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Biomedical subjects

M Decurtins

Publications and source records attributed to M Decurtins.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Opportunistic infections in patients with disordered immune status].

Dysfunction of the immune system can result in opportunistic infections, which are frequently responsible for high morbidity and mortality. With regard to surgery, opportunistic infections are found in specific risk groups, including individuals with tumors, AIDS, thermic or mechanical trauma and organ transplantation. These infections can be caused by bacteria, fungi, viruses and protozoa. If there are indications of a possible opportunistic infection, a rapid diagnosis is required, followed by immediate therapeutic intervention.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Removal of kidneys from donors with circulatory arrest. A simple procedure in lessening the shortage of donor kidneys].

The increasing list of patients waiting for an organ transplantation shows clearly the shortage of donor organs at disposal. This shortage is particularly high in the field of kidney allotransplantation. As the nephrectomy in non-heart beating (NHB) donor is technically practicable in most of our hospitals, the aim of this contribution is to pass on further informations about the nephrectomy to those doctors who are interested in the procedure. The first part of the paper explains the different facts of the end staging renal disease in Switzerland and of transplantation activity. We focus then on the conditions and preparations of the nephrectomy in NHB donor, the exact technique of the operation and the organ perfusion. As it is shown by different studies, the long-term results of NHB donor kidneys are good. The nephrectomy in NHB donor is an effective method to solve kidney shortage.

Brain Death↗
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↗
PubMed1992

Cytofluorometry as a diagnosis of protoporphyria.

Protoporphyria is a disorder that usually has cutaneous symptoms. Only in a few cases liver disease develops, invariably progressing to cirrhosis and liver failure. A case of a patient who suffered from photosensitivity as a result of protoporphyria since the age of 2 is described. At age 33, she first presented with cholestatic hepatitis. At age 40, liver failure developed requiring liver transplantation. Quantitative cytofluorometry proved to be a quick and simple method in the follow-up of her erythrocyte protoporphyrin levels before, during, and after transplantation. Fluorescence correlated well with the protoporphyrin levels obtained by high-performance liquid chromatography (r = 0.98), a comparably cumbersome and complicated method for the determination of protoporphyrin. In addition, single cell analysis enabled us to follow the effects of transfusion therapy on protoporphyrin levels of the patient's own erythrocytes, which has not been possible by previous methods. Thus, cytofluorometry might prove to be elegant and useful for screening and future studies on therapy and pathophysiology of protoporphyria.

Adult↗
PubMed1992

Latex agglutination test for cytomegalovirus antibody screening of transplant donors. Important aspects.

In a retrospective study, false negative readings of CMV Scan results were detected. In a following prospective survey of 72 transplant donor sera, CMV Scan had a sensitivity and a negative predictive value of greater than 95%. Although CMV Scan is a rapid and useful test, a higher reliability can be achieved if results are controlled by another sensitive test or, at the least, CMV Scan is read by two different persons.

Antibodies, Viral↗
PubMed1992

Secondary pyeloureterostomy after ureter necrosis in renal transplant recipients.

After kidney transplantation, urological complications account for significant morbidity necessitating reoperation in a substantial number of patients. In cases with urinary tract necrosis after renal transplantation secondary pyeloureterostomy represents an accepted method for urinary tract reconstruction. In our institution 2% of all kidney grafts required secondary pyeloureterostomy. In all cases the recipient's own ureter was investigated before reoperation by retrograde pyeloureterography. Pyeloureterostomy was performed with a standard technic, the recipients own kidney being removed in all but 5 patients. All 25 patients had normal kidney function immediately after secondary pyeloureterostomy. Urological complications occurred in 7 patients (anastomotic leakages in 4, stenosis in 3); 5 out of 7 complications were managed conservatively (nephrostomy, transureteral stenting). Two patients needed reexploration for reanastomosis. Our results confirm the simple and safe technic of pyeloureterostomy for urinary reconstruction in patients with ureter necrosis after renal transplantation.

Adult↗
PubMed1992

[General aspects of kidney removal from donors with cardiovascular arrest].

The increasing list of patients waiting for an organ transplantation shows clearly the shortage of donor organs at disposal. This shortage is particularly high in the field of kidney allotransplantation. As the nephrectomy in non-heart beating (NHB) donor is technically practicable in most of our hospitals, the aim of this contribution is to pass on further informations about the nephrectomy to those surgeons who are interested in the procedure. The first part of the paper explains the different facts of the end stage renal disease in Switzerland and of transplantation activity. We focus then on the conditions and preparations of the nephrectomy in NHB donor, the exact technique of the operation and the organ perfusion. As it is shown by different studies, the long-term results of NHB donor kidneys are good. The nephrectomy in NHB donor is an effective method to solve kidney shortage.

Heart Arrest↗
PubMed1992

[Initial experiences with the bio-fragmentable Valtrac anastomosis ring].

The biofragmentable ring (Valtrac) to perform a sutureless bowel anastomosis was used in a short period until complications rate became to big. There were six ileo-colostomies with the 28 mm ring and 7 colo-colostomies with the 31 mm ring. In 4 patients additional sutures were placed because the ring was shining through the tissue. Thirteen patients (4 women, 9 men) with a mean age of 63 years (36-78) were included. Complications occurred in 3 men (71, 36 and 63 years old). Two of them had an additional suturing. One demonstrated insufficiency at day four with many small gabs in the anastomotic line according to the ring design. Histology demonstrated perfect microcirculation. The second patient developed a fistula three weeks after operation. Both had an ileo-colostomy. The third operated because of a gastrocolic fistula with cachexia reentered hospital seven weeks postoperatively with a new gastrocolic fistula on X-ray. He died with a cardiac arrest. Postmortem was refused. We conclude from our results that the Valtrac ring should be used only by experienced surgeons, there is no reduction in operation time, and ileo-colostomy needs special care. We believe that surgeons using an extramucosal monofilament running suture for colonic anastomosis are more unlikely to switch to the Valtrac ring than those using other technics.

Adult↗
PubMed1992

[Results of kidney transplantation in patients over 60 years of age].

In the same measure as the age of population is growing, the importance of the problems rising by the renal transplantation in elder persons is increasing. At the University Hospital of Zurich 1313 kidney transplantations were performed between 1964 and 1990, 44 of them to patients who at the moment of operation were older than 60 years of age. The actuarial patient survival after 3 months reached 81%, after 1 year 74% and after 5 years 42%. The actuarial allograft survival after 3 months was 75%, after 1 year 67%, after 5 years 40%. The mortality was 131 per 1000, the mortality ratio compared to a standard population 6 times higher. The main causes of death were infections (52%) and cardiovascular diseases (28%). These results explain our opinion, that renal transplantation in elder patients should be indicated retentively.

Adult↗
PubMed1991

[Emergency hospitalization for acute, non-accidental abdominal pain. Prospective data of a surgical university clinic].

During a 19-month period 549 patients (278 women, 271 men) suffering from abdominal pain unrelated to trauma (mean age 48.2 years) entered the emergency room of the Department of Surgery of the University Hospital Zürich. 43% presented during business hours, whereas 57% were admitted during nighttime and/or weekends. Clinical examination, abdominal roentgenograms (upright and supine) as well as sonography were the most commonly used diagnostic tools. 40% suffered from abdominal pain of unknown cause. The most common diagnosis on admission was appendicitis. Only half of these cases really proved to be an appendicitis. In 36% the diagnosis on admission corresponds both to the initial diagnosis made by a member of staff during his first visit, as well as to the final diagnosis. The initial diagnosis agrees in 57% with the final diagnosis. In 10% of the patients the cause of pain was not elucidated despite extensive diagnostic procedures. High technology and sophisticated diagnostics are less important than the clinical evaluation. The decision between operative or nonoperative treatment was mainly based on clinical findings.

Abdomen, Acute↗
PubMed1991

Emergency room patients with abdominal pain unrelated to trauma: prospective analysis in a surgical university hospital.

During an 8-month-period, 241 patients suffering from abdominal pain unrelated to trauma (mean age 48 years) attended the emergency room of the Department of Surgery of the University Hospital, Zürich. Forty-three percent presented during working hours, while 57% were admitted during the night or at the weekend. Clinical examination, abdominal roentgenograms (upright and supine) and sonography were the most commonly used diagnostic tools. Forty percent suffered from abdominal pain of unknown origin. The most common diagnosis on admission was appendicitis, but only half of these cases proved to be appendicitis. In 36% the diagnosis on admission corresponded both to the initial diagnosis made by a member of staff during his first visit, and to the final diagnosis. The initial diagnosis agreed with the final diagnosis in 57%. In 10% of the patients the cause of pain was not elucidated despite extensive diagnostic procedures. High technology and sophisticated diagnostic evaluation are less important than the clinical evaluation. The decision between operative and nonoperative treatment was based mainly on clinical findings.

Abdominal Pain↗
PubMed1990

Liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome.

We report the case of a young woman with Budd-Chiari syndrome in whom mesentericoval shunt was first performed, followed by transcaval liver resection and hepatoatrial anatomosis 3 years later. Liver transplantation became necessary 5 years later because of deterioarating liver function with portal hypertension and bleeding. Successful transplantation was performed with atrioatrial anastomosis with help of cardiopulmonary bypass, simplifying considerably the technical procedure and reducing dramatically blood loss.

Adult↗
PubMed1990

The delayed duct occlusion technique of human pancreatic transplantation.

This is a report on a consecutive series of 50 primary human pancreatic transplants performed between 1980 and March 1989. All patients suffered from end-stage diabetic nephropathy, thus all received a kidney graft simultaneously. The basic technique consisted of intraperitoneal placement of a duct-occluded pancreas segment. The main technical and non-immunological complications included primary non-function (10%) because of ischemic damage or technical error, graft pancreatitis (4%), arterial thrombosis (6%) and venous thrombosis (16%). Five patients (10%) died in the later course with functioning transplant, and 10 transplants (20%) were lost due to acute or chronic rejection, 7 of them in the pre-cyclosporin era. The technical modifications introduced during these years to overcome complications consisted of temporary percutaneous drainage of the exocrine secretion for function control, delayed occlusion of the ductal system with polyurethane, and continuous heparin perfusion of the graft in the postoperative period by means of an arterial catheter.

Adult↗
PubMed1990

[Nosocomial lung infections. Epidemiology and problems of stress ulcer prevention].

The incidence of pulmonary complications in patients with tracheal intubation is 17-25%. The mortality rate is considered to be between 50 and 81%. Aspiration of contaminated gastric fluid has been suggested to be a source of many of these complications. Gastric fluid contamination depends on the pH of the gastric fluid among other things. This results in a much higher incidence of nosocomial pneumonias in patients receiving H2-blockers (36%) or antacids and H2-blockers (38%) than placebo (8%) or sucralfate (10%). In contrast H2-blockers, antacids, omeprazole, pirenzepine and sucralfate show similar bleeding rates due to stress ulcers, but all are significantly lower than that of placebo. The routine application of prophylaxis for stress ulcer bleeding should nowadays be reserved for risk patients only. If necessary antimuscarinic drugs or sucralfate should be applied.

Anti-Ulcer Agents↗
PubMed1990

[Omniflow: a new vascular prosthesis for hemodialysis access].

Between January and November 1988 20 a.-v. shunts for haemodialysis access were performed at the University Hospital of Zurich with the Omniflow, a prosthesis composed of sheep collagen and polyester mesh. The main reason to implant this vascular prosthesis was the failure of Cimino-shunts. In 9 cases a straight and in 11 cases a performed "u" shape graft was used. During the follow-up period of 3-11 months the following 6 complications were observed: 5 graft thrombosis (in 2 cases due to hypotonia, in other 2 cases due to wrong graft selection and in 1 case due to narrowed venous anastomosis), and one graft dysfunction due to a stenosis in the patients vein. In comparison to the vascular prostheses used earlier, the Omniflow graft is characterized by a high patency rate and an easy puncturing.

Arteriovenous Shunt, Surgical↗
PubMed1990

[Surgical treatment of acute portal vein thrombosis].

A concept of the surgical treatment of acute portal vein obstruction is presented: thrombectomy, small bowel resection and placing of a portal vein catheter for local application of heparin, allowing also angiographic control. Two cases are reported. With early diagnosis and surgical therapy acute portal vein obstruction seems to have a favorable prognosis.

Female↗