Kombinierte Nieren-Pankreas-Transplantation

BACKGROUND: Differences in graft survival due to gender have been reported after transplantation of the kidney, liver, and heart. However, little is known about the role of donor and recipient gender in simultaneous pancreas-kidney transplantation. METHODS: Single-centre analysis was performed of first simultaneous pancreas-kidney transplantations performed between 1994 and 2005 at the Bochum Transplant Center in Germany (n=218). RESULTS: Recipients of female donor organs exhibited acute organ rejections earlier and more frequently (P<0.05). Male recipients of organs from male donors had a lower risk of acute rejection than recipients of female donor organs (P<0.05). In addition to female donor gender, higher donor age and early kidney dysfunction were risk factors for perioperative rejection (P<0.05). Long-term kidney and pancreas function was best in male-donor-to-female-recipient transplants over the time periods of 7 and 3 years, respectively (P<0.05). Risk factors of long-term organ failure were: the need of revision laparotomy, organ rejection, and early postoperative organ dysfunction (P<0.05). CONCLUSION: This is the first report of graft function after simultaneous pancreas-kidney transplantation looking specifically at gender differences with respect to donor and recipient. There was an increased risk of organ rejection of female donor organs.     

Kombinierte AC-Gelenk-Luxation und laterale Klavikulafraktur

Background

A 55-year-old male patient sustained a dislocation of the acromioclavicular (AC) joint in combination with a distal clavicle fracture.

Methods

Following closed reduction of the fractured clavicle, arthroscopically assisted coracoclavicular fixation was performed.

Discussion and conclusion

A combined injury of a complete ac joint dislocation and a distal clavicle fracture is rare and is not included in currently available classification systems; therefore, in this article a classification and assessment of the stability of this injury as well as appropriate treatment options are discussed.

     

Kombinierte endoskopische Versorgung der Spieghel-Hernie

Spigelian hernias are rare forms of abdominal hernia but can lead to severe complications. Besides conventional techniques there are only a few reports on the successful use of minimally invasive surgery (MIS) techniques. In this paper the combination of laparoscopy and TEP (total extraperitoneal patch plasty) technique without mesh fixation is presented. In our opinion laparoscopy ?C TEP ?C laparoscopy is a logical, safe and beneficial method for treatment of Spigelian hernias.     

Kombinierte Korrekturen an Nase und Kiefer

Ohne Zusammenfassung     

Kombinierte Beugesehnen- und Nervenverletzungen der Hand

Any restoration of hand function following tendon and nerve injury has to include the repair or replacement of the hand’s ability to perform a great many tasks. It is hard at first to appreciate fully the loss that occurs with flexor tendon injury. Also sensibility can be compromised from tendon injury without direct injury to the nerve, as object recognition in the absence of vision requires finger movement. When peripheral nerve injury is combined with flexor tendon injury, sensibility is directly impaired. There is a loss in the sense of finger or thumb position, pain temperature and touch or pressure recognition, in addition to the tendon injury. However, the outcome after operative treatment of these“minor” injuries of the hand is horrible. Therefore, we try to summarize practical consequences for the repair of combined flexor tendon and nerve injuries which will improve operative outcome. These guidelines are based on current scientific knowledge and our own experience.     

53. Kombinierte Strahlenschäden

Zusammenfassung Ein durch Ganzkörperbestrahlung mit hoher Dosis vorgeschädigter Organismus wird durch eine hinzukommende Verwundung oder Verbrennung in besonderem Ma\e gefährdet. Die bestrahlungsbedingte Knochenmarkinsuffizienz mit nachfolgender Agranulocytose bedingt eine gesteigerte Infektanfälligkeit gegenüber den durch die offenen Wunden eindringenden Keimen. Bakterielle Allgemeininfektion und Blutungen als Folgen der Thrombocytopenie verschlechtern die Prognose. Für die Therapie derartiger Kombinationsschäden ergeben sich erhebliche Probleme.     

165. Kombinierte Katheterperiduralanaesthesie bei thoraco-abdominellen Eingriffen

Zusammenfassung Es wird über 28 große thoraco-abdominelle chirurgische Eingriffe berichtet, bei denen eine Kombination von Intubationsnarkose und Katheterperiduralanaesthesie mit Bupivacain 0,5 % zum Einsatz kam. Die Patienten sind während des Eingriffs unter Sedierung und mechanischer Beatmung schmerzfrei und benötigen keine weiteren Analgetica. Die Vorteile dieses Narkoseverfahrens liegen in einer schonenden Narkoseführung mit verminderter Streßantwort und nicht atemdepressiver postoperativer Analgesierung mit Bupivacain oder Buprenorphin peridural.     

Kombinierte flexible und semirigide Ureterorenoskopie mit Laserlithotripsie

BACKGROUND: Flexible ureteroscopic laser lithotripsy of intrarenal calculi is technically demanding and challenging due to potential dislocation from the calyx and damage to the tissue or the fiber optic during in situ laser lithotripsy. MATERIAL AND METHODS: In 12 consecutive patients ESWL resistant renal stones were collected with the flexible ureteroscope using the nitinol basket and repositioned into the renal pelvis. After removing the flexible ureteroscope from the ureter the stones were treated through an additionally inserted semirigid ureteroscope with frequency-doubled double-pulse Neodym:YAG (FREDDY) laser under direct vision. RESULTS: Operating time was on average 110 min. During the complication-free 3 month follow-up, 8 patients had complete success, 3 partial success, 1 patient had residual fragments >3 mm and 88% of lower pole calyces were stone-free. CONCLUSIONS: As an alternative to percutaneous nephrolithotomy, repositioning of renal stones to the renal pelvis with the flexible instrument allows in selected cases safe laser fragmentation through a semirigid instrument. Access or exposition-related problems can be solved and repair costs of the instruments will be minimized.     

Kombinierte Schussverletzung des Herzens und der Lunge

The authors present a case report of a 38-year-old man who suffered combined gunshot injuries of the heart and lungs from a small caliber gun. The gunshot resulted in combined injuries of a penetrating wound of the left lung, the right heart chambers and the right lung which were successfully managed despite a delay in surgery of several hours by pledget sutures of the heart wounds, wedge resection of the lingula and right lower lung lobectomy performed via a clamshell thoracotomy.     

165. Kombinierte Katheterperiduralanaesthesie bei thoraco-abdominellen Eingriffen

Zusammenfassung Aktuelle Standortbestimmung der Verwertbarkeit und Rentabilität dieser Biopsie an Hand von 110 Fällen (68 Männer, 42 Frauen). Die Methode zeichnet sich aus durch relativ einfache Ausführungen in geübten Händen und durch die Seltenheit von Komplikationen (4 Hämatombildungen, 2 Lymphfisteln, die sich spontan schlossen). Die beste Indikation gibt die Sarkoidose ab: positive Ergebnisse 62% und die Hodginerkrankung 41 %, dagegen nur begrenztes Interesse beim Bronchialkrebs: 25 %. Bei letzterem hat die Biopsie vorzügliche prognostische Bedeutung: die Feststellung von Scalenus-Lymphknotenmetastasen macht eine Probe-Thoracotomie überflüssig.     

Kombinierte Anwendung neuer radiologischer Methoden in der Tumordiagnostik

Zusammenfassung Arteriographische, venographische, lymphographische und szintigraphische Untersuchungsmethoden wurden in wechselnder Kombination bei der radiologischen Diagnostik maligner Tumoren zur Anwendung gebracht. Es wird gezeigt, welche Verbesserung der diagnostischen Aussagemöglichkeiten bei der Metastasierung in die Lymphknoten des Beckens und Retroperitonealraumes, bei Lebermetastasen und bei Nierentumoren damit zu erreichen ist.Mit 9 TextabbildungenHerrn Professor Dr. Dr. h. c. Dr. h. c. Dr. h. c.K. H. Bauer zum 75. Geburtstag gewidmet.     

Kombinierte transgluteale N.-ischiadicus- und N.-femoralis-Blockade

For amputations of the lower limbs the combined blockade of the sciatic nerve (via the transgluteal approach) and the femoral nerve (via the inguinal route) may be a suitable alternative to general or neuroaxial anaesthetic methods. In highly comorbid, high risk patients this catheter-linked regional anaesthesia combines the advantages of avoiding controlled ventilation with decreased cardiovascular depression, as conveyed by the use of general anaesthesia or neuraxial techniques. Furthermore, improved postoperative analgesia may be achieved for several days. In our retrospective study, 65 patients who were scheduled for amputation of the lower limbs were analysed. In 58 patients (89%), a regional anaesthesia technique employing only a catheter technique was performed and only 7 patients (11%) required additional general anaesthesia. For postoperative pain management, local anaesthetics were administered via an indwelling nerve block catheter and excellent pain scores were achieved in these patients. However, successful employment of this technique necessitates sufficiently trained personnel as well as on-going training in the performance of catheter-based local analgesia.     

Kombinierte Technik der chirurgischen Zytoreduktion und hyperthermen intrathorakalen Chemotherapieperfusion

The multimodal approach using macroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) may improve local tumor control and prognosis of patients with primary and secondary pleural tumors. After complete surgical cytoreduction, consisting of parietal and visceral pleurectomy, the intraoperative HITHOC procedure allows for better local dissemination and a higher concentration of the chemotherapeutics in the pleural cavity in contrast to systemic application. This new combined treatment strategy can result in improved patient survival with acceptable morbidity and mortality in selected patients, having no indication for radical resection (extrapleural pneumonectomy). Patients with primary and secondary tumors of the pleural should be evaluated by an interdisciplinary team, concerning this therapeutic alternative. In this report, cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy perfusion is discussed, and the current literature is reviewed.     

Kombinierte Plastik des vorderen Kreuzbandes mit gestieltem Periostlappen und Kutisstreifen

In view of the increasing incidence of injuries to the knee ligament and the persisting problems associated with the substitution of the cruciate ligament, a new combined reconstruction of the anterior cruciate ligament is presented which is performed with a pedicle periosteous flap and a cutaneous stripe. The advantages of the technically simple method using mechanically and biologically valuable substitutes are discussed.