RESUMO
OBJECTIVES: Throughout the world, 45 000 kidney transplants are performed per year. Graft and overall survival vary according to the type of donor (living or deceased donor). Anastomosis of a short renal vein with iliac vein or common external iliac vein has been associated with technical problems such as angulation of the vein or tension on the anastomosis, which could limit visualization and control of bleeding from the graft. The main objective of our study was to analyze patients undergoing deceased-donor kidney transplant and compare results in patients who had extension of the right renal vein with a patch of vena cava from the same donor versus patients who received the left kidney. MATERIALS AND METHODS: A prospective cohort study was performed from December 31, 2007 to December 31, 2009. We compared 2 patients groups. We used statistical software (R, Version 2.5.1). The analyzing team was blinded to the surgical technique, and informed consent was obtained from all patients. RESULTS: There was no statistically significant difference in surgical time (P > .85) or ultrasonographic parameters between groups, but it was possible to perform an easier vein anastomosis with the vena cava graft in right kidney transplant. CONCLUSIONS: We recommend considering our procedure with the vena cava graft in right kidney as an alternative option to decrease warm ischemia time, perform an easier vein anastomosis with the vena cava extension, and make the procedure comfortable for the surgeon.
Assuntos
Transplante de Rim/métodos , Veias Renais/cirurgia , Doadores de Tecidos , Adulto , Estudos de Coortes , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Duração da Cirurgia , Estudos Prospectivos , Transplante Homólogo , Ultrassonografia , Veias Cavas/transplanteRESUMO
OBJECTIVES: To identify the variables that predict the failure to treat amoebic liver abscesses. METHODS: We prospectively carried out a case-control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic, and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure. RESULTS: Of 40 patients with amoebic liver abscess, 24 (mean age: 36·7±11·2 years) responded to medical treatment and 16 (41·8±11·6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0·05) on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline phosphatase level, and large abscess volume or diameter. CONCLUSIONS: The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and easy tool for determining appropriate therapy.
Assuntos
Antiprotozoários/administração & dosagem , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/cirurgia , Metronidazol/administração & dosagem , Sucção , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Abscesso Hepático Amebiano/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Falha de TratamentoRESUMO
OBJECTIVE: Hydrocephalus due to neurocysticercosis usually shows poor prognosis and shunt failure is a common complication. Neuroendoscopy has been suggested as treatment, but the indications remain unclear. METHODS: A cohort of patients with clinical/radiological diagnosis of hydrocephalus due to NCC, treated between January 2002 and September 2006, were the subjects of the study. We excluded patients with tumors or those in whom diagnosis was not confirmed (histology/positive ELISA in CSF). Neuroendoscopy was offered as the first line of treatment. Shunt failure rate and Karnofsky index at 12 months were assessed. RESULTS: Eighty-six patients (47 male) with a median age of 38 (9-79) were included in the study. Of them, 36.1% had a shunt before endoscopy and 97.7% had a Karnofsky index <80. We did not find the parasite in 18.6%, extraction was achieved in 79%, and in 87.2% an endoscopic third ventriculostomy (ETV) was performed. The median follow-up time was 43 months (1-72). Shunt failure was seen in 6.6% of patients with ETV in comparison to 27.2% in those without ETV. A hazard ratio of 0.22 (95% CI, 0.05-0.93) for shunt failure after ETV was calculated. At 12 months, 20.9% had a Karnofsky index <80. CONCLUSION: Early extraction of parasite plus ETV might allow improving outcome and reducing shunt failure. Limitation of inflammatory stimulation by parasite antigens and improvement of CSF dynamics could be an explanation for these findings.
Assuntos
Endoscopia , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Neurocisticercose/complicações , Procedimentos Neurocirúrgicos , Adolescente , Adulto , Idoso , Algoritmos , Anestesia Geral , Aqueduto do Mesencéfalo/cirurgia , Criança , Estudos de Coortes , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Hidrocefalia/líquido cefalorraquidiano , Avaliação de Estado de Karnofsky , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurocisticercose/líquido cefalorraquidiano , Neurocisticercose/parasitologia , Neuroendoscopia , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Ventriculostomia , Adulto JovemRESUMO
Introducción: Los programas de transplante de órganos de donador fallecido requieren una estructura compleja desde el punto de vista médico, logístico y cultural. Material y métodos: Se analizó la detección de posibles donadores en el estado de San Luis Potosí, del 21 de agosto de 1999 al 30 de agosto de 2002; se estudiaron las principales causas de muerte cerebral, su conversión a donadores, las implicaciones médicolegales y las causas de donación y no donación. Resultados: 71.42% de donadores y 64.15% de los no donadores tuvieron implicaciones médico-legales. La principal causa de muerte cerebral fue el traumatismo craneoencefálico (66.97%). La tasa de donantes por millón de habitantes fue de 8.3. Conclusiones: El manejo adecuado de los aspectos médico-legales influye en la tasa de donadores fallecidos lograda. Esto, aunado a la coordinación y efectividad del Consejo Estatal de Trasplantes, permitió obtener la tasa más alta de donación de este tipo en México.
INTRODUCTION: The transplantation program of organs obtained from deceased donors requires a complex structural organization. Medical, logistic, and cultural aspects must be taken into account. MATERIAL AND METHODS: We analyzed the detection of possible organ donors in San Luis Potosí, Mexico, from August 21, 1999 to August 30, 2002. We studied the main causes of brain death, donor conversion, legal implications, reasons for donation and refusal to donate. RESULTS: 71.42% of donors and 64.15% of non donors required legal intervention. The main cause of brain death was brain traumatic injury (66.97%). The donation rate per one million inhabitants was 8.3. CONCLUSIONS: Adequate forensic management has a positive influence on achieved deceased donors. An effective team work and coordination with the State Council of Transplants has allowed the State of San Luis Potosí to have the highest rate of organ donation in Mexico.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Morte Encefálica , Obtenção de Tecidos e Órgãos , México , Morte Encefálica/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Estudos RetrospectivosRESUMO
INTRODUCTION: The transplantation program of organs obtained from deceased donors requires a complex structural organization. Medical, logistic, and cultural aspects must be taken into account. MATERIAL AND METHODS: We analyzed the detection of possible organ donors in San Luis Potosí, Mexico, from August 21, 1999 to August 30, 2002. We studied the main causes of brain death, donor conversion, legal implications, reasons for donation and refusal to donate. RESULTS: 71.42% of donors and 64.15% of non donors required legal intervention. The main cause of brain death was brain traumatic injury (66.97%). The donation rate per one million inhabitants was 8.3. CONCLUSIONS: Adequate forensic management has a positive influence on achieved deceased donors. An effective team work and coordination with the State Council of Transplants has allowed the State of San Luis Potosí to have the highest rate of organ donation in Mexico.