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  • 1
    Digitale Medien
    Digitale Medien
    A randomized controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients (2004)
    Oxford, UK : Blackwell Science Ltd
    British journal of dermatology 151 (2004), S. 0 
    Details
    ISSN: 1365-2133
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background  Transplant recipients have an increased propensity to develop multiple actinic keratoses, which demonstrate an increased transformation rate into invasive squamous cell carcinoma.Objective  To evaluate the efficacy and tolerability of topical photodynamic therapy with the new highly tumour-selective photosensitizer methyl aminolaevulinate vs. placebo in the treatment of actinic keratoses in transplant recipients.Methods  Seventeen transplant recipients with a total number of 129 mild to moderate actinic keratoses were enrolled in a prospective, randomized, double-blind, placebo-controlled study. Two lesional areas within a patient were randomized for two consecutive treatments of topical photodynamic therapy 1 week apart using either methyl aminolaevulinate or placebo cream. Sites were illuminated with 75 J cm−2 of visible light delivered at 80 mW cm−2 by a noncoherent light source. Complete resolution and reduction in the number or size of actinic keratoses within the lesional area relative to the initial findings were evaluated at weeks 4, 8 and 16 after treatment.Results  The lesional areas treated with methyl aminolaevulinate were clinically cleared in 13 of 17 patients at 16 weeks. A partial response was recorded in a further three. No reduction in the size or number of actinic keratoses was observed in one area treated with methyl aminolaevulinate and in all placebo-treated areas. Adverse events, such as erythema, oedema and crust formation, were mild to moderate, and treatment was well tolerated by all patients.Conclusion  Photodynamic therapy using methyl aminolaevulinate is a safe and effective treatment for actinic keratoses in transplant recipients. It may also reduce the risk of transformation of actinic keratoses to invasive, potentially fatal, squamous cell carcinoma.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2133.2004.06054.x
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  • 2
    Digitale Medien
    Digitale Medien
    Late complications after total hip replacement in renal allograft recipients (1994)
    Springer
    International orthopaedics 18 (1994), S. 368-371 
    Details
    ISSN: 1432-5195
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Résumé Cinquante six transplantés rénaux (TR) ont été traités par arthroplastie totale de hanche (ATH) pour nécrose aseptique de la tête fémorale (NA), de 1972 à 1992 (recul moyen 6.9 ans). Huit hanches (10.1%) chez 6 patients (11.3%) ont dû être réopérées pour descellement aseptique après un délai moyen de 11.2 ans. Trois patients ont présenté une arthrite septique à Salmonella enteritidis, 6.2 ans en moyenne après l'intervention. Un des trois patients a été traité par révision de l'arthroplastie, le deuxième par une dèsarticulation de hanche en raison d'un risque vital et le troisième par antibiothérapie. Deux fois sur les trois, l'examen bactériologique des urines a révélé la présence de salmonelles. L'analyse des courbes de survie en cas d'ATH et de TR montre un risque de réintervention sur la hanche de 9.9% à dix ans et de 54.6% à quinze ans et un risque de mortalité de 32.2% à dix ans et de 42.2% à quinze ans. Donc les patients qui survivent quinze ans ont plus de risque de voir leur prothèse se desceller que de mourir. L'espérance de vie pour TR n'ayant cessé d'augmenter grâce à l'amélioration des traitements immuno-suppresseurs, les prothèses non-cimentées peuvent représenter une alternative intéressante pour ces jeunes patients, même s'ils souffrent d'une ostéopathie rénale et d'une ostéoporose par corticothérapie.
    Notizen: Summary Seventy nine hips in 53 recipients of renal allografts were treated by cemented total hip replacement for avascular necrosis of the femoral head between 1972 and 1992. Eight hips in 6 patients required revision for aseptic loosening after a mean of 11.2 years. Three replacements in 3 patients became infected with salmonella enteritidis after a mean of 6.2 years. One was revised, one had a disarticulation of the hip, and the third was treated with long term antibiotics. Survivorship analysis for total hip replacement and the renal allografts showed a hip reoperation rate of 9.9% at 10 years and 54.6% at 15 years with mortality rates of 32.2% and 42.2% respectively. Thus patients surviving 15 years are at a higher risk of failure of the prostheses than of dying.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00187084
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  • 3
    Digitale Medien
    Digitale Medien
    Transplantatpyelonephritis (1980)
    Springer
    Journal of molecular medicine 58 (1980), S. 73-84 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Kidney allograft transplantation ; Urinary tract infection ; Leucocyturia ; Antibody-coated bacteria ; Transplant pyelonephritis ; Nierentransplantation ; Harnwegsinfekt ; Leukozyturie ; antikörperbesetzte Bakterien ; Transplantatpyelonephritis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung Anläßlich von 1802 Urinuntersuchungen bei 216 ambulanten Trägern von Nierenallotransplantaten wurden 274 signifikante Bakteriurien festgestellt. Bei 30 Patienten wurden rezidivierende oder chronisch persistierende Harnwegsinfekte beobachtet, wobei 399 Befunde von Urinuntersuchungen ausgewertet wurden (13,3 Untersuchungen pro Patient). Es handelte sich um 15 Patienten mit klinischer und/oder pathologisch-anatomisch verifizierter Transplantatpyelonephritis und um 11 Patienten mit Cystitis. Vier Patienten mit urologischen Komplikationen nach Transplantation wurden von der Studie ausgeschlossen. Besonderes Gewicht für die Diagnose einer Transplantatpyelonephritis erlangen kontinuierliche Leukozyturie und der Nachweis antikörperbedeckter Urinbakterien. Beide Befunde wurden bei allen Patienten mit Transplantatpyelonephritis mehrfach erhoben. Wichtige klinische Symptome sind Fieber und Dysurie. Im Gegensatz zur Kontrollgruppe mit Cystitis kann bei 13 von 15 Patienten mit Transplantatpyelonephritis eine Abnahme der Transplantatfunktion festgestellt werden; zwei Patienten wurden erneut dialysebedürftig. Eine weitere schwerwiegende Komplikation stellt die Urosepsis bei acht von 15 Patienten dar. Die Ergebnisse weisen mit 15 Erkrankungen bei 26 Patienten auf die Häufigkeit einer Transplantatpyelonephritis bei chronischer Harnwegsinfektion nach Nierentransplantation hin. Begünstigt wird ihr Auftreten durch eine Abflußbehinderung in den ableitenden Harnwegen (acht von 15 Patienten) und durch hochdosierte immunosuppressive Therapie: acht der 15 Patienten erhielten beim Auftreten der Pyelonephritis mehr als 10 mg Prednison/die. Durch Infektkontrolle konnte die Nierenfunktion bei drei Patienten gehalten werden, bei Abschluß der Untersuchung war die Funktionseinbuße des Transplantates bei vier Patienten teilweise reversibel.
    Notizen: Summary Examinations of the urine in 216 kidney allograft recipients resulted in significant bacteriuria in 274 samples of 1,802 urines tested. Bacteruria was found in 30 patients with recurrent or chronic persistent infections of the urinary tract; this patient group was studied by examination of 399 urine samples (mean 13.3 samples per patient). Four patients suffered from urologic complications after kidney grafting and were excluded from the study; 15 patients were diagnosed clinically and/or histologically with transplant pyelonephritis, 11 patients with cystitis. Of main importance for the diagnosis of transplant pyelonephritis were findings of persistent leucocyturia and the presence of antibody-coated bacteria. Both of these findings were repeatedly seen in all patients with transplant pyelonephritis. Clinical symptoms included fever and dysuria. In contrast to patients suffering from cystitis, transplant function detoriated in 13 of 15 patients with transplant pyelonephritis; two patients had to be treated by hemodialysis. Septicemia occurred in eight of the 15 patients studied. The data illustrate the frequency of transplant pyelonephritis as observed in 15 of 26 patients accompaining chronic urinary tract infection after kidney allograft transplantation. As a predisposing factor, obstruction of the urinary tract was diagnosed in eight of the 15 transplant recipients with pyelonephritis. The prednisone dose was higher than 10 mg in eight of 15 patients at the time transplant infection was diagnosed. Successful antibiotic treatment resulted in stable transplant function in three patients; four patients exhibited even lower serum creatinine levels after therapy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01477191
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  • 4
    Digitale Medien
    Digitale Medien
    Successful pregnancy in advanced renal failure without dialysis (1989)
    Springer
    Pediatric nephrology 3 (1989), S. 189-190 
    Details
    ISSN: 1432-198X
    Schlagwort(e): Pregnancy ; Advanced renal failure
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We describe a successful pregnancy in a 22-year-old patient with advanced renal failure, who gave birth to a living boy in the 35th week of pregnancy. At the time of spontaneous delivery the mother had a serum creatinine of 851 μmol/l. No dialysis treatment had been instituted during this successful pregnancy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00852908
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  • 5
    Digitale Medien
    Digitale Medien
    Fragliche Aussagekraft der chemischen Analyse eines einzelnen 24 h-Urins bei rezidivierender Kalziumoxalat-Nephrolithiasis (1986)
    Springer
    Journal of molecular medicine 64 (1986), S. 411-416 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Calcium ; Oxalate nephrolithiasis ; 24 h urine ; Chemical analysis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Chemical findings were obtained from 24 h urine samples of 43 male calcium-oxalate stone-formers on an unrestricted diet. Results were compared with data from 51 age-matched healthy blood donors. No differences were found in the excreted quantities of calcium, oxalic acid, uric acid and inorganic phosphate, nor in the calcium to creatinine ratio or the activity product of calcium and oxalic acid. The only differences were a higher output of magnesium and a higher magnesium to calcium ratio for controls. The extent of these differences, however, does not justify further subdivision of the group of stone-formers. The diagnostic and therapeutic significance of the chemical analysis of one 24 h urine sample is doubtful for this group of patients.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01727526
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  • 6
    Digitale Medien
    Digitale Medien
    Behandlung der Peritonitis während kontinuierlich ambulanter Peritonealdialyse (CAPD) mit Co-Trimoxazol, Cefazolin oder Vancomycin (1987)
    Springer
    Journal of molecular medicine 65 (1987), S. 562-570 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Peritonitis ; CAPD ; Initial treatment
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Three initial treatment schedules of peritonitis during continuous ambulatory peritoneal dialysis are analysed. In 20 patients 56 peritonitides were treated by co-trimoxazole, 29 episodes in 20 patients by cefazolin, and 29 infections in 22 patients by vancomycin. The efficiency of the treatment modes was comparable. Vancomycin was found to be appropriate in particular because of the resistance characteristics of bacterial isolates.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01727623
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  • 7
    Digitale Medien
    Digitale Medien
    Reversibles Azathioprin assoziiertes dysmyeloproliferatives Syndrom nach Nierenallotransplantation (1987)
    Springer
    Journal of molecular medicine 65 (1987), S. 620-624 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Reversible myelodysplasia ; Azathioprine ; Kidney allotransplantation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Three recipients of kidney allotransplants developed dysmyeloproliferative syndromes which were fully reversible after switching from azathioprine to cyclosporin A for immunosuppression. Similar bone marrow changes described in the literature progressed to leukemia. Whether the abnormalities observed in our patients could be early stages of the disease described in the literature and whether a fatal development can be prevented by changing the immunosuppressive therapy remains to be elucidated.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01726672
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  • 8
    Digitale Medien
    Digitale Medien
    Acute uric acid nephropathy in two gouty patients with moderate hyperuricemia and high urine acidity (1990)
    Springer
    Journal of molecular medicine 68 (1990), S. 874-879 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Acute uric acid nephropathy ; Hyperuricemia and gout ; Renal tubular defects in gout
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Acute uric acid nephropathy has been described almost uniformly in patients with massive uric acid overload (malignancies with rapid cell destruction, epileptic seizures). Severe hyperuricosuria and intratubular uric acid precipitation result. Here we present two patients with gout, normal uric acid production, and moderate hyperuricemia, both of whom developed acute uric acid nephropathy. Because of pronounced urine acidity (pH values of 4.6 and 5.0 in morning fasting urines), supersaturation with respect to undissociated uric acid exceeded solubility (0.54 mmol/l), despite basal urate secretions of less than 2.2 mmol/24 hours. Additional predisposing factors, such as uricosuric treatment, heavy beer-drinking, over-consumption of purine-rich foods, and hot environment, were superimposed in both cases.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01662787
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  • 9
    Digitale Medien
    Digitale Medien
    Einflu\ von Absto\ungskrisen und immunsuppressiver Therapie auf die Lymphozytensubpopulationen von Patienten nach Nierentransplantation (1990)
    Springer
    Journal of molecular medicine 68 (1990), S. 408-414 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Renal transplantation ; Immunosuppression ; Cyclosporine A ; Immunologic monitoring ; T lymphocytes ; Cell surface antigens ; Monoclonal antibodies ; Flow cytometry
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The lymphocyte subsets in the peripheral blood were examined 3 times a week in 17 patients receiving a cadaveric renal allograft using 2-color flow cytometry and several combinations of monoclonal antibodies. Patients who experienced a rejection crisis (n=12) had a significantly higher CD4/CD8-ratio (2.72±1.26 mean±SD) than patients with stable graft function (1.76±1.33, p〈0.05). 9/12 patients showed 0–3 days prior to the rejection episode an increase of the CD4/CD8-ratio (≥0.5) and/or a high ratio (≥2.5) with a decrease following antirejection therapy. The activation markers HLA-DR and IL-2 receptor on T cells were increased only during 3/12 rejection episodes. Patients with rejections resistant to prednisone pulse therapy (n=6) had significantly more lymphocytes/mm3 in the peripheral blood (1111.7±597.5) than successfully treated patients (n=6, 336.7±196.0, p〈0.02). Antirejection therapy with prednisone pulses and/or antithymocyte globuline resulted in a significant decrease of T lymphocytes (CD3+) with a selective reduction of T helper/inducer cells (CD4+). 6 months after renal transplantation the patients had a higher percentage of suppressor/cytotoxic cells (CD8+) compared to the pretransplant values (26.3±10.9% vs 17.7±6.2%, p〈0.02) and blood donors (16.3±6.2%, p〈0.01). Furthermore the percentage of T helper cells (CD4+/CD28−) was significantly higher and the T suppressor-inducer cells (CD4+/CD28+) were significantly lower compared to the controls. Serial flow cytometric determinations of lymphocyte subsets in renal allograft recipients may be helpful in some cases although rejection episodes could not be predicted in the individual patient.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01648582
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  • 10
    Digitale Medien
    Digitale Medien
    Hyperparathyroidism after kidney transplantation: a retrospective case controlled study (1991)
    Springer
    Journal of molecular medicine 69 (1991), S. 669-673 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Renal allotransplantation ; Hyperparathyroidism ; Parathyroidectomy ; Serum calcium ; Inorganic phosphate ; Alkaline phosphatase
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary We studied retrospectively patients with hyperparathyroidism after successful renal allotransplantation. Since 1972, 1119 transplantations have been performed in our department, and 534 patients survive with functioning grafts. Hyperparathyroidism requiring parathyroidectomy developed in 32 (5.9%). The frequency of interventions increased markedly after introduction of cyclosporine A treatment in our unit. The time between transplantation and parathyroidectomy was 22.5 months (SD 16.5, range 1–82 months). The age of the patients was 49.0 years (SD 10.5, range 17–63 years); the group consisted of 16 female and 16 male patients. All patients but two (no measurement performed) repeatedly exhibited high serum parathormone and calcium levels and therefore underwent surgery. In comparison to a control group, matched for time of transplantation, age, sex, and cause of renal failure, the patients with hyperparathyroidism had longer dialysis treatment (54.2 months, range 9–132 vs 26.9 months, range 1–72) and exhibited lower phosphate concentrations in the early posttransplantation period. Before surgery, serum chemistry was different for hyperparathyroid and control subjects: serum calcium 2.80±0.23 mmol/l vs 2.48±0.13 mmol/l and alkaline phosphatase 157.4±92.0 U/l vs 85.2±51.5, respectively. We did not see any influence of oral phosphate binders, calcium supplementation, or vitamin D treatment on the development of parathyroid gland hyperactivity during dialysis treatment. Serum creatinine concentration did not change after parathyroidectomy. In four patients, long-term calcium supplementation after surgery was necessary.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01649429
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