Council of Europe Black Sea Area Project: International Cooperation for the Development of Activities Related to Donation and Transplantation of Organs in the Region.

BACKGROUND: In 2011, the European Directorate for the Quality of Medicines & Healthcare of the Council of Europe launched a 3-year collaborative project to address the organ shortage and improve access to transplant health services in Council of Europe member states in the Black Sea area (Armenia, Azerbaijan, Bulgaria, Georgia, Moldova, Romania, Turkey, Ukraine, and the Russian Federation) through the development of safe and ethical donation and transplantation programs. OBJECTIVE: Support the development of donation and transplantation programs through close interstate cooperation between national health organizations and relevant stakeholders. METHODOLOGY: Several work packages (WP) were established: WP1, project coordination (European Directorate for the Quality of Medicines & Healthcare); WP2, development and implementation of an effective legislative and financial framework (Czech Republic and France); WP3, establishment of National Transplant Authorities (Italy and Portugal); and WP4, clinical practices (DTI Foundation). Data collection, surveys, and expert visits allowed for the collection of first-hand information from each participant country at national, regional, and hospital levels. RESULTS: Data analysis showed the positive impact of the project represented by a tendency to increase the total donation rates (per million people) in the participant countries (2011 vs 2013): Azerbaijan, +7.3; Armenia, -0.7; Georgia, +3.3; Bulgaria, +0.9; Moldova, +2.5; Ukraine:, +0.8; Romania, +2.3; and Turkey, +2.7. CONCLUSIONS: Increases in total donation rates are the result of a number of initiatives in the Black Sea area, including the stepwise implementation of legislative, organizational and institutional country-specific recommendations tailored by the CoE, efforts of the respective Ministries of Health in each country and synergism with other European projects in the region. These countries should invest further in implementing the recommendations that emerged from this project to improve their organ donation and transplantation programs and progress toward self-sufficiency.

Intermediate to late results of surgical relief of vascular tracheobronchial compression.

Since 1979, a total of 69 infants and children aged 0.1 to 11.9 (median 0.7) years required surgical intervention for: double aortic arch (26), anomalous origin of innominate artery (26), right aortic arch with left ligamentum arteriosum (9), pulmonary artery sling (5), retroesophageal right subclavian artery (3). Before operation, the morbidity was high: 84% of children were symptomatic in the first trimester of life with 24 patients requiring mechanical ventilation. Seven children had an accompanying heart defect. Left thoracotomy was the preferred approach. There were 2 early (asphyxic brain damage, postoperative pneumonia) and 2 late (tracheomalacia, complex heart defect) deaths. Five patients (2 originally operated elsewhere) needed reoperation for persistent symptoms. All 65 survivors are well 1 month to 11.9 (mean 3.9 +/- 3.62) years after surgery. Tracheobronchoscopy, magnetic resonance imaging, and lung function testing were helpful for postoperative evaluation. Minor tracheal compression was revealed in 4 patients despite their good clinical condition.

Stenosing processes due to endotracheal intubation and tracheostomy in children.

In 1976-1978 there were 15 children hospitalized in the Children's ORL Clinics in Prague and treated for larynx trauma caused by long-term endotracheal intubation. Tracheostomy was performed in all cases, the changes in the larynx were mostly treated in a conservative manner. In one instance we used laryngofissura; however, further dilatations had to be carried out. With a single exception, all the patients have been healed successfully. Plastic operations were performed to make decannulation easier.

[The physician and the computer. 26. Commercial software]. / Lékar a pocítac. 26. Komercni software.

The authors give an account of different types of commercially supplied programmes which can be used also in the health services. They discuss the properties and types of different software - data base programmes, text processors, graphic and statistical programmes and finally so-called integrated software along with data on possible mutual combinations. At the same time also general conditions for the application of these programmes within the framework of clinical informations systems are discussed incl. their advantages and short-comings.

[Laryngotrachoesophageal cleft]. / Laryngotracheozofageální rozstep.

In 1988-1989 the authors diagnosed and treated in the Paediatric Faculty Hospital in Prague 5 - Motol three neonates with a rare developmental anomaly--a cleft of the larynx, trachea and oesophagus. This rare anomaly was not yet published in our literature. Once a grade II cleft was observed, twice a grade III cleft. All neonates died. The authors discuss diagnostic and therapeutic problems associated with successful therapy. Early diagnosis, depending on the evaluation of the contrast examination of the deglutition pathways and endo scopic examination, are the basis for successful surgical treatment.

[The role of bronchoalveolar lavage in the diagnosis and therapy of recurrent respiratory tract diseases in children]. / Prínos bronchoalveolárních lavází pro diagnostiku a lécbu opakovaných respiracních onemocnení u detí.

In 32 patients with relapsing bronchopneumonia, bronchiectasis, relapsing obstructive bronchitis and asthma bronchiale during aimed bronchoscopy bronchoalveolar lavage was made (BAL). The authors found typical cytological findings and deviations in the phosphatidyl choline level which is the main constituent of the pulmonary surfactant. The authors evaluated the importance of the surfactant for the proper function of the lungs and outlined possible therapeutic measures which by the action of some drugs will influence its formation.

[Surgical treatment of congenital vascular anomalies causing tracheoesophageal compression]. / Chirurgická lécba vrozených cévních anomálií zpusobujících tracheoezofageální útlak.

Forty four children underwent surgery for congenital vascular anomalies causing tracheal compression in Kardiocentrum--Motol during last ten years. Double aortic arch was encountered 18 times, tracheal compression by the innominate artery in 12 instances, right aortic arch with left ligamentum arteriosum and possibly aberrant left subclavian artery 7 times, pulmonary artery sling in 5, finally aberrant right subclavian artery twice. The age of the children was 2 weeks to 11 years (median 6 months). Stridor was present in 38 infants under 3 months, 17 children with severe dyspnoea had artificial ventilation or were resuscitated or hospitalized at the intensive care department. In four an associated cardiac defects was present. The diagnosis was made by oesophagography, echography, laryngotracheoscopy, in the majority of children it was confirmed by angiography of the sometime with tracheobronchography. The operation was performed in 41 children from left-sided thoracotomy, the vascular ring was released by resection or retraction of the compromising vessel and connective tissue from the trachea. Serious stenosis of the distal trachea in one patient found before operation persists one year after operation, the patient breathes through an individual tracheostomic cannula. Four children could not be extubated for prolonged periods after operation, they were re-operated, the annulus was released. Three patients died, one from bronchopneumonia during the postoperative period, the second one from hypoxic brain damage and the third one after operation of a complex heart disease. In 40 children satisfactory long-term results were achieved, the operation resolved respiratory complaints. The prerequisite of satisfactory results in an accurate diagnosis, early indication of the operation and a perfect surgical operation and good postoperative care.

[Psychodiagnostics of learning disabilities (author's transl)]. / Psychodiagnostik bei Lernbehinderten.

Various procedures for psychodiagnosis of mentally disabled persons are critically described. Diagnostics and therapy are conceived as a process that should not be fragmented. Advantages and disadvantages of a rigidly structured diagnostic approach are discussed. The various possibilities for psychological examination of the learning disabled are accepted as a meaningful foundation for subsequent stimulation and therapy only if they include cooperation of the parents and the therapeutic or functional personnel. Anamnesis as well as observation and analysis of behaviour are emphasised as especially needed diagnostic tools. This is illustrated by means of the diagnosis of aggressive behavioural disorders in learning disabled included in a therapy group. The main emphasis in psychological management of the mentally disabled is placed on behavioural therapy. The author posits departure from its more orthodox methods, and suggests orientation towards Lazarus' model. The necessity for the therapist to be committed with his whole personality is regarded as fundamental to a community for diagnosis and therapy.

[Hemangiomas of the larynx in children--results of surgical treatment]. / Hemangiomy hrtanu u detí--výsledky chirurgické lécby.

Surgical treatment of six cases of haemangiomas of the larynx. Surgery was used only after all conservative means were exhausted. After complete removal of the tumour after a two-year interval no relapse was recorded. The function of the larynx was not impaired.

[Tracheobronchography in neonates and infants with obstruction of the upper respiratory tract]. / Tracheobronchografie novorozencu a kojencu s obstrukcí horních dýchacích cest.

In the period of 1980 to 1989 the authors performed contrast examinations of tracheobronchial tree in 38 children up to one year of age, three of them being newborns. In 29 examined children (74.4%) there was an anatomical defect causing the obstruction of upper respiratory pathways. In 15 of them the trachea compression was caused by pressure of hyperplastic thymus on the brachiocephalic arterial truncus crossing trachea. For visualization of upper respiratory pathways Hexabrix 320 (Byk Gulden) was used in 30 children, administered in 10 cases by jet ventilation. The filling was recorded by radiocinematographic method.