Risk Stratification of Ruptured Abdominal Aortic Aneurysms in Patients Treated by Open Surgical Repair.

OBJECTIVE: The present study tested scoring models for ruptured abdominal aortic aneurysms (rAAAs) in patients treated by open surgical repair (OSR). Scores were tested in a European population to validate their applicability for predicting outcome. METHODS: Between 2002 and 2013, 92 patients with rAAAs underwent OSR and medical records were reviewed retrospectively. The Edinburgh Rupture Aneurysm Score (ERAS), Vascular Study Group of New England (VSGNE) rAAA risk score, Hardman Index, and Glasgow Aneurysm Score (GAS) were calculated and analyzed according to in hospital mortality. The discriminatory power and calibration of all models were assessed by applying the receiver operating characteristic and the Hosmer-Lemeshow test χ(2). RESULTS: An ERAS ≤ 1 (n = 55), 2 (n = 15) and 3 (n = 16) was associated with a mortality of 27%, 47%, and 69%, respectively. The calibration was the best of all tested scores (χ(2) = 0.44; p = .81) and the area under the curve (AUC) was 0.71 (95% CI 0.6-0.82; p = .001). A VSGNE rAAA risk score = 0 (n = 19), 1 (n = 15), 2 (n = 19), 3 (n = 25), and ≥ 4 (n = 9) was associated with a mortality of 11%, 20%, 32%, 72%, and 56%, and an AUC of 0.76 (95% CI 0.66-0.87; p = .001). The calibration was reduced (χ(2) = 6.9; p = .08). The GAS and Hardman Index increased stepwise with increasing in hospital mortality, but were inferior to ERAS and the VSGNE rAAA risk score. The Hardman Index showed the smallest AUC (0.68; 95% CI 0.56-0.80; p = .011) and demonstrated a lack of fit (χ(2) = 8.2; p = .04). The GAS showed good discrimination (AUC = 0.75; 95% CI 0.64-0.85; p < .001) and calibration (χ(2) = 0.85; p = .66); however, the parametric scale of GAS limits its use to classifying patients according to their risk. CONCLUSION: The present study revealed remarkable differences in survival between subgroups (10-70%) and underscores the need for risk stratification. The ERAS was favorable with striking ease of use and high accuracy in predicting outcome.

Mid- and long-term results after replacement of infected peripheral vascular prosthetic grafts with biosynthetic collagen prosthesis.

AIM: We assess mid- and long-term outcome after prosthetic graft replacement with biosynthetic collagen prosthesis (Omniflow II®) in the presence of graft infection. METHODS: Between December 2010 and January 2012, an analysis of 9 consecutive patients was performed, who underwent replacement of an infected peripheral graft with a biosynthetic prosthesis. Morbidity, in-hospital mortality, primary and secondary patency were analyzed. FDG-PET was performed to diagnose graft infection, and exclude reinfection at long-term follow-up. RESULTS: Graft infection occurred after a median of 12 (range 3-97) months after the initial procedure. Replacement surgery was performed successfully in all 9 patients without intraoperative complications. Microbiological cultures revealed pathogenic infection in 7 cases. In 2 patients, no pathogen was isolated. The morbidity rate was 55.5% with no in-hospital deaths. Early and late bypass occlusion occurred in 2 patients. One high above-knee amputation was performed due to patient deterioration. The median length of stay was 23 (range 12-122) days and after graft replacement 13 (range 10-62) days. The median time of follow up was 23 (range 8-25) months. Primary and secondary patency rates were 66.6% and 78% at 19 months, respectively. FDG-PET was performed in 6 (85.5%) patients after a median follow up period of 19 (range 3-23) months, and excluded graft reinfection in all patients. CONCLUSION: Replacement of infected peripheral prosthetic grafts with the prosthesis (Omniflow II®) has encouraging results. The collagen prosthesis appears to be a promising alternative with a low reocclusion rate and no reinfection.

[Early results after peripheral vascular replacement with biosynthetic collagen prosthesis in cases of graft infection]. / Frühergebnisse nach peripherem Gefäßersatz mit einer biosynthetischen Kollagenprothese bei Protheseninfektionen.

INTRODUCTION: Vascular graft infection in peripheral bypass surgery represents a highly significant risk with regard to limb loss and morbidity. In the absence of autologous superficial veins, finding a suitable replacement material can be difficult. Silver-coated polyester grafts, homografts, or use of deep veins can pose additional risks. Use of a biosynthetic collagen prosthesis on a Dacron matrix ("Omniflow-II®") was investigated as an alternative method, and the cost-effectiveness was evaluated. MATERIALS AND METHODS: From December 2010 to December 2011, eight patients with clinical symptoms of vascular graft infection, confirmed by imaging, were treated. Graft function or acute graft failure due to the infection was necessary for enrollment in the study. Infected material was removed, microbiological specimens taken and, in the absence of superficial veins, an "Omniflow-II®" prosthesis was implanted in an orthotopic position. Patients were followed up to evaluate their outcome, and the cost-effectiveness of the procedure was also analysed. RESULTS: The technical feasibility of the procedure was assessed in all cases. Pathogens were detected in five of eight cases. After a mean follow-up of 8 months, seven of eight patients showed that they were clinically cured of infection. Primary patency was 63%, secondary patency was 75%, and prevalence of limb salvage was 88%. One patient had to undergo limb amputation to avoid sepsis, and another unsuccessfully underwent thrombectomy after 12 months. Four PET-CT follow-up studies showed a reduction of uptake in the affected area. To generate adequate revenue by using this technique, specialised knowledge of the diagnosis-related group system is necessary. DISCUSSION: Treatment of vascular graft infections in peripheral bypass surgery in the absence of endogenous material necessitates the use of infection-resistant materials. The present study showed promising results using a collagen-biosynthetic prosthesis. Due to a lack of long-term results, the graft should be used only after detailed informed consent is obtained from the patient. The expenses incurred by using the biosynthetic graft should be covered adequately by revenues from these patients.

[Arterial allografts in vascular surgery--best choice in cases of aortic graft infection?!]. / Arterielle Homografts in der Gefäßchirurgie - idealer Gefäßersatz bei aortalen Gefäßprotheseninfektionen?!

Infection of vascular prostheses, particularly in the central aortic position, is a growing challenge in vascular surgery. Beside the use of extra-anatomic prosthetic bypasses the need for anatomic reconstruction with infection-resistant materials is growing. The use of arterial allografts is an established method in many centres for in situ reconstruction. Used historically as the only option for vessel replacement, allografts were seldom used once the development of synthetic prostheses started. Use as a vascular graft in infected regions began in the 1990s. Discussions about the use of "fresh" allografts without preservation were terminated by order of the European Union in 2003 (although the long-term benefits have been foreseen). Currently, because of the German Tissue Act, only "cryopreserved" allografts can be used. Larger, partially controlled studies about the outcome after cryopreserved allograft transplantation have shown similar results to the use of silver prostheses, with a significantly lower prevalence of re-infection. Questions remain about the use of immunosuppression after human allograft transplantation. Immunological interactions are mainly involved in allograft degeneration. Aneurysmal changes (most commonly late degeneration of allografts) can be treated with endovascular procedures and therefore have no direct impact on long-term results. The availability of allografts in Europe tends to be restricted, but companies based outside the EU permit a good supply. The use of allografts in non-university institutions shows the wide acceptance of the material and its suitability for routine use in vascular surgery, even if the treatment of infected vascular prostheses in the central position remains associated with high morbidity and mortality.

Tacrolimus inhibits intimal hyperplasia in arterialised veins in rats.

OBJECTVES: We investigated whether tacrolimus (FK506) can inhibit neointimal formation in arterialised vein grafts in rats. METHODS: Lewis iliolumbar veins were implanted into the abdominal aorta of isogeneic rats. Animals in the treatment groups had daily intramuscular injections of tacrolimus at 0.2 mg/kg (group B) and 0.1 mg/kg (Group C), respectively. The control group A had no treatment. Light microscope evaluations of arterialised vein grafts were performed 30 days after operation. We determined the presence of endothelial cells, the thickness of intima and media, and the degree of infiltration by MHC class II positive, CD4 positive, and CD8 positive cells into the adventitia. RESULTS: The intimal thickness in group B (5.0±1.0 µm) was statistically lower (P < 0.05) when compared to group C (7.0±3.0 µm). The intimal thickness in untreated group A (12.7±7.0 µm) was statistically higher (P < 0.01) when compared to both treated groups B and C, respectively. The medial thickness and degree of adventitial infiltration by MHC class II positive, CD8 positive, and CD4 positive cells did not differ between groups. CONCLUSION: Treatment with tacrolimus (FK506) showed a dose dependant inhibition of neointimal hyperplasia in arterialised vein grafts in rats (Tab. 1, Fig. 3, Ref. 22).

[Immunosuppression following venous allografts transplantations--the authors' experience]. / Imunosuprese po transplantaci zilních allograftu --nase zkusenosti.

AIM: Venous and arterial graft usage in vascular reconstructions was re-discovered in connection with organ transplantation development. Allografts are employed in many clinics, however, uniform opinion on the use of immunosuppression after the procedure of venous graft transfer from a cadaveric donor, is still lacking. MATERIAL AND METHODS: The authors present their own group of patients who underwent vascular reconstructions, and in whom allogenic vein was used. The majority of indications for bypass procedures resulted from critical limb ischemia. Immunosuppressive medication was administered during the vascular procedure and, over the past several years, it purely consisted of tacrolimus monotherapy. RESULTS: In the group of 101 patients, no serious complications due to adverse effects of immunosuppression therapy were recorded.

[Clinical experience with cold-preservation of venous and arterial allografts. long-term outcomes]. / Klinické zkusenosti s pouzitím chladem konzervovaných zilních a tepenných allostepu: dlouhodobé výsledky.

INTRODUCTION: Venous and arterial allografts extend the possibilities of peripheral arterial disease as well as vascular prosthesis infections treatment. MATERIAL AND METHODS: Between 10/1997 and 1/2009 we used 112 allogeneic vessels (30 arteries, 82 veins) in 104 patients. Venous allografts were used for 82 reconstructions in 75 patients (M/F 41/34, aged 41-85 years, median 66 years) with critical limb ischemia and no suitable autogenous venous material. Arterial allografts were used in 9 patients (M/F 8/1, aged 56-77 years, median 63 years) with aortoiliac prosthetic infections or mycotic abdominal aortic aneurysms and in 20 transplanted patients (M/F 11/9, aged 32-67 years, median 56 years) with aortoiliac atherosclerotic disease. RESULTS: Patients survival rate after allovenous bypasses was 92% at 1 year and 78% at 3 years. Limb salvage rate was 67% at 1 year and 53% and 3 years. Secondary patency rate was 48% at 1 year and 27% at 3 years. Patient survival rate after alloarterial bypasses was 86% at 1 year and 69% at 3 years. No signs of arterial grafts aneurysmal formation and no need for secondary intervention of any arterial reconstruction was observed during the follow up period in any patient after alloarterial transplantation. CONCLUSIONS: Cold-stored venous and arterial allografts are suitable alternative conduits for limb salvage procedures, vascular prosthesis infections as well as for arterial reconstructions in transplanted patients.

The positive effect of immunosuppression on adaptation of venous allografts to arterialisation in rats.

OBJECTIVES AND DESIGN: We investigated whether immunosuppression was necessary for transplanted allogeneic veins to adapt to arterialisation. We used a transplant rat model with or without immunosuppression. MATERIAL AND METHODS: Iliolumbar veins from Lewis (LEW) or Brown-Norway (BN) rats were transplanted into the abdominal aorta of isogeneic (LEW to LEW; group A) or allogeneic (BN to LEW; groups B and C) rats. Group C had daily intramuscular injections of 0.2mgkg(-1) FK506. Light microscope evaluations of grafts were performed at 30 days following transplantation. We determined the presence of endothelial cells, the intensity of intimal proliferation and the degree of infiltration by Lewis major histocompatibility complex (MHC) class II positive, CD4-positive and CD8-positive cells into the adventitia. RESULTS: Groups A and C displayed similar results in intimal thickness (12.7+/-7.0microm vs. 15.0+/-8.4 mum, respectively) and degree of adventitial infiltration by MHC class II positive (16.6+/-7.5 vs. 14.6+/-6.2, respectively), CD8-positive (0.8+/-1.7 vs. 1.8+/-2.6, respectively) and CD4-positive (12.5+/-7.7 vs. 5.8+/-4.6, respectively) cells. In contrast, allogeneic rats without immunosuppression (group B) showed infiltration of host immunocompetent cells and destruction of the venous wall with no histological signs of arterialisation. CONCLUSION: Immunosuppressive therapy is necessary for venous allograft adaptation to arterialisation in rats.

[Pancreatic resection for metastatic renal cell carcinoma]. / Resekce pankreatu pro metastázy karcinomu ledviny.

BACKGROUNDS: Late metastases of renal cell carcinoma (RCC) are quite common. However, metastases in the pancreas are rare. Between 2004-2008 the Department of transplantation surgery of the institute of clinical and experimental medicine performed 87 pancreatic resections for tumour. From this, metastasis of RCC was histologically verified in four cases.The aim of this study was to summarize in the form of brief case reports our experience with the surgical treatment of pancreatic metastasis of RCC. OBSERVATION: The interval from nephrectomy to the occurrence of pancreatic metastasis was 10, 11, 15 and 16 years. All patients were examined to exclude metastatic generalization. Surgical treatment was: one total pancreatectomy, two subtotal pancreatectomies and one caudal resection. Two patients had solitary pancreatic metastasis, one had two metastases and one had multiple metastatic lesions. No complications were observed in the postoperative period. All patients are living with survival time of 7, 23, 26 and 52 months. None of them has signs of recurrence of the primary disease. CONCLUSION: The follow up in patients with a history of RCC should be lifelong. Considering the low response of RCC and its metastases to oncological treatment, pancreatic resection is a safe method with a low rate of complications in patients with RCC metastases limited only to the pancreas and detected in time.

[Transarterial chemoembolization in hepatocellular carcinoma]. / Transarteriální chemoembolizace u hepatocelulárního karcinomu jater.

INTRODUCTION: Hepatocelullar carcinoma (HCC) is the fifth most common cancer in the world. It mostly occurs in patients with cirrhosis. In the Czech Republic, about 250 new cases are reported per year. Surgery, i.e. liver resection or transplantation, as the only potentially curable method is possible in 15-20% of them. For the rest, palliative treatment is indicated. This includes ablative methods (radiofrequency ablation, alcoholization), transarterial chemoembolization (TACE), systemic chemotherapy or biological treatment by sorafenib. TACE is method of choice in patients unsuitable for surgery and ablative treatment. Another indication is embolization of HCC before liver transplantation to prevent tumour progression. In combination with other methods, down staging of the tumour and curable treatment afterward is possible. AIMS: To assess the outcome of transarterial chemoembolisation in patients with hepatocellular carcinoma. METHODS: Between 2004-2008 we performed 30 TACE. Of that number, 28 TACE were performed in 20 patients with HCC. We super selectively catheterized the tumour via arteria femoralis and used Doxorubicin with Lipiodol as embolic material. In follow up, we carried out laboratory studies and CT. RESULTS: We have not noticed any major complications. Post-embolization syndrome with fever, nausea and right upper quadrant pain occurred after 10 TACE (33%). One-, two- and three years survival of the patients was 53%, 40% a 20%. CONCLUSION: TACE is safe method prolonging patients' survival with unresectable HCC. For the correct treatment of HCC, its concentration to cancer centres and the cooperation between multiple specialists is necessary.

Aortoiliac reconstruction with allograft and kidney transplantation as a one-stage procedure: long term results.

OBJECTIVES: An increasing number of aortoiliac lesions and abdominal aortic aneurysms occur in renal failure patients waiting for renal transplantation. The aim of our study was to assess long term results of simultaneous renal transplantation and surgical repair of aortoiliac lesions with arterial allografts. DESIGN: A retrospective observational study. PATIENTS AND METHODS: From October 1997 to June 2007, we performed simultaneous aortoiliac reconstructions using fresh arterial allografts and kidney transplantation in 14 patients with chronic renal failure (men 9, women 5, mean age 53 years). The indication for vascular reconstruction was an asymptomatic abdominal aneurysm in 6 patients or aortoiliac stenosis/occlusion in 8 patients. The median follow up period for the cohort was 55.5 months (range from 1 to 116 months). RESULTS: Three patients died during the follow up period. In none of them there was an allograft (neither arterial nor renal) related death. No signs of arterial grafts infection or aneurysmal formation and no need for secondary intervention (angioplasty and/or thrombolysis) of any arterial reconstruction was observed during the follow up period in any patient. The renal grafts failed in three patients. CONCLUSIONS: Our experience suggests that it is possible and safe to use arterial allografts in the treatment of arterial occlusive disease or abdominal aortic aneurysm simultaneously with renal transplantation.

Cold-stored venous allografts in the treatment of critical limb ischaemia.

OBJECTIVES: To assess the outcome of cold-stored venous allografts in critically ischemic limbs in patients with no ipsilateral autogenous greater saphenous vein. DESIGN: A non-randomised, retrospective, single-center study. METHODS: From September 2000 to June 2006, 46 cold-stored venous allografts obtained during multiorgan harvest were implanted into 44 critically ischaemic limbs of 43 patients. The indication for reconstructions was rest pain (24%) or tissue lost (76%). Sixty-seven percent of procedures were performed as secondary reconstructions, and 61% of veins were anastomosed to tibial or pedal arteries. Thirty-seven percent of patients received prednisone, and 46% tacrolimus as postoperative immunosuppressive therapy. Mean patient follow-up period was 13.3 months (range 1 week to 60 months). RESULTS: The secondary patency rate for the cohort was 83+/-5.6% at 1 month, 64+/-8.2% at 6 months, 57+/-10.0% at 12 months and 46+/-10.7% at 24 months. Limb salvage rate was 96+/-3.1% at 1 month, 78+/-6.9% at 6 months, 71+/-8.1% at 12 months and 50+/-11.8% at 24 months. CONCLUSION: Cold-stored venous allografts are an alternative conduit for limb salvage procedures when ipsilateral autogenous vein is unavailable.

[Intracraneal hemorrhage caused by neonatal alloimmune thrombocytopenia. Report of a case and review]. / Hemorragia intracraneal por trombopenia neonatal aloinmune. Comunicación de un caso y revisión.

INTRODUCTION: Neonatal alloimmune thrombocytopenia (NAT) is due to the transplacental transfer of circulating maternal alloantibodies developed against fetal platelet antigens inherited from the father. Intracranial hemorrhage occurs in 15-30% of the cases, and very important neurological sequelaes can be due to it. CASE REPORT: We present the clinical and immunohematologic findings of a case of severe NAT that had two siblings who died by this illness. In the 31st week of gestation an intracranial hemorrhage is detected by echography, the birth was by caesarean section. Apgar score of 8 and 9, it wasn't necessary reanimation procedures. Cutaneous purpura and pallor were presented since birth. Neonatal complete blood count showed a platelet count of 6,000/mm3 (whereas maternal blood count was normal), haemoglobin of 8.8 g/dL and hematocrit of 26.1%, without other biological alterations. In maternal blood alloantibodies antiHPA-1a were detected, being the father homozigous for 1a/1a and the mother homozigous for 1b/1b. The patient was treated with transfusions, endovenous gammaglobulin and corticosteroids and his condition improved. CONCLUSIONS: Intraparenchymatous hemorrhage is an uncommon pathology in neonates, but when this occurs it's obligated to rule out a coagulation inherited illness, NTA especially, because of its prevalence and potentially serious neurological sequelaes, sometimes having a good neurological development. Prevention, early treatment and neuroimaging studies should be done in all newborn babies with alloimmune thrombocytopenia even when no neurological clinic is seen.

Hemorragia intracraneal por trombopenia neonatal aloinmune. Comunicación de un caso y revisión / Intracraneal hemorrhage caused by neonatal alloinmune thrombocytopenia. Report of a case and review

Introducción. La trombopenia neonatal aloinmune (TNA)se debe al paso de aloanticuerpos maternos dirigidos contra losantígenos plaquetarios fetales heredados del padre. En un 15-30%de los casos se produce hemorragia cerebromeníngea que puedeconducir a secuelas neurológicas importantes. Caso clínico. Sedescribe un caso de TNA en un recién nacido con antecedentes dedos hermanos fallecidos por el mismo motivo. A las 31 semanas sedetecta por ecografía hemorragia cerebral intraparenquimatosa yse efectúa parto por cesárea. Apgar de 8 y 9, no precisa maniobrasde reanimación. El examen físico revelaba desde el nacimientopúrpura cutánea generalizada y palidez, y el hemograma, una plaquetopeniagrave de 6.000/mm3; el recuento de la madre es normal,hemoglobina de 8,8 g/dL y hematocrito de 26,1%, sin otrasalteraciones biológicas destacables. En la sangre materna se detectaronaloanticuerpos de especificidad anti-HPA-1a; el padre eshomocigoto para 1a/1a, y la madre, para 1b/1b. Recibió transfusionesde plaquetas, así como inmunoglobulina endovenosa y corticoterapia,y evoluciona favorablemente. Conclusiones. La hemorragiaintracraneal parenquimatosa es una patología neonatal pocofrecuente, lo que obliga siempre a descartar un trastorno congénitode la coagulación, especialmente una TNA por su frecuencia ypotencial gravedad; en ocasiones puede tener una buena evoluciónneurológica. Es fundamental su prevención y tratamiento precoz yla realización de estudios de imagen, aun en ausencia de clínicaneurológica

Introduction. Neonatal alloimmune thrombocytopenia (NAT) is due to the transplacental transfer of circulatingmaternal alloantibodies developed against fetal platelet antigens inherited from the father. Intracranial hemorrhage occurs in15-30% of the cases, and very important neurological sequelaes can be due to it. Case report. We present the clinical andimmunohematologic findings of a case of severe NAT that had two siblings who died by this illness. In the 31st week ofgestation an intracranial hemorrhage is detected by echography, the birth was by caesarean section. Apgar score of 8 and 9,it wasn’t necessary reanimation procedures. Cutaneous purpura and pallor were presented since birth. Neonatal completeblood count showed a platelet count of 6,000/mm3 (whereas maternal blood count was normal), haemoglobin of 8.8 g/dL andhematocrit of 26.1%, without other biological alterations. In maternal blood alloantibodies antiHPA-1a were detected, beingthe father homozigous for 1a/1a and the mother homozigous for 1b/1b. The patient was treated with transfusions, endovenousgammaglobulin and corticosteroids and his condition improved. Conclusions. Intraparenchymatous hemorrhage is an uncommonpathology in neonates, but when this occurs it’s obligated to rule out a coagulation inherited illness, NTA especially,because of its prevalence and potentially serious neurological sequelaes, sometimes having a good neurological development.Prevention, early treatment and neuroimaging studies should be done in all newborn babies with alloimmune thrombocytopeniaeven when no neurological clinic is seen

Fresh arterial grafts as conduits for vascular reconstructions in transplanted patients.

OBJECTIVES: To assess the outcome of arterial allografts in patients receiving organ transplantation. DESIGN: From October 1997 to June 2005, we used fresh arterial allografts as vascular conduits in 21 patients for the treatment of claudications (10), abdominal aortic aneurysm (6), complicated renal transplantation (2), acute lower extremity ischemia (2) and gangrene (1). At the time of the vascular procedure, ten of the patients (Group A) had already undergone organ transplantation. The mean follow up period was 32 months for renal and 37 months for heart recipients, respectively. In 11 patients (Group B), the vascular reconstruction was undertaken simultaneously with the renal transplantation. The mean follow up period was 49 months. RESULTS: There was no arterial allograft related deaths. No signs of arterial graft infection or requirement for secondary intervention (angioplasty and/or thrombolysis) were observed during the follow up period. CONCLUSIONS: Our experience suggests that it is possible to use fresh arterial allografts in the treatment of arterial occlusive disease or abdominal aortic aneurysm, both in already transplanted patients and simultaneously with organ transplantation, with good results.

[Experimental use of the peritoneal graft as a vascular prosthesis]. / Vyuzitie peritoneálneho stepu ako cievnej náhrady v experimente.

INTRODUCTION: The parietal peritoneum appears to be a suitable material for the vascular system reconstructions. AIM: The aim was to assess and compare thrombogenicity and ability for endothelization of the mesothelial and submesothelial side of the parietal peritoneum in the canine venous system. EXPERIMENTAL ANIMALS: canis familiaris (n = 13), half-breeds of both sexes, aged between 1 and 2 years, weighting 15-25kgs, underwent authological transplantations of the peritoneal grafts with the mesothelial side in the lumen- the group M (n = 5) and with the submesothelial side in the lumen the group S (n = 5). In the control group K (n = 3) a part of the venous wall was used as a graft and was affixed back to its original place. The bioptic samples collected on the 10th, 20th, 30th and 40th postoperative day (POD) were stained using the HE staining, NADPH-d and imunohistochemically on the intermedial filaments. The endothelization rate of the peritoneal graft was measured using morphometry and the trombogenicity was assessed peroperatively. RESULTS: In none of the trial groups a presence of thrombi was detected peroperatively. In the first trial group (group M), the onset of the peritoneal graft epithelization (reaching 20%) was recorded on the 10th POD. The endothelization process was completed on the 30th POD in this trial group. In the second trial group (group S), the peritoneal graft epithelization reaching 10% was recorded on the 10th POD. The process was completed on the 40th POD. In the third trial group K, no endothelial changes were recorded during the experiment. CONCLUSION: Both sides of the peritoneum do not show signs of thrombogenicity and possess ability for endothelization.

Preservation injury of jejunal grafts and its modulation by custodiol and university of wisconsin perfusion solutions in wistar rats.

BACKGROUND: The two preservation solutions most commonly used in human transplantation surgery are University of Wisconsin (UW) and Custodiol (histidine-tryptophan-ketoglutarate; HTK). The aim of our study was to compare the protective effect of UW and HTK solutions on preservation-induced injury of jejunal grafts, as evaluated by the histological changes (semiquantitative method) and small bowel mucosal serotonin levels (as a possible new quantitative method). METHODS: Male Wistar rats (n = 50) weighing 316 +/- 52 g were divided into two main groups according to which preservation solution was used, i.e. UW (n = 25) or HTK (n = 25), and each of these groups was divided into five subgroups according to cold ischemic time (0, 1, 6, 9 and 12 h). Jejunal mucosa biopsy specimens were obtained to determine the serotonin concentration in mucosa and for standard light histology. To grade histological changes in mucosa, Park's small bowel injury grading system was used. RESULTS: Histological examination revealed that injury increased with cold ischemic time in the UW as well as in the HTK group, and there were no significant differences in injury between the two groups, except for the 6-hour cold ischemic period (p < 0.05), when HTK-preserved grafts showed a lower degree of injury (0.97 +/- 0.41) compared with UW-preserved grafts (1.25 +/- 0.39). The mucosal serotonin concentration decreased with cold ischemic time in both groups, and there were significant differences (p < 0.05) in concentrations between the groups after 9 and 12 h of cold ischemia. A significantly higher concentration was measured in grafts preserved in UW solution at these time points. CONCLUSION: The concentration of mucosal serotonin in rat small bowel grafts preserved for 9 and 12 h in UW preservation solution was significantly higher than that in HTK solution. These findings indicate a better protective effect of UW solution on small bowel injury after 9 h of cold ischemia.

Morphological changes of small bowel graft in Wistar rats after preservation injury.

OBJECTIVE: In our study we decided to define the harvesting and preservation injury of the graft using Park's scheme for the quantification of morphological changes. ANIMALS: Male Wistar rats (n=25) weighting 322+/-18 g. Harvesting preservation technique: Proximal jejunum (5-7 cm) was flushed with 5 ml of HTK solution and preserved for 0, 1, 6, 9 and 12 hours at 4 degrees C in the same solution. Biopsies for light microscopic evaluations were obtained after the preservation period. Park's scheme was used for the quantitative assessment of histological changes. t-test for two independent samples was used to evaluate statistical significance. HISTOLOGY: The extent of the preservation injury in the samples obtained at 0 hours was of grade 0 and increased to 1.84 after 12 hours of preservation time. At 0 hours of preservation a degree of 0 (s=0: no changes) was observed, after 1 hour, a degree of 0.50 (s=0.47: slight changes, similar to 0 time), after 6 hours a degree of 1 (0.97, s=0.41: discrete subepitelial oedemas in villi apexes), after 9 hours a degree of 2 (1.74, s=0.64: extension of subeppitelial spaces in villi apexes), and after 12 hours a degree of 2 (1.83, s=0.64: more extension of subepitelial spaces) was observed, except for these findings, there were also changes of grade 3 (massive subepitelial edema and sequestration of the mucosa from lamina propria) in the 12-hour group. A statistically significant (p=0.05) difference was found between all groups except for 9 and 12-hour groups. CONCLUSIONS: HISTOLOGY revealed increasing preservation injury with a increasing duration of preservation and its dynamic. (Tab. 1, Fig. 2, Ref: 6.)

Modulating amylase and lipase secretion in the pancreatic graft by somatostatin administration: preliminary results of a prospective, randomized trial.

Pancreas transplantation is a routine method for the treatment of diabetes mellitus. One of the main challenges of a transplant with extraperitoneal placement of the pancreatic graft is impaired wound healing due to massive amylase and lipase secretion by the pancreatic graft, evoking edemtous fluid. From February 2002 through January 2003, we performed pancreatic transplant procedures in 21 patients who were prospectively and randomly assigned to two groups: 8 organ donors and the recipients were administered somatostatin by continuous infusion. Thirteen grafts were harvested and transplanted without somatostatin infusion. The two groups did not show significantly differences in mean donor or recipient ages, weights, of serum amylase and lipase content values or drain output until day 6. There was a significantly lower lipase in the drain output of transplant recipients given somatostatin (12.5 and 54.2 micromol/L, respectively; P <.05). Neither the post-pancreatic transplant wound healing nor the number of rejection episodes were affected by somatostatin administration.

[Histologic changes in the jejunal wall after autotransplantation in a dog]. / Histologické zmeny v stene jejuna po jeho autotransplantácii u psa.

INTRODUCTION: Damages to the small intestinal wall resulting from ischemic-reperfusion changes, represent common complications of the clinical transplantation of the small intestine. AIM: Evaluation and quantification of the histological changes in the jejunal wall following its autotransplantation in a dog using the scale according to Park. MATERIAL AND METHODS: In dogs (n = 8), mongrel of both sexes, aged from 6 months to 2 years, weighting from 10 to 25 kgs, a resection of the jejunum followed by its autotransplantation was performed. At the time of the jejunal harvest, then after one-hour-long cold ischemia, 20 minutes after its reperfusion and then the 10th and the 20th day after the transplantation, bioptic samples of the whole jejunal wall were taken to be examined histologically. After being stained with hematoxyllin-eosine, the samples were evaluated according to the Park grading system. STATISTICS: The severity of the jejunal wall damage at the respective biopsy samples collection times was evaluated using the t-test for two dependent samples. RESULTS: After an hour-long cold ischemia, signs of increasing damage to the intestinal wall were observed, when compared to the peroperative sample (0 +/- 0) up to the degree 0.68 +/- 0.5 of the Park grading schema (p < 0.05). This damage degree increased 20 minutes after the reperfusion up to the value of 4 +/- 0 (p < 0.05). On the 10th and the 20th day a practically normal histological picture of the jejunal wall was observed. The histological changes in both cases were graded 0.38 +/- 0.5 (p < 0.05). CONCLUSION: Maximum histological changes following the autotransplantation of the small intestine with an hour-long cold ischemia were observed 20 minutes after the reperfusion. After 10 postoperative days, a practically normal histological picture of the small intestinal wall structure was observed. It remained unchanged even on the 20th postoperative day.