Renal insufficiency caused by an ectopic contralateral multicystic kidney.
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Humans↗
Biomedical subjects
W F Feitz
Publications and source records attributed to W F Feitz.
Feasibility of minimally invasive intrauterine fetal access in a monkey model.
PURPOSE: We evaluated new intervention techniques and surgical instruments in a fetal monkey model to determine improvements that would be useful for early intrauterine intervention. Our findings may be helpful in the future for treating select cases of severe prenatal obstructive uropathology. MATERIALS AND METHODS: In a series of experiments on 18 pregnant rhesus monkeys (Macaca mulatta) at mid trimester we assessed various endoscopic intra-amniotic access techniques as well as morbidity, mortality and possibilities for fetoscopy. RESULTS: In all 18 fetuses adequate fetoscopy was possible with no maternal mortality. Of the 18 pregnancies 14 went to term with no early or late postoperative complications. Technical improvements changed the intrauterine access technique from open placement of trocars to the use of the Seldinger technique, gun introduction of needles with small caliber sheets and small caliber introduction trocars, resulting in minimal amniotic membrane separation. Various rigid and flexible endoscopes were evaluated for fetoscopy and up to 3 cannulas were placed. No change in the fetal growth pattern was observed on postoperative ultrasound. Subsequent pregnancies occurred during this study period, and there were no acceptance problems of the newborns by the mothers. CONCLUSIONS: New techniques have led to improved intrauterine fetal access. Morbidity mainly depends on the disruption of amniotic membranes, which has an important preterm role. Adapted endoscopes and other instruments offer new possibilities for fetal diagnosis and therapy in the future. Our primate model seems to be suitable for evaluating these new techniques before they are used in a clinical setting.
Animals↗
Wall dissection of the neourethra: a rare complication after hypospadias repair.
We present a rare complication causing severe infravesical obstruction after hypospadias repair after an initially successful double-faced island flap repair. The obstruction was caused by partial dissection of the epithelium of the urethral wall, comparable to intima dissection in an aortic aneurysm. To our knowledge, this type of urethral obstruction after a hypospadias repair has not been reported before.
Child↗
Wilms tumor with teratomatous cysts in a horseshoe kidney: a diagnostic pitfall.
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Diagnosis, Differential↗
Short- and mid-term outcome of different types of one-stage hypospadias corrections.
OBJECTIVE: This study is a retrospective analysis of the outcome of our one-stage hypospadias corrections. PATIENTS AND METHODS: In the period from August 1979 to January 1991, 316 boys less than 14 years of age underwent a one-stage hypospadias correction in our hospital. For 283 patients, data on the familial incidence, associated urological pathology, age at the time of operation, operation technique and follow-up were analyzed. RESULTS: The familial incidence in our study group was 9.4%, associated cryptorchidism was seen in 8.6%, kidney abnormalities in 1.8% and urethral valves in 0.4%. The majority (65.3%) of the children were operated on before the age of 3 years. The operation was performed according to Magpi, Mathieu, Devine-Horton, an onlay, and tube formation according to Duckett and the double-faced island flap procedure. Including all postoperative disturbances, urethral complications were seen in 18.1% and skin-related complications in 4.6% of the patients. CONCLUSION: Even in experienced hands the overall complications rate is relatively high, and additional problems can be expected in the future. It is important to provide adequate information on the procedures and possible complication to the parents. The final long-term outcome after puberty has to be awaited.
Adolescent↗
Endoscopic intrauterine fetal therapy: a monkey model.
OBJECTIVES: Prenatal ultrasonographic investigations have led to an increasing number of prenatally detected abnormalities, of which a large number involves the urogenital tract. This study was performed to evaluate if endoscopic intra-amniotic access is possible in primates. METHODS: In 10 midtrimester rhesus monkeys (Macaca mulatta), endoscopic intrauterine fetoscopy was performed with three access cannulas. Using a Seldinger technique, a vascular access system, and a pediatric laparoscopy set, intra-amniotic inspection was attempted. Fetal growth throughout pregnancy was monitored by ultrasonographic measurements of fetal biometry. RESULTS: Intrauterine access could successfully be achieved in 10 rhesus monkeys with three cannulas. After partial amniotic fluid exchange, adequate fetoscopy was always possible. Two monkeys aborted on the second and sixth postoperative days. Serial ultrasonographic investigations for fetal biometry showed no disturbance of the intrauterine growth patterns in the remaining 8 monkeys. CONCLUSIONS: We currently conclude that the rhesus monkey model for experimental intrauterine endoscopic surgery may be suitable for study of the developmental abnormalities of the genitourinary tract.
Animals↗
Numerical aberrations of chromosomes 1 and 7 in renal cell carcinomas as detected by interphase cytogenetics.
Alcohol-fixed single cell suspensions of 37 renal cell carcinomas (RCCs) were assessed by both flow cytometry (FCM) and the fluorescence in situ hybridization (FISH) technique, using chromosome 1- and chromosome 7-specific centromere DNA probes. DNA diploidy or near-diploidy was observed in 30 of the 37 RCCs and only 12 of these (near-)diploid tumours were disomic for both chromosomes 1 and 7. Numerical aberrations of chromosome 1 and/or chromosome 7 were present in 18 of the 30 (near-)diploid RCCs and five of these cases showed monosomy for chromosome 1 in more than 50 per cent of the tumour cells. A double target FISH, with a centromeric and a telomeric specific probe for 1p36, excluded misinterpretation on the basis of clustering of 1q12, and suggested a complete loss of chromosome 1. All these five (near-)diploid RCCs with monosomy for chromosome 1 were eosinophilic chromophilic cell carcinomas, according to the Thoenes classification of RCC. This observation is of special interest, because it was recently concluded from cytogenetic studies that the diagnosis of chromophilic renal cell carcinoma must be considered as obsolete. Monosomy for chromosome 1 seems to be a non-random numerical aberration of (near-)diploid eosinophilic chromophilic cell carcinomas, and a gain of one or more chromosomes 1 appeared to be a common phenomenon in RCCs, especially in the DNA aneuploid tumours. As these chromosomal abnormalities were not found in the earlier classical cytogenetic studies, we conclude that in situ hybridization techniques are required in addition to chromosome banding techniques to obtain a complete characterization of the chromosome imbalances in RCCs.
Carcinoma, Renal Cell↗
Pediatric urology and the daily medical practice: way apart?
This is a study about the current status of knowledge and level of insight in treatment possibilities of pediatric urological diseases in daily practice of Dutch general practitioners (GPs). A questionnaire was mailed to GPs with questions concerning the structure of their medical practice, the localization, the received education in pediatric urology and knowledge of this subspeciality. Also, questions were asked about their current knowledge and first choice of treatment for maldescensus testis, urinary tract infections, enuresis nocturna and congenital abnormalities. The 995 forms that were returned, representing 1,457 GPs, are discussed. New developments in diagnostic procedures and treatment possibilities should be reflected in the exchange of information between GPs and (sub)specialists. However, before changes can be realized, the current knowledge and opinions should be known. This study investigates the current opinion of GPs of different pediatric urological diseases. Additionally, the incidence and current state of the art in diagnosis and treatment are discussed.
Child↗
Ureterocele associated with a single collecting system of the involved kidney.
OBJECTIVE: This is a study concerning ureteroceles associated with a single collecting system of the involved kidney. METHODS: Over an eight-year period 9 children (5 boys, 4 girls) had a ureterocele subtending a single collecting system, whereas 63 children had duplex ureteroceles. Malformations of other organ systems were present in only 1 patient. RESULTS: Three patients have undergone surgical interventions: a transurethral incision of bilateral obstructive ureteroceles in 1 and nephroureterectomy in 2. In 4 cases cystic/dysplastic kidneys involuted and were reabsorbed with collapse of the ureteroceles. The last 2 patients have received antibiotic treatment for single episodes of a urinary tract infection. CONCLUSIONS: Earlier reports of a high incidence of concomitant anomalies and male predominance in patients with single-system ectopic ureteroceles could not be verified by our experience. Our current policy for a patient is careful evaluation, individualized therapy, and long-term surveillance.
Adolescent↗
Outcome analysis of the psychosexual and socioeconomical development of adult patients born with bladder exstrophy.
Since sonographic evaluation of the fetus became routine, prenatally established diagnosis of multiple or severe malformations raises the question of whether a pregnancy should be terminated. To answer this question properly, all aspects concerning the life of a child born with a serious malformation, such as exstrophy of the bladder, must be considered. Therefore, more than ever an evaluation of the quality of life of these patients is necessary to be able to make a solid based decision. We studied the psychosexual and socioeconomic development of 22 adult exstrophy patients (11 men and 11 women) by a standardized personal interview, evaluation of a standard performance test SCL-90 (symptom checklist 1990) and an adapted personality score test. The latter 2 tests are well established and provide reproducible results. Based on several large scale investigations, standard scores are available. Nine women (82%) and 10 men (91%) scored better or in accordance with the standard scores. Exstrophy of the bladder does influence the psychosexual and socioeconomic development. The quality of life is hardly ever considered so poor that termination of pregnancy is a realistic alternative.
Adult↗
Intermediate filament expression and the progression of prostatic cancer as studied in the Dunning R-3327 rat prostatic carcinoma system.
To evaluate if there is any consistent relationship between the expression of intermediate filament proteins (IFP), particularly keratins, and the degree of malignancy of prostatic cancer cells, a series of nine Dunning rat prostatic cancer sublines that span the entire spectrum of progression of prostatic cancer were studied immunocytochemically by the use of a variety of antibodies specific for keratins, vimentin, or desmin. For the keratin studies, monoclonal antibodies with either a general reactivity to several keratins or highly specific for either luminal or basal epithelial cells of the normal rat prostate were used. By use of an antibody specific for luminal cell keratin 18, the luminal tumor cells of the well-differentiated, slow-growing H and HI-S sublines were positively stained. In most of the sublines with a more advanced state of progression (i.e., the moderately differentiated, moderately fast growing HI-M; the poorly differentiated, faster growing HI-F; and the anaplastic, very fast growing AT-1, AT-2, and MAT-Lu tumors), however, no expression of keratin specific for luminal cells was detected. In addition, several of the most advanced sublines (i.e., AT-1, AT-2, and MAT-Lu) were negative using any of the keratin antibodies. In contrast, several of the other sublines with the most advanced degree of progression (i.e., the anaplastic, very fast growing MAT-LyLu tumor derived from the AT-1 subline; and the anaplastic, very fast growing AT-3 tumor, derived from the HI-F subline), however, were positively stained with the keratin antibody specific for the luminal cells. By use of the keratin antibody specific for the basal cells of the normal rat prostate, the basal tumor cells of the well-differentiated slow-growing H and HI-S tumor were positively stained. This positive staining for basal cell keratin was also found in the HI-M and HI-F tumors, while the AT-1, AT-2, MAT-Lu, MAT-LyLu, and AT-3 were negative with this antibody. Thus, a loss in staining for basal cell keratin was consistently associated with the most advanced state of tumor progression. Vimentin-positive staining was demonstrated either alone or with keratin-positive staining in part of the epithelial cancer cells of all the sublines. An increase in the positive staining for vimentin was consistently associated with a more advanced state of tumor progression. Desmin-positive staining was found only in smooth cells present within the various tumor sublines.(ABSTRACT TRUNCATED AT 400 WORDS)
Adenocarcinoma↗
The predictive value of repeated urine cell culture in soft agar for recurrences of transitional cell carcinoma.
To evaluate the predictive value for recurrences of repeated urine cell culture in double layer soft-agar in patients with transitional cell carcinoma, 272 urine samples were collected from 75 patients. After a limited period of follow-up (mean 19.5 +/- 15.1 months) nine out of 46 patients with at least one evaluable culture and evaluable for clinical follow-up had a histologically proven recurrence preceded or accompanied by tumor colony growth in culture; one patient had tumor recurrence with growth negative urine cell culture; 15 patients had growth negative urine cell cultures and at first evaluation no recurrence of transitional cell carcinoma; 21 patients had growth positive urine cell cultures and no recurrence at first evaluation of follow-up. These two latter groups were evaluated again after an additional 30 months of follow-up. In the group with growth positive urine cell cultures (21 patients) nine patients (47.6%) developed a recurrence; 10 developed no recurrence. In the other group of patients with growth negative urine cell cultures (15 patients) six patients (40%) developed a recurrence, three following a growth positive urine cell culture. In the group of 46 evaluable patients in this study, 25 patients developed a recurrence, 21 had at least one growth positive culture. The sensitivity is 84% (21/25). Of 33 patients with positive cultures 21 have had a recurrence (64%) while 12/33 (36.7%) are "false positive." The false negative rate is 36.4% (four of 11 patients developed recurrences not preceded by growth positive urine cell cultures).(ABSTRACT TRUNCATED AT 250 WORDS)
Agar↗
Keratin expression during neoplastic progression of bladder cancer.
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Antibodies, Monoclonal↗
Intravesical and intradermal Bacillus Calmette-Guérin application. A phase I study to the toxicity of a Dutch Bacillus Calmette-Guérin preparation in patients with superficial bladder cancer.
In 30 patients toxic side effects of Bacillus Calmette-Guérin (BCG) were evaluated after intradermal and intravesical administration. The BCG preparation (BCG-RIVM) was produced in a homogeneously dispersed culture yielding a relatively high number of culturable particles per milligram dry weight BCG. All patients had a history of recurrent multiple noninvasive superficial transitional cell carcinoma of the bladder, and were previously unsuccessfully treated with intravesical chemotherapy (epodyl and/or adriamycin). BCG-RIVM (1 X 10(9) culturable particles) was instilled in the bladder, in combination with intradermal BCG-RIVM (8 X 10(7) culturable particles) administration once a week for 6 consecutive weeks. BCG was applied intradermally by a multiple-puncture technique. During and after therapy, subjective and objective side effects and toxicity were registered. Hematology and blood chemistry, including hepatic and renal function, was monitored. Only minor toxicity and/or side effects were observed during therapy and for a period of 6 months after treatment. After a period of 7 days no significant amount of BCG bacteria could be detected in the urine of 24 investigated patients.
Administration, Intravesical↗
Tissue-specific markers in flow cytometry of urological cancers. III. Comparing chromosomal and flow cytometric DNA analysis of bladder tumors.
Thirty-seven transitional-cell carcinomas (TCC) of the urinary bladder were analyzed by DNA flow cytometry (FCM). After labelling of the cell suspensions with antibodies to cytokeratin, the cytokeratin-positive cells and the non-epithelial cytokeratin-negative cells could be analyzed separately. After estimation of S- and G2M phase, 3/17 cases (18%) with a normal DNA index showed elevated proliferative levels, among cytokeratin-labelled suspensions only. Of these 17 cases, 14 showed chromosomal abnormalities. The remaining 20 cases were abnormal, irrespective of the technique used. Although immuno-labeling of tumor cells for cytokeratin in FCM increases the sensitivity of this method in detecting aneuploid tumors or tumors with high proliferation fractions, the discriminating power of chromosomal analysis of TCC is greater than FCM.
Carcinoma, Transitional Cell↗
Comparison of tissue disaggregation techniques of transitional cell bladder carcinomas for flow cytometry and chromosomal analysis.
DNA index (DI) measurements and chromosomal analysis of 42 transitional cell carcinomas were done after mechanical and enzymatical disaggregation of the tumor specimens. The results obtained with these different disaggregation techniques were compared in the 33 cases (79%) that showed recognizable chromosomes. The enzymatically obtained cell suspensions could not be used for chromosomal analysis after short-term culture of 24 hours. In four cases, the DI after enzymatical treatment could not be estimated. In most cases, the DI obtained from the tumor cells was similar for both aggregation techniques, with the exception of four cases of enzymatically treated cell suspensions in which the DI could not be estimated. The average DI of the aneuploid tumors was 13% higher than the corresponding chromosome count. In 19% of the aneuploid tumors the proportion of aneuploid cells could not be measured after enzymatical treatment. In the remaining suspensions the proportion of diploid cells was higher after enzymatical disaggregation than after mechanical treatment. It is concluded that for flow cytometric and direct chromosomal analysis of bladder tumors, the mechanical disaggregation technique is most suitable.
Adult↗
Expression of proto-oncogenes in xenografts of human renal cell carcinomas.
In a recent paper, we described the expression pattern of proto-oncogenes in primary human renal cell carcinoma [12]. To test the possibility of using xenografts as a useful alternative for such studies, we analyzed xenografts of a number of human renal cell carcinomas in nu/nu mice. Xenografts included RC2, RC14, RC21, RC43 and NC65. Northern blot analysis indicated that c-Ras was expressed in all these xenografts. The identity of the ras transcripts in the individual xenografts was further specified as c-Ha-ras, c-Ki-ras or N-ras. Expression of c-myc and the p53 gene was also found in a number of these tumors. Only RC21 failed to express the c-myc or the p53 gene. In all xenografts, a 3.0 kb c-fes/fps mRNA was present. In RC2, RC14, RC21 and RC43, low levels of the 4.8 kb ab 1 transcript were detectable. Transcripts of myb and sis could not be detected in any of the xenografts. The results indicated that the expression pattern of a variety of proto-oncogenes in xenografts of human renal cell carcinomas was similar to that in the primary tumors.
Animals↗
Intermediate filament proteins as tissue specific markers in normal and neoplastic testicular tissue.
Normal testicular tissue and primary and metastatic testicular germ cell tumours were examined for their intermediate filament protein (IFP) expression. Seminomas were shown to react with antibodies to vimentin, while non-seminomatous germ cell tumours were strongly positive with antibodies to cytokeratin. In the case of teratocarcinoma, several components of the tumour can be distinguished using a combination of monoclonal and polyclonal antisera in the double-label immunofluorescence technique. We conclude that antibodies to cytokeratin and vimentin can be helpful in the diagnosis of testicular germ cell tumours, especially in the differentiation between seminomas and non-seminomatous testis tumours.
Fluorescent Antibody Technique↗