Asunto(s)
Neoplasias Hepáticas/secundario , Trasplante de Hígado/métodos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
To determine whether acetyl salicylic acid (ASA) in a daily dose of 1500 mg versus untreated controls is effective in patients with peripheral arterial disease a prospective randomized but not placebo-controlled one single centre trial was undertaken. Patients were assigned to one of two groups by means of multi-dimensional contingency tables whereas the risk factors age, sex, height, body weight, diabetic metabolic state, hypertension, history of myocardial infarction, smoking habits and preoperative clinical status according to the Fontaine classification where found in the state of balance. 298 patients with arterial occlusions in the iliaco-femoro-popliteal level were recruited during 1971-1974, the primary end points were probability of patency and probability of survival. In regard as well as to the probability of patency (p less than 0.56 Breslow, p less than 0.66 Mantel) as to the probability of survival (p less than 0.10 Breslow, p less than 0.70 Mantel) no statistical significant difference was detected. In conclusion ASA, in the doses administered here, was unable to improve patency or prolong patient survival, an outcome, which is at variance with results obtained by others.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Aspirina/administración & dosificación , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Arteria Poplítea/cirugía , Complicaciones Posoperatorias/prevención & control , Terapia Combinada , Humanos , Estudios ProspectivosRESUMEN
In the years 1965 to 1988 one or more organs were harvested for the purpose of transplantation from 649 brain dead organ donors reported to the Vienna transplantation centre. Based on a 1982 law regulating organ donation a large number of initiatives aiming at the improvement of the organ procurement system have taken place. In particular, the introduction of a decentralized donor guidance and organ retrieval system, a few information campaigns, as well as the introduction of full-time transplantation coordinators have significantly increased the number of organ donors. This development has made the Vienna transplantation centre one of the largest centres in Europe and has recently resulted in the achievement of a virtual balance between the increase of patients on the waiting list and the growth of the rate of transplantations performed. If this organ procurement policy is consistently continued in the years to come, there is a good chance of ensuring sufficient supply of organs for all patients on waiting lists, at least within the Viennese area.
Asunto(s)
Donantes de Tejidos/legislación & jurisprudencia , Trasplante/legislación & jurisprudencia , Austria , Humanos , Trasplante/estadística & datos numéricosAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Ciclosporinas/uso terapéutico , Rechazo de Injerto , Trasplante de Hígado , Bilirrubina/sangre , Ensayos Clínicos como Asunto , Creatinina/sangre , Ciclosporinas/sangre , Estudios de Seguimiento , Humanos , Terapia de Inmunosupresión , Virosis/etiologíaAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Azatioprina/uso terapéutico , Ciclosporinas/uso terapéutico , Trasplante de Hígado , Linfocitos/inmunología , Prednisona/uso terapéutico , Anticuerpos Monoclonales/inmunología , Ensayos Clínicos como Asunto , Ciclosporinas/sangre , Quimioterapia Combinada , Femenino , Rechazo de Injerto , Humanos , Activación de Linfocitos/efectos de los fármacos , Linfocitos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Valores de ReferenciaAsunto(s)
Infecciones por Citomegalovirus/diagnóstico , Trasplante de Hígado , Linfocitos T/inmunología , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Antivirales/análisis , Azatioprina/uso terapéutico , Células Cultivadas , Ciclosporinas/uso terapéutico , Infecciones por Citomegalovirus/inmunología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Terapia de Inmunosupresión , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Monitorización Inmunológica , Monocitos/inmunología , Prednisona/uso terapéutico , Linfocitos T/clasificaciónRESUMEN
Between 1977 and 1986, 172 patients with primary hepatic cancer were treated at the Department of Surgery I, University of Vienna Medical School. In 76 cases (80%) males, 20% females), cirrhosis of the liver was also present. Ninety patients underwent curative surgery (hepatic resection in 64, and liver transplantation in 26 cases). There were no early tumor stages. Forty-five large tumors were confined to one lobe, 42 involved both lobes, 3 even invaded adjacent structures, the majority (74%) being hepatocellular carcinomas. Forty-four of the 64 liver resections were performed in patients with otherwise normal livers (mortality 18%), while 20 patients had associated liver cirrhosis. In view of the extremely high mortality rates after extended liver resection, only limited local resections have been performed in cirrhotic malignancies since 1982 (mortality 25%). Perioperative mortality (25% overall) was due mainly to hepatic failure and sepsis; non-fatal complications occurred in 12 patients (26%). Seventeen of the 26 liver transplants were cirrhotic hepatomas. Nine deaths (34%) were caused by technical problems (graft failure, clotting disorder after massive transfusion) and systemic infections. The outcome for the patient after the immediate postoperative period was determined by tumor regrowth (residual liver tissue, graft, distant metastases) in both groups (median life expectancy 18.4 months after radical liver resection and 18.6 months after liver transplantation). Surgery is the only alternative for these patients (50% survival of untreated hepatoma: 2.6 months), improving both their quality of life and survival. We believe that in carefully selected candidates with non-resectable tumors liver replacement may be a useful alternative.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
A randomized prospective study comparing PTFE-Y and Dacron-Y-grafts with regard to function rate, morphology, hemodynamic differences along the proximal anastomosis and body of the graft, complications and quality of material was performed. Between March 1983 and February 1987, 112 patients were admitted to the study. Randomization including the criteria of age, sex, indication to operation (chronic occlusive disease, aneurysm) run-off, diabetes, nicotine consumption and operative approach (transperitoneal, retroextraperitoneal) followed the methods of adaptive randomization developed by Pocock and Simon and was well balanced. Function rate and complications as well as morphological alterations showed no significant differences in either group. During a mean observation period of 24 months, Group I yielded a 97% and Group II a 95% function rate (Kaplan-Meier). In all patients but one in each group with limb graft occlusions (n = 5) function was regained by successful thrombectomy and profundaplasty. With respect to Doppler ultrasound differences in flow pattern, in four patients with enlarged proximal side-end anastomosis and adequate--not to large--incision is recommended performing the proximal anastomosis.
Asunto(s)
Aorta Abdominal/cirugía , Prótesis Vascular , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Tereftalatos Polietilenos , Politetrafluoroetileno , Anastomosis Quirúrgica , Aneurisma de la Aorta/fisiopatología , Aneurisma de la Aorta/cirugía , Arteriopatías Oclusivas/fisiopatología , Arteriopatías Oclusivas/cirugía , Femenino , Oclusión de Injerto Vascular , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Distribución AleatoriaAsunto(s)
Anestesia General , Anestesia por Inhalación , Trombosis de las Arterias Carótidas/cirugía , Endarterectomía , Fentanilo , Isoflurano , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The influence of match, immunological therapy, age of the recipient and sex has been analysed by graft survival in 91 patients receiving a second kidney graft. Effects of these risk factors in first kidney grafts are not demonstrable in second grafts with the exception of cyclosporin which also produces better second graft survival. The main active risk factor for second transplants is endurance of function of the first graft. Function of the first graft over a period exceeding 1 year gives a significantly better second graft survival rate than function lasting less than one year.
Asunto(s)
Rechazo de Injerto , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Complicaciones Posoperatorias/cirugía , Inmunología del Trasplante , Adulto , Ciclosporinas/uso terapéutico , Femenino , Estudios de Seguimiento , Rechazo de Injerto/efectos de los fármacos , Humanos , Pruebas de Función Renal , Masculino , Reoperación , Factores de Riesgo , Inmunología del Trasplante/efectos de los fármacosRESUMEN
An observational study by multifactorial statistical analysis was undertaken on 785 kidney transplants. Risk factors in first transplants for primary non-function are cold ischaemic time, donor centre and acute rejection, with a non-function rate of 8% and a delayed function of 37%. Risk factors for transplant survival are bad match, no preoperative transfusions, age of recipient below 40 years, male sex, diabetes, conventional immunosuppressive therapy and cadaver donors. Donor centre and delayed primary function have no influence on long-term kidney function. The analysis revealed additive effects of various risk factors. This has to be taken into account in recipient-selecting policy.
Asunto(s)
Trasplante de Riñón , Complicaciones Posoperatorias/etiología , Cadáver , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Pruebas de Función Renal , Factores de RiesgoRESUMEN
During the years 1970 to 1985, 463 patients with obliterative atherosclerosis at the femoropopliteal level underwent elective surgery. The operation performed was an autologous saphenous vein bypass using the reversed technique. The vascular surgical treatment was documented in reasonable detail (both baseline and follow-up) in accordance with the documentation system of the Austrian Society of Vascular Surgery. On-line data entry with use of SAS data-base management software was used. The patency curves were estimated in accordance with the Kaplan-Meier method; possible differences were checked by means Breslow's and Mantel's tests. The preoperative clinical status (claudicants, n = 200; limb salvage, n = 263) influenced the postoperative results in a statistically significant manner (Breslow p less than 0.01; Mantel p less than 0.03). All the other risk factors analyzed (site of distal anastomosis above versus below the knee, n = 231, and n = 232, respectively; Breslow p less than 0.58, Mantel p less than 0.58. Presence [n = 122] or nonpresence [n = 341], of diabetes mellitus [Breslow p less than 0.77, Mantel p less than 0.68]; smoking habits [nonsmokers, n = 93, smokers n = 370, Breslow p less than 0.68, Mantel p less than 0.69;]) did not reach statistical significance. Anticoagulant treatment (n = 101) had no effect (Breslow p less than 0.93, Mantel p less than 0.72), even when the therapy was restricted to cases with disease at advanced clinical stages (stages III, IV; n = 50; Breslow p less than 0.55, Mantel p less than 0.95). On the basis of these analyses, a prospective trial was initiated in 1979. Eighty-eight patients were studied; those in group I (n = 42) received dicumarol, and those in group II (n = 46) were controls who did not receive anticoagulant treatment. At present, the median follow-up time is at 30 months. Treatment with dicumarol favorably influenced graft patency (Breslow, p less than 0.03, Mantel p less than 0.07; one-tailed tests). The patients' preoperative clinical status affected the results of surgery (Breslow p less than 0.03, Mantel p less than 0.02; one-tailed tests). In relation to the preoperative clinical status, a therapeutic effect was observed in stages III and IV (n = 45; Breslow p less than 0.03, Mantel p less than 0.07; one-tailed tests), while no effect of therapy was demonstrable in claudicants (n = 43; Breslow p less than 0.3, Mantel p less than 0.4; one-tailed tests).(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Arteriosclerosis/cirugía , Dicumarol/uso terapéutico , Arteria Femoral/cirugía , Arteria Poplítea/cirugía , Anciano , Arteriosclerosis/tratamiento farmacológico , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Estudios Prospectivos , Distribución Aleatoria , Recurrencia , RiesgoRESUMEN
One-hundred and sixty-three patients in whom an isolated profundaplasty was performed as treatment for superficial femoral artery occlusion were evaluated for postoperative improvement, taking into consideration the degree of stenosis of the profunda origin and the patency of peripheral vessels. One-hundred and eleven (68.1%) patients achieved clinical improvement. Fifty-two patients had to undergo amputation (27 below the knee and 19 above the knee) or distal reconstruction (6 patients) because of unrelieved ischaemia. In patients with Fontaine stage II and III disease (89% and 70% respectively) improvement was observed more often than in those with stage IV disease (53%). Half of the patients had an increase of the resting systolic ankle-brachial arterial pressure index, but the rise was only slight (0.12 +/- 0.1). While radiological information of the presence and degree of a stenosis had little influence on the operative outcome stenosis at the origin of the profunda, when seen and described at operation, resulted in a more frequent improvement in the clinical state and systolic ankle-brachial arterial pressure index. A patent popliteal artery was not necessary for a favourable outcome but the number of patent tibial arteries was important. Whenever two tibial vessels were patent, relief was achieved in 75% of the cases: the existence of one patent tibial artery produced improvement in 64% but if all were occluded only 31% showed improvement. In cases of severe ischaemia, success following profundaplasty is limited and the results are often inadequate. If at least one tibial artery is patent, the alternative is a femoro-crural reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Arteriopatías Oclusivas/cirugía , Arteria Femoral/cirugía , Pierna/irrigación sanguínea , Amputación Quirúrgica , Arteriopatías Oclusivas/patología , Arteriopatías Oclusivas/fisiopatología , Comportamiento del Consumidor , Arteria Femoral/fisiopatología , Humanos , Pierna/fisiopatología , Arteria Poplítea/fisiopatología , Flujo Pulsátil , Flujo Sanguíneo Regional , Grado de Desobstrucción VascularRESUMEN
Nephrotoxicity is the main side effect of cyclosporine therapy. In this study 2 groups consisting of 6 kidney transplant recipients were investigated. The oral cyclosporine daily dose was in the first group 13 mg/kg, in the second 11 mg/kg, respectively. In both groups, the daily dose was divided on the first day of investigation in 2 equal portions given at an interval of 12 hours. On the second day, the same dose was divided in 3 equal portions given at an interval of 8 hours. After cyclosporine administration twice a day very high blood cyclosporine peak concentrations (two to three times higher than the therapeutic range) were measured. These potential nephrotoxic cyclosporine concentrations could be prevented by cyclosporine application in 3 equal portions. A reduction of the daily dose in the early period after kidney transplantation to a starting daily dose of 12 mg/kg or even 10 mg/kg can be recommended.