Biomedical subjects
Publications and source records attributed to K Rothenberger.
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Therapy of urinary bladder tumors with the aid of the Neodymium-YAG-laser is improved by two following demands. A homogeneous, deep necrosis must be obtained for the tumor cells to be devitalised completely, and neighbouring organs must be protected adequately. Both depth and shape of the necrosis were determined on liver tissue at different conditions, e.g. laser application with air, water and various time/power ratios. Measurements of temperature profiles at the bladder back wall reveal that the parameters necessary for sufficient transmural destruction of bladder tumors do not affect neighbouring organs. In clinical application it is not necessary to control temperatures occurring at the bladder wall during irradiation by means of temperature probes. It is sufficient to adjust the dosis of laser on the basis of superficial, visual discoloration. Carbonisation should be avoided by all means. Comparable effects were obtained by clinical application of data obtained during animal experimentation.
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Methods of diagnosis in metastatic disease of patients with prostatic cancer are reported. There is a high rate of inaccuracy in lymphography. In 23 patients the technique of transperitoneal fine needle aspiration biopsy of retroperitoneal lymph nodes after lymphography was used. In 8 patients malignant cells were found while lymphography showed metastases only in 4 cases. In these 8 cases a staging-operation was not indicated.
Transcutaneous fine needle biopsy of retroperitoneal lymph nodes after lymphography minor is connected with only discomfort for the patient. It is used for clarification of a possible infestation of metastases by malignant growth, the lymphatic drainage of which is situated retroperitoneally. A new instrument for puncture is presented, the use of which permits increase in accuracy of impact and reduction of radiation exposure for both patient and examiner. These advantages are of great importance, especially in serial puncture of several lymph nodes along the lymphogenous pathway of metastases. The quality of the fluoroscopic picture is even improved by the instrument for puncture.
The A-mode ultrasonography is especially qualified for measuring tissue thickness. By using high frequencies (8--10 MHz) upper layers can be measured with an accuracy of approximately 0.15 mm. This accuracy in measurement is required in connexion with optimization of dose during therapy of urinary bladder tumors by way of the Neodymium-YAG laser. The newly developed 8 MHz-endo-transducer makes possible intravesical measurement of bladder-wall thickness under cystoscopoic view. This method presents itself as a new opportunity for staging urinary bladder tumors.
Two hundred and three patients with urographic appearances suspicious of a space-occupying lesion were examined by sonography. Seventy-nine showed normal results; there were 65 cysts, 20 malignant lesions, 20 pseudo-tumours and 19 with other abnormalities such as hydronephrosis, urolithiasis and inflammatory lesions. Pseudotumours are due to varients of the structure of the kidney, which resemble space-occupying lesions in the excretory urogram. The sonogram shows them as low echo, centrally protruding structures arising from the edge of the parenchyma. Angiographically they are islands of parenchyma with normal vessels. Sonography has proved to be a necessary complement to excretion urography and provides a more certain indication for renal arteriography. Angiography can be limited to changes in the parenchyma, since sonography is able to define cystic processes.
Preoperative lymphography was performed in 97 patients with urological malignoma. Fine needle punctions were performed of 458 suspicious as well as non-suspecious lymph nodes. In 22 cases lymphographic and cytological findings were compared with histological results after lymphadenectomy. It could be shown that of 15 cases with lymph node metastases lymphographic and cytologic findings were corresponding in 6 cases. In 9 cases tumor cells were found in lymph nodes even though the lymphogram was rated non-suspicious. It is concluded that fine needle biopsy of lymph nodes after lymphography is an important improvement in preoperative diagnosis of malignoma.
Behind the typical signs of a staghorn calculus of a kidney and a ureterocele with calculi in x-ray a transitional cell carcinoma of the kidney and the whole ureter was found. The nonfunction of the organ was thought to be due to pyonephrosis. Four other cases reported in the literature are discussed.
In a prospective study 260 urographies were evaluated regarding clinical compatibility. In altogether 11% of the patients mild incompatibility reactions were observed (heat sensation, urticaria, nausea, vomiting). 29% of the patients with known prior contrast agent incompatibility suffered from anaphylactoid symptoms mostly of a subjective type (heat sensation, nausea). There was no statistically significant difference in the frequency of objective symptoms (urticaria, vomiting) between patients with prior contrast media incompatibility (3%) and patients who had tolerated previous contrast media applications without symptoms (2%).
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Following lymphography, 76 lymph nodes were punctured percutaneously using a fine needle in 23 patients and an aspiration biopsy was performed. This simple procedure provided cytological comfirmation in cases of doubtful lymphograms. Systematic puncture of representative lymph nodes in the area of metastatic spread may at times be able to replace a staging operation.
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In discussing the frequency of kidney adenomas we present a rare case of a large oncocytoma, with all diagnostic and therapeutic aspects. The special angiografic picture of thistumor seems to be important. Furthermore the criteria for malignancy of epithelial tumors of the kidney are discussed.
In this paper the problem of early diagnosis in hypernephroid carcinoma of the kidney is explained. Hematuria remains inspite of other possible causes suspect for tumor as long as a tumor is certainly excluded. The different methods for diagnostic and characteristic signs for tumor in the X-ray (EVP) are discussed. Three cases of late diagnosis of hypernephroid carcinoma of the kidney, due to long time not explained symptoms, are described.
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