Search PubMed⌕ Search

Biomedical subjects

W Weidner

Publications and source records attributed to W Weidner.

At least 145 records · Page 8Linked to original sources
PubMed1997

[Transurethral laser ablation of the prostate in high risk patients with obstructive benign prostatic hyperplasia. Perioperative morbidity and 6 month outcome in 72 patients].

Between November 1993 and September 1995, we carried out visual laser ablation of the prostate (VLAP) in 72 high-risk patients (ASA 3-4; severe cardiovascular and/or pulmonary diseases) aged 60-88 years (mean 76.7 years); the prostate volume was 22-136 ml (mean 56 ml). The urinary peak flow rates (Qmax.) ranged from 2 to 15 ml/s (mean 4.4 ml/s) preoperatively; 42 patients (58.3%) suffered from acute urinary retention for up to 2 weeks and had an indwelling catheter. The residual urinary volume (RUV) was 0-320 ml (mean 142.3 ml) in those 30 patients with spontaneous micturition. The International Prostate Symptom Score (IPSS) ranged from 10 to 33 (mean 21.8). In the first 37 patients, pressure-flow studies were carried out only in cases of doubt to verify obstruction. In the last 35 patients, pressure-flow studies were carried out in every case. Perioperatively, there was no appearance of blood loss of absorption of irrigation fluid. None of our patients needed transfusions or intensive care perioperatively. Further complications were not severe and could be handled without problems. In two patients with large benign prostate hypertrophy (BPH) a second operation (VLAP, no conventional transurethral prostatectomy) was necessary. After 6 weeks, 29.4% of the patients suffered from symptomatic urinary tract infections (UTI). After 6 months, only 7.1% of the patients had symptomatic UTI. After 6 weeks (n = 61), Qmax. was 6-34 ml/s (mean 15.3 ml/s), RUV was 0-230 ml (mean 51.5 ml), and the IPSS was 12.3 (8-28). After 3 months (n = 54), Qmax. was 9-45 ml/s (mean 19.8 ml/s), RUV was 0-96 ml (mean 31.6 ml), and the IPSS was 1-23 (mean 7.4). After 6 months (n = 52) Qmax. was 12-33 ml/s (mean 20.4 ml), RUV was 0-53 ml (mean 26.4 ml), and the IPSS was 1-12 (mean 4.1). VLAP provided no further risks for our high-risk patients, while Qmax., RUV, and IPSS were improved noticeably (improvement of more than 75%). It represents a step forward in the treatment of obstructive BPH in high-risk patients. Particularly in high-risk patients with cardiac diseases, this procedure lessens the perioperative risk. Despite the minimal appearance of UTI after 6 months, UTI seemed to be the most important complication during the first few weeks after VLAP by virtue of the bothersome symptoms.

Aged↗
PubMed1997

Sexual dysfunction in Peyronie's disease: an analysis of 222 patients without previous local plaque therapy.

PURPOSE: We obtained an objective evaluation of erectile function in patients with Peyronie's disease. MATERIALS AND METHODS: Sexual dysfunction was analyzed in 222 patients with Peyronie's disease without previous local plaque therapy using a standardized protocol. RESULTS: Of the 222 patients 70 (31.5%) complained of not being able to perform intercourse. In 4 men (1.8%) standardized diagnostic procedure demonstrated only a severe angulation making coitus impossible, and in 3 men (1.4%) intercourse became unsatisfactory due to pain. Seven men (3.1%) reported distal penile flaccidity, including 4 in whom dynamic pharmacocavernosometry and pharmacocavernosography revealed veno-occlusive dysfunction. Of 56 men who complained of a complete loss of erection 51 did not respond to intracavernous pharmacological injection with prostaglandin E1, and 27 (48.2%) had abnormal arterial blood flow as shown by duplex sonography of the cavernous arteries, 47 (83.9%) had evidence of veno-occlusive dysfunction based on cavernosometric criteria and 33 (58.9%) also had cavernosographic evidence of the condition. Plaque associated venous drainage was evident in 15 of the 56 impotent patients (26.8%), equivalent to 45.5% of all cases with abnormal cavernosographic findings. CONCLUSIONS: Sexual dysfunction was evaluable in 31.5% of patients, and the main cause of impotence and loss of erection was veno-occlusive dysfunction.

Adult↗
PubMed1996

[A case-control study for the recognition of nonoccupational risk factors for tumors of the lower urinary tract].

OBJECTIVE: A case-control study was performed to assess various nonoccupational factors (smoking, eating and drinking habits, intake of analgesics) that may be aetiological factors in the development of tumours of the lower urinary tract, while vitamins may be protective. PATIENTS AND METHODS: 150 patients (125 men, mean age 66.4 years; 25 women, mean age 68.2 years) with histologically confirmed malignant tumour of bladder or other part of the lower urinary tract and a comparable group of controls, matched for age, sex and home location, were asked in a standardised personal interview about their life-long habits of smoking, eating and drinking, as well as intake of analgesics. RESULTS: Smoking was the greatest risk factor. In men there was a significant positive dose-effect relationship between the number of cigarettes smoked and relative carcinoma risk, compared with nonsmokers, by a factor of 3.68 among those with the highest dosage (> 40 pack-years). Because of the small number of cases this relationship could not be proven in women, but twice as many female tumour patients than controls were smokers (8 vs 4). In men, even after adjusting for smoking, increased coffee consumption increased the risk by a factor of 2 (2-4 cups: odds ratio 2.14 [P < 0.05]; > 5 cups: odds ratio 2.22 [not significant]). An increased beer consumption had no apparent effect on the development of tumours. Findings regarding vitamin C were ambiguous. More prolonged and increased intake of phenacetin-containing analgesics in men showed a tendency towards a higher tumour risk. CONCLUSION: Smoking cigarettes is one of the main risk factors for the development of bladder and other lower urinary tract tumours. The influence of other risk factors needs to be elucidated.

Age Distribution↗
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

Human Y chromosome azoospermia factors (AZF) mapped to different subregions in Yq11.

In a large collaborative screening project, 370 men with idiopathic azoospermia or severe oligozoospermia were analysed for deletions of 76 DNA loci in Yq11. In 12 individuals, we observed de novo microdeletions involving several DNA loci, while an additional patient had an inherited deletion. They were mapped to three different subregions in Yq11. One subregion coincides to the AZF region defined recently in distal Yq11. The second and third subregion were mapped proximal to it, in proximal and middle Yq11, respectively. The different deletions observed were not overlapping but the extension of the deleted Y DNA in each subregion was similar in each patient analysed. In testis tissue sections, disruption of spermatogenesis was shown to be at the same phase when the microdeletion occurred in the same Yq11 subregion but at a different phase when the microdeletion occurred in a different Yq11 subregion. Therefore, we propose the presence of not one but three spermatogenesis loci in Yq11 and that each locus is active during a different phase of male germ cell development. As the most severe phenotype after deletion of each locus is azoospermia, we designated them as: AZFa, AZFb and AZFc. Their probable phase of function in human spermatogenesis and candidate genes involved will be discussed.

Chromosome Mapping↗
PubMed1996

A comparative study of two different regimens of sparfloxacin versus doxycycline in the treatment of non-gonococcal urethritis in men.

A multicentre, double-blind, randomised study comparing the efficacy and safety of oral sparfloxacin (200 mg on day 1 followed by 100 mg daily for 2 or 6 additional days) with doxycycline (200 mg once daily for 7 days) in the treatment of non-gonococcal urethritis in men was conducted. The overall success rates for the three treatment groups were statistically equivalent both at the end of treatment and at the follow-up visits. For chlamydial urethritis, the rates of relapse or possible reinfection were similar in the 7-day sparfloxacin and doxycycline groups. For ureaplasmal urethritis and urethritis of unknown aetiology, the rates of relapse or possible reinfection were lower in the 7-day sparfloxacin group than in the other two treatment groups. Sparfloxacin was well tolerated. A 7-day sparfloxacin regimen appears to be a useful alternative to doxycycline for the treatment of non-gonococcal urethritis in men.

Adolescent↗
PubMed1996

Influence of Escherichia coli on motility parameters of human spermatozoa in vitro.

The influence of E. coli on human sperm motility was studied in vitro. Semen samples were prepared by a swim-up technique and adjusted to 22 x 10(6) spermatozoa/ml. Samples were then inoculated with different concentrations of a uropathogenic strain of E. coli, serotype 06, with initial sperm/bacteria ratios varying between 10:1 and 10000:1. Motion parameters were analysed by computer-aided motility analysis directly, and 2, 4 and 6 h after inoculation. In a second series of experiments, bacterial replication was inhibited by addition of chloramphenicol. In a third series, the effect of E. coli culture filtrates on sperm motility was investigated. The direct inhibitory effect of E. coli on progressive motility of spermatozoa was found to depend upon the bacterial concentration. A distinct inhibitory effect was observed only at a sperm/bacteria ratio of approximately 1, achieved by growth of E. coli during the experiments. For modality of motion, no distinct changes were observed. When growth of bacteria was prevented by chloramphenicol, no inhibitory effect on sperm motility was detected. Sperm motility was not inhibited by E. coli culture filtrates. Analysis by electron microscopy revealed multiple adhesions of E. coli to spermatozoa, causing variable ultrastructural damage as probable morphological correlates of immobilization.

Bacterial Adhesion↗
PubMed1996

Relationship between 1,25-dihydroxyvitamin-D, calcium and uric acid in urinary stone formers.

In order to clarify the role of 1,25-dihydroxyvitamin-D [1,25-(OH)2-D] in calcium stone formation, correlations between 1,25-(OH)2-D serum levels and levels of calcium, phosphate and uric acid (UA) in serum or urine and between the 1,25-(OH)2-D serum level and age were analyzed in 111 formers of urinary stones (57 Ca stones) and in 44 controls. Furthermore, 1,25-(OH)2-D serum levels as well as levels of Ca, phosphate and UA in serum and urine from formers of different urinary stones and controls were compared. 1,25-(OH)2-D serum levels were determined by a radio-receptor assay based on a calf thymus receptor. 1,25-(OH)2-D serum levels correlated positively with urinary UA excretion in formers of Ca stones and with urinary Ca excretion in formers of Ca stones and controls. In formers of Ca stones urinary Ca excretion was higher and serum phosphate was lower than in controls. 1,25-(OH)2-D serum levels did not differ. 1,25-(OH)2-D serum levels decreased with increasing age in controls, but not in stone formers. Our results show that urinary UA and 1,25-(OH)2-D in serum co-influence Ca stone formation, and they suggest that there is an increased sensitivity to 1,25-(OH)2-D in formers of Ca stones.

Age Factors↗
PubMed1996

Primary plasmacytoma of the testis. Case report and review of the literature.

A primary plasmacytoma of the testis is an extremely rare tumor. To date less than 10 cases have been published. Typically a firm mass of the testis or also of the epididymis is found. Histologically, infiltration can be seen with atypical plasma cells compressing the seminiferous tubuli. Immunohistochemical examination shows a PAS-positive reaction. Monoclonality can be confirmed by identification of the IgA lambda chain. Therapy of choice is the radical orchiectomy. The prognosis of primary plasmacytoma of the testis seems to be good. Nevertheless, a follow-up of some years is necessary to detect possible intramedullar manifestations.

Humans↗
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

[Cryptorchism--assessment from an andrologic viewpoint].

This report deals with the pathology, diagnosis and therapy of cryptorchidism from the andrological point of view. Hypothalamic-pituitary gonadal failure and a reduced transformation of gonocytes are the key factors in fertility disorders. The aim of all well-timed therapy must be to improve the fertility potential of the sexually mature male. At present, the determination through biopsy of the fertility index during orchiopexy offers the only possibility of prospective diagnosis in this respect. In the future, it will be necessary to have a standardized procedure in order to guarantee the long-term effect of correctly timed orchiopexy on fertility.

Adolescent↗
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

Struvite stones: long term follow up under metaphylaxis.

This study presents the results of a 10-year metaphylaxis of 19 former struvite stone formers, each having had 2-3 stone operations. In these patients, urine was acidified with L-methionine (Acimethin) using a dose of three to six tablets 500 mg/day. Every three months, 11 laboratory parameters were checked in 24-hour urine. 6 parameters were determined in serum. In addition, urine samples were tested for infection. Statistical analysis of analytical data, which was supported by computer graphs, provided the results for the urinary parameters. They were described by geometric means and 95% confidence intervals using ANOVA (analysis of variance). During therapy, the mean pH values decreased significantly from 7.5 to 5.5. Signific-ant increases were found in the excretion of citrate, magnesium, potassium, and uric acid. An increase was also found for calcium, which, however, could not be confirmed to be statistically significant (p = 0.08). In serum, changes of parameters could only be registered for calcium and phosphate. However, at all times, total serum concentrations stayed within their normal limits. Three patients suffered occasional infections (16%), only two of them formed recurrent stones (10%). In assessing the efficacy of L-methionine therapy, the drop in urinary pH to acidic values was the most relevant factor for metaphylaxis.

Analysis of Variance↗
PubMed1996

Transurethral laser therapy and urinary tract infections.

To date transurethral laser ablation of the prostate (TULAP) in benign prostatic hyperplasia (BPH) is the commonest form of transurethral laser surgery. The invention of the so-called "sidefire" laser fibre was the prerequisite condition for effective transurethral laser ablation of the prostate. Since the first transurethral laser ablation in human BPH was performed by Costello in September 1990, a multitude of urologists have adopted this technique. In the meantime, a great many studies have been carried out and a lot of data have been published. The initial, to some extent euphoric, enthusiasm of some urologists as well as some patients, especially in the USA and Europe, has turned into a more critical reflection. There is no doubt at all that TULAP is a feasible alternative treatment method with reasonable results. Especially in the high-risk patient, there is neither severe blood loss nor an uptake of irrigation fluid. It is also beneficial to allow unlimited treatment in patients on anticoagulant medication. Nevertheless, the value of TULAP in comparison to transurethral electroresection of the prostate (TURP), generally accepted as the "gold-standard" in the surgical therapy of BPH, remains unclear. A final assessment will only be possible when further data on mortality, short and long term morbidity and outcome with this method have been presented. Strong evidence exists that the operation can be performed without blood loss and uptake of irrigation fluid. A further advantage seems to be preservation of sexual function, especially anterograde ejaculation in the majority of patients, in comparison to the "gold-standard" TURP. In most studies, the value of TULAP is further compared with regard to the elimination of obstruction by means of pressure-flow-studies. The aspect most frequently neglected by all investigators to date is the frequency and severity of urinary tract infections (UTI) in patients in whom TULAP is performed. Basically, UTI in the form of cystitis, ascending infections such as male adnexitis or pyelonephritis, prostatitis of the remaining parts of the prostate and catheter-induced urethritis are associated with transurethral surgery in general. Certain data indicate an age-related frequency of UTI. From a rate of approximately 1% of UTI in infants, the frequency rises to 30% in the 8th decade of life. According to these data, one can expect that in a study of TULAP in high risk patients, most of whom are elderly, a large number present for surgery with a preexisting UTI. Other data demonstrate that after 4.5 days 50% and more of patients with an indwelling catheter develop an ascending UTI, although a closed urinary drainage system has been used. In most cases enterobacteriaceae, in 80% Escherichia coli, are detected. Especially in TULAP, a period of prolonged catheterisation has to be expected in the majority of patients. The risk of UTI in the perioperative phase is therefore expected to be higher. There are several higher risks and possibilities of complications in transurethral surgery in patients with UTI. Taking this into account, all our patients routinely undergo low dose antibiotic prophylactic treatment. The frequency of infections of the remaining parts of the prostate after prostatic surgery is strongly correlated to the flow characteristics in the prostatic urethra and to the amount of destruction of the prostatic tissue. Here are further reasons for a higher risk of infection after TULAP. Due to the fact that the prostatic tissue is not removed by a clear cut, but coagulated by laser beam, a rough surface due to tissue necrosis results. This is an ideal culture medium for bacteria aggravated by the disturbed laminar flow in the prostatic urethra, which favours an intraprostatic reflux of infected urine. There is evidence that UTI are the most important factor of morbidity during the first weeks after TULAP because of their bothersome symptoms.(ABSTRACT TRUNCATED)

Aged↗
PubMed1996

Chlamydia trachomatis antibodies in serum and ejaculate of male patients without acute urethritis.

In a prospective study, the prevalence of specific antibodies against Chlamydia trachomatis in serum and seminal plasma evaluated by a genus specific immunofluorescence test in 101 men without acute urethritis was investigated. The results were compared to the clinical diagnosis, cell culture of urethral swabs, demonstration of DNA particles by Polymerase Chain Reaction (PCR) in the ejaculate and signs of genital inflammation by counting peroxidase-positive leukocytes and elastase level in semen. The objective was to evaluate the significance of chlamydial antibodies in genital infection. Serum specific IgG and IgA antibodies were found in 26% and 15%, respectively; seminal IgG and IgA antibodies were present in 6% and 7%, respectively. Serum specific antibodies were not associated with the clinical diagnosis of infection nor with C. trachomatis cell culture, PCR findings, peroxidase positive leukocytes or PMN-elastase level. It is concluded that serum antibodies are not useful in detecting a chlamydial infection. Seminal plasma antibodies were not correlated with the clinical diagnosis of infection, positive cell culture, PMN-elastase levels and leukocytes in semen. However, a significant correlation was found for positive PCR in the ejaculate (p < 0.001 for IgG, p < 0.05 for IgA, p < 0.001 when combined). Though seminal antibodies may be more useful in detecting ascended or occult chlamydial infection, their significance remains unclear, their absence does not exclude chlamydial infection. In particular, the biological significance of locally derived IgA needs further evaluation.

Acute Disease↗
PubMed1996

[Long-term outcome of sex reassignment of male transsexual patients].

We report on our experience and our results with gender reassignment during the past 20 years. This study investigates the cosmetic and functional adequacy of the neovagina and also the psychological and social status in 37 surgically reassigned male-to-female transsexuals after a mean postsurgical follow-up of 7.5 years. There were 169 subjects who desired operations to adjust sex. In 58 cases the diagnosis "transsexualism" was supported by two psychosomatic and psychiatric expert opinions. We carried out 52 such operations in two stages. The mean age of the patients was 29 (18-40) years. The depth of the neovagina was approximately 12 cm, a cosmetic and physiologic result which adds greatly to the patients' satisfaction. There were no complications such as rectal or urethral fistulas. In one patient, vaginal stenosis developed after reoperation at a different institution. Three patients complained about short vaginas (6-9 cm). Correspondingly, the psychosocial status showed good improvement after surgery.

Adolescent↗