Ruptured abdominal aortic aneurysms - university center experience.

OBJECTIVES: Mortality of ruptured abdominal aortic aneurysm (RAAA) is still very high. Various factors contribute to the patients' mortality. Some of them could be affected. Therefore, we evaluate the main factors of mortality of patients with RAAA who were operated on at our University Vascular Center. METHODS: Univariate and multivariate analysis of various factors associated with RAAA was performed in the group of 182 patients operated on for RAAA between 1 January 1992 and 1 September 2005. RESULTS: The 30-day mortality rate was 33.5%. The main factors of mortality were: misdiagnosis, cardiopulmocerebral resuscitation (CPCR) on admission, configuration of RAAA (P<0.001), number of blood transfusions, hypotension on admission (P<0.0001) and duration of operation, type of reconstruction and hypertension in anamnesis (P<0.01). Important factors (P<0.05) of postoperative mortality were also low hemoglobin level on admission, abdominal aortic aneurysm (AAA) diameter and ischemic heart disease in anamnesis. The probability of patient's death is the highest (P<0.003), if factors like CPCR, number of blood transfusions and aneurysm diameter are combined (multivariate analysis, stepwise method). CONCLUSIONS: The early detection and elective treatment of AAA, the regular dispensarization of patients with small AAA especially hypertonics, the correct diagnosis of RAAA without time delay are the best tools for patients' survival. The survival of patients with RAAA increases with a highly trained and experienced vascular team in a high volume vascular center.

First kidney transplantation from a non-heart-beating donor in the Czech Republic.

The long-lasting decline in the number of kidney donors with brain death in recent years is the reason for a quest for new sources of kidney donors in the Czech Republic. One possible source to increase the number of donor kidneys is the program of obtaining kidneys from non-heart-beating donors (NHBDs). Based on previous experience abroad, optimum hospital conditions, and, first of all, three years of experimental work, it was possible to realise an NHBD program for the first time in the Czech Republic, in the Transplant Centre of the Plzen Hospital in early 2002. The first two kidneys were obtained from a donor with a devastating gunshot brain injury (Maastricht criteria, Class III). After machine perfusion (RM3 renal perfusion system, Waters Medical) both kidneys were transplanted into two recipients with chronic renal insufficiency (chronic glomerulonephritis, nephrosclerosis). Both kidneys resumed their function immediately. For immunosuppression, basiliximab (Simulect, Novartis), rapamycin (Rapamune, Wyeth), and methylprednisolone (Urbason solubile forte, Hoechst) were used. To improve renal function, cyclosporine A (Sandimmune Neoral, Novartis) was started later in the course, simultaneously reducing the dose of rapamycin. The postoperative course was uneventful and both patients could be discharged on the twenty-first day of hospitalisation for further care at home.