Successful kidney transplantation from a deceased donor to a recipient with chronic intradialytic hypotension (clinical case report)
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01.03.2020 |
Pinchuk A.
Zhuravel N.
Balkarov A.
Kondrashkin A.
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Transplantation Reports |
10.1016/j.tpr.2019.100036 |
0 |
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© 2019 The Author(s) Intradialytic hypotension is a frequent complication of chronic kidney disease. According to different authors, the incidence of this condition varies in severity and being recorded in 10–70% of cases during chronic intermittent hemodialysis. The development of severe chronic intradialytic hypotension in most cases is considered as a relative contraindication to kidney transplantation due to the risk of the graft dysfunction and loss in the early postoperative period. Meanwhile, there is no consensus on the lower limit of blood pressure, which would be an absolute contraindication for kidney transplantation. In addition, patients with intradialytic hypotension have the dialysis session reduced which leads to inadequate dialysis; also, they often have such complications as thrombosis of an arteriovenous fistula, as a result of which further dialysis sessions become impossible. In such cases, renal transplantation is a risky, but lifesaving operation. We present a clinical case report of kidney allotransplantation in a female patient with a history of bilateral nephrectomy, who had been suffering from severe chronic intradialytic hypotension for three years before the operation. After allograft transplantation, her blood pressure was normalized to reference values, and the graft function fully recovered.
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Successful kidney transplantation from a deceased donor to a recipient with chronic intradialytic hypotension (clinical case report)
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01.03.2020 |
Pinchuk A.
Zhuravel N.
Balkarov A.
Kondrashkin A.
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Transplantation Reports |
10.1016/j.tpr.2019.100036 |
0 |
Ссылка
© 2019 The Author(s) Intradialytic hypotension is a frequent complication of chronic kidney disease. According to different authors, the incidence of this condition varies in severity and being recorded in 10–70% of cases during chronic intermittent hemodialysis. The development of severe chronic intradialytic hypotension in most cases is considered as a relative contraindication to kidney transplantation due to the risk of the graft dysfunction and loss in the early postoperative period. Meanwhile, there is no consensus on the lower limit of blood pressure, which would be an absolute contraindication for kidney transplantation. In addition, patients with intradialytic hypotension have the dialysis session reduced which leads to inadequate dialysis; also, they often have such complications as thrombosis of an arteriovenous fistula, as a result of which further dialysis sessions become impossible. In such cases, renal transplantation is a risky, but lifesaving operation. We present a clinical case report of kidney allotransplantation in a female patient with a history of bilateral nephrectomy, who had been suffering from severe chronic intradialytic hypotension for three years before the operation. After allograft transplantation, her blood pressure was normalized to reference values, and the graft function fully recovered.
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Allocation of liver grafts worldwide – Is there a best system?
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01.10.2019 |
Tschuor C.
Ferrarese A.
Kuemmerli C.
Dutkowski P.
Burra P.
Clavien P.
Lendoire J.
Imventarza O.
Crawford M.
Andraus W.
D'Albuquerque L.
Hernandez-Alejandro R.
Dokus M.
Tomiyama K.
Zheng S.
Echeverri G.
Taimr P.
Fronek J.
de Rosner-van Rosmalen M.
Vogelaar S.
Lesurtel M.
Mabrut J.
Nagral S.
Kakaei F.
Malek-Hosseini S.
Egawa H.
Contreras A.
Czerwinski J.
Danek T.
Pinto-Marques H.
Gautier S.
Monakhov A.
Melum E.
Ericzon B.
Kang K.
Kim M.
Sanchez-Velazquez P.
Oberkofler C.
Müllhaupt B.
Linecker M.
Eshmuminov D.
Grochola L.
Song Z.
Kambakamba P.
Chen C.
Haberal M.
Yilmaz S.
Rowe I.
Kron P.
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Journal of Hepatology |
10.1016/j.jhep.2019.05.025 |
4 |
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© 2019 European Association for the Study of the Liver Background & Aims: An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages. Methods: Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics. Results: Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient's laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention. Conclusion: The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. Lay summary: An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
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The participation of religious organizations in formation of population attitude to transplantation of organs and tissues
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01.09.2019 |
Abaeva O.
Romanov S.
Smirnova G.
Prisiazhnaia N.
Dubograi E.
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Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsiny |
10.32687/0869-866X-2019-27-5-831-835 |
0 |
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The article discusses issue of possibility of influence of religious organizations on the attitude of population to issues of human organ transplantation. The attitude of followers of different religions to key issues of bioethics related to organ donation and transplantation is analyzed. It is concluded that there are no definite prohibitions on implementing this kind of medical intervention in modern religious regulations. The study of results of questionnaire survey of two groups of respondents revealed certain part of population, whose decision on the issues of posthumous organ donation would be influenced by the opinion of representative of religious organization. It is established that every tenth respondent appealed to the Orthodox priest when making decision to sign consent paper concerning posthumous exempt of organ from relatives. It is concluded that it is possible to affect the formation in certain part of population understanding of need to support organ donation and transplantation in case of active work in this direction of representatives of religious organizations.
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Clinical diagnosis of lipocalin 2 detection associated with neutrophil gelatinase (UNGAL) in urine in children with pyelonephritis debut
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01.09.2018 |
Yeremeyeva A.
Dlin V.
Korsunskiy A.
Zaykova N.
Bondarenko E.
Turina I.
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Pediatriya - Zhurnal im G.N. Speranskogo |
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0 |
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© 2018; Pediatria Ltd. All rights reserved. Search for biomarkers, reflecting the severity of inflammation and damage to kidney tissue in children with pyelonephritis is very important. Objective of the research - to study clinical significance of lipocalin 2 associated with neutrophil gelatinase (uNGAL) in urine as a marker of renal parenchymal lesion severity in children with pyelonephritis debut. Study materials and methods: 73 children with pyelonephritis debut hospitalized in the nephrologic department were examined. Children were divided into 2 groups: 1st group - 41 children with acute pyelonephritis (without USO abnormalities), 2nd group - 32 children with acute pyelonephritis combined with various abnormalities of urinary system organs. In all patients, the levels of urea, creatinine, cystatin C, procalcitonin, renal concentration capacity, uric excretion of lipocalin 2 associated with neutrophil gelatinase (uNGAL) were assessed. Results: the study revealed that the level of uNGAL/Cr excretionat the admission in children of both main groups did not differ significantly. A positive correlation was found between uNGAL/Cr value and cystatin C level in patients of the 2nd group. All children had a direct correlation between the duration of febrile fever from the onset of antibiotic therapy and the uNGAL/Cr excretion level. The study also revealed a correlation between uNGAL/Cr excretion level in the acute period of the disease and the degree of renal parenchymal lesion in children from the first and second groups confirmed by static DMCA nephroscintigraphy. Conclusion: a high urinary excretion of uNGAL/Cr in patients with acute pyelonephritis indicates a marked renal parenchyma lesion and requires static nephroscintigraphy with further observation, but not earlier than 6 months after the normalization of clinical-laboratory indicators.
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Laparoscopic left lateral section procurement in living liver donors: A single center propensity score-matched study
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01.09.2018 |
Gautier S.
Monakhov A.
Gallyamov E.
Tsirulnikova O.
Zagaynov E.
Dzhanbekov T.
Semash K.
Khizroev K.
Oleshkevich D.
Chekletsova E.
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Clinical Transplantation |
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1 |
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© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Laparoscopic living donor liver procurement for transplantation has increased in popularity over the past decade. The purpose of this study was to compare the laparoscopic and open approaches in living donor left lateral sectionectomy (LLS) and to assess the safety and feasibility of this laparoscopic approach. Methods: A total of 103 living donor LLSs were performed at our center from May 2016 to December 2017. Of these, 35 were completely laparoscopic procedures, which represented the subject of this study. An additional 68 open living donor LLSs performed during the same period were studied as a comparison group. To overcome selection bias, LLS donors were balanced on a 1:1 ratio (laparoscopic [n = 35]: open [n = 35]) according to covariates with similar values. The PSM was based on the operation date, recipient age, diagnosis, recipient weight, and donor age. Results: There were significant differences between the laparoscopic and open LLS groups (P < 0.001) in terms of blood loss (96.8 ± 16.5 vs 155.8 ± 17.8 mL) as well as the duration of hospital stay (4 ± 0.4 vs 6.9 ± 0.5 days). Conclusion: Laparoscopic LLS is a feasible and efficacious in the setting of a developed program with advanced laparoscopic expertise.
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Peculiarities of Osteogenesis by Periosteal Cells after Experimental Ectopic Transplantation
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01.07.2018 |
Ivanov A.
Danilova T.
Popova O.
Erohin A.
Semenihina E.
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Bulletin of Experimental Biology and Medicine |
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0 |
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© 2018, Springer Science+Business Media, LLC, part of Springer Nature. We carried out a comparative study of the features of osteogenesis from the progenitor osteogenic periosteal cells in rabbit and human. At the initial stages, high osteogenic potential of both human and rabbit periosteal cells was observed. However, at the later stages, the cell response favors resorption of the new bone tissue formed from periosteal cells in rabbits, but does not affect the bone tissue formed from human progenitor osteogenic periosteal cells. These functional characteristics of rabbit periosteal cells should be considered when planning the experiment.
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Genetically-modified bone mesenchymal stem cells with TGF-β <inf>3</inf> improve wound healing and reduce scar tissue formation in a rabbit model
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01.06.2018 |
Li M.
Qiu L.
Hu W.
Deng X.
Xu H.
Cao Y.
Xiao Z.
Peng L.
Johnson S.
Alexey L.
Kingston P.
Li Q.
Zhang Y.
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Experimental Cell Research |
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7 |
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© 2018 Extensive scar tissue formation often occurs after severe burn injury, trauma, or as one of complications after surgical intervention. Despite significant therapeutic advances, it is still a significant challenge to manage massive scar tissue formation while also promoting normal wound healing. The goal of this study was to investigate the therapeutic effect of bone mesenchymal stem cells (BMSCs) that were genetically modified to overexpress transforming growth factor-beta 3 (TGF-β 3 ), an inhibitor of myofibroblast proliferation and collagen type I deposition, on full-thickness cutaneous wound healing in a rabbit model. Twenty-four rabbits with surgically-induced full-thickness cutaneous wounds created on the external ear (1.5 × 1.5 cm, two wounds/ear) were randomized into four groups: (G1), wounds with no special treatment but common serum-free culture medium as negative controls; (G2), topically-applied recombinant adenovirus, expressing TGF-β 3 /GFP; (G3), topically-applied BMSCs alone; (G4), topically-applied BMSCs transfected with Ad-TGF-β 3 /GFP (BMSCs TGF-β3 ); and (G5), an additional normal control (n = 2) with neither wound nor treatment on the external ear skin. The sizes of wounds on the ear tissues were grossly examined, and the scar depth and density of wounds were histologically evaluated 21, 45, and 90 days after surgical wound creation. Our results demonstrated that G4 significantly reduced the wound scar depth and density, compared to G1~3. Numbers of cells expressing GFP significantly increased in G4, compared to G2. The protein expression of TGF-β 3 and type III collagen in G4 significantly increased, while the ratio of type I to type III collagen was also significantly reduced, which is similar to the tissue architecture found in G5, as compared the other treatment groups. In conclusion, transplantation of BMSCs TGF-β3 remarkably improves wound healing and reduces skin scar tissue formation in an animal model, which may potentially provide an alternative in the treatment of extensive scar tissue formation after soft tissue injury.
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Long-term oucomes of tracheal transplantation: success and unsolved problems
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01.01.2018 |
Parshin V.
Lyundup A.
Tarabrin E.
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Khirurgiia |
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AIM: To analyze long-term outcomes of tracheal transplantation. MATERIAL AND METHODS: There were 1128 patients with cicatricial tracheal stenosis who have been operated at the Petrovsky Russian Research Center for Surgery and the Sechenov First Moscow State Medical University for the period 1963-2015. RESULTS: Operations have become safer. Postoperative morbidity and mortality reduced from 41.4% (1963-1980) to 5.6% (2001-2015) and from 21.9% (1963-1980) to 0.5% (2001-2015), respectively. Tracheal transplantation was performed in 2 cases and fundamentally different tracheal structures were applied. Donor thyreotracheal complex with restored blood supply through thyroid vessels was used in the first case (2006). Perennial experimental trials preceded clinical application of this technique. In the second case (2010) we applied scientific results of foreign colleagues (cellular technologies and methods of regenerative medicine to create artificial trachea). Patients are still alive after 12 and 8 years, respectively. Restoration of blood supply of donor trachea is possible through thyroid collaterals. This technique is successful in long-term period. Tissue-engineered trachea cannot be considered true trachea due to no all tracheal components. However, such trachea provides air-conducting, evacuation and protective functions. Tracheomalacia requires further researches as one of the main problems of tracheal transplantation.
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Quality of life of chronic kidney disease patients on renal replacement therapy
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01.01.2018 |
Milovanov Y.
Dobrosmyslov I.
Milovanova S.
Taranova M.
Milovanova L.
Fomin V.
Kozlov V.
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Terapevticheskii Arkhiv |
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0 |
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© 2018 Media Sphera Publishing Group. All rights reserved. The study demonstrated the results of the comparative analysis of various types of renal replacement therapy effects on the quality of life patients with terminal stage of chronic kidney disease on the basis of standardized questionnaires. It has been shown that the quality of life is significantly improved after a kidney transplantation. At the same time, it has also been found that the introduction of home dialysis, epoetins, active metabolites of Vitamin D, calcimimetics in the clinic care expanded the opportunities for the labor rehabilitation of the dialysis patients and made their quality of life comparable with the same of the kidney transplant recipients.
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Current state of the problem of allotransplantation of Langerhans cells (achievements and prospects)
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01.01.2018 |
Alekberzade A.
Krylov N.
Adzhun Z.
Laftavi M.
Shakhbazov R.
Zuykova K.
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Khirurgiia |
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0 |
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Literature data devoted to transplantation of Langerhans cells have been analyzed. The main stages, indications, dissection of islets, immunosuppressive therapy, complications and data of the latest clinical trials were discussed.
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Conversion to everolimus to preserve kidney function in a heart transplant recipient, a personalized approach of immunosuppressive therapy
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01.01.2018 |
Koloskova N.
Nikitina
Zakharevich V.
Muminov I.
Cvan V.
Poptsov V.
Ahmadzai R.
Izotov D.
Shevchenko A.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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0 |
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© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the «gold standard» of treatment severe heart failure. Patient survival after heart transplantation has improved dramatically since the availability of calcineurin inhibitor (CNIs). However, nephrotoxicity of CNIs has been largely responsible for the progressive development of renal dysfunction and reduces long-term patient survival. Use mTOR inhibitor in immunosuppressive therapy may improve renal function when everolimus is administered associated with a progressive reduction of CNIs. The purpose of our report is to demonstrate the successful case of conversion of the recipient after heart transplantation to everolimus and to evaluate the effectiveness of this drug during the observation year after heart transplantation.
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Antiviral therapy of hepatitis C with 1 genotype after liver transplantation
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01.01.2018 |
Tsiroulnikova O.
Umrik D.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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0 |
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© 2018 Russian Transplant Society. All rights reserved. Chronic HCV infection is the leading cause of liver transplantation in adults in developed countries. Unfortunately, the reinfection of the graft inevitably occurs in all patients with persistent replication of the virus. Against the background of the necessary immunosuppressive therapy, the progression of the disease accelerates, leading to rapid decompensation of the liver. Antiviral therapy significantly improves the results of transplantation, but the use of standard interferon-based regimens is associated with low efficacy (no more than 30% for the most common 1 genotype of the virus) and poor tolerance. The article describes new interferon-free oral regimens used to treat the recurrence of HCV infection of 1 genotype.
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The individual tailoring of immunosuppressive therapy after heart transplantation
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01.01.2018 |
Koloskova N.
Poptsov V.
Shevchenko A.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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0 |
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© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the gold standard of treatment severe heart failure. Immunosuppressive therapy aimed at the prevention of acute allograft rejection is the cornerstone of post-transplant management. In addition to its direct effects, immunosuppressive therapy is also involved in the generation of a number of post-transplant morbidities that limit the long-term outcome of heart transplant recipients. Given these data it appears that the individual tailoring of immunosuppressive therapy is of paramount importance in determining the outcome of heart transplantation. The goal of immunosuppressive therapy is to prevent rejection of the transplanted heart, while minimizing drug-related effects, such as infection, malignancy, diabetes, hypertension, and renal insuffi ciency. This review aimed is to analyze the protocols for the appointment of immunosuppressive therapy in various groups of recipients after heart transplantation.
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Necrotizing infection of soft tissues as the complication of perforating tumor of sigmoid colon
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01.01.2018 |
Lipatov K.
Komarova E.
Borodin A.
Struchkov Y.
Frolkov V.
Kirillin A.
Kiryupina M.
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Novosti Khirurgii |
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0 |
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© 2018 Vitebsk State Medical University. All rights reserved. This clinical case demonstrates the development of severe streptococcal (Streptococcus pyogenes) necrotizing soft tissue infection as a result of perforation of the sigmoid neoplasm. The rapidly progressive necrotic process in the soft tissues of the lumbar and gluteal region as well as necrotic process in the left thigh (with the predominant lesion of the superficial fascia, subcutaneous fat and skin) led to the formation of an extensive postnecrectomic wound defect with an area of more than 1000 square centimeters. In addition to the severity of illness, the patient's belated treatment and the underestimation of the clinical situation by surgeons who provided emergency care contributed to such an extensive spread of the pathological process. The development of sepsis was accompanied by severe multiple organ failure. Because of the severity of the patient's condition, the surgical removal of the sigmoid neoplasm extended in the abdomen wall became possible only after its stabilization as a result of surgical focal sanation and complex intensive therapy in the conditions of the ICU. The most important point of the stage-by-stage surgical treatment was the choice of methods for the plastic closure of an extensive postnecrectomic wound that involved the entire left gluteal region, part of the lumbar and antero-inner surface of the left thigh. Taking into account the size and localization of the defect, the plastic reserves of the surrounding skin, the wound was closed in three stages with the help of combined plastic surgery techniques: with local tissues by the method of tissue expansion and a split-thickness skin graft.
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The microsurgical tissue autotransplantation in the treatment of late radiation tissue injuries with complicated osteomyelitis of the tibia
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01.01.2018 |
Zelyanin A.
Filippov V.
Dubrov V.
Meskhi K.
Kelban D.
Zelyanin D.
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Clinical and Experimental Surgery |
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0 |
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© 2018 GEOTAR Media. All rights reserved. Aim. Study of the remote results free flaps usage in treatment of patients with the late radiation injuries complicated by tibial bone osteomyelitis. Material and methods. Our work is based on a retrospective study of treatment of eight patients with late radiation tissue injuries and chronic osteomyelitis of the tibia. In them we performed 9 operations using free, vascularized flaps. According to RTOG/EORTC Late Radiation Morbidity Scoring Scheme, skin lesions corresponded to grade IV, bone damage – grade II–III. In the zone of the late radiation injuries, the lesion of the cortical plate of the tibia was detected in 5 patients, a lesion that occurred more than a third of the tibial circumference – in 3 patients. 6 patients had cicatricial osteomyelitis form, and 2 had osteomyelitis with the inclusion of a chronic draining fistula. Late radiation ulcer was emerged in all patients after previous radiotherapy in a total dose of 40 to 60 Gy for different types of neoplasms. For 7 patients, the timing of the previous radiotherapy ranged from 5 to 19 years before the appearance of a late radiation tissue injury. Three patients received radiotherapy in childhood. In one patient, with posttraumatic osteomyelitis of the tibia, in remission, squamous cell carcinoma was diagnosed. Patients underwent radiation therapy in a total dose of 60 Gy. Later it was associated a radiation ulcer with open defects of the tibia. The objectives of surgical treatment included the preservation of the limb, adequate surgical debridement and the replacement of the tissues defect. The surgical technique included a radical resection of the affected areas of the bone tissue. To fill dead space, a musculo-fasciocutaneous thoracodorsal flap was used in all paients. In 2 out of 3 patients with localized form of osteomyelitis, the autograft complex, supplementary to the thoracodorsal component, included additionally a fragment of the anterior serratus muscle for tamponade of the osteomyelitis cavity. For one patient with localized osteomyelitis, a tamponade method of the post osteomyelitis bone defects included use of the distal part of the fragment of the latissimus muscle flap. 1 patient originally addressed concerning a late radiation ulcer on the back surface of a crus without involvement of bone structures. Two years after elimination of cicatricial and ulcer defect the torakodorsal skin and muscular flap, created a late radiation ulcer on the forward surface of a shin with defeat of a cortical plate of a tibial bone. Discussion. Fundamental difference of patients with local radiation injury from patients with traumatic osteomyelitis and investing tissue extensive defects is the feature of a course of wound process against the background of the progressing depression of a reparation both in the focus, and in surrounding tissues with lack of a clear boundary defeat. Morphological basis of local late radiation defeat are permanent damages of blood and lymphatic vessels with tissue fibrosis progressing. In the conditions of local reserve opportunities decrease, free revascularised flaps application, with one's own axial blood supply, allows to save an extremity, to receive the best immediate and long-term results of tissues defects elimination in the irradiated zone. It can be confirmed with the fact that directly under the replaced skin and muscular revascularised flap the covered functional structures purulent defeat stopped and patients achieved osteomyelitic process permanent remission. Results. In all observations the full flap engraftment has received. All patients have achieved osteomiyelitic process remission. Conclusions. The radical debridement of the affected zones, followed by the filling of the bone defect with muscle tissue and the defect elimination of the tissues by the skin portion of the vascularized musculocutaneous autograft is the method of choice in the treatment of patients with local post radiation injuries, complicated by osteomyelitis of the tibia.
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Experience of effective antiviral therapy in a liver recipient with recurrent HCV infection genotype 1
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01.01.2018 |
Umrik D.
Tsiroulnikova O.
Miloserdov I.
Latypov R.
Egorova E.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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0 |
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© 2018 Russian Transplant Society. All Rights Reserved. HCV infection is one of the most common causes leading to the development of terminal liver diseases – cirrhosis and hepatocellular carcinoma, the main treatment for which is orthotopic liver transplantation. However, with continued virus replication, 100% reinfection occurs, which leads to the rapid progression of cirrhosis of the graft and the loss of its function. Standard interferon-containing therapy is ineffective for HCV infection, especially genotype 1, both before and after transplantation, and also has a wide range of adverse events. The article presents the successful experience of treating the recurrence of HCV infection 1 genotype in a patient who underwent liver transplantation and several courses of ineffective antiviral therapy.
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The efficacy and safety of antiviral drugs of direct action in liver recipients with recurrence of chronic hepatitis c genotype 1 after transplantation
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01.01.2018 |
Tsiroulnikova O.
Umrik D.
Miloserdov I.
Egorova E.
Latypov R.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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0 |
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© 2018 Russian Transplant Society. All Rights Reserved. Aim. To study the efficacy and safety of the use of paritaprevir, ritonavir, ombitasvir and dasabuvir in combination or without ribavirin in liver recipients with recurrence of HCV 1 genotype after transplantation. Materials and methods. The study included 46 patients after orthotopic liver transplantation with recurrence of HCV 1 genotype. 37 patients completed a 24-week course of antiviral therapy, including paritaprevir, ritonavir, ombitasvir and dasabuvir in combination or without ribavirin. The effectiveness of the therapy was calculated as the proportion of patients who achieved aviremia 12 weeks after the end of the course of treatment. The safety of therapy was assessed by the number of adverse events that occurred during the course of antiviral therapy. Results. A sustained virologic response at 12 weeks after the end of the course of antiviral therapy, including paritaprevir, ritonavir, ombitasvir and dasabuvir, reached 100% of the recipients of the liver. Reduction in the intensity of cytolytic and cholestatic syndromes was noted at week 4 of therapy. Adverse events were recorded in 56.7% of the subjects, mostly they were not severe and were stopped on their own. Acute cellular rejection of the transplant developed in 1 patient (2.7%). There have been no cases of irreversible liver transplant dysfunction or death of the recipient. The conclusion. The use of paritaprevir, ritonavir, ombitasvir and dasabuvir is safe and effective in the treatment of relapse of HCV infection of 1 genotype after liver transplantation.
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Organ donation and transplantation in Russian Federation in 2017 10th report of the national registry
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01.01.2018 |
Gautier S.
Khomyakov S.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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0 |
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© 2018 Russian Transplant Society. All rights reserved. Aim. To analyse the status and trends in the development of organ donation and organ transplantation in the Russian Federation according to 2017 data. Materials and methods. The survey of heads of transplantation centers was conducted. A comparative analysis of the data obtained in the dynamics of years, between individual subjects of the Russian Federation, the centers of transplantation is performed. Results. According to the register in 2017 in Russia there were only 41 centers for kidney transplantation, 24 liver and 16 hearts. The waiting list for kidney transplantation in 2017 included 5,531 potential recipients, which is approximately 13.8% of the total number of 40,000 patients receiving dialysis. The level of donor activity in 2017 was 3.8 per million of the population, while the share of multiorgan seizures was 66.5%, the average number of organs received from one effective donor was 2.8. In 2017, the level of kidney transplantation was 8.0 per million of the population, the liver transplantation index was 3.0 per million of the population; the rate of heart transplantation is 1.7 per million of the population. In 2017 the number of transplants in Russia increased by 11.3% compared to 2016. There are 11 transplantation centers on the territory of Moscow and the Moscow Region, and half of all kidney transplants and 70% of all liver and heart transplantations are performed. The number of patients with transplanted organs in the Russian Federation is approaching 13,000. Conclusion. In the Russian Federation there is a strong tendency to increase the number of effective donors and to increase the number of organ transplants, and the number of transplant centers is also increasing. In recent years, the country has created prerequisites for the development of organ donation and transplantation: the regulatory and legal framework, public donation funding, material and technical base, etc. In the coming years, positive experience and organizational patterns of organ donation and transplantation from successful regions in Other subjects of the Russian Federation for building effective programs. The leading role in this process should be played by the Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs.
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Physical development of a child with Alagille syndrome before and after liver transplantation
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01.01.2018 |
Degtyaryova A.
Bolmasova A.
Filippova E.
Pisareva E.
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Voprosy Prakticheskoi Pediatrii |
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© 2018 Dynasty Publishing House. All rights reserved. The article presents a clinical case of a patient with genetically confirmed Alagille syndrome (ALGS) with marked delay of physical development that did not correspond to the severity of liver damage. Alagille syndrome (ALGS) is a rare hereditary disease with underlying hypoplasia of the intrahepatic bile ducts manifested by cholestasis syndrome in the first weeks of life. Developmental delay is characteristic for cholestatic diseases of the liver, including ALGS, which is conditioned by impaired absorption of fats and fat-soluble vitamins in the intestines. But growth delay and underweight in this syndrome often do not correlate with the severity of cholestatis syndrome, and causes of their development remain unstudied. Cholestatis syndrome was moderate, and clinical signs of liver cirrhosis were absent. Intense skin itching, greatly disturbing not only the baby's wake period but also sleep, along with marked height and weight deficit were indications for liver transplantation at the age of 4 years, after which a fast normalisation of the parameters of physical development was noted. This clinical case study permits to hypothesize that developmental delay in children with ALGS is conditioned by chronic cholestatic liver damage, irrespective of the severity of its clinical presentation.
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