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Biomedical subjects

L Steffens

Publications and source records attributed to L Steffens.

At least 19 recordsLinked to original sources
PubMed2000

Politano-leadbetter ureteroneocystostomy. A 30-year experience.

PURPOSE: We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension. MATERIALS AND METHODS: From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patiens were evaluable 10 years after surgery. RESULTS: Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87. 9% of these 30 patients. CONCLUSIONS: The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux.

Adolescent↗
PubMed1994

Urinary undiversion after implantation of an alloplastic urethral sling for male continence.

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.

Follow-Up Studies↗
PubMed1994

DNA fingerprinting of Eikenella corrodens by pulsed-field gel electrophoresis.

In order to conduct molecular typing of Eikenella corrodens strains by macrorestriction fingerprinting, we evaluated different restriction enzymes for digestion of genomic DNA and determined the optimal parameters for separating E. corrodens DNA by pulsed-field gel electrophoresis. Ten E. corrodens strains isolated from oral and extraoral infection sites in different individuals were analyzed. The rare-cutting restriction endonucleases DraI, SmaI and XbaI usually used for pulsed-field gel electrophoresis analyses were not suitable for digestion of E. corrodens genomic DNA because they either did not digest the DNA or produced bands of similar molecular weights that could not be separated. Accordingly, among additional enzymes including BamHI, BglII, EcoRI and Hind III, we found BamHI and BglII to be the most suitable rare-cutting enzymes for pulsed-field gel electrophoresis analysis. They cleaved the genomes of all the above strains into 15-20 fragment bands that were clearly separated by the following pulsed-field gel electrophoresis conditions: 140 V with a running time of 40 h, pulse times of 5 to 50 s with linear ramping and an electrical field angle of 120 degrees. These conditions enabled us to distinguish 8 individual pulsed-field gel electrophoresis patterns from the 10 strains analyzed. However, only 4 identical outer membrane protein profiles were differentiated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The data obtained in this analysis showed clonal divergence among members of the E. corrodens species, at the same time revealing this pulsed-field gel electrophoresis as being a highly attractive procedure for epidemiological investigation of this organism, including its acquisition and transmission.

Bacterial Outer Membrane Proteins↗
PubMed1992

Effectiveness of cefetamet pivoxil in the treatment of pyelonephritis in children.

Cefetamet pivoxil was investigated in an open, randomized comparative study involving a total of 37 children with acute pyelonephritis, whose ages ranged from 2 to 14 years. The patients received either 10 mg/kg (n = 18) or 20 mg/kg (n = 8) cefetamet pivoxil twice daily, or 30-50 mg/kg amoxycillin/clavulanic acid three times daily (n = 11) for a period of 7-10 days. Escherichia coli was the main causative agent isolated in 28 (75.7%) of the patients; other pathogens included Proteus mirabilis (three patients). Proteus species (one patient), Klebsiella pneumoniae (two patients), Pseudomonas diminuta (one patient) and mixed infections (three patients). No differences in the overall treatment outcome could be observed between the treatment regimens used and, at the end of treatment, all pathogens were eradicated with neither relapse, nor persistence of the isolated pathogen, nor reinfection occurring. The clinical signs and symptoms had subsided in all patients at treatment end and the tolerability of the trial drugs was found to be satisfactory with no premature treatment withdrawal required. It is concluded that cefetamet pivoxil in the standard twice-daily dose of 10 mg/kg was equally effective and as well tolerated as 20 mg/kg cefetamet pivoxil given twice daily or 30-50 mg/kg amoxycillin/clavulanic acid given three times daily.

Acute Disease↗
PubMed1988

Ureteral stone extraction with the Steffens lasso loop. A neglected procedure.

The main advantages of the Steffens lasso loop are its olive-tipped, 45 degrees-angled Tiemann guide, which allows easier and less traumatic passage above the ureteral stone, the tri-part lasso, which affords a better grasp of the stone, and the outlet for urine drainage. Between 1976 and 1986 we used this loop in 560 of 919 patients with distal ureteral stones. Immediate stone extraction was possible in 85.7% of the patients treated in 1986. Perforation of the ureter occurred in 2.3%, and 3% required ureterolithotomy. Our experience with this lasso loop has shown this instrument to be a valuable addition to other endourological methods.

Humans↗
PubMed1988

[Results and acceptance of corpus cavernosum autoinjection therapy in organic erectile dysfunction].

Ambulatory autoinjection therapy of the corpus cavernosum with a vasoactive drug combination for vasculogenic and neurogenic erectile dysfunction was performed in 50 men from 10/85-6/87. Acceptance was excellent by all patients and their wives. Transitory hematomas appeared in 6/50 (12%) cases. Local infections, cavernitis or systemic side effects were not observed. In 3/50 (6%) patients prolonged erections occurred. Treatment included drainage of the intracavernous blood, manual decompression and if necessary additional application of 1 mg metaraminol under extreme caution. Only 1 (2%) patient developed a nodular tunica fibrosis at the injection site which disappeared spontaneously upon cessation of treatment within 4 weeks.

Erectile Dysfunction↗
PubMed1988

[Enuresis--causes, diagnosis and therapy].

672 children aged between 4 and 16 years were treated for primary or secondary enuresis between 1980 and 1986. The group included more girls than boys. A systematic diagnostic investigation, consisting of a detailed medical history, physical examination, urinalysis and sonography of the kidneys and bladder, was carried out in all cases. This investigation was followed by urodynamic tests to detect any functional disorders of the lower urinary tract. Finally, a voiding cystogram, urethral calibration and urethrocystoscopy were conducted to screen for morphological changes. Three major groups of causes of enuresis were identified. Functional miction disorders were found in 312 (46.4%) children. In these cases there was an inability to voluntarily control the detrusor, detrusor-sphincter dyssynergia and hyperactivity of the detrusor. 223 (33.2%) of the children had pathological anatomical changes of the urinary tract, such as malformations leading to vesicoureteral reflux, vesicular diverticula, duplication of the upper urinary tract, megaureter, urethral stenosis or urethral valves, with associated infection. Psychogenic disorders were diagnosed in 137 (20.4%) cases. The first group received drug treatment and biofeedback training for reestablishment of conscious control over the vegetative functions of the lower urinary tract. The second group underwent surgery for correction of the pathological anatomical changes. The third group was referred for psychotherapy.

Adolescent↗
PubMed1987

[Treatment of female urinary stress incontinence with a Zoedler suspension-plasty and a new, stable, radiopaque polyester sling].

We report on 183 patients with urinary stress incontinence treated with bladder-neck suspension plasty according to Zoedler from 1972-1982 using the conventional nylon sling. 86.1% of the patients were continent postoperatively. Long term follow-up to 10 years however showed a continuous decrease of success rate in the first 2 postoperative years (74.9% in the 1st, 67.2% in the 2nd year). From the 3rd postoperative year there was a stable continence-rate of 50.7%. As the significant increase of incontinence relapse is due to enzymatic destruction of the nylon sling--first described in ophtalmology--we developed a new form-stable and radiopaque polyester sling. Since 1983 we implanted this new sling in 40 patients. Long term results of the conventional Zoedler procedure and first results of a modified method using the new polyester sling are discussed.

Female↗
PubMed1986

Atraumatic partial nephrectomy. Experience with 112 consecutive patients.

The aim of the described method of partial nephrectomy is to minimize injury to the kidney, if possible without causing unnecessary loss of blood, and without interrupting the arterial or venous blood flow during surgery. Use of a pedicle clamp, compressing forceps for the renal parenchyma or hypothermia is superfluous. Following pre- and intraoperative estimation of the dimensions of the area of the renal parenchyma to be removed, virtual hemostasis is achieved by applying a continuous U-shaped suture distal to the portion of the kidney to be resected, using an atraumatic chromic catgut suture. Total hemostasis in the area to be excised is attained with the aid of a second U-shaped suture, running parallel to the first but entering on the opposite renal margin. Following excision, the raw surfaces are then reapproximated by means of a continuous suture and thus sealed. To conclude the operation a temporary nephrostomy is inserted. The immediate and later follow-up results and the advantages and potential complications of the new technique are described in 112 consecutive patients presenting for treatment during a period of 12 years.

Adolescent↗
PubMed1986

[Indications and results of Politano-Leadbetter antireflux-plasty in 565 cases of ureterorenal surgery].

The Politano-Leadbetter antireflux procedure is a standardized and safe method for the treatment of primary and secondary reflux persisting after successful therapy of infravesical obstruction. Indications for antireflux surgery depend on reflux classification, age, urethral calibration and evaluation of position and shape of the ureteral orifice, associated malformations and successful antimicrobial therapy. Reflux was cured in 90.4 per cent of 565 ureterorenal units in 361 children and 103 adults. A persisting reflux occurred in 5.1 per cent and a stenosis of the terminal ureter requiring reimplantation occurred in 0.7 per cent. The overall rate of reinterventions was 8.1 per cent. This low complication rate makes surgical correction advisable if urinary tract infection and primary reflux cannot be eradicated by continuous antimicrobial therapy.

Adolescent↗
PubMed1985

Comparison between continuous and intermittent administration of Estracyt in the treatment of carcinoma of the prostate.

Ninety-five patients with prostatic carcinoma, stages A-D and of all histological grades were randomized between a continuous and an intermittent treatment regimen of Estracyt (estramustine phosphate). 77 patients were evaluated (46 with continuous and 31 with intermittent therapy). Remissions were seen in 13 (28%) and (13%), respectively. Stable disease was recorded in 30 (65%) and 24 (77%), respectively. Progression experienced 3 (6%) and 3 (10%) respectively. 19% were unable to continue therapy due to intolerable gastrointestinal side effects (7 patients receiving continuous and 8 patients receiving intermittent therapy).

Aged↗
PubMed1978

Induction of transitional cell carcinoma of the urinary bladder in rats by feeding N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide. Histological and ultrastructural findings.

After feeding with 0.188% N-[4-(5-nitro-2 furyl)-2-thiazolyl] formamide (FANFT), transitional cell carcinoma of the urinary bladder was induced in all female Wistar rats tested. Histological changes of the urothelium consisted of various degrees of hyperplasia and dysplasia. An infiltrating transitional cell carcinoma first appeared after 8 months. These results are compared with the findings of other authors, and divergencies of the tumour induction rates are discussed with respect to strain, sex and weight of experimental animals as well as concentration and amount of ingested carcinogen. Electron microscopy shows microvillous transformation of the luminal plasma membrane and appearance of a thick fluffy cell coat (glycocalyx). These changes are explained by an altered function of the Golgi complex occurring during malignancy and leading to a loss of the specific discoid vesicles of the urothelial cells.

Animals↗
PubMed1978

Biological behavior of N-[4-(5-nitro-2-furyl)-2-thiazolyl]-formamide induced carcinoma of the transitional epithelium in the rat.

30 female Wistar rats weighing between 70 and 90 g were fed for 8 months with 0,188% N-[4-(5-nitro-2-furyl)-2-thiazolyl] Formamide (FANFT). After this period a papillary tumor of the urinary bladder was demonstrable in each animal. Histological examination always revealed a transitional cell carcinoma with prevailing medium tumor stages; no distant metastases were found. The grade of malignancy was classified as medium and high. No significant statistical relationship could be ascertained between tumor stage and grade or between grade and weight, but a correlation was established between tumor stage and weight. After 12 months, 36/60 kidneys were found to be normal, whereas in 20/60 dysplasias and in 2/60 transitional cell carcinomas of the renal pelvis were observed; secondary hydronephrosis due to bladder tumors occured 4 times. Other organ changes were not noticeable.

Animals↗
PubMed1978

[New trocar housing with an interchangeable cryotherapy sound for after-treatment of bladder outlet tumors].

The cryotherapy of tumours of the urinary bladder hitherto used by means of transurethrally introduced sounds with or without optics made necessary the development of an irrigation trocar casing with exchangeable cryotherapy sound for the entire therapeutic comprehension of all parts of the wall of the urinary bladder, particularly in the region of the outlet of the urinary bladder from 7 till 17 o'clock. The optic control is performed by means of a simultaneously suprapubically introduced trocar cystoscope. Thus also extremely localised tumorous changes in the region of the outlet of the urinary bladder (dead angle) are optically established and rendered accessible to cryotherapy.

Cryosurgery↗
PubMed1977

[Primary tumors of the ureter (author's transl)].

13 own cases of primary tumors of the ureter are presented and discussed with reference to the presenting clinical symptoms, diagnostic procedures, and therapy. In our patients, excretory urography was not always of diagnostic value, whereas retrograde pyelography contributed to the correct diagnosis. The radiographic appearance of ureteral tumors has to be differentiated from strictures. In one case with a calcified papilloma, preoperative roentgendiagnosis suggested an ureteral stone.

Adult↗