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Biomedical subjects

V Kocandrle

Publications and source records attributed to V Kocandrle.

At least 37 records · Page 2Linked to original sources
PubMed1990

The mobilized omentum and muscle flaps in the treatment of infectious complications in cardiovascular surgery.

Infection in cardiovascular surgery invariably constitutes a very serious complication that cannot be controlled by antibiotics in all cases. Improved blood supply to the tissue affected by infection largely helps to control these complications. The article reports on three cases in which mobilized muscle and omental flaps helped essentially to heal infectious complications following heart transplantation, aortic valve replacement, and reconstruction of arteries of the lower limb.

Adult↗
PubMed1990

Bile composition in patients with chronic renal insufficiency.

Very little is known about bile composition in the end stage of chronic renal sufficiency. Patients with this condition are either assigned to a dialysis-transplantation programme, or are treated temporarily with a low-protein diet. Our study was designed to determine bile composition both in a group of ten patients treated with a low-protein diet over a long period of time, and in 11 patients on regular haemodialysis. The patients on haemodialysis were found to have increased bile cholesterol and an increased saturation index in the bile, i.e. changes implying increased risk of cholecystolithiasis. These changes were further enhanced by the effect of a low-protein diet with subsequent increases in cholesterol values and the bile saturation index, as well as a decrease in primary and an increase in secondary bile acids in the bile, i.e. a change in the spectrum of bile acid characteristic for cholecystolithiasis.

Adult↗
PubMed1990

Aneurysm of the common hepatic artery diagnosed by ultrasonography.

The authors report on their observation of a patient with an aneurysm of the common hepatic artery, the diagnosis of which had been previously established by ultrasonography. Verification of the finding by angiography was followed by timely surgery including aneurysm resection. The potential of ultrasonography in diagnosing this rare vascular abnormality, the CT scan of which had been erroneously interpreted as an inoperable tumour, is pointed out.

Adult↗
PubMed1990

Right ventricle in patients after orthotopic heart transplantation.

Eighteen patients were examined by echocardiography one month before, and one month after orthotopic heart transplantation (OHT). The right-heart echocardiographic parameters were compared with pulmonary haemodynamics. All recipients showed increased mean pulmonary artery pressure (PAP) (42 +/- 8 mmHg) and pulmonary vascular resistance 3.0 +/- 1.3 u.) before OHT. The causes of the pulmonary hypertension, and indications for OHT, were the end stage of dilated cardiomyopathy (n = 8), ischaemic heart disease (n = 9) and aortic valve disease (n = 1). After transplantation, the donor's right ventricle dilates due to the recipient's elevated pulmonary vascular resistance. The right ventricular dimension after OHT was greater than 30 mm in 1/3 of patients. The right ventricular diastolic dimension correlates statistically significantly with mean PAP of the recipient before the procedure. Right ventricular dilatation is accompanied by a mild degree of tricuspid insufficiency (in 89% of cases), as documented by Doppler examination. Neither the degree of right ventricular dilatation, nor the degree of tricuspid insufficiency show a tendency to progression during follow-up.

Adult↗
PubMed1990

[Computer tomography in the diagnosis of hyperparathyroidism].

The paper presents long-term experience in the diagnosis of hyperparathyroidism by means of computer tomography. A large number of examinations (164) of parathyroid glands, the possibility of verification and comparison with sonography or with other diagnostic methods of visualization make it possible to define the role of computer tomography in hyperparathyroidism and to show advantages and limitations of the method. For the high diagnostic precision the CT examination may be considered to be the reliable method in the demonstration of enlarged parathyroid glands.

Adolescent↗
PubMed1990

Cardioprotective conditioning with glucose and insulin prior to cardiac surgery involving ischaemic cold arrest.

The study describes cardioprotective conditioning by means of high doses of glucose together with insulin and potassium. Eighteen hours before cardiac surgery, nine patients received continuous infusion of 1000 ml of 40% glucose solution along with 112 U of insulin and 60 mmol of potassium. Before and after ischaemic cold arrest, the myocardial a--v differences of lactate, pyruvate, glucose, Na, K, Cl, Ca, P, free fatty acids and triglycerides were analysed in all patients. Blood collections were performed in parallel with ultramicroscopy of biopsy specimens from the right atrium. The results were compared with those obtained in a control group of 22 patients without cardioprotective conditioning with glucose, insulin and potassium. Neither the analysis of the myocardial a--v differences of metabolites, nor the finding on the mitochondria and myofibrils documented statistically significant differences between the control and conditioned groups. Following termination of ischaemic cold arrest, patients in the conditioned group exhibited more glycogen grains in myocardial cells than those in the control group. While 34% of patients in the control group were defibrillated after revascularization, it was not necessary in any of the conditioned patients.

Adult↗
PubMed1990

Transplantation of the kidneys in diabetics.

Diabetic nephropathy affects half the type 1 diabetics and is the most frequent cause of death there. While in some countries diabetics account for 25-30% of all patients newly admitted in dialysis and transplantation programmes, in Czechoslovakia the number of diabetics treated by dialysis or transplantation is small. From August 1985 to June 1988, 15 isolated kidney transplant operations were performed on 13 diabetics with serious late complications of diabetes. By the time of writing, all recipients had been surviving (for 1 up to 35 months), and only two were receiving artificial kidney treatment. Progressive vascular complications were in two cases the cause of gangrene of the lower extremity, one patient had a central cerebrovascular attack. Despite this, successful transplantation resulted in a marked improvement of the patients' general condition and quality of life. Due to intensified insulin therapy, diabetes, too, was satisfactorily compensated in the majority of the recipients. As experience so far indicates, if the patient is prepared in good time, which includes diabetological, nephrological and ophthalmological treatment, the results of transplantation in diabetics can be comparable to those achieved in non-diabetic patients. Renal transplantation in diabetics should be developed in all transplantation centres in Czechoslovakia, and uraemic diabetics should not be eliminated from the dialysis-transplantation programme except in cases of serious contraindication.

Adult↗
PubMed1990

[Electrolyte disorders in cadaveric kidney donors before explantation and the functional development of the transplant in the early postoperative period].

In a group of cadaveric kidney transplantations the problem of the dependence of the functional development of the graft on the function of donor kidney before explanation and on the total time of ischaemia in the immediate postoperative period was investigated. Based on the plasma concentration of endogenous creatinine (PKr), urea (PUrea) and the total ischaemic time (GI), the early function of the graft cannot be predicted. On the contrary, the values of PKr, GI and the kidney index (NIKI = PKr x GI) allow an accurate prediction that the early function of the graft will not be sufficient. Early function of the graft is not likely to develop when PKr is higher than 160 mumol/l, total ischaemic time is longer than 30 hours and the NIKI is over 3,500. Severe alterations in the level of serum potassium (SK) occurred in 61.4% of the donors. In cases where SK was 3.0 mmol/l or less, early function of the graft did not develop in 82.3%. With high probability haemodialysis was necessary. More pronounced alterations of the level of SNa occurred in more than 60% of the donors. When SNa was 125 mmol/l or less, early function of the graft did not develop in 76%. Diuresis over 400 ml/h increased significantly the number of early nonfunctional grafts. In cases where fractional sodium excretion (FENa) was over 5%, early function of the graft did not develop. With a FENa less or equal to 1%, early function of the graft was most likely to develop.

Electrolytes↗
PubMed1990

[Endomyocardial biopsy and acute rejection in heart transplantation].

Nearly 6-year experience with EMB in patients with transplanted heart concerned especially problems of acute rejection. EMB proved to be a sensitive and for the time being unique method for the detection of acute rejection in patients treated by Cyclosporine immunosuppression. EMB were also criterion of correctness of immunosuppression because they reflected changes in treatment.

Acute Disease↗
PubMed1989

[Electrolyte disorders in brain dead organ donors and early functional development of the transplanted kidney].

In 70 cadaverous donors the authors examined 2 hours before collection of organs the serum and urinary electrolyte levels and the creatinine and urea levels. Serious hypokaliaemia (less than 3.0 mmol/l) was found in 24.5% of the donors, hyperkaliaemia (more than 6.0 mmol/l) in 11.4%. Hyponatraemia (less than 125 mmol/l) was present in 11.4%, hypernatraemia (above 160 mmol/l) in 18.6% of the donors. Hyperchloraemia (above 130 mmol/l) was recorded in 22.8 percentage of the donors. In cases where SK less than or equal to 3.0 mmol/l, early functional development of the graft did not occur in 82.3% (p less than 0.001), in cases where SNa less than or equal to 125 mmol/l in 75% (p less than 0.01). When the value of FENa greater than or equal to 5%, early restoration of the graft did not occur in 81.3% of the cases (p less than 0.01). Conversely when FENa less than or equal to 1%, functional development of the graft was highly probable (p less than 0.001). Diuresis above 400 ml/h had an adverse (p less than 0.01) effect on the early functional development of the graft.

Brain Death↗
PubMed1989

[Personal experience with surgical treatment of hyperparathyroidism in chronic kidney failure. I. Etiopathogenesis of secondary hyperparathyroidism, preoperative findings, indications for parathyroidectomy].

The authors give an account of the fundamental relations of the calcium-phosphate metabolism in conjunction with the development of secondary HPT in chronic renal failure. The authors analyzed a group of 20 patients operated on account of secondary and tertiary forms of HPT as regards preoperative findings. The analysis comprised the clinical condition, biochemical, radiological and histological findings pertaining to bone, along with evidence of enlarged parathyroid glands by computed tomography and ultrasonography. The mentioned findings supplemented by some findings from the literature are the sum of indications for PTE. From the practical aspect they are indicators of the affection, of a high total ALP blood level and X-ray evidence of subperiostal absorption.

Adolescent↗
PubMed1989

[Personal experience with surgical treatment of hyperparathyroidism in chronic kidney failure. II. Surgical technic, postoperative course and the state of bone metabolism after parathyroidectomy].

In 20 haemodialyzed patients operated on account of HPT, in 12 instances total PTE was performed with autotransplantation of portions of the parathyroid gland and in 8 patients so-called partial PTE was performed, leaving one parathyroid gland (in one instance two). Histomorphological examination revealed diffuse to nodular hyperplasia and twice an adenoma of the parathyroid; the mean weight of the excised tissue was 4000 mg. The follow-up period after operation varied from two months to 36 months. After total PTE the regression of HPT is more marked and more rapid. Possible relapses are more probable after partial PTE, also the possible development of hyperplasia of the implanted tissue cannot be ruled out. A new rise of C-HPT levels precedes changes of the clinical picture and a rise of indicators of bone metabolism. From linear correlations between serum levels of the ALP bone fraction, total ACP, free OH-P and values of C-PTH (p less than 0.01-0.001) conclusions can be drawn on regression or progress of the osseous finding after PTE. Data on the possible participation of aluminum osteopathy are essential, as in the florid stage it is a contraindication of PTE. The positive effect of operation recorded in 17 patients comprised not only restoration of a satisfactory mobility but also an improved mental condition. Surgical treatment of advanced forms of HPT in dialyzed patients is therefore still considered an indicated operation, provided these patients receive subsequently further aimed care.

Adolescent↗
PubMed1989

[Kidney transplantation in diabetics].

Diabetic nephropathy affects half the type I diabetics and is their most frequent cause of death. While in some countries diabetics account for 25-30% of all newly admitted patients in dialyzation-transplantation programmes, in the CSSR the number of diabetic patients treated by dialyzation or transplantation is small. From August 1985 to June 1988 in the Institute of Clinical and Experimental Medicine a total of 15 isolated transplantations of the kidneys were made in 13 diabetics with serious late complications of diabetes. At present all recipients survive (1-35 months) and only two are treated by an artificial kidney. Progressing vascular complications were in two instances the cause of gangrene of the lower extremity, one recipient had a central cerebrovascular attack. Despite this, successful transplantation caused a marked improvement of the general condition and quality of life. The compensation of diabetes was also, due to intensified insulin therapy, satisfactory in the majority of recipients. Hitherto assembled experience indicates that when the patient is prepared in time, which includes diabetological, nephrological and opthalmological treatment, the results of transplantation treatment in diabetic patients can be comparable with results in should be developed in all transplantation centres in the CSSR and uraemic diabetics should be eliminated from the dialyzation transplantation programme only in case of fundamental contraindications.

Adult↗
PubMed1989

Serum beta 2-microglobulin before and after renal and heart allotransplantation and in infection.

UNLABELLED: beta 2-microglobulin (beta 2-m) serum levels were significantly elevated in patients waiting for kidney transplantation. The levels decreased after successful transplantation, even when they were never as low as in a control group of healthy blood donors. A higher amount of serum (s-) beta 2-m was observed also in heart transplant recipients. A significant reincrease in s-beta 2-m occurred during rejection of renal allograft and during CMV and EBV infection. The levels of s-beta 2-m were higher in patients infected with CMV than in those infected with EBV. ABBREVIATIONS: beta 2-m = beta 2-microglobulin, s-beta 2-m = serum beta 2-microglobulin, CMV = cytomegalovirus, EBV = Epstein-Barr virus.

Cytomegalovirus Infections↗
PubMed1989

[Aneurysm of the hepatic artery].

Aneurysms of the hepatic artery are a very rare disease. The authors describe the symptomatology, most frequent localization, diagnostic methods and possibilities of surgical treatment.

Adult↗