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  • 1
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Lebertransplantation ; Postoperative Komplikationen ; Interventionelle Radiologie ; Angioplastie ; Stents ; Drainage ; Key words Liver transplantation ; Vascular and biliary complications ; Angioplasty ; Stents ; Drainage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: Postoperative complications contribute significantly to the morbidity and mortality of liver transplant patients. The management of these complications requires a multidisciplinary approach in which interventional radiology plays an integral role. Indications, techniques, and results of radiological interventions in the management of the liver transplant patient are presented. Material and methods: During a 10-year period, 52 out of 420 liver transplant recipients underwent radiological interventions, including angioplasty (n = 20), embolization (n = 2), percutaneous drainage (n = 11), and biliary interventions (n = 19). Results: Nine out of ten arterial stenoses located at the anastomoses (n = 8), within the liver (n = 1) and in the coeliac trunk (n = 1) were successfully treated by balloon dilatation. Angioplasty of supra- or infrahepatic anastomotic stenoses of the IVC (n = 5) provided long-term success only in combination with stent implantation. Portal vein stenoses and chronic thrombosis were treated by balloon dilatation and stent insertion via transhepatic catheterization of the portal vein. Late strictures of bile-duct anastomoses can be managed by ante- or retrograde interventions. If biliary complications are related to inflammatory or septic problems, the prognosis of graft survival is poor. Conclusion: Interventional radiological procedures are very useful in the management of vascular and biliary complications after liver transplantation. These techniques provide a cure in many situations, and thus, surgical interventions may be avoided in selected cases.
    Notes: Zusammenfassung Die komplexe chirurgisch-technische Operation sowie immunologische und ischämieverursachte Probleme tragen zur relativ hohen Komplikationsrate nach Lebertransplantation bei, die grundsätzlich organ- bzw. lebensbedrohlich für den Patienten sind. Interventionelle radiologische Techniken sind aufgrund ihres minimal-invasiven Charakters in der klinischen Versorgung dieser Komplikationen akzeptiert. Über 10 % der lebertransplantierten Patienten im Klinikum Großhadern sind im Verlauf mit vaskulären (n = 22) oder biliären (n = 19) postoperativen Komplikationen einer interventionellen radiologischen Behandlung zugeführt worden. Wichtigste Verfahren sind die Angioplastie (n = 20), die Katheterembolisation (n = 2), die perkutanen Drainageverfahren (n = 11) und Gallengangsinterventionen (n = 19). 20 von 22 vaskulären Interventionen wurden technisch erfolgreich durchgeführt. Für die Langzeitprognose des Organs bzw. der Patienten ist die aktuelle Organfunktion zum Zeitpunkt der Intervention entscheidend; dies entspricht weitgehend den Ergebnissen nach operativen Revisionen. Bei biliär-septischen Komplikationen ist die Organprognose als deutlich eingeschränkt anzusehen. Interventionelle Eingriffe bei Problemen der biliären Anastomosen sind als erster Therapieschritt akzeptiert und können auch in der Langzeitbeobachtung eine zufriedenstellende Problemlösung durch Ballondilatation und Prothesenimplantation gewährleisten. Interventionelle radiologische Techniken spielen in differentialtherapeutischen Überlegungen zur Behandlung postoperativer Komplikationen eine wichtige Rolle. Bei entsprechender Patientenselektion sind sie als erster Therapieschritt einzusetzen.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Lungentransplantation ; Anastomosenkomplikation ; Angioplastie ; Bronchialstent ; Key words Lung transplantation ; Anastomotic complications ; Angioplasty ; Bronchial stenting
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: Bronchial and arterial anastomotic stenoses are major complications after lung transplantation. Interventional techniques provide a definitive cure in certain cases. Material and methods: Three out of four patients had ischemia-related stenoses of the bronchial anastomoses postoperatively; one patient developed malacia of the bronchus main stem 1 year after transplantation. Four patients had stenoses of the arterial anastomoses, which resulted in hemodynamic instability and reduced perfusion of the graft. Results: Stent implantation in the bronchial anastomoses (n = 3) and in the main stem (n = 1) improved ventilation and oxygen saturation in all patients. The stents were incorporated by mucosal overgrowth, as demonstrated by endoscopy, as early as 6 weeks after implantation. Balloon dilatation (n = 3) and stent implantation (n = 1) were successfully performed in 4 patients with stenoses of the arterial anastomoses. The mean transstenotic pressure gradient of 9.5 mm Hg was reduced to 2.2 mm Hg after angioplasty. Lung perfusion shifted towards the grafts, as shown by 99mTc perfusion scans. Conclusion: The minimally invasive techniques of interventional radiology are very effective in the treatment of anastomotic complications after lung transplantation and may avoid surgery in certain cases.
    Notes: Zusammenfassung Komplikationen nach Lungentransplantation betreffen in erster Linie die Bronchusanastomose und die Pulmonalarterienanastomose. Sie sind ischämieinduziert oder auf chirurgisch-technische Probleme zurückzuführen. Bei 8 von 66 transplantierten Patienten traten postoperative Stenosen an der arteriellen Anastomose (n = 4) und an der Bronchusanastomose (n = 4) auf, die jeweils zu einem organ- bzw. lebensbedrohlichen Zustand der Patienten geführt hatten. Die interventionelle Behandlung war bei allen Patienten erfolgreich; 4 Patienten wurden bei Anastomosenstenose bzw. Malazie der Bronchusanastomose mit Metallstent versorgt, 4 Patienten mit Stenosierung an der Pulmonalarterienanastomose wurden einer Ballondilatation bzw. zusätzlicher Stentimplantation zugeführt. Die Indikation zur Behandlung und die Überprüfung des Dilatationsergebnisses wurde anhand der Stenosegradienten ermittelt, zur ausreichenden Erweiterung war eine Ballonkaliberstärke von 15 bis 20 mm erforderlich. Indikation zur Stentimplantation war eine elastische Instabilität bei einem Patienten. Der minimal-invasive Eingriff bei schwerkranken Patienten, die effiziente und komplikationslose Therapie und der erfolgreiche Langzeitverlauf sprechen dafür, bei Anastomosenproblemen nach Lungentransplantation interventionelle radiologische Verfahren primär einzusetzen.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2932
    Keywords: acidification ; Brown trout ; calcium ; density ; juveniles ; streams
    Source: Springer Online Journal Archives 1860-2000
    Topics: Energy, Environment Protection, Nuclear Power Engineering
    Notes: Abstract We examined the relationship between young brown trout ( Salmo trutta) density in lake tributaries, and water chemistry and habitat variables. The study was carried out during the autumn in three acidic, softwater river systems in western and southwestern Norway; Gaular and Vikedal (1987–1993) and Bjerkreim (1988–1993). The streams had mean calcium concentrations of 0.35 mg L-1 (Gaular), 0.52 mg L-1 (Vikedal) and 0.84 mg L-1 (Bjerkreim). The concentration of inorganic Al was generally low, with mean values of 8.40 (Gaular), 22.22 (Vikedal) and 43.36 μg L-1 (Bjerkreim). In multiple regressions that involved different water chemistry variables, brown trout density correlated best with calcium concentration and with a combination of calcium and pH; the Ca2+:H+ ratio. In Vikedal and Gaular, calcium explained 51 and 57%, respectively, of the variability in brown trout densities. Althoug alkalinity exhibited the best correlation with brown trout density in Bjerkreim ( r2=0.33), it was similar to that of the model that included all major ions plus pH. The Ca2+:H+ ratio had a larger effect for variability in brown trout density in Gaular (r2=0.66) than calcium alone. In Vikedal and Bjerkreim, the Ca2+:H+ ratio also correlated with brown trout density, but considerably less than in Gaular. The predictive power of habitat variables was much lower than that of water chemistry; the single most important factors were altitude in Gaular (r2=0.22), mean water temperature in Vikedal (r2=0.11) and depth SD (index of heterogeneity) in Bjerkreim (r2=0.07). Models that included both habitat and water chemistry variables showed that the density of young brown trout was predicted primarily by calcium concentrations in Gaular (r2=0.75) and Vikedal (r2=0.54), as opposed to pH in Bjerkreim (r2=0.25). Habitat had low effect in all three river systems (r2=0.01–0.04). The final model explained 86, 68 and 32%, respectively, of the variability in brown trout density in the three catchments. Thus, water chemistry variables seem to be factors that limit the density of young brown trout in acidic softwater streams.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1573-2932
    Keywords: northern Norway ; lakes ; acidification ; brown trout ; Arctic charr
    Source: Springer Online Journal Archives 1860-2000
    Topics: Energy, Environment Protection, Nuclear Power Engineering
    Notes: Abstract In this paper we document the effects of acidification on fish populations in lakes in Sør-Varanger near the Russian border in northern Norway. We used questionnaires in order to assess the current status and distribution of different fish species, and conducted test-fishing to determine relative abundance (CPUE-T) and age structure. Acidification of surface waters in this area is due to emissions of SO2 from smelters on the Kola Peninsula in Russia (Nikel and Zapoljarnij) between 10 and 30 km from the Norwegian border. Sulphur deposition in Sør-Varanger ranges from 0.6 to 2.0 g S m-2 yr-1, which is similar to levels in the most acidified areas in southern Norway. However, a dominant fraction of the acidic deposition reaches the ground in particulate form during summer and autumn. Coastal areas in Sør-Varanger receive small amounts of precipitation; the annual mean is 580 mm. We obtained fish status from 401 lakes, about 40% of all lakes larger than 3 ha, which were inhabited by 236 and 293 populations of Arctic charr (Salvelinus alpinus) and brown trout (Salmo trutta), respectively. The extent of fish damage was small as only three populations of Arctic charr were lost, while three populations of Arctic charr and eight populations of brown trout were at various stages of reduction. Damaged and lost fish populations were identified in smaller lakes at relatively high elevations (172–349 m) in six areas in the Jarfjord Mountains, covering a land area of 30.0 km2. Most of the damage probably occurred during the 1970s and 1980s. In lakes that supported or had supported Arctic charr and brown trout, we found a significant relationship between CPUE-T, and acid neutralizing capacity (ANC) and pH, and also between alkalinity and the concentration of inorganic Al for brown trout. In both species, the catch of fish in age groups 1+ and 2+ (CPUE-R) increased significantly with CPUE-T. Affected populations typically exhibited irregular age composition, and age-classes were missing, indicating that reductions in fish populations were due to recruitment failure. The limited fish damage is related to relatively good catchment resistance to acidic inputs, small amounts of wet deposition as well as precipitation. These conditions result in low accumulation of acidic compounds, producing less acidic run-off waters and few episodes of unfavourable water quality.
    Type of Medium: Electronic Resource
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