Laparoscopic adrenalectomy in urological centres - the experience of the German Laparoscopic Working Group.

Objective: To evaluate the safety and feasibility of laparoscopic adrenalectomy (LA) performed in several German centres with different laparoscopic experience, as LA has become the gold-standard approach for benign surgical adrenal disorders; however, for solitary metastasis or primary adrenal cancer its precise role is uncertain.

Patients And Methods: The data of 363 patients who underwent a LA were prospectively collected in 23 centres. All centres were stratified into three groups according to their experience: group A (<10 LAs/year), group B (10-20 LAs/year) and group C (>20 LAs/year).

[The future of ESWL].

With the introduction of the Dornier HM3 lithotripter, the successful history of extracorporeal shock wave lithotripsy (ESWL) for noninvasive treatment of urinary stones began about 25 years ago. The development of newer lithotripters has not been able to improve clinical efficacy because the shock wave parameters specifically responsible for stone disintegration or tissue trauma and pain induction have not yet been identified. Actual research in lithotripter technology deals with modification of the focal point.

[Renal oncocytoma. Diagnosis and its therapeutic consequences].

The angiographic findings (hypovascularity, spokewheel phenomenon, lucent rim, linear course of vessels) and CT features (central scar, hyperdense without contrast medium) of 20 patients with renal oncocytomas were analyzed. Simultaneously seven patients with renal cell carcinoma preoperatively misdiagnosed as oncocytoma were compared and critically discussed. Preoperatively, reliable differentiation of renal oncocytoma and renal carcinoma is not possible.

[Piezoelectric extracorporeal lithotripsy in children. Assessment over 3 years].

From 1987 to 1990, 45 children whose age ranged from 5 months to 14 years and who presented with urinary lithiasis underwent piezoelectrical extracorporeal lithotripsy with a Piezolith 2,300 and 2,500 system. We were able to perform the treatment without anesthesia in 53% of the children. The results were highly encouraging as, and without any severe complication; 84% of the children had no residual calculus after 3 months.

Effects of prostaglandin synthetase inhibitors on the upper urinary tract. Experimental studies on isolated preparations and urodynamic measurements in men.

Prostaglandin inhibitors such as indomethacin have been used for the treatment of renal colic. While opioids have a central analgesic effect, the effects of indomethacin are mainly peripheral, acting directly on the kidney. Pharmacourodynamic investigations of the upper urinary tract in men have demonstrated that intravenous indomethacin reduces renal pelvic pressure.

Renal ultrasonography in the management of calculus disease.

Our experience with piezoelectric ultrasound-guided lithotripsy began in December 1985, and in the three years to February 1989, we have treated stones in more than 2200 kidneys in 2000 patients. Stones of any size or composition were treated. All stones apart from those situated in the area hidden by the pelvic bones could be localized by ultrasound.

[Extracorporeal lithotripsy of gallbladder calculi with piezoelectrically generated shock waves: initial experiences].

A piezoelectric lithotripter ("Piezolith 2300") was used in 24 patients for extracorporeal fragmentation of radiolucent gallbladder stones. In 19 patients with one stone and 4 patients with two stones (diameter: 0.8-3.

Haemodynamic effects of acute and chronic renin inhibition in marmosets.

We have developed marmoset models for the in vivo evaluation of primate-specific inhibitors of human renin. After acute intravenous administration to normotensive sodium-depleted marmosets, renin inhibitors of different structural types induced a maximum hypotensive response of a magnitude similar to that induced after angiotensin converting enzyme (ACE) inhibition. The response was prevented by pretreatment with an ACE inhibitor.

Computed tomographic and angiographic findings in renal oncocytoma.

Nine cases with histologically proven renal oncocytoma are presented. In all cases, ultrasonography gave the first indication of a tumour and intravenous urography was tumour-specific in only six, whilst angiography was so in only four of the cases with peripheral extension beyond the normal organ limits. Examination by computed tomography showed retrospectively, in the three cases with smaller oncocytomas up to 3 cm in diameter, findings that seemed promisingly characteristic: without contrast medium, the tumour appeared homogeneously hyperdense in comparison with normal renal parenchyma, but homogeneously hypodense after injection of contrast medium.

Treatment of prevesical ureteral calculi by extracorporeal shock wave lithotripsy.

Since August 1985 extracorporeal shock wave lithotripsy has been performed in 39 patients with prevesical ureteral stones, including 3 with steinstrasse after extracorporeal shock wave lithotripsy of kidney stones. Female patients less than 40 years old were excluded because of the theoretical possibility of harm to the ovary by shock waves. Via a modified technique with the patient in a flat position, x-rays and shock waves enter through the foramen obturatum.

[Extracorporeal shockwave lithotripsy in the treatment of urolithiasis--experiences from a center with the Piezolith 2200 and HM3 lithotriptors].

The Piezolith 2200 allows not only a qualitatively identical treatment of urolithiasis like the HM-Dornier systems or the Siemens Lithostar, but the application of lithotriptable urinary calculi could be extended to cardiac risk patients, to patients with skeletal deformities and to those with unusual body height and weight. As the piezolithotripsy does not cause pain, treatment is possible without anaesthesia or analgesia. Combined with internal ureteral stenting by self-retaining double-J-ureteral catheter also calculi with larger stone masses can be treated advantageously by exclusive piezolithotripsy as monotherapy.

Results in the use of extracorporeal piezoelectric lithotripsy (EPL) for treatment of urinary calculi.

The Piezolith 2200 as an extracorporeal shock wave lithotripter uses piezoelectrically generated, high-energy sonic impulses for treatment of urinary calculi; the shock wave generator is self-focussing. Localization of concrements is performed by means of ultrasound imaging. Treatment with the Piezolith 2200 is painless for the patient and thus possible without anesthesia and analgesia.

Antihypertensive effect of a renin inhibitor in marmosets with a segmental renal infarction.

Hypertension was induced in marmosets by ligating the minor branch of one renal artery. The blood pressure (BP), measured by a tail-cuff method, increased to hypertensive levels within 4-5 weeks and the maximum increases occurred after 4-15 weeks (BP, mean +/- s.e.

Sustained reduction in blood pressure during chronic administration of a renin inhibitor to normotensive marmosets.

In this study, the hypotensive efficacy of a renin inhibitor was investigated during chronic administration. The renin inhibitor CGP 29,287 was administered by continuous intraperitoneal infusion with osmotic mini-pumps to normotensive marmosets fed a low-sodium diet. Marmosets received a dose of 0.

Renal vasodilatation after inhibition of renin or converting enzyme in marmoset.

The relative importance of angiotensin II for the renal vasodilatory response after converting-enzyme inhibition was evaluated by a comparison of the effects of converting-enzyme and renin inhibition on renal vascular resistance. Renal, mesenteric, and hindquarter blood flows were measured with chronically implanted ultrasonic-pulsed Doppler flow probes in conscious, mildly volume-depleted marmosets after administration of a converting-enzyme inhibitor (enalaprilat, 2 mg/kg iv), a synthetic renin inhibitor (CGP 29,287, 1 mg/kg iv), or a renin-inhibitory monoclonal antibody (R-3-36-16, 0.1 mg/kg iv).

[Disintegration of kidney calculi with a piezoelectric instrument system. Initial clinical experiences].

Since December 1985 extracorporeal piezoelectric renal lithotripsy has been tested in humans. Up to now 50 patients with renal calculi have been treated. The lithotriptor consists of a special mobile table with an opening in the surface to apply shock waves.

[Renal hypertension - a threatening complication of blunt kidney injuries].

The therapeutic management of renal trauma is mainly determined by the type and grade of kidney damage. However, imminent complications of renal trauma should already be considered during the primary therapy. The posttraumatic development of the arterial blood pressure was analysed in 153 kidney injuries by a retrospective study during a period of 17 years.