Impact of severe diabetic kidney disease on the clinical outcome of autologous cell therapy in people with diabetes and critical limb ischaemia.

AIM: To assess the impact of autologous cell therapy on critical limb ischaemia in people with diabetes and diabetic kidney disease. METHODS: A total of 59 people with diabetes (type 1 or type 2) and critical limb ischaemia, persisting after standard revascularization, were treated with cell therapy in our foot clinic over 7 years; this group comprised 17 people with and 42 without severe diabetic kidney disease. The control group had the same inclusion criteria, but was treated conservatively and comprised 21 people with and 23 without severe diabetic kidney disease. Severe diabetic kidney disease was defined as chronic kidney disease stages 4-5 (GFR <30 ml/min/1.73 m²). Death and amputation-free survival were assessed during the 18-month follow-up; changes in transcutaneous oxygen pressure were evaluated at 6 and 12 months after cell therapy. RESULTS: Transcutaneous oxygen pressure increased significantly in both groups receiving cell therapy compared to baseline (both P<0.01); no significant change in either of the control groups was observed. The cell therapy severe diabetic kidney disease group had a significantly longer amputation-free survival time compared to the severe diabetic kidney disease control group (hazard ratio 0.36, 95% CI 0.14-0.91; P=0.042); there was no difference in the non-severe diabetic kidney disease groups. The severe diabetic kidney disease control group had a tendency to have higher mortality (hazard ratio 2.82, 95% CI 0.81-9.80; P=0.062) than the non-severe diabetic kidney disease control group, but there was no difference between the severe diabetic kidney disease and non-severe diabetic kidney disease cell therapy groups. CONCLUSIONS: The present study shows that autologous cell therapy in people with severe diabetic kidney disease significantly improved critical limb ischaemia and lengthened amputation-free survival in comparison with conservative treatment; however, the treatment did not influence overall survival.

Aorto-iliac endarterectomy: Old-fashioned or re-newed method?

INTRODUCTION: Aorto-iliac occlusive disease is best treated with endovascular angioplasty/stenting or surgical bypass, depending on disease severity. Aorto-iliac endarterectomy was frequently used until the 1980s. However, it can still be performed in cases of previous failure or contraindication of standard methods. The aim was a retrospective evaluation of a single-center case series of aorto-iliac endarterectomy. METHODS: Seven patients at mean age 60±8 years (5768 years) were treated by aorto-iliac endarterectomy between 2013 and 2018. Rutherford categories of leg ischemia were 2 (moderate claudication) 3x, 3 (severe claudication) 2x, 4 (rest pain) and 5 (toe gangrene). The reasons for endarterectomy approach were: late in-stent iliac occlusion in an oncology patient, failure or complication of previous endovascular treatment of short iliac stenosis 2×, high infection risk of prosthesis use in long iliac-femoral occlusion, and short iliac occlusions 3x. Two patients after previous organ transplant were on immunosuppression. RESULTS: Technical success rate was 100%. There was no peri-operative (30 days) death or amputation. Mean follow-up was 17 months (1.1 month3.3 year). One patient required additional tibial bypass 1 month after endarterectomy to heal foot gangrene. One patient developed symptomatic re-stenosis which was treated with iliac stenting 8 months after procedure. All patients clinically improved and recovered from leg ischemia. Two patients died of tumor with preserved limb 1.1 month and 3.1 years after procedure, respectively. Five remaining patients are asymptomatic with patent revascularization to date. CONCLUSION: Aorto-iliac endarterectomy is a vital alternative technique for revascularization in selected patients when other methods seem inappropriate. Key words: endarterectomy - peripheral arterial disease - iliac artery - abdominal aorta.

[Ileocaecal actinomycosis - a case report]. / Ileocékalna aktinomykóza - kazuistika.

Abdominal actinomycosis as an aetiological cause of acute abdomen in immunocompetent patients is considered to be very rare. The authors present a case of a young patient with acute appendicitis in the terrain of specific colitis imitating caecal tumour. Especially nowadays, in the era of globalization, it would be an unnecessary mistake not to think of this aetiological unit when the pain and tenderness in the right hypogastrium with signs of peritonism are expressed.

[Diverticular disease of the large bowel - surgical treatment]. / Divertikulární choroba tracníku - chirurgická lécba.

INTRODUCTION: Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease. AIM: The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel. METHODS: Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon. CONCLUSION: The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.