Liver transplantation in the experience of the centre commencing the program.

From 1989 to 1999, 43 orthotopic liver transplantations (OLT) in 40 patients (3 retransplantations) were performed in our Department. The most common indications for OLT were noninflammatory, primary cholestatic liver diseases and postinflammatory liver cirrhosis. Fourty OLT's were done for elective indications, three--on emergency basis, because of fulminant liver failure. The majority of transplantations was performed with classical technique with the excision of retrohepatic vena cava and routine use of the extracorporeal veno-venous bypass. Only in 4 patients the piggyback technique was used and performed without temporary portocaval anastomosis. All 3 patients transplanted for fulminant liver failure died in the perioperative period. Twenty four patients are still alive and well, the longest period of observation exceeding 5 years.

Serum cholesterol in cerebral malignancies.

Reduced blood cholesterol levels were reported in patients with a variety of malignant peripheral tumors. This fact is likely related to increased cholesterol demand by proliferating tumor cells. The question arises whether this 'tumor-associated hypocholesterolemia' occurs also in patients with brain tumors, and--if it does not--whether its absence can be related to the location of the tumors. We have compared fasting serum total cholesterol levels among three groups of patients: 52 patients with gliomas, 56 patients with symptomatic metastatic brain tumors, and 50 patients harboring malignant tumors of peripheral location but showing no clinical signs of brain metastases. Patients in the last group, despite being--on an average--more age-advanced, had lower total serum cholesterol levels than either the patients with gliomas, or the patients with brain metastases. No difference in the cholesterol levels was found between the two latter groups, and a majority of these patients had borderline or elevated cholesterol levels. This apparent absence of 'tumor-associated hypocholesterolemia' in brain tumor patients may be related to either brain tumors' ability to synthesize cholesterol de novo and their reduced dependence on peripheral cholesterol supply, the existence of brain tumor-blood barrier, effect of medications used to counteract brain edema and seizures, or a combination of these factors.

[Treatment of liver injuries in personal clinical material from 1990-1996]. / Leczenie obrazen watroby w materiale wlasnym Kliniki w latach 1990-1996.

From 1990 to 1996 two hundred and sixteen patients with abdominal trauma were treated in our Department. In 170 cases there were blunt, and in 46-penetrating injuries (stab and gunshot wounds). Injuries of the other regions of the body coexisted in 117 patients (multiple trauma). In 42 cases (19.4%) abdominal trauma caused injury to the liver. In this group blunt mechanism of trauma also dominated (71%). The victims were usually young men (90% of the group, mean age - 35.3 years). The most common cause of injury were traffic accidents (47.6%), penetrating injury being the second commonest cause (12 patients i.e. 29%). Four patients were treated conservatively, the remaining 38 required surgical intervention. Most frequently liver suture and peritoneal drainage were performed (20), followed by liver tissue resections (16) and liver packing (12). Other surgical procedures to treat coexisting injuries were performed in 24 patients. In 22 patients postoperative complications occurred: liver abscess in 6 cases, hemorrhage in 4, wound infection in 4, biliary fistula in 2, intrahepatic aneurysm in 2 and other complications in 8 patients. The mean time of hospitalisation were of 20 days (range: 0-64 days). Mean volume of blood transfused equaled 6.9 U. There were 16 deaths (38%), in all cases in multiple trauma victims. All patients with penetrating liver trauma survived.

[Orthotopic liver transplantation using timely veno-venous bypass]. / Ortotopowy przeszczep watroby z zastosowaniem czasowego, pozaustrojowego by-passu zylno-zylnego.

The authors present their own experience in the use of veno-venous bypass during the anhepatic phase of orthotopic liver transplantation. The selected hemodynamic parameters (arterial pressure, central venous pressure, peripheral resistance) of the anhepatic phase as well as the effects of the graft reperfusion were analyzed in the group of 14 adult orthotopic liver allograft recipients transplanted in the Dept. of General Surgery & Liver Diseases from December 1994 to April 1997. In conclusion, the use of the veno-venous bypass allowed to avoid severe hemodynamic disturbances during the anhepatic phase and to minimize the complications of the reperfusion syndrome. The possibility of the relatively safe prolongation of the anhepatic phase is particularly important during the period of gaining experience by the surgeons and anesthesiologists.

[Evaluation of the usefulness of the liver for transplantation based on 26 multiorgan harvests]. / Ocena przydatnosci watroby do jej transplantacji na podstawie 26 pobran wielonarzadowych.

UNLABELLED: This study is aimed at the clinical and morphological criteria of estimation of the liver harvested for transplantation. In the period from January 1996 to May 1997 our team obtained 26 livers at the multi-organ harvesting. Most of the donors were young people after the trauma of central nervous system. The liver was harvested according to the principles of Starzl's fast method with the successive preparation on the "cold table". The donor's clinical status was estimated, as well as appearance, density and colour of the organ, quality of perfusion with UW solution In 23 cases the histological examination of the harvested organ allowed to estimate the degree of steatosis, hepatocyte necrosis, vacuolar degeneration and other abnormalities. In 3 cases the graft was estimated only by means of macroscopic examination. RESULTS: As a result of clinical and histological findings 8 organs were considered as unsuitable for transplantation. In one case the histological findings were the contraindication despite the satisfactory macroscopic appearance of the organ 15 organs were successfully transplanted, proving the conformity of clinical and histological criteria. In 4 livers (15%) the abnormalities of arterial supply were found. CONCLUSIONS: Clinical and pathomorphological estimation of the harvested liver is adequate to it's suitability for transplantation, advisable for the centres initiating the liver transplantation program. Detailed analysis of the donor's clinical status and laboratory data and competent macroscopic estimation of the harvested liver allow the experienced surgeon to resign from the routine histological verification, which might be necessary in doubtful cases only.

[Orthotopic liver transplantation in a patient with primary biliary cirrhosis]. / Ortotopowy przeszczep watroby u chorej z pierwotna marskoscia zólciowa.

In December 1994 an orthotopic liver transplantation was performed in a 46-year old female patient with liver failure due to primary biliary cirrhosis. The patient was discharged on the 31-st postoperative day. The graft was obtained at the multi-organ harvesting. The results of the donor's biochemical tests and the histological estimation of the graft tissue allowed to prognose a successful postoperative course.

Endoscopic laser treatment of benign tracheal stenoses.

We present the technique and results of endoscopic neodymium-yttrium aluminum garnet laser treatment of benign tracheal stenoses. This therapy was used in 15 patients with tracheal stenoses. Benign tracheal granulomas were caused by prolonged tracheal intubation in eight patients, permanent maintenance of tracheostomy tube in five patients, and nonspecific inflammatory process of the trachea in two patients. The clinical picture was dominated by dyspnea and stridor. The achievement of normal tracheal patency required several laser therapy sessions, repeated at 5- to 7-day intervals. In 30% of patients additional laser vaporization was required as well. The immediate and short-term results were encouraging; in all cases the normal tracheal lumen was restored, resulting in alleviation of patients' symptoms.

[Endoscopic treatment of iatrogenic tracheal stenosis by laser Nd:YAG]. / Endoskopowe leczenie jatrogennych zwezen tchawicy laserem Nd:YAG.

The authors present the technique and results of endoscopic Nd:YAG laser treatment of inflammatory tracheal stenoses. This kind of therapy was employed in 10 patients with tracheal stenosis, resulting from long-term nastotracheal intubation (6 cases), tracheostomy tube after radical laryngectomy (3 cases) and tracheal trauma. The laser fiber was introduced into trachea by the operative channel of a flexible bronchoscope and vaporization of obstructing tissues carried out using contact method in continuous mode of light emission (power 7-20 Watts). The achievement of normal tracheal patency usually required several laser therapy sessions (3-5), repeated in 3-5 days intervals. The short-term results are encouraging: in all cases the normal tracheal was lumen was restored, resulting in alleviation of patients' symptoms. In 3 cases a recurrent tracheal stenosis, requiring additional laser treatment was observed.