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Biomedical subjects

R E Hautmann

Publications and source records attributed to R E Hautmann.

At least 73 records · Page 4Linked to original sources
PubMed1996

Predictive value of magnetic resonance imaging and computerized tomography for conservative renal surgery in an ex vivo tumor enucleation study followed by step-sectioning.

PURPOSE: Due to the early diagnosis of many renal cell cancers, the treatment options of organ conserving surgery is of interest even for patients with a normal contralateral kidney. To our knowledge the predictive value of preoperative investigations in such patients has not been clarified. MATERIALS AND METHODS: In a prospective study of 30 patients with stage T1/T2 renal cell carcinoma ex vivo enucleation was performed following tumor nephrectomy. Magnetic resonance imaging (MRI) and computerized tomography (CT) were done preoperatively in all patients. For pathological evaluation the kidneys were step-sectioned in 1 mm. slices. Macroscopic and microscopic findings were compared to those of the preoperative investigations. RESULTS: Mean tumor diameter was 4.6 cm. (range 2.0 to 10.0). Twelve tumors were incidental and smaller than 4 cm. Residual carcinoma due to incomplete resection was found in 4 kidneys with tumors larger than 4 cm. Parenchymal or hilar venous invasion was noted in 4 cases, including 1 in the incidental group. Prediction of renal fat capsule invasion by MRI was highly confirmed by pathological examination. On the other hand, parenchymal venous involvement or secondary renal tumors smaller than 2 cm. could not be predicted by MRI or CT. CONCLUSIONS: Neither MRI nor CT predicts complete tumor control when conservative renal surgery is considered. All incidental tumors smaller than 4 cm. could be resected completely by nephron sparing surgery. Nevertheless, microscopic venous invasion was present in 1 of the latter cases.

Adult↗
PubMed1996

[Can examination of spontaneous urine samples adequately replace 24-hour-urine samples for determining excretory rate of various lithogenic and inhibitory substances in metabolic evaluation of kidney calculi patients?].

The gold standard for metabolic evaluation of stone-forming patients is the 24-h urine specimen. Recently, some authors have suggested that for routine metabolic evaluation spot urine samples are as valuable as the 24-h urine specimen. The purpose of our study, was to determine the value of the spot urine sample in comparison with the 24-h urine specimens. Eighty-eight healthy volunteers on different diets were investigated (32 vegetarians, 12 body-builders without protein concentrates, 28 body-builders on protein concentrates, and 16 subjects on a regular European diet). Using 24-h specimens, excretion rates of oxalate, calcium, sodium and potassium were determined. The concentration ratio of these electrolytes to creatinine was calculated for spot urine samples. A highly significant correlation between the excretion rates and the results of the spot urine samples was found for all parameters. However, the correlations showed considerable variations. On the other hand, we were able to show that creatinine excretion is highly dependent on daily protein intake, body weight and glomerular filtration rate. This leads to a considerable inter- and intraindividual variation in creatinine excretion. This variation of the creatinine excretion is the major cause for the variation in the results of spot urine samples. It is concluded that spot urine samples are an inadequate substitute for the 24-h urine specimen and that the 24-h urine specimen is still the basis for metabolic evaluation in stone patients.

Adolescent↗
PubMed1996

[Minimally invasive treatment of stress urinary incontinence by collagen administration. Comparison between endosonography controlled and transurethral submucous collagen injection].

For many years, injectable substances have been in use for the treatment of incontinence. We examined different methods of injecting glutaraldehyde cross-linked bovine collagen injection for their effectiveness in treatment of genuine stress incontinence. In the first group of patients collagen injection was done under endo-ultrasound guidance. In the second group an endoscopic system was used. There was no major difference in patient selection for the two groups. Incontinence symptoms became less severe in only 5 of 15 (33%) patients in the endo-ultrasound group, who then had moderate stress incontinence. Endoscopic collagen treatment resulted in social continence in 15 of the 22 (68.2%) patients. We conclude that endoscopic collagen is superior to endo-ultrasound-guided collagen injection in the treatment of incontinence.

Adult↗
PubMed1996

Effect of chronic dietary protein intake on the renal function in healthy subjects.

OBJECTIVE: Relatively little is known about the influence of chronic oral protein intake on the kidney function. In most studies only the effect of a short-term change in protein intake [6-28 days] or the effect of an acute protein load on the glomerular filtration rate was studied. The purpose of this study was to investigate the effect of chronic oral protein intake on endogenous creatinine clearance and on the albumin excretion rate. DESIGN AND SUBJECTS: In a prospective study 88 healthy volunteers with normal renal function (32 vegetarians, 12 body-builders with no supplementary protein concentrates, 28 body-builders with supplementary protein concentrates and 16 subjects with no special diet) were examined. In order to investigate the effect of chronic oral protein intake, the participants were on their diet for at least 4 months. RESULTS: Endogenous creatinine clearance as a measure for glomerular filtration rate varied between 32 ml/min and 197 ml/min or 34 and 186 ml/min x 1.73 m2, respectively. Nitrogen excretion rate was used as a measure for the daily protein intake, since it is known to correlate linearly with the daily protein intake. Nitrogen excretion rates ranged between 2.66 g/d and 33.93 g/d reflecting a daily protein consumption between 17 and 212 g/d or 0.29 g/kg bw/d and 2.6 g/kg bw/day, respectively. Between nitrogen excretion rate and endogenous creatinine clearance a non linear, highly significant correlation was found showing a saturation with a maximum endogenous creatinine clearance of 181.7 ml/min (dose response curve). A similar correlation was observed between urea excretion rate and endogenous creatinine clearance. Using a model for multiple regression analysis the dependence of the albumin excretion rate on nitrogen excretion rate and endogenous creatinine clearance was examined. Only a significant correlation was found between albumin excretion rate and endogenous creatinine clearance, while the correlation between albumin excretion rate and nitrogen excretion rate was not significant. CONCLUSION: This investigation shows that chronic oral protein intake of widely varying amounts of protein is a crucial control variable for the glomerular filtration rate in subjects with healthy kidneys. It is suggested that these changes reflect in part structural changes of the glomerulus and tubules due to chronic protein intake.

Adult↗
PubMed1995

Renal pelvis rupture after blunt abdominal trauma.

A 45-year-old male patient presented with rupture of the left renal pelvis after blunt abdominal trauma. The patient had preexisting bilateral megaureters with secondary obstruction of the pyeloureteral junction. The underlying disease was a persisting type III posterior urethral valve. Diagnosis of renal pelvis rupture and the underlying malformation was achieved sonographically and by abdominal CT scan. The left kidney was exposed at the time of admission and a pyeloplasty according to Anderson-Hynes was carried out. Secondarily the urethral valve was resected.

Abdominal Injuries↗
PubMed1995

[Is radical prostatectomy a suitable model for determination of PSA half-life?].

A review of the literature relating to PSA half-life reveals great variability in absolute values and pharmacokinetic models. A critical view is needed, however, since some authors suggest that the PSA half-life has implications for diagnosis and prognosis after radical prostatectomy. The aim of our study, therefore, was to characterize the value of PSA half-life determination after radical prostatectomy. Serial serum PSA detections were performed in 16 patients with localized prostatic cancer who had undergone radical prostatectomy. Serum PSA was detected on days 0, 1, 2, 3, 6, 9, 12, 15, 18, after radical prostatectomy. In all patients elimination of PSA from serum followed a biphasic logarithmic decay pattern indicating a two-compartment model of first order elimination kinetics (t1 = 1.01 +/- 0.06 days, t2 = 3.42 +/- 0.23 days; P < 0.00001). In this two-compartment model 56.3 +/- 4.8% of the preoperative PSA serum concentration was cleared by the first compartment. To find a biological correlative for the first compartment a mathematical model was developed to approximate the effect of operative blood and plasma loss on PSA serum concentration. In this model changes of hematocrit were used to estimate blood and plasma loss. These calculations showed that 50.12 +/- 3.04% of the preoperative PSA serum concentration was excreted by operative blood loss. This value was not significantly different from the clearance rate calculated for the first compartment. It is, therefore, concluded that the determination of PSA half-life after radical prostatectomy without correction of the operation-related PSA loss is only of limited value.

Adult↗
PubMed1995

[Transurethral laser ablation of the prostate (TULAP). Initial results with 188 patients].

Laser therapy for benign prostatic hyperplasia (BPH) is now the most impressive alternative to transurethral resection of the prostate (TUR-P). Transurethral laser ablation of the prostate (TULAP) is a new technique that combines non-contact and contact laser treatment of BPH. From November 1992 to August 1994, 188 patients were treated by the TULAP technique. Their median age was 70.3 (58-87) years. The mean prostatic volume determined by transrectal ultrasound, was 49.2 ml. A 6-month follow up was possible for 102 patients. The AUA 7-Symptom Score decreased from 29 points preoperatively to 6 points after 6 months. Residual urine volume decreased from 205 ml to 27 ml after 6 months. Maximum flow rate increased from 7.2 ml/s to 19.3 ml/s after 6 months. No severe complications were observed, and in particular no major bleeding or TUR syndrome. We regard the TULAP procedure as an effective treatment alternative for obstructive symptoms caused by BPH.

Aged↗
PubMed1995

[Nerve-sparing cystectomy technique in the woman].

With the advent of the nerve-sparing and urethral-support-sparing cystectomy technique, the urethral closure mechanism and the rhabdosphincter muscle of the lower urethra are left intact. The fibers of the interior hypogastric plexus supporting the urethra and the vagina remain intact. The autonomic nerve fibers are particularly at risk at two points: where they cross under the ureters between the uterine and vaginal arteries and in the bladder neck area. In both areas damage must bei avoided by careful dissection. The endopelvic fascia is incised immediately lateral to the posterior urethra at the urethrovesical junction. As much as possible of the urethropelvic ligament and the paraurethral vascular and nerve plexus must be saved. The urethrovesical junction is dissected off the anterior vaginal wall down to the posterior bladder wall. The cardinal ligaments are divided well anterior to avoid the pelvic plexus. The superior vesical artery and uterine vessels are cross-clamped, cut and tied. Once the uterine artery is transsected, the distal ureter comes into view and can be isolated, avoiding damage to the nerve fibers. The vaginal cavity is entered by a transverse incision, and the edges of the vaginal incision are held open with Ellis clamps. The distal stump of the ureter following its division is pulled medially to facilitate dissection of the lateral bladder wall. The perivesical vascular plexus and the inferior hypogastric plexus, which is located laterally to the vessels, are separated from the lateral wall of the bladder and vagina. (ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Nervous System↗
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↗
PubMed1995

[Extracorporeal shockwave lithotripsy in children. Complications and long-term results].

ESWL of urinary stones is a well-established treatment in adult patients. The treatment of urinary stones in children has gained increasing importance in recent years. From 1987 to 1993, a series of 27 children with urolithiasis in all parts of the urinary tract were treated by ESWL. Treatment was performed with general anaesthesia or analgosedation. During the treatment no complications occurred. On average, 34 sessions of ESWL, with 2165 shockwaves and 22.3 kV energy, were performed. Minor early complications, such as fever, pain and hydronephrosis, were observed in 7 patients. The overall stone clearance rate was 92%. Stone recurrence occurred in only 1 patient. There were no late complications, such as malfunction of the kidney, skeletal deformation or hypertension after 38 months of follow up. In conclusion, ESWL is the treatment of first choice in paediatric urolithiasis.

Adolescent↗
PubMed1995

[Positron emission tomography. Introduction of a new procedure in diagnosis of urologic tumors and initial clinical results].

Correct preoperative staging of malignant tumors is a prerequisite for an adequate therapy. This is not always possible with the imaging techniques available. Often, only an exploratory laparotomy can give the final diagnosis. Therefore, the search is on for a non-invasive technique for staging. Positron emission tomography (PET) is a new method in nuclear medicine; it is used for the diagnosis of primary tumors, for staging, and for follow-up after therapy. With PET, biochemical pathways and physiological functions are studied, in contrast to CT and MRI, with which anatomy and morphology are examined. In our department PET was used in 26 patients with invasive bladder cancer, in 11 patients with renal cell carcinoma and in 1 patient for follow-up after testicular cancer. The primary bladder tumor was found in 85% of cases; in 4 a non-organ-confined tumor was diagnosed preoperatively. Specificity in staging of lymph nodes was 86% (18/21); in 3 patients lymph nodes were false-positive on PET. However, in 5 patients all lymph node metastases were found by PET. Renal cell carcinoma were found in 8 out of 9 patients; in 2 patients with high-grade tumors an FDG-uptake defect was found. Lymph node staging was accurate in 9 patients without metastases and in 2 with metastases. One patient had a slightly enlarged retroperitoneal lymph node in the follow-up of a non-seminomatous germ cell tumor, which was positive on PET. Histology confirmed that it was the only positive lymph node within the whole specimen after retroperitoneal lymphadenectomy. PET gives new insights in uro-oncology by examination of the metabolism. Our initial results are promising and warrant further studies.

Adult↗
PubMed1995

[New technique of hypothermic renal protection in surgery for tumor of the solitary kidney].

Ex-situ protection of donor organs for transplantation with initial cold perfusion is routinely used. The superiority of the Histidin-Tryptophyn-Ketoglutarate solution (HTK) has been demonstrated in animal models and clinical use. On the other hand, nephron sparing surgery for surgical or functional solitary kidneys has been proved effective for many years. Due to widely used ultrasound and computerized tomography, the incidence of small renal tumors has increased. Therefore, new concepts in conservative renal surgery are gaining more popularity. In this study we report about 11 patients with renal masses in a functional solitary kidney. For the first time, all enucleations were performed with continuous in-situ perfusion with HTK-solution. Despite extensive tumors with central extension, complete in-situ tumor resection and kidney reconstruction were possible. There were no intraoperative complications. Postoperatively, one kidney was lost secondary to renal artery embolism. Urine production started within one hour postoperatively in all cases. No further patient needs haemodialysis. Postoperatively, renal function was largely unchanged except for a transient minor elevation of the serum creatinine. There were no changes of serum creatinine. There were no changes of serum electrolytes and no cardiac failures under HTK. The indication, the surgical procédures and the first clinical results of continuous in-situ perfusion with HTK-solution for conservative renal surgery are presented.

Aged↗
PubMed1995

[Continuous in situ cold perfusion with HTK solution in conservative surgery of kidney tumor].

Ex situ protection of donor organs for transplantation with initial cold perfusion is routinely used. The superiority of histidine-tryptophan-ketoglutarate solution (HTK) has been demonstrated in animal models and clinical use, however. On the other hand, nephron-sparing surgery for surgical or functional solitary kidneys has been an established procedure for many years. Owing to wide use of ultrasound and computerized tomography, the detection of small renal tumors has increased. New concepts in conservative renal surgery are therefore gaining in importance. In this study we report on 11 patients with renal masses in a surgical or functional solitary kidney. For the first time, all enucleations were performed with continuous in situ perfusion with HTK solution. Despite extensive tumors with central extension, complete in situ tumor resection and kidney reconstruction were possible. There were no intraoperative complications. Postoperatively one kidney was lost secondary to renal artery embolism. Urine production started within 1 h postoperatively in all other cases. No further patients needed hemodialysis. Apart from temporary elevation of serum creatinine, postoperative renal function was unimpaired. There were no changes in serum electrolytes and no disorders of cardiac conduction. The indications, the surgical procedure and the first clinical results of continuous in situ perfusion with HTK solution for conservative renal surgery are presented.

Aged↗
PubMed1994

Radical retropubic prostatectomy: morbidity and urinary continence in 418 consecutive cases.

OBJECTIVE: To evaluate morbidity and mortality after standard retropubic radical prostatectomy with special attention to postoperative urinary continence. METHODS: Four hundred eighteen consecutive patients undergoing radical prostatectomy for treatment of localized prostatic cancer were reviewed. Both clinical and pathologic staging was assessed retrospectively according to the new TNM classification (International Union Against Cancer, 1992). Postoperative urinary continence was assessed according to the criteria of the International Continence Society. RESULTS: There were no operative deaths. Perioperative mortality was 1.2 percent, with 3 patients dying of myocardial infarction and 2 of pulmonary embolism after uneventful operations. Rectal injury, which was primarily closed, occurred in 2.9 percent. In 1 case (0.2%), reimplantation of the left ureter had to be performed. A total of 20 patients (4.7%) required reoperation: abscess 1.7 percent; postoperative hemorrhage, 1.7 percent; anastomotic urinary leakage, 1.2 percent: massive lymphocele, 0.2 percent. Complications that were treated conservatively occurred in 73 patients (17.4%): lymphocele, 6.4 percent; hemorrhage, 5.7 percent; thromboembolism, 2.6 percent; secondary wound healing, 2.6 percent. Of all patients who were followed for one year or longer, 80 percent achieved complete urinary control or reported occasional spotting only; 15 percent experienced stress incontinence grade II; and 3 percent were totally incontinent. CONCLUSIONS: Despite extensive surgical experience, our continence rates are far from the optimistic 1-3 percent incontinence rates reported in the literature. In our experience, radical retropubic prostatectomy can be performed with acceptable morbidity and without significantly affecting the quality of life in the majority of patients.

Follow-Up Studies↗
PubMed1994

Thermosensitive stent (Memotherm) for the treatment of benign prostatic hyperplasia.

Recently, more and more alternative therapeutic methods have been used for the treatment of benign prostatic hyperplasia (BPH). We will report on therapeutic results with a new thermosensitive stent system (Memotherm). This wire mesh stent has been designed especially for urological purposes. It is made of Nitinol, a thermoreactive material, and gains its maximum expansion force al body temperature. Due to the properties of the material the stent is flexible and can adapt to the anatomical conditions of the prostatic part of the urethra. Because of individual variations in the length of the prostatic part of the urethra, the system is available in lengths from 2 to 8 cm. The knitted structure for the first time allows atraumatic removal. Between April, 1992, and September, 1993, we treated a total of 54 BPH patients with the stent system. Mean patient age was 76.1 +/- 7.6 years (61-98). Mean prostatic volume was 51.9 +/- 25 ml (20-150), and the length of the applicated stents was 32.3 +/- 9.5 mm (20-70). Patient selection for stent treatment was carried out with regard to the preoperative risk status of this patient group. Fourteen (26%) of the patients treated were able to micturate before operation; in 40 (74%) urinary drainage was accomplished by means of an indwelling catheter. Following stent application, 53 out of 54 patients were able to micturate. With the first group (preoperative voiding ability), maximum flow had increased from 4.5 ml/s to a mean of 15.8 ml/s, while residual urine volume had decreased from 194.4 ml to 11.8 ml and the AUA 6 Symptoms Score had improved from 24 points to 3.5 points 6 months after stent application. All differences were statistically significant (P < 0.02). With the second group (no preoperative voiding ability), the AUA 6 Symptoms Score had improved from 25 points to 3.9 points (P < 0.02) 6 months after the operation, at which time the mean maximum flow rate was 14.8 ml/s and residual urine volume 14.8 ml. There was no statistically significant difference between the patients who were able and those who were unable to micturate before operation. One case of epididymitis was the only major complication observed after stent placement. Frequent urgency symptoms (30 out of 54 patients; 55.5%) subsided after a mean period of 1 week. The Memotherm stent offers an interesting therapeutic alternative for BPH risk patients.

Aged↗