[Bloodstream infections after liver and hematopoietic stem cell transplantation]. / Infekcije krvotoka u bolesnika nakon transplantacije jetre i krvotvornih maticnih stanica.

The aim of this retrospective study was to evaluate and compare the incidence, timing and etiology of bloodstream infections (BSIs) in patients treated with liver-(LT) or hematopoietic stem cell transplantation (HSCT) in a single institution. We evaluated 280 consecutive transplantations over a period of 34 months. Our results demonstrated 84 episodes of BSIs (47 in LT patients and 37 in HSCT patients) at a median of 28 days post-transplantation. Relative incidence of 34.6 and 29.4 BSI episodes per 100 LT and HSCT patients, respectively, did not differ significantly between the two groups (p = 0.52). BSIs in HSCT patients occurred significantly earlier (p = 0.003) than in LT patients. The recently described reemergence of gram-negative (GN) pathogens as causative agents of BSIs in these patients was confirmed: GN bacilli were the predominant isolates in the LT group, responsible for 58.5% of BSIs and a very frequent (39%) cause of BSIs in the HSCT group. A higher incidence of resistant enterobacteriaceae producing extended spectrum beta-lactamases was found in isolates from LT patients compared to HSCT patients. In both groups, Pseudomonas aeruginosa was the most difficult to treat organism, with 57% of these isolates in LT patients and 44% in HSCT patients being resistant to carbapenems. To conclude, BSIs were confirmed to be important infectious complications of both LT and HSCT. Surveillance and analysis of bacteria causing bloodstream and other serious infections in transplanted patients remain the main prerequisites for planning interventions regarding prevention and treatment of infections in these patients.

Epitheloid hemangioendothelioma in patient with liver transplantation.

Malignant hepatic epithelioid hemangioendothelioma (HEH) is a rare malignant tumor of vascular origin with unknown aetiology and a variable natural course. At the time of diagnosis, most patients present with multifocal tumours lesions that involve both liver lobes. From the therapeutic aspect, liver resection (LRx), liver transplantation (LTx), chemotherapy, radiotherapy, and/or immunotherapy have been used in the treatment of patients with HEH. However, because of the rarity of this tumor and its unpredictable natural history, it is impossible to assess the effectiveness of these respective therapies. In this report, our objective was to present clinical aspects, diagnostic options, therapeutic modalities, and the clinical outcome of single patient with LTx because of this rare tumor.

Parvovirus B 19 (PVB19) induced pure red cell aplasia (PRCA) in immunocompromised patient after liver transplantation.

Presented here is a case of human parvovirus B19 (PVB19) induced pure red-cell aplasia (PRCA) in immunocompromised patient after orthotopic liver transplantation (OLT). PVB19 is a small, single-stranded DNA whose target cell is the erythroid progenitor in bone marrow. Manifestations of PVB19 infection vary with the immunologic status of the patient, ranging from asymptomatic to severe infections and PRCA. Post-transplant PRCA is induced either by immunosuppressive agents or PVB19. In the presented case, bone marrow aspiration characterized by the absence of mature erythroid precursors and detection of PVB19 DNA in blood led to treatment with high-dose intravenous human immunoglobulins (IVIG) and subsequent recovery of erythropoiesis. Due to insufficient antibody response in immunocompromised patients, suppression of the PVB19 infection is delayed and repetitive treatments may be administrated in attempt of reversing PRCA.

[Minimally invasive aortic surgery (MIAS)]. / Minimalno invazivna aortna kirurgija.

In this study we presented benefits of minimally invasive approach (MIAS) for treating abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD). MIAS technique consisted of minilaparotomy approach using incision length of 7-12 cm, intraabdominal small bowel retraction and standard aortic reconstruction with terminoterminal anastomosis or aortobifemoral bypass. Between December 2004 and January 2007 we perfomed 32 repairs for AAA and AIOD using MIAS technique. Mean infrarenal aortic cross clamp time was 48.5 +/- 17 minutes. Duration ofnasogastric suction and period before starting liquid diet was meanly 1.2 +/- 0.5 days. Mean time of stay in intensive care unit was 1.3 +/- 0.6 days, and hospital stay was 7.1 +/- 1.4 days. We had no 30-day mortality rate and there was no wound infection. MIAS technique is a safe method for the treatment of infrarenal AAA and AIOD including smaller wound size, shorter duration of postoperative ileus, intensive care unit stay and hospital stay, and lower hospital costs compared with those of standard way of treatment.