Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
Nestr.
Vaskulární komplikace jsou akutním stavem časného pooperačního období po transplantaci ledviny. Pokud nejsou bezodkladně odstraněny, často vedou k selhání štěpu. V dnešní době nemáme diagnostické metody, které by kontinuálně monitorovaly prokrvení štěpu ledviny. V tomto projektu bychom chtěli vyvinout a otestovat systém kontinuální monitorace prokrvení štěpu ledviny v časném pooperačním období. Navrhovaný systém je založen na principu spektroskopie ve viditelné a infračervené oblasti a nabízí jednoduchou aplikaci a odstranění měřícího senzoru. Cílem projektu je vyvinout a vyzkoušet funkční prototyp a zdokonalit příslušnou chirurgickou manipulaci. Experiment bude probíhat na zvířecím experimentálním modelu (laboratorní prase). Využití navrhovaného monitorovacího systému snižuje nebezpečí selhání štěpu ledviny, což vede ke zlepšení kvality pacientova života, snížení čekací doby na čekací listině a významným ekonomickým úsporám.; Early vascular complications are an acute condition after renal transplantation. They often lead to graft failure, if not intervened immediately. Nowadays, we lack diagnostic means, to monitor graft perfusion continuously. In the project, we would like to develop and test a kidney graft monitoring system that would allow to continuously measure blood perfusion in the early postoperative period. The proposed monitoring system operates on the principle of visible and near infrared light spectroscopy, and allows easy application and removal of the measurement probe. We propose to develop and test a functional prototype and associated surgical procedures, all of which will be tested on animal models (laboratory pigs). The use of the proposed monitoring system promises prevention of a kidney graft failure, resulting in the improvement of patient’s quality of life, shortening the waiting period on the waiting list and considerable economical savings.
- MeSH
- Spectroscopy, Near-Infrared MeSH
- Humans MeSH
- Disease Models, Animal MeSH
- Monitoring, Physiologic MeSH
- Perfusion MeSH
- Postoperative Period MeSH
- Swine MeSH
- Graft Survival physiology MeSH
- Regional Blood Flow MeSH
- Kidney Transplantation MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Evaluation Study MeSH
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- nefrologie
- transplantologie
- NML Publication type
- závěrečné zprávy o řešení grantu AZV MZ ČR
Introduction: Desmoid tumours (DT) are commonly associated with Gardener's syndrome. Their surgical resection may be complicated by their close proximity to major vessels, multiple organ involvement, and frequent local recurrence. Multivisceral transplantation (MVTx) is an alternative treatment for patients with intestinal and liver failure. In patients with DT closely associated with renal structures but without end-stage kidney disease, concomitant excision of the patient's own kidney, ex vivo tumour resection with nephron-sparing surgery, or autotransplantation has been proposed. Case Presentation: A 36-year-old Caucasian female weighing 60 kg with Gardener's syndrome with a history of abdominal surgery was presented to our department with progressive abdominal distention associated with paroxysmal pain. With the use of CT, the patient was diagnosed with a mass arising from the mesenterial region. The patient had normal kidney function and nonalcoholic steatohepatitis. The patient was indicated for MVTx. Management and Outcome: After 16 months on the waiting list, the patient received a multivisceral graft from a deceased donor. Following the restoration of graft vascular flow, the patient's right kidney was removed and the DT dissected ex vivo before autotransplantation into the right pelvic fossa. The patient received immunosuppressive, antithrombotic, and antibiotic treatment. There was no acute rejection, though the patient experienced pulmonary infection, dysphagia, and oesophageal reflux with fungal infection. The patient had required temporary dialysis for acute renal failure for 75 days. One year after the surgery, nausea and violent vomiting caused delayed gastric emptying caused by spastic pylorus. Clinical improvement was achieved using gastric peroral endoscopic myotomy (G-POEM). Conclusion: MVTx with kidney autotransplantation is a feasible treatment option in patients with familiar adenomatous polyposis complicated by an abdominal DT. Precise tumour dissection with nephron-sparing surgery was carried ex vivo. G-POEM was used to relieve MVTx-related gastroparesis. The patient had no disease reoccurrence after one-year follow-up.
- Publication type
- Case Reports MeSH
- MeSH
- Blood Vessel Prosthesis * history classification trends MeSH
- Humans MeSH
- Vascular Diseases surgery MeSH
- Vascular Surgical Procedures * history methods instrumentation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Immunosuppression Therapy methods MeSH
- Organ Sparing Treatments MeSH
- Humans MeSH
- Postoperative Complications epidemiology etiology therapy MeSH
- Reperfusion methods MeSH
- Replantation methods MeSH
- Kidney Transplantation * MeSH
- Thrombectomy methods MeSH
- Renal Veins surgery injuries MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
Cíl: Cílem studie bylo retrospektivní hodnocení souboru pacientů s trombózou v. portae a následnou transplantací jater. Materiál a metodika: Diagnostika PVT byla předoperačně provedena sonograficky a CT portografií. Doba sledování byla 1 den až 6 let. Pooperační imunosupresi jsme podávali v kombinaci cyklosporin A, prednison a imuran v počátcích transplantačního programu (8 pacientů). Tento protokol jsme v průběhu let nahradili FK 506, cell cept a prednisonem. Při podezření na rejekci jsme provedli jaterní biopsii. Výsledky: V období 1996–2009 jsme na našem pracovišti provedli 740 transplantací jater u 303 žen a 437 mužů. 703 bylo prvních transplantací, 33 retransplantací a čtyři druhé retransplantace. Z tohoto souboru mělo 57 (7,7 %) příjemců obliterovanou v. portae. Bylo to 42 mužů a 15 žen průměrného věku 52 (9–67) let. U těchto 57 pacientů jsme provedli 62 transplantací jater. V souboru se vyskytly tyto komplikace: dysfunkce štěpu v 10,5 %, revize pro krvácení v 28 %, trombóza a. hepatica v 10,5 %, retrombóza v. portae v 1,8 %, biliární komplikace v 17,5 %, akutní rejekce v 19,3 %. Perioperační mortalita byla 15,8 %. Průměrná spotřeba krevních derivátů byla 17,1 (0–425) transfuzních jednotek erytrocytů, 27,1 (0–132) transfuzních jednotek mražené plazmy a 2,6 (0–20) transfuzních jednotek trombocytů. Závěr: Výsledky naší retrospektivní studie ukazují, že trombóza portálního řečiště není kontraindikací k transplantaci jater. Současné chirurgické techniky umožňují úspěšně transplantovat pacienty i s kompletní trombózou splanchnického žilního řečiště.
Aim: The aim of the study was to perform a retrospective assessment in a group of patients with portal vein thromboses who underwent consecutive liver transplantation. Material and Methods: PVT was preoperatively diagnosed with ultrasound and CT portography. The follow up period was 1 to 6 years. Postoperative immunosuppressive medication was administered in combination with cyclosporin A, prednison and imuran upon initiation of the transplantation programme (8 patients). During the follow up period, the treatment protocol was replaced with FK 506, Cell Cept and prednisone. Liver biopsy was indicated when rejection was suspected. Results: During 1996–2009, the team of authors performed a total of 740 liver transplantations in 303 female and 437 male subjects. The procedures included 703 primary procedures, 33 retransplantations and four second retransplantations. Out of the total, 57 recipients (7.7 %) had portal vein obliteration. These subjects included 42 male and 15 females, their mean age was 52 (9–67) years. 62 liver transplantations were performed in these 57 patients. The following complications were recorded in the patient group: graft dysfunction in 10.5%, revisions for bleeding in 28%, hepatic artery thrombosis in 10.5%, portal vein rethrombosis in 1.8%, biliary complications in 17.5%, acute rejections in 19.3 %. Perioperative mortality rate was 15.8%. The mean blood derivates requirement was 17.1 (0–425) erythrocyte transfusion units, 27.1 (0–132) frozen plasma transfusion units and 2.6 (0–20) thrombocyte transfusion units. Conclusion: The results of out retrospective study indicate that portal thrombosis is not a contraindication for liver transplantation. Current surgical techniques make liver transplantations in patients with complete splanchnic venous thrombosis possible.
- Keywords
- v. portae,
- MeSH
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Aged MeSH
- Liver Transplantation adverse effects MeSH
- Portal Vein MeSH
- Venous Thrombosis diagnosis etiology surgery MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
Stroke is the third most common cause of mortality, and carotid artery stenosis causes up to 30% of all ischemic strokes. Eversion CEA (ECEA) has been proposed as an acceptable alternative to the standard bifurcation endarterectomy in many patients. This study was designed to analyze the long-term durability of ECEA in symptomatic and asymptomatic patients. Data were retrospectively reviewed to determine the incidence of major adverse cardiovascular events (MACEs) within 30 days of surgery, late survival, and the incidence of restenosis. METHODS AND RESULTS: From January 1999 to June 2010, 344 ECEAs were performed on 324 patients (34% female, 38% symptomatic). The mean follow-up period was 30 months. CONCLUSIONS: MACEs occurred in 28 patients (8.6%). The overall incidence of stroke or death after ECEA was 1.7% and 0.9% at discharge. The overall incidence of stoke or death after CEA was 4.3% and 21% (14 strokes, 69 deaths, 8 of which were stroke-related). The overall occurrence of any restenosis (> 50%) after CEA was 4.3% (14 of 324 procedures).
- Keywords
- everzní technika, restenóza,
- MeSH
- Carotid Artery, Internal MeSH
- Stroke MeSH
- Endarterectomy, Carotid methods adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Recurrence MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Carotid Stenosis surgery complications MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
Portal vein thrombosis has (PVT) long been an absolute contraindication to liver transplantation. In patients scheduled for liver transplantation, portal vein thrombosis occurs in 4-15%. METHODS AND RESULTS: The authors retrospectively collected data on 740 patients who underwent an initial orthotopic liver transplant at the authors' institution between 1996 and 2009. Mean follow-up was from 1 day to 6 years. There were 437 male patients and 303 female patients. We have performed this procedure in 57 recipients with PVT; this constitutes 7.7% of the overall transplant population. There was a 10.5% incidence of liver graft dysfunction, 10.5% of hepatic artery thrombosis, 19.3% of acute rejection and 17.5% of biliary complications. The overall incidence of relaparotomy for bleeding was 28% (16 patients). In-hospital mortality and late mortality were 15.8% and 31.6%, respectively. Volumes transfused were 17.1 (0-425) transfusion units of red blood cell, 27.1 (0-132) of fresh-frozen plasma and 2.6 (0-20) of platelets respectively. CONCLUSIONS: We confirm that PVT is not a contraindication to LTx at the present time.
- MeSH
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Reoperation MeSH
- Liver Failure surgery complications MeSH
- Aged MeSH
- Liver Transplantation contraindications adverse effects MeSH
- Portal Vein MeSH
- Venous Thrombosis complications MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
