Perfusion of a Kidney Graft from a Donor After Cardiac Death Based on Immediately Started Pulsatile Machine Perfusion

Immediately started pulsatile machine perfusion of a kidney graft from a DCD (donor after cardiac death) as a way to improve its properties Opatrný V. Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague Introduction: The number of kidneys available for transplantation still does not match the number of patients on the waiting list, which gets longer every year. At the same time, kidney transplantation is the only chance for the long-term survival of patients with good quality of life. Therefore, organs from marginal donors, including donors after cardiac death (DCD), have recently been used. The most common cause of death of these donors is severe trauma, especially craniocerebral trauma, or sudden cardiac arrest, followed by unsuccessful resuscitation. Kidneys can be harvested once an individual is declared dead according to the exact criteria. This involves initial washing of the grafts in the donor's body using a perfusion solution, followed by their removal and storage using selected preservation method. Mechanical pulsatile perfusion using special instrumentation is the most frequently used technique in the area of DCD. Despite of good long-term outcomes of grafts from DCDs, this group is burdened by a greater number of delayed graft...Možnosti zlepšení vlastností ledvinných štěpů od nebijících dárců pomocí ihned zahájené mechanické pulzatilní perfuze Opatrný V. Chirurgická klinika FN Plzeň a LF UK v Plzni Úvod: Množství ledvin dostupných k transplantaci stále nedosahuje počtu pacientů na čekací listině, jež se každoročně prodlužuje. Přitom je transplantace ledvin jedinou šancí pacientů na dlouhodobé přežití s dobrou kvalitou života. Proto jsou v poslední době využívány i orgány od tzv. marginálních dárců, mezi něž patří též zemřelí dárci po nezvratné zástavě oběhu (DCD - donors after cardiac death). Nejčastější příčinou smrti těchto dárců je závažné trauma, zejména kraniocerebrální, či náhlá srdeční zástava s následnou neúspěšnou resuscitační péčí. Po konstatování smrti jedince dle přesně daných kritérií, je možno přistoupit k odběru ledvin. Při tom dochází nejprve k promytí štěpů v těle dárce pomocí perfuzního roztoku a následně k jejich vyjmutí a uchování zvolenou prezervační metodou. V oblasti DCD je nejčastěji využívána mechanická pulzatilní perfuze pomocí speciálního přístrojového vybavení. I přes dobré dlouhodobé výsledky štěpů od DCD, je tato skupina zatížena větším počtem opožděného nástupu funkce štěpu (DGF) i primární afunkce štěpu (PNF). Cíl: Shrnutí základních poznatků o DCD a jejich následné využití v experimentální práci....Klinika chirurgickáLékařská fakulta v PlzniFaculty of Medicine in Pilse

Abdominal Aortic Aneurysm and Malignancies

Concomitant AAA and abdominal malignancy are always very complicated conditions requiring early management of both pathologies. This is undoubtedly a dilemma for a surgeon who cannot currently rely on any large randomized trials or mandatory guidelines. When making decisions, a surgeon most often relies on personal experience, the experience of his/her center and/or limited literary guidelines and recommendations. Efforts should be aimed at achieving a consensual multidisciplinary decision about which pathology requires “more acute” management. The decision-making process is easier if one of the pathologies is life-threatening, and such pathology should be managed first. In most cases, however, AAA is asymptomatic and a malignancy is found randomly, as a secondary finding during the follow-up of AAA patients, or vice versa, AAA is found randomly during the staging of cancer patients. In these cases, the therapeutic algorithm already admits several possible variants. Endovascular repair of AAA (EVAR) resulted in an absolute change in the management of these patients. EVAR can be used in simultaneous or stage procedures with minimal time delay. Also, surgical open resection is an option (simultaneously or staged). It is necessary to know the advantages and risks of all approaches

Perfusion of a Kidney Graft from a Donor After Cardiac Death Based on Immediately Started Pulsatile Machine Perfusion

Immediately started pulsatile machine perfusion of a kidney graft from a DCD (donor after cardiac death) as a way to improve its properties Opatrný V. Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague Introduction: The number of kidneys available for transplantation still does not match the number of patients on the waiting list, which gets longer every year. At the same time, kidney transplantation is the only chance for the long-term survival of patients with good quality of life. Therefore, organs from marginal donors, including donors after cardiac death (DCD), have recently been used. The most common cause of death of these donors is severe trauma, especially craniocerebral trauma, or sudden cardiac arrest, followed by unsuccessful resuscitation. Kidneys can be harvested once an individual is declared dead according to the exact criteria. This involves initial washing of the grafts in the donor's body using a perfusion solution, followed by their removal and storage using selected preservation method. Mechanical pulsatile perfusion using special instrumentation is the most frequently used technique in the area of DCD. Despite of good long-term outcomes of grafts from DCDs, this group is burdened by a greater number of delayed graft..

Perfusion of a Kidney Graft from a Donor After Cardiac Death Based on Immediately Started Pulsatile Machine Perfusion

Immediately started pulsatile machine perfusion of a kidney graft from a DCD (donor after cardiac death) as a way to improve its properties Opatrný V. Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague Introduction: The number of kidneys available for transplantation still does not match the number of patients on the waiting list, which gets longer every year. At the same time, kidney transplantation is the only chance for the long-term survival of patients with good quality of life. Therefore, organs from marginal donors, including donors after cardiac death (DCD), have recently been used. The most common cause of death of these donors is severe trauma, especially craniocerebral trauma, or sudden cardiac arrest, followed by unsuccessful resuscitation. Kidneys can be harvested once an individual is declared dead according to the exact criteria. This involves initial washing of the grafts in the donor's body using a perfusion solution, followed by their removal and storage using selected preservation method. Mechanical pulsatile perfusion using special instrumentation is the most frequently used technique in the area of DCD. Despite of good long-term outcomes of grafts from DCDs, this group is burdened by a greater number of delayed graft..

First Year of Donald Trump's Foreign Policy towards DPRK

This Bachelor thesis analyses the main aspects of American foreign policy of Donald Trump's administrative in his first year towards Democratic People's Republic of Korea in context of North Korean nuclear and rocket program. During the year 2017, North Korean regime reached pivotal milestones in nuclear and rocket technologies, which laid the foundations of building large-scale arsenal of intercontinental ballistic missiles with nuclear warheads. This technological progress meant major threat not only for East Asian allies (South Korea and Japan) but even for United States mainland. The policy of previous American administrations did not succeed with solving the North Korean nuclear threat. North Korea proved the capability of circumventing international sanctions and systematically violate agreements. As a result, Donald Trump turned American foreign policy to harder line and primarily used huge American economic and military potential for the enforcement and achievement of his political goals.Bakalářská práce analyzuje hlavní aspekty zahraniční politiky Spojených států amerických v prvním roce úřadování administrativy Donalda Trumpa vůči Korejské lidově demokratické republice v kontextu severokorejského jaderného a raketového programu. Severokorejský režim v průběhu roku 2017 dosáhl na poli jaderných a raketových technologií několika klíčových milníků, které položily zásadní základy pro vybudování arzenálu mezikontinentálních balistických raket s jadernými hlavicemi. Tento technologický pokrok tedy znamenal nejen ohrožení východoasijských spojenců Jižní Koreje a Japonska, ale již i samotných Spojených států. Politika předešlých amerických vlád se s vyřešením severokorejské jaderné otázky nesetkala s úspěchem. KLDR dokázala obcházet mezinárodní sankce a soustavně porušovat uzavřené dohody. Donald Trump v tomto ohledu vsadil zejména na přístup z pozice síly, kdy využíval především obrovského ekonomického a vojenského potencionálu Spojených států k vynucení a dosažení svých mocenských cílů.Katedra severoamerických studiíDepartment of North American StudiesFaculty of Social SciencesFakulta sociálních vě

First Year of Donald Trump's Foreign Policy towards DPRK

This Bachelor thesis analyses the main aspects of American foreign policy of Donald Trump's administrative in his first year towards Democratic People's Republic of Korea in context of North Korean nuclear and rocket program. During the year 2017, North Korean regime reached pivotal milestones in nuclear and rocket technologies, which laid the foundations of building large-scale arsenal of intercontinental ballistic missiles with nuclear warheads. This technological progress meant major threat not only for East Asian allies (South Korea and Japan) but even for United States mainland. The policy of previous American administrations did not succeed with solving the North Korean nuclear threat. North Korea proved the capability of circumventing international sanctions and systematically violate agreements. As a result, Donald Trump turned American foreign policy to harder line and primarily used huge American economic and military potential for the enforcement and achievement of his political goals

Use of a Silver-Impregnated Vascular Graft: Single-Center Experience

Introduction: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. Methods: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. Results: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). Conclusions: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option