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Biomedical subjects

G Blumhardt

Publications and source records attributed to G Blumhardt.

At least 55 records · Page 3Linked to original sources
PubMed1994

Treatment of the Budd-Chiari syndrome with orthotopic liver transplantation and long-term anticoagulation.

The Budd-Chiari syndrome (BCS) with hepatic vein occlusion is a rare disorder that can effectively be treated with orthotopic liver transplantation. In this retrospective analysis we report on 7 patients who received 9 liver grafts for terminal BCS. One patient died after 4 months due to cytomegalovirus-pneumonia. The actuarial survival rate is 85.7% compared to more than 90% in all other 376 patients transplanted between September 1988 and April 1993 at our institution. Anticoagulation management consisted of early postoperative intravenous heparin and continuation with dicoumarin. One patient with thrombocytosis received hydroxyurea. Under this regimen one postoperative hemorrhage requiring laparotomy was observed. Discontinuation of oral anticoagulation due to gastrointestinal bleeding caused hepatic artery and portal vein thrombosis in 1 patient who had to be retransplanted. One recurrence requiring retransplantation as well was due to an insufficient dicoumarin intake. In conclusion, terminal BCS represents a good indication for orthotopic liver transplantation with a closely-monitored anticoagulation to avoid such adverse side effects as thrombosis and hemorrhage.

Adolescent↗
PubMed1993

[Liver transplantation as a routine procedure? Indications and results in 270 patients].

AIM: To represent the current state of the art of orthotopic liver transplantation (OLT). The constantly expanding spectrum of indications are discussed in detail, and the specific risks of the individual indications considered. Major points discussed: On the basis of the authors' own results obtained at the Rudolf Virchow Hospital, University of Berlin, the current survival rates following orthotopic liver transplantation are shown. In addition to established indications for liver transplantation (primary biliary cirrhosis, primary sclerosing cholangitis, acute hepatic failure, various metabolic diseases, small hepatocellular carcinomas and a number of posthepatic cirrhoses) the indication and results of liver transplantation in HbsAg-positive and alcoholic cirrhosis are presented in detail. In contrast to reports in the Anglo-American literature, the incidence and severity of graft re-infections with the hepatitis virus was appreciably reduced through the use of anti-HBs hyperimmunoglobulin preparations in HBsAg-positive cirrhotics. The results obtained were comparable with those achieved for other indications.

Follow-Up Studies↗
PubMed1993

Liver transplantation for PNH with Budd-Chiari syndrome. A case report.

A 54-year-old male patient with end-stage liver failure from Budd-Chiari syndrome due to paroxysmal nocturnal hemoglobinuria (PNH) underwent liver transplantation (OLT) in 1989. Retransplantation became necessary 1 year later when thrombotic occlusion of the portal vein and common hepatic artery led to graft loss after withdrawal of anticoagulation therapy because of several gastrointestinal bleeding episodes. The patient is now alive 3 years after the first OLT. To the best of our knowledge and according to the literature, this is, to date, the longest that any PNH patient has survived after liver transplantation. Although the course of this patient was complicated in a way similar to that reported for other cases in the literature, patients with PNH should not, in principle, be excluded from liver transplantation. Lifelong anticoagulation with coumarin and the use of steroids together with cyclosporin reduce the risk of recurrent thrombosis and PNH crises.

Budd-Chiari Syndrome↗
PubMed1993

Transplantation of shipped donor livers.

Between September 1988 and November 1991, 201 donor hepatectomies and transplantations were performed. Fifty-four livers (26.9%) were harvested by other teams and shipped for transplantation; 147 livers (73.1%) were procured by teams from our transplant center. Comparing the maximal postoperative serum-aminotransferases (s-AT), we evaluated the postischemic damage of shipped organs (AST 951 +/- 931 IU/l; ALT 820 +/- 666 IU/l) and nonshipped organs (AST 753 +/- 1256 IU/l; ALT 636 +/- 896 IU/l); this did not differ significantly. Donor-related factors, such as critical parameters (i.e., cardiac arrest, arterial hypotension, age over 50 years, or elevated preoperative s-AT), length of stay in the intensive care unit before harvesting, and cause of death showed similar patterns in both groups. The mean cold ischemia time in the group of shipped livers (12 h 10 min +/- 4 h 22 min) and in the nonshipped livers (10 h 6 min +/- 3 h 53 min) did not differ significantly. Five cases (2.5%) of a primary non-functioning graft presenting with significantly (P < 0.001) elevated s-AT (AST 4944 +/- 2280 IU/l; ALT 3186 +/- 1918 IU/l) necessitated an early retransplantation. One organ was shipped and four organs were nonshipped, thus corresponding to their portion of all grafts. These data indicate that the transplantation of shipped livers is a safe procedure procedure, provided that procurement is done by experienced centers.

Adolescent↗
PubMed1993

"Goal-directed" transfusion management leads to distinct reduction of fluid requirement in liver transplantation.

Complications in patients undergoing OLT, such as hemorrhagic events, are caused not only by surgical problems but also by the profound functional disturbances arising from hepatic insufficiency, which are at least partially cured by the procedure itself. Preoperative clotting data give insight only into the dysfunction of the explanted organ. Hence, we tried to perform a standardized, "goal-directed" anesthesiologic management in the perioperative phase in OLT, following strict indications for blood replacement according to diuresis, hemoglobin level, and hemodynamic parameters. We performed 200 OLTs in 185 patients, according to usual methods. The mean intraoperative fluid requirement was 884 ml of balanced salt solution, 8.1 units of RBC, and 9.4 units of FFP. During the first 24 hours postoperatively, an average of 2.4 units of RBC and 5.6 units of FFP had to be transfused. Currently, 170 of the 185 patients (91.9%) are alive and well. Our data demonstrate that a distinct reduction of transfusion rates in OLT is possible, neglecting clotting data and improving clotting function by avoiding hemodilution.

Aprotinin↗
PubMed1993

Changes in urokinase-type plasminogen activator in orthotopic liver transplantation.

Elevated levels of u-PA Ag and scu-PA preoperatively and before revascularization of the graft are explained by an impaired clearance function by the diseased liver. They are parallel preoperatively and in the beginning of OLT by increased tcu-PA activity. This may reflect a role of the intrinsic fibrinolytic system in the "hyperfibrinolytic state" observed in patients with end stage liver disease. u-PA Ag and scu-PA normalize following reperfusion. The increase in tcu-PA observed during the anhepatic phase coincided with greatly increased fibrinolysis, as demonstrated by thrombelastography. This indicates that u-PA seems to be involved in the development of fibrinolysis during OLT. It had been demonstrated in previous investigations that a significant increase of t-PA activity was seen in the late anhepatic phase leading to an elevated plasmin generation. Since plasmin is a major activator of scu-PA, a t-PA mediated scu-PA activation would explain the concomitant increase in both plasminogen activators.

Aprotinin↗
PubMed1993

Comparison of quadruple immunosuppression after liver transplantation with ATG or IL-2 receptor antibody.

Treatment with monoclonal IL-2 receptor antibodies has been successfully used for immunosuppressive induction therapy following organ transplantation in the recent past. The present study was conducted to compare for the first time a cyclosporine-based quadruple immunosuppressive regimen including a monoclonal IL-2 receptor antibody or ATG as induction therapy after orthotopic liver transplantation. In two groups of 33 patients each, postoperative survival, graft biopsies, liver function enzymes, and the clinical courses after OLT were evaluated. Our results indicate that monoclonal IL-2 receptor antibody therapy as part of a quadruple immunosuppressive regimen is better tolerated and is at least as effective as ATG in prevention of allograft rejection following OLT. Furthermore, our data indicate that a slightly better liver function in general and a lower incidence of rejection reactions necessitating treatment could be observed in the group of patients treated with the monoclonal IL-2 receptor antibody. This study provides evidence that monoclonal IL-2 receptor antibody therapy may be a useful tool for the immunosuppressive induction therapy following clinical orthotopic liver transplantation.

Adult↗
PubMed1993

Quality of life of liver transplant recipients. A pilot study.

In a cross-sectional survey of the quality of life of 45 liver transplant recipients, physical and psychological status, physical complaints, capability to participate in daily life, social support, and global quality of life were assessed. The average time of follow-up was 9 months after transplantation. Nine patients had moderate liver damage, 12 suffered from drug side effects, and 10 had extrahepatic diseases. Physical complaints, especially rheumatism, exhaustion, and gastric complaints, were higher than in the general population. Most patients were able to participate in daily life (do housework, take part in family life, etc.). Apart from the complex "health" (use of body), they did not differ in this respect from healthy individuals. Eighty percent of the patients reported having very good social support. The psychological status was generally good, with only 5% complaining of anxiety and nervousness. Sixty percent regarded their quality of life to be very high, 31% reported medium quality of life, and 9% felt very bad. No relationship was found between low quality of life and transplant malfunction; patients with extrahepatic diseases had the lowest quality of life. Among all subgroups, the individuals who were actively working again felt best. Psychological qualities necessary for coping with daily life (self-assurance, self-realization, satisfaction, and happiness) correlated most with the global quality of life (r = 0.80), whereas no relationship was found between quality of life and complaints in total (r = -0.32). This survey shows that during the first year after transplantation, transplant recipients report a high quality of life in important areas of living, despite many physical complaints, and even display an almost euphoric mood.

Adult↗
PubMed1993

[Experiences with simultaneous exploration of the bile ducts in surgical therapy of gallstone ileus].

During the last 16 years, 14 patients with a gallstone ileus were treated at our institution. In 11 cases we performed in addition to the enterolithotomy, a cholecystectomy and a resection of the fistula as one-stage repair. Despite the high average age (74.3 years) and the presence of various other serious morbidity in our patient population, we only observed a hospital mortality of 7.1%. Serious postoperative complications, such as sepsis and/or shock were not observed. Utilizing today's advanced anesthesia and proper intensive-care therapy, as well as early operative intervention and safe surgical technique, we believe that enterolithotomy with cholecystectomy and fistula resection as one-stage operation, should primarily be considered before performing enterolithotomy alone.

Aged↗
PubMed1993

Extracorporeal liver perfusion: applications of an improved model for experimental studies of the liver.

Long-term extracorporeal liver perfusion of up to 24 hours was achieved with an improved model of pig liver perfusion. Functional and structural integrity of the extracorporeal liver was maintained during the entire duration of extracorporeal perfusion. After 24 hours SGOT was 33.5 (+/- 6.5) U/L, bile production was 11.5 ml/h. Survival of hepatectomized pigs could be extended to 18.9 (+/- 3.8) hours with extracorporeal liver perfusion (p < 0.01). The improvement of liver perfusion in our particular model is primarily based on optimised perfusion of the low pressure system of the portal and hepatic vein by the application of sinusoidal pressure profiles. These pressure profiles imitate intra-abdominal conditions and achieve homogeneous perfusion of the low pressure system of the portal vein and complete drainage of hepatic venous blood.

Animals↗