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  • 1
    ISSN: 1432-1076
    Keywords: Bladder exstrophy ; Interpersonal relations ; Sexual behaviour ; Fertility and education
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract After primary bladder closure or urinary diversion, other factors apart from the reconstruction itself gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility. Between 1968 and July 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime. Of the remaining 102 patients 48 attend school, 4 are in college, 40 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic centre and 6 are younger than 6 years of age. A total of 95% of the patients with continent urinary diversion are continent day and night, whereas only three of five patients with a sling plasty (incontinent epispadias) or with primary bladder closure followed by a Young-Dees procedure are continent. None of the patients showed deterioration of renal function. In 25 females the external genitalia were reconstructed. Fixation of the uterus was done in 13 to correct or prevent uterine prolapse. Of the 17 women older than 18 years of age with genital reconstruction, 16 are satisfied with the cosmetic result. All adults engage in sexual intercourse. Five women have delivered seven children by Caesarean section. Of the 35 male adults 32 underwent reconstruction of the external genitalia and 34 males achieve erection. One developed necrosis of the penis early in life following primary bladder closure performed at an outside hospital. Penile deviation was present in 11 of the 32 patients with genital reconstruction, which is distressing in only 2. Thirty patients are satisfied with the cosmetic result. After genital reconstruction 9 males developed epididymitis, necessitating two orchiectomies and three vasectomies. No patient with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas ejaculation was normal in the three men who did not undergo genital reconstruction and in two patients prior to post-pubertal reconstruction. Furthermore, two of these three men have fathered four children.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1076
    Keywords: Key words Bladder exstrophy ; Interpersonal relations ; Sexual ; behaviour ; Fertility and education
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract After primary bladder closure or urinary diversion, other factors apart from the reconstruction itself gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility. Between 1968 and July 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime. Of the remaining 102 patients 48 attend school, 4 are in college, 40 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic centre and 6 are younger than 6 years of age. A total of 95% of the patients with continent urinary diversion are continent day and night, whereas only three of five patients with a sling plasty (incontinent epispadias) or with primary bladder closure followed by a Young-Dees procedure are continent. None of the patients showed deterioration of renal function. In 25 females the external genitalia were reconstructed. Fixation of the uterus was done in 13 to correct or prevent uterine prolapse. Of the 17 women older than 18 years of age with genital reconstruction, 16 are satisfied with the cosmetic result. All adults engage in sexual intercourse. Five women have delivered seven children by Caesarean section. Of the 35 male adults 32 underwent reconstruction of the external genitalia and 34 males achieve erection. One developed necrosis of the penis early in life following primary bladder closure performed at an outside hospital. Penile deviation was present in 11 of the 32 patients with genital reconstruction, which is distressing in only 2. Thirty patients are satisfied with the cosmetic result. After genital reconstruction 9 males developed epididymitis, necessitating two orchiectomies and three vasectomies. No patient with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas ejaculation was normal in the three men who did not undergo genital reconstruction and in two patients prior to post-pubertal reconstruction. Furthermore, two of these three men have fathered four children. Conclusion Education, occupation and social development of patients with urinary diversion are uneventful. The cosmetic results achieved by genital reconstruction are satisfactory. In female patients, antefixation of the uterus should be performed before or together with an introitusplasty to prevent uterine prolapse. In male patients, however, surgery is performed at the expense of fertility. Detailed discussions with the patients and their parents should include not only the question of primary bladder closure versus urinary diversion, but also the pros and cons of correction of the external and – in females – the internal genitalia.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Between 1969 und 1989 conservative surgery for kidney tumors was performed in 123 patients. In 49 patients there was an imperative indication for a parenchyma-sparing operation because nephrectomy would have made dialysis obligatory. Thirty-five of these 49 patients show no signs of tumor progression after a mean follow-up of 4.5 years. Known metastases were present in 3 of 6 patients who died as a result of their tumors. In two patients there was a recurrence after 1 and 5 years, respectively, requiring a second organ-preserving operation. In one further patient we suspect that multiple small tumor lesions may be present 2 years after the first operation. In 74 patients with a healthy contralateral kidney the tumor was enucleated by choice (elective indication). Sixty-eight of these 74 patients show no signs of tumor progression after a mean follow-up period of 3.3 years. One patient died from tumor metastases. Two patients had tumor recurrence, requiring nephrectomy and enucleation, respectively. Fifty-seven enucleated tumors were available for image analysis DNA cytometry. Only the two patients with a hypertriploid tumor died from their cancer.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a retrospective study, paraffin-embedded cystectomy specimens obtained from 46 patients with bladder cancer (stage pT1 — pT4a, pN0, pN2) were analysed for tumor DNA ploidy and proliferation using automated image cytometry (LEYTAS). In 41 cases, DNA ploidy could be measured. Estimation of proliferation was possible in 26 tumors. The number of cells with a DNA content higher than 5C could be calculated in 38 of the tumors. All these three parameters are shown to correlate with patient outcome.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    World journal of urology 13 (1995), S. 163-165 
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The role of nephron-sparing surgery for renal cell carcinoma is well established in patients with an anatomical or functional solitary kidney (imperative indication) in which a radical nephrectomy would render the patient anephric with subsequent need for hemodialysis. This also encompasses patients with a unilateral renal cell carcinoma and a functioning contralateral kidney when the opposite renal unit is affected by a disease that might threaten its future function, such as renal artery stenosis, chronic pyelonephritis, stone disease or systemic conditions such as diabetes. A functioning renal remant of at least 20% of normal renal parenchyma seems to be necessary to avoid end-stage renal failure in these patients [16]. There have been several reports in the literature of excellent 5-year cancer-specific survival rates of over 80% in such circumstances [12, 15]. These results were confirmed in our institution, with a 5-year cancer-specific survival rate of 83% in over 70 patients with an imperative indication for nephron-sparing surgery. Thereby the prognosis was significantly influenced by the local tumor stage and the grade of malignancy. These data support the efficacy of nephron-sparing surgery in this clinical situation.
    Type of Medium: Electronic Resource
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  • 6
    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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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Urological research 22 (1994), S. 17-20 
    ISSN: 1434-0879
    Keywords: Testicular tumor ; Automated image analysis ; DNA cytometry ; Classification ; Seminoma ; Embryonal carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The value of automated DNA cytometry for differentiation of testis cancer was evaluated in 54 seminomas, 13 HCG-positive seminomas, and 48 embryonal carcinomas. Slices of paraffin embedded tissue were enzymatically digested and stained with Feulgen SITS after fixation on glass slides. Automated DNA cytometry was performed with a Modular Image Analysis Computer (MIAC). DNA histogram phenotpye and computed DNA indices were correlated with the different tumor types. The ratio of hypertriploid to hypotriploid increased from HCG-positive seminoma over embryonal carcinoma to seminoma. The following mathematical DNA indices were found to correlate with tumor type: mean ploidy, 2c deviation index, 5c exceeding rate, variation coefficient of the GO/1 fraction and DNA nucleus diameter correlation.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1433-0563
    Keywords: Schlüsselwörter Prostataspezifisches Antigen ; Transrektaler Ultraschall ; Artifizielle Neuronale Netzwerkanalyse ; Key words Prostate specific antigen ; Transrectal ultrasound ; Artificial neural network analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract As a result of the enhanced clinical application of prostate specific antigen (PSA), an increasing number of men are becoming candidates for prostate cancer work-up. A high PSA value over 20 ng/ml is a good indicator of the presence of prostate cancer, but within the range of 4–10 ng/ml, it is rather unreliable. Even more alarming is the fact that prostate cancer has been found in 12–37% of patients with a “normal” PSA value of under 4 ng/ml (Hybritech). While PSA is capable of indicating a statistical risk of prostate cancer in a defined patient population, it is not able to localize cancer within the prostate gland or guide a biopsy needle to a suspicious area. This necessitates an additional effective diagnostic technique that is able to localize or rule out a malignant growth within the prostate. The methods available for the detection of these prostate cancers are digital rectal examination (DRE) and Transrectal ultasound (TRUS). DRE is not suitable for early detection, as about 70% of the palpable malignancies have already spread beyond the prostate. The classic problem of visual interpretation of TRUS images is that hypoechoic areas suspicious for cancer may be either normal or cancerous histologically. Moreover, about 25% of all cancers have been found to be isoechoic and therefore not distinguishable from normal-appearing areas. None of the current biobsy or imaging techniques are able to cope with this dilemma. Artificial neural networks (ANN) are complex nonlinear computational models, designed much like the neuronal organization of a brain. These networks are able to model complicated biologic relationships without making assumptions based on conventional statistical distributions. Applications in Medicine and Urology have been promising. One example of such an application will be discussed in detail: A new method of Artificial Neural Network Analysis (ANNA) was employed in an attempt to obtain existing subvisual information, other than the gray scale, from conventional TRUS and to improve the accuracy of prostate cancer identification.
    Notes: Zusammenfassung Das prostataspezifische Antigen (PSA) ist heutzutage der meistgenutzte Marker in der Diagnostik des Prostatakarzinoms. Hieraus resultiert eine vermehrte Anzahl von asymptomatischen Männern, die allein durch eine PSA-Werterhöhung Kandidaten für eine weiterführende Prostatadiagnostik werden. Ein deutlich erhöhter PSA-Serumwert (〉20 ng/ml) lässt mit hoher Wahrscheinlichkeit auf das Vorhandensein eines Prostatakarzinoms schließen. Im sog. Graubereich zwischen 4 und 10 ng/ml ist der Gewebemarker PSA meist durch gutartige Veränderungen beeinflusst, so dass eine Unterscheidung zwischen maligner und benigner Ursache aufgrund des PSA-Wertes allein nicht möglich ist [1–4]. Darüber hinaus findet man Karzinome bei Patienten, die ein PSA unter dem Normwert von 4 ng/ml aufweisen. Die Methoden, die bislang für die Früherkennung oder Erkennung des Prostatakarzinoms zur Verfügung standen (Tastbefund und Ultraschall) sind unzureichend. So sind ca. 70% der palpablen Tumoren nicht mehr organbegrenzt [5, 6]. Das klassische Problem der visuellen Ultraschallbeurteilung ist die mangelnde Spezifität, insbesondere bei geringer Erfahrung mit der Methode [7–11]. Um die diagnostischen Möglichkeiten des transrektalen Ultraschalls (TRUS) in der Prostatakarzinom-Früherkennung und -Stadieneinteilung zu erhöhen, wird in der hier vorgestellten Studie eine Artifizielle Neuronale Netzwerkanalyse (ANNA) eingesetzt, die zusätzliche subvisuelle, graustufendifferente Informationen des TRUS erfassen und auswerten kann [12–14]. Dieser Ansatz erscheint vielversprechend, da Artifizielle Neuronale Netzwerke die im Ultraschallbild vorhandenen komplexen Datenformationen erkennen können, sie gleichsam “lernen” und diese dann bei noch nicht gesehenen Datenformationen wiedererkennen und korrekt klassifizieren können [15].
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1435-2451
    Keywords: Stomach carcinoma ; DNA content ; Histomorphological parameter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Am Tumormaterial von 103 Patienten nach kurativer Resektion wegen eines Magenkarzinoms wurde ein Vergleich des DNS-Gehaltes der Tumorzellen mit den histomorphologischen Parametern vorgenommen. Es zeigte sich, daß der DNS-Gehalt mit den histomorphologischen Parametern korreliert, ohne jedoch eine weitere prognostische Aussage zu ermöglichen. In der multivariaten Regressionsanalyse zur Beurteilung der prognostisch unabhängigen Variablen war demzufolge die rezidivfreie Überlebenszeit allein von der Infiltrationstiefe des Tumors und dem Lymphknotenstatus abhängig. Keinen Einfluß auf die rezidivfreie Überlebenszeit hatten der histologische Tumortyp, die Tumorlokalisation, das Operationsverfahren und der DNS-Gehalt.
    Notes: Summary After curative resection of stomach carcinomas (adenocarcinomas: n=58, signet ring cell carcinomas: n = 24, undifferentiated carcinomas: n = 21) the DNA content of the tumor cells was compared with the histomorphological parameters. There was a correlation between the DNA content and the histomorphological parameters. The DNA analysis had no additionally prognostic influence. In the multivariate regression analysis the prognosis depended on lymph node status (p=0.0009), pT-stage (p = 0.02), tumor localization (p = 0.03) and the histological type (p=0.05). The prognosis was independent of the DNA content. Furthermore, neither did the degree of differentiation, the operative procedure, the safety distance, the size of the tumor, the sex nor the age of the patient have any influence on the prognosis.
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  • 10
    ISSN: 1435-2451
    Keywords: DNA-analysis ; Prognosis ; Papillary thyroid carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 19 Patienten, bei denen wegen eines papillären Schilddrüsenkarzinomes eine Resektion durchgeführt worden war, wurde neben der TNM-Klassifikation und den üblichen morphologischen Beurteilungskriterien zusätzlich eine bildanalytische DNS-Zytometrie durchgeführt. Es fanden sich 13 diploide and 6 aneuploide Tumoren. Bei Patienten mit diploiden Tumoren betrug die rezidivfreie Überlebensrate Bowie die Überlebensrate nach 103 Monaten 84% bzw. 92%, wäh-rend 3 von 6 Patienten mit nichtdiploiden Tumoren in nerhalb von 70 Monaten ein Rezidiv erlitten. Zwischen dem DNS-Gehalt der Tumoren einerseits and dem Tumorstadium, der pT-Einteilung, dem Vorhandensein von Lymphknotenmetastasen and einer tumorbedingten Gefäβinfiltration andererseits fand sich kein Zusammenhang.
    Notes: Summary In this study we analysed DNA-ploidy as a potential prognostic parameter in papillary thyreoid carcinoma. Paraffin embedded histological material, obtained by resection from 19 patients with a papillary thyreoid carcinoma, was selected for analysis. Tumor areas within the paraffin-embedded material were identified by HE-stained reference sections. One 50 pin section was dewaxed, rehydrated and mechanically and enzymatically prepared to form a suspension of 10,000 cells/ml. 1 ml of the suspension, which contained bare nuclei with small rests of cytoplasma, was centrifuged on glass slides. The fixed nuclei were air-dried and stained by Feulgen SITS technique, which allows for the quantitative measurement of DNA. The DNA analysis was carried out with a computer-controlled single-cell cytophotometry. In contrast to using flow cytometry, only the tumor cells were measured by image-cytometry. Overlapping nuclei, dirt and other artifacts as well as inflammatory cells were efficiently eliminated. With DNA image-cytometry, we could differentiate between diploid (n = 13) and aneuploid (n = 6) tumors. Best prognosis with a survival rate of 92% after 103 months had patients with diploid tumors in contrast to patients with aneuploid tumors who did not survive more than 72 months.
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