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Biomedical subjects

R Pichlmayr

Publications and source records attributed to R Pichlmayr.

At least 361 records · Page 20Linked to original sources
PubMed1989

[Liver transplantation in low portal vein flow: separation of portal vein areas with divided portal-venous and arterialized caval-venous liver perfusion. 1. Clinical case report].

A new method for the performance of a hepatic transplantation in spite of a low portal blood flow situation is described casuistically. In a 36-year-old-patient suffering from liver cirrhosis due to hepatitis B, the portal blood system of the right and left liver parts were divided, the left part was perfused with a low flow of portal blood, the right one with arterialized caval blood. The function of the transplanted liver and the early postoperative course were excellent. During the further postoperative course portal perfusion presumably diminished or stopped on the left side from three weeks and on the right side from two months postoperatively. Nevertheless the general condition of the patient improved continuously; transient elevations of transaminases may reflect the disturbance of portal perfusion. The technique of this arterialized caval blood perfusion of the portal system is presumably applicable also for situations, in which there is no portal blood flow available for perfusion of a liver graft. Thus, the absence of possibility for reconstruction of portal blood inflow or a situation with a hypoplastic portal vein may no longer be considered as a technical contraindication for liver grafting.

Adult↗
PubMed1989

Potential various appearances of hyperacute rejection in human liver transplantation.

Out of 81 liver transplantations 2 graft failures were diagnosed to be due to hyperacute rejection. In the first patient the operative procedure was difficult requiring 19 units of blood and plasma, but the graft was functioning well from the beginning until day 1-2, when rapid deterioration occurred. The cross-match was positive. The second patient received a third graft after the first graft had failed due to donor reasons and the second AB0-incompatible graft had been rejected. The third graft transplanted in an uncomplicated operation requiring only 10 units of blood and plasma failed within hours. Both incidences are thought to be a consequence of an immunological assault, consistent with hyperacute rejection. Thus two different clinical appearances could be observed: the so-called delayed type in the first patient and the more classical type in the second patient. For establishing diagnosis of hyperacute rejection two prerequisites were considered essential: 1) histological findings of necrosis and patchy deposits of immunoglobulins, namely IgG, IgM, IgA, C-3 complement component, properdine and fibrinogen, and 2) the proof of at least a short period of an initial function of the graft prior to deterioration in order to exclude primary non-function due to other causes. The low frequency of the appearance of the classical hyperacute rejection and hypothetical causes for the more frequent appearance of the delayed type are discussed.

Adult↗
PubMed1989

Special aspects of timing of liver transplantation in patients with liver cirrhosis.

The introduction of liver transplantation as a therapeutic procedure in the treatment of chronic liver disease has accelerated efforts to establish objective criteria in the evaluation of the prognosis of chronic liver disease. Evaluation of the optimum time for liver replacement involves the estimation of the spontaneous prognosis and the possible prognosis after transplantation. Because both items develop dynamically in different directions, criteria for the best time for the indication of liver transplantation are controversial; clinical deterioration of the patient seems to mark the beginning of this time even if the dynamic process of the evolution of clinical complications are taken into account. The change in biochemical parameters is more likely to define the end-point of this period when transplantation could be performed with reasonable success. The development of scores from multivariate statistical analyses has to include the aetiology of the underlying liver disease, but also the specific dynamics of the course of the disease. If these presumptions are fulfilled, the use of such scores seems to be a great step forward to the goal of objective criteria to define the optimum time for liver transplantation.

Hepatitis B↗
PubMed1989

Liver transplantation for malignant tumours.

Despite considerable overall progress in human liver transplantation the results obtained in patients with malignant tumours have not improved significantly over the past years. One of the crucial questions in the ongoing controversial discussion remains the identification of tumour patients with the most favourable prognosis. In a consecutive series of 114 patients who received hepatic transplants for various malignant tumours of the liver and biliary tract, at least some factors could be shown to play a prognostic role. Regarding the histological type of tumour, fibrolamellar carcinoma, epitheloid haemangioendothelioma, and endocrine hepatic metastases seem to have a better long-term survival, whereas cholangiocellular carcinoma and other liver metastases had the worst outcome. In patients with primary liver or proximal bile duct cancer there was a significant influence of the pathological tumour stage at the time of transplantation: significant palliation or cure was almost essentially restricted to patients with early tumour stages as compared with advanced primary tumours and extrahepatic spread where early tumour recurrence developed in all recipients. Thus, the present concept for the treatment of malignant hepatobiliary tumours should include partial as well as total hepatectomy with subsequent liver replacement. In cases of non-resectable lesions or intrahepatic tumour recurrence following previous resection, liver transplantation offers the only chance for long-term survival.

Adenoma, Bile Duct↗
PubMed1989

The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence.

The role of hepatic transplantation in patients with nonresectable liver or bile duct cancer remains a controversial issue. An analysis of 95 consecutive cases was undertaken to evaluate retrospectively the pathological tumor stage--in accordance with the TNM system--and outcome after transplantation. Included were patients with the following diagnoses: hepatocellular carcinoma (n = 52), cholangiocellular carcinoma (n = 10), hepatoblastoma (n = 2), hemangiosarcoma (n = 2), bile duct carcinoma (n = 20), and liver metastases from different primary tumors (n = 9). The overall actuarial survival rate at 5 years was 20.4%. Median survival improved significantly within the last 4 years as compared to the preceding era (18.06 vs. 4.0 months). Currently 27 patients are alive, with the longest follow-up more than 12 years. The incidences of residual or recurrent tumor were 27 and 28, respectively. Particularly in patients who underwent transplantation for hepatocellular or bile duct carcinoma without extra-hepatic tumor spread, the results were significantly better; median survival time achieved for these two groups were 120 (p less than 0.01) and 35 months (p less than 0.05). Prolonged survival without tumor recurrence was not seen in patients with cholangiocellular carcinoma or liver metastases. These results demonstrate clearly that liver transplantation for hepatobiliary malignancy is still justified on the premises of careful patient selection by adequate tumor staging.

Actuarial Analysis↗
PubMed1989

Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy.

Emptying of the gastric substitute and small bowel transit time of a 99mTc-labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study.

Anastomosis, Roux-en-Y↗
PubMed1989

[The European liver surgery topic--recent developments in liver surgery (in situ protection and ex situ operation)].

Ex situ operations on the liver, a new surgical approach, and operations on a vascularly isolated and in situ hypothermic-perfused liver were performed in 12 patients. The indications for either approach were limited to patients for whom a conventional approach was impossible or seemed insufficiently radical. In one case a huge symptomatic focal nodular hyperplasia in segment IV became resectable only with the ex situ-technique. Our first experience showed that preoperative cholestasis is a high-risk factor for postoperative hepatic insufficiency; three patients with marked preoperative cholestasis died. In patients with good preoperative liver function these two approaches allow a more radical liver resection and are the only possibility for tumor resection in particular situations.

Hepatectomy↗
PubMed1989

[The procedure in recurrent tumors of the liver].

From 1981 to 1988, 13 patients with liver metastasis and 7 patients with primary hepatic tumors underwent a second hepatic resection for tumor recurrence. A second resection was feasible even after an extensive first resection. Several patients experienced tumor recurrence shortly after the first resection, but lived a long time after the second resection. The actuarial survival after a second resection for colorectal metastasis was similar to that after the first resection. Therefore a second resection for tumor recurrence is reasonable and may prove especially important in individual situations.

Adenoma, Bile Duct↗
PubMed1989

[Surgery of benign liver tumors].

The most frequent benign liver tumors are hemangioma, focal nodular hyperplasia (FNH) and adenoma. It is essential for the diagnosis to differentiate these lesions from malignant tumors. While sonography, bolus-CT scan, chole-/bloodpool scintigraphy usually yield a safe diagnosis of hemangioma or FNH, adenomas do not show characteristic features. Operation is indicated for hemangioma of FNH only in case of tumor growth and/or symptoms. Operation for adenoma is as a rule indicated because of possible malignant transformation or uncertain differentiation from malignoma. Operative procedures include anatomical/atypical liver resection, ex situ resection or liver transplantation.

Adolescent↗
PubMed1989

[Progress in surgery and quality of life, quality of life after organ transplantation].

Kidney and liver transplantations are well established surgical procedures. During the past years survival rates have improved 3% of kidney transplantations have 1-year mortality. Subjective quality of life and professional rehabilitation are associated with the graft function parameters of successful therapy. Seventy-six percent of liver-transplanted patients consider their quality of life improved after the operation. 52% are able to return to work. Future efforts must focus on improving immunosuppression for specific tolerance and sensitizing the public to the problems of obtaining organs for transplantation.

Activities of Daily Living↗