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  • 1
    ISSN: 1432-1084
    Keywords: Lithotripsy ; gallstones ; Cholecystolithiasis ; extracorporeal shock-waves
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a three-year period, 207 patients with cholecystolithiasis were referred to an interdisciplinary team at our hospital to evaluate the possibility of non-surgical treatment. Fifty-eight patients were found eligible for extracorporeal shock-wave lithotripsy (ESWL); 50 of them underwent ESWL on an outpatient basis with adjuvant bile acid therapy. Thirty patients (60%) had single stones, 14 (28%) had two or three stones, and 6 (12%) had five-ten stones. The mean total stone volume of all patients was 2,5 cm3, equivalent to a single stone of 1.7 cm diameter; 6 patients (12%) had slightly calcified stones. Successful stone fragmentation (fragments 〈- 4 mm) was achieved in 45 patients (90%). In the remaining 5 patients (10%) with residual fragments 〉 4 mm, ESWL was considered a failure and elective cholecystectomy was eventually performed or recommended. All patients received adjuvant oral bile acid therapy. The stone clearance rates after 3, 6, 12 and 18 months were 29%, 50%, 83% and 95% in patients with single stones and 22%, 40%, 64% and 88%, respectively, in all patients. The duration of treatment in 32 patients who have cleared all their gallstone fragments to date, was 8.5 months (range: 0.4–20.4 months); all of these patients are also free of their initial symptoms. Sideeffects and complications of ESWL included biliary colic in 17 patients (34%), mild acute pancreatitis in 1 patient (2%) and acute cholecystitis requiring emergency cholecystectomy in another patient (2%). The electromagnetic device and the protocol we used is well suited for ambulatory treatment of patients with a limited stone volume. A fragment size 〈- 4 mm was usually achieved with 2 treatment sessions and appears to be a reasonable endpoint of ESWL. Although laparoscopic cholecystectomy is now a routine procedure in our hospital, we believe that ESWL remains a valid treatment option in selected patients.
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  • 2
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; acute rejection ; liver function tests ; Liver function tests ; acute rejection ; liver transplantation ; Acute rejection ; liver function tests ; liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Whereas early acute cellular rejection, even if successfully treated, seems to have an impact on late function and survival of kidney and heart transplants, little quantitative data are available on its effect(s) on liver transplants. Routine liver function tests, the functioning liver cell mass (galactose elimination capacity) and microsomal metabolic capacity (aminopyrine breath test) were determined prospectively in 37 consecutive patients 1 year after liver transplantation. Of these, 19 (7 females and 12 males, 32–69 years of age) had previously required treatment for at least one biopsy proven acute cellular rejection episode occuring a median 7 days after grafting, while 18 (6 females and 12 males, 30–67 years of age) had not. The functioning liver cell mass and microsomal metabolic capacity were both within normal limits for the majority of patients and did not differ significantly between patients with and without previous acute cellular rejection episodes. In contrast to other solid organ transplants, early acute cellular rejection episodes do not affect late function of liver allografts in man.
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  • 3
    ISSN: 1433-0385
    Keywords: Key words: Liver transplantation ; Quality ; Results ; Small centre. ; Schlüsselwörter: Orthotope Lebertransplantation ; Qualität im kleinen Zentrum ; Langzeitergebnisse.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die orthotope Lebertransplantation ist heute zur Therapie der Wahl der Endstadien verschiedener Lebererkrankungen geworden. International beträgt das perioperative Überleben 80 % und die 5-Jahres-Überlebensrate liegt bei elektiv operierten nicht malignen Erkrankungen über 70 %. Das Lebertransplantationsprogramm in Bern ist im internationalen Vergleich klein und basiert auf dem Routinebetrieb einer Universitätsklinik. Es stellt sich daher die Frage nach den Resultaten und der Daseinsberechtigung eines solchen Programms. Im Zeitraum von 66 Monaten wurden am Inselspital in Bern 62 Lebertransplantationen bei 60 Patienten durchgeführt. Die perioperative Letalität betrug 3,3 %, die 30-Monats-Überlebensrate 92 % (elektive Patienten mit benignen Erkrankungen). 68 % der Patienten sind im Median 30 Monate nach der Transplantation arbeitsfähig und 83 % unabhängig von fremder Hilfe. Diese Resultate über einen 5-Jahres-Zeitraum sind vergleichbar mit den Ergebnissen internationaler Transplantationszentren. Aus unserer Sicht hat ein solches kleines Programm daher, wenn es interdisziplinär im Konzept einer Universitätsklinik eingepaßt ist, Daseinsberechtigung und Perspektive.
    Notes: Summary. Today, orthotopic liver transplantation is the treatment of choice for the end-stage of various liver diseases, and a 1-year survival rate of 80 % and a 5-year survival rate of 70 % in elective patients without tumor are reported in international surveys. The liver transplant programme of the Inselspital in Bern is small compared with international centres, which may raise questions about the results and the justification for such a programme. Over a period of 66 months, 62 liver transplantations were performed in 60 patients at the Inselspital. The hospital mortality was 3.3 %, and the 2.5-year overall survival rate was 92 % for elective cases without tumor. After a median follow-up of 30 months, 68 % of all patients were re-integrated in housework or full- or part-time in their profession, and 83 % were independent from the help of others. We conclude that a small liver transplant programme based only on routine resources can achieve results comparable to the international standards.
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