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Biomedical subjects

F Längle

Publications and source records attributed to F Längle.

49 records · Page 3Linked to original sources
PubMed1989

[Professional organ procurement as a prerequisite for attaining the necessary transplantation frequency: experiences with organ distribution at the transplantation center in Vienna].

In the years 1965 to 1988 one or more organs were harvested for the purpose of transplantation from 649 brain dead organ donors reported to the Vienna transplantation centre. Based on a 1982 law regulating organ donation a large number of initiatives aiming at the improvement of the organ procurement system have taken place. In particular, the introduction of a decentralized donor guidance and organ retrieval system, a few information campaigns, as well as the introduction of full-time transplantation coordinators have significantly increased the number of organ donors. This development has made the Vienna transplantation centre one of the largest centres in Europe and has recently resulted in the achievement of a virtual balance between the increase of patients on the waiting list and the growth of the rate of transplantations performed. If this organ procurement policy is consistently continued in the years to come, there is a good chance of ensuring sufficient supply of organs for all patients on waiting lists, at least within the Viennese area.

Austria↗
PubMed1989

Percutaneous transluminal angioplasty of failing arteriovenous dialysis fistulae.

Percutaneous transluminal angioplasty (PTA), a method combining diagnostic and therapeutic procedures, was studied prospectively in 40 patients with clinically failing a-v fistulae. Forty-seven procedures were performed in 40 patients with a variety of a-v fistulae (26 Cimino, five saphenous loops, five goretex grafts, and four upper-arm fistulae). In 43 cases the procedure was initially successful. The mean time of fistula patency after first PTA was 10.06 +/- 2.10 months. Primary failures were due either to technical inability to pass the stenosis (two patients) or to vessel perforation during the attempt (two patients). Surgical intervention had to follow both perforations. Restenosis at the dilatation site occurred in six patients, and in one a new stenosis at a different site occurred; the mean time of fistula patency in these patients was 5.8 months. Our results suggest that PTA is a highly effective therapy for the majority of cases of shunt stenosis. The success rate of the method is excellent and the complication rate low. The combination of this interventional approach with the mandatory angiographic procedure if stenosis of a fistula is suspected makes PTA a favourable first-line treatment and appears to save a considerable number of surgical interventions.

Adult↗
PubMed1989

[Preoperative plasma exchange in treatment of plasma-related coagulation disorders before liver transplantation].

PATIENTS AND METHODS: Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years). The indications for liver transplantation are listed in Table 1. All transplant procedures were performed without using a bypass technique. The intraoperative management and surgical procedure have been described elsewhere [7]. Patients were categorized in two groups, each of which was divided in two subgroups. Group I consisted of 18 patients transplanted before the introduction of preoperative plasma exchange. These were retrospectively allocated to two subgroups on basis of their preoperative prothrombin times (PT): A (n = 9): preoperative PT less than 40%; B (n = 9): preoperative PT greater than 40%. The two subgroups of group 2, which contained 54 patients, were compared on a prospective basis: C (n = 32): preoperative PT above 40%; D (n = 22): PT on admission below 40%, preoperative plasma exchange. Comparison of the two subgroups was based on the following parameters: (1) pre-exchange PT (subgroup D); (2) preoperative PT (= PT post-plasma exchange in subgroup D; (3) intraoperative infusion volumes (balanced electrolyte solutions and human albumin to maintain an intravascular colloid osmotic pressure greater than 16 mm Hg); (4) transfusion volumes (whole blood stored for no more than 72 h or packed red cells and fresh plasma, as available; and (5) intraoperative sodium bicarbonate requirements to maintain an arterial pH greater than 7.20. RESULTS: (Table 2) . Prothrombin time (PT): Group 1: Patients in subgroup A had a mean preoperative PT of 34% (range: 15%-40%). This was significantly lower than in subgroup B (74%; 52%-100%; P less than 0.001). Group 2: The pre-exchange mean PT in subgroup D was 27% (12%-39%) vs. 68% in subgroup C (45%-104%), the difference being highly significant (P less than 0.0001). In patients in subgroup D a mean plasma volume of 3638 ml was exchanged by plasmapheresis. This resulted in a significant increase in PT to 55% (Table 3). As a result, the preoperative post-exchange PT in subgroup D was slightly but significantly (P less than 0.005) less than in subgroup C. Transfusion volumes: Group 1: Patients in subgroup A needed significantly more blood units than those in subgroup B (55.3 units [19-110] vs. 18.7 [3-33]).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[The covering of the infected cubital vessels after complications of dialysis shunts by the use of the musculus brachioradialis].

The case of a 52-year-old patient with uremia and infection in his av-shunt (homologous saphenous vein) is described. Due to the infection a rupture of the venous anastomosis in the cubital area with acute hemorrhage occurred and the av-fistula had to be removed and the artery repaired by an autologous vein patch. To cover the exposed cubital artery and the infected ventral elbow area a brachioradial muscle flap was inserted. By this procedure the amputation of the upper extremity could be avoided. Full range of extension and flexion was obtained within 4 weeks.

Anastomosis, Surgical↗
PubMed1988

Primary hepatic cancer--the role of limited resection and total hepatectomy with orthotopic liver replacement.

Between 1977 and 1986, 172 patients with primary hepatic cancer were treated at the Department of Surgery I, University of Vienna Medical School. In 76 cases (80%) males, 20% females), cirrhosis of the liver was also present. Ninety patients underwent curative surgery (hepatic resection in 64, and liver transplantation in 26 cases). There were no early tumor stages. Forty-five large tumors were confined to one lobe, 42 involved both lobes, 3 even invaded adjacent structures, the majority (74%) being hepatocellular carcinomas. Forty-four of the 64 liver resections were performed in patients with otherwise normal livers (mortality 18%), while 20 patients had associated liver cirrhosis. In view of the extremely high mortality rates after extended liver resection, only limited local resections have been performed in cirrhotic malignancies since 1982 (mortality 25%). Perioperative mortality (25% overall) was due mainly to hepatic failure and sepsis; non-fatal complications occurred in 12 patients (26%). Seventeen of the 26 liver transplants were cirrhotic hepatomas. Nine deaths (34%) were caused by technical problems (graft failure, clotting disorder after massive transfusion) and systemic infections. The outcome for the patient after the immediate postoperative period was determined by tumor regrowth (residual liver tissue, graft, distant metastases) in both groups (median life expectancy 18.4 months after radical liver resection and 18.6 months after liver transplantation). Surgery is the only alternative for these patients (50% survival of untreated hepatoma: 2.6 months), improving both their quality of life and survival. We believe that in carefully selected candidates with non-resectable tumors liver replacement may be a useful alternative.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Three-dimensional reconstruction of the liver venous system using the preservation solution as contrast agent.

To investigate whether MRI without using artificial contrast agents can provide sufficient image contrast to visualize the venous tree in the cold stored liver graft, two pig liver grafts were scanned with a multislice turbo spin-echo sequence with long TE (200 msec). The quality of the data obtained at 1-T field strength was sufficient for three-dimensional reconstruction of the hepatic vascular system, potentially useful for liver splitting surgery.

Animals↗
PubMedDate not supplied

CD15 (LeuM1) immunoreactivity: prognostic factor for sporadic and hereditary medullary thyroid cancer? Study Group on Multiple Endocrine Neoplasia of Austria.

Patients treated for sporadic and hereditary medullary thyroid carcinoma (MTC) have varying rates of persistent disease, recurrence, and survival. The aim of this study was to correlate the immunoreactivity of the monoclonal antibody CD15 (LeuM1) to initial clinical findings and the outcome of treatment. The primary tumors of 75 patients with sporadic MTC, 7 with hereditary disease, and 3 members of MEN 2A families were studied. Of these subjects 74 (87%) showed no or little immunoreactivity (< 15% positive cells; score 0) in most tumors. The remaining 13% had surgery for tumors with more than 15% cells with positive staining (score I). There was no correlation between LeuM1 immunoreactivity and sex, age, and type of MTC. There was, however, a significant correlation with the pTNM classification and UICC staging. The prognosis for patients with score 0 was significantly better than score 1 patients. CD15 immunoreactivity appears to be a predictive factor in sporadic and hereditary MTC. Lymph node dissection seems to be more successful in patients with score 0 tumors than in those with score 1 tumors. The question of reoperation in patients with recurrence of disease (especially with biochemical recurrence or persistence) should be discussed on the basis of CD15 immunoreactivity.

Adolescent↗
PubMedDate not supplied

Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data.

Comparing patients with primary hyperparathyroidism (PHP) to a normocalcemic control population, those with PHP have a higher incidence of cardiovascular disease and cardiac abnormalities. This study aimed at correlating cardiac findings (valvular and myocardial calcification, myocardial hypertrophy) with clinical data (age, sex, clinical manifestation, nephrolithiasis, nephrocalcinosis, hypertension, skeletal abnormalities, hypercalcemic syndrome) and biochemical data (serum calcium, serum phosphate, serum iPTH level, serum creatinine). A group of 132 consecutive patients with surgically verified PHP (94 women, 38 men; ages 15-86, mean age 57 +/- 16 years) were included in this study. Blood chemistry, clinical presentation, radiography, and echocardiography were carried out in all patients for univariate and multivariate analyses of all parameters. There was no statistical correlation between clinical symptoms, biochemical data, and cardiac calcific alterations. Typical skeletal manifestations (osteolysis/subperiostal resorption) and valvular calcifications were significantly correlated to left ventricular hypertrophy (p = 0.005). Cardiac abnormalities such as calcific myocardial deposits or mitral and aortic valvular calcifications do not correlate with laboratory findings and clinical presentation at the time of diagnosis. There was no biochemical or clinical variable that could predict the frequency or severity of valvular sclerosis or calcific deposits in the myocardium. However, PHP-related skeletal abnormalities and valvular calcification were predicting factors for left ventricular hypertrophy, a reversible cardiac manifestation of PHP. Myocardial hypertrophy is more often found with classic symptomatic PHP with osseous abnormalities.

Adolescent↗
PubMedDate not supplied

Primary hyperparathyroidism in Austria: results of an 8-year prospective study.

Serum calcium determinations in 45,217 hospitalized patients during an 8 year period revealed sustained hypercalcemia in 124 (0.3%) patients. Further clinical and biochemical investigations established primary hyperparathyroidism (PHP) in at least 40 (32%) patients, an incidence of PHP of 89.6 +/- 41.5 per 100,000 patients per year. The incidence of PHP in males and females was 31.5 and 124.2 per 100,000, respectively. The highest incidence was found in females greater than 66 years of age (268.8 per 100,000). Nineteen (48%) patients showed classical symptoms of PHP, 14 (35%) patients were minimally symptomatic, and 7 (17%) patients were asymptomatic. The incidence and symptomatology of PHP in Austria is nearly the same as in other countries. Because of the multiple actions of parathyroid hormone in the body, PHP can cause debilitating symptoms but too often it remains undiagnosed clinically. Routine calcium determinations are very important and PHP must always be considered in the differential diagnosis, especially in minimally symptomatic patients.

Adult↗