MULTIFACTORIAL ASSESSMENT OF POSTMORTEM LUNG DONOR

The appropriate evaluation and the development of special measures to protect donor lungs are important factors for successful lung transplantation. Aim. To develop and determine the effectiveness of the protocol of morpho- functional assessment of potential lung donor. Methods and results. During the period from May, 2011 to May, 2012, 37 donors with diagnoses of brain death were surveyed. 5 bilateral lung transplantations were performed only in 2 cases donors have been evaluated as «ideal». In the majority of recipients early postoperative period was evaluated as satisfactory. Conclusion. Designed multivariate algorithm of donor with brain death assess- ment, effectively implemented through the selection of donors for lung transplantation with satisfactory results in the early postoperative period. However, compliance with ideal criteria will not allow to effectively provide care for patients with terminal lung disease under conditions of continuous growth of «waiting list»

ТРАНСПЛАНТАЦИЯ ЛЕГКИХ ПРИ МУКОВИСЦИДОЗЕ С ХРОНИЧЕСКИМ ИНФИЦИРОВАНИЕМ ДЫХАТЕЛЬНЫХ ПУТЕЙ BURKHOLDERIA CEPACIA (первое наблюдение в Российской Федерации)

Cystic fibrosis (CF) is the third most common indication for lung transplantation. The recipients with CF have shown the best early and late survival rates after surgery. The special group of CF patients consists of those, whose airways were infected with Burkholderia cepacia (B. cepacia), since the recurrence of B. cepacia infection after transplantation are coupled with extremely high risk of death. Up to the present, the question whether the patients in such conditions should be included onto the lung transplant waiting list is still unanswered. We describe a case of lung transplantation in the patient with late postoperative complication in the form of severe pyoseptic infl ammatory process caused by the recurrence of B. cepacia infection. The success of the treatment of this patient was achieved thanks to combined multidisciplinary approach. This therapeutic approach could be considered as a standard treatment protocol in case of its validation by further clinical experience.Муковисцидоз (МВ) занимает третье место среди показаний к трансплантации легких, при этом реципиенты с этим заболеванием имеют наилучшие ранние и отдаленные результаты после операции. Особую группу пациентов с МВ составляют те, у которых дыхательные пути инфицированы Burkholderia cepacia (B. cepacia), так как рецидив этой инфекции в послеоперационном периоде сопряжен с крайне высоким риском летального исхода. До настоящего времени в мировом научном медицинском сообществе обсуждается вопрос о необходимости и возможности включения таких пациентов в лист ожидания. Мы приводим собственное наблюдение трансплантации легких такому пациенту с развитием в позднем послеоперационном периоде тяжелого гнойно-септического процесса, обусловленного рецидивом инфекции B. cepacia. Успех в лечении рассматриваемого пациента был обусловлен комплексным мультидисциплинарным подходом, который может претендовать на стандартный протокол в случае подтверждения его эффективности дальнейшим клиническим опытом.

МНОГОФАКТОРНАЯ ОЦЕНКА ПОСМЕРТНОГО ДОНОРА С ПОЗИЦИИ ТРАНСПЛАНТАЦИИ ЛЕГКИХ

The appropriate evaluation and the development of special measures to protect donor lungs are important factors for successful lung transplantation. Aim. To develop and determine the effectiveness of the protocol of morpho- functional assessment of potential lung donor. Methods and results. During the period from May, 2011 to May, 2012, 37 donors with diagnoses of brain death were surveyed. 5 bilateral lung transplantations were performed only in 2 cases donors have been evaluated as «ideal». In the majority of recipients early postoperative period was evaluated as satisfactory. Conclusion. Designed multivariate algorithm of donor with brain death assess- ment, effectively implemented through the selection of donors for lung transplantation with satisfactory results in the early postoperative period. However, compliance with ideal criteria will not allow to effectively provide care for patients with terminal lung disease under conditions of continuous growth of «waiting list». Цель исследования. Адекватная оценка и разработка специальных мероприятий по защите и восста- новлению морфофункциональнальных свойств легких потенциального донора. Методы и результа- ты. В период с мая 2011 года по май 2012 года наблюдали 37 доноров с диагнозом смерти мозга. Было выполнено 5 билатеральных трансплантаций легких, и только в 2 случаях доноры были определены как удовлетворительные. У большинства реципиентов ранний послеоперационный период протекал удовлет- ворительно. Заключение. Предложенный многофакторный алгоритм поддержки донора со смертью мозга позволяет эффективно отбирать доноров для трансплантации легких с удовлетворительным результатом в раннем послеоперационном периоде. Однако следование идеальным критериям не позволяет оказывать эффективную помощь пациентам в терминальной стадии болезни легких, включенным в лист ожидания трансплантации.

Non-isothermal bioremediation of waters polluted by phenol and some of its derivatives by laccase covalently immobilized on polypropylene membranes

In view of the heath problems induced by the presence into the environment of endocrine disruptors, laccase from Trametes versicolor was covalently immobilized on a chemically modified polypropylene membrane in order to remove phenol and its derivatives from polluted waters. Using phenol as substrate model the optimal immobilization conditions were determined. The immobilized laccase exhibited maximal enzyme activity at pH 5.5 and optimal temperature at 55 °C. These operative parameters have been compared with those obtained with the soluble laccase in order to ascertain the immobilization effect. When employed in a bioreactor operating under isothermal conditions the immobilized laccase was able to oxidize a wide range of phenolic substrates. In particular it was found that some phenol derivatives (2-CP, 3-CP, 4-CP, NP and chlorophene) were oxidized at a similar rate than phenol, other derivatives (paracetamol, 3-MP and chloroxyphenol) at a smaller rate, while others (2,4-DCP and BPA) at higher rate. When the catalytic membrane was employed in a non-isothermal reactor the reaction rate increased with the increase of the applied temperature difference. Practically the increase of the laccase oxidative power under the non-isothermal conditions followed the same sequence observed under isothermal conditions. Interesting enough, the percentage increase of enzyme reaction rate under non-isothermal conditions resulted higher in the cases in which the isothermal reaction rate was smaller. When the reduction of the production times by the presence of a temperature gradient is considered, the measured values strongly candidate the technology of non-isothermal bioreactors as a useful tool in processes of detoxification of waste waters polluted by endocrine disruptors of phenolic origin. © 2010 Elsevier B.V. All rights reserved