B Ringe

Mast cells distribution in human liver disease and experimental rat liver fibrosis. Indications for mast cell participation in development of liver fibrosis

BACKGROUND/AIMS The development of liver fibrosis due to chronic liver diseases is thought to be mediated by inflammatory cells releasing fibrogenic mediators that activate fat-storing cells (Ito-cells). Recently, the involvement of mast cells in fibrogenesis has been suggested. We studied the distribution of these cells in normal human liver and human nonfibrotic and fibrotic liver disease as well as in normal rat liver and acutely and chronically injured rat liver (CCl4 model). METHODS Mast cells were identified by histochemical and immunohistochemical methods. The immunoreactivity of liver and comparatively of rat peritoneal mast cells to the serpins alpha1-antitrypsin, alpha1-antichymotrypsin and antithrombin III was also studied. RESULTS In normal human and rat liver, mast cells were rarely found in portal tracts, and there was no change in cell numbers in nonfibrotic human or acutely injured rat livers. In contrast, cirrhotic human and rat livers contained numerous mast cells in the portal tracts and the fibrous septa. They exhibited strong immunoreactivity to the serpins, as did rat peritoneal mast cells. CONCLUSIONS The results indicate that in the late stages of liver fibrogenesis, mast cells may be involved by displaying protease inhibitory activity in the fibrotic septa.

Pantoprazole does not affect cyclosporin A blood concentration in kidney-transplant patients

AbstractObjective: Renal-transplant patients who are immunosuppressed with cyclosporin A (CyA) are often treated with proton-pump inhibitors to prevent ulcer disease. No data are available on the effect of the novel proton-pump inhibitor pantoprazole on CyA levels. Methods: In a controlled treatment, we investigated the effect of pantoprazole, which was administered in a pragmatic schedule for acid suppression (40 mg as single oral dose at 2200 hours) in six renal-transplant patients who received CyA (Sandimmun optoral, 50–175 mg twice daily) and prednisolone (5–7.5 mg/24 h). CyA trough levels (0730–0800 hours) were measured by immunoassay. Results: In the absence of pantoprazole, mean CyA trough levels measured on three consecutive days were between 164 ng/ml and 173 ng/ml (therapeutic range 120–200 ng/ml). Pantoprazole did not affect CyA trough levels during an observation period up to 3 months long. Conclusions: Pantoprazole seems to be a safe drug in combination with CyA.

Chirurgische Therapie benigner Lebertumoren

Zum ThemaDurch Sonographie, Farb-Doppler-Technik, Computer- und Magnetresonanztomographie sowie szintigraphische Methoden gelingt in aller Regel eine gute Differenzierung der häufigsten benignen Lebertumoren. Ergänzt wird diese natürlich durch klinische und humorale Untersuchung unter Einschluß von Tumormarkern, um die Verdachtsdiagnose maligne oder benigne zu untermauern. Die Biopsie sollte weitgehend vermieden werden, da die meistens sichere Diagnostik eindeutig nichtmaligner Strukturen durch die genannten Verfahren möglich ist und malignitätsverdächtige Strukturen ohnehin eine Operation notwendig machen, sofern der Zustand des Patienten dies erlaubt.In dieser Arbeit werden nur die benignen soliden Lebertumoren behandelt, nicht die (poly-)zystischen, parasitär zystischen Lebererkrankungen und Abszesse.

Development of liver size and perfusion after reduced‐size liver transplantation in children

Abstract: The technique of segmental liver transplantation (s‐LTx) provides a method to overcome the shortage of suitable livers for small recipients. Patient survival rates are parallel to those obtained with whole liver transplantation (w‐LTx). For long‐term rehabilitation, adaptive liver growth and adequate perfusion is crucial; however, morphometric and hemodynamic parameters in growing children with s‐LTx are not available. Seventeen children who received a s‐LTx and 25 with a w‐LTx who had follow‐up evaluation 1 and 2 yr after LTx were studied. Mean age at time of transplantation was 4.3 ± 3.5 yr for s‐LTx and 10.3 ± 6.0 yr for w‐LTx, mean height 98 ± 21 cm and 122 ± 30 cm respectively. At follow‐up evaluation mean values for liver enzymes, bilirubin and prothrombin time were in the normal ranges for both groups. Liver dimensions were measured by gray scale ultrasound, and hemodynamic parameters by Doppler sonography in the portal vein and hepatic artery using an Acuson 128 machine. Maximal (Vmax), minimal (Vmin) and time‐average velocity (TAV) were measured and the resistive index (RI) calculated. We found that 1 and 2 yr after LTx liver dimensions were at a mean in the upper normal range of healthy controls. Spleen size was above the normal range and did not show any tendency towards regression. Mean Vmax in the hepatic artery in s‐LTx and w‐LTx was 48 cm/sec vs. 28 cm/sec after 1 yr and 30 cm/sec vs. 35 cm/sec after 2 yr, the RI 0.66 vs. 0.55 and 0.59 vs. 0.73, respectively (p for all parameters > 0.05). Maximal portal vein flow was 25 cm/sec in s‐LTx vs. 29 cm/sec in w‐LTx. Blood flow calculated by vessel diameter and TAV showed no statistical difference between both groups. In conclusion, liver size after s‐LTx and w‐LTx was increased to the upper normal range, and portal vein blood flow velocities were within the normal range. Vmax in the hepatic artery was reduced in s‐LTx; however, the reduction was to the same extent as in w‐LTx. In the view of long‐term functional adaptation, s‐LTx is not inferior to w‐LTx.

Lectin staining for urine cytologic monitoring after kidney transplantation

Background. Urine cytology, although considered a valuable diagnostic tool in the monitoring of kidney graft function, is hampered by difficulty in differentiating the nucleated non-squamous cells in urine using conventional techniques. We have now developed a method for the simple identification of urinary cell types by lectin staining. Methods. Acetone-fixed cytopreparations of urinary sediments were incubated with the lectin combination Sophora Japonica agglutinin (SJA; rhodaminelabelled) and Erythrina cristagalli agglutinin (ECA; fluorescein isothiocyanate (FITC)-labelled) for 15 min, followed by staining of the nuclei with 49,6-diamidino2-phenylindole (DAPI). The courses of 38 patients were serially monitored after kidney transplantation during the period in hospital. Results. Nucleated urinary cell types could be easily identified from one specimen by their characteristic lectin-binding pattern using triple-immunofluorescence microscopy (FITCurhodamineuultra violet), permitting a differentiation between proximal (SJAquECAq) and distal tubules (SJA uECAq), collecting ducts (SJAquECA ) and lymphocytes (SJA uECA ). Stable graft function was characterized by low numbers of lymphocytes, tubular cells and urothelia. During rejection episodes, but not graft dysfunction unrelated to rejection, urinary excretion of lymphocytes as well as of distal tubular cells (from 1.0 to 6.0 and from 1.4 to 4.0 per 10 high-power fields, respectively) increased significantly up to 3 days prior to clinical diagnosis. Conclusions. Lectin staining facilitates unambiguous differentiation of the urinary cell types, in particular the various tubular epithelial cells, which are otherwise difficult to identify. This technique provides a rapid and easily applicable tool to evaluate the significance of the respective cell types in the monitoring of kidney graft function.

Pantoprazole and cyclosporine or tacrolimus

correlates well with the degree of endoscopic and histological disease activity. This remains hard to reconcile with the hypothesis that endoscopic and/or histological improvement of ulcerative colitis reported in some studies with transdennal nicotine may be related to the NO-stimulating effects of that substance. Greens ®ndings takes us a step forward in the understanding of the mechanism of action of nicotine in ulcerative colitis, but we have still a long way to go. This is especially true if considering the long-term effects of nicotine therapy. While nicotine itself seems ineffective as a maintenance treatment, ̄are-up of ulcerative colitis during mesalazine maintenance therapy is less frequent in patients whose remission was initially induced by transdermal nicotine than by corticosteroids. Incidentally the in ̄uence of steroids on NO production in ulcerative colitis is also ambiguous. Clearly the search for a satisfactory explanation of the therapeutic effects of nicotine in ulcerative colitis is only at the beginning; other mechanisms of action in addition to NO release, have been suggested , but at the present time the real mode of action of nicotine remains elusive.

Gallenblasenkarzinom: Aggressive Chirurgie ja oder nein?

Einleitung: Gallenblasenkarzinome haben eine ungunstige Prognose. Eine 5-Jahres-Uberlebensrate ohne Therapie liegt bei unter 5%. Mehr als 50% der inzidentiellen Karzinome betreffen die Stadien I–II. Patienten und Methoden: 23 Patienten (14 w, 9 m), medianes Alter 60,4 (47–85) Jahre. Tl: 1, T2: 3, T3: 6 und T4: 13 Patienten. Die elektive Operation im Fruhstadium bestand aus einer erweiterten Cholezystektomie mit radikaler Lymphadenektomie. Ergebnisse und Schlusfolgerung: Die Uberlebensrate nach 6 Monaten war bei T2: 65%, T3: 80% und T4: 20%. Beim inzidentiellen Karzinom war die Prognose gunstiger, da unabhangig vom Tumorstadium die Uberlebenszeit uber 6 Monate lag. Im Fruhstadium ist eine radikale Operation nicht nur unter dem Gesichtspunkt der Radikalitat sondern auch der Palliation angezeigt.

Technik, Risiko und Ergebnisse der zusätzlichen Pfortaderresektion bei der chirurgischen Therapie des proximalen Gallengangscarcinoms

Die Pfortaderinfiltration stellt keine absolute Kontraindikation fur die Resektionsbehandlung von proximalen Gallengangstumoren dar. Pfortaderresektionen und -rekonstruktionen konnen ohne zusatzliches perioperatives Risiko nach Hilusre-sektion mit anatomischer Leberresektion durchgefuhrt werden. Die aus dem Leberresek-tat isolierte Vena hepatica ist ein geeigneter Gefasersatz fur die Pfortaderrekonstruktion. Patienten mit zusatzlicher Pfortaderresektion wegen Gefasinfiltration profitieren in unserem Patientenkollektiv, da hierdurch eine Resektionsbehandlung moglich wird und sich das mediane Uberleben gegenuber den Patienten gleicher Tumorstadien ohne Gefasresektion angleicht.

Xeno-Nierentransplantation vom Miniaturschwein zum Primaten

Xenotransplantationen konnten eine Losung fur das Misverhaltnis zwischen Organangebot und Anzahl der notwendigen Transplantationen darstellen. Deshalb untersuchten wir die Moglichkeit ein klinikrelevantes Modell fur die Xenotrans-plantation vom Miniaturschwein zum nicht humanen Primaten zu entwickeln.

111. Extrarenaler Hyperparathyreoidismus —Eigene Ergebnisse und Vorgehen der Wahl

SummaryIn 100 patients operated on for primary hyperparathyroidism the following frequency of recurrent hyperparathyroidism (re-operation) was found: solitary adenoma 3 out of 77 patients (3.8%), multiple gland disease 6 out of 15 patients (42.3%), carcinoma 3 out of 8 patients (33.3%). To recognize a multiple gland disease at the first operation a systematic surgical approach is recommended starting with unilateral neck exploration; only if an adenoma and a normal parathyroid gland cannot be identified contralateral exploration is mandatory. Following this concept the risk of an unnecessary extended neck exploration or re-operation is avoided.ZusammenfasssungBei 100 wegen extrarenalem Hyperparathyreoidismus operierten Patienten fand sich folgende Rezidiv-(Reoperations-)frequenz: solitäres Adenom 3 von 77 Patienten (3,8%), multiple Nebenschilddrüsenerkrankung 6 von 15 Patienten (42,3%) und Carcinom 3 von 8 Patienten (33,3%). Zum sicheren Erkennen einer Mehrdrüsenerkrankung bei der ersten Operation wird daher ein systematisches operatives Vorgehen empfohlen, wobei zunächst nur eine Halsseite exploriert wird; finden sich hierbei nicht ein Adenom und eine normale Nebenschilddrüse, ist die Revision der Gegenseite obligat. Hierdurch können die Folgen einer nicht notwendigen ausgedehnten Halsexploration oder Reoperation weitgehend vermieden werden.