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Biomedical subjects

R Pichlmayr

Publications and source records attributed to R Pichlmayr.

At least 217 records · Page 12Linked to original sources

Use of organotypical cultures of primary hepatocytes to analyse drug biotransformation in man and animals.

1. In conventional single-gel culture systems for primary hepatocytes, rapid loss of drug metabolizing capacities is a common feature and parallels general loss of function. An organotypical (double gel) culture technique for primary hepatocytes is established by enclosing the cells within two layers of extra cellular matrix. This serves to imitate the in vivo microenvironment within the space of Dissé. Using rat hepatocytes, this technique has been shown previously to maintain protein synthetic functions in vitro and to allow more efficient P450A-dependent biotransformation of drugs than a standard single-gel culture system. 2. The aim was to test the capacity of this organotypical culture model for primary rat and human hepatocytes to generate drug metabolites in a typical species-dependent pattern. 3. Urapidil, an antihypertensive drug, was used as a test compound, since it is metabolized in vivo in a species-dependent manner in rat and man. 4. Primary rat and human hepatocytes were cultured within two layers of collagen and exposed to 2.25 micrograms/ml urapidil for periods of 1-24 h at 3 days in culture. Urapidil metabolites were measured using hplc. 5. Metabolite M1 (hydroxylated product) was produced preferentially in human hepatocyte cultures, and metabolites M2/M3 (O-demethylated, N-demethylated product) were preferentially generated in rat cultures. This corresponded to the in vivo pattern found in man and rat, respectively. 6. Since in vitro urapidil metabolism by human and rat hepatocytes cultured in a double-gel system reflects that in vivo, it is suggested that information from such a system may be useful to predict the metabolic pathway of novel xenobiotics and to direct further toxicological evaluation.

Adult↗

Plasma vs whole blood for therapeutic drug monitoring of patients receiving FK 506 for immunosuppression.

By retrospective analysis of 13,000 blood samples obtained from 248 patients receiving FK 506 therapy, we compared the suitability of plasma with that of whole blood as the matrix for therapeutic drug monitoring of FK 506. The plasma concentrations did not correlate with the concentrations in whole blood (r = 0.56). In contrast to plasma samples (analyzed by enzyme immunoassay), FK 506 was detectable in all whole-blood samples (analyzed by enzyme immunoassay/microparticle enzyme immunoassay). The inter- and intraindividual variations of FK 506 measurements were greater in plasma than in whole blood. Moreover, plasma concentrations correlated only poorly with clinical events. There was a tendency to greater plasma concentrations being measured during episodes of toxicity, but no clear difference was evident between stable course and rejection. In whole-blood specimens, a correlation between reduced or increased FK 506 concentrations and rejection or toxicity, respectively, was observed. The discriminatory power of whole-blood values was greater for the differentiation between toxicity and stable course than between rejection and stable course. We therefore recommend whole blood rather than plasma as the matrix for therapeutic monitoring of FK 506 concentrations.

Drug Monitoring↗

Auxiliary partial orthotopic liver transplantation for acute liver failure: the Hannover experience.

APOLT has been developed both to enable the native liver to regenerate in acute liver failure and to avoid the risks of long-term immunosuppressive therapy. We present our experience with APOLT in 4 patients with acute liver failure. The patients were 33, 18, 5, and 34 years of age, respectively. The causes of hepatic failure were: one HELLP syndrome, one paracetamol intoxication, and 2 causes which remained undetermined. All patients were in coma before transplantation. First symptoms had occurred 13, 2, 30, and 20 days prior to APOLT, respectively. In all cases, segments II and III of the recipient's own liver were resected before implanting the auxiliary liver orthotopically. The auxiliary graft consisted of segments II and III in 2 cases and of II, III, and IV in the other 2 patients. The auxiliary graft showed good initial function in all cases. All 4 patients are alive 5 years, 15 months, 6 months, and one month after transplantation. In the last patient, an arterial thrombosis of the graft on the 5th postoperative day required retransplantation. The immunosuppressive therapy could be stopped in 3 cases and the graft was removed in 2 patients 15 and 40 days after APOLT, respectively. This shows that APOLT represents an effective treatment for patients with acute liver failure, which enables restoration of native liver function. Thus, APOLT should be considered in every patient with acute and potentially reversible liver failure in whom a transplantation is indicated.

Acetaminophen↗

[Molecular biology and immunohistochemical studies of Her2/neu oncogene in stomach cancer].

In 58 gastric carcinomas the expression of the Her2/neu gene product p185 was immunohistochemically analyzed. Fresh tumor tissue for molecular studies was available in 25 cases. The results were correlated with various pathohistological and prognostic factors. A 16-32fold Her2/neu amplification was found in 20% of the tumors (n = 5). The oncogene product p185 was detected at the basement membrane in 38% of the tumors (n = 22). Amplification and p185 overexpression occurred in intestinal, but not diffuse type carcinomas (p < 0.001). p185 expression was independent from tumor site and tumor stage, but correlated with pT-stage (p < 0.001). Overall prognosis was influenced by tumor stage and R-classification, but not by p185 expression. Multivariate analysis, however, defined patients with stage IIIA/B and IV and R0-resection who had a poorer survival in case of p185 expression (p < 0.05). Her2/neu amplification and p185 overexpression appear to be characteristic molecular events in intestinal type gastric carcinogenesis and may help in identifying a subgroup of patients at increased risk for shorter survival.

Adult↗

Spontaneous proliferation of peripheral blood lymphocytes as an indicator of intragraft immune activation in liver transplant patients.

The presence of activated lymphocytes in the blood of transplant recipients is considered to be a marker of an ongoing immune process. In this study, the clinical utility of spontaneous proliferation (SP) of peripheral blood mononuclear cells (PBMC) as a marker of in vivo activation was evaluated by in vitro [3H]thymidine incorporation in 22 patients in the 1st month after liver transplantation. Also immune activation in the graft was monitored by transplant aspiration cytology (TAC-A). In the study period, there were only 2 mild episodes of clinical acute rejection, where SP of PBMC was 1290 and 1541 cpm (vs. 99 cpm averaged in healthy controls). Though SP of PBMC was also increased in systemic infections, a significant positive correlation was observed between SP of PBMC and TAC-A score. In all episodes where TAC-A score was elevated to above 2, SP of PBMC was simultaneously increased to more than 1000 cpm. In 8 patients prophylactically treated with the anti-interleukin-2-receptor antibody, BT563, SP of PBMC was significantly lower compared to 7 patients treated with antithymocyte globulin. It is suggested that SP can be a reliable parameter of the in vivo activation of lymphocytes, which accompanies immune activation in liver graft, and is potentially useful as a sensitive, although rather non-specific, and non-invasive monitoring of intragraft alloresponse.

Adult↗

The Budd-Chiari syndrome: clinical presentation and diagnostic findings in 45 patients treated by surgery.

We report on the clinical presentation and diagnostic findings in 45 patients with Budd-Chiari syndrome. The diagnosis was confirmed by histology at the time of liver transplantation (n = 37) or shunt surgery (n = 8). An underlying disorder could be established only in half of the patients, oral contraceptives as predisposing factor were known in 18 cases. Clinically, abdominal pain and distension as well as hepatomegaly and ascites were most frequent findings, whereas changes in laboratory data were more or less unspecific. By use of repeated ultrasound, a definite diagnosis of a Budd-Chiari syndrome could be confirmed in all cases by obligatory demonstration of obstruction or thrombosis of at least one major liver vein. Hepatic venography revealed only one false-negative result. Celio-mesenteric arteriography plus portography, cavography and preoperative liver biopsy did not present additional diagnostic information. These techniques may contribute to treatment planning of portosystemic shunt surgery or hepatic transplantation. In conclusion, the presence of hepatosplenomegaly, ascites, abdominal pain and distension, especially in combination with a known hypercoagulable state, should alert to the possibility of a Budd-Chiari syndrome. Ultrasound is the diagnostic tool of choice. Hepatic venography should only be performed if even repeated ultrasound is not conclusive.

Adolescent↗

[Analysis of liver hemodynamics in severe ischemia and reperfusion injury after liver transplantation].

AIM: The pathogenesis of the ischemia-/reperfusion injury after liver transplantation is not fully understood. The purpose of this study was to analyse blood flow and vascular resistance of the hepatic artery and the portal vein after long ischemic time. METHODS: A model of orthotopic liver transplantation in pigs was used. Two groups with different cold ischemic times (CIT) were formed: group A: short ischemic time (4-6 hrs CIT), 7 transplantations/group B: long ischemic time (20-24 hrs CIT), 7 transplantations. The blood flow was measured by means of electromagnetic technique. The intravascular pressure was determined in the aorta, portal vein and hepatic vein after direct punction or by inserted catheters. RESULTS: After short ischemic time and 1 hour of reperfusion a decrease of the arterial and portal venous resistance was observed, while the total hepatic blood flow remained constant. Six hours after reperfusion the arterial and portal venous vascular resistance increased and reached almost values of the donor animal. However, marked changes of hemodynamic parameters were found after long ischemic time, especially in the portal venous vascular system. The vascular resistance of the portal vein was significantly elevated and reached values ten-times higher than during the donor operation. CONCLUSION: The decrease of the vascular resistance during the early reperfusion period was surprising because of the well-known results of histological studies and analysis of the microcirculation. The cause remained unknown, but an increased perfusion via intrahepatic shunts or denervation of the transplant may be responsible for this observation. The elevated portal venous resistance after severe ischemic damage most likely reflected the increase of interstitial pressure. In the clinic monitoring of the portal venous vascular system by means of doppler-sonography may be an useful adjunct in the diagnosis of early postoperative transplant-dysfunction.

Animals↗

[Surgical therapy of stomach cancer--indications for splenectomy in gastrectomy].

The indication for (obligatory) splenectomy in case of total gastrectomy for gastric carcinoma remains controversial. Overall, an increase of morbidity, but not of postoperative mortality following splenectomy is assumed. Among the prognostic parameters, splenectomy is not an independent indicator. The indication for splenectomy results from the depth of tumor infiltration, tumor site and pattern of lymph node metastases. In T1/2 lesions of the mid-stomach and of the antrum the spleen may be preserved, but splenectomy should be performed in all advanced tumors, carcinomas of proximal sites and infiltration of the spleen. Surgical radicality may be further increased by simultaneous left pancreatic or left upper quadrant resection.

Gastrectomy↗

Treatment of portal vein thrombosis by thrombectomy and regional thrombolysis.

BACKGROUND: Portal vein thrombosis is a rare disorder. The prognosis of both the acute and the chronic forms is determined by the resulting acute or chronic portal hypertension. The therapeutic approach of choice is controversial. METHODS: A case of etiologically unclear thrombosis of the portal vein system in a young man is reported, which was treated successfully by means of portal vein thrombectomy combined with intraoperative and postoperative thrombolysis with recombinant tissue plasminogen activator (rTPA). RESULTS: Initial thrombectomy established sufficient venous return. However, rethrombosis of the portal vein occurred 2 days later. In a second operation rethrombectomy was followed by intraoperative regional application of rTPA, which was continued after operation during a period of 48 hours through a catheter inserted in a mesenteric vein. Patency of the portal system was confirmed 1 week after the procedure. The 1-year follow-up reconfirmed this result (through indirect portography and Doppler sonography). The patient received the anticoagulant phenprocoumon. CONCLUSIONS: The combination of surgical thrombectomy and regional thrombolysis with rTPA could offer a feasible therapeutic option for selected patients with acute prehepatic portal vein thrombosis.

Acute Disease↗

Vascular complications in adult patients after orthotopic liver transplantation: role of color duplex sonography in the diagnosis and management of vascular complications.

Vascular complications after orthotopic liver transplantation are one of the most serious problems in liver-grafted patients, and if undetected they may result in graft failure and death unless prompt revascularization or retransplantation is performed. As the outcome of treatment of vascular complications depends on an early diagnosis, the role of color-coded duplex sonography (CCD) for diagnosis and treatment was analyzed during a 17-month observation period. Altogether, 88 consecutive liver allografts in 77 adult patients were studied by serial CCD. Vascular complications occurred with an incidence of 12.9%. Hepatic artery complications represented the most frequent event with an incidence of 11.6%. CCD showed a sensitivity of 100%, a specificity of 97% and a positive predictive value of 0.84. With the use of CCD, vasculature and localization of the site of arterial complications can be directly visualized and the various types of complications can be differentiated, thus reducing the time needed for diagnosis. Early hepatic artery complications, occurring during the first 3 days after transplantation, which were immediately diagnosed by CCD examination and rapidly treated by revascularization had a good clinical outcome. In contrast, the outcome of vascular complications requiring retransplantation was found to be poor. As radiologic intervention offers an alternative to the treatment strategy of vascular complications in liver-grafted patients, CCD is the method of choice to noninvasively monitor the initial and follow-up examinations after intervention.

Adolescent↗

A new procedure for abdominal wound closure after pediatric liver transplantation: the "sandwich" technique.

Primary wound closure cannot always be achieved after pediatric liver transplantation (LTx). This may be due to lack of intraabdominal space from postanhepatic small bowel edema or oversized grafts despite partial LTx. For those instances we developed the "sandwich" technique. This procedure incorporates advantages of previous techniques with some additional advantages described herein. Use of polyglactin 910/silicone meshs in a sandwich fashion allows for one-stage permanent abdominal closure without major loss of body plasma fluids after pediatric LTx. So far our clinical experience with this technique has been very satisfying.

Abdomen↗