[The legal situation concerning the sterilization of mentally handicapped persons].
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Persons with Disabilities↗
Biomedical subjects
U Engelmann
Publications and source records attributed to U Engelmann.
31P NMR spectroscopy of blood plasma: determination and quantification of phospholipid classes in patients with renal cell carcinoma.
Advanced renal cell carcinoma (RCC) has a poor prognosis and is characterized by an unpredictable clinical course. The aim of this study was to assess the systemic phospholipid distribution as a possible marker of tumor stage and tumor spread beyond the kidney. To this end, the effect of renal cell carcinoma (RCC) on phospholipid concentrations in blood plasma using 31P NMR spectroscopy was studied in: (a) 29 patients with RCC prior to nephrectomy; (b) 19 healthy volunteers; (c) three patients with other renal tumors (renal metastases of bronchial carcinoma and of renal pelvic carcinoma, and a benign renal tumor). Furthermore, the phospholipid concentrations of eight patients of group (a) were determined 6 months after nephrectomy, when they were in remission. We found considerable deviations in the concentrations of the lysophosphatidylcholines (LPC1, LPC2) in both male and female patients with RCC compared to healthy volunteers (male--LPC1 0.217+/-0.062 vs 0.297+/-0.049 mmol/l, LPC2 0.036+/-0.014 vs 0.068+/-0.024 mmol/l; female--LPC1 0.195+/-0.071 vs 0.296+/-0.044 mmol/l, LPC2 0.037+/-0.027 vs 0.044+/-0.014 mmol/l). In addition, female patients with RCC showed lower concentrations of phosphatidylcholines (PC; 1.409+/-0.268 vs 1.947+/-0.259 mmol/l). The low phospholipid concentrations normalized for patients in remission. Phospholipid concentrations were found to depend on tumor stage and metastatic spread. The deviations in phospholipid concentrations (LPC1, LPC2, PC) observed may be attributable to systemic effects caused by the tumor as well as changes in enzyme activities.
Adult↗
[Evaluation of CHILI teleradiology network 4 years after clinical implementation].
The CHILI teleradiology network has more than 60 installations in Germany and the USA. Radiological images and cardiological multiframe series are exchanged in clinical routine. This article investigates in what way and how often the system is used. This is done by means of accounting files that are produced automatically by the system. User functions, transmission protocols, data quantity, frequencies and time of data transmission and teleconferences are evaluated and discussed in this paper. Different application scenarios have been identified and are described and analyzed as well. An important result is, that the system is not merely an emergency system. Instead, it is used in daily routine as a multifunctional, multimodality workstation with advanced features for teleradiology and telecardiology.
Computer Communication Networks↗
MAP kinase 1/2 (Erk 1/2) and serine/threonine specific protein kinase Akt/PKB expression and activity in the human corpus cavernosum.
Nitric oxide (NO) is an important mediator in the cavernosal smooth muscle relaxation that causes erections. The purpose of this study was to examine the existence, distribution and phosphorylation stage of two recently discovered key enzymes for NO regulation in human cavernosal tissue, the MAP Kinase 1/2 (Erk 1/2) and the serine/threonine specific protein kinase Akt/PKB. The expression of the enzymes was examined in corpus cavernosum specimens taken from both potent men and from patients with long-term impotence. There was a distinct difference in the activation stage of the MAP Kinase 1/2 (Erk 1/2) between endothelium and smooth muscle cells in potent patients. This finding gives evidence for a cell-type-specific regulation of the eNOS-dependent NO release. Furthermore, we found a higher basal level of active MAP Kinase 1/2 (Erk 1/2) in impotent patients. This finding gives the first evidence for an inhibitory influence of MAP Kinase 1/2 (Erk 1/2) on cavernosal eNOS activity.
Adolescent↗
Epidemiology of Peyronie's disease.
Francois Gigot de la Peyronie, surgeon to Louis XV of France, has become synonymous with the rather enigmatic though not uncommon condition of Peyronie's disease (PD), a localized connective tissue disorder of the penile tunica albuginea. The true prevalence of Peyronie's disease is unknown. Therefore, we decided to perform an evaluation of existing epidemiological data. A prevalence rate of 3.2% was determined in male inhabitants of the greater Cologne area. This is much higher than revealed by the data reported up to now, thus rendering the accepted prevalence rates of 0.3% to 1% untenable. The actual prevalence of Peyronie's disease may be even higher, considering many patients' reluctance to report this embarrassing condition to their physicians. Along these lines, most clinicians note that the number of Peyronie's patients has increased since the advent of oral sildenafil. Comparably high prevalences are known for diabetes and urolithiasis, suggesting a greater frequency of this rare disease than formerly believed.
Age Distribution↗
[Changes in penile blood flow during cycling--how does one prevent a decreased perfusion?].
BACKGROUND AND OBJECTIVES: An increased incidence of erectile dysfunction has been observed in cycling enthusiasts. Compression of the perineal region during cycling seems to cause decreased penile perfusion. The resulting hypoxaemia in the corpus cavernosum is associated with penile fibrosis, which leads in the long run to erectile dysfunction. This study set out to determine if cycling can cause changes in penile perfusion and, if so, what precautions can be taken to avoid any associated health hazards, including whether various saddle forms and designs might influence penile blood flow. COHORTS AND METHODS: In 100 healthy athletic men (aged 36 +/- 6.2 years) transcutaneous penile oxygen pressure (tpO (2)) at the glans penis was measured during cycling in different positions and with different types of saddle, using a modified Clark oxygen electrode. RESULTS: The penile blood supply decreased significantly during cycling in a seated position. Cycling in a standing or reclining position (on a reclining bicycle) did not lead to any decrease in penile blood flow. Saddle width was the most important factor for ensuring adequate penile perfusion while cycling in a seated position. CONCLUSION: This study demonstrates that changing from a seated to a standing position during cycling leads to a significant increase in penile perfusion. Therefore we suggest frequent changes from a seated to a standing position during cycling. Additionally we suggest taking sufficient breaks during prolonged and vigorous bike tours, in order to avoid any possible health hazards. Another, not yet widespread, alternative for avoiding a reduction in penile blood flow is cycling on a reclining bicycle.
Adult↗
[Alternative therapies of local prostatic carcinoma].
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Combined Modality Therapy↗
[Value of cryotherapy in localized prostatic carcinoma].
Prostate cancer represents the second most frequent malignant male disease in Germany. In the United States, approximately 35,000 men die from prostate cancer annually. The treatment of this disease is of particular interest to both clinical and investigative urologists. Radical prostatectomy and radiotherapy are established standard modalities in the treatment of organ-confined prostate cancer. As in other fields of urology, minimally invasive procedures have gained increased interest in urologic oncology. With cryoablation of the prostate, a minimally invasive therapy for prostate cancer has been available since 1989 and has been used and under investigation since then. Improvements in cryotechnique and progress in transrectal high-resolution ultrasonography enable the surgeon to achieve the curative target of thermoinduced destruction of the whole prostate gland. Control with thermocouples, ultrasound, and double-freeze techniques makes it possible to destroy the whole organ or the region of interest in high-risk patients or in patients who refuse to undergo open surgical procedures.
Aged↗
Reality and perspectives in teleradiology: a personal view based on personal experiences.
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Computer Security↗
Sildenafil (Viagra): is there an influence on psychological performance?
BACKGROUND: Sildenafil (Viagra) is a well-introduced medicine for erectile dysfunction; many studies about effects and side effects are published. Beside these aspects of treatment the influence of sildenafil on psychophysical performance is of interest. cGMP is one of the most important second messengers in the central nervous system (CNS), so even very small changes of the intracellular cGMP-level caused by phosphodiesterases inhibition may be relevant for CNS-function. We wanted to verify the hypothesis whether sildenfail influences human psychomotor performance, especially under the aspect of traffic safety, or not. METHODS: Designed as a pilot study we tested 6 male healthy volunteers using a test battery of 7 different psychophysical performances tests. Each individual did the test battery twice, once without drug and once after a single oral dose of 100-mg sildenafil. 3 persons did the first and 3 others did the second experiment under the influence of drug (UID). All results (37 parameters) were analysed by t-test for paired samples using a confidence interval of 95%. RESULTS: Only two parameters of 2 different tests showed significant differences. In the simple choice reaction test (DR2) the mean reaction time got better in the group with sildenafil; in the multiple choice reaction test with stress induction (RST3) the amount of wrong answers indicated a weak influence of performance without statistical significance, six parameters (dominantly in the speed anticipation test (DEST)) represented an increase and one other (RST3 second part) showed a decrease UID. The uppermost parameters (76% of all items) stayed on equal levels for both groups. CONCLUSION: Sildenafil showed no important impairment of psychophysical performance, no strong improvement was found as well. With a look at the therapeutically indication of sildenafil the improvement in sexual activity may indicate no incapacity in traffic and other psychomotoric/psychophysical functions.
Adult↗
Creative-dynamic image synthesis: a useful addition to the treatment options for impotence.
In contrast to the impressive advances made in somatic research on erectile dysfunction, psychogenic erectile dysfunction is usually treated as a monolithic block. In this study, we evaluated the erectogenic power of creative-dynamic image synthesis in men with psychogenic erectile dysfunction. Sixty-nine men with a mean age of 46 y, suffering from erectile dysfunction of no known organic cause, were entered in a placebo-controlled study in which the erectogenic power of imagination, yohimbine and a placebo were compared. There was a significant difference between the subjective results of creative-dynamic image synthesis (75% increase of potency) and those achieved through treatment with the drug yohimbine (55% increase in potency) and with a placebo (30% increase in potency). Creative-dynamic image synthesis is a potent initiator of erections in men with psychogenic erectile dysfunction, has no known side effects and is very cost-effective.
Adrenergic alpha-Antagonists↗
The prevalence of Peyronie's disease: results of a large survey.
OBJECTIVES: To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany. SUBJECTS AND METHODS: A standardized questionnaire was sent to 8000 male inhabitants (age range 30-80 years) of the greater Cologne area (approximately 1.5 million inhabitants). Three questions about the self-diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men. RESULTS: The response rate after the third mailing was 55.4% (4432 men): 142 men (3.2%, mean age 57.4 years, SD 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30-39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40-49 and 50-59 years, 4.0% in those 60-69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction. CONCLUSIONS: This is the first large cross-sectional, community-based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this 'rare' disease is more widespread than previously thought.
Adult↗
Impotence and genital numbness in cyclists.
Cyclists often complain of genital numbness and even of impotence. The purpose of this study was to determine if perineal compression during cycling causes changes in the penile blood supply, impotence and penile numbness. Forty healthy athletic men with a mean age of 30 +/- 5.3 years took part in the study. Transcutaneous penile oxygen pressure was obtained using a device consisting of a modified Clark pO2 electrode, attached to the glans of the penis. All men were measured in a standing position before, in a seated and standing position during and in a standing position after cycling. Additionally, a detailed interview was carried out with each man. The penile blood supply--which correlates with the transcutaneous PO2 at the glans-- decreased significantly in over 70% of the test subjects during cycling in a seated position. Cycling in a standing position did not show any alteration in the penile blood supply as compared to the values measured before exercising. Numbness of the genital region was reported by 61% of the cyclists. 19% of cyclists who had a weekly training distance of more than 400 km complained of erectile dysfunction. The results of the present study showed that there is a deficiency in penile perfusion due to perineal arterial compression. This could be a reason for penile numbness and impotence in long-distance cyclists. Therefore, we suggest restricting the training distance, and taking sufficient pauses during the course of prolonged and vigorous bicycle riding, in order to avoid penile numbness and impotence.
Adult↗
Microscopic and biochemical fertility characteristics of semen after shockwave lithotripsy of distal ureteral calculi.
PURPOSE: To elucidate the frequency and adversity of the effects of shockwave lithotripsy (SWL) on the male reproductive system. We investigated the possible alterations in the quality of semen in patients treated by SWL for pelvic ureteral stones. PATIENTS AND METHODS: The semen of 10 men was examined 1 day before and 5 and 90 days after SWL for distal ureteral stones, in accordance with the World Health Organisation guidelines. The results were compared with those from the semen samples of 10 healthy male volunteers undergoing SWL for calculi of the upper urinary tract. RESULTS: Microscopic analysis of the semen samples revealed a transient decline in sperm density (24.7%), sperm motility (10%), sperm vitality (8%), and seminal fructose (27.5%) after SWL for distal ureteral stones. A distinctly higher number of spermatozoa of pathological origin was detected after SWL in the same group. There was no trace of microscopic hemospermia before shockwave treatment, but it was detected in 90% of the patients with lower ureteral calculi after SWL. Macroscopic hemospermia was detected in two of these nine patients. No deterioration of the semen characteristics and no hemospermia was observed after treatment in the control group with upper urinary stones. CONCLUSIONS: Our investigations confirmed a transient deterioration in semen quality after SWL for distal ureteral calculi, whereas no deterioration was observed after SWL for upper ureteral stones. Impaired sperm quality values returned to normal within 12 weeks after SWL, clearly indicating a damaging effect of SWL on seminal vesicle or ejaculatory duct function. The initial procreative capacity was restored in all patients.
Adult↗
Endoscopic lithotripsy with a new device combining ultrasound and lithoclast.
BACKGROUND AND PURPOSE: Endoscopic lithotripsy is still the method of choice for a number of stones, especially large stones. Various disintegration techniques exist. We investigated the combination of two of these techniques: ultrasound and pneumatic lithotripsy. PATIENTS AND METHODS: Fourteen consecutive patients with renal and one patient with bladder stones were treated with this new device. Ultrasound and pneumatic lithotripsy could be used independently or simultaneously. RESULTS: Disintegration and stone removal was fast. The use of forceps or other instruments could generally be avoided. No complications attributable to the lithotripsy device were observed. CONCLUSION: The combined ultrasound/pneumatic lithotripsy device is safe and highly effective. It reduces treatment time and enhances surgeon's comfort.
Adult↗
Significance of fluorescence cystoscopy for diagnosis of superficial bladder cancer after intravesical instillation of delta aminolevulinic acid.
OBJECTIVES: Most lesions of superficial bladder cancer may be easily missed during conventional white light cystoscopy. The aim of this work was to evaluate the efficiency of endoscopic fluorescence diagnosis of superficial malignant bladder tumours following intravesical instillation of delta-aminoleviulenic acid. PATIENTS AND METHODS: 30 patients of suspected or previously diagnosed bladder cancer were subject of evaluation. All patients received 50 ml of a 3% delta-ALA solution intravesically, 2-3 h prior to diagnostic cystoscopy. Fluorescence excitation intraoperatively was achieved by a violet-blue light from a xenon light source. RESULTS: A clear strong red fluorescence colour was observed emitting from all malignant vesical lesions. A diagnostic sensitivity of 98% and specificity of 65% has been determined for this novel diagnostic modality. CONCLUSION: Fluorescence cystoscopy using delta-ALA is a reliable procedure that can be offered to all patients with suspected bladder cancer lesions.
Adenocarcinoma↗
Comparison of individual urologists' performance.
OBJECTIVE: In the last few years, comparative outcome quality statistics have been one of the key topics for discussion in health care. Comparative audits using overall mortality and morbidity figures can be misleading as they do not take into account variations in urological procedure and patient fitness. The purpose of our study was to compare the crude operative morbidity and mortality rates with the predicted rates using an established scoring system (POSSUM). MATERIALS AND METHODS: To examine these effects, we compared 5 urological operations (transurethral resection of the prostate, transurethral resection of the bladder, radical nephrectomy, suprapubic enucleation of the prostate and radical prostatovesiculectomy) performed by 2 urologists in a prospective study during a 12-month period. POSSUM consists of a simple preoperative physiological score, a postoperative score and defined kinds of complications. RESULTS: One urologist operated on 160 patients, with an operative mortality of 2.5% and morbidity of 31.3%. The other urologist operated on 144 patients, with an operative mortality of 0.7% and morbidity of 9%. At first sight, there appear to be significant differences in operative outcome between the 2 urologists. However, analysis using the POSSUM system predicts a mortality rate of 3.1% for the first urologist and 0.7% for the second urologist (morbidity rates of 35% for the first urologist and 10.4% for the second urologist). Receiver operating curve analysis demonstrated no significant difference between the 2 urologists. CONCLUSION: The present study demonstrates how misleading crude mortality and morbidity figures can be when comparing different urologists. By producing a single assessment of physiological status at the time of operation and of operative severity, POSSUM analysis allows a more realistic comparison between different urologists.
Medical Audit↗
Erectile dysfunction in cyclists. Is there any difference in penile blood flow during cycling in an upright versus a reclining position?
OBJECTIVE: Perineal compression during bicycling appears to be responsible for some cases of erectile dysfunction. MATERIAL AND METHODS: In 46 healthy athletic men transcutaneous penile oxygen pressure (tpO(2)) at the glands of the penis was measured, using a transcutaneous measurement device. It has been shown that the tpO(2) levels measured at the glans correlate with the penile blood flow. Our measurements were performed before, during and after cycling in an upright and a reclining position in a crossover study. RESULTS: The mean transcutaneous pO(2) at the glans in a standing position before biking was 60.5+/-8.1 mm Hg. It decreased after sitting on the saddle in an upright position to 17.9+/-3.9 mm Hg. Continued cycling in a seated upright position showed pO(2) levels of 18.3+/-5.2 mm Hg, with a full return to normal pO(2) values after a 10-min recovery period in a standing position. Cycling in a reclining position resulted in pO(2) levels of 59.4+/-4.2 mm Hg, a similar level to that obtained before exercising. CONCLUSIONS: The results of the present study demonstrated that there is a deficiency in penile perfusion caused by perineal arterial compression. Cycling in a reclining position - in which no perineal compression was seen - caused no alteration in penile blood flow during exercising. Therefore, we suggest cycling in a reclining position to avoid health hazards - such as penile numbness and hypoxygenation of the corpora cavernosa, which can result in impotency.
Adult↗