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Copyright of Der Gastroenterologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Nephrologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To determine the inter-patient variability of apparent diffusion coefficients (ADC) and concurrent micro-circulation contributions from diffusion-weighted MR imaging (DW-MRI) in renal allografts early after transplantation, and to obtain initial information on whether these measures are altered in histologically proven acute allograft rejection (AR).Methods: DW-MRI was performed in 15 renal allograft recipients 5-19 days after transplantation. Four patients presented with AR and one with acute tubular necrosis (ATN). Total ADC (ADC(T)) was determined, which includes diffusion and micro-circulation contributions. Furthermore, diffusion and micro-circulation contributions were separated, yielding the "perfusion fraction" (F(P)), and "perfusion-free" diffusion (ADC(D)).Results: Diffusion parameters in the ten allografts with stable function early after transplantation demonstrated low variabilities. Values for ADC(T) and ADC(D) were (x10(-5) mm(2)/s) 228 +/- 14 and 203 +/- 9, respectively, in cortex and 226 +/- 16 and 199 +/- 9, respectively, in medulla. F(P) values were 18 +/- 5% in cortex and 19 +/- 5% in medulla. F(P) values were strongly reduced to less than 12% in cortex and medulla of renal transplants with AR and ATN. F(P) values correlated with creatinine clearance.Conclusion: DW-MRI allows reliable determination of diffusion and micro-circulation contributions in renal allografts shortly after transplantation; deviations in AR indicate potential clinical utility of this method to non-invasively monitor derangements in renal allografts. [ABSTRACT FROM AUTHOR]

Key words: Gemella morbillorum; magnetic resonance imaging; renal transplantation; spondylodiscitis [ABSTRACT FROM PUBLISHER]

Objective: Digital volume pulse is a non-invasive method for indirect measurement of arterial stiffness. Stiffness index (SI) is defined as body height divided by time delay between maximal direct and reflected pulse wave. Our study was designed to evaluate the feasibility of stiffness index in hemodialysis and renal transplant patients and to test whether it is correlated to age, as already shown for healthy subjects. Methods: A photoplethysmograph (Micro Medical®, Kent, United Kingdom) was placed at the index finger of the right hand in renal transplant patients (Tx) (n = 32), healthy subjects (n = 35) and at the index finger of the contralateral shunt arm in hemodialysis patients (HD) (n = 40). In every patients, two to four measurements were obtained under controlled conditions. Pulse curves were analysed computer assisted and after visual control for the inflection point by two independent observers. Results: SI was impossible to calculated due to loss of inflection point in one third of all dialysis patients, (see table 1). The median age of these HD patients was comparable to those of all HD patients. Correlation between age was confirmed for the control group and interestingly as a new finding for renal transplantat patients, but not in the HD- group. Intraindividuell variability in all groups with analysed curves for SI were comparable (10.5-11.5 %). Conclusions: Digital volume pulse is a reliable method to mesure SI in renal transplantat patients and increases with age, as shown for healthy subjects. High interindividual variability, no firm correlation with age and nonreliable curve analysis in a HD-subgroup decreases the utility of this method in dialysis patients. The loss of inflection point in one third of all HD patients could represent an extremely high arterial stiffness, not measurable by digital volume pulse. [ABSTRACT FROM AUTHOR]

Objective: In order to establish a protocol biopsy program after renal transplantation, we started to perform renal transplant biopsies on a day-care basis in October of 2000. Since then, we performed 1,470 ambulant biopsies on 796 patients. Methods: Biopsies were done using an 18-gauge automated biopsy needle (since October 2003 16 gauge) followed by 4 hours bed rest in hospital with blood pressure and urine control as well as an ultrasound before and after biopsy, keeping the patient in hospital in cases of complication or rejection. Results: 1,039 protocol biopsies were performed in 444 renal transplant patients (1st biopsy after 6 weeks, n = 356, 2nd biopsy after 12 weeks, n = 358, 3rd biopsy after 6 months, n = 325); as well as 431 biopsies on indication in 384 patients (creatinine increase or proteinuria). The following complications were observed: Gross hematuria n = 55 (3.7%); hospitalization 20, urinary catheter 12, blood transfusion 1; Perirenal hematoma (ultrasound) n = 31 (2%); hospitalization 7, blood transfusion 4; Vasovagal reaction n = 7 (0.5%); hospitalization 3; av-fistula (doppler sonography) n = 113 (7.7%); persistent 14, spontaneous resolution 46, without control 53. There was no statistically significant difference between complications in protocol biopsies and biopsies on indication (hematuria, 3.8 vs 3.5%; perirenal hematoma, 2.4 vs 1.4%; vasovagal reaction, 0.7 vs 0%; av-fistula, 7.8 vs 7.4%); and no significant difference using a 18 gauge (1,222 biopsies) or a 16 gauge needle (248 biopsies) (hematuria, 4 vs 4%; perirenal hematoma, 2 vs 3%; av-fistula, 8 vs 4%). According to the Banff criteria of specimen adequacy, all biopsies had sufficient cortical area for evaluation of interstitial fibrosis and tubular atrophy; however, evaluating one tissue core, 49.6% of biopsies showed <7 glomeruli and/or no arterial cross section (18 gauge needle). Specimen adequacy increased using a 16 gauge needle (only 19% <7 glomeruli and/or no arterial cross section). Conclusions: We conclude that outpatient renal transplant biopsies can be performed safely and allow for the establishment of a protocol biopsy program. To ameliorate specimen adequacy, we changed from 18 to 16 gauge biopsy needle. Relevant biopsy complications like gross hematuria or perirenal hematoma are usually noticed during the 4 hours of bed rest following the biopsy. Biopsyinduced av-fistula are frequent and are either resolved spontaneously or remain without clinical importance. [ABSTRACT FROM AUTHOR]