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.
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 prema proširenim kriterijima lošiji zbog veće učestalosti oštećenja tijekom prezervacije 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 prema proširenim kriterijima i darivatelja prema standardnim kriterijima. Ovaj cilj uključuje strogu kontrolu skraćivanja vremena hladne ishemije, odabira primatelja, prilagođene protokole imunosupresije, povećanja mase nefrona s transplantacijom “dva u jedan” i primjenu histoloških kriterija u odabiru presatka marginalnog darivatelja. Zasad nema mnogo objavljenih radova o ishodu transplantiranog bubrega darivatelja s akutnim zatajenjem bubrega ili visokom zadnjom vrijednosti kreatinina u serumu. Ovim preglednim člankom željeli smo prikazati najnoviju definiciju marginalnog darivatelja i darivatelja s akutnim zatajenjem bubrega. Primatelji bubrega darivatelja prema 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 prema proširenim kriterijima mogu sigurno transplantirati odabranim primateljima s dobrim kratkoročnim i dugoročnim ishodom.
Aging is a natural process that occurs in all tissues and organs resulting in a decreasing functional capacity. Aging of the population results in an increased number of elderly patients who require ...replacement of renal function. Renal transplantation is the method of choice for this group of patients if they have no contraindications for immunosuppressive therapy. The lack of donors is the main obstacle for renal transplantation. However, the use of organs from elderly donors for transplantation in elderly recipients is an appropriate method of renal replacement therapy in this group of patients.
The presence of end-stage renal disease (ESRD) has been associated with profound clinical effects on hemostasis ranging from thrombosis to bleeding complications. The pathogenesis of uremic bleeding ...is multifactorial. It has been attributed to platelet dysfunction, the most important feature, particularly platelet-platelet and platelet-vessel wall interactions. Renal replacement therapy has helped reduce bleeding episodes, but the risk of morbidity and mortality due to hemorrhage persists. Abnormalities of blood coagulation and fibrinolysis predispose uremic patients to hypercoagulable state carrying the risk of atherosclerotic cardiovascular disease and thrombotic complications such as thrombosis of the vascular access wall. There are differences in the measurement of various hemostatic parameters in patients with ESRD concerning treatment with either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Hemostatic disturbances are overlapped by changes in the coagulation/fibrinolytic system after renal transplantation (RT). Despite the etiology, renal transplant patients are at an increased risk of thromboembolic events as a consequence of prothrombotic clotting and fibrinolytic abnormalities. This hypercoagulable state is to a large extent associated with immunosuppressive drugs. This review will give a summary of views on hemostasis in patients with ESRD and after RT.
We report a case of a complete, ectopic blind-ending ureteral duplication in a 26-year-old man who presented with the symptoms of an acute urinary tract infection for the first time. Since anamnestic ...data and clinical examination indicated a complicated urinary infection he was referred for further examination. On the left side, the imaging studies revealed a normal ureter draining the lower pole of the kidney and a blind-ending ureter with ectopia in the seminal vesicle. The patient recovered completely following surgical removal of the blind-ending ureter.
It has been appreciated for a long time that surgery is the treatment of choice for pancreatic pseudocysts. Endoscopic internal drainage is an alternative to surgical intervention, but requires ...bulging of pseudocyst in gastric lumen and carries the risk of bleeding from gastric vessels. Endosonographically guided pseudocyst drainage, an elegant one-step method to connect gastric lumen with pseudocyst avoiding the risk of bleeding using EUS guidance and Doppler is described with review of literature. The procedure was for the first time successfully performed in Croatia.
Background and Aims: Disorders of haemostasis by hydroxyethyl starch (HES) are mostly affected with large and highly substituted HES molecules or with longer duration and larger amount of HES ...infused. The development of HES solution with lower molecular weight and lower degree of substitution (HES 130/0.4) provides important advantage which affects less coagulation in vivo (8, 11, 13, and 16). We conducted a pilot study to evaluate influence of the HES 130/0.4 solution on coagulation parameters in patients with benign prostatic hyperplasia (BPH) undergoing transurethral
resection (TURP) in spinal anaesthesia.
Patients and Methods: Seventeen patients scheduled for TURP were
enrolled in this pilot study. For intravascular volume replacement, only HES 130/0.4 was used during and 1 hour after surgery. The venous blood samples have been taken 1 hour before surgery (as control) and 1 hour postoperative. Standard coagulation parameters prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, platelet count, fibrinogen were measured and whole blood coagulation was assessed using thromboelastography (TEG).
Results: Coagulation time (CT) and clot formation time (CFT) increased significantly postoperative both in Intrinsic Thromboelastography (INTEM) and Extrinsic Thromboelastography (EXTEM). Maximum clot firmness (MCF) decreased significantly in postoperative period in all TEG test INTEM, EXTEM and Fibrinogen Thromboelastography (FIBTEM) and alpha angle (α) decreased significantly both in INTEM and EXTEM. Despite significant postoperative changes of TEG parameters, they were
still within normal clinical range.
Discussion: We concluded that intravascular replacement exclusively
with HES 130/0.4 may be a safe choice for patients during TURP estimated by TEG.
Prikazan je rijedak slučaj zdjelične i retroperitonealne lipomatoze koji traje više od tri desetljeća. Iako je ova bolest u svojoj naravi dobroćudna ona uglavnom s vremenom napreduje te može dovesti ...do bubrežne insuficijencije, a mogućnosti liječenja su ograničene s upitnim rezultatima. Opisuju se kliničke značajke, slike intravenske urografije te kompjutorizirane tomografije i magnetske rezonance, kao i diferencijalna dijagnoza te terapijske mogućnosti liječenja zdjelične i retroperitonealne lipomatoze.
