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Biomedical subjects

A Czerniak

Publications and source records attributed to A Czerniak.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Does acute graft rejection modify subsequent function of a transplanted liver?].

While in kidney, heart and pancreas transplantation the impairment of graft function associated with acute rejection is only partially reversible upon successful antirejection therapy, little is known about the effect of acute rejection on late graft function after liver transplantation. Our data however gives similar findings in regards to conventional and quantitative liver function tests in patients with or without acute rejection more than 12 months after liver transplantation. This may most likely be attributable to the unique regeneration potential of the adult human liver.

Acute Disease↗
PubMed1994

[Can the quality of a modest liver transplantation program compare to international standards? Results in Inselspital Berne].

Today, orthotopic liver transplantation is the treatment of choice for the endstage of various liver diseases, and a 1-year survival rate of over 80% is reported in international surveys. The liver transplant program of the Inselspital is very small compared to international centers and this may raise questions about the results and the justification for such a program. In a 24-month period, 20 liver transplants (including 2 retransplants) have been performed in 18 patients at the Inselspital. 2 patients (11%) died 20 and 268 days respectively after transplantation. 2 patients (11%) had significant morbidity 502 and 529 days respectively after transplantation. After a median follow-up of 11.5 months postoperatively, 14 (80% of all patients) lived an independent life. 9 (50%) were fully reintegrated in the household or in their profession and 5 others (30%) were working part time. We conclude that even a small liver transplant program based only on routine resources can achieve results comparable to international standards.

Adult↗
PubMed1994

Changes in bone mass early after kidney transplantation.

Renal transplant patients exhibit increased rates of trabecular bone fractures, probably due to glucocorticoid-induced osteopenia, which is known to occur within 6 months after kidney grafting. This mineral loss at a mostly trabecular site (lumbar spine) contrasts with a gain at the radius, which consists mainly of cortical bone. However, the early effects of kidney transplantation on the other parts of the human skeleton and the time course of these changes during the first 5 months after transplantation remain unknown. Therefore, 34 kidney transplant recipients were prospectively followed immediately after kidney grafting (12 +/- 1 days, mean +/- SEM, and then on a monthly basis up to 152 +/- 3 days) and compared with 34 normal healthy volunteers matched for age, sex, and body mass index. Bone mineral measurements of whole body (n = 34), lumbar spine (n = 32), and upper femur (n = 23) were performed using dual-energy x-ray absorptiometry (Hologic QDR 1000W). At time of transplantation, lumbar bone mineral density (BMD) and BMD of the upper femur were lower (p < 0.01) in female but not male patients compared with controls. Lumbar BMD decreased by 1.6 +/- 0.2% per month in both sexes (p < 0.01), whereas BMD of upper femur further decreased in males (p < 0.01) but only tended to decrease in females. At time of transplantation, whole-body bone area (BA), bone mineral content (BMC), and BMD were decreased by about 8, 15, and 9%, respectively, in patients compared with controls (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1993

Extended left hepatectomy: technical aspects of an evolving procedure.

Lessons learned in an operative experience of 14 patients submitted to extended left hepatectomy for the management of liver tumours are presented. There were no deaths within 30 days of operation. Essential preoperative studies, indications and technical details of the operation are described. The importance of the morphology of the tumour and the influence of the tumour on the technique to be adopted are emphasized. Modifications of technique that allow selection of patients for the procedure, control of venous bleeding, accurate identification of the sectorial portal pedicles within the right liver and definition of the plane of parenchymal transection are addressed.

Hepatectomy↗
PubMed1993

A rare complication of the use of a finger cot to protect the cuff of a tracheal tube during nasotracheal intubation.

Some anesthetists in Switzerland and elsewhere use a finger cot to protect the cuff of the endotracheal tube during nasotracheal intubation. In the presented report the finger cut was lost during the procedure and the patient presented 3 months later with a lateral neck mass. The finger cot was found within that mass at exploration. Apart from the other potential risks of this manoeuvre, this severe complication should incite caution against the practice described above.

Aged↗
PubMed1993

Analysis of peripheral blood lymphocyte cell surface density of functional and activation associated markers in young and old hemodialysis patients.

Aging has been associated with specific shifts in various peripheral blood immune competent cell subsets. As part of pre-transplant immune profile evaluation possible parallel age-related changes in mean T-cell surface density of several cluster differentiation and activation linked antigens were into 2 groups: group 1-114 patients 40 years old or younger and group 2-36 patients 55 years old or older. Peripheral blood CD3+, DR+, CD3+DR+, CD4+, CD4+DR+, CD8+, CD8+DR+, CD56+, CD8+CD56+, CD3+IL-2-R+ and CD3+TR+ (interleukin-2 and transferrin receptors bearing CD3+ cells respectively), all mononuclear cells expressing IL-2-R and TR, and CD4+CD45+ cell subsets were analyzed and enumerated by 2-color flow cytometry. Subset relative levels as well as absolute counts were recorded. Cell surface density computation was performed using a computerized mathematical model based on fluorescence intensity vector analysis and cell size score determination based on light scatter pattern from raw data obtained by flow cytometry studies. Younger age was significantly associated with higher absolute cell count of CD3+ (p < 0.001), DR+ (p < 0.05), CD4+ (p < 0.01), CD8+ (p < 0.005), CD3+IL-2-R+ (p < 0.05), CD3+TR+ (p < 0.03) and IL-2-R+ (p < 0.05). Older patients had a slightly higher mean absolute count of CD4+CD45+ subset (p not significant) and significantly higher mean count for CD8+CD56+ cell subset (p < 0.001). When cell subset levels were compared between the 2 groups as the relative fraction of cells expressing a given marker out of all mononuclear cells gated out by flow cytometry, younger age was significantly associated with higher levels of CD3+ (p < 0.005), CD8+ (p < 0.001), CD4+DR+ (p < 0.004), CD3-TR+ (p < 0.05) and CD8+IL-2-R+ (p < 0.05). In contrast, slightly higher subset levels of CD56+ (p not significant), and significantly elevated levels of CD8+CD56+ (p < 0.0019) and CD4+CD45+ (p < 0.004) were observed in the older patients. Cell surface density analysis showed that younger patients had higher mean density per cell of CD3 (p < 0.05), CD8 (p < 0.001), IL-2-R on CD3+ cells (p < 0.05) and TR on CD3+ cells (p < 0.05). Mean cell surface density of CD56 on all CD56+ cells as well as on CD8+ cells was higher in older individuals (p < 0.001 and p < 0.003, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[The value of conservative therapy, surgical treatment and interventional radiology in perforations and ruptures of the esophagus].

We have reviewed all the records of 23 patients hospitalized in our institution from January 1981 till December 1991 and presenting a confirmed diagnosis of esophageal perforation. We have studied the aetiology, the localization, morbidity and mortality and we discuss the therapeutic management. 9 patients presented a cervical perforation, 13 patients a thoracic perforation and 1 patient an abdominal perforation. Among the patients with cervical perforation 2 patients had a local revision with drainage, 3 patients a primary suture and 4 patients were treated conservatively. No complication was found in this group. The patients with thoracic perforation have been treated as follow: 3 conservatively, 8 with thoracotomy, primary suture +/- patch, drainage, 2 patients with thoracotomy and drainage alone. All complications happened in this group: 2 gastro-intestinal bleeding, 2 ARDS, 3 mediastinitis, 1 pneumonia. 2 patients in a very poor general condition died, one with a metastatic breast carcinoma, the other after a CVI with a massive gastro-intestinal bleeding. The cervical perforations have an excellent prognosis and can be treated conservatively if they are asymptomatic and do not display a pleural lesion. The thoracic perforations can be treated surgically if they are diagnosed early before septic complications. If not, they will be better treated conservatively with drainage. The intraabdominal perforations have to be treated as every intraabdominal perforation. In this case, we perform a primary suture completed with fundoplication.

Aged↗
PubMed1993

[Surgical-radiologic interventional treatment in liver abscess with Streptococcus anginosus Milleri].

Pyogenic liver abscess is a relatively rare disease, often concerning elderly patients in bad general condition and with underlying diseases. Out of a retrospective study (1984-1991) of 44 patients (f 43%, m 57%) with pyogenic liver abscesses and 12 patients (f 17%, m 83%) with amebic liver abscesses we present 5 patients with multifocal lesions due to Streptococcus anginosus Milleri--a special group concerning therapy and course of disease. The therapy was high-dose i.v. antibiotic therapy in all 5 cases and additional percutaneous drainage with pig-tail catheters--inserted under CT guidance--in 4 cases (1-5 catheters, time of drainage 6-63 days). The duration of hospitalisation was 15-73 days (median 45), intravenous antibiotic treatment lasted 4-40 days. After discharge oral antibiotics were continued for 14-42 days.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Biliary pancreatitis--a good indication for laparoscopic cholecystectomy].

Recently the indication for laparoscopic cholecystectomy has been enlarged to include biliary pancreatitis. While a majority of reports recommend early open cholecystectomy for biliary pancreatitis the use of laparoscopic cholecystectomy in this disease has not yet been discussed. We retrospectively reviewed 52 patients with biliary pancreatitis being admitted to our ward in the last five years. Cholecystectomy was performed in 48 patients. Ten had undergone laparoscopic cholecystectomy. Postoperative complications occurred in 8 of the 48 patients (16.6%). Four patients (8.3%) died due to necrotizing pancreatitis or rupture of pseudocysts. We found a correlation between morbidity and mortality and the prognostic score as well as the presence of pseudocysts. We conclude that biliary pancreatitis is a good indication for laparoscopic cholecystectomy in patients with a low prognostic score. The presence of pseudocysts in our view is no contraindication for laparoscopy. Although it may increase postoperative morbidity. Choledocholithiasis has to be ruled out either by preoperative ERCP or during laparoscopy with intraoperative cholangiography.

Acute Disease↗
PubMed1993

[Mirizzi syndrome--a contraindication for laparoscopic surgery].

The Mirizzi syndrome refers to a benign obstruction of the common hepatic duct by a stone impacted within the cystic duct or the neck of the gallbladder causing an obstructive jaundice. According to McSherry's subclassification based on endoscopic retrograde cholangio-pancreatography we distinguish a type I, involving an external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch without lesion of the gallbladder or the common hepatic duct wall. In type II a cholecysto-choledochal fistula is present, caused by a calculous which has already eroded partly or completely into the common bile duct. The type I is better treated with a partial cholecystectomy, the type II with a partial cholecystectomy and a bilio-digestive anastomosis. Due to a severe inflammatory process with dense adhesions and odematous changes of the hepato-duodenal ligament, it is dangerous to prepare the Calot's triangle, in case of conventional cholecystectomy and/or in case of laparoscopic cholecystectomy. From 1986-1991 we have successfully treated 10 patients according to this concept (7 patients with type II, 3 patients with type I). We have no mortality and no lesion of the biliary system. One patient has been reoperated because of a postoperative hemorrhage and biliary fistula. One patient developed a benign stricture which could be dilated two months after the procedure. Two patients were found with an incidental carcinoma of the gallbladder.

Adult↗
PubMed1992

Hepatic transplantation in children using reduced size allografts.

The shortage of paediatric liver donors has led to the use of reduced size hepatic allografts. Between July 1987 and July 1990, 30 reduced size orthotopic liver transplantations were performed in 24 children aged between 3 months and 7 years. All patients were in advanced chronic or acute liver failure and were considered unlikely to survive for long enough for a size-matched donor to become available. The most common indication was biliary atresia. The median intraoperative blood loss was 75 (range 13-1015) ml kg-1. Nine patients have died and seven have undergone retransplantation, four successfully. Seven patients had portal vein hypoplasia with a high graft failure rate due to ischaemic infarction. There was significant morbidity from biliary tract complications, leading to further operations in four cases. The 1-year actuarial survival rate was 62 per cent.

Biliary Atresia↗
PubMed1991

The use of radioiodinated toluidine blue for preoperative localization of parathyroid pathology.

The efficiency of preoperative radioactive toluidine blue (RTB) scintigraphy for the localization of parathyroid pathology was evaluated prospectively in 69 patients (age range, 15 to 81 years; mean, 56 years) with primary hyperparathyroidism. Four patients have previously undergone negative exploratory surgery. Patients underwent preoperative dual radionuclide parathyroid-RTB/technetium 99m (Tc 99m)-thyroid scintigraphies with a computer-interfaced gamma-camera with a pinhole collimator. Computer-acquired scintigraphic data were analyzed for parathyroid localizations by an RTB-parathyroid/thyroid superposition technique. At surgery, parathyroid adenomas were found in 64 patients (single adenomas in 60 patients; two adenomas in four patients), nine of these adenomas were mediastinal. Four patients had parathyroid hyperplasia. One patient had no parathyroid pathology (negative exploratory surgery). Correlation between the surgical-pathologic findings and the scintigraphic RTB localization studies disclosed a sensitivity of 87%, with a specificity of 94%, and an overall accuracy of 92%. The routine use of preoperative scintigraphic parathyroid-RTB/Tc 99m-thyroid localization has proved to be highly effective, enabling detection of small hyperfunctioning parathyroid glands in normal and ectopic locations in a wide range of weights. In this series a success rate of 98% was achieved on initial and reexploratory surgery for primary hyperparathyroidism.

Adenoma↗
PubMed1990

Role of endoscopic retrograde cholangiopancreatography in differentiating pancreatic cancer coexisting with chronic pancreatitis.

The pancreatographic appearance and the clinical presentation of ten patients presenting with adenocarcinoma of the head of the pancreas coexisting with chronic pancreatitis were compared with those of 45 patients with chronic pancreatitis (CP), without malignancy, investigated at the same time period. All ten patients, had typical pancreatographic findings of CP, combined with an elongated narrowing of the duct of Wirsung. Marked localized irregularity of the adjacent main duct and of side branches were found in all ten patients. Such findings were not detected in the other 45 patients with CP only. Ultrasonography or computed tomography have detected a definite pancreatic mass in only five of these patients, and in six patients with CP without malignancy. It is concluded that endoscopic retrograde cholangiopancreatography is highly accurate in detecting pancreatic cancer coexisting with CP. It is primarily helpful in elderly patients having severe degrees of CP to rule out cancer.

Aged↗
PubMed1990

A comparison between emergency and delayed endoscopic injection sclerotherapy of bleeding esophageal varices in nonalcoholic portal hypertension.

To study whether or not emergency sclerotherapy was more effective than a program of stabilization and elective sclerosis, we studied 84 patients with bleeding esophageal varices. They underwent 332 sessions of endoscopic injection sclerotherapy, 134 of which were performed for acute variceal bleeding. Most patients (90.5%) had nonalcoholic portal hypertension. Emergency sclerotherapy (1-6 h after presentation) was performed in 65 bleeding episodes in 43 patients, and delayed sclerotherapy (more than 24 h from presentation) was performed in 69 episodes in 41 patients. The selection of patients was randomized. Emergency sclerotherapy arrested active variceal bleeding in all patients and resulted in an earlier eradication of varices and for a longer period than delayed sclerotherapy. Larger volumes of sclerosant (a mean of 26 ml compared to 13 ml) were more effective in arrest of bleeding and in an early eradication of varices. We conclude that emergency sclerotherapy, mainly with a large sclerosant volume, is highly effective in arresting active variceal bleeding. Such earlier arrest of bleeding was associated with reduced morbidity and mortality.

Adolescent↗
PubMed1990

Early endoscopic sphincterotomy in the management of acute gallstone pancreatitis in elderly patients.

Eighteen elderly patients with acute attacks of gallstone pancreatitis underwent early endoscopic sphincterotomy of the papilla of Vater. Eleven patients were considered to be at high risk for surgery due to chronic cardiorespiratory or renal problems. The outcome of these patients was compared with that of 20 consecutive elderly patients with gallstone pancreatitis treated at the same time by means other than endoscopic sphincterotomy. Endoscopic sphincterotomy resulted in an immediate clinical improvement in all patients, except in one patient who developed transient cholangitis; there was no mortality. In contrast, there was one death (5%) and 20% morbidity in the controls. Mean hospitalization period was shorter in patients undergoing sphincterotomy (6 compared with 9.5 days), although the patients managed by sphincterotomy were initially more seriously ill than controls. Only two of the 11 high-risk patients underwent elective cholecystectomy; all others were well during a mean follow-up of 22 months. It is concluded that early endoscopic sphincterotomy is highly effective and safe in acute attacks of gallstone pancreatitis in elderly high-risk patients.

Acute Disease↗