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Biomedical subjects

D Candinas

Publications and source records attributed to D Candinas.

At least 73 records · Page 4Linked to original sources
PubMed1995

Biliary complications after paediatric liver transplantation: Birmingham's experience.

Between 1983 and 1992, 112 children underwent liver transplantation. Of 138 grafts, 60 (43.4%) were whole livers, 77 (55.6%) were reduced livers, and 1 (0.7%) was a split liver. Biliary complications (BC) were defined as any abnormality, even minor, related to the biliary tract. Results were analysed with a minimum follow-up of 9 months. Some 36 grafts (26.1%) in 34 patients (30.4%) presented with BC: bile leaks (17 grafts), biliary obstructions or dilatations (16 grafts), and other complications (3 grafts). Management was mainly surgical with biliary reconstruction via a Roux-en-Y loop. Interventional radiology had an increasing role in recent years. BC were associated with a mortality of 1.8% (2/112), a graft loss rate of 4.3% (6/138), and significant morbidity. Among the various factors whose association with BC was studied, the date of transplantation, the use of reduced grafts and the use of gallbladder conduits appeared to be the main determining factors for BC. From multivariate analysis the use of reduced grafts emerged as the most important factor in reducing BC. We therefore conclude that BC are associated with significant morbidity, but general improvements in both surgical and medical management seem to account for better results in recent years.

Adolescent↗
PubMed1995

Rat heart-aorta cluster transplantation: a novel model to study transplant rejection.

The purpose of this study was to develop a microsurgical cluster model of heart plus entire thoracic aorta transplantation and to compare it to the isolated model of heart transplantation as a tool to study transplant rejection. Thirty-six syngeneic (DA x DA and Lew x Lew) and allogeneic (DA x PVG and DA x Lew) cluster heart-aorta transplants were compared to 43 syngeneic and allogeneic isolated heart grafts. Graft survival, recipient survival and histological data on myocardial and aortic tissues were assessed. There was no statistically significant difference in graft survival between the two models studied (P > 0.05). In the cluster transplants, the aortic component was spared the severity of acute rejection noted for the myocardial counterpart. In conclusion, the results demonstrated that the cluster model was technically feasible and highly reproducible. Additionally, it was possible to apply this model to the study of experimental allograft rejection using novel immunosuppressants. The success of the cluster model in strongly mismatched transplant strain combinations underscores its potential for application in slower rejection combinations, making it particularly suited for chronic rejection studies. The inherent capacity for sampling a broader range of vessel sizes in one animal makes the cluster model more suitable than the isolated models of aorta or heart for application to experimental protocols.

Animals↗
PubMed1995

Restorative proctocolectomy and pouch anal anastomosis for ulcerative colitis following orthotopic liver transplantation.

This study reports on the outcome of four patients having ileal pouch anal anastomosis after orthotopic liver transplantation for sclerosing cholangitis complicating ulcerative colitis. There were no deaths on follow up. Early postoperative bleeding was a complication of colectomy or rectal excision in three, one of whom developed hepatic artery thrombosis and the overall complication rate was high. All patients are continent but one has chronic pouchitis (while receiving longterm metronidazole) and one patient has recurrent sclerosing cholangitis in the transplant.

Adult↗
PubMed1995

Role of endothelial cells in transplantation.

Endothelial cell activation with accompanying vascular inflammatory changes is considered central to the experimental manifestations of both hyperacute and delayed xenograft rejection responses. Natural xenoreactive antibodies directed at alpha-galactosyl residues of xenogeneic glycoproteins and glycolipids, with associated complement activation via the classical pathway, are considered major immediate mediators of graft endothelial cell injury in the clinically relevant discordant swine to primate combinations. In delayed xenograft rejection processes, where recipients are treated prophylactically to ameliorate these initial events, activation of infiltrating mononuclear phagocytes and natural killer cells are associated with ongoing endothelial cell activation processes, procoagulant generation and vascular thrombosis. Allograft hyperacute rejection is observed when vascularised organs are transplanted to sensitized individuals with high levels of cytotoxic antibodies. Less dramatic forms of humoral allograft rejection (termed accelerated or vascular rejection) and the more common cell-mediated endothelialitis are associated with significant graft damage. Endothelial cell activation is also linked with graft preservation injury, forms of chronic rejection and delayed graft loss. Experimental work is currently being directed at the control of hyperacute rejection, the close understanding of endothelial cell thromboregulation in both transplanted xeno- and allografts and the development of novel therapeutic agents including gene therapy and the possible use of organs from transgenic animals.

Cell Transplantation↗
PubMed1995

[Risk assessment before elective visceral surgery interventions].

AIM OF THE STUDY: Since 1988 all our patients undergoing elective general surgery entered a prospective study, with the aim of identifying risk factors, responsible for a fatal postoperative outcome. METHODS: From 1988-1992 a total of 3250 patients (mean age 52.0 years [SD +/- 16.8]), 1750 male and 1500 female have been registered. RESULTS: General complications occurred in 10.4% of patients and local complications have been registered in 10.8% of cases. 29 patients (0,89%) died within 30 days following the operative procedure. The operation per se, the ASA-classification, a history of respiratory disease and an operation for a malignant disease could be identified as risk factors for general postoperative complications. CONCLUSIONS: The study design allows us to determine risk factors in elective general surgery. These risk factors can easy be used in clinical practice to evaluate the operative risk of a planned operative procedure.

Adult↗
PubMed1995

[Preservation of kidney transplants with a modified UW solution--initial clinical results].

Although the University of Wisconsin (UW) has become the standard solution for the preservation of kidneys for transplantation, the importance of the colloid hydroxyethylstarch (HES), one of the key compounds of the UW solution, has been judged controversial. It has been shown in various experimental models that dextran-40 may successfully substitute for HES. Dextran-40 is not only cheaper but also has a variety of biological effects which may be beneficial during the graft reperfusion phase. The aim of this clinical study was to examine the efficiacy of dextran-40 based preservation solution (Dex-PS) for its use for human kidney graft preservation and to compare the transplantation results with kidneys preserved with UW solution. A total of 87 kidneys were preserved with Dex-PS and matched with 87 kidneys preserved with UW solution. Both groups were comparable in terms of donor and recipients characteristics. Patient survival and graft survival after 1 year was 95% and 86% for the Dex-PS group and 94% and 90% for the UW group, respectively (p = n.s.). Primary non-function, delayed graft function, postoperative need for dialysis, and follow-up of serum creatinine were statistically comparable between these two groups. We conclude that dextran-40 can safely replace HES in the UW solution for the purpose of human kidney preservation for transplantation. There were no statistically detectable differences in graft performance between the kidneys preserved with UW and those preserved with Dex-PS.

Adenosine↗
PubMed1994

[Hemolytic-uremic syndrome following kidney transplantation: prognostic factors].

Posttransplant hemolytic uremic syndrome (P-HUS) is a rare complication following kidney transplantation and is due to thrombotic microangiopathy. The aim of the present study was to determine patients at risk for this condition and to describe the follow-up in patients who developed P-HUS. The study is based on 557 consecutive patients who underwent either renal or combined renal and pancreatic transplantation in the cyclosporin era. P-HUS occurred in 19 out of 557 patients (3.4%). The reasons for developing P-HUS were: vascular rejection in 10 patients, association with cyclosporin in 5 patients, recurrence of an original HUS in 3 patients, and a transplanted shock-damaged kidney in 1 case. Patients with retransplants, grafts procured from non-heartbeating donors, high levels of anti-HLA antibodies, high HLA-DR mismatch, and HUS or Alport syndrome as the original disease, were found to be at increased risk for developing P-HUS. One-year graft survival for the P-HUS group was 42% and 88% for patients without this complication. Despite full therapy the prognosis of a P-HUS remains poor. Therefore, prevention of P-HUS, which consists in avoidance of the combination of the risk factors mentioned above, is emphasised.

Adult↗
PubMed1994

[Long-term course following kidney transplantation].

The first 100 recipients of cadaveric renal allotransplants operated at our institution between 1964 and 1971 were retrospectively analyzed in terms of a long-term follow-up, complications and survival parameters. Patient and graft survival (indicated in parenthesis) after transplantation were 68% (58%) at 1 year, 50% (38%) at 5 years, 40% (27%) at 10 years, 32% (20%) at 15 years and 20% (13%) at 20 years. Half-life of graft survival was computed using two different mathematical models and was compared with the results of a control group operated in 1986. Half-life was 9.5 years for the study group and 13 years for the control group respectively.

Adolescent↗
PubMed1994

[Ultrasound diagnosis of appendicitis by surgeons--a matter of experience? A prospective study].

A number of studies have shown that ultrasound has an advantage over physical examination in the diagnosis of acute appendicitis. Most of these studies were conducted by experts in the field of ultrasonography. In this study the influence of experience on the results of the sonography of acute appendicitis were evaluated. All 203 patients admitted to our unit between December 1990 and December 1992 were examined physically and sonographically by a team of surgeons consisting of one experienced sonographer and six inexperienced surgical trainees. Laparotomy was performed in 136 patients (46%). Appendicitis was demonstrated histologically in 119 cases (39.4%). Initial clinical findings were positive in 87 (28.8%). Sonography was positive in 119 patients (39.4%). The 163 patients not operated on demonstrated other pathology on ultrasound in 60 cases (19.9%). The rate of negative laparotomies amounted to 7.2% in our study. Sensitivity and specificity for the sonographic diagnosis were 92% and 95%, respectively. They were only 81% and 80% for physical examination. Overall accuracy was 92% for sonography. Sensitivity and specificity for the inexperienced surgeons were 87% and 93%, respectively, while the experienced surgeon reached values of 97% and 98%, respectively. The results of both groups are comparable with values in the literature, suggesting that ultrasound evaluation of appendicitis is not a diagnostic tool limited to a few experienced sonographers.

Abdomen, Acute↗
PubMed1994

[Preoperative risk assessment in elective visceral surgery. Study design--results--perspectives].

Since 1988 we have been analysing all our patients undergoing elective general surgery with general or spinal anaesthesia in a prospective study, with the aim of identifying and weighing up risk factors. The risk factors have been divided into the following groups: environment, surgeon, anaesthesia, operative intervention, disease and patient, regardless of the current illness. In 1990 a total of 682 patients (mean age 51.6 years, range 14-90), 365 male and 317 female, entered on study. General complications have been recorded in 63 patients (9.2%), whereas local complications occurred in 73 patients (10.7%). The following parameters were identified as risk factors for general complications: age > or = 70 years, hypertensive blood pressure level, haematocrit < 40% (male patients), operative procedure for malignancies, reduced physical capacity, pathologic cardiac or lung history, pathologic ECG, excessive alcohol consumption, hepatosplenomegaly, foreign origin, carotid artery bruit. Five patients died within 30 days following surgery for a malignant disease. This ongoing prospective study is a valuable instrument for the definition of preoperative risk factors in elective general surgery with the objective of eliminating mortality by the end of the century.

Adolescent↗
PubMed1994

Hepatitis C RNA prevalence in a Western European organ donor pool and virus transmission by organ transplantation.

Liver disease is a common finding after organ transplantation and might in part be due to transmission of hepatitis C virus (HCV). The aim of this study was to determine the prevalence of positive results with different anti-HCV tests and HCV-RNA in a local donor pool and to clarify to what extent HCV was transmitted to organ recipients. Serum samples from 207 consecutive organ donors were analysed retrospectively with anti-HCV ELISA (2nd and 3rd generation), anti-HCV RIBA (2nd generation) and HCV polymerase chain reaction (PCR). Organ recipients at risk were identified and followed up serologically and clinically. Anti-HCV seroprevalance in organ donors was 4.3% for 2nd generation ELISA, 4.8% for 3rd generation ELISA and 1.9% for 2nd generation RIBA. HCV-PCR was positive in 1.4%. Nine organs from four RIBA-positive donors were transplanted into eight recipients of whom four became anti-HCV and PCR positive after transplantation. HCV-PCR became positive several days after transplantation whereas anti-HCV seroconversion took place after 8-9 months. Two recipients developed acute liver disease and another two showed features of mild chronic liver disease but no serious complications due to HCV infection were observed.

Enzyme-Linked Immunosorbent Assay↗
PubMed1994

The immunomodulatory effects of a novel agent, leflunomide, in rat cardiac allotransplantation.

We assessed the immunomodulatory effect of leflunomide (LEF) in a heterotopic abdominal model of rat heart transplantation using a major histocompatibility mismatch (DA X LEW). The endpoint of this study was cardiac rejection assessed by abdominal palpation of the ventricular impulse and confirmed by laparotomy and histology. In this study, LF was investigated using four dosages (5, 10, 20 and 30 mg/kg per day orally) against cyclosporine (CsA) (15 mg/kg per day orally) and FK 506 (1 mg/kg per day orally). The ability of LEF to prevent rejection and reverse ongoing acute rejection was assessed. The results showed that untreated hearts were fully rejected by day 5 and that LEF at 5 mg/kg was significantly better than any other dose tested, was superior to FK 1 mg/kg, and was as effective as CsA 15 mg/kg in preventing rejection after a short course of treatment. After a longer course, 10 and 20 mg/kg LEF proved more effective than 5 mg/kg in controlling rejection and as efficacious as 1 mg/kg FK and 15 mg/kg CsA. In the control of ongoing established early rejection. LEF proved to be equally effective, even at lower doses (5 mg/kg), to CsA 15 mg/kg and FK 1 mg/kg. In the control of ongoing established late rejection, 20 mg/kg LEF proved to be superior to 10 mg/kg LEF and 15 mg/kg CsA, and was as effective as FK 1 mg/kg. However, when higher doses of CsA (25 mg/kg) and FK (2 mg/kg) were tested against 20 mg/kg LEF in this mode of rescue, LEF proved as effective as CsA and superior to FK. In the assessment of drug toxicity using body weight as a parameter, 20 mg/kg LEF proved safer than any other LEF dose tested, and safer than 15 mg/kg CsA and 1 mg/kg FK in both short- and long term administration. We conclude that LEF is a relatively safe and potent immunosuppressant with promising clinical potential.

Animals↗
PubMed1993

Ultrasound in blunt abdominal and thoracic trauma.

Between July 1989 and June 1991, 312 patients with blunt thoracic or abdominal injuries were examined prospectively. Sonographic examination was performed by surgeons in the emergency room using a mobile ultrasound unit. In 113 (36.2%) cases pathologic findings were demonstrated sonographically. These included 47 cases of hemothorax, 11 pericardial effusions, 52 cases of intra-abdominal fluid, 24 lesions of intra-abdominal organs, and 10 cases of retroperitoneal hematoma. Physical examination findings were positive in 96 (30.8%), negative in 63 (20.2%), and equivocal in 153 (49.0%). Two hundred thirty-nine patients had between one and eight injuries in addition to the blunt abdominal or thoracic trauma. These patients had an average Injury Severity Score (ISS) of 19.9 (range, 1 to 75). The 73 patients with isolated blunt trauma of the thorax or abdomen had an ISS of 4.9 (range, 0-25). None of the 66 patients (21.2%) with positive clinical findings and negative sonographic examination results had to be operated on later in the course of treatment, while 5 (36%) of 14 patients (4.5%) with negative physical examination findings and positive sonographic findings had to undergo surgery. The sensitivity for the demonstration of intra-abdominal fluid and organ lesions was 98.1% and 41.4%, respectively. The overall sensitivity and specificity of the ultrasonic examination were 90.0% and 99.5%, respectively.

Abdominal Injuries↗
PubMed1993

[Lymphoepithelial cyst of the pancreas].

In a routine check-up a cystic tumour of the head of the pancreas was found in a asymptomatic 59-year-old man. As the investigation with several radiological means was not conclusive and there was found an increased value for CEA in the cysts liquid a explorative laparotomy was performed. Already the intraoperatively performed histology confirmed the diagnosis of a benign lymphoepithelial cyst of the pancreas. After local resection the postoperative course was uneventful and the patient is today, one year later, disease-free. Lymphoepithelial tumours are well known in the parotis whereas in the pancreas only 5 cases have been reported. For positivity for CA 19-9 marker we found some evidence for the hypothesis that these kind of cysts could derive from metaplastic tissue in obstructed pancreatic ducts.

Biomarkers, Tumor↗