RESUMEN
Background: Isolated intestinal transplantation (IT) is indicated in cases of intestinal failure (IF) in the absence of severe liver dysfunction. Short bowel syndrome (SBS) is the most frequent IF etiology, and due to the absence or considerable reduction of intestinal loops in the abdominal cavity in these patients, there is atrophy and muscle retraction of the abdominal wall, leading to loss of the abdominal domain and elasticity and preventing the primary closure of the abdominal wall. This study aimed to describe a technique for the closure of the abdominal wall after IT without using prostheses. Methods: Four patients underwent IT with the impossibility of primary closure of the abdominal wall. We describe a novel technique, associating a series of vacuum-assisted closure dressings, components separation, and relaxation incisions. Results: All patients presented a successful closure of the abdominal wall with the described technique, with no complications related to the abdominal wall. Conclusion: The technique proved to be safe, effective, and reproducible as an option for abdominal wall closure after IT. Employing this technique in a greater number of cases is necessary to confirm these results.
RESUMEN
OBJETIVOS: Analisar o conhecimento e a opinião de estudantes de medicina sobre doação e transplante de órgãos. MÉTODOS: Trezentos e quarenta e sete estudantes responderam, voluntariamente, questionário com 17 perguntas sobre doação e transplante de órgãos. Eles foram avaliados globalmente, para verificar tendências gerais, e agrupados de acordo com o seu ano no curso médico (primeiro ao sexto), para avaliar diferenças entre os períodos. Alunos do quinto e sexto ano foram reunidos em um só grupo. Os resultados foram analisados pelo teste Qui quadrado. RESULTADOS: A intenção de ser doador post mortem foi de 89 por cento e intervivo de 90 por cento, contudo, apenas 62 por cento sabiam dos riscos da doação intervivo. Entre os 347 estudantes, 70 por cento admitiram conhecimento regular, ruim ou péssimo do assunto, 90,2 por cento consideraram importante o tema transplante para a graduação médica, 76,9 por cento consideraram o consentimento informado/expresso como o melhor critério de doação e 64,3 por cento optaram pela gravidade da doença do paciente como melhor forma de alocação. O entendimento sobre transplante aumentou conforme o avanço no curso de graduação. Estudantes do quarto, quinto e sexto ano adotaram atitude negativa, em comparação aos dos anos iniciais, quanto à doação de órgãos para pacientes alcoólatras, não doadores, usuários de drogas ilícitas, estrangeiros e criminosos. CONCLUSÃO: Este trabalho demonstrou grande interesse e atitude positiva dos estudantes de medicina sobre doação e transplante de órgãos, embora a maioria tenha declarado conhecimento deficiente sobre o tema. Observamos também atitude negativa dos estudantes do quarto, quinto e sexto ano médico em relação à doação para alcoólatras, não doadores, usuários de drogas ilícitas, estrangeiros e criminosos.
We analyzed the opinion and understanding of medical students about organ donation and transplantation. METHODS: 347 students voluntarily completed a questionnaire with 17 queries concerning organ donation and transplantation. They were analyzed to identify general tendencies and divided into five groups, according to their year of study (first through sixth year), to assess differences among the years. Students of the fifth and sixth years were placed in the same group. RESULTS:were analyzed by the Chi-square test. RESULTS: The intention to become a post mortem or living donor was of 89 percent and 90 percent respectively; however, only 62 percent were aware of living donation risks. 70 percent of the 347 students admitted regular or little knowledge of the subject, 90.2 percent considered organ transplantation an important issue for a medical graduation program, 76.9 percent considered informed/expressed consent the best organ donation criterion and 64.3 percent of them chose severity of patient disease as the best allocation condition. As students progressed in their studies their understanding about transplantation improved. Students of the fourth, fifth and sixth year manifested a negative attitude about organ donation to alcohol addicts, non donors, drug users, law offenders and foreigners. CONCLUSION: This data show the great interest and positive attitude of medical students toward organ donation and transplantation, despite the fact that most of them admitted having insufficient knowledge on the subject. A negative attitude by students of the fourth, fifth and sixth year on organ donation to alcohol addicts, non donors, drug users, law offenders and foreigners was also observed.