Urologic complications in 200 patients with Crohn disease

The main urological complications of Crohn's disease are: vesico-intestinal fistula, ureteral obstruction, formation of urinary calculi and amyloidosis of the kidney. 200 patients suffering from Crohn's disease who had been treated in- or outpatient between 1973 and 1982 have been examined concerning urological complications. The frequency of complications was 14,5 per cent. Twenty patients developed fistulae, eleven had ureteral obstructions, two patients suffered from calculi and two from amyloidosis of the kidney. Due to this frequency a special urological diagnostic program is mandatory. A sonogram of the kidney and an i.v. urography should be made in case of pathological sonogram. This is as necessary as the control of kidney function and diagnosis of the urine. These specific urological complications are demonstrated in symptoms, diagnosis and therapy.     

Preoperative renal tumor embolization. A useful procedure?

The medical reports of 113 patients operated upon for renal tumors were retrospectively reviewed to assess the value of preoperative embolization. Coils or ethanol were used preoperatively in 55 patients while 58 patients underwent nephrectomy without embolization. The tumors were staged according to the TNM and the Robson staging classification. T1 and T2 tumors as well as T3 and T4 tumors were grouped together for statistical evaluation. There was no significant difference in intraoperative blood loss, operation time and survival rate between patients undergoing preoperative embolization and those who had only nephrectomy. Duration of hospital stay was always longer in the preoperatively embolized group. Preoperative embolization of renal tumors neither improved the patients' outcome nor reduced the surgical risk. Robson's classification, stage III/IV, did not show any significant differences for embolized patients or for those nephrectomized without embolization.     

Priapism: a three-phase concept of management according to aetiology and prognosis

Priapism is a persistent, painful erection of the penis unassociated with sexual stimulation or desire, and detumescence does not occur following ejaculation. Prolonged pathological erections may occur and it is only when they are painful that the term priapism should be used. The erection is limited to the corpora cavernosa. Although the syndrome was named after Priapos, the mythical Greek god of fertility, impotence persists in one half of patients treated for priapism. The disease is rare; the literature consists mainly of case reports and comprehensive reviews are seldom found. Permanent sequelae cause a psychological and physical handicap and justify the present review, which is based upon recent literature as well as personal clinical experience of 15 patients. We have reviewed 170 reports describing 1400 cases of priapism and have based the analysis upon the 230 single case reports found in the literature.     

Methoxyisobutylisonitrile (MIBI) Tc 99m SPECT to establish a correlate to coronary flow reserve,the perfusion reserve,from global and regional myocardial uptake after exercise and rest

With^99mTc-MIBI SPECT and a 4 h exercise (E; 150 MBq iv) and rest (R; 800 MBq iv) protocol global and regional left ventricular (LV) myocardial uptake was determined in 70 patients with angiographicall, confirmed coronary heart disease (CHD) and in 10 controls. The aim was to establish an E/R ratio as a correlate to coronary vascular reserve, representing perfusion reserve (PR). E/R ratios, obtained from total LV myocardium or from normal or impaired regions, were > 1.19 under all conditions, indicating the presence of higher flow during exercise than at rest (even in areas of low flow). Global PR separated (P<0.01) controls (1.63±0.21; mean ± SD) from severely diseased patients (1.29 ±0.14 in 2- or 3-vessel disease) only. Improved differential diagnosis was gained from calibrating the regional E/R ratio to regional differences (E minus R) of uptake. For the left ventricle regional PRs (RPR) for 25 ROIs of the target, framing the myocardium, were determined RPR at the regional maximum of^99mTc-MIBI uptake was similar in both controls (1.66) and patients (1.63), indicating a high probability of meeting some areas with functionally normal perfusion in patients with CHD. RPR allowed sufficient separation (P<0.025) concerning the degree of coronary artery stenosis (RPR in occlusion, 0.26; stenosis >75%, 0.39; <75%, 0.56). In controls, the overall value for RPR was 1.14+0.28 (P< 0.001). LV global PR and RPR were useful in separating patients with CHD vs controls and in classifying the severity of vascular stenosis.Dedicated to Prof. Dr. D. Emrich, Göttingen on the occasion of his 60^th birthday     

Myocardial kinetics of 99Tcm hexakis-(2-methoxy-isobutyl-isonitrile) (HMIBI) in patients with coronary heart disease: a comparative study versus 201Tl with SPECT

In 15 patients with coronary heart disease, 74 MBq 201Tl (A) and 240 MBq 99Tcm HMIBI (B) were injected during exercise on separate days and SPECT imaging was applied. In (B) a consecutive second injection was given with an identical dose 3 h later (at rest) and net rest distribution was obtained from a subtraction technique. From polar, target-like ROIs, data were computed to compare regional vitality, wash-out and wash-out corrected redistribution. Myocardial wash-out, in contrast to 201Tl, was found to be 20% for 99Tcm independent of the regional myocardial state. Since no considerable redistribution occurred, myocardial distribution of 99Tcm HMIBI remained rather constant for 3 h, resulting in a maximum myocardium to lung ration of about 5. After the second injection, redistribution revealed the same results as in the 201Tl targets. From regional exercise to rest ratios a 'perfusion reserve' was determined which was 2.1 in normal and 1.3 in myocardial areas with defects. Myocardial defect uptake and defect size were nearly identical, yielding agreement in 97% of the myocardial segments. We conclude that 99Tcm HMIBI is a most powerful myocardial imaging agent. The final routine protocol, however, is as yet not established.     

Über das Trockengewicht,den DNS- und Histonproteingehalt von menschlichen Tumoren

Zusammenfassung An acht Carcinomfällen wurden vergleichende interferenzmikroskopische (Trockengewicht), UV-photometrische (DNS und RNS) sowie cytophotometrische Messungen nach Feulgen-(DNS) und Fastgreen-Färbung (pH 8,2, Histonprotein) ausgeführt. Die Messungen ergaben, daß die untersuchten Tumorzellpopulationen durch eine große Streuung der Meßwerte und Gipfelbildungen im diploiden oder hyperdiploiden Bereich ausgezeichnet sind, denen entsprechende Häufigkeitsgruppierungen der Trockengewichte zugeordnet werden können. Charakteristische Unterschiede zu normalen Zellen lassen sich weder im Trockengewicht noch in der Masse pro ², noch in der Beziehung zwischen Volumen und Trockengewicht feststellen. Die kombinierte Anwendung von interferenzmikroskopischen Trockengewichtsbestimmungen und UV-photometrischen Messungen ergibt die Möglichkeit, den prozentualen Nucleinsäuregehalt und den Anteil der Nucleinsäure an der Masse pro ² zu errechnen. Der Nucleinsäuregehalt beträgt 15–30% des Trockengewichts bei normalen Zellen, 10–24% bei Tumorzellen.Die Verteilung der Meßwerte stimmt bei UV-photometrischen und Feulgenphotometrischen (Schnitt und Ausstrich) Messungen weitgehend überein. Auch die Histone (Fastgreen-Färbung) zeigen ein gleichartiges Häufigkeitsmuster. Eine Korrelation der Meßwerte zum klinischen Verlauf oder dem morphologischen Erscheinungsbild der Tumoren ist nicht möglich.

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Summary Comparative studies were carried out on eight carcinomas using interference microscopy (dry weight), and UV photometric (DNA and RNA) and cytophotometric measurements after Feulgen staining (DNA) and fast green staining (pH 8.2, histone-protein). The measurements disclosed, that the population of tumor cells studied were characterized by widely dispersed values and peaks in the diploid and hyperdiploid regions, to which corresponding frequency groupings of the dry weight could be classified. Characteristic differences from normal cells could not be detected in the dry weight, nor in the mass per ², nor in the relation between volume and dry weight. When the determinations for dry weight, as ascertained by interference microscopy, and the UV photometric measurements were combined, it became possible to calculate the percentage content of nucleic acid and the component of nucleic acid of the mass per ². The content of nucleic acid was 15–30% of the dry weight in normal cells and 10–24% in the tumor cells.The values of the UV and Feulgen photometric measurements (made on sections and smears) were distributed alike. The histone (fast green stain) also showed a similar frequency pattern. A correlation of the values with the clinical course or with morphologic manifestations of the tumor was not possible.

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Mit 8 Textabbildungen

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Herrn Prof. Dr. Geissendörfer (Direktor der Chirung. Univ.-Klinik, Frankfurt a. M.) in Dankbarkeit gewidmet.

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Mit Unterstützung der Deutschen Forschungsgemeinschaft.

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Die mitgeteilten Meßergebnisse basieren zum Teil auf den Dissertationen von C. Pollak, R. Nickel und R. Fischer.