摘要:

We have tested an immune monitoring program consisting of cytofluorometric analysis of lymphocytic and monocytic markers, using a set of different monoclonal antibodies (mAb), in about 500 transplant patients including about 300 long-term renal allograft recipients. The high sensitivity (95%) of these cytofluorometric analyses in the peripheral blood allows to discriminate between acute rejection and other causes of deteriorated kidney transplant function (infection, toxicity, arteriopathy), especially in the late phase ( > 1 year) after transplantation. Additionally, the immune monitoring is sufficient to predict success of antirejection therapy as early as a few days after onset of treatment. A life-threatening complication in allograft recipients is septic disease. Proceeding from immune parameters, septic patients were found to fall into two categories: those with decreased expression of HLA-DR on monocytes ( < 20%, termed as ‘immunoparalysis’) and patients with nearly normal HLA-DR+ monocytes. Septic immunoparalysis requires drastic reduction of immunosuppression (mortality after drastic reduction: 8%; after marginal reduction or without reduction: 90%). We have not observed severe rejection as a consequence of reduced immunosuppression in such patients. Our immune monitoring seems to be useful for management of immunosuppression in patients with unclear deterioration in graft function as well as patients with septic complications in order to minimize two risks, i.e. death by sepsis or loss of graft.

ISSN:0042-1138    

DOI:10.1159/000282398

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The incidence and mortality rates of urologic complications in renal transplantation have decreased significantly during the last decade. This was achieved by improved techniques of donor nephrectomy with preservation of the ureteric blood supply and refined procedures for the reconstruction of the urinary tract. Intra- and extravesical ureteroneocystostomies have shown to be the most reliable and preferred techniques to restore the urinary tract continuity. Beside ureteral ischemia and technical failure ureteral rejection is increasingly accepted as an important contributory factor for the development of ureteric fistula and stenosis formation. Controversy still exists concerning the pathogenesis of reflux into the graft and its impact on long-term graft function. Percutaneous and endoscopic procedures have supplemented and partially replaced open surgical management of ureteric fistulas and stenoses. By adherence to the principles described the frequency of urologic complications and its associated mortality rates can be minimized.

ISSN:0042-1138    

DOI:10.1159/000282399

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

After kidney transplantation, urological complications account for significant morbidity necessitating reoperation in a substantial number of patients. In cases with urinary tract necrosis after renal transplantation secondary pyeloureterostomy represents an accepted method for urinary tract reconstruction. In our institution 2% of all kidney grafts required secondary pyeloureterostomy. In all cases the recipient’s own ureter was investigated before reoperation by retrograde pyeloureterography. Pyeloureterostomy was performed with a standard technic, the recipients own kidney being removed in all but 5 patients. All 25 patients had normal kidney function immediately after secondary pyeloureterostomy. Urological complications occurred in 7 patients (anastomotic leakages in 4, stenosis in 3); 5 out of 7 complications were managed conservatively (nephrostomy, transureteral stenting). Two patients needed reexploration for reanastomosis. Our results confirm the simple and safe technic of pyeloureterostomy for urinary reconstruction in patients with ureter necrosis after renal transplantation.

ISSN:0042-1138    

DOI:10.1159/000282400

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Problems arising from the lower urinary tract in patients with a terminal renal insufficiency are usually known long before transplantation; they can even be the cause of chronic renal failure. A careful investigation of morphology and function of upper and lower urinary tract before performing renal transplantation is still of great importance. In up to a quarter of the cases pathological findings can be recorded. Whether a supravesical urinary diversion or a bladder augmentation has to be performed in case of insufficient bladder function is dependent on the urodynamic results. However, so far there are no reliable prognostic factors indicating whether or not a bladder with increased capacity due to renal transplantation reacts with normal pressure. An investigation of the lower urinary tract also has to be carried out in patients who already have a supravesical urinary derivation at the time of renal transplantation, as a possible removal always has to be taken into consideration. Survival rate following transplantation in patients with a conduit is not lower than in those with a normal bladder.

ISSN:0042-1138    

DOI:10.1159/000282401

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Between January 1973 and January 1990 we carried out 1,038 kidney transplantations using a transvesical end-to-side implantation of the ureter in the bladder without an antireflux mechanism. Moreover, 30 transplantations were done in 26 patients with a urinary diversion. We examined the urological complications in these 1,068 consecutive transplants. Urinary leakage and obstruction were the two main urological posttransplant complications. Severe leakage occurred in 21 patients (2.0%), and was treated by open surgery; 2 patients had a urinary diversion. The treatment of choice is a pyeloureterostomy (anastomosis between the transplant renal pelvis and the native ureter). There were 35 patients (3.3%) with severe ureteral obstruction of whom 5 had a urinary diversion. In 30 patients open surgical treatment of the obstruction was necessary and in 7 patients a percutaneous endourologic treatment was done (dilatation of a confined ureteral stricture in 6 patients and percutaneous stone treatment in 1). The postoperative mortality in the patients treated for leakage or obstruction was low: 4 patients (7%) died, 3 of septicemia due to leakage and 1 of pulmonary embolism after repair of the obstruction. The results of surgical treatment were good. The graft survival after 2 years in the group of urologically complicated transplants was 68% for the patients with leakage and 80% for those with obstruction. The 2-year graft survival in the patients without complications was 67% and 71 % for the patients with a urinary diversion. We conclude from these results that urological complications after renal transplantation can be treated successfully by surgical (or percutaneous) correction.

ISSN:0042-1138    

DOI:10.1159/000282402

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In order to evaluate the effectiveness of microwave coagulation therapy on urinary bladder carcinoma, we conducted a series of experiments using carcinoma VX-2 cells designed for the application on animal hosts. Three days after implantation of VX-2 cells into the bladder of the rabbits, microwave coagulation therapy was performed. The antitumor effect, i.e. the survival rate, the histological study and the immunological response of the microwave therapy was examined in comparison with the control group (no treatment), the partially cystectomized group and the sham-operated group (no tumor cell implantation). The results were obtained as follows. (1) The survival rate in the microwave group was greater than that in the control group. (2) The stimulation index value (SI), which represents humoral immunity, decreased post-operatively in all groups. In the microwave group, SI increased gradually beginning 21 days after the transient decrease. (3) Histological findings revealed severe degeneration, necrosis and complete eradication of the cancer cells of the bladder wall in the microwave group, however, perforation of the urinary bladder could not be detected. The results indicate that microwave coagulation therapy is an effective procedure for urinary bladder tumors. Furthermore, microwave therapy may also accelerate the inactivation of immunological suppressors in the carcinoma host, an additional benefit of the microwave procedure.

ISSN:0042-1138    

DOI:10.1159/000282403

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Twenty males underwent transrectal ultrasonography before and after ejaculation to examine possible alterations that could influence interpretation of seminal vesicle ultrasonography. The preejaculation length of 35 mm was significantly (p < 0.05) decreased to 30 mm after ejaculation. The mean width of the seminal vesicles was 13 mm before and 11 mm after ejaculation. The seminal vesicle volume was significantly diminished after ejaculation (p < 0.05). It therefore seems important to maintain a period of abstinence when evaluating the seminal vesicles by ultrasonography.

ISSN:0042-1138    

DOI:10.1159/000282404

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We present 2 patients who developed stones (6 and 57 g) in the ileal conduit; the first stone was passed and the second required surgical removal; its nidus was a surgical staple. After a review of the literature which includes 25 other cases of stones in ileal conduits, as well as over 20 cases of stones in continent urinary pouches, it is concluded that the use of metallic staples in the construction of the ileal conduit or the continent urinary pouch should be abandoned.

ISSN:0042-1138    

DOI:10.1159/000282405

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

An 81-year-old male patient was admitted to hospital because of macrohematuria. The clinical examination revealed a multifractured double J stent which had been placed 17 months before in another clinic because of hydronephrosis. In the reported case, a combined endoscopic and open surgical management was necessary to remove all fragments from the renal pelvis, the ureter and the bladder. Occlusion, encrustration and migration are among the most frequent risks of ureter stenting. The breakage of the stent, however, is a rare but severe complication. Therefore, patients should generally be controlled by sonography every 2 months and when malfunction of the stent is suspected, a cystogram should follow. In general, a stent exchange should be performed after 12 months.

ISSN:0042-1138    

DOI:10.1159/000282406

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A case of dehiscence of a previously repaired bladder rupture occurring 3 years after the original repair is reported. There was no obvious predisposing cause to this event. As this occurrence is very rare, it brings into question the need for long-term review of patients with conservatively treated bladder rupture.

ISSN:0042-1138    

DOI:10.1159/000282407

出版商:S. Karger AG    

年代:1992

数据来源: Karger