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Biomedical subjects

R Hofmann

Publications and source records attributed to R Hofmann.

At least 37 records · Page 2Linked to original sources
PubMed1992

Renal artery embolism: clinical features and therapeutic options.

Renal artery embolism is an infrequent but important cause of renal loss. However, due to its rarity and nonspecific presentation diagnosis is often delayed and occasionally missed. Furthermore, proper therapeutic intervention is not well established and aggressive surgical management is often ill-advised. We review the literature and present 3 cases seen recently at our institution. Selective intra-arterial infusion of thrombolytic agents appears to be the most favorable treatment. The duration of occlusion does not necessarily correlate with the return of renal function, and the degree of collateral renal blood flow can be important.

Adult↗
PubMed1992

Ureteroscopy without routine balloon dilation: an outcome assessment.

A retrospective analysis of 156 rigid ureteroscopic stone procedures in 145 patients revealed successful manipulation in 90%. The stone-free rate after adjunctive procedures was 95%. Access was achieved without balloon dilation in all but 18 patients. There were 24 perforations, occurring in 31% of proximal, 8% of mid ureteral and 8% of distal stone manipulations. Of the evaluable patients 63% underwent radiographic assessment for stricture disease, 75% at 6 months or more after the procedure. The stricture rate was 3.5% in all patients and 5.9% in patients with perforations. Of 37 patients evaluated for vesicoureteral reflux only 1 had reflux. Questionnaire followup was obtained for 74% of the patients (mean followup 2.6 years) and 32% felt normal within 3 days. Postoperative symptoms included flank pain (13%), renal colic (12%), pelvic discomfort (30%) and Double-J stent related complaints (49%). Of the patients 15% have reported recurrent stones. Ureteroscopy is effective and well tolerated, and it has minimal long-term complications.

Catheterization↗
PubMed1992

Pyonephrosis: diagnosis and treatment.

A series of 23 confirmed cases of pyonephrosis initially treated by percutaneous nephrostomy drainage were reviewed. Presentation was extremely variable, ranging from sepsis to asymptomatic bacteriuria. Fever, flank pain and leukocytosis were often absent. Ultrasonography was diagnostic in only 3 of 12 patients. In all, 17 patients had associated nephrolithiasis, and 5 patients ultimately required nephrectomy. Renal urine cultures were positive in 16 of 21 instances, with multiple organisms found in 8 of 21, and added bacteriological data not provided by bladder urine cultures in 11 cases. A pre-existing history of urinary tract infection, hypertension and malignancy was common. Percutaneous drainage was a safe, quick and effective diagnostic and therapeutic method.

Adult↗
PubMed1992

Adenosine triphosphate and adenosine diphosphate in human semen: correlation with sperm count and motility.

Adenosine triphosphate (ATP) and adenosine diphosphate (ADP) have been correlated with traditional semen parameters such as forward motility and sperm count. ATP and ADP were determined by a bioluminescence assay using the luciferin-luciferase reaction. Short boiling of the ejaculate was performed to inactivate phosphatases (ATPases) in the seminal plasma and the sperm tails. Fresh and deep-frozen semen samples from 45 men with oligozoospermia (n = 22) and normal sperm count (n = 23) were evaluated. Freezing of the sperm for 12 weeks did not effect the ATP or ADP content in the spermatozoa as compared to fresh semen. ATP and ADP concentration was in the range of picomoles/microliter and showed a significant correlation with the number of normal sperm per milliliter and a less marked correlation with the sperm motility. ATP and ADP concentration in the spermatozoa can be measured relatively easy and is reproducible. Unlike the monotonous evaluation of sperm motility by a technician, this biochemical method provides an objective parameter for semen quality. These qualities suggest that this method could be a way to determine the fertilizing potential of semen and to relate this to actual pregnancy rates.

Adenosine Diphosphate↗
PubMed1992

[Initial studies of the possibility of selective ablation of arteriosclerotic vascular changes using laser-induced shock waves].

We studied the effect of laser-induced shock waves in 94 arterial segments from freshly obtained autopsy material. In analogy to the well-established method of shock-wave based lithotripsy, the new principle of our treatment depends on an indirect interaction of the laser energy with the arterial wall via laser-induced mechanical shock waves (angiotripsy). We used a Nd:YAG laser, 1064 nm, 8-20 ns pulse-length to create shock waves that effected smooth craters in arteriosclerotically affected arteries. The histological examination found no thermal damage. Shock waves applied to the healthy and normal arterial wall only resulted in focal intimal ablation and in a minor loosening of the medial structures. The examination of the irrigation solution by means of a laser-guided, high-resolution analysis of the particles revealed that, in 97%, the particles created by our shock wave angiotripsy showed a diameter of less than 5 mm and an area of less than 25 mm2. Based on these first in vitro results, it seems possible to ablate arteriosclerotically affected tissue without significant damage to normal wall segments. Further in vitro and in vivo studies are required to evaluate the clinical implications of this new therapeutic approach.

Angioplasty, Laser↗
PubMed1992

[High-dose-rate brachytherapy of prostatic carcinoma with iridium 192].

In the therapy of localized prostatic cancer the radical prostatectomy shows good results within a five-year interval with no evidence of disease in nearly 90%. An important alternative is the radiotherapy by external beam or interstitial technique with iodine, gold or iridium. We use the high dose rate technique with Ir-192. In this technique five to seven hollow needles are placed in the prostate from perineal punctures under transrectal sonographic control. The three-dimensional brachytherapy planning is done according the actual needle position. A computer program calculates the radiation dose and distribution for each needle by adjustment of time and stops of the Ir-implants. The Ir-192 is temporary loaded twice with 9 Gy supplemented with external beam radiation (18 x 2 Gy). Since 1985 29 patients with localized tumor (T1-T3, N0, M0) have been irradiated. 21/29 had a pelvic lymphadenectomy before. In 85% of the patients were seen no side effects. Only one patient had a serious complication through a recto-vesical fistula. Out of the 21 followed-up patients 16 were in full remission, three had an androgen deprivation because of progression. A local tumor control could be demonstrated by cytology in 70% of the patients. This rational technique seems to be an alternative for patients not eligible for a radical prostatectomy.

Aged↗
PubMed1991

Opitz trigonocephaly syndrome.

We report on a patient with Opitz trigonocephaly syndrome. The girl was the first-born child of consanguineous parents and had trigonocephaly, apparent hypertelorism, upslanted palpebral fissures, strabismus, small nose with broad root, abnormally modeled ears, high palate, short neck with loose skin, polysyndactyly, and prominent clitoris and labia majora. In addition, a complex cardiovascular defect (Eisenmenger disease) was observed. The patient was mentally retarded.

Abnormalities, Multiple↗
PubMed1991

Purification, characterization and mechanism of action of scatter factor from human placenta.

Scatter factor (SF) causes contiguous sheets of epithelium to spread and cells to separate from each other. SF also increases the velocity, area, and reduces the circularity of individual cells. These changes are mediated in part by alterations in protein synthesis, protein phosphorylation, cytoskeletal reorganization, and cell surface components. SF has been purified from the conditioned medium of ras transformed 3T3 cells and human placenta. Sequence information suggests that SF from 3T3 cells is closely related to hepatocyte growth factor. SF is a glycoprotein, but glycosylation is not necessary for its activity. Glycosylation of target cell proteins, however, is required for SF action.

Animals↗
PubMed1991

Immunocytochemical typing of ABO blood groups in vaginal swabs partly contaminated with semen.

ABH typing by immunocytochemical method has been carried out on 163 selected vaginal swabs. 127 cases (78%) were determined correctly, 11 cases (7%) incorrectly and 25 cases (15%) could not be classified. Often, not all of the vaginal cells showed the expected positive staining, which was not counted as a false result. The incorrect results were not dependent on the secretor status, but 37% of the non-secretor cases could not be classified immunocytochemically, as compared with 12% of the secretors. In a second series, 61 vaginal swabs, dried on microscope slides, have been covered with semen from an A1 B secretor. Absorption of heterologous antigens by the vaginal epithelia could be demonstrated only after extremely long incubation with semen and extremely long incubation with the anti-A or anti-B antibodies. From the 163 "native" swabs, 17 gave a positive reaction with the acid phosphatase test, but only one false ABH result. A possible influence of bacteria upon the results is discussed. We believe that in practice, no faults in immunocytochemical ABH typing have to be expected, due to absorption of heterologous antigens.

ABO Blood-Group System↗
PubMed1991

Purulent corporeal cavernositis secondary to papaverine-induced priapism.

Intracavernous autoinjection of vasoactive substances is used to treat erectile dysfunction. Infection of the corpora cavernosa can be a serious life-threatening complication with this treatment modality. Cavernositis is an unusual complication, especially in otherwise healthy men. In diabetic patients with altered blood supply to the penis and a change of cavernous tissue ischemia can lead to a fulminant infection. We report on a 63-year-old diabetic patient who presented with purulent cavernositis a few weeks after beginning intracavernous injection of papaverine. Treatment included bilateral corporotomy, debridement, and placement of intracorporeal irrigation and suction drains. The patient survived this serious infection leaving both corpora cavernosa with severe fibrosis.

Erectile Dysfunction↗
PubMed1991

Entodermal inclusion cyst of the tricuspid valve.

This is a report on an epithelial inclusion cyst covering the septal leaflet of the tricuspid valve. The tumor was an accidental finding in a 5 1/2 years-old boy with congenital heart disease including double-chambered right ventricle, ventricular and atrial septal defects and subvalvular aortic stenosis. Histological examination showed a two-layered ciliated epithelium, typically present in the respiratory system. Embryologic tissue heterotopia arising from sequestered entodermal elements from the primitive foregut during cardiac organogenesis is a possible explanation for the locality and histology of the tumor. To our knowledge, a similar case has never been presented before.

Child, Preschool↗
PubMed1991

Importance of coronary spasm for recurrences following percutaneous transluminal coronary angioplasty (PTCA).

To examine the importance of coronary spasm for recurrences following coronary angioplasty, the incidence of spontaneous and ergonivine-provoked coronary spasm was studied, during initial and 6 months follow-up coronary angiography, in a consecutive series of 102 patients with single-vessel disease and successful coronary angioplasty. Repeat angiography demonstrated restenosis in 35 patients (34%). In patients with no demonstrable coronary spasm before and 6 months after PTCA, restenosis occurred in 23% (14/61). The recurrence rate for patients with spasms only before PTCA was similar (29%; 6/21). An increase of recurrences was observed in patients with coronary spasm before and 6 months after PTCA (69%; 9/13) and was extremely high in patients with detectable spasms only after PTCA (86%; 6/7). The importance of the severity of underlying coronary stenosis as regards the ergonovine testing result, demonstrated no relationship between the degree of underlying stenosis and the incidence of provokable coronary spasms. Thus, coronary spasms provokable only before PTCA do not increase the risk for recurrences. Spasms persisting after PTCA or seen only after the procedure are associated with a significantly higher rate of restenoses.

Angina Pectoris, Variant↗
PubMed1991

[Risk of complications of early coronary angioplasty after thrombolysis in acute myocardial infarct].

The present study reports on the complication rates in 143 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) within 4 weeks after thrombolysis for acute myocardial infarction. The results were analyzed with respect to the time between thrombolysis and PTCA. PTCA was successful in 130 patients (91%). The mortality was 0.7% (1 patient). Severe complications occurred in 9 further patients (7%): 8 reinfarctions (6%) and one patient with a large haematoma of the groin requiring surgical treatment (0.7%). The total complication rate, including milder was 24%. A comparison of patients treated with PTCA within the first 4 days after thrombolysis (group I, n = 67) with patients dilated between 5 and 28 days after thrombolysis (group II, n = 76) resulted in a complication rate of 33% in group I and 16% in group II (p less than 0.01). This important difference was due to the higher frequency of ischaemic complications in group I than in group II (28% versus 12%). Besides reinfarction (7.5% in group I versus 4% in group II), prolonged ischaemic episodes were the most frequent cause of complications. Our results demonstrate a very high risk of complications if PTCA is performed within the first 4 days after thrombolysis for acute myocardial infarction.

Adult↗
PubMed1991

[Purulent cavernitis as a complication of self injection into the cavernous body].

Intracavernous self-injection of vasoactive drugs is commonly prescribed for the treatment of erectile failure. Cavernitis is a serious complication of this treatment. The case of a 63-years-old patient with cavernitis following intracavernous injection of papaverine and subsequent priapism is reported. He had a phlegmonous infection of both corpora cavernosa without infection of the corpus spongiosum. The treatment consisted in surgical debridement of the corpora cavernosa with intracavernous drains inserted for continued irrigation and suction. Complete remission of the infection was ultimately obtained, but fibrosis of the remnants of both corpora cavernosa remained.

Erectile Dysfunction↗
PubMed1990

Modulation of pro-epidermal growth factor, pro-transforming growth factor alpha and epidermal growth factor receptor gene expression in human renal carcinomas.

We have analyzed the expression of the genes for the precursors of epidermal growth factor (pro-EGF) and transforming growth factor alpha (proTGF-alpha) as well as for the EGF receptor in tissue specimens of a large number of adult patients with renal cell carcinoma. Since normal kidney tissue was available from the same patients we could directly compare the expression of these genes in tumors with that in adjacent normal renal tissue. Our experiments reveal underexpression of the proEGF gene in all tumors analyzed (21 of 21) and overexpression of the genes for proTGF-alpha (33 of 33 analyzed) and EGF receptor (22 of 23 analyzed) in tumor samples, when compared with normal kidney tissue. The expression of the proTGF-alpha gene appeared to depend on grade and differentiation of the tumor, since well differentiated tumors (grade 1) expressed more proTGF-alpha mRNA than the adjacent normal tissue but significantly less than poorly differentiated tumors (grade 2 or 3), which are the most aggressive ones. In none of these tissue specimens did we find, by Southern analysis, amplification of the proTGF-alpha or EGF receptor gene. Therefore, overexpression of these genes must be due to another effect, perhaps an alteration of their mRNA turnover. Although the EGF receptor gene (c-erbB1) is overexpressed in nearly all carcinomas analyzed, there was no linear coexpression with the proTGF-alpha gene. In contrast, transcription of the proEGF gene was completely turned off in tumor tissue. Although we have found by restriction fragment length polymorphism analysis, in one of three tumor samples, evidence for a somatic mutation within the proEGF gene, we do not know yet, due to the limited number of Southern analyses, whether this somatic mutation is causally involved in the decrease of proEGF mRNA expression and, hence, is representative of renal cell carcinoma. To our knowledge, this is the first observation on primary tumor tissue in humans that upon malignant transformation the gene for a polypeptide growth factor gene is underexpressed.

Blotting, Northern↗
PubMed1990

Laser-induced shock wave lithotripsy. Influence of laser pulse energy and irrigation solutions on stone disintegration.

With a high intensity Q-switched Nd-YAG laser shock waves can be generated in a liquid close to the calculus. Up to 80 mJ single pulse energy with 8 nsec pulse duration can be transmitted through flexible quartz fibers. Energy conversion and enhancement can be accomplished at the fiber tip with optical focussing of the light at the quartz tip, with irrigation solutions and with high pulse energies. Iron-III-dextran solutions (1 mg Fe3+/1) and magnesium chloride (50 mmol/l) increased the pressure in the laser induced breakdown up to ten times (8,000-10,000 bar). Smaller stone particles and higher efficacy in stone fragmentation could be achieved.

Humans↗