RESUMEN
Despite the good overall condition of Polish transplantation medicine there is a shortage of organs for transplantation. Health care is also in a stage of development with problems including insufficient funding and lack of personnel. In 2015 the number of deceased organ donors in Poland was 526, which was distinctly lower than in 2014 when it reached 594. The aim of this paper was to collect, elaborate on, and summarize the opinions of transplant coordinators regarding the decrease of donation indicators in Poland. MATERIALS AND METHODS: The opinions of the transplant coordinators were collected during training meetings and questionnaires performed in 2016. The questionnaires targeted coordinators of active hospitals (above 5 retrievals a year) and less active donor hospitals. RESULTS AND DISCUSSION: Transplant coordinators indicated a number of factors that influence donor hospital activity, such as changing roles of intensive care units, changes in hospital flow of patients in critical condition, lack of nurses and anesthesiologists resulting in work overload, changes in forms of doctors' employment, low basic income of health professionals, difficulties in determination of brain death, decrease in engagement of transplant centers in cooperation with donors' hospitals, inadequate in-hospital training meetings, undermining of authority of doctors and medical personnel, change of attitude towards transplantation medicine (treated as profitable, regular specialty), insufficient funding of hospitals and personnel for deceased donor recruitment, and disobeying the rules of personnel remuneration for their engagement in donation and retrieval. CONCLUSIONS: Analyzing the opinions of the coordinators, we can state the following: 1. support of the hospital or hospital unit management is crucial for effective donation programs, 2. there is a need to build and implement a hospital quality systems covering each stage of donor recruitment as well as hospital trainings, 3. there should be a transplant coordination team rather than a single coordinator, 4. transplantation centers should maintain good cooperation with donor hospitals, and 5. intensive care unit personnel identification with their own hospital, which is less likely in the case of "locum" employment, is one of the major factors supporting donation programs.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Femenino , Humanos , Masculino , Polonia , Encuestas y Cuestionarios , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/estadística & datos numéricosRESUMEN
AIM: To be able to calculate the potential of organ donation from deceased donors in a single hospital, region, and country, it is necessary to develop a useful stratification system for all hospitals taking into account their characteristics in having or not having departments crucial for donor identification and recruitment, such as an intensive care unit (ICU or neurology and neurosurgery departments), number of beds, and patient profiles (pediatric vs adult). MATERIALS AND METHODS: There are 1032 hospitals in Poland, and 388 have facilities and tools to confirm death according to neurological criteria. These hospitals with the potential of deceased donation were characterized accordingly to the criteria presented above. RESULTS: The largest group of institutions were first-degree referral hospitals having ICUs only for adults (161 hospitals), followed by hospitals with ICU and stroke departments for adults (76), then hospitals for adults with ICU and neurological department with no stroke beds (25), and hospitals for adults with second-degree referral and with ICU, stroke departments, and neurosurgery. In the case of pediatric patients and possible pediatric organ donation, the largest group consisted of 5 hospitals with pediatric ICU, pediatric neurology, and pediatric neurosurgery units. The remaining hospitals were unique in the country range. An exemplary analysis of 1 of the 40 stratified groups (19 out of 388 hospitals) showed that differences in actual activity in the donation process between similar hospitals are significant (from 0 to 62 donations in a 3-year period). CONCLUSION: We believe the results of this study are fundamental for the calculation of potential donation in the country. Our thesis is that hospitals from the same group should have the same potential and should be active in donation process on the same level. Formal comparative analysis of historical data on donor referral from active and nonactive hospitals will allow us to estimate the lost numbers of possible donations and will help focus efforts to improve transplantation systems.
Asunto(s)
Hospitales/estadística & datos numéricos , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adulto , Muerte , Femenino , Unidades Hospitalarias , Humanos , Polonia , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
INTRODUCTION: The surgical procedures due to aortoiliac aneurysm (AAA) represent the most demanding procedures in conventional vascular surgery. This is due, among other things, to the relatively frequent systemic and surgical complications in polymorbid and often urgently operated patients. Surgical and vascular complications after resections of aortoiliac aneurysms are relatively common, and reintervention due to these complications is reported to range around 14%. METHOD: Retrospective clinical study of a group of patients undergoing surgical management for aortoiliac aneurysms in the period from 1 January 2010 to 31 December 2017 at the Department of Vascular and Plastic Surgery of Pardubice Hospital NPK. RESULTS: In a group of 240 patients (205 males, 35 females), mortality reached a total of 10.4%, with mortality in elective cases 3.4% and 31.1% in urgent procedures (37.5% in AAA rupture). Overall, in the elective group, we recorded a total of 29 (16.2%) surgical and/or vascular complications with the necessity of 16 (8.9%) surgical, endovascular or combined interventions. In the emergency group, these complications were recorded 30 times (49%) with the need for intervention in 19 cases (31.1% of emergency procedures). CONCLUSION: Open surgical procedures on AAA are accompanied by a high incidence of systemic and surgical and/or vascular complications. These patients therefore require high attention and quality of intensive care in the postoperative period, focusing on early diagnosis and subsequent treatment of these complications. Key words: aortoiliac aneurysm surgical complications - bleeding limb ischemia abdominal compartment syndrome.
Asunto(s)
Aneurisma de la Aorta Abdominal , Procedimientos Quirúrgicos Vasculares , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Isquemia , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
BACKGROUND: Since 2007, the Medical University of Warsaw has been organizing the Transplant Coordinators Postgraduate Studies, which are funded by the National Programme for the Development of Transplantation Medicine. The aim of the studies is to recruit medical professionals for every hospital with the potential of deceased donations. The goal of the present study was to formally evaluate the previous 16 editions of Transplant Coordinators Postgraduate Studies by assessing graduate profiles and analyzing the efficiency and sustainability of their education. METHODS: Graduate profiles were determined by gathering sociodemographic information contained in student records. Training efficiency and sustainability were defined by assessing the actual performance of the coordinators' functions in the hospital after taking the course. RESULTS: As of May 2015, the number of Transplant Coordinators Postgraduate Studies graduates totals 501. Approximately one half of the graduates (n = 248) had nursing degrees; training was also finished by 199 physicians, and 54 individuals had other medical education. The number of graduates per million population across the whole country totals 13. A total of 226 of the graduates (45%) were employed in the years 2007-2015 in hospitals as transplant coordinators; physicians (93 graduates), nurses (107 graduates) and other medical proffessionals (26 graduates). CONCLUSIONS: The academic formula of the Transplant Coordinators Postgraduate Studies funded by public sources makes it possible to educate practicing staff (physicians and nurses alike) for a nationwide system of donor hospital transplant coordinators posted in >200 hospitals and maintained by a national transplant organization.
Asunto(s)
Educación de Postgrado , Enfermeras y Enfermeros , Trasplante de Órganos/educación , Médicos , Obtención de Tejidos y Órganos , Humanos , PoloniaRESUMEN
BACKGROUND: In 2010 the formation of the Polish Hospitals Network of Organ Donation Coordinators, originated by Poltransplant, began. One of the goals of this project is to report all deaths in hospital ICUs in which a coordinator is posted. The aim of this strategy is to monitor donation potential, following the recruitment process of potential donors and indicating stages of that process that may be improved to increase effective recruitment. Until the end of 2014 all data were forwarded to Poltransplant as Excel files, but since January 1, 2015, reporting and data collection have been are performed using web tool www.koordynator.net. AIMS: The aim of the paper is to present the essentials in functioning principles, structure, and usage of the www.koordynator.net system, its technical construction, and to display good practices (know-how) tested by 1 country, for countries such as Poland, that contend with organ insufficiency. METHODS: The application www.koordynator.net allows for remote addition of individual records with information about deceased patients in hospital ICUs, the forwarding of data about potential and actual organ donors, the generation of complete reports about deceased patients in each hospital monthly, and the introduction of historical data. SUMMARY: Introduction of a potential donation monitoring system in 209 hospitals with transplant coordinators increases the number of identified potential and effective actual donors due to self-assessment analysis. Eventually, the www.koordynator.net reporting system allowed for external evaluation by coordinators from other hospitals, regional coordinators, and Poltransplant. The system is a modern tool that improves and increases the quality system in the organ donation field (quality assurance program).
Asunto(s)
Internet , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/organización & administración , Recolección de Datos/métodos , Hospitales , Humanos , Polonia , Donantes de Tejidos/estadística & datos numéricosRESUMEN
BACKGROUND: Several events inspired us to collect data on organ transplantation in Poland (2016: the 50th anniversary of the first transplantation and the 20th anniversary of Polish Transplant Coordinating Center Poltransplant). The paper aims at presenting comprehensive data on all organ transplants, beginning with the first in 1966 (deceased kidney) until the end of 2014. METHODS: Source documents were reports published in Poltransplant Bulletin, a website registry managed by Poltransplant, reports by the Transplantation Council and by the Transplantation Institute of Warsaw. A source data enabled us to establish a preliminary report, presented for verification during the 12th Congress of the Polish Transplantation Society. RESULTS: By the end of 2014, the total number of organ transplants was 26,691. Kidney transplantation is the most common (total number = 19,812). The number of living kidney transplants is low, about 50 per year. The number of liver part transplants from living donors is relatively high, 20 to 30 annually. The program of deceased liver transplantation results in more than 300 transplants yearly. The first heart transplantation was in 1985, but the number of these procedures has been decreasing. No significant increase in the number of lung transplantations was noted. CONCLUSIONS: The number of organ transplantations from deceased donors places Poland in the middle among European countries. The number of living donor kidney transplants is lower than in other countries; therefore a living donor liver transplantation program belongs to leading programs. Progress of lung transplantation has been slow. The development is highlighted by vascularized composite tissue transplantations of the hands and face. The strength of the report lies in its reliability and completeness. Numbers are the unique source of information to be used and referred to in the literature.
Asunto(s)
Trasplante de Riñón/estadística & datos numéricos , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Pulmón/estadística & datos numéricos , Humanos , Trasplante de Riñón/tendencias , Trasplante de Hígado/tendencias , Donadores Vivos/estadística & datos numéricos , Trasplante de Pulmón/tendencias , Polonia , Sistema de Registros , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Obtención de Tejidos y Órganos/tendenciasRESUMEN
BACKGROUND: In Poland as well as in other European countries, the number of organs from deceased donors is too small to meet the needs of transplantation therapy. METHODS: This situation can be improved by increasing the number of hospital transplant coordinators in hospitals with potential of donation. Since 2010, 200 Polish hospitals have employed coordinators whose role is to recruit deceased organ donors, to monitor the potential of donation (quality assurance program), and to run the training courses. In Malopolskie Province, there are 26 hospitals in which organ procurement from brain-dead donors is possible. In 13 hospitals, donor transplant coordinators have been employed. The objective of this study was to evaluate the activity of hospitals in Malopolskie Province in the field of donor recruitment before and after employment of coordinators (19 months before and after). For the purpose of the study, the number of hospitals with positive effects and with no effects of coordinator employment was calculated, and several donation rates were compared in the period before and after employment of the coordinator. We also compared the number of deceased organ donors in 13 hospitals employing a coordinator and in 13 hospitals without a coordinator. RESULTS: The desired impact of employment of coordinators in Malopolskie Province measured by improvement of organ donation rates was observed in half of the hospitals (7 of 13; 54%) with a transplant donor coordinator. The number of potential organ donors increased by 100% (from 24 to 48), and the number of actual organ donors increased by 113% (from 16 to 34). The percentage of family objections to organ donation decreased (from 17% to 8%). The best result of employing coordinators was observed at university hospitals and multidisciplinary hospitals and at hospitals in which the coordinator was a physician. The worst effect was recorded at county hospitals. CONCLUSIONS: The employment of hospital transplant coordinators in Malopolskie Province has a global impact on the increase of the number of actual organ donors in that region and improvement of organ donation rates, but it is effective only in half of the hospitals with coordinators. It indicates that other measurements should also be undertaken to run donation programs.
Asunto(s)
Personal de Hospital , Obtención de Tejidos y Órganos/organización & administración , Muerte Encefálica , Humanos , Masculino , Polonia , Donantes de Tejidos/estadística & datos numéricos , Recursos HumanosRESUMEN
INTRODUCTION: In 2010, the system of donor hospital transplant coordinators was implemented in 200 hospitals in Poland on the basis of contracts with Poltransplant. METHODS: This study evaluated whether the system (nationwide, maintained and funded by national organization) is sufficient, improved donation after brain death rates, and hospital activities. RESULTS: Donation indicators over a 21-month period of coordinators' work were compared with the 21-month period before their employment. The number of hospitals with a positive effect and with no effect was analyzed overall and in groups of hospitals with specific profiles. The implemented system resulted in increasing the number of potential donors by 27% (effectively, 24%); increasing utilized organs by 20% and multiorgan retrievals from 54% to 56%; decreasing the rate of utilized organs/actual donors from 2.65 to 2.57; and increasing family refusals from 8.5% to 9.3%. A positive effect was achieved in 102 hospitals (51%). Better results were achieved in regions where donation were initially low, namely, 59% in university hospitals, 63% in hospitals in large cities, 77% in hospitals with 2 coordinators, 67% in hospitals for adults, and 52% in hospitals where the coordinator was a doctor and not a nurse. This system resulted globally in increasing donation rates, but was effective only in one half of hospitals. CONCLUSIONS: Additional activities should be introduced to improve these results (quality systems, trainings, techniques for monitoring potential of donation, changes in profile of a coordinator). A formal analysis of coordinators' activities gives also the national organization a rational basis for their employment policy, taking into account the characteristics of hospitals and coordination teams.
Asunto(s)
Personal de Hospital , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polonia , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/organización & administración , Recursos HumanosRESUMEN
INTRODUCTION: Infection of the prosthetic graft represents one of the biggest challenges for practising vascular surgeons. The patient is jeopardized with possible future limb loss or, in the most serious cases, even death due to this complication. The incidence in the infrainguinal area amounts to a maximum of 6% of all arterial surgical procedures. MATERIAL AND METHODS: Between January 2010 and December 2011, the authors performed a total of 689 vascular surgical reconstructions, of which 311 were performed in the infrainguinal area where 7 cases (2.25%) of graft infection occurred. RESULTS: None of the patients died or lost a limb due to this complication. Two patients with an infected infrainguinal prosthetic graft were successfully treated with vacuum-assisted closure (VAC) system. CONCLUSION: The prosthetic vascular graft infection is the most feared complication in vascular surgery. The generally recognized principles of the traditional surgical approach are well-known and widely accepted. However, in selected cases of infrainguinal vascular prosthetic infection, both the affected limb and the patent graft may be saved and successfully treated with the use of vacuum-assisted closure.
Asunto(s)
Prótesis Vascular/efectos adversos , Terapia de Presión Negativa para Heridas , Complicaciones Posoperatorias/terapia , Infecciones de los Tejidos Blandos/terapia , Procedimientos Quirúrgicos Vasculares/efectos adversos , Adulto , Anciano , Femenino , Humanos , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Procedimientos de Cirugía Plástica , Infecciones de los Tejidos Blandos/etiologíaRESUMEN
The authors present a case report of long- term follow up of 66-year old male with the abdominal aortic aneurysm treated with aortouniiliac stent-graft implantation in combination with the cross-over femoro-femoral bypass 14 years ago. Various leaks type Ia, IIb and III developed during follow-up. In spite of endovascular treatment of these complications the size of the aneurysmal sac enlarged and the patient was successfully treated by the aortobifemoral bypass.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares , Anciano , Fuga Anastomótica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Implantación de Prótesis Vascular , Arteria Femoral/cirugía , Estudios de Seguimiento , Humanos , Masculino , Radiografía , StentsRESUMEN
PURPOSE: Presentation of our own experience with percutaneous treatment of symptomatic bile-duct stones like late complication in patients with biliodigestive anastomosis. METHOD: Three symptomatic female patients with biliodigestive anastomosis and acutely symptomatic with proven bile-duct stones above anastomosis were treated with initial percutaneous transhepatic drainage and later via percutaneous route using of endoscopic lithotryptor with special technique. RESULTS: All procedures were successful without complication, the patients are free of biliary symptoms in the long term. CONCLUSION: Percutaneous removal of bile-duct stones in patients with biliodigestive anastomosis is safe and effective method which can be used as an alternative to surgery.
Asunto(s)
Cálculos Biliares/terapia , Litotricia , Adulto , Anciano , Anastomosis Quirúrgica , Procedimientos Quirúrgicos del Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Drenaje , Femenino , Humanos , Intestinos/cirugía , Persona de Mediana EdadRESUMEN
Authors describe a case report of complications and theirs solutions after endovascular abdominal aneurysm repair. There was symptomatic progression of aneurysmal sac due to endoleak type Ib in this patient 4 years after successful stentgraft treatment. Endovascular treatment was done with optimal effect, but aneurysm sac rupture had early become. The patient was urgently operated. The cause of the rupture was endoleak type IIIa, that was diagnosed perioperatively. This complication was solved with direct suture of disconnected parts of stentgraft. Despite of postoperative complications the patient vas released home in a good condition after 23 days of hospital staying. Endoleaks and their management are discussed in the article.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/etiología , Implantación de Prótesis Vascular , Endofuga/diagnóstico , Procedimientos Endovasculares/efectos adversos , Stents , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/cirugía , Endofuga/patología , Endofuga/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Nutritional support in critically ill patients has an impact on both prevention and treatment. Development of complications and organ failure can be prevented, good status of gut mucosa kept and positive nitrogen balance induced. Inflammatory response can be modulated. NUTRITIONAL SCREENING: Patients undergoing major surgery should be actively screened for the nutritional risk level according to described parameters since it is considered to be very important for the postoperative period. Enteral nutrition (EN) versus parenteral nutrition (PN): Current study findings do not show any difference in mortality of critically ill patients with regard to the administration route. Inflammatory complications rate is significantly lower in EN patients. ESPEN Guidelines on Enteral Nutrition: The most recent recommendations for surgery patients are based on the evidence. CONCLUSION: There is a need for an active nutritional screening to find patients in the risk. Other important points are the following: a progressive approach to early enteral nutrition combined with PN, multiprofessional cooperation and protocol implementation.
Asunto(s)
Enfermedad Crítica , Nutrición Enteral , Unidades de Cuidados Intensivos , Cuidados Posoperatorios , Humanos , Apoyo Nutricional , Nutrición ParenteralRESUMEN
BACKGROUND: Vein shrinkage is a surrogate marker for successful laser treatment of varicose veins. However, many controversies still remain concerning the best laser parameters to use. The aim of this study was standardisation of intraoperative energy dosages and pull-back rates to achieve optimal clinical results. DESIGN: Ex-vivo study in surgically removed saphenous trunks. MATERIAL AND METHODS: Great saphenous veins were removed by Babcock stripping and irradiated with laser energy delivered by a laser diode emitting at 980 nm. In total, 279 vein segments (5 cm long) were treated using powers from 5-15 W. Vein segments were opened longitudinally and the circumference measured in the treated and untreated regions to assess thermal shrinkage. RESULTS: The greatest shrinkage and minimum number of perforations was achieved using lower or medium power (8 to 12 W) with longer exposure to administer laser energy. The median percentage vein shrinkage was 50% (power 5 W), 45% (8 W), 40% (10 W), 45% (12 W) and 59% (15 W). When a higher power was used (15 W), the perforations were more frequent and carbonisation was marked. CONCLUSIONS: Our data suggests that similar efficacy with fewer vein perforations may be obtained with low or medium power settings and increased exposure when undertaking laser obliteration of saphenous trunks. This may result in fewer adverse events such as ecchymosis following treatment in patients.
Asunto(s)
Terapia por Láser/normas , Vena Safena/cirugía , Várices/cirugía , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/métodos , Guías de Práctica Clínica como Asunto , Vena Safena/patología , Várices/patologíaRESUMEN
AIMS: Following surgical therapy, new varicose veins may develop, in particular at the site of the previous saphenofemoral junction. The objective of this study is the appreciation of the causes of the bad results of surgical procedures in the treatment of varicose veins and the proposal of the possibilities of their prevention. MATERIAL AND METHODS: Retrospective study of the group of 404 patients (573 procedures) with the diagnosis of the recurrence after previous radical surgery was performed. After exclusion of perforator refluxes, the most frequently, the great saphenous vein territory was affected (86%), followed by the small saphenous vein territory (14%). The group of 30 consecutive patients (35 limbs) with saphenofemoral or saphenopopliteal recurrence was selected for this study. Based on preoperative ultrasound and per-operative morphological findings, in 12 patients (14 limbs) - 8 women and 4 men, meticulous histopathological examination of the venous tissue block from the saphenofemoral or saphenopopliteal region, VEGF (Vascular endothelial growth factor) and protein S-100 investigation were performed. RESULTS: In 14 limbs with sonographic and clinical suspition for neovascularisation, this entity was confirmed in 11 of them (79%) which represents 31.42% of the whole group. CONCLUSIONS: The varicose veins recurrences can be observed not only after technically or tactically imperfect primary procedure (which is surely the most common cause of the varicose veins recurrence), but also after the operations performed by the experienced venous surgeon in the perfect way. Neovascularisation explains a certain number of postoperative recurrences despite correctly conducted disconnection of the saphenous termination. The endovascular procedures (endovenous laser or radiofrequency saphenous obliteration) without open groin access can minimise the possibility of this complication.
Asunto(s)
Pierna/irrigación sanguínea , Neovascularización Patológica/complicaciones , Várices/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neovascularización Patológica/fisiopatología , Recurrencia , Proteínas S100/análisis , Várices/fisiopatología , Factor A de Crecimiento Endotelial Vascular/análisis , Venas/químicaRESUMEN
Authors present their experience with combined trombolytic-surgical treatment of acute ischaemia of low extremity based on trombosis of popliteal artery aneurysm. This treatment was performed in three patients. Authors compare results of intraarterial catheter pharmacological trombolysis of infrapopliteal arteries with indirect surgical trombolysis.
Asunto(s)
Aneurisma/complicaciones , Isquemia/etiología , Pierna/irrigación sanguínea , Arteria Poplítea , Terapia Trombolítica , Trombosis/complicaciones , Enfermedad Aguda , Anciano , Aneurisma/cirugía , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Arteria Poplítea/cirugía , Trombosis/tratamiento farmacológico , Trombosis/cirugíaRESUMEN
The case report dissertates upon successful treatment of iatrogenic perforation of distal oesophagus with subcutaneous emphysema, pneumoperitoneum and pneumomediastinum. The endoclips and classic conservative treatment were used in therapy. The patient was treated 3 hours after the injury, no early or late complications related to perforation were noted.
Asunto(s)
Perforación del Esófago/cirugía , Esofagoscopía/efectos adversos , Instrumentos Quirúrgicos , Adulto , Perforación del Esófago/etiología , Humanos , MasculinoRESUMEN
There is discussed case of malignant paraganglioma with cervical lymph node metastasis that was complicated by mistake during peroperative histology. Peroperative histological examination revealed metastasis of medular carcinoma of thyroid gland. Total thyroidectomy was performed. Postoperative histological assessment revealed metastasis of carotic paraganglioma. Tumour was resected together with carotic arteries. Their reconstruction was performed during second procedure.
Asunto(s)
Tumor del Cuerpo Carotídeo/patología , Tumor del Cuerpo Carotídeo/diagnóstico , Tumor del Cuerpo Carotídeo/cirugía , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Neoplasias de la Tiroides/secundarioRESUMEN
There discussed casuistics of the 64 years old man, who underwent urgent resection of perforated subrenal aortic aneurysm that expanded to both iliac arteries. Aortobifemoral bypass and packing of retroperitoneum were performed. The patient was operated for periprothetic abscess and aorto-enteric phistula three months later. Phistula was closed, infected prothesis was resected and replaced by new prothesis. Omentoplasty was added.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Complicaciones Posoperatorias , Implantación de Prótesis Vascular , Humanos , Fístula Intestinal/etiología , Enfermedades del Yeyuno/etiología , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/cirugíaRESUMEN
Mesenteric artery embolisation is serious complication of heart diseases. Its mortality is almost 95%. Diagnostics of mesenteric artery embolisation is based not only on clinical examination, but also on CT scan. Presence of the gas in portal and mesenteric venous basin is very suspected from vascular ileus. This sign can be very helpful in diagnostics and consequently in treatment of this disease. Late diagnostics and treatment of vascular ileus has fatal prognosis.