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Biomedical subjects

J Jirka

Publications and source records attributed to J Jirka.

At least 19 recordsLinked to original sources
PubMed1992

[Initial clinical experience with Consupren, a new preparation manufactured in Czechoslovakia (Galena), in patients after liver transplantation].

Fourteen patients on average 10 months after transplantation of the kidney treated with Sandimmune were changed to a new Czechoslovak preparation Consupren, Galena (Cyclosporine A), while maintaining the other components of immunosuppressive treatment (azathioprine, prednisone). The patients were followed up for 6-12 months on the new drug. The tolerance of Consupren was in all patients satisfactory. Two weeks after the change the mean cyclosporine A level was significantly higher and called for a reduced dosage. No significant changes in the clinical condition and laboratory indicators were observed, the serum creatinine values did not change during the investigation and within 6 months after the change no rejection was recorded, despite the fact that during the first six weeks after the change an insignificant rise of mean absolute number of lymphocytes, CD4 lymphocytes and the regulatory index and a significant rise of CD3 lymphocytes was observed.

Adult↗
PubMed1991

[Preventive administration of antithymocyte globulin in combined immunosuppressive therapy with cyclosporin A, azathioprine and prednisone in kidney transplantation].

Forty-five patients after transplantation of the kidney from a dead donor were treated by a triple combination of cyclosporin A, azathioprine and prednisone. In patients where during the first two days after transplantation the function of the graft was not restored, cyclosporin A was reduced and treatment supplemented by a combination of four by prophylactic administration of ATG for a period of 7 days. A total of 18 patients had a complete prophylactic dose of ATG. The results in this group were compared with a historical comparable group of 27 subjects treated only with the triple combination of drugs without reduction of cyclosporin A. In patients treated with ATG the mean initial function of the graft was reduced only insignificantly and the one-year survival of the graft was only insignificantly better than in the control group. During the first two months after transplantation there were significantly more leucopenic episodes in patients treated with ATG, however, no direct relationship with the latter was proved. The number of infectious complications in these patients was lower than in the control group.

Antilymphocyte Serum↗
PubMed1991

Arteriolosclerosis of the human renal allograft: morphology, origin, life history and relationship to cyclosporine therapy.

In the decade 1979-1988, 658 biopsies were collected from 568 cadaveric renal allografts. In 118 grafts a non-proliferative insudative vasculopathy (IVA) was found in afferent vessels. Immunosuppression was based on azathioprine (AZA) or on cyclosporin A (CsA), from 1983. The prevalence and extent of IVA has increased significantly since 1984. Light microscopy showed fibrinoid and hyaline masses of varying extent; transmural insudative "knobs", intimal oedema with metachromasia, and microthrombosis were also seen with CsA. The ultrastructure of the insudates was unremarkable but CsA grafts displayed early oedema and hypergranulation of endothelial cells with a disarray of smooth muscle cell (SMC) microfibrils, and pronounced degenerative changes of SMC. Rebiopsy showed stationary IVA in AZA grafts and progression in one-half of CsA-treated patients. Nephrectomy specimens revealed, however, a marked predominance of late rejection endarteritis; in only 3 cases was IVA and/or microthrombosis the possible cause of nephrectomy. The mean donor age was higher in severe IVA in CsA grafts and the mean post-transplantation interval at the time of diagnosis of IVA was significantly shorter in CsA-treated patients. No important differences in cumulative graft survival were seen between grafts with absent, moderate or severe IVA. Unused cadaveric donors' kidneys of comparable age exhibited normal arterioles or a slight focal insudative or hyaline lesion.

Arteries↗
PubMed1990

[Change from treatment with cyclosporin A to conventional treatment in kidney transplantation].

Patients after a first transplantation of the kidney from a dead donor treated with cyclosporin A in combination with one, two or three drugs were switched to conventional treatment with azathioprine and prednisone. Fifty-two patients were switched to the new treatment 11-15 months after transplantation (group I), 9 patients after 6-10 months (groups II), 17 patients after 16-30 months (groups III). Group I was compared with 21 patients where no switched was made after 11-15 months (group IV). The authors did not reveal any change in the survival of grafts nor in the number of rejections during the three-month period following the switch. Survival of grafts in patients with rejection was after two years following the switch significantly lower than in patients without rejection, the loss of grafts, however, did not differ as compared with patients who suffered a rejection during a comparable period but were not switched to conventional therapy. The interval of the switch after transplantation did not influence the incidence of rejections. Rejections after the switch cannot be reliably foreseen from the level of cytotoxic anti-HLA antibodies or previous repections before the switch.

Azathioprine↗
PubMed1990

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. I. Therapeutic effectiveness].

Two groups of patient after a first renal transplantation from a dead donor were treated by a double combination of cyclosporin A and prednisone (group A) and triple combination cyclosporin A and azathioprin and prednisone (group B). The groups were similar as regards effectiveness of treatment (evaluated with regard to the survival of recipients and grafts and the number of rejection episodes); they did not differ as to the losses of grafts for other than immunity reasons, which predominated in both groups over losses caused by rejection. Discontinuation of prednisone after four months in group A was complicated by rejection in 54%. Discontinuation of cyclosporin A after one year's treatment and a change to azothioprin and prednisone treatment was in both groups complicated by rejection in cca one fifth of the patients.

Adult↗
PubMed1990

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. II. Adverse effects of cyclosporin A and therapeutic complications].

The incidence of irreversibly afunctional grafts, late functional development and period of the initial temporary lack of function did not differ in the two groups. The total number of nephrotoxic episodes was significantly (p less than 0.05) lower in the triple combination, chronic nephrotoxicity developed with equal frequency. Infectious complications were present in 54% of the patients in group A and in 60% in group B, viral complications in 15% patients in group A and in 16% in group B. Serious bacterial infections were the cause of death in one of three patients in group A and in five of six patients in group B.

Adult↗
PubMed1978

Contribution to the problem of the relationship of infection and rejection in patients with kidney transplants.

The paper deals with the incidence of infectious complications and rejection crises in patients with renal transplants. It was revealed by statistical methods that there exists a certain correlation between infections and rejections, which depends on the type of the infectious agent. In patients where infectious complications were caused only by gram-negative flora an indirect relationship was revealed, while in patients with infectious complications where gram-positive flora, viruses or fungi participated, a marked direct correlation was found. Statistical methods proved also a higher incidence of rejection crises in patients with active cytomegalic infection.

Cytomegalovirus Infections↗
PubMed1978

Influence of protein intake and renal function on plasma amino acids in patients with renal impairment and after kidney transplantation.

A group of 17 patients with chronic renal impairment and a group of 11 patients surviving for 3--7 years after kidney transplantation were examined. In all patients plasma amino acids were analyzed. The ratio of essential/nonessential amino acids, the valine/glycine ratio and Whitehead's quotient are influenced above all by the dietary protein intake. Raised citrulline and 3-methylhistidine values were not influenced by the protein intake, while they correlate with indicators of renal function. Changes detected after kidney transplantation are analogous.

Adult↗
PubMed1978

Miliary tuberculosis in a patient after renal transplantation.

A report is presented on the first case of miliary tuberculosis in a group of 84 kidney transplant recipients treated in the Institute of Clinical and Experimental Medicine, Prague, until March 1976. The specific process was verified by bacteriological investigations of the sputum and urine. Productive specific tuberculoid-type nodules with sporadically occurring acidoresistant rods were detected in a bioptic specimen of the transplanted kidney. Also discussed are therapeutical problems in progressive renal graft insufficiency and in simultaneous chronic hepatopathy.

Adult↗
PubMed1978

Renal transplantation and pregnancy.

Processing of data from 79 pregnancies (incl. 11 observed by the authors) in 64 women (incl. 6 of their own patients) after renal transplantation revealed that approximately in 20% of the pregnancies in chronological association with the pregnancy the function of the graft deteriorated or ceased and in four instances this participated indirectly in the mother's death within one year after delivery. The effect of immunosuppressive treatment of the pregnant mother on the development of the foetus and 57 evaluated infants resp. was manifested by a 50% incidence of prematurity, in seven neonates by clinical or post-mortem findings of adrenal hypofunction or hypoplasia resp. and by hypofunction or hypoplasia of the lymphatic apparatus. Only in one neonate and one foetus (observed by the authors) an inborn defect was revealed. In five neonates chromosomal aberrations were described. The above findings support our disapproval of pregnancy in women after renal transplantation with the exception of recipients of grafts from siblings with closely related tissue properties and with a renal function stabilized for a long period and with minimal immunosuppression.

Chromosome Aberrations↗
PubMed1978

Possibilities of dynamic scintigraphy in renal allografts.

Dynamic scintigraphy, a non-invasive method, is suitable due to its sparing procedure in particular in clinical conditions where more pretentious examination methods are contraindicated or risky. Very frequently it can serve as a guide for more aimed examination methods. Its diagnostic value is great in particular where pathological conditions of the efferent urinary pathways are concerned, i.e. above all fistulae. In parenchymatous lesions it provides information on focal processes of an inflammatory and non-inflammatory nature. Investigation of both functions, of perfusion and transport of hippuran is sometimes a supplement for the differentiation of ATN and rejection nephropathies. The distribution of perfusion after administration of technetate helps to detect occlusion of the afferent arteries and minor arterioles.

Adult↗
PubMed1978

Urea and ammonia excretion into gastric juice in regularly dialyzed patients and patients after renal transplantation. I. Dialyzed patients.

In regularly dialyzed patients in basal gastric juice and after stimulation with pentagastrin the volume of titrable acidity, urea and ammonia were assessed. It was revealed that in relation to the plasma urea concentration in basal juice the mean urea and ammonia concentration is roughly half and in stimulation juice roughly one third. The urea concentration in gastric juice is negatively correlated to the ammonia concentration. Urea excretion into the stomach depends on the plasma urea level and on the secretory gastric activity. The decisive factor of gastric secretion is probably parietal cell secretion. From the results ensues that gastric juice of dialyzed patients contains a quantitatively significant amount of urea and ammonia. Ammonia due to its neutralizing action distorts the examination of gastric acidity assessed by titration. The findings call for a revision of hitherto known data concerning gastric secretion of uraemic patients.

Ammonia↗