Nuclear magnetic resonance and mass spectrometry-based milk metabolomics in dairy cows during early and late lactation.

Milk production in dairy cows has dramatically increased over the past few decades. The selection for higher milk yield affects the partitioning of available nutrients, with more energy being allocated to milk synthesis and less to physiological processes essential to fertility and fitness. In this study, the abundance of numerous milk metabolites in early and late lactation was systematically investigated, with an emphasis on metabolites related to energy metabolism. The aim of the study was the identification and correlation of milk constituents to the metabolic status of the cows. To investigate the influence of lactation stage on physiological and metabolic variables, 2 breeds of different productivity were selected for investigation by high-resolution nuclear magnetic resonance spectroscopy and gas chromatography-mass spectrometry. We could reliably quantify 44 different milk metabolites. The results show that biomarkers such as acetone and beta-hydroxybutyrate are clearly correlated to the metabolic status of the individual cows during early lactation. Based on these data, the selection of cows that cope well with the metabolic stress of early lactation should become an option.

[Color-coded Doppler sonography of the male urethra: studies in vivo and experimental results]. / Farbkodierte Dopplersonographie der männlichen Urethra: Untersuchungen in vivo und experimentelle Ergebnisse.

The so-called ureter jet is a well known phenomenon, which consists of echoes due to turbulent urine flow emanating from the ureteral orifices during forced diuresis. These motion phenomena are also visible in colour Doppler examinations. In analogy to the ureter jet we could demonstrate different colour phenomena in the normal (n = 20) and stenosed (n = 14) male urethra during voiding by using colour coded Doppler sonography. These observations are obviously caused by turbulent urine flow. In an experimental study, this hypothesis could be verified. Because certain intraurethral colour phenomena are related to stenoses of the urethra, and because their intensity depends on the degree of stenosis and on urine flow (in ml/s), it seems to be possible to draw conclusions on the urodynamic consequences of a stenosis in the urethra by means of colour coded Doppler sonography.

[Complications of one-stage urethroplasties]. / Komplikationen der einzeitigen offenen Harnröhrenplastik.

Different techniques applied for one-stage urethroplasty were compared with reference to complications. We followed up 48 patients operated on for bulbous or penile strictures caused by inflammation or by urethral irritation following endoscopic manipulation or catheterization. The techniques compared were end-to-end anastomosis, pedicled scrotal skin patch, penile/preputial island flap, free penile skin, free full-thickness skin patch. With pedicled scrotal skin patches there was a 60% complication rate, while after penile island flap technique complications occurred only in 13%. Scrotal skin should no longer be used for urethroplasties if penile skin is available.

[The value of physical therapy in genuine female stress incontinence]. / Der Stellenwert der Physikotherapie bei der weiblichen genuinen Stress-inkontinenz.

In a prospective randomized study the efficiacy of physical therapy in female stress incontinence could be verified. The greatest success rate was achieved by medical gymnastics, whereas the perineal electrical stimulation should be used as supporting measure like a biofeedback mechanism because of its low effective intensity. Despite of the good therapeutic success (51.5%) with lasting effects no objective criteria to the use of physical therapy in female stress incontinence were found.

Diagnostic potential of diuresis renography: limitations by the severity of hydronephrosis and by impairment of renal function.

Eighty ureterorenal units (65 patients) with upper urinary tract dilatation underwent pressure perfusion studies and diuresis renographies separated by short intervals. Pressure perfusion studies were evaluated as suggested by Whitaker, while wash-out curves of diuretic renographies were analysed quantitatively by calculating peak elimination rates. Upper urinary tract volume was estimated from i.v. urographies and measured directly in 21 cases. Renal function was assessed from base-line renograms and plasma creatinine levels. In patients with minor upper urinary tract dilatation (less than 30 ml) the two procedures agreed in 88% of cases, in those with massive dilatation (greater than 70 ml) agreement was limited to 58%. Diuretic renal scans were more often obstructed than pressure perfusion studies in the latter situation. The effect of severely reduced renal function was less prominent than that of massive dilatation. This was confirmed by the exaggerated response to frusemide reflected by urinary flow measurements in patients with a creatinine clearance of 10 ml min-1 or less. Of the eight patients with severely reduced renal function, who did not show full agreement between the procedures, six had massive dilatation of the upper urinary tract.

[Spinal lipoma with a dural closure defect as a cause of neurogenic bladder and chronic renal failure]. / Spinales Lipom mit Duraschlussdefekt als Ursache einer neurogenen Blasenstörung und chronischen Niereninsuffizienz.

It is reported on a 6-year-old boy, in whom 3 years after the appearance of a neurogenic disturbance of the urinary bladder a lipoma in the spinal canal of the inferior thoracic region was diagnosed myelographically. The operative removal of the growing and displacing fatty tissue which by a (congenital?) dural gap continued in epidural direction indeed resulted in a far-reaching regression of the paresis of the lower extremities, not, however, in an improvement of the urological picture of the disease. The renal insufficiency caused by the hydronephrosis was no more reversible, which emphasizes the importance of the early diagnosis of this relatively infrequent malformation.

[Value of the distal urethrotomy in girls with infravesicular obstruction and vesico-ureteral reflux]. / Die Wertigkeit der distalen Urethrotomie bei Mädchen mit infravesikaler Obstruktion und vesiko-ureteralem Reflux.

In 43 girls with vesicoureteral reflux and subvesical obstruction (distal urethral stenosis) a urethrotomy was performed as primary treatment. Vesicoureteral reflux was cured by this in 53.5% after a mean control period of 6 months. In these cases the reflux proved to be related to the subvesical obstruction (secondary reflux). The obstruction can cause the decompensation of partially competent vesico-ureteral junctions. The success of urethrotomy depends on the grade of the reflux as well as on the pathology of the ureteral orifice. In persisting cases of reflux a coincidence of subvesical obstruction and primary vesicoureteral reflux has to be discussed, requiring further operative treatment.

[Normal values of urine stream velocity in boys]. / Normalwerte der Harnstrahlgeschwindigkeit bei Knaben.

Apart from the uroflowmetry the measurement of the speed of the urinary stream proved as second suitable non-invasive parameter for the clarification of subvesical obstructions in boys. Above all the combination of the two measuring methods with the help of the urinary stream speed-uroflow-diagram rendered possible a good differentiation of different forms of obstruction (proximal vs distal). Since up to now only few data existed for children, the attempt was made to gain normal values of the speed of the urinary stream of boys. In 37 boys in whom a subvesical obstruction could be excluded radiologically as well as with the help of combined urodynamic methods combined measurements of speed and flow were performed. The speed values were between 235 and 325 cm/s, the uroflow values between 12.5 and 30 ml/s. The data obtained were written down into a V/Q diagram and in this way a normal region could be restricted so far that by this means the delimitation of pathological V/Q-values is rendered possible and thus the classification of subvesical obstructions in boys is facilitated by non-invasive methods.

[Measurement of urinary flow velocity and peak flow rate in the detection of subvesical obstructions in boys]. / Die Messung von Harnstrahlgeschwindigkeit und Uroflow zur Erfassung subvesikaler Obstruktionen bei Knaben.

Urinary flow velocity and urinary peak flow rate were measured in 41 boys. Using combined urodynamic and radiological methods 23 boys showed proximal and/or distal urethral obstruction, whilst 18 boys had no signs of subvesical obstructions. The peak flow rate alone does not discriminate reliably between the normal and abnormal population. Many boys with normal flow rates showed subvesical obstruction on measurement of the peak urinary velocity. In spite of the fact that flow velocity determination alone only partially discriminated between the different groups, in combination with uroflowmetry it proved to be a valuable secondary non-invasive parameter. The flow velocity vs. flow rate diagram is shown to be a good tool for the urodynamic classification of boys with subvesical obstruction.

[Urological problems in the treatment of recurrent colorectal carcinoma]. / Die urologische Problematik in der Behandlung des Lokalrezidivs nach kolorektalem Karzinom.

The infiltration of the ureters, bladder or urethra by recurrent colorectal carcinoma raises both urodynamic and surgical problems. These include the question of whether reconstruction or urinary diversion is indicated. The present paper describes the surgical procedures carried out in 19 patients with tumour extention of recurrent colorectal carcinoma to the urinary tract. In the majority of cases the treatment of choice can be decided only intraoperatively. It is important to choose the procedure which guarantees both surgical radicality and minimal discomfort to the patient.

[Prostaglandin E2--an improvement in the therapy of bladder emptying disorders?]. / Prostaglandin E2--Eine Bereicherung in der Therapie der Blasenentleerungsstörungen?

21 patients suffering from bladder motor disturbances were investigated by simultaneous pressure-flow studies before and after intravesical application of PGE2. The detrusor response as well as the influence on the bladder outlet resistance were registered. A remarkable improvement of the detrusor function could only be obtained in cases with intact sacral reflex-arcs with isolated transitory myogenic disturbances. Neuromyogenic bladder disturbances could not be influenced permanently by PGE2 instillations.