Search

Purpose: To compare performance data of adolescents collected with five different bicycle spiroergometry protocols and to assess the necessity for establishing standard values for each protocol., Methods: One-hundred-twenty adolescents completed two bicycle spiroergometries within 14 days. One of the two tests was performed based on our institutional weight-adapted protocol (P0). The other test was performed based on one out of four exercise protocols widely used for children and adolescents (P1, 2, 3 or 4) with 30 persons each. The two tests were performed in a random order. Routine parameters of cardiopulmonary exercise tests (CPET) such as VO 2 peak, maximum power, O 2 pulse, OUES, VE/VCO 2 slope as well as ventilatory and lactate thresholds were investigated. Agreement between protocols was evaluated by Bland-Altman analysis, coefficients of variation (CV) and intra-class correlation coefficients (ICC)., Results: None of the CPET parameters were significantly different between P0 and P1, 2, 3 or 4. For most of the parameters, low biases between P0 and P1-P4 were found and 95% confidence intervalls were narrow. CV and ICC values largely corresponded to well-defined analytical goals (CV < 10% and ICC > 0.9). Only maximal power (Pmax) showed differences in size and drift of the bias depending on the length of the step duration of the protocols., Conclusion: Comparability between examination protocols has been shown for CPET parameters independent on step duration. Protocol-dependent standard values do not appear to be necessary. Only Pmax is dependent on the step duration, but in most cases, this has no significant influence on the fitness assessment.

Radical cystectomy in combination with different types of continent and incontinent urinary diversion is an integral part of the treatment concept for bladder tumors. Although in principle this operation does not cause disability in general, it represents a potentially massive encroachment on the physical and psychological integrity of the individual. The term "quality of life" appears with increasing frequency in modern concepts of evidence-based medicine. Also recognition of the subjective assessment of treatment by those affected in comparison to the "objective" view of qualified doctors and functionaries has become more relevant.Nevertheless, few studies have analyzed the "quality of life" after cystectomy. In addition, methodological factors hinder comparability. Only a few authors have used validated measuring instruments that allow comparison of the data. Low case numbers limit the statistical significance. Besides typical postoperative consequences and their effect on quality of life, potential influences on the pre- and postoperative assessment in the intraindividual course are discussed. The authors argue in favor of postoperative urological rehabilitation in qualified urological centers to optimize physical and psychological coping with the new life situation of "cystectomy with urinary diversion."

A 24-year-old patient with chronic granulomatous disease had bilateral hydronephrosis resulting from ureteral granuloma formation. He was treated with high-dose steroids, antibiotics and percutaneous nephrostomy. The etiology, incidence, clinical findings and treatment of chronic granulomatous disease are discussed.

To evaluate the diagnostic value of preoperative staging of bladder cancer and cancer of the prostate, CT and NMR scans of 45 histologically defined tumors of the bladder and the scans of 24 patients with radical prostatectomy were compared. Lack of extravesical spread was imaged correctly by NMR in all cases of urothelial cancer (pT1-pT3a). CT diagnosis failed in 39%. False-negative results were obtained in 2 of 5 invading tumors (pT3b) by NMR and in 3 of 5 by CT. Extraglandular spread of cancer of the prostate was diagnosed with an accuracy rate of 79% by NMR and of 46% by CT. The diagnostic value for detection of pelvic lymph node metastases had a low-sensitivity rate of 26% in NMR and of 22% in CT.