The uncemented primary Bicontact stem in revision total hip arthroplasty in young patients.

AIM: The purpose of this study was to evaluate the uncemented primary Bicontact stem (B.Braun-Aesculap, Tuttlingen, Germany) as a possible adequate alternative to other revision systems in revision total hip arthroplasty. METHODS: Twenty patients aged up to 58 years (34-58 years, mean age 5.7 +/- 5.8 years) with minor bone defects underwent a revision total hip arthroplasty with the uncemented primary Bicontact stem. The patients were assessed clinically and radiologically at follow-up (follow-up: 8.0 +/- 3. years). RESULTS: The postoperative Harris Hip Score, Motion and Pain Score improved significantly. There was only one further revision in these patients because of infection and only one case with mild stress shielding. CONCLUSION: The uncemented primary Bicontact stem seems to be a good alternative to other revision systems in total hip revision arthroplasty in young patients.

Local control of prostate cancer by transrectal HIFU-therapy.

Transrectal high intensity focused ultrasound (HIFU) as a minimal invasive treatment approach of localized prostate cancer was evaluated concerning its efficacy and security. Post-operative monitoring included PSA-levels and histological results of control random biopsies. Seventy-three HIFU sessions were performed on 62 patients during the period from November 1997 to April 2000. Patients were classified in 4 indication groups: 1) localized prostate cancer, T1-T2, initial PSA < 15 ng/ml, Gleason score < 7, volume < 30 cc, no more than 4 of 6 random biopsies affected by cancer, not suitable for radical prostatectomy; 2) localized prostate cancer, T1-T3, no PSA or Gleason score limitation; 3) local recurrence after first line therapy (RPE, radiation, hormonal ablation); 4) for local debulking. Mean plus or minus standard deviation for patient age was 67.5 +/- 7.48 years, for PSA was 7.64 +/- 5.26 ng/ml and for prostate volume was 21.3 +/- 7.9 cc. Median follow up was 15 months (range 5-29) and included PSA development, control sextant biopsies and transrectal color coded duplex sonography (TCCDS) at 1, 3, 6, 12 and 24 months. At least 1 control biopsy result was available in 48 patients. We evaluated the therapy in 3 categories: 1) group 1 (complete response) included 33/48 patients (68.7%) with no residual cancer and PSA < 4 ng/ml; 2) group 2 (biochemical control) 8/48 patients (16.7%) with small residual cancer and PSA < 4 ng/ml; 3) group 3 (failure) 7/48 patients (14.6%) with residual cancer and PSA > 4 ng/ml (4 of them received hormone therapy). As major complications 2 urethrorectal fistulas occurred, both in post-radiation patients, 3 stress-incontinences II-III after TUR post HIFU. In 20 patients (32.3%) transurethral manoeuvres were necessary to remove obstructive necrotic tissue or because of bladderneck or urethral strictures. 11 of these patients were among the first 20 treated patients. Regarding the individual learning curve about technique, indication and the technical developments HIFU treatment can currently be considered as a valid alternative treatment strategy for patients with localized prostate cancer, who are not suitable for radical surgery. HIFU treatment can be repeated depending on biopsy result and PSA development. Local control of the localized prostate cancer was observed in group 1 and 2 (85%).

Correlation of persistent stress urinary incontinence with quality of life after suspension procedures: is continence the only decisive postoperative criterion of success?

OBJECTIVES: To determine objective continence rates and to include in the evaluation subjective assessment of continence and quality of life by the affected patients and correlate these with the objective continence rates in a retrospective study. METHODS: One hundred thirty-three female patients in our clinic underwent suspension procedures for stress urinary incontinence, 68 undergoing a Burch colposuspension and 65 a Raz bladder neck suspension. The continence rate was evaluated by questionnaire and compared with patients' postoperative self-assessment of continence and pre- and postoperative quality of life assessments. RESULTS: For the 105 women returning evaluable questionnaires (57 Burch and 48 Raz procedure), the continence rate was 69.5% (75.4% in the Burch group, 60.4% in the Raz group). Mild incontinence requiring 1 to 2 sanitary pads daily was found in 19.3% of the Burch group and 31.3% of the Raz group. Moderate incontinence requiring 3 to 5 pads daily was found in 5.3% of the Burch and 8.3% of the Raz group. No patients had severe incontinence (more than 5 pads daily). Both groups showed statistically significant improvement in postoperative quality of life. Despite persistent incontinence, the satisfaction rate was comparable to that of continent patients. CONCLUSIONS: The results show that in addition to objective parameters, subjective assessment of quality of life is a factor that should be included in the postoperative evaluation of surgical results.

Clinical results of the transurethreal resection and evaluation of superficial bladder carcinomas by means of fluorescence diagnosis after intravesical instillation of 5-aminolevulinic acid.

BACKGROUND AND OBJECTIVE: The high recurrence rate of superficial bladder carcinomas requires new approaches in diagnosis and therapy. Particularly, an improvement in detection, resulting in better resection of flat lesions, which are poorly or not detectable under white light, is necessary. The effectiveness of fluorescence diagnosis for detection and transurethral resection of bladder carcinomas was investigated in a prospective study. MATERIALS AND METHODS: From 120 patients, 347 biopsies were taken or tumors resected with the aid of fluorescence from 5-aminolevulinic acid. Urothelial carcinomas and dysplasias were detected in 124 cases. RESULTS: Of the lesions, 119 were fluorescence positive (N = 74 pTaG1/2; N = 9 pT1G1/2; N = 11 pT1G3; N = 7 carcinoma in situ; N = 6 p > T1; N = 12 dysplasia II), and 5 were falsely negative (N = 3 pTaG1/2; N = 1 pT1G1/2; N = 1 dysplasia II). The sensitivity of the fluorescence diagnosis (96.0%) was significantly higher than the 67.5% sensitivity of white-light cystoscopy (P < 0.0001). Taking the data for primary or recurrent tumor resection and secondary resection separately, the sensitivity was 100% and 80%, respectively, and was significantly higher than that of white-light cystoscopy, which was 80.8% and 20 %, respectively (P < 0.0001 and P < 0.0008). The lower sensitivity of fluorescence diagnosis in secondary transurethral resection is attributed to the higher rate of false-negative findings in areas of former resection. CONCLUSIONS: The high rate of false-positive findings limits the correct interpretation of fluorescence findings. In spite of this, fluorescence diagnosis is superior to white-light cystoscopy in every case. By means of better detection of urothelial neoplasias and dysplasias, as well as more thorough and extensive resection under fluorescence control, it should be possible to reduce the recurrence rate of superficial bladder carcinomas.

5-aminolevulinic acid-induced fluorescence endoscopy applied at secondary transurethral resection after conventional resection of primary superficial bladder tumors.

OBJECTIVES: A prospective investigation was carried out to evaluate the use of 5-aminolevulinic acid (5-ALA)-induced fluorescence diagnosis with secondary transurethral resection (TUR). METHODS: Fifty patients underwent secondary TUR of the former resection area 6 weeks after conventional TUR for superficial bladder carcinoma. 5-ALA-induced fluorescence diagnosis was used in addition to standard white light endoscopy. All former resection areas were biopsied regardless of fluorescence findings. In addition, specific red fluorescent areas were resected, as were suspicious areas seen at white light endoscopy. RESULTS: One hundred thirty areas or tumors were resected. The sensitivity of fluorescence cystoscopy was 77.8% (95% confidence interval 52.4% to 93.6%). Residual tumors were found in the area of the former resection in 7 (14%) of 50 patients; 4 of these 7 were fluorescence negative and 3 were fluorescence positive. In an additional 7 patients (14%), exclusively fluorescing tumors not visible under white light could be detected outside the areas of former resection (n = 5, Stage pTaG1/2; n = 1, Stage pT1G1/2; n = 1, carcinoma in situ). CONCLUSIONS: Despite high sensitivity, fluorescence diagnosis at this early stage of control does not allow us to evaluate sufficiently the granulation tissue of necrotic areas after TUR without biopsy. The main advantage of the 5-ALA-induced fluorescence endoscopy is in the evaluation of untreated urothelium because of the easier detection of tumors not visible by conventional endoscopy.

Benign ureteral tumors. Four case reports and a review of the literature.

The diagnosis of benign ureteral polyps should be considered especially in patients younger than 40 years with filling defects of the proximal ureter on the intravenous pyelogram (IVP). The excellent results of conservative organ-saving surgery (open resection, ureteroscopic resection, laser coagulation) require precise diagnostic management preoperatively in these patients.

Microlenses as Amplification for CCD-Based Detection Devices for Screening Applications in Biology, Biochemistry, and Chemistry.

We describe the use of microlenses as amplification for CCD-based detection devices. The possible amplification of a signal in areaction chamber of a nanoplate is estimated with a first-order approximation. This value was proved with a commercially available microlens and with a specially constructed microlens array made of glass hemispheres. Possible applications of this approach to amplification are given.

Follow-up of moderately elevated serum CEA levels in "healthy patients".

In a retrospective analysis of 254 patients with a moderately elevated serum CEA level (3.6 to 10.0 ng/ml) a satisfactory explanation for the increased CEA level could not be identified in 42 patients despite intensive diagnostic procedures. The follow-up of these patients showed a decrease of CEA level in 28 patients (80%), returning to normal range below 3.5 ng/ml in 20 patients (57%). There was an increase of CEA level in 5 (14.3%) and no change in two patients (5.7%). Except one patient who died of an unknown cause, none of the other patients developed malignancy in a period up to 34 months. We conclude that a single elevated serum CEA level does not justify further diagnostic procedures if clinical signs of a disease are absent. Patients with increasing CEA levels should be checked more intensively, because in some cases a previously undetectable malignant disease may become evident.

[Swelling of the ball of the foot (bumblefoot) in birds of prey]. / Die Ballengeschwulst ("Dicke Hände") bei Greifvögeln.

Bumblefoot is an inflammation of the talons of birds of prey which can be caused by various (exogenous and endogenous) factors. Falcons and eagles suffer more than other species of prey from this complaint. Affected birds show all stages from acute to chronic inflammation. Bumblefoot must be distinguished diagnostically from pox-infections and skin tuberculosis. To a large extent the inflammation can be prevented by providing the bird with a properly designed perch, with a correct diet, and with adequate grooming. Surgical treatment is the only promising therapy, though the chances of success depend on the extent of the inflammation. Generally all healing processes in region close to the talons are difficult and lengthy.

Citric Acid Fermentation by Aspergillus niger on Low Sugar Concentrations and Cotton Waste.

The possible use of cotton waste as a carbohydrate source of citric acid production by Aspergillus niger was examined. No citric acid was produced when A. niger was grown on cotton waste as a sole carbon source. In two-stage fermentations, however, mycelium obtained from surface cultures in cotton waste medium yielded more citric acid when transferred to sucrose-containing media than when directly inoculated to sucrose-containing media. It is concluded that cotton waste can be used for saving sucrose and for increasing yields of citric acid fermentation by A. niger.

Inhibition of experimental bladder tumor induction by systemic BCG treatment.

Transitional cell carcinoma of the urinary bladder was induced in rats by ingestion of 0.188% N-[4-5-nitro-2-furyl)-2-thiazolyl] formamide. During the induction period of 8 months, one animal group received systemic BCG treatment. After 12 months, the BCG-treated rats showed a significantly lower bladder tumor weight and stage than the corresponding controls. The results are discussed with regard to the possibility of BCG prophylaxis of human bladder tumors.

Leaching of a silicate and carbonate copper ore with heterotrophic fungi and bacteria, producing organic acids.

Leaching of metals with carbon-heterotrophic microorganisms and organic acids as active agents has been performed with Timna copper ore containing 1.1% copper as carbonates and silicate and with some other metal oxides. Aspergillus niger surface cultures on a 14% sucrose fermentation medium yeilded 87.3% of total copper from 10% suspension within 2 weeks of leaching. On sulfite liquor as an industrial waste product A. niger solubilized 73.8% Cu within 4 weeks. In percolators with 14% sucrose medium up to 1780 ppm copper were found in solution. In leaching experiments with a sea water medium containing 7% sucrose only 684 ppm Cu were soluble. Leaching with lactobacilli containing whey yielded 83.4% of the total copper in 4 weeks.

Effect of intralesional and systemic BCG-application or a combined cyclophosphamide/BCG treatment on experimental bladder cancer.

Infiltrating transitional cell carcinomas of the urinary bladder were induced by ingestion of 0.188% N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT) in 145 female Wistar rats. After 8 months of carcinogen exposure, the animals were divided into different treatment groups. They received cyclophosphamide intraperitoneally as a single injection or BCG either once intralesionally or weekly subcutaneously or a combination of cyclophosphamide followed by subcutaneous BCG. The treatment effect was determined by body weight measurements and bladder tumour weight after 12 months. Compared with a control group statistically significant differences of bladder tumour weights were found after treatment with BCG alone or in combination with cyclophosphamide. Intralesional BCG resulted in an insignificant increase of tumour weights.

Avian pox virus. An ultrastructural study on a cherrug falcon. Brief report.

The ultrastructure and maturation of avian pox particles is described in the rare case of a naturally infected hawk (Falco cherrug). As in other cells infected by fowlpox virus two types of inclusion bodies are encountered in the cytoplasm: firstly assemblies of fluffy filamentous material apparently giving rise to immature virions. They are thought to present virus factories (inclusion body B). Secondly mature virus particles budded into extensive groupings (Bollinger bodies, inclusion body A) which display a fine structure identical to other strains of fowlpox virus.

Induction of transitional cell carcinoma of the urinary bladder in rats by feeding N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide. Histological and ultrastructural findings.

After feeding with 0.188% N-[4-(5-nitro-2 furyl)-2-thiazolyl] formamide (FANFT), transitional cell carcinoma of the urinary bladder was induced in all female Wistar rats tested. Histological changes of the urothelium consisted of various degrees of hyperplasia and dysplasia. An infiltrating transitional cell carcinoma first appeared after 8 months. These results are compared with the findings of other authors, and divergencies of the tumour induction rates are discussed with respect to strain, sex and weight of experimental animals as well as concentration and amount of ingested carcinogen. Electron microscopy shows microvillous transformation of the luminal plasma membrane and appearance of a thick fluffy cell coat (glycocalyx). These changes are explained by an altered function of the Golgi complex occurring during malignancy and leading to a loss of the specific discoid vesicles of the urothelial cells.

Biological behavior of N-[4-(5-nitro-2-furyl)-2-thiazolyl]-formamide induced carcinoma of the transitional epithelium in the rat.

30 female Wistar rats weighing between 70 and 90 g were fed for 8 months with 0,188% N-[4-(5-nitro-2-furyl)-2-thiazolyl] Formamide (FANFT). After this period a papillary tumor of the urinary bladder was demonstrable in each animal. Histological examination always revealed a transitional cell carcinoma with prevailing medium tumor stages; no distant metastases were found. The grade of malignancy was classified as medium and high. No significant statistical relationship could be ascertained between tumor stage and grade or between grade and weight, but a correlation was established between tumor stage and weight. After 12 months, 36/60 kidneys were found to be normal, whereas in 20/60 dysplasias and in 2/60 transitional cell carcinomas of the renal pelvis were observed; secondary hydronephrosis due to bladder tumors occured 4 times. Other organ changes were not noticeable.

[Toxicological investigations of the combination sulfamoxole/trimethoprim, a new broad-spectrum chemotherapeutic (author's transl)]. / Toxikologische Untersuchungen der Kombination Sulfamoxol/Trimethoprim (CN 3123), eines neuen Breitbandchemotherapeutikums

The chemotherapeutically effective 5:1 combination N1-(4,5-dimethyl-2-oxazolyl)-sulfanilamide (sulfamoxole) and 2,4-diamino-5-(3,4,5-trimethoxy-benzyl)-pyrimidine (trimethoprim) (CN 3123, Nevin, Supristol) was investigated to determine any evidence of toxicological potentiation or new toxic signs. It was found that CN 3123 had a very low acute toxicity when administered orally to mice, rats and dogs (oral LD50: mouse greater than 12 000 mg/kg; rat greater than 14 000 mg/kg; dog greater than 1000 mg/kg body weight). The combination was also tolerated by rats and dogs in repeated doses administered over a period of 4 or 26 weeks, that greatly exceeded the therapeutic dose. The only change observed occurred in the thyroid, which in all doses administered exhibited a dose-related increase in weight accompanied by histological changes indicating an activation of thyroid function and a hypersecretion of basophilic thyrotropic cells in the anterior lobe of the pituitary. Six weeks after discontinuation of treatment this condition showed a tendency to reversibility or had already returned to normal. In dogs there was a dose-related increase in iodine uptake by the thyroid and a decrease in serum thyroxine over a period of 6 months under the highest dosage of CN 3123 administered. Whereas the thyroid changes observed under the combination could be reproduced with sulfamoxole, no effect on thyroid weight was observed in rats and dogs in the subacute toxicity phase of a comparative investigation with trimethoprim. Moreover, trimethoprim did not increase the effect of sulfamoxole on the thyroid gland. The effect of sulfamoxole on the thyroid is discussed in detail with a review of the literature. It can be characterized as species-specific for sulfonamides in mice, rats, rabbits and dogs but not in monkeys or in man and appears to be caused by the inhibition of the organic binding of iodine in the thyroid, whereby the predisposing factors must vary considerably from species to species. The thyroid hypertrophy observed is due to the activation of the regulatory cycle via the anterior lobe of the pituitary. The following systemic changes occurred after 600 mg CN 3123/kg, a lethal-toxic dosage and the highest administered in the study: reduced body weight, decreased food consumption leading to cachexia, slightly increased SGPT and alkaline phosphatase, slight thrombocyte depression, enlargement and increased fatty degeneration of the liver, occurrence of necrotic areas in the liver, hemosiderin accumulation in Kupffer's cells, and an increase of reticular cells in the spleen. The acute toxicity of CN 3123 and all major functional and histological changes under repeated administration were due exclusively to sulfamoxole. The combination sulfamoxole/trimethoprim gives no indication of toxicological potentiation or new toxic signs.