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Refinement of tissue diagnostics in the transplant program
Balko, Jan ; Zámečník, Josef (advisor) ; Škarda, Jozef (referee) ; Němejcová, Kristýna (referee)
Refinement of tissue diagnostics in the transplant program Abstract The thesis describes tissue diagnostics of organ transplants of the donor as well as recipient. In case of donated organs (grafts), it aims to improve the provisional scoring system of graft rejection after uterine transplantation. Using histopathological methods including immunohistochemistry, it compares lymphocytic population classified in the scoring system with histopathological findings within the resected uteri of women who underwent hysterectomy for benign reasons. The aim was to validate the necessity of the category of so called borderline changes, whose morphology was proven to overlap with physiological finding within healthy uterine cervix. Therefore, there is no need for immunosuppressive therapy in such cases. In case of recipients, the thesis investigates the role of pulmonary megakaryocytes in explanted lungs after transplantation. The idea was to elucidate pathogenesis of the diseases leading to the need of transplantation itself. Pulmonary megakaryocytes within explanted lungs of various recipients were mapped using histopathological methods and immunohistochemistry. The strikingly increased number of such cells was detected among vascular disorders, especially idiopathic pulmonary hypertension. This finding could...
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Dynamics of thorax in patients with COPD, its influence through POWERbreathe
Chmelařová, Anna ; Smolíková, Libuše (advisor) ; Babková, Lenka (referee)
This diploma thesis deals with chronic obstructive pulmonary disease (COPD) and its influence on the musculoskeletal system, lung transplantation and pulmonary rehabilitation. It discusses the role of POWERbreathe, a breathing training device, which is primarily used to strengthen the inspiratory muscles. The practical part was performed as a randomized control pilot study to assess the effect of POWERbreathe on the strength of the inspiratory muscles, the thorax dynamics and selected pulmonary function. The aim of the study is to determine the benefits of using the POWERbreathe for COPD patients during the pre-transplant period. In total, 18 patients with COPD IV. grade participated in the study (6 women and 12 men) with an average age of 59.8 ± 5.53 years. Probands were divided into two groups, only one of which used a POWERbreathe. Pulmonary functions (FEV1, VCin, FVC, PIF), muscle strength (SIndex), and chest dynamics (chest disturbances in the mezosternal and xiphosternal region with maximum inspiration and exhalation and respiratory amplitudes in these areas) were evaluated. The results did not show a significant inter-group difference in the strength of the inspiratory muscles. Within pulmonary function, this difference was evident in the FEV1 parameter and the chest dynamics increased...
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Ischemia-reperfusion injury in lungs after transplantation and the role of radical oxygen species
Mrázková, Hana ; Lischke, Robert (advisor) ; Třeška, Vladislav (referee) ; Kittnar, Otomar (referee)
Keywords: Lung Tx, EVLP, NHBD, IR injury, ROS, hypercapnia, gender differences This dissertation thesis deals with a very topical issue of the lack of donor organs for lung transplants. As with other organs, the number of patients on waiting lists in terminal stages of their diseases is also constantly rising but there is not an adequate increase in donor organs. We focused our experimental work on the development of research concerning the solution which is most successful in a long-term perspective, i.e. organ transplants from non- heart-beating donors (NHBDs), in an ex vivo lung transplant protocol (EVLP) on an animal model (Wistar rats). This is a method which is clinically established worldwide (in the Czech Republic only experimentally) and is constantly subject to further research. Based on earlier studies, we focused the first experimental part of this work on the potential protective effect of hypercapnic ventilation on ischemia-reperfusion (IR) lung injury in EVLP. The study proved that the hypercapnic ventilation has a protective effect on the generation of reactive oxygen species (ROS) in IR lung injury, but only when used in the period of reperfusion. In the second experimental study, we followed up a very topical issue of the effect of gender on IR lung injury in EVLP in...
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The influence of extrinsic motivation on physical condition in lung transplant candidates
Jordáková, Magdalena ; Babková, Lenka (advisor) ; Procházka, Michal (referee)
Rehabilitation takes an important part in the care for lung transplant candidates with chronic lung disease. The theoretical part of this thesis summarizes current knowledge about motivation and adherence to rehabilitation, about telerehabilitation options (telemonitoring physical activity using pedometer), and their use in lung transplant candidates. In the practical part it was investigated whether extrinsic motivation (education, pedometer, communication with physiotherapist via e-mail) leads to an improvement in the six-minute walking test outcome (6MWD) or in adherence to rehabilitation in lung transplant candidates. It was found no statistically significant improvement in 6MWD nor in adherence to rehabilitation in extrinsically motivated patients waiting for a lung transplant. However, data suggested increasing trend of 6MWD after intervention.
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Influence of the condition of patients before lung transplantation on length of hospitalization after transplantation
Saláková, Kamila ; Babková, Lenka (advisor) ; Krocová, Valerie (referee)
This thesis aims to assess whether the level of the physical condition of patients before lung transplantation affects the length of hospitalization after transplantation. The study includes patients over 18 years of age with both unilateral and bilateral lung transplantation who underwent hospitalization between 2016 and 2018 and underwent a six-minute walk test in the preoperative examination. Data were collected at the 3rd Department of Surgery, First Faculty of Medicine, Charles University in Prague and Motol University Hospital and at the Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital. The results partially confirmed the correlation between hospitalization and physical condition in some patient groups. Thus, the higher the level of fitness in patients before lung transplantation, the shorter the hospitalization period. The length of hospitalization is influenced not only by the condition of the patient before surgery but also by other significant preoperative, perioperative and postoperative factors that are not related to the condition. For this reason, there is generally no clear correlation between the length of hospitalization and physical condition. Preoperative condition improvement is desirable in lung transplant candidates...
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Comparison of performance of pediatric patients with diagnosis of cystic fibrosis before and after a lung transplantation
Chrz, Josef ; Smolíková, Libuše (advisor) ; Maršáková, Kateřina (referee)
Title: Comparison of performance of pediatric patients with diagnosis of cystic fibrosis before and after a lung transplantation. Objectives: To compare selected parameters of pediatric patients as an index of physical condition in time before and 1 year after transplantation. To compare a group of patients that undergone longtherm intensive physiotherapeutic treatment before transplantation with group of patients that did not using spirometric parameters FVC, FEV1 and BMI. To compare subjective signs of dyspnea between these groups using selected questionnaires. Methods: This theses was attended by 15 probands (7 boys and 8 girls) in age between 12 and 18 years. The data were collected by using selected dyspnea questionares and by using hospital documentation files taking place at the Motol University Hospital. The data were statistically analysed using Jamovi programme, mostly using correlations and paired T- test, and graphically analysed by using MS Excel programme. Results: We found changes of spirometric parameters in the level of significance of p < 0,001 (FEV1) and p = 0,003 (FVC) after transplantation in comparison with time before transplantation. Group that undergone longtherm intensive physiotherapeutic treatment before lung transplantation showed more physiological spirometric values...
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Rehabilitation in lung transplant candidates
Jordáková, Magdalena ; Babková, Lenka (advisor) ; Obešlo, Marek (referee)
Lung transplantation is the method of treatment for patients with end-stage lung disease. The main theoretical part of this bachelor's thesis is focused on the possibilities of rehabilitation in lung transplant candidates. This rehabilitation concept includes patient's education, individually designed exercise program, techniques of respiratory physiotherapy, nutrition therapy and psychological support. The practical section of this bachelor's thesis incorporates a case report of a lung transplant candidate who underwent 4 months of preoperative rehabilitation program. Tha main difference after completing preoperative rehabilitation was found in maximal inspiratory muscles strength, which increased of 17,71 cmH2O.
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Nursing care of patient after Lung Transplantation
Kopecká, Olga ; Hakenová, Renata (advisor) ; Hocková, Jana (referee)
The Lung Transplantation is comprehensive treatment method intended for the patient with a long term respiratory insufficiency, at the terminal stage of pulmonary disease. For the patients with incurable and mostly lethal disease, gives possibility for long term survival and at the same time significant improvement in quality of life. Post-operative care classifying as the most complex and demanding in intensive care. The lung function is very vulnerable with a high risk of rejection and infections complication. The bacherol diploma thesis comprise two major parts. Theoretical part aim to the beging of the Lung transplantation in the Czech republic, anatomy of the respiratory system and description of complete transplantation course. Sources for the diploma thesis adaptation obtained from the National Medical library, Medvik database, Pub Med database and Internet finder searching based on the keywords. Practical part elaborated using quantitative methods - case study with evaluation of medical records and scientific literature, as well as using methods of observation and questioning. During processing all ethical rules was strictly adhered. The aim of the thesis is to point out to the specifics of nursing process performance. Outcome of this work is recommendation how to improve nursing process...
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Complex nursing care for patient after lung transplant at Anesthesiology resuscitation department.
Ivánková, Vendula ; Hocková, Jana (advisor) ; Maffei Svobodová, Ludmila (referee)
Lungs transplantation is a solution for the end stage of pulmonary disease after other therapeutic possibilities that the modern medicine has to offer have been exhausted. The main objective of this thesis is to show postoperative patient care after lung transplantation in the department anesthesiology and resuscitation. A highly specialized complex care and cooperation of various fields is needed. Nurses who take care of these patients must be experienced and skillful. They also need to manage well the nursing care for patients in sedation as well as fully conscious patents. It is also needed that the nurses are acquainted with specialized methods of hemodynamics measurements, administration of nitrous oxide and operation of extracorporeal membrane oxygenation machine. They need to know well the drugs that are being administered. The thesis summarizes anatomy and physiology of respiratory system, it deals with lung disease and their symptoms which most often lead to lung transplantation. Finally, the thesis describes the development of lung transplantation from its beginning to the present including the number of cases of lung transplantation per year. The last chapter of the theoretical part also shows indication, contraindication and the main principles of patient care that is given prior to and...
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Dynamics of thorax in patients with COPD, its influence through POWERbreathe
Chmelařová, Anna ; Smolíková, Libuše (advisor) ; Babková, Lenka (referee)
This diploma thesis deals with chronic obstructive pulmonary disease (COPD) and its influence on the musculoskeletal system, lung transplantation and pulmonary rehabilitation. It discusses the role of POWERbreathe, a breathing training device, which is primarily used to strengthen the inspiratory muscles. The practical part was performed as a randomized control pilot study to assess the effect of POWERbreathe on the strength of the inspiratory muscles, the thorax dynamics and selected pulmonary function. The aim of the study is to determine the benefits of using the POWERbreathe for COPD patients during the pre-transplant period. In total, 18 patients with COPD IV. grade participated in the study (6 women and 12 men) with an average age of 59.8 ± 5.53 years. Probands were divided into two groups, only one of which used a POWERbreathe. Pulmonary functions (FEV1, VCin, FVC, PIF), muscle strength (SIndex), and chest dynamics (chest disturbances in the mezosternal and xiphosternal region with maximum inspiration and exhalation and respiratory amplitudes in these areas) were evaluated. The results did not show a significant inter-group difference in the strength of the inspiratory muscles. Within pulmonary function, this difference was evident in the FEV1 parameter and the chest dynamics increased...
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