Search PubMed⌕ Search

Biomedical subjects

G Kirste

Publications and source records attributed to G Kirste.

At least 55 records · Page 3Linked to original sources
PubMed1994

Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients.

Kidney transplant recipients have multiple factors leading to osteoporosis. The purpose of this study was to determine the fracture rate after kidney transplantation and the significance of osteodensitometry with dual energy x-ray absorptiometry (DXA) in identifying the risk patients. Bone mineral density (BMD) was measured with DXA in 100 graft recipients (mean interval 63 +/- 53 months after transplantation) and correlated with the incidence of fractures. Fracture rate of peripheral bones increased from 0.009 before transplantation and 0.012 on hemodialysis to 0.032 fractures per patient and year after transplantation. Seventeen fractures of peripheral bones occurred in 11% of the patients within a mean of 103 +/- 59 months after transplantation. Three additional patients had fractures of the lumbar spine. Patients with fractures were characterized by low or low-normal BMD (0.93 +/- 0.23 versus 1.04 +/- 0.17 g/cm2 at lumbar spine), a frequent history of parathyroidectomy (21% versus 6%), and a longer transplant interval (103 +/- 59 versus 57 +/- 49 months). Fractures occurred in patients with low and normal BMD. DXA at the femoral neck proved to be of no value to define patients at risk of fractures. DXA at the lumbar spine also proved to be of limited value for this question. Therefore, alternatively, more sensitive methods of BMD and of bone architecture measurements are necessary for identifying the kidney transplant recipients at risk of fracture.

Absorptiometry, Photon↗
PubMed1994

Incidence, diagnosis, and treatment of ureteric stenosis in 1298 renal transplant patients.

Of 1130 patients who had undergone a total of 1298 kidney transplantations, 40 developed a stenosis of the ureter (3.1%). In all of the transplants, the anastomosis between the ureter and the urinary bladder was established as extravesical ureteroneocystostomy. Up until 1984, in cases where an obstruction in the urinary tract was suspected, the diagnosis was made by an i.v. pyelogram or by nuclear scans of the transplant. Thereafter, in 28 patients, in cases of sonographically suspected stenosis of the ureter, the diagnosis was established by means of a simplified Whitaker test. Nearly one-half of the stenoses of the ureter developed within the first 3 months after transplantation. In five patients (12.5%) the stenosis developed significantly later, 3-10 years after kidney transplantation. Seventy percent of the stenoses were localized in the distal third of the ureter. About 75% of the surgically explored stenoses could be corrected by resection and reimplantation of the ureter. During the post-operative follow-up, restenosis occurred in three patients. At present, 62% of all patients whose ureteric stenoses were corrected have well-functioning kidney transplants.

Adolescent↗
PubMed1994

Progressive proliferative diabetic retinopathy after transplantation of the pancreas. A case and a review of the topic.

The unusual case history of the development of a progressive diabetic retinopathy despite normal blood glucose after transplantation of the pancreas and despite panretinal laser coagulations is described. A 26-year-old male with diabetic background retinopathy underwent a segmental transplantation of the pancreas in 1988. One year after surgery, a progressive proliferative retinopathy despite normoglycemia was found, which required an intensive panretinal photocoagulation during the following months. However, despite massive retinal coagulations, vitreous hemorrhages and retinal neovascularizations continuously occurred, thus requiring two vitrectomies. After these procedures, visual acuity recovered distinctly. It is suggested that the 'point of no return' for the development of proliferative changes in the retina had been passed at a time when a background retinopathy was still present. The effect of normoglycemia during follow-up of patients with diabetic retinopathy, described in the literature, is compared to this unusual case history.

Adult↗
PubMed1994

A new operative technique of paratopic positioning of pediatric en bloc kidneys for transplantation.

Technical difficulties and insufficient renal mass have been reasons not to use en bloc-removed kidneys from organ donors under the age of 3 years. We developed a new technique of paratopic positioning of en bloc-removed kidneys with a prolonging interpositional graft of donor aorta and vena cava. With transperitoneal approach, anastomosis directly to the recipient's aorta and vena cava can be performed. Using this technique, 7 patients have been transplanted so far. They were chosen out of a list of possible recipients according to HLA-match, body weight and blood pressure. All patients had primary function. Anastomosis and renal vessels were controlled by color duplex ultrasound imaging and angiography. Patients developed a stable kidney function. There were no surgical complications except a thrombosed kidney in 1 patient. With the new technique described, transplantation of en bloc-removed kidneys from donors under the age of 3 years can be performed with a low rate of technical complications. Donors of this age should be considered not only as potential liver donors but as kidney donors as well.

Adult↗
PubMed1993

Pheochromocytomas, multiple endocrine neoplasia type 2, and von Hippel-Lindau disease.

BACKGROUND: Pheochromocytoma is a feature of two disorders with an autosomal dominant pattern of inheritance--multiple endocrine neoplasia type 2 (MEN-2) (with medullary thyroid carcinoma and hyperparathyroidism) and von Hippel-Lindau disease (with angioma of the retina, hemangioblastoma of the central nervous system, renal-cell carcinoma, pancreatic cysts, and epididymal cystadenoma). The frequency of these syndromes in patients with pheochromocytoma is not known. METHODS: In an unselected group of patients with pheochromocytoma, we performed pentagastrin tests, parathyroid hormone assays, computed tomography (CT) or magnetic resonance imaging (MRI) of the brain, ophthalmoscopy, CT imaging of the abdomen, and ultrasonography of the testes. We also screened members of families with MEN-2 or von Hippel-Lindau disease for pheochromocytoma by measuring plasma and urine catecholamines and plasma chromogranin A and by performing abdominal ultrasonography, CT and MRI, and metaiodobenzylguanidine scintigraphy. RESULTS: Nineteen of 82 unselected patients with pheochromocytomas (23 percent) were carriers of familial disorders; 19 percent had von Hippel-Lindau disease and 4 percent had MEN-2. Prospectively, in 36 of 79 subjects at risk for pheochromocytoma (46 percent), 42 unsuspected pheochromocytomas were found. Overall, there were 130 patients with 185 pheochromocytomas; 43 had von Hippel-Lindau disease, 24 had MEN-2, and 63 had sporadic tumors. The patients with familial and those with sporadic pheochromocytomas differed in mean age at diagnosis (32 vs. 46 years, P < 0.001), multifocal localization (55 vs. 8 percent, P < 0.001), and cancer (0 vs. 11 percent, P = 0.005); but not in the frequency of extraadrenal tumors (24 vs. 16 percent). Thirty-eight percent of carriers of von Hippel-Lindau disease and 24 percent of carriers of MEN-2 had pheochromocytoma as the only manifestation of their syndrome. CONCLUSIONS: All patients with pheochromocytomas should be screened for MEN-2 and von Hippel-Lindau disease to avert further morbidity and mortality in the patients and their families. All patients in families with MEN-2 or von Hippel-Lindau disease should be screened for pheochromocytoma, even if they are asymptomatic.

Adolescent↗
PubMed1993

[Color-coded duplex sonography in the diagnosis of renal venous thromboses in the early phase following kidney transplantation].

A total of 91 colour-coded duplex Doppler ultrasound scans were performed in the early phase following renal transplantation in 53 out of 109 patients (48.6%) between 1. 1. 1992 and 15. 3. 1993. The indications for the investigation were primary failure of functional improvement in the transplanted kidney or secondary worsening of function. In five of the 53 patients (ten scans) constant retrograde flow in the segmentary arteries provided specific evidence of renal vein thrombosis, this diagnosis being confirmed histologically following nephrectomy. The Pourcelot index was raised (RI > 0.72) in all five cases. The RI was also raised in 35 of 53 patients; however, continuous retrograde diastolic flow was absent. The results of renal biopsy and the clinical course both excluded renal vein thrombosis in these cases. The colour Doppler ultrasound scans were unremarkable in 13 patients. The comparison group consisted of 151 patients in the later posttransplantation phase (> 2 months), in whom 171 colour Doppler ultrasound scans showed no signals associated with renal vein thrombosis. In agreement with the literature, these results show that colour-coded duplex Doppler ultrasound should be regarded as the definitive diagnostic procedure for renal vein thrombosis after transplantation, and if positive findings are obtained further invasive diagnostic procedures can be avoided.

Adolescent↗
PubMed1993

[Current status and development of kidney transplantation].

Since the first successful procedure in 1954 kidney transplantation has become a standard therapy of end stage renal disease. The knowledge of immunoregulation and immune response of the body has enabled people to recognize acute rejection of organs. HLA-testing and organ exchange on basis of HLA-compatibility are extremely important for a successful kidney transplantation. A shortage of organs is limiting the further increase of transplantations. Chronic rejection is in most cases the reason for late graft failure. Further investigations to develop new immunosuppressive drugs and to clarify immunological processes underlying chronic rejections are necessary in the future.

Graft Rejection↗
PubMed1992

[Pheochromocytoma as dominant manifestation of v. Hippel-Lindau syndrome].

A diagnosis of von Hippel-Lindau syndrome was made in two families originating from the same part of the Black Forest but apparently unrelated. Nine affected persons (seven males and two females) had a total of 17 tumours: retinal angioma (4), haemangioblastoma of the CNS (1), and phaeochromocytoma (12). Three of the affected persons and eight of the tumours (six phaeochromocytomas, two retinal angiomas) were diagnosed by family screening. Phaeochromocytoma was diagnosed in eight persons; in four it was the only symptomatic lesion. After extensive diagnostic tests the phaeochromocytoma was the sole tumour in four. Despite severe symptoms the diagnosis of von Hippel-Lindau syndrome had not been made prior to the screening examinations because either the common aetiology of the tumour was not known or there was insufficient exchange of information between the two families.--It is recommended that in each case of phaeochromocytoma von Hippel-Lindau syndrome should be excluded so that lesions can be discovered early in other organs and in other affected family members. If the syndrome is present, annual examinations are indicated because of asynchronous and multi-focal tumour growth.

Adolescent↗
PubMed1992

Lectin histochemical investigations of fetal cultivated pancreatic tissue.

The terminal glycoproteins of fetal, cultivated (7-12 days), and adult nondiabetic and diabetic pancreatic tissues (Balb c, C3h mice) were investigated by lectin histology (peanut-, phytohemagglutinin, wheat germ agglutinin, Ulex europeus I, concanavalin A and Ricinus communis agglutinin, PaP method +/- neuraminidase). Anti-insulin and -glucagon were used to identify islet cells. S-100 antibody showed dendritic reticulum cells, anti-IAK proved MHC II antigens (C3h). Cultured tissue was partly incubated with anti-IAK and complement for lysis of MHC II antigens. On the 19th gestational day fetal pancreatic tissue did not bind peanut agglutinin, Phytohemagglutinin, or wheat germ agglutinin, whereas concanavalin A and Ricinus communis were weakly bound. Terminal fucose residues were not expressed by C3h fetal islet cells in contrast to Balb c. Following neuraminidase digestion peanut agglutinin and phytohemagglutinin were strongly bound, indicating sialic acid-substituted terminal glycoproteins. Cultivated tissue (Day 7) bound all investigated lectins (except Ulex europeus I in C3h mice), indicating maturation of islet cells. In spite of the peak of insulin concentration in the medium we observed a faint binding of anti-insulin and investigated lectins following 12 days of cultivation. This indicates a disorder of terminal glycoprotein synthesis at this point. There was no difference in lectin binding patterns of adult nondiabetic islet cells compared to the cultivated tissue (7 days), but no Ulex europaeus I binding of the adult Balb c mice was observed. S-100 binding decreased during the cultivation period as dendritic reticulum cells became destroyed by cultivation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[20 years kidney transplantation. Experience of a practice].

Between September, 1969, and May, 1990, 1,086 kidney transplantations were performed in Freiburg. In the majority of cases, the transplantations were allografts and had been made possible by close cooperation with the Eurotransplant Foundation. The results of this long-term study show that the transplant function rates at one year in the period under observation were comparable. Only the introduction of the immunosuppressive agent cyclosporine A brought about any improvement. On the basis of the results achieved at our center, the HLA system had an influence on transplantation function rate only in the case of the DR system. However, this does not mean that, for organ matching, the HLA system should no longer be complied with, since multicentric studies have substantiated its importance. High-risk groups, such as diabetics and elderly patients who undergo a transplantation achieve the same good results as the low-risk groups, provided that each case is carefully considered on its individual merits.

Adolescent↗