RESUMO
BACKGROUND: Intrahepatic cholangiocarcinomas are the second most common malignant tumors of the liver with an unfavorable prognosis. The role of CA19-9 in terms of patient prognosis is still under debate in the literature. OBJECTIVE: The aim of the present study was to investigate the prognostic value of preoperatively assessed CA19-9 levels in patients with intrahepatic cholangiocarcinoma after surgery. MATERIAL AND METHODS: A total of 63 patients suffering from intrahepatic cholangiocarcinoma underwent surgery between March 2001 and February 2013 at the West German Cancer Center in Essen, Germany. The follow-up ended in December 2017. The UICC stages, clinicopathological parameters and postoperative tumor-specific survival rates were analyzed with respect to preoperatively measured CA19-9 serum levels. RESULTS: Increased CA19-9 serum levels correlated with higher UICC tumor stages and other unfavorable clinicopathological parameters. Moreover, patients with preoperative elevated CA19-9 serum levels displayed significantly reduced overall survival rates (especially >1000â¯U/ml vs. ≤1000â¯U/ml; median overall survival: 14.05 months vs. 42.40 months; pâ¯= 0.0003). CONCLUSION: Preoperatively assessed CA19-9 levels >1000â¯U/ml are a strong negative prognostic factor of postoperative disease-specific survival in patients suffering from intrahepatic cholangiocarcinoma. Future studies are necessary to evaluate if patients with highly elevated CA19-9 serum levels should be considered for modified treatment strategies (e.â¯g. neoadjuvant or adjuvant therapy).
Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Antígeno CA-19-9 , Colangiocarcinoma , Neoplasias dos Ductos Biliares/diagnóstico , Antígeno CA-19-9/análise , Colangiocarcinoma/diagnóstico , Alemanha , Humanos , PrognósticoRESUMO
BACKGROUND: Since the introduction of minimally invasive surgery its use in liver resections is controversial. The importance of laparoscopic liver surgery within a large collective has been studied insufficiently to date. OBJECTIVES: In this article we report our experiences with minimally invasive liver resections. METHODS: A retrospective analysis was conducted looking at all patients in our clinic where a laparoscopic liver resection was performed between 01 January 2000 and 30 April 2013. RESULTS: In total, we performed 94 laparoscopic liver resections in 90 patients (female n = 44, 46.8 %, male n = 50, 53.2 %) with 28 primary and 63 secondary liver tumors and 3 tumors remaining unclear. Of these 62 were atypical or wedge resections, 19 segmental resections, 8, left lateral and 3 right lateral resections as well as 1 hemihepatectomy left and 1 right. Switching to an open resection intraoperatively was necessary in eight cases. Postoperative complications were observed in two patients, one patient experienced a postoperative cerebral artery stroke and one patient died on postoperative day 13 from sepsis in multiorgan failure. The average operative time was 145 ± 82.34 min (range 10-430 min) and the average hospital stay 7 days. In 79 patients an R0 resection was achieved. CONCLUSIONS: Laparoscopic liver resection can be considered a safe procedure for the treatment of liver tumors. The accurate selection of patients and appropriate expertise of the attending team in minimally invasive surgery are essential to the outcome.
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Carcinoma Hepatocelular/cirurgia , Neoplasias Colorretais/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Hepatopatias/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adolescente , Adulto , Idoso , Conversão para Cirurgia Aberta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: The current organ donor shortage in Germany results in the death of 1000 patients on the transplant waiting list every year. In response, a recent amendment to the German Transplant Act aiming to increase donor rates was passed. Among a number of other measures, Germans are asked to decide whether they choose to donate organs or not in the event of a brain death or whether they would like to designate someone who should decide for them in this situation. The objective of this study was to collect and evaluate data on the public's attitude toward organ donation before the expected amendment. METHODS: A survey on the subject of organ donation was conducted in 2011 among clients of a public pharmacy in a major city in the federal state North Rhine-Westphalia, Germany. Data regarding sex, age, health behavior, and attitude toward the amendment were collected and association organ donor card possession was analyzed. RESULTS: A total of 1485 questionnaires were evaluated. Of those surveyed, only 14.1% had an organ donor card. No statistically significant associations between sex (P value .3045), age (P value .1453) and the possession of a donor card were observed. We found that 72.5% of respondents stated that they appreciated the expected amendment, and in the case of implementation, the majority would obtain an organ donor card. DISCUSSION: The future success of transplantation medicine relies on an increase in the public's overall willingness to donate organs. Educating the public and ensuring transparency in transplantation medicine are vital to achieving higher donation rates. The new German transplantation act may be an important step to increase society's awareness and participation in organ donation.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/organização & administração , Adolescente , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Opinião Pública , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The relevance of hollow organ trauma in severely injured patients within a large collective has not been thoroughly reviewed as yet. This study aimed at assessing the prevalence of hollow organ trauma in relation to the outcome and the currently established method of treatment. PATIENTS AND METHODS: Altogether data of all patients of the Trauma Register of the German Society of Trauma Surgery (DGU) (1993â-â2009) were interpreted retrospectively. All patients with an "Injury Severity Score" (ISS)â≥â16, direct admission to a trauma centre and an age of ≥â16âyears were included. All patients with abdominal trauma (AISabdomenâ≥â2) were compared with patients with hollow organ trauma (AIShollow organâ≥â2). The following organs were attributed to the hollow organs: stomach, small intestine (duodenum, jejunumâ/âileum), colon, gall bladder and urinary bladder. RESULTS: From 9268âpatients with abdominal injuries 1127 (12.2â%) additionally showed a hollow organ injury (AISabdomenâ≥â2, AIShollow organ 2â-â5) and were analysed in dependence on the classification of the "American Association for the Surgery of Trauma" (AAST) organ severity score. AAST-hollow organ: II°: 4.6â%, III°: 5.3â%, IV°: 2.1â%, V°: 0.2â%. Patients with leading hollow organ injury (gradesâIV and V) thereby showed a significant increase of lethality (IV°: 32.7â% and V°: 31.3â%). With an increasing grade of hollow organ injury, however, the ISS increased as well. Lethality was not increased over the expected lethality rate (RISC score) due to the additional hollow organ injury though. CONCLUSION: The results presented here show the prevalence and the outcome of hollow organ injury in a large collective within the Trauma Register of the DGU for the first time.
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Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Trato Gastrointestinal/lesões , Trato Gastrointestinal/cirurgia , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/cirurgia , Sistema de Registros , Bexiga Urinária/lesões , Bexiga Urinária/cirurgia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sociedades Médicas , Taxa de Sobrevida , Adulto JovemRESUMO
Knowledge of an individual's human leukocyte antigen (HLA) genotype is essential for modern medical genetics, and is crucial for hematopoietic stem cell and solid-organ transplantation. However, the high levels of polymorphism known for the HLA genes make it difficult to generate an HLA genotype that unambiguously identifies the alleles that are present at a given HLA locus in an individual. For the last 20 years, the histocompatibility and immunogenetics community has recorded this HLA genotyping ambiguity using allele codes developed by the National Marrow Donor Program (NMDP). While these allele codes may have been effective for recording an HLA genotyping result when initially developed, their use today results in increased ambiguity in an HLA genotype, and they are no longer suitable in the era of rapid allele discovery and ultra-high allele polymorphism. Here, we present a text string format capable of fully representing HLA genotyping results. This Genotype List (GL) String format is an extension of a proposed standard for reporting killer-cell immunoglobulin-like receptor (KIR) genotype data that can be applied to any genetic data that use a standard nomenclature for identifying variants. The GL String format uses a hierarchical set of operators to describe the relationships between alleles, lists of possible alleles, phased alleles, genotypes, lists of possible genotypes, and multilocus unphased genotypes, without losing typing information or increasing typing ambiguity. When used in concert with appropriate tools to create, exchange, and parse these strings, we anticipate that GL Strings will replace NMDP allele codes for reporting HLA genotypes.
Assuntos
Algoritmos , Técnicas de Genotipagem/normas , Antígenos HLA/imunologia , Transplante de Células-Tronco Hematopoéticas , Teste de Histocompatibilidade/normas , Transplante de Órgãos , Receptores KIR/imunologia , Alelos , Frequência do Gene , Genótipo , Técnicas de Genotipagem/estatística & dados numéricos , Antígenos HLA/genética , Teste de Histocompatibilidade/estatística & dados numéricos , Humanos , Polimorfismo Genético , Receptores KIR/genética , Análise de Sequência de DNA , Terminologia como Assunto , Doadores não RelacionadosRESUMO
BACKGROUND: The decreasing number of organ donors in Germany remains a major issue in transplantation medicine. The aim of this study was to estimate the organ donor potential at German maximum care hospitals. METHODS: To critically review potential in comparison with organ donation rates in 2010. We separated Maximum care hospitals into university institutions (A-level) and centers with a neurosurgical unit (B-level) based upon the size of hospital as indicated by the total number of beds. To estimate the number of possible organ donors, we adopted the American model previously published by Sheehy et al: the potential was 0.015 organ donors/bed/year for hospitals with more than 350 beds. RESULTS: In 2010 overall in Germany there were 1296 organ donations resulting in 4205 transplanted organs. University hospitals realized 397 organ donations namely 0.008 organ donors/bed/year (57% of calculated organ donor potential), whereas B-level hospitals accounted for 555 of organ donors with a rate of 0.007 organ donors/bed/year (48% of calculated organ donor potential). Large variations in realizing organ donations occurred among single hospitals. CONCLUSION: Our results indicated a substantial potential to increase organ donation rates in German maximum care hospitals. These hospitals (n = 145) are responsible for 73% (non-maximum care hospital n = 1195) of the absolute organ donor pool. Further studies are needed to evaluate possibilities to address the organ shortage particularly with regard to donor detection in intensive care units and also the refusal rate by families.
Assuntos
Hospitais , Doadores de Tecidos/provisão & distribuição , Humanos , Doadores de Tecidos/estatística & dados numéricosRESUMO
BACKGROUND: Due to the lack of donor organs many patients cannot be helped in time with the necessary transplantation in Germany. At the same time, there is an organ donor potential that is not being exploited. A high refusal rate with a low rate of organ donor card holders remains problematic. The objective of this study was to collect the rate of holders of organ donor cards in a collective and to evaluate the collective according to other attributes in the context of a targeted trial. METHODS: In 2009, a three-part questionnaire including an educational text regarding the topic of "organ donation" was sent out to the employees of the Sparkasse Essen (a savings bank). RESULTS: Altogether, 974 out of 1480 (65.8â%) completely answered questionnaires were evaluated. 21.3â% of the respondents had an organ donor card at the time the survey was carried out. A statistically significant association between gender (p value, 0.0438), age (p value, 0.0267) and the possession of a donor card could be determined. 22.1â% of the respondents who participated in sports regularly or donated blood (p value, <â0.0049), were holding an organ donor card. 60â% of the respondents found the brief information to be sufficient, 22.6â% could imagine acquiring an organ donor card for them based on the presented information alone. CONCLUSION: The spread of information and transparency in transplant medicine are essential for the facilitation of "willingness to donate organs". In the framework of this trial, besides data analysis, also fundamental information on "organ donation" could be conveyed. After all, 95.3â% of the respondents have read the information material and hence document the success of the study.
Assuntos
Inquéritos e Questionários , Doadores de Tecidos/educação , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/organização & administração , Adolescente , Adulto , Atitude Frente a Saúde , Feminino , Alemanha , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Adulto JovemRESUMO
PURPOSE: The relevance of abdominal vascular injuries in polytraumatic patients within a large collective has not yet been thoroughly analyzed. This study aimed at assessing the prevalence of traumatic injuries in relation to outcome and currently established treatment options. METHODS: 51,425 patients from the Trauma Registry of the German Society of Trauma Surgery (TR DGU) (1993-2009) were analyzed retrospectively. All patients who had an Injury Severity Score (ISS) of ≥16, were directly admitted to a trauma center and subsequently received treatment for at least three days, were ≥16 years old, and had an abdominal injury (AISabdomen ≥2) were included. Patients with abdominal trauma (AISabdomen ≥2) were compared with patients with additional vascular trauma (AISvascular 2-5). RESULTS: 10,530 (20.5 %) of the 51,425 patients had documented abdominal injury. 760 (7.2 %) of the patients with abdominal injury additionally showed abdominal vascular injury (AISabdomen ≥2, AISvascular 2-5) and were analyzed based on the classification of the American Association for the Surgery of Trauma (AAST) organ severity score (AAST vascular injury grade: II, 2.4 %; III, 2.7 %; IV, 1.8 %; V, 0.2 %. Patients with high-grade abdominal vascular injury (grades IV and V) showed a significant increase in mortality (IV, 44.6 %; V, 60 %) and consequently a decrease in the need for surgical intervention (IV, 67.4 %; V, 64 %). CONCLUSIONS: The results presented here show the prevalence and outcome of abdominal vascular injuries in a large collective within the TR DGU for the first time. Based on the current literature and these findings, a treatment algorithm has been developed.
RESUMO
BACKGROUND: The relevance of renal trauma in severely injured patients within a large collective has not yet been thoroughly reviewed. This study aimed at assessing the prevalence of renal trauma in relation to the outcome and the currently established method of treatment. PATIENTS AND METHODS: Altogether data of 35,664 patients of the TraumaRegister of the German Society of Trauma Surgery (DGU) (1996-2007) were interpreted retrospectively. All patients with an injury severity score (ISS) ≥16, direct admission to a trauma center and an age of ≥16 years were included. All patients with abdominal trauma (AIS(Abdomen) ≥2) were compared with patients with abdominal and renal trauma (AIS(Kidney) ≥2). RESULTS: A total of 18,416 patients fulfilled the inclusion criteria of which 6,218 (34.1%) had abdominal injuries. Of these patients with abdominal injury 835 (13.3%) additionally showed a kidney injury (AIS(Abdomen) ≥2, AIS(Kidney) 2-5) and were analyzed according to the classification of the American Association for the Surgery of Trauma (AAST) organ-severity-score. AAST kidney: II°: 45.5%, III°: 31.1%, IV°: 15.6%, V°: 7.8%. Patients with leading kidney injury (grade IV and V) thereby showed a significant increase in mortality (IV: 32.3% and V: 40.0%) and an increase in the need for surgical intervention (IV: 61.5 and V: 81.5%). With an increasing grade of renal injury, however, the ISS is also increased but mortality was not increased over the expected mortality rate (RISC score) due to the additional renal injury. Dialysis rate in the surviving patients showed an increased rate depending on the degree of the kidney injury (II: 5.5%, III: 7.6%, IV: 18.8%, V: 8.3%). CONCLUSION: The results presented here show the prevalence and the outcome of kidney injury in a large collective within the TraumaRegister of the DGU for the first time. Based on the current literature and the findings a treatment algorithm has been developed.
Assuntos
Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/terapia , Sistema de Registros , Diálise Renal/mortalidade , Adulto , Algoritmos , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Diálise Renal/estatística & dados numéricos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Doenças das Artérias Carótidas/diagnóstico , Artéria Carótida Primitiva , Diagnóstico Diferencial , Hematoma/diagnóstico , Neoplasias Hipofaríngeas/diagnóstico , Infarto da Artéria Cerebral Média/diagnóstico , Pescoço , Fístula Vascular/diagnóstico , Doença Aguda , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/cirurgia , Implante de Prótese Vascular , Doenças das Artérias Carótidas/cirurgia , Endarterectomia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , RupturaRESUMO
BACKGROUND: A chronic shortage of organs for transplantation has developed due to the disparity between the demand for solid organs and the current supply. Improved processes for identifying potential donors could expand the pool of available organs. PATIENTS AND METHODS: All patients who died between January 1, 2006 and December 31, 2008 in the University hospital of Essen suffering from a primary or secondary cerebral injury were assessed retrospectively. Age, date of death, duration of stay in the intensive care unit, main and additional diagnoses and diagnostic test for assessing brain death as well as discussions with relatives were recorded anonymously. RESULTS: 424 deaths with primary or secondary cerebral injury (group A) were identified during the study period. 267 deaths (62.9â%) (group B) were further evaluated for organ donation after excluding absolute medical contraindications, e.âg. malignancies, multiple organ failure. In 68 cases (16.0â%), diagnostic test of brain death had been completed (group C). Despite a high refusal rate, 36 (8.5â%) organ procurements were realized (group D) resulting in 140 transplanted organs (3.9 per organ donor). CONCLUSION: The first crucial step to improve the rate of organ donation is to identify any potential donor. In 8.5â% of intensive care unit deaths with primary or secondary cerebral damage, organ procurement was realized. In addition, education regarding transplant medicine and a positive attitude to organ donation among the general public as well as medical personnel is necessary to minimize the high refusal rates.
Assuntos
Morte Encefálica , Lesões Encefálicas/mortalidade , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Causas de Morte , Coleta de Dados/estatística & dados numéricos , Documentação/estatística & dados numéricos , Seleção do Doador/estatística & dados numéricos , Seleção do Doador/tendências , Previsões , Alemanha , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Hospitais Universitários/normas , Humanos , Consentimento Livre e Esclarecido/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/tendênciasRESUMO
OBJECTIVE: Hilar cholangiocarcinoma is the fourth most common gastrointestinal malignancy. CA19-9 and CEA are helpful devices in the management of gastrointestinal malignancies and belong to clinical routine in surgical oncology. But the validity of these parameters in terms of tumor extension and prognosis of bile duct malignancies still remains unclear. METHODS: From 1998 to 2008, we obtained preoperative CA19-9 and CEA serum levels in 136 patients with hilar cholangiocarcinoma. We correlated tumor stage, resectability rate and survival with preoperative CA 19-9 and CEA serum levels. RESULTS: CA19-9 (UICC I: 253 ± 561U/ml; UICC II: 742 ± 1572 U/ml; UICC III: 906 ± 1708 U/ml; UICC IV: 1707 ± 3053U/ml) and CEA levels (UICC I: 2.9 ± 3.8U/ml; UICC II: 4.6 ± 6.5 U/ml; UICC III: 18.1 ± 29.6 U/ml; UICC IV: 22.7 ± 53.9 U/ml) increase significantly with rising tumor stage. Patients with pre?operative serum levels of CA19-9 (>1000U/ml) and CEA (>14.4ng/ml) showed a significant poorer resectability rate and survival than patients with lower CA19-9 and CEA serum levels respectively. CONCLUSION: CA19-9 and CEA serum levels are associated with the tumor stage. If preoperatively obtained CA19-9 and CEA serum levels are highly elevated patients have an even worse survival and the frequency of irresectability is significantly higher.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Biomarcadores Tumorais/sangue , Colangiocarcinoma/diagnóstico , Adulto , Idoso , Neoplasias dos Ductos Biliares/sangue , Neoplasias dos Ductos Biliares/patologia , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Colangiocarcinoma/sangue , Colangiocarcinoma/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , PrognósticoRESUMO
OBJECTIVE: Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. METHODS: 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score >16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I) and conservative managed patients (II)). RESULTS: From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3%) of the patients with splenectomy and 102 (18.5%) without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2%) in both groups. After massive transfusion of red blood cells (>10) non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40%) and sepsis (38% vs. 25%). CONCLUSIONS: Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3) and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.
Assuntos
Sepse/etiologia , Baço/lesões , Esplenectomia/efeitos adversos , Infecção da Ferida Cirúrgica/complicações , Ferimentos não Penetrantes/cirurgia , Adulto , Medicina de Emergência , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Sepse/mortalidade , Infecção da Ferida Cirúrgica/mortalidade , Taxa de Sobrevida , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/mortalidadeRESUMO
OBJECTIVE: Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation. METHODS: We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well. RESULTS: A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%). CONCLUSION: Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.
Assuntos
Transplante de Rim , Infecções Relacionadas à Prótese/epidemiologia , Stents/efeitos adversos , Ureter/cirurgia , Infecções Urinárias/epidemiologia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Enterococcus/isolamento & purificação , Escherichia coli/isolamento & purificação , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Fatores Sexuais , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologiaRESUMO
INTRODUCTION: A model of orthotopic liver transplantation in swine was developed to investigate an advanced reperfusion approach. Thereby, we consciously disclaim otherwise commonly practiced venovenous bypass during the recipient operation. MATERIAL AND METHODS: Ten liver transplantations were performed according to the described technique without using venovenous bypass. In each swine the observation period was 48 h. RESULTS: All transplantations were carried out after a median cold ischemic time of 307.5 min (295-340); the median warm ischemic time in these cases was 25 min (20-32). Eight of 10 swine survived 48 h after the operation. CONCLUSION: Orthotopic liver transplantations in the recipient swine are feasible even without using venovenous bypass.
Assuntos
Transplante de Fígado/métodos , Anastomose Cirúrgica , Animais , Ducto Colédoco/cirurgia , Modelos Animais de Doenças , Feminino , Hemofiltração , Hepatectomia/métodos , Artéria Hepática/cirurgia , Transplante de Fígado/mortalidade , Transplante de Fígado/fisiologia , Transplante de Fígado/veterinária , Veia Porta/cirurgia , Traumatismo por Reperfusão , Suturas , Suínos , Veia Cava Inferior/cirurgiaRESUMO
The persistent shortage of organs for transplantation could be minimized by increasing the number of potential donors. The opinion of the staff of a university hospital toward organ donation is of special interest because they are directly involved in solid organ transplantation. In 2007, we conducted a first voluntary survey concerning organ donation among the staff of the university hospital of Essen. A short information campaign and further opinion poll among staff as well as visitors was performed in 2009 to compare professional and public attitudes toward organ donation. The first poll comprised 242 questionnaires showing 55% of the hospital staff carrying organ donor cards, particularly more women (60%) than men (46%). After this survey, an additional 19% of the hospital staff imagined they might carrying an organ donor card in the future. In the second survey, we analyzed 151 questionnaires, showing 66% of staff members carrying an organ donor card, an incidence significantly greater than among visitors (48%). The need for information regarding organ donation was greater among visitors (35%). However, 21% of the hospital staff still also need education concerning organ donation. More education and increased transparency of transplantation practice are necessary for hospital staff to act successfully as initiators. Hospital staff with positive attitudes toward organ donation may have a positive impact on the attitudes of the general public toward organ donation.
Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos em Hospital/psicologia , Obtenção de Tecidos e Órgãos , Feminino , Alemanha , Inquéritos Epidemiológicos , Hospitais Universitários , Humanos , Aprendizagem , Masculino , Estado Civil , Caracteres Sexuais , Inquéritos e Questionários , Obtenção de Tecidos e Órgãos/estatística & dados numéricosRESUMO
Pandemic influenza A (H1N1) virus infection is rapidly spreading and has also become a common problem in Germany. Many cases with severe clinical presentation and death have been documented, especially in persons with underlying medical conditions. As of December 15, 2009, Germany has reported 119 H1N1-associated deaths. We report here the first H1N1-associated death in Germany, a 36-year-old woman with morbid obesity. The patient underwent a laparotomy with colon resection due to colon ischemia, a rare visceral complication in such cases. In this article an attempt has been made to reflect the state of requirements in terms of safety, occupational health, hygiene and working conditions with respect to activities involving logistics in the diagnostics, treatment (also surgical) and handling of such patients. Given the rapidly evolving nature the outbreak of human infection with the novel influenza A (H1N1) virus, influenza vaccination is recommended as the only way to prevent the infection of health care workers and patients with underlying medical conditions.
Assuntos
Colectomia/métodos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Obesidade Mórbida/cirurgia , Adulto , Evolução Fatal , Feminino , Humanos , Influenza Humana/mortalidade , Obesidade Mórbida/complicaçõesRESUMO
OBJECTIVE: Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function. METHODS: All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk. RESULTS: Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33%) as compared to marginal recipients, of whom two-thirds received a marginal organ (p<0.0001). Graft function significantly differed between the groups, but detrimental effect of marginal recipient status on eGFR after 12 months (-6 ml/min/1.73qm, 95% CI -2 to -9) was clearly smaller than the effect of marginal donor status (-10 ml/min/1.73qm, 95% CI -7 to -14). CONCLUSIONS: As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.
Assuntos
Falência Renal Crônica/mortalidade , Transplante de Rim/mortalidade , Transplante de Rim/normas , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Adulto , Distribuição por Idade , Idoso , Cuidados Críticos/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Histocompatibilidade , Humanos , Falência Renal Crônica/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Fatores de RiscoRESUMO
INTRODUCTION: Each year in Germany, the lack of donor organs results in more than 1000 patients dying while on the transplant waiting list. At the same time, there is an organ donor potential that is not being exploited. The objective of this study was to collect the rate of holders of organ donor cards among public officials in a major German city. METHODS: In 2007, a survey was conducted among public officials in Essen, North Rhine-Westphalia, Germany, regarding the topic of organ donation. Gender, age, and the "indicator for organ donation willingness" were stratified and analyzed according to the holding of organ donor cards. RESULTS: A total of 1582 completely answered questionnaires were evaluated; 20.92% of the respondents had an organ donor card. No statistically significant association between gender (P = .0691), age (P = .8513), or possession of a donor card could be determined. We observed a significant correlation (P < .0001) between the indicator for organ donation willingness and possession of an organ donor card. DISCUSSION: Based on current research, we consider an up-to-date, broader-reaching, representative inquiry necessary for our society. Should this present similar results, then a special education campaign is necessary, which considers sociocultural backgrounds and responds to the indicator for organ donation willingness that we analyzed. In so doing, one individual goal is the promotion of health and body awareness and thus an increase in the associated potential organ donor willingness.
Assuntos
Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos , Adolescente , Adulto , Atitude Frente a Saúde , Família , Feminino , Alemanha , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Inquéritos e Questionários , Doadores de Tecidos/psicologia , População Urbana , Adulto JovemRESUMO
BACKGROUND: Currently, organ transplantation is the treatment of choice for patients with chronic or acute organ failure. However, due to a lack of donor organs, every day three patients die on the waiting list for transplantation. At the same time there is a high potential of organ donors that is not utilized. Statements concerning the number of potential donors are possible only to a limited extent at present. Objective of this study was to collect the rate of holders of organ donor cards among the employees of the city of Essen before a targeted awareness raising campaign had been carried out. PATIENTS AND METHODS: A questionnaire was sent out to the employees of the city of Essen in 2007. Gender, age and the "indicator for readiness for organ donation" were stratified and analyzed according to the holding of organ donor cards. The indicator reflects the evaluation of health awareness in the respondents. RESULTS: Altogether, 1 814 questionnaires were evaluated. 20 % of the respondents were holding an organ donor card at the time of the survey. No association between gender (p-value 0.17) respectively age (p-value 0.79) and the possession of an organ donor card could be detected. 23 % of the respondents who regularly worked out or donated blood were identified as organ donor card holders. This is significantly more (p-value < 0.0001) than in respondents where this criterion did not apply. CONCLUSION: In order to optimize the potential of organ donors in the long term, it is necessary to reconsider and advance attitude towards the readiness for organ donation. Further spreading of information and education as well as transparency in the transplantation medicine are essential for this project.