Von Recklinghausen neurofibromatosis with urinary bladder involvement.

von Recklinghausen neurofibromatosis is an autosomal dominant transmitted disease with 100% penetrance but variable phenotypic expression. The incidence of this systemic disease is 1 in 3000 live births; however, genitourinary manifestations are rare. We report on our management of 1 case during the past 16 years.

Phenotypic characterization of human skin mast cells by combined staining with toluidine blue and CD antibodies.

Mast cells (MC) are important cellular components of the immune network in diverse organs. The skin MC has likewise been implicated in IgE- and complement-mediated cutaneous reactions. Such reactions supposedly involve specific cell surface membrane receptors. In this study, the cell surface marker profile of human skin MC was established using monoclonal antibodies (MoAb) against defined CD antigens. MC were isolated from juvenile foreskin (n = 55) and adult mammary skin (n = 5). The reactivity of MC with MoAb was assessed by a combined toluidine blue/immunofluorescence staining technique. Confirming our previous analyses on lung MC, foreskin MC reacted with MoAb against CD9, CD29, CD33, CD43, CD44, CD45, CD46, CD51, CD54, CD55, CD58, CD59, CD61, and CD117 (c-kit). Foreskin MC were also recognized by MoAb to CD47, CD48, CD49d, CD53, CD60, CD63, CD81, CD82, CD84, CD87, CD92, CD97, CD98, and CD99. Recently clustered CD antigens detectable on foreskin MC were CD147 (neurothelin), CD149 (MEM133), CD151 (PETA-3), and CD157 (BST-1). In contrast to lung MC and MC from adult skin, foreskin MC were found to express CD88 (C5aR). Also, cutaneous MC (from both juvenile foreskin and adult mammary skin), but not lung MC, were found to bind the CD32 MoAb IV.3, 2E1, and FLI8.26 (Fc gammaRII). The CD50 antigen (ICAM-3) was detectable on lung MC, but not on foreskin MC or MC of adult mammary skin. In summary, our data show that cutaneous MC and lung MC express an almost identical phenotype; however, in contrast to lung MC, cutaneous MC appear to express substantial amounts of CD32 and to lack CD50. In addition, foreskin MC, unlike MC from adult skin or lung, express CD88.

Nitinol urethral stents: long-term results in dogs.

No information has been available to date on the long-term behavior of nitinol (nickel-titanium alloy) urethral stents. In the present study, prostheses of this type were implanted in 18 German shepherd dogs in order to evaluate the reaction of the mucosa, muscles and periurethral tissue. Follow-up examinations performed after 1 week, and 1, 3, 6, 12 and 18 months included urine, macroscopic, radiologic, histologic and scanning electron microscopic analyses. Despite the excellent biocompatibility of the material, with no evidence of foreign body reactions or corrosion, there were no complete incorporations of the stent by epithelialization. Clinical application therefore appears to be problematic.

[Effect of kidney occlusion on survival in renal cell carcinoma: a 10-year retrospective study]. / Einfluss der Nierenokklusion auf die Uberlebenszeit beim Nierenzellkarzinom: Eine retrospektive 10-Jahres-Studie.

84 out of 116 patients suffering from renal cancer with comparable tumor stages were nephrectomized. 39 out of these 84 patients have had an additional embolization preoperatively. The survival rate and the development of metastases did not show any significant difference between only nephrectomized and occluded plus nephrectomized patients.

[Ureter perforation in ureterorenoscopy--management and follow-up]. / Ureterperforation bei Ureterorenoskopie--Management und Verlauf.

From 1984 to 1988 in 65 patients an ureterorenoscopic operation have been performed because of lower ureteral stones. An ureteral perforation was observed in 6 out of 65 patients (9.2%). In 5 patients an ureteral stent was introduced and one patient had an open operation. In one patient as a late complication an ureteral neoimplantation because of prevesical stenosis was necessary. In ureteral perforation due to ureterorenoscopy an ureteral stenting or a percutaneous nephrostomy should be done.

[Late results following avulsion injury of the shaft of the penis]. / Spätergebnisse nach Ablederungsverletzung des Penisschaftes.

Two patients had an avulsing injury of the penis with considerable loss of skin. One was bitten by a dog and the other lost the skin when his clothes were caught by a rotating machine and thus the skin was stripped off by traction and crushed. The detached skin was resutured immediately after injury and in both cases the cosmetic and functional result was more than satisfactory. Though it is not easy to judge the extent of the crush injury in this type of an accident, we feel--even when going against common literature (skin grafting usually is suggested)--that resuturing of the skin is a highly successful method.

[Significance of preventive orchidopexy of the contralateral testis following testicular torsion]. / Bedeutung der prophylaktischen Pexie des kontralateralen Hodens nach Hodentorsion.

From 1977 to 1987 in 94 patients an operative intervention was done because of testicular torsion. A followup was possible in 66 out of 94 patients (71%). A prophylactic orchiopexy was performed in 46 out of 66 patients (69.7%). The average followup time was 6.2 years. In 65 out of 66 patients (98.5%) neither pain attacks nor torsion were found retrospectively. Because of one testicular torsion with organ loss in a group of 20 patients without prophylactic orchiopexy this operation should be done simultaneously with the first operative intervention.

[Detecting recurrence by computer-assisted tumor after-care in renal cell carcinoma]. / Rezidivaufdeckung durch computergestützte Tumornachsorge beim Nierenzellkarzinom.

In a period of 11 years (1977-1988) 111 patients were recorded after tumor nephrectomy because renal cell carcinoma in a computer-assisted follow-up program. The controls were performed in the first postoperative year every thirds months, from the 2nd to the 5th year 6-monthly and yearly after the 5th year including complete blood count, erythrocyte sedimentation rate, serum creatinine, electrolytes, blood glucose, liver enzymes, ultrasonography (kidney, renal lodge, liver, retroperitoneum) and chest roentgenogram, but 6-monthly also computerized tomography and bone scan. The drop-out rate was 18.2% (20/110). In the other 90 patients a recurrent disease was found in 16.7% (15/90) and 5.6% (5/90) have been treated operatively. Currently, all patients survive after recurrent operation. Therefore, these results may support a computer-assisted follow-up in tumor patients with increasing compliance and efficacy.

[Diffuse xanthogranulomatous pyelonephritis in childhood]. / Diffuse xanthogranulomatöse Pyelonephritis im Kindesalter.

Xanthogranulomatous pyelonephritis is a rare disease and rare cause of suppurative proliferative pseudotumor in children. An accurate diagnosis is difficult because of its clinical, radiological, sonographical and pathologic-anatomical similarities to renal tuberculosis. After removing the diseased kidney the prognosis is excellent. A 6-year old boy with xanthogranulomatous pyelonephritis is reported.

Urological aspects of surgical management for metastatic renal cell cancer.

At the time of diagnosis one-third of patients with renal cell cancer are found to have metastatic spread. The patient's general condition and biological age as well as the resectability of the primary and/or secondary tumor decide whether surgery is indicated. Of our 44 patients, 12 underwent extirpation of metastases; 5-year survival was 47%. This is in agreement with published data. Patients with renal cell cancer and a solitary metastasis are, therefore, good candidates for surgery. In the presence of disseminated metastatic spread there is currently no place for tumor-reducing surgery because of the lack of effective adjuvant treatment modalities.

[Primary metastasized hypernephroma: therapy and follow-up]. / Das primär metastasierte Hypernephrom: Therapie und Verlauf.

Out of 44 patients suffering from disseminated renal cell carcinoma 24/44 patients (group I) underwent nephrectomy, in 20/44 patients the primary tumor was not removed. In 12/44 patients chemotherapy was performed (7 patients group I, 5 patients group II). Comparison of the survival rate with and without chemotherapy revealed no significant difference in the two groups. Partial response was noted only in four patients with a mean duration of four months. These results can not give a final answer for the indication of chemotherapy in metastatic renal cancer.

[Complications following transcutaneous operations on the kidney]. / Komplikationen nach transkutaner Operation an der Niere.

Percutaneous nephrostomy was performed in 249 patients in regard to different indications since 1979. The following complications were found: technical difficulties 5/249/2%, bleeding 3/249/1% and pyelonephritis 25/229/11%. 124 patients with percutaneous nephrostomy are compared to 125 patients with nephrostomy followed by percutaneous nephrolithotripsy regarding the septic complication. No difference could be pointed out.

[Urolithiasis in pediatrics: analysis of 34 patients]. / Urolithiasis in der Pädiatrie: Analyse von 34 Patienten.

The increasing incidence of urolithiasis makes it important to report about 34 children with urolithiasis seen between 1976 and 1986 at the Department of Pediatrics, University Medical School Vienna. At the time of the first diagnosis 59 percent of the patients were less than 7 years of age; 62 percent of our patients were males. Recurrent chronic urinary tract infection in 32 percent, metabolic disorder (secondary hyperoxaluria 5, idiopathic hypercalciuria 3, cystinuria 2, hyperuricuria 2) in 27 percent were evaluated; in 13 patients the origin of calculi was idiopathic. Most infectious stones contained magnesium ammonium phosphate, most idiopathic stones calcium oxalate. In 21 patients (62%) surgical treatment, in one patient extracorporal shock wave lithotripsie was realized. Adequate metaphylaxis (general, dietetic, medicementous) can lower the rate of occurrence of stone formation.

[Open revision following unsuccessful litholapaxy]. / Offene Revision nach frustraner Litholapaxie.

125 patients suffering from nephrolithiasis were treated by means of percutaneous lithotomy. 10/125 (8%) patients had to undergo open surgery in case of intraoperative complications. This complications and the consecutive surgical interventions are pointed out in detail.

[Complications of preoperative arterial vascular embolization in malignant kidney tumors]. / Komplikationen der präoperativen arteriellen Gefässembolisation bei malignem Nierentumor.

In 66 patients with renal tumours on 30 patients a preoperative transfemoral embolisation of the renal artery of the tumour-bearing kidney was performed. The complications were established and compared with the 36 patients without occlusion. On account of the considerable side effects a preoperative occlusion seems to be reasonable only in selected cases.

[Malignant kidney tumors in old age--postoperative complications and mortality]. / Maligne Nierentumoren im Senium--postoperative Komplikationen und Letalität.

Surgery was performed on 38 patients over 70 years of age with malignant renal tumours. The mortality rate (29%) and the incidence of postoperative complications (18%) were relatively high. Various means of preventing these complications, taking the factor of old age into particular consideration, are discussed in this paper.

[Repeated internal urethrotomy in male urethral stricture]. / Die Urethrotomia interna der männlichen Harnröhrenstriktur bei mehrfacher Anwendung.

The results of further treatment of 40 patients with recurrence of urethral stricture following internal urethrotomy are assessed. Repeat internal urethrotomy was often successful even in cases presenting with extensive stricture, multiple stenoses or stenosis in an unfavourable site. Altogether 47% of the patients remained recurrence-free after the second attempt at internal urethrotomy. Open surgery was necessary in 3 patients. In old or unfit patients who could not be subjected to open surgery internal urethrotomy was performed up to 5 or even 6 times. This operation is often preferred by patients to conservative forms of treatment such as bougienage or an indwelling catheter. It is tolerated well, even on a repeated basis and the complication rate is low.

Bladder obstruction--a rare complication after percutaneous renal biopsy.

In the treatment of diffuse renal disease exact histological diagnosis is of great importance. Biopsy, therefore, is an integrated component of patient management. The most common complication following percutaneous renal biopsy (PRB) is bleeding. Gross hematuria can be easily detected; an uncommon complication after PRB, however, is bleeding into the urinary system, with obstruction of the bladder by blood clots. By means of ultrasonic control obstruction of the bladder can easily be diagnosed in a non-invasive way. As far as we know, no cases where bladder obstruction due to blood clots after PRB were diagnosed by ultrasonography have been documented so far.

[Success of internal urethrotomy as the 1st operation in male urethral stricture]. / Der Erfolg der Urethrotomia interna als Erstoperation bei Harnröhrenstriktur des Mannes.

A follow-up examination was possible on 179 out of 226 patients operated on for urethrostenosis using sight urethrotomy according to Sachse. The results are classification according to the observation period, ranging from 3 months to 3 years. The most important criteria of a successful operation were lack of discomfort and a rise in uroflow to over 10 ml. Relapses occur more frequently than average in patients who had recidive infections of the urinary tract before the operation. Where the operation was successful the urinary tract infection almost always subsided. Recidive strictures occurred frequently in patients over 70 years. However, internal urethrotomy is often the only suitable method of operation at that age. Long prior bouginage makes prognosis worse. In terms of aetiology, iatrogenic stenoses give the worst results, bulbar ring stenoses, the best. In cases of long stenoses, particularly in the penile part of the urethra, the results of the operation are clearly worse than average, so that another method of operation should be considered, especially if the patients are young.

[The social infrastructure of patients with urinary calculi (author's transl)]. / Die soziale Infrastruktur von Harnsteinpatienten.

The social infrastructure was investigated in 379 patients with urinary stones. The rates of 50% for employees and 32% for old-age pensioners were surprisingly high. 16% of the patients were employed in jobs with hard manual labour. Only 9% of the patients went in for regular physical activity in their leisure. A significant increase in urinary excretion of calcium and uric acid (p - 0.01) and inorganic phosphate (p less than 0.001) was seen in connexion with increase in net income. On the other hand, urinary pH was lowest in the highest income group (p = 0.01). According to these findings an increased net income combined with a lack of physical exercise seems to enhance the risk of stone formation.