[Right-sided or left-sided donor nephrectomy-is this really relevant?] / Rechts- oder linksseitige Donornephrektomie ­ ist das wirklich relevant?

BACKGROUND: In the context of living donation, the protection of the donor and the outcome are very important aspects. However, the side selection of the donor nephrectomy is also decisive. In this work, the basics of side selection and the question of whether there are differences regarding the left-sided or right-sided donor nephrectomy are considered. MATERIALS AND METHODS: Living kidney donation data of our center between December 2004 and July 2019 were evaluated in terms of withdrawal side, complications and outcome, as well as the current literature in PubMed. Finally, the results from our center are compared with the current literature. RESULTS: During the investigation period, 152 live donations were carried out in our center. In these cases 66 patients had a left-sided and in 86 cases a right-sided donor nephrectomy. One transplant vein thrombosis occurred in each group. Complications and outcome were similar for the recipient in both groups. It was noticed in the current literature that generally more left-sided donor nephrectomies are performed, most likely due to the preference of the surgeon. Although a low significantly increased risk of transplant vein thrombosis after right-sided donor nephrectomy is described, all authors agree that right-sided donor nephrectomy is a safe procedure with good outcome. CONCLUSIONS: Our own results and the current literature show that the right-sided donor nephrectomy is a safe procedure with only a slightly increased risk of complications compared to the left side and therefore can be recommended. It is clearly safe for the donor and organ, with an equivalent outcome for the recipient. The results are also dependent on the experience of the surgeon.

[Organ donation in Germany: Don't we want to? Can't we? Or are we not allowed?] / Organspende in Deutschland: Wollen wir nicht? Können wir nicht? Oder dürfen wir nicht?

Organ donation has reached a new low in Germany. The number of organ donations dropped from 1296 in 2010 to just 797 organ donations in 2017. This represents a decrease of 916 kidney transplants in the last six years. Thus, Germany occupies the penultimate position in the Eurotransplant association with the number of organ donors per million inhabitants. Only Luxembourg has fewer because of foreigners proportion of 47.5% and many of them lives in the neighboring european countries. However, Germany is not only far behind in the Eurotransplant association with the number of organ donors, but Germany is also at the bottom in comparison with other European countries with comparable political, ethical, religious and social structures-are we so different from our European neighbors? Germany is a country with one of the best health care systems in the world, but not in the field of organ donation. In an international comparison of organ donation, even emerging economies are in a far better position than Germany. Thus, we should ask ourselves if a flaw in the system is leading to this organ donor shortage. But what is the cause and how can we change it? There is no single and general solution to this problem. There are many different points to consider and tackle. These include educating the population, indicating of the will to donate organs or its rejection, training physicians to recognize potential organ donors, support for transplant officers, and much more. In particular, however, thought should be given to an opt-out (presumed consent) solution. It is time to question the system of organ donation in Germany and to discuss it objectively.

Safety of Direct-Acting Antiviral Therapy Regarding Renal Function in Post-Liver Transplant Patients Infected with Hepatitis C Virus and a 100% 12-Week Sustained Virologic Response-A Single-Center Study.

BACKGROUND: Patients after liver transplantation (LT) with hepatitis C virus (HCV) infection often suffer from renal or hepatic impairment. Treating patients after LT with direct-acting antivirals (DAA) might result in decreasing renal function due to interaction of DAA and immunosuppressive therapy. In this single-center study we analyzed clinical parameters of 18 HCV-infected patients treated with DAA therapy after LT. METHODS: The primary end points were change of renal function (glomerular filtration rate) and sustained virologic response 12 weeks after therapy (SVR12). For secondary end points, we investigated the influence of DAA therapy on transaminases, bilirubin, international normalized ratio, noninvasive fibrosis measurement, and Model for End-Stage Liver Disease (MELD) score. RESULTS: Five out of 18 patients treated with DAA suffered from renal impairment stage 2, and 7 patients of renal impairment stage 3. Renal function at SVR12 was not influenced by preexisting renal impairment (P > .5), type of immunosuppressant (P > .5), or type of DAA regimen (P > .5). All patients reached SVR12. The levels of transaminases and bilirubin declined rapidly, as expected. Ten out of 18 patients already suffered from cirrhosis or liver fibrosis >F3 according to noninvasive measurement before initiation of treatment. Single-point acoustic radiation force impulse imaging improved in 9 patients (P = .012). In 7 patients, MELD score improved owing to the decrease of bilirubin levels. In 6 patients it worsened. CONCLUSIONS: DAA therapy in LT patients was effective and safe in this single-center real-life cohort. Renal function was not influenced by the administered drug combinations, even in patients with preexisting renal impairment.

[Radiation cystitis : Pathophysiology and treatment]. / Radiogen bedingte Zystitis : Pathophysiologie und Therapie.

Radiation cystitis (RC) is a common side-effect of radiation to the pelvis. Their clinical appearance as well as their degree of expression is manifold, as are the therapeutic options. However, in the absence of randomized examinations, recommendations are difficult. We differentiate between oral, systemic therapies, intravesical instillations and interventions as well as interventional, radiological and, as an ultima ratio, surgical treatments. This article provides an overview of the different treatment options with particular emphasis on the conservative-interventional therapy options.

[Expert recommendations: Hepatitis C and transplantation]. / Empfehlungen zur antiviralen Therapie der chronischen Hepatitis C bei Patienten auf der Warteliste und nach Transplantation.

With the approval of new direct acting antiviral agents (DAA), therapeutic options for patients with chronic hepatitis C virus (HCV) infection are now generally available before and after liver transplantation (LT). Interferon-free DAA regimens are highly effective therapies and provide a good safety profile. However, the body of clinical evidence in this patient population is limited and the best treatment strategies for patients on the waiting list with (de)compensated cirrhosis and after LT are not well defined. The following recommendations for antiviral therapy in the context of LT are based on the currently available literature and clinical experience of experts in the field, and have been discussed in an expert meeting. The aim of this article is to guide clinicians in the decision making when treating patients before and after LT with DAAs.

[Living kidney donation - an overview]. / Lebendnierenspende - ein aktueller Überblick.

BACKGROUND: The living kidney donation has become increasingly important in recent years. Because of the decreasing number of postmortem donors, there has been a dramatic increase in morbidity and mortality due to the long waiting times for patients on dialysis. By timely living donation after dialysis entry or even preemptively, this can be avoided. AIM: In addition, the living donor has better graft function and better graft survival which is due to the predictability of the donation, the optimal conditioning of donor and recipient, and the short ischemia time. To protect the donor, to provide legal protection, and to avoid abuse, the German legislature reacted with the Transplantation Act and its amendment. The recent recommendations for donor evaluation from the Amsterdam Forum have been used by the Federal Medical Council to revise current guidelines and guidelines for living donation will be drawn up. CONCLUSION: The focus of these efforts is standardization of the procedure and protection of the kidney donor. This is also reflected in the recommendations for organ removal technique and the selection of the organ to be used for kidney donation.

Activation of natural killer cells by hepatitis C virus particles in vitro.

Little is known about the ability of hepatitis C virus (HCV) to alter early innate immune responses in infected patients. Previous studies have shown that natural killer (NK) cells are functionally impaired after interaction of recombinant HCV glycoprotein E2 with the co-stimulatory CD81 molecule in vitro; however, the functional consequences of a prolonged contact of NK cells with HCV particles have remained unclear. We have examined the phenotypes of purified, interleukin-2-activated NK cells from healthy donors and HCV genotype 1b patients after culture for 5 days with HCV pseudoparticles (HCVpp) and serum samples containing HCV genotype 1b. NK cells from healthy donors and chronic HCV patients were found to up-regulate receptors associated with activation (NKp46, NKp44, NKp30, NKG2D), while NK receptors from the killer cell immunoglobulin-like receptor family (KIR/CD158), predominantly having an inhibitory function, were significantly down-modulated after culture in the presence of HCV particles compared with control cultures of NK cells. HCV-infected sera and HCVpp elicited significantly higher secretion of the NK effector lymphokines interferon-γ and tumour necrosis factor-α. Furthermore, HCV stimulated the cytotoxic potential of NK cells from normal donors and patients. The enhanced activation of NK cells after prolonged culture with HCVpp or HCV-containing sera for 5 days suggests that these innate effector cells may play an important role in viral control during early phases of HCV infection.

Cytomegalovirus infection after liver transplantation incidence, risks, and benefits of prophylaxis.

BACKGROUND: Cytomegalovirus (CMV) infection and related disease is a feared complication after liver transplantation. Antiviral prophylaxis is recommended in clinical practice guidelines depending on the CMV status of both donor and recipient as well as the individual risk profile. METHODS: We retrospectively analyzed 211 liver transplant recipients with respect to the incidence of CMV infection after transplantation, the influence of donor and recipient CMV status, and the effect of antiviral prophylaxis. In addition, the underlying liver disease and immunosuppressive regimen were compared with the incidence of CMV infection. Patients were divided into 4 groups according to CMV donor/recipient (D/R) profile: group A (D-/R-) 28 patients (13.3%), group B (D-/R+) 64 patients (30.3%), group C (D+/R+) 79 patients (37.4%), and group D (D+/R-) 40 patients (19.0%). RESULTS: CMV infection was observed in 17.9%, 29.7%, 24.1%, and 22.5% of the patients, respectively, with no significant difference in infection rates between the groups. CMV infection occurred in 5 patients (17.9%) in the presumed low-risk profile (group A), despite an antiviral prophylaxis in 4 out of these 5 patients. In contrast, CMV infection occurred in only 9/40 patients (22.5%) in the presumed high-risk profile (group D). The most frequent infection rates were found in groups B and C (R+ groups). After successful treatment of CMV infection, no recurrence was detected. Underlying liver disease or immunosuppressive protocol had no influence on CMV infection. CONCLUSION: Approximately one fourth of patients will acquire CMV infection after liver transplantation independent of donor/recipient status. Surprisingly, antiviral prophylaxis does not seem to be sufficient to reduce this proportion of patients, either in presumed high-risk or in presumed low-risk situations.

Transperitoneal, hand-assisted laparoscopic donor nephrectomy: surveillance of renal function by immune monitoring.

UNLABELLED: The history of living donor nephrectomy has undergone several development phases with respect to medical, immunologic, and operative aspects. Due to the shortage of postmortem organ donations and the rising number of patients with terminal renal insufficiency who are awaiting kidney transplantation, living kidney donation has become increasingly important during recent years. METHODS: From December 2004 to May 2005, we performed hand-assisted laparoscopic donor nephrectomies on 15 female and 9 male patients of median age 37 years. Our immunosuppressive regimen included tacrolimus, mycophenolate mofetil, methylprednisolone, and a monoclonal antibody. RESULTS: The median operative time was 138 minutes (113-180 minutes), and the median warm ischemia time was 87 seconds (63-150 seconds); results comparable to those of open donor nephrectomy. The hospitalization periods of the donors were between 5 and 7 days. The renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached baseline levels by postoperative day 3 or 4. CONCLUSION: Together with the clinical data, these findings confirmed the efficacy and minimal invasiveness of laparoscopic donor nephrectomy. It is thus possible that in the future this operative method will become the procedure of choice.

Esophagitis in an adolescent patient with Crohn's disease after changing treatment from prednisolone to budesonide.

Studies have demonstrated that budesonide is effective in the treatment of active Crohn's disease. Due to its extensive hepatic metabolism, budesonide has much lower adverse events compared to prednisolone. Consequently, the low systemic availability restricts its application to Crohn's disease of the terminal ileum and the colon. Esophageal ulceration is a rare complication of Crohn's disease. This article describes the case of a young lady who presented at the age of 16 with active Crohn's disease of the terminal ileum and the colon without dysphagia or pain in the chest. Her disease was successfully treated with prednisolone for almost two years. Because of weight gain, acne, and moon face she was switched to budesonide. A few days later she presented with intractable pain of the esophagus, dysphagia, and inability to eat. Endoscopy demonstrated aphthous ulcerations of the esophagus and the histology was compatible with Crohn's disease. After two weeks of treatment with prednisolone all symptoms resolved and at follow-up gastroscopy ulcers had disappeared.

A cart cage for transferring macaques, capuchins, and small dogs.

A novel mobile monkey transport cart cage allows ease of handling, safety, secure holding, good visual access to the monkeys, room for large macaques, and ease of assembly, all at a modest cost.

[Application possibilities of laser surgery in veterinary medicine. 3: Literature review and some case reports]. / Einsatzmöglichkeiten der Laserchirurgie in der Tiermedizin. Teil 3: Laseranwendungen: Literaturübersicht und eigene Erfahrungen.

The transmission of the laser beam trough flexible fibers enables an endoscopic application. Since this technique is minimal invasive and often does not require general anaesthesia there is an increasing interest in the use of laser techniques-for example in equine upper respiratory tract surgery. This paper gives a review about reported laser application in the different fields of veterinary surgery with emphasis on laser practice in dermatology, ophthalmology and endoscopic laser application.

[Possibilities for the us of laser surgery in veterinary medicine. Part 2: Effects of laser beams on tissue]. / Einsatzmöglichkeiten der Laserchirurgie in der Tiermedizin. Teil 2: Gewebewirkung der Laserstrahlung.

The effect of a certain laser beam on tissue is dependent on the different properties of the tissue. The various kinds of laser radiation are absorbed from different components of an organ. Only where absorption takes place there will be a transformation of the energy of radiation to other forms of energy and changes in tissue will occur. The arising thermal energy not only heats the area exposed to the laser beam but the surrounding tissue. The extent of the heating effect on tissue is due to properties of the tissue, e.g. the degree of blood supply and with it the draining of heat, and the parameters of the laser system, e.g. time of exposition and power of radiation. By increasing power of radiation the effect will be an unspecific heat stimulation, coagulation of tissue up to vaporization of tissue. By using different ways of transmission the effects produced by laser will change and can be adapted to various medical and anatomical requirements.

[Application of laser surgery in veterinary medicine. 1. Fundamentals]. / Einsatzmöglichkeiten der Laserchirurgie in der Tiermedizin. Teil 1: Grundlagen.

This article will outline the key words of laser physics. Albert Einstein set the basics of laser physics by characterizing the principles of stimulated emission of radiation in 1914. An excited atom can change from these excited energy level to a lower level by emitting energy in form of photons. If this photon strikes another excited atom, it will stimulate emission of another photon. By these action two identical photons will emerge. An optical resonator is used to amplify the stimulated light emission coming from a laser medium. Laser differs from other light sources in three important properties: coherence, collimation, and monochromasia.

Stereoselectivity of in vitro isoprene metabolism.

The stereoselectivity of the in vitro conversion of isoprene by liver enzymes of rats and mice was determined. Isoprene was epoxidized by cytochrome P450 of rats and mice to 2-isopropenyloxirane and 2-methyl-2-vinyloxirane with slight but different product enantioselectivity. Only with mouse liver microsomes was a distinct regioselectivity observed. Both monooxiranes were further epoxidized to 2-methyl-2,2'-bioxirane with substrate enantioselectivity, product diastereoselectivity, and with product enantioselectivity. The epoxide hydrolase-catalyzed hydrolysis with rat and mouse liver microsomes occurs with substrate enantioselectivity. A better kinetic resolution was found for 2-isopropenyloxirane than for 2-methyl-2-vinyloxirane. While 2(R)-isopropenyloxirane was conjugated preferentially with glutathione, catalyzed by glutathione S-transferase, no enantiomer differentiation takes place in the case of 2-methyl-2-vinyloxirane.

[Post-cholestatic hypercholeresis in a patient with malignant obstruction of the bile ducts]. / Postcholestatische Hypercholerese bei einem Patienten mit maligner Obstruktion des Gallenganges.

Increased choleresis of up to 4950 ml per day was observed after positioning of a PTCD in a patient with complete biliary obstruction due to a malignant tumor. Bile secretion could be temporarily reduced to 15% of the initial flow rate by intravenous administration of somatostatin. Simultaneously, the concentration of bile acids increased from 1.2 to 6.2 mmol/l, whereas the concentrations of electrolytes remained constant. Cholic acid had no influence on bile secretion. To safeguard the patient from excessive loss of fluid and electrolytes, the drained bile was reinfused into the duodenum via a PEG.

[Meat from the nutritional medicine viewpoint]. / Fleisch aus ernährungsmedizinischer Sicht.

As in all forms of food, contaminants can also be present in meat. Because of the growing awareness of ecological and health issue, more tests with sophisticated equipment are now being implemented, thus reducing the risk of consuming contaminated meat. Meat has become the most heavily inspected form of food. In contrast to vegetable matter, animals can discharge many contaminants. Meat, with the exception of the liver and kidneys, is therefore less likely to be contaminated than vegetables. Facts show that meat is a highly nutritious food which, if consumed moderately, can contribute to our well-being. Meat contains the right combination of amino acids for protein synthesis in the human body, and especially it contains plenty of essential amino acids. Above all, meat contains many vitamins, trace elements, and iron. Large amounts of these substances are particularly necessary for growing children and people who are doing hard physical work. A reduction of meat consumption is only necessary in the case of a few illnesses. Some other illnesses actually require an increase in protein, and thus an increase in meat in the diet.