Hans Joerg Mischinger

Long-term quality of life of liver transplant recipients beyond 60 years of age

Due to ameliorated surgery as well as better immunosuppression, the recipient age after liver transplantation has been extended over the past years. This study aimed to investigate the health related quality of life after liver transplantation in recipients beyond 60 years of age. The SF-36 was used to evaluate the recipients’ health-related quality of life as standardized tool. It comprises 36 items that are attributed to 8 subscales attributed to 2 components: the physical component score and the mental component score. Differences in the health-related quality of life between the included aged recipients and age-matched general population as well as among female and male recipients. Aged recipients showed significantly lower scores in physical functioning (29 vs. 76, p = 0.001), role physical (42 vs. 73, p = 0.003), bodily pain (34 vs. 71, p = 0.003), general health (28 vs. 59, p = 0.001), vitality (25 vs. 61, p = 0.001), social functioning (36 vs. 87, p = 0.001), role emotional (46 vs. 89, p = 0.001) as well as the physical component score (28 vs. 76, p = 0.001). Aged female recipients showed lower results as compared to males in social functioning, physical functioning, role physical, and social functioning (p = 0.03 respectively) but comparable results in the remaining. Quality of life seems to be an issue among aged recipients and should be assessed on a regular basis.

Chicken-bone perforation of a sigmoid colon diverticulum into the right groin and subsequent phlegmonous inflammation of the abdominal wall

ZusammenfassungDie Prävalenz von Kolondivertikel ist hoch in westlichen Ländern und etwa 80% der Patienten mit Divertikulitis sind älter als 50 Jahre. Das Colon sigmoideum und descendens sind am häufigsten befallen. Die klinische Manifestation reicht von asymptomatischen Divertikula bis zu lebensbedrohlichen Komplikationen wie die Perforation von Divertikula mit nachfolgender Peritonitis. In einem geringen Prozentsatz der Patienten kann das Verschlucken eines Fremdkörpers eine Sigmadivertikel Perforation verursachen. Das Verschlucken von Fremdkörpern wie Hühnerknochen, Fischknochen, Zahnstocher und Zahnersatzteilen hat gewöhnlich keine Konsequenzen und nur in 5% der Fälle muss chirurgisch interveniert werden. Meistens merken die Patienten nicht, das Sie einen Fremdkörper verschluckt haben und die Ursache für das Akute Abdomen und Darmperforation wird erst intraoperativ oder im Rahmen der histologischen Aufarbeitung entdeckt. Wir berichten über eine 82-jährige Frau mit Perforation eines Sigmadivertikels in die rechte Leiste mit nachfolgender Bauchdeckenphlegmone. Eine Operation nach Hartmann mit Nekrektomie der Bauchdecke wurde durchgeführt. Die histopathologische Aufarbeitung fand einen Hühnerkochen im perforierten Sigmadivertikel. Bei älteren Patienten mit Divertikulitis und Abszess bzw. Perforation muss die Möglichkeit einer Fremdkörperingestion ursächlich in Betracht gezogen werden.SummaryColonic diverticula are frequent in western countries and approximately 80% of patients who develop diverticulitis are elderly. The sigmoid and descending colon are most commonly involved. Clinical manifestations range from asymptomatic diverticula to life-threatening complications such as diverticulum perforation and subsequent peritonitis. In a small percentage of cases ingestion of foreign bodies can cause perforation of the sigmoid diverticulum. Ingestion of foreign bodies such as chicken bones, fish bones, toothpicks and dentures usually has no consequence and only 5% of such cases require surgery. Patients frequently do not realize that they have ingested the foreign body and the cause of the damage is usually discovered intraoperatively or on pathological examination of the surgical specimen. We report an 82-year-old woman with perforation of a sigmoid diverticulum into the right groin with subsequent phlegmonous inflammation of the abdominal wall. A Hartmanns procedure with necrectomy of the abdominal wall was performed. Histopathologic examination revealed an ingested chicken bone perforating the diverticulum. When diverticulitis or diverticular abscess is suspected in an elderly patient, foreign body impaction or perforation should be considered as a possible cause.

The disease relevance of human hepatocellular xenograft models: molecular characterization and review of the literature.

In recent years a number of new therapeutics has been developed that were not general toxins and inhibitors of cell division like classical chemotherapeutics, but were designed to target a specific pathway. A prerequisite for this development was the comprehensive characterization of molecular alterations occurring in human hepatocellular carcinoma (HCC). However, while much knowledge of the molecular pathogenesis of human HCC has been gained, the model systems used to test the functional relevance of these alterations and applied for preclinical evaluation of drug candidates are still poorly characterized. In this paper, we reviewed the literature about several commonly used HCC cell lines and xenotransplantation models and present our own data on the molecular characterization of these. Results obtained demonstrate that it is important to have a sound knowledge of the specific molecular constitution of the experimental model and to carefully evaluate the functional status of the pathway of interest. For this reason, we make the gene expression profiles publicly available to help researchers making an informed decision about which model to use.

Spontane Milzruptur bei Einflußokklusion der Leber

A 45-year-old woman underwent a resection for a hepatic metastasis of the liver caused by a carcinoma of the colon. Shortly after the Pringle maneuver severe hemorrhage from the upper left quadrant of the abdomen was observed. Exploration revealed a spontaneous parenchymal laceration of the spleen.ZusammenfassungBei einer 45jährigen Patientin wurde wegen einer Metastase nach einem Kolonkarzinom an der Leber eine Segmentresektion in Einflußokklusion durchgeführt. Kurz nach dem Pringle-Manöver trat eine massive spontane Blutung aus dem linken Oberbauch auf. Als Ursache zeigte sich eine spontane Ruptur der Milz.

Congenital absence of the portal vein in an adult woman: a case report.

SummaryCongenital absence of the portal vein is a rare malformation. Mesenteric and splenic venous blood bypasses the liver and drains into the renal veins or directly into the inferior vena cava. The malformation occurs predominantly in females and children and is often associated with other anomalies such as hepatic tumors, cardiac malformations and skeletal abnormalities. We describe a 23-year-old female with congenital absence of the portal vein associated with variant origin of the hepatic artery from the superior mesenteric artery. Additional anomalies were not present. The patient is in good condition. Laboratory tests showed elevated total bilirubin; other liver parameters were within normal range. The absence of the portal vein was confirmed by MR angiography, which revealed that the upper part of the superior mesenteric vein and the splenic vein drained into the left renal vein. A liver biopsy showed no signs of cirrhosis. Yearly follow-up with laboratory tests and ultrasonography was recommended to our patient. According to the literature, the prognosis of this patient depends on the presence of cardiac defects and liver tumors. There is little information on the outcome of patients with congenital absence of the portal vein; only long-term follow-up investigations will provide answers to the numerous remaining questions.ZusammenfassungDas angeborene Fehlen der Pfortader ist eine sehr seltene Fehlbildung. Das venöse Blut aus dem Intestinum und der Milz umgeht die Leber und drainiert direkt in die Nierenvenen oder in die untere Hohlvene. Es tritt vor allem bei Kindern auf und das weibliche Geschlecht ist häufiger betroffen. Assoziert sind oft Missbildungen des Herzens und des Skeletts. Weiters kommt es zu einem gehäuften Auftreten von Lebertumoren. Wir berichten über eine 23-jährige Patientin mit Pfortaderaplasie und variantenhaften Abgang der Arteria hepatica aus der Arteria mesenterica superior. Zusätzliche Fehlbildungen traten nicht auf. Die Patientin ist in gutem Allgemeinzustand. Im Labor zeigte sich ein erhöhtes totales Bilirubin, andere Leberparameter waren im Normbereich. Das Fehlen der Pfortader wurde durch eine MR-Angiographie bestätigt. Hier zeigte sich, dass die Milzvene und die obere Mesenterialvene in die linke Nierenvene drainieren. Eine Leberbiopsie wurde auch durchgeführt und zeigte keine Zeichen einer Zirrhose. Wir haben mit der Patientin jährliche Labor- und Ultraschallkontrollen vereinbart. Bezugnehmend auf die Literatur, ist die Prognose abhängig vom Auftreten von Herzfehlbildungen und zusätzlichen Lebertumoren. Derzeit besteht wenig Information über den klinischen Verlauf dieser Patienten. Erst weitere, über einen längeren Zeitraum laufende Nachsorgeuntersuchungen werden diese Fragen beantworten können.

Effectiveness of porcine dermal collagen in giant hernia closure in patients with deleterious fascia constitution after orthotopic liver transplantation

Incisional hernias (IHs) occur universally after orthotopic liver transplantation (OLT). This study aimed to investigate the effectiveness of porcine dermal collagen (PDC) as a closing aid in giant hernias after OLT in a prospective trial. If direct closure (DC) was not feasible due to the hernia size and abdominal wall constitution, a PDC mesh was implanted. All patients from the PDC and DC groups were followed prospectively for 24 months. IH recurrence rates served as the primary endpoint, and the development of infections and wound healing disorders served as the secondary endpoints. Recurrence rate was 21% (4/19) in DC patients and 12% (2/16) in PDC patients (P = 0.045). Implant site infections occurred in five of PDC and one of DC patients (P < 0.05). All of them were managed with antibiotics; two of the PDC patients required surgical drainage. Histological analysis of PDC mesh biopsies indicated good angiogenesis and integration of the PDC into the abdominal wall. PDC was effective in our study for incisional hernia repair, and our results compared favourably with those of patients in whom direct hernia closure was feasible.