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Takotsubo syndrome is named after the octopus trap used by Japanese fisherman and reflects the shape of the left ventricle during systole in patients with this condition. Takotsubo is an acute cardiac syndrome (ACS), starting with chest pain, dyspnoea, ECG changes, sometimes presenting as STEMI or non-STEMI, and in some cases with hypotension, arrhythmias, pump failure, and sudden death. In most patients, the massive left ventricular dysfunction with a reduction in ejection fraction down to 35% is reversible over days, weeks, and months. However, around 4% of patients do not survive the acute condition. The mechanisms are thought to be neurological in nature, involving abnormalities of the amygdala and hippocampus of the mid-brain with over-activation of the sympathetic nervous and endothelin systems, leading to microvascular ischaemia and myocardial stunning. Treatment currently is not evidence-based, but for patients presenting in cardiogenic shock may involve left ventricular assist devices such as ImpelllaR and ECMO (extra corporeal membrane oxygenation), as in apical ballooning inotropes may worsen the condition by creating a pressure gradient across the left ventricular outflow tract.

Background:High-speed burring used to prepare bony surfaces during arthrodesis procedures can increase heat generation that may impede healing and fusion. Irrigation during burring has the potential to improve early healing of burred bone surfaces and result in a stronger fusion mass. The purpose of this study was to determine the effects of continuous irrigation during burring on thermal necrosis and fusion strength in an in vivo arthrodesis animal model.Methods:A small joint rabbit ulnohumeral arthrodesis model was developed and utilized in 16 New Zealand white rabbits. Joints were prepared and contoured using a high-speed cutting burr and fixed in compression with crossed screws to obtain fusion. Prepared bony surfaces were either irrigated (n = 8) with chilled 6°C (43°F) saline or not irrigated (n = 8). Specimens were harvested, radiographed, mechanically tested for torque to failure and stiffness, and evaluated for histology.Results:Fusion rate was 100% (8/8) when joints were irrigated during burring and 75% (6/8) when joints were not irrigated ( P = .45). Mechanical testing showed a mean torque to failure of 0.85 Nm and 0.72 Nm in irrigated and nonirrigated specimens, respectively ( P = .57). Histology showed evidence of less mature osseous formation in nonirrigated specimens compared to irrigated specimens.Conclusion:There was an overall trend toward decreased fusion rate and lower fusion mass strength in nonirrigated fusion specimens compared with those treated with chilled irrigation during bone preparation.Clinical Relevance:Continuous chilled irrigation during bone preparation with burring may have a positive effect on fusion rate and fusion mass strength for arthrodesis procedures.

Determining the stability of the cervical spine is paramount to the successful management of patients with cervical spine trauma or neoplastic disease. While this article will discuss both traumatic instability and neoplastic instability, the underlying pathology of each requires a different approach. Traumatic cervical spine injuries must be broken down into upper and lower cervical spine injuries, and the stability is predicated on both the boney and ligamentous injury. This article will go through the different fracture patterns and discuss the stability of each one. Additionally, it will discuss the important biomechanical and clinical issues that lead to the diagnosis of metastatic instability in the cervical spine.

This paper reports the results of a ten-year effort to establish ethics as a learning objective for all business students, to assess the effectiveness in achieving that learning objective and to incorporate ethical conduct as a part of the school's organizational culture. First, it addresses the importance of ethics instruction for all business students. Then curricular concerns are addressed, specifically the establishment of ethics as an overarching learning objective and ensuring adequate coverage of ethics throughout the curriculum. Next, assessment mechanisms are described to demonstrate improvement in student's moral judgment and moral courage, in achieving the ethics learning objective using pre-tests and post-tests. These tests validated the use of ethical vignettes/cases to improve ethical awareness and exposure and writing about moral exemplars to increase student resolve to have moral courage. Finally, the paper addresses ways to measure and improve the ethical climate of the organization (faculty and students)

Spinal stenosis occurs most commonly in the elderly population and patients typically present with symptoms of neurogenic claudication. Complex stenosis is that which occurs in conjunction with spondylolisthesis or scoliosis. In addition to typical complaints, patients commonly develop radicular pain and back pain. In most cases initial treatment is nonoperative. Patients who fail to respond symptomatically are treated surgically. Surgical intervention in cases of complex stenosis necessitates decompression of the neural elements, and recent literature supports the addition of instrumented fusion to the decompression. More minimally invasive strategies are beginning to surface to treat complex stenosis as well.

Late graft outcome depends on an intensive post-transplant care program. Direct post-transplant inpatient rehabilitation in a specialized hospital as well as outpatient services, along with an inpatient check-up every 2-3 years are important for maintaining an excellent long-term graft function. In our experience recognizing and treating risk factors after organ transplantation such as arterial hypertension, vasculopathy, hyperlipidemia, metabolic syndrome including PTDM, osteoporosis, recurrent diseases and also the recipient's education (compliance) are most important landmarks in a post-transplant care program. This inpatient as well as outpatient post-transplant care program with the aim of long-term graft function for organ recipients, performed in a network, represents a modern health service including effective and economical aspects, which health insurance in Germany is obliged to pay for.

Inpatient rehabilitation and "Anschlussheilbehandlung" (rehabilitation soon after operation or acute intervention) are effective and economic for long-term improvement of urologic patients. Only therapy guided by urologic specialists during rehabilitation and afterwards guarantees the possibility of excellent results. Especially QOL and functional deficits are improved markedly by urologic rehabilitation. Therefore, inpatient urologic rehabilitation should be initiated more often in the future.

Background context The reported incidence of vertebral hemangioma within the spinal column is common. Most often these benign vascular tumors are incidental radiographic findings and do not cause neurological sequelae. Rarely, vertebral hemangiomas will cause compressive neurological symptoms, such as radiculopathy, myelopathy and paralysis. In these cases the clinical presentation is usually the subacute or delayed onset of progressive neurological symptoms. This report demonstrates a symptomatic vertebral hemangioma presenting with rapid onset neurologic sequelae. Purpose To discuss diagnostic and management issues presented by symptomatic vertebral hemangioma. Study design Case report and review of literature. Patient sample Sixty-one-year-old white woman with low back pain and rapidly progressive myelopathic symptoms. Methods A case of vertebral hemangioma with neurological sequelae is presented followed by a discussion of the literature concerning diagnostic and therapeutic options in the management of this pathologic entity. Results The results of our review reveal that the incidence of vertebral hemangioma causing compressive neurological symptoms is rare despite the overall prevalence of vertebral hemangioma. Vertebral hemangioma may present with rapid onset myelopathic symptoms and may mimic those symptoms caused by a malignancy. Radiographic imaging modalities are extremely useful and display characteristic findings in the diagnostic evaluation of these tumors. Angiographic embolization of feeding vessels has been effective in minimizing operative blood loss, and surgical decompression and stabilization is frequently indicated. Postsurgical radiotherapy has also been demonstrated to serve as a limited adjunct to surgery by reducing tumor recurrence in the event of less than complete tumor resection. Conclusions Because of the rapid presentation of myelopathic symptoms in this case, preoperative angiographic embolization was not performed, and the patient underwent emergent decompressive surgery. In this case emergent operative decompression and stabilization was effective in reversing the patient's myelopathic symptoms, while maintaining long-term stability of the spinal column. Postoperative radiation was not administered because of the extent of tumor resection. Surgical intervention has produced long-term cure of this patient's myelopathy and T10 vertebral hemangioma.

Vascular rejection after renal transplantation is connected with a higher frequency of allograft dysfunction or graft loss. Plasmapheresis as an adjunctive therapy in the treatment of humoral mediated acute graft rejection was compared with protein A immunoadsorption. Eleven patients with acute graft rejection and high titers of cytotoxic HLA- Ab and/or signs of vascular rejection at graft biopsy (performed in 9 patients) have been treated. Six of them have a stable graft function, the longest graft survival until now is 41 months, four are back on haemodialysis and one patient died from CMV-pneumonia with a stable graft function 9 months after transplantation. We conclude that IA is a useful adjunctive therapy in the treatment of vascular rejection after renal transplantation. Further investigations are necessary to optimize criteria for inclusion.

This study presents the case of a male university basketball player who died of a heart attack caused by an abnormal heart rhythm (Wolff-Parkinson-White syndrome) and describes the various emotional stages his teammates and coaches experienced during the days and months following this tragic incident. The team’s emotional responses to their teammates’ sudden death were categorized into several stages: shock, confusion, and denial; performance resolve; realization of loss; glorification and memorialization; closure and relief; avoidance and debriefing; reentry and acceptance. A modified critical incident stress debriefing process was used by educational and clinical sport psychologists who collaborated to manage and provide care-giving services to team members and coaches.

Background As alcohol use is highly prevalent in trauma patients, we hypothesized that a significant proportion of hospitalized trauma patients would demonstrate alcohol withdrawal (AW). Methods The trauma registries at a joint trauma center system from 1999 to 2008 were evaluated for patients aged at least 16 years. Results Of 19,369 trauma admissions, 159 patients had AW. Blood alcohol concentration (BAC) testing was performed in 31.5% of the patients. BAC was significantly higher in AW patients versus other traumas (205.7 ± 130.1 vs 102.9 ± 121.7 mg/dL). BAC was 0 in 14.4% of AW patients. As compared with other trauma patients, patients with AW had a significantly greater age (50.2 vs 42.1 years), hospital length of stay (10 vs 3 days), intensive care unit length of stay (2 vs 0 days), need for mechanical ventilation (34% vs 12.7%), and pneumonia (12% vs 2.3%). AW patients were less frequently discharged to home (59.8% vs 69.9%). Mortality was not different. Conclusions AW was diagnosed in few patients. Of note, it occurred in patients with an initial BAC of 0. AW is associated with adverse outcomes.

Even though there have been repeated calls for greater use of commercial purchasing practices in the Department of Defense (DoD), the actual adoption of such practices has been quite limited. This article explores the potential barriers and benefits of DoD use of commercial buying practices in the electronics, space, and aircraft industries. BACKGROUND Numerous commissions have called for streamlining and simplification of the defense acquisition process, especially when commercial or proprietary products are involved. Recommendations have included: 1. Emulation of private sector buying practices (1983 Grace Commission) 2. Decreased use of military specifications (MILSPECS) and increased use of commercial products (1983 Grace Commission and 1986 Packard Commission) 3. Use of commercial style competition rather than price-based competition (1970 Fitzhugh Commission and 1986 Packard Commission).|1~ Researchers have identified significant barriers in making such reforms. Fox concluded that in spite of 12 major studies since 1960, all with similar findings, virtually all attempts at improvement have fallen short. Barriers arise, not from a lack of ideas, but from the difficulty in identifying and changing counterproductive government and industry incentives.|2~ Gansler has called for increased use of commercial specifications and for deregulation to permit DoD to buy "standard commercial items by standard commercial practices."|3~ Researchers have also examined the policy issues and the regulatory structure related to the acquisition of commercial products which limit the judgment and flexibility needed to use commercial buying practices.|4~ Lamm identified barriers to doing business with DoD from a survey of 427 firms representing a cross-section of industries.|5~ MacManus conducted an extensive survey of 3,282 firms to identify problems businesses encounter when dealing with governments.|6~ Although the relative rankings are different, both found burdensome paper work requirements, low prices/profitability, delays in making awards, and late payments to be barriers or problem areas in doing business with government entities. Most of these studies have been conducted at a generic overview level. Just as there are great differences between the acquisition of weapon systems and commercial items, there are also differences between industry sectors. This article reports the results of three research efforts designed to identify the opportunities and the obstacles associated with DoD's use of commercial buying practices in the electronics, space, and aircraft industries. ELECTRONICS INDUSTRY DoD buys a wide spectrum of electronic products, including many commercial or commercial-like products. The quality and reliability of commercial electronic products have met or, at times, even exceeded DoD requirements. However, in many cases products must be modified to operate in hostile environments, such as that of Operation Desert Storm. To identify the barriers and benefits of pursuing commercial buying practices in the electronics industry, Holland conducted telephone interviews with 379 firms randomly drawn from The Electronics Industry Telephone Directory.|7~ Most of the firms had considerable experience in the electronics industry. Nearly 36 percent had 10 to 20 years experience. Another 35.6 percent had more than 20 years experience. Most of the firms (83 percent) were small businesses. The sample contained a mix of commercial and DoD firms, with 38.8 percent of them currently doing business with DoD. Barriers As detailed in Table I, respondents rated 17 potential barriers to doing business with DoD. In general, the barriers can be grouped into problems associated with contract requirements, the contracting process, and government personnel. The overall complexity of government contracts was a significant barrier for electronics firms. …

ZusammenfassungWir entwickelten ein quantitatives Auswertungsverfahren der Nierenperfusionsszintigraphie, den Trendverteilungsquotienten (TQ), und unterzogen ihn einer klinischen Validisierung an 137 Untersuchungen. Dieser Quotient ist ein Maß für die Verteilung der Bluteinflußgeschwindigkeiten in den verschiedenen Anteilen der Niere. Wir erreichten bezüglich der differentialdiagnostischen Abgrenzung der verschiedenen Formen der Rejektionsnephropathie vom akuten Nierenversagen eine Sensitivität von 0,83 und eine Spezifität von 0,54. Die Trennung eines normal funktionierenden Transplantats von einer Niere mit bestehender Rejektion gelang mit einer Spezifität von 0,88 und einer Sensitivität von 0,83. Eine Trennung der verschiedenen histologischen Typen der Rejektion war nicht möglich.

Due to the high prevalence and chronic nature of low back pain, specialist spinal services are often overwhelmed by a large quantity of referrals that do not require detailed investigation or surgical intervention. Therefore, a successful spine surgery practice commonly requires screening a large volume of patients before potential surgical cases are identified. It is a labor-intensive task to actively manage both a large number of nonoperatively treated and surgical low back patients in a busy spinal practice. These complex patients generate large numbers of phone calls, follow-up visits, prescription refills, disability forms for Worker’s Compensation, and personal injury claims, all representing a significant expenditure of physician and staff management time. In this environment, skilled physician extenders such as advanced nurse practitioners, physician assistants, and physiotherapists are a necessity to successfully meet patient’s needs and expectations in the modern medical environment. The introduction of physician extenders can aid in the reduction of the waiting periods for specialized spine care. Furthermore, the additional attention that patients receive, as opposed to care delivered only by a single, often busy, physician, is positively perceived by patients as comprehensive, timely, and thorough, high-quality healthcare. Physician extenders can function in the clinic and hospital environment participating in all aspects of patient care from initial evaluation to follow-up care. Additionally, if adequately credentialed, they can assist in surgical procedures. Many aspects of the care provided by qualified physician extenders are financially reimbursable, in most cases completely offsetting their salary and expenses.

Incidental dural tears are a common complication of lumbar spine surgery, but if unrecognized cerebrospinal fluid (CSF) leakage can lead to the formation of a fistula or pseudomeningocele. Traditionally, fistulae and pseudomeningoceles have been treated with open revision surgery, but acute fistulae with direct CSF leakage through the incision site have reportedly been treated by extracorporal drainage. This report presents a case in which an established or chronic pseudomeningocele was successfully managed without open surgical repair.

Late graft outcome depends on an intensive post-transplant care program. Direct post-transplant inpatient rehabilitation in a specialized hospital as well as outpatient services, along with an inpatient check-up every 2-3 years are important for maintaining an excellent long-term graft function. In our experience recognizing and treating risk factors after organ transplantation such as arterial hypertension, vasculopathy, hyperlipidemia, metabolic syndrome including PTDM, osteoporosis, recurrent diseases and also the recipient's education (compliance) are most important landmarks in a post-transplant care program. This inpatient as well as outpatient post-transplant care program with the aim of long-term graft function for organ recipients, performed in a network, represents a modern health service including effective and economical aspects, which health insurance in Germany is obliged to pay for.

Incidental dural tears are a common complication of lumbar spine surgery, but if unrecognized cerebrospinal fluid (CSF) leakage can lead to the formation of a fistula or pseudomeningocele. Traditionally, fistulae and pseudomeningoceles have been treated with open revision surgery, but acute fistulae with direct CSF leakage through the incision site have reportedly been treated by extracorporal drainage. This report presents a case in which an established or chronic pseudomeningocele was successfully managed without open surgical repair.

In kidney transplant recipients the inhibition of immune response is possible, if there are those drugs given to patients, when vessel anastomosis is finished.

After successful experimental organ transplant studies on the efficacy of PUVA therapy combining donor pretreatment with the photosensitizer 8-methoxypsoralen (P) and the ex vivo irradiation of organs with long-wave ultraviolet light (UVA) prior to transplantation, we started in 1989 the first randomized, prospective, double-blind study to clarify the efficacy of PUVA therapy in human kidney transplantation. This study included 50 kidney donors, 25 of whom were PUVA-treated. A total of 75 kidneys were transplanted in Berlin, Halle and Rostock. The complete data of these 75 recipients were available for the final evaluation. The PUVA group (n = 36) and the non-PUVA group (n = 39) were not statistically significantly different as to donor and recipient data. Regarding the results, no differences were seen in initial hospitalization time, early graft function, rejection rate, number and time of rejection episodes. After a follow-up of 24 months, both graft survival (PUVA vs. non-PUVA: 75% vs. 71.8%) and patient survival (97.2% vs. 97.4%, respectively) were comparably high. PUVA therapy did not influence the development of vascular rejection. Interestingly, the rate of late graft loss after the 6th posttransplant month was lower, but not statistically significantly so, in the PUVA than in the non-PUVA-group (2 vs. 6 graft losses). Thus, PUVA-pretreated kidneys may be associated with a reduced development of chronic rejection.

We developed a new quantitative concept in dynamic renal transplant imaging, the Trend Distribution Ratio, and tested its diagnostic usefulness in 137 examinations. This ratio is an expression of the distribution of blood flow velocity in different areas of the kidney. With regard to the differential diagnosis between acute tubular necrosis and the various forms of rejection we arrived at a sensitivity of 0.83 and a specificity of 0.54. A differentiation between the various histological types of rejection has not yet been possible.

Among 331 recipients of cadaveric renal allografts, transplanted from 1976 to 1986 at the Rostock Transplant Center the graft survival rates have been analyzed. All patients have been treated by conventional immunosuppressive therapy using azathioprine and prednisolone. A relation between graft survival and immunological factors was found: the better the HLA match, the better the transplant results. The necessity of a restrictive transfusion regime was stressed. The higher the number of pretransplant transfusions, the higher is the panel reactivity with following lower graft survival. Cold ischemic time was without influence on graft survival. The introduction of cyclosporin may improve the graft survival rate as known of 10-20%.

Tests were conducted to determine the effect of operating conditions on pressure drop in a pulse-jet cleaned fabric filter. A three-bag, pilot-scale filter was used. Polyester bags with ptfe-laminated surface and untreated surface collected fly ash and limestone dust at 30, 120, and 480 seconds between cleaning pulses to each bag. Tests were conducted using off-line and on-line cleaning. Results were compared to predictions of theoretical models. The models should be used only when sufficient dust is on the fabric to cause model parameters to remain constant.

The concentrations of fibrin degradation products (FDP) in the urine were determined by the passive hemagglutination test in 115 patients with biopsy-proven chronic proliferating glomerulonephritis (GN), 93 patients with urinary tract infection (UTI) and 23 patients who received kidney transplants. The active GN values (12.3 micrograms/ml) are significantly higher than those for latent GN (0.3 micrograms/ml). Those for acute UTI (9.2 micrograms/ml) are significantly higher than for chronic UTI (1.3 micrograms/ml). In contrast to the reports published by others, the numerous 'false-positive' and 'false-negative' values make diagnosis of the activity questionable. Prognostic value can be expected in GN with the nephrotic syndrome (NS): patients with steroid-sensitive NS excrete FDP and patients with steroid-resistant NS excrete larger quantities of FDP. We have confirmed that a rise in the urinary FDP level in transplantation is indicative of rejection. However, since 10 of 27 rejections were FDP-negative, the absence of FDP in the urine does not preclude rejection.

55 of 113 receivers of cadaver donor kidney transplants could be control-examined and analysed postoperatively immunologically with the electrophoresis mobility test (EM test). A high coincidence appears in the group with clinical rejection symptoms and a rejections hint in the EM test (28 of 29) and also in the group with the rejection clinically not conceivable and with a negative test result (20 of 26). The EM test appears suitable for an additional support of the diagnosis "acute rejection". More cases should confirm this assertion.

Urinary fibrin degradation products (FDP) were determined by Merskey's passive haemagglutination test in 115 patients with biopsy proven chronic proliferative glomerulonephritis (GN), 94 with urinary tract infection (UTI), and 23 transplanted patients. The active GN values (12.3 microgram/ml) are significantly higher than those for latent GN (0.3 microgram/ml). Those for acute UTI (9.2 microgram/ml) are significantly higher than for chronic UTI (1.3 microgram/ml). In contrast to the reports published by others, the numerous 'false positive' and 'false negative' values make diagnosis of the activity unreliable. Some prognostic value can be expected in GN with the nephrotic syndrome (NS): patients with steroid-sensitive NS excrete no FDP and patients with steroid-resistant NS excrete larger quantities of FDP. We have confirmed that a rise in FDP level following kidney transplantation is indicative of an acute rejection crisis. However, since 10 of 27 rejections were FDP negative, the absence of FDP in the urine does not preclude rejection, so that the diagnostic value is restricted.

Chronic haemodialysis and renal transplantation are mutually supplementing methods for the treatment of patients with terminal renal lesion. The two methods have proved their worth in clinical practice. The expectance of life of patients with chronic renal insufficiency could essentially be improved during the last years. In last consequence the successes of the transplantation of kidneys depend on the solution of immunobiological problems, which are not yet cleared up nowadays. 1. In the determination of genotypical determinants possibly not all are known or recognizable. 2. The at present clinically usable examination methods do not yet allow to recognize rejections so early that by an aimed immunosuppressive treatment irreversible damages on the graft may be prevented. After a transplantation of kidneys of relatives a long survival time of transplanted patients is better than after a transplantation of kidneys taken from dead bodies. The rejection is still the main factor of the failure of the graft, the sepsis is the most frequent cause of death. It is neccessary, to develop less toxical remedies for the adaptation of the graft. Nevertheless, thousands of optimally transplanted patients prove the usefulness of the allogenic transplantation of the kidney.

21 canine and 12 human kidneys were submitted to long-term perfusion for 24 hours. During that time LDH-activity, histologic, enzyme-histochemic, and ultrastructural examinations were carried out. The findings proved that kidneys with lesser damage from ischemia showed lower activities during the first 4 to 6 hours than kidneys which were more injured before. The latter showed the same ultrastructural alterations as kidneys after perfusion for 24 hours, which suggests an irreversible partial damage of the organ.

In 42 patients the determination of alanine aminopeptidase and lactate dehydrogenase in the urine was performed after transplantation of a kidney. In the evaluation of the enzyme activities it was referred to the clinically made rejection diagnosis as well as to the increase of the serum creatinine. We found out that with regard to the clinically made rejection diagnosis the alanine aminopeptidase in 56% and the lactate dehydrogenase in 55% of the cases showed an increase before the beginning of the rejection therapy. Before the corresponding increase of the serum creatinine we could establish an increase of the enzyme activity in the alanine aminopeptidase in 45% and in the lactate dehydrogenase in 65% of the cases. For a better interpretation of the urinary enzyme activities during the rejection crises the average activities of the enzymes immediately after the dismissal of the patients as well as three months, six months and one year after the transplantation are cited. From our investigation results that the daily determination of alanine aminopeptidase and lactate dehydrogenase in the urine is suited, taking into consideration other possible influence factors on the enzyme activity as well as other parameters, to support the diagnostics in finding the rejection after the transplantation of a kidney.

The demonstrated modifications of the Gambro perfusion apparatus PF 3A can be used with great success in the field of experimental research. By means of the measurings which can now be performed the course of the perfusion is to be established from the point of view of measuring technique.

In 10 human-allo-transplanted persons and evaluation of the postoperative course was done with the help of specific and unspecific, cellular and humoral immune tests which were compared with clinical parameters. While the E-rosette-test did not show any correlation to the typical courses in the immunoglobulins postoperatively after a clear decrease at the time of the clinically diagnosed first set reaction an increase above all of the IgM could be observed. Unspecific tests, such as CRP and FSP may, concerning the rejection diagnostics, confirm the suspicion in as far as other factors, such as infection of the urinary tract were excluded. By choice of a suitable relation system the evidence of the immunoglobulins could possibly be proved, whereas for the cellular demonstration methods the E-rosette test does not seem to be recommendable in the performed way.

The aetiopathogenesis of the diabetic nephropathy today is still unknown. Uncontested is the contribution of chronic hyperglycemia in the pathogenesis of diabetic nephropathy. For this, there are convincing evidences from clinical and experimental experiences including transplantation surgery. The quality of the metabolic adjustment of the diabetics from the first time of diabetes manifestation is important to prevent the development of diabetic nephropathy. For this, an almost normoglycemic compensation of the glucose metabolism is mandatory. More problematically is the management of the diabetic metabolism during chronic renal insufficiency. Considerable fluctuations of the blood glucose concentration are predominately in the daily profile. The intensive conventional metabolic therapy by multiple insuline injections under self control of the blood glucose level are indicated absolutely in those patients. The therapeutic aim is a smoothing of the blood glucose fluctuation. With that it is possible--together with the elimination of hemodynamic risk factors--to delay effectively a progradient decline of the glomerulo-filtration rate and to improve the assumption to an invasive therapy.

In 62 cadaver-donor-allograft recipients we observed 11 times gastrointestinal complications 7 times (11%) an ulcer or an erosion of the mucous membrane could be secured gastroscopically. The therapeutic remedy of choice seems to be the well-timed 2/3-resection after Billroth II, since a too long hesitation increases the number of complications, has a negative influence on the choice of the intervention and increases the lethality.

The newest results of transplantation in diabetic nephropathy (diabetics type I) of the world were described according to the data of the EDTA and after the symposium in The Hague. Own experience in the field of transplantation carried out in diabetics needing insulin with terminal renal failure were critically evaluated. The investigations in several centres of the GDR concerning the decompensation of diabetic nephropathy show that it is necessary to perform a three- to six-month creatinine control in long-term diabetics from the 15th year of the disease and from a serum value of 200 mumol/l to carry out in good time a common diabetological and nephrological control with test concerning the fitness for a kidney transplantation. Only by this means the conditions for an improvement of the consequence of transplantation may be achieved.

Of 80 recipients of kidney transplants 46 patients could after operation immunologically be controlled by means of the electrophoresis mobility test. Here a good correlation to the clinically observed or not established immune responses was shown. The method seems to be suitable for a postoperative immunological control, needs, however, a testing in a great number of patients.