[Retroperitoneal giant angiomyolipoma diagnosed post-partum with lymph node involvement]. / Postpartal diagnostiziertes retroperitoneales Riesenangiomyolipom mit Lymphknotenbefall.

HISTORY AND PRESENTING COMPLAINT: A 30-year-old primipara after a normal pregnancy had delivered a 3340 g child. After an uneventful post-partum period she had noticed her abdomen failing to reduce in size. INVESTIGATIONS, DIAGNOSIS AND TREATMENT: The abdominal sonography discovered a large retroperitoneal tumor. CT and MRI showed a giant tumor which originated from the right kidney. Suspecting the diagnosis of renal liposarcoma the kidney and tumor were excised with removal of enlarged precaval and preaortal lymph nodes. Gross inspection revealed a ca. 3,2 kg myxoid tumor, measuring 27 x 19 x 10 cm. The histological examination of the surgical preparation revealed a retroperitoneal angiomyolipoma. CONCLUSION: This is the first case of a giant retroperitoneal angiomyolipoma with lymph node involvement diagnosed post partum.

[Integrated treatment of children with chronic renal insufficiency]. / Integrierte Behandlung von Kindern mit chronischer Niereninsuffizienz.

Early diagnosis of chronic renal failure in childhood is difficult, since the course of CRF shows in children with congenital renal diseases unspecific symptoms. The active cooperation of the practical pediatrician with a pediatric nephrologist enables this team for prevention of complications of chronic uremia. The integration of treatment between general pediatrician and specialist also prevents long hospitalisation and makes the prevention of the child for the best mode of treatment possible, i.g. ambulant hospital dialysis, home dialysis or CAPD. Pediatric dialysis should be performed in one of the established 14 pediatric dialysis centres in our country, because psychological, somatic and technical problems in children differ from those in adults. In dialysed children the general pediatrician should be further involved in treatment and may contribute worthy help in medical (control of drug compliance, hypertension) and psychosocial (school, employment) care of the chronic sick children. Even after successful renal transplantation the local pediatrician should continue to be involved in patient care, in spite of more frequent check up controls at hospital.

[Kidney transplantation in childhood]. / Nierentransplantation im Kindesalter.

40 renal transplantations on children up to 15 years of age have been performed in our hospital in the years 1976 to June 1982 with one exception in 1972. We did verify the findings of previous authors that renal transplantation in children has produced good results so far (1, 5, 6). Dialysis treatment in children often evokes extreme problems for the patients, parents, and medical team. Considering this dialysis is seen as only a provisional measure, transplantation however as the final aim in the therapeutic concept of children with terminal renal insufficiency (1). Furthermore dialysis treatment for infants is justified in our opinion only if a renal transplantation ca be realized.

Results of a ten year period of reconstructive surgery for renovascular disease.

During a 10-year period 242 patients underwent 259 renal artery reconstruction for correction of renovascular hypertension or preservation of renal function. Bilateral stenosis was found in 26 patients (10.7%). Twenty-five of the 259 renal arteries were totally occluded. Stenosis was atheroslcerotic in 147 patients, fibrodysplastic in 88 and of other origin in 7 patients. The operative procedures included thrombendarterectomy with or without patch plasty in 105 patients, resection and end-to-end-anastomosis in 68, reimplantation in 34, vein graft interposition in 32, and patch graft angioplasty in 14 patients.--Overall hospital mortality was 4.1%. Whereas there were no deaths in fibrodysplastic disease, it was 6.8% in atherosclerosis. The late mortality of 185 patients followed was 9.2%, stroke and myocardial infarction being the most common causes of death. Postoperatively, blood pressure was normal in 36% of patients with atherosclerosis and in 70% of those with fibrodysplastic disease. Blood pressure improved in 53% of the patients with fibrodysplastic disease. These relationships did not change significantly 2, 4, and 6 years after reconstruction. The results indicate the favorable prognosis of renal artery reconstruction in fibrodysplastic stenosis and the limitations of surgery in atherosclerosis in a non-selected group of patients. Although the introduction of percutaneous intraluminal dilatation widens the therapeutic possibilities for renovascular hypertension, exact indications and intensive after-care are still mandatory.

Renal revascularisation in 36 patients with chronic total occlusion of the renal artery.

From 1972 to 1982 36 patients with totally occluded renal arteries were operated on. Contralateral stenosis existed in 11 patients, in five of whom a bilateral operative procedure and in three of whom an additional intraluminal dilatation was performed. A revascularisation of the occluded artery was performed in 33 and a primary nephrectomy in three patients. Hospital mortality was 14 per cent, the causes of death being cardiac or cerebral complications. In spite of cure or improvement of hypertension in 75 per cent of all patients and improvement or stabilisation of pre-operative azotaemia in 11 patients, the significant postoperative mortality indicates the difficult problem of proper selection of patients for operation.

[Perirenal masses following kidney transplantation. Ultrasonically guided punctures and aspirate analyses]. / Perirenale Raumforderungen nach Nierentransplantation. Ultraschallgeführte Punktionen und Punktatanalysen.

24 perirenal masses in renal allograft recipients were aspirated by means of ultrasonographically guided percutaneous fine needle puncture, analysed biochemically, bacteriologically and identified as 15 lymphoceles, 5 hematomas, 2 abscesses and 2 urinomas. The discrimination criteria, based on macroscopic findings and biochemical analysis, are previously described in detail. According to ultrasonographic and clinical characteristics the lymphoceles are divided into two groups: 1. Large lymphoceles without any sign of rejection, which seem to be caused by injury of lymphatic vessels in the pelvic region of the graft recipient. 2. Small lymphoceles with signs of rejection, which evidently result from increased secretion of lymph by the allograft. In 54 punctures a therapeutic effect was achieved in small abscesses and lymphoceles only, which were drained percutaneously. A repeated fine needle evacuation of lymphoceles did not result in an obliteration of the lymphocele in any case. Ultrasonographically guided fine needle puncture of perirenal masses is of great importance, since the perirenal fluid can be identified exactly and an immediate and definitive therapy is made possible.

Sonographic criteria for renal allograft rejection.

In order to define sonographic criteria for acute rejection of renal allografts, the following sonographic criteria were evaluated: (a) parenchymal thickness, (b) index of maximal sagittal to maximal longitudinal diameter, (c) cortical echos, (d) sinus echo changes, and (e) the medullary pyramids. Thirteen kidneys were removed for rejection. All had ultrasound studies 24 hours preoperatively. The sonographic changes in rejected kidneys were compared to those in 21 normal allografts. We found that renal enlargement, enlarged medullary pyramids, and a reduction in or a disappearance of the sinus echos were seen in acute rejection but were not seen in normal renal transplants. We conclude that these criteria are early signs of acute rejection and may be helpful in diagnosis, particularly if control sonograms are available.

In vitro immunoresponsiveness in recipients of cadaveric renal allografts during ATG therapy.

Anti-human-T-cell-globulin (ATG-Fresenius) was given prophylactically in a fixed dose of 2mg per kg bodyweight to 32 renal allograft recipients in addition to a conventional immunosuppressive regimen, over a period of 20 days. ATG therapy resulted in a significant decrease of circulating T-lymphocytes, whereas B-lymphocytes remained unaffected. The mitogen reactivity during therapy paralleled the T-lymphocyte profile with a maximum decrease on day 8. With in vitro testing of ATG immunoresponsiveness it could be demonstrated that patients with rejection episodes after transplantation reacted differently from patients without signs of rejection. Actuarial patient and graft survival was about 5% higher in the ATG treated group of patients than in retrospective controls.

[Regional service for dialysis and kidney-transplantation in children (author's transl)]. / Regionale Behandlung von Kindern mit Nierenversagen. Organisation und bisherige Behandlungsergebnisse des Dialysezentrums für Kinder und Jugendliche in Essen.

Children with renal failure should be treated in specialized pediatric centres. In October 1977 we initiated a pediatric dialysis unit at the university of Essen, as there were no special facilities for this area (Ruhr). In 18 months 24 children with end-stage renal failure and 15 children with acute renal failure or severe poisoning had to be treated. We performed 2300 hemodialyses and 400 peritonealdialyses; 12 children got a transplant. The pediatric dialysis unit of Essen has all facilities for treatment of children with acute and chronic renal failure. The documented results were possible by cooperation with all specialists of our hospital and with the neighbouring pediatric dialysis centres.

The juxtaglomerular apparatus in a human kidney with polar artery stenosis.

Juxtaglomerular apparatuses (JGA) of a human kidney with stenosis of a polar artery from a hypertensive 18-year-old male patient were studied qualitatively and quantitatively on 2 mu thick serial sections from plastic embedded renal tissue. 11 JGA from juxtamedullary and 9 JGA from subcapsular cortical zones were photographed serially, the copies taped together and the cells and relationships within the JGA studied. On the copies the lenght of contact between the different juxtaglomerular structures and the basement membrane of the macula densa was measured. Futhermore we calculated the areas of surface contact and the macula densa basal area. In the juxtamedullary JGA affected by the polar artery stenosis all Goormaghtigh cells were transformed into epitheloid cells and the Goormaghtigh cell field was significantly larger than in the JGA of the subcapsular cortex, which obviously had been exposed to the systemic hypertension. The macula densa basal area was significantly greater in the juxtamedullary JGA than in the subcapsular JGA, but neither of these differed significantly from the macula densa in the normal JGA reported previously.

[Renal transplantation: results and conditions for donor-nephrectomy (author's transl)]. / Ergebnisse und Vorbedingungen zur Organgewinnung für Nierentransplantationen.

The role of renal transplantation as a method of treatment of chronically uraemic patients is presented considering recent data. The number of chronically haemodialysed patients is 64,0000 in the world. About 20,000 kidneys have been transplanted. In spite of advantages of a combined treatment by dialysis and transplantation, the frequency of transplantation is very low in West Germany. Lack of donor-organs is one of the most striking factors in this situation. Cooperation between the different disciplines would solve these problems. The conditions for donor procurement are presented.

[Blood-pressure behavior in rats following the diversion of renal-vein blood into the portal vein]. / Blutdruckverhalten bei Ratten nach Ableitung des Nierenvenenblutes in die Pfortader

Experimental studies on 22 hypertonic rats which had previously one kidney removed show that the deviation of the renal vein blood into the portal vein through a cavorportal or splenoportal anastomosis does not result in a lowering of the experimentally induced renovascular hypertension. These anastomoses did not alter the blood pressure in 3 normotonic rats. The prophylactic use of these anastomoses could not prevent the development of experimental renal hypertension in 2 of 3 test animals.