Biomedical subjects
Publications and source records attributed to R Engelking.
We report on the case of a 22-year-old heroin-dependent diabetic woman. She presented with a gas-forming fungal infection of the kidney caused by Candida tropicalis. The patient was successfully treated by conservative means. Problems in the diagnosis and therapy of this rare disease are discussed.
The electrical and acoustic output created by the spark discharge for electrohydraulic lithotripsy at the tip of a 3.3-F probe was evaluated. Spark generation was achieved by variable combinations of voltage and capacity. The effective electrical output was determined by means of a high-voltage probe, a current coil and a digital oscilloscope. Peak pressures, rise times and pulse width of the shock waves were recorded using a polyvinylidene difluoride needle hydrophone in 0.9% NaCl solution at a distance of 10 mm. The effective electrical output is lower than the calculated output, due to inductivities, capacities and resistances of the cables and plugs. The life of the probes is markedly shorter when a combination of high voltage and low capacity is used than with low voltage and high capacity corresponding to the same energy. The peak pressure and the slope of the shock front depend solely on the voltage, while the pulse width is correlated with the capacity. The pulse intensity integral of the shock wave is likely to be the best equivalent to the applied energy.
Activity and side-effects of clodronate (Ostac), an inhibitor of osteoclastic bone resorption, were recorded in an open prospective uncontrolled study on 35 patients with metastatic prostatic cancer. All patients had progressive symptomatic bone metastases despite prior hormone therapy. Clodronate was initially administered i.v. for 8 days with 300 mg/day. This was followed by a daily oral administration of 1600 mg. The analgesic effect was evaluated by using a visual analogue scale and by recording the daily consumption of analgesic drugs. Karnofsky index and routine blood examinations, including PSA, were assessed. Repeated bone scans and radiological evaluations were performed. An improvement in pain was observed in 71% of the patients. The mean duration of improvement was 4 weeks. Average survival time was 12 weeks. There were no side-effects after i.v. administration. Slight gastrointestinal discomfort was observed in 3 patients after oral administration. No effect was observed on the extent or biology of the metastases. Clodronate is an effective drug for palliative treatment of symptomatic bone metastases of prostatic carcinoma. It causes fewer and less pronounced side effects than other palliative drug therapies.
We report on 82 ureteroscopies and electrohydraulic lithotripsies performed with small semirigid ureteroscopes with a minimum outer diameter of 6.5 F and probes of 2.4 F and 3.3 F. Prototypes of new lithotripters were employed, which incorporate infinitely variable energy within a range of 265-1382 mJ per pulse. Increased energy was provided by a rise in voltage, thus modifying the peak pressure and the initial slope of the shock wave. One third of the stones were situated in the upper ureter, 15% in the middle and 46% in the lower ureter. In 54% of these cases previous ESWL (Dornier MFL 5000) had been performed without success. Over 85% of the manipulations were performed under local anesthesia and i.v. sedation. Stone contact was achieved in 99%. Lithotripsy was fully successful in over 90%. The average energy per pulse was 450 mJ. In 7% partial disintegration was achieved and the residual stone was flushed back into the renal pelvis followed by further effective ESWL treatment. One stone had to be removed by open surgery. There were no major complications, such as perforations, due to the electrohydraulic lithotripsy itself. One perforation was caused when the endoscope was advanced into the ureter. No strictures were seen at the 6-month follow-up examination. An indwelling stent was placed in 48% of cases, as the stone burden or an inflamed stone bed suggested this was necessary. We conclude that electrohydraulic lithotripsy with adjustable energy resulting in various peak pressures of the shock wave is a safe and effective method of endoureteral stone treatment.
The new technique of rapid magnetic resonance imaging (MRI) with a paramagnetic contrast agent provides excellent imaging of the kidneys and their lesions. MR imaging of this anatomical region at short breath holding intervals matches the well-known quality of computed tomography (CT) for the first time. MR and CT studies were performed on 36 patients with proven renal cell carcinoma. Different investigators evaluated the staging of the tumor by means of both techniques in a prospective study. In all patients a radical nephrectomy was performed. Surgical and pathological findings were compared. Though little difference was found in diagnostic value between the two systems, MRI results concerning the T-stage were better. Venous invasion was clearly shown by MRI without the use of contrast medium. Furthermore, sagittal and transaxial images provided a more direct assessment of the extent of the tumor and its demarcation to healthy parenchyma. Thus, MRI is helpful in planning of the surgical approach when organ-sparing excision of renal tumors is to be performed.
Recent advances in fiberoptic technology have resulted in the development of endoscopes with an outer diameter of less than 6 F, including an irrigating or working channel. After preliminary testing of these ultrathin fiberscopes for ureteroscopy on 6 pigs, 17 patients were examined during routine retrograde pyelography. Prototypes of flexible endoscopes without an actively deflectable tip and an outer diameter of 5.5 F (= 1.8 mm) and a 1.5 F (= 0.5 mm) channel were used. Fine-needle aspiration cytology was obtained through the channel. The feasibility, performance and benefits of ureteroscopy with ultrathin, flexible endoscopes were evaluated. At present the lack of maneuverability and the fragility of the fiberscopes limit this method. Yet its routine clinical use, in addition to retrograde ureteropyelography under local anesthesia, shows great promise.
Recent advances in fiberoptic technology have resulted in the development of fiberscopes with an outer diameter of less than 6 F and an irrigating or working channel. The feasibility, conditions and benefit of ureteropyeloscopy with ultrathin, flexible endoscopes were evaluated in two sets of investigations: (1) in 6 pigs and (2) in 12 patients during routine retrograde pyelography. Prototypes of flexible endoscopes with a passively deflectable tip, an outer diameter of 5.5 F (1.8 mm) and a 1.5 F (0.5 mm) channel were used. Fine-needle aspiration cytology is possible through the channel under endoscopic control. At present, the lack of maneuverability and the fragility of the fiberscopes limit this method. Its use in the clinical routine, in addition to retrograde ureteropyelography, under local anesthesia is of great promise, however.
Gradient-echo pulse sequences with fast acquisition times permit examinations in short breath-holding intervals. In this way an improvement of MR imaging of upper abdominal organs can be expected. In 41 patients with space-occupying lesions of kidneys and adrenals, influence of external parameter variations on resulting contrasts was analyzed and results were compared to other imaging methods. Gradient-echo sequences demonstrated a high sensitivity in detection of tumorous lesions of kidneys and adrenals, the specificity being similar to that of CT. Further differentiation was only possible by performing dynamic perfusion studies using paramagnetic contrast agents.
On the basis of results obtained in a multicentric study on testicular tumors (Bonn 1982) including our own group of patients, we give an outline of the present state of modern diagnosis, therapy, and prognosis concerning germinative tumors of the testes: Etiologically essential is an unknown dysontogenetic disturbance of both gonads. The only clinical predilection factor is cryptorchism. Among the new diagnostic methods, specific tumor markers and high-resolution ultra-sonography have been proved especially useful. In non-seminomas, orchidectomy and lymphadenectomy is followed by chemotherapy instead of radiation therapy, today. Polychemotherapy has greatly improved the prognosis. Andrologically most interesting questions concerning sperm conservation, limited retroperitoneal lymphadenectomy, as well as late sequelae of chemotherapy cannot be definitely answered. Our findings rise new questions, which are fully discussed in concluding remarks.
A case of malformation of the urogenital system with a persistent urogenital sinus and a cloaca is reported. There was unilateral agenesis of the kidney, megaureter and a double ureter with an ureteral orifice into the vagina and the clitoris. There was a double uterus and vagina with an orifice into the terminal gut. The patient had chronic recurrent urinary tract infections which required a colostomy during childhood. The operation largely restored a normal urogenital area and a functional anus.
This paper presents first experiences with a new method of bilateral retroperitoneal lymph node dissection in cases of nonseminomatous testis tumors: lymph node-bearing tissue - labeled by conventional lymphoscintigraphy - is intraoperatively directly detected by means of a semiconductor and then removed. In our experience this nuclide detector-directed lymph node dissection seems to be a remarkable improvement of retroperitoneal lymph node dissection because of higher effectiveness, more careful surgical technique and shortened time of operation.
Shorter scan times have been shown to improve image quality in Computerized Tomography. With the help of bolus injected contrast medium blood vessels and well vascularized structures in the kidneys can be visualized. In this report normal anatomy and pathological changes of the kidneys are described and demonstrated. CT was found to be a reliable method in diagnosis of various kidney diseases especially involving space occupying lesions, and it reduces the need of invasive techniques such as angiography. Nevertheless intravenous urogramm should be the initial examination in kidney disorders.
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A renal tumour in a 4-year old girl morphologically appeared as both a nephroblastoma and, in parts, as a sarcoma botryoides of the renal pelvis. The histogenesis of this dysontogenetic tumour is most probably due to a disturbance of growth and differentiation both of the metanephrogenic blastema as well as partly of the urethral bud. This type of dysontogenetic tumour is extremely rare. Problems of diagnosis and operative therapy and the possibility of postoperative radiation therapy and cystostatic treatment are discussed.
An in-vitro double labelling technique with 3H- AND 14C-Thymidine was applied to biopsy specimens of the human urinary bladder mucosa in order to determine proliferation kinetics of normal bladder epithelium as well as its benign and malignant alterations. Application of above mentioned technique led to evaluable autoradiographs. The mean 3H-Thymidine labelling-index in bladder cancer was remarkably higher than in normal bladder epithelium and in benign papillomas. There was a good correlation between histologic grading of malignancy and increase of the mean 3H-Thymidine labelling index. Addition of 5-Fluorodesoxyuridine to the incubation medium had no influence on the labelling of the incubated tissue.
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Over a 10-year period 321 children underwent 490 antireflux operations. 21 duplicated vesicoureteric reflux was observed in 18 patients. The follow-up and the comparison with other authors results in 334 patients indicate that the submucosal inlay of the duplicated ureters is a particularly suitable operation. The Politano-Leadbetter and the Lich-Grégoir techniques yield good results.
1. There is no causal relationship between mechanical trauma and testicular tumor. 2. Only a traumatically related enlargement of the tumorous area can be acknowledged as aggravation of an existing testicular tumor. This is true also only when an infiltration from the scrotum and epididymis can definitely be diagnosed as metastases from the corresponding first lymph node stage. 3. With an existing testicular tumor, the release of metastases through a mechanical trauma cannot be ruled out. 4. There is no justification for the use of the term "pontine symptoms (Brückensymptome)" in a correlative evaluation of the relationship between trauma and testicular tumor.