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Modulating amylase and lipase secretion in the pancreatic graft by somatostatin administration and its effect on recipient wound healing and pancreas graft survival
Janoušek, Libor ; Adamec, Miloš (advisor) ; Brůha, Radan (referee) ; Vaněk, Ivan (referee)
Somatostatin administration decreases external pancreatic secretion during harvesting. Additionally, it leads to a reduction in post-transplant external pancreatic secretion. The result is a decrease in the risk of developing edematous pancreatitis. Wound healing and the rates of other surgical complications are not affected by somatostatin administration. Our study did not confirm a vasoconstrictor effect of somatostatin resulting in increased thrombotic complication rates. The number of rejection episodes in the group of somatostatin-treated recipients was at the limit of significance. This might be due to the protective effect of somatostatin resulting in smaller ischemiareperfusion graft injury A surgical complication after pancreas transplantation statistically significantly raises the risk for graft explantation and is a risk factor for progression of diabetic foot in graft recipients. Our modified technique of pancreas transplantation does not reduce the risk for graft explantation. The surgical complication does not increase the mortality rate of pancreas graft recipients.
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Pathogenesis of the Lymphocele following the Kidney Transplantation
Pacovský, Jaroslav ; Navrátil, Pavel (advisor) ; Třeška, Vladislav (referee) ; Adamec, Miloš (referee)
The lymphocele is a surgical transplant complication resulting from lymphatic vessels injury. This injury is background of the lymphocele pathogenesis, no lymphocele cannot become into existence without this step. On the other hand, the all organ procurement and transplantation procedures are associated with any rate of this injury at all time. Our results present proteins as a very important factor influencing interstitial fluids transport. The colloid osmotic pressure of the proteins controls interstitial fluids flow even across the vessel walls. Lymph fluid flow is also under the osmotic pressure control. The proteins play serious role in the second phase post-transplant lymphocele pathogenesis. At first, proteins control return of the leaked lymph back into the lymphatic vessels. Finally, inflammatory proteins participate on development of the fibrous lymphocele capsule. Postoperative care for protein metabolism seems to be very important in the protection against the post-transplant lymphocele formation. Carefully metabolic care for patient after renal transplantation should help to decline risk of lymphocele. The knowledge of the pre-transplant protein level and its fractions is very useful for relevant estimation of the risk of the post-transplant lymphocele formation. Calculation of the...
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Experimental Small Bowel Transplantation
Kudla, Michal ; Adamec, Miloš (advisor) ; Kohout, Pavel (referee) ; Hejnal, Jiří (referee)
The small bowel transplantation (SBT) represents reasonable alternative to ultimate total parenteral nutrition of the patient suffering from terminal stage of chronic bowel failure. To date, the small bowel transplantation was not carried out in the Czech Republic. The initial experimental research and gaining experience with transplantations on animal models are inevitable before successful commencement of small bowel transplantation programme. In my dissertation thesis I am in full details describing the surgical technique of small bowel transplantation in rat. In comparison with the published data I have succeed to reach rather similar results of operating time and survival of the experimental animals. In the second part of my experiment I tried to influence the acute rejection of the small bowel graft occurrence by administration of cytostatic agent gemcitabin. The chosen dosage of the remedy did not suppress the rejection. In the third part I am describing the surgical technique of lymphatic vessels reconstruction in SBT rat model, which might lead to improvement of the SBT outcome. The last part of my dissertation thesis is preclinical. I am describing the initial experience with surgical technique of small bowel graft harvesting from cadaverous donor.
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Contribution to the Hemodynamic of Vascular Anastomosis
Grus, Tomáš ; Lindner, Jaroslav (advisor) ; Adamec, Miloš (referee) ; Veverková, Lenka (referee)
The primary objective of the research project was the optimization of geometry of the infrainguinal prosthetic bypass in the site of the distal end-to-side anastomosis. Due to the negative influence of hemodynamics, it is most frequently this location, which is responsible for the longterm failure of the graft. Our prospective angiographic study in patients as well as experimental and computational simulations indicate that flow type in the anastomosis and wall shear stress (WSS) in particular are the key factors that determine the location of neointimal hyperplasia and promote its progression. Maximum of such changes was located in the toe, heel, and bottom of the anastomosis, and these clinical findings correspond with the results from the simulations. We carried out several clinical experiments that suggest the importance of the angle of the distal anastomosis of an infrainguinal prosthetic bypass as a key factor in the development (both location and quantity) of neointimal hyperplasia 6 to 24 months following the procedure. The construction of the anastomosis at a more acute angle results in WSS values that are closer to physiological flow. This reduces both mechanical impairment of the endothelial cells and stimulation of the smooth muscle cells. From the researched set of anastomotic angles (25ř, 45ř,...
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Fresh arterial allograft in vascular surgery - immunosuppression in experiment
Matia, Ivan ; Adamec, Miloš (advisor) ; Stingl, Josef (referee) ; Špatenka, Jaroslav (referee)
Arterial allografts are used nowadays as a modality in the treatment of vascular prosthesis infections. Prolonged administration of immunosuppressive drugs seemed to be essential for long time patency rates of alloarterial vascular reconstructions. Nevertheless, the use of immunosuppressives if there exists an acute infection is controversial. My experimental work described herein studied effects of a delayed low-dose FK 506 administration on the development of acute rejection changes 30 days after aortal transplantation in rats. The response of the recipient's immune system to aortal wall antigens of the donor in the field of no immunosuppression resulted in an intimal proliferation and its infiltration by immunocompetent cells of the recipient, necrosis of medial smooth muscle cells, including deposition of immunoglobulines, and a massive adventitial infiltration of CD4 and CD8 positive cells. On the other hand, all the principal histological signs of rejection listed above were suppressed by FK 506 administration, no matter whether the immunosuppressive was administered on Day 0 or Day 7 after the transplantation.
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Benefit of assesment of cytokines in inflammatory postoperative complications
Chachkhiani, Ivane ; Gürlich, Robert (advisor) ; Vokurka, Martin (referee) ; Adamec, Miloš (referee)
Infection and the resulting sepsis continue to be important causes of morbidity in surgical patients. Cytokine network causes activation of neutrophils and vascular endothelium with increased upregulation of adhesion molecules, setting at a train of pathogenic inflammatory reactions in the host. Increased concentrations of inflammatory cytokines observed in the initial phase of postoperative complications have a great significance in forecasting a potentially fatal outcome of the disease and can be used for an early diagnosis of systemic complications.Prospective, clinical trial. Levels of cytokines, procalcitonin (PCT), leptin and acute phase proteins (APP) were measured before and after the operation (planned resection of colorectal cancer) and compared with levels in sepsis. Cytokine levels were measured by ELISA method. APP were estimated by nephelometric analysis.PCT was measured by immunoluminometric analysisDuring the first 24 h after the planned resection of colorectal cancer there was a significant increase in serum concentration of interleukin (IL)-6 which declined in next 48 to 72 h. Serum concentration of tumor necrosis factor (TNF)was the highest between 18 to 24 h after the operation. IL-1 had a stable serum concentration without significant elevation. Serum concentration of IL-8 rose after 36...
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název v anglickém jazyce není uveden
Lischke, Robert ; Pafko, Pavel (advisor) ; Král, Vladimír (referee) ; Adamec, Miloš (referee)
Induction therapy in lung transplantation: initial single-center experience comparing daclizumab and anti-thymocyte globulin BACKGROUND: Acute and chronic rejection remain unresolved problems after lung transplantation, despite heavy multidrug immunosuppression. In turn, the strong immunosuppression has been responsible for mortality and pervasive morbidity. Because acute rejection is associated with inferior outcomes in lung transplantation, we have routinely employed anti-thymocyte globulin (ATG), or daclizumab as adjuncts to reduce rejection. Daclizumab is a human monoclonal antibody that binds to the interleukin-2 receptor. METHOD: We performed a controlled clinical trial of these 2 therapies to determine differences in post-operative rejection, infection, bronchiolitis obliterans syndrome (BOS) and survival. 25 consecutive lung transplant patients received ATG (n = 12)(Group 1) and daclizumab (n = 13)(Group2) as induction agents. The groups had similar demographics and immunosuppression protocols differing only in induction agents used. RESULTS: No differences were observed in immediate post-operative outcomes such as length of hospitalization, ICU stay, or time on ventilators. No patient receiving daclizumab developed drug specific side-effects. There were no significant differences in the...
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