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Improvements in immunosuppressive therapy during the past decade brought about improvements of the long term tolerance of organ allografts. However, the long-term immunosuppressive therapy has an important limitation, because it can increase the risk of cardivascular diseases, infections and tumors. As compared with age-matched healthy population, organ-transplant recipients have an increased incidence of tumors.

Results of a formative evaluation of a patient education documentation system will be presented. Both quantitative and qualitative approaches to data collection are being used. The goal of integrating patient education documentation into the electronic patient record is to facilitate seamless, multidisciplinary patient/family education across time and settings. The system is being piloted by oncology services at The Nebraska Medical Center. The evaluation addresses the usability and comprehensiveness of the system.

Paper refers the first in Czech Republic liver transplantation in a child with the donor being the close living relative - the father. Indication was the chronic liver failure caused by biliary atresia after the Kasai procedures, which enabled the child to survive two years. Liver segments II. -III were transplanted with favourable postoperative development. Within the following twenty months the nutrition status and the psychomotor development of the child significantly improved. Authors discuss present situation and results of the paediatric liver transplantation in the world.

In a prospective pilot study, we evaluated the possibility of performing a total parathyroidectomy with parathyroid gland implantation into the forearm (a combined neck and upper extremity procedure) under cervical epidural anesthesia (CEA) at C6-7 level using ropivacaine. The indication for CEA was the patient's choice or a previous procedure on the neck with unilateral vocal cord paralysis. Anesthesia was induced by 10 mL of 0.75% ropivacaine plus 10 mug of sufentanil in 2 mL. Block onset time, success rate, analgesia, sensory block extent, changes in respiratory and hemodynamic variables, complications, and length of hospital stay were assessed. All 15 procedures were successfully performed under CEA. Sensory block was registered in the range C2-T10, with a lower median of T3. The upper margin of sensory block was C2 in all patients. Of the respiratory variables, the only significant decrease was observed in forced vital capacity; none of the patients developed clinically significant respiratory insufficiency. We conclude that combined procedures involving the neck and upper limbs can be performed using CEA with ropivacaine. CEA allows verbal communication with patients and early detection of vocal cord paralysis.

An increasing number of abdominal aortic aneurysms occurs in renal failure patients because of an accelerated atherosclerosis process associated with uraemia. When technically feasible, endovascular repair of an abdominal aortic lesion should be considered as the treatment of choice. If a surgical repair is suggested, there are several options to select from. Since November 1999, we performed simultaneous aortic reconstruction using fresh arterial allograft and kidney transplantation in five uraemic patients with asymptomatic abdominal aortic aneurysm. The operative and postoperative course of four patients passed without major complications. One patient had ischaemic colitis early after the operation, which required a partial resection of the colon. One patient died 6 weeks after the operation due to non-vascular causes. In conclusion, the advantage of our single-phase procedure is that both diseases are treated simultaneously during a single hospital stay. Moreover, with our procedure, the risk of vascular graft infection in patients with chronic immunosuppression is low.

Pancreas transplantation is a routine method for the treatment of diabetes mellitus. One of the main challenges of a transplant with extraperitoneal placement of the pancreatic graft is impaired wound healing due to massive amylase and lipase secretion by the pancreatic graft, evoking edemtous fluid. From February 2002 through January 2003, we performed pancreatic transplant procedures in 21 patients who were prospectively and randomly assigned to two groups: 8 organ donors and the recipients were administered somatostatin by continuous infusion. Thirteen grafts were harvested and transplanted without somatostatin infusion. The two groups did not show significantly differences in mean donor or recipient ages, weights, of serum amylase and lipase content values or drain output until day 6. There was a significantly lower lipase in the drain output of transplant recipients given somatostatin (12.5 and 54.2 micromol/L, respectively; P <.05). Neither the post-pancreatic transplant wound healing nor the number of rejection episodes were affected by somatostatin administration.

Although the number of pancreas transplants has increased significantly in previous years, debate continues concerning the optimum technique for exocrine pancreas drainage. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD). We prospectively assigned 40 consecutive pancreas transplant recipients to either bladder (n = 20) or enteric (n = 20) drainage. Patient, kidney, and pancreas graft survival rates at 1 year after simultaneous kidney-pancreas transplantation were 95%, 95%, 85%, for BD group and 90%, 85%, 85% for ED group, respectively. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections, and CMV disease were similar between groups. The length of the initial hospital stay was likewise comparable. However, the BD group showed a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Based on the results of our study, patient and graft survivals were excellent irrespective of technique.

Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibilities for obliterating arterial disorders of low extremities or for the abdominal aortic aneurysm in patients waiting for organ transplantation. Between the year 1998 and the end of the year 2002, our work-team performed parallel reconstructions of the abdominal aorta using fresh grafts and cadaverous kidney transplantations in a group of five patients. The simultaneous surgical treatment of the both disorders during a single hospitalization as well as a considerable decrease of the artificial blood vessel prosthesis infection risk during chronic imunosuppression, represent the biggest advantage of this method. On the other hand, the risk of possible surgical complications is increased in these patients. During the operation and postoperation period, our four patients suffered from no serious complications. In case of one patient, ischemic colitis occurred which required surgical revision and subtotal colectomy. In this article, the authors describe the postoperation course of the patient condition with the above complication, which required a close cooperation of surgeons, anesthesiologists and nephrologists, in full detail.

Transplantation of pancreas is presently the only way of treating diabetes of the 1st type, capable to secure a long-term normoglycemia. In spite of the fact that the surgical technique and tactics of the whole intervention has been standardized over the last years, surgical complications and more specifically vascular complications still pose a certain risk of the graft loss. The thrombosis of vessels of the transplanted pancreas occurred in our group in 4.1 per cent of cases. The other rare complications included a false aneurysm of the supplying artery and stenosis of the out-coming vein from the pancreatic graft. Both these complications were successfully treated by a radio-invasive approach. A refinement of the surgical technique and the introduction of new immunosuppressive drugs manifests favorably in decreasing occurrence of vascular complications after the transplantation of pancreas.

Only marginally improved results have been observed in standard autonomic function tests (AFT) in follow-up studies after simultaneous pancreas and kidney transplantation (SPK). We therefore used power spectral analysis (PSA) of heart rate variability (HRV) to assess the effect of SPK on autonomic neuropathy in patients with type I diabetes mellitus (DM I). We evaluated 82 patients with DM I who were insulin and dialysis free following SPK. Both pre- and posttransplant (at [mean +/- SD], 25 +/- 15 months post-SPK) examinations were performed in 29 patients. Posttransplant evolution was examined in another 60 patients with two serial examinations at 20 +/- 20 and 43 +/- 27 months after SPK. Comparisons included 32 age-matched healthy controls and 13 patients with kidney transplant alone (KTA) matched for age and duration of DM I at a comparable time point posttransplant. Short-term time (modified Ewing battery) and frequency domain (PSA of HRV: LF-low, HF-high frequency, and TP-total spectral power) analysis was performed with a telemetric, on-line, computer-aided system. Significantly worse results in all standard AFT and PSA indexes were obtained for SPK patients compared with controls at all time points. No significant improvement was seen in SPK patients in the posttransplant period and no differences were found compared with KTA patients. Thus the results of a power spectral analysis of HRV failed to show improvement following SPK. This examination adds little positive information to that obtained from standard autonomic function tests.

Background: The aim of our study was to evaluate the potential advantages of the left retroperitoneal (RP) approach for abdominal aortic surgery and compare the aortic exposure with the transperitoneal (TP) approach which is widely used., Patients and Methods: Total 55 consecutive patients who underwent elective aortic surgery between 1998 and 1999 were evaluated retrospectively. Thirty three patients underwent the RP exposure and 22 the TP approach in the treatment of abdominal aortic aneurysm or aortoiliac occlusive disease. Demographic data and premorbid status were not significantly different between these two groups. Fourteen intraoperative and postoperative parameters were monitored and statistically analyzed., Results: We found statistically significant differences in three of 14 intraoperative and postoperative parameters. Patients operated with the RP approach to the abdominal aorta were able to take clear fluids orally sooner. A statistically significant difference was also detected in the postoperative extubation time as RP patients were extubated almost one hour sooner than TP patients. Bowel function onset was statistically significantly faster return in the RP group. In the rest of recorded data there were no significant differences, however in all of follow-up parameters we found results in favour of RP group., Conclusion: We conclude that the RP group of patients had statistically significant improvements three of 14 postoperative clinical parameters. (Tab. 3, Ref. 18.)

Aim: The aim of this retrospective analysis was assessment of both patency and limb salvage rates of diabetic ischemic feet which underwent pedal bypass surgery within the period of 3 years., Material and Methods: Authors evaluated 50 critically ischemic diabetic feet where the pedal bypass was indicated for limb salvage. Total 41 pedal bypasses were performed and median follow-up was 16.7 months (1-39). The free muscle transfer were performed either in one session with or subsequently after the pedal bypass surgery in six limbs., Results: Authors achieved 61% and 76% graft patency and limb salvage rates, respectively, within the median 16.7 months follow-up. All successfully revascularised feet healed up within the median period of 3 months postoperatively. No patient died within 30 days postoperatively., Conclusion: We conclude, that pedal bypass is safe procedure with acceptable limb salvage rate in the medium-term follow-up. Surgeons can markedly extend an indication criterions for limb salvage by exploiting of this technique.

The authors present their results of the treatment of diabetic foot critical ischemia by means of surgical revascularisation together with minor amputation or debridement. They discuss the causes of higher amputations and re-amputations in revascularised ischemic diabetic lower limbs and presents patency rates in different types of peripheral arterial bypasses. The authors evaluated 81 diabetic feet with chronic critical ischemia, where they performed 50 arterial bypass procedures in the 50 limbs (13 femoropopliteal, 13 femorodistal, 19 pedal bypasses and 5 aorto/ilicofemoral or extraanatomical bypasses). 41 minor amputations or debridements (82%), 6 minor re-amputations (12%) was performed in the group of 50 revascularised limbs. The primary patency rates, secondary patency rates and limb salvage was achieved 92%, 92% and 92% in femoropopliteal bypass, 91%, 91% and 92% in femorodistal bypass, 78%, 83% and 84% in pedal bypass, respectively. The average follow-up time was 11.4 months. 6 minor re-amputations (12%) and 5 high amputations was necessary to perform in the group of 50 revascularised lower limbs. The main cause of re-amputation and high amputation was continuing ischemia. 30 day mortality rate was 0%, 30 day morbidity rate was 8% (myocardial infarction and pulmonary embolism).

The authors present the results of 100 pancreatico-duodenal grafts placed extraperitoneally with the bladder drainage. The onset of pancreatic graft function was immediate in all cases and the patients became insulin free. Despite the extraperitoneal graft placement the incidence of surgical complications was low. The only exception was slightly impaired wound healing. The Authors claim that this surgical technique allows the elimination of intraperitoneal infection and easy performance of the graft biopsy.

The authors present the technique of chemical lumbar sympathectomy by an anatomically new medial transdiscal approach. On a group of 80 operations they analyze the indication criteria, complications and results of this method. They compare the percutaneous technique of severing of the sympathetic nerve with the classical surgical approach. In 41 patients where a modified transdiscal approach was used the authors did not encounter any serious complications. Using thin needles (minimum 23-G) they recommend this method as an alternative of the classical approach of Kappis.

A formerly established theory on obliteration of diabetic foot arteries was dismissed. In the last decade, diabetic foot revascularization using so called very distal bypass has became a routine procedure. The reconstructions are undertaken in patients with chronic critical limb ischemia. This paper presents our initial experience with this, not yet widely used, operative technique in 16 patients who had a total of 14 pedal bypass procedures performed. The parameters we monitored included the 3-, 6-, and 12-month patency rates, defect healing, and limb salvage rates. The primary and secondary patency rates were 64.3% and 78.6% at 3 months; 55.5% and 66.7% at 6 months; and 50% and 75% at one year, respectively. The overall limb salvage rate for the above periods was 92.9%. All defects healed following successful revascularization using pedal bypass. In patients where bypass could not be established, limb salvage was accomplished in one in three cases only.

The most frequently used surgical technique in transplantations of the pancreas is to connect the duodenum of the graft with the urinary bladder of the recipient. Introduction of this method led during the last five years to marked improvement of results. On the other hand duodenocystoanastomosis is a frequent cause of metabolic and urological complications in patients after transplantation. The authors present the case-record of a female patient after combined transplantation of the pancreas and kidney where surgical conversion of the drainage of pancreatic juice from the urinary bladder to the gut was necessary.

The number of combined transplantations of the pancreas and kidney in type I diabetics with chronic renal failure is increasing every year. The authors present their experience with a new technique of duodenocystostomy during this transplantation. The use of a circular stapler to create the duodenocystoanastomosis can hasten the surgical procedure and reduce at the same time the risk of development of a pancreatic fistula.

Prophylaxis by means of antibiotics in the form of a so-called "protected coagulum" is an important part of prevention of postoperative infections in renal transplantations. The antibiotic is selected with regard to its effectiveness against the most frequent pathogens, tissue penetration, undesirable effects (in particular nephrotoxicity). The authors investigated a group of 450 renal transplantations with cefotaxime prophylaxis. During the four-week follow-up period after operation infection of the surgical wound (abscess, purulent secretion) occurred in 15 patients (3.33%). The mentioned results indicate that cefotaxime is suitable for use as a protected coagulum also in patients with postoperative immunosuppression.