[Experience with uretero-neocystostomy in 338 kidney transplantations]. / Erfahrungen mit der Uretero-Neo-Zystostomie bei 338 Nierentransplantationen.

In 338 consecutive human kidney transplants since 1972 uretero-neocystostomy was performed in a typical manner. The technique is a modification of Leadbetter's ureterosigmoid anastomosis and it is used for all cases of ureteral reimplantation at our institution. The rate of operative complications belonging to the urinary tract is 4.8%. In 29% out of 31 reexamined patients a vesico-ureteral reflux to the transplant appeared. We believe that the demonstrated method is useful for reconstruction of the urinary tract in renal transplants.

The in-vivo effect of sodium-potassium citrate on the crystal growth rate of calcium oxalate and other parameters in human urine.

In this study, an efficient microtechnique (gel crystallization method) was used to investigate the in-vivo effect of sodium-potassium citrate on the crystal growth rate of calcium oxalate (Vcr) in human urine samples of 6 healthy volunteers. With a daily dose of 3 X 11 mmol of alkali citrate, Vcr decreased by 70%. This could have been due to the decrease of calcium excretion, which caused 50-60% of the total change, and to the increase of citrate and pH, each contributing about 20-25% to the decline of Vcr. The findings explain the clinical advantages of alkali citrates in the prevention of recurrent calcium oxalate stone formation.

Testicular tumors: prospective analysis of real-time US patterns and abdominal staging.

Echomorphologic features of 57 testicular lesions (48 neoplasms, nine benign lesions) were analyzed prospectively by means of high-resolution real-time ultrasonography (US). There was a broad spectrum of texture patterns for testicular malignancies, 92% of which exhibited a predominantly decreased echogenicity compared with that of normal tissue. US findings alone could not be used to make a specific prediction of malignant disease or to classify a neoplasm histologically. However, different kinds of tumors exhibited characteristic echomorphologic features that corresponded to their gross morphologic appearance; a knowledge of these echomorphologic features is extremely useful for the US differentiation of tumors from nonneoplastic scrotal pathologic conditions. All neoplasms in this series displayed distinct abnormalities in parenchymal texture, and all were detected with US. The sensitivity and predictive value of a normal sonogram were as high as 100%. With regard to the detection of retroperitoneal lymph node metastases from testicular tumors, abdominal US had an overall accuracy rate of 96% and was of superior diagnostic value compared with bipedal lymphangiography.

Venous renal tumor extension: a prospective US evaluation.

To evaluate the ability of ultrasonography (US) to determine venous tumor extension, we studied 120 consecutive patients with renal neoplasms. The incidence of renal vein involvement in this group was 18%; caval tumor extension occurred in 11% of the patients. Real-time US clearly visualized the entire retrohepatic inferior vena cava (IVC) in 96% of the examinations, and the ipsilateral renal vein was well seen on 88% of the scans. Of the caval sonograms that could be evaluated (115/120), intravascular tumor thrombi were detected in all 13 cases (sensitivity and specificity = 100%). Of the assessable sonograms of the renal vein (105/120), tumor invasion was identified by US in 21 of 22 cases (sensitivity = 95.5%, specificity = 100%). Venous tumor involvement was seen with intravascular lesions of different echogenicity, which caused a neoplastic-induced renal or caval vein enlargement in most cases. Our findings show that US is of great value in the preoperative assessment of intravascular tumor extension and provides a useful alternative to inferior venacavography.

[Ultrasound diagnosis of venous tumor thrombi in kidney cancer. A prospective study]. / Ultraschalldiagnostik venöser Tumorthromben bei Nierenkarzinomen. Eine prospektive Studie.

In a controlled prospective study 65 patients with renal tumors were evaluated by sonography prior to surgery in order to detect venous tumor extension. Tumor thrombi in the inferior vena cava (IVC) occurred in 12.3% and in the main renal vein (RV) in 16.9% of the patients. It was possible to visualize the entire retrohepatic IVC by ultrasound in 62%, as well as the RV of the tumor-bearing kidney along its length or in the proximity of the IVC in 85% of the cases. Among the assessable caval sonograms (60 of 65), endoluminal tumor thrombin were recognized in all 8 cases (accuracy 100%; sensitivity and specificity 100%). Among the assessable sonograms of the RV (55 of 65), venous tumor extension was identified in 10 of 11 cases (accuracy 98%, sensitivity 91%; specificity 100%). Compared with the results of transfemoral cavography, sonography apparently provides more information on endoluminal venous tumor extension.

[Tuberculosis following kidney transplantation]. / Tuberkulose nach Nierentransplantation.

Morbidity of tuberculosis following kidney transplantation is about 1% (14/1719 kidney transplantations). All cases occurred within 1 year after transplantation; surprising was the relative high incidence in patients from outside Central Europe. Four patients with lack of clinical symptoms in whom the diagnosis was made by routine X-ray films of the chest survived after immediate therapy while five of ten patients with miliary tuberculosis died although proper treatment was performed. In cases of fever not caused by rejection or in pneumonia resistant to common antibiotics prophylactic antituberculous therapy should be considered even if microbiological evidence is not yet confirmed.

[Treatment of metastasizing prostatic carcinoma with DMF. Presentation of a prospective study]. / Behandlung des metastasierenden Prostatakarzinoms mit MAF. Vorstellung einer prospektiven Studie.

Logothetis and von Eschenbach first 1981 reported encouraging preliminary results of the DMF regimen (Doxorubicine = Adriamycin, Mitomycin, 5 Fluorouracil) in hormone refractory adenocarcinoma of the prostate. 60% out of 62 patients had an objective remission over a mean period of 27 weeks. At the beginning of this year together with 5 other hospitals we started our study based on the results of Logothetis. In difference to his study all of our patients had prior therapy with Estracyt and patients with extrapelvic radiation were excluded. It is too early to present our results but we believe that this regimen is an advancement in the therapy of terminal prostatic carcinoma.

[Indications and contraindications for kidney transplantation]. / Indikationen und Kontraindikationen zur Nierentransplantation.

The indication for renal transplantation has to be made individually in every single case, considering the few absolute contraindications (tumors, acute infections and the presence of cyto-toxical antibodies) and the general risks. Chances of success, resulting from the EDTA-statistics from 1979 concerning the survival rate of patients and the functional rate of the transplant of donors deceased or alive, are discussed as well as possible complications. The good rehabilitation of successfully transplanted patients must be especially emphasized. Risk factors are: advanced age, adipositas, cardio-vascular and pulmonary lesions as well as gastro-intestinal disease in the past and diabetes mellitus with certain reservation. The possible effects the the transplant caused by the underlying disease leading on renal insufficiency and systemic diseases which limit the indication are outlined and discusssed. Good interdisciplinary cooperation in the pre- and postoperative phase is necessary.

[Effects of an ultrasonic technic on diagnosis and therapy in urology]. / Auswirkungen der Ultraschall-Technik auf Diagnostik und Therapie in der Urologie.

Sonography today has essentially influenced the diagnostical and therapeutical procedure in urology. Concerning ordinary methods of examination, sonography is not only a superior one, but can give further information. We surely shall get more indications in future. As a method of examination - non-invasive, without danger, always repeatable and sensitive, - sonography fulfills in many cases the qualifications which have to be made to the screening method.

[New diagnostic examinations in patients with urinary calculi, taking into consideration primary hyperparathyroidism]. / Neue diagnostische Untersuchungen bei Harnsteinträgern unter Berücksichtigung des primären Hyperparathyreoidismus.

The serum levels of total calcium and anorganic phosphate have been the leading parameters in the diagnosis of primary hyperparathyroidism. In addition to these, it is now possible to measure ionized calcium (Ca++) by an ion-selective electrode and parathormone (PTH) by C- and N-terminal radioimmunoassays (RIA). Whereas Ca++ determination and C-terminal PTH RIA represent a diagnostic progress, this can not be claimed for the N-terminal PTH RIA in peripheral venous blood especially in border-line cases.

[Fistulas between bowel and urinary tract (author's transl)]. / Fistelverbindungen zwischen Darm- und Harntrakt.

From 1968 to 1977, 21 patients were observed who had fistulas between the bowel and the urinary tract. Except in five patients, fistulas were located vesicointestinally. The main etiologic factors were inflammatory lesions of the bowel, especially diverticulitis and appendicitis. All patients had symptoms relating to the urinary tract, mainly recurrent urinary infection with dysuria. On the average, nine months passed until the fistula was diagnosed. Urethrocystoscopy proved to be the most valuable aid in diagnosing intestinovesical fistulas, the fistulous opening was thus seen in 11 patients. Thirteen patients were treated by operation and eight by conservative treatment only. In the conservatively treated group, two fistulas healed spontaneously. Fistulas based on diverticulitis from the sigma were treated using a multiple stage procedure. No complications were observed.

[Urologic findings in patients with kidney transplantations. Evaluation of a technic for uretero-cysto-neostomy]. / Urologische Befunde bei Nierentransplantatträgern.

74 consecutive human kidney transplants are reported. In 72 cases uretero-cysto-neostomies with an antireflux procedure were performed in a typical way. The technique, a modification of Leadbetter's uretero-sigmoido-neostomy, has been used by the author for years. The only urological complications were one proximal and one distal ureteral fistula. In 25% out of 20 reexamined patients a vesico-ureteral reflux was demonstrated by micturition cysto-urethrography. There was no correlation between urinary tract infections (25%) and vesico-ureteral reflux. The results are compared with the data given in literature.

[Clinic of Urotuberculosis (author's transl)]. / Klinik der Urotuberkulose

Most of all cases of extrapulmonary tuberculosis i.e. 35% are urogenital tuberculosis UGT. A shifting of morbidity to older age Groups could be ascertained. 1164 cases were evaluated, 684 in a combined medicamentons - operative manner. Of the conservatively treated Group were 283 males and 197 females; the relation of the sexus in the other group is roughly the same. The frequency has a maximum in the forth decade. Whereas most of 90 patients, who have been in stationary treatment in April 1975, were between 40 and 60 years old. The pathogeny of the UGT is shown according to the scherne of Gloor. Most of the initial Symptoms (26.5%) are dysuria, the mext are hematuriae and ache of the flanks. On an average 1-2 years pass from the first appearance of symtonis to the time of diagnosis. The diagnosis can only be verified by evidence of Tbc-bacteria in cultures and biological experiments or through histological appearance. Essential informations on localisation and expansion are obtained by x-ray examination, that is urograms and urethrocystograms. Angiography and side-disconnectet isotope clearance are importantant additional examinations. According to the results of the x-ray examinations the stages can be ascertained: Stage I: parenchymal-ulcerated pattern - Stage II: ulcerated-cavernous pattern - Stage III: totally-destructing tuberculosis, tbc-pyonephrosis, Special terms characterize the obstructions of the urinary tract. For the therapy the following polity can be proposed: Stage I: chemotherapy - Stage II: chemotherapy, perhaps backed by conservative operative treatment - Stage III: chemotherapy and nephro-ureterektomy.