RESUMO

Se presentó un caso de mucormicosis gástrica en una serie de 18 pacientes que han recibido trasplante hepático en un período de 2 años en este centro. Se trató de una paciente diabética tipo 2 de 57 años, con cirrosis hepática alcohólica estadio C de Child-Pugh. Se le realizó trasplante ortotópico de hígado sin complicaciones y se utilizó esquema inmunosupresor con prednisona, ciclosporina y azatioprina. Evolutivamente, se presentó episodio neurológico de excitación y después sepsis respiratoria por Acinetobacter sp y Pseudomona sp que llevaron al distrés y, posteriormente, al fallo múltiple de órganos, además de sangrado digestivo alto a los 6 d de evolución. La paciente falleció a los 13 d del trasplante. En la necropsia se encontraron hifas de Mucor en tejidos gástricos. Se realizó diagnóstico post mortem, en una paciente con factores predisponentes como diabetes mellitus, tratamiento inmunosupresor, y sepsis bacteriana asociada. Se corroboró que es el único caso de mucormicosis gástrica reportado entre 5 772 necropsias realizadas en este centro

Assuntos

RESUMO

INTRODUCTION: The pressing need to obtain organs for transplantation demands an optimal usage of donors. Surgical techniques based on rapid multiorganic retrieval gain vital importance especially when hemodynamically unstable donors are involved. OBJECTIVE: To highlight the advantages of this technique and evaluate our experience after 2 years of implementation. MATERIAL AND METHODS: A longitudinal, prospective non-controlled study was performed, including 34 multiorganic retrievals using the Total Abdominal Evisceration (TAE) technique. Information on demographic characteristics, surgical times, anatomical variations and final fate of organs is gathered. RESULTS: Thirty four organ retrievals were performed using TAE techniques. Included donors had a mean age of 47 years and a mean weight of 66 kg. Dissection time range was 35 +/- 10 min, bloc retrieval was performed in 20 +/- 8 min and dissection at backbench range was 100 +/- 30 min. All anatomic variations were detected and were present in 46.9% of cases. Over 70% of livers retrieved by TAE resulted in minimal preservation injury. Only one presented primary non-function after transplantation, directly related to hemodynamic instability. CONCLUSIONS: The TAE technique for multiorgan retrieval allows adequate harvesting of organs for transplantation with favorable preservation. It is a valid alternative for transplant groups in our country, especially when dealing with unstable donors.

Assuntos

RESUMO

Hepatic retransplant constitutes 10-20% of all orthotopic hepatic transplants. The piggy-back technique was used in hepatectomy with conservation of the retrohepatic vena cava. A side-to-side cavo-cavostomy technique is described in the case of hepatic congestion or acute Budd Chiari syndrome post-transplant. This is an extremely serious condition and can result in death. We present the first case of hepatic retransplant performed in Hospital Hermanos Ameijeiras in a patient who received who received his first transplant due to non-resectable hepatocarcinoma and who required retransplant due to acute rejection and graft dysfunction. During retransplant, the Belghiti side-to-side anastomosis technique was used to resolve the acute Budd Chiari syndrome that presented itself. Post-surgical evolution at 18 months was satisfactory without evidence of complications of the graft. Acute Budd Chiari syndrome post-transplant can satisfactorily be resolved with the Belghiti technique, although it is preferable to take prophylactic measures to avoid it.

Assuntos

RESUMO

OBJECTIVE: Our objective was to know rate of general and specific satisfaction of patients going through major out-patient surgery (MOPS), to determine the relationship between satisfaction and sociodemographic variables, and to ascertain the influence that MOPS can exert on certain facets of the care relationship, user valoration of health services, and out-patient method characteristics. SITE: Primary-care polyclinic and secondary-care municipal hospital. DESIGN: We conducted a descriptive, qualitative transversal study by means of anonymous questionnaires answered by out-patients at home. RESULTS: The questionnaires, considered due to its credible and valid characteristics, was applied by drained personnel to 83 persons by simple random sanepling to the forget population. The majority of out-patients stated that they were very (51.81%) or quite (31.12%) satisfied with the method, independently of age, sex, place of origin, educational lave, and occupation. A statistical relationship was found between general satisfaction and the occurrence of postoperative complications, the possibility given to the patient of choosing between in- and out-patient surgery, and specific satisfaction with medical care received at he hospital and at home. These and then results are discussed and compared whit experiences in other fields. In conclusion, patients expressed satisfaction with the MOPS program linked with primary health care (PHC), although they stated that some aspects of MOPS should be improved.

Assuntos

RESUMO

Se realizó estudio prospectivo que incluyó a todos los pacientes con feocromocitoma, operados en el Servicio de Cirugía General del Hospital Clinicoquirúrgico ôHermanos Ameijeirasö, durante el período comprendido entre junio de 1984 y junio de 2000. Incluyó a 33 pacientes, 24 mujeres y 9 hombres. Predominó la afección en la tercera, cuarta y quinta décadas de la vida. La hipertensión arterial fue la manifestación clínica principal, presente en el 85(por ciento) de los casos; el incidentaloma y la neoplasia endocrina múltiple (NEM) IIA fueron otras formas de presentación. La tomografía axial computadorizada y el ultrasonido tuvieron una sensibilidad de 95 y 100 (por ciento), respectivamente, para el diagnóstico de la entidad. La adrenalectomía fue el tratamiento de elección y la lumbar (84,8 por ciento), la vía de abordaje más empleada. La apertura pleural fue el accidente más frecuente y las complicaciones predominantes fueron el neumotórax y el hematoma lumbar. El resultado final del tratamiento fue bueno en 28 pacientes (84,8 por ciento) y ocurrieron 2 fallecimientos (6,1 por ciento)(AU)

A prospective study that included all the patients with pheochromocytoma operated on at the General Surgery Service of Hermanos Ameijeiras Clinical and Surgical Hospital from June, 1984, to June, 2000, was conducted. 33 patients, 24 females and 9 males, were included. The affection predominated in the third, fourth and fifth decade of life. Arterial hypertension was the main clinical manifestation present in 85 percent of th cases. The incidentaloma and the multiple endocrine neoplasia (MEN) II A were other forms of presentation. Computed axial tomography and ultrasound had a sensitivity of 95 and 100 percent , respectively, for the diagnosis of the entity. Adrenalectomy was the elective treatment and the lumbar approach(84.8 percent ) was the most used. The pleural opening was the most frequent accident and the prevailing complications were pneumothorax and lumbar hematoma. The final result of the treatment was good in 28 patients (84.84 percent) and 2 deaths were registered (6.1 percent )(AU)

Assuntos

RESUMO

El cáncer de páncreas constituye la quinta causa de muerte por cáncer. En la actualidad se considera que la única posibilidad de curación para la enfermedad es la pancreatoduodenectomía. En el trabajo se expone un estudio prospectivo realizado con 18 pacientes operados, desde octubre de 1996 hasta enero del 2000, con el diagnóstico de tumor periampular. En la serie se halló que la afección se asocia frecuentemente con la diabetes mellitus y que los tipos hísticos más diagnosticados fueron el adenocarcinoma de páncreas y el ampuloma. La colangiopancreatografía retrógrada endoscópica fue el estudio complementario más útil, y alcanzó una sensibilidad del 94 porciento en el diagnóstico. Se encontró una relación directa entre el volumen de sangre trasfundido perioperatoriamente y la mortalidad. La morbilidad global fue de 50 porciento. La mortalidad ha disminuido en relación con años anteriores. La supervivencia a largo plazo sigue siendo baja(AU)

Pancreatic cancer is the fifth cause of death from cancer. Pancreaticoduodenectomy is considered as the only possibility of cure for this disease at present. A prospective study conducted among 18 patients with the diagnosis of periampullar tumor that were operated on from October, 1996, to January, 2000, is presented. It was found that the affection is frequently associated with diabetes mellitus and that the most diagnosed histic types were pancreatic adenocarcinoma and ampuloma. The endoscopic retrograde cholangiopancreatography was the most useful complementary study and reached a sensitivity of 94 percent in the diagnosis. It was observed a direct relationship between the perioperatively transfused blood volume and mortality. Total morbidity was 50 percent. Mortality has decreased in comparison with pevious years. Long-term survival is still low(AU)

Assuntos