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L Bühler

Publications and source records attributed to L Bühler.

77 records · Page 5Linked to original sources
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[Long-term followup of patients with alveolar echinococcosis].

INTRODUCTION: Alveolar Echinicoccosis is a severe parasitic disease: its natural evolution is comparable to a slowly progressive malignant liver tumour. There is no definitive medical therapy. Surgery remains the only option to assure a cure. This report is our surgical experience for the care of this affection. PATIENTS AND METHOD: Between 1980 and 2002, 12 patients were operated for an hepatic alveolar echinococcosis. For 11 of them, the affection was primary. Lesions were located in the right liver lobe (n = 9), in the left lobe (n = 1), in both lobes (n = 1) and close to the hilar region (n = 1). Twice there was a diaphragmatic infiltration and once a pleural infiltration. Resections consisted in: segmentectomies in the right lobe (n = 4), right hepatectomy (n = 5, associated once with a partial I and IV segmentectomy), left hepatectomy (n = 1), one liver transplantation (n = 1), one drainage of a parasitic cavity (n = 1). One pleurectomy and a partial diaphragmatic resection were made. All patients were treated postoperatively with benzimidazole chemotherapy. RESULTS: Three patients presented some complications: segmental necrosis with biloma (n = 1), biliary fistula tract (n = 1), subdiaphragmatic hematoma (n = 1), cholangitis (n = 1). 10 patients are alive (median follow-up of 10 years). Two patients still present some parasitic lesions; the situation remains doubtful for one of them. Two patients died (one of them in the context of a disease progression). CONCLUSION: Surgical treatment, associated with medical therapy, assured a control of the parasitic lesions or a definitive cure in most cases. When the disease is limited to the liver with no possibility for partial hepatectomy, a transplantation is an option.

Adult↗
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Effect of HLA matching in simultaneous pancreas-kidney transplantation.

UNLABELLED: Simultaneous pancreas-kidney (SPK) transplantation has become the therapy of choice for type 1 diabetic patients with end-stage renal disease. The current analysis examined the impact of HLA matching on graft outcome following SPK transplantation. The study population was obtained from patients enrolled in the Euro-SPK 001 study. PATIENTS AND METHODS: The effect of HLA matching on graft function and survival was assessed in 180 SPK recipients in whom complete donor-recipient HLA data were available. A group of 45 patients with 0 to 3 HLA mismatches (MM) was compared to 135 patients with 4 to 6 MM. RESULTS: There were no differences in 3-year kidney, pancreas, or patient survival rates between the 0 to 3 and 4 to 6 MM groups. Biological parameters of kidney and pancreas graft function were similar in both groups. Significantly more patients with 0 to 3 MM (66%) were rejection free at 3 years than those with 4 to 6 MM (41%; P = .003). The relative risk of acute rejection was 2.6 times higher among patients with 4 to 6 MM than among those with 0 to 3 MM. In conclusion, there was no evidence that HLA matching was associated with improved kidney or pancreas survival. However, a higher rate of acute rejection was observed with poor HLA matches, which may impact long-term survival.

Follow-Up Studies↗
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Isolation of adult porcine islets of Langerhans.

While human islet allotransplantation is limited due to the shortage of donors, pig islet xenotransplantation appears to be a possible alternative. Enzymatic digestion is the method most commonly used for adult pig islet isolation, but since the description of the semiautomated isolation technique in the late 1980s, yields of pig islet isolations have not increased significantly. This review article is intended to collate published information on adult pig islet isolation to provide the reader with a clear overview of the relevant issues in this field, and to detail the current state of the art.

Animals↗
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Long-term results after surgical management of chronic pancreatitis.

BACKGROUND/AIMS: Long-term outcome in surgery for chronic pancreatitis remains relatively unknown. METHODOLOGY: Between 1963 and 1993, we performed 123 pancreatic resections and 35 drainage procedures for severe chronic pancreatitis. We reviewed 131 patients with a mean follow-up of 48 months (4 months to 18 years). RESULTS: Actual 10-year survival was 82% for nonalcoholic patients and 51% for alcoholic pancreatitis. Pain was successfully treated in 71% with pancreatic resection and in 42% with drainage procedures (p<0.01). Although post-operative diabetes mellitus occurred in 56% of patients after pancreatic resection, long-term nutritional status was similar after pancreatic resection and drainage procedures. Weight gain could be observed in 75 patients (47%) and quality-of-life was good to excellent in 97 patients (74%). CONCLUSIONS: In conclusion, long-term survival was mainly conditioned by the etiology of the disease. Pancreatic resections were more successful in treating intractable pain than drainage and required fewer re-interventions. As presumed, resections were associated with a higher rate of diabetes mellitus, but this, however, had no impact on long-term nutritional status and quality-of-life.

Adult↗