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V Kocandrle

Publications and source records attributed to V Kocandrle.

At least 19 recordsLinked to original sources
PubMed1998

[Repeat kidney transplantation].

BACKGROUND: The objective of the study was an analysis of results of repeated kidney transplantations (Tx2, Tx3) implemented during the first 29 years of activities of the Transplantation Centre of the Institute of the Clinical and Experimental Medicine in subjects with a different maintenance immunosuppression. METHODS AND RESULTS: The retrospective study pertains to 134 Tx2 and 17 Tx3 in 134 non-diabetic subjects: 43 of them had during Tx1 and Tx2 (1966-1981 and 1966-1985 resp.) immunosuppression on the basis of azathioprin (Aza, sub-group AA), 42 during Tx1 (1972-85), Aza, while during Tx2 (1984-85) immunosuppression on the basis of cyclosporin (CyA, subgroup AC) and 49 both during Tx1 and Tx2 (1985-93 and 1986-95 resp.) CyA (subgroup CC). Compared was survival of grafts by the actuarial method (with regard to all losses regardless of cause) by the end of the 4th year inside the subgroups (Tx2, vs. Tx1 and Tx3 vs. Tx2 in the same subjects) and between subgroups (Tx1 vs. Tx1 and Tx2 vs. Tx2 in different subjects). Moreover in paired investigations the survival of recipients and grafts after Tx2 was compared after immunosuppression on the basis of CyA with the same parameters after Tx1 in different subjects with the same immunosuppression, operated at approximately the same time (n = 81) and survival of subjects with Tx1 + Tx2 on the CC regime regardless whether the second grafts functioned at the time of the last examination, with survival of subjects after Tx1 where after graft failure Tx2 was not performed (n = 34). Prophylaxis with antilymphocyte globulins was not used. Survival of second and first grafts did not differ in any of the subgroups, third grafts survived at the end of the third year more frequently than second grafts (66 vs. 18%, p < 0.01). Second grafts in CC survived more than in AA (55 vs. 28%, p < 0.01). In the paired study Tx2 vs. Tx1 the survival of grafts and recipients was the same (88 vs. 89%, N.S. and 47 vs. 62% resp.), in the paired study Tx1 + Tx2 vs. Tx1 more subjects with Tx1 + Tx2 survived 10 years after Tx1 than subjects who did not have Tx2 (82 vs. 49%, p < 0.05). CONCLUSIONS: A further transplantation of the kidney after functional loss of the first graft is the method of choice: the mortality is low, the probability of several years' function is considerable and the prognosis as regards quality and length of life better than with regular dialysis treatment.

Adult↗
PubMed1994

[Dynamic bone scintigraphy in the diagnosis of renal osteopathy].

UNLABELLED: A study was undertaken to assess types of RO by a dynamic modification of osteoscintigraphy 53 pts dialyzed for 27-75 mths, 19-52 yrs old were divided, according to histological bone pictures, into 4 groups: I) 11 pts with hyperparathyroidism, II) 12 pts with osteomalacia, III) 11 pts with mixed RO, IV) 11 pts were after parathyroidectomy (PTE) and 13 controls. INVESTIGATIONS: the rate of 99mTc-Sn-HEDP accumulation in the skeleton, skeletal/background radioactivity index both registered for 60 min. (parameters K and P), serum levels of C-PTH, bone isoenzyme of alkaline phosphatase (bALP), acid phosphatase (ACP), free hydroxyproline (S-Hypro). RESULTS: 1. compared to controls: elevations of K and all biochemical parameters, P in groups I and III (p < 0.01 - < 0.001) were found. 2. Group 1 was characterized by the highest values of all parameters compared to groups II and IV (p < 0.01). 3. Linear relationships were found between K and bALP (p < 0.01), P and bALP, ACP, S-Hypro (p < 0.01) in pts of groups I, II, III. 4. PTE in group IV was followed by a decrease in all parameters (p < 0.01) compared to values of the same pts in group I. Aluminum osteopathy was present in 2/3 of cases in group II showing the lowest values of all parameters. CONCLUSION: DBS is a sensitive method for assessing bone turnover rate according to the degree of skeletal uptake of radionuclide. In this manner it is possible to determine both the type of RO and it's further development in repeated measurements.

Adult↗
PubMed1993

[Changes in plasma renin and aldosterone after parathyroidectomy in patients with hyperparathyroidism].

The plasma renin activity and its changes after parathyroidectomy indicate a preserved internal secretory renal function in dialyzed patients. The PRA values before parathyroidectomy are not unequivocally related to the blood pressure reading. After parathyroidectomy during the initial months the renin and aldosterone plasma levels decline in patients with secondary and primary HPT (p < 0.001), the urinary Na/K quotient rises in primary HPT (p < 0.05) and the systemic blood pressure declines in dialyzed patients with secondary HPT (p < 0.001). The findings suggest relations between the two hormonal systems during hyperparathyroidism and in the early stage after parathyroidectomy. Parathormone probably stimulates renin secretion. After a prolonged time interval following operation the parathormone levels in the blood steam reach normal levels and the same probably applies to intracellular calcium in cells of the iuxtaglomerular apparatus along with PRA.

Adult↗
PubMed1993

The optimal treatment of lymphoceles following renal transplantation.

Lymphoceles are well-recognized complications following kidney transplantation. The authors describe their experience with the treatment of eight clinically significant lymphoceles (incidence 2.7%). In seven patients percutaneous needle aspiration was attempted, often repeatedly, both for diagnostic and therapeutic purposes. In all of the patients the lymphocele recurred within days and internal marsupialization was therefore performed, in the last two patients utilizing minimal access surgery through laparoscopy. There were no postoperative complications or signs of a recurrence of the lymphocele. Patients following the laparoscopic marsupialization had a much briefer hospital stay and postoperative convalescence. Our results confirm that internal marsupialization is the procedure of choice for most post-transplant lymphoceles. Internal marsupialization through laparoscopy should be used in patients who meet the standard criteria for laparoscopy.

Adult↗
PubMed1993

[Hyperparathyroidism and parathyroidectomy in dialyzed patients].

The authors present older and more recent views regarding the pathogenesis of hypocalcaemia and secondary hyperparathyroidism in patients with chronic renal failure with emphasis on the impact of inorganic phosphate retention and lack of 1,25-dihydroxyvitamin D3 in body fluids. As regards therapeutic procedures the initial problem is to control hyperphosphataemia and to suppress the increased parathormone secretion in particular in dialyzed patients. When treating hyperphosphataemia it is necessary with regard to the severity of the finding to use concurrently several procedures and avoid aluminium phosphate binders. Aimed reduction of high parathormone levels in the blood stream can be achieved by medicamentous--pharmacological means, using 1,25 (OH)2 D3 or surgery of the hypertrophic parathyroid glands. The term parathyroidectomy can comprise also percutaneous infiltration of the parathyroid glands with ethanol. From this aspect under certain circumstances a combination of different therapeutic procedures may prove useful. In the conclusion the authors mention basic data on para-thyroidectomies performed in their department: the favourable long-term results of operations amounted to 80.4%.

Humans↗
PubMed1993

The importance of early renal graft function.

Onset of function and consequent graft and patient survival in 7923 cadaveric kidney transplants (Tx) were analysed; 42.3% of grafts had early function, 43.6% delayed function, defined as a temporary need of dialysis postoperatively, and 14.1% grafts never functioned. Multivariate analysis of 1743 cases showed that important risk factors for delayed function were of non-immune origin, i.e. length of pre-Tx dialysis, or warm and cold ischaemia. The significant risk factors for non-functioning were of immune origin i.e. panel-reactive antibodies, DR mismatches, immunosuppression without cyclosporin A and previous Tx. Five-year survival rates of early function and delayed function grafts were identical when non-functioning grafts were excluded. Comparison of early function with delayed function grafts divided according to the length of the function delay showed worse (P < 0.05) survival in grafts with delayed function > 20 days only (50.6% grafts had delayed function < 10 days, 32.7% 10-20 days, and 16.7% > 20 days). Survival of recipients with non-functioning grafts was worse (P < 0.01) than those with early function and delayed function grafts. There was no difference in recipients' survival between early function and delayed function groups. When comparing early function and delayed function graft outcome, the problem is not so much a question of how as when to define early function. A statement that delayed function is prognostically a bad sign is not correct, as most delayed function grafts recover spontaneously without any effect on long-term graft and patient survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclosporine↗
PubMed1992

[Initial clinical experience with Consupren, a new preparation manufactured in Czechoslovakia (Galena), in patients after liver transplantation].

Fourteen patients on average 10 months after transplantation of the kidney treated with Sandimmune were changed to a new Czechoslovak preparation Consupren, Galena (Cyclosporine A), while maintaining the other components of immunosuppressive treatment (azathioprine, prednisone). The patients were followed up for 6-12 months on the new drug. The tolerance of Consupren was in all patients satisfactory. Two weeks after the change the mean cyclosporine A level was significantly higher and called for a reduced dosage. No significant changes in the clinical condition and laboratory indicators were observed, the serum creatinine values did not change during the investigation and within 6 months after the change no rejection was recorded, despite the fact that during the first six weeks after the change an insignificant rise of mean absolute number of lymphocytes, CD4 lymphocytes and the regulatory index and a significant rise of CD3 lymphocytes was observed.

Adult↗
PubMed1992

[Personal experience with heart transplantation].

During the period from 1984-1991 in the Institute of Clinical and Experimental Medicine 72 orthotopic transplantations of the heart were performed in 71 patients with irreversible cardiac failure. Indication for transplantation in 39 patients was IHD, in 28 cardiomyopathy, in 3 RHD and in one instance a tumour. The mean age of the patients was 41 years, the youngest patient was 17 and the oldest 62 years old. Immunosuppression involved a combination of three preparations Azathioprine, corticoids and Cyclosporine A. Nineteen patients died within one month after operation. The most frequent cause of death was cardiac failure. As to postoperative complications, renal failure was most frequent. Fifty patients were followed-up on a long-term basis. The longest survival period was 8 years and 2 months. The most frequent cause of death in the long-term follow-up was sudden death caused in the majority most probably by rapid development of coronary disease.

Adolescent↗
PubMed1991

[Heart surgery in Czechoslovakia].

In 1985, the cardiovascular Section of the Society of Surgery decided to start a registry of cardiac surgery procedures. Since then, basic data on surgical treatment of patients with heart disease have been collected each year. The following conclusions have been drawn from the data available: 1. The situation in cardiac surgery in Czechoslovakia is catastrophic. Czechoslovakia ranks among nations with the lowest numbers of operations per population in Europe. The most critical situation exists in IHD. 2. The standard of care provided to patients in individual areas of Czechoslovakia is about the same. 3. The critical lack of funds led to a decrease in the number of operations performed in 1990. 4. Organization of health care is poor, as indicated by length of hospital stay longer than that in the industrialized nations. 5. It is crucial to allocate more money to departments of cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1990

[Change from treatment with cyclosporin A to conventional treatment in kidney transplantation].

Patients after a first transplantation of the kidney from a dead donor treated with cyclosporin A in combination with one, two or three drugs were switched to conventional treatment with azathioprine and prednisone. Fifty-two patients were switched to the new treatment 11-15 months after transplantation (group I), 9 patients after 6-10 months (groups II), 17 patients after 16-30 months (groups III). Group I was compared with 21 patients where no switched was made after 11-15 months (group IV). The authors did not reveal any change in the survival of grafts nor in the number of rejections during the three-month period following the switch. Survival of grafts in patients with rejection was after two years following the switch significantly lower than in patients without rejection, the loss of grafts, however, did not differ as compared with patients who suffered a rejection during a comparable period but were not switched to conventional therapy. The interval of the switch after transplantation did not influence the incidence of rejections. Rejections after the switch cannot be reliably foreseen from the level of cytotoxic anti-HLA antibodies or previous repections before the switch.

Azathioprine↗
PubMed1990

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. I. Therapeutic effectiveness].

Two groups of patient after a first renal transplantation from a dead donor were treated by a double combination of cyclosporin A and prednisone (group A) and triple combination cyclosporin A and azathioprin and prednisone (group B). The groups were similar as regards effectiveness of treatment (evaluated with regard to the survival of recipients and grafts and the number of rejection episodes); they did not differ as to the losses of grafts for other than immunity reasons, which predominated in both groups over losses caused by rejection. Discontinuation of prednisone after four months in group A was complicated by rejection in 54%. Discontinuation of cyclosporin A after one year's treatment and a change to azothioprin and prednisone treatment was in both groups complicated by rejection in cca one fifth of the patients.

Adult↗
PubMed1990

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. II. Adverse effects of cyclosporin A and therapeutic complications].

The incidence of irreversibly afunctional grafts, late functional development and period of the initial temporary lack of function did not differ in the two groups. The total number of nephrotoxic episodes was significantly (p less than 0.05) lower in the triple combination, chronic nephrotoxicity developed with equal frequency. Infectious complications were present in 54% of the patients in group A and in 60% in group B, viral complications in 15% patients in group A and in 16% in group B. Serious bacterial infections were the cause of death in one of three patients in group A and in five of six patients in group B.

Adult↗
PubMed1990

[Precordial mapping of the R wave in the diagnosis of rejection after orthotopic heart transplantation].

In 15 patients after orthotopic transplantation of the heart the authors made repeated examinations of electromaps of the R wave and endomyocardial biopsies (TMB) during a long-term, at least one-year, investigation. In the detection of rejection EMB plays a dominating role. In three patients the authors found at the time of rejection a significant reduction of the R waves on maps, which correlated closely with the bioptic findings. It was revealed that maps of R waves are a good indicator of rejection of the transplanted heart. The examination may prove helpful when checking treatment of rejection but does not lead so far to a restriction of the number of endomyocardial biopsies of the heart.

Biopsy↗
PubMed1990

Vasoconstriction in patients after heart transplantation.

We have the values of rest and maximal blood flow and of venous compliance in the forearm in three groups of patients: those undergoing orthotopic heart transplantation, those with severe cardiac insufficiency, and a control group. The findings suggest the presence of arteriolo- as well as venoconstriction in transplanted patients. This, however, was less pronounced than in the patients with heart failure. Neither the values of maximal blood flow nor those of minimal peripheral resistance in the forearm obtained after a 5-minute ischaemic insult differed significantly between the patients after heart transplantation and the controls. Thus, arteriolar constriction can be removed by this insult in patients after transplantation.

Blood Pressure↗