ABSTRACT
BACKGROUND: Primary sclerosing cholangitis (PSC) manifests within a broad ethnic and racial spectrum, reflecting different levels of access to health care. AIM: To evaluate the clinical profile, complications and survival rates of patients with PSC undergoing liver transplantation (LTx) at a Brazilian reference center. METHODS: All patients diagnosed with PSC before or after LTx were included. The medical records were reviewed for demographic and clinical variables, including outcomes and survival. The level of statistical significance was set at P < 0.05. RESULTS: Our cohort represented 1.6% (n = 34) of the 2113 patients receiving liver grafts at our service over the past two decades. Most were male (n = 19; 56%). The average age (40 ± 14 years) was similar for men and women (P = 0.347). The mean follow-up time from diagnosis to LTx was 68 mo. Most patients had the classic form of PSC. Three women had PSC/autoimmune hepatitis overlap syndrome, and one patient had small-duct PSC. Alkaline phosphatase levels at diagnosis and pre-LTx model for end-stage liver disease. scores were significantly higher in males. Inflammatory bowel research (IBD) was investigated by colonoscopy in 26/34 (76%) and was present in most cases (18/26; 69%). IBD was less common in women than in men (44.4% vs. 55.6%) (P = 0.692). Cholangiocarcinoma (CCA) was diagnosed in 2/34 (5.9%) patients by histopathology of the explant (survival: 3 years 6 mo, and 4 years 11 mo). Two patients had complications requiring a second LTx (one after 7 d due to hepatic artery thrombosis and one after 17 d due to primary graft dysfunction). Five patients (14.7%) developed biliary stricture. The overall median post-LTx survival was 66 mo. Most deaths occurred in the first year (infection n = 2, primary liver graft dysfunction n = 3, unknown cause n = 1). The 1-year and 5-year survival rates of this cohort were 82.3% and 70.6%, respectively, matching the mean overall survival rates of LTx patients at our center (87.1% and 69.43%, respectively) (P = 0.83). CONCLUSION: Survival after 1 and 5 years was similar to that of other LTx indications. The observed CCA survival rate suggests CCA may be an indication for LTx in selected cases.
ABSTRACT
Objetivo: realizar uma revisão na literatura para caracterizar o perfil epidemiológico das lesões traumáticas provocadas pela prática dessa modalidade. Metodologia: realizou-se uma revisão narrativa da literatura acerca das lesões decorrentes da prática esportiva do kitesurf na base de dados da Scielo, Ovid MEDLINE e Google Scholar de artigos de janeiro de 2000 a dezembro de 2022. Resultados: foram eleitos 14 artigos que se ajustaram aos objetivos dessa revisão. Mediante análise dos artigos, foram encontradas discussões que direcionam os principais mecanismos de trauma, riscos de lesões, estruturas mais frequentemente acometidas e propostas para minimizar os danos e a recuperação. Conclusão: as lesões que podem acometer os praticantes deste esporte aquático, em sua maioria, são leves e principalmente nos membros inferiores; entretanto, podem ser letais, o que desperta a necessidade de maior investigação epidemiológica e clínica dos casos atendidos, bem como a adoção de medidas de prevenção.
Objective: the objective of this study is to conduct a literature review to characterize the epidemiological profile of traumatic injuries caused by the practice of this modality. Methods: a narrative review of the literature was carried out on injuries resulting from the practice of kitesurfing in the database of Scielo, Ovid MEDLINE, and Google Scholar articles from January 2000 to December 2022. Results: 14 articles were chosen that suited the objectives of this review. Through the analysis of the articles, discussions were found that guide the main mechanisms of trauma, risk of injuries, structures most frequently affected, and proposals to minimize damage and recovery. Conclusion: the injuries that can affect practitioners of this aquatic sport are mostly mild and mainly in the lower members; however, they can be lethal, which raises the need for further epidemiological and clinical investigation of the cases treated, as well as the adoption of measures of prevention.
