Use of aerobic treadmill exercises on nerve regeneration after sciatic nerve injury in spontaneously hypertensive rats

Purpose: Various postoperative protocols have been proposed to improve outcomes and accelerate nerve regeneration. Recently, the use of physical exercise in a post-surgical neurorraphy procedure has shown good results when started early. We experimentally investigated the hypothesis that post-operative exercise speeds up results and improves clinical and morphologic parameters. Methods: Isogenic rats were randomly divided into four groups: 1 SHAM; 2 SHAM submitted to the exercise protocol (EP); 3 Grafting of the sciatic nerve; and 4 Grafting of the sciatic nerve associated with the EP. The EP was based on aerobic activities with a treadmill, with a progressive increase in time and intensity during 6 weeks. The results were evaluated by the sciatic functional index (SFI), morphometric and morphologic analysis of nerve distal to the lesion, and the number of spinal cord motor neurons, positive to the marker Fluoro-Gold (FG), captured retrogradely through neurorraphy. Results: Functional analysis (SFI) did not show a statistical difference between the group grafted with (­50.94) and without exercise (-65.79) after 90 days. The motoneurons count (Spinal cord histology) also showed no diference between these groups (834.5 × 833 respectively). Although functionally there is no difference between these groups, morphometric study showed a greater density (53.62) and larger fibers (7.762) in GRAFT group. When comparing both operated groups with both SHAM groups, all values were much lower. Conclusions: The experimental model that this aerobic treadmill exercises protocol did not modify nerve regeneration after sciatic nerve injury and repair with nerve graft.

Necrose tissular em equino associada ao uso de fenilbutazona / Tissue necrosis in equine associated with use of phenylbutazone

Background: Wounds that occur with tissue necrosis and that result from the application of medications through the most diverse accesses are described as drug skin medical embolism or Nicholas syndrome in human medicine, with wide description. In veterinary medicine, this subject has not yet been described extensively and specifically in veterinary medicine, especially regarding to wounds that occurred after the application of non-intravenous medications in horses, even though these lesions are recurrent in the clinical routine. This report aims to describe a case of skin necrosis in a horse, due to phenylbutazone infection. Case: A 7 year-old Mangalarga Marchador horse, weighing 400 kg, was admitted to the Veterinary Hospital for Large Animals of the Universiade Federal Rural do Rio de Janeiro (UFRRJ), with a history of phenylbutazone injection to the left side of the neck. The animal had an extensive wound on the neck and face on the left side and was characterized by the presence of cold and devitalized skin, with a hardened and parched appearance and that easily detached. During the anamnesis, a single administration of 10 mL of a non-steroidal anti-inflammatory drug based on phenylbutazone was reported intramuscularly for about 10 days to control the pain resulting from the claudication present for 14 days. The medication was administered in the region of the lateral border of the neck, on the left side. After drug administration, the animal presented an increase in volume at the application site. After 24 h, the lesion spread from the inoculation region, extending to the head and chest of the animal. During debridement, it was found that the lesion did not reach the underlying muscle tissue. In addition to the wound, the animal had upper eyelid palsy, lower lip, and auricular ptosis. Treatment with surgical debridement of devitalized tissue, topical application of ozonated sunflower oil, ketanserin, and a free skin graft was instituted. During hospitalization, the animal had a corneal ulcer in the left eye with an unfavorable prognosis due to paralysis of the upper eyelid, with enucleation of the affected eyeball. The animal was under veterinary care for 180 days and was discharged when his wound was already in an advanced stage of healing. Discussion: The history of the application of phenylbutazone intramuscularly and the location and characteristics of the lesion presented by the patient in the present report suggest that this animal presented aseptic tissue necrosis resulting from the administration of non-steroidal anti-inflammatory drugs, phenylbutazone. Although aseptic tissue necrosis, better known as Nicolau's syndrome or drug embolism cutis, is widely characterized and described in this species, there are studies in the literature that reproduce the syndrome in pigs and rabbits. Phenylbutazone was able to cause arterial damage, mainly in the tunica intima of the artery in which the medication was administered, with perivascular inflammatory infiltrate and subsequent skin necrosis at the site of administration. In addition to the skin lesion, the animal started to show signs compatible with the left facial nerve lesion, evidenced by the immobility of the upper eyelid and labial and ear ptosis. This resulted in corneal ulceration and subsequent enucleation. The animal also developed chewing difficulty in the first months of hospitalization. This dysfunction may be due to a lesion of the mandibular nerve, responsible for innervating the masticatory muscles and the oral mucosa. However, the animal showed improvement in this aspect, no longer showing this condition after 90 days of hospitalization. The treatment used was successful in healing the wound.

Clinical, hematological, blood gasometric and electrolytic changes in dogs receiving whole blood transfusions

Blood transfusion is a tool capable of saving lives. Patients undergoing blood transfusion usually present several alterations in the acid-base and electrolyte balance, aggravating the condition of critically ill patients. Some studies have demonstrated haematological alterations in certain species that received whole blood transfusions, however, few studies have evaluated acid base and electrolyte changes in dogs undergoing whole blood haemotherapy. The aim of this study was to analyze clinical, hematological, blood gas and electrolyte changes in anemic dogs after whole blood transfusion. Twenty nine dogs transfused due to anemia were enrolled in the study. Donors blood was collected in a transfusion bag containing citrate phosphate adenine dextrose and stored up to 24 h. Blood collections and evaluations were made before and 24 h after the transfusion. Data distribution normality was tested by the Shapiro Wilk Test. The means of the variables were compared by paired t-test. It was observed an increase in diastolic blood pressure and a reduction in heart rate (P < 0.05). There was a not significant increase in systolic blood pressure, temperature, and a reduction in respiratory rate per minute. Erythrocyte, haemoglobin and haematocrit averages were significantly increased after blood transfusion (P < 0.05). It was observed a reduction in the mean values of pH (P < 0.05), potassium (P > 0.05) and ionized calcium (P > 0.05) and an increase in the mean partial pressure of carbon dioxide (pCO2 ) (P < 0.001), bicarbonate (P > 0.05) and sodium (P < 0.05). The probable cause of anemia was monocytic ehrlichiosis (14/29), visceral leishmaniasis (1/29), babesiosis (1/29), co-infection of Ehrlichia canis and Leishmania infantum (2/29), co-infection of E. canis and Babesia vogeli (1/29). It was not possible to determine the etiology of the anemia in ten dogs. Heart rate significantly reduced after transfusion, probably because of the increase in hematocrit, hemoglobin and erythrocyte values. It may be justified by the displacement of extravascular fluid to the intravascular space. Mean values of systolic blood pressure were slightly elevated before transfusion and remained elevated afterwards, while diastolic and mean arterial pressure increased significantly after transfusion. These changes may be due to the morbid condition and may be influenced by many other factors. Haematocrit, haemoglobin and erythrocyte values increased significantly after transfusion, according to what was observed in other studies. The significant reduction in pH and increase in pCO2 reflects the compensatory mechanism for metabolic acidosis to increase ventilation, leading to pCO2 reduction and changes in pH. The reduction in pH due to the contact of the collected blood with conservative solutions is one of the main changes thar occurs during blood storage. It was described significantly lower pH in dogs' whole blood samples stored for more than 24 h in vacutainer plastic containing CPDA-1. We may assume there was no intense pH reduction in the present study because the bags were stored for up to 24 h. Although not statistically significant, the increase of pO2 mean reflects the improvement of tissue oxygen perfusion. It was observed a significant increase in sodium ions. The mean sodium ion concentration before transfusion was very close to the maximum reference value. Hyperkalaemia was not observed, nor was there significant reduction of potassium ions after transfusion. Several studies report hyperkalaemia and transfusion-associated cardiac arrests in humans, associated with infusion of large volumes of blood. Whole blood transfusion increased erythrogram values and did not negatively affect the electrolyte or acid-base status, representing a safe and useful tool in the intensive care of small animals.(AU)

Characterization of the intestinal graft in a swine hypotensive after brain death model

Purpose: To establish a hypotensive brain death pig model and observe the effects of hypotension on small bowel donors. Methods: The hypotensive brain death model was produced using the modified intracranial water sac inflation method in ten domestic crossbred pigs. Effects of hypotensive brain death on small bowel tissue morphology were evaluated through changes in intestinal tissue pathology, tight junction protein of the intestinal mucosa and plasma intestinal fatty acid-binding protein (i-FABP) levels. The pathophysiological mechanism was examined based on changes in superior mesenteric artery (SMA) blood flow and systemic hemodynamics. Results: After model establishment, SMA blood flow, and the mean arterial pressure (MAP) significantly decreased, while heart rate increased rapidly and fluctuated significantly. Small bowel tissue morphology and levels of tight junction protein of the intestinal mucosa showed that after model establishment, small bowel tissue injury was gradually aggravated over time (P 0.05). Plasma i-FABP levels significantly increased after brain death (P 0.05). Conclusions: A hypotensive brain death pig model was successfully established using an improved intracranial water sac inflation method. This method offers a possibility of describing the injury mechanisms more clearly during and after brain death.(AU)

Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

To investigate the effect of Botulinum toxin A (BoNTA) on skin flap viability in healthy, tobacco-exposed and diabetic rats. Ninety male Wistar rats (250-300g) were randomly divided into six groups: control+saline (C1), control+BoNTA (C2), tobacco-exposed+saline (T1), tobacco-exposed+BoNTA (T2) diabetes+saline (D1) and diabetes+BoNTA (D2). A dorsal cutaneous flap (3×10cm) was performed. Survival area and total area of the flaps were measured. Lumen diameter, external arterial diameter and lumen/wall thickness ratio were recorded. Survival area increased in control group with BoNTA injection compared with control animals injected with saline (C2 x C1; 0.9±0.1 vs0.67±0.15, p= 0.001). A similar result was found in diabetes group injected with BontA (D2 x D1; 0.97±0.2 vs0.61±0.24, p=0.018). No difference was observed in skin flap viability in tobacco-exposed groups (T2 x T1; 0.74±0.24 vs 0.64±0.21, p=0.871). Lumen diameter (p= 0.004), external arterial diameter (p = 0.0046,) and lumen/wall thickness ratio (p= 0.003) were increased in diabetes+BoNTA-treated animals. This effect was not observed in control or in tobacco-exposed groups. Botulinum toxin A increased skin flap viability in control and diabetic rats on the seventh post-operative day. Increased lumen diameter, external arterial diameter, and lumen/wall thickness ratio were observed in the diabetes+BoNTA group. BoNTA had no effect in the tobacco-exposed group on the seventh postoperative day.(AU)

Prospective analysis of 44 consecutive liver transplants performed at a university hospital

PURPOSE: To analyze the intraoperative and immediate postoperative biochemical parameters of patients submitted to orthotopic liver transplantation. METHODS: Forty four consecutive orthotopic liver transplants performed from October 2009 to December 2010 were analyzed. The patients (38 male and eight female) were divided into two groups: group A, survivors, and group B, non-survivors. Fifty percent of group A patients were Chid-Pugh C, 40% Chid-Pugh B and 10% Chid-Pugh A. In group B, 52% of the patients were Chid-Pugh C, 41% Chid-Pugh B, and 17% Chid-Pugh A. All orthotopic liver transplants were performed by the piggy-back technique without a portacaval shunt in an anhepatic phase. ALT, AST, LDH and lactate levels were determined preoperatively, at five, 60 minutes after arterial revascularization of the graft and 24 and 48 hours after the end of the surgery.( or: after the surgery was finished). RESULTS: There were no preoperative clinical differences (Child and Meld) between the two groups. The times of warm and hypothermal ischemia were similar for both groups (p>0.05). Serum aminotransferases levels at five and 60 minutes after arterial revascularization of the graft were similar (p>0.05) for both groups, as also were lactate levels at the time points studied. There was no significant difference in Δ lactate between groups at any time point studied (p>0.05). No significant difference was observed between groups during the first 24 and 48 hours after surgery (p>0.05). CONCLUSION: No significant difference in any of the parameters studied was observed between groups. Under the conditions of the present study and considering the parameters evaluated, no direct relationship was detected between the intraoperative situation and the type of evolution of the patients of the two groups studied.(AU)

Can joint analysis of postoperative MELD, base excess and blood lactate levels be used as an index of postoperative outcome for patients submitted to liver transplantation? / A análise conjunta do MELD pós-operatório, do base excess e dos níveis séricos de lactato pode ser usada como um índice prognóstico para pacientes submetidos a transplante de fígado?

PURPOSE: The objective of the present study was to evaluate the postoperative levels of classical or pure MELD and changes in lactate or base excess (BE) levels as possible predictive factors of the type of outcome of patients submitted to orthotopic liver trasplantation (OLT). METHODS: The study was conducted on 60 patients submitted to OLT at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, between October 2008 and March 2012. The 30 latest survivor (S) and non-survivor (NS) cases were selected. All liver transplants were performed using the piggy-back technique. ALT, AST, BE and blood lactate values were determined for each group at five time points (immediate preoperative period, end of hypothermal ischemia, 5 and 60 minutes after arterial revascularization and in the immediate postoperative period, when the postoperative MELD was also calculated. RESULTS: The aminotransferases reached a maximum increase 24 hours after surgery in both the S and NS groups. There was a significantly higher increase in BE and blood lactate in the NS group, especially after 5 minutes of afterial reperfusion of the graft, p<0.05. There was no significant difference in preoperative MELD between groups (p>0.05), while the postoperative MELD was higher in the NS than in the S group (p<0.05) CONCLUSION: Joint analysis of postoperative MELD, BE and blood lactate can be used as an index of severity of the postoperative course of patients submitted to liver transplantation.(AU)

OBJETIVO: O objetivo do presente estudo é avaliar os níveis do MELD clássico ou puro pós-operatório, alterações dos níveis séricos do lactado e BE, analisando-os como possíveis fatores preditivos do tipo de sobrevida de pacientes submetidos ao transplante ortotópico de fígado (OLT). MÉTODOS: Foram analisados 60 pacientes submetidos ao OLT (técnica de piggy-back) no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, entre Outubro 2008 e Março de 2012. Foram selecionados os 30 últimos casos de sobreviventes (S) e 30 de não-sobreviventes (NS). Avaliou-se para cada grupo, os valores ALT, AST, de base excess (BE) e lactato sanguíneos em cinco momentos (pré-operatório imediato, no final da isquemia hipotérmica, 5 e 60 minutos após a revascularização arterial e no pós-operatório imediato, quando também foi calculado o MELD pós-operatório. RESULTADOS: Com relação às aminotransferases, houve um aumento máximo após 24 horas de pós-operatório em ambos os grupos S e NS. Houve aumento significativo dos níveis de BE e lactato sanguíneo significativamente maior no grupo NS, sobretudo nos tempos após 5 minutos de reperfusão arterial do enxerto, p<0,05. Não houve diferença significativa entre o MELD pré-operatório em ambos os grupos (p>0,05). O MELD pós-operatório foi maior no grupo NS do que no grupo S (p<0,05). CONCLUSÃO: A análise conjunta do MELD pós-operatório, do BE e do lactato sanguíneo pode ser usada como índice de gravidade da evolução pós-operatória de pacientes submetidos ao OLT.(AU)

The influence of type of vascular pedicle occlusion on the viability of skin island flaps: a postoperative quantitative assessment of flap survival in an experimental model in rats

PURPOSE: To evaluate the role of pedicle occlusion on the viable area of a skin island flap. METHODS: An epigastric skin island flap was performed in 160 Wistar rats. The animals were randomly divided into four groups: G-1: occlusion of inferior epigastric artery; G-2: inferior epigastric vein; G-3: inferior epigastric vessels (artery/vein). At varying times postoperatively (2,3,4,5th day), animals from each group were randomly selected, and the pedicle was occluded. On the 10th. postop. day, the skin flaps were evaluated by templates to determine the percentage of surviving skin. The computer HP™ 9830A captured the photographs and the mean flap necrosis area was assessed. RESULTS: An increasing area of flap survived with less area of necrosis with increased time of days intervals. In the G-1, the mean area of necrosis observed (two to five days) were 95.2, 60.8, 31 and 3.7 % respectively. In the G-2 were 95.5, 57.6, 19.5 and 5.6 % respectively. In the G-3, a 100, 80, 32.4 and 14.9 % of mean area was observed. CONCLUSIONS: The arterial suppy/venous drainage is important for flap circulation up to five days following pedicle occlusion. After this period, the pedicle can be interrupted once the circulation through the flap margins has already been established.(AU)

Utilização do pericárdio de avestruz na aortoplasia em coelhos: avaliação dopplerfluxométrica e estrutural

A utilização de membranas biológicas em cirurgia vascular vem sendo utilizada em larga escala na medicina veterinária e na medicina humana. Os objetivos desse estudo foram avaliar os padrões Dopplefluxométrico e estrutural da região da aorta abdominal dos coelhos do grupo controle e do grupo onde fora implantado o pericárdio de avestruz. Nesse experimento foram utilizados fragmentos de pericárdio de avestruz tratado e conservado em solução de gluteraldeido a 0,5 % e implantado na porção abdominal da aorta de coelhos. Foram estabelecidos dois grupos: Grupo I (controle), Grupo II (pericárdio de avestruz) que foi subdividido em três grupos de sete, 14 e 21 dias. Os coelhos do Grupo II foram submetidos a protocolo anestésico padrão e celiotomia para acesso a porção abdominal da aorta onde foi feita a aortoplastia usando fragmento de pericárdio de avestruz com cola cirúrgica. Os animais dos dois grupos também foram avaliados pelo Doppler para caracterização de parâmetros Dopplefluxométrico e estrutural arteriais. Foi utilizado um aparelho Sonosite Titan, com transdutor linear multifrequencial de 4,0-7,0MHz. Com os diferentes tempos de cicatrização (7,14 e 21 dias) os animais do grupo II e do grupo controle foram submetidos a eutanásia por meio de overdose de thiopental sódico endovenoso e necropsiados para a coleta de fragmentos da aorta. Os fragmentos foram clivados transversalmente e fixados em solução de formol a 10% tamponado. Todos os cortes foram processados para inclusão em parafina seguindo a técnica histológica de rotina e corados pelas técnicas histológicas, histoquímicas e observados em microscopia de luz. A aorta dos animais submetidos ao implante com o pericárdio de avestruz ao 7o dia mostrou-se com forte reação inflamatória na porção voltada para o lúmen do vaso, assim como uma desorganização das camadas íntima e média. Além disso, observou-se que o pericárdio se manteve íntegro sem haver extravasamento de sangue. Aos 14 dias foi observado a reorganização da camada íntima e média. O pericárdio manteve-se íntegro. Aos 21º dias a aorta já apresentava suas camadas consolidadas. Na aorta abdominal foi visualizado um perfil de fluxo laminar. A média e o desvio padrão do diâmetro da aorta foi de 0,431±0,030 cm no grupo controle, 0,404±0,100 no grupo sete dias, 0,408±0,008 no grupo 14 dias e 0,431±0,006 no grupo 21 dias (p=0,2095). A média e desvio padrão da espessura da aorta foi de 0,107±0,011cm no grupo controle, 0,105±0,007 cm no grupo sete dias, 0,108±0,008cm no grupo 14 dias e 0,121±0,006cm no grupo 21 dias (p<0,0105). A média e desvio padrão da velocidade do pico sistólico foi de 49,44±2,260 cm/s no grupo controle, 67,49±3,128cm/s no grupo sete dias, 35,07 ±0,657 no grupo14 dias e 31,50±1,190cm/s no grupo 21 dia (p<0,0001). A média e desvio padrão da velocidade do fluxo diastólico final de 8,264 ± 0,292cm/s no grupo controle, 16,07±0,680cm/s no grupo sete dias, 7,090±0,171 no grupo 14 dias e 10,37±0,427cm/s no grupo 21 dias (p<0,0001). A média e desvio padrão da relação sístole diástole foi de 4,263±1,042 no grupo controle 2,854±1,153 no grupo sete dias, 3,890±1,017 no grupo 14 dias e 3,201±0,171 no grupo 21 dias (p=0,0376). A média e desvio padrão do índice de resistividade foi de 0,742±0,061 no grupo controle, 0,612±0,131 no grupo sete dias, 0,620±0,100 no grupo 14 dias e 0,635±0,033 no grupo 21 dias (p=0,0416). A média e desvio padrão do índice de pulsatilidade foi de 1,289±0,159 no grupo controle, 1,159± 0,029 no grupo sete dias II, 1,311± 0,026 no grupo 14 dias e 1,333±0,014 no grupo 21 dias (p=0,0025). A aortoplastia utilizando pericárdio de avestruz com fixação por cola cirúrgica mostrou-se totalmente exequível e segura. O enxerto de pericárdio de avestruz com cola cirúrgica promoveu ótima fixação do implante de pericárdio, não apresentou deformação de sua estrutura, não resultando em dilatação aneurismática, nem hemorragia em sítio do enxerto

The use of biological membranes in vascular surgery has been widely used in veterinary medicine and in human medicine. The objectives of this study were to evaluate the Dopplefluxometric and structural patterns of the abdominal aorta region of the rabbits of the control group and the group where the ostrich pericardium was implanted. In this experiment, fragments of ostrich pericardium were treated and preserved in 0.5% gluteraldehyde solution and implanted in the abdominal portion of the rabbit aorta. Two groups were established: Group I (control), Group II (ostrich pericardium), which was subdivided into three groups of seven, 14 and 21 days. Group II rabbits underwent standard anesthetic protocol and celiotomy to access the abdominal portion of the aorta where the aortoplasty was performed using an ostrich pericardium fragment with surgical glue. The animals of the two groups were also evaluated by Doppler for characterization of arterial Dopplefluxometric and structural parameters. A Sonosite Titan was used, with a linear multi-frequency transducer of 4.0-7.0 MHz. With the different healing times (7,14 and 21 days) the animals of group II and the control group were submitted to euthanasia through an intravenous thiopental sodium overdose and necropsied for the collection of aortic fragments. The fragments were cleaved transversely and fixed in 10% buffered formalin solution. All sections were processed for inclusion in paraffin following the routine histological technique and stained by histological, histochemical and light microscopy techniques. The aorta of the animals submitted to the implant with the ostrich pericardium on the 7th day showed a strong inflammatory reaction in the portion facing the lumen of the vessel, as well as a disorganization of the intima and middle layers. In addition, it was observed that the pericardium remained intact without blood leakage. At 14 days, the reorganization of the intima and middle layers was observed. The pericardium remained intact. At 21 days the aorta already had its layers consolidated. A laminar flow profile was visualized in the abdominal aorta. The mean and standard deviation of the aorta diameter was 0.431 ± 0.030 cm in the control group, 0.404 ± 0.100 in the 7-day group, 0.408 ± 0.008 in the 14-day group, and 0.431 ± 0.006 in the 21-day group (p = 0.2095) . The mean and standard deviation of the aortic thickness was 0.107 ± 0.011 cm in the control group, 0.105 ± 0.007 cm in the 7-day group, 0.108 ± 0.008 cm in the 14-day group and 0,121 ± 0,006 cm in the 21-day group (p < 0105). The mean and standard deviation of systolic peak velocity was 49.44 ± 2.260 cm / s in the control group, 67.49 ± 3.128cm / s in the seven day group, 35.07 ± 0.657 in the 14 day group and 31.50 ± 1,190cm / s in the 21 day group (p <0.0001).The mean and standard deviation of the systole diastole ratio was 4,263 ± 1,042 in the control group 2,854 ± 1,153 in the 7-day group, 3,890 ± 1,017 in the 14-day group and 3,201 ± 0,171 in the 21-day group (p = 0.0376). The mean and standard deviation of the resistivity index was 0.742 ± 0.061 in the control group, 0.612 ± 0.131 in the seven day group, 0.620 ± 0.100 in the 14 day group and 0.635 ± 0.033 in the 21 day group (p = 0.0416). The mean and standard deviation of the pulsatility index was 1.289 ± 0.159 in the control group, 1.159 ± 0.029 in the 7-day group II, 1,311 ± 0,026 in the 14-day group and 1,333 ± 0,014 in the 21-day group (p = 0.0025). Aortoplasty using ostrich pericardium with fixation by surgical glue was totally feasible and safe. The ostrich pericardium graft with surgical glue promoted optimal fixation of the pericardium implant, did not present deformation of its structure, not resulting in aneurysm dilatation, nor hemorrhage at graft site

Analysis of 83 consecutive liver transplants performed at a tertiary care reference hospital in the interior of the state of Sao Paulo / Analise de 83 transplantes hepáticos consecutivos realizados em hospital universitário de referência terciária do interior do estado de São Paulo

PURPOSE: To analyze pre-, intra- and immediate postoperative parameters of patients submitted to liver transplantation. METHODS: Eighty-three consecutive orthotopic liver transplants performed from January 2009 to July 2011 were analyzed. The patients were divided into 2 groups: A, survivors (MELD between 9 and 60) and B, non-survivors (MELD between 14 and 40), with 30.6% of group A patients being CHILD C, 51℅ CHILD B and 18,4℅ CHILD A. In group B ,32.1℅ of the patients were CHILD C, 42,9℅ CHILD B, and 25℅ CHILD A. All orthotopic liver transplantations were performed using the piggyback technique without a portacaval shunt. Systemic arterial pressure and serum ALT and AST levels were determined preoperatively and 5, 60 and 1440 minutes after arterial graft revascularization. Serum ALT and AST profiles were evaluated for seven days after surgery. RESULTS: Systemic arterial blood pressure levels, time of hot and hypothermic ischemia and time of graft implant were statistically similar for the two groups (p>0.05). Serum levels (U/L) of ALT and AST at the 5, 60 and 1440 minute time points after arterial revascularization of the graft were also similar for the two groups studied, as also were the serum ALT and AST profiles. CONCLUSIONS: No statistically significant difference in any of the parameters studied was detected between the two groups. Under the conditions of the present study and on the basis of the parameters evaluated, no direct relation was detected between the intraoperative period and the type of patient outcome in the two groups studied.(AU)

OBJETIVO: Analisar parâmetros do pré, intra e pós-operatório imediato de pacientes submetidos ao transplante de fígado. MÉTODOS: Foram analisados 83 transplantes ortotópicos de fígado realizados consecutivamente no período janeiro de 2009 a julho de 2011. Os pacientes foram dividos em dois grupos: A, survivors (MELD entre 16 e 60), e B, non-survivors (MELD entre 14 e 40) sendo que 30,6℅ dos pacientes do grupo A eram CHILD C, 51℅ CHILD B e 18,4℅ CHILD A. No grupo B, 32,1℅ dos pacientes eram CHILD C, 42,9℅ CHILD B, e 25℅ CHILD A. Todos os transplantes ortotópicos de fígado foram feitos com a técnica de piggyback sem "shunt" porto cava. Foram analisados os valores de pressão arterial sistêmica e os níveis séricos de ALT e AST, no pré-operatório, 5, 60 e 1440 minutos após revascularização arterial do enxerto. Avaliaram-se os perfis séricos da ALT e AST durante sete dias de pós-operatorio. RESULTADOS: Verificou-se que em ambos os grupos, os níveis de pressão arterial sistêmica, os tempos de isquemia normotérmica, hipotérmica e de implante do enxerto foram estatisticamente semelhantes (p>0,05). Os níveis séricos (U/L) de ALT e AST nos tempos de 5, 60 e 1440 minutos após a revascularização arterial do enxerto também foram semelhantes nos grupos estudados. Os perfis séricos da ALT e AST foram semelhantes nos dois grupos estudados. CONCLUSÕES: Não se verificou diferença estatisticamente significante entre todos os parâmetros estudados, em ambos os grupos. Nas condições do presente estudo, não se verificou relação direta do intra-operatório com o tipo de evolução (outcome) dos pacientes nos dois grupos estudados.(AU)

Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation / Efeitos hemodinâmicos e metabólicos iniciais da evisceração abdominal total para transplante multivisceral experimental

PURPOSE: Multivisceral transplantation (MVTx) has been accepted as standard therapeutic modality for patients with short-bowel syndrome associated with irreversible liver failure. Even nowadays, experimental models of MVTx grounds high incidence of intraoperative or early recipient mortality. Despite the known deleterious effects of hepatosplanchnic exenteration the impact of this procedure on systemic hemodynamics and metabolism remains to be determined. METHODS: Nine dogs (20.1±0.5 kg) were subjected to an en bloc resection of all abdominal organs including, stomach, duodenum, pancreas, liver, spleen, small bowel, and colon. A woven double velour vascular graft was interposed between the suprahepatic and infrahepatic vena cava. Systemic hemodynamic were evaluated through a Swan-Ganz catheter, ultrasonic flowprobes, and arterial lines. Systemic O2-derived variables, glucose, and lactate metabolism were analyzed throughout the experiment. RESULTS: Complete abdominal exenteration was associated with significant reduction in cardiac output, and mean arterial pressure (57% and 14%, respectively). Two hours after reperfusion a significant reduction in arterial pH and glucose were also observed. Oxygen consumption remained unaltered during the first two hours of the experiment, with a significant increase of lactate levels (1.4±0.3 vs. 7.6±0.4, p<0.05). Three animals died before the 3 hours of reperfusion were completed. Total abdominal exenteration for MVTx in dogs is associated with early major hemodynamics, and metabolic changes. CONCLUSION: The deleterious hemodynamic alterations observed are probably related with the association of severe acidosis, hyperlactemia, hypoglycemia, and reduction of total circulating blood volume. Close hemodynamic and metabolic monitoring should be provided during experimental MVTx in order to promote an increase in successful rates of this complex and challenging procedure.(AU)

OBJETIVO: O transplante multivisceral (MVTx) é preconizado como tratamento de escolha em pacientes com síndrome do intestine curto associado com falência hepática irreverssível. Modelos experimentais de MVTx apresentam altas taxas de mortalidade intra-operatória e nas primeiras horas apos a reperfusão. Apesar dos deletérios efeitos hemodinâmicos da exenteração abdominal, o impacto deste procedimento na perfusão e no metabolismo sistêmico ainda esta por ser determinado. MÉTODOS: Nove cães (20.1±0.5 kg) foram submetidos a ressecção em bloco de todos os orgãos abdominais incluindo, estômago, duodeno, pancreas, fígado, baço, intestino delgado, e colon. Uma prótese vascular foi interposta entre a veia cava infra e supra-hepática. Efeitos hemodinâmicos foram avaliados por meio de um cateter de Swan-Ganz catheter e Doppler ultrassônico. As variáveis dependentes de oxigênio, e o metabolismo da glicose e lactato foram avaliados durante todo o experimento. RESULTADOS: A evisceração abdominal esteve associada a uma redução significativa do débito cardiaco e da pressão arterial média (57% and 14%, respectivamente). Duas horas após a reconstrução vascular da veia cava inferior observou-se uma redução significativa do pH e da glicose arterial. O consumo de oxigênio se manteve inalterado nas primeiras duas horas do experimento, com um significativo aumento dos níveis séricos de lactato (1.4±0.3 vs. 7.6±0.4, p<0.05). Três animais morreram antes de 180 minutos após a reperfusão. CONCLUSÃO: A evisceração abdominal total esteve associada com graves repercussões hemodinâmicas e metabólicas sistêmicas. Estas graves alterações hemodinâmicas estam associadas, provavelmente, a combinação de vários fatores incluindo: acidose metabólica, hiperlactemia, hipoglicemia e redução do volume de sangue circulante. A cuidadosa monitorização hemodinâmica e metabólica deve ser realizada durante o MVTx experimental com a finalidade de promover um aumento...(AU)

Enxertos vasculares homólogos e heterólogos conservados em glicerina na fleboplastia da jugular em eqüinos / Arterial homograft and venous heterograft conserved in glycerin in the phleboplasty of the jugular in equines

Doze eqüinos foram divididos aleatoriamente em dois grupos de seis animais (grupos I e II), com a finalidade de estudar a compatibilidade tecidual e a propriedade de indução de trombos de dois tecidos biológicos conservados em glicerina a 98 por cento. Esses tecidos foram usados na restauração da jugular externa e se constituíram de artéria carótida comum homóloga (ACCHo), no grupo I, e veia jugular externa heteróloga (VJEHe), no grupo II. Para a restauração, utilizaram-se duas técnicas de anastomose da jugular, sendo, no grupo I, a técnica de bypass e, no grupo II, a substituição de um segmento da jugular esquerda por meio de anastomose vascular término-terminal. Para avaliar a trombogênese local e a histocompatibilidade, foram realizados exames clínicos, hematológicos, ecoDopplercardiográficos e histológicos dos segmentos vasculares enxertados. Os segmentos foram colhidos após 45 dias da avaliação pós-operatória, tendo a jugular direita como testemunha para os exames histológicos. Ambos os tecidos foram compatíveis quando implantados nos eqüinos, sem processo inflamatório acentuado, indicativo de rejeição. A técnica de bypass não foi eficiente na restauração da jugular, ocorrendo trombose obliterante dos enxertos de ACCHo. A substituição completa do segmento da jugular por VJEHe pode ser viável para o restabelecimento do fluxo sangüíneo da jugular de eqüinos, desde que se mantenha a igualdade dos diâmetros entre o enxerto e o vaso receptor.(AU)

Twelve horses were randomly divided into two groups of six animals each (groups I and II) in order to study the compatibility and trombogenicity of two biological tissues conserved in glycerin at 98% which were used to restore the external jugular. The tissues consisted of arterial homograft - ACCHo (group I) and venous heterograft - VJEHe (group II). Two different techniques for jugular anastomosis were performed bypass in group I and replacement of a segment of the left jugular by means of end to end vascular anastomosis in group II. Clinical, hematological, Doppler ultrasonography, and histological examinations of the grafted vascular segments were conducted to evaluate local trombogenicity and tissue compatibility. All animals had the segments collected after 45 days, being the right jugular used as standard for the histopathological exams. Both tissues were compatible since no serious inflammatory process indicative of rejection took place. The bypass technique was not efficient for jugular restoration because of the occurrence of obliterant trombosys of the ACCHo. The full replacement of a jugular segment by the VJEHe can be feasible in reestablishing blood flow through the jugular of horses as long as the diameters of the grafted tissue and the original blood vessel are kept the same.(AU)

Implantação de homoenxerto heterotópico na artéria femoral de cães

The purpose of this study was to evaluate an interposition of an arterial heterotopic homograft in the femoral artery of adult mongrel dogs. Eighteen dogs were used and distributed in three groups of six animals in order to study the results in 15 days (group I), 30 days (group II), 45 days (group III). Another three dogs were observed for 75 days (group IV). Grafts were preserved in glycerol 98% during a 60-180-day period. The graft was interposed in the femoral artery of each dog with the help of a surgical microscope under 6x magnification. Grafts were evaluated by clinical, arteriographic and histopathological examination. After implantation grafts presented cellular invasion of the adventicia and absence of cells in the media. The smooth muscle cells progressively disappeared and were replaced by collagen fiber deposition. There was no clinical or histopathological evidence of immunological reaction.

A presente pesquisa visou estudar a interposição de um segmento de carótida homógena, preservada em glicerina, na artéria femoral de cães. Foram utilizados 18 cães mestiços, adultos, separados em três grupos, e observados por 15 dias (grupo I), 30 dias (grupo II) e 45 dias (grupo III). Três outros cães foram observados por 75 dias (grupo IV). Os enxertos foram preservados em glicerina 98%, por período de 60-180 dias. As artérias foram implantadas com auxílio de microscópio cirúrgico em magnificação de 6x e foram avaliadas por inspeção clínica, arteriográfica e histopatológica. Foi observada invasão mononuclear da adventícia, ausência de células na média e progressiva diminuição nas células musculares lisas, com deposição de fibras colágenas. Não foram evidenciados sinais clínicos ou histopatológicos de reação imunológica.

Arterioplastia com enxerto de pericárdio bovino: estudo experimental em cães

The aim of this work was to evaluate the efficacy of bovine pericardium (BP) patch graft to treat arterial defects created in the femoral artery of dogs, compared to the cephalic vein autograft (CVA) on both side of the arteries. Twenty mongrel dogs (eight males and twelve females), were used and disbuted in two groups of ten animals (I and II), to be re-operated on 7th and 30th post operative days, respstively. Clinical and histolgical data analysis were done using the chi-square an exact Fisher test (a£ 0,05). Significant alterations wasn't found in the clinical examinations, independetly, of the kin of graft used and post operative observation period. It wasn't found any significant difference between the BP and CVA grafts in the histological analyses concerning the presence of inflammatory cell infiltration and mural thrombi that predominated on the 7th post operative day. Whilst, the presence of granulation tisseu, myofibroblastic plaque and endothelization predominated on the 30th post operative day. The presence of necrosis was found significant for both BP and CVA, on the 7th post operative day, being higher for BP. Calcification of the grafts was not observed. A significant reaction of strange body kind to the polypropylene yarn take place on the 30th PO for both grafts. These results sugested that BP was efficient as artery substitute for dogs, which was comparable to CVA, for the settled period of observation.

Com o objetivo de avaliar a eficácia do pericárdio bovino (PB) para corrigir defeitos arteriais, provocado nas artérias femorais cão, foram realizados remendos de PB e veia cefálica autóloga (VA). Foram utilizados vinte cães, Canis familiaris (oito machos e doze fêmeas), divididos em dois grupos de dez animais (I e II), para serem reoperados no 7º e 30º dias de pós-operatório (PO), respectivamente. Para análise dos dados, aplicou-se o teste do qui-quadrado ou teste exato de Fisher (a£ 0,05). Nas avaliações clínicas não foram observadas alterações significantes, independentemente, do tipo de enxerto utilizado e tempo de observação PO. As avaliações histológicas, entre os enxertos de PB e VA, não diferiram significantemente quanto à presença de infiltrado inflamatório agudo e trombo mural, que predominaram no 7º PO, enquanto a presença de tecido de granulação, placa miofibroblástica e células endoteliais predominaram no 30º PO. A presença de necrose, no 7º PO, entre os enxertos de PB e VA, foi significantemente maior no PB. Os enxertos não sofreram calcificação. Ocorreu significante reação tipo corpo estranho ao fio de polipropileno, no 30º PO, em ambos os enxertos. O PB mostrou-se eficaz como substituto arterial em cães, comparável à VA, para o período de observação estabelecido.

Alterações cardiovasculares de gatos submetidos à toracotomia intercostal, pré-medicados com associação de tramadol, butorfanol e atropina e anestesiados com propofol e halotano

Intercostal thoracotomy is a very painful procedure that deserves proper prevention and treatment. In this study we aimed to investigate the cardiovascular effect of the association of tramadol, butorphanol and atropine in the premedication of cats anesthetised with propofol and halothane. Twelve cats of mixed breed, female and male, with mean body weight of 2.7 ± 0.62kg were premedicated with 2.0mg kg-1 tramadol and 0.4mg kg-1 butorphanol and 0.044mg kg-1 atropine combined in the same syringe intramuscularly administered. After 30 minutes of premedication, anesthetic induction was obtained with 5.0mg kg-1 propofol intravenously. Anesthetic maintenance was done with halothane and 100% oxygen with manual artificial ventilation. All cats were submitted to lateral intercostal thoracotomy for an autogenic pericardium graft implantation in the diaphragm. Variables studied were heart rate (bpm), hemoglobin oxygen saturation (%), systolic arterial pressure (mmHg), and halothane vaporization (%). Time for data collection were 20 minutes after premedication (TMPA), 10 minutes after induction and every 10 minutes up to the end of the surgical procedure (T10 to T100). Data were analyzed with ANOVA and Bonferroni's test (p 0.05). Results demonstrated statistically significant reduction in arterial systolic pressure and heart rate, however, kept within the physiologic variation parameter to felines. Hemoglobin oxygen saturation was close to 100% in all times. Halothane vaporization decreased significantly from T30 to T100, staying for most of the surgical time below the minim alveolar concentration for cats. In conclusion the assotiation tramadol (2.0mg kg-1), butorphanol (0.4mg kg-1) and atropine (0.044mg kg-1) in the premedication of cats anesthetised with propofol (5.0mg kg-1) and halothane, intramuscularly, produces minimal changes cardiovasculares, don't produce sedation and promote analgesia satisfactory for lateral intercostal thoracotomy.

A toracotomia é um procedimento cirúrgico que produz estímulo doloroso intenso. O objetivo deste estudo foi avaliar o efeito cardiovascular da associação tramadol, butorfanol e atropina na medicação pré-anestésica de gatos anestesiados com propofol e halotano. Doze animais, SRD, machos ou fêmeas, com peso médio de 2,7 ± 0,62kg receberam como medicação pré-anestésica (MPA), a associação de tramadol (2,0mg kg-1), butorfanol (0,4mg kg-1) e atropina (0,044mg kg-1), via intramuscular. Trinta minutos após MPA, a indução foi realizada com propofol (5,0mg kg-1) por via intravenosa. A manutenção anestésica foi obtida com halotano e oxigênio 100% sob ventilação artificial manual. Os gatos foram submetidos à toracotomia intercostal para implante de um segmento autólogo de pericárdio no diafragma. As variáveis avaliadas foram: freqüência cardíaca (bpm), saturação de oxigênio da hemoglobina (%), pressão arterial sistólica (mmHg) e vaporização de halotano (%). As variáveis foram mensuradas 20 minutos após a MPA (TMPA), 10 minutos após indução e a cada 10 minutos até o final do procedimento cirúrgico (T10 a T100).Os dados obtidos foram analisados estatisticamente através de ANOVA e teste de Bonferroni (p 0,05). Os resultados demonstraram redução na pressão arterial sistólica e freqüência cardíaca, estatisticamente significativa (p 0,05), porém, se mantiveram dentro da faixa de variação fisiológica para a espécie felina. Saturação de oxigênio da hemoglobina manteve-se ao redor de 100% em todos os tempos. A vaporização de halotano diminuiu significativamente do T30 ao T100, permancendo na maior parte do tempo cirúrgico abaixo da concentração alveolar mínima para gatos. Conclui-se que a associação tramadol (2,0mg kg-1) , butorfanol (0,4mg kg-1) e atropina (0,044mg kg-1), via intramuscular, como pré-medicação, em gatos, anestesiados com propofol (5,0mg kg-1) e halotano produz mínimas alterações cardiovasculares, não induz sedação e promove analgesia satisfatória para realização de toracotomia intercostal lateral.

Alterações cardiovasculares de gatos submetidos à toracotomia intercostal, pré-medicados com associação de tramadol, butorfanol e atropina e anestesiados com propofol e halotano

Intercostal thoracotomy is a very painful procedure that deserves proper prevention and treatment. In this study we aimed to investigate the cardiovascular effect of the association of tramadol, butorphanol and atropine in the premedication of cats anesthetised with propofol and halothane. Twelve cats of mixed breed, female and male, with mean body weight of 2.7 ± 0.62kg were premedicated with 2.0mg kg-1 tramadol and 0.4mg kg-1 butorphanol and 0.044mg kg-1 atropine combined in the same syringe intramuscularly administered. After 30 minutes of premedication, anesthetic induction was obtained with 5.0mg kg-1 propofol intravenously. Anesthetic maintenance was done with halothane and 100% oxygen with manual artificial ventilation. All cats were submitted to lateral intercostal thoracotomy for an autogenic pericardium graft implantation in the diaphragm. Variables studied were heart rate (bpm), hemoglobin oxygen saturation (%), systolic arterial pressure (mmHg), and halothane vaporization (%). Time for data collection were 20 minutes after premedication (TMPA), 10 minutes after induction and every 10 minutes up to the end of the surgical procedure (T10 to T100). Data were analyzed with ANOVA and Bonferroni's test (p 0.05). Results demonstrated statistically significant reduction in arterial systolic pressure and heart rate, however, kept within the physiologic variation parameter to felines. Hemoglobin oxygen saturation was close to 100% in all times. Halothane vaporization decreased significantly from T30 to T100, staying for most of the surgical time below the minim alveolar concentration for cats. In conclusion the assotiation tramadol (2.0mg kg-1), butorphanol (0.4mg kg-1) and atropine (0.044mg kg-1) in the premedication of cats anesthetised with propofol (5.0mg kg-1) and halothane, intramuscularly, produces minimal changes cardiovasculares, don't produce sedation and promote analgesia satisfactory for lateral intercostal thoracotomy.

A toracotomia é um procedimento cirúrgico que produz estímulo doloroso intenso. O objetivo deste estudo foi avaliar o efeito cardiovascular da associação tramadol, butorfanol e atropina na medicação pré-anestésica de gatos anestesiados com propofol e halotano. Doze animais, SRD, machos ou fêmeas, com peso médio de 2,7 ± 0,62kg receberam como medicação pré-anestésica (MPA), a associação de tramadol (2,0mg kg-1), butorfanol (0,4mg kg-1) e atropina (0,044mg kg-1), via intramuscular. Trinta minutos após MPA, a indução foi realizada com propofol (5,0mg kg-1) por via intravenosa. A manutenção anestésica foi obtida com halotano e oxigênio 100% sob ventilação artificial manual. Os gatos foram submetidos à toracotomia intercostal para implante de um segmento autólogo de pericárdio no diafragma. As variáveis avaliadas foram: freqüência cardíaca (bpm), saturação de oxigênio da hemoglobina (%), pressão arterial sistólica (mmHg) e vaporização de halotano (%). As variáveis foram mensuradas 20 minutos após a MPA (TMPA), 10 minutos após indução e a cada 10 minutos até o final do procedimento cirúrgico (T10 a T100).Os dados obtidos foram analisados estatisticamente através de ANOVA e teste de Bonferroni (p 0,05). Os resultados demonstraram redução na pressão arterial sistólica e freqüência cardíaca, estatisticamente significativa (p 0,05), porém, se mantiveram dentro da faixa de variação fisiológica para a espécie felina. Saturação de oxigênio da hemoglobina manteve-se ao redor de 100% em todos os tempos. A vaporização de halotano diminuiu significativamente do T30 ao T100, permancendo na maior parte do tempo cirúrgico abaixo da concentração alveolar mínima para gatos. Conclui-se que a associação tramadol (2,0mg kg-1) , butorfanol (0,4mg kg-1) e atropina (0,044mg kg-1), via intramuscular, como pré-medicação, em gatos, anestesiados com propofol (5,0mg kg-1) e halotano produz mínimas alterações cardiovasculares, não induz sedação e promove analgesia satisfatória para realização de toracotomia intercostal lateral.

Retalho venoso unipediculado transposto comparado ao não transposto: estudo experimental em coelhos

Conventional flaps are caracterized by arterial blood inflow and venous blood outflow. Venous flaps have only one vein in their pedicle. Determination of survival area and vascularization in transpositioned venous flaps is the aim of this study. A 2x2 cm² skin flap, based in the distal pedicle of anterior marginal vein, was performed in 8 rabbits ears. The flaps were divided in two groups: group I (n=8)-the flaps were elevated are fixated in the same position.; group II (n=8)-the flaps were elevated and transpositioned in 90°. These two groups were compared in between and with group III (n=8), in which was performed a skin graft. Necrosis mean area in group I (6,5%) was smaller than in group II (43,5%), and in both groups I and II was smaller than group III (88,75%). Angiography didn't alterations in vascular pattern comparing groups I and II. Anterior marginal vein was important for flap survival. Necrosis area in group II, which was transpositioned, was wider than in group I.

Retalhos venosos são aqueles que apresentam em seu pedículo apenas uma veia, diferente dos retalhos convencionais que são caracterizados por entrada de sangue arterial e saída de sangue venoso. O objetivo deste trabalho foi determinar se a transposição do retalho venoso unipediculado modifica a sua área de sobrevida e vascularização. As orelhas de oito coelhos foram submetidas à realização de retalhos venosos. Dissecou-se um retalho de pele de dois por dois centímetros baseado no pedículo distal da veia marginal anterior. Os retalhos foram divididos em dois grupos: no grupo I(n=8), os retalhos venosos foram levantados e suturados na mesma posição; no grupo II (n=8), os retalhos foram levantados e transpostos 90 graus. Estes dois grupos foram comparados entre si e ao grupo III(n=8), no qual foi realizado enxerto de pele com subcutâneo sobre um leito bem vascularizado. A área média de necrose no grupo I (6,5%) foi significativamente menor que no grupo II (43,75%), e as áreas de necrose dos grupos I e II foram significativamente menor do que no grupo III (88,75%). O estudo angiográfico não mostrou alterações no padrão vascular comparando-se os grupos I e II. A veia marginal anterior foi importante para a sobrevida do retalho. Houve uma maior área de necrose do grupo II, em que foi realizada transposição, em relação ao grupo I.

Transplante renal em bloco de doadores-cadáveres infantis: experiência do hcfmrp-usp

The high demand for organs for transplantation has made it necessary to consider using the youngest of potential donors in order to increase the organ supply. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. This is a chart review with the objective to analyse the results achieved with transplantation of children kidneys ( 2 years) in the HCFMRP-USP from 1998 to 2000. A total of 5 pacients received en bloc renal transplants from donors aged 9 months to 2 years old, weighthing between 8 and 14 kg. Results: Only one patient lost the allograft within 8 days of transplantation due to allograft trombosis. Two patients had ureteral complications, one with ureteral necrosis and urinary fistula and the other with total ureterovesical anastomosis disrupture. Both were successfully repaired. Intra operatory complication was experienced in one pacient, with arterial anastomosis rupture. In loco reperfusion and repair was made. Another patient had inferior renal pole rupture, treated with polar nefrectomy at the 4º PO. Despite such problems, mean follow up of 20,7 months showed serum creatinine ranging from 0,9 to 2 mg/100ml, with no serious complications. Conclusion: Our data support the use of en bloc child cadaveric kidneys, even from infant donors less than two year of age, when the organ necessity supplant the higher rates of complications.

A grande procura de órgãos para transplante tornou necessária a aceitação de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicação fizeram com que cirurgiões considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis ( 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicações ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicação intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusão in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicações sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgão seja maior que o risco oferecido pelo alto índice de complicações.

TRANSPLANTE RENAL EM BLOCO DE DOADORES-CADÁVERES INFANTIS: EXPERIÊNCIA DO HCFMRP-USP

The high demand for organs for transplantation has made it necessary to consider using the youngest of potential donors in order to increase the organ supply. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. This is a chart review with the objective to analyse the results achieved with transplantation of children kidneys ( 2 years) in the HCFMRP-USP from 1998 to 2000. A total of 5 pacients received en bloc renal transplants from donors aged 9 months to 2 years old, weighthing between 8 and 14 kg. Results: Only one patient lost the allograft within 8 days of transplantation due to allograft trombosis. Two patients had ureteral complications, one with ureteral necrosis and urinary fistula and the other with total ureterovesical anastomosis disrupture. Both were successfully repaired. Intra operatory complication was experienced in one pacient, with arterial anastomosis rupture. In loco reperfusion and repair was made. Another patient had inferior renal pole rupture, treated with polar nefrectomy at the 4º PO. Despite such problems, mean follow up of 20,7 months showed serum creatinine ranging from 0,9 to 2 mg/100ml, with no serious complications. Conclusion: Our data support the use of en bloc child cadaveric kidneys, even from infant donors less than two year of age, when the organ necessity supplant the higher rates of complications.

A grande procura de órgãos para transplante tornou necessária a aceitação de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicação fizeram com que cirurgiões considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis ( 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicações ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicação intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusão in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicações sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgão seja maior que o risco oferecido pelo alto índice de complicações.

Retalho venoso unipediculado transposto comparado ao não transposto: estudo experimental em coelhos

Conventional flaps are caracterized by arterial blood inflow and venous blood outflow. Venous flaps have only one vein in their pedicle. Determination of survival area and vascularization in transpositioned venous flaps is the aim of this study. A 2x2 cm² skin flap, based in the distal pedicle of anterior marginal vein, was performed in 8 rabbits ears. The flaps were divided in two groups: group I (n=8)-the flaps were elevated are fixated in the same position.; group II (n=8)-the flaps were elevated and transpositioned in 90°. These two groups were compared in between and with group III (n=8), in which was performed a skin graft. Necrosis mean area in group I (6,5%) was smaller than in group II (43,5%), and in both groups I and II was smaller than group III (88,75%). Angiography didn't alterations in vascular pattern comparing groups I and II. Anterior marginal vein was important for flap survival. Necrosis area in group II, which was transpositioned, was wider than in group I.

Retalhos venosos são aqueles que apresentam em seu pedículo apenas uma veia, diferente dos retalhos convencionais que são caracterizados por entrada de sangue arterial e saída de sangue venoso. O objetivo deste trabalho foi determinar se a transposição do retalho venoso unipediculado modifica a sua área de sobrevida e vascularização. As orelhas de oito coelhos foram submetidas à realização de retalhos venosos. Dissecou-se um retalho de pele de dois por dois centímetros baseado no pedículo distal da veia marginal anterior. Os retalhos foram divididos em dois grupos: no grupo I(n=8), os retalhos venosos foram levantados e suturados na mesma posição; no grupo II (n=8), os retalhos foram levantados e transpostos 90 graus. Estes dois grupos foram comparados entre si e ao grupo III(n=8), no qual foi realizado enxerto de pele com subcutâneo sobre um leito bem vascularizado. A área média de necrose no grupo I (6,5%) foi significativamente menor que no grupo II (43,75%), e as áreas de necrose dos grupos I e II foram significativamente menor do que no grupo III (88,75%). O estudo angiográfico não mostrou alterações no padrão vascular comparando-se os grupos I e II. A veia marginal anterior foi importante para a sobrevida do retalho. Houve uma maior área de necrose do grupo II, em que foi realizada transposição, em relação ao grupo I.