Entangled Pure State Transformations via Local Operations Assisted by Finitely Many Rounds of Classical Communication.

We consider generic pure n-qubit states and a general class of pure states of arbitrary dimensions and arbitrarily many subsystems. We characterize those states which can be reached from some other state via local operations assisted by finitely many rounds of classical communication (LOCC_{N}). For n qubits with n>3, we show that this set of states is of measure zero, which implies that the maximally entangled set is generically of full measure if restricted to the practical scenario of LOCC_{N}. Moreover, we identify a class of states for which any LOCC_{N} protocol can be realized via a concatenation of deterministic steps. We show, however, that in general there exist state transformations which require a probabilistic step within the protocol, which highlights the difference between bipartite and multipartite LOCC.

Operational Multipartite Entanglement Measures.

We introduce two operational entanglement measures that are applicable for arbitrary multipartite (pure or mixed) states. One of them characterizes the potentiality of a state to generate other states via local operations assisted by classical communication and the other characterizes the simplicity of generating the state at hand. We show how these measures can be generalized to two classes of entanglement measures. Moreover, we compute the new measures for pure few-partite systems and use them to characterize the entanglement contained in a three-qubit state. We identify the Greenberger-Horne-Zeilinger and W state as the most powerful pure three-qubit states regarding state manipulation.

[Structure and process quality of inpatient urologic rehabilitation]. / Struktur- und Prozessqualität der stationären urologischen Rehabilitation.

Inpatient rehabilitation and "Anschlussheilbehandlung" (rehabilitation soon after operation or acute intervention) are effective and economic for long-term improvement of urologic patients. Only therapy guided by urologic specialists during rehabilitation and afterwards guarantees the possibility of excellent results. Especially QOL and functional deficits are improved markedly by urologic rehabilitation. Therefore, inpatient urologic rehabilitation should be initiated more often in the future.

Urinary tract infection in patients with neurogenic bladder dysfunction.

Recurrent urinary tract infections (UTI) are a significant problem in all patients with neurogenic bladder leading to high morbidity, poor quality of life and a limited life expectancy. For the diagnosis of UTI, a urine specimen taken by bladder puncture or catheterization is required. In patients with neurogenic bladders, clinical symptoms and leukocyturia must be present together with bacteriuria in order to qualify as UTI. The spectrum of pathogens differs significantly from that in patients with normal bladder function. Culture and antimicrobial susceptibility testing must, therefore, be performed prior to the initiation of antibiotic therapy. This is also important in the prevention of the emergence of antimicrobial resistance. The main way to prevent recurrent UTI in the neurogenic bladder is by restoring the normal low-pressure reservoir function of the bladder and is the aim of neuro-urological management.

Penile prostheses in paraplegic men.

OBJECTIVES: To determine the efficacy of penile prostheses in paraplegic men. PATIENTS AND METHODS: Between 1980 and 1992, penile prostheses were implanted in 209 paralysed men of whom the records of 179 were evaluable. The indication for implantation was erectile dysfunction, penile retraction, or a combination of the two. RESULTS: The outcome of the implantation of semi-rigid prostheses was worse than that of semi-flexible or flexible prostheses. Antibiotic treatment and body disinfection reduced the infection rate to below that in a normal population. The results were satisfactory for patients with either problem and patients treated successfully for erectile dysfunction became more self-confident. CONCLUSIONS: When paraplegic patients are able to regain sexual activity after successful implantation of a penile prosthesis, their self-confidence is increased. Prostheses might also be useful for patients who will not accept self-injection and for those using external condom drainage. Penile prostheses clearly have a place in the treatment of paralysed men.

Wallstents in patients with detrusor-sphincter dyssynergia.

PURPOSE: For patients with spinal cord injuries who are unable to perform clean intermittent self-catheterization, sphincterotomy is performed most commonly to avoid high bladder pressure. This procedure causes additional trauma and does not always lead to a satisfactory result. Therefore, we sought an alternative therapy. MATERIALS AND METHODS: We introduce our initial experience with the UroLume Wallstent* in the treatment of 51 patients with spinal cord injuries and detrusor-sphincter dyssynergia (observation time 12 to 36 months). Prior sphincterotomy was unsuccessful in all patients. RESULTS: All observed urodynamic, radiological and clinical findings improved, and the results are encouraging. CONCLUSIONS: Implantation of this device seems to be appropriate in select paraplegic patients.

Transurethral sphincterotomy in quadriplegic patients: long-term-follow-up.

Sphincterotomy was the treatment of choice in spinal cord injured patients with reflex bladder activity and detrusor sphincter dyssynergia after World War II. However, nowadays the conversion of a spastic bladder into a low pressure reservoir by medication or operatively has become a more favourable bladder management. Only in quadriplegic patients who are not able to perform self-catheterization, this treatment modality seemed to be an alternative. With twelve o'clock sphincterotomy, urodynamic parameters of the lower urinary tract can be brought to favourable measures (leak-point, residuals). However, the reoperation rate for the maintenance of these urodynamic results is high (57%). Laser sphincterotomy seems to be advantageous in this respect, as it reduces the need for resphincterotomy significantly. Additionally, 14% of the patients needed operations, which made condom fixation possible. Upper tract could only be preserved if sphincterotomy is done early enough. Patients who do not empty completely while in the wheelchair are at risk to develop a hydronephrosis.

Single potential analysis of cavernous electrical activity in spinal cord injury patients.

Introduced in 1988, cavernous electromyography and its evolution, single potential analysis of cavernous electrical activity (SPACE), seem to be promising diagnostic methods in the evaluation of erectile dysfunction. The aim of our study was to determine the influence of a centrally disturbed autonomic supply on SPACE recordings. SPACE was performed in 35 male patients with complete and 2 with incomplete spinal cord lesions at a cervical or thoracic level. Simultaneous recording was done with concentric needle electrodes in both cavernous bodies with a frequency range of 0.5 to 100 Hz. All patients underwent a full neurological and urological evaluation, including cystometry. The lesion was cervical in 12 patients and thoracic in 22. Three patients underwent sacral deafferentation and bladder pacemaker implantation. One of 12 patients with cervical and 10 of 22 with thoracic lesions reported full rigid reflexogenic erections, while 3 of 12 patients with cervical lesions were not evaluable due to grounding failure. Of these patients 31 were eligible for our study. No patient had an entirely normal SPACE. Four of 9 patients with cervical and 19 of 22 with thoracic lesions had a normal, silent basic electric (less than 5 mu v.) oscillation, while the remainder had a baseline oscillation of up to 100 mu v. Normal potentials were found in 2 of 9 and 10 of 22 patients, respectively. Low frequency, high amplitude potentials were found in 6 of 9 and 21 of 22 patients, respectively, while low frequency, low amplitude potentials occurred in 8 and 8, respectively, and high frequency potentials occurred in 5 and 1, respectively. Our results show that abnormal autonomic input induces abnormal SPACE findings in patients with (presumably) normal cavernous tissue.

A modified technique for nerve-sparing retroperitoneal lymph node dissection in stage II nonseminomatous germ cell tumors using intraoperative measurement of bladder neck pressure alterations following sympathetic nerve fiber electrostimulation.

We present a simplified method for nerve-sparing retroperitoneal lymph node dissection in patients with nonseminomatous testicular cancer. The sympathetic fibers involved in antegrade ejaculation are identified by intraoperative electrostimulation, resulting in an increase of bladder neck closure pressure. This increase is demonstrated by intraoperative monitoring of both the intravesical pressure and the pressure within the bladder neck by a two-channel microtip measuring catheter. 4 patients with stage I and 6 patients with stage II nonseminomatous testicular cancer were operated on with this modified technique. Ejaculation was preserved in all cases. Semen volume ranged from 2.2 to 4.0 ml. Sperm cell count ranged from 2 to 22 x 10(6)/ml with 20-50% motile spermatozoa, except for 2 of the 3 patients who initially presented with preoperative azoospermia following chemotherapy. In 1 of these 3 patients, postoperative semen analyses revealed a recovery of germ cell function demonstrated by oligoasthenozoospermia.

The influence of anterior root stimulation (S2) in deafferented spinal cord injury men on cavernous electrical activity.

Registration of cavernous electrical activity (single potential analysis of cavernous electrical activity) was recently suggested for the diagnosis of autonomic cavernous dysfunction. For validation of this method the effect of sacral neurostimulation on cavernous electrical activity was examined. In 3 male patients with a complete spinal cord lesion (T3, T4 and T12, respectively), deafferentation was done at the S2 to S5 levels. Around the anterior roots of S2 to S5 electrodes for neurostimulation were placed. Cavernous electrical activity was recorded with an intracavernous needle electrode and with surface electrodes in the flaccid as well as in the erect states induced by neurostimulation (at 7, 8, 12, 18, 20, 30 and 45 Hz., 30 v. and 0.4 msec). In all patients similar potentials compared to the normal values, as well as additional pathological potentials were recorded during flaccidity. During neurostimulation all patients achieved full erection with no or markedly decreased cavernous electrical activity to frequencies of 12, 18, 20 and 30 Hz., while to 7, 8 and, more pronounced, 45 Hz. only partial erection with ongoing cavernous electrical activity was found. Our study strongly suggests that cavernous electrical activity and, subsequently, the cavernous smooth muscle tone are dependent on autonomic input. This finding supports the hypothesis that single potential analysis of cavernous electrical activity may be valid in the diagnosis of cavernous autonomic dysfunction. Furthermore, our results suggest a possible role for single potential analysis of cavernous electrical activity in the fine tuning of erection inducing neurostimulators.

[Nerve sparing retroperitoneal lymphadenectomy with intraoperative electrostimulation in patients with nonseminomatous testicular tumors]. / Nerverhaltende retroperitoneale Lymphadenektomie mit intraoperativer Elektrostimulation bei Patienten mit nichtseminomatösen Hodentumoren.

Thirteen patients with nonseminomatous testicular germ cell tumours underwent nerve-sparing retroperitoneal lymphadenectomy (RLA) with prospective isolation and preservation of postganglionic sympathetic nerve fibres. In all ten patients with pathological stage I in whom a unilateral nerve-sparing RLA was performed, ejaculation was preserved. In two of three patients with pathological stage IIa who underwent a bilateral RLA with a nerve-sparing technique on one side, ejaculation was also preserved. In nine patients intraoperative electrostimulation of isolated sympathetic nerve fibres was performed employing Brindley's stimulation device. The result was an immediate and reproducible ejaculation in seven patients. Thus electrostimulation of sympathetic nerves may be a useful intraoperative test for the identification of the nerve fibres that need to be protected for ejaculation. Nerve-sparing RLA seems to be superior to modified (unilateral) RLA with regard to preservation of ejaculation.

Urethral sphincteric responses to sacral root stimulation.

Deafferentation and stimulation of sacral nerves in patients with complete spinal cord lesions is a good model to study the parasympathetic influence on urethral behavior. During intradural sacral deafferentation from S2 to S4/S5 in preparation for implantation of the Finetech-Brindley anterior sacral root stimulator, sacral roots were stimulated with 3 and 30 Hz and 3 and 10 V and the bladder and urethral responses noted. Stimulation of the posterior roots at 3 Hz gives a urethral relaxation without bladder contraction. At this frequency, anterior sacral root stimulation has no effect on bladder nor urethral pressure. Stimulation of the anterior roots at 30 Hz produces simultaneous bladder contraction and urethral relaxation. These findings support the presence of an afferent parasympathetic inhibitory mechanism in the spinal micturition center in the human.

Extradural implantation of sacral anterior root stimulators.

A technique for extradural deafferentation of the S2 to S5 segments and extradural implantation of stimulating electrodes is described, and its application to twelve patients with spinal cord lesions is reported. Nine patients use their implants for micturition, and seven are fully continent. The advantages and disadvantages of this technique compared with the more usual intrathecal procedure are discussed.

[Surgical treatment of spastic bladder paralysis in paraplegic patients. Sacral deafferentation with implantation of a sacral anterior root stimulator]. / Die operative Behandlung der spastischen Blasenlähmung bei Querschnittlähmung. Sakrale Deafferentation (SDAF) mit der Implantation eines sakralen Vorderwurzelstimulators (SARS).

Because of incalculable incontinence, recurrent urinary infections and morphological and functional damage of the urinary tract, treatment of the spastic bladder is frequently problematic in patients with spinal cord lesions. The operative method presented is designed to stop the spastic detrusor action and to achieve controlled low-resistance voiding. Using either an intradural or an extradural approach, the afferent and efferent nerves of the parasympathetic spinal center are identified. The posterior roots S2 to S5 are cut. Electrodes are implanted at the anterior roots, and these allow transmitter-controlled stimulation. From September 1986 to September 1989, 45 patients were treated by this method. Sacral deafferentation (SDAF) at S2 to S5 helped and the spasticity of the bladder disappeared. The patients achieved continence and a bladder volume of more than 500 ml. The frequency of infection was reduced and renal insufficiency was corrected. The use of a special stimulation technique (sacral anterior root stimulation; SARS) allowed low-resistance voiding and avoided the problem of dyssynergia. Patient acceptance of this operation is high because of the resulting improvement in the quality of life.

Hypogastric plexus stimulators for obtaining semen from paraplegic men.

Radio-linked devices to stimulate the hypogastric plexus have been implanted into 7 patients with spinal injuries and 1 with primary anorgasmia. They caused seminal emission in all patients and still do so in the spinal injury patients. Insemination with semen thus obtained has yielded 5 pregnancies (2 live births) in the wives of 4 patients. The range of application is discussed.

Spectrum of bacterial pathogens in uncomplicated and complicated urinary tract infections.

The spectra of bacterial organisms of urinary tract infections (UTI) in patients with and without abnormalities in the urinary tract (complicated and uncomplicated UTIs) are compared. Data from the United Kingdom and the Federal Republic of Germany are included. In addition, the susceptibility of the pathogens to antibiotics (for oral or parenteral application) in both countries are compared. In conclusion, rational antibiotic therapy of complicated UTIs should strictly follow the antibiogram of the causative organism. For therapy of uncomplicated UTIs, the regional state of antibiotic susceptibility of the pathogens according to geographical location should be considered and kept up to date.

[Spermatogenesis in patients with traumatic transverse paralysis]. / Spermatogenese bei Patienten mit traumatischer Querschnittlähmung.

Testicular biopsies from 22 paraplegic men were studied by light and electron microscopy. The investigations of semithin sections by a special standardized method revealed that normal spermatogenesis occurred in only one patient, whereas in 21 patients severe disturbance of spermatogenesis was found. The germinal epithelium displayed a decrease of spermatogenic cells, an increase of degenerating cells, especially of spermatids, and a release of large groups of premature germ cells. Cross sectioned tubules often showed no patent lumina. As revealed by electron microscopical investigations the spermatids show malformations in most cases of the head and acrosome, rarely of the tail. Decreased spermatogenic activity occurred in various degrees in each of the 21 men. There is no evidence that any specific form of spermatogenic disturbance exists typical of spinal cord injury. No obvious relationship was found between the degree of spermatogenic disturbance and duration or level of the spinal cord lesion or incidence of urinary tract infection.