[Show abstract][Hide abstract] ABSTRACT: Hydatid disease is a systemic disorder affecting especially the liver and lungs. Although it is not endemic in Europe, it can be seen sporadically, particularly because of travel and immigration. Severe, multiple organ involvement is quite rare. A 39-year-old Kurdish male patient presented with the previous diagnosis of hydatid disease and disseminated cysts in the liver, lung, and left kidney, leading to renal failure and the need for hemodialysis. Following multiple operations, complete eradication of infectious cysts was achieved, and a kidney transplantation was performed. After 4 years of follow up, the patient is in good condition, especially with normal renal function and no sign of recurrent hydatid disease. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Hepatitis C is the leading indication for liver transplantation. Differentiation between recurrent graft hepatitis C (RGH-C) and graft rejection (GR) is challenging. Liver biopsy is standard to diagnose both conditions; however, little information is available regarding this procedure in hepatitis C virus (HCV)-infected liver transplant recipients.
[Show abstract][Hide abstract] ABSTRACT: Abdominal complications after thoracic transplantation (Tx) are potentially associated with an increased risk of mortality. We recently reported about the severe outcome after bowel perforation in patients following lung transplantation (LuTx). The aim of the present study was to likewise identify the risk factors with an impact on patient survival following heart transplantation (HTx).
A retrospective analysis for the frequency and outcome of abdominal interventions following HTx was performed in 342 patients, and these data thereafter compared to a re-evaluated pool of 1,074 patients following LuTx. All patients were transplanted at Hanover Medical School, Germany, between January 2000 and October 2011.
The incidence for abdominal surgery was comparable between patients following HTx (n = 33; 9.6 %) and LuTx (n = 90; 8.4 %). Elective operations were more frequently performed in patients after HTx (8.5 vs. 5.1 %). In contrast, the incidence of emergency interventions was higher after LuTx (5.3 %) than that following HTx (2.3 %). Herewith associated was the mortality observed in these transplant recipients (15.3 and 9.9 % for LuTx and HTx, respectively). Leading diagnosis for emergency surgery was bowel perforation (n = 18, regarding all cases). In 11 of these patients, perforation occurred within the first 6 months after Tx and eight of them died in the course of this complication (one patient after HTx and seven patients after LuTx).
Abdominal complications after HTx are less frequently than after LuTx but equally correlate with a high mortality rate. In finding or even reasonable suspicion of an acute abdomen after thoracic Tx, a broad practice for extended diagnostics and a low barrier for an early explorative laparotomy thus are recommended.
Langenbeck s Archives of Surgery 04/2014; · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: HCV RNA levels correlate with the long-term outcome of hepatitis C in liver transplant recipients. Nucleic acid testing (NAT) is usually used to confirm HCV reinfection and to examine viral loads after liver transplantation. HCV core antigen (HCVcoreAg) testing could be an alternative to NAT with some potential advantages including very low intra- and interassay variabilities and lower costs. The performance of HCVcoreAg testing in organ transplant recipients is unknown. We prospectively studied 1011 sera for HCV RNA and HCVcoreAg in a routine real-world setting including 222 samples obtained from patients after liver or kidney transplantation. HCV RNA and HCVcoreAg test results showed a consistency of 98% with a very good correlation in transplanted patients (r > 0.85). The correlation between HCV RNA and HCVcoreAg was higher in sera with high viral loads and in samples from patients with low biochemical disease. Patients treated with tacrolimus showed a better correlation between both parameters than individuals receiving cyclosporine A. HCV RNA/HCVcoreAg ratios did not differ between transplanted and nontransplanted patients, and HCV RNA and HCVcoreAg kinetics were almost identical during the first days after liver transplantation. HCVcoreAg testing can be used to monitor HCV viral loads in patients after organ transplantation. However, the assay is not recommended to monitor antiviral therapies.
Journal of Viral Hepatitis 11/2013; · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.
Zeitschrift für Gastroenterologie 11/2013; 51(11):1269-326. · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bei Gurtmarken am Abdomen muss auch an eine mögliche Bauchwandzerreißung gedacht werden. Die FAST-Sonographie und das Traumascan-CT stellen bei kreislaufstabilen Patienten mit Gurtmarken das Diagnostikum der Wahl dar. Aufgrund des Unfallmechanismus können zusätzliche intraabdominelle Verletzungen, Wirbelsäulenverletzungen und Aortenrupturen vorliegen. Bauchwandverletzungen ab Grad IV nach Dennis sollten chirurgisch versorgt werden. Aufgrund der zunehmenden Zahl adipöser Insassen und deren spezieller Verletzungsrisiken könnten aktive Rückhaltesysteme, neben der korrekten Positionierung das Verletzungsrisiko reduzieren.
Der Unfallchirurg 10/2013; 117(10). · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abdominal seat belt marks can be an indication of abdominal wall rupture. The focused assessment with sonography for trauma (FAST) and computed tomography (CT) scanning are the diagnostic tools of choice in hemodynamically stable patients. The typical mechanism of trauma frequently leads to additional intra-abdominal injuries, spinal injuries and in some cases aortic rupture. Abdominal wall injuries of grade IV according to Dennis should be surgically treated. The increasing numbers of obese vehicle occupants and the resulting special risk of injury warrant optimization of technical restraint systems.
[Show abstract][Hide abstract] ABSTRACT: Following resection of colorectal liver metastases (CLMs) up to 75 per cent of patients develop recurrent liver metastases. Although repeat resection remains the only curative therapy, data evaluating the outcome are deficient. This study analysed postoperative morbidity, mortality and independent predictors of survival following repeat resection of CLMs.
Data on surgical treatment of primary and recurrent CLMs between 1994 and 2010 were collected retrospectively, and compared with those for single hepatic resections carried out during the same period. Independent predictors of survival were evaluated by means of univariable and multivariable Cox regression models.
In this interval 1026 primary resections of CLMs were performed and 94 patients underwent repeat CLM excision. Overall postoperative morbidity and mortality rates were low (15·8 and 1·3 per cent respectively), with no statistical difference in patients undergoing repeat surgery (P = 0·072). Compared with single liver resections, overall survival was improved in repeat resections (P = 0·003). Multivariable analysis revealed that size of primary CLM over 50 mm was an independent predictor of survival (hazard ratio (HR) 2·61; P = 0·008). Only major hepatic resection was associated with poorer outcome following repeat surgery (HR 2·62; P = 0·009). International Union Against Cancer stage, number of CLMs, age at surgery and need for intraoperative transfusion had no impact on survival after repeat resection.
Recurrent CLM surgery is feasible with similar morbidity and mortality rates to those of initial or single CLM resections.
British Journal of Surgery 06/2013; 100(7):926-32. · 4.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and study aim: Placement of covered self-expanding metal or plastic stents (SEMS or SEPS) is an established method for managing intrathoracic leaks. Recently, endoscopic vacuum-assisted closure (EVAC) has been described as a new effective treatment option. Our aim was to compare stent placement with EVAC for nonsurgical closure of intrathoracic anastomotic leaks.Patients and methods: In a retrospective analysis we were able to identify 39 patients who were treated with SEMS or SEPS and 32 patients who were treated with EVAC for intrathoracic leakage. In addition to successful fistula closure, we analyzed hospital mortality, number of endoscopic interventions, incidence of stenoses, and duration of hospitalization. Results: In a multivariate analysis, successful wound closure was independently associated with EVAC therapy (hazard ratio 2.997, 95 % confidence interval [95 %CI] 1.568 - 5.729; P = 0.001). The overall closure rate was significantly higher in the EVAC group (84.4 %) compared with the SEMS/SEPS group (53.8 %). No difference was found for hospitalization and hospital mortality. We found significantly more strictures in the stent group (28.2 % vs. 9.4 % with EVAC, P < 0,05). Conclusions: EVAC is an effective endoscopic treatment option for intrathoracic leaks and showed higher effectiveness than stent placement in our cohort.
[Show abstract][Hide abstract] ABSTRACT: Objective: The purpose of this study was to assess outcomes and indications in a large cohort of patients who underwent liver transplantation (LT) for liver metastases (LM) from neuroendocrine tumors (NET) over a 27-year period. Background: LT for NET remains controversial due to the absence of clear selection criteria and the scarcity and heterogeneity of reported cases. Methods: This retrospective multicentric study included 213 patients who underwent LT for NET performed in 35 centers in 11 European countries be-tween 1982 and 2009. One hundred seven patients underwent transplantation before 2000 and 106 after 2000. Mean age at the time of LT was 46 years. Half of the patients presented hormone secretion and 55% had hepatomegaly. Before LT, 83% of patients had undergone surgical treatment of the primary tumor and/or LM and 76% had received chemotherapy. The median interval between diagnosis of LM and LT was 25 months (range, 1–149 months). In addition to LT, 24 patients underwent major resection procedures and 30 patients underwent minor resection procedures. Results: Three-month postoperative mortality was 10%. At 5 years after LT, overall survival (OS) was 52% and disease-free survival was 30%. At 5 years from diagnosis of LM, OS was 73%. Multivariate analysis identified 3 pre-From the
[Show abstract][Hide abstract] ABSTRACT: Einleitung
Die Expansion des Spenderpools durch die Verwendung von Spenderorganen, die erweiterte Spenderkriterien erfüllen, verringert die Wartelistenmortalität mit einem erhöhten Risiko für das Patienten- und Transplantatüberleben nach Lebertransplantation. Die Eignung der Anzahl der erfüllten erweiterten Spenderkriterien nach der aktuellen Definition der Bundesärztekammer (BÄK-Score) für die Voraussage der frühen Ergebnisse nach Lebertransplantation ist unbekannt.
Untersucht wurden 257 erwachsene Empfänger, die zwischen dem 01.01.2007 und dem 31.12.2010 insgesamt 291 konsekutive Lebertransplantate erhielten.
Primäre Studienendpunkte waren die 30-Tage-Mortalität, 3-Monats-Mortalität, das 3-Monats-Patientenüberleben, 3-Monats-Transplantatüberleben und die Notwendigkeit einer akuten Retransplantation innerhalb von 30 Tagen. Der BÄK-Score wurde als prognostisches Modell mit der ROC-Kurven-Analyse mit Bestimmung der Sensitivität, Spezifität und Gesamtmodellkorrektheit des Modells für die Voraussage der primären Studienendpunkte untersucht. Weiterhin wurden Kaplan-Meier-Überlebensanalysen, Log-Rank-Tests, Cox-Regressionsanalysen, logistische Regressionen und χ2-Tests durchgeführt.
Die Anzahl der erfüllten erweiterten Spenderkriterien hatte keinen signifikanten Einfluss auf die primären Studienendpunkte (p > 0,05) und das Patientenüberleben (p > 0,05). Die ROC-Kurven-Analyse zeigte für die Voraussage der primären Studienendpunkte Flächen ≤ 0,561 mit einer Gesamtkorrektheit des Modells < 58% bei einer Sensitivität < 52%.
Die Anzahl der erfüllten erweiterten Spenderkriterien nach der aktuellen Definition der Bundesärztekammer kann die frühe Prognose innerhalb der ersten 3 Monate nach Lebertransplantation als prognostisches Modell nicht voraussagen.