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H Keck

Publications and source records attributed to H Keck.

At least 37 records · Page 2Linked to original sources
PubMed1996

The importance of late infections for the long-term outcome after liver transplantation.

We investigated the late infections of 400 consecutive liver transplantations performed in 368 patients. After a mean follow-up of 45 months, a total of 180 late infections occurred in 110 liver recipients. Frequent agents were CMV, enterococcus, candida and staphylococcus. Pneumonia was the most dangerous late infection with a high mortality rate. Late infections were responsible for ten deaths that were all caused by atypical pneumonia. The majority of late infections appeared during the first year after liver transplantation. Thereafter, the risk of infection declined significantly.

Humans↗
PubMed1996

Incidence and outcome of arterial complications after orthotopic liver transplantation.

Arterial complications can be a major factor in morbidity and mortality after orthotopic liver transplantation (OLT), as they may cause graft failure, sepsis and complications of the biliary tract. From September 1988 to December 1994, 571 OLT were performed in 529 patients. The follow-up period ranged from 8 to 83 months. Actuarial 1-, 3- and 5-year survival figures were 91%, 87% and 85%, respectively. In 12 cases (2.1%) complications of the arterial anastomoses were observed. Early arterial complications occurred in eight cases from various causes, while late arterial complications were exclusively thromboses and developed in four patients 8, 12, 26 and 37 months after surgery, respectively. The main clinical course in patients with arterial thromboses was septic cholangitis with destruction of the biliary tree. Although 70% of the grafts with arterial thrombosis were lost, 30% could, at least temporarily, be salvaged by other treatment options. Provided adequate treatment is carried out, arterial complications do not affect overall patient survival.

Adolescent↗
PubMed1996

Hepatitis C: indication for anti-viral therapy?

Hepatitis C infection is a frequent indication for liver transplantation. In general, recurrent graft hepatitis is assumed to be mild, but may be the cause of lethal postoperative complications in a small patient population. Out of 500 transplants in 458 patients, 123 patients were transplanted due to hepatitis C infection (26.7%) between September 1988 and April 1994. Cumulative 1- to 6-year patient survival was similar for patients transplanted due to hepatitis C (87.0%) and those transplanted for other indications (86.0%). In patients with hepatitis C virus (HCV), death, in 50% of the cases, was related to HCV recurrence and chronic rejection. Four patients (25.0%) died because of severe infection and multiple organ failure syndrome unrelated to HCV recurrence and chronic rejection. The incidence of retransplantation was similar in HCV (9.8%) and other patients (8.4%). In HCV patients, 6 of 12 retransplantations (50.0%) were performed due to HCV recurrence and chronic rejection. Of 123 HCV patients, 45 experienced histologically proven recurrent graft hepatitis between 2 weeks and 5.5 years after transplantation. The incidence of acute rejection was similar in both groups. The incidence of steroid-resistant rejection was, however, higher in HCV patients (29.3%) than in those transplanted for other indications (14.5%; P < or = 0.05). Furthermore, there was a significant association between acute rejection and the development of recurrent graft hepatitis. In conclusion, patients with hepatitis C may be transplanted with as good patient and graft survival rates as patients transplanted for other indications. However, the combination of recurrent graft hepatitis and chronic rejection remains the most limiting factor for some of these patients, which strengthens the necessity for a specific anti-viral therapy.

Graft Rejection↗
PubMed1996

Superparamagnetic iron oxide--enhanced versus gadolinium-enhanced MR imaging for differential diagnosis of focal liver lesions.

PURPOSE: To assess AMI-25- versus gadolinium-enhanced magnetic resonance (MR) imaging in the differential diagnosis of liver tumors. MATERIALS AND METHODS: Twenty-nine patients with liver tumors underwent unenhanced, AMI-25-enhanced (15 micromol/kg), and gadolinium-enhanced(0.1 mmol/kg) imaging within 2 weeks. RESULTS: A significant (P< .05) difference in percentage signal intensity loss (PSIL) was seen in benign tumors on AMI-25-enhanced proton-density-weighted images (nine focal nodular hyperplasia [FNH], 41%; one adenoma, 32.4%) versus malignant tumors. Gadolinium-enhanced T1-weighted gradient-echo images showed strong enhancement in benign lesions (seven FNH, 147.5%; one adenoma, 91.3%) and moderate enhancement in malignant tumors (eight hepatocellular carcinomas, 116.2%, 11 metastases, 39.7%). Receiver operating characteristic analysis revealed a threshold PSIL of 10% on AMI-25-enhanced images as the most essential criteria to distinguish benign from malignant lesions (sensitivity, 88%; specificity. 89%). Interobserver analysis for two observers revealed specificity of 93% for AMI-25-enhanced imaging versus 81.5% for gadolinium-enhanced MR imaging. CONCLUSION: AMI-25 decreased the SI of benign tumors and helped differentiate benign from malignant tumors.

Adenoma↗
PubMed1996

[Cholecystoduodenal fistula with subsequent gallstone ileus: case report of an unusual course].

Gallstone ileus is a rare complication of cholecystolithiasis with a high mortality because of the advanced age of the patients and the often delayed diagnosis. Signs of a cholecystoduodenal fistula are often absent in conventional ultrasonic and radiological methods. Treatment options are: 1. Enterolithotomy, 2. One stage procedure or 3. Two stage procedure consisting of enterolithotomy and the surgery of the biliary tract. In the case of our patient we performed a conventional cholecystectomy and the closure of the cholecystoduodenal fistula, which was found accidentally. When the gallstone ileus appeared 6 days later the enterolithotomy was performed. Thus in case of accidentally found cholecystoduodenal fistula an exploration of the abdominal cavity and the small intestine to find the gallstone should be performed on principle. Gallstones with a diameter of more than 2-3 cm should be removed by enterolithotomy to prevent the gallstone ileus.

Aged↗
PubMed1996

[Effect of minimally invasive technique on the educational curriculum of future surgeons].

The retrospective evaluation of 1219 operations for appendicitis (n = 602) or cholecystolithiasis and/or cholecystitis (n = 617) in the advent of minimal invasive techniques reveals a shift from educational interventions to mere care-taking interventions. In our investigation, we observed a decrease in appendectomies and an increase in cholecystectomies which nevertheless hazards surgical education because of the marked decrease in "teaching operations" in the advent of minimal invasive techniques. This development has to be taken into consideration in order to guarantee a qualified education for future generations of surgeons, and specific measures have to be taken to face this problem effectively.

Appendectomy↗
PubMed1995

The effect of temporary hepatic ischemia on liver surface pH and potassium ion activity in the rat.

The effects of hepatic ischemia can be analyzed with a wide variety of functional and morphological methods. In this study we used a new organ monitoring device that accurately determines pH and K+ activities on the liver surface with ion-selective electrodes. Four groups of rats (n = 6 each) were subjected to complete, arterial or portal warm ischemia for 15 min (achieved by clamping of the hepatoduodenal ligament, the hepatic artery or the portal vein) and subsequent reperfusion. One group was sham-operated. Complete and portal ischemia were characterized by an immediate decline of pH and a more retarded rise of K+ activity on the liver surface. Arterial ischemia had almost no effect on these two parameters when compared with the sham group. Upon reperfusion the shifts of pH and K+ activity reversed towards initial baseline values. The organ monitoring system offers the option to assess ional shifts non-invasively during organ procurement, ischemia and reperfusion and may be used as an additional criterion for the estimation of organ viability.

Acid-Base Equilibrium↗
PubMed1995

Mycobacterial infection after liver transplantation.

Tuberculosis occurred in 5 (1.2%) of 462 liver transplant recipients. De novo infection was assumed in 4 patients and a recurrent infection in 1. The clinical courses varied, from asymptomatic open lung tuberculosis to disseminated disease with cerebral tuberculoma and convulsions. Four patients survived with anti-tuberculous triple-drug therapy. Very few cases of tuberculosis after liver transplantation have been reported (4 patients in the medical literature and 5 patients in this paper). However, the incidence, course of infection, and outcome seem to be similar to those of tuberculosis in renal transplant recipients, approximately 150 cases of which are known.

Adolescent↗
PubMed1995

[Spiral CT of the pancreas. A clinical comparison with conventional CT and dynamic CT].

PURPOSE: Spiral CT is compared with the dynamic CT and the conventional CT with regard to the enhancement of the pancreas and peripancreatic vessels and the visualisation of anatomic details. METHODS: In 15 patients spiral CT of the pancreatic region was performed in the arterial phase followed by spiral CT of the upper abdomen in the arterial-venous phase. In 30 patients dynamic CT (n = 15) and spiral CT (n = 15) of the pancreatic region was performed in the arterial phase followed by conventional CT of the upper abdomen. RESULTS: Compared with dynamic CT, spiral CT of the pancreatic region in the arterial phase (flow 4 ml/s, delay 15-18 s) leads to a stronger contrast of the peripancreatic vessels (p < 0.001) and the pancreas (108 vs. 86 HU) (p < 0.05). In the following spiral CT of the upper abdomen (flow 1 ml/s, delay 70 s), a high enhancement of both arteries and veins could be achieved. Intrapancreatic structures and peripancreatic vessels were better seen in the spiral CT than in the conventional CT (p < 0.05) and p < 0.005, respectively). CONCLUSION: The combination of spiral CT of the pancreatic region in the arterial perfusion phase and spiral CT of the upper abdomen in the arterial-venous phase enables an optimal enhancement of the pancreas and the abdominal vessels and a reliable visualisation of anatomic details.

Artifacts↗
PubMed1995

[MRI of focal liver lesions using a 1.5 turbo-spin-echo technique compared with spin-echo technique].

AIM: The aim of our study was to evaluate a T2-weighted turbo-spinecho sequence in comparison to a T2-weighted spinecho sequence in imaging focal liver lesions. METHODS: In our study 35 patients with suspected focal liver lesions were examined. Standardised imaging protocol included a conventional T2-weighted SE sequence (TR/TE = 2000/90/45, acquisition time = 10.20) as well as a T2-weighted TSE sequence (TR/TE = 4700/90, acquisition time = 6.33). Calculation of S/N and C/N ratio as a basis of quantitative evaluation was done using standard methods. A diagnostic score was implemented to enable qualitative assessment. RESULTS: In 7% (n = 2) the TSE sequence enabled detection of further liver lesions showing a size of less than 1 cm in diameter. Comparing anatomical details the TSE sequence was superior. S/N and C/N ratio of anatomic and pathologic structures of the TSE sequence were higher compared to results of the SE sequence. CONCLUSION: Our results indicate that the T2-weighted turbo-spinecho sequence is well appropriate for imaging focal liver lesions, and leads to reduction of imaging time.

Carcinoma, Hepatocellular↗
PubMed1995

[Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments].

AIM: Vessel infiltration of the portal vein is often considered as contraindication for pancreas resection for carcinoma. In this retrospective analysis we investigated if an extended Whipple's procedure including vessel resection submits the patient to a significantly higher risk. PATIENTS AND METHODS: From August 1985 until February 1994 179 Whipple's procedures were carried out, in 74 cases for carcinoma of the pancreatic head. In this group 26 patients were classified as stage I (35.2%), 5 as stage II (6.7%), 38 as stage III (51.4%) and one patient as stage IV. In 18 cases a segment of the portal vein was resected, in 16 cases reconstructed by end-to-end anastomosis and in two cases by implantation of a GoreTex prosthesis. No special anticoagulation was applied. RESULTS: There were no anastomosis-related complications such as hemorrhage, thrombosis or stenosis. The lethality rate was 1.4% (1/74), insufficiencies at the pancreas and bile duct anastomosis occurred in 0% and 1.4% (1/74), resp. Patients with segmental vessel resection in stage III had a mean survival of 9 months and by 3 years there was no survivor compared to 11.7 months and 17% survival after 4 years in stage III without vessel resection. CONCLUSION: By performing vessel resection more pancreas tumors than earlier are resectable without increased risk. Since the results of oncologic alternative treatment modalities are still poor pancreas resection represents at present the best option for the patient.

Adult↗
PubMed1995

[Cause of death after liver transplantation: an analysis of 41 cases in 382 patients].

UNLABELLED: The aim of this study was to analyse the causes of death after liver transplantation in order to find and to avoid preventable fatal complications if possible. METHODS: Between September 1988 and September 1993 415 orthotopic liver transplantations in 382 patients were performed at the Rudolf Virchow University Hospital in Berlin. During the same interval 41 (10.7%) of these patients died. Their clinical records were reviewed. RESULTS: The main cause of death was infection (29.3%), followed by recurrent malignancy (21.9%). Less patients died because of hepatitis B-reinfection (14.6%), chronic rejection (7.3%), hemorrhage (7.3%), cardiac failure (7.3%), trauma (4.8%), hypoxia (4.8%) and recurrence of alcoholic liver disease (4.8%). There was a wide spectrum of opportunistic infectious agents with CMV and Pneumocystis carinii being the most important pathogenic organisms. Only one isolated bacterial infection as principle cause of death was found. In all fatal infections the lung was the primary site of infection, 7 patients additionally developed sepsis. Altogether 75 patients (19.6%) with hepatitis B-cirrhosis were transplanted. Six of them (8%) developed a fatal hepatitis B-reinfection. Malignancy was the indication for OLT in 41 patients (10.7%). Six of these patients (14.6%) died because of recurrent tumor. Regarding the whole series, most deaths occurred four to twelve months (58.5%) and only five (12.2%) during the first month after OLT. CONCLUSION: Recurrence of primary disease is an important factor regarding total mortality. Therefore it is necessary to practise a careful selection of liver transplant recipients. In the future more attention needs to be drawn towards prevention, identification and management of opportunistic infections.

Adult↗
PubMed1995

[Is liver abscess still an indication for liver resection?].

AIM: The standard therapy for liver abscesses consists of percutaneous drainage. In certain cases a liver resection may be indicated. The indication for liver resection in six patients with liver abscess is analysed retrospectively. METHODS: Between 7.7.87-13.10.93 six patients (4 male, 2 fem.) in the age of 40-72 years (mean 59 yrs.) underwent liver resection for liver abscess at our institution. The patients suffered from symptoms of a progressive liver abscess formation: fever, hepatomegaly, loss of weight, jaundice and anorexia. Abscess localization was performed preoperatively by ultrasound and CT. Drainage attempts were unsuccessful in these patients, resections were carried out for suspicion of malignancy or during a laparotomy due to other reasons. RESULTS: Liver resections were left and right hemihepatectomy (1x each), left lateral resection (3x) and one wedge resection. Intraoperative blood transfusion requirements were not different from those of other indications for resection. Postoperative hospitalization lasted 12-33 days (mean 19 days). The postoperative course was uneventful, in one case a hematoma at the resection site required drainage. CONCLUSION: Resection for liver abscesses is indicated only in exceptional cases but allows for definite therapy.

Adult↗