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Fouzas I, Sgourakis G, Nowak KM, Lang H, Cicinnati VR, Molmenti EP, Saner FH, Nadalin S, Papanikolaou V, Broelsch CE, Paul A, Sotiropoulos GC. Liver transplantation with grafts from septuagenarians. Transplant Proc 2009; 40:3198-200. [PMID: 19010233 DOI: 10.1016/j.transproceed.2008.08.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate our experience with orthotopic liver transplantation (OLT) using grafts from septuagenarians. PATIENTS AND METHODS Seventeen adult patients underwent transplantation with grafts from donors 70 years of age or older during an 8-year period. RESULTS The median donor age was 73 years (range, 70-83). Eleven (64.7%) donors had experienced at least 1 hypotensive period and received vasoactive drugs. Median cold and warm ischemia times were 7.25 hours and 35 minutes, respectively. Two recipients underwent retransplantation because of dysfunction or primary nonfunction. Morbidity rate was 47% and hospital mortality rate was 23.5%. After a median follow-up of 34.5 months (range, 3-84 months), 5 additional patients died. Median patient survival was 17 months (range, 0-84 months). One-, 3-, 5-, and 7-year cumulative survival rates were 69.7%, 57.5%, 46.2%, and 23.3%, respectively. Only graft dysfunction (P = .042) was observed to be an independent predictor of survival upon multivariate analysis. CONCLUSIONS Although grafts from septuagenarians allow for expansion of the donor pool, long-term recipient survival is inferior to that encountered with younger donors.
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Saner FH, Sotiropoulos GC, Radtke A, Fouzas I, Molmenti EP, Nadalin S, Paul A. Intensive care unit management of liver transplant patients: a formidable challenge for the intensivist. Transplant Proc 2009; 40:3206-8. [PMID: 19010236 DOI: 10.1016/j.transproceed.2008.08.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with end-stage liver disease, particular following liver transplantation, are a major challenge for the intensivist. The recipient is at risk for cardiac decompensation, respiratory failure following reperfusion, and kidney failure. This review will focus on these topics to provide useful information concerning pathophysiology and treatment. Intensivists, who are involved in the postoperative care of liver transplant patients, have to be aware of these problems.
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Lang H, Sotiropoulos GC, Beckebaum S, Fouzas I, Molmenti EP, Omar OS, Sgourakis G, Radtke A, Nadalin S, Saner FH, Malagó M, Gerken G, Paul A, Broelsch CE. Incidence of liver retransplantation and its effect on patient survival. Transplant Proc 2009; 40:3201-3. [PMID: 19010234 DOI: 10.1016/j.transproceed.2008.09.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to review our institutional experience with re-liver transplantation (OLT) after split and full-size OLT. PATIENTS AND METHODS We evaluated data corresponding to retransplanted patients over an 8-year period who underwent deceased donor OLT at our institution. Variables analyzed included indications for primary OLT, and re-OLT, the type of graft used during the initial versus re-OLT, the time from initial to re-OLT, and patient survival after re-OLT. RESULTS Sixty-four of 697 first OLT (9.2%) required re-OLT. Forty-nine cases were among 637 (7.6%) full-size OLT, while 15 were among 60 (25%) split OLT (P < .001). Median time to re-OLT was 8 days (range = 1-1885 days). Main indications for re-OLT were primary nonfunction/initial poor function (44%), hepatic artery thrombosis (26%), biliary complications (11%), and hepatitis C recurrence (6%). Forty-eight percent of the re-OLTs were performed within the first posttransplant week. The overall survival for these 64 patients was 55% and 48% at 1 and 3 years after the primary OLT, and 44% at both 1 and 3 years after the re-OLT, respectively. CONCLUSIONS The overall incidence of re-OLT remains 9%. Approximately half of all re-OLT occured within the first posttransplant week. Early retransplantation was associated with the best patient survival. Overall survival after re-OLT was about 10% to 20% lower than that after primary OLT.
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Sotiropoulos GC, Kaiser GM, Lang H, Molmenti EP, Beckebaum S, Fouzas I, Sgourakis G, Radtke A, Bockhorn M, Nadalin S, Treckmann J, Niebel W, Baba HA, Broelsch CE, Paul A. Liver transplantation as a primary indication for intrahepatic cholangiocarcinoma: a single-center experience. Transplant Proc 2009; 40:3194-5. [PMID: 19010231 DOI: 10.1016/j.transproceed.2008.08.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is not a widely accepted indication for orthotopic liver transplantation (OLT). The present study describes our institutional experience with patients who underwent transplantation for ICC as well as those with ICC who underwent transplantation with the incorrect diagnosis of hepatocellular carcinoma (HCC). PATIENTS AND METHODS Data corresponding to ICC patients were reviewed for the purposes of this study. Patients with hilar cholangiocarcinoma and incidentally found ICC after OLT for benign diseases were excluded from further consideration. RESULTS Among the 10 patients, 6 underwent transplantation before 1996 and 4 after 2001. Those who underwent transplantation in the early period had a preoperative diagnosis of inoperable ICC (n = 4) and ICC in the setting of primary sclerosing cholangitis (n = 2). In the latter period the subjects had a diagnosis of HCC in cirrhosis (n = 3) or recurrent ICC after an extended right hepatectomy (n = 1). Median survival was 25.3 months for the whole series and 32.2 months (range, 18-130 months) when hospital mortality was excluded (n = 3). Four patients are currently alive after 30, 35, 42, and 130 months post-OLT, respectively. Two patients died of tumor recurrence at 18 and 21 months post-OLT, respectively. One-, 3-, and 5-year survival rates were 70%, 50%, and 33%, respectively. CONCLUSIONS The role of OLT in the setting of ICC may be re-evaluated in the future under strict selection criteria and with prospective multicenter randomized studies. Potential candidates to be included are those with liver cirrhosis and no hilar involvement who meet the Milan criteria for HCC.
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Sandberg RL, Raymondson DA, La-O-Vorakiat C, Paul A, Raines KS, Miao J, Murnane MM, Kapteyn HC, Schlotter WF. Tabletop soft-x-ray Fourier transform holography with 50 nm resolution. OPTICS LETTERS 2009; 34:1618-1620. [PMID: 19488126 DOI: 10.1364/ol.34.001618] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present what we believe to be the first implementation of Fourier transform (FT) holography using a tabletop coherent x-ray source. By applying curvature correction to compensate for the large angles inherent in high-NA coherent imaging, we achieve image resolution of 89 nm using high-harmonic beams at a wavelength of 29 nm. Moreover, by combining holography with iterative phase retrieval, we improve the image resolution to <53 nm. We also demonstrate that FT holography can be used effectively with short exposure times of 30 s. This technique will enable biological and materials microscopy with simultaneously high spatial and temporal resolution on a tabletop soft-x-ray source.
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Seidel S, Hartl T, Weber M, Matterey S, Paul A, Riederer F, Gharabaghi M, Wöber-Bingöl Ç, Wöber C. Quality of Sleep, Fatigue and Daytime Sleepiness in Migraine—A Controlled Study. Cephalalgia 2009; 29:662-9. [DOI: 10.1111/j.1468-2982.2008.01784.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate whether the quality of sleep and the degree of fatigue and daytime sleepiness are related to migraine. We investigated 489 subjects comprising 97 patients with eight or more, 77 patients with five to seven and 196 patients with one to four migraine days per month, and 119 migraine-free controls with fewer than six headache days per year. The patients were recruited via articles in newspapers not stressing the subject of the study. All participants underwent a semistructured interview and completed the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and the Self-rating Depression Scale and the Self-rating Anxiety Scale. For statistical analysis we used two way MANOVAs, post hoc univariate two-way ANOVAs and Hochberg's GT2 tests as well as three-way mixed design ANOVAs. The PSQI total score was highest in patients with frequent migraine (5.9 ± 4.3) and lowest in controls (4.3 ± 2.5, P = 0.04). Four subscores of the PSQI showed similar statistically significant differences. The FSS and ESS scores did not differ in the four study groups. Analysing depression and anxiety revealed a significant impact on PSQI, FSS and ESS, but did not demonstrate interactions with migraine, thus suggesting that the impact of migraine is similar in patients without and with psychiatric comorbidity. In conclusion, the quality of sleep is decreased in patients with migraine, whereas fatigue and daytime sleepiness do not differ from healthy controls. The decreased quality of sleep in migraineurs is also a consequence of migraine itself and cannot be explained exclusively by comorbidity with depression or anxiety.
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Caporaso G, Chen Y, Sampayan S, Akana G, Anaya R, Anderson D, Blackfield D, Carroll J, Cook E, Falabella S, Guethlein G, Harris J, Hawkins S, Hickman B, Holmes C, Horner A, Nelson S, Paul A, Pearson D, Poole B, Richardson R, Sanders D, Selenes K, Sullivan J, Stanley J, Wang L, Watson J, Weir J. MO-D-BRD-02: Dielectric Wall Accelerators for Proton Therapy. Med Phys 2009. [DOI: 10.1118/1.3182207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Basu Baul TS, Mizar A, Paul A, Ruisi G, Willem R, Biesemans M, Linden A. Crystal and solution structures of di-n-butyltin(IV) complexes of 5-[(E)-2-(4-methoxyphenyl)-1-diazenyl]quinolin-8-ol and benzoic acid derivatives: En route to elegant self-assembly via modulation of the tin coordination geometry. J Organomet Chem 2009. [DOI: 10.1016/j.jorganchem.2009.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heuer M, Hertel S, Remmer N, Wirges U, Philipp T, Gerken G, Paul A, Kaiser GM. [Readiness for organ donation: analysis of a survey for health themes]. Dtsch Med Wochenschr 2009; 134:923-6. [PMID: 19384810 DOI: 10.1055/s-0029-1220249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Currently, organ transplantation is the treatment of choice for patients with chronic or acute organ failure. However, due to a lack of donor organs, every day three patients die on the waiting list for transplantation. At the same time there is a high potential of organ donors that is not utilized. Statements concerning the number of potential donors are possible only to a limited extent at present. Objective of this study was to collect the rate of holders of organ donor cards among the employees of the city of Essen before a targeted awareness raising campaign had been carried out. PATIENTS AND METHODS A questionnaire was sent out to the employees of the city of Essen in 2007. Gender, age and the "indicator for readiness for organ donation" were stratified and analyzed according to the holding of organ donor cards. The indicator reflects the evaluation of health awareness in the respondents. RESULTS Altogether, 1 814 questionnaires were evaluated. 20 % of the respondents were holding an organ donor card at the time of the survey. No association between gender (p-value 0.17) respectively age (p-value 0.79) and the possession of an organ donor card could be detected. 23 % of the respondents who regularly worked out or donated blood were identified as organ donor card holders. This is significantly more (p-value < 0.0001) than in respondents where this criterion did not apply. CONCLUSION In order to optimize the potential of organ donors in the long term, it is necessary to reconsider and advance attitude towards the readiness for organ donation. Further spreading of information and education as well as transparency in the transplantation medicine are essential for this project.
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Steinmann J, Buer J, Rath PM, Paul A, Saner F. Invasive aspergillosis in two liver transplant recipients: diagnosis by SeptiFast. Transpl Infect Dis 2009; 11:175-8. [DOI: 10.1111/j.1399-3062.2009.00367.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heuer M, Frühauf NR, Treckmann J, Witzke O, Paul A, Kaiser GM. [Kidney procurement and transplantation from a surgical perspective]. Dtsch Med Wochenschr 2009; 134:412-6. [PMID: 19212932 DOI: 10.1055/s-0028-1124009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Kidney transplantation is the best therapeutic option in many patients with end-stage renal disease, because it significantly increases lifespan over that of patients who remain on dialysis. Because of organ shortage the average waiting time for a suitable kidney in Germany is about four years after the onset of dialysis treatment. Currently about 80% of all transplanted kidneys are obtained from brain-dead patients. The possibility for kidney transplantation after living donation reduces the minimum waiting time to a few weeks. An optimized organizational strategy as well as donor and recipient preparation are possible in living donation, resulting in excellent transplant quality and a short cold-ischemia time. Pre-emptive kidney transplantation after living donation is an attractive treatment option without the need for previous dialysis and is also an option for children. The excellent long-term results after kidney transplantation have been caused by improvement of operative technique, organizational strategy, donor preparation, postoperative care and, in particular, immunosuppression.
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Erim Y, Beckmann MB, Gräf J, Beckebaum S, Cicinnati V, Böttcher M, Paul A, Senf W. Abstinenz nach Lebertransplantation: Beurteilungsmethoden und psychische Einflüsse. PPMP - PSYCHOTHERAPIE · PSYCHOSOMATIK · MEDIZINISCHE PSYCHOLOGIE 2009. [DOI: 10.1055/s-0029-1208196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Draxler J, Schuch M, Paul A, Sycha T, Valenta C, Likar R, Gustorff B. [Topical application of morphine and buprenorphine gel has no effect in the sunburn model]. Schmerz 2008; 22:571-4. [PMID: 18438689 DOI: 10.1007/s00482-008-0660-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this placebo-controlled double-blinded cross-over study was to investigate the antihyperalgesic effect of topical morphine and buprenorphine in the sunburn pain model. MATERIAL AND METHODS The study was designed as a double-blind, placebo-controlled cross-over trial, separated into 2 parts each with 16 volunteers. In part A morphine dissolved in Ultrabas-ultrasic ointment at 3 concentrations (0.1, 0.2, 0.4%) and placebo ointment were applied to 4 UVB-induced erythemas on the thighs. In part B buprenorphine at 3 concentrations (0.01, 0.02 and 0.1%) and placebo dissolved in a gel for transcutaneous application, was applied to 4 erythemas on the thighs. Thermal and mechanical hyperalgesia were assessed in the respective erythema by standardized quantitative sensory testing and opioids were compared to the placebo. RESULTS Neither morphine nor buprenorphine showed any significant reduction of hyperalgesia in comparison to the placebo. CONCLUSION The topical application of opioids in this form has no effect on inflamed skin.
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Sotiropoulos GC, Treckmann J, Fouzas I, Molmenti EP, Nowak KM, Broelsch CE, Paul A, Lang H. Eurotransplant special request for high-urgency status after liver transplantation for hepatocellular carcinoma: a case report. Transplant Proc 2008; 40:3211-2. [PMID: 19010237 DOI: 10.1016/j.transproceed.2008.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hepatic artery thrombosis after liver transplantation remains a major indication for retransplantation. We report the case of a 49-year-old man with a hepatocellular carcinoma in the setting of cirrhosis associated with chronic hepatitis B and C infections who underwent split liver transplantation. The patient experienced a complicated postoperative course, characterized by 2 relaparotomies for necrosis of segment IV, and a late hepatic artery thrombosis, first discovered on postoperative day 20. His subsequent course was characterized by relapsing cholangitis and liver abscesses requiring antibiotics and percutaneous drainage. Transient control of the septic complications allowed for the filing of a special high-urgency status request that was approved by Eurotransplant. The patient underwent retransplantation 1 week later with a full-size deceased donor graft. He is currently alive, well, with no evidence of tumor recurrence at 30 months posttransplantation. The existence of exceptions within the system, such as the "special high-urgency status" of Eurotransplant, as well as the aggressive treatment of complications to obtain a "window of clinical opportunity" saved this patient's life.
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Michalsen A, Lehmann N, Paul A, Budde T, Moebus S, Lanhghorst J, Kerckhoff G, Dobos G. Long-term effects of an integrative medicine and lifestyle modification intervention in patients with coronary artery disease on cardiovascular risk factors, need of medication and coronary calcium. Eur J Integr Med 2008. [DOI: 10.1016/j.eujim.2008.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Basu Baul TS, Paul A, Arman HD, Tiekink ERT. 2-[(E)-(5-tert-Butyl-2-hydroxy-phen-yl)-diazen-yl]benzoic acid. Acta Crystallogr Sect E Struct Rep Online 2008; 64:o2125. [PMID: 21580987 PMCID: PMC2959775 DOI: 10.1107/s160053680803290x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 10/11/2008] [Indexed: 11/10/2022]
Abstract
The title compound, C(17)H(18)N(2)O(3), is approximately planar, owing in part to an intra-molecular bifurcated O-H⋯(N,O) hydrogen bond; the dihedral angle between the two aromatic rings is 23.86 (9)°. In the crystal struture, centrosymmetrically related mol-ecules associate into dimers via the eight-membered carboxyl-ate {⋯H-O-C=O}(2) synthon.
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Audrézet MP, Bolch GL, Floch V, Yaouanc JJ, Clément J, des Abbayes H, Mercier B, Paul A, Férec C. Novel Cationic Phosphonolipids Agents for in Vitro Gene Transfer to Epithelial Cell Lines. J Liposome Res 2008. [DOI: 10.3109/08982109709035502] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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269
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Vogt T, Lüssi F, Paul A, Urban P. Langzeittherapie fokaler Dystonien und des Hemispasmus facialis mit Botulinum-Toxin A. DER NERVENARZT 2008; 79:912-7. [PMID: 18551268 DOI: 10.1007/s00115-008-2486-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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270
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Paul A, Lewis A. Safety goggles: are they adequate to prevent eye injuries caused by rotating wire brushes? Emerg Med J 2008; 25:385. [DOI: 10.1136/emj.2007.054759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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271
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Saad S, Arns W, Paul A, Nagelschmidt M, Heiss M, Treckmann J. [The way to establish laparoscopic donor nephrectomy as the method of choice in live kidney donation--a single centre experience]. Zentralbl Chir 2008; 133:188-92. [PMID: 18415910 DOI: 10.1055/s-2008-1004740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In contrast to the USA, laparoscopic donor nephrectomy is rarely practised in German transplant centres. Safety concerns and difficulties with the learning curve of this advanced laparoscopic procedure are the main obstacles to the establishment of this operation. PATIENTS AND METHODS From 1998-2005, we performed laparoscopic kidney procurement in 50 live kidney donors on an intention to treat basis harvesting a total of 29 left and 21 right kidneys for transplantation. RESULTS Negative adverse effects on the donor side were temporary nerve irritation (2 patients) and postoperative retroperitoneal hematoma. Reasons to convert to open nephrectomy were bleeding (2 patients) and adhesions (1 patient). On the recipient side, one kidney was lost due to renal vein thrombosis. Three patients required short-time dialysis after transplantation. All other kidney transplants worked without any problems. CONCLUSION Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our hospital.
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Li J, Frilling A, Nadalin S, Paul A, Malagò M, Broelsch CE. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. Br J Surg 2008; 95:460-5. [PMID: 18161898 DOI: 10.1002/bjs.6022] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Concomitant hepatic artery injury is a rare but severe complication associated with bile duct injury during laparoscopic cholecystectomy (LC). METHODS Sixty patients referred with biliary injury after LC between April 1998 and December 2005 were divided into two groups according to the time elapsed between injury and definitive surgical revision; patients in group 1 were referred early (within 4 days) after operation and those in group 2 were referred later. Hepatic rearterialization was performed in addition to biliary reconstruction when technically possible. RESULTS Damage to the hepatic artery was detected in ten patients. Hepatic rearterialization was carried out in five patients by end-to-end anastomosis (one), or by using an autologous graft (three) or allogeneic vascular graft (one). Three patients in group 2 underwent right hemihepatectomy without arterial reconstruction owing to liver necrosis or lobar atrophy. Three of ten patients died from postoperative complications. CONCLUSION Combined bile duct and hepatic artery injury during LC led to a complicated clinical course, with a high mortality rate. Reconstruction of the right hepatic artery might be helpful in reducing hepatic ischaemia, but is usually feasible only if the injury is identified early.
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Chaudhuri K, Paul A. Glucocorticoids and rheumatoid arthritis—a reappraisal. INDIAN JOURNAL OF RHEUMATOLOGY 2008. [DOI: 10.1016/s0973-3698(10)60075-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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274
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Wendel HP, Hoffmann J, Paul A, Walker T, Scheule A, Ziemer G. Self-endothelialization of vascular prostheses by immobilized capture molecules for circulating endothelial progenitor cells. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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275
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Paul A, Rahim A, Mikhail M, Burke J, Stafanous SN. An unusual case of complete ptosis and failure of elevation due to severe facial trauma. Orbit 2007; 26:323-5. [PMID: 18097978 DOI: 10.1080/01676830600987367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors describe the case of 49-year-old female teacher who had sustained severe facial lacerations following a minor fall on the kerb. The severe shearing force by which the flap was ripped off the forehead caused complete ptosis and complete failure of elevation of the left eye, which was presumed to be due to mechanical damage to the superior rectus and levator complex. The management by a multidisciplinary approach and clinical course of the patient are described with documentary photographs. This presentation is meant to highlight an unusual case of severe facial trauma resulting from a minor injury, and its successful management with gratifying results for both patient and the surgeon.
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