Immunoperoxidase Staining of Fine-Needle Aspiration Biopsies of Renal Cell Carcinoma Using Tumor-Specific Monoclonal Antibody

In 30 nephrectomy specimens, fine needle aspiration biopsies (FNAB) were performed both in the tumor and in the macroscopically normal part of the kidney: 18 were well differentiated renal cell carcinoma (RCC), 6 were moderately differentiated RCC, 4 were poorly differentiated RCC, and 2 were oncocytomas. FNAB was also performed in a bone metastasis of RCC. FNAB materials were stained using the immunoperoxidase method with RCC-specific monoclonal antibody and were compared with the staining of frozen sections. In all cases where tumor-antigen expression could be demonstrated in the frozen sections, a FNAB had already proven positive. There were only 2 false-negative cases where sufficient c…

Expression of transketolase TKTL1 predicts colon and urothelial cancer patient survival: Warburg effect reinterpreted

Abstract Tumours ferment glucose to lactate even in the presence of oxygen (aerobic glycolysis; Warburg effect). The pentose phosphate pathway (PPP) allows glucose conversion to ribose for nucleic acid synthesis and glucose degradation to lactate. The nonoxidative part of the PPP is controlled by transketolase enzyme reactions. We have detected upregulation of a mutated transketolase transcript (TKTL1) in human malignancies, whereas transketolase (TKT) and transketolase-like-2 (TKTL2) transcripts were not upregulated. Strong TKTL1 protein expression was correlated to invasive colon and urothelial tumours and to poor patients outcome. TKTL1 encodes a transketolase with unusual enzymatic prop…

Percutaneous ultrasonic destruction of renal calculi.

Tumor Volume, CT Scan, Lymphography, Sonography, Intravenous Pyelography, and Tumor Markers in Testis Tumors

Correlation of tumor volume to tumor stage in 134 patients with nonseminomatous testicular tumors, which were classified according to the TNM system, revealed similar tumor load for N0 and N1 patients. CT scans (n = 92), lymphangiography (n = 47), intravenous pyelography (IVP) (n = 134), sonography (n = 118) and serial tumor markers (n = 82) were evaluated for sensitivity, specificity and accuracy, both separately and in different combinations. The best individual results were obtained by lymphangiography (sensitivity 0.77, specificity 0.73, accuracy 0.75) and CT scan (sensitivity 0.52, specificity 0.91, accuracy 0.70). In combination CT scan and lymphangiography were the most valuable diag…

Die perkutane Nephrolithotomie

Zu einem Zeitpunkt, als sich die extrakorporale Stoswellenlithotripsie noch in einem experimentellen und klinischen Versuchsstadium befand, wurde die perkutane Nephrolithotomie als neues Behandlungsverfahren vorgestellt (1). Bei mangelnder allgemeiner Verfugbarkeit von Stoswelleneinrichtungen konnte sie sich in der Folgezeit als alternatives Behandlungsverfahren zur offenen operativen Behandlung von Nieren- und Harnleitersteinen weltweit durchsetzen. Ihr derzeitiger Stellenwert mus in Relation zu den Behandlungsmoglichkeiten, die die Stoswellenlithotripsie und auch andere endourologische Masnahmen wie die Ureterorenoskopie bieten, definiert werden.

Internal Urinary Diversion by a Percutaneous Ureteric Splint

Der Ausguß-Stein — Kontroverse Therapiekonzepte und Langzeitergebnisse

Die Extrakorporale Stoswellen-Lithotripsie ist fuhrende Behandlungsform fur die Mehrzahl der nichtabgangsfahigen Nierensteine geworden und hinsichtlich ihrer Indikationsstellung bei der Behandlung kleiner Nierenbecken — oder Kelchsteine unumstritten. Lediglich bei der Behandlung von Ausgussteinen variieren die therapeutischen Konzepte von Klinik zu Klinik teilweise noch erheblich und eine endgultige Beurteilung der verschiedenen Behandlungsprinzipien ist derzeit noch nicht sicher moglich, weil es an Langzeitbeobachtungen fehlt.

Extracorporeal Perfusion of the Tumor Bearing Human Kidney Using Tumor-Specific Monoclonal Antibodies: A Therapeutic Model

The use of monoclonal antibodies for tumor specific in vitro diagnosis is well established. With the possibility of producing tumor specific monoclonal antibodies, not only the in vitro application but also the in vivo use for tumor imaging is of great interest (Bander 1984; Mitchell and Oettgen 1982; Moon et al. 1983; Ritz et al. 1981). Methodology for radiolabelling of immunoglobulines is a well established and simple biochemical procedure thus making these antibodies ideal for immuno-szintigraphy (Greenwood et al. 1963; Hunter and Greenwood 1962; Mach et al. 1981; Scheinberg et al. 1982; Solter et al. 1982). Using alpha- or beta-emitting isotopes the therapeutic use of antibodies as tumo…

MAINZ-Pouch: Blasenaugmentation, Blasenersatz und kontinente Harnableitung

Operationsverfahren zur kontinenten Harnableitung, der Blasenaugmentation oder zum Blasenersatz haben in den letzten Jahren eine Renaissance erfahren. Vorteil der 1983 vorgestellten Technik des Mainz-Pouch [6] ist, das sie in standardisiertem Vorgehen fur alle drei genannten Indikationen geeignet ist. Seit 1983 wurden an der Universitatsklinik Mainz 79 Eingriffe zur kontinenten Harnableitung (n = 39), zur Blasenaugmentation (n = 28) und zum Blasenersatz (n = 12) durchgefuhrt. Bei der In dikation zur Operation standen ein funktioneller oder morphologischer Blasenverlust (n = 43) oder die Zystektomie wegen Blasenkarzinom (n = 31) im Vordergrund.

Zweite Generation der extrakorporalen Stoßwellenlithotripsie (Lithostar) – Klinische Ergebnisse

100 cases of Mainz pouch: continuing experience and evolution.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz…

Localization of segmental arteries in renal surgery by Doppler sonography.

Abstract To avoid damage to major arteries of the renal parenchyma during nephrotomy, intraoperative Doppler sonography was used experimentally and clinically as an artery finder. In experiments with 7 beagles segmental arteries were detected easily and reliably by sonography, and the arterial course thus indicated correlated perfectly with arteriograms and casts. In a clinical trial the Doppler artery finder was used in 7 patients with staghorn calculi that were removed via the renal pelvis and additional multiple selective nephrotomies. With as many as 7 selective nephrotomies in a single kidney there was no damage to the major arteries in any of these patients. Selective, avascular nephr…

Experimental Evaluation of a New Electromagnetic Shock Wave Source

Clinical application of new shock wave sources always warrants prior experimental evaluation of the stone disintegration capabilities and characterization of the shock wave impulses. The least possible tissue traumatization is necessary for successful clinical introduction. After the spark-gap generation of shock waves with semi-ellipsoid focussing had been introduced to the urological armamentarium for extracorporeal destruction of renal and ureteral stones in 1980 (Chaussy 1982), new modes of shock wave generation have been developed. In cooperation with the Siemens Company of Erlangen, Germany, a new electromagnetic shock wave source was evaluated by in vitro and in vivo animal experimen…

Short Ammonium Chloride Loading Test for Evaluation of Hyperparathyroidism

The dilemma in the diagnosis of hyperparathyroidism (HPT) is reflected by three factors: Hypercalcemia is still regarded as the most important diagnostic sign, but unless multiple determinations of serum calcium are done, the so-called borderline cases will be missed. Tests that readily identify HPT combine either simple performance, widespread use and low accuracy (CP, TRP, PEI, TMP/GFR)l or sophisticated methods, limited use and high accuracy (PTH, Ca+++, c-AMP). Consequently, some authors perform neck explorations to cure patients with recurrent nephrolithiasis who do not fulfill the diagnostic criteria of HPT. However, the stone recurrence rate may then reach 75%2,3 In this situation, t…

Percutaneous transrenal catheter retrieval.

Percutaneous transrenal catheter retrieval was successfully performed in 6 of 7 patients using the percutaneous transrenal access. Three broken nephrostomy tubes and 3 indwelling splints were extracted. The instruments used were deflecting guide wire in 1, grasping forceps in 2, and Dormia stone basket in 3 instances. No complications were encountered.

Diagnostik und operative Therapie beim vesiko-renalen Reflux

Fur die Abklarung und Klassifizierung des vesiko-renalen Refluxes stehen eine Reihe diagnostischer Masnahmen zur Verfugung, deren Aussagekraft nicht unumstritten ist. Aus diesen Grunden mussen therapeutische Entscheidungen bei der Refluxerkrankung haufig vom klinischen Verlauf abhangig gemacht werden. Durch die operative Refluxkorrektur kann mit hoher Zuverlassigkeit und geringer Komplikationsrate der vesiko-renale Reflux unabhangig vom praoperativ nachgewiesenen Refluxgrad beseitigt werden.

Treatment of Iatrogenic Functional or Morphologic Bladder Loss

From 1984 to 1986, six children from 4 to 13 years of age, received a bladder augmentation by ileocecal cystoplasty (Mainz-pouch technique) because of an iatrogenic functional or morphologic bladder loss. Indications for operation were incontinence due to the low bladder capacity or threat to the upper urinary tract due to ureteral obstruction or vesicorenal reflux. Two of the children had already undergone supravesical urinary diversion by sigmoid conduit. After a follow-up period of 2 to 19 months, (mean 11 months), five of the six children are completely continent. One boy with a known weak sphincter still has slight, but decreasing, enuresis nocturna in periods of complete filling of th…

Doppler and B-mode ultrasound for avascular nephrotomy.

AbstractDoppler sonography for intraoperative localization of the intrarenal arteries combined with B-scan sonography for intraoperative visualization of stones allows complete stone removal via small radial nephrotomies for which clamping of the renal artery is no longer necessary. Since September 1980 we used this technique on 35 patients with staghorn or recurrent calculi. The main advantages of this technique are exact and quick stone localization, minimal loss of renal function owing to preservation of the intrarenal vascular system, and no need for renal ischemia and cooling.

Slightly radiopaque uric acid calculi: impact upon therapeutic considerations?

Ten patients with slightly radiopaque urinary calculi were treated by percutaneous litholapaxy or even open surgery. The stone analysis revealed uric acid as the main stone composite suggesting that these patients should have been treated by oral litholysis alone alkalinizing the urine and decreasing uric acid levels with allopurinol. CT density measurements proved that concrements with HE less than 600 can be successfully dissolved by oral medication alone. Twenty-four patients were subsequently treated by oral citrate alkalinizing the spontaneous urine to pH 6.8-7.2 dissolving even large staghorns within 6-8 weeks. CT density measurements have become a routine diagnostic procedure when po…

Transrenal Ureteral Occlusion with a Detachable Balloon

Transrenal ureteral occlusion using a detachable balloon was successfully employed to stop urinary flow in seven patients. The balloon was filled with low-viscosity silicone rubber and released in the distal ureter. Percutaneous nephrostomy provided external drainage. Indications were painful dysuria and large urinary fistulas in advanced pelvic malignancy. The method is preferable to ureteral embolization with tissue adhesive.

Computerized tomography: an unreliable method for accurate staging of bladder tumors in patients who are candidates for radical cystectomy.

A total of 164 patients with bladder tumors underwent preoperative staging by computerized tomography. All patients were previously untreated, or had undergone only transurethral biopsy or resection of the tumor before computerized tomography. The post-cystectomy histological stage was compared to the preoperative computerized tomography stage. Computerized tomography accuracy according to the tumor, nodes and metastasis classification was only 32.3%, whereas overstaging was found in 39.6% and understaging in 28.1% of the cases. In untouched tumors or after transurethral resection computerized tomography accuracy demonstrated no significant difference. Only 2 of 19 true positive lymph nodes…

The telescope dilators

The telescope dilation set has been developed to allow for one-step percutaneous intrarenal instrumentation. As it is used for dilation as well as introduction of nephroscopes and nephrostomy tubes, it has become a central part of percutaneous procedures. A precise puncture technique has been developed to guarantee safe and effective use of the telescope dilators. Application in more than 300 cases involved minimal morbidity.

The Value of Sonography and Lymphography in the Detection of Retroperitoneal Metastases in Testicular Tumors

Lymphography has led to falsely negative or falsely positive diagnoses in 10 to 45 per cent of the cases of testicular tumor metastases reported in the literature. In our comparative study of lymphography and sonography in the preoperative staging of 29 malignant testicular tumors lymphography was accurate in 58.5 per cent of the cases, while sonography had an accuracy rate of 82.5 per cent. Sonography was superior to lymphography in the evaluation of hilar lymph node metastases and their extent, as well as for routine checkups after lymphadenectomy or irradiation.

Die perkutane Instrumentation bei Nierensteinen

Trotz vermehrter Kenntnisse uber die Steingenese und Erweiterung der konservativen Therapiemoglichkeiten, erreicht das Steinleiden einiger Patienten ein Stadium, in dem die Probleme der Therapie auf die Frage der Organerhaltung der steintragenden Niere reduziert sind. In derartigen Grenzfallen haben sich die perkutane Nephrostomie und die perkutane Steinextraktion bewahrt.

Zweite Generation der extrakorporalen Stoßwellenlithotripsie, Lithostar — Klinische Ergebnisse

Als zweite Generation wird der hier vorgestellte Lithotriptor definiert, der im Gegensatz zu dem in Betrieb befindlichen System HM 3 dez Firma Dornier (l) nicht mit einem offenen Wasserbehalter, sondern lokal mit einem abgeschlossenen System an den Patienten angekoppelt wird.

Conservative surgery of renal cell carcinoma.

Abstract From 1967 to 1985 conservative surgery (enucleation, n = 49; partial resection, n = 7) was performed for renal tumors in 57 patients (age 31-77, mean 54.8 years). Imperative indications for conservative surgery (n = 29) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective conservative surgery (n = 28) was done for small, peripherally located lesions, in cases of uncertain malignancy and in one tumor detected by chance during stone surgery. Tumors removed for imperative indications were 2-11 cm (mean 5.8 cm) in size. In the elective group, tumor size ranged from 1 to 7 cm (mean 3.3 cm). Follow-…

Transrenal ureteral occlusion using a detachable balloon

Percutaneous transrenal ureteral occlusion using a detachable balloon filled with silicone was performed in 20 patients. The main indications were palliation of large urinary fistulas and as a treatment of last resort for severe dysuria in patients with advanced pelvic malignancies. In 6 patients the contralateral kidney was rendered nonfunctional to obviate the need for bilateral nephrostomy. Due to frequent obstruction of the tube, ureteral blockage in 3 became insufficient. Two dislocated balloons were extracted percutaneously and replaced. In order to achieve effective interruption of urinary flow down the ureter, well-functioning external nephrostomy drainage is necessary.

Percutaneous Stone Manipulation

Percutaneous stone manipulation by direct ultrasound disintegration, extraction or chemolysis was done on 34 patients. A total of 15 patients presented with an operatively established nephrostomy, while percutaneous nephrostomy and subsequent dilation of the nephrostomy channel were done in 19. The rate of complete stone clearance was 19 of 20 stones after percutaneous nephrostomy and 8 of 16 stones in the group with an operatively established nephrostomy. The primary goal, to remove obstructing pelvic stones, was achieved in all cases. There were no untoward side effects, such as back pressure damage owing to flushing of the collecting system during ultrasound disintegration, or persistent…

Extracorporeal shock wave lithotripsy (ESWL): alternatives and adjuvant procedures

Within a short time, extensive statistics on ESWL have documented its efficiency in the treatment of most renal and ureteral stones. Approximately 20% of all stone patients, however, require additional or other forms of therapy, such as URS, PNL, or surgery. Up to now, the differential indications for these procedures have not been completely established. A crucial factor for successful application of ESWL is stone volume and localization. Large stones with a central stone mass may be successfully treated by combining ESWL and PNL, while surgery is still preferred in those with a peripheral stone mass.

Probleme der Stadieneinteilung beim fortgeschrittenen Blasentumor

Eine bis zu 50% reichende Unterschatzung der Blasencarcinome in den Stadien pTa bis hin zum Stadium pT3a, eine uber 50% reichende Uberschatzung der Stadien pT3b und pT4 und eine richtige Aussage in nur 44% der Falle kennzeichnen die Problematik der exakten klinischen Stadienerfassung von Blasentumoren in der „Vor-CT-Aera“ [2].

Local excision of urothelial cancer of the upper urinary tract.

Abstract In 9 of 93 patients (9.7%) with urothelial cancer of the upper tract (7 renal pelvis tumors, 3 ureteral tumors), conservative surgery was employed using a free peritoneal autotransplant for replacement of the renal pelvis in 5 kidneys. Absolute indications for conservative surgery were solitary kidneys/nonfunctioning contralateral kidneys in 4 patients and bilateral tumors in 1 patient. Local recurrences developed 1-3 years after operation in 4 of 6 kidneys (3 patients), 3 of which had grade-2 and grade-3 primary lesions. All patients were treated successfully by repeated local excision. In the presence of a normal contralateral kidney, local tumor excision was done electively in 4…

The impact of in-situ balloon occlusion of the renal artery and hypothermic perfusion on renal blood flow

Unilateral renal blood flow was evaluated in-situ in 13 dogs by cineangiodensitometry and microsphere distribution studies before and after intermittent balloon occlusion with and without hypothermic perfusion of one kidney. The contralateral kidney served as control. No significant difference in renal blood flow and vascular resistance was noted before, and 5, 30 and 60 minutes after unilateral intra-arterial manipulation. Compartmental flow distribution studies in 5 dogs revealed no evidence of alteration of intra-renal haemodynamics. In a clinical pilot study, unilateral renal blood flow measured by cineangiodensitometry showed no change of clinical significance 5 and 60 minutes after in…

The mainz-pouch (mixed augmentation ileum 'n zecum) for bladder augmentation and continent diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

The Mainz Pouch (Mixed Augmentation Ileum and Cecum) for Bladder Augmentation and Continent Diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

Die perkutane Nephrolitholapaxie

Der operativen Nierensteinentfernung sind trotz verbesserter Operationstechniken Grenzen gesetzt. Ein alternatives und wenig belastendes Verfahren ist die perkutane Steinextraktion. Diese Technik stutzt sich auf zwei Fakten: 1. Uber einen Nephrostomiekanal konnen Nierensteine wie Blasensteine mechanisch oder mit dem Ultraschall-Lithotriptor zertrummert und extrahiert werden; 2. die perkutane Nephrostomie, in Lokalanasthesie unter Ultraschall- oder Rontgenkontrolle durchgefuhrt, bietet Zugang zu Steinen beliebiger Lokalisation.

ESWL und Endourologie — Beginn einer Umstrukturierung im Erscheinungsbild des Harnsteinleidens?

Extrakorporale Stoswellenlithotripsie und endourologische Techniken erlauben durch die kurzen Hospitalisierungszeiten die Behandlung groser Patientenzahlen in kurzen Zeitraumen. An der Urologischen Universitatsklinik Mainz wurden in nur 21/2 Jahren — seit Einrichtung eines Stoswellenlithotriptors — von Dezember 1983 bis Juni 1986 2977 Steinpatienten behandelt, gegenuber nur 2468 Patienten von 1968 bis 1983. Eine Entwicklung, die an anderen Stoswellenzentren identisch ist. Da klinisch der Eindruck entstand, das sich im Zeitraum 1984–1986 das Erscheinungsbild des Harnsteinleidens verandert hat, wurden von den 2977 zuletzt behandelten Patienten Steinlage und-art (Ausgus-, Nierenbecken-, Kelch-…

Extracorporeal Shock Wave Lithotripsy of Ureteral Stones: Clinical Experience and Experimental Findings

AbstractESWL of impacted ureteral or caliceal stones is not as successful as expected. To study this problem a model for extracorporeal shock wave lithotripsy of ureteral stones has been designed. After initial fragmentation of the outer shell of impacted stones during the first series of shock wave application those fragments are kept in place by external mucosal contact, creating a lot of new interfaces.Absorption or reflection of shock wave energy within this fragmented shell seems to be responsible for the poor success rate in these cases. In regard to our experimental and clinical results we advise pushing ureteral stones back into the renal collecting system by means of a ureteral cat…

Hat die pelvine Lymphadenektomie im Rahmen der radikalen Zystektomie eine therapeutische Bedeutung?

Bei mehr als 270 Zystektomien seit 1968 stellt die pelvine Lymphadenektomie seit 1973 einen integralen Bestandteil der radikalen Zystektomie an unserer Klinik dar. Wir beginnen die Lymphadenektomie mit der Dissektion der iliacalen Lymphknoten, nach cranial bis zur Aortenbifurkation. Sie wird zwischen V.iliaca und Muskulus psoas fortgesetzt, wo die sakrale Lymphknotengruppe entlang des proximalen Anteils des N. obturatorius ausgeraumt wird. Dem Verlauf dieses Nervs folgend, schliest sich die Ausraumung der Fossa obturatoria an, welche die Lymphadenektomie beendet.

Karyotype analysis and marker chromosomes of renal cell carcinoma.

Karyotyping was performed in 46 human renal cell carcinomas of various histological grades. Controls included chromosome analysis of normal renal parenchymal cells from the same patients. Various numerical chromosome aberrations were found as well as marker chromosomes. They are specific of the individual tumor but no single marker was identified occurring in all tumors tested. Only trisomy 3 was found in different tumors (31%), suggesting a more general character of this aberration. Histological dedifferentiation and large tumor size correlate with focusing of the karyotype towards distinct chromosomal modes indicative of distinct tumor cell subclones within these tumors. Their rapid growt…

Radical Cystectomy - Often Too Late?

From 1967 to 1985, 246 cystectomies for treatment of transitional cell carcinoma of the urinary bladder were performed. Perioperative mortality decreased from 15% in the early years to 0% in 1985. Preoperative radiotherapy was not given. Patients who underwent cystectomy immediately following the diagnosis of invasive bladder carcinoma had a significantly better prognosis than those having cystectomy after recurrence of a transurethrally resected invasive carcinoma in spite of identical G and T criteria. A total of 26 patients who were cystectomized because of tumor recurrence after definitive radiotherapy (salvage cystectomy) represented the group with the worst prognosis: they had a 5-yea…