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Biomedical subjects

M Adamec

Publications and source records attributed to M Adamec.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Metabolic sequelae of pancreatic transplantation using two different surgical techniques].

BACKGROUND: By transplantation of the pancreas in diabetics type 1 long-term-term independence on exogenous insulin can be achieved. The extent of normalization of the carbohydrate metabolism can depend on the applied surgical technique. The objective of the submitted work was to compare indicators of compensation of diabetes one year after combined transplantation of the kidney and pancreas, using the method of transplantation of a segment of the pancreas with obliteration of the pancreatic duct by a polymer and the method of transplantation of the whole pancreas with drainage of the pancreatic duct into the urinary bladder. METHODS AND RESULTS: The authors examined two groups of recipients, 13 subjects each with full function of the pancreatic graft one year after transplantation where a combined transplantation of the kidney and pancreatic segment (group SP) had been performed or of the kidney and whole pancreas (group CP). The authors investigated the blood sugar level, glycated haemoglobin, intravenous glucose tolerance test, free insulin level and C-peptide as well as some indicators of the lipid metabolism and acid base balance. In both groups normal blood sugar levels were achieved, though the mean values in the course of the day were higher in group SP than in group CP (mean +/- SE 5.48 +/- 0.11 as compared with 4.98 +/- 0.09; p < 0.01). Glycated haemoglobin declined in group SP from the pretransplantation value of 9.31 +/- 0.09 to 6.40 +/- 0.10% and in group CP from 9.49 +/- 0.15 to 4.92 +/- 0.08%. In group CP the glycated haemoglobin after transplantation was significantly lower (p < 0.01), similarly as the coefficient of glucose assimilation (1.83 +/- 0.03 as compared with 1.25 +/- 0.15; p < 0.05). Indicators of the acid base balance did not differ. Recipients in group CP were however permanently treated with bicarbonate. CONCLUSIONS: With both transplantation method it is possible to achieve compensation of diabetes close to normal. The carbohydrate tolerance is however better after transplantation of the whole pancreas.

Adult↗
PubMed1997

[Initial experience with angioscopy in infrainguinal reconstruction using the in situ saphenous vein technique].

The authors report on their experience with lower limb revascularization using the in-situ saphenous vein bypass grafting in four patients with angioscopically assisted valvulotomy. They describe the surgical technique employed and outcome of the procedure. The discussion section examines the pros and cons of the technique of in-situ saphenous vein bypass with angioscopically assisted valvulotomy (ISB + AV) compared with the standard technique of reversed bypass (RVB).

Adult↗
PubMed1997

[Use of the circular stapler for duodenal-cystic anastomosis in pancreas transplantation].

The number of combined transplantations of the pancreas and kidney in type I diabetics with chronic renal failure is increasing every year. The authors present their experience with a new technique of duodenocystostomy during this transplantation. The use of a circular stapler to create the duodenocystoanastomosis can hasten the surgical procedure and reduce at the same time the risk of development of a pancreatic fistula.

Anastomosis, Surgical↗
PubMed1997

[Pulsed doses of calcitriol in the treatment of secondary hyperparathyroidism in patients on hemodialysis].

Administration of pulse doses of calcitriol is a better way of conservative treatment of secondary hyperparathyroidism (2HPT), making use of the direct suppression of parathormone (PTH) secretion. In a group of 29 haemodialyzed patients the authors evaluated during a six-month follow-up the effect of intravenous Calcijex in 12 and of oral Rocaltrol in 8 subjects. In responders of the calcijex group the PTH level declined by 67.6%, the mean baseline PTH value being 787.8 pg/ml, as compared with non-responders where the decline of PTH at the end of the investigation was 7.5%, the baseline PTH being 1296.4 pg/ml. The difference was significant (p < 0.05). In patients treated with Rocaltrol the therapeutic effect was apparent also in subjects with a lower baseline PTH. An associated phenomenon of treatment are as a rule parallel changes of kALP and ACP levels with those of PTH. It was however revealed that the drop of serum activities can occur also without a concurrent drop of PTH which indicates a dissociation between the level of bone metabolism and PTH secretion. The therapeutic effect can be influenced not only by the stage of 2HPT but also by the route of administration and quantity of calcitriol doses, as ensues from a long-term follow up of one patient. Moreover, the morphological substrate of the hyperplastic tissue of the parathyroid gland and their receptors for 1,25(OH)2D3 must be taken into account. Successfully performed parathyroidectomy, a still justified therapeutic step, is associated as a rule with rapid restoration of PTH levels. TO CONCLUDE: Pulse doses of calcitriol seem to be at present the effective treatment of diagnosed 2HPT, conventional oral calcitriol doses are useful in 2HPT prophylaxis. 2. The i.v. form should be the last resort of conservative treatment before parathyroidectomy. 3. Calcitriol treatment should attempt to maintain slightly raised PTH levels. 4. The limiting indicators of treatment are hypercalcaemia, hyperphosphataemia and the development of extraosseous calcifications. 5. In order to adhere to these criteria it is necessary to use dietary provisions, the dialyzation technique and check biochemical indicators of bone metabolism and possibly change doses of pharmaceutical preparations.

Administration, Oral↗
PubMed1996

[Large-scale isolation of islets of Langerhans in dogs and human].

BACKGROUND: Transplantation of isolated islets of Langerhans is a perspective method of treating type 1 diabetes. The first prerequisite for its implementation is to obtain sufficient amounts of vital islets. The objective to the authors' experiments was to introduce a method of massive isolation of islets of Langerhans from dogs which would serve as a model pro obtaining islets of Langerhans from humans and would permit to use them in future in clinical practice. METHODS AND RESULTS: After excision of the dog pancreas the authors injected into the ducts a 1% collagenase solution and the tissue was deposited in a specially developed semi-automatic isolation system which consisted of a vibrating isolation chamber in which an isolation solution with controlled temperature circulated. As soon as the islets started to be released, the system was cooled and the disintegrated tissue was collected. The islets were separated from the acinar mass by centrifuging in a ficoll mass gradient. The islet function was tested by transplantation to athymic diabetic mice. A total of 15 isolations of dog islets was performed, incl. 5 which were evaluated quantitatively. In a similar way twice isolation from a human cadaverous pancreas was implemented. On average 6336 +/- 745 (+/-SD) purified dog islets were obtained. Their function was tested by normalization of the blood sugar after transplantation to diabetic mice. The authors obtained also vital highly purified human islets. CONCLUSIONS: The authors developed a method of isolation of dog and human islets of Langerhans which makes it possible to obtain sufficient amounts of vital islet tissue which could be used for transplantation. A further task will be to standardize the process and adjust it to hygienic norms essential for clinical use.

Animals↗
PubMed1996

[Long-term treatment of diabetes with transplantation of a pancreatic segment].

BACKGROUND: Successful transplantation of the pancreas is at present the only way how to ensure on a long-term basis an almost physiological regulation of the carbohydrate metabolism in type 1 diabetics. So far it is, however, indicated mainly in patients with already advanced microangiopathy where at the same time also renal transplantation is planned and long-term experience is so far limited. The objective of the submitted paper is to report on the development of metabolic compensation and its impact on the development of microangiopathic changes in type 1 diabetics where the complete function of both grafts persisted more han five years. METHODS AND RESULTS: From a group of 34 combined transplantations of a pancreatic segment with an obliterated duct and a kidney, implemented in 1983-1988 in the Institute of Clinical and Experimental Medicine, a group of nine type 1 diabetics was followed up where the independence on exogenous insulin and haemodialyzation treatment persisted for or still persists for 5-8 years. After annual intervals the blood sugar level was examined, the intravenous glucose to tolerance test, free insulin levels, glycosylated haemoglobin, an ophthalmological and neurological examination was made, incl. the peripheral and autonomous system, and by means of a standard questionnaire the quality of life before and after transplantation was assessed. In all examined subjects normal blood sugar levels were recorded. The fasting insulin levels in transplant recipients were higher than in healthy subjects (22 vs. 10.2 microU/ml, p < 0.01) while in the course of the blood sugar curve corresponding levels were recorded. Glycosylated haemoglobin remained after 5 years quite or almost normal (4.2-7.2%). The coefficient of glucose assimilation after 5 years varied in the range from 0.7 to 1.9% min. Hypoglycaemic states were not recorded. In none of the recipients in the course of the investigation deterioration of the ophthalmological finding was observed and in three patients improvement was recorded. Symptoms of somatic polyneuropathy improved in all patients but signs of vegetative neuropathy remained unchanged. In all recipients psychic, physical and social rehabilitation as well as the general quality of life improved markedly. CONCLUSIONS: Although the group of investigated patients is so far small, the authors provided evidence that combined transplantation of the pancreas and kidney can influence in a very favourable way the quality of life and development of microangiopathic complications. As the success rate of transplantations of the pancreas in increasing and the risk of surgical complications is declining due to improving surgical techniques, the authors conclude that combined transplantation of the pancreas and kidney is at present the optimal therapeutic procedure in type 1 diabetics with chronic renal insufficiency and that indication for transplantation of the pancreas could be moved to earlier stages of diabetes when it would be possible to influence the development of diabetic microangiopathy more favourably.

Adult↗
PubMed1996

[Personal experience with use of Claforan in the form of a "protected coagulum" in patients after kidney transplantation].

Prophylaxis by means of antibiotics in the form of a so-called "protected coagulum" is an important part of prevention of postoperative infections in renal transplantations. The antibiotic is selected with regard to its effectiveness against the most frequent pathogens, tissue penetration, undesirable effects (in particular nephrotoxicity). The authors investigated a group of 450 renal transplantations with cefotaxime prophylaxis. During the four-week follow-up period after operation infection of the surgical wound (abscess, purulent secretion) occurred in 15 patients (3.33%). The mentioned results indicate that cefotaxime is suitable for use as a protected coagulum also in patients with postoperative immunosuppression.

Adolescent↗
PubMed1996

[Treatment of a pancreatic fistula after pancreatic transplantation using the obliterative technic].

The authors present the case-record of a patient after combined transplantation of the pancreas and kidney who developed a chronic duodenocutaneous fistula. The case was resolved by elimination of the duodenocystoanastomosis of the transplanted pancreas and by obliteration of the pancreatic duct of the graft by a polymer. One year after surgery the patient has no complaints and the function of both transplanted organs is satisfactory.

Adult↗
PubMed1996

[Surgical complications after kidney transplantation].

In the period from 1 January 1992 through 31 December 1995, a total of 582 renal transplantations were performed at the Department of Cardiovascular and Transplant Surgery of the Prague-based Institute for Clinical and Experimental Medicine. This number does not include combined kidney and pancreas transplantations. In 571 cases, the kidney was transplanted from a cadaveric donor while living related donors were involved in 11 cases. Of the 582 procedures, 515 were first transplantations while the remaining 67 were re-transplantations. The most frequent surgical procedure was lymphocele developing in 70 patients. Urinary fistula was present in 39 patients while 21 patients developed early obstruction or stenosis of the ureter. Other complications included graft rupture, bleeding, vascular thrombosis and a rare case of bowel perforation. Surgical complications required graft nephrectomy in 27 cases (4.6%).

Female↗
PubMed1995

[Removal of the kidney from a related transplant donor using subcostal lumbotomy].

Transplantation of the kidney from a live donor and transplantations to relatives account still for a not negligible percentage of all transplantations. Removal of the kidney from a healthy subject is a demanding and subtle operation. In recent years usually this procedure for transplantations to relatives is performed by subcostal lumbotomy. The authors analyze a group of eight patients, kidney donors, after operation. There were no serious surgical complications and therefore the authors will prefer this procedure also for future operations.

Female↗
PubMed1994

[Surgical complications in combined transplantation of a kidney and a pancreatic segment with an obliterated duct].

The surgical aspect of transplantation of the pancreas is despite its many years' history still an unresolved problem. If we summarize contemporary knowledge and achieved results, it ensues that so far unity has not be attained as regards surgical tactics and technique of the operation. The authors submit an analysis of surgical complications after combined transplantation of a kidney and a pancreatic segment with an obliterated duct. In the group of 38 patients with transplantations the moc frequent cause of loss of function of the transplanted gland during the early postoperative period was vascular thrombosis of the pancreatic graft. Infectious complications, haemorrhage, necrosis of the graft and ileus were also described. Surgical complications developed in more than half the patients of the investigated group which made the authors contemplate a change of surgical technique and after experimental preparation transplant the entire gland with drainage of the pancreatic duct into the urinary bladder.

Adult↗
PubMed1994

[100 renal transplantations with intravesical implantation of the ureter].

Transplantation of the kidney is nowadays a common therapeutic method. During the past 30 years in the transplantation centre of IKEM more than 1200 transplantations were performed. The authors present a group of 100 patients where the ureter of the transplanted Kidney was attached to the urinary bladder of the recipient by intravesical technique. With regard to the low incidence of fistulas and the easy solution of complications this technique can be widely used in clinical transplantation programmers.

Humans↗