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T Klotz

Publications and source records attributed to T Klotz.

At least 37 records · Page 2Linked to original sources
PubMed2000

Epidemiology of erectile dysfunction: results of the 'Cologne Male Survey'.

The last few decades have seen a marked increase in mean life expectancy in Central Europe. This has made elderly people and their quality of life a matter of ever-increasing medical concern. Available data from the United States and Scandinavia relating to erectile dysfunction (ED) do not enable us to draw valid conclusions about the current situation in Germany. The aim of the present study was to evaluate the epidemiology of male sexuality in Germany, and the proportion of men who need medical treatment because of increased suffering from this.A newly developed and validated questionnaire on male erectile dysfunction was mailed to a representative population sample of 8000 men, 30-80 y of age in the Cologne urban district. The response included 4489 evaluable replies (56.1%). The response rates in different age groups ranged from 49.2% to 68.4%. Regular sexual activity was reported by 96.0% (youngest age group) to 71.3% (oldest group). There were 31.5%-44% of responders who were dissatisfied with their current sex life. The prevalence of ED was 19.2%, with a steep age-related increase (2.3-53.4%) and a high co-morbidity of ED with hypertension, diabetes, pelvic surgery and 'lower urinary tract symptoms'. When treatment need was defined by co-occurrence of ED and dissatisfaction with sex life, 6.9% men required treatment for ED. Oral treatment of ED was preferred by 73.8% of respondents. There were 46.2% respondents who were willing to contribute more than DM 50 (25 Euro) per month for ED treatment. We conclude that regular sexual activity is a normal finding in advanced age. ED is a frequent disorder, contributing to dissatisfaction with sex life in a considerable proportion of men. The high burden of ED is reflected in willingness to pay for treatment. ED is frequently associated with chronic diseases. Therefore adequate diagnostic workup is essential, to offer patients individually adapted treatment. General non-reimbursability of treatment for ED appears to be unacceptable.

Adult↗
PubMed1999

[Ulcerating scrotal leiomyoma].

A 74-years old patient is admitted to the hospital with a over a period of 4 years growing, scrotal, ulcerated tumor. There is no connection to the testicle or the epididymis palpable. All laboratory findings including the tumorparameters are normal. The scrotal sonography shows a solid tumor, that is filled with vessels in the Doppler sonography. The complete tumor resection with histological examination leads to the diagnosis of a scrotal leiomyoma. This rare, benign tumor is a differential diagnosis to paratesticular or non-germinal tumors.

Aged↗
PubMed1999

Immunolocalization of inducible and constitutive nitric oxide synthases in human bladder cancer.

OBJECTIVES: Nitric oxide (NO) is synthesized by the enzyme family of NO synthases (NOS) and plays an important role in tumor growth and angiogenesis. NO generation by inducible NOS (iNOS) also influences the cytotoxicity of macrophages and tumor-induced immunosuppression. Before now, the expression of iNOS and constitutive NOS in bladder carcinoma tissue had not been determined. METHODS: Bladder carcinoma tissue specimens were procured from 18 patients (mean age 69.7 years) undergoing transurethral resection. In every patient, tumor biopsies were compared with biopsies of benign bladder regions. Histochemical NADPH-diaphorase staining and NOS immunohistochemistry were performed on all tissue specimens. RESULTS: Positive NADPH-diaphorase staining was detected in all sections from bladder carcinoma tissue. NOS immunohistochemistry showed a different pattern. The malignant epithelial cells were highly iNOS positive. Specimens of bladder mucosa outside of the malignant regions showed only a weak positive iNOS immunostaining. The endothelial cells of abundant precapillary vessels in the stroma of bladder tumors showed a highly positive endothelial NOS (eNOS) immunostaining compared with the stroma of nonmalignant bladder tissue. Neuronal NOS immunoreactivity was only found in nitrinergic fibers in the fibromuscular stroma. CONCLUSIONS: Bladder carcinoma tissue had a high iNOS content; benign tissue did not. NO generation from iNOS in the malignant epithelium and from eNOS in tumor stroma may play different roles in tumor angiogenesis and tumor-induced immunosuppression.

Aged↗
PubMed1999

Penetration of a single infusion of ampicillin and sulbactam into prostatic tissue during transurethral prostatectomy.

Antibiotic prophylaxis is recommended in endoscopic urological operations to diminish the rate of intraoperative septic complications and relevant urogenital infections. The objective of the study was to determine the tissue concentrations of preoperatively administered ampicillin and sulbactam in the human prostate in patients undergoing transurethral resection (TUR-P) for benign prostatic hyperplasia (BPH). In 19 patients (mean age 68.7 years) the serum and tissue concentrations of ampicillin and sulbactam were determined. For all patients the dosage was administered as a single infusion over 15 min at a 2:1 ratio, i.e. 2 g ampicillin and 1 g sulbactam. The serum and prostatic tissue samples were taken 15 to 55 min (mean 29.5 min) after infusion. Of transurethral resected prostatic chips 3 g were immediately collected after resection and stored at -70 degrees C. Ampicillin was determined by bioassay and sulbactam was determined by gas chromatography/mass spectrometry. Tissue concentrations of ampicillin ranged from 0.42 to 548.33 mg/kg (median 47 mg/kg). Tissue concentrations of sulbactam ranged from 0.15 to 249.74 mg/kg (median 19 mg/kg). Six (32%) of 19 patients showed a tissue concentration of ampicillin <4 mg/kg (MIC90), respectively 5 (26%) patients of sulbactam <8 mg/kg. The mean serum concentrations at tissue sampling time were 118.8+/-48.9 mg/l respectively 32.2+/-12.2 mg/l. There exists a high variability of intraprostatic concentrations of ampicillin and sulbactam after single infusion in patients with BPH. In a relevant part of patients both compounds do not exceed the minimal inhibitory concentrations (MIC) of important bacterial pathogens. A single shot infusion of 3 g ampicillin/sulbactam for intraoperative antibiotic prophylaxis is not sufficient in patients undergoing TUR-P. It seems that the prostate cannot be compared to other tissues in view of penetration of ampicillin/sulbactam.

Aged↗
PubMed1999

Nitric oxide based influence of nitrates on micturition in patients with benign prostatic hyperplasia.

BACKGROUND: Nitric oxide (NO) is involved in the physiologic regulation of smooth muscle relaxation in the prostate. Organic nitrates act as NO donors. In this prospective open study we prove the influence of orally given nitrates on micturition. METHODS: Thirty-two patients underwent a urological medical check-up prior to starting nitrate medication for cardiovascular disease. We examined peak flow rates, residual urine, IPS-score, PSA level and prostate volume. Exact inclusion and exclusion criteria were defined. Fifteen patients suffered from obstructive symptoms, 17 patients reported no subjective micturition problems. Urological re-evaluation was performed two weeks and three months after nitrate medication. RESULTS: A significant improvement of peak urinary flow rates (+3.1 ml/s; p<0.05), IPS score and significant decrease of residual urine volume (-22 ml; p<0.05) were found in the symptomatic patients. No significant changes of micturition parameters were found in asymptomatic patients. PSA levels and prostate volumes did not change in either groups. CONCLUSIONS: Organic nitrates influence micturition parameters in patients with obstructive benign prostatic hyperplasia. This might be explained by the known mechanism of NO donation (smooth muscle relaxation) of nitrates. More functional controlled studies are necessary to describe the grade of influence of nitrates on the prostate. Concomitant oral medication with nitrates must be considered as a relevant bias factor on BPH in future clinical studies.

Aged↗
PubMed1999

Transcutaneous penile oxygen pressure during bicycling.

OBJECTIVE: To evaluate the blood supply to the penis during bicycling and thus determine whether the associated perineal compression might be responsible for some cases of impotence. SUBJECTS AND METHODS: The transcutaneous penile oxygen partial pressure (pO2 ) at the glans of the penis was measured in 25 healthy athletic men; pO2 is readily measured by noninvasive techniques currently widely used in the management of premature infants, and which have been shown to give pO2 levels that correlate with arterial pO2 levels. The measurements in the healthy subjects were taken in various positions, before, during and after bicycling. RESULTS: The mean (sd) pO2 of the glans when standing before cycling was 61.4 (7.2) mmHg; it decreased after 3 min of cycling to 19.4 (4. 7) mmHg. After 1 min of cycling in a standing position it increased significantly to 68 (7.6) mmHg; when cycling was continued in a seated position, after 3 min the pO2 fell to 18.4 (4.2) mmHg and there was a full return to normal pO2 values after a 10-min recovery period. CONCLUSION: The pO2 seems to correlate with the blood supply to the penis. The present results support the hypothesis that as the penile arteries are compressed against the pubic bone by the saddle during bicycling, the pO2 values decrease. Additionally, shifting from a seated to a standing position while cycling significantly improved the pO2 value of the penis and penile blood oxygenation was then even greater. Therefore, we suggest that cyclists change their body position frequently during cycling. Correcting the handlebars or the height of the saddle, tipping the nose of the saddle to produce a more horizontal, or even downward pointing position, and attention to the design of the saddle may be the only required precautions.

Adult↗
PubMed1999

Effectiveness of oral L-arginine in first-line treatment of erectile dysfunction in a controlled crossover study.

BACKGROUND AND AIMS: Relaxation of cavernous smooth muscle is a parasympathetic and non-adrenergic, non-cholinergic mediated process which requires nitric oxide (NO). NO is synthesized from L-arginine by NO synthase (NOS). Some studies report good clinical results under oral L-arginine medication in the treatment of erectile dysfunction. We examined the effectiveness and safety of L-arginine in the treatment of mixed-type impotence. METHODS: 32 patients (mean age 51.6 years) with mixed-type impotence diagnosed according to the results of sexual history and urological examination were enrolled in a randomized, placebo-controlled, crossover comparison of an oral placebo with 3 x 500 mg L-arginine/day. A validated questionnaire (KEED) was used to define the grade of impotence with a score. The treatment consisted of two 17-day courses (50 tablets). After a 7-day washout period the patients who initially received the placebo for 17 days were switched to L-arginine and vice versa. We assessed the efficacy with the validated questionnaire at the end of each drug period. RESULTS: 30 patients (94%) completed the whole treatment schedule. Five (17%) patients reported a significant improvement in erectile function at the end of the L-arginine phase and 6 (20%) patients after the placebo period. 17 (56%) patients showed little improvement with L-arginine and 13 (43%) with placebo. In 8 patients (27%) of the verum group there was either no change in the ED score or even a slight worsening. No statistical difference in the impotence scores were found. No drug-related adverse effects occurred with L-arginine treatment. CONCLUSION: Oral L-arginine 3 x 500 mg/day is not better than placebo as a first-line treatment for mixed-type impotence.

Administration, Oral↗
PubMed1999

Diffuse metastasized testicular teratoma and paraneoplastic thyreotoxicosis. Case report and literature review.

Paraneoplastic syndromes are rare entities in patients with excessive HCG production. This has been attributed to the thyroid-stimulating hormone-like activity of HCG. In most cases hyperthyroidism remains subclinical. We report on a patient with diffuse metastasized malignant teratoma and thyrotoxicosis due to excessive levels of tumor-derived HCG. This complication of nonseminomatous germ cell tumors is associated with potential morbidity and the need for prompt recognition is stressed. Treatment consists of standard antithyroid medication and immediate cytoreductive chemotherapy to reduce the paraneoplastic stimulus. Evaluation of thyroid hormone levels in all patients with serum HCG levels exceeding 20,000 U/l is recommended.

Adult↗
PubMed1998

Selective expression of inducible nitric oxide synthase in human prostate carcinoma.

BACKGROUND: Nitric oxide (NO) is synthesized by inducible nitric oxide synthase (iNOS) and plays an important role in tumor growth and angiogenesis. NO generation by iNOS also influences the cytotoxicity of macrophages and tumor-induced immunosuppression. Before now, the expression of iNOS in prostate carcinoma tissue had not been determined. METHODS: In this study, tissue sections from 16 patients with prostate carcinoma were studied immunohistochemically and compared with tissue specimens from 10 patients with benign hyperplasia. RESULTS: Positive iNOS immunostaining was detected in all sections from patients with prostate carcinoma. The malignant epithelial cells were highly positive. The antibody against iNOS also marked round cells, which had the same cell shape as that observed for macrophages. These cells were located in stroma and epithelium adjacent to tumor islets. However, round cells in benign tissue stained negative for iNOS. None of the benign hyperplasia specimens stained positive for iNOS immunohistochemically. CONCLUSIONS: Prostate carcinoma tissue had a high iNOS content, whereas benign tissue did not. The authors suggest that epithelial iNOS expression can be used as a specific immunohistochemical marker for prostate carcinoma. NO generation by iNOS may play multiple roles in the development of this disease.

Adenocarcinoma↗
PubMed1998

[Complete urethral rupture with symphysis injury and anterior pelvic ring fracture during spontaneous delivery].

We report on a complete longitudinal rupture of the urethra in combination with a rupture of the pubic symphysis and pelvic fracture during spontaneous vaginal delivery. Only after stabilisation of the pelvic fracture by external skeletal fixation adaptation of the urethra was possible. Three weeks later after removing of the transurethral catheter a mild stress incontinence could be observed. In the follow up one year later the patient was completely continent. The cosmetic result was satisfactory. There was no cystocele. An unclear haematuria after delivery needs a meticulous urological examination. Early repair of urethral disruption minimize the risk of severe incontinence. Coordinated care between the trauma surgeon and urologist is required for successful treatment of this rare combined injury after birth.

Adult↗
PubMed1998

Evidence for the involvement of endothelial nitric oxide synthase from smooth muscle cells in the erectile function of the human corpus cavernosum.

Nitric oxide (NO) is an important mediator in the relaxation of cavernosal smooth muscle. The present study examines the existence and location of the constitutive isoform eNOS (endothelial NO synthase) accompanying the already substantiated neurogenic NOS (nNOS) in the human corpus cavernosum of men with and without erectile dysfunction. Activities of NOS enzymes were examined in specimens of 11 potent and nine long-term impotent patients by means of light and electron microscopy using NADPH-diaphorase staining and immunohistochemical eNOS-specific, smooth muscle actin-specific and nNOS-specific markers. Cavernosal smooth muscle shows a distinct expression of eNOS. In contrast to the weaker expression of eNOS and nitrinergic innervation found in larger veins, the small intracavernosal helicine arteries express large quantities of eNOS and possess a dense nitrinergic innervation. Long-term impotent patients display a broad heterogeneity in eNOS expression and nitrinergic innervation while no overall correlation between NOS expression and erectile function was observed. The expression of eNOS indicates eNOS as a main source of NO alongside nNOS. The differentiated localization of eNOS supports at least a role of this isoform in vascular regulation.

Erectile Dysfunction↗
PubMed1998

Pneumatic v electrokinetic lithotripsy in treatment of ureteral stones.

Recently, a new device (Combilith) for electrokinetic lithotripsy (EKL) has become available which is very similar to the well-known device for pneumatic (ballistic) lithotripsy (Swiss Lithoclast). The Lithoclast uses air pressure to push a projectile within the handpiece against the end of a metal probe, which is thereby accelerated and thrown like a jackhammer against the stone. In principle, the same stroking movement of a small metal probe is provided by EKL; the difference is that instead of a projectile, a magnetic core within the handpiece is accelerated by the electromagnetic principle. This paper compares the clinical efficacy and the features of the two devices. Testing the devices on a stone model, taking into account stone propulsion, the systems turned out to equally effective regarding stone disintegration. However, stone displacement was more pronounced with the Lithoclast applied on easily breaking stones. In a second experiment, an optoelectronic movement-measuring apparatus (Zimmer camera) was employed to measure the range and velocity of the movement of the probe tip without any contact. The linear acceleration velocity ranged from 5 to a maximum of 12.5 m/sec with both systems, but the maximum height of the stroke was 2.5 mm with the Lithoclast and 1 mm with EKL. After the initial break-up of soft stones, further impact of the probe tip against the stone resulted merely in propulsion; thus, the greater probe stroke height is the cause of the stone displacement. In a clinical trial, 22 ureteral stones were treated with the Lithoclast and 35 with the EKL. The two devices were equally effective in terms of stone disintegration and safety margin. Fixation using a Dormia basket was necessary in 12 cases (8 Lithoclast, 4 EKL). Although a difference in probe stroke height was noted when comparing pneumatic and electrokinetic lithotripsy, there were no clinically significant differences in the efficacy of stone fragmentation or stone-free rates. At the current time, EKL is less costly.

Air↗
PubMed1997

Distribution of nitric oxide synthase implies a regulation of circulation, smooth muscle tone, and secretory function in the human prostate by nitric oxide.

BACKGROUND: Nitric oxide (NO) is suggested as a mediator involved in the regulation of smooth muscle tone, blood flow, and secretory function of the genitourinary tract and originates from different NO synthase (NOS) isoforms located in endothelial, neuronal, and epithelial structures. The aim of the present study was to determine the location of endothelial and neuronal NOS in the human prostate. METHODS: Histochemical NADPH-diaphorase (NADPH-d) staining, ultrastructural NADPH examination, and NOS immunohistochemistry were performed on histologically verified nonmalignant prostate tissue from normal nonobstructive and hyperplastic obstructive human prostates. RESULTS: In the prostatic tissue, NADPH-d staining and immunohistochemistry with bNOS antibody revealed the existence of a dense nitrinergic innervation of glandular epithelium, fibromuscular stroma, and blood vessels. NADPH-d reaction in glandular epithelium was not confirmed by ecNOS or bNOS immunohistochemistry. In benign prostatic hyperplasia (BPH), the nitrinergic innervation is reduced. The vascular distribution of ecNOS provides evidence for a segmental differentiation of the NO-mediated vascular regulation. CONCLUSIONS: NO plays an important role in the autonomic innervation of all compartments of prostatic tissue. In obstructive BPH, the nitrinergic innervation is reduced compared to that in normal prostate tissue. Further studies are necessary to elucidate the complex role of NO in the prostate.

Aged↗
PubMed1997

[Pattern of distribution of constitutive isoforms of NO synthase in the normal prostate and obstructive prostatic hyperplasia].

Nitric oxide (NO) is suggested as an important mediator for the regulation of biological processes. In the present study we tried to determine histochemically and immunohistochemically the localization and distribution of the constitutive NO-synthase Isoforms (bNOS and eNOS) of 14 normal non-obstructive and 12 hyperplastic obstructive human prostates. Differentiated nitrinergic innervation was shown for the prostate glands, fibromuscular stroma and blood vessels by NADPH-diaphorase staining and immunohistochemically with specific NOS antibodies. In the specimens with benign prostatic hyperplasia nitrinergic innervation seems to be distinctly reduced. The vascular distribution of NOS provides evidence for segmental differentiation of NO-mediated vascular regulation. The NADPH-diaphorase reaction was not confirmed immunohistochemically by the specific NOS antibody in the glandular epithelium. The distribution of NO synthase shows the importance of nitric oxide in the regulation of smooth muscle tone, blood flow and secretory function in the normal and hyperplastic human prostate.

Adult↗
PubMed1997

Nuclear medical assessment of penile hemodynamics following revascularization surgery.

Variations of Hauri's penile revascularization have been in clinical use since 1983. The hemodynamics of the so-called three-vessel anastomosis remain uncertain despite successful, clinically reproducible results. The goal of this study was to depict the increased perfusion of the erectile system of the penis following revascularization by means of the inferior epigastric artery. Ten milliliters of heparinized peripheral venous blood was drawn from 10 patients prior to surgery. The radioactively tagged erythrocytes (1 mCi 99mTc) were reinjected via an additional incision in the donor vessel proximal to the anastomosis following completion of the three-vessel anastomosis and intracavernous injection of 20 micrograms PGE1. Once again, blood was drawn during the tumescence phase from both a peripheral vein and the corpora cavernosa within the normal circulatory duration and compared to the original specimen. Eight of ten patients displayed evidence of primary reperfusion of the corpora cavernosa via the inferior epigastric artery as the donor vessel. Using strict indications, revascularization of the penis is an effective mode of therapy for arterial erectile dysfunction.

Anastomosis, Surgical↗
PubMed1996

[The determination of patient satisfaction as a part of quality management in the hospital].

BASIC PROBLEM AND OBJECTIVE OF STUDY: Patient-satisfaction is an important part of the quality of results of medical treatment in hospital. Such satisfaction can be measured with a standardised multi-dimensional questionnaire which takes into account all relevant parts of a hospital. An enquiry was undertaken on patients in a university department of urology to find out whether a scientifically based measurement of patient-satisfaction is possible and whether organisational improvement can result from it. PATIENTS AND METHODS: Dimensions of patients-satisfaction included "care by doctors", "care by nursing staff", "food and accommodation", and "administration and daily activity". A questionnaire with a scale for answers (total of 65 items with closed answers) was developed for each of the dimensions. A one-month pretest served to ascertain acceptance and understanding of the questionnaire. In the three-month main test period questionnaires were given to all in-patients over 16 years old on admission. Participation was voluntary and anonymous. RESULTS: 232 patients took part (172 men, 60 women; median age 57 years), a response rate of 61%. The scales were shown to have a high internal consistency. The answers provided, for example, the means for simple and directly applicable improvement in patient information and the organisation of daily routine. Making the results known had a positive effect on the motivation of the staff. CONCLUSION: The work and cost involved in such a study are reasonable. This is the more so since in future investigation on patient-satisfaction will be undertaken every year or two as part of the demanded quality management in hospitals. However, scientific principles in the methodology must be taken into account when evaluating the results.

Adult↗