Plasma disappearance rate of indocyanine green (PDRICG) has been proposed for assessment of liver function in liver transplants donors and recipients, in patients with chronic liver failure, and as a prognostic factor in critically ill patients. The assessment of PDRICG using a newly developed noninvasive digital pulse densitometry method was simultaneously compared to invasive aortic fiber-optic method in patients undergoing orthotopic liver transplantation (OLT). Fourteen consecutive liver transplant candidates (11 male, 3 female) were prospectively enrolled into the study. A 4F aortic catheter with an integrated fiber-optic device and a thermistor was inserted via a femoral artery sheath for invasive aortic (INV) PDRICG assessment in all patients. The fiber-optic device was connected to a computer system (COLD-Z021, PULSION Medical Systems, Munich, Germany). A finger-piece sensor was used for non-invasive (NINV) pulsedensitometric PDRICG assessment. For the PDRICG assessment .5 mg/kg of ICG in cooled saline (10-15 mL) was injected through a central venous catheter. The assessments of PDRICG were performed after induction of anesthesia, after clamping of the hepatic artery, after clamping of the inferior vena cava, after reperfusion of the graft, and on the first postoperative day. During the PDRICG measurements, the investigators were blinded for the results of the noninvasive monitoring. Seventy-one pairs of measurements were performed successfully. PDRICG ranged from 0%/min to 43.8 %/min (11.6%/ min ؎ 9.6 %/min, mean ؎ SD) for invasive and from I ndocyanine green (ICG) is a water-soluble anioniccompound that is injected intravenously and binds mainly albumin and ␤-lipoproteins in the plasma. ICG is then selectively taken up by hepatocytes, independent of adenosine triphosphate (ATP), and is later excreted unchanged into the bile via an ATP-dependent transport system. It is not metabolized and does not undergo enterohepatic recirculation. 1 Due to these features, ICG has been proposed for assessment of liver function in liver tranplants donors and recipients, in patients with chronic liver failure, and as a prognostic factor in critically ill patients. 2 -5 Plasma disappearance rate of ICG (PDRICG), plasma clearance rate, and retention rate are some of the parameters calculated from the decay of the dilution curve after intravenous ICG injection. PDRICG is the most commonly used ICG-derived parameter for clinical and experimental assessment of liver function with normal range of 18 -25 %/min.There are different techniques assessing the PDRICG in vivo. The gold standard relies on serial blood sampling after ICG injection at certain time intervals and consecutive spectrophotometric concentration analysis. 3,4 However, this method proves to be both expensive and time consuming. Another method implements the use of a fiber-optic aortic catheter inserted via the femoral artery sheath. 6,7 This method was found to correlate well with the serial blood-samAbbreviations: ICG, indocyanine green; ATP, adenosine tripho...

Background: One‐week proton pump inhibitor‐based triple therapies are very popular in the US despite limited US data documenting efficacy. We assessed 1‐week proton pump inhibitor triple therapies for Helicobacter pylori, and compared them to dual antibiotic therapies (to assess benefit of omeprazole) and to omeprazole–amoxycillin (to assess benefit of clarithro‐ mycin) in a large, randomized, US multicentre study. Methods: Healthy subjects who were H. pylori‐positive by rapid serological test and 13C‐urea breath test were randomly assigned to (i) omeprazole (O) 20 mg b.d. + amoxycillin (A) 1 g t.d.s. for 14 days (OA); (ii) A 1 g b.d. + clarithromycin (C) 500 mg b.d. for 7 days (AC); (iii) C 250 mg b.d. + metronidazole (M) 500 mg b.d. for 7 days (CM); (iv) O 20 mg b.d. + C 250 mg b.d. + M 500 mg b.d. for 7 days (MOC); or (v) O 20 mg b.d. + C 500 mg b.d. + A 1 g b.d. for 7 days (OAC). Repeat breath tests were done at 6 weeks to assess H. pylori status. Results: Three hundred and two H. pylori‐positive subjects at 25 centres received medication. Intention‐to‐treat cure rate was significantly higher for OAC (82%) than for MOC (67%), CM (59%), AC (18%) or OA (58%). Per‐protocol cure rates were 85% for OAC and 75% for MOC. Discontinuation of therapy due to a side‐effect occurred in 0–3% of each study group. Conclusions: One‐week twice‐daily triple therapy with omeprazole, amoxycillin and clarithromycin provides the best rate of eradication of the five regimens studied. However, treatment in the US for 7 days may be unable to achieve eradication rates of ≥ 90% with proton pump inhibitor‐based triple therapy.

ECAD appeared to be a successful treatment perspective in supporting liver regeneration or in sufficient bridging to OLT and also in treatment of graft dysfunction after OLT in patients with A. phalloides poisoning.

No abstract

Acute liver failure (ALF) is a rare clinical syndrome associated with a mortality of up to 80% and its management remains an interdisciplinary challenge. Despite recent improvements in intensive care management, the mortality of patients with ALF remains high and is related to complications such as cerebral edema, sepsis and multiple organ failure. Emergency orthotopic liver transplantation (OLT) is currently the only effective treatment for those patients who are unlikely to recover spontaneously. Nevertheless, OLT is not always possible because of the shortage of the organs and/or complications related to ALF. Newly introduced liver-assist devices can temporarily support the patient's liver until native liver recovers or can serve as a bridging device until a liver graft is available. The support devices use both cell-based and non-cell-based techniques. One of the latest non-cell-based extracorporeal hepatic support devices, the molecular adsorbent recycling system (MARS), is based on the concept of albumin dialysis. MARS utilises selective hemodiafiltration with countercurrent albumin dialysis aiming to selectively remove both water-soluble and albumin-bound toxins of the low and middle molecular-weight range. We report on a young patient who presented with clinical symptoms of ischemic hepatitis and multi-organ failure (APACHE II score 38-->predicted postoperative mortality 87%) due to prolonged hemorrhagic shock. OLT was contraindicated because of history of pancreas cancer with metastases. It was necessary to use aggressive conservative therapy and an extracorporeal liver-assist device until liver regeneration began and hemodynamic conditions were stable. The patient underwent five treatments with MARS. During the treatment, there were improvements of hemodynamics, respiratory function, acid-base disturbances and laboratory parameters. The plasma disappearance rate of indocyanine green, a parameter of dynamic liver function, improved during MARS treatment. Although repeated neurological examination predicted diffuse brain damage (brain oedema, decreased cerebral blood flow), the patient recovered without any neurological deficits. The patient survived and was discharged from the hospital in good condition. In this case MARS treatment was successful in supporting the patient through the most critical period of ALF.