[Kidney transplantation from donors dying of methanol intoxication]. / Transplantace ledvin od dárcu zemrelých na intoxikaci metanolem.

INTRODUCTION: Intoxicated patients represent only a minimum of the total number of cadaveric donors; however, their significance within the transplant program in the Czech Republic has recently been emphasized in connection with the so-called methanol affair. MATERIAL AND METHODS: A retrospective analysis of methanol-poisoned patients who were declared brain-dead and subsequently underwent organ removal for transplantation purposes in the University Hospital Ostrava was performed. In cooperation with other transplant centres (Institute for Clinical and Experimental Medicine, Transplant Centre of the University Hospital Hradec Kráilové, Centre for Cardiovascular and Transplantation Surgery in Brno) the graft function, postoperative morbidity and mortality was evaluated. RESULTS: During the study period (since September 2012), organs from three brain-dead donors as a result of methanol intoxication were retrieved in the Transplant Centre of the University Hospital Ostrava. Subsequently, six kidneys were transplanted (3 males, 3 females). Postoperative complications occurred in two patients (33.3%), one patient died (16.7%). In one case (16.7%), the graft failed. None of the graft recipients developed clinical or laboratory signs of methanol poisoning. CONCLUSION: Death due to methanol intoxication is not a contraindication to organ donation, graft function and patient survival being comparable to organs from non-intoxicated donors.

[An overview of the results of renal transplantation in the Czech Republic]. / Piehled výsledku transplantací ledvin v Ceské republice.

Renal (kidney) transplantation is now a routine and the most successful form of renal replacement therapy. There is a long tradition of renal transplantation in the Czech Republic, The first was performed as early as 1961 in Hradec Kralove, and the programme as such was launched in 1966 with the first successful transplantation at the Institute of Experimental Surgery (later Institute for Clinical and Experimental Medicine, Prague). At present, transplantations are being performed at 7 transplantation centres (IKEM Prague, Centre for Cardiovascular and Transplantation Surgery Brno, Faculty Hospitals Hradec Kralove, Plzen, Olomouc and Ostrava and Faculty Hospital Motol for children). From the programme launch until the end of 2010, 8,761 renal transplantations were performed, 364 in 2010 alone. One-year patient and cadaver renal allograft survival, transplanted in the CR between 2000 and 2009, is around 95% and 92%, respectively, and 5-year survival is 87% and 81%, respectively. As of 31st December 2009, a total of 3,771 patients lived with functional renal allograft in the Czech Republic and the proportion of patients with irreversible renal failure treated with transplantation has recently been around 40%.

["Low volume" laparoscopic nephrectomy for relative-to-relative transplantation]. / "Low volume" laparoskopická nefrektomie pro príbuzenskou transplantaci.

AIM: Worldwide, the number of suitable cadaverous donors is limited. Therefore, as a solution for patients with chronic renal failure appears to extend the group of living donors of healthy individuals who voluntarily donate kidney to relatives or emotionally related recipients. Given the altruistic circumstances of these operations, the main monitored parameters are security for donors and excellent graft function for recipients. Currently published works show that minimally invasive technique can guarantee comparable results with open access in both monitored parameters. The aim of this study is to asses our results with laparoscopic assisted living donor nephrectomy for transplantation. PATIENTS AND METHODS: In retrospective study we analyzed data of patients in whom laparoscopic donor nephrectomy was performed on the Surgical Clinic, University Hospital Ostrava in the period from May 13, 2002 to June 30, 2010. Group of 34 donors were analyzed according to demographic characteristics (sex, age, ASA classification and BMI). From the perioperative data were monitored length of operation and warm ischemia, blood loss, frequency of intraoperative complications and conversion rate. In the postoperative period were evaluated in donors length of postoperative hospitalization, frequency of early and late reoperations, causes of morbidity and mortality, dynamics of the levels of creatinine and in the recipients was monitored 1-year survival of the graft. RESULTS: There were 14 men (41%) and 20 women (59%), median age was 48 years (25-77 years), BMI 26.9 (18.7-37.0), 53% of patients were ASA II, 44% ASA I, 1 patient (3%) ASA III. Median length of operation was 180 min (90-300 min), warm ischemia 120 s (58-240 s), blood loss 50 ml (30-1000 ml). There was no conversion. Intraoperative complications occured in 3 donors (8.8%). The length of hospital stay was 7 days (3-26 days), morbidity rate was 14.7%, without mortality. Early reoperations were in 2 patients (5.9%), late reoperations were performed in 4 patients (11.8%). In donors an average increase of creatinine value was 35.5 micromol/l the first postoperative day. One-year graft survival in our cohort was 94.1%. CONCLUSION: For patients with terminal renal insufficiency the living donor kidney transplantation offers possibility to shorten time in waiting list and to ensure a better graft function with its longer survival. Minimally invasive laparoscopic technique (we prefer transperitoneal approach), represents a safe alternative to open operation.

[Preoperative preparation and examinations before scheduled cardiosurgical intervention]. / Predoperacní príprava a vysetrení pacienta pred plánovaným kardiochirurgickým výkonem.

In our article we inform about complete preoperative preparation and about required examinations before the scheduled cardiosurgical procedure. Important part of the preoperative preparation is also detailed instruction about the character of the operation, a way of its realization and about the operation risks. In the end of this article we discus the instruction of the patient about the types of the valvular prosthesis.

[Atrial transport function after surgical ablation of atrial fibrillation using cryoenergy]. / Transportní funkce síní po chirurgické ablaci fibrilace síní pomocí kryoenergie.

BACKGROUND: Surgical ablation is one of the most effective techniques for treatment of atrial fibrillation. Stable sinus rhythm is achieved and effective atrial contractions are restored in the majority of patients. The aim of the prospective study is to assess the presence of atrial transport function after surgical ablation of atrial fibrillation using cryoenergy and to evaluate predictors of the procedural success. METHODS AND RESULTS: Between January 2005 and September 2006, 100 consecutive patients underwent left atrium cryoablation as a concomitant cardiac procedure. Their mean age was 67.6 years (range 50 to 82 years), there were 41 (41 %) women. Forty six patients (46 %) suffered from paroxysmal or persistent atrial fibrillation and 54 (54 %) of them from permanent atrial fibrillation before surgery. Atrial mechanical function was assessed by echocardiography (pulsed Doppler examination of the mitral and tricuspidal inflow, presence of the atrial filling [A] wave) after 3.5, 6, 12 and 18 months postoperatively. 79.6 % of patients, who have had sinus rhythm at 3.5 months, were free from atrial fibrillation at 18 months after surgery. The effective left atrial contractions were present at 3.5, 6, 12 and 18 months postoperatively in 70.2 %, 71.9 %, 81.4 % and 73.5 % of patients and we found right atrial transport function in 97 %, 95.3 %, 97.7 % and 97.1 % of patients. There was no significant difference between group with paroxysmal or persistent atrial fibrillation and permanent fibrillation. Negative predictors for restoration of the left atrial transport function were: preoperative mitral stenosis (at 3.5 and 6 months, p=0.02 and p=0.03 respectively), bigger left atrial dimension prior to procedure (only at 3.5 months, p=0.01) and severity of tricuspid regurgitation before surgery (only at 18 months, p=0.01). An ischaemic stroke occured in 7 %. Thirty-day motality was 12 % (12 patients). CONCLUSIONS: Left atrial mechanical funtion was detected in 70-80 % of patients and right atrial function in 95-98 % of patients with sinus rhythm during follow-up of 18 months. Preoperative left atrial dimension, presence of mitral stenosis and severity of tricuspid regurgitation were the most significant predictors for postoperative restoration of the left atrial transport function. Significant reduction in occurence of ischaemic stroke by surgical ablation was not achieved.

[Manually-assisted laparoscopic nephrectomy in a living donor]. / Manuálne asistovaná laparoskopická nefrektomie od zivého dárce.

Manually assisted laparoscopic nephrectomy from a live donor combines the advantage of a mini-invasive approach with the advantage of the assisting hand in the abdominal cavity to which the surgeon is used from classical operations. The authors performed the first nephrectomy from a live donor by this method on May 13, 2002. Our initial experience with five nephrectomies by this method indicate that every subsequent operation was shorter and the period of warm ischemia was also shorter. There was no postoperative complication. In the second operation suppuration of the minilaparotomy occurred which protracted hospitalization and the convalescent period. The prerequisite of these operations is a certain amount of experience with laparoscopic operations. This type of nephrectomy has the general advantages of a miniinvasive approach, i.e. greater postoperative comfort and a shorter convalescence as compared with an open operation. The period of warm ischaemia does not differ markedly from nephrectmies by the classical procedure.

[The results of kidney transplantation from very young paediatric cadaveric donors to adult recipients in Czech Republic in the years 1994-2001 (retrospective study of the Czech transplant centres)]. / Výsledky transplantací ledvin od malých detských kadaverózních dárcu dospelým príjemcum v Ceské republice v letech 1994-2001 (Retrospektivní studie ceských transplantacních center).

The results of kidney transplantation from very young paediatric cadaveric donors up to five years, which were transplanted to adult recipients, are evaluated in the first retrospective study of all Czech transplantcentres. In general, 42 of these transplantations were carried out during 1994-2001. In 28 cases single kidney was transplanted, in 14 cases en bloc graft of both children kidneys was transplanted. The reasons of kidney failure by recipients are usual (in 42.9% glomerulonephritis). An average age of the donors was 34.7 months (median 39 months). An average age of the recipients during transplantation was 42.6 years (median 43.5 years). All the kidneys were placed into retroperitoneum. As long as only single kidney was transplanted, the rules, already propagated by Salvatiera in 1970, were respected. At the transplantation of en bloc graft, Kinne's method with possible vessels elongation of the graft and with uretero-uretero anastomoses (in so called Ostrava modification) was used. The higher occurrence of the primary graft non-function (as 50% losses of all grafts) was confirmed in the study. Its reason was an acute thrombosis of vessels or rotation of graft stem. One-, three- and five-years patients and grafts survival were 97.6-90.5-90.5% and 76.2-73.8-73.8% actually. Patients survival are very good while grafts survival are average, momentarily a bit worse than national data published by the Czech Transplant Society, which determines one-, three- and five-years grafts survival with 90.3-82.9-75.5% and 79.1-71.1-65% actually. The kidney transplantation from paediatric cadaveric donors to adult recipients is acceptable under present allocated criteria, in case that some principles are kept. The study confirms the international experiences about rather higher incidence of surgical complications and primary graft non-function. In conclusion, some general references for reduction of complications, as well as for improvement of these transplantation results are introduced.

[Major vascular injuries in laparoscopic operations]. / Velká cévní poranení u laparoskopických operací.

The authors present three case-histories of major vascular injuries during laparoscopic operations. Subsequently they discuss causes and possible prevention of these rare but serious complications.

[Metastatic choriocarcinoma as a cause of hemorrhage in the digestive tract and abdominal cavity]. / Metastatický choriokarcinom jako prícina krvácení do trávicí trubice a brisní dutiny.

Authors present a case report of an young woman with metastatic choriocarcinoma. Clinical presentation of the disease was intracerebral bleeding concurring with intestinal bleeding and bleeding from ruptured spleen according to metastatic spread. Physicians firstly didn't think of choriocarcinoma because of small incidence of the disease and long period after the patient's latest pregnancy. At last the aggressive treatment was successful. Authors would like to bring out the reality that the surgeon could be the first who is faced with diagnosis and treatment of serious complications of choriocarcinoma.

[Ureteroureteral end-to-side anastomosis in kidney transplantation--personal experience]. / Uretero-uretero anastomóza end to side u transplantací ledvin--nase zkusenosti.

The most widely used way of reconstruction of the urinary pathways in transplantations of the kidney is at present a ureteroneocysto anastomosis. In some patients this type of reconstruction is difficult, if not impossible (adhesions in the lesser pelvis of the recipient, atrophic urinary bladder, short ureter of the graft, transplantation of child kidneys). In these instances the authors indicated a uretero-uretero end-to-side anastomosis. The authors performed in 13 patients a total of 17 uretero-uretero end-to-side anastomoses. In six transplantation of child kidneys en bloc was involved. During the postoperative period one female patient developed a urinary fistula from the renal pelvis of the graft which healed after conservative treatment. End-to-side uretero-uretero anastomosis is a simple and safe way of reconstruction of the urinary pathways in renal transplantations.