7. Symposion Dialyseshuntchirurgie2. Jahrestagung der IAD

Weimar, 12./13. Dezember 2014

Dr. Stanley Shaldon

Der bekannte Unbekannte

Klaus Konnerklaus.konner@gmx.de

gia Ebh + Gkamph

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* 8.11.1931 † 20.12.2013

31. März 2001

STANLEY SHALDON MD FRCPHackney, London 6 November 1931 - 20 December 2013, MonacoProfessor Stanley Shaldon was born in 1931 in London to immigrant orthodox Jewish parents. Thefamily name was changed from Schlaff to Shaldon in 1943 as a consequence of the Second World War,during which he was a runner for the Air Raid Protection service.Stanley Shaldon was an unorthodox figure, but had a brilliant academic career and was a major figure inNephrology and especially hemodialysis for many decades, introducing and promoting new ways oftreating patients with renal failure.

1962 Performing acute Prof Stanley Shaldon Prof Stanley Sahldonhaemodialysis using a coil in the 1990s in 2012dialyser and a percutaneousfemoral

http://www.renal.org/news-item/2014/05/20/professor-stanley-shaldon-obituaryhttp://www.renal.org/newshttp://www.renal.org/news--item/2014/05/20/professoritem/2014/05/20/professor--stanleystanley--shaldonshaldon--obituaryobituary

-- freedom of intellect„direct, dominant, agressive“ (St.C.)

-- respect of individuality

Twin Principles

Pardon,

zum Abgewöhnen …

ORGAN BLOOD FLOW STUDIES

A new method of measuring renal blood flow.Journal of Physiology 1962;21;162

Shaldon S, Garsenstein M, Higgs B and Walker G

The Demonstration of Porta-Pulmonary anastomoses in portalcirrhosis with the use of radioactive krypton Kr85.

New England Journal of Medicine 1961;265;410-414.Shaldon S, Caesar J, Chiandussi L, Williams HS, Sheville E and Sherlock S.

Hepatic Vein Catheterisation. Royal Free Hospital 1959

Prof. Sheila Sherlock

Premier Congrès International de Néphrologie

Genève, Suisse Evian (Haute Savoie), France1er Septembre 1960 2 au 4 Septembre 1960

• Liste des Communications

• Allwall N., Lund, Sweden. Fifteen hundred treatments with the artificial• kidney (dialysis, ultrafiltration) 1946-1960.

• Scribner B.H., Seattle, Continuous hemodialysis as a method ofWashington, USA. preventing uremia in chronic renal failure.

eikosi octw !!!!

Premier Congrès International de Néphrologie

Genève, Suisse Evian (Haute Savoie), France1er Septembre 1960 2 au 4 Septembre 1960

• Liste des Communications

• Allwall N., Lund, Sweden. Fifteen hundred treatments with the artificial• kidney (dialysis, ultrafiltration) 1946-1960.

• Scribner B.H., Seattle, Continuous hemodialysis as a method ofWashington, USA. preventing uremia in chronic renal failure.

• Shaldon S., Londres, The mechanism of salt and water retention inAngleterre cirrhotic patients with refractory ascites.

eikosi octw !!!!

Dank an Prof. St. Shaldon, Monaco

= Zwillings-Spulen-Niere

W.Kolff, B.WatschingerSalt Lake City 1956

Treating Acute Renal Failure by Daily Dialysis 1962

Royal Free Hospital September 1963

During this meeting, William Drukker, David Kerr and Stanley Shaldon founded EDTA

*

*

* KIIL-Platten-Dialysator

Ein Schlusspunkt …

Insulin of the chronic nephritic

“Chronic dialysis therapy has now kept 3 patients alivefor over 5 years in Seattle, yet there are probably under200 patients receiving this form of treatment through-out the world. Technical advances have demonstrated

that self dialysis and home dialysis are realities. It doesnot seem unreasonable to postulate that in the next

decade chronic dialysis will become the

“Insulin of the chronic Nephritic”

S.Shaldon: Conclusions of a paper presented atthe General meeting of the Med.Soc.London.

Transactions of the Medical Society of London;193rd Session. Monday, October 11th 1965

28 Patients installed on home HD between 1966-1968Greater London (11), Belfast (1), Middlesborough (1),Liverpool (2), Stoke/Trent (1), Birmingham (2), Coventry (1),Oxford (1), Cardiff (1), Luton (1), Harlow (1), Stevenage (1),Southend on Sea (1),Maidstone/Kent (1), Exeter (2)

NATIONAL KIDNEY CENTRE: UK HOME PATIENTS1966-1968

idiwtikos !!!

Brescia MJ, Cimino JE, Appel K, Hurwich BJChronic hemodialysis using venepuncture and a surgically created arterio-venous fistula

NEJM 1966;275;1089

In my opinion, probably the most important contributionto long term survival of haemodialysis patientsSt.Sh.:

National Kidney Centre:1968 - Start of Self-Puncture of AV Fistula

E.K. - First German Home Dialysis Patient -Training at National Kidney Centre, London 1968

EK solved the problem of reimbursement by establishing a contract betweenhimself and AOK. Thus permitting the Krankenkasse to reimburse a hospital

treatment at home, without involving the GP. This precedent permitted the KFHto be created one year later, acting as a broker on behalf of the patient.

NATIONAL KIDNEY CENTER 1969

H

*Frankfurt Area (15), *Goettingen (5),* Hannover (4), Rendsburg (1), Kassel (2),Kreuztal-Ferndorf (1) Hanau (2)), Darmstadt (1), Stuttgart (1), Munich (2)

*HHome Training Centre

NKC + KFH Joint Venture 1969-1971(35 patients trained in London and

3 training centres established in Germany)

H

H

h

Lauterbrunnen

Bergen

H

H

H Athens

H Nicosia

Home Dialysis Patients trained by National Kidney CentreYears 1966 - 1972

Europe

HH

HH

HH

H

HH

H

H

H

Amman

Teheran

H

Kinshasa

Harare Colombo

Middle East Africa Asia Pacific

Home Dialysis Patients trained by National Kidney CentreYears 1966 - 1972

Pat: SA. Colonel in Jordanian Army 1966

Longterm HD SurvivalHH: born 16.05.1935First HD: 19.01.1970First AV fistula: 1970 - 1991Second AV fistula: 1991 - 2001

FU: born 12.03.1938First HD: 19.01.1970First AV fistula: 1970,used for more than 31 years

Self dialysis at home - Salt restricted dietBoth normotensive

Längst funktionierende av-Fistel: 35Jahre

- no blood transfusions,

- only 7 EPO injections in35 yrs

- Hct 35%

- anuric

- BP 100/65,

- obsessive 5g salt intake

Der Patient istnach >38 Jahren

Heim-Hämodialysegestorben –

mit funktionierendererster av-Fistel

The Shrinking Man Syndrome

“The majority of patients I know who are 20 years pluson dialysis are in fact shrinking men with increasingfibrous tissue and I’m wondering whether the next

generation of long-term survivors is going to be anybetter….. Frankly I would not like to be one of them.”

S SHALDONContr Nephrol 1985 44:119

The Shrinking Man Syndrome

FU 33yrs: 1970 FU 64yrs: 2001

The Shrinking Man Syndrome (Control)

1967 2001

Eli Friedman *1933 Stanley Shaldon *1931

CONCLUSIONSCAVEAT EMPTOR

• Evidence based medicine can tell you that abarefooted person needs shoes!

• However, it cannot tell you the size!• Correlative statistics demonstrate associations:

Causality relations depend upon the logicalacceptance of the associations which is based uponparadigms of the day.

Today, I have no doubt that theonly acceptable long term approach to haemodialysis

is via a venipuncture of an fistularised veinresulting from a surgically created

arteriovenous fistula

Stanley ShaldonMonaco

1st October 2003

http://www.uninet.edu/cin2003/conf/shaldon/shaldon.html

First use of nocturnal hemodialysisStanley Shaldon1

125 le Michelangelo, 7 Avenue des Papalins, Fontvieille, MonacoCorrespondence: Stanley Shaldon, 25 le Michelangelo, 7 Avenue des Papalins,

Fontvieille 98000, Monaco. E-mail: stanley.shaldon@libello.comTo the Editor: Priority claims are often difficult to substantiate. Such is the case with

the Canadian school of nocturnal hemodialysis, which has continuously refused torecognize that they were not the first to carry out overnight hemodialysis. Thus, the

statement 'nocturnal hemodialysis, a technique first developed in the 1970s' publishedin Kidney International,1 cannot be allowed to go unchallenged. On numerous

occasions, I have pointed out to the Canadian nocturnal hemodialysis school thatfrequency of hemodialysis does not permit claims to originality in the use of the night

for hemodialysis.2 We were the first to report the successful use of unattendedovernight hemodialysis in 19633, 4, 5 and this was recognized by Scribner6 in 1966

when he stated 'Shaldon has taken a big step forward in this respect by demonstratingthe feasibility of unattended nighttime hemodialysis'. The development of the high lowvenous pressure monitor, which was the key to safe overnight hemodialysis was alsoreported in the Lancet in 1963.7 As regards frequency, we started in 1961 with two

dialyses per week, but very soon increased the frequency to three, four, and even fivedialyses per week. The system was reported in detail at the first meeting of the

European Dialysis and Transplant Association in Amsterdam in 1964.8

Letter to the EditorKidney International (2009) 76, 230; doi:10.1038/ki.2009.129

Stanley with his bust at the Royal Free Hospital in 2004

Dr. Stanley Shaldon

Prof. Shaldon was appointed as Honorary Member of the ERA-EDTA in 1994

In 2011 he was awarded the "ERA-EDTA Award" for his outstandingcontributions to nephrology

finally in 2012 the ERA-EDTA renamed its young nephrologists´award into the "Stanley Shaldon Award for Young Investigators"

The long forgotten salt factor and the benefits ofusing a 5-g-salt-restricted diet in all ESRD patients

Shaldon S, Vienken JNephrol Dial Transplant 2008;23:2118-20

Writing about older concepts of therapy in medicine often provoke anautomatic negative response based on assumptions that they aredinosaurian and empirical and consequently unlikely to impact

upon modern therapeutic paradigms unless supportedby randomized controlled studies.

However, occasionally, new ideas resuscitate these forgotten paradigmsand allow one to make progress from observational studies

without the benefit of evidence-based medicine.

� 20. Dez. 2013

Danke für Ihre Aufmerksamkeit

W.A.Mozart Gran Partita KV 361

gia Ebh kai Gkamph

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