Transient Multiple Removal and Subsequent Reimplantation of Abdominal and Retroperitoneal Organs with Multisystemic Neoplastic Lesions

The aim of the study was to develop simple, minimally invasive method of transient multiple removal and subsequent reimplantation of abdominal and retroperitoneal organs with multisystemic neoplastic lesions, allowing subsequent reimplantation of the organ block after extracorporeal surgery. Material and Methods. Ten human cadavers of subjects who died of causes unrelated to pathology of the abdominal organs were used in this study. The anatomical experiment involved transient multiple removal of the abdominal and retroperitoneal organs with multisystemic neoplastic lesions and their subsequent reimplantation. Surgery was performed using the method developed at the Department of Operative Surgery and Topographic Anatomy of I.M. Sechenov First Moscow State Medical University (Patent RU 2601100). Results. The proposed method showed several advantages: consistency of cold perfusion in deep hypothermia of the patient,hypothermic circulatory arrest of the abdominal organs (up to 4–6 h); feasibility of insertion and subsequent removal of arterial and venous shunts, reimplantation of the abdominal organs; restoration of arterial and venous blood flow in the patient (cadaver) and preserved integrity of the transected anatomical structures. Conclusion. The proposed method of transient multiple removal and subsequent reimplantation of the abdominal and retroperitoneal organs with multisystemic neoplastic lesions provides sustained viability of the organs and can be recommended as a suitable model for further application in clinical practice

КОМПЛЕКСНАЯ ОЦЕНКА СОСТОЯНИЯ ПЕЧЕНИ ПОСЛЕ ВЫПОЛНЕНИЯ ЛАПАРОТОМИИ У МУЛЬТИОРГАННЫХ ДОНОРОВ

The macroscopical evaluation of the liver of 310 donors is presented and the ball estimation of liver quality is develo- ped. In 181 cases the retrospective morphological evaluation was performed (58.6%) undesirable pathology of donor liver – the fatty dystrophy (steatosis) was frequent. It is proved that most trustworthy information about the condition of donor liver is its complex evaluation including visual survey and biopsy with staining on fat that. It coned promote increase in a donor pool at 10%. Представлена макроскопическая оценка качества печени у 310 доноров органов и разработана балльная оценка качества трансплантата печени. У 181 донора проведена ретроспективная морфологическая оценка качества органа. Частой (58,6%) и нежелательной патологией донорской печени являлась жировая дистрофия (стеатоз). Обосновано, что наиболее достоверной информацией о состоянии донорской печени является комплексная ее оценка, включающая визуальный осмотр и исследование биопсийного материала с окраской на жир, что может способствовать увеличению донорского пула на 10%.

ПРАКТИЧЕСКОЕ ИСПОЛЬЗОВАНИЕ ЭКСТРАКОРПОРАЛЬНОЙ МЕМБРАННОЙ ОКСИГЕНАЦИИ В ДОНОРСТВЕ ОРГАНОВ ДЛЯ ТРАНСПЛАНТАЦИИ

In Russia more than 50% of effective donors are non – heartbeating donors. As we all know, they appear mainly as the source of kidney transplants. The perfusion in situ through DBTL catheter is the most frequent technique usable. The rate of delayed graft function (DGF) following the DBTL perfusion may vary from 48 to 78,4%. ECMO technology use in organ donation may lead to dramatic decrease in DGF and create premises for multiorgan explantation. In the following paper we present the first Moscow experience of ECMO use in our practice of organ donation. В России пул эффективных доноров с небьющимся сердцем (ДНС) составляет более 50% от общего пула эффективных доноров. Как известно, такие доноры являются преимущественно донорами почек. Наиболее часто для эксплантации почек у ДНС используется перфузия in situ через двухбаллонный трехпросветный катетер. Частота отсроченной функции почечных трансплантатов составляет при таком методе, по разным данным, от 48 до 78,4%. Использование технологии экстракорпоральной мембранной оксигенации (ЭКМО) у ДНС позволяет значимо снизить частоту отсроченной функции почечных трансплантатов, а также при соблюдении ряда условий выполнять у ДНС мультиорганную эксплантацию. В статье представлен первый опыт Москвы в использовании технологии ЭКМО в донорстве органов.

Features of the Restoration of Arterial Circulation in Liver Transplantation

Objectives. Violations of tissue blood supply remain one of the most serious complications after liver transplantation. Design. To improve the surgical technique of performing reconstructive interventions on the arteries of the donor and the recipient in order to reduce the frequency of its thrombosis after liver transplantation. We studied 25 donors, 20 men and 5 women, the mean age was 56± 4 years, eighteen of them had left aberrant supplementary artery, which in fifteen departed from the left gastric artery and in three from the aorta above the ventricular stem. Seventeen had the right aberrant artery moving away from the upper mesenteric artery. Twenty recipients with liver cirrhosis (eleven with primary biliary cirrhosis, five with primary sclerosing cholangitis, five with viral etiology C cirrhosis, and three of the lower cirrhosis-cirrhosis disseminated within the Milan criteria. All recipients had standard anatomical branching of the arteries of the liver. The average age was 50±6. All recipients had standard anatomical branching of the liver arteries. Patients underwent liver transplantation with new methods of reconstructive interventions on the donor and recipient arteries. The developed technique provides the shortest pathway of the recipient's arterial blood to the liver transplant, through the superior mesenteric artery provides an alternative source of arterial blood supply from the aorta in which this transplant additionally needs. Presented method of blood circulation restoration at liver transplantation at abnormal structure of arterial channel of the liver transplant is performed inside the recipient's abdominal cavity. At first, blood flow is restored along the reconstructed common hepatic artery, after the right or left aberrant arteries liver transplant. Such technique provides the shortest route of the recipient's arterial blood to the liver transplant, through the upper mesenteric artery provides an alternative source of arterial blood supply from the aorta for which the transplant is additionally needed. This new method of blood circulation restoration provides an opportunity to avoid the formation of "kinking" syndrome, in the occurrence of which the blood vessels are lengthened, the angulation and location of the blood vessel in relation to the grafts and other abdominal organs. This reduces the risk of thrombosis of the arteries of the transplanted liver

COMPREHENSIVE ASSESSMENT OF THE LIVER AFTER LAPAROTOMY IN DONOR MULTIORGAN

The macroscopical evaluation of the liver of 310 donors is presented and the ball estimation of liver quality is develo- ped. In 181 cases the retrospective morphological evaluation was performed (58.6%) undesirable pathology of donor liver – the fatty dystrophy (steatosis) was frequent. It is proved that most trustworthy information about the condition of donor liver is its complex evaluation including visual survey and biopsy with staining on fat that. It coned promote increase in a donor pool at 10%

Extending the life of metal used in nuclear power plant

Translated from Russian (Ehlektr. Stn. 1987 (2) p. 11-14)SIGLEAvailable from British Library Document Supply Centre- DSC:9022.09(CE-Trans--8282)T / BLDSC - British Library Document Supply CentreGBUnited Kingdo

PRACTICAL USE OF EXTRACORPOREAL MEMBRANE OXYGENATION IN ORGAN DONATION FOR TRANSPLANTATION

In Russia more than 50% of effective donors are non – heartbeating donors. As we all know, they appear mainly as the source of kidney transplants. The perfusion in situ through DBTL catheter is the most frequent technique usable. The rate of delayed graft function (DGF) following the DBTL perfusion may vary from 48 to 78,4%. ECMO technology use in organ donation may lead to dramatic decrease in DGF and create premises for multiorgan explantation. In the following paper we present the first Moscow experience of ECMO use in our practice of organ donation