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Biomedical subjects

U Frei

Publications and source records attributed to U Frei.

At least 181 records · Page 10Linked to original sources
PubMed1982

[Transplantation hyperparathyroidism--tumorlike growth and autonomous function of autografts of the hyperplastic parathyroid (author's transl)].

The results of clinical and morphologic studies performed in 41 patients with chronic, renal failure and secondary hyperparathyroidism, who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. In five cases, 7--33 months after autotransplantation we found transplantation tumors developing in the forearm. Explanted grafts showed invasive growth of parathyroid tissue in the adjacent structures, into the musculature and blood vessels. The increased incidence of mitosis otherwise seen as evidence of malignant neoplasia of parathyroid tumors, indicated atypical focal proliferation of the transplanted tissue. This is justification for not performing transplantations any more in the treatment of renal osteodystrophy.

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed1982

Sympathetic and hemodynamic response to volume removal during different forms of renal replacement therapy.

Sympathetic and hemodynamic response to a constant volume removal was investigated during pure ultrafiltration, hemofiltration, acetate hemodialysis, and bicarbonate hemodialysis in the same ESRD patients. Small solute removal rates were matched. The sympathetic response resulting in an increase of total peripheral vascular resistance was found to be qualitatively adequate in ultrafiltration and hemofiltration, but not in acetate and bicarbonate hemodialysis. This inadequate response to volume removal explains the clinically observed hemodynamic instability during hemodialysis. The purpose of the study was to substantiate the, compared to hemodialysis, improved tolerance to fluid withdrawal during ultrafiltration and hemofiltration with hemodynamic data and to correlate hemodynamic and sympathetic changes during the different treatment modalities of uremia.

Adult↗
PubMed1982

[Results of transplantation of kidneys from related living donors].

Between 1973 and 1981 23 transplantations of kidneys from living related donors have been performed in Frankfurt/Main. Donor complications were haematopneumothorax (1 case) and reversible urinary tract infections (3 cases). All donors were discharged after 8-12 days, all have until now (6 months to 8 years postoperatively) normal excretory renal function and normal arterial blood pressure. Patient-survival in the recipients is 5 years postoperatively 96% and graft-survival is 90%. Nine patients received HLA-identical kidneys, all have excellent to fair function of the grafts, 7 patients are off steroids. In 14 cases kidneys were transplanted, although donor and recipient shared only one haplotype. In these patients 5-year graft survival is 84%. Seven patients have normal graft function, whereas 6 patients have a reduced function or have rejected. One patient died. Results of kidney transplantation using living related donors are--even when donors with only one haplotype-identity are accepted--much better than those obtainable when using cadaveric donors. When renal transplantation is considered, patients should be informed about the favourable results attainable with kidneys from living related donors.

Adolescent↗
PubMed1981

[Cardiac tamponade, a usually fatal complication of central venous catheterisation (author's transl)].

Cardiac tamponade is a complication of central venous catheterisation. It is not very rare and may, according to the literature, be fatal in 75%. The diagnosis is established by loss of blood pressure, extreme tachycardia, congestive heart failure, and markedly increased central venous pressure accompanied by a venous catheter in situ. Two out of four patients with cardiac tamponade survived this complication.

Adult↗
PubMed1981

Tumour-like growth of parathyroid autografts in uraemic patients.

Total parathyroidectomy with autotransplantation of parathyroid tissue into the forearm musculature has been recommended as surgical treatment for renal hyperparathyroidism. Five of 41 patients, in whom this procedure was performed, developed hyperparathyroidism 7 to 33 months after surgery due to graft hyperplasia. Grafts had to be removed. Whereas about 20--25mg were implanted, the removed grafts weighed 0.9--3.1g. Morphological examination showed signs of accelerated growth, infiltration of adjacent structures and invasion of blood vessels. For total removal, repeated and extensive surgery was necessary. Conservative treatment failed to prevent tumour-like growth of autografts. We no longer recommend parathyroidectomy with autotransplantation of parathyroid tissue as the method of choice for the surgical treatment of renal hyperparathyroidism.

Adult↗
PubMed1980

Improving anemia by hemodialysis: effect of serum erythropoietin.

Serum erythropoietin (SEP) concentration was measured on two occasions in 42 patients with terminal renal failure (1) immediately before the first hemodialysis, and (2) 3 to 27 months following the onset of regular hemodialysis treatment. Although the hematocrit (Hct) showed an increase in every patient, the SEP concentration decreased in every patient. The mean Hct rose frm 21.7 to 28.6% (volume per volume) P < 0.001), and the SEP dropped from 509 to 182 mU/ml (P < 0.001). This shows that anemia improvement is not a consequence of increased erythropoietin production but that it is most likely due to elimination of an inhibitor of the bone marrow by hemodialysis treatment. The decrease of SEP concentration has to be interpreted as a response to the improved tissue oxygenation that correlates with the hjigher hematocrit or as a consequence of further reduction of renal mass with progress of the renal disease.

Anemia↗
PubMed1979

Haemolysis due to formaldehyde-induced anti-N-like antibodies in haemodialysis patients.

During reuse of formaldehyde sterilized Kiil-dialysers, red cell survival, measured by means of 51Cr t/2, was significantly reduced (p less than 0.001) in 16 patients with anti-N-like positive sera, when compared with 19 antibody negative control patients (mean +/- SD: 16.5 +/- 2.7 versus 22.4 +/- 3.1 days.) In antibody negative patients (n = 10) replacement of formaldehyde sterilized dialysers by ethylene-oxide sterilized disposable dialysers resulted in a significant increase (p less than 0.002) of 51Cr t/2 (Mean +/- SD, days: Kiildialyser 16.3 +/- 1.9; disposable dialyser 20.3 +/- 3.5). This improvement took place, although antibody titres persisted during the 51Cr-measurements and declined thereafter only slowly. In antibody negative patients (n = 6) red cell survival did not increase, when formaldehyde as a sterilant was avoided. In antibody positive patients mean haematocrit rose significantly (p less than 0.05), whereas in none of the antibody negative patients a definite change of haematocrit occurred. The data demonstrate, that formaldehyde sterilisation of dialysers may cause antibody-mediated haemolysis contributing to the extent of renal anaemia. This immunohaemolysis may be corrected, in spite of continuing antibody persistance, when formaldehyde exposure is totally avoided, or possibly when minimized.

Antibody Formation↗
PubMed1978

[Recurrent hyperparathyroidism following subtotal parathyroidectomy].

Recurrent hyperparathyreoidism occurred in 3 of 9 patients in terminal renal failure from 9 months to 2 years after an initially successful subtotal parathyroidectomy. In all cases we find temporary remission of clinical signs of hyperparathyreoidism after surgery. Our clinical experience provided by followup in these patients showed an insufficient biochemical and clinical control. We find recurrence in 3 cases and repeat neck exploration was indicated for 2 patients.

Humans↗
PubMed1978

[Morphological aspects of parathyroid gland transplantation. Contribution on the clinical relevance of induced, invasive tissue growth].

The results of morphologic studies performed in 18 patients who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. All patients had long-standing renal disease with azotemia, hyperphosphatemia and high levels of parathyroid hormone. The histologic findings after total parathyroidectomy, before gland transplantation, are important for selection of parathyroid tissue for surgery. Diffuse hyperplasia with the development of multiple nodules of the parathyroids can possibly be adverse for the transplant. In one case, nine month after autotransplantation we found a tumor in the forearm, measuring 2.0 X 3.0 X 2.2 cm in diameter. Morphologic findings in this case before implantation showed diffuse hyperplasia with adenomatous nodules but no signs of carcinoma. The grafted parathyroid tissue after excision was seen with blood vessel invasion in the normal skeletal muscle. In the case of primary renal disease with secondary parathyroid hyperplasia, the light microscopic examination revealed an autonomous tumorlike adenomatous formation in the autografted parathyroid tissue, with graft-dependent hypercalcemia. The invasive growth with some signs of neoplasia following autotransplantation raises the question of the development of certain neoplasia.

Adult↗
PubMed1978

Total parathyroidectomy with autograft of parathyroid tissue in treatment of secondary hyperparathyroidism.

In 16 patients with severe symptomatic hyperparathyroidism reduction of hyperplastic parathyroid mass was performed by total parathyroidectomy with autotransplantation of parathyroid tissue. In all patients except one serum parathormone (PTH) levels returned to normal and postoperative difficulties in calcium homeostasis were rarely observed. Fifteen patients had normal PTH levels after surgery. Graft function was proven in 10 cases, but in 5 cases graft function could not be definitely established with the methods applied. One graft failure was observed. Total parathyroidectomy with autotransplanation of parathyroid tissue is recommended as the treatment of choice when surgical correction of secondary hyperparathyroidism is necessary.

Adult↗
PubMed1976

Factors predisposing to priapism in haemodialysis patients.

Clinical data and therapy of all male home dialysis patients of two centres were compared in order to establish predisposing factors to priapism. One centre (Frankfurt) had nine priapisms in 96 patients, whereas the other centre (Montpellier) had none in 59 patients. The only difference found were higher haematocrits in Frankfurt than in Montpellier. The highest haematocrits were found in the priapism patients. Further evaluation of the Frankfurt data showed that androgen therapy, high haematocrits and hypovolemia increase the risk of dialysis priapism. It is recommended to withdraw androgen therapy when the haematocrit is consistantly above 25%.

Adult↗