Biomedical subjects

J Chudek

Publications and source records attributed to J Chudek.

45 records · Page 3Linked to original sources

PubMed1993

[Analysing cause of death in chronically hemodialyzed patients].

The documentation was analysed of 123 haemodialysed patients dying in the years 1984-1990 in nine extracorporeal dialysis centres in the Provinces of Bielsko, Czestochowa and Katowice. Among the dying haemodialysed patients were 61 men and 62 women. The mean age of these patients was 43.7 +/- 1.0 years. The mean time from starting the haemodialysis therapy to death was 29.2 +/- 3.9 months. Mortality among the haemodialysed patients in individual years ranged from 6.5 to 14.4% and was 9.7% on the average. The most frequent death causes in this group of patient in the studied time period were infections (45.5%) and cardiovascular complications (35%). The results of the analysis of death causes in haemodialysed patients suggest the need of constant monitoring of the risk factors contributing to the development of infections and cardiovascular complications.

Adult↗

PubMed1993

[Relationship between renal biopsy histopathology and profile of changes in serum protein, lipids and proteinuria in patients with nephrotic syndrome due to chronic glomerulonephritis].

UNLABELLED: Relationship was assessed between the type of renal pathology and the degree of plasma protein and lipid abnormalities in 59 patients with nephrotic syndrome due to chronic glomerulonephritis (GN). All patients were divided into 5 subgroups according to the type of renal pathology (extracapillary proliferative GN--23, mesangioproliferative GN--18, membranous GN--5, minimal changes--5, other--8 patients) and according to the presence (22 patients) or absence (37 patients) of altered interstitium (inflammation and/or fibrosis). In all patients the following parameters were analyzed: plasma levels of creatinine, total cholesterol and lipids, triglycerides, total protein, electrophoretic fractions of plasma proteins and urinary protein excretion. Type of renal pathology as well as presence of interstitial lesion did not influence the degree of protein and lipid abnormalities in nephrotic patients. Significantly more marked (p < 0.05) abnormalities in the serum and lipid profile were found in patients in whom 76-100% of all glomeruli were abnormal than in patients with a lower percentage of damaged glomeruli. CONCLUSION: Percentage of damaged glomeruli but not the type of renal pathology (glomerular or/and interstitial) are the main factors influencing the magnitude of abnormal serum protein and lipid profiles in nephrotic patients.

Adolescent↗

PubMed1992

[Efficacy of recombinant human erythropoietin (rhuEPO) in treatment of anemia in patients with myelodysplastic syndrome].

This paper summarizes results of rhuEPO--treatment obtained by different authors in 27 patients with a myelodysplastic syndrome (MDS). Only 1/3 of all patients with a MDS were responsive to rhuEPO treatment, while in 2/3 of these subjects no amelioration of anaemia was noticed, even after extremely high doses of this hormone. A detailed description of a patient with MDS, which was observed by the authors, is presented. In this patient the anaemia was refractive even after very high doses of rhuEPO administered for 10 weeks.

Anemia↗

PubMedDate not supplied

Early donor lymph node procurement and local HLA typing reduce cold ischemia time and risk of acute tubular necrosis in cadaveric kidney transplantation.

Prolonged cold ischemia time (CIT) is one of the most common causes of acute tubular necrosis (ATN) with consequent delayed graft function after kidney transplantation. The aim of the study was to analyze the impact of early donor lymph nodes (LN) procurement in combination with local or central HLA typing on CIT, on donor-recipient HLA mismatches, and on the early results of grafts. Two hundred six cadaveric procedures were performed from 2001 to 2004 including 86 cases out of 119 recipients who were matched locally and 60 cases out of 87 recipients who were matched centrally, wherein LN were obtained before kidney harvest. CIT was significantly shorter when LN were obtained before kidney harvesting both in local (13.6 vs 20.6 hours) and central (20.1 vs 27.7 hours) matching (both P < .001). ATN frequency was significantly lower in patients with LN obtained earlier (27.9%) when matched locally versus (35.0%) when matched centrally. Kidney graft function estimated at 12 months was similar in both groups. CIT longer than 19.5 hours predicted ATN occurrence with 57.7% sensitivity and 66.4% specificity. Local matching resulted in shortening CIT compared to central matching (15.5 vs 22.4 hours); however, the mismatch in HLA class I and HLA class II were significantly worse (HLA A + B 2.76 vs 2.45, HLA DR 1.21 vs 0.82). These discrepancies did not significantly influence the frequency of ATN (36.1% vs 40.0%) or the kidney graft function at 12 months.

Cadaver↗

PubMedDate not supplied

The intrarenal vascular resistance parameters measured by duplex Doppler ultrasound shortly after kidney transplantation in patients with immediate, slow, and delayed graft function.

BACKGROUND: Evaluation of pulsatility (PI) and resistive (RI) indexes by duplex Doppler ultrasound shortly after kidney transplantation reflects the exacerbation of interstitial edema. The aim of study was to characterize factors that influence PI and RI in patients with immediate (IGF), slow (SGF), or delayed (DGF) kidney graft function. PATIENTS AND METHODS: PI and RI were measured in 200 transplanted patients at 2 to 4 days postoperatively. We excluded patients with acute rejection episodes within the first month. IGF, which was defined as serum creatinine <264 micromol/L at 3 days, SGF, which was defined as creatinine >264 micromol/L by day 3 with a maximum of one dialysis, and DGF, which was defined as more than 1 dialysis were observed in 33.3%, 41.5%, and 25.2% of patients, respectively. The examined donor parameters were age, hypotensive episodes, catecholamine infusion, central venous pressure, and glomerular filtration rate. The recipient factors were age, history of hypertension, diabetes mellitus, ischemic heart disease, and stroke. Additionally cold ischemia time (CIT), HLA mismatch, and PRA were analyzed. RESULTS: The lowest PI and RI values were observed among patients with IGF (PI 1.37 [1.28 to 1.46]; RI 0.72 [0.69 to 0.74]); moderate values in SGF (PI 1.65 [1.52 to 1.78]; RI 0.78 [0.76 to 0.80]) and the highest values in DGF (PI 2.09 [1.83 to 2.35]; RI 0.83 [0.80 to 0.86]) differences that were highly significant. Hypotensive episodes and catecholamine infusion in the preharvest period had essential impacts on PI or RI values in the early posttransplant period. There was no significant correlation between PI or RI values and CIT. A slower ATN resolution was observed in DGF patients with higher PI values. CONCLUSION: Ischemic injury, which occurred mainly prior to organ harvesting, played a dominant role determining intrarenal resistance in the early posttransplant period.

Adult↗

PubMedDate not supplied

Simultaneous transabdominal bilateral nephrectomy in potential kidney transplant recipients.

BACKGROUND: Bilateral nephrectomy of potential kidney graft recipients is indicated for patients with recurrent infections in the polycystic kidneys or chronic pyelonephritis resulting from vesicoureteric reflux. The aim of this study was to analyze the frequency of complications after simultaneous bilateral transperitoneal nephrectomy. PATIENTS AND METHODS: Twenty hemodialysis patients (age 28 to 55 years) were referred for simultaneous bilateral nephrectomy between 1996 and 2004. Among the 18 patients with autosomal-dominant polycystic kidney disease, 11 experienced recurrent cysts or urinary tract infections and two, episodes of disabling flank pain. Five patients with extremely enlarged kidneys were asymptomatic. Two patients presented vesicoureteric reflux with chronic pyelonephritis. In all cases the kidneys were removed transperitoneally via a transverse or midline incision. RESULTS: Although no fatal outcome was recorded, three patients required brief hospitalizations in the intensive care unit. The only intraoperative complication was spleen injury in five patients. Surgical postoperative complications developed in nine patients (45%) including: extended drainage and delayed wound healing (n = 4), postoperative hernia (n = 3), prolonged abdominal pain (n = 3), perihepatic hematoma (n = 2), stress duodenal ulceration (n = 1), and subileus (n = 1). Five patients displayed thrombosis of their dialysis access, probably as a consequence of low blood pressure. After surgery 15 patients were placed on the waiting list and 10, successfully transplanted. CONCLUSION: Simultaneous transabdominal bilateral nephrectomy was associated with a high risk of postoperative complications, but may save the suffering associated with a repeated operation in potential kidney graft recipients who have an indication for bilateral nephrectomy.

Abdomen↗

PubMedDate not supplied

Surgical treatment of urological complications after kidney transplantation.

Urological complications after kidney transplantation develop in 2.5% to 14.1% of recipients. The aim of the study was to analyze postoperative urological complications that required surgical treatment. Thirty-three urological complications developed in 30 among 321 patients (9.3%). Complications were divided into two groups: I, related to urine retention (60.6%); and II, related to urine leakage (39.4%). For 70% of group I, in patients a double pigtail ureteral stent was inserted; for 53.8% of group II, a vesicoureteric reanastomosis was performed. Good urine outflow was achieved in 90.0% of patients. Total early graft loss was 20% of patients. Urological complications related to stenosis or leakage can be treated with ureteral stent insertion or vesicoureteral reanastomosis. Hemorrhage or infection coexisting with a urological complication increased the risk of early graft loss. Long-term graft survival among patients after successful treatment of urological complications was similar to that of patients without them.

Adult↗

PubMedDate not supplied

Influence of antihypertensive treatment with perindopril, pindolol or felodipinon plasma leptin concentration in patients with essential hypertension.

UNLABELLED: Leptin - produced predominantly by adipocytes - is presumably also involved in pathogenesis of essential hypertension (EH). In the present study, we addressed the question whether and to what extent antihypertensive monotherapy does influence leptinemia in patients with mild or moderate EH. Forty-two EH patients were enrolled in this randomized, open-labeled study. In all subjects, plasma concentrations of leptin, insulin, glucose, cholesterol, triglycerides and creatinine were estimated twice - before and one month after initiation of monotherapy with perindopril, pindolol or felodipin, respectively. Plasma leptin concentration, in the afternoon and midnight, was significantly higher in patients with essential hypertension than in normotensive healthy subjects (p < 0.01). Therapy with perindopril or felodipin did not influence the daily profile of leptinemia or insulinemia, respectively. However, pindolol monotherapy showed a marked (p < 0.01) suppressive effect on the daily profile of leptinemia, but did not influence insulinemia. CONCLUSIONS: First, patients with essential hypertension are characterized by higher plasma leptin levels as compared with normotensive healthy subjects; second, suppressive effect of pindolol on leptinemia may be of pathophysiological relevance in the course of weight gain during beta-blocker therapy.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Plasma parathyroid hormone, phosphatemia and vitamin D receptor genotype: are they interrelated?

It is not clear how the rate of bone mineral loss and vitamin D receptor (VDR) Bsml polymorphism in hemodialysed patients are related. We therefore analysed the relationships between indices of calcium-phosphate metabolism in respect to VDR genotype in 180 hemodialysed patients. We measured plasma concentrations of calcium, phosphate, iPTH, 1,25(OH)2D3 and activity of the bone fraction of alkaline phosphatase on the day before dialysis. VDR genotype BB, Bb and bb were found in 39, 84 and 57 patients, respectively. The allele frequency was B 0.45 and b 0.55. Subjects with BB genotype had insignificantly higher plasma levels of phosphate, iPTH and activity of the bone fraction of alkaline phosphatase, but significantly lower (p<0.02) concentrations of 1,25(OH)2D3 [iP (mmol/l): 2.05+/-0.09, 1.98+/-0.06, 1.93+/-0.06; iPTH (pg/ml): 257+/-50, 229+/-24, 219+/-30; AP(BF) (nmol/l/s): 515+/-45, 477+/-27, 457+/-34; 1,25(OH)2D3 (pg/ml): 23.4+/-1.5, 26.2+/-1.0, 29.3+/-1.3, for BB, Bb and bb respectively]. The strongest significant correlation between phosphatemia and iPTH was in the BB subgroup (r=0.343). Moreover, only in this subgroup did phosphatemia significantly contribute to the increase in iPTH, assessed by multiple regression analysis. In conclusion, it seems likely that BB VDR genotype in HD patients contributes to the severity of secondary hyperparathyroidism by a mechanism involving phosphatemia.

Aged↗