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Biomedical subjects

C Chmielewski

Publications and source records attributed to C Chmielewski.

7 recordsLinked to original sources
PubMed1992

A recent decrease in the time to development of monomorphous and polymorphous posttransplant lymphoproliferative disorder.

We have noted a decrease in the time to development of posttransplant lymphoproliferative disorder (PTLD) over the last two and one-half years in our multiorgan transplant program. From February 1965 until December 1990, 1622 transplants were performed including 1489 kidneys (KTxp), 87 livers (LTxp), and 46 pancreata. Between February 1965 and July 1988 (group 1), there were 1260 transplants performed and nine cases of either monomorphous PTLD (M-PTLD, n = 8) or polymorphous PTLD (P-PTLD, n = 1) were diagnosed. The mean time to development of PTLD was 163 +/- 128 weeks, all after KTxp. Five of these nine patients received haploidentical living-related grafts. All patients had presented with advanced disease, none had transplant nephrectomy, and all died of their disease. Between July 1988 and December 1990 (group 2), 362 transplants were performed, and four cases of M-PTLD and three cases of P-PTLD were recognized. Of the seven cases of PTLD in group 2, six developed within 90 days posttransplant (early PTLD). The mean time to development of PTLD was 11 +/- 16 weeks. This was significantly earlier than group 1 (P less than .01). Four of the five cases after KTxp had a 1 or 2 DR-matched donor. Five of these seven patients had serological evidence of recent Epstein-Barr Virus infection, and four of these five had received OKT3 and then developed early PTLD. In group 2, three patients are alive 7-15 months after KTxp nephrectomy, the remaining four have died. We hypothesize that risk factors for the development of PTLD may include heavy immunosuppression, including the use of OKT3, good DR matching, and active EBV infection. Treatment should include graft removal, if applicable, and reduction or cessation of immuno-suppression.

Herpesvirus 4, Human↗
PubMed1992

Renal physiology series: Part 1 of 8. Renal anatomy and overview of nephron function.

The kidneys are highly vascularized organs that are responsible for maintaining the body's internal environment. The nephron is the basic structural and functional unit of the kidney involved in the complex interplay between tubular and vascular components resulting in the excretion of fluid and solutes. The regulation of body fluid and solutes is governed by the processes of filtration, reabsorption, and secretion. Unwanted fluid and substances are excreted from the body as urine.

Education, Nursing, Continuing↗
PubMed1991

Psychiatric morbidity following implantation of the automatic implantable cardioverter defibrillator.

The automatic implantable cardioverter defibrillator (AICD) has found a place in the treatment of sustained ventricular tachycardia and in survivors of sudden arrhythmic death. However, little is known about the psychological impact of this device on patients and their families. In a group of 20 AICD recipients, examined between 3 and 21 months post-implantation, the prevalence of psychiatric disorder was 50%. Following implantation, six patients suffered from adjustment disorder; three suffered from major depression; and one developed panic disorder. Psychiatric morbidity in patients was associated with psychopathology in family members, peri-operative AICD shocks, and social support that was perceived to be inadequate.

Adaptation, Psychological↗
PubMed1991

Case study: end stage liver failure patient managed with CAVH pretransplant.

The patient met 4 of the 5 expected outcomes. Effective therapy with CAVH was maintained in the ICU setting and in the operating room. The catheters functioned throughout the entire treatment without signs or symptoms of infection, bleeding, or thrombosis. She received hyperalimentation, filtration replacement fluid, and adequate fluid boluses to maintain volume status, nutritional requirements and vital signs. Cardiac vasopressor medications were required for a short period. The one problem that did occur was related to the anticoagulation therapy. The PTT was checked every 4 hours and the heparin drip was titrated to keep the PTT at 50 to 60 seconds. At one point, the PTT was 92 seconds but immediate measures were undertaken to reverse the condition. In the situation where a patient has an underlying coagulopathy and a potential source of bleeding, the nursing recommendation is that hourly bedside ACTs with every 4 hour PTTs should be performed as a routine part of the care. CRRT has been used successfully in critically ill unstable patients with multiorgan involvement. These therapies provide an avenue for collaboration between nursing professionals in nephrology and critical care. The focus of CRRT can now progress from the technical aspects of the procedures to patient centered nursing issues.

Adult↗
PubMed1990

Liquid crystal domains and thixotropy of filamentous actin suspensions.

The thixotropic properties of filamentous actin suspensions were examined by a step-function shearing protocol. Samples of purified filamentous actin were sheared at 0.2 sec-1 in a cone and plate rheometer. We noted a sharp stress overshoot upon the initiation of shear, indicative of a gel state, and a nearly instantaneous drop to zero stress upon cessation of shear. Stress-overshoot recovery was almost complete after 5 min of "rest" before samples were again sheared at 0.2 sec-1. Overshoot recovery increased linearly with the square root of rest time, suggesting that gel-state recovery is diffusion limited. Actin suspensions subjected to oscillatory shearing at frequencies from 0.003 to 30 radians/sec confirmed the existence of a 5-min time scale in the gel, similar to that for stress-overshoot recovery. Flow of filamentous actin was visualized by polarized light observations. Actin from 6 mg/ml to 20 mg/ml showed the "polycrystalline" texture of birefringence typical for liquid crystal structure. At shear rates less than 1 sec-1, flow occurred by the relative movement of irregular, roughly ellipsoidal actin domains 40-140 microns long; the appearance was similar to moving ice floes. At shear rates greater than 1 sec-1, domains decreased in size, possibly by frictional interactions among domains. Eventually domains flow in a "river" of actin aligned by the flow. Our observations confirm our previous domain-friction model for actin rheology. The similarities between the unusual flow properties of actin and cytoplasm argue that cytoplasm also may flow as domains.

Actins↗
PubMed1990

Continuous arteriovenous hemofiltration in the patient with hepatorenal syndrome. A case study.

CAVH has gained increasing medical acceptance, as favorable outcomes in the critically ill have proven its worth. Unfortunately, CAVH is often used as a "last ditch" effort for the patient with multisystem organ failure and septicemia. Performing the procedure in such a setting sometimes seems little more than an exercise in futility. However, as more patients such as the patient described in this case study are shown to benefit from CAVH, the nursing role needs to be examined both in performing the procedure and in caring for the critically ill patients. The nursing literature has kept abreast of the procedural aspects of CAVH. Now, critical care nurses must move on to the patient-oriented approach, share case studies, and work together to formulate nursing diagnoses, develop specialized care plans, and identify areas for nursing research.

Adult↗