[Treatment of ascites with reinfusion of ascitic fluid concentrate]. / Liecba ascitu reinfúziou ascitického koncentrátu.

Ascites which is refractory to common therapeutical measures is a great problem. It deteriorates patient's life and is a sign of poor prognosis. Different methods of peritoneal fluid reinfusion belong to effective non-pharmaceutical therapeutic approaches. Main target of this study was to analyse the effectiveness and safety of peritoneal fluid reinfusion and to compare two methods of its administration (i.v. reinfusion and intraperitoneal reinfusion). During three years we have performed 97 reinfusions in 4 patients (2 women and 2 men; mean age 56 years). I.v. reinfusion was administered 68 times and intraperitoneal ewinfusion was performed 28 times. Usually we evacuated 8000 ml of ultrafiltrate. The most common complications were haemoperitoneum (6x) and short-term chills (2x). We didn't have any complications such as coagulopathy, peritonitis or circulation collapse. Intraperitoneal administration seems to be more advantageous when compared with i.v. application, because of less frequent detection of fibrin degradation products and D-dimers after the procedure and higher diuresis during the following days. (Tab. 2, Fig. 5, Ref. 13.).

[Procedure for multiorgan procurement (heart, liver, kidneys)]. / Postup pri multiorgánových odberoch (srdce, pecen, oblicky).

A significant growth in transplantation activity has been recorded in the past decade, namely in transplantations of the heart and liver. The numbers of transplantations of the lungs, and of the combination of pancreas with kidneys have increased to a smaller extent. The number of transplanted kidneys has become stabilized during the past several years. The development of organ transplantations led to a change of conception in the procurement of cadaveric organs from the until now performed procurement of a single organ to multiorgan procurements where in addition to the kidneys at least one other organ is procured. In countries with the highest number of multiorgan procurements the latter form as many as 80% of the total number of cadaveric procurements. Since January 1, 1995 a principle has been officially recognized in the Slovak Republic where an agreement with organ donation is presumed. Procurements of organs do not take place in cases when the donors have made during their lives a written or any other kind of declaration disapproving any intervention into their corporal integrity. Organs are also not procured in cases of foreigners, persons under legal sentence and those whose identities cannot be proved. The authors describe the technique of multiorgan procurement (heart, liver, kidneys) as well as contraindications to procurements of individual organs. (Fig. 2, Tab. 1, Ref. 12.).

[Indications and contraindications for liver transplantation]. / Indikácie a kontraindikácie transplantácie pecene.

Liver transplantation (LT) is a therapeutic method in many, otherwise infaust diseases of the liver. During the recent decade the experimental therapeutic procedure has become a routine therapeutical method. The stage of clinical experiment was ultimated by the Washington Conference held on the consensus in LT indications (1983). Large centries (USA, England, Germany) yield 80-100 liver transplantations per year. The recent years have recorded a change in some principal opinions on LT. It is possible to state that liver transplantation is being abstained from cases with more extensive primary neoplamatic affliction of the liver. Conservative therapy in primary biliary cirrhosis of the liver by means of ursodeoxycholic acid has shifted the LT indication into the later stages of the disease. The opinions on the meaning of LT in alcoholic cirrhosis remain still unsettled. LT remains unambiquously indicated in life-endangering fulminant and subfulminant liver failures. Among the viral diseases, attention is paid to liver cirrhosis caused by infection by the hepatitis C virus. Cirrhosis due to hepatitis B has a better prognosis, owing to the complex antiviral therapy. Liver transplantation represents, beside the main indications, the therapy of first selection, e.g. also in Wilson's disease, alpha-1-antitrypsin deficiency, alveolar echinococcosis etc. (Tab. 1, Fig. 2, Ref. 54.)

[Benign esophageal stenoses]. / Benígne stenózy ezofagu.

Benign oesophageal stenoses, which in the past were most frequently the consequence of corrosion of the oesophagus, develop nowadays more frequently as a result of gastrooesophageal reflux. For its detection in addition to classical X-ray examination also oesophagoscopy, pH-metry and dynamic isotope scintigraphy of the oesophagus is important. In the treatment balloon dilatation and anti-reflux surgery should be considered which are recommended by some authors even as a preventive measure.

[Extensive defect in the inguinal region and damaged femoral arteries. Single stage reconstruction of the arterial supply and skin coverage. Case Report]. / Rozsiahly defekt inguinálnej oblasti s poskodením stehenných ciev. Rekonstrukcia arteriálneho zásobenia a kozného krytu v jednej dobe. Kazuistika.

The authors present an account on a patient with extensive damage of the tissue in the area of the right groin with complete severing of the artery and vein. After control of the infections they reconstructed the arterial supply and skin cover in one stage. They used a PTFE prosthesis with an extraanatomical localization and a muculocutaneous flap formed from the musculus rectus abdominis on a caudal stalk.

[Total vascular exclusion of the liver--an advance in hepatic surgery]. / Totálna vaskulárna exklúzia pecene--pokrok v hepatochirurgii.

The authors present the technique of total vascular exclusion of the liver. The main indication for resection of the liver by this technique are central and dorsal tumours, and it can be used successfully also in cases of risky dissection of the hepatic veins. Thermal ischaemia lasting up to one hour proved safe. Total vascular exclusion is a safe and useful technique in major resections of the liver even in case of infiltration of the hepatic veins and the vena cava inferior.

[Liver transplants from living donors]. / Transplantácia pecene od zivého darcu.

In this article the authors discuss the advantages of Living Related Liver Transplantation (LRLT), criteria for the selection of donors and the standard operation technique. Among a total of 241 liver transplantation (LTx), 42 LRLT were performed at the University of Hamburg between October 1, 1991 and December 19, 1994. The body weight of recipients for LRLT ranged from 4,6 to 39 kg, with 64,2% having less than 10 kg. The volume of the donor left lateral liver lobe ranged from 100 cc to 350 cc. The average one year survival rate among electively operated patients-status 3-4 (UNOS 1995 classification) was 86.7%, two year survival rate 83.3%. The main advantages of LRLT are consired the following: 1. Absence of mortality on the waiting list, 2. Optimal timing of the transplantation (elective procedure, patient in a good condition), 3. Excellent organ (no primary non function), 4. A possible immunologic advantage, 5. Relief of the waiting list for cadaveric organs, 6. Psychological benefit for the family, 7. Cost effectiveness. Potential candidates for living donation with more than one cardiovascular risk factors were excluded. Social and psychological reasons leading to rejection of candidates were as follows: unstable family structure, expected professional or financial difficulties after living donation or withdrawal from consent. LRLT gives parents of a child with TLD a chance to avoid the risk of death on the waiting list or primary non function of the graft. LRLT has therefore established an important place in pediatric liver transplantation.

Successful regrafting of a transplanted liver.

We report on the successful regrafting of a transplanted liver. The donor liver was first grafted into a patient suffering from cryptogenic cirrhosis; the patient died 1 day after the elective transplantation of cerebral bleeding. The well-functioning graft was harvested again and transferred to our institution. After another 12 h of cold ischemia, the liver was reperfused in an urgently registered patient with recurrence of hepatitis B in his first graft. The transplantation was successfully performed and the patient is now doing well, more than 5 months after regrafting with the reused liver.

Protection of the rat liver against rewarming ischemic injury by University of Wisconsin solution.

BACKGROUND/AIM: University of Wisconsin (UW) solution has been proven able to prevent liver injury during cold ischemia. During rewarming ischemia, however, the efficacy of this solution in preserving hepatocyte function is unclear. The aim of the present study was to investigate to what extent UW solution protects rat liver during rewarming ischemia. METHODS: Livers were washed out with cool physiologic saline or with UW solution and subjected to rewarming ischemia for periods of 20 min or 45 min followed by reperfusion using a blood-free perfusion model. RESULTS: In comparison with controls, ischemia for 20 min in saline-treated livers led to mild depression of hepatocyte function, while UW solution afforded complete protection of the liver. In UW-treated livers, compared with saline-treated livers exposed to ischemia for 45 min, portal flow was slightly but significantly higher, bile production was increased by 62%, and lactate dehydrogenase leakage into the perfusate was reduced by 61%. In an attempt to explain mechanisms of liver protection by UW solution, we found that UW solution inhibited conversion of hypoxanthine into uric acid, but this effect was not associated with decreased degradation of adenine nucleotides in the liver during ischemia. Following 30 min reperfusion, UW solution increased tissue levels of adenosine triphosphate (not significantly) and adenosine diphosphate (significantly). Further, UW solution markedly reduced tumor necrosis factor-alpha release by the liver both after ischemia and after reperfusion. CONCLUSIONS: These results create the hypothesis that UW solution may protect liver tissue during ischemia in liver surgery as well as during the implantation stage of liver transplantation.