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Primary hyperoxaluria (PH) is a rare disease, autosomal recessive inheritance disorder. This disease leads to overproduction of oxalates, and the excretation inability results in deposition of calcium oxalate crystals in almost all tissues presenting the oxalosis condition. The treatment is a combined liver and kidney transplantation (CLKT), which enables a better patient survival. Due to this survival, the patients had could present a several oral manifestations such as periodontal disease, root resorption, dental pain and increased tooth mobility. However, currently, there is a lack of information in the literature about all oral manifestations that this patient can present. Beside this, there are doubt and challenge about treatments to this patient in these different oral manifestations. The present study aims to report a case of a patient with hyperoxaluria type I with oxalosis oral manifestations. La hiperoxaluria primaria (HP) es una enfermedad rara, un trastorno hereditario autosómico recesivo. Esta enfermedad conduce a la sobreproducción de oxalatos y la incapacidad de excreción da como resultado el depósito de cristales de oxalato de calcio en casi todos los tejidos que presentan la condición de oxalosis. El tratamiento es un trasplante combinado de hígado y riñón (TCHR), que permite una mejor supervivencia del paciente. Debido a esta supervivencia los pacientes pudieron presentar diversas manifestaciones bucales como enfermedad periodontal, reabsorción radicular, dolor dentario y aumento de la movilidad dentaria. Sin embargo, hasta la fecha, existe una falta de información en la literatura sobre todas las manifestaciones bucales que puede presentar este paciente. Además de esto, tengo una duda y un desafío sobre los tratamientos a este paciente en estas diferentes manifestaciones orales. El presente estudio tiene como objetivo reportar el caso de un paciente con hiperoxaluria tipo I con manifestaciones orales de oxalosis. A hiperoxalúria primária (HP) é uma doença rara de herança autossômica recessiva. Essa doença leva à superprodução de oxalatos, e a incapacidade de excreção resulta na deposição de cristais de oxalato de cálcio em quase todos os tecidos que apresentam a condição de oxalose. O tratamento é o transplante combinado de fígado e rim (TCFR), que permite melhor sobrevida do paciente. Devido a esta sobrevida os pacientes puderam apresentar diversas manifestações bucais como doença periodontal, reabsorção radicular, dor dentária e aumento da mobilidade dentária. Porém, até o momento, faltam informações na literatura sobre todas as manifestações orais que esse paciente pode apresentar. Ao lado disso temos uma dúvida e um desafio quanto aos tratamentos a esse paciente nessas diferentes manifestações orais. O presente trabalho tem como objetivo relatar um caso de uma paciente com hiperoxalúria tipo I, apresentando manifestações orais de oxalose.

Background: Simultaneous pancreas-kidney transplantation (SPK) has become the treatment of choice for type 1 diabetes mellitus (T1DM) patients with chronic renal failure. Type 2 diabetes mellitus (T2DM), was once considered to be a contraindication for pancreas transplantation; however, it has been accepted as a new indication, under strict criteria. Although favorable results have increase the indication for T2DM in developed countries, there have been no reports of long-term results for this indication from Latin American centers. Methods: From April 2008 to March 2016, patients receiving SPK or pancreas transplant alone (PTA) for T2DM were included and compared with T1DM recipients. Variables were compared between groups with the use of χ2 and t tests; Kaplan-Meier with log rank was used for patient and graft survivals; P

Purpose of review Intestinal failure is a life-threatening medical condition that remains as a rare or orphan disease in most countries. The prevalence of intestinal failure and the therapeutic options available in middle-income countries (MIC) remain unclear. We aim to provide an overview on the current differences in management of intestinal failure patients in MIC from Latin America and Asia. Recent findings In order to fulfil the challenge, and after facing the difficulties of going over a topic with scarce available data, from countries with an extreme variety of social and economic problems, which are closely related to the treatment of intestinal failure patients, we have used both the existing publications and personal surveys to draft this document. Our results have shown that there is still significant disparity among MIC over the last years, concepts such as the need for establishing multidisciplinary dedicated teams as well as the need to evolve first home parenteral nutrition (HPN), then rehabilitation, and finally transplantation, have become important signals of an adequate understanding of this evolving field. Summary The manuscript presents, for the first time, an overview of the different developments and needs to manage intestinal failure patients in MIC from Latin America and Asia. Future discussions will emerge from this manuscript, aiming to pursue the development of registries, guidelines and health policies to continue improving the long-term care of intestinal failure patients in all MIC. Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Pattín, Francisco. Fundación Favaloro; Argentina Fil: Nikkoupur, Hamed. Shiraz Infertility Center; Irán

Introduction: There is a lack of information regarding outcomes after liver transplant in Latin America. Objectives: This study sought to describe outcomes after liver transplant in adult patients from Argentina. Methods: We performed an ambispective cohort study of adult patients transplanted between June 2010 and October 2012 in 6 centers from Argentina. Only patients who survived after the first 48 hours postransplantation were included. Pretransplantation and posttransplantation data were collected. Results: A total of 200 patients were included in the study. Median age at time of transplant was 50 (interquartile range [IQR] 26 to 54) years. In total, 173 (86%) patients had cirrhosis, and the most frequent etiology in these patients was hepatitis C (32%). A total of 35 (17%) patients were transplanted with hepatocellular carcinoma. In patients with cirrhosis, the median Model for End-Stage Liver Disease (MELD) score at time of liver transplant was 25 (IQR 19 to 30). Median time on the waiting list for elective patients was 101 (IQR 27 to 295) days, and 3 (IQR 2 to 4) days for urgent patients. Almost 40% of the patients were readmitted during the first 6 months after liver transplant. Acute rejection occurred in 27% of the patients. Biliary and vascular complications were reported in 39 (19%) and 19 (9%) patients, respectively. Renal failure, diabetes, and dyslipidemia were present in 40 (26%), 87 (57%), and 77 (50%) at 2 years, respectively. Conclusions: We believe the information contained in this article might be of value for reviewing current practices and developing local policies. Fil: Haddad, L.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina Fil: Marciano, S.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina Fil: Cleres, M.. Fundación Favaloro; Argentina Fil: Zerega, A.. Sanatorio Allende; Argentina Fil: Piñero, F.. Hospital Universitario Austral; Argentina Fil: Orozco, F.. Hospital Aleman; Argentina Fil: Braslavsky, G.. Hospital General de Agudos Cosme Argerich; Argentina Fil: Mendizabal, M.. Hospital Universitario Austral; Argentina Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Gil, O.. Sanatorio Allende; Argentina Fil: Silva, M.. Hospital Universitario Austral; Argentina Fil: Mastai, Ricardo. Hospital Aleman; Argentina Fil: Imvertaza, O.. Hospital General de Agudos Cosme Argerich; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Descalzi, V.. Fundación Favaloro; Argentina Fil: Gadano, A.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina

RESUMO Objetivo: avaliar o impacto financeiro das complicações pós-operatórias no transplante simultâneo pâncreas-rim durante a internação hospitalar. Métodos: estudo retrospectivo dos dados da internação hospitalar dos pacientes submetidos consecutivamente ao transplante simultâneo pâncreas-rim no período de janeiro de 2008 a dezembro de 2014 no Hospital do Rim/Fundação Oswaldo Ramos. As principais variáveis estudadas foram a reoperação, pancreatectomia do enxerto, óbito, complicações pós-operatórias (cirúrgicas, infecciosas, clínicas e imunológicas) e os dados financeiros da internação para o transplante. Resultados: a amostra foi composta de 179 pacientes transplantados. As características dos doadores e receptores foram semelhantes nos pacientes com e sem complicações. Na análise dos dados, 58,7% dos pacientes apresentaram alguma complicação pós-operatória, 21,8% necessitaram de reoperação, 12,3%, de pancreatectomia do enxerto e 8,4% evoluíram para o óbito. A necessidade de reoperação ou pancreatectomia do enxerto aumentou o custo da internação em 53,3% e 78,57%, respectivamente. A presença de complicação pós-operatória aumentou significativamente o custo. Entretanto, a presença de óbito, hérnia interna, infarto agudo do miocárdio, acidente vascular cerebral e disfunção do enxerto pancreático não apresentaram significância estatística no custo, cuja média foi de US$ 18,516.02. Conclusão: complicações pós-operatórias, reoperação e pancreatectomia do enxerto aumentaram significativamente o custo médio da internação hospitalar do SPK, assim como as complicações cirúrgicas, infecciosas, clínicas e imunológicas. No entanto, o óbito durante a internação, a hérnia interna, o infarto agudo do miocárdio, o acidente vascular cerebral e a disfunção do enxerto pancreático não interferiram estatisticamente neste custo. ABSTRACT Objective: considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost. Methods: a retrospective study of hospitalization data from patients consecutively submitted to simultaneous pancreas-kidney transplantation (SPKT), from January 2008 to December 2014, at Kidney Hospital/Oswaldo Ramos Foundation (Sao Paulo, Brazil). The main studied variables were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical, and immunological ones), and hospitalization financial data for transplantation. Results: the sample was composed of 179 transplanted patients. The characteristics of donors and recipients were similar in patients with and without complications. In data analysis, 58.7% of the patients presented some postoperative complication, 21.8% required reoperation, 12.3% demanded graft pancreatectomy, and 8.4% died. The need for reoperation or graft pancreatectomy increased hospitalization cost by 53.3% and 78.57%, respectively. The presence of postoperative complications significantly increased hospitalization cost. However, the presence of death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not present statistical significance in hospitalization cost (in average US$ 18,516.02). Conclusion: considering patients who underwent SPKT, postoperative complications, reoperation, and graft pancreatectomy, as well as surgical, infectious, clinical, and immunological complications, significantly increased the mean cost of hospitalization. However, death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not statistically interfere in hospitalization cost.

Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Because both organs are from the same donor, the kidney has been treated traditionally as the “sentinel” organ to biopsy, presumably representing the status of both allografts. Truly concurrent biopsy studies, however, are needed to confirm this hypothesis. We examined 101 concurrent biopsies from 70 patients with dysfunction in either or both organs. Results showed concurrent rejection in 23 of 57 (40%) of cases with rejection; 19 of 57 (33.5%) and 15 of 57 (26.5%) showed kidney or pancreas only rejection, respectively. The degree and type of rejection differed in the majority (13 of 23, 56.5%) of cases with concurrent rejection, with the pancreas more often showing higher rejection grade. Taking into account pancreas dysfunction, a positive kidney biopsy should correctly predict pancreas rejection in 86% of the instances. However, the lack of complete concordance between the 2 organs, the discrepancies in grade and type of rejection, and the tendency for higher rejection grades in concurrent or pancreas only rejections, all support the rationale for pancreas biopsies. The latter provide additional data on the overall status of the organ, as well as information on nonrejection-related pathologies. Fil: Uva, Pablo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina. Instituto de Nefrología de Buenos Aires; Argentina Fil: Papadimitriou, J. C.. University of Maryland; Estados Unidos Fil: Drachenberg, Cinthia B.. University of Maryland; Estados Unidos Fil: Toniolo, María F.. Instituto de Nefrología de Buenos Aires; Argentina Fil: Quevedo, Alejandra. Instituto de Nefrología de Buenos Aires; Argentina Fil: Dotta, A. C.. Instituto de Nefrología de Buenos Aires; Argentina Fil: Chuluyan, Hector Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina Fil: Casadei, D. H.. Instituto de Nefrología de Buenos Aires; Argentina

Objetivo: Revisar e discutir a literatura sobre transplantes de celulas-tronco hematopoieticas (TCTH) com doador haploidentico no Brasil. Metodos: Revisao da literatura medica. Resultados: Os transplantes haploidenticos de celulas-tronco hematopoieticas tornaram-se uma opcao segura na hematologia a partir dos anos 1980, com a possibilidade de deplecao de celulas T ex-vivo. No entanto, sua ampla utilizacao em todo mundo ocorreu apos os trabalhos com os transplantes haploidenticos nao mieloablativos, com deplecao de celulas T in-vivo, utilizando ciclofosfamida pos-transplante. Os resultados se mostraram encorajadores, apesar do maior risco de infeccoes e recidiva pos-transplante. Estudos em determinadas patologias, principalmente na leucemia mieloide aguda, mielodisplasia e linfoma de Hodgkin, mostram resultados semelhantes entre transplantes haploidenticos e nao aparentados e aparentados totalmente compativeis. Logicamente, esses achados de estudos retrospectivos precisam ser confirmados por estudos clinicos. Conclusoes: No Brasil, a modalidade de transplante com doador haploidentico se mostrou factivel e as primeiras publicacoes e resultados mostram resultados animadores.

To compare the functional results from surgical treatment for anatomical reconstruction of the anterior cruciate ligament (ACL) with a single band, using two types of autologous grafts.Twenty-seven patients who underwent anatomical reconstruction of the ACL by means of the Chambat technique were evaluated prospectively. They were divided into two groups: A, with 14 patients, using grafts from flexor tendons; and B, with 13 patients, using grafts from the patellar tendon. In both groups, fixation was performed using an absorbable interference screw.Based on the Lysholm score, group A presented a mean score of 71.6 in the first month, while B presented 75. At the end of the sixth month, both groups presented 96.6. Evaluation of the total IKDC showed that in the first month, the majority of the patients, both in group A (85.7%) and in group B (76.9%), presented a knee assessment that was close to normal. In the sixth month, 92.9% of group A had normal presentations, and 100% of group B.According to the Lysholm functional evaluation and the IKDC subjective assessment, there was no statistically significant difference in the results between the groups, and the results were better in the sixth month.Comparar o resultado funcional do tratamento cirúrgico da reconstrução anatômica do ligamento cruzado anterior (LCA) com banda única com o uso de dois tipos de enxerto autólogos.Foram avaliados prospectivamente 27 pacientes, submetidos à reconstrução anatômica do LCA pela técnica de Chambat, divididos em dois grupos: A, com 14 e uso como enxerto dos tendões flexores; e B, com 13 e uso como enxerto do tendão patelar. Em ambos os grupos foi feita fixação com parafuso de interferência absorvível.Com base no escore de Lysholm, o grupo A apresentou pontuação média de 71,6 no primeiro mês, enquanto o B apresentou 75. Já no fim do sexto mês ambos apresentaram 96,6. A avaliação do IKDC total mostrou que no primeiro mês a maioria dos pacientes, tanto no grupo A (85,7%) no grupo B (76,9%), apresentava uma avaliação do joelho próximo do normal e no sexto mês o grupo A apresentou 92,9% como normal e o grupo B, 100%.Os resultados, segundo avaliação funcional de Lysholm e subjetiva do IKDC, não apresentaram diferenças estatisticamente significantes entre os grupos e foram melhores no sexto mês.

Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection, principally in immunosuppressed patients. Our study aimed to evaluate the application of conventional polymerase chain reaction (cPCR) and real-time PCR (qPCR). Polymerase chain reaction (PCR) and real-time PCR (qPCR) targeting the 18S rRNA gene for detection of Strongyloides stercoralis infection among transplant candidates were applied in stool samples obtained from 150 transplant candidates, preliminarily analyzed by parasitological methods. S. stercoralis larvae were visualized in 15/150 (10.0%) transplant candidates by parasitological methods. DNA from S. stercoralis was amplified in 26/150 (17.3%) and 49/150 (32.7%) stool samples of transplant candidates, using cPCR and qPCR, respectively. The results suggest that molecular methods, especially qPCR, should be used as an additional tool for diagnostic of S. stercoralis infection among transplant candidates.

Introduction: Crohn’s disease (CD) has an annual incidence per 100.000 person-year of 20.2 in North America and 12.7 in Europe, and the purpose of this review is to evaluate its medical management, from diagnosis to transplant. Pharmacologic manipulation with nutritional care aims to achieve and maintain remission, but more than half of patients will undergo an intestinal resection, very often repeated over time. They could experience short bowel syndrome (SBS) requiring total parenteral nutrition (TPN). Intestinal transplantation (ITx) represents an alternative in case of irreversible intestinal failure (IF) with life-threatening TPN complications. Patient survival after ITx is 79%, 53% and 43% at 1, 3 and 5 years respectively, with no differences among ITx for other disorders. Areas covered: The research discussed medical therapy with nutritional support, evaluating the role of endoscopy, surgery and transplant in CD. A systematic literature review was conducted using the PubMed search engine up to May 31th, 2017 without restriction of the language. The decision on paper’s eligibility was reached by consensus between the 3 screening authors. Expert commentary: CD treatment is mainly medical, leaving endoscopy and surgery for a complex course. ITx represents a therapeutic option if TPN complications with IF arise. Fil: Lauro, Augusto. Universidad de Bologna; Italia Fil: D'Amico, Francesco. Azienda Ospedaliera Di Padova; Italia Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina

Resumo A doação de órgãos e tecidos é vista pela sociedade em geral como ato de solidariedade e amor dos familiares. No entanto, exige decisões importantes em momentos de extrema dor e angústia, dado o impacto da notícia de uma morte inesperada. Este estudo teve como objetivo identificar o conhecimento de 57 graduandos de enfermagem sobre doação de órgãos e o desejo de ser ou não doador; participaram graduandos do quinto, sexto, sétimo e oitavo semestres da Universidade Católica de Brasília, que responderam a questionário. Utilizou-se como método abordagem qualitativa, tendo como pergunta norteadora: “Qual é o posicionamento dos graduandos de enfermagem sobre o tema ‘doação de órgãos’?”. Levando-se em conta o que foi observado, concluímos que esses estudantes estão pouco esclarecidos quanto ao assunto, manifestam positivamente sua solidariedade na manutenção da vida e que a religião não impede tal ato. Abstract Organ and tissue donation is generally seen by society as an act of solidarity and love of families. However, it requires crucial decisions in a moment of extreme pain and distress, considering the impact of an unexpected death. This study aimed to identify the organ donation awareness of 57 nursing undergraduate students and their wish to be donors. Students in the fifth, sixth, seventh and eighth semesters of the Catholic University of Brasília, Brazil, participated and answered a questionnaire. The study used a qualitative approach, with the guiding question: “What is the position of nursing students regarding organ donation?” Considering the results, the study concluded that these students are not well informed about the subject, showed solidarity in maintaining life and their religion does not prevent such an act. Resumen La donación de órganos y tejidos es vista por la sociedad brasileña en general como un acto de solidaridad y amor de parte de los familiares. Sin embargo, requiere la toma de decisiones en momentos de extremo dolor y angustia, causados por el impacto de la noticia de una muerte inesperada. Este estudio tuvo como objetivo identificar el conocimiento de 57 estudiantes de enfermería acerca de la donación de órganos y el deseo de ser o no donante; participaron estudiantes de quinto, sexto, séptimo y octavo semestres de la Universidad Católica de Brasilia, respondiendo a un cuestionario. Se utilizó un enfoque cualitativo, con la pregunta guía: “¿Cuál es la posición de los estudiantes de enfermería sobre el tema de la donación de órganos?”. Teniendo en cuenta lo que se ha observado, concluimos que estos estudiantes no están bien informados sobre la temática, manifestando positivamente su solidaridad en el mantenimiento de la vida y que la religión no impide tal acto.

A Síndrome de Parry-Romberg, também conhecida como atrofia hemifacial progressiva, é uma doença rara caracterizada por lenta e progressiva atrofia de hemiface. O tratamento ofertado para a síndrome, geralmente, visa melhorar o aspecto estético. Os enxertos gordurosos, as injeções de silicone ou as próteses de acrílico são alternativas sugeridas para correção da atrofia facial. Atualmente, a técnica recomendada para correção da atrofia facial é cirurgia dermatológica cosmética com lipoenxertia autóloga. O objetivo deste estudo é relatar um caso de SPR e demonstrar que a cirurgia dermatológica pode aliviar danos sérios à anatomia do paciente, a partir da discussão dos aspectos terapêuticos da síndrome, com ênfase na lipoenxertia autóloga

No Brasil, a maioria dos transplantes de fígado é realizada na região Sudeste. Nos estados em que não há serviço de transplante de fígado, como Sergipe, os pacientes usuários do Sistema Único de Saúde são encaminhados para outros estados e as despesas com deslocamento e ajuda de custo são financiadas pelo Programa de Tratamento Fora de Domicílio (TFD). Objetivo: Avaliar os principais aspectos dos pacientes cadastrados para transplante de fígado (pré- e pós-) e custos dos serviços financiados pelo TFD em Sergipe no ano de 2008. Método: Análise dos prontuários de 55 pacientes cadastrados no TFD em Sergipe que viajaram em 2008. Foram avaliados: idade, gênero, procedência, naturalidade, presença de cirrose e evolução com óbito em 2008. Compararam-se as características e custos gerados pelos pacientes, acompanhantes e doadores e ainda entre os pacientes transplantados e não-transplantados. Resultados: Predominaram pacientes do gênero masculino (63,6%), com idades entre 12 e 59 anos (61,8%) procedentes da capital - Aracaju/SE - (50,9%) e do interior de Sergipe (49,1%). Apresentaram cirrose 80% dos pacientes e 12,7% evoluíram para óbito em 2008. As principais causas da cirrose foram Hepatite C e Alcoolismo, com 15,9% dos casos cada uma. Foram transplantados 30,9% dos pacientes, sendo 76,5% desses transplantes realizados em São Paulo. Os acompanhantes formaram o grupo que gerou maior despesa para o TFD, com gasto de R$ 217.575,72, em um total de R$ 442.088,43 incluindo pacientes e doadores. O custo médio de cada paciente financiado pelo TFD foi de R$ 8.037,97 e quando incluídas despesas adicionais, a média foi de R$ 10.590,49 por paciente. Os pacientes viajaram em média 4,76 vezes em 2008 e os transplantados geraram despesa 1,8 vezes maior do que os não-transplantados. Conclusão: Cirrose hepática foi a principal causa de indicação de transplante de fígado. Em 2008, o custo do programa foi de cerca de R$ 8.000,00 por paciente, valor que poderia ser investido, em parte, na estruturação de serviço especializado no acompanhamento tanto no pré- quanto no pós-transplante no estado de origem do paciente._________________________________________________________________________________________ ABSTRACT: Introduction: In Brazil, liver transplantation is performed mainly in the Southeast region. In states where there is no liver transplantation service, such as Sergipe, patients of the National Health System are driven to other states, and such expenses are funded by the Out of Home Treatment Program (TOH). Purpose: The aim of this study was to set main aspects of patients referred to liver transplantation and the costs of services funded by TOH in Sergipe along 2008. Methods: Analysis of 55 records of patients who were registered in TOH in Sergipe during 2008. Age, gender, origination, place of birth of the patients, presence of cirrhosis and death in 2008 were assessed. Carers, donors and patients’ features and their costs were compared, as well as transplanted versus non-transplanted patients. Some additional costs of those patients were also analyzed. Results: Most patients were men (63.6%), with ages between 12 and 59 (61.8%) from Aracaju/ SE (50.9%), and 49.1% came from the country area of Sergipe. About 80% of patients presented cirrhosis, and 12.7% died along 2008. The main causes of cirrhosis were hepatitis C and alcoholism, both in 15.9% of cases. Liver transplantation was performed in 30.9% of patients, and 76.5% of those transplantations were performed in São Paulo. Carers caused higher TOH expenditures. R$ 217,575.72 from a total amount of R$ 442,088.43 included patients and donors. The average cost of each patient funded by TOH was R$ 8,037.97 or R$ 10,590.49, with additional costs included. Patients traveled an average of 4.76 times in 2008, and the transplanted patients spent 1.8 times more than non-transplanted patients. Conclusion: Hepatic cirrhosis was the major cause for the TOH indication. It was concluded that the cost of the program was around R$ 8,000.00 per patient in 2008. Based on this figure, a pre- and post-liver transplantation service could be created at the state level.

Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation. Fil: Rubio, Juan S.. Fundación Favaloro; Argentina Fil: Rumbo, Carolina. Fundación Favaloro; Argentina Fil: Farinelli, Pablo A.. Fundación Favaloro; Argentina Fil: Aguirre, Nicolás. Fundación Favaloro; Argentina Fil: Ramisch, Diego A.. Fundación Favaloro; Argentina Fil: Paladini, Hugo. Fundación Favaloro; Argentina Fil: D´Angelo, Pablo. Fundación Favaloro; Argentina Fil: Barros Schelotto, Pablo. Fundación Favaloro; Argentina Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina

Respiratory syncytial virus (RSV) is recognized as the leading cause of nosocomial respiratory infection among hematopoietic stem cell transplant (HSCT) recipients, causing considerable morbidity and mortality. RSV is easily transmitted by contact with contaminated surfaces, and in HSCT units, more than 50% of RSV infections have been characterized as of nosocomial origin. From April 2001 to October 2002, RSV was identified by direct immunofluorescent assay in 42 symptomatic HSCT recipients. Seven RSV strains from 2001 and 12 RSV strains from 2002 were sequenced. RNA extraction, cDNA synthesis, and seminested polymerase chain reaction (PCR) with primers complementary to RSV genes G and F were performed. PCR products were analyzed by nucleotide sequencing of the C-terminal region of gene G for typing (in group A or B). Of the 7 strains analyzed in 2001, only 2 belonged to group B; the other 5 belonged to group A. Of these 7 strains, 3 were identical and were from recipients receiving outpatient care. In 2002, of the 12 strains analyzed, 3 belonged to group A and the other 9 belonged to group B. Of these 9 strains, 7 were genetically identical and were also from recipients receiving outpatient care. Therefore, multiple strains of RSV cocirculated in the hematopoietic stem cell transplant units (ward and outpatient units) between 2001 and 2002. Nosocomial transmission was more likely to occur at the HSCT outpatient unit than in the HSCT ward. Infection control practices should also be implemented in the outpatient setting.

Submitted by arminda sustelo (arminda.sustelo@hff.min-saude.pt) on 2016-05-02T14:55:49Z No. of bitstreams: 1 Eur J Emerg Med. 2015 Dec, 22(6) 444-5.pdf: 67630 bytes, checksum: a0afdd54f9aaac06e88d52426ced8f93 (MD5) Made available in DSpace on 2016-05-02T14:55:49Z (GMT). No. of bitstreams: 1 Eur J Emerg Med. 2015 Dec, 22(6) 444-5.pdf: 67630 bytes, checksum: a0afdd54f9aaac06e88d52426ced8f93 (MD5) Previous issue date: 2015

The aim of the present study was to review the literature regarding the utilization of 2-octyl cyanoacrylate's (Dermabond®, Ethicon US, USA) as a tissue adhesive in dentistry; also, to report its use in the stabilization and fixation of a free gingival graft, indicated to increase the width of the keratinized attached mucosa at the lower incisive region. Literature analysis revealed numerous indications for this tissue adhesive in the medical field related to maxillofacial injuries. In dentistry, clinical reports, as well as controlled clinical studies conducted in humans and in animal models, using histological analysis described positive results for the use of different cyanoacrylate-based tissue adhesives. These studies reported that the use of tissue adhesives reduced the surgical procedure time period, eliminated postoperative visits as well as the discomfort of suture removal and, in addition, did not interfere with the clinical repair process. Favorable results, like the ones described in the literature, were obtained in the present case report using Dermabond®. O objetivo do presente estudo foi revisar a literatura pertinente sobre a utilização do 2-octil cianoacrilato (Dermabond®, Ethicon US, USA) como adesivo tecidual na Odontologia, assim como relatar seu uso na estabilização e fixação de um enxerto gengival livre indicado para aumento da mucosa ceratinizada inserida na região dos incisivos inferiores. A análise da literatura revelou ampla aplicabilidade deste adesivo tecidual na área médica relacionada aos ferimentos maxilofaciais. Na Odontologia existem relatos clínicos e estudos controlados em humanos e em modelos animais, descrevendo resultados positivos, inclusive por meio da análise histológica, sobre a utilização de diferentes adesivos teciduais, à base do cianocrilato. Estes estudos relataram que o uso dos adesivos teciduais, reduz o tempo operatório, elimina visitas pós-operatórias, não apresenta o desconforto da remoção de suturas, além de não interferir no processo de reparo clínico. Resultados favoráveis como os descritos na literatura, foram obtidos no presente relato de caso com a utilização do Dermabond®.

Fil: León, Luis. Instituto de Nefrología de Buenos Aires; Argentina Fil: Uva, Pablo Daniel. Instituto de Nefrología de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Minué, Elena. Instituto de Nefrología de Buenos Aires; Argentina Fil: Pilotti, Roxana. Instituto de Nefrología de Buenos Aires; Argentina Fil: Cabrera, Ignacio. Instituto de Nefrología de Buenos Aires; Argentina Fil: Giunippero, Alejandro. Instituto de Nefrología de Buenos Aires; Argentina Fil: Gallo, Antonio. Instituto de Nefrología de Buenos Aires; Argentina Fil: Osella, Francisco. Instituto de Nefrología de Buenos Aires; Argentina Fil: Toniolo, Fernanda. Instituto de Nefrología de Buenos Aires; Argentina Fil: Chuluyan, Hector Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina. Instituto de Nefrología de Buenos Aires; Argentina Fil: Casadei, Domingo. Instituto de Nefrología de Buenos Aires; Argentina

We have determined the number of circulating T, B and natural killer cells in renal transplant recipients in order to detect changes during cytomegalovirus (CMV) infections. Serial blood samples were taken from 61 patients on standard triple immunosuppression therapy (cyclosporin A, azathioprine and prednisone). Using two-color flow cytometry analysis, the absolute number of CD3+, CD4+, CD8+, CD19+, CD3+HLA-DR+ and CD16+56+ cells was determined. Forty-eight patients (78.7%) developed active CMV infection, and all of them subsequently recovered. Twenty of the infected patients (32.8%) presented symptoms compatible with CMV disease during the infectious process. The number of lymphocytes and their main subpopulations were normal before the onset of CMV disease. During the disease there was a decrease followed by a significant increase (P

Bioethics, as a branch of philosophy that focuses on questions relative to health and human life, is closely tied to the idea of justice and equality. As such, in understanding the concept of equality in its original sense, that is, in associating it to the idea to treat "unequals" (those who are unequal or different, in terms of conditions or circumstances) unequally (differentially), in proportion to their inequalities (differences), we see that the so-called "one-and-only waiting list" for transplants established in law no. 9.434/97, ends up not addressing the concept of equality and justice, bearing upon bioethics, even when considering the objective criteria of precedence established in regulation no. 9.4347/98, Thus, the organizing of transplants on a one-and-only waiting list, with a few exceptions that are weakly applicable, without a case by case technical and grounded analysis, according to each particular necessity, ends up institutionalizing inequalities, condemning patients to happenstance and, consequently, departs from the ratio legis, which aims at seeking the greatest application of justice in regards to organ transplants. We conclude, therefore, that from an analysis of the legislation and of the principles of bioethics and justice, there is a need for the creation of a collegiate of medical experts, that, based on medical criteria and done in a well established manner, can analyze each case to be included on the waiting list, deferentially and according to the necessity; thus, precluding that people in special circumstances be treated equal to people in normal circumstances. A bioética, como ramo da filosofia que enfoca as questões relativas a saúde e a vida humana, está intimamente ligada à idéia de justiça e igualdade. Desta forma, entendendo o conceito de igualdade em sua acepção original, ou seja, associando-o à idéia de tratar desigualmente os desiguais na medida de suas desigualdades, observamos que a denominada "lista única de espera" para transplantes, prevista na Lei 9.434/97, acaba por se afastar do conceito de igualdade e justiça, norteadores da bioética, mesmo considerando os critérios objetivos de precedência previstos na Portaria n.o 3.407/98. Assim, a organização dos transplantes em lista única de espera, com tímidas exceções para alguns casos, sem a análise técnica e fundamentada, caso por caso, quanto à necessidade preeminente, acaba institucionalizando desigualdades, relegando os pacientes à própria sorte e apartando-se, assim, da ratio legis, que visa buscar maior justiça no que tange ao transplante de órgãos. Concluímos, então, a partir da análise da legislação e dos princípios da bioética e justiça, pela necessidade da criação de um colegiado de médicos experts, que baseados em critérios técnicos e de forma fundamentada, possam analisar cada caso para fins de inclusão na lista de espera, de acordo com a necessidade e preeminência, evitando-se, assim, que pessoas em situações desiguais sejam tratadas igualmente.

Body iron disorders have been reported after myeloablative conditioning in patients undergoing hematopoietic stem cell transplantation (HSCT). There is a concern that labile plasma iron (LPI), the redox-active form of iron, can be involved in the occurrence of toxicity and other complications commonly observed in the early post-HSCT period. In order to better understand the LPI kinetics and its determinants and implications, we undertook sequential LPI determinations before and after conditioning until engraftment in 25 auto-HSCT patients. Increased LPI was present in only 5 patients before starting conditioning. Shortly after conditioning, LPI levels were increased in 23 patients, with peak at day 0, returning to normal range upon engraftment in 21 patients. Overall, LPI levels correlated weakly with serum ferritin and more strongly with transferrin saturation; however, both parameters were apparently not applicable as surrogate markers for increased LPI. Although this was a small cohort, logistic regression suggested that baseline LPI levels could predict occurrence of grade III or IV toxicity. In conclusion, LPI kinetics is influenced by aplasia following conditioning and engraftment. Measuring LPI before starting conditioning can offer an opportunity to predict toxicity and, perhaps, the need for chelation therapy.

INTRODUÇÃO: Frequentemente, a reconstrução mamária requer um segundo tempo cirúrgico para corrigir visíveis irregularidades no contorno da mama. A lipoenxertia constitui-se em uma técnica cirúrgica que pode melhorar ou corrigir essas deformidades em substituição a outras técnicas convencionais de maior morbidade ou complexidade. O objetivo deste estudo é demonstrar um método de correção de defeitos de contorno de mamas reconstruídas previamente pelas técnicas convencionais com enxerto de gordura, após 8 anos de experiência. MÉTODO: Todas as pacientes incluídas neste estudo foram previamente submetidas a mastectomia (total ou parcial) e a algum tipo de reconstrução mamária. A gordura foi obtida por meio de método clássico de lipoaspiração com seringa, delicadamente lavada com solução salina em uma peneira de aço inoxidável, decantada em uma seringa de 60 cc e enxertada após alguns minutos. RESULTADOS: Foram operadas 112 pacientes no período de 2005 a 2012. Houve 1 (8,9%) caso de perda total do enxerto de gordura, 22 (19,6%) pacientes apresentaram pequenos nódulos palpáveis, o volume médio enxertado foi de 100 cc e foram necessários múltiplos procedimentos para se alcançar o volume desejado. CONCLUSÕES: A lipoenxertia constitui-se em uma técnica segura, com baixa morbidade e altos índices de satisfação do cirurgião e das pacientes, apesar de necessitar de múltiplos procedimentos cirúrgicos para atingir bom resultado. BACKGROUND: Breast reconstruction often requires a second surgical procedure to correct visible irregularities of the breast contour. Lipofilling (fat grafting) consists of a surgical technique that improves or corrects such deformities, and serves as an alternative to other conventional techniques that have higher morbidity rates and complexity. In the present study, we aimed to describe our 8-year experience with a fat grafting method for correcting contour deformities of breasts that were previously reconstructed using conventional techniques. METHODS: All patients in this study previously underwent mastectomy (total or partial) and some degree of breast reconstruction. The fat was obtained by liposuction using a syringe, and was gently rinsed with a saline solution in a stainless steel sieve, poured into a 60 cc syringe, and grafted after a few minutes. RESULTS: In total, 112 patients underwent surgery between 2005 and 2012. There was one (8.9%) case of total loss of the fat graft, while 22 (19.6%) patients had small palpable nodules. The average graft volume was 100 cc, and multiple procedures were required to achieve the desired volume. CONCLUSIONS: Fat grafting is a safe technique with low morbidity rates that demonstrates high surgeon and patient satisfaction levels, despite the need for multiple procedures to achieve good results.

Made available in DSpace on 2016-01-28T16:53:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-01-28T17:00:54Z : No. of bitstreams: 1 S0100-69912014000100061-en.pdf: 2179981 bytes, checksum: 5c22c986cb95b96d381908e2c6c7ed88 (MD5). Added 1 bitstream(s) on 2016-01-28T17:00:54Z : No. of bitstreams: 2 S0100-69912014000100061-en.pdf: 2179981 bytes, checksum: 5c22c986cb95b96d381908e2c6c7ed88 (MD5) S0100-69912014000100061-pt.pdf: 2182100 bytes, checksum: bea5d73a19a30566d8e85cc211332874 (MD5) Para a reabilitação bucal com as próteses implantossuportadas é necessário a realização de procedimentos para criar o volume ósseo necessário para a instalação dos implantes. Com isso, os enxertos ósseos provenientes de áreas doadoras intrabucais ou extrabucais, representam uma possibilidade bastante favorável. O presente trabalho objetivou realizar uma revisão da literatura em que procurou discutir parâmetros para as indicações, as vantagens e complicações para as técnicas dos enxertos ósseos autógenos. For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts. Universidade Estadual Paulista, Departamento de Cirurgia e Clínica Integrada, Faculdade de Odontologia de Araçatuba

O transplante hepático inter vivos adulto expandiu as possibilidades terapêuticas para pacientes com insuficiência hepática terminal. A necessidade de um volume hepático adequado que será retirado do doador e necessário ao receptor limita sua utilização em alguns casos. Apresentamos um caso em que se utilizou dois lobos esquerdos de dois doadores vivos no intuito de prover parênquima hepático suficiente ao receptor. Living donor liver transplantation expanded the therapeutic possibilities for liver failure patients. The necessary correct match between the liver mass donated and received sometimes limits its use. A case that was used two left liver grafts from adult living donors is reported.

CONTEXT AND OBJECTIVE: Cancer patients undergoing bone marrow transplantation (BMT) often require nutritional therapy due to treatment toxicities. The aim here was to evaluate the use of tube feeding and its applicability, indications, contraindications and complications in these patients. DESIGN AND SETTING: Prospective observational study conducted at a public university in São Paulo between January 2002 and August 2007. METHODS: The patients were followed up daily in the BMT unit by a research dietitian. Tube feeding was indicated when oral supplementation proved to be insufficient, when the patient had severe malnutrition or there was an impediment to use of oral feeding. It was contraindicated in the presence of gastrointestinal toxicity of grade 3 and 4 or other conditions that implied a risk or hindered its use or placement. Complications of tube feeding were divided into minor and major, according to whether they had life-threatening implications. RESULTS: Forty-two (47.2%) patients had indications for tube feeding: the main reasons were transplantation inadequate food and supplement intake, insufficient intake with malnutrition or weight loss, severe malnutrition or need for oral fasting. Thirty-one (73.8%) received tube feeding: 11 autologous and 20 allogenic patients (P = 0.04). The main contraindications were severe gastrointestinal toxicities and sinusitis. Minor complications from tube feeding were more prevalent in patients with allogenic BMT, but no major complications were observed. CONCLUSION: Enteral nutrition is a feasible procedure in patients undergoing BMT and should be encouraged. The main difficulty in BMT patients, in relation to tube feeding, is gastrointestinal toxicities. CONTEXTO E OBJETIVO: Pacientes com câncer submetidos ao transplante de medula óssea (TMO) frequentemente necessitam de terapia nutricional devido às toxicidades do tratamento. O objetivo foi avaliar uso de sonda enteral, aplicabilidade, indicações, contraindicações e complicações nesses pacientes. TIPO DE ESTUDO E LOCAL: Estudo observacional prospectivo, conduzido de janeiro de 2002 a agosto de 2007 em uma universidade pública em São Paulo. MÉTODOS: Os pacientes foram acompanhados diariamente na unidade de TMO por uma nutricionista da pesquisa. Indicações de sonda: suplementação oral insuficiente, desnutrição grave, ou alguma contraindicação para alimentação via oral. A contraindicação da sonda ocorreu na presença de toxicidades gastrintestinais de grau 3 e 4 ou outras condições que implicassem em risco ou impedissem seu uso ou passagem. As complicações da sonda foram divididas em menores e maiores, de acordo com implicações para o risco de vida. RESULTADOS: Quarenta e dois (47,2%) pacientes tiveram indicações de nutrição por sonda: os principais motivos foram: ingestão alimentar e de suplemento inadequada, ingestão insuficiente com desnutrição ou perda de peso, desnutrição grave ou necessidade de jejum. Trinta e um (73,8%) pacientes usaram sonda: 11 com transplantes autólogos e 20 alogênicos (P = 0,04). As principais contraindicações foram toxicidades gastrintestinais graves e sinusite. Complicações leves com a sonda foram mais prevalentes nos pacientes em TMO alogênico, mas nenhuma complicação grave foi observada. CONCLUSÃO: O uso de sonda enteral é um procedimento factível em pacientes durante o TMO e deve ser encorajado. A principal dificuldade nesse grupo em relação ao uso de sonda foi a toxicidade gastrintestinal.

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.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.Several variables were analyzed in 74 pancreata relative to the outcome of total IEQs obtained at the end of the process.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 BMI30 yielding more islets than donors with BMI30 (p0.001).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.

JUSTIFICATIVA E OBJETIVOS: A falha ou atraso no diagnóstico de morte encefálica resulta na ocupação desnecessária de um leito hospitalar, em perdas emocionais e financeiras e na indisponibilidade de órgãos para transplante. O médico intensivista tem fundamental papel nesse diagnóstico. O objetivo deste estudo foi avaliar o conhecimento sobre morte encefálica entre os intensivistas. MÉTODO: Estudo transversal em 15 unidades de terapia intensiva (UTI) em oito hospitais da cidade de Porto Alegre, Brasil. RESULTADOS: Duzentos e quarenta e seis intensivistas foram entrevistados em uma amostra consecutiva entre abril e dezembro de 2005. Encontrou-se prevalência de desconhecimento do conceito de morte encefálica de 17%. Vinte por cento dos entrevistados desconheciam a necessidade legal de exame complementar para o seu diagnóstico. Quarenta e sete por cento se consideraram no nível máximo de segurança para explicar o conceito para a família de um paciente. Vinte e nove por cento desconheciam a hora do óbito legal para os pacientes em morte encefálica. Os intensivistas pediátricos tiveram menor conhecimento do conceito em relação aos intensivistas de adultos (p < 0,001). CONCLUSÕES: O atual conhecimento sobre morte encefálica é insufi ciente entre os profi ssionais que mais freqüentemente se deparam com pacientes nessa situação. Há necessidade de educação sobre o tema a fi m de evitar gastos desnecessários, diminuir o sofrimento familiar e aumentar a oferta de órgãos para transplantes. BACKGROUND AND OBJECTIVES: Failure or delay to diagnose brain death leads to needless occupation of a hospital bed, emotional and fi nancial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis. This study intended to evaluate intensivists’ knowledge concerning brain death. METHODS: Cross-sectional study in 15 intensive care units (ICU) in eight hospitals in the city of Porto Alegre, Brazil. RESULTS: Two hundred forty-six intensivists were interviewed in a consecutive sample between April and December 2005. The prevalence of lack of knowledge regarding the concept was of 17%. Twenty per cent of the interviewees ignored the legal need for complementary confi rmatory tests for their diagnosis. Forty-seven per cent considered themselves as having the highest level of assurance to explain the concept to a patient’s family members. Twentynine per cent erroneously determined the legal time of death for brain dead patients. Pediatric intensivists had less knowledge about the concept, when compared to intensivists for adults (p < 0.001). CONCLUSIONS: Current knowledge of brain death is insuffi cient in Brazil, among the health care professionals who most often fi nd patients in this situation. Education on the subject is needed to avoid unnecessary expenses, reduce family suffering and increase the offer of organs for transplant.

BACKGROUND: This is a cohort trial (1997-2005) of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG) and a reinforcement device. OBJECTIVE: To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS: There were two groups: I (n=26) receiving human grafts and II (n=25) receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d'Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn's et al. criteria for radiographic bone incorporation. RESULTS: No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424). CONCLUSION: The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty.

Poucos são os trabalhos em que o músculo gastrocnêmio medial (MGM) foi estudado profundamente em sua anatomia ou foi utilizado a distância como músculo livre para transferência funcional. OBJETIVOS: Os autores apresentam os resultados da dissecção do MGM e seu feixe vasculonervoso, particularmente sua inervação, com o objetivo de contribuir anatomicamente com seu estudo. MÉTODOS: Foram dissecadas 40 peças englobando o joelho e perna (20 à direita e 20 à esquerda), de 40 cadáveres adultos (26 masculinos e 14 femininos), 20 fixados em formaldeído e 20 frescos. Foi realizado estudo anatômico detalhado avaliando o padrão de distribuição, trajeto, número e comprimento da inervação do MGM. RESULTADOS: Foi observado que em 95% dos casos o nervo sural medial é um ramo motor único, de comprimento médio de 3,29cm. Pode-se ganhar em média 1,66cm de extensão ao se dissecar o epineuro, separando-o do nervo poplíteo medial. CONCLUSÃO: O MGM dispõe de um feixe vasculonervoso com irrigação e inervação terminal, o que torna possível a sua transferência muscular livre funcional para membros superiores e não somente como retalho local em membros inferiores. There are not many papers in which the anatomy of the medial gastrocnemius muscle (MGM) was studied in depth or in which the medial gastrocnemius muscle was used remotely as free muscle for functional transfer. OBJECTIVES: The authors present the results of dissecting the MGM and its neurovascular bundle, the innervation in particular, with the purpose of making an anatomical contribution to the study. METHODS: 40 specimens were dissected, including knee joint and leg (20 right legs and 20 left legs) of 40 adult cadavers (26 male and 14 female), 20 fixated with formaldehyde and 20 fresh cadavers. A detailed anatomical study was performed to evaluate the standard distribution, the pathway, the number, and the length of MGM innervation. RESULTS:In 95% of the cases, the medial sural nerve was seen to be a single motor branch, with a mean length of 3.29 cm. An average 1.66 cm in length can be gained by dissecting the epineurium, separating it from the medial popliteal nerve. CONCLUSION: The MGM has a neurovascular bundle with irrigation and terminal innervation that permits its functional free muscle transfer to upper limbs and not only as a local flap of the lower limbs.

PURPOSE: Verify the role of ischemic preconditioning (IPC) in ischemia and reperfusion injury on gracilis muscle of rats. METHODS: Wistar rats (n=30) were distributed in three groups, I/R and IPC groups were subdivided concerning ischemia time. A near-amputation model of the posterior limb was produced by a hip joint level incision, preserving the vascular bundle and the femur bone and ischemia was induced for 2h and 4h, G-I 2h/R (n=6) and G-I 4h/R (n=6), followed by 1h of vascular reperfusion. The preconditioned groups, G-PCI 2h (n=6) and G-PCI 4h (n=6), were preceded by 3 cycles of 5min of ischemia followed by 5min of vascular reperfusion before sustained ischemia. In the Control Group, C-G (n=6) animals were subjected to regional approach. The analysis was done with Light Microscopy (LM). RESULTS: The levels of fibril fragmentation were progressive in the G-I 2h/R (67% of muscle preservation) and in the G-I4 h/R (0% of muscle preservation). However in the group of the precondition the lesion degree being in level similar to the group controls in the G-I 2h/R (100% of muscle preservation) while at G-I 4h/r occur less protection (67% of muscle preservation). The degree of tissue inflammatory reaction was worst at G-I 4h/R (0% without inflammation signals) than at G-I 2h/R (50% without inflammation signals); while in the precondition group G-IPC-2h (83% without inflammation signals) was better than the G-IPC-4h (67% without inflammation signals). The vascular stasis was absent only in 17% of the G-I 4h/R and in 33% of the G-I 2h/R. In precondition group, however, the vascular stasis was absent in 33% at G-IPC 2h and absent in 50% at G-IPC 4h. CONCLUSION: The IPC showed, in an earlier phase, a benefic role at I/R derived injury on gracilis muscle of rats, as proven for the largest preservation of the fibers muscular, smaller inflammatory reaction and smaller vascular stasis. OBJETIVO: Verificar o papel do precondicionamento isquêmico (PCI) na lesão de isquemia e reperfusão (I/R) do músculo grácil de ratos. MÉTODOS: Trinta ratos Wistar foram distribuídos em três grupos, sendo G-I/R e G-PCI subdivididos em relação ao tempo de isquemia. Produziu-se modelo de quase-amputação do membro posterior por meio de uma incisão, preservando o feixe vascular e o osso femoral, induzindo-se isquemia por 2h e 4h, G-I 2h/R (n=6) e G-I 4h/R (n=6), seguida por 1h de reperfusão. Os Grupos Precondicionados, G-PCI 2h (n=6) e G-PCI 4h (n=6), foram precedidos por 3 ciclos de 5min de isquemia seguidos de 5min de reperfusão, antes da isquemia sustentada. No Grupo Controle, G-C (n=6) realizou-se apenas a abordagem regional. As avaliações morfológicas foram realizadas por meio de Microscopia Óptica (MO) para avaliação da desestruturação miofibrilar, processo inflamatório e estase venosa no tecido do músculo grácil. Foram atribuídos escores semi-quantitativos às variáveis estudadas. RESULTADOS: Houve preservação miofibrilar de 76% em G-I2h/R e 0% em G-I4h/R; G-IPC 2h a preservação foi de 100% e de 67% em G-IPC 4h. A reação inflamatória foi mais acentuada em G-I 4h (100% com inflamação) do que em G-I2h (50%);G-IPC 2h apresentou 82% sem inflamação e G-IPC 4h apresentou 67% sem inflamação. A estase vascular esteve ausente em 17% do G-I 4h e em 33% do G-I 2h; em G-IPC 2h esteve ausente em33% e em G-IPC 4h em 50%. CONCLUSÃO: O PCI mostrou, em uma fase inicial, papel benéfico na lesão de I/R no músculo grácil de ratos, comprovado pela maior preservação das fibras musculares, menor reação inflamatória e menor estase venosa.

CONTEXT AND OBJECTIVE: Recent studies have indicated that vitiligo areas contain inactive or dormant melanocytes. Melanin synthesis is related to tyrosinase presence and indicative of active metabolic state. The aim of this study was to compare repigmentation, epidermal melanocyte distribution and tyrosinase mRNA detection through reverse transcriptase polymerase chain reaction, in tissue samples of vitiligo, before and after curettage, with or without subsequent autologous skin graft using a new method. DESIGN AND SETTING: Prospective, in the Department of Dermatology, Faculdade de Medicina do ABC, Santo André. METHODS: Two vitiligo areas were curetted. One subsequently received grafted normal sacral autologous skin, whereas the other had no further treatment. The curetted areas were examined after 30 days, to evaluate the degree of repigmentation. The melanocyte percentages and tyrosinase mRNA presence in normal skin and vitiligo areas, before and after curettage and grafting, were compared. RESULTS: Complete repigmentation was seen in all grafted areas, whereas non-grafted curetted vitiligo presented partial repigmentation. The melanocyte percentage in grafted areas was greater than in non-treated vitiligo skin (p = 0.01) and skin with curettage alone (p = 0.015). Tyrosinase mRNA was negative in 93.75% of non-treated vitiligo areas. After treatment (curettage alone or curettage and grafting), all lesions became positive for tyrosinase mRNA. CONCLUSION: Metabolically inactive or dormant melanocytes are probably present within vitiligo areas, and may be activated by exogenous or endogenous stimuli. CONTEXTO E OBJETIVO: Estudos recentes têm indicado que áreas de vitiligo contêm melanócitos inativos ou dormentes. A síntese de melanina está relacionada com a presença de tirosinase é indicadora de estado metabólico ativo. O escopo deste artigo é comparar repigmentação, distribuição epidérmica de melanócitos e detecção do RNAm de tirosinase através da reação de polimerase em cadeia por transcriptase reversa, em amostras de tecido de vitiligo, antes e após curetagem, seguido ou não por uma nova técnica de enxerto autólogo de pele. TIPO DE ESTUDO E LOCAL: Prospectivo, na Disciplina de Dermatologia da Faculdade de Medicina do ABC, Santo André. MÉTODOS: Duas áreas de vitiligo foram curetadas. Uma foi subseqüentemente enxertada com pele autóloga sacral normal, enquanto a outra não recebeu nenhum enxerto. As áreas curetadas foram examinadas após 30 dias, para avaliar o grau de repigmentação. A porcentagem de melanócitos e a presença de RNAm de tirosinase de pele normal e de pele de vitiligo (antes e após curetagem apenas e antes e após curetagem seguida de enxertia) foram comparadas. RESULTADOS: Repigmentação completa foi observada em todas as áreas enxertadas, enquanto as áreas de vitiligo apenas curetadas apresentaram repigmentação parcial. A porcentagem de melanócitos nas áreas enxertadas excederam as áreas de vitiligo não tratados (p = 0.01) e as áreas tratadas com curetagem simples (p = 0,015). RNAm de tirosinase foi negativo em 93.75% das áreas não tratadas de vitiligo. Após tratamento (somente curetagem ou curetagem seguida de enxerto), todas as lesões tornaram-se positivas para RNAm de tirosinase. CONCLUSÃO: Melanócitos metabolicamente inativos ou dormentes estão provavelmente presentes dentro das áreas de vitiligo, e podem ser ativados por estímulos endógenos ou exógenos.

Trata-se de estudo de revisão de literatura com o objetivo de caracterizar a legislação vigente com pertinência aos obstáculos encontrados pela Comissão Intra-Hospitalar de Doação de Órgãos e Tecidos para Transplantes. Observou-se que devem ser tomadas medidas de educação contínua entre os profissionais que atuam nessa comissão, bem como conhecer o perfil cultural da população que atende e levar à sociedade informações pertinentes ao processo de doação, visando suscitar entre as famílias essa discussão e, quem sabe assim, reduzir as filas de espera por um transplante no Brasil. Se trata de un estudio de repaso de la literatura que tiene como objetivo caracterizar la legislación vigente que se refiere a los obstáculos encontrados por la Comisión de Donación Intrahospitalaria de Donación de Órganos y Tejidos para Trasplante. Se observó que se debe adoptar medidas de educación continua entre los profesionales que actúan en este comité, así como conocer el perfil cultural de la población que atiende y llevar a la sociedad informaciones relacionadas con este proceso de donación con el fin de plantear esta discusión entre las familias y, quizá, reducir las listas de espera para un trasplante en Brasil. This is a literature review with the aim of characterizing the legislation that refers to the obstacles encountered by Intra Hospital Commission of Organs and Tissues Donation for Transplantation. It was observed that should be taken continuing education measures among health professionals in this committee to know the cultural profile of the population which serves this population and lead to relevant information to the donation process in order to raise this discussion between families and perhaps thereby reduce waiting lists for a transplant in Brazil.

Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to Vaccording to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.

Objective: Analyze risk factors for infection in kidney transplant recipients from deceased expanded criteria donors (DECD) in the first two years of follow-up. Method: This is a prospective cohort study with 466 patients from DECD who underwent kidney transplantation in 2015 and 2016 in Brazil. A total of 551 events were recorded. The largest incidence of infectious events occurred in the first month after kidney transplantation. Cytomegalovirus infection was the most common infectious episode. Results: The incidence rate of infections was 57.1%. Among bacterial infections, only 4% were due to multidrug-resistant microorganisms. The death rate was 3.3% (15) patients. The main cause of death was infectious (73.3%). Hospitalization until the first infection (aOR:1.61), Number of infections in 1 year (aOR:40.16), and Cytomegalovirus infection (aOR:13.84) was risk factors for infection by multidrug resistant microorganisms (MDR). Conclusion: Infection incidence with MDR bacteria was high among kidney transplant recipients from DECD, and the main cause of death was infection. Survival was high among patients with infection. RESUMEN Objetivo: Analizar los factores de riesgo de infección en receptores de trasplante renal de donante fallecido con criterios expandidos (DFCE) en los dos primeros años de seguimiento. Método: Estudio prospectivo de cohorte con 466 pacientes con DFCE sometidos a trasplante renal, en 2015 y 2016, en Brasil. Se registraron un total de 551 eventos. La mayor incidencia de eventos infecciosos ocurrió en el primer mes después del trasplante de riñón. La infección por citomegalovirus fue el episodio infeccioso más común. Resultados: La tasa de incidencia de infecciones fue del 57,1%. Entre las infecciones bacterianas, solo el 4% se debió a microorganismos multirresistentes. La tasa de mortalidad fue del 3,3% (15) pacientes. La principal causa de muerte fue infecciosa (73,3%). La hospitalización hasta la primera infección (ORa: 1,61), el número de infecciones en 1 año (ORa: 40,16) y la infección por citomegalovirus (ORa: 13,84) fueron factores de riesgo de infección por microorganismos multirresistentes (MR). Conclusión: La incidencia de infección bacteriana por MR fue alta entre los receptores de trasplante renal DFCE y la principal causa de muerte fue la infección. La supervivencia fue alta entre los pacientes con infección. RESUMO Objetivo: Analisar fatores de risco para infecção em receptores de transplante renal de doador falecido com critério expandido (DFCE) nos primeiros dois anos de seguimento. Método: Trata-se de estudo de coorte prospectivo, com 466 pacientes do DFCE submetidos a transplante renal, em 2015 e 2016, no Brasil. Um total de 551 eventos foram registrados. A maior incidência de eventos infecciosos ocorreu no primeiro mês após o transplante renal. A infecção por citomegalovírus foi o episódio infeccioso mais comum. Resultados: A taxa de incidência de infecções foi de 57,1%. Entre as infecções bacterianas, apenas 4% foram devidas a microrganismos multirresistentes. A taxa de mortalidade foi de 3,3% (15) pacientes. A principal causa de morte foi infecciosa (73,3%). Hospitalização até a primeira infecção (ORa: 1,61), número de infecções em 1 ano (ORa: 40,16) e infecção por citomegalovírus (ORa: 13,84) foram fatores de risco para infecção por microrganismos multirresistentes (MR). Conclusão: A incidência de infecção por bactérias MR foi alta entre receptores de transplante renal de DFCE, e a principal causa de morte foi infecção. A sobrevivência foi alta entre os pacientes com infecção.