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Biomedical subjects

S C Müller

Publications and source records attributed to S C Müller.

At least 91 records · Page 5Linked to original sources
PubMed1997

Management of complete ureteral replacement. Experiences and review of the literature.

The common treatment for patients with extensive damage to the ureter is complete ureteral replacement, combining Boari flap-psoas bladder hitch and downward mobilization of the involved kidney, with complete ideal replacement of the ureter, renal autotransplantation, of elective nephrectomy. Three case reports serve to describe two options of reconstructive treatment for complete ureteral replacement. The operative techniques, their limits, their postoperative results, and the treatment alternatives are discussed with due regard to recent literature. In the case of ileal replacement we have used a very short ileal segment to reduce the absorption surface of the ileal mucosa. Reflux prevention of the ileal segment was performed by creating an invaginated distal ileum nipple which was additionally fixed at the Boari flap by a third stapler row (auto suture TASS) to prevent potential nipple-gliding.

Adult↗
PubMed1997

Rhenium-186 HEDP: palliative radionuclide therapy of painful bone metastases. Preliminary results.

The aim of this study was to evaluate the efficacy of rhenium-186 hydroxyethyledine diphosphonate (Re-186 HEDP) for pain relief in patients with disseminated bone metastases primarily from prostate or breast cancer. Up to now, 44 patients taking analgesics were entered in this study and received one or more injections of 1295 MBq of Re-186 HEDP. An analgesic effect of more than 20%, evaluated by using a verbal rating scale (VRS) and a visual analogous scale (VAS), was defined as significant and could be achieved in 60% of these patients. Duration of clinical response averaged 1-4 months (median 5.5 weeks). Side effects such as a moderate decrease of platelets or an increase of pain for 1-2 days (flare-up effect) were observed. Radioactive treatment with Re-186 HEDP appears to be a useful compound for the palliation of painful skeletal metastases and improvement of the remaining quality of life.

Bone Neoplasms↗
PubMed1996

Traveling NADH and proton waves during oscillatory glycolysis in vitro.

Propagation and mutual annihilation of circular and spiral NADH and proton waves were detected by spatially resolved spectrophotometry and fluorescent proton indicators in a biological in vitro system: an organelle-free yeast extract. Spontaneous wave generation during glycolytic sugar degradation is established after an induction period of about 1 h. Controlled wave initiation could be performed by local injection of the strong activator of phosphofructokinase, fructose 2,6-bisphosphate. A crucial role for wave initiation and control of pattern dynamics is attributed to the key enzyme of glycolysis, the allosterically regulated phosphofructokinase. An overall increase in the concentration of its positive effector AMP leads to the formation of rotating spirals. The dynamics of the observed wave patterns resemble that of self-organized calcium waves as recently found in frog eggs and heart cells.

Cell-Free System↗
PubMed1996

Epithelioid leiomyoma of the prostate.

We report a case of an unusual mesenchymal tumor of the prostate. Rectal-digital palpation and transrectal ultrasound showed a circumscribed and inhomogeneous tumor within the right prostatic lobe. Surgical treatment consisted of transurethral resection of the right prostatic lobe. On the basis of morphology and immunohistochemical detection of desmin and smooth-muscle-type actin, the diagnosis of an epithelioid leiomyoma was made. This is the first report of this entity in the prostate. A definite prediction of the biological potential is currently not yet possible.

Humans↗
PubMed1996

Long-term results of internal urethrotomy.

PURPOSE: A retrospective analysis was done of long-term results of internal urethrotomy to evaluate risk factors of stricture recurrence. MATERIALS AND METHODS: Followup studies were performed of 937 patients with urethral strictures treated with internal urethrotomy. Of the patients 357 were treated at Mainz University between 1977 and 1989 (mean followup 4.6 years) and 580 were treated at Bonn University between 1974 and 1986 (mean followup 3.2 years). RESULTS: Strictures recurred in 96 of 357 (26.9%) and 260 of 580 (44.8%) patients, respectively. Risk factors for recurrence were etiology (post-transurethral resection and inflammation), stricture longer than 1 cm. and postoperative catheter drainage for longer than 3 days. CONCLUSIONS: Urethroplasty should be considered in patients at high risk for stricture recurrence and with more than 1 treatment failure after urethrotomy.

Adolescent↗
PubMed1994

Hormone therapy prior to radical prostatectomy in patients with clinical stage C prostate cancer.

Seventy patients with clinical stage C carcinoma of the prostate were treated for 3 months with the gonadotropin-releasing hormone analog, goserelin acetate (Zoladex; Zeneca Pharmaceuticals, Macclesfield, UK) plus an antiandrogen (flutamide). Based on digital rectal examination (DRE), reductions of the size of the prostate and the tumor were noted in 91.4% of patients. Ultrasound demonstrated a decrease in prostatic volume between 0% and 62.5% (median 31%). Prostate-specific antigen (PSA) levels (Hybritech) decreased substantially (mean PSA of 31.3 ng/ml before, to a mean PSA of 1.4 ng/ml after hormonal treatment). A total of 64 patients subsequently underwent radical retropubic prostatectomy. Pathologically, only 9 patients (14.1%) had organ-confined disease (stage B), 34 (53.1%) had stage C tumors, and 21 (32.8%) had positive lymph nodes (stage D1). In 5 patients with nodal metastasis and 7 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Maximal androgen blockade for a period of 3 months in clinical stage C prostate cancer induces a notable reduction in prostate size ("downsizing"). A "downstaging" effect, as suggested by DRE, ultrasound, and PSA, was not observed. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.

Chemotherapy, Adjuvant↗
PubMed1994

The fate of the adult exstrophy patient.

Between 1968 and 1993, 101 patients with bladder exstrophy or incontinent epispadias underwent surgery at our hospital. The standard procedure was ureterosigmoidostomy and additional genital reconstruction. Of the 56 patients who have reached adulthood 45 could be interviewed regarding social integration, sexuality and fertility. All patients have a functioning urinary diversion. Of the 45 patients questioned 41 have completed vocational training or are currently in training, 3 are unemployed and 1 lives at a therapeutic center. Among the patients 29 are married or have a steady partner. All women engage in sexual intercourse and 2 have delivered 3 children by cesarean section. All men achieve erection. Of the 28 men who underwent reconstruction of the external genitalia 11 have a penile deviation, which is distressing in only 2. Only 3 of the men are dissatisfied with the cosmetic result and 33% had epididymitis, necessitating 2 orchiectomies and 3 vasectomies. No patient with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas all 5 who did not undergo genital reconstruction had normal ejaculation and 2 have fathered children. Male patients with genital reconstruction and closure of the urethra have a high risk of infertility. Our patients demonstrate that the cosmetic results after genital reconstruction are satisfactory. However, in male patients, surgery is performed at the expense of fertility. Because this corrective procedure is usually performed during childhood, the parents must be informed of these consequences before surgical correction.

Adolescent↗
PubMed1994

Ileocecal valve reconstruction during continent urinary diversion.

During construction of an ileocecal reservoir, such as the Mainz or Indiana pouch, the ileocecal valve is lost. Subsequently, the intestinal transit time is shortened and malabsorption as well as diarrhea may result. Patients having undergone previous bowel resection as well as children with myelomeningocele who often already have frequent defecations will be heavily affected by the loss of the ileocecal valve. We have functionally reconstructed the ileocecal valve by embedding ileum into the ascending colon via a submucosal tunnel in analogy to the technique used when creating the continence mechanism during the Mainz pouch procedure using the appendix. Experimental results in 15 dogs demonstrated that the surgically reconstructed valve genuinely mimics the physiological function of the authentic valve and confirmed a marked transit time prolongation without evidence of obstruction. Our first clinical experience in 12 patients using this operative technique is promising. Equally, the morphological appearance of the newly created valve closely resembles the genuine ileocecal valve during barium enema as well as endoscopic investigations.

Adolescent↗
PubMed1994

The Mainz pouch II.

The Mainz pouch II procedure has proved to be a substantial modification of the classical technique of ureterosigmoidostomy at many institutions. To date we have used this procedure in 72 patients, including 15 children. Detubularization causes a low pressure and eliminates high-pressure contractions. Without the risk of compromising the blood supply the pouch is fixed at the promontory which reduces the risk of ureteral kinking and upper urinary tract dilatation as it is sometimes observed after ureterosigmoidostomy. The technique is not only indicated in cases of failed ureterosigmoidostomy but also for primary urinary diversion. Of the 72 patients operated, all are evaluable with a follow-up of 1-31 months. All patients are continent during the daytime with a mean emptying frequency of 5. All but one elderly woman are dry at night with a mean frequency of 1. The described urodynamic/rectodynamic evaluation enables a reliable prediction of postoperative continence. With the reservoir full the basal pressure was 24 cm H2O and the highest peak pressure recorded was 35 cm H2O.

Adult↗
PubMed1994

Management of renal angiomyolipoma: a report of 14 cases and review of the literature. Is nonsurgical treatment adequate for this tumor?

14 patients with renal angiomyolipoma are presented. Two of them had tuberous sclerosis (TS) with synchronous bilateral and multiple tumors. Two other patients without TS also had multiple tumors in 1 kidney. More than half the patients were symptomatic (n = 8), 2 of them with spontaneous rupture of the tumor. Misdiagnosis, spontaneous rupture and tumor growth can be prevented by utilizing conservative, organ-sparing techniques. In cases of solitary kidneys with large and/or hemorrhagic angiomyolipoma, superselective arterial embolization is indicated.

Adult↗
PubMed1993

Three-dimensional waves of excitation during Dictyostelium morphogenesis.

Cells in Dictyostelium slugs follow well-defined patterns of motion. We found that the chemotactic cell response is controlled by a scroll wave of messenger concentration in the highly excitable prestalk zone of the slug that decays in the less-excitable prespore region into planar wave fronts. This phenomenon is investigated by numerical solutions of partial differential equations that couple local nonlinear kinetics and diffusive transport of the chemotactic signal. In the interface of both regions a complex twisted scroll wave is formed that reduces the wave frequency in the prespore zone. The spatio-temporal dynamics of waves and filaments are followed over 33 periods of rotation. These results yield an explanation of collective self-organized cell motion in a multicellular organism.

Animals↗
PubMed1993

Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.

We report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described. We discuss whether the primary implantation of a penile prosthesis during 1-stage surgical phalloplasty is more advantageous in comparison with the currently favored secondary implantation. Phalloplasty should be represented by a 1-stage surgical procedure encompassing the creation of a neourethra, restoration of tactile and possibly erogenous sensibility, and implantation of a penile prosthesis. The result should have aesthetic value and be pleasing to the patient.

Adult↗
PubMed1993

The Mainz pouch II (sigma rectum pouch).

A low pressure rectosigmoid reservoir for urine is created obviating the need for colostomy, augmentation or extensive bowel surgery. Antimesenteric splitting of the intestine at the rectosigmoid junction and subsequent side-to-side anastomosis are performed. Urodynamic data demonstrate that the detubularization is effective in rendering high pressure bowel contractions ineffective. Without the risk of damaging the mesentery the pouch is fixed at the promontory, which lessens the risk of ureteral kinking and upper urinary tract dilatation. The technique is indicated not only in cases of failed ureterosigmoidostomy but also for primary urinary diversion. All 47 patients who underwent the operation were evaluable with a followup of 1 to 20 months (mean 10 months). All patients are continent during the daytime with a mean emptying frequency of 5 times. All but 1 elderly woman are dry at night with a mean frequency of 1 episode. With the reservoir full the basal pressure was 24 cm. water and the highest peak pressure recorded was 35 cm. water. The low pressure improves continence, protects the upper urinary tract and even allows dilated ureters to be implanted.

Adult↗
PubMed1993

[Penile venous outflow occlusion: a comparison of erectile function and cavernosometry before and after percutaneous interventions].

After percutaneous transpenile or retrograde venous occlusion for the treatment of a cavernous leak, the clinical results were correlated with cavernosometric flow measurements in 27 patients. In 15 patients, venous occlusion led to a reduction of the maintenance flow: in patients who showed improvement there was an average reduction of 30 ml/min, in those without improvement or deterioration it averaged 0.3 or 13 ml/min respectively. In 7 patients there was increased flow (up to +21 ml/min). One of these patients showed improved erectile function; the remaining 6 showed no change as was also the case in 5 other patients who had no change in cavernosometric measurements. Our findings suggest a multifactorial cause of the venous leaks.

Embolization, Therapeutic↗
PubMed1993

[Retrograde venous occlusion--therapy of impotence of venous origin].

Retrograde occlusion of penile drainage veins can produce improvement in patients with impotence due to venous leaks. We performed 50 transfemoral and three transjugular procedures; 46 (86%) were technically successful. Clinical improvement was found in 24 out of the 46 procedures (52%). In 20 patients spontaneous intercourse became possible, in four this occurred after intracavernous injection of vaso-active substances. In eleven patients there was deterioration after one to twenty months; in seven this was treated by repeated venous occlusion. In 13 patients improvement has been maintained over a period of one to thirty months (average 10.5 months). There were no complications.

Angiography↗
PubMed1993

Sigma-rectum pouch (Mainz pouch II).

A substantial modification of the classic technique of ureterosigmoidostomy is introduced in this article. To date, this procedure has been used in 47 patients. This article reviews the surgical technique of the antemesenterial splitting of the intestine at the recto-sigmoid junction which creates a pouch by subsequent side-to-side anastomosis.

Bladder Exstrophy↗