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Biomedical subjects

A Lampel

Publications and source records attributed to A Lampel.

At least 19 recordsLinked to original sources
PubMed2000

Modified seromuscular tube: serosa lined bowel wall imbrication as a continent outlet for continent cutaneous urinary diversion.

PURPOSE: We created a simplified modification of the seromuscular tube technique for continent cutaneous urinary diversion. MATERIALS AND METHODS: We applied a simplified modification of our seromuscular tube technique in 1 woman and 2 men with a mean age of 53 years in whom outlet failure developed after continent cutaneous urinary diversion, and in whom adiposity and postoperative adhesions rendered revision difficult. We constructed a continent outlet conduit by imbricating the whole bowel wall and suturing it into a tube. RESULTS: At a followup of 4 to 13 months (mean 7) all 3 patients are completely continent without leakage. Catheterization is performed at 3 to 5-hour intervals (mean 4) with 14 to 16Fr catheters. CONCLUSIONS: The wall imbrication technique involves the flap valve principle, as does the seromuscular tube, and it is easy to perform. To date followup is too short for judging the long-term reliability of this continence mechanism. If the outcome stands the test of time in this series, which represents the worst case scenario, application of this technique may be extended to continent cutaneous urinary diversion.

Adult↗
PubMed1999

Radical cystoprostatectomy combined with Mainz pouch bladder substitution to the urethra: long-term results.

OBJECTIVE: To analyse, in a retrospective study, the oncological outcome, pouch-related complications, continence and micturition after radical cystoprostatectomy combined with Mainz pouch orthotopic bladder substitution to the urethra for the treatment of bladder cancer. PATIENTS AND METHODS: Between 1986 and 1996, three urological departments contributed 108 male patients to the review. The same exclusion criteria from orthotopic bladder substitution were applied by all centres, i.e. multifocal or concomitant carcinoma in situ, tumour at the bladder neck, positive biopsy from the prostatic urethra, locally advanced tumour and lymph node involvement. In all, 103 patients were evaluable for follow-up, with a mean (range) follow-up of 42 (3-132) months. RESULTS: Pathological examination of the cystectomy specimen revealed 81% organ-confined tumours. During follow-up, 84% of patients remained free of tumour, 7% developed distant metastases, 5% local recurrences, 4% urethral recurrences, and 1% upper tract urothelial cancer; 85% of patients are capable of spontaneous voiding, with a mean pouch capacity of 720 mL. Daytime continence was achieved in 88%, including 17% wearing one safety pad; 9% had stress incontinence and 3% total incontinence; 67% could sleep through the night, with either complete continence (34%) or one safety pad (33%). Nocturnal incontinence occurred in 11%. Uretero-intestinal stenosis occurred in 15 of 205 (7%) renal units, requiring ureteric reimplantations in 11, nephrectomy in three and antegrade dilatation in one. Reflux was not noted in any patient. About half the patients were on anti-acidotic prophylaxis. CONCLUSION: The large bowel segment in the Mainz-pouch technique of orthotopic bladder substitution provides good reservoir capacity and continence rates, with less ileum used than in all-ileum pouches. The surgical technique is simple and reproducible, and in particular the antireflux ureteric implantation into the caecum protects the upper urinary tracts.

Adult↗
PubMed1999

Neo-adjuvant and adjuvant treatment of locally invasive bladder cancer.

Since Sternberg et al. in 1985 first published preliminary results of polychemotherapy in patients with metastatic bladder cancer, it became apparent that transitional carcinoma of the bladder is highly responsive to chemotherapy. Response rates up to 70% with combination therapy regimens like methotrexate, vinblastine, doxorubicin or adriamycin and cisplatin promised that transitional carcinoma might be able to cure even in advanced stages. Chemotherapy has either been applied prior to the local treatment (such as radical cystectomy or radiotherapy) in a neo-adjuvant regimen, or after local therapy in an adjuvant regimen. Although a large number of studies have been published in the past 20 years, the role of the different chemotherapeutic approaches has not been clearly defined. Therefore, neither neo-adjuvant nor adjuvant chemotherapy can be recommended as 'gold standard' treatment for advanced bladder cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association.

PURPOSE: The centers of the laparoscopy working group of the German Urologic Association collected data to prove the efficacy, safety and reproducibility of laparoscopic nephrectomy. MATERIALS AND METHODS: At 14 centers 482 laparoscopic nephrectomies have been performed until December 1996 via a transperitoneal approach in 344 (71%) and a retroperitoneal approach in 138 (29%). All 482 laparoscopic nephrectomies were performed by a total of 20 surgeons with an average of 24 procedures per surgeon (range 4 to 105). The indications for nephrectomy were benign renal pathology in 444 patients (92%), including renovascular disease in 28%, hydronephrosis in 20%, reflux nephropathy in 15%, chronic pyelonephritis in 12%, end stage nephrolithiasis in 11%, renal dysplasia in 4% and renal tuberculosis in 1%. Of the remaining 38 patients (8%) laparoscopic radical nephrectomy was performed for renal cell carcinoma in 5% and for upper tract transitional cell carcinoma in 3%. RESULTS: Operating time depended mainly on the pathology of the kidney (that is small dysplastic organ versus large hydronephrosis) and the learning curve of the surgeon. However, the average operating time did not vary significantly among the different centers (maximum 277.6 and minimum 81.9 minutes). Intraoperative or perioperative complications were noted in 29 patients (6.0%), including bleeding in 22 (4.6%), bowel injury in 3, hypercarbia in 2 and pleura lesion in 1 and pulmonary embolism in 1. The conversion rate was 10.3% (bleeding, bowel injury, difficult dissection), including 4 patients with renal tuberculosis, 2 with xanthogranulomatous nephritis, and 1 each following renal trauma and embolization. The re-intervention rate was 3.4% due to bleeding in 6 cases, abscess formation in 3, intestinal stenosis in 2 and a pancreatic fistula and port hernia in 1. Mean hospital stay was 5.4 days. CONCLUSIONS: Laparoscopic nephrectomy has become a well established procedure in those urology departments focusing on laparoscopy. The indications and results are reproducible at these centers. However, for patients with severe perinephritis (that is renal tuberculosis, xanthogranulomatous nephritis, posttraumatic atrophy) a higher likelihood of open conversion must be considered.

Adolescent↗
PubMed1997

[Calculation of lavage volume in transurethral prostate resection (TURP)].

PURPOSE: Evaluation of the relationship between ethanol concentration in expired air and the amount of absorbed irrigation fluid in patients who undergo a transurethral resection of the prostate. METHODS: 76 patients were evaluated in a prospective study. The irrigation fluid contained 1.92 w/w% of ethanol. The ethanol concentration in breath was measured at least every 10 minutes with a Alcotest 7410 (Dräger) or a Biomed 3010 (Biotest). Documented values: breath ethanol concentration, mean arterial pressure, heart rate, haemoglobin concentration, serum sodium concentration, the amount of irrigation fluid, the time of operation, special events, therapeutic interventions. A modification of the Widmark formula was used for calculating the amount of absorbed irrigation fluid from the breath ethanol concentration. RESULTS: A rise of the ethanol level above 0.2/1000 was observed in 10 patients. No clinically significant difference in heart rate and blood pressure during surgery between the 24 patients with no alcohol in breath and the 10 patients with more than 0.2/1000 was observed. Prolonged duration of resection and greater amount of used irrigation fluid correlated with higher ethanol concentration in breath. During the study period no patient developed the clinical features of a transurethral resection syndrome. CONCLUSIONS: If 2 w/w% of ethanol is added to the irrigation fluid, breath ethanol concentration under 0.2/1000 may be considered harmless, while values above 0.2/1000 are predictors of massive absorption of irrigation fluid. In our patients, the addition of ethanol to the irrigation fluid has been a suitable and easy way to monitor the absorption of irrigation fluid, if the ethanol concentration in the breath is measured every ten minutes. If 2 w/w% of ethanol have been added to the irrigation fluid, the absorbed volume (E) can be estimated using the formula: E = 37.5 x body weight (kg) x ethanol concentration (/1000).

Aged↗
PubMed1997

Appendix carcinoma invading the urinary bladder.

We report a case of an appendix carcinoma invading the urinary bladder. In contrast to other bowel tumors invading the bladder, history and symptoms were consistent with a primary bladder tumor. This is due to the unique anatomical position of the appendix where the tumor did not hinder passage of bowel contents or cause melena. Findings on physical examination as well as diagnostic imaging and transurethral resection were inconclusive. Consideration of local progression of an appendix carcinoma is an important differential diagnosis. In contrast to other vesical or extravesical T4 tumors, the appendix carcinoma offers a good chance for resection en bloc by right-sided hemicolectomy and partial cystectomy.

Adenocarcinoma, Mucinous↗
PubMed1997

Experimental evaluation of free versus pedicled fascial flaps for sling surgery of urinary stress incontinence.

PURPOSE: Bladder neck suspension using an autologous fascial sling is an established surgical technique for treatment of urinary stress incontinence. However, the biological fate and physical properties of autologous fascial sling yet remain to be determined. MATERIALS AND METHODS: Our study was designed to evaluate in an animal model of twenty rabbits fascial slings from free and pedicled fascial flaps of two different widths (7 mm and 15 mm.) and uniform length (60 mm.) in respect to changes of length, width, tensile strength and histological criteria of vitality and integrity 3 months after surgery. RESULTS: The results 3 months after surgery revealed shrinkage in length by 37% (31%-46%) of the original length, shrinkage in width by 63% (60%-69%) of the original width and reduction of tensile strength of 53% (51%-55%) without consistent differences between free and pedicled flaps or 7 mm. and 15 mm. wide flaps. In the groups with 7 mm. wide flaps a total of two dystrophic slings (1 pedicled, 1 free) were seen; however, no dystrophies were seen in 15 mm. wide flaps. On microscopy, all slings were vital regardless of their surgical configuration. CONCLUSIONS: In summary, on macroscopic, microscopic and physical examination no gross differences between free and pedicled slings could be detected, so that preferences for use of free or pedicled fascial flaps could not be established for clinical applications in sling surgery. However, 15 mm. wide flaps had a lower incidence of dystrophy and retained greater absolute tensile strength than 7 mm. wide flaps.

Analysis of Variance↗
PubMed1997

[Extracorporeal shockwave lithotripsy in childhood].

In general, the criteria for treatment of urolithiasis in children are the same as those for adults. Today, extracorporeal shock wave lithotripsy (ESWL) is the method of choice for treatment of most pediatric urinary stones. Stone-free rates between 57% and 97% at short-term follow-up and 57%-92% at long-term follow-up have proven the efficacy of ESWL treatment in children. So far, there is no evidence of negative side effects of ESWL treatment in children in the long-term, confirming the safety of ESWL treatment seen in the short-term results. In particular, neither induction of hypertension nor deterioration of renal function have been detected in children when limitation of shock wave energy and shock wave numbers have been carefully observed.

Adolescent↗
PubMed1997

5-Fluorouracil versus folinic acid and 5-fluorouracil in advanced, hormone-resistant prostate cancer: a prospective randomized pilot trial.

OBJECTIVES: Results of cytotoxic chemotherapy for hormone-resistant prostate cancer are not impressive. One of the substances which seems to have a therapeutic benefit is 5-fluorouracil (5-FU). The effect of 5-FU can be modulated by addition of folinic acid (FA). We tested in a prospective, randomized phase II trial monotherapy with 5-FU versus the combination of 5-FU and high-dose FA. METHODS: 25 patients received 600 mg/m2 5-FU, and 24 patients 400 mg/m2 FA plus 600 or 400 mg/m2 5-FU. They were treated for two cycles for 5 days in a 21-day interval followed by a weekly single-day application until progression occurred. Pain remission, toxicity, time to progression and survival were evaluated. RESULTS: Both regimens led to a pain remission in nearly 70% of the patients. Mucosal side effects like diarrhea and stomatitis occurred more often in the combination arm, whereas leukopenias were more frequent in the monotherapy are. We observed no statistically significant difference between the two treatment arms regarding time to progression and survival. CONCLUSIONS: Although both regimens led to a pain remission, side effects are too severe to recommend these protocols for standard treatment of hormone-resistant prostate cancer.

Aged↗
PubMed1996

Continent diversion with the Mainz pouch.

From 1983 until July 1994, 561 patients in 2 urology departments (Mainz and Wuppertal) underwent a Mainz pouch 1 procedure. The Mainz pouch 1 was used for bladder augmentation in 60 patients, for orthotopic bladder substitution in 61 patients, and for continent cutaneous urinary diversion in 440 patients. In the group of continent cutaneous urinary diversion, the continence mechanism applied was an ileal intussusception nipple in 270 patients, an appendix stoma in 146 patients, a submucosal seromuscular bowel-flap tube in 14 patients, and a submucosal full-thickness bowel-flap tube in 10 patients. Indications for urinary diversion were bladder cancer in 339 patients, anatomical or functional loss of bladder capacity in 179 patients, and other primary or secondary malignancies of the bladder or true pelvis in 43 patients. After a mean follow-up period of 57 months (range, 3-127 months), early and late complications were encountered in 12% and 37% of the patients, respectively. In the bladder-augmentation group, 93% of the patients are completely continent day and night. All but three patients, who empty their reservoir by intermittent self-catheterization (CIC), void spontaneously by abdominal straining. In the orthotopic bladder-substitution group, 95% of the patients are continent during the daytime. To prevent urinary leakage, 13% have to empty their reservoirs regularly at 4-h intervals and 13% have to perform CIC to avoid residual urine. Among the patients treated with continent cutaneous urinary diversion, stoma failure occurred in 11%, stoma stenosis was encountered in 13% and required open revision in 2%, endoscopical incision in 10%, and conservative treatment (dilation) in 1% of cases.

Cecum↗
PubMed1996

Urolithiasis in horseshoe kidneys: therapeutic management.

OBJECTIVES: We sought to compare the results of different therapeutic strategies in patients with horseshoe kidneys and urolithiasis. METHODS: The records of 47 patients (28 male, 19 female; mean age, 42 years) with horseshoe kidney treated for urolithiasis from 1983 to 1994 were reviewed retrospectively and follow-up studies of 38 of 47 patients were obtained after 7 to 122 months (mean, 79). RESULTS: Open surgery was performed in 6 patients with ureteropelvic junction obstruction; 1 required nephrectomy of a nonfunctioning right kidney and the other 5 are stone free. Percutaneous nephrolithotomy (PNL) was performed in 4 patients with normal drainage and a moderate to large stone burden; 3 became stone free and the other required extracorporeal shock-wave lithotripsy (ESWL) secondarily. In the remaining 37 patients with normal drainage and a small to moderate stone burden, ESWL achieved a 100% disintegration rate and a 76% stone-free rate. CONCLUSIONS: The presence of anatomic obstruction will necessitate open surgery for urolithiasis in patients with horseshoe kidney; however, in patients with normal urinary drainage PNL or ESWL can be considered, either singly or as a part of combination therapy. When management is tailored to the individual patient's needs, results of stone treatment can be equivalent to those in normal kidneys.

Adolescent↗
PubMed1995

In situ tunneled bowel flap tubes: 2 new techniques of a continent outlet for Mainz pouch cutaneous diversion.

In Mainz pouch continent cutaneous urinary diversion, introduction of the in situ tunneled appendix as the continent outlet in 1990 has simplified the surgical technique and greatly increased the acceptance of the procedure. Based on the results of long-term animal studies, 2 new techniques of a continent outlet were randomly used with a Mainz pouch 1 procedure (ileocecal pouch) in 17 patients in whom the appendix was not available or usable for construction of a continent outlet. According to the flap valve principle of the tunneled appendix, in 17 patients a small caliber conduit was created from large bowel wall at the lower pole of the cecum and was tunneled in situ under the mucosa. In technique 1 (seromuscular bowel flap tube), a tube lined by serosa was created from a pedicled island flap of large bowel wall in 11 patients. In technique 2 (full thickness bowel flap tube), a tube lined by mucosa was created from a pedicled flap of large bowel wall in 6 patients. After a mean followup of 8 months (range 2 to 17) 16 of 17 patients catheterize the reservoir at intervals of 4 to more than 6 hours using 14 to 16F catheters and are continent day and night without leakage. The only major complication in this series was incontinence in 1 patient with a seromuscular bowel flap tube who died of metastatic tumor 6 months postoperatively.

Dermatologic Surgical Procedures↗