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  • 1
    ISSN: 1432-2277
    Keywords: Key words Liver graft quality ; Effluates ; Prediction of survival ; Glutathione S-transferase ; Glutamate dehydrogenase ; Leucocyte count
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Because transplantation success is influenced by the quality of the graft, the objective of this study was to find parameters to evaluate transplant livers in the recipient centre. In 64 liver grafts, the venous effluates of a portal back-table flush were investigated for various parameters. Amongst them, glutathione S-transferase (GST), glutamate dehydrogenase (GLDH) and the leucocyte count were found superior in predicting graft survival. Using the combination of these parameters, 100-day graft survival of between 95 % (all parameters positive) and 0 % (all parameters negative) was predicted. We concluded that good liver grafts are characterized by a low width of injury (cytosolic component: GST), a low depth of injury (mitochondrial component: GLDH), as well as by a potential to induce tolerance (passenger leucocytes). Perfusate analysis seems to be a valuable tool to recognize problematic grafts in advance and to quantify the “graft factor” in considerations concerning quality control.
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  • 2
    ISSN: 1432-2277
    Keywords: Key words Endotoxin ; Liver transplantation ; Graft function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Translocation of endotoxin (LPS) to the portal-venous system is produced by multiple factors. In the case of normal liver function, LPS is rapidly cleared from the portal blood by Kupffer cells; in impaired liver function, LPS can reach the systemic circulation. The objective of this study was to investigate whether elevated donor endotoxin levels affect graft function in the recipient. LPS levels in donor plasma were measured in 14 consecutive liver transplantations. Grafts with donor LPS levels ≤ 12 pg/ml had a function probability of 100 % after 600 days (n = 10). LPS concentrations of 〉 12 pg/ml in donor plasma led to loss of function in 75 % of the liver grafts (n = 4; P = 0.003; Wilcoxon). Elevated LPS values in donor plasma seem to impair the prognosis of the grafts and could predict poor graft function as early as at the time of brain death.
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  • 3
    ISSN: 1432-2277
    Keywords: Key words Soluble HLA I (sHLA) ; Flush catheter ; Rejection ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Soluble HLA I (sHLA I) in human serum are ascribed an immunoregulatory role in the context of organ transplantation. Based on histological findings, the objective of the current study was to evaluate the protective influence of sHLA I in liver transplantation from the time point of reperfusion. The sHLA I concentrations in serum samples derived from the liver vein immediately after reperfusion (flush catheter) of 38 patients with liver transplantations were determined by ELISA. The postoperative histological findings of the transplant biopsies were categorized according to rejection, endothelialitis, cholestasis, and necrosis, as well as fatty degeneration. An evaluation according to Kaplan-Meier showed a lower incidence for all of these factors in liver grafts with high sHLA concentrations (P 〈 0.05). We conclude that low sHLA I concentrations during reperfusion correlate with later complications, thus indicating that sHLA I may have protective potential in liver transplantation.
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  • 4
    ISSN: 1619-7089
    Keywords: Key words: Liver cell hypoxia ; Nitroimidazole imaging ; Fluorine-18 fluoromisonidazole ; Positron emission tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Fluorine-18 labelled fluoromisonidazole ([18F]FMISO) has been shown to accumulate in hypoxic tissue in inverse proportion to tissue oxygenation. In order to evaluate the potential of [18F]FMISO as a possible positron emission tomography (PET) tracer for imaging of liver tissue hypoxia, we measured the [18F]FMISO uptake in 13 domestic pigs using dynamic PET scanning. Hypoxia was induced by segmental arterial hepatic occlusion. During the experimental procedure the fractional concentration of inspired oxygen (FiO2) was set to 0.67 in group A (n=6) and to 0.21 in group B (n=7) animals. Before and after arterial occlusion, the partial pressure of O2 in tissue (TPO2) and the arterial blood flow were determined in normal flow and flow-impaired liver segments. Standardised uptake values [SUV=kBq tissue (in g) / body weight (in kg) × injected dose (in kBq)] for [18F]FMISO were calculated from PET images obtained 3 hours after injection of about 10 MBq/kg body weight [18F]FMISO. Immediately before PET scanning, the mean arterial blood flow was significantly decreased in arterially occluded segments [group A: 0.41 (0.32–0.52); group B: 0.24 (0.16–0.33) ml min–1 g–1] compared with normal flow segments [group A: 1.05 (0.76–1.46); group B: 1.14 (0.83–1.57) ml min–1 g–1; geometric mean (95% confidence limits); P〈0.001 for both groups]. After PET scanning, the TPO2 of occluded segments (group A: 5.1 (4.1–6.4); group B: 3.5 (2.6–4.9) mmHg] was significantly decreased compared with normal flow segments [group A: 26.4 (21.2–33.0); group B: 18.2 (13.3–25.1) mmHg; P〈0.001 for both groups]. During the 3-h PET scan, the mean [18F]FMISO SUV determined in occluded segments increased significantly to 3.84 (3.12–4.72) in group A and 5.7 (4.71–6.9) in group B, while the SUV remained unchanged in corresponding normal liver tissue [group A: 1.4 (1.14–1.71); group B: 1.31 (1.09–1.57); P〈0.001 for both groups]. Regardless of ventilation conditions, a significant inverse exponential relationship was found between the TPO2 and the [18F]FMISO SUV (r 2=0.88, P〈0.001). Our results suggest that because tracer delivery to hypoxic tissues was maintained by the portal circulation, the [18F]FMISO accumulation in the liver was found to be directly related to the severity of tissue hypoxia. Thus, [18F]FMISO PET allows in vivo quantification of pig liver hypoxia using simple SUV analysis as long as tracer delivery is not critically reduced.
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  • 5
    ISSN: 0011-2240
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Medicine
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  • 6
    ISSN: 1432-1289
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Vorbemerkung Die nachfolgend formulierten Leitlinien zur Therapie von Gallensteinen sind das Ergebnis einer Konsensuskonferenz (Teilnehmer siehe Addendum B u. D), die auf den gesammelten Antworten eines vorab versandten Fragebogens aufbaute. Drei Themengruppen wurden in getrennten Sitzungen vorbereitet (siehe Addendum B). Erstens: “Chirurgische Therapie der Gallenblasensteine”, zweitens: “Konservative Therapie der Gallenblasensteine” und drittens: “Therapie der Gallengangssteine”. Die Einschätzungen des Plenums hinsichtlich der Stärke der einzelnen Leitlinien sind mit Buchstaben, die Evidenz für die Leitlinie aus der Literatur mit römischen bzw. arabischen Ziffern (siehe Addendum A) angegeben. Die Leitlinien sind fett, die Kommentare zu den einzelnen Leitlinien normal gedruckt. Zwei Firmen unterstützten die Leitlinienerarbeitung durch sparsame Mittel, die auf ein von der DGVS verwaltetes Spendenkonto überwiesen wurden. Die Kommentare zu den Leitlinien wurden von einzelnen Mitgliedern des Plenums verfasst (siehe Addendum B) und allen Teilnehmern der Leitlinienkonferenz zur Korrektur vorgelegt. Weitere Kommentare zweier unabhängiger Gutachter (Prof. Dr. G. Adler, Internist, und Prof. Dr. Th. Junginger, Chirurg) sind am Ende der Leitlinien aufgeführt. Das Manuskript wurde abschließend der Kommission für Leitlinien der DGVS vorgelegt und von dieser verabschiedet.
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  • 7
    ISSN: 1435-2451
    Keywords: Gastroduodenostomy ; Duodenogastric reflux ; Alkaline reflux gastritis ; Lysolecithin ; Bile acids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An 36 Schweinen wurde der C14-Gallensäurereflux und die Lysolecithinkonzentration im Magen nach Hemigastrektomie und verschiedenen Formen der Gastroduodenostomie (Billroth I) gemessen. Untersucht wurden die terminoterminale, die terminolaterale, die supraduodenale terminolaterale Anastomose sowie eine isoperistaltische Interposition von 15 bzw. 25 cm Jejunum. Nach allen Formen der direkten Gastroduodenostomie fanden sich signifikant gesteigerte intragastrale C14-Gallensäurenwerte und Lysolecithinkonzentrationen. Eine zusätzliche Jejunuminterposition verringerte diese Werte in-Abhängigkeit von der Länge des Interponats. Die Bedeutung des duodenogastralen Refluxes von Gallensäuren und Lysolecithin für die Ausbildung der alkalischen Refluxgastritis und das Stumpfcarcinom werden diskutiert. Die klinische Alternative einer primären Interposition in der Ulcuschirurgie wird dargestellt.
    Notes: Summary In 36 pigs the intragastric C14 bile acid reflux and the concentration of lysolecithin is measured following different types of hemigastrectomy and gastroduodenostomy. Termino-terminal, termino-lateral and supraduodenal termino-lateral anastomosisses were as well studied as an isoperistaltic jejunal transposition of 15 cm resp. 25 cm length.-After all types of direct gastroduodenostomy the amounts of intragastral C14 bile acids and lysolecithin were significantly elevated. An additional jejunal transposition decrease the reflux in relation to the length of the transposed jejunal segment. The importance of the duodenogastric reflex of bile acids and lysolecithin for the development of alkaline reflux gastritis and carcinoma of the gastric stump is discussed. For clinical purpose a replacement of the pyloric reflux barrier by a primary jejunal transposition in case of pylorectomy has to be discussed.
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  • 8
    ISSN: 1435-2451
    Keywords: Liver transplantation ; Children ; Lebertransplantation ; Kinder
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Indikationen zur Lebertransplantation bei 30 Kindern (Alter 11 Monate-15 Jahre) waren Gallengangsatresie (13), Cirrhose (9), metabolische Erkrankungen (5) und Lebertumoren (3). Entsprechend der prä- und intraoperativen Situation war die hohe Rate postoperativer Komplikationen, an denen 4 Kinder innerhalb von 60 Tagen starben. Tumorrezidiv und chronische Abstoßung führten bei 5 Patienten nach 11–30 Monaten zum Tode. Derzeitig leben 21 Kinder länger als 6 Monate (2-Jahres-Überlebensrate 80%), davon die meisten mit normaler Transplantatfunktion und exzellenter Rehabilitation.
    Notes: Summary Indications for liver transplantation in 30 children (age 11 months–15 years) were biliary atresia (13), cirrhosis (9), metabolic diseases (5), and liver tumors (3). Depending upon the pre- and intraoperative situation there was a rather high rate of postoperative complications, with 4 children dying within 60 days. Tumor recurrence and chronic rejection led to the deaths of 5 other patients after 11–30 months. At present, 21 children are still alive after 6 months (a 2-year-survival rate of 80 %), the majority of whom have normal graft function and have had excellent clinical and social rehabilitation.
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  • 9
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 10
    ISSN: 1435-2451
    Keywords: Liver transplantation ; Indication ; Survival rate ; Lebertransplantation ; Indikation ; Überlebensrate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Lebertransplantation ist ein noch immer selten geübter Eingriff. Bislang wurde er im eigenen Krankengut bei 30 Patienten durchgeführt: 16mal bei Malignomen, 11mal bei Cirrhosen und 3mal bei angeborener Gallengangsatresie. 10 Patienten sind zur Zeit am Leben. Lebertransplantation bei Malignomen ist von hoher Rezidivrate belastet, doch überleben manche Patienten lange (im eigenen Krankengut bisher über 5 1/2 Jahre). Bei Cirrhosepatienten ist die Frühletalität wegen der schlechten Ausgangslage in Endstadien und den größeren operativ technischen Schwierigkeiten noch hoch. Diese Indikation dürfte jedoch bei Präzisierung des Indikationszeitpunktes die Hauptbedeutung bekommen. Bei Kindern mit Gallengangsatresie findet im erfolgreichen Falle eine sehr gute Rehabilitation statt.
    Notes: Summary Liver grafting is seldom performed. To date we have performed transplants on 30 patients: 16 with malignancies, 11 with end-stage cirrhosis, and 3 children with biliary atresia. Of these patients, 10 are still alive. Liver grafting in malignancy is generally followed by a high recurrence rate, but individual patients survive a long time (in our caseload up to 51/2 years). In patients with cirrhosis, early mortality is still high as a result of the deteriorated condition of the patient at the time of surgery and the greater operative technical difficulties. This fact should be of major importance, however, when considering the time for surgery. In children with untreatable biliary obstruction, liver transplantation can provide a high degree of rehabilitation.
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