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Biomedical subjects

R Pichlmayr

Publications and source records attributed to R Pichlmayr.

At least 145 records · Page 8Linked to original sources

[Living related kidney transplantation in children younger than 5 years of age--intraperitoneal or extraperitoneal surgical procedure?].

The extraperitoneal approach and positioning of the vascular anastomoses, invariably to the distal aorta and inferior caval vein has been shown to represent a technically feasible, safe, and successful procedure for transplanting adult renal grafts to children under 5 years of age weighing less than 10 kg. Since it offers additional advantages compared to the transperitoneal approach we recommend the extraperitoneal approach in the pediatric living-related renal transplantation setting as the standard procedure.

Adult↗

[Liver transplantation in patients with primary sclerosing cholangitis. Determining timing with reference to risk of malignancy].

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease associated with hepatobiliary malignancies which are in the majority of cases not known prior to transplantation. Applying the Mayo PSC natural history model, patients can be classified in low, medium and high risk groups; particularly patients at medium and high risk are in danger of developing malignancies in a PSC setting. Therefore, regular scoring of patients using the above-mentioned model is suggested, and transplantation should be performed at scores above 4.

Adult↗

[Is liver transplantation as surgical therapy concept in metastases of neuroendocrine tumors justified?].

Between 1982 and February 1996 11 patients underwent liver transplantation for irresectable neuroendocrine hepatic metastases. The operative mortality was one of 11, while two patients died due to sepsis respectively tumor recurrence 7 and 68 months after transplantation. Eight patients are alive with a median survival of 55 months (range from 10 days to 8.5 years). In three patients there is no evidence of tumor and the longest disease-free survival is 102 months after LTx. These results suggest that liver transplantation represents a justified treatment for irresectable hepatic metastases arising from neuroendocrine tumors.

Adolescent↗

[Geriatric surgery in stomach carcinoma--resection as therapy of choice].

Due to improved perioperative management resection of gastric carcinoma in elderly patients is the treatment of choice. Although these patients often have age-related cardiovascular and pulmonary morbidity, postoperative morbidity and mortality even after extensive resections is low. The survival data are absolutely comparable to younger patients, and the prognosis is best after R0-resection which, therefore, should be the goal of surgery for gastric carcinoma in aged patients.

Aged↗

[Liver transplantation in elderly patients: indications, risks and results].

This study analyzes the course of 62 patients aged over 60 years (i.e., 7% of all recipients) which were liver transplanted over the last 10 years. The data show that the results of transplantation in patients with malignant tumors (n = 25) are unfavorable (20% 5-year survival), while good results could be obtained in patients with benign indications (n = 37), including mainly posthepatitic cirrhosis, but also three fulminant liver failures (75% 5-year survival). Causes of death were mainly septic complications in the early phase and tumor recurrence in patients with malignant disease.

Actuarial Analysis↗

[Adjuvant and neoadjuvant methods: what is their value--do they change surgical procedure?].

Despite advances in surgical treatment for gastrointestinal tumors, in general, improvements in prognosis could not be achieved; therefore other therapeutical options were evaluated in a multimodal concept. Stage III or II/III disease of colorectal cancer appears to benefit from adjuvant chemo/radiotherapy by reduced relapse and mortality rates. After application of preoperative therapy for locally advanced tumors of the upper gastrointestinal tract and rectum tumor debulking and better local tumor control was achieved resulting in an increased curative resection and survival rate. Surgical procedures and the extent of resection should not be modified in multimodal treatment: the aim must be a complete tumor (R0)-resection.

Chemotherapy, Adjuvant↗

Backgrounds of early intragraft immune activation and rejection in liver transplant recipients. Impact of graft reperfusion quality.

In solid organ transplantation, acute rejections are most frequent during the first weeks. The aim of this study was to investigate the relationship between graft reperfusion injury and later immune responses against the graft. Intragraft immune activation was routinely monitored by transplant aspiration cytology in 47 recipients of hepatic allografts. As a parameter of reperfusion quality, oxygen saturation of hemoglobin (SO2) in hepatic tissue was determined intraoperatively by a near-infrared spectroscopy. Grafts that presented aspiration cytology scores of 2 or more (i.e., more than 10% of lymphocytes activated) at 1 week after operation (group I, n = 14) were associated with a higher heterogeneity of hepatic tissue SO2 at the end of operation (coefficient of variation in 12 points 18.3 +/- 18.3%, mean +/- SD) than grafts with no or very mild intragraft immune activation (group II, n = 33, 9.2 +/- 4.2%; P < 0.01). Group I was also accompanied by higher postoperative peak glutamic oxalacetic transaminase level (corrected by graft size, P < 0.05) and higher donor age (43.9 +/- 12.9 vs. 32.6 +/- 13.9 years, P < 0.02). Heterogenous reperfusion (P < 0.01), higher peak glutamic oxalacetic transaminase level (P < 0.01), and higher donor age (P < 0.05) were also associated with clinical rejection at 1 week (n = 10), but not with later-onset rejection (n = 11). These data suggest that intragraft immune activation and clinical rejection in the early phase after hepatic engraftment are strongly influenced by graft injury, which can be recognized early after reperfusion.

Adult↗

Ultrastructural and functional differentiation of hepatocytes under long-term culture conditions.

BACKGROUND: Studies on hepatocytes grown in different culture systems have shown that these cells rapidly dedifferentiate on a single support with liquid medium on top (single gel technique). However, in systems sandwiching them between two layers of extracellular matrix (double gel technique), the cells are able to regain and maintain typical light microscopical appearance and function. Their ultrastructural morphology is as yet unknown. METHODS: Isolated, adult rat hepatocytes were grown in both systems, and their fine structure (thin section electron microscopy) and the functional ability of albumin production (immunoassay) were studied and compared in both culture systems after 2, 7, and 14 days. RESULTS: The hepatocytes in conventional single gel culture did not completely regain their normal morphology and rapidly underwent progressive dedifferentiation. This was characterized by loss of cell polarization in terms of obliteration of the bile canaliculi-like intercellular expansions, loss of cell membrane differentiations, and reduction of organelles. Cytoskeletal components gradually increased, building up large filamentous zones underneath the plasma membrane. In double gel culture, the hepatocytes reachieved and maintained intact morphology and polarity over at least 14 days. The bile canaliculi were formed, preserved, or even enlarged and were associated with dense peribiliary bodies and Golgi fields. The plasma membrane facing both collagen layers bore numerous cytoplasmic microprojections like the sinusoidal surfaces of the hepatocytes in situ. Cell organelles, glycogen particles, and lipid droplets were always present. CONCLUSIONS: The hepatocyte is a cell type in which ultrastructural and functional differentiation are strongly interdependent. For these cells, the morphological microenvironment (i.e. the bipolar position of the extracellular matrix) may be as important or even more decisive for maintenance of normal cell differentiation than modifications of the composition of the matrix itself or addition of other cell types, as focused in other studies.

Albumins↗

Total hepatectomy and liver transplantation: a life-saving procedure in patients with severe hepatic trauma.

Management of blunt hepatic trauma has been refined recently and now ranges from non-operative measures to the use of extensive surgical techniques. A consecutive series of eight patients was treated by total hepatectomy, either with a temporary portacaval shunt as a bridging procedure (since no donor liver was available immediately; six patients) or followed by standard liver transplantation (two). Previous operations included perihepatic packing, deep suturing, partial liver resection and hepatic artery ligation, and were attended by severe complications, namely uncontrollable bleeding (four patients) and massive liver necrosis (four). Six of the eight patients died from multiorgan failure or sepsis, and two recipients are alive 49 and 67 months after two-stage hepatectomy and transplantation. This experience demonstrates that total hepatectomy can be a life-saving procedure in exceptional emergencies in patients with potentially lethal hepatic trauma. The prognosis is dependent not only on the severity of liver injury but also on the complications of primary treatment.

Adolescent↗

Prognostic factors after resection of ampullary carcinoma: multivariate survival analysis in comparison with ductal cancer of the pancreatic head.

Resection was performed in 85 patients with ampullary and in 150 with ductal pancreatic head carcinoma. Curative resection was achieved in 98 and 87 per cent respectively. Patient survival at 5 years after exclusion of hospital deaths was 38 versus 16 per cent respectively. The patients were compared retrospectively in a multivariate survival analysis. For patients with pancreatic carcinoma, residual tumour stage, tumour size and grading were independent prognostic factors, but for those with ampullary carcinoma only tumour size was a prognostic factor. Lymph node metastasis impaired prognosis, but this effect was demonstrable for both groups only after univariate analysis. The Union Internacional Contra la Cancrum classification system was not a reliable parameter of prognosis after resection of ampullary carcinoma. Patients with ampullary cancer appear to have a better prognosis intrinsically than those with pancreatic head tumours, and not simply because they present at an earlier stage. The difference in prognosis cannot be explained sufficiently by a differential importance of the various survival variables.

Adult↗

Extramedullary erythropoiesis in human liver grafts.

Extramedullary erythropoiesis in the adult is very rare and is generally confined to situations of severe bone marrow irritation or replacement. In this study, we describe the occurrence of intrahepatic erythropoiesis in patients who have received a liver allograft and who have no evidence of bone marrow dysfunction. By routinely performed transplant aspiration cytology (TAC), marked intrahepatic erythropoiesis could be detected in 39 of 312 patients (12.5%) with liver allograft. In 19 patients, including 5 of 8 (63%) after combined liver and kidney transplantation, intrahepatic erythropoiesis occurred within the first 3 weeks after surgery. Twenty patients showed intrahepatic erythropoiesis between 3 weeks and 4 months after transplantation. Erythropoiesis was usually transient, lasting between 1 and 3 weeks. Cytologically, mature as well as immature erythroblasts of GlyA+ CD36+ CD45- phenotype could be detected in the grafts, whereas they were absent in blood; histologically, the cells could be localized to the sinusoids of the liver. There was no clear correlation of preoperative or postoperative hemoglobin levels, graft function, kidney function, and immunosuppressive medication with the presence or absence of erythropoiesis. Moreover, serum levels of erythropoietin (EPO) and stem cell factor (SCF) in patients with and without intrahepatic erythropoiesis in the early postoperative phase did not show significant differences. These findings show that intrahepatic erythropoiesis can occur transiently in human liver allografts and suggest that systemic stimuli as well as local factors may contribute to it.

Biopsy↗

[What is the role of nutrition in ulcerative colitis? A contribution to the current status of diet therapy in treatment of inflammatory bowel diseases].

Nutritional therapy for ulcerative colitis (UC) is controversial. Studies are usually designed to investigate total parenteral (TPN) or total enteral nutrition (TEN), and before these can be compared it is necessary to differentiate between the different therapeutic aims. The aims of artificial nutritional support in patients with UC are the readjustment of the nutritional status, possible remission of disease activity, and decrease in the incidence of surgical intervention or postoperative complication. Owing to the heterogeneity of the results published so far, it is still difficult to compare studies. Nevertheless, they indicate that the extent and severity of the colitis and the patient selection are of paramount importance in the implementation of nutritional therapy. Positive effects of TPN reported from non-controlled studies were not confirmed by controlled trials. Moreover, TPN was no more effective than an oral diet. Regarding remission rates or operative interventions needed, TPN had more side effects than and no defined advantages over TEN. TEN seems to be useful for certain patients. In some patients with UC, it seems to be accompanied by fewer postoperative complications. However, a definitive conclusion on the effects of TEN or TPN is not yet possible. In this context, certain fatty acids may have an important role in the treatment of UC. In prospective, randomized and controlled studies omega-3 fatty acids were found to be therapeutically useful. A reduction of the steroid doses needed is particularly important. Another therapeutic approach in distal UC is seen in the rectal administration of short chain fatty acids.

Colitis, Ulcerative↗

[Multivariate analysis of prognostic factors after resection of ductal pancreatic carcinomas].

At Hanover Medical School 466 patients were operated for ductal pancreatic cancer from 1971 to 1993. In 192 cases the pancreatic tumor could be resected, which amounts to a resection rate of 41%. These patients were subjected to uni- und multivariate factorial analysis in order to evaluate factors of significant prognostic value. Extended pancreatic resection because of vascular involvement or invasion of adjacent organs was performed in 40% (n = 77) of the cases. A curative R0 resection was possible in 85% of patients. The operative lethality dropped with time and from 1985 to 1993 was 3.5%. Patient survival at 5 years was 13.4% with a median survival time of 10.9 months. According to the univariate analysis the prognosis deteriorated with increasing tumor size and lymphatic and hematogenic metastases. There was a significant correlation between tumor stage according to the UICC and prognosis. The prognosis after resection was also significantly influenced by the residual tumor state and tumor grading. Extended pancreatic resections, however, had no significant prognostic impact. The multivariate analysis showed that only three factors were of independent significant relevance: residual tumor state, tumor size and tumor grade. The presence or absence of lymphatic and hematogenic metastases had no independent prognostic significance after resection of ductal pancreatic carcinomas.

Adult↗

Early intragraft inflammatory events of liver allografts leading to chronic rejection.

In this retrospective study, we have investigated the early intragraft inflammatory events of 12 liver allografts leading to chronic rejection. The cytological findings and clinical follow-up were analyzed in detail. Nine patients underwent at least one typical lymphoid activation of acute rejection, and three of them were treated more than once. Diagnosis of rejection was based on biopsy histology, cytology and liver dysfunction. In addition to the acute rejections, cytological analysis demonstrated in 11 of 12 grafts an unidentified lymphoid episode that differed from that of rejection. These lymphoid responses were associated with viral infections; cytomegalovirus (CMV) infection in 10 of 12 patients, hepatitis C virus (HCV) infection in 2 of 12 patients, 1 combined with CMV, and hepatitis B virus (HBV) infection in 1 patient. Graft dysfunction was still seen at the end of the follow-up. Thus, intragraft inflammation caused either by acute rejection or by viral infections may be involved in the induction of chronic rejection.

Biopsy, Needle↗

Influence of bile on cyclosporin absorption from microemulsion formulation in primary liver transplant recipients.

We analysed the absorption, after oral application, of a new galenic form of cyclosporin A (CyA-NOF) in liver-grafted patients (n = 12) during the 1st week (days 2-4) after transplantation. Pharmacokinetic profiling was performed with an open or clamped T tube in situ or with the T tube absent. The pharmacokinetic parameters of CyA-NOF were influenced by T tube clamping and bile diversion. The highest AUC, Cmax and earliest Tmax values were found in patients without a T tube in situ, indicating that absorption of CyA-NOF in patients during the early course after liver transplantation is not bile-independent. CyA-NOF, at a dose of 7.5 mg/kg, was enterally absorbed with appropriate AUC and Cmax levels. Patients receiving a starting dose of 7.5 mg/kg were successfully maintained on CyA-NOF during the subsequent clinical course.

Absorption↗