[Urogenic spondylodiscitis]. / Urogene Spondylodiszitis.

Despite modern diagnostic investigations, pyogenic infections of the spine are often detected late and are therefore associated with a high lethality. To ensure efficient and adequate therapy, it is necessary to identify and treat the focus of the inflammation. Urogenic spinal infections are often underestimated in their frequency of occurrence and severity of symptoms. From 1994 to 2006, 209 patients suffering a spinal infection were treated in the Department of Orthopedic Surgery. In 13 of them (6.2%), a urogenital inflammation caused the spondylodiscitis. In the context of a retrospective clinical trial, we investigated the risk factors, clinical aspects, and therapeutic consequences of patients with urogenic spinal infections and those with another genesis. The two data sets were compared, and therapeutic differences were extracted.

[Retroperitoneal leiomyosarcoma. A rare differential diagnosis of an adrenal tumor]. / Retroperitoneales Leiomyosarkom. Eine seltene Differentialdiagnose des Nebennierentumors.

A pararenal mass is a clinical finding that cannot be explored preoperatively regarding its parent organ even nowadays. We report in the following about a patient who was admitted with dull pain located in the flank and upper abdomen. Ultrasound investigation at admission showed a solid homogeneous mass close to the upper pole of the left kidney. Urinalysis and catecholamine levels were normal. Intraoperatively, a sarcoma infiltrating the renal capsule and renal vein was observed. In the case of a mass located in the area of the adrenal gland, an extra-adrenal tumor must be considered especially if there are normal findings for urinalysis and catecholamine levels even if modern imaging techniques had been applied.

[131I] Hippuran renography in the detection of orthostatic hypertension.

Scintigrams in prone and standing positions were done in 11 hypertensive women. All had nephroptosis with ventral rotation. On the basis of the renograms, seven patients were identified as suffering from orthostatic hypertension. Nephropexy resulted in normalization of blood pressure in six of the seven patients and normalization of the renograms of all seven. We believe that sequence scintigrams in prone and standing positions offer a simple method of identifying patients with orthostatic hypertension.

Antibody-coated bacteria in ejaculate in bacterial prostatitis.

In patients with bacteriologically proved prostatitis (Stamey test) ejaculate was examined for antibody-coated bacteria (ACB). Forty-four of the 68 patients (65%) with bacteriologically proved prostatitis had ACB in the ejaculate, but only 7 of 89 patients (8%) with prostatodynia. Concomitantly, coeruloplasmin and complement (C3) concentrations in the ejaculate were examined by radial immunodiffusion (RID). The ACB test had much higher specificity (92%) than RID, and the sensitivity of ACB was 65 per cent.

Microcalcifications in testicular malignancy: diagnostic tool in occult tumor?

Malignant testicular tumor microcalcifications are being reported at an increasing rate. However, whether or not the detection of microcalcifications had any clinical significance has not been clarified. In the the present study testicular specimens from 92 patients (43 with malignant and 49 with nonmalignant testicular diseases) were examined postoperatively by mammographic technique. Microcalcifications were identified in 32 of the testicular tumor specimens (74 per cent), more frequently in teratomas (87 per cent) than in seminomas (60 per cent), and in 3 "burned-out" tumors. In contrast, only 8 of the benign testicular specimens showed microcalcifications (16 per cent). The arrangement of microcalcifications as well as the distinct pattern of distribution may further discriminate nonmalignant from malignant entities. Though the rate of detection and allocation of microcalcifications in malignant testicular tumors was a surprising finding, the general use of orchioradiography seems problematic because of the risk of potential damage to the germinal epithelium. In occult carcinoma, however, preoperative or orchioradiography may be justified.

Failure of subureteral bovine collagen injection for the endoscopic treatment of primary vesicoureteral reflux in long-term follow-up.

OBJECTIVES: To evaluate the long-term efficacy of subureteral glutaraldehyde cross-linked collagen injection (GAX 35) for endoscopic treatment of primary vesicoureteral reflux (VUR). METHODS: We prospectively studied 36 patients (58 ureteral renal units), 30 girls and 6 boys with a median age of 6 years (range 2 months to 18 years). All patients had primary VUR and were treated with a single subureteral collagen injection (GAX 35). The patients were followed up by voiding cystography. RESULTS: According to the International Reflux Study Classification, we found the following reflux grades preoperatively: grade I, 2 ureteral units; grade II, 21 units; grade III, 28 units; grade IV, 4 units, and grade V, 3 units. All patients were treated with subureteral bovine collagen injection (GAX 35, mean volume 1.7 mL, range 0.7 to 3.5). All but 3 cases of reflux resolved initially. The mean follow-up was 13 months (range 1 to 108). After 37 months of follow-up, only 5 (9%) of 57 treated units remained reflux free. One unit was followed up for 17 months and also remained reflux free. CONCLUSIONS: These data suggest that a single endoscopic subureteral collagen injection is not effective in the long-term follow-up of patients with primary VUR. In the future, it will be important to determine whether the new, currently used, and soon be approved bulking agents show better long-term clinical results to prevent VUR recurrence than bovine collagen does.

[Intravesical prevention of recurrence of superficial urinary bladder cancer with BCG and KLH. A prospective randomized study]. / Intravesikale Rezidivprophylaxe beim oberflächlichen Harnblasenkarzinom mit BCG und KLH. Eine prospectiv randomisierte Studie.

In a prospective randomized trial intravesical prophylaxis for recurrence of superficial bladder cancer with BCG versus KLH was performed in 42 patients, 38 of whom were then evaluable. After a mean observation period of 20 +/- 7 months (8-32 months) 41.2% (7/17) of the patients in the KLH and 14.3% (3/21) of the patients in the BCG group developed recurrent bladder tumours. The recurrence rate according to EORTC was 1.95 in the KLH group versus 0.76 in the BCG group. Among the BCG treated patients, 60% (15/25) had cystitis and 28% (7/25) fever, whereas only 1 of 19 (5.3%) patients treated with KLH had cystitis. BCG is a highly effective prophylactic against recurrence of superficial bladder cancer. Intravesical instillation therapy with KLH has only a slight prophylactic effect if treatment is started 6 weeks postoperatively.

[Kidney transplantation in children]. / Nierentransplantation bei Kindern.

Renal transplantation has become an established form of therapy for children with endstage renal disease. Evaluation and elimination of potential risk factors, standardization of operative technique and better immunosuppressive regimens improved the outcome in paediatric patients. A shortage or organs means that transplantations cannot always be offered to children for whom it would be the treatment of choice. Kidney donation by living relatives opens up the potential for optimal rehabilitation of patients in the paediatric age group.

[Spontaneous kidney ruptures--a complication of panarteritis nodosa]. / Spontane Nierenrupturen--eine Komplikation der Panarteriitis nodosa.

Besides renal cell carcinomas and angiomyolipomas panarteritis nodosa (PAN) is a common underlying disorder for spontaneous perirenal hematomas (SPH). Herein we report on 3 cases with PAN associated kidney ruptures where diagnosis of PAN was not known before in 2 instances. The hematoma was identified by computerized tomography (CT) in all patients, nevertheless CT failed to reveal the underlying disorder in any case. In this situation angiography was extremely valuable visualizing multiple renal microaneurysms that are typical for PAN. Operative exploration and drainage of the hematoma was necessary in two patients because of hemodynamic instability. In one patient bleeding could be controlled after an immediate immunosuppressive therapy with prednisone and cyclophosphamide. Due to the high incidence of PAN associated spontaneous perirenal hematomas angiography should be performed in all cases with unclear SPH after CT evaluation. In our opinion an immediate surgical intervention is only indicated in cases with hemodynamic instability. Otherwise a conservative approach including immediate immunosuppression seems justified. Nephrectomy should be avoided whenever possible.