Association of total white cell count with mortality and major adverse events in patients with peripheral arterial disease: a systematic review.

OBJECTIVES: Peripheral arterial disease (PAD) is principally caused by atherosclerosis, an established inflammatory disease. Total white cell count (TWCC) is a marker of inflammation and has been associated with outcomes for patients with inflammatory diseases. The aim of this systematic review was to assess the association of TWCC with mortality and major adverse events (MAEs) in PAD patients. METHODS: Studies investigating the association of TWCC with outcome in patients with PAD were identified by a literature search using the Medline and Cochrane databases. To be eligible for inclusion, studies needed to investigate the association of TWCC with mortality or a composite endpoint that included mortality in patients with PAD. Studies were excluded when the primary focus was carotid artery disease, aortic aneurysmal disease, intracranial vascular disease, or rheumatoid arthritis and treatment with chemotherapy or transplantation of stem cells. Secondary searching of reference lists and relevant reviews was performed. RESULTS: Ten studies including 8,490 patients with PAD met the inclusion criteria. All studies investigated more than 100 patients with four studies assessing more than 1,000 patients. Study quality varied with well-established risk factors of outcome such as age, smoking, diabetes, and the ankle brachial index being adjusted for inconsistently. The study populations were also disparate. Few studies reported relative risk and 95% confidence intervals for the association of TWCC with mortality or MAE. TWCC was positively and significantly associated with death alone in four of five studies investigating 3,387 patients. TWCC was positively and significantly associated with MAE in five of six studies investigating a total of 6,846 patients. CONCLUSIONS: Current evidence suggests a positive association of TWCC with mortality and MAEs in patients with PAD. Further well-designed prospective studies are required with high-quality analysis and more complete reporting of outcomes.

[Antithrombotic prophylaxis in surgery--American College of Chest Physicians recommendations 2008]. / Antitrombotická profylaxe v chirurgických oborech--doporucení American College Of Chest Physicians 2008.

A brief content of American College of Chest Physicians Venous thromboembolism prophylaxis guidelines for surgical specialties published in 2008 and selection of significant studies and corresponding references is provided thus a reader has easily accessible review and literature.

[Autovenous ilicofemoral bypass, 21 years later --a case-review]. / Autovenózní ilikofemorální bypass po 21 letech - kazuistika.

We present the case of patient with autovenous ilicofemoral bypass after 21 years. The indication was traumatic demage of left iliac artery during car accident. The arterial reconstruction was patent for more than two decades with gradual arterialisation of graft. Excessive dilatation has caused the late occlusion of bypass. Ischaemia of the left limb was treated by crossover ilico-femoral bypass.

A prospective comparison of bladder versus enteric drainage in vascularized pancreas transplantation.

In previous years, the number of pancreas transplants has increased significantly. Debate continues over the optimum technique for exocrine drainage. Enteric drainage (ED) has recently been increasingly popular owing to the long-term complications of bladder drainage (BD). We prospectively evaluated 40 consecutive pancreas transplant recipients undergoing either bladder (n = 20) or enteric (n = 20) drainage. After simultaneous kidney-pancreas transplantation 1-year patient, kidney, and pancreas graft survival rates were 95%, 95%, 85% for the BD group, and 90%, 85%, 85%, for the ED group. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections and cytomegalovirus disease were also similar. The length of the initial hospital stay was likewise comparable. However, the BD group was characterized by a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Our results suggest excellent patient and graft survival irrespective of the drainage technique.

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.

[Ischemia of the large intestine after simultaneous kidney transplantation and aortic replacement with a fresh graft in an abdominal aortic aneurysm]. / Ischemie tlustého streva po soucasné transplantaci ledviny a náhrade výdute brisní aorty cerstvým tepenným stepem.

Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibilities for obliterating arterial disorders of low extremities or for the abdominal aortic aneurysm in patients waiting for organ transplantation. Between the year 1998 and the end of the year 2002, our work-team performed parallel reconstructions of the abdominal aorta using fresh grafts and cadaverous kidney transplantations in a group of five patients. The simultaneous surgical treatment of the both disorders during a single hospitalization as well as a considerable decrease of the artificial blood vessel prosthesis infection risk during chronic imunosuppression, represent the biggest advantage of this method. On the other hand, the risk of possible surgical complications is increased in these patients. During the operation and postoperation period, our four patients suffered from no serious complications. In case of one patient, ischemic colitis occurred which required surgical revision and subtotal colectomy. In this article, the authors describe the postoperation course of the patient condition with the above complication, which required a close cooperation of surgeons, anesthesiologists and nephrologists, in full detail.

Left retroperitoneal versus transperitoneal approach for abdominal aortic surgery - retrospective comparison of intraoperative and postoperative data.

BACKGROUND: The aim of our study was to evaluate the potential advantages of the left retroperitoneal (RP) approach for abdominal aortic surgery and compare the aortic exposure with the transperitoneal (TP) approach which is widely used. PATIENTS AND METHODS: Total 55 consecutive patients who underwent elective aortic surgery between 1998 and 1999 were evaluated retrospectively. Thirty three patients underwent the RP exposure and 22 the TP approach in the treatment of abdominal aortic aneurysm or aortoiliac occlusive disease. Demographic data and premorbid status were not significantly different between these two groups. Fourteen intraoperative and postoperative parameters were monitored and statistically analyzed. RESULTS: We found statistically significant differences in three of 14 intraoperative and postoperative parameters. Patients operated with the RP approach to the abdominal aorta were able to take clear fluids orally sooner. A statistically significant difference was also detected in the postoperative extubation time as RP patients were extubated almost one hour sooner than TP patients. Bowel function onset was statistically significantly faster return in the RP group. In the rest of recorded data there were no significant differences, however in all of follow-up parameters we found results in favour of RP group. CONCLUSION: We conclude that the RP group of patients had statistically significant improvements three of 14 postoperative clinical parameters. (Tab. 3, Ref. 18.)

[Pedal bypass in the treatment of ischemic diabetic foot]. / Pedální bypass v lécbe ischemie diabetické nohy.

AIM: The aim of this retrospective analysis was assessment of both patency and limb salvage rates of diabetic ischemic feet which underwent pedal bypass surgery within the period of 3 years. MATERIAL AND METHODS: Authors evaluated 50 critically ischemic diabetic feet where the pedal bypass was indicated for limb salvage. Total 41 pedal bypasses were performed and median follow-up was 16.7 months (1-39). The free muscle transfer were performed either in one session with or subsequently after the pedal bypass surgery in six limbs. RESULTS: Authors achieved 61% and 76% graft patency and limb salvage rates, respectively, within the median 16.7 months follow-up. All successfully revascularised feet healed up within the median period of 3 months postoperatively. No patient died within 30 days postoperatively. CONCLUSION: We conclude, that pedal bypass is safe procedure with acceptable limb salvage rate in the medium-term follow-up. Surgeons can markedly extend an indication criterions for limb salvage by exploiting of this technique.

[Surgical treatment of ischemia in the diabetic foot syndrome]. / Chirurgická lécba ischemie u syndromu diabetické nohy.

The authors present their results of the treatment of diabetic foot critical ischemia by means of surgical revascularisation together with minor amputation or debridement. They discuss the causes of higher amputations and re-amputations in revascularised ischemic diabetic lower limbs and presents patency rates in different types of peripheral arterial bypasses. The authors evaluated 81 diabetic feet with chronic critical ischemia, where they performed 50 arterial bypass procedures in the 50 limbs (13 femoropopliteal, 13 femorodistal, 19 pedal bypasses and 5 aorto/ilicofemoral or extraanatomical bypasses). 41 minor amputations or debridements (82%), 6 minor re-amputations (12%) was performed in the group of 50 revascularised limbs. The primary patency rates, secondary patency rates and limb salvage was achieved 92%, 92% and 92% in femoropopliteal bypass, 91%, 91% and 92% in femorodistal bypass, 78%, 83% and 84% in pedal bypass, respectively. The average follow-up time was 11.4 months. 6 minor re-amputations (12%) and 5 high amputations was necessary to perform in the group of 50 revascularised lower limbs. The main cause of re-amputation and high amputation was continuing ischemia. 30 day mortality rate was 0%, 30 day morbidity rate was 8% (myocardial infarction and pulmonary embolism).

100 pancreas transplantations with extraperitoneal graft placement.

The authors present the results of 100 pancreatico-duodenal grafts placed extraperitoneally with the bladder drainage. The onset of pancreatic graft function was immediate in all cases and the patients became insulin free. Despite the extraperitoneal graft placement the incidence of surgical complications was low. The only exception was slightly impaired wound healing. The Authors claim that this surgical technique allows the elimination of intraperitoneal infection and easy performance of the graft biopsy.

[Pedal bypass in the treatment of critical ischemia in the diabetic foot]. / Pedální bypass v lécbe kritické ischemie diabetické nohy.

A formerly established theory on obliteration of diabetic foot arteries was dismissed. In the last decade, diabetic foot revascularization using so called very distal bypass has became a routine procedure. The reconstructions are undertaken in patients with chronic critical limb ischemia. This paper presents our initial experience with this, not yet widely used, operative technique in 16 patients who had a total of 14 pedal bypass procedures performed. The parameters we monitored included the 3-, 6-, and 12-month patency rates, defect healing, and limb salvage rates. The primary and secondary patency rates were 64.3% and 78.6% at 3 months; 55.5% and 66.7% at 6 months; and 50% and 75% at one year, respectively. The overall limb salvage rate for the above periods was 92.9%. All defects healed following successful revascularization using pedal bypass. In patients where bypass could not be established, limb salvage was accomplished in one in three cases only.

[Conversion of drainage of a pancreatic transplant from the urinary bladder to the intestine in a recipient]. / Konverze drenáze pankreatického stepu z mocového mechýre na strevo príjemce.

The most frequently used surgical technique in transplantations of the pancreas is to connect the duodenum of the graft with the urinary bladder of the recipient. Introduction of this method led during the last five years to marked improvement of results. On the other hand duodenocystoanastomosis is a frequent cause of metabolic and urological complications in patients after transplantation. The authors present the case-record of a female patient after combined transplantation of the pancreas and kidney where surgical conversion of the drainage of pancreatic juice from the urinary bladder to the gut was necessary.

[Use of the circular stapler for duodenal-cystic anastomosis in pancreas transplantation]. / Pouzití cirkulárního stapleru k provedení duodenocystoanastomózy pri transplantaci slinivky brisní.

The number of combined transplantations of the pancreas and kidney in type I diabetics with chronic renal failure is increasing every year. The authors present their experience with a new technique of duodenocystostomy during this transplantation. The use of a circular stapler to create the duodenocystoanastomosis can hasten the surgical procedure and reduce at the same time the risk of development of a pancreatic fistula.

[Initial experience with angioscopy in infrainguinal reconstruction using the in situ saphenous vein technique]. / První zkusenosti s angioskopií pri infrainguinálních rekonstrukcích technikou in-situ pomocí velké safény.

The authors report on their experience with lower limb revascularization using the in-situ saphenous vein bypass grafting in four patients with angioscopically assisted valvulotomy. They describe the surgical technique employed and outcome of the procedure. The discussion section examines the pros and cons of the technique of in-situ saphenous vein bypass with angioscopically assisted valvulotomy (ISB + AV) compared with the standard technique of reversed bypass (RVB).