Hadamard-Transform Fluorescence Excitation-Emission-Matrix Spectroscopy.

We present a fluorescence excitation-emission-matrix spectrometer with superior data acquisition rates over previous instruments. Light from a white light emitting diode (LED) source is dispersed onto a digital micromirror array (DMA) and encoded using binary n-size Walsh functions ("barcodes"). The encoded excitation light is used to irradiate the liquid sample and its fluorescence is dispersed and detected using a conventional array spectrometer. After exposure to excitation light encoded in n different ways, the 2-dimensional excitation-emission-matrix (EEM) spectrum is obtained by inverse Hadamard transformation. Using this technique we examined the kinetics of the fluorescence of rhodamine B as a function of temperature and the acid-driven demetalation of chlorophyll-a into pheophytin-a. For these experiments, EEM spectra with 31 excitation channels and 2048 emission channels were recorded every 15 s. In total, data from over 3000 EEM spectra were included in this report. It is shown that the increase in data acquisition rate can be as high as [{n(n + 1)}/2]-fold over conventional EEM spectrometers. Spectral acquisition rates of more than two spectra per second were demonstrated.

Predictive factors for urinary retention following kidney transplantation in male patients.

OBJECTIVE: Urinary retention frequently occurs in patients after kidney transplantation. This study aimed to identify predictive factors for urinary retention requiring transurethral resection of the prostate (TURP) following kidney transplantation. MATERIAL AND METHODS: Seventy male patients (median age 56 years, range 37-73 years) who underwent kidney transplantation between 1995 and 2006, and experienced urinary retention and consecutively required TURP, were studied retrospectively. Residual diuresis before transplantation, duration of dialysis, patient age, prostate size, rejection reactions, transplant loss, combined kidney and pancreas transplantation, type 1 and 2 diabetes mellitus, and carcinoma of the prostate were evaluated as predictive factors. RESULTS: Duration of dialysis longer than 120 months (p = 0.0174), patient age over 60 years (p = 0.0045) and the absence of diabetes (n = 46, p = 0.0029) were associated with a significantly higher risk of urinary retention requiring TURP following kidney transplantation. Residual diuresis, prostate size, frequency of rejection reactions, transplant loss and detection of carcinoma, however, could not be identified as predictive factors. CONCLUSIONS: In male patients after kidney transplantation with a long history of dialysis, early TURP due to urinary retention must be anticipated. Surprisingly, the presence of type 1 or 2 diabetes seems to prevent the occurrence of retention, independently of age.

Polymorphism 1558 C > T in the aromatase gene (CYP19A1) in low-grade endometrial stromal sarcoma.

Low-grade endometrial stromal sacomas (ESS) are estrogen-sensitive tumors. Polymorphic variation in the CYP19 gene can affect estrogen synthesis by increasing aromatase activity resulting in elevated levels of estrone and estradiol. We examined the polymorphism 1558 C > T in he aromatase gene (CYP19A1) in a series of 20 low-grade endometrial stromal sarcomas. Archival formalinfixed and paraffin-embedded material was analyzed with a fast real-time PCR system. The homozygous C/T- and the homozygous mutant T/T-genotypes were detected in 10/20 (50%) and 7/20 (35%) samples, respectively. Polymorphism 1558 C > T in the aromatase gene may represent a high-risk allele with increased local estrogen levels.

European consensus statement on essential colposcopy.

This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.

Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi >2 cm.

The objectives of this study are to assess the efficacy and safety of retrograde ureteroscopic holmium laser lithotripsy for intrarenal calculi greater than 2 cm in diameter. A total of 24 patients with a stone burden >2 cm were treated with retrograde ureteroscopic laser lithotripsy. Primary study endpoints were number of treatments until the patient was stone free and perioperative complications with a follow-up of at least 3 months after intervention. In 24 patients (11 women and 13 men, 20-78 years of age), a total of 40 intrarenal calculi were treated with retrograde endoscopic procedures. At the time of the initial procedure, calculi had an average total linear diameter of 29.75 ± 1.57 mm and an average stone volume of 739.52 ± 82.12 mm(3). The mean number of procedures per patient was 1.7 ± 0.8 (range 1-3 procedures). The overall stone-free rate was 92%. After 1, 2 and 3 procedures 54, 79 and 92% of patients were stone free, respectively. There were no major complications. Minor postoperative complications included pyelonephritis in three cases (7.5%), of whom all responded immediately to parenteral antibiotics. In one patient the development of steinstrasse in the distal ureter required ureteroscopic fragment disruption and basketing. Ureteroscopy with holmium laser lithotripsy represents an efficient treatment option and allows the treatment of large intrarenal calculi of all compositions and throughout the whole collecting system even for patients with a stone burden of more than 2 cm size.

Minimizing complications during retropubic radical prostatectomy - Is ureteral stenting necessary?

OBJECTIVES AND AIMS: To avoid damage to the ureters during bladder neck preparation in radical prostatectomy for prostate cancer, it may be helpful to insert ureteral stents temporarily or to intravenously administer indigo carmine dye for enhanced visualisation of ureteric orifices. We evaluated our bladder neck preserving technique at radical prostatectomy with regard to ureteric injuries. PATIENTS AND METHODS: We analysed 369 consecutive radical prostatectomies operated in our clinic in a bladder neck preserving technique. The following parameters were assessed in this retrospective study: number of prophylactic ureteric stent insertions, application of indigo carmine dye, observed injuries of the ureters by the surgeon, postoperative increase of serum creatinine and postoperative status of kidney ultrasound. RESULTS: In 7/369 prostatectomies (1.90%) a ureteric stent insertion was performed, indigo carmine was not applied to any patient at all, yet no intraoperative injury of a ureter was observed by a surgeon. No revision was necessary due to a ureteral injury within the observation period of one year after surgery. In 17 patients with preoperative normal creatinine value a pathological value was observed on the first postoperative day (mean 1.4 mg/dl). In these patients no consecutive postrenal acute renal failure was observed, no hydronephrosis was monitored by ultrasound and no further intervention was necessary. CONCLUSIONS: Bladder neck preserving operation technique does not implicate the need of prophylactic ureteric stent insertions and has no higher incidence of ureteric injuries.

Comparison of guideline recommendations with daily practice in patients with renal cell carcinoma.

OBJECTIVES AND AIMS: To compare guideline recommendations with daily practice patterns in a German patient cohort with renal cell carcinoma. PATIENTS AND METHODS: 81 patients with T1 oder T2 renal cell carcinoma (RCC) were included in this prospective single-center study. All patients were operated in a single institution either by open radical nephrectomy (ORN) or nephron sparing surgery (NSS). Patients and doctors were evaluated using a written questionnaire with a follow-up of 12 months. Follow-up intervals, follow-up modalities (e. g. imaging modalities, laboratory controls of blood and urine) and the call on psycho-oncological support were evaluated. RESULTS: The majority of patients (72%) were followed up by their urologists. Follow-up examinations included abdominal ultrasound, urine and blood diagnostics, conventional chest x-rays, computed tomography (CT) of abdomen, chest or head or abdominal Magnetic Resonance Imaging (MRI). There were no significant differences between patients operated by ORN or NSS. In total, 12.5% of patients were asking for psycho-oncological support. CONCLUSIONS: In general, patients were followed up according to existing guideline recommendations. Only a small proportion of patients asked for psycho-oncological treatment.

DNA cytometry as a first-line method for diagnosis of cervical precancer with respect to clinical behaviour.

BACKGROUND: The objective of this study was to estimate DNA image cytometry (DNA-ICM) as a first-line diagnostic method for diagnosis of cervical precancer with respect to its clinical behaviour. METHODS: 30 consecutive patients with Papanicolaou smears that yielded diagnoses of LSIL or HSIL and showed single cell or stem line aneuploidy were included in a prospective cohort study. Slides were classified according to the Bethesda system. DNA-ICM was performed according to the consensus reports of the European Society of Analytical Cellular Pathology. RESULTS: 24 (80%) patients with DNA aneuploid cervical epithelial cell abnormalities had cervical intraepithelial neoplasia (CIN) (CIN I: n = 5; CIN II: n = 6; CIN III n = 13). Six (20%) patients showed no evidence of CIN in subsequent biopsies. During follow-up of three years none of the six patients with negative histology developed cervical precancer or cancer. All 24 (100%) lesions confirmed as CIN by histology showed DNA aneuploidy in cytology. CONCLUSIONS: DNA-ICM should be used as an objective first-line diagnostic tool for predicting cervical precancer. Yet, due to immune response, DNA aneuploid cervical cell abnormalities do not seem to be enough to predict the definitive clinical outcome in each patient.

High levels of xenoestrogens in patients with low-grade endometrial stromal sarcoma--report of two cases.

BACKGROUND: Endometrial stromal sarcomas (ESS) are rare uterine tumors with unknown etiological risk factors, but estrogen-dependent growth promotion. CASES: We present two patients with advanced ESS, who had increased levels of p,p-DDE; hexachlorobenzene; PCB 28; PCB 52; PCB 101; PCB 138; PCB 153 and PCB 180 in abdominal adipose tissue. Other xenoestrogens were within expected limits for the non-exposed European population. CONCLUSION: Increased levels of xenoestrogens in patients with ESS may be involved in the pathogenesis of ESS. Chronic exposure to xenoestrogens may be a risk factor for tumor progression.

[Injury of ICA during endonasal sinus surgery and management by endovascular stent application]. / Verletzung der ACI bei Nasennebenhöhlenoperation und Management durch endovaskuläre Stentapplikation.

BACKGROUND: Injury of the internal carotid artery (ICA) during endonasal sinus surgery is rare but a life-threatening situation for the patient. For adequate treatment endovascular therapy as embolization or balloon occlusion is usually performed although there is a high risk of irreversible neurological deficits. CASE REPORT: We report on a twenty-five-year-old female patient with acute exacerbated chronic polyposis nasi suffering from an injury of the ICA during endonasal sinus surgery. After intraoperative identification of the site of hemorrhage the massive bleeding could temporarily be controlled by a nasal pack. The woman was immediately transferred to a neuroradiological department. After angiographic localization of the vessel defect the bleeding could be stopped by application of a vascular stent without any neurological deficits during or after the procedure. Anatomical characteristics of the ICA in the sphenoid sinus, and recommended emergency treatment and preventive measures are discussed. CONCLUSION: Although vascular stents are difficult to place in the intrasphenoidal course of the ICA, it provides an effective closure of the vascular injury and above all a sufficient cerebral perfusion, therefore, the risk of neurological defects can be reduced.

[Laser vaporization of the prostate: all as it should be?]. / Laservaporisation der Prostata: Alles im grünen Bereich?

Laser vaporization of the prostate currently occupies a prominent place among the surgical options for treatment of benign prostatic syndrome. Particularly the so-called GreenLight laser vaporization with the KTP (80 W) or LBO (120 W) laser has become remarkably widespread throughout the world. There are already 100 of these GreenLight laser systems in use in Germany alone. The introduction of a separate DRG for "laser vaporization" is expected to further increase the significance of this surgical technique. The aim of this study is to evaluate laser vaporization as a whole and to identify possible differences between the different lasers.

[Organ-sparing surgery for penile cancer]. / Organerhaltende Chirurgie des Peniskarzinoms.

In patients with penile cancer health-related quality of life is closely related to organ-sparing surgery. To achieve an ideally suited treatment modality for this rare but aggressive tumor entity different operating techniques like micrographic surgery, laser treatment, and glansectomy were developed. These should offer optimal oncological treatment while preserving sexual function. This article gives an overview of indications and limits of organ-sparing treatment in penile cancer.

[Technical aspects of intraoperative assessment of treatment progress in laser lithotripsy]. / Technische Aspekte zur intraoperativen Bewertung des Behandlungsfortschritts bei der Laserlithotripsie.

BACKGROUND: During laser-induced fragmentation, differences in assessing the intraoperative results can depend on the individual characteristics of the laser system used. METHODS: Laser parameters like pulse energy and repetition rate, the penetration depth in silicon tissue, and the laser beam width on photographic paper were determined for three different clinical laser systems. RESULTS: Pulse energy and repetition rate were subject to variations depending on the laser system employed. Significant differences between the three devices were found for penetration depth in silicon and interaction. CONCLUSIONS: Further investigations to ascertain the ablation threshold and fragmentation rate can be based on these findings. Intraoperative assessment of the lithotripsy results should take technical aspects of the laser equipment, stone consistency, and the surgeon's experience into consideration.

[PDE5 inhibitors. A new option in the treatment of ureteral colic?]. / PDE-5-Inhibitoren. Ein neuer Therapieansatz in der Behandlung der Harnleiterkolik?

BACKGROUND: PDE5 inhibitors represent the gold standard in the medical therapy of erectile dysfunction (ED). Promising results have been published regarding further urological indications such as treatment of ureteral colic. The aim of the present study was to evaluate the functional effects of the PDE5 inhibitors sildenafil (SIL), vardenafil (VAR), and tadalafil (TAD) on tissue tension and cyclic nucleotide levels of human ureteral smooth muscle segments in vitro. METHODS: Relaxant responses of human ureteral smooth muscle were investigated in vitro using the organ bath technique. Cyclic nucleotides cAMP and cGMP were determined by specific radioimmunoassays. RESULTS: Relaxing effects of ureteral muscle tension were observed in the rank order VAR>SIL>TAD. While only VAR significantly elevated cGMP levels 3.3-fold over control, no increase for cAMP levels was observed. CONCLUSIONS: Our data provide evidence that cGMP is involved in the control of the normal function of the smooth musculature of the human ureter. Our findings suggest the potential of using selective inhibitors of PDE isoenzymes in the treatment of ureteral colic.

[Diode laser. Ex vivo studies on vaporization and coagulation characteristics]. / Der Diodenlaser. Ex-vivo-Untersuchungen zu den Vaporisations- und Koagulationseigenschaften.

INTRODUCTION AND OBJECTIVES: Laser therapy of symptomatic benign prostatic hyperplasia (BPH) remains a challenge for most urologic surgeons. The main goal of laser surgery is to achieve a marked volume reduction and to decrease bladder outlet obstruction and lower urinary tract symptoms with minimal morbidity. Laser therapy encompasses a variety of techniques using different laser wavelengths, application systems, and surgical techniques to achieve contrasting tissue effects. In an in vitro animal model we compared the vaporization and coagulation effects of the potassium-titanyl-phosphate (KTP) laser, holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and diode laser (980 nm). MATERIAL AND METHODS: In an in vitro model using isolated perfused porcine kidneys we investigated the vaporization, the coagulation effect, and the bleeding rate of the KTP, Ho:YAG, and diode lasers on five porcine kidneys each. The application of each laser type was standardized. The area of laser application was 1 cm x 1 cm. The KTP group received an application with 80 W, the Ho:YAG group an application with 10-30 W, and the diode group an application with 30, 60, and 100 W. Hemostasis was measured semiquantitatively. Ablation and coagulation were investigated macro- and microscopically. RESULTS: Concerning the ablation capacity, the diode laser is most effective (more than fivefold) compared to the KTP and Ho:YAG lasers but demonstrated a rather large coagulation zone of up to tenfold in comparison to the KTP and Ho:YAG lasers. Semiquantitatively, in terms of bleeding rate, all lasers were equivalent in this ex vivo model. CONCLUSIONS: Our very early and limited experience indicates that KTP (80 W) and Ho:YAG (30 W) laser application are equivalent in terms of tissue ablation capacity and coagulation in an experimental setting. The diode laser at 980 nm is superior in terms of ablation capacity but has a large coagulation zone. Concerning the bleeding rate all tested lasers are equivalent in this ex vivo model.

[Imaging procedures to diagnose prostate cancer]. / Bildgebende Verfahren bei der Diagnose des Prostatakarzinoms.

Prostate cancer is one of the most frequent malignant diseases in men. Despite constant progress achieved in imaging procedures, prostate biopsy is the gold standard for diagnosing prostate cancer. For the assessment of lymph node status, only staging lymphadenectomy provides valid information. The aim of this work is to analyze the imaging procedures available in Germany and their value in primary and lymph node staging as well as biochemical recurrence.

[Benign prostatic hyperplasia: background and diagnosis]. / Probleme beim Wasserlassen, Harndrang, Restharngefühl. So gehen Sie diagnostisch vor.

Lower UrinaryTracts Symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) represent an increasing prevalent condition in ageing men. Patients often seek primarily consultation at their general practitioner. Aetiology and natural history of LUTS due to BPH have not been completely clarified. The development of symptomatic LUTS is age-dependent and determined to varying degrees by the presence of Benign Prostatic Hyperplasia (BPH), Benign Prostatic Enlargement (BPE) as well as Bladder Outlet Obstruction (BOO). A causal relationship does not always exist. Basis for a specific medical or surgical treatment in the individual patient with LUTS due to BPH is an exact diagnosis by the practising urologist.

[Benign prostatic hyperplasia: medical therapy]. / Prostatagrösse, PSA-Wert, Leidensdruck. Die Wegweiser für die medikamentöse Therapie.

Primary aims of the medical therapy for BPH are improvement of subjective symptoms and quality of life as well as the prevention of long-term complications such as acute urinary retention and renal failure. Secondary goal is inhibition of disease progression. The medical therapy should be tailored to each patient according to the individual complaints and risk of progression. Plant extracts, alpha-blockers and 5-alpha reductase inhibitors represent the most common prescribed substances. Recent data suggest beneficial effects for the use of antimuscarinic agents and phosphodiesterase type 5 inhibitors.