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Biomedical subjects

B Ringe

Publications and source records attributed to B Ringe.

At least 199 records · Page 11Linked to original sources
PubMed1991

[Anatomic variations in the course of the left hepatic artery. A problem for systematic lymphadenectomy in gastrectomy or proximal stomach resection before stomach tube formation].

In 21 patients resected for gastric or esophageal malignancy an aberrant left hepatic artery from the left gastric artery was found. The study shows that in systematic lymphadenectomy ligation of the left gastric artery distally from the origin can safely preserve an aberrant hepatic artery without impairment of oncological quality. Related to a control group no difference in the number of resected lymph-nodes and the operation time was observed. Postoperatively there was no problem concerning liver function and surgical morbidity. In real-time sonography the aberrant artery could be postoperatively seen precisely in 19%, but duplex signal was found in 63%. Limited visualization in sonography may be caused by technical problems due to anatomy and overlying air from small-bowel reconstruction after gastrectomy.

Aged↗
PubMed1991

Management of severe hepatic trauma by two-stage total hepatectomy and subsequent liver transplantation.

Even today major hepatic trauma remains a formidable surgical challenge with considerable deaths from exsanguination. Apart from conservative operative techniques that allow successful management in most cases, liver transplantation may be indicated in a more severe injury. This is a report on a patient with massive, unsalvageable liver trauma on whom the first two-staged procedure was successfully performed. After total hepatectomy as the first step and a prolonged anhepatic period of more than 14 hours, liver replacement by an allograft was carried out in a second operation. The patient recovered completely from the potentially lethal hepatic trauma and is alive more than 17 months later.

Accidents, Traffic↗
PubMed1990

[Twin pregnancy after liver transplantation].

Orthotopic liver transplantation was performed in a 29-year-old woman because of increasing decompensation of HBs-antigen positive post-hepatitic cirrhosis. Postoperatively she developed a mild rejection reaction and diabetes mellitus. Thirteen months after the transplant she conceived twins. This high risk pregnancy was complicated by a febrile viral infection with purulent tracheobronchitis at 9 weeks and a threatened abortion at 11 weeks. At 33 weeks there was a sudden drop in haemoglobin due to a minor uterine rupture which necessitated cesarean section. The female infants--of development in keeping with the dates--showed no clinical or ultrasound evidence of any malformations. Apart from initial difficulties--asphyxia (second twin), fluctuating glucose and calcium levels, an episode of neonatal jaundice which required phototherapy, reluctance to suck and hypotonia--the further development of both twins proceeded normally. The maternal diabetes disappeared after delivery, HBs-antigen remained negative and the HBs-antibody titre rose. The patient has remained in good condition, both mentally and physically.

Abortion, Threatened↗
PubMed1990

[Pregnancy following liver transplantation and during immunosuppression with cyclosporine].

Orthotopic liver transplantation had been performed in 1983 in a now 40-year-old woman in the terminal stage of posthepatitis liver cirrhosis with recurrent oesophageal bleedings and precoma from complete liver-cell failure. She became pregnant in 1988 while under immunosuppression with cyclosporin (2.1-2.7 mg/kg body-weight) and prednisolone (5 or 7.5 mg daily in rotation). Pregnancy proceeded without complication and there were no side effects from cyclosporin. After premature membrane rupture in the 39th week of pregnancy uterine inertia developed during oxytocin stimulation of contractions, and caesarean section was performed. The female infant was normally developed without any malformations. Liver, kidney and adrenal functions were normal, as was haemopoiesis. But possible late sequelae of cyclosporin treatment in the child cannot as yet be assessed because of the short follow-up.

Abnormalities, Drug-Induced↗
PubMed1990

Postoperative recovery of mitochondrial function of the human liver graft procured and preserved with University of Wisconsin (UW) solution.

Changes in arterial blood ketone body ratio (KBR) were investigated in 47 human liver transplantations. Of the 20 grafts preserved with University of Wisconsin (UW) solution, 10 had a cold preservation period of less than 10 h (UWS group) and 10 of more than 10 h (UWL group). In 27 other cases, grafts were preserved with EuroCollins (EC) solution for less than 10 h (EC group). In the EC group, KBR increased over 0.7 within 6 h after reperfusion of the graft in 17 cases (63%) and within 24 h in 7 cases (26%). In the 3 other cases, KBR failed to recover, and these patients underwent retransplantation. In the UW group, KBR recovered within 6 h in 13 cases (65%) and within 24 h in 7 cases (35%). There were no significant differences between the UWS and UWL groups. It is shown that the mitochondrial function of liver grafts preserved with UW solution can be well maintained even after extended preservation periods of more than 10 h.

Adenosine↗
PubMed1990

HTK-solution (Bretschneider) for human liver transplantation. First clinical experiences.

The cardioplegic HTK-solution (Bretschneider) has not been used in human liver transplantation as yet. Herein the first results obtained from 14 patients with HTK-preserved liver grafts are presented. The suitability of HTK-solution could be shown. All grafts functioned primarily except one, where initial non-function was obviously due to donor reasons. The early postoperative peak values of transaminases as a sign of ischemic damage were average and similar to the values of other flushout solutions. Using HTK primary function could be achieved even in livers prospectively assessed as only of fair quality, and livers with poor donor function tests (MegX) functioned from the beginning. HTK-solution therefore seems to allow widening of the acceptance criteria for donor livers. It was not the aim of this trial to extend cold ischemic time, but 3 livers with 11 h and 12 h 25 showed immediate function. How far cold ischemic time can be extended is a still open question. All livers were rapidly cooled and homogeneously flushed out due to the low viscosity of HTK-solution. All livers had a soft consistency after perfusion indicating a low degree of cell edema. HTK therefore is an effective solution for liver preservation.

Adenosine↗
PubMed1990

Fat emulsions in parenteral nutrition after liver transplantation: The recovery of the allografts RES function and histological observations.

Following liver transplantation, the effect of post-operative parenteral nutrition with MCT LCT (Medium Chain Triglycerides/Long Chain Triglycerides) fat emulsions on the recovery of allografts RES function was investigated in a randomised prospective study of three groups of patients (group I, n = 14: 50g MCT LCT fats twice weekly, group II, n = 15: 0.7 g/kg body weight per day MCT LCT fats, group III, n = 17: 1.5 g/kg body weight per day MCT LCT fats). RES function was assessed using the (99m)Tc-HSA-MM-Clearance ((99m)Technitium-Human serum albumen-Millimicrosphere-Clearance). There were no statistically significant differences in the recovery of RES function between the groups. A negative effect on RES function as a result of the administration of MCT LCT fat emulsions up to 1.5 g/kg b.w. per day can therefore be excluded. The evaluation of liver biopsies before the administration of fats and at the end of TPN (Total Parenteral Nutrition) showed no evidence, in the 20 patients investigated, of any fatty changes in the liver caused by the infusion of fat.

Journal Article↗
PubMed1990

Significance of arterial ketone body ratio measurement in human liver transplantation.

Arterial ketone body ratio (KBR), which reflects the NAD+/NADH ratio of hepatic mitochondria, was measured sequentially in 39 liver transplantations. In 22 cases, KBR was increased to above 0.7 within 6 hr after reperfusion (group A). In 11 cases, restoration of KBR was delayed until the first postoperative day (group B) and in 6 cases, KBR failed to recover (group C). The patients in group A survived liver transplantation without complications. By contrast, morbidity and mortality were significantly higher in groups B and C. In 2 cases in group C, the livers were clinically diagnosed as initially nonfunctioning grafts and the patients underwent retransplantation. Another two died of hepatic failure soon after the operation. It is suggested that delayed recovery of KBR is an early indicator of metabolic overload in the liver allograft, and that a delay exceeding 24 hr may imply the need for retransplantation.

Adult↗
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

[Fat emulsions in parenteral feeding following liver transplantation. I. Effect on the recovery of RES function in the transplant].

Following liver transplantation, the effect of postoperative parenteral nutrition with MCT/LCT fatty emulsions on the recovery of RES function in the allograft was investigated in a randomised prospective study of three groups of patients (group I: 50 g MCT/LCT fats twice weekly, group II: 0.7 g/kg body weight per day MCT/LCT fats, group III: 1.5 g/kg body weight per day MCT/LCT fats). RES function was assessed using 99mTc-HSA-MM clearance. There were no statistically significant differences in the recovery of RES function after transplantation between the three groups. A negative effect on RES function as a result of the administration of MCT/LCT fats up to 1.5 g/kg body weight per day can therefore be excluded.

Fat Emulsions, Intravenous↗
PubMed1990

Evaluation of the liver graft before procurement. Significance of arterial ketone body ratio in brain-dead patients.

Hepatic energy metabolism was assessed by measuring the blood ketone body ratio (KBR), that is, the ratio of acetoacetate to beta-hydroxybutyrate in the arterial blood, in 31 brain-dead patients in an intensive care unit (ICU) in Japan and in 25 donors just before procurement of the liver for transplantation in Germany. In the study in Japan, 7 of the 12 brain-dead patients treated with high-dose catecholamine showed significantly decreased KBRs, revealing the detrimental effect of catecholamine on liver metabolism. In contrast, 8 of the 9 untreated patients with blood pressure below 80 mm Hg showed almost normal KBRs. In the 25 donors in Germany, KBR was maintained within the normal range. Based upon conventional criteria, 21 livers were selected for use and the other 4 were discarded. Nineteen of the grafts were able to normalize KBR within 24 h after reperfusion, while 2 failed to function and required a second transplantation. It was suggested that a KBR in the normal range in donors is a prerequisite to immediate recovery of metabolic function of the liver graft after transplantation, and that hypotensive donors as a potential source of liver grafts may warrant further study.

Adolescent↗
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↗