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Biomedical subjects

M Kitzis

Publications and source records attributed to M Kitzis.

At least 19 recordsLinked to original sources
PubMed2001

Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta.

PURPOSE: This prospective, observational study determined the long-term outcome in patients with abdominal aortic infection (primary or prosthetic graft) who were treated with simultaneous aortic/graft excision and cryopreserved arterial allograft reconstruction. METHODS: From April 1992 to March 2000, patients with abdominal aortic infection underwent complete or partial excision of the infected aorta/prosthetic graft and cryopreserved arterial allograft reconstruction. Arterial allografts were harvested from multiple organ donors and cryopreserved at -80 degrees C without rate-controlled freezing. The patients were observed for survival, limb salvage, persistence and/or recurrence of infection, and allograft patency. The results were calculated with life-table methods. RESULTS: During the 8-year study period, 28 consecutive patients (27 men, 1 woman; mean age, 64 years) underwent treatment for abdominal aortic infection (23 graft infections, including 7 graft-enteric fistulas and 5 primary aortic infections). Allograft reconstruction was performed as an emergency procedure in 13 patients (46%). The mean follow-up period was 35.4 months (range, 6-101 months). The overall treatment-related mortality rate was 17.8% (17% for graft infection, 20% for primary aortic infection). The overall 3-year survival was 67%. There was no early or late amputation. There was no persistent or recurrent infection, and none of the patients received long-term (> 3 months) antibiotic therapy. Reoperation for allograft revision, excision, or replacement was necessary in four patients (17%) who were available for examination, with no reoperative perioperative death. The 3-year primary and secondary allograft patency rates were 81% and 96%, respectively. CONCLUSION: Our experience with cryopreserved arterial allograft in the management of abdominal aortic infection suggests that this technique seems to be a useful option for treating one of the most dreaded vascular complications.

Adult↗
PubMed1996

Elution of six antibiotics bonded to polyethylene vascular grafts sealed with three proteins.

The elution of six antistaphylococcal antibiotics from vascular polyethylene grafts sealed with albumin, gelatin, or collagen were studied in an in vitro system. The antibiotics tested were pefloxacin, vancomycin, teicoplanin, fusidic acid, pristinamycin, and rifampicin. The grafts were impregnated by simple soaking in antibiotic (1 mg/ml). The data were fitted to an exponential model and antibiotic half-lives (t1/2) were calculated from the regression lines. All the antibiotics tested were bound to the protein sealants. Antibiotic release varied with the type of antibiotic and the sealant. Rifampicin was eluted most slowly, particularly with albumin- and gelatin-sealed grafts, with t1/2 at 4-5.5 hr and antibiotic activity was still found at 48 hr. The glycopeptides were also eluted more slowly from albumin or gelatin sealant than from collagen. Although large quantities of glycopeptides were initially bound, they were quickly eluted (t1/2 = 30-44 min) and there was no residual antibiotic activity at 24 hr. Pefloxacin, pristinamycin, and fusidic acid bound to collagen or gelatin sealants were the most rapidly eluted, with t1/2 of 3-14 min, but they were eluted more slowly from albumin-sealed grafts, with t1/2 of 22-90 min. In vitro studies can be useful for evaluating the binding of antibiotics to protein-sealed grafts before animal experiments or human testing.

Albumins↗
PubMed1995

[Single-lung transplant in chronic obstructive disease].

The feasibility and the good immediate acceptability of unilateral lung transplants in the patients with obstructive respiratory problems have recently been demonstrated and since the initial reports, some hundreds of lung transplants have been performed in various parts of the world for this indication. Nevertheless, few results of respiratory function are currently available in the medium term. We report these in a series of 20 patients with severe obstruction who were given single lung transplants. The actual probability of survival for 1 and 2 years was 75 and 70% respectively with 4 peri-operative deaths and 2 later deaths. In the 16 survivors of more than 6 months, in relation to the pre-operative values, a significant improvement was observed 3 months after the graft in the FEV1 which rose from 17 +/- 6 to 53 +/- 13% of the predicted values. The PaO2 rose from 52 +/- 10 to 81 +/- 3 mmHg. The distance covered on the six minute walking test went from 99 +/- 84 m before the graft to 587 +/- 147 m 6 months after the operation. In addition to the improved distance, the lung function was stable in a group of patients as the months went by, although there was a fall in the respiratory function in others with the appearance of the syndrome of bronchiolitis obliterans or in 2 patients with bronchial complications. The four patients with severe deterioration in the graft function were re-transplanted with a good clinical result in three of them, the fourth dying in the immediate post-operative period. We conclude that single lung transplant represents an effective treatment both in the short and medium term in patients with chronic airflow obstruction.

Adult↗
PubMed1994

The distribution of BrK alpha/RbK alpha peak intensity ratio in human whole blood samples. Comparison between normal and colorectal cancer cases.

A preliminary study was conducted to compare the BrK alpha/RbK alpha peak intensity ratio in colorectal cancer (CRC) patients and healthy subjects (controls) in Israel. Blood samples were obtained from 61 CRC patients and 124 controls. The controls represent a normal population from different areas in Israel. Three hundred microliters of wet whole blood samples were analyzed by the EDXRF method. A weighted mean of 2.45 +/- 0.38 Br/Rb ratio was obtained for CRC patients, as compared with 3.28 +/- 0.40 Br/Rb ratio for controls. The mean value for controls represents only 112 subjects, since 12 individuals of the control group suffered from some other diseases and therefore were not included for the mean value calculation in this group. The results indicate that the Br/Rb ratio in CRC patients is significantly lower (p < 0.05) than in controls. No significant difference was found in Br/Rb ratio correlated to age and sex. It was not possible to draw final conclusion concerning the relationship between the Br/Rb ratio and the malignancy stage, since there was a relatively small number of cases in each stage under investigation.

Adult↗
PubMed1994

[Antibiotic prophylaxis in vascular surgery].

Vascular surgery includes various surgical procedures and sites. Infectious risk is low but with a high functional risk and a high mortality rate. Infection risk factors are numerous. Among them the incision in the Scarpa's triangle is at the first place. Antimicrobial prophylaxis in vascular surgery has shown its efficacy whatever the agent. The second generation cephalosporins are the most logical, with a duration of administration of less than 24 hours. In case of re-operation glycopeptides have shown their efficacy.

Anti-Bacterial Agents↗
PubMed1994

Open window thoracostomy, myoplasty, and epiploplasty for treatment of postpneumonectomy empyema: CT evaluation.

PURPOSE: To demonstrate the computed tomographic (CT) appearance of the postpneumonectomy space (PPS) after surgical treatment of postpneumonectomy empyema. MATERIALS AND METHODS: The authors retrospectively reviewed 22 CT scans obtained in 15 patients after open window thoracostomy (OWT) (n = 4), myoplasty (n = 12), and epiploplasty (n = 1). RESULTS: After uncomplicated OWT, the retracted PPS contained air and/or gauze without residual pleural fluid. After uncomplicated myoplasty, marked retraction of the operated hemithorax was observed. CT allowed localization of transposed muscle flaps and fatty tissue within the PPS. A moderate amount of fluid and air was present during the 1st month after surgery. After uncomplicated epiploplasty, the retracted PPS contained homogeneous tissue with characteristic fatty attenuation. Complications including recurrent empyema, recurrent bronchopleural fistula, aseptic fluid collection, necrosis and fatty transformation of muscle flaps, and tumor recurrence were accurately demonstrated. CONCLUSION: CT is useful in follow-up after surgical treatment of postpneumonectomy empyema because it permits accurate evaluation of the PPS.

Aged↗
PubMed1994

Functional results of single-lung transplantation for chronic obstructive lung disease.

The feasibility and immediate tolerance of single-lung transplantation were recently demonstrated in patients with severe obstructive lung disease. Since initial reports, hundreds of procedures have been performed worldwide in such patients, but views regarding the results are still controversial. Since few data concerning medium-term functional results are available, we report here our series of 20 patients with chronic obstructive pulmonary disease who received a single-lung transplant. A group of 16 patients who survived for 6 mo or more form the basis of this report. Current 1- and 2-yr actuarial survival are 75 and 70%, respectively, with 4 perioperative deaths and 2 deaths at 9 and 15 mo after transplantation. Before transplantation the patients were severely obstructive, with a FEV1 of 17 +/- 6% of predicted, a PaO2 of 51 +/- 10 mm Hg, a PaCO2 of 49 +/- 11 mm Hg, and a 6 min walk test of 99 +/- 84 m. A significant functional improvement was observed postoperatively, the patients' FEV1 at 3 mo reached 53 +/- 13%, PaO2 81 +/- 3 mm Hg, and PaCO2 39 +/- 3 mm Hg. The distance covered during 6 min was 587 +/- 147 m at 6 mo. Throughout postoperative follow-up, lung function remained stable in some patients but decreased in others after several mo, this decline related to the occurrence of bronchiolitis obliterans, except in two patients who had airway complications. Impairment in lung function led to retransplantation in four patients, with good clinical results in three patients, one patient dying postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

["Logic" and doubts in the surgery of associated carotid and vertebral lesions].

Combined vertebral artery and carotid artery surgery may be performed in patients with proximal subclavian or vertebral artery stenosis provided that general anesthesia is not contraindicated? Others indications may be considered in patients with proved arterial thrombo-embolism or in patients for whom arteriography, cerebral angioscintigraphy and ultrasound velocimetry enable the physician to suspect a cerebral low flow and the lack of collateral pathways between the posterior and anterior cerebral system.

Carotid Artery Diseases↗
PubMed1992

[Aneurysms of the abdominal aorta with periaortic fibrosis. A retrospective study of 23 consecutive successful operations].

Aneurysms of the abdominal aorta associated with periaortic fibrosis (AFPA) are a different clinicopathological entity from atheromatous aneurysms and nonspecific inflammatory periaortitis. The physiopathology and diagnostic and therapeutic modalities for these AFPAs are controversial. Over a 12-year period, 23 aneurysms with periaortic fibrosis (4%) confirmed by a histological study were operated at Beaujon hospital. Four patients were operated at the rupture stage, 2 with acute rupture and 2 with contained chronic rupture. Uni- or bilateral ureteral obstruction was noted in 8 patients. The diagnosis was suspected preoperatively in 60% of cases. Surgery confirmed the accuracy of the anatomical information provided preoperatively by the CT examination performed in 9 patients. Debridement and grafting were performed in 22 patients. Three patients with associated ureteral obstruction were treated with ureterolysis during the same operative step at the beginning of our experience. Later on, 3 documented cases of hydronephrosis receded after the isolated debridement and grafting of the aneurysm. Hospital mortality was of 5% in 19 patients operated electively. Two patients died later, after 2 months and after 5 years, and 16 are still alive and without symptoms at present, after and average time lapse of 68 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Aortoiliac surgery and kidney transplantation.

Between January 1980 and December 1989, we performed 407 renal transplantations. Twelve of these patients (3%) underwent aortoiliac reconstruction before (Group I, two patients), concomitant to (Group II, five patients) or after (Group III, five patients) renal transplantation. The aortoiliac lesions treated included four aneurysms and seven occlusions of the abdominal aorta and one postarteriography dissection of the iliac artery. A prosthetic graft was inserted in nine cases (75%). Endarterectomy was performed in the three other cases (25%). Four of five patients in Group III were operated on without any particular protection for the transplant. There were no postoperative deaths in Groups I and III. In Group II, one patient died of infection secondary to a urinary tract fistula. Early and late vascular morbidity (renal artery stenosis, occlusion of aortoiliac reconstruction, anastomotic false aneurysm) occurred with equal frequency in the three groups. Renal transplantation in patients having already undergone aortoiliac surgery and, conversely, aortoiliac reconstruction in the renal transplant patient, are possible without any particular technical precautions with minimal mortality and kidney morbidity. Simultaneous renal transplantation and aortoiliac reconstruction carries a significant risk of infection and a two-stage procedure should be considered in this situation.

Adult↗
PubMed1990

Combined lung and heart extraction in clinical transplantation.

The anatomical conditions for single lung and double lung transplantation allow a heart transplant and one or two lung transplants to be performed in two or three different recipients from a single donor with healthy lungs. The extraction of the heart and lung block for the purposes of these separate transplantations is described on the basis of our experience of 6 single lung transplants with 6 extractions for cardiac transplantation in different recipients, of a total of 8 lung transplants. We report these 12 successful operations and the particular technical modalities of cardiopulmonary extraction for separate transplantation. After cannulation for cooling of the abdominal viscera (kidneys, liver, pancreas), thoracic and mediastinal dissection, cardioplegia and surface pulmonary cooling by iced saline on the collapsed lungs, the heart and lungs were extracted as a single block and were separated ex situ. After periods of cold ischaemia of 1 h to 3 h 30 min for the hearts and 1 h 30 min to 5 h for the lungs, the immediate and medium term functions were satisfactory. Logistical difficulties involved in matching the population of recipients have prevented the grafting of three different recipients up until now. These successes make it essential to preserve the lungs from donors with healthy lungs. A rigorous coordination between the various transplantation teams helps to avoid competition between the three types of transplantation: heart-lung, double lung and single lung.

Adolescent↗
PubMed1990

[Intra-caval leiomyomatosis. Surgical treatment].

The authors report a case of intracaval leiomyomatosis diagnosed in a 11-year old female, who had been initially operated for a massive tumor of uterus (35 X 45 X 25) and who had had subtotal hysterectomy performed. The histologic diagnosis at was intravenous leiomyomatosis. Investigation of extent of neoplastic spread included echography, cavography and revealed inferior vena cava involvement. Cavotomy removed a tumor fragment. Intravenous leiomyomatosis has always its source in the uterus and spreads by progressive invasion of the vena cava. The right cardiac cavities and, at times, the pulmonary artery are also involved. Management of cardiac invasion is a determinant factor of the severity of the disease. Indication for surgery is systematic and should result in complete tumor excision.

Adult↗
PubMed1989

Unilateral lung transplantation in end-stage pulmonary emphysema.

Patients with end-stage pulmonary emphysema are usually proposed for either heart-lung or double-lung transplantation. The single-lung transplantation is reversed for patients with pulmonary fibrosis. Patients with emphysema are thought to be unsuitable for single-lung transplantation because of the ventilation-perfusion imbalance that is supposed to occur, the ventilation being preferentially distributed to the native lung when the perfusion is distributed to the transplanted lung. We now report a preliminary success with single-lung transplantation in two consecutive patients with end-stage pulmonary emphysema. Despite the persistence after transplantation of an obstructive syndrome, the clinical status was good, the blood gases were markedly improved, and ventilation-perfusion imbalance did not occur on lung scans. After discharge from the hospital, the patients could return to an almost normal life. Thus, our data support the feasibility of single-lung transplantation in patients with end-stage pulmonary emphysema, and we consider that single-lung transplantation could be the optimal form of lung transplantation in these patients.

Humans↗
PubMed1989

Treatment of AIDS-associated heart disease.

Although the diagnosis of AIDS-associated heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then administration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphotericin B. The response, which included resolution of congestive heart failure, occurred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.

Acquired Immunodeficiency Syndrome↗