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Biomedical subjects

F J Marx

Publications and source records attributed to F J Marx.

At least 19 recordsLinked to original sources
PubMed1987

[The acute external genital].

Under the heading "acute diseases of the external genital organs" affections of the scrotal contents and the penis (without urethra) demanding immediate therapy are summarized. Crucial is the differential diagnosis epididymitis vs. torsion of the spermatic cord for an error may have very serious consequences for the patient as well as for the physician undertaking primary care. As to the other acute diseases of the scrotal contents the increasingly important role of scrotal sonography is stressed. Among the relatively rare acute affections of the penis traumatic rupture of the corpus cavernosum and priapism of various origin deserve particular interest because delayed wrong treatment may lead to loss of erectile potency.

Acute Disease↗
PubMed1979

[Suprapubic drainage of the bladder (author's transl)].

The principal advantages of suprapubic drainage of the bladder compared with the transurethral indwelling catheter are to be seen in holding back ascending infection of the urinary tract and avoidance of urethral trauma. In addition to relieving the bladder in subvesical obstructions the most important indication in practise is continuous drainage of urine in patients in intensive care. With strict observation of puncture technique and contraindications (contracted bladder, tumors in the lower abdomen, bladder carcinoma, macrohematuria and hemorrhagic diathesis) the entire complication rate is 4.3% (2.3% macrohematuria, 1.5% local infection, 0.5% peritoneal lesion). With the introduction of the disposable puncture systems the suprapubic bladder fistula has become a superior alternative to the indwelling catheter in many cases.

Catheters, Indwelling↗
PubMed1979

[Ectopia of vas deferens with opening into the ureter (author's transl)].

A 13 years old boy with a 2 year history recurrent rightsided epididymitis was found to have an ectopic orifice of the vas deferens opening into the distal part of the left ureter of a hypoplastic left kidney. Because of possible interference with fertility vasovesiculography was not done. Therefore it could not be identified whether the vas deferens was of right or left sided origin. The genesis of this extremely rare malformation is discussed.

Adolescent↗
PubMed1978

[Transfemoral catheter embolization of inoperable kidney cancer].

Ten patients with inoperable renal carcinoma underwent embolization of the renal artery. As embolic material homogenized autologous muscle was used. Besides conventional catheters introduced by the Seldinger technique also flow-directed balloon catheters were employed. The merely palliative purposes of embolization were staunching of otherwise untreatable hematuria in eight and reduction of tumor bulk in two cases. Bleeding could be stopped in all, tumor mass reduced in 6 patients as shown by control angiographies. There was always a recanalization of the renal arteries, the vascular tree, however, being much rarefied. Five patients died of the metastatic cancer within the first seven months after embolization, one patient three days after embolization due to phlegmonous retroperitoneal infection. Further complications consisted in flank pain, reversible rises of body temperature, blood pressure and serum creatinine levels. Thrombotic occlusion of deep veins occurred in two patients. The only true benefit of embolization for the patient consists in a relatively simple, fast and safe way to control an otherwise untreatable hemorrhage from inoperable renal carcinoma. Whether prolongation of survival can be reached remains doubtful in spite of a reduction of the tumor mass.

Aged↗
PubMed1978

[Complications following transfemoral embolization of renal carcinoma. Survey and experience (author's transl)].

A comprehensive survey of the complications following 151 transfemoral embolizations of renal carcinoma is presented, including 9 of our own patients. The main side effects seen after this procedure are (in decreasing frequency): elevation of body temperature, transient elevation of arterial blood pressure, impairment of renal function, infection of the necrotic tumor, thromboembolic incidents, and accidental embolization of other organs. Total lethality is about 3.3%. Possible contraindications and precautionary measures are derived from the discussion of the pathophysiologic reactions in the course of the complication: avoidance of therapeutic embolization immediately after diagnostic angiography, strict asepsis, addition of antibiotics to the embolization mixture, prophylactic administration of heparin, and the use of flowdirected balloon catheters.

Adult↗
PubMed1977

[Septic shock in the urologic patient. III. Microbiological problems (author's transl)].

From a microbiological point of view, the onset of septicemia in urology is related mainly to nosocomial germs; germs acquired outside of the hospital play a lesser role. The special problems caused by this kind of germ are analyzed in terms of our own cases. The limulus test as a possible method for the early diagnosis of gram negative septicemia is discussed critically. Chemotherapy as well as prophylactic measures is discussed.

Age Factors↗
PubMed1977

[Septic shock in the urologic patient. IV. monitoring and therapy (author's transl)].

The high mortality from septic shock in urologically ill patients can only be diminished by early diagnosis and treatment of the sepsis. However, there is no defined, steady sign from which the precise diagnosis septic shock can be established. Therefore the critical patient has to be controlled by a system that covers numerous signs that contribute to the diagnosis. Once septic shock is established its outcome depends on how early the failure of the microcirculation can be eliminated. The therapeutic approach is based on an improved cardiac output achieved by adequate volume therapy and positive inotropic drugs. For this reason the actual circulatory failure has to be defined and each therapeutic step has to be controlled using the Swan Ganz thermodilution catheter. The microcirculatory failure can be treated directly with dextran 40 and with specifically chosen vasoactive drugs. Disorders of the blood gases and base excess have to be corrected immediately. Treatment of acute renal and respiratory failure is mentioned.

Acid-Base Imbalance↗
PubMed1977

[Transfemoral cannulation of the renal vessels. Diagnostic and therapeutic use in urology (author's transl)].

Transfemoral cannulation of renal vessels with the Seldinger technique has been used as well as routine angiography in the following urologic indications. 1. Hypothermic in situ perfusion of the kidney in difficult surgical procedures on the renal parenchyma, e.g., multiple stones, stag-horn calculi, benign and malignant tumors in solitary, residual or functionally residual kidneys. The advantages of this method are sufficient time for surgery, no contamination of blood and therefore excellent view by means of complete ischemia and good long-term results of the renal function. 2. Embolization of inoperable renal tumors to reduce tumor growth and control bleeding. The material used for embolization was a modified preparation of homogenized autologous muscle tissue. 3. Occlusion of the renal artery prior to tumor nephrectomy by a flow-guided balloon catheter in order to reduce the difficulty of the surgical produce, e.g., in massive carcinomatous infiltration of the hilus vessels. 4. Retrograde phlebography of the left internal spermatic vein in recurrent or persistent varicocele and in infertility with only insignificant or doubtful varicocele. The advantage compared with orthograde phlebography via plexus pampiniformis is the direct evidence that the venous reflux causes the varicocele. When the technique has been mastered transfemoral cannulation of the renal vessels can be used in routinely in the clinic Critical consideration of the indications, however, is necessary.

Catheterization↗
PubMed1977

[Septic shock in the uroseptic patient. I. General and specific pathomechanisms of the septic shock (author's transl)].

Failure of microcirculation in septic shock is due to the generalized release of catecholamins following a fall in cardiac output by the activity of bacterial toxin. The failure of the microcirculation can be defined as 1. a failure of the distribution of the tissue perfusion, and 2. a decrease of capillary flow due to obstructed inflow, reduced capillary flow passage and obstructed outflow. Bloodviscosity increases because of fluid sequestration, aggregation of rbc's and decrease in velocity of the blood flow. All this results in a dispariaty of oxygen consumption and availability to the tissue. The characteristics of specific organ disturbances in shock go along with the distribution of the alpha-receptors in each organ, the specific physiological function and architecture of the organ as well as previous diseases of the organ.

Angiotensin II↗
PubMed1977

[Septic shock in the urologic patient. II. Pathomechanisms of hemostatic disorders (author's transl)].

In urosepsis endotoxins usually deriving from gram-negative bacteria can initiate primary disturbances of hemostasis by activation of coagulation up to clinically manifest consumption coagulopathy. The reaction is triggered by an endotoxin induced alteration of granulocytes, endothelial cells, and platelets, thereby releasing procoagulant activities that possibly cause diffuse intravascular coagulation with impairment of vital organs. Additional negative effects on hemostasis can be caused by secondary hyperfibrino(geno)lysis. Secondary disturbances of hemostasis occur in urosepsis as a consequence of an impairment of liver (hypoproduction of coagulation factors, decrease of the clearance of activated coagulation factors) and kidney function (thrombocytopathy by uremic toxins). Disturbances of hemostasis induced by the treatment of urosepsis are the K-hypovitaminosis in parenteral feeding accompanied by antibiotics affecting the intestinal bacterial growth and the alteration of platelet function and fibrin formation by carbenicillin.

Carbenicillin↗
PubMed1977

[Vaginal metastasis of renal carcinoma (author's transl)].

Four cases of vaginal metastases of renal carcinoma are reported. This is an incidence of 1.3% in 313 operated patients (from 1/1/70 to 12/31/76). A surgical treatment of primary renal carcinoma and vaginal metastasis seems to be reasonable in there cases. Since in accordance with the literature metastatic involvement of vagina and vulva seems not to be a very rare finding, the diagnostic in renal carcinoma should imply a gynecologic examination. Although in carcinoma of the left kidney metastatic spreading into the external female genitalia most probably occurs by a retrograde venous pathway (left ovarian vein), the way of dissemination in carcinoma of the right side is unclear.

Aged↗
PubMed1975

[Mycoplasma prostatourethritis. The improtance of immunoelectrophoresis of the ejaculate for the diagnosis].

The secretions expessed from the prostate and/or urethral smears from 846 patients of a prostatitis clinic were examined microbiologically. With negative findings in 62.9%, which suggested a high proportion of patients with a vegetative urogenital syndrome, mycoplasma could be isolated in 9.9% of the entire collective. In the cases with mycoplasma in the expressed prostatic secretion, a close, statistically significant correlation to the degree of clinical complaint and the mumber of leukocytes in the secretion was established. Immunoelectrophoresis of the ejaculate was carried out in 20 subjects in the mycoplasma group. Although unequivocal statement are not yet possible because of the small number of cases, there is a statistically striking trend towards infection with urea-splitting mycoplasma when the immunoelectrophoresis of the ejaculate is unchanged, which might indicate the induction of a predominantly localised urethritis due to this strain.

Humans↗