[Frequency of kidney cyst wall cancer--results of 22,000 ultrasound studies]. / Die Häufigkeit des Nierenzystenwandkarzinoms - Ergebnisse von 22 000 Ultraschalluntersuchungen.

In 22 198 sonographic examinations of the epigastric region, the authors identified 759 renal cysts (3.4%) and 165 renal tumours (0.74%). The percentage of incidence of the renal cysts is identical with that found in post-mortem examinations, whereas tumours were distinctly more frequent. Tumours of the cystic wall had been found in 0.5% of all sonographically diagnosed cysts and in 4% of renal cysts examined via fine-needle biopsy. Of the latter cysts (i.e. out of the 4% of cysts diagnosed by fine-needle biopsy), which were associated with tumours, two had been diagnosed as tumour suspects via sonography. Hence, the sonographic absence of abnormal findings in carcinoma of the renal cyst wall is rare. However, cysts diagnosed via sonography which cannot be subjected to fine-needle biopsy, should be rechecked and followed up at regular intervals. If all possible methods of diagnosis are utilised (I.V. urography, sonography, fine-needle biopsy guided by sonography, computed tomography, angiography), successful differential diagnosis of localised pathological conditions of the kidneys can be achieved in 97% of all cases. Patient risk and cost of diagnosis can be kept at a minimum by proceeding in steps as described in the article. Primary surgical exposure of the kidneys in case of a cystic renal process would now appear justified for therapeutic reasons only, not for the purpose of arriving at a diagnosis.

[A rare form of Kaposi's sarcoma with intestinal symptoms (author's transl)]. / Kaposi-Sarkom: Seltenes Krankheitsbild mit intestinaler Manifestation.

Kaposi's sarcoma is a rare systemic disease with cutaneous and occasional visceral manifestations. A 39 year old male caucasian patient developed Kaposi's sarcoma 10 months after receiving a renal transplant; subacute pancreatitis was suspected because of the clinical symptoms on the first hand. Multiple, miliary, dark and well vascularized lesions appeared on forehead, cheeks, and trunk. In addition flat tumours of 1.5 cm in diameter, well vascularized and with a central indentation were found radiographically and endoscopically in the jejunum and colon. The diagnosis was confirmed bioptically using specimens of rectal mucosa and facial epidermis. The specimens taken were infiltrated by eosinophiles and granulocytes suggesting parasitosis, the correct diagnosis however could be made. After chemotherapy with actinomycin-D, vincristine and cyclophosphamide, cutaneous and visceral lesions vanished completely. Renal and pancreatic function remained normal. There are no symptoms of relapse of the disease 16 months after stop of chemotherapy by now.

[Prophylaxis of gastroduodenal complications after renal transplantation (author's transl)]. / Zur Prophylaxe gastroduodenaler Komplikationen nach Nierentransplantation.

Gastroduodenal bleeding or perforation following renal transplantation constitute a serious complication with a high lethality. 82 patients with terminal renal insufficiency were grouped in 4 categories with increasing gastroduodenal risk factors. Parameters for judging gastroduodenal risk consisted of gastric acid secretion, history and endoscopic demonstration of acute or chronic ulcer disease. 33 transplant candidates of groups I (hypochlorhydria, no ulcer) and II (normochlorhydria, no ulcer) were treated by medical prophylaxis alone. 23/33 were transplanted without prophylactic surgery, 1 patient in group II with erosive duodenitis before transplantation died from bleeding duodenal ulcer. Patients of group III (hyperchlorhydria up to 40 mval/h, MAO, no ulcer) received selective proximal vagomty, patients of group IV (hyperchlorhydria, 40 mval/h MAO and/or ulcer) underwent selective gastric vagotomy and 50% gastric resection. In 25 of 49 patients of group III and IV prophylactic operations were performed without serious complications. In 16 later on transplantated patients no gastrointestinal bleeding occurred. 2 patients of group III without gastric operation had minor bleedings out of erosive lesions in the gastric antrum and duodenal bulb, that could be managed by medical treatment. The positive experience with prophylactic gastric surgery in this limited number of patients seems to advocate a broader application of such a protocol. A considerable rise in gastric secretion was demonstrated in 19/21 patients during the first 3 years following the commencement of dialysis, BAO rose by an average of 72,2%, MAO by 41%. Thus, gastric analysis should be repeated once a year. Erosive gastritis and duodenitis seem to predispose for bleeding episodes after renal transplantation, this diagnosis should prompt prophylactic SPV.

[Preventive gastrectomies before kidney transplantations]. / Prophylaktische Magenoperationen vor Nierentransplantation.

Gastroduodenal bleeding or perforation occurs in 3.5 to 60% of renal transplant patients. Mortality ranges from 35 to 75%. Experience with prophylactic gastric surgery is based on 61 patients with chronic hemodialysis, who were prepared for renal transplantation since 1974. History, presence of ulcer disease or hyperchlorhydria were assumed to represent a gastroduodenal risk. All 20 patients with such a risk-factor received prophylactic gastric surgery (high risk: selective gastric vagotomy + hemigastrectomy in 12, low risk: selective proximal vagotomy in 6; truncal vagotomy + drainage in 2 cases). Postoperatively there were no serious complications, no lethality.