Indwelling and transrenal splint techniques for pyeloplasty.

A report is presented on experience with 118 pyeloplasties using indwelling and transrenal splints. Detailed analysis of infections with both splint modifications has confirmed that better long-term results are achieved with internal drainage, due to the absence of potential contamination between splint and renal parenchyma which exists with external drainage.

Ultrasound guided percutaneous biopsy or operative biopsy in patients with renal impairment?

Sixty-four percutaneous renal biopsies under ultrasound guidance done in 60 patients with renal impairment are compared with 33 open, operative biopsies. In 62 percutaneous biopsies (96.8%), more than 3 glomeruli could be obtained. Eight biopsies (12.5%) presented with minor complications afterwards. All of them were spontaneously reversible. In the operative biopsy group, there were complications in 6 patients (18.2%). In 2 cases, operative revision was necessary. In conclusion, percutaneous ultrasound guided biopsy in experienced hands offers several advantages in patients with renal impairment. It must be kept in mind that from a minority of patients only an operative biopsy can be taken due to certain risks.

[Rare kidney tumours (author's transl)]. / Seltene Nierentumoren

In 508 patients with tumours of the kidney, 14 rare neoplasms has been found. These are analyzed with regard to diagnosis, therapy, and prognosis.

[Infection analysis in pyeloplasty with special reference to endoprosthesis]. / Infektanalyse bei Nierenbeckenplastiken unter besonderer Berücksichtigung der Endoprothese

An analysis of urinary infection in pyeloplasties with the inner splinting method as opposed to external drainage was done. Five main bacterial groups were found. Based on the author's studies there are better results with the "endoprothesis". Preferring this modification, the question of the then existing reflux is discussed.

[Renal dysplasia combined with ureter duplex and vesica duplex (author's transl)]. / Einseitige Nierendysplasie mit Doppelureter und Doppelblase.

A case of a 29-year-old man with left renal dysplasia, ureter duplex and vesica duplex is presented. Clinical aspects, therapy and pathogenesis are discussed.

[Experience with the internal splinting method (endoprosthesis) (author's transl)]. / Erfahrung mit der inneren Schiene (Endoprothese)

We have used internal splints for 20 years; the endoprosthesis creates an internal urinary diversion of dilatated kidneys due to incurable gynecological, prostatic and bladder cancer. Also in pyeloplasties, difficult stone operations and retroperitoneal fibrosis the pyelovesical splinting method is useful. Scanning electron microscopic research shows that incrustations are rare and even not existing if siliconised polyvinylchlorid (PVC) splints are used. The so called "pig-tail"-splint (double-JTM-ureteral stent) is of pure silicone material and therefore well fit for therapy even over a longer period.

[Inner pyelovesical splinting in pyeloplasties (author's transl)]. / Innere splintung (Endoprothese) bei Nierenbeckenplastiken

A total of 112 cases of pyeloplasty were analyzed and the advantages of inner pyelovesical splinting as opposed to external drainage are outlined. Long-term results especially favor the former procedure. Scanning electron microscopic studies were done on the splinting material.

[Case of a malignant angiolipoleiomyoma of the kidney -- angiographic and pathohistologic findings in hamartomas of the kidney (author's transl)]. / Maligne entartetes angiolipoleiomyom der Niere--Renovasographie und Pathohistologie bei Nierenhamartomen

A malignant angiolipoleiomyoma and two benign angiomyolipomas are analyzed. Angiography and pathohistology are opposed. The renovasographic signs of these tumors are not specific for hamartomas and similar to those of hypernephroid carcinoma.

[Collateral circulation through uretral arteries caused by chronical central renal artery obstruction (author's transl)]. / Kollateralkreislauf über Ureterarterien bei chronischem Verschluss der zentralen Nierenarterie.

In 48-year old hypertonic patient, angiography showed obstruction of the right renal arterial ramus ventralis. Collateral circulation, especially through the ureteral plexus and lumbal arteries, developed. Differential diagnosis, embryologic background, and therapy are discussed.

[Unusual benign and malignant ureteral stenosis. Causes, therapy and clinical course]. / Seltene gut- und bösartige Harnleiterstenosen. Ursachen, Therapie und Verlauf.

In 652 patients with ureteral stenoses treated in the last 23 years we found 12 (1.8%) patients with rare benign and 5 (0.7%) patients with rare malignant diseases resulting in ureteral stenoses. Causes, clinical symptoms, diagnostic procedures and pathohistological findings are analysed and discussed with emphasis on the pathohistological diagnosis. Operative procedures are demonstrated and long term follow-up studies presented.

[Indication and clinical value of vesiculodeferentography concerning urologic-andrologic diseases (author's transl)]. / Indikation und Bedeutung der Vesiculo-Deferentographie bei urologisch-andrologischen Erkrankungen.

There are 29 cases of vesiculodeferentography (VDG) (1962-1975) presented. The very indication of VDG was the evaluation of azoospermia due to occlusion of the vas deferens, in addition to other urologic diseases. Especially from the andrologic point of view the various forms of occlusion-azoospermia are classified and analyzed. It is pointed out, that the rete testis region is not to be elucidated by VDG.

[Mucouria in urachal adenoma (author's transl)]. / Mucourie bei Urachusadenom

Recurrent macrohematuria and massive mucous flow from the urethra have been observed in a 81-year-old woman. Cystoscopy reveals a tumor of about pea-size in the apex of the bladder, which is histologically classified as an urachal adenoma. Clinical aspects and pathogenesis are discussed.

[Results after varicocelectomy Palomo's operation (author's transl)]. / Untersuchungen zur Varikozelenoperation nach Palomo.

123 patients with fertility problems were examined after 6 months, 1 year and more than 1 year, postoperatively following Palomo's operation. Preoperative semen analysis was done in all cases. The most important aspects of this study are: 1. Excellent quality of semen characteristics after the first 3 postoperative months. 2. Reduced semen quality during the following time. 3. Most frequent complication was a aseptic epididymitis which could be caused hemodynamically. 4. Necrosis of the testicle was never observed.

[Viable cells from human renal cell carcinoma: isolation procedure and analysis of hormone sensitivity (author's transl)]. / Vitale Nierenkarzinomzellen: Isolierungsmethode und Untersuchung der Hormonempfindlichkeit.

An enzymatic procedure for the isolation of metabolically active tumour cells from human renal cell carcinoma is described. The cells were suspended by a multistep incubation procedure of the tissue in the presence of collagenase (10 mg enzyme/g tumour wet weight) dissolved in a calcium-free buffer solution. About 90% of the isolated tumour cells were viable, as judged by routine trypan blue staining. Electron microscopic examination revealed tumour cells in various stages of dedifferentiation. The cells had retained their capability of protein synthesis. In short term experiments the effects of 17 beta-oestradiol and progesterone on the incorporation of [U - C] L-leucine into cellular proteins was studied; Progesterone was found to exhibit a slight tumour antianabolic or catabolic action. A 17 beta-oestradiol-dependent modulation of the rates of protein synthesis was not observed.

[Pain relief by means of continuous epidural analgesia after retroperitoneal lymph node dissection (author's transl)]. / Schmerzbekämpfung nach retroperitonealer Lymphadenektomie mit Hilfe der kontinuierlichen Epiduralanalgesie.

A retrospective study compares the effectiveness of postoperative epidural analgesia with conventional analgetic medication in cases of retroperitoneal lymph node dissection. Epidural analgesia is noted for its reduced need for additional medication and for its lower incidence of complications.

[In vitro perfusion of so-called endoprothesis. An experimental study of incrustations on internal splinting plastic tubes (author's transl)]. / In vitro Urin--Perfusion von Endoprothesen. Eine Studie zu Inkrustationstendenzen in Kunststoffschläuchen.

We have used the method of internal splinting of the ureter (endoprothesis) for the past ten years. Because we observed partial obstruction of the lumen by incrustations and/or fibrin coagula in cases in which the splints had been in place for long periods, we conducted in vitro experiments into the problem. Under constant and variable conditions, urine was perfused through plastic tubes of different materials. Organic and inorganic urine substances and urine pH were analyzed. The materials used were examined with special scanning electron microscopic techniques, and various depositions, especially in comparisons of in vivo and in vitro conditions, were found.

[Horners syndrome. A complication of the lateral recumbent position (author's transl)]. / Horner-Syndrom. Eine Komplikation der Seitenlagerung.

The appearance of a unilateral Horner's syndrome after an anesthetic in the lateral recumbent position is reported. It was caused by a damage to the sympathetic nerve at the level of Th 1 probably due to the extreme lateral flexion of the cervical vertebral spine. The importance of correct positioning of the head during anesthesia is stressed.

[Clinical and genetic aspects of the horseshoe kidney (author's transl)]. / Klinisch-Genetische Aspekte der Hufeisenniere

The horseshoe kidney is a not so rare fusion anomaly of the urinary tract system. Clinical and genetic aspects of this phenomenon are shown in a case of familiar occurrence. Genetic consultation of the family must consider various inheritable possibilities and sources of this disease. The difficulty of an exact genealogical tree analysis is pointed out.

The endocrine background of human renal cell carcinoma. I. Binding of the highly potent progestin R 5020 by tumour cytosol.

Based on the potential sensitivity of the growth of human renal cell carcinoma, tumour tissue from 88 patients was analysed for progestin receptors. With the dextran-coated charcoal assay, cytoplasmic components which bound the potent progestin R 5020 specifically and with high affinity could be detected in 42% of the carcinomas. The apparent dissociation constant of the R-5020-binder complex amounted to 3.1 +/- 1.2 X 10(-8) mol/l. Sedimentation in sucrose gradients revealed the bulk of these components to be in the 4-S region. The ligand specificity for binding to these sites indicated a requirement for progestins. Despite the enormous case material investigated, we were unable to confirm the presence of the high receptor concentrations reported in the literature.

The endocrine background of human renal cell carcinoma. II. Attempt to induce the R-5020-binding components by oestrogens.

In an attempt to elevate the concentration of progestin-binding components in human renal cell carcinoma, 24 patients were treated prior to tumour nephrectomy with various doses of oestrogens, potent inducers of progestin receptor synthesis. Low-dose oestrogen treatment was found to be insufficient to significantly induce progestin-binder synthesis in the tumour tissue. In the carcinoma of patients receiving high-dose oestrogen treatment, the average concentration of R-5020-binding sites did not differ from that of the low-dose group. However, 2 out of these patients (12.5%) exhibited R-5020-binder concentrations in the tumour tissue which exceeded the highest quantities of progestin-binding components found in 88 untreated controls previously analysed in our laboratory.