Biomedical subjects

M Adamec

Publications and source records attributed to M Adamec.

At least 19 recordsLinked to original sources

PubMed2006

Fresh arterial grafts as conduits for vascular reconstructions in transplanted patients.

OBJECTIVES: To assess the outcome of arterial allografts in patients receiving organ transplantation. DESIGN: From October 1997 to June 2005, we used fresh arterial allografts as vascular conduits in 21 patients for the treatment of claudications (10), abdominal aortic aneurysm (6), complicated renal transplantation (2), acute lower extremity ischemia (2) and gangrene (1). At the time of the vascular procedure, ten of the patients (Group A) had already undergone organ transplantation. The mean follow up period was 32 months for renal and 37 months for heart recipients, respectively. In 11 patients (Group B), the vascular reconstruction was undertaken simultaneously with the renal transplantation. The mean follow up period was 49 months. RESULTS: There was no arterial allograft related deaths. No signs of arterial graft infection or requirement for secondary intervention (angioplasty and/or thrombolysis) were observed during the follow up period. CONCLUSIONS: Our experience suggests that it is possible to use fresh arterial allografts in the treatment of arterial occlusive disease or abdominal aortic aneurysm, both in already transplanted patients and simultaneously with organ transplantation, with good results.

Adult↗

PubMed2006

Papillomatosis in a European bison.

Five European bison (Bison bonasus) from three European zoos were shipped to the Bukovské Vrchy Hills (Slovakia) in June 2004 and kept together in an acclimatization enclosure. The European bison were released into the wild in December 2004. At that time, papillomas were found at the medial canthus of the left eye of a 12-yr-old female bison. Cutaneous papillomatosis was confirmed histologically. Negative stain transmission electron microscopic examination revealed papillomavirus in the papillomas, and papillomavirus DNA also was detected using the polymerase chain reaction with FAP59 and FAP64 primers. The amplified 413 bp DNA sequence was identical to that of BAPV2 bovine papillomavirus. This paper is the first report of papillomatosis in European bison.

Animals↗

PubMed2005

Severe depletion of intraepidermal nerve fibers in skin biopsies of pancreas transplant recipients.

BACKGROUND: The minimally invasive method of skin biopsy with intraepidermal nerve fiber (IENF) counts may be used to analyze nerve regeneration in pancreas transplant (PTx) recipients. We assessed IENF counts as a database for long-term follow-up of diabetic neuropathy. METHODS: Skin biopsies were performed using a 3-mm punch from lower thigh and upper calf areas of 16 (13 pancreas/kidney, 3 pancreas alone) PTx patients (mean +/- SD: age, 45+/-8 years; type 1 diabetes duration, 27 +/- 8 years) at 1 month posttransplant. Ten healthy gender- and age-matched controls (C) were also examined. After fixation and freezing, 40-microm sections were stained using rabbit polyclonal antibody to the panaxonal marker PGP 9.5 followed by mouse antirabbit IgG antibody conjugated with rhodamine. Samples were imaged with a digital camera, mounted on a microscope, and equipped for fluorescence. The average number of IENF per millimeter length of epidermis was derived. Clinical neuropathy was assessed by foot vibration perception thresholds (VPT) with a biothesiometer (normal values < mean + 2 SD of C). RESULTS: Significantly lower IENF densities were found in skin biopsies from PTx (PTx vs C: thigh, 0.74 +/- 0.88 vs 9.74 +/- 2.41 IENF/mm; calf, 0.34 +/- 0.91 vs 7.66 +/- 3.16 IENF/mm; P < .001). IENF were totally absent from the thigh and calf samples of 7 and 12 PTxs, respectively. Clinical neuropathy (VPT > 21 V) was present in all but one PTx. CONCLUSIONS: Severe intraepidermal nerve fiber depletion is present in the lower limb area of pancreas transplant recipients with neuropathy. Long-term follow-up would probably be necessary to assess the possibility of posttransplant nerve fiber regeneration.

Adult↗

PubMed2005

Metabolic effect of sirolimus versus mycophenolate mofetil on pancreatic graft function in the early posttransplant period.

Metabolic effects of immunosuppressive agents are of great importance in pancreas or islet transplantation. The aim of our study was to compare effects of tacrolimus-based immunosuppression in conjunction with sirolimus (RAPA) versus mycophenolate mofetil (MMF) on glucose metabolism in type 1 diabetic recipients following a simultaneous pancreas and kidney transplantation (SPK). We examined 30 insulin-independent patients after SPK with venous systemic drainage of the pancreatic graft. All recipients had good kidney graft function. Fasting glycemia, insulin levels, glycosylated hemoglobin (HbA(lc)), standard intravenous glucose tolerance test (IVGTT), and trough RAPA levels were assessed in pancreas recipients before elective steroid withdrawal. Insulin sensitivity was evaluated using the homeostasis model assessment (HOMA-IR). The groups did not differ in age, BMI, posttransplant period, steroid daily dose, HbA(lc), and fasting glycemia. We did not find any significant difference in the IVGTT response. Area under the curve of insulin levels during IVGTT and HOMA-IR were significantly lower in the RAPA group. Trough levels of RAPA had no significant impact on any of the examined parameters. Glucose tolerance measured with the use of IVGTT was similar in patients treated with RAPA and MMF. However, recipients on sirolimus treatment had significantly lower insulinemia during the test and consequently more favorable indices of insulin action as assessed by HOMA-IR.

Area Under Curve↗

PubMed2005

The effect of gemcitabine in the treatment of rejection in experimental small intestine transplantation.

The aim of our study was to test the immunosuppressive effect of gemcitabine in monotherapy following heterotopic SBT in the rat. The BN and LEW rats were used as donors and recipients, respectively. Recipients were divided into 4 groups--group A without immunosuppression, group B treated with a therapeutic dose of tacrolimus, groups C and D treated with various doses of gemcitabine (100 and 150 microg/kg/day). Immunosuppression was administered once a day for 7 days after SBT, when the animals were sacrificed and a histological examination of grafts was performed. Only in group B no signs of acute rejection were seen. Significant differences (P < 0.01) were noted only between group B versus groups A, C, and D. No significant differences were demonstrated between groups A versus groups C, D and between group C versus group D. Monotherapy by gemcitabine (when administered at given doses) was not shown to be effective in preventing acute rejection in a rat model of heterotopic SBT.

Animals↗

PubMed2005

[Small bowel transplantation].

Intestinal transplantation is the logical alternative to definitive total parenteral nutrition in patients with chronic intestinal failure. It has become a lifesaving procedure for patients with intestinal failure who cannot be treated using conventional therapies. In children (over 50% of the recipients) indications include short gut syndrome, primary disorders of intestinal motility and mucosal diseases. In adults, the major indication for intestinal transplantation is inadaptable short bowel syndrome after total or subtotal resection. Patients with irreversible intestinal failure and total parenteral nutrition dependency without consistent liver disease must be considered as candidates for isolated small bowel transplantation. Patients with irreversible intestinal failure and end-stage liver diseases are candidates for lifesaving procedure such as combined liver-small bowel transplantation. The appropriate timing for transplantation remains vague. Advanced disease has further consequences because a considerable number of patients may die of progressive liver failure or infection before suitable organs are available. Candidates for intestinal transplantation should be assessed early and should undergo transplantation.

Animals↗

PubMed2005

[Pregnancy and labor after combined pancreas-kidney transplantation in Czech Republic].

OBJECTIVE: To inform about the first own experiences and to present opinion on leading pregnancy and delivery after a combined pancreas and kidney transplantation. DESIGN: Case report and review article. SETTING: Department of Obstetric and Gynecology, 1st Medical Faculty of the Charles University and General Faculty Hospital, Prague. RESULTS AND CONCLUSIONS: Pregnancies and deliveries after the transplantation of solid organs are not common. Mostly there are experiences with women after kidney transplantation, smaller or no experiences are with women after transplantation of other solid organs. About 25 pancreas transplantation per year are performed in the Czech republic. Two women after the combined kidney and pancreas transplantation were the first in Czech republic to get pregnant spontaneously and delivered by using a chronic immunosupressive. therapy (Prograf, Imuran, Prednison) in 2002 and 2003. These single pregnancies were led as a high-risk pregnancy in Regional Perinatology Center in collaboration with Transplant and Diabetic Center. Both pregnancies were termined from the obstetrical indication before the term by cesarean section. Both children were healthy. The pregnancy of both patients has not affected the function of the transplanted organs and development of both children has been normal.

Adult↗

PubMed2005

Small bowel transplantation in experimental and clinical medicine.

Small bowel transplantation (SBT) has recently the attention of clinicians as an alternative to management of patients with irreversible bowel failure. In this paper, the authors provide an overview of basic facts regarding SBT in experimental and clinical medicine. The paper describes the evolution of bowel transplantation in experiment before it was introduced into clinical practice. In the part discussing clinical SBT, the author's report the currently available international data on SBT. In its conclusion, the paper presents the authors own experience with experimental SBT in animals and humans (Ref. 15).

Animals↗

PubMed2004

Modulating amylase and lipase secretion in the pancreatic graft by somatostatin administration: preliminary results of a prospective, randomized trial.

Pancreas transplantation is a routine method for the treatment of diabetes mellitus. One of the main challenges of a transplant with extraperitoneal placement of the pancreatic graft is impaired wound healing due to massive amylase and lipase secretion by the pancreatic graft, evoking edemtous fluid. From February 2002 through January 2003, we performed pancreatic transplant procedures in 21 patients who were prospectively and randomly assigned to two groups: 8 organ donors and the recipients were administered somatostatin by continuous infusion. Thirteen grafts were harvested and transplanted without somatostatin infusion. The two groups did not show significantly differences in mean donor or recipient ages, weights, of serum amylase and lipase content values or drain output until day 6. There was a significantly lower lipase in the drain output of transplant recipients given somatostatin (12.5 and 54.2 micromol/L, respectively; P <.05). Neither the post-pancreatic transplant wound healing nor the number of rejection episodes were affected by somatostatin administration.

Amylases↗

PubMed2004

A prospective comparison of bladder versus enteric drainage in vascularized pancreas transplantation.

In previous years, the number of pancreas transplants has increased significantly. Debate continues over the optimum technique for exocrine drainage. Enteric drainage (ED) has recently been increasingly popular owing to the long-term complications of bladder drainage (BD). We prospectively evaluated 40 consecutive pancreas transplant recipients undergoing either bladder (n = 20) or enteric (n = 20) drainage. After simultaneous kidney-pancreas transplantation 1-year patient, kidney, and pancreas graft survival rates were 95%, 95%, 85% for the BD group, and 90%, 85%, 85%, for the ED group. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections and cytomegalovirus disease were also similar. The length of the initial hospital stay was likewise comparable. However, the BD group was characterized by a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Our results suggest excellent patient and graft survival irrespective of the drainage technique.

Adult↗

PubMed2004

A prospective comparison of bladder versus enteric drainage in vascularized pancreas transplantation.

Although the number of pancreas transplants has increased significantly in previous years, debate continues concerning the optimum technique for exocrine pancreas drainage. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD). We prospectively assigned 40 consecutive pancreas transplant recipients to either bladder (n = 20) or enteric (n = 20) drainage. Patient, kidney, and pancreas graft survival rates at 1 year after simultaneous kidney-pancreas transplantation were 95%, 95%, 85%, for BD group and 90%, 85%, 85% for ED group, respectively. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections, and CMV disease were similar between groups. The length of the initial hospital stay was likewise comparable. However, the BD group showed a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Based on the results of our study, patient and graft survivals were excellent irrespective of technique.

Adult↗

PubMed2004

[Ischemia of the large intestine after simultaneous kidney transplantation and aortic replacement with a fresh graft in an abdominal aortic aneurysm].

Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibilities for obliterating arterial disorders of low extremities or for the abdominal aortic aneurysm in patients waiting for organ transplantation. Between the year 1998 and the end of the year 2002, our work-team performed parallel reconstructions of the abdominal aorta using fresh grafts and cadaverous kidney transplantations in a group of five patients. The simultaneous surgical treatment of the both disorders during a single hospitalization as well as a considerable decrease of the artificial blood vessel prosthesis infection risk during chronic imunosuppression, represent the biggest advantage of this method. On the other hand, the risk of possible surgical complications is increased in these patients. During the operation and postoperation period, our four patients suffered from no serious complications. In case of one patient, ischemic colitis occurred which required surgical revision and subtotal colectomy. In this article, the authors describe the postoperation course of the patient condition with the above complication, which required a close cooperation of surgeons, anesthesiologists and nephrologists, in full detail.

Aorta, Abdominal↗

PubMed2003

Spectral analysis of heart rate variation following simultaneous pancreas and kidney transplantation.

Only marginally improved results have been observed in standard autonomic function tests (AFT) in follow-up studies after simultaneous pancreas and kidney transplantation (SPK). We therefore used power spectral analysis (PSA) of heart rate variability (HRV) to assess the effect of SPK on autonomic neuropathy in patients with type I diabetes mellitus (DM I). We evaluated 82 patients with DM I who were insulin and dialysis free following SPK. Both pre- and posttransplant (at [mean +/- SD], 25 +/- 15 months post-SPK) examinations were performed in 29 patients. Posttransplant evolution was examined in another 60 patients with two serial examinations at 20 +/- 20 and 43 +/- 27 months after SPK. Comparisons included 32 age-matched healthy controls and 13 patients with kidney transplant alone (KTA) matched for age and duration of DM I at a comparable time point posttransplant. Short-term time (modified Ewing battery) and frequency domain (PSA of HRV: LF-low, HF-high frequency, and TP-total spectral power) analysis was performed with a telemetric, on-line, computer-aided system. Significantly worse results in all standard AFT and PSA indexes were obtained for SPK patients compared with controls at all time points. No significant improvement was seen in SPK patients in the posttransplant period and no differences were found compared with KTA patients. Thus the results of a power spectral analysis of HRV failed to show improvement following SPK. This examination adds little positive information to that obtained from standard autonomic function tests.

Adult↗

PubMed2003

[Disorders of parathyroid function in patients on regular dialysis therapy and after kidney transplantation].

BACKGROUND: Parathyroids dysfunction is a key disorder in the spectrum of renal osteopathy, occurring after renal transplantation and, occasionally, after parathyroidectomy. In our subjects, dysfunction is understood as plus or minus activity. METHODS AND RESULTS: Parathyroidectomy as the primary procedure was performed in 179 patients for all types of hyperparathyrodism. In 70% of cases the secondary hyperparathyroidism was treated, believed to be the most severe condition. Present assessment was focused on postoperative parathyroid hormone levels (pg/ml) in three groups of patients (n = 92). Group 1 with parathyroid gland autoimplants following total parathyroidectomy; Group 2 after partial or subtotal surgery; Group 3 after autologous implantation of cryopreserved parathyroid glands in severe hypoparathyroidism. Group 1 (32 dialysis and 9 non-dialysed patients): 228.9 vs 85.9 pg/ml; ns; hypofunction in 50% and in 33% respectively, afunction in 12.5% of dialysed patients, in non-dialysed patients it was not detected. Group 2 (25 dialysis and 24 non-dialysed patients): 603.3 vs 169.8 (pg/ml); p = 0.01; hypofunction in 16% and in 8% respectively, afunction was not detected. Complete groups 1 and 2 of patients: 197.5 vs 382.3 pg/ml (p = 0.0016). Dialysed patients in Group 1 and 2: 228.9 vs 603.3 pg/ml (p = 0.007); non-dialysed patients: 85.9 vs 169.8 pg/ml; ns. Group 3 (15 dialysed patients): 63.0; hypofunction and afunction in 40%. This group (63.0 pg/ml) vs Groups 1 and 2 of dialysed patients (p = 0.031 and 0.0004), respectively. Basic laboratory findings before operations of tertiary hyperparathyroidism were shown. CONCLUSIONS: After total parathyroidectomy with parathyroids autoimplantation, parathyroid hormone is acceptable to dialysis and non-dialysis patients. Partial parathyroidectomy prevents development of hypoparathyroidism. It is associated, however, with a risk because of hyperparathyrodism recurrence. Cryopreserved autologous parathyroids reach lower parathyroid levels compared with "fresh" parathyroid tissue autoimplants. Parathyroidectomy after successful renal transplantation may be indicated.

Adolescent↗

PubMed2003

[Vascular complications after pancreatic transplantation].

Transplantation of pancreas is presently the only way of treating diabetes of the 1st type, capable to secure a long-term normoglycemia. In spite of the fact that the surgical technique and tactics of the whole intervention has been standardized over the last years, surgical complications and more specifically vascular complications still pose a certain risk of the graft loss. The thrombosis of vessels of the transplanted pancreas occurred in our group in 4.1 per cent of cases. The other rare complications included a false aneurysm of the supplying artery and stenosis of the out-coming vein from the pancreatic graft. Both these complications were successfully treated by a radio-invasive approach. A refinement of the surgical technique and the introduction of new immunosuppressive drugs manifests favorably in decreasing occurrence of vascular complications after the transplantation of pancreas.

Adult↗

PubMed2003

[Viability of parathyroid gland tissue measured by flow cytometry].

BACKGROUND: Postoperative hypoparathyroidism after the total parathyroidectomy (PTX) remains a problem, no matter our experiences with 243 operations on parathyroid glands (PG). Implantation of "fresh" tissue, cryopreservation and reimplantation of cryopreserved tissue are performed with uncertain results. The aim of this project was to compare viability of cryopreserved tissue of parathyroid glands with "fresh" tissue obtained during parathyreoidectomy and with tissue from cadaverous donors. METHODS AND RESULTS: Group 1 included 55 cryopreserved samples obtained from 41 patients after PTX (22M, 19F, a mean age of 46 +/- 11 years). Average duration of storage in liquid nitrogen was 84 +/- 49 months. Group 2 included "fresh" tissue of PG, harvested during PTX. Viability was measured in different time in samples from 42 patients with hyperparathyroidism (11M, 31F, a mean age of 55 +/- 13 years). Group 3 included tissue of 14 cadaverous donors obtained during multiorgan harvesting (7M, 7F, a mean age of 31 +/- 5 years, WIT 32 min). Viability was measured by flow cytometry with propidium iodide after dissociation of tissue. Evaluation of PG tissue was proven by histology. Average viability in group 1 was 36.9 +/- 24.7%, no correlation with the duration of storage in liquid nitrogen was found. Average viability in group 2 was 51.4 +/- 24%. Viability in group 3 was 66.8 +/- 32%. Group 1 vs. group 2 were different with p < 0.05, group 2 vs. 3 did not reach significance (with marginal p = 0.06) and group 1 vs 3 were different with p < 0.001. CONCLUSIONS: The highest viability was found in tissue of cadaverous donors, the lowest in cryopreserved tissue (with no correlation to the duration of storage in liquid nitrogen).

Cadaver↗

PubMed2003

[Transplantation of the pancreas].

Diabetes mellitus is a chronic disease with increasing prevalence in the population of the whole word. Transplantation of pancreas represents pro tempore the only treatment of Type I diabetes, which can assure long-lasting normal glycaemia and the independence from the insulin administration. However, transplantation still has higher morbidity and requires permanent immunosuppression. Authors describe their clinical experience with more than 200 transplantation of pancreas and they compare them with literary data. They review the basic problems and indications to the transplantation and in details describe the technique of the operation. Attention is given to the possible complications and to the immunological side of treatment. As a standard, the surgical technique has been using combined transplantation of pancreas and kidney. The most widely used method is the transplantation of the whole gland with a duodenal segment, which enables drainage of pancreatic juices into the intestine of the recipient. Due to the introduction of new immunosuppressives, it is possible to improve the long-term results of transplantations. Early diagnostics of the rejection of the pancreatic graft remains a specific problem.

Czech Republic↗

PubMed2002

[Pedal bypass in the treatment of ischemic diabetic foot].

AIM: The aim of this retrospective analysis was assessment of both patency and limb salvage rates of diabetic ischemic feet which underwent pedal bypass surgery within the period of 3 years. MATERIAL AND METHODS: Authors evaluated 50 critically ischemic diabetic feet where the pedal bypass was indicated for limb salvage. Total 41 pedal bypasses were performed and median follow-up was 16.7 months (1-39). The free muscle transfer were performed either in one session with or subsequently after the pedal bypass surgery in six limbs. RESULTS: Authors achieved 61% and 76% graft patency and limb salvage rates, respectively, within the median 16.7 months follow-up. All successfully revascularised feet healed up within the median period of 3 months postoperatively. No patient died within 30 days postoperatively. CONCLUSION: We conclude, that pedal bypass is safe procedure with acceptable limb salvage rate in the medium-term follow-up. Surgeons can markedly extend an indication criterions for limb salvage by exploiting of this technique.

Adult↗