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  • 1
    ISSN: 1437-9813
    Schlagwort(e): Biliary atresia ; Cirrhosis ; Liver transplantation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Two anicteric children were transplanted for hepatic decompensation 5 and 7 years after an initial “successful” Kasai portoenterostomy. Examination of the hepatectomy specimens showed two distinct zones: a central zone of apparently normal parenchyma with draining ductules surrounded by a peripheral zone of fibrotic tissue with no ductules. This is in contrast with the completely fibrotic explanted livers from children who are persistently jaundiced after an unsuccessful Kasai procedure. It is possible that the peripheral fibrotic tissue might have prevented the normal growth of the draining central segment, leading to hepatic decompensation at a later age. It may also contribute to the development of the portal hypertension seen so often in these patients. The earliest evidence of impending hepatic decompensation in these two cases was a steady decline in serum albumin level.
    Materialart: Digitale Medien
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  • 2
    Digitale Medien
    Digitale Medien
    Springer
    European journal of pediatrics 157 (1998), S. 856-860 
    ISSN: 1432-1076
    Schlagwort(e): Key words Liver transplantation ; Coping strategies ; Quality of life ; Psychological adjustment
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Psychological adjustment in children with liver disease was investigated. Three groups of children 6–15 years old participated: ten had undergone a liver transplant (Gp1), 15 had ongoing chronic liver disease (Gp2) and 15 were healthy controls (Gp3). Children who had had a transplant appeared well adjusted and thought of themselves as healthy rather than ill, although areas of vulnerability were present, for example increased anxiety. No differences emerged in terms of coping with common or illness-related problems or understanding of the causes of illness and use of medication. Gps 1 and 2 showed higher levels of understanding of the functions of the liver but less understanding of illness prevention when compared to their healthy peers. Gp2 experienced less control over their health when compared to the other two groups. Gp1 rated themselves as more “healthy” than Gp2 but less so than Gp3. Conclusion Children with chronic liver disease are able to communicate how they deal with the stresses of the condition. Though well adjusted in many ways, those who have had a transplant still show areas of psychological vulnerability which need to be addressed in clinical practice.
    Materialart: Digitale Medien
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  • 3
    ISSN: 1432-2277
    Schlagwort(e): Metabolic disorders, liver transplantation ; Liver transplantation, metabolic disorders Wilson's disease, liver transplantation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Between January 1989 and June 1993, a total of 470 liver transplantations were performed at King's College Hospital. Thirty-seven transplantations were performed in 34 patients with liver-based metabolic disease. There were 16 females and 18 males with a median age of 19 years (range 1 month to 62 years). There were 14 patients under 16 years of age. The indications for liver transplantation were Wilson's disease (n=16), alpha 1-antitrypsin deficiency (n=10), tyrosinaemia (n=2), primary hyperoxaluria type 1 (PH1; n=2), congenital haemochromatosis (n=1), familial amyloidotic polyneuropathy (FAP; n=1, familial hypercholesterolaemia) (n=1) and Crigler-Najjar syndrome type I (CNS1; n=1). These included two patients who received combined heart-liver grafts for familial hypercholesterolaemia and FAP, respectively. Two patients received combined liver-kidney transplants for PH1. There were four deaths: from sepsis (n=2), acute hepatic vein obstruction in a left lateral segment graft (n=1) and portal vein thrombosis with liver necrosis (n=1). Three patients were retransplanted, one for chronic rejection and two for hepatic artery thrombosis, giving an overall graft survival of 81% and patient survival of 88% (30/34), at a mean follow-up of 34 months (range 10–64 months).
    Materialart: Digitale Medien
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  • 4
    ISSN: 1432-2277
    Schlagwort(e): Biliary complications, liver transplantation, children
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Biliary complications following liver transplantation are a cause of significant morbidity and mortality. During the period 1988–1993 ten cases of biliary complications occurred after 98 transplantations in 78 children. The complications were four bile leaks, three intrahepatic biliary strictures (one with recurrent cholangitis), two anastomotic biliary strictures (one with recurrent cholangitis) and one recurrent cholangitis. All leaks occurred within 6 weeks of transplantation whereas all strictures and cholangitic episodes occurred after 3 months. Two biliary complications (20%) — one intrahepatic and one anastomotic stricture — developed secondary to hepatic artery thrombosis. The incidence of biliary complications was 13.2% with whole liver grafts as compared to 6.7% with partial liver grafts and it was 4.3% with duct-to-duct anastomosis as compared to 12.0% with Roux-en-Y hepatico-jejunostomy. Seven children required intervention for management of biliary complications and three were managed conservatively. There were no deaths related to the biliary complications.
    Materialart: Digitale Medien
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  • 5
    ISSN: 1573-2665
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Materialart: Digitale Medien
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  • 6
    Digitale Medien
    Digitale Medien
    Springer
    European journal of applied physiology 68 (1994), S. 514-518 
    ISSN: 1439-6327
    Schlagwort(e): Body surface area ; Anthropometry ; Liver disease ; Childhood ; Three-dimensional surface anthropometry
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Body surface area (BSA) is used in paediatrics to assess fluid requirement, drug doses, cardiac output and glomerular filtration rate. The aim of this study was to examine, in children with liver disease, the relationship between BSA determined by a traditional nomogram and BSA measured by a novel three-dimensional technique — Loughborough Anthropometric Shadow Scanner (LASS). Subjects were 16 children, mean age 8.1 (range 3.6–14.9) years, with a variety of liver diseases. Twenty-eight controls had a mean age of 7.1 (3.1–10.5) years. All had LASS scans performed as well as 21 anthropometric measurements taken by a single observer. There was a significant relationship between BSA (LASS) and BSA nomogram for liver-diseased children (r=0.99) and controls (r=0.96). The BSA nomogram values were significantly greater (P 〈 0.05) than BSA (LASS) for liver-diseased subjects by 10.1% (−0.35 to + 20.6; 95% confidence interval), and for controls by 9.6% (4.1–23.2). Best prediction of BSA (LASS) for liver-disease subjects used height, body weight and gluteal furrow circumference [r 2=0.997; standard estimated error (SEE) = 0.015 m2] and for controls used body weight alone (r 2=0.907; SEE=0.048 m2). BSA nomogram has no additional error in children with liver disease, but may overestimate BSA by 10% compared with a novel three-dimensional body surface scanning technique.
    Materialart: Digitale Medien
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  • 7
    Digitale Medien
    Digitale Medien
    Springer
    Journal of inherited metabolic disease 14 (1991), S. 497-511 
    ISSN: 1573-2665
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The α1-antitrypsin deficient subject (protease inhibitor (PI) phenotype ZZ) has an increased susceptibility to liver disease. The condition is most commonly identified in early infancy as a conjugated hyperbilirubinaemia with hepatitis (11%) or a bleeding state due to vitamin K malabsorption (2%). 50% of cases have cirrhosis and 25% die in the first decade of life. A further 2% present with cirrhosis in later childhood. Adult males are at risk of hepatoma development with or without cirrhosis. Diagnosis is by isoelectric focussing or allele-specific oligonucleotide hybridization. The treatment is that of cholestasis and cirrhosis including transplantation. The pathobiology of the deficiency state, the mechanism of liver damage and the vulnerability of the newborn liver are discussed in this review. A plea is made for a trial of infusions of α1-antitrypsin in early infancy, as is used safely but without proven efficacy in the emphysematous PIZZ subject. Prospects of therapy by gene modification are also reviewed.
    Materialart: Digitale Medien
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