Biomedical subjects
Publications and source records attributed to P Burchardt.
Our experiences with a flexible fiberscope for nephroscopy during operation are reported. With high pressure of the irrigation fluid, good judgement of the pelviocaliceal system is possible. Sounds for coagulation and forceps for stone extraction can be introduced. We found nephroscopy helpful after stone extraction and in identification of pyelocaliceal tumours.
13 patients presenting with immobilization stones are reported. Young males with an infection of the urinary tract are most commonly affected. In the case of phosphate stones, the infection of the urinary tract with an alkaline shift of the pH and an idiopathic hyperuricosuria play a decisive part together with temporary hyperphosphaturia and hypercalciuria. The importance of urea splitting bacteria in the urine for stone formation is stressed. Applied in time increase of fluid intake, specific antibiotics and allopurinol can lead to litholysis. If the urine of immobilized patients were monitored closely from the beginning of the hospitalisation for the above factors, and treated appropriately, urine calculi should be largely prevented.
25 (30%) out of 85 adult patients with endstage renal disease were found to have vesicoureteral reflux. In group I with 15 patients renal insufficiency was caused by kidney disease alone. In a second group 8 patients had the diagnosis chronic pyelonephritis with well documented history of urinary tract infection. In a third group 2 patients have megaloureter-megalocystis syndrome. There was no case of uncomplicated, sterile reflux in the second and third groups, which seems to be a rare cause of renal insufficiency.
Techniques to localize an upper urinary tract infection--the bladder wash-out test and the ureteral catheterization method--are described. Case reports are given to demonstrate the usefulness of these methods when surgical treatment of urinary tract infections seems to be indicated.
45 cases of nephrectomy are reported. Mortality was 8.9%. Thirty-one had a drug-resistant, severe hypertension, three had infected kidneys, and in eleven cases nephrectomy was performed prior to transplantation. Although blood pressure improved in all patients, of the first group 24% died within one year after nephrectomy, which shows unsatisfactory prognosis of malignant nephrosclerosis. Only early nephrectomy can lead to better results. Routine nephrectomy before transplantation should be avoided. Indications for this group are discussed.
A case of retroperitoneal, nonchromaffin paraganglioma simulating a hypernephroma of the right kidney is described. Prognosis and therapy of this rare tumor is discussed and the literature is reviewed.
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83 prostatic carcinomas were analysed morphologically and clinically before and after combined therapy. The classification of these tumors is based on the proliferation pattern resulting in a group with only one and a group with a variety of growth patterns. The largest groups were carcinomas with glandular structures. On the basis of multiple biopsies the histologic regression of the tumors was determined. In 71% of the cases there was good agreement of morphological results and local palpation findings. Further analyses revealed a correlation between histological growth pattern of the carcinomas and degree of regression: prostatic carcinomas with glandular pattern showed more often a good regression after combined therapy than solid and(or) cribriform tumors. In the groups with a variety of structural pattern the degree of regression was dependent on the prevailing tumor structure. According to these results the organoid-glandular carcinomas of prostate are prognostically more favourable than all the other proliferation patterns. Nevertheless in a single case a prognosis of the therapeutic effect based only on the tumor differentiation can not be made.
Carcinomas of the prostate treated by orchiectomy, 60Co-radiation, and hormonal drugs a relatively short time prior to the time of biopsy were studied with the electron microscope. The following degenerative changes of tumor cells and fibromuscular stroma were found: The nuclei of the tumor cells were intensely heterochromatic, irregularly shaped, and the perinuclear rim dilated; large atypical sizes, multiple segmentations and "nuclear invaginations" were observed. The tumor cell cytoplasm showed vacuolar degeneration, and the limiting membranes of the tumor cells were extensively destroyed. Remarkable changes were also found in the fibromuscular stroma: There was a proliferation of collagenous fibers as well as degenerative transformations ending in hyalinization. The smooth muscle cells were dissociated and fragmented, sometimes showing vacuolar degeneration of the cytoplasm. The endothelium of the blood vessels was swollen, and the vessel walls were thickened. In spite of these radiation-induced lesions it remains undecided as to what degree the other therapeutic measures take part in the total therapeutic effects as seen in the ultrastructural findings. However, these regressive changes are much more pronounced than those seen after orchiectomy alone and partly resemble the findings which are characteristic of radiation induced structural lesions. The morphological changes are not uniform throughout the tumor. It is not unusual to find intact tumor cells next to totally degenerated cells. They represent poorly differentiated tumor cells. It is discussed whether these "embryonic" tumor cell types are and remain resistant to treatment and if a tumor recurrance may originate in them later on.
Nine cystinuric patients (8 females and 1 male) with recurrent L-cystine stone formation have been treated since 1971 with the new drug Thiola (alpha-mercaptopropionyl glycine). Thiola was found to be more effective than D-penicillamine in dissolving L-cystine. In two case a partial dissolution was observed after 20 months of Thiola administration. In four cases further stone growth was stopped. In the last two cases stone growth occurred even after administration of Thiola. Tolerance of the drug was good, and no serious effects were observed sufficient to interrupt treatment.
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