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Siefert J, Hillebrandt KH, Moosburner S, Podrabsky P, Geisel D, Denecke T, Unger JK, Sawitzki B, Gül-Klein S, Lippert S, Tang P, Reutzel-Selke A, Morgul MH, Reske AW, Kafert-Kasting S, Rüdinger W, Oetvoes J, Pratschke J, Sauer IM, Raschzok N. Hepatocyte Transplantation to the Liver via the Splenic Artery in a Juvenile Large Animal Model. Cell Transplant 2019; 28:14S-24S. [PMID: 31842585 PMCID: PMC7016464 DOI: 10.1177/0963689719885091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hepatocyte transplantation (HcTx) is a promising approach for the treatment of metabolic diseases in newborns and children. The most common application route is the portal vein, which is difficult to access in the newborn. Transfemoral access to the splenic artery for HcTx has been evaluated in adults, with trials suggesting hepatocyte translocation from the spleen to the liver with a reduced risk for thromboembolic complications. Using juvenile Göttingen minipigs, we aimed to evaluate feasibility of hepatocyte transplantation by transfemoral splenic artery catheterization, while providing insight on engraftment, translocation, viability, and thromboembolic complications. Four Göttingen Minipigs weighing 5.6 kg to 12.6 kg were infused with human hepatocytes (two infusions per cycle, 1.00E08 cells per kg body weight). Immunosuppression consisted of tacrolimus and prednisolone. The animals were sacrificed directly after cell infusion (n=2), 2 days (n=1), or 14 days after infusion (n=1). The splenic and portal venous blood flow was controlled via color-coded Doppler sonography. Computed tomography was performed on days 6 and 18 after the first infusion. Tissue samples were stained in search of human hepatocytes. Catheter placement was feasible in all cases without procedure-associated complications. Repetitive cell transplantations were possible without serious adverse effects associated with hepatocyte transplantation. Immunohistochemical staining has proven cell relocation to the portal venous system and liver parenchyma. However, cells were neither present in the liver nor the spleen 18 days after HcTx. Immunological analyses showed a response of the adaptive immune system to the human cells. We show that interventional cell application via the femoral artery is feasible in a juvenile large animal model of HcTx. Moreover, cells are able to pass through the spleen to relocate in the liver after splenic artery infusion. Further studies are necessary to compare this approach with umbilical or transhepatic hepatocyte administration.
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Affiliation(s)
- J Siefert
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - K H Hillebrandt
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S Moosburner
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P Podrabsky
- Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - D Geisel
- Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - T Denecke
- Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J K Unger
- Department of Experimental Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - B Sawitzki
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S Gül-Klein
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S Lippert
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P Tang
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Reutzel-Selke
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M H Morgul
- Department of General, Visceral and Transplantation Surgery, University of Münster, Münster, Germany
| | - A W Reske
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | | | - W Rüdinger
- Cytonet GmbH & Co. KG, Weinheim, Germany
| | - J Oetvoes
- Department of Experimental Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J Pratschke
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - I M Sauer
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - N Raschzok
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,BIH Charité Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
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Fuss CT, Treitl M, Rayes N, Podrabsky P, Fenske WK, Heinrich DA, Reincke M, Petersen TO, Fassnacht M, Quinkler M, Kickuth R, Hahner S. Radiation exposure of adrenal vein sampling: a German Multicenter Study. Eur J Endocrinol 2018; 179:261-267. [PMID: 30299899 PMCID: PMC6182189 DOI: 10.1530/eje-18-0328] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Adrenal vein sampling (AVS) represents the current diagnostic standard for subtype differentiation in primary aldosteronism (PA). However, AVS has its drawbacks. It is invasive, expensive, requires an experienced interventional radiologist and comes with radiation exposure. However, exact radiation exposure of patients undergoing AVS has never been examined. DESIGN AND METHODS We retrospectively analyzed radiation exposure of 656 AVS performed between 1999 and 2017 at four university hospitals. The primary outcomes were dose area product (DAP) and fluoroscopy time (FT). Consecutively the effective dose (ED) was approximately calculated. RESULTS Median DAP was found to be 32.5 Gy*cm2 (0.3–3181) and FT 18 min (0.3–184). The calculated ED was 6.4 mSv (0.1–636). Remarkably, values between participating centers highly varied: Median DAP ranged from 16 to 147 Gy*cm2, FT from 16 to 27 min, and ED from 3.2 to 29 mSv. As main reason for this variation, differences regarding AVS protocols between centers could be identified, such as number of sampling locations, frames per second and the use of digital subtraction angiographies. CONCLUSIONS This first systematic assessment of radiation exposure in AVS not only shows fairly high values for patients, but also states notable differences among the centers. Thus, we not only recommend taking into account the risk of radiation exposure, when referring patients to undergo AVS, but also to establish improved standard operating procedures to prevent unnecessary radiation exposure.
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Affiliation(s)
- C T Fuss
- Department of Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany
| | - M Treitl
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - N Rayes
- Department of General, Visceral and Transplant Surgery, University Hospital Leipzig, Leipzig, Germany
| | - P Podrabsky
- Department of Radiology, Charité Campus Virchow Klinikum, Berlin, Germany
| | - W K Fenske
- Leipzig University Medical Center, Integrated Center for Research and Treatment Adiposity Diseases, Leipzig, Germany
- Internal Medicine (Endocrinology and Nephrology), University of Leipzig, Leipzig, Germany
| | - D A Heinrich
- Department of Endocrinology, Ludwig-Maximilians-University, Munich, Germany
| | - M Reincke
- Department of Endocrinology, Ludwig-Maximilians-University, Munich, Germany
| | - T-O Petersen
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - M Fassnacht
- Department of Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany
| | - M Quinkler
- Endokrinologie in Charlottenburg, Endokrinologie Praxis am Stuttgarter Platz, Berlin, Germany
| | - R Kickuth
- Department of Radiology, University Hospital Würzburg, Würzburg, Germany
| | - S Hahner
- Department of Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany
- Correspondence should be addressed to S Hahner;
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Siefert J, Hillebrandt KH, Kluge M, Geisel D, Podrabsky P, Denecke T, Nösser M, Gassner J, Reutzel-Selke A, Strücker B, Morgul MH, Guel-Klein S, Unger JK, Reske A, Pratschke J, Sauer IM, Raschzok N. Computed tomography-based survey of the vascular anatomy of the juvenile Göttingen minipig. Lab Anim 2016; 51:388-396. [PMID: 27932686 DOI: 10.1177/0023677216680238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past 50 years, image-guided procedures have been established for a wide range of applications. The development and clinical translation of new treatment regimens necessitate the availability of suitable animal models. The juvenile Göttingen minipig presents a favourable profile as a model for human infants. However, no information can be found regarding the vascular system of juvenile minipigs in the literature. Such information is imperative for planning the accessibility of target structures by catheterization. We present here a complete mapping of the arterial system of the juvenile minipig based on contrast-enhanced computed tomography. Four female animals weighing 6.13 ± 0.72 kg were used for the analyses. Imaging was performed under anaesthesia, and the measurement of the vascular structures was performed independently by four investigators. Our dataset forms a basis for future interventional studies in juvenile minipigs, and enables planning and refinement of future experiments according to the 3R (replacement, reduction and refinement) principles of animal research.
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Affiliation(s)
- J Siefert
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K H Hillebrandt
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Kluge
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - D Geisel
- 2 Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - P Podrabsky
- 2 Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - T Denecke
- 2 Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - M Nösser
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Gassner
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Reutzel-Selke
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - B Strücker
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,3 BIH-Charité Clinican Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - M H Morgul
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Guel-Klein
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J K Unger
- 4 Department of Experimental Medicine, Charité - Universitaütsmedizin Berlin, Berlin, Germany
| | - A Reske
- 5 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - J Pratschke
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - I M Sauer
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - N Raschzok
- 1 Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,3 BIH-Charité Clinican Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
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Denecke T, Grieser C, Podrabsky P, Andreou A, Neuhaus P, Glanemann M. Pankreaslinksresektion mit Resektion des Truncus cöliacus nach radiologisch-interventioneller Präkonditionierung bei lokal fortgeschrittenem Pankreaskarzinom. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279414] [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: 10/18/2022]
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Gehrmann N, Fotopoulou C, Darb-Esfahani S, Podrabsky P, Lichtenegger W, Sehouli J. „Frau Doktor, ich verwandele mich in meinen Vater!“ – Auswirkungen eines seltenen Eierstocktumors. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269977] [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: 10/18/2022] Open
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Nicolaou A, Goerke A, Sinn M, Hildebrandt B, Ricke J, Pech M, Podrabsky P, Neumann UP, Dörken B, Riess H. Hepatic arterial infusion chemotherapy (HAI) with oxaliplatin (O), 5-fluorouracil (5FU), and folinic acid (FA) in patients with advanced hepatocellular carcinoma (HCC) or biliary tract carcinoma (BTC): A phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Denecke T, Weigelt A, Steffen I, Pech M, Podrabsky P, Grieser C, Neuhaus P, Lopez-Hänninen E. Hypertrophieinduktion der Leber vor erweiterter Resektion bei Klatskin-Tumoren: arterielle oder portalvenöse Embolisation? Eine prospektiv randomisierte Studie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073787] [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: 10/21/2022]
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Denecke T, Amthauer H, Rühl R, Stelter L, Siepani H, Podrabsky P, Ricke J, Hamm B, Lopez Hänninen E. Planung transarterieller Radioembolisation von kolorektalen Lebermetastasen mit Y90-Mikrosphären: Wertigkeit kombinierter radiologischer und nuklearmedizinischer Verfahren. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976792] [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: 10/21/2022]
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Dudeck O, Jordan O, Hoffmann KT, Okuducu AF, Husmann I, Kreuzer-Nagy T, Tesmer K, Podrabsky P, Bruhn H, Hilborn J, Rüfenacht DA, Doelker E, Felix R. Embolization of experimental wide-necked aneurysms with iodine-containing polyvinyl alcohol solubilized in a low-angiotoxicity solvent. AJNR Am J Neuroradiol 2006; 27:1849-55. [PMID: 17032855 PMCID: PMC7977908] [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: 05/12/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the ready-to-use iodine-containing polyvinyl alcohol (I-PVA) dissolved in the low angiotoxic solvent N-methyl pyrrolidone (NMP) for embolization of porcine wide-necked aneurysms. METHODS Fourteen broad-based carotid sidewall aneurysms were surgically constructed in 7 swine. I-PVA (40%) in NMP was injected under temporary balloon occlusion bridging the aneurysm neck. After 4 weeks, follow-up angiography, multisection CT angiography (MSCTA), and 3T MR imaging including MR angiography (MRA) sequences were performed. Afterward, harvested aneurysms were investigated histopathologically. RESULTS The liquid embolic was well visible under fluoroscopy and displayed a favorable precipitation pattern, allowing for controlled polymer delivery. Ten aneurysms (71%) were initially completely occluded, whereas in 1 aneurysm, a minimal polymer leakage was observed. The other 4 aneurysms (29%) were almost completely occluded. One animal suffered a lethal rebleeding from the anastomosis after uneventful embolization. Aneurysms embolized with I-PVA could be discriminated well from the parent artery without beam-hardening artifacts on MSCTA, and no susceptibility artifacts were encountered on MR imaging. Histologic examination revealed all aneurysms covered with a membrane of fibroblasts and an endothelial cell layer while a moderate intraaneurysmal inflammatory response to the polymer was observed. CONCLUSION I-PVA dissolved in NMP has proved its effectiveness for the embolization of experimental wide-necked aneurysms. This precipitating liquid embolic offers several interesting features in that it needs no preparation before use and no radiopaque admixtures, the latter allowing for artifact-free evaluation of treated aneurysms with MSCTA and MRA. Moreover, it uses NMP as a solvent, which has only a low angiotoxicity.
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Affiliation(s)
- O Dudeck
- Department of Radiology, Charité, Campus Virchow Clinic, Berlin, Germany.
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Quateen A, Pech M, Berg T, Bergk A, Podrabsky P, Felix R, Ricke J. Percutaneous Transjugular Direct Porto-caval Shunt in Patients with Budd-Chiari Syndrome. Cardiovasc Intervent Radiol 2006; 29:565-70. [PMID: 16729230 DOI: 10.1007/s00270-005-0103-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of the study was to evaluate the feasibility and effectiveness of direct porto-caval shunts in patients with Budd-Chiari syndrome (BCS) in whom there is no access to the hepatic veins during transjugular intrahepatic portosystemic shunt (TIPSS). We included six consecutive patients with fulminant/acute Budd-Chiari syndrome (mean age: 35 years) in whom a conventional TIPSS was not possible due to inaccessible hepatic veins. We performed a direct porto-caval shunt via a transhepatic approach. Patients were followed up by means of clinical examination, laboratory investigations, and Doppler ultrasound. TIPSS implantation from the inferior vena cava (IVC) was successful in all six patients (100%). The median transhepatic shunt length was 9 cm (8-10 cm). No procedure-related complications were observed in our patients. Early shunt occlusion occurred in three out of six patients (50%). In all three of these patients, the stent used to stabilize the shunt ended 1-2 cm before reaching the IVC. All occlusions were successfully recanalized. One of these patients developed recurrent early shunt as well as mesenteric and splenic vein occlusions. She died 7 days after TIPSS placement due to an unmanageable coagulation disorder. The remaining five patients were followed up by planned clinical examination and laboratory investigations (mean follow-up time was 15 months; patient 1 was followed up for 13 months, patient 2 for 14 months, patient 3 for 15 months, and patients 4 and 5 for 16 months) and all displayed a complete and durable resolution of liver failure and ascites without reintervention. In patients with acute liver failure originating from BCS and inaccessible hepatic veins, a direct transhepatic porto-caval shunt can be performed safely and effectively under ultrasound guidance. Future studies in larger patient groups should investigate if the patency of transcaval TIPSS with long transhepatic shunt segments is similar compared to conventional TIPSS via the hepatic vein.
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Affiliation(s)
- A Quateen
- Department of Diagnostic and Interventional Radiology, Charité Campus Virchow Clinic, Universitätsmedizin Berlin, 13353 Berlin, Germany
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Pech M, Wieners G, Podrabsky P, Lopez-Hänninen E, Ricke J. Interventionelle Portanlage für hepatische Chemoperfusion: Tipps und Tricks. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Denecke T, Stelter L, Podrabsky P, Knollmann F, Schindler R, Tulius S, Felix R, Lopez-Hänninen E. Bewertung von Versorgungsvarianten der Nierenarterien bei Nierenlebendspendern: Vergleich von 4-Zeilen-CT, 16-Zeilen-CT und digitaler Subtraktionsangiographie. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gebauer B, Teichgräber UKM, Podrabsky P, Beck A, Wagner HJ. Ultraschall- und durchleuchtungsgesteuerte Implantation peripher inserierter zentral-venöser Katheter (PICC). ROFO-FORTSCHR RONTG 2004; 176:386-91. [PMID: 15026952 DOI: 10.1055/s-2004-812737] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Abstract
PURPOSE Evaluation of ultrasound- and fluoroscopy-guided implantation of peripherally inserted central venous catheters (PICCs). MATERIALS AND METHODS In 32 patients (12 males, 20 females; mean age 64.1 +/- 11.9 years) with clinical indication for long term central venous catheter (chemotherapy: N = 5; parenteral nutrition and fluid substitution: N = 26; parenteral pain therapy: N = 1) a PICC was placed by an interventional radiologist using ultrasound guidance. RESULTS The placement of the PICC was technically successful in 31 (96.9%) patients, with placement of 20 single-lumen 5F PICCs, 4 double-lumen 6F PICCs and 7 double-lumen 7F PICCs. The mean duration of catheter usage was 28.4 (2 - 161) days with a total of 910 catheter days. No catheter occlusions were recorded. Two patients developed a superficial venous thrombosis of the upper extremity. The resulting thrombotic rate was 2.2 per 1000 catheter days. No catheter associated infection was recorded. CONCLUSION The ultrasound guided placement of peripherally inserted central venous catheters (PICCs) via a superficial vein of the upper extremity is a practical alternative to central catheters via central veins.
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Affiliation(s)
- B Gebauer
- Klinik für Strahlenheilkunde, Charité Campus Virchow-Klinikum, Berlin.
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Hänninen EL, Röttgen R, Podrabsky P, Pascher A, Langrehr J, Pech M, Ricke J, Felix R. Bewertung der Magnetresonanz-Angiographie zur Evaluierung der Gefäßversorgung vor Lebertransplantation. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Warschewske G, Podrabsky P, Seidensticker M, Berg T, Ricke J. Revision sehr langer transjugulärer porto-kavaler Shunts mittels eines rotierenden Thrombektomiesystems. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ricke J, Warschewske G, Berg T, Podrabsky P, Felix R. Perkutaner transjugulärer porto-kavaler Shunt bei Budd-Chiari-Syndrom und nicht-katheterisierbaren Lebervenen. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Puls R, Stroszczynski C, Hildebrandt B, Amthauer H, Podrabsky P, Hidajat N, Riess H, Schlag P, Hosten N. [Radiological-guided liver-port implantation: Evaluation, technical approach, interventional procedure and follow up]. ROFO-FORTSCHR RONTG 2001; 173:914-9. [PMID: 11588679 DOI: 10.1055/s-2001-17594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
UNLABELLED Radiological-guided liver-port implantation: Evaluation, technical approach, interventional procedure and follow up. PURPOSE Description of evaluation, technical approach, interventional procedure and follow up of radiological-guided liver-port implantation. METHOD Percutaneous implantation of a liver-port system was performed in twelve patients through a transfemoral approach and in one patient via the superficial epigastric artery after surgical exploration. In four patients we used port systems which are accessible via ventral puncture. Strecker-port systems were implanted in the remaining nine patients. RESULTS The liver-port implantation was technically successful in all cases. No dislocation of the distal catheter tip, no thrombosis of the hepatic or splenic artery, no leakage near connections of the catheters or connections of catheter and port system and no thrombosis of the femoral arteries were observed. Correction of a kink in the catheter was performed in one patient. Another patient showed prolonged healing of the subcutaneous pocket. CONCLUSIONS Interventional liver-port implantation is a safe procedure and leads to good clinical results. From the view of the radiologist the Strecker-system shows a good performance. The approach via the superficial epigastric artery demands excellent interdisciplinary cooperation.
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Affiliation(s)
- R Puls
- Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Germany.
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Pfitzmann R, Heise M, Langrehr JM, Jonas S, Steinmüller T, Podrabsky P, Ewert R, Settmacher U, Neuhaus R, Neuhaus P. Liver transplantation for treatment of intrahepatic Osler's disease: first experiences. Transplantation 2001; 72:237-41. [PMID: 11477345 DOI: 10.1097/00007890-200107270-00012] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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: 11/27/2022]
Abstract
BACKGROUND Intrahepatic Osler's disease with multiple arteriovenous malformations and high intrahepatic shunting may lead to secondary pulmonary hypertension followed by right-heart stress and insufficiency. Until now, therapy with arterial embolization, banding, or ligation of the hepatic arteries is still limited and provides unsatisfactory long-term results. Liver transplantation offers another therapeutic option. METHODS We report on four patients with intrahepatic involvement of Osler's disease who were liver transplanted between 1995 and 1999. All patients suffered from restricted liver function and right-heart insufficiency with multiple cardiac decompensations. One patient received one course of embolization, and another received six courses of embolization and then banding of the main hepatic artery before transplantation. In both patients, the clinical symptoms improved for only a few months. RESULTS All patients had high degrees of intrahepatic arteriovenous shunting, and cardiac output measurements were between 8.0 to 13.3 L/min preoperatively. Preoperative mean pulmonary artery pressure was between 24 to 35 mmHg. After liver transplantation, cardiac output and right-heart diameter decreased or normalized and pulmonary pressure reached the normal range after 2 months. All patients received tacrolimus and steroids for primary immunosuppression. In one case, temporary hemodialysis was necessary for 2 weeks after transplantation, but renal function recovered completely. After follow-up time of 12 to 65 months, all patients had normal graft function and good cardiopulmonary condition. CONCLUSIONS Indication for liver transplantation should be considered in patients with intrahepatic Osler's disease, high arteriovenous shunting with right-heart stress, and restricted liver function before irreversible fixed pulmonary hypertension leads to severe right-heart insufficiency or failure. Our therapeutic regimen of early liver transplantation in the case of intrahepatic Osler's disease in four patients has promising results.
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Affiliation(s)
- R Pfitzmann
- Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow-Klinikum, Humboldt-University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Glanemann M, Settmacher U, Stange B, Haase R, Lopez-Häninnen E, Podrabsky P, Bechstein WO, Neuhaus P. Caval complications after orthotopic liver transplantation. Transplant Proc 2000; 32:539-40. [PMID: 10812103 DOI: 10.1016/s0041-1345(00)00880-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Glanemann
- Department of Surgery, Charité, Virchow Clinic, Humboldt University, Berlin, Germany
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Lehmann J, Böck JC, Podrabsky P, Wlodarczyk W, Felix R. Young Investigator Award presentation at the 13th annual meeting of the ESMRMB, September 1996, Prague. Quantification of pulmonary water compartments by magnetic resonance. MAGMA 1997; 5:3-11. [PMID: 9219173 DOI: 10.1007/bf02592259] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to quantify pulmonary water compartments of total, intravascular, and extravascular lung water in excised and perfused sheep lungs with the use of magnetic resonance imaging techniques. Total lung water was measured by proton density maps calculated from multi-spin-echo images. Intravascular lung water was evaluated by magnetic resonance angiography before and after injection of gadolinium diethylenetriamine penta-acetic acid polylysine, a macromolecular paramagnetic contrast agent. Intravascular lung water was calculated from signal intensity histogram changes comparing pre- and postcontrast angiograms. Extravascular water was calculated as the difference between total and intravascular lung water. Quantities of total and intravascular lung water measured by magnetic resonance techniques were compared to reference results obtained from wet/dry weight gravimetry and Evans blue dilution performed after imaging. Magnetic resonance and reference results correlated significantly (total lung water: r = 0.93, p < 0.001; intravascular lung water: r = 0.80, p < 0.001; extravascular lung water: r = 0.89, p < 0.001). Therefore, we conclude that quantitative magnetic resonance techniques are potentially useful for the clinical evaluation of pulmonary water compartments.
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Affiliation(s)
- J Lehmann
- Strahlenklinik und Poliklinik, Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität Berlin, Germany
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Hierholzer J, Benndorf G, Lehmann T, Schneider GH, Podrabsky P, Sander B, Sörensen R, Siekmann R, Stoltenburg G, Felix R. Epidural lipomatosis: case report and literature review. Neuroradiology 1996; 38:343-8. [PMID: 8738093 DOI: 10.1007/bf00596585] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [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: 02/01/2023]
Abstract
We report a case of symptomatic epidural lipomatosis in a 36-year-old man following a heart lung transplant and 3.5 years of steroid medication. A review of the pertinent literature emphasises the importance of including this diagnosis in the differential diagnosis of patients receiving steroid medication or markedly obese patients with back pain or symptoms suggesting spinal cord or cauda equina compression.
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Affiliation(s)
- J Hierholzer
- Department of Radiology, Virchow-Klinikum, Humboldt-Universität zu Berlin, Germany
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Venz S, Hosten N, Ilg J, Mäurer J, Podrabsky P, Fedel M, Ebert T, Nagel R. [Preoperative staging of bladder carcinomas with Gd-DTPA-supported dynamic magnetic resonance tomography. Comparison with plain and Gd-DTPA-supported spin-echo sequences]. ROFO-FORTSCHR RONTG 1996; 164:218-25. [PMID: 8672777 DOI: 10.1055/s-2007-1015644] [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: 02/01/2023]
Abstract
PURPOSE Evaluation of dynamic Gd-DTPA enhanced MR imaging in the staging of bladder cancer. METHODS We studied 40 patients with histologically proven bladder cancer. All patients were examined with routine T1- and T2-weighted MRI and late Gd-DTPA enhanced T1-weighted MRI. Additionally, a dynamic study was performed with 10 subsequent short FLASH-2-D gradient echo sequences without delay immediately after bolus injection of Gd-DTPA. Signal intensities of the tumour and of the surrounding tissue as well as image contrast parameters were quantified. RESULTS The dynamic study showed a higher accuracy in the evaluation of stage pTa to pT2 cancer compared to spin echo MRI (63% and 46%, respectively) and no difference regarding the sensitivity (87.5%). However, overstaging was a problem with both modalities. The contrast-to-noise ratio of bladder tumour and muscle was equal or significant higher with the dynamic study compared to spin echo MRI. A higher signal-to-contrast ratio of bladder tumour and bladder muscle was calculated for the dynamic study compared with the spin-echo MRI (p < 0.01; Mann-Whitney U test). CONCLUSION Dynamic Gd-DTPA enhanced MRI is recommended to be used additionally in the preoperative staging of bladder neoplasms.
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Affiliation(s)
- S Venz
- Strahlenklinik und Poliklinik, Universitätsklinikum Rudolf Virchow, FU Berlin
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