PubMed Health⌕ Search

Biomedical subjects

W O Bechstein

Publications and source records attributed to W O Bechstein.

At least 271 records · Page 15Linked to original sources
PubMed1992

[Liver transplantation in erythrohepatic protoporphyria].

A 51-year-old man had for 5 years been known to have erythropoietic protoporphyria. GPT levels were raised up to 40 U/l, gamma-GT up to 120 U/l. After lengthy exposure to sun radiation an erythema with blisters, abdominal discomfort and jaundice developed (total bilirubin 7.3 mg/dl) and biliary liver cirrhosis with portal hypertension and splenomegaly were diagnosed. Because the acute hepatobiliary complications were not improved by conservative treatment (daily 750 mg ursodeoxycholic acid and 12 g colestyramine), an orthotopic liver transplantation was performed without complication. The excised liver showed small nodular parenchymal transformation and contained reddish brown protoporphyrin pigment in the hepatocellular cytoplasm, the Kupffer cells, the canaliculi and in some biliary ducts. Bilirubin and transaminase levels in blood became normal after the transplantation, as did the urinary excretion of coproporphyrin. However, isomer I was still dominant. The protoporphyrin level in erythrocytes and plasma remained elevated. After a symptom-free interval of one year biochemical and histological tests demonstrated protoporphyrin-induced damage in the transplanted liver.

Cholestyramine Resin↗
PubMed1992

Hepatitis C virus reinfection in allografts after orthotopic liver transplantation.

From September 1988 to May 1991, 160 orthotopic liver transplantations were performed in our hospital. Twenty-four patients had end-stage cirrhosis caused by chronic non-A, non-B hepatitis. Antibodies against hepatitis C virus were documented before and after orthotopic liver transplantation in 13 patients. Studies using the polymerase chain reaction demonstrated hepatitis C virus RNA in the serum and liver tissue of 17 patients (10 of whom tested positive for hepatitis C virus antibodies) before orthotopic liver transplantation. Tissue samples taken from liver grafts during the operation were hepatitis C virus RNA negative in every case. Ten of these 17 patients had positive hepatitis C virus RNA findings in serum and liver biopsy specimens within the first month after surgery. One patient died of Mucor sepsis 2 mo after orthotopic liver transplantation. Another patient died of multi-organ failure 3 mo after a retransplantation. Two patients underwent retransplantation for graft rejection at 2 and 3 mo, respectively. One year after orthotopic liver transplantation, hepatitis C virus RNA was demonstrated in allograft biopsy specimens in 13 of 15 patients. Two patients remained hepatitis C virus RNA negative in repeated biopsies up to 12 mo. Mild portal and lobular hepatitis developed within 6 months of orthotopic liver transplantation in four patients and within 1 yr in five additional patients. The data suggest that persistent hepatitis C virus reinfects the allograft in most cases, but the risk of acute organ damage caused by hepatitis C virus reinfection is low.

Adult↗
PubMed1992

Low-dose combination therapy of DUP-785 and RS-61443 prolongs cardiac allograft survival in rats.

The introduction of cyclosporine into the immunosuppressive armamentarium has revolutionized transplant surgery with significant improvements in graft survival. The apparent lack of effect of cyclosporine on humoral rejection mechanisms makes the search for other immunosuppressive agents desirable. Two anti-metabolites affecting nucleotide synthesis via different pathways have recently been evaluated for their immunosuppressive potential. DUP-785 (DUP), also known as brequinar sodium, reversibly inhibits de novo pyrimidine synthesis by blocking dihydro-orotate dehydrogenase, thus resulting in the deletion of critical precursors for RNA and DNA synthesis. RS-61443, a morpholinoethyl ester of mycophenolic acid, reversibly and non-competitively blocks inosin monophosphate dehydrogenase, the key enzyme in purine de novo synthesis. A possible additive effect of both drugs was investigated in the rat heart allograft model.

Animals↗
PubMed1992

Different aprotinin applications influencing hemostatic changes in orthotopic liver transplantation.

The effect of different aprotinin applications on hemostatic changes and blood product requirements in orthotopic liver transplantation was investigated in a prospective, open, and randomized study. From November 1989 to June 1990, 13 patients received aprotinin as a bolus of 0.5 Mill. Kallikrein inactivator units (KIU) on three occasions in the course of an OLT, whereas 10 other patients were treated with continuous aprotinin infusion of 0.1-0.4 Mill. KIU/hr. Before and after reperfusion of the graft liver, signs of hyperfibrinolysis, measured by thrombelastography, were significantly lower in the infusion group. Tissue-type plasminogen activator (t-PA) activity increased during the anhepatic phase but to a significantly lesser extent in the infusion group. Blood product requirements during OLT were tendentiously higher in the bolus group but not significantly so. However, the use of packed red blood cells was significantly lower in the postoperative period, whereas there was no significant difference in fresh frozen plasma requirements between the two groups. All 23 patients have survived, and only one woman of each group required retransplantation due to severe host-versus-graft reactions. Furthermore, we investigated the perfusate of the graft liver in both groups and detected signs of a decreased t-PA release in the infusion group. Our results demonstrate an advantage of aprotinin given as continuous infusion over bolus application in OLT.

Aprotinin↗
PubMed1992

[Orthotopic liver transplantation in hepatic cirrhosis: on the problem of infection of the transplant with persistent hepatitis viruses].

269 orthotopic liver transplantations (OLT) were performed in 253 patients at our institution from September 1988 to May 1992. 121 patients had end-stage cirrhosis secondary to viral hepatitis type B, delta, or type non-A non-B and C respectively. Reinfection of the graft by persistent viruses is a potential complication in these cases. Passive immunization with anti-HBs hyperimmunoglobulin (HIg) can prevent clinically relevant reinfection of the graft in patients with hepatitis B virus (HBV) infection and low replication rates. Patients with high replication rates will rarely benefit from OLT. Patients with hepatitis delta virus (HDV) infection usually experience HDV reinfection of the graft with subsequent chronic hepatitis although prophylaxis with anti-HBs-HIg was performed. Treatment with interferon alpha had no apparent effect on the incidence of graft reinfection with HBV in this series, but the replication rate of HDV was reduced. Persistent hepatitis C viruses (HCV) usually infect the graft; this was demonstrated in 17 patients by means of the polymerase chain reaction. HCV infection usually causes a mild form of acute hepatitis with transition to a chronic course. Therefore the significance of persistent viral infection lies in the potential for chronic hepatitis in the transplanted organ rather than in the danger of acute injury of the allograft.

Biopsy, Needle↗
PubMed1992

RS-61443 reverses acute renal allograft rejection in dogs.

RS-61443 is a noncompetitive allosteric inhibitor of inosine monophosphate dehydrogenase. It blocks the proliferative response of T and B lymphocytes, prevents the generation of cytotoxic T cells, and inhibits antibody formation. This study was conducted to see whether or not RS-61443 can reverse acute renal allograft rejection in dogs. It was possible to reverse this process.

Acute Disease↗
PubMed1992

[Progress in the field of liver transplantation in the last 10 years].

During the past 10 years, liver transplantation has developed into an established form of treatment. In 1991 alone, almost 450 liver transplants were performed in Germany with a mean 1-year survival of 70%. Consistent progress in the fields of organ preservation, surgical techniques, and prevention of disease recurrence has made a more than 90% 1-year survival rate achievable during the last 3 years in Berlin. Progress in organ preservation is based on the use of colloidal solutions, pharmacological improvement of microcirculation, and probably prevention of reperfusion injury by the use of calcium antagonists and free oxygen radical scavengers. Improvements in surgical techniques have led to a reduction in blood loss and vascular complications, and to a drastic reduction of biliary leaks and stenosis. The introduction of cyclosporin, FK-506, and monoclonal antibodies into immunosuppressive therapy has contributed to the improvement of results in a major way. Furthermore, progress in intensive care in the areas of fluid therapy and blood component substitution, respiratory care and prophylaxis of infection as well as postoperative nutrition has led to a reduction in early postoperative morbidity and mortality. Efficient prophylaxis of the recurrence of hepatitis-B-virus-related disease by using hepatitis B hyperimmunoglobulin after liver transplantation has prevented this lethal recurrence, which was previously frequent, in a large group of patients.

Critical Care↗
PubMed1991

Follow-up of recurrent hepatitis B and delta infection in liver allograft recipients after treatment with recombinant interferon-alpha.

Reinfection of the graft with hepatitis B virus (HBV) and hepatitis delta virus (HDV) is a potential complication in patients undergoing orthotopic liver transplantation (OLT). Therefore, we added recombinant interferon-alpha (rIFNa) to the standard immunosuppressive regimen in 11 patients who received transplants following liver failure attributed to cirrhosis B (n = 10, with HDV co-infection in four cases) or fulminant hepatitis B (n = 1). Patients were treated with rIFNa for periods ranging from 2 to 3 months between the first and the 13th month after OLT. All patients received immunosuppressive treatment with low-dose corticosteroids, azathioprine and cyclosporine. Anti-HBs hyperimmune globulin was also administered. None of the patients showed evidence of severe allograft rejection. Seven patients suffered HBV reinfection of the graft with histological signs of acute hepatitis in five cases and transition to chronic hepatitis in one patient. Treatment with rIFNa did not prevent or reduce HBV replication. Reinfection of the graft with HDV was demonstrated by PCR in four patients co-infected with HDV. During treatment with rIFNa liver biopsy specimens from three reinfected patients were transiently negative for HDV antigen but not for HDV RNA, and the sera from two patients were transiently negative for HDV RNA. The data indicate that rIFNa can reduce HDV replication in reinfected liver allografts.

Adrenal Cortex Hormones↗
PubMed1991

RS-61443 reverses acute allograft rejection in dogs.

RS-61443, a morpholinoethyl ester of mycophenolic acid, has been shown to prevent renal allograft rejection in dogs when administered in combination with low-dose cyclosporine and prednisolone. The purpose of this study was to test whether high-dose RS-61443 can reverse acute renal allograft rejection. Mongrel dogs receiving a renal allograft were treated with baseline immunosuppression consisting of RS-61443 10 mg/kg, cyclosporine 5 mg/kg, and prednisolone 0.1 mg/kg. All animals developed acute allograft rejection. Dogs in group I (n = 11) received 14, 7, and 3.5 mg/kg methylprednisolone intravenously on 3 consecutive days after the diagnosis of rejection. Dogs in group II (n = 16) were given RS-61443 80 mg/kg twice daily. After rejection treatment, RS-61443 was increased to 20 mg/kg in all animals; cyclosporine and prednisolone were continued as before. In group I, five of 11 dogs developed uncontrollable rejection; in six of 11 dogs only a temporary reversal occurred. None of the dogs in group I survived for more than 20 days after the diagnosis of rejection. In group II rejection was completely reversed in 14 of 16 dogs (87.5%), resulting in a return of serum creatinine to prerejection levels. Thus, high-dose therapy with RS-61443 can successfully reverse acute kidney allograft rejection in dogs in a high proportion of cases.

Animals↗
PubMed1990

[Liver resection in 157 patients with colorectal metastases].

The mean life expectancy for patients with hepatic metastases from colorectal carcinoma is poor. Removal of those tumors leads to an improvement of this situation. In 157 patients with colorectal metastases liver resection was performed. The overall 5-year survival rate was 23% with a median of 34.9 months. Significant prognostic factors for survival were size, and distribution of metastases, percent hepatic replacement by tumor, and radicality of operation. These results emphasize again that in selected patients with colorectal liver metastases resectional therapy is in principle indicated. Especially in the light of lacking therapeutical alternatives this offers presently the only chance for longterm cure or at least significant palliation.

Adult↗
PubMed1990

Management of portal venous thrombosis in hepatic transplant recipients.

Portal venous thrombosis in hepatic transplant candidates is considered a relative contraindication to transplantation. In addition to thrombectomy, which is often technically impossible, donor portal venous arterialization or extra-anatomic venous bypass have been described. Two patients who underwent portal venous resection and subsequent anatomic reconstruction are presented herein. In the first patient, a graft with donor common iliac vein was interposed, and in the second, the donor portal vein was long enough to be anastomosed to the mesentericosplenic venous confluens. One patient is well 12 months after transplantation with patent portal vein and the other died of fungal sepsis after rejection treatment (the portal vein being open and unobstructed at autopsy).

Anastomosis, Surgical↗