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  • 1
    ISSN: 1435-2451
    Keywords: Cyclosporin A ; Renal transplantation ; Immunosuppression ; Cyclosporin A ; Nierentransplantation ; Immunsuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 1982 wurden 75 erwachsene Nierentransplantatempfänger (6mal 3. Transpl., 11mal 2. Transpl.) mit einer Kombination aus Cyclosporin A (CyA) und Prednisolon behandelt. Die CyA Dosierung war 14 mg/kg p.o. in der ersten Woche postop., dann 11 mg/kg in der zweiten und 8 mg/kg als Dauertherapie. Prednisolon wurde hinzugefügt (2,0 mg/kg, schnelle Reduktion auf 0,15 mg/kg). Bei einer Mindestbeobachtungszeit von 4 Monaten ergab sich eine drastische Reduktion der Abstoßungsepisoden auf insges. 22 % der Patienten. Die Transplantatfunktion nach 12 Mon. (act. surv.) was 73 % (keine Ausschlüsse), die Nebenwirkungen gering. Wir halten diese Immunsuppression für die derzeit bestmögliche.
    Notes: Summary In 1982 75 renal transplant recipients (6 third transplants, 11 second transplants) were treated with cyclosporin A (CyA) and prednisolone. The CyA dose was initially 14 mg/kg post operative, reduced to a maintenance dose of 8 mg/kg after 2 weeks. Prednisolone was then added (2.0 mg/kg, fast reduction to 0.15 mg/kg). After a follow-up of at least 4 months we found a dramatic reduction of rejection episodes (22 % of all patients). Graft survival (actual survival) at 12 months was 73 % (no exclusions); side effects were few. We consider this protocol superior to other protocols nreviouslv used.
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  • 2
    ISSN: 1435-2451
    Keywords: Chronic pancreatitis ; Transduodenal papilloplasty ; Diabetes mellitus ; Chronische Pankreatitis ; Pankreojejunostomie ; Diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Exokrine und endokrine Funktionsminderung sind typische Merkmale der chronischen Pankreatitis. Seit 1982 wurden bei 76 Patienten mit calcifizierender Pankreatitis wegen extrapankreatischer Komplikationen oder Schmerz eine langstreckige Pankreojejunostomie und eine transduodenale Papilloplastik der Wirsungianusmündung durchgeführt. Die Frühletalität betrug 5,3%, die Spätletalität 7,9%. 59 Patienten wurden bei der Erstoperation beschwerdefrei, bei 7 Patienten wurde im Verlauf eine Nachoperation wegen Schmerz erforderlich (0% Letalität); 61 Patienten sind derzeit beschwerdefrei. 32 Patienten haben einen Diabetes mellitus, der bei 13 Patienten bisher mit Insulin behandelt wird. Verlaufskontrollen zeigen eine stabile endokrine Funktion an. Die Ergebnisse zeigen die Möglichkeit des Parenchymerhalts bei schwerer chronischer Pankreatitis durch diese Operation auf. Sie erlaubt eine bestmögliche funktionelle Reserve.
    Notes: Summary Impairment of exocrine and endocrine function are signs of severe chronic pancreatitis. Starting in 1982, we have tried to avoid tissue loss in 76 patients who required surgery because of pain or extrapancreatic complications. A long pancreojejunostomy was combined with transduodenal papilloplasty of the duct of Wirsung. Early mortality was 5.3%; late mortality 7.9%. Fifty-nine patients were free of pain; 7 patients underwent reoperation for pain (0% mortality). At present, 61 patients are free of pain. Thirty-two are diabetic; 13 are treated with insulin. The operation did not significantly influence the endocrine status. Long-term endocrine function is stable in nondiabetics. The results show the feasibility of nonresection operations for chronic pancreatitis to preserve the remaining exocrine and endocrine function.
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  • 3
    ISSN: 1435-2451
    Keywords: Segmental liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ein Spenderleberorgan wurde so getrennt, daß der linke Teil (Segment II und III ohne Vena cava) auf ein Kind, der rechte Teil (Segment 1, IV, V bis VIII) auf einen Erwachsenen erfolgreich transplantiert werden konnte. Choledochus und Arteria hepatica communis bzw. propria blieben beim linken Leberteil, Vena portae beim rechten. Beim Empfänger der linken Seite blieb die eigene Vena cava erhalten; in sie wurde die linke Vena hepatica anastomosiert; die übrigen Anastomosen wurden in üblicher Weise durchgeführt. Beim Empfänger des rechten Leberteiles wurde die spenderseitige Arteria hepatica dextra mit einem Saphenainterponat verlängert und mit der Arteria hepatica communis des Empfängers anastomosiert; zwei getrennte Hepaticusäste wurden mit einer Jejunumschlinge anastomosiert. Die übrigen Anastomosen wurden in typischer Weise ausgeführt. Die Möglichkeit der Verwendung einer Spenderleber für zwei Empfänger (Splitting-Transplantation) ist damit gezeigt.
    Notes: Summary A donor liver was divided in such a way that the left part (segment 11 and III without caval vein) could be transplanted into a child, the right part (segment I, IV, V to VIII) into an adult successfully. Common bile duct and common hepatic artery remained with the left part of the liver, portal vein with the right one. In the recipient of the left part of the liver the own caval vein was preserved and anastomosed with the left hepatic vein; the other anastomoses were carried out in the typical way. In the recipient of the right part of the liver the right hepatic artery of the graft was anastomosed with the recipient's common hepatic artery using a saphenous interponate. Two separate intrahepatic bile ducts were anastomosed with a Roux-en-Y loop of the jejunum. The other anastomoses were carried out in the typical way. Thus the possibility of using one donor liver for two recipients (splitting transplantation) has been demonstrated.
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  • 4
    ISSN: 1435-2451
    Keywords: Kidney transplantation ; Childhood ; Results ; Nierentransplantation ; Kindesalter ; Ergebnisse
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von insgesamt 400 Nierentransplantationen in Hannover wurden 45 an Kindern im Alter von 2 1/2 –16 Jahren durchgeführt. 2 Patienten erhielten ein 2. Transplantat. Die Nieren wurden in 9 Fallen von einem Elternteil gespendet, 25 Transplantate von einem verstorbenen Spender. Unsere Ergebnisse weisen eine aktualisierte Überlebensrate von 87 % und eine Transplantatfunktionsrate von 57 % nach 5 Jahren auf. Als Todesursache von 4 Patienten, die verstarben, wurde in 3 Fallen eine Sepsis festgestellt. Unter Berücksichtigung dieser Ergebnisse halten wir die Nierentransplantation als ein geeignetes Verfahren zur Behandlung der terminalen Niereninsuffizienz im Kindesalter.
    Notes: Summary Of a total of 400 kidney transplantations performed in Hannover, 45 were carried out in children between the ages of 2 1/2 –16 years. 2 patients received a second transplant. In 9 cases the parents acted as donor and in 35 cases cadaver kidneys were used. Our results show an actualised survival rate of 87 % and a function rate of 57 % after 5 years. 4 patients died postoperatively. The cause of death in 3 cases was sepsis. On the basis of the results obtained as far as survival rate and rehabilitation are concerned we recommend kidney transplantation as the method of treatment of kidney insufficiency also in children.
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  • 5
    ISSN: 1435-2451
    Keywords: Cyclosporine A ; Kidney transplantation ; Cyclosporin ; Nierentransplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 1982/83 wurde bei 19 Kindern Cyclosporin (CyA) und niedrig dosierte Steroide verwendet. Unter regelmäßiger CyA-Blutspiegelkontrolle wurde eine Dosis von 9,5 ±2,7 mg/kg im Vergleich zu Erwachsenen mit 6,2±1,9 mg/kg für einen angestrebten Vollblutspiegel (trough level) von 200–500 ng/ml ermittelt. 18 Kinder haben derzeit stabile Transplantatfunktion, 3 Patienten mit einem erhöhten Serumkreatinin. MaBiggradige Hypertonie war eine häufige Nebenwirkung. Diese Immunsuppression ist mit einer geringen Incidenz von Abstoßungen sehr wirksam. Die Nebenwirkungen sind vertretbar. Gute Langzeitergebnisse können erwartet werden.
    Notes: Summary From 1982 to 1983 cyclosporine (CyA) and low-dose steroids were used in 19 pediatric patients. Using blood-level monitoring, the CyA dosage was 9.5±2.7 mg/kg, as compared with 6.2 mg/kg ±1.9 in adults for the desired whole-blood trough level of 200–500 ng/ml. Of these children, 18 have a graft with stable function, 1 child died of sepsis with a functioning kidney, and 3 have elevated serum creatinine values. Mild hypertension is a frequent side effect. This type of immunosuppression is very effective with a low incidence of graft loss or rejection episodes. Side effects are acceptable. Good long-term results can be expected.
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  • 6
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Calculated chemotherapy is based on the knowledge of the typical bacterial agents of a particular infection. From January 1983 to August 1985 bacteriological findings from surgical patients with peritonitis, septicemia or pneumonia treated in an intensive care unit were analysed. The study concentrated on those findings only which differed from previous bacteriological investigations. During the first three days 53 patients on assisted ventilation suffering from peritonitis exhibited mainly enterobacteria in their peritoneal secretions. At day 10 or later we also found bacteria from the pseudomonas group. At that time the bacterial spectrum of bronchial secretions was comparable to that of the peritoneal secretions of the same patient. After day 10, the bacterial spectrum was similar in 36 ventilated patients without peritonitis, in 56 patients suffering from post-operative pneumonia and in peritonitis patients. According to our findings, calculated chemotherapy may be based on the fact that patients with peritonitis who cannot be cured within a few days have a bacterial flora comparable to that of patients with septicemia or pneumonia. Patients with severe infections following surgery, such as potentially fatal pneumonia, generalised peritonitis or septicemia were treated with imipenem/cilastatin, according to the above definitions of calculated chemotherapy. 37 of 46 patients treated between May and December 1985, were clinically cured. Microorganisms persisted in five clinically cured patients. Development of resistance to imipenem was observed in one case. In one case treatment had to be stopped because of an allergic skin reaction. Monotherapy of peritonitis by imipenem/cilastatin appeared more satisfactory than treatment with combinations of other antibiotics.
    Notes: Zusammenfassung Voraussetzung einer kalkulierten Chemotherapie ist die Kenntnis der typischerweise bei einer bestimmten Krankheit gefundenen Keime. Von Januar 1983 bis August 1985 haben wir bakteriologische Befunde bei chirurgischen intensivmedizinisch behandelten Patienten mit Peritonitis, Sepsis oder Pneumonie ausgewertet. Dabei wurden nur Befunde berücksichtigt, die jeweils vom Vorbefund unterschiedlich waren. Bei 53 beatmeten Patienten mit Peritonitis haben wir innerhalb der ersten drei Tage im Peritonealsekret überwiegend Darmkeime nachgewiesen. Nach zehn Tagen und später sahen wir zusätzlich Keime der Pseudomonas-Gruppe. Ebenfalls nach zehn Tagen und später fand sich bei denselben Patienten im Bronchialsekret ein vergleichbares Keimspektrum wie im Peritonealsekret. Bei 36 beatmeten septischen Patienten ohne Peritonitis und ebenso bei 56 beatmeten Patienten mit postoperativer Pneumonie sahen wir eine ähnliche Keimflora wie bei den Peritonitis-Patienten nach zehn Tagen. Grundlage einer kalkulierten Chemotherapie kann nach diesen Ergebnissen die Kenntnis sein, daß bei einer Peritonitis, die voraussichtlich nicht in einigen Tagen ausheilen kann, mit einem ähnlichen Keimspektrum wie bei einer Sepsis und einer Pneumonie zu rechnen ist. Nach diesen Befunden haben wir postoperative Patienten mit schweren Infektionen wie lebensbedrohlicher Pneumonie, generalisierter Peritonitis und Sepsis im Sinne einer kalkulierten Chemotherapie mit Imipenem/Cilastatin behandelt. Von Mai bis Dezember 1985 konnten 37 von 46 Patienten klinisch geheilt werden, bei fünf Patienten persistierten Keime bei klinischer Heilung. Bei einem Patienten konnten wir eine Resistenzentwicklung beobachten, einmal wurde die Imipenem/Cilastatin-Therapie wegen einer allergischen Hautreaktion abgebrochen. Bei der primären Monotherapie der Peritonitis mit Imipenem/Cilastatin beobachteten wir im Vergleich zu Kombinationsbehandlungen mit anderen Antibiotika häufiger günstige Verläufe.
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  • 7
    ISSN: 1432-2277
    Keywords: Multiorgan procurement ; Pancreas transplantation ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Combination harvesting procedures for the liver and whole pancreas can be carried out successfully in most instances, but this requires agreement between the liver and pancreas teams concerning the vascular supply for the grafts. If one donor team is in charge of both organs, the procedure has considerable economical advantages. Even if one organ is not suitable, partial success is sufficient to compensate for the effort and costs.
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  • 8
    ISSN: 1432-2277
    Keywords: Liver preservation, UW solution ; Mitochondrial function, in liver preservation ; Preservation, liver UW solution ; Ketone body ratio, liver
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Changes in arterial blood ketone body ratio (KBR) were investigated in 47 human liver transplantations. Of the 20 grafts preserved with University of Wisconsin (UW) solution, 10 had a cold preservation period of less than 10 h (UWS group) and 10 of more than 10 h (UWL group). In 27 other cases, grafts were preserved with EuroCollins (EC) solution for less than 10 h (EC group). In the EC group, KBR increased over 0.7 within 6 h after reperfusion of the graft in 17 cases (63%) and within 24 h in 7 cases (26%). In the 3 other cases, KBR failed to recover, and these patients underwent retransplantation. In the UW group, KBR recovered within 6 h in 13 cases (65%) and within 24 h in 7 cases (35%). There were no significant differences between the UWS and UWL groups. It is shown that the mitochondrial function of liver grafts preserved with UW solution can be well maintained even after extended preservation periods of more than 10 h.
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  • 9
    ISSN: 1432-2277
    Keywords: Cyclosporin, role of metabolites, liver transplantation ; Metabolites of cyclosporin, in liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to analyse the immunosuppressive contribution of cyclosporin metabolites in liver-grafted patients. Therefore the immunosuppressive potency of 17 metabolites, alone and in combination, was tested in human mixed lymphocyte cultures, and the results were correlated with metabolite blood levels in liver-grafted patients. Of the 17 metabolites tested only six highly lipophilic metabolites showed a detectable immunosuppressive activity of up to 10% of the activity of cyclosporin; the effect of combining metabolites was additive. For calculation of the in vivo activity, blood levels of seven major cyclosporin metabolites were determined in liver-grafted patients with normal liver function (group A, 43 episodes) and with severe hyperbilirubinaemia (group B, 66 episodes). Both patient groups had comparable levels of parent drug (122.9±17.4 vs. 111.1±23.5 ng/ml by HPLC) and similar blood levels of the highly lipophilic metabolites 17, 1 and 18. By contrast, blood levels of the less lipophilic metabolites 8, 9, 26 and 203–218 were substantially increased in group B (P〈0.05). High overall metabolite blood levels in group B were also indicated by a non-specific monoclonal RIA (520±199 ng/ml for group A vs. 1318±407 ng/ml for group B). Despite the very high levels in group B, however, the overall contribution of the metabolites to immunosuppression was similar in both groups (12.6±5.0% for group A vs. 13.8±5.6% for group B). These findings indicate that, despite a marked accumulation of cyclosporin metabolites in patients with severe cholestatic liver dysfunction, their immunosuppressive contribution remains low. This suggests that for assessment of the immunosuppressive potency of cyclosporin therapy monitoring of parent drug levels is necessary and sufficient. Since a variety of non-immunological effects of high metabolite levels cannot be excluded, however, additional non-specific measurements may, nevertheless, be useful in patients with severely disturbed liver graft function.
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  • 10
    ISSN: 1432-2277
    Keywords: Liver graft viability ; Ketone body ratio, in brain-dead patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hepatic energy metabolism was assessed by measuring the blood ketone body ratio (KBR), that is, the ratio of acetoacetate to β-hydroxybutyrate in the arterial blood, in 31 brain-dead patients in an intensive care unit (ICU) in Japan and in 25 donors just before procurement of the liver for transplantation in Germany. In the study in Japan, 7 of the 12 brain-dead patients treated with highdose catecholamine showed significantly decreased KBRs, revealing the detrimental effect of catecholamine on livermmetabolism. In contrast, 8 of the 9 untreated patients with blood pressure below 80 mm Hg showed almost normal KBRs. In the 25 donors in Germany, KBR was maintained within the normal range. Based upon conventional criteria, 21 livers were selected for use and the other 4 were discarded. Nineteen of the grafts were able to normalize KBR within 24 h after reperfusion, while 2 failed to function and required a second transplantation. It was suggested that a KBR in the normal range in donors is a prerequisite to immediate recovery of metabolic function of the liver graft after transplantation, and that hypotensive donors as a potential source of liver grafts may warrant further study.
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