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Biomedical subjects

R H Ringert

Publications and source records attributed to R H Ringert.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Infections of the ejaculate by sexually transmissible pathogens].

Certain ejaculate infections can be traced back to sexually transmitted microorganisms, such as Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum and Trichomonas vaginalis. To varying extents, these microorganisms cause such classical genital infections as urethritis, epididymitis and prostatitis as well as subclinical genital tract infections. Several different pathomechanisms are under discussion for infection of the ejaculate: reduction of spermatogenesis resulting from testicular damage, autoimmune processes induced by inflammation, direct influence on the spermatozoal function, disturbances in spermatozoal transport, secretory dysfunction of the male accessory sex glands and leukocytospermia with secondary influence on ejaculate parameters. The relevance of these microorganisms for the localization of the inflammatory process within the genital tract are discussed in detail. Their importance for male fertility is a matter of debate. In particular, the significance of C. trachomatis and U. urealyticum, both of which are detectable in the urethra, is still uncertain and cannot be assessed conclusively. Further information allowing delimitation of an infection resulting from bacterial colonization may be provided, on the one hand, by biochemical markers for an inflammatory reaction and indicators of an immune response in the ejaculate, e.g. PMN elastase, complement C3, or coeruloplasmin, and on the other hand, by secretion markers such as alpha-glucosidase, PSA and phosphatase. Whether the assessment of these markers and indicators can help to clarify the inflammatory origin of infertility in individual cases remains doubtful.

Acute-Phase Proteins↗
PubMed1994

[HIV infection and AIDS in urology].

Up to December 1993, a total of 10858 AIDS cases were reported to the central AIDS registry at the Federal Health Office. Human immunodeficiency virus is acquired through needle sharing (i.v. drug users), contaminated blood transfusions, intercourse with infected persons and transplacentally by fetuses. In Germany, about seven people a day are estimated to acquire the HIV infection. Half the patients will develop systemic manifestations of AIDS within 12-13 years. Only a small percentage of these patients suffer from urological manifestations, e.g. urinary tract infection, prostatism or HIV-associated nephropathy. Nevertheless, knowledge of genitourinary pathology caused by HIV makes early diagnosis of AIDS possible.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Diagnosis and therapy of erectile dysfunction: a function of legal health insurance?].

From the medical point of view erectile dysfunction (ED) is accepted as a disease. However, there is a difference between the medical definition and the definition used by the official health insurance companies. This means that these health insurance companies have sometimes refused payment to the urologists for work done in the diagnosis and treatment of ED, especially in elderly men. Studies on the sexual behavior of elderly men show that 53-80% of men older than 75 years are still interested in sex and that 26% of this group have intercourse several times a month. Therefore, no one can say that sexual interest and activity decrease in elderly men to the point of complete inactivity. For this reason, the basic principle of maintaining the health of the individual is just as applicable in this case as it is in elderly people who are hard-of-hearing or who have weak eyesight. Thus, the diagnosis and therapy of ED must, strictly speaking, be considered a medical service that is recognized and paid for by the official health insurance companies. The substances used have not been licensed for this indication by the German BGA (German equivalent of the FDA), but this does not influence the possibility of prescribing them. Generally speaking papaverine, papaverine/phentolamine and prostaglandin E1 can be prescribed. In our opinion, prostaglandin E1 is to be preferred.

Aged↗
PubMed1993

[Follow-up of tissue acidosis, lactic acid production and morphologic changes in testicular tissue in ischemia and the effect of cooling].

More than 90% of the patients with a testicular torsion are loosing their testis by orchiectomy or by following ischemic atrophy. The critical time of irreversible changes of the testis is according to literature 4-6 hours. The aim of our study was to measure the tissue acidification (pH) in the testis at different temperatures and to estimate the cooling effect on pH, lactate accumulation and morphological changes. We have measured in 36 human testis (orchiectomy in patients with metastatic prostate cancer) the tissue acidification (pH), the tissue lactate level and the morphology changes at a temperature of 35, 25, 15 and 5 C. In 12 testis of young dogs we have measured the same parameters. Starting with a normal testis temperature of 35 C the pH is falling to 6.0 within 1 hour of ischemia. By colling to 15 C this time can be prolonged to 6 hours. The tissue lactate level rises from 25 mumol/gdw to nearly 200 mumol/gdw at 35 C. The morphology of semi-thick slices of the testis shows a swelling of the intratubular tissue (spermatogenesis) by loss of the interstitial space. By reducing temperature also a slowdown of the changes can be observed. The critical pH value of the testis for irreversible changes is not known. A ph of less than 6.0 is probably a value, which may result in such changes.

Acid-Base Equilibrium↗
PubMed1993

[Course of tissue acidosis, lactic acid production and morphologic changes in testicular tissue during ischemia. Effect of hypothermic measures].

More than 90% of patients with testicular torsion lose their testis, either because orchiectomy is necessary or because ischaemic atrophy develops. The critical time before irreversible changes to the testis have taken place is, according to literature, 4-6 h. The aim of our study was to measure the tissue acidification (pH) in the testis at different temperatures and to estimate the effect of cooling on pH, lactate accumulation and morphological changes. In 36 human testes (obtained by orchiectomy in patients with metastatic prostate cancer) we measured the tissue acidification (pH), the tissue lactate level and the morphological changes at temperatures of 35, 25, 15 and 5 degrees C. We also measured the same parameters in 12 testes taken from young dogs. At the normal testicular temperature of about 35 degrees C the pH falls to 6.0 within 1 h of ischaemia. Cooling to 15 degrees C can extend this time to 6 h. The tissue lactate level rises from 25 mumol/gdw to nearly 200 mumol/gdw at 35 degrees C. The morphology of semithin sections of the testis shows swelling of the intratubular tissue (spermatogenesis) with loss of the interstitial space. Reducing temperature can also slow-down these changes. The critical pH value of the testis beyond which irreversible changes take place is not known; a pH of less than 6.0 is thought to be the probable threshold.

Acid-Base Equilibrium↗
PubMed1992

Digital radiography in urologic imaging: radiation dose reduction on urethrocystography.

Digital luminescent radiography (DLR) is a new form of digital radiographic technology which can be used as an alternative to conventional radiologic systems; it replaces conventional screen-film systems by photostimulable phosphorus. Due to the linear dynamic range of photostimulable phosphorus, x-ray examinations can be performed with significantly lower radiation exposure. In this study radiation dose was reduced by about 90% using DLR for urethrocystography.

Humans↗
PubMed1992

[Imaging and functional parameters in diagnosis of obstructive nephropathy].

Obstruction of the kidney leads to terminal kidney failure within a few years. Therefore, early recognition of such obstruction is of importance. Non-invasive diagnostic ultrasound examination now allows intrauterine visualization of a suspected obstruction. However, the implications of such a dilated ureteral pelvic system are obscure. Whether there is obstruction or dilatation can only be evaluated postnatally by a nuclear technique. The aim of our study was to measure the recovery of kidney function. We investigated 13 kidneys of 9 newborns or small infants (up to 2 years). The follow-up was continuous for up to 29 days. The parameters were: urine output (24-h clearance), glomerular filtration rate, fractional excretion of sodium and potassium, free water clearance, total protein excretion, albumin and alpha 1 microglobulin excretion. The urine output fell from 0.3 to 0.12 ml/min within 14 days after relief of obstruction. The glomerular filtration rate rose from nearly 30 ml/min to about 50 ml/min within a week. The fractional excretion of sodium and potassium indicated recovery of the proximal tubli. The fractional sodium excretion fell below 1% within 4 days. The free water clearance reflects the concentrating ability of the kidney, and in kidneys from newborns it had only positive values, while in kidneys of children older than 6 months there were also negative values. The protein excretion and the albuminuria showed recovery of the glomerular as well as the tubular system.(ABSTRACT TRUNCATED AT 250 WORDS)

Alpha-Globulins↗
PubMed1992

[Wilm's tumor 1992. State of research and results of current therapeutic concepts].

Wilms' tumor is the most frequent and most important pediatric tumor in urologic oncology. In recent years the prognosis of Wilms' tumor has improved markedly and a cure rate of more than 80% can be achieved by means of standardized therapy protocols such as those established by the National Wilms' Tumor Study (NWTS), the Société Internationale d'Oncologie Pédiatrique (SIOP), and the German Society of Pediatric Oncology (GPO). However, since the number of long-term survivors is now expected to increase, serious long-term complications must be taken into account, especially after radiation therapy, and treatment modalities must be modified with due consideration for toxicity and late effects of treatment. Refinement of treatment protocols is therefore the main aim to two studies, SIOP-9/GPO and NWTS-4. In Germany, children with Wilms' tumor are now treated according to the SIOP-9/GPO protocol including preoperative chemotherapy. Preoperative chemotherapy can reduce tumor volume markedly, leading to a significantly higher proportion of children with stage I/II tumors at the time of surgery. Thus, postoperative chemotherapy can be reduced and radiation therapy avoided in children in whom stage III tumors would other wise have to be expected. Radiation therapy of pulmonary metastases can be restricted to children who have not responded to prior chemotherapy, whereas in others it seems tumor-free survival can be achieved by extirpation of the remaining pulmonary metastases alone following chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemotherapy, Adjuvant↗
PubMed1992

[Sex differentiation disorders from the andrologic viewpoint].

Abnormal sex differentiation with ambiguous genitalia now leads to prompt and comprehensive diagnostic evaluation in the neonate. If necessary, phenotypic gender assignment is done very early and appropriate surgical correction is performed. Management at puberty and later is more difficult. Andrological guidance at this time covers problems of genital identification, sexuality and fertility. The different types of abnormal differentiation, i.e. genetic, gonadal and phenotypic alterations, may result in different andrological problems, e.g. hypogonadism including micropenis and undescended testes, lack of secondary sex characteristics and impotence. With respect to fertility the major problems are testicular azoospermia and/or congenital abnormalities of the male reproductive tract. Any proposals for treatment have to take account of all these different aspects of pathogenesis and the natural course of the disease. In each case, andrological guidance must be formulated with due consideration for the results of genital determination in childhood, including surgical correction.

Disorders of Sex Development↗
PubMed1992

[Treatment of bladder exstrophy. Reconstruction or urinary diversion].

Bladder exstrophy is seen in 1 of 30,000-40,000 live births, and is seldom treated in many urological departments. Treatment options for children with exstrophy are upper urinary tract diversion or reconstruction of the bladder and plastic surgery of the bladder neck to gain urinary continence by the age of 4-7 years. Historical reviews report continence rates of 10-30% after a staged approach with primary reconstruction and secondary bladder neck repair. This formerly meant upper urinary tract diversion as a third stage in 70-90%. Multiple operative procedures could be avoided when primary diversion was done. The best results were reported following antirefluxive implantation of ureters into the sigmoid colon (ureterosigmoidostomy). In boys, the base of the bladder was removed, leaving a small residual bladder which together with the reconstructed epispadias served as a "seminal tract". Total removal of the bladder was performed in girls. Long-term follow up of upper urinary tract diversion showed disturbances of serum electrolytes, urinary tract infections and stone formation, and after ureterosigmoidostomies an increased rate of colon carcinomas was documented. These results led to renewed interest in reconstruction. The technique of bladder neck reconstruction was changed, resulting in a higher rate of late urinary continence: augmentation cystoplasties, clean intermittent catheterization and the artificial sphincter help to achieve a continence rate of more than 90%. This goal was reached only after multiple operations and without knowledge of the long-term sequelae of augmentation cystoplasties. The years to come will show whether new concepts of ureterosigmoidotomies, such as the sigma-rectum pouch, will be preferable, or a late urinary tract diversion after failed reconstruction. Most centers are now agreed that primary reconstruction of bladder exstrophy should be attempted in the newborn child.

Abdominal Muscles↗
PubMed1991

Color-coded duplex sonography for diagnosis of testicular torsion.

By color-coded duplex sonography moving structures are visualized as red or blue colors within a normal gray-scale B-mode ultrasound image. Thus, blood flow even within small vessels can be visualized clearly. Color-coded duplex sonographic examination was performed in 11 patients who presented with scrotal pain. This method proved to be reliable to differentiate between testicular torsion and testicular inflammation. By clearly demonstrating a lack of intratesticular blood flow in testicular torsion, while avoiding flow in scrotal skin vessels being misinterpreted as intratesticular blood flow, this method significantly decreases the number of patients in whom surgical evaluation is necessary to exclude testicular torsion.

Color↗
PubMed1991

Pre- and postoperative urodynamic findings in children with tethered spinal cord syndrome.

14 children with tethered spinal cord syndrome undergoing neurosurgical untethering were urodynamically evaluated in the pre- and postoperative period. The tethered spinal cord syndrome was mainly due to a previous surgical repair of meningomyeloceles. Preoperatively a neurogenic bladder dysfunction was found in 8 patients; postoperatively a transient amelioration could be demonstrated in 3 patients, whereas 2 children developed urinary retention, 1 of whom had never any complaint of bladder symptoms before. Thus, a high incidence of bladder dysfunction was revealed in children with tethered spinal cord syndrome, demonstrating substantial changes of the bladder function following neurosurgical intervention. With regard to these results a urodynamic evaluation should be part of the pre- and postoperative examinations in children with a tethered spinal cord syndrome.

Adolescent↗
PubMed1991

[Localization and extent of tissue damage caused by extracorporeal lithotripsy (ESWL)].

Extracorporeal shock wave lithotripsy (ESWL) causes proteinuria. In our study we investigated the protein fractions and the electrolyte composition of the urine in patients who had been treated with ESWL. The aim was to obtain information on the degree and the localisation of the glomerular, tubular or vascular destruction caused by ESWL in humans. A total of 34 patients with stones had been treated with ESWL. As parameters we used: urine output, creatinine clearance, total protein, albumin, immunoglobulin G, N-acetyl-beta-D-glucosaminidase (beta-NAG), alpha-1-microglobulin, the fractional excretion of Na+ and apolipoprotein-A-1. After ESWL treatment proteinuria and albuminuria are found. Our parameters show no deterioration of the glomerula or the tubulus. The increase in apolipoprotein-A-1, a postglomerular parameter, however, is interpreted as a manifestation of vascular destruction after ESWL; this is normally temporary, leaving no permanent damage.

Acetylglucosaminidase↗
PubMed1990

A new method for conservative renal surgery--experimental and first clinical results.

So far two methods for prolonging the tolerance of renal ischemia are available: 1) surface cooling with crushed ice and 2) perfusion cooling with an extracellular-like solution. Both methods use only the principle of reducing metabolism through cooling. While rewarming during surgery the ischemic protection is lost, or the kidney must be cooled once again. Therefore, a new preservation solution should reduce energy consumption due to its composition in addition to cooling. For open heart surgery, the HTK solution by Bretschneider is already used clinically. In 71 dog kidney experiments, the ischemic time kidneys could tolerate was prolonged by this solution from 15 to 120 min at 35 degrees C and from 45 to 360 min at 25 degrees C. After 2 h of ischemia at 30 degrees C glomerular filtration rate was about 20 ml/min.100gww within 3 h of reperfusion. After six postoperative days the filtration rate was 40 ml/min.100 gww. No ischemic damage could be recognized by histological investigations. The clinical effectiveness of this method was shown in 7 clinical applications. Ischemic duration lasted up to 113 min, and blood creatinine was between 0.8 and 2.4 mg% at the 6th postoperative day. Use of this preservation technique thus leads to improved kidney function immediately following operation. Longer ischemia can be tolerated by a kidney thus protected, and using this technique excellent visibility can be achieved during intrarenal surgery, simplifying, for example, tumor extirpation.

Animals↗
PubMed1990

["Imperative indication" for organ-preserving kidney tumor surgery].

Imperative indications for organ-sparing surgery of renal tumors are given mainly in existing or imminent restriction of renal function. Organ-sparing excision of renal tumors under in-situ protection with HTK-solution compared with operations without protection have the following advantages: 1. reduced blood loss, 2. longer ischemia, 3. better tissue differentiation with benefit for radicality, 4. shorter hospital stay.

Cardioplegic Solutions↗
PubMed1990

[Impulse cytophotometry and irrigation cytology in the diagnosis of bladder cancer].

In a retrospective study in which 273 patients with histologically proven carcinoma of the urinary bladder had been examined by performed cytological and flow cytometric analysis carried out in parallel, the diagnostic yield of flow cytometry was compared with the result of urinary cytology. Urinary cytology and flow cytometry made it possible to detect histologically proven transitional cell carcinoma (TCC) in 60% and 64%, respectively. Combination of the two methods increased the diagnostic yield to 76%. An increase in the diagnostic yield was seen especially for well-differentiated TCC, from 34% to 51%. In spite of this improvement, the combination of flow cytometry with urinary cytology did not mean fewer endoscopic investigations were needed in view of the persisting substantial diagnostic deficit in well-differentiated TCC.

Aneuploidy↗
PubMed1990

[Extracorporeal shockwave lithotripsy with combined ultrasound and roentgenologic calculus localization. Initial clinical experiences with the Lithostar plus].

Since the introduction of extracorporeal shock wave lithotripsy for non-invasive treatment of renal and ureteral stones, lithotripter units have relied on either fluoroscopic or ultrasound stone localization. While ultrasound stone localization reduces X-ray exposure and facilitates treatment of radiolucent renal stones, fluoroscopic stone localization is superior in the detection of ureteral stones. Since April 1989 we have been using the Lithostar plus, a new lithotriptor system, which provides both fluoroscopic and ultrasound stone localization. After treatment of 108 patients, the initial data suggest that this system combines the advantages of both localization principles, while being as efficient as other second-generation lithotriptor units in bringing about the disintegration of renal and ureteral stones.

Equipment Design↗