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  • 1
    ISSN: 1432-1440
    Keywords: Vesico-renal reflux ; Renal parenchymal scar ; Urinary tract infection ; Asymptomatic bacteriuria ; Uroepithelial cell ; Vesico-renaler Reflux ; Nierenparenchymnarbe ; Harnwegsinfektion ; Asymptomatische Bakteriurie ; Uroepithelzelle
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 62 Patienten (14 Knaben, 48 Mädchen), bei denen an insgesamt 85 Niereneinheiten ein vesico-renaler Reflux (Grad 2–4) erfolgreich operiert worden war, wurden im Durchschnitt 9,3 Jahre postoperativ auf das Auftreten von Harnwegsinfektionen (HWI) und von neuen Nierenparenchymnarben (NN) verfolgt. Bei den männlichen Patienten traten postoperativ bis auf einen Knaben keine HWI bzw. NN auf. Ähnliches galt auch für etwa 45% der Mädchen. Beide Gruppen von Patienten wiesen vor Operation hohe Refluxgrade auf. Bei den übrigen Mädchen, deren präoperative Reflux-Grade im Durchschnitt relativ niedrig lagen, traten jedoch postoperativ über Jahre noch HWI auf. NN entwickelten sich vorwiegend in dieser Zeit. Untersuchungen der Fähigkeit von Uroepithelzellen (UEZ), das Bakterienwachstum zu hemmen, zeigten, daß die UEZ dieser Patienten das Bakterienwachstum nicht supprimieren konnten. Somit entsprachen diese Mädchen bezüglich ihrer UEZ-Funktion Patientinnen mit asymptomatischer Bakteriurie. HWI und NN bei Reflux scheinen somit durch unterschiedliche Ursachen ausgelöst zu werden.
    Notes: Summary 62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2–4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of uroepithelial cells (UEC) to suppress bacterial growth revealed a deficient antibacterial effect of UEC in these patients. Such an UEC defect has also been shown in patients with asymptomatic bacteriuria. In conclusion, different reasons seem to be responsible for recurrent UTI and the development of RS in patients with reflux.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 63 (1985), S. 912-919 
    ISSN: 1432-1440
    Keywords: Vesico-renal reflux ; Classification of reflux ; Diagnostic procedures ; Surgical techniques ; Vesiko-renaler Reflux ; Refluxklassifizierung ; Diagnostische Verfahren ; Operationstechniken
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Für die Abklärung und Klassifizierung des vesiko-renalen Refluxes stehen eine Reihe diagnostischer Maßnahmen zur Verfügung, deren Aussagekraft nicht unumstritten ist. Aus diesen Gründen müssen therapeutische Entscheidungen bei der Refluxerkrankung häufig vom klinischen Verlauf abhängig gemacht werden. Durch die operative Refluxkorrektur kann mit hoher Zuverlässigkeit und geringer Komplikationsrate der vesiko-renale Reflux unabhängig vom präoperativ nachgewiesenen Refluxgrad beseitigt werden.
    Notes: Summary Detection and accurate grading of vesico-renal reflux is rendered difficult by the limited realiability of the different diagnostic procedures. Therapeutic decisions are therefore to a large extent influenced by the clinical situation. Properly performed antireflux surgery combines a high cure rate with a low complication rate.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 147 (1988), S. 579-581 
    ISSN: 1432-1076
    Keywords: Nephrolithiasis ; Extracorporeal shock-wave lithotripsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Non-surgical removal of renal and ureteral stones has proven successful in adults. In this study, 21 paediatric patients have been treated with the first generation extracorporeal shock-wave lithotriptor and an additional 13 children with a second generation local shock-wave lithotriptor. A total of 47 stones was treated. Treatment-related complications such as colics (17%/18.8%) or fever (8.3%/6.2%) were minimal. Stone passage occurred in 93% and 100%, respectively of each group. Open surgery is still the treatment of choice for large staghorn calculi. Extracorporeal shock-wave lithotripsy can be performed successfully in paediatric nephrolithiasis with stones of limited size.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1076
    Keywords: Beckwith-Wiedemann syndrome ; Congenital hemihypertrophy ; Medullary sponge kidney ; Wilms tumour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The occurrence of a Wilms tumour in a 4-year-old girl with bilateral medullary sponge kidney, Beckwith-Wiedemann syndrome and congenital hemihypertrophy demonstrates the close relationship between these disorders. Another six cases from the literature with congenital hemihypertrophy and with medullary sponge kidney are discussed, two of them also developed intra-abdominal neoplasm.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Extracorporeal shock wave lithotripsy (ESWL) has been in clinical use for more than 5 years. Several devices commonly designated “second generation” lithotriptors are now under experimental or clinical trials. A multifunctional lithotriptor unit developed in cooperation with the Siemens Company in Germany is described, which utilizes an electromagnetic mode of shock wave generation along with local coupling to the patient. The results of 795 treatments are presented. The prototype has been in operation since March 1986. Adjuvant endourological measures, all of which have been performed on the same table, include insertion of double-J stents and ureteral catheters prior to ESWL in 27% of all treatments. Shock wave lithotripsy alone has been performed successfully under local anesthesia or a combination of parenteral analgesia and sedation. Results of treatment have been uniformly satisfying.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been done since 1983 in 26 patients. Of these 11 were for bladder augmentation after subtotal cystectomy and 15 for continent urinary diversion. All of the patients with bladder augmentation are completely dry day and night; 2 patients with myelomeningocele are on intermittent catheterization for bladder evacuation. The remainder void spontaneously without significant residual urine. Of 15 patients with Mainz-pouch urinary diversion, 4 had an alloplastic stomal prosthesis implanted for control of continence and 11 have isoperistaltic ileo-ileal invagination, where by the invagination valve can easily be fixed to the intussuscepting ileum by sutures or staples. Of the 4 alloplastic stomal prostheses, 2 have been removed because of infection. In 1 of these patients, an ileo-ileal invagination was performed in the same operation to achieve continent closure. All patients with the invagination valve, as well as the 2 patients with an alloplastic stomal prosthesis, are completely continent, but in 3 cases, revision of the ileo-ileal invagination became necessary due to prolapse of the valve.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-198X
    Keywords: Continent urinary diversion ; Bladder augmentation ; Young-Dees technique, modified ; Ileocaecal pouch ; Iatrogenic bladder loss, therapy of
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The formation of a bowel reservoir of large capacity at low pressure by using small and large bowel (ileocaecal segment) has proved reliable for achieving continent urinary diversion (n=80), for bladder augmentation (n=42) as well as for total bladder replacement (n=24). Encouraged by the results we obtained in our adult patients, we have used this technique during the last 3.5 years in 29 children. Indications for urinary diversions in children have been: neurogenic bladder with diplegia (n=8), bladder exstrophy (n=2), traumatic loss of the bladder (n=1), urogenital sinus (n=1) and rhabdomyosarcoma of the prostate or bladder (n=2). Bladder augmentation was indicated in 6 children with iatrogenic bladder loss, in 5 children with neurogenic bladder without diplegia and in 4 boys with incontinent epispadias or exstrophy. In children with bladder exstrophy or incontinent epispadias, continence was achieved using a modified Young-Dees technique with formation of a long intra-abdominal muscular tube made out of the bladder plate or the low-capacity bladder. The capacity of the urinary reservoir was guaranteed by bladder augmentation or bladder replacement with an ileocaecal pouch. During a mean follow-up period of 26 months (bladder augmentation) and 21 months (continent diversion) there was only one postoperative complication (intussusception ileus) which required operative revision. Two children had to undergo reoperation because of nipple problems. Follow-up, with monitoring of biochemical and metabolic parameters, is necessary to show whether this technique will provide a long-term successful solution for these problems.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1434-0879
    Keywords: Urinary diversion ; Carcinoma induction ; Carcinoma prophylaxis ; Ileal interposition ; Urointestinal anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eighty Wistar rats were randomized into two groups. In group 1 vesicosigmoidostomy with proximal colostomy was performed, in group 2, vesicosigmoidostomy. The total tumor incidence did not differ significantly (group 1 10/40, 25%; group 2 13/40, 32.5%). The tumor spectrum differed, with more adenocarcinomas in group 2 (11/40, 27.5% vs 4/40, 10%;P=0.047) and urothelial carcinomas only in group 1 (5/40, 2.5%). One hundred and ten other Wistar rats were randomized into three groups. Animals in group A received vesicoileosigmoidostomy, group B, two-step vesicosigmoidostomy with initial separation of urine and the urocolonic anastomosis, group C, vesicosigmoidostomy. Significantly fewer adenocarcinomas were observed in group A (2/40, 5%) than in group B (16/40, 40%,P〈0.002) and group C (9/30, 30%;P〈0.007). These results indicate a similar cancer risk in all continent forms of urinary diversion, at least via colon. Ileal interposition seems to be an effective carcinoma prophylaxis following ureterosigmoidostomy. The proliferative instability at the urointestinal anastomosis is crucial for the pathogenesis and prophylaxis of this form of carcinogenesis, whereas urine seems to play only a minor role.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1434-0879
    Keywords: Transglutaminases ; Prostate cancer ; Metastasis ; Cellular wound repair
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Using biochemical assays, we compared enzyme activities with the immunoreactivity of antibodies against rat seminal transglutaminase (TGase), human erythrocyte TGase and guinea pig liver TGase in human normal prostate, primary prostatic carcinomas and prostatic carcinoma cell lines. Glandular cells of the epithelium were only exceptionally positive with the antibody against (rat) secretory TGase. Using the antibodies against tissue-type TGase, most immunoreactive cells were found in the basal cell layer of prostatic epithelium as well as in stroma (fibroblasts, endothelial cells), whereas immunoreactive glandular cells were sparse. In the case of benign prostatic hyperplasia, few, irregularly distributed secretory cells along with a small number of stromal cells were also immunoreactive with the tissue-type TGase antibody. In dedifferentiated carcinomas, immunoreactive cells were nearly completely absent. Of the prostate cancer cell lines, the LNCaP line showed neither TGase enzyme activity nor immunoreactivity, whereas the PC-3 cell line displayed significant enzyme activity and immunoreactivity. No hormone-dependent changes in either enzyme activity or immunoreactivity were recorded after in vitro treatment of the respective cell lines with estrogens, androgens and antiandrogens. As there is no correlation between androgen deprivation and TGase expression in nonmalignant and malignant human prostatic epithelial cells, TGase activity more likely indicates cellular lesions and consecutive repair mechanisms.
    Type of Medium: Electronic Resource
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