[Gross haematuria as the primary symptom of extramedullary IgM plasmacytoma of the bladder]. / Makrohämaturie als Primärsymptom eines extramedullären IgM-Plasmozytoms der Harnblase.

Haematuria is the most common clinical symptom of bladder cancer. Besides antibiotic treatment of a probably existing urinary tract infection, ultrasonography of the urinary organs, diagnostic cystoscopy (with biopsy if needed), and radiologic evaluation of the upper urinary tract (intravenous urography, computed tomography or magnetic resonance urography, retrograde pyelography) should be done for further evaluation. Atypical manifestations of systemic diseases with bladder infiltration could feign the clinical appearance of chronic cystitis and hinder determination of the correct diagnosis. The case of a 40-year-old man with recurrent gross haematuria due to extremely rare bladder infiltration through an IgM plasmacytoma is presented.

[Psychosocial aspects of interstitial cystitis. Do biographical factors have a relevant impact on the disease course?]. / Psychosoziale Aspekte der interstitiellen Zystitis. Haben biographische Faktoren einen relevanten Einfluss auf das Krankheitsgeschehen?

BACKGROUND: The present study explores the influence of psychosocial adversities on the etiology and progress of interstitial cystitis (IC). METHODS: A systematic survey of the childhood risk factors was carried out using a specially developed, structured interview for pain patients (MSBA-Mainzer Strukturierte Biographische Anamnese) and additionally the Brief Symptom Inventory (BSI). Essentially a descriptive evaluation was performed. Thirty IC patients who fulfilled the current diagnostic criteria participated in the study. RESULTS: The investigation showed higher values for relevant childhood adversities in IC patients. A poor emotional relationship with both parents, chronic diseases of the parents, and physical maltreatment were frequently reported. In the cumulative adverse childhood experience score IC patients showed higher levels than published data of healthy control groups. The contemporary social history did not show relevant psychosocial adversities. The quality of life is extremely reduced because of IC symptoms. The BSI showed high levels especially in the dimensions somatization, anxiety, and phobic anxiety. CONCLUSION: The results of this study argue for a participatory role of psychosomatic factors in the assumed multifactorial etiology of interstitial cystitis.

[The Frankfurt concept for health counseling for men]. / Das Frankfurter Konzept einer Männergesundheitsberatung.

The discussion on the difference between the sexes received significant impulses from the formation of feminist theory. Masculinity was interpreted in a rather morally negative manner. Masculinity continuously endeavors to achieve reproduction and self-confirmation. Competitive pursuit of hegemony is the preeminent pattern by which masculine identity is formed. Male socialization leads to externalization, which impedes the development of communicative skills. Males tend to lead a high-risk life-style, which instrumentalizes their body. Symptoms are less often interpreted as warning signals, reflected in a significantly reduced life expectancy in comparison to females. In view of the specific male socialization, the Frankfurt concept of "men's health counseling" attempts to create a professional atmosphere in which men seeking advice are offered the opportunity to consult a specialist on all topics of men's health anonymously and, for the moment, free of charge.

[LaMedica. The medical education academy on the internet]. / LaMedica. Die medizinische Lernakademie im Internet.

At present, "modern media" are still a novelty in medical education. The "LaMedica Project"--a program supported by the Federal Ministry for Education and Research--intends to provide an Internet-based education and training system for the entire field of medicine, using all available media resources. This online educational program will provide subjects for medical laypersons as well as medical experts. Various styles of learning and different learning requests will be promoted. The project presented mirrors the cutting edge of database technology, computer-based training and media didactics, critical content processing as well as supplying individual subjects. This report summarizes our 10 months of experience with this program at the Department for Urology and Pediatric Urology of the Johann Wolfgang Goethe University of Frankfurt Main.

The role of cumulative physical work load in lumbar spine disease: risk factors for lumbar osteochondrosis and spondylosis associated with chronic complaints.

OBJECTIVES: To investigate the relation with a case-control study between symptomatic osteochondrosis or spondylosis of the lumbar spine and cumulative occupational exposure to lifting or carrying and to working postures with extreme forward bending. METHODS: From two practices and four clinics were recruited 229 male patients with radiographically confirmed osteochondrosis or spondylosis of the lumbar spine associated with chronic complaints. Of these 135 had additionally had acute lumbar disc herniation. A total of 197 control subjects was recruited: 107 subjects with anamnestic exclusion of lumbar spine disease were drawn as a random population control group and 90 patients admitted to hospital for urolithiasis who had no osteochondrosis or spondylosis of the lumbar spine radiographically were recruited as a hospital based control group. Data were gathered in a structured personal interview and analysed using logistic regression to control for age, region, nationality, and other diseases affecting the lumbar spine. To calculate cumulative forces to the lumbar spine over the entire working life, the Mainz-Dortmund dose model (MDD), which is based on an overproportional weighting of the lumbar disc compression force relative to the respective duration of the lifting process was applied with modifications: any objects weighing >or=5 kg were included in the calculation and no minimum daily exposure limits were established. Calculation of forces to the lumbar spine was based on self reported estimates of occupational lifting, trunk flexion, and duration. RESULTS: For a lumbar spine dose >9 x 10(6) Nh (Newton x hours), the risk of having radiographically confirmed osteochondrosis or spondylosis of the lumbar spine as measured by the odds ratio (OR) was 8.5 (95% confidence interval (95% CI) 4.1 to 17.5) compared with subjects with a load of 0 Nh. To avoid differential bias, forces to the lumbar spine were also calculated on the basis of an internal job exposure matrix based on the control subjects' exposure assessments for their respective job groups. Although ORs were lower with this approach, they remained significant. CONCLUSIONS: The calculation of the sum of forces to the lumbar spine is a useful tool for risk assessment for symptomatic osteochondrosis or spondylosis of the lumbar spine. The results suggest that cumulative occupational exposure to lifting or carrying and extreme forward bending increases the risk for developing symptomatic osteochondrosis or spondylosis of the lumbar spine.

Pathophysiology of cyclosporine-induced nephrotoxicity in humans: a role for nitric oxide?

BACKGROUND: The causes for the nephrotoxicity of cyclosporine A (CsA) have not been fully elucidated. Intrarenal vasoconstriction induced by several different mediators, both in humans and experimental animals, have been proposed. METHODS: We studied prostaglandin metabolites, endothelin and nitric oxide in kidney transplant patients receiving their first CsA dose. Prostaglandin metabolites in the urine and endothelin and nitric oxide (NO2/NO3 in urine and plasma were measured in 14 patients before and 3 and 6 h after oral ingestion of CsA (10 mg/kg b.w.). Clearances for inulin and p-aminohippuric acid (PAH) were measured before and in two separate 3-hour periods after CsA. Blood pressure, heart rate, and CsA blood levels were also determined. RESULTS: Clearances of inulin and PAH decreased progressively after CsA dosage while renal vascular resistance increased. Nitric oxide plasma levels decreased in nearly all patients from 21.0 +/- 2.8 to 19.1 +/- 2.6 (p = 0.003) and then rose slightly to 19.5 +/- 2.5 micromol/l (p = 0.1) 3 and 6 h after CsA ingestion, respectively. Urinary excretion of NO2/NO3 decreased nonsignificantly from 269 +/- 38.8 to 259 +/- 27.7 and 254 +/- 41.6 micromol/min (p = 0.5 and 0.5). At the same time, urinary prostaglandin E2 and 6-keto-prostaglandin F(1 alpha) excretion rate declined significantly [from 1,187 +/- 254 to 1,186 +/- 351 and 730 +/- 148 pg/min (p = 0.27 and 0.02) and from 697 +/- 115 to 645 +/- 134 and 508 +/- 58.2 pg/min (p = 0.34 and 0.05)]. Urinary thromboxane B2 and plasma and urinary endothelin first increased and then decreased nonsignificantly. Mean arterial pressure rose from 107 +/- 2.5 to 110 +/- 2.6 and 114 +/- 3.4 mm Hg (p = 0.1 and 0.05). CONCLUSION: The pathophysiology of CsA-induced acute renal vasoconstriction involves several different mechanisms including a decrease of the vasodilating prostaglandins E2 and 6-keto-prostaglandin F(1 alpha) and possibly nitric oxide.

Synchronous bladder augmentation and living related kidney transplantation.

Ileocystoplasty for enlargement of bladder capacity in conjunction with renal transplantation has been described in several cases. However, the surgical approach has been accomplished as a two-stage procedure. We report the case of a 21-year-old female myelomeningocele patient with end-stage renal insufficiency who was treated with ileocytstoplasty and living related renal transplantation at a single stage. Convalescence remained uneventful. On follow-up 13 months after the operation, the renal parameters remained stable.

Reversal of multidrug resistance and increase in plasma membrane fluidity in CHO cells with R-verapamil and bile salts.

Studies with multidrug resistance modifiers indicate that perturbations of the cell membrane structure may influence P-glycoprotein (P-gp)-mediated drug transport. We describe studies of plasma membrane order using electron-paramagnetic resonance (EPR) in resistant (CH(R)C5) and sensitive (AUXB1) chinese hamster ovary cells treated with R-verapamil and bile salts. Cell growth rates were determined in presence of doxorubicin mitomycin and cisplatin. The plasma membrane order in untreated resistant cells was higher than in the sensitive cells. Both the bile salt taurochenodeoxycholate (TCDC; 0.2-1.6 mM) and R-verapamil (1-3 microM) lowered the membrane order in the CH(R)C5 cells to that in the sensitive cells and reversed the resistance to doxorubicin and mitomycin. The bile salt tauroursodeoxycholate (TUDC; 0.2-3 mM) did not lower membrane order and did not sensitise CH(R)C5 cells. Neither R-verapamil, TCDC nor TUDC reduced the membrane order of the sensitive cells AUXB1 cells. These results support the view that changes in multidrug resistance in Chinese hamster ovary cells and P-gp function are associated with alterations in the fluidity of the plasma membrane.

Resistance modulation in CHO cells by R-verapamil and bile salts is associated with physical and chemical changes in the cell membrane.

OBJECTIVES: Changes in multidrug resistance by resistance modifiers such as R-verapamil cause changes in fluidity of the cell membrane. The extent to which these changes involve structural alterations in membrane lipids has been investigated in CHO cells. METHODS: Sensitive (AUXB1) and resistant (CH(R)C5) chinese hamster ovary cells (CHO) were grown in culture. Incubations were carried out with R-verapamil (0-10 microM) or the membrane perturbing agents tauro-cheno-deoxycholate (0-1.6 mM, TCDC) and tauro-urso-deoxycholate (0-3.5mM, TUDC). Cell membrane fluidity was determined by electron-paramagnetic resonance spectroscopy and membrane lipids by HPLC and TLC. RESULTS: The resistant CH(R)C5 subline had a higher cell membrane order (lower fluidity, S = 0.7234) in the interface region of the cell membrane than sensitive AUXB1 cells (S = 0.6984) determined using EPR. The MDR-modulator R-verapamil and TCDC, but not TUDC, lowered cell membrane order in a concentration-dependent manner and increased membrane fluidity of the resistant CH(R)C5 subline. TCDC and R-verapamil were without effect on the cell membrane fluidity of AUXB1 cells. These changes were accompanied by alterations in the fatty acid composition of the plasma membrane. Untreated sensitive AUXB1 cells had higher levels of unsaturated fatty acids than resistant CH(R)C5 cells. In CH(R)C5 cells, R-verapamil increased the content of poly-unsaturated fatty acids and TCDC, but not TUDC, increased the content of mono-unsaturated fatty acids. CONCLUSIONS: The results demonstrate that resistance modifiers such as verapamil may influence cytostatic drug action by producing structural changes to lipid domains in the plasma membrane.

Cytostatic sensitivity and MDR in bladder carcinoma cells: implications for tumor therapy.

The clinical success generally seen in chemotherapy of advanced bladder carcinoma is far from optimal. The mechanism of resistance development is unclear and the expression of P-170 glycoprotein is generally low. The aim of this study, carried out in vitro in sensitive and cisplatin-resistant cell lines, was to examine sensitivity modulation using R-verapamil and cell membrane perturbing agents. Cell growth rates and changes in the order of the cell membrane, determined using electron-paramagnetic resonance spectrometry, were recorded. R-verapamil increased the toxic effect of doxorubicin in the cisplatin-resistant cell line which showed the highest membrane order. Linolenic acid had a similar effect and also increased sensitivity to cisplatin and methotrexate. Bile salts (tauro-cheno-deoxycholate,TCDC, and tauro-urso-deoxycholate TUDC), had little effect on cytotoxicity. These results indicate that R-verapamil and linolenic acid can act as sensitivity modulators in bladder carcinoma cells and that the action of these agents may involve membrane fluidity changes, a phenomenon noted previously in regard to sensitivity modulation in chinese hamster ovary cell lines.

Value of tumor M2 (Tu M2-PK) in patients with renal carcinoma.

Pyruvate kinase is one of the glycolytic key enzymes. It exists in various isoforms which are expressed in different cell types. One of these isoforms, the type Tu M2-PK, is strongly overexpressed by tumor cells and released into body fluids. The concentration of Tu M2-PK in body fluids can be quantitatively determined by a commercially available enzyme-linked immunosorbent assay (ELISA)-kit. The Tu M2-PK concentration was measured in EDTA-plasma of 116 patients with renal carcinoma and 42 patients suffering from nephritis, by using this kit. The ranges of the Tu M2-PK-concentrations of the two groups did not overlap, indicating a highly significant discrimination of renal carcinoma and benign renal diseases. Furthermore, the Tu M2-PK concentration in EDTA-plasma correlated strongly with the Robson tumor stage of the 116 patients. The present results indicated that the Tu M2-PK might be the first tumor marker, which could be an excellent complementation of the diagnostic program for renal carcinoma.

Association between diesel exposure at work and prostate cancer.

OBJECTIVES: The possible etiologic relevance of occupational factors such as cadmium, cutting oils, diesel fuel and fumes, herbicides, polycyclic aromatic hydrocarbons (PAH), polychlorinated biphenyls, soot, tar, mineral oil, and solvents to prostate cancer was studied. METHODS: A case-referent study design was used to recruit 192 subjects with histologically confirmed prostate cancer and 210 referents who had prostate cancer histologically excluded either in one of two urologic practices (Hamburg and Frankfurt) or in the urological policlinic of the Frankfurt University. Data were gathered with a self-administered questionnaire and analyzed using logistic regression to control for age, region, and cigarette smoking. A job-exposure matrix was used for assigning exposure. For the calculation of dose-years, the duration of contact with specific substances was weighted by the intensity and probability of exposure according to a job-exposure matrix. RESULTS: The analysis of dose-years yielded a statistically significant association between occupational exposure to diesel fuel or fumes and prostate cancer (odds ratio 3.7, 95% confidence interval 1.4-9.8, for subjects exposed to more than 25 dose-years in a comparison with subjects never exposed). For the other substances, no statistically significant differences in exposure were found between the cases and referents. When only jobs with a high exposure probability were used to classify the participants as exposed, only exposure to PAH was significantly associated with prostate cancer. CONCLUSIONS: In keeping with results from other studies, this study provides further evidence that exposure to diesel fuel or fumes - possibly mediated through PAH - may be associated with the development of prostate cancer.

[Work-related risk factors of prostate carcinoma: results of a case-control study]. / Arbeitsbezogene Risikofaktoren des Prostatakarzinoms: Ergebnisse einer Fall-Kontroll-Studie.

In a case-control study 192 patients with histologically confirmed prostate cancer were compared with 210 men in whom carcinoma of the prostate had been histologically excluded. Cases and controls were recruited from two urological practices in Hamburg and Frankfurt/M. and from the urologic policlinic at the University of Frankfurt/M. The probands were questioned about smoking habits and alcohol consumption, about all occupational activities of least one years' duration, and about exposure to specific substances. Odds ratios (OR) were calculated using logistic regression analysis, adjusting for age, region and smoking. There were no differences between patients and controls in self-reported occupational exposures or the consumption of alcohol or smoking. There was a positive association between having worked in transportation/communication and having prostate cancer (p for trend = 0.006): ORs varied according to the number of years worked as follows: 1-10 years versus never, OR = 0.6 (95% Cl: 0.3-1.2), 11-30 years, OR = 2.0 (95% Cl: 0.8-4.8), > 30 years OR = 3.2 (95% Cl: 1.3-7.5). Work in other occupational groups was not associated with an increased risk for prostate cancer. These results suggest that transport work may be associated with the development of prostate cancer.

[Practical and therapeutical management of enuresis]. / Praktisches und therapeutisches Vorgehen bei Enuresis.

The often occurring problem of the enuresis rises diagnostical and therapeutical questions for the pediatrician. People like to assume psychological reasons for this problem, however, there is no proof for the importance of any psychological factors. A genetic disposition of the maturity delay has to be differentiated from the neurogenic enuresis. Different practical treatments with high success exist.

[The indication for cystoscopy in children]. / Die Indikation zur Zystoskopie bei Kindern.

The diagnostic procedures in children presenting urological symptoms, i.e. hematuria, recurrent urinary tract infections, disorders of the upper urinary tract or of the pattern of micturition include urinary sediment and bacterial culture, the investigation of red blood cell morphology, urinary electrolytes and osmolarity, ultrasound, i.v. pyelogram, cysturethrogram, combined uroflow and pelvic floor-EMG, MAG III-clearance and a urodynamic evaluation. In the rare situation of unclear symptoms that defy the non-invasive diagnostic procedures mentioned, a urethrocystoscopy can be advisable. A cystoscopy will be mandatory in endoscopic therapy or when operative interventions are planned.

[The electromotor unit of the upper urinary tract]. / Zum Problem der elektromotorischen Einheit der oberen Harnwege.

The muscular architecture of the upper urinary tract constitutes a functional but no anatomical syncytium, where the cells are coupled by nexus and crosslinking with low electrical resistance. The action potentials are evoked by spontaneous depolarisation of muscle cells. The sites of peak depolarisation could be termed pace-maker cells. They are localized in the calices. Recent studies have, however, described myofilaments capable of contraction in the proximal tubuli already. Volume and pressure loads on the hollow system have been identified as the regulation mechanism. Modulatory function is directly related to evidence of alpha- and beta-adrenergic receptors, of receptor subtypes, of the adenylate cyclase system, of histamine- and possibly prostaglandin- and serotonin-receptors as well.

Histological and scanning electron microscopic alterations in ileal conduit depending on the time factor.

Five ileal conduit biopsies, taken after 1-7 years, were examined by light microscopy and scanning electron microscopy. The total height of the lamina mucosa decreased from 700 to 275 microns. The height of the villi diminished from 550 to 50 microns; the depth of the crypts increased from 130 to 244 microns and the villus-crypt index changed from 4.2 to 0.2. Signs of chronic inflammation could be observed. Scanning electron microscopy shows that the number of microvilli per cell was markedly reduced. There was a varied picture of different stages of atrophy. After 3 years microvilli could no longer be observed. In view of the prolonged urinary contamination time, it appears to be imperative to check neobladders with regard to possible carcinoma induction.

Actin as a component of cytoskeleton in the collecting tubule system of the mouse kidney.

Actin as a component of the cytoskeleton is familiar as a protein which possibly mediates contraction in nonmuscular cells. In 20 mouse kidneys, the distribution of intracellular actin in the collecting tubule system was investigated by means of the anti-actin PAP method. It could be shown that the positive PAP reaction increases from the proximal to distal up to the collecting tubules in the region of papilla. Stiffening, stabilization and contraction functions are discussed with regard to the biology of the collecting tubule actin.