Surgery for vascular access.
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Arteriovenous Shunt, Surgical↗
Biomedical subjects
J Landmann
Publications and source records attributed to J Landmann.
von Willebrand factor and factor VIII in renal transplant recipients under immunosuppression with cyclosporine and steroids. Sequential measurements over 4 months in 17 patients.
In 17 consecutive cadaver kidney transplant recipients treated with cyclosporine (CsA) and steroids, the median of antigenic and functional levels of von Willebrand factor (vWF) and factor VIII (FVIII) before transplantation were elevated (vWF:Ag: 206%, vWF:RCof: 202%; FVIII:Ag: 248%, FVIII:C: 224%; normal values 50-150%). Sequential measurements after transplantation and during CsA treatment revealed a transient significant increase of median values with highest amounts of vWF:Ag of 362% (2 p less than 0.0001), FVIII:Ag of 398% (2 p less than 0.001) and FVIII:C of 360% (2 p less than 0.0001) (Friedman test). vWF:RCof did not show statistically significant changes. After 4 months, levels of vWF and FVIII comparable to those obtained before transplantation were observed. In univariate statistical analysis no correlation was found between vWF of FVIII on the one hand and plasma creatinine levels, CsA dose or CsA whole blood through levels on the other hand. However, multivariate statistics revealed to some extent a positive influence of CsA blood levels on vWF:Ag levels. Patients with vascular rejection or chronic CsA nephrotoxicity showed significantly lower levels of vWF:Ag as compared with patients without endothelial cell damage in the kidney (2 p less than 0.05). However, the difference in vWF:Ag levels already existed before transplantation. In contrast to recent reports, plasma vWF levels were not indicative of vascular injury in kidney graft recipients nor was the marked elevation of vWF and FVIII associated with thromboembolic complications ascribed to CsA treatment.
Cadaver↗
[Problems with long-term immunosuppression following organ transplantation].
Long-term immunosuppression is followed by an increase of malignancies (skin cancer, lymphomas and Kaposi's sarkoma). Among the infectious complications an incidence of bacteraemia up to 48% is found, a relative increase of infection with listeria and salmonella, and viruses from the herpes group. The major side effect of azathioprine is haematologic, whereas Cyclosporin A is nephrotoxic. Three classes of renal functional impairment by Cyclosporine are defined: 1. renal dysfunction, 2. acute nephrotoxicity and 3. chronic nephrotoxicity. Appropriate ways to handle chronic nephrotoxicity are discussed.
Humans↗
[Surgical treatment of cholelithiasis and its complications. Comparison of 2 treatment periods].
We have realized a retrospective analysis of all cholecystectomies performed during two five-year periods (period I: 1970 to 1974, period II: 1984 to 1988) for stone disease. We were especially interested in the development concerning the type of intervention, the diagnostic procedures, the morbidity and mortality. Our analysis showed in the second period the substitution of the preoperative diagnostic procedure away from the cholangiography up to the ultrasound, a significant decrease of interventions, a marked decrease of surgically performed papillotomies and a reduction of mortality.
Ampulla of Vater↗
[HIV infection caused by kidney transplant: case report and review of 18 published cases].
Since 1985 organ donors are routinely tested for the presence of HIV-antibodies, but prior to that time several patients acquired HIV-infection from grafts. In May 1984 a 65-year-old woman on hemodialysis received a cadaver kidney graft from a young iv drug addict. The transplant functioned perfectly with cyclosporin A immunosuppression. Retrospectively, 22 days after surgery HIV antigen was detected. At this time only a faint band of anti-p24 antibodies was found in the Western blot. Two years after surgery splenomegaly was found in the apparently healthy patient. During the third year thrombocytes fell and she developed lymphadenopathy and constitutional symptoms. Up to this time the immunological parameters were in the range of 10 healthy renal transplant patients with cyclosporin A treatment. In the 4th year T-lymphocytes dropped to values below 200 and the patient developed Pneumocystis carinii pneumonia. A few months later a pulmonary node, which later proved to be a B-cell lymphoma, appeared. Slightly less than 5 years after transplantation the patient died from clinically diagnosed pulmonary embolism. The progression of the HIV-Infection in this patient and in one of 18 patients in published reports show that the incubation period is several years shorter in renal transplant patients than in those who acquire HIV from blood products.
AIDS Serodiagnosis↗
[Tubulo-villous adenoma of the duodenum: case report and review of the literature].
In the literature only 123 cases of tubulovillous adenoma of the duodenum have so far been reported. This rare tumor can be readily diagnosed by endoscopy or hypotonic duodenography. Complete surgical or endoscopic removal is necessary in view of cancerous degeneration in 53% of cases. Depending on the localization, extension and size of the tumor, duodenal segment resection, duodenotomy and submucosal excision or duodenopancreatectomy is the best surgical procedure.
Adenocarcinoma, Papillary↗
Primary duodenal carcinoma arising in a non-vaterian tubulo-villous adenoma. A case report with immunocytochemical analysis and review of the literature.
Primary duodenal carcinoma and duodenal adenoma are rare tumours. Duodenal carcinoma makes up about 0.3% of all malignant tumours of the gastrointestinal tract (Alwmark et al. 1980; Spira et al. 1977). The present paper describes a duodenal carcinoma arising in a mixed tubulo-villous non-Vaterian adenoma in a 68 year old male. Immunocytochemical analysis revealed evidence of neuroendocrine differentiation in both adenoma and carcinoma. In a review of the literature a correlation between the size of adenoma and the probability of concomitant carcinoma is demonstrated. Duodenal adenoma measuring more than 4 cm in diameter should be considered potentially malignant.
Adenocarcinoma↗
Changes in maternal and newborn lymphocyte reactivity in reciprocal mixed lymphocyte cultures during the postpartum period.
Reciprocal one-way mixed mother-newborn lymphocyte cultures (MMNLC) containing alternatively maternal or newborn responding (R) or stimulating (S) cells were investigated in both directions in primiparae at three different times: a few hours after delivery, and at 4 and at 16 weeks. Cultures were grown in the presence of maternal and pooled control serum prepared from the blood of five to eight unrelated healthy donors. Four weeks after delivery in maternal and in control serum a significant increase in MMNLC reactivity could be observed, which disappeared at 16 weeks when a pronounced decline in MMNLC values in both directions was found. The suppressive effect of maternal serum was more pronounced at delivery, still evident 4 weeks later, and insignificant after 16 weeks. The results of this study suggest that 4 weeks after delivery, maternal sensitization to fetal histocompatibility antigens can be detected in primiparae with MMNLC; and that 16 weeks later, this was no longer detectable with the same test.
Adult↗
Lymphocyte subpopulations in mother and newborn: correlation with sex of the newborn and number of pregnancies.
T cell subsets were defined with monoclonal antibodies of the OKT series, OKT3, OKT4 and OKT8, in 23 male and 22 female newborns and in their mothers 4-10 h after delivery. The data were compared and statistically evaluated between mother and newborn, between male and female newborns as well as between parity groups. The results indicate that the distribution of OKT4 and OKT8+ cells is different in mother and newborn and a significantly increased percentage of OKT4+ cells and a significantly decreased percentage of OKT3+ cells was observed in newborns as compared to their mothers after the first and second delivery. For maternal cells from male as compared to female newborns the percentage of OKT4+ was significantly decreased after the second delivery. OKT8+ cells in the mother were significantly decreased after the second as well as after three or more deliveries of male as compared to female newborns. With increasing parity the percentage of OKT3+, OKT4+ and OKT8+ cells decreased slowly for both sexes and the difference was significant between primi- and multiparae. The present findings suggest a possible role of the newborn sex and of parity in the distribution of specific T cell subsets in mother and newborn shortly after delivery.
Antibodies, Monoclonal↗
[Transplantation of kidneys of relatives].
In the last few decades kidney transplants have shown an increasing survival rate of about 85% after one year. The growing demand for transplants is limited by the insufficient availability of kidneys and the living donor represents a possible means of reducing the discrepancy between supply and demand. We report here results of 41 transplantations from related, living donors. The overall transplant survival rate at one year was 91% and at 5 years 71%. In the group treated with cyclosporine the survival rate was 92% at 5 years. The mean serum creatinine levels at the latest follow-up was 115 mumol/l, while the mean blood pressure was 139/82 mmHg. Donor nephrectomy resulted neither in morbidity nor mortality. An extensive follow-up study of 8 donors revealed normal values for both blood pressure and serum creatinine. Careful donor selection is crucial in order to guarantee the voluntary nature of donation and, thus, to avoid the risk of commercialism.
Follow-Up Studies↗
[Reduction of renal reperfusion damage following warm ischemia by allopurinol and superoxide dismutase].
Preserved organs are damaged not only by the ischemic injury due to lack of oxygen. The reperfusion injury mediated by oxygen free radicals is an important factor in the postischemic organ failure. The prevention of free radical-induced reperfusion injury with allopurinol (AP) and superoxide dismutase (SOD) is shown in a warm ischemia kidney model. Rats were treated with allopurinol (40 mg/kg i.v.) one hour, or with SOD (20,000 IU/kg i.v.) one minute before reperfusion after a period of 35 minutes of warm ischemia. Allopurinol and SOD reduced significantly the postischemic kidney failure with a less important increase of creatinine. Creatinine levels on day three in the control group: 517 +/- 87 mumol/ml, in the SOD-group: 206 +/- 105 mumol/ml, and in the AP-group: 163 +/- 81 mumol/ml (anal. of variance: p = 0.0001). AP has a wide therapeutic range. We feel, that it is important to confirm the prevention of reperfusion injury by allopurinol prophylaxis clinically.
Allopurinol↗
[Vascular reconstruction following trauma. Experience in Basel 1980-1988].
From 1980-1988 twenty patients with vascular trauma were treated at the Kantonsspital Basel, Switzerland. The incidence of 1% in open fractures is low. Nerve lesions in combination with vascular trauma are very frequent, specially at the upper extremity. Nearly all patients were treated with the interposition of a venous graft from the vena saphena magna. We deplore 3 amputations after successful vascular reconstruction, mainly due to extensive bone and soft tissue damage. Our long-term control shows very satisfying vascular results, but poor neurological results. We therefore conclude that the functional outcome is--apart from a short ischemia time--highly related to the neurological situation at the time of the trauma.
Adult↗
[Implantable catheter system for ambulatory parenteral antibiotic chemotherapy. A prospective study].
17 patients with infectious diseases needed a long-term parenteral antibiotic therapy. Therefore a subcutaneous catheter system (Port-a-Cath) was implanted for intravenous application of the antibiotic drugs. With a total dwelling-time of 952 patient/days no catheter super-infection was observed. Due to postoperative hematoma in an anticoagulated patient one catheter system was not functioning temporarily. One had to be removed on suspicion of a fungous colonization which could not be verified after bacterial examination. Quality of life for all patients was unaltered so that ambulant therapy was possible in almost 20%.
Adult↗
[Organ transplantation].
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Ethics, Medical↗
[A case from practice (104). Patient: Mr. A. M., born 1946].
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Adult↗
Absorption of protein in the early postoperative period in chronic conscious dogs.
Postoperative alterations in amino acid exchange across the intestinal tract and in the capacity for protein absorption were investigated in a chronic canine model. Changes in postoperative splanchnic amino acid exchange consisted of a temporary decrease of total splanchnic amino acid release, including a significant reduction in alanine production, and an increase in glutamine consumption. Contrary to results under stable metabolic conditions, branched chain amino acids were also taken up by the intestine in the early postoperative period. The changes in postoperative amino acid exchange were not, however, reflected by a corresponding alteration in protein transport capacity. The absorptive capacity for a protein hydrolysate remained stable during the early postoperative period.
Amino Acids↗
Risk factors for the development of chronic cyclosporine-nephrotoxicity.
Ninety CSA-treated kidney transplants recipients entered the study. The patients were allocated to three groups based on serum creatinine at 12 months and kidney biopsy findings: control group (serum creatinine less than 177 mumol/l), rejection group (verified by biopsy, serum creatinine greater than 177 mumol/l), nephrotoxicity group (verified by biopsy, serum creatinine greater than 177 mumol/l). Thirty variables were systematically evaluated. The following parameters had a predictive value for the development of chronic CSA-nephrotoxicity: number of CSA-induced episodes of acute deterioration of renal function, CSA trough level (day 0-30, day 31-90), number of unexplained episodes of acute deterioration of renal function, number of nephrotoxic drugs, number of rejection treatments, number of rejection episodes and primary poor renal function. The results indicate that all factors leading to acute renal failure, favor the development of CSA-nephrotoxicity.
Acute Kidney Injury↗
[Arteriovenous fistula for chronic hemodialysis].
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Arteriovenous Shunt, Surgical↗