Journal of gastrointestinal and liver diseases: JGLD
Prognosis of multiple injured patients is mainly limited by severe haemorrhage. Although mechanis... more Prognosis of multiple injured patients is mainly limited by severe haemorrhage. Although mechanisms of altered immune response have been intensively investigated, little is known about the relevance of liver trauma as an independent predictive outcome factor in these patients. 10,469 patients from the DGU Trauma Registry (1993-2005) were retrospectively analyzed. Primary admitted patients with an injury severity score > or = 16, without isolated head injury were included. Patients were analyzed according to the injury pattern as liver injury (Abbreviated Injury Scale--AIS abdomen < 3 and AIS liver 2-5; n = 321), non-liver abdominal trauma (AIS abdomen 2-5 or AIS liver < 3; n = 574) and control group without abdominal injuries (AIS abdomen or liver < 3; n = 9,574). Severe liver injury was associated with excessive demands for volume resuscitation and induced a significantly increased risk for sepsis and multi-organ failure (MOF) compared to both other groups (sepsis 19.9% vs. 11.0%; MOF 32.7% vs. 16.6%). Furthermore, deleterious outcome was more frequently associated with severe liver trauma (mortality 34.9%) compared to severe abdominal trauma (12.0%). Severe liver trauma is an independent predictor for severe haemorrhage with a substantially increased risk of sepsis, MOF and trauma-related death. While conservative treatment of patients with liver trauma but no haemorrhage is effective, patients with hemodynamic instability seem to be from a subgroup where contemporary treatment modalities are not yet sufficient.
Our objective was to evaluate liver transplantation as a treatment option for Klatskin tumor. Res... more Our objective was to evaluate liver transplantation as a treatment option for Klatskin tumor. Results for transplanted patients suffering from hilar cholangiocarcinoma were therefore compared to patients after hemihepatectomy. In a retrospective case-control study, seven patients transplanted for hilar cholangiocarcinoma were matched in terms of UICC stage with seven patients who underwent resection of the hilar bifurcation combined with a hemihepatectomy. Median survival was 22 months (range 1-55 months) for patients after liver resection and 64 months (range 1-138 months) for patients after liver transplantation. One and three year overall survival was 71% and 43% after liver resection versus 71% and 57% after liver transplantation. One patient from each group died within one month after surgery. Fatal cerebral bleeding and post-resection liver failure leading to multi-organ failure and sepsis were the causes of early mortality. Three patients are currently alive: one with 64 months after transplantation and two patients with 42 and 55 months after liver resection. Based on our findings and recently published promising results using liver transplantation for Klatskin tumor, it seems worthwhile to reconsider its potential use in the light of multimodal tumor treatment.
Epithelioid hemangioendothelioma of the liver is very uncommon and is quite difficult to distingu... more Epithelioid hemangioendothelioma of the liver is very uncommon and is quite difficult to distinguish from a cholangiocarcinoma or a metastatic liver disease by imaging diagnostics. However, the histological features are characteristic for this soft-tissue tumor. Although liver tumor is usually multifocal and a liver resection is not possible in most cases, we report a case of a multifocal epithelioid hemangioendothelioma of the liver that was completely resected. The tumor was associated with a solitary extrahepatic lesion, which was first discovered six months after the liver resection and which was also resected.
Tracheobronchial lesions after blunt chest injury are rare. Diagnosis and therapy can prove to be... more Tracheobronchial lesions after blunt chest injury are rare. Diagnosis and therapy can prove to be challenging for the attending physician. Nonrecognition of this injury may entail severe complications. Herein we report the case of a 9-year-old girl with rupture of the trachea due to a fall against the handlebar of her kickboard. The clinical, radiological, and features of the therapy performed are discussed.
Liver cells are key players in innate immunity. Thus, studying primary isolated liver cells is ne... more Liver cells are key players in innate immunity. Thus, studying primary isolated liver cells is necessary for determining their role in liver physiology and pathophysiology. In particular, the quantity and quality of isolated cells are crucial to their function. Our aim was to isolate a large quantity of high-quality human parenchymal and non-parenchymal cells from a single liver specimen. Hepatocytes, Kupffer cells, liver sinusoidal endothelial cells, and stellate cells were isolated from liver tissues by collagenase perfusion in combination with low-speed centrifugation, density gradient centrifugation, and magnetic-activated cell sorting. The purity and functionality of cultured cell populations were controlled by determining their morphology, discriminative cell marker expression, and functional activity. Cell preparation yielded the following cell counts per gram of liver tissue: 2.0±0.4×107 hepatocytes, 1.8±0.5×106 Kupffer cells, 4.3±1.9×105 liver sinusoidal endothelial cells, ...
The Bismuth-Corlette (BC) classification is the current preoperative standard to assess hilar cho... more The Bismuth-Corlette (BC) classification is the current preoperative standard to assess hilar cholangiocarcinomas (HC). The aim of this study is to evaluate the accuracy, sensitivity, and prognostic value of the BC classification. Data of patients undergoing resection for HC were analyzed. Endoscopic retrograde cholangiography and standard computed tomography were undertaken in all cases. Additional 3D-CT-reconstructions, magnetic resonance imaging, and percutaneous transhepatic cholangiography were obtained in selected patients. A systematic review and meta-analysis of the literature was performed. Ninety patients underwent resection of the hilar bile duct confluence, with right or left hemihepatectomy in 68 instances. The overall accuracy of the BC classification was 48 per cent. Rates of BC under- and over-estimation were 29 per cent and 23 per cent, respectively. The addition of MRI, 3D-CT-reconstructions, or percutaneous transhepatic cholangiography improved the accuracy to 49 ...
As patients with gastric cancer are offered choices between surgical resection, neoadjuvant or pa... more As patients with gastric cancer are offered choices between surgical resection, neoadjuvant or palliative chemotherapy, or symptomatic relief alone, the need for accurate preoperative staging becomes apparent. Laparoscopy has been suggested as an appropriate staging modality in a variety of upper gastrointestinal malignancies. Staging laparoscopy was performed in 45 patients with potentially resectable gastric cancer as determined by physical examination, gastroscopy, endosonography, transcutaneous ultrasonography and current generation computed tomography. Conventional clinic staging and laparoscopic staging according to the Tumor-Node-Metastases classification of the International Union against Cancer were registered separately on a database. Results were then compared to evaluate the agreement of both staging procedures. Compared to conventional staging, laparoscopy resulted in up staging of 23 patients (51.1%). In 10 patients of them peritoneal seeding was first found during lap...
Over the last three decades, liver transplantation has become an established therapy for patients... more Over the last three decades, liver transplantation has become an established therapy for patients suffering from end-stage liver disease. The first orthotopic liver transplantation - an unsuccessful attempt - was performed by Thomas Starzl in Denver in 1963. Long-term patient survival after liver transplantation was first reported in 1968 (Starzl et al. 1968). The evolution of liver transplantation was given further impetus by several major advances in the early 1980s, namely improvements in immunosuppressant regimens (Calne et al. 1979), organ preservation (Belzer and Southard 1988), surgical techniques (Starzl and Demetris 1990) and postoperative management (with reduction of infectious complications and prevention of disease recurrence).
Journal of gastrointestinal and liver diseases: JGLD
Prognosis of multiple injured patients is mainly limited by severe haemorrhage. Although mechanis... more Prognosis of multiple injured patients is mainly limited by severe haemorrhage. Although mechanisms of altered immune response have been intensively investigated, little is known about the relevance of liver trauma as an independent predictive outcome factor in these patients. 10,469 patients from the DGU Trauma Registry (1993-2005) were retrospectively analyzed. Primary admitted patients with an injury severity score > or = 16, without isolated head injury were included. Patients were analyzed according to the injury pattern as liver injury (Abbreviated Injury Scale--AIS abdomen < 3 and AIS liver 2-5; n = 321), non-liver abdominal trauma (AIS abdomen 2-5 or AIS liver < 3; n = 574) and control group without abdominal injuries (AIS abdomen or liver < 3; n = 9,574). Severe liver injury was associated with excessive demands for volume resuscitation and induced a significantly increased risk for sepsis and multi-organ failure (MOF) compared to both other groups (sepsis 19.9% vs. 11.0%; MOF 32.7% vs. 16.6%). Furthermore, deleterious outcome was more frequently associated with severe liver trauma (mortality 34.9%) compared to severe abdominal trauma (12.0%). Severe liver trauma is an independent predictor for severe haemorrhage with a substantially increased risk of sepsis, MOF and trauma-related death. While conservative treatment of patients with liver trauma but no haemorrhage is effective, patients with hemodynamic instability seem to be from a subgroup where contemporary treatment modalities are not yet sufficient.
Our objective was to evaluate liver transplantation as a treatment option for Klatskin tumor. Res... more Our objective was to evaluate liver transplantation as a treatment option for Klatskin tumor. Results for transplanted patients suffering from hilar cholangiocarcinoma were therefore compared to patients after hemihepatectomy. In a retrospective case-control study, seven patients transplanted for hilar cholangiocarcinoma were matched in terms of UICC stage with seven patients who underwent resection of the hilar bifurcation combined with a hemihepatectomy. Median survival was 22 months (range 1-55 months) for patients after liver resection and 64 months (range 1-138 months) for patients after liver transplantation. One and three year overall survival was 71% and 43% after liver resection versus 71% and 57% after liver transplantation. One patient from each group died within one month after surgery. Fatal cerebral bleeding and post-resection liver failure leading to multi-organ failure and sepsis were the causes of early mortality. Three patients are currently alive: one with 64 months after transplantation and two patients with 42 and 55 months after liver resection. Based on our findings and recently published promising results using liver transplantation for Klatskin tumor, it seems worthwhile to reconsider its potential use in the light of multimodal tumor treatment.
Epithelioid hemangioendothelioma of the liver is very uncommon and is quite difficult to distingu... more Epithelioid hemangioendothelioma of the liver is very uncommon and is quite difficult to distinguish from a cholangiocarcinoma or a metastatic liver disease by imaging diagnostics. However, the histological features are characteristic for this soft-tissue tumor. Although liver tumor is usually multifocal and a liver resection is not possible in most cases, we report a case of a multifocal epithelioid hemangioendothelioma of the liver that was completely resected. The tumor was associated with a solitary extrahepatic lesion, which was first discovered six months after the liver resection and which was also resected.
Tracheobronchial lesions after blunt chest injury are rare. Diagnosis and therapy can prove to be... more Tracheobronchial lesions after blunt chest injury are rare. Diagnosis and therapy can prove to be challenging for the attending physician. Nonrecognition of this injury may entail severe complications. Herein we report the case of a 9-year-old girl with rupture of the trachea due to a fall against the handlebar of her kickboard. The clinical, radiological, and features of the therapy performed are discussed.
Liver cells are key players in innate immunity. Thus, studying primary isolated liver cells is ne... more Liver cells are key players in innate immunity. Thus, studying primary isolated liver cells is necessary for determining their role in liver physiology and pathophysiology. In particular, the quantity and quality of isolated cells are crucial to their function. Our aim was to isolate a large quantity of high-quality human parenchymal and non-parenchymal cells from a single liver specimen. Hepatocytes, Kupffer cells, liver sinusoidal endothelial cells, and stellate cells were isolated from liver tissues by collagenase perfusion in combination with low-speed centrifugation, density gradient centrifugation, and magnetic-activated cell sorting. The purity and functionality of cultured cell populations were controlled by determining their morphology, discriminative cell marker expression, and functional activity. Cell preparation yielded the following cell counts per gram of liver tissue: 2.0±0.4×107 hepatocytes, 1.8±0.5×106 Kupffer cells, 4.3±1.9×105 liver sinusoidal endothelial cells, ...
The Bismuth-Corlette (BC) classification is the current preoperative standard to assess hilar cho... more The Bismuth-Corlette (BC) classification is the current preoperative standard to assess hilar cholangiocarcinomas (HC). The aim of this study is to evaluate the accuracy, sensitivity, and prognostic value of the BC classification. Data of patients undergoing resection for HC were analyzed. Endoscopic retrograde cholangiography and standard computed tomography were undertaken in all cases. Additional 3D-CT-reconstructions, magnetic resonance imaging, and percutaneous transhepatic cholangiography were obtained in selected patients. A systematic review and meta-analysis of the literature was performed. Ninety patients underwent resection of the hilar bile duct confluence, with right or left hemihepatectomy in 68 instances. The overall accuracy of the BC classification was 48 per cent. Rates of BC under- and over-estimation were 29 per cent and 23 per cent, respectively. The addition of MRI, 3D-CT-reconstructions, or percutaneous transhepatic cholangiography improved the accuracy to 49 ...
As patients with gastric cancer are offered choices between surgical resection, neoadjuvant or pa... more As patients with gastric cancer are offered choices between surgical resection, neoadjuvant or palliative chemotherapy, or symptomatic relief alone, the need for accurate preoperative staging becomes apparent. Laparoscopy has been suggested as an appropriate staging modality in a variety of upper gastrointestinal malignancies. Staging laparoscopy was performed in 45 patients with potentially resectable gastric cancer as determined by physical examination, gastroscopy, endosonography, transcutaneous ultrasonography and current generation computed tomography. Conventional clinic staging and laparoscopic staging according to the Tumor-Node-Metastases classification of the International Union against Cancer were registered separately on a database. Results were then compared to evaluate the agreement of both staging procedures. Compared to conventional staging, laparoscopy resulted in up staging of 23 patients (51.1%). In 10 patients of them peritoneal seeding was first found during lap...
Over the last three decades, liver transplantation has become an established therapy for patients... more Over the last three decades, liver transplantation has become an established therapy for patients suffering from end-stage liver disease. The first orthotopic liver transplantation - an unsuccessful attempt - was performed by Thomas Starzl in Denver in 1963. Long-term patient survival after liver transplantation was first reported in 1968 (Starzl et al. 1968). The evolution of liver transplantation was given further impetus by several major advances in the early 1980s, namely improvements in immunosuppressant regimens (Calne et al. 1979), organ preservation (Belzer and Southard 1988), surgical techniques (Starzl and Demetris 1990) and postoperative management (with reduction of infectious complications and prevention of disease recurrence).
Uploads
Papers by Gernot Kaiser