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Biomedical subjects

A G Hofstetter

Publications and source records attributed to A G Hofstetter.

At least 19 recordsLinked to original sources
PubMed2003

[European Association of Urology guidelines on urinary and male genital tract infections].

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

Disease Notification↗
PubMed1999

[Viral sexually transmitted urogenital infections. Increased importance of viral STD in industrial countries].

Sexually transmitted urogenital virus infections have shown in recent decades a growing prevalence worldwide. In the industrial nations, human papilloma virus and herpes simplex virus infections occur more frequently than the typical venereal diseases (syphilis, gonorrhoea and ulcus molle). Molluscum caused by molluscum contagiosum virus (MCV), while frequently found in HIV-infected and AIDS patients (13%), are generally diagnosed decidedly less often than the previously mentioned virus infections. Considering the pathogenetic relationship of several HPV-subtypes with precancerosis and carcinomas in both genders, increasingly greater demands are placed upon the physician today regarding the diagnoses and treatment of virus-associated urogenital STDs. Discussed in this survey are the epidemiology, clinical symptoms, diagnostic and treatment of the three referred to virus infections.

Developed Countries↗
PubMed1999

[Partial priapism. Case report and review of the literature of diagnostic and therapeutic measures].

Partial priapism is a rare condition which has been previously reported in the literature only in eight cases. Unlike the typical case of priapism, patial priapism generally shows erection only of the proximal corpora cavernosa. In most of the cases a well defined membrane separated the proximal erected and the distal flaccid part of the corpus. The origin of the fibrous membrane is not clear. Usually a painful segmental thrombosis of the corpora cavernosa was found proximal the membrane. Until 1985 diagnosis and therapy of this entity have principially involved invasiv methods. Later computed tomography (CT) and magnetic resonance (MR) were used for noninvasive imaging and conservative management was elected. We report a case of partial priapism and review the diagnostic and therapeutic procedure in the previous literature.

Adult↗
PubMed1999

Coagulative interstitial laser-induced thermotherapy of benign prostatic hyperplasia: online imaging with a T2-weighted fast spin-echo MR sequence--experience in six patients.

PURPOSE: To determine if hypointense lesions clearly outline on T2-weighted fast spin-echo (SE) magnetic resonance (MR) images obtained during coagulative interstitial laser-induced thermotherapy (LITT) of a prostate with benign hyperplasia. MATERIALS AND METHODS: In six patients with benign prostatic hyperplasia (BPH), 12 LITT treatments were followed online with repetitive axial T2-weighted fast SE imaging (repetition time, 3,700 msec; echo time, 138 msec; acquisition time, 19 seconds). Development, time course, correlation with interstitial tissue temperature, and diameters of hypointense lesions around the laser diffusor tip were investigated. Lesion diameters on T2-weighted images acquired during LITT were compared with diameters of final lesions on T2-weighted images and unperfused lesions on enhanced T1-weighted SE images obtained at the end of therapy. RESULTS: Hypointense lesions developed within 20-40 seconds of LITT. Average correlation coefficients between interstitial temperature development and signal intensity development were 0.92 during LITT and 0.90 after LITT. Regression slopes were significantly steeper during LITT (0.67% signal intensity change per degree Celsius) than after LITT (0.47% per degree Celsius; P = .038). Lesions remained visible after LITT for all procedures. Average maximum diameters of lesions were 1-3 mm larger during LITT than after LITT (P = .0006-.019). CONCLUSION: Repetitive T2-weighted fast SE MR imaging during interstitial coagulative LITT of BPH demonstrates the development of permanent hypointense prostate lesions. However, posttherapeutic lesion diameters tend to be overestimated during LITT.

Aged↗
PubMed1993

[Treatment of ureteral colic with glycerol trinitrate].

METHOD: In an open randomized clinical trial, the efficacy of 2.4 mg glycerol trinitrate (GTN) administered in a variety of forms (2 x 1.2 mg capsules; 6 x 0.4 mg puffs of an atomizer; 2.4 ml of an 0.1% infusion solution) in comparison with 20 mg of butylscopolamine bromide i.v. (BSB) in 80 patients suffering from acute ureteral colic. RESULTS: Some 30 minutes following medication, the effect was adjudged by the physician to be good (no pain) moderate (some pain still present) or non-existent (alternative treatment within 30 minutes). CONCLUSION: GTN was effective in 40% of the cases, BSB in 26.3%. A moderate effect was seen in 46.7% and 62.3%, respectively, while no response was elicited in 13.3 and 10.5%, respectively. In addition, recurrence within 24 hours, blood pressure, pulse rate and laboratory tests were recorded. Side effects occurred in 13 patients (12 in the GTN and 1 in the BSB group), but, with one exception (GTN i.v.), were all mild in nature.

Administration, Inhalation↗
PubMed1992

[Renal cell carcinoma--diagnosis, differential diagnosis and prognosis].

OBJECTIVES: Consideration of the approach to the diagnosis and differential diagnosis of renal cell carcinoma and the criteria needed for an assessment of prognosis. MAJOR POINTS: Thanks to the comprehensive use of ultrasonography and abdominal CT, asymptomatic renal cell carcinomas confined within the renal capsule are now more often being discovered and treated by curative surgery. With the aid of ultrasonography, abdominal CT and NMR imaging, pre-operative visualization of tumor spread is now better, although, with the exception of angiomyolipoma, it is still not possible to adequately differentiate the rare benign tumors of the kidney, for example oncocytoma, from renal cell carcinomas with these procedures. The TNM classification permits a highly differentiated prognostic classification of the renal cell carcinomas. The additional prognostic parameters, triploidy and hypertetraploidy determinable by flow cytophotometry, are also considered. CONCLUSIONS: Early detection of renal cell carcinomas in an asymptomatic stage decisively influences the further prognosis, so that for all upper abdominal ultrasonographic explorations, performed for whatever reason, attention should be paid to such incidental findings.

Carcinoma, Renal Cell↗
PubMed1992

Cefodizime given once daily for the treatment of upper urinary tract infections and complicated lower urinary tract infections.

The efficacy of cefodizime (CDZ) in upper urinary tract infections (UUTI) and complicated lower urinary tract infections (LUTI) was assessed by analysis of the combined results of five clinical trials. Doses of CDZ 1 g i.m. daily, 1 x 2 g i.v. or i.m. and 2 x 2 g i.v. were investigated; comparative agents were cefuroxime 3 x 1.5 g and ceftizoxime 1 x 2 g. Median duration of treatment was seven days. A total of 544 patients, 61% of whom had UUTI, entered the studies. Four hundred twenty-two patients were evaluable clinically and 375 bacteriologically. The most frequent pathogen at baseline was Escherichia coli, followed by Proteus mirabilis, Klebsiella spp. and Staphylococcus aureus. Both clinical and bacteriological cure rates were above 90% in all study groups. The dosage of 1 x 2 g CDZ is recommended for the treatment of UUTI and complicated LUTI.

Bacteria↗
PubMed1990

Detection of urinary TNF, IL 1, and IL 2 after local BCG immunotherapy for bladder carcinoma.

Intravesical application of bacillus Calmette-Guérin (BCG) is highly active against recurrences of superficial urothelial bladder carcinoma. In an attempt to monitor the immunological effects of this therapy, we analyzed the urine of patients following the sixth intravessical instillation, to show the presence of the monokines TNF and IL 1 and the lymphokine IL 2. Within 24 hours following the instillation, all (n = 10) patients exhibited a strong increase in urinary cytokine secretion, which was significantly different from the control group (n = 10), with respect to TNF L929 biological assay (P less than 0.01), TNF sandwich-ELISA (P less than 0.01), IL 2 CTL 6 biological assay (P less than 0.05), IL 2 sandwich-ELISA (P less than 0.005), and IL 1 sandwich-ELISA (P less than 0.05), but not to the IL 1 fibroblast biological assay. The maximum urinary secretion varied between individual patients and different cytokines, but was generally found within 2 to 8 hr after the instillation. A persistent high urinary activity was demonstrated in BCG-treated patients for IL 2 in sandwich-ELISA. These results reflect the local inflammatory response to BCG and suggest an immunomodulatory mode of action against urothelial carcinoma cells. Elucidation of the possible role of each urinary cytokine against this cancer warrants further investigations.

BCG Vaccine↗
PubMed1990

Effects of local bacillus Calmette-Guerin therapy in patients with bladder carcinoma on immunocompetent cells of the bladder wall.

The antitumoral effects of intravesical bacillus Calmette-Guerin against recurrent superficial urothelial bladder cancer seem to be linked to immunological effector mechanisms. To characterize further the local cellular response in the bladder wall of patients receiving intravesical bacillus Calmette-Guerin bladder biopsies were examined before and immediately after a 6-week course of bacillus Calmette-Guerin and for up to 1 year at 3-month intervals thereafter. The results showed a marked infiltration after bacillus Calmette-Guerin therapy predominantly of the suburothelial tissue with mononuclear cells, which expressed activation markers and accumulated to follicle-like granulomatous structures. With regard to T lymphocyte subsets the ratio of T helper-to-T suppressor cells in the bladder wall increased from 0.5 to nearly 2. This phenomenon persisted even in biopsies 1 year after initial treatment. In some probes activated mononuclear cells invaded the urothelium, emanating from suburothelial granulomas. It is tempting to assume that these changes within the local immunocompetent cells are related to the therapeutic effect of bacillus Calmette-Guerin against bladder cancer.

Administration, Intravesical↗
PubMed1990

Elevations of cytokines interleukin-1, interleukin-2 and tumor necrosis factor in the urine of patients after intravesical bacillus Calmette-Guerin immunotherapy.

In an attempt to elucidate further the immunological mechanisms responsible for the effectiveness of intravesical bacillus Calmette-Guerin in the therapy of superficial urothelial bladder cancer, a prospective study was performed in which the urine of patients was examined before and after 6 intravesical instillations of bacillus Calmette-Guerin for the presence of the cytokines interleukin-1, interleukin-2 and tumor necrosis factor-alpha. Biological assays such as specific sandwich enzyme-linked immunosorbent assays were used for the analysis of each cytokine. Urinary titers of interleukin-1, interleukin-2 and tumor necrosis factor increased significantly after bacillus Calmette-Guerin instillation but showed inter-individual differences. The maximum of secretion into the urine was seen between 4 and 8 hours after the instillation, and titers returned to baseline values within 24 hours. The differences in 24-hour secretion between the bacillus Calmette-Guerin-treated (10 patients) and the control (10) groups were significant with respect to all cytokines as tested in both assays each, except for the interleukin-1 biological assay. These results reflect the strong inflammatory response in the bladder wall to bacillus Calmette-Guerin, in which the urinary secretion of the detected cytokines may be associated with the local tumor control.

BCG Vaccine↗
PubMed1990

[Diverticular calculi of the kidney calices--extracorporeal shockwave lithotripsy, percutaneous extraction or open surgery].

The incidence of caliceal diverticula, mostly found on routine excretory urography, is very low. The indications for treatment include chronic or recurrent pyelonephritis, pain, gross hematuria and renal damage. There is controversy as to which treatment is best: extracorporeal shock-wave lithotripsy (ESWL), percutaneous techniques, or traditional open surgery. Since 1984, 27 patients with 28 caliceal diverticula calculi have been treated. Ten patients underwent ESWL, 13 patients percutaneous treatment, and 4 patients open surgery. The success rates as far as a stone-free status is concerned were: 1 patient (ESWL), 10 (percutaneous), and 4 (open surgery). There were no complications due to ESWL or open surgical treatment. Direct traumata such as severe bleeding in two and hydrothorax in one patient occurred during the training phase of the percutaneous techniques. Due to the low complication rate, non-invasive ESWL treatment should be tried first. The indications for percutaneous removal of calculi in caliceal diverticula depend on two aspects: it should be possible to puncture the caliceal diverticula via by a short parenchymal route coaxial to the axis of the calix and, if the intercostal approach is used, a pleural lesion must be excluded. If these requirements cannot be fulfilled, open surgical treatment should be performed, especially if the diverticula are located in the upper and anterior part of the kidney.

Adolescent↗
PubMed1989

[Antibiotic prophylaxis with enoxacin in extracorporeal shockwave lithotripsy].

According to literature, 16 to 35% of operatively removed renal stones harbour bacteria. The efficacy of antibiotic prophylaxis with enoxacin in reducing the rate of bacteriuria after extracorporeal shock wave lithotripsy (ESWL) was investigated in a prospective randomized study. Twenty-five patients received a single 400 mg dose of enoxacin one hour before ESWL, 25 patients did not receive an antibiotic. It was found that a single 400 mg dose of enoxacin one hour before ESWL can reduce the rate of bacteriuria significantly.

Bacteriuria↗