[Prevalence of lymph node metastases in non-muscle-invasive bladder cancer. Delay of radical cystectomy and upstaging in the cystectomy specimen as risk factors]. / Prävalenz von Lymphknotenmetastasen beim nicht muskelinvasiven Blasenkarzinom. Verzögerung der Zystektomie und Upstaging im Zystektomiepräparat als Risikofaktoren.

OBJECTIVE: To study clinical and histopathologic parameters after cystectomy and lymphadenectomy in non-muscle-invasive transitional cell carcinoma (TCC) of the bladder and their association with the prevalence of lymph node metastases (N+). PATIENTS AND METHODS: Of 866 patients treated with radical cystectomy and lymphadenectomy, 219 had non-muscle-invasive TCC of the bladder. The prevalence of N+ was related to parameters such as gender, age, number of transurethral resections of the bladder (TURBs), intervals between first TURB and cystectomy, adjuvant therapy, maximum histopathologic tumor stage and grade at TURB, and tumor upstaging in the cystectomy specimen by univariate and multivariate analysis. RESULTS: A total of 33 patients (15%) had N+. By multivariate analyses, tumor upstaging and the number of TURBs were independent predictors of N+ at cystectomy. The number of TURBs increased the prevalence of N+ from 8% (one TURB) to 24% (two to four TURBs). Tumor upstaging in the cystectomy specimen increased the prevalence of N+ from 4% to 36%. CONCLUSION: Inappropriate delay and staging errors of"high risk" non-muscle-invasive TCC of the bladder contribute to an increased prevalence of N+ and should be avoided. In our series, the number of TURBs and tumor upstaging in the cystectomy specimen were independent predictors for N+ by multivariate analysis.

[Contractile reserve as a new parameter for determining the performance of the heart muscle using a noninvasive measuring method]. / Kontraktile Reserve als neuer Parameter zur Bestimmung der Leistungsfähigkeit des Herzmuskels mit Hilfe eines nichtinvasiven Messverfahrens.

Chronic cardiac insufficiency is an illness with increasing epidemiological importance and mortality. Therefore different invasive and non-invasive investigation methods for early recording were developed. The left ventricular ejection fraction (LVEF) has played a special role in this direction. The determination of the contractile reserve by means of non-invasive measurement of blood pressure and flow through the aortic valve is a new and up to now widely unknown method for recording the capability and power reserve of the of myocardium. Since no comparative investigations are known from literature and results from a follow-up are not available yet, we tested whether, by means of contractile reserve, the discrimination of subjects with different cardiac power is possible or not. Forty-two men between 44 and 62 years of age belonging to three groups with different cardiac power (persistence trained, healthy subjects and patients with CHD) were examined non-invasively. The main result of the study is that it is possible to distinguish between the three groups significantly by means of the contractile reserve. The largest value (15.25 W +/- 3.46 W) was found in the "persistence trained" group, followed by the "healthy subjects" (10.85 W +/- 4.19 W). The smallest values were from the "patients" group (7.88 W +/- 2.95 W). The differences between the mean values of the CHD "patients" and the "persistence trained" were significant (p < 0.001). Similar comparisons of the groups of "healthy subjects" and "trained persons" and "healthy subjects" and "patients", respectively, yield p values of p = 0.007 and p = 0.040. These differences are also significant. This study is a first investigation and description of the method. A validation only can be achieved by follow-up investigations.

[Effect of dyshemoglobinemia (methemoglobinemia and carboxyhemoglobinemia) on accuracy of measurement in pulse oximetry in operations of long duration]. / Der Einfluss der Dyshämoglobinämie (Methämoglobin- und Carboxyhämoglobinämie) auf die Messgenauigkeit der Pulsoximetrie während langdauernder Operationen.

In two groups - eleven patients each - who underwent long lasting surgical procedures, arterial oxygen saturation was measured non-invasively (pulse oximeter) and invasively (CO-oximeter). In addition, total haemoglobin (THb), fractions of haemoglobin (metHb) and bloodgases were monitored. All patients of group I received an epidural anaesthesia via catheter with prilocaine combined with general anaesthesia. In group II a modified neurolept analgesia (balanced) was performed. As expepted we found a prilocaine-induced methaemoglobinaemia (metHb up to 11.6 Vol%) whereas in group II physiological values were not exceeded. Carboxyhaemoglobin up to 4 Vol% was found in the smokers of both groups, which decreased continuously - in contrast to metHb - during hyperoxic ventilation. Comparing the non-invasively and the invasively determined saturations no correlation (r = -0.002) was found in group I. However, a positive correlation (r = 0.652) was obtained in group II. After correction of SaO2 (pulse oximeter) using an adjusted formula a fair correlation (0.613) was found in group I, too. Using this equation for correction the correlation in group II increased to r = 0.824. Because of methodological facts (the pulse oximeter registers only desoxygenated haemoglobin) the arterial oxygen desaturation (O2Hb or fractional saturation) accompanying dyshaemoglobinaemia remains undetectable to the pulse oximeter. In the cases of known or expected dyshaemoglobinaemia pulse oximetry can yield only limited information; fractions of inactive haemoglobin should be measured by other means or accounted for by the given equation for correction (SaO2 corr. = SaO2 pulse oximeter - (COHb + metHb]. Pathophysiological effects of dyshaemoglobinaemia are discussed.