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Biomedical subjects

J Landmann

Publications and source records attributed to J Landmann.

At least 19 recordsLinked to original sources
PubMed1992

[Abdominal aortic aneurysm. Risks and early postoperative course].

A review of the literature shows a very variable mortality, especially after emergency operations for abdominal aortic aneurysm (AAA) (14-70%). We therefore analyzed the mortality of our patients in different subgroups. The hospital data of 82 patients operated on for abdominal aortic aneurysm were analyzed retrospectively. 42 patients underwent emergency operations and 40 patients elective surgery. The mean age was 67.5 +/- 9.4 and 70.7 +/- 7.3 years respectively. The overall 30-day mortality in elective cases was 5% (2/40); elective patients under the age of 75 years had a mortality of 0%. 33% of the emergency cases died within 30 days. The mortality in various subgroups was as follows: "asymptomatic AAA" 5.4% (2/37), "symptomatic AAA" 10% (1/10), "retroperitoneal rupture" 34% (11/32) and "intraperitoneal rupture" 66.6% (2/3). Preoperatively 21/42 patients who underwent emergency surgery were in hypovolemic shock (systolic blood pressure < or = 90 mm Hg). The mortality of these patients was 52% (11/21) compared to 9.5% (2/21), (p < 0.01), in emergency patients without preoperative shock. The causes of death after emergency procedures were hypovolemic shock in 6, heart failure in 4, and multi-organ failure, respiratory insufficiency, unknown and pulmonary embolism in 1 each. 5/14 patients died in theatre. Two patients died after elective procedures: one 9 days postoperatively from myocardial infarction and the second 23 days after the operation from an unknown cause. Reoperation rate after elective and emergency procedures was 7.5% and 16.6% respectively. Mortality after reoperation was 40%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

The efficacy and tolerability of cyclosporine G in human kidney transplant recipients.

Twelve consecutive first cadaveric kidney transplant recipients received cyclosporine G (CsG)(initial dose 12 mg/kg per day) as basic immunosuppressive treatment along with prednisone (initial dose 0.5 mg/kg per day) for the first three months after transplantation. Thereafter CsG was replaced by Sandimmun (cyclosporine, CsA). Evaluation of the immunosuppressive efficacy and assessment of possible side effects of CsG was made and compared with the results in 38 historical control patients starting with the same dose of CsA as part of the same immunosuppressive dosage schedule. Statistically, there was no difference in patient survival at three (91% in CsG group versus 95% in CsA group) and twelve months (91% in CsG group versus 92% in CsA group), or in graft survival at three (75% in CsG group versus 89% in CsA group) and twelve months (75% in CsG group versus 84% in the CsA group). At equivalent oral doses of CsG and CsA significantly higher blood levels of CsG were observed (2P less than 0.05). Nephrotoxicity assessed by graft biopsy could be demonstrated to a similar extent in both groups, whereas hepatotoxicity was more pronounced during CsG treatment. Sequential measurements of bilirubin revealed a significant increase in all patients but median values were significantly higher in the CsG patients. A pronounced and concordant elevation of liver enzymes occurred during CsG treatment in three out of 12 patients. Liver biopsies performed in these patients revealed histological alterations consistent with toxic liver injury. Thus, in human kidney transplant recipients CsG and CsA appeared to be equally immunosuppressive and nephrotoxic but more hepatotoxic. On the basis of this limited experience we conclude that in human kidney transplant recipients CsG has no advantage over CsA.

Adult↗
PubMed1992

Sialic acid level in maternal and neonatal lymphocytes and sera correlated to birth order and sex of the neonate.

Sialic acid (N-acetylneuraminic acid) was determined 1 h after normal term deliveries on peripheral blood lymphocytes from 42 mother-neonate pairs and in 29 maternal and neonatal sera. Results were evaluated according to maternal parity and sex of the neonate. The cases were divided into two groups: primiparae, and secundi- and multiparae. In primiparae the sialic acid level on lymphocytes from male neonates and from their mothers was by 23-30% decreased as compared to female neonatal and maternal cells. In the higher parity group, a significantly increased sialic acid level was found on lymphocytes from male as compared to female neonates, and maternal serum sialic acid concentration, unrelated to the newborns' sex, was by 17-20% increased as compared to primiparae. The results suggest that with increasing parity higher levels of sialic acid on male neonatal cells may possibly contribute to mask fetal male-specific histocompatibility antigens. Increased sialic acid levels in maternal sera from secundi- and multiparae suggest its possible contribution to an increased serum blocking effect.

Birth Order↗
PubMed1992

Risks and benefits of graft biopsy in renal transplantation under cyclosporin-A.

261 patients who received a kidney transplant under cyclosporin-A immunosuppression were reviewed in order evaluate the benefits and the risks of renal graft biopsies. 240 graft biopsies were performed in 124 of the 261 patients. The biopsy diagnoses were 103x rejection, 90x cyclosporin-A toxicity, 8x acute tubular necrosis, 8x glomerulonephritis, 9x different biopsy results, and 12 cases of normal renal tissue. In 214 cases the clinical course was well explained by the biopsy result. The histological results led to therapeutical changes in 199 cases. 221 of the 240 biopsies were performed without any complications. There was only one biopsy with irreversible and there were 19 biopsies with reversible complications.

Biopsy↗
PubMed1992

[Donor allopurinol treatment improves organ preservation of the kidney also when using UW solution].

Kidney function following hypothermic preservation with Eurocollins (EC) was previously shown to be improved by donor treatment with Allopurinol (AP) [1]. The University of Wisconsin organ preservation solution (UW), however, contains Allopurinol (1 mM). A syngeneic rat kidney transplant model was used to investigate concurrent Allopurinol donor-pretreatment (40 mg/kg b.w.). Kidney graft function resulted to be improved by AP pretreatment following organ preservation with both EC or UW as evidenced by significant reduction in serum creatinine values. On day two following transplantation the respective serum creatinine values (mumol/l) with and without AP-pretreatment were 424 +/- 39 and 662 +/- 25 for EC, and 259 +/- 48 and 387 +/- 48 for UW organ preservation. Furthermore survival- and histology-data were also superior for recipients of kidney grafts from AP-pretreated donors. We conclude that Allopurinol concentration in the UW solution might be to low or that adding AP into an organ storage solution is not the best application modality.

Adenosine↗
PubMed1991

[Glomerular hyperfiltration following unilateral nephrectomy in healthy subjects].

23 living related kidney transplant donors were prospectively studied to determine the degree of hyperfiltration which occurs after uninephrectomy and to monitor potential consequences of this procedure such as hypertension, microalbuminuria or renal functional impairment. Standard inulin and PAH clearance studies were performed immediately before (n = 23), one week after (n = 22) and one year after nephrectomy (n = 12). Hyperfiltration was defined as the ratio of (post-nephrectomy inulin clearance)/(0.5 x pre-nephrectomy inulin clearance), hyperperfusion was defined in an analogous way for PAH clearance. One week after uninephrectomy, hyperfiltration averaged 134 +/- 6% (SEM) and hyperperfusion was 138 +/- 6%. The degree of hyperfiltration did not correlate with donor age. One year after nephrectomy, hyperfiltration was nearly unchanged (130 +/- 7%) whereas hyperperfusion had significantly decreased to 119 +/- 8% (p less than 0.05). Blood pressure did not increase after nephrectomy and no new cases of hypertension were observed during follow-up. In contrast, there were two new cases of microalbuminuria at one week and one year after nephrectomy. Further follow-up of these kidney donors is warranted.

Adult↗
PubMed1991

Surgical experiences with 191 implanted venous Port-a-Cath systems.

The introduction of totally implantable catheter device has provided a simple, permanent and safe access to the vascular system. They have greatly improved the quality of life of the patients involved, whose activities, daily hygiene and bodily attractiveness remain practically unrestricted. To gain the greatest freedom from complications in the use of fully implantable catheter devices, the following requirements are important in to our experience: 1. Experience with only one kind of catheter system, irrespective of whether it is claimed to be the best, the simplest, or the cheapest. Various companies offer a variety of totally implantable catheter devices. Every system has its advantages and its disadvantages. However, each system also requires a considerable degree of surgical experience and experience in postoperative care and management to keep the complication rate as low as possible. Frequent changing to other systems does not enlarge the experience obtained. 2. The experience of the surgical team. In Basel catheter systems are implanted by three surgeons only. We are convinced that this contributes to our relatively low rate of complications. Brothers et al. (1988) also show that the rate of complications is inversely related to the experience of the surgeon involved. 3. The experience, commitment and training of the nursing staff responsible for the care and maintenance of the implanted catheter device. This care and maintenance of the implanted catheter device should start immediately after the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Expression of transferrin receptor on human maternal and neonatal peripheral blood lymphocytes.

The levels of peripheral blood lymphocytes expressing the receptor for transferrin (TSR) on untreated and phytohemagglutinin (PHA)-stimulated cell samples from maternal-neonate pairs were evaluated 4-12 h postpartum. Significantly increased levels of TSR+ cells were observed on fresh, unstimulated neonatal and maternal cells, as compared to control cells from young adult males and females, and the values seemed to correlate with the sex of the neonate and with birth order. The level of TSR+ cells in culture was found to be increased on neonatal cells and decreased on maternal cells.

Adult↗
PubMed1991

Protective effect of allopurinol and superoxide dismutase in renal isografts in cyclosporin A-treated rats.

Acute tubular necrosis (ATN) after renal transplantation is related to the duration of warm and cold ischemia and leads to temporary or permanent impairment of graft function. An increased incidence of ATN has been reported since the introduction of cyclosporin A. Kidney damage resulting from hypothermic storage is generated in part during reperfusion rather than during ischemia itself. Potential mediators of the reperfusion injury are oxygen-derived free radicals. Therefore, the influence of two oxygen radical antagonists, allopurinol and superoxide dismutase, was evaluated in syngeneic rat kidney transplantation with and without concurrent administration of cyclosporin A. At 15 h cold ischemia, 28-day survival increased from 8% (no treatment) to 22% (superoxide dismutase), 33% (superoxide dismutase and allopurinol), and 73% (allopurinol). Cyclosporin A cotreatment (10 mg/kg over 14 days) resulted in survival rates of 0%, 25%, 17%, and 50% for the respective treatment groups. The results of serum creatinine values and morphological evaluation of biopsies paralleled the survival rates. Cyclosporin A nephrotoxicity was evidenced by significant serum creatinine elevations throughout the 28-day period of observation. In conclusion, allopurinol significantly protects syngeneic rat kidney transplants against a critical duration of cold ischemia. Under the conditions of this experiment, allopurinol was clearly superior to superoxide dismutase treatment. Cyclosporin A nephrotoxicity was, however, not ablated by the oxygen radical antagonists employed.

Allopurinol↗
PubMed1991

Morphologic findings in "zero-hour" biopsies of renal transplants.

The extreme lack of renal grafts for transplantation stimulated us to analyze how strict the selection criteria of kidney donors must be. We investigated therefore if preexisting lesions in renal grafts influence initial and late renal function. 147 zero-hour biopsies of 101 donors (mean age 33, from 6-64 years) were examined. By ligh microscopy 38% of biopsies showed no, 44% showed nonspecific and 18% specific lesions. Nonspecific lesions comprised intimal fibrosis of small arteries in 44%, interstitial fibrosis in 8% and an arteriolar hyalinosis in 29%. Out of 102 immunohistologically examined biopsies 74.5% showed nonspecific IgM/C3 deposits in glomeruli and/or arterioles. An age dependent decrease of normal renal biopsies was found which was most evident in donors older than 40 years. Specific findings consisted of glomerulosclerosis (n = 4), glomerulonephritis (n = 11), intravascular coagulation (n = 10) and eclamptic kidney (n = 1). In case of nonspecific immunohistologic findings and in glomerulonephritis rebiopsies showed that antigen deposits usually disappeared within 4 months. Independent of morphologic findings 82% of transplant recipients had a good initial and late renal function. Since donor age, glomerulosclerosis, glomerulonephritis, intravascular coagulation or eclamptic changes seem not to compromise renal function after transplantation a more liberal choice of donors should be considered.

Adult↗
PubMed1991

[Familial adult cystic kidneys and malignant teratomas after kidney transplantation with cyclosporin therapy].

We report on two brothers with adult polycystic kidney disease, malignant teratomas and other genital malformations. Because of the unusual accumulation of malformations of embryologically related organs, we postulate a connection between malformations of the kidneys and the genital tract, on the one hand, and teratomas on the other. No genetic coherence is known so far. It is unlikely that immunosuppression with cyclosporin after transplantation had caused these tumours.

Adult↗
PubMed1991

[New therapeutic approach in the celiac trunk compression syndrome].

Etiology and treatment of the coeliac compression syndrome remains controversial. The external compression, near the origin of the truncus coeliacus and the poststenotic dilatation is well demonstrated by angiography on a lateral projection. The development of collaterals like the pancreaticoduodenal and gastroduodenal artery can be assessed on a frontal view. The grading of the stenosis as well as the direction of the flow in these artery can be measured with the duplex sonography. These investigations show a steal syndrome: blood coming from the mesenteric artery irrigate the common hepatic artery through the collaterals. The flow in the common hepatic artery is therefore retrograde. We used an original technique to correct this flow pattern in the case of a 52-year-old patient: after dividing the arcuate ligament, we reduced the vascular territory of the truncus coeliacus with the proximal ligation of the splenic artery. The duplex sonography shows postoperatively the suppression of the steal syndrome with a normal flow pattern in the hepatic artery despite minimal change in the stenosis of the truncus coeliacus. The patient remained asymptomatic since the operation. We concluded that an angioplasty or reimplantation of the truncus coeliacus is unnecessary to correct the steal syndrome. A normal flow can be provided by a stenotic truncus coeliacus once the splenic artery has been ligated.

Blood Flow Velocity↗
PubMed1990

von Willebrand factor and factor VIII in renal transplant recipients under immunosuppression with cyclosporine and steroids. Sequential measurements over 4 months in 17 patients.

In 17 consecutive cadaver kidney transplant recipients treated with cyclosporine (CsA) and steroids, the median of antigenic and functional levels of von Willebrand factor (vWF) and factor VIII (FVIII) before transplantation were elevated (vWF:Ag: 206%, vWF:RCof: 202%; FVIII:Ag: 248%, FVIII:C: 224%; normal values 50-150%). Sequential measurements after transplantation and during CsA treatment revealed a transient significant increase of median values with highest amounts of vWF:Ag of 362% (2 p less than 0.0001), FVIII:Ag of 398% (2 p less than 0.001) and FVIII:C of 360% (2 p less than 0.0001) (Friedman test). vWF:RCof did not show statistically significant changes. After 4 months, levels of vWF and FVIII comparable to those obtained before transplantation were observed. In univariate statistical analysis no correlation was found between vWF of FVIII on the one hand and plasma creatinine levels, CsA dose or CsA whole blood through levels on the other hand. However, multivariate statistics revealed to some extent a positive influence of CsA blood levels on vWF:Ag levels. Patients with vascular rejection or chronic CsA nephrotoxicity showed significantly lower levels of vWF:Ag as compared with patients without endothelial cell damage in the kidney (2 p less than 0.05). However, the difference in vWF:Ag levels already existed before transplantation. In contrast to recent reports, plasma vWF levels were not indicative of vascular injury in kidney graft recipients nor was the marked elevation of vWF and FVIII associated with thromboembolic complications ascribed to CsA treatment.

Cadaver↗
PubMed1990

[Problems with long-term immunosuppression following organ transplantation].

Long-term immunosuppression is followed by an increase of malignancies (skin cancer, lymphomas and Kaposi's sarkoma). Among the infectious complications an incidence of bacteraemia up to 48% is found, a relative increase of infection with listeria and salmonella, and viruses from the herpes group. The major side effect of azathioprine is haematologic, whereas Cyclosporin A is nephrotoxic. Three classes of renal functional impairment by Cyclosporine are defined: 1. renal dysfunction, 2. acute nephrotoxicity and 3. chronic nephrotoxicity. Appropriate ways to handle chronic nephrotoxicity are discussed.

Humans↗