Selected activities in Scandiatransplant

Scandiatransplant is the Nordic organ exchange organization. It has existed for 35 years and it is owned by all organ transplantation hospital departments in the five Nordic countries--Denmark, Finland, Iceland, Norway, and Sweden. The use of living organ donors for kidney transplantation has become a more common procedure not only in Norway but also in Sweden and Denmark. For the first time, in 2003, one transplant center performed relatively more living donor kidney transplantations than with deceased donors. The overall organ transplant activity reveals a remarkably stable situation in the area covered by Scandiatransplant. Scandiatransplant as an organ exchange organization has changed from a solely kidney exchange organization to an organization in which the more immediate vital organs as liver and heart are exchanged more commonly than kidneys.     

外科的历史、现状与未来

<正>1外科的历史有人类以来便有战争,为获取食物与野兽战斗,为获取地盘及奴隶与人类战斗,有战争便有外伤,因此就有了外科,因此外科的历史是与人俱生的,甚至是与人猿俱生的。但历史上外科少有突出贡献,因     

Hepatic Assist: Present and Future

Fulminant hepatic failure due to acute massive liver cell necrosis is a complex pathophysiological entity, and treatment is still unsatisfactory. Artificial liver supports such as hemodialysis, hemoperfusion, and plasmapheresis have recently been used clinically to treat fulminant hepatic failure. However, survival rate has not improved as expected, although the consciousness of the patient has improved frequently. In this article the present status of clinical artificial liver support and basic research of hybrid artificial liver will be discussed. Moreover, the future aspects of total artificial liver support and hepatocyte transplantation for chronic liver failure will be introduced.     

Artificial Liver: Present and Future

Early in 1956, the first model of a biological artificial liver, using a live dog's liver incorporated in a cross-hemodialyzer, was placed in an experimental animal with portocaval encephalopathy. This "biological artificial liver," a hybrid artificial liver in the present terminology, was the first in the world. In October 1958, the first human patient, a young male patient in hepatic coma due to liver cirrhosis, was placed on the laboratory-made biological artificial liver composed of four parabiotic cross-hemodialyzers connected with four live dogs' livers to which the "hepatic reactors" for ammonium adsorption and acid-base balance were additionally equipped. This first case was very successful, resulting in the patient's recovery from coma. This article introduces the past history of the artificial liver, research of which has mainly been conducted in Japan since the early 1950s by the author, M. Mito, and Y. Nosé. Until recently, little progress has been made in this field through the application of blood purification principles such as hemoadsorption, plasmapheresis, and other modifications and combinations. Accumulation of clinical experiences with such conventional methods has stimulated the third generation of the artificial liver to a return to a hybrid organ applying modern science and technology. A concept of hybrid organs in comparison with organ transplants is introduced. The Japanese national project of developing a new artificial liver system, as conducted by the author as the chairman and his associates, is introduced.     

甲状腺外科的现状与展望

甲状腺可发生多种疾病 ,治疗方法各异 ,其中 ,适宜外科治疗者主要是甲状腺肿瘤 ,尤其是恶性肿瘤 ,甲状腺功能亢进症虽然有些也采用外科治疗 ,但并非该病的唯一治疗方法。甲状腺肿瘤外科治疗所采用的术式及病例选择等 ,至今国内、外仍存在一些不同见解。现就甲状腺肿瘤的外科治疗现状进行重点讨论 ,并就今后发展略抒己见。1　甲状腺结节的外科处理原则1.1　甲状腺结节的定性甲状腺结节是临床最为常见的体征 ,尤其在现代B型超声检查下 ,经常可以查见临床不能触及的微小结节。应当指出 ,甲状腺是处于动态的内分泌器官 ,受机体多种因素的影响 ,…     

Molecular Imaging in Breast Cancer - Potential Future Aspects

SUMMARY: Molecular imaging aims to visualize and quantify biological, physiological, and pathological processes at cellular and molecular levels. Recently, molecular imaging has been introduced into breast cancer imaging. In this review, we will present a survey of the molecular imaging techniques that are either clinically available or are being introduced into clinical imaging. We will discuss nuclear imaging and multiparametric magnetic resonance imaging as well as the combined application of molecular imaging in the assessment of breast lesions. In addition, we will briefly discuss other evolving molecular imaging techniques, such as phosphorus magnetic resonance spectroscopic imaging and sodium imaging.     

Present and Future Uses of Hemoperfusion with Sorbents

International interest in the clinical uses of hemoperfusion has increasingly grown in the last ten years and, as a result, sorbent hemoperfusion has emerged as first-line management in several areas. This center and many others have shown that there is a clear role for hemoperfusion in severe self-poisoning. Plasma extraction ratios for most drugs are significantly higher for hemoperfusion over both resin (0.8) and activated charcoal (0.5; CHP) than for hemodialysis (0.27), under similar conditions of blood flow, plasma drug concentrations, etc. Using appropriate pharmacokinetic models in the analysis of plasma drug profiles, it has been shown that CHP can increase drug elimination rate constants and whole body clearance rates in experimentally intoxicated animals. Enhancement of drug elimination broadens the scope of sorbent hemoperfusion to other areas of application, such as the removal of anticancer drugs (e.g., methotrexate, adriamycin) after cancer chemotherapy. Evaluation of the role of hemoperfusion in hepatic encephalopathy or uremia is limited by the lack of knowledge regarding specific toxic molecules in these syndromes. Nevertheless, in the authors' series of ten patients with fulminant hepatic failure, four survived, in contradistinction to an 80–90% mortality for untreated patients, and virtually all awoke from deep coma. Accompanying reversal of coma, there were significant changes in plasma and cerebrospinal fluid amino acids and in cerebrospinal fluid cyclic AMP concentrations. This suggests that hemoperfusion over charcoal in hepatic encephalopathy may be a useful technique. In this series of uremic patients, although hemoperfusion with charcoal has been shown capable of adsorbing putative uremic toxins including middle molecules up to the present, hemoperfusion alone is only marginally superior to standard hemodialysis. Fouremia, it is likely that multiple specific sorbents will be required, and several compounds for urea and creatinine sorption are presently under investigation.     

Present and Future Therapies of Articular Cartilage Defects

Background: Until today, no universally successful therapy to treat substantial articular cartilage defects has been available. Numerous therapeutic approaches can only improve clinical symptoms of joint lesions, but cannot stimulate the regenerative and reactive capacity of the biological tissue in the defect, and, thus, cannot restore an articular surface capable of functional load bearing. Some other therapeutic options promised impressing results at the beginning, but did not withstand the process of a closer investigation. Even after laborious, invasive and expensive therapies, patients still complain about pain, joint effusions, restricted movement, or articular blockage. Established and Novel Therapies: The aim of all therapeutic procedures to treat patients with damaged articular cartilage is to reconstruct the integrity of the articular cartilage surface in order to enable them to live an unrestricted painless professional and private life. This article gives an overview of the clinically established procedures, their indications and the present long-term results, as well as a crucial look on the limitations of each approach. Novel therapies, which integrate molecular biology techniques and tissue engineering into transplantation surgery, are introduced and analyzed in terms of their capability and future potential.     

The Present and Future of Cardiac Assist Devices

This article describes the status of development of an implantable electrically powered ventricular assist device designed for a minimum of a 2-year operation in patients with advanced heart failure. While these devices are envisioned for chronic support of the failing circulation, air-driven blood pumps have been used to provide life support to patients with acute ventricular dysfunction produced by a reversible myocardial injury of unknown origin. The physical and hemodynamic characteristics of the mechanical circulatory support devices are detailed. Clinical indications and results are provided on patients treated with temporary ventricular assist devices. Long-term follow-up of some patients has demonstrated sustained improved cardiac function for up to 5 years after treatment. Reperfusion injury and postischemic myocardial depression are discussed as two possible etiologies of acute ventricular dysfunction. In the summer of 1984, investigators began a collaborative program to test the engineering reliability of implantable devices as well as their performance in animals. This 3-year Device Readiness Program had a goal of demonstrating an 80% reliability with a confidence interval of 70%. In the future, the implantable device will be evaluated clinically in selected patients to investigate its ability to support circulatory functions and the results of host-device interactions. These devices have potential both as experimental tools in studies of heart and vascular disease and in the treatment of patients with intractable heart failure.     

Past,Present and Future of Surgical Training in Belgium

The objective of the authors is to assess the natural history of carotid artery disease and the role of carotid intervention in preventing ipsilateral stroke. The development of endovascular techniques for correction of carotid artery stenoses made this less invasive technique very popular, with an inherent risk of unregulated overuse by a variety of medical specialists, who are not always well informed on the natural history of carotid artery disease. It re-opened the discussion on the value of carotid endarterectomy for stroke prophylaxis. This ongoing debate offers the opportunity to distil evidence-based guidelines for the management of extracranial carotid artery stenoses.

In recent papers, some authors expressed doubts on the validity and general applicability of the results of the pivotal randomised trials of carotid endarterectomy. The excellent results in terms of operative outcome and long term stroke prevention would, according to certain comments, not be attainable in routine practice.

Another criticism of carotid endarterectomy is its higher operative morbidity in terms of cranial nerve lesions and myocardial infarctions, compared to endovascular procedures. This consideration is, for some authors, the main reason to espouse carotid artery stenting as a better alternative to carotid endarterectomy. Any evidence supporting this point of view is missing. The supposed equivalence or non-inferiority of carotid artery stenting is purely speculative. The aim of this review paper is to summarize the crude data of carotid surgery trials. The authors aim to answer four questions. For which lesions is carotid endarterectomy most beneficial ? Are the results of randomised carotid surgery trials biased by the selection of patients ? Is operative morbidity, other than stroke, under-estimated ? Is carotid artery stenting safe and efficacious ?

An in-depth review with a critical analysis is made of recently published and on-going trials, comparing carotid surgery with percutaneous carotid angioplasty.     

Overview of the Present and Future of Clinical Transplantation

An historical overview of kidney transplantation including the rehabilitation status of long–term survivors, the ethical issues related to current American transplant ation, and projections for the future are presented.     

Spinal Cord Injury-Past,Present, and Future

Abstract

Summary: This special report traces the path of spinal cord injury (SCI) from ancient times through the present and provides an optimistic overview of promising clinical trials and avenues of basic research. The spinal cord injuries of Lord Admiral Sir Horatio Nelson, President James A. Garfield, and General George Patton provide an interesting perspective on the evolution of the standard of care for SCI. The author details the contributions of a wide spectrum of professionals in the United States, Europe, and Australia, as well as the roles of various government and professional organizations, legislation, and overall advances in surgery, anesthesia, trauma care, imaging, pharmacology, and infection control, in the advancement of care for the individual with SCI.