Migration rates of radionuclides deposited after the Chernobyl accident in various North German soils

In three soils typical for Northern Germany including Eutric Cambisol, Orthic Podsol and Eutric Histosol (Food and Agriculture Organization nomenclature), distributions of 90Sr, 134Cs, 137Cs and 239Pu + 240Pu in the soil profiles were determined. Sampling was performed more than 3 years after deposition of Chernobyl fallout nuclides. Migration rates calculated with a compartmental model showed no significant differences between Cs originating from either atomic weapons or Chernobyl fallout. This result indicates that Chernobyl Cs may have reached sorption equilibrium with the soil matrix 3 years after the accident. Both the compartmental model and the dispersion equation reproduce distributions of most of the activities, but fail to reproduce some (minor) activity fractions that show increased mobility.

[Possibilities and limitations of heterotopic auxiliary liver transplantation]

Although auxiliary heterotopic liver transplantation offers theoretical advantages over orthotopic liver replacement, clinical results have heretofore been dismal. After development of a technique of reduced size liver grafts provided with portal and arterial blood and venous drainage via the suprahepatic V. cava (HLT) in experimental animals, this method was applied in 21 transplantations in 19 patients. 11 of 16 patients with chronic liver insufficiency and one of three patients with fulminant liver failure survived transplantation for at least 1 year. HLT was well tolerated even by high-risk patients. Possibilities and limitations of this novel approach are discussed.

Moderate effect of preoperative blood transfusions on pancreas allograft survival in rats and dogs

Treatment of type I diabetes by early pancreas transplantation requires the availability of a safe and effective transplantation technique. With the currently available immunosuppressive drugs it is difficult to obtain long-term pancreatic allograft survival. In this respect pancreas grafts compare unfavorably with heart or kidney grafts. Using a relatively simple and safe subcutaneous transplantation technique we investigated the effect of blood transfusions combined with low-dose immunosuppressive drugs in rats and dogs in order to attain an immunosuppressive schedule of low toxicity. Subcutaneous pancreas transplantation appeared to be a feasible technique, with long-term graft survival in syngeneically transplanted rats and autotransplanted dogs. Only a moderate prolongation of pancreatic allograft survival by blood transfusions was demonstrated in both models. In rats one or three preoperative donor-specific blood transfusions significantly prolonged pancreas graft survival to 23 +/- 15 and 29 +/- 15 days, respectively, compared with 12 +/- 2 days in untreated controls. Low-dose cyclosporine (15 mg/kg on the day of operation) led to improved graft survival in nontransfused recipients (17 +/- 4 days), however, this treatment could not further prolong graft survival in transfused animals (34 +/- 20 days). In dogs, treated postoperatively with azathioprine and prednisolone, three preoperative third-party blood transfusions led to 29 +/- 19 days of pancreas graft survival, which was not significantly different from nontransfused controls (17 +/- 5 days). These results indicate that, in rats as well in dogs, pancreatic allografts are less sensitive to the immunomodulating effect of blood transfusions than heart and kidney grafts.

Intraoperative hemodynamics in liver transplantation comparing orthotopic with heterotopic transplantation in the pig

The intraoperative hemodynamic changes and several graft function parameters were studied comparing orthotopic liver transplantation with auxiliary partial liver transplantation (APLT) in the pig. Thirty-one Yorkshire pigs (ca. 25 kg b.w.) were randomly allocated to OLT (n = 16) or APLT (n = 15). During the construction of portal anastomosis the median cardiac output dropped to 67% of the initial value in OLT and to 49% in APLT (P less than 0.02). Median duration of the portal flow interruption was shorter in APLT: 15 min versus 48 min in OLT (P less than 0.002). After unclamping of the aorta, the median systolic blood pressure dropped to 75 mmHg in OLT and to 90 mmHg in APLT (P less than 0.02). APLT is less time-consuming: median duration of transplantation was 128 min versus 165 min in OLT (P less than 0.002). SGOT levels were lower in APLT than in OLT (median SGOT on the first postoperative day 67 was IU/L versus 177 IU/L, P less than 0.002). It is concluded that APLT is a shorter procedure than OLT with a shorter portal flow interruption, being less offensive to the recipient.

Auxiliary partial liver transplantation for end-stage chronic liver disease

Auxiliary heterotopic liver transplantation is theoretically attractive because it leaves the recipient's liver in place. The surgical trauma of hepatectomy is avoided, and failure of the graft does not necessarily lead to the death of the patient or a second, emergency transplantation. Another advantage is that matching the body sizes of the donor and the recipient is not mandatory, which increases the number of possible donors. However, previous clinical results of auxiliary liver transplantation have been poor. We performed auxiliary partial liver transplantation in six consecutive patients with end-stage chronic liver disease who were not accepted for orthotopic liver transplantation because they had massive ascites, deficient clotting function, cachexia, or poor pulmonary reserve. The donor liver was transplanted to the right subhepatic region after removal of segments II and III, and it was provided with portal and arterial blood. There were no major changes in hemodynamic measurements during surgery. The mean hospital stay after transplantation was 22.7 days (range, 14 to 29). After a mean follow-up period of 14 months (range, 5 to 23), all patients were alive, with good graft function as demonstrated by scintigraphy, Doppler ultrasonography, and synthesis of clotting factors. From these observations we conclude that auxiliary partial liver transplantation is an attractive alternative to orthotopic liver transplantation in high-risk patients. Its role in other patients who need liver transplants remains to be defined.

Catheter-related complications during continuous ambulatory peritoneal dialysis (CAPD): a retrospective study on sixty-two double-cuff Tenckhoff catheters

From May 1980 to April 1985, a total of 62 double-cuff Tenckhoff catheters were surgically implanted in 54 patients through a low medial laparotomy. The follow-up on continuous ambulatory peritoneal dialysis accounted for 1,029 patient-monthly. The patients who used a detachable double-bag system developed a total of four exit-site infections, one tunnel infection, three outer cuff erosions, four catheter dislocations, and two dialysate leaks. In five patients, the catheter had to be removed (one exit-site infection, two catheter breaks, and two catheter dislocations). Cumulative catheter survival using the method of life-time analysis was 81% and 70% after 1 and 2 years, respectively, considering all catheters implanted, and 92% and 92%, respectively, when peritonitis-related removal was excluded.

A sigmoidoscope to facilitate reanastomosis following a Hartmann procedure

The use of a sigmoidoscope to introduce the circular stapler is described. This technique facilitates reanastomosis following a Hartmann procedure.

[Endoscopic division of an obstructive intraluminal duodenal diverticulum]

Intraluminal duodenal diverticula are rare malformations which usually are noted first in adulthood. High intestinal obstruction predominates the clinical picture. Surgical resection of the diverticulum is the treatment of choice. In a 52-year-old woman it was possible to split the intraluminal obstruction along its whole length by endoscopic means. This method would seem to present a possible alternative to surgical intervention.

Antegrade pyelography, percutaneous nephrostomy and ureteral perfusion (Whitaker test) for the renal transplant recipient

Ureteral obstruction is a serious complication in renal transplant recipients. The diagnosis may be difficult with standard methods of investigation, and definite treatment may, therefore, be delayed. This paper describes the indications, the technique, and the experience with antegrade pyelography, ureteral perfusion and percutaneous drainage in 18 patients with suspected urinary obstruction. Though invasive, these methods proved to be a safe, fast and accurate means for evaluating the location and significance of ureteral obstruction. For initial treatment in obstruction, percutaneous nephrostomy is the method of choice. Surgery should be delayed until recovery of renal function with decreasing serum creatinine is demonstrated. Patients with persistent or rising serum creatinine (greater than 250 mumol./l.) did not benefit from surgical relief of obstruction.

[Further developments in pancreatic islet transplantation I. Induction of selective morphological changes in the exocrine pancreas]

For pancreatic islet transplantation to become clinically applicable, chemical agents are needed which cause selective morphological alterations in the exocrine part of the organ within a few hours after application. DL-ethionine (Aet), cerulein (Cd), seleno-DL-methionine (SeMet) and seleno-DL-ethionine (SeAet) were given to rats during various time periods. At 4 h after i.p. injection, 40 mg/kg SeMet caused the greatest selective morphological alterations in the exocrine pancreas. Acinar structure disappeared, the exocrine cells were abnormal and their nuclei had various dimensions and forms. There were, however, no alterations in the islet cells. At this time, neither Aet, Cd, nor SeAet produced similar changes. SeMet was the most toxic substance and was taken up in the shortest time and in the greatest amount. This selective destructive SeMet effect allows better isolation of the islets from exocrine tissue thereby increasing islet yield and decreasing transplantation volume. Better islet purification may prevent an early rejection.

Growth, zinc and copper nutritional status of male premature infants with different zinc intake

Zinc is an essential nutrient for growth and low intake can result in growth retardation. However, high zinc intake can affect copper metabolism. Therefore, data from a study of 10 male premature infants fed a cow's milk-based formula nonfortified with zinc (mean +/- SD = 1.4 +/- 0.1 mg X l-1) were compared with data of 10 similar infants fed the same formula fortified with zinc (4.1 +/- 0.3 mg X l-1). Growth, food intake, zinc and copper nutritional status were studied from 6 through 122 days of age. No differences in gain of weight, length and head circumference and in food intake were found. Serum zinc concentration was significantly (p less than 0.05) and hair zinc concentration was slightly higher in the infants fed the zinc-fortified formula at 122 days of age. Copper and ceruloplasmin concentrations in serum and hair copper concentration were similar in both groups at 122 days of age. The results suggest that feeding a formula nonfortified with zinc did not affect growth of male premature infants. Feeding a zinc-fortified formula on the other hand had no influence on copper nutritional status.