Acute paranoid psychosis as sole clinical presentation of hepatic artery thrombosis after living donor liver transplantation

<p>Abstract</p> <p>Background</p> <p>Hepatic artery thrombosis is a devastating complication after orthotopic liver transplantation often requiring revascularization or re-transplantation. It is associated with considerably increased morbidity and mortality. Acute cognitive dysfunction such as delirium or acute psychosis may occur after major surgery and may be associated with the advent of surgical complications.</p> <p>Case presentation</p> <p>Here we describe a case of hepatic artery thrombosis after living-donor liver transplantation which was not preceded by signs of liver failure but rather by an episode of acute psychosis. After re-transplantation the patient recovered without sequelae.</p> <p>Conclusion</p> <p>This case highlights the need to remain cautious when psychiatric disorders occur in patients after liver transplantation. The diagnostic procedures should not be restricted to medical or neurological causes of psychosis alone but should also focus vascular complications related to orthotopic liver transplantation.</p

Recurrence of primary sclerosing cholangitis after liver transplantation – analysing the European Liver Transplant Registry and beyond

Liver transplantation for primary sclerosing cholangitis (PSC) can be complicated by recurrence of PSC (rPSC). This may compromise graft survival but the effect on patient survival is less clear. We investigated the effect of post-transplant rPSC on graft and patient survival in a large European cohort. Registry data from the European Liver Transplant Registry regarding all first transplants for PSC between 1980 and 2015 were supplemented with detailed data on rPSC from 48 out of 138 contributing transplant centres, involving 1,549 patients. Bayesian proportional hazards models were used to investigate the impact of rPSC and other covariates on patient and graft survival. Recurrence of PSC was diagnosed in 259 patients (16.7%) after a median follow-up of 5.0 years (quantile 2.5%-97.5%: 0.4–18.5), with a significant negative impact on both graft (HR 6.7; 95% CI 4.9–9.1) and patient survival (HR 2.3; 95% CI 1.5–3.3). Patients with rPSC underwent significantly more re-transplants than those without rPSC (OR 3.6, 95% CI 2.7–4.8). PSC recurrence has a negative impact on both graft and patient survival, independent of transplant-related covariates. Recurrence of PSC leads to higher number of re-transplantations and a 33% decrease in 10-year graft survival

Altered regulation of Prox1-gene-expression in liver tumors

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival

PURPOSE: Surgery is the standard of care for resectable colorectal liver metastases (CRC-LM). Unfortunately, 60 % of patients develop secondary metastatic recurrence (SMR) after R0-resection of CRC-LM. We investigated the impact of surgical re-intervention and chemotherapy (Ctx) on survival in a consecutive series of patients with SMR. METHODS: From 01/2001 to 11/2011, 104 out of 178 consecutive patients with R0-resection of CRC-LM developed SMR and were evaluated. The impact of surgical and Ctx re-interventions on recurrence free (RFS) and cancer-specific survival (CSS) was analyzed. Median follow-up was 28.0 (95 %CI: 19.4–37.4) months. RESULTS: SMR occurred in 81 patients at a single site (49× liver, 18× lung, 14× other) and in 23 patients at multiple sites. Forty-two patients were scheduled for primary surgery. Fifty-three patients were classified as non-resectable and treated with median 5.0 [IQR, 3.0–10.0] cycles of Ctx, combined with an EGFR/VEGF-antibody in 27 patients. Nine patients received best supportive care only. R0/R1 resection could be achieved in 35 patients primarily and even in 8 patients secondarily after Ctx. Surgical morbidity and mortality were 16 and 0 %, respectively. The 5-year RFS rates for patients with R0 versus R1-resection were 22 and 24 % (p = 0.948). The 5-year CSS rate for R0/R1-resected patients was 38 % versus 10 % for those patients treated by Ctx alone (p < 0.001). CONCLUSION: In SMR, surgical re-intervention is feasible and safe in a remarkable number of patients and offers significantly longer CSS compared to patients without resection

Untersuchungen optoelektronischer Messverfahren zur automatischen Mangelerkennung bei der Eiersortierung

Mit einem eindimensionalen optoelektronischen Halbleitersensor wurde waehrend einer Rotation der Eier die Oberflaeche abgetastet. Zur Bildaufnahme wurde ein Bildanalysesystem und ein Binaerbilderkennungssystem benutzt, das Grauwertbilder des Formats 128x128x4 bit und 256x1x8 bit erstellte. Das Durchlichtverfahren mit Hellfeldbeleuchtung eignete sich zur Erkennung von Schalenschaeden, Schmutzbelaegen, Bluteinschluessen sowie Fauleiern bestens. Die Klassifikation der Eier erfolgte ueber einen Entscheidungsbaumklassifikator, der aus 3 Ebenen bestand. Die Erkennungssicherheit der Maengel lag zwischen 94.4% und 95%Available from: Ingenieurhochschule, D-13059 Berlin-Wartenberg (Germany). Bibliothek / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Apheresis in Adult Living-donor Liver Transplantation with ABO-incompatible Grafts

Adult living donor liver transplantation (ALDLT) across the ABO blood group barrier is now an accepted therapeutic option when no deceased or living blood group compatible donor is available for transplant within the desired or necessary time frame. Several different multimodal strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host and no gold standard has emerged yet. But the basis of most treatment regimens is apheresis or immunoadsorption. Here we will introduce common concepts of treatment regimens for ABO-incompatible ALDLT, exemplify the application of these concepts in a case series, and finally discuss the implications in the light of new therapeutic options