Search PubMed⌕ Search

Biomedical subjects

M J Slooff

Publications and source records attributed to M J Slooff.

At least 163 records · Page 9Linked to original sources
PubMed1988

[Cystic dilatation of the choledochus. 9 cases].

A retrospective study of 9 cases of extra-hepatic biliary cyst is presented. Prior to admission to our hospital, 5 patients had been operated upon elsewhere. This initial operation proved to be of great importance. In 4 patients initial excision of the cyst was performed resulting in complete regression of symptoms, and no further surgery was required. In 5 patients the cyst was not excised initially and cysto-enterostomy was performed. Recurrence of symptoms and complaints, with major morbidity, occurred in all but one of these patients. After several operations, only final excision of the cyst definitively suppressed the symptoms, but in one patient the cyst could no longer be excised. Cysto-enterostomy results in recurrent symptoms and cholangitis and should be avoided. Early excision of extra-hepatic biliary cysts should be performed whenever technically feasible, not only to prevent these complications but also because of the risk of malignant degeneration related to the cyst.

Adolescent↗
PubMed1988

Research into quality of life: a qualitative approach in the evaluation of a liver transplant programme.

This article describes and analyses the psycho-social impact of a liver transplant programme. Through in-depth interviews an inventory has been made of experiences of liver patients/their relatives: those who were on the waiting list, those in the green-light phase, patients who were transplanted (with or without success), patients who were turned down. The article is based on qualitative data. This qualitative approach can provide a better understanding of the problems of the liver transplant technology, and in this way it can contribute to the frame of reference of those who draw up the health policy.

Health Policy↗
PubMed1988

Bone disease after orthotopic liver transplantation.

After orthotopic liver transplantation (OLT), not infrequently a deterioration of bone disease leading to compression fractures of vertebrae is seen. In a consecutive series of 36 adult OLT patients, we studied, clinically and radiologically, the incidence and degree of bone disease before and after OLT; we also studied whether clinical, radiological and laboratory findings were related to the event of postoperative vertebral collapse. Before OLT, radiological signs of mostly slight osteoporosis were seen in a minority of patients. After OLT, 38% of patients developed vertebral collapse, mainly in the second trimester. Collapse occurred in both previously normal and abnormal vertebrae. Of the preoperative parameters sex, age, menopause, intake of prednisolone, duration and diagnosis of liver disease, duration and degree of cholestasis, bone radiology and urinary calcium, only a low urinary calcium was related to postoperative collapse. Of the postoperative parameters duration of cholestasis, urinary calcium, duration of hospital stay, prednisolone dose and outcome in terms of life and death, none was related to collapse. We conclude that vertebral collapse after OLT occurs frequently and is not easily predicted. Early prevention of bone disease in patients with chronic liver disease before OLT and a low steroid-containing immunosuppressive regimen after OLT are advocated.

Adolescent↗
PubMed1988

Prophylaxis with ranitidine against peptic ulcer disease after liver transplantation.

Upper gastrointestinal bleeding resulting from peptic ulcer disease is a potentially life-threatening situation. There are several reports on the association of ulcer disease and corticosteroid treatment, especially when high doses (greater than 40 mg/day) are used. Some categories of patients are prone to ulcer disease under steroid treatment. Prophylaxis in this situation therefore seems reasonable. We compared 23 consecutive liver transplant patients who received ranitidine prophylaxis with 33 previously transplanted patients who had no prophylaxis. In the control group there were 13 patients who had an ulcer, seven of whom bled. In the treated group two ulcers without upper GI bleeding were found. The results indicate that ranitidine can effectively reduce peptic ulcer disease in liver transplantation patients, despite the use of very high doses of corticosteroids.

Adolescent↗
PubMed1988

Liver transplantation in a 48-year-old female with primary biliary cirrhosis.

In 1983, a Danish female with primary biliary cirrhosis underwent orthotopic liver transplantation (OLT). The transplantation took place in Groningen under a Danish-Dutch cooperation, at this writing, and more than four years after transplantation, the patient is still alive. The quality of her life has been dramatically improved, making possible her return to work. Liver tests, liver function, and biopsies are normal and without signs of development of primary biliary cirrhosis in the transplanted liver. Liver transplantation is now frequently performed at several centres throughout the world with an increasing success rate. In Scandinavia, centres have been established in Norway, Finland, and Sweden, whereas in Denmark the organisation of a programme for liver transplantation is still being discussed. Because of the extremely high costs, liver transplantation has to be approved medically and politically, and the brain death criteria have to be accepted before it can be considered as a generally accepted modality of treatment.

Female↗
PubMed1988

Early induction of MHC antigens in human liver grafts. An immunohistologic study.

The present study documents major histocompatibility complex (MHC) Class I and II expression during early acute rejection of human liver grafts. Serial graft biopsies (pretransplant, time zero, and 1 week) were studied. Ten patients received azathioprine (AZA) and prednisone; the other six patients were treated with quadruple therapy (azathioprine, cyclosporine A, prednisone, and cyclophosphamide). To study the specificity of changes in MHC antigen expression, biopsies of six patients with minor or no morphologic abnormalities served as controls. In addition, phenotypes of inflammatory cells present during rejection were analyzed using a panel of monoclonal antibodies. The results show that during acute rejection expression of MHC Class I and II antigens increased significantly in the AZA-treated patients, in a pattern similar to that seen in the patients treated with quadruple therapy, showing enhanced MHC Class I expression on hepatocytes, bile duct epithelium, and sinusoidal endothelium, and Class II antigen on Kupffer cells and sinusoidal endothelium. Bile duct epithelium was consistently positive for Class II antigen; no significant difference with the nonrejection group was observed. T cells are the predominant inflammatory cells during rejection with equal quantities of CD4+ and CD8+ cells. A majority of the infiltrating T cells show expression of Class II antigen but do not react with anti-interleukin-2 receptor antibody. This may be the result of immunosuppressive therapy or a simple reflection of the temporary expression of interleukin-2 receptors during lymphocyte activation. The authors hypothesize that the induction of MHC antigens on bile duct epithelium leads to rejection whereas the expression on hepatocytes represents an epiphenomenon.

Adolescent↗
PubMed1988

Mortality after orthotopic liver transplantation. An analysis of the causes of death in the first 50 liver transplantations in Groningen, The Netherlands.

An analysis was made of the causes of death in 22 of 50 patients receiving consecutive orthotopic liver transplants. A close look at the fatal course of these patients revealed three major patterns: surgical complications (27%), pathology of the hepatic artery anastomosis (23%), and cholestasis (32%). Technical factors were the major reasons for excessive peroperative blood loss, and not the coagulopathy accompanying the liver disease. The etiology of hepatic artery thrombosis is not known. It leads to irreversible damage of the graft, causing death due to acute hepatic failure or to cholangitis and sepsis. The only way to treat patients with this complication is retransplantation. Several factors can induce cholestasis. Retrospectively, it appears that this was mostly due to inappropriate immunosuppression, often a result of the difficult differential diagnosis between rejection and viral infection. Recognition of these three basic patterns should enable us to anticipate their subsequent complications. This may lead to a reduction in morbidity and mortality after liver transplantation.

Adolescent↗
PubMed1987

Selection criteria and decisions in 375 patients with liver disease, considered for liver transplantation during 1977-1985.

We performed a prospective study on 375 patients with liver disease, 60% female, for whom orthotopic liver transplantation (OLT) was considered during 1977-1985. Fifty-four per cent had cirrhosis, 8.5% congenital/hereditary disorders, 25% malignant tumour, 6% benign tumour, 2% Budd-Chiari syndrome, 1.5% acute hepatic failure, 3% other diagnoses, and 10% were under 15 years of age. As of July 1st, 1985, 99 patients (47 chronic active/inactive cirrhosis (CAC/CIC), 28 primary biliary cirrhosis (PBC), five hepatocellular carcinoma (HCC), 19 other diagnoses) were accepted for OLT (median age 40 years, 10% under age 15). By that date, 45 patients (median age 42), had had an OLT (20 CAC/CIC, 15 PBC, three biliary atresia, two HCC, five other diagnoses). Fifty-four per cent (201 patients) were rejected for transplantation. The primary reasons for rejection were: no indication (11%), age (5%), other surgical procedures possible (3%), severe liver failure (14%), extrahepatic spread of liver tumour (11%), cardiovascular or pulmonary problems (2%), severe hepatic bone disease (1%), and miscellaneous (7%). Thirty per cent of the patients with CAC/CIC, 38% with PBC, 88% with HCC and 71% with biliary atresia were rejected. In the CAC/CIC, PBC and biliary atresia patients severe liver failure was the most frequent reason for rejection (62%, 50% and 60%, respectively). In HCC, extrahepatic tumour spread was the most frequent reason (72%) for rejection. In this category only two patients (7%) ultimately underwent liver transplantation.

Adolescent↗
PubMed1987

Pulmonary dysfunction is common during a cytomegalovirus infection after renal transplantation even in asymptomatic patients. Possible relationship with complement activation.

In 24 patients with a cadaveric renal allograft, serial measurements after transplantation were made of the diffusing capacity for carbon monoxide (DLCO) together with serial measurements of C3d, the stable conversion product of the complement factor C3, and determinations of the anaphylatoxin C3a. Twelve patients were studied during an active cytomegalovirus (CMV) infection, and 12 patients were studied during allograft rejection or during a stable phase after renal transplantation (control subjects). No patients had pulmonary symptoms nor abnormal chest radiographs or arterial blood gas determinations. During an active CMV infection, DLCO was significantly reduced compared with the measurements made during allograft rejection or during a stable phase after renal transplantation. This was true both with (p less than 0.01) and without (p less than 0.01) correction for the hemoglobin concentration. Serum C3d levels were increased in 8 of the 12 patients with a CMV infection, but not in any of the patients in the control group. In 8 patients with a CMV infection, measurements were made of the anaphylatoxin C3a, and were found to be significantly higher than the levels in the control population (p less than 0.01). We conclude that our data are consistent with pulmonary dysfunction in every patient with an active CMV infection. The concomitant findings of complement activation and formation of anaphylatoxins suggest a causal relationship of the complement activation and a decreased DLCO, although further studies are warranted to determine the exact role of complement in the pulmonary events during an active CMV infection after renal transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Pneumatosis intestinalis related to cytomegalo-virus infection--a new etiology?

Five patients who developed pneumatosis intestinalis in the course of a cytomegalo virus (CMV) infection after cadaveric kidney transplantation are described. Based on the fact that CMV is known to cause intestinal ulcers, we postulate a causal relationship between CMV and pneumatosis intestinalis.

Cytomegalovirus Infections↗