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A Zollinger

Publications and source records attributed to A Zollinger.

71 records · Page 4Linked to original sources
PubMed1995

[Isolated lung transplantation--evaluation of patients and initial results].

Between November 1992 and May 1994 we performed 10 single and 5 double lung transplants in patients with end-stage lung diseases due to lymphangioleiomyomatosis (4), cystic fibrosis (3), pulmonary hypertension (3), pulmonary fibrosis (3) and chronic obstructive lung disease (2). In the 13 patients (87%) surviving for median 245 (19-567) days, FEV1 improved from median 640 ml to 1410 ml and the 12-minute walk distance from median 315 to 1100 meters. 10 patients (77%) enjoy a good or even excellent quality of life. 2 patients died 11 and 62 days postoperatively, due to multi-organ failure and invasive pulmonary aspergillosis respectively. The main postoperative problems are fungal and cytomegalovirus infections and chronic rejection in the form of bronchiolitis obliterans. In Switzerland as elsewhere, lung transplantation has become an established modality for the management of end-stage diseases of the lung and pulmonary circulation.

Adolescent↗
PubMed1995

[Isolated lung transplantation].

Over the last 10 years, single and bilateral lung transplantation has developed from an experimental technique to a valid therapy for patients with end-stage pulmonary or pulmonary-vascular disease. The main reasons for this progress are better defined selection criteria, improved operative technique and organ preservation, optimized peri- and postoperative management and more precise immunosuppressive and antiinfective therapy. Since 1983 more than 3000 lung transplantations have been performed worldwide with a 1- and 3-year survival rate of 70-90% and 60-70% respectively. In Switzerland 41 lung transplantations have been performed since 1992 with a 1-year survival rate of more than 80%. Indications, technique, treatment and results are discussed.

Adult↗
PubMed1995

Positron emission tomography in drug evaluation: influence of three different catechol-O-methyltransferase inhibitors on metabolism of [NCA] 6-[18F]fluoro-L-dopa in rhesus monkey.

We compared the influence of three different catechol-O-methyltransferase (COMT) inhibitors (CGP 28014, OR-611 and Ro 40-7592) on the metabolism of no-carrier-added (NCA) 6-[18F]fluoro-L-dopa (6-FDOPA) in one Rhesus monkey. All three COMT inhibitors improved 6-FDOPA availability in plasma, increased the specific uptake in the brain and thus improved 6-FDOPA uptake measurements using positron emission tomography (PET). Best results were obtained with Ro 40-7592.

Amidines↗
PubMed1994

[Risk assessment and patient information before anesthesia].

In order to determine the risk of anesthesia the anesthesiologist has to assess both the physical and the psychological status of the patient. The essential basis of any preoperative medical evaluation are the history and complete physical examination of the patient. Few laboratory screening tests and, in case of pathological findings, specific diagnostic procedures will ensue. If possible, preoperative therapies must be considered in order to reduce the risk resulting from concomitant diseases. However, apart from the patients diseases, both the risks of the anesthetic and surgical procedures contribute to the overall perioperative risk. On the basis of the preoperative evaluation, the anesthesiologist determines the methods of anesthesia to be applied. He also informs the patient about the planned anesthesia, the sequence of further measures, the risk of anesthesia, and accompanying risks. The family doctor can help to facilitate the preoperative assessment by performing certain examinations himself and by providing the anesthesiologist with relevant informations. By giving a piece of advice to the patient he can help to prepare him for anesthesia and to reduce fear and apprehensiveness.

Anesthesia, General↗
PubMed1993

[Prognostic importance of early recorded somatosensory evoked potentials in patients not neurologically assessable after craniocerebral trauma].

By stimulation of the median nerve at the wrist we recorded the somatosensory evoked potentials (SEP) at several points between the midpoint of the clavicle and the scalp, overlying the area of sensorimotor cortex. The SEP of each side were graded (bilaterally normal SEP's: grade-1/1, pathological SEP's grade-2/1 to grade-4/4). The aim of these recordings is to judge the probability of survival in adult comatous patients in the early phase after a head injury. Our retrospective analysis of these recordings in 108 patients (collective 1988/89) shows a significant correlation of the SEP with the Glasgow Coma Scale score (GCS) (GCS > 8/SEP grade-3 or grade-4: p < 0.005) and the pupillary function (pupillary function disturbed uni- or bilaterally/SEP grade-3 or grade-4: p < 0.0005), being less pronounced with the intracranial pressure (ICP) too. In patients with lack of the component N20 death or vegetative outcome is significantly more frequent than if this component is present (p < 0.005). All the 7 patients without recognisable bilateral component N20 (SEP grade-4/4) died as a consequence of the initial brain injury. 7 out of 9 patients with unilateral lack of the component N20 combined with diminished amplitude ratio and delayed central conduction time (CCT) contralaterally (SEP grade-4/3) died or survived in a vegetative condition; none of them became independent. If the results of the analysis of the patient collective 1988/89 were applied to the patients of 1990 (n = 67) a good correlation between SEP and outcome was confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Kidney procurement from non-heartbeating donors: transplantation results.

To overcome the shortage of kidneys (kdn's) available for transplantation we reactivated kdn procurement from non-heartbeating donors (NON-HBD). In this study, we reviewed our results with 34 kdn's from NON-HBD, transplanted between 1985 and 1991, and compared these with 34 control kdn's procured from heartbeating donors (HBD) matched for age, sex, primary graft or retransplant and transplant year. There was no difference in cold ischemia time, preservation solutions used, duration and type of preoperative dialysis, number of HLA mismatches and serum antibody levels between the two groups. The only significant findings were a lower diuresis in the last hour in the donors in the NON-HBD group, and a significantly higher serum creatinine level compared to the HBD group. The 1-year patient and graft survival rates were 89.4% and 84.9% for the HBD group, and 78% and 76.1% for the NON-HBD group respectively. There was need for dialysis support in the first posttransplant week in 10 out of 34 (29%) recipients in the HBD and 17 out of 34 (50%) recipients in the NON-HBD group. Primary non-function was observed in 1 of 34 (3%) recipients in the HBD group versus 3 of 34 (9%) in the NON-HBD group. None of the differences were statistically significant. There was also no difference in average serum creatinine levels at days 1, 3, and 7, at 1 month and at 1 year between the HBD and NON-HBD groups. In the NON-HBD group 6 of 34 kdn's (18%), 5 of which were retransplants, showed vascular rejection, 5 of them associated with haemolytic uremic syndrome (thrombotic microangiopathy); 2 of these 6 kdn's recovered, and 4 failed (2 with primary non-function). This important observation needs to be investigated further. The results is this study showed, however, that good short- and long-term results can be achieved with kdn's from NON-HBD. We concluded that organ procurement from NON-HBD is an adequate approach to an important cadaver donor source that in general is not effeciently used, but could significantly increase the number of kdn grafts in most transplant programs.

Adult↗
PubMed1991

[Anesthesia for ambulatory procedures].

Ambulatory surgery and anesthesia continued to grow and develop over the last few years: Longer lasting and more complex diagnostic and therapeutic procedures are being performed on an outpatient basis. In addition, outpatient procedures, being less disruptive to the patient's everyday life, are of potential benefit especially for children and elderly patients. The proper selection and evaluation of these patients from the anesthesiological and surgical points of view are very important with regard to successful ambulatory interventions. The preoperative assessment is obviously essential. Good communication and teamwork between anesthesiologists, surgeons and admitting doctors are necessary. Patients should be informed early, i.e. before the day of operation, about the planned procedures (fasting periods, adult person necessary to accompany the patient home, etc.), and their written consent should be there. During the preoperative personal interview, the anesthesiologist identifies risk factors which may influence the management and outcome of the anesthetic procedure. Outpatients profit from a short-acting anxiolytic and sedative premedication before entering the operation room. The choice of the anesthetic procedure itself is made individually. An adequate intra- and postoperative monitoring is essential. A checklist with exact discharge criteria is helpful in practice.

Aged↗
PubMed1990

[Monitoring during secondary transportation].

Stabilization of the vital functions of critical patients prior to transport is mandatory even in urgent interhospital transfers. Although distances may be short, hasty transport is potentially harmful for the patient. The monitoring systems available for emergency care today facilitate mobile intensive care medicine. However, there are still technical limitations which may compromise the continuous invasive monitoring already installed before transport. Special care is needed in developing combinations of monitoring and treatment systems, especially for the transport of critically ill and injured patients.

Continuity of Patient Care↗
PubMed1989

[Enoximone as an alternative to mechanical circulatory support prior to heart transplantation].

Enoximone, a relatively new type III phosphodiesterase (PDE III) inhibitor with combined positive inotropic and vasodilating properties, was used as a pharmacological bridge to heart transplantation in a patient with severe dilatative cardiomyopathy (ejection fraction 11-13%), who developed cardiogenic shock refractory to conventional therapy with catecholamines and vasodilators. Enoximone led to an 88% increase in cardiac index (from 1.6 to 3.0 l/min.m2). Despite a noticeable rise in heart rate, stroke index increased by 57%. Systemic vascular resistance decreased by 48% without any relevant change in mean arterial pressure. Cardiac filling pressures remained high. Oxygen transport doubled and oxygen extraction ratio decreased by 10%. Apart from a decrease in arterial oxygen tension (from 15.8 to 12.8 kPa [119 to 96 mm Hg]), no other side effects were noted. Withdrawal of catecholamine therapy did not cause any relevant haemodynamic changes. Although complications arose from an uncontrolled septic state, orthotopic heart transplantation was performed with success 74 hours after initiation of enoximone therapy. As the PDE III inhibitor enoximone exerts its potent inotropic and vasodilating effects without requiring adrenergic receptor activation, it may be used as an alternative to mechanical support in patients who develop cardiogenic shock resistant to catecholamines while awaiting heart transplantation.

Adult↗
PubMed1983

[X chromosome-linked mental retardation with fragile X chromosome and macro-orchidism].

Description of the first Swiss family with the new syndrome of X-linked mental retardation. The three brothers described are the first of all males traced back for four generations to be affected. In two of the brothers macroorchidism and the fragile X-chromosome were demonstrated, while the third brother died before diagnosis. As expected, the fragile X was not demonstrable in the 75-year-old mother of the three brothers.

Adolescent↗
PubMedDate not supplied

A new model for the assessment of lung allograft ischemia/reperfusion injury.

Lung edema is the main clinical manifestation of reperfusion injury following lung transplantation. The evaluation of strategies to prevent this injury is of high clinical importance. Therefore we developed a large-animal model to study the mechanisms of ischemia/reperfusion injury including dynamics of posttransplant reperfusion edema and their prevention. Left lung allotransplantation was performed in 6 weight-matched pigs (25-31 kg). Donor lungs were flushed with 1.5 L low-potassium dextran (LPD) solution (4 degrees C) and preserved for 20 h at 1 degrees C. One hour after reperfusion the recipient contralateral right lung was excluded from perfusion and ventilation to assess graft function only. Extravascular lung water index (EVLWI), intrathoracic blood volume (ITBV), and cardiac output (CO) were assessed (q = 30 min) with a lung water computer (Cold Z-021, Partig, Munich, Germany) by the thermo-dye technique during a 5-h observation period. Gas exchange (FIO2 = 1.0) was measured hourly, and hemodynamics were monitored continuously. The EVLWI of the recipient contralateral lung together with the donor left lung at the time of reperfusion was 6.5+/-1.1 ml/kg, increasing to 7.1+/-1.0 ml/kg at 60 min after reperfusion. After occlusion of the recipient right lung, EVLWI in the graft further increased within 80 min from 8.1+/-0.5 ml/kg to a peak of 11.4+/-1.3 ml/kg, followed by a decrease to 8.5+/-0.8 ml/kg at 5 h after reperfusion in 5 of 6 animals. In 1 animal a severe alveolar edema developed with subsequent deterioration of gas exchange and death 4.5 h after reperfusion. In this animal, peak EVLWI reached 16.8 ml/kg, PaO2 deteriorated from 60.1 to 7.8 kPa, and CO decreased from 3.1 to 1.4 L/min. In all other animals, ITBV (515+/-51 ml), left atrial pressure (LAP), central venous pressure (CVP), and CO (2.9+/-0.3 L/min) were stable during the 5-h assessment period. We conclude that EVLWI measurement is a reliable and very sensitive method to quantify lung allograft reperfusion edema. It may prove useful in early assessment of lung allograft reperfusion injury in the clinical setting and in experimental models.

Animals↗