Biomedical subjects
Publications and source records attributed to D Jonas.
The simultaneous appearance of bilateral testicular germ cell tumors is a rare clinicopathologic entity. Two new cases are described, both presenting as bilateral seminoma. The incidence is estimated to be approximately 1% of all testicular tumors. A synopsis of 89 cases published to date is given.
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13 cases of Angiomyolipoma are presented with special regards to clinical presentation and diagnostic and therapeutic procedures. Combined use of ultrasonography and computer tomography proved to be accurate diagnostically. Questions concerning the nature of Angiomyolipoma are discussed.
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Critical injuries of the kidney have to be treated surgically immediately. Here also have to consider the same rules of the surgery that go with an acute abdomen. By slight and severe injuries to the kidneys there is adaequate time for a thorrow diagnostic work up, prior to eventual operative intervention. The extreme rare ureter lesions with the symptomatic of a peritonism due to an urinoma and a retroperitoneal haematoma have to be treated operatively at the earliest possible time. Injuries to the urine bladder have always to be treated operatively with a special urgency since letality increases rapidly after six hours after the injury. Lesions of the urethra have to be treated operatively early by eliminating haematoma and urine and exact anastomosis of urethra's stumps to avoid later complications through scar-building.
40% or 116 of 350 patients with renal carcinoma had distant metastases at the time of hospital admission (M1, N0-4). Women fell ill less often than men did (3:7). 82 of 116 patients (71%) received nephrectomy primarily. Lethality within the first 30 days was 6%. Patients with nephrectomy survived longer than those without, women with nephrectomy survived longer than men. Patients with a grade II tumor survived longer than those with a grade III tumor. Palliative nephrectomy can therefore be recommended as treatment of choice, if the general condition of the patient allows it, the more so as there are no alternative ways of treatment.
In an animal experiment, excellent results were obtained using both microsurgical mucosa and all-layer, single-knot polyglactin (8/0 Vicryl) suture of the ureter. These results motivated clinical use of this microsurgical operative technique on five infants (4-9 months of age) with stenosis of the pelvis outlet. Both the microsurgical and suture techniques are equally suitable for plastic surgery of the renal pelvis, particularly with small anatomical conditions. However, all-layer suture carried out with magnifying lenses seems to be the simpler method, as the 8/0 Vicryl suture used becomes completely epithelialized intraluminally within a short period of time.
We investigated in a prospective study the effects of perioperative blood transfusions on the outcome of renal transplantation. All patients (n = 105) receiving their first cadaveric renal allograft were transfused perioperatively (i.e. 0-6 hours before transplantation) with two units of non-washed, unfiltered packed red cells. Forty-eight were transfused perioperatively only; 57 patients had received blood earlier and thus were transfused pre- and perioperatively. Graft survival one and two years post-transplant was 79 per cent at both time intervals in the group transfused perioperatively only, and 85 per cent and 74 per cent in the pre- and peroperatively transfused group. No adverse effects were observed concerning perioperative transfusions. In patients transfused perioperatively only, acceptable graft survival rates are obtainable. In these patients the risk or presensitisation is avoided, and thus their chance of successful transplantation increased.
The vast majority of grafts with acute vascular rejection (AVR) undergoes irreversible loss of function, since this type of rejection usually does not respond to increased immunosuppression. Since 1980 we have treated in 22 patients 27 steroid resistant AVR by plasmafiltration (PF). Per episode 6 x 5 L plasma were filtered and simultaneously replaced by 3.5% Albumin-Ringer-lactate. After each PF 20 g immunoglobulins (Intraglobin(R] was substituted i.v.. In all cases renal function improved following PF. In the long run 1 graft was lost due to chronic irreversible vascular rejection, in 2 patients rejection was not reversed by PF, all others are still functioning, 19 of them 6 months and 8 of them 12 months post PF treatment. They show no signs of rejection. PF with repletion of immunoglobulins after treatment is a simple and safe procedure, which in our hands proved to be quite effectful in reversal of AVR.
The main advantages of retrograde infusion-urethrocystography are compared with conventional diagnostic procedures: a sterile infusion set is used for small anatomic situations in the childs urethra; the radiological evaluation of the urethra can be performed painlessly, non invasively, and avoids radiation of the investigator as shown by the examination of 35 young patients in our department.
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Between 1973 and 1981 23 transplantations of kidneys from living related donors have been performed in Frankfurt/Main. Donor complications were haematopneumothorax (1 case) and reversible urinary tract infections (3 cases). All donors were discharged after 8-12 days, all have until now (6 months to 8 years postoperatively) normal excretory renal function and normal arterial blood pressure. Patient-survival in the recipients is 5 years postoperatively 96% and graft-survival is 90%. Nine patients received HLA-identical kidneys, all have excellent to fair function of the grafts, 7 patients are off steroids. In 14 cases kidneys were transplanted, although donor and recipient shared only one haplotype. In these patients 5-year graft survival is 84%. Seven patients have normal graft function, whereas 6 patients have a reduced function or have rejected. One patient died. Results of kidney transplantation using living related donors are--even when donors with only one haplotype-identity are accepted--much better than those obtainable when using cadaveric donors. When renal transplantation is considered, patients should be informed about the favourable results attainable with kidneys from living related donors.
In an experimental study in dogs, four different techniques of microsurgical anastomosis using Vicryl 8-0, have been compared: 1. Interrupted submucosal sutures; 2. Continuous submucosal sutures; 3. Full thickness interrupted sutures; 4. Full thickness continuous sutures. Intravenous urography and electron microscopic studies three months post operatively showed that ureteric stricture had occurred in only 2 cases out of 24. Microsurgical techniques are recommended for ureteric anastomoses.
Eight out of 35 human intracranial tumors were shown by restriction enzyme analysis to contain unintegrated simian virus 40 (SV40) DNA molecules. The relative amount of viral DNA was estimated to be the equivalent of one viral genome within every 10th to 20th cell. No infectious virus was detected in tissue cultures established from the tumors. From only one tumor was it possible to rescue, by cell fusion, infectious SV40 displaying wild-type properties. In those cases that permitted a more detailed analysis, the restriction enzyme cleavage patterns appeared to correspond to the wild-type patterns with one exception, in which the SV40 episomes displayed a deletion of approximately 70 base pairs close to the origin of DNA replication. From one tumor, the SV40 genomes were transferred into permissive CV-1 monkey cells by transfection with the total tumor DNA. Despite their persistence as episomes no infectious virus was produced. Furthermore, no viral antigens were detectable, although the SV40 messengers for the small and the large tumor antigens were present. These cells had, however, acquired the ability to form colonies in low concentrations of serum. Thus this report provides, by restriction enzyme analysis, direct evidence for the presence of SV40 DNA in human tumors.
An attempt was made to trace alpha-adrenoceptor-binding sites in the lower urinary tract tissue of the rat by means of analyzing the distribution of radioactivity in autoradiograms of freeze-dried or glutaraldehyde-fixed tissue following intravenous injection of an alpha-agonist, 3H-ST-1059, or an alpha-antagonist, 3H-phentolamine. Both drugs were rapidly excreted into the urine and reabsorbed by the bladder mucosa. This is evidenced by the presence of high amounts of silver grains superimposed onto the epithelium and bordering the lamina propria structures 10-30 min after intravenous injection of 3H-ST-1059 or 3H-phentolamine in rats not subjected to ligation of their ureters. In rats that underwent ligation of their abdominal ureters prior to intravenous injection of 3H-ST-1059 or 3H-phentolamine, silver grains were preferentially localized over the plasmalemmata of smooth muscle cells and fibroblasts of the detrusor and trigonum of the urinary bladder. Phentolamine and phenoxybenzamine but not propranolol counteracted the labelling of the plasma membranes of smooth muscle cells, fibroblasts and striated muscle fibres of the pelvic floor by low doses of 3H-ST-1059 and 3H-phentolamine, suggesting that both drugs have affinity to alpha-adrenoceptor-agonist and alpha-adrenoceptor-antagonist binding sites. Since phentolamine and phenoxybenzamine as well as hydrocortisone pretreatment also attenuated the accumulation of radiolabel in the perikarya of the three types of cells mentioned, both drugs--at the concentration used--are also substrates for membrane-bound carriers, such as uptake two according to Iversen. A more selective in vivo demonstrationof alpha-agonist-binding and alpha-antagonist-binding sites requires drugs of higher specific activity than available at present.
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The long-term treatment of retrograde ejaculation disorders following retroperitoneal lymphadenectomy with the alpha-sympathomimetic, Midodrin, administered orally, led to improvements in the intensity of orgasm and the degree of erection. Normal ejaculation was induced in 7 out of 12 patients and emission of spermatozoa into the posterior urethra was restored in 3 out of 12 patients by a single intravenous injection of 25--30 mg Midodrin.
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