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Biomedical subjects

K Kleinschmidt

Publications and source records attributed to K Kleinschmidt.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Ileal neobladder with anastomosis to the female urethra].

Orthotopic reconstruction to the native urethra has revolutionized urinary diversion, allowing patients to void per the urethra. This form of urinary diversion was initially performed solely in male patients after cystectomy. More recently, however, with a better understanding of the female continence mechanism, including the urethral/vaginal support mechanism, and the ability to select appropriate female candidates properly for this type of surgery, orthotopic reconstruction has become a viable option in women. Since November 1986, 24 women aged 53 years (range 17-76) have undergone orthotopic reconstruction using the ileal neobladder. Indications for cystectomy included transitional cell carcinoma of the bladder (8), fibrotic radiated bladder (4), interstitial cystitis (5), tuberculotic bladder (2), urge incontinence (2), neurogenic fibrotic bladder (2), and fibrotic bladder of unknown etiology (1). Nineteen patients are available with a median follow-up of 48 months (range 3 to 109 months). There were no perioperative deaths, with few early and late complications. Two women previously irradiated developed a neovesicovaginal fistula and had to be diverted by an ileal loop. Three patients from the far East are no longer available for follow-up. Ten years of experience with 24 patients have led to a nerve- and urethral-support-sparing cystectomy technique with the ileal neobladder anastomosed to the proximal urethra. However, even then, retention in 20% of the patients rather than the expected incontinence is the critical issue. Incontinence has never been a problem. The advent of orthotopic lower urinary reconstruction in women is a major achievement in the evolution of urinary diversion. With our increasing understanding of the continence mechanism in women and with increasing evidence that the female urethra can be safely preserved after cystectomy, orthotopic lower urinary tract reconstruction by the ileal neobladder can now be offered safely not only to males, but also to female patients undergoing cystectomy, and the functional results are superb.

Adolescent↗
PubMed1995

Continuous in situ cold perfusion with histidine tryptophan ketoglutarate solution in nephron sparing surgery for renal tumors.

PURPOSE: In transplantation medicine the superiority of Bretschneider's histidine tryptophan ketoglutarate solution has been demonstrated in various animal investigations and in donor organs under clinical conditions. Because of the wide use of ultrasound scans and computerized tomography there has been a sharp increase in the number of small renal tumors detected. Therefore, efficient protection methods designed to conserve kidney tissues are attracting growing attention. MATERIALS AND METHODS: We report on 11 patients with space-occupying lesions involving a solitary kidney. All tumor resections were performed under continuous in situ perfusion with Bretschneider's solution. Even when dealing with extensive tumors involving the hilum, complete resection and reconstruction of the kidney in situ proved feasible. RESULTS: The mean cold ischemia time was 62.1 minutes (range 18 to 88) and mean Bretschneider's perfusion volume was 2,875 cc. The kidneys resumed excretion within an average of 16.8 minutes (range 0 to 60) and no patient required dialysis. Apart from temporary elevation of serum creatinine levels, postoperative renal function was unimpaired. There were no changes in serum electrolyte levels and no disorders of cardiac conduction. One kidney was lost postoperatively due to renal artery embolism. CONCLUSIONS: Continuous in situ perfusion with Bretschneider's solution is a new and interesting method for patients undergoing partial nephrectomy. Particularly for locally extended tumors, this procedure is highly efficient for intrarenal surgery.

Aged↗
PubMed1993

[PSA volume quotient: an additional parameter in diagnosis of locally confined prostate cancer].

The sensitivity and specificity of prostate-specific antigen density (PSAD), a quotient of serum PSA and prostate volume, in the detection of localized prostate cancer was analysed in a prospective study. A total of 235 patients were examined, 145 without prostate cancer and 90 patients before radical prostatectomy for localized prostate cancer. PSAD was determined by dividing the serum level of PSA by the volume of the entire prostate (estimated by transrectal ultrasound) and multiplying by 100. Using a PSAD of 15, the specificity achieved in our collective was the same as with an absolute PSA value of 4 ng/ml (88.9-90%). On the other hand, with the PSAD of 15 we also found the same sensitivity as with an ab-solute PSA of 10 ng/ml (75.2-76.5%).

Adult↗
PubMed1991

[Intra- and postoperative morbidity of radical prostatectomy].

Operation-related morbidity was analyzed in 147 patients, who had undergone radical prostatectomy during the last 3 years. Six major complications (4.1%) had occurred requiring surgical revision. One single postoperative death (0.7%) was caused by a pulmonary embolus. In 51 patients (34.7%) minor complications were noted. Urinary incontinence was severe in 4 patients (3.9%), which was treated by an artificial sphincter in one man during the follow-up period. Twelve patients (11.8%) complained of stress incontinence, grade I-II. Postoperative determinations of serum PSA were below the detectable range in 81% of the patients, including those with a locally advanced tumor stage and adjuvant antiandrogen therapy. Based on our data, it is concluded that radical prostatectomy is today a safe and standardized operative procedure.

Aged↗
PubMed1991

The ileal neobladder. Operative technique and results.

Bladder substitution by continent bowel reservoirs has been one of the real advancements in modern urology. Short-term experience with and patients' acceptance of the ileal neobladder have been excellent. As do others, we consider this technique to date the procedure of choice in male patients requiring radical cystectomy.

Adult↗
PubMed1990

[Initial therapy of acute unilateral epididymitis using ofloxacin. I. Clinical and microbiological findings].

In a prospective study, 70 men suffering from uncomplicated acute unilateral epididymitis were treated initially with 2 x 200 mg ofloxacin p.o. per day for 14 days. Patients were reexamined at the end of therapy and again after 6 and 12 weeks. Patients were retreated when the pathogens had not been eliminated. Aetiologically epididymitis was caused in one-third of cases each by C. trachomatis (n = 20) and common urinary tract pathogens (n = 20); in the remaining one-third we found N. gonorrhoeae (n = 1). U. urealyticum (n = 3), or no pathogens (n = 26). At the first check-up examination, in 64/70 patients no pathogens were found. Relevant bacteria were still detected in 6 patients: C. trachomatis in 5 and E. aerogenes in 1. After 12 weeks, infection still persisted in 3 patients (E. coli, P. aeruginosa, enterococci). In vitro the microorganisms were invariably sensitive to ofloxacin. Due to abscess formation, surgical intervention became necessary in 6 patients. In 3 of these cases the causative agent was C. trachomatis. Regardless of the aetiology, after 12 weeks, in 20% of our patients the epididymis was still infiltrated and 14% complained of persistent symptoms.

Acute Disease↗
PubMed1990

[Initial therapy of acute unilateral epididymitis using ofloxacin. II. Andrological findings].

A total of 70 men suffering from uncomplicated acute unilateral epididymitis were enrolled in a prospective study. They were treated initially with 2 x 200 mg ofloxacin p.o. per day for 14 days, after which the spermatological examination was repeated for each. Ejaculate quality, i.e. density, motility, and morphology of spermatozoa, was determined on the last day of therapy, i.e. after 14 days, and again after 6 and 12 weeks. In most patients, initially decreased sperm counts increased significantly and global motility improved, while the numbers of abnormal spermatozoa decreased. Only in a few cases were azoospermia, kryptozoospermia, consistently reduced motility, and constant or even increasing numbers of deformed spermatozoa observed.

Acute Disease↗
PubMed1989

Carcinoma in situ of the testis in the presence of contralateral germ cell tumor.

Carcinoma in situ (CIS) of the testis is considered a precursor of germ cell tumor. Diagnosis is made by biopsy, a procedure which is justifiable for patients with increased tumor risk. This group includes patients with testicular tumors who may develop contralateral second malignancies. After obtaining contralateral biopsies from 21 such patients we found one CIS. Treatment consisted of local irradiation (20 Gy) of the remaining testis. No clinical side effects were observed. In a control biopsy 6 months later, no evidence of CIS was found. Leydig cells were morphologically normal. Nine months after therapy, plasma testosterone levels were still normal, LH and FSH levels were increased. Long-term observations are needed to assess the value of radiotherapy as compared to orchiectomy.

Adult↗
PubMed1989

[Early detection of a contralateral second carcinoma in patients with testicular tumors caused by testicular carcinoma in situ].

Carcinoma in situ (CIS) of the testis is considered to be a precursor of germ cell cancer. Diagnosis is made by the conventional biopsy technique. Only for patients at risk is a screening biopsy justifiable. This group includes patients with testicular cancer in whom the incidence of contralateral second germ cell tumors is increased. In a prospective study we found three cases of testicular CIS in biopsies from the contralateral testes of 61 such patients. All cases with a diagnosis of CIS presented with testicular atrophy (volume less than 12 ml), associated with necrozoospermia in one patient and with azoospermia in two patients. Treatment consisted in local irradiation (20 Gy) of the remaining testis to preserve Leydig cell function. In control biopsies no evidence of CIS or germ cells was found. More than 3 months after therapy, plasma testosterone levels were normal and LH and FSH levels were increased. None of the patients with negative biopsy (n = 49) who were followed up was found to have a second cancer of the contralateral testis. The average observation time so far is 17.2 months.

Biopsy↗
PubMed1983

[One-time therapy of acute cystitis in women. Comparison between gentamycin and amoxicillin].

In a randomized trial 65 women with symptoms of acute cystitis and significant bacteruria were treated with 120 mg gentamycin intramuscularly or 3 g amoxicillin orally. The patients were selected by excluding those with recurrent infection and involvement of the upper urinary tract (by history and clinical examination). The urine was sterile in 53 patients (82%) after a one-week treatment-free interval. The results indicate that there was no statistically significant difference between the two treatment groups. Further diagnostic tests revealed an underlying urological disease in five of the 12 remaining patients.

Acute Disease↗
PubMed1977

Rheological changes in the blood of patients with chronic arterial occlusive disease after the administration of vasoactive drugs.

Patients with chronic arterial occlusive disease were found to have higher blood and plasma viscosity levels than healthy controls. Measurements were taken at high and low shear rates. Blood and plasma viscosity in these patients was significantly reduced following parental administration of pentoxifyline, and this effect was particularly pronounced at low shear rates. The changes recorded after administriation of bencyclane did not follow a consistent pattern. There was no significant correlation between the rheological changes measured and changes in plasma protein fractions.

Arterial Occlusive Diseases↗