Biomedical subjects
Publications and source records attributed to W F Thon.
We report here the familial occurrence of bilateral testicular germ cell tumors in 2 non-twin brothers, developing after an interval of 16 and 4 years, respectively. To our knowledge, this is the first report on the occurrence of metachronous and bilateral testicular tumors in non-twin brothers.
An acute epididymo-orchitis, followed by a viral arthritis of the left hand, occurred as complications of a mumps vaccination. In the last 17 years 4 certain cases of orchitis following vaccination have been published in Germany. We describe an additional case and discuss the possible consequences.
Registration of cavernous electrical activity (single potential analysis of cavernous electrical activity) was recently suggested for the diagnosis of autonomic cavernous dysfunction. For validation of this method the effect of sacral neurostimulation on cavernous electrical activity was examined. In 3 male patients with a complete spinal cord lesion (T3, T4 and T12, respectively), deafferentation was done at the S2 to S5 levels. Around the anterior roots of S2 to S5 electrodes for neurostimulation were placed. Cavernous electrical activity was recorded with an intracavernous needle electrode and with surface electrodes in the flaccid as well as in the erect states induced by neurostimulation (at 7, 8, 12, 18, 20, 30 and 45 Hz., 30 v. and 0.4 msec). In all patients similar potentials compared to the normal values, as well as additional pathological potentials were recorded during flaccidity. During neurostimulation all patients achieved full erection with no or markedly decreased cavernous electrical activity to frequencies of 12, 18, 20 and 30 Hz., while to 7, 8 and, more pronounced, 45 Hz. only partial erection with ongoing cavernous electrical activity was found. Our study strongly suggests that cavernous electrical activity and, subsequently, the cavernous smooth muscle tone are dependent on autonomic input. This finding supports the hypothesis that single potential analysis of cavernous electrical activity may be valid in the diagnosis of cavernous autonomic dysfunction. Furthermore, our results suggest a possible role for single potential analysis of cavernous electrical activity in the fine tuning of erection inducing neurostimulators.
In a therapeutic attempt on an 18-year-old patient with iatrogenic priapism lasting for more than 2 weeks after internal urethrotomy, intracavernous lysis was commenced with 80,000 IU streptokinase per hour. Following a dosage of 300,000 IU streptokinase the lysis was stopped because of severe bleeding from the urethrotomy scar. At 4 weeks after the patient was discharged from the hospital he reported normal erections and intercourse, while single potential analysis of cavernous electrical activity and ultrasound returned to normal. Provided there are no contraindications, intracavernous lysis seems to be an effective treatment for long-lasting priapism induced by intracavernous thrombosis.
Registration of cavernous electrical activity was shown to be a possible method for the evaluation of cavernous autonomic innervation. Recent studies in patients with normal erectile function showed that cavernous electrical activity is synchronous throughout the entire cavernous bodies. Therefore, we examined the feasibility of transcutaneous registration of cavernous electrical activity in 8 normal and 62 impotent patients. In the sitting patient cavernous electrical activity was recorded with a 2-channel electrophysiological unit. Recording was done with a coaxial needle electrode in the proximal left cavernous body and with surface electrodes bilaterally on the penile shaft. In 7 of 8 normal patients swelling of the penile shaft after circumcision resulted in a dramatically decreased amplitude of the potentials. In 41 of 62 impotent patients recordings were similar. In 10 of 62 patients no recording or markedly decreased amplitudes were noted with the surface electrodes and in these patients a small penis or penile retraction with consecutive electrode displacement was found. Careful repositioning of the surface electrodes with the patient in the supine position resulted in similar recordings in 9 (inconsistently in 4). In 11 of the 62 patients more information was obtained with the surface than with the needle electrode. Our results show that recording of cavernous electrical activity can be done in a completely noninvasive manner using surface electrodes with similar or even better information obtained than with needle electrodes.
Claims for compensation following dissatisfaction with the results of medical treatment have increased in frequency over the last few years. Medical records, such as declarations of consent and operation reports, often constitute important evidence in legal proceedings, particularly in the field of surgery. Before a vasectomy is performed for the purpose of contraception, detailed information must be given on how safe this is as a method of birth control and the patient must be made aware of the importance of sperm count controls after the operation. The surgeon is held responsible if it can be shown that a failed sterilization is due to ligation of only one vas deferens or to failure to notice an accessory one. Claims for compensation can include support for children up to the age of 18 years and financial compensation to the mother in respect of the labour pains.
Recording of cavernous electric activity was performed in 178 patients with erectile dysfunction and in 37 normal patients. In 34/37 normal patients, potentials of a uniform shape were recorded during flaccidity: At cut-off frequencies of 0.5-500 Hz, the length was 8-18 (mean 12.8, SD 2.8), the amplitude 250-750 (mean 444, SD 109) microV, and the polyphasity 8-22 (mean 13.8, SD 3.3). In impotent patients with upper motor neuron lesions or peripheral lesions, specific types of potentials were observed. In 11/14 impotent patients with insulin-dependent diabetes for over 20 years and clinical findings of cavernous myopathy, potentials showed low amplitude, irregular shape, and slow depolarizations. In 51% of the consecutive impotent patients, abnormal findings of cavernous electric activity were recorded. Our clinical study suggests that single potential analysis of cavernous electric activity (SPACE) may be useful in the diagnosis of cavernous autonomic neuropathy and cavernous smooth muscle myopathy.
Of 31 boys 10 to 16 years old referred for treatment of a left grade II or III varicocele 28 underwent percutaneous sclerotherapy. Due to anatomical and technical obstacles sclerotherapy was not possible in 3 boys. At follow-up 1 of 16 boys (6.2 per cent) had a mild recurrence detected by Doppler sonography of the spermatic cord. Percutaneous sclerotherapy had no serious side effects, and proved to be an efficient and convenient treatment of left varicocele in childhood.
Explore the source record for details and available documents.
Between June 1980 and June 1986, 345 inguinal explorations for intrascrotal space-occupying lesions were performed. In 47 patients benign testicular tumors were diagnosed (13.5%). In 32 of the 47 tumors (68%), the testis could be preserved by excision or enucleation of the tumor. In the remaining 15 patients a high semicastration was carried out: in 12 cases macroscopic examination or frozen section revealed doubtful benignity (6 Leydig cells tumors, 5 dermoid cysts and 1 epidermoid cyst), in 3 patients because of extensive involvement of the testis. In a follow-up period of 1-7 years none of the patients has shown evidence of tumor recurrence or metastasis. Changing the concept of not incising the parietal tunica of the testis and regarding clear-cut macroscopic and histological criteria of benignity on frozen section will safely lower the testicular loss rate from up to 80% to about 30% when benign tumors are encountered.
A case of segmental priapism in a 24-year-old man with congenital spherocytosis is presented. Preoperative cavernosography and computer tomography clearly revealed thrombosis of the left proximal corpus cavernosum. Because the lesion had already been in existence for 5 weeks irrigation to flush out the thrombosis was no longer possible.
The results of clinical evaluation of 71 patients with primary or secondary enuresis are presented. In 66 patients a complete urodynamic assessment was possible. 35 percent of these patients showed a normal urodynamic pattern, in 45 percent detrusor hyperreflexia and in 18 percent a combination of detrusor hyperreflexia and a functional infravesical obstruction was demonstrated.
Explore the source record for details and available documents.
Since the initiation of a 'surveillance' therapy the role of retroperitoneal lymph node dissection as standard treatment in the management of patients with clinical stage I nonseminomatous germ cell testicular tumor (NSGCTT) continues to be debated. Noninvasive staging techniques (CT scans, lymphography, ultrasound and serologic tumor markers) help to identify more accurately patients with distant metastases. 'Surveillance' alone as a possible treatment modality following orchidectomy in selected patients with clinical stage I NSGCTT requires cooperative and reliable patients. In our urological clinic surveillance alone is not justified any longer because of a noncompliance rate of 10% and a relapse rate of 30%, although the early detection of small-volume metastatic disease, lymphadenectomy and polychemotherapy result in a high rate of cure. Any patient should be excluded from 'wait and see' protocols if metastatic prognostic factors such as vascular infiltration of the primary tumor or local tumor stage greater than pT1 are identified.
Between February 1985 and January 1987, 186 patients with erectile dysfunction were selected for cavernosal autoinjection therapy (CAT). After more than 4800 protocolled autoinjections and 10-230 CAT/pt., no cavernous fibrosis, penile deviation or cavernitis occurred. The only serious side effects were prolonged erections in about 10% during diagnostic and less than 1% during therapeutic use. These prolonged erections could be easily treated by puncture and aspiration of corpora cavernosa or intracavernosal injection of Metaraminol.
In 25-30% of the patients with erectile dysfunction, venous insufficiency is the (additional) reason for the erectile failure. Surgical procedures and prognosis depend largely on the precise localisation of the pathological drainage. The venous leakage is proven and exactly localized by a multiprojectional cavernosography, measurement of the maintainance flow and intracavernous pressure monitoring. The most reliable screening test for venous erectile dysfunction is the intracavernous application of a standardised vasoactive drug combination.
Ureteral stump metastasis after tumor nephrectomy is very rare. To date 43 cases have been published. In our patient this type of metastasis was diagnosed 2 years after nephrectomy for renal adenocarcinoma with prominent rhabdomyosarcomatoid components. The pathogenesis of ureteral stump metastasis is discussed.
In addition to neuropediatrical, neurosurgical and orthopedical care a continuous urological surveillance is indicated in children with myelodysplasia. Urodynamic assessment, voiding cystourethrography, kidney- and residual urine, ultrasound, excretory urography and radioisotope studies at birth and periodically until puberty are performed to evaluate the urinary tract. Early and specific treatment of bladder dysfunction is necessary to prevent urinary infection and preserve renal parenchyma. Urodynamic testing showed evidence of neurogenic bladder dysfunction in 13 of 14 evaluated children (including 8 newborns): detrusor-sphinkter-dyssynergia in 57 percent, detrusor hyperreflexia in 21 percent and detrusor areflexia in 14 percent. 4 of 5 children with detrusor-sphkincter-dyssynergia were treated effectively with anticholinergic agents and clean intermittend catheterization.