Ca. 10% der Beckenfrakturen sind mit Verletzungen der hinteren Harnröhre begleitet. Durch Scherkräfte, die durch Muskelzug bei Beckenfrakturen auftreten, oder durch Knochentrümmer und Splitter kann die hintere Harnröhre im intra- oder extrapelvinen Bereich verletzt werden; allein dadurch können auch Nerven- und Gefäßverletzungen im Beckenbereich verursacht werden, zusätzlich kann auch das bei den Traumen auftretende Hämatom zu Druckschädigung der Nerven- und Blutversorgung führen.

You have accessJournal of Urology1 Apr 2009VERY LOW RECURRENCE RATE AFTER LONG EXPERIENCE WITH ADJUVANT CARBOPLATIN MONTHERAPY FOR CLINICAL STAGE I SEMINOMA Hannes Steiner, Karl Scheiber, Brigitte Stoehr, Nicolai Leonhartsberger, Andreas Fritzer, and Florian Zangerl Hannes SteinerHannes Steiner More articles by this author , Karl ScheiberKarl Scheiber More articles by this author , Brigitte StoehrBrigitte Stoehr More articles by this author , Nicolai LeonhartsbergerNicolai Leonhartsberger More articles by this author , Andreas FritzerAndreas Fritzer More articles by this author , and Florian ZangerlFlorian Zangerl More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)60924-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "VERY LOW RECURRENCE RATE AFTER LONG EXPERIENCE WITH ADJUVANT CARBOPLATIN MONTHERAPY FOR CLINICAL STAGE I SEMINOMA." The Journal of Urology, 181(4S), p. 325 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 325 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Hannes Steiner More articles by this author Karl Scheiber More articles by this author Brigitte Stoehr More articles by this author Nicolai Leonhartsberger More articles by this author Andreas Fritzer More articles by this author Florian Zangerl More articles by this author Expand All Advertisement PDF downloadLoading ...

In the divertor of the nuclear fusion experiment WENDELSTEIN 7-X (W7-X) plasma facing high heat flux target elements have to withstand severe loading conditions. The thermally induced mechanical stressing turns out to be most critical with respect to lifetime predictions of the target elements. Therefore, different design variants of those CFC flat tile armoured high heat flux components have been analysed via the finite element package ABAQUS aiming at derivation of an optimized component design under high heat flux conditions. The investigated design variants comprise also promising alterations in the cooling channel design and castellation of the CFC flat tiles which, however, from a system integration and manufacturing standpoint of view, respectively, are evaluated to be critical. Therefore, the numerical study as presented here mainly comprises a reference variant that is comparatively studied with a variant incorporating a bi-layer-type AMC-Cu/OF-Cu interlayer at the CFC/Cu-interface. The thermo-mechanical material characteristics are accounted for in the finite element models with elastic–plastic properties being assigned to the metallic sections CuCrZr, AMC-Cu and OF-Cu, respectively, and orthotropic nonlinear-elastic properties being used for the CFC sections. The calculated temporal and spatial evolution of temperatures, stresses, and strains for the individual design variants are evaluated with special attention being paid to stress measures, plastic strains, and damage parameters indicating the risk of failure of CFC and the CFC/Cu-interface, respectively. This way the finite element analysis allows to numerically derive an optimized design variant within the framework of expected operating conditions in W7-X.

The target elements of the WENDELSTEIN 7-X (W7-X) divertor are designed to sustain a stationary heat flux of 10MW/m2 and to remove a maximum power of 100kW. CFC Sepcarb® NB31 tiles are bonded to a water-cooled CuCrZr heat sink in two steps: active metal casting (AMC®) of an AMC®-copper interlayer to CFC tiles, electron beam welding (EBW) or hot isostatic pressing (HIP) of the AMC®-NB31 tiles to CuCrZr. The fabrication of the whole amount of CFC NB31 has been completed. The key target of the pre-series phase is the qualification of this bond based on a series of examinations. The introduction of silicon during the AMC® process significantly improved the strength of the joint between CFC and AMC®-copper. The strength of the bond is preserved after either EBW or HIP processes. High heat flux testing carried out in the ion beam facility GLADIS exhibited a too high percentage of defective tiles. Pre-series activities have been extended to reduce the stress concentration at the interface between tiles and heat sink by optimizing the design.

Different welding strategies were investigated to improve the tubular transition of CuCrZr to 316L in cooling pipes for actively cooled plasma facing components. Electron beam welding experiments have been carried out on tubular samples using different filler and adapter materials. After non-destructive testing by dye penetrant and He-leak tight testing samples were tensile tested at RT and 400 °C to down-select promising candidates. Furthermore samples were taken for a metallographic examination in order to determine the integrity of the welds, the depth of penetration and the hardness profile across the weld. In the scanning electron microscope the weld microstructure and the formation of phases were studied. Good results were obtained by the use of a Ni-filler, an Inconel and explosive welded adapter. The tested samples of these variations fulfilled the strength requirements according to the ITER specification and showed an improved transition compared with the current solution of a pure Ni-adapter. The final down-selection will be based on the results of fatigue and torsion testing.

The target areas intercept the open field lines at the plasma boundary and are the most heat-loaded zone of the WENDELSTEIN 7-X (W7-X) divertor. The 19m2 of the target areas, which are formed by 890 water-cooled target elements, are made of CuCrZr heat sinks covered with CFC tiles. Before mass-production, a pre-series stage has been launched to qualify the design and the various steps of the manufacturing route. The purpose is to select the technology to bond the tiles, to qualify the different non-destructive examinations and to better define the relevant acceptance criteria for the serial production.

To determine the usefulness of placental alkaline phosphatase (PlAP) as a marker for germ cell rumours the current literature has been reviewed and the preliminary results of a retrospective analysis, currently performed by the Austrian Uro-Oncology Group, are reported. PlAP is an excellent tissue marker for seminoma and for intraepithelial neoplasia (TIN) in biopsies of the testis. Irrespective of the tumour stage, FLAP serum assays were positive in 72% of seminoma patients. In 21% of cases PlAP was the only positive marker. Combining PlAP with HCG and LDH gave a marker incidence in seminomas comparable to that in non-seminomatous tumours. There is strong evidence that seminomatous elements and surrounding TIN in the primary tumour are responsible for the 36% PlAP positivity in non-smoking NSGCT patients. Serum FLAP half-life in non-smokers was calculated to be 0.4-2.8 days. Prolonged half-life correlated well with known higher stages and therefore may be also able to identify patients with clinically undetectable metastases. PlAP decline during chemotherapy of higher stages correlated very well with clinical response.During follow-up the false positive rate in non-smokers in stage I disease was no more than 3% versus 38% in smokers. In all but one non-smoker, disease progression was associated with PlAP levels above 100 U/l. Determination of PlAP levels should be mandatory in non-smokers with seminoma, but as PlAP levels Vary too much due to smoking, they should not be performed routinely in smokers.

The complications after extracorporeal shock wave lithotripsy (ESWL) for large renal calculi could be reduced by insertion of ureteral stents. In a prospective study, the critical stone size for ESWL combined with ureteral stenting was looked for. Sixty consecutive patients entered the study, 17 patients suffered from renal calculi with a length of greater than 4 cm and a width of greater than 3 cm (group 1), and in 43 patients the calculi measured between 4 x 3 and 2.5 x 1.5 cm2 (group 2). ESWL was performed with the Dornier apparatus HM-3. A ureteral stent was placed immediately before ESWL. In group 1 with very large stones, significantly more obstructive problems were encountered. Three months after ESWL, only 6 of 14 (43%) were free of stones or with stone material likely to discharge spontaneously. In group 2, a success rate of 25 of 29 (86%) was noticed, which was considered satisfactory. For most stones greater than 4 x 3 cm2 the combination of percutaneous nephrolithotomy and ESWL seems to be the preferred treatment.

Zwischen 1980 und 1984 wurden 19 Patienten mit einem fortgeschrittenen nicht-seminomatösen Hodentumor behandelt (Stadium HC, IIIC, IVCL2, IVCL3, HCG-Wert über 10000 ng/ml, -Fetoprotein-Wert über 1000 ng/ml, Peckham et al. 1979).

Kein anderer Tumor kann durch spezifische und sensible Tumormarker so gut erfaßt werden wie der Hodentumor. Im klinischen Einsatz haben sich das α-Fetoprotein und das β-HCG bewährt. Andere Marker wie die plazentare alkalische Phosphatase, Gamma-GlutamylTranspeptidase, verschiedene plazentare Proteine und das plazentare Lactogen haben sich bisher im routinemäßigen klinischen Einsatz nicht bewährt (4). Wir untersuchten, ob das schwangerschaftsspezifische β-1-Glukoprotein als Marker eingesetzt werden kann (6). Dabei fanden sich prätherapeutisch erhöhte Werte für SP1 nur bei 54% der Patienten. Auch in Kombination mit AFP und β-HCG kann das SP1 nur in wenigen Fällen zusätzliche Informationen bringen.

Of 412 patients with unilateral testicular cancer 20 (4.3 per cent) suffered a second primary germ cell tumor: 1 had a simultaneous bilateral tumor and in the remaining 19 the second tumor was diagnosed after an interval of 2 months to 32 years. Patients with clinical stages III and IV disease were found only in the group with a second tumor. In 5 patients known risk factors for the development of testicular tumors were found and in 2 prior testicular biopsies showed carcinoma in situ. Effective chemotherapy was used more often in the treatment of the second primary tumor.

Das XX-Mann-Syndrom zählt zu den seltensten Chromosomenanomalien. 2 Patienten aus dem andrologischen Patientengut mil unterschiedlichem klinischen Erscheinungsbild und Azoospermie werden vorgestellt. Klinik und Hormonbefunde ermöglichen keine differentialdiagnostische Abgrenzung zum Klinefeltersyndrom; nur mit einer exakten zytogenetischen Abklärung kann die Diagnose gestellt werden. Eine einheitliche ätiologische Erklärung zum XX-Mann-Phänomen existiert noch nicht.

Tumor recurrences were observed 70 times in 715 cystoscopies performed in 253 patients. The sensitivity of microhematuria to detect a tumor recurrence was 61%, the specificity 84%. The sensitivity of microhematuria increased to 90% in Tis and T2 tumors. Urine cytology showed a specificity of 100% and a sensitivity of only 43%. The specificity and sensitivity of TPA was only 58% and 41%, respectively, the latter increased to 80% in Tis. 60 patients with proven tumor recurrence showed an increase of neopterin with higher tumor stage. In tumors of stage T2 and Tis serum neopterin was raised in 90% and urine neopterin in 75%. Based on these results cystoscopy, exfoliative urinary cytology and urine analysis are obligatory in the follow-up of patients with superficial bladder cancer. Because of the low specificity (29-41%) TPA and neopterin are not suitable for follow-up.

Tumor recurrences were observed 70 times in 715 cystoscopies performed in 253 patients. The sensitivity of microhematuria to detect a tumor recurrence was 61%, the specificity 84%. The sensitivity of microhematuria increased to 90% in Tis and T2 tumors. Urine cytology showed a specificity of 100% and a sensitivity of only 43%. The specificity and sensitivity of TPA was only 58% and 41%, respectively, the latter increased to 80% in Tis. 60 patients with proven tumor recurrence showed an increase of neopterine with higher tumor stage. In tumors of stage T2 and Tis serum neopterine was raised in 90% and urine neopterine in 75%. Based on these results cystoscopy, exfoliative urinary cytology and urine analysis are obligatory in the follow-up of patients with superficial bladder cancer. Because of the low specificity (29–41%) TPA and neopterine are not suitable for follow-up.

Objective and reproducible determinations of sperm motility and morphology are achieved using a semi-automatic image analysis system under optomanual control. The method was used to evaluate the short-and long-term effects of the operative treatment of varicocele on sperm density, motility and velocity in 27 men with left-sided varicosities. Whereas a significant improvement (p=0.0001) in sperm density was found within 3 months after surgery, almost no increases in sperm motility and velocity occurred. The actual post-operative improvement in sperm density did not correlate with the preoperative sperm counts (r=0.291). Between the preoperative values of motility and velocity and the postoperative improvement, however, a negative correlation of −0.431 and −0.759, respectively, was found. Considering the 21 patients, who were followed up for a minimum of 9 months, a sustained increase in sperm density, motility and velocity of at least 50% was observed in 14 (66.7%), 7 (33.3%) and 5 (23.8%), respectively. In general, the better results were obtained in the group with the poorer preoperative semen characteristics. However, only 4 patients (19%) showed a lasting improvement in all 3 parameters. Even more interesting was the sustained decrease in sperm velocity observed in 9 men (42.9%), who had rather good preoperative values. It is concluded, that a timely operative treatment of varicocele might prevent further impairment of semen quality. However, more research on the natural course of varicocele is necessary.

The authors report on a two-stage rupture of the kidney that occurred in an eight-year old boy after a bicycle accident and was confirmed by sonographic diagnosis and by urography and surgery. Attention is drawn to the advantage and necessity of sonography, which is rapid, can be repeated any number of times, remains non invasive and is very accurate, as a diagnostic tool in renal trauma.