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Biomedical subjects

S Chlepas

Publications and source records attributed to S Chlepas.

11 recordsLinked to original sources
PubMed1979

[Desobstructive sodium and water diuresis: pathophysiologic and clinical aspects of bilateral obstructive nephropathy (author's transl)].

The measurement of sodium and water loss after relieve of the obstruction shows that the obstructive nephropathy originates in three pathogenetic mechanisms. (1) Acute complete bilateral ureteric obstruction causes tubular atrophy, prevents both resorption and glomerular filtration, reduces the renal blood flow and increases the extracellular space by retention of water and products subject to urinary excretion. (2) Relieve of obstruction results in excess polyuria as blood flow and glomerular filtration recover rapidly, the extracellular space gets rid of its osmotic load, and the tubular dysfunction of resorption continues for several days until the epithelium has recovered from its pressure atrophy. All this will result in a high loss of sodium and water which requires adequate substitution; otherwise, natriuretic shock will result. (3) The chronic (bilateral) obstruction behaves in a similar way, yet is less reversible. The tubular damage is the same. Moderate polyuria occurs already during the stage of obstruction. Hereby the extracellular space decreases. After relieve of the obstruction the polyuria increases significantly, yet less rapidly than after acute obstruction as the glomerular function does not recover completely. The renal blood flow remains diminished, the vascular calibers stay narrowed, and the kidney remains shrunken. Loss of sodium and water will endanger the patient with chronic obstruction. Furthermore, the patient will be at risk due to dehydration, acidosis, anemia and uremia. The infusion therapy of the desobstructive nephropathy syndrome is based upon the venous pressure and the serum electrolytes which are measured twice daily.

Adult↗
PubMed1979

[Recurrence of inguinal, undescended, testicle (author's transl)].

An analysis of 94 patients from 1970 to 1977 demonstrates the problems of recurrence of the inguinal undescended testis. In more than 2/3 of the patients operative deficiencies were considered as the cause. The technique of secondary corrective surgery is described. The special difficulties with short internal spermatic vessels are outlined. In 90% of the patients a good anatomical result was obtained but no data are available concerning later functional results.

Cryptorchidism↗
PubMed1978

[The cancerologically correct operation for nephroblastoma (author's transl)].

The following methodology is suitable for increasing the radicality of and the safety of the vessels during a transperitoneal operation for nephroblastoma and simultaneously for sparing the necessity of postoperative radiation: 1. primary exposure of the renal vascular cross, the vena cava, and the aorta through incision of the plica duodeno jejunalis together with mobilization of the duodenum to the right, the mesocolon to the left; 2. primary ligature of the a. renalis in front of the v. renalis (no problems on either side); 3. systematic retroperitoneal en bloc lymphodissection from the a. mesenterica superior to the forking of the aorta, laterally to the diaphragm, probative at the adnexa; 4. subsequent lateral release of the left-sided tumorous kidney, medial release of the right-sided tumorous kidney after mobilization of the cecum.

Humans↗
PubMed1978

[Technique and results of the colon conduit, continent by means of a new magnetic stoma seal. An animal experiment study. Enterocystoplasty as model of continent urinary diversion. Review and comparison of the results of colocystoplasty, coloprostatoplasty and colourethroplasty (authors transl)].

On the basis of satisfactory results with a new magnetic stoma seal in colostomy patients, this seal, consisting of a magnetic ring and cap, was used in an experimental study to convert the colonic conduit into a continent reservoir. The aim of the study, involving 16 dogs, was to find a method of ring implantation that would avoid infection of the ring and yield complete continence in a higher percentage than had been achieved so far in patients. Complete continence was obtained in all animals but there was a 75% incidence of immediate and delayed infection of the magnetic ring when the ring was inserted transcutaneously. In contrast, all rings were well accepted by the tissue when the procedure was staged with the ring being implanted transperitoneally several weeks prior to fashioning of the conduit. The general problems arising from the colonic conduit when used as continent reservoir are known from the results of colocystoplasty, coloprostatoplasty and colourethroplasty, which are reviewed and compared with our observations. Residual urine was low due to an ideal energy-balance pattern. Coloureteric reflux was successfully prevented in all cases operated on by a long-tunnel modification of the Leadbetter-Clarke technique. Hyperchloremic acidosis and renal function deterioration were not observed. All conduits were infected.

Animals↗
PubMed1977

[Kidney transplantation from a nephrological-urological viewpoint--results and problems. 2. Diagnosis and therapy after transplantation, complications, long-term results].

Indications, selection of donor and recipient, medical and surgical management and complications, problems of organ procurement. Renal transplantation has become routine therapy. Organs are predominantly obtained from cadavers, transplantations from living donors are rarely indicated. Advances in preservation methods have improved organ quality and prolonged storage time. Selection of the most suitable recipient is based on histocompatibility matching. Blood transfusions before transplantation seem to improve the results. Recognition of a rejection crisis is primarily based on clinical symptoms. Persistent rejection calls for prompt explantation and the patient has to return to dialysis. Infections, serum-hepatitis and gastro-intestinal bleeding are the most common complications. Late complicatons are diabetes mellitus, cirrhosis of the liver, osteopathy, recurring glomerulonephritis, and, rarely, malignomas. Transplantation frequency in the Federal Republic of Germany could be increased by more awareness of physicians and a better knowledge of the general public about the need for cadaver donors.

Graft Rejection↗
PubMed1977

[Clinical pathology and treatment of upper urinary tract urothelial tumors--a 10-year review (author's transl)].

Fifty-four patients with upper urinary tract urothelial tumors were treated from 1966 to 1975 at the Urologische Klinik und Poliklinik der Universität Erlangen-Nürnberg. The neoplasms were multicentric in 13 patients (24%). All of the tumors were classified according to the WHO classification and the recommendation of the UICC. The correlations between histologic grade of malignancy and local spread are statistically significant. Lymph node metastases were found primarily with grade 3 tumors and infiltration into outer muscle layer. Nephroureterectomy with radical lymphadenomectomy via transabdominal approach and frozen-section histology of marginal nodes are recommended. The overall 5-year survival rate was 65% (+/- 16%) in all patients with malignant disease.

Carcinoma, Transitional Cell↗
PubMed1977

[Regional lymph node metastases in renal cell cancer. Morphologic findings and clinical consequences (authors transl)].

With a uniform pathohistological technique of investigation the frequency of histological verified lymph node metastases in tumor nephrectomy depends on the surgical approach. Lymph node metastases were seen twice (6%) in 33 cases of lumbar nephrectomy, 22 times (17%) in 132 cases of abdomino-paracolic operations without systematic lymphadenectomy, 11 times (37%) in 30 abdomino-transplical nephrectomies with systematic lymphadenectomy. Primarily, one can expect lymph node metastases in case of infiltration of capsula adiposa, macroscopic invasion of veins, histologic grade 3 of malignancy, and/or if the tumor exceeds a size of 10 cm. Metastases are also possible in not enlarged and macroscopic normal lymph nodes. Without systematic dissection of the regional abdominal lymph nodes unknown regional lymph node metastases are likely to remain. Therefore, the treatment of choice in renal cell cancer is abdominal transplical nephrectomy with systematic lymphadenomectomy.

Abdomen↗
PubMed1976

Combined staging and grading of renal cell carcinoma.

After surgical removal of renal cell cancers we can compare and contrast 3 prognostically differing groups by combining staging after Robson and histologic grading of malignancy. Good cancers (grade 1, stage I or II) have an (uncorrected) 5-year-survival rate of 93%, bad cancers (grade 3, Robson stage II or III) one of 35%. The remaining tumors (intermediate cancers) have a 5-year-survival rate of 64%. Classification in 3 groups is also advisable for future comparison of end result reports.

Adenocarcinoma↗
PubMed1976

Renal cell carcinoma--invasion of veins.

Out of 188 operatively removed renal cell carcinomas 49% showed macroscopic evidence of vein invasion and in 28% of the cases only histologically provable vein invasion. The uncorrected 5-year survival rates amounted to 40.8% in macroscopic vein invasion, 60.6% in histologically provable vein invasion and 75.6% in the absence of vein invasion. The term 'vein invasion' should therefore always be defined more precisely. Hence suggest to modify the V classification of 1974 of the UICC.

Adenocarcinoma↗
PubMed1976

Histological grading of renal cell carcinoma.

The Erlangen system of histologic grading of the malignancy of renal cell cancers is described in detail. It takes into consideration the type of cell and pattern of the tumor and differentiates between grades 1, 2, and 3. Grade 1 was observed in 10%, grade 2 in 51%, and grade 3 in 39% of the cases. The difference in the 5-year survival rates between tumors of grade 3 and those of tumors of grades 1 and 2 is statistically significant.

Adenocarcinoma↗