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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European radiology 9 (1999), S. 428-435 
    ISSN: 1432-1084
    Keywords: Key words: Liver ; Neoplasms ; Ultrasound ; Doppler studies ; Contrast media
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Echo patterns of focal liver lesions as well as other morphological criteria do not suffice for differential diagnosis. In an attempt to increase the specificity of ultrasound of focal liver lesions, several years of Doppler-flow information was evaluated. Recent advances in ultrasound technology (power Doppler imaging, second harmonic imaging) as well as commercial availability of an intravenous signal enhancer (contrast agent) have additionally improved results of this technique.
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  • 2
    ISSN: 1433-0385
    Keywords: Key words: Liver transplantation ; Budd-Chiari syndrome. ; Schlüsselwörter: Lebertransplantation ; Budd-Chiari-Syndrom.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Das Budd-Chiari-Syndrom (BCS) ist eine seltene Krankheit mit Verschluß der Lebervenen, die sowohl in akuten wie auch chronischen lebensbedrohlichen Situationen durch eine orthotope Lebertransplantation behandelt werden kann. Wir berichten über 16 Patienten, die insgesamt 18 Lebertransplantate wegen eines BCS erhielten und mindestens zwei Jahre nachbeobachtet wurden. Bei 7 Patienten lag eine hämatologische Erkrankung zugrunde, die anderen Fälle blieben ätiologisch ungeklärt. Ein Patient verstarb 4 Monate nach Transplantation an einer CMV-Pneumonie, ein weiterer 2 Jahre nach Transplantation an protrahiertem Leberversagen bei Pfortaderthrombose. Die aktuarische 5-Jahres-Überlebensrate beträgt 87,5 %, die aller an unserer Institution durchgeführten 710 Transplantationen von 9/1988 bis 12/1995 liegt bei 85,3 %. Die Rezidivprophylaxe bestand aus Anticoagulation mit Heparin und überlappender Fortsetzung mit Marcumar. Drei Patienten wurden bei Thrombocytose mit Hydroxyharnstoff behandelt, davon einer lediglich für eine Woche in der Frühphase nach Transplantation. Zwei revisionsbedürftige, abdominelle Nachblutungen sind möglicherweise auf die Anticoagulation zurückzuführen. Zwei Patienten mußten retransplantiert werden, der eine wegen Teilthrombose von Leberarterie und Pfortader, nachdem Marcumar bei gastrointestinaler Blutung abgesetzt worden war, der andere wegen Rezidivverschluß der Lebervenen nach insuffizienter Marcumareinnahme. Das BCS kann erfolgreich durch eine Lebertransplantation behandelt werden, erfordert jedoch eine lebenslange, engmaschig kontrollierte Anticoagulation zur Rezidivprophylaxe.
    Notes: Summary. Budd-Chiari syndrome (BCS) with hepatic vein occlusion is a rare disorder that can effectively be treated in advanced stages with orthotopic liver transplantation. We report on 16 patients who received 18 liver grafts and were followed up for at least 2 years. In 7 patients a hematological disorder was confirmed by bone marrow biopsy. One patient died after 4 months due to cytomegalovirus pneumonia; another patient died after 2 years due to progressive liver failure after portal vein thrombosis. The actuarial 5-year survival rate is 87.5 % compared to 85.3 % in all other 710 orthotopic liver transplantations performed from September 1988 to December 1995 at our institution. Anticoagulation consisted of intravenous heparin and overlapping continuation with dicoumarin. Three patients received hydroxyurea for thrombocytosis, one patient for 1 week only early after the transplantation. Two postoperative abdominal hemorrhages required laparotomy. Two patients had to be retransplanted, one for thrombosis of the hepatic artery and portal vein after discontinuation of dicoumarin due to GI bleeding and one for hepatic vein thrombosis after insufficient dicoumarin intake. Terminal BCS represents a good indication for orthotopic liver transplantation; however, life-long, closely monitored anticoagulation is essential.
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  • 3
    ISSN: 1433-0385
    Keywords: Keywords: Laparoscopic cholecystectomy – Iatrogenic biliary injury – Classification – Treatment. ; Schlüsselwörter: Laparoskopische Cholecystektomie – iatrogene Gallengangverletzung – Klassifikation – Therapie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die iatrogene Gallengangverletzung stellt eine schwerwiegende Komplikation der laparoskopischen Cholecystektomie dar. Sie umfaßt periphere Galleleckagen und Verletzungen des extrahepatischen Gallengangsystems. Ihre Incidenz ist im Vergleich zur konventionellen Cholecystektomie um das 2–3 fache erhöht. In unserem Zentrum wurden 108 Patienten wegen einer iatrogenen Gallengangläsion nach laparoskopischer Cholecystektomie behandelt. Während 68 Patienten erfolgreich endoskopisch therapiert werden konnten, war bei 34 Patienten eine chirurgische Intervention erforderlich. Bei 6 Patienten mit einem peripheren Galleleck war die alleinige percutane äußere Drainage ausreichend. Für die Gallengangverletzungen wird unter Berücksichtigung der Ätiologie, der Lokalisation und des diagnostischen Intervalls eine neue Klassifikation vorgeschlagen, aus der sich diagnostische und therapeutische Konsequenzen ableiten lassen.
    Notes: Abstract. Iatrogenic bile duct lesions are serious complications during laparoscopic cholecystectomy and include biliary leakage and major bile duct injury. The incidence of biliary lesions following laparoscopic cholecystectomy is up to threefold higher than that of the open procedure. A total of 108 patients with bile duct lesions after laparoscopic cholecystectomy were treated at our institution. Endoscopic treatment was successful in 68 cases, 6 patients were treated by external drainage, and 34 patients required surgical therapy. Selection criteria for the type of treatment included the etiology, anatomical situation, and diagnostic interval of the biliary lesion. We suggest a classification of bile duct injury and a proposal for diagnosis and treatment of these complications.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 5 (1999), S. 344-345 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 5 (1999), S. 515-520 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Radikale Resektionen zentraler Gallengangskarzinome gelten als Therapieoption mit den günstigsten Langzeitergebnissen, können aber derzeit nur bei etwa 20% der Patienten mit einem kurativen Ansatz zur Anwendung kommen [6, 8]. Auch wenn zentrale Gallengangskarzinome eher spät im Verlauf der Tumorprogression zu einer Fernmetastasierung neigen, werden Versuche einer kurativen Resektion häufig durch eine ausgedehnte longitudinale und auch laterale lokale Tumorinfiltration beeinträchtigt. Die Diagnosestellung erfolgt in der Regel erst mit dem Auftreten eines Ikterus, der aufgrund der detergenten Galleeigenschaften, die einen Abfluß auch durch feinste oder obstruierte Lumina gestattet, als Spätmanifestation anzusehen ist [19].
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  • 6
    ISSN: 1432-2277
    Keywords: Key words Hepatocellular carcinoma ; Liver transplantation ; Recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recurrence-free survival (RFS) in patients with small hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT) was analyzed. From 1988 until 1996, 725 OLTs were performed in 669 patients. In 52 adults, HCC was confirmed histologically. OLT was limited to patients with small (〈 5 cm) HCC with a maximum number of three nodules. Actuarial survival for these 52 patients at 1 and 5 years is 88 % and 71 %. RFS was defined as time until death without recurrence, time until follow up with a diagnosis of recurrence, or, in patients without recurrence, time of last follow up. Overall, the 5-year RFS was 60 %. Five-year RFS was less for bilobar compared to unilobar tumors (36 % vs 70 %), less for stage IVa tumors (UICC) compared to stage I–III tumors (17 % vs 71 %), and less for multiple compared to solitary tumors (54 % vs 67 %). In conclusion, potential cure may be achieved in more than 50 % of all transplanted patients.
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  • 7
    ISSN: 1432-2277
    Keywords: Key words Hilar cholangiocarcinoma ; Extended bile duct resection ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although the surgical treatment of hilar cholangiocarcinoma represents the only potentially curative option, survival figures remain low over the long term. After hilar and partial hepatic resections for hilar cholangiocarcinoma, locoregional tumor recurrence appears as the primary site of failure. From April 1992 to April 1996, 14 patients underwent extended bile duct resections. Extended bile duct resections combine total hepatectomy, partial pancreatoduodenectomy, and liver transplantation in an attempt to eradicate the entire biliary tract without dissecting the hepatoduodenal ligament. The postoperative 60-day mortality rate was 14% (n = 2).The rate of curative resections was 93% (13 of 14 extended bile duct resections). One- and 4-year survival rates after curative resections were 56% and 30%, respectively. The rate of curative resections increased by combining total hepatectomy, partial pancreatoduodenectomy, and liver transplantation, i. e., extended bile duct resection. However, survival figures have not improved accordingly. Therefore, this extended surgical procedure has to be implemented with caution and possibly not without modifications (e. g., multimodal treatment).
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Transplant international 13 (2000), S. 313-326 
    ISSN: 1432-2277
    Keywords: Key words Neurotoxicity ; Immunosuppressant ; Cyclosporine ; Tacrolimus ; Mycophenolate mofetil
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between 10 %–28 % of patients who receive the immunosuppressant cyclosporine (CsA) experience some form of neurotoxic adverse event. Both sensorial motoric functions may be adversely affected, and thus patients present with a wide range of neurological and psychiatrical disorders. Mild symptoms are common and include tremor, neuralgia, and peripheral neuropathy. Severe symptoms affect up to 5 % of patients and include psychoses, hallucinations, blindness, seizures, cerebellar ataxia, motoric weakness, or leukoencephalopathy. Tacrolimus is associated with similar neurotoxic adverse events. Neurotoxicity may result in serious complications for some patients, particularly recipients of orthotopic liver transplants. Factors that may promote the development of serious complications include advanced liver failure, hypertension, hypocholesterolemia, elevated CsA or tacrolimus blood levels, hypomagnesemia, and methylprednisolone. Occipital white matter appears to be uniquely susceptible to the neurotoxic effects of CsA; injury to both the major and minor vasculature may cause hypoperfusion or ischemia and local secondary toxicity in the white matter. Calcineurin inhibition by CsA and tacrolimus alters sympathetic outflow, which may play a role in the mediation of neurotoxic and hypertensive adverse events. The symptoms of CsA- and tacrolimus-associated neurotoxicity may be reversed in most patients by substantially reducing the dosage of immunosuppressant or discontinuing these drugs. However, some patients have experienced permanent or even fatal neurological damage even after dose reduction or discontinuation. CsA-sparing and tacrolimus-sparing drug regimens that use the immunosuppressant mycophenolate mofetil, which has no neurotoxic effects, may reduce the incidence and severity of neurotoxic adverse events while maintaining an adequate level of immunoisuppression.
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  • 9
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Arterial complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From September 1988 through April 1998, 1000 liver transplantations were performed on 911 patients. During the postoperative control examinations of 837 patients, we found 23 (2.74 %) with hepatic artery thromboses, 27 stenoses of the hepatic artery (3.22 %), and 6 aneurysms of the graft artery. Seventeen patients underwent retransplantation because of arterial complications. Depending on the clinical symptoms, we treated both the local situation as well as the resulting complications of inadequate arterial graft flow. The aneurysms were primarily treated surgically. The first choice of treatment of stenoses was balloon angioplasty. Early postoperative artery thromboses were also treated surgically by thrombectomy in selected cases. For the resulting biliary and local septic complications we preferred endoscopic and drainage procedures. Our clinical experiences have led us to find pretransplantation angiography recommendable, especially in the case of splanchnic artery stenoses, for bypassing from the aorta for arterial perfusion of the graft.
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  • 10
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Alcoholic cirrhosis ; Alcohol relapse ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Because of the donor shortage, there are concerns for liver transplantation in patients with alcoholic cirrhosis. We therefore analyzed patients transplanted for alcoholic cirrhosis at our center with respect to patient and graft survival, recurrence of disease, and postoperative complications. Out of 1000 liver transplantations performed in 911 patients, 167 patients were transplanted for alcoholic cirrhosis; 91 patients received CsA- and 76 patients FK506-based immunosuppression. Recurrence was diagnosed by patient's or relative's declaration, blood alcohol determination, and delirium. Diagnosis and treatment of acute and chronic rejection was performed as previously described. One- (96.8 % versus 91.3 %) and 9-year patient survival (83.3 % versus 80 %) compared well with other indications. Five of 15 patients died due to disease recurrence. Recurrence of disease was significantly related to the duration of alcohol abstinence prior to transplantation. In patients who were abstinent for less than 6 months (17.1 %), recurrence rate was 65 %, including four of the five patients who died of recurrence. Recurrence rate decreased to 11.8 %, when abstinence time was 6–12 months and to 5.5 %, when the abstinence times was 〉 2 years. Next to duration of abstinence, alcohol relapse was significantly related to sex, social environment, and psychological stability. The incidence of acute rejection compared well with other indications (38.1 %); CsA: 40.1 % versus 33.3 % in FK506 patients. In all, 18.2 % of CsA patients experienced steroid-resistant rejection compared with 2.6 % of FK506 patients. Seven patients (7.6 %) in the CsA group and one patient (1.3 %) in the FK506 group developed chronic rejection. A total of 57.1 % developed infections; 5.7 % were life-threatening. CMV infections were observed in 14.3 % (versus 25 % for other indications). New onset of insulin-dependent diabetes was observed in 8.6 % and hypertension in 32.4 %. In conclusion, alcoholic cirrhosis is a good indication for liver transplantation with respect to graft and patient survival and development of postoperative complications. FK506 therapy was favourable to CsA treatment. Patient selection is a major issue and established criteria should be strictly adhered to. Patients with alcohol abstinence times shorter than 6 months should be excluded, since recurrence and death due to recurrence was markedly increased in this group of patients.
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