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Biomedical subjects

R Hohenfellner

Publications and source records attributed to R Hohenfellner.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Clinical tests on reno-ureteral lithiasis with a new Lithostar 2 model C shock wave generator system].

Lithotripsy has confirmed its place in the treatment of urinary stones and there are now few indications for open surgery in this disease. Lithotripsy used to be rarely used, as it required a great deal of patience on the part of the patient, lying in the water bath, and the medical team. Increasing efficient systems are now available with a marked advantage for patients. Simple analgesia-sedation is often sufficient when requested by the patients and the duration of treatment has been considerably decreased. The authors present a review of their results with the new Lithostar 2 Model C shock wave generator system. The modifications made to this system take into account physical possibilities and medical requirements. As a result of the new configuration of this system, the treatment time per patient has been further decreased, a higher energy is applied to the stones and the disintegration rate is excellent.

Colic↗
PubMed1993

Image analysis DNA cytometry of bladder cancer.

In a retrospective analysis, the DNA histograms of 65 paraffin-embedded bladder carcinomas from radical cystectomy specimens (stage pT1-pT4a, pN0, pN1, pN2) were analyzed using an automated image analysis system (Leytas 2). Automated image analysis was able to characterize invasive bladder carcinoma as being either diploid, polyploid, or aneuploid. Within the group of aneuploid tumors, the DNA content of the stem-cell line allowed further subtyping of the tumors; hypotriploid, hypertriploid, hypertetraploid, and even hyperpentaploid tumors could be distinguished. Comparing different sites of identical tumors, the DNA histogram was found to be a stable and reproducible tumor characteristic. The various tumor types differed significantly in prognosis. This technique can also be applied to smears of urine sediment or transurethrally resected tumor chips. In the case of superficial tumors, DNA cytometry defines those tumors which are potentially invasive, requiring careful follow-up and/or early aggressive treatment.

DNA, Neoplasm↗
PubMed1993

Reservoir characteristics of Mainz pouch studied in animal model. Osmolality of filling solution and effect of oxybutynin.

In a canine model of the Mainz pouch, intracavitary pressure and compliance were measured during instillation of isosmotic and hyperosmotic (900 mmol/kg water) solutions of saline. Wall properties of small- and large-bowel segments of the pouch were assessed individually by sonomicrometry. Intraluminal pressures increased more steeply during filling with hyperosmotic solution, resulting in reduced distensibility of small- and large-bowel segments. Additionally, instillation of the hyperosmotic solution resulted in increased amplitudes and frequency of intracavitary pressure waves. The results indicate that this was the result of a combination of intensified bowel contractions and an increased mural tension. Topical application of oxybutynin abolished these effects. These findings are reviewed in light of the nocturnal increase in urine osmolality, its correlation with nocturnal incontinence in patients with enterocystoplasty, and possible treatment choices.

Animals↗
PubMed1993

Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.

We report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described. We discuss whether the primary implantation of a penile prosthesis during 1-stage surgical phalloplasty is more advantageous in comparison with the currently favored secondary implantation. Phalloplasty should be represented by a 1-stage surgical procedure encompassing the creation of a neourethra, restoration of tactile and possibly erogenous sensibility, and implantation of a penile prosthesis. The result should have aesthetic value and be pleasing to the patient.

Adult↗
PubMed1993

The Mainz pouch II (sigma rectum pouch).

A low pressure rectosigmoid reservoir for urine is created obviating the need for colostomy, augmentation or extensive bowel surgery. Antimesenteric splitting of the intestine at the rectosigmoid junction and subsequent side-to-side anastomosis are performed. Urodynamic data demonstrate that the detubularization is effective in rendering high pressure bowel contractions ineffective. Without the risk of damaging the mesentery the pouch is fixed at the promontory, which lessens the risk of ureteral kinking and upper urinary tract dilatation. The technique is indicated not only in cases of failed ureterosigmoidostomy but also for primary urinary diversion. All 47 patients who underwent the operation were evaluable with a followup of 1 to 20 months (mean 10 months). All patients are continent during the daytime with a mean emptying frequency of 5 times. All but 1 elderly woman are dry at night with a mean frequency of 1 episode. With the reservoir full the basal pressure was 24 cm. water and the highest peak pressure recorded was 35 cm. water. The low pressure improves continence, protects the upper urinary tract and even allows dilated ureters to be implanted.

Adult↗
PubMed1993

Sutureless laser-welded anastomosis of the femoral artery and vein in rats using CO2 and Nd:YAG lasers.

In a comparative study, it was demonstrated that sutureless, laser-welded, end-to-end anastomoses in the rat femoral artery and vein are feasible, using either CO2 or Nd:YAG laser. Conventional microsurgical suture anastomoses served as the controls. Patency rates in experimental animals and controls were equal (96 to 100 percent). No aneurysms were observed. For successful laser welding, the anastomosis must be completely tension-free. In arteries, this was accomplished only by interposition of a graft from the contralateral artery. The absence of any foreign-body reaction and the saving in operative time support the use of sutureless laser welding.

Anastomosis, Surgical↗
PubMed1993

[Combined surgical and radiotherapeutic treatment of pelvic wall recurrences: report of experiences after 3 years].

CORT has been developed to treat recurrent gynaecological malignancies infiltrating the pelvic wall unilaterally. The surgical part consists of: (i) staging laparotomy/lymphadenectomy, (ii) maximum tumour resection at the pelvic wall and exenteration of infiltrated central pelvic organs, (iii) implantation of guiding tubes on the residual tumour/tumour bed on the pelvic wall, (iv) pelvic wall plasty with muscle, musculocutaneous and omentum flaps, (v) operative reconstruction of bowel, bladder and perineo-vulvo-vaginal functions. Radiation is performed as interstitial high dose rate brachytherapy through the implanted tubes. Patients without prior pelvic irradiation receive in addition, whole pelvis teletherapy. CORT has been evaluated in a prospective phase I and II trial at the University of Mainz. Within a 3-year period, 21 patients with pelvic wall recurrences from various gynaecological primary tumours were treated. Seventeen patients had been irradiated as (part of) the previous therapy with a median total mid-pelvic dose of 65 Gy (range 40-100 Gy). There was no operative mortality. Five patients developed complications necessitating surgical intervention. One patient died from fatal thromboembolism 6 months after CORT without evidence of tumour progression. In 14 patients, local tumour control has been achieved. After a median follow-up period of 27 months (range 6-38 months) Kaplan-Meier life table analysis revealed an actuarial survival probability of 55% (recurrence-free 49%). We conclude from these preliminary results, that the CORT procedure for the treatment of pelvic wall recurrences is feasible and may lead to encouraging therapeutic success in selected patients, whose situation had been hopeless so far.

Adult↗
PubMed1993

[The role of M-VAC polychemotherapy in the treatment of advanced urothelial carcinoma of the bladder].

Over the last seven years, M-VAC combination chemotherapy has been used for: the treatment of transitional cell carcinoma with metastases (palliative indication) or to reduce operable T4a tumours (inductive, initial or preliminary indication), or before or after t for bladder cancers (neoadjuvant and adjuvant indications). The authors present their experience of 17 cases of stage T4a transitional cell carcinoma transformed into an operable stage by M-VAC. Those patients with regression of the tumour to a non-invasive stage at operation (patients with a good response) had a good prognosis. In contrast those patients with residual invasive tumour all died from their disease. A prospective comparative study was performed between total cystectomy alone and cystectomy completed by adjuvant M-VAC in patients with a worrying histology. This study was based on 49 cases up until December 1990. A significant improvement in the prognosis was observed in patients receiving adjuvant M-VAC. The recurrence-free survival was considerably prolonged in this second group (study suspended in November 1992). When metastases developed, palliative M-VAC only rarely prolonged survival.

Adult↗
PubMed1993

Ureterovesicovaginal fistulas.

Our experience with urogenital fistulas are reviewed and three instances of complex ureterovesicovaginal fistulas, which can be mistaken for pure vesicovaginal fistulas because of diagnostic difficulties, are presented. If the ureterovaginal component of these fistulas is overlooked intraoperatively, urinary leakage will persist despite otherwise successful closure of the vesicovaginal component of the fistula. Because of the involvement of the terminal ureter in the fistulous system, operative therapy must combine the closure of the vesicovaginal fistula with reimplantation of the ureter into the bladder and interposition of omentum or a peritoneal patch between the bladder and vagina. Diagnosis and therapy are illustrated by patient reports and literature review.

Female↗
PubMed1993

Sigma-rectum pouch (Mainz pouch II).

A substantial modification of the classic technique of ureterosigmoidostomy is introduced in this article. To date, this procedure has been used in 47 patients. This article reviews the surgical technique of the antemesenterial splitting of the intestine at the recto-sigmoid junction which creates a pouch by subsequent side-to-side anastomosis.

Bladder Exstrophy↗