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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Lebertransplantation ; Aprotinin ; Transfusionsbedarf ; Gerinnungsparameter ; Key words Liver transplantation ; Aprotinin ; Transfusion requirements ; Coagulation parameters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The effect of aprotinin (2000000 IU as a bolus +500000 JU/h until the end of the operation) on transfusion requirements and coagulation parameters in orthotopic liver transplantation (study group: n=9; placebo group: n=9) was investigated in a randomised, double-blind study. Coagulation parameters were monitored intraoperatively using a mobile laboratory. In contrast to the published results, no effect on transfusion requirements could be demonstrated. However, aprotinin showed a positive effect on some coagulation parameters in the reperfusion phase. The mechanism appeared to be inhibition of the contact activation of the intrinsic system with less thrombin generation in the study group.
    Notes: Zusammenfassung In einer randomisierten Doppelblindstudie wurde der Effekt von Aprotinin (2000000 KIE als Bolus+500000 KIE/h bis zum Ende der Operation, Verumgruppe n=9; Plazebogruppe n=9) auf Gerinnungsparameter und Transfusionsbedarf bei orthotoper Lebertransplantation untersucht. Alle Patienten wurden mit Hilfe eines fahrbaren Gerinnungslabors intraoperativ optimal überwacht. Im Gegensatz zu anderen Arbeitsgruppen fand sich unter diesen Bedingungen für den Transfusionsbedarf kein signifikanter Unterschied zwischen Verum- und Plazebogruppe. Dagegen beobachteten wir einen günstigen Effekt des Proteinaseninhibitors auf verschiedene Gerinnungsparameter, besonders in der Reperfusionsphase. Offensichtlich wird die Kontaktaktivierung des intrinsischen Gerinnungssystems, die durch geschädigte Gefäße des transplantierten Organs eingeleitet wird, durch Aprotinin gehemmt.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1440
    Keywords: Epidermal growth factor ; EGF ; Transforming growth factor ; EGF-receptor ; Carcinogenesis ; Colon ; Rectum ; Colonic adenoma ; Colonic carcinoma ; Familial polyposis coli
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The epidermal growth factor (EGF) and alpha-tumor growth factor are mitogenic proteins which bind to the EGF-receptor and may play a role in carcinogenesis or tumor progression. Our study investigated whether colorectal carcinomas and adenomas express altered levels of EGF-receptors or overproduce EGF-like activity by comparing histologically normal mucosa to carcinomas resected from the same patients. EGF-receptors were characterized by radioligand binding studies. Carcinomas contained unchanged or decreased levels of EGF-receptors in 13/16 and moderately increased levels in 3/16 patients as compared to normal mucosa. Adenomas obtained from 2 patients with familial polyposis coli and from a third patient with a coincident carcinoma had similar numbers of EGF-receptors as normal mucosa. EGF-like growth factors, in contrast, were significantly elevated in carcinoma extracts as compared to extracts from normal mucosa of the same patients. Adenomas did not contain elevated levels of EGF-like activity. We conclude that increased expression of EGF-receptors is infrequent in colonic adenocarcinomas. Increased production of EGF-like growth factors may frequently occur but seems to be associated with tumor progression rather than with premalignant lesions as represented by adenomas.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 21 (1995), S. 32-37 
    ISSN: 1432-1238
    Keywords: Scoring systems ; Orthotopic liver transplantation ; Intensive care medicine ; Prognosis of outcome ; Apache II score ; MPM score ; SAPS score ; Hospital mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To compare 4 general severity classification scoring systems concerning prognosis of outcome in 123 liver transplant recipients. The compared scoring systems were: the mortality prediction model (admission model and 24 h model); the simplified acute physiology score; the acute physiology and chronic health evaluation (Apache II) and the acute organ systems failre score. Design Retrospective, consecutive sample. Setting Adult intensive care unit in a university hospital. Patients 123 adult liver allograft recipients after admission to the intensive care unit. Measurements and main results The scoring systems were calculated as described by the authors to classify the severity of illness after admission of the allograft recipients to the intensive care unit. The mean and median values of survivors and the group of patients, that died during hospital stay were compared. Receiver-operating characteristics were plotted for all scoring systems and the areas under the curves of receiver-operating characteristics were calculated. The predictive value of the 4 scoring systems was tested using a variety of sensitivity analyses. The mortality prediction model (24 h model) was found to have a high significance (p〈0.001) in predicting mortality and showed the greatest area under the curve (0.829). Simplified acute physiology score (p〈0.001) and acute physiology and chronic health evaluation (Apache II) (p〈0.01) had a high significance as well, but did not hit the level of prognosis of mortality prediction model, as shown in the area under the curves. Accordingly, sensitivity was highest in MPM-24 h (83%), followed by SAPS (72%) and Apache II (71%). MPM-24h had a total misclassification rate of 22% (SAPS=32%, Apache II=33%). MPM-admission failed in predicting mortality (sensitivity=52%). Organ systems failure score seemed not to be useful in liver transplant recipients. Conclusion General disease classification systems, such as the mortality prediction model, simplified acute physiology score or acute physiology and chronic health evaluation are good mortality prediction models in patients after liver transplantation. We suggest that there is no need for improvement of a special scoring system.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0022-4731
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 6 (1982), S. 517-524 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les définitions respectives de la résection antérieure classique et de la résection antérieure basse du rectum sont précisés dans cet article. La technique opératoire et le traitement pré et post opératoire de chacune des méthodes sont décrites. La mortalité opératoire d'une série de 157 malades opérés de 1973 à mars 1982 fut de 4,5% (7 morts pour 157 malades) 2 morts seulement furent à déplorer chez les 107 derniers opérés (lors des 5 dernières années). Le taux des déhiscences anastomotiques s'abaissa parall'èlement. Le taux de survie à cinq ans fut identique à celui des autres séries de la littérature. Il ne fut constaté aucune différence entre le taux de survie après résection antérieure classique ou résection antérieure basse dès lors que la résection s'appliquait aux tumeurs de A à C selon la classification de Dukes.
    Notes: Abstract The various definitions of anterior and low anterior resection are outlined. The operative technique for performance of both and their perioperative management are described. Operative mortality in 157 patients operated on from 1973 to March 31, 1982, was 4.5% (7 of 157 patients) and had decreased to 1.9% (2 of 107 patients) within the last 5 years. The rate of anastomotic leakage also decreased concomitantly. Five-year survival rates are similar to those reported in the literature; there was no difference between anterior and low anterior resection for tumors of Dukes' stage A-C.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 18 (1992), S. 60-61 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 377 (1992), S. 100-103 
    ISSN: 1435-2451
    Keywords: HELLP-syndrome ; Liver hematoma ; Hepatic rupture ; Gestosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Das HELLP-Syndrom (Hemolysis, Elevated Liver enzymes, Low Platelets) tritt als Komplikation einer Schwangerschaftspräeklampsie auf und kann zu ausgedehnten subkapsulären Leberhämatomen führen. Wegen der Rupturgefahr der Hämatome besteht eine lebensbedrohende Notfallsituation für Mutter und Ungeborenes. Anhand von 2 Fallbeispielen wird das interdisziplinäre Vorgehen diskutiert. Mit Diagnosestellung der subkapsulären Leberhämatome sollte die notfallmäßige Entbindung durch Sectio erfolgen. Dann kann die chirurgische Entscheidung für eine konservative, abwartende Therapie mit Intensivüberwachung oder für eine Notfalloperation im Falle einer Leberkapselruptur ohne vermeidbares Risiko getroffen werden.
    Notes: Summary The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. Therefore, an interdisciplinary diagnostic and therapeutic approach is discussed and compared to two examples. The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.
    Type of Medium: Electronic Resource
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