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Biomedical subjects

M Durlik

Publications and source records attributed to M Durlik.

At least 91 records · Page 5Linked to original sources
PubMed1996

Clinical course of concomitant Hbv and Hcv infection in renal allograft recipients.

We evaluated the impact of concomitant infection with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) on the clinical course after renal transplantation (Tx). In 335 patients (pts) transplanted between 1991 and 1993 we found 30 (9%) recipients who were positive for Hepatitis B surface antigen (HBsAg) (ELISA, Organon) and anti-HCV antibodies (immunoblot assay Lia Tek) preTx. Chronic liver disease (CLD) (two-fold or greater increase in serum ALT and AST levels for at least six months) developed in 40.7% coinfected pts as compared to 24.4% and 25.7% pts infected only with HCV or HBV, respectively. Maintenance immunosuppression consisted of P + Aza + CsA, mean follow-up time was 28 +/- 15 months. The mean time of the onset of CLD was 3.0 months (range: 1-18 months) after Tx. Percutaneous liver biopsy performed in 5 CLD pts revealed chronic active hepatitis (CAH) in 4 and chronic persistent hepatitis (CPH) in 1 pt. Four pts who had CAH and were positive for HCV RNA (RT PCR) in serum and for HBcAg in liver tissue, received interferon-alpha therapy for 6 months. Clinical improvement of liver function was observed in all of them, but none cleared HBsAg or HCV RNA. One pt lost his graft due to acute rejection. Concomitant infection with HBV and HCV is associated with the high risk of development of CLD early after Tx. We recommend that pretransplant evaluation of both anti-HCV and HBsAg positive pts should include liver biopsy to exclude potential recipients with CAH.

Adult↗
PubMed1996

Reconstitution of lymphoid tissue after vascularized bone marrow transplantation.

We reported previously that vascularized bone marrow transplantation (VBMT) in an orthotopic hind limb graft brings about complete repopulation of bone marrow cavities in lethally irradiated syngeneic recipients within 10 days. Intravenous infusion of an equivalent volume of bone marrow cell suspension was evidently less effective. The purpose of this study was to investigate the reconstitution of immunocompetent compartments of lethally irradiated syngeneic rats after VBMT. Lewis rat hind limbs were transplanted orthotopically into irradiated recipients. Ten days after irradiation and bone marrow transplantation, bone marrow, mesenteric lymph nodes and sera from rats were harvested. Responsiveness of mesenteric lymph node lymphocytes (MLNL) to mitogens and lymphocyte proliferation in the presence of sera and bone marrow cell (BMC) culture supernatants was measured. Our studies have shown that vascularized bone marrow transplantation brings about rapid replenishment of lymphoid organs of lethally irradiated syngeneic recipients. The repopulating subsets were fully responsive to mitogens. Sera from reconstituting rats had no evident effect on proliferation of mature lymphocytes. Intravenous infusion of BMC in suspension, in a number equivalent to that grafted in hind limb transplant, was less efficient in reconstituting lymphoid tissue.

Amputation, Surgical↗
PubMed1995

[Personal experience with simultaneous transplantation of pancreas segment and kidney].

Between February 1988 and December 1994, 25 patients underwent simultaneous kidney and segmental pancreatic transplantation. Diabetes type I with the end-stage renal disease secondary to the diabetic nephropathy was the indication for this procedure. The original method of the four vascular anastomoses was introduced to prevent early pancreatic graft thrombosis. The cross section of the pancreatic segment was anastomosed to Roux--en Y loop in 80% cases and in 20% ductal occlusion with Ethiblock was performed. One-year survival rate for kidney and the pancreas was 81% and 57% and five - years survival rate 57% and 42%, respectively. One - year and five - year survival rate for the patients was 72% and 68%, respectively. The most serious complication leading to the graft removal was intrapancreatic abscess. Sepsis was the main cause of the death among transplant patients.

Adult↗
PubMed1994

Treatment of chronic hepatitis B and C with interferon-alpha in renal allograft recipients: preliminary results.

We evaluated the effects of treatment with interferon (IFN) on liver disease and renal allograft function in ten immunosuppressed cadaver kidney recipients. Two females and eight males (mean age 39 years) with biopsy-proven chronic active hepatitis (n = 8) or persistent hepatitis (n = 2) and serum positive for hepatitis B surface antigen (HBsAg) and HBe antigen (n = 5) or serum positive for anti-HCV antibodies (n = 3) or serum positive for HBsAg, anti-HCV and anti-HDV antibodies (n = 2) received 3 million units IFN thrice weekly of 6 months. All patients responded with a reduction in serum aminotransferase activity and in five of them liver function completely normalized. Three patients among five infected with HBV cleared HBeAg. During the follow-up period liver function remained stable in 9 patients after discontinuation of IFN therapy. Three patients lost their grafts due to rejection 1, 2, and 4 months after IFN therapy, respectively. In six patients renal function remained stable during and after IFN therapy. We conclude that in selected groups of renal allograft recipients IFN can be used safely and effectively for the treatment of chronic viral hepatitis.

Adult↗
PubMed1994

[Tuberculosis in patients after kidney transplantation].

Infection caused by Mycobacterium tuberculosis is common among population in Poland. We analyzed the effect of tuberculosis (TB) on patients and graft survival in the group of renal allograft recipients (RAR), treated in our center. Among 1669 renal allograft recipients transplanted from 1981 to 1992, tuberculosis developed in 33 (2%) patients (16 M/17F, age: 22-57 years). The patients were on following immunosuppressive regiments" Pred+Aza+CsA (12 pts), Pred+Aza (12), Pred+CsA (6) and Pred+Aza+CsA+ATG (3). Acute rejection was diagnosed in 27 of them and was treated with methyloprednisone pulses, and in a few cases additionally with ATG (2 pts) or OKT3 (1 pt). In two pts TB had been diagnosed and successfully treated in the past. In 6 pts, on chest X-ray done immediately before transplantation, healed primary lesion (Ghon complex) had been seen. In 16 pts TB developed in the early posttransplant period (median: 3.8 +/- 1.8, range: 1-6 months) and in 17--late after transplantation (median: 31.2 +/- 1.8, range: 13-156 months). In 19 pts symptoms developed soon after treatment of acute rejection. Clinical manifestations include pulmonary TB (30 pts) and extrapulmonary lesions (15 pts): pleural TB (3 pts), miliary TB (5 pts), tuberculous lymphadenitis (1 pt), uveitis (1 pt), renal allograft (2 pts), skeletal (2 pts) and GI tract (1 pt). Diagnosis of TB was made based on clinical presentation and radiologic findings and it was confirmed by positive cultures in 18 pts, by tissue biopsy in 4 pts and by autopsy examination in 9 pts. Treatment regimen included one of the following drug combinations: INH+EMB+RMP (20 pts), INH+RMB+RMP+PZA (10 pts) or INH+EMB+SM (3 pts). Three pts died before TB was recognized and 4 deaths occurred after treatment was started. All these pts developed renal failure. 26 pts were treated for 3-12 months (median, range: 7.8 +/- 2.9) and in 24 of them complete remission was achieved. In this group renal function remained stable in 16 pts and 6 pts developed terminal failure due to chronic rejection. Authors conclude: 1. TB remains a frequent complication in RAR but can be successfully treated when diagnosed early. 2. Extrapulmonary TB is common in RAR. 3. TB deteriorates one year patients (75%) and graft (49%) survivals.

Adult↗
PubMed1992

Diminished integrin expression on granulocytes from renal allograft recipients.

Integrin (beta 2 subunit of the LEU-CAM family, CD18) expression on peripheral blood and urinary granulocytes was studied in renal allograft recipients. Circulating granulocyte CD18 expression was normal except for patients with CMV infection. In contrast, the majority of patients with urinary tract infection had low numbers of CD18+ cells collected from urine, and the same abnormality could also be observed in approx. 50% of non-infected recipients. These disturbances were associated with transplantation, as no such deficits were seen in the infected non-transplant patients or patients with glomerular diseases on immunosuppression. Short culture of granulocytes with immunosuppressants did not diminish integrin expression. Deficient granulocyte integrin expression, especially in urinary tract, may be associated with increased susceptibility to infection in renal transplant recipients, although immunosuppression alone could not be incriminated as a sole factor responsible for this deficit.

Antigens, CD↗
PubMed1989

Laser-Doppler versus fluorometry in the postoperative assessment of a cutaneous free flap.

To find the optimal means for monitoring the vascularity of a cutaneous free flap in the postoperative period, we have experimentally compared laser-Doppler velocimetry and fluorometry. Using the rat groin model, five groups were evaluated: 1. flap isolation without division of the pedicle vessels (island flap); 2) flap isolation, division, and repair of the pedicle artery and vein (free flap); 3) flap isolation, with ligation of the pedicle artery immediately or 1 hour later; 4) flap isolation, with ligation of the pedicle vein immediately or 1 hour later; 5) flap isolation, with ligation of the pedicle artery and vein immediately or 1 hour later. The laser-Doppler processes the signal by combination of the root mean square and differential amplification. The fluoroscan gives an index in relation to the fluorescence of a control area. The results obtained with both methods correlated well with findings in clinical situations. However, the laser-Doppler readings were more rapid and sensitive than those with fluorometry. We suggest that laser-Doppler velocimetry is a superior means of monitoring the vascular status of a free tissue transfer or digital replant.

Animals↗
PubMed1986

A new laser Doppler interface for the continuous measurement of the rat gastric mucosal blood flow.

The laser Doppler system (LD) has been proposed for a tissue blood flowmetry. However, its accuracy is dependent on the pressure and direction of the laser probe. Therefore, we have devised a new interface for the measurement of the gastric mucosal blood flow in rats keeping the probe constant in pressure and direction. This interface is a small cylinder with one end fixed upon the gastric serosa and the other end fixed externally upon the skin. The laser probe adjusts exactly in direction and pressure inside this button. The LD apparatus processes two shifted beams with a differential amplification and a root mean square. It delivers an index (LDI) from 0 to 10. This interface was tested in 3 groups of rats, comparing the mucosal (open stomach) with the serosal gastric LDI and the same serosal LDI with a 133Xe washout flow. Finally, the interface was used in control and restrained rats. The gastric serosal LDI was found to be similar to the mucosal LDI. The correlation between the LDI and the 133Xe washout flow was good, with a coefficient of 0.9. Finally, the LDI of the gastric mucosal blood was significantly different in control and stressed rats. This new interface makes the LD more reliable for the monitoring of gastric mucosal flowmetry. It has the same accuracy as the xenon washout and additionally it is simpler, cheaper and may be repeated or even be used continuously.

Animals↗
PubMed1986

Gastric stress ulcer of the rat: relative contribution of the pyloric sphincter, HCO3- bile reflux and mucosal blood flow.

Gastric ulceration has been induced after stress, combining 24 h of fasting and 48 h of restraint in 9 groups of 20 rats with or without a pyloroplasty or a pylorojejunostomy combined with atropine and gastric infusion of NaHCO3 or taurocholic acid. After death or sacrifice at 48 h, ulcer index and blood in the jejunum were determined. Gastric mucosal blood flow was measured semi-continuously by a laser Doppler velocimeter. There were 45% deaths after 48 h of restraint alone, and 70% in the group combining pylorojejunostomy with taurocholic acid. Mortality was lower (p less than or equal to 0.01) pylorojejunostomy alone and more significantly so (p less than or equal to 0.001) when associated with NaHCO3. There was no death when NaHCO3 and atropine were combined with restraint. The mucosal blood flow increased significantly during the first 12 h of restraint in the taurocholic acid group. Both groups with NaHCO3 had mucosal blood flows similar to the controls. Gastric acid and gastric emptying, mucosal ischemia and bile reflux are joint factors inducing gastric stress ulcer. The 100% survival and the low ulcer index after a treatment by atropine and gastric infusion of NaHCO3 suggest that these well-known drugs should be used more frequently.

Animals↗