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PubMed1996

Organ and tissue transplantation in Latvia.

From 1973 to May, 1996 585 kidney transplantations were performed in the Department of Transplantation. From 1983 to 1988 investigations on transplantation of pancreas islet cell culture were carried out. Because of financial difficulties these investigations had to be stopped. In 1992 a law was adopted which regulates organ removal for transplantation by the "option out" system. In 1996, a transplantation association of the Baltic countries, Balttransplant, which includes the Latvian Department, began to function. Work of this association in the field of transplantation coordination has lead to an increase of donor kidneys and improvement of graft quality. The center performs 14-16 transplantations of kidneys per 1 million of population every year. The patient one year survival rate is 87%, survival of transplants--72-75%. Further progress of transplantation in Latvia will be possible only if the economic conditions and progress in medicine in general improve.

Demography↗
PubMed1995

Free tissue transplantation in the 90's.

Free tissue transplantation is now a well-established discipline and a common phrase in the medical literature. Only as recent as two decades ago, free tissue transplantation with microvascular anastomosis was a daring venture attempted by a selected few. It was considered to be a heroic effort of last resort when other reconstructive options were exhausted. Reconstructive surgeons were limited by tissue availability before free tissue transplantation with microsurgical techniques. With pedicle flaps, patients were subjected to multiple operations and hospitalizations and long periods of immobilization. The possibility of moving a large block of tissue to another body location by anastomosing its vascular pedicle with local blood vessels was tantalizing to reconstructive surgeons. The ability to perform anastomosis on small vessels had to be mastered before such a dream could be realized.

Amputation, Traumatic↗
PubMed1990

Ethical considerations in fetal tissue transplantation.

Recent research using fetal tissue transplants has expanded possible treatment options for several traumatic and degenerative neurologic disorders. However, the expectations of therapeutic benefit to be gained from these methods have been challenged by an equivalent degree of controversy. Fundamental viewpoints regarding abortion, physical autonomy and the principle of harm have been raised against continuing research and the use of fetal tissue transplants. In this article, we first attempt to elucidate the practice, potential and limitations of such techniques. The critical, yet unresolved issues of supply and sources of fetal tissue are also discussed. In light of these concepts, we examine certain pertinent obligations and ethical concerns that may clarify the nurses' role in dealing with cases involving the use of fetal tissue transplants.

Abortion, Legal↗
PubMed1987

Patterns of angiogenesis in neural transplant models: I. Autonomic tissue transplants.

Functional vascular connections must form rapidly to prevent ischemic damage to grafted neural tissues. The temporal sequence by which transplant circulation is re-established provides information about the angiogenic capacity of either intact or damaged CNS blood vessels. This study compares the time course and mechanism of vascular reperfusion in allografts of superior cervical ganglia or adrenal medulla inserted either into the fourth ventricle or directly into the parietal cortex of perinatal rats. Tritiated thymidine was administered to recipients to determine angiogenic patterns at various postoperative time periods. After processing for light microscopic autoradiography, host and graft endothelial labelling indices were determined in order to establish the temporal sequence and location of vascular proliferation. Correlative electron microscopy depicted the morphological changes in transplant vasculature. Some recipients were prelabelled with 3H thymidine prior to transplantation to determine if host vessels invaded the grafts. Intraventricular graft vessels initially collapsed but sustained minimal ischemic damage and were completely reperfused by 24 hours postoperative. Adjacent intact host vessels attained peak 3H thymidine incorporation at 20 hours. Intrinsic graft vessels were radioactively labelled only after 48 hours. Intraparenchymal transplants surrounded by minimal trauma exhibited a similar temporal sequence of reperfusion and host endothelial proliferation. Intrinsic graft vessels in intraparenchymal grafts sustained more severe damage. With increased trauma, a concomitant delay in graft reperfusion time was observed. Grafts within prelabelled hosts rarely contained any labelled endothelium, indicating that anastomotic connections were made between original, intrinsic graft vessels and nearby host vascular sprouts. This study demonstrates that mature autonomic tissue stimulates the growth of adjacent host vessels when transplanted to undamaged brain surfaces. The anastomosis of nascent host vessels with pre-existing graft vessels is responsible for the rapid re-establishment of circulation within the transplants. A similar mechanism occurs within intraparenchymal grafts, although the rapidity of reperfusion appears to be predicated on the amount of trauma present at the graft site.

Adrenal Medulla↗
PubMed1993

Extracorporeal circulation for tissue transplantation (in the case of venous flaps).

During free-tissue transplantation, recipient vessels are often crushed as a result of trauma or radiation therapy, making anastomosis of vessels difficult. In some cases, a second operation is unavoidable because of formation of a postoperative thrombus at sites of the anastomosis. To solve such problems, it should be possible to transplant tissue anywhere in the body without vascular anastomosis by extracorporeal circulation. This study mainly concerned venous flaps that were spindle-shaped and 4 x 3 cm in size. One hundred and forty-six male Japanese White rabbits, weighing 2.0 to 2.5 kg, were used. Stabilized hemoglobin, lactated Ringer's solution, whole blood, and plasma were used as perfusate. Each of these perfusates was injected at a rate of 5 ml per hour continuously for 3 days in good recipient sites and for 7 days in poor recipient sites. Five rabbits were used in each group. The flaps were examined histologically and electron microscopically. Moreover, in the plasma group, microangiography was performed to observe blood circulation between the flap and the surrounding tissue. The flaps survived in all cases in which the plasma group had good recipient beds but did not survive in any of the other cases, in which degeneration of the endothelial cells was detected prior to edema. According to the results of this examination, tissue viability of the venous flap could be maintained for at least 3 days by perfusion of plasma. During this time, in the cases of good recipient sites, blood may begin to recirculate between the flap and the surrounding tissue.

Angiography↗
PubMed2005

[Combined tissue transplantation for complicated hand injury].

OBJECTIVE: To investigate the effect of combined types in treating cases with 2 to 5 tissues transplantation. METHODS: 305 cases treated from December 1989 to December 2002 were analyzed and summarized. 214 cases were constructed with 2 combined tissues transplantation, the combined types were:toe combined flap,the second toe at both sides transplanted, 2 flaps combined transferred; 75 cases were constructed with 3 combined tissues transplantation, the combined types were: the second toe at both sides combined flap, 2 flaps combined toe, 3 flaps combined transferred; 11 cases were constructed with 4 combined tissues transplantation, the combined types were: 2 flaps combined 2 toes,1 toes combined 3 flaps, 4 flaps combined transferred; 5 cases were constructed with 5 combined tissues transplantation, the combined type was: the wrap flap and the second toe with 1 vascular pedicle and another second toe combined bilateral femoris anterior flaps were transferred. The principles of repair were: the thumb was reconstructed first,the wrap round flap was used for the thumb's skin, the second toe transplantation was used for the thumb defect. The opposite toe was transferred to finger to reconstruct the pinch function. 1 or 2 flaps were selected for repair according to the area of damage. The anterolateral thigh flaps were used for the large areas and the lateral arm flaps were used for the small areas in selecting the donor area. RESULTS: Of the 722 tissues in 305 cases, 14 of them were necrosis, in which the toe were 6 and the flap were 8,and other transferred tissues all survived, the survival rate of tissue transplantation was 98.1%. 251 cases were followed up for 1 year to 7 years (2. 6 years in average). All the patients could care themselves in daily life. The pinch and opposition functions of the constructed thumbs and fingers were recovered, the two-point discrimination was 6 to 14 mm, but 2 cases recovered adduction function only because the thumb was 6 degree defect without the thenar muscle and did not fix the reconstructed thumb in opposite side in operation. All transplanted flaps recovered protecting sensory with S2, 56 flaps required plastic operation because of their swelling appearance. The donor areas gained primary stage heal in 285 cases, 20 cases gained secondary stage heal, in which part grafted skin necrosis in donor of wrap round flap were 12 cases, the distal of donor big toe necrosis were 2 cases and grafted skin necrosis in donor of anterolateral thigh flap were 8 cases and skin grafted were successful. CONCLUSION: Different combined types can be used according to the traumatic situation. Surgical operation and early rehabilitation is conducive to the final function. Combined tissue transplantation is the best way to repair complicated hand injuries.

Adolescent↗
PubMed1985

Late patency of clinical microvascular anastomoses to free composite tissue transplants. II. Hemodynamical aspects.

In a series of 37 free composite tissue transplantations performed to the lower extremity in 34 patients, skin islands were included in 35 cases, as a cutaneous island flap (3), as a musculocutaneous island flap (19), and as an osteocutaneous island flap (13). In a follow-up study which included 26 patients with 29 flaps 6-48 months postoperatively an estimate was made of the importance of the blood supply through the vascular pedicle relative to the collateral blood supply through the recipient bed. Using transcutaneous oxygen tension measurements a significant reduction in calculated relative skin blood flow averaging 70% (p much less than 0.01) was seen after digital occlusion of the vascular stalk, suggesting that patent microvascular anastomoses are important for the vascularity of the transplanted tissues, not only for immediate postoperative survival, but also on the longer view.

Adolescent↗
PubMed1981

The brain and subarachnoid space as possible sites for endocrine tissue transplantation.

Immunological rejection has been the major problem limiting the successful transplantation of tissue from one animal to another. Recent technological developments, combined with the use of the central nervous system as an immunologically privileged site, suggest that it might be possible to achieve long-term survival of hormone-secreting tissues, between two gentically dissimilar animals, if these tissues are transplanted to the brain and subarachnoid space of the host. The physiological parameters that should be considered in the clinical application of a transplant of this type are discussed.

Animals↗
PubMed1993

[Microsurgical tissue transplantation in the treatment of recurrent basaliomas of the head].

The authors analyse their experience in the use of microsurgical transplantation of tissues in the management of recurrent basaliomas of the head in 20 patients. Various types of autografts were used, such as: the greater omentum, thoracodorsal, inguinal, scapular, deltoid, and radius grafts. The results were good in most cases. It is claimed that microsurgical autotransplantation of tissue complexes is a necessary component in the treatment of severe forms of basaliomas of the skin of the head.

Adult↗
PubMed1989

Magnetic resonance imaging of rat brain following kainic acid-induced lesions and fetal striatal tissue transplants.

Use of a small diameter (5.1 cm) radiofrequency coil provided relatively high resolution magnetic resonance (MR) images of rat heads at 0.14 Tesla. On T1-weighted images, the rat brain was clearly visible in the rat head as a region of high signal intensity. No structures were distinguished within the normal rat brain. In contrast, in the brains of rats receiving unilateral kainic acid lesions of the striatum, enlarged lateral ventricles, which are characteristic of the lesion, were clearly visible as dark areas of low signal intensity. Extrastriatal damage on the lesioned side of the brain was also evident in some of the images. Fetal striatal tissue transplants growing within the lesioned striata were also identified in the MR images. The transplanted tissue appeared as areas of high and intermediate signal intensity, similar to the host brain. MR imaging is a useful technique for monitoring excitotoxin lesions of brain and fetal striatal tissue transplants in vivo.

Animals↗
PubMed1996

Do brain tissue transplants alter personal identity? Inadequacies of some "standard" arguments.

Currently, brain tissue transplantations are being developed as a clinical-therapeutic tool in neurodegenerative diseases such as Parkinson's or Alzheimer's disease. From an ethical point of view, distinguishing between the preservation and an alteration of personal identity seems to be central to determining the scope for further application of brain tissue transplantation therapy. The purpose of this article is to review "standard" arguments which are used on the one hand by proponents to prove preservation of personal identity and by opponents on the other hand to prove that brain tissue transplantation results in an altered personal identity. Proponents and opponents are shown to use the same arguments, albeit with different presuppositions. These presuppositions concern the meaning of the term "identity", either numerical or qualitative, the definition of brain identity, either structurally or functionally, and the relationship between mental states, psychological functions and neurophysiological properties as criteria for personal identity. Furthermore the respective neurophysiological, clinical and philosophical evidence for the different presuppositions are discussed. It is concluded that evaluation of personal identity in brain tissue transplantation should not only rely on the "standard" arguments but, additionally, neurophysiological, clinical and philosophical implications should be discussed.

Brain Diseases↗
PubMed1992

Evaluation of parathyroid tissue transplants by TI-201 scintigraphy.

Hyperplasia of the parathyroid glands usually is treated surgically by total parathyroidectomy, which would deprive the patient of the parathormone essential for calcium metabolism. The postoperative management of patients submitted to total parathyroidectomy consists either in oral administration of vitamin D and calcium, or in the transplantation of parathyroid tissue, which would produce the required parathormone. The purpose of this study is the scintigraphic assessment of parathyroid tissue transplantation patients. Eighteen patients were examined in the immediate and during a later postoperative period. The examination had three parts. The first one consisted of the assessment of the viability and function of the transplant by dynamic study, using TI-201. The second part consisted of the acquisition of static images of the transplant, and the third part was investigation for possible remnants of pathologic parathyroid tissue in the neck by dual tracer (TI-201/Tc-99m) subtraction imaging.

Follow-Up Studies↗