Uncultured Gammaproteobacteria and Desulfobacteraceae Account for Major Acetate Assimilation in a Coastal Marine Sediment

Acetate is a key intermediate in anaerobic mineralization of organic matter in marine sediments. Its turnover is central to carbon cycling, however, the relative contribution of different microbial populations to acetate assimilation in marine sediments is unknown. To quantify acetate assimilation by in situ abundant bacterial populations, we incubated coastal marine sediments with ¹⁴C-labeled acetate and flow-sorted cells that had been labeled and identified by fluorescence in situ hybridization. Subsequently, scintillography determined the amount of ¹⁴C-acetate assimilated by distinct populations. This approach fostered a high-throughput quantification of acetate assimilation by phylogenetically identified populations. Acetate uptake was highest in the oxic-suboxic surface layer for all sorted bacterial populations, including deltaproteobacterial sulfate-reducing bacteria (SRB), which accounted for up to 32% of total bacterial acetate assimilation. We show that the family Desulfobulbaceae also assimilates acetate in marine sediments, while the more abundant Desulfobacteraceae dominated acetate assimilation despite lower uptake rates. Unexpectedly, members of Gammaproteobacteria accounted for the highest relative acetate assimilation in all sediment layers with up to 31–62% of total bacterial acetate uptake. We also show that acetate is used to build up storage compounds such as polyalkanoates. Together, our findings demonstrate that not only the usual suspects SRB but a diverse bacterial community may substantially contribute to acetate assimilation in marine sediments. This study highlights the importance of quantitative approaches to reveal the roles of distinct microbial populations in acetate turnover.

Optical and thermal modeling of an optrode microdevice for infrared neural stimulation

Infrared neural stimulation is a promising medical technique using pulsed infrared light for generating temperature-controlled firing of neurons. A combined optical and thermal model of a stimulating microtool-or so-called optrode-has been developed to investigate the amount, the spatial distribution, and the temporal behavior of the thermal excitation. Ray tracing and Fourier optics were used to describe the propagation and scattering of light in the optrode, and the finite element method was applied to model heat transfer. The scattered intensity distribution profiles were calculated based on measured surface roughness of the device and were integrated into the ray optics model. As a validation of the optical model, the simulated and measured values of the light efficiency of the microoptical system are compared. The temperature rise of the brain tissue during the infrared stimulation was estimated using the combined model. Using 30 mW total power and a single 100 ms pulse, the excitation resulted in a temperature rise of 3°C of the brain tissue. The spatial and temporal distributions of the tissue temperature are discussed in the paper. The proposed combined model is an efficient tool for the investigation and optimization of the stimulation process and for further development of the optrode configuration.

Simulation of small- and wide-angle scattering properties of glass-bead retroreflectors

Retroreflective materials are extensively used as traffic signs and security patterns. These goods are often realized by spherical glass-beads attached to some reflective substrate. New applications, especially 3D projection, require the precise evaluation and design of the characteristics of light backscattered from retroreflective screens. Simulation of such materials is not straightforward due to the different optical processes taking place: direct retroreflection involving small-angle diffraction effects, and multiple scattering resulting in wide-angle diffuse light. We propose a new complex method to describe the backscattering properties of glass-bead retroreflectors that uniquely combines diffraction calculations with ray tracing based on the microscopic properties of the screen. We validated our simulation method by measurements performed on commercial retroreflective samples.

Recoding of the stop codon UGA to glycine by a BD1-5/SN-2 bacterium and niche partitioning between Alpha- and Gammaproteobacteria in a tidal sediment microbial community naturally selected in a laboratory chemostat

Sandy coastal sediments are global hotspots for microbial mineralization of organic matter and denitrification. These sediments are characterized by advective porewater flow, tidal cycling and an active and complex microbial community. Metagenomic sequencing of microbial communities sampled from such sediments showed that potential sulfur oxidizing Gammaproteobacteria and members of the enigmatic BD1-5/SN-2 candidate phylum were abundant in situ (>10% and ~2% respectively). By mimicking the dynamic oxic/anoxic environmental conditions of the sediment in a laboratory chemostat, a simplified microbial community was selected from the more complex inoculum. Metagenomics, proteomics and fluorescence in situ hybridization showed that this simplified community contained both a potential sulfur oxidizing Gammaproteobacteria (at 24 ± 2% abundance) and a member of the BD1-5/SN-2 candidate phylum (at 7 ± 6% abundance). Despite the abundant supply of organic substrates to the chemostat, proteomic analysis suggested that the selected gammaproteobacterium grew partially autotrophically and performed hydrogen/formate oxidation. The enrichment of a member of the BD1-5/SN-2 candidate phylum enabled, for the first time, direct microscopic observation by fluorescent in situ hybridization and the experimental validation of the previously predicted translation of the stop codon UGA into glycine.

Roseobacter clade bacteria are abundant in coastal sediments and encode a novel combination of sulfur oxidation genes

Roseobacter clade bacteria (RCB) are abundant in marine bacterioplankton worldwide and central to pelagic sulfur cycling. Very little is known about their abundance and function in marine sediments. We investigated the abundance, diversity and sulfur oxidation potential of RCB in surface sediments of two tidal flats. Here, RCB accounted for up to 9.6% of all cells and exceeded abundances commonly known for pelagic RCB by 1000-fold as revealed by fluorescence in situ hybridization (FISH). Phylogenetic analysis of 16S rRNA and sulfate thiohydrolase (SoxB) genes indicated diverse, possibly sulfur-oxidizing RCB related to sequences known from bacterioplankton and marine biofilms. To investigate the sulfur oxidation potential of RCB in sediments in more detail, we analyzed a metagenomic fragment from a RCB. This fragment encoded the reverse dissimilatory sulfite reductase (rDSR) pathway, which was not yet found in RCB, a novel type of sulfite dehydrogenase (SoeABC) and the Sox multi-enzyme complex including the SoxCD subunits. This was unexpected as soxCD and dsr genes were presumed to be mutually exclusive in sulfur-oxidizing prokaryotes. This unique gene arrangement would allow a metabolic flexibility beyond known sulfur-oxidizing pathways. We confirmed the presence of dsrA by geneFISH in closely related RCB from an enrichment culture. Our results show that RCB are an integral part of the microbial community in marine sediments, where they possibly oxidize inorganic and organic sulfur compounds in oxic and suboxic sediment layers.

Vacuolated Beggiatoa-like filaments from different hypersaline environments form a novel genus

In this study, members of a specific group of thin (6-14 µm filament diameter), vacuolated Beggiatoa-like filaments from six different hypersaline microbial mats were morphologically and phylogenetically characterized. Therefore, enrichment cultures were established, filaments were stained with fluorochromes to show intracellular structures and 16S rRNA genes were sequenced. Morphological characteristics of Beggiatoa-like filaments, in particular the presence of intracellular vacuoles, and the distribution of nucleic acids were visualized. In the intracellular vacuole nitrate reached concentrations of up to 650 mM. Fifteen of the retrieved 16S rRNA gene sequences formed a monophyletic cluster and were phylogenetically closely related (≥ 94.4% sequence identity). Sequences of known filamentous sulfide-oxidizing genera Beggiatoa and Thioploca that comprise non-vacuolated and vacuolated filaments from diverse habitats clearly delineated from this cluster. The novel monophyletic cluster was furthermore divided into two sub-clusters: one contained sequences originating from Guerrero Negro (Mexico) microbial mats and the other comprised sequences from five distinct Spanish hypersaline microbial mats from Ibiza, Formentera and Lake Chiprana. Our data suggest that Beggiatoa-like filaments from hypersaline environments displaying a thin filament diameter contain nitrate-storing vacuoles and are phylogenetically separate from known Beggiatoa. Therefore, we propose a novel genus for these organisms, which we suggest to name 'Candidatus Allobeggiatoa'.

Novel groups of Gammaproteobacteria catalyse sulfur oxidation and carbon fixation in a coastal, intertidal sediment

The oxidation of hydrogen sulfide is essential to sulfur cycling in marine habitats. However, the role of microbial sulfur oxidation in marine sediments and the microorganisms involved are largely unknown, except for the filamentous, mat-forming bacteria. In this study we explored the diversity, abundance and activity of sulfur-oxidizing prokaryotes (SOP) in sulfidic intertidal sediments using 16S rRNA and functional gene sequence analyses, fluorescence in situ hybridization (FISH) and microautoradiography. The 16S rRNA gene analysis revealed that distinct clades of uncultured Gammaproteobacteria are important SOP in the tidal sediments. This was supported by the dominance of gammaproteobacterial sequences in clone libraries of genes encoding the reverse dissimilatory sulfite reductase (rDSR) and the adenosine phosphosulfate reductase (APR). Numerous sequences of all three genes grouped with uncultured autotrophic SOP. Accordingly, Gammaproteobacteria accounted for 40-70% of all ¹⁴CO₂ -incorporating cells in surface sediments as shown by microautoradiography. Furthermore, phylogenetic analysis of all three genes consistently suggested a discrete population of SOP that was most closely related to the sulfur-oxidizing endosymbionts of the tubeworm Oligobrachia spp. FISH showed that members of this population (WS-Gam209 group) were abundant, reaching up to 1.3 × 10⁸ cells ml⁻¹ (4.6% of all cells). Approximately 25% of this population incorporated CO₂, consistent with a chemolithoautotrophic metabolism most likely based on sulfur oxidation. Thus, we hypothesize that novel, gammaproteobacterial SOP attached to sediment particles may play a more important role for sulfide removal and primary production in marine sediments than previously assumed.

[Vaccinations in recurrent urinary tract infections--an observation study relating to health economy]

BACKGROUND AND PURPOSE

Urinary tract infection (UTI) is one of the most common bacterial infections in women. Despite the need for therapy alter-natives only the conventional treatment using antibiotics is investigated in the literature. A vaccination, however, can be a useful medical and economic alternative for the treatment of recurrent urinary tract infections.

MATERIALS AND METHODS

An open, prospective, not-randomised, multicentric observation study was carried out to determine the costs and effects of a vaccination in 842 patients with recurrent urinary tract infections. The data for efficacy, safety and costs of recurrent urinary tract infections were collected via patient documentation and a standardised documentation of the physicians.

RESULTS

The efficacy was rated as good to very good by 82.7 % of the physicians and 82.1 % of the patients. The values for safety show even better results. They were rated as good to very good by 92.4 % of the physicians and 90.9 % of the patients. The total costs amounted to 433 euro per patient in the six months before vaccination and decreased significantly to 238 euro in the six months after vaccination (p < 0.0001).

CONCLUSIONS

The results of this observation study show a clinically relevant reduction of recurrent urinary tract infections with acceptable side effects in the six months after vaccination. As the treatment costs are reduced from a mean of 238 euro to 91 euro per patient. The healthcare insurances can also benefit from the vaccination against recurrent urinary tract infections.

High-resolution magnetic resonance imaging of trabecular bone in the wrist at 3 tesla: initial results

PURPOSE

To evaluate the feasibility of high-resolution magnetic resonance imaging (MRI) of trabecular bone of the wrist at 3 Tesla (3T) in vivo and to assess the potential benefit of the increased resolution for clinical assessment of structural changes in spongy bone.

MATERIAL AND METHODS

High-resolution MRI of the wrist was performed with a whole-body 3T MR scanner using a dedicated circularly polarized transmit-receive wrist-coil. Two 3D-FISP sequences with a spatial resolution of 300 x 300 x 300 microm3 in a measuring time of TA = 7:51 min, and 200 x 200 x 200 microm3 in TA = 9:33 min were applied. Seven young healthy volunteers and three elderly subjects with suspected osteoporosis were examined. The signal-to-noise ratio (SNR) in the optimized setup at 3T was compared to measurements at 1.5T.

RESULTS

The images at 3T allow microscopic analysis of the bone structure at an isotropic spatial resolution of 200 microm in examination times of <10 min. Differences in the structure of the spongy bone between normal and markedly osteoporotic subjects are well depicted. The SNR at 3T was found up to 16 times higher than at 1.5T applying unchanged imaging parameters.

CONCLUSION

The proposed high-resolution MRI technique offers high potential in the diagnosis and follow-up of diseases with impaired bone structure of hand and/or wrist in clinical applications.

[Possibilities of whole-body MRI for investigating musculoskeletal diseases]

This contribution outlines possibilities and limitations of whole-body MRI for investigating musculoskeletal diseases. Benefits and drawbacks of the novel whole-body MRI technology are discussed and a possible whole-body MRI sequence protocol for musculoskeletal examinations is proposed. Muscle, joint and bone diseases are discussed in which the application of whole-body MRI may be of advantage. Particularly, polymyositis, muscledystrophy, rheumatoid arthritis, spondylitis ancylosans, multiple trauma, skeletal metastases, multiple myeloma and malignant lymphoma are mentioned. Whole-body MRI opens new advantages for the examination of multifocal musculoskeletal diseases. The clinical benefit of this method for particular diseases has to be evaluated in further studies, however.

3.0 T high-resolution MR imaging of carpal ligaments and TFCC

PURPOSE

To determine the diagnostic value of 3.0 Tesla MRI for imaging carpal ligaments and triangular fibrocartilage complex (TFCC). Image quality of different optimized MRI sequences is evaluated for high resolution wrist anatomy.

MATERIALS AND METHODS

Ten healthy volunteers were examined at 3.0 T and 1.5 T using following sequences: T1 SE, fat-saturated PD-/T2-TSE, TIRM, 3D T1/T2* DESS, 3D-CISS, 2D and 3D T2* MEDIC. Voxel size varied from 0.2 x 0.2 x 1.5 mm (2D sequences) to 0.33 mm (3) and 0.26 mm (3) (3D sequences). Image quality (signal-to-noise-ratio, contrast-to-noise-ratio, artifacts) and carpal ligament/TFCC detection rate were judged by a score. The results obtained from the 3.0 T and 1.5 T devices were compared.

RESULTS

With identical voxel size, image matrix and FOV, 3.0 T MRI provided significantly better image quality and ligament detection rates for all sequences in comparison with 1.5 T. The 2D and 3D MEDIC sequences yielded best image quality and detection rates. Excellent image quality and visualization of ligament structures by the fat-suppressed PD-TSE sequence were compromised by a relatively high susceptibility to pulsation and motion artifacts. T1 SE and 3D DESS sequences gave moderate image quality and allowed only partial differentiation between ligament structures. TIRM, T2-TSE and 3D-CISS sequence proved to be unsuitable for examining ligaments at 3.0 T due to their poor image quality and detection rate.

CONCLUSION

3.0 T MRI of the wrist proved to be superior to 1.5 T MRI for high-resolution imaging of carpal ligaments and TFCC using 2D and 3D T2* MEDIC sequences. Clinical studies investigating ligament injuries or carpal instability are recommended for evaluating clinical relevance of high-resolution MRI of the wrist.

[European Association of Urology guidelines on urinary and male genital tract infections]

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

[Diagnosis of chronic prostatitis]

The new classification of prostatitis syndromes by the National Institutes of Health clearly defines the diagnostic criteria for categorization according to the clinical symptoms. In addition to the validated symptom scores, the four-glass test demonstrating increased numbers of leukocytes and/or bacteria serves for differentiating between the symptoms. Increased levels of leukocytes and/or increased bacterial count in expressed prostatic excretion (EPS) are typical of prostatitis, although there is a high degree of correspondence with the VB3 fraction (urine voided after prostatic massage). The detection of peroxidase cells (granulocytes) and of an increased concentration of polymorphonuclear (PMN) leukocyte elastase in the ejaculate are indicative of uroadnexitis. Nonbacterial forms of prostatitis (NIH III) and increased PSA levels require intensive clinical diagnosis.

Genitourinary tuberculosis

The worldwide prevalence of tuberculosis is still high and has remained almost unchanged over the past century as a result of increasing incidence in countries of the Third World. Twenty per cent of patients with tuberculosis will develop an extrapulmonary manifestation over time, the most common site being the genitourinary tract. The patient's history can lead to the sometimes difficult diagnosis. Radiological imaging helps in depicting genitourinary tuberculosis. However, the diagnosis of genitourinary tuberculosis is made on the basis of culture studies and is supported by polymerase chain reaction. The latter has impressive sensitivity and specificity, but lacks the ability to determine biological activity. The combination of three or four anti-tuberculosis drugs over a course of 6 to 9 months remains the treatment of choice. Drug resistance is increasing and necessitates tight therapy control. Tuberculosis of the male seminal duct may be an important cause of male infertility as a result of multiple epididymidal scarring. In these cases testicular sperm extraction is the method of choice for sperm retrieval. The outcome of sperm retrieval followed by intracytoplasmatic sperm injection is not affected.

Relationship between semen quality and the seminal plasma components carnitine, alpha-glucosidase, fructose, citrate and granulocyte elastase in infertile men compared with a normal population

The seminal plasma components neutral alpha-glucosidase, carnitine, fructose, citrate, and polymorphonuclear granulocyte (PMN) elastase in 253 men were determined. The seminal plasma of 221 infertile men, a control group with proved fertility and 13 patients after vasectomy were investigated. The concentrations of free carnitine (212 versus 521 micromol/l, n = 219, P < 0.001), total carnitine (437 versus 743 micromol/l, n = 219, P < 0.001), and the activity of neutral alpha-glucosidase (15.1 versus 23.4 IU/l, n = 236, P < 0.05) were significantly reduced in the infertile patient group as compared to the fertile control group, the concentration of PMN elastase (102 versus 48 microg/l, n = 234, P < 0.05) being significantly increased in the infertile patients. In the patients after vasectomy the activity of neutral alpha-glucosidase was the only epididymal marker that was significantly reduced (4.3 versus 9. 8 IU/l, n = 35, P = 0.002) in comparison with the patients with testicular azoospermia. At a limit of 6 IU/l the sensitivity of the method was 92% and the specificity was 72%. Altogether, the epididymal markers were reduced in subfertile patients compared with the control group. For the differential diagnosis of azoospermia only the determination of the neutral alpha-glucosidase activity is useful.

Rapid detection of elevated prostate-specific antigen levels in blood: performance of various membrane strip tests compared

OBJECTIVES

To compare the ability of four commercially available membrane strip tests to detect increased (4 microg/L or more) concentrations of prostate-specific antigen (PSA) in blood.

METHODS

Serum samples with PSA concentrations less than 4 microg/L (n = 67) and from greater than 4 microg/L to 20 microg/L (n = 32) were independently examined by two observers using the PSA membrane strip tests from Chembio, Medpro, Seratec, and Syntron. The positive and negative results of each membrane strip test were classified as either true positive or negative and false negative or positive by comparing them with the quantitative PSA assay of Immulite DPC using the conventional threshold value of 4 microg/L.

RESULTS

The interobserver variations of the tests were between 93% and 97%. The color stability of the Seratec and Chembio tests did not show significant differences between test results read within 10 to 20 minutes of the reaction time; however, the results of the other two tests were especially affected by variations in the reading time. The sensitivity and specificity of the tests in relation to the threshold of 4 microg/L were 67% to 93% and 87% to 97%, respectively.

CONCLUSIONS

The Syntron test and, within certain limitations, the Seratec test fulfill the concept of a rapid and convenient PSA determination to detect PSA concentrations greater than 4 microg/L. Methodologic optimization of the tests by a grading of the PSA measuring ranges (eg, between 0 and 2, 3 and 4, 4 and 6, and 7 and 10 microg/L) should be taken into account for future development.

[Pneumocysts juxta-articular to the ilial bone and the sacral bone]

PURPOSE

The purpose of the study was to detect and safely diagnose pneumatocysts by means of computed tomography.

METHODS

From September 1995 to May 1996 computed tomography of the pelvis was performed in six patients for various indications. A slice thickness of 8 mm was employed for all studies. One patient had undergone surgery for hyperparathyroidism nine years previously. Attenuation values within the coincidentally diagnosed pneumatocysts were obtained.

RESULTS

We found a total of 14 pneumatocysts juxtaarticular to the sacroiliac joint. Three patients demonstrated a bilateral intraarticular vacuum phenomenon, yet a joint communication was not found. The lesions did not coincide with inflammation, tumour or trauma.

CONCLUSION

Pneumatocysts are benign bone lesions associated with arthrotic changes of the sacroiliac joint. Computed tomography is the modality of choice for the diagnosis of pneumatocysts.

Comparison of different methods of treating varicocele

Varicocele treatment was performed in 331 patients. One hundred fifteen patients were operated upon according to the technique of Bernardi (1947), 80 patients underwent occlusion of the testicular vein by detachable balloons, 47 patients were treated with percutaneous sclerotherapy, and 89 patients underwent laparoscopic varicocele treatment. The laparoscopic occlusion of the testicular vessels was done in two different ways: (1) coagulation of the testicular veins with electrocoagulating tweezers, and (2) occlusion of the suprainguinal testicular vessel with metal clips and transection of the vessels. Laparoscopic Group 1 showed a clearly higher complication rate and recurrence rate in comparison with the other methods, whereas in Group 2 we observed the best results with only 4% complications and recurrences. Because of its higher complication rate and recurrence rate, laparoscopic electrocoagulation of the testicular veins proved to be inadequate.

Renal autotransplantation for idiopathic retroperitoneal fibrosis

Extensive loss of the ureter is a potential complication of surgery performed to relieve ureteral obstruction caused by retroperitoneal fibrosis. The authors describe the twelfth case managed successfully by renal auto-transplantation and review the literature.

Increased serum concentrations of procollagen type III peptide in severely injured patients: an indicator of fibrosing activity?

OBJECTIVES

To determine the serum concentrations of procollagen type III peptide in severely injured patients with different outcomes and to evaluate the relationship between serum procollagen type III peptide concentrations, sources of increased posttraumatic fibrotic activity (wounds, lung, liver, kidney), and decreased elimination of procollagen type III peptide (liver).

DESIGN

Prospective study.

SETTING

Surgical ICU, university hospital.

PATIENTS

Fifty-seven patients (mean injury severity score: 38.5 points, range 13 to 75 points), between 16 and 70 yrs of age, treated in our institution within 6 hrs after the accident.

MEASUREMENTS

Serial measurements were started on admission and continued on a 6-hr basis. After 48 hrs, the monitoring interval was extended to 24 hrs until recovery (but at least until day 14) or death. At each point of evaluation, pulmonary and circulatory function parameters and chest radiographs (once a day) were evaluated, the results were recorded, and blood samples were drawn to determine procollagen type III peptide, total bilirubin, creatinine, gamma-glutamyl transferase, polymorphonuclear elastase, and other parameters. Statistic evaluation was done with the Wilcoxon test, Spearman rank correlation, and a multiple regression model.

RESULTS

Mean procollagen type III peptide serum concentrations (+/- SD) were significantly different in patients who died (8.0 +/- 3.8 U/mL) compared with those patients who survived with organ failure (2.7 +/- 1.3 U/mL) or without complications (1.4 +/- 0.5 U/mL), respectively. Significant correlations of procollagen type III peptide concentrations with the serum bilirubin concentrations (r = .7), days with need of mechanical ventilation (r = .64), PaO2/FIO2 ratio (r = -.6), polymorphonuclear elastase (r = .6), serum creatinine concentrations (r = .55), and injury severity score (r = .33) were observed. There was a tendency toward higher serum procollagen type III peptide concentrations in patients with severe skeletal injuries.

CONCLUSIONS

Serum procollagen type III peptide concentrations in severely injured patients may be considerably increased in correlation with injury severity and outcome. Procollagen type III peptide serum concentrations seem to reflect the sum of increased collagen formation from wound healing and fibrogenesis of mediator-related organ damage (especially lung) and decreased procollagen type III peptide excretion due to impaired liver function. Further data are necessary to evaluate the role of hepatic elimination in these patients.

Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma

The relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score = 37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. In patients with early onset of OF (n=45), infection followed with a lag of 2 or more days. In 16 (44%) of these patients, infection led to a deterioration in organ function. With late onset of OF (n=18), infection preceded OF in nine patients. Polymorphonuclear leukocyte-elastase, neopterin, C-reactive protein, lactate, antithrombin III, and phospholipase A discriminated significantly among the three outcome groups. Of all factors, only polymorphonuclear leukocyte-elastase showed a difference between patients with and without infection or sepsis, respectively. These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear.

Laser surgery in superficial penile tumours

The first results of laser surgery in superficial penile tumours are reported. In 2 patients with condylomata acuminata, 2 cases of giant condylomata Buschke-Löwenstein and in 2 patients suffering from early stage penile cancer diagnostic and/or therapeutic treatments using carbon dioxide or neodymium-YAG laser have been performed. In one patient with giant condyloma a recurrent tumour was found 5 weeks after the initial treatment and a second one using CO2 laser was done. All other patients are tumour-free with a follow up of 6-24 months and erectile function is normal. Therefore, in superficial penile tumours laser treatment is an excellent alternative therapeutic approach.

[Histologic changes after laser treatment of superficial penis tumors]

In the last years the excision of superficial benign and malignant penile tumors by laser surgery has been well established. Our first experience confirm the excellent cosmetic and functional results after laser surgery. Furthermore a decrease of recurrence rate was found due to laser vaporization of the adjacent tumor area. In spite of tissue damage by histological examination we were able to classify benign and malignant findings.

[Obstructive disorders of urine transport of the upper urinary tract--benign and malignant retroperitoneal fibrosis]

Our experience in diagnosis, treatment and follow-up course of patients suffering from benign and malignant retroperitoneal fibrosis are reported. Especially in idiopathic fibrosis the initial placement of percutaneous nephrostomy and long-term immunosuppression is the treatment of choice. In the follow-up ultrasonography and computerized tomography are valuable methods.

[Corpus cavernosum injection treatment of erectile impotence]

Through the use of vasoactive substances an improvement of diagnosis and treatment of men suffering from erectile dysfunction was obtained. From June 1988 to December 1989 in 108 patients an intracavernous injection therapy trial was performed. The response rate 85% and in 69% of the patients an organic disorders was found. Five percent of the patients have had a prolonged erection after intracavernous papaverine phentolamine injection. All cases have been treated successfully by local use of the sympaticomimetics Noradrenaline. The use of vasoactive substances is the method of choice in diagnosis and treatment of erectile dysfunction.

[Percutaneous nephrostomy and temporary immunosuppression in treatment of idiopathic retroperitoneal fibrosis (Ormond disease)]

Our experiences in the diagnostics, treatment and follow-up-course of 10 patients suffering from idiopathic retroperitoneal fibrosis are reported. The ureterolysis and temporary nephrostomy, initially as percutaneous nephrostomy, and a long-term immunosuppressive therapy is the treatment of choice. In the follow-up control ultrasonography and computerized tomography are valuable and the prognosis of the disease quoad functionem is good.

[Surgical treatment of venous-induced erectile impotence in the male]

In 14 out of 94 patients with erectile dysfunction a venous insufficiency was suspected. Localization and securing of the venous leak were done by dynamic cavernosography. An insufficient penile blood supply could excluded by Doppler ultrasonography and measurement of the penile-brachial artery-pressure index. In 7 out of 13 patients treated by ligation of penile veins the erectile function was normalized after operation, in 4 cases an additional intracavernous injection therapy was necessary and in 2 patients the operation was unsuccessful. If impotence occurs once more due to venous collaterals the implantation of a penile prosthesis should considered.

Urolithiasis associated with urogenital tuberculosis. Clinical and mineralogical aspects

Of 628 patients with bacteriologically or histologically proven urogenital tuberculosis (UGT) treated from 1960 to 1985. 126 patients (20.1%) had additional urinary tract infection and 66 patients (10.5%) developed urolithiasis. In these 66 patients a simultaneous urinary tract infection occurred in 29 cases (43.9%). Twenty-eight calculi were analyzed by a combined crystal-optical and x-ray-diffraction method. A high incidence of struvite/carbonate apatite calculi (11/28) as well as of calcium phosphate calculi (6/28) was found. The texture of 15 calculi was investigated on thin sections by polarization microscopy and a high concentration of organic material was found in both calcium oxalate and struvite/carbonate apatite calculi probably due to the specific and nonspecific infection with deposition of cell and protein degradation products.

[Treatment of idiopathic varicocele in children and adults by occlusion of the testicular vein with a detachable balloon]

The results of varicocele treatment by balloon occlusion of the testicular vein in 22 children and 29 adults are compared with the results after operative ligation of the testicular vein in 95 patients. In 6 out of 22 children (27%) the varicocele persisted after balloon occlusion, compared with 3 out of 29 adult patients (10%). These results in adults are comparable to the results after operative ligation of the testicular vein, whereas the complication rate was significantly lower after balloon occlusion in comparison with operative treatment.

Tuberculosis in cadaveric renal allograft recipients. Report of 4 cases and review of the literature

Tuberculosis is an uncommon infectious complication after kidney transplantation, but such an infection carries a significant mortality and morbidity and may jeopardize the function of the renal allograft. Herein we report our experience in the treatment of mycobacterial infections in 4 renal transplant recipients and review the literature.

[CO2 laser treatment of the Buschke-Löwenstein tumor]

On the basis of two casuistics is reported on the laser treatment of Buschke-Löwenstein tumours. Hereby the advantages of this method are emphasized and compared with the former treatment techniques.

[Tuberculous prostatitis within the scope of urogenital tuberculosis--pathogenetic and diagnostic aspects]

208 males with tuberculosis of the urogenital system showed a participation of prostate in 110 cases (53%), however, in 52 transrectal punch biopsies of the prostate only 25 times a tuberculosis could histologically be proved. An isolated tuberculosis of the prostate was found only in 6 males (5.4%), in most cases accidentally in biopsies of the prostate, after adenomectomy of the prostate or TURP. The way of the infection of the tuberculosis of the male genitals and the question of the primary focus on the genitals remained unclarified.

[Detection of mycobacteria in tissue in urogenital tuberculosis]

121 tissue specimens of the urogenital systems (66 from the kidney, 39 from the epididymis and testis, 8 from the prostate, 4 from the bladder and 4 from the female genital tract) were examined by microscopy, culture and animal experiment on the presence of mycobacteria. In 37 of these specimens (30.6%) mycobacteria were demonstrated, 10 of that only by microscopy and in 27 cases by culture and/or animal experiment. Up to 20 weeks after onset of treatment mycobacteria were demonstrated from the kidney tissue of treated patients by the diagnostic methods mentioned above. After this time mycobacteria never could be demonstrated. There was no correlation between the histological findings and the mycobacteriological investigations. The investigation of tissue specimens on the presence of mycobacteria also from other organs of the urogenital tract is suitable method of the bacteriological proof of tuberculosis, especially in the absence or positive bacteriological findings from the urine or accessory gland secretion for the estimation of species and resistance of these bacteria.

[Nonspecific pyelonephritis and the formation of urinary calculi in urogenital tuberculosis]

The course of urogenital tuberculosis is complicated by unspecific bacterial infections of the urinary tract and nephrolithiasis. Among 605 patients with bacteriological or histological verified urogenital tuberculosis, 122 patients (20%) developed unspecific bacterial urinary infection--commonly caused by E. coli, proteus and pseudomonas--and 57 patients (9.4%) showed nephrolithiasis. In 42% of the lithiasis patients an urinary tract infection simultaneously occurred. 22 calculi are analyzed by the combined crystal-optical and x-ray-diffraction method with following results: 9 X struvite/carbonate apatite, 6 X calcium phosphate, 7 X calcium oxalate. The texture of 12 calculi was investigated on thin sections by polarization microscopy and a high concentration of organic material was found in both calcium oxalate and struvite/carbonate apatite calculi.

[Results of ligature of the upper testicular vein in idiopathic varicocele and subfertility]

The results of a total of 102 varicocele operations, 83 of which were performed because of subfertility and a desire to have children, are presented. In 3% of the cases a recidive operation was necessary because of persistent varicocele. 55 patients with limited fertility were subsequently examined for volume, density and form of sperm, total motility and propulsive motility. Whereas the volume of sperm and the total motility remained unchanged, the density and form of sperm and the propulsive motility had improved significantly 9 months after the operation. Among the men followed up the conception rate was 20%.