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  • 1
    ISSN: 1433-0385
    Keywords: Key words: Mushroom poisoning ; Liver transplantation ; Fulminant hepatic failure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Der Verlauf von 12 Patienten mit Knollenblätterpilzvergiftung wurde retrospektiv analysiert, um prognostische Kriterien für die Indikationsstellung zur Lebertransplantation herauszuarbeiten. Acht Patienten erholten sich unter konservativer Therapie, bei 3 Patienten war eine Lebertransplantation erforderlich; ein Patient starb bei Vorliegen schwerer Begleiterkrankungen unter konservativer Therapie. Die transplantierten Patienten wiesen initial einen Quick- und Faktor-V-Wert unter 10 % auf. Die Höhe der Transaminasen, des Serumbilirubins, des Serumkreatinins, eine Verlängerung der PTT sowie eine Azotämie hatten keinen sicheren prognostischen Wert. Für die Indikationsstellung zur Transplantation war der initiale Quick- und Faktor-V-Wert und deren inadäquater Anstieg unter Substitution entscheidend. Die Ausbildung einer Encephalopathie sowie ein progredientes Nierenversagen stellen zusätzliche prognostisch schlechte Parameter dar.
    Abstract: Schlüsselwörter: Knollenblätterpilzvergiftung – Lebertransplantation – fulminantes Leberversagen.
    Notes: Summary. The clinical course of 12 patients with mushroom poisoning was evaluated in order to define the parameters considered to be relevant to the indication for liver transplantation. Eight patients recovered under conservative therapy; one patient died due to pre-existing, concomitant cardiopulmonary disease. In three patients transplantations had to be performed because of severe liver failure. On admission, the transplanted patients had a decreased Quick's test score and factor V value (〈 10 %). The peak of liver enzymes, serum bilirubin, serum creatinine, partial thromboplastin time and azotemia were not of any prognostic value. Main indications for liver transplantation were a very low initial Quick's test score and factor V value (both 〈 10 %) and their inadequate response under substitution therapy. The development of encephalopathy and renal failure were further parameters indicating poor prognosis.
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  • 2
    ISSN: 1433-0385
    Keywords: Key words: Liver tumor ; Liver resection ; Computed tomography ; Three-dimensional visualization ; Preoperative planning. ; Schlüsselwörter: Lebertumoren ; Leberresektionen ; Computertomographie ; dreidimensionale Visualisierung ; präoperative Planung.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei Patienten mit Lebertumoren stellen Sonographie, Computertomographie (CT) und in einigen Fällen die Magnetresonanztomographie (MRT) die Grundlage für die präoperative Planung von Leberresektionen dar. Auf der Basis von CT-Untersuchungen wurde ein dreidimensionales (3-D) Visualisierungsprogramm entwickelt. In dieser Studie wurde das 3-D-Visualisierungsprogramm bei 6 Patienten mit problematischer Lokalisation von Lebertumoren zur Planung des operativen Vorgehens angewendet. Bei 5 von 6 Patienten konnte die Leberresektion – wie präoperativ am Computermodell geplant – durchgeführt werden. Die intraoperativen Befunde entsprachen den 3-D-Visualisierungen. Die 3-D-Visualisierung der Leber erlaubte eine anschauliche und interaktive Planung von Leberresektionen am Computermodell und stellte somit eine verbesserte Vorbereitung für die komplexen Leberresektionen dar.
    Notes: Summary. Preoperative planning of liver resections in patients with liver tumors is based on sonography, computed tomography and magnetic resonance imaging. A new three-dimensional (3D) visualization program was developed based on CT data. This visualization program was used for preoperative planning in 6 patients with liver tumors in problematic intrahepatic localizations. In 5 out of 6 patients the liver resection could be performed as preoperatively planned. The intraoperative findings agreed with the 3D visualization in all these patients. 3D Visualization of the liver allowed clear and interactive planning of liver resections and improved the preparation of complex liver resections.
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  • 3
    ISSN: 1433-0385
    Keywords: Keywords: Liver resection ; Circulatory arrest ; Hepatoblastoma. ; Schlüsselwörter: Leberresektion ; Kreislaufstillstand ; Hepatoblastom.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Für die Resektion von großen kindlichen Lebertumoren in kritischer Lokalisation wurde die Resektion im Kreislaufstillstand und tiefer Hypothermie an der Herz-Lungen-Maschine eingeführt. Wir berichten über unsere Erfahrungen mit Leberresektionen an der Herz-Lungen-Maschine bei 3 Kindern mit Hepatoblastomen. Beim ersten Kind wurde die Resektion im kompletten Kreislaufstillstand durchgeführt, bei den beiden anderen unter Low-flow-Kreislaufbedingungen. Die Phasen an der Herz-Lungen-Maschine wurden von den kleinen Patienten gut vertragen. Es wurden erweiterte rechtsseitige Resektionen mit Gefäßrekonstruktionen vorgenommen. Die postoperativen Leberenzymanstiege waren überraschend niedrig. So lagen die maximalen Werte für die GOT zwischen 100 und 200 U/l. Durch die Resektion konnte in Kombination mit der Chemotherapie ein befriedigendes Langzeitüberleben trotz des ausgedehnten Tumorwachstums erreicht werden. Ein Kind lebt 8 Jahre, ein weiteres 10 Monate ohne Tumorrezidiv. Das 3. Kind verstarb an einer Sepsis während der adjuvanten Chemotherapie, nachdem es sich von der Leberresektion gut erholt hatte.
    Notes: Abstract. In order to perform resections of tumors at critical sites in the liver in young children, liver resections in cardiac arrest and deep hypothermia under cardiopulmonary bypass have been developed. We report our experience with liver resection under cardiopulmonary bypass in three children with hepatoblastoma. In the first child the operation was performed under cardiac arrest and, the other two children were operated on under „low flow“ conditions. The periods under cardiopulmonary bypass circulation were well tolerated. Extended right liver resections with vascular reconstructions were performed. The postoperative increase of liver enzymes was moderate. The increase in GOT was between 100 and 200 U/l. In spite of the extended tumor growth, reasonable long-term results were achieved by resection in combination with chemotherapy. One child has been living 8 years and another 10 months without tumor recurrence. The third child died due to sepsis during adjuvant chemotherapy, after she had recovered well from liver resection.
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  • 4
    ISSN: 1432-2277
    Keywords: Key words Kidney transplantation ; Ureteral complications ; Pyeloureterostomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Necrosis and stenosis of the ureter are severe complications after kidney transplantation and occur with mean incidence of 2,9–13,4 %. Several surgical techniques like simple nephrostomy or complex urinary tract reconstruction have been applied for repair. In this study, our experience with native pyeloureterostomy (NPUS) using the native ureter is presented. Between March 1978 and June 1996, 2592 kidney transplantations were performed in our institution. In 48 patients (1,9 %), secondary urinary tract reconstruction by NPUS was necessary. These patients were evaluated retrospectively by review of the case notes. At the time of operation the mean age was 45 ± 14 years. Indications for NPUS were distal ureteral stenosis (n = 29), necrosis (n = 17), bleeding (n = 1) or iatrogenic lesion of the ureter (n = 1). The mean time period between transplantation and urinary tract reconstruction was 20 ± 23 days (range: 1–90 days) for necrosis and 404 ± 637 days (range: 14–2385 days) for stenosis. A pyeloureterostomy was technically feasible in all patients using the recipient's ipsilateral ureter. In 40 out of 48 patients the graft developed a normal function postoperatively (follow up: 39 ± 48 months). A graft nephrectomy was necessary only in one patient, because of complete pyelonnecrosis 6 days after NPUS. Two grafts were lost due to acute rejection. Data of five patients were not available 〉 15 years after successful reconstruction. We can conclude that NPUS is a safe and simple rescue technique for the treatment of distal ureteral complications after kidney transplantation. Therefore, this technique should be the therapy of choice when secondary reconstruction by re-ureteroneocystostomy is not possible.
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  • 5
    ISSN: 1432-2277
    Keywords: Liver transplantation ; Budd-Chiari syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This report documents two cases of Budd-Chiari syndrome (BCS) with essential thrombocytosis and antithrombin (AT) III deficiency as underlying etiological factors. Orthotopic liver transplantation was successfully performed in both patients but with different therapeutic intention. In the patient with essential thrombocytosis, hepatic transplantation only relieved the symptoms of the predisposing thrombogenic condition; it dìd not cure the underlying disorder. Prophylactic long-term anticoagulation, as well as adjuvant therapy for the causative disease, remained necessary. On the other hand, in the patient with AT III deficiency, liver transplantation was curative, resulting in complete reconstitution of serum AT III activity with resolution of the hypercoagulable state postoperatively. Thus, depending on the underlying etiology, liver transplantation for BCS can be considered as palliative, necessitating long-term adjuvant therapy, or as curative, with correction of a metabolic defect.
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  • 6
    ISSN: 1433-0385
    Keywords: Key words: Mushroom poisoning ; Liver transplantation ; Fulminant hepatic failure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Der Verlauf von 12 Patienten mit Knollenblätterpilzvergiftung wurde retrospektiv analysiert, um prognostische Kriterien für die Indikationsstellung zur Lebertransplantation herauszuarbeiten. Acht Patienten erholten sich unter konservativer Therapie, bei 3 Patienten war eine Lebertransplantation erforderlich; ein Patient starb bei Vorliegen schwerer Begleiterkrankungen unter konservativer Therapie. Die transplantierten Patienten wiesen initial einen Quick- und Faktor-V-Wert unter 10 % auf. Die Höhe der Transaminasen, des Serumbilirubins, des Serumkreatinins, eine Verlängerung der PTT sowie eine Azotämie hatten keinen sicheren prognostischen Wert. Für die Indikationsstellung zur Transplantation war der initiale Quick- und Faktor-V-Wert und deren inadäquater Anstieg unter Substitution entscheidend. Die Ausbildung einer Encephalopathie sowie ein progredientes Nierenversagen stellen zusätzliche prognostisch schlechte Parameter dar.
    Abstract: Schlüsselwörter: Knollenblätterpilzvergiftung – Lebertransplantation – fulminantes Leberversagen.
    Notes: Summary. The clinical course of 12 patients with mushroom poisoning was evaluated in order to define the parameters considered to be relevant to the indication for liver transplantation. Eight patients recovered under conservative therapy; one patient died due to pre-existing, concomitant cardiopulmonary disease. In three patients transplantations had to be performed because of severe liver failure. On admission, the transplanted patients had a decreased Quick's test score and factor V value (〈 10 %). The peak of liver enzymes, serum bilirubin, serum creatinine, partial thromboplastin time and azotemia were not of any prognostic value. Main indications for liver transplantation were a very low initial Quick's test score and factor V value (both 〈 10 %) and their inadequate response under substitution therapy. The development of encephalopathy and renal failure were further parameters indicating poor prognosis.
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  • 7
    ISSN: 1432-2218
    Keywords: Key words: Intraoperative ultrasound — Extracorporeal liver surgery — Liver resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. This report describes the application of intraoperative ultrasound at the explanted liver during ex situ liver surgery. A 55-year-old woman underwent extracorporeal liver resection for multilocular metastases of a duodenal leiomyosarcoma. At surgery, routine intraoperative ultrasound (5-MHz probe) was performed before hepatectomy at the completely mobilized but still normally perfused liver. After hepatectomy ultrasound of the liver was repeated at the back table. By use of the ultrasonographic examination at the back table all the metastases seen with usual intraoperative ultrasound could be confirmed. In addition, one metastasis with a diameter of 6 mm was detected which had neither been suggested by peroperative computer tomography and sonography nor by intraoperative ultrasound or surgical exploration. In cases of extracorporeal liver surgery the combination of in situ and ex situ sonography may improve the identification of hepatic metastases.
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  • 8
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Leber ; Leberresektion ; Leberlebendspende ; Operationsplanung ; Visualisierung ; Key words Liver ; Liver resection ; Living-relative liver transplantation ; Surgical planning ; 3D visualisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background: In an interdisciplinary approach, HepaVision (MEVIS, Bremen), a software tool specifically developed for 3D visualization of the liver, was employed for individual planning of extensive liver resections and evaluation of living-relative donations. So far there is experience with more than 50 biphasic spiral CT examinations. Results: The spatial relationship of large tumors to crucial hepatic structures, the demonstration and evaluation of anatomic variants regarding vascular supply and the risk stratification of liver failure by volumetric analysis on the basis of portal venous drainage supported precise indication for surgery. Surgical safety is increased by preoperative planning and simulation of necessary vessel reconstructions. By hiding selective areas of portal venous drainage or applying freely selectable clip planes, segmental as well as non-anatomical resections can be simulated and their effects analyzed. The virtual preoperative situs was confirmed intraoperatively in all 17 patients of our study population who underwent segmental liver resection for either a tumor or living-relative donation.
    Notes: Zusammenfassung Hintergrund: In einem interdisziplinären Ansatz wurde das speziell für die 3D-Visualisierung der Leber entwickelte Programm HepaVision (MEVIS, Bremen) für die individuelle Planung ausgedehnter Leberresektionen und von Leberlebendspenden eingesetzt und evaluiert. Erfahrungen mit dem Programm liegen bisher für 〉50 Volumendatensätze biphasischer Spiral-CT-Untersuchungen vor. Ergebnisse: Die räumliche Darstellung der Lagebeziehung großer Tumoren zu den kritischen Strukturen, der Nachweis und die Bewertung von Versorgungsvarianten sowie die Abschätzung des Risikos eines Leberversagens durch Volumetrie auf der Basis portalvenöser Versorgungsgebiete unterstützen die Indikationsstellung zum Eingriff. Zusätzlich wird der Sicherheitsgrad des Eingriffs durch Vorplanung und Vorbereitung etwa notwendiger Gefäßrekonstruktionen erhöht. Durch das selektive Ausblenden portalvenöser Versorgungsgebiete oder durch frei wählbare Clip-planes können sowohl Segmentresektionen als auch nicht-anatomische Resektionen simuliert und in ihren Auswirkungen analysiert werden. Der präoperativ virtuell erhobene Situs bestätigte sich intraoperativ bei allen 17 Patienten des Gesamtkollektivs, die einem Eingriff, sei es in Form einer Tumorresektion oder einer Teilorganentnahme zur Transplantation, unterzogen wurden.
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  • 9
    ISSN: 1432-2218
    Keywords: Intraoperative ultrasound ; Extracorporeal liver surgery ; Liver resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This report describes the application of intraoperative ultrasound at the explanted liver during ex situ liver surgery. A 55-year-old woman underwent extracorporeal liver resection for multilocular metastases of a duodenal leiomyosarcoma. At surgery, routine intraoperative ultrasound (5-MHz probe) was performed before hepatectomy at the completely mobilized but still normally perfused liver. After hepatectomy ultrasound of the liver was repeated at the back table. By use of the ultrasonographic examination at the back table all the metastases seen with usual intraoperative ultrasound could be confirmed. In addition, one metastasis with a diameter of 6 mm was detected which had neither been suggested by peroperative computer tomography and sonography nor by intraoperative ultrasound or surgical exploration. In cases of extracorporeal liver surgery the combination of in situ and ex situ sonography may improve the identification of hepatic metastases.
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  • 10
    ISSN: 1435-2451
    Keywords: Key words Liver transplantation ; Neuroendocrine pancreatic tumors ; Hepatic metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: Metastatic neuroendocrine pancreatic tumors have a poor prognosis. We have studied retrospectively the efficacy of liver transplantation as ultimate therapy of otherwise untreatable symptomatic neuroendocrine hepatic metastases originating in the pancreas. Methods: We reviewed our experience of liver transplantation (LTx) for hepatic metastases of neuroendocrine pancreatic tumors in ten patients. The indication for liver grafting was seen in cases of irresectable metastases and when patients were suffering from otherwise untreatable tumor-associated symptoms due to massive hormonal release or large intra-abdominal tumor bulk. Results: In four patients, the primary tumors had been removed before LTx, in five patients simultaneously with LTx and in one case 46 months after grafting. There was no operative mortality. After hepatectomy and LTx, all patients had complete relief of symptoms and all preoperatively increased hormonal levels returned to normal. In nine of ten patients, the transplant procedure had the potential for cure, whereas, in one patient, the primary tumor had remained in situ at LTx and was removed 46 months later by an R2-resection. At present, nine patients are alive with a median follow-up of 33 months (range 13.5 months to 117 months). The one patient in whom the primary tumor was removed after transplantation died due to massive intra-abdominal tumor spread 68 months after LTx. Currently, two patients are without evidence of disease, but one of them after re-operation because of lymph-node metastases 8 months after transplantation. The longest disease-free survival is now more than 7 years. In seven of nine patients, tumor recurred between 1.5 months and 48 months after transplantation. Conclusions: Patients with otherwise untreatable symptomatic neuroendocrine hepatic metastases of pancreatic origin may benefit from total hepatectomy and liver transplantation with regard to symptomatic relief and long-term survival, despite frequent recurrence of disease. In some patients, liver transplantation may even offer the chance for cure.
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