Correlation among prostate stroma, plasma estrogen levels, and urinary estrogen excretion in patients with benign prostatic hypertrophy.

Plasma testosterone, plasma estradiol, and the total estrogen excretion in the urine were obtained from patients with benign prostatic hypertrophy and correlated to the histological pattern of the resected or enucleated prostates. There was a highly significant increase of prostate stroma in association with higher individual estradiol concentrations and urinary estrogen excretion, while no apparent correlation could be found with testosterone.

[Doppler sonography in the differential diagnosis of scrotal lesions (author's transl)]. / Die Dopplersonographie bei der Differentialdiagnose des "Akuten Scrotums".

Physical examination, body temperature, leukocytes count in blood and urine, and the evaluation of blood flow on the affected side were registered preoperatively in 46 patients with an acute scrotum. Operations revealed four different diagnoses: torsion of testis, torsion of appendix testis, torsion of testis erroneously diagnosed as epididymitis, and epididymitis. Synopsis of all preoperative findings makes an explorative operation rarely necessary. Possible conservative treatment of torsion of appendix testis is discussed.

[Videocystometry (VCM)--a method for quantitative and qualitative diagnosis of refluxes (author's transl)]. / Die Videocystometrie (VCM)--eine Methode zur quantitativen und qualitativen Refluxdiagnostik.

Videocystometry (VCM) is a combination of videography and cystometry for the investigation of vesico-ureteral refluxes and is an accurate method of reflux classification that registers intravesical pressure and volume simultaneously after X-ray detection. We investigated 86 refluxes detected by micturating cystourethrography; 21 could not be confirmed, 14 disappeared with conservative treatment, and 10 underwent surgery, because their condition became worse during examination. Especially refluxes without primary indications for operation can be verified by comparative data. This facilitates the decision to continue conservative or operative treatment.

[The bifid ureter with a blind-ending branch -- its clinical problematic (author's transl)]. / Der Ureter fissus mit blindem Ast -- seine klinische Problematik

The symptoms and clinical significance of the bifid ureter with a blind-ending branch are presented. A uretero-ureteral reflux is the pathophysiologic pre-condition for the disease and its diagnosis. Complaints arise from recurrent urinary infection and/or dilatation of the blind end.

[A second bladder-neck intervention following open transvesical prostatectomy (author's transl)]. / Zweiteingriffe am Blasenhals nach Prostata-Adenomektomie

Over a 10-year period 27 patients required a second transurethral revision operation after previous open transvesical prostatectomy. The so-called sphincter-sclerosis, residual and recidivous adenoma, and prostatic cancer were the causes of repeated bladder neck obstruction. Prostatic cancer after prostatectomy seems to be more benign clinically, more differentiated histologically and is diagnosed sooner because it presents with earlier symptoms than does primary prostatic cancer.

[Complications following ureteroneocystostomy without antireflux technique in the adult (author's transl)]. / Komplikationen nach direkter Ureterocystoneostomie (UCN) beim Erwachsenen.

65 adult patients subjected to direct uretero-vesical implantation without the use of a recognized antirefluxing technique were followed up to 9 years. Good results could be achieved in 90.8%, whereas failures were mainly due to radiation damage and malignant tumors. A postoperative stenosis was observed five times. Reflux was demonstrable in 7 cases, of which, however, only one was of pathologic significance.

[Histologic components of benign prostatic hypertrophy (bph) in relation to the androgen-estrogen status (author's transl)]. / Histologische Komponenten des Prostata-Adenoms im Verhältnis zum Androgen-Ostrogen-Status.

Histometric microscopic quantifications of stromal and glandular portions of BPH revealed a significant correlation of the amount of the stromal portion to the individual estrogens in the serum and to the estrogen secretion in the urine. The serum androgen level, the so-called androgen/estrogen ratio, and age had no influence.

[Decapeptyl (D-Trp6-LH-RH) in the therapy of prostatic cancer with reference to the intramuscular administration of a depot preparation]. / Decapeptyl (D-Trp6-LH-RH) zur Therapie von Prostatakarzinomen unter Berücksichtigung eines intramuskulär applizierbaren Depotpräparates.

Thirteen patients with untreated prostate cancer were treated initially with subcutaneous 0.5 mg D-Trp6-LH-RH daily for the first week, 0.1 mg daily for the next three weeks and thereafter with intramuscular depot preparations of 3.2 mg every three weeks. Serum testosterone was suppressed to castration levels. Serum LH, FSH and prolactin were reduced, serum cortisol did not change. 10/13 patients showed remissions, as shown by transrectal prostate volumetry, cytological regression grading, serum phosphatases and clinical status. 3/13 tumors showing progression were undifferentiated and androgen-resistant. The investigated compound seems to be effective in selecting androgen sensitive tumors and may be a possible alternative to orchiectomy.

[Pararenal pseudocyst. A rare sequela following blunt abdominal trauma (author's transl)]. / Die pararenale Pseudocyste Eine seltene Verletzungsfolge bei stumpfem Bauchtrauma

On the basis of an organ preserving operative case, the patho-physiological postulation of the origin and the diagnostic difficulty of this rare clinical picture are discussed. Out of the only 30 cases known in the world literature, 26 nephrectomies had to be made. Decisive for the formation are the grave concomitant injuries which mask the local symptomatology of the ureter tear. The duration of the interval trauma - therapy influences decisively the chances of organ preservation (from many weeks to 37 years is unknown).

Therapeutic approaches to postoperative contracture of the vesical neck.

Postoperative contracture is a rare cause of the secondary obstructions of the vesical neck, besides remnants of prostatic adenomas, recurrent adenoma and prostatic cancer. It appears morphologically either as circumscribed sclerosis, as so-called sphincter sclerosis, or as extensive contracture of the entire prostatic urethra. Severe postoperative contracture with an iris-shaped membrane at the site of the internal sphincter is the most frequent form up to one year after primary surgery. The overall incidence has been given as 1.37%, of which 13.6% were refractory to therapy and recurred. Special forms of therapy are discussed.

Nuclear DNA cytophotometry in prostate carcinoma.

Eighty patients with prostate carcinoma underwent fine-needle aspiration biopsy for cytologic grading and DNA-single-cell fluorescence photometry before and at 6-month intervals after endocrine treatment. The histograms of DNA values showed single peaks and bimodal and scattered distributions which correlated to the different tumor grades before therapy. The DNA values were significantly different from the controls with benign prostatic hypertrophy. After start of therapy, regressive changes of the DNA-histograms were increases of diploid and hypodiploid DNA values and disappearance of secondary peaks. Progressive changes were increased scattering of DNA values and appearance of secondary peaks. Progressive changes in the histograms were closely related to clinical remission and stable disease, but related poorly to clinical progression. The survival correlated with the pretherapeutic DNA-histograms and with the DNA-median, third-quartile, and maximum parameters.

[Cancer of a renal cyst wall]. / Das Karzinom der Nierenzystenwand.

It is reported on three cases of cyst wall carcinomata in altogether 202 patients (= 1.5%) in whom a resection of the cyst wall was clinically indicated. Only in one case there was preoperatively an angiographically proved suspicion of the presence of a cyst wall carcinoma. Since there do not exist any exact methods for proving cyst wall carcinomata and the slight size of the tumour does not evoke systemic, unspecific tumour signs, their evidence remains depending upon accidentally found, discrete changes in the picture-producing techniques.

[Toxic dilatation of the colon]. / Toxische Kolondilatation

Twelve patients (8 males and 4 females) with toxic dilatation of the colon in acute ulcerative colitis were reviewed, who required surgery between 1962 and 1974 at the Department of Surgery, University Kiel. This complication always occured during a relapsing exacerbation of known colitis. Nine patients died. This high operative mortality (75%) was related to faecel sepsis because of praeoperative perforations, operative disruptions of walled-off perforations and to a delaying conservative approach of more than ten days. These results with the onestage coloproctectomy or colectomy with later excision of the rectum urge an early surgical intervention before perforation took place. The diverting ileostomy and decompression colostomy may additionally lead to a better prognosis.

[DNA oriented automated malignancy diagnosis and malignancy grading in prostatic cancer]. / Untersuchungen zur Frage einer DNS-orientierten automatisierten Malignitätsdiagnostik und des Malignitäts-Grading beim Prostatakarzinom.

85 patients with prostate cancer and 20 patients with benign prostatic hypertrophy underwent DNA single-cell fluorescence photometry to investigate the possibility of DNA-related automatic diagnosis and grading of prostate cancer. The DNA histograms were analysed statistically by univariate data description, stepwise linear discriminant analysis and regression analysis. The accuracy for the malignancy diagnosis was 85.1%, with 10.6% false-negative and 4.3% false-positive results. The accuracy of the malignancy grading, however, was very poor with only 39.5%.

Investigation of automated DNA diagnosis and grading of prostatic cancer.

As a preliminary step towards a DNA-related automatic diagnosis and grading, the fine needle aspiration biopsies of 85 patients with prostatic cancer and of 20 patients with benign prostatic hypertrophy were subjected to DNA single-cell fluorescence cytometry. The DNA histograms were analyzed statistically by univariate data description, stepwise linear discriminant analysis and multiple regression analysis. The accuracy of the DNA-based malignancy diagnosis was 85.1%, with 10.6% false-negative and 4.3% false-positive results. The accuracy of the prognosis-related malignancy grading was, however, only 39.5% and thus unsatisfactory. The results indicate that a DNA-related diagnosis of prostatic malignancy is possible but that a similar automatic grading of prostatic cancer is not yet possible.

[Comparative study on clinical effectiveness of mecillinam and pivmecillinam versus ampicillin in acute urinary infections (author's transl)]. / Vergleich klinischer Wirksamkeit von Mecillinam und Pivmecillinam gegenüber Ampicillin bei Harnwegsinfekten.

30 outpatients suffering from acute urinary infections underwent oral treatment with pivaloyloxymethyl-(2S,5R,6R)-6-(perhydroazepin-1-ylmethylenamino)penicillinate (pivmecillinam) (n = 15) or ampicillin (n = 15) in a first study. In a second study 6-beta-(hexahydro-1H-azepin-1-yl)-methylenamino penicillanic acid (mecillinam) (n = 16) or ampicillin (n = 14) were applied i.v. to 30 patients with pretreated urinary infections. The tolerance of the drugs proved to be comparatively good in both studies. The clinical and antibacterial effectiveness were equally good in the first study. However, in the second study the effectiveness of mecillinam However, in the second study the effectiveness of mecillinam seemed to be comparatively inferior.

Long term follow-up of combined radiochemotherapy for locally advanced bladder carcinoma.

BACKGROUND: The 5- and 10-year survival rates and the toxicity of combined radiochemotherapy for 53 consecutive patients with locally advanced bladder carcinoma were studied in a noncomparative trial. METHODS: Between November 1986 and October 1987, 53 consecutive patients (mean age, 68 years) with muscle invasive and/or locally advanced bladder carcinoma were treated by simultaneous chemotherapy and hyperfractionated irradiation. Radiation was administered during the first to fourth week and during the ninth to tenth week as an interrupted treatment protocol. Cisplatin and epirubicin were used as radiosensitizers before radiation. The maximum dose of irradiation was 57.6 grays. RESULTS: Of 53 patients, 45 completed the planned treatment course. Causes for discontinuing therapy in 8 patients were pronounced myelosuppression (n = 2), severe gastrointestinal symptoms (n = 2), nephrotoxicity (n = 1), and severe radioproctitis (n = 1). Two additional patients stopped therapy due to vascular diseases independent of treatment-related toxicity. The overall survival for all 53 patients was 23% after 5 years and 8% after 10 years. Cause specific survival was 36% after 5 years and 29% after 10 years. Four patients are still alive after 10 years without disease progression. One of them received incomplete therapy due to toxicity. All four patients underwent transurethral resections for superficial, local tumor recurrences. CONCLUSIONS: The poor prognosis group of patients with invasive and/or locally advanced bladder carcinoma was found to have a limited disease specific survival after combined radiochemotherapy.