No abstract

Color-coded Doppler ultrasonography is a combination of real-time sonography and duplex sonography for noninvasive imaging of arterial and venous blood vessels. In 40 patients with acute onset of scrotal pain this diagnostic procedure was correlated with the findings at surgical exploration: 11 had testicular torsion, 4 hydatid torsion, 13 spontaneous detorsion, 2 blunt scrotal trauma and 10 epididymitis. For testicular torsion color-coded Doppler ultrasonography had a sensitivity of 82% and a specificity of 100%, and for epididymitis the sensitivity was 70% and specificity was 88%. Color-coded ultrasonography readily demonstrates testicular perfusion. In cases of incomplete or early torsion some residual perfusion may be detected leading to false-negative results. Despite this fact, color-coded Doppler ultrasonography currently is the most valuable diagnostic modality in the evaluation of the acute scrotum.

At present, no sufficient therapy for metastatic renal cell carcinoma is available. Several immunotherapeutical protocols have been studied, success rates, however, were inconsistent. The purpose of this study was to assess the pretherapeutic immunological status of 13 patients with metastatic and 16 patients with nonmetastatic renal cell carcinoma and of 15 healthy volunteers. Determined were differential blood counts, lymphocyte subpopulations, β2-microglobulin, tumor necrosis factor (TNF), neopterin, immunoglobulin, fibronectin and ferritin. Additionally, these parameters were recorded for monitoring an immunotherapeutical approach with the xenogeneic biological response modifier Keyhole limpet hemocyanine (KLH) in 10 patients with metastatic and in 5 patients with nonmetastatic disease. The pretherapeutic immunological status of patients with metastatic disease was characterized by significantly reduced T4-, T8- and B-cell counts. Significantly increased were granulocyte counts, β2-microglobulin, neopterin and TNF. In patients who did not suffer from metastases, only β2-microglobulin and neopterin were increased significantly. During immunotherapy, in patients with metastases, there was a decline of lymphocyte subsets and of the T4/T8-ratio, which correlated with progress of the disease. Humoral immune parameters showed no changes compared to pretherapeutic values. In patients who did not suffer from metastases, cellular immune parameters showed stable values during immunotherapy; neopterin, β2-microglobulin and TNF increased considerably. These findings indicate immunosuppression in patients with metastatic renal cell carcinoma, increasing with progression of the disease and possibly impairing the immunostimulating effects of biological response modifiers during immunotherapy. In conclusion, the clinical response of metastatic renal cell carcinoma to immunotherapy might be improved if the immunostimulant is combined with agents suitable to overcome immunosuppression, i.e. low doses of cyclophosphamide or inhibitors of prostaglandin synthesis. In addition, assessment of immune parameters for monitoring the actual immune status of a patient and the immunological effects of therapy was found to be a necessary part of immunotherapy.

In a retrospective study, the data of 102 patients were evaluated for effectiveness of treatment of upper ureteral calculi by extracorporeal shock wave lithotripsy (SWL) alone (in situ) or after repositioning of (push and smash) (53 cases). Whereas no significant differences were seen concerning the duration of stone impaction and obstruction, significant differences were found concerning the number of treatments per patient (1.5 1.2) and the number of shock waves (1500 1240) necessary to destroy the stones. The calculi treated in situ necessitated a considerably higher number of auxiliary measures (ureteral catheterization, double-J stent insertion). The stone-free rates after 6 months were comparable in the two groups. Ureteral catheter mobilization of obstructive upper ureteral calculi prior to SWL provides for short and uneventful passage of fragments.

Bone metastases of urological tumors occur in nearly 40% of all primary tumors of the prostate, the kidney and the bladder. The quality of metastases may be described as osteolytic, osteoplastic or mixed lesion. Whereas prostate cancers produce mainly osteoplastic lesions, renal cell carcinomas predominantly generate osteolytic lesions. In bladder cancer both forms of metastases occur in tantamount numbers. However, diagnostics still presents many difficulties, since it is not feasible to identify very small metastases until symptoms have manifested themselves. The purpose of our study was to evaluate measurement technique and classification of significant serum markers for monitoring the course of disease. Patients with primary urological tumors and metastases in the skeleton were investigated and compared with healthy volunteers. Osteodensitometry was used to confirm and to replace radiological diagnosis of bone metastases. Thus it was possible to locate the extent and obtain information on the maximum charge and the stability of metastases. Our examinations revealed that distinct serum markers describe the changes in bone evoked by metastases. In comparison with healthy volunteers, patients with osteoplastic lesions and osteolytic lesions showed increases in hydroxyproline and pyridinium crosslinks (significance at least p < 0.005). Osteocalcin was elevated only in osteoplastic lesions versus healthy volunteers (p < 0.01). For diagnostics of osteoplastic and osteolytic metastases, either alkaline phosphatase or the skeleton-specific phosphatase (ostase) can be measured serologically. Both parameters showed significant elevation in the patient groups when set against the healthy controls (both p < 0.0001). Compared with lytic lesions osteoplastic carcinomas revealed significant increase of alkaline phosphatase (p < 0.0001) and osteocalcin (p < 0.005). In examination of bone metabolism in patients with skeletal meastases the following parameters are of eminent interest: osteocalcin, hydroxyproline or pyridinium crosslinks, alkaline phosphatase or ostase. These serological parameters could be helpful even with regard to early diagnosis of bone metastases. Evaluation of measuring techniques suggests quantifying pyridinium crosslinks instead of hydroxyproline, because they may be assessed without taking the patient’s diet into account. Determination of bone density may be helpful in diagnostics or control of therapy modalities.