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Intestinal transplantation on an experimental model.
Oliverius, Martin ; Adamec, Miloš (advisor) ; Gürlich, Robert (referee) ; Kala, Zdeněk (referee)
Intestinal transplantation represents a life-saving procedure for patients with an intestinal failure. An experiment on pigs was carried out during the preparation part of a clinical project in the Czech Republic. The main aim of the experiment was to successfully master the transplant surgery technique (i.e. small bowel harvesting, its preservation, followed by the transplantation). Another goal was to decide on the optimal immunosuppressive regime. Immunosuppression was based on tacrolimus monotherapy or its combination with sirolimus. A graft biopsy still remains the most reliable method for the diagnosis of an acute cellular rejection. In an attempt to find a suitable noninvasive humoral marker of the acute cellular rejection, we examined the correlation between plasma citrulin level and the acute rejection. The plasmatic level of proinflamatory and antiinflamatory cytokines was investigated as another potential marker of the rejection. We succeeded in standardizing the technique of intestinal transplantation. Connecting the graft to aorta and inferior vena cava is simpler and safer than connecting it to the portomesenteric vessel bed due to fewer subsequent complications. Both immunosuppressive regimes seem to be equally effective in preventing the acute cellular rejection. Histopathological...
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Selected Theoretical and Practical Aspects of the Quality of Nursing Care
Kazatelová, Petra ; Holmerová, Iva (advisor) ; Gürlich, Robert (referee)
The subject of this diploma paper is the quality of The Health Sevice. This is a major issue of interest, not only to medical experts, but patiens and the general public. Due to increasing competititon within The Nursery Health Service, hospitals must now, monitor and evaluate the quality of patient care and instigate changes as necessary . A glossary of words used within this paper, relating to quality in The Helath Service, is found in the Introduction. Systems of quality assurance, accreditation and resource issues are also introduced. The research focuses on patient satisfaction with the nursing care in the Intensive Care Unit within the surgery department of IKEM. The answers are categorised and either presented graphically or compared statistically. The conclusion contains recommmendations for changes that would improve the quality of nursing care.
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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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