Dynamic magnetic resonance imaging of the contralateral testis in patients with malignant tumor of the testis.

OBJECTIVES: Dynamic magnetic resonance imaging (MRI) was tested using a dynamic technique to evaluate the possibility of differentiating between normal contralateral testes and testes with a carcinoma in situ. METHODS: Since March 1990, 20 volunteers and 21 patients with a malignant tumor of the testis were examined in a field strength of 1.5 Tesla (Philips Gyroscan S15) with a multislice T1-weighted fast field echo sequence before and every 63 seconds after the injection of 0.1 mmol/kg gadolinium-diethylenetriamine pentaacetic acid. RESULTS: Significant differences (p < 0.001) in signal changes of contralateral testes were detected in dynamic MRI. This increased signal enhancement is detected even 45 months after orchiectomy in the contralateral testes. The signal increase is reduced in follow-up controls. These observations are explained by an increased perfusion which seems to be induced after a postoperative irritation, an unspecific inflammation, or postoperative bleeding. CONCLUSIONS: To avoid false-positive diagnoses of tumors or carcinomata in situ in contralateral testes, these increased enhancements caused by postoperative reactions have to be kept in mind.

[Magnetic resonance tomography of the kidney: the testing of new pulse sequences and comparison with CT in the differential diagnosis of space-occupying lesions]. / Magnetresonanztomographie der Niere: Erprobung neuer Pulssequenzen und Vergleich mit der CT in der Differentialdiagnose von Raumforderungen.

PURPOSE: To evaluate new pulse sequences (turbo-spin-echo [TSE] and turbo-field-echo [TFE] sequences) for study protocol optimisation and to assess the role of MRI in the differential diagnosis of renal tumours. METHODS: In six volunteers MRI of the kidney was performed at 0.5 T using a conventional T2 weighted spin-echo (SE) sequence (TR/TE 1800/90 ms) and three different TSE sequences (TR 1800-5000 ms, TE 90-150 ms). Additionally CT and MRI was performed in 34 patients with 41 renal masses. Two readers evaluated both images regarding the differentiation between malignant and benign masses. RESULTS: The pilot study showed that the heavily T2-weighted TSE sequence (TR/TE 5500/150 ms) was superior to other sequences with regard to image quality and differentiation of the corticomedullary junction. In the clinical study malignant tumours were correctly classified with CT and MRI in 86.4% and 95.5% of the cases, whereas the accuracy in the diagnosis of benign lesions of CT and MRI was 73.7% and 89.5%, respectively. CONCLUSION: Using new puls sequences MRI is superior to CT in the differential diagnosis of renal tumours. MRI is superior to CT in the differentiation between complicated cysts and cystic or hypovascular renal cell carcinomas.

Special aspects of stone composition and aetiology of different types of urinary calculi.

The authors present a detailed analysis of the composition of urinary calculi with regard to the causes of stone formation and to the prevention of its consequences.

Tumour induction as a consequence of immunosuppression after renal transplantation.

Immunosuppressed recipients of organ transplants have a higher incidence of carcinoma than the general population. A retrospective analysis was made at the Department of Urology of Bonn University, investigating 236 renal allograft recipients as to the incidence of neoplasms before and after transplantation. Eleven patients developed malignant tumours after transplantation. In 4 out of these 11 patients, case history showed pre-existing malignancies. Two of the 4 patients developed a second tumour, while the other two had tumour progression (latency period 21-77 months). Three of the 4 patients died of their tumours 21, 42 and 77 months after transplantation, whereas one female patient is still alive and free of neoplasms 32 months after transplantation. In 7 out of these 11 patients de novo tumours were diagnosed (latency period 3-88 months). All of them are still alive (NED between 15 and 85 months), six of them with good transplant function. There was no difference to be seen in the incidence of malignancies between kidneys supplied by Eurotransplant (n = 40) and ABO compatible kidneys from our own donors (n = 196). The higher incidence rate of neoplasms in transplant recipients requires high standards in preventive measures. Any suspicious change that may occur in the course of a thorough follow-up of transplant recipients must be removed and examined histologically. Patients with previous malignant diseases must be payed special attention, since they frequently tend to develop another malignant tumour and progression of existing tumours, respectively. As far as immunosuppression is concerned, therapeutic guidelines for the treatment of transplant recipients do not differ from those set up for patients on haemodialysis. Since immunosuppression with increased rates of tumour incidence can also be observed in dialysis patients, the mere fact of increased incidence of neoplasms cannot be taken as an argument against transplantation. With a more or less equal risk of tumour incidence the crucial factor should be the higher quality of life for transplant recipients.

Wilms' tumour in adults. Review of 10 cases.

Nephroblastoma (Wilms' tumour) is very rarely found in adult patients. We report on 10 cases to demonstrate the diagnostic and therapeutic problems. In case of flank pain, large tumour mass, fast tumour growth and young age, the possibility of Wilms' tumour should be taken into consideration even in adult patients. The chances for a successful treatment by primary surgery with adjuvant therapy are favourable for the lower stages I and II. All our patients presenting with tumour stages I and II have survived and have been free of disease for 68 months now. One of the patients with stage III Wilms' tumour died 8 months postoperatively while the other one has been free of disease for 120 months now. In the advanced stage IV no patient survived. In cases of inoperable large tumours in adults, the possibility of primary chemotherapy should be considered under certain circumstances. Rapid tumour regression may confirm the diagnosis and will make feasible a salvage operation in some cases.

[Pheochromocytoma and adrenal gland hyperplasia in a remaining atrophic kidney]. / Phäochromozytom und Nebennierenhyperplasie in einer Rest-Schrumpfniere.

We report the not-yet-published case of a renal cell carcinoma in an atrophic kidney in combination with ipsilateral pheochromocytoma and adrenal cortex hyperplasia. The cause of the adrenal cortex hyperplasia was found to be the result of a reaction to the accompanying adaptation hyperplasia.

[Penile melanomas]. / Penismelanome.

Melanoma of the penis is a rare, very malignant tumor with poor prognosis. At present improvements of therapeutic results can only be achieved by means of early diagnosis, perhaps also by means of radical surgery. Radiation therapy and chemotherapy are used mostly as adjuvant or palliative therapy. Two cases of malignant melanoma of the penis are presented.

A new microsurgical model for the study of carcinogenesis in colonic urinary diversion in rats.

A new rat model is presented to study the carcinogenesis in colonic urinary diversion. Surgical techniques performed on humans are simulated by microsurgery. The altered metabolism--hyperchloraemic acidosis--is taken into consideration. It seems to be an important co-factor for the carcinogenesis.

Induction of carcinoma at ureterosigmoid anastomosis--with and without faecal stream.

The induction of tumours at the site of uretero-intestinal anastomosis was investigated in Hannover: WISTAR rats. The rats were divided into 3 groups. In one group (n = 70) the ureter of the left kidney was implanted into the colon, using microsurgical techniques developed for humans. In 13% of the rats in this group benign tumours developed; in 16% malignant tumours occurred. In a second group (n = 76) the ureter was implanted into a rectal bladder; the faeces were excluded from the anastomosis by a descending colon anus praeter. In this group benign tumours developed in 17% and malignant tumours in 8%, all of them being situated at the site of the anastomosis. In a control group (n = 80) no colonic tumour could be identified.

[Ectopic adrenal cortex tissue]. / Nebennierenrindenektopien.

A case of a 40-year-old man with an adreno-cortical ectopia in the region of the spermatic cord is presented. The genesis and complexity of this anomaly is discussed. The seldom occurring, but sometimes important clinical relevance of these ectopies is demonstrated.

Peranal dilatation of a postsurgical colonic stenosis by means of a flexible endoscope.

Colonic stenosis following resection and end-to-end-anastomosis of the colon is observed in 2-5% of all patients. The authors report that a patient with repeated episodes of colonic stenosis after resection of the sigmoid was successfully treated with an Eder-Puestow dilatator by means of a flexible endoscope.

On the necessity of adrenal extirpation combined with radical nephrectomy.

Adrenal metastasis of renal cell carcinoma usually is an autopsy finding and seldom a clinical diagnosis. The incidence of ipsilateral suprarenal gland involvement also can be identified by histological examination of the organ with radical nephrectomy. The necessity of adrenalectomy performed in combination with nephrectomy is discussed. After a retrospective examination of our patients we discovered 8 adrenal metastases among 138 radical nephrectomies. Five patients who also had metastases in the lymph nodes (stages pN1 to pN2) died after an average of 26.4 months. Three patients without lymph node involvement are free of tumor. In these cases routine adrenalectomy must be regarded as a possible curative treatment.

Laparoscopic varicocelectomy: indication, technique and surgical results.

OBJECTIVE: To assess the efficacy of laparoscopic techniques for the operative therapy of varicocele. PATIENTS AND METHODS: Fifty-one patients who underwent laparoscopic varicocelectomy due to subfertility and/or pain between June 1992 and December 1994 were evaluated. RESULTS: In all patients, except one with a remaining slight reflux on post-operative Valsalva's manoeuvre, operative therapy was effective and no major complications occurred. The procedure was minimally invasive, effective and, because the anatomy was readily seen, multiple veins and/or collaterals were easily assessed and the surgery precise. CONCLUSION: The laparoscopic technique is an efficient, minimally invasive operation with optimal results. After a brief period of training the operation can be performed in 15-30 min and is therefore no longer than embolization techniques. Treatment of both sides in one session was not a problem.

[Splenogonadal fusion]. / Splenogonadale Fusion.

The splenogonadal fusion is a rare but benign anomaly. The diagnosis is usually given at operation or histologically after operation. In about 50% of the patients who undergo surgery for scrotal tumor, an unnecessary orchidectomy is performed due to clinical unawareness of this rare condition. A case of splenogonadal fusion belonging to the continuous type is presented to illustrate problems of this anomaly and point out the importance of intraoperative microscopic sections.

Simultaneous determination of urinary phosphate and sulphate by ion-chromatography.

An ion-chromatographic system was used for the simultaneous determination of urinary phosphate and sulphate. This method was compared with conventional methods (colorimetric, turbidimetric) with regard to practicability and reliability. All methods showed good precision and accuracy. The comparative analysis of phosphate in 80 samples revealed that both methods lead to identical results. However, in case of sulphate a significant difference of about 8% was found between the two methods. Overestimation of the analyte concentration by the turbidimetric method might be responsible for this difference. From the point of view of economy, routine analysis of urinary phosphate and sulphate by ion-chromatography is acceptable only if automated systems are used.

2,8-Dihydroxyadeninuria: laboratory diagnosis and therapy control.

This report is concerned with the experience gained with two 2,8-dihydroxyadenine (2,8-DHA) stone patients. When adenine phosphoribosyltransferase (APRT) deficiency is suspected, the risk of stone formation can be detected at an early stage from the crystalline urinary sediment. Infrared spectroscopic analysis of the crystals or of a urinary stone, if present, will confirm the diagnosis. Determination of the APRT activity will facilitate quantification of the enzyme deficiency and elucidation of the hereditary history. 2,8-DHA excretion in the 24-hour urine and its circadian rhythm were determined at 3-hour intervals using a new method of high performance liquid chromatography determination. This method also provides a means of monitoring the effectiveness of allopurinol therapy.

Acute rejection relapses posttransplant: definition of risk group and evaluation of potent therapeutic regimens.

A group of 113 patients were investigated after allogenic cadaver renal transplantation to analyse whether the small number of patients presenting acute rejection relapses could be defined by risk factors and whether there is an efficacious regimen for the safe therapy of recurrent rejection episodes. According to these results we are aware of a group of "highly reactive rejectors" especially within the younger recipients and there are further characteristics which can be identified as being associated with an elevated risk of recurrent acute rejection. By adequate antirejection therapy we can achieve a favourable transplant survival rate of 97% in the critical first year. An additional benefit may result from ALG consolidation related to suppression of the remaining CD8-positive human natural killer cells.