Sborník lékar̆ský
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Sborník lékar̆ský · Jan 2003
Review[Kidney transplantation from paediatric cadaveric donors to adult recipients (review article)].
The basic problem of all developed transplant programs is organs deficiency available for transplantation. There is an effort within last 10 years to get each organ for transplantation that it is supposed to be functional for several years. These problems also occur in the program of kidney transplantation. ⋯ All at once the present surgical technique is described and the problems of some post-operative complications are discussed, especially the higher occurrence of primary graft non-function. The principle that kidneys from donor up to three years should be transplanted as a block to the single recipient is emphasized. In conclusion the author recommends, on the basis of his own experiences, the realizing of these transplantations.
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Sborník lékar̆ský · Jan 2002
Review[Disseminated intravascular coagulation syndrome and protein C].
Disseminated intravascular coagulation (DIC) is characterized by systemic activation of the haemostasis. In many instances the release of inflammatory cytokines and tissue factor trigger the system in septic or traumatic conditions. Initially, the increased activation of haemostasis can be compensated by natural inhibitor systems. ⋯ Fresh frozen plasma, blood transfusion, and fibrinogen concentrate correct the bleeding, if needed, in the case of traumatic (obstetric) DIC. Arrest of the activated haemostasis by heparin and natural anticoagulants (antithrombin or/and protein C) is recommended, mainly in septic conditions with systemic inflammatory reactions. A case of stercoral sepsis usefully treated by recombinant human activated protein C is reported.
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To evaluate response of cardiovascular system in laparoscopic surgery. The main aim was: 1--comparison of healthy subjects and morbid obese population, 2--comparison of healthy subjects and cohort of patients with organic cardiopathy. Secondly we compared the influence of the operation position. ⋯ Our data were obtained on relatively small cohort of patients but the number of patients was respected by statistics and results might be borderline but significant. Laparoscopic gastric band (operation is done in semi-sitting position) in morbid obese patients is well tolerated without any differences in comparison to healthy population. The population of patients with severe organic cardiopathy needs careful approach. Our data are favourable but significant change in the left ventricle filling together with non-significant hemodynamic disadvantageous trends in EF, CI and MAP requires care. Further investigations are needed and with intraoperative monitoring (transesophageal echocardiography is preferred) can be considered as safe.
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The dynamic changes in levels of procalcitonin (PCT), as well as other cytokines and acute phase proteins (APP) in post-operative stages reflect the systemic immune response, integrating perioperative infectious and non-infectious stimuli. This study evaluates PCT in context of 16 other inflammatory parameters in patients with different types of infectious post-operative complications. It analyses the specificity and sensitivity of PCT, cytokines and APP and their relationships during systemic inflammatory response. ⋯ Individual inflammatory parameters vary in sensitivity and specificity to causative stimulus. PCT when compared to major cytokines and APP reacts sensitively mainly to systemic stimuli accompanying bacterial infection, notably endotoxin. It is characterized by markedly lower sensitivity to non-bacterial stimuli (trauma of surgery) or localized bacterial inflammations. It is this behaviour that makes it a useful diagnostic tool in post-op courses. Unlike other parameters, PCT allows with sufficient sensitivity and specificity single-test diagnosis of initial sepsis.
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Many neurological diseases cause permanent ventilatory insufficiency. In the ambulatory care we consider regular observation of these patients as a very important. ⋯ Invasive home care ventilation is very difficult and needs adequate social, medical and economical conditions. We present one case.