Biomedical subjects
R Küss
Publications and source records attributed to R Küss.
[Results of one year (1978) of kidney transplantation (author's transl)].
Kidney transplantation in France is not as common as both patients and health authorities would wish. While at least 1 000 transplantations would be required each year, only 550 were done in 1978. The authors report on the experience of a team which for the first time was able to perform 75 transplantations in one year, and bring to the pull of transplantation 74 cadaver kidneys. The 75 patients will be followed up by the same group which operated upon them not only during the post-operative period, but also for many years to come. As far as possible, the team endeavours to transplant kidneys from local donors or sent directly to the surgeons. Such a "regionalisation" of kidney transplantations suffers from the drawback of lesser compatibility, but makes it possible to obtain the expected results.
Renal transplantation in hamsters.
Hamsters have never before been used for experimental kidney transplantation. An original anesthetic and microsurgical protocol is presented for renal transplantation in hamsters based on a series of 152 orthotopic renal transplantations. This operation is performed with the animal under general anesthesia of acepromazine and sodium thiopental. A left nephrectomy is followed by left renal orthotopic transplantation. The transplantation is performed in the following order: anastomosis of the renal artery and aorta, anastomosis of the renal vein to the inferior vena cava, and implantation of the ureter in the bladder. The survival rate after contralateral nephrectomy was 71 % in 45 female hamsters. Male hamsters should not be used because of a high risk of severe periureteral stenosis caused by fibrosis secondary to necessary dissection of the large seminal vesicles. The prevention of hypothermia in hamsters is mandatory.
[Immediate renal function after kidney transplantation (author's transl)].
The postoperative course management of kidney transplant patients appears to be easier when a large efficient diuresis resumes without delay. A decreased hemodialysis rate is observed and diagnosis of rejection is easier. Immediate diuresis resumed in 180 out of 186 (97%) recipients who received a large fluid load, given under mean pulmonary arterial pressure (PAP) monitoring. The purpose of fluid load is to provide the graft with an optimal blood flow immediately after vascular clamp release. The optimal filling pressure required varies according to initial PAP value. Fluid load aims to raise PAP to reach 25 mm Hg when the initial value is below this figure whereas it merely maintains the initial value when PAP is at 25 mm Hg or above. Mean peroperative fluid load reaches 3860 ml of water with 33 g of sodium chloride, 600 ml of 20% albumin and 3 units of packed red blood cells. During the immediate postoperative course a minimal 400 ml/h urine output is aimed at. Good hemodynamic tolerance is maintained through deliberate controlled ventilation during the first six postoperative hours. Application of this protocol was associated with general improvement of kidney transplantation outcome.
[General or specialized surgery? A duality no longer valid?].
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Estramustine phosphate in the treatment of advanced prostatic cancer.
Thirty patients with advanced carcinoma of the prostate were treated with estramustine phosphate. All patients were followed up for a minimum of 9 months. Of 15 not previously treated with oestrogens 9 responded objectively and 11 subjectively. Of 15 patients whose tumours had failed to respond to at least 2 oestrogens, 3 responded objectively and 5 subjectively. Adverse effects consisted of cardiovascular complications, gynaecomastia and impotence. Gastrointestinal side effects were minimal and no hepatic, renal or marrow toxicity was seen. The criteria of assessment of response are discussed.
Diagnosis and treatment of renal angiomyolipoma (based on 15 cases). Arguments in favor of conservative surgery (based on 8 cases).
Angiomyolipoma should be suspected when a renal tumor is present especially when the patient is young, the tumor is bilateral, associated with hemorrhagic incidents or if there are multiple tumors in one kidney. When tuberous sclerosis is present the diagnosis is easier and when it is not, arteriography and tomodensitometry are of great help. The benign nature of these tumors is not an argument in favor of nonsurgical treatment. They may sometimes be associated with an authentic malignancy which underlines the necessity of confirming the diagnosis by peroperative examination of a frozen section. When angiomyolipoma is confirmed the surgical treatment of this benign tumor should, in our opinion, be conservative considering the frequency of bilateral disease. This approach is supported by the results published and by our own 8 cases treated by conservative surgery.
Bilateral ureteral necrosis in a child with dermatomyositis.
A nearly symmetrical ureteral necrosis was observed in a child with dermatomyositis. The ureters were treated conventionally by resection, anastomosis and repeated catheterization with good results.
[Scanner examination of the kidney].
On the basis of a large series of documents, the authors participate in establishment of the classification of scanner appearances of urological diseases of the kidney : peripheral or parapelvic sub-capsular cysts, carcinomas and their spread, multiple tumours but of different nature in the same kidney, angiomyolipomas, polycystic disease, renal abscess, hydated cyst, non-invasive exploration of kidneys showed to be non-functioning by I.V.U., tumours of the intrarenal excretory system, lumbar trauma, long-term surveillance of the retroperitoneal space in individuals undergoing surgery for a urological malignant renoureteric tumour. The authors suggest a new chronological arrangement of investigations in the presence of a renal mass discovered by I.V.U. Scanner has its place between echotomography and renal arteriography. Investigations may be stopped at renal echotomography when this examination offers definite evidence of the fluid nature of the mass. Solid or doubtful nature of the mass necessitates the use of a scanner examination.
[Contraceptive vasectomy. Study of apropos of 100 cases].
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The contribution of France to the progress of urology.
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Early anuria prevention in human kidney transplantation. Advantage of fluid load under pulmonary arterial pressure monitoring during surgical period.
In human kidney transplantation, a high blood flow established through the graft immediately upon clamp release is usually associated with immediate satisfactory renal function. One hundred consecutive kidney transplant patients were thus provided with a large volume of fluid during surgery. To avoid pulmonary edema, fluid load was given under mean pulmonary arterial pressure (PAP) monitoring, and controlled ventilation was maintained during the early postoperative period. Whether initial PAP value was within normal range or elevated, all patients required an equivalent fluid load to reach the best hemodynamic condition upon clamp removal. The mean intraoperative fluid load consisted of 2406 +/- 968 ml of water with 22.8 +/- 9.4 g of sodium chloride, 5.9 +/- 1.8 units of albumin, and 2.6 +/- 1.8 units of packed red blood cells. Immediately before clamp release patients were given furosemide and mannitol. During the postoperative period, i.v. infusions consisted of water and sodium chloride (6 g/liter) to match urine output, provided that diuresis was equal to or above 400 ml/hr. If diuresis remained or decreased below this level, diuresis replacement was associated with PAP-controlled infusion of saline, albumin, and red blood cells if needed. Furosemide was eventually given if diuresis did not increase above 400 ml/hr with fluid loading. With this protocol a good early diuresis was established in 95% of the cases. Ten patients required dialysis before the 5th postoperative day, one of them because of fluid overload and anuria. Concurrently, a decreased mortality rate and an increased graft survival rate were observed.
[The passage of antibiotics into prostatic secretions: theoretical and experimental study. Apropos of a new urinary antibiotic: oxolinic acid (proceedings)].
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[Long-term course of mega-ureters: their appearance in adults].
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The effect of transurethral resection of the prostate on lymphocyte response in patients with prostatic cancer.
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[Embolization of prostatic arteries, a rescue approach in uncontrolled hemorrhage after adenomectomy (proceedings)].
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Dense deposit disease: long term follow-up of three cases of recurrence after transplantation.
The incidence and early recurrence after transplantation prove the specificity of the appearance of an electron dense alteration of kidney basement membrane often called dense intra-membranous deposit disease. Three new cases with dense deposit disease affecting the original kidneys have been followed-up after transplantation for periods ranging from 4 to 8 years and illustrate the natural history of the recurrence. Serial kidney biopsies showed the predominance of dense deposits near the mesangial area and the vascular pole. These deposits were also seen in some tubular basement membranes. Absence of cell proliferation was noted in all biopsies performed. Immunofluorescence studies revealed fixation of C3 alone. Histological signs of recurrence are compatible with the absence of clinical and biological signs. Transient or permanent proteinuria and microhematuria were common findings. Serum complement levels, measured after transplantation, were low in all three cases. Despite recurrence of the original glomerulonephritis, long-term survival of the graft was commonly observed, two cases being followed-up for 7 and 8 years. Patients with dense intra-membranous deposits glomerulonephritis should not be excluded from a transplantation program. One of the three cases reported here illustrates the exceptional association of recurrence of dense intramembranous deposits, de novo membranous glomerulonephritis and chronic rejection.
[Arterial embolization in surgical pathology. A trial involving 250 cases].
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