Transplantacija bubrega od preminulih darivatelja s povišenom zadnjom vrijednosti kreatinina

The increasing number of possible recipients for kidney transplantation and relatively unchanged number of organ donors has led to consideration of alternative strategies and expansion of deceased donor criteria in order to expand donor pool. Previously, kidneys from expanded criteria donors (ECD) were strongly underestimated because of the conventional opinion suggesting these kidneys to have a higher rate of preservation injury, delayed graft function, rejection and nonfunction. Reducing the difference between graft outcome in patients transplanted from ECD and standard criteria donor (SCD) is one of the goals of many respectable kidney transplantation centers. This assignment includes major concern about reduction of cold ischemia time, recipient selection, novel and adapted immunosuppressive regimens, increased nephron mass by dual kidney transplantation, and using histologic criteria for marginal donor graft selection. There are not many reports on the outcome of kidneys transplanted from donors with acute renal failure and high terminal creatinine. This review presents the exact definition of marginal donor, especially donor with acute renal failure. The management of such grafts during preimplantation and implantation period, outcomes and post-transplantation care are the main assignments for transplantation teams. Recipients of such grafts should be well informed about the possibilities and potential complications and sign their informed consent thereafter. Some respectable studies have shown that under certain, highly controlled conditions, these kidneys can be used safely, with excellent short- and long-term outcomes.Ukupni broj darivatelja organa u posljednje je vrijeme nepromijenjen, a sve veći broj potencijalnih primatelja bubrega na listi čekanja doveo je do razvoja novih strategija i proširenja kriterija kojima se procjenjuje mogući darivatelj organa. Prije se smatralo da su bubrezi darivatelja po proširenim kriterijima lošiji zbog veće učestalosti oštećenja tijekom konzerviranja bubrega, češće odgođene funkcije presatka, odbacivanja i primarne afunkcije organa. Danas je mnogim velikim transplantacijskim centrima cilj smanjenje razlike u ishodu presatka transplantiranog s darivatelja po proširenim kriterijima i darivatelja po standardnim kriterijima. Ovaj cilj uključuje strogu kontrolu u skraćivanju vremena hladne ishemije, odabira primatelja, prilagođene protokole imunosupresije, povećanje mase nefrona s transplantacijom “dva u jedan” i primjenu histoloških kriterija u odabiru grafta marginalnog darivatelja. Zasad nema mnogo objavljenih radova o ishodu transplantiranog bubrega darivatelja s akutnim zatajenjem bubrega ili visokom zadnjom vrijednosti kreatinina u serumu. Namjera ovoga preglednog članka je prikazati najnoviju definiciju marginalnog darivatelja i darivatelja s akutnim zatajenjem bubrega. Primatelji bubrega darivatelja po proširenim kriterijima moraju tijekom prijetransplantacijske obrade biti dobro obaviješteni o svim mogućnostima i komplikacijama takvog postupka, te potpisati obaviješteni pristanak. Poznate studije pokazale su da se pod strogo kontroliranim kriterijima bubrezi darivatelja po proširenim kriterijima mogu sigurno transplantirati odabranim primateljima, s dobrim kratkoročnim i dugoročnim ishodom

Comparison of Vertical Forces during Root Canal Filling with Three Different Obturation Techniques

The aim of this study was to examine and compare vertical forces exerted during root canal obturation with the cold lateral condensation technique, Thermafil technique and ProTaper guttapercha. Fourty-five single-rooted permanent teeth were used in the study. All specimens were instrumented using the ProTaper rotating technique and were randomly divided into three experimental groups (n=15 per group). In the first group, root canals were obturated using the cold lateral condensation technique. In the second group, the Thermafil technique was used to obturate root canals. In the last group, a ProTaper gutta-percha of the same taper as the instrumented root canals was used for root canal obturation. Vertical forces were measured using the device developed for simulation of endodontic treatment. The results showed a statistically significant difference (p=0.0001) for vertical forces when cold lateral condensation obturation technique was used in comparison to other techniques. No statistically significant difference was found for vertical forces during obturation with Thermafil and ProTaper gutta-percha (p=0.16). The cold lateral condensation technique exerted higher vertical forces in comparison to the Thermafil and ProTaper obturation techniques

In vitro Antioxidant and Antibacterial Activity of Lamiaceae Phenolic Extracts: A Correlation Study

U radu je spektrofotometrijski određen udjel ukupnih fenola i fenolnih podgrupa u ekstraktima pet biljaka iz porodice Lamiaceae (kadulja, majčina dušica, matičnjak, menta i mravinac), a udjel je pojedinih fenola utvrđen pomoću visokodjelotvorne tekućinske kromatografije. Antioksidacijska je aktivnost ekstrakata ispitana pomoću različitih metoda, a njihov antibakterijski učinak s pomoću najvažnijih patogenih bakterija prisutnih u hrani, kao što su: Campylobacter coli, Salmonella Infantis, Escherichia coli, Bacillus cereus, Listeria monocytogenes i Staphylococcus aureus. Najveći su udjeli ukupnih fenola i neflavonoida pronađeni u ekstraktu kadulje, koji je imao i najbolji antibakterijski učinak, osobito na Gram-pozitivne bakterije i C. coli. Najbolja je reducirajuća snaga i sposobnost uklanjanja molekula slobodnih radikala dokazana za ekstrakt matičnjaka, koji je imao najveći udjel ružmarinske kiseline. Nadalje, analizom glavnih komponenata ispitan je utjecaj fenola, osobito ružmarinske kiseline, na biološka svojstva ekstrakata biljaka iz porodice Lamiaceae. Udjel je ružmarinske kiseline bio u pozitivnoj korelaciji sa svim antioksidacijskim parametrima, što potvrđuje njezin značajan doprinos antioksidacijskoj aktivnosti ispitanih ekstrakata.Total phenols and phenolic subgroups of five Lamiaceae plant extracts (sage, thyme, lemon balm, peppermint and oregano) were determined spectrophotometrically, whereas the individual phenolics were determined by high-performance liquid chromatography. The antioxidant activity of the extracts was evaluated by means of a multiple method approach, while the antibacterial activity was tested against major foodborne pathogens such as Campylobacter coli, Escherichia coli, Salmonella Infantis, Bacillus cereus, Listeria monocytogenes and Staphylococcus aureus. The highest content of total phenolics and non-flavonoids was detected in the sage extract, which also showed the best antibacterial activity, especially against Gram-positive bacteria and C. coli. The best reducing power and free radical scavenging activity were obtained in lemon balm extract, with the highest content of rosmarinic acid. Additionally, the effect of the phenolics, especially rosmarinic acid, on biological properties of Lamiaceae plant extracts was investigated using principal component analysis. Rosmarinic acid showed good correlation with all antioxidant parameters, confirming its significant contribution to antioxidant activity of investigated plant extracts

Učinak niske doze preemptivnog intravenskog magnezij sulfata na ranu poslijeoperacijsku bol nakon laparoskopske kolecistektomije

As an N-methyl-D-aspartate antagonist, magnesium sulfate has analgesic properties and reduces noxious input during surgery. The aim of the study was to determine the effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. In this prospective, randomized study, 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were assigned to three groups (n=20 each). After anesthesia induction, prior to surgical incision, patients received magnesium sulfate 5.0 mg/kg (group A), magnesium sulfate 7.5 mg/kg (group B) or saline intravenously (group C). General anesthesia was performed with the same drugs in all three groups. Postoperative pain intensities at rest, according to the visual analog scale (VAS 0-10), were evaluated at 1, 3, 6, 9 and 24 hours after surgery. According to the VAS scores, patients intravenously received metamizol 2.5 g (VAS 3-4), diclofenac 75 mg (VAS 5-7) or tramadol 1 mg/kg (VAS 8-10). VAS scores at 1 hour postoperatively were significantly lower in groups A (4.7±1.7; p<0.05) and B (3.2±1.8; p<0.01) than in group C (5.2±2.0). At 3 hours postoperatively, VAS score was significantly lower in group B (2.4±1.5) than in group A (3.7±1.8) or group C (3.8± 2.3) (p<0.05). After 6, 9 and 24 hours postoperatively, there were no differences in VAS scores among the groups. In conclusion, preemptive intravenous administration of both 5.0 mg/kg and 7.5 mg/kg of magnesium sulfate significantly reduced early postoperative pain after laparoscopic cholecystectomy, but 7.5 mg/kg was found to be more effective. There was no effect on pain reduction at 6, 9 and 24 hours after surgery and no adverse effects were recorded.Magnezij sulfat kao antagonist N-metil-D-aspartata ima analgetski učinak i smanjuje osjet boli tijekom operacijskog zahvata. Cilj ove studije bio je odrediti učinak preemptivne intravenske primjene male doze magnezij sulfata na bol u ranom poslijeoperacijskom tijeku nakon laparoskopske kolecistektomije. U ovom prospektivnom randomiziranom istraživanju 60 bolesnika ASA I-II koji su podvrgnuti laparoskopskoj kolecistektomiji podijeljeno je u tri skupine po 20 bolesnika. Nakon uvoda u anesteziju, a prije kirurškog reza, bolesnici su intravenski dobili 5 mg/kg magnezij sulfata (skupina A), 7.5 mg magnezij sulfata (skupina B) ili fiziološku otopinu (skupina C). Intenzitet poslijeoperacijske boli je ocijenjen vizualnom analognom skalom (VAS 0-10) 1, 3, 6, 9 i 24 sata nakon operacijskog zahvata. Na osnovi zbroja VAS bolesnici bi intravenski primili metamizol 2,5 mg (VAS 3-4), diklofenak 75 mg (VAS 5-7) ili tramadol 1 mg/kg (VAS 8-10). Zbrojevi VAS su prvog poslijeoperacijskog sata bili značajno niži u skupini A (4,7±1.7; p<0,05) i skupini B (3,2±1,8; P<0,01) nego u skupini C (5,2±2,0). Tri sata nakon operacijskog zahvata zbroj VAS u skupini B (2,4±1,5) je bio značajno niži nego u skupini A (3,7±1,8) ili skupini C (3,8±2,3) (P<0,05). Nakon 6, 9 i 24 sata nije bilo razlike među skupinama. U zaključku, preemptivna intravenska primjena 5,0 i 7,5 mg/kg magnezij sulfata značajno smanjuje poslijeoperacijsku bol nakon laparoskopske kolecistektomije, ali je 7,5 mg/kg bilo učinkovitije

KIDNEY TRANSPLANTATION IN HIV POSITIVE RECIPIENTS

Zbog razvoja visoko aktivne antiretroviralne terapije (HAART) produljen je životni vijek HIV pozitivnih bolesnika zbog čega im raste rizik razvoja kroničnih bolesti među kojima je i kronična bubrežna bolest. Terapijske opcije za nadomještanje bubrežne funkcije uključuju peritonejsku dijalizu, hemodijalizu i transplantaciju bubrega. HIV infekcija je dugo bila apsolutna kontraindikacija za transplantaciju bubrega zbog bojazni od primjene imunosupresijske terapije. Danas se, zbog napretka na području antiretroviralne terapije i zbog boljeg razumijevanja farmakoloških interakcija između HAART i imunosupresije, uspješno provodi. Mi smo do sada u KBC-u Zagreb uspješno proveli transplantaciju bubrega u dva HIV pozitivna bolesnika.With development of highly active antiretroviral therapy (HAART), HIV positive patients have longer life expectancy and therefore a higher risk of developing chronic diseases such as chronic kidney disease. HIV associated nephropathy is one of the most common causes of end stage renal failure in HIV positive patients. Therapy choices for renal replacement therapy for those patients are peritoneal dialysis, hemodialysis and kidney transplantation. HIV infection was considered as absolute contraindication for transplantation due to fear from consequences of immunosuppression. Today, with HAART and better understanding in pharmacology, interactions between HAART and immunosuppression, kidney transplantation is an option in HIV positive patients. Two cases of deceased-donor kidney transplantation in HIV positive patients were performed at the Zagreb University Hospital Centre