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M Gnant

Publications and source records attributed to M Gnant.

At least 55 records · Page 3Linked to original sources
PubMed1994

Reasons for 50% reduction in the number of organ donors within 2 years--opinion poll amongst all ICUs of a transplant centre.

To detect the reasons for a massive decrease in the annual number of organ donors and as a means of evaluating the effectiveness of our information programme, a questionnaire was designed and sent to all intensive care units (ICUs) in our catchment area. We wished to obtain information about medical, organizational and capacity problems and negative occurrences that had happend during past retrievals. Although 60% of the answers we reiceved (87% feedback rate) mentioned the additional workload involved in treating an organ donor (and 88% had serious problems because of the shortage of nurses), less than 16% remembered a "lost" donor because of capacity problems. Eighty-six percent recognized our efforts to support them in any respect and were satisfied with the amount of "service" provided by the transplantation (TX) centre. About 45% remembered negative occurrences. More than 85% of all replies asked for more and continuing information related to organ donation and transplantation. We think that the key to a successful TX programme is a system of active care for the ICU staff in all peripheral hospitals; repeated mailing of updated information brochures, annual lectures about new developments, letters of thanks after each reported donor (including information on the fate of the organs), visiting donor ICU's accompanied by successfully transplanted recipients, etc.... The downwards trend of donor rates in our area clearly shows that it takes more than a stable legal situation to ensure the necessary amount of donor organs, even a very successful TX centre has to work hard to maintain a certain standard of knowledge, information and motivation amongst the staff of the peripheral hospitals. Moreover, the high turnover rate of ICU personnel requires a steady "flow of information" and cooperation between the "transplant people" and their coworkers outside to guarantee a permanent state of awareness concerning organ donation and transplantation. In fact, awareness seems to be the key issue: the activity of sending out the questionnaires was enough to raise the number of reported donors from 72 (estimated in July) to 96 (31 December 1992).

Austria↗
PubMed1993

[Laparoscopic colon surgery--from experiment to initial clinical experience].

The technique of Laparoscopic resection of the colon sigmoideum was practised in an experimental model before starting a clinical program of laparoscopic colonic surgery. Until now, two resections of the colon sigmoideum, one ileocecal resection, one right colectomy, one Hartmann's procedure and one transversostomy have been performed laparoscopically. Three patients had colonic carcinoma. One sigmoid resection had to be converted to open surgery and this patient underwent relaparotomy because of postoperative ileus. The postoperative course of the other patients was uncomplicated. The promising initial experience demonstrates that laparoscopic colonic surgery is feasible, although further studies have to prove advantages and indications, especially with respect to oncology.

Adolescent↗
PubMed1993

[Bile duct injuries in laparoscopic cholecystectomy].

We report on three patients with iatrogenic lesions of the common bile duct after laparoscopic cholecystectomy. In one patient, an additional occlusion of the hepatic artery was found. The leading postoperative signs were jaundice and cholangitis. Endoscopic and radiologic intervention failed to correct the common bile duct stenosis in all three patients. Surgical correction by hepaticojejunostomy was successful, although the postoperative follow-up is still short.

Adult↗
PubMed1992

Cadaveric kidney donation beyond the age of 60 years--a comparative analysis of 1180 grafts from different donor age groups.

The impact of high donor age on transplantation outcome was analysed in 1180 consecutive cadaveric grafts transplanted in adult recipients. Grafts were divided into three groups acording to donor age (< 55 years (n = 1073, group 1), 55-59 years (n = 51, group 2), > or = 60 years (n = 56, group 3)) and transplantation outcome was compared for these groups. Criteria investigated were the incidence of primary non-function (PNF), initial function (IF) (urine production first 24 h) and long-term function (LTF). The impact of donor age on LTF was analysed among other potential donor, graft and recipient risk factors by the multivariate proportional hazardous model analysis (Cox model). The incidence of PNF was 5.8% (group 1), 11.8% (group 2), and 16.1% (group 3) (P = 0.002). Analysis of paired kidneys of PNF grafts in group 2 and group 3 revealed good function for all paired grafts except for one in each group. IF was anuria in 19.7% of group 1, 29.4% group 2 and 21.5% of group 3, oliguria in 18.2% of group 1, 23.5% of group 2 and 32% of group 3. Normal diuresis was found in 62.1% of group, 47.1% of group 2 and 47.3% of group 3 (P = 0.05). Independent risk factors for graft survival were year of transplantation, recipient age, panel reactive antibodies, donor age group and number of transplantation. After the exclusion of PNF grafts from the analysis, recipient age, year of transplantation and level of panel reactive antibodies remained as independent risk factors.

Adult↗
PubMed1992

Risk factors for development of panel reactive antibodies and their impact on kidney transplantation outcome.

The impact of potential risk factors for development of panel reactive antibodies (PRA) in 1078 cadaveric kidney graft recipients was investigated in a multivariate analysis. Multiple transplantation, transfusion of more than five blood units and more than two pregnancies were revealed as factors with a significant independent impact on the formation of high levels of PRA. Multiple transplantation and polytransfusion also affected primary non-function, initial function and long-term graft survival at 1, 3 and 5 years. Incidence of early rejection (within 30 days) was significantly increased with repeated transplantation and decreased with a full-house HLA match. However, these effects on transplantation outcome could only be observed when risk factors lead to the formation of antibodies. In patients with risk factors present, but without subsequent sensitization, the graft survival expectation was the same as in patients in whom risk factors were absent.

Antibodies↗
PubMed1992

Relationship of CD15 immunoreactivity and prognosis in sporadic medullary thyroid carcinoma.

Immunoreactivity with monoclonal antibody CD15 (Leu-M1) was investigated in the primary tumours, the metastases and local recurrences of 47 cases of sporadic medullary carcinoma of the thyroid (MTC). Of these tumours, 36.5% showed a varying degree of CD15 immunostaining; in 7 carcinomas the CD15 immunoreactivity was found to be significant (greater than 15% tumour cells positively stained). Staining of the amyloid stroma was observed in 3 tumours. Significantly higher epithelial CD15 positivity was seen more frequently in the group with larger tumours (greater than 4 cm) and was found exclusively in the presence of lymph node metastases. No substantial difference in the percentage of immunostained cells was seen between primary tumours and metastatic or recurrent lesions, except for two cases that revealed a significant increase in the number of CD15-immunostained cells in metastatic and recurrent lesions. Five of 7 patients with recurrences showing significant CD15 immunostaining died of cancer, while in the absence of significant CD15 staining all patients with recurrences were still alive at the conclusion of the study. The prognostic value of CD15 immunoreactivity, found by univariate analysis, becomes weaker after adjustment for the size and stage of tumour. Particularly in patients with tumour recurrences CD15 immunostaining may be of clinical relevance for the selection of patients in whom a more radical surgical approach would be justified.

Adult↗
PubMed1992

[Laparoscopic cholecystectomy--evaluation of a prospective follow-up study].

A report is presented on 105 patients who underwent laparoscopic cholecystectomy because of symptomatic gallstone disease. Preoperative and intraoperative findings, complications and results were prospectively documented. In four (3.8%) patients the laparoscopic procedure had to be converted into open cholecystectomy. There were only minor surgical complications such as wound infection and a subhepatic haematoma. On average, patients were discharged on the second postoperative day. The operating time decreased from a median of 98 minutes in the first half to 73 minutes in the second half of the study, despite augmentation of the number of surgeons and of the indications to include patients with acute cholecystitis (n = 11), previous upper abdominal surgery (n = 7) and cirrhosis (n = 2).

Aged↗
PubMed1991

[Experiences with liver transplantation in hepatitis B antigen positive liver cirrhosis].

From 1982 to January 1991 228 orthotopic liver transplantations (OLT) were performed in 213 patients with end-stage disease at the Vienna transplantation centre, 1st University Department of Surgery. 14 patients were serum HBV surface antigen (HBsAg) positive at the time of transplantation. In the first 4 patients only OLT was performed; postoperatively all grafts became reinfected and the patients developed chronic hepatitis. In a further series, immunoprophylaxis against hepatitis B virus reinfection was carried out with hyperimmuneglobulin. In 4 patients short-term immunoprophylaxis was performed; all of them were seronegative after OLT, but HBsAg ++reoccurred in the serum within 3-16 weeks after transplantation and all patients experienced reinfection of their graft. The 2 patients, who had been transplanted in a replicative state (HBeAg positive) showed a fatal course of hepatitis in the graft. Out of 6 patients given long-term immunoprophylaxis 3 cases showed stable liver function, without any signs of reinfection, and the HBsAg negative status remained for up to 19 months after transplantation. Since two patients displayed a HBV replicate status prior to transplantation, alpha interferon was administered preoperatively, which resulted in decreased serum HBV-DNA levels.

Adult↗