fenpiverinium has exclusively anticholinergic properties. Metamizole had no direct effect on smooth muscle activity, and its clinical effects may be rather due to its analgesic action.

Adult↗
PubMed1984

Psoas-hitch ureteroneocystostomy: experience with 181 cases.

The operative technique, indications and results of the psoas-hitch ureteroneocystostomy in 181 patients are reported. The principles of this procedure are as follows. Dissection of the ureter under direct vision, fixation of the mobilized bladder to the psoas muscle, longitudinal opening of the bladder up to the point of fixation, implantation of the ureter in an immobile bladder portion using a long submucosal tunnel. The original course of the ureter is maintained and is identical to the axis of the fixed bladder part. The broad spectrum of indications includes the repair of distal ureteral defects due to iatrogenic lesion, radiotherapy or inflammation, correction of congenital ureteral anomalies as well as therapy of reflux in adulthood and complicated reflux in children. Especially in cases in which previous ureteroneocystostomy has failed, the psoas-hitch plasty is the method of choice. Contraindications are neurogenic bladder dysfunction and a highly reduced bladder capacity or the impossibility of bladder mobilization because of a 'frozen pelvis'. The success rate of psoas-hitch ureteroneocystostomy performed in 181 cases was 96.7%. The preconditions for a successful ureteroneocystostomy are: tension-free anastomosis between ureter and bladder; antireflux implantation of the ureter through a long submucosal tunnel, and a straight course of the implanted ureter without kinking at the point of entrance into the bladder.

Adult↗
PubMed1984

Computed tomography in xanthogranulomatous pyelonephritis.

Two cases of xanthogranulomatous pyelonephritis (XGP) examined preoperatively by computed tomography are reported. In one, preoperative diagnosis of an inflammatory abscess-forming disease was possible. Several features of computed tomography in XGP permit differentiation from renal carcinoma. Global renal enlargement, the presence of calculi, the spread of infiltration into the fatty capsule with thickening of Gerota's fascia, and the characteristic density differences between cortex and medulla as a result of reduced contrast medium concentrations in the pyramids are suspicious of this special form of interstitial nephritis.

Diagnosis, Differential↗
PubMed1982

Plasma renin activity and cardiovascular changes in patients with chronic bladder distension.

Arterial plasma renin activity, arterial blood pressure, heart rate and respiratory frequency were measured in 10 patients with chronically distended bladder due to benign prostatic hyperplasia before and after bladder drainage. After suprapubical bladder puncture there was a decrease in all the values. Similar changes were also found in 3 patients with artificially induced acute bladder distension, who did not suffer from infravesical obstruction. A significant correlation was found between the changes of the arterial pressure and arterial plasma renin activity. It is therefore suggested that the renin-angiotensin system might be involved in patients with bladder distension.

Aged↗
PubMed1980

[Xanthogranulomatous pyelonephritis (author's transl)].

Xanthogranulomatous pyelonephritis, a special form of pyonephrosis, is hard to differentiate from other inflammatory or tumourous changes of the kidney. This is due to manifold clinical symptoms and uncharacteristic X-ray findings. The diagnosis is made histologically. The disease was observed in four female patients ages 11 to 53 years. Nephrectomy leads to cure in diffuse forms of the disease. In localised forms organ preserving operations with partial renal resections are sufficient.

Adult↗
PubMedDate not supplied

Sacral neuromodulation for urinary retention caused by sexual abuse.

OBJECTIVE: This case report describes the use of sacral neuromodulation to treat urinary retention after sexual abuse. METHODS: Sacral neuromodulation was added to therapeutic regimen of a 38-year-old woman in whom chronic, complete urinary retention developed after psychological and sexual abuse during childhood. RESULTS: The combination of psychotherapy and neuromodulation restored the patient's ability to void, whereas psychotherapy alone had not. CONCLUSIONS: Although a multifactorial etiology of retention cannot be ruled out in this patient, neuromodulation might effectively treat urinary retention in cases of a conversion disorder after sexual abuse.

Adult↗
PubMedDate not supplied

The impact of intraoperative manipulation of the prostate on total and free prostate-specific antigen.

OBJECTIVES: It is well documented that mechanical manipulation of the prostate can elevate total PSA (t-PSA) levels in serum. However, less is known about its effects on free PSA (f-PSA) and the free-to-total PSA ratio (f/t-PSA). We therefore examined the impact of prostate manipulation on t-PSA and f-PSA during surgical procedures involving the prostate. METHODS: Intraoperative blood samples for t-PSA and f-PSA measurement (Hybritech) were collected every 15 min during 14 radical retropubic prostatectomies (RRP) and 10 radical cystoprostatectomies (RCP). RESULTS: Prostatic manipulation induced significant elevations in t-PSA and f-PSA during RRP and RCP. Postmanipulatory peaks were markedly higher for f-PSA than for t-PSA. The mean maximum f-PSA levels showed a 4.3- (RRP) and 7.9-fold (RCP) increase, followed by a rapid decline after prostate removal. t-PSA increased 1.2- (RRP) and 1.3-fold (RCP), and declined more slowly. Postmanipulatory f/t-PSA ratios also increased significantly, reaching mean elevations of +0.29 and +0.28 over preoperative ratios during RRP and RCP, respectively. CONCLUSIONS: Prostate manipulation can induce transient increases in t-PSA, f-PSA and f/t-PSA in benign and malignant prostates. The extent of these alterations and their course over time must be taken into account when postmanipulatory changes in PSA forms are investigated. Timing of postmanipulatory venipunctures and the molar response ratio of t-PSA assays used (equimolar versus nonequimolar) seem to have substantial impact on the results of such studies.

Adult↗
PubMedDate not supplied

Possible synergy of radiotherapy and chemo-immunotherapy in metastatic renal cell carcinoma (RCC).

PURPOSE: Bone metastases or local recurrences are widely viewed as poor prognostic signs for successful immunotherapy for metastatic renal cell carcinoma (RCC), and even partial remission is a rarity. We assessed the efficacy of the combination of radio and chemo-immunotherapy for bone metastases or local recurrences form RCC. MATERIALS AND METHODS: From February 1994 until September 1997 twelve patients with progressive renal cell carcinoma (9 with bone metastases and 3 with local recurrence) were treated with a combination of chemo-immunotherapy and radio therapy. RESULTS: Four out of twelve patients achieved complete remission (CR), one patient had a partial remission (PR), three were stable and four had disease progression under radio therapy and chemo-immunotherapy. Yet three pts. died of the disease. The toxicity symptoms according to WHO ranged between grade 2 and grade 3. CONCLUSION: Our data suggest that the combination of radio therapy and chemo-immunotherapy may induce a synergistic antitumor effect for the treatment of bone metastases or local recurrences from renal cell carcinoma.

Adult↗
PubMedDate not supplied

Radical prostatectomy: survival outcome and correlation to prostate-specific antigen levels.

BACKGROUND: This paper reviews a 10-year experience with radical retropubic prostatectomy (RP) focussing on survival outcome related to pre- and postoperative levels of prostate-specific antigen (PSA). PATIENTS AND METHODS: 739 patients who underwent RP between 1987 and 1998 were prospectively investigated. Kaplan-Meier analyses were performed and correlated to pre- and postoperative PSA concentrations. RESULTS: In a follow up period of 11 years duration, (mean 3 yrs.) 57 of 739 patients died (20 from prostate disease progression, 37 from other causes). Correlation between low pre-operative PSA and pathological organ-confinement was significant (p < 0.001). Of 175 patients with PSA progression, 53 (30%) had never reached undetectable levels of PSA. 57% of PSA relapses were detected during the first year, and 3% later than 5 years post-operatively. Kaplan-Meier analysis yielded an average 3 years advantage in estimated prostate-cancer-specific survival when pre-operative PSA levels were below 50 ng/ml. Overall, prostate-cancer-specific and PSA-free 5-year survival-rates were 88%, 96% and 67% respectively. CONCLUSIONS: Survival-rates after RP are high even in conjunction with unfavourable PSA outcome. Merely one third of deaths resulted from prostate cancer, since men at risk frequently suffer from concomitant diseases that affect survival.

Aged↗
PubMedDate not supplied

Prostate specific antigen in as a dynamic model in advanced prostate cancer.

BACKGROUND: Prostate specific antigen doubling time (PSADT) is a prognostic factor after radical prostatectomy, radiation therapy, and hormonal therapy respectively for prostate cancer. However, its role in patients receiving chemotherapy has not been evaluated to date. PATIENTS AND METHODS: Thirty patients (pts.) with hormone resistant prostate cancer were enrolled in a prospective phase II study to receive oral Idarubicin. The drug was administered at a dose of 35 mg on day 1 and 8 of each cycle, and treatment was repeated every 3 weeks. RESULTS: Fully evaluable for response were 26 pts. 13 of these 26 had measurable disease and 3 out of 13 had no change (NC) after therapy. Ten pts. had progression. All 13 pts. with non-measurable disease showed no response. PSA values increased exponentially over time in all pts., except for the 3 pts. with NC, in whom PSA values remained stable. Median PSADT of pts. with a rising PSA was 2.1 months (mean 2.6; range 0.7-6.1). CONCLUSIONS: PSA levels in pts. not responding to treatment with Idarubicin rose in an exponential fashion similar to pts. who were only on hormonal therapy. PSADT should be evaluated in a larger number of hormone resistant prostate cancer pts. as a possible surrogate endpoint.

Aged↗
PubMedDate not supplied

[Interdisciplinary management of fetal obstructive uropathy].

The joint care of children with obstructive uropathy by perinatologists, pediatric intensivists, pediatric nephrologists and urologists can preserve as much renal function as possible. Complications such as urinary tract infections and problems with renal insufficiency can be prevented. Preterm delivery for early surgical decompression of the urinary tract postpartal should be performed only in exceptional cases. We want to underline that supporting and counselling parents in coping with severe findings and prognosis of the disease is among our main aims. We will present two selected cases to demonstrate the spectrum of methods for handling fetal obstructive uropathy.

Female↗