Results of 5,035 stone analyses: a contribution to epidemiology of urinary stone disease.

Between 1978 and 1988 5,035 urinary calculi have been analysed by X-ray diffractometry. 1,615 of these stones have additionally been investigated by scanning electron microscopy (SEM). The overall sex-ratio was 1.86 (m/f). Ca-stones and uric acid containing stones are more frequent in male patients (m/f = 2.08 and 3.86, respectively) whereas infection stones and cystine stones show a higher rate of appearance in female patients (m/f = 0.6 and 0.88, respectively). The percentage of open surgery ranged about 30% in the first few years but decreased to 5-7% in the last few years due to the new methods of stone removal. The rate of occurrence of the crystalline phases does not differ remarkably from other statistics except for a higher incidence of apatite because of the high sensitivity of detection of this phase by SEM. The recurrence rate of brushite stones amounting to 66.7% is very high and exceeds even that of cystine stones (60.7%).

[Closure of large vesico--urethra--vaginal defect with pedicled myocutaneous gracilis flap (author's transl)]. / Verschluss eines grossen Blasen-Harnröhren-Scheidenwanddefektes durch gestielten myokultanen Musculus-gracilis-Lappen.

Operative treatment of large bladder-vaginal-urethral defects is a problem, especially after radiogenic tissue damage. Successful reconstruction of the defect is only possible when healthy and sufficiently perfused tissue is used. This may be obtained by the interposition of pedicles omentum flap. Contrary to the use of a pedicled myocutaneous gracilis muscle flap this transabdominal procedure is a more extensive operation. The use of myocutaneous flaps offers healthy tissue for defect repair in a sufficient amount. Sufficient perfusion guarantees a safe healing and stability of the reconstruction. An advantage is that no functional defects result from this procedure. In reconstruction of the bladder floor and neck a tissue cushion is formed which seems to improve postoperative continence.

Endodermal germ cell carcinoma (endodermal sinus tumor) of the vagina in infant girls.

An endodermal sinus tumor (endodermal germ cell carcinoma) was diagnosed in a 1-year-old girl in the vagina after hemorrhage; the tumor was completely removed by radical abdominal surgery. Postoperative polychemotherapy was performed for two years with Actinomycin D, Adriamycin, Vincristin, and Cyclophosphamide. The infant is now tumor-free for 26 months, showing almost normal somatic and psychic development. The characteristic histological patterns and clinical course of this strongly malignant tumor are demonstrated, based on 25 published case reports of endodermal sinus tumors in the vagina of little girls (aged 5-26 months). This neoplasm in early infancy has to be separated from the clear-cell adenocarcinoma of the vagina which occurs after puberty in adolescent girls and young women, and is induced by stilbestrol therapy to the mother during early pregnancy.