Biomedical subjects
Publications and source records attributed to C Bick.
Rupture of an abdominal aortic aneurysm (AAA) is often a catastrophic event, while elective traditional repair involves major surgery. This article explains AAA development and traditional repair, and introduces a new, less invasive method of repair: endovascular stenting.
The potential role of 4-1BB in human immunodeficiency virus (HIV-1)-infected T cells was investigated with HIV-1-infected subjects. 4-1BB expression was readily inducible on PHA stimulation of T cells from HIV-1-infected individuals. The level of 4-1BB expression and the percentage of 4-1BB-expressing T cells were higher in HIV-1+ individuals than in the HIV-1- controls (p < 0.01). The difference in 4-1BB expression was more significant in CD8+ T cells and the high level of 4-1BB expression was correlated with low CD4+ T cell counts (r = -0.63, p < 0.05). 4-1BB signal cooperated with CD28 for proper HIV-1+ CD4+ T cell proliferation. In addition, cross-linking 4-1BB with agonistic monoclonal antibody enhanced HIV-1 replication both in primary stimulation and secondary restimulation of CD4+ T cells from HIV-1+ individuals. To test whether 4-1BB cross-linking signals an activation of HIV-1, J8-1, a 4-1BB+ Jurkat subline, was transiently transfected with pHIV-1-LTR-CAT plasmid and stimulated through 4-1BB. Combined stimulation of 4-1BB and CD3 resulted in an enhanced CAT activity compared with CD3 stimulation alone. Thus, 4-1BB may be involved in the activation of HIV-1 replication from latently infected CD4+ T cells.
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The experiences with 3,000 extracorporeal shock wave lithotripsies of kidney and ureteral calculi using the Lithostar are reported. Indications, contraindications and therapeutic approach are reviewed and the importance of out-patient follow-up is stressed. The success rate of 75% (including further spontaneous passage of residual desintegrated calculi) is good in the view of an unselected and unfavourable patient population. In the other patients a second ESWL treatment may be necessary. In the initial period in 6% of the patients percutaneous nephrolitholapaxy or open operation have been performed whereas in the last 100 patients it was not necessary.
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The applications of microsurgery in the reconstruction of the injured ureter using a double-layer end-to-end anastomosis and in the repair of ureteropelvic junction obstruction using modified pyeloplasty techniques are described in detail. The advantages of the use of microsurgical techniques in reconstructive surgery of the upper urinary tract are elimination of routine urinary diversion, shorter duration of hospitalization and a higher success rate. Therefore, the application of microsurgery is cost-saving.
The use of microsurgery in the treatment of 20 patients with ureteropelvic junction obstruction is described. The Culp-DeWeerd vertical flap pyeloplasty and the dismembered Anderson-Hynes technique were modified by means of microsurgical instruments, optical magnification and fine absorbable polyglactine sutures, described in detail and used in 11 and 8 cases, respectively. In a further patient a similar modified Kucera pyeloplasty was performed. The advantages of the application of microsurgical technique in reconstructive surgery of the renal pelvis and the ureter are the following: no routine use of urinary diversion; shorter hospitalization time; higher success rate, and a cost-saving therapy.
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Experiences are reported in the therapy of recurrent colics caused by ureteroliths. In 41 patients an initial treatment with indomethacin suppositories was performed which led to a removal of the colics in 37 patients. A comparative group of 46 patients was conventionally treated by means of an injection therapy of analgin/papaverin. In order to achieve painlessness, on a average 10 to 15 injections were necessary during the hospital treatment. The importance of the indomethacin therapy described lies in the possible self-application by the patient as well as in the avoidance of recurrent colics, frequent consultations of emergency physicians and hospitalisations.
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Ureteropelvic junction obstruction is a congenital anomaly commonly afflicting the pediatric population, however, it is also more frequently than generally appreciated in the adult population. The method of postoperative urinary diversion - to divert by nephrostomy tube and/or splint or not to divert - was a matter of debate during the last twenty years. Through the application of microsurgery in pyeloplasty an external urinary diversion under commonly circumstances is not necessary. The Culp vertical flap pyeloplasty was modified by means of microsurgical instruments, ophthalmologic loupes (X 2, 6) and fine absorbable polyglactine sutures and used in 7 cases in 1984. The top of the flap is fixed in the distal ureteral incision by a U-shaped suture of 5-0 or 6-0 Vicryl followed by 2 continuous watertight sutures of the flap and the ureter and pyelon respectively. Only an extrarenal drainage for 4-8 days postoperatively was used. The mean duration of postoperative hospitalization was 10 days. The short-term radiographic, functional and clinical results after microsurgical pyeloplasty are excellent in 4 patients and good in 1 patient. The mean follow-up was only 4 months. Further experience, long-term follow-up and comparison with conventionally operated patients are necessary to evaluate the advantage of our microsurgical technique.
Due to a hypercalcaemia and changeably appearing hypercalciuria 13 patients with relapsing urolithiasis were under suspicion of a primary hyperparathyroidism. After selective sounding and withdrawal of blood from the cervical veins in all cases the determination of parathormones was performed and always an increased activity of parathormones was found. The exploration of the cervical region carried out could in 11 performed operations in 8 cases prove an adenoma and in 3 cases a hyperplasia as cause of hyperparathyroidism. A localization of the suspected adenoma was in 5 cases possible in combination with the angiography of the thyroid gland. By equally high activity in 3 cases no clear evidence was possible. An improvement of the diagnostics of localization might be achieved by supraselective sounding of the veins. On principle the authors recommend to perform a selective determination of parathormones before operation, which in case of need is to be supplemented by a selective angiography of the thyroid gland.
Rupture of the corpus cavernosum, commonly referred to as "fracture" of the penis, is a rare occurrence. The etiology, clinical symptoms, diagnostic and therapeutic methods in 6 cases are described and the experiences compared with those in the literature.
Ureteral injuries following blunt pelvic trauma are extremely rare. Experiences with two cases of lacerations of the lower ureter due to pelvic fractures are presented. In patients with acetabular fractures the likelihood of lower ureteral injuries should be suspected and excluded by an intravenous urogram.
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Separate core and shell examinations were made on 10,000 urinary stones using a combined crystal-optical X-ray diffractometric method of analysis. 29.5% of these concrements showed differences in qualitative phases between central and peripheral stone parts. All the more frequent stone components were found in core and shell to the same extent. Only weddellite and uric acid dihydrate show a clear preference of the shell. Our method of analysis showed cores to be mostly monomineralic and peripheral stone parts mostly bimineralic. Consequences of this topographic stone analysis for metaphylaxis of urolithiasis are pointed out.
Reference is made to the significance of hypercalciuria in the aetiology of calcium oxalate lithiasis. Differentiation between the various forms of hypercalciuria allows the therapy to be suited to the respective causes. In order to measure intestinal calcium absorption the authors examined serum samples from 22 patients after oral administration of Ca47; in 13 cases absorptive calciuria was diagnosed.
Ureteral injuries due to external blunt violence are quite rare. Less than 40% of these injuries are diagnosed in the first 24 hours. The authors described 2 cases of traumatic injuries of the lower ureter due to pelvic fractures. In both patients the injuries are caused by a bony spicule of the fractured acetabulum. If acetabular fracture occurs possible ureteral injury should be suspected and excluded by an intravenous urogram.