PubMed Health⌕ Search

Biomedical subjects

K Dreikorn

Publications and source records attributed to K Dreikorn.

At least 19 recordsLinked to original sources
PubMed1992

Problems of the distal ureter in renal transplantation.

The incidence and mortality rates of urologic complications in renal transplantation have decreased significantly during the last decade. This was achieved by improved techniques of donor nephrectomy with preservation of the ureteric blood supply and refined procedures for the reconstruction of the urinary tract. Intra- and extravesical ureteroneocystostomies have shown to be the most reliable and preferred techniques to restore the urinary tract continuity. Beside ureteral ischemia and technical failure ureteral rejection is increasingly accepted as an important contributory factor for the development of ureteric fistula and stenosis formation. Controversy still exists concerning the pathogenesis of reflux into the graft and its impact on long-term graft function. Percutaneous and endoscopic procedures have supplemented and partially replaced open surgical management of ureteric fistulas and stenoses. By adherence to the principles described the frequency of urologic complications and its associated mortality rates can be minimized.

Graft Rejection↗
PubMed1992

Surgical treatment of acute epididymitis and its underlying diseases.

Two hundred and seventy of 1,031 patients (26%) treated for acute epididymitis between 1979 and 1989 underwent surgery for their disease. Eighty percent of these interventions were therapeutic, 20% diagnostic to exclude testicular torsion or tumor. Diagnostic procedures detected underlying diseases that required surgery in 278/1,031 patients (27%). Two hundred and sixteen of these diseases caused lower urinary tract obstruction and were potentially responsible for the acute epididymitis. There were striking differences in type and frequency of the surgery performed depending on the patients' age. Surgery of epididymitis was almost exclusively diagnostic in patients of a young age (exclusion of testicular torsion) and almost always therapeutic in patients of an old age (abscess, prolonged disease). The rate of surgery for underlying diseases was the same for the young (55%) and old (62%) age groups. Obstruction of the lower urinary tract was the predominant cause for surgical treatment of underlying diseases, being mainly due to malformation in the young age group and due to acquired obstructive diseases in the old.

Acute Disease↗
PubMed1992

[Organ preservation].

For organ preservation in Europe the Euro-Collins-, UW- and HTK-solution are preferred. While the HTK-solution is mainly used for heart preservation, the UW-solution has shown its advantages for longterm preservation of kidney, liver and pancreas. With regard to renal preservation the HTK-solution provides a higher buffer capacity. According to experimental and theroretical considerations the content of glucose in the Euro-Collins-solution does not seem to correspond to the current state of knowledge. In order to obtain a sufficient primary function renoprotective measurements have proven their efficacy, in addition to an optimal method of organ preservation. Especially in case of suboptimal donors the preservation time should be kept as short as possible.

Animals↗
PubMed1979

[Kidney transplantation in children].

Ten years' experience of renal transplantation in 40 children (aged 5--18 years) is reviewed. Including 3 second transplantations 40 cadaver grafts and 3 living donor grafts were transplanted. Mean graft survival was found to be 19 months, the longest being 8 years. At the time of last examination 24 children were alive wtith a functioning graft (mean serum creatinine level 1.5 mg/dl). After graft failure 9 children were again on intermittent hemodialysis. 7 children had died mainly because of infections or cardiovascular complications. Cumulative survival rate of patients and cadaver grafts after 2 years was 84 and 53% respectively. Growth velocity was variable but improved in the majority of patients compared to the previous dialysis period. Full social rehabilitation could be achieved in every case. Main complications were acute rejections (irreversible in 7 of 67), chronic rejections (irreversible in 6 of 10), side effects of immunosuppressive drugs (infections; hematologic, metabolic, and bone disorders), hypertension (60%), recurrence of primary renal disease (in 5 of 9 patients with focal segmental glomerulosclerosis) and surgical complications (28%). Therapeutic guide-lines are given emphasizing the role of specialized children's centres and the cooperation between pediatric nephrologists, immunologists, urologists and psychologists including the time before, during and after transplantation.

Adolescent↗
PubMed1979

Alloplastic replacement of the partially resected canine urethra by expanded polytetrafluoroethylene grafts. Preliminary results.

In 12 male dogs 3-8 cm of the penile urethra were resected and replaced by expanded polytetrafluoroethylene (GORE-TEX) grafts. Follow-up consisted of periodic urethrograms. Maximum observation time has been 12 months. Up to now, no major complications were noted. Tissue reactions were minimal and patency of all grafts was demonstrated during the follow-up period.

Animals↗
PubMed1979

Urodynamic studies in prune belly syndrome. A case report.

Urodynamic studies were carried out in a 14-year-old boy with Prune Belly Syndrome and terminal renal failure prior and after successful renal transplantation. Increased bladder capacity, nonprovocative detrusor instability and a high compliance were the most characteristic findings during the filling phase of the bladder. During the voiding phase an increased detrusor pressure was demonstrated. Outflow resistance and maximum urinary flow rate were within normal range before and after transplantation. In contrast to the findings before renal transplantation, however, micturition was imbalanced after transplantation (residual urine 100 ml). Urodynamics revealed that the bulging of the posterior urethra, observed in the early voiding phase, was due to a congenital insufficiency of the posterior urethral musculature (megalourethra) and not caused by mechanical obstruction leading to urethral dilatation. It is suggested that detrusor-bladder-neck-dyssynergia is the primary cause of the imbalanced micturition and its consequences (bladder distention, reflux, urinary tract infection, hydronephrosis, pyelonephritis) in patients with Prune Belly Syndrome. The findings of a normal, respectively increased detrusor activity are in contrast to the observations of some authors, describing attenutation and absence of detrusor muscle fibres. The indications and effects of transurethral resection and internal urethrotomy, proposed by some authors, are discussed.

Abdominal Muscles↗
PubMed1979

[Organ preserving surgical treatment of solitary and bilateral renal tumors].

The surgical treatment of patients with tumours in solitary kidneys and bilateral renal tumours is controversial. Conservative surgical procedures by excision of the tumour in situ or by extracorporeal "work bench surgery" with subsequent autotransplantation are a real alternative to radical nephrectomy which necessitates chronic dialysis or renal allotransplantation. 23 patients with tumours in solitary kidneys resp. bilateral renal tumours have been treated by local excision in situ (10 patients) or extracorporeal surgery (15 patients). The preoperative diagnostic investigations, indications for in situ resp. extracorporeal surgery, details of the operative procedure and results of treatment are presented and discussed.

Carcinoma↗
PubMed1979

The Lewis antigen system and its relevance for clinical transplantation.

The influence of the Lewis blood group system on transplant survival was studied retrospectively in 161 kidney transplantations. Le (a-b+) recipients had significantly higher graft survival rates than Le (a+b-) or Le (a-b-) recipients. From the known distribution of the Lewis blood groups among the European population, a high percentage of Lewis-compatible transplants would be expected among Le (a-b+) recipients in contrast to the Le (a+b-) and Le (a-b-) recipients. Other factors which are known to influence transplant prognosis such as HLA-match between donor and recipient, ischemic time of the transplants and pretransplant blood transfusions did not differ significantly in any of the three groups studied. Our data again suggest the relevance of the Lewis blood group system for clinical kidney transplantation. The findings should be confirmed by prospective typing of donor and recipient for Lewis antigens.

Graft Survival↗
PubMed1979

[Conservative surgery of spontaneous rupture of renal grafts].

17 cases of spontaneous rupture of renal allografts were noted after 285 renal transplantations performed during the years 1967-1978. All ruptures occurred within the first two weeks after transplantation. Acute rejection, combined with hypertension, dialysis and/or anticoagulation seem to be the main etiological factors of graft rupture. Due to severe hemorrhage surgical exploration had to be performed in 15 patients. While removal of the graft was necessary in 4 patients the kidney could be preserved by tamponade and suture in 11 patients. 5 patients later lost their graft, due to chronic rejection, while 8 patients (6 of the 15 patients who needed surgical exploration) currently have satisfactory graft function.

Anticoagulants↗
PubMed1979

[Treatment of ureteral obstruction and urinary fistulas after kidney transplantation].

In 285 renal transplantations, performed during the years 1967-1978, 6 ureteral obstructions (2,1%) and 15 urinary fistulas (5,3%) were observed. Ureteral obstructions occurred in the late phase after transplantation and were caused by strictures at the uretero-vesical anastomosis (two patients), compression of the ureter by enlarged kidney during rejection (one patient) resp. lymphocele (one patient) and strictures at the pyelo-ureteral junction (two patients). Satisfactory results were achieved by surgical treatment in all patients. Urinary fistulas occurred in the early postoperative phase. Two vesical, 12 vesico-ureteral and one calyceal fistula were observed. 7 fistulas (1 vesical, 6 vesico-ureteral) closed spontaneously after temporary drainage of the bladder. 8 fistulas were repaired surgically. While satisfactory results were obtained in 13 patients, two patients died due to infection and sepsis after reoccurrence of fistulas.

Drainage↗
PubMed1979

Renal graft evaluation with pertechnetate and I-131 Hippuran. A comparative clinical study.

This retrospective study compared standard clinical and biochemical data from 50 graft recipients against 533 I-131 Hippuran sequential scintigrams and 515 [99mTc]pertechnetate serial scintigrams. All grafts included in this study are cadaver kidneys. The majority of the studies were made during the early posttransplantation period. Anuria or oliguria of at least 4 days duration was seen in 18 patients. The study spans 574 days of oliguria during which 136 dual-tracer studies were made. I-131 Hippuran renography of functioning grafts was carried out 397 times, and the Tc-99m sequential scintigraphy 379 times. In all, 47 espisodes of actue rejection were registered clinically in functioning gfafrs, 36 of which were recognized during Hippuran renography and 38 with the pertechnetate study. False-positive errors were seen 12 times during renography. The study also demonstrated that furosemide will significantly and predictably influence renography and the pertechnetate study. This seems noteworthy since furosemide is extensively used in posttransplant management.

Adolescent↗
PubMed1979

Influence of the Lewis blood group system on clinical kidney transplantation.

The different Lewis phenotypes were determined retrospectively in 201 kidney transplant recipients. Transplant survival rates in Lewis compatible recipients were significantly higher (p less than 0.0005) than in Lewis incompatible recipients. The improvement of transplant prognosis by matching for Lewis antigens was confirmed by a prospective study comprising 55 donor/recipient combinations. HLA matching had little benefit on transplant survival whereas survival rates are strikingly increased by Lewis compatibility. In the Lewis compatible but HLA mismatched group, graft survival was definitely higher than in the HLA matched but Lewis mismatched group. Our data indicate that Lewis antigens play an important role in transplant prognosis. Compatibility in the Lewis system should therefore be considered when recipients are selected.

ABO Blood-Group System↗
PubMed1978

Antibody coating of urinary bacteria in transplanted patients.

24 patients with renal transplants were studied beyond the immediate postoperative period (greater than 8 weeks p.o.) for a period of 6 months in three weekly intervals. Quantitative bacteriology (dip slide method) and immunofluorescence microscopy (antibody coating of urinary bacteria) of the urine were regularly performed. Urinary tract infection was found in 13 of 24 patients, being permanent in 9 and episodic in 4 of the patients. There was no correlation between presence of urinary tract infection and deterioration of renal function. Mixed infection was found in 7 of the 13 patients and monoinfection in the others. In 7 out of these 13 patients, antibody coating of urinary bacteria could be demonstrated by immunofluorescence microscopy. In 3 of the 7 cases with antibody coating, this was permanently positive, in the other 4 it was intermittently positive. In only 1 case could conversion to positive antibody coating be attributed to urological complications (pyelostomy). Both IGG and IGA were demonstrable in 6 of 7 cases with positive antibody coating and IGG exclusively was demonstrable in 1 more case. IGM was questionably positive in 1 case and complement (beta1C) could not be demonstrated in any of the patients. This investigation shows that despite immunosuppression patients with renal transplants are able to mount an immune response against urinary tract infections.

Adolescent↗
PubMed1978

Alloplastic replacement of the canine ureter by expanded polytetrafluoroethylene (gore-tex) grafts. Preliminary report.

In 12 female dogs, subtotal unilateral (8 dogs) or bilateral (4 dogs) ureteric resection and replacement by expanded polytetrafluoroethylene (Gore-Tex) prostheses were performed. Follow-up consisted of periodic excretory urographies. Short- and long-term results, consisting of periodic excretory urographies for up to 12 months, are promising and induce further studies with this new type of graft.

Animals↗
PubMed1978

Long-term results in children following dialysis and renal transplantation.

Since 1966, 93 children in end-stage renal disease, aged between 5 and 16 years were treated by a combined programme of dialysis and transplantation. In 91 patients treatment of uraemia was started either as hospital or home haemodialysis, until now covering more than 90 dialysis years. Forty-one children were transplanted. Twenty children died during dialysis treatment, 7 after renal transplantation. Sixty-six children are currently alive, 25 with a functioning graft, 28 are treated by hospital dialysis, 13 by home haemodialysis. Eighty-three per cent of the patients on hospital dialysis are classified in rehabilitation category 2 according to the EDTA categories, and all children on home dialysis and those with functioning grafts, category 1.

Adolescent↗
PubMed1977

The use of double renal transplants from paediatric cadaver donors.

In 224 consecutive kidney transplantations, 3 patients, aged 44, 37 and 13 years received double renal transplants from paediatric cadaver donors aged 1 day, 23 and 19 months respectively. Both adult recipients developed severe hypertension during postoperative rejection crises leading to multiple graft ruptures in the recipient of the neonatal kidneys. 1 patient died from massive gastrointestinal bleeding 4 weeks after transplantation while kidney function was satisfactory. Excellent graft function was achieved in the 3rd patient. The techniques of removal, preservation and transplantation of double renal transplants are described. The significance of increasing the potential number of donor kidneys by the use of paediatric cadaver donors is stressed.

Adolescent↗
PubMed1977

Prune belly syndrome: treatment of terminal renal failure by hemodialysis and renal transplantation.

The second case of successful renal transplantation in a patient with "prune belly" syndrome is reported. In spite of early aggressive surgical approach in the management of this disease terminal renal failure frequently ensues. Hemodialysis and renal transplantation have offered new possibilities of prolonging life in these patients. The success of renal transplantation depends on the anatomic and functional state of the lower urinary tract. Pretransplant urologic examination is extremely important for the evaluation of urinary tract abnormalities.

Abdominal Muscles↗