[Prostate cancer prophylaxis by dietary supplements: more than just an illusion?]. / Prostatakarzinomprophylaxe durch Nahrungsergänzungsmittel : Mehr als trügerische Hoffnung?

Prophylaxis of tumors of the prostate gland is theoretically simple but what makes it difficult is that no appropriate test methods are available. The topic of prostate cancer prophylaxis by dietary supplements remains difficult as there are still no really certain data. The psychological aspect of wanting and being able to actively contribute to success of a therapy oneself, is absolutely not an aspect to be ignored to accept such dietary supplements. There are also studies which show that a certain helpful effect seems to be present. From these considerations the question arises whether cancer prophylaxis could be developed from this. This article presents the state of the art in early 2014.

[Secondary malignancies in urinary diversions]. / Sekundärmalignome in Harnableitungen.

In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.

[Investigation of diabetic men with erectile dysfunction to determine coronary flow reserve (CFR) and cardiac risk under medication with sildenafil (Viagra)]. / Untersuchung von Diabetikern mit erektiler Dysfunktion (ED) zur Bestimmung der CFR (koronare Flussreserve) und des kardialen Risikos unter Medikation mit Sildenafil (Viagra).

PURPOSE: Since Sildenafil (Viagra) has become available, there have been reports of death and cardiac risks associated with its use. As large doses of Sildenafil medication is often prescribed particularly in diabetic patients with erectile dysfunction (ED), our study was designed to evaluate the coronary flow reserve (CFR) and possible resulting cardiac risk specifically in diabetic men. MATERIALS AND METHODS: Because these men often suffer from clinically significant ischaemic heart problems without their knowledge and without symptoms, all of our patients were examined by treadmill ECG and CFR. RESULTS: In 44 men (35 - 74 years) with type I and II diabetes also suffering from ED objectified by FCDS measurement of the penile vessels, a surprisingly high rate of objective cardiac problems were found, which were then verified by coronary angiography. These patients are at risk for ischaemic problems during Sildenafil-assisted intercourse and were excluded from further study. Interestingly, only 3 of theses 11 men would have been detected by conventional examinations. Patients free of coronary stenosis who received 50 mg Sildenafil (20 patients) showed no cardiac problems during treadmill exercise and CFR measurement. CONCLUSIONS: Coronary flow reserve in diabetic men lies at the lower end of the normal range, but is not further decreased by Sildenafil. However, diabetics with ED frequently showed coronary artery stenosis that was not clinically symptomatic. Furthermore, conventional cardiological examinations often fail to detect these patients, although they are at ischaemic risk during medically assisted intercourse. Furthermore, although 5 of 20 men who received Sildenafil had an increase in penile blood flow without sexual stimulation, only 7 of 20 were responders to Sildenafil after take home medication. Thus, Sildenafil medication is not a suitable test medication for organic erectile dysfunction.

[Sildenafil does not change coronary flow reserve in diabetics with erectile dysfunction]. / Sildenafil verändert nicht die koronare Flussreserve bei Diabetikern mit erektiler Dysfunktion.

BACKGROUND AND AIM OF STUDY: Disturbance of the microvascular coronary circuit is common in diabetics with erectile dysfunction. We investigated effects of sildenafil on coronary flow reserve (CFR) of the left anterior descending branch. PATIENTS AND METHODS: 43 diabetics (aged 59 +/- 7 years) with erectile dysfunction and without symptoms of coronary artery disease were selected. Cardiac diagnosis, including stress ECG and echocardiography was performed in all. Because of the clinical suspicion of coronary artery disease coronary angiography was performed in 16 of them. Severe coronary artery disease was confirmed in 12 patients who were excluded from further analyses as well as 10 diabetics in whom coronary flow measurements were not possible. In the other 21 diabetics, adenosine-mediated CFR was calculated at baseline and 1 hour after ingestion of 50 mg sildenafil by transthoracic Doppler echocardiography. RESULTS: CFR at baseline was at the lower level of the normal range in 17/21 diabetics (median 245 %, range 210 - 490 %). CFR decreased insignificantly in 12/21 patients after sildenafil administration (Delta CFR -10 %, p = 0.3). Patients with a body mass index > 25 kg/m(2), and left ventricular hypertrophy had the highest reduction of CFR after sildenafil, but a drop of the CFR below 200 % was not observed in any patient. Systemic blood pressure dropped significantly from 130/80 mmHg to 120/72 mmHg (p < 0.002). CONCLUSION: Diabetics with erectile dysfunction often have a CFR in the lower range of normal. Sildenafil did not further reduce CFR. Asymptomatic, severe coronary artery disease often can be found in diabetics with erectile dysfunction. Cardiological screening for contraindications for sildenafil seems mandatory in diabetics with a high cardiovascular risk profile.

[Colour Doppler transrectal 3D-sonography of the prostate--first experiences]. / Farbcodierte transrektale 3D-Sonographie der Prostata - Erste Erfahrungen.

INTRODUCTION: Early detection of prostate carcinoma still is problematic in spite of advantages in lab testing and sonography. This report demonstrates the new technique of colour Doppler 3-dimensional transrectal ultrasound in differential diagnosis of elevated PSA. CASE REPORTS: In 13 cases this new ultrasound technique is described and typical results are demonstrated. All cases are histologically and clinically verified. CONCLUSION: Colour Doppler 3-dimensional transrectal ultrasound is a useful new technique with specific diagnostic capabilities for differential diagnosis of an increased PSA level. Prostate carcinoma can be detected early, prostatitis can be found easily and therapeutic effects can be followed. Colour Doppler 3-dimensional transrectal ultrasound has however to prove in clinical comparative studies its specific advantages for screening of prostate carcinoma.

Involuntary contractions of the striated anal sphincters as a cause of constipation: report of a case.

PATIENT HISTORY: We present a case of anismus in a 36-year-old patient. He complained of therapy refractory constipation that had been present for 15 years, with delayed micturition and voiding by stages. METHODS AND RESULTS: During digital examination of the anal canal, we found spontaneous contractions of the sphincters at rest. The urethral pressure profile showed irregular contractions during micturition. The electromyogram, which was performed with concentric needle electrodes from the external anal sphincter, puborectalis, and external vesical sphincter, revealed synchronous contractions of these muscles. Injections of botulinum toxin into the sphincters showed good effects and no incontinence. CONCLUSION: Focal dystonia of the striated anal and vesical sphincters is a very rare cause of constipation but should be included in the differential diagnosis.

[Intrafemoral pressure measurement in different cement removal procedures during hip prosthesis replacement operations--experimental study with cadaver femora]. / Intrafemorale Druckmessung bei unterschiedlichen Zemententfernungsverfahren bei Hüftprothesenschaftwechseloperationen--Experimentelle Studie an Leichenfemora.

During primary hip arthroplasty an increase in intramedullary pressure (IMP) of up to 1000 mm Hg can be observed. As a result of this increased intrafemoral pressure, intramedullary constituents can pass into the venous circulation creating a risk of fat embolism syndrome (FES). In the present experimental study on 9 femora obtained from human corpses, we investigated the question as to whether various methods of cement removal during total hip revision arthroplasty are also associated with increased intramedullary pressure and a risk of FES. The IMP was recorded with a standardized experimental set-up during removal of cement from the proximal and distal regions, including removal of the cement "tip" and the intramedullary plug. The methods employed for this purpose included the osteotome and mallet, a compressed air powered chisel, and a modified intracorporal lithotripter. All the methods induced fluctuations in the IMP the highest values being recorded for the conventional method using the osteotome and mallet (45 mm Hg) and the lowest values for the intracorporeal lithotripter (7.5 mm Hg). Working on the distal cement caused higher fluctuations in comparison with the proximal region. The study failed to reveal any increase in mean IMP, and all measured values were in the low pressure range (considerably below 150 mm Hg). While there seems to be no apparent risk of an FES developing during removal of cement, careless manipulation of the distal cement plug may result in higher intrafemoral pressures--above 150 mm Hg--thus increasing the risk of a fat embolism syndrome.

[Recurrent urethral strictures in men. Modern diagnosis and therapy using ultrasound and laser]. / Rezidivierende Harnröhrenstrikturen des Mannes. Moderne Diagnostik und Therapie unter Einsatz von Sonographie und Laser.

The new method of urethral sonography allows visualization of urethral strictures preoperatively in more detail than conventional X-ray urethrogram. Poor results of urethrotomies can thus be avoided in patients who have peristrictural scars. These patients can be treated by the newly developed technique of laser incisions of urethral strictures. The success rate is so promising that wall-stent implantations and even open procedures may well become very rare. Diagnostic and therapeutic techniques are discussed and described in detail with reference to illustrations.

Measles-mumps vaccination in the FRG: an empirical analysis after 14 years of use. II. Tolerability and analysis of spontaneously reported side effects.

Four hundred and thirty-three reports of suspected side effects following measles-mumps vaccination had been received at Behringwerke by the end of December 1989. The analysis of the data shows that no new risks of the vaccination could be identified and that the frequency of side effects is in good agreement with the findings of other authors. It therefore can be assumed that the relative risks of the vaccination continue to be distinctly outweighed by the benefits. The findings clearly demonstrate once more that it is necessary to carry out a thorough differential diagnosis before one can assume that the symptoms observed are causally related to the vaccination. In addition the analysis shows the importance of the epidemiological approach to the assessment of rare side effects.

Measles-mumps vaccination in the FRG: an empirical analysis after 14 years of use. I. Efficacy and analysis of vaccine failures.

One hundred and ninety two reports on vaccine failures after measles and mumps vaccination are analysed. These reports were received by the Drug Surveillance Department at Behringwerke between 1976 and 1989. Seventy-six per cent of the suspected measles and 41% of the suspected mumps cases occurred within the first 3 years postvaccination. Most probably these were primary vaccine failures. The analysis of the data collected in the 14 years since the introduction of measles-mumps vaccination in the FRG gives no reason to suspect that the protection afforded by the vaccines wanes with time.

Risk of recurrent stricture following internal urethrotomy. Prospective ultrasound study of distal male urethra.

A group of 60 patients was examined prior to surgery in a prospective ultrasound study of the distal male urethra to predict the individual rate of stricture recurrence after internal urethrotomy. The patients were divided into 2 groups according to the ultrasound findings. One group had no evidence of scarred tissue and no recurrence was predicted. The other group did have periurethral scarring and stricture recurrence within approximately 6 months was predicted. We present the ultrasound findings and discuss the accuracy of the predictions. Correct prognoses were made in 92.9% of cases.

Cause of deviation of the erectile penis after urethral manipulations (Kelami syndrome)--demonstration of ultrasound findings and case reports.

The cause of deviation of the erectile penis after urethral manipulations is shown to be periurethral scarring which can be outlined by ultrasound investigation of the urethra and periurethral structures. Sonographic findings are demonstrated. 6 case reports are presented.

Sonography of the distal male urethra--a new diagnostic procedure for urethral strictures: results of a retrospective study.

We describe a new method of ultrasound investigation of the distal male urethra. With this procedure the periurethral structures are outlined, and the extent of periurethral scarring can be shown. In a retrospective study only strictures with significant periurethral scars recurred after internal urethrotomy. Patients without prominent scars had no stricture recurrence at the previous location. This new method allows for the appropriate decision to be made easier for optimal treatment of urethral strictures.

Virus safety of a pasteurized antithrombin III concentrate. Preclinical and clinical data.

Blood derived products carry the risk of virus transmission, especially for the hepatitis B virus (HBV), non-A/non-B virus(es) (NANBV) and human immunodeficiency virus (HIV). The precautionary measures for guaranteeing the virus safety of the pasteurized antithrombin III concentrate Kybernin HS/P are described and the efficacy of these measures is demonstrated by in vitro studies and by chimpanzee trials. The inactivation rate is greater than or equal to 10(6.7) for HIV, greater than or equal to 10(6.7) for HBV, and greater than or equal to 10(5.3) for NANBV (Hutchinson Pool). Clinically, virus safety was demonstrated by long-term drug surveillance as well as by both a retrospective and prospective clinical trial. The 13 participants of the prospective study were checked clinically and biochemically according to the standards of the International Committee of Thrombosis and Hemostasis (ICTH). Within an observation period of 12 months, no seroconversion has been detected for HIV or HBV. Neither have any increases in the transaminases occurred which would indicate NANB hepatitis.

Biometrical aspects in the design and analysis of chimpanzees trials assessing hepatitis virus inactivation.

Hepatitis virus safety of products derived from blood is achieved by screening of individual blood donations and by production processes efficient in eliminating and inactivating residual amounts of hepatitis viruses. A quantitative measure of process inactivation efficiency is the inactivation factor derived from process overchallenging experiments. A product is safe if the corresponding process inactivation factor is as high as the one of a product whose safety has been clinically established. Reliable information on hepatitis safety cannot be obtained by testing commercial end product samples in chimpanzees.

Inactivation of HTLV-III/LAV, hepatitis B and non-A/non-B viruses by pasteurization in human plasma protein preparations.

Pasteurization (heat treatment at +60 degrees C for 10 hours in solution) during the production of human plasma protein preparations has proved useful 1. to inactivate a broad spectrum of viruses and 2. in combination with stabilizers to leave the nativity of the products unaffected. Their efficacy has been experimentally tested for HTLV-III/LAV, Hepatitis B and non-A/non-B viruses. The following preparations were tested: with HTLV-III/LAV: Factor VIII, Factor IX, AT III, AHC and PPSB; with Hepatitis B virus: Factor VIII, Factor XIII, AT III, PPSB and Fibrinogen; with Hepatitis non-A/non-B virus: Factor VIII and AT III.

[Spontaneous adrenal gland hemorrhage in adults]. / Die spontane Nebennierenblutung im Erwachsenenalter.

Three cases of the very rare spontaneous unilateral adrenal hemorrhage in adults are described. The main symptoms are hemorrhagic shock, flank pain and fever in some cases. Most important for diagnosis are ultrasound, i.v. pyelogram and computed tomography. In case of emergency computed tomography is the most decisive diagnostic step before removing the adrenal gland. The preferred operative approach is through the 10th intercostal space. No Postoperative corticoid hormone substitution is necessary.