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Biomedical subjects

R Pichlmayr

Publications and source records attributed to R Pichlmayr.

At least 343 records · Page 19Linked to original sources
PubMed1990

Experience with partial liver transplantation in Hannover.

Within a 7-year period 37 PLTx have been performed in 32 patients (25 children, 7 adults). Age at the time of operation was 5 years in two-thirds of all cases (23 of 37). Indications were elective in 17 patients and urgent in 20. The following types of PLTx were used: a LLL in 24 cases, a LL in 9, and a RL in 4. Three donor livers were split and transplanted into 2 recipients each. The body weight ratio between donors and recipients ranged from 0.9:1 to 12.3:1. Nineteen of 26 adult-donor livers were transplanted into pediatric recipients. Patient and graft survival following elective PLTx at 2 years was 69.7% and 50.5%, respectively, which was not significantly different from the results following urgent transplantation. Overall, 30-day mortality was 18.8% (6 of 32 patients) and was relative to the patients' clinical status at the time of transplantation. Graft loss in 29.7% (11 of 37 transplants) was due to liver-related causes such as chronic rejection (n = 5) and primary nonfunction (n = 4). Postoperative surgical complications were noted in 13 cases but were not different from those seen with WLTx. At present, 19 of 32 recipients (59.4%) are alive between 1 and 43 months following transplantation.

Adolescent↗
PubMed1990

Cyclosporine monitoring in liver allograft recipients: two distinct patterns of blood level derangement associated with nephrotoxicity.

The parallel measurement of specific and nonspecific CyA levels by second generation radioimmunoassays based on monoclonal antibodies proved to be an effective procedure to monitor both parent CyA levels and the capacity to eliminate its metabolite. Using this monitoring procedure it could be shown that CyA-associated nephrotoxicity in the early course after liver transplantation is associated with two distinct patterns of blood level derangement. One pattern is characterized by increased parent drug levels, the other by an increased metabolite concentration resulting from severely disturbed CyA metabolite excretion. This raises the possibility that not only the parent drug but also some of its metabolites may exert nephrotoxic effects when present in excessively high concentrations. This finding provided the rationale for a therapeutic CyA-monitoring regimen taking into account both specific and nonspecific measurements. In liver transplant patients monitored according to this regimen and treated with quadruple immunosuppression the incidence and severity of CyA-associated nephrotoxicity was markedly reduced. The metabolite-associated type of nephrotoxicity was only found in patients with severely disturbed liver function.

Creatinine↗
PubMed1990

Budd-Chiari syndrome: portacaval shunt and subsequent liver transplantation.

The Budd-Chiari syndrome (BCS) is caused by hepatic venous outflow obstruction, which often leads to death as a result of portal hypertension and liver failure. Therapeutic approaches vary widely from conventional medical therapy to liver transplantation. If and when a patient suffering with BCS needs surgery remains a matter of contention. However, it is well accepted that portacaval shunt surgery and orthotopic liver transplantation represent efficient surgical treatments of this condition. We report on a patient with an eventful course after BCS was diagnosed. After portacaval shunt surgery the patient had acute liver failure and had a successful orthotopic liver transplantation.

Adult↗
PubMed1990

[Liver resection in 157 patients with colorectal metastases].

The mean life expectancy for patients with hepatic metastases from colorectal carcinoma is poor. Removal of those tumors leads to an improvement of this situation. In 157 patients with colorectal metastases liver resection was performed. The overall 5-year survival rate was 23% with a median of 34.9 months. Significant prognostic factors for survival were size, and distribution of metastases, percent hepatic replacement by tumor, and radicality of operation. These results emphasize again that in selected patients with colorectal liver metastases resectional therapy is in principle indicated. Especially in the light of lacking therapeutical alternatives this offers presently the only chance for longterm cure or at least significant palliation.

Adult↗
PubMed1990

[Ex situ surgery of the liver--anesthesiologic management].

In a 40-year old patient multiple liver tumours that were otherwise regarded as irresectable were removed in an ex situ operation--according to the authors' knowledge for the first time in a human. After protective perfusion with a hypothermic HTK solution hepatectomy was performed. After extirpation of the tumours ex situ, the residual liver was re-implanted. The total operation time was 13 h 50 min, the anhepatic period lasted for 6 h 9 min. During the anhepatic period a venous bypass shunted the blood from the a femoral and the portal vein to an axillary vein. Considerable blood loss was balanced by the transfusion of 26 units of banked blood. Severe disturbances of blood coagulation could be avoided by early substitution with fresh frozen plasma, platelets and fresh blood. The long anhepatic phase caused an acidosis that required the application of 330 mVal NaHCC3. In the discussion the necessity for an aggressive intraoperative monitoring of haemodynamic and laboratory parameters is emphasized.

Adult↗
PubMed1990

Nutritional consequences of total gastrectomy: the relationship between mode of reconstruction, postprandial symptoms, and body composition.

Body composition, postprandial symptoms, and social performance were assessed in 41 patients who were free of tumors 16 to 63 months (median, 41 months) after total gastrectomy with Roux-en-Y esophagojejunostomy (n = 15) or jejunal interposition (n = 26). There were no significant differences with respect to age, sex, initial tumor stage, interval since operation, and premorbid weight/height2 (body mass index). The lowest postoperative body mass index (BMI) was 72% +/- 3% of the preillness BMI in patients with Roux-en-Y reconstruction and 79% +/- 2% in patients with jejunal interposition (p less than 0.05). At the time of the study the relative BMI was 88% +/- 2% of the preillness BMI in patients with jejunal interposition but only 81% +/- 3% in patients with the Roux-en-Y reconstruction (p less than 0.01). Muscle mass and lean body mass estimated from anthropometric and bioelectric impedance measurements were correlated with sex (p = 0.0001) and with the mode of reconstruction (p = 0.02) independently, which was confirmed by multiple linear regression. The postprandial symptoms were not significantly associated with changes in body composition except for an inverse relationship between Sigstad's dumping score and the extracellular mass/body cell mass ratio (r = 0.553; p = 0.0002). Of the patients under 60 years of age, 10 of 15 patients with jejunal interposition and two of eight patients with Roux-en-Y reconstruction were back at work (p = 0.057). The persons who had resumed their work had a significantly higher relative BMI (90% +/- 2% vs 82% +/- 3%), lean body mass (53 +/- 3 kg vs 46 +/- 3 kg), and muscle mass (25 +/- 2 kg vs 21 +/- 1 kg) than persons in early retirement. We concluded that preserving the duodenal transit should be a main objective of gastric replacement after total gastrectomy.

Anastomosis, Roux-en-Y↗
PubMed1989

Unusually rapid development of a HBsAG-positive liver cirrhosis after liver transplantation.

We report the case of a 44-year-old man who was transplanted in 1986 for hepatocellular carcinoma in a HBsAG-positive liver cirrhosis. The patient had no severe complications postoperatively. He received passive immunization for the prevention of hepatitis B reinfection during the first 6 months after liver grafting. Twelve months after the transplantation the new liver was reinfected with hepatitis B virus. Without any clinical or laboratory signs of severe hepatitis, the patient developed a histologically proven complete liver cirrhosis within 8 months after reinfection of the graft. The reasons for this might have been, first, a deleterious course of the infection under immunosuppressive therapy, and, second, the additional influence of a postoperatively acquired CMV infection or the combined toxic influence of cyclosporin A and its metabolites on the acute inflammation in the liver.

Adult↗
PubMed1989

Lignocaine metabolite formation as a measure of pre-transplant liver function.

A method for rapid assessment of hepatic function in liver donors based on the formation of the lignocaine metabolite monoethylglycinexylidide (MEGX), was used in a prospective study of 69 donor-recipient pairs. The probability of graft survival over 120 days was significantly higher for livers from donors with MEGX test values above 90 micrograms/l than for those from donors with MEGX values of 90 micrograms/l or below. Other liver function tests (bilirubin, prothrombin time, activity of aminotransferases, glutamate dehydrogenase, and cholinesterase, indocyanine green clearance, and galactose elimination capacity) were inefficient at predicting early outcome of transplantation. For a 20-day graft survival, the MEGX test showed prognostic sensitivity of 73% and specificity of 78%. These findings suggest that the MEGX formation test could be valuable for selection of donor organs.

Adolescent↗
PubMed1989

"Conservative" treatment of intra-abdominal complications after total gastrectomy with interventional radiological techniques.

Septic complications following total gastrectomy usually require relaparotomy, which is associated with a high operative mortality. Due to the improvement of percutaneous drainage of abdominal abscesses we prefer this therapy for septic complications after total gastrectomy. Among 141 total gastrectomies, 14 patients developed subphrenic abscesses. While 2 patients required relaparotomy, 12 had interventional therapy by sonographically guided drainage and insertion of a pigtail catheter. The catheters were irrigated daily, and the patients received systemic antibiotics. Complete resolution of the abscess cavity was achieved, even in 1 case with simultaneous duodenal stump insufficiency without increasing morbidity. The hospital stay was prolonged for an average of 20 days by this "conservative" treatment. The management of septic complications following total gastrectomy with interventional techniques may reduce the number of operative reinterventions. The indication for such a therapy, however, needs to be evaluated on an individual basis.

Anti-Bacterial Agents↗