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  • 1
    ISSN: 1433-0385
    Keywords: Key words: Lymphoepithelial carcinoma ; Extrahepatic bile duct ; Hemihepatectomy. ; Schlüsselwörter: Lymphoepitheliales Carcinom ; extrahepatischer Gallengang ; Hemihepatektomie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Eine 36 jährige Frau wurde zur chirurgischen Therapie einer Gallengangstenosierung unserer Abteilung zugewiesen. Die endoskopische retrograde Cholangiographie zeigte eine Stenosierung des D. choledochus mit Beteiligung der Hepaticusbifurcation. Weder eine primär sklerosierende Cholangitis noch ein Carcinom des Gallengangs konnten histologisch anhand des Biopsiematerials nachgewiesen werden. Tumormarker und Autoimmunmarker waren im Normbereich. Intraoperative Schnellschnittuntersuchungen des resezierten Gallengangs erbrachten keine sichere Diagnose. Die Veränderungen wurden als malignes Lymphom des extrahepatischen Gallengangs interpretiert. Zur Therapie der tumorösen Gallengangobstruktion wurden eine En-bloc-Resektion der extrahepatischen Gallenwege, verbunden mit rechtsseitiger Hemihepatektomie, und eine Rekonstruktion mittels Hepaticojejunostomie durchgeführt. Die endgültige histologische Diagnose ergab ein lymphoepitheliales Carcinom des extrahepatischen Gallengangs. Der postoperative Verlauf der Patientin gestaltete sich unauffällig, sie ist nach 12 Monaten in gutem Zustand und rezidivfrei. Dieses niedrigmaligne Carcinom wurde bislang ausschließlich als Tumor der salivatorischen Drüsen sowie in seltenen Fällen des Magens beschrieben. Detaillierte histologische Untersuchungen bestätigten die Diagnose eines lymphoepithelialen Carcinoms des extrahepatischen Gallengangs.
    Notes: Summary. A 36-year-old female patient was transferred to our unit for surgical treatment of a biliary tract obstruction. ERC disclosed an obliteration of the common hepatic duct involving the hepatic bifurcation. Primary sclerotic cholangitis and carcinoma of the bile duct could not be confirmed histologically in the biopsy specimens. Tumor markers and autoimmune antibodies were normal. Histological examination of the ductus choledochus during the operation was not conclusive and a malignant lymphoma was considered. The macroscopic appearance comprised obliterative alterations extending to the right hepatic duct. Therefore, resection of the extrahepatic bile duct, right hemihepatectomy and hepaticojejunostomy were performed. The final histological statement revealed a lymphoepithelial carcinoma. The postoperative course of the patient was uneventful, and the patient is in good condition without any signs of recurrent disease 12 months after the operation. This tumor has been described as occurring as a neoplasm of the stomach and salivary glands exclusively and as being of low-grade malignancy. Additional histological evaluations confirmed the diagnosis of lymphoepithelial carcinoma.
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  • 2
    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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  • 3
    ISSN: 1432-2277
    Keywords: Key words Tolerance introduction ; Chronic graft dysfunction ; Second renal allograft ; TH1/TH2 shift
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a previous experiment we demonstrated the induction of tolerance by the allograft itself. In this model of weak histoincompatibility, second grafts of donor origin replacing chronically rejected first renal allografts were accepted long term. Additionally grafted donor-specific hearts functioned indefinitely while adoptive transfer experiments demonstrated the development of donor-specific transferable tolerance. In the current experiment we compared intragraft gene expression of chronically rejected first and tolerant second grafts by RT-PCR. Second renal allografts of donor origin (F-344) replaced first grafts 2, 4, 8, 12, and 16 weeks after the initial engraftment. No immunosuppression was used during second engraftment. Grafts were followed by serial proteinuria; morphological and immunohistological studies (APAAP/infiltrating cells, ICAM-1, MHC II expression) and competitive RT-PCR analyses (expressed as arbitary units AU/cDNA) for relevant cells and cytokines (CD-3, IFNγ, IL-10, and IL-4) were assessed by the end of the observation period (16 weeks). Macrophages/monocytes (ED-1 + ) and T-cells (CD-5 and CD-4 + ) infiltrated first allografts in high numbers by 12 weeks associated with strong structural signs of chronic graft rejection (ca. 30 % arterio- and glomerulosclerosis, tubular atrophy and interstitial fibrosis). Cellular infiltrates in second grafts were prominent, however significantly reduced, while histological changes were minor. At cDNA levels, CD-3 transcripts were elevated in second renal allografts performed 2, 4, and 8 weeks after the initial engraftment while comparable levels were observed when second engraftment was performed after 12 and 16 weeks. Analyses of relevant cytokines demonstrated a TH1/TH2 shift independent from the time interval between first and second engraftment. These results emphasize the role of alloresponsiveness for the development of chronic graft dysfunction. Mechanisms of tolerance induction in our model are associated with a distinct alloresponsive pattern. A crucial role for regulatory T-cells is suggested.
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  • 4
    ISSN: 1432-2277
    Keywords: Key words Chronic rejection ; Acute rejection episodes ; Retransplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Acute rejection episodes have been cited as a major immunological risk factor for the development of chronic rejection. To examine the influence of a single rejection event on ultimate graft outcome, acutely rejection rat kidney grafts were retransplanted sequentially into syngeneic rats and their functional and structural behavior assessed over time. Early structural changes (days 3 and 4) were completely reversible, while signs of chronic rejection did become obvious during the long-term follow up. More advanced deteriorated grafts (days 5 and 7) were irreversibly damaged and the rats died shortly after retransplantation. Those results indicate the critical impact of acute rejection episodes on chronic graft rejection. Immediate and aggressive treatment of acute rejection episodes may remove this event as a risk factor for late deteriorating changes.
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