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1.
P. Nadziakiewicz B. Szyguła-Jurkiewicz J. Pacholewicz M. Zakliczyński P. Przybyłowski A. Krauchuk M. Łowicka M. Zembala 《Transplantation proceedings》2018,50(7):2075-2079
Background
Model for End-Stage Liver Disease (MELD) score predicts multisystem dysfunction and death in patients with heart failure (HF). Left ventricular assist devices (LVADs) have been used for the treatment of end-stage HF.Aim of the study
We evaluated the prognostic values of MELD, MELD-XI, and MELD-Na scores in patients with POLVAD MEV LVAD.Materials and methods
We retrospectively analyzed data of 25 consecutive pulsatile flow POLVAD MEV LVAD patients (22 men and 3 women) divided in 2 groups: Group S (survivors), 20 patients (18 men and 2 women), and Group NS (nonsurvivors), 5 patients (4 men and 1 woman). Patients were qualified in INTERMACS class 1 (7 patients) and class 2 (18 patients). Clinical data and laboratory parameters for MELD, MELD-XI, and MELD-Na score calculation were obtained on postoperative days 1, 2, and 3. Study endpoints were mortality or 30 days survival. MELD scores and complications were compared between Groups S and NS.Results
20 patients survived, and 5 (4 men and 1 woman) died during observation. Demographics did not differ. MELD scores were insignificantly higher in patients who died (Group 2). Values were as follows: 1. MELD preoperatively (21.71 vs 15.28, P = .225) in day 1 (22.03 vs 17.14, P = .126), day 2 (20.52 vs 17.03, P = .296); 2. MELD-XI preoperatively (19.28 vs 16.39, P = .48), day 1 (21.55 vs 18.14, P = .2662), day 2 (20.45 vs 17.2, P = .461); and 3. MELD-Na preoperatively (20.78 vs 18.7, P = .46), day 1 23.68 vs 18.12, P = .083), day 2 (22.00 vs 19.19, P = .295) consecutively.Conclusions
The MELD scores do not identify patients with pulsatile LVAD at high risk for mortality in our series. Further investigation is needed. 相似文献2.
J. Nowak B. Hudzik J. Niedziela P. Rozentryt M. Zembala M. Gąsior 《Transplantation proceedings》2018,50(7):2044-2047
Background
Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration is elevated in patients with pulmonary hypertension (PH); however, its role in the detection of PH associated with lung disease is not well established.Aim
The aim of this study was to assess the value of NT-proBNP in the detection of PH in patients with end-stage lung disease (esLD) referred for lung transplantation.Materials and methods
The study population consisted of 65 patients: 37 with idiopathic pulmonary fibrosis (IPF), 20 with chronic obstructive pulmonary disease, and 8 patients with other interstitial lung diseases (75% men, mean age 53.3 ± 9.5 years). Serum concentration of NT-proBNP was assessed with an immunoradiometric assay kit. The mean pulmonary artery pressure (mPAP) was measured using a Swan-Ganz catheter. PH was defined as mPAP ≥ 25 mm Hg.Results
Median NT-proBNP concentrations were significantly higher in patients with PH than in patients without PH: 139 (49–1236) pg/mL vs 67 (38–116) pg/mL, respectively; P = .016. Receiver operating characteristic (ROC) analysis revealed that NT-proBNP concentration higher than 131.5 pg/mL was a predictor of PH with good specificity (81%) and positive predictive value (78.9%) but low sensitivity (55.6%) and negative predictive value (58.6%). The area under the ROC curve of serum NT-proBNP concentration for PH was 0.71 (95% confidence interval 0.57–0.85, P = .039).Conclusion
Serum concentration of NT-proBNP may be useful in the diagnosis of PH in patients with esLD referred for lung transplantation. 相似文献3.
M. Ochman A. Stanjek-Cichoracka M. Latos J. Wojarski M. Kukla E. Woźniak-Grygiel M. Maruszewski W. Karolak P. Przybyłowski S. Żegleń 《Transplantation proceedings》2018,50(7):2039-2043
The aim of the study was to investigate serum concentration of visfatin, irisin, and omentin in patients diagnosed as having end-stage lung diseases who qualified for lung transplantation (LTx) and to find the relationship between adipokine levels and clinical status.
Material and methods
The study population consisted of 23 consecutive patients (10 patients diagnosed as having cystic fibrosis, 6 patients diagnosed as having chronic obstructive pulmonary disease, and 7 patients diagnosed as having idiopathic pulmonary fibrosis) who qualified for LTx. Patients performed pulmonary function tests; visfatin, irisin, and omentin serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits.Results
Mean visfatin serum level was 4.99 ±?3.83 pg/mL; mean irisin serum level was 2.82 ± 0.24 ng/mL; mean omentin serum level was 389.99 ± 320.85 ng/mL. Mean distance in 6-minute walk test (6MWT) was 310.62 ± 147.09 m. Average partial pressure of oxygen (pO2) was 55.79 ± 10.33 mm Hg, forced expiratory volume (FEV1) was 26.25 ± 22.38%, and forced vital capacity (FVC) was 56.95 ± 21.91% of a due value. There was no statistically significant correlation between adipokine levels and 6MWT, pO2, FEV1, and FVC in patients waiting for LTx, regardless of underlying lung disease. Significant difference between patients was noted only in 6MWT, FEV1, and pO2 in connection to lung disease.Conclusion
Our findings indicate that adipokines may not have a statistically significant effect on parameters of pulmonary function. Results require further investigation on a larger study group, especially comparison of adipokine serum levels between groups of overweight patients, obese patients, and patients with normal weight who qualify for LTx. 相似文献4.
J. Wojarski M. Ochman W. Medrala Z. Kulaczkowska W. Karolak M. Maruszewski M. Urlik E. Wozniak-Grygiel M. Sioła M. Latos P. Biniszkiewicz K. Pyrc S. Zeglen 《Transplantation proceedings》2018,50(7):2064-2069
Introduction
The aim of the study was to assess the impact of bacterial infection during hospital stay on long-term follow-up.Materials and Methods
This was a retrospective single-center study of 97 recipients of lung transplantations performed between December 2004 and June 2016 at a single center. Information about age, sex, underlying lung disease, and date and type of procedure was gathered from patients' charts. Immunosuppressive treatment has been analyzed individually among the cohort. Microbiological evaluation included the presence of infection, bacterial species in recipients and donors, as well as type of biological material.Results
During a mean hospitalization time of 57 days (range 4–398 days), 67 patients (69%) were diagnosed with bacterial infection. There were 120 episodes of infection caused by 32 species of bacteria. The most common were Pseudomonas aeruginosa (27%), Acinetobacter baumanii (21%), Klebsiella pneumoniae (10%) and Stenotrophomonas maltophilia (11%). Analysis revealed that 39 patients developed bronchiolitis obliterans syndrome (43%). Patients with A baumanii had a lower probability of survival than the rest of the population (P < .05). Patients treated with mammalian target of rapamycin inhibitors had a higher probability of survival.Conclusions
Infection with A baumanii affects lung transplant recipients' survival. Incorporating sirolimus could be beneficial for the lung transplant recipients' survival. 相似文献5.
M. Ochman J. Wojarski A. Wiórek W. Slezak M. Maruszewski W. Karolak P. Przybyłowski Ł. Krzych S. Zeglen 《Transplantation proceedings》2018,50(7):2070-2074
Background
After successful lung transplantation, patients are monitored for chronic lung allograft dysfunction. Pulmonary function tests and 6-minute-walk tests are commonly used for functional graft monitoring. As these methods require substantial effort, however, many patients are unable to complete testing fully. The impulse oscillometry system is a noninvasive method that requires minimal patient cooperation and is suitable for use for patients incapable of strenuous activity. We compared impulse oscillometry system with pulmonary function tests and 6-minute-walk tests to determine if impulse oscillometry system could serve as a substitute measure.Methods
This prospective, observational study evaluated 25 consecutive patients (19 men, median age 54.5 years) admitted to a single institution from January to October 2016 (double-lung = 13, single-lung = 13). Patients were assessed using pulmonary function tests, impulse oscillometry system, and 6-minute-walk tests.Results
Eighty-eight percent of patients reached high-resonance frequency (Fres) and, in 84% of patients, the value of Ax (area of reactance) increased above the norm (N < 0.33 kPa/L) indicating peripheral airways obstruction. High resistance of small airways, measured with an R5 – R20 difference, followed higher Ax values. The increase of resistance at 5 Hz in 31% of patients (R5 >150% predicted value) also indicated small airway obstruction. Airway obturation in patients with elevated Ax and R5 was confirmed by decreased FEV1 (<75% predictive value) and FEV1/FVC ratio in 38% of patients.Conclusions
Study results confirm the impulse oscillometry system method could be a substitute for pulmonary function tests in determining the occurrence of chronic lung allograft dysfunction. 6-minute-walk tests showed neither strong correlations regarding impulse oscillometry system and pulmonary function tests nor any base for differentiation of results regarding main factor codes. 相似文献6.
J. Wojarski M. Ochman M. Latos P. Biniszkiewicz W. Karolak E. Woźniak-Grygiel M. Maruszewski M. Urlik W. Mędrala Z. Kułaczkowska K. Pyrc S. Żegleń 《Transplantation proceedings》2018,50(7):2053-2058
Background
The aim of the study was to assess the frequency of infections caused by Pneumocystis jiroveci, Chlamydophila pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae among lung transplant recipients in the context of immunosuppression.Methods
The study group consisted of 94 patients (37 women and 57 men; mean age 42.03 years) transplanted between 2009 and 2016 at the Silesia Center for Heart Diseases (SCCS). Immunosuppressive treatment (induction and maintenance therapy) was assessed. The immunofluorescence methods were used to detect the P. jiroveci, L. pneumophila, C. pneumoniae, and M. pneumoniae antigens in samples obtained from the respiratory tract.Results
Thirty-two of 94 graft recipients developed atypical or opportunistic infection. The median time of its occurrence was 178 days after transplantation. P. jiroveci was responsible for 84.38% of first infections. Five patients developed infection with P. jiroveci and C. pneumoniae. None of the infections occurred during induction of immunosuppression. An opportunistic or atypical infection developed in 19.35% of the patients treated with a tacrolimus-based regimen, and in 43.33% of patients on a cyclosporine-based regimen.Conclusion
Infection with P. jiroveci is a recognized problem after lung transplantation and should be monitored. The percentage of infected patients is higher in patients treated with a cyclosporine-based regimen in comparison to those treated with tacrolimus. 相似文献7.
K. Antończyk T. Niklewski R. Antończyk M. Zakliczyński M. Zembala T. Kukulski 《Transplantation proceedings》2018,50(7):2090-2094
Background
The diagnosis of acute cellular rejection (ACR) is a major objective in the management of heart transplant recipients. The aim of this study was to assess the utility of speckle-tracking derived parameters in identifying patients at risk of graft rejection.Methods
A prospective, single-center study was carried out involving 45 consecutive heart transplant patients who underwent a total of 220 routine endomyocardial biopsies (EMBs) with correlative echocardiographic examination.Results
No significant ACR (grade 0-1R) was seen in 190 biopsies (81.2% of the ACR-free group), and moderate ACR requiring specific treatment (grade 2R) was detected in 30 biopsies (13.6% of the ACR group). Grade 3R was not observed. All longitudinal left ventricular (LV) and right ventricular (RV) strain parameters were greater in the ACR-free group than in patients with ACR, while no differences were observed between radial and circumferential strain parameters. In our analysis, we selected RV free wall longitudinal strain (RV FW) ≤ 16.8% and 4-chamber longitudinal strain (4CH LS) ≤ 13.8%, which related to the presence of ACR requiring treatment. We assigned 1 point for each parameter (minimum 0, maximum 2 points) and derived a new echocardiographic index, the Strain Rejection Score (SRS). Our proposed approach—a combination of the 2 abovementioned indices—for screening patients at risk of ACR ≥ 2R, when expressed by a score 2 points, showed good specificity, strong negative predictive value, and the highest area under the curve.Conclusions
Our study demonstrated that combination of 4CH LS and RV FW as a new echocardiographic index, the Strain Rejection Score, can be useful as a noninvasive assessment of ACR during the first year of follow-up after heart transplant. 相似文献8.
P. Przybyłowski G. Wasilewski E. Koc-Żórawska J. Małyszko 《Transplantation proceedings》2018,50(7):2100-2104
Background
One of the main actions of vitamin D is bone mineralization regulation. Vitamin D is linked also to hypertension, diabetes, and cardiovascular disease. Vitamin D deficiency may result in osteomalacia, but its excess may result in bone calcium mobilization. Kidney transplant recipients are also at risk of hypovitaminosis D because of impaired graft function. The aim of the study was to assess vitamin D concentration in patients after heart and kidney transplantation.Material and methods
Ninety-eight stable heart transplant recipients were enrolled in the study; 80 kidney transplant recipients and 22 healthy volunteers served as controls. The laboratory tests, including parameters of 25-hydroxyvitamin D (calcidiol), were assayed using commercially available kits.Results
Calcidiol deficiency (level below 10 ng/mL) was observed in 10% of the transplant group and in 55 % of the orthotopic heart transplant recipients (OHT). There was positive correlation between calcidiol concentration, hemoglobin, kidney function, and serum glucose in kidney transplant recipients. In OHT, vitamin D correlated with age, kidney function, hemoglobin, cholesterol, low-density lipoprotein cholesterol, and glucose. Both groups had similar kidney function. In both groups of patients with estimated glomerular filtration rate above 60 mL/min/1.72 m2, vitamin D was significantly higher. In OHT, vitamin D was higher in nondiabetic patients. In OHT in multivariate analysis, vitamin D was predicted in 24% by kidney function (beta = ?0.30; P?=?.02) and hemoglobin concentration (beta = 0.25; P?=?.03).Conclusions
Vitamin D deficiency is more common in patients after heart transplantation than in kidney allograft recipients despite similar kidney function. The possible associations between the cardiovascular system and vitamin D merit further studies. 相似文献9.
J. Nowak B. Hudzik P. Przybyłowski J. Niedziela P. Walczak P. Rozentryt M. Ochman S. Żegleń J. Wojarski M. Zembala M. Gąsior 《Transplantation proceedings》2018,50(7):2048-2052
Background
Pulmonary hypertension (PH) is a common complication in end-stage lung disease (esLD). The aim of this study was to establish the best threshold values for mean, systolic, and diastolic artery pressure (mPAP, dPAP, and sPAP, respectively) to identify patients with esLD referred for lung transplantation and to predict 1-year prognosis.Methods
Sixty-five patients were enrolled in the study (75% men) with a mean age of 53.3 ± 9.5 years; 31% had chronic obstructive pulmonary disease (COPD), 57% had idiopathic pulmonary fibrosis (IPF), and 12% had interstitial lung diseases (ILDs). The mean period of observation was 14.4 ± 5 months. We assessed invasively mPAP, dPAP, and sPAP, as well as pulmonary capillary wedge pressure (PCWP), using a Swan-Ganz catheter. Receiver-operating characteristic (ROC) curves were constructed to identify the best cutoff points for mPAP, dPAP, and sPAP to predict survival. The study endpoint was defined as 1-year mortality before transplantation. Survival analysis was completed according to the Kaplan-Meier method.Results
During follow-up, 30 (46.1%) patients died and 19 (29%) underwent lung transplantation. Based on ROC curve analysis, we estimated mPAP ≥30 mm Hg, dPAP ≥20 mm Hg, and sPAP ≥44 mm Hg as the best threshold values with the highest sensitivity (70%, 70%, and 73%, respectively) and specificity (76%, 69%, and 72%, respectively) and the acceptable area under curve (0.67, 0.68, and 0.72, respectively). The negative predictive values for mPAP, dPAP, and sPAP were higher than the positive predictive values (79%, 77%, and 81% vs 67%, 61%, and 64%, respectively). We also constructed Kaplan-Meier curves for mPAP, dPAP, and sPAP threshold values. There were significant differences in 1-year survival between patients with and without PH for mPAP, dPAP, and sPAP threshold values (P = .005, P = .035, and P < .001; respectively).Conclusion
Elevated mPAP, dPAP, and sPAP are related to worse prognosis in patients with esLD referred for lung transplantation. 相似文献10.
P. Przybyłowski G. Wasilewski E. Koc-Żórawska J. Małyszko 《Transplantation proceedings》2018,50(7):2105-2109
Development of arterial hypertension is to some extent related to decreased activity of the kallikrein-kinin system. This poorly understood hormonal system consists of blood proteins playing a role in the process of inflammation, coagulation, blood pressure control, and pain conduction. The system consists of kallikreins (plasma and tissue), kallistatin, kininogens, kinins (bradykinin, kallidin-lizynobradykinin), kininases (I and II), and membrane receptors of bradykinin. The aim of the study was the assessment of kallistatin in correlation to blood pressure value in heart transplant recipients.
Patients and Methods
Kallistatin level was estimated in 131 heart transplant recipients on standard 3 drugs immunosuppressive regimens (calcineurin inhibitor, mycophenolate mofetil/mycophenolic acid, and steroids) in correlation to inflammation markers and blood pressure values. Additionally, 22 healthy volunteers served as controls. In cross-sectional study, kallistatin and catecholamine concentrations were assessed using commercially available assays.Results
Kallistatin concentration did not differ significantly among heart transplant recipients in comparison with controls; serum noradrenaline concentration was lower in the study group. In the orthotopic heart transplant group, kallistatin correlated with renal function; estimated glomerular filtration rate was calculated by Modification of Diet in Renal Disease formula (r = ?0.28, P?<?.01; hemoglobin r = ?0.19, P?<?.05; cholesterol level r = ?0.23, P?<?.01; low-density lipoprotein r = 0.25, P?<?.01; ferritin r = 0.21, P?<?.05; noradrenaline r = ?0.28, P?<?.01). No correlation with blood pressure values were revealed. In multivariate analysis, cholesterol serum level and age predicted 32% of variability of kallistatin concentration.Conclusion
Kallistatin among heart transplant recipients does not seem to be the pathogenetic factor of arterial hypertension but may be involved in the development of hyperlipidemia often present in this group of patients. 相似文献11.
M. Ochman M. Maruszewski M. Latos D. Jastrzębski J. Wojarski W. Karolak P. Przybyłowski S. Zeglen 《Transplantation proceedings》2018,50(7):2059-2063
Background
Although the effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung disease, cystic fibrosis, and interstitial lung disease is well documented, little is known about pulmonary rehabilitation in patients who are referred for lung transplantation. Nordic walking is a low-cost and accessible form of physical exercise with proven benefits. The purpose of this prospective study was to examine the effects of Nordic walking on lung function, perception of dyspnea, and health-related quality of life in patients referred for lung transplantation.Methods
Twenty-two of 40 patients who was qualified for lung transplantation at the Department of Lung Diseases in Zabrze, Poland, completed a rehabilitation program consisting of 12 weeks of Nordic walking. Lung function tests, exercise tolerance, and perception of dyspnea and quality of life were assessed before and after completion of the program.Results
No adverse events were observed during the rehabilitation program. After 12 weeks, there was a significant increase in mean 6-minute walk distance (374 meters vs 288 meters, P < .034) and a significant reduction in perception of dyspnea after completion of the rehabilitation program. Assessment of general health and quality of life showed significant improvement (P < .05). No significant changes in lung function tests were noted.Conclusion
Nordic walking is a safe and feasible physical activity for pulmonary rehabilitation in patients with end-stage lung disease who are referred for lung transplantation. This rehabilitation technique results in significant improvements in patient mobility and quality of life. 相似文献12.
Heart transplantation, one of the treatment options for end-stage heart failure, is still regarded as the gold standard treatment to improve quality and length of life. However, the rapid increase in the number of patients waiting for heart transplantation and the inadequate number of donors makes heart transplantation a less feasible option and increases the need for ventricular assist devices as an alternative. The success of ventricular assist device implantation requires the collaboration of a multidisciplinary team consisting of cardiac surgeons, nurses, ventricular assist device coordinators, cardiologist, cardiac anesthesia specialists, perfusionists, and physiotherapists. Nurses working in different fields such as intensive care units, operating rooms, outpatient clinics, and ventricular assist device coordination units have important responsibilities in multidisciplinary teams. In this study, national and international studies on the responsibilities of nurses for the management and care of ventricular assist devices were reviewed. Nurses undertake many tasks, especially in the postoperative care of patients and in preparing them for discharge. Important responsibilities of nurses in the care of patients with ventricular assist devices include monitoring complications, managing equipment and emergency situations, establishing dressing change protocols, organizing daily life activities, determining rehabilitation needs, ensuring use of medicines, and providing comprehensive discharge education. Organizational and communication skills of nurses working with multidisciplinary teams are very important for the success of the ventricular assist device implantation process. 相似文献
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O. Seguchi K. Kuroda Y. Kumai S. Nakajima M. Yanase K. Wada Y. Matsumoto S. Fukushima T. Fujita J. Kobayashi N. Fukushima 《Transplantation proceedings》2018,50(9):2726-2732
Background
Left ventricular assist device (LVAD) therapy is the “gold standard” alternative therapy for patients with advanced heart failure. However, LVAD therapy is still uncommon in the Asia-Pacific region. Therefore, we aimed to elucidate the clinical outcomes of patients from Japan supported with the HeartMate II (HM-II) LVAD at our institution.Methods
Ninety-two patients (mean 44.3 ± 12.1 years, 68 men, average body mass index 1.65 ± 0.28 m2; 81 with nonischemic cardiomyopathy) who underwent HM-II implantation for bridge to transplantation (n = 91) or for destination therapy in a clinical study (n = 1) at the National Cerebral and Cardiovascular Center between April 2013 and October 2017 were enrolled in this analysis. Preoperatively, most patients (n = 73, 79%) had an INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile of between level 2 and 4. Postoperatively, the average pump speed was 8602 ± 258 rpm and the hemodynamics were well compensated.Results
Adverse events consisted of 38 (41.3%) hemolysis, 30 (32.6%) major infection, 27 (29.3%) major bleeding (6 [6.5%] with gastrointestinal bleeding), and 18 (19.6%) neurologic dysfunction events. Eighteen patients underwent heart transplantation (HTx) after an average of 32.9 ± 8.9 months of VAD support, and overall survival at both 6 months and 3 years was 96.3%.Conclusion
Clinical outcome among patients with HM-II at our institution is satisfactory for both survival and adverse events. The HM-II can provide effective hemodynamic support during the extremely long waiting period for HTx in Japan. 相似文献17.
E. Karakulska-Prystupiuk G. Basak J. Dwilewicz-Trojaczek M. Paluszewska P. Boguradzki W. Jędrzejczak 《Transplantation proceedings》2018,50(7):2218-2222
Background
There are only a few cases of pericarditis complications following allogeneic bone marrow transplantation described in the literature and there are no data available on the risk and frequency of this condition. The aim of this study was to assess the frequency of exudative pericarditis complicating chronic graft-vs-host disease in allogeneic hematopoietic cell transplant recipients.Methods
Retrospective analysis involved a group of 105 patients of the Outpatient Transplantation Service of the Department of Hematology, Medical University of Warsaw, who received transplants in the years 2010–2016 and were evaluated for the years 2014–2016. In this group, 50 patients suffered from chronic graft-vs-host disease (cGVHD), including 24 with moderate or severe disease. Cardiology parameters evaluated included electrocardiography, echocardiography, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and systematic clinical follow-up.Results
Pericarditis was diagnosed in 6 patients (aged 20–56 years) within 4 to 23 months after allogenic hematopoietic stem cell transplantation. All patients suffered from severe cGVHD with involvement of at least 2 organs but none had earlier history of heart disease. All patients had elevated NT-proBNP and demonstrated signs of heart insufficiency grade II or III according to the New York Heart Association. There were no major changes in electrocardiogram. Only 1 patient improved following glucocorticosteroids as monotherapy, while others required complex approaches including tacrolimus plus sirolimus, rituximab, and extracorporeal photopheresis.Conclusion
Late pericarditis may occur in up to 5% of allogenic hematopoietic stem cell transplantation survivors, primarily affecting patients with moderate and severe grade cGVHD. It requires escalation of immunosuppressive treatment but usually has favorable outcome. Early diagnosis may be achieved by systematic NT-proBNP testing and periodic echocardiograph evaluation. 相似文献18.
Andrzej Berman Michal Wszola Lukasz Gorski Marta Serwanska-Swietek Agata Ostaszewska Anna Lipinska Andrzej Chmura Artur Kwiatkowski 《Transplantation proceedings》2019,51(8):2781-2786
IntroductionPainful chronic pancreatitis (CP) is the main indication for analgesic pancreatectomy with simultaneous islet autotransplantation to prevent postoperative diabetes mellitus (DM). However, advanced CP may lead to insulin secretion disorders and DM. There are doubts as to whether islet autotransplantation in such cases is an appropriate procedure. The aim of this study was to analyze the results of islet autotransplantation in patients with CP with already diagnosed with DM.MethodBetween 2008 and 2015, at the Department of General and Transplantation Surgery, patients with CP and unsatisfying pain treatment with positive fasting C-peptide ( > 0.3 ng/mL) level were qualified for simultaneous pancreatectomy and islet autotransplantation. Eight procedures were performed. In 5 cases patients had DM diagnosed prior to the procedure (DM group n = 5). Three patients without DM diagnosed prior to surgery were the control group (n = 3).ResultThere were no cases of procedure-related deaths in either group. Pain relief without analgesics was reported by all patients. Good islet function was observed in 80% (4/5) of the DM group vs 100% (3/3) in the control group (P = ns). Brittle diabetes was diagnosed in 1 patient in the DM group as a result of islet primary non-function.ConclusionPatients with CP-related severe pain and DM patients with positive C-peptides should be considered for pancreatectomy and islet autotransplantation. 相似文献
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A. Montalto A. Palermo R. Gherli A. Cammardella C. Contento V. Piazza F. Musumeci 《Transplantation proceedings》2019,51(1):210-214
Introduction
The measurement of blood pressure (BP) and the management of hypertension in patients with continuous-flow ventricular assist devices (CF-VADs) can present unique challenges. Patients with CF-VADs often do not have a palpable pulse, and therefore traditional blood pressure measurement by auscultation or automated cuff is less reliable. We tested the efficacy of blood pressure estimation using sphygmomanometry combined with finger pulse oximetry only after a hemodynamic optimization was effected to make the values estimated approximately similar to mean arterial pressure.Methods
Fifteen consecutive patients with a mean age of 57.8 ± 11.2 years were implanted with HeartMate 3 between November 2015 and March 2017. All patients underwent pump speed optimization by conducting a ramp test during right heart catheterization. The patients were prospectively studied during the follow-up period and mean arterial pressure was estimated using 3 different methodologies: Doppler ultrasound, pulse oximeter, and automated blood pressure cuff. For each method 3 consecutive evaluations were conducted during 3 follow-up visits.Results
For each patient, 9 different evaluations were obtained (3 for each method). The overall success rate was 100% for blood pressure assessment conducted with Doppler ultrasound and pulse oximeter and 80%-87% for automated monitor evaluations. The first 2 methodologies were 100% successful, while the third was 60% successful. Pearson's correlation analyses for the Doppler ultrasound and pulse oximeter measurements showed a good correlation when evaluations conducted with the same method were compared. A high variability emerged between estimations obtained by using an automated monitor and a poor correlation was found when this method was compared to the Doppler ultrasound and pulse oximeter measurements.Conclusion
According to our results, the pulse oximeter method showed a high success rate and a good correlation level with the standard procedure. Our data encourage the use of oximeters for domiciliary blood pressure assessment in patients implanted with a continuous flow device. 相似文献20.
K. Nowańska P. Donizy K. Kościelska-Kasprzak D. Kamińska M. Krajewska O. Mazanowska K. Madziarska S. Zmonarski P. Chudoba B. Małkiewicz A. Hałoń M. Klinger M. Banasik 《Transplantation proceedings》2018,50(6):1760-1764