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Biomedical subjects

K J Oldhafer

Publications and source records attributed to K J Oldhafer.

At least 19 recordsLinked to original sources
PubMed2004

[Symptomatic biliary stones at the lower end of the common duct following hepaticoduodenostomy].

A 66-year-old patient developed episodes of severe pain due to recurrent cholangitis and pancreatitis. 2 years prior to this referral the patient had undergone an end-to-side hepaticoduodenostomy and a cholecystectomy because of choledocholithiasis and obstructive jaundice. 20 years previously a Billroth II operation had been carried out for the treatment of ulcer disease. Since the hepaticoduodenostomy the patient has suffered from recurrent epigastric pain, nausea and postprandial vomiting. An oedematous pancreatitis following a recurrent chronic cholangitis was assumed. As the intrahepatic biliary ducts appeared to be normal on radiological studies and hepatobiliary scintigraphy showed a downright transit of the tracer, recurrent cholangitis appeared at first to be a rather unlikely explanation. However, follow-up MRI and MRCP showed large calculi at the lower end of the common duct, which was also enlarged up to 1 cm. For this reason an open duodenotomy with subsequent papillosphincterotomy and retrograde choledochoscopy was carried out. The diagnosis was confirmed hereby and all calculi were removed during the operation. Since then the patient has been free of symptoms and complaints. This case shows that remaining calculi at the lower end of the common bile duct can cause severe clinical problems. Therefore the bile ducts should be inspected endoscopically and stones removed prior to, or during the primary operation.

Aged↗
PubMed2003

[Intraoperative radiotherapy in Germany].

BACKGROUND: Intraoperative radiotherapy (IORT) represents an attractive method for local tumour control after surgical resection. IORT was introduced into multimodal treatment protocols in the 1980s. Aim of this study was to analyse the actual clinical and scientific activity of IORT in Germany. METHODS: Questionnaires were sent to 102 centres in Germany. The analysis was focussed on indications in general surgery including bone tumours to evaluate the activity of IORT. The literature was analysed by a medline search for the years 1975 to 2001. RESULTS: Questionnaires were answered by 92% of the centres. 24 departments are working with IORT in Germany (16 of them are university hospitals). Main Indications for IORT treatment are rectum carcinoma and soft tissue sarcoma. Furthermore, IORT is used in patients suffering from gastric, pancreatic and bile duct malignancies. Some IORT programs are also targeting on patients with head and neck malignancies and brain tumours. German institutions published within the last 5 years about 14% of all " Medline"-listed publications concerning IORT. CONCLUSION: There is an profound activity of IORT in Germany, which is concentrated on a few centres. A need for better national and international cooperation of centres performing IORT for clinical trials and to collect significant numbers of patients seems to be evident.

Bile Duct Neoplasms↗
PubMed2002

[Acceptance of computer-assisted surgery planning in visceral (abdominal) surgery].

The acceptance of computer assisted surgical planning was studied by polling 500 German surgeons. 500 questionnaires were sent, from which 105 have been returned, from which 102 could be analysed. The questionnaire consisted of 14 questions relating to the current practice of surgery planning as well as to desired improvements. In general, the computer assisted surgical planning was assessed as a promising tool in the future. 82 % of the surgeons expected a benefit by computer assisted surgical planning. Better assessment of resectability, better training of residents and more safety of surgical procedures were mentioned in the majority. Computer assisted surgical planning should focus on 3D visualization of spatial relations between lesions and vascular structures, on facilities for the preoperative trial of resection strategies and on the documentation of the planned procedure. The current version of a research prototype (Surgery-Planner) is presented which is dealing with these goals.

Adult↗
PubMed2002

[Gastrocolic fistula - a rare cause of cachexia and polyneuropathy].

Gastrocolic fistula is a rare clinical disorder which in the past most often occurred after gastric surgery or carcinoma of the gastrointestinal tract. However, during the last decade an increasing number of cases after benign gastric ulcers have been described. Most common symptoms have been weight loss, abdominal pain, diarrhea and copremesis. A 49-year-old cachectic patient presented with a 2-year history of abdominal discomfort and diarrhea. He reported a weight loss of 32 kg during this period and was finally unable to move because of exhaustion. Furthermore, he suffered of burning paresthesia of the legs and the abdomen. His medical history included a Billroth II operation because of recurrent ulcer disease in 1987. Barium enema revealed a gastrocolic fistula which caused small bowel bacterial overgrowth with villous atrophy and malabsorption and development of polyneuropathy. The fistula was surgically resected, and postoperatively, the patient improved and regained his weight. Gastrocolic fistula is a rare cause of diarrhea and should be considered in clinical practice. Barium enema is superior to endoscopy in detecting gastrocolic fistula.

Cachexia↗
PubMed2001

[Ex situ resection and resection of the in situ perfused liver: are there still indications?].

Most liver tumors can be removed with conventional resection techniques employing partial or total vascular occlusion when needed. Duration of tolerable warm ischemia has not yet been defined, but it seems to be well tolerated up to 60 min. In a few cases with extended vascular resection and reconstruction liver protection by hypothermic perfusion is advantageous. This can be achieved by in situ perfusion, ante situm resection or ex situ resection. Major reconstruction of hepatic vessels with good technical access should be performed under in situ hypothermic protection using veno-venous bypass. Tumors involving the hepatic venous confluence and/or retrohepatic vena cava should be approached by either the in situ, or preferentially, the ante situm resection technique. The indication for an ex situ liver resection resulting in autotransplantation of the remnant liver exists only in rare cases for oncological reasons.

Adult↗
PubMed2001

Filtration of malignant cells: tumour cell depletion in an ex vivo model using a leukocyte adhesion filter.

The clinical use of leukocyte adhesion filters is based on differentiated depletion of blood cells, although most of the mechanisms of filtration are still unclear. There is also evidence that leukocyte adhesion filters can remove disseminated tumour cells from patients' blood. The following proves this observation and consists of three parts: in the first part we analysed the depletion capacity of the LeucotrapWB filter medium (Pall) in an employed small-scale model for the cell line HT29 (colorectal origin) in phosphate-buffered saline (PBS) solution. A depletion rate of more than 99.6% for HT29 cells was seen. In the second part of the study, samples of whole blood were spiked with HT29 cells in a similar setting, showing comparable results. In the last part, defined cell suspensions of various human primary tumours were admixed to whole blood samples and afterwards filtrated in a scale-up model. Again, a nearly complete tumour cell reduction was seen after filtration. Results show a significant tumour cell reduction and, for most cases, a complete depletion of tumour cells independently from quality and origin of the tumour tissue. These experiments and further investigation are supposed to help to reduce the risk of dissemination of tumour cells in patients undergoing oncological surgery.

Cell Adhesion↗
PubMed2000

Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction.

STUDY DESIGN: This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 degrees gibbus at the thoracolumbar junction. OBJECTIVES: A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving lengthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. SUMMARY OF BACKGROUND DATA: Review of the literature showed no reported cases of hepatic ischemia or descriptions of the status of celiac trunk stenosis after spinal surgery. Even in more commonly associated settings, diagnosis of both phenomena is often delayed, with possible morbid consequences. METHODS: A case is presented of a patient who underwent gibbus correction and re-establishment of lost anterior intervertebral distance at the thoracolumbar junction. After surgery, ischemic hepatitis, a perforated gallbladder, and splenic infarction developed secondary to celiac trunk stenosis-a result of cephalad displacement of the celiac trunk and compression of the artery by the diaphragmatic ligament. RESULTS: An emergent exploratory laparotomy with cholecystectomy was performed followed by an angiogram, which demonstrated stenosis of the celiac trunk. After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. CONCLUSIONS: The consequences of a delay in diagnosis of hepatic ischemia can be disastrous. An awareness of the possibility of this complication after spinal lengthening should facilitate a timely angiogram and operative intervention.

Adult↗
PubMed2000

[Extended liver resection in small children under circulatory arrest and "low-flow" cardiopulmonary bypass].

In order to perform resections of tumors at critical sites in the liver in young children, liver resections in cardiac arrest and deep hypothermia under cardiopulmonary bypass have been developed. We report our experience with liver resection under cardiopulmonary bypass in three children with hepatoblastoma. In the first child the operation was performed under cardiac arrest and, the other two children were operated on under "low flow" conditions. The periods under cardiopulmonary bypass circulation were well tolerated. Extended right liver resections with vascular reconstructions were performed. The postoperative increase of liver enzymes was moderate. The increase in GOT was between 100 and 200 U/l. In spite of the extended tumor growth, reasonable long-term results were achieved by resection in combination with chemotherapy. One child has been living 8 years and another 10 months without tumor recurrence. The third child died due to sepsis during adjuvant chemotherapy, after she had recovered well from liver resection.

Age Factors↗
PubMed2000

[Individual planning of liver surgery interventions with a virtual model of the liver and its associated structures].

BACKGROUND: In an interdisciplinary approach, HepaVision (MEVIS, Bremen), a software tool specifically developed for 3D visualization of the liver, was employed for individual planning of extensive liver resections and evaluation of living-relative donations. So far there is experience with more than 50 biphasic spiral CT examinations. RESULTS: The spatial relationship of large tumors to crucial hepatic structures, the demonstration and evaluation of anatomic variants regarding vascular supply and the risk stratification of liver failure by volumetric analysis on the basis of portal venous drainage supported precise indication for surgery. Surgical safety is increased by preoperative planning and simulation of necessary vessel reconstructions. By hiding selective areas of portal venous drainage or applying freely selectable clip planes, segmental as well as non-anatomical resections can be simulated and their effects analyzed. The virtual preoperative situs was confirmed intraoperatively in all 17 patients of our study population who underwent segmental liver resection for either a tumor or living-relative donation.

Adenoma, Liver Cell↗
PubMed2000

Native pyeloureterostomy after kidney transplantation: experience in 48 cases.

Necrosis and stenosis of the ureter are severe complications after kidney transplantation and occur with mean incidence of 2,9-13,4 %. Several surgical techniques like simple nephrostomy or complex urinary tract reconstruction have been applied for repair. In this study, our experience with native pyeloureterostomy (NPUS) using the native ureter is presented. Between March 1978 and June 1996, 2,592 kidney transplantations were performed in our institution. In 48 patients (1,9%), secondary urinary tract reconstruction by NPUS was necessary. These patients were evaluated retrospectively by review of the case notes. At the time of operation the mean age was 45 +/- 14 years. Indications for NPUS were distal ureteral stenosis (n = 29), necrosis (n = 17), bleeding (n = 1) or iatrogenic lesion of the ureter (n = 1). The mean time period between transplantation and urinary tract reconstruction was 20 +/- 23 days (range: 1-90 days) for necrosis and 404 +/- 637 days (range: 14-2,385 days) for stenosis. A pyeloureterostomy was technically feasible in all patients using the recipient's ipsilateral ureter. In 40 out of 48 patients the graft developed a normal function postoperatively (follow up: 39 +/- 48 months). A graft nephrectomy was necessary only in one patient, because of complete pyelonnecrosis 6 days after NPUS. Two grafts were lost due to acute rejection. Data of five patients were not available > 15 years after successful reconstruction. We can conclude that NPUS is a safe and simple rescue technique for the treatment of distal ureteral complications after kidney transplantation. Therefore, this technique should be the therapy of choice when secondary reconstruction by re-ureteroneocystostomy is not possible.

Female↗
PubMed2000

Ex-vivo resection techniques in tissue-preserving surgery for liver malignancies.

Some primary and secondary liver tumours are not absolutely irresectable, but cannot be resected using a conventional approach because of the limited warm ischaemia tolerance of the liver or poor accessibility of the tumour region. In such situations, the techniques of ex vivo liver surgery, pioneered by Rudolf Pichlmayr some 10 years ago, offer new chances for R0 resection. All the three different approaches, namely "in situ"-, "ante situm"-, and "ex situ" resection, require the use of measures originally developed for transplantation, such as hypothermic liver perfusion and veno-venous bypass. They differ mainly in the extent to which major vessels are divided in order to achieve optimal mobility of the organ. The results show that radical resection can be achieved accomplished in many cases. If necessary, complex vascular reconstructions can be performed. Although perioperative morbidity and mortality are high, there are a number of long-term survivors. Tumour recurrence, however, remains the main problem over the long term. In conclusion, ex vivo liver surgery is an important extension of surgical treatment possibilities. However, the procedure is suitable only for a small number of carefully selected patients and should be reserved for use in specialised centres. Furthermore, in view of the fact that the results are not yet optimal, additive and adjuvant treatment modalities are needed.

Blood Loss, Surgical↗
PubMed2000

Long-term experience after ex situ liver surgery.

BACKGROUND: Ex situ liver surgery allows liver resection and vascular reconstruction in patients who have liver tumors located at critical sites. Only a small series of studies about ex situ liver surgery is available in the literature. No long-term results have been published. METHODS: Twenty-four patients were considered for ex situ liver surgery because conventional liver surgery was considered impossible or too hazardous. The patient's ages were 51.3 +/- 7.5 years. Indications were various primary and secondary liver malignancies and benign liver tumors in 2 patients. RESULTS: In 22 of 24 patients, the ex situ liver resection and subsequent autotransplantation were performed. The anhepatic periods in these patients lasted for 5.6 +/- 1.1 hours. In the remaining 2 patients, autotransplantation was not possible and allogenic liver transplantation was performed 17 and 19 hours after hepatectomy. In 4 patients, liver failure occurred after autotransplantation and required transplantation. The confluens between hepatic veins and the inferior vena cava was reconstructed in 5 patients. Fifteen patients survived the postoperative period and were discharged after 36.5 +/- 16 days. The median survival time of 6 patients who had metastases of colonic carcinoma was 21 months. The 2 patients with benign liver disease are alive 9 and 5 years after ex situ surgery. CONCLUSIONS: Extended liver resections with difficult reconstructions of the hepatic venous confluens are feasible by ex situ liver surgery and subsequent autotransplantation. However, the early postoperative mortality rate is high, especially in patients with cholestatic livers. Early tumor recurrence remained the problem in these patients with extended local tumor spread. Ex situ liver surgery should only be performed in selected patients.

Adult↗
PubMed2000

Isolated hyperthermic liver perfusion with high dose tumor necrosis factor alpha in pigs: an experimental study in preparation of clinical Use.

Isolated hyperthermic perfusion of the liver was performed for 45 min in 27 pigs via hepatic artery and portal vein at mean inflow temperatures between 40.7 and 41.2 degrees C. In two study groups B and C (n = 9 pigs each) 50 microg recombinant human tumor necrosis factor-alpha (rhTNFalpha) per kg body weight were added to the perfusate, whereas in a control group A liver perfusion was done without rhTNFalpha. Before reperfusion the livers were washed out with Ringer's solution in all groups followed by a protein solution in group C. At 30 and 60 min after reperfusion the maximum systemic rhTNFalpha concentrations were significantly higher in group B with 68 and 61 ng/ml compared to 14.5 and 14.9 ng/ml in group C (p < 0. 05). Mean systemic porcine TNFalpha concentration was significantly higher in group B (217 pg/ml) compared to group C (50 pg/ml) 30 min after reperfusion (p = 0.012). Survival was 7/9 in group A and C and only 2/9 in group B with 6/7 pigs dying due to severe cardiopulmonary failure within 12 h after operation. In surviving pigs of group A and C only mild and transient hepatotoxicity was registered. The presented study underlines the feasibility of high dose rhTNFalpha application in an isolated hyperthermic liver perfusion system. Washout of the liver with a protein solution before reperfusion reduces systemic TNFalpha levels as well as associated lethal cardiocirculatory and hepatotoxic side effects.

Animals↗