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Biomedical subjects

J Rassweiler

Publications and source records attributed to J Rassweiler.

At least 19 recordsLinked to original sources
PubMed1992

Extracorporeal shock wave lithotripsy of ureteric stones with the Modulith SL 20.

A series of 138 patients with ureteric calculi was treated by in situ extracorporeal shock wave lithotripsy (ESWL) during the clinical introduction of the Modulith SL 20. This machine represents a newly developed lithotriptor with an electromagnetic cylinder as shock wave source and a dual localisation system consisting of in-line ultrasound and an integrated fluoroscope C-arm. During the first 2 months, 12 patients (phase 1) were treated under ultrasound localisation alone; during the next 5 months, 37 patients (phase 2) were treated using dual imaging modalities with reduced peak pressure (max. 18 kV = 800 bar); during the final 7 months, 89 patients (phase 3) were treated under ultrasonic and fluoroscopic localisation combined with an increased maximal shock wave pressure (20 kV = 1024 bar). The introduction of fluoroscopic targeting (phases 2 and 3) resulted in satisfactory localisation of calculi in the mid-ureter, previously limited by use of only coaxial ultrasound. The extension of stone localisation to the whole length of the ureter was associated with a marked decrease in treatment time, reflecting the easy handling of the dual localisation system. The rise in generator voltage (phase 3) improved the disintegration rate from 81% (phase 2) to 85%, whereas the number of impulses remained unchanged. However, the rate of auxiliary procedures following ESWL (adjuvant and curative) was reduced from 33% (phase 2) to 24.5%. Thus the Modulith SL 20 in its final design enables in situ ESWL to be the treatment of choice for all ureteric calculi, rendering special positioning techniques or multiple treatment unnecessary.

Humans↗
PubMed1992

Penile revascularization in nonresponders to intracavernous injections using a modified microsurgical technique.

At certain centers, microsurgical penile revascularization, using different surgical techniques, has gained importance throughout the past years. In general, only patients classified as intracavernous injection nonresponders are subjected to this kind of surgery. Since 1988, revascularization surgery has been performed at our clinic on 19 intracavernous injection nonresponders. The Hauri technique was carried out on the first 6 patients. The last 10 patients underwent modified anastomosis surgery. The inferior epigastric artery and the dorsal penile artery are anastomosed, one behind the other, end-to-side, to the dorsal penile vein. This results in a more simple procedure with assurance of flow. The Virag technique was performed on 3 patients. 18 patients achieved erections with or without the aid of intracavernous injections (at a mean follow-up of 13.4 months). 11 patients were capable of spontaneous erections, whereby it was particularly noted that 8 of the 10 patients undergoing the modified technique achieved spontaneous erections. The results demonstrate that intracavernous injection nonresponders benefit from revascularization surgery.

Alprostadil↗
PubMed1991

[Success and failure with double J ureteral stent. Analysis of 107 cases].

An internal urinary diversion of the upper urinary tract was planned in 107 patients with acute, stone-related or chronic tumor-induced ureteral obstruction. Acute ureteral obstruction (n = 34, group I): in 30 of 32 cases (94.1%), successful placement of an indwelling stent resulted in complete drainage in 28 of 30 patients (93.7%). In 2 cases, no satisfactory urine diversion was possible, despite several catheter changes and confirmed clearway through the installed catheters. Chronic ureteral obstruction (n = 73, group II): successful placement of the indwelling stent was possible in 63 of 73 (86.3%) cases. Complete urine diversion was achieved in only 25 patients (39.7%). Hydronephrosis was diminished in 28 patients (44.4%) and persisted or increased in 10 cases (15.9%), despite orthotopic positioning of the catheter and numerous stent changes. Complete urine drainage was achieved with an internal urine diversion in only 4 of 10 cases with chronic hydronephrosis. It is assumed that the reason for the high failure rate lies in the catheter construction and, with respect to chronic hydronephrosis, the reduced or non-existent contractility of the upper urinary tract in combination with the inevitable pressure connection between the upper and lower urinary tract.

Acute Disease↗
PubMed1990

Minimally invasive treatment of ureteric calculi using modern techniques.

Between July 1985 and July 1986, 226 upper and 62 distal ureteric calculi were treated. In situ extracorporeal shockwave lithotripsy (ESWL) is the treatment of choice for upper and distal ureteric calculi, with success rates of 81 and 76% respectively. Retrograde manipulation of the calculus was undertaken only when in situ ESWL was impossible because of difficulty in localisation. Although ESWL after successful mobilisation was successful in 95% of patients, retrograde mobilisation was possible in only 80%. Antegrade ureterorenoscopy via a percutaneous nephrostomy was performed to avoid open surgery if retrograde mobilisation was not feasible, and was successful in 90%. Two second generation lithotripters, the modified Dornier HM3+ and the Wolf Piezolith 2200, both suitable for treatment without anaesthesia, were compared in terms of efficacy. In situ ESWL of upper ureteric calculi was successful in 70.6% with the HM3+ and 37.2% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2200 because of inadequate ultrasound localisation. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. We report our experience of ESWL using the prone position for iliac ureteric calculi; 8 of 10 patients were treated successfully in situ.

Humans↗
PubMed1990

Modulith SL 10/20--experimental introduction and first clinical experience with a new interdisciplinary lithotriptor.

More than 20 second-generation lithotriptors have been introduced for extracorporeal shock-wave lithotripsy. Despite great technical progress, each machine still has its specific short-comings. In cooperation, Storz Medical (Kreuzlingen, Switzerland) and the Department of Urology (Klinikum Mannheim, FRG), have developed a new lithotriptor designed to overcome these drawbacks. Energy source: Electromagnetic cylinder with paraboloid reflector (40 cm) for focusing, providing a wide range of pressure (190-1,000 bar) and a focal zone of 28 x 6 mm. The focal depth is maximally 15 cm. Coupling and positioning: Water cushion with patient lying on a specially designed 'acoustic cradle' consisting of an impedance-adapted foil. This is integrated in either a manually or automatically operated table. Localization: Coaxial ultrasound probe for real-time scanning and integrated C arm with pulsed fluoroscopy using a virtual focus (moved along x-axis) for stone localization. In 1989, we commenced with the first treatment based on our own in vitro and in vivo studies to determine the range of energy required for safe application. We treated 137 stones (100 caliceal, 19 pelvic and 18 ureteral) in 88 patients. The mean generator voltage was 16 kV (10-18 kV). Successful disintegration was achieved in 83 patients (95%) employing an average of 2,359 impulses (940-3,500). Thirteen percent of the treatments were performed without any anesthesia on lower generator voltage (10-15 kV), whereas the majority of calculi were treated under intravenous analgesia. The 5 failure cases included 2 stones in a caliceal diverticulum. Moreover, 12 patients with biliary calculi (11 gallstones and 1 bile duct stone) were successfully treated; 1 of these cases required a second treatment session.

Animals↗
PubMed1990

ESWL for ureteral calculi. Using the Dornier HM 3, HM 3+ and Wolf Piezolith 2,200.

In a one year period from July 1985 to July 1986 226 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76% respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of the anesthesia, the modified Dornier HM 3- and the Wolf Piezolith 2,200 were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful with the Piezolith 2,200. In situ ESWL of middle ureteric calculi was successful 81.8% with modified HM 3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2,200 due to insufficient localization with ultrasound of middle ureteric calculi were treated successfully in 71.4% with the modified Dornier HM 3+ and in 64% with the Piezolith 2,200. First clinical experience of ESWL in prone position for iliac ureteric calculi was reported. 8 of 10 cases were treated successfully in situ.

Humans↗
PubMed1990

[Electronic data processing-assisted text processing at the clinic and in general practice].

Word processing is currently the most frequent application for personal computers, and a wide variety of standard software is available. The capabilities of modern word-processing software includes the convenient typing and correction of all routine correspondence, as well as the professional layout of scientific manuscripts. The decision to purchase a certain word-processing programm should be made according to local needs and prerequisities. Three to six months may be necessary to fully adapt the organization of a clinic or private practice to the new technology.

Computer Systems↗
PubMed1990

Minimal invasive therapy of ureteral calculi using modern techniques.

In a one year period from July 1985 to July 1986, 224 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76%, respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of anesthesia, the modified Dornier HM3+ and the Wolf Piezolith 2200, were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful for upper ureter calculi in 70.7% with the HM3+ and 37.9% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the piezolith 2200 due to insufficient localization of middle ureteric calculi with ultrasound. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. Our initial clinical experience with ESWL in the prone position for iliac ureteric calculi is reported. Eight of 10 cases were treated successfully in situ.

Humans↗
PubMed1989

[Extracorporeal shockwave lithotripsy. Current status in treatment of kidney calculus disease].

The introduction of extracorporal shock wave lithotripsy has led to a revolution in stone management. After five years of clinical experience with increasing use of second generation lithotripters, the following conclusions can be drawn: There is an increasing tendency to employ ESWL for ureteral calculi, although only 60% of those can be located by ultrasound. In the case of staghorn stones, a differentiated approach is adopted (ESWL-, PCNL-monotherapy or a combination of the two) depending on stone size, localisation, chemical composition, radiodensity, and the state of the collecting system. With almost all second generation lithotripters, ESWL can be performed under i.v.-analgesia. Some machines with a large-aperture shock wave source (i.e. Wolf Piezolith, Edap LT 01, Dornier MPL 9000) even permit painfree treatment without the need for analgesia. However, this is associated with a 30% increase in retreatment rate. Further development of low-cost lithotripters and increasing use of ESWL for biliary stones make it necessary for ever more hospitals to face the question of installing such a machine. In this situation, the choice must be based on the local situation (i.e. number of patients, interdisciplinary use of ESWL).

Humans↗
PubMed1989

Wolf Piezolith 2200 versus the modified Dornier HM3. Efficacy and range of indications.

From February to September 1987, a prospective study was performed at two clinics to compare the Piezolith and the Dornier HM3+ lithotripters. Based on the same clinical indications for extracorporeal shock wave lithotripsy, 334 patients were treated with the Dornier HM3+ and 378 patients with the Piezolith. Whereas stone size was similar in both groups, more ureteral calculi were treated with the Dornier HM3+ (31.1 versus 23%). The rate of successful disintegration and total number of auxiliary measures were similar in both groups. However, the mean number of impulses (HM3+ 1,997 versus Piezolith 2,855) and number of secondary ESWL treatments (HM3+ 15.5% versus Piezolith 45%) differed significantly. According to the locating systems, the success of in situ treatment was similar for renal calculi; however, fewer ureteric stones could be treated in situ at the Piezolith (HM3+ upper ureter 70.6%, middle ureter 82%, distal ureter 71.4% versus Piezolith upper ureter 37.5%, middle ureter 0%, distal ureter 62.8%). The stone-free rate at discharge and after 3 months did not differ in both centers (HM3+ 75% versus Piezolith 72%).

Child↗
PubMed1989

Technical considerations using a pulsed neodym-YAG laser for endoscopic shock wave lithotripsy.

First clinical experience with the use of a Q-switched pulsed Neodym-YAG Laser showed promising results. This paper focuses on two problems with respect to the optimal use of this laser: (1) is there any need for a special iron (Fe3+)-enriched irrigant, and (2) what is the best frequency for laser lithotripsy? To answer these questions, we used an in vitro model, measuring the laser-induced breakdown (LIB) photographically utilizing sodium chloride as an irrigant enriched with different amounts of Fe3+ ions. The disintegrative efficacy of the laser was tested utilizing a standard stone model (plaster cube) and working at different frequencies (1, 10, 40 Hz). The addition of Fe3+ ions resulted in significant improvement of LIB. However, in the presence of a test stone no difference between sodium chloride and Fe3+-enriched irrigants was noted. The use of lower frequencies (1, 10 Hz) lead to a remarkable improvement in the disintegrative efficacy of the laser compared to the standard frequencies (40, 50 Hz). For clinical use, addition of Fe3+ ions seems only necessary if optical breakdown (LIB) is insufficient despite the increase in generator voltage. In such a situation, we recommend the addition of an 1-ml Fe3+ solution to 10 liters of sodium chloride irrigant (= 0.5 mg Fe3+/dl). Moreover, the standard frequency for laser-induced intracorporeal lithotripsy should be 1-10 Hz.

Ferric Compounds↗
PubMed1989

[Treatment of staghorn calculi. Strategies and results of the combined use of new technics].

From January 1984 to June 1986, 270 patients with staghorn calculi were treated by ESWL, PCNL, or a combination of both. The indications were determined according to stone burden, distribution of stone load, architecture of the renal collecting system, radiopacity, and chemical composition of the calculi. Another group (83 patients) treated from January 1982 to October 1983 exclusively with open surgery was also examined. In a retrospective study, the treatment and follow-up data of the two groups were evaluated and compared. At discharge, 78 (29%) of the patients treated by the new techniques were free of stones, while 192 (71%) still had residual fragments in the kidney or in the ureter. Among the group treated by open surgery, 54 (65.1%) were free of stones at discharge, 17 (20.4%) still had residual fragments, and 12 (14.5%) had to undergo nephrectomy. The follow-up data (18 months n = 186) for the ESWL-PCNL-group revealed a stone-free rate of 54.8%. Residual fragments were observed in 40.3% and recurrent stone formation occurred in only 4.9%. Follow-up examination of group treated by open surgery (42 months, n = 61) revealed a stone-free rate of 72.1%, while residual stones persisted in 8.2% and recurrent stone formation occurred in 19.7%. The incidence of urinary tract infection was only 11.3% after ESWL/PCNL, as against 30% after open surgery. It is remarkable that 80% of the patients with residual fragments after ESWL-PCNL did not have any such symptoms as infection or colic.

Combined Modality Therapy↗
PubMed1989

[Microcomputer systems in urology: hardware--mole's hole or useful equipment?].

The basic concepts and elements of micro- and minicomputer hardware components frequently used in urology are described. For advanced users, the details and trends are discussed in more detail. The interdependence of hardware and operating systems is emphasized. In addition, a method for the evaluation of personal computer performance is presented. Finally, proposals are made concerning purchasing procedures and selection criteria.

Humans↗
PubMed1989

[Polychemotherapy using the M-VEC protocol (methotrexate, vinblastine, epirubicin, cisplatin) in advanced urinary bladder cancer--effectiveness and toxicity].

We report on preliminary experience with a modified M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) regimen in which adriamycin was replaced by the less toxic 4-epirubicin at equal doses (M-VEC). This study includes 58 patients suffering from advanced bladder cancer, with a minimum observation time of 12 months; each patient received at least two courses of M-VEC (mean follow-up 22 months, average 3.9 cycles). Most (22; 37.9%) of the tumors were T3-4 NO MO; 20 (34.4%) were T3-4 N1-2 MO; and 16 (27.7%) were T3-4 NO-2 M1. Microscopically, 52 (89.6%) were pure transitional cell carcinoma, 5 were (8.6%) squamous cell/carcinomatous transformation; 1 (1.8%) sarcoma was found. Chemotherapy was given as palliative treatment in 34 (58.6%) patients, as neo-adjuvant therapy in 19 (32.8%) cases and as adjuvant therapy in 5 (8.6%) patients. The overall response rate was 72.3% (CR = 51.7%), with a mean duration of response of 18+ months. The disease-free survival so far amounts to 24/58 (41.4%). Squamous cell carcinoma does not respond to M-VEC. Locally advanced bladder cancer (T3-4 NO-2 MO) responds significantly better than metastatic (M1) disease (78.5% vs 56.2%), resulting in an increased survival rate (57% versus 12.5%) after 22 months. The toxicity of M-VEC is considerably lower than has been reported for other regimens (M-VAC, CMV, CM). The toxic effects included mucositis (3%), nadir sepsis (2.4%) and drug-related death (2.4%).

Aged↗