Biomedical subjects
Publications and source records attributed to R Hartung.
We report about the rare situation of a duplex system with double ectopia. The first diagnosis of a single ectopic ureter had to be corrected as persistent symptoms of urinary incontinence led to further investigation which finally helped to discover a second ectopic megaureter.
Ultrasound has enriched the armamentarium of the pediatric urologist. Miniprobes enable examination of preterm children without taking them out of the incubator. Special puncture needles facilitate percutaneous diagnostic procedures. A neonatal nephrostomy set was developed for temporary urinary diversion.
Twenty-three children with equivocal uretero pelvic junction (UPJ)-obstruction underwent antegrade pressure flow studies. In three of the twelve children with upper urinary tract dilatation without vesicorenal reflux UPJ-obstruction could be excluded. Voiding cystograms showed vesicorenal reflux in eleven of the children with reflux induced hydronephrosis in seven cases. The coexistence of UPJ-obstruction and vesicorenal reflux has been noted in four children. In 23 pressure flow studies there was only one equivocal result. Twelve kidneys said to be obstructed were operated and the diagnosis was confirmed. The uneventful follow-up in the other ten children confirms the diagnosis of hydronephrosis without obstruction. The overall accuracy rate of the Whitaker-test was 96%.
Enuresis, recurrent urinary tract infection and vesico-ureteral reflux in 157 girls between 4 months and 11 years of age were the reasons for urological examination including calibration of urethra and urodynamic evaluation. Meatal stenosis or distal urethral stenosis was found in 14% measured by bougie à boule calibration. Functional disorders of the lower urinary tract were found in 47.8%. While anatomical stenosis requires surgical intervention functional infravesical obstruction is treated by biofeedback procedures. Functional infravesical obstruction is found much more often than anatomical stenosis.
Hypertension in childhood is often due to refluxnephropathy. In case of segmental lesion of the kidney hypertension may be curable by partial nephrectomy. We report on a girl with bilateral lesions and hypertension. The patient became normotensive without medication after bilateral upper pole partial nephrectomy.
107 patients were submitted to operative treatment of a duplex kidney from 1968 to 1980. In 62 kidneys of children heminephrectomy was performed and in 26 parenchymapreserving operations like ureterocystoneostomies (n = 17) and pyelopyelostomies (n = 9) were done. Fever and urinary tract infection was seen more often in patients submitted to partial ureterectomy than after total ureterectomy. Long time follow-up (medium 8.8 years) was available in 33% of the children. Two non-functioning renal units after heminephrectomy and one recurrent vesicoureteral reflux were documented. Renal length was determined by planimetry. While values within the +/- 2SD range were seen after antireflux surgery and after pyelopyelostomies growth of the kidneys after heminephrectomy seemed to be hampered. Although renal hypoplasia and dysplasia is seen in a lot of duplex kidneys, heminephrectomy should not be done routinely. Preoperative planimetry of the kidney gives information about the amount of parenchyma most probably lost by heminephrectomy. In addition malfunction of the contralateral "good" kidney should be suspected, if compensatory hypertrophy of this kidney does not develop in spite of a grossly scarred contralateral kidney.
To achieve continence in ileostomies by free transplantation of small intestinal smooth muscle according to Schmidt failed frequently because of hemorrhagic necrosis of this graft. To safeguard intact vascularisation of the transplant flapped intestinal smooth muscle was used therefore in 15 dogs with ileostomy for sphincter replacements. Contrary to free grafts, histological studies of flapped small intestinal muscle cuffs show generally undisturbed healing. Furthermore, monitoring of electrical activities corroborate the viability of the graft. In continent animals, pressure studies show the presence of a high pressure zone in the sphincter canal. The positive pressure profile was maintained and contributes to appropriate closing of the ileostomy. Despite histological, manometrical and electrical criterions of viability of the artificial sphincter, nevertheless the continence achieved by this procedure remains limited because of the restricted ability to contract the small intestinal muscle and the lacking ileal compliance.
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For non-malignant colon diseases the indications for preventive measures can be of tumorous and non-tumorous nature. In case of ulcerative colitis and Crohn's colitis local and systemic complications may demand a colectomy. The operative procedures in this case are proctomucosectomy with ileumpouch or ileorectostomy , if continence can be preserved. Mucosal proctectomy with ileumpouch will prevent the obligatory malignant change in familial adenomatosis. The preventive resection in diverticulitis bewares of the complication of the progressive phlegmonous infection of the colonic wall.
Acclimated normal rainbow trout were exposed to 130 ppb hexachlorocyclopentadiene (HEX) in a flow-through well water circuit which was designed to permit measurements of oxygen consumption by the fish. Compared to preHEX values, HEX increased oxygen consumption rates by 186 +/- 24% (means +/- SEM), with maximum oxygen consumption rates being reached in approximately 84 min after HEX exposure. Oxygen consumption subsequently decreased, and all HEX-exposed fish died within 6.5 hr of exposure. Fish exposed to HEX-free vehicle (acetone) showed no changes of oxygen consumption. When added to normal isolated trout heart mitochondria, HEX appeared to uncouple oxidative phosphorylation, with calculated respiratory control ratios being decreased 50% from control values at a HEX concentration of 0.41 microM. We postulate that one important mechanism of HEX intoxication in the intact animal may be due to increased oxygen consumption and impaired oxidative ATP synthesis due to the mitochondrial uncoupling action of the toxicant.
The results of treating the 51 children suffering from Wilms' tumour seen in the 10 years to January 1982 are described and the need of an interdisciplinary approach is stressed.
In 1976, we began using ultrasound for staging of the retroperitoneal status in patients with testicular cancer. Determinations of tumor markers AFP and beta-HCG were done in all patients. Up to 1981 these investigations were followed by retroperitoneal lymphadenectomy in 148 patients. Ultrasound staging had an over-all accuracy of 79% (n = 117). From 31 incorrect results of sonographic staging there were 29 falsely negative findings in the surgical-pathologic stage IIA with only minimal retroperitoneal disease. Because of this fact the sensitivity of sonographic staging was only 67%, the specificity was 98%. Differentiation between stage I and IIA proved to be very difficult. In this group (stage I and IIA; n = 104) the over-all accuracy was 71%, the sensitivity was only 40%, the specificity was 98%. Adding the results of tumor marker determinations to the sonographic findings, we got a staging error of 41.7% in the stage IIA. Retroperitoneal lymphadenectomy and histologic analysis of the removed nodes thus remains the only reliable staging system for early nonseminomatous testicular cancer.
Determination of the biochemical tumor markers, alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-HCG) gained much importance in respect to staging and follow-up examination of patients presenting with testicular cancer. After cytostatic chemotherapy the reliability of tumor markers is diminished. Retroperitoneal lymphadenectomy (RLA) was done in 60 patients after chemotherapy. Tumor marker elevation was found only in 52% of the patients showing retroperitoneal carcinoma (n = 25).
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5 children with yolk-sac tumor of the testis (= infantile embryonal carcinoma) were admitted to our hospital between 1973 and 1981. Evaluation of serum alpha-fetoprotein concentrations and ultrasonography of the retroperitoneal area proved to be extremely valuable to predict the tumor stage in these children. Therapy consisted of high inguinal orchiectomy, retroperitoneal lymphadenectomy and cytostatic chemotherapy in 3 children using the T2-protocol. All children are now between 1 1/2 and 8 years free of recurrence and metastases. Therapy of this tumor ought to be differentiated according to the individual tumor stage. Most patients with stage-I tumor require only radical orchiectomy for cure.
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