RESUMO
BACKGROUND: Although pancreas transplantation (PT) is the treatment of choice in selected diabetic patients, the International Pancreas Transplant Registry (IPTR) has reported important differences in activity between USA and Europe. Of all cases reported, 75% are from USA and only 23% from Europe. Therefore, an analysis of PT activity in selected European countries (SEC) and USA was performed. Materials and methods. We compared national data reports (2002-06) of deceased donors (DD) and deceased solid organ transplantation (DSOT), with special attention to PT activity from 13 SEC countries (375 million inhabitants) and USA (298 million inhabitants). RESULTS: The number of PT performed in USA was 2-fold higher than in SEC, with the annual rate >2.4 times higher in USA [5.08-4.64 versus 1.61-1.91 per million population (p.m.p.)]. DD and other DSOT activity rates were only slightly higher in USA. In SEC, important differences in PT activity rate were found between countries in the same year (0-6.21 p.m.p.) and in the same country between different years (6.21-2.47 p.m.p.), unrelated to DD or other DSOT activity rate. PT activity rate increased in SEC from 1.61 to 1.91 p.m.p. but decreased in six countries. The waiting list for PT at the end of 2006 was almost 2-fold higher in USA than in SEC. CONCLUSIONS: Differences in PT activity rate between 13 SEC countries and USA were not related to DD or other DSOT activity. Different waiting list inclusion criteria or incidence of diabetes complications may be considered in more specific studies.
Assuntos
Transplante de Pâncreas/estatística & dados numéricos , Sistema de Registros , Europa (Continente) , Humanos , Estudos Retrospectivos , Doadores de Tecidos , Estados Unidos , Listas de EsperaAssuntos
Neoplasias Intestinais/complicações , Obstrução Intestinal/etiologia , Melanoma/complicações , Feminino , Humanos , Mucosa Intestinal , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We report the case of a 62-year-old patient with congenital interruption of the inferior vena cava and azygos continuation who required transthoracic esophagectomy to remove a tumor in the middle esophagus. The consequences of dividing an enlarged azygos vein in this kind of patient are reported and discussed.
Assuntos
Veia Ázigos/anormalidades , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Carcinoma de Células Escamosas/patologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/irrigação sanguínea , Junção Esofagogástrica/patologia , Esofagoscopia , Seguimentos , Gastroscopia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Medição de Risco , Toracotomia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: In selected type 1 diabetic (T1DM) patients with end-stage renal disease (ESRD), simultaneous pancreas-kidney transplantation (SPKT) offers higher long-term graft and patient survival, but also higher initial morbidity and mortality than cadaveric kidney transplantation alone (CKTA). The development of new immunosuppressive regimens and surgical approach has improved this initial outcome, but little is known about their effect on short-term renal function and surgical complications related to the renal graft. METHODS: We analysed retrospectively the short-term follow-up of 45 T1DM patients consecutively transplanted during 42 months (20 SPKT and 25 CKTA) in order to compare short-term (6 months) renal allograft function and surgical complications related to the renal allograft in both groups. RESULTS: There were no differences in donor characteristics. SPKT recipients had a significantly shorter time on dialysis and cold ischaemia time, with a higher number of HLA mismatches. There was no difference in acute rejection incidence, but delayed kidney graft function was less frequent in SPKT (5% vs 32%; P<0.05). Plasma creatinine level at discharge and 6 months was significantly lower in SPKT (1.1+/-0.3 vs 1.6+/-0.7; P<0.005 and 1.1+/-0.3 vs 1.5+/-0.6; P<0.05, respectively). There were no differences in surgical renal complications (haemorrhage, thrombosis or arterial stenosis, ureter leaks or stricture, lymphoceles or dehiscences). Two SPKT patients needed reintervention on the renal allograft and only one CKTA patient. CONCLUSIONS: In the modern transplant era, SPKT in ESRD diabetic patients, offers a slightly better short-term kidney allograft function without significant increase in surgical morbidity, compared with CKTA.