[A survey of labour pain management in Germany]. / Eine Umfrage zur geburtshilflichen Schmerztherapie in Deutschland.

BACKGROUND: In a survey of German hospitals with obstetric units, data on anaesthesia and analgesia in obstetric pain management were collected. METHODS: At each of 918 hospitals with obstetric units, the head of the anaesthetic department received a questionnaire on obstetric pain management. RESULTS: The response rate was 47.1%. On average, there were 748+/-407 (median 663;1st/3rd quartiles 309/1,303) births per year and hospital, 69.4% with spontaneous vaginal delivery. Opioids were the systemic analgesics most frequently administered in the delivery rooms. Epidural analgesia (EA) was given to 17.5+/-12.6% of the parturients. The number of deliveries per annum had a significant influence on the frequency of EA (<500 deliveries/year: 12.7%, 500-1000/year: 18.6%, >1,000/year: 21.6%). The preferred local anaesthetics were ropivacaine und bupivacaine. When an opioid was given this was almost always sufentanil. In 16% of the responding hospitals adrenaline was added to the epidural test bolus. CONCLUSION: EA is the mainstream method of relieving labour pains in almost all German hospitals, but is used significantly more often in hospitals with rather high numbers of yearly deliveries than in hospitals in which there are few deliveries per year.

[Comparison of kidney transplantation with and without regard to HLA typing]. / Vergleich der Nierentransplantation mit und ohne Berücksichtigung der HLA-Typisierung.

OBJECTIVE: To compare the functional results after transplantation of locally obtained and assigned kidneys (without taking into account HLA typing) with those after transplantation of kidneys obtained via Eurotransplant (with HLA typing as principal criterion for assignment). PATIENTS AND METHODS: Between December 1983 and December 1993 a total of 236 kidneys were transplanted into 234 patients, 40 kidneys having been obtained via Eurotransplant and 196 removed locally and transplanted directly into patients on the local waiting list according to strict criteria: same blood group; waiting time since decision on transplantation; negative current crossmatch between recipient's serum and donor lymphocytes. Transplantation results were analysed retrospectively according to: ischaemia time, HLA mismatch, postoperative renal failure, postoperative renal function, rejection rate and transplant survival. Mean observation period was 55 months for the local and 50 months for the Eurotransplant kidneys. RESULTS: The number of HLA matches was higher in Eurotransplant group (P < 0.001). However, the cold ischaemia time was greater for this group (20.2 vs 15.7 hours; P < 0.01). Acute renal failure was less common with locally assigned kidneys (33 vs 53%: P < 0.02). There were no significant differences with regard to one-year and five-year renal function (serum creatinine; percentage of normal): 90.2% local vs 88.3% Eurotransplant and 81.8% vs 62.3%, respectively). Survival rates were also similar (96.9% local vs 95% Eurotransplant after one year, 94.4% vs 90% after 5 years). CONCLUSION: Local assignment by waiting time and blood group gave results that were similar to those via Eurotransplant based on HLA typing criteria.

Pregnancy and postpartum after kidney transplantation and cyclosporin therapy--review of the literature adding a new case.

The number of pregnancies after renal transplantation and immunosuppression is relative low. Since the introduction of a most effective medication, Cyclosporin A, there is not only an increasing improvement of the transplantation results, but there are also more reports on successfully concluded pregnancies. This report pertains to a 26-year old primigravida, whose pregnancy progressed without severe complications until the 33rd week of gestation. Then a sudden and rapidly worsening preeclampsia led to admission and delivery. The postoperative period was complicated by a severe septical shock. The literature is reviewed. Problems following pregnancy after kidney transplantation and triple immunotherapy with Cyclosporin A treatment are pointed out.

[Pregnancy, labor and postpartum development after kidney transplantation and triple therapy with cyclosporin A--follow-up in relation to literature review]. / Schwangerschaft, Entbindung und postpartale Entwicklung nach Nierentransplantation und Triple-Therapie mit Cyclosporin A--Eine Verlaufsbeschreibung im Spiegel der Literatur.

This report pertains to a 26-year old primigravida three years after kidney transplantation and still on immunotherapy. Her pregnancy progressed without severe complications until the 33rd week of gestation. Then a sudden and rapidly worsening pre-eclampsia led to admission and delivery. The postoperative period was complicated by an episode of severe septic shock. Reported is a review of the literature. Problems following pregnancy after kidney transplantation and triple therapy including Cyclosporin A are pointed out.

[Nephroblastoma in adults]. / Das Nephroblastom im Erwachsenenalter.

Nephroblastoma is very rare in adults and must be differentiated from renal cell carcinoma. The diagnosis can only be made by means of histological examination, which can cause problems because of the various morphological types of the tumor. In this paper an account is given of the authors' experience in the diagnosis and treatment of four Wilms tumors in stages I (n = 1), II (n = 1), III (n = 1) and IV (n = 1) in adult patients. One patient died of a relapse, two patients are taking part in a follow-up study and one patient is undergoing chemotherapy.

[Splenogonadal fusion]. / Splenogonadale Fusion.

The splenogonadal fusion is a rare but benign anomaly. The diagnosis is usually given at operation or histologically after operation. In about 50% of the patients who undergo surgery for scrotal tumor, an unnecessary orchidectomy is performed due to clinical unawareness of this rare condition. A case of splenogonadal fusion belonging to the continuous type is presented to illustrate problems of this anomaly and point out the importance of intraoperative microscopic sections.

[Ectopic adrenal cortex tissue]. / Nebennierenrindenektopien.

A case of a 40-year-old man with an adreno-cortical ectopia in the region of the spermatic cord is presented. The genesis and complexity of this anomaly is discussed. The seldom occurring, but sometimes important clinical relevance of these ectopies is demonstrated.

[Fluorocytophotometic DNA studies in kidney carcinoma]. / Fluoreszenzcytophotometrische DNS-Studien an Nierenkarzinomen.

DNA measurements in renal cell carcinoma are demonstrating a considerable tumor heterogeneity. Tumor DNA content is one of important prognostic factors. Renal cell carcinomas can be divided into two main groups by single-cell cytophotometry: diploid/near diploid in grade 1 and 2 and mainly aneuploid in grade 3 with variable blocks and peaks. In different tissue samples from the same carcinoma we can found different polymorphism and DNA content.

[Pheochromocytoma and adrenal gland hyperplasia in a remaining atrophic kidney]. / Phäochromozytom und Nebennierenhyperplasie in einer Rest-Schrumpfniere.

We report the not-yet-published case of a renal cell carcinoma in an atrophic kidney in combination with ipsilateral pheochromocytoma and adrenal cortex hyperplasia. The cause of the adrenal cortex hyperplasia was found to be the result of a reaction to the accompanying adaptation hyperplasia.

[MR tomography following kidney transplantation]. / MR-Tomographie nach Nierentransplantation.

The results obtained by MR tomography in 30 patients after renal grafting are compared with the clinical and histological data in respect of corticomedullary contrast (CMC). In 22 patients with regular functioning of the transplant the CMC was normal at 19.4%. Eight MR examinations yielded a clearly reduced CMC below 14%. In 7 of these 8 patients it was possible to prove histologically the existence of an acute tubular necrosis or of a transplant rejection. Noninvasive MR tomography yielded an early indication for treating the acute renal transplant rejection without being able to differentiate between such a rejection and acute renal failure.

[A new simple procedure for immersion sonography of the scrotal contents in real time technic. II: contribution to the differential diagnosis of diseases of the scrotal contents]. / Ein neues einfaches Verfahren für die Immersionssonographie des Skrotalinhaltes in real-time-Technik. II. Mitteilung: Beitrag zur Differentialdiagnose der Erkrankungen des Skrotalinhaltes.

In this communication the experiences obtained in 221 patients with a newly developed immersion method for scrotal sonography are analysed. The specific criteria for testicular neoplasms are derived from 22 patients with 100% true-positive diagnosis. In this context, the diagnostic difficulties in defining and identifying the benignity of an affection are discussed. The typical sonographic alterations of scrotal structures in diseases like epididymitis, epididymo-orchitis, spermatocele, varicocele and trauma are also described. An approach to calculating the testicular volume and hydrocele volume is given. The increase in diagnostic reliability makes this method suitable for pre-invasive diagnosis. The simple and non-hazardous procedure can be recommended as a routine method.

[Do retroperitoneal vascular abnormalities influence the operability of metastasizing testicular tumors?]. / Limitiert der retroperitoneale Gefässsitus die Operabilität des metastasierenden Hodentumors?

The lymphatic drainage of the testis is closely related topographically to the large retroperitoneal vessels. In retroperitoneal lymphadenectomy (RLA), the surgeon therefore takes the vessel topography as his point of orientation. Typical vascular findings, deviated from the norm, of altogether 285 lymphadenectomies (Jan. 1966-Dec. 1980) are described. The vascular variations do not influence the radicality of the operation. Knowledge of these variations help to prevent vascular lesions. On the other hand, infiltrations of larger vessels entail an extension of the operation. Involvement of the renal vessels (walling in, infiltration) may necessitate nephrectomy. Infiltrations of the wall of the aorta, vena cava or the pelvic vessels are resected and sutured according to the rules of vascular surgery. Involvement of infrarenal and unilateral renal vessels may not be allowed to impede radical extirpation of the tumor.

[Operative removal of tumor thrombus from vena cava in hypernephroid carcinoma (author's transl)]. / Operative Konzeption zur Beseitigung eines Tumorthrombus aus der unteren Hohlvene bei hypernephroidem Carcinom.

The prognosis of renal cell carcinoma correlates with the aggressiveness of surgery, especially in patients with involvement of the vena cava. Without significant bleeding the operative management and the successful removal of a free floating tumor thrombus from the vena cava has been described. In a 69-years old female patient the vascular surgery consists of cross clamping of the vena cava with free back-flow of the contralateral renal vein, cavotomy, insertion of a Fogarty catheter for occlusion of the suprarenal vena cava without blocking the liver veins, and extraction of the thrombus.