Management of pelvic lymphoceles after radical prostatectomy: a multicentre community based study.

INTRODUCTION: Pelvic lymphoceles (LC) following radical prostatectomy (LC-RP) have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients. OBJECTIVES: To describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study. PATIENTS AND METHODS: Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions. - RESULTS: Median age was 64 years. Complications occurred in 9% (28/304) of patients. Median LC-volume was 36ml (range 20-1800ml). There were more complications for LCs with ≥ 100ml volume than those <100ml (27% versus 17%, p = 0.346). Conservative therapy was the standard in uncomplicated cases (87%, 239 of 276 patients), while intervention was done in 13% (puncture and/or drainage, surgery). Surgical intervention was performed significantly more often in complicated cases (82%, 23 from 28 patients; p<0.001). Based on these data, LCs can be stratified into 3 groups depending on the size and clinical presentation. Therapeutic decisions were used to develop the illustrated new therapy algorithm. CONCLUSIONS: This study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.

[Antiparasitic effects of peracetic acid (PAA) against infective stages (theronts) of white spot disease, Ichthyophthirius multifiliis in vitro]. / Antiparasitäre Effekte von Peressigsäure (PES) gegen infektiöse Stadien (Theronten) der Weisspünktchenkrankheit, Ichthyophthirius multifiliis in vitro.

White spot disease, caused by the protozoan parasite Ichthyophthirius multifiliis (I. multifiliis), invades nearly all fresh water fish species and causes huge economic losses. In Germany no protocide substance is legal for the treatment of I. multifilis. As an alternative substance the peracetic acid (PAA) was tested to treat the free invasive stage (theront) of the parasite. PAA concentrations of 0.3 ppm were able to kill all theronts in 120 min in our investigations. As a result of these investigations we recommend an interval-application of 0.3 to 0.5 ppm PAA for 30 to 150 min. This application should be prolonged for two life cycles of the parasite. Biotic parameters as e. g. fish species, and age as well as abiotic parameters as e. g. temperature, pH and organic load of the water could possibly influence the efficiency of the PAA application and should therefore be taken into account while picking the dosage and length of the PAA exposure.

[Application of peracetic acid for the treatment of juvenile sander (Sander lucioperca) during Ichthyophthirius multifiliis infestation]. / Einsatz von Peressigsäure zur Behandlung juveniler Zander (Sander lucioperca) bei Ichthyophthirius-multifiliis-Befall.

White spot disease caused by the ciliate protozoan parasite Ichthyophthirius multifiliis (I. m.), is one of the most dangerous diseases in aquaculture and ornamental fish breeding worldwide. The parasite is characterized by three developmental stages: a reproductive tomont, an infective theront and a parasitic trophont. In sander (Sander lucioperca) breeding I. m. causes serious economic losses. After banning of the traditional therapeutic agent malachite green we have to face a state of emergency for the treatment of the ichthyophthiriasis in Germany. The peracetic acid (PAA), characterized by positive therapeutical properties, might close this gap. The purpose of our investigations was the determination of the toxicity of PES to juvenile sander as well as the evaluation of the therapeutic effectiveness of the substance to combat I. m. For juvenile sander (length 3 cm) we determined a 24-h-LC50 of 1.14 (0.97; 1.3) ppm PES. In two investigations PAA was applied in daily intervals of 0.5; 1, 3, 5 and 24 h and concentrations of 0.5; 1; 1.5 and 2 ppm to treat I.-m.-infection in sander. In test I all sander (length 9 cm) died as a result of the I.-m.-infection. However, the PAA exposed fish survived longer than the PES-free controls! This might be due to a disinfection of other pathogens by PAA. In test II, the fish (length 12 cm) were less infected than fish in test I. Four of six fish died in the group exposed with 2 ppm PAA for 24 hours. The abundance of I.-m.-trophonts was determined in mucus, fin and gill tissues of all fish. Significant differences could not be observed between test I and test II because of dissimilar: 1. exposure in time and concentration, 2. age and condition of the fish and 3. homogenity of the variances. Therefore, no therapy strategy was successful while fighting the parasitic trophonts protected by the overlaying fish tissues. We speculate that a successful therapy of I. m. with PAA is, as known e.g. for malachite green, only possible while fighting the free living stages theronts and tomonts. This will be part of our subsequent investigations.

Relationships of ultrasonic backscatter with ultrasonic attenuation, sound speed and bone mineral density in human calcaneus.

Ultrasonic attenuation and sound speed have been investigated in trabecular bone by numerous authors. Ultrasonic backscatter has received much less attention. To investigate relationships among these three ultrasonic parameters and bone mineral density (BMD), 30 defatted human calcanei were investigated in vitro. Normalized broadband ultrasonic attenuation (nBUA), sound speed (SOS), and logarithm of ultrasonic backscatter coefficient (LBC) were measured. Bone mineral density was assessed using single-beam dual energy x-ray absorptiometry (DEXA). The correlation coefficients of least squares linear regressions of the three individual ultrasound (US) parameters with BMD were 0.84 (nBUA), 0.84 (SOS) and 0.79 (LBC). The 95% confidence intervals for the correlation coefficients were 0. 69-0.92 (nBUA), 0.68-0.92 (SOS) and 0.60-0.90 (LBC). The correlations among pairs of US variables ranged from 0.63-0.79. Variations in nBUA accounted for r(2) = 62% of the variations in LBC. Variations in SOS accounted for r(2) = 40% of the variations in LBC. These results suggest that ultrasonic backscattering properties may contain substantial information not already contained in nBUA and SOS. A multiple regression model including all three US variables was somewhat more predictive of BMD than a model including only nBUA and SOS.

Expression pattern of activation and adhesion molecules on peripheral blood CD4+ T-lymphocytes in relapsing-remitting multiple sclerosis patients: a serial analysis.

We studied the expression of various cell surface molecules (CD25, CD28, CD29, CD45RO, CD56, LFA-1, VLA-4) on peripheral blood CD4+ T-cells in 6 relapsing-remitting multiple sclerosis (RR-MS) patients. Furthermore, changes in the expression pattern of these surface markers during intervals of increased disease activity, which was measured by gadolinium (Gd-DTPA) magnetic resonance imaging (MRI) were examined. Although several patients showed signs of increased disease activity during the observation period, this was not paralleled by a relevant change in the expression of these activation and adhesion molecules.

Relationship between maternal and infant iron stores: 1. Full term infants.

Serum ferritin, serum iron and total iron binding capacity were determined in 218 pregnant women at term and in the cord blood of their normal term infants. Both the mean weight (3210 g) and serum ferritin level (geometric mean 81 micrograms/l) of the neonates of iron deficient mothers were significantly lower than those of mothers with "normal" iron stores (weight 3390 g; cord ferritin level 115 micrograms/l). A weakly significant correlation was found between the logarithm of the maternal and neonatal serum ferritin concentration (r = 0.15, p less than 0.05) and the maternal log serum ferritin and the newborn's weight (r = 0.15, p less than 0.05). The weak correlations were supported by the differences between the values of cord samples from babies of iron deficient mothers and those whose mothers had "normal" iron values. Adequate iron supplementation during the early period of pregnancy is suggested.

National programme for prevention of the recurrence of neural tube defects.

Mothers who since 1970 gave birth to children with anencephaly or spina bifida in Hungary are informed about the recurrence risk, the possibility of prevention and about the four institutes where alpha-feto-protein determination is done. In one of these institutes the examination was recommended to 175 women of whom 158 availed themselves of the opportunity. The outcome of their pregnancy is now known in 131 cases. Of these, in 101 the examination was performed because of previous occurrence of anencephaly-spina bifida. High concentration (400, 200, 140 micrograms/ml) were found in 3 cases; they were due to anencephaly (selective induced abortion), severe spina bifida (liveborn) and macerated fetal death. The examination yielded values above the 99% confidence limit in the given gestational week in further 9 cases. The elevated values were due to twinning in 2 cases, to closed spina bifida in 1, and to fetal death in 1 case. The slightly elevated alpha-fetoprotein in 4 of them may have been due to chance.

Investigation of some cord blood components.

The practical result borne by our investigations has been the introduction of routine estimation of cord blood total protein. In every case when the concentration is below the 10 percentile value, the clinicians are warned. Further catamnestic studies are needed to judge the values of cord blood cholesterol estimations in screening for familial hyperlipoproteinemias. The hypercholeterolemic infants of the present series, who are 2-3 years old at present, as well as their families must be subjected to repeat analysis. The change in opposite directions of cord blood total protein and cholesterol levels with the advance of gestation was a remarkable finding. This correlation indicates a close interaction between protein and lipid metabolism. Less promising results have been obtained in investigations of the cord blood calcium and magnesium levels, but final conclusions can only be drawn after repeat analyses. Introduction of the routine estimation of these two parameters does not seem necessary at present. Besides clinical data, biochemical parameters have also been found suitable for differentiating small-for-date infants from true prematures. The functional maturity of these infants was shown by the fact that their different cord blood components were normal.

Amniotic fluid creatinine and uric acid levels in high risk pregnancy.

Comparison of two methods of creatinine and uric acid assay in amniotic fluid showed that the two-point-reaction rate measurement of creatinine and the enzymatic assay of uric acid give more reliable results than the methods used previously. At the end of pregnancy, increased creatinine and uric acid levels were found. In cases of blood group incompatibility the values were mostly in the normal range, while in diabetic or toxaemic mothers higher, normal and lower values were equally found. It has been concluded that a single investigation does not suffice for the estimation of fetal maturity. Only repeated tests showing an increase in the creatinine and uric acid levels offer reliable information.

A simple and rapid determination of the lecithin/sphingomyelin (LS) ratio in amniotic fluids and in pharyngeal aspirates of newborn infants.

A simple, rapid method for the routine determination of the lecithin/sphingomyelin (L/S) ratio in amniotic fluid and/or in pharyngeal aspirate of the newborn has been developed. In 33 samples of amniotic fluid at various gestational ages, an L/S ratio corresponding to the fetal age was found: in 16 samples of biochemically immature amniotic fluid (gestation age less than 34 weeks) the mean of the ratio was 1.26 and in 17 samples of mature amniotic fluid (gestation age greater than 35 weeks) the mean value was 3.02. Pharyngeal aspirates of 55 non-selected newborn were examined by the same method. The L/S ratio of 39 infants (gestation age greater than 38 weeks) gave a mean value of 7.3 and that of 16 premature infants (gestation age less than 37 weeks) a mean value of 5.5. In none of these cases did RDS develop after birth. The results suggest that the method is useful for the determination in both amniotic fluid and pharyngeal aspirate.