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Biomedical subjects

J Pawlak

Publications and source records attributed to J Pawlak.

At least 37 records · Page 2Linked to original sources
PubMed2001

Antimicrobial activity of moxifloxacin, gatifloxacin and six fluoroquinolones against Streptococcus pneumoniae.

The in vitro and pharmacodynamic effects of moxifloxacin and gatifloxacin against Streptococcus pneumoniae were compared with six other fluoroquinolones. Organisms included penicillin-susceptible (54) and penicillin-non-susceptible (145) isolates from 1998-1999. Moxifloxacin and clinafloxacin demonstrated the greatest in vitro activity, with MIC90s of 0.13 mg/L, followed by trovafloxacin, grepafloxacin > gatifloxacin, sparfloxacin > levofloxacin > ciprofloxacin. There was no difference in fluoroquinolone activity between penicillin-susceptible and -non-susceptible strains. Pharmacodynamic analysis using published pharmacokinetic information indicates that all the agents tested except ciprofloxacin had an AUC/MIC90 > 30, with moxifloxacin having the greatest free-drug availability.

Anti-Infective Agents↗
PubMed2001

Intrahepatic portosystemic shunt in treatment of complications of portal hypertension.

BACKGROUND: The aim of the paper is to present the role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension complications such as variceal bleeding and persistent ascites. MATERIAL AND METHODS: Between June 1992 and December 2000, 56 patients with portal hypertension developed in the course of hepatic cirrhosis were qualified for TIPS. The indications for TIPS included esophageal variceal bleeding, recurrent despite endoscopic treatment (N-40), active esophageal variceal hemorrhages in which traditional methods used to stop the bleeding proved ineffective (N-8) and ascites failing to respond to high doses of diuretic agents (N-8). The studied group consisted of 30 females and 26 male patients aged from 17 to 68 (mean age 52 yrs). According to Child-Pugh surgical risk classification, 26 patients belonged to group B, and 30 to group C. RESULTS: In 50 patients (83.5%) an intrahepatic shunt was formed and the stent(s) implanted. In 42 cases (75%), long-lasting patency of the shunt was obtained and esophageal variceal bleeding was stopped. Active esophageal variceal hemorrhages were stopped in all the cases. The remission of massive ascites and hepatorenal syndrome was obtained in 7 out of 8 patients. CONCLUSIONS: TIPS is a non-surgical method relieving portal hypertension in patients with variceal hemorrhages recurrent despite endoscopic treatment. Very good results were also obtained in the cases with active variceal hemorrhages. TIPS has proved to be an effective method of treatment in the patients with massive ascites and hepatorenal syndrome.

Adolescent↗
PubMed2001

Correlation between the haemodynamics of portal collateral circulation and the incidence of esophageal bleeding in patients with portal vein thrombosis--a preliminary report.

The aim of this study was to determine a correlation between the haemodynamics of portal collateral circulation (PCC) and the incidence of bleeding episodes. The prospective analysis included 17 patients with portal hypertension resulting from prehepatic block but without history of oesophageal bleeding. Every two months the changes in PCC and incidence of oesophageal bleeding were evaluated. The follow-up ranged from 3 to 12 months. The statistical correlation between the portal haemodynamic disorders and the tendency to bleed was investigated. Variceal bleeding occurred in 6 patients during the time of observation, mostly in patients with development of hepatofugal PCC. Authors suggest that the development of hepatofugal PCC is the main factor of variceal bleeding in patients with portal vein thrombosis (PVT).

Esophagus↗
PubMed2000

Liver transplantation in the experience of the centre commencing the program.

From 1989 to 1999, 43 orthotopic liver transplantations (OLT) in 40 patients (3 retransplantations) were performed in our Department. The most common indications for OLT were noninflammatory, primary cholestatic liver diseases and postinflammatory liver cirrhosis. Fourty OLT's were done for elective indications, three--on emergency basis, because of fulminant liver failure. The majority of transplantations was performed with classical technique with the excision of retrohepatic vena cava and routine use of the extracorporeal veno-venous bypass. Only in 4 patients the piggyback technique was used and performed without temporary portocaval anastomosis. All 3 patients transplanted for fulminant liver failure died in the perioperative period. Twenty four patients are still alive and well, the longest period of observation exceeding 5 years.

Humans↗
PubMed1999

In-vitro activity of 29 antimicrobial agents against penicillin-resistant and -intermediate isolates of Streptococcus pneumoniae.

Antibiotic resistance among isolates of Streptococcus pneumoniae is increasing worldwide. Optimal therapy, though unknown, should be guided by in-vitro susceptibility testing. Currently, vancomycin is the only approved antibiotic that is universally active against multiresistant S. pneumoniae. In-vitro activities were determined for 29 antimicrobial agents against 22 penicillin-intermediate S. pneumoniae (PISP) and 16 penicillin-resistant S. pneumoniae (PRSP) isolates. MICs were determined in cation-adjusted Mueller-Hinton broth with 3% lysed horse blood in microtitre trays. Antimicrobial classes tested included cephalosporins, penicillin, aminopenicillins, macrolides, quinolones, carbapenems and other antimicrobial agents. Among the classes of antimicrobial agents tested, wide differences in susceptibility were demonstrated for both PISP and PRSP. Of the cephalosporins, ceftriaxone and cefotaxime demonstrated the best in-vitro activity for both PISP and PRSP. Of the quinolones, clinafloxacin and trovafloxacin showed the greatest in-vitro activity. Rifampicin and teicoplanin demonstrated excellent in-vitro activity. Promising in-vitro results of newer agents, such as quinupristin/dalfopristin, ramoplanin, teicoplanin and linezolid may justify further evaluation of these agents in clinical trials.

Anti-Bacterial Agents↗
PubMed1998

Prospective double-arm study of fibrinolysis in surgical patients.

BACKGROUND: During surgery, the balance between thrombosis and fibrinolysis is altered. Methods reported to increase fibrinolysis, such as compression devices, may reduce venous thrombosis. However, there are no prospective studies comparing methods and the effect on fibrinolysis. MATERIALS AND METHODS: In a prospective study, general surgical patients were randomized to either sequential compression devices (Group 1) or subcutaneous heparin (Group 2), and fibrinolysis factors were measured in order to determine the effect on the fibrinolysis system. Blood samples were drawn at a similar time of the day with the tourniquet off. Specifically, t-PA antigen, plasminogen activator inhibitor-1 (PAI-1), and D-dimer were measured preoperatively (preop) and on Postoperative Days (POD) 1 and 7 by the ELISA method. Fibrinolysis factors were reported as the mean +/- SD and as percentage change from preoperative values. Noninvasive vascular studies were performed preop, and on POD 1, 7, and 30, by an examination of the infrainguinal venous system and external iliac veins in bilateral lower extremities. Nonambulatory patients were excluded from the study and DVT prophylaxis methods were initiated at surgery and used through POD 2. RESULTS: For the 136 patients in the study, there were no differences in clinical characteristics such as age, surgical time (all > 60 min), anesthesia type (general or spinal), type of surgical procedure, or other risk factors for DVT. Two DVTs occurred at POD 1 and 30 (both Group 2), and one pulmonary embolism in each group (POD 7 for Group 1; POD 1 for Group 2). For subjects without thrombosis, D-dimer changes were parallel for both groups, increasing through POD 7. Similarly, t-PA antigen levels rose from baseline on POD 1 in both groups, with a return toward baseline by POD 7. The PAI-1 levels increased on POD 1 in both groups, but severalfold more in Group 1 (compression devices). The elevation in PAI-1 decreased by 50% in Group 1 by POD 7, while values returned to normal in Group 2. These changes were not significant using the Mann-Whitney test. Only three patients had thrombotic episodes so that data on changes in fibrinolysis factors are difficult to compare with the larger group. CONCLUSIONS: This is the first report of a prospective, randomized comparison of fibrinolysis factors using sequential compression devices in comparison to low dose unfractionated heparin in general surgical patients, and comparing postoperative values to preop. Both groups showed an enhanced fibrinolysis by elevation in t-PA antigen and D-dimer on POD 1, as expected when fibrinolysis occurs. While PAI-1 and t-PA work in parallel, the marked elevation of PAI-1 on POD 1 (although only slightly above reference values) and continuing into POD 7 for subjects using compression devices requires further inquiry. The elevation of PAI-1 in the face of elevated t-PA and D-dimer has been reported, but the comparison between patients using sequential compression devices and mini-dose heparin has not been reported. The reason for the elevation requires additional study into other influences on the synthesis, secretion, and/or function of PAI-1 that do not affect t-PA.

Female↗
PubMed1998

[Intrahepatic portocaval shunt as a new method for treating and prevention of bleeding from esophageal varices in portal hypertension].

UNLABELLED: The aim of this study was the presentation of percutaneous transjugular intrahepatic porto-systemic shunt (TIPS) and its place among the other methods of the treatment of esophageal variceal bleedings. In the period from June 1992 to December 1997, 31 cirrhotic patients with portal hypertension and recurrent variceal bleedings were submitted for TIPS. This group consisted of 14 female and 17 male patients, their age ranging from 17 to 68 years (average 52). According to Child-Pugh classification 4 patients represented group A, 11--group B and 16--group C. Each of these patient was admitted to our Department after recurrent bleeding, resistant to typical treatment: terlipressein infusion, balloon tamponade and endoscopic sclerotherapy. In 24 patients (78%) TIPS was performed successfully. In 7 cases TIPS was performed in candidates for orthotopic liver transplantation. CONCLUSIONS: TIPS is quite new, nearly 10 years old method for portal decompression. It is an effective and less invasive method than surgical procedures in the treatment of portal hypertension, especially in Child-Pugh group B and C patients if the sclerotherapy is not effective. It protects cirrhotic patients waiting for liver transplantation against the esophageal bleedings.

Adolescent↗
PubMed1997

[Surgical treatment of biliary tract neoplasms].

The authors present their own experiences concerning the treatment of the 34 patients with the benign and malignant tumors of the biliary tract. In the group of patients with malignant tumors, the type and extent of the surgery were dictated by the stage of the disease. Patients with benign tumors were subjected to resection of the region of bile duct bifurcation with Roux-Y hepaticojejunostomy.

Adolescent↗
PubMed1997

[TIPS in treatment of patients with recurrent bleeding from esophageal varices].

In the period from January 1992 to May 1997 we performed 20 procedures of percutaneous transjugular intrahepatic porto-systemic shunt (TIPS) in the patients with liver cirrhosis and recurrent variceal bleedings. This group consisted of 10 male and 10 female patients, their age ranging from 17 to 68 years (average 52). The etiology of cirrhosis was alcoholic in 8 cases, postinflammatory in 6, primary biliary in 4 and autoimmunological in 2 cases. According to Child-Pugh classification 4 patients represented group A, 10-group B and 6-group C. Each of these patient was admitted to our Department after recurrent bleeding, resistant to typical treatment: vasopressin infusion, balloon tamponade and endoscopic sclerotherapy. In 3 cases TIPS was performed in candidates for orthotopic liver transplantation.

Adolescent↗
PubMed1997

[Orthotopic liver transplantation in clinical materials].

The authors present their own experience in orthotopic liver transplantation as a treatment of acute and chronic liver failure. 18 transplantations were performed in 16 patients. The indications for transplantation: acute liver failure-3 cases, chronic advanced disease of the liver-13 cases, graft failure requiring retransplantation-2 cases. All 3 patients with acute failure died after transplantation. Out of 13 patients after elective transplantations 11 remain alive, (in this number both retransplanted). The longest follow-up period is 2.5 years.

Adult↗
PubMed1997

[Evaluation of the usefulness of the liver for transplantation based on 26 multiorgan harvests].

UNLABELLED: This study is aimed at the clinical and morphological criteria of estimation of the liver harvested for transplantation. In the period from January 1996 to May 1997 our team obtained 26 livers at the multi-organ harvesting. Most of the donors were young people after the trauma of central nervous system. The liver was harvested according to the principles of Starzl's fast method with the successive preparation on the "cold table". The donor's clinical status was estimated, as well as appearance, density and colour of the organ, quality of perfusion with UW solution In 23 cases the histological examination of the harvested organ allowed to estimate the degree of steatosis, hepatocyte necrosis, vacuolar degeneration and other abnormalities. In 3 cases the graft was estimated only by means of macroscopic examination. RESULTS: As a result of clinical and histological findings 8 organs were considered as unsuitable for transplantation. In one case the histological findings were the contraindication despite the satisfactory macroscopic appearance of the organ 15 organs were successfully transplanted, proving the conformity of clinical and histological criteria. In 4 livers (15%) the abnormalities of arterial supply were found. CONCLUSIONS: Clinical and pathomorphological estimation of the harvested liver is adequate to it's suitability for transplantation, advisable for the centres initiating the liver transplantation program. Detailed analysis of the donor's clinical status and laboratory data and competent macroscopic estimation of the harvested liver allow the experienced surgeon to resign from the routine histological verification, which might be necessary in doubtful cases only.

Humans↗