Zeitschrift fur Urologie und Nephrologie最新文献

As a result of introduction of quadruple immunosuppression using cyclosporine, antithymocyte globulin, azathioprine and prednisone in immunological high-risk patients with a presensitization greater than or equal to 80% and/or multiple grafts the rate of immediate graft function could significantly increased, the frequency of rejection and graft rupture was reduced and the patient survival rate could improved to 100%. The problem of vascular rejection should resolved by a more aggressive biopsy approach.

The splenogonadal fusion is a rare but benign anomaly. The diagnosis is usually given at operation or histologically after operation. In about 50% of the patients who undergo surgery for scrotal tumor, an unnecessary orchidectomy is performed due to clinical unawareness of this rare condition. A case of splenogonadal fusion belonging to the continuous type is presented to illustrate problems of this anomaly and point out the importance of intraoperative microscopic sections.

In the first 6 weeks after kidney transplantation 15 patients suffering from vascular rejection were treated by 46 plasmapheres. In transplants with additional interstitial rejection the plasmapheresis was introduced after failure of ATG therapy. In 1 patient no histological confirmation was done. In 4 patients the plasmapheresis was successful and in 6 patients suffering from combined vascular and interstitial rejection the ATG therapy was successful only after initial plasmapheresis. In 4 cases the therapy failed to reverse rejection. The early use of plasmapheresis is recommended to obtain the best results.

It is reported on an asymptomatic rare vascular anomaly, the agenesis of the inferior vena cava. The knowledge of such malformations is important in operative procedures.

84 out of 116 patients suffering from renal cancer with comparable tumor stages were nephrectomized. 39 out of these 84 patients have had an additional embolization preoperatively. The survival rate and the development of metastases did not show any significant difference between only nephrectomized and occluded plus nephrectomized patients.

102 kidney transplantation were performed in 1987 in the Kidney Transplant Center at Berlin. The course of 22 contaminated grafts (22%) was analyzed. The main bacteria were staphylococcus aureus and pseudomonas aeruginosa. In 6 out of 22 contaminated transplants (27%) a delayed wound healing did occur. In 2 cases the infection was the cause of graft removal and 2 patients died due to septical complications of the contaminated graft. Therefore, the contaminated kidney is a potential risk for graft and patient survival and strong asepsis and effective perioperative antibiotic prophylaxis is necessary.

After presentation of the history of kidney transplantation and experimental transplantation research with own contributions like microsurgery and photochemotherapy the importance of experimental kidney transplantation as the basis of progress in clinical transplantation is represented.

After temporary postoperative PUVA treatment of the graft recipient the survival time of rat renal allotransplants is significantly prolonged. In the semiallogeneic F1 model all animals survived without rejection signs. The mechanism of action should be cleared and as adjunctive method introduced into clinical organ transplantation.

20 non-related patients suffering from autosomal dominantly polycystic renal disease were HLA-A, -B, -C and -DR typified and the HLA frequencies were compared with the normal population. Tissue typing was performed using the lymphocytotoxicity test using 180 well-characterized test sera. In contrast to the literature no significant differences were found. However, the value of erythrocytic phosphoglycolate-phosphatase-phenotyping should be checked in the genetic control and consultation.

Since 1981 a curative radiation treatment was performed in 84 patients with prostatic carcinoma. Previously, in 37 cases a transurethral resection of bladder outlet obstruction was done and in 18 patients a pelvic lymph node dissection was performed, whereas 29 patients were without operative therapy. Mild side effects of radiation could observed in all 3 groups in nearly the same portion (59/56/65%). However, in the group with transurethral resection after follow-up of 4,4 years severe late complications were found (cystitis, incontinence, urethral fistula). Therefore, radiation treatment of prostatic carcinoma after transurethral resection was abandoned. The cumulative 5-year-survival rate was 63% and in the TUR group only 41%. 9 out of 10 patients with histological verified lymph node metastases and radiation treatment are alive after mean follow-up time of 3.1 years without evidence of recurrent disease.