Fetal wound healing.

Multiple distinctions concerning the adult and fetal wound healing processes exist. In the fetus, a minimal inflammatory response to wounding is seen with a marked deposition of glycosaminoglycans, particularly hyaluronic acid. Collagen seems to be present in small amounts and is rapidly and efficiently organized into structural nonscarred tissue components, a process that seems to be uniquely influenced by the ECM and its components. The exact mechanisms of control of growth, development and healing in the fetus are unclear, although a transition from fetal to adult processes takes place in utero. Furthermore, some processes may, in part, transiently reappear in healing wound found in adults. Clearly, there is a vast horizon for future investigation. The concept of fetal surgical treatment has become a reality. Many observations made in this field may well be applied in future attempts to prevent pathologic healing, and may even yield wounds far superior to the predicted "normal" results we see today. The future of wound manipulations may involve the crafting of complex matrices interwoven with a variety of cytokinetic agents, which could result in a healed wound or regenerated tissue that is mechanically and functionally equivalent to adjacent unwounded tissue. Furthermore, if the secrets of fetal healing can be revealed, areas of clinical intervention may be expanded to aid in controlling other abnormal patterns of tissue growth observed in clinical medicine as well.

The differential effect of corticosteroids on wound disruption strength in mice.

The detrimental role of corticosteroids on wound healing is well recognized. This study examined the effect of equipotent anti-inflammatory doses of dexamethasone sodium phosphate, methylprednisolone sodium succinate, or hydrocortisone sodium succinate on wound healing in mice. Mice were injected daily for 12 days; the mice were wounded on day 3 of steroid injection, with wound analysis done on day 10 after wounding. Dexamethasone and hydrocortisone significantly impaired wound healing, as assessed by wound disruption strength when compared with controls or methylprednisolone. Dexamethasone and hydrocortisone both displayed dose-dependent relationships for impairment of healing, while over comparative doses, methylprednisolone failed to affect healing significantly. Regression analysis revealed nearly identical curves for hydrocortisone and dexamethasone that differed significantly from that of methylprednisolone. Our observations suggested that these preparations possessed a differential effect on the healing wound that should be considered to minimize postsurgical or traumatic wound-healing problems.

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.

[Indications, surgical technique and results in renovascular hypertension (author's transl)]. / Indikation, Operationsverfahren und Operationsergebnisse bei renovaskulärem Hochdruck.

After more than 25 years of surgical treatment of renovascular hypertension alterations in indication and operative methods have evolved. While split renal function tests have been abandoned, renin values seem of some importance, but the most valuable signs are poststenotic dilatation and collateralisation on the aortogram. For therapy the transcutaneous intraluminal dilatation has been developed as a fairly safe method. Though long term results are lacking this procedure seems indicated under certain conditions. The only primary indication for surgery therefore would be total occlusion of the renal artery. In many instances secondary surgery is still necessary. Interposition of a venous graft is the most often used procedure. In our own experience direct thrombendarterectomy also gives good results. In fibrodysplastic stenoses the results with respect not only to blood pressure behaviour and mortality rate but also life expectancy are satisfactory. On the other hand operations of arteriosclerotic lesions have still a considerable early and late mortality rate. The extent of the underlying disease, age and sex are important factors. The aim of preserving renal function in special situations (occlusion of renal artery, stenosis of single kidney and bilateral stenosis) is especially stressed.

[Results of 200 renal transplantations (author's transl)]. / Ergebnisse bei 200 Nierentransplantationen.

Two hundred renal transplantations were performed on 187 patients between July, 1972 and June, 1978. On a follow-up of 6--78 months the survival rate after allogenic transplantation was 80% at one year and 64% at five years. Satisfactory renal function was present in 62% at one year and 31% at six years. Gastrointestinal complications were common and caused about 40% of all deaths. Severe infections were the second most common cause of death. Local complications required explantation in 4%, and caused death in 0.5% of cases. Change in the treatment regimen, using less massive immunosuppressive measures during acute rejection, lowered the death-rate without a higher loss of transplants. The death-rate was 16% at three months and 26% at one year in the first of the 200 transplantations, but 6% and 12%, respectively, in the last 50 consecutive transplantations. The survival rate of patients with transplants is thus comparable to that of patients receiving chronic haemodialysis.

[Early ureteral complications after renal transplantation (author's transl)]. / Frühe Ureterkomplikationen nach Nierentransplantation.

Ureteral complications occurred in 23 cases after 225 renal transplantations. The complications consisted of 17 urinary fistulas and 6 stenoses of the ureter. Fourteen of the urinary fistulas were successfully treated by conservative management. Two transplants were lost secondary to operation because of ureteral obstruction. Factors contributing to ureteral leakage were the technique of ureteral anastomosis, the handling of the donor ureter during donor nephrectomy and possibly ureteral necrosis by rejection crises. Ureteral stenosis and rejection crisis may have the same symptoms. Urinary fistulas can easily be observed by the urine extravasation. The treatment of urinary fistulas can be managed only by replacing the suprapubical drainage. The stenosis of ureter with subsequent deterioration of graft function needs an operation with the danger of loss of the transplanted kidney.

[Surgical correction of venous insufficiency following arteriovenous fistula for hemodialysis]. / Die operative Korrektur der venösen Insuffizienz nach arterio-venöser Fistel zur Hämodialyse.

The percentage of venous insufficiency in the original Cimino-Brescia shunt is very low. In cases of venous insufficiency, early diagnosis is important; operative correction is then easily performed. Ligature of the distal venous limb next to the anastomosis is the treatment of choice, providing the proximal limb is still open. If the proximal limb is obstructed, the distal venous part is dissected and anastomosed to a more proximal vein. The result is an immediately functioning shunt for dialysis.

[Immunosuppressive properties of Anturan]. / Untersuchungen zur immunsuppressiven Eigenschaft von Anturan.

The influence of Anturan on rosette-forming cells and hemolytic antibodies in male Wistar rats immunized with 5 . 10(8) sheep red blood cells was investigated. An unknown influence of Anturan on the cellular and humoral immune response was detected. Anturan was most effective when given 2 days after immunization.

[Thrombectomy for acute renal-vein thrombosis (author's transl)]. / Thrombektomie der akuten Nierenvenenthrombose.

Three personal cases are presented to indicate the growing need for thrombectomy as a method of treatment of renal-vein thrombosis. In addition to known causes of renal-vein thrombosis (e.g. iatrogenic, post-traumatic) there is the so-called spontaneous renal-vein thrombosis especially in newborns. The possibility of renal-vein thrombosis must be considered in the presence of sudden, circumscribed pain in the flanks, haematuria and albuminuria, large kidney shadow radiologically, loss of renal function. Reported cases and the three personal ones suggest a trial of thrombectomy. It is not known how long the kidneys can tolerate venous occlusion. But the personal observations suggest that even occlusion lasting for serveral days may be reversible. In one patient with renal-vein thrombosis after unrecognised misplacement of a Mobin-Uddin filter into the right renal vein, surgical restoration of venous drainage after several weeks indicates that long-term observations are necessary to judge final results.

[Allorosettes after renal transplantation in inbred strains of rats (author's transl)]. / Allo-Rosetten nach Nierentransplantation bei isohistogenen Rattenstämmen

33 renal transplantations in the isohistogeneic rat strains DA/Han and BDE/Han were performed. The transplanted animals were killed at different days after transplantation and the following dates investigated: 1. number of rosette forming spleen cells with donor erythrocytes, calculated for 10,000 spleen cells and to the total number of extracted spleen cells, 2. haemagglutinin titers with donor erythrocytes. 3. titers of serum IgG, 4. Total number of spleen cells, weight of spleens, weight and volumes of kidney transplants and the number of peripheral blood lymphocytes and granulocytes. The results deomonstrate that the method of immunocytoadherence as described by BIOZZI and ZAALBERG in xenogeneic transplantation systems can also be used in allogenic systems. The course of the immune response was biphasic. Quantitation of allorosette forming cells can be considered as a paramter of allograft rejection. The current literature as to the T- or B-cell specificity of rosetting cells is discussed.

[Effect of time of splenectomy on the increase in survival time following kidney transplantation in rats]. / Der Einfluss des Splenektomie-Zeitpunktes auf die Verlängerung der Uberlebenszeit nach Nierentransplantation bei der Ratte.

Survival time of Lewis-rats with transplanted DA-kidney grafts following splenectomy at different times after transplantation was evaluated. Splenectomy five days after renal transplantation produced a significant prolongation of survival time (p less than 0.05) whereas splenectomy at the day of transplantation did not extend survival time significantly (p less than 0.1).

[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.

[Spontaneous rupture of the allografted kidney (author's transl)]. / Die spontane Nierentransplantatruptur

Spontaneous rupture of allografted kidneys occurred in 6 cases after 95 renal transplantations performed in the Department of General Surgery at the University Clinic in Essen. An analysis of this complication after renal transplantation is presented considering our own experience and 60 cases from the literature. The characteristic symptoms which were found in all cases consisted of oliguria, pain and swelling of the graft site and signs of hemorrhage. In 90% transplant rupture occurred within 3 weeks postoperatively. The surgical therapy should preserve the ruptured organ whenever possible. In 5 of our 6 cases we were successful in preserving the graft by suturing the tear. The analysis of the etiologic factors of 66 cases shows that oedema of the renal graft is the most common finding. A possible etiological factor seems to be the method of organ preservation.