Search PubMed⌕ Search

Biomedical subjects

X Rogiers

Publications and source records attributed to X Rogiers.

At least 91 records · Page 5Linked to original sources
PubMed1998

Vertebral osteomyelitis due to Rhodococcus equi in a liver transplant recipient.

Rhodococcus equi is a rare but well-documented cause of cavitary pneumonia in immunocompromised patients. In this report the first case of R. equi infection manifesting as vertebral osteomyelitis is described. A 39-year-old liver transplant recipient presented with recurrent pneumonia and a pleura-based lung abscess and subsequently developed osteomyelitis of the lower thoracic spine. Surgical debridement and prolonged treatment with rifabutin and clarithromycin resulted in clinical cure. In the literature, 12 other cases of R. equi infection in solid-organ transplant recipients have been reported. Ten of these patients had documented pulmonary disease and seven had extrapulmonary manifestations. Prolonged antibiotic therapy and surgical drainage resulted in clinical improvement in > 90% of the reported cases.

Actinomycetales Infections↗
PubMed1998

Carbohydrate-deficient transferrin: diagnostic efficiency among patients with end-stage liver disease before and after liver transplantation.

We tested the diagnostic validity of carbohydrate-deficient transferrin (CDT) as an indicator for relapse into elevated alcohol consumption among patients who were examined under follow-up treatment before (n = 147) and after (n = 102) orthotopic liver transplantation (OLT) in the outpatient-department of the University Hospital Department of Surgery in Hamburg-Eppendorf. CDT measurements were performed with two commercial kits in parallel (CDTect-RIA and CDT%-RIA). Short-term parameters of alcohol consumption (ethanol, methanol) indicated relapses into elevated alcohol consumption in 11.4% of the evaluated patients with alcoholic liver disease (ALD) before transplantation. Before OLT, median CDT values were determined to be elevated among patients with alcoholic as well as nonalcoholic end-stage liver diseases (NALD). Among patients with ALD, we found elevated CDT medians even in those who were successfully scheduled for OLT after long-term evidence of abstinence proved by biochemical short-term parameters and psychological tests. Both CDTect and CDT% assays had comparable low specificities in selected patient groups before transplantation. CDT% and CDTect were negatively correlated with the albumin level. Before the study ended, CDT was no longer implemented in the evaluation of whether an OLT should be administered. This was due to inconsistent results of CDT in ALD as well as NALD. After OLT, patients with ALD, as well as NALD, had statistically significant lower CDT medians than before OLT, which ranged within reference levels. We determined, according to CDT, elevated alcohol consumption subsequent to OLT in 4 of 13 patients with ALD who underwent transplantation during the study (median observation period: 10 months). CDT does not appear to be useful in evaluating patients before OLT. With regained specificity and high sensitivity in patients after OLT, CDT could be recommended as a standard instrument for quality control in patients with ALD after liver transplantation.

Adult↗
PubMed1998

[Differences in properties of interstitial procedures and their effect on clinical applications].

The effects of percutaneous ethanol injection (PEI) and cryosurgery (CS) on normal liver tissue are investigated in a mini-pig model. It was not possible to create a circumscribed, reproducible necrosis by PEI; there was a high incidence of thromboembolic complications. Due to the discrepancy between the temperatures necessary to induce freezing and to induce total cell destruction, the necroses were smaller than the ice balls induced by CS and contained vital cells in their periphery. In conclusion, PEI should not be used when ethanol spreading into normal parenchyma has to be assumed, and the difference in size between ice ball and complete necrosis has to be considered in tumor treatment by CS.

Animals↗
PubMed1997

[Surgical therapy of primary and secondary liver tumors].

Advances in operative, diagnostic and post-operative care technique have rendered liver resections safe. Consecutively, indications for operative interventions in primary and secondary liver tumors have changed. A current state of the art is presented. Focal nodular hyperplasia, if found incidentally during laparotomy, should be removed en-passant. Large or central lesions should be biopsied and can be observed if they remain asymptomatic and stable in size. Symptomatic or growing FNH should be removed. If the diagnosis is evasive resection should be favored. Most patients with hepatocellular adenoma are symptomatic and the lesion should therefore be removed. Hemangiomas are rarely causing symptoms. In case they truly are, or if they cause complications they should be excised. Anatomical resections for hepatocellular carcinoma are only feasible in non-cirrhotic livers or in patients with cirrhosis and compensated liver function. Other patients are candidates for liver transplantation if the cancer is stage I or II. Stage III and IVa lesions are subject of current studies. Surgical resection remains the only potentially curative treatment for intrahepatic cholangiocellular carcinoma. Because of their dismal prognosis these patients are not candidates for transplantation. Resection continues to be the most effective therapy for colorectal metastases to the liver. Patients with non-colorectal, non-neuroendocrine metastases are usually only candidates for surgical palliation. Cure can be achieved in patients with renal cell carcinoma or Wilms' tumor. Additionally, neuroendocrine metastases to the liver can be resected in curative intent if extrahepatic disease was excluded. In the few symptomatic patients in whom extrahepatic disease was excluded, symptomatic treatment has failed, and the lesions are not resectable, liver transplantation can provide a reasonable therapeutic choice.

Carcinoma, Hepatocellular↗
PubMed1997

Hilar traumatic neuroma after liver transplantation.

We report our first case of symptomatic traumatic neuroma in the liver hilum after orthotopic liver transplantation. Compression of the hepatic artery caused extraluminal obstruction and resulted in perfusion damage to the graft. Moreover, intimal hyperplasia of the hepatic artery was present. Retransplantation was necessary because the hepatic artery was not salvageable. Potential pathophysiological mechanisms for these findings are discussed.

Adult↗
PubMed1997

Hepatitis B virus sequence changes evolving in liver transplant recipients with fulminant hepatitis.

BACKGROUND/AIMS: Patients undergoing liver transplantation for hepatitis B virus (HBV) related liver cirrhosis are at major risk of developing HBV recurrence, and occasionally fulminant hepatitis. Here we tested in a longitudinal study whether specific viral variants are associated with fulminant HBV infection in the graft. METHODS: The complete HBV genomes isolated from the sera of three patients with HBV and HBV and hepatitis delta virus (HDV) coinfection during chronic infection before and during fulminant reinfection after transplantation were amplified and directly sequenced. RESULTS: Twenty, 25 and 19 mutations, distributed over the entire genome, were identified which differed between the HBV genomes isolated from each patient during chronic and fulminant infection, respectively. This reflects a much higher rate of nucleotide sequence changes than expected from the natural variation of HBV. No common HBV mutation emerged in any of the three cases during fulminant infection. However, precore defective viruses were found to be present in all three patients at the time of fulminant infection and in two of the patients before fulminant infection. Two of the patients had preS2-defective HBVs both before and after transplantation. A point mutation in the 'a'-determinant of the surface protein emerged in one case after transplantation under treatment with polyclonal HBV specific immunoglobulins. CONCLUSIONS: Many new, but no specific common mutations emerged during fulminant HBV reinfection. Although HBeAg defective variants were found in all cases studied, the presence of these variants also during chronic infection in two cases demonstrates that they are not sufficient to cause fulminant hepatitis. Thus, other factors than the emergence of a specific viral strain seem to contribute to the development of fulminant reinfection in a liver graft.

Adult↗
PubMed1997

[The significance of the arterial vascular supply of segment IV in living liver donation].

PURPOSE: Postoperative CT's in living liver donors were analysed retrospectively to examine whether atrophies of segment IV occur after procurement depending on arterial vascular supply. PATIENTS AND METHODS: Postoperative CT's from 19 living donors were retrospectively analysed. DSA of the upper abdomen had been performed on all donors prior to donation. RESULTS: The pre-operative DSA images demonstrated an arterial vascular supply of segment IV from the right hepatic artery in 10/19 cases, from the left hepatic artery in 7/19 cases and from both, left and right hepatic artery, in 2/19 cases. Atrophies were seen in 3/7 patients in which segment IV was perfused via left hepatic artery, in further two patients with perfusion from the right hepatic artery or from both sides respectively. Clinically only one patient presented with an abscess. CONCLUSIONS: The patterns of vascular supply to segment IV seen in our patients differ from those published by Couinaud. Since only 3/7 patients with an arterial supply from the left hepatic artery developed a segmental atrophy, we conclude that there must be additional, radiologically not identifiable portal venous branches or collaterals from the right portal vein that maintain perfusion of segment IV.

Adult↗
PubMed1997

Liver splitting and living donor techniques.

Split liver transplantation (SLT) and living related transplantation (LRT) have been developed following advancements in liver surgery. In experienced hands they can yield results comparable to full organ liver transplantation. They are today a reality which has to be implemented and used more widely. LRT is the best procedure available and should be the method of choice despite the high success of SLT. Any method safely enlarging the pool of donors has to be utilized, especially in view of the possible future application for adults. The procedures should be initially performed and tested in centres specialized in liver transplantation and liver surgery, with the aim of making the techniques more widely available in the future. High ethical standards are required to perform LRT. In the short term, SLT and LRT are the methods more apt to increase the organ pool and thus decrease pre-transplant mortality both in children and adults.

Adult↗
PubMed1997

The Hamburg liver transplant program.

The program of the University of Hamburg is exemplary of the problems faced by programs with rapid growth. Establishing expertise at all levels is essential to shorten the inevitable learning curve. The combination of an adult and a pediatric program was an ideal environment for the development of living donation and cadaveric in-situ split liver transplantation as complimentary solutions to eliminate pediatric mortality on the waiting list without affecting the chances of adult liver transplant candidates.

Adolescent↗
PubMed1996

One year of experience with extended application and modified techniques of split liver transplantation.

As organ donation rates decreased in Europe, the authors started a systematic approach of liver splitting in their center in 1994. During this 1-year experience, 73 cadaveric liver transplantations were performed in 66 patients. Sixteen of these transplantations were the result of split-liver transplantation (21.9% of grafts, 24.2% of patients). Patient and graft survival rates at 3 months were 81.2% and 75%, compared with 89.1% and 76.9 % for whole organs. Two modified techniques were developed, based on the technique of living related liver procurement, and applied in 10 cases. With these new techniques, patient and graft survival rates were 90% and 90%. This systematic approach allowed the total number of transplantations in our program to be maintained, despite the decrease in organ availability.

Graft Survival↗
PubMed1996

[Selection of live donors for segmental liver transplantation in children].

OBJECTIVE: To analyse selection criteria and complications in living related donors of liver segments with a view to introducing standardised guidelines for the selection of such donors. PATIENTS AND METHODS: Forty-two mothers and 31 fathers (median age 31 [19-50] years) were tested between October 1991 and July 1994 for their suitability as donors of a liver segment. RESULTS: 24 of the potential donors (33%) were found not to be suitable. Reasons for this were: poor immunological match of the donor liver as transplant (13), risk factors for thromboembolism (5), and psychological or socioeconomic factors (6). 35 live related donor liver segment transplantations were performed, 34 of the left lateral liver segment, and one of the left liver lobe. The average duration of the operation was 4.5 (3.0-6.0) hours. No foreign blood transfusions were needed. There was one death from pulmonary emboli, and various complications: cerebral seizure (1), gallbladder leak (1), incisional hernia (2) and duodenal ulcer (2). CONCLUSION: Risk of thromboembolism as well as psychological and social factors are the most important exclusion criteria in the selection of donors for live liver segment transplantation.

Adolescent↗
PubMed1996

Auxiliary liver transplantation: regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure--a multicenter European study.

Auxiliary liver transplantation (LT) is a special procedure of LT which could be proposed to patients with fulminant hepatic failure (FHF) and has for aim that complete regeneration of the native liver (NL) left in place will allow the graft recipient to resume normal liver function after allograft withdrawal. We report 30 cases of auxiliary LT performed for FHF in 12 European centers. Twenty-five of 30 patients were younger than 50 years. The cause of FHF was hepatitis A virus (HAV) in 4 patients, hepatitis B virus (HBV) in 7, paracetamol overdose in 5, ecstasy in 2, hepatotoxic drugs in 4, autoimmune hepatitis in 2, liver lesions of preeclampsia in 1 and unknown in 5. A postoperative, both clinical and histological follow-up of more than 3 weeks was obtained in 22 patients, enabling us to look for indicators predictive of NL regeneration and outcome. Histological changes observed in the NL included complete regeneration in 68%, incomplete regeneration with obvious fibrous sequelae in 14% and severe liver fibrosis or cirrhosis in 18%, of the 22 patients studied. The percentage and distribution of necrosis observed in tissue samples of the NL at the time of transplantation was not related to the final outcome. Complete NL regeneration was observed in 15 patients, out of whom 14 were younger than 40 years. Patients with complete regeneration were mainly affected by FHF due to HAV, HBV, or paracetamol overdose. After a follow-up of 18/11 (mean/median) months (range, 3 to 67 months), 19 of the 30 patients (63%) survived and 13 of them (68%), i.e., 43% of the 30 patients, had resumed normal NL function, with interrupted immunosuppression, the ultimate goal of emergency auxiliary LT. We conclude that, in patients with FHF, auxiliary LT is a procedure feasible in a number of centers and is associated with a complete regeneration capability of the NL in a majority of survivors, especially in those younger than 40 years. Confirmation of these encouraging preliminary results by large-scale prospective studies is required.

Adolescent↗