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  • 1
    Digitale Medien
    Digitale Medien
    Springer
    Der Urologe 39 (2000), S. 166-170 
    ISSN: 1433-0563
    Schlagwort(e): Schlüsselwörter Urolithiasis • Harnsteinleiden • Metaphylaxe • Volkswirtschaft • Kosteneffektivität ; Key words Urolithiasis • Stone disease • Metaphylaxis • Economy • Cost-effectiveness
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary A calculation model was developed for the cost of stone therapy and metaphylaxis in Germany based on estimates of stone incidence, types and recurrence rates, actual costs for stone removal and metaphylaxis (based on data from a district of the social health care system). There are 200,000 stone recurrences per year in Germany. Cost for treatment of these stones amount to $687,000,000. Stone metaphylaxis reduces the recurrence rate by some 40 %. The annual cost for stone removal could be lowered by $275,300,000. Metabolic evaluation/metaphylaxis amount to $70,100,000 per year, resulting in an net saving of $205,200,000. In 1997, there were 96 days off-work per stone patient resulting in 5,800,000 days off-work in Germany per year. Metaphylaxis in stone formers can lower health care cost significantly. Although health care conditions may vary from country to country, in principle this calculation model is applicable also to other countries.
    Notizen: Zusammenfassung Das Berechnungsmodell für die Kosten der Harnsteintherapie und Metaphylaxe in Deutschland basiert auf Schätzungen der Inzidenz und Rezidivraten verschiedener Steinarten sowie den tatsächlichen Kosten für die Steintherapie (Erhebung in einem Bezirk einer gesetzlichen Krankenversicherung) und die Metaphylaxe (entsprechend dem EBM und den Medikamentenkosten). In Deutschland ist mit 200 000 Steinrezidiven zu rechnen. Eine stationäre Steinbehandlung kostete 1997 11 500 DM pro Fall. Die Kosten für die Behandlung aller Rezidive kostet 1,33 Mrd. DM (50 % stationär). Eine rationelle Metaphylaxe kann die Rezidivrate um 40 % senken. Damit ließen sich die Kosten für die Steinentfernung um 468 Mio. DM senken. Metabolische Diagnostik/Metaphylaxe kosten 119,12 Mio. DM. Die Netto-Ersparnis beträgt daher 348,88 Mio. DM jährlich. 1997 betrug die durchschnittliche Arbeitsunfähigkeitsdauer eines Steinpatienten des untersuchten Bezirk 97 Tage, daraus resultieren insgesamt 5,8 Mio. Fehltage in Deutschland. Das Berechnungsmodell zeigt, daß die Steinmetaphylaxe die Gesundheitskosten signifikant senken kann und eine große volkswirtschaftliche Bedeutung hat.
    Materialart: Digitale Medien
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  • 2
    Digitale Medien
    Digitale Medien
    Springer
    Der Urologe 35 (1996), S. 408-412 
    ISSN: 1433-0563
    Schlagwort(e): Schlüsselwörter Hyperkalziurie ; Urolithiasis ; Kalziumstoffwechsel ; Pak-Test ; Osteokalzin ; Key words Hypercalciuria ; Urolithiasis ; Calcium metabolism ; Pak test ; Osteocalcin
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary The different subgroups of hypercalciuria cannot be separated clearly by the Pak calcium-load test. To improve the diagnosis and therapy we examined all relevant parameters of calcium metabolism in 32 patients with calcium urolithiasis and hypercalciuria (〉 6.25 mmol/day). We also conducted bone mineral density measurements as well as the Pak calcium-load test. In most cases the pathophysiological constellations which Pak takes as the basis for his classification of hypercalciuria could not be shown. To date, diagnostics only insufficiently explains the genesis of hypercalciuria (except pHPT). As a consequence, a therapeutic problem arises: a low-calcium diet should not be generally recommended, since some patients may develop osteopenia. From our investigation the following diagnostic and therapeutic conclusions can be drawn: (1) Hypercalciuria in primary hyperparathyroidism should be treated by surgical removal of the adenoma. (2) The parathormone-independent osteogenic form should be treated with thiazides. (3) Hypercalciuria with increased 1,25-dihydroxyvitamin D should be treated by low-calcium diet.
    Notizen: Zusammenfassung Der Kalziumbelastungstest nach Pak kann die verschiedenen Untergruppen der Hyperkalziurie nicht eindeutig voneinander trennen. Zur Klärung der Möglichkeit einer verbesserten Diagnostik und der daraus abzuleitenden Therapie haben wir bei 32 Patienten mit Kalziumurolithiasis und Hyperkalziurie (〉 6,25 mmol/die) die relevanten Parameter des Kalziumstoffwechsels untersucht, die vertebrale Knochendichte gemessen sowie einen Pak-Test durchgeführt. Die pathophysiologischen Konstellationen, die Pak seiner Hyperkalziurieklassifikation zugrunde legt, konnten zumeist nicht nachgewiesen werden. Durch die bisherige Diagnostik läßt sich nicht eindeutig entscheiden, welche Genese der Hyperkalziurie zugrundeliegt (Ausnahme: pHPT). Daraus resultiert ein therapeutisches Problem: Die Empfehlung einer kalziumarmen Diät kann grundsätzlich nicht mehr gegeben werden, da bei manchen Patienten langfristig Osteopenien resultieren könnten. Aus unseren Untersuchungen ergeben sich folgende diagnostische und therapeutische Konsequenzen: Drei Gruppen lassen sich unterscheiden: 1. Die Hyperkalziurie bei primärem Hyperparathyreoidismus ist durch die operative Entfernung des Nebenschilddrüsenadenoms zu behandeln. 2. Die parathormon-unabhängige osteogene Form sollte mit Thiaziden behandelt werden. 3. Die Hyperkalziurie bei erhöhtem 1,25-Dihydroxycholecalciferol kann durch kalziumarme Diät behandelt werden.
    Materialart: Digitale Medien
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  • 3
    Digitale Medien
    Digitale Medien
    Springer
    Urological research 19 (1991), S. 367-373 
    ISSN: 1434-0879
    Schlagwort(e): Tumor necrosis factor ; Renal-cell carcinoma ; Uromodulin ; Tamm-Horsfall protein
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The use of tumor necrosis factor (TNF) in immunotherapy of tumor diseases has attracted increasing interest. Since the direct antitumor effect of the TNF is mediated by receptor-bound TNF, we immunohistologically stained both benign and malignant tissue from 35 tumor-bearing human kidneys for TNF. Using a polyclonal anti-TNF-antiserum, paraffin sections were tested in the presence and absence of in vitro preincubation with TNF. Futhermore, all specimens were stained immunohistologically for Tamm-Horsfall protein (THP) because this renospecific glycoprotein can bind TNF in a lectin-like manner. In the absence of TNF preincubation, malignant tissue was TNF-positive in 34 specimens, as was benign tissue from the same tumor-bearing kidneys in 35 cases. In several specimens the staining was so intense that preincubation with TNF did not enhance the reaction. Whereas TNF staining in tumor tissue was relatively homogenous, that in benign tissue was intensive in distal tubuli, moderate in proximal tubuli, and negative in glomeruli. THP staining was negative in malignant kidney tissue but positive in the distal tubuli of benign tissue, i. e., in the regions in which TNF staining was most intense. These results indicate that TNF binds not only to membrane, most likely in a receptor-mediated manner, but also to THP both in vivo and in vitro. In vivo binding of TNF to THP was confirmed in animal experiments in which pigs were given injections of TNF. Immunohistological staining of the animals' kidneys revealed positive reactions for both TNF and THP at the distal tubuli, indicating TNF binding to THP after in vivo TNF administration. The presence of TNF in human kidney tumors implies that renal-cell carcinoma cells in situ are resistant to the direct cytotoxic effect of TNF. This resistance should be taken into account when TNF is considered for use as a possible immunotherapeutic agent in renal-cell carcinoma.
    Materialart: Digitale Medien
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  • 4
    Digitale Medien
    Digitale Medien
    Springer
    Urological research 22 (1994), S. 301-303 
    ISSN: 1434-0879
    Schlagwort(e): Vitamin D ; 1,25-Dihydroxycholecalciferol Nephrolithiasis ; Calcium antagonists
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Investigations were carried out as to whether cytoprotective agents such as calcium antagonists can influence vitamin D induced nephrolithiasis. Increased vitamin D levels are found in 10–30% of all calcium oxalate stone formers. Male rats were assigned to one of the following groups: (1) 1,25-dihydroxycholecalciferol (DHCC) (n=8), (2) 1,25-DHCC+calcium antagonist Goe 6070 (a new 1,4-dihydronaphthyridine, Goedecke, Berlin) (n=8), or (3) control (n=8). 1,25-DHCC was administered for 6 days (120 pmol/24 h s.c.), Goe 6070 (1 mg/kg/24 h) by gavage. Clearance studies were performed on day 6. Kidneys were taken for histological examination and determination of calcium tissue content. 1,25-DHCC induced substantial concrement formation, which could be significantly limited by Geo 6070. The calcium tissue content was also reduced (0.17 vs. 0.04 mg/100 mg dry weight). 1,25-DHCC induced a dramatic fall in the glomerular filtration rate (GFR) (3.84 ml/min per kilogram). This reduction could be almost completely inhibited by the concomitant application of Goe 6070 (9.4 ml/min per kilogram; control 10.7 ml/min per kilogram). Goe 6070 did not influence the calcium handling. The results demonstrate a protective effect of Goe 6070 on vitamin D induced nephrolithias. The histological pattern (intracellular and membrane-bound concretions) and the fact that biochemical parameters were not influenced significantly by Goe 6070 indicate that cellular processes are important for 1,25-DHCC-induced nephrolithiasis.
    Materialart: Digitale Medien
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  • 5
    ISSN: 1434-0879
    Schlagwort(e): ESWL ; Shock waves ; MDCK cells ; LDH ; GOT
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Shock wave lithotripsy (ESWL) has become an almost non-invasive standard treatment modality for urolithiasis. Several investigations, however, demonstrated that ESWL is not completely free of side effects. Among others alteration of renal tubular function has been reported. To study the effect of shock waves on tubular cells directly an in-vitro model with cultured Madin Darby Canine Kidney (MDCK) cells was established. Suspensions of MDCK cells (7 groups of 6 containers each) were exposed to 0, 16, 32, 64, 128, 256 shock waves (Dornier HM4, 18 kV). Before and 0, 1, 3, 6, 9, 12, 24 h after ESWL the following parameters were measured in the nutrient medium: lactate dehydroxygenase (LDH), glutamate oxalacetate transaminase (GOT), electrolytes. LDH and GOT increased depending on the number of shock waves indicating a membrane damage of MDCK cells. The MDCK model seems suitable for further studies on the effect of shock waves on renal tubular cells.
    Materialart: Digitale Medien
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  • 6
    Digitale Medien
    Digitale Medien
    Springer
    Urological research 16 (1988), S. 437-440 
    ISSN: 1434-0879
    Schlagwort(e): Hypercalciuria ; Dietary fibres ; Parathyroid hormon ; 1,25-dihydroxyvitamin D
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary In the present study Farnolith® (a granular powder consisting of different dietary fibres) was given to normals (n=6), patients suffering from absorptive hypercalciuria type I (n=6) and to one patient suffering from renal hypercalciuria. Farnolith binds calcium and reduces the calcium absorption from the intestine. In normals the urine- and serum parameters of calcium metabolism (total-and ionised calcium, parathyroid hormone and vitamin-D-metabolites) remained unchanged. In patients suffering from absorptive hypercalciuria type I a significant reduction of hypercalciuria was found; oxalic acid excretion had decreased as well. Lowered parathyroid hormone values returned to normal, vitamin-D-metabolites remained unaffected. In one patient suffering from renal hypercalciuria parathyroid hormone and 1,25-dihydroxy-vitamin D values increased, calcium excretion had not decreased, though. Our investigation shows that Farnolith® is suitable for the treatment of absorptive hypercalciuria. Calcium homoeostasis is returned to normal by Farnolith®, at the same time it does not produce secondary hyperoxaluria (as e.g. sodium cellulose phosphate). Patients with primary renal calcium loss should not be treated by Farnolith.
    Materialart: Digitale Medien
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