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Dive into the research topics where Karl J. Oldhafer is active.

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Featured researches published by Karl J. Oldhafer.


Surgery | 1998

First experience and technical aspects of isolated liver perfusion for extensive liver metastasis

Karl J. Oldhafer; Hauke Lang; Markus Frerker; Laura Moreno; Ajay Chavan; Peer Flemming; Silvio Nadalin; Ekkehard Schmoll; R. Pichlmayr

BACKGROUNDnNew drugs and modalities for locoregional tumor treatment in recent years may offer new potential for isolated liver perfusion in patients with nonresectable liver tumors. The purpose of this study was to prove the feasibility of arterial isolated liver perfusion and to assess the tolerance of perfusion with high-dose tumor necrosis factor (TNF).nnnMETHODSnTwelve patients with extensive liver metastases previously treated unsuccessfully with systemic chemotherapy underwent isolated hyperthermic liver perfusion using a heart-lung machine. High doses of mitomycin were administered in the first six and a combination of TNF and melphalan in the last six patients.nnnRESULTSnNo operative death occurred and no direct postoperative liver failure was observed in any patient. In cases of variations of the arterial hepatic blood supply, the perfusion was done through the splenic artery or an angiography catheter. Histologic analysis of tumor biopsy specimens obtained on the first postoperative day revealed major tumor necrosis in 8 of 12 patients.nnnCONCLUSIONSnIsolated arterial perfusion of the liver is a complex surgical procedure that is feasible in patients with anatomic variations of the hepatic artery. The remarkable histologic response to perfusion in several pretreated patients, especially after application of high-dose TNF and melphalan, suggests that this modality is very effective in tumor killing.


The Annals of Thoracic Surgery | 1997

Open Heart Operations After Renal Transplantation

Christoph Dresler; Kai Uthoff; Thorsten Wahlers; Volker Kliem; Jochen Schäfers; Karl J. Oldhafer; Hans-Georg Borst

BACKGROUNDnBecause of the increasing number of renal transplantations performed, secondary cardiac operations in these patients are discussed concerning their impact on patient and graft survival.nnnMETHODSnWe reviewed our experience in 45 patients (33 male and 12 female) who underwent open heart operations after previous renal transplantation. Thirty-one patients (group I) received coronary artery bypass grafting and 14 (group II) underwent valve replacement. Mean age at the time of operation was 55 +/- 9 years. The interval between renal transplantation and cardiac operation was 57 +/- 39 months (range, 5 days to 174 months). All patients had functioning renal allografts with preoperative serum creatinine levels ranging from 100 to 338 mol/mL (mean +/- standard deviation, 195 +/- 86).nnnRESULTSnOverall early operative mortality (30 days) was 8.8% (group I, 1 patient; group II, 3 patients). Underlying causes of death were septic endocarditis (n = 2, group II), necrotizing enterocolitis (n = 1, group I), and myocardial infarction (n = 1, group II). One further patient in group II also died of septic endocarditis after 69 days (in-hospital death). The mean follow-up of the 40 surviving patients was 44 +/- 31 months. There was another late death (24 months postoperatively) caused by coagulopathy. Four patients had returned to hemodialysis at intervals of 27 to 83 months (mean, 51 months) because of renal transplant failure. In all patients, the function of the renal allograft was not impaired by open heart operation.nnnCONCLUSIONSnOpen heart operations in renal transplant recipients have acceptable mortality and morbidity rates. In almost all patients, function of the transplanted organ can be maintained at the preoperative level.


Transplant International | 1994

Liver transplantation for Budd‐Chiari syndrome‐palliation or cure?

Hauke Lang; Karl J. Oldhafer; E. Kupsch; B. Ringe; R. Pichlmayr

This report documents two cases of Budd-Chiari syndrome (BCS) with essential thrombocytosis and antithrombin (AT) III deficiency as underlying etiological factors. Orthotopic liver transplantation was successfully performed in both patients but with different therapeutic intention. In the patient with essential thrombocytosis, hepatic transplantation only relieved the symptoms of the predisposing thrombogenic condition; it dìd not cure the underlying disorder. Prophylactic long-term anticoagulation, as well as adjuvant therapy for the causative disease, remained necessary. On the other hand, in the patient with AT III deficiency, liver transplantation was curative, resulting in complete reconstitution of serum AT III activity with resolution of the hypercoagulable state postoperatively. Thus, depending on the underlying etiology, liver transplantation for BCS can be considered as palliative, necessitating long-term adjuvant therapy, or as curative, with correction of a metabolic defect.


The American Journal of Medicine | 1989

Primary Hodgkin's lymphoma: An unusual cause of graft dysfunction after kidney transplantation

Karl J. Oldhafer; Hartwig Bunzendahl; Ulrich Frei; Josef Kemnitz; Peter M. Vogt; R. Pichlmayr

I mmunosuppressed allograft recipients run a higher risk of developing malignancies than does the general population [l]. Lymphomas are disproportionately frequent among posttransplant malignancies [1,2]. Since the introduction of cyclosporin therapy, they have even become the predominant tumor [l]. The majority of these lymphomas are non-Hodgkin’s types. Hodgkin’s lymphoma accounts for only 2% to 4% of lymphomas in transplant recipients, compared with 18% in the general population [2]. In this report, we describe a patient who developed primary Hodgkin’s lymphoma in the allograft during cyclosporin therapy after kidney transplantation.


The American Journal of Gastroenterology | 1998

Two-step procedure in Budd-Chiari syndrome with severe intrahepatic vena cava stenosis: vena cava stenting and portocaval shunt

Karl J. Oldhafer; Markus Frerker; M Prokop; Hauke Lang; K. Böker; R. Pichlmayr

Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction, which often leads to death as a result of portal hypertension and liver failure. Venous decompressive shunt surgery and liver transplantation represent efficient surgical treatments of Budd-Chiari syndrome. In the case presented here, severe intrahepatic compression of the inferior vena cava (IVC) was caused by the hypertrophic caudate lobe. A mere portocaval shunt was not feasible because of a large pressure gradient across the intrahepatic stenosis. A two-step procedure with preoperative radiological dilation and stenting of the intrahepatic IVC followed by a portocaval shunt was successfully performed. Consequently, liver transplantation and its subsequent immunosuppression could be avoided.


Journal of Investigative Surgery | 1998

High-Dose Mitomycin C in Isolated Hyperthermic Liver Perfusion for Unresectable Liver Metastases

Karl J. Oldhafer; Markus Frerker; Hauke Lang; J. Fader; Peer Flemming; Ekkehard Schmoll; Silvio Nadalin; L. Moreno; R. Pichlmayr

In order to reduce systemic side effects and increase intrahepatic mitomycin C (MMC) concentrations, isolated hyperthermic liver perfusion (IHLP) has been performed using MMC. This article describes the pharmacokinetics of MMC in IHLP and presents our clinical experience with its use in six patients suffering from unresectable liver metastases. Primary tumors consisted of colorectal carcinomas in three cases, breast cancer in two, and a choroidal melanoma in one. Dosages of MMC varied between 0.5 and 1.0 mg MMC/kg body weight. MMC was added as a bolus directly into the extracorporeal circuit. Intrahepatic temperature was elevated to 40.0-41.0 degrees C by hyperthermic perfusion. MMC concentrations were measured in peripheral blood (preperfusion, then at 5, 30, and 55 min during perfusion, and finally at 5 and 60 min and 6 and 24 h after perfusion) and in recirculating perfusate (5, 30, and 55 min). While markedly elevated MMC concentrations (maximum 6290 ng/mL) were found in the liver perfusate, systemic concentrations remained low (maximum 45 ng/mL), indicating no considerable leakage. MMC concentrations in the perfusate constantly decreased during perfusion. After rinsing with 1500 mL saline, a mean concentration of 52.5+/-33 ng MMC/mL was measured in the washout from 5 patients. In 1 patient with a colorectal carcinoma, MMC concentrations in the perfusion medium were 10-fold and in the plasma 2-fold higher than in the other patients. This high MMC concentration caused severe intrahepatic vascular damage and finally led to the patients death. In conclusion, IHLP and intrahepatic perfusion with MMC resulted in a high response of hepatic tumors. Systemic exposure of MMC can be reduced effectively by isolated perfusion. However, hepatic toxicity of MMC must be considered.


Hpb | 2006

Liver resection for metastasis due to malignant mesenchymal tumours

Gregor A. Stavrou; Peer Flemming; Karl J. Oldhafer

While liver resection for colorectal metastases has shown promising long-term survival, data for metastasectomy in sarcoma and leiomyosarcoma patients have not yielded the same optimism. Due to the rarity of the tumour entity it has always been difficult to provide significant data. Advances in tumour classification suggest that most of the metastases formerly classified to be of sarcomatoid and especially leiomyosarcomatoid origin are actually metastases of GISTs (gastro-intestinal stromal tumours). Neoadjuvant/adjuvant imatinib therapy might improve overall survival and enable surgeons to provide resections in previously unresectable patients. Only R0 resection has been proven to prolong survival so far, with a long disease-free interval as the only independent predictor of outcome.


Journal of The American College of Surgeons | 2014

Identification Tags for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy: A Critical Appraisal of an “Original” Technical Proposal

Marcello Donati; Francesco Basile; Gregor A. Stavrou; Karl J. Oldhafer

Figure 1. Example of vessel loop technique during first step of associating liver partition and portal vein ligation for staged hepatectomy; 2 loops, respectively, for right bile duct (yellow) and right hepatic artery (red), and a T-drain for main bile duct (orange). Identification Tags for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy: A Critical Appraisal of an “Original” Technical Proposal


Surgical Endoscopy and Other Interventional Techniques | 1996

Intraoperative ultrasound during ex situ liver resection

Hauke Lang; Karl J. Oldhafer; A. Weimann; Hans-Joachim Meyer; R. Pichlmayr

This report describes the application of intraoperative ultrasound at the explanted liver during ex situ liver surgery. A 55-year-old woman underwent extracorporeal liver resection for multilocular metastases of a duodenal leiomyosarcoma. At surgery, routine intraoperative ultrasound (5-MHz probe) was performed before hepatectomy at the completely mobilized but still normally perfused liver. After hepatectomy ultrasound of the liver was repeated at the back table. By use of the ultrasonographic examination at the back table all the metastases seen with usual intraoperative ultrasound could be confirmed. In addition, one metastasis with a diameter of 6 mm was detected which had neither been suggested by peroperative computer tomography and sonography nor by intraoperative ultrasound or surgical exploration. In cases of extracorporeal liver surgery the combination of in situ and ex situ sonography may improve the identification of hepatic metastases.


The Annals of Thoracic Surgery | 1991

Infected intravenous port device causing tricuspid valve regurgitation

Markus K. Heinemann; Guenter Frank; Karl J. Oldhafer; Ekkehard Schmoll

Sepsis and tricuspid valve regurgitation developed in a 29-year-old man with Crohns disease after implantation of an intravenous port device for parenteral nutrition. A thrombus, caused by Staphylococcus epidermidis, had grown along the catheter and prolapsed through the valve without affecting it. Complete removal in an open heart procedure led to quick recovery.

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Hauke Lang

Hannover Medical School

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B. Ringe

Hannover Medical School

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