[Clinical value of interleukin 1- and interleukin 2-determinations in patients after kidney transplantation]. / Klinische Wertigkeit von Interleukin 1- und Interleukin 2-Bestimmungen bei Patienten nach Nierentransplantation.

In a retrospective study of allograft rejections in renal transplant recipients we examined the value of cytokine production monitoring. Interleukin 1 (IL 1) and interleukin 2 (IL 2) activities were determined in supernatants of mitogen-stimulated peripheral blood lymphocytes in 8 renal transplant recipients serially for a period up to 60 days after transplantation. LPS-induced IL 1 as well as PHA-induced IL 2 production in patients after renal transplantation were significantly decreased in comparison to healthy controls. Seven episodes of cellular rejection were diagnosed in renal allograft recipients during this time, only 4 rejection episodes, however, were associated with a rise in the IL 1 and simultaneous IL 2 production occurred for 2 up to 3 days before the diagnosis of rejection. Moreover there were 12 instances in which an elevation of IL 1 and IL 2 production was found independently from the rejection. In 8 cases the augmentation of IL 1 and IL 2 production could be associated with clinical infections. We conclude from these results that a cytokine monitoring for the diagnosis of allograft rejection does not seem to be useful.

[Preparation and implementation of kidney transplantation in patients with terminal renal failure and type I diabetes]. / Vorberetiung und Durchführung der Nierentransplantation bei Patienten mit terminalem Nierenversagen und Typ-I-Diabetes.

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.

[Cell electrophoresis studies of peripheral blood lymphocytes in patients following kidney transplantation]. / Zellelektrophoretische Untersuchungen an peripheren Blutlymphozyten von Patienten nach Nierentransplantation.

In 111 patients (control group, dialysis patients, kidney recipients) the behaviour of T lymphocytes was observed using an automatic measuring apparatus ( Parmoquant cytopherometer ) and the spontaneous rosette test. The Parmoquant method gives no information on the process of rejection, but it helps to identify risk situations due to bacteria of viruses. In cases of rejection after the second post-operative week, the results of the two methods are reversed.

[Therapeutic attitude of kidney transplantation patients--initial results of a psychological test study]. / Zur therapeutischen Haltung von Nierentransplantationspatienten--erste Ergebnisse einer testpsychologischen Studie.

After kidney transplantation the patient is subject to psychological stress due to problem situations. To date these problems have described only in very general clinical terms. Initial results of a psychological study on 26 kidney-transplant patients allow us to recognize factors which influence the patients' attitude to the disease and therapy. Such factors are: success of therapy, emotional tension, attitude towards the doctor and the self-confidence of the patient. The doctor-patient relation corresponds to the attitude towards therapy only in the immediate post-operative period and in patients with a negative attitude towards therapy. In the assessment of the doctor-patient relation it is only of medium importance whether the patient likes the doctor. The Study is being continued.

[The immunologic behavior of carcinoma in situ of the bladder]. / Zum immunologischem Verhalten beim Carcinoma in situ der Harnblase.

A report is given on 13 patients with c. i. s. of the bladder, which are examined in vivo and in vitro with respect to their immune reactivity. In skin tests with 5 recall antigens and the primary antigen DNFB there is no difference as compared with a control group of 29 patients. In an EM test 11 of the 13 patients with c. i. s. reacted with histospecific lymphocyte sensitisation, 10 out of 13 positive results were obtained with the antigen HEP. These findings support the current view of c. i. s. of the bladder as the first stage of a malign degeneration.

[Current immunologic findings in bladder cancer]. / Aktuelle immunologische Befunde beim Harnblasenkarzinom.

As a result of the growing significance of immunological findings in malignant growths, more attention is being paid to these questions in the diagnosis and treatment of carcinomas of the urinary bladder in humans. In this particular field the findings are not very numerous. In the field of immunodiagnosis demonstrable immunoreactions caused by cells seem to possess greater significance. Skin tests have only had prognostic significance to date. In the field of immunotherapy a non-specific BCG treatment was carried out on a small number of patients with various forms of application. These results do not give any certain information. The author refers to studies on chemically induced carcinomas of the urinary bladder in animals.

Local BCG-immunotherapy in bladder cancer patients. Immunological follow-up studies.

In a controlled clinical study 10 patients with bladder cancer were treated with an additional local BCG-therapy. For this investigations only patients with tumour stage T1-2 NO MO were elected. The local BCG-therapy was done as intralesional BCG-injections, the interval between each management was 4 weeks over a period of 4 months to 1 year. Under this treatment in all 10 patients tumor regression in different forms was seen. In 5 patients the tumor was not more found, neither in clinical nor in histological examinations. Side effects of the therapy were: influenza-like syndrome (6 patients), mild temperature (6 patients), increase of liver transaminases (5 patients), and granulomas in lung and liver (2 patients). In the immunological follow-up studies we have seen an increase of the lymphocyte activity against tumor-associated antigen from bladder cancer tissue in the electrophoretic mobility test in 6 patients. The results in skin testing, using 5 recall-antigens and DNFB, showed an increase of reactivity in only 4 patients. The total number of lymphocytes increased over a longer period. We didn't find typical humoral changes. The results of our 10 patients show that an intralesional BCG-therapy could be successful in 5 patients. The effect of BCG for immunostimulation was seen in vitro in 6 patients and in vivo in 4 patients.

[Results of combined surgical and radiological treatment of bladder cancer with particular reference to local tumor recurrence]. / Ergebnisse der kombinierten chirurgisch-radiologischen Behandlung des Blasenkarzinoms unter besonderer Berücksichtigung der lokalen Tumorrezidive.

The combined surgico-radiological treatment of the carcinoma of the urinary bladder has clearly improved the results of treatment. The local number of recidivations after this therapy is, however, still very high and in the own number of patients is about 50%. Most recidivations appear briefly (1 to 2 years) after the end of the radiological treatment and are spread above all multilocularly in the bladder. Thus an additional more radical surgical therapy is indicated. In the planning of the primary therapy, therefore, the scarcely reduced treatment under conservation of the bladder should be taken into consideration, since the recidivations decisively determine the further prognosis of the patient.

Antibody-coating of bacteria in the urine in relation to various immunologic indexes.

Little is known about the immunologic aspects of antibody coating, though the test for determining antibody-coated bacteria in urine has been examined for its diagnostic uses by many authors after its inauguration in 1974. In adults with chronic pyelonephritis with and without antibody-coated bacteria in the urine, we tested whether bacterial coating is correlated with the homologous O-antibody titre in the urine. We also determined Ig levels in urine and serum, as well as homologous O-antibody titres in serum. By means of indirect immunofluorescence technique, we were able to show homologous O-antibodies in the urine of all patients with and without antibody-coated bacteria. IgG and IgA levels in urine were mostly raised, as were often the O-antibody titres in the serum. There were no significant differences in the immunologic parameters within the patient groups with or without antibody-coating. The presence of homologous O-antibodies in urine does not therefore necessarily lead to coating of the bacteria.

[Problems of assessment and occupational rehabilitation of patients with malignant urogenital neoplasm]. / Probleme bei der Begurachtung und beruflichen Rehabilitation von Patienten mit malignen Urogenitaltumoren.

The expert opinion and the rehabilitation of patients with urogenital tumours often render great problems and tasks for the urologist. A schematic invalidisation of these patients is to be refused. The leading idea of an expert opinion should be the rehabilitation. This demands from the expert a judgment of the function with evaluation of the oncological prognosis quoad vitam and a judgment of the remaining functions of the treated organism as well as a recommendation for the further professional activity based on this judgment. A close cooperation with industrial institutions, the factory public health, the medical advisory commissions and the rehabilitation commissions is necessary for rehabilitation. The notion of rehabilitation--professional as well as social--is to be extended to the not unconsiderable number of patients at pensioner's age. The resumption of a suitable work effects in a patient sith successfully treated tumour disease the improvement of the general physico-psychic resistance, increases the will to recovery and activity and furthers the acclimatization and adaptation to remaining disturbances. Thus expert opinion in the sense of rehabilitation is also a therapy. The results of modern tumour therapy should not be measured only at the survival rates, but also at the degree of the social and professional rehabilitation of the patients.

[Value of DNFB skin testing in patients with bladder cancer (author's transl)]. / Beitrag zur Wertigkeit der DNFB-Hauttestung beim Harnblasenkarzinom.

Dinitrofluorobenzene (DNFB) was used to sensitize 156 patients (124 patients with bladder cancer, 32 controls) to test their ability to be immunized with a newly encountered antigen. All control persons had a normal reaction to DNFB. 16.1% of the tumor patients reacted anerg. The reactivity of the cancer patients depended on the tumor stage. Patients with stage T 1 tumors reacted more positive than those with stage T 3 tumors. Unfortunately, these results had only a value for a group of patients and cannot be extrapolated for application to a given patient. Our results suggested that the prognosis of a cancer patient could be depend of the skin reactivity result. DNFB skin testing is a good method for the estimation of immune status in bladder cancer.

[DNFB reaction in bladder cancer, an immunological study]. / Die DNFB-Reaktion beim Blasenkarzinom--eine immunologische Studie.

It is stated that the determination of the reactivity against the primary antigen dinitrofluorbenzol by means of the epicutaneous skin test before the beginning of a therapy may give an essential reference to the spreading of the tumour and to the prognosis. The course control in patients with carcinoma of the urinary bladder should therefore consist not only of clinical but also of immunological examinations.

[Value of the electrophoresis mobility test in the differential diagnosis of obscure kidney findings]. / Zum Wert des Elektrophorese-Mobilitäts-Testes bei der differentialdiagnostischen Klärung unklarer Nierenbefunde.

The differential diagnosis of unclear carcinoma-suspicious renal findings often finishes with the test-exposition and nephrectomy. Also when all modern diagnostic possibilities are used not always a clear establishment of the diagnosis may be achieved. The cell electrophoresis mobility test after Field and Caspary may contribute to the differential-diagnostic clarification of the findings, when adequate antigens are used. For this purpose 10 own cases are discussed and these results are compared with suitable comparative groups. Summarizingly by the present study can be shown that the immunologic diagnostics of tumours in the field of unclear renal tumours may be a very good help in the diagnostics. When adequate antigens are used in the cell electrophoresis mobility test a coordination concerning the histospecificity can be achieved.

[A contribution to the early diagnosis and differential diagnosis of bladder neoplasms by means of immunological methods]. / Ein Beitrag zur Frühdiagnose und Differentialdiagnose des Harnblasenkarzinoms mit Hilfe immunologischer Methoden.

According to the present examinations it is pretty probable that already in early histological forms of the carcinoma of the urinary bladder the EM-test is able to indicate immunologically malignity, i.e. that the papillary non-infiltrating carcinoma of the transitional cell as well as the carcinoma in situ of the urinary bladder (23) also immunologically behave like tumors of the bladder. In differential-diagnostic questions concerning the organ localisation of the primary tumor the EM-test seems to give valuable references. Histologically not unequivocally malignant tumors of the bladder with positive results in the EM-test should be submitted to an exacter examination and control.