Liver transplantation using University of Wisconsin or Celsior preserving solutions in the portal vein and Euro-Collins in the aorta.

INTRODUCTION: Orthotopic liver transplantation (OLT) is today the gold standard treatment of the end-stage liver disease. Different solutions are used for graft preservation. Our objective was to compare the results of cadaveric donor OLT, preserved with the University of Wisconsin (UW) or Celsior solutions in the portal vein and Euro-Collins in the aorta. METHODS: We evaluated retrospectively 72 OLT recipients, including 36 with UW solution (group UW) and 36 with Celsior (group CS). Donors were perfused in situ with 1000 mL UW or Celsior in the portal vein of and 3000 mL of Euro-Collins in the aortia and on the back table managed with 500 mL UW or Celsior in the portal vein, 250 mL in the hepatic artery, and 250 mL in the biliary duct. We evaluated the following variables: donor characteristics, recipient features, intraoperative details, reperfusion injury, and steatosis via a biopsy after reperfusion. We noted grafts with primary nonfunction (PNF), initial poor function (IPF), rejection episodes, biliary duct complications, hepatic artery complications, re-OLT, and recipient death in the first year after OLT. RESULTS: The average age was 33.6 years in the UW group versus 41 years in the CS group (P = .048). There was a longer duration of surgery in the UW group (P = .001). The other recipient characteristics, ischemia-reperfusion injury, steatosis, PNF, IPF, rejection, re-OLT, and recipient survival were not different. Stenosis of the biliary duct occured in 3 (8.3%) cases in the UW group and 8 (22.2%) in the CS (P = .19) with hepatic artery thrombosis in 4 (11.1%) CS versus none in the UW group (P = .11). CONCLUSION: Cadaveric donor OLT showed similar results with organs preserved with UW or Celsior in the portal vein and Euro-Collins in the aorta.

Effect of frequency of static stretching on flexibility, hamstring tightness and electromyographic activity

We compared the effect of the number of weekly repetitions of a static stretching program on the flexibility, hamstring tightness and electromyographic activity of the hamstring and of the triceps surae muscles. Thirty-one healthy subjects with hamstring tightness, defined as the inability to perform total knee extension, and shortened triceps surae, defined by a tibiotarsal angle wider than 90° during trunk flexion, were divided into three groups: G1 performed the stretching exercises once a week; G2, three times a week, and G3, five times a week. The parameters were determined before and after the stretching program. Flexibility improved in all groups after intervention, from 7.65 ± 10.38 to 3.67 ± 12.08 in G1, from 10.73 ± 12.07 to 0.77 ± 10.45 in G2, and from 14.20 ± 10.75 to 6.85 ± 12.19 cm in G3 (P < 0.05 for all comparisons). The increase in flexibility was higher in G2 than in G1 (P = 0.018), while G2 and G3 showed no significant difference (G1: 4 ± 2.17, G2: 10 ± 5.27; G3: 7.5 ± 4.77 cm). Hamstring tightness improved in all groups, from 37.90 ± 6.44 to 29 ± 11.65 in G1, from 39.82 ± 9.63 to 21.91 ± 8.40 in G2, and from 37.20 ± 6.63 to 26.10 ± 5.72° in G3 (P < 0.05 for all comparisons). During stretching, a statistically significant difference was observed in electromyographic activity of biceps femoris muscle between G1 and G3 (P = 0.048) and G2 and G3 (P = 0.0009). No significant differences were found in electromyographic activity during maximal isometric contraction. Stretching exercises performed three times a week were sufficient to improve flexibility and range of motion compared to subjects exercising once a week, with results similar to those of subjects who exercised five times a week.

Effect of frequency of static stretching on flexibility, hamstring tightness and electromyographic activity.

We compared the effect of the number of weekly repetitions of a static stretching program on the flexibility, hamstring tightness and electromyographic activity of the hamstring and of the triceps surae muscles. Thirty-one healthy subjects with hamstring tightness, defined as the inability to perform total knee extension, and shortened triceps surae, defined by a tibiotarsal angle wider than 90 degrees during trunk flexion, were divided into three groups: G1 performed the stretching exercises once a week; G2, three times a week, and G3, five times a week. The parameters were determined before and after the stretching program. Flexibility improved in all groups after intervention, from 7.65 +/- 10.38 to 3.67 +/- 12.08 in G1, from 10.73 +/- 12.07 to 0.77 +/- 10.45 in G2, and from 14.20 +/- 10.75 to 6.85 +/- 12.19 cm in G3 (P < 0.05 for all comparisons). The increase in flexibility was higher in G2 than in G1 (P = 0.018), while G2 and G3 showed no significant difference (G1: 4 +/- 2.17, G2: 10 +/- 5.27; G3: 7.5 +/- 4.77 cm). Hamstring tightness improved in all groups, from 37.90 +/- 6.44 to 29 +/- 11.65 in G1, from 39.82 +/- 9.63 to 21.91 +/- 8.40 in G2, and from 37.20 +/- 6.63 to 26.10 +/- 5.72 degrees in G3 (P < 0.05 for all comparisons). During stretching, a statistically significant difference was observed in electromyographic activity of biceps femoris muscle between G1 and G3 (P = 0.048) and G2 and G3 (P = 0.0009). No significant differences were found in electromyographic activity during maximal isometric contraction. Stretching exercises performed three times a week were sufficient to improve flexibility and range of motion compared to subjects exercising once a week, with results similar to those of subjects who exercised five times a week.

Migration of transjugular intrahepatic portosystemic shunt to the right atrium: complications in the intraoperative period of liver transplantation.

This article reports the case of a patient who underwent transjugular intrahepatic portosystemic shunt, which migrated to the right atrium. During liver transplantation, the extracardiac portion was sectioned and the portion adherent inside the atrium was managed expectantly.

Efeitos do alongamento muscular e condicionamento físico no tratamento fisioterápico de pacientes com fibromialgia / Effects of muscle stretching and physical conditioning as physical therapy treatment for patients with fibromyalgia

OBJETIVO: Verificar os efeitos de exercícios de alongamento muscular e condicionamento físico no tratamento fisioterápico da fibromialgia (FM). CASUÍSTICA E MÉTODOS: Foram avaliadas 15 mulheres com diagnóstico de FM, segundo os critérios do Colégio Americano de Reumatologia, divididas em dois grupos: Grupo 1 (G1) com oito pacientes, realizou tratamento por meio de alongamentos musculares e Grupo 2 (G2), sete pacientes, condicionamento físico. Foram avaliados qualidade do sono, fatores de piora e melhora da dor, sintomas associados e medicamentos utilizados. Além disso, foi aplicado o Fibromyalgia Impact Questionnaire (FIQ), para avaliar o impacto da FM. O tratamento durou oito semanas, sendo uma sessão semanal com duração de 40 a 45 minutos. As variáveis do FIQ antes e depois dos tratamentos foram comparadas pelo teste t para amostras dependentes (alfa< 0,05) e as demais foram analisadas descritivamente. RESULTADOS: A maioria das pacientes apresentava sono não reparador (86,67 por cento), piora da dor com serviços domésticos (40 por cento), nenhum fator de melhora da dor (28,57 por cento), distúrbios do sono como sintomas associados (100 por cento) e utilizava antidepressivos (69,23 por cento). Em relação às variáveis do FIQ, observaram-se diferenças estatisticamente significantes no sono (p= 0,0428) e rigidez matinal (p= 0,0130) nas pacientes do G1. Já no G2, não foram observadas diferenças significantes após o tratamento. CONCLUSÕES: Sugere-se que os alongamentos musculares realizados podem gerar impacto positivo na FM, promovendo melhora do sono e rigidez matinal das pacientes avaliadas.

OBJECTIVE: To investigate the effects of muscle stretching exercises and physical conditioning as physical therapy treatment for fibromyalgia. METHODS: Fifteen women with a diagnosis of fibromyalgia in accordance with the criteria of the American College of Rheumatology were evaluated and divided into two groups: Group 1 (G1, eight patients) underwent treatment consisting of muscle stretching and Group 2 (G2, seven patients), participated in a physical conditioning program. Sleep quality, pain-modulating factors, associated symptoms and medications used were evaluated. Furthermore, the Fibromyalgia Impact Questionnaire (FIQ) was applied to evaluate the impact of fibromyalgia. The treatment lasted for eight weeks, with one session per week of 40 to 45 minutes in duration. The FIQ data obtained before and after treatment were analyzed by means of Student's t test for dependent samples (alpha< 0.05) and other variables were analyzed descriptively. RESULTS: Most of the patients presented poor quality of sleep (86.67 percent). Many presented worsening of their pain when doing domestic tasks (40 percent) and there were no factors that relieved their pain (28.57 percent). All presented sleep disorders with associated symptoms (100 percent) and most used antidepressives (69.23 percent). For the FIQ data, statistically significant differences were observed in morning tiredness (p= 0.0428) and stiffness (p= 0.0130) among the G1 patients. Conversely, no difference was observed in G2 after the treatment. CONCLUSIONS: It is suggested that the muscle stretching may have had a positive impact on fibromyalgia, with reductions in morning tiredness and stiffness among the patients evaluated.

Complications following transjugular intrahepatic portosystemic shunt: a retrospective analysis.

Transjugular intrahepatic portosystemic shunt (TIPS) has been the therapeutic option for severe decompensation of chronic liver disease and as a bridge to liver transplantation. The aim of this study was to analyze the complications of this procedure. The records of 47 patients (39 men) of mean age 48 years underwent TIPS procedures from 1998 to 2003 were reviewed. Forty-one patients received 45 successful TIPS; it failed in six patients. Improvement was observed in 20 of 28 patients with upper gastrointestinal bleeding (71%); 9 of 11 with ascites (82%); and 5 of 8 with impaired renal function (62%). The Child-Pugh scores improved in 6 of the 47 patients (13%). Transplantation was performed in 11 patients (23%). The complications were: encephalopathy (49%); infection (19%); renal failure (17%); TIPS migration to the portal vein (4%) and to the right atrium (4%). Mortality was 32% (15/47) over 3 months. Eight patients developed active bleeding during TIPS installation requiring mechanical ventilation and intensive care, and died within the first week. Other causes of death were sepsis (n = 2), liver failure (n = 1), accidental puncture of the Glisson's capsule leading to intra-abdominal bleeding (n = 1) and refractory upper gastrointestinal bleeding (n = 3). The latter four patients had TIPS placement failure. In conclusion, TIPS produced clinical improvement among 51% of patients with complications in 49%. The main complications were encephalopathy (49%), infection (19%), and renal failure (17%). The 3-month mortality rate after TIPS placement was 32%.

Recuperacao funcional de individuos com disfuncao femoro-patelar por meio de exercicios em cadeia cinetica fechada: revisao da literatura / Functional recovery of patients suffering from patellofemoral dysfunction through closed kinetic chain exercices

A disfuncao femoro-patelar constitui importante lesao musculo-esqueletica, acometendo adultos jovens e uma grande porcentagem de atletas. Varios fatores etiologicos estao envolvidos nessa patologia da articulacao femoro-patelar, a qual e estabilizada principalmentepor estruturas dinamicas - musculos. Somente apos o correto conhecimento dos estabilizadores dinamicos da articulacao femoro-patelar e dos principais fatores envolvidos em sua etiologia pode-se prescrever um correto protocolo de exercicios na reabilitacao funcional. Dentre os mais utilizados estao os exercicios em cadeia cinetica fechada, realizados com o segmento distal do membro inferior fixo. Exemplos desses exercicios sao o agachamento e os exercicios realizados no leg-press e no step. Apesar de varios estudos terem analisado os estabilizadores dinamicos da articulacao femoro-patelar nesses exercicios em cadeia cinetica fechada, faltam evidencias cientificas que comprovem o aumento da hipertrofia ou do desempenho muscular. Dessa forma, mais estudos biomecanicos, anatomicos e eletromiograficos tornam-se necessarios para embasar em cadeia cinetica fechada na reabilitacao de pacientes com disfuncao femoro-patelar

Monoassociation with Lactobacillus acidophilus UFV-H2b20 stimulates the immune defense mechanisms of germfree mice

Probiotics are formulations containing live microorganisms or microbial stimulants that have some beneficial influence on the maintenance of a balanced intestinal microbiota and on the resistance to infections. The search for probiotics to be used in prevention or treatment of enteric infections, as an alternative to antibiotic therapy, has gained significant impulse in the last few years. Several studies have demonstrated the beneficial effects of lactic acid bacteria in controlling infection by intestinal pathogens and in boosting the host's nonspecific immune response. Here, we studied the use of Lactobacillus acidophilus UFV-H2b20, a lactic acid bacterium isolated from a human newborn from Viçosa, Minas Gerais, Brazil, as a probiotic. A suspension containing 108 cells of Lactobacillus acidophilus UFV-H2b20 was inoculated into groups of at least five conventional and germfree Swiss mice to determine its capacity to stimulate the host mononuclear phagocytic activity. We demonstrate that this strain can survive the stressing conditions of the intestinal tract in vivo. Moreover, the monoassociation of germfree mice with this strain for seven days improved the host's macrophage phagocytic capacity, as demonstrated by the clearance of a Gram-negative bacterium inoculated intravenously. Monoassociated mice showed an undetectable number of circulating E. coli, while 0.1 percent of the original inoculum was still present in germfree animals. Mice treated with viable or heat-killed Lactobacillus acidophilus UFV-H2b20 presented similarly improved clearance capacity when compared with germfree controls. In addition, monoassociated mice had twice the amount of Kupffer cells, which are responsible for the clearance of circulating bacteria, compared to germfree controls. These results suggest that the L. acidophilus strain used here stimulates a nonspecific immune response and is a strong candidate to be used as a probiotic

Monoassociation with Lactobacillus acidophilus UFV-H2b20 stimulates the immune defense mechanisms of germfree mice.

Probiotics are formulations containing live microorganisms or microbial stimulants that have some beneficial influence on the maintenance of a balanced intestinal microbiota and on the resistance to infections. The search for probiotics to be used in prevention or treatment of enteric infections, as an alternative to antibiotic therapy, has gained significant impulse in the last few years. Several studies have demonstrated the beneficial effects of lactic acid bacteria in controlling infection by intestinal pathogens and in boosting the host's nonspecific immune response. Here, we studied the use of Lactobacillus acidophilus UFV-H2b20, a lactic acid bacterium isolated from a human newborn from Viçosa, Minas Gerais, Brazil, as a probiotic. A suspension containing 10(8) cells of Lactobacillus acidophilus UFV-H2b20 was inoculated into groups of at least five conventional and germfree Swiss mice to determine its capacity to stimulate the host mononuclear phagocytic activity. We demonstrate that this strain can survive the stressing conditions of the intestinal tract in vivo. Moreover, the monoassociation of germfree mice with this strain for seven days improved the host's macrophage phagocytic capacity, as demonstrated by the clearance of a Gram-negative bacterium inoculated intravenously. Monoassociated mice showed an undetectable number of circulating E. coli, while 0.1% of the original inoculum was still present in germfree animals. Mice treated with viable or heat-killed Lactobacillus acidophilus UFV-H2b20 presented similarly improved clearance capacity when compared with germfree controls. In addition, monoassociated mice had twice the amount of Kupffer cells, which are responsible for the clearance of circulating bacteria, compared to germfree controls. These results suggest that the L. acidophilus strain used here stimulates a nonspecific immune response and is a strong candidate to be used as a probiotic.