PubMed Health⌕ Search

Biomedical subjects

J Erhard

Publications and source records attributed to J Erhard.

At least 19 recordsLinked to original sources
PubMed2003

[Blood management in surgery--an analysis].

The surgeon has a tremendous influence on the usage of blood and blood products. He determines the indication and operative strategy. So the co-operation of anesthetist, intensivist, transfusion specialist, and surgeon is essential to achieve improvement in blood saving. Guidelines of blood saving methods can support the aim of an effective blood management. We analyzed the today's situation of blood saving in surgery and discuss the matter by a questionnaire sent to all surgical institutions of Nordrhein-Westfalen. The data observed cover the results of the Sanguis study from 1994 and the resume that the indication of blood transfusion mostly is not driven by clinical and scientific facts alone. Till today no evidence based data exist on indications for transfusion of blood and blood products. This is required for the next years in order to create changes in the current system of blood saving. The key points to stay within the low range of the number of transfusions are to develop a specific peri-, intra-, and postoperative strategy according to patient, disease, and expected procedure. The surgical aspects are discussed.

Blood Component Transfusion↗
PubMed2003

[Echinococcosis - a rare differential diagnosis of a tumorous hepatic lesion].

We report the case of a 44-year-old woman who was admitted to our hospital because of a newly developed painless jaundice. Though she felt quite well sonographic and radiographic evaluation showed a tumor of the liver. An extensive diagnostic workup was performed but it was not until laparotomy that a malignant tumor could definitely be ruled out and the presumptive diagnosis of an echinococcosis was proven. A partial resection of the liver was performed.

Adult↗
PubMed2002

Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation.

BACKGROUND: Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair. METHODS: A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months. Follow-up data were obtained from medical records and the outpatient service. Patients were evaluated for various clinical and surgical factors. Hernias were analysed with respect to localization, type of surgical repair and recurrence rate. RESULTS: Some 17 per cent of the transplanted patients experienced an incisional hernia. Risk factors were acute rejection with affiliated steroid bolus therapy (P = 0.025), a low platelet count after transplantation (P = 0.048), and a transverse abdominal incision with upper midline approach (P = 0.04). Hernias were mainly located at the junction of the transverse and midline incision (P < 0.001) and the recurrence rate was highest here (P = 0.007). Prosthetic hernia repair achieved the lowest rate of recurrence and did not increase the incidence of infectious complications. CONCLUSION: Improved immunosuppression should avoid early steroid bolus therapy after transplantation. A low platelet count promotes herniation. Transverse abdominal incision seems to be the best approach for liver transplantation. Prosthetic hernia repair does not increase the complication rate.

Adult↗
PubMed2001

Serum bile acids in liver transplantation--early indicator for acute rejection and monitor for antirejection therapy.

We studied the course of serum bile acids to investigate its reliability in the diagnosis of acute rejection after liver transplantation in relation to pathohistological findings. Serum bile acid concentration, bilirubin and transaminases were measured in 41 patients who underwent liver transplantation. Their course was correlated to liver biopsy. Group I (n = 19) patients were without acute rejection, whereas group II (n = 22) patients showed acute rejection. Bile acid concentrations in group II showed a statistically highly significant (P < or = 0.001) threefold increase 3 days prior to biopsy. Successful antirejection treatment was correlated with a statistically significant (P = 0.008) decrease of serum bile acid 1 day after initiation of therapy. Patients without acute rejection showed a baseline bile acid concentration at the time of biopsy. Bilirubin and transaminases did not show any statistically significant correlation to acute rejection. Infection did not lead to a significant bile acid increase. Our study shows that serum bile acids monitored after liver transplantation can easily be used to detect acute rejection and at the same time they reflect the success of antirejection therapy.

Acute Disease↗
PubMed2000

Auxiliary rat liver transplantation with portal vein arterialization in acute hepatic failure.

BACKGROUND: The aim of our work was to study the effect of the portal vein arterialization of an auxiliary liver graft on survival, liver function, and regeneration of the native liver suffering from surgically induced acute liver failure (ALF). METHODS: In Lewis rats (control group: n=10), ALF was induced by resection of about 85% of liver tissue. The auxiliary liver graft (reduced size of 30%) was transplanted into the right upper quadrant of the abdomen (trial group: n=12). The portal vein was arterialized via the renal artery. The infrahepatic vena cava was anastomosed end-to-side, and the bile duct was implanted into the duodenum. RESULTS: Survival rate over a 3-month period was 10/12 in the trial group vs. 2/10 in the controls. In the trial group, the prothrombin time rose up to 38+/-2 sec on day 1 after surgery (control group: 66+/-6 sec); on day 5 after surgery, it returned to values of 30+/-1 sec. On day 1 after surgery, serum albumin fell to 25+/-1 g/L (preoperative value: 32+/-1 g/L). Within 3 weeks, it returned to normal. The hepatobiliary scan on day 7 after surgery showed normal uptake in the liver graft, whereas the uptake of the native liver was distinctly reduced. After 3 months, the transplanted liver had atrophied (0.6% of body weight), the native liver hypertrophied (2.5% of body weight), with a normal total weight for both livers of 3.1% of body weight. CONCLUSIONS: Thus, auxiliary liver transplantation with arterialized portal vein allows maintenance of liver function at the time of ALF and regeneration of the native liver.

Animals↗
PubMed2000

[Long-term follow up of bile duct injury by laparoscopic cholecystectomy and reconstruction with jejunum interposition].

The follow-up of patients with severe bile duct lesions after laparoscopic cholecystectomy often shows secondary complications. We report on a female patient suffering from long-lasting complications after bile duct injury and early reconstruction by end-to-end anastomosis via a T-tube drainage. More than 5 years later and after multiple dilatation and stenting of the bile duct stenosis the patient was treated with an expanding metal stent. The severe cholangitis persisted. So the patient was operated on: bile duct and connected stent were resected. The reconstruction was performed with an isoperistaltic jejunal conduit. More than 24 months later the patient is healthy and at work again.

Cholangitis↗
PubMed1999

Auxiliary liver transplantation in acute liver failure in the rat -- an illustrated description of a new surgical approach.

INTRODUCTION: To investigate auxiliary liver transplantation successfully in rats suffering from acute liver failure, we developed a new surgical approach. METHODS: A 70% hepatectomized liver graft was implanted into the right upper quadrant of the abdomen. The donor portal vein was anastomosed with the recipient's right renal artery using the splint technique. The donor infrahepatic vena cava was attached onto the recipient vena cava end to side. The bile duct was implanted into the duodenum.

Anastomosis, Surgical↗
PubMed1999

Altered adrenergic responsiveness of endothelium-denuded hepatic arteries and portal veins in patients with cirrhosis.

BACKGROUND & AIMS: Patients with cirrhosis are characterized by a reduced splanchnic vascular resistance and a hyporeactivity to adrenergic vasoconstrictors. So far, their adrenergic splanchnic vascular responsiveness has not been evaluated in vitro. We compared responses to alpha1- and beta2-adrenoceptor stimulation of hepatic arteries and portal veins of patients with cirrhosis undergoing transplantation with those of organ donors. METHODS: Isometric contractions of endothelium-denuded vessel rings were induced cumulatively by methoxamine and relaxations by isoproterenol. Results are expressed as percentage of the contraction obtained by 85 mmol/L KCl or of the relaxation obtained by 100 micromol/L papaverine, respectively. RESULTS: Maximal methoxamine-induced contractions were reduced in cirrhotic hepatic arteries (cirrhosis, 51.8% +/- 6.8%; donor, 89.9% +/- 6.6%; P < 0.01) and portal veins (cirrhosis, 49.2% +/- 6.4%; donor, 94.0% +/- 5.3%; P < 0.01). In cirrhosis, isoproterenol induced a less marked relaxation of hepatic arteries (cirrhosis, 46.6% +/- 3.2%; donor, 100.3% +/- 4.4%; P < 0. 01) but an increased relaxation of portal veins (cirrhosis, 41.9% +/- 6.2%; donor, 26.2% +/- 2.8%; P < 0.01). CONCLUSIONS: In cirrhosis, endothelium-free hepatic arteries are hyporeactive to alpha1- and beta2-adrenoceptor agonists, and portal veins are hyporeactive to alpha1- but hyperreactive to beta2-adrenoceptor agonists. These findings support the in vivo findings of a hyporesponsiveness to adrenergic vasoconstrictors in patients with cirrhosis.

Adrenergic Agonists↗
PubMed1999

Monitoring of soluble HLA class I size variants after liver transplantation.

To monitor soluble HLA class I (sHLA-I) and their size variants after liver transplantation (LTX) plasma samples from 22 LTX patients were studied by sHLA-I ELISA, SDS-PAGE, and densitometry. Samples collected were classified into three groups: Group 1 comprised samples taken during episodes without complications, group 2 during episodes of cholangitis/cholestasis (CC), and group 3 during episodes of acute rejection (AR). Compared to group 1 (0.27 +/- 0.03 SEM microg/ml) mean sHLA-I increments in groups 2 and 3 were with 0.53 +/- 0.05 SEM microg/ml and 0.47 +/- 0.04 SEM microg/ml increased (p < 0.001). The same samples were studied by SDS-PAGE and the 43, 39, and 35 kD sHLA-I variants were quantified densitometrically. In samples of group 1 ratios of 43 vs. 39 kD bands revealed a mean of 2.1 +/- 0.3, whereas in group 2 and 3 these were only 0.8 +/- 0.1 SEM and 0.9 +/- 0.1 SEM, respectively, (p < 0.001). For the relation between 43 and 35 kD variants a reduced ratio of 1.1 +/- 0.2 SEM was confined to group 3 samples (p < 0.001), as groups 1 and 2 had ratios of 13.4 +/- 2.3 SEM and 8.4 +/- 2.9 SEM, respectively. This indicates that elevated sHLA-I levels during CC or AR are mainly caused by increases of 39 and/or 35 kD sized molecules. Therefore, our study demonstrates, that after LTX the contribution of sHLA-I size variants to total sHLA-I amounts changes drastically during immune activation pointing to different mechanisms of sHLA-I release.

Acute Disease↗
PubMed1999

[Assessing the quality of life after pancreas-kidney transplantation].

The pancreas-kidney transplantation strives for a reestablishment both of the physiological regulation of blood glucose levels without external insulin and of kidney function without the need of dialysis. Nevertheless, the postoperative morbidity of the combined transplantation is high. In long lasting diabetes type I, a strict selection of transplant candidates is necessary to minimize the risks of cardio-vascular complications. Between 1990 and 1997 only 17 of 44 patients really were accepted for transplantation in our unit. 13/17 patients are actually independent from external insulin and dialysis. Two other patients are free of dialysis, but the pancreas transplants had to be removed due to thrombosis or infection. In one case therapy-resistant acute rejection occurred and both organs had to be removed after two months. One women died four years after transplantation with a functioning kidney graft from myocardial infarction. 10 patients with stable transplant function are at work again. After normal pregnancy two women gave birth to healthy children, in one case twins. Drug regimen and outpatients visits are not seen as significant restrictions of the quality of life.

Adolescent↗
PubMed1998

Analysis of intragraft cytokine expression during early reperfusion after liver transplantation using semi-quantitative RT-PCR.

In the present study the intergraft mRNA formation immediately before and after transplantation of human livers was investigated by semi-quantitative polymerase chain reaction. The analysis was carried out with mRNA isolated from biopsies routinely taken perioperatively and included the determination of the expression of tumour necrosis factor alpha (TNF-alpha), interleukin (IL-6), IL-8, IL-10, transforming growth factor beta (TGF-beta) and beta-actin. It was found that biopsies obtained 30-60 min after reperfusion of the liver graft contained significantly higher levels of mRNA for TNF-alpha, IL-6 and IL-8 than biopsies collected subsequently to cold preservation. No such differences were obtained for TGF-beta and IL-10 mRNA. Considerable interindivdual differences were observed concerning the degree of inducibility, in particular for IL-6 mRNA. Retrospective comparison with the clinical course of the individual patients revealed a close and statistically significant correlation between low IL-6 expression and the occurrence of acute rejection episodes within 30 postoperative days, while high IL-6 mRNA levels coincided with the absence of rejection signs. High values for TNF-alpha mRNA were associated with ensuing acute rejection episodes.

Actins↗
PubMed1998

[Effect of kinetic therapy on the treatment outcome in patients with post-traumatic lung failure].

Intermittent prone positioning (PP) is a promising therapy of patients with severe respiratory failure. Evaluations of patient outcomes can not, to dare, be found in the literature. This study was conducted to investigate the effects of intermittent PP on patients with posttraumatic respiratory failure (PaO2/FiO2 < 280 mmHg) in comparison with conventional therapy in suspine position. The collected data is part of our prospective polytrauma study. 136 polytraumized patients (mean ISS 23.4) were included and evaluated. 77 patients had a severe chest trauma with an AIS > or = 3. Of these, 47 patients developed a respiratory failure. 19 of these patients were treated conventionally in suspine position, 28 patients were intermittently turned prone. Having similar AIS (3.6 vs. 33), the PP-patients had a significantly severer trauma (ISS 35.8 vs. 24.5). Though the injury severity of the PP-patients was much higher, the time of ventilation (32 vs. 31 d) and the ICU stay (39 vs. 36 d) was similar to the patients treated in suspine position. The mortility of PP-patients was 0%, of suspine positioned patients 26%. After the first PP the PaO2/FiO2 ratio increased with an average of 82 mmHg (26-151 mmHg). The FiO2 was reduced from 0.45 (0.35-1.0) to 0.26 (0.21-0.35). Beside the beneficial effect of PP on the oxygenation we have, for the first time evidence that PP improves the outcome of patients with posttraumatic respiratory failure.

Adolescent↗