RESUMO
Despite the fact laparoscopic liver resections (LLR) for cholangiocarcinoma is still limited, this systematic review addressed surgical and oncological outcomes of LLR to treat both perihilar cholangiocarcinoma (pCCA) and intrahepatic cholangiocarcinoma (iCCA). Five comparative and 20 noncomparative studies were found. Regarding iCCA, LLR had lower blood loss and less need for Pringle maneuver. However, open liver resections (OLR) were performed more for major hepatectomies, with better lymphadenectomy rates and higher number of harvested lymph nodes. High heterogeneity and selection bias were suggested for iCCA studies.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Laparoscopia , Perda Sanguínea Cirúrgica , Humanos , Excisão de LinfonodoRESUMO
ABSTRACT Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules. Aim: To evaluate the outcome of liver transplantation within the CMB. Methods: The medical records of patients with HCC undergoing liver transplantation in relation to recurrence and survival by comparing CM and CMB, were analyzed. Results: 414 LTx for HCC, the survival at 1 and 5 years was 84.1 and 72.7%. Of these, 7% reached the CMB through downstaging, with survival at 1 and 5 years of 93.1 and 71.9%. The CMB patient group that exceeded the CM (8.6%) had a survival rate of 58.1% at five years. There was no statistical difference in survival between the groups CM, CMB and downstaging. Vascular invasion (p<0.001), higher nodule size (p=0.001) and number of nodules >2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p<0.001), real MELD (p<0.001), vascular invasion (p=0.045) and number of nodes >2 cm (p<0.014) were associated with worse survival. Conclusions: CMB increased by 8.6% indications of liver transplantation, and showed survival rates similar to CM.
RESUMO Racional: O critério de Milão (CM) vem sendo utilizado como padrão para indicação do transplante hepático (TxH) por hepatocarcinoma (HCC) em todo mundo há quase 20 anos. Diversos centros têm adotado critérios expandidos com intuito de aumentar o número de pacientes candidatos ao transplante, mantendo bons índices de sobrevida. No Brasil, desde 2006, o critério de Milão/Brasil (CMB), que desconsidera nódulos <2 cm, é adotado, incluindo pacientes com maior número de nódulos pequenos. Objetivo: Avaliar o resultado do transplante hepático dentro do CMB. Métodos: Foram analisados os prontuários dos pacientes com HCC submetidos ao TxH em relação à recidiva e sobrevida através da comparação entre CM e CMB. Resultados: Em 414 TxH por HCC, a sobrevida em 1 e 5 anos foi de 84,1 e 72,7%. Destes, 7% atingiram o CMB através de downstaging, com sobrevida em 1 e 5 anos de 93,1 e 71,9%. O grupo de pacientes do CMB que excederam o CM (8,6%) teve sobrevida de 58,1% em cinco anos. Não houve diferença estatística na sobrevida entre os grupos CM, CMB e downstaging. A invasão vascular (p<0,001), tamanho do maior nódulo (p=0,001) e número de nódulos >2 cm (p=0,028) associaram-se com recidiva. A idade (p=0,001), sexo feminino (p<0,001), MELD real (p<0,001), invasão vascular (p=0,045) e o número de nódulos >2 cm (p<0,014) estiveram associados com a piora na sobrevida. Conclusões: O CMB aumentou em 8,6% as indicações de TxH e apresentou índices de sobrevida semelhantes ao CM.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Transplante de Fígado , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/diagnóstico , Brasil , Taxa de Sobrevida , Estudos Retrospectivos , Carcinoma Hepatocelular/mortalidade , Itália , Neoplasias Hepáticas/mortalidadeRESUMO
Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules. Aim: To evaluate the outcome of liver transplantation within the CMB. Methods: The medical records of patients with HCC undergoing liver transplantation in relation to recurrence and survival by comparing CM and CMB, were analyzed. Results: 414 LTx for HCC, the survival at 1 and 5 years was 84.1 and 72.7%. Of these, 7% reached the CMB through downstaging, with survival at 1 and 5 years of 93.1 and 71.9%. The CMB patient group that exceeded the CM (8.6%) had a survival rate of 58.1% at five years. There was no statistical difference in survival between the groups CM, CMB and downstaging. Vascular invasion (p<0.001), higher nodule size (p=0.001) and number of nodules >2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p<0.001), real MELD (p<0.001), vascular invasion (p=0.045) and number of nodes >2 cm (p<0.014) were associated with worse survival. Conclusions: CMB increased by 8.6% indications of liver transplantation, and showed survival rates similar to CM.
Racional: O critério de Milão (CM) vem sendo utilizado como padrão para indicação do transplante hepático (TxH) por hepatocarcinoma (HCC) em todo mundo há quase 20 anos. Diversos centros têm adotado critérios expandidos com intuito de aumentar o número de pacientes candidatos ao transplante, mantendo bons índices de sobrevida. No Brasil, desde 2006, o critério de Milão/Brasil (CMB), que desconsidera nódulos <2 cm, é adotado, incluindo pacientes com maior número de nódulos pequenos. Objetivo: Avaliar o resultado do transplante hepático dentro do CMB. Métodos: Foram analisados os prontuários dos pacientes com HCC submetidos ao TxH em relação à recidiva e sobrevida através da comparação entre CM e CMB. Resultados: Em 414 TxH por HCC, a sobrevida em 1 e 5 anos foi de 84,1 e 72,7%. Destes, 7% atingiram o CMB através de downstaging, com sobrevida em 1 e 5 anos de 93,1 e 71,9%. O grupo de pacientes do CMB que excederam o CM (8,6%) teve sobrevida de 58,1% em cinco anos. Não houve diferença estatística na sobrevida entre os grupos CM, CMB e downstaging. A invasão vascular (p<0,001), tamanho do maior nódulo (p=0,001) e número de nódulos >2 cm (p=0,028) associaram-se com recidiva. A idade (p=0,001), sexo feminino (p<0,001), MELD real (p<0,001), invasão vascular (p=0,045) e o número de nódulos >2 cm (p<0,014) estiveram associados com a piora na sobrevida. Conclusões: O CMB aumentou em 8,6% as indicações de TxH e apresentou índices de sobrevida semelhantes ao CM.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Brasil , Carcinoma Hepatocelular/mortalidade , Feminino , Humanos , Itália , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Many studies have evaluated whether there are characteristics related to pancreas donors and the islet isolation process that can influence pancreatic islet yield. However, this analysis has not yet been performed in Brazil, one of the world leaders in whole pancreas organ transplantation (WOPT), where pancreas allocation for pancreatic islet transplantation (PIT) has no officially defined criteria. Definition of parameters that would predict the outcome of islet isolation from local pancreas donors would be useful for defining allocation priority in Brazil. OBJECTIVE: To analyze the relationship between multiple donor-related and islet isolation variables with the total number of isolated pancreatic islet equivalents (IEQ) in a brazilian sample of pancreas donors. METHODS: Several variables were analyzed in 74 pancreata relative to the outcome of total IEQs obtained at the end of the process. RESULTS: In univariate analysis, body mass index (BMI) (p = 0.003), the presence of fatty infiltrates in the pancreas as observed during harvesting (p = 0.042) and pancreas digestion time (p = 0.046) were identified as variables related to a greater IEQ yield. In a multivariate analysis a statistically significant contribution to the variability of islet yield was found only for the BMI (p = 0.017). A ROC curve defined a BMI = 30 as a cut-off point, with pancreata from donors with BMI > 30 yielding more islets than donors with BMI < 30 (p< 0.001). CONCLUSION: These data reinforce the importance of the donor BMI as a defining parameter for successful islet isolation and establishes this variable as a potential pancreas allocation criterion in Brazil, where there is unequal competition for good quality organs between WOPT and PIT.
Assuntos
Transplante das Ilhotas Pancreáticas/métodos , Transplante de Pâncreas/métodos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Índice de Massa Corporal , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Estatísticas não ParamétricasRESUMO
Atrial septostomy (AS) is a palliative treatment for right ventricular failure from severe pulmonary arterial hypertension (PAH). We sought to investigate the effect of AS, alone or combined with PAH-specific pharmacotherapy, on the survival of patients with PAH. We performed a retrospective analysis of the functional and haemodynamic changes in patients with PAH following AS, and long-term survival characteristics for the whole group and separately for the subgroup who received post-procedural pharmacotherapy. 50 procedures performed in 34 patients (mean ± SD age 35 ± 10 yrs) resulted in haemodynamic and symptomatic improvement in most of the patients. Only one (2%) procedure-related death occurred. Due to spontaneous closure of the defect, AS was repeated in 10 patients. In 21 patients, AS was the only form of treatment, while 11 received additional pharmacotherapy after AS. During follow-up (58.5 ± 38 months), 21 patients died; median survival of the group was 60 months (95% CI 43-77 months). Median survival for patients on pharmacotherapy additional to AS was 83 months (95% CI 57-109 months), which was better than that for patients with AS alone (53 months, 95% CI 39-67 months) (log-rank 6.52; p = 0.010). In selected patients with PAH, AS is a safe and effective intervention that exerts a beneficial impact on long-term survival. Survival appears to be improved when AS is combined with PAH-specific pharmacotherapy.
Assuntos
Septo Interatrial/cirurgia , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Terapia Combinada , Hipertensão Pulmonar Primária Familiar , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Belzer solution is considered to be the best preservation media used for pancreas transplantation; however, its high cost accounts for approximately 14.5% of all resources allocated by the Brazilian government toward each pancreatic transplant. The objective of the present study was to test a reduction of Belzer solution during pancreas harvest, thereby lowering procedural cost. METHODS: The patients received pancreas-kidney transplantations during the period from January 2003 to August 2004. Patients were divided into two groups. Patients assigned to Group A (n=30) received only Belzer solution (2 L through the aorta artery), whereas patients in Group B (n=16) were perfused first with 1 L of Eurocollins solution followed by 1 L of Belzer solution. The two groups were assessed for differences in the following clinical parameters: the need for insulin replacement or antifungal and anticytomegalovirus treatment, pancreatitis, acute cellular rejection, graft vascular thrombosis, fistulas, intra-abdominal collection, graft loss, deaths, pancreatic ischemia time, and average hospitalization time. RESULTS: No statistically significant differences were observed in any of the parameters analyzed (P<0.05). The use of Eurocollins solution, followed by Belzer solution during pancreas harvesting, did not result in differences in graft survival or functionality, postsurgical complications, or patient survival and hospitalization time, when compared to the use of Belzer solution alone. CONCLUSIONS: Perfusion with 1 L of Eurocollins solution followed by 1 L of Belzer solution during pancreas harvesting seems to be a simple and efficient alternative for reducing the costs of the harvesting process.
Assuntos
Aorta , Soluções Hipertônicas/normas , Soluções para Preservação de Órgãos/normas , Pâncreas , Coleta de Tecidos e Órgãos , Adenosina/economia , Adulto , Alopurinol/economia , Controle de Custos , Custos de Medicamentos , Feminino , Glutationa/economia , Humanos , Insulina/economia , Tempo de Internação , Masculino , Soluções para Preservação de Órgãos/economia , Pâncreas/fisiopatologia , Transplante de Pâncreas/efeitos adversos , Rafinose/economia , Análise de Sobrevida , Irrigação Terapêutica , Sobrevivência de Tecidos , Coleta de Tecidos e Órgãos/economia , Coleta de Tecidos e Órgãos/métodosRESUMO
Covering a stent with a membrane (stent graft) allows treatment of diverse coronary abnormalities such as aneurysms, rupture and fistulas (which, until recently, required surgical therapy). A stent graft could also reduce embolic complications associated with angioplasty of saphenous vein grafts. The objective of this study is to evaluate bovine pericardium as a graft for conventional stents. In vitro testing of the bovine pericardium disclosed an elasticity of 15% and a resistance to rupture of 0.22 kg/mm2, well above the pressure commonly used during stent deployment. In 18 pigs, 29 of 32 (90.63%) attempts to implant stent grafts were successful. Histology of acute porcine studies revealed correct apposition of the stent graft to the vessel wall, subacute and chronic (10 days and 1 month) samples showed adequate endothelization and exclusion of proliferative media. Twenty stents were placed in 15 patients with a 100% success rate. Seven patients had coronary aneurysms and in all a complete exclusion of the aneurysm was obtained without complications. Fourteen patients have a follow-up of 6 or more months with evidence of clinical restenosis in 2 (14.28%), whereas angiographic follow-up in 9 patients, which included the 2 cases with recurrent angina, evidenced restenosis in 3 of 14 stents (21.4%), two of which were overlapped in the LAD of one patient and one corresponded to a series of 9 stents (in 5 patients) placed in saphenous vein grafts. It is concluded that bovine pericardium is a suitable material for stent-grafts and its efficacy to seal coronary aneurysms was demonstrated. These results warrant a larger comparative study to better define its restenosis rate and further delineate its usefulness in the treatment of diseased saphenous vein grafts.
Assuntos
Materiais Revestidos Biocompatíveis , Pericárdio , Stents , Doenças Vasculares/cirurgia , Animais , Bovinos , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , SuínosRESUMO
We present the results from the National Census of cardiac catheterization and interventionist Cardiology Services performed by the Chapter of interventional Cardiology of the Mexican Society of Cardiology up to the year 2000. The present document identifies the total number of existing services, their physical characteristics and available human resources, as well as the number and type of procedures performed in them.
Assuntos
Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Censos , Hemodinâmica , Humanos , MéxicoRESUMO
This report describes a patient with severe hypertrophic obstructive cardiomyopathy in New York Heart Association functional class III. Complete reduction of left ventricular outflow tract gradient was achieved by the selective occlusion of three target septal arteries with a pericardium-covered stent. The patient's in-hospital course was uneventful and has improved to functional class I.
Assuntos
Cardiomiopatia Hipertrófica/terapia , Ablação por Cateter , Embolização Terapêutica/métodos , Septos Cardíacos , Stents , Cardiomiopatia Hipertrófica/fisiopatologia , Materiais Revestidos Biocompatíveis , Etanol/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Pericárdio , Desenho de Prótese , Pressão VentricularRESUMO
Study based on testament-letters written by freshmen students of the undergraduate course in Nursing, who should imagine to be in the year 2030. Everything imagined by these students and that might have happened in the three earlier decades was the subject of this study, such as professional and nurses achievements, outbreak of cure for illnesses, social prestige and positions.
Assuntos
Educação de Pós-Graduação em Enfermagem , Previsões , Estudantes de Enfermagem , Adolescente , Adulto , Brasil , Currículo , Educação Continuada em Enfermagem , Feminino , Humanos , MasculinoRESUMO
Electron microscopy and immunolabelling with antiserum specific to cucumber mosaic virus coat protein were used to examine tobacco leaf cells infected by cucumber mosaic virus isolated from Catharanthus roseus (CMV-Cr). Crystalline and amorphous inclusions in the vacuoles were the most obvious cytological modifications seen. Immunogold labelling indicated that the crystalline inclusion was made up of virus particles and amorphous inclusions contained coat protein. Rows of CMV-Cr particles were found between membranes of dictyosomes, but membranous bodies and tonoplast-associated vesicles were not evident. Virus particles and/or free coat protein were easily detected in the cytoplasm by immunolabelling. No gold labelling was found within nuclei, chloroplasts and mitochondria.
Assuntos
Capsídeo/metabolismo , Cucumovirus/metabolismo , Nicotiana/virologia , Plantas Tóxicas , Cucumovirus/ultraestrutura , Microscopia Imunoeletrônica , Nicotiana/metabolismo , Nicotiana/ultraestruturaRESUMO
The no-reflow phenomenon refers to the inability to reperfuse myocardial tissue despite removal of an occlusion of a coronary artery. No reflow is a complication that may occur after revascularization of patients. This study examined the incidence and, clinical characteristics of no-reflow in a patient population treated with conventional percutaneous transluminal coronary angioplasty at the Instituto Nacional de Cardiología "Ignacio Chávez". We reviewed 204 elective angioplasties and 62 direct angioplasties; 14 patients were included (4 from the first group and 10 from the second group). No-reflow were more frequently in men, the mean age was 56 years and diabetes and smoking were the risk factors more frequently reported. No-reflow was found in left anterior descending coronary artery in 7 patients, the time of reperfusion, in direct angioplasty, was 10.6 hours (mean) and the strategy most frequently used to reestablish normal anterograde flow was intracoronary verapamil. The overall incidence of no-reflow for the two modalities was 5.2% (16.12% for direct angioplasty and 1.9% for elective angioplasty). The current study shows that the no-reflow phenomenon is not uncommon after angioplasty; no-reflow appears higher than the previous reports for both modalities of treatment.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Circulação Coronária , Isquemia Miocárdica/epidemiologia , Angioplastia Coronária com Balão/estatística & dados numéricos , Angiografia Coronária , Circulação Coronária/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/tratamento farmacológico , Falha de TratamentoRESUMO
OBJECTIVES: We sought to investigate the acute hemodynamic effects of graded balloon dilation atrial septostomy (BDAS) and to define the long-term impact of this procedure on New York Heart Association functional class and survival in adult patients with primary pulmonary hypertension (PPH). BACKGROUND: Current treatment strategies for patients with severe and refractory PPH are limited by either technical difficulties and high mortality or cost. METHODS: We studied 15 patients with severe PPH. BDAS was successfully performed in all patients by crossing the interatrial septum with a Brockenbrough needle, followed by progressive dilation of the orifice with a Mansfield balloon in a hemodynamically controlled, step-by-step manner. RESULTS: BDAS caused an immediate significant fall in right ventricular end-diastolic pressure and in systemic arterial oxygen saturation and an increase in cardiac index. One patient died, and 14 survived the procedure and significantly improved their mean functional class (from 3.57 +/- 0.6 to 2.07 +/- 0.3 [mean +/- SD], p < 0.001). Exercise endurance (6-min test) also improved from 107 +/- 127 to 217 +/- 108 m (p < 0.001). Because of spontaneous closure, BDAS was repeated in four patients. The survival rate among patients who survived the procedure was 92% at 1, 2 and 3 years, which is better than that for historical control PPH patients (73%, 59% and 52%, respectively). CONCLUSIONS: With careful monitoring, BDAS is a safe and useful palliative treatment for selected patients with severe PPH.
Assuntos
Cateterismo , Átrios do Coração/cirurgia , Septos Cardíacos/cirurgia , Hipertensão Pulmonar/cirurgia , Adulto , Débito Cardíaco/fisiologia , Causas de Morte , Diástole , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Agulhas , Oxigênio/sangue , Cuidados Paliativos , Resistência Física/fisiologia , Segurança , Taxa de Sobrevida , Função Ventricular Direita/fisiologia , Pressão Ventricular/fisiologiaRESUMO
A prospective, observational, comparative study of 100 patients with acute myocardial infarction and primary angioplasty was performed to establish if there was statistically difference between the lag of time when symptoms begin and the time of the emergency admission to the time of arrival at the catheterization suite during working hours vs the "on call" hours. Patients were allocated in two groups accordingly to morning hours or on call hours. Time of onset of symptoms to the catheterization suite arrival between the two groups was no significantly different. Time from emergency room arrival to catheterization suite arrival was significant different < 0.05, however success rate between groups 86% vs 80% and complications rate were statistically non significant between both groups. We conclude that primary angioplasty is a highly effective method of reperfusion. Even though the time from the emergency room arrival to the catheterization suite arrival was significantly less during day than the on call hours, there is no difference between the success rate and complications incidence in both groups.
Assuntos
Angioplastia , Infarto do Miocárdio/cirurgia , Idoso , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Estudos Prospectivos , Fatores de TempoRESUMO
To assess the efficacy and safety of the AVE Micro Stent, we deployed 204 stents in 144 consecutive patients during a one year period. Indications for stenting were acute closure in 3.4%, dissection in 5.4%, post balloon pTCA restenosis in 3.4%, non-favorable result in 16.7% and de novo in 71.1%. Patient population included 39 (27%) patients with stable angina, 86 (59.7%) with unstable angina, 16 (11.1%) with acute MI and 3 (2.1%) with cardiogenic shock. Angiographic lesion morphology were as follows: type A, 17.7%, type B1, 42.1%; type B2, 16.2%; type C, 24%. Procedural success was obtained in 204 of 205 attempted stents (99.5%) and clinical success was 93.1%. Oral anticoagulation was not routinely used. Enzymatic elevation consistent with myocardial necrosis occurred in 3.2% with Q wave MI in 0.7%. Three patients (2.1%) had bleeding at site of femoral puncture with one requiring transfusion and surgery. Mortality was 0.8% in the angina group, 6.25% in the MI group and one of the 3 patients with cardiogenic shock died and represents the only apparent stent thrombosis as she experienced sudden death one week after successful left main stenting. We conclude that high success rates can be obtained with the AVE Micro Stent due to it's excellent trackability, adequate radio-opacity and relative flexibility.