Peter Petritsch

Functional magnetic resonance imaging of human renal allografts during the post-transplant period: Preliminary observations

Graft dysfunction is a common occurrence during the first weeks following renal transplantation. The current study was designed to evaluate the potential of renal magnetic resonance (MR) perfusion imaging to differentiate acute allograft rejection (AAR) from acute tubular necrosis (ATN) during the post-transplant period. Twenty-three consecutive patients with clinically suspected ATN and/or AAR and eight consecutive control patients (asymptomatic, serum creatinine concentration < 1.5 mg/dL) underwent MR perfusion imaging of the renal allograft within 64 days after transplantation. Histopathology was obtained in all cases with clinical suspicion of ATN or AAR. Sixty sequential fast gradient-recalled-echo MR images were acquired in each patient after intravenous administration of gadolinium-DTPA (0.1 mmol/kg). Histopathology revealed 6 patients with pure AAR, 4 patients with a combination of AAR and ATN, 12 patients with ATN and 1 patient with normal findings. Kidney graft recipients with normal renal function showed a moderate increase in signal intensity (SI) of the renal cortex and medulla after administration of contrast agent followed by an immediate and short decrease in SI of the medulla (biphasic medullary enhancement pattern). The increase in cortical SI of patients with AAR was significantly smaller (61 +/- 4% increase above baseline) than that measured in normal allografts (136 +/- 9% increase above baseline) (p < 0.05) and patients with ATN (129 +/- 3% increase above baseline) (p < .05). Patients with ATN had a slightly delayed and diminished cortical enhancement and an uniphasic and lesser medullary enhancement pattern compared to that observed in normal allografts (p < 0.05). A close correlation (r = 0.72) was found between serum creatinine concentration levels and changes in SI. Thus, MR imaging results and histopathology were in agreement in 22 of 23 patients (96%). MR perfusion imaging of renal allografts can be used to noninvasively differentiate ATN from AAR during the post-transplant period, and may also be helpful in cases were covert AAR is superimposing ATN during a phase of anuria. Patients with ATN can be separated from normals in the majority of cases as reflected by an uniphasic medullary enhancement pattern.

Angiomyolipoma with a Caval Thrombus

We report the case of a female patient presenting with flank pain. Abdominal ultrasound revealed a tumor of 8 cm in diameter. After abdominal computerized tomography, the tumor was classified as angiomyolipoma with a tumor thrombus in the inferior vena cava. After nephrectomy, the diagnosis was confirmed histologically. To our knowledge, this is the 11th case of a renal angiomyolipoma extending into the vena cava.

Prostatic Phyto-Oestrogen Tissue Levels in Different Austrian Regions

Introduction: A number of studies suggest that the low incidence of prostate cancer as well as benign prostatic enlargement in Asia depends on the extended consumption of phyto-oestrogens in these parts of the world. In most Asian men, phyto-oestrogen levels are multiple higher compared to Austrian (European) men. The aim of our study was to evaluate, according to the East-West decline, whether there were significant differences within the Austrian population. We compared prostate phyto-oestrogen tissue levels of men living in three different geographical regions of Austria. We further compared men living in rural and urban environments. Material and Methods: Prostatic tissue samples of 103 men undergoing surgery for benign prostatic hyperplasia or prostate cancer were collected and frozen at –40°C. In tissue samples, enterolactone (representative for lignans) and genistein levels (representative for isoflavones) were determined in duplicate by monoclonal antibody-based immunoassays. We subsequently compared tissue levels of men living in rural and urban environments and different geographical regions of Austria. Results: Prostatic enterolactone tissue levels were similar in men living in an urban (median 19.1 ng/g dry weight, range 1.5–76.4) or rural environment (median 15.7 range 0.6–140.6) p = 0.99. The respective values for genistein were 20.5 ng/g dry weight (range 4.6–47.4) and 9.3 (range 0.1–156.7) p = 0.77. Furthermore, enterolactone (p = 0.1) and genistein (p = 0.65) levels were similar in three different geographic regions in Austria. Conclusion: No significant differences regarding genistein and enterolactone were found between our study populations. However, we found a wide variation between individual patients.

Ultrasonography of urinary tract and micturition as an alternative to radiologic investigations in the spinal-cord-injured patient

Over a period of 1.5 years (July 1989-Jan. 1991), a total of 504 patients, 442 of them suffering from spinal cord injuries with subsequent voiding disorders, were investigated by ultrasonography of the genitourinary tract. Ultrasonography of the upper urinary tract as well as the bladder and prostate provided and accurate image of the pathomorphological changes which go along with this kind of malfunction of the lower urinary tract in this group of patients. The application of rectal ultrasonography using a linear array rectal transducer was able to provide equal or even better images of the micturition process than micturition cystourethrography (MCU). An adequate and accurate real time image of the bladderneck, the prostatic urethra and the external rhabdosphincter could be obtained in all instances. Combined micturition cytourethrosonography (MCUS) with urodynamic evaluation has also been performed, which made the observation and judgement of the bladder outlet as well as the position of the catheter possible throughout the procedure without the interference of X-rays.

Nierentransplantation@@@Kidney transplantation

ZusammenfassungDie Nierentransplantation ist die am häufigsten durchgeführte Organtransplantation und führt zu exzellenten Langzeitresultaten mit einem Fünfjahrestransplantatüberleben von bis zu 80%. Bei normaler Anatomie ist der Eingriff technisch verhältnismäßig einfach. Beim Vorliegen von multiplen Nierenarterien oder verkalkten und zur Dissektion neigenden Beckenarterien kann aber die Anastomose der Transplantatarterie an die Beckenarterie eine chirurgische Herausforderung darstellen und die verschiedensten gefäßchirurgischen Rekonstruktionstechniken erfordern. In diesen Situationen ist gefäßchirurgische Erfahrung unerlässlich, oder es kann sogar empfehlenswert sein, einen Gefäßchirurgen zur Transplantation hinzuzuziehen. Umgekehrt bedeutet dies, dass Gefäßchirurgen, die an Zentren arbeiten, wo Nieren transplantiert werden, sich mit der Nierentransplantation gut auskennen sollten. Offene Eingriffe an der abdominalen Aorta bei nierentransplantierten Patienten sind dadurch kompliziert, dass während des Abklemmens der Aorta eine längere Minderdurchblutung der Transplantatniere auftritt. Erstaunlicherweise wird dies aber gut toleriert, sodass Protektionsmaßnahmen wie die Anlage eines temporären aortofemoralen Bypass eher nicht empfohlen werden. Die endovaskuläre Versorgung eines abdominalen Aortenaneurysmas beim nierentransplantierten Patienten scheint in den meisten Fällen bedenkenlos möglich.AbstractKidney transplantation is the most frequently performed solid organ transplantation and is associated with excellent long-term results with 5-year transplant survival rates of up to 80 %. In the presence of normal anatomy the procedure is surgically straightforward and relatively simple but in the presence of multiple renal arteries or severely calcified iliac arteries prone to dissection, the anastomosis of the transplant artery to the iliac artery can pose a formidable surgical challenge and may require the entire armamentarium of vascular reconstruction techniques. For these cases extensive experience in vascular surgery is important and it may even be advisable to have a vascular surgeon present for the transplantation. This in turn means that vascular surgeons at centers where kidney transplantation is performed should be very well acquainted with the procedure. Open surgery on the abdominal aorta in a patient with a kidney transplant is complicated by an inevitable period of decreased renal perfusion while the aorta is clamped. The transplanted kidney, however, appears to tolerate this surprisingly well and protective measures, such as a temporary axillofemoral bypass are not generally recommended. The limited experience published on endovascular repair of an abdominal aortic aneurysm in a patient with a kidney transplant suggests that it can be done with no harm to the transplanted kidney.

Urologische Erstversorgung beim polytraumatisierten Patienten

Jahrlich werden ca. 100 Patienten mit Polytrauma und Verletzung der Wirbelsaule in unserer Klinik betreut (1986-1989 = 306 Patienten). Bei den polytraumatisierten Patienten fanden sich in ca. 15% begleitende Wirbelsaulenverletzungen. Davon zeigten 2–3% neurologische Ausfalle. Bei den isolierten Verletzungen der Wirbelsaule fanden sich in 50% des Krankenguts Ruckenmarkschadigungen. Bei den neurologischen Ausfallen lagen in einem Drittel komplette und in zwei Drittel inkomplette Querschnittlasionen vor. Als Beispiel seien die Verletzungen der HWS angefuhrt, wo nach Illgner 1989 bei 169 akuten Verletzungen der HWS 46% der Patienten neurologisch unauffallig waren, 16% eine komplette Querschnitt- und 38% eine inkomplette Querschnittlasion aufwiesen.

Urologische komplikationen bei nierentransplantierten

ZusammenfassungIn einer retrospektiven untersuchung konnten wir anhand von 100 konsekutiven nierentransplantationen in den jahren 1969 bis 1986 urologische komplikationen bei insgesamt 15 patienten (15%) beobachten: am transplantat in 4%, am ureter in 5% und an der blase in 3%. Mit 3% waren in unserem krankengut rezidivierende bzw. persistierende harnwegsinfekte eher selten zu beobachten und waren ausdruck von urodynamischen stßrungen. die diagnostik und therapie sowie eine etwaige prophylaxe derartiger komplikationen durch eine adäquate präoperative urologische untersuchung der potentiellen empänger werden diskutiert.SummaryOver a period of 17 years a rather small number of 100 renal transplants has been performed at our department and urological complications could be observed in 15% of our patients. They consisted of renal complications in 5%, spontaneous graft ruptures 2%, staghorn calculus 1%, transitional carcinoma of the renal pelvis 1%, ureteral complications such as partial necrosis 2%, total necrosis 1%, stenosis 2% and complications from the bladder in 2%.Recurrent or persistent urinary tract infection was observed in 3% and tended to be caused by urodynamic disorders. The diagnostic procedures, therapy, as well as prophylactic measures to avoid some of the above mentioned complications by an adequate preoperative urological investigation of the potential recipients will be presented and discussed.