Biomedical subjects

M Kalinowski

Publications and source records attributed to M Kalinowski.

At least 19 recordsLinked to original sources

PubMed2006

[Rare cause of chronic recurrent pulmonary emboli and pulmonary artery hypertension].

HISTORY AND CLINICAL FINDINGS: A 41-year-old man with known Klippel-Trenaunay syndrome was admitted to hospital because of progressive dyspnea on exertion. Examination on admission revealed the typical signs of Klippel-Trenaunay syndrome, predominantly of the left leg. INVESTIGATIONS: D-dimers were significantly increased. Contrast-enhanced computed tomography of the chest revealed multiple small pulmonary arterial emboli in subsegmental arteries on both lungs. Pulmonary arterial digital subtraction angiography revealed extensive peripherally localized perfusion defects. Pulmonary artery pressure measurement demonstrated bilateral pulmonary artery hypertension. Phlebography of the left lower leg showed marked varices in the calf. There was also a persisting sciatic vein. DIAGNOSIS, TREATMENT AND COURSE: The recurrent peripheral pulmonary emboli with pulmonary arterial hypertension was a complication of a Klippel-Trenaunay syndrome. Another rare entity of this syndrome was a persisting sciatic vein. Heparinization was initiated, followed by oral anticoagulation. As the patient had not been anticoagulated before, implantation of an inferior vena cava filter was not deemed appropriate. CONCLUSIONS: Recurrent peripheral pulmonary emboli leading to chronic pulmonary artery hypertension is a rare but typical complication of Klippel-Trenaunay syndrome. Early recognition of this syndrome and any complications as a separate entity, as well as initiation of therapeutic measures, like anticoagulation or early pulmonary thrombendarterectomy for chronic pulmonary artery emboli, are of prognostic importance.

Adult↗

PubMed2006

Use of the LMA-ProSeal in an experimental pig model -- a potential animal model for laryngeal mask airway research: results of a pilot study.

OBJECTIVE: In light of the increased use of the LMA-ProSeal (P-LMA) it seems desirable to consider the P-LMA for prolonged surgical cases or post-operative ventilation. Long-term use could carry the risk of serious complications. An experimental pig model could be used to gain basic knowledge about long-term use before conducting clinical trails. In this randomized controlled study we tested the hypothesis if prolonged positive pressure ventilation (PPV) with the P-LMA in the pig is possible. METHODS: The P-LMA was used for airway maintenance under general anaesthesia and PPV in 15 German country pigs. Randomised into 3 groups, the animals were ventilated for 90, 150 and 390 minutes, respectively. Arterial blood gas measurements were used to determine adequacy of ventilation. Airway leak pressure (P (leak)) and maximum tidal volume (TV) were measured in the supine, lateral and prone positions. A bronchoscopic examination was performed to detect signs of aspiration. RESULTS: Adequate ventilation was demonstrated both after 120 min (4.7 +/- 0.4 kPa) and 360 min (4.7 +/- 0.5 kPa). The corresponding PaO(2) at FiO(2) = 1.0 was 59 +/- 5 kPa and 64 +/- 10 kPa, respectively. The mean P (leak) was 34 +/- 7 cm H(2)O. Change of position did not result in any significant change in P(leak) or maximum TV kg (-1). There was no bronchoscopic evidence of aspiration in any pig. CONCLUSION: It was possible to ensure sufficient PPV with the P-LMA in the pig over different periods of time and in different body positions without any complications of airway management. The P-LMA can be used for PPV in the pig for durations of up to 390 minutes. We conclude that investigations into the long-term use of the LMA can be carried out in a pig model.

Anesthesia↗

PubMed2004

[1-molar Gadobutrol as a contrast agent for digital subtraction angiography].

PURPOSE: To evaluate one-molar Gadobutrol solution as contrast media for intra-arterial digital subtraction angiography (DSA). MATERIALS AND METHODS: In 10 patients (7 males, 3 females; mean age 68 years) with contraindications for the use of iodinated contrast media (n = 8 renal insufficiency, n = 2 previous allergic reaction), Gadobutrol solution (1 mol/l) was used as contrast media for DSA. Six diagnostic angiograms and four DSAs for percutaneous transluminal angioplasty (PTA) were performed. RESULTS: In all cases, Gadobutrol yielded sufficient contrast for diagnostic DSA. Because of dose limitations (maximum 0.3 ml/kg body weight), small amounts of iodinated contrast media were administered to complete the angiographic procedure (mean 15 ml) in two patients. Allergic reactions were not recorded in any patient. In patients with pre-existing renal insufficiency, mean serum creatinine level was not statistically significant different from the initial level (mean 2.88 mg/dl before and 2.83 mg/dl after DSA). Selective injection of Gadobutrol resulted in temporary discomfort. CONCLUSION: One molar Gadobutrol is an alternate contrast media for DSA in patients with contraindications for iodinated contrast media. Current dose limitations require selective injections.

Aged↗

PubMed2003

[Transjugular implantation of venous port catheter systems].

PURPOSE: Prospective analysis of success and complication rates of chest port implantation via the internal jugular vein. MATERIALS AND METHODS: In 50 consecutive patients (25 men, 25 women; mean age 61 +/- 14 years) the internal jugular vein was punctured under ultrasound guidance. Through this access, a port system was inserted and the catheter tip was placed at the cavoatrial junction. The port reservoir was implanted into a subcutaneous infraclavicular pocket and fixed to the fascia of the pectoralis muscle. Indications for port implantation were chemotherapy (n = 46), total parenteral nutrition (n = 2) or intravenous medication (n = 2). RESULTS: A chest port catheter system was successfully implanted in all 50 patients. The mean duration of placement was 90 +/- 65 catheter days. No complications occurred during implantation. In the post-interventional period a single catheter dysfunction occurred (0.22 per 1,000 catheter days). Two local infections occurred in the early post-interventional period (0.43 per 1,000 catheter days). One port system had to be explanted prematurely due to pain. CONCLUSION: The ultrasound guided puncture of the internal jugular vein enables a safe access for insertion of a central venous port catheter system and is associated with a very low complication rate. Port placement via this access vein should therefore be the primary treatment.

Adult↗

PubMed2002

Rotational digital cholangiography (RDC) and 3D-cholangiography (3DC) for guidance of percutaneous biliary drainage procedures.

PURPOSE: To evaluate whether RDC and 3DC help clarifying anatomic details in biliary duct disease and is useful for guidance of drainage procedures. MATERIALS AND METHODS: RDC was conducted in 11 consecutive patients (8 male, 3 female, mean age 63 years). Nine patients underwent PTBD for malignant biliary duct stenosis, one patient because of ischemic stenosis after hepaticojejunostomy and one patient presented with an infected biloma. Images were obtained after initial bile duct puncture during single breath hold from 120 projection angles using a rotating C-arm. These images were immediately available and evaluated in order to facilitate the definitive drainage procedure. For additional 3D reconstruction, data were sent to a dedicated workstation and judged by a blinded observer. RESULTS: The availability of a rotating data set of images was judged to be helpful in three patients with complex anatomical situations. Additionally, RDC holds the potential to reduce fluoroscopy time. 3DC allowed analysis of the hepatic bifurcation from different viewing angles in 10 cases with high spatial resolution (mean voxel size 480 micro micro m 3). This may allow a better classification of hilar obstructions according to our preliminary observations. CONCLUSION: Images from RDC and 3DC are helpful in guiding PTBD procedures and for better diagnosis in selected patients with hilar biliary duct stenoses.

Adult↗

PubMed2001

In vivo evaluation of an intravascular receiver coil for MRI at 1.0 Tesla.

BACKGROUND: Evaluation of the applicability of intravascular radiofrequency receiver coils by means of a pig in-vivo-experiment for the detection of vessel wall structures at 1.0 Tesla. MATERIALS AND METHODS: The intravascular receiver coil was constructed according to a well evaluated single-loop-design, which was mounted onto a balloon catheter for angioplasty. Under fluoroscopy control the balloon catheter was placed in the common carotid artery of a porcine. Images were obtained in a 1.0 Tesla clinical scanner using a fast-spin-echo-, a gradient-echo- and a high resolution spin-echo-sequence. Histological examinations were obtained to detect any vessel wall damage associated with the use of the receiver coil. RESULTS: High quality images with a resolution up to 0.16*0.12 mm2 could be acquired in aquisition times of about 5 minutes. Subtle intra- and extra-vascular structures such as the balloon, irregularities of the vessel wall or bordering structures could be visualized. The histological examination showed no vessel damage due to the application of the intravascular receiver coil. CONCLUSIONS: The application of intravascular receiver coils for the visualization of the vessel wall is feasible at 1.0 Tesla without histologically detectable trauma to the vessel wall.

Animals↗

PubMed2001

Local intra-arterial drug delivery for prevention of restenosis: comparison of the efficiency of delivery of different radiopharmaceuticals through a porous catheter.

RATIONALE AND OBJECTIVES: Several radiopharmaceuticals were administered through a porous balloon catheter to compare the absolute amount deposited and the retention in the vessel wall. The reported efficiency of local drug delivery ranges from 0.001% to 0.1%, with poor retention after 24 hours. METHODS: An endothelin derivative (n = 6), pertechnetate (n = 6), hexamethylpropylene amineoxime (HMPAO) (n = 5), ethyl cysteinate dimer (ECD) (n = 5), and tin colloid (n = 5) were labeled with 185 MBq/mL 99m-technetium. After balloon denudation of the infrarenal aorta in 27 New Zealand White rabbits, 100 microL of each agent was administered through a porous balloon at a pressure of 4 bar. Dynamic and static whole-body scintigrams were obtained for 24 hours. The infrarenal aorta was excised and the activity calculated in a gamma counter. RESULTS: Apart from their retention in the region of local administration, the radiopharmaceuticals showed different distribution patterns. The highest regional tracer retention was observed with HMPAO. After administration of HMPAO, a significant difference between regional (vessel wall plus surrounding tissue: 14.5% of injected dose [ID]/24 hours) and local (vessel wall: 1.8% ID/24 hours) delivery was found. In contrast, ECD was eliminated quickly (local retention after 24 hours = 0% ID). The retention efficiencies were HMPAO > endothelin derivative > tin colloid > pertechnetate > ECD. CONCLUSIONS: The different physicochemical and pharmacokinetic properties of radiopharmaceuticals resulted in different delivery efficiencies after local application.

Animals↗

PubMed2001

The use of gadolinium chelates for X-ray digital subtraction angiography.

RATIONALE AND OBJECTIVES: To evaluate the feasibility and safety of using gadolinium chelates for x-ray digital subtraction angiography (DSA) in patients with contraindications to iodinated contrast material. METHODS: We performed 30 DSAs in 22 patients (5 females, 17 males; mean age 64.9 years) with contraindications to iodinated contrast media (renal insufficiency: n = 28; hyperthyroidism: n = 1; contrast allergy: n = 2). Gadolinium chelates were administered as 0.5 mol/L solutions (mean volume of gadolinium chelates per patient was 34 +/- 19 mL). Gadolinium chelates were the sole contrast agent in 17 examinations, were used in conjunction with carbon dioxide (CO2) in 8 studies, (mean 212 +/- 226 mL), and were combined with the restricted use of nonionic iodinated contrast (mean 12.8 +/- 4.7 mL) in 6 examinations. We carried out 15 diagnostic angiographies and 15 percutaneous transluminal angioplasties. RESULTS: Use of gadolinium chelates allowed us to obtain diagnostic angiographic images in all cases. However, the quality of angiograms was inferior compared with that obtained with iodinated contrast agents and superior compared with CO2 as the contrast material. Adverse events were not noted. Mean serum creatinine was 2.6 +/- 1.5 mg/dL before and 2.3 +/- 1.0 mg/dL after DSA. No patient developed contrast-induced nephropathy. CONCLUSIONS: Gadolinium chelates produce an x-ray DSA intermediate in image quality between iodinated contrast and CO2. Digital subtraction angiography with intra-arterial gadolinium chelate administration may offer an alternative to iodinated contrast material in patients with contraindications to iodine.

Aged↗

PubMed2001

Comparative trial of local pharmacotherapy with L-arginine, r-hirudin, and molsidomine to reduce restenosis after balloon angioplasty of stenotic rabbit iliac arteries.

PURPOSE: To determine if local application of L-arginine, r-hirudin, or molsidomine significantly reduces restenosis after balloon angioplasty in stenotic rabbit iliac arteries. MATERIALS AND METHODS: Thirty-one male cholesterol-fed New Zealand white rabbits underwent balloon dilation of both common iliac arteries to induce arterial stenosis. Four weeks later, one stenotic iliac artery was simultaneously dilated and received local application of L-arginine (210 mg/mL, n = 7), r-hirudin (0.5 mg/mL, n = 8), or molsidomine (0.2 mg/mL, n = 8) with a channeled balloon catheter. On the contralateral side, 0.9% saline was injected as a control. In eight sham animals, saline was applied to one iliac artery and balloon dilation to only the contralateral artery. Six weeks after local treatment, vessels were harvested, and computerized morphometric and immunohistologic analyses were performed. RESULTS: Application of drugs resulted in a significant reduction of neointimal area as follows: 53% with L-arginine (1.01 mm(2) vs. 2.17 mm(2), P <.05), 43% with molsidomine (1.04 mm(2) vs. 1.89 mm(2), P <.05), and 20% with r-hirudin (1.79 mm(2) vs. 2.24 mm(2), P <.05). Infusion of saline led to a significant increase (50%, 1.21 mm(2) vs. 1.93 mm(2), P <.05) in neointimal area compared with balloon dilation alone. Immunohistologic findings showed a significant reduction of macrophages (5.0% vs. 10.2%, P <.05) and proliferating cells (6.2% vs. 10.6%, P <.05) in the neointima after local application of L-arginine. CONCLUSION: Reduction of neointimal area was significant for L-arginine and molsidomine but not for r-hirudin. Saline infusion caused significant arterial trauma, resulting in additional neointimal proliferation.

Administration, Topical↗

PubMed2000

Prospective comparison of magnetic resonance sialography and digital subtraction sialography.

We sought to compare the diagnostic utility of magnetic resonance sialography (MRS) and digital subtraction sialography (DSS) in patients with suspected sialolithiasis or sialadenitis. Sixteen consecutive patients (4 female and 12 male, mean age 51+/-16 years) with suspected sialolithiasis or sialadenitis underwent DSS by a standard technique and MRS. MRS was obtained with a T2-weighted single-shot TSE sequence (TR/TE 2800/1100 msec, acquisition time 7 seconds) using a quadrature head (n = 16) and a surface coil (n = 8). Nineteen symptomatic glands were investigated with DSS: eight submandibular glands in 6 patients (two bilateral) and unilateral parotid glands in 11 patients. MRS was always carried out to visualize gland ducts bilaterally. The ductal system was visualized in all glands examined by MRS. DSS depicted the ductal system in all 11 parotid glands, but only 4 of the 8 submandibular glands (50%). Sialolithiasis was diagnosed in three cases (one parotid, two submandibular glands) by MRS and in two cases by DSS. DSS demonstrated tertiary branching ducts and MRS secondary branching ducts. MRS is able to visualize the ductal system of the parotid and submandibular gland noninvasively and is thus not dependent on successful cannulation of the orifice of the ductal system. Our preliminary data indicate that MRS is useful for diagnosing sialolithiasis. MRS allows diagnosis of sialadenitic changes, but DSS achieves a better diagnostic performance due to higher spatial resolution.

Adolescent↗

PubMed2000

Quantitative human in vivo evaluation of high resolution MRI for vessel wall morphometry after percutaneous transluminal angioplasty.

Visualization of the vessel wall after transluminal angioplasty is important to monitor the restenosis progress. Intravascular ultrasound proved its capabilities as an invasive procedure in many studies. The aim of this study was to evaluate the feasibility of high-resolution MRI as a non-invasive tool for follow-up after PTA. High-resolution magnetic resonance images (pixel size: 0.49 * 0.49 mm(2)) were acquired on a 1.0 T clinical scanner. Morphometry was conducted after conversion of DICOM images into TIFF format using ScionImage on a PC. In-vitro studies using a polyvinylchloride tube were evaluated by two independent investigators. Goldstandard was a caliper rule and direct radiography. Five patients were monitored before and 24 h, six weeks, three months and six months after PTA. In vivo measurements promised a good concordance for both investigators for area as well as for diameter measurements. Area measurements showed correlations up to r = 0.86 (p < 0.001) whereas the correlations of diameters were slightly inferior (r between 0.58 and 0.84; p < 0.005). Relocation of the same slice position in the follow up studies could be guaranteed using anatomic landmarks in the images. As a non-invasive tool to assess restenosis after PTA high-resolution MRI promises to be a reproducible technique. It is easy to identify the same vascular region in different studies due to neighboring anatomic landmarks. Progression of disease as well as success of pharmacologic treatment to prevent restenosis may be monitored.

Aged↗

PubMed2000

Mid-term follow-up after percutaneous hydrodynamic thrombectomy in lower limb ischemia: initial experience with two-dimensional MR imaging and three-dimensional MR angiography.

PURPOSE: To assess noninvasively mid-term patency, reocclusion, and mid-term changes of the arterial wall after percutaneous hydrodynamic thrombectomy in patients with acute lower limb ischemia using magnetic resonance (MR) imaging/MR angiography (MRA). MATERIALS AND METHODS: Arterial wall and luminal changes were evaluated in 16 patients (10 men, six women; mean age, 70 years), with a minimum follow-up of 12 months after percutaneous thrombectomy with a hydrodynamic catheter for acute lower limb ischemia (embolic, n = 5; thrombotic, n = 11). Adjunctive PTA was performed in 44%. The mean follow-up was 23 months +/- 7.6 (range, 12-33 months). MR imaging and MRA were performed on a 1.0 T system using an extremity coil and two-dimensional (2D) time-of-flight, turbo spin echo, 2D gradient echo, and contrast enhanced three-dimensional (3D) gradient echo sequences. RESULTS: In one patient, a complete reocclusion was noted and, in two patients, a hemodynamically insignificant restenosis (< or = 50%) was identified with MR imaging. This was in accordance with color flow duplex sonography, physical examination, ankle/brachial index measurements, and the treadmill test. The MR morphometry documented an increase of the entire vessel area from 48.9 mm2 +/- 3.3 (control segments) to 55.5 mm2 +/- 2.8 at the treated segments (+13.3%; P < .05). The vessel wall area increased from 31.7 mm2 +/- 1.8 to 39.4 mm2 +/- 2.3 (+24.4%; P < .05). The mean area stenosis grade was 12%. CONCLUSION: MR imaging with use of morphometric analysis is a possible tool to noninvasively determine the mid-term patency and restenosis/reocclusion and remodeling process after percutaneous thrombectomy and other interventional procedures.

Aged↗

PubMed2000

[A review of molecular radiology. I: Gene therapy].

The term molecular radiology intermediate region between radiological imaging and interventional radiology on the one side and molecular biology on the other. In the field of imaging methods are currently being developed by which molecular processes, i.e., gene expression and protein function, can be visualized in vivo. These techniques open new perspectives for research and clinical diagnosis and will be presented in the second part of this review. The present part provides a survey of current developments in gene therapy from a radiological point of view and highlights the part that our specialty may play in this field.

Animals↗

PubMed2000

Rheolytic hydrodynamic thrombectomy for percutaneous treatment of acutely occluded infra-aortic native arteries and bypass grafts: midterm follow-up results.

RATIONALE AND OBJECTIVES: To evaluate the efficacy of a rheolytic thrombectomy catheter (RTC) for treatment of acutely occluded infra-aortic native arteries and bypass grafts and to determine midterm primary patency, death, and amputation-free survival rates. METHODS: From March 1995 to September 1997, 112 patients with occluded arteries or bypass grafts were primarily treated with RTC at two centers. Thrombus removal was evaluated by two angiographers. RESULTS: More than 75% of the thromboembolic material could be removed with RTC alone. Mean activation time of RTC was 280 +/- 163 seconds. Residual mural or organized thrombi (29%) required adjunctive fibrinolytic therapy or aspiration thrombectomy. Remaining stenoses were treated with percutaneous transluminal angioplasty and additional stent implantation. For acute reocclusions, surgical intervention was required. Technical success after the entire procedure was 88.4%. RTC-associated complications included distal embolization, dissection, vessel perforation, and technical failure of RTC. Mean follow-up time was 14.8 months +/- 11.5, rates of primary patency, secondary patency, death, and amputation-free survival were 60%, 84%, 16%, and 75% after 2 years, respectively. CONCLUSIONS: RTC is a rapid and efficient technique for mechanical thrombectomy of acutely thrombosed native leg arteries and bypass grafts. Midterm results are comparable to the results of alternative treatment modalities such as Fogarty balloon thromboembolectomy or local fibrinolysis.

Aged↗

PubMed1999

FGFR2 signaling in normal and limbless chick limb buds.

FGF10 and FGF8, which are reciprocally expressed by the mesoderm and AER of the developing limb bud, have been implicated in limb initiation, outgrowth, and patterning. FGF10 and FGF8 signal through the FGFR2b and FGFR2c alternative splice isoforms, respectively [Ornitz DM, et al. 1996. J Biol Chem 271:15292-15297; Igarashi M, et al. 1998. J Biol Chem 273:13230-13235]. A paracrine signaling loop model has been proposed whereby FGF10 expressed by limb mesoderm signals via ectodermally restricted FGFR2b to regulate FGF8 expression by the apical ectoderm; in turn, FGF8 signals via mesodermally restricted FGFR2c to maintain FGF10 expression [Ohuchi H, et al. 1997. Development 124:2235-2244; Xu X, et al. 1998. Development 125:753-765]. To explore this model, we have examined FGFR2b and FGFR2c mRNA expression, using isoform-specific probes during the early stages of development of the chick limb when limb initiation, AER induction, and outgrowth are occurring. We have found that FGFR2b is expressed by limb ectoderm, including the AER, consistent with paracrine signaling of FGF10. By contrast, FGFR2c is expressed by both mesoderm and ectoderm, indicating that FGF8 has the potential to function in an autocrine as well as paracrine fashion. Indeed, as the limb grows out in response to the AER, FGFR2c expression attenuates in the mesoderm of the progress zone, but is maintained in the AER itself, arguing against exclusive paracrine signaling of FGF8 during limb outgrowth. We also report that transcripts for FGF10, FGFR2b, and FGFR2c are expressed normally in the limb buds of limbless mutant embryos, which fail to form an AER and do not express FGF8. Furthermore, we detect no mutations in exons specific for the FGFR2c or FGFR2b isoforms in limbless embryos. Since gene targeting has shown that expression of FGF8 in limb ectoderm depends on FGF10 [Min H, et al. 1998. Genes Dev 12:3156-3161; Sekine K, et al. 1999. Nature Genet 21:138-141], these results indicate that the product of the limbless gene is required for FGF10 to induce expression of FGF8.

Animals↗

PubMed1999

Cleavage of surfactant-incorporating fibrin by different fibrinolytic agents. Kinetics of lysis and rescue of surface activity.

Incorporation of surfactant into polymerizing fibrin causes loss of surface activity and marked retardation of clot lysis by plasmin (Günther and colleagues, Am. J. Physiol. 1994;267:L618-L624). We compared the efficacy of tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), activated anisoylated streptokinase-plasminogen activator complex (APSAC), and plasmin to dissolve surfactant-incorporating fibrin. Alveofact was employed as a natural surfactant source, and plasminogen was coincorporated into the fibrin matrix at a physiologic ratio to fibrin. Fibrinolysis was quantified by the release of tracer from (125)I-labeled fibrin, and the pattern of split products was characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis. In addition, we investigated the fibrinolysis-related restoration of surface activity by measurement in the pulsating bubble surfactometer. Concentrations of all fibrinolytic agents were chosen to effect approximately 40% lysis of clot material in the absence of surfactant (control). When incorporated into the fibrin matrix, but not when admixed after clot formation, surfactant inhibited the cleavage of fibrin by all fibrinolytic agents in a dose-dependent manner. Interestingly, t-PA and u-PA were significantly less inhibited than was plasmin or APSAC. The pattern of arising fibrin scission products was identical for all fibrinolytic approaches and was independent of surfactant incorporation. Adsorption and minimum surface tension-lowering properties of Alveofact were almost completely lost upon incorporation into fibrin, but surface activity was fully restored upon sustained clot lysis with all fibrinolytic agents. We conclude that the fibrinolytic capacity of all agents investigated is markedly inhibited by surfactant incorporation in fibrin, but this inhibition is significantly less pronounced in the agents employing preincorporated plasminogen (t-PA and u-PA), as compared with plasmin and APSAC. The plasminogen activators may thus proffer to "rescue" pulmonary surfactant function by induction of fibrinolysis in the alveolar compartment.

Animals↗

PubMed1999

[Effects of L-carnitine on erythropoiesis and blood platelet aggregation in patients with chronic renal failure treated with hemodialysis].

The aim of the work has to assess the effects of L-carnitine therapy on erythropoiesis and whole blood platelet aggregation. The studies were performed in 28 patients divided into 3 groups: I-group was given erythropoietin, II-group was given erythropoietin and L-carnitine, III-group was given L-carnitine. After 22 month of the therapy a statistically significant rise in hematocrit was observed in group III, improvement in muscle strength, a rise in free and total carnitine concentration was found in group II and III. There were no significant changes in urea concentration, platelet count and iron metabolism. Whole blood platelet aggregation induced by ADP, collagen and ristocetin was impaired relative to healthy volunteers. After 2 month of L-carnitine treatment of significant rise in collagen induced platelet aggregation was observed in group II.

Adult↗

PubMed1998

[Yamakawa prosthesis with prolonged placement as a therapy concept exemplified by benign biliary stricture].

AIM: As an alternative method to the operative revision of benign bile duct strictures, we report the use of a large-bore bile duct prosthesis (Yamakawa prosthesis) in one patient. METHODS: Bilateral percutaneous transhepatic implantation of Yamakawa prostheses (14 F right side, 12 F left side) was performed without adjunctive balloon dilatation. The prostheses were exchanged every 8 weeks under continuous antibiotic treatment and were finally removed after 8 months. RESULTS: Control cholangiography showed a normal intrahepatic biliary system on the right side and a 50% stenosis at the orifice of the left hepatic duct. Follow-up over 18 months showed no signs of recurrent disease. CONCLUSIONS: In comparison to balloon dilatation and implantation of metallic stents, prolonged bilateral splinting with large-bore Yamakawa prostheses seems to be an alternative for the treatment of benign bile duct strictures.

Adult↗