[The history of kidney transplantation in Germany].

In 1910 Ernst Unger started kidney transplantation in Germany, when he tried to cure an uremic patient in Berlin by transplanting a monkey kidney. But it was not until 1963 that the urologists Brosig and Nagel - again in Berlin - began relevant clinical renal transplantation. In the late sixties the teams in Munich and Heidelberg took over the main initiative.

Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation.

Background: Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair.

Methods: A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months.

Serum bile acids in liver transplantation--early indicator for acute rejection and monitor for antirejection therapy.

We studied the course of serum bile acids to investigate its reliability in the diagnosis of acute rejection after liver transplantation in relation to pathohistological findings. Serum bile acid concentration, bilirubin and transaminases were measured in 41 patients who underwent liver transplantation. Their course was correlated to liver biopsy.

Relevance of two-stage total hepatectomy and liver transplantation in acute liver failure and severe liver trauma.

Emergency liver transplantation frequently is the only life-saving procedure in cases of acute liver failure. It remains unclear whether emergency hepatectomy with portocaval shunt followed by liver transplantation as a two-stage procedure should be performed in cases in which a donor organ is not yet available. It has been stated that "toxic liver syndrome" could be treated by means of this strategy.

Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years.

Posterior retroperitoneoscopic adrenalectomy is one of the new endoscopic methods in endocrine surgery. In a prospective clinical study 142 posterior retroperitoneoscopic adrenalectomies (72 right, 70 left) were performed in 130 patients (52 males, 78 females, age 49.1 +/- 14.

Monitoring of soluble HLA class I size variants after liver transplantation.

To monitor soluble HLA class I (sHLA-I) and their size variants after liver transplantation (LTX) plasma samples from 22 LTX patients were studied by sHLA-I ELISA, SDS-PAGE, and densitometry. Samples collected were classified into three groups: Group 1 comprised samples taken during episodes without complications, group 2 during episodes of cholangitis/cholestasis (CC), and group 3 during episodes of acute rejection (AR). Compared to group 1 (0.

[Subtotal retroperitoneoscopic adrenal gland resection--an alternative to adrenalectomy?].

Primary adrenal tumors were removed in 24 patients by the posterior retroperitoneoscopic approach, maintaining tumor-free parts of the ipsilateral adrenal gland. These partial adrenal resections did not cause a significantly different operating time or blood loss compared to 58 complete adrenalectomies performed during the same period. All 20 patients with hormonally active tumors are biochemically and clinically cured (mean follow-up 18 months).

[Extended resection of locally advanced primary and recurrent rectal carcinomas by interdisciplinary cooperation of various surgical specialties].

Multivisceral resections have been performed on 35 patients with primary and 45 with recurrent rectal cancer. Lethality was 3.7%, morbidity was 9%.

Percutaneous dilatational tracheostomy--early results and long-term outcome of 326 critically ill patients.

Objective: To analyze perioperative and postoperative complications and long-term sequelae following percutaneous dilatational tracheostomy (PDT).

Design: A prospective clinical study of patients undergoing PDT.

Setting: Seven intensive care units at a University hospital

Patients: 326 intensive care patients (202 male, 124 female; age: 11-95 years) with indications for tracheostomy.

Auxiliary liver transplantation with arterialization of the portal vein for acute hepatic failure.

Six adult patients suffering from acute hepatic failure and with a high urgent status underwent heterotopic auxiliary liver transplantation. In four of these patients, the portal vein of the liver graft was arterialized in order to leave the native liver and the liver hilum untouched and to be able to place the liver graft wherever space was available in the abdomen. The arterial blood flow via the portal vein was tapered by the width of the anastomosis.

Subtotal adrenalectomy by the posterior retroperitoneoscopic approach.

The retroperitoneoscopic approach offers an established operative procedure for primary adrenal gland tumors. It allows a detailed view of the adrenal gland and its surrounding region. Therefore clear differentiation between normal and neoplastic adrenal tissue is sometimes possible, permitting a planned, unilateral, subtotal resection of the gland.

[Can "internal intestinal splinting" prevent ileus recurrence? Results of a retrospective comparative study].

The high rate of recurrence after the treatment of adhesive obstruction demands special prophylactic treatment. In a 13-year period, 52 out of 95 patients with major adhesions were provided with a long nasointestinal tube for intestinal splinting intraoperatively. The was being left in situ on an average of 6.

Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease.

Sigmoid perforation due to diverticulitis is a life-threatening complication in the postoperative course of allogenic kidney transplantation. The incidence of diverticulosis is especially high among patients with autosomal dominant polycystic kidney disease (ADPKD). Thus, those who undergo allogenic kidney transplantation represent a high-risk group.

Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems.

Totally implantable venous access systems are widely used, but large-scale studies evaluating these systems are lacking. In this study 1500 patients (719 male, 781 female) with an average age of 49 years (15-86 years) were fitted with subcutaneously implanted venous access systems, in most cases for long-term chemotherapy. All patients were observed until removal of the system, death, or the end of treatment.

[Upper gastrointestinal hemorrhage caused by necrotizing cholecystitis with gallstone perforation into the duodenum].

A 68-year-old woman suffering from severe upper gastrointestinal bleeding underwent an urgent laparotomy. A necrotizing cholecystitis was found. The source of the bleeding was the eroded cystic artery.

GB virus C infection in patients who underwent liver transplantation.

To elucidate the impact of an infection with the recently discovered GB virus C (GBV-C) on the clinical course after orthotopic liver transplantation (OLT), we studied eight patients who were GBV-C RNA positive after transplantation. Five individuals had been viraemic before transplantation, three became GBV-C RNA positive thereafter. A control group comprised eight patients without pre- or post-transplant GBV-C infection.

Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection: a report of the European Tacrolimus Multicenter Renal Study Group.

Background: To confirm the results of a number of studies conducted in Europe, the United States, and Japan, this multicenter, randomized trial compared the 12-month efficacy and safety of tacrolimus- and cyclosporine-based immunosuppressive regimens in the prevention of renal allograft rejection.

Methods: A total of 448 renal transplant recipients were recruited from 15 centers and assigned to receive triple-drug therapy consisting of tacrolimus (n=303) or cyclosporine (n=145) in conjunction with azathioprine and low-dose corticosteroids.

Results: At 12 months after transplantation, tacrolimus therapy was associated with a significant reduction in the frequency of both acute (tacrolimus 25.

[Surgery in patients with renal failure in emergency and elective interventions].

The classification of renal insufficiency into stages of full compensation, compensated and decompensated retention and terminal renal failure is of importance if patients with impaired renal function are to undergo elective and emergency surgery. Furthermore, it should be established whether the renal disease is stable or progressive. Preoperatively, particular attention should be paid to problems of fluid and electrolyte homoeostasis as well as to acid-base balance.