RESUMEN
AIM: Endorectal advancement flaps are an established treatment for high transsphincteric and suprasphincteric fistulae. The outcome of a repeat procedure in the case of flap breakdown and fistula recurrence remains unclear. The aim of the study was to analyse the outcome of repeat endorectal advancement flaps. METHODS: We retrospectively analysed patients with a repeat endorectal advancement flap procedure after flap breakdown and recurrence of fistula-in-ano of cryptoglandular origin who had been treated in our unit between 1994 and 2010. RESULTS: In all, 97 patients underwent an endorectal advancement flap procedure for fistula-in-ano and, of these, nine patients (five men, four women, 9.3%) subsequently underwent a repeat procedure due to flap breakdown. Median age was 40 years (range 25-60). Median follow-up time was 85 months (range 26-136). Seven full-thickness and two mucosal flap repeat procedures were performed because of eight transsphincteric and one suprasphincteric fistulae. The repeat procedure was successful in seven (78%) patients. In one of the two patients with repeat flap failure, a third flap procedure failed again. Disturbances of postoperative faecal incontinence were observed in five (55%) patients. Overall, the median postoperative Vaizey faecal incontinence score was 1 (range 0-4). CONCLUSION: Repeat endorectal advancement flap procedures are feasible and associated with a low recurrence rate and mild postoperative faecal incontinence. Therefore, a repeat procedure is a viable option in the case of a flap breakdown and fistula recurrence.
Asunto(s)
Incontinencia Fecal/cirugía , Fístula Rectal/cirugía , Recto/cirugía , Colgajos Quirúrgicos , Adulto , Austria , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Incontinencia Fecal/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Fístula Rectal/complicaciones , Recurrencia , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
AIM: The study investigated the fate of patients with perianal sepsis of cryptoglandular origin. METHOD: All patients treated for perianal sepsis between January 1994 and December 2000 were retrospectively analysed regarding recurrence and faecal incontinence. Data collection was conducted by chart review and by telephone questionnaire using the Vaizey incontinence score. RESULTS: One hundred seventy-three (58%) of 300 patients were available for follow-up at a median period of 121 (77-171) months. Fistula-in-ano was diagnosed in 156 (90%) patients. After a single surgical procedure, 55 (32%) patients had no recurrence of perianal sepsis. In 118 (68%), recurrence required multiple procedures (median 3, range 2-19). If only a single incision and drainage was performed (n = 10, 6%), no faecal incontinence occurred. Drainage with fistulotomy (n = 45, 26%) induced mild incontinence in 9% and severe incontinence in 4%. After multiple procedures that were required in 118 (68%) patients, mild and severe faecal incontinence was found in 16% and 4% of them, respectively. CONCLUSION: Treatment of anal sepsis is associated with a high recurrence rate and a substantial risk of faecal incontinence.
Asunto(s)
Absceso/cirugía , Canal Anal/cirugía , Fístula/cirugía , Perineo , Fístula Rectal/cirugía , Absceso/complicaciones , Absceso/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Drenaje , Incontinencia Fecal/etiología , Femenino , Fístula/complicaciones , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Perineo/cirugía , Fístula Rectal/complicaciones , Recurrencia , Reoperación/efectos adversos , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: Patients with slow transit constipation who do not respond satisfactorily to common medical treatment are considered candidates for colectomy. The present observational long term study was designed to assess outcome after surgery. METHOD: Twenty consecutive patients were treated by colectomy for slow transit constipation between 1996 and 2004. Preoperative and postoperative data were reviewed by using our institutional database. A questionnaire including validated scoring systems and questions about complications and subsequent surgical interventions was sent to all available patients. RESULTS: Three patients (15%) died perioperatively. Median long term follow up was 84 months. Ten patients (50%) needed further operations after colectomy: Three patients (15%) had surgery during the early postoperative period, seven patients (35%) during follow up. A total of 31 operations had to be performed in these patients. Twelve patients (86%) responded to the questionnaires. Their median Wexner constipation score was 11.5 (range 8-23). Six patients fulfilled the Rome II criteria for constipation. The median Vaizey incontinence score was 7.5 (range 0-22). The median GIQLI showed 80 points (range 32-129). CONCLUSION: Morbidity and mortality rate after colectomy were inadmissibly high. Taking into account the poor functional results, we cannot recommend colectomy for slow transit constipation.
Asunto(s)
Colectomía/métodos , Estreñimiento/diagnóstico , Estreñimiento/cirugía , Tránsito Gastrointestinal , Calidad de Vida , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica/métodos , Estudios de Cohortes , Colectomía/efectos adversos , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Satisfacción del Paciente , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenAsunto(s)
Acidosis/inducido químicamente , Anestésicos Intravenosos/efectos adversos , Cuidados Críticos , Fiebre/inducido químicamente , Hiperpotasemia/inducido químicamente , Propofol/efectos adversos , Tiopental/efectos adversos , Acidosis/diagnóstico , Acidosis/tratamiento farmacológico , Adulto , Anestésicos Intravenosos/administración & dosificación , Coma/inducido químicamente , Sedación Consciente/efectos adversos , Sedación Consciente/métodos , Cuidados Críticos/métodos , Resultado Fatal , Femenino , Humanos , Hiperpotasemia/diagnóstico , Hiperpotasemia/tratamiento farmacológico , Infusiones Intravenosas , Masculino , Propofol/administración & dosificación , Enfermedades Raras , Síndrome , Tiopental/administración & dosificación , Factores de TiempoAsunto(s)
Arteriosclerosis/epidemiología , Trasplante de Corazón/fisiología , Terapia de Inmunosupresión/métodos , Complicaciones Posoperatorias/epidemiología , Enfermedad Coronaria/epidemiología , Femenino , Estudios de Seguimiento , Rechazo de Injerto/epidemiología , Humanos , Incidencia , Masculino , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Factores de TiempoRESUMEN
BACKGROUND: The need for better immunosuppressive protocols after lung transplantation led us to investigate tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and steroids or cyclosporine (CsA) in combination with MMF and steroids in a prospective, open, randomized trial after lung transplantation. METHODS: Between September 1997 and April 1999, 50 lung transplant recipients were randomized to receive either Tac (n = 26) or CsA (n = 24) in combination with MMF and steroids. All patients underwent induction therapy with rabbit antithymocyte globulin (ATG) for 3 days. Freedom from acute rejection (AR), patient survival, infection episodes, and side effects were monitored. RESULTS: There was no difference in patient demographics between the two groups. Six-month and 1-year survival was similar (84.6% and 73.1% in the Tac group vs 83.3% and 79.2% in the CsA group). Freedom from AR at 6 months and 1 year after lung transplantation was slightly higher in the Tac group (57.7% and 50% vs 45.8% and 33.3%, p = not significant [n.s.]), whereas the number of treated rejection episodes per 100 patient days in the Tac group was significantly lower (0.225 vs 0.426, p < .05). Four patients in the CsA group had to be switched to Tac. Two patients in the CsA group had to be retransplanted. Incidence of infections was similar in both groups with a trend toward more fungal infections in the Tac group (n = 7 vs n = 1, p = n.s.). CONCLUSIONS: The combination of Tac and MMF seems to have slightly higher immunosuppressive potential compared with CsA and MMF. The effectiveness of Tac as a rescue agent is not paralleled with undue signs of overimmunosuppression.
Asunto(s)
Inmunosupresores/uso terapéutico , Trasplante de Pulmón/inmunología , Enfermedad Aguda , Adulto , Anciano , Bronquiolitis Obliterante/etiología , Enfermedad Crónica , Creatinina/sangre , Ciclosporina/uso terapéutico , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Rechazo de Injerto/etiología , Rechazo de Injerto/prevención & control , Humanos , Incidencia , Infecciones/epidemiología , Infecciones/etiología , Masculino , Persona de Mediana Edad , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Estudios Prospectivos , Tasa de Supervivencia , Tacrolimus/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Lung transplantation has become an accepted surgical modality, and it is indicated in patients with a long-term benign pulmonary disease in stage when all the other therapeutic possibilities failed. Nowadays it presents a real possibility to significantly improve the quality of life. Success, (mainly in the last decade), establishing international professional centers, national coordinations, shifts transplantation towards the standard treatment procedures. The objective of the paper is to offer an overview of the international activities, trends and results in the area of lung transplantation. Authors present a review of the current situation based on their own experiences gained from the bilateral cooperation with Vienna Transplant Group. (Tab. 4, Fig. 4, Ref. 19.)
Asunto(s)
Trasplante de Pulmón , Humanos , Trasplante de Pulmón/métodos , Selección de PacienteRESUMEN
We describe a 54-yr-old man with cardiogenic shock caused by acute right heart failure after pulmonary embolectomy. Inhalation of nitric oxide led to immediate improvement in respiratory and haemodynamic variables. Inhaled nitric oxide can be used to reduce acute right heart failure until conventional therapy can provide successful haemodynamic stability.
Asunto(s)
Óxido Nítrico/uso terapéutico , Complicaciones Posoperatorias/tratamiento farmacológico , Embolia Pulmonar/cirugía , Choque Cardiogénico/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Administración por Inhalación , Humanos , Masculino , Persona de Mediana Edad , Óxido Nítrico/administración & dosificación , Vasodilatadores/administración & dosificaciónRESUMEN
OBJECTIVE: Postpneumonectomy bronchial stump fistula (PBSF) is a serious complication with a reported incidence between 0 and 12%. The aim of this retrospective study was to investigate the effectiveness of different coverage techniques of the bronchial stump applied in a consecutive series of pneumonectomies in avoiding this particular problem. METHODS: Between 1/87 and 10/97, 129 patients (90 male, 39 female, mean age 57.8 years, range: 15-78 years) underwent pneumonectomy by one surgeon (W.K.). In 14 patients, additional resection procedures were performed (aorta n = 6, vena cava n = 5, thoracic wall n = 3). In all patients with malignancies (n = 123), mediastinal lymphadenectomy was routinely added to the procedure. Bronchial stump closure was performed by means of stapling devices in all patients. Coverage of the bronchial stump was performed with a generous pedicled pericardial flap and concomitant reconstruction of the pericardium with Vicryl mesh (n = 50), with a portion of the posterior pericardium (n = 16), with the azygos vein (n = 12), with surrounding mediastinal tissue (n = 25), with pleura (n = 16), or with intercostal muscle flap (n = 3); no coverage at all was performed in seven patients. In all patients with high risk for development of PBSF, i.e. patients who received any form of neoadjuvant therapy or had extended resections, the pericardial flap technique was used. RESULTS: Perioperative mortality was 5.4% (n = 7) and five patients (3.9%) experienced significant perioperative complications, with one of them directly related to the method of bronchial stump coverage (cardiac tamponade due to the use of a too small Vicryl mesh for reconstruction of the pericardium). Follow-up was 96.1% complete (five patients were lost to follow-up). Fourty-seven patients (36.4%) died late after operation (mean 19+/-13 months, median 17 months), mainly due to recurrence of their underlying malignant disease. PBSF occurred in one patient only (0.8%), 2 weeks after operation (coverage with pleura). No PBSF was seen in the long term follow-up period. CONCLUSION: Coverage of the bronchial stump contributes to a low incidence of PBSF. In view of the fact, that this serious complication was completely avoided in the pericardial flap group (used in patients with expected higher risk for PBSF), this particular technique seems to offer the best results.
Asunto(s)
Fístula Bronquial/cirugía , Neumonectomía/efectos adversos , Adolescente , Adulto , Anciano , Bronquios/cirugía , Fístula Bronquial/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos , Grapado QuirúrgicoRESUMEN
OBJECTIVE: Bilateral anterior trans-sternal thoracotomy (clam shell incision) is the standard approach used for bilateral sequential lung transplantation (BLTX). The morbidity of this large incision can be considerable. Two separate sequential anterolateral thoractomies represent a less invasive approach. METHODS: The value of this approach was investigated in a prospective series of 22 consecutive patients who received BLTX between June 1997 and July 1998. Their underlying diseases were COPD (n = 16), cystic fibrosis (n = 4) and other (n = 2). All patients underwent BLTX through two anterolateral thoracotomies, without the use of cardiopulmonary bypass. The anterior mediastinum and the sternum with all the surrounding tissue were left completely intact. Twenty-one patients underwent spirometrical examination during the postoperative in-hospital stay. Follow-up is 7+/-4 months (range: 3 to 15). RESULTS: The only intraoperative complication was severe reperfusion edema of the first transplanted lung seen in one patient at the end of the operation, which required pneumonectomy during the same session. All other operations were uneventful. The difference between the cold ischemic time of the first and second transplanted lung was 83+/-17 min. Median intubation duration, ICU- and in-hospital-stay were 1.5, 5 and 20 days, respectively (ranges: 1 to 96, 2 to 96 and 15 to 96, respectively). One major perioperative complication occurred and was due to gross donor/recipient size mismatch: the patient required lobectomy of the consolidated right upper lobe 11 days after transplantation. In 19 patients (86.4%), this less extensive incision allowed early postoperative mobilization, which resulted in good ventilatory performance, with VC of 53+/-15 and FEV1 of 60+/-20% of the predicted, respectively, at the first spirometry, 3 weeks after the operation. Three months survival was 100%. CONCLUSION: The bilateral sequential anterolateral thoracotomy represents a safe and minimal invasive approach for BLTX compared with the clam shell incision. It minimizes the operative trauma, improves postoperative functional recovery and prevents the potential spread of unilateral complications to the other pleural cavity.
Asunto(s)
Trasplante de Pulmón/métodos , Toracotomía/métodos , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pruebas de Función Respiratoria , Toracotomía/efectos adversos , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaAsunto(s)
Fibrosis Quística/cirugía , Trasplante de Pulmón/métodos , Adolescente , Anastomosis Quirúrgica/métodos , Bronquios/cirugía , Fibrosis Quística/complicaciones , Fibrosis Quística/diagnóstico por imagen , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Arteria Pulmonar/cirugía , Venas Pulmonares/cirugía , Radiografía Torácica , Insuficiencia Respiratoria/diagnóstico por imagen , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/cirugía , Índice de Severidad de la Enfermedad , Donantes de TejidosRESUMEN
BACKGROUND: The aim of the study was to assess the impact of mycophenolate mofetil (MMF) on the early phase after lung transplantation. PATIENTS AND METHODS: Thirty-eight consecutive patients between November 1994 and January 1997 were treated with cyclosporine, prednisolone, antithymocyte globuline induction therapy, and either MMF (n = 21) or azathioprine (Aza) (n = 17). Four patients from the MMF group and 2 patients from the Aza group were intubated and in the ICU prior to transplantation. Demographic data and primary diagnosis were comparable. MMF was administered at a dosage of 2 gm/day whereas Aza was initiated at 2 mg/kg/day and adapted by leukocyte count. Three-month survival and incidence of rejections and infections were compared. RESULTS: Six-month survival in the MMF group was 76% compared to 65% in the Aza group (n.s.). The mean number of acute rejection episodes in the MMF and Aza group were 0.29+/-0.10 and 1.53+/-0.29 (p<0.01) respectively. Transbronchial biopsy (TBB) results > or =grade 2 ISHLT were seen in 10% of MMF and in 43% of Aza-treated patients; completely free from rejection were 17 MMF and 3 Aza patients. The mean number of infections per patient in the MMF and Aza group were 1.57+/-0.29 and 2.29+/-0.40 respectively, bacterial (1.10 vs. 1.71), viral (0.35 vs. 0.33), and fungal (0.14 vs. 0.24) infections were the same in both groups. CONCLUSIONS: These data result suggest that mycophenolate mofetil therapy is more effective in preventing rejection episodes in patients early after lung transplantation than therapy with azathioprine. We therefore conclude that MMF is a safe and effective drug to optimize immunosuppressive therapy in the early phase after lung transplantation.
Asunto(s)
Azatioprina/uso terapéutico , Rechazo de Injerto/prevención & control , Inmunosupresores/uso terapéutico , Trasplante de Pulmón , Ácido Micofenólico/análogos & derivados , Adolescente , Adulto , Biopsia , Ciclosporina/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Glucocorticoides/uso terapéutico , Rechazo de Injerto/epidemiología , Rechazo de Injerto/patología , Humanos , IMP Deshidrogenasa/antagonistas & inhibidores , Inmunoglobulinas Estimulantes de la Tiroides/uso terapéutico , Incidencia , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Prednisolona/uso terapéutico , Estudios Prospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Bilateral transsternal thoracotomy (clamshell incision) is the standard approach used for bilateral sequential lung transplantation (BLTX). The morbidity of this large incision can be considerable. Two separate sequential anterolateral thoracotomies represent a less invasive approach. METHODS: The value of this approach was investigated in a prospective series of 13 consecutive patients with the underlying diagnosis of COPD or cystic fibrosis (group A). Results were compared to 8 consecutive patients with similar indications who had undergone BLTX via clamshell incision during the last year prior to this new technique (group B). RESULTS: No intraoperative complications occurred in either group. The difference between the cold ischemic time of the 1st and 2nd transplanted lung was comparable between the 2 groups (81 min+/-17 min in group A vs 79 min+/-14 min in group B, p = 0.783). Postoperative restriction was significantly less in the group operated through 2 separate thoracotomies, as proven by the vital capacity in the first spirometry performed during the 3rd postoperative week (VC group A 55%+/-16% predicted vs 41%+/-11% predicted in group B; p = 0.043). CONCLUSION: The bilateral sequential anterolateral thoracotomy represents a safe and less invasive approach for BLTX in patients with large chest volumes. It minimizes the operative trauma, improves postoperative functional recovery and prevents the potential spread of unilateral complications to the other pleural cavity.
Asunto(s)
Fibrosis Quística/cirugía , Enfermedades Pulmonares Obstructivas/cirugía , Trasplante de Pulmón/métodos , Toracotomía/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: Bilateral lung transplantation is an established therapy for end-stage pulmonary hypertension. Its early postoperative outcome may be biased by various complications resulting in unexpected deterioration of the patient in terms of hemodynamics and blood gases. METHODS: We have reviewed the early postoperative course of patients who underwent bilateral lung transplantation for pulmonary hypertension at our institution and analyzed all available data, especially hemodynamic measurements, echocardiographic documentation and therapeutical strategies, in those cases where cardiac dysfunction was found to be responsible for clinical deterioration. RESULTS: Three out of 20 lung transplant recipients operated for pulmonary hypertension experienced severe respiratory insufficiency accompanied by hemodynamic decompensation during the first days after surgery. Clinical and laboratory findings together with results of echocardiography and pulmonary artery catheterism helped establish the diagnosis of left ventricular failure. This proved to be transitory, but the response to therapy (inotropic drugs, afterload reduction and eventually prostaglandins) was very variable. Adequately treated, this complication did not preclude the outcome of transplantation by itself. CONCLUSION: Left ventricular failure is a possible complication after lung transplantation for pulmonary hypertension. Echocardiography and pulmonary artery catheterism may be useful adjuvant diagnostic tools, beside routine physical examination, chest X-ray, and laboratory analysis. Therapy of this complication must be adapted individually and may be complex.
Asunto(s)
Gasto Cardíaco Bajo/etiología , Hipertensión Pulmonar/cirugía , Trasplante de Pulmón/efectos adversos , Disfunción Ventricular Izquierda/etiología , Adulto , Alprostadil/uso terapéutico , Antihipertensivos/uso terapéutico , Gasto Cardíaco Bajo/diagnóstico por imagen , Gasto Cardíaco Bajo/tratamiento farmacológico , Cardiotónicos/uso terapéutico , Cateterismo de Swan-Ganz , Clonidina/uso terapéutico , Dobutamina/uso terapéutico , Ecocardiografía , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Nifedipino/uso terapéutico , Insuficiencia Respiratoria/etiología , Resultado del Tratamiento , Vasodilatadores/uso terapéutico , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/tratamiento farmacológicoRESUMEN
BACKGROUND: Only anecdotal reports about the results of combined resection of T4 lung tumors infiltrating the thoracic aorta exist. METHODS: Seven patients (mean age, 57.5 years; range, 43 to 78 years) underwent a resection of the infiltrated segment of the thoracic aorta together with a left pneumonectomy (n = 6) or left upper lobectomy (n = 1). Five tumors were primary non-small cell lung carcinomas (T4N2 in 3 patients, T4N1 in 2), one was a metastasis of breast cancer, and one was rhabdomyosarcoma. RESULTS: No patient died perioperatively. The 2 patients with rhabdomyosarcoma and metastasis of breast cancer died 2 and 7 months postoperatively. Of the 5 patients with bronchial carcinoma, 3 died after 17, 26, and 27 months as a result of distant metastasis. Two patients are alive after 14 and 50 months without evidence of disease recurrence. One-year, 2-year, and 4-year survival rates for patients with bronchial carcinoma were 100%, 75%, and 25%, respectively. CONCLUSIONS: Combined resection of the lung and thoracic aorta can be performed with low morbidity and mortality when offered to highly selected patients. Adequate local control of tumor can be achieved for N1 and single-level N2 non-small cell lung carcinomas, but not for tumors with other histologies.
Asunto(s)
Adenocarcinoma/secundario , Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Carcinoma de Células Escamosas/secundario , Neoplasias Pulmonares/cirugía , Rabdomiosarcoma/secundario , Neoplasias Vasculares/secundario , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Aorta Torácica/patología , Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/patología , Implantación de Prótesis Vascular , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Neumonectomía , Complicaciones Posoperatorias/mortalidad , Rabdomiosarcoma/mortalidad , Rabdomiosarcoma/patología , Rabdomiosarcoma/cirugía , Tasa de Supervivencia , Neoplasias Vasculares/mortalidad , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugíaAsunto(s)
Ciclosporina/efectos adversos , Inmunosupresores/uso terapéutico , Riñón/efectos de los fármacos , Trasplante de Pulmón/inmunología , Ácido Micofenólico/análogos & derivados , Adolescente , Adulto , Azatioprina/uso terapéutico , Creatinina/sangre , Quimioterapia Combinada , Femenino , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/patología , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/efectos adversos , Riñón/patología , Pruebas de Función Renal , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/uso terapéutico , Tasa de Supervivencia , Tacrolimus/uso terapéuticoRESUMEN
In the present study the formation of thrombin-antithrombin-complexes (TAT) during incubation of thrombin (0.89, 4.5, 8.9 nmol/l) and antithrombin (4.6 micromol/l) on the surface of cultured human EC, derived from different parts of the circulation, and on the surface of human vessel segments was studied. In the absence of EC TAT increased over time reaching a maximum at 60 sec; 10 sec (8.9 nmol/l thrombin): 6.35+/-0.72 nmol/l, 60 sec: 10.49+/-1.04 nmol/l. In the presence of exogenous heparin (0.1 IU/ml) maximum TAT levels were already reached after 10 sec (10.75+/-0.97); cultured EC and EC on vessel segments did not show such heparin effects. Incubation of EC with heparin resulted in an EC-surface localized heparin activity only when very high doses (3.0 IU/ml) of the drug were used. When thrombin was incubated on the EC surface in the presence of AT the efficiency of the thrombomodulin(TM)-protein C(PC)-system was markedly reduced, while in the presence of exogenous heparin (0.5 IU/l) the activity of this pathway was nearly abolished. Our results demonstrate that 1) human EC do not exert heparin-like accelerating effects on TAT formation, 2) an EC localized heparin activity is only generated when EC are incubated with amounts clearly exceeding therapeutical doses, and 3) an acceleration of TAT formation at the EC surface by heparin causes a switching off of the TM-PC-system.