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Biomedical subjects

R H Ringert

Publications and source records attributed to R H Ringert.

At least 55 records · Page 3Linked to original sources
PubMed1997

Management of involuntary childlessness.

Any definition of involuntary childlessness has to consider the difference between sterility and subfertility. As the latter affects about 20-30% of all couples at least once in their lives, general practitioners (GPs) may be the first to be confronted with this problem. This review presents the most relevant diagnostic and therapeutic options in cases of female or male infertility, and discusses the new assisted reproductive technologies (such as insemination, in vitro fertilization, gamete transfer and intracytoplasmatic sperm injection) so that GPs may adequately inform their patients about these procedures and their risks and outcomes. Although controversial, involuntary childlessness and its clinical treatment seem to have a strong psychological impact on a couple's social, emotional and sexual life. Being available for discussion with childless couples and offering ongoing support may be the most important role for the GP in this context.

Family Practice↗
PubMed1996

Microcalorimetric measurements carried out on isolated tumorous and nontumorous tissue samples from organs in the urogenital tract in comparison to histological and impulse-cytophotometric investigations.

In this comparative study, microcalorimetric measurements were carried out on a total of 96 tumorous and nontumorous tissue samples taken from organs of the urogenital tract using a thermal activity monitor (TAM). Changes in the heat emission of the tissue samples were measured at 1-min intervals and graphically displayed as a function of time. The aim of the study was to compare the microcalorimetric results with impulse-cytophotometric and histological findings and provide evidence for the metabolic activity of tumorous and nontumorous tissue. In order to obtain the variation in metabolic activity, the maxima (Pmax) of the curves were determined as a value of the maximum thermal power of a tissue sample, the mean values (P) were determined by the mean thermal power and the contour integrals (W) were defined by the behavior of the energy reserves and their mobilization. The first part of the study was carried out to investigate whether tumorous and nontumorous tissue samples differ in general according to their metabolic activity. We discovered, using the parameters described above, that in general tumorous tissue exhibited a higher metabolic activity than nontumorous tissue samples. For example, both W and P in tumorous prostate tissue samples were eightfold higher and the (Pmax) value was 8.4-fold higher than in normal tissue. Additional investigations on testicle and kidney tissues were performed to find a possible correlation between microcalorimetric results and histological grading. We found that an increasing malignancy correlated with a higher metabolic activity of the tissue. Based upon these results we were able to differentiate the various histological gradings of these tumorous tissues by microcalorimetric measurements. The results show it is possible to differentiate between normal and tumorous tissue samples by microcalorimetric measurement based on the distinctly higher metabolic activity of malignant tissue. Furthermore, microcalorimetry allows a differentiation and classification of tissue samples into their histological grading. With the help of microcalorimetry, it might be possible in future to detect and record the metabolic processes of isolated tissue structures and changes in these activities as a result of medical intervention such as cytostatic treatment.

Aged↗
PubMed1996

The influence of temperature on changes in pH, lactate and morphology during testicular ischaemia.

OBJECTIVE: To examine the role of temperature in the irreversible changes that occur within 4-6 h as ischaemic atrophy develops in the testis during testicular torsion, by determining effects on testicular pH, lactate accumulation and morphology. MATERIALS AND METHODS: Tissue acidification (pH), tissue lactate and structural changes were measured at temperatures of 35, 25, 15 and 5 degrees C in 34 human testes obtained as orchidectomy specimens from patients with metastatic prostatic cancer, and in 19 testes taken from young dogs. RESULTS: At a normal testicular temperature of 35 degrees C, the pH decreased to 6.0 within 2 h of the onset of ischaemia; cooling to 15 degrees C extended this delay to 6 h. Tissue lactate increased from 25 mumol/g dry weight to about 200 mumol/g at 35 degrees C. Semi-thin sections of the canine testes showed swelling of the intratubular tissue with loss of interstitial space; lower temperature delayed these changes. CONCLUSIONS: In the present study, 6 h of torsion was relatively prolonged, in that the pH decreased to 5.8 and testicular tissue was destroyed. Acidification and histological damage can be prevented by cooling. The critical pH of the testis beyond which irreversible changes occur is unknown; a pH of < 6.0 is likely to provoke such changes.

Aged↗
PubMed1996

Penile prostheses in paraplegic men.

OBJECTIVES: To determine the efficacy of penile prostheses in paraplegic men. PATIENTS AND METHODS: Between 1980 and 1992, penile prostheses were implanted in 209 paralysed men of whom the records of 179 were evaluable. The indication for implantation was erectile dysfunction, penile retraction, or a combination of the two. RESULTS: The outcome of the implantation of semi-rigid prostheses was worse than that of semi-flexible or flexible prostheses. Antibiotic treatment and body disinfection reduced the infection rate to below that in a normal population. The results were satisfactory for patients with either problem and patients treated successfully for erectile dysfunction became more self-confident. CONCLUSIONS: When paraplegic patients are able to regain sexual activity after successful implantation of a penile prosthesis, their self-confidence is increased. Prostheses might also be useful for patients who will not accept self-injection and for those using external condom drainage. Penile prostheses clearly have a place in the treatment of paralysed men.

Adolescent↗
PubMed1996

Human papillomavirus in tissue of bladder and bladder carcinoma specimens. A preliminary study.

OBJECTIVE: To evaluate the significance of HPV type 6b, 11, 16 and 18 together with type-specific antibodies in the serum of bladder carcinoma. METHODS: The prevalence of HPV type 6b, 11, 16 and 18 in bladder tumor, normal bladder and urethra together with type-specific antibodies in serum was investigated in 23 patients with bladder cancer and 9 patients with chronic cystitis. HPV DNA analysis was done by polymerase chain reaction (PCR). Open reading frames of HPV were expressed in Escherichia coli as beta-galactosidase fusion proteins. RESULTS: HPV 6b was demonstrated in the tumor tissue of 6 patients (19%), and in the nonmalignant specimens of 6 further patients (19%). HPV 16/18 was only found in the urethral swabs of 2 patients (6%). Anti-HPV antibodies were positive in 7 patients (22%). There was no association between the demonstration of HPV 6b and the occurrence of bladder tumor in this study. CONCLUSION: Though, in this study, HPV was not associated with bladder cancer, further investigation is necessary to elucidate the role of HPV 6b in bladder tissue possibly by a semiquantitative PCR in tissue samples and of anti-HPV antibodies in serum.

Adenocarcinoma↗
PubMed1996

Citrobacter emphysematous pyelonephritis in a tuberculous kidney caused by citrobacter. A case report in a diabetic patient.

Emphysematous pyelonephritis caused by gas-producing bacteria like Escherichia coli or Klebsiella pneumonia is generally observed in female diabetic patients. We report a case in which Citrobacter was the microbiologically documented pathogen. High-dose antibiotic regimen was administered, but nephrectomy was necessary to overcome the life-threatening situation.

Citrobacter freundii↗
PubMed1996

[Bladder catheter or suprapubic fistula? Indications and contraindications].

Even in closed sterile transurethral catheter drainage, infections of the lower urinary tract are documented in 50% of cases after 1 week of indwelling catheter. Not all of these cases develop symptomatic catheter-associated urinary tract infection. Suprapubic catheter drainage of the bladder results in markedly later urinary tract infection, presenting 50% of patients infected on day 40. The markedly later onset of catheter-associated urinary tract infection makes the suprapubic approach to bladder drainage suitable for all those patients, who may need catheters for more than 3 days postoperatively. Transfusion-dependent bleeding after puncture in 2-4% of cases and perforation of adjacent organs in 0.3% are the main complications. Suprapubic insertion of a catheter is contraindicted in patients with bleeding disorders and in those with bladder cancer in their history.

Catheters, Indwelling↗
PubMed1995

Wallstents in patients with detrusor-sphincter dyssynergia.

PURPOSE: For patients with spinal cord injuries who are unable to perform clean intermittent self-catheterization, sphincterotomy is performed most commonly to avoid high bladder pressure. This procedure causes additional trauma and does not always lead to a satisfactory result. Therefore, we sought an alternative therapy. MATERIALS AND METHODS: We introduce our initial experience with the UroLume Wallstent* in the treatment of 51 patients with spinal cord injuries and detrusor-sphincter dyssynergia (observation time 12 to 36 months). Prior sphincterotomy was unsuccessful in all patients. RESULTS: All observed urodynamic, radiological and clinical findings improved, and the results are encouraging. CONCLUSIONS: Implantation of this device seems to be appropriate in select paraplegic patients.

Adult↗
PubMed1995

Staging problems in the pre-operative chemotherapy of Wilms' tumour.

OBJECTIVE: To determine the effect of the International Society of Paediatric Oncology (SIOP) Wilms' tumour protocols (pre-operative chemotherapy based on clinical and radiological findings, with no prior tumour verification by open or needle biopsy) on subsequent intra-operative tumour diagnosis and staging. PATIENTS AND METHODS: The diagnosis and staging of possible Wilms' tumour by clinical, ultrasonographic and radiological assessment were compared with the intra-operative findings in 14 consecutive children (1-12 years of age) treated between 1989 and 1994. RESULTS: A diagnosis of Wilms' tumour was histologically verified in 11 of 14 children. In two children, verification was not possible due to complete necrosis of the tumour following pre-operative chemotherapy. In a 12-year-old boy with an estimated stage IV disease due to a solitary lung metastasis, a renal cell carcinoma was revealed in the nephrectomy specimen while subsequent thoracotomy revealed dysmorphic but not malignant tissue. The estimated tumour stage was correct with regard to localized or metastatic disease in nine of 11 children with histologically confirmed Wilms' tumour, while in two children with an estimated stage II tumour, liver metastases were found intra-operatively and the tumour was upstaged to IV. CONCLUSION: Exact tumour diagnosis and staging was difficult in these patients. Although the accuracy of tumour staging depends on the sensitivity of radiological and ultrasonographic examinations, difficulties in tumour diagnosis may be overcome by biopsies of the primary tumour. The justification of upstaging a low-stage I/II tumour to stage III, provoking a more intense post-operative treatment, should be proven by prospective randomized studies. The decision to perform a primary tumour biopsy would be facilitated if possible subsequent deterioration of outcome could be excluded.

Child↗
PubMed1995

Value of magnetic resonance imaging in patients with penile induration (Peyronie's disease).

Magnetic resonance imaging (MRI) is a noninvasive procedure that enables exact imaging of penile anatomy. A total of 34 patients with clinical Peyronie's disease underwent palpation, ultrasound and MRI after intracavernous injection of 10 micrograms. prostaglandin E1. MRI images were obtained before and after intravenous application of gadolinium-diethylenetriaminepentaacetic acid. In 34 patients 45 plaques were palpable. Ultrasound revealed evidence of lesions in 66.6% of the cases. On MRI 36 of 45 palpable plaques (80%) were detected. Not palpable or sonographically revealed indurations could be shown in 4 cases. After intravenous application of gadolinium-diethylenetriaminepentaacetic acid 4 plaques demonstrated contrast enhancement, thus indicating local inflammatory activity. The combination of clinical examination and sonography remains the method of choice for diagnosis and observation of patients with Peyronie's disease. MRI enables exact imaging of penile structures but it does not provide a significant advantage over standard investigative procedures.

Adult↗
PubMed1994

[Percutaneous drainage of renal and perirenal abscesses. 2 case reports].

Undetected and untreated renal and perinephritic abcesses are associated with high morbidity and mortality rates. Thanks to the technique of ultrasonography and computed tomography, it is now possible to identify a suspected abscess early on. As treatment, percutaneous drainage has proved both effective and associated with only few side effects. Two cases are reported, one with renal, one with perinephritic abscess, both of which were successfully treated with percutaneous drainage.

Abscess↗
PubMed1994

Wilms tumor: the problem of diagnostic accuracy in children undergoing preoperative chemotherapy without histological tumor verification.

From 1989 to 1992, 9 consecutive children with a tentative diagnosis of Wilms tumor underwent therapy planned according to the International Society of Pediatric Oncology (SIOP)-9 Wilms tumor protocol, including preoperative chemotherapy. Because tumor biopsy is not recommended in this SIOP-9 protocol due to a possible tumor spread from open or needle biopsy, diagnostic accuracy is mandatory. We present our problems in diagnostic accuracy resulting in withdrawal of 2 children from preoperative chemotherapy, understaging the tumor in 2 and missing exact tumor histology due to complete tumor necrosis in 2. In addition, preoperative chemotherapy was applied in 1 child who later was found to have renal cell carcinoma. Although the SIOP-9 protocol of Wilms tumor treatment may be effective with regard to reducing the intensity of therapy, staging problems may be a major drawback in this therapeutic strategy based on preoperative chemotherapy.

Child↗
PubMed1994

Transrectal prostatic sonography as a useful diagnostic means for patients with chronic prostatitis or prostatodynia.

OBJECTIVE: To evaluate the sonographic changes that occur in patients with chronic prostatitis and compare them with those of non-inflammatory prostatodynia using transrectal prostatic sonography (TPS). PATIENTS AND METHODS: In a prospective study, TPS findings were analysed in 88 men with chronic prostatitis and 53 patients with prostatodynia, all of whom had undergone a standardized diagnostic procedure to detect inflammation. RESULTS: A statistically significant accumulation of prostatic calcifications and unilateral seminal gland alterations was demonstrated in patients with chronic inflammation. Nevertheless, both findings were also present in patients with prostatodynia (22% and 11%, respectively). CONCLUSION: TPS is widely recommended for differential diagnosis in cases of chronic prostatitis and prostatodynia. Prostatic calcifications and seminal vesical abnormalities are regarded as typical signs of inflammation. The results of this study show that these sonographic abnormalities are indicative but do not prove the presence of chronic prostatitis.

Adult↗
PubMed1994

Malignant priapism in a patient with metastatic prostate adenocarcinoma.

Metastases to the penis due to a primary carcinoma of the prostate are rare. In approximately half of the patients, malignant priapism is the main symptom. This study reports on a case of malignant priapism, caused by a direct and metastatic infiltration of the corpora cavernosa by a prostatic adenocarcinoma. Sonography gave hints, the magnetic resonance imaging verified the infiltration and aspiration cytology verified the carcinoma. Hemodynamics, evaluated by Doppler sonography, and intracavernosal blood gas analysis demonstrated a mixed high-low priapism without need of therapy.

Adenocarcinoma↗
PubMed1994

A modified technique for nerve-sparing retroperitoneal lymph node dissection in stage II nonseminomatous germ cell tumors using intraoperative measurement of bladder neck pressure alterations following sympathetic nerve fiber electrostimulation.

We present a simplified method for nerve-sparing retroperitoneal lymph node dissection in patients with nonseminomatous testicular cancer. The sympathetic fibers involved in antegrade ejaculation are identified by intraoperative electrostimulation, resulting in an increase of bladder neck closure pressure. This increase is demonstrated by intraoperative monitoring of both the intravesical pressure and the pressure within the bladder neck by a two-channel microtip measuring catheter. 4 patients with stage I and 6 patients with stage II nonseminomatous testicular cancer were operated on with this modified technique. Ejaculation was preserved in all cases. Semen volume ranged from 2.2 to 4.0 ml. Sperm cell count ranged from 2 to 22 x 10(6)/ml with 20-50% motile spermatozoa, except for 2 of the 3 patients who initially presented with preoperative azoospermia following chemotherapy. In 1 of these 3 patients, postoperative semen analyses revealed a recovery of germ cell function demonstrated by oligoasthenozoospermia.

Adrenergic Fibers↗
PubMed1994

Bone marrow immunoscintigraphy versus conventional bone scintigraphy in the diagnosis of skeletal metastases in urogenital malignancies.

Bone marrow immunoscintigraphy using a 99mTc-labelled anti-NCA-95 monoclonal antibody and conventional bone scintigraphy with 99mTc-methylene-diphosphonate were compared in the diagnosis of skeletal metastases in 58 patients with urogenital tumours. In 13 patients with metastatic disease, bone marrow immunoscintigraphy proved to be superior to bone scintigraphy, detecting 431 metastatic lesions on immunoscans as compared to 261 lesions on bone scans. However, on a patient-by-patient basis bone marrow immunoscintigraphy did not demonstrate a clinical advantage over conventional bone scanning, as in this study no patient was identified with metastatic disease still confined to the marrow space, with bone scintigraphy and bone X-ray being normal.

Adult↗