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Biomedical subjects

B Ringe

Publications and source records attributed to B Ringe.

At least 271 records · Page 15Linked to original sources
PubMed1986

99mTc-diethyl-iodo-HIDA (JODIDA): a new hepatobiliary agent in clinical comparison with 99mTc-diisopropyl-HIDA (DISIDA) in jaundiced patients.

The new HIDA derivative, 99mTc-diethyl-iodine-HIDA (JODIDA), was compared with 99mTc-diisopropyl-HIDA (DISIDA) in 17 patients with jaundice by means of paired cholescintigraphic imaging studies. The following parameters were visually assessed: the extent of urinary tract visualization, biliary contrast and appearance time, and gallbladder visualization and appearance time. In the 6 patients with a total bilirubin level of between 19 and 66 mumol/l (1.1 and 3.9 mg/dl), both radiopharmaceuticals gave similar results except for the moderate visualization of the urinary tract with DISIDA in contrast to JODIDA. In the remaining 11 patients with a total bilirubin level between 102 and 1303 mumol/l (6 and 76 mg/dl). JODIDA showed significant advantages over DISIDA: nonvisualization of the urinary tract, stronger and faster biliary contrast, and better gallbladder visualization. JODIDA thus offered substantial diagnostic advantages over DISIDA in 8 of these patients. In 4 patients, the differential diagnosis of jaundice (intrahepatic or mechanical disorder) was possible with JODIDA, whereas DISIDA either could not visualize intestinal or gallbladder activity at all or could not differentiate it from the urinary tract. In one patient, JODIDA offered faster (18 h) diagnosis. In the remaining 3 patients, other, substantially false interpretations could be avoided through the use of JODIDA. Further clinical experience with JODIDA in more than 40 patients confirmed the results of this study. We concluded that JODIDA is of significant advantage over DISIDA in clinical situations such as total bilirubin level above 80-100 mumol/l (4.7 to 5.8 mg/dl), examination of small children and critically ill patients and suggestion of bile leakage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Current clinical management of organoprotection in hepatic surgery.

Ischemia of the liver in hepatic resection under inflow occlusion is tolerable for at least up to 60 min. For protection of the liver from ischemic injury, steroids are frequently used. In liver transplantation, cold ischemia of 6-8 h for the graft is considered to be acceptable. Organ preservation is most frequently accomplished by in situ perfusion of the liver with Euro Collins solution in the donor and consecutive hypothermic storage after hepatectomy, resulting in 96% of all grafts in primary function.

Humans↗
PubMed1985

Aims and practical application of a multi organ procurement protocol.

According to the present situation of nonrenal organ transplantation there is an urgent need for heart, liver and pancreas grafts. To confront the steadily widening gap between cadaveric organ demand and supply the introduction of a multiorgan procurement protocol is mandatory. This protocol that is described in detail should regulate the collaboration between donor hospitals, the Eurotransplant Foundation, and transplant centers. On the basis of general, specific, and organspecific criteria potential donors can be evaluated, selected and accepted, then being followed by a well organized combined organ retrieval. The application of the proposed procurement protocol is expected to contribute significantly to the frequency and success rate of organ transplantation in Europe.

Adolescent↗
PubMed1985

Developments in liver transplantation.

Liver transplantation has gained increasing interest. While liver grafting for tumor is successful over prolonged periods only in its early course, liver grafting for end-stage cirrhosis may lead to a long survival. Liver grafting in children is the most successful indication; in adults the results depend largely on timing and indication. Actual developments are mainly seen in the following points: a. Improvement in immunosuppression by use of Cyclosporin A. The resorption and metabolism of the drug, in relation to liver function, have to be carefully observed. b. The tendency to perform liver grafting electively instead of in emergency. c. Improvement in operative management, particularly the use of veno-venous bypass. d. The best possible anaesthesiological and intensive care management for the patients. It can be expected, that these developments will enable continuous improvement of results, particularly in an elective situation. One hundred and forty liver grafts have been done in our institution and the results are discussed herein. Progress in liver transplantation is marked by steadily growing numbers of liver grafts performed, and of centers performing grafts, as well as by improved success rates and the recommendation of the U.S. National Institutes of Health, based on discussions at a liver transplantation consent meeting, held in June 1983. This interest is also reflected in discussions among the medical and non-medical community. The first section of this paper will deal with the present state and results of liver grafting particularly, at our own institution and some actual developments in this field will be discussed.

Bile Ducts↗
PubMed1975

[SLA-testing and MCL-reaction in swine and their reaction to rejection of skin and liver transplants].

After porcine skin allografts there is a regular rejection within 6 - 12 days with a characteristic pattern of humoral antibodies corresponding to the histocompatibility testing. The rejection of skin allografts may be due to weak histocompatibility antigens which are not measured by the SL-A and MLC typing. A porcine liver allograft induces an immunological reaction of moderate degree. This state of hyporeactivity i. e. partial tolerance could be induced and maintained by the release of tolerogenic antigens from the porcine liver.

Animals↗
PubMedDate not supplied

Role of liver transplantation in management of esophageal variceal hemorrhage.

The management of esophageal variceal hemorrhage ranges from conservative to surgical modalities. Before introduction of liver transplantation as a potentially curative therapy of the underlying etiology, decompressive portosystemic shunt operations have been the mainstay of mostly palliative procedures. Our own experience with surgery for advanced hepatic disease and portal hypertension over 20 years includes 803 liver transplantations and 201 portosystemic shunts, emphasizing our primary objective of treatment. The results after shunt surgery were favorable in Child class A candidates when performed electively and with selective decompression. After liver replacement the clinical status of the patient, including hepatic function and extrahepatic complications, had a strong influence on postoperative outcome, with the chance of excellent long-term survival. The additional risk of previous shunt surgery for subsequent transplantation could be reduced over time. Based on this experience and reports from others there are enough reasonable arguments for shunt and transplantation. Instead of the choice being controversial, the two forms of therapy should supplement each other and be available in the same center that specializes in the treatment of patients with diseases that eventually lead to liver failure and portal hypertension. Selection of either approach must depend on etiology, stage of the disease, and proper timing. Shunt procedures may be indicated in stable patients with the risk of bleeding after sclerotherapy failure, in those with contraindications to transplantation, or as a bridge to transplantation. The role of liver transplantation has been clearly established in patients with progressive or endstage (otherwise intractable) hepatobiliary disease.

Adolescent↗
PubMedDate not supplied

Surgical treatment of cholangiocellular carcinoma.

Intrahepatic cholangiocellular carcinoma (CCC) is known to be associated with severe symptoms and a particularly poor prognosis. Nonsurgical methods have failed to change this situation up to now. Surgical therapy, so far, is the only chance for effective treatment, but it has had limited success. The relative infrequency of this tumor does not allow extensive statistics and limits our present knowledge. In this contribution the outcome of 50 patients who underwent liver resection or liver transplantation in our institution is reported. Their courses have been reevaluated according to pathohistologic classification and TNM tumor staging. The median survival rates were 12.8 months in the group of patients after liver resection (n = 32) and 5.0 months after liver transplantation (n = 18). Liver transplantation, however, was performed only in patients with unresectable tumors. The longest survival after transplantation was 25 months; after resection four patients survived more than 5 years. In the resection group and the transplantation group survival rates correlated with tumor size and tumor stages according to TNM, although the differences were not statistically significant. Liver resection thus has its place in resectable situations. Liver transplantation for unresectable lesions of this tumor type--always deemed critically in the past--seems not to be indicated with our present stage of knowledge, unless adjuvant protocols appear promising and are tested.

Bile Duct Neoplasms↗
PubMedDate not supplied

Resection of synchronous liver metastases from colorectal cancer.

Whereas resection for metachronous liver metastases from colorectal cancer is considered to be a potentially curative approach, little is known about the prognosis after resection of synchronous liver metastases. In the past, these patients usually underwent only palliative therapy. Therefore, we have analyzed the data of 36 patients who underwent curative hepatic resection of synchronous liver metastases from colorectal carcinomas from 1977 to 1987 at the Department of Surgery, Hannover Medical School. In 19 patients, liver resection was combined with colonic resection; in the other 17 patients, hepatic resection was performed after a median interval of 2 months following resection of the primary tumor. No operative mortality was observed in either of the approaches. The median survival time was 28 months for all patients with a median recurrence-free interval of 13.5 months. Overall 5-year survival probability for all patients was 20%. There were no significant differences observed between immediate or delayed liver resection (median survival 18 months versus 31 months). Survival rates were not different after resection of solitary versus multiple liver metastases (26 versus 28 months). Twenty-one of the 36 patients had a recurrence of their liver metastases. In 7 of them, curative liver resection could be performed again. These 7 patients had a significantly improved survival (p less than 0.05) compared to the residual 14 patients. It is concluded that patients with synchronous liver metastases from colorectal cancer may profit from resection of the primary tumor and liver metastases. Timing of liver resection--immediate versus delayed--obviously has no impact on survival rates.

Adult↗
PubMedDate not supplied

Score-aided decision making in patients with severe liver damage after hepatic transplantation.

This article describes how a system of scoring risk factors contributes to deciding whether a patient showing signs of liver failure soon after hepatic transplantation should be treated expectedly or should undergo immediate retransplantation. Of 78 adult patients receiving a first liver graft, 25 had evidence of severe damage of the graft and were further investigated. Nine had failure due to irreversible initial nonfunction, and 2 of the 9 died before a second graft was available. Seven were retransplanted with 3 long-term survivors. The other 16 patients showed reversible severe damage and survived without retransplantation. Since retransplantation for irreversible initial nonfunction is successful only in the first postoperative days, there is an urgent need to identify the degree of the observed damage. We devised a scoring system which identified and weighted factors that were predictable in determining irreversibility. Measurements of highest relevance are transaminases, bile volume, the slope of the enzyme GLDH, and the amount of fresh blood and fresh-frozen plasma required for support on the day of operation and the following day. Logistic regressional analysis produced a numerical score which was applied to a decision tree and produced probabilities and utilities to indicate whether reoperation is advisable. We use this scoring system and believe it assists our decisions in the early posttransplant period.

Abstracting and Indexing↗
PubMedDate not supplied

Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients.

Surgical therapy offers the only chance for long-term cure of patients with hepatocellular carcinoma. The role of partial and total hepatectomy with subsequent liver replacement was analyzed in a consecutive series of 198 patients. It was the aim of this study to compare both treatment modalities on the basis of various clinicopathological prognostic factors including the TNM system of pathological classification. One hundred thirty-one resections and 61 transplantations were performed for the following histological diagnoses: hepatocellular carcinoma without coexisting liver disease (86) or associated with various hepatic abnormalities (79), fibrolamellar carcinoma (19), and mixed hepatocholangiocellular carcinoma (8). Overall actuarial survival rates at 5 years were 35.8% following resection and 15.2% after transplantation, respectively. For partial hepatectomy, factors significantly associated with improved long-term outcome were: age 30-50 years, hepatocellular carcinoma without coexisting liver disease, fibrolamellar carcinoma, solitary tumor, unilobar location, absence of vascular invasion, portal vein thrombosis or extrahepatic spread, primary tumor categories pT 2/3, stage groups II/III, and curative operation (R0). Regarding total hepatectomy, the corresponding figures were: pT2, absence of portal vein thrombosis or extrahepatic spread (negative regional lymph nodes, no distant metastases), stage group II, and curative surgery. It could be clearly shown by uni- and multivariate analyses that the pTNM classification is of clinical value regarding the assessment of prognostic significance after resection and transplantation. A group of 13 patients had secondary resection (8) or transplantation (6) for intrahepatic tumor recurrence. Whereas in all resected patients cancer recurred again, 5 of 6 transplant recipients are alive and disease-free at 12-40 months. The results of this study demonstrate that liver resection is the treatment of choice for primary liver cancer while transplantation may be indicated, especially in cases of nonresectable or recurrent lesions. Thus, the therapeutic spectrum for hepatocellular carcinoma should include both partial and total hepatectomy, being integrated into one common concept.

Adult↗
PubMedDate not supplied

Benign liver tumors: differential diagnosis and indications for surgery.

The differential diagnosis for hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma may be difficult. Reliable diagnosis is mandatory for the decision of whether to apply surgery or observation. Experience with long-term observation in nonoperated patients with hemangioma and FNH is limited. A group of 437 patients from a single institution were analyzed with regard to a diagnostic algorithm, the indications for surgery, and observation. There were 238 hemangiomas, 150 cases of FNH, 44 adenomas, and 5 mixed tumors. Of the 437 patients, 173 underwent surgery; 103 with hemangioma and 54 with FNH were observed at our own institution, whereas 117 patients underwent follow-up elsewhere or were lost. Among the operated patients with confirmed histology, a good diagnostic yield was found for a combination of ultrasonography (US), contrast (bolus)-enhanced computed tomography (CT), and labeled red blood cell (RBC) scanning: sensitivity 85.7%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 81.8%, and accuracy 91.3%. For FNH and combination of US and CT plus cholescintigraphy showed a sensitivity 82.1%, specificity 97.1%, PPV 95.8%, NPV 84.6%, and accuracy 90.3%. Surgical mortality was 0.6%. Observation of patients with hemangioma and FNH for a median of 32 months revealed no increase in tumor size in 80% and a decrease in fewer than 7%. There was no tumor rupture and no evidence of malignant transformation. We concluded that liver hemangioma and FNH can be differentiated from adenoma with high sensitivity, specificity, and accuracy by labeled RBC scanning and cholescintigraphy in combination with US and contrast-enhanced CT. In the case of symptoms or an equivocal diagnosis with respect to adenoma or hepatocellular carcinoma, surgery can be performed with very low risk. Because in asymptomatic patients with observed hemangioma or FNH no increase of tumor size can be expected for many years, the indications for surgery must be carefully evaluated.

Adenoma, Liver Cell↗