[The development of real-time multispectral imaging for the diagnostics of bladder cancer]. / Entwicklung der Echtzeitmultispektralbildgebung für die Diagnostik des Harnblasenkarzinoms.

The performance of white light (WL) cystoscopy in the diagnostics of bladder cancer can be optimized by the use of modern imaging modalities, such as photodynamic diagnostics (PDD) and narrow band imaging (NBI). Real-time multispectral imaging (rMSI) enables simultaneous imaging of reflectance and fluorescence modalities in multiple spectral bands. We created a multiparametric cystoscopy image by digital overlapping of several modalities, e.g. WL, enhanced vascular contrast (EVC), raw fluorescence mode, protoporphyrin IX and autofluorescence (AF). The technical development and the subsequent clinical implementation of rMSI required a structured preclinical evaluation process, including both ex vivo and in vivo trials before the technology can be applied in patients. This review article presents the phases of testing, validation and the first clinical application of rMSI in urological endoscopy.

A new suprapubic cystostomy trocar system.

We describe a newly developed suprapubic catheterization set with a defined sigmoidal, geometrically and functionally tripartite tip and grooved trocar shaft. The device was designed to enhance the handling and safety features of the current commercially available sets to promote the broader application of suprapubic catheterization.

[A new trocar for suprapubic urinary drainage]. / Un nouveau trocart pour le drainage urinaire sus-pubien.

Most of the trocars provided with systems for suprapublic puncture are not entirely acceptable due to inadequate technical development. Since suprapublic trocars are particularly useful in clinical practice, we developed a new type of trocar with several improvements. The tip of the new trocar has three functional parts. The first third is a hard very sharp lancet which perforates the tissue layers like a scalpel. The second third of the tip is more flexible and cuts a half-circle. The last third has a smooth edge which separates and dilates the borders of the opening. This eliminates the punch effect and ensures a constant contact between the body of the trocar and the catheter placed within its central groove. The trocar has a continuous curve between its dilating part and the body for smooth insertion. Entry is controlled with a handle, thus avoiding accidental lesions. Since the tissues are elastic, the wound closes spontaneously when the trocar is removed. The advantages of the new puncture system have been confirmed with clinical data.

[Radiotelemetric manometry of the urinary bladder]. / Radiotelemetrische Manometrie der Harnblase.

The standard procedure for manometric investigation of bladder function involves the use of a urethral catheter. The presence of this foreign body causes irritations, however, with a resultant increase in urethral resistance. This perturbs the micturition process, but it can be avoided by a new telemetric method of intravesical pressure measurements. A very small pressure gauge and radio emitter are introduced into the bladder, and the values measured are transmitted to an external receiver. Thus, for the first time, is possible to perform physiological studies of bladder function that do not require catheterization or special positioning of the patient and are well tolerated. Some examples are described, which show that this method allows repeated catheter-free investigations over longer periods of time and accurate evaluation of the effects of pharmacological products on bladder function.

[Cardiocirculatory side effects of hyperthermic extremity perfusion]. / Kardiozirkulatorische Nebenwirkungen der hyperthermen Extremitätenperfusion.

The risk of cardiocirculatory disorders was investigated in 23 consecutive patients with high-risk melanomas, who had been treated with hyperthermal limb perfusion. Postoperatively, there was a rise in the pulmonary vascular resistance. In addition, 14 patients with vascular occlusive diseases (1-2b, Fontaine) showed intraoperatively an increasing amount of leakage of the extracorporeal circulation. Elevations of thromboxane and prostacyclin in excess of the norm caused by mechanical and thermic traumatization of blood in the heart lung machine were detected in 8 patients investigated during and after the perfusion procedure. Significant increase of cisplatin, one of the two cytostatic agents injected extracorporeally, could not be demonstrated in the blood of the systemic circulation by atomic absorption spectroscopy. Increased pulmonary and arterial pressure disorders were observed in the group with occlusive vascular diseases, caused by a rising rate of vascular collaterals to the body and the rising rate of thromboxane and prostacyclin in the body blood flow. We believe that it is necessary to monitor pulmonary arterial pressure during isolated limb perfusion, especially in patients with vascular occlusive disease.

[Technique and results of hyperthermic perfusion of the extremity in melanoma patients]. / Technik und Ergebnisse der hyperthermen Extremitätenperfusion bei Melanompatienten.

The results of hyperthermic isolated limb perfusion therapy in 36 patients with stage II-IV malignant melanoma of the extremities are presented. With the technique employed, neither severe complications nor functional deficiencies attributable to the perfusion therapy were observed. The findings on follow-up for up to 36 months are comparable to those reported in the literature, with survival rates of about 90% for stage II and III patients and nearly 50% for stage IV patients. Thus, our technique appears to be beneficial, especially in respect of the very low rate of side effects.

[Intra-arterial calcium provocation for the preoperative diagnosis of the location of an occult insulinoma]. / Intraarterielle Calciumprovokation zur präoperativen Lokalisationsdiagnostik des okkulten Insulinoms.

Blood-sugar levels below 40 mg/dl were measured during syncope in two female patients (aged 59 and 73 years). Suspected organic hyperinsulinism was confirmed by a fasting test. Ultrasound examination and computed tomography failed to demonstrate an insulinoma. Coeliacomesentericography was then undertaken together with a selective intra-arterial calcium provocation test of the pancreas (0.4 or 0.5 mmol calcium in physiological saline was injected into the pancreas-supplying arteries--proximal and distal splenic, superior mesenteric and gastroduodenal). The insulin level was determined in simultaneously obtained hepatic venous blood. In case 1, the insulin level rose tenfold after calcium injection into the proximal splenic artery, indicating a process in the body of the pancreas. In case 2, a steep rise in insulin occurred after injection into the truncus coeliacus and the proximal and distal splenic artery, suggesting an insulinoma in the tail of the pancreas. The site of the insulinoma was confirmed in both cases at surgery. The adenoma was enucleated in case 1, removed by partial resection of the tail of the pancreas in case 2.--These observations show that occult insulinomas can be localized preoperatively by intraarterial calcium injection with measurement of insulin concentration in simultaneously obtained hepatic venous blood.

[Puncture sets for suprapubic catheter drainage of the bladder]. / Punktionssets zur suprapubischen Katheterdrainage der Harnblase.

Suprapubic fistula catheter drainage (SFC) has numerous important advantages compared with transurethral bladder drainage. Commercial SFC-sets should provide security and comfort to a high degree for patients and users in general, so that they can make profitable use of these advantages. The equipment of SFC-sets should be adapted to the site and circumstances of use. Therefore, we recommend the introduction of defined standard SFC-sets for application in intensive-care units. We describe 16 usual SFC-sets. Every single set possesses certain disadvantages. Improvements, especially as far as trocar and catheter are concerned, are necessary to lead to a further spread of the SFC-method, so that more patients can benefit from the method. Detailed hints for improvements and alterations are provided.

[Status epilepticus in MVEC chemotherapy of urothelial cancer]. / Status epilepticus unter MVEC-Chemotherapie eines Urothelkarzinoms.

We present a patient with an urethral urethelial carcinoma (T3N2M0) treated by chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin, which induced a non-convulsive status epilepticus. In this report the possible mechanism for this phenomenon and its management are discussed.

Bacteriorhodopsin mutants of Halobacterium sp. GRB. II. Characterization of mutants.

The bacterioopsin genes of Halobacterium sp. GRB (Ebert, K., Goebel, W., and Pfeifer, F. (1984) Mol. & Gen. Genet. 194, 91-97) wild type and 10 independent mutants of different phenotypes have been cloned and sequenced. The wild type gene has two conservative changes compared to the gene of Halobacterium halobium, so that the proteins of the two species are identical. Six different mutations at five different codons have been found, leading to the following amino acid changes compared to the wild type: Trp10----Cys (three cases), Tyr57----Asn, Asp85----Glu, Asp06----Asn (three cases), Asp96----Gly, Trp138----Arg. A first characterization of the mutant proteins is given, and their implications for models of bacteriorhodopsin structure and function are discussed.