[Small intestine transplantation--a causal therapy in short bowel syndrome]

The problems of surgical technique, graft physiology and immunological reactions in small-bowel transplantation have been investigated in extended animal experiments. In these experiments, the fundamentals of a successful clinical application of small-bowel transplantation could be laid. A successful human small-bowel transplantation could be carried out by the Kiel Group for the first time in 1988. A graft which had been removed from a related donor showed a complete adaptation after 22 months, so that the patient became completely independent from parenteral nutrition. After that, in several cases small-bowel and combined liver and small-bowel transplantation have been carried out. Thus, the clinical small-bowel transplantation represents the causal therapy of short-bowel syndrome and should be developed in further clinical trials.

Upper gastrointestinal endoscopy at a student health centre

605 upper gastrointestinal endoscopies were performed at a student health centre on university students under the age of 35. Some abnormality, and sometimes more than one, was found in 291 (48.0%) patients. 93 (15.4%) had chronic superficial gastritis, 36 (5.9%) acute gastritis, three had atrophic gastritis, and two eosinophilic gastritis. 53 patients (8.7%) had an oesophageal abnormality. Coeliac disease was found in 16 (2.6%) and new cases of duodenal ulcer in 14 (2.3%). 19 patients (3.1%) had gastric polyps. It is concluded that upper gastrointestinal endoscopy is a procedure well suited for primary health care, and that a significant proportion of young adults examined for abdominal complaints in such a setting will be found to have some abnormality.

Small bowel transplantation

Small intestinal transplantation has had several clinical attempts based on extensive experimental work during the past two decades. Several models, such as auxiliary (heterotopic) or orthotopic models, have been developed in regard to problems with graft immunology and function. The question of mesenteric-portal or mesenteric-caval graft drainage was raised, and the answer seems to be open. Concerning lipid absorption, interest was directed to the reconstitution of lymphatic vessels, because orally administered cyclosporine A is absorbed by the lipid mechanism. Carbohydrate digestion and absorption are used for determination of graft function and for monitoring graft rejection. This article summarizes these problems and deals with the surgical procedure of small bowel transplantation in the rat.

Small bowel transplantation in a child. Morphologic, immunohistochemical, and clinical results

A small bowel transplant was performed on a five-year-old boy with a short bowel syndrome. The donor was the child's mother. Despite immunosuppressive therapy, the transplant was acutely rejected and had to be explanted on the twelfth day. Morphologic and immunohistochemical investigations on subsequent biopsies taken from the small bowel transplant were carried out. Besides typical changes in epithelial cells and the presence of T-cell infiltrates and Ig-deposits in vessels, many macrophages were seen. The submucosa in particular was invaded before rejection by numerous macrophages with positive results of antimonocyte/macrophage antibodies Ki-M6 and Ki-M7. The number of the macrophage antibodies Ki-M6 and Ki-M7. The number of the monocyte/macrophage cells and the immunohistochemical characteristics of the same may be important parameters for monitoring small bowel transplantations.

[First successful clinical small intestine transplantation. Tactics and surgical technic]

A case of successful clinical small bowel transplantation is demonstrated. A segment of 60 cm of jejunum and ileum has been harvested from the sister of the recipient and has been brought in heterotopic position in the first operative step. It was anastomosed to the recipient's GI-tract 6 weeks later. This procedure has the advantage that the graft can recover from ischemic damage in heterotopic position and that an immunological steady state can be achieved. This case of successful clinical small bowel transplantation offers a new causal therapy for patients with short gut syndrome.

[Surgical indications status in ileus using a simple clinical index]

Based on a retrospective analysis of a group of patients with ileus disease in regard of the indication for operative intervention an "ileus index" was created which is derived from simple clinical and radiological findings and laboratory data. Prospective evaluation of this index showed its effectiveness in separating patients who had to undergo an emergency operation from those who could be operated electively after preceding diagnostic procedures or could be treated conservatively.

Directions and dilemmas in nursing quality assurance

Effects of the health care environment have been a catalyst for the evolution of nursing quality assurance programs. Changes can be summarized as an increased focus on actual clinical practice, an increased participation by professional nurses, and an increased sophistication in the methods used to monitor and evaluate. Much work remains to be done in creating environments that assure quality of care.