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Biomedical subjects

A Sigel

Publications and source records attributed to A Sigel.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1984

[Injuries of the ureter caused by external force].

Based on 10 own cases during the past 12 years, and a review of the literature, the subject is divided into classification and correlations, morbidity, aetiology, traumatogenesis and pathomechanisms, pathological anatomy and physiology, diagnostical pathways, therapy and results. There are closed and open injuries of the ureter, isolated and combined ones, and among the latter, combined related and not related. This injury is rare in general; in overseas countries, more often the open and in Central Europe, mostly the closed trauma can be seen. The indirect rupture of the ureter happens by hyperlordosis, the direct rupture by wheel lesion. The prevalence of youth for the indirect mechanism of the injury is explained by the hyperextensibility of the lumbar region in juveniles. Usually, the rupture is located proximally, a distal rupture (pelvic fracture) is an exception. Criteria of the closed injury are urinoma within Gerota's fascia and local resorption, later infection or urosepsis. The open injury is marked additionally by abdominal resorption of urine, followed by uremia and peritonitis. Delayed diagnosis is common, as the trauma causes few symptoms initially. Further, it is often obscured by concomitant injuries. For therapy, the rupture must be closed operatively by suture and splint. The operative approach follows usually the lumbar, but in cases of concomitant abdominal injury the abdominal route. Loss of kidney occurs in 20% and lethal outcome in 10%.

Abdominal Injuries↗
PubMed1983

Urinary excretion of calcium, magnesium, oxalate and citrate in duodenal ulcer patients. Preliminary results before and up to five years after highly selective vagotomy.

The urinary excretion of calcium, oxalate, citrate and magnesium, and the relative saturation products in urine of either calcium oxalate or calcium phosphate, were determined in male duodenal ulcer (DU) patients preoperatively (n = 60), and 1 and 5 years following highly selective vagotomy (HSV), and in male healthy controls (n = 30). In DU before HSV citrate and magnesium were lowered, oxalate was in the low normal range and calcium was normal. The calcium oxalate product was lower than in controls, while the calcium phosphate product was unchanged. Within 5 years HSV normalized urinary citrate and oxalate, but not urinary magnesium, and the median urinary pH was lower than pre-operatively. There thus results a normal product for calcium oxalate, but a reduced one for calcium phosphate. It is suggested that: (1) unoperated DU patients have a urine composition similar to that exhibited in normocalciuric recurrent calcium urolithiasis; (2) this spectrum of urinary constituents may be changed by HSV.

Adult↗
PubMed1983

[Reflux persisting into adulthood. A clinical study].

UNLABELLED: 1. Incidence: about 1/10 of all cases; 9/10 mature with/without scarring, even in the case of complicated reflux. 2. SYMPTOMS: onset after age of 16; prior to this clinical silence or minimal symptomatology. 3. Grading and staging: all of them may persist, low as well as high stages; scarring usually progressing; Grade I reflux and Stage III scarring often occur together. 4. INFECTION: female: rare between age of 10 and 15, as the bladder has become stable, later on frequent again due to new instability caused by sexual activity. 5. THERAPY: a. Conversion of complicated reflux into uncomplicated reflux (infravesical relief of obstruction). b. Antirefluxiv operation when urinary tract infections recur and the kidney is worth saving. c. Extirpative operation when unilateral hypertension or grave renal scarring. 6. PROGNOSIS: depends on uni-/bilaterality. 7. Operative results (Gregoir): good in cases of primary reflux, discouraging in cases of complicated reflux.

Adult↗
PubMed1982

Mineral metabolism during prolonged oral calcium substitution after jejuno-ileal bypass for morbid obesity.

The influence of jejuno-ileal bypass surgery on mineral metabolism was studied in patients with morbid obesity before operation, and 2 and 5 years after-wards. When calcium and potassium were orally substituted post-operatively, in serum calcium fractions, parathyroid hormone, phosphate, potassium and the bone mineral content remained unchanged, while serum magnesium decreased. Serum 25-hydroxyvitamin D was already low before bypass operation, and did not change thereafter. Post-operatively, the urinary excretion of oxalate rose into the upper normal range, while that of calcium, magnesium and citrate was markedly reduced. The urinary activity product of calcium oxalate rose slightly, but that of brushite decreased. Since these changes were manifest in the urine of all patients, the reasons for the post-operative formation of renal stones in 4 of 19 patients remain unclear at the moment. We conclude that the recommendation for precise oral calcium substitution after jejuno-ileal bypass operation seems justified in order to avoid serious disturbances of calcium metabolism in the long term, and to reduce intestinal oxalate absorption.

Adult↗
PubMed1982

Double-blind study with thiazide in recurrent calcium lithiasis.

The effect of 25 mg. hydrochlorothiazide twice daily on the meta-phylaxis of recurrent calcium lithiasis was compared to placebo in a double-blind study during 1 year in 51 patients. A distinct and continuous decrease in urinary calcium excretion occurred only in patients given hyrochlorothiazide. On the other hand, both groups showed a slight increase in total serum calcium levels, unchanged values for ionized and ultrafilterable calcium, and decreased urinary excretion of oxalate during the study. The activity products of calcium oxalate and calcium phosphate also were decreased in both groups but remained within the metastable range. Spontaneous passage of renal stones occurred during treatment in 6 patients given placebo and in 6 treated with hydrochlorothiazide despite decreased urinary calcium excretion in the latter group. The findings show the specific effect of hydrochlorothiazide treatment to be a decrease in urinary calcium excretion in patients with calcium lithiasis, while other changes appear to be nonspecific effects of treatment.

Adult↗
PubMed1982

[Repair of megaureter by tailoring in two layers while preserving vascular supply (author's transl)].

Since 1976 we tapered extremely wide obstructive or refluxive megaureters with partial fibrosis by this new technique, sometimes over 2/3 of length with ureterolysis in the upper segment. In these cases, preservation of the mesoureteric vascular supply is important in addition to the regular intramural nutrition. The mesoureteric arteries and veins spread into the adventitia and turn around in curves like a network. Exactly linear resection would cause damage. Therefore, we remove the adventitia from the lateral shape, resect beneath the abundant strip of muscularis with mucosa, trimming the megaureter downwards to a diameter of 7 to 4 mm, close the inner layer with running and interlocking 5-0 chromic suture over a splint and then readapt the adventitia. The advantages are: better arterial vascular supply, minimal thrombosis, no necrosis and no urinary leakage, less scarring and, therefore, good peristalsis.

Child, Preschool↗
PubMed1982

Citrate in urine and serum and associated variables in subgroups of urolithiasis. Results from an outpatient stone clinic.

Outpatient renal stone formers belonging to the established urolithiasis subgroups and controls were examined with respect to urinary and serum citrate (Cit) and several associated variables. Only in the normocalciuric majority of calcium and in uric acid stone formers was Cit in 24-hour urine decreased, but was normal in 2-hour fasting morning, and in 3-hour postprandial urine following a Cit-free test meal. Serum Cit was elevated in normocalciuria, renal and resorptive hypercalciuria. This Cit constellation was associated with either normal (absorptive, renal hypercalciuria) or low (normocalciuria, uric acid stone formers) parathyroid gland function as assessed by serum parathyroid hormone and nephrogenous urinary cyclic AMP, except in patients with primary hyperparathyroidism. In 2-hour morning urine the magnesium/creatinine ratio (normocalciuria) and ammonia excretion (uric acid stone formers) were decreased, while ammonia in 24-hour urine was low in all stone formers. It is suggested that Cit metabolism is altered in renal stone disease in general, and that in normocalciuria, stone inhibitors (Cit; magnesium) may be deficient.

Adult↗
PubMed1982

Necessary extent of lymph node dissection in testicular tumours. A histopathological investigation.

The findings of a prospective topographic histopathological study of the lymphatic spread of testicular tumours are reported. The study includes 150 patients, 9 of whom were subjected to exploratory laparotomy while 141 patients underwent retroperitoneal lymph node dissection. Lymphatic spread occurs in accordance with a quite definite pattern, atypical metastases were observed in only 3 of the 150 patients. The material was analyzed with respect to the possibilities of using limited unilateral dissections. The results show that by observing appropriate safety precautions, including frozen section histology, limited unilateral dissections can be used more frequently.

Humans↗
PubMed1982

Determination of urinary oxalate by isotachophoresis practical improvement and critical evaluation.

We developed an electronic control unit for the determination of oxalate in urine by isotachophoresis with the LKB 2127 Tachophor. It permits a considerable reduction of the time required for analysis. Measurements were carried out in samples of untreated urine using different leading electrolytes and standardization procedures. Determination of oxalate can be thus achieved within 25 min, whereof the manpower expenditure is about 5 min. In the range of 1.0-0.1 mmol/l urinary oxalate can be determined with a coefficient of variation of 4-6%. The detection limit of the method is about 0.04 mmol/l.

Cations↗
PubMed1982

[Immunosuppressive therapy following kidney transplantation].

Immunosuppressive therapy is necessary after transplanting allogenous organs. Various methods of non-specific immunosuppression are discussed. It is usually achieved by combined administration of glucocorticosteroids, azathioprine and antilymphocyte globulin. Improvement may result from using cyclosporine A. Other methods such as total radiation of the lymph nodes, drainage of the thoracic duct or plasmapheresis are restricted in their application because of additional high risk and the additional effort. Complications after a kidney transplantation are often complications of the immunosuppressive therapy. Low dosage of the substances used and limitation of the dosage in the therapy of acute rejection seem to be advisable.

Adrenal Cortex Hormones↗
PubMed1982

[Bladder diverticulum, a congenital disease of children and adults].

Genetically all diverticula are congenital and arise from the zone between trigone and detrusor which is susceptible to embryonal disturbances. The climax of the morbidity is in the first and sixth decennium. In both cases, the diverticulum is caused by infravesical obstruction which is congenital in the first group and acquired in the second. The morbidity in the male patient is characteristically higher than in the female. Morphologically, we differentiate between small, medium sized and large diverticula with a gradually increasing morbidity, depending on the size of the diverticulum and involvement of the ipsilateral ureter. The musculature of the diverticular wall is deficient. Pathophysiologically, the growth of a diverticulum depends on three stimuli: an intrinsic one, the exposure to micturitional pressures and a coincidental infravesical obstruction. The micturition has lost its efficiency and is incomplete. The urine in the diverticulum empties incompletely into the urinary bladder. Correlated pathologies include reflux and tendencies towards chronic inflammation and malignant degeneration. Therapeutically, an endoscopic incision of a narrow diverticular neck should be considered first. If this is not sufficient diverticulectomy should be considered next and this is the treatment of choice for large diverticula. No treatment is necessary for small diverticula. If a paraostial diverticulum in children causes reflux of marked degree, the reflux should be operated on by an extravesical approach, sinking the diverticulum into the urinary bladder and eliminating the diverticulum this way.

Adult↗