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R Raakow

Publications and source records attributed to R Raakow.

At least 37 records · Page 2Linked to original sources
PubMed1998

A liver with polycystic liver disease as graft for orthotopic liver transplantation.

Donor organ shortage calls for widening of criteria for organ transplantation. In exceptional cases, even livers with macroscopic alterations may be accepted for transplantation. The case of a patient who received a liver graft from a donor with previously unknown adult polycystic degeneration is reported. The liver showed only small bilobar cysts with less than 10% of hepatic replacement and was successfully used for orthotopic liver transplantation. Two years after transplantation the patient is in good clinical condition and has returned to work.

Cysts↗
PubMed1998

[Results of laparoscopic fundoplication for treatment of gastroesophageal reflux].

We report on 48 patients, treated by laparoscopic fundoplication for pronounced gastroesophageal reflux disease. The results show that laparoscopic fundoplication is a very safe, gentle, and successful procedure for the therapy of gastroesophageal reflux disease. We regard laparoscopic fundoplication as a good alternative to long term medical therapy if a careful diagnosis and indication is provided.

Adult↗
PubMed1998

[Surgical interventional endoscopic treatment concept of bile duct lesions after laparoscopic cholecystectomy].

In this study we analysed 25 patients with bile duct injuries following laparoscopic cholecystectomy retrospectively. Reconstructive surgery was necessary in 24 patients with bile duct lesions that could not be treated endoscopically. After a mean follow-up of 28 months (3-65) we have good functional outcome in the majority of patients, however, one patient required liver transplantation because of secondary biliary cirrhosis.

Bile Ducts↗
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

Famciclovir therapy for recurrent hepatitis B virus infection after liver transplantation.

Between November 1993 and June 1995 18 patients received oral famciclovir (3 x 500 mg) for treatment of hepatitis B virus (HBV) reinfection after liver transplantation. Reinfection was defined as the reoccurrence of HBsAg in the serum. In the first 15 patients, famciclovir therapy was initiated after clinical signs of graft hepatitis, whereas the last 3 patients received treatment immediately after HBV-DNA was detected. Famciclovir was well-tolerated in all patients. HBV-DNA values were decreased to undetectable levels in 8 out of 18 patients. Clinical status improved in 7 patients, whereas 5 patients remained unchanged and 6 patients progressed to deteriorating graft function and death. When famciclovir was initiated early after reinfection, a response rate of approximately 66% was observed. Late onset of therapy in patients with fulminant hepatitis generally failed to provide any clinical benefit.

2-Aminopurine↗
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

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↗
PubMed1994

Fungal infections in liver transplant recipients.

A retrospective analysis of 462 consecutive orthotopic liver transplantations was undertaken to evaluate incidence, risk factors, clinical course, and outcome of fungal infections. Infections involving Aspergillus (6 cases), Candida (5 cases), Mucor (1 case), and Cryptococcus (1 case) were observed in 2.8% (13/462) of our patients. Twelve of the 13 episodes developed during the first 2 postoperative months. None of the potential risk factors for fungal infections described by other authors (i.e., age, rejection treatment, dialysis, mechanical ventilation, graft failure, long operation time, second transplant, serious non-fungal infection) correlated significantly with the episodes in our patients. However, in patients who exhibited three or more of these potential risk factors the incidence of fungal infections was elevated (P < 0.001). Six of seven exogenous infections (Aspergillus, Mucor) began before July 1991 when our department moved from Charlottenburg to Wedding, thus indicating that the incidence of these infections is highly influenced by exposure (P = 0.01). Exposure prophylaxis should therefore by meticulously followed, particularly when severely compromised patients are involved, in order to prevent exogenous infections (i.e., Aspergillus/Mucor). Infections involving such patients are combined with a very high mortality (57%). We observed Candida infection as a pathological overgrowth of physiological oropharynx flora into the esophagus and/or trachea in five patients. In each case treatment led to full recovery.

Adolescent↗
PubMed1994

Bacterial and fungal colonization and infections using oral selective bowel decontamination in orthotopic liver transplantations.

Bacterial and fungal infections are a major cause of morbidity and mortality after orthotopic liver transplantation. In the immunocompromised host, infections are thought to arise from the gut, which is almost always colonized with potential pathogens. Using oral selective bowel decontamination (SBD), potential pathogens can be eradicated from the gut and infections prevented. In this catamnestic study we have reviewed gastrointestinal colonization, bacterial and fungal infections, and bacterial resistance to standard antibiotics in our first 206 liver transplant patients while under SBD. With few exceptions, gram-negatives were eradicated from the gastrointestinal tract and secondary colonization was inhibited. In spite of unsatisfactory elimination of Candida, probably because nystatin doses were too low, Candida infections were rare (n = 4) and none was fatal. One and two-year survival rates were 93% and 92%, respectively. The bacterial and fungal infection rate was 27.8% with an infection-related mortality of 1.95%. Infections with aerobic gram-positive bacteria prevailed and only 11 gram-negative and 11 fungal infections occurred; among the latter, Aspergillus and Mucor were the most serious and responsible for three of the six deaths in this series. With regard to the development of resistance, we found an increasing number of enterococci and coagulase-negative staphylococci resistant to ciprofloxacin and imipenem, respectively, but unlikely as a consequence of SBD.

Administration, Oral↗
PubMed1994

Results of liver transplantation in acute liver failure caused by viral hepatitis.

Fulminant liver failure due to acute viral hepatitis is the most common emergency indication for liver transplantation. The postoperative course is highly correlated with the type and duration of infection. The complication rate is lowest in fulminant hepatitis B patients and highest in subacute hepatitis C/NANB patients.

Bilirubin↗
PubMed1993

[Special "supportive" therapy (nutrition, control of infection, intensive care) in transplantation medicine].

With the increase in clinical organ transplantation the importance of specific "supportive" therapy in addition to surgical technique and immunosuppression is being recognized more widely. Our own experience is based on 273 orthotopic liver transplants which were performed in 255 adult patients between September 1988 and May 1992 with an one-year survival rate of 91%. With the routine use of selective bowel decontamination (SBD) pre- and postoperatively 63 bacterial or fungal infections occurred in 57 of 230 liver graft recipients during the first 4 postoperative weeks, 4 of these infections with fatal outcome. The incidence of cytomegalovirus (CMV) disease reached 18.6% (39 of 210 patients). The risk of developing CMV disease depended upon the previous serological status of donor and recipient but also showed an increase after anti-rejection therapy with steroids or OKT3. One death due to CMV pneumonitis occurred. The importance of nutritional support, infectious disease control and intensive care therapy for solid organ transplantation is being discussed in general.

Critical Care↗
PubMed1992

Quadruple immunosuppression including a new IL-2-receptor antibody and the incidence of infections after liver transplantation.

Immunosuppression is a primary concern after orthotopic liver transplantation (OLT). On the one hand, the graft is at jeopardy through acute or chronic rejection, and on the other, immunosuppression and antirejection therapy increase the risk of infectious complications. Effective immunosuppression therefore should prevent rejections without leading to a high rate of infections, bearing in mind the fact that infections and infection-related complications are the most frequent causes of early death after liver transplantation. With more specific immunosuppression the infectious complications can potentially be minimized. Antithymocyte globulin (ATG) and the first monoclonal antibody OKT3 immunosuppression are non-specific. The replacement of these antibodies in a quadruple immunosuppressive regimen with the new monoclonal IL-2R antibody BT 563 probably reduces the early infection rate. We report on our first experience with BT 563. The incidence of infection was compared with a historical control group with ATG.

Adult↗