Enteric conversion after bladder drained pancreas transplantation experience of 14 cases.

The method of exocrine diversion in pancreas allograft continues to be controversial due to the advantages versus disadvantages of bladder versus enteric techniques. Bladder drainage (BD) exposes the patient to urological and metabolic problems that may require conversion to enteric drainage (ED). The purpose of this study was to review our initial experience of conversion from BD to ED for patients who underwent pancreas transplantation originally with bladder diversion. Among 114 pancreas transplantation performed with BD, from January 1996 to April 2003, 60 were simultaneous pancreas-kidney transplantation (SPKT), 35 were pancreas transplantation alone (PA), and 19 were pancreas after kidney transplantations (PAK). Twenty-three (20.2%) cases were excluded due to early death of the patient or the graft, yielding an analyses of 91 patients. Enteric conversion (EC) was performed in 14 (15.4%) patients with a mean follow-up of 15.7 months (range, 3-51 months) after transplantation including 8 (8.8%) SPKT, 4 (4.4%) PAK, and 2 (2.2%) PA. No surgical morbidity or mortality was observed related to EC. All patients had complete resolution of the initial problem with preservation of pancreatic function. EC represents an easy, safe procedure with low morbidity and mortality rates, representing the option of choice for patients with persistent urological or metabolic disturbances.

Glycemic control during pancreas transplantation: continous infusion versus bolus.

Pancreas transplantation is a method to restore endogenous insulin secretion in insulin-dependent diabetic patients. Because glycemia >150 mg/dL may harm pancreatic graft beta cells, early glucose control using insulin administration is recommended during transplantation. The aim of this study was to evaluate the benefits of strict glycemic control during pancreas transplantation by comparing two types of insulin and glucose administration: continuous infusion and bolus. Capillary glucose was measured every 30 minutes after anesthetic induction for pancreas transplantation alone or simultaneously with kidney transplantation. Intravenous regular insulin was administered for values >150 mg/dL or glucose for values <100 mg/dL. The following timepoints were evaluated: anesthetic induction, before pancreatic graft reperfusion, and the first 4 minutes after reperfusion. Pancreatic graft ischemia time was significantly lower in the bolus group (P <.02). Immediately after reperfusion, there was a small increase in glycemia with a decrease in subsequent measurements in both groups. No significant difference in glycemia was observed between the groups at any time. Induction values were greater than all other timepoints in both groups. Glycemic control is important; it was successfully obtained with both methods. The trend to decrease glucose after reperfusion suggest early graft function.

Tratamento da síndrome de Budd-Chiari com trombose de veia cava inferior por anastomose mesoatrial / Treatment of Budd-Chiari syndrome with venous cava thrombosis by mesoatrial shunt

A Síndrome de Budd-Chiari (SBC) é uma doença rara, ocorre com maior frequência nos adultos, não havendo predominância de sexo e é mais comum nos países do leste asiático. Relatamos o tratamento cirúrgico de paciente com SBC e trombose de veia cava. Paciente do sexo masculino, 29 anos, com Síndrome de Budd-Chiari consequente a trombose de veia cava inferior (VCI). Apresentava função hepática preservada, esplenomegalia, gastropatia congestiva com vários episódios de hemorragia digestiva alta e fígado com fibrose. Optou-se por realizar anastomose mesoatrial (AMA). Concluímos que AMA foi eficaz na descompressão hepática e resultou no desaparecimento dos sinais e sintomas da SBC além de ser seguida de melhora das provas de função hepática do paciente num seguimento de 8 meses