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Biomedical subjects

F Lehner

Publications and source records attributed to F Lehner.

9 recordsLinked to original sources
PubMed2003

[Surgical treatment for hilar cholangiocarcinoma (Klatskin's tumor)].

Surgical treatment of hilar bile duct carcinoma remains difficult, which is due to the inadequate possibilities in assessing tumor extent during the preoperative diagnostic procedure as well as intraoperatively. Radical resection with negative histologic margins offers the best chance for long-term survival. The decision regarding the appropriate surgical approach is challenging due to the complexity of tumor localization and neighboring vascular structures. Aggressive resection demands extended liver resection, which is associated with the risk of postoperative liver failure. However, even limited surgery such as hilar resection can be curative and leads to long-term survival in individual cases. The principles of surgical oncology have led to more aggressive procedures, including the combination of liver transplantation and multivisceral resection, and can be performed with calculable morbidity and mortality. Nevertheless, the high risk of tumor recurrence under long-term immunosuppression, the limited availability of donor organs and the excellent results of liver transplantation in non-malignant diseases do not justify this procedure at present. Neoadjuvant radiochemotherapy has failed to demonstrate major benefit. In patients with irresectable tumor or distant metastases palliative measures are aimed at restoring an unobstructed bile flow with endoscopic placement of metal stents. Palliative treatment with additional radio- or photodynamic therapy may be considered in individual cases.

Adult↗
PubMed2003

[Angiodysplasia of the colon combined with portal hypertension and recurrent gastrointestinal bleeding].

Angiodysplasia of the colon has been reported as one of the most common sources of lower gastrointestinal bleeding in the elderly whereas it is very rare in younger patients. Apart from this, portal hypertension may also have effects on the colon. There are, however, only a few reports which have investigated the colon in patients with portal hypertension. We report the case of a 16-year-old woman who presented massive bleeding from angiodysplasia of the colon assembled together with portal hypertension due to portal vein thrombosis caused presumably by neonatal umbilical cord infection. In this regard we discuss diagnosis, therapy and prognosis of this disease.

Adolescent↗
PubMed2002

Successful outcome of acute graft-versus-host disease in a liver allograft recipient by withdrawal of immunosuppression.

BACKGROUND: Graft-versus-host disease (GVHD) after liver transplantation is uncommon, and the outcome is almost always fatal. Since 1987, about 30 cases have been described, and patient survival is mostly exceptional. METHODS: A 29-year-old man underwent retransplantation due to chronic cholestatic syndrome, 5 years after his first liver transplantation. Indication for the first liver transplantation was acute liver failure caused by exsiccosis. After the second transplantation, the patient had an initially uneventful course, developing thrombocytopenia at day 21 followed by skin rash and septic complications. Diagnosis of acute GVHD was made by using serological techniques for HLA-A and HLA-DRB and subsequently by fluorogenic sequence-specific primed polymerase chain reaction. In addition, donor lymphocytes were marked by immunohistochemical methods via biopsies of the skin. Immunosuppressive therapy was withdrawn to allow the patient's own immune system to eliminate donor cells. RESULTS: By withdrawing the immunosuppressive therapy, clinical and morphological signs of GVHD vanished. The patient is doing well without recurrence 13 months after transplantation. CONCLUSION: Withdrawal of immunosuppressive therapy is a promising approach in the treatment of acute GVHD to allow the patient's immune system to reconstitute itself, reject offending lymphocytes, and avoid lethal septic complications.

Acute Disease↗
PubMed2002

[Neuroendocrine tumors of the stomach. Surgery therapy and prognosis].

Gastric carcinoid tumors are rare lesions characterized by hypergastrinemia that arise from enterochromaffin-like (ECL) cells of the stomach. A classification system distinguishing three types of gastric carcinoid tumors has been proposed: 1) tumors related to chronic atrophic gastritis, 2) tumors associated with Zollinger-Ellison syndrome, and 3) sporadic lesions. It is apparent that hypergastrinemia-associated gastric carcinoids show a rather benign biological behavior. Normo-gastrinemic sporadic lesions, on the other hand, require an aggressive surgical management. We report seven patients with gastric neuroendocrine tumors ("carcinoids"), who underwent surgical treatment in our department between 1988 and 2000. Surgical therapy included total gastrectomy with D2 lymphadenectomy in two cases with type I tumors and for one patient with type III tumor. One patient with a type II tumor was treated by distal subtotal gastrectomy and another by antrectomy. A local excision was performed on one patient with type I tumor. After a mean follow-up of 8 years, 5 of 7 patients are alive without recurrence.

Adult↗
PubMed2001

[Surgical therapy of cystic echinococcosis of the liver].

This study analyses the results of a surgical deroofing technique that was used for the treatment of cystic echinococcosis of the liver in our institution during the last 18 years. The deroofing technique was used on 106 of 132 patients from January 1981 to December 1998. Other operative techniques (pericystectomy, hemihepatectomy) were performed on 26 patients. In 12 cases (9%) the operative procedure was completed by interventions at the extrahepatic bile ducts. 99 patients (75%) showed one or two cysts, and the remaining 33 patients (25%) had three or more cysts in the liver. 18 (14%) patients had to be reoperated on account of complications: in 5 cases a postoperative hemorrhage, in 11 cases a bile duct leakage and in 2 cases an intraabdominal abscess had to be treated operatively. The follow-up of 74 patients (81%) revealed recurrent disease in 14 (19%) cases. Surgical deroofing of cystic echinococcosis of the liver is easy to perform and in contrast to other minor surgical interventions universally applicable. The recurrence rate and the rate of postoperative complications are comparable to other minor surgical techniques. Therefore in our view this procedure represents the therapy of choice.

Adolescent↗
PubMed2000

Beer and breastfeeding.

Traditional wisdom claims that moderate beer consumption may be beneficial for initiation of breastfeeding and enhancement of breastfeeding success. Here we review the question whether or not there is any scientific basis for this popular belief. There are clear indications that beer can stimulate prolactin secretion which may enhance lactogenesis both in non-lactating humans and in experimental animals. The component in beer responsible for the effect on prolactin secretion is not the alcohol content but apparently a polysaccharide from barley, which explains that the effect on prolactin can also be induced by non-alcoholic beer. No systematic studies are available to evaluate the clinical effects of beer on induction of lactogenesis, and short term studies have shown a reduced breast milk intake by infants after moderate alcohol consumption of their mothers. It is conceivable that relaxing effects of both alcohol and components of hop might also have beneficial effects on lactogenesis is some women, but there is no hard evidence for causal effects. It appears prudent not to generally advocate the regular use of alcoholic drinks during lactation but to rather refer mothers to non-alcoholic beer, even though no adverse effects of an occasional alcoholic drink during lactation have been documented.

Beer↗
PubMed1999

Diclazuril in the horse: its identification and detection and preliminary pharmacokinetics.

Diclazuril (4-chlorophenyl [2,6-dichloro-4-(4,5-dihydro-3H-3,5-dioxo-1,2,4-triazin-2-yl)pheny l] acetonitrile), is a benzeneacetonitrile antiprotozoal agent (Janssen Research Compound R 64433) marketed as Clinacox . Diclazuril may have clinical application in the treatment of Equine Protozoal Myeloencephalitis (EPM). To evaluate its bioavailability and preliminary pharmacokinetics in the horse we developed a sensitive quantitative high-pressure liquid chromatography (HPLC) method for diclazuril in equine biological fluids. MS/MS analysis of diclazuril in our HPLC solvent yielded mass spectral data consistent with the presence of diclazuril. After a single oral dose of diclazuril at 2.5 g/450 kg (as 500 g Clinacox), plasma samples from four horses showed good plasma concentrations of diclazuril which peaked at 1.077 +/- 0.174 microg/mL (mean +/- SEM) with an apparent plasma half-life of about 43 h. When this dose of Clinacox was administered daily for 21 days to two horses, mean steady state plasma concentrations of 7-9 microg/mL were attained. Steady-state levels in the CSF ranged between 100 and 250 ng/mL. There was no detectable parent diclazuril in the urine samples of dosed horses by HPLC or by routine postrace thin layer chromatography (TLC). These results show that diclazuril is absorbed after oral administration and attains steady-state concentrations in plasma and CSF. The steady state concentrations attained in CSF are more than sufficient to interfere with Sarcocystis neurona, whose proliferation is reportedly 95% inhibited by concentrations of diclazuril as low as 1 ng/mL. These results are therefore entirely consistent with and support the reported clinical efficacy of diclazuril in the treatment of clinical cases of EPM.

Administration, Oral↗