[Autosomal dominant polycystic kidney disease. Case report of a 20 kg polycystic kidney]. / Autosomal-dominante polyzystische Nierenerkrankung. Ein Fallbericht von 20 kg schweren polyzystischen Nieren.

Polycystic kidneys can reach huge dimensions as a result of their continuous growth and thus lead to a "mechanical problem." We report on a 69-year-old patient with enormous polycystic kidneys having been treated for 4 years with standard hemodialysis. In the last 12 months, the patient was suffering from a deterioration of his condition and progressively developed cachexy. The preoperative status of the multi-morbid patient jeopardized operability. It was decided to perform bilateral nephrectomy with a Chevron incision on the right side. The right kidney weighed 11 kg, the left 9 kg. There were no postoperative problems. The massive relief resulted in an impressive improvement of this risk-patient's fitness and quality of life. There is a clear indication of unilateral nephrectomy in case of a renal transplantation. The role and necessity of a bilateral nephrectomy in the event of polycystic kidneys is discussed based on the respective literature.

Effect of carboplatin on response and palliation in hormone-refractory prostate cancer. Swiss Group for Clinical Cancer Research (SAKK).

To assess the efficacy of carboplatin in patients with hormone-refractory prostate cancer in terms of response rate and palliation, the Swiss Group for Clinical Cancer Research (SAKK) conducted this phase II clinical trial (SAKK 08/91). Carboplatin 400 mg/m2 was administered i.v. every 28 days to 27 patients. The prostate-specific antigen (PSA) level was monitored and compared with the clinical response. Tumour response was evaluated according to EORTC criteria. For patients with nonmeasurable disease, response was defined as the absence of progression in any tumour localization, with no increase in PSA and a decrease of at least 2 points in the WHO pain score. Selected aspects of quality of life (QL) and use of analgesics were assessed to describe patients' experience of toxicity and palliation. Only 1 patient with measurable and 2 patients with nonmeasurable disease achieved partial remission or a response according to our criteria. However, 13 of the 27 evaluable patients had some benefit from carboplatin therapy, as indicated by an improvement in performance status, reduction of pain, and stabilization of metastases. There was no clear-cut association between clinical response and PSA level. QL data suggested that carboplatin was relatively well tolerated and confirmed the clinically documented palliation. In particular, from baseline, for at least two consecutive cycles 7 patients reported either an improvement in pain by 1 point or more on a 4-point scale (> or = 33%) without an increase in analgesic intake or a decrease by 50% or more in analgesic intake without an increase in pain. With the dose and schedule used in this study, carboplatin had only limited objective activity in advanced prostate cancer, but induced palliation in about half the patients.

A phase II study of oral idarubicin as a treatment for metastatic hormone-refractory prostate carcinoma with special focus on prostate specific antigen doubling time. Swiss Group for Clinical Cancer Research, Berne, Switzerland.

BACKGROUND: Treatment of hormone-refractory prostate carcinoma with chemotherapy is purely palliative, and reported response rates have been low. At the time this study was conducted, there was an urgent need for a trial using potentially efficacious drugs, with quality of life (QL), and serial prostate specific antigen (PSA) behavior as endpoints. METHODS: In this Swiss multicenter Phase II study, 30 patients were enrolled to receive oral idarubicin. Patients were administered 35 mg idarubicin on Days 1 and 8 of each cycle, and treatment was repeated every 3 weeks. Assessment was based on response rates, sequential PSA measurements in serum, toxicity, and selected aspects of QL. RESULTS: Twenty-six of 30 patients were evaluable for response, and none of them achieved a response. Three patients had stable disease as their best response, and their PSA levels also remained stable. In all other patients, PSA increased exponentially over time; the median PSA doubling time was 2.1 months (mean, 2.6; range, 0.7-6.1). Toxicity was minimal and consisted mainly of myelosuppression and nausea/vomiting. QL did not change significantly during therapy with regard to general well-being, fatigue, or nausea/vomiting. However, there were improvements in patient-rated and physician-rated pain. CONCLUSIONS: At the dose and schedule used in this study, oral idarubicin showed only minimal efficacy against hormone-refractory prostate carcinoma. In patients who did not respond, PSA doubling times were similar to those in patients who relapsed while receiving only antiandrogen therapy. In future clinical trials, QL and serial PSA behavior should be included in analysis.

[The bladder catheter]. / Der Blasenkatheter.

The benefit of the transurethral catheter to protect or measure renal function is well accepted. Urethral stricture and infection of the lower urinary tract as the complications should lead to a cautious use of catheters. A careful placement, the choice of the best material and a correct management help to avoid complications. Alternatives are discussed.

[Preoperative T-staging of prostatic carcinoma: endorectal magnetic resonance tomography compared with other imaging and clinical methods]. / Präoperatives T-Staging des Prostatakarzinoms: Endorektale Magnetresonanztomographie im Vergleich zu anderen bildgebenden und klinischen Methoden.

PURPOSE: The diagnostic value of endorectal magnetic resonance imaging (MRI) in comparison to clinical information and other imaging modalities was analysed in order to define the most accurate preoperative staging method. METHODS: 54 patients with biopsy proven prostate carcinoma, who underwent subsequent prostatectomy, were examined with an endorectal surface coil. The results were compared to body coil MRI, digital rectal examination and prostate specific antigen levels. In 37 patients, results of endorectal ultrasound were available. RESULTS: Staging accuracy, sensitivity and specificity of endorectal coil MRI were 83.3%. For body coil MRI, staging accuracy was 59.2%, sensitivity 43.3% and specificity 82.6%, for transrectal ultrasound 59.5%, 36.4% and 91.7% and for the digital rectal examination 55.6%, 26.7% and 91.7%, respectively. Staging accuracy of endorectal MRI was significantly (p < 0.05) superior to that of the other imaging modalities. CONCLUSION: Endorectal coil MRI allows reliable distinction between localised and advanced tumour stages and is superior to other imaging techniques in this regard. It can thus be recommended for staging in patients with prostate carcinoma.

[Kaposi sarcoma of the glans penis with meatal obstruction. Case report and literature review]. / Kaposi-Sarkom der Glans penis mit Meatusobstruktion. Fallbeschreibung mit Literaturübersicht.

Kaposi sarcoma was first described by Moritz Kaposi 1872. It is a disease of the reticuloendothelial system. Preferred manifestations are mainly skin, mucosa and gastrointestinal tract. Location of penile glans with meatal obstruction has been mentioned to date in 4 cases. We report a patient with acquired immune deficiency syndrome who presented a meatal obstruction caused by Kaposi-sarcoma. In this patient with a survival time of 8 months meatotomy and locoregional radiotherapy was an adequate therapy.

Contrast-enhanced endorectal coil MRI in local staging of prostate carcinoma.

OBJECTIVE: Our goal was to evaluate contrast-enhanced MRI using an endorectal coil in detecting and staging prostate carcinoma. MATERIALS AND METHODS: Sixty patients with clinically suspected prostate carcinoma were examined by T1-weighted contrast-enhanced endorectal coil MRI at 1.5 T. Results were compared with T2-weighted images in all cases and with histologic findings following radical prostatectomy in 28 patients. RESULTS: Prostate carcinomas showed no consistent pattern of contrast enhancement. In 27 patients, the tumor enhanced less than the surrounding prostatic tissue; in 10 patients, enhancement was heterogeneous; and in 23 cases, the lesion was hyperintense compared with normal glandular tissue. With respect to tumor delineation, contrast-enhanced sequences were superior to T2-weighted images in 1 case only; in 24 patients, the tumor could not be delineated at all. However, contrast-enhanced sequences provided a higher diagnostic confidence in delineating the seminal vesicles, prostate capsule, and neurovascular bundle in nine, six, and three cases, respectively. In the operated patients, accuracy, sensitivity, and specificity for staging advanced disease were comparable for both sequences. CONCLUSION: The T2-weighted sequences remain mandatory for delineation of prostate carcinoma. Contrast-enhanced T1-weighted sequences do not improve overall staging accuracy and therefore are not warranted routinely, but should be considered in cases requiring clearer delineation of the prostate capsule and/or seminal vesicles.

[Experience with video transurethral resection]. / Erfahrungen mit der Video-TUR.

During 14 months more than 300 endoscopic interventions were performed by video-control only: 160 TUR of prostate, 37 TUR of bladder-tumours, 7 ureteroscopies, 17 manipulations with bladder stones and stents, 9 sight-urethrotomies, 72 diagnostic cystoscopies, 2 percutaneous nephrolithotripsies and 12 laparoscopic interventions. Technical requirement is a light and rotatable camera, preferably a monitor mounted over the patient and a self-adjusting light-source. The advantages are better identification of tissue, the use where there is limited mobility of the patient's hip joint and the possibility of demonstration and documentation. The urologist's face is protected against blood contact (HIV-prophylaxis), and he is taking care of his spine. It is the best way of instruction for the learning urologist and even a good training for laparoscopic surgery.

[Spontaneous recanalization after vasectomy]. / Spontane Rekanalisation nach Vasektomie.

Two cases of spontaneous recanalisation could be reoperated. The recanalisation was proved histologically. The reasons were analysed. The own technique is presented: resection of at least two centimeters of the vas, ligature, electrocoagulation, proximally turning-up fixation of the end, distally immersing the end in a tobacco-pouch.

[Problems with the intraurethral spiral]. / Problematik der intraurethralen Spirale.

In the last decade numerous attempts have been undertaken in non-surgical treatment of benign prostatic hyperplasia in order to enable the patient to void his bladder under control, without residual urine and without surgical resection. For the time being, attempts with drug therapy, as well as the more invasive methods with thermic or dilating effect on the prostatogenic infravesical obstruction are based on empiric studies. For many patients transurethral or suprapubic long-term catheterisation is, after all, the only solution. In this respect the "urologic spiral" represents a conservative alternative. In 1980 Fabian was the first to report on the successful clinical application of the intraprostatic "partial catheter" in 2 patients. 4 years later Fabian's remarkably good results in 48 patients are promising. However, what strikes first as an efficient innovation may also have its shortcomings and complications, as it was our experience in the first applications.

[Infectious complications after transurethral resection]. / Infektiöse Komplikationen nach transurethralen Resektionen (TUR).

300 consecutive TUR were prospectively examined bacteriologically. We used, lacking contraindications, Co-Trimoxazol as antibiotic prophylaxis, when urine at admittance was sterile, otherwise we treated the urinary infection. The antibiotics were applied from the beginning of the intervention until the catheter was removed. Of the 49 patients with a indwelling catheter 28 (57%) had an urinary infection. All but one were cured. 2 of 64 (3%) patients undergoing resection of a bladder tumour acquired asymptomatic nosocomial infection. 198 patients underwent TUR of the prostate with initially sterile urine. 7 patients suffered from fever in the postoperative course, in 6 cases the origin remained unclear. 3 patients showed an asymptomatic nosocomial infection. Overall, with antibiotic prophylaxis we found an infection rate of 2-5% for the TUR of the prostate and of 3% for the TUR of bladder. Primarily infected urine, in this study, did not elevate the risk for infectious complications.

[Further observations of dyslexia patients with prism correction]. / Weitere Beobachtungen von Legasthenikern mit Prismenkorrektion.

Report on 370 dyslexics, whereof 281 can be evaluated. The heterophoric cases were all corrected by Haase's method of prismatic binocular full correction. There are mainly esophorias but only little exophorias and strabisms. 3% are orthophoric. Visual acuity improved as well as sensory adaptations. The latter were mainly fixation disparities II. 82 operated cases resulted in a residual angle of 3+/-3 prism-diopters measured by Polatest. The influence on dyslexia is very good in 11%, good in 60%. 17% showed no influence on dyslexia but got rid of asthenopic symptoms. Only 12% failed. Good results are seen already after three months up to one year and in some cases even after 2 or 3 years. As optical and surgical corrections do not heal the dyslexia, it is discussed how to explain the obtained good results. The author's opinion is that prismatic corrections may save energy as the patients have no longer to compensate their heterophoria themselves. Thus they dispose on more energy e.g. for understanding of the text they are reading.

[Results of full binocular correction versus conventional methods]. / Resultate binokularer Vollkorrektion versus konventionelle Methoden.

UNLABELLED: 163 patients suffering from different serious troubles were treated with binocular full correction (BFC) i.e. examination by Polatest and prismatic correction. Before, they all had seen other ophthalmologists. The former diagnose and therapy are listed and compared with those of the author. RESULTS: After a 2 2/3 years average follow-up period 68% of the patients were complaintless, 23% felt better. All patients reached at least binocular single vision, although initially 13% had no binocular vision and 1% complained about diplopia. 70% got ideal binocular vision (initially 0%). In the beginning 50 patients suffered from reduced visual acuity. It improved in all cases with differences of v.a. from 2-4/10 to 10/10. From the shown results the author concludes that conventional binocular diagnostic and therapeutic methods do no longer meet the state of the art. It is postulated that BFC should be accepted by school-medicine and that ophthalmologists and orthoptists should be trained in BFC. Only in this way ophthalmologists may fulfil their task to free patients from the many complaints caused by binocular troubles. The used terminology about BFC is explained in the appendix.

[Transient normalization of the thrombocyte count in chronic idiopathic thrombocytopenia during pneumonia]. / Transiente Normalisierung der Thrombozytenzahl bei chronischer idiopathischer Thrombozytopenie während einer Pneumonie.

A patient is described with severe chronic idiopathic thrombocytopenic purpura. The platelet count was constantly below 20 X 10(9) Tc/L. Therapy with steroids, immunoglobulin-infusion with and without steroids, vincristine and danazol produced no improvement of the thrombocytopenia. During acute pneumonia a transient remission of the platelet count was observed. Antibodies against thrombocytes and immune complexes were not detected. The level of platelet-associated IgG was increased before and after infection but was only slightly elevated when platelet count was normal. An attempt to imitate the infection by vaccinating the patient with pneumovac with a view to later splenectomy did not change the platelet count. This observation confirms the hypothesis that elevation of platelet count during infection is due to decreased production of platelet autoantibody. Even severe forms of ITP are potentially reversible.

Immunohistochemical localization of alcohol dehydrogenase in the human gastrointestinal tract.

To elucidate the possible role of alcohol dehydrogenase in the generation of damages caused by alcohol abuse, it is important to know the exact localization of this enzyme. Anti-alcohol dehydrogenase antibodies were used to localize the enzyme in human gastrointestinal tissues. Alcohol dehydrogenase was detectable in the mucosa of all parts of the gastrointestinal tract. There is a notable decrease in the amount of alcohol dehydrogenase with increasing distance from the stomach. In the stomach, the reaction for alcohol dehydrogenase was strongest in the mucus-producing cells, moderate in the parietal cells, and weak in the chief cells. Throughout the gut, alcohol dehydrogenase was present in cells exposed to the lumen in amounts comparable to that of the parietal cells. Crypt cells and goblet cells were negative. The results strongly indicate that alcohol dehydrogenase is an intrinsic component of gastrointestinal epithelial cells.

The polymorphisms of alcohol and aldehyde dehydrogenase and their significance for acetaldehyde toxicity.

Evidence is growing that acetaldehyde is responsible for some toxic effects after ethanol intake. Large individual and racial differences in blood and breath acetaldehyde concentrations are observed after alcohol consumption. In many Orientals but few Caucasians extremely high blood acetaldehyde levels occur leading to an acute aldehyde syndrome also observed after treatment with aldehyde dehydrogenase inhibitors. Individuals suffering from the aversive symptoms of that syndrome will be protected from excessive drinking and the related problems. In chronic aldehydism slightly elevated aldehyde concentrations are observed possibly leading to organic injury due to the cytotoxic action of acetaldehyde. Sites exhibiting high alcohol dehydrogenase activity may specifically be affected in alcoholics.

Immunohistochemical localization of alcohol dehydrogenase in human kidney, endocrine organs and brain.

Antibodies against human liver alcohol dehydrogenase (ADH) were produced in rabbits. Peroxidase-labeled protein-A with diaminobenzidine as substrate was used to detect anti-ADH binding in human tissue thin sections. In the kidney, ADH was localized in the epithelia of the tubuli; glomeruli and collecting tubules appeared negative. In prostata and epididymis, the epithelia stained strongly. In the testes, the seminiferous epithelium and the Leydig cells stained higher in the cortex than in the medulla. In the pancreas, the Langerhans islets exhibited particularly high ADH concentrations. In the brain, ADH was localized in neurons of the cerebral cortex, hypothalamus, infundibular stalk of the pituitary, and Purkinje cells of the cerebellum. In summary, ADH could be localized primarily in cells known as targets of ethanol toxicity.

Immunohistochemical evidence for cell surface and Golgi localization of galactosyltransferase in human stomach, jejunum, liver and pancreas.

Immunohistochemical localization of galactosyltransferase (UDP-galactose: 2-acetamido-2-deoxy beta-D-glucopyranose beta (1-4) transferase) in human tissue specimens of gastric and jejunal mucosa, exocrine pancreas, and liver was carried out at the light microscopic level using affinity purified rabbit anti-human milk galactosyltransferase antibodies. Intracellular localization of galactosyltransferase in epithelial cells appeared as a triangular compact structure close to the apical pole of the nucleus. In hepatocytes, the enzyme was found in discrete spots in the cytoplasm between the nuclei and the bile canaliculi. In addition to the intracellular, juxtanuclear location an intense reaction at the luminal part of the cell surface was found in the lining epithelium of the stomach, in enterocytes of the jejunal villus tips, and in ductular cells of the pancreas. Enterocytes located in the middle portion along the cryptvillus gradient exhibited cytoplasmic staining adjacent to the brush borders. Basolateral membranes appeared negative. Little or no enzyme could be demonstrated in cells belonging to the connective tissue. These results show that secretory cells contain a Golgi apparatus which can be visualized at the light microscopic level by virtue of its content in galactosyltransferase. Presence of galactosyltransferase antigen on the surface of certain cells supports the assumption that ectoglycosyltransferases do exist, at sites, however, apparently not involved in cell contact and adhesion.

[Surgical correction of esophorias]. / Operative Korrektur von Esophorien.

A report covering 80 cases of esophoria in which surgery was performed. All the patients had previously suffered from severe headache and other complaints. Preoperative treatment consisted of full prismatic correction. The power of the prisms was measured by the "Polatest" method. We observed that the increase of the angle was initially very slow; sometimes two years or more were needed for it to reach 15 degrees. Subsequently the angle increased rapidly, stabilizing a few months later, whereupon surgery was performed. The peroperative angle varied from 15 degrees to 56 degrees. Postoperatively most cases attained orthophoria, some others a residual esophoria; there were only three cases of exophoria, these being among the 14 cases who had to undergo surgery twice. Sixty percent of the patients were subsequently free of complaints and the rest, with two exceptions, showed a distinct improvement. The average follow-up period was 2.2 years after surgery. One may conclude that esophorias which give rise to complaints can be treated with prisms, but that some of them may have to be operated on. For successful treatment a reliable instrument for measuring the angle of the phoria is indispensable. We found the Polatest best for this purpose. In most cases orthophoria and permanent relief of symptoms will result.