[Preemptive kidney transplantation in children--experience in UHC Zagreb]. / Preemptivna transplantacija bubrega u djece--iskustvo KBC-a Zagreb.

AIM: To discuss preemptive kidney transplantation outcomes in children with end stage kidney disease. METHODS: We present the data of patients younger than 18 years who were transplanted without previous dialysis in our Clinic. We retrospectively analyzed data available in medical health records. RESULTS: Preemptive living donor kidney transplantation was performed in 6 patients younger than 18 years. Creatinine clearance before transplantation was 9 +/- 4.15 ml/min (range = 2.7-12.3 ml/min, median = 8.5 ml/min). Currently, serum creatinine in patients with functioning graft is 139.4 +/- 60.9 micromol/l (range = 72-237 micromol/l, median = 130 micromol/l). One, three and five year graft survival was 100%. Overall graft and patient survival in the follow-up period was 83.3% and 100%, respectively. After 10 years one patient started with dialysis due to chronic graft rejection. CONCLUSION: From medical and socioeconomic point of view preemptive transplantation is optimal method for treatment of children with end-stage kidney disease. Membership in Eurotransplant should increase the number of preemptive transplantations in Croatia.

Postintubation tracheal injuries--case series and literature review.

SUMMARY - Post-intubation tracheal injury is a rare and potentially fatal complication. The most common causes are overinflation ofendotracheal tube cuffs and multiple intubation attempts in emergency cases. The diagnosis is based on clinical and radiological suspicion of tracheal injury confirmed by fiberoptic bronchoscopy. Decision between conservative and surgical management of the injury depends on clinical presentation (respiratory instability, concomitant diseases), lesion characteristics (lesion site, size, and number), and time elapsed from injury to diagnosis. We present three cases ofpost-intubation tracheal injury. In two cases, the patients were treated conservatively; in the third case, the patient died from asphyxia caused by thrombus occlusion of the trachea after a longitudinal tracheal lesion. Pre-anesthetic examination did not indicate any possibility of difficult intubation in any of the patients; however, in one of the patients admitted through the emergency department, emergency intubation was performed.

Iatrogenic tracheal laceration causing asphyxia.

Endotracheal intubation is a simple, rapid, and safe technique that is being used as a standard procedure for airway management. However, airway injury during endotracheal intubation could be a significant source of morbidity or even mortality for patients and a source of liability for physicians as well. We report an unusual case of fatal tracheal occlusion by intraluminal blood clot complicating endotracheal intubation. The patient, a 62-year-old woman, with renovascular hypertension and incipient renal failure was scheduled for renal autotransplantation. The surgery was uneventful but the postoperative course was complicated with a lethal airway obstruction. At autopsy a linear longitudinal tracheal laceration was identified with an intraluminal blood clot obstructing the tracheal lumen. Tracheal laceration as a cause of death is a rare and potentially fatal complication of endotracheal intubation with intratracheal bleeding, clot formation, tracheal occlusion, and subsequent asphyxia.