Results of donor kidney pairs after local versus HLA-dependent allocation.
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Adolescent↗
Biomedical subjects
D Heimbach
Publications and source records attributed to D Heimbach.
Nephrogenic adenoma in children. Case report and review of literature.
Nephrogenic adenoma in children is an extremely rare kind of tumor (22 cases have been described to date). We report and discuss here the case of a 7-year-old girl, taking into account the findings described in medical literature. In contrast to nephrogenic adenomas in adults, who present with this tumor in the entire ureteral tract, it has been observed exclusively in the bladder in children so far. The most frequent predisposing factors for the development of this tumor are extensive surgical injury such as ureter reimplantation or long-term stimuli on the urothelium caused by a foreign body. Diagnosis primarily includes sonography of the urinary tract and cystoscopy. Transurethral resection is regarded as the treatment of choice. Owing to the frequency of persistence, control cystoscopies after primary therapy are necessary.
Adenoma↗
Dissolution of artificial (natural) stones in a standard model: first results.
In studying the dissolution of stones in vitro, the advantage of artificial stones in comparison to natural stones is that one can get substance-specific standardized and reproducible results. Our investigations were performed with artificial stones composed of natural material (calcium apatite). These stones were of spherical form and consisted of layers built up around a core. They were comparable to natural stones in their physical properties. Litholysis was performed in a special apparatus with continuous exposure to Suby G solution under standard conditions. Natural stones of the same chemical composition served as a reference. Statistical measurements were performed. By hardening of the artificial stones, it was possible to reach a dissolution comparable to natural stones composed of calcium apatite depending on the Suby G concentration (artificial 2.5 resp. 4.75 mg/h; natural 2.18 resp. 4.2 mg/h). For the first time, an artificial stone model has been created with reproducible behaviour in response to chemolitholysis and with properties of dissolution comparable to those of natural stones of identical chemical composition.
Apatites↗
Urological aspects of Munchausen's syndrome.
Munchausen's syndrome (MHS) is classed among the self-manipulated disease but is frequently not recognized as such. Patients suffering from MHS successfully obtain repeated invasive diagnostic management by the permanent presentation of various symptoms especially in the surgical branches of medicine. In urology, the 'hemorrhagic type', the 'abdominal type' and the 'neurological type' are predominant. In the course of his 'history' the MHS patient shows definite organic lesions as a result of numerous artificial and iatrogenic procedures. Consequently, diagnosis gets more and more difficult. In the majority of cases psychotherapy ends after few psychiatric interviews in the initial stage of therapy. Increasing somatic lesions are predominant.
Adult↗
Production of artificial urinary stones from natural materials and their physical properties. First results.
Considered from a clinical point of view, all artificial stones known so far are inappropriate for experimental investigations, because they do not correspond to natural urinary stones in shape, physical properties and chemical composition. A special technique has now been developed for the production of biometric artificial stone models. Standard artificial carbonate apatite stones were produced by a coating technique where several layers of a suspension consisting of pure substance were applied around a core. Density and crushing strength of these ball-shaped artificial stones corresponded to natural apatite stones. Experimental chemolitholysis investigations showed comparable results in respect to the dissolution of artificial apatite stones and of natural stones of the same chemical composition. The disintegration behaviour was studied in ESWL tests which revealed a correlation between generator voltage and number of shock waves necessary for complete disintegration. For the first time, an artificial urinary stone has now been produced which is comparable to a natural stone of the same chemical composition not only in shape but also in its physical properties and lysis behaviour. These stones are suitable for use in systemic scientific investigations on disintegration and chemolitholysis.
Apatites↗
Is immediate decompression of high voltage electrical injuries to the upper extremity always necessary?
OBJECTIVE: To determine if immediate decompression is required for all high voltage injuries to the upper extremity. DESIGN: Retrospective review. MATERIALS AND METHODS: Charts reviewed of 62 patients who had upper extremity contact with >1,000 volts of electricity over a 10-year period. MAIN RESULTS: One hundred upper extremities were treated. Twenty-two percent were decompressed within 24 hours because of progressive nerve dysfunction, clinical compartment syndrome, or failure of resuscitation. This group required a mean of 4.2 operations with an amputation rate of 45%, similar to other series. Thirty-five percent of burned extremities had their first operative procedure delayed until resuscitation was complete. This group required a mean of 2.1 operations with no amputations. Forty-three percent of extremities did not require operations to achieve healing. Overall results show a 10.0% amputation rate and mean hospital stay of 27 days. CONCLUSIONS: We conclude that the need for amputation and multiple operations is determined by the injury itself and that immediate decompression is only required for the usual clinical signs of compartment syndrome. Selective decompression may actually preserve tissue and decrease the need for eventual amputation because fasciotomy can lead to soft tissue dessication by exposing viable tissue.
Adolescent↗
Improved accuracy of burn wound assessment using laser Doppler.
The utility of the laser Doppler for determining burn depth has been questioned because of problems with technology and methodology. This study prospectively evaluates the ability of a new laser Doppler technique to predict burn healing time. Using the Periflux System 4000 laser Doppler, readings were taken on 305 burns (147 patients) on postburn day 3 or 4. Sixty-six wounds were used to derive a predictive function (phase I) and 152 wounds were used to test the function (phase II). Blood flow dynamics (flux), microvascular dilation capacity of the wounds to beat stress, and flow motion wave pattern (vasomotion) were studied using the laser Doppler, and seven parameters were evaluated to determine their relative contribution to the prediction of healing time. These parameters are hyperemic flux (flux value after heating to 42 degrees C), average hyperemic wave amplitude (AHWA), number of average flux units >100(F100), number readings with wave amplitude 75 (A5), average flux change (AFC), percentage of average flux increase, and relative flow capacity (RFC = AFC/average hyperemic flux). After readings were made, the wounds were observed and divided into two groups: those that healed in less than 14 days and those that healed or were grafted after 14 days. A step-wise discriminant analysis was used to assess the relative contribution of the Doppler-derived measures to healing time prediction. AHWA, F100, and RFC were included in the final discriminant function explaining 72% of the healing time variance (Wilks' lambda value 0.28; p value <0.0001). Predicted outcome = 0.05(AHWA) + 0.31(F100) + 5.0(RFC) - 2.3. With this derived function, there is 94% accuracy in the prediction of burn wound healing time compared with a physician predictive accuracy of 70%.
Adolescent↗
Ureterosciatic hernia.
We report on a patient with a hydronephrosis of the left kidney caused by an ureterosciatic hernia. Curlicue formation is a characteristic sign in urography. In case of symptomatic sciatic hernia the hernia should be treated by operation.
Female↗
N-acetyl-beta-D-glucosaminidase excretion in calcium oxalate stone patients and its relation to the risk of stone formation.
A tubular renal damage induced by crystals in the renal tubuli can be the triggering primary but also secondary cause of stone formation. In 72 calcium oxalate stone patients (45 men, 27 women) N-acetyl-beta-D-glucosaminidase [NAG] excretion in 24h-urine was investigated. 48 healthy test persons (27 men, 21 women) served as a control group and helped to establish reference values. In order to find out a possible relation between NAG reference values and the risks of urolithiasis, lithogenous and inhibitory substances were determined in both groups. In the following, relative calcium oxalate supersaturation, representing a risk of urinary stone formation, was analyzed and compared to NAG excretion values. The threshold value of pathologic NAG excretion was determined in the group of healthy test subjects (mean value +/- 2 standard deviation) and was fixed at 4.2 U/d (women 3.06 U/d, men 4.24 U/d). In our investigations on NAG excretion significantly (p < 0.05) increased values were found in stone patients (4.43 U/d +/- 4.27) as compared to healthy test persons (2.13 U/d +/- 1.02). In the case of increased NAG excretion in stone patients there was a positive correlation between NAG excretion and increased phosphate, sulphate, uric acid, oxalate, and creatinine excretion. Only in female patients there was a relation between relative calcium oxalate supersaturation and NAG excretion values. As a result, NAG determination is considered to be an appropriate means of tracing a certain risk group within calcium oxalate stone patients.
Acetylglucosaminidase↗
Prognosis and treatment of burns.
Survival rates for burn patients in general have improved markedly over the past several decades. The development of topical antibiotic therapy for burn wounds, the institution of the practice of early excision and grafting, and major advances in intensive care management have all contributed to this success. In this review we address these 3 important advances in the modern treatment of burn injuries and provide a brief historical overview of these accomplishments and others, emphasizing specific achievements of note and promises for the future. We also discuss 3 topics of interest to burn physicians, including the special problems and high mortality of elderly burn patients, the disturbingly high mortality in burn patients with inhalation injury, and the possible use of artificial skin to facilitate rapid wound closure.
Burns↗
Munchhausen's syndrome in urology.
Munchhausen's syndrome (MHS) is classed among the self-manipulated diseases but frequently is not recognized as such. Patients suffering from MHS successfully obtain repeated invasive diagnostic management by the permanent presentation of various symptoms especially in the surgical branches of medicine. In urology the "haemorrhagic type", the "abdominal type" and the "neurological type" are predominant. In the course of his "history" the MHS patient shows definite organic lesions as a result of numerous artificial and iatrogenic procedures. Consequently diagnosis is more and more difficult. In the majority of cases psychotherapy ends after few psychiatric interviews in the initial stage of therapy. Increasing somatic lesions are predominant.
Adult↗
Is the transplant-preserving management of renal allograft rupture justified?
OBJECTIVE: To evaluate the transplant-preserving management of renal allograft rupture. PATIENTS AND METHODS: From April 1982 to January 1994 a total of 238 renal transplantations were performed on 227 patients. Eight cases (3.5%) of renal allograft rupture occurred. Transplant nephrectomy was necessary in one patient. Seven patients were surgically treated with collagen foam, fibrin glue and vicryl mesh. RESULTS: In all seven cases treated conservatively, renal salvage and satisfactory graft function was achieved. After a mean follow-up of 52.9 months (range 2-94) the mean creatinine level was 15.6 mg/L (range 11-21). Of these seven patients with renal allograft rupture one returned to haemodialysis 22 months after transplantation and had several episodes of rejection. Almost 4.5 years after renal allograft rupture, the creatinine value in six of the seven patients was only slightly higher than the mean creatinine values of all donor kidney recipients (14.4 +/- 5.5 mg/L). CONCLUSION: There should be an attempt to salvage the transplant after allograft rupture in all cases. Using these transplant-preserving techniques, renal function could be achieved for all patients with allograft rupture.
Adolescent↗
When is the indication of percutaneous chemolysis justified?
Persistent residual stone fragments after extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL) as well as pyelo- and nephrolithotomy represent a great problem in the treatment of stones. The choice of therapy for patients with insufficient renal drainage, poor renal function, and a high anesthetic risk also remains quite difficult. Between 1991 and 1993, 5 patients underwent percutaneous antegrading chemolysis with 'Suby G' solution. Two patients, presenting struvite and apatite stones, were free of stones afterwards. In 1 patient, where stone size could be observed. In 2 other brushite component, a large decrease in stone size could be observed. In 2 other cases, with stones mainly consisting of whewellite and weddelite, chemolysis proved ineffective. Evaluating our own clinical experience and relevant medical literature, the present study goes on to prove that the indication of percutaneous chemolysis in risk patients as described above is dependent on stone analysis, and must be regarded as an effective adjuvant treatment.
Adult↗
Maximal displacement of the ureter by a liposarcoma.
We describe a patient with displacement of both ureters to the right side caused by a liposarcoma. The left ureter was displaced beyond the right ureter. The risk of intraoperative trauma to the ureter could be minimized by preoperative placement of ureteral stents.
Humans↗
Lich-Gregoir anti-reflux procedure; indications and results with 283 vesicoureteral units.
While reflux is not the cause of the ascension of microorganisms into the urinary bladder, it enables bacteria to reach the kidney and fosters pyelonephritis, persistent infections and nephropathy with all related consequences. The efficiency of the Lich-Gregoir antireflux procedure must be judged by its results. The criterion of success in operations upon 225 children (283 vesicoureteral units) is the procedure's positive effect on renal growth and physical development of the patients by controlling pyelonephritis and the elimination of recurrent supravesical infections in more than 98 per cent of children operated upon.
Adolescent↗
Manifestation of metabolic risk factors after renal transplantation: I: Association with long-term allograft function.
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Adult↗
Manifestation of metabolic risk factors after renal transplantation: II. Impact of maintenance therapy.
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Adult↗