Dieter Broering - Academia.edu (original) (raw)

Papers by Dieter Broering

Curr Prob Surg, 2008

An extensive knowledge of hepatic anatomy is required for the transplant surgeon. For explantatio... more An extensive knowledge of hepatic anatomy is required for the transplant surgeon. For explantation and implantation of the whole liver graft, the interest is focused on the hilar structures placed in the gastroduodenal ligament, with the proper hepatic artery located ventromedially, the common bile duct running ventrolaterally, and the main portal vein dorsally, and also the extrahepatic course of the hepatic veins. Despite few variations, venous drainage into the inferior vena cava (IVC) consists of the right hepatic vein and the common trunk arising from the confluence of the left and middle hepatic vein.

Chirurgische Gastroenterologie, 2003

This chapter elaborates the different aspects of cytokines and monoclonal antibodies. Colony-stim... more This chapter elaborates the different aspects of cytokines and monoclonal antibodies. Colony-stimulating factors improve granulocyte count in neutropenic patients, reduce the incidence and duration of neutropenia in patients receiving cytotoxic chemotherapy, and mobilize peripheral blood stem cells before leukapheresis in both autologous and allogeneic hemopoietic cell transplantation. The use of colony-stimulating factors allows a modest to moderate increase in chemotherapy dosage regimens. The prophylactic use of colony-stimulating factors for patients with diffuse aggressive lymphoma aged 65 years and older treated with curative chemotherapy reduces the incidence of febrile neutropenia and infections. In a preliminary randomized, blind, controlled comparison with usual care in 10 patients with acute cerebral infarction who presented within 7 days of onset, subcutaneous G-CSF 15 mg/kg/day for 5 days produced greater improvement in neurological function; there were no severe adverse effects. Interferon alfa and ribavirin combination therapy for chronic infection with hepatitis C virus produces a number of well-described adverse effects. Combination therapy with pegylated interferon yields an adverse event profile similar to that observed with standard interferon, although the frequency of certain adverse events varies according to the formulation.

Journal of Hepatology, Nov 1, 2002

The environmental triggers which control liver regeneration following partial hepatectomy (PH) ar... more The environmental triggers which control liver regeneration following partial hepatectomy (PH) are not clear. With respect to haemodynamic changes, the model of rat portal branch ligation (PBL) provides the unique opportunity to discriminate transcriptional events, which selectively result from increased portal flow. The potential role of portal over-flow on early expression of early growth response gene-1 (Egr-1), type-1 plasminogen activator inhibitor (PAI-1) and phosphatase of regenerating liver-1 (PRL-1) was analysed by a comparative experimental study using PBL and PH. Operative procedures were carried out in male Wistar rats. Growth kinetics were measured by liver weight indices. S-phase-specific mRNA-levels of H2B-histone protein (H2B), as well as expression analysis of Egr-1, PAI-1 and PRL-1 were examined by Northern blot experiments. Growth patterns did not differ significantly between PBL and PH, whereas peak H2B expression occurred earlier after PH. Egr-1 and PAI-1 were specifically induced during the first few hours in the hyper-perfused lobes following PBL and PH. PRL-1-expression selectively peaked 3h after PH and PBL in the hyper-perfused lobes. Increased portal flow after PBL and PH was associated with induction of Egr-1, PAI-1 and PRL-1. Thus, haemodynamic changes affect the molecular immediate-early response during liver regeneration.

The American Journal of Gastroenterology, Feb 1, 1998

Surgical treatment for duodenal stenosis caused by Crohn's disease is only indicated in s... more Surgical treatment for duodenal stenosis caused by Crohn's disease is only indicated in symptomatic duodenal obstruction when conservative treatment has failed. Previously described operative procedures include strictureplasty for short stenoses and bypass or resectional procedures, if duodenal stenosis is extensive. In this case of an extensive duodenal Crohn's stenosis, we performed a strictureplasty of the duodenum with a pedunculated jejunal patch. Thus, duodenal passage could be well preserved, and the patient has remained asyptomatic during a follow-up of more than 9 months.

Deutsche Gesellschaft für Chirurgie, 2001

Deutsche Gesellschaft für Chirurgie, 2000

This chapter presents the observational studies, infection risk, psychiatric and hematologic effe... more This chapter presents the observational studies, infection risk, psychiatric and hematologic effects of cytokines and monoclonal antibodies that act on the immune system. Colony-stimulating factors such as granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor, interferons, interleukins are described. G-CSF is associated with a significantly higher hazard of myelodysplastic syndrome or acute myeloid leukemia. The use of interleukin-1 receptor antagonist is related to the risk of serious infections and systemic inflammatory response syndrome. In a meta-analysis, it was suggested that the risk needs to be taken seriously only during high-dose therapy in patients with significant co-morbidities. Psychiatric adverse effects of pegylated interferon are reported. Tumor necrosis factor alfa antagonists effects in cardiovascular system, sensory system, gastrointestinal system, and skin are discussed. Monoclonal antibodies discussed include alemtuzumab, daclizumab, efalizumab, natalizumab, and omalizumab.

Liver Transplantation and Surgery Official Publication of the American Association For the Study of Liver Diseases and the International Liver Transplantation Society, May 1, 1998

I n living donor or in situ split-liver procurement, a left lateral hepatectomy (segments II and ... more I n living donor or in situ split-liver procurement, a left lateral hepatectomy (segments II and III, according to the method of Couinaud 1 ) is performed without use of the vascular exclusion technique on either side of the liver. 1,2 One of the technical difficulties of this operation consists in following the right plane of transection. This is important because the angle between the left and middle hepatic vein can be narrow. Deviation from the ideal transection plane to either side can cause damage to the respective hepatic vein, which would require suturing and increase the risk of stenosis.

This chapter discusses the adverse effects of immunosuppressive and immunostimulatory drugs. Hype... more This chapter discusses the adverse effects of immunosuppressive and immunostimulatory drugs. Hypertension is a well-known adverse effect of calcineurin inhibitor therapy. In a patient undergoing hemodialysis, cardiothoracic bioimpedance showed evidence of raised systemic vascular resistance with normal blood volume. Treatment with calcineurin inhibitors is often associated with chronic renal insufficiency and conversion to mycophenolate may improve renal function. There have been several reports of bronchiolitis obliterans organizing pneumonia in patients taking everolimus. In a short-term study in eight kidney transplant recipients who were switched from a calcineurin inhibitor to everolimus, renal biopsies were performed in six and showed chronic allograft nephropathy grades 1A–2. Renal tubular acidosis has been associated with leflunomide. Leflunomide-induced subacute cutaneous lupus erythematosus with erythema multiforme-like lesions, leflunomideinduced skin necrosis and progressive generalized blistering and a widespread prunosus skin rash have been described.

Hepatology International, 2015

Organ shortage has been the ongoing obstacle to expanding liver transplantation worldwide. Living... more Organ shortage has been the ongoing obstacle to expanding liver transplantation worldwide. Living donor liver transplantation (LDLT) is hoped to improve this shortage. The aim of the present study is to analyze the impact of metabolic syndrome and prevalent liver disease on living donations. From July 2007 to May 2012, 1065 potential living donors were evaluated according to a stepwise evaluation protocol. The age of the worked-up donors ranged from 18 to 45 years. Only 190 (18 %) were accepted for donation, and 875 (82 %) were rejected. In total, 265 (24.9 %) potential donors were excluded because of either diabetes or a body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;28. Some potential donors were excluded at initial screening because of incompatible blood groups (115; 10.8 %), social reasons (40; 3.8 %), or elevated liver enzymes (9; 1 %). Eighty-five (8 %) donors were excluded because of positive hepatitis serology. Steatosis resulted in the exclusion of 84 (8 %) donors. In addition, 80 (7.5 %) potential donors were rejected because of variations in biliary anatomy, and 20 (2 %) were rejected because of aberrant vascular anatomy. Rejection due to biliary-related aberrancy decreased significantly in the second half of our program (11 vs. 4 %, p = 0.001). In total, 110 (10.3 %) potential donors were rejected because of insufficient remnant volume (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 %) as determined by CT volumetry, whereas 24 (2.2 %) were rejected because of a graft-to-recipient body weight ratio less than 0.8 %. Metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.

World journal of gastroenterology : WJG, Jan 14, 2015

To evaluate the indication and outcome of hepatitis B virus (HBV)-related liver transplantation (... more To evaluate the indication and outcome of hepatitis B virus (HBV)-related liver transplantation (LT) in the era of newer antiviral agents. We collected data on all patients who underwent transplantation at King Faisal Specialist Hospital and Research Center. These data included demographic, perioperative and long-term postoperative follow-up data including viral serological markers, HBV DNA, and repeated liver imaging. Between January 1990 and January 2012, 133 patients (106 males and 27 females) underwent LT for HBV-related cirrhosis at our center. All patients were followed up frequently during the first year following transplantation, according to our standard protocol; follow-up visits occurred every 3-6 mo thereafter. Breakthrough infection was defined as re-emergence of HBV-DNA or hepatitis B surface antigen (HBsAg) while on treatment. Five patients transplanted prior to 1992 did not receive immediate posttransplant anti-HBV prophylaxis; all other patients were treated with HB...

Transplantation, 2004

Despite major surgical and medical advances, it is still a challenge to perform transplantation i... more Despite major surgical and medical advances, it is still a challenge to perform transplantation in small infants. This study, focusing on short- and long-term outcomes, summarizes our 10-year experience with liver transplantation (LTx) in infants aged less than 6 months. We analyzed 43 patients aged 6 months or less (range: 12-184 days, median: 136 days) whose median weight at the time of LTx was 5.8 kg (range: 2.8-8.0 kg). The reasons for LTx were biliary atresia (n=27; 62.8%), neonatal hepatitis (n=6; 14%), neonatal cholestasis (n=4; 9.3%), and miscellaneous (n=6; 14%). The patients were followed up for a median time of 3 years and evaluated with respect to graft function, physical, and neurodevelopmental outcome. The patient survival was 90.7% after 1 year and 87.2% after 2 years. The graft survival was 86% after 1 year and 82.1% after 2 years. Twelve patients (27.9%) experienced 15 surgical complications requiring intervention, two of whom demonstrated vascular thrombosis (4.7%). Acute early rejection occurred in 15 patients (34.9%), and chronic rejection occurred in 3 patients (7%); 83.3% of the patients had normal liver function test results at the time of evaluation. Complications such as posttransplant lymphoproliferative disease (4.7%) and persistent arterial hypertension (4.7%) were rarely seen. The physical and neurodevelopmental outcomes were good. LTx in infants aged less than 6 months provides excellent short- and long-term results. Low weight or young age of infants awaiting LTx should not be exclusion criteria for LTx.

Transplantation, 2001

The T helper cell type 1 (Th1) cytokines interleukin (IL)-2 and interferon (IFN)-gamma are mediat... more The T helper cell type 1 (Th1) cytokines interleukin (IL)-2 and interferon (IFN)-gamma are mediators of acute graft rejection after liver transplantation and Th2 cytokines, such as IL-4 and IL-10, may have a protective role and correlate with graft acceptance. To test the hypothesis that infants aged <1 year have an immunological advantage with regard to graft acceptance because of a partially immature immune system with a physiological balance toward a Th2 cytokine profile, we conducted the present study. We compared the T helper serum cytokine profiles in 105 infants and children after liver transplantation with or without acute graft rejection and analyzed the normal age-distributed concentrations of T helper cytokines in 51 healthy controls. The incidence of acute graft rejection was as follows: 0 to 12 months, 26.8%; 1 to 3 years, 40.0%; and >3 years, 71.8%. There was a significantly lower incidence of acute rejection in infants 0 to 12 months of age compared with children >1 year (11/41 vs. 38/64; P=0.001). In healthy infants, significant increasing Th1 cytokine concentrations and decreasing Th2 cytokine concentrations were found with increasing age. Patients with acute rejection had significantly higher values of Th1 cytokines compared with nonrejecting subjects, who had significantly higher concentrations of Th2 cytokines. A longitudinal analysis of serum cytokines from patients showed that changes of the cytokine patterns in the follow-up did not differ significantly from preoperative values, except in the 4 weeks posttransplant. We conclude from the data that the physiological balance toward a Th2 cytokine profile of infants in the first months of life predisposes to improved graft acceptance. Transplantation of children with biliary atresia as early as possible, avoiding Th1 stimulation by recurrent infections and vaccinations, may have a positive impact on overall tolerance.

Surgery of the Esophagus, 2009

Due to the grave risk of insufficiency of the esophageal anastomosis and considering the severe o... more Due to the grave risk of insufficiency of the esophageal anastomosis and considering the severe operative trauma that is involved, surgery of the esophagus is one of the most dreaded operations in visceral surgery even today.

The American journal of gastroenterology, 1998

Surgical treatment for duodenal stenosis caused by Crohn's disease is only indicated in sympt... more Surgical treatment for duodenal stenosis caused by Crohn's disease is only indicated in symptomatic duodenal obstruction when conservative treatment has failed. Previously described operative procedures include strictureplasty for short stenoses and bypass or resectional procedures, if duodenal stenosis is extensive. In this case of an extensive duodenal Crohn's stenosis, we performed a strictureplasty of the duodenum with a pedunculated jejunal patch. Thus, duodenal passage could be well preserved, and the patient has remained asyptomatic during a follow-up of more than 9 months.

Hepato-gastroenterology

Inadequate knowledge of the right (RHV) and accessory (IHV) hepatic 'venous drainage' ter... more Inadequate knowledge of the right (RHV) and accessory (IHV) hepatic 'venous drainage' territories can lead to severe postoperative venous congestion after right graft live donor liver transplantation. The purpose of our study was to define the anatomical-functional RHV and IHV drainage territories. One hundred and forty consecutive live liver donor candidates were evaluated by means of 3-D CT reconstructions and 3-D virtual hepatectomies. Three RHV/IHV drainage patterns were identified and 'risky' configurations for right graft resections were defined. Livers with 'small' IHV drainage volumes (90.1±63.2mL) had dominant type IRHV/ IHV or non-dominant type III-RHV/IHV total liver (TL) complexes. All other cases had 'large' IHV volumes (294.7±115.5mL, p<0.001) with dominant type II-RHV/IHV TL complexes. Loss of IHV drainage volume (such as with no IHV reconstruction) in these cases was associated with a 'dominance transition' from right (RHV) ...