Color-coded duplex sonography for diagnosis of testicular torsion

By color-coded duplex sonography moving structures are visualized as red or blue colors within a normal gray-scale B-mode ultrasound image. Thus, blood flow even within small vessels can be visualized clearly. Color-coded duplex sonographic examination was performed in 11 patients who presented with scrotal pain. This method proved to be reliable to differentiate between testicular torsion and testicular inflammation. By clearly demonstrating a lack of intratesticular blood flow in testicular torsion, while avoiding flow in scrotal skin vessels being misinterpreted as intratesticular blood flow, this method significantly decreases the number of patients in whom surgical evaluation is necessary to exclude testicular torsion.     

Extracorporeal shockwave lithotripsy with combined ultrasound and roentgenologic calculus localization. Initial clinical experiences with the Lithostar plus

Since the introduction of extracorporeal shock wave lithotripsy for non-invasive treatment of renal and ureteral stones, lithotripter units have relied on either fluoroscopic or ultrasound stone localization. While ultrasound stone localization reduces X-ray exposure and facilitates treatment of radiolucent renal stones, fluoroscopic stone localization is superior in the detection of ureteral stones. Since April 1989 we have been using the Lithostar plus, a new lithotriptor system, which provides both fluoroscopic and ultrasound stone localization. After treatment of 108 patients, the initial data suggest that this system combines the advantages of both localization principles, while being as efficient as other second-generation lithotriptor units in bringing about the disintegration of renal and ureteral stones.     

Effects of chemotherapy on the cytogenetic constitution of Wilms' tumor.

The management of Wilms' tumors consists of a combination of surgery, chemotherapy, and possibly radiotherapy. To date, chemotherapy is being risk stratified according to histologic subtype and stage. Although the cytogenetic characteristics of Wilms' tumors are well established, the cytogenetic effects related to chemotherapy are widely unknown. We herein report on comparative genomic hybridization findings in 41 primary Wilms' tumors of blastemal type, of which 19 had received preoperative chemotherapy (PCT group) and 22 did not (non-PCT group). Overall, imbalances could be detected in 32 tumors, with +1q (17 cases), +7q (10 cases), +7p (6 cases), and -7p (6 cases) as the most common changes. Among these, +7q and -7p were both significantly associated with metastatic disease at the time of surgery (P = 0.002 and 0.007, respectively), and +7q was also associated with higher stage (stages III + IV; P = 0.003). There were significant differences in the cytogenetic constitution of tumors between the two treatment groups. As a trend, tumors in the preoperative-chemotherapy group had fewer changes (mean, 2.7) than those in the non-preoperative-chemotherapy group (mean, 3.8), and the frequencies of imbalances at 7p or +7q, respectively, were significantly lower compared with tumors in the non-preoperative-chemotherapy group (2 of 19 versus 10 of 22, P = 0.019; 1 of 19 versus 9 of 22, P = 0.011). In contrast, -1q was common in both the preop-CT group (10 of 19) and the non-preop-CT group (7 of 22). The results suggest that Wilms' tumor clones with +1q are not obliterated by preoperative chemotherapy, whereas cytogenetically more complex clones with +7q and/or imbalances at 7p seem more responsive and are more likely to be eliminated by chemotherapeutic treatment.     

"Imperative indication" for organ-preserving kidney tumor surgery

Imperative indications for organ-sparing surgery of renal tumors are given mainly in existing or imminent restriction of renal function. Organ-sparing excision of renal tumors under in-situ protection with HTK-solution compared with operations without protection have the following advantages: 1. reduced blood loss, 2. longer ischemia, 3. better tissue differentiation with benefit for radicality, 4. shorter hospital stay.     

Preoperative diagnosis of kidney cancers with involvement of the vena cava

85 patients with adenocarcinoma of the kidney were operated in 1982 and 1983. 9 patients showed a tumor thrombus extending into the renal vena and vena cava. Ultrasound examination of the retroperitoneal cava up to the liver veins was always able to diagnose the tumor thrombus and its cranial extension. If the end of the thrombus was visualised ultrasonographically below the diaphragma and confluence of the liver veins into the cava, no additional diagnostic procedure except intravenous urography was found to be necessary for planning operative treatment. Arteriography, cavography and computer scanning did not give additional information important for surgical intervention.     

Gender differences in voluntary micturition control: an fMRI study

In the last decade functional imaging has gained substantial importance for identifying cortical and subcortical brain regions being involved in the micturition circuit. However, possible gender differences are still a matter of debate. In the present study we used functional magnetic resonance imaging (fMRI) to determine micturition related brain regions in healthy men and compared them with those in women to elucidate gender-related differences. fMRI was performed at 3 T in 12 healthy men with urge to void due to a filled bladder. In a non-voiding model they were instructed to contract or to relax the pelvic floor muscles repetitively. As previously reported in women, contraction and relaxation of pelvic floor muscles induced strong activations in the brainstem and more rostral areas in our group of healthy men. In general, men had stronger activations during contraction than women in nearly all identified areas. In contrast, results for the relaxation condition were similar. Some of the differences between contraction and relaxation, formerly detected in females, could be found in our group of males as well. The results suggest that in women and men the same cortical and subcortical networks exist for micturition control. Especially, the well located activations in the putative pontine micturition centre and the periaqueductal grey could be identified in both sexes. However, pelvic floor muscle control seems to induce different activation intensities in men and women.     

Treosulfan shows cytotoxic effect on spheroids from primary cell cultures of kidney cell carcinomas independently of P-glycoprotein expression

Summary Therapy of advanced renal cell carcinoma remains difficult. New therapeutic schemes besides cytokine treatment should be evaluated. The following study analyzes the in vitro toxicity of treosulfan on spheroids of 8 primary cultures of renal cell carcinoma cells. These data were compared to the toxicity of vinblastine. All investigations were performed in regard to the P-glycoprotein (Pgp) expression of the cells, which is one of the main causes of multidrug resistance. Four Pgp positive and four Pgp negative spheroids were incubated with the drugs in increasing doses. Toxicity was measured using the MTT toxicity assay as well as trypan blue exclusion. Significantly higher toxicity of treosulfan compared to vinblastine could be demonstrated. In addition, the effects of treosulfan were not related to Pgp expression. These results are encouraging and a phase II study analyzing the efficacy of treosulfan in patients with advanced renal cell carcinoma has been initiated in our institution.      

Differences in cortical microcirculation in the kidneys of unilaterally congenital hydronephrotic rats

The surgically induced split hydronephrotic kidney has been generally accepted as a valid model for the assessment of renal microcirculation by means of intravital microscopy. Whereas nearly all previous work on this issue has been done with a transillumination technique, we used an epiillumination model that is suitable for investigation of microvascular perfusion in both normal and hydronephrotic kidneys without surgical manipulation of the ureter. By means of the congenital unilaterally hydronephrotic Tauchi rat, microcirculation of the hydronephrotic and that of the nonhydronephrotic kidney were compared. For that purpose both the hydronephrotic and the nonhydronephrotic kidneys of Tauchi rats were exteriorized on a specially designed microscopy stage. After injection of FITC-dextran and rhodamine 6G, microvascular perfusion was assessed in both kidneys. The new model allowed visualization of arterioles, capillaries, and postcapillary venules in both the hydronephrotic and the nonhydronephrotic kidneys. Glomeruli could only be regularly seen in the hydronephrotic kidney, but also in some normal kidneys. Capillary blood cell velocity was significantly higher in the hydronephrotic kidneys (0.67 +/- 0.03 mm/s) compared to the normal kidney (0.32 +/- 0.05 mm/s; P < 0.05), whereas capillary diameters were smaller (4.2 +/- 0.02 microm vs. 5.7 +/- 0.2 microm; P < 0.05). In addition, the hydronephrotic kidney showed a significantly lower density of perfused microvessels compared to the normal controls. Epiillumination intravital microscopy allows assessment of the cortical microcirculation in both the hydronephrotic and the nonhydronephrotic kidneys without surgical induction of hydronephrosis. The hydronephrotic kidney shows significant microcirculatory differences compared to normal kidneys that should be taken into account when using a hydronephrotic model for pharmacological testing.