RESUMEN
Organ transplantation is one of the most important medical achievements of the 20th century. Kidney transplantation is the most efficient method of renal replacement therapy. The first successful kidney transplantation in human was performed in 1954 in Boston, USA. In former Yugoslavia, the first kidney transplantation was performed on April 16, 1970 in Ljubljana, Slovenia, and second one on January 30, 1971 in Rijeka, Croatia. In both cases, the mother donated kidney to the son. In the article, we describe the prerequisite conditions for this operation, the characteristics of first patients, and the impact of transplantation program on the development of the hospitals and medical schools.
Asunto(s)
Trasplante de Riñón , Croacia/epidemiología , Europa (Continente) , Femenino , Historia del Siglo XX , Humanos , Riñón , Trasplante de Riñón/historia , Eslovenia/epidemiologíaRESUMEN
Kidney transplantation is the most efficient method of renal replacement therapy. When this method is performed, native urinary bladder is the preferred urinary reservoir. However, in some patients with an anatomically and functionally abnormal lower urinary tract, the urinary bladder cannot be used for transplantation. In these patients, urinary diversion should be performed before kidney transplantation. We present a case of a 32-year-old male patient with orthotopic kidney transplantation performed using a colon pouch (Mainz-pouch III). He was born with severe anomalies including sacral agenesis, anorectal atresia, and hypospadias, which were corrected during childhood. Neurogenic bladder with severe vesicoureteral reflux led to end-stage renal disease. This dysfunctional bladder was unsuitable for kidney transplantation, and a staged approach for future transplantation was chosen. The first step was the creation of urinary diversion. Due to a short appendix, we created a continent, colon pouch (Mainz pouch III). Two years later, orthotopic kidney transplantation was performed using a right cadaveric kidney. The renal vessels were anastomosed to the aorta and inferior vena cava and the pyelon to the native ureter. Four years after transplantation, the patient has stable renal function without any complications. This is the first documented case of using Mainz-pouch III as a reliable option for kidney transplantation in selected patients.
Asunto(s)
Colon/cirugía , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Vejiga Urinaria Neurogénica/cirugía , Reservorios Urinarios Continentes , Adulto , Humanos , Fallo Renal Crónico/etiología , Masculino , Vejiga Urinaria Neurogénica/complicaciones , Derivación UrinariaRESUMEN
AIM: To explore personal biography of Vinko Franciskovic (1919-1984), to improve the understanding of the beginnings of Croatian cardiothoracic and transplantation surgery. METHODS: Comparative critical analysis of written published materials, archival materials and information collected through oral history interviews. RESULTS: Vinko Serafin Franciskovic was born in Praputnjak, a settlement of the eastern surroundings of Rijeka, Croatia. He was raised up in the Italian language and culture by hisaunt, a mother's sister and her husband. He went to the Royal Classical Grammar School Giovanni Prati in Trento. On July 15, 1943, he defended his thesis, titled A contribution to the surgical therapy of fractures of the femoral neck at the Faculty of Medicine, University of Padua. CONCLUSION: The represented data about Vinko Franciskovic's life, especially those concerning his secondary and higher education, explain some of his crucial personal traits and his later professional pathway.
Asunto(s)
Médicos/historia , Cirugía Torácica/historia , Procedimientos Quirúrgicos Torácicos/historia , Trasplante/historia , Croacia , Historia del Siglo XXRESUMEN
Peripheral arterial insufficiency appears at all stages regardless of the patient age; however its appearance is most common in the elderly in which cases it mostly appears as stage described by Fontaine as stage III or IV The most com- mon cause of peripheral arterial insufficiency is atherosclerotic degeneration, and is remarkably often accompanied by the diabetes. In the years 2012 and 2013 department of vascular surgery, University Hospital Rijeka admitted 169 patients older than 70 with peripheral arterial insufficiency of type Fontaine III and IV That number represents 68.8% of total number of patients admitted for peripheral arterial insufficiency. The goal of this research is to identify to what extent and in what percentage can patients older than 70 with advanced peripheral arterial insufficiency be subjected to vascular treatment and if there exist and absolute indication for angiographic treatment of such patients. In majority of patients, 148 of them, three or more comorbidities were present. Diabetes was present at almost half of patients, to be exact 46.7%. Assessment of possibility for vascular treatment and the need for angiographic treatment was followed in patients in three age groups: 70-75 years of age, 76-80 years of age and over 80 years of age. Angiography was performed on 69 patients and the insight into angiographic finding resulted in only 33 patients being subjected to some type of vascular treatment. From the total number of patient's subjected to vascular treatment 20 had symptoms of Fontaine III while the remaining 13 had symptoms of Fontaine IV Amputation procedure was performed 119 times. The research shows that angiograph- ic treatment is not a routine treatment in mentioned patients and that the number of vascular procedures is significantly higher in the 70-75 years age group.
Asunto(s)
Arterias/fisiopatología , Claudicación Intermitente/terapia , Enfermedad Arterial Periférica/terapia , Enfermedades Vasculares/terapia , Anciano , Anciano de 80 o más Años , Angiografía , Aterosclerosis/complicaciones , Comorbilidad , Complicaciones de la Diabetes , Femenino , Hospitalización , Humanos , Claudicación Intermitente/fisiopatología , Masculino , Enfermedad Arterial Periférica/fisiopatologíaRESUMEN
We report a successful treatment of unusual case of a 48 year old male patient with acute aortic dissection type Stanford A that expanded into left common and external iliac artery diagnosed by MSCT angiography, presenting as a single leg paresis, without symptoms of a chest or back pain. Patient was operated with conventional ascending aortic replacement. Patient had no known prior medical condition. He has been treated for acute thrombosis of the left popliteal artery developing one day after ascending aortic replacement surgery, embolectomy was performed. Critical limb ischemia developed due to preocclusive stenosis of the left common and left external iliac artery and was treated by endovascular procedure of iliac artery stenting performed on the fifth postoperative day. After 17 days patient was discharged form hospital, showing no neurological or vascular deficit. For successful treatment of acute aortic dissection type Stanford A complicated with limb ischemia, rapid and accurate diagnosis is essential, together with close cooperation of cardio surgeons, vascular surgeons and invasive radiologists and individual approach to these demanding patients.