[Calcium and citrate excretion by patients with calculi and healthy probands during induced acidosis]. / Kalzium- und Zitratausscheidung von Steinpatienten und Gesunden bei azidotischer Stoffwechsellage.

Acidosis induced increase in renal calcium excretion and decrease in renal citrate excretion was produced by means of ammonium chloride load in 15 patients with recurrent oxalate lithiasis and in 15 control subjects. The expected increase in the calcium citrate relationship in urine is more marked and more lasting in stone patients. Stone formers obviously respond to an acidotic metabolic situation by a more clear relative decrease in citrate excretion, in addition to more intensive calcium excretion, which is known. A certain individual sensitivity of renal tubular mechanisms is discussed with regard to acid base changes.

Assessment and maintenance of the quality of urolith analyses in a comparison of methods. 4th International Ring Test to check quality.

For five test samples of the fourth International Ring Test to check the quality of methods for urinary calculus analysis, 45 findings obtained by 10 different methods were sent from 16 countries. The mean deviation of 0.11 molecular parts per component for all five samples is considerably low. The average standard SQ for all participants is 2.44. It falls off from X-ray diffraction via IR down to other quantitative methods. Advantages and disadvantages of X-ray diffraction and IR-spectroscopic analyses are discussed. Analysis of urinary calculi according to centralized, methodically uniform standards offers advantages in analytical quality.

Investigations on the early diagnosis of cystinuria in children.

The procedure described confirms that the Ni2+/S2O4(2-) tablet test is a suitable quick cystine screening test for large groups. In 16 (0.67%) of 2,395 one- to three-year-old crèche children significantly enhanced cystine levels of 0.60-0.96 mmol/l were found. The corresponding creatinine values (mmol/l) did not reveal any significant deviations from the normal values. In a preliminary group of 9 children, enhanced lysine levels support the suspicion of the existence of cystinuria without clinical symptoms. This also forms the basis for further necessary family histories as well as for prophylactic measures.

[Long-term results of small intestine interpositionplasty]. / Langzeitergebnisse bei Dünndarminterpositionsplastiken.

The results of interposition plastic operations of the small intestine are presented which were performed in 8 patients. The control period comprises 4 to 23 years. The relatively complicationless postoperative course confirms an efficient technique, by means of which the functionless ureter may be bridged over. The function of the kidneys remains compensated and this the technique fulfils the main criterion of an operative technique conserving the organ.

[Calcium excretion in patients with calcium oxalate calculi in acid administration]. / Untersuchungen zur Kalziumausscheidung bei Kalziumoxalatsteinpatienten unter Säurebelastung.

Acidosis induced increase in renal calcium excretion was produced by means of ammonium chloride load in 12 control persons and in 76 patients with recurrent oxalate lithiasis. This increase is more marked in stone patients - even in those with normocalciuria - than in control persons. The calcium excretion is especially increased in patients with renal hypercalciuria. This might result from the primary nature of the renal defect. The acid load did not prove useful in the diagnosis of hyperparathyroidism.

Disturbed urinary transport in the pelvi-calyceal system in calcium-oxalate stone patients.

This study is intended to elucidate the process of urinary transport through the pelvi-calyceal system (PCS). PCS-motility of a total of 28 PCS was qualitatively and quantitatively determined in 9 stone patients and 14 control persons by examination of contrast medium excretion. From X-ray videograms recorded by means of Siemens urography, four different urinary transport types could be distinguished as well as the duration of the contraction periods and the intervals between the PCS-contractions. In stone patients physiological types of urinary transport are less common (33%) than in control subjects (81.25%). In stone patients the PCS is often characterized by reduced or even absent motility. Calyceal reflux is usually found in the systolic phase of PCS-contractions, which may apparently be regarded as a physiological process.

[Acute urine retention in a large myoma of the perivesical connective tissue]. / Akute Harnverhaltung bei grossem Myom des perivesikalen Bindegewebes.

In this paper we present the base history of a 49 years old patient suffering from acute bladder outlet obstruction caused by a large leiomyofibroma of the perivesical connective tissue. We discuss our experiences with the results reported by literature. We conclude that the team work of urologists and gynecologists was very important to cure this women.

[Diclofenac-Na--an alternative treatment possibility in therapy-resistant calcium oxalate urolithiasis?]. / Diclofenac-Na--eine alternative Behandlungsmöglichkeit beim therapieresistenten Kalzium-Oxalat-Harnsteinleiden?

In a prospective study, the influence of sole Diclofenac-Na therapy (3 X 25 mg Rewodina, Voltaren) on the calculus recurrence rate of eight frequently relapsing and therapy resistant calcium-oxalate stone patients is analysed. During a period of one year's treatment, the recurrence rate could be reduced by 73.2%, from 123 to 33 calculi. Serious side effects, changes in blood serological parameters and various urine components were not observed. The course of passages of calculi was improved by reduced pain and rapid passage. The paper summarizes all results of calcium-oxalate stone treatments with nonsteroidal antiphlogistics known so far. In the opinion of the authors, the present successful Diclofenac-Na treatment offers a novel possibility of influencing therapy resistant stone-formers over long periods.

[Possibilities and limits in the treatment of cystine calculus diathesis with high-dose ascorbic acid. Results of a combined study with 17 patients]. / Möglichkeiten und Grenzen bei der Behandlung der Zystinsteindiathese mit hochdosierter Ascorbinsäure. Ergebnisse einer Verbundstudie mit 17 Patienten.

17 cystine stone patients were treated with high doses of ascorbic acid (5 g p. d.). During the observation period, a total of only two natural passages of cystine stones could be observed. For five patients the therapeutic strategy was altered because the recurrence rate did not change and the cystine concentration in the urine was enhanced. One mixed calcium-oxalate/cystine stone had to be resected. In this case as well as on the occasion of further medical check-ups of other patients, an increased risk of calcium-oxalate stone formation was signalled by an enhanced oxalic-acid concentration in the 24-hour urine. Changes in blood serum and impairment in hepatic and renal functions were not observed. With three patients, the therapy had to be interrupted because of gastritis symptoms. The use of high-dose ascorbic acid therapy is recommended and is continued. In special cases, an additive of low do ses of alpha-mercaptopropionyl-glycine is recommended.

Influence of magnesium on the absorption and excretion of calcium and oxalate ions.

In two test series additional oxalic acid excretion in urine was induced in healthy test persons by administering a spinach diet. This additional excretion could be markedly reduced by magnesium administration. Calcium and citrate excretions are largely unaffected by magnesium administration. Magnesium excretions, however, are clearly increased. The calcium oxalate crystallization rates in the 5-or 7-hour urines reveal a behavior parallel to that of the oxalic acid excretion profile. In the control urines, the crystal picture is characterized by numerous medium-sized whewellite crystals. In contrast, in the test series weddellite crystals are reduced in size and frequency after magnesium administration. New aspects of magnesium effects must be discussed; above all the possible absorption changes resulting from gastrointestinal diseases.

[Ensuring quality in the analyses of urinary calculi by a comparison of methods. 3d International Ring Trial]. / Sicherung der Qualität von Harnsteinanalysen durch Methodenvergleiche. 3. Internationaler Ringversuch.

Of 5 analysis tests of the 3rd International Ring Experiment for the control of the quality of methods of the analysis of urinary calculi 38 findings compiled according to 9 different techniques came in from 12 countries. The average deviation per component concerning all 5 analysis tests is considerably low with 0.10 mol proportions. The average quality measure SQ concerning all participants is approximately 2.00; it deteriorates from the X-ray diffraction method over the IR-technique to the other quantitative methods used. Advantages and disadvantages of the X-ray diffraction and IR-spectroscopic analysis are discussed. A methodically homogeneous and centralized performed analysis of urinary calculi shows advantages in the quality of the analyses.

[Results of radiotherapeutic optimization within the scope of combined operative-radiologic therapy of urinary bladder cancer]. / Ergebnisse strahlentherapeutischer Optimierung im Rahmen der kombinierten operativ-radiologischen Therapie des Harnblasenkarzinoms.

The results of a prospective randomized clinical study for the comparison of a uniserial irradiation with a biserial irradiation are demonstrated. The investigations were performed on altogether 191 patients. Patients after cystectomy and supravesical by-pass of the urine were excluded. The operative treatment consisted of TUTUR, transvesical tumour resection or partial resection of the urinary bladder. According to the life table method the uniserial irradiation a survival rate of 52% and for the biserial irradiation of 39% after 54 months was calculated.

[Modification of the risk of urolithiasis by changes in magnesium and calcium concentrations in the urine as affected by stress conditions]. / Uber die Beeinflussung des Harnsteinbildungsrisikos durch Veränderungen der Magnesium- und Calciumkonzentration im Urin unter Stressbedingungen.

Under defined stress conditions, a slight decrease in the calcium concentration in the urine of calcium oxalate stone patients on the first and second experimental days was observed. Taking simultaneously recorded calcium concentrations into consideration, Ca/Mg quotients, were calculated, which, at least in single cases, exceed the limiting range, thus signalling an increased risk of calculus formation.

[Rhythm of diurnal and seasonal urine excretion in calcium oxalate-urinary calculi patients and healthy humans and its effect on the incidence of calculi]. / Zur Rhythmik der tages- und jahreszeitlichen Harnausscheidung bei Kalziumoxalat-Harnsteinpatienten und Gesunden und deren Einfluss auf die Steinfrequenz.

Distinct sinus-like variations in the production of urine - with regard to diurnal as well as seasonal rhythms - result in an increased risk of stone formation in the months of May, June, September and November (concerning seasonal rhythm) and between midnight and 6 a.m. (concerning diurnal rhythm). Other data of importance influencing urinary excretion are sex, age and supply of fluid.

[Lymphography in testicular tumors]. / Lymphographie bei Hodentumoren.

In 45 patients with tumours of the testes (5 seminomas, 40 nonseminomas) the pretherapeutic lymphographic diagnosis could be histologically tested after a retroperitoneal removal of lymph nodes. The lymphographic security was more than 82%, 4 diagnoses each were falsely positive and falsely negative. The sensitivity was 81%, the specifity 83%. With these results the lymphography meets the requirements which are made upon a diagnostic method. It shall be relevant to therapy. An increase of the security by additional examinations (tomography and cavography) is possible. Taking into consideration its limits the bipedal lymphography belongs to the obligatory spread diagnosis in tumours of the testes, its results allow an estimation of the spread of the tumour, the therapeutic effect and the prognosis of the tumour disease.

[Results of repeated adenomectomies in high-risk patients]. / Ergebnisse der zweizeitigen Adenomektomie bei Risikopatienten.

It is reported on 76 patients who were operated on due to an adenoma of the prostate and simultaneous cystolithiasis. The bilateral adenomectomy of the prostate is justified in geriatric patients who are endangered by a secondary failure of other organ systems. The mortality of this selected number of patients is high in simultaneous adenomectomy with lithotomy despite progress in operation technique, anaesthesiology and treatment with antibiotics. On the other hand, all bilaterally operated patients survived so that we recommend this procedure in all risk patients.