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Biomedical subjects

H Porst

Publications and source records attributed to H Porst.

At least 19 recordsLinked to original sources
PubMed1990

[The diagnostic value of MR tomography following gadolinium-DTPA compared to computed tomography in bladder tumors].

In a prospective study, 58 patients with carcinomas of the bladder were examined by CT and MRI; in 48, gadolinium-DTPA was administered intravenously. MRI provided exact staging in 89%, compared with 80% with CT. There was 13% over-staging with CT and 11% with MRI. MRI, unlike CT did not result in any under-staging. In 36 patients a quotient could be calculated from the signal intensity of the tumour and surrounding soft tissues both before and after the intravenous contrast medium and the increased quotient after contrast administration could be estimated. There was a significant increase in the tumour/muscle quotient with a mean of 72 +/- 22% (minimum 43%, maximum 153%), corresponding to a marked increase of the signal from the tumour when compared with the pre-contrast images. This had the following advantages compared with CT: accurate differentiation between superficial and intramural spread. MRI was better than CT at demonstrating tumours in the roof of the bladder and at the trigone.

Adult↗
PubMed1990

[Pharmacoangiography and pharmacoangiodynography of the penis in erectile dysfunction].

In 80 patients suffering from eretile dysfunction both pharmaco-angiography and pharmaco-Dopplerultrasonography of the penis were performed. The two methods showed a correlation of 96% with regard to the dorsal arteries and 92% with regard to the deep penile arteries. In a further 21 patients with erectile dysfunction pharmaco-angiodynography with the new QUANTUM device from Philips has been performed in recent weeks. The excellent illustration of vasculogenic details, even in the penile periphery, the exact measurement of the relevant hemodynamic parameters, e.g. peak flow velocity or pulsatility index, the short time needed for investigation and its non-invasive character give convincing evidence for the superiority of this new method over conventional angiographic procedures. This is also true when procedures for revascularization of the penis are planned. The only remaining indication for conventional pharmaco-angiography of the penis is now clarification of the connections in posttraumatic impotence of arterial etiology.

Alprostadil↗
PubMed1990

[Drug-induced liver damage from the clinical viewpoint].

Extensive drug-induced hepatic injury leading up to jaundice occurs relatively rarely. Generally it is not predictable, independent on dosage and irreproductible in animals. As a rule you find it in less than 0.1% of the patients taking the drug, whereas the degree may range up to heavy or lethal (e.g. for isoniazid, methyldopa, halothane). Pathogenetically reactive metabolites capable of producing cytotoxic and/or immune reactions may play a role. Obviously higher age, female sex and endogenous or exogenous alterations in hepatocellular drug metabolism are disposing factors. Drugs, to which our patients most frequently reacted, were dihydralazine alone or in combination with propranolol, and ketophenylbutazone. The lymphocyte transformation test proved diagnostically valuable although it cannot be considered to represent a generally reliable testing method for drug-induced liver disease. Clinical, laboratory and histological findings are typical with a wider range of drugs, but liver biopsy provides the most reliable criteria. Clinical suspicion and stopping the intake of potentially noxious drugs are of importance. The reexposition test should be reserved to exceptional cases.

Chemical and Drug Induced Liver Injury↗
PubMed1989

[Erectile dysfunction. Review and current status of diagnosis and therapy].

A rational concept of the diagnostic evaluation and treatment of erectile dysfunction (ED) is based on the corpus cavernosum drug test (CCDT) employing in combination with penis Doppler sonography. A positive CCDT with erection within 10 minutes indicates psychogenic or neurogenic ED, which is treated with sexual therapy of intracavernous (self)injection (ICI, ICSI). An erection after 10-30 minutes and pathological Doppler sonographic findings document a hemodynamically relevant penile blood flow disturbance which is treated with papaverine administered by ICI or ICSI. A negative CCDT with normal Doppler findings correlates with venous insufficiency as the cause of ED. On the basis of the results of drug cavernosography the indication for venous or penile prosthetic surgery is established. Depending on the pathological Doppler sonographic findings, in negativ CCDT the surgical treatment comprises prosthesis implantation or, in suitable cases, revascularization procedures.

Diagnosis, Differential↗
PubMed1989

Noradrenaline release in human corpus cavernosum and its modulation via presynaptic alpha 2-adrenoceptors.

Strips of human corpus cavernosum were incubated with 3H-noradrenaline and subsequently superfused with physiological salt solution containing desipramine and corticosterone. The electrically (0.66 Hz) evoked tritium overflow was abolished by tetrodotoxin or omission of Ca2+ from the superfusion fluid. The alpha 2-adrenoceptor agonist B-HT 920 (6-allyl-2-amino-5, 6, 7, 8-4H-thiazolo-5,4-d-azepine), inhibited the evoked overflow, whereas the alpha 1-adrenoceptor agonist, methoxamine, was ineffective. The alpha 2-adrenoceptor antagonist, rauwolscine, facilitated the evoked tritium overflow. It is concluded that the stimulation-evoked release of noradrenaline from the sympathetic nerve fibres of the human corpus cavernosum is modulated via presynaptic alpha 2-adrenoceptors.

Adolescent↗
PubMed1989

Intracavernous self-injection of prostaglandin E1 in the therapy of erectile dysfunction.

The efficacy of intracavernous autoinjection therapy with prostaglandin E1 was investigated over a period of up to six months in 187 patients with long-term erectile dysfunction. All patients had to undergo an investigation program consisting of routine laboratory tests, directional doppler sonography of the penile arteries, measurements of the BCR-latencies, as well as intracuvernum drug testing with PGE1. Six months follow-up results are available so far in 115 patients. The mean injection dose was 13.5 mcg PGE1 at the beginning of therapy and 12.8 mcg PGE1 at the end of therapy. An average of 24 prostaglandin E1 injections per patient was given. In 16.6% of the 187 patients slight to moderate pain occurred at the injection site, not influencing sexual intercourse. No priapisms lasting more than six hours were observed. A significant improvement of the blood flow in the deep and dorsal penile arteries was shown by penile doppler sonography after 6 months treatment. The efficacy and tolerability of the therapy were designated as very good to good in 91% respectively in 98% of the patients. 94% of the patients would like to continue the therapy. The results indicate that PGE1 due to its erectile potency and great tolerability will occupy an important position in the therapy of the erectile dysfunction.

Adult↗
PubMed1989

[Prostaglandin E1 in erectile dysfunction].

Of 447 presenting with erectile dysfunction, 322 (72%) responded to intracavernous injection of PGE1 with erections that were adequate for sexual intercourse. A multidisciplinary comparative study of PGE1 and other vasoactive drugs, e.g., papaverine or the combination of papaverine and phentolamine, was performed in 249 patients. Whereas 180 of the 249 patients (72.3%) showed adequate erections after 10 or 20 micrograms PGE1, only 79 of them (31.3%) did so after papaverine. A further 72 of the 249 patients (29%) had adequate erections after papaverine/phentolamine; thus, a total of 151 of 249 patients (60.3%) developed good erections after papaverine/phentolamine. Whereas after PGE1 no patients at all suffered from priapism lasting more than 6 h, this occurred in 13 of 249 patients (5.2%) after papaverine or papaverine/phentolamine. After intracavernous injection of PGE1, 9.4% of the patients complained of uncomfortable penile sensations during erection interfering with sexual intercourse. Since the initial study, 60 patients have been instructed in self-injection therapy and a further 45 patients obtain intracavernous PGE1 injections periodically, with very promising results. In vitro studies of cavernosal tissue samples obtained from potent men with penile deviations showed both the excellent relaxation of the smooth muscles of cavernous bodies by PGE1 and the antiadrenergic effect of the drug.

Alprostadil↗
PubMed1989

[Drug-induced priapism--a report of experiences in 101 cases].

Within a period of 3 1/2 years, 101 patients with drug-induced priapism lasting more than 6 h were observed. In 73 of the 101 patients (average age 47.4 years) with an average duration of priapism of 11.9 h priapism was interrupted by means including cavernosal puncture, evacuation, and injection of metaraminol. In 28 patients priapism subsided after an average duration of 8.8 h without medical intervention. Intracavernous blood gas analyses revealed unphysiological acid values with clearly negative excess base values. Nevertheless, in the present series only 3 patients had irreversible damage of cavernosal function as a sequela of priapism of more than 24 h duration. Intracavernosal injection of meta-ramininol was followed by severe hypertensive crisis in 2 patients. These results show convincingly that the demand for early interruption of drug-induced priapism within a time limit of 6 h is not based on objective necessity. Interruption of drug-induced priapism within 6-8 h seems to be adequate. Prostaglandin E1 has proved a reliable means of preventing priapism in the initial test period.

Adult↗
PubMed1989

[Corporoplasty of congenital and acquired penis deviations. Technic and results in 62 patients].

Between 1985 and 1988, a total of 62 patients with penile deviations underwent corporoplasty; 26 (average age 22.2 years) of the patients had congenital, mainly ventrally directed deviations and 36 (average age 51.7 years), acquired, mainly dorsally directed deviations most of which were due to Peyronie's disease. With a follow-up of at least 6 months (range 6 months to 3 1/2 years), 92.3% of the patients with congenital deviations and 72% of those with acquired curvatures expressed unqualified satisfaction with the results of surgery and said they would agree to the operation again. There were few complications: one patient experienced hematoma requiring reoperation and one patient, a skin necrosis resulting from incorrect wound dressing; three patients complained of recurrence of the angulation, which resulted from plication of the tunica albuginea alone without excision in all three. These results justify the statement that the original Nesbit procedure is the method of choice in both congenital and acquired penile deviations and yields a high success rate. Only in patients with relevant impairment of erectile capacity does the primary insertion of an penile prosthesis seems to be justified.

Adult↗
PubMed1988

[Disorders of the hypothalamo-hypophyseal-gonadal axis and erectile impotence].

In the course of a standardized diagnostic programme LH, FSH, testosterone, prolactin and oestradiol were measured in 204 patients with erectile impotence (mean age 47.6 years). A purely organogenic abnormality was found in 125 (61.3%), a mixed organogenic-psychogenic one in 39 (19.1%), and a purely psychogenic one in 40 (19.6%). Thirteen patients (6.3%) had an abnormality of the hypothalamic-hypophyseal-gonadal axis, nine in addition had severe organogenic changes as the clear cause of the impotence. History and clinical findings were unremarkable in only one patient. Routine determination of hormones would seem to be cost-effective only if an important organic deficit has been excluded as the cause of an erection abnormality and therapeutic consequences can be drawn from any abnormal hormone values that are obtained.

Adult↗
PubMed1988

Bulbocavernosus reflex latencies and somatosensory evoked potentials after pudendal nerve stimulation in the diagnosis of impotence.

The bulbocavernosus reflex (BCR) was examined in 39 normal potent men and in 252 patients with impaired potency of varying aetiology. For BCR evaluation minimum, maximum and mean latencies, the temporal dispersion in ten successive responses, together with minimum and maximum side differences from simultaneous recordings of the left and right bulbocavernosus muscles were determined. Pathological findings were detected in 125 patients. Somatosensory evoked potentials (SSEPs) recorded from the scalp after stimulation of the penile dorsal nerves and the terminal branches of the pudendal nerve were investigated in 30 controls and in 246 patients. An abnormal SSEP was found in 63 patients.

Adolescent↗
PubMed1988

[Echo morphology of testicular tumors].

The ultrasound and histological findings of 130 testicular tumours were compared; these included 56 seminomas, 49 teratomas, 16 mixed tumours, five Leydig cell tumours, three lymphomas and one metastasis. There was only a slight tendency to low echo homogeneous structure with seminomas and low echo irregular structure with teratomas and mixed tumours. Cystic components, or strongly echogenic structures, were found in 20 to 30% of primary testicular malignant tumours, but these findings were non-specific. Cystic lesions were found at histology to be due to necroses, haemorrhage or specific tumour cysts. Strongly echogenic appearances correlated with calcification, fibrosis or bone or cartilage development. There were no specific sonographic criteria suitable for the identification of specific tumour types.

Adult↗
PubMed1988

Neurophysiological investigations in potent and impotent men. Assessment of bulbocavernosus reflex latencies and somatosensory evoked potentials.

A multidisciplinary investigation was carried out on 130 patients with erectile dysfunction. The bulbocavernosus reflex (BCR) latency times were evaluated in all patients and in 116 the somatosensory evoked potentials (SSEP) were also assessed. BCR latency times were examined in 39 potent control patients and the SSEP were measured in 30 members of this group. There were no abnormal findings in the control group. Of the 130 patients with erectile dysfunction, 65 had anomalies in the BCR measurements and 36 of 116 patients had abnormal SSEP findings. When compared with the control group, 76 of 130 patients with erectile disorders (66%) had irregularities in BCR latency times and/or SSEP. As a result of these findings, lesions of the somatic penile innervation are considered to be one of the many causes of erectile dysfunction.

Adolescent↗
PubMed1988

Pediatric blunt renal trauma--surgical or conservative treatment?

To evaluate the indications for conservative and surgical treatment, we analyzed the type of injury, associated injuries, diagnostic procedures and the results of therapy. Contusions were treated conservatively. In the 24 severe injuries surgery rate was 66% (16/24), renal loss rate was 16% (4/24), the other organs being saved by the operation. With primarily conservative treatment we had to operate in 1 case only due to recurrent hematuria; the renal loss rate was 0%. As indications for surgical treatment we defined: (1) deteriorating vital signs, (2) pedicle injuries and (3) large extravasations of contrast medium.

Adolescent↗
PubMed1988

[Inguinal metastasis of stage I testicular tumors].

In 9 of 152 patients treated between 1975 and 1985 for stage I germ cell tumours of the testis we saw inguinal metastases. They appeared 2 to 26 months (median = 9.3 months) after orchiectomy and unilateral lymphadenectomy, including peri-iliac lymphadenectomy. In 3 cases predisposing factors such as surgical interference or local tumour extent explained the unusual metastasis; in 6 patients it was obviously due to atypical lymphatic drainage. The therapy of choice in these cases is (adjuvant) chemotherapy and salvage lymphadenectomy in the case of residual tumour.

Antineoplastic Agents↗
PubMed1988

[Value of prostaglandin El in the diagnosis of erectile dysfunction in comparison with papaverine and papaverine/phentolamine in 61 patients with erectile dysfunction].

In 61 patients with erectile dysfunction a comparative study with intracavernous injection of prostaglandin E1 (PGE1), papaverine and a mixture of papaverine and phentolamine was performed. All patients underwent comprehensive multidisciplinary examinations, including bulbocavernosus reflex (BCR) latencies and somatosensory evoked potentials, penile Doppler sonography, dynamic or pharmaco-cavernosonography, and for 11 patients nocturnal penile tumescence (NPT) was also recorded with the Rigiscan. This diagnostic approach suggested that in 24 (39.3%) of the 61 pts the etiology was psychogenic and in the remaining 37 (60.7%) it was organogenic. PGE1 had a much higher erectile potency than papaverine and a somewhat higher potency than the mixture of papaverine and phentolamine. Complete erection was achieved in 41 of the 61 patients (67.2%) with PGE1, as against 20 of the 61 patients (32.8%) with papaverine alone and 20 of the 61 (32.8%) with papaverine/phentolamine. Whereas 7 of 61 patients (11.5%) had priapism of more than 6 h duration and requiring therapy after injection of papaverine or papaverine/phentolamine, no priapism occurred after PGE1. Thus, compared with papaverine and phentolamine, PGE1 offers important advantages in the diagnosis and perhaps also in the therapy of erectile dysfunction.

Adult↗
PubMed1988

[Complete separation of the cavernous bodies with penis deviation--an epispadias equivalent].

The presented case report describes the not-yet-published existence of an epispadia equivalent, which consists of the complete separation of both cavernous bodies associated with both an atypical location of the urethral orifice on the dorsal site of the glans and a considerable ventral deviation of the penis. This separation was simultaneously associated with a unilateral arterialization of the whole penis via the right internal pudendal artery. The patient complained about an inadequate sexual performance, which was due to a marked ventral penile curvature requiring surgical correction. The operative approach included not only a corporoplasty, but also a complicated fusion of the cavernous bodies, accomplished by a fenestration and subsequent anastomosis. The result was cosmetically and functionally optimal.

Adult↗