RESUMO
There is a lack of evidence as to the relevance of vascular trauma (VT) in patients with severe injuries. Therefore, we reviewed registry data in the present study in order to systematically objectify the effect of VT in these patients. This study aimed to provide an adequate picture of the relevance of vascular trauma and to identify adverse prognostic factors. In a retrospective analysis of records from the TraumaRegister DGU® (TR-DGU) in two subgroups with moderate and severe VT, we examined the records for differences in terms of morbidity, mortality, follow-up and prognostic parameters compared to patients without VT with the same ISS. From a total of 42,326 patients, 2,961 (7â%) had a VT, and in 2,437 cases a severe VT (AIS ≥ 3) was diagnosed (5.8â%). In addition to a higher incidence of shock and a 2 to 3-fold increase in fluid replacement and erythrocyte transfusion, patients with severe VT had a 60â% higher rate of multiple organ failure, and in-hospital mortality was twice as high (33.8â%). The massively increased early mortality (8.0 vs. 25.2â%) clearly illustrates how severely injured patients are placed at risk by the presence of a relevant VT with a comparable ISS. In our opinion, due to an unexpected poor prognosis in the TR-DGU data for vascular injuries, increased attention is required in the care of severely injured patients. Based on our comprehensive analysis of negative prognostic factors, a further adjustment to the standards of vascular medicine could be advisable. The influence of the level of care provided by the admitting hospital and the relevance of a further hospital transfer to prognosis and clinical outcome is currently being analysed.
Assuntos
Traumatismo Múltiplo/cirurgia , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Alemanha , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/mortalidade , Complicações Pós-Operatórias/mortalidade , Prognóstico , Sistema de Registros , Fatores de Risco , Choque/diagnóstico , Choque/mortalidade , Choque/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidadeRESUMO
BACKGROUND: Hepatic microcirculation is a main determinant of reperfusion injury and graft quality in liver transplantation. One of the important diagnostic procedures to recognize reperfusion failure is contrast-enhanced computed tomography or magnetic resonance imaging. PURPOSE: To examine the additional effect of contrast media (iomeprol and gadopentetate dimeglumine) on hepatic microcirculation and hepatic cellular damage in the phase of early ischemia/reperfusion injury of the rat liver. MATERIAL AND METHODS: The partial warm ischemia-reperfusion injury model of rat liver was used. Microcirculation and leukocyte-endothelium interaction were measured by intravital microscopy. Hepatic cellular damage was indicated by liver enzyme activity in the sera. The evaluation parameters were measured at baseline and at 30, 60, and 90 min after reperfusion. The contrast media (iomeprol group, n = 6; gadopentetate dimeglumine group, n = 6) or Ringer's solution (control group, n = 8) were applied after 30 min of reperfusion. RESULTS: No additional injury to the ischemia/reperfusion injury of the liver after intravenous application of radiographic contrast media was found. Some protective effect was even recorded after application of iodinated contrast media. CONCLUSION: The use of contrast media during diagnostic procedure of the liver seems to be relatively safe, even in the stage of early reperfusion after liver transplantation.
Assuntos
Meios de Contraste/farmacologia , Gadolínio DTPA/farmacologia , Iopamidol/análogos & derivados , Fígado/efeitos dos fármacos , Traumatismo por Reperfusão/fisiopatologia , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Modelos Animais de Doenças , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Hepatócitos/efeitos dos fármacos , Hepatócitos/fisiologia , Iopamidol/farmacologia , Soluções Isotônicas/administração & dosagem , Leucócitos/efeitos dos fármacos , Leucócitos/fisiologia , Fígado/irrigação sanguínea , Imageamento por Ressonância Magnética/métodos , Masculino , Microcirculação/efeitos dos fármacos , Microcirculação/fisiopatologia , Ratos , Ratos Wistar , Reperfusão , Solução de Ringer , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Isquemia Quente/métodosAssuntos
Endotélio Vascular/fisiologia , Isquemia/fisiopatologia , Leucócitos/fisiologia , Circulação Hepática/efeitos dos fármacos , NF-kappa B/genética , Oligodesoxirribonucleotídeos Antissenso/farmacologia , Animais , Endotélio Vascular/efeitos dos fármacos , Leucócitos/efeitos dos fármacos , Masculino , Microcirculação/efeitos dos fármacos , Ratos , Ratos Wistar , ReperfusãoRESUMO
BACKGROUND: Protective effects of desmopressin in brain dead organ donors oppose reports on a hypercoagulatory potential and an increased leukocyte-endothelial interaction (LEI) after application of the drug. The aim was to evaluate the effect of desmopressin on organ donor's pancreas and early graft function. METHODS: Donor microcirculation was evaluated via intra-vital microscopy (IVM) in 24 BR (di/di) rats with central diabetes insipidus, randomly assigned to groups I (control without desmopressin application), II (single i.v. application, no pretreatment) or group III (single i.v. desmopressin application, s.c. pretreatment for 3 days). Microcirculation in recipients was evaluated 1 hr and 6 hr after syngenic pancreas transplantation. Groups III and I served as organ donors. After IVM specimens were taken for histology and immunohistochemistry. RESULTS: Desmopressin in II vs. I led to temporarily (30') increased LEI (Sticker 274.3+/-87.7 vs. 76.5+/-31.1/mm2 endothelial surface; P<0.01) and impaired microcirculation (MCEV 0.43+/-0.07 vs. 0.99+/-0.06 mm/s; P<0.01). Repeated application reduced MCEV and increased LEI for up to 12 hr. Histology in I vs. III showed increased inflammation (n.s.), necrosis (P<0.05) and vacuolization (P<0.01). Immunohistochemistry revealed increased endothelial P-selectin 20' after application. 6 hr after reperfusion organs from III showed reduced MCEV and increased LEI (P<0.01). CONCLUSION: Repeated application of desmopressin impairs graft microcirculation. Perfusion of the pancreas is significantly reduced at the beginning of organ tissue conservation as well as after reperfusion. These disturbances might partly be due to observed endothelial P-selectin expression. Application of desmopressin up to 12 hr prior to organ explantation may impact graft quality.
Assuntos
Capilares/fisiologia , Desamino Arginina Vasopressina/farmacologia , Diabetes Insípido/fisiopatologia , Hemodinâmica/fisiologia , Hemostáticos/farmacologia , Leucócitos/fisiologia , Microcirculação/efeitos dos fármacos , Transplante de Pâncreas/fisiologia , Pâncreas/irrigação sanguínea , Animais , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Velocidade do Fluxo Sanguíneo/fisiologia , Plaquetas/efeitos dos fármacos , Plaquetas/fisiologia , Capilares/efeitos dos fármacos , Diabetes Insípido/genética , Diabetes Insípido/cirurgia , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiologia , Hematócrito , Hemodinâmica/efeitos dos fármacos , Leucócitos/efeitos dos fármacos , Microcirculação/fisiologia , Transplante de Pâncreas/métodos , Transplante de Pâncreas/patologia , Ratos , Ratos Mutantes , Reperfusão , Doadores de Tecidos , Transplante Isogênico , Vênulas/efeitos dos fármacos , Vênulas/fisiologiaRESUMO
Improving organ preservation techniques for transplantation is one of the most important goals of transplantation research. We have established a new, nonfreezing cryopreservation method to optimize the viability of rat kidneys for transplantation with up to 4 M dimethylsulphoxide (DMSO) in EuroCollins solution (EC) at -5 degrees C to -15 degrees C. We have confirmed the occurrence of a tubular and glomerular defect pattern that mediates acute tubular necrosis (ATN) and that may be a cause of major histocompatibility complex (MHC) independent immunological components of chronic transplant rejection. The extent of this defect [transplant survival and function, 31P-NMR spectroscopy, histological defect index] in the nonfreezing cryopreserved groups (n = 22) is significantly (P = 0.017) lower than in the simple cold storage group (n = 12). Quality and localization of the lesions in kidney transplants can elucidate the context of organ preservation, progressive hyperfiltration defects, and the occurrence of graft failure without elevated frequency of acute rejection episodes. These results indicate that further efforts to provide higher pretransplant organ viability without using it to prolong cold storage intervals may provide better insight into MHC-independent factors of chronic transplant failure and may result in improved long-term transplant outcome.
Assuntos
Criopreservação/métodos , Rim , Preservação de Órgãos/métodos , Animais , Crioprotetores/farmacologia , Dimetil Sulfóxido/farmacologia , Rejeição de Enxerto/prevenção & controle , Rim/efeitos dos fármacos , Rim/ultraestrutura , Espectroscopia de Ressonância Magnética , Ratos , Fatores de TempoRESUMO
OBJECTIVES: This study was performed to establish oncological guidelines for the surgical treatment of invasive penile cancer. MATERIALS AND METHODS: The medical records of 51 patients with invasive penile cancer seen between 1968 and 1994 were reviewed in respect to treatment and long-term outcome. RESULTS: For stage T1 tumors treated with organ-preserving procedures the local recurrence rats was 56%, whereas no patient experienced a local recurrence after partial amputation. For stage T2 tumors, local recurrence rate was 100% (organ preservation) versus 20% (amputative procedures). There was no significant difference related to regional recurrence between surveillance, inguinal radiation and lymphadenectomy for stage N0 tumors. For N+ stages, survival was related to the extent of inguinal metastasis after dissection (5-year survival rate for N1: 71 vs. 33% for N2/3). CONCLUSIONS: Organ-preserving procedures include a high risk of local and regional recurrence. Adjuvant regional lymphadenectomy seems beneficial only in patients with solitary metastasis.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Penianas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Seguimentos , Guias como Assunto , Humanos , Estudos Longitudinais , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Neoplasias Penianas/mortalidade , Neoplasias Penianas/patologia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Donor-recipient histocompatibility, as evaluated by the HLA matching results, plays an important role in the outcome of renal transplants, although much controversy surrounds the benefit of kidney allocation based on HLA typing. In this report HLA matching and survival data on 1,342 transplants performed at the University of California at San Francisco between 1984 and 1992 and treated uniformly by quadruple immunosuppression were analyzed in relation to the recipient's age. With respect to the influence of the increasing number of mismatches from 0 to 6, the analysis revealed decreasing 3-year graft survival rates as follows: 85.4%; 87.3%; 71.3%; 78.2%; 75.8%; 70.9% and 67.5%. Whereas the impact of cold ischemia time and histocompatibility was equally important during the 3-year postoperative period, the essential positive influence of good HLA matching on the long-term graft survival was demonstrated. The children aged between 5 and 18 years were identified as a high-risk group by the analysis, HLA-A incompatibility being attributed to poor graft survival in this age group. With respect to the effect of HLA-A histoincompatibility, the data provide evidence that HLA-A matching results seem to play an important role in graft survival in children, whereas transplants well matched in terms of HLA-B did well in adult recipients. No age difference in the impact of HLA-DR could be detected. In conclusion, HLA matching is still essential. It seems that there are differences in the impact of HLA loci in relation to the recipient's age.
Assuntos
Teste de Histocompatibilidade , Transplante de Rim/fisiologia , Sobrevivência de Tecidos/genética , Adolescente , Adulto , Fatores Etários , Cadáver , Criança , Pré-Escolar , Feminino , Humanos , Terapia de Imunossupressão , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The risk for renal allograft failure in pediatric renal transplantation (donor age below 3 years) is still high, although it has been reduced by the use of potent immunosuppressive therapies. In this study we report on experience with 80 kidneys of donors below 3 years of age (PD) transplanted at the University of California at San Francisco Hospital in accordance with the policy of minimizing donor-recipient size differences. The graft survival rates were comparable with the results for adult donors, 18-50 years of age (AD, n = 891): at 1 year PD 74.1% vs AD 85.5%, at 2 years PD 70.5% vs AD 80.2%, at 3 years PD 63.5% vs AD 76%; there were no significant differences. The policy of minimizing donor-recipient size differences seems to improve graft survival rates, avoiding the tendency for hyperfiltration phenomena and possibly being responsible for this salutary effect. We conclude that the use of pediatric donor kidneys can yield excellent long-term results independent of primary disease if the donor-recipient size difference is minimized and a potent immunosuppressive regimen is employed.