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  • 1
    Electronic Resource
    Electronic Resource
    Modified intra-arterial calcium stimulation with venous sampling test for preoperative localization of insulinomas (1998)
    Springer
    Abdominal imaging 23 (1998), S. 322-331 
    Details
    ISSN: 1432-0509
    Keywords: Key words: Pancreas angiography—Pancreas neoplasms—Venous blood sampling—Hormones.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Background: To determine the accuracy and safety of a modified intra-arterial calcium stimulation with the venous sampling test (ASVS) for preoperative localization of insulinomas. Modification included stimulation with a fixed low dose of calcium gluconate, additional stimulation in the distal splenic artery, and no insulin sampling in the left hepatic vein. Methods: In 10 patients showing biochemical evidence of organic hyperinsulinemia, 0.45 mmol of Ca2+ was injected into the gastroduodenal, superior mesenteric, proper hepatic, proximal, and distal splenic arteries during angiography. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60, 90, 120, 180, and 300 s after Ca2+ injection. Results: Insulin gradients with an increase of more than fourfold indicated direct tumor supply, two- to fourfold correlated with collateral supply, and less than twofold correlated with normal tissue vascularization. ASVS localized all the adenomas of the pancreatic head (n = 3) and body (n = 2) and two of four adenomas of the tail correctly, as confirmed by surgery. Two adenomas of the proximal pancreatic tail were erroneously localized to the body segment, but the fault was rectified by angiography. In one patient with a negative ASVS and without exploration, the diagnosis of an insulinoma was revised. Conclusion: ASVS with a fixed low dose of calcium gluconate is a highly accurate and safe method for preoperative localization of insulinomas. Sampling in the left hepatic vein can be routinely omitted. Additional stimulation in the distal splenic artery seems helpful in surgical decision making, but additional experience is needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900350
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  • 2
    Electronic Resource
    Electronic Resource
    Die Lebertransplantation mit Erhalt der Vena cava und einem temporären portocavalen Shunt (1999)
    Springer
    Der Chirurg 70 (1999), S. 174-177 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Liver transplantation ; Temporary portocaval shunt. ; Schlüsselwörter: Lebertransplantation ; temporärer portocavaler Shunt.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die laterolaterale Cavocavostomie zur hepatovenösen Rekonstruktion bei der Lebertransplantation wird vorgestellt, mit und ohne Anlage eines temporären portocavalen Shunts. Insgesamt 65 Lebertransplantationen wurden analysiert. Bei 49 Transplantationen wurde eine laterolaterale cavocavale Anastomose angelegt (Gruppe I). Bei 16 weiteren Patienten (Gruppe II) wurde ein temporärer portocavaler Shunt während der Hepatektomie durchgeführt. Der gemittelte arterielle Blutdruck betrug in mmHg für Gruppe I 128 ± 34, in Gruppe II 109 ± 32. Das Herzzeitvolumen (l/min) reduzierte sich während der anhepatischen Phase bei Gruppe I um 2,3 ± 1,9 bei Gruppe II um 1,2 ± 1,5 (p 〈 0,05). Der perioperative Blutverlust gemessen an der Anzahl Erythrocytenkonzentrate betrug 16,4 ± 15,8 in Gruppe I versus 1,2 ± 2,3 in Gruppe II (p 〈 0,04) an der Anzahl Einheiten Frischplasma 19,0 ± 14,7 vs. 3,7 ± 4,0 (p 〈 0,02). Der Verbleib auf der Intensivstation in Tagen, die Leberfunktionsteste sowie die renale Funktion und die Häufigkeit erforderlicher Reoperationen wegen Blutung waren nicht statistisch signifikant unterschiedlich zwischen den beiden Gruppen. Die 1-Jahres-Überlebensrate betrug 82,7 % bzw. 85,7 %. Schlußfolgerung: Die Anlage eines temporären portocavalen Shunts kann bei der Cava-erhaltenden Hepatektomie und Spender-zu-Empfänger-Cavocavostomie zu besserer hämodynamischer Stabilität, weniger Blutverlust und vereinfachter Transplantatimplantation beitragen.
    Notes: Summary. The experience with laterolateral cavocavostomy for hepatovenous reconstruction in liver transplantation is reviewed with and without the use of a temporary portocaval shunt. A total of 65 liver transplantations were analyzed. In 49 transplantations a laterolateral cavocaval anastomosis was performed (group I). In group II (n = 16) the same technique was used after a temporary portal caval shunt was constructed. Mean arterial pressure (mmHg): group I 128 ± 34; group II 109 ± 32. Cardiac output (l/min) decrease during the anhepatic phase was 2.3 ± 1.9 and 1.2 ± 1.5, respectively (P 〈 0.05). The peroperative blood loss measured as the number of packed cells transfused was 16.4 ± 15.8 versus 1.2 ± 2.3 (P 〈 0.04) and fresh frozen plasma 19.0 ± 14.7 versus 3.7 ± 4.0 (P 〈 0.02). Course on ICU (days), liver function tests, renal function and the need for reoperation because of bleeding were not statistically significantly different between the groups. One-year patient survival was 82.7 and 85.7 %, respectively. In conclusion, we found that despite preservation of the caval flow during hepatectomy, the additional use of a temporary portocaval shunt was advantageous with regard to peroperative hemorrhage and hemodynamic stability and can potentially facilitate implantation of the liver graft.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050065
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  • 3
    Electronic Resource
    Electronic Resource
    Die sequentielle orthotope Lebertransplantation –Dominotransplantation (1997)
    Springer
    Der Chirurg 68 (1997), S. 1011-1013 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Domino liver transplantation ; Familial amyloid polyneuropathy. ; Schlüsselwörter: Dominolebertransplantation ; familiäre amyloidotische Polyneuropathie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die familiäre amyloidotische Polyneuropathie (FAP) ist eine seltene Indikation zur Lebertransplantation. Die excidierte Leber des FAP-Patienten kann einem ausgewählten Patienten transplantiert werden. Im folgenden wird über eine sequentielle Lebertransplantation berichtet, die bei einer 34 jährigen FAP-Patientin mit der Leber eines hirntoten Organspenders durchgeführt wurde. Die excidierte Leber der Patientin wurde einem 60 jährigen Patienten mit hepatocellulärem Carcinom bei Cirrhose nach Hepatitis-C-Infektion implantiert.
    Notes: Summary. Familial amyloid polyneuropathy (FAP) is a rare indication for liver transplantation. The excised liver of the FAP patient can be transplanted into a selected patient. In the following report, sequential liver transplantation is described where a 34-year-old female FAP patient received a cadaver donor liver. The excised native liver was transplanted to a 60-year-old male patient suffering from hepatocellular carcinoma in cirrhosis due to hepatitis C.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050312
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  • 4
    Electronic Resource
    Electronic Resource
    Expanded criteria donors and dual kidney transplantation (1998)
    Springer
    Transplant international 11 (1998), S. 457-458 
    Details
    ISSN: 1432-2277
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050176
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  • 5
    Electronic Resource
    Electronic Resource
    Physiologic and metabolic results of pancreatic cold storage with Histidine-Tryptophan-Ketoglutarate-HTK solution (Custodiol)® in the porcine autotransplantation model (2000)
    Springer
    Transplant international 13 (2000), S. 98-105 
    Details
    ISSN: 1432-2277
    Keywords: Key words Pancreas preservation ; HTK-solution ; Segmental porcine pancreatic autotransplantation ; Delayed endocrine graft function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Delayed graft function (DEGF) remains an obscure phenomenon in organ transplantation. For the optimal washing of the compounds of the different organ flush solutions, adequate temperature and equilibrium of electrolytes have to be provided. A total of 29 landrace pigs weighing 37.3–5.4 kg were included in this study. According to the model, the left hemipancreas was perfused with Histidine-Tryptophan-Ketoglutarate (HTK)-solution and autotransplanted after 24 h (G1, n = 13) and 48 h (G2, n = 4) of cold storage (CS). Results were compared with grafts perfused with UW-solution and autotransplanted after 24 h (G3, n = 8) and 48 h (G4, n = 4) CS respectively. Daily measurements of glycemia, glucosuria, amylase and lipase were carried out. HTK perfusion resulted in an increase in wet weight of the grafts after 24 h and 48 h CS (P = 0.031 vs UW). Postoperative glycemia levels in pancreases flushed with HTK-solution were higher after 48 h than after 24 h CS until the 6th postoperative day, when the glycemia returned to normal range (P = 0.02), suggesting a delayed endocrine graft function. The mean IVGTT values attained after full function were comparable in G1 and in G3 (–1.22 ± 0.23 vs. –1.5 ± 0.65). The rises in serum amylase and lipase levels were more pronounced after 48 h CS in both HTK and UW groups, (P = n.s.). Appearance of interstitial and intracellular edema after CS and reperfusion did not influence the function.¶Conclusion: HTK-solution is suitable for 24 h pancreatic preservation in vivo; the perfusion requires at least 4 min for electrolyte equilibration. Long preservation time (48 h) resulted in a transitory DEGF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050669
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  • 6
    Electronic Resource
    Electronic Resource
    31P kernspinspektroskopie der magenwand nach proximaler selektiver vagotomie (1990)
    Springer
    Langenbeck's archives of surgery 375 (1990), S. 205-207 
    Details
    ISSN: 1435-2451
    Keywords: Proximal selective vagotomy ; Metabolism of the gastric wall ; 31P-NMR spectroscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Experiment wurde der Einfluß der SPV auf den Phosphatmetabolismus der Magenwand bei Ratten mittels 31P-NMR Spektroskopie untersucht. Die SPV bewirkt unmittelbar nach der Operation eine Destruktion des Stoffwechsels der Magenwandzellen. Vier Tage nch der SPV kommt es zur Regeneration des Metabolismus. Eine Woche nach der Operation ist die funktionelle Zellregeneration abgeschlossen, der Stoffwechsel aber verlangsamt. Dies hat eine reduzierte Produktion von S`aure und Schutzfaktoren der Magenschleimhaut zur Folge. Experimentelle Läasionen der Magenschleimhaut durch Phenylbutazon bewirken ebenso eine Zerstörung des Stoffwechsels der Magenwandzellen bis zum kompletten Zelluntergang.
    Notes: Summary The phosphate metabolism of the gastric wall after proximal selective vagotomy (PSV) was investigated by means of 31P-NMR spectroscopy. The destruction of metabolism has been found just after PSV resulting in a significant decrease of adenosine diphosphates and adenosine triphosphates. 4 and 7 days after PSV the progress of metabolism regeneration was detected, nevertheless with the retardation of high energy phosphates ischemic degradation. The results indicate not only a hydrochloric acid activity reduction but diminution of gastric mucosa protective factors, too. In experimental gastric ulcers no energy phosphates have been found suggesting a mucosa cells necrobiosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187439
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  • 7
    Electronic Resource
    Electronic Resource
    In-vitro- und In-vivo-Studien zur Isolierung, Transplantation und Funktion von Langerhans-Inseln am Schwein (1990)
    Springer
    Langenbeck's archives of surgery 375 (1990), S. 259-265 
    Details
    ISSN: 1435-2451
    Keywords: Islets of Langerhans transplantation ; Pig
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Grenzen und Möglichkeiten der Transplantation von Langerhans-Inseln wurden am Schwein erprobt. Nach totaler Pankreatektomie wurden durch intraduktale Kollagenaseandauung zwischen 6mal 104 and 3mal 106 Inseln and inseltragende Fragmente pro Pankreas gewonnen. Nach Injektion des Transplantates in die Milz oder wahlweise in die Leber konnte bei den Tieren ein normoglykämischer Zustand mit normalen intravenösen Glukosetoleranztesten und ein Überleben bis zu 1 Jahr erreicht werden. Apankreatische Kontrollen verstarben im diabetischen Koma 10–12 Tage postoperativ. Eine gute Korrelation zwischen der Anzahl transplantierter Inseln und Normoglykämie nach Transplantation konnte demonstriert werden. Darüber hinaus war die synchrone In-vitro-Stimulation der Inseln mit Glukose und die daraus resultierende Inselsekretion ein wichtiger Indikator für die funktionelle Integrität der Inseln nach der Transplantation. Das Schwein bietet somit auch aufgrund der dem Menschen sehr ähnlichen immunologischen, physiologischen und anatomischen Eigenschaften bezüglich des Pankreas und der Ernährung ein gutes Modell zur weiteren präklinischen Erforschung der Inseltransplantation als Therapie des Diabetes mellitus.
    Notes: Summary Limits and possibilities of the transplantation of islets of Langerhans in pigs were studied. 6 × 104 to 3 × 106 islets and insulin producing fragments per pancreas were obtained by intraductal collagenase digestion of the pancreatic gland following total pancreatectomy. Islets grafted into the spleen or liver rendered normoglycemia to the pancreatectomized animals as demonstrated by normal fasting blood sugars and normal intravenous glucose tolerance tests as compared to not operated animals permitting a survival time of up to one year. Apancreatic controls died of ketoacidosis and diabetic coma 10 to 12 days posttransplant. The number of isolated and transplanted islets correlated well to the normoglycemic state of the animal. Beyond that the in vitro challenge of the islets with glucose and resulting insulin secretion was a very important indicator for the functional status and integrity of the islets after transplantation. Thus the pig appears to be a suitable model for the preclinical studying of islet transplantation especially since immunologic, physiologic and anatomic features of the pig are similar to those in the human regarding pancreas and nutrition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00184165
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  • 8
    Electronic Resource
    Electronic Resource
    Die Beziehung zwischen implantierter Betazellmasse und metabolischer Stoffwechsellage nach Transplantation pankreatischer Fragmente beim Hund (1987)
    Springer
    Langenbeck's archives of surgery 370 (1987), S. 211-221 
    Details
    ISSN: 1435-2451
    Keywords: Islet transplantation ; Dogs ; Metabolic function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Pancreata von 20 Hunden wurden total excidiert, mittels einer intraductalen Kollagenaseperfusionstechnik und mechanischer Zerkleinerung zu insulinproduzierenden Pankreasfragmenten verarbeitet und als Autotransplantat in die Milz eines jeden Tieres mittels intravenösem Reflux in die V. lienalis injiziert. Bei 75% aller transplantierten Tiere wurde eine langfristige normoglykämische Stoffwechsellage hergestellt, wobei die Glucosetoleranzteste im Vergleich zu 13 Kontrolltieren pathologisch verändert waren. Der Milzinsulingehalt der erfolgreich transplantierten Tiere war auf ca. 5 bis 15% des urspünglichen Pankreasinsulingehaltes reduziert, was für die Funktionseinschränkung verantwortlich sein dürfte. Die angewandte intraductale Kollagenaseperfusionstechnik ist eine zuverlässige Methode zur Wiederherstellung einer normoglykämischen Stoffwechsellage nach totaler Pankreatektomie im Autotransplantationsmodell. Zur Steigerung der Funktionsfähigkeit des Inseltransplantates ist eine erhöhte Inselimplantationsrate erforderlich.
    Notes: Summary 20 dogs underwent total pancreatectomy. Pancreatic fragments were produced using an intraductal collagenase perfusion technique and mechanical disruption of the pancreatic gland. The resulting tissue suspension was transplanted as an autotransplant to the spleen of each animal by intravenous reflux injection into the splenic vein. In 75% of all transplanted animals long-term function with normoglycemia was restored while i.v. glucose tolerance tests were impaired as compared to 13 controls. The spleen insulin content of these sucessfully transplanted animals corresponded to only 5 to 15% of the original pancreas insulin content which was responsible for the reduced function. Intraductal collagenase perfusion is a reliable method to restore normoglycemia after total pancreatectomy in the autotransplant model using pancreatic fragments. To improve the metabolic function of the islet transplant an increased number of islets has to be implanted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01259309
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