F. Langer

Preservation solutions for transplantation

Eurocollins has almost been abandoned because of the glucose disadvantage. UW is certainly the most used preservation solution for livers, kidneys, and pancreases with excellent clinical and experimental preservation data. UW can certainly be considered the current golden standard solution. However, the disadvantage of high viscosity, high price, uneasy handling of many 1-L bags, and the fact that the radical scavenger glutathion cannot be detected in the bags by chemical analysis (presumably due to diffusion) encourage competitors to produce new compounds with better cost to effect ratios. HTK has a firm place in cardiac preservation; by demonstration of equal safety and efficacy in preserving livers and kidneys, at least in the middle and lower range of cold ischemia time, HTK will be sued more frequently, particularly with the consideration of lower price and more easy handling aspects. The suggested high volume perfusion is not really necessary, calculation based on a total volume of 10 L for a multiorgan donor show significant cost reductions. Celsior is current only used for cardiac preservation. Beyond all aspects of conservation and preservation potencies of all these fluids, it must not be forgotten that cold ischemia itself is a risk factor for organ function. Therefore, cold ischemia time should be kept as short as possible. People are willing to accept 24 hours or more cold ischemia time in kidney transplantation because organ failure can be treated by dialysis. In other organs, where immediate organ function is essential, like in clinical heart transplantation, cold ischemia is hardly ever extended beyond 6 hours. Why are hearts and kidneys so different? Very likely, there is no difference, and the outstanding results in living unrelated kidney transplants is mostly due to short cold ischemia time.

Radical Surgical Therapy of Abdominal Cystic Hydatid Disease: Factors of Recurrence

Abstract. A series of 74 consecutive patients (48 women, 26 men) were operated for abdominal hydatid disease between June 1949 and December 1995. The patients ranged in age from 15 to 81 years (median 49 years). In 69 cases only the liver was affected; two patients had concomitant extrahepatic disease (one spleen, one spleen and lung), and 3 had cysts in the spleen only. Cysts were multiple in 11 patients and calcified in 24. Conservative surgical procedures were used for 22 cysts in 20 patients [open partial (n= 3), open total (n= 6), closed total cystectomy (n= 9), marsupialization (n= 2), drainage (n= 2)] and radical surgical procedures for 72 cysts in 54 patients [pericystectomy (n= 41), wedge liver resection or hemihepatectomy (n= 25), splenectomy (n= 5), radical resection of a lung cyst (n= 1)]. Altogether 37 patients (50%) were given perioperative antihelmintic chemotherapy with mebendazole (18 patients) or albendazole (19 patients). Operative mortality rates were 5.0% after conservative surgery and 1.8% after radical surgery. Morbidity rates were 25.0% following conservative surgery and 24.1% following radical surgery. Antihelmintic therapy was well tolerated by all but five patients. All side effects were entirely reversible. Among the 74 patients, 60 (81.0%) were available for long-term follow-up (median 7.2 years; range 2.0–47.0 years). Recurrence of disease was seen in 9 of 60 patients at an interval of 3 months to 20 years from the first operation. The rate of recurrence was significantly lower after radical surgical procedures (p= 0.03) and after closed removal of the cyst (p= 0.04).

Eating behavior in laparoscopic sleeve gastrectomy: Correlation between plasma ghrelin levels and hunger

ZusammenfassungGRUNDLAGEN: Bariatrische Operationsverfahren wie das Magenband, VGB und Magenbypass haben nachgewiesenermaßen Einfluss auf das postoperative Essverhalten. Nachdem die laparoskopische Sleeve gastrectomy (LSG) zu verringerten Ghrelin-Spiegeln führt, ist eine Reduktion im Hungerempfinden zu erwarten. Ziel dieser Studie war es, den Einfluss der LSG auf das Essverhalten in Korrelation Plasma-Ghrelin-Spiegeln zu bestimmen. METHODIK: In dieser prospektiven Studie von 15 morbid adipösen LSG-Patienten wurde die deutsche Version des Self-report Three-Factor Eating Questionnaire (TFEQ) vor der Operation und 6 Monate postoperativ angewandt, um den Einfluss der LSG auf die drei Dimensionen des Essverhaltens: Kontrolle, Irritierbarkeit und Hungerempfinden zu bestimmen. In einer Untergruppe von 7 Patienten wurde die Korrelation zwischen Plasma-Ghrelin-Spiegeln und dem Hungerempfinden untersucht. ERGEBNISSE: LSG führte zu einer Zunahme in der kognitiven Einschränkung und zu einer reduzierten Kontrolle, Irritierbarkeit. Weiters wurde eine signifikante Reduktion im Hungerempfinden nachgewiesen, welche ebenfalls mit den Ghrelin-Spiegeln korrelierte (r = 0.834, p = 0.01). SCHLUSSFOLGERUNGEN: LSG führt zu einem reduzierten Hungerempfinden, welches mit den ebenfalls verringerten Plasma-Ghrelin-Spiegeln korreliert. Diese Effekte können zu dem exzellenten Gewichtsverlust nach LSG beitragen.SummaryBACKGROUND: Bariatric procedures like gastric banding, vertically banded gastroplasty and Roux-en-Y gastric bypass have impacted on the postoperative eating behavior. Since laparoscopic sleeve gastrectomy (LSG) leads to decreased plasma ghrelin levels, a reduced sensation of hunger following surgery is expected. The aim of this study was to assess the impact of LSG on the eating behavior in correlation with plasma ghrelin levels. METHODS: This prospective study was carried out in 15 morbidly obese patients who underwent LSG. The German version of the self-report Three-Factor Eating Questionnaire (TFEQ) was applied preoperatively and at six months following surgery to assess the impact of LSG on the three dimensions of eating behavior: restraint, disinhibition and hunger. The correlation between plasma ghrelin levels and the sensation of hunger was assessed in a subset of seven patients. RESULTS: Following LSG, increased cognitive restraint and decreased disinhibition of eating were found. Furthermore, a significant decrease in hunger was observed with a significant correlation (r = 0.834, p = 0.01) between circulating plasma ghrelin levels and hunger scores. CONCLUSIONS: Following LSG, a high correlation between decreased ghrelin levels and the reduced sensation of hunger was found. This may contribute to the excellent weight loss observed following laparoscopic sleeve gastrectomy.

Chirurgische Therapie der Adipositas

SummaryAt the beginning of the 21st century, obesity has become an epidemic with the greatest prevalence in the western world. For morbidly obese patients, conservative treatment has yielded disappointing results: On the other hand, bariatric surgery offers a sustained substantial weight loss for these patients. Common bariatric procedures including results and complications are described. Different bariatric procedures including gastric banding, vertical banded gastroplasty, gastric bypass, duodenal switch, and gastric pacing are introduced. Bariatric procedures can result in permanent excessive-weight loss ranging from 25 to 78% and thus are an effective treatment for morbidly obese patients. Efficacy, morbidity, and late-term complications, however, should be considered in choosing the most effective bariatric approach.ZusammenfassungAdipositas stellt zu Beginn des 21. Jahrhunderts die Epidemie mit der größten Prävalenz in der westlichen Welt dar. Konservative Behandlungsmethoden haben bei morbid adipösen Patienten überwiegend enttäuschende Ergebnisse erbracht: Demgegenüber bietet die bariatrische Chirurgie für diese Patienten anhaltenden, substantiellen Gewichtsverlust. Die derzeit gebräuchlichen bariatrischen Operationen werden unter Berücksichtigung von Resultaten und Komplikationen beschrieben. Das verstellbare Magenband, die vertikale bandverstärkte Gastroplastik, der Magenbypass, die biliopankreatische Diversion und der Magenschrittmacher werden vorgestellt. Diese Operationen können eine permanente Reduktion des Übergewichts um 25 bis 78 % erzielen. Bariatrische Operationen stellen eine effektive Behandlung der morbiden Adipositas dar. Bei der Wahl des Verfahrens sind neben den Lebensumständen der Patienten die Effektivität, Morbidität sowie mögliche Langzeitkomplikationen der jeweiligen Operationsmethode zu berücksichtigen.

Use of absorbable mesh in the treatment of parenchymal liver injuries during orthotopic liver transplantation

OBJECTIVEnTo find out whether packing or wrapping with polyglactin 910 mesh was more effective in stopping bleeding in livers that had been damaged during transplantation.nnnDESIGNnRetrospective study.nnnSETTINGnUniversity hospital, Austria.nnnSUBJECTS AND INTERVENTIONSn15 of 27 livers that had been damaged during transplantation bled sufficiently to warrant either packing (n = 6) or wrapping (n = 9).nnnMAIN OUTCOME MEASURESnArrest of bleeding; other complications.nnnRESULTSnBoth packing and wrapping succeeded in stopping the bleeding, and neither caused infections. Packing may theoretically cause an increase in intra-abdominal pressure and impair organ function.nnnCONCLUSIONnIt is preferable to wrap rather than pack a bleeding liver that has been damaged during transplantation.

transplantation for alcoholic cirrhosis

Abstract In recent years, alcoholic cirrhosis has been accepted as an indication for OLT, compliance of patients suffering from alcoholic cirrhosis is still under discussion, however. 118 patients who had undergone OLT for alcoholic cirrhosis were considered for analysis. The mean follow‐up time of the study population was 53.7 ± 38.9 months. Compliance was defined by 3 parameters: 1. Sobriety. Fifteen (13%) out of 118 recipients suffered an alcohol relapse during the observation period. There was no difference between the groups with or without alcohol relapse concerning compliance with medication, incidence of rejection, or adherence to checkups. 2. Drug‐compliance. Nineteen recipients (16%) were not within the target range with the immunosuppressive medication. Comparison of the compliant‐ and non‐compliant groups produced a significant difference for late acute rejection, the other parameters being similar in the subgroups. 3. Adherence to appointments. Nearly all patients in the study population (>95%) were compliant with both transplant and psychological appointments in the outpatient clinic. In conclusion, analysis of our data indicates that patients with OLT for alcoholic cirrhosis are compliant, although alcohol relapse occurs in 13% of recipients.

Ursache für einen Abszeß in der Psoasloge bei Sarkoidose

SchlußfolgerungenIn 3 bis 10% aller Fälle einer akuten Cholezystitis kommt es zu einer Perforation der Gallenblase. In 35% kommt es dabei zu einer akuten freien Perforation mit galliger Peritonitis, in 50% ist ein percholezystitischer Abszeß die Folge. Eine chronische Perforation (15%) kann entweder zu einer cholezystointestinalen (ins Duodenum oder Kolon) oder zu einer cholezystokutanen Fistelbildung führen. Die perforierende Cholezystitis hat eine bis zu 30%ige Letalität.Wäre die Cholezystitis schon vor der operativen Revision bekannt gewesen, hätte man, um die Keimverschleppung zu minimieren, primär die Cholezystektomie durchgeführt. Ist die Ursache für einen Psoasabszeß präoperativ nicht geklärt, sollte auch an eine Gallenblasenperforation gedacht werden.