[Indinavir urolithiasis in HIV-positive patients. Treatment and prophylaxis]. / Indinavir-Urolithiasis bei HIV-positiven Patienten. Behandlung und Prophylaxe.

TARGET: The approximate incidence of indinavir urolithiasis in HIV positive patients receiving the drug is 10%. The exact mechanism of lithogenesis is still unknown. Pure indinavir stones are radiolucent on plane abdominal X-ray or CT scan. Indinavir urolithiasis can be associated with acute unilateral renal colic or severe azotaemia. MATERIAL AND METHODS: 20 HIV patients were treated conservatively by increasing oral fluid intake (urine production of 2 l/day and more), discontinuation of indinavir therapy for 1 week and acidification of urine with l-methionin (urine pH 5,3-5,8). Some patients were additionally treated with endoscopic procedures. RESULTS: In all patients renal function normalized. Increase of oral fluid intake, especially during the first 2 hours after intake of indinavir and during night prevented recurrence of indinavir urolithiasis. CONCLUSION: HIV positive patients with renal colic or renal insufficiency and roentgenological absence of radio-opaque stone formations should make the urologist consider indinavir urolithiasis as a possible diagnosis.

Polymeric controlled delivery for immunization.

Current vaccine technology has limitations; for example, most vaccines require repeat administration for long-term protection, and immunity at mucosal surfaces is difficult to achieve. In animal models, polymeric controlled-release systems provide long-lasting systemic or mucosal immunoprotection, often after a single administration. Polymeric devices that deliver a controlled amount of antibody can provide passive immunity against genital herpes infections in mice; orally administered polymeric-microsphere-based vaccines produce enhanced immune responses in rodents and primates. These new delivery technologies have many desirable features, and so their use in humans could have a substantial impact on worldwide public health.

Neutrophil motility in extracellular matrix gels: mesh size and adhesion affect speed of migration.

Polymorphonuclear leukocyte (PMN) migration through tissue extracellular space is an essential step in the inflammatory response, but little is known about the factors influencing PMN migration through gels of extracellular matrix (ECM). In this study, PMN migration within reconstituted gels containing collagen type I or collagen type I supplemented with laminin, fibronectin, or heparin was measured by quantitative direct visualization, resulting in a random motility coefficient (mum a quantitative index for rate of cell dispersion) for the migrating cell population. The random motility coefficient in unsupplemented collagen (0.4 mg/ml) gels was approximately 9 x 10(-9) cm2/s. Supplementing gels with heparin or fibronectin produced a significant decrease in mu, even at the lowest concentrations studied (1 microgram/ml fibronectin or 0.4 microgram/ml heparin). At least 100 micrograms/ml of laminin, or 20% of the total gel protein, was required to produce a similar decrease in mu. Scanning electron microscopy revealed two different gel morphologies: laminin or fibronectin appeared to coat the 150-nm collagen fibers whereas heparin appeared to induce fiber bundle formation and, therefore, larger interstitial spaces. The decrease in mu observed in heparin-supplemented gels correlated with the increased mesh size of the fiber network, but the difference observed in mu for fibronectin- and laminin-supplemented gels did not correlate with either mesh size or the mechanical properties of the gel, as determined by rheological measurements. However, PMNs adhered to fibronectin-coated surfaces in greater numbers than to collagen- or laminin-coated surfaces, suggesting that changes in cell adhesion to protein fibers can also produce significant changes in cell motility within an ECM gel.

[67Ga scintigraphy in retroperitoneal fibrosis (RPF): indications, application and clinical relevance--report of five patients]. / 67Ga-Szintigraphie bei retroperitonealer Fibrose (RPF): Indikation, Durchführung und klinische Bedeutung.

AIM: The aim of the study was to evaluate the indication for 67Ga-citrate imaging and its clinical impact on patients with retroperitoneal fibrosis (RPF). METHOD: The scanning with ventral and dorsal projections was done 48 an 72 h after i.v.-injection of 370 Mbq 67Ga-citrate. RESULTS: In the 5 patients with idiopathic RPF included in the study, there was a remarkably high correlation between the clinical symptoms, the surgical and histologic findings, the activity of the disease and the results of 67Ga-scintigraphy. CONCLUSION: While CT and--maybe even better--MRI might perfectly show the extension, shape and contour of the fibrotic tissue, Gallium-67 scan appears to be superior in assessing the intensity and activity of the disease process.

[Spectrum of morphologic findings in cystectomy specimens]. / Spektrum der morphologischen Befunde an Zystektomiepräparaten.

A report of 64 cystectomy specimens is presented with emphasis on the macroscopic tumor pattern of the urinary bladder carcinoma. From gross observations bladder cancer gives a wide spectrum: unifocal or multiple papillary, mostly superficial carcinomas, nodular tumors more or less deeply invading the bladder muscle, flat carcinomas, widespread diffuse carcinomas with infiltration of the whole bladder wall, flat ulcers with or without tumor rest after TUR, and tumors almost filling the whole bladder and destroying the bladder wall; miscellaneous tumours were also observed. In 3 cases bladder cancer arose from the lumen of one or more diverticula. This study describes the features presented at the time that patients underwent radical cystectomy in early as well as in advanced stages.

[Carcinosarcoma of the urinary bladder]. / Zum Karzinosarkom der Harnblase.

A female patient is presented who had a large carcinosarcoma of the urinary bladder that became clinically manifest only 2 months before treatment. The initial treatment by transurethral resection was followed by radical cystectomy; 7 months postoperatively the patient died of local tumour recurrence with widespread metastases. Carcinosarcoma of the urinary bladder is a rare tumour with a poor prognosis. The majority of such tumours are not diagnosed until tumour growth is already far advanced. Owing to the small number of cases there is no clinically proven form of management. In contrast with superficial transitional cell carcinoma of the bladder, superficial carcinosarcoma of the bladder has always invaded the lamina propria, since in addition to the carcinomatous degeneration of the mucosa, sarcomatous degeneration of the underlying submucosal stroma is also present. Any local surgical treatment, such as TUR or partial cystectomy, involves the risk of incomplete tumor removal, because the sarcomatous elements typically invade the submucosa while the overlying mucosa remains intact. Therefore, radical cystectomy appears to be the treatment of choice for both superficial and invasive carcinosarcoma of the urinary bladder.

[CT findings and CT-guided puncture of a perineal cyst]. / CT-Befunde und CT-gezielte Punktion einer perinealen Zyste.

CT findings and treatment results after CT-monitored surgery of a large perineal cyst are described. This was identified as a Müllerian duct cyst which is considered--according to world literature--to be a great rarity. The high rate of relapses even on instillation of sclerosing solutions, as well as differential diagnosis in relation to other perineal cystic space-occupying growths, are discussed.

Simultaneous determination of six tumor markers in patients with prostatic carcinoma and bladder tumors.

Serum levels of fucosyltransferase (FT), phosphohexoseisomerase (PHI), tissue polypeptide antigen (TPA), Tennessee antigen (TAG), carcinoembryonic antigen (CEA) and prostatic acid phosphate (PAP) were determined in 75 healthy individuals and in 86 patients with prostatic carcinoma and 38 patients with bladder tumors. The discrimination capacities of the different markers were compared by using inverse distribution plots. At a rate of 5% false positive values the sensitivities for bladder tumors were: FT 30%, TPA 24%, CEA 16%, TAG 15%. The sensitivities for prostatic carcinoma were: PAP 63%, PHI 36%, TPA 18%, CEA 14%, TAG 14%.

Active sodium transport across the epithelium of the human kidney pelvis. Part 1.

To clarify whether the epithelium of the human urinary tract possesses an active transepithelial sodium transport, the unidirectional sodium fluxes and the electrical parameters of the epithelium were determined on isolated pieces of renal pelvis. The epithelium was incubated in isotonic Ringer's solution at 37.3C in Ussing-type chambers. The transepithelial potential difference was found to be 15.8 +/- 3.0 mV and the transepithelial electrical resistance 760 +/- 48 omega . cm.-2. The transepithelial, unidirectional sodium fluxes were measured under short-circuit conditions. From both the unidirectional sodium influx from the luminal to the serosal side (7.01 +/- 2.17) and from the efflux in the opposite direction (0.45 +/- 0.07) a transepithelial sodium net flux of 6.56 +/- 2.20 nmol. . minutes-1. cm.-2 was calculated. Since there are no passive forces across the epithelium under short circuited conditions to explain the net flux, an active sodium transport has to be postulated. In all experiments, the simultaneously measured short circuit current (6.43 +/- 2.18 nmol. . minutes-1 . cm-2) was not significantly different from the net sodium flux, and can therefore be taken as a measure of the net flux.

[Traumatic renal vein thrombosis]. / Traumatisch bedingte Nierenvenen-Thrombose.

Two female patients with left renal vein thrombosis are reported. In one case, the thrombosis was induced by preoperative selective renal vein phlebography for diagnosis of a perirenal tumor. The thrombosis was then detected intraoperatively. In the other case, the thrombosis was caused by traumatic avulsion. Predominantly, left renal vein thrombosis is treated conservatively. Both patients were operated, however. The operation of the first patient was indicated because of the operative tumor therapy. Relaparotomy of the second patient led to nephrectomy due to kidney contusion.

[Aggressive fibromatosis]. / Aggressive Fibromatose.

On the basis of examinations made in 16 patients, morphological and clinical aspects as well as aetiology and therapy of desmoid tumours are discussed. For the first time human lymphocyte antigens (HLA) were determined, pointing to a genetic predisposition. Guide-lines for the surgical management are established. Hormonal, cytostatic and irradiation therapy are evaluated.

[Unrecognized traumatic rupture of the diaphragm (author's transl)]. / Diagnostische Problematik verspätet erkannter traumatischer Zwerchfellrupturen.

20 cases of rupture of the diaphragm (one due to direct trauma, the other 19 due to indirect trauma) which were not recognized at the time of the accident are described. The reasons for the delay in diagnosing the true nature of the condition and the misleading complaints caused by the unrecognized injury are reviewed. Essential diagnostic measures are discussed and guide-lines are suggested to ensure the early diagnosis of rupture of the diaphragm.