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M Decurtins

Publications and source records attributed to M Decurtins.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Bile duct reconstruction in liver transplantation].

Complications of the biliary anatomosis are common after liver transplantation. Even with improved techniques the frequency of biliary complications is approximately ten percent. Main reason for this high morbidity rate is the unfavourable blood supply to the biliary tract. A variant of reconstructions has been described and recommended. The end-to-end-choledochocholedochostomy over a T tube turned out to be the preferred technique in most centers. In cases of different diameter of donor and recipient biliary tract, the side-to-side-choledochocholedochostomy provides a relayable alternative method. When the length of the bile duct doesn't allow direct anastomosis, the gallbladder-conduit may help to overcome this problem. The choledochojejunostomy with Roux-en-Y loop has become a frequently used biliary anastomosis, especially when the recipients bile duct is absent or otherwise destroyed. - Our own experience with fourteen liver transplantations shows biliary tract complications in three cases: a leakage and a stenosis of the anastomosis after choledochocholedochostomy were successfully transformed to a hepaticojejunostomy. In the third case, intrahepatic biliary stenosis were treated by percutaneous transhepatic dilatation.

Adult↗
PubMed1990

Thrombocytosis following segmental duct-occluded pancreatic transplantation.

The average platelet counts in our patients with functioning SPK were significantly higher during postoperative week 2 and the interval of weeks 5 through 9 compared with a matched group of KTA recipients. The thrombocyte values in the SPK group were consistently elevated above the normal range (except postoperative week 1) but less than a platelet level typically requiring therapeutic intervention (greater than 1 mil/mm3). However, because potential pathology both locally (graft pancreatitis, endothelial damage of preservation and operative trauma, diminished graft blood flow) as well as systemically (atherosclerosis, hypertension) is present in SPK patients, we consider them at high risk for thromboembolic complications and therefore support prophylaxis of post-SPK thrombocytosis with platelet inhibitors.

Blood Transfusion↗
PubMed1990

[Postoperative complications following biliodigestive anastomoses].

Between 1980 and 1988 a total of 91 bilidigestive anastomoses were performed in 91 patients at the University Hospital of Zurich. Fifty-seven percent of the patients with an average age of 55 years were male. The main reasons for surgery were cancer of the pancreas, gallbladder or bile-duct in 38%, and chronic pancreatitis in 33%. In 57% the bilidigestive anastomosis was performed as hepaticojejunostomy, in 38% as choledochojejunostomy. The hospital mortality was 7.6%, the morbidity 40%. Thirteen percent had a leakage of the anastomosis: 11% of the hepaticojejunostomy and 17% of the choledochojejunostomy. Ten percent of the patients with a one-layer single knotted suture presented a leakage of the anastomosis, 11% of those with a two-layer single knotted suture, and 25% of those with a continuous suture. Only a quarter of the leakages had to be reoperated. All the others could be managed conservatively. Renal failure appeared in 13%. Two of those patients needed dialysis. No cases of gastrointestinal bleeding were found in this series. Concluding from these results we perform the bilidigestive anastomosis as hepaticojejunostomy with a one- or two-layer single knotted suture.

Adult↗
PubMed1989

[Hepatic veno-occlusive disease: indication for liver transplantation?].

Since 1976 liver replacement has become a widespread and successful procedure in the management of acute or chronic Budd-Chiari syndrome. Since transcaval resection of the liver with direct hepato-atrial anastomosis provides a less formidable method of treating Budd-Chiari syndrome, we consider liver transplantation only in cases with thrombosis of central liver veins (veno-occlusive disease). Even in such a desperate situation liver transplantation can be very helpful, as documented in this report.

Adult↗
PubMed1989

Long-term survival of kidney allografts in dogs after withdrawal of immunosuppression with ciclosporin and azathioprine.

We have examined the immunosuppressive effects of combined azathioprine (Aza) and ciclosporin (CS) in two groups of mongrel dogs receiving kidney allografts. In group 1, Aza and CS were given together daily after transplantation and in group 2 twice the dose of each drug was given separately on alternate days. Doses were halved in each group at successive 84-day intervals and all immunosuppression was stopped on day 336. Thus the same total amounts of Aza and CS were given to all recipients in both groups. Up to day-60 the incidence of rejection in each group was similar, thereafter recipients in group 1 were more susceptible to fatal infection and marrow hypoplasia. This accounted for the difference in long-term survival between the two groups (1/14 in group 1, 5/12 in group 2 at day 420). Subsequently, two long-term survivors in group 2 died, 1 on day 452 from chronic rejection and the other on day 529 from gastroenteritis with a histologically normal allograft kidney. An in vitro analysis of the alloreactive repertoire of two healthy recipients in group 2, bearing each other's kidneys for more than 2.5 years and more than 500 days without immunosuppression, showed a profound donor-specific defect which could account for their operationally tolerant state.

Animals↗
PubMed1989

Magnetic resonance imaging and computed tomography in long-term-functioning duct-occluded pancreas allotransplants.

Duct-occluded segmental-pancreas transplants develop progressive fibrotic atrophy, even though endocrine function seems to be unaffected. To determine end-stage size of the graft and to evaluate magnetic resonance imaging (MRI) and computed tomography (CT), these imaging techniques were applied in eight patients with well-functioning intraperitoneal prolamine-injected segmental-pancreas transplants for 79, 48, 35, 20, 19, 19, 18, and 10 mo. MRI was performed on a 1.5 Tesla system (Philips Gyroscan S15). T1- and T2-weighted images were acquired. CT (Siemens Somatom 2) was done before and after intravenous contrast agent. The graft was visualized in seven of eight patients with both techniques. Visualization with MRI (vs. CT) was considered excellent in 2 (vs. 1), good in 3 (vs. 6), and poor in 2 (vs. 0). The three grafts with function longer than 2 yr measured 3-4 cm in length; the remaining grafts measured 3-6 cm. Because of a marked decrease in size the transplants were no longer localized in Douglas' pouch but adjacent to or on top of the uterus or bladder, the position depending on the volume of these organs. The allografts exhibited an inhomogeneous structure with casual cystic degeneration visible with MRI due to a high signal intensity on T2-weighted images. This study suggests that shrinkage of the duct-occluded pancreatic segment due to exocrine atrophy may be terminated after approximately 2 yr. It is concluded that thereafter an overshooting fibrosis causing late endocrine graft failure may not be anticipated.

Adult↗
PubMed1989

[Transplantation of kidneys from children].

During an 11-year period from 1978 to 1988, 720 cadaver kidneys were transplanted at the University Hospital of Zurich. 103 of the kidney grafts were from donors 16 years old or younger. The mean age of these donors was 11 years (range 2 1/3 to 16 years). There were 3 donors under 5 years, where we preserved and transplanted both kidneys en bloc. Only 3 recipients were less than 16 years old. After 1 year, 67 out of 103 recipients had a functioning pediatric graft. In the cyclosporine-treated group, the 1-year graft survival was even 80%, similar to kidney transplants from adult donors. Graft loss was observed in 48 cases. 33 patients rejected the transplant and 10 grafts were lost after recurrence of the primary renal disease. Only 5 grafts had a vascular complication. We conclude that kidneys from pediatric donors can successfully be transplanted into adults.

Adolescent↗
PubMed1989

[Thrombocytosis following pancreas transplantation].

Thrombosis of the pancreas transplant is one of the main causes for the lower success rate of this procedure compared with that of other organ transplantations. Approximately one quarter of the pancreas transplantations discussed in this study are unsuccessful for this reason. This work is a retrospective study focusing on the postoperative blood platelet counts from 19 patients with a combined pancreas and kidney transplant, functioning well for at least 1.5 months. 19 patients with only a kidney transplantation with similar distribution of sex, age and postoperative immunosuppressive treatment were observed as a control group. After pancreas transplantation the platelet counts increased considerably and were found to be far above the normal level. There are no proven pathophysiological explanations for this thrombocytosis. Because of an increased risk of thrombosis, we recommend to use platelet inhibitors during the first two postoperative months.

Adult↗
PubMed1989

[Is there an age limit for organ donors?].

Multi-organ-harvesting, living related organ donation and a continuing extension of donor age are well known methods to overcome the shortage of suitable cadaveric organs for transplantation. With an appropriate technique even neonatal grafts can be successfully grafted. When specific organ damage is excluded, kidneys, livers, hearts and pancreas from donors as old as sixty-five, fifty-five, fifty-five and sixty years, respectively, can be used for transplantation with satisfactory results.

Adolescent↗
PubMed1989

[Liver transplantation: initial experiences from Zurich].

Liver transplantation program in Zurich was started in 1986. Between November 1986 and May 1988, 29 patients have been referred for evaluation. 19 (65%) of the admitted patients were accepted for transplantation, 7 patients died while waiting for a suitable organ. 9 patients have been transplanted. This report summarizes the results with the first 9 transplantations.

Follow-Up Studies↗
PubMed1989

[Experimental pancreatic duct occlusion with polyurethane].

Pancreatic transplantation requires an effective method to manage exocrine secretion. A new technique to eliminate the exocrine function of the pancreas by obstruction of the duct with polyurethane was investigated in terms of function, outcome and morphology. Polyurethane is an alcoholic solution of block copolymers with the property of polymerizing within 5-10 min. In this study the in-situ pancreatic tail model in dogs was utilized, the pancreatic duct was cannulated and injected with 2-3 ml of polyurethane. As a result, complete atrophy and fibrosclerosis of the exocrine tissue was obtained leaving islets well vascularized and functioning for the entire experimental periods. All animals remained normoglycemic and showed normal K-values. Amylase levels were found to be maximally elevated at 24 h and returned to normal within 2 weeks after duct occlusion. Insulin, glucagon and somatostatin levels remained normal. Because of its ability to effect a complete occlusion of the pancreatic ducts with subsequent atrophy of the exocrine gland and without notable disturbance of endocrine function, we feel that polyurethane solution is superior to previously used materials for this purpose.

Animals↗
PubMed1988

[CT and MRT following liver transplantation].

The potential technical complications after liver transplantation are numerous. CT is most useful in the evaluation of the hepatic parenchyma and in the identification of perihepatic fluid collections. CT provides complementary data when the sonographic findings in cases with suspected vascular or biliary complications are unclear. The value of MRI in the evaluation of liver transplants has not yet been fully determined. In patients with complex venous hemodynamics MRI can add useful information.

Humans↗
PubMed1988

[Radiologic diagnosis following pancreas transplantation].

Technical complications are relatively common after pancreatic transplantation, and most require radiological evaluation. Ultrasonography and computed tomography are helpful in the identification of peripancreatic and intra-abdominal fluid collections. Sterile fluid collections can be effectively treated by percutaneous catheter drainage, whereas most intra-abdominal infections require surgical intervention. Angiography is performed primarily for diagnosis of vascular thrombosis. Recent results suggest that magnetic resonance imaging may be a useful non-invasive method for the detection of pancreatic transplant rejection. Further imaging studies are needed to better define the development of progressive fibrotic atrophy in long-term functioning pancreatic transplants.

Humans↗