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Biomedical subjects

F W Eigler

Publications and source records attributed to F W Eigler.

At least 37 records · Page 2Linked to original sources
PubMed1997

Value of an extended monoethylglycinexylidide formation test and other dynamic liver function tests in liver transplant donors.

Measuring monoethylglycinexylidide (MEGX) formation after intravenous administration of lidocaine in potential organ donors (MEGX test) has been advocated as a useful test to select donor livers for transplantation, but some groups have demonstrated a low test efficacy. We, therefore, investigated the value of an extended MEGX formation test and the value of other dynamic liver function tests, in selecting suitable human donor livers. In 51 human multi-organ donors, we measured elimination of galactose, indocyanine green, and lidocaine, as well as formation of MEGX, at 15, 30, and 60 min after administration of the test substances. In the early postoperative period, the function of the transplanted liver was then classified as good or poor, as defined by a prothrombin time above or below 65% by day 4 and fibrinogen concentration above or below 300 mg/dl by day 7. Donor characteristics and preservation modalities were very similar between the two groups. Galactose, indocyanine green, and lidocaine metabolism failed to predict good or poor graft function in the early postoperative period. MEGX serum concentrations, however, were significantly higher in the group of donors whose organs functioned well in the recipients, as compared with donors whose organs functioned poorly in the recipients. This was true for MEGX concentrations at 15 min (117+/-9 vs. 90+/-9 ng/ml; P=0.03), 30 min (108+/-8 vs. 86+/-8 ng/ml; P=0.04), and 60 min (100+/-6 vs. 73+/-5 ng/ml; P=0.006). Extending the MEGX formation test from 15 to 60 min improved test efficacy. Maximal MEGX concentration in 9 or up to 12 consecutive blood samples, drawn between 3 and 120 min after lidocaine infusion, was also significantly higher in donors whose organs functioned well, than in donors whose organs functioned poorly (129+/-10 vs. 101+/-10 ng/ml; P=0.03). Although the groups with good and poor organ function differed significantly with respect to their MEGX serum concentrations, and although efficacy of the MEGX test was improved by extending the test from 15 to 60 min, the overlap in individual MEGX serum concentrations was still so wide that it is virtually impossible to predict early graft function only on the basis of the MEGX test in the donor. Therefore, the MEGX test, although of potential scientific interest, does not predict early graft function with an accuracy necessary for clinical use.

Adult↗
PubMed1997

Preservation of pig liver allografts after warm ischemia: normothermic perfusion versus cold storage.

Warm ischemia is known to induce substantial damage to the liver parenchyma. With respect to clinical liver transplantation, the tolerance of the liver to warm ischemia and the preservation of these organs have not been studied in detail. In isolated reperfused pig livers we proceeded according to the following concept: Livers were subjected to 1 or 3 h of warm ischemia. Subsequently, these organs were preserved by either normothermic perfusion or cold storage (histidine-tryptophan-alpha-ketoglutarate, HTK) for 3 h each. After storage, liver function was assessed in a reperfusion circuit for another 3 h. Parameters under evaluation were bile flow, perfusion flow, oxygen consumption, enzyme release into the perfusate (creatine kinase, glutamic oxaloacetic transaminase (GOT), lactic dehydrogenase, and glutamic pyruvic transaminase), and histomorphology. Damage to the liver was lowest after warm ischemia of 1 h. The results after cold storage were superior to those after normothermic perfusion (GOT: 3.2 +/- 0.3 and 2.6 +/- 0.2 U/g liver; cumulative bile production: 14.7 +/- 2.1 and 9.4 +/- 1 ml, respectively; P < 0.05). In contrast, we found substantial damage at the end of reperfusion in livers undergoing 3 h of warm ischemia under both preservation techniques with severe hepatocellular pyknoses and essentially altered nonparenchymal cells. The results suggest that pig livers undergoing 1 h of warm ischemia and cold storage for 3 h with HTK solution may lead to functioning after transplantation.

Alanine Transaminase↗
PubMed1997

[Surgery in patients with renal failure in emergency and elective interventions].

The classification of renal insufficiency into stages of full compensation, compensated and decompensated retention and terminal renal failure is of importance if patients with impaired renal function are to undergo elective and emergency surgery. Furthermore, it should be established whether the renal disease is stable or progressive. Preoperatively, particular attention should be paid to problems of fluid and electrolyte homoeostasis as well as to acid-base balance. Many drugs should be avoided altogether in patients with kidney disease.

Acid-Base Imbalance↗
PubMed1997

[Upper gastrointestinal hemorrhage caused by necrotizing cholecystitis with gallstone perforation into the duodenum].

A 68-year-old woman suffering from severe upper gastrointestinal bleeding underwent an urgent laparotomy. A necrotizing cholecystitis was found. The source of the bleeding was the eroded cystic artery. Perforation of a giant gallstone led to a fistula into the duodenum. The gallstone was removed from the distal jejunum. The patient's postoperative course was uneventful. Later on a choledochal stenosis had to be treated by stenting. One year after the procedure the patient is alive and well.

Aged↗
PubMed1997

Conventional and quantitative liver function tests after hepatic transplantation: a prospective long-term follow-up.

In long-term survivors of liver transplantation, hepatic function is obviously of vital importance. Therefore, we prospectively performed conventional and quantitative liver function tests in patients who had survived a first transplantation for at least 4 years. Compared to 6 months after transplantation, serum bilirubin concentration and gamma GT activity were significantly lower after 3, 4, and 5 years (bilirubin 1.2 +/- 0.2 mg/dl at 6 months vs 1.0 +/- 0.1, 1.0 +/- 0.2, and 0.8 +/- 0.1 mg/dl respectively; gamma GT 106 +/- 0 33 U/l at 6 months vs 56 +/- 17, 67 +/- 35, 39 +/- 10 U/l respectively). At these points in time, blood levels of cyclosporin A were also significantly lower. Other parameters of liver cell function and liver cell integrity (AP, AST, ALT, GLDH, total protein, thromboplastin time, partial thromboplastin time) were unchanged over time. Serial quantitative liver function tests (indocyanine green half-life, galactose elimination capacity, lidocaine half-life, and MEGX formation) also remained stable. Thus, we conclude that hepatic function remains stable in long-term survivors of liver transplantation for at least several years.

Adult↗
PubMed1997

[Animal experiment studies of arterialization of the portal vein in liver transplantation using the Göttingen minipig].

The aim of the present experimental investigation was to assess the circulatory, biochemical and histopathological consequences of complete portal vein arterialization of the transplanted liver in 'Göttinger' miniature pigs. Orthotopic liver transplantations using a passive portojugular shunt were performed in six male 'Göttinger' miniature pigs. Using an iliac artery segment interposition of the animal donor, the hepatic artery (HA) of the transplant liver was anastomized end-to-end and the portal vein (PA) also united with the internal iliac artery stump end-to-end. The central anastomosis was performed onto the suprarenal aorta. Portal vein blood was drained into the infrahepatic caval vein via an end-to-side shunt (PCS). During the course, the following parameters were determined: arterial blood pressure, venous pressure, cardiac output, electromagnetic blood flow measurements across the HA, PA, and PCS, PA mean pressure, transaminases, partial thromboplastin time and fibrinogen. Liver biopsies and autopsy specimens were investigated. One of six animals died a few hours postoperatively, two of six died after 48 and 72 h, respectively, whereas three pigs survived the scheduled 7 days. The cardiac output fell intraoperatively initially by an average of 20% but had approximately the starting volume of 2.2 l/min at the end of the operation. Although the diameter of the anastomosis was reduced to 4 mm, the flow in the arterialized PA on average was 340 ml/min when the vessel clamp was opened. At the end of operation the mean was 380 ml/min, the interval of measurement being 75 min. The flow across the PCS and the HA were constant during the course. As mechanism for this phenomenon, autoregulation of the liver blood flow on a sinusidal level has been suggested. The biochemical results and the histopathological findings showed no change compared to previous findings in a control group of animals in which liver transplantation was performed by our team. Complete arterialization of the PA is well tolerated in liver transplantation in 'Göttinger' miniature pigs with regard to circulation and liver function in a short-term trial of a maximum of 7 days. Long-term results are still to come.

Anastomosis, Surgical↗
PubMed1997

First results of laparoscopic gastrostomy.

BACKGROUND: Laparoscopic gastrostomy as an alternative to open gastrostomy was introduced with various technical variants 5 years ago. However, long-term results of these new methods are still lacking. METHODS: From 4/1993 to 2/1996, laparoscopic gastrostomies were performed on 42 patients (50.9 +/- 15.6 [24-71] years) with esophageal stenosis in locally advanced hypopharyngeal (17 patients) or oropharyngeal (nine patients) carcinoma, incurable esophageal carcinoma (13 patients) and cerebral dyspagia (three patients). Operating time was 38 +/- 11 min [15-65 min]. Procedure-related mortality was 0%. Major complications occurred in 2/42 (4.7%) patients; minor complications were found in 4/42 (9.4%) patients. During a total usage time of 427 months, 14 stoma infections occurred (0.11 infections/100 days). CONCLUSION: Laparoscopic gastrostomy allows a safe, fast, and cheap reestablishment of enteral nutrition. The procedure is minimally invasive and can also be performed under local anesthesia. It has become our method of choice in patients with malignant, nonresectable subtotal stenosis of the hypopharynx or esophagus.

Adult↗
PubMed1997

Triiodothyronine (T3) reflects renal graft function after renal transplantation.

OBJECTIVE: Abnormalities in thyroid function are observed in patients with end stage renal disease. However, there are no data available evaluating sequential changes of thyroid function after renal transplantation. Therefore, we have studied thyroid hormone function in the immediate post-operative period after renal transplantation in order to determine the relationship between improving renal function and changes in thyroid hormone economy. DESIGN AND PATIENTS: Thyroid function was evaluated in 22 patients before and on days 1, 3, 7 and 15 after renal transplantation. All patients received prednisone and cyclosporin as immunosuppressive therapy. Twelve patients with normal renal function undergoing comparable surgical procedures served as a control group. MEASUREMENTS: Serum creatinine and thyroid hormone parameters (total T4, total T3, free T4, free T3, thyroxin binding globulin (TBG), reverse T3, T3 sulphate and TSH) were measured. RESULTS: According to post-operative kidney function after renal transplantation, patients could be subdivided into three groups: five patients had primary graft function (group I); seven patients had delayed graft function because of acute renal failure (group II); 10 patients had delayed graft function requiring high doses of prednisone and some also of OKT3 because of acute rejection (group III). There was a significant fall in T3 and T4 concentrations with a concomitant rise in reverse T3 in all patients up to 3 days after renal transplantation. However, only patients in group I reached pre-operative values on day 15 after renal transplantation (serum creatinine 167 +/- 52 microM), whereas patients in group II (creatinine 609 +/- 118 microM) and group III (creatinine 839 +/- 71 microM) continued to have T3 concentrations well in the hypothyroid range (group I, 1.68 +/- 0.28 nM) vs 0.87 +/- 0.09 nM in group II and 0.76 +/- 0.10 nM in group III; P < 0.01). Serum T4 concentrations were also low in group III (47.7 nM vs 100.2 nM in group I; P < 0.05) 15 days after renal transplantation. These changes were accompanied by a concomitant fall in T3/TBG ratio and in free T3. Elevated reverse T3 returned to normal values in all groups on the 15th day after renal transplantation. TSH fell significantly on the first post-operative day, but did not return to pre-operative values in renal transplantation patients. In the control group, TSH did not change during the study period. T3 sulphate, known to be elevated in chronic renal failure, remained above normal in all patients irrespective of graft function during this study period. CONCLUSIONS: T3 concentrations reflect renal graft function after renal transplantation. T3 is below normal in patients with delayed graft function (acute renal failure or acute rejection). The post-operative period (up to 3 days after renal transplantation) is associated with a low T3 syndrome. TSH does not return to pre-operative values even in patients with primary graft function. This might be due to the administration of prednisone. T3-sulphate is elevated before and after renal transplantation irrespective of graft function.

Acute Kidney Injury↗
PubMed1997

GB virus C infection in patients who underwent liver transplantation.

To elucidate the impact of an infection with the recently discovered GB virus C (GBV-C) on the clinical course after orthotopic liver transplantation (OLT), we studied eight patients who were GBV-C RNA positive after transplantation. Five individuals had been viraemic before transplantation, three became GBV-C RNA positive thereafter. A control group comprised eight patients without pre- or post-transplant GBV-C infection. GBV-C RNA was detected by reverse-transcription followed by nested polymerase-chain-reaction (PCR) with primers corresponding to the NS5 genome region. Nested PCR products were sequenced directly. The five patients infected with GBV-C before transplantation remained GBV-C RNA positive throughout the time of observation. Pre- and post-transplant GBV-C RNA titres were almost identical. Phylogenetic analysis revealed a very close relationship between the pre- and post-transplant viral nucleotide sequences indicating persistent GBV-C infection. No signs of hepatitis could be detected after transplantation in all GBV-C infected patients. However, four out of eight GBV-C RNA positive patients had a clinical course complicated by severe cholestasis, which was not observed in the control group. Although GBV-C infection does not lead to an increase in the rate of post-transplant hepatitis, it might be associated with severe unexplained cholestatic courses after OLT.

Adult↗
PubMed1997

[Aorto-duodenal fistula--direct suture and pedicled omentum flap-plasty].

Between 1985 and 1993, six patients underwent emergency operation at the Department of General Surgery, Essen University Hospitals, for a secondary aorto-duodenal fistula. In all patients, a Dacron tube- or bifurcation prosthesis has been implanted 1-10 years previously to repair an arteriosclerotic aneurysm of the abdominal aorta. The main symptom of the aorto-duodenal fistula was massive gastrointestinal hemorrhage, with manifest shock in two cases. The most reliable diagnostic procedure, in addition to ultrasonography, was found to be computed angio-tomography. In three cases where there was erosion around the proximal aorto-prosthetic anastomosis, bacterial contamination was found during surgery. Direct reconstruction and pedunculated omentum plasty appear to be a safe method for closing an aorto-duodenal fistula. No patient died in the immediate postoperative period after direct reconstruction. One patient, however, died three months after surgery of myocardial infarction. Two patients suffered from fistula recurrence 1.25 and 3 years respectively after operation and died as a result. One patient died of the sequelae of a chronic obstructive pulmonary disease 3.5 years after the operation. The remaining two patients are still alive and free of complications more than 4 years after operation. Direct reconstruction and pedunculated omentum plasty appear to be a safe method for closing an aorto-duodenal fistula.

Aged↗
PubMed1997

[Crossectomy in ascending superficial thrombophlebitis of the leg veins].

Ascending thrombophlebitis of the superficial leg veins is known to propagate into the deep leg veins and to embolize. In a prospective study we followed up 44 patients with sonographically diagnosed ascending thrombophlebitis into the deep veins (V. saphena magna n = 40, V. saphena parva n = 4). In 15 of 44 cases (34%) thrombosis of the crossing veins was found intraoperatively and 6 of 44 crossings were filled with floating thrombi into the deep vein lumina (14%). Among complications of treatment (11.4%) recurrence of thrombi in the ligated superficial residual vein stump was seen in 2 of 44 cases. One of these patients suffered a symptomatic, non-fulminant pulmonary embolism. The other patient developed a femoral vein thrombosis. 1 patient had an abscess and 1 a seroma of the groin. In 11% of all cases ascending thrombophlebitis diagnosed duplex sonographically was not effective in preventing propagation of thrombi into the deep veins thromboembolism remains a complication of ascending thrombophlebitis.

Adult↗
PubMed1997

[Guidelines for stomach carcinoma and lymphoma].

The manual is based on a consensus-conference of the oncological study groups surgery, internal medicine and radio therapy. Additionally to gastrectomy and exceptionally the high resection it contains lymphdysection of the second compartment. When R0 resection seems impossible preoperatively, a neoadjuvant therapy under study protocol should take place. Especially in gastric lymphoma the therapeutical variety is large. Therefore taking part in clinical studies is urgently required.

Carcinoma↗
PubMed1997

[Unilateral neck exploration in primary hyperparathyroidism].

Within a prospective case control study from 1993 to 1996, in 85 first operations for primary hyperparathyroidism the neck exploration was ended unilaterally when an adenoma (also histologically proven) and one normally small parathyroid gland were found. Otherwise or in case of simultaneous surgery of the thyroid gland, a bilateral exploration was performed. The primary success rate with this strategy, additionally based on 69.4% correct results of cervical ultrasound, was 95.3%, with a significant saving of an average of 30 min. operating time.

Adenoma↗
PubMed1997

[Laparoscopic gastrostomy--advantages in comparison with percutaneous endoscopic gastrostomy (PEG)].

Laparoscopic gastrostomy was performed on 70 patients with contraindications to PEG. All procedures were performed successfully, even in patients with gastric resections, after gallbladder surgery, and in patients with liver cirrhosis and ascites. Long-term results comprise a low complication rate of 0.12 in 100 application days. Laparoscopic gastrostomy is a highly effective procedure with low morbidity and good long-term results in patients with contraindications to PEG requiring enteral feeding.

Adult↗