RESUMO
AIM: This study analyzed a 10-year single-center experience in orthotopic liver transplantation (OLT) without venovenous bypass (VVB). METHODS: We retrospectively analysed a nonrandomized series (1999-2008) of 125 adult OLT patients without VVB. RESULTS: The main causes of liver failure were viral hepatitis (n = 39), alcoholic liver disease (n = 22), and liver cancer (n = 17). One-year survival was 76.4%. The most common postoperative complications were bile duct stenosis (n = 12), postoperative bleeding (n = 8), hepatic artery thrombosis (n = 7), and primary liver failure (n = 6). Twelve patients required hemodialysis and four underwent retransplantations of the liver. Fourteen patients died before postoperative day 30(th). Univariate analysis showed significant differences between patients who did and did not survive 30 days among donor death diagnoses (P = .05), red blood cell units transfused (P = .03), aspartate aminotranferase on the first postoperative day (P = .002), ABO type (P = .04), time of orotracheal intubation (P = .001), hemodialysis (P = .001), and period of postoperative vasoactive drug use (P = .006). The total length of orotracheal tube intubation showed a significant independent association with mortality before 30 days (P < .001). CONCLUSION: OLT without VVB can be safely performed even in severe cases of chronic liver failure.
Assuntos
Veias Hepáticas/cirurgia , Falência Hepática/cirurgia , Transplante de Fígado/métodos , Procedimentos Cirúrgicos Vasculares , Veia Cava Inferior/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Brasil , Criança , Feminino , Hepatectomia , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal , Estimativa de Kaplan-Meier , Falência Hepática/etiologia , Falência Hepática/mortalidade , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Diálise Renal , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Adulto JovemRESUMO
Migratory behaviour of selected fish species is described in the Paraná River, Brazil-Argentina-Paraguay, to search for patterns relevant to tropical regulated river systems. In a 10 year mark-recapture study, spanning a 1425 km section of the river, 32 867 fishes composed of 18 species were released and 1083 fishes were recaptured. The fishes recaptured were at liberty an average 166 days (maximum 1548 days) and travelled an average 35 km (range 0-625 km). Cluster analysis applied to variables descriptive of movement behaviour identified four general movement patterns. Cluster 1 included species that moved long distances (mean 164 km) upstream (54%) and downstream (40%) the mainstem river and showed high incidence (27%) of passage through dams; cluster 2 also exhibited high rate of movement along the mainstem (49% upstream, 13% downstream), but moved small distances (mean 10 km); cluster 3 included the most fishes moving laterally into tributaries (45%) or not moving at all (25%), but little downstream movement (8%); fishes in cluster 4 exhibited little upstream movement (13%) and farthest downstream movements (mean 41 km). Whereas species could be numerically clustered with statistical models, a species ordination showed ample spread, suggesting that species exhibit diverse movement patterns that cannot be easily classified into just a few classes. The cluster and ordination procedures also showed that adults and juveniles of the same species exhibit similar movement patterns. Conventional concepts about Neotropical migratory fishes portray them as travelling long distances upstream. The present results broaden these concepts suggesting that migratory movements are more diverse, could be long, short or at times absent, upriver, downriver or lateral, and the diversity of movements can vary within and among species. The intense lateral migrations exhibited by a diversity of species, especially to and from large tributaries (above reservoirs) and reservoir tributaries, illustrate the importance of these habitats for the fish species life cycle. Considering that the Paraná River is highly impounded, special attention should be given to the few remaining low-impact habitats as they continue to be targets of hydropower development that will probably intensify the effects on migratory fish stocks.
Assuntos
Migração Animal , Peixes/fisiologia , Rios , Sistemas de Identificação Animal , Animais , Argentina , Brasil , Ecossistema , Modelos Estatísticos , ParaguaiRESUMO
INTRODUCTION: Orthotopic liver transplantation is a widely used procedure for the treatment of irreversible liver diseases for which there is no possibility of medical treatment. When this procedure is performed by the conventional technique, the retrohepatic vena cava is removed along with the native liver. The inferior vena cava (IVC) remains clamped until the revascularization of the graft, and in this period there is a reduction in the venous return, which may induce a fall by up to 50% in the cardiac output with hemodynamic instability and a fall in renal perfusion pressure. The use of a portal-femoral-axillary venovenous bypass system, in which the blood from the femoral and portal veins returns to the heart via the axillary vein propelled by a centrifugal pump, is intended to minimize the effects of the IVC clamping. In the piggyback (PB) technique, the native liver is removed and the IVC of the recipient is preserved and only partially clamped. We have employed both techniques without the use of venovenous bypass for 10 years. The objective of this study was to compare the results obtained from the use of the two techniques. PATIENTS AND METHODS: A retrospective analysis was performed of 195 patients transplanted between 1999 and 2008: 125 by the conventional technique and 70, the PB technique. The intraoperative parameters were analyzed (surgical time, ischemia time, use of blood products, and diuresis), as well as intensive care support (duration of stay in intensive care unit and use of vasoactive drugs), period of intubation, length of hospital stay, renal function, graft function, postoperative complications, retransplantation, and patient survival. RESULTS: The PB group showed a reduction in surgical time, warm ischemia time, the use of packed red blood cells concentrates, and fresh frozen plasma, as well as mortality at 30 days (P<.05). There were no differences in relation to cold ischemia time, intraoperative diuresis; length of stay and use of vasoactive drugs in the intensive care unit; the period of intubation; the duration of hospital stay; the renal function; the graft function; the need for reoperation; the incidence of sepsis, biliary complications, vascular complications; need for retransplantation; and 1-year mortality. The cumulative survival rate at 1 year was significantly better among the PB patients. CONCLUSION: Orthotopic liver transplantation can be performed without venovenous bypass with good results, using either the conventional technique or the PB technique. Provided that there is no technical contraindication and a long ischemia period is not foreseen, the PB technique should be the technique of choice.
Assuntos
Circulação Extracorpórea , Transplante de Fígado/métodos , Veia Cava Inferior/cirurgia , Adulto , Idoso , Transfusão de Sangue , Brasil , Distribuição de Qui-Quadrado , Constrição , Feminino , Hemodinâmica , Humanos , Estimativa de Kaplan-Meier , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/fisiopatologia , Isquemia Quente , Adulto JovemRESUMO
Hepatic ischemia followed by reperfusion (IR) results in mild to severe remote organ injury. Oxidative stress and nitric oxide (NO) seem to be involved in the IR injury. Our aim was to investigate the effects of liver I/R on hepatic function and lipid peroxidation, leukocyte infiltration and NO synthase (NOS) immunostaining in the lung and the kidney. We randomized 24 male Wistar rats into 3 groups: 1) control; 2) 60 minutes of partial (70%) liver I and 2 hours of global liver R; and 3) 60 minutes of partial (70%) liver I and 6 hours of global liver R. Groups 2 and 3 showed significant increases in plasma alanine and aspartate aminotransferase levels and in tissue malondialdehyde and myeloperoxidase contents. In the kidney, positive endothelial NOS (eNOS) staining was significantly decreased in group 3 compared with group 1. However, staining for inducible NOS (iNOS) and neuronal NOS (nNOS) did not differ among the groups. In the lung, the staining for eNOS and iNOS did not show significant differences among the groups; no positive nNOS staining was observed in any group. These results suggested that partial liver I followed by global liver R induced liver, kidney, and lung injuries characterized by neutrophil sequestration and increased oxidative stress. In addition, we supposed that the reduced NO formation via eNOS may be implicated in the moderate impairment of renal function, observed by others at 24 hours after liver I/R.
Assuntos
Traumatismo por Reperfusão/fisiopatologia , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Imuno-Histoquímica , Isquemia/fisiopatologia , Rim/enzimologia , Pulmão/enzimologia , Masculino , Malondialdeído/sangue , Neutrófilos/enzimologia , Neutrófilos/fisiologia , Óxido Nítrico Sintase/metabolismo , Peroxidase/sangue , Ratos , Ratos Wistar , Traumatismo por Reperfusão/patologiaRESUMO
BACKGROUND: Since July 2006, the Model for End-stage Liver Disease (MELD) score has served as the national basis for allocation of donor livers for transplantation in Brazil. Patients with higher MELD scores receive greater priority for allocation regardless of the time on the waiting list. PURPOSE: To investigate the impact of MELD score implementation on the survival of waiting list patients. METHODS: A retrospective study of patients registered at the national Organ Procurement Organization (OPO) for the liver transplantation waiting list between January 2004 and June 2006 (pre-MELD) and between July 2006 and December 2008 (post-MELD). RESULTS: We included listed patients awaiting liver transplantation in the pre-MELD era (n = 250, 48.4%) and in the post-MELD era (n = 266, 51.6%). The times awaiting transplant prior to and after the MELD system were 487.2 +/- 384.8 days and 183.9 +/- 157.2 days, respectively. Prior to the MELD score, waiting list survivals were greater when compared to rates in the current system. Early posttransplant patient survival rates were significantly reduced in the post-MELD era (83.4%) compared to the period before MELD implementation (93.2%). CONCLUSIONS: MELD score provides a transparent, objective system to drive allocation policy; however, it presents several important limitations. Constant need of changes and reevaluation are needed as an evolutionary process. Future changes in the present system may be addressed by adjusting the MELD system.
Assuntos
Falência Hepática/cirurgia , Transplante de Fígado/estatística & dados numéricos , Listas de Espera , Adolescente , Adulto , Idoso , Cadáver , Criança , Pré-Escolar , Feminino , Humanos , Falência Hepática/mortalidade , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Alocação de Recursos/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Sobreviventes , Doadores de Tecidos/estatística & dados numéricosRESUMO
INTRODUCTION: Vitamin A deficiency (VAD) is a worldwide public health problem. Epidemiological studies of VAD prevalence have been conducted in individuals with chromosome load and genetic potential compared with the general population; however, there are few studies in patients with Down's syndrome (DS). The objective of this study was to determine the prevalence of VAD and analyse nutritional status in patients with DS. METHODS: A prospective and cross-sectional study was performed, with 50 karyotypically normal (KN) individuals (10.4+/-3.7 years old) and 38 randomly selected patients with DS (8.2+/-4.1 years old). Serum retinol was determined by HPLC using the Bieri method, with an international reference standard to define VAD (serum retinol <20 microg/dL). The data were analysed using the SAS/STAT statistical program. RESULTS: The prevalence of VAD was 18.4% in individuals with DS and 4% in KN individuals (OR: 5.42; 95% CI=0.93-40.64; p=0.02). Children with DS between two and six years old shown a significativily lower serum retinol (p=<0.05).The patients with DS also showed a significant decrease in height and weight compared to KN (p=<0.001). CONCLUSIONS: The prevalence of VAD detected in patients with DS could be considered a public health problem. Also, the chromosome 21 trisomy represent a risk factor associated with VAD.
Assuntos
Síndrome de Down/complicações , Estado Nutricional , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Estudos ProspectivosRESUMO
The double piggyback technique has been proposed for domino liver transplantation. To make this possible, it is necessary to reconstruct the venous outflow of the domino liver graft on the back table. The authors describe the technical details of this procedure in three consecutive cases. A deceased donor cava-iliac bifurcation segment was used. The iliac veins were anastomosed to the ostia of the right and middle-left hepatic veins, and the graft cava vein was anastomosed to the ostium of the three hepatic veins of the recipient. In all cases anatomic compatibility was observed; the outcome of the patients was satisfactory.
Assuntos
Veias Hepáticas/cirurgia , Veia Ilíaca/transplante , Circulação Hepática , Transplante de Fígado/métodos , Veia Cava Inferior/transplante , Cadáver , Humanos , Procedimentos de Cirurgia Plástica , Doadores de TecidosRESUMO
Spontaneous rupture of the spleen has been described in cases of hematologic, neoplasic and infectious diseases, or resulting from pancreatitis. We report a rare case of spontaneous splenic rupture, and favorable evolution after splenectomy, in a patient with dengue fever, which occurred during the last outbreak of dengue fever in Brazil.
Assuntos
Pessoa de Meia-Idade , Feminino , Humanos , Dengue , Ruptura Esplênica , Ruptura Espontânea , EsplenectomiaRESUMO
Spontaneous rupture of the spleen has been described in cases of hematologic, neoplasic and infectious diseases, or resulting from pancreatitis. We report a rare case of spontaneous splenic rupture, and favorable evolution after splenectomy, in a patient with dengue fever, which occurred during the last outbreak of dengue fever in Brazil.
Assuntos
Dengue/complicações , Ruptura Esplênica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Ruptura Espontânea/etiologia , EsplenectomiaRESUMO
An outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBLKp) infections in a neonatal intensive care unit (NICU) prompted a prospective investigation of colonization and infection with this pathogen. From August 1, 1997 to May 30, 1999, neonates admitted to the NICU for more than 24 h were screened for ESBLKp acquisition. Neonatal gastrointestinal screening was performed by means of faecal sampling within 48 h of admission and then weekly until discharge. Isolates were typed using pulsed-field gel electrophoresis (PFGE). Time-dependent proportional hazard models were used to identify independent effects of invasive procedures and antimicrobials after controlling for duration of stay at the NICU. During the study period, 464 neonates were admitted and 383 were regularly screened. Infections occurred in 13 (3.4%) neonates and 206 (53.8%) became colonized. Independent risk factors for colonization during the first nine days in the NICU were the antimicrobial combination cephalosporin plus aminoglycoside [hazard rate (HR)=4.60; 95% CI: 1.48-14.31], and each NICU-day was associated with a 26% increase in the hazard rate for colonization (HR=1.26; 95% CI: 1.16-1.37). Previous colonization (HR=5.19; 95% CI: 1.58-17.08) and central vascular catheter use (HR=13.89; 95% CI: 2.71-71.3) were independent risk factors for infection. In an outbreak setting the proportion of neonates colonized with ESBLKp was observed to increase with the duration of stay and antimicrobial use, and once colonized, infants exposed to invasive devices may become infected.
Assuntos
Portador Sadio , Infecção Hospitalar/etiologia , Surtos de Doenças/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/etiologia , Klebsiella pneumoniae , beta-Lactamases , Antibacterianos/efeitos adversos , Brasil/epidemiologia , Portador Sadio/epidemiologia , Portador Sadio/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Análise por Conglomerados , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Feminino , Hospitais com 100 a 299 Leitos , Hospitais Privados , Humanos , Incidência , Lactente , Recém-Nascido , Controle de Infecções/métodos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/prevenção & controle , Klebsiella pneumoniae/classificação , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Tempo de Internação/estatística & dados numéricos , Masculino , Programas de Rastreamento , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Estações do Ano , SorotipagemRESUMO
Clinical experience with balanced reciprocal translocations: In order to evaluate past experience with respect to the occurrence of balanced reciprocal translocations (BRT) in patients with malformation syndromes and/or mental retardation (MS/MR) and in couples with reproductive failure, 4,335 karyotypes from the Genetics Unit of the Universidad del Zulia from January 1971 to December 1994 were reviewed, resulting in the identification of 15 cases of BRT (0.34%). All BRT were classic (CT) according to the number of breakpoints. In 66.6% of the cases, the indication for chromosome analysis was a MS/MR; 20% reproductive failure and, in 13.3% the BRT was a fortuitous finding. BRT were of familial origin in 6/15 (40%), 3/15 (20%) were de novo and the other 6/15 (40%) were of unknown origin. It was concluded that BRT can affect the phenotype, particularly when the request for the karyotype is motivated by MS/MR, and that genetic counseling in individuals at risk to be carrier is indicated.