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Shapovalyants SG, Michalev AI, Timofeev ME, Polushkin VG, Volkov VV, Oettinger AP, Lorenz R, Koch A, Köckerling F, Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J, Friis-Andersen H, Li JW, Le F, Zheng MH, Roscio F, Combi F, Frattini P, Clerici F, Scandroglio I, Zhao X, Nie Y, Liu J, Wang M, Kuo L, Tsai CC, Mok KT, Liu SI, Chen IS, Chou NH, Wang BW, Chen YC, Chang BM, Liang TJ, Kang CH, Tsai CY, Dudai M, Zeng YJ, Liu TL, Shi CM, Sun L, Shu R, Kawaguchi M, Takahashi Y, Tochimoto M, Horiguchi Y, Kato H, Tawaraya K, Hosokawa O, Huang C, Sorge A, Masoni L, Maglio R, Di Marzo F, Mosconi C, Gallinella Muzi M, Kato J, Iuamoto L, Meyer A, Almehdi R, Alazri Y, Sahoo B, Ahmed R, Nasser M, Inaba T, Fukuhsima R, Yaguchi Y, Horikawa M, Ogawa E, Kumata Y, Pokorny H, Fischer I, Resinger C, Lorenz V, Podar S, Längue F, Etherson K, Atkinson K, Khan S, Pradeep R, Viswanath Y, Munipalle PC, Chung J, Schuricht A, Magalhães C, Marcos M, Flores A, Sekmen U, Paksoy M, Ceriani F, Cutaia S, Canziani M, Caravati F. Inguinal Hernia: Recurrences, Tailored Surgery & Pubic Inguinal Pain Syndrome (Sportsman Hernia). Hernia 2015; 19 Suppl 1:S167-75. [PMID: 26518795 DOI: 10.1007/bf03355345] [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: 11/28/2022]
Affiliation(s)
- S G Shapovalyants
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - A I Michalev
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - M E Timofeev
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - V G Polushkin
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - V V Volkov
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - A P Oettinger
- Institution of Applied Medical Sciences, Russian National Research Medical University, Moscow, Russia
| | - R Lorenz
- Hernia Center 3 Chirurgen, Berlin, Germany
| | - A Koch
- Surgical Practise, Cottbus, Germany
| | - F Köckerling
- Klinik für Allgemein, Viszeral und Gefäβchirurgie, Vivantes Klinikum Spandau, Berlin, Germany
| | - J Burcharth
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - K Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark.,Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H-C Pommergaard
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - T Bisgaard
- Department of Surgery, Hvidovre Hospital, Hvidovre, Denmark.,The Danish Hernia Database, Copenhagen, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark.,The Danish Hernia Database, Copenhagen, Denmark.,Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - J W Li
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | | | - F Roscio
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - F Combi
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - P Frattini
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - F Clerici
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - I Scandroglio
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - X Zhao
- Beijing Chao-Yang Hospital, Beijing, China
| | | | | | | | - L Kuo
- Department of General Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | - M Dudai
- Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel
| | - Y J Zeng
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - T L Liu
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - C M Shi
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - L Sun
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - R Shu
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - M Kawaguchi
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Y Takahashi
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - M Tochimoto
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Y Horiguchi
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - H Kato
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - K Tawaraya
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - O Hosokawa
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - C Huang
- Cathay medical center, Taipei, Taiwan.,Taipei medical university, Taipei, Taiwan
| | - A Sorge
- Ospedale S. Giovanni Bosco, Napoli, Italy
| | | | - R Maglio
- Ospedale Israelitico, Roma, Italy
| | - F Di Marzo
- Ospedale S. Giovanni Bosco, Napoli, Italy
| | - C Mosconi
- Policlinico Universitario Tor Vergata, Roma, Italy
| | | | - J Kato
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - L Iuamoto
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A Meyer
- Abdominal Wall Repair Center, Samaritano Hospital, Sao Paulo, Brazil
| | | | | | | | | | | | - T Inaba
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - R Fukuhsima
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Y Yaguchi
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - M Horikawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - E Ogawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Y Kumata
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - H Pokorny
- LK Wiener Neustadt, Wiener Neustadt, Austria
| | | | | | | | | | | | - K Etherson
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - K Atkinson
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - S Khan
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - R Pradeep
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Y Viswanath
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - J Chung
- University of Pennsylvania Health System, Philadelphia, USA
| | - A Schuricht
- University of Pennsylvania Health System, Philadelphia, USA
| | | | - M Marcos
- Centro Hospitalar Porto, Porto, Portugal.,Institute Cuf, Porto, Portugal
| | - A Flores
- Centro Hospitalar Porto, Porto, Portugal.,Institute Cuf, Porto, Portugal
| | - U Sekmen
- Acibadem Hospital, Istanbul, Turkey
| | - M Paksoy
- Dept. of Gen. Surg., Istanbul Uni. Cerrahpasa Med. School, Istanbul, Turkey
| | - F Ceriani
- Multimedica Santa Maria, Castellanza, Va, Italy
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Scheyer M, Antonietti E, Rollinger G, Lancee S, Pokorny H. Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center. Tech Coloproctol 2014; 19:5-9. [PMID: 25407664 DOI: 10.1007/s10151-014-1246-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 07/16/2013] [Accepted: 04/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rectoanal repair (RAR), which combines doppler-guided hemorrhoidal artery ligation (HAL) and mucopexy via lifting of the hemorrhoidal prolapse, offers a minimally invasive alternative to conventional hemorrhoidectomy. METHODS Patients with grade II hemorrhoids were treated with HAL, and patients with grade III and IV hemorrhoids were treated with the RAR procedure by two surgeons. Postoperative follow-up was performed clinically and by proctoscopy after 8 weeks routinely, and long-term follow-up was performed using a standardized postal questionnaire. RESULTS The overall complication rate was 29% (n = 118). After short-term follow-up, 26% (n = 106) of patients reported recurrent or persistent prolapsing piles, while 21% (n = 86) of patients had recurrent bleeding. After long-term follow-up, 24% (n = 98) of patients reported prolapsing piles, 3% (n = 12) bleeding, 3% (n = 12) pruritus, and 2% (n = 8) anal pain, while 20% (n = 82) complained of persistent mixed symptoms. CONCLUSIONS HAL and RAR provide prolonged relief for patients with hemorrhoidal disease whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as an initial indication.
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Affiliation(s)
- M Scheyer
- Department of General Surgery, State Hospital, 6700, Bludenz, Vorarlberg, Austria
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Payrits T, Ernst A, Ladits E, Pokorny H, Viragos I, Längle F. Vagale Stimulation – eine neue Möglichkeit zur konservativen Therapie der peripheren arteriellen Verschlusskrankheit. Zentralbl Chir 2011; 136:431-5. [DOI: 10.1055/s-0031-1283739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Pokorny H, Gruenberger T, Soliman T, Rockenschaub S, Längle F, Steininger R. Organ survival after primary dysfunction of liver grafts in clinical orthotopic liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02009.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [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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Langer F, Györi G, Pokorny H, Burghuber C, Rasoul-Rockenschaub S, Berlakovich G, Mühlbacher F, Steininger R. Outcome of hepaticojejunostomy for biliary tract obstruction following liver transplantation. Clin Transplant 2009; 23:361-7. [DOI: 10.1111/j.1399-0012.2008.00923.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Függer R, Scheyer M. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 2008; 12:385-9. [PMID: 18283518 DOI: 10.1007/s10029-008-0357-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 01/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this prospective randomized multicenter trial was to evaluate the recurrence rates and complications of open versus laparoscopic repairs of inguinal hernias. METHODS Patients with primary unilateral inguinal hernias were randomized to Shouldice repair, Bassini operation, tension-free hernioplasty (Lichtenstein repair), laparoscopic transabdominal extraperitoneal hernioplasty (TEP), or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). The primary outcome parameter was the rate of recurrence at 3 years. The secondary outcome was the rate of intraoperative, perioperative, and long-term complications. Follow-up comprised of clinical examination after 1, 2, and 3 years. RESULTS Three hundred and sixty-five patients were randomly assigned to one of the five procedures. The intention-to-treat analysis showed that the cumulative 3-year recurrence rate was 3.4% in the Bassini group, 4.7% in the Shouldice group, 0% in the Lichtenstein group, 4.7% in the TAPP group, and 5.9% in the TEP group (p = 0.48). Comparing open (Bassini, Shouldice, Lichtenstein) versus laparoscopic (TAPP, TEP) techniques (p = 0.29) and comparing the use of mesh prostheses (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) (p = 0.74) showed no significance in the rate of recurrence. The rates of intraoperative (p = 0.15), perioperative (p = 0.09), and long-term complications (p = 0.13) were without significance between the five groups. Comparing mesh techniques (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) showed no significance in the rate of complications. The per-protocol analysis for the comparison of mesh (Lichtenstein, TAPP, TEP) versus suturing (Bassini, Shouldice) techniques revealed that recurrences (p = 0.74), intraoperative (p = 0.64), perioperative (p = 0.27), and long-term complications (p = 0.91) were evenly distributed. CONCLUSIONS In this multicenter study, no significant difference in the recurrence rate and complications between laparoscopic and open methods of hernia repair was revealed.
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Affiliation(s)
- H Pokorny
- Department of Surgery, University Hospital of Vienna, Vienna, Austria.
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Pokorny H, Klingler A, Scheyer M, Függer R, Bischof G. Postoperative pain and quality of life after laparoscopic and open inguinal hernia repair: results of a prospective randomized trial. Hernia 2006; 10:331-7. [PMID: 16819563 DOI: 10.1007/s10029-006-0105-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Accepted: 04/27/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND As part of a large prospective randomized Austrian multicenter trial evaluating recurrence rates and complications of open and laparoscopic unilateral inguinal hernia repairs we assessed postoperative pain and quality of life. METHODS Approximately 151 patients were randomized to Shouldice repair, Bassini operation, or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). Pain was recorded preoperatively and on the first four postoperative days. Quality of life was recorded preoperatively and 1 month postoperatively. RESULTS Patients having Shouldice repairs had significantly higher visual analog-scale scores for pain on the fourth postoperative day (P=0.048) and significantly higher scores in McGill pain questionnaires on the first four postoperative days (P=0.046) compared with the other groups. Apart from a significantly lower score in postoperative bodily pain in the Shouldice group (P=0.039), no significant differences in quality of life were apparent among the three methods. CONCLUSIONS The TAPP and Bassini repairs result in less short-term postoperative pain.
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Affiliation(s)
- H Pokorny
- Department of Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Pokorny H, Langer F, Herkner H, Schernberger R, Plöchl W, Soliman T, Steininger R, Muehlbacher F. Influence of cumulative number of marginal donor criteria on primary organ dysfunction in liver recipients. Clin Transplant 2005; 19:532-6. [PMID: 16008601 DOI: 10.1111/j.1399-0012.2005.00384.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [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: 12/15/2022]
Abstract
BACKGROUND The aim of this cohort study was to assess the cumulative effect of marginal donor criteria on initial graft function and patient survival after liver transplantation. METHODS We included 734 consecutive patients who underwent orthotopic liver transplantation at the Vienna General Hospital between January 1993 and December 2003. We employed the local registry of the Department of Transplant Surgery, where variables of all patients are routinely and prospectively recorded. Primary outcome was initial graft function, secondary outcome was patient survival. RESULTS Cumulative number of marginal donor criteria was significantly and linearly associated with an increased rate of primary dysfunction (PDF; p = 0.005). In patients with more than three cumulative marginal donor criteria the rate of PDF was 36%. Patient survival was not influenced by the cumulative number of donor criteria (log-rank test, p = 0.81). Independent marginal donor criteria to predict PDF were cold ischemia time >10 h [odds ratio (OR) 0.56; 95% CI 0.32-0.98] and donor peak serum sodium >155 mEq/L (OR 0.44; 95% CI 0.26-0.77), as assessed in a multivariate regression model. CONCLUSIONS The use of marginal liver donors with more than three marginal donor criteria shows deleterious effects on initial graft function. Noteworthy, patient survival was not associated with marginal donor criteria, which may be explained by early and successful retransplantation of liver recipients with primary non-function.
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Affiliation(s)
- H Pokorny
- Department of Surgery, University Hospital of Vienna, Vienna, Austria.
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Puhalla H, Gruenberger T, Pokorny H, Ploner M, Bareck E, Depisch D, Zacherl J, Bischof G. Influence of laparoscopy on survival after surgery for gallbladder carcinoma: a matched-pair analysis. Eur Surg 2004. [DOI: 10.1007/s10353-004-0089-0] [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: 10/25/2022]
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10
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Pokorny H, Bischof G. Open mesh versus laparoscopic mesh repair of inguinal hernia. Eur Surg 2004. [DOI: 10.1007/s10353-004-0085-4] [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: 10/25/2022]
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Puhalla H, Wild T, Bareck E, Pokorny H, Ploner M, Soliman T, Stremitzer S, Depisch D, Laengle F, Gruenberger T. Long-term follow-up of surgically treated gallbladder cancer patients. Eur J Surg Oncol 2002; 28:857-63. [PMID: 12477478 DOI: 10.1053/ejso.2002.1301] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [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: 02/06/2023]
Abstract
AIMS Palliative attempts have traditionally led treatment of gallbladder cancer but resection offers the only chance for long-term survival. This study investigates the impact of surgery with curative intent in gallbladder cancer treatment and evaluates prognostic factors for survival. METHODS Two hundred and sixty-seven patients were admitted for surgical therapy. Sixty received resection with curative intent and form the basis of this analysis. RESULTS R0 resection (n=45) was a highly significant independent survival predictor (P<0.001). All 5-year survivors (n=10) had tumour-free resection margins. Early T stage (P=0.017) and highly differentiated cancer (P=0.008) had a significant better outcome. Nodal spreading increased by local tumour extension and lymphatic involvement decreased patient survival (P=0.018). Patients' age (>75 years) was without influence on long-term survival. CONCLUSIONS Long-term survival is possible both in elderly patients and in advanced cancer.
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Affiliation(s)
- H Puhalla
- Department of General Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Abstract
Epiphrenic diverticula are rare. The exact prevalence of this condition is unknown because asymptomatic patients are usually not discovered. Symptoms are more often the result of an esophageal motility disorder than the diverticulum itself and no correlation exists between the size of the diverticulum and the severity of symptoms. We present a patient suffering from dysphagia, chest pain, food retention and regurgitation because of an epiphrenic diverticulum. The current treatment of choice for symptomatic epiphrenic diverticula is diverticulectomy via a left thoracic approach. We performed a successful abdominal laparoscopic approach.
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Affiliation(s)
- H Pokorny
- Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, AKH Wien, Währinger Gürtel 18-20, 1090 Wien, Osterreich
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Bodingbauer M, Rasoul-Rockenschaub S, Gall* W, Langer F, Asari R, Pokorny H, Sporn E, Berlakovich G, Steininger R, Muhlbacher F. Nierentransplantation bei geriatrischen Patienten - Vorlaufige Ergebnisse. Eur Surg 2001. [DOI: 10.1046/j.1563-2563.2001.01197.x] [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: 11/20/2022]
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Pokorny H, Gruenberger T, Soliman T, Rockenschaub S, Längle F, Steininger R. Organ survival after primary dysfunction of liver grafts in clinical orthotopic liver transplantation. Transpl Int 2001; 13 Suppl 1:S154-7. [PMID: 11111986 DOI: 10.1007/s001470050310] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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: 11/28/2022]
Abstract
In a retrospective analysis of 632 orthototopic liver transplant procedures performed between 1982 and 1997, the incidence of primary dysfunction (PDF) of the liver and its influence on organ survival were studied. Graft function during the first 3 postoperative days was categorized into four groups: (1) good (GOT max < 1000 U/l, spontaneous PT > 50%, bile production > 100 ml/day); (2) fair (GOT 1000-2500 U/l, clotting factor support < 2 days, bile < 100 ml/day); (3) poor (GOT > 2500 U/l, clotting factor support > 2 days, bile < 20 ml/day); (4) primary non-function (PNF; retransplantation required within 7 days). The aim of this study was to evaluate graft survival comparing organs with PDF (poor function) and PNF vs organs with initial good or fair function. After a median follow-up of 45 months, initially good and fair function of liver grafts resulted in a significantly better long-term graft survival compared with grafts with initially poor function or primary non-function (if re-transplanted) (P < 0.01). The Cox model revealed primary function as a highly significant factor in the prediction of long-term graft survival (P < 0.0001). We conclude that these results confirm the hypothesis that primary graft function is of major importance for the long-term survival of liver transplants. Patients with a poor primary function have the worst survival prognosis, which leads to the interpretation that these patients may be candidates for early retransplantation.
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Affiliation(s)
- H Pokorny
- Department of General Surgery, University of Vienna, Austria
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15
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Plochl W, Kozek-Langenecker S, Spiss C, Plochl E, Pokorny H, Zacherl J, Muhlbacher F, Stockler-Ipsiroglu S, Wermuth B. Multiorgan donation from a donor with unrecognized ornithine transcarbamylase deficiency. Transpl Int 2001. [DOI: 10.1111/j.1432-2277.2001.tb00041.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Plöchl W, Plöchl E, Pokorny H, Kozek-Langenecker S, Zacherl J, Stöckler-Ipsiroglu S, Wermuth B, Spiss CK, Mühlbacher F. Multiorgan donation from a donor with unrecognized ornithine transcarbamylase deficiency. Transpl Int 2001; 14:196-201. [PMID: 11499911 DOI: 10.1007/s001479900134] [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: 10/27/2022]
Abstract
Ornithine transcarbamylase (OTC) deficiency, the most common inherited urea cycle disorder, shows a spectrum of severity ranging from severe neonatal hyperammonemic coma to no symptoms among adults. We report on the multiorgan procurement from a donor who died of cerebral edema due to unrecognized late-onset OTC deficiency. The donor's OTC deficiency was diagnosed retrospectively since the liver graft recipient developed cerebral edema postoperatively due to hyperammonemia. Plasma ammonia was extremely elevated (3793 micromol/l), but was not accompanied by general liver dysfunction. Post mortem, the diagnosis of OTC deficiency was established by enzyme and molecular analysis in a biopsy of the transplanted liver. In contrast to the fatal course of the liver graft recipient, the kidney, lung, and heart transplantations were successful. Ten months after transplantation these recipients were alive and showed good graft function. This case demonstrates the importance of careful donor evaluation, particularly if the donor's cause of death is obscure.
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Affiliation(s)
- W Plöchl
- Department of Anesthesiology and General Intensive Care, University of Vienna, General Hospital of Vienna, Austria.
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Nomayo M, Thanner R, Pokorny H, Grotheer HH, Stützle R. Measurements in the raw gas of a full scale municipal waste incinerator using a wavelength resolved REMPI mass spectrometer. Chemosphere 2001; 43:461-467. [PMID: 11372827 DOI: 10.1016/s0045-6535(00)00395-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A resonance enhanced multiphoton ionization (REMPI) mass spectrometer consisting of a tunable laser unit (Nd:YAG pump laser and OPO) and a reflectron mass spectrometer have been upgraded to cope with the difficult conditions such as vibrations, temperature fluctuations and dust, prevailing in an incinerator. On-line measurements of the raw gas have been carried out at the municipal waste incinerator in Stuttgart. Although this test series could not be completed the results are encouraging. They show that wavelength resolution can provide valuable information beyond the one obtainable by fixed frequency REMPI. Examples discussed include separation of interferants to the aniline signal and identification of phenantrene.
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Affiliation(s)
- M Nomayo
- DLR Institute of Combustion Technology, Stuttgart Paffenwaldring 38, Germany
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Ploechl E, Ploechl W, Stoeckler-Ipsiroglu S, Pokorny H, Wermuth B. Late-onset ornithine transcarbamylase deficiency in two families with different mutations in the same codon. Clin Genet 2001; 59:111-4. [PMID: 11260212 DOI: 10.1034/j.1399-0004.2001.590208.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/23/2022]
Abstract
We report on late-onset ornithine transcarbamylase (OTC) deficiency in two families with mutations in the same codon, but different base substitutions. Onset of symptoms showed great variation, and five hemizygotes finally died. Clinical diagnosis was late and difficult. In family A, 1 patient also developed the signs of Gilbert's disease. In family B, the index case came to attention as OTC deficiency, after the transplantation of his liver when the recipient died of cerebral edema and hyperammonemia. In family A, the hemizygote males died at the ages of 12 and 18 years; in family B, they died at the ages of 20, 26, and 30 years, respectively. Diagnosis was confirmed by reduced OTC activity in liver specimens. The residual activity in autopsy liver of the index patient in family A was less than the activity in the biopsy of the transplanted liver of the index patient in family B. The molecular investigations showed mutations in exon 2 at codon 40 in the OTC gene in both families. However, different bases were substituted. In family A, the single-base mutation was a cytosine-to-thymine transition (Arg 40 Cys); in family B, it was a guanine-to-adenine transition (Arg 40 His). Published data on in vitro expression studies of the recurrent OTC mutation Arg 40 His have shown little effect on the protein structure of the enzyme. These studies would fit well with our observation of higher OTC activity and later age of onset of symptoms in family B.
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Affiliation(s)
- E Ploechl
- Clinical Genetics, Children's Hospital, St. Johanns Hospital, Müllner Haupstrasse 48, A-5020 Salzburg, Austria.
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Soliman TH, Langer F, Puhalla H, Pokorny H, Grünberger TH, Berlakovich GA, Mühlbacher F, Steininger R. Use of absorbable mesh in the treatment of parenchymal liver injuries during orthotopic liver transplantation. Eur J Surg 2001; 167:29-34. [PMID: 11213817 DOI: 10.1080/110241501750069783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To find out whether packing or wrapping with polyglactin 910 mesh was more effective in stopping bleeding in livers that had been damaged during transplantation. DESIGN Retrospective study. SETTING University hospital, Austria. SUBJECTS AND INTERVENTIONS 15 of 27 livers that had been damaged during transplantation bled sufficiently to warrant either packing (n = 6) or wrapping (n = 9). MAIN OUTCOME MEASURES Arrest of bleeding; other complications. RESULTS Both packing and wrapping succeeded in stopping the bleeding, and neither caused infections. Packing may theoretically cause an increase in intra-abdominal pressure and impair organ function. CONCLUSION It is preferable to wrap rather than pack a bleeding liver that has been damaged during transplantation.
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Affiliation(s)
- T H Soliman
- Department of Surgery, University of Vienna, Austria
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Berlakovich GA, Langer F, Freundorfer E, Windhager T, Rockenschaub S, Sporn E, Soliman T, Pokorny H, Steininger R, Mühlbacher F. General compliance after liver transplantation for alcoholic cirrhosis. Transpl Int 2000; 13:129-35. [PMID: 10836649 DOI: 10.1007/s001470050298] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In recent years, alcoholic cirrhosis has been accepted as an indication for OLT, compliance of patients suffering from alcoholic cirrhosis is still under discussion, however. 118 patients who had undergone OLT for alcoholic cirrhosis were considered for analysis. The mean follow-up time of the study population was 53.7 +/- 38.9 months. Compliance was defined by 3 parameters: 1. Sobriety. Fifteen (13%) out of 118 recipients suffered an alcohol relapse during the observation period. There was no difference between the groups with or without alcohol relapse concerning compliance with medication, incidence of rejection, or adherence to check-ups. 2. Drug-compliance. Nineteen recipients (16 %) were not within the target range with the immunosuppressive medication. Comparison of the compliant- and non-compliant groups produced a significant difference for late acute rejection, the other parameters being similar in the subgroups. 3. Adherence to appointments. Nearly all patients in the study population ( > 95 %) were compliant with both transplant and psychological appointments in the outpatient clinic. In conclusion, analysis of our data indicates that patients with OLT for alcoholic cirrhosis are compliant, although alcohol relapse occurs in 13 % of recipients.
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Affiliation(s)
- G A Berlakovich
- Department of Transplant Surgery, University of Vienna, Austria.
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21
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Krenn CG, Krafft P, Schaefer B, Pokorny H, Schneider B, Pinsky MR, Steltzer H. Effects of positive end-expiratory pressure on hemodynamics and indocyanine green kinetics in patients after orthotopic liver transplantation. Crit Care Med 2000; 28:1760-5. [PMID: 10890615 DOI: 10.1097/00003246-200006000-00010] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine the impact of positive end-expiratory pressure (PEEP) ventilation on hemodynamics and a clinical test for assessment of dynamic liver performance in patients undergoing orthotopic liver transplantation (OLT). DESIGN Prospective, descriptive patient study. SETTING University hospital intensive care unit. PATIENTS A total of 25 patients after OLT. INTERVENTIONS All patients were intubated and mechanically ventilated with biphasic positive airway pressure. The effects of three different randomly chosen levels of PEEP (0 cm H2O, 5 cm H2O, and 10 cm H2O) were studied in the immediate postoperative period. MEASUREMENTS AND MAIN RESULTS Systemic hemodynamics, arterial and venous blood gas analyses, and plasma disappearance rate of indocyanine green (ICG(PDR)), using the transpulmonary indicator dilution technique, were obtained simultaneously. For data evaluation, patients were grouped retrospectively according to their hemodynamic response to PEEP (Group A and Group B). In Group A (n = 13), PEEP did not alter cardiac index. In Group B (n = 11), PEEP levels of 5 cm H2O and 10 cm H2O significantly reduced cardiac index and oxygen delivery. ICG(PDR) remained statistically unchanged in both groups. CONCLUSIONS Short-term pressure-controlled ventilation with PEEP levels of up to 10 cm H2O does not exert detrimental effects on systemic hemodynamics in OLT patients and does not interfere with ICG(PDR). However, it remains to be determined whether these findings could be confirmed under the application of higher PEEP levels over a longer period of time and whether they could be of clinical relevance for the use of indocyanine green as a dynamic liver function test.
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Affiliation(s)
- C G Krenn
- Department of Anesthesia & Intensive Care Medicine, the University of Vienna, Austria
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Soliman T, Langer F, Puhalla H, Pokorny H, Grunberger T, Berlakovich GA, Langle F, Muhlbacher F, Steininger R. Parenchymal liver injury in orthotopic liver transplantation. Transplantation 2000; 69:2079-84. [PMID: 10852600 DOI: 10.1097/00007890-200005270-00018] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
BACKGROUND A 35-year period of clinical development resulted in orthotopic liver transplantation (OLT) becoming a standardized surgical procedure. Despite this progress, the rate of technical complications is still high. Although the main problem in most analyses is vascular or bile duct failure, we observed a remarkable number of parenchymal liver injuries that led to intraoperative problems. Our aim, therefore, is to present an overall report on the incidence, treatment, and clinical course of parenchymal liver injuries in OLT. METHODS Five hundred seventy-two consecutive OLT procedures performed between 1988 and 1998 were analyzed in a retrospective study. Parenchymal liver injury was diagnosed by means of examination of the surgical reports. Donor- and recipient-related data followed the medical report. The lesions were classified according to the Organ Injury Scale. RESULTS Parenchymal liver injury was diagnosed in 23 patients (4%). The lesions were classified as grade Ia (13.1%), grade Ib (13.1%), grade IIb (52.1%), grade IIIa (17.1%), and grade IIIb (4.3%). In 19 patients (82.6%), the lesion was detected during OLT, and in four patients (17.4%), during relaparotomy. The latter group showed significantly higher-grade injuries. Treatment was suture or fibringlue alone, 17.4%; fibringlue and hemostyptics, 26.1%, mesh wrapping 30.4%, and mesh packing 26.1%. Seven patients (30.4%) underwent relaparotomy. Further active bleeding was not found in any of them. Statistical analysis found a correlation between injury grade and relaparotomy rate. No patients died as a result of parenchymal liver injury. CONCLUSIONS Parenchymal liver injuries can be treated well, with no adverse effect on patient or graft survival. An early decision concerning the surgical procedure for controlling hemorrhage is required. A basically aggressive therapeutic approach might avoid further complications relating to reperfusion edema.
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Affiliation(s)
- T Soliman
- University of Vienna, Department of Surgery, Austria
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Pokorny H, Grünberger T, Rockenschaub S, Krenn CG, Puhalla H, Langer F, Gollackner B, Berlakovich G, Mühlbacher F, Steininger R. Preservation of the liver: is it possible to extend the time of storage? Transplant Proc 1999; 31:2074-6. [PMID: 10455974 DOI: 10.1016/s0041-1345(99)00267-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- H Pokorny
- Department of Transplantation and Anaesthesia, University Hospital Vienna, Austria
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Krenn CG, Plöchl W, Schäfer B, Pokorny H, Pernerstorfer T, Spiss CK, Steltzer H. [Difference between gastric mucosal pCO2 and arterio-intramucosal pCO2 during orthotopic liver transplantation]. Wien Klin Wochenschr 1999; 111:555-9. [PMID: 10467642] [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: 02/13/2023]
Abstract
Tonometry is a clinically accepted method to monitor blood flow of the splanchnic region, which is of particular interest in orthotopic liver transplantation (OLT). We investigated the hemodynamic changes and the tonometrically registered perioperative course of the difference between gastric mucosal pCO2 (prCO2) and arterial mucosal CO2 (CO2 gap) in 23 patients undergoing OLT without veno-venous bypass. Gastric mucosal pH (pHi) was additionally calculated. Despite significant changes in systemic hemodynamics during the anhepatic stage and after reperfusion and a significant drop in pHi during anhepacy, the difference between prCO2 and CO2 was constant. These contrasting findings of tonometry, i.e. solely a drop in pHi is, in our opinion, a consequence of the poor metabolic capacity of the liver in the perioperative OLT period, which influenced the calculation of the pHi with the Henderson-Hasselbalch equation. We conclude that, due to methodical problems, calculated pHi is not a reliable indicator of splanchnic blood flow and oxygenation during OLT. We therefore suggest that the prCO2 and the CO2 gap be used to monitor the splanchnic region. These parameters, obtained perioperatively, do not indicate a further reduction in splanchnic oxygenation despite profound changes in systemic hemodynamics during OLT without veno-venous bypass.
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Affiliation(s)
- C G Krenn
- Abteilung für Anästhesiologie und Allgemeine Intensivmedizin, Universität Wien, Osterreich
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Plöchl W, Krenn CG, Pokorny H, Pezawas L, Pezawas T, Steltzer H. The use of the antioxidant tirilazad mesylate in human liver transplantation: is there a therapeutic benefit? Intensive Care Med 1999; 25:616-9. [PMID: 10416915 DOI: 10.1007/s001340050912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 10/28/2022]
Abstract
OBJECTIVES To test the hypothesis whether in patients undergoing liver transplantation the antioxidant tirilazad mesylate can reduce hepatic ischaemia-reperfusion injury and improve postoperative outcome. DESIGN Prospective, randomised, placebo controlled trial. SETTING University hospital. PATIENTS 20 patients were randomised to receive either tirilazad mesylate or placebo (saline). INTERVENTIONS Patients in the tirilazad group (n = 10) received four intravenous infusions of tirilazad at 6-h intervals (men 3 mg/kg, women 3.75 mg/kg) after the induction of anaesthesia. The other patients (n = 10) served as controls. MEASUREMENTS AND RESULTS Plasma levels of malonaldehyde (MDA) were determined after the induction of anaesthesia prior to the infusion of tirilazad (baseline), during the anhepatic period, and 5 min and 24 h after reperfusion. Postoperatively, alanine aminotransferase, aspartate aminotransferase, prothrombin time, and serum cholinesterase were determined daily for 1 week. Compared to baseline, plasma MDA levels did not significantly change during the anhepatic period and after reperfusion and they did not differ between groups. Postoperative liver enzymes and prothrombin time did not differ between groups, but on the first (p = 0.03) and second (p = 0.01) postoperative day cholinesterase levels were significantly higher in tirilazad-treated patients than in control patients. For neither length of stay in the intensive care unit nor hospital stay were any differences observed between groups. CONCLUSIONS In patients undergoing liver transplantation, tirilazad does not improve overall outcome. Whether the higher cholinesterase levels on the first 2 postoperative days in tirilazad treated patients indicates an earlier recovery of liver function remains to be tested.
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Affiliation(s)
- W Plöchl
- Department of Anaesthesiology and General Intensive Care, University of Vienna, Austria.
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Krenn CG, Pernerstorfer T, Pokorny H, Metnitz PG, Steltzer H. Splanchnic circulation is maintained during passive hyperventilation in orthotopic liver recipients. Acta Anaesthesiol Scand 1999; 43:515-9. [PMID: 10341998 DOI: 10.1034/j.1399-6576.1999.430505.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/23/2022]
Abstract
BACKGROUND Mechanical hyperventilation is an established treatment to reduce brain edema and intracranial pressure in patients with encephalopathia caused by acute liver failure. Hyperventilation and ensuing hypocarbia may also affect central and systemic circulation and thereby influence graft performance in patients following orthotopic liver transplantation (OLT). METHODS We measured the effects of normocapnia and hypocapnia on systemic hemodynamics, gastric tonometry, as a marker of splanchnic oxygenation, and the indocyanine green kinetic, as a global marker of graft function, in humans post OLT. RESULTS Hyperventilation was performed to a PaCO2 of 4.2 +/- 0.4 kPa (31 +/- 3.4 mm Hg) for about 1 h in 14 liver transplant recipients. Systemic hemodynamics as well as indices of splanchnic oxygenation and indocyanine green kinetics remained statistically unchanged. CONCLUSION We did not observe any statistically significant circulatory effects or changes in indocyanine green kinetics in liver transplant recipients in the immediate OLT postoperative period caused by short-term mechanical hyperventilation.
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Affiliation(s)
- C G Krenn
- Department of Anesthesiology & General Intensive Care, University of Vienna, School of Medicine, Austria
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Soliman T, Pokorny H, Rockenschaub S, Langer F, Puhalla H, Grünberger T, Schindl M, Längle F, Berlakovich GA, Mühlbacher F, Steininger R. First experiences with mesh wrapping for parenchymal liver injuries in orthotopic liver transplantation. Transplant Proc 1999; 31:538-9. [PMID: 10083226 DOI: 10.1016/s0041-1345(98)01544-9] [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: 12/01/2022]
Affiliation(s)
- T Soliman
- University of Vienna, Department of Surgery, Austria
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Blaicher W, Pokorny H, Rockenschaub S, Puhalla H, Mühlbacher F. Organ transplantation in Austria. Ann Transplant 1998; 1:41-4. [PMID: 9869919] [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: 02/09/2023] Open
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Pokorny H, Rockenschaub S, Puhalla H, Blaicher W, Windhager T, Berlakovich GA, Steininger R, Mühlbacher F. Transplantation of kidneys from non-heart-beating donors: retrospective analysis of the outcome. Transplant Proc 1997; 29:3545-8. [PMID: 9414830 DOI: 10.1016/s0041-1345(97)01016-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- H Pokorny
- Department of Surgery, University Hospital Vienna, Austria
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Murri A, Fleiss O, Fleiss H, Pokorny H. [Biomechanical gait analysis after elongation of the Achilles tendon in patients with cerebral movement disorders]. Wien Med Wochenschr 1982; 132:507-13. [PMID: 7157814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The biomechanical gate analysis makes possible an exact interpretation of single locomotion in all details. Even by patients with cerebral palsy an improvement of objective and self-critical clinical assessment of therapy was achieved. We report on the results of biomechanical gate analysis after elongation of the Achilles tendon. The effects of the operation especially concerning coordination of the gate have been analysed.
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