[Traumatic rupture of a kidney transplant in chronic lymphocele]

The lymphocele is a seldom complication after kidney transplantation (2.2% of our patients). This manifestation occurs typically 3-4 months after transplantation, as a late complication it's a rarity. The rupture of a kidney graft because of a trauma is unique in our clinical experience, which contains more than 1200 kidney transplantations. We report the case of a 28-year-old man who had 19 years after transplantation a traumatic rupture of the kidney graft. Because of the trauma a preexistent chronic lymphocele got clinically manifest. The histology of the lymphocele wall shows fatty and collagen tissue with a strong fibrosis. The diagnostic and therapeutic procedure is described. There are different possible relations between the rare problems:--the tight lymphocele carries over the force on the graft--the lymphocele has grown together with the graft at the lower pole and ruptures in this place--a little graft rupture makes a clinical manifest bleeding in the lymphocele because the deficiency of perirenal tissue.

[Surgical management of severe pelvic crush injuries]

Control of hemorrhage and prevention of septic complications are the predominant difficulties associated with severe pelvic crush injuries. According to our experience spontaneous tamponade, external compression (MAST/G-suits), and blind ligation of the hypogastric artery seem to be ineffective, whereas angiography followed by embolization, controlled ligation or vascular reconstruction, packing with scheduled 2nd look reexploration, and rigid fixation of the pelvic ring are recommended to control severe hemorrhage associated with these injuries. Moreover, early repair of bowel and urinary tract lesions, diverting colostomy with rectal wash-out, radical debridement, and open wound care of degloving avulsion injuries appear to be the most important procedures to prevent posttraumatic sepsis. Our pelvic crush trauma protocol is based on 84 consecutive cases treated between 1972 and 1990. In all cases the Injury Severity Score (ISS) was over 40 points, each patient required at least 10 units of whole blood or red cells, the overall mortality rate was 41 out of 84 patients.

Biosynthesis of ferulic acid esters of plant cell wall polysaccharides in endomembranes from parsley cells

A microsomal preparation from suspension-cultured parsley cells is able to transfer ferulic acid from the respective CoA thioester to endogenous acceptors. The reaction is not enhanced by digitonin but stimulated by Mg2+, Ca2+ and Co2+. Spermine can partly replace divalent ions. Solubility properties and degradation by polysaccharide hydrolases suggest that the products are polymeric cell wall carbohydrates. Sucrose density gradient centrifugation revealed that the most active vesicle fraction is distinct from plasma membranes but does also not peak with IDPase. It is suggested that a subfraction of the Golgi-apparatus is the source of enzyme and acceptors.

[Modified postoperative prevention of recurrence in euthyroid struma nodosa]

In a prospective clinical study after uni- or bilateral subtotal thyreoidectomy, cause of euthyreote goitre, no substitution with L-thyroxin was ordered postoperatively. The follow-up after three months and one year shows a representative time for judgement of the hormonal situation after three months. Over one year 55% with bilateral resection need hormone substitution but only 4% with unilateral. Bilateral subtotal thyroid resection seems to be a too extensive resection to leave enough functional thyroid tissue for a physiological function.

A controlled study of early neurologic abnormalities in men with asymptomatic human immunodeficiency virus infection

BACKGROUND

Although neurologic complications are frequent in the acquired immunodeficiency syndrome, their incidence and progression in early human immunodeficiency virus (HIV) infection remain controversial. The goal of this study was to assess neurologic manifestations in asymptomatic carriers of HIV.

METHODS

We studied 29 HIV-seropositive homosexual men and 33 seronegative homosexual controls by means of neurologic and neuropsychological examinations, magnetic resonance imaging (MRI), and electrophysiologic tests (electroencephalography, multimodal evoked-potential tests, and otoneurologic tests). After six to nine months, the tests were repeated in 27 seropositive men and 30 controls. The investigators were blind to the serologic status of the subjects.

RESULTS

The seropositive subjects had a mean CD4+ lymphocyte count of 635 X 10(6) per liter. Neurologic and neuropsychological examination, MRI, and measurements of pattern visual evoked potentials did not show significant differences between the two groups. The latencies of the median-nerve somatosensory evoked potentials were slightly prolonged in the seropositive men. The initial electroencephalogram was judged abnormal in 8 of 27 of the seropositive subjects (30 percent) as compared with none of the controls, with a slowing of fundamental activity, anterior spread [corrected] of alpha rhythm, subnormal reactivity, and unusual anterior theta activities. These findings were confirmed by computerized spectral analysis. The second electroencephalogram was abnormal in 10 of 25 of the seropositive men (40 percent). The otoneurologic evaluation identified abnormalities in the central auditory or vestibulo-ocular pathways in 34 percent of the seropositive men (10 of 29), as compared with 6 percent of the controls (2 of 33), on the first examination and in 44 percent (12 of 27) and 7 percent (2 of 30), respectively, on the second examination. Altogether, electrophysiologic abnormalities were found in 67 percent of the seropositive men (18 of 27) and 10 percent of the controls (3 of 30) (P less than 0.00005).

CONCLUSIONS

In persons with asymptomatic HIV infection, electrophysiologic tests may be the most sensitive indicators of subclinical neurologic impairment. Electrophysiologic abnormalities are far more common in asymptomatic carriers of HIV than in controls and tend to progress over time.

Fisher's syndrome associated with Campylobacter jejuni infection

A patient developed typical features of Fisher's syndrome after an infection with Campylobacter jejuni as ascertained by positive serology both in the blood and spinal fluid. This may be the first case of this association described.