An incidental finding--bilateral multifocal renal oncocytoma.
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Adenoma, Oxyphilic↗
Biomedical subjects
U Wetterauer
Publications and source records attributed to U Wetterauer.
[Decrease in sperm count does not yet signify infertility. Interview by Elisabeth B. Moosmann, M.A..].
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Adult↗
Analysis of the immune reactivity of infiltrating and peripheral lymphocytes from patients with renal cell carcinoma by measuring cytokine secretion.
The immunological properties of tumour-infiltrating (TIL) and peripheral blood lymphocytes (PBL) from 29 patients with renal cell carcinomas were characterized with respect to their phenotypic expression and cytokine production. TIL were isolated from mechanically disaggregated tumor material and PBL from peripheral blood by gradient centrifugation. To eliminate all non-lymphoid cells, CD3-positive cells were specifically separated from these cell fractions with anti-CD3 magnetic beads. These pure CD3-positive PBL (CD3+PBL) and TIL (CD3+TIL) were cultured with pokeweed mitogen and the levels of the cytokines interleukin-1alpha (IL-1 alpha), IL-1 beta, IL-2, interferon gamma (IFNgamma), and tumor necrosis factor alpha (TNFalpha) measured in the 4-day post-inductional cell culture supernatants. In all cell cultures a wide range of cytokine values was found, indicating a large variation in the immunological activity of the lymphocytes of each individual. When the cell cultures of the CD3+TIL and CD3+PBL were compared in each patient similar values for IL-1 alpha, IL-1 beta, IFNgamma and TNFalpha were found. However CD3+TIL produced significantly lower levels of IL-2 than CD3+PBL upon mitogenic stimulation. This may be due to a lower CD4/CD8 ratio in the CD3+TIL as compared to the CD3+PBL. These results suggest that there are no fundamental qualitative and quantitative differences in the lymphokine-producing capacity of CD3+TIL and CD3+PBL derived from patients with renal cell carcinomas.
CD3 Complex↗
Tuberous sclerosis complex with end-stage renal failure.
Renal angiomyolipoma is common in the tuberous sclerosis complex (TSC), the classic features of which are facial angiofibroma, seizures, and mental retardation. We report a family with three affected members demonstrating the wide spectrum of TSC-associated lesions ranging from asymptomatic findings to life-threatening complications. The predominant symptoms of the index patient were hypertension and mild renal insufficiency at age 48, resulting in end-stage renal failure at age 63 due to giant bilateral angiomyolipoma of the kidneys. The two TSC-affected siblings had died years previously, one from pulmonary lymphangioleiomyomatosis and the other during an epileptic state; the latter had situs inversus totalis as another remarkable finding. The diagnosis of TSC may be overlooked if CNS symptoms are absent and if cutaneous lesions are masked by cosmetic procedures, as occurred in the index case. Chronic renal failure due to angiomyolipoma is not widely known to clinical nephrologists, but develops in approximately 15% of TSC patients. Displacement of functional renal parenchyma by abnormal tissue appears to be the major pathogenetic mechanism leading to end-stage renal failure. Angiomyolipomas can be diagnosed from this characteristic sonographic pattern and the demonstration of fatty tissue in CT or MRI. Multiple renal cysts are also common in TSC. Therefore TSC should be considered in the differential diagnosis of polycystic kidney disease.
Angiomyolipoma↗
Impaired cytokine production in whole blood cell cultures of patients with urological carcinomas.
The production of the cytokines interferon gamma (IFN gamma), interleukin-1 alpha (IL-1 alpha) and tumor necrosis factor alpha (TNF alpha) was investigated in the mitogen-stimulated whole blood cell culture media from 51 patients with urinary bladder carcinomas, 52 patients with renal carcinomas, 31 patients with prostatic carcinomas and 360 healthy controls. The cytokines were measured 4 days after induction by a sensitive enzymo-immunological assay. In the blood cell culture supernatants of the patients with urinary bladder carcinomas significant lower levels of IFN gamma (P < or = 0.001), IL-2 (P < or = 0.01) and TNF alpha (P < or = 0.05) were found as compared to the controls. Blood cells of patients with renal carcinomas had lower production of IFN gamma (P < or = 0.01), IL-2 (P < or = 0.001) and IL-1 alpha (P < or = 0.01), whereas the values of the total group of patients with prostatic carcinomas were not significantly different from those of the controls. Lymphocyte and monocyte counts were almost identical in the control and all tumor patient groups. When the patients with renal carcinomas and prostatic carcinomas were analyzed according to their different clinical stages we could show a gradual depression of the IFN-gamma levels, which was related to tumor burden.
Aged↗
Calcitonin gene-related peptide: possibly neurotransmitter contributes to penile erection in monkeys.
The distribution of calcitonin gene-related peptide (CGRP) immunoreactivity in the cavernous tissue and the erectile response to intracavernous injection of CGRP was investigated in 7 monkeys. Intracavernous CGRP increased cavernous arterial flow and induced cavernous smooth muscle relaxation and venous outflow occlusion. Intracavernous injection of CGRP antibody did not significantly change the erectile response to cavernous nerve stimulation. Histologic staining for CGRP immunoreactivity showed nerve fiber-like staining within the cavernous arterial wall and the cavernous smooth muscles. These data suggest that CGRP may contribute to penile erection in monkeys.
Animals↗
Penile venous surgery for cavernosal venous leakage: long-term results and retrospective studies.
From February 1987 to September 1991, 122 men with erectile impotence and confirmed cavernosal venous leakage underwent penile venous surgery. After a postoperative follow-up of 36 months, only 18.8% of the patients had satisfactory erections without further therapy. Another 32.5% postoperatively converted to responders to intracavernous injection therapy with vasoactive drugs. Therefore, a total of 51.3% benefitted from the operation. Dynamic pharmacocavernography proved to be the most important examination in terms of establishing indication and prognosis. According to our results, there are two basically different forms of cavernosal venous leakage with different postoperative outcomes: primary and secondary corporeal incompetence. In many cases, an arterial cofactor was determined.
Adolescent↗
Calcitonin-gene-related peptide: a possible role in human penile erection and its therapeutic application in impotent patients.
A functional study was done to examine a possible role of calcitonin-gene-related peptide in human penile erection and its possible therapeutic applications for patients with erectile dysfunction. In the determination of an effective dosage, 5 ng. (2 patients), 50 ng. (2 patients), 500 ng. (4 patients), 5 micrograms (4 patients) and 25 micrograms (7 patients) were injected intracavernously, and pulse and blood pressure were monitored. Arterial inflow was measured by Doppler sonography, smooth muscle relaxation was determined by the analysis of cavernous electrical activity and cavernous outflow occlusion was recorded by cavernosometry. In 12 patients the erectile response of prostaglandin E1 was compared to the response of an equal (6 patients) or decreased dose of prostaglandin E1 combined with an equal weight of calcitonin-gene-related peptide. In 14 patients the erectile response to the combination of calcitonin-gene-related peptide and prostaglandin E1 was compared to the response of prostaglandin E1 alone, and with a combination of 15 mg./ml. papaverine and 0.5 mg./ml. phentolamine. Calcitonin-gene-related peptide induced an increase in the penile arterial inflow, cavernous smooth muscle relaxation and cavernous outflow occlusion. Histochemical results indicated nerve fibers positive for calcitonin-gene-related peptide within the cavernous bodies. A dose-dependent erectile response to calcitonin-gene-related peptide was observed at doses of 500 ng. to 25 micrograms. Systemic side effects were first observed at a dose of 25 micrograms in 2 of 7 patients. The combination of calcitonin-gene-related peptide and prostaglandin E1 was more effective in inducing a full erection than either prostaglandin E1 alone or the combination of papaverine and phentolamine. Pain was reported in 4% of the patients who received the combination of calcitonin-gene-related peptide and prostaglandin E1, whereas 42% of those who received prostaglandin E1 alone reported pain. Our results suggest that calcitonin-gene-related peptide may be a possible neurotransmitter for penile erection. A combination of calcitonin-gene-related peptide and prostaglandin E1 seems to be an effective alternative combination in the treatment of impotence.
Adult↗
The effect of venous incompetence and arterial insufficiency on erectile function: an animal model.
We designed an animal model to elucidate the effect of venous leakage and arterial insufficiency on erectile function. In 10 dogs, electrodes were implanted around the cavernous nerves for electroerection and blood flow in the internal pudendal artery was recorded. Venous leakage was mimicked by inserting needles of varying gauges (30 to 16G) into the corpus cavernosum and the erectile response to neurostimulation was recorded before and after the creation of the leak. The relationship between the size and the amount of the venous leakage, the changes in the intracavernous pressure (peak and drop), and the changes in the peak and maintenance arterial blood flow were documented. Arterial blood flow was then reduced by 25 and 50 per cent by means of a screw clamp on the terminal aorta. The erectile response to neurostimulation was again determined, with the same electrical parameters, first with reduced blood flow alone, then in combination with leakage of varying size. Our results showed that minor cavernous vein leakage in the presence of normal arterial flow and a healthy sinusoidal system had a minimal effect on erectile function owing to a compensatory increase in penile blood flow. However, when reduction of arterial blood flow was superimposed on venous leakage, even of a minor degree, the erectile response to neurostimulation was markedly impaired.
Animals↗
Intracavernous drug delivery system: an alternative to intracavernous injection in the treatment of impotence?
In 6 monkeys, the feasibility of chronic intracavernous drug application via a permanent intracavernous catheter was examined. In 4 monkeys, a combination of papaverine (15 mg/ml) and phentolamine (0.5 mg/ml) was injected via the drug delivery system; in 2 monkeys each, 30 or 100 injections were done. As a control, saline was injected in 2 monkeys. The dose of the papaverine-phentolamine mixture to induce full erection had to be increased by a mean of 240%, comparing the 1st to the 30th injection. The dose then remained stable. After 100 injections, penile histology showed a thin fibrotic layer around the implantation site of the catheter. Beside slight smooth muscle hypertrophy in the papaverine-phentolamine group, there were no abnormal findings in the proximal and medical part of the cavernous bodies. The distal part of the cavernous bodies showed extensive fibrosis due to mechanical irritation by the tip of the intracavernous catheter. Given appropriate selection and indication, implantation of an intracavernous drug delivery system may be an alternative to chronic intracavernous injection in the treatment of impotence.
Animals↗
Quantitative and qualitative analysis of dynamic cavernosographies in erectile dysfunction due to venous leakage.
Of 521 patients with erectile dysfunction in whom a multidisciplinary approach was used, 145 (27.8%) showed venous leakage as (concomitant) etiology of the impotence in dynamic cavernosography. The rate of the maintenance flow corresponded well with the response to a standardized intracavernosal injection of vasoactive drugs (p less than 0.05) in patients with venous leakage. The maintenance flow increased with the age in secondary impotent men. It was not statistically different in patients with or without concomitant arterial insufficiency (p = 0.19). Fifty-one of 145 patients (32.2%) presented a pathologic cavernosal drainage via a single venous system; 94/145 (64.8%) showed a combined venous leakage. The type of leakage corresponded neither to the maintenance flow nor to the response to intracavernosal injections. Our findings show that standardized intracavernosal testing and Doppler have a high predictive value for the status of the venous occlusive system. Exact evaluation of the type of leakage can be made by bidimensional cavernosography only.
Adult↗
[The left ovarian vein as a functional renal vein].
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Aged↗
Intra-individual comparative study of dynamic and pharmacocavernography.
A series of 65 consecutive patients with suspected venous leakage as a cause of their erectile dysfunction underwent dynamic and pharmacocavernometry/cavernography. This comparison of methods for diagnosing venous leakage produced divergent findings in 25/65 patients (38.5%). Because of its theoretical advantages, pharmacocavernometry/cavernography is recommended for the diagnosis of venous leakage.
Blood Flow Velocity↗
[Diagnosis of a venous fistula as a cause of erection disorders. Experimental principles and practical conclusions].
An experimental study was done in ten dogs and eight monkeys to evaluate the accuracy of dynamic and pharmacologic cavernosometry and cavernosography in the diagnosis of venogenic impotence. Our findings show that erection induced by saline perfusion comes about because the penile venous outflow capacity is exceeded. Thus, the cavernous occlusive mechanisms are not activated. Cavernosography in induced erection always demonstrated the entire cavernous venous system. However, cavernosometry after pharmacologic cavernous smooth muscle relaxation provides useful diagnostic information. Similarly, cavernosography after pharmacologic cavernous smooth muscle relaxation proved to be useful for the identification of abnormally draining veins.
Animals↗
Hemodynamics of varicoceles: venous shunting in grade II and III varicoceles.
In 42 consecutive patients with moderate (grade II) or large (grade III) left-sided idiopathic varicoceles, which were referred for percutaneous sclerotherapy, not only the reflux in the testicular vein but the venous drainage as well was studied by venography. As suggested by bidirectional Doppler sonography the reflux in the testicular vein is always associated with an upward (in physiologic direction) flow in these varicoceles. The draining veins are shown to be the deferential, cremasteric, external pudendal, or any combination of these. Thus, the grade II and III varicoceles are termed shunt-type varicoceles.
Collateral Circulation↗
Erectile responses to intracavernous papaverine and phentolamine: comparison of single and combined delivery.
In a prospective study of 15 consecutive impotent patients we evaluated the erectile responses to intracavernous injections of standardized doses of papaverine and phentolamine alone and in combination. Of the 15 patients 13 achieved a full erection with the drug combination, whereas only 6 achieved a full erection with papaverine and 1 with phentolamine. Our results suggest an effective alternative to the use of papaverine alone, whose long-term sequelae have been shown to be deleterious.
Adult↗
[Open multicenter study of the differential diagnosis of erectile dysfunction with a papaverine-phentolamine combination (BY023)].
We report the results of an open multicenter clinical trial with 115 patients. The results of a pharmacological test using intracavernously applied mixture of papaverine and phentolamine were compared with the results of a multidisciplinary evaluation of erectile dysfunction. Sensitivity and specificity of our test were determined. The injection of our drug solution caused an increase in tumescence and/or rigidity in all patients. The evaluation of the dose dependent erectile response makes it possible to distinguish between the three main pathogenetic principles: non-vascular, arterial and venous etiology of erectile dysfunction. The pharmacological test requires one to four intracavernous injections of 0.5-3.0 ml of the drug solution (7.5-45 mg papaverine hydrochloride, 0.25-1.5 mg phentolamine mesylate).
Adolescent↗