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V Lent

Publications and source records attributed to V Lent.

At least 19 recordsLinked to original sources
PubMed2005

[Treatment errors involving diagnosis using prostate specific antigen. Decisions of the commission of experts for medical mistakes of treatment of the state medical board of North Rhine].

Advances in prostate specific antigen (PSA) diagnosis are accompanied by deficits in realization. The justification of claims by affected patients against their doctors are reviewed by commissions of experts and mediation by medical councils out of court, impartial and free of charge. The objectivity of the review is ensured by the independence of the commission and its members as well as the determination of facts and their assessment. Criteria are professional standards and required care. Since 1995, 21 requests by affected patients have been reviewed. In 15 cases (71.4%), treatment errors were ascertained. This involved either a delayed or an insufficient diagnosis (prostatic biopsy). In ten of the patients, a mostly early prostate cancer would have be diagnosed and treated at the time of the first finding of PSA values between 3.3 and 10.4 ng/ml. In ten of 13 patients, the tumor was diagnosed late, having PSA values between 6.8 and 1251 ng/ml with no chance of curative therapy. As in other life threatening diseases, time of recognition is most important for the diagnosis and treatment of patients with prostate cancer. Particularly for early recognition, PSA is much more sensitive then digital rectal examination, and in cases without a digital finding is the only parameter for early diagnoses. In men with suspicious PSA values (>4.0 ng/ml) suitable a diagnostic test (prostate biopsy) is required early, until cancer is detected or excluded.

Commission on Professional and Hospital Activities↗
PubMed2005

[Uterovesical fistula].

INTRODUCTION: Uterovesical fistulas belong to the least common types of urogenital fistulas. Although uncommon, they cannot be considered a rarity in view of about 800 published cases in the literature. They are most frequently caused by repeated caesarean sections, which are increasing, and their complications can be expected to increase as well. CASE REPORT: During the second caesarean section of a 31-year-old woman, the urinary bladder was opened and subsequently closed by a urologic surgeon. In the following weeks and months, the patient suffers from urinary incontinence in response to bladder filling, cyclic hematuria (menouria) and recurrent cystitis. After multiple examinations without establishing a diagnosis, an uterovesical fistula was suggested by cystoscopy and confirmed by cystography. The fistula, which measured 2 cm in diameter, was successfully closed by transperitoneal approach without interposition of omentum. CONCLUSION: Uterovesical fistulas are to be expected to increase due to an increasing rate of repeated caesarean sections. They can be suggested by their typical symptoms, easily diagnosed by imaging examinations and successfully treated by transperitoneal closure.

Adult↗
PubMed1997

Management of bleeding, transfusion requirement and removal of catheters in transurethral prostate resection.

OBJECTIVE: The objective of the present study was to establish the therapeutic value of early coagulation of severe postoperative bleeding after transurethral prostate resection in unselected patients. PATIENTS AND METHODS: In a prospective study of 772 prostate resections carried out in 617 patients, bleeding complications, hemostatic measures, blood transfusions, catheter removals, and catheter-related and general complications were registered, and the factors influencing them were analyzed. RESULTS: Severe postoperative bleeding was coagulated endoscopically on the day of the operation in 70 resections (9.1%), and after removing the catheter in a further 19 cases (2.7%). Blood was transfused perioperatively in 14 patients (2.3%): in 11 patients (2.0%) because of preoperative anemia, and in 3 patients (0.3%) because of postoperative hemorrhage. In 96.3% of the resections, the catheter was removed on the first postoperative day, and in the last year of the study in 99.3% of the cases. Neither additional hemostasis nor early catheter removal had disadvantageous consequences. CONCLUSIONS: Transurethral prostate resections can be performed without any blood transfusion in more than 99.0% of patients without preexisting risk when severe postoperative hemorrhage is coagulated at an early stage. Moreover, this enables early catheter removal, after 24 h at the latest, in more than 99.0% of the cases.

Aged↗
PubMed1996

A retrospective quality analysis of 102 randomized trials in four leading urological journals from 1984-1989.

The objective of the present study was to analyse critically the quality of the reporting in 102 randomized trials from four leading urological journals from 1984 to 1989 on the basis of an evaluation system we have developed. This comprises 21 principal parameters selected in terms of their significance for the validity of the studies. These parameters were evaluated by two readers independently of each other as to whether they were specified, not specified, could not be evaluated or were not applicable. The study score of each paper resulted from the sum of all specified criteria. In the 102 studies, out of 21 criteria 69.1% and 69.8% (investigators A and B, respectively) were reported; 29.8% and 29.4%, respectively were not reported, 0.4% and 0.1%, respectively, could not be evaluated and 0.7% did not apply. Such important principal parameters as the sample size (6.9% and 7.8%, respectively), statistical power (11.8%), method of randomization (22.5% and 23.5%, respectively), patient blinding (30.4%), investigator blinding (33.3%), loss to follow-up (34.8% and 35.3%, respectively) and rate of discontinuation (36.0% and 37.7%, respectively) were mentioned least often. The study score of all investigations ranged from 20.5 (97.6%) to 9.0 (42.9%) points. Most (60/59% and 62/61%, respectively) attained values between 16 (76.2%) and 13 (61.9%). Accordingly, randomized trials in urological journals show similar deficits to those in internal medicine, surgery and intensive care medicine. A particular problem is that they concern the most important techniques for systematic reduction of inadvertent errors (bias), and thus doubt is cast upon the hardcore of controlled studies. If it is possible for many authors to mention individual criteria completely, this should also apply (and in particular) to the most critical parameters. In our opinion, the 21 criteria selected for an evaluation system constitute a practical compromise between the 3 and 38 criteria alternatively suggested by other authors. Moreover, use of a comprehensive check list should be the precondition for acceptance of papers for publication.

Publishing↗
PubMed1996

What classification is appropriate in renal trauma?

OBJECTIVE: The objective of this paper is to attain an adequate consideration of the relevant factors in conventional classifications of renal trauma and to work out a differentiated classification with a simple trauma formula suitable for both scientific purposes and for clinical decision-making. METHOD: Previous classifications of renal trauma were evaluated retrospectively to establish whether and to what extent all criteria have been considered which may be important for the outcome of kidney trauma. The pathogenesis, the locations and the symptoms of the injuries with their degrees served as principal parameters. RESULTS: From 1950 to 1991, a minimum of 24 classifications of renal trauma with different criteria has been used. In 54.2% of these, blunt and perforating injuries were not distinguished. Injuries of the renal pelvis or the vascular system were not considered in 62.9 and 8.3% of these, respectively. The degrees of severity ranged from 2 to 6 (on average, 3.5). In 87.5%, there was a combination with the injury location (renal pelvis, vascular system). Finally, of 29 definable criteria, an average of only 9.6 was specified, i.e. most were not evaluated at all. CONCLUSION: It is concluded that most of the previous classifications of renal trauma neither clearly distinguish between nor adequately differentiate their individual factors. This may be a major reason for the persistence of controversies with regard to concepts of therapy, since they are based on inadequate definitions of comparative studies. A more differentiated PLS classification is proposed comprising the following elements: the pathogenesis P1 (blunt injuries), P2 (perforating injuries), the locations of the injuries LA (parenchyma), LB (renal pelvis), LC (vascular system) with their degrees of injury LA 0-7, LB 0-2, LC 0-9, and the symptoms of injury SA (hemorrhage), SB (extravasation of urine), SC (kidney damage) with their degrees of severity SA 0-3, SB 0-3, SC 0-3 as prognostic factors. The new classification incorporated in a simple trauma formula may enable more precise scientific investigation and also facilitate clinical decisions, so that patients with kidney trauma can be treated more specifically.

Adult↗
PubMed1995

[What treatment in kidney trauma? A critical evaluation treatment reports up to now based on a new classification].

The objective of treatment in renal injuries is to save the life of the traumatized patient, to maintain the function of the affected kidney(s) and to avoid later complications with their sequelae. It has not by any means been established what therapeutic measures (conservative or surgical) are appropriate to obtain the best results in certain traumas, e.g. penetrating injuries, 'moderately severe' parenchymal ruptures or obstructive vascular lesions, since 'conservative' does not automatically entail that there is no operation, and no operation does not automatically mean 'conservative'. According to my own analysis of treatment reports published up to now, inadequate classifications play a major role amongst the multivarious reasons for this. The results and complications are based on such heterogeneous criteria that valid comparisons are not possible. More differentiated measures with modern interventional and surgical techniques appropriate to each individual case can be used for a treatment enabling maximal preservation of the kidneys and which is as free of complications as possible. However, this presupposes a differentiated classification which takes all the relevant factors of renal trauma into consideration. Such a classification of the pathogenesis, location, extent and symptoms as prognostic factors is presented in a suggestion of my own in a gradual differentiation and a simple trauma formula. This enables therapies to be compared, and facilitates clinical decision-making, thereby improving the results of renal trauma treatment.

Humans↗
PubMed1994

Nephropathy in remnant kidneys: pathological proteinuria after unilateral nephrectomy.

It is a matter of dispute as to whether and to what extent hyperfiltrative nephropathy occurs in a contralateral remnant kidney after unilateral nephrectomy. This question was investigated in a retrospective progress observation using urinary electrophoresis among other methods. Of 106 patients who underwent nephrectomy between 1963 and 1984 because of unilateral kidney diseases, only 39 fulfilled all of the requisite criteria for a followup examination 2 to 23 years later. Whereas there was arterial hypertension or decreased kidney function in 4 cases (10.3%), pathological proteinuria was found in 32 of the remnant kidneys (82.1%): tubular in 13 (40.6%) and glomerular in 19 (59.4%). In contrast to that of arterial hypertension or decreased kidney function, this incidence is far greater than the expected risk in the normal population, which in our opinion indicates that hyperfiltrative nephropathy occurs in the contralateral remnant kidney after unilateral nephrectomy without causing relevant restriction of kidney function or increasing the arterial pressure.

Adult↗
PubMed1993

Eversion of the tunica vaginalis for prophylaxis of testicular torsion recurrences.

After direct orchiopexy with punctiform suture fixation for prophylaxis of testicular torsion recurrence, at worst recurrent torsion may result in complete loss of the testis. Clinical and animal experience makes it appear more effective and reliable to prevent recurrent testicular torsion by eversion of the tunica vaginalis with extensive superficial adherence of the testicular integuments. We present the early and late results in 35 patients who underwent 46 eversion orchiopexies with a primary and definitive salvage rate of 87.5% and no case of recurrent testicular torsion.

Adolescent↗
PubMed1993

Transureteropyeloureterocutaneostomy. Results after 3 years.

Despite the most recently available means of creating transitory and palliative diversionary conduits via percutaneous nephrostomy and avoiding definitive conduits by means of intestinal bladder substitutes, alternative supravesical conduits remain topical. This is the case on the one hand when nephrostomy is not desired or tolerated and on the other hand when the general and local prerequisites for vesical bladder replacement are absent. For these cases, transureteropyeloureterocutaneostomy is available as a new modification. In this method, both kidneys are drained with a single cutaneous stoma without intestinal connection via an intubated ureter (as a ureteral conduit). The results of 3 years of experience in 23 patients are communicated.

Aged↗
PubMed1987

[Cortico-renal oxygen pressures in acute venous renal obstruction].

In a pilot study experiments on animals were done to follow oxygen pressure fields on the kidney surface during different degrees of cavorenal obstruction. Acute, complete blockade of one hour duration at the side of the suprarenal vena cava (group I), of the supra- and infra-renal vena cava (group II), of the left renal vein close to the vena cava (group III) and of the left renal vein close to the kidney (group IV) show gradually increasing disturbances of corticorenal oxygen supply and its postobstructive recovery. How far these changes correlate with the intra-renal circulation has to be clarified by simultaneous measurements.

Animals↗
PubMed1986

[Experiences with a modified nephrostomy instrument kit in ultrasound-guided kidney fistulization].

During a period of 24 months, ultrasound-guided percutaneous nephrostomies were performed in 51 patients in the Hospital at Köln-Merheim. The procedure was carried out with a modified nephrostomy instrument manufactured by Angiomed, Ettlingen, according to our own design. The procedure was successful in 49 patients. In one case it had to be abandoned because of lack of patient co-operation. In one patient a pyonephrosis was found and the patient was treated surgically.

Humans↗
PubMed1983

'Rotation cut technique' for avoiding damage to the external sphincter.

Resectional lesions of the external sphincter muscle are not only caused by inadequate identification but also by technical misadventure. This apparently overlooked hazard can probably be diminished by using rotating cuts in the apical region. In a personal series of 721 patients subsequently followed up, there was no case of permanent gravity incontinence.

Follow-Up Studies↗
PubMed1982

Cortical oxygen pressure during acute venous kidney obstruction.

Different degrees of obstruction to the renal venous drainage were produced in rabbits, and the cortical oxygen pressures in the kidney measured with the multiple-wire surface electrode of Kessler and Luebbers. Sudden complete occlusion of the inferior vena cava (IVC) above the renal vein, or above and below the renal vein simultaneously, produced a slight decrease of about 27%. Sudden complete occlusion of the renal vein itself caused a severe decrease of 67% (obstruction near the IVC) or 100% (obstruction near the kidney). One hour later different degrees of incomplete recovery were found. The PO2 curves for the renal cortex revealed different pressure-dependent pathophysiological changes in the microcirculation. The multiple-wire surface electrode may well prove to be of use during renal surgery in which venous obstruction is a critical factor.

Animals↗
PubMed1981

[Free transplantation of skin, underlying fatty tissue and muscle after traumatic loss (author's transl)].

Large extended defects of the soft parts can be covered by free transplantation of the skin and the underlying fatty tissue with the aid of microsurgical techniques. Likewise lacking functionally important muscle areas as the forearm flexor are restored by the free transplanted latissimus dorsi muscle with good function as described in this paper. Indications, operative possibilities, surgical techniques and clinical results are presented and discussed in respect of own case reports.

Amputation, Traumatic↗
PubMed1980

[Transverse incision in ureterolithotomy].

Anatomical, physiological, physical and technical reasons support a transverse ureteral incision for stone removal. Its advantages are confirmed by early clinical and radiological results.

Humans↗