BACKGROUND: Surgical factors and direct cytotoxicity of bile salts on cholangiocytes may play a role in the development of ischemic cholangiopathy (IC) after liver transplantation (LTx). There is no validated consensus on how to protect the bile ducts during procurement, static preservation, and LTx. Meanwhile, IC remains the most troublesome complication after LTx. AIM: To characterize bile duct management techniques during the LTx process among European transplant centers in cases of donation after brain death (DBD) and circulatory death (DCD). METHOD: An European Liver and Intestine Transplant Association-European Liver Transplant Registry web survey designed to conceal respondents' personal information was sent to surgeons procuring and/or transplanting livers in Europe. RESULTS: Sixty-five percent of responses came from large transplant centers (>50 procurements/y). In 8% of DBDs and 14% of DCDs the bile duct is not rinsed. In 46% of DBDs and 52% of DCDs surgeons prefer to remove the gallbladder after graft reperfusion. Protocols concerning preservation solutions (nature, pressure, volume) are extremely heterogeneous. In 54% of DBDs and 61% of DCDs an arterial back table pressure perfusion is performed. Steroids (20%-10%), heparin (72%-60%), prostacyclin (3%-7%), and fibrinolytics (4%-11%) are used as donor-protective interventions in DBD and DCD cases, respectively. In 2% of DBD and 6% of DCD cases a hepatic artery reperfusion is performed first. In 4% of DBD and 6% of DCD cases, fibrinolytics are administered through the hepatic artery during the bench and/or implantation. CONCLUSION: This European web survey shows for the first time the heterogeneity in the management of bile ducts during procurement, preservation, and transplantation in Europe. In the context of sharing more marginal liver grafts, an expert meeting must be organized to formulate guidelines to be applied to protect liver grafts against IC.

• MeSH
• cholangitida etiologie   MeSH
• ischemie etiologie   MeSH
• lidé MeSH
• odběr tkání a orgánů škodlivé účinky   metody   MeSH
• perfuze škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   MeSH
• přežívání štěpu MeSH
• průzkumy a dotazníky MeSH
• reperfuze škodlivé účinky   metody   MeSH
• transplantace jater škodlivé účinky   MeSH
• uchovávání orgánů škodlivé účinky   metody   MeSH
• žlučové cesty krevní zásobení   transplantace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND AND AIM: Thromboembolic disease is the third most common cardiovascular disorder and deep vein thrombosis carries the risk of pulmonary embolism (PE). Questions related to reperfusion after PE remain, especially risk factors. Incomplete reperfusion after PE is closely related to the development of chronic thromboembolic pulmonary hypertension. The aim of this study was to determine the relation between reperfusion after PE in the long term over a period of 24 months, laboratory results and clinical risk factors found during the initial PE event. PATIENTS AND METHODS: 85 consecutive patients with a first episode of acute PE, diagnosed at 4 cardiology clinics, were followed up using clinical evaluation, scintigraphy and echocardiography (6, 12 and 24 months after the PE. 35 patients were in the low risk category (41%), 42 (49%) in the intermediate risk group and 8 (9%) in the high risk category. RESULTS: Perfusion defects persisted in 20 patients (26%) after 6 months, in 19 patients (25%) after 12 months and in 14 patients (19%) after 24 months. The incidence was more frequent in older patients, with more serious (higher risk) PE, increased right ventricular internal diameter during the initial episode, and more significant tricuspid insufficiency in the initial echocardiography. Notably, higher hemoglobin levels were also shown as a significant risk factor. The presence of perfusion defects after 24 months correlated with a concurrent higher pulmonary pressure but not with either patient function or adverse events (recurrence of PE, re-hospitalization or bleeding). In 3 cases (4% of patients), long-term echocardiographic evidence of pulmonary hypertension was detected. CONCLUSION: Even after 24 months from acute PE with adequate anticoagulation treatment, incomplete reperfusion was found in 19% of patients with a corresponding risk of chronic thromboembolic pulmonary disease and hypertension.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• CT angiografie MeSH
• dospělí MeSH
• echokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• multimodální zobrazování MeSH
• následné studie MeSH
• perfuzní zobrazování MeSH
• plicní embolie diagnostické zobrazování   farmakoterapie   MeSH
• prospektivní studie MeSH
• reperfuze metody   MeSH
• rizikové faktory MeSH
• senioři MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

UNLABELLED: Backround. Intermittent claudication is a classic symptom of peripheral arterial disease. It is mainly treated conservatively but if this fails, a form of revascularization is indicated. The revascularization in chronic occlusion of femoropopliteal region is currently performed by two basic methods: the standard method of surgical bypass and the newer miniinvasive alternative represented by the endovascular method. The treatment of patients with solely claudication and long occlusion of femoropopliteal region remains controversial. The aim of this minireview was to determine whether surgical bypass is still the best method of choice in a time of endovascular techniques. METHODS: A MEDLINE search for original and review articles using key terms, intermittent claudication and long femoropopliteal oclusion. RESULTS AND CONCLUSION: No ideal treatment for long occlusions of the femoropopliteal segment has been established to date. It is clear that the role of endovascular techniques in the treatment of SFA occlusions is increasing. It remains that, lower risk patients with claudication should be examined to assess the quality of veins suitable for revascularization and bypass should be selected as the first method of choice.

• MeSH
• arteria femoralis chirurgie   MeSH
• arteria poplitea chirurgie   MeSH
• cévní protézy MeSH
• cévy - implantace protéz metody   MeSH
• endovaskulární výkony metody   MeSH
• intermitentní klaudikace chirurgie   MeSH
• lidé MeSH
• reperfuze metody   MeSH
• výkony cévní chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

The evolution of reperfusion therapy in acute myocardial infarction and acute ischaemic stroke has many similarities: thrombolysis is superior to placebo, intra-arterial thrombolysis is not superior to intravenous (i.v.), facilitated intervention is of questionable value, and direct mechanical recanalization without thrombolysis is proven (myocardial infarction) or promising (stroke) to be superior to thrombolysis-but only when started with no or minimal delay. However, there are also substantial differences. Direct catheter-based thrombectomy in acute ischaemic stroke is more difficult than primary angioplasty (in ST-elevation myocardial infarction [STEMI]) in many ways: complex pre-intervention diagnostic workup, shorter time window for clinically effective reperfusion, need for an emergent multidisciplinary approach from the first medical contact, vessel tortuosity, vessel fragility, no evidence available about dosage and combination of peri-procedural antithrombotic drugs, risk of intracranial bleeding, unclear respective roles of thrombolysis and mechanical intervention, lower number of suitable patients, and thus longer learning curves of the staff. Thus, starting acute stroke interventional programme requires a lot of learning, discipline, and humility. Randomized trials comparing different reperfusion strategies provided similar results in acute ischaemic stroke as in STEMI. Thus, it might be expected that also a future randomized trial comparing direct (primary) catheter-based thrombectomy vs. i.v. thrombolysis could show superiority of the mechanical intervention if it would be initiated without delay. Such randomized trial is needed to define the role of mechanical intervention alone in acute stroke treatment.

• MeSH
• akutní nemoc MeSH
• cévní mozková příhoda terapie   MeSH
• fibrinolytika terapeutické užití   MeSH
• infarkt myokardu terapie   MeSH
• intravenózní infuze MeSH
• klinické zkoušky jako téma MeSH
• kombinovaná terapie MeSH
• koronární angioplastika metody   MeSH
• lidé MeSH
• reperfuze metody   MeSH
• trombektomie metody   MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Numerous acute reperfusion therapies (RPT) are currently investigated as potential new therapeutic targets in acute ischemic stroke (AIS). We conducted a comprehensive benefit-risk analysis of available clinical studies assessing different acute RPT, and investigated the utility of each intervention in comparison to standard intravenous thrombolysis (IVT) and in relation to the onset-to-treatment time (OTT). METHODS: A comprehensive literature search was conducted to identify all available published, peer-reviewed clinical studies that evaluated the efficacy of different RPT in AIS. Benefit-to-risk ratio (BRR), adjusted for baseline stroke severity, was estimated as the percentage of patients achieving favorable functional outcome (BRR1, mRS score: 0-1) or functional independence (BRR2, mRS score: 0-2) at 3 months divided by the percentage of patients who died during the same period. RESULTS: A total of 18 randomized (n = 13) and nonrandomized (n = 5) clinical studies fulfilled our inclusion criteria. IV therapy with tenecteplase (TNK) was found to have the highest BRRs (BRR1 = 5.76 and BRR2 = 6.82 for low-dose TNK; BRR1 = 5.80 and BRR2 = 6.87 for high-dose TNK), followed by sonothrombolysis (BRR1 = 2.75 and BRR2 = 3.38), while endovascular thrombectomy with MERCI retriever was found to have the lowest BRRs (BRR1 range, 0.31-0.65; BRR2 range, 0.52-1.18). A second degree negative polynomial correlation was detected between favorable functional outcome and OTT (R (2) value: 0.6419; P < 0.00001) indicating the time dependency of clinical efficacy of all reperfusion therapies. CONCLUSION: Intravenous thrombolysis (IVT) with TNK and sonothrombolysis have the higher BRR among investigational reperfusion therapies. The combination of sonothrombolysis with IV administration of TNK appears a potentially promising therapeutic option deserving further investigation.

• MeSH
• cévní mozková příhoda terapie   MeSH
• fibrinolytika terapeutické užití   MeSH
• hodnocení rizik MeSH
• ischemie mozku terapie   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• reperfuze metody   MeSH
• tkáňový aktivátor plazminogenu terapeutické užití   MeSH
• ultrazvuková terapie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• Klíčová slova
• sulodexid (Vessel Due F),
• MeSH
• antikoagulancia terapeutické užití   MeSH
• dolní končetina krevní zásobení   patologie   MeSH
• glykosaminoglykany aplikace a dávkování   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• posttrombotický syndrom * farmakoterapie   prevence a kontrola   MeSH
• reperfuze metody   MeSH
• warfarin terapeutické užití   MeSH
• žilní trombóza diagnóza   etiologie   farmakoterapie   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Systémová intravenózna trombolýza sa v súčasnosti považuje za zlatý štandard v liečbe akútnych mozgových infarktov do 4,5 hodiny od začiatku ťažkostí. Jej účinnosť a bezpečnosť je najvyššia, ak sa podá lege artis, t. j. v správnom čase, v správnej dávke, správnemu pacientovi. Aký je správny čas? Aká je správna dávka? Ktorý pacient je ten správny? Je systémová trombolýza najlepšou alternatívou liečby pre pacientov s akútnym mozgovým infarktom? Poznáme odpoveď na všetky otázky? Na základe publikovaných údajov a vlastných skúseností autor rozoberá niektoré aspekty tejto zaujímavej problematiky.

Systemic intravenous thrombolysis is considered gold standard for the treatment of ischemic cerebral strokes up to 4,5 hours from the onset of symptoms. It´s efficacy and safety are greatest when given lege artis, i. e. at appropriate time, at appropriate dosis and to appropriate patient. Which time is the best? Which dosis is correct? Which patient is the best candidate? Is really systemic thrombolysis the best alternative of treatment for the patients with ischemic stroke? Do we have answers for all these questions? On the basis of recently published data and personal experience we discuss several aspects of this interesting topic.

• Klíčová slova
• systémová intravenózní trombolýza,
• MeSH
• akutní nemoc MeSH
• časná lékařská intervence MeSH
• časové faktory MeSH
• intravenózní infuze MeSH
• klinické zkoušky jako téma statistika a číselné údaje   MeSH
• lidé MeSH
• management nemoci MeSH
• mechanická trombolýza MeSH
• mozkový infarkt * farmakoterapie   MeSH
• reperfuze metody   MeSH
• tkáňový aktivátor plazminogenu aplikace a dávkování   terapeutické užití   MeSH
• trombolytická terapie * kontraindikace   metody   normy   trendy   MeSH
• urgentní zdravotnické služby trendy   MeSH
• výběr pacientů MeSH
• zdravotní výchova MeSH
• Check Tag
• lidé MeSH

Akutní okluze krčních nebo intrakraniální mozkové tepny je nejčastější příčinou ischemické cévní mozkové tepny (CMP). Časná rekanalizace tepny s reperfuzí mozku je v současnosti nejúčinnější metodou léčby ischemické CMP. Zlatým standardem v reperfuzní terapii je systémová trombolýza s podáním rtPA v dávce 0,9 mg/kg v hodinové infuzi. Intraarteriální trombolýza a různé metody mechanické rekanalizace mozkové tepny včetně sonolýzy jsou alternativní možností léčby především u pacientů, u nichž došlo k selhání systémové trombolýzy (nedošlo k rekanalizaci tepny) nebo byla trombolýza kontraindikovaná. Přes rychlý rozvoj rekanalizačních metod je jejich účinnost stále omezená nejen časovým terapeutickým oknem, mnohými kontraindikacemi, ale také faktem, že přes úspěšnou časnou rekanalizaci tepny dosáhne soběstačnosti do 3 měsíců jen okolo 50–60 % takto léčených pacientů. Z těchto důvodů je nezbytné do budoucna hledat také další terapeutické přístupy.

Acute occlusion of the cervical or intracranial cerebral artery is the most common cause of ischemic stroke. Early arterial recanalization with brain reperfusion is currently the most effective method of treatment of ischemic stroke. The gold standard of stroke reperfusion therapy is na intravenous thrombolysis with administration of 0.9 mg/kg tPA in hourly infusion. Intra-arterial thrombolysis and different mechanical recanalization methods of cerebral arteries including sonolysis are alternative treatment especially for patients who have failed systemic thrombolysis (recanalization of the artery) or a thrombolysis was contraindicated. Despite the rapid development of recanalization methods, their effectiveness remains limited not only therapeutic window, numerous contraindications, but also the fact that despite successful early recanalization of the artery only about 50–60 % of treated patients reach independency within 3 months. For these reasons it is necessary to look for other therapeutic approaches in the future.

• Klíčová slova
• sonolýza,
• MeSH
• arteriální okluzní nemoci farmakoterapie   terapie   MeSH
• časná lékařská intervence MeSH
• cévní mozková příhoda * farmakoterapie   terapie   MeSH
• ischemie mozku * farmakoterapie   terapie   MeSH
• klinické zkoušky jako téma statistika a číselné údaje   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• management nemoci MeSH
• mechanická trombolýza přístrojové vybavení   trendy   MeSH
• reperfuze * kontraindikace   metody   trendy   MeSH
• tkáňový aktivátor plazminogenu terapeutické užití   MeSH
• trombolytická terapie metody   MeSH
• ultrazvuková terapie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• imunosupresivní léčba metody   MeSH
• léčba šetřící orgány MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   etiologie   terapie   MeSH
• reperfuze metody   MeSH
• replantace metody   MeSH
• transplantace ledvin * MeSH
• trombektomie metody   MeSH
• venae renales chirurgie   zranění   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

This review compares acute myocardial infarction and acute stroke— their similarities and differences. The focus is given on reperfusion therapy: pharmacologic, mechanical or combined. The key trials and metaanalyses are described.The published data on iv. thrombolysis show, that even among a subgroup of patients treated within 90 min from stroke onset the trend to lower mortality is not significant and in all other subgroups (i.e. treated after >90 min) there is a trend towards increased mortality with thrombolytic treatment.The data on combined therapy demonstrate, that there is no benefit from facilitated intervention (iv. thrombolysis followed by ia. thrombolysis ± catheter intervention) over iv. thrombolysis alone in acute stroke. This is very similar to the situation in acute myocardial infarction 25 years ago (intracoronary thrombolysis was not superior to intravenous thrombolysis) or more recently (facilitated PCI was not shown to be superior in several trials).The latest generation of stent retrievers is able to recanalize >70% of occluded intracranial arteries—approximately twice more compared to thrombolysis. However, it is not yet known whether this translates to better clinical outcomes. The sufficient data on clinical outcomes after primary catheter-based thrombectomy (without thrombolysis) are still missing and trials comparing iv. thrombolysis versus primary catheter-based thrombectomy are urgently needed.The future trials in acute stroke may follow the way paved by acute myocardial infarction trials. If such trials would demonstrate superiority of catheter-based thrombectomy, we can face in future similar revolution in acute stroke treatment as we have been facing in acute MI treatment in the past years.

• MeSH
• akutní nemoc MeSH
• angioplastika trendy   využití   MeSH
• cévní mozková příhoda * etiologie   chirurgie   patologie   terapie   MeSH
• infarkt myokardu * etiologie   chirurgie   patologie   terapie   MeSH
• katétry MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• reperfuze * metody   trendy   MeSH
• trombolytická terapie MeSH
• trombóza terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH