Infections in patients with liver transplantation

Transplantacija jetre danas je postala rutinski oblik liječenja za bolesnike s kroničnim stadijem jetrene bolesti i akutnim zatajenjem jetre. Zahvaljujući velikom napretku u postoperativnom liječenju bolesnika s transplantacijom jetre vidljivo je nedvojbeno produljenje života tih bolesnika te manji broj umrlih. Napredak u liječenju prvenstveno je ostvaren u sprječavanju odbacivanja novoga organa i liječenju postoperativnih infekcija, koje uzrokuju najveći broj smrti transplantiranih bolesnika. Epidemiološka slika uzročnika ovisi o vremenu koje je proteklo od transplantacije pa tako u ranom postoperativnom tijeku većinu infekcija uzrokuju bakterije (većinom iz flore gram negativnih štapića i gram pozitivnih koka), dok s odmakom od operacije zastupljeniji postaju virusi i mikobakterije. Osobit problem, zbog visoke smrtnosti transplantiranih bolesnika, danas predstavljaju infekcije uzrokovane multiplorezistentnim patogenima (MDR, engl. multiple drug resistance) , za koje su nam terapijske mogućnosti izuzetno sužene, a u nekim slučajevima čak i ne postoje. Zbog izrazito velike i neracionalne primjene antibiotika za očekivati je daljnji porast rezistencije i otkrivanje novih MDR uzročnika. Iz tih razloga osobite napore treba uložiti u prevenciju infekcija, jer je prevencija najbolji oblik "liječenja".Liver transplantation has become routine way of treatment in patients with chronic stage of the liver disease and acute liver failure. Thanks to the great progress in the postoperative treatment of patients with the liver transplantation, the prolongation of life is undoubtely evident, as well as smaller number of deaths. Namely, the progress in treatment is primarily being achieved in prevention of the new liver rejection and postoperative infections treatment, which cause the greatest number of deaths in patients with liver transplant. Epidemiological picture of pathogens depends on the time that has elapsed since transplantation. In early postoperative course the majority of infections are being caused by bacteria (mostly gram negative bacilli and gram positive cocci), while in late postoperative course viruses and micobacteria are becoming more frequent. Particular problem nowadays, because of the high mortality in liver transplanted patients, are infections caused by multidrug-resistant pathogens, where therapeutic options are extremely reduced and even in some cases do not exist. Because of extremely large and irrational use of antibiotics, it is logical to expect a further increase in drug resistance and discovery of new multidrug-resistant pathogens. For these reasons, great efforts in prevention of infections should be made, because in the end the prevention is the best form of „treatment“

Infections in patients with liver transplantation

Transplantacija jetre danas je postala rutinski oblik liječenja za bolesnike s kroničnim stadijem jetrene bolesti i akutnim zatajenjem jetre. Zahvaljujući velikom napretku u postoperativnom liječenju bolesnika s transplantacijom jetre vidljivo je nedvojbeno produljenje života tih bolesnika te manji broj umrlih. Napredak u liječenju prvenstveno je ostvaren u sprječavanju odbacivanja novoga organa i liječenju postoperativnih infekcija, koje uzrokuju najveći broj smrti transplantiranih bolesnika. Epidemiološka slika uzročnika ovisi o vremenu koje je proteklo od transplantacije pa tako u ranom postoperativnom tijeku većinu infekcija uzrokuju bakterije (većinom iz flore gram negativnih štapića i gram pozitivnih koka), dok s odmakom od operacije zastupljeniji postaju virusi i mikobakterije. Osobit problem, zbog visoke smrtnosti transplantiranih bolesnika, danas predstavljaju infekcije uzrokovane multiplorezistentnim patogenima (MDR, engl. multiple drug resistance) , za koje su nam terapijske mogućnosti izuzetno sužene, a u nekim slučajevima čak i ne postoje. Zbog izrazito velike i neracionalne primjene antibiotika za očekivati je daljnji porast rezistencije i otkrivanje novih MDR uzročnika. Iz tih razloga osobite napore treba uložiti u prevenciju infekcija, jer je prevencija najbolji oblik "liječenja".Liver transplantation has become routine way of treatment in patients with chronic stage of the liver disease and acute liver failure. Thanks to the great progress in the postoperative treatment of patients with the liver transplantation, the prolongation of life is undoubtely evident, as well as smaller number of deaths. Namely, the progress in treatment is primarily being achieved in prevention of the new liver rejection and postoperative infections treatment, which cause the greatest number of deaths in patients with liver transplant. Epidemiological picture of pathogens depends on the time that has elapsed since transplantation. In early postoperative course the majority of infections are being caused by bacteria (mostly gram negative bacilli and gram positive cocci), while in late postoperative course viruses and micobacteria are becoming more frequent. Particular problem nowadays, because of the high mortality in liver transplanted patients, are infections caused by multidrug-resistant pathogens, where therapeutic options are extremely reduced and even in some cases do not exist. Because of extremely large and irrational use of antibiotics, it is logical to expect a further increase in drug resistance and discovery of new multidrug-resistant pathogens. For these reasons, great efforts in prevention of infections should be made, because in the end the prevention is the best form of „treatment“

Infections in patients with liver transplantation

Transplantacija jetre danas je postala rutinski oblik liječenja za bolesnike s kroničnim stadijem jetrene bolesti i akutnim zatajenjem jetre. Zahvaljujući velikom napretku u postoperativnom liječenju bolesnika s transplantacijom jetre vidljivo je nedvojbeno produljenje života tih bolesnika te manji broj umrlih. Napredak u liječenju prvenstveno je ostvaren u sprječavanju odbacivanja novoga organa i liječenju postoperativnih infekcija, koje uzrokuju najveći broj smrti transplantiranih bolesnika. Epidemiološka slika uzročnika ovisi o vremenu koje je proteklo od transplantacije pa tako u ranom postoperativnom tijeku većinu infekcija uzrokuju bakterije (većinom iz flore gram negativnih štapića i gram pozitivnih koka), dok s odmakom od operacije zastupljeniji postaju virusi i mikobakterije. Osobit problem, zbog visoke smrtnosti transplantiranih bolesnika, danas predstavljaju infekcije uzrokovane multiplorezistentnim patogenima (MDR, engl. multiple drug resistance) , za koje su nam terapijske mogućnosti izuzetno sužene, a u nekim slučajevima čak i ne postoje. Zbog izrazito velike i neracionalne primjene antibiotika za očekivati je daljnji porast rezistencije i otkrivanje novih MDR uzročnika. Iz tih razloga osobite napore treba uložiti u prevenciju infekcija, jer je prevencija najbolji oblik "liječenja".Liver transplantation has become routine way of treatment in patients with chronic stage of the liver disease and acute liver failure. Thanks to the great progress in the postoperative treatment of patients with the liver transplantation, the prolongation of life is undoubtely evident, as well as smaller number of deaths. Namely, the progress in treatment is primarily being achieved in prevention of the new liver rejection and postoperative infections treatment, which cause the greatest number of deaths in patients with liver transplant. Epidemiological picture of pathogens depends on the time that has elapsed since transplantation. In early postoperative course the majority of infections are being caused by bacteria (mostly gram negative bacilli and gram positive cocci), while in late postoperative course viruses and micobacteria are becoming more frequent. Particular problem nowadays, because of the high mortality in liver transplanted patients, are infections caused by multidrug-resistant pathogens, where therapeutic options are extremely reduced and even in some cases do not exist. Because of extremely large and irrational use of antibiotics, it is logical to expect a further increase in drug resistance and discovery of new multidrug-resistant pathogens. For these reasons, great efforts in prevention of infections should be made, because in the end the prevention is the best form of „treatment“

Rijedak slučaj intraneuralnog hematoma medijanog živca nakon stentiranja desne ilijačne arterije: prikaz slučaja

Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.Cilj: Pristup brahijalnoj arteriji alternativni je pristup endovaskularnim intervencijama kada pristup femoralnoj, radijalnoj ili ulnarnoj arteriji nije izvediv, ali nosi veći rizik od periproceduralnih komplikacija nego drugi pristupi, što uključuje i ozljede medijanog živca. Ozljede živca mogu nastati izravnom punkcijom ili kompresijom, pri čemu je najčešći uzrok hematom. Ponekad sindrom mišićnih odjeljaka može pratiti izravnu ozljedu živca, prikrivajući znakove živčane lezije. Prikaz slučaja: Predstavljamo bolesnicu s lažnom aneurizmom brahijalne arterije, okolnim hematomom mekih tkiva, sindromom volarnog mišićnog odjeljka nadlaktice i podlaktice te s istodobnim intraneuralnim hematomom medijalnog živca koji je bio uzrokovan izravnom punkcijom. Ove udružene ozljede nastale su nakon punkcije brahijalne arterije u sklopu endovaskularnog liječenja bilateralne stenookluzivne bolesti ilijačne arterije. Pacijentica je bila uspješno liječena fasciotomijom, izravnim šavom arterije i dekompresijom živca (paraneuriotomijom). Zaključci: Intraneuralni hematom uzrokovan izravnom punkcijom može biti prikriven znakovima pratećeg sindroma mišićnih odjeljaka. Stoga treba staviti naglasak na prevenciju, rano prepoznavanje i pravodobno kirurško liječenje intraneuralnih hematoma, osobito onih popraćenih sindromom mišićnog odjeljka nakon endovaskularnih intervencija

Novel Therapeutic Effects in Rat Spinal Cord Injuries: Recovery of the Definitive and Early Spinal Cord Injury by the Administration of Pentadecapeptide BPC 157 Therapy

Recently, marked therapeutic effects pertaining to the recovery of injured rat spinal cords (1 min compression injury of the sacrocaudal spinal cord (S2-Co1) resulting in tail paralysis) appeared after a single intraperitoneal administration of the stable gastric pentadecapeptide BPC 157 at 10 min post-injury. Besides the demonstrated rapid and sustained recovery (1 year), we showed the particular points of the immediate effect of the BPC 157 therapy that began rapidly after its administration, (i) soon after injury (10 min), or (ii) later (4 days), in the rats with a definitive spinal cord injury. Specifically, in counteracting spinal cord hematoma and swelling, (i) in rats that had undergone acute spinal cord injury, followed by intraperitoneal BPC 157 application at 10 min, we focused on the first 10–30 min post-injury period (assessment of gross, microscopic, and gene expression changes). Taking day 4 post-injury as the definitive injury, (ii) we focused on the immediate effects after the BPC 157 intragastric application over 20 min of the post-therapy period. Comparable long-time recovery was noted in treated rats which had definitive tail paralysis: (iii) the therapy was continuously given per orally in drinking water, beginning at day 4 after injury and lasting one month after injury. BPC 157 rats presented only discrete edema and minimal hemorrhage and increased Nos1, Nos2, and Nos3 values (30 min post-injury, (i)) or only mild hemorrhage, and only discrete vacuolation of tissue (day 4, (ii)). In the day 4–30 post-injury study (iii), BPC 157 rats rapidly presented tail function recovery, and no demyelination process (Luxol fast blue staining)

Antiarrhythmic Sotalol, Occlusion/Occlusion-like Syndrome in Rats, and Stable Gastric Pentadecapeptide BPC 157 Therapy

We focused on the first demonstration that antiarrhythmics, particularly class II and class III antiarrhythmic and beta-blocker sotalol can induce severe occlusion/occlusion-like syndrome in rats. In this syndrome, as in similar syndromes with permanent occlusion of major vessels, peripheral and central, and other similar noxious procedures that severely disable endothelium function, the stable gastric pentadecapeptide BPC 157-collateral pathways activation, was a resolving therapy. After a high dose of sotalol (80 mg/kg intragastrically) in 180 min study, there were cause-consequence lesions in the brain (swelling, intracerebral hemorrhage), congestion in the heart, lung, liver, kidney, and gastrointestinal tract, severe bradycardia, and intracranial (superior sagittal sinus), portal and caval hypertension, and aortal hypotension, and widespread thrombosis, peripherally and centrally. Major vessels failed (congested inferior caval and superior mesenteric vein, collapsed azygos vein). BPC 157 therapy (10 µg, 10 ng/kg given intragastrically at 5 min or 90 min sotalol-time) effectively counteracted sotalol-occlusion/occlusion-like syndrome. In particular, eliminated were heart dilatation, and myocardial congestion affecting coronary veins and arteries, as well as myocardial vessels; eliminated were portal and caval hypertension, lung parenchyma congestion, venous and arterial thrombosis, attenuated aortal hypotension, and centrally, attenuated intracranial (superior sagittal sinus) hypertension, brain lesions and pronounced intracerebral hemorrhage. Further, BPC 157 eliminated and/or markedly attenuated liver, kidney, and gastrointestinal tract congestion and major veins congestion. Therefore, azygos vein activation and direct blood delivery were essential for particular BPC 157 effects. Thus, preventing such and similar events, and responding adequately when that event is at risk, strongly advocates for further BPC 157 therapy