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Biomedical subjects

A Sigel

Publications and source records attributed to A Sigel.

At least 19 recordsLinked to original sources
PubMed1995

[Ureteral injuries caused by external force].

The pathologic mechanism responsible for ureteral injuries is no different now than in past decades. Nowadays, however, we distinguish diagnostically between partial traumatic tears and complete ones. This distinction leads to different therapeutic strategies: endoscopic surgery for the former and open surgery for the latter. We further distinguish between the pathophysiology of closed and of open urinomas; the latter have a less favourable prognosis. This means that the treatment strategies and the degree of urgency are also different. We report on 16 cases treated over the past 22 years and review the international literature.

Abdominal Injuries↗
PubMed1994

Regulation of mRNA transcripts and DNA synthesis in the rat heart following intravenous injection of transforming growth factor beta 1.

Transforming Growth Factor-beta 1 (TGF-beta 1) is expressed in the heart by muscle and non-muscle cardiac cells. In vitro, cardiac myocytes and non-muscle cells including cardiac fibroblasts and endothelial cells respond to regulatory effects of TGF-beta 1. Expression of TGF-beta 1 in the heart is subject to regulation by hemodynamic stimuli. Increased expression of mRNA transcripts for TGF-beta 1 has been reported in several models of cardiac hypertrophy. The objective of this study was to determine the effect of TGF-beta 1 in the myocardium. TGF-beta 1 was injected intravenously. Expression of mRNA transcripts for functional and structural proteins was determined by Northern hybridization analysis. DNA synthesis was determined by measurement of 3H-thymidine incorporation into ventricular DNA. The results showed differential regulation of mRNAs for myocyte- and non-myocyte-specific proteins in the heart of TGF-beta 1 treated rats. Moderate but statistically significant decrease in DNA synthesis was observed in the heart of TGF-beta 1 treated rats (37.5%, P < 0.025). Together, these data point to a physiological role for TGF-beta 1 in the heart. They further suggest that similar to its diverse in vitro cell-specific regulatory effects, TGF-beta 1 may have multicellular targets in the heart. Effect of TGF-beta 1 alone or combined with those of other cytokines/hormones that come into play, as the result of its administration, may be responsible for altered gene expression and DNA synthesis in the myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Classification and prognosis of supravesical urothelioma with the new TNM classification].

We report on 149 patients with supravesical urothelioma (transitional cell carcinoma of the upper urinary tract) treated in our hospital during the years 1967-1991. The introduction shows the distribution of sex and age as well as the localization of the tumor. Main topic of this paper is a new definition of the clinical pathology of supravesical urothelioma by means of the TNM classification published 1987. Based on the pathological pioneer work of P. Hermanek our results are as follows: during the first diagnosis pT3 predominates with 30.2%, followed by pT1 with 25.5% and pTa, pT1 and pT4 with a relatively low incidence. G2 predominates with 47.7%; G1 and G3 have almost the same frequency. The G/pT ratio shows a decreasing linearity for G1 from pTa to pT4; for G2 there is equivalence of pT1-pT3; and pTa and pT4 are relatively rare. With respect to G3, pT3 predominates with 51%, followed by pT4, pT1 and finally pTa with zero frequency. The G/M ratio shows M0 only for G1, 10% M positive for G2 and 15% M positive for G3. The 10-year survival rate for patients with R0 resection and stage pTa is 64% and for pT1-pT4, 33-36%. The 10-year survival rate for patients with G1 tumor is 51%, and that for G3 tumors 30%. Multicentric occurrence and carcinoma in situ have no prognostic significance in our sample. As is well known, papillary growth has a better prognosis than solid infiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Pathologic development of the kidney].

In the absence of firmly established views on the development of nephropathy, we describe in this paper the embryogenetic and clinical aspects of kidney disease. Congenital reductive nephropathy always arises in the ureteral bud and is determined by two factors, endogenous dysplasia and endogenous obstruction. The nine well-known patterns of disease that may result are described herein. The most important starting points are as follows: (a) A dysplastically disorganized and hence refluxive trigone of the bladder induces, via pyramidal-medullary deficiencies, a defect of the metanephros and thus what we term reflux nephropathy (III-V). BU and PN may supervene postnatally. (b) Similarly, obstruction of the ureteral outlet in the first trimester induces dysplastic ascending nephropathy. (c) The same obstruction beginning in the second trimester induces nondysplastic, purely obstructive nephropathy, characterized by glomerular hypogenesis and hemo-obliterative cirrhosis which varies considerably from stage to stage and from case to case and may go as far as complete loss of the parenchyma. (d) Obstruction of the pyeloureteral junction, occurring late in the embryonic phase and originating outside the urinary system, provides the clearest example of fully developed nondysplastic reductive nephropathy. The lesional process may come to a halt at any time. (e) Coincidence of early embryonic dysplastic-refluxive nephropathy and late embryonic infravesical obstruction (with no causal link) accounts for half the morbidity from valvular disease. The other half results from simple nondysplastic obstruction.

Female↗
PubMed1991

What are the benefits of extended dissection of the regional renal lymph nodes in the therapy of renal cell carcinoma.

In a prospective study of 511 patients we compared the data of 320 who underwent systematically extended dissection of the regional lymph nodes with data of 191 who underwent only facultative dissection of the lymph nodes, which means that no lymph nodes had been removed or only a few were taken for staging purposes. Only patients without distant metastases and who were less than 72 years old were included. All patients were treated with a transabdominal approach. The incidence of positive nodes in the patients with systematically extended lymphadenectomy was 17.5% and for patients with facultative lymphadenectomy it was 10%. Survival rates of patients with facultative lymphadenectomy were 58% after 5 years and 40.9% after 10 years, compared to 66% and 56.1%, respectively, for patients with systematically extended lymphadenectomy (p less than 0.01). Patients with stage pT1-2 (Robson stage I) and pT3aN0M0 (Robson stage II) tumor obviously had the highest benefits with extended lymphadenectomy. Operative mortality was less than 1% after systematically extended lymphadenectomy and 3.8% after facultative lymphadenectomy. We conclude from our data that the systematic and extended lymphadenectomy improves the prognosis of patients with renal cell carcinoma without any additional operative risks.

Carcinoma, Renal Cell↗
PubMed1990

[Adrenal apoplexy--endogenous, exogenous and therapeutic multiplicity].

From the aspect of morbidity, adrenal apoplexy is primarily a disease of newborns or infants, frequently with subclinical rather than frank manifestations. The development is governed by the susceptibility fetal processes of adrenal transformation to disturbances and injury. Exogenous causes such as birth trauma and bacterial inflammation, are seen in some cases, as are sympathogenous neoplasms. When it is diagnosed some uncertainty about benign or malignant development of the disorder persists in the background. With sonography now available as a diagnostic tool, in the majority of the cases conservative monitoring for a tendency to spontaneous resorption is enough. This approach, however, also involves the risk of identifying a protracted circulatory shock or the growth of an adrenal tumor too late. The surgeon also faces the problem of possible misinterpretation of hematoma impacted into the fascia of the capsule of Gerota as a nephroblastoma with consequent erroneous treatment. The relative rareness of the disorder means surgeons have little personal experience with it, which compounds the difficulties. In comparison with the situation in children, treatment of the adult form of the disorder appears almost simple.

Adrenal Gland Diseases↗
PubMed1990

[What is the benefit of systematic regional lymph node dissection in tumor nephrectomy?].

What is the benefit of an extended dissection of the regional lymph nodes in the treatment of renal cell carcinoma (RCC)? We evaluated the results of 511 consecutive patients which we operated on RCC. The data of 320 patients (SLD) who had an extended dissection of the regional lymph nodes have been compared with those of 191 patients (FLD) who had a dissection of none or only of a few nodes for staging reasons. All patients were nephrectomized under curative intent (M0) with a transabdominal approach. 1. The incidence of N+ in the SLD group was 17.5% and 10% in the FLD group. 2. The overall 5-year survival rates were 58% after FLD and 66% after SLD, the 10-year survival rates 38% after FLD and 54% after SLD (p less than 0.01). 3. The perioperative mortality of patients with extended dissection was 0.9%. We conclude from our data that the extended dissection of the regional lymph nodes significantly improves the prognosis of patients which were operated for RCC.

Carcinoma, Renal Cell↗
PubMed1989

[Terminal renal failure of pediatric urologic origin according to cause and inverted morphometry].

An age-specific renal reaction becomes evident on comparison of pediatric and adult urology. Reduction of the renal parenchyma by 80% of its bilateral substance because of renal disease can be survived by an adult for some decades with normal blood urea and creatinine, providing the residual parenchyma is histologically normal. Loss of the same proportion of the parenchyma in infancy leads to end-stage renal failure in spite of the better compensatory hypertrophy of the residual renal tissue. This is because the limit of 20% residual substance is only true for a fully developed adult body. While the body is still in the biological growth phase in the second decade of life, a markedly reduced kidney that is no longer growing with the rest of the body is incapable providing the enhancement of renal function needed at this time. The histological implication is glomerulo-sclerotic changes--possibly as a result of hyperfiltration--and the clinical implications, renal failure requiring dialysis or transplantation, the only alternative being a fatal outcome. In a few cases reduced renal work can be compensated function for some years. In all, 46 cases of end-stage renal disease and 13 of chronic retention are detailed according to primary diagnosis.

Child↗
PubMed1989

[Fornix rupture--a review of pathophysiology and clinical aspects].

Rupture of the fornix renalis, a special form of obstructive nephropathy that receives too little attention as a separate entity, is reintegrated into urological thinking, with a fuller description of the pathophysiology, morphology and clinical course than has previously been given. Overloading (iatrogenic mainly) of the lymphatic and venous system of the kidney caused by excessive pressure is usually implicated, affecting the renal parenchyma, the renal sinus and Gerota's fascia. Rupture of the calyceal fornix renalis functions partly as a self-help mechanism. Measurement of the urovascular diversions of urine caused by obstruction is not yet possible. Clinical observation and experimental reproduction give predominantly corresponding results. Schematics make the text easier to understand. Recent ureteroscopic techniques are introduced to bring the topic up to date.

Humans↗
PubMed1989

[Improved actuarial results in the treatment of kidney cancer by systematic lymph node excision].

From January 1st 1970 to December 31th 1985, 706 nephrectomies for renal cell carcinoma have been performed by the staff of the urologic clinic of the University of Erlangen-Nürnberg. 222 nephrectomies by lumbal and 484 by transabdominal incision. The following study compares the results of two groups of patients, who all have been operated transabdominally with curative goal (this means that there was no evidence for distant metastases). The two groups differ in the character of the associated lymph node dissection. The first group consists of patients on whom we performed a systematic lymph node dissection (LAS, n = 291). The second group consists of those patients on whome we performed a facultative lymp node dissection (LAF, n = 193). In this prospective study of postoperative survival rates, significantly better results are obtained in the LAS-group. The survival rates according to the stage of the tumor (Robson-classification) show that stage I and II profit most of the extended lymph node dissection. The bad prognosis for stage IIIa patients, determinated by tumor invasion into the renal vein, will not be changed after extended lymph node dissection. Patients with positive regional lymph nodes (stage IIIb + c) have a significantly better prognosis during the first three years after nephrectomy, obviously as the result of reduce tumor volume, but the benefit does not last over a longer period as 5 years. According to our results we are convinced that the systematically extended lymph node dissection is an important curative measure in the surgical therapy of renal cell carcinoma.

Actuarial Analysis↗
PubMed1988

[Pathogenetic synopsis of diverticular disease of the female urethra].

Diverticular disease of the female urethra is rare, but not so rare as assumed hitherto. The predominant theory is that diverticula urethrae is secondary to infection of the glandulae paraurethrales, but they can be easily pared out, and this together with their three-dimensional appearance with subdivision in side, undermines this theory. On the other hand, the known fact that urethral diverticula can be observed in female babies and girls of school age and also in urethral moulds of healthy young women, in which widened urethral glands can be found, supports the idea of a congenital origin. The irritability of the female urethra results from the fact that it is made up of two germ layers. Inflammation of paraurethral ducts causes secondary widening of small congenital diverticula of the female urethra. Proximally located diverticula can irritate sphincter function, as does invasive treatment. In some cases endoscopic therapy might be justified rather than plastic surgical removal via the vagina. The history, symptoms, diagnostis, histology and secondary pathology are indicated only very briefly.

Diverticulum↗
PubMed1987

[Sonography in the early detection of non-palpable second testicular tumors: a prospective study].

As part of the tumor aftercare service afforded by our policlinic, 91 patients were examined one to six times in 18 months following radical orchiectomy for testicular germ cell tumors. The period of observation averaged 35 months (3-147) after the contralateral removal of the testicle. In addition to the usual routine checks, sonography of the residual testicle also formed part of the established followup protocol. Among these patients sonography identified in residual testicles 3 testicular tumors (3.3%) which had escaped detection on palpation. The existence of these second tumors was demonstrated 3, 25 and 38 months following contralateral orchiectomy. In all instances the second lesion differed from the first tumor in histology. In another patient a plum-sized malignancy was revealed within a large concurrent hydrocele by scrotal sonography carried out 18 months following preceding contralateral orchiectomy. Thus, our group of patients gave an incidence of 4.4% for second primary testicular tumors, a poor known incidence rate. Such malignancies can be spotted early by ultrasound, they are genetically obscure just as the increasing morbidity of the unilateral disease. These results urgently suggest that after semicastration for testicular germ cell tumor the residual testicles should be regularly scanned by ultrasonography at four-month intervals. Retrograde sonography has been shown to detect even those small occult testicular tumors which pass unnoticed until metastasizing.

Adult↗
PubMed1986

[Classification of staghorn calculus disease of the kidney based on 105 personal cases and a review of the literature].

The majority of staghorn calculi (branched calculi)--25 per cent bilateral--is mainly composed of calcium phosphates, in about 2/3 with varying fractions of Struvite. Pure Struvite stones are rare. Large fractions of Struvite form a soft concrement. Infection with urea splitting bacteria arises ascending, therefore predominantly in female kidneys, except for the first decennium. Staghorn calculi without Struvite (1/3 of our cases), show extremely large growth and sterile urine. Some Struvite stones have sterile urine or Struvite without urea splitting bacteria. The shape of branched calculi depends on the form of hilus renalis and the aggressiveness of the alkaline urine and the infection. Renal cirrhosis--almost always present--follows bacterial or abacterial obstruction, depending on the degree of vascular obliteration by reactive fibrosis of the intima, with or without pyonephrotic, xanthomatous necrosis, similar to renal tuberculosis. The so-called "large stone kidney" is obstructive, aseptic and lipomatous special form of staghorn calculus and cirrhosis. Stone formation and grade of cirrhosis may be determined by tomography.

Adult↗
PubMed1984

[Method of radical transabdominal tumor nephrectomy with facultative or systemic lymph node dissection and results in 381 patients].

The prognosis of 381 patients without metastases operated on renal cell carcinoma depends on the extent of the lymph node dissection. After facultative lymph node dissection (FLD) the uncorrected actuarial survival rates (SR) are 64 +/- 8% after 3 years and 50 +/- 9% after 5 years compared to 77 +/- 7% (3 years) and 60 +/- 11% (5 years) when systematic lymph node dissection (SLD) was performed. For stage I the better results in the SLD-group (80 +/- 10% 5 years SR for SLD; 67 +/- 13% 5 years SR for FLD) are partially to be explained as a staging-effect, whereas in stage II the difference (92 +/- 10% 5 years SR for SLD; 45 +/- 25% 5 years SR for FLD) is due to the higher radicality of the systematic dissection. In stage III (35 +/- 14% 5 years SR for SLD; 37 +/- 12% 5 years SR for FLD) the predominant influence of the tumor invasion in renal veins cannot be influenced by local extension of the operation. The incidence of lymph node metastases was 16% (n = 170) in the FLD and 23% (n = 211) in the SLD group. When only facultative dissection is done, 30% of lymph node metastases escape detection. Without any lymph node dissection the number of unrecognized lymphmetastases can be expected to be still higher. The controversies about the role of lymph node dissection in radical tumor nephrectomy are mainly caused by the lack of standardized criteria for operative and patho-histological staging procedures. Any conclusions drawn from comparing reports in the literature should be related to these modalities.

Aged↗