Human glomerular structure under normal conditions and in isolated glomerular disease.

Investigation of the human glomerulus in health and disease shows that the human glomerulus comprises seven lobule-like structures with numerous anastomoses. The total length of the capillaries in a single glomerulus is 0.95 cm, making a total of 19 km for all 2-million glomeruli. The total surface area of all glomerular capillaries is 6,000 cm2. The total filtration surface area is 516.1 cm2. Severe isolated disease of the glomerulus, as seen in acute endocapillary glomerulonephritis, membranoproliferative glomerulonephritis types I and II, membranoproliferative glomerulonephritis plus chronic membranous glomerulonephritis, diabetic glomerulosclerosis, and glomerular amyloidosis, does not lead to elevation of serum creatinine concentration, even if the filtration area is reduced to about 20% (as in diabetes) of the normal value. It is concluded that isolated glomerular disease does not lead to elevation of the serum creatinine concentration. Glomerulopathies in which there is acute or chronic elevation of the serum creatinine concentration are accompanied by acute renal failure or involvement of the renal cortical interstitium, respectively.

Influence of cyclosporine A on adaptive hypertrophy after unilateral nephrectomy in the rat.

The functional challenge to a transplanted kidney is comparable to that of a single kidney after unilateral nephrectomy. The single kidney model was used in rats to study the influence of the immunosuppressant CyA. Using this model interference with immunological or preservation/transplantation problems can be excluded. Two month old rats were studied 4 weeks after unilateral nephrectomy. After unilateral nephrectomy the juvenile rats had been fed for 28 days with 10 or 15 mg/kg BW CyA daily. These rats were compared to intact control rats and to age-matched uni-nephrectomized rats. Single kidney weight was measured in one group. Single kidney function was measured in a second group, first in the metabolic cage and then in experiments with isolated kidneys perfused under standard conditions. The glomerular filtration coefficient Kf was measured by micropuncture techniques. Glomerular capillary surface area was estimated after perfusion fixation in order to calculate the effective hydraulic permeability k of the glomerular capillary wall (k = Kf/S). Standard allogeneic skin transplantation across the MHC barrier was used to establish that the CyA dosage used was immunosuppressive. The results showed that the single kidney mass (as a measure of tubular hypertrophy) and GFR were suppressed under the influence of CyA compared to controls. Analysis of glomerular filtration parameters in the isolated perfused kidneys on the single nephron level had the following results: a small increase of the glomerular capillary surface (morphometry) was suppressed under CyA, whereas the effective hydraulic permeability (k) increased by almost 40% whether CyA was given or not.

[Computed tomographic and sonographic detection of renal and perirenal changes following shockwave lithotripsy]. / Computertomographischer und sonographischer Nachweis von renalen und perirenalen Veränderungen nach einer extrakorporalen Stosswellenlithotripsie.

The finding of a major haemorrhage after lithotripsy induced us to look at 42 patients undergoing extracorporeal lithotripsy by CT and by sonography, both before and after the procedure, in order to determine the frequency of bleeding. In 37 patients, significant bleeding was found in the perirenal tract and in Gerota's capsule. There were six small sub-capsular haematomas which were not found by sonography and two extensive renal haematomas.

Intrascrotal metastases from renal cell carcinoma.

This is an up-to-date report about two patients suffering respectively from testicular and epididymal metastases of a renal adenocarcinoma in the condition following tumour nephrectomy in anamnesis. It is a survey on literature including the number of cases published.

[Possibilities and departure points for quantitative cytologic evaluation of urothelial cells for cancer diagnosis using microscopic procedures and digital image processing]. / Möglichkeiten und Ansatzpunkte einer messtechnischen zytologischen Auswertung von Urothelzellen zur Krebsdiagnostik mit Hilfe mikroskopischer Verfahren und digitaler Bildverarbeitung.

Examination of exfoliated urothelial cells present in the urine has been shown to be useful by cytologists, but urinary cytology is not yet widely accepted for routine diagnostic purposes. The accuracy of urinary cytology is almost limited to high-grade transitional carcinoma (grade II-III), but is of limited value in the diagnosis of benign papilloma and low-grade tumors (grade I). The sensitivity of cytology would be increased from 50% to 80% by using a computer-based cytophotometric microscope, especially in differentiating grade I tumors.

[Measuring of urine cells by a high resolution microscope cytophotometric system (author's transl)]. / Untersuchungen zur Messbarkiet und Objektivierbarkeit der Urinzytologie durch ein hochauflösendes mikroskopzytophotometrisches Messsystem.

Especially bladder tumors of low malignancy (grade I) reveal minor abnormalities and therefore these tumors are often overlooked using cytological methods. Therefore, it appeared useful to examine the applicability of microscopic scanning cytophotometry to discriminate urothelial cells by objective parameters. A special combination of a Leitz MPV 2 microscope Cytophotometer and a digitizer has been built for reasons of interactive segmentation of the cell into nucleus, plasma and background. 240 cells, stained by Papanicolaou technique, have been visually classified and the computer discrimination between benign, atypical and malignant cells has been accomplished with a small error of classification, not greater than five percent.

[The clinical significance of extratesticular originating tumors (author's transl)]. / Die klinische Bedeutung extratesticulär entstehender Hodentumoren

A case of large retroperitoneal metastasis of a seminoma is demonstrated. The primary tumor was impossible to recognize clinically. The extremely scarred primary tumor was at last discovered histologically in the normal appearing testis on the same side. This experience leads to the conclusion that the diagnosis "extratesticular originating testicular tumor" not be accepted unless a "burned-out" tumor can be exluded histologically in the ipsilateral testis.

[Histochemical investigations on human bladder cancer (author's transl)]. / Histochemische Untersuchungen an menschlichen Harnblasentumoren.

The histochemical enzyme activity of alkaline phosphatase, nonspecific esterase, 5-nucleotidase, beta-glucuronidase, glucose-6-phosphatase, succinate dehydrogenase, and glucose-6-phosphate dehydrogenase in human bladder cancer was investigated. Tumors of 84 patients, classified into grades I-III according to the WHO classification, were compared with 12 normal and 16 inflamed bladder epithelia. As a rule, loss of alkaline phosphatase activity and a decrease of nonspecific esterase activity was found in most of these tumors. The activity of beta-glucuronidase was decreased and compared with normal tissue, also the activity of 5-nucleotidase. The succinate dehydrogenase activity in tumor tissue was frequently increased, whereas glucose-6-phosphate dehydrogenase did not show any significant reaction.

[Chances of an automated prescreening test based on cytology of the urinary tract. Preliminary report based on a high-resolution system (author's transl)]. / Möglichkeiten der Krebsvorsorge der Blase und der Ableitenden Harnwege auf der Basis einer automatisierten Urinzytologieauswertung. Vorläufige Mitteilung über erste Ergebnisse und Erfahrungen mit einem hochauflösenden zytologischen Messystem.

The incidence of bladder tumors has increased in the last years. Often, at the time of diagnosis the tumor has reached a stage in which a curative radical therapy is no longer possible. With the help of urinary cytology it is often possible to obtain evidence of tumors at an early stage, before clinical symptoms become evident. For this reason, urinary cytology would appear to be a reasonable screening method for tumor detection. In the framework laws concerning measures for the preventive treatment of tumors, there is no provision for the early detection of tumors of the bladder and urinary tract. As urine is easily obtainable it appears that urinary cytology could easily by integrated into such a program for early detection of tumors. The evaluation is relatively costly in man-hours and, therefore, not suitable for screening. For this reason, urothelical cells were investigated in respect to their use as a diagnostic parameter in an automated screening test. Urinary cells can be analyzed automatically, but little experience has been made in this area of research. However, it seems that automation of urinary cytology would be a step towards screening method for tumors of the bladder and urinary tract.

[The influence of completely ligated ureters on the regeneration of tubulus cells after diversion of the urine by ureterocystoneostomy (author's transl)]. / Der Einfluss vollständig ligierter Harnleiter auf die Tubuluszellregeneration nach Entstauung durch Ureterozystoneostomie.

After a complete destruction of the ureter, renal function recovers more completely after diversion of the urine by splints than by ureterocystoneostomy. After a longer period of obstruction and successive restoration of urinary diversion by ureterocystoneostomy a relative increase in pressure of the ureter continues. This is the result of a functional obstruction, caused by disintegration of the muscle cells by connective tissue. The proliferation of connective tissue is probably induced and maintained by extravasation of urine into the layers of the ureter and that after abolition of the special function of the tunica mucosa. The defects of the mucosa are probably caused by metabolic disturbance after a pressure-induced decrease of blood supply.

[Caryometry for testing the effectiveness of hormone treatment of carcinoma of the prostate gland (author's transl)]. / Karyometrie zur Verlaufskontrolle beim hormonbehandelten Prostatakarzinom.

Control aspiration biopsy should be performed on patients with carcinoma of the prostate gland, because the tumour cells show morphological signs of regression if estrogen therapy is successful: the nuclei of the tumor cells shrink. This can be measured by caryometry. In tumors refractory to estrogen primarily, the nuclei fail to shrink, whereas in tumors refractory to estrogen secondarily, the nuclei reexpand. The cytologic-caryometric findings are therefore an important means of assessing the effectiveness of hormone therapy.

[Morphometry on the juxtaglomerular apparatus and the glomerulus of the rat (author's transl)]. / Morphometrische Untersuchungen am juxtaglomerulären Apparat und Glomerulum der Rattenniere.

The area of contact between the macula densa and the terminal vascular components, the vas afferens, the vas efferens and the mesangium (Goormaghtigh cells) of five glomeruli of the rat has been determined morphometrically using serial sections. The surface, the filtration area, the volume and the total length of the capillaries of each glomeruli has been estimated, and these data have been correlated. There is evidence, that a contact between the macula densa and the mesangium always exists, a contact to the vas afferens is not obligatory.

Investigation about the penetration depth in the normal bladder wall and tumor by local instillation of mitomycin into the urinary bladder.

The penetration depth of mitomycin into the normal urinary bladder wall and tumor was determined in 21 bladder tumor patients. Either 20 mg mitomycin/20 ml distilled water or 40 mg/40 ml distilled water was locally instilled into the bladder with a catheter after emptying it and was left for about 25-l20 min. The individual concentrations of mitomycin within the various bladder layers (epithelial, lamina propria, up to the middle of the musculature) were determined with a thin-layer cup method specially modified for these investigations. The results show a high scatter of resorption from 2 up to 442 micrograms of mitomycin/g dry weight. With this method, mitomycin could be determined in the bladder musculature.

[The segmentation of urinary cells--a first step in the automated processing in urine cytology (author's transl)]. / Segmentierungsversuche an Urothelzellen als Vorstufe zur automatisierten Urin-Zytologie-Auswertung.

By segmentation of cell images we understand the automated decomposition of microscopic cell scenes into nucleus, plasma and background. A segmentation is achieved by using information from the microscope image and prior knowledge about the content of the scene. Different algorithms have been investigated and applied to samples of urothelial cells. A particular algorithm based on a histogram approach which can be easily implemented in hardware is discussed in more detail.

[A cytophotometric study of urothelcells with a combination of MPV and A.S.M. (auther's transl)]. / Kombination des MPV mit dem A.S.M am Beispiel der Auswertung von Urothelzellen in Absorptionsmessung.

The frequency of bladder carcinoma is increasing all over the world. In civilized countries the cause of the increasing frequency is depending on environmental factors of different kinds. The cytologic examination of the urine has proved itself as a screening test for papillomas and carcinomas. With the help of the urine cytology it is possible to detect the cancer of teh bladder frequently at a time, when an operative treatment is still successfull. Tumors of low malignancy (grade I) reveal minor abnormalities and therefore these tumors are often overlooked using cytological methods. For these reasons it is desirable to develop methods for further characterisations of the tumors. Therefore, it appeared useful to examine the applicability of microscopic scanning cytophotometry to discriminate urothelial cells. A special combination of MPV and A.S.M has been built for reasons of interactive segmentation of the cell into nucleus, plasma and background. Computer discrimination between benign, atypical and malignant cells by means of cytophotometry has been accomplished with a small error of classification, not greater than five percent.

[Studies of the morphological and morphometrical changes in the rat nephron after unilateral ureteral ligation (author's transl)]. / Morphologische Untersuchungen und morphometrische Messungen am Nephron einseitig harnleiterligierter Ratten.

The influence of unilateral ureteral ligation in the rat nephron has been morphometrically analysed. The glomeruli show no significant differences compared with the control groups. The lumen of the tubulus rectus I increases significantly, but irregularly, after the 6th day of ureter ligation. The brush border is mostly destroyed after the 8th day. The tubulus rectus II changes only very little during this period. At the beginning of the ligation the lumen dilates, and at the end of the experiment the tubulus becomes normalised. The most important changes have been seen on the collecting tubules. As a consequence of increased intratubular pressure the lumina continuously dilate.

[Catheter peridural anesthesia with bupivacaine-HCl and bupivacaine-CO2 during extracorporeal shock-wave lithotripsy]. / Katheterperiduralanaesthesie mit Bupivacain-HCl und Bupivacain-CO2 bei extrakorporaler Stosswellen-Lithotrypsie.

The effects of 0.5% bupivacaine-CO2 and bupivacaine-HCl were tested in a prospective randomised trial on 16 patients who underwent extracorporal shock wave lithotripsy (ESWL) with epidural analgesia. A shorter time of onset of analgesia (3.75 +/- 0.51 min) and a faster distribution of analgesia were noted with bupivacaine-CO2. Hypoalgesic regions were not registered with bupivacaine-CO2 nor with bupivacaine-HCl under shock wave treatment. About thirty minutes after application of either substance a level 1 block according to Bromage was noted, which was not desirable during positioning of the patient on the hydraulic lithotriptor chair. However, toxic blood levels were not reached in either group of patients to any extent.

[In vitro sensitivity testing of human kidney tumors to cytostatic drugs with a rapid in vitro test]. / In-vitro-Sensibilitätstestung von menschlichen Nierentumoren gegenüber Zytostatika mit einem In-vitro-Kurzzeittest.

We present a new modified in vitro culture assay for primary human renal cell carcinoma similar to the 'soft agar clonogenic assay'. However, the carrying out and expense of metrology are more simplified, allowing tumor-specific chemotherapeutic drug sensitivity testing under easier conditions. Twelve different samples of human renal carcinoma and one sample of a transitional cell carcinoma of the renal pelvis were tested for in vitro chemotherapy sensitivity using this modified colony-forming assay. The rate of tumor cells establishing in culture was 100%. Corresponding to clinical experience we observed a nearly complete resistance to the cytotoxic effects of standard chemotherapeutic agents at usual plasma concentrations in man. Only higher concentrated chemotherapeutic drugs showed in vitro therapeutic effects. The assay described here lasts about 7 days, which is beneficial from the clinical point of view. The modification of this in vitro chemotherapeutic drug treatment is unlimited for plasma concentration and duration of standard and experimental chemotherapeutic agents, drug combination and so on. So we have interesting scientific steps which could not have been undertaken under usual clinical-empirical conditions.

Initial experience with local anesthesia in extracorporeal shock wave lithotripsy.

The report concerns initial experience with local anesthesia in the treatment of urolithiasis by extracorporeal shock wave lithotripsy. This form of anesthesia is well tolerated for stones of limited size and hardness, though the patients must be carefully selected.

[The structure and function of the vena spermatica interna--the etiology of varicocele]. / Untersuchungen zur Struktur und Funktion der Vena spermatica interna--Ein Beitrag zur Atiologie der Varikozele

From 60 male corpse in the age of 13 to 77 both venae spermaticae internae were completely removed. On the basis of these specimens we investigated the incidence, localization, form and scale of the venous valves in the vena spermatica interna. All venous valves were remodeled and examined for their sufficiency on the basis of these date. In the left vena spermatica interna we found in 83% and in the right vena spermatica in 97% of the cases one or more valves. On the average the left vena spermatica contains 3.5 and the right 3.8 valves. From each vein a drawing was made, showing the remification, the localization of the valves and the valvular function. On the basis of this drawing and reconstructions of valves in the left vena spermatica interna for 90% of the cases and in the right vena spermatica for 75% of the cases a retrograde flow of the blood is possible. The absence of a varicocele can be explained by the presence of a sufficient venous valve on the left side in only 10% and on the right side in 25% of our cases. For the development of a varicocele therefore further facts are of importance.