[Therapy and follow-up of superficial bladder cancer in in patients less than 30 years of age]. / Therapie und Verlauf des oberflächlichen Harnblasenkarzinoms bei Patienten unter 30 Jahren.

Transitional cell carcinoma of the bladder is relatively uncommon in patients under 30 years old. We treated 11 patients with superficial bladder carcinoma under 30 years of age. In 10 cases gross haematuria was the most common presenting symptom. The pathological reports of the patients revealed grade I, stage Ta transitional cell carcinoma in seven patients, grade I, stage T1 tumour in two patients and bladder myoma and inverted papilloma in two patients each. Four of nine patients with superficial bladder carcinoma stayed free of disease for 1-10 years after initial transurethral resection (TUR). Four patients suffered multiple tumour recurrences 1-4 months after initial TUR, with progressive disease in three cases. One patient was lost to follow-up after primary operation. In the two patients with benign bladder tumours, no recurrences were observed within 12 and 48 months. Owing to the high rates of recurrence (44%) and tumour progression (33%) all patients under 30 years of age should be treated as aggressively as necessary on the basis of the grade and stage of the tumour, in the same way older patients.

The penile plication procedure: an alternative method for straightening penile deviation.

The number of reported cases of congenital and acquired penile deviation is evidently increasing. We describe our experience with the penile plication procedure, which we used to treat 40 patients with penile deviation. Postoperatively, all patients regained the ability for sexual intercourse, with potency remaining unimpaired. Of the patients 96% were completely satisfied with the result of the operation. Sustained complications have not been observed. To avoid major trauma the surgical intervention should not include removal of ellipsoids from the penile tunica albuginea as proposed by Nesbit. Since the penile plication method produces equally good results in terms of performance and appearance, this therapy should be preferred.

[Systemic alpha-interferon therapy: a possible method for prevention of testicular atrophy and permanent sterility in patients with bilateral mumps orchitis]. / Die systemische alpha-Interferontherapie: ein möglicher Weg zur Prävention testikulärer Atrophien und dauerhafter Sterilitäten bei Patienten mit bilateraler Mumpsorchitis.

In postpubertal men orchitis is the most common complication of mumps infection, occurring in 5-37% of this population. A bilateral manifestation is observed in 16-65%. The most important danger is the risk of developing testicular atrophy, which results in sterility. Four patients with bilateral mumps orchitis received systemic treatment with interferon-alpha 2B (3 X 10(6) IU/day) for 7 days. All acute symptoms of mumps orchitis disappeared within 2 or 4 days of hospitalization. During 12-20 months of follow-up no incidence of testicular atrophy was observed. In three of the four patients pretreatment examination revealed subfertility (oligoasthenozoospermia), while 2-4 months after interferon treatment and throughout the entire follow-up period normozoospermia was found. No severe adverse effects occurred during treatment. The flu-like symptoms could be prevented by concomitant administration of paracetamol (3 X 500 mg/day). Systemic treatment with interferon-alpha 2B appears to be highly effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. Further investigations involving larger populations should be performed to confirm the present promising results.

Systemic treatment with interferon-alpha 2B: an effective method to prevent sterility after bilateral mumps orchitis.

In men orchitis represents the most common complication of mumps infection and occurs in 5 to 37% of this population. Bilateral manifestation is observed in 16 to 65% of the patients. The most important danger is the risk of testicular atrophy which results in sterility. Four patients with bilateral mumps orchitis received systemic treatment with interferon-alpha 2B (3 x 10(6) IU per day) for 7 days. All acute symptoms of mumps orchitis disappeared within 2 to 4 days of hospitalization. During 6 to 15 months of followup no incidence of testicular atrophy was observed. In 3 of 4 patients pre-treatment examination revealed subfertility (oligoasthenospermia), while 2 to 4 months after interferon treatment, as well as during the entire followup period normospermia was found. No severe adverse effects occurred during treatment. The flu-like symptoms could be prevented by concomitant administration of paracetamol (500 mg. 3 times a day). Systemic treatment with interferon-alpha 2B appears to be highly effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. Further investigations involving larger populations should be performed to establish the present promising results.

[Improvement in nuclear medicine diagnosis of kidney function using 99m technetium mercaptoacetyltriglycine (MAG3)]. / Verbesserung der nuklearmedizinischen Nierenfunktionsdiagnostik durch den Einsatz von 99m-Technetiummercaptoacetyltriglycin (MAG3).

Renal scintigraphy and clearance measurement are indispensable in nephro-urologic disorders. A continuous series of 103 sequential scintigraphies and clearance measurements were performed with the new technetium-labelled agent MAG3 (Gamma-kamera, Phillips Tomo Diagnost) and 131I-orthohippuric acid (OIH) using the Oberhausen method (Nucleopan, Siemens). The time-activity curves obtained with the two radionuclides agreed exactly. Reaching a tubular excretion rate of nearly 90%, the clearance of MAG3 differed by no more than 6% from the OIH clearance in 95% of the cases. The factor between clearances of the two radionuclides was determined by means of a commercially available software according to the Oberhausen method and amounted to 0.59 +/- 0.09. The favorable physical properties and high activity of MAG3 permit exact examination of tubular function and better assessment of renal morphology than hippuran-labelled radionuclides. The low radiation dose combined with a better spatial resolution, especially, the constant availability in a nuclear medicine department should give the preference to MAG3.

[Penile plication for the treatment of severe penile deviations]. / Penisraffplastik zur Behandlung schwerer Penisdeviationen.

Penile plication procedure was performed on 27 patients (median age 24 years) to correct marked penile deviation (mean deviation angle 50 degrees). On average 4 (2-10) sutures were necessary. Normal intercourse and potency was restored in all. 26 patients were fully satisfied with the result, while in three there were suture problems (fistula, granuloma). There was one recurrence, three weeks postoperatively, in a patient who failed to follow the recommended six-week period of sexual abstinence. But this recurrence was lastingly corrected by a second penile plication procedure. No lasting complications were noted a mean of 48 months postoperatively. This type of operation is the treatment of choice for significant penile curvature.

[Perineal tumors in male patients]. / Perineale Tumoren beim männlichen Patienten.

Perineal tumors are rare and are malignant primaries in 66% of cases. We treated three patients with perineal tumors. Histological examination led to a diagnosis of benign tumor (lipoma, granulomatous tumor) in two patients and a diagnosis of local perineal metastasis of a malignant nonseminomatous germ cell tumor in the third. After local tumor excision all patients stayed free of disease for 1-3 years. Neither physical nor clinical examination (standard blood parameters, ultrasound, X-ray of pelvis, urethrocystoscopy and rectoscopy) allowed determination before surgery of whether any of these perineal tumors was benign or malignant; percutaneous biopsy was the only way to find this out preoperatively. Radical excision of the perineal tumor is the treatment of choice. If extended dissemination has not taken place, malignant perineal tumors are curable by radical resection in nearly 80% of cases.

[Asymptomatic paraganglioma of the bladder wall with unusual extensive submucous vascular proliferation]. / Asymptomatisches Paragangliom der Harnblasenwand mit ungewöhnlich ausgeprägter submuköser Gefässproliferation.

Paraganglioma of the urinary bladder is a very rare tumor, which is usually diagnosed on the basis of its endocrine symptoms because of the excretion of vasoactive substances. One case of asymptomatic paraganglioma detected by chance is described, it was misdiagnosed as hemangioma because of its marked suburothelial vessel proliferation.

[Results of close testicular tumor after-care]. / Ergebnisse einer engmaschigen Hodentumornachsorge.

Close monitoring schedules for patients with malignant germ cell tumors improved cure rates, since early detection and treatment of tumor recurrences was possible. In a retrospective analysis we evaluated 210 of 274 patients with malignant germ cell tumor, 189 (90%) of whom achieved complete remission after primary therapy. There were 15 patients (7.9%) who experienced tumor relapse, 14 patients attaining complete remission after a second treatment. Out of these, 4 patients experienced a second relapse after 5 months. In 2 patients only, a third complete remission was obtained. A total of 3 patients died to their disease. The 19 recurrences were detected by clinical symptoms in 4 cases, by chest X-ray in 10, and by elevation tumor markers in 5. In 6 patients a second malignant germ cell tumor was discovered during follow up by palpation of the testis (n = 4) or marker elevation (n = 2). A second complete remission was achieved in 5 of these patients, while 1 died of chemotherapy-induced sepsis. Of the 19 tumor recurrences, 17 were detected within the first 2 years. The patients with a second malignant germ cell tumor perceived their disease within the first 5 years in 83% of cases. These results support the necessity on close monitoring for a minimum of 5 years after the initial treatment. After 5 years yearly examination is recommended for early detection of any late recurrences and second malignant germ cell tumors.

[Adjuvant systemic interferon alpha-2B treatment in treatment refractory anogenital Condylomata acuminata]. / Adjuvant-systemische Interferon-alpha 2B-Behandlung bei therapieresistenten anogenitalen Condylomata acuminata.

Despite different treatment modalities, resistance to treatment is observed in 4-15% of patients with anogenital condylomata acuminata. A total of 16 patients with resistant condylomata acuminata or extended infection affecting an area of more than 6 cm2 were treated with a prospectively defined therapy entailing laser treatment and adjuvant systemic interferon-alpha 2B (3 x 1 MU/day for 7 days). Of the 16 patients, 13 (81%) were in complete remission after an 8-month period of follow up. The typical side-effects of interferon were attenuated in 80% of cases by simultaneous paracetamol (3 x 500 mg/day). The combination of laser treatment and adjuvant systemic interferon-alpha 2B seems to be highly effective in the treatment of resistant or extended condylomata acuminata. At present, these results are being tested for significance in a prospectively randomized study.

[Penis plication-plasty--an alternative to the treatment of penile deviation]. / Die Penisraffplastik--eine Alternative zur Behandlung der Penisdeviation.

Congenital and acquired penile curvature are observed increasingly often. A new surgical technique (plicating procedure) was applied in 27 patients with penile deviation. All patients retained potency, and 96% were completely satisfied with the functional result of surgical correction. No severe complications were observed. Nesbit's technique of excising ellipses from the tunica albuginea to correct penile deviation should be discontinued as it involves greater surgical trauma. Since the functional and cosmetic results are equally good with the plicating procedure, we believe this is the operation of choice for the correction of penile curvature.

[Adjuvant 5-fluorouracil lacquer administration for reducing the rate of recurrence of condylomata acuminata following laser surgery treatment]. / Die adjuvante 5-Fluorouracil-Lack-Applikation zur Senkung der Rezidivrate von Condylomata acuminata nach laserchirurgischer Behandlung.

In the recent past we have observed HPV-induced condylomata acuminata with increasing frequency. Providing 60-80% complete remission the laser coagulation is primary in the treatment of condylomata acuminata. However, the generalized mucosal infection with subclinical condylomata acuminata leads to a recurrence in 30-70% of cases. Therefore, we combined laser treatment with adjuvant 5-fluorouracil painting. In a prospective study, 137 patients with a total of 225 treatments were randomly allocated to three groups (laser/laser + 5-FU ointment 5%/Laser + 5-FU 2% painting). After laser treatment only, relapse occurred in 29% of cases, after laser treatment plus 5-fluorouracil 5% ointment in 32%, and after laser treatment and adjuvant 5-fluorouracil 2% painting in only 4%. A topical prophylactic treatment is beneficial because of the multifocal action of HPV. The adjuvant 5-FU painting after laser surgery has been shown to be superior to other treatment modalities with a recurrence rate of only 4%.

The intestinal diamine oxidase activity under the influence of adaptive proliferation of the intestinal mucosa--a proliferation terminating principle?

Under clinical conditions, intestinal mucosal hyperproliferation together with a reduced diamine oxidase (DAO) activity was found in inflammatory and neoplastic diseases. Therefore, we studied the influence on DAO activity of a regulated mucosal proliferation as obtained following partial small bowel resection in a rat model. A statistically significant, more than 4-fold elevation of the enzymic activity was observed during the first days after partial resection. At the peak of mucosal proliferation (8th. postoperative day) the DAO activity was significantly reduced by about 50% of the initial value. We suggest that the DAO may be involved in a negative feed-back control mechanism of mucosal proliferation.

[Value of perfusion scintigraphy of the testis]. / Wertigkeit der Hoden-Perfusionsszintigraphie.

Perfusion scintigraphy of the testicles has still its place, in addition to scrotal ultrasound imaging, in the investigation of the "acute scrotum". It reveals scintigraphic patterns typical for twisted testicle and acute or subacute epididymitis. Especially in the Bundeswehr, with its large number of young men, this method enhances the diagnostic spectrum and helps in making surgical decisions. However, in the examination of scrotal masses, ultrasound imaging or surgery is to be preferred.

Diamine oxidase (DAO) activity and intestinal mucosa integrity: influence of suture techniques.

After various kinds of intestinal mucosal injuries, whether by disease or by experiment, the diamine oxidase activity is reduced. Therefore, we studied the effect of surgical manipulations on the intestinal mucosa and diamine oxidase activity. The reaction of the gut on the insertion of sutures was a transient increase of the enzymic activity followed by reduction as soon as the mucosa started to gain weight. After a standardized pressure injury only a reduction of the diamine oxidase activity together with an enhancement of the mass of the intestinal wall was found. A hypothesis of a feed-back regulation of the diamine oxidase activity connected with mucosal proliferation is proposed.