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Wagner D, Karitnig R, Wienerroither V, Hau HM, Lederer A, Sucher R, Kornprat P. Sarcopenic Obesity Promotes Recurrence in Patients Undergoing Resection for Colorectal Liver Metastases (CRLM). Anticancer Res 2024; 44:2177-2183. [PMID: 38677767 DOI: 10.21873/anticanres.17024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM Sarcopenia, is predictive of a worse outcome after resection for colorectal liver metastases (CRLM). Obesity leads to a metabolic double burden if sarcopenia is as present, prompting malignancy progression, known as sarcopenic obesity (SO). This study aimed to compare sarcopenia and SO in patients undergoing CRLM resection, to prognostic parameters. PATIENTS AND METHODS The skeletal muscle index (SMI) defined sarcopenia using sex specific cut off values (48.4 cm2/m2 for females and 59.1 cm2/m2 for males) by calculating the preoperative muscle mass at the vertebral height L3 using OSIRIX DICOM viewer. SO was determined as sarcopenia in patients showing obesity, as shown via fat percentage measurements on the preoperative CT scan. Established prognostic parameters (KRAS status, TNM classification, inflammatory response) were evaluated against SMI and SO to assess their predictability for postoperative outcomes. RESULTS A total of 251 patients (62% female, median age 68 years) were included. Sarcopenic patients showed a threefold higher risk for postoperative death as compared to non-sarcopenic patients (p=0.04). Prevalent SO increased this risk to fivefold (p=0.01) compared to non-sarcopenic patients. COX regression analysis revealed SO and KRAS positivity as independent prognostic factors for disease-free survival (SO: p=0.038; KRAS: p=0.041; TNM, tumor size, Charlson Comorbidity Index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio all not significant). Patients risk of death in case of KRAS positivity and SO was seven times higher (p=0.03). CONCLUSION There seems to be a benefit in merging data on mutational status and muscle wasting in patients with CRLM to facilitate an individual, patient-tailored approach.
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Affiliation(s)
- Doris Wagner
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Robert Karitnig
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Valerie Wienerroither
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Hans Michael Hau
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Andri Lederer
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Robert Sucher
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Peter Kornprat
- Department of Surgery, Division of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
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Wagner D, Wienerroither V, Scherrer M, Thalhammer M, Faschinger F, Lederer A, Hau HM, Sucher R, Kornprat P. Value of sarcopenia in the resection of colorectal liver metastases-a systematic review and meta-analysis. Front Oncol 2023; 13:1241561. [PMID: 37841447 PMCID: PMC10569723 DOI: 10.3389/fonc.2023.1241561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/07/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Sarcopenia is defined as a decline in muscle function as well as muscle mass. Sarcopenia itself and sarcopenic obesity, defined as sarcopenia in obese patients, have been used as surrogates for a worse prognosis in colorectal cancer. This review aims to determine if there is evidence for sarcopenia as a prognostic parameter in colorectal liver metastases (CRLM). Methods PubMed, Embase, Cochrane Central, Web of Science, SCOPUS, and CINAHL databases were searched for articles that were selected in accordance with the PRISMA guidelines. The primary outcomes were overall survival (OS) and disease-free survival (DFS). A random effects meta-analysis was conducted. Results After eliminating duplicates and screening abstracts (n = 111), 949 studies were screened, and 33 publications met the inclusion criteria. Of them, 15 were selected after close paper review, and 10 were incorporated into the meta-analysis, which comprised 825 patients. No significant influence of sarcopenia for OS (odds ratio (OR), 2.802 (95% confidence interval (CI), 1.094-1.11); p = 0.4) or DFS (OR, 1.203 (95% CI, 1.162-1.208); p = 0.5) was found, although a trend was defined toward sarcopenia. Sarcopenia significantly influenced postoperative complication rates (OR, 7.905 (95% CI, 1.876-3.32); p = 0.001) in two studies where data were available. Conclusion Existing evidence on the influence of sarcopenia on postoperative OS as well as DFS in patients undergoing resection for CRLM exists. We were not able to confirm that sarcopenic patients have a significantly worse OS and DFS in our analysis, although a trend toward this hypothesis was visible. Sarcopenia seems to influence complication rates but prospective studies are needed.
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Knapp M, Moore T, Lockhart J, Lederer A, Kimball M. Restaurant-based Healthy Eating Program and Other Factors Influence Customer Food Choices in New Orleans, Louisiana. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sucher R, Scheuermann U, Rademacher S, Lederer A, Sucher E, Hau HM, Brandacher G, Schneeberger S, Gockel I, Seehofer D. Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI). Hepatobiliary Surg Nutr 2022; 11:67-77. [PMID: 35284501 PMCID: PMC8847868 DOI: 10.21037/hbsn-20-744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022]
Abstract
Background The most common causes of early graft loss in pancreas transplantation are insufficient blood supply and leakage of the intestinal anastomosis. Therefore, it is critical to monitor graft perfusion and oxygenation during the early post-transplant period. The goal of our pilot study was to evaluate the utility of hyperspectral imaging (HSI) in monitoring the microcirculation of the graft and adequate perfusion of the intestinal anastomosis during pancreatic allotransplantation. Methods We imaged pancreatic grafts and intestinal anastomosis in real-time in three consecutive, simultaneous pancreas-kidney transplantations using the TIVITA® HSI system. Further, the intraoperative oxygen saturation (StO2), tissue perfusion (near-infrared perfusion index, NIR), organ hemoglobin index (OHI), and tissue water index (TWI) were measured 15 minutes after reperfusion by HSI. Results All pancreas grafts showed a high and homogeneous StO2 (92.6%±10.45%). Intraoperative HSI analysis of the intestinal anastomosis displayed significant differences of StO2 (graft duodenum 67.46%±5.60% vs. recipient jejunum: 75.93%±4.71%, P<0.001) and TWI {graft duodenum: 0.63±0.09 [I (Index)] vs. recipient jejunum: 0.72±0.09 [I], P<0.001}. NIR and OHI did not display remarkable differences {NIR duodenum: 0.68±0.06 [I] vs. NIR jejunum: 0.69±0.04 [I], P=0.747; OHI duodenum: 0.70±0.12 [I] vs. OHI jejunum: 0.68±0.13 [I], P=0.449}. All 3 patients had an uneventful postoperative course with one displaying a Banff 1a rejection which was responsive to steroid treatment. Conclusions Our study shows that contact-free HSI has potential utility as a novel tool for real-time monitoring of human pancreatic grafts after reperfusion, which could improve the outcome of pancreas transplantation. Further investigations are required to determine the predictive value of intraoperative HSI imaging.
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Affiliation(s)
- Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andri Lederer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Division of Hepatology, Clinic and Polyclinic for Gastroenterology, Hepatology, Infectiology, and Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.,Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Dresden, Dresden, Germany
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
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Scheuermann U, Rademacher S, Wagner T, Lederer A, Hau HM, Seehofer D, Sucher R. Influence of Multiple Donor Renal Arteries on the Outcome and Graft Survival in Deceased Donor Kidney Transplantation. J Clin Med 2021; 10:jcm10194395. [PMID: 34640413 PMCID: PMC8509629 DOI: 10.3390/jcm10194395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
AIM Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. METHODS A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. RESULTS With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218-109.554; p = 0.033). CONCLUSION Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Correspondence:
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany
| | - Andri Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Hans-Michael Hau
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus, TU Dresden, 01307 Dresden, Germany;
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
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Hau HM, Jahn N, Rademacher S, Sucher E, Babel J, Mehdorn M, Lederer A, Seehofer D, Scheuermann U, Sucher R. The Value of Graft Implantation Sequence in Simultaneous Pancreas-Kidney Transplantation on the Outcome and Graft Survival. J Clin Med 2021; 10:1632. [PMID: 33921391 PMCID: PMC8070486 DOI: 10.3390/jcm10081632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. MATERIAL AND METHODS 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. RESULTS Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3-17.1, p = 0.026) and five years (HR 3.7, 2.1-23.4, p = 0.040). CONCLUSION Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Elisabeth Sucher
- Department of Gastroenterology, Section of Hepatology, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Jonas Babel
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Matthias Mehdorn
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Andri Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
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Brunotte M, Rademacher S, Weber J, Sucher E, Lederer A, Hau HM, Stolzenburg JU, Seehofer D, Sucher R. Robotic assisted nephrectomy for living kidney donation (RANLD) with use of multiple locking clips or ligatures for renal vascular closure. Ann Transl Med 2020; 8:305. [PMID: 32355749 PMCID: PMC7186662 DOI: 10.21037/atm.2020.02.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Robotic assisted nephrectomy for living donation (RANLD) is a rapid emerging surgical technique competing for supremacy with totally laparoscopic and laparoscopic hand assisted techniques. Opinions about the safety of specific techniques of vascular closure in minimally invasive living kidney donation are heterogeneous and may be different for laparoscopic and robotic assisted surgical techniques. Methods We retrospectively analyzed perioperative and short-term outcomes of our first (n=40) RANLD performed with the da Vinci Si surgical platform. Vascular closure of renal vessels was performed by either double clipping or a combination of clips and non-transfixing suture ligatures. Results RANLD almost quintupled in our center for the observed time period. A total of n=21 (52.5%) left and n=19 (47.5%) right kidneys were procured. Renal vessel sealing with two locking clips was performed in 18 cases (45%) Both, clips and non-transfixing ligatures were used in 22 cases (55%). Mean donor age was 53.075±11.68 years (range, 28–70). The average total operative time was 150.75±27.30 min. Right donor nephrectomy (139±22 min) was performed significantly faster than left (160.95±27.93 min, P=0.01). Warm ischemia time was similar for both vascular sealing techniques and did not differ between left and right nephrectomies. No conversion was necessary. Clavien-Dindo Grade ≤IIIb complications occurred in (n=5) 12.5%. Grade IV and V complications did not develop. In particular no hemorrhage occurred using multiple locking clips or suture ligatures for renal vascular closure. Mortality was 0%. Thirteen kidneys (32.5%) were transplanted across the AB0 barrier. Conclusions RANLD is an emerging minimally invasive surgical technique which facilitates excellent perioperative and short-term outcomes also when using multiple locking clips or suture ligatures for renal vascular closure.
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Affiliation(s)
- Maximilian Brunotte
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Justine Weber
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, Division of Hepatology, University Hospital of Leipzig, Leipzig, Germany
| | - Andri Lederer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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Sucher R, Rademacher S, Lederer A, Hau HM, Petersen TO, Seehofer D. [Laparoscopic Left Hemihepatectoy Applying Intraoperative Indocyanine Green Fluorescence Detection Counter Perfusion Method for Visualization]. Zentralbl Chir 2019; 145:135-137. [PMID: 31711247 DOI: 10.1055/a-0988-0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intraoperative indocyanine green (ICG) fluorescence detection by the "counter perfusion method" is a useful tool to identify hepatic segments and intersegmental planes during anatomic liver resection. We report of a 54-year old patient with recurrent cholangitis due to Caroli disease, who underwent a laparoscopic hemihepatectomy. To determine the resection line and resection plane, we injected ICG intravenously after clamping/ligating the left hepatic artery and left portal vein. Before and during resection the liver was observed under visible light and under near-infrared (NIR) light. This method allowed for precise anatomical resection of non-perfused liver segments 2, 3 and 4.
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Affiliation(s)
- Robert Sucher
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
| | - Sebastian Rademacher
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
| | - Andri Lederer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
| | - Hans-Michael Hau
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
| | - Tim Ole Petersen
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Deutschland
| | - Daniel Seehofer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
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Sucher R, Athanasios A, Köhler H, Wagner T, Brunotte M, Lederer A, Gockel I, Seehofer D. Hyperspectral Imaging (HSI) in anatomic left liver resection. Int J Surg Case Rep 2019; 62:108-111. [PMID: 31493663 PMCID: PMC6731347 DOI: 10.1016/j.ijscr.2019.08.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 12/11/2022] Open
Abstract
Hyperspectral Imaging (HSI) is non-contact, non-ionizing and non-invasive. HSI detects tissue pathology based on spectral characteristics of different tissues. HSI is well suited for counter perfusion staining in anatomic liver resection. HSI can be used for future image guided liver surgery.
Introduction Anatomic liver resection is based on the description of functional segments, which rely on the organs arterial and portal venous blood supply. Vascular inflow control of the left liver is performed by occlusion of the left hepatic artery (LHA) and left portal vein (LPV). Depending on the quality of the parenchyma a sharp demarcation line (Cantlie Line) between segments IV and V/VIII can hence be detected. Material and Methods TIVITA® is a novel contact free tool which facilitates non-invasive hyperspectral imaging (HSI) and near infrared spectroscopy (NIRS) for the assessment of tissue- oxygenation (StO2) and perfusion (NIR Perfusion). We hypothesized that this imaging modality might be practicable to identify the future resection plane after left vascular inflow occlusion in anatomic liver resection. Presentation of Case TIVITA ® is a viable tool for the identification of segments with reduced StO2 (inflow occlusion: 0.23 ± 0.03 vs normal: 0.50 ± 0.06) and NIR Perfusion (inflow occlusion: 0.02 ± 0.04 vs normal: 0.47 ± 0.06) and allows for a visual differentiation of well oxygenated, perfused (green) and low oxygenated, poorly perfused (blue) liver tissue in a patient undergoing left hemihepatectomy for hepatocellular carcinoma. Conclusion Hyperspectral Imaging is an emerging optical technique with the potential to identify exact resection planes for anatomic liver resection based on the optically determined perfusion and oxygenation status of liver segments lined up for resection. This novel Hyperspectral Demarcation Technique (HSI DT) is non- contact, non-ionizing and non-invasive.
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Affiliation(s)
- Robert Sucher
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany.
| | - Alvanos Athanasios
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery, University of Leipzig, Germany
| | - Tristan Wagner
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany
| | - Maximilian Brunotte
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany
| | - Andri Lederer
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany
| | - Ines Gockel
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral-, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Germany
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Trose M, Reiß M, Reiß F, Anke F, Spannenberg A, Boye S, Lederer A, Arndt P, Beweries T. Dehydropolymerisation of methylamine borane using a dinuclear 1,3-allenediyl bridged zirconocene complex. Dalton Trans 2018; 47:12858-12862. [PMID: 30156242 DOI: 10.1039/c8dt03311k] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The dinuclear zirconocene chloride complex 1 is a highly active precatalyst for the dehydropolymerisation of methylamine borane. Comparison with mononuclear Zr chlorides and related dinuclear complexes suggests that the nature of the bridging motif is essential for the unique reactivity of 1.
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Affiliation(s)
- M Trose
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - M Reiß
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - F Reiß
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - F Anke
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - A Spannenberg
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - S Boye
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01069 Dresden, Germany
| | - A Lederer
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01069 Dresden, Germany and Technische Universität Dresden, 01062 Dresden, Germany
| | - P Arndt
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - T Beweries
- Leibniz-Institut für Katalyse e.V. an der Universität Rostock, Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
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Abstract
The purpose of this study was to develop an in vitro model for the validation of near-infrared transillumination (NIRT) for proximal caries detection, to enhance NIRT with high-dynamic-range imaging (HDRI), and to compare both methods, using micro-computed tomography (µCT) as a reference standard. Both proximal surfaces of 53 healthy or decayed permanent human teeth were examined using the Diagnocam (DC) (KaVo) and NIRT with HDRI (NIRT-HDRI). NIRT was combined with HDRI to improve the diagnostic performance by reducing under- and overexposed image areas. For NIRT-HDRI, an exposure series was captured and merged into a single HDR image. A classification was applied according to lesion depth. All surfaces were assessed twice by 2 trained examiners, and additionally with µCT for validation. The Kappa statistic was used to calculate inter-rater reliability and agreement between DC and NIRT-HDRI. Inter-rater reliability (weighted Kappa, wκ) showed very good agreement for the DC (0.90) and NIRT-HDRI (0.96). The overall agreement (wκ) was almost perfect (0.85). In the individual categories (0 to 4), the agreement (simple Kappa) ranged from almost perfect (category 4) to moderate (1 and 2) to substantial (categories 0 and 3). Sensitivity and specificity of sound surfaces, enamel, and dentin caries ranged from 0.57 to 0.99 and were similar for both methods in the different categories. NIRT-HDRI had a higher sensitivity for sound surfaces and enamel caries, as well as a higher specificity for dentin caries. Regarding the obtained images, HDRI allowed for the detection of caries within a greater range of luminance levels, resulting in a more detailed visualization of structures without under- or overexposure. However, HDRI this did not improve the diagnostics significantly. Distinguishing between a processed demineralized enamel and dentin lesions appears to be a problem specific to NIRT and cannot be balanced using HDRI.
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Affiliation(s)
- A Lederer
- 1 Department of Operative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - K H Kunzelmann
- 1 Department of Operative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - R Hickel
- 1 Department of Operative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - F Litzenburger
- 1 Department of Operative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
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Seehofer D, Sucher R, Schmelzle M, Öllinger R, Lederer A, Denecke T, Schott E, Pratschke J. Evolution of laparoscopic liver surgery as standard procedure for HCC in cirrhosis? Z Gastroenterol 2017; 55:453-460. [PMID: 28241370 DOI: 10.1055/s-0043-100021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with hepatocellular carcinoma (HCC) in cirrhosis have an increased risk for postoperative complications including liver failure. However, there is some evidence that the use of laparoscopy markedly decreases this risk. Patients Between 2010 - 2015, a total of 21 laparoscopic liver resections were performed for HCC in Child-A cirrhosis at our center. Mean MELD score was 9 (6 - 12), and the mean LiMAx was 261 µg/h/kg (101 - 489). All resections were performed by conventional laparoscopy using 4 - 6 trocars. Liver parenchyma was transected using ultrasonic shears. Hilar occlusion was used on demand. In the earlier years, laparoscopic resections were performed occasionally and mainly if tumors were easily accessible. With increasing experience, currently most HCC in cirrhosis are resected laparoscopically. Likewise, 12 out of the 21 resections were performed within the last 12 months, including 2 anatomic left hemihepatectomies. Results Conversion rate, postoperative mortality, and operative revision rate were all 0 %. Four patients (19 %) developed mild complications Clavien-Dindo grade 1 or 2 (ascites, transfusion, pneumonia, renal impairment). One patient (4.8 %) developed a grade 3 event (bile leak, percutaneous drainage). All but 1 early patient underwent R0 resection (95 %). The mean duration of hospital stay was 10.5 days (5 - 21), and the mean duration of ICU stay was 1.8 days (1 - 7). No case of decompensation of liver cirrhosis was observed. In 1 case, a prolonged production of ascites evolved. Conclusion Even in patients with severely impaired liver function, no severe complications and especially no decompensation of cirrhosis was observed. Therefore, in accordance with other single center experiences, liver resection for HCC in cirrhosis should be performed preferentially by laparoscopy.
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Affiliation(s)
- Daniel Seehofer
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Robert Sucher
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Moritz Schmelzle
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Robert Öllinger
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Andri Lederer
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Timm Denecke
- Klinik für Radiologie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Eckart Schott
- Klinik für Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Johann Pratschke
- Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
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Lederer A, Herrmann P, Seehofer D, Dietel M, Pratschke J, Schlag P, Stein U. Metastasis-associated in colon cancer 1 is an independent prognostic biomarker for survival in Klatskin tumor patients. Hepatology 2015; 62:841-50. [PMID: 25953673 DOI: 10.1002/hep.27885] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED Curative treatment of intrahepatic cholangiocarcinoma (ICC) and hilar cholangiocarcinoma (Klatskin tumors) is limited to surgical resection or orthotopic liver transplantation. However, not all patients benefit from a surgical approach and suffer from early tumor recurrence. Response to chemotherapy is generally poor and, until today, no targeted therapy could be established. Metastasis-associated in colon cancer 1 (MACC1) is a recently discovered regulator of the hepatocyte growth factor (HGF)/Met/mitogen-activated protein kinase pathway, which induces proliferation, migration, and invasion in cell culture, as well as metastasis in mice. MACC1 expression shows a significant correlation with Met expression in colon cancer tissue and is highly prognostic for occurrence of distant metastasis and survival in colon cancer patients. Thus, we aimed to measure the expression of MACC1, Met, and HGF messenger RNA in microdissected tumor tissue and corresponding normal liver tissue of 156 patients with Klatskin tumors (n = 76) and ICC (n = 80) using real-time quantitative reverse-transcriptase polymerase chain reaction. We used immunohistochemical staining to validate the results. MACC1 expression in tumor tissue of both tumor entities was significantly higher than in corresponding normal liver tissue (P < 0.001). Klatskin tumor patients with a history of tumor recurrence had significantly higher MACC1 expression than those without tumor recurrence (P = 0.005). Uni- und multivariate survival analysis showed that Klatskin tumor patients with high MACC1 had a significantly shorter overall (OS) and disease-free survival (DFS; P = 0.001 and P < 0.001, respectively). The multivariate analysis confirmed MACC1 to be an independent factor for overall survival in Klatskin tumor patients (hazard ratio: 2.777; 95% confidence interval: 1.389-5.555; P = 0.004). CONCLUSION Our study identified MACC1 as a highly prognostic biomarker for OS and DFS in Klatskin tumor patients. MACC1 expression could become an important diagnostic tool and might be a candidate for targeted therapy.
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Affiliation(s)
- Andri Lederer
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.,Department of General-, Visceral- and Transplant Surgery, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Pia Herrmann
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Daniel Seehofer
- Department of General-, Visceral- and Transplant Surgery, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Manfred Dietel
- Department of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Johann Pratschke
- Department of General-, Visceral- and Transplant Surgery, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Peter Schlag
- Charité Comprehensive Cancer Center, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Ulrike Stein
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.,German Cancer Consortium, Heidelberg, Germany
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Schausberger CE, Jacobs VR, Lederer A, Wohlmuth C, Fischer T. Mayer-Rokitansky-Küster-Hauser Syndrom mit 1,2 kg schweren Leiomyomen. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Lederer A, Seehofer D, Schirmeier A, Levasseur S, Stockmann M, Nüssler AK, Menger MD, Neuhaus P, Rayes N. Postoperative Bile Leakage Inhibits Liver Regeneration after 70% Hepatectomy in Rats. J INVEST SURG 2013; 26:36-45. [DOI: 10.3109/08941939.2012.691603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Boye S, Appelhans D, Boyko V, Zschoche S, Komber H, Friedel P, Formanek P, Janke A, Voit BI, Lederer A. pH-Triggered Aggregate Shape of Different Generations Lysine-Dendronized Maleimide Copolymers with Maltose Shell. Biomacromolecules 2012; 13:4222-35. [DOI: 10.1021/bm301489s] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- S. Boye
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - D. Appelhans
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - V. Boyko
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - S. Zschoche
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - H. Komber
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - P. Friedel
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - P. Formanek
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - A. Janke
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
| | - B. I. Voit
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
- Technische Universität Dresden, D-01062 Dresden, Germany
| | - A. Lederer
- Leibniz-Institut für Polymerforschung Dresden, Hohe Str. 6, 01109
Dresden, Germany
- Technische Universität Dresden, D-01062 Dresden, Germany
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Burchard W, Khalyavina A, Lindner P, Schweins R, Friedel P, Wiemann M, Lederer A. SANS Investigation of Global and Segmental Structures of Hyperbranched Aliphatic–Aromatic Polyesters. Macromolecules 2012. [DOI: 10.1021/ma300031g] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- W. Burchard
- Institute of Macromolecular
Chemistry, University of Freiburg, Stefan-Meier-Strasse
31a, 79104 Freiburg, Germany
| | - A. Khalyavina
- Leibniz Institute of Polymer Research, Hohe Strasse 6, D-1069 Dresden,
Germany
| | - P. Lindner
- Institut Laue-Langevin (ILL), 6 rue Jules Horowitz, F-38042 Grenoble, France
| | - R. Schweins
- Institut Laue-Langevin (ILL), 6 rue Jules Horowitz, F-38042 Grenoble, France
| | - P. Friedel
- Leibniz Institute of Polymer Research, Hohe Strasse 6, D-1069 Dresden,
Germany
| | - M. Wiemann
- Insitute of Physical Chemistry, University of Freiburg, Stefan-Meier-Strasse 31a, 70104
Freiburg. Germany
| | - A. Lederer
- Leibniz Institute of Polymer Research, Hohe Strasse 6, D-1069 Dresden,
Germany
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Lederer A, Schimpl G, Schweintzger G, Jaeger T, Steiner H. A case of intrauterine right paraduodenal hernia into the fossa of Waldeyer with neonatal death. Ultraschall Med 2010; 31:302-303. [PMID: 20091467 DOI: 10.1055/s-0028-1109840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Abdominal Wall/abnormalities
- Abdominal Wall/diagnostic imaging
- Abdominal Wall/pathology
- Duodenum/abnormalities
- Duodenum/diagnostic imaging
- Duodenum/pathology
- Female
- Fetal Diseases/diagnostic imaging
- Hernia, Abdominal/congenital
- Hernia, Abdominal/diagnostic imaging
- Hernia, Abdominal/pathology
- Humans
- Infant, Newborn
- Interdisciplinary Communication
- Intestine, Small/abnormalities
- Intestine, Small/diagnostic imaging
- Intestine, Small/pathology
- Meconium
- Obstetric Labor, Premature/diagnostic imaging
- Obstetric Labor, Premature/pathology
- Patient Care Team
- Peritonitis/diagnostic imaging
- Peritonitis/pathology
- Pregnancy
- Stillbirth
- Ultrasonography, Doppler
- Ultrasonography, Prenatal
- Young Adult
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Lederer A, Schimpl G, Weisser C, Jäger T, Steiner H. Intrauterine Paraduodenalhernie und andere gastrointestinale Pathologien als peripartaler Notfall. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1254935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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20
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Scholz M, Lederer A, Jäger T, Steiner H, Schimpl G. Gastroschisis: Ein perinatologischer Notfall? Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1254950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Lederer A, Speil-Ostheim A, Schwamberger A, Batka M. Total laparoskopische Hysterektomie mittels Hohl-Adapter®: Ergebnisse von 217 Fällen. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1186011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Seehofer D, Schirmeier A, Bengmark S, Cho SYR, Koch M, Lederer A, Rayes N, Menger MD, Neuhaus P, Nüssler AK. Curcumin attenuates oxidative stress and inflammatory response in the early phase after partial hepatectomy with simultaneous intraabdominal infection in rats. J Surg Res 2008; 159:497-502. [PMID: 19321178 DOI: 10.1016/j.jss.2008.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 11/18/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Curcumin is a nontoxic, hepatoprotective antioxidant. It has been shown to efficiently scavenge oxygen free radicals, increase intracellular glutathione concentrations, and prevent lipid peroxidation in rat hepatocytes. Moreover, it has strong anti-inflammatory effects. In the present study we assessed its effect in a model of liver regeneration impaired by bacterial infections. MATERIAL AND METHODS Male Sprague-Dawley rats underwent sham operation, cecal ligation and puncture (CLP), synchronous partial hepatectomy (PH), and CLP or synchronous PH+CLP with perioperative application of curcumin (100 mg per kg bodyweight per d) 48 h before surgery. Rats were sacrificed 24 h after surgery. Liver function was analyzed by measuring the serum albumin, serum bilirubin, and bile production. The local inflammatory response in the liver tissue was evaluated by quantification of TNF-alpha, IL-6 mRNA, and quantification of IL-1beta by ELISA. In addition, hepatic concentrations of reduced glutathione (GSH) and the oxidized disulfide dimer of glutathione (GSSG) were measured for determination of the redox state. RESULTS After simultaneous PH+CLP curcumin significantly reduced the expression of TNF-alpha and IL-6 mRNA in the liver tissue. The IL-1beta concentration in the liver was also slightly, but not significantly, lower in the curcumin group. A severe depletion of hepatic glutathione was found in the PH+CLP group. This was reversed by curcumin application, after which the GSH to GSSG ratio increased markedly. The hepatocellular damage, measured by ALT liberation, was significantly lower in the curcumin treated group. The relative liver weight in the curcumin group was significantly higher 24 h after PH+CLP. However, hepatocellular proliferation parameters were not significantly improved by antioxidative treatment with curcumin. Only the Ki-67 index was slightly higher in the curcumin treated PH+CLP group (14+/-3%) than in the untreated PH+CLP group (7%+/-3%). The hepatocyte density was significantly lower in the curcumin group than in the corresponding untreated group. CONCLUSION In the present model, curcumin revealed significant hepatoprotective effects with stabilization of redox state, reduced liberation of liver enzymes, and attenuated expression of pro-inflammatory cytokines. However, the hepatocellular proliferation was not significantly influenced.
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Affiliation(s)
- Daniel Seehofer
- Department of General, Visceral, and Transplant Surgery, Charité Campus Virchow, Berlin, Germany.
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Schallausky F, Erber M, Komber H, Lederer A. An Easy Strategy for the Synthesis of Well-Defined Aliphatic-Aromatic Hyperbranched Polyesters. MACROMOL CHEM PHYS 2008. [DOI: 10.1002/macp.200800346] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Seehofer D, Neumann UP, Schirmeier A, Carter J, Cho SYR, Lederer A, Rayes N, Menger MD, Nüssler AK, Neuhaus P. Synergistic effect of erythropoietin but not G-CSF in combination with curcumin on impaired liver regeneration in rats. Langenbecks Arch Surg 2008; 393:325-32. [PMID: 18301913 DOI: 10.1007/s00423-008-0290-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The effect of erythropoietin (Epo) and granulocyte colony-stimulating factor (G-CSF) alone or in combination with the hepatoprotective antioxidant curcumin (Cur) was evaluated in a model of delayed liver regeneration. MATERIALS AND METHODS Sprague Dawley rats underwent 70% liver resection with simultaneous cecal ligation and puncture and were randomised to five groups: no treatment, G-CSF (100 microg/kg), Epo (1,000 IU/kg), each alone or in combination with Cur (100mg/kg). Twenty-four hours after surgery, blood and tissue samples were collected. Markers of liver regeneration (liver weight, mitotic index, Ki-67 index), function (bilirubin, bile flow) and hepatocellular damage (liver enzymes, histomorphology) were determined. In addition, cytokine expression and hepatic glutathione concentrations were measured. RESULTS Liver regeneration was not improved by G-CSF or Epo monotherapy. Epo more effectively increased liver weight and regeneration markers, but the difference was not significant. Whereas liver regeneration was slightly inhibited in the G-CSF plus Cur group, Epo plus Cur significantly improved liver regeneration. This was accompanied by reduced oxidative stress. Liver function and the expression of pro-inflammatory cytokines were comparable in all treatment groups. CONCLUSION In the present model, Epo, at a relatively low dosage, did not improve liver regeneration. However, the combination of Epo and Cur showed a synergistic effect with highly significant stimulation of liver regeneration.
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Affiliation(s)
- Daniel Seehofer
- Department of General-, Visceral- and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany.
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Steiner H, Boemers T, Forstner R, Ofner S, Lederer A, Ruecker J. Ex-Utero Intrapartum Treatment (EXIT) in a giant case of Congenital Cystic Adenomatoid Malformation (CCAM) of the lung. Ultraschall Med 2007; 28:626-8. [PMID: 17806010 DOI: 10.1055/s-2007-963347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Congenital Cystic Adenomatoid Malformations (CCAM) of the lung are a relatively rare anomaly. The majority of cases do not require any antenatal or perinatal interventions. However, selected cases need special and intensified management. This article discusses a case of a CCAM of the left pulmonary lobe covering 2/3 to 3/4 of the thoracic volume, causing mediastinal shift and hydrops. The enormous size required the planning of an EXIT (Ex Utero-Intrapartum Treatment) procedure, which was performed when the trial of intraoperative ventilation of the lungs was unsuccessful. A thoracotomy and resection of the left upper lobe were performed with the fetus on feto-placental circulation. After resection and closure of the thoracotomy, improvement of lung ventilation allowed the delivery of the child. The child and mother were discharged in a healthy condition. We conclude that the EXIT procedure is a feasible and potentially life-saving method for select cases of prenatally detected CCAM.
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Affiliation(s)
- H Steiner
- Obstetrics and Gynecology, Paracelsus Private Medical University, Salzburg.
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Lederer A, Hasenöhrl G, Gruber R, Steiner H. [Feasibility of fetal echocardiography at 11-14 weeks scan]. Ultraschall Med 2006; 27:563-7. [PMID: 17160762 DOI: 10.1055/s-2006-927028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Sonographic diagnostics are increasingly brought forward into the first trimenon. Lately, more and more expert studies have been published on echocardiography in the context of the Nuchal Translucency (NT) screening (gestational age 11-14 weeks). The aim of this study has been to evaluate the feasibility of early echocardiography on the occasion of first trimenon screening in the context of routine operation. MATERIALS AND METHODS From February 2003 to March 2004, an echocardiography was prospectively sought in 130 assigned, unselected pregnant women during the first trimenon screening. Three doctors with different OGUM/DEGUM (Austrian and German societies for ultrasound in medicine) qualifications at our ward tried to represent the four-chamber view (4CV) and the outflow tracts (OFT), each via B-mode and color Doppler. The study conditions were "routine", in particular they were temporally limited. In case no sufficient visual representation was achievable with the transabdominal examination, transvaginal sonography was also used. RESULTS Via B-mode, 4CV was indicated as successful in 86/130, and OFTs in 37/130. Via color Doppler, on the other hand, it was possible to sufficiently represent 4CV in 75/130 and OFTs in 87/130. CONCLUSION In routine screening, early heart examination is a big challenge and in many cases even with good equipment no complete diagnostic echocardiography can be achieved. The utilisation of the color Doppler is helpful particularly for the representation of the outflow tracts.
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Affiliation(s)
- A Lederer
- Pränatalmedizin, Universitätsklinik für Geburtshilfe und Frauenheilkunde, Paracelsus Medizinische Privatuniversität Salzburg, Austria
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Lechleitner P, Riedl B, Raneburger W, Gamper G, Theurl A, Lederer A. Chest sonography in the diagnosis of pulmonary embolism: a comparison with MRI angiography and ventilation perfusion scintigraphy. Ultraschall Med 2002; 23:373-378. [PMID: 12514752 DOI: 10.1055/s-2002-36173] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
AIM To compare the diagnostic performance of chest sonography, MRI angiography and ventilation/perfusion intigraphy in pulmonary embolism (PE). METHOD In a prospective clinical study, 55 patients (41 women, 14 men, age 23 - 91 years) with clinical signs of PE were investigated within 48 hours of the onset of symptoms. The final diagnosis was made by MRI angiography (reference method). RESULTS PE was diagnosed in a total of 36 patients. Chest sonography revealed rounded or wedge-shaped hypoechoic lesions in 30 patients. On ventilation/perfusion (V/P) scintigraphy, 41 patients had positive V/P scans, but only 23 were of high probability. Chest ultrasound had a positive predictive value of 97 % to diagnose PE. The sensitivity, specificity, the negative predictive value and accuracy were 81 %, 84 %, 84 % and 82 %, respectively. As 18 patients had inconclusive scans, the diagnostic performance of ventilation/perfusion scintigraphy was poor. The positive predictive value, sensitivity and specificity were 58 %, 42 % and 91 %, respectively. Patients in whom PE was excluded mainly suffered from congestive heart failure, bronchopulmonary infections or pulmonary hypertension. CONCLUSION A negative sonographic study cannot rule out PE with certainty. However, a chest sonography is of acceptable diagnostic value in patients with suspected PE and may be used as an adjunct or guide to more established methods.
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Abstract
The work reported here experimentally investigates a striking generalization about vocabulary acquisition: Noun learning is superior to verb learning in the earliest moments of child language development. The dominant explanation of this phenomenon in the literature invokes differing conceptual requirements for items in these lexical categories: Verbs are cognitively more complex than nouns and so their acquisition must await certain mental developments in the infant. In the present work, we investigate an alternative hypothesis; namely, that it is the information requirements of verb learning, not the conceptual requirements, that crucially determine the acquisition order. Efficient verb learning requires access to structural features of the exposure language and thus cannot take place until a scaffolding of noun knowledge enables the acquisition of clause-level syntax. More generally, we experimentally investigate the hypothesis that vocabulary acquisition takes place via an incremental constraint-satisfaction procedure that bootstraps itself into successively more sophisticated linguistic representations which, in turn, enable new kinds of vocabulary learning. If the experimental subjects were young children, it would be difficult to distinguish between this information-centered hypothesis and the conceptual change hypothesis. Therefore the experimental "learners" are adults. The items to be "acquired" in the experiments were the 24 most frequent nouns and 24 most frequent verbs from a sample of maternal speech to 18-24-month-old infants. The various experiments ask about the kinds of information that will support identification of these words as they occur in mother-to-child discourse. Both the proportion correctly identified and the type of word that is identifiable changes significantly as a function of information type. We discuss these results as consistent with the incremental construction of a highly lexicalized grammar by cognitively and pragmatically sophisticated human infants, but inconsistent with a procedure in which lexical acquisition is independent of and antecedent to syntax acquisition.
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Affiliation(s)
- J Gillette
- Department of Psychology, Institute for Research in Cognitive Science, University of Pennsylvania, 3815 Walnut Street, Philadelphia, USA
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Lederer A. Information systems. Buying, investing right. Mod Healthc 1997; 27:130, 132. [PMID: 10164586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Lederer
- Kennedy Group, Redwood City, CA, USA
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Lederer A. Take it on the CHIN. Infocare 1996:66. [PMID: 10162582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Lederer A. Climbing out of the basement: IT (information technology) organizational requirements. Infocare 1995:48. [PMID: 10142489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Lederer A. Anticipating & supporting the evolution of an IDS. Infocare 1994:48. [PMID: 10140751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Hauser H, Beham A, Uranüs S, Frühwirth H, Lederer A, Klimpfinger M. Malignant fibrous histiocytoma of the mesentery--a rare cause of abdominal pain. Case report with a review of literature. Z Gastroenterol 1993; 31:735-8. [PMID: 8310727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Malignant fibrous histiocytoma (MFH) is a tumor most frequently occurring in lower and upper extremities and in retroperitoneum. This paper presents the extremely rare case of a 55-year-old male patient with a MFH of storiform pleomorphic subtype originating from the mesentery. Sonography, computed tomography as well as endoscopy and ERCP did not reveal the diagnosis. Finally the tumor was diagnosed by laparoscopy with biopsy and histological examination. Two months after diagnosis of the tumor the patient died of bronchopneumony and heart failure contracted during a generalisation of MFH.
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Affiliation(s)
- H Hauser
- Universitätsklinik für Chirurgie, Graz
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Wildling R, Schnedl WJ, Reisinger EC, Schreiber F, Lipp RW, Lederer A, Krejs GJ. Agenesis of the dorsal pancreas in a woman with diabetes mellitus and in both of her sons. Gastroenterology 1993; 104:1182-6. [PMID: 8462806 DOI: 10.1016/0016-5085(93)90290-s] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Complete agenesis of the dorsal pancreas has rarely been described. Complete agenesis of the dorsal pancreas in a female who developed insulin-dependent diabetes mellitus at the age of 39 years is reported. The diagnosis of agenesis of the dorsal pancreas was suspected by abdominal ultrasound and confirmed by abdominal computed tomography (CT), magnetic resonance imaging, and endoscopic retrograde pancreatography. Her exocrine pancreatic function was essentially normal. Both of the patient's sons also had agenesis of the body and tail of the pancreas verified by abdominal CT but had no evidence of diabetes mellitus. This familial occurrence of agenesis of the dorsal pancreas suggests that hereditary mechanisms may play a role in the pathogenesis of this anomaly.
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Affiliation(s)
- R Wildling
- Department of Radiology, Karl Franzens University, Graz, Austria
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Flueckiger F, Lammer J, Klein GE, Hausegger K, Lederer A, Szolar D, Tamussino K. Malignant ureteral obstruction: preliminary results of treatment with metallic self-expandable stents. Radiology 1993; 186:169-73. [PMID: 8416559 DOI: 10.1148/radiology.186.1.8416559] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Self-expandable metal stents 7 mm in diameter were percutaneously implanted into 13 ureters in 10 patients with malignant ureteral obstruction not amenable to double-J stent placement. In nine ureters, one stent was placed, and in four ureters, two overlapping stents were placed. Primary reconstitution of ureteral patency was achieved in all ureters. After 1-2 weeks, four ureters showed a urothelial reaction encroaching on the lumen of the ureter, and a double-J stent was placed coaxially. One ureter was occluded by urothelial hyperplasia 4 weeks after stent placement, and a double-J stent was therefore placed. One ureter was occluded 8 months after stent placement by distal tumor overgrowth. The other ureters showed no signs of obstruction during a follow-up of 3-14 (average, 5.8) months. Peristalsis was preserved at both ends of the stent in all ureters. The use of this stent alone or in combination with a double-J stent alleviated upper urinary tract obstruction and avoided external drainage in all patients.
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Affiliation(s)
- F Flueckiger
- Department of Radiology, University Hospital of Graz, Austria
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Lederer A, Kullnig P, Pongratz M. [Extrinsic allergic alveolitis in CT and HR-CT]. ROFO-FORTSCHR RONTG 1992; 157:257-61. [PMID: 1391821 DOI: 10.1055/s-2008-1033009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The CT changes on conventional and high-resolution CT in 14 patients with exogenous allergic alveolitis (EAA) were analysed retrospectively. There were 8 patients with clinically subacute disease, 5 patients in a chronic stage and 1 patient with acute EAA. The appearances and their distribution were examined. Seven of the 8 patients in the subacute stage showed a ground glass pattern and multiple nodules of less than 2 mm. All patients in the chronic stage showed a combination of fine infiltrates, small nodules and irregular linear densities; distortion of the pulmonary pattern was present in 3 cases. The patient with acute EAA showed diffuse dense areas of consolidation in both lungs as well as multiple nodules and a ground glass pattern. The CT appearances of EAA correspond with the basic micropathology and, within the clinical context, permit diagnostic classification.
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Affiliation(s)
- A Lederer
- Univ.-Klinik für Radiologie, Karl-Franzens-Universität Graz
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Lederer A, Kullnig P, Pongratz M. [Pulmonary alveolar proteinosis in CT and HR-CT]. ROFO-FORTSCHR RONTG 1992; 156:98-9. [PMID: 1733483 DOI: 10.1055/s-2008-1032844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Lederer
- Universitätsklinik für Radiologie, Karl-Franzens-Universität Graz
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Lederer A. Modification suggested for nursing intervention. Oncol Nurs Forum 1991; 18:659. [PMID: 2067957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Lederer A, Flückiger F, Wildling R, Fruhwirth J. [A solitary metastasis in the trapezium bone]. Radiologe 1990; 30:79-80. [PMID: 2320730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Carpal bone is an uncommon location for metastases, and diagnostic problems can occur when a solitary metastasis mimics acute arthritis or osteomyelitis clinically as well as radiologically.
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Affiliation(s)
- A Lederer
- Universitätsklinik für Radiologie, Karl-Franzens-Universität Graz
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Lederer A. Confusion: recognition and remedy. Notes on a nursing home. Geriatr Nurs 1983; 4:224-7. [PMID: 6553005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Lederer A. URGENT NEED FOR THE STANDARDIZATION OF LABORATORY WORK. Am J Public Health (N Y) 1920; 10:876-9. [PMID: 18010395 DOI: 10.2105/ajph.10.11.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
As a practical man familiar with the technique of the laboratory this author urges the need of establishing standards in laboratory practice. "This task will have to be faced in the near future," he writes, "And I believe that the A. P. H. A. is the proper organization to assume this important duty."
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Lederer A. NOTES ON THE PRACTICAL APPLICATION OF THE "SALTPETER METHOD" FOR DETERMINING THE STRENGTH OF SEWAGES. Am J Public Health (N Y) 1915; 5:354-61. [PMID: 18009223 DOI: 10.2105/ajph.5.4.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lederer A. The Relation of the Nitrates to the Putrescibility of Sewages. J Infect Dis 1913. [DOI: 10.1093/infdis/13.2.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lederer A. Laboratory Section: THE INFLUENCE OF STORAGE AND VARIOUS PRESERVATIVES UPON THE DISSOLVED OXYGEN IN WATERS. J Am Public Health Assoc 1911; 1:740-6. [PMID: 19599668 DOI: 10.2105/ajph.1.10.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lederer A, Hommon HB. Laboratory Section: THE PRESERVATION OF SEWAGE BY THE AID OF CHLOROFORM AND COLD STORAGE. J Am Public Health Assoc 1911; 1:267-72. [PMID: 19599593 DOI: 10.2105/ajph.1.4.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Lederer A. The Relation of Public Water Supplies to General and Specific Mortalities in Cities. Am J Public Hygiene 1910; 20:295-305. [PMID: 19599465 PMCID: PMC2543690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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