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Automated image analysis DNA cytometry in testicular cancer

The value of automated DNA cytometry for differentiation of testis cancer was evaluated in 54 seminomas, 13 HCG-positive seminomas, and 48 embryonal carcinomas. Slices of paraffin embedded tissue were enzymatically digested and stained with Feulgen SITS after fixation on glass slides. Automated DNA cytometry was performed with a Modular Image Analysis Computer (MIAC). DNA histogram phenotpye and computed DNA indices were correlated with the different tumor types. The ratio of hypertriploid to hypotriploid increased from HCG-positive seminoma over embryonal carcinoma to seminoma. The following mathematical DNA indices were found to correlate with tumor type: mean ploidy, 2c deviation index, …

Die experimentelle Laser-assistierte Gefäßanastomose an großen Arterien

Nach der ersten Anwendung der Laserenergie zur Herstellung von Ge-fasanastomosen durch JAIN 1979 haben weitere Untersuchungen gezeigt, das diese Technik in Hinblick auf Thrombogenitat, Durchgan-gigkeitsraten, Fremdkorperreaktion und Entwicklung einer Intimahy-perplasie mit der konventionellen Nahttechnik vergleichbar oder dieser sogar uberlegen ist. Die meisten dieser Experimente haben sich im Mikrogefasbereich (< 2 mm) abgespielt, sodas hier die Frage bearbeitet wurde, ob diese Technik auch an groseren Arterien anwendbar ist und im Vergleich zur konventionellen Nahttechnik ein besseres Mitwachsen der Anastomose mit dem Organismus ermoglicht.

Extracorporeal shock wave lithotripsy with ultrasound-guided lithostar plus.

Abstract Since 1989, the Siemens lithostar plus, an upgrade of the lithostar with the ultrasonically guided overhead module, has been available for clinical use. This unit may be used for the treatment of either biliary or urinary calculi. We report on 75 patients with urinary calculi treated between March 1989 and June 1990 with the lithostar overhead module. Stone localization showed a rate of: caliceal stones 33.5%, pelvic stones 44%, upper ureteral stones 9.3% and lower ureter stones 13%. The overall disintegration rate was 86%, with a stone-free rate after 3 months of 78%.

Extent of Surgery in Rhabdomyosarcoma of Urogenital Structures

After high inguinal semicastration in group-1 paratesticular rhabdomyosarcoma (RMS), the patient having undergone chemotherapy can be followed closely by CT scanning without retroperitoneal lymphadenectomy. In contrast, retroperitoneal RMS should be operated on as radically as possible after downstaging the tumor mass. In RMS of the female genitalia locally limited organ-preserving surgery is the method of choice. The prognosis is excellent with adjuvant chemotherapy. Only 20% of all bladder RMS arise from the bladder dome or the movable part of the bladder, where primary partial resection including a safety margin of 3 cm of healthy tissue is possible. The majority, however, arising from t…

MR-Tomographie bei Hodenprozessen

The value of T1-weighted sequences after intravenous administration of Gd-DTPA and of T2-weighted sequences was compared in 43 patients suspected of having scrotal abnormalities. T2-weighted sequences gave better demonstration of the tunica albuginea and better contrast between tumor and parenchyma. The two techniques were equally sensitive for demonstrating testicular tumors but orchitis was better demonstrated on the contrast enhanced sequences. Motion artifacts were less marked in the T1-weighted sequences with contrast enhancement. In selected cases, contrast enhancement may be a valuable addition to native protocols. Our experience has indicated that MRI provides specific findings in c…

Reservoir characteristics of Mainz pouch studied in animal model

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 increas…

The Appendix as a Continence Mechanism

Although we have progressed very well in creating large capacity, low pressure reservoirs, the construction of a simple and reliable continent outlet still remains a problem. The appendix vermiformis serves well as a continence mechanism for either the bladder or intestinal reservoirs for urine. The different surgical techniques described in the literature are reviewed and discussed in this context. Moreover, we report on our clinical and experimental results of using the appendix during the Mainz pouch procedure for continent urinary diversion.

Komplikationen bei 229 retroperitonealen Lymphadenektomien

Im Rahmen einer retrospektiven Studie ermittelten wir Komplikationsrate, Komplikationsart und stadienabhangiges Verteilungsmuster der Komplikationen bei der retroperitonealen Lymphadenektomie (RPLA).

Die Ileozökalscheide

In 3 patients with vaginal aplasia respectively traumatic vaginal loss a neovagina was created out of the separated ileocecal segment. Advantages of this technique are the excellent blood supply of the ileocecal region and the long vascular pedicle. The additional application of terminal ileum for prolongation of the cecal vaginoplasty allows the tensionless anastomosis between neovagina and vulva even in patients with difficult anatomical conditions. The present paper gives a detailed description of the operative technique and the indications of the ileocecal vaginoplasty. Furthermore the common techniques for vaginal replacement are reviewed and discussed.

Laser welded vascular anastomosis

A comparative study was undertaken to investigate the application of a specially adapted microsurgical Neodymium Yag Laser system with a wavelength of 1,319 microns and a CO2 laser system for laser assisted microvascular end-to-end anastomosis (LAMA) of the rat femoral artery. Conventionally sutured anastomoses served as controls. Postoperative investigations included patency tests, light microscopy and tensile strength measurements. Both laser systems seem to be equally suitable for LAMA: The patency rates do not differ from those of sutured anastomoses and formation of microscopically small aneurysms occurred predominantly in control animals and only once in laser groups. The clamp time n…

Adriamycin Permeability of the Rat Bladder under Different Conditions

Abstract Fifty female Sprague-Dawley rats were treated with 1.4 or 2.4 mg. adriamycin intravesically. Radioimmunological measurement of serum concentrations were performed up to 3 hours post-instillation in normal bladder mucosa, cystitis, and after electrocoagulation, under different filling conditions, as well as with the use of a detergent (Tween 80). The serum concentrations achieved were markedly higher after electrocoagulation or cystitis; altogether they reached only 1/6,000 of the instilled concentration. These studies on the rat bladder suggest that perioperative instillation of adriamycin to prevent recurrence is not contraindicated shortly before or after transurethral resection …

Surgery in rhabdomyosarcoma of the bladder, prostate and vagina

The treatment of bladder and prostate rhabdomyosarcoma (RMS) is highly controversial. Aside from chemotherapy, treatment modalities include conservative surgery, radical surgery, and pre-, intra-, or postoperative irradiation. Between 1968 and 1993, 78 children with RMS were treated at our institution. In all, 22 tumors were located in the urogenital tract (bladder/prostate, 13; paratesticular, 5; vaginal, 2; others, 2). Altogether, 6 patients had stage II disease; 7, stage III disease; and 2, stage IV disease. All 15 patients with RMS of the bladder, prostate, or vagina received chemotherapy, and 4 had additional radiotherapy. Surgery was also done in 10 patients; parents refused an operat…

Postersitzung 10: Operative Techniken

Abdominale Wunddehiszenzen treten postoperativ mit einer absoluten Haufigkeit von 1–3% auf und sind mit einer Mortalitat von bis zu 35% belastet. Die postoperative Festigkeit der Abdominalaponeurose beruht bis zum 7. postoperativen Tag allein auf dem chirurgischen Faden. Die Reisfestigkeit des Wundverschlusses steigt dann durch die Wundheilungsvorgange bis zum 21. Tag schnell an. Nach einem Vierteljahr ist eine endgultige Festigkeit erreicht [2, 4]. Die vordere Bauchwand weist durch den Faserverlauf der drei seitlichen Bauchmuskeln und der sie fortsetzenden Aponeurosen eine vorwiegend quere Struktur auf (Abb. 1, 2, 3). Die Zugfestigkeit der Abdominalaponeurosen ist in querer Richtung 3mal g…

Permeability of the rat bladder to Cisplatinum under different conditions: comparison with Mitomycin C and Adriamycin.

In 50 female Sprague-Dawley rats the absorption of Cisplatinum through the bladder wall was studied. Under different conditions, including cystitis and electrocoagulation of the bladder mucosa, the absorption was low and the measureable serum concentrations did not exceed 2.64 micrograms/ml. The influence of Tween 80--a non-ionic surfactant--on the absorption is investigated. The results are compared with those found for Adriamycin and Mitomycin C under identical conditions.

The Buccal Mucosal Graft For Urethral Reconstruction: A Preliminary Report

Autologous buccal mucosa as a substitute for urethral epithelium was studied in 2 dogs and used in 6 patients with difficult urethral reconstruction problems. The indications for an operation in these patients were failed hypospadias repairs with limited skin in 3, severe structure disease after hypospadias repair in 1, a short urethra in 1 and epispadias in 1. Three urethral fistulas and 1 meatal stenosis occurred in 3 patients. No urethral stricture or diverticulum was noted, and the final outcome was good functionally and cosmetically in all patients. This technique is useful for urethral reconstruction when local skin is not available.

Laser — Klinische Anwendung

Der Neodym-YAG-Laser mit einer Emissionswellenlange von 1,06 μm besitzt eine hohe Penetrationstiefe ins Gewebe von ca. 5 mm mit einem homogenen Koagulationssaum. Bereits 1973 wurden von Mussiggang u. Mitarb. [3] Hautschnitte und Resektionen an Nieren, Leber und Milz im Tierversuch durchgefuhrt, die jedoch offensichtlich wegen der damals zur Verfugung stehenden Laserleistung von nur ca. 50 Watt nicht uberzeugend verliefen. Nach dem nunmehr der Neodym-YAG-Laser in der Urologie (insbesondere in der Behandlung des Blasentumorleidens und bei pathologischen Veranderungen am auseren Genitale) und anderen Fachdisziplinen nach Verbesserung des Instrumentariums und einer hoheren Leistung bei zahlreic…

Transpenile Venenokklusion zur Therapie der erektilen Impotenz

In 15 of 18 patients, 2 of them with previous surgery, transpenile venoablation was performed for treatment of erectile dysfunction due to cavernous leakage. In 4 this was combined with retrograde venooclusion via the internal iliac vein. In 4 patients normal erectile status could be obtained. In 3 other patients erections became possible with use of intracavernous vasoactive agents. In two only mild amelioration, and in two others no change of erectile dysfunction were obtained. Follow-up studies are yet missing in 3 patients. Complications of the procedure were not observed.

Surgical aspects of urolithiasis in children.

Operative management of renal calculi has changed radically in the last decade. New operative techniques. the use of intra-operative ultrasound and Doppler sonography have even made possible the removal of complete staghorn calculi in short and kidney-preserving procedures. The introduction of percutaneous nephrolithotomy and stone extraction using a specially designed ureteroscope and, above all, the clinical application of extracorporeal shock wave lithotripsy have made stone surgery less invasive and have provided a higher rate of preservation of kidney function.