Biomedical subjects

W O Bechstein

Publications and source records attributed to W O Bechstein.

At least 19 recordsLinked to original sources

PubMed2007

[Colorectal liver metastases. Neoadjuvant chemotherapy: aspects of medical and surgical oncology].

Colorectal liver metastases are detected in 15-20% of patients at the time of diagnosis of the primary tumor, they develop in an additional 20-30% of patients during further course of the disease. Radical resection enables 5-year survival rates of 30-50%. Resectability may be increased by surgical techniques including two-stage hepatectomy and portal vein embolization. Furthermore, modern chemotherapy including various combinations of oxaliplatin, irinotecan, bevacizumab, and cetuximab has led to secondary resectability correlating to response rates which may be up to 80%. Changes of hepatic histology such as sinusoidal obstruction (e.g. following oxaliplatin) or steatohepatitis (e.g. following irinotecan) have been described. Individually, this may increase the risk of subsequent liver resection. As of today the role of neoadjuvant chemotherapy for resectable lesions has not been definitively confirmed.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

Epstein-barr virus-associated posttransplant lymphoproliferative disorder of donor origin after simultaneous pancreas-kidney transplantation limited to pancreas allograft: A case report.

A 45-year-old man was admitted with fever and elevated pancreas enzymes 6 months after simultaneous pancreas-kidney transplantation (SPKT). Function of the allografts was normal. Bacterial and fungal infections were excluded, while Epstein-Barr virus (EBV)-polymerase chain reaction (PCR) was positive. However, screening for EBV-associated lymphoma was negative. EBV infection did not respond to antiviral therapy. After an 18F-Fluorodeoxyglucose positron emission tomography positive signal and an abnormal computed tomography scan of the pancreas transplant, a biopsy revealed a diffuse large monomorphic B-cell lymphoma, which was confined to the grafted organ. Its origin was assigned to the donor by microsatellite analysis. Reduction of immunosuppression and immunotherapy with rituximab was unsuccessful. After 10 weeks, the patient developed an acute hemolytic uremic syndrome which required explantation of the allografts. Subsequent to the intervention, fever disappeared, EBV DNA became undetectable and lymphoma screening remained negative. In posttransplant lymphoproliferative disorder of donor origin after SPKT, transplantectomy may be a curative therapy.

Adult↗

PubMed2006

Evaluation of type 1 diabetics for simultaneous pancreas-kidney transplantation with regard to cardiovascular risk.

The main cause of death for diabetic patients and patients on dialysis is coronary artery disease (CAD). The most common cause of graft loss following simultaneous pancreas and kidney transplantation (SPK) is death with a functioning graft due to CAD. Therefore, careful pretransplantation evaluation of CAD is mandatory. In our series, every patient undergoes a noninvasive cardiac function test like dobutamine stress echocardiography (DSE) or myocardial thallium scintigraphy using adenosine to induce medical stress. Thirty patients were evaluated for SPK: 15 patients with myocardial scintigraphy and 8 with DSE. Seven investigations showed pathological findings and we performed coronary angiograms, none of which showed coronary artery stenosis. Seven primary coronary angiograms were performed: four due to a history of CAD and three as a primary diagnostic. Following SPK one patient died at 21 days after transplantation due to myocardial infarction. He had a history of CAD with angioplasty and stent implantation. Noninvasive cardiac function tests like DSE or myocardial scintigraphy are reliable methods to evaluate CAD in patients with diabetic nephropathy awaiting SPK. In case of a suspicious finding or a history of CAD, a coronary angiogram should be performed to assess the need for revascularization. Following this algorithm we may further reduce the mortality of SPK.

Adult↗

PubMed2006

[Colorectal cancer liver metastases -- neoadjuvant concepts for preoperative down-sizing].

Liver resection for colorectal metastases disease can be performed with curative intent at low morbidity and mortality. Only 15-30 % of liver metastases are amenable to potentially curative resection. Five year survival following primary and repeat liver resection has consistently been reported as 25-40 %. Future strategies focus at widening the indication and extending therapeutic options. The aim of neoadjuvant treatment of irresectable liver metastasis is the conversion to secondary resectability either via increasing residual liver mass (portal vein embolisation/2-stage resection) and/or reducing tumor load via chemotherapy ("down-sizing"). Current data suggest resectability following neoadjuvant chemotherapy in around 8 % of cases but varying between 1-33 %.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

[Radiological diagnostics and follow-up of rectal carcinoma].

Rectal carcinoma is one of the most frequent malignant tumors in adulthood. Not only after total resection but also after partial resection of the tumor with postoperative radiochemotherapy a sufficient follow-up is necessary to diagnose recurrent rectal cancer as early as possible. Various guidelines suggest different intervals for physical examinations and diagnostic methods depending on the initial tumor stage. In addition to routine examinations, the physician can choose between CT, MRI, endosonography and functional imaging techniques such as PET and immunoscintigraphy for further evaluation if a recurrent rectal cancer is suspected. Multiple studies and meta-analyses show the differences in the specificity and sensitivity of the diagnostic methods in the detection of lymph nodes, metastases, and local tumor infiltration. Endosonography and endorectal MRI show very good results in staging local tumor infiltration. However, obstructive lesions can inhibit an adequate examination. CT provides prompt and convincing results in the evaluation of the metastases. Most of the time the tumor can be identified but the lack of detailed imaging makes it hard to perform sufficient staging. Additionally image-guided biopsy can be performed. Immunoscintigraphy and PET have a high specificity because they take advantage of the tumor's metabolism. The introduction of the PET-CT has eliminated the disadvantage of low image resolution. In addition to the detection of small nodular pulmonary metastases, MRI with its "phased-array" coils is another excellent tool for the diagnosis of recurrent rectal cancer and search for metastases. This review shows the advantages and disadvantages of each diagnostic method in the visualization of recurrent rectal cancer.

Diagnostic Imaging↗

PubMed2006

Nutritional support after open liver resection: a systematic review.

BACKGROUND: Perioperative nutrition in patients with limited liver function after partial hepatic resection is still controversial. In particular, the significance of perioperative total enteral nutrition remains unresolved. The aim of this review is to investigate the impact of early postoperative total enteral nutrition on convalescence after partial liver resection. MATERIALS AND METHODS: In an internet-based Medline-Search (time course: 1960-08/2005) a total of five prospective, randomized controlled trials were found comparing the impact of enteral and parenteral nutrition after liver resection. After study validity had been established, a systematic review was undertaken (odds ratio, 95% confidence interval, p < 0.05 level of significance; Review Manager 4.2, The Cochrane Collaboration). Primary endpoints were complication rate (infection, organ malfunction) and mortality. Standardized immune parameters were also surveyed. RESULTS: Statistical analysis showed that enteral nutrition resulted in a significantly lower rate (p = 0.04) of wound infection and catheter-related complications than parenteral nutrition did. No statistically significant differences in mortality due to enteral or parenteral nutrition could be found. Patients receiving enteral nutrition showed better postoperative immune competence. CONCLUSION: Early enteral nutrition after liver resection is a safe procedure. Compared to parenteral nutrition it is associated with a decreased incidence of postoperative complications. Facing the inhomogeneity of these trials, especially in nutrition protocols and end points, this first systematic review stresses the need for an update of the importance of early enteral nutrition after liver resection within randomized controlled multicenter trials.

Hepatectomy↗

PubMed2005

[Standard surgical resection of colorectal liver metastases].

Liver resection for colorectal metastases can be performed with curative intent in about 15-20% of patients. From a surgical point of view, achieving a radical (R0) resection is of paramount importance. Perioperative mortality is mainly linked to the extent of the resection (class I/II). Results of ischemic or drug-induced preconditioning have been ambiguous, and their clinical use is at most questionable. Five-year survival following primary and repeated liver resection is consistently reported at 30-40%. The options for improving prognosis by purely technical means appear limited. Instead, future strategies must aim at the conversion of primarily irresectable and potentially resectable liver metastases into resectable tumors. This could be achieved preoperatively via portal vein embolisation and neoadjuvant chemotherapy and surgically via sequential resection or a combination of surgery with local ablative therapy. All suggested modalities for primarily inoperable tumors should be systematically evaluated in clinical trials.

Colorectal Neoplasms↗

PubMed2005

Does the liver ever age? Results of liver transplantation with donors above 80 years of age.

INTRODUCTION: Facing an increasing shortage of donor organs, donor criteria become more extended and so-called marginal organs are accepted for transplantation. For liver donation donor age above 70 years is accepted as a risk factor concerning primary dysfunction or nonfunction. Therefore, the aim of this study was to compare the early outcome of grafts older versus younger than 80 years of age. PATIENTS AND METHOD: Between August 2002 and February 2004, 40 adult liver transplants were performed using triple immunosuppression with tacrolimus, MMF, and low-dose corticosteroids. Recipients with HCC received low-dose rapamycin after postoperative day 14. The outcome of grafts from donors under 80 years of age (n=35) was compared with those from donors 80 years old or more (n=5). For statistical analysis Mann-Whitney-U-Test and Fisher's Exact Test were used with P < .05 considered statistically significant. RESULTS: The average donor age of our population was 54.4 +/- 17.3 years with five donors older than 80 years (80-83 years). These donors all had additional risk factors. The recipients of the latter grafts suffered from HCC and liver cirrhosis Child A (n=2) or from viral hepatitis (n=3). One recipient had advanced cirrhosis with severe complications. The outcomes of both groups were comparable concerning intraoperative and postoperative courses. All recipients of old liver grafts left the hospital with stable graft function. CONCLUSION: Liver grafts over 80 years can be transplanted with good results, especially if given to recipients with malignancy and otherwise stable liver function.

Age Factors↗

PubMed2005

Acceptance criteria of pancreas grafts: how do surgeons decide in Europe?

OBJECTIVES: Some donor factors, such as age, cause of death, and obesity, affect the outcomes of pancreas transplantation. Donors with a high-risk profile are usually not declined for pancreas donation. The purpose of our study was to investigate differences between accepted and refused pancreata after being procured and offered. METHODS: In a retrospective study we analyzed all offered pancreata (n = 1360) in the "Eurotransplant Area" between May 25, 2002 and September 18, 2003. Included in this study were 525 pancreata transplanted (38.6%) and 608 pancreata refused for medical reasons (44.7%). A total of 227 pancreata (16.7%) refused for other than medical reasons were excluded from this analysis. RESULTS: The significant differences in the donor profiles between transplanted and refused pancreata were cause of death (P < .001), donor age (P < .001), body mass index (BMI, P < .001), serum lipase and amylase (P < .05) at the time of procurement, and a history of smoking (P = .001) or alcohol abuse (P < .001). No differences were found for serum sodium (P = .188), blood leukocytes (P = .349), serum glucose at the time of procurement (P = .155), amylase and lipase at the time of admission (P = .34; P = .758), and vasopressor use at the time of admission or at the procedure (P = .802; P = .982). CONCLUSION: Even after procuring and offering potentially good pancreata, nearly half the organs are refused for medical reasons. Acceptance criteria in the Eurotransplant region reveal a conservative attitude toward pancreas acceptance.

Adolescent↗

PubMed2005

Influence of methicillin-resistant Staphylococcus aureus carrier status in liver transplant recipients.

The prevalence of methicillin-resistant Staphylococus aureus (MRSA) has increased worldwide and MRSA has emerged as an important cause of sepsis in cirrhotic patients and liver transplant recipients. In this retrospective study, the prevalence of MRSA colonization and its influence on infections following orthotopic liver transplantation (OLT) was investigated. From August, 2002 until November, 2004, 66 primary cadaver OLT were performed for adult recipients. Antibody induction used Daclizumab (n = 49) or ATG (n = 14). Maintenance immunosuppression consisted of tacrolimus and steroids, with 30 patients receiving mycophenolate mofetil and 4, rapamune. For perioperative anti-infectious prophylaxis cefotaxime, metronidazole, and tobramycin were administered for 48 hours. The preoperatively performed routine swabs revealed MRSA colonization in 12 of 66 (18.2%) patients. The stage of cirrhosis was equivalent for MRSA(-) patients according to Child score. The mean MELD score was significantly higher for MRSA(+) patients (24.3 versus 18.7, P = .036). More MRSA(+) patients were hospitalized at the time of transplantation (14/54 versus 8/12, P = .018). The incidence of posttransplant infections was not significantly different among the two groups. Within the first year 7 of 66 (10.6%) patients died: 3 of 12 (25%) MRSA(+) and 4 of 54 (7.4%) MRSA(-). The 1-year survival was lower in the MRSA(+) group (74.1% versus 94.1%). In conclusion, this study did not show that an MRSA-positive carrier status implies an increased risk for septic complications following OLT. Mortality was increased for MRSA(+), but failed to show a significant difference. A significantly higher MELD score and pretransplant hospitalization for MRSA(+) patients may contribute to the higher mortality and reflect sicker patients.

Carrier State↗

PubMed2004

Does telerobotic assistance improve laparoscopic colorectal surgery?

BACKGROUND AND AIMS: The laparoscopic approach is common for several surgical procedures. Although the laparoscopic approach in colorectal surgery is described as being beneficial, its use is not yet widespread. This restriction may be due to technical difficulties. The use of telerobotic assistance may simplify complex laparoscopic procedures. We compared the traditional laparoscopic and the telerobotic-assisted approaches to colorectal surgery. PATIENTS AND METHODS: Between August 2002 and January 2004, 61 laparoscopic colorectal operations were performed. In this study we focused on sigmoid resection for benign disease. Twenty-three patients underwent sigmoid resection for diverticulitis using traditional laparoscopy, and 4 using telerobotic-assisted laparoscopy. The DaVinci system was used for telerobotic assistance. Four patients underwent resection rectopexies, 2 with traditional and 2 with telerobotic-assisted laparoscopy. RESULTS: The DaVinci device worked well during all operations. No robot-related complications occurred. The conversion rate was 3 out of 23 with traditional laparoscopy and 1 out of 4 in the telerobotic-assisted group. The incidence of postoperative complications was 5 out of 23 after traditional laparoscopic and 1 out of 4 following telerobotic-assisted laparoscopic resection. Operation time was significantly longer using the telerobotic-assisted approach (236.7+/-5.8 vs. 172.4+/-38 min, p<0.05). CONCLUSION: Colorectal surgery using the DaVinci system is safe and feasible. Compared to traditional laparoscopy, we did not see any relevant practical advantages of the supportive features of the telerobotic assistance that simplified the operation significantly. However, it would be useful to evaluate the telerobotic-assisted approach for other kinds of laparoscopic procedures.

Anastomosis, Surgical↗

PubMed2004

Transarterial chemoembolization alone and in combination with other therapies: a comparative study in an animal HCC model.

The purpose of this study is to compare transarterial chemoembolization (TACE) alone and in combination with other therapies in an animal model. Subcapsular implantation of a solid Morris hepatoma 3924A in the liver was carried out in 50 male ACI rats (day 0). Tumor volume (V1) was measured by MRI (day 13). After laparotomy and retrograde placement of a catheter into the gastroduodenal artery (day 14), the following protocols of the interventional procedure were applied: TACE (mitomycin C + lipiodol) + immunotherapy (group A: TNFalpha + IL-2, group B: OK-432 + IL-2); TACE + antiangiogenesis therapy (group C: TNP-470, group D: endostatin); TACE alone in group E (control group). Tumor volume (V2) was assessed by MRI and the mean ratio of x (V2/V1) was calculated. Data were analyzed using Dunnett's t test (comparing therapeutic groups with the control group) and the Student-Newman-Keuls test (comparing significant therapeutic groups). Multivariate analysis showed a significant reduction in the tumor growth rate (P<0.05) in groups B (x=6.53) and C (x=4.01) compared to the mean ratio of the control group E (x=9.14). Significant results were observed in group C (P<0.05) in comparison with the other therapeutic groups. TACE combined with immunotherapy (OK-432) and antiangiogenesis therapy (TNP-470) retards tumor growth compared with TACE alone in an HCC animal model.

Angiogenesis Inhibitors↗

PubMed2004

Predicting creatinine clearance by a simple formula following live-donor kidney transplantation.

The outcome after live-donor kidney transplantation is influenced by many parameters. The aim of our study was to establish a multivariate prognostic model for calculating the recipient's creatinine clearance after transplantation. Basic immunological, donor-, recipient- and process-related variables were assessed in a series of 18 live-donor kidney transplant patients with an uncomplicated postoperative course. Multivariate analysis was carried out with automated forward and backward selection. The following four parameters were included in the predictive model: recipient age, recipient BMI, graft clearance and degree of relationship. The coefficient of determination (R(2)) was 0.67. It could be shown that a significant prediction of creatinine clearance after living related kidney transplantation can be made, based on simple variables. Therefore, this formula could help to detect early complications in the post-transplantation course if the recipient's creatinine clearance drops below the predicted result.

Adolescent↗

PubMed2004

High levels of C-reactive protein after simultaneous pancreas-kidney transplantation predict pancreas graft-related complications and graft survival.

BACKGROUND: Although pancreas graft-related complications are frequent after simultaneous pancreas-kidney transplantation (SPK), there are no parameters predicting the risk for these complications. METHOD: A two-center retrospective study was performed in 97 patients who underwent SPK to investigate the peak serum value of c-reactive protein (CRP) during the first 72 hr after SPK in view of graft-related complications and graft survival. RESULTS: Mean peak CRP was 115.6 +/- 71.5 mg/L. Mean peak CRP was higher in patients needing relaparotomy (n=31) (136.4 vs. 105.8 mg/L, P=0.048), especially when postoperative bleeding was excluded (P=0.015); in patients with graft pancreatitis (P=0.03); and in patients with graft loss (n=19; P<0.001) compared with patients without these complications. With a cut-off of peak CRP at the level of mean plus 1 SD (187.05 mg/L), there was a significantly higher incidence of relaparotomies (P=0.01; bleedings excluded: P=0.003), graft pancreatitis (P=0.03), and pancreas graft loss (P<0.0001) in patients with high peak CRP compared with patients with low peak CRP. No differences were noticed with regard to rejection rate, mortality, and kidney graft loss. CONCLUSION: Our findings suggest that peak CRP is a helpful parameter in predicting pancreas graft-related complications and pancreas graft survival after SPK. Our results also stress the importance of early graft damage in pancreas transplantation.

Adult↗

PubMed2004

[Acute pancreatitis].

Acute pancreatitis is an acute inflammatory process of the pancreas mainly due to biliary obstruction or alcohol consumption. Most episodes of acute pancreatitis are mild and resolve under conservative treatment. Severe forms of acute pancreatitis, especially the necrotising form, still have a high mortality rate and can be difficult to treat. The problem today is to identify the few cases that should be treated operatively. Infected necroses are well accepted as an indication for operative treatment. Surgery consists of débridement and necrosectomy followed by closed or open lavage. In biliary pancreatitis, ERCP is performed early in cases of biliary obstruction, with or without cholangitis. In these patients cholecystectomy should be performed electively after clinical recovery.

Acute Disease↗

PubMed2004

[Splenic trauma--a rare complication during colonoscopy].

The less frequent complications of colonoscopy include pneumothorax, pneumoperitoneum, emphysema of the retroperitoneum or of the subcutis, septicemia and injuries of visceral organs (mainly the spleen). Since the mid 1970 s more than 30 splenic injuries during colonoscopy have been described. Any cause of increased splenocolic adhesions (inflammatory bowel disease, pancreatitis or prior abdominal surgery) might be a predisposing factor for splenic injury during colonoscopy. Other contributing factors are techniques that result in a strong torsion of the spleno-colic ligament. Patients with left shoulder and abdominal pain, hypotension, and a drop in hemoglobin without rectal bleeding after colonoscopy should be suspected to have splenic injury. Many physicians are not aware of splenic injuries as a potential complication of colonoscopy. Therefore the diagnosis of splenic injury during colonoscopy is often described in the literature as delayed (hours until 10 days). Since a colonoscopic splenic injury can be fatal, this exceedindly rare event must be considered when a patient shows the above-mentioned symptoms and no signs of colon perforation.

Colonoscopy↗

PubMed2004

[Consensus-recommendations for sirolimus in liver transplantation].

Sirolimus is an m-TOR inhibitor without renal side effects and potentially protects against the development of malignancy. Due to a higher incidence of complications in two trials and an official warning in the drug information, the use of Sirolimus in liver transplantation is limited. The participants of this consensus meeting had to analyse and evaluate the literature with respect to the potential role of Sirolimus in liver transplantation. This consensus statement follows the scheme normally employed for the presentation of guidelines including the grading of evidence (1a-5) and the extent of recommendation (A-C). Moreover, the consensus included the experience of the authors with respect to the handling of Sirolimus after liver transplantation.

Drug Therapy, Combination↗

PubMed2003

Simultaneous pancreas-kidney transplantation in patients with antiphospholipid syndrome.

BACKGROUND: Graft thrombosis is one of the main reasons of graft loss following simultaneous pancreas-kidney transplantation (SPK). Although antiphospholipid syndrome (APLS) is known as a high risk for graft thrombosis in kidney transplants alone, little is known about APLS in SPK. METHODS: Between September 2000 and December 2001, 45 SPK were performed. The treatment and clinical course of 2 patients with APLS is presented. RESULTS: In one patient, APLS was known before transplantation. After SPK, she was treated by systemic heparin followed by coumarin. Both grafts are doing well 5 months posttransplant. The second patient underwent SPK without knowledge of APLS. The patient developed a deep vein thrombosis 5 weeks posttransplant. Hypercoagulability screening revealed APLS. Treatment consisted of systemic anticoagulation. Grafts were not affected. CONCLUSION: SPK can successfully be performed in APLS patients if anticoagulation is performed consistently. To reduce the risk of graft thrombosis, a pretransplant screening for APLS would probably be of benefit.

Adult↗