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Biomedical subjects

C E Brölsch

Publications and source records attributed to C E Brölsch.

16 recordsLinked to original sources
PubMed1999

Liver transplantation in children: long-term outcome and quality of life.

UNLABELLED: Liver transplantation has become a standard therapy in acute and chronic liver failure. Since 1968, 2554 paediatric patients receiving a liver transplant have been registered in the European Liver Transplant Registry (ELTR). Compared with 22,600 total transplants registered in the ELTR over the same period of time this means that about 10% of all liver transplants performed in Europe concern paediatric recipients, aged from 0 to 15 years. The indications in the paediatric population differ significantly from those of adult patients: More than 50% of patients suffer from cholestatic disorders, followed by hepatic based metabolic disorders, acute liver failure, non-cholestatic cirrhosis and liver tumours. The results of liver transplantation in paediatric patients have improved remarkably since the early 1980s. In 1997 a survival rate of 80% is almost the international standard. This improvement is due to the use of better immunosuppressive agents such as cyclosporin A and tacrolimus, followed by improvement in surgical techniques and finally by improvement in intensive care, better diagnostic tools for viral, bacterial and fungal infections and corresponding appropriate therapies. Quality of life as a measure of transplant results has not been sufficiently studied. The majority of paediatric liver transplant recipients has a good quality of life; only 10% suffer from significant morbidity. The impact of pretransplant damage to other organs such as brain, kidneys, bone and lungs and the influence of immunosuppression on somatic growth, neurological development, infection and metabolic balance are subjects of increasing concern. CONCLUSION: The results available today show convincing evidence that liver transplantation is a therapeutic option in otherwise fatal hepatic disorders. Much effort, however, has to be made in order to achieve further improvements by increasing our knowledge of the pathophysiology of both pre- and posttransplant conditions.

Adolescent↗
PubMed1993

[Liver regeneration in man. A prospective CT-volumetric study].

To get reliable data on human liver regeneration we performed CT volumetry in 25 patients who underwent partial hepatectomy for benign and malignant liver tumours preoperatively and at least one year postoperatively in regular intervals in a prospective study. All patients received standardised CT-scans preoperatively and two weeks, 3, 6 and 12 months post-operatively. The resected specimen size was determined by water displacement. We were able to demonstrate human liver regeneration. Contrary to the well-known animal model the amount of regeneration in humans is less and regeneration takes a longer time. We did not find any statistical correlation to extent of resection, age of patients and other parameters. On the contrary, the human liver seems to regenerate until a certain relationship of liver volume and body-surface area is reached: 0.8 l/m2.

Adult↗
PubMed1993

[Right-sided hemihepatectomy in echinococcosis of the liver in pregnancy].

The treatment of symptomatic echinococcal disease of the liver during pregnancy is a rare, but difficult problem. A 42 year old, pregnant woman with obstructive jaundice and acute cholangitis due to extensive echinococcus cysticus infection of the right hepatic lobe is presented. A formal, right hemihepatectomy was successfully performed.

Abdominal Pain↗
PubMed1993

[Laparoscopic splenectomy].

From August until October 1992 laparoscopic splenectomy has been performed upon three patients with idiopathic thrombocytopenia. The splenic vessels were divided by an Endo-GIA. The spleen could be removed through a slightly extended trocar-incision. The Idiopathic thrombocytopenia without an enlarged spleen provides a possible indication for laparoscopic surgery.

Adult↗
PubMed1992

Primary sarcoma of the liver in the adult. Report of five surgically treated patients.

During the 5-year period between 1988 and 1989, five patients with primary sarcomas of the liver underwent surgery. Since the patients presented in an early stage of the tumor, all the sarcomas were resectable, in three cases with wide margins (R-0 resection). Five histological types were detected: malignant hemangiopericytoma, malignant fibrous histiocytoma, hemangiosarcoma, rhabdomyosarcoma, and embryonal sarcoma. Two patients with high-grade sarcomas received adjuvant chemotherapy. The follow-up was favorable in three patients with R-0 resections (two had adjuvant chemotherapy). They were still alive, with no evidence of disease 30, 46, and 63 months after the diagnosis. The two other patients had to be reoperated on for local recurrences. Both died of their tumor disease, 30 and 35 months after the initial diagnosis. Extensive chemotherapy in one of these cases failed to arrest tumor progression. Hence, liver resection with wide margins is a very important measure in such cases.

Adult↗
PubMed1991

The use of reduced-size liver transplants in children, including split livers and living related liver transplants.

One of the key problems facing children awaiting liver transplantation is the shortage of donor organs. Surgical procedures that address this problem include: reduced-size liver transplantation (RLT), split liver transplantation (SLT), and living related liver transplantation (LRLT). RLT makes more of the current donor pool accessible to the pediatric recipient. SLT furnishes 2 liver grafts from 1 cadaveric donor, and LRLT provides an innovative supply of donor organs. This report compares the results achieved with RLT, SLT, and LRLT to those seen with full-size orthotopic liver transplantation (OLT). Between November 1984 and February 1991, 457 liver transplants were performed at the University of Chicago. Two hundred fourteen of these transplants were placed into recipients less than 13 years of age. Of these 214 pediatric orthotopic liver transplants (OLT), 103 were full-size livers and 111 were some type of reduced graft (RLT, SLT, or LRLT). There were 57 RLT, 34 SLT, and 20 LRLT. The recipients of the reduced grafts (RLT, SLT, or LRLT) averaged 1.9 +/- 1.8 years of age and 9.6 +/- 6.4 kg compared to the recipients of the full-size livers who averaged 3.5 +/- 3.4 years of age and 14.1 +/- 8.8 kg (p = 0.0001). The most common indication for transplantation was biliary atresia (105 patients). Overall patient survival after primary full-size OLT was 71.8%. Reduced-size OLT (RLT, SLT, and LRLT) resulted in an overall patient survival of 72.6% after primary transplantation. Patient survivals for primary transplants with specific types of reduced-size grafts were: RLT 76.5% (after RLT was used routinely), SLT 66.7%, and LRLT 89.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Liver transplantation in children.

Liver transplantation in children is still rarely performed although the prognosis for children with benign and final-stage liver disease and individual cases with unresectable hepatomas is acceptable. This report is based on the cases of eight children who underwent liver transplantation, in five cases for end-stage cirrhosis and in three cases for hepatoma. There was early mortality in only one case while in all the others development and rehabilitation were remarkable. For patients with malignancies, tumour recurrence is a limiting factor. Transplantation in biliary atresia is complicated when carried out at late stages of the disease. In cases where the time of indication is sufficiently early, a long waiting period for a suitable donor organ must be expected, during which several potential candidates may succumb to the underlying disease. Increasing experience and improved immunosuppressive therapy signify that liver transplantation can be considered more often in end-stage liver diseases.

Age Factors↗
PubMed1978

[Improvement of the oxygen supply of the cirrhotic rat liver by selection of portacaval shunt method].

Intrahepatic disturbances of circulation following various portasystemic shunting procedures can be monitored by means of the Pt-multiwire surface electorde. The normal liver is capable of compensating for each degree of portal blood deprivation. In the presence of a thioacetamide-induced liver cirrhosis in the rat a side-to-side PCS significantly improves oxygen supply of the liver. Preserving residual portal perfusion of the liver by choice of different portasystemic shunts, the oxygen supply is slightly improved, too. This effect does not correlate with the quantity of residual liver perfusion, but is possibly due to vasocative hormonal substances, from a pancreatico-duodenal source, that regualte liver circulation.

Animals↗
PubMed1978

[The effect of liver arterialization on the regeneration process of the cirrhotic rat liver].

A portocaval shunt in the normal and cirrhotic rat liver results in a considerably diminished regenerative response following a 70% hepatectomy. Increased regenerative activity of a normal liver after arterialization of the portal vein is not necessarily due to improvement of total blood supply, since a similar regenerative response in the cirrhotic liver does not occur, although regenerative activity in a cirrhotic liver is quite similar to that in a normal liver. In the presence of a TAA-induced liver cirrhosis, liver regeneration 7 days after PCS and 70% hepatectomy is not improved by additional arterialization of the portal vein.

Animals↗
PubMedDate not supplied

Monitoring of liver oxygenation during neuroleptanalgesia in the dog.

In an animal study (7 mongrel dogs) the effects of neuroleptanalgesia (NLA) and combinations of NLA with nitrous oxide (N2O) and isoflurane on the macro- and microcirculation of the liver were investigated. Measurements were made in three steps. After NLA alone the dogs were supplementarily ventilated with nitrous oxide/oxygen at a ratio of 2:1. During the last step, 1 MAC isoflurane was added to the inspired gas. From the portal vein, arterial and mixed-venous systems' hemodynamic parameters, blood gases, and acid-base balance were recorded. As a parameter of oxygenation the tissue PO2 of the liver was measured with a multiwire surface electrode. During NLA stable hemodynamic conditions and a balanced acid-base status were observed. The nitrous oxide combination resulted in an increase of the mean pulmonary artery pressure of 16%. The addition of isoflurane had a negative inotropic effect: The heart index decreased to 74% of the starting value and the total peripheral resistance (TPR) increased by 27%. The summarized PO2 histograms under NLA and NLA/N2O showed arithmetic mean values of 34.1 and 35.2 mm Hg, respectively. The addition of isoflurane resulted in a left shift and a decrease of the mean value to 28.6 mm Hg. This histogram corresponds exactly to the oxygen pressure distribution in the dog liver during piritramide basic anesthesia. It seems that NLA and the combination of NLA/N2O increase the liver perfusion with a higher portal-venous and tissue PO2. This effect can be explained only by a massive change of visceral circulation. It is canceled by the addition of isoflurane.

Animals↗