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Biomedical subjects

D Candinas

Publications and source records attributed to D Candinas.

88 records · Page 5Linked to original sources
PubMed1993

[Thrombopenia after liver transplantation].

Thrombocytopenia (TP) is a common finding after liver transplantation and is often multifactorially induced. In 31 of 33 liver transplant recipients (operated between 1986 and 1991 at our institution) TP was observed but only in 4 the nadir of the platelet count was less than 20,000/mm3. Highly significant influence in the severity of postoperative TP as well as on the recovery time (defined as the first day with a platelet count higher than 100,000/mm3) was found for a preexisting TP and for the intraoperative need for blood transfusions. 8/33 patients had a concomitant splenectomy but no effect on platelet nadir nor on the recovery time could be detected. In our series we could not find any platelet related factor with a significant impact on patient survival. In one patient severe TP was induced by a CMV-related hematophagic histiocytosis fully regredient with antiviral therapy. Another patient with AB0 incompatible graft had a severe TP induced by graft versus host disease.

Adult↗
PubMed1993

[Results of intramedullary nailing in humerus shaft fractures].

We present an analysis of a retrospective study of 61 humeral shaft fractures, stabilized with a thin AO tibial nail. All fractures were analysed according to the AO-classification. Follow-up included 48/61 patients and averaged 82 months. Local complications were postoperative radial nerve palsy in 1/61, infection in 0/61 and non-union in 4/56. A good result in shoulder function was obtained in 41/48 cases.

Adolescent↗
PubMed1992

[Removal of kidneys from donors with circulatory arrest. A simple procedure in lessening the shortage of donor kidneys].

The increasing list of patients waiting for an organ transplantation shows clearly the shortage of donor organs at disposal. This shortage is particularly high in the field of kidney allotransplantation. As the nephrectomy in non-heart beating (NHB) donor is technically practicable in most of our hospitals, the aim of this contribution is to pass on further informations about the nephrectomy to those doctors who are interested in the procedure. The first part of the paper explains the different facts of the end staging renal disease in Switzerland and of transplantation activity. We focus then on the conditions and preparations of the nephrectomy in NHB donor, the exact technique of the operation and the organ perfusion. As it is shown by different studies, the long-term results of NHB donor kidneys are good. The nephrectomy in NHB donor is an effective method to solve kidney shortage.

Brain Death↗
PubMed1992

Kidney procurement from non-heartbeating donors: transplantation results.

To overcome the shortage of kidneys (kdn's) available for transplantation we reactivated kdn procurement from non-heartbeating donors (NON-HBD). In this study, we reviewed our results with 34 kdn's from NON-HBD, transplanted between 1985 and 1991, and compared these with 34 control kdn's procured from heartbeating donors (HBD) matched for age, sex, primary graft or retransplant and transplant year. There was no difference in cold ischemia time, preservation solutions used, duration and type of preoperative dialysis, number of HLA mismatches and serum antibody levels between the two groups. The only significant findings were a lower diuresis in the last hour in the donors in the NON-HBD group, and a significantly higher serum creatinine level compared to the HBD group. The 1-year patient and graft survival rates were 89.4% and 84.9% for the HBD group, and 78% and 76.1% for the NON-HBD group respectively. There was need for dialysis support in the first posttransplant week in 10 out of 34 (29%) recipients in the HBD and 17 out of 34 (50%) recipients in the NON-HBD group. Primary non-function was observed in 1 of 34 (3%) recipients in the HBD group versus 3 of 34 (9%) in the NON-HBD group. None of the differences were statistically significant. There was also no difference in average serum creatinine levels at days 1, 3, and 7, at 1 month and at 1 year between the HBD and NON-HBD groups. In the NON-HBD group 6 of 34 kdn's (18%), 5 of which were retransplants, showed vascular rejection, 5 of them associated with haemolytic uremic syndrome (thrombotic microangiopathy); 2 of these 6 kdn's recovered, and 4 failed (2 with primary non-function). This important observation needs to be investigated further. The results is this study showed, however, that good short- and long-term results can be achieved with kdn's from NON-HBD. We concluded that organ procurement from NON-HBD is an adequate approach to an important cadaver donor source that in general is not effeciently used, but could significantly increase the number of kdn grafts in most transplant programs.

Adult↗
PubMed1992

[How much experience is required for ultrasound diagnosis of blunt abdominal trauma?].

Between July, 1st 1989 and June, 30th 1991, 312 patients were entered into a prospective study concerning the reliability of sonographic evidence in blunt abdominal trauma. There were 231 male and 81 female patients aged between 15 and 88 years (mean: 39.9 years). The sonographic team consisted of one experienced sonographer/surgeon (greater than 4000 examinations) and 3 sonographic beginners (less than 200 examinations at the start of the study). The experienced sonographer and the beginners examined 168 and 144 patients, respectively. Patient distribution to the two groups was done according to the sonographic duty roster without consideration of injury severity. The examination was performed with a mobile ultrasound unit at the surgical intake as part of the primary diagnostic work-up. It consisted of four sonographic views (right and left lateral longitudinal, suprapubic and epigastric transverse view) and took about 2 min. Clinical evidence supporting blunt abdominal trauma could only be found in 64 cases, while in 153 patients physical examination was equivocal due to assisted ventilation or paraplegia. Sensitivity and specificity for the clinical examination amounted to 80.6% and 44.5%, respectively. Sensitivity and specificity for the sonographic finding of intraabdominal liquid were 100% each for the experienced sonographer and 96% and 100%, respectively for the beginners. Organ lesions were demonstrated with a sensitivity and specificity of 45% and 99% by the experienced and 36% and 100% by the beginners. The experienced sonographer misdiagnosed one case of free intraabdominal gas, which could not be corroborated both by clinical and radiological evidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1992

[Technique of intraoperative laparoscopic cholangiography].

Since laparoscopic cholecystectomy has been established at our institution, the routine use of intraoperative cholangiography was abandoned but preoperative intravenous cholangiography and sonography are mandatory. However, these investigations are not always conclusive and in some cases not applicable. We have therefore started to use selective intraoperative laparoscopic cholangiography for laparoscopic cholecystectomy. Our technique and the materials required for this peroperative investigation are described in the present article.

Cholangiography↗
PubMed1992

[General aspects of kidney removal from donors with cardiovascular arrest].

The increasing list of patients waiting for an organ transplantation shows clearly the shortage of donor organs at disposal. This shortage is particularly high in the field of kidney allotransplantation. As the nephrectomy in non-heart beating (NHB) donor is technically practicable in most of our hospitals, the aim of this contribution is to pass on further informations about the nephrectomy to those surgeons who are interested in the procedure. The first part of the paper explains the different facts of the end stage renal disease in Switzerland and of transplantation activity. We focus then on the conditions and preparations of the nephrectomy in NHB donor, the exact technique of the operation and the organ perfusion. As it is shown by different studies, the long-term results of NHB donor kidneys are good. The nephrectomy in NHB donor is an effective method to solve kidney shortage.

Heart Arrest↗
PubMed1992

[Revascularization of tracheal transplants with omentum].

UNLABELLED: In a series of 6 dogs we performed an autotransplantation of a four-ring segment of the thoracic trachea. In 3 cases the omentum was brought into the chest and wrapped around the transplant (omentum group) and compared with the others (control group). After 20 days or at occurrence of severe tracheal stenosis the study was determined. In the omentum group all tracheal transplants healed with structural integrity. Microfil injection into the gastro-epiploic artery demonstrated revascularization through omental vessels. In the control group all transplants developed a severe stenosis due to chondromalacia within 2 weeks. IN CONCLUSION: The omentum can successfully revascularize a transplant of a four-ring segment of the thoracic trachea.

Animals↗
PubMed1992

[Results of kidney transplantation in patients over 60 years of age].

In the same measure as the age of population is growing, the importance of the problems rising by the renal transplantation in elder persons is increasing. At the University Hospital of Zurich 1313 kidney transplantations were performed between 1964 and 1990, 44 of them to patients who at the moment of operation were older than 60 years of age. The actuarial patient survival after 3 months reached 81%, after 1 year 74% and after 5 years 42%. The actuarial allograft survival after 3 months was 75%, after 1 year 67%, after 5 years 40%. The mortality was 131 per 1000, the mortality ratio compared to a standard population 6 times higher. The main causes of death were infections (52%) and cardiovascular diseases (28%). These results explain our opinion, that renal transplantation in elder patients should be indicated retentively.

Adult↗
PubMedDate not supplied

Optimized veno-venous bypass with the affinity pump.

Veno-venous bypass (VVBP) is increasingly used to avoid acute venous hypertension and low cardiac output after clamping the vena cava. Air embolism upon accidental decannulation of the inflow line and endothelial damage due to suction of the blood collecting cannula to the vessel wall are known complications specific to the currently used roller and centrifugal pumps, because they generate negative pressure at the inflow site of the pump. The Affinity pump has a unique chamber design with an occlusive segment, that collapses in low filling states preventing negative pressure at the inflow site of the pump chamber. This device was tested for VVBP in three pigs (each weighing 52.3 +/- 5.1 kg) with hepatic vascular exclusion. Blood was pumped from the femoral and portal veins to the external jugular vein and perfusion was maintained for 6 hours. The hemodynamic state of the animals was assessed by recording heart rate; systolic, mean arterial, and diastolic pressure; as well as central venous pressure. Mean pump flow during the experiment was 1,629.3 +/- 372.2 ml/min. After clamping, the inflow line of the pump mean arterial pressure significantly decreased (from 69.5 +/- 4.4 to 43.1 +/- 3.5 mm Hg), and mean pressure in the femoral vein increased significantly (from 16.1 +/- 2.6 to 26.8 +/- 5.9 mm Hg), whereas the mean pressure in the internal jugular vein did not significantly change (from 6.0 +/- 1.7 to 5.0 +/- 2.1 mm Hg). There was no suction by the blood collecting cannula on the vessel wall, and neither bubbles nor air emboli were detected and no operator intervention was needed. In conclusion, the Affinity pump eliminates device related complications due to negative pressure generated at the inlet, and guarantees stable hemodynamics. Its application is simple and safe and minimal operator intervention is needed, making the Affinity pump particularly suited for veno-venous bypass.

Animals↗
PubMedDate not supplied

Local and remote ischemia-reperfusion injury is mitigated in mice overexpressing human C1 inhibitor.

Activation of the classical complement pathway is crucially involved in complement-mediated endothelial cell damage in ischemia-reperfusion injury. C1 inhibitor is the only known physiological inhibitor of classical complement pathway activation. Transgenic mice overexpressing human C1 inhibitor were used in a surgical lower torso and a liver ischemia-reperfusion model. Organ-specific endothelial disruption was determined by 125I-tagged albumin extravasation. In the lower torso ischemia-reperfusion model, transgenic mice overexpressing the C1 inhibitor were protected in the muscle and the lungs from endothelial cell damage. In the liver ischemia-reperfusion model, endothelial cell integrity was preserved in transgenic animals in the liver, the gut and the lungs. Our data indicate that inhibiting complement activation by a transgenic approach is effective in protection against ischemia-reperfusion injury.

Albumins↗