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Biomedical subjects

J Erhard

Publications and source records attributed to J Erhard.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Use of continuous veno-venous high volume hemofiltration (CVVHVH) in patients with multiple organ failure. Principle and applications].

Between 1987 and 1994 in 24 patients suffering from multiple organ failure the new method of continuous high-volume veno-venous hemofiltration (HVCVVH) was performed. Compared with the usual methods of dialysis and hemofiltration the HVCVVH has proven two advantages: at first, it was possible to obtain a high blood flow through the filter powered by a pump. Secondly the fluid withdrawal from the infracardiac body region and the controlled infusion of fluid into the supracardiac veins was possible without decreasing the cardiac preload in patients with severe disorders of volume distribution. 18 of 24 treated patients had a stable circulation without need of catecholamines after the filtration. In 14 of the 24 patients the FiO2 was reduced to 0.3 and decreased during filtration. 13 patients survived the observation time of 30 days, 2 patients died during the procedure of filtration.

Adult↗
PubMed1996

[Preclinical diagnosis and management in severe craniocerebral trauma].

Both prehospital and hospital management of patients with severe head injury has clearly improved in the last decades. There is a greater knowledge of how secondary brain injury is caused and how it can be prevented. Intracranial mechanisms (e.g. haematoma and elevated intracranial pressure and systemic mechanism (e.g. shock and hypoxaemia) are two of the major causes of secondary brain injury. Adequate prehospital evaluation and treatment determine the later outcome for the patient. The Glasgow Coma Scale has become the standard score for assessing the level of consciousness. Early prehospital treatment must prevent secondary brain damage through adequate oxygenation (intubation, ventilation) and a sufficient cerebral perfusion pressure (treatment of shock). The neck of the patient should be positioned straight and the upper part of the body should be elevated to about 30 degrees. The prophylactic use of steroids, mannitol or high dose barbiturates is not indicated. Aggressive hyperventilation (pCO2 < 30 mmHg), especially during the first few days after severe brain injury, should be avoided.

Brain Damage, Chronic↗
PubMed1996

[Therapy of abdominal neuroblastoma in Essen].

Between 1980 and 1996, 74 children aged between 3 and 148 months were operated for neuroblastomas at the University Clinic Essen. A total of 44 patients had a neuroblastoma stage 4, 11 a stage 3, nine a stage 2, two a stage 1, and eight a stage 4s. If there was doubt about the possibility of a primary resection of the tumor, chemotherapy was carried out before surgery. This procedure enabled a complete local resection of the tumor in 46 children. In the postoperative course 29 children died, 25 of which presented tumor progress; four died of complications following bone marrow transplantation. Two children are currently being treated for tumor recurrence, while 43 have survived without tumor recurrence for 15 years. Complete tumor resection produced a better survival rate. If there is any doubt in the primary possibility of complete tumor resection a reduction of the tumor mass can be achieved by chemotherapy. This allows radical surgery can be achieved in significantly more cases.

Adolescent↗
PubMed1996

[Auxiliary liver transplantation in urgent and emergency indications].

This report will focus on seven patients treated with auxiliary liver transplantation. In two cases the indication was severe metabolic disorder and in five cases a fulminant hepatic failure. The clinical course was highly complicated in both cases with metabolic disorder (the transplant was lost, one patient died), but satisfactory in the patients suffering from fulminant hepatic disease: three of five are off immunosuppression, one is under therapy and one patient died of sepsis in the early phase.

Adolescent↗
PubMed1995

Evidence for increased nitric oxide production after liver transplantation in humans.

To evaluate the role of in vivo-produced nitric oxide (NO) after orthotopic liver transplantation, nitrate, a stable end product of spontaneous NO conversion in blood, was assayed in plasma samples of 32 patients. In 31 patients, nitrate increased from 36 +/- 2 microM to 137 +/- 8 microM within the first 6 postoperative days. In 11 out of 12 patients with an uneventful early postoperative course, nitrate increased from 33 +/- 2 microM to 70 +/- 8 microM, and returned to baseline levels within 2-3 days. In the remaining 20 patients with episodes of rejection and/or infection, the nitrate peak was augmented and prolonged. Ten patients suffering from these events in the later postoperative course showed a second nitrate elevation. In 31 patients, effective plasma levels of cyclosporine were reached 4-5 days after OLT. The patient without significant elevation in plasma nitrate had effective levels already at day 1. After liver resection or coronary bypass grafting, the median nitrate level remained at 21 microM (range 15-36 microM; healthy persons: median 24 microM, range 18-32 microM). After kidney transplantation nitrate was elevated in the early postoperative course. Thus, NO formation appears to be increased after solid organ transplantation, but not after other surgeries. After OLT, the increase appears to occur (a) in response to rejection and/or infection, and (b) 4-6 days after surgery in the absence of overt complications. In the latter case, NO might be involved in subclinical rejection and its production is possibly dependent upon the effectiveness of the immunosuppressive therapy.

Cyclosporine↗
PubMed1995

A new technique for reconstruction of the common bile duct after severe injury by laparoscopic cholecystectomy.

Laparoscopic cholecystectomy involves a higher incidence of severe common bile duct injury than did open cholecystectomy. The severe injuries most often result from technical problems and inadequate exposure. Reconstruction of the bile duct is then possible provided that an immediate diagnosis is made and an appropriate surgical technique is applied. The report focuses on a new method of reconstruction of the common bile duct by interposition of a small jejunal conduit. The procedure was performed in five patients with severe bile duct injury (Bismuth class 3-4) that occurred during laparoscopic cholecystectomy. The outcome after follow-up periods of 9 months to more than 2 years is promising. This method of reconstruction is therefore recommended for severe forms of bile duct injury.

Adult↗
PubMed1995

[Follow-up of plasma endothelin and serum interleukin 2 receptor level after liver transplantation].

In a prospective study levels of interleukin-2 receptors (Il-2-R) in serum and of endothelin (ET) in plasma were sequentially determined in 97 patients (39 women, 58 men) before and after liver transplantation (Ltx). The aim of the study was no evaluate the correlation and the time course of these two parameters after Ltx. The postoperative levels of Il-2-R and ET were higher in transplant recipients with no postoperative complications than in patients who had undergone operations to the liver. Patients suffering from acute rejection episodes after transplantation had more markedly increased Il-2-R and ET levels than those with an uneventful course, and this persisted for 3 months. A significant rise of Il-2-R concentrations 3-6 days before a biopsy confirmed rejection proved to have a sensitivity of 68% and a specificity of 68% respectively. A corresponding ET increase preceded rejection episodes confirmed by biopsy with a sensitivity of 62% and a specificity of 67%, respectively. These laboratory data can be obtained daily: they cannot undermine the "gold standard" of liver biopsy, but they are extremely beneficial in determining the timing and indication for the liver biopsy.

Adult↗
PubMed1995

FK 506 versus cyclosporin in the prevention of renal allograft rejection--European pilot study: six-week results.

FK 506 was compared with cyclosporin in a randomised trial in good-risk cadaveric renal transplant recipients. The objective was to evaluate whether oral FK 506 dosing was viable and whether blood concentrations in the range 10-20 ng/ml would prove to be practical. Thirty-one adult patients were randomised to FK 506 and 16 to cyclosporin. Both groups received an identical regimen of azathioprine and corticosteroids. Serum creatinine concentrations decreased rapidly in both groups with mean values below 200 mumol/l within 2 weeks. One graft in the cyclosporin group was lost due to renal vein thrombosis. During the 6-week study period, 19.4% of patients on FK 506 and 31.3% on cyclosporin experienced acute rejection. One patient in each group experienced corticosteroid-resistant rejection that responded to anti-lymphocyte therapy. Infections were reported in 51.6% of the FK 506 group compared with 37.5% of the cyclosporin group. The spectrum of adverse events was similar in both groups. However, minor neurological disorders were more common in the FK 506 group (54.8% versus 6.3%) whereas hypertension was less common (48.8% versus 75.0%). The results indicate that oral FK 506 rapidly achieves therapeutic blood concentrations and is an effective immunosuppressant for the initial treatment of renal allograft recipients.

Adolescent↗
PubMed1994

Nonparenchymal cell and hepatocellular injury to human liver grafts assessed by enzyme-release into the perfusate.

Experimental studies have demonstrated preferential injury to the sinusoidal endothelium during liver preservation with University of Wisconsin (UW) or Euro-Collins solution. This endothelial cell injury has an unclear pathogenesis, and it has not yet been studied in the human liver. Therefore, we analyzed the effluent of 21 human liver allografts after cold storage. Markers of hepatocellular and nonparenchymal cell injury were assessed. After preservation with UW solution, early effluent samples contained 1823 +/- 1494 U/l lactate dehydrogenase (LDH), 493 +/- 516 U/l alanine aminotransferase (ALT) and 132 +/- 97 U/l creatine kinase (CK; 92 +/- 92 U/l CK-BB). The effluent of livers preserved in histidine-tryptophan-ketoglutarate (HTK) solution contained 3681 +/- 2009 U/l LDH, 1139 +/- 599 U/l ALT and 282 +/- 120 U/l CK (165 +/- 91 U/l CK-BB). Comparison of effluent enzyme activities with liver tissue enzyme activities indicates that the release of the endothelial cell/nonparenchymal cell marker creatine kinase was higher, by a factor of 7-8, than the release of hepatocellular enzymes. Effluent thrombomodulin concentrations were 123 +/- 248 ng/ml (UW) and 604 +/- 299 ng/ml (HTK), and effluent glucose concentrations, 40.3 +/- 27.0 mM (726 +/- 486 mg/dl; UW) and 10.4 +/- 4.5 mM (187 +/- 81 mg/dl; HTK). We conclude that prominent endothelial cell injury also occurs in human liver grafts after preservation with UW solution or HTK solution. This endothelial cell injury is unlikely to be caused by hypoxia-induced energy deficiency, as it affects a cell type with a high glycolytic capacity in the presence of high glucose levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1994

[The value of duplex sonography after orthotopic liver transplantation. Experience with 44 patients].

In a prospective study, 44 patients (11 women, 33 men) who had received orthotopic liver transplants underwent a total of 196 consecutive duplex Doppler ultrasound examinations. The aim of the study was to evaluate the correlation between the pulsatile flow index (PFI) and the damping index (DI) as far as complications as rejection or cholangitis were concerned. The patients were examined five times each on average. The PFI and DI were measured in the hepatic artery, the portal vein and the hepatic veins. The findings were compared with the clinical course (cholangitis, rejection) and the histomorphological diagnosis as determined in biopsy specimens. In biopsy-proven rejection episodes, the sensitivity of the PFI in the hepatic artery was 69.4%, the specificity 72.2%. The sensitivity of the DI in the hepatic vein was 89.4%, the specificity 89.1%. Combining the two, specificity was more than 90%. PFI and DI in the portal vein bore no apparent relation to clinical course or histomorphological diagnosis. We found duplex Doppler ultrasound extremely beneficial in determining the timing and indication for liver biopsy. In addition, this simple examination, which can be performed as often as desired, accurately shows the transplanted liver's response to measures taken to counter rejection.

Adult↗
PubMed1994

Comparison of histidine-tryptophan-ketoglutarate (HTK) solution versus University of Wisconsin (UW) solution for organ preservation in human liver transplantation. A prospective, randomized study.

Over a 30-month period, 60 patients (30 in each group) suffering from end-stage liver disease or primary hepatic malignancy and scheduled for liver transplantation were enrolled in a prospective, randomized study to compare two methods of liver preservation: histidine-tryptophan-ketoglutarate (HTK) solution versus University of Wisconsin (UW) solution. Entry criteria for both groups were: age (18-65 years), elective surgery (transplantable or urgent category of the recipients), first transplantations and harvesting procedure performed by the same team. The parameters under investigation were the clinical and laboratory data pre- and post-transplantation, as well as follow-up data such as complications and survival. There were no significant differences in the two groups as far as the evaluation criteria were concerned, even when cold ischemia time was more than 15 h (n = 7). A slight, yet not significant, increase in late complications of the biliary anastomoses could be seen in the UW group. Hepatocellular injury (SGOT, SGPT, GLDH, lactate) appeared to be more marked in the HTK group. These results suggest that both HTK and UW solutions are appropriate for clinical use in liver transplantation, even if cold ischemia time is more than 15 h.

Adenosine↗
PubMed1994

[The effect of substitution with AT III- and PPSB-concentrates in patients with terminal liver insufficiency].

UNLABELLED: Patients with end-stage liver disease frequently develop combined coagulopathies due to increased procoagulant and fibrinolytic turnover as well as thrombocytopenia. The onset of clinical symptoms of a haemorrhagic diathesis requires balanced substitution of coagulation factors, since fresh frozen plasma alone does not always maintain a sufficient haemostatic potential in these patients. This substitution commonly follows standard rules based on the assumption that 0.5-1 IU of a coagulation factor or inhibitor concentrate given per kg body weight will increase its endogenous activity by 1%. We set out to investigate the validity of this standard regime in patients with end-stage liver disease scheduled for orthotopic liver transplantation. PATIENTS AND METHODS: Fifty-one adult patients were prospectively studied. In 37 patients with antithrombin III (AT III) activity < 70%, an AT III preparation (Kybernin, Behring, Marburg, Germany) was given preoperatively (mean dose 2616 +/- 207 IU) following standard calculations in order to increase endogenous activity to 80%. Twenty-seven of the patients had chronic hepatic failure (CHF group) with histologically proven cirrhosis and 10 had acute hepatic failure (AHF group). Blood samples were drawn prior to a 15-min infusion of AT III concentrate and 30 min thereafter. In 14 patients with prothrombin time (PT) < 40%, AT III levels had been corrected earlier during the clinical course to achieve activities > 70%. Prothrombin complex (PPSB, Beriplex, Behring, Marburg, Germany) was substituted (mean dose 2304 +/- 289 IU) to increase procoagulant activity to PT > 60%. Blood samples were drawn in the same fashion as in the AT III group. The amounts of AT III and PPSB concentrates (delta AT III, [IU/kg]; delta PPSB [IU/kg]) required to increase AT III activity and PT, respectively, by 1% were calculated. RESULTS: Standard calculations for AT III substitution indicated AT III recovery in all 37 patients who received AT III concentrate. However, there was a statistically significant difference between patients with CLF and ALF. In patients with CLF, delta AT III was found to be 0.8 IU/kg (+/- 0.1 SEM) and in those with ALF it was 1.5 IU/kg (+/- 0.1 SEM) (P < 0.05, t-test). In patients treated with PPSB concentrate, delta PPSB was 1.6 U/kg (+/- 0.2 SEM) for both CLF and ALF groups. CONCLUSIONS: In patients with end-stage liver disease standard rules for substitution with AT III-concentrate are adequate only for patients with CLF. In patients with ALF higher AT III doses are required to achieve the expected effect on endogenous AT III activity. Procoagulant activity, as reflected by PT, can be increased by 1% when 1.6 IU/kg PPSB concentrate is given. However, this study shows the effects of coagulation concentrates only 30 min after administration. An increased volume of distribution and increased turnover may explain the poor recovery of AT III activity in the ALF group, indicating that the dose of coagulation concentrate should be estimated against the background of the patient's clinical symptoms and diagnosis.

Adult↗
PubMed1994

A new method of veno-venous bypass during human orthotopic liver transplantation.

Veno-venous bypass is commonly used during orthotopic liver transplantation, but there is some controversy as to whether it contributes to a better outcome. Low shunt flows frequently reduce the efficacy of portofemoro-axillary systems and so a percutaneous cannulation technique for the subclavian and femoral vein with large bore catheters was developed in order to facilitate bypass management. This study reports the performance and complications of a portofemoro-subclavian bypass system during the anhepatic phase of human orthotopic liver transplantation in 85 patients. A percutaneous cannulation technique and two 7 mm (subclavian and femoral) catheters, inserted pre-operatively, were used in a pump driven portofemoro-subclavian bypass system. Coagulation profiles, shunt flows, haemodynamic parameters, and peri-operative complications associated with bypass were recorded for each patient. Percutaneous cannulation of the left femoral and subclavian vein was successful in 78 patients (91.8%). Mean femoro-subclavian shunt flow was 1.45 l.min-1 (SD 0.37), and mean portofemoro-subclavian flow was 4.28 l.min-1 (SD 1.03). Although oxygen delivery was not maintained at pre-shunt levels (559.7 (SD 147) vs 506 (SD 107) ml.min-1.m-2, p < 0.05) renal perfusion pressure stayed above 50 mmHg (during shunt it was 56 (SD 9) mmHg). One intra-operative air embolism was observed (1.2%), and in one patient a myocardial infarction occurred during the anhepatic phase; neither complication was considered to be related to the percutaneous cannulation technique. There were no bleeding complications. After operation, all chest X rays were normal and clinical examination revealed no adverse effects of portofemoro-subclavian bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Liver complications of HELLP syndrome--an indication for emergency liver transplantation?].

Three patients were treated suffering from a severe HELLP-syndrome. The problems as far as the diagnostic and therapy are concerned are discussed. All three patients had to be operated on in an emergency state. The operations were performed due to acute and severe abdominal bleeding. Two of the patients needed liver transplantation as an emergency procedure, one of them died after hepatectomy waiting for a graft. Another one died seven weeks after successful transplantation due to prolonged sepsis. The third patient is more than one year after transplantation alive and doing well.

Adult↗
PubMed1994

[Liver complications in HELLP syndrome].

In a 5 years period 5 female patients suffering from a severe HELLP syndrome were treated. The problems concerning diagnostic and treatment are discussed. 3 patients had to be operated on in an emergency state. The operations were performed because of acute and severe abdominal bleeding. Two of the patients needed liver transplantation as an emergency procedure, one of them died after hepatectomy on the list. Another one died 7 weeks after successful transplantation in a state of prolonged sepsis. The two conservatively treated and the one transplanted patient are still alive and well.

Adult↗