Naturlatexallergie-Screening bei Kindern mit neurogener Blasenentleerungsstörung

Zusammenfassung Fragestellung: Naturlatexallergien kommen bei Kindern mit angeborener neurogener Blasenentleerungsst?rung geh?uft vor. Es wurde deshalb untersucht, ob bei dieser Patientengruppe ein serologisches Screening zur Erfassung einer Sensibilisierung gegenüber Naturlatex sinnvoll ist. Patienten und Methode: Untersucht wurden 40 Kinder im Alter von 6 Monaten bis 17 Jahren. Die Untersuchung umfa?te eine gezielte Anamneseerhebung durch Fragebogen sowie die Bestimmung des Gesamtimmunglobulin E (Gesamt-IgE) und des naturlatexspezifischen Immunglobulin E (Latex-IgE) im Serum durch Festphasenimmunoassays. Ergebnisse: 5 Kinder hatten anamnestisch Zeichen einer allergischen Reaktion nach Gummikontakt. 10 Kinder wiesen im Serum erh?hte Werte des Latex-IgE auf, wobei 6 dieser Kinder bisher noch keine Zeichen einer Latexallergie hatten. Pathologische Werte für das Latex-IgE korrelierten statistisch signifikant mit der Anzahl operativer Eingriffe (p < 0,0006), nicht aber mit einem durchgeführten sauber intermittierenden Einmalkatheterismus (p = 0,408). Schlu?folgerung: Im Vergleich zur alleinigen fragebogengestützen Anamneseerhebung k?nnen durch ein serologisches Screening mit Bestimmung des Latex-IgE mehr Kinder entdeckt werden, die durch eine Sensibilisierung gegenüber Naturlatex gef?hrdet sind.      

Management of involuntary childlessness.

Any definition of involuntary childlessness has to consider the difference between sterility and subfertility. As the latter affects about 20-30% of all couples at least once in their lives, general practitioners (GPs) may be the first to be confronted with this problem. This review presents the most relevant diagnostic and therapeutic options in cases of female or male infertility, and discusses the new assisted reproductive technologies (such as insemination, in vitro fertilization, gamete transfer and intracytoplasmatic sperm injection) so that GPs may adequately inform their patients about these procedures and their risks and outcomes. Although controversial, involuntary childlessness and its clinical treatment seem to have a strong psychological impact on a couple's social, emotional and sexual life. Being available for discussion with childless couples and offering ongoing support may be the most important role for the GP in this context.     

Push and smash increases success rates in treatment of ureteric calculi by ESWL

During a 3-year period 105 patients underwent attempted retrograde manipulation for ureteric calculi into the renal pelvis prior to extracorporeal shock wave lithotripsy (ESWL). The success rate of this group was compared to 93 patients receiving ESWL of ureteric calculi in situ. The method of retrograde manipulation was recorded prospectively. Retrograde flushing with a 5 F Tiemann ureteral catheter was performed after coating the proximal ureter and renal pelvis with a mixture of saline and lidocaine gel. Success rate of calculi push was 91.4%. Mean number of ESWL treatments in this group of patients was 1.4, compared to 2.1 in patients with in situ treatment. Reposition of ureteric calculi prior to ESWL treatment increases successful initial treatment and can be performed easily.     

Microcalorimetric measurements carried out on isolated tumorous and nontumorous tissue samples from organs in the urogenital tract in comparison to histological and impulse-cytophotometric investigations

In this comparative study, microcalorimetric measurements were carried out on a total of 96 tumorous and nontumorous tissue samples taken from organs of the urogenital tract using a thermal activity monitor (TAM). Changes in the heat emission of the tissue samples were measured at 1-min intervals and graphically displayed as a function of time. The aim of the study was to compare the microcalorimetric results with impulse-cytophotometric and histological findings and provide evidence for the metabolic activity of tumorous and nontumorous tissue. In order to obtain the variation in metabolic activity, the maxima (P _max) of the curves were determined as a value of the maximum thermal power of a tissue sample, the mean values (P) were determined by the mean thermal power and the contour integrals (W) were defined by the behavior of the energy reserves and their mobilization. The first part of the study was carried out to investigate whether tumorous and nontumorous tissue samples differ in general according to their metabolic activity. We discovered, using the parameters described above, that in general tumorous tissue exhibited a higher metabolic activity than nontumorous tissue samples. For example, both W and P in tumorous prostate tissue samples were eightfold higher and the (P _max) value was 8.4-fold higher than in normal tissue. Additional investigations on testicle and kidney tissues were performed to find a possible correlation between microcalorimetric results and histological grading. We found that an increasing malignancy correlated with a higher metabolic activity of the tissue. Based upon these results were were able to differentiate the various histological gradings of these tumorous tissues by microcalorimetric measurements. The results show it is possible to differentiate between normal and tumorous tissue samples by microcalorimetric measurement based on the distinctly higher metabolic activity of malignant tissue. Furthermore, microcalorimetry allows a differentiation and classification of tissue samples into their histological grading. With the help of microcalorimetry, it might be possible in future to detect and record the metabolic processes of isolated tissue structures and changes in these activities as a result of medical intervention such as cytostatic treatment.     

Therapieformen des metastasierten Nierenzellkarzinoms

30–50% der Patienten mit Nierenzellkarzinom (RCC) werden in einem metastasierten Stadium diagnostiziert oder entwickeln nach prim?r erfolgreicher Therapie eine disseminierte Metastasierung. Die klassische Chemotherapie zeigte sich wenig effektiv. Dies ist v. a. in der überexpression des Membranglykoproteins p-170 von Nierenzellkarzinomen begründet, die Hauptursache der multi drug resistance (MDR) dieser Tumorerkrankung [1].     

Differential expression of the lung resistance-related protein/major vault protein in the histological compartments of nephroblastomas.

Nephroblastomas (Wilms' tumors) are curable with survival rates above 80%. Some tumors, however, fail to respond to therapy and those patients have a poor prognosis. In a search for molecular markers of drug resistance, we investigated the expression of lung resistance protein (LRP) in tissue samples from 32 children with nephroblastoma by means of immunohistochemistry. LRP is a human major vault protein (MVP) and is associated with multidrug resistance of tumors. LRP/MVP expression was found in the blastemal and epithelial compartments but to a significantly lesser extent in the stromal compartment of Wilms' tumors. Expression was generally heterogeneous with respect to staining intensity and percentage of positive cells. We found significant relationships between LRP/MVP expression and chemotherapeutic pre-treatment of tumors and tumor stage. The immunohistochemical results were validated with a real-time RT-PCR technique and a significant association between protein and mRNA expression was observed.     

Sex differentiation disorders from the andrologic viewpoint]

Abnormal sex differentiation with ambiguous genitalia now leads to prompt and comprehensive diagnostic evaluation in the neonate. If necessary, phenotypic gender assignment is done very early and appropriate surgical correction is performed. Management at puberty and later is more difficult. Andrological guidance at this time covers problems of genital identification, sexuality and fertility. The different types of abnormal differentiation, i.e. genetic, gonadal and phenotypic alterations, may result in different andrological problems, e.g. hypogonadism including micropenis and undescended testes, lack of secondary sex characteristics and impotence. With respect to fertility the major problems are testicular azoospermia and/or congenital abnormalities of the male reproductive tract. Any proposals for treatment have to take account of all these different aspects of pathogenesis and the natural course of the disease. In each case, andrological guidance must be formulated with due consideration for the results of genital determination in childhood, including surgical correction.     

Interdisciplinary treatment of Wilms' tumour

The results of treating the 51 children suffering from Wilms' tumour seen in the 10 years to January 1982 are described and the need of an interdisciplinary approach is stressed.     

Progress in diagnosis of the urinary tract in children

Ultrasound has enriched the armamentarium of the pediatric urologist. Miniprobes enable examination of preterm children without taking them out of the incubator. Special puncture needles facilitate percutaneous diagnostic procedures. A neonatal nephrostomy set was developed for temporary urinary diversion.