Search results for "brain death"
showing 10 items of 20 documents
Long-term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the E…
2021
Knowledge of living donor liver transplantation (LDLT) for autoimmune liver diseases (AILDs) is scarce. This study analyzed survival in LDLT recipients registered in the European Liver Transplant Registry with autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis (PSC) and the non-autoimmune disorder alcohol-related cirrhosis. In total, 29 902 individuals enrolled between 1998 and 2017 were analyzed, including 1003 with LDLT. Survival from >90 days after LDLT for AILDs in adults was 85.5%, 74.2%, and 58.0% after 5, 10, and 15 years. Adjusted for recipient age, sex, and liver transplantation era, adult PSC patients receiving LDLT showed increased mortality compare…
Continuous Normothermic Ex Vivo Kidney Perfusion Is Superior to Brief Normothermic Perfusion Following Static Cold Storage in Donation After Circulat…
2016
Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) versus short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS versus prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 min of warm ischemia, kidneys were removed from 30-kg Yorkshire pigs and preserved for 16 h with (A) 16 h SCS, (B) 15 h SCS + 1 h NEVKP, (C) 8 h SCS + 8 h NEVKP, and (D) 16 h NEVKP. After contralateral kidney resection, grafts were autotransplanted and pigs followed up for 8 days. Perfusate injury markers such a…
Scalp, earlobe and nasopharyngeal recordings of the median nerve somatosensory evoked P14 potential in coma and brain death
1996
Median nerve somatosensory evoked potentials (SEPs) were recorded in a total of 181 patients in coma and brain death. Special attention was paid to derivation of P14 (the positive potential occurring approximately 14 ms after median nerve stimulation) with different electrode montages, using midfrontal scalp (Fz), linked earlobe (A1/2), median nasopharyngeal (Pgz) and non-cephalic reference (NC) electrodes. The P14 amplitude (and, to a lesser extent, latency) were invariably lower in brain death than in coma. The potential was preserved in coma in all patients, but lost in brain death in 9.8% in Fz-NC and Pgz-NC recordings, in 23.2% in Fz-A1/2, and in 100% in Fz-Pgz. Thus, Fz-Pgz was the de…
Tc-99m HMPAO Cerebral Scintigraphy A Reliable, Noninvaslve Method for Determination of Brain Death
1993
To determine the usefulness of cerebral blood flow imaging for the diagnosis of brain death, 4 female and 12 male patients, aged 19 to 69 years and suffering from various intracranial lesions, were studied. In addition to neurologic examination, electroencephalographic recording, and cerebral angiography, tomographic brain scintigraphy was performed using a SPECT system with a LEAP collimator after the intravenous administration of 555 MBq Tc-99m HMPAO. The radioisotopic scanning procedure revealed no intracranial perfusion in 14 of the 16 patients. Only minimal cerebellar blood flow was seen in one patient. In another, residual right-sided supratentorial flow was initially present but abse…
Progressive Development of Renal Vascular Dysfunction in Brain Death Implicates Reversible Alterations of Nitric Oxide Metabolism
2011
Vascular endothelial dysfunction occurs in the kidney graft from marginal brain death (BD) donors and may be responsible for a low success rate after transplantation.BD was induced in 16 dogs for 6 hours. Immediately after the inflation of the intracranial balloon, the treated group (n = 8) received 40 mg/kg bolus followed by 3 mg/kg/min infusion of L-arginine for 30 minutes. Renal vascular function and hemodynamic and biochemical parameters were determined.BD caused vasoconstriction, increase in renal venous nitrite (4.9 ± 0.8 versus 2.6 ± 0.1, P.05) and myeloperoxidase levels (1.43 ± 0.04 versus 2.43 ± 0.23, P.001), and reduced vasodilatation of renal artery to acetylcholine. Larginine di…
Contrast-enhanced transcranial Doppler ultrasonography in the diagnosis of brain death
2013
The diagnosis of brain death (BD) is based on clinical criteria including deep coma, brain stem areflexia and apnoea. Depending on different local guidelines, confirmatory technical tests are sometimes mandatory.1 Since the 1990s, transcranial Doppler sonography (TCD) has found its place in these circumstances and fulfils most of the criteria of an ‘ideal test’ in confirming BD. To confirm intracranial circulatory arrest (CA) with Doppler sonography, typical flow patterns must be recorded in bilateral intracranial and extracranial brain-supplying arteries.2 A completely absent intracranial flow signal is not a reliable sign to determine CA because this can be due to transmission problems. I…
Cerebral potentials elicited by mechanical stimuli to the human leg: influence of artifacts
1992
Mechanical stimulation with a reflex hammer was applied to the quadriceps muscle tendon of healthy volunteers and patients. The time-locked electrical signals were recorded from the scalp. In all cases, reproducible potentials could be recorded, with latencies in a range of 20 ms to 100 ms. The potentials recorded in patients under complete spinal anesthesia were similar to those derived before the anesthesia. In brain dead patients who showed absence of median nerve or posterior tibial nerve SEP, reproducible potentials after mechanical stimuli could be recorded as well. The results suggest that the hammer taps lead to mechanical shock waves which are propagated along the body producing ti…
Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the…
2021
In recent years commensal microorganisms are not just “passive occupants”, but important element of homeostasis. There are numerous reports documenting the composition and role of the gut, skin or vagina microbiome but the role of commensal organisms living in the lungs is relatively unknown. Pulmonary microbiome impact on the immune response of the host organism and may indicate new therapeutic directions. Lung microbiome, by modulating the expression of innate immunity genes, causes an increase in the concentration of IL-5, IL-10, IFNγ and CCL11, affects the TLR4 dependent response of pulmonary macrophages and modulate the production of antibacterial peptides contained in the mucus. It is…
Somatosensory evoked potentials aiding the diagnosis of brain death.
1988
SEP were recorded in 14 patients, who fulfilled the clinical and electroencephalographic criteria of brain death. The results are compared with the respective ones in healthy subjects. Beside the absence of cortical N 20 in each brain dead patient, reduction of amplitude or absence of near field negativity (N 13b) from upper neck regardless of the position of the reference electrode represents the predominant result. The near field potential from the lower neck (N 13a) was unaffected. The counterpart in the far field potential recorded from F z was amplitude reduction of P 13. These results suggest that the dissociation of N 13a and N 13b can confirm the diagnosis of brain death. Moreover t…
Detection of intracranial circulatory arrest in brain death using cranial CT-angiography.
2011
Background and purpose Computed tomographic-angiography (CT-A) is becoming more accepted in detecting intracranial circulatory arrest in brain death (BD). An international consensus about the use and the parameters of this technique is currently not established. We examined intracranial contrast enhancement in CT-A after clinically confirmed BD, compared the results with electroencephalography (EEG) and Transcranial Doppler Ultrasonography (TCD) findings and developed a commonly applicable CT-A protocol. Methods Prospective, monocentric study between April 2008 and October 2011. EEG, TCD and CT-A were performed in 63 patients aged between 18 and 88 years (mean, 55 years) who fulfilled clini…