Publications (28) View all
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Article: Clinical outcome of patients with advanced ovarian cancer after resection of liver metastases.
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ABSTRACT: Aim: Hepatic resection has become the standard treatment for patients with primary or metastatic liver malignancies. The aim of our study was to evaluate the clinical outcome of hepatic resection in patients with advanced ovarian cancer (AOC). All patients undergoing hepatic resection for AOC in our institution between 11/1991 and 02/2007 were evaluated by a validated intraoperative documentation tool. Seventy patients were evaluated (median age=59 years; range=29-76 years). Forty-one (58.6%) patients underwent liver resection; 29 patients had unresectable disease. Additional multivisceral procedures performed were: colic resection (51.4%), small bowel resection (32.9%), gastric resection (5.7%), pancreatic resection (4.3%), splenectomy (5.7%). The median survival of patients with R0 resection was 42 months (95% confidence interval (CI)=17-66 months), 4 months for R1, 6 months (95% CI=0-11 months) for R2, and 5 months (95% CI=0-9 months) for those without liver resection. In multivariate analysis, postoperative residual tumor mass was the strongest predictor of survival. Our data indicate that complete macroscopical tumor resection remains the strongest predictor of survival in patients with liver metastases from AOC.Anticancer research 10/2012; 32(10):4517-21. · 1.73 Impact Factor -
Article: A 7-gene signature of the recipient predicts the progression of fibrosis after liver transplantation for hepatitis C virus infection.
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ABSTRACT: Fibrosis recurrence after liver transplantation (LT) for hepatitis C virus (HCV) is a universal event and strongly determines a patient's prognosis. The recipient risk factors for fibrosis recurrence are still poorly defined. Here we assess a genetic risk score as a predictor of fibrosis after LT. The cirrhosis risk score (CRS), which comprises allele variants in 7 genes (adaptor-related protein complex 3 S2, aquaporin 2, antizyme inhibitor 1, degenerative spermatocyte homolog 1 lipid desaturase, syntaxin binding protein 5-like, toll-like receptor 4, and transient receptor potential cation channel M5), was calculated for 137 patients who underwent LT for HCV infection and experienced HCV reinfection of the graft. The patients were stratified into 3 CRS categories: <0.5, 0.5 to 0.7, and >0.7. All patients underwent protocol biopsy after LT (median follow-up = 5 years), and liver fibrosis was assessed according to the Desmet and Scheuer score. The data were analyzed with univariate and multivariate analyses. The results showed that the highest CRS category was strongly associated with the presence of F2 or F3 fibrosis in protocol biopsy samples 1, 3, and 5 years after LT (P = 0.006, P = 0.001, and P = 0.02, respectively). Overall, 75.0% of the patients with a CRS > 0.7 developed at least F2 fibrosis, whereas 51.5% developed F3 fibrosis during follow-up. The predictive value of the CRS for fibrosis progression was independent of known clinical risk factors, including the age of the donor, the sex of the recipient, and the occurrence of acute rejection. A Kaplan-Meier analysis confirmed the prognostic value of the CRS with respect to the recurrence of severe liver fibrosis in HCV-infected patients after LT (log rank = 6.23, P = 0.03). In conclusion, the genetic signature of the recipient predicts the likelihood of severe liver fibrosis in the graft after HCV recurrence. The CRS might help with early clinical decision making (eg, the selection of patients for antiviral therapy after LT).Liver Transplantation 12/2011; 18(3):298-304. · 3.39 Impact Factor -
Article: Delayed formation of a devastating granulomatous process after metal-on-metal lumbar disc arthroplasty.
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ABSTRACT: A case report. We report the case of a female patient with a delayed and devastating complication after lumbar total disc arthroplasty (TDA). The formation of granulomatous tissue surrounding arthroplasty devices has been described after hip replacements, but has been reported only in a few cases after spinal surgery. Retrospective case study of a female patient with a delayed complication after lumbar TDA with a metal-on-metal device for degenerative disc disease at level L4-L5 and with follow-up examination 8 months after surgery. About 11 months after lumbar arthroplasty surgery, the patient developed back pain and progressive weakness of both legs. A computed tomographic scan revealed soft tissue surrounding the TDA device and infiltrating the spinal canal. The revision surgery (posterior fixation and decompression) did not improve the clinical situation. The progressive growth of soft tissue led to a high-grade paraparesis and occlusion of the left ureter as well as of both common iliac veins and the infrarenal part of the vena cava inferior. The TDA device was removed. Another posterior surgery with extensive instrumentation was necessary to treat the destruction of vertebral bodies L4 and L5 2 months after the last surgery. The histopathological analysis revealed a granulomatous necrotizing inflammation. After the last revision surgery, the patient's back pain decreased. At her last follow-up, no further growth of the soft tissue mass could be found. Metal-on-Metal TDA devices can induce a tumor-like growth with devastating consequences. The reduction of device motion by posterior stabilizing surgery does not seem to stop the growth of the granulomatous mass. The device has to be removed.Spine 11/2011; 37(13):E809-13. · 2.08 Impact Factor -
Article: Mycophenolate mofetil monotherapy in liver transplantation: 5-year follow-up of a prospective randomized trial.
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ABSTRACT: Calcineurin inhibitors (CNIs) play the key role in immunosuppressive protocols yet are often associated with numerous side effects. Renal insufficiency, hypertension, hyperglycemia, and increased risk of secondary malignancy are major problems in short- and long-term follow-up of liver transplant patients. Mycophenolate mofetil (MMF) has proved to be a potent immunosuppressive agent free of the CNI-associated side effects. One hundred fifty patients who received liver transplantation at our institution (1998-2003) were prospectively randomized: 75 patients continued CNI standard therapy, 75 patients were switched to MMF monotherapy, and follow-up was 5 years. Incidence of rejection, renal complication, cardiovascular, neurological and gastrointestinal adverse effects, and diabetes and malignancy development was recorded. Graft biopsies were performed every 2 to 3 years. No significant difference regarding the incidence of acute rejection was detected. A trend to higher rejection frequency was apparent in the MMF monotherapy group. Chronic rejection was absent; organ and patient survival were identical in the two groups. No significant difference occurred concerning the incidence of cardiovascular, gastrointestinal or neurological adverse effects, or the development of malignancies. Renal function improved significantly in patients with renal insufficiency when patients treated with CNI were switched to MMF monotherapy. MMF monotherapy may serve as safe long-term immunosuppression after liver transplantation for a subgroup of patients. Especially for patients with renal insufficiency MMF offers immunosuppression without the risk of nephrotoxicity.Transplantation 08/2011; 92(8):923-9. · 4.00 Impact Factor -
Article: Serum chemokine CXC ligand 10 (CXCL10) predicts fibrosis progression after liver transplantation for hepatitis C infection.
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ABSTRACT: The recurrence of liver fibrosis after liver transplantation (LT) for hepatitis C virus (HCV) infection is responsible for graft loss and patient mortality. Although the contribution of the immune system to fibrosis recurrence is anticipated, systematic studies evaluating immune parameters as predictive markers of allograft fibrosis are lacking. The infiltration of immune cells into the graft is governed by chemokines. Here we assessed the predictive value of serum levels of chemokines [chemokine (C-X-C motif) ligand 9 (CXCL9), CXCL10, CXCL11, and chemokine (C-C motif) ligand 2 (CCL2)] with respect to fibrosis recurrence after LT in 90 HCV-infected organ recipients. Chemokines were determined within the first and third years after LT and were correlated with histological fibrosis progression in protocol biopsy samples at 1, 3, 5, and 7 years (median follow-up = 3 years). The association of chemokines with fibrosis progression was assessed by univariate and multivariate analyses and by Cox regression analysis. The results for the analyzed chemokines showed that CXCL10 levels in the first year after LT were strongly associated with early fibrosis recurrence (P = 0.005) independently of risk confounders (including the donor age, HCV viral load, HCV genotype, acute rejection, and inflammatory activity). As assessed by Cox regression analysis, a CXCL10 serum level ≤ 140 pg/mL was significantly predictive of the absence of F2 fibrosis (P = 0.001), whereas a level ≤ 220 pg/mL early after LT predicted the absence of F3 fibrosis during follow-up (P = 0.035). CONCLUSION: CXCL10 is an independent biomarker of the recurrence of significant fibrosis after LT for HCV infection. These results might guide patients' care after transplantation and help us to select optimal candidates for antiviral therapy post-LT.Hepatology 02/2011; 53(2):596-603. · 11.66 Impact Factor
