Biomedical subjects
R Gilabert
Publications and source records attributed to R Gilabert.
Human long-term bone marrow culture as a prognostic factor for hematopoietic reconstitution in autologous transplantation.
Human long-term bone marrow cultures allow persistence of hematopoietic stem cells in vitro for several weeks. Abnormalities in these cultures have been observed after cell treatment for purging in vitro. In autologous transplantation trials an increase in grafting failures after purging has also been reported. These results suggest a correlation between culture behaviour and graft kinetics. We analyzed the pattern of growth in Dexter culture of the bone marrow fraction infused in 52 patients with malignant diseases and subjected to autologous transplantation. In 23 cases, bone marrow cells had previously been treated in vitro with Asta-Z 7654 (n = 7) or with monoclonal antibodies plus complement (n = 16). Some of the long-term bone marrow culture parameters seemed to correlate with grafting kinetics, mainly adherent cell layer development and persistence of committed hematopoietic progenitors (CFU-GM) in the supernatant cells. The absence of a stromal layer defined a group with very poor hematological recovery after transplantation. Nine cases were included in this group and only one patient (11%) had recovered granulocytes and platelets. However, 90% of patients whose long-term cultures displayed normal adherent cell behavior had recovered peripheral hematological values. These results suggest that long-term bone marrow cultures could be used as a prognostic factor for hematopoietic reconstitution in autologous transplantation.
Ursodeoxycholic acid treatment of primary hepatolithiasis in Caroli's syndrome.
Congenital cystic dilation of the intrahepatic bile ducts (Caroli's syndrome) is a rare cause of chronic cholestasis and hepatolithiasis in young adults. Long-term prognosis is poor even with surgical drainage. We treated twelve patients who had Caroli's syndrome and intrahepatic stones with ursodeoxycholic acid (UDCA), 10-20 mg/kg daily. The duodenal bile of these patients contained cholesterol crystals, which suggests that the stones were cholesterol rich. UDCA led to sustained clinical remission, return to normal liver function, and dissolution of intrahepatic stones on ultrasound in all patients (nine partial, three complete) after 48 (range 12-114) months' follow-up. Litholytic therapy is indicated for intrahepatic stones in Caroli's syndrome.
Native and graft pancreatitis following combined pancreas-renal transplantation.
Ten patients who had undergone whole-organ pancreas transplantation and pancreatoduodenocystostomy from a total of 60 simultaneous cadaveric kidney-pancreas transplants met the criteria for graft pancreatitis. This condition is clearly different from acute rejection on the basis of marked hyperamylasaemia and significant local findings over the allograft. Graft rejection was the cause of graft loss in one of the patients; eight are alive, seven with a functioning graft 61, 30, 27, 25, 21, 18 and 14 months after transplantation. Two patients died: one from severe graft pancreatitis and the other from cytomegalovirus infection. Bladder drainage with or without antibiotics has been the most common therapy, based on the theory that damage is caused by duodenal content and infected urine reflux. To prevent graft loss, antiviral treatment should be given when pancreatitis due to cytomegalovirus is suspected or diagnosed. Two patients with native pancreatitis are also described; the disease was severe and surgery was required in both cases. The pancreas grafts have now been functioning for 2 years 7 months and 2 years 10 months respectively.
Sonographic diagnosis and hemodynamic correlation in veno-occlusive disease of the liver.
This study evaluated the role of duplex Doppler sonography in the diagnosis of VOD of the liver after bone marrow transplantation. Sixteen patients with clinical criteria of VOD were studied. The final diagnosis was achieved by transjugular liver biopsy, and the hepatic venous pressure gradient was measured during the procedure to estimate portal pressure. Nine patients (56.2%) had histologically proved VOD. Gallbladder wall thickening was present in 75% of patients with VOD, but in none of those without it (P = 0.01). Gallbladder wall thickening and ascites were present only in patients with portal hypertension. Nine patients (five with VOD and four without it) also were evaluated with duplex Doppler sonography, and no obvious flow abnormalities were detected in the portal vein and hepatic veins. These results suggest that sonography is useful in detecting early signs of portal hypertension pointing to the diagnosis of VOD in patients with bone marrow transplantation.
Long-term effects of distal splenorenal shunt on hepatic hemodynamics and liver function in patients with cirrhosis: importance of reversal of portal blood flow.
We studied 23 patients with cirrhosis who had undergone retroperitoneal distal splenorenal shunt without portal-azygos disconnection more than 2 yr earlier. We investigated the suitability of the Doppler technique (ultrasound + Doppler) to assess the patency and blood flow direction through the portal vein and the distal splenorenal shunt and its correlation with the continuous thermal dilution technique. The study also assessed the influence of the distal splenorenal shunt and time after surgery on portal perfusion and liver function. Ultrasound + Doppler distal splenorenal shunt thrombosis in two patients; however, none was confirmed by continuous thermal dilution. Ultrasound + Doppler flowmetry was possible in 19 patients (83%) (mean, 1.58 +/- 0.53 L/min). Distal splenorenal shunt continuous thermal dilution measurements were performed in all patients (100%), (mean, 1.65 +/- 0.5 L/min). Good correlation was seen between them (r = 0.66). Ultrasound + Doppler of the portal vein showed a hepatopetal flow in 16 patients (69.9%). Hepatic blood flow was significantly higher in patients with hepatopetal flow (p = 0.003). Hepatic clearance and intrinsic hepatic clearance of indocyanine green were significantly lower in patients with hepatofugal flow. Patients with hepatofugal flow had a higher incidence of chronic encephalopathy. None of the patients with a follow-up of less than 4 yr exhibited hepatofugal flow, whereas 7 of the 16 patients with a longer follow-up had hepatofugal flow (43.7%). The difference was statistically significant (p = 0.04). This study suggests that ultrasound + Doppler sonography may provide useful data in the evaluation of the patency and blood flow direction through the portal vein and the distal splenorenal shunt.(ABSTRACT TRUNCATED AT 250 WORDS)
Prospective analysis of pancreatic grafts with duplex-Doppler ultrasound: value of resistive index in the diagnosis of rejection.
The diagnosis of rejection and its differentiation from other causes of pancreatic graft dysfunction remain the basic problem in pancreas transplantation. A previous study with pulsed Doppler (PD) done at our institution demonstrated an increase of the resistive index (RI) during pancreatic graft rejection episodes. The aim of the study was to determine prospectively the utility of duplex-Doppler (DD) ultrasound (US) in identifying the cause of pancreatic graft dysfunction. The major clinical categories were graft rejection and graft pancreatitis.
Pancreatic transplant rejection: evaluation by duplex-Doppler ultrasound with urinary amylase monitoring correlation.
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Bile-duct hamartomas presenting as multiple focal lesions on hepatic ultrasonography.
Multiple bile-duct hamartomas are usually diagnosed at autopsy as an incidental finding. We report a case of a 50-yr-old male in whom multiple bile-duct hamartomas were suspected in an abdominal ultrasonography and confirmed by an echo-guided needle liver biopsy. The ultrasonography disclosed multiple scattered hyperechoic lesions with a diameter of up to 1 cm, associated with some anechoic lesions of a larger size and a cystic appearance. Computed tomography demonstrated multiple hypodense lesions that were not modified by the administration of contrast. Bile-duct hamartomas should be included in the differential diagnosis of multiple focal hepatic lesions at ultrasonography or computed tomography.
Utility of pulsed Doppler in the diagnosis and follow-up of acute vascular graft rejection treated with OKT3 monoclonal antibody or antilymphocyte serum.
Fifteen patients with severe acute vascular graft rejection (twelve of them steroid-resistant) treated with OKT3 monoclonal antibody (8) or antilymphocyte serum (7) were sequentially studied with duplex-Doppler ultrasonography (DDUS). Measurements of intrarenal resistance were obtained by means of the resistive index (RI). During rejection episodes, the intrarenal resistance was increased in all patients (RI range: 0.89-1), with absent or reversed diastolic blood flow. Normalization of diastolic blood flow was documented prior to the decrease of serum creatinine level in all patients who recovered from a rejection episode. We conclude that DDUS is a noninvasive technique useful in the diagnosis and monitoring of acute vascular graft rejection. Prediction of graft outcome after rejection treatment could probably be made based on DDUS findings.
Ultrasonography and computed tomography in adrenal myelolipoma.
We report 2 cases of adrenal myelolipoma with sonographic and computerized tomographic findings. Characteristic radiologic signs of this rare clinical entity must be known to avoid unnecessary surgical procedures.
Diagnostic accuracy of fine-needle aspiration biopsy in patients with hepatocellular carcinoma.
The present study was undertaken to investigate the diagnostic usefulness of fine-needle aspiration biopsy (FNAB) in a large series of patients with hepatocellular carcinoma (HCC) seen over a 1-year period. During 1986, ultrasonographically guided percutaneous FNAB was performed in 72 patients with suspected HCC. A final diagnosis of HCC was made in 58 patients. The presence or absence of HCC was ascertained by histological examination and/or by other diagnostic procedures (alpha 1-fetoprotein, computed tomography, arteriography) and by clinical follow-up (repeated ultrasonographic controls) and/or by surgery or necropsy. A total of 61 FNABs were carried out in these 58 patients. Only 42 (69%) of the 61 FNABs allowed the diagnosis of HCC. This moderate diagnostic sensitivity was not related to tumor size. Only one false positive result was observed in the non-HCC group. Therefore, the diagnostic specificity of FNAB for HCC was 93%, with a positive predictive value of 97% and a negative predictive value of 40%. These results show that FNAB is a useful diagnostic technique in patients with HCC. However, these data also show that there is a large proportion (31%) of subjects with false negative results. Therefore, we suggest that further efforts should be made to improve the diagnostic accuracy of this procedure.
Duplex-Doppler ultrasonography in monitoring clinical pancreas transplantation.
The findings are reported that were obtained with duplex-Doppler ultrasonography (US) in seven diabetic patients who underwent pancreatic grafting with pancreaticocystostomy. Five normal functioning grafts showed homogenous echostructure and pulsed Doppler spectrum characteristics of low impedance vascular beds. Four of these patients developed graft rejection (five episodes). The remaining two grafts had pulsed Doppler evidence of venous thrombosis. It was not possible to differentiate graft rejection from venous thrombosis using real-time US. In both circumstances a heterogeneous pancreatic echostructure with a small amount of peripancreatic fluid and an increase in pancreas size were observed. Pulsed Doppler, however, showed absence of venous flow in both cases of venous thrombosis whereas all rejection episodes were characterized by an increase in arterial impedance. We conclude that duplex-Doppler US is a promising noninvasive method of detecting surgical complications and graft rejection in pancreatic transplant recipients.
Hepatic artery aneurysm: diagnosis by duplex-Doppler ultrasound. Case report.
A case of hepatic aneurysm diagnosed by duplex-Doppler US is reported. The demonstration of a complex hepatic hiliar mass with an arterial turbulent blood flow spectrum, permitted the diagnosis, which was confirmed by subsequent abdominal CT exploration. Our case confirms that duplex-Doppler US is useful non-invasive tool for the diagnosis of hepatic artery aneurysm.
Abdominal sonographic study of autosomal dominant polycystic kidney disease.
PURPOSE: The purpose of this study was to determine whether kidney size in patients who have autosomal dominant polycystic kidney disease (ADPKD) is related to renal function, hypertension, or extrarenal manifestations of the disease and to sonographically evaluate the abdominal manifestations of ADPKD. METHODS: Between 1994 and 1998, 400 individuals from 85 families with a history of ADPKD were examined. There were 213 persons with ADPKD and 187 unaffected family members; there were 182 males and 218 females, 1-82 years old (mean, 39.3 years). We obtained a complete medical history, performed a physical examination, measured the arterial blood pressure and serum creatinine levels, and performed abdominal sonography on each subject. The sonographic features that were studied were renal length and the presence and number of cysts on the kidneys, liver, and pancreas. RESULTS: There was a relationship between kidney size and age (p < 0.05), kidney size and renal function (p < 0.001), and kidney size and hypertension (p < 0.001). The overall prevalence of hepatic cysts in patients with ADPKD was 67%, and the prevalence increased with age. The presence of hepatic cysts was related to the severity of renal disease. Females had more severe polycystic liver disease, and massive polycystic liver disease (ie, hepatomegaly with innumerable cysts) was seen only in females. The prevalence of pancreatic cysts in the 187 persons in whom the pancreas was well evaluated sonographically was 5%. CONCLUSIONS: Kidney size in patients with ADPKD is related to renal function, hypertension, and extrarenal involvement and can be used to predict the outcome of the disease. Hepatic cysts are very common in patients with ADPKD and are related to age and renal function; pancreatic cysts are infrequent in these patients.
Increased prevalence of carotid and femoral atherosclerosis in renal transplant recipients.
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Duplex-Doppler ultrasound and MAG-3 scintigraphy in the evaluation of acute tubular necrosis after kidney transplantation.
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CT appearance of localized pulmonary amyloidosis.
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