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Biomedical subjects

R A Bürger

Publications and source records attributed to R A Bürger.

At least 19 recordsLinked to original sources
PubMed1997

Urinary diversion in children and young adults using the Mainz Pouch I technique.

OBJECTIVES: To determine the late complications and consequences for renal function, vitamin and acid-base metabolism after application of the Mainz Pouch I (MZP-I) technique in children and young adults. PATIENTS AND METHODS: To November 1994, the MZP-I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (< or = 20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow-up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1-10.5). RESULTS: At the last examination, 23 of 55 (42%) preoperatively dilated RUs had improved. 131 of the 163 RUs (80%) were stable and nine RUs (5.5%) showed a slight clinical asymptomatic increase in the upper tract dilatation. Through an extraperitoneal flank incision, 11% of the RUs which developed stenosis at the ureterocolic anastomosis were successfully reimplanted (16% in patients with neurogenic disorders, 17% with pre-operative irradiation and 5% in the remaining patients). Two of 32 patients with an intussuscepted and invaginated ileal nipple required re-operation due to incontinence, but none of the patients with an appendiceal stoma were incontinent. Open revision of a stomal stenosis was performed in three and endoscopic treatment in nine patients. In 54 patients, the levels of vitamins A, B1, B2, B6, E, folic and bile acid were within normal ranges. There was no significant decrease in vitamin B12 levels after operation. In none of the patients with normal pre-operative creatinine values had the levels increased and none developed severe acidosis or bowel neoplasm. CONCLUSION: The MZP-I is recommended as a technique for bladder augmentation or continent urinary diversion in children and young adults, with an acceptable complication rate which offers long-term protection of the upper urinary tract.

Acid-Base Equilibrium↗
PubMed1994

Automated image analysis DNA cytometry in testicular cancer.

The value of automated DNA cytometry for differentiation of testis cancer was evaluated in 54 seminomas, 13 HCG-positive seminomas, and 48 embryonal carcinomas. Slices of paraffin embedded tissue were enzymatically digested and stained with Feulgen SITS after fixation on glass slides. Automated DNA cytometry was performed with a Modular Image Analysis Computer (MIAC). DNA histogram phenotpye and computed DNA indices were correlated with the different tumor types. The ratio of hypertriploid to hypotriploid increased from HCG-positive seminoma over embryonal carcinoma to seminoma. The following mathematical DNA indices were found to correlate with tumor type: mean ploidy, 2c deviation index, 5c exceeding rate, variation coefficient of the GO/1 fraction and DNA nucleus diameter correlation.

Carcinoma, Embryonal↗
PubMed1994

[Clinical tests on reno-ureteral lithiasis with a new Lithostar 2 model C shock wave generator system].

Lithotripsy has confirmed its place in the treatment of urinary stones and there are now few indications for open surgery in this disease. Lithotripsy used to be rarely used, as it required a great deal of patience on the part of the patient, lying in the water bath, and the medical team. Increasing efficient systems are now available with a marked advantage for patients. Simple analgesia-sedation is often sufficient when requested by the patients and the duration of treatment has been considerably decreased. The authors present a review of their results with the new Lithostar 2 Model C shock wave generator system. The modifications made to this system take into account physical possibilities and medical requirements. As a result of the new configuration of this system, the treatment time per patient has been further decreased, a higher energy is applied to the stones and the disintegration rate is excellent.

Colic↗
PubMed1993

Sutureless laser-welded anastomosis of the femoral artery and vein in rats using CO2 and Nd:YAG lasers.

In a comparative study, it was demonstrated that sutureless, laser-welded, end-to-end anastomoses in the rat femoral artery and vein are feasible, using either CO2 or Nd:YAG laser. Conventional microsurgical suture anastomoses served as the controls. Patency rates in experimental animals and controls were equal (96 to 100 percent). No aneurysms were observed. For successful laser welding, the anastomosis must be completely tension-free. In arteries, this was accomplished only by interposition of a graft from the contralateral artery. The absence of any foreign-body reaction and the saving in operative time support the use of sutureless laser welding.

Anastomosis, Surgical↗
PubMed1993

[Extracorporeal shock-wave therapy (ESWT) for pseudoarthrosis. A new indication for regional anesthesia].

Extracorporeal shock-wave therapy for the treatment of pseudarthrosis is a new indication for anaesthesia. In a clinical trial of 65 treatments in 53 patients, the anaesthetic procedure is shown. Regional anaesthesia, mainly plexus blocks of the upper and lower extremities, was performed in nearly all cases. The various localisations of the pseudarthroses and the types of anaesthetic techniques used are shown in Table 1. In all, we performed 9 epidural blocks, 2 spinal blocks, 29 axillary blocks, 3 supraclavicular perivascular blocks (Winnie), 1 psoas compartment block, and 20 sciatic/femoral 3-in-1 blocks. The shock waves used for this therapy are several times stronger than those used for nephrolithotripsy. Furthermore, the shockwaves are focused on bone and periosteum, which is abundantly innervated. Therefore, in contrast to nephro-lithotripsy with second-generation lithotripters, anaesthesia must be performed for this therapy. We chose regional anaesthesia for several reasons: the procedures are located in the arms or legs, which can readily be anaesthetised by regional blocks. The duration of treatment ranged up to several hours. By using regional anaesthesia, we were able to avoid unnecessary exposure to general anaesthetics. Finally, most of the patients wanted to stay awake during the new treatment and therefore opted for regional techniques. A typical set-up for the treatment is shown in Fig 1. In 67% of the patients fracture healing was significantly improved by the new therapy. Acceptance of therapy and anaesthesia by the patients was very good.

Anesthesia, Conduction↗
PubMed1992

The buccal mucosal graft for urethral reconstruction: a preliminary report.

Autologous buccal mucosa as a substitute for urethral epithelium was studied in 2 dogs and used in 6 patients with difficult urethral reconstruction problems. The indications for an operation in these patients were failed hypospadias repairs with limited skin in 3, severe structure disease after hypospadias repair in 1, a short urethra in 1 and epispadias in 1. Three urethral fistulas and 1 meatal stenosis occurred in 3 patients. No urethral stricture or diverticulum was noted, and the final outcome was good functionally and cosmetically in all patients. This technique is useful for urethral reconstruction when local skin is not available.

Adolescent↗
PubMed1992

[MR tomography in testicular processes. The significance of Gd-DTPA enhanced sequences in comparison with plain T2-weighted sequences].

The value of T1-weighted sequences after intravenous administration of Gd-DTPA and of T2-weighted sequences was compared in 43 patients suspected of having scrotal abnormalities. T2-weighted sequences gave better demonstration of the tunica albuginea and better contrast between tumor and parenchyma. The two techniques were equally sensitive for demonstrating testicular tumors but orchitis was better demonstrated on the contrast enhanced sequences. Motion artifacts were less marked in the T1-weighted sequences with contrast enhancement. In selected cases, contrast enhancement may be a valuable addition to native protocols. Our experience has indicated that MRI provides specific findings in cases of orchitis which are clinically atypical; this facilitates the decision to conservative treatment and prevents unnecessary exploration of the testes.

Adolescent↗
PubMed1992

Extracorporeal shock wave lithotripsy with ultrasound-guided lithostar plus.

Since 1989, the Siemens lithostar plus, an upgrade of the lithostar with the ultrasonically guided overhead module, has been available for clinical use. This unit may be used for the treatment of either biliary or urinary calculi. We report on 75 patients with urinary calculi treated between March 1989 and June 1990 with the lithostar overhead module. Stone localization showed a rate of: caliceal stones 33.5%, pelvic stones 44%, upper ureteral stones 9.3% and lower ureter stones 13%. The overall disintegration rate was 86%, with a stone-free rate after 3 months of 78%.

Humans↗
PubMed1991

CO2 and Nd:YAG laser systems in microsurgical venous anastomoses.

A comparative study was undertaken in 81 rats to investigate a CO2 and Nd:YAG laser system for laser-welded anastomosis of the femoral vein. Conventionally sutured anastomoses (CMSA) served as controls. Laser-welded anastomosis (LAMA) was easier and could be performed 30% faster than CMSA. Postoperative investigations included patency tests, postmortem examinations and light and electron microscopy. Aneurysms were not seen. Foreign-body reaction was more pronounced in CMSA. Patency rates for CO2-LAMA and CMSA were equal, whereas Nd:YAG-LAMA resulted in significantly higher rate of early postoperative thrombosis (P less than 0.01). Because of its physical properties, the CO2-laser system seems to be better suited for laser welding of delicate structures such as the rat femoral vein.

Anastomosis, Surgical↗
PubMed1991

Bursting strength of the rat aorta: comparison of suture and laser anastomoses.

The bursting strength of sutured and laser-welded vascular anastomoses were assessed in a rat aorta model. Postoperative investigations included postmortems, light and scanning electron microscopy and measurements of bursting strength at set intervals (30 min, 3, 14 and 28 days postoperatively, p.o.). Laser-bonded anastomoses consistently demonstrated lower bursting strengths than suture controls, with statistically significant differences at 30 min and 3 days p.o. (p less than 0.01). Laser anastomosis was easier and faster to perform, the foreign body reaction was markedly lower than in sutured controls. Formation of aneurysms was not observed.

Anastomosis, Surgical↗
PubMed1990

Laser assisted urethral closure in the rat: comparison of CO2 and Neodymium-YAG laser techniques.

In 65 male rats a comparative study was undertaken to investigate a Neodymium-YAG and CO2 laser system for the microsurgical repair of longitudinal incisions of the rat urethra. Postoperative investigations included patency tests, necropsy and light microscopy. Use of the laser systems did not reduce operation time. The highest rate of postoperative strictures (90%), urethral fistulas (30%), urinomas (20%) and postoperative deaths (70%) was seen in the Neodymium-YAG laser group. CO2 laser repair was almost as efficacious as microsuture repair, except for a higher rate of urethral fistulas resulting from the initially weak laser weld. Based on these findings, the Neodymium-YAG laser seems unsuitable for urethral repair. Further studies in larger animals are warranted using a CO2 laser in combination with postoperative cystostomy for urinary diversion in order to avoid fistulas in the early postoperative period.

Animals↗
PubMed1989

Urology.

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Child↗
PubMed1989

Urology.

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Candidiasis↗
PubMed1989

Ileocecal vaginal construction.

In 10 patients, six with previously failed vaginal reconstruction of Mayer-Rokitansky syndrome, two with male pseudohermaphroditism, one with a history of Wertheim-Meigs operation followed by irradiation of the true pelvis, and one with vaginectomy caused by trauma, a neovagina was created out of cecal or ileocecal segments. Advantages of this technique are the excellent blood supply to the ileocecal region and the long vascular pedicle. The supplemental application of terminal ileum for prolongation of the cecal vaginoplasty allows for tensionless anastomosis between the neovagina and the vulva, even in patients with difficult anatomic conditions. A detailed description of the operative technique and indications for ileocecal and cecal vaginoplasty are presented, and the techniques in current use for vaginal replacement are reviewed and discussed.

Adolescent↗
PubMed1989

[Transpenile venous occlusion in the treatment of erectile impotence].

In 15 of 18 patients, 2 of them with previous surgery, transpenile venoablation was performed for treatment of erectile dysfunction due to cavernous leakage. In 4 this was combined with retrograde venooclusion via the internal iliac vein. In 4 patients normal erectile status could be obtained. In 3 other patients erections became possible with use of intracavernous vasoactive agents. In two only mild amelioration, and in two others no change of erectile dysfunction were obtained. Follow-up studies are yet missing in 3 patients. Complications of the procedure were not observed.

Adult↗
PubMed1989

Extent of surgery in rhabdomyosarcoma of urogenital structures.

After high inguinal semicastration in group-1 paratesticular rhabdomyosarcoma (RMS), the patient having undergone chemotherapy can be followed closely by CT scanning without retroperitoneal lymphadenectomy. In contrast, retroperitoneal RMS should be operated on as radically as possible after downstaging the tumor mass. In RMS of the female genitalia locally limited organ-preserving surgery is the method of choice. The prognosis is excellent with adjuvant chemotherapy. Only 20% of all bladder RMS arise from the bladder dome or the movable part of the bladder, where primary partial resection including a safety margin of 3 cm of healthy tissue is possible. The majority, however, arising from the submucous tissue of the bladder base, trigonal area and bladder neck, infiltrates the prostatic urethra and the surrounding pelvic fascia. Therefore differentiation between primary bladder or prostate RMS is often doubtful. The current strategy of downstaging by chemotherapy or chemo-radiotherapy followed either by limited organ-preserving surgery or by a wait-and-see policy includes the high risk of residual tumor or local tumor recurrence, which has proved to have the worst prognosis of all. As organ-preserving therapy was recommended as the method of choice, mainly to avoid anterior pelvic exenteration and urinary diversion, the question of advantages in comparison to the risk of tumor recurrence is still open. The routine use of chemoradiotherapy and increasing follow-up has called attention to a variety of chronic sequelae, such as contracted bladders with reduced capacity and upper urinary tract deterioration, which subsequently require secondary urinary diversion. Progress in continent urinary diversion may be an alternative procedure for better life quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Laser welded vascular anastomosis. Comparison of CO2 and neodym yag laser techniques.

A comparative study was undertaken to investigate the application of a specially adapted microsurgical Neodymium Yag Laser system with a wavelength of 1,319 microns and a CO2 laser system for laser assisted microvascular end-to-end anastomosis (LAMA) of the rat femoral artery. Conventionally sutured anastomoses served as controls. Postoperative investigations included patency tests, light microscopy and tensile strength measurements. Both laser systems seem to be equally suitable for LAMA: The patency rates do not differ from those of sutured anastomoses and formation of microscopically small aneurysms occurred predominantly in control animals and only once in laser groups. The clamp time needed for LAMA was half the time that was needed for sutured anastomoses. Wound healing in all groups was similar with less fibrotic reactions and less foreign body granulomas in laser groups. At all intervals tensile strength was significantly higher for sutured anastomoses while differences between the CO2- and the ND: Yag-laser groups were not statistically significant. Potential applications in urology include microvascular anastomoses in erectile dysfunction, pediatric and reconstructive urology.

Anastomosis, Surgical↗