The Extension of Traumatic Subdural Hematoma into the Interhemispheric Fissure Is Associated with Coagulation Disorders: A Retrospective Study.

Background:  This study investigates the correlation of the radiologic sign of interhemispheric subdural hematoma (iSDH) in different injury patterns with clinical coagulation disorders. It is hypothesized that the presence of iSDHs is correlated with clinical coagulation disorders in patients with traumatic brain injuries and subdural hematoma (SDH).

Methods:  Between January 1, 2020 and June 30, 2022, 154 patients with SDH were identified.

Impact of early follow-up CT in the conservative management of traumatic brain injury on surgical decision making: A retrospective, single-center analysis with special respect to coagulopathy.

Introduction: Initial management of traumatic brain injury (TBI) without immediate need for surgical therapy varies across centers. The additional value of routine repeat cranial computerized tomography (CT) to neurological monitoring is controversial. This retrospective study investigates the impact of routine follow-up CT after 6 h (CT6h) in initially conservatively managed TBI on surgical decision making.

Operative V2 decompression for traumatic vertebrobasilar insufficiency: illustrative case.

Background: Blunt vertebral artery injuries after cervical trauma due to the close anatomical relationship of the vertebral artery to the cervical spine may have fatal consequences because of posterior circulation ischemia and vertebrobasilar insufficiency. While the standard of care remains medical treatment by anticoagulation or antiplatelet therapy, surgical decompression of the vertebral artery is rarely indicated.

Observations: The authors present a case of selective decompression of a traumatically constricted vertebral artery within the transverse foramen of C2 presenting with vertebrobasilar insufficiency due to bilateral aplasia of the posterior communicating arteries and contralateral hypoplasia of the vertebral artery.

Percheron-like artery infarction after transsphenoidal surgery: illustrative case.

Background: The transsphenoidal approach to the skull base has enjoyed increasing popularity for surgery of the sellar region avoiding brain retraction and causing few severe complications. While vitally important vessels in this region show a high degree of variability, some anatomical variants might be involved in characteristic complications.

Observations: We present the case of a 40-year-old female patient with acromegaly due to a pituitary adenoma that was transsphenoidally operated.

Study protocol of a randomized controlled trial evaluating home treatment with peer support for acute mental health crises (HoPe).

Background: Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery.

A novel mutation in NEB causing foetal nemaline myopathy with arthrogryposis during early gestation.

Nemaline myopathies are a clinically and genetically heterogeneous group of congenital myopathies, mainly characterized by muscle weakness, hypotonia and respiratory insufficiency. Here, we report a male foetus of consanguineous parents with a severe congenital syndrome characterized by arthrogryposis detected at 13 weeks of gestation. We describe severe complex dysmorphic facial and musculoskeletal features by post mortem fetal examination confirming the prenatal diagnosis.

HIF2α supports pro-metastatic behavior in pheochromocytomas/paragangliomas.

Mutations that drive the stabilization of hypoxia inducible factor 2α (HIF2α) and downstream pseudohypoxic signaling are known to predispose to the development of pheochromocytomas and paragangliomas (PPGLs). However, any role of HIF2α in predisposition to metastatic disease remains unclear. To assess such a role we combined gene-manipulations in pheochromocytoma cell lines with retrospective analyses of patient data and gene expression profiling in tumor specimens.

Session 1: The surgeon as a prognostic factor in colon and rectal cancer?

The impact of quality of surgery, colorectal surgical specialization, training and expertise has been far greater on survival outcomes than adjuvant and neoadjuvant therapies. The review of the evidence by Professor Martling and expert discussion addresses the evidence base and the crucial importance of the surgeon as a prognostic factor, and how this has been relatively neglected in comparison to other resources invested in improving the treatment of colorectal cancer.

Technological review on endoscopic submucosal dissection: available equipment, recent developments and emerging techniques.

Endoscopic submucosal dissection (ESD) is widely practiced in Japan and the Eastern World and is rapidly expanding in western countries for the management of early malignancies of the upper and lower gastrointestinal tube. In addition, novel therapeutic applications deriving from ESD have emerged including the treatment of achalasia, of submucosal tumors, of diverticula, of strictures and of reflux disease. An ESD procedure necessitates not only skills and specific training, but also familiarization with a vast spectrum of devices (endoscopes, high-frequency generators and their settings, endoknives, hoods, irrigation devices) and techniques (such as countertraction, artificial ulcer closure), that render the procedure faster, more efficient and safer.

Dynamics and Diagnostic Relevance of Kynurenine Serum Level after Kidney Transplantation.

Background: Inflammatory events after kidney transplantation (Tx) may lead to activation of the tryptophane-catabolizing enzyme indoleamine 2,3-dioxygenase followed by the formation of kynurenine (KYN). Post-transplant KYN serum levels in kidney allograft recipients were analyzed for their diagnostic value.

Material And Methods: This was a retrospective analysis of KYN levels (normal value: 2.

High graft protection and low incidences of infections, malignancies and other adverse effects with intra-operative high dose ATG-induction: a single centre cohort study of 760 cases.

Background: In 1990 we introduced the intra-operative single high-dose induction (HDI) with ATG-Fresenius as a novel renal sparing concept. The aim of this analysis was to compare both the long-term patient and graft survival and the incidences of adverse effects in recipients treated with standard triple-drug therapy (TDT) alone or with an additional HDI with ATG-F.

Material And Methods: A total of 760 renal transplant recipients receiving either TDT, consisting of steroids, azathioprine and cyclosporine (n=238) or TDT + 9mg/kg ATG-F intra-operatively (n=522) were included in this retrospective analysis.

Factors impacting short and long-term kidney graft survival: modification by single intra-operative -high-dose induction with ATG-Fresenius.

Background: A majority of recipients benefited from the intra-operative single high-dose induction (HDI) with ATG-Fresenius (ATG-F) still leaving a group of recipients who did not profit from this kind of induction. Therefore the aim of this retrospective analysis was 1st to identify the risk factors impacting short and long-term graft survival, and 2nd to assess the efficacy of this type of induction in kidney graft recipients with or without these risk factors.

Material/methods: A total of 606 recipients receiving two different immunosuppressive treatment regimens (1st: Triple drug therapy [TDT, n=196] consisting mainly of steroids, azathioprine and cyclosporine; 2nd: TDT + 9 mg/kg ATG-F intra-operatively [HDI, n=410]) were included in this analysis and grouped according to their kidney graft survival time (short GST: ≤1 yr, n=100 and long GST: >5 yrs, n=506).

IL-6 determination in serum of kidney graft recipients by a new bedside test: its diagnostic relevance.

Interleukin-6 (IL-6) has diagnostic importance as one of the earliest indicators of inflammation, tissue damage, hypoxia, or infection. In contrast to the time-consuming immunoassays actually used in many laboratories, results of a new IL-6 bedside test, which is interpreted visually or photometrically, are available at 20 minutes. The photometric measurement using a stored standard curve allowed differentiation of five ranges: <50, 50-100, >100-200, >200-500, and >500-1000 pg/mL.

The dynamics of antidonor antibody formation early after clinical kidney transplantation measured by flow cytometry and microcytotoxicity test.

To study the dynamics of antidonor sensitization 92 patients were monitored for antibodies against donor T and B spleen lymphocytes before transplantation, within the first month after transplantation and 3 months after transplantation. Patients were monitored for donorreactive antibodies (DRA) of immunoglobulin G (IgG), IgA, and IgM isotype using flow cytometry (FC) and the standard microcytotoxicity test (CYT). Graft function was followed for at least 2 yrs, 51% of patients for 3 yrs after transplantation.

Eleven years intraoperative ATG bolus. A list of successes.

Induction therapy for organ transplantation using monoclonal antibodies has been in recent years reevaluated. Results from various centers indicate the value of such therapy, especially in sensitized patients undergoing kidney transplantation as well as in simultaneous kidney--pancreas transplant patients. Author presents the experience of eleven years of intraoperative ATG bolus administration in the Berlin--Friedrichshain Kidney Transplantation Center.

Lipopolysaccharide-binding protein as a new and reliable infection marker after kidney transplantation.

The early and reliable differentiation of rejections, viral infections and bacterial infections is one of the main problems after organ transplantation. One promising solution to this problem is the lipopolysaccharide-binding protein (LBP), which is regulated upwards in gram-negative sepsis and related conditions. Therefore, the aim of our study was to explore the diagnostic potential of LBP serum levels in well-defined, non-infectious and infectious events after kidney transplantation (KTx).

Increasing urinary IL-6 levels announce kidney graft rejection.

Acute rejection (AR) is the recipient's inflammatory response to the grafted organ. Within the graft-infiltrating cells, a high ratio of IL-6 producing cells can be found, indicating local IL-6 production. Therefore, in cases of kidney transplantation, urinary (u) IL-6 should be detectable.

Epstein-Barr virus infection after kidney transplantation.

Besides the well-known association of Epstein-Barr virus (EBV) and lymphomas developing posttransplantation, there are only a few data concerning the prevalence of EBV antibodies (abs) in organ donors and recipients, the posttransplant development of antibody titer in the recipient population, the extent of EBV-IgM seroconversion, and the clinical and laboratory signs associated with infection. Therefore, in a retrospective analysis, we evaluated the data of 119 organ donors and 215 kidney graft recipients who received their kidney allografts between 1993 and 1995. A total of 665 sera were quantitatively tested by means of immunofluorescence assay for EBV abs against capsid (CA; IgM, IgG), early (IgG), and nuclear (IgG) antigens.

HLA class I and class II antibodies: monitoring before and after kidney transplantation and their clinical relevance.

Background: In search of an alternative screening technique, we compared complement-dependent cytotoxicity (CDC) with PRA-STAT, a commercially available enzyme-linked immunosorbent assay (ELISA).

Methods: A total of 188 pre- and posttransplant sera from 50 renal allograft recipients were tested with both methods.

Results: A significant correlation was found between both methods.

Dynamics of donor-reactive IgG, IgA and IgM antibodies against T and B lymphocytes early after clinical kidney transplantation using flow cytometry.

Using flow cytometry, 32 kidney graft recipients were monitored retrospectively for at least 1 month to study the dynamics of serum IgG, IgA and IgM antibodies against donor T and B lymphocytes before and after transplantation. Donor spleen lymphocytes were used as targets. In the B cell cross-match, the surface immunoglobulins were blocked with an anti-human immunoglobulin antibody.

A critical analysis of soluble interleukin-2 receptor levels in kidney allograft recipients.

Soluble interleukin-2 receptor (sIL-2R) was measured by the Cellfree Kit (T Cell sciences) in 103 pretransplant and 1590 posttransplant samples from 103 patients with cadaveric kidney allografts. The mean values (+/- SD) detected in pretransplant sera were significantly higher (1932 +/- 1389 U/ml) than in 72 healthy adults (267 +/- 139 U/ml), but after transplantation they continuously fell towards normal levels within the first 3 postoperative weeks. Recipients with acute rejection episodes showed higher sIL-2R levels (1762 +/- 904 U/ml) than those with stable transplants at discharge (937 +/- 398 U/ml).