A study regarding the anterior cruciate ligament remnant: Differences in balance and postural control between remnant-preserving and remnant-non-preserving patients.

INTRODUCTION: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. However, quantitative studies on evaluate the postural control influence resulted from the ACL remnant preservation or not are scarce. The aim of this study is to evaluate the postural control of patients submitted to ACL reconstruction with and without preservation of the injured remnant in pre and postoperative periods. METHODS: Eighteen patients underwent ACL reconstruction and separated into 2 groups according to the preservation or not of the remnant: (I) submitted to ACL reconstruction with preservation of the remnant (10 patients); (II) submitted to ACL reconstruction without preservation of the remnant (8 patients). They were assessed using the Lysholm score and force plate, which evaluated the patient's postural stability for remnant and non-remnant preservation in ACL reconstruction surgery. RESULTS: Group I showed statistically significant subjective and objective improvements, both at 3 and 6 months. Additionally, improvement of the Lysholm test at 6 months in Group II was also statistically significant. Furthermore, the results of the Friedman test for the VCOP and VY variables of Group I, with support of the injured side in the force plate, showed a statistically significant difference both for pre and postoperative period at 3 months, compared to the 6-month postoperative period. The variables EAC and VX were statistically different for Group II, considering the preoperative period, 3 and 6 months postoperatively. CONCLUSION: Preserving the ACL remnant in patients with ACL injuries has a positive impact on postural stability during recovery.

Physical and physiological soybean seed qualities stored under different environmental conditions and storage bag depths.

The Brazilian Midwest is responsible for 54.3% of the country's soybean production. Adequate storage technologies are essential to maintain physical, physiological, and sanitary seed qualities while also minimizing deterioration processes and consequent germination and vigor declines. In this context, the aim of the present study was to evaluate the physiological potential and physical qualities of soybean seeds stored under different environmental conditions and storage bag depths. Assays were carried out in September 2021 employing Foco 74i77 RSF IPRO cultivar seeds stored from April to August 2021 under three conditions, as follows: chilled at an average temperature of ≤20 °C, at an average temperature of ≤25 °C using a with blanket, and in without blanket warehouse structure at an average temperature of ≥25 °C with no with blanket. A completely randomized 3x3 factorial experimental design was applied, comprising three storage environments and three bag positions (top, middle, and bottom), with three replication each. Physical, physiological, and biochemical tests were performed on the stored seeds. The findings indicate better seed preservation in the chilled environment or when using a with blanket, with significant differences noted for seeds stored the middle of the storage bag. Therefore, soybean seed storage in a chilled environment or using a with blanket aids in slowing down the seed deterioration processes, preserving physiological quality and vigor compared to a conventional storage environment. Additionally, the quality of soybean seeds stored under these conditions in the middle of storage bags is maintained.

Comparative study of the physiological and health quality of traditional and biofortified cowpea seeds.

Cowpea is one of the main crops in family agriculture, especially in the Northeastern region of Brazil, and it is expanding to other regions in Brazil. The use of seeds with low physiological and health quality is reflected in the plant development and consequently yield, making it important to study the seed physiological and health quality. The objective of the present study was to assess the physiology and health of traditional and biofortified cowpea seeds. The traditional cowpea varieties (Angelim, Mercado and Manteguinha) and the biofortified cowpea cultivars (BRS Aracê, BRS Xique-Xique and BRS Tumucumaque) were assessed for the following physiological parameters: water content (WC), first count (FC), germination test (G), germination speed index (GSI), seedling emergence in the greenhouse (E), emergence speed index (ESI), seedling aerial part and root length (APL and RL) and electric conductivity test (EC). The seed health quality was assessed by the Blotter Test. The water content present in the seeds of the traditional and biofortified varieties ranged from 10% to 14%. All the traditional and biofortified varieties showed high germination and emergence value in the greenhouse. The germination and emergence speed indexes indicated the BRS Aracê and BRS Xique-Xique cultivars as the most vigorous. In the health tests the highest indexes were the storage fungi Aspergillus sp., Cladosporium sp. and Penicillium sp., with the highest prevalence in the BRS Tumucumaque variety, which was probably related to the higher water content present in this variety.

Mitochondrial genome analysis in penile carcinoma.

Penile cancer is a rare neoplasm that seems to be linked to socio-economic differences. Mitochondrial genome alterations are common in many tumors types and are reported as regulating oxidative metabolism and impacting tumorigenesis. In this study, we evaluate for the first time the mitochondrial genome in penile carcinoma (PeCa), aiming to evaluate heteroplasmy, mitochondrial DNA (mtDNA) mutational load and mtDNA content in Penile tumors. Using next generation sequencing (NGS), we sequenced the mitochondrial genome of 13 penile tumors and 12 non-neoplastic tissue samples, which allowed us to identify mtDNA variants and heteroplasmy. We further evaluated variant's pathogenicity using Mutpred predictive software and calculated mtDNA content using quantitative PCR. Mitochondrial genome sequencing revealed an increase number of non-synonymous variants in the tumor tissue, along with higher frequency of heteroplasmy and mtDNA depletion in penile tumors, suggesting an increased mitochondrial instability in penile tumors. We also described a list of mitochondrial variants found in penile tumor and normal tissue, including five novel variants found in the tumoral tissue. Our results showed an increased mitochondrial genome instability in penile tumors. We also suggest that mitochondrial DNA copy number (mtDNAcn) and mtDNA variants may act together to imbalance mitochondrial function in PeCa. The better understanding of mitochondrial biology can bring new insights on mechanisms and open a new field for therapy in PeCa.

Profile of organ donors in Ceará, northeastern Brazil, from 1998 to 2012.

The use of cadaver donors for transplantation is often the only alternative in the treatment of patients with organ failure. The purpose of this study was to draw a comprehensive profile of solid organ donors in Ceará, northeastern Brazil, from 1998 to 2012. The study was retrospective and based on secondary data regarding sex, age, blood typing, and cause of brain death obtained from the solid organ donor database of the Ceará Transplantation Center covering the period November 1998 to December 2012. During the study period, 976 donors (69% male) were used. Donors were distributed in 4 age groups as follows: 12.9% <18 years, 50.9% 18-40 years, 28.5% 41-60 years, and 7.7% >60 years. The average age was 35 ± 16 years. On the average, female donors were older than male donors (38.4 ± 17 y vs 33.5 ± 16 y; P < .0001). Men were predominant in the age groups 18-40 y (75.3%; P < .0001) and 41-60 y (59.4%; P < .0001). The main causes of brain death were traumatic brain injury (TBI) (56.7%) and stroke (33.1%). The former was more common in men (P < .0001), the latter in women (P < .0001). TBI was caused by traffic accidents (51.4%), of which 50.7% were motorcycle accidents, and urban violence (22.6%), of which 71.2% were associated with firearms. The number of donations increased in the study period (11.2 donors per million population in 1998-2002 to 68.1 in 2008-2012). In Ceará, solid organ donation is on the rise. The predominant donor profile was young men aged 18-40 years with brain death due to TBI caused by traffic accidents and urban violence.

Diurnal behavior of dairy cows on alfalfa pastures supplemented with corn silage and concentrate / Comportamento diurno de vacas leiteiras em pastagem de alfafa suplementada com silagem de milho e concentrado

The diurnal ingestive behavior of dairy cows on alfalfa pastures supplemented with corn silage and concentrate was evaluated. Sixteen Holstein dairy cows in mid-lactation were used in a randomized block design. The treatments were partial replacement of corn silage for limited alfalfa grazing time (LGT) or unlimited grazing time (UGT). Rotational alfalfa grazing was used and the amount of concentrate fed was the same in both treatments. Behavioral activities observed were time spent grazing, rumination and idleness, during four days, from 8:00 AM to 7:00 PM. From 2:00 to 5:00 PM grazing was intermittent and short-lasting on UGT, whereas on LGT grazing activity was longer than UGT in the morning and at the end of the afternoon. Restriction in available grazing time clearly influenced the distribution of time spent with grazing, rumination and idleness throughout the day. However, this effect was not observed in the total time spent in these activities...

Avaliou-se o comportamento ingestivo de vacas leiteiras com acesso restrito ou irrestrito a uma pastagem de alfafa suplementada com silagem de milho e concentrado. Utilizaram-se 16 vacas da raça Holandesa, em estádio médio de lactação, em delineamento em blocos ao acaso. Os tratamentos foram: silagem de milho substituída parcialmente por pastejo restrito ou irrestrito de alfafa. As vacas foram manejadas em sistema de pastejo rotacionado e a quantidade de concentrado foi igual em ambos os tratamentos. As atividades comportamentais observadas foram pastejo, ruminação e ócio, das oito às 19 horas, em quatro ocasiões. No pastejo irrestrito, observou-se que, nos horários entre 14 e 17 horas, o pastejo foi intermitente e de curta duração, enquanto no pastejo restrito a atividade de pastejo foi mais prolongada durante a manhã e no final da tarde. A restrição no tempo disponível para pastejo da alfafa influenciou marcadamente a distribuição, no decorrer do dia, do tempo gasto em pastejo, da ruminação e do ócio. Entretanto, não se observou este efeito no tempo total gasto nestas atividades...

Polyvinyl alcohol hydrogel irradiated and acetalized for osteochondral defect repair: mechanical, chemical, and histological evaluation after implantation in rat knees.

Polyvinyl Alcohol (PVA) hydrogel plugs were implanted in artificial osteochondral defects on the trochlear groove of rat knees. After 0, 3, 6, 12, and 24 weeks of followup, samples containing the implants were mechanically evaluated by creep indentation test, chemically, and histologically by optical microscopy. The mechanical test pointed towards an increase of the implant creep modulus and the chemical analysis exhibited an increasing concentration of calcium and phosphorus within the implants over time. Optical microscopy showed no foreign body reaction and revealed formation, differentiation, and maintenance of new tissue at the defect/implant interface. The absence of implant wear indicated that the natural articular lubrication process was not disturbed by the implant. The performance of the irradiated and acetalized PVA was considered satisfactory for the proposed application.

Kinetics of the inflammatory response in subcutaneous cysticercosis induced in mice by Taenia crassiceps.

The larval stage of Taenia crassiceps has been used to study human cysticercosis as these larvae have antigenic similarity to the cysticerci of Taenia solium. The aim of this study was to evaluate the histopathological and immunological changes that followed the inoculation of T. crassiceps cysticerci into the subcutaneous tissue of C57BL/6 mice. Microscopically, granulomas formed of neutrophils and macrophages developed at the sites of inoculation. The serum concentration of the cytokine interferon (IFN)-γ increased throughout the course of infection, while the serum concentration of interleukin-4 increased during the period of transition from the initial phase (7-30 days postinoculation [dpi]) to the late phase (60-90 dpi) of infection. Destruction of the parasite therefore appears to be associated with an increase in IFN-γ, suggesting that a type 1 immune response is important in the control of the parasite.

Why not to use kidney grafts from elderly donors.

BACKGROUND: Kidney transplantation is widely recognized as the best treatment in patients who require renal replacement therapy. Although considered a clinical and surgical triumph, it is also a source of frustration because of lack of donor organs and the growth of waiting lists. Strategies need to be developed to increase the supply of organs. One measure is use of expanded criteria for donation. OBJECTIVE: To evaluate the effect of donor age on cadaver graft survival. MATERIALS AND METHODS: We reviewed the medical records for 454 patients who underwent kidney transplantation with cadaver donors from April 1987 to December 2003. RESULTS: Donor age had a significant effect on kidney transplant survival. Survival of grafts from donors aged 16 to 40 years (mean, 143.30 months) was significantly greater compared with that of grafts from donors older than 40 years (66.46 months) (P = .005). The HLA matching and cold ischemia time did not significantly affect transplant survival (P = .98 and P = .16, respectively). CONCLUSIONS: Kidneys from cadaver donors older than 40 years significantly compromised graft survival, generating a negative effect via early return of recipients to waiting lists and increasing the rate of repeat transplantation, risk of death, and unnecessary costs.

Therapeutic option for infected urinary tract fistulas in renal transplantation.

BACKGROUND: Approximately 20% of urinary tract fistulas after renal allografting are complicated by urinary tract infection, which presents a therapeutic challenge. OBJECTIVE: To evaluate an option for treatment of urinary tract fistulas associated with urinary tract infection and unsuitable for minimally invasive or primary surgical urinary tract repair. PATIENTS AND METHODS: The study included 650 recipients who underwent transplantation over 17 years. Urinary leakage was initially treated with indwelling bladder catheterization. Patients with fistulas refractory to treatment underwent surgical intervention to repair the urinary tract. In patients who were not candidates for primary repair of the urinary tract, temporary urinary diversion was performed, rather than classic percutaneous or open nephrostomy, using a ureteral stent (ie, a 6F or 8F Foley catheter with the balloon placed inside the renal pelvis). RESULTS: Overall, urinary leakage occurred in 36 patients (5.5%). Conservative management was successful in 14 vesical fistulas (42.4%) and no ureteral fistulas (0%). Three patients died of sepsis during conservative treatment, before the new surgical approach. Five of 36 urinary leaks (13.9%) were managed using ureteral intubation with an 8F Foley catheter, with a success rate of 80%. CONCLUSION: Ureteral catheterization with an 8F Foley catheter is a feasible therapeutic option to treat complicated urinary tract fistulas unsuitable for primary surgical repair of the urinary tract.

Azithromycin inhibits vertical transmission of Toxoplasma gondii in Calomys callosus (Rodentia: Cricetidae).

Toxoplasma gondii infection during pregnancy may cause severe consequences to the embryo. Current toxoplasmosis treatment for pregnant women is based on the administration of spiramycin or a drug combination as sulphadiazine-pyrimethamine-folinic acid (SPFA) in cases of confirmed fetal infection. However, these drugs are few tolerated and present many disadvantages due to their toxic effects to the host. The aim of this study was to evaluate the effectiveness of different treatments on the vertical transmission of T. gondii, including azithromycin, Artemisia annua infusion, spiramycin and SPFA in Calomys callosus as model of congenital toxoplasmosis. C. callosus females were perorally infected with 20 cysts of T. gondii ME49 strain at the day that a vaginal plug was observed (1st day of pregnancy - dop). Treatment with azithromycin, A. annua infusion, and spiramycin started at the 4th dop, while the treatment with SPFA started at the 14th dop. Placenta and embryonic tissues were collected for morphological and immunohistochemical analyses, mouse bioassay and PCR from the 15th to 20th dop. No morphological changes were seen in the placenta and embryonic tissues from females treated with azithromycin, spiramycin and SPFA, but embryonic atrophy was observed in animals treated with A. annua infusion. Parasites were found in the placenta and fetal (brain and liver) tissues of animals treated with SPFA, A. annua infusion and spiramycin, although the number of parasites was lower than in non-treated animals. Parasites were also observed in the placenta of animals treated with azithromycin, but not in their embryos. Bioassay and PCR results confirmed the immunohistochemical data. Also, bradyzoite immunostaining was observed only in placental and fetal tissues of animals treated with SPFA. In conclusion, the treatment with azithromycin showed to be more effective, since it was capable to inhibit the vertical transmission of T. gondii in this model of congenital toxoplasmosis.

Antibodies to Neospora caninum and Toxoplasma gondii in domestic cats from Brazil.

The occurrence of antibodies to Neospora caninum and Toxoplasma gondii was determined in 400 domestic cats (Siamese, Persian, and undetermined breeds) from the Municipality of Araçatuba, Sao Paulo, Brazil, through the indirect fluorescence antibody test (IFAT). Of the 400 cats, 100 were seropositive to T. gondii (25%, titer > or =64) and 98 to N. caninum (24.5%, titer > or =16). The rate of seropositive cats for T. gondii was correlated with age (chi(2)=35.7; p<0.001), with a higher number of infected animals at older ages. Of the 219 cats younger than 1-year-old, 13.2% were seropositive for T. gondii, while 39.2% were positive in the 181 older animals. The presence of N. caninum was also correlated with age (/(2)=8.8; p<0.01), with 18.7% (41/219) and 31.5% (57/181) of positive animals at ages below and above 12-month, respectively. An association between the occurrences of both protozoa in the felines was also observed (chi(2)=19.6; p<0.001).

Effect of non-feeding period length on the intermittent operation of UASB reactors treating dairy effluents.

Recent environmental concerns have prompted a re-evaluation of conventional management strategies and refueled the search of innovative waste management practices. In this sense, the anaerobic digestion of both fat and the remaining complex organic matter present in dairy wastewaters is attractive, although the continuous operation of high rate anaerobic processes treating this type of wastewaters causes the failure of the process. This work accesses the influence of non-feeding period length on the intermittent operation of mesophilic UASB reactors treating dairy wastewater, in order to allow the biological degradation to catch up with adsorption phenomenon. During the experiments, two UASB reactors were subject to three organic loading rates, ranging from 6 to 12 g(COD) x L(-1) x d(-1), with the same daily load applied to both reactors, each one with a different non-feeding period. Both reactors showed good COD removal efficiencies (87-92%). A material balance for COD in the reactors during the feeding and non-feeding periods showed the importance of the feedless period, which allowed the biomass to degrade substrate that was accumulated during the feeding period. The reactor with the longest non-feeding period had a better performance, which resulted in a higher methane production and adsorption capacity for the same organic load applied with a consequent less accumulation of substrate into the biomass. In addition, both reactors had a stable operation for the organic load of 12 g(COD) x L(-1) x d(-1), which is higher than the maximum applicable load reported in literature for continuous systems (3-6 g(COD) x L(-1) x d(-1)).

Seroepidemiology of Toxoplasma gondii and Neospora caninum in dogs from the state of Paraíba, Northeast region of Brazil.

A cross-sectional study was conducted to determine the seroprevalence of anti-Toxoplasma gondii and anti-Neospora caninum antibodies and to investigate the risk factors related to antibodies against T. gondii and N. caninum in dogs of the city of Campina Grande, state of Paraiba, Northeast region of Brazil. For this purpose, 286 blood samples were collected from dogs during the rabies vaccination campaign, in September 2003, and on this occasion questionnaires addressing epidemiological aspects of the infections were given to each dog owner. The sera were analyzed for anti-T. gondii and anti-N. caninum antibodies by indirect fluorescent antibody tests. Of the total of 286 dogs, 129 were positive for T. gondii (titer16) with a prevalence value of 45.1% (95% CI=39.24-51.07%). For N. caninum, 24 dogs were positive (titer50), with a prevalence value of 8.4% (95% CI=5.45-12.23%). Antibodies to T. gondii and N. caninum were found simultaneously in 14 dogs (4.9%; 95% CI=2.7-8.08%). For T. gondii infection, the risk factors associated with seroprevalence was the age of the animals, with dogs older than one year presenting higher values of odds ratio, and co-habitation of cats in the household. For N. caninum infection, dogs that have street contact had higher odds of seropositivity than dogs that remained exclusively in a domestic environment.

Serological responses to Neospora caninum in experimentally and naturally infected water buffaloes (Bubalus bubalis).

The water buffalo (Bubalus bubalis) is an important natural host for Neospora caninum. Serologic responses to N. caninum were studied in experimentally and naturally infected water buffaloes in Brazil. Antibodies were assayed by the indirect fluorescent antibody test (IFAT) using a cut off value of 1:25. Six buffaloes were each inoculated subcutaneously with 5 x 10(6) live culture-derived tachyzoites of the cattle Illinois strain of N. caninum, and two calves were kept as uninoculated controls. Post-inoculation (p.i.) blood samples were collected weekly for 8 weeks and then monthly until 1 year p.i. All inoculated buffaloes developed IFAT titers of 1:100 or more between 7 and 11 days p.i. and the titers remained elevated until 7 weeks p.i. Antibody titers peaked to 1:1600 in 1, 1:800 in 3 and 1:400 in 2, usually by 3 weeks p.i. Antibody titers declined to 1:25 or 1:50 in all the six buffaloes by 12 months p.i. IFAT titers to N. caninum remained at an undetectable level (< 1:25) in both control uninoculated buffaloes. To follow the dynamics of N. caninum antibodies, sera from 29 buffaloes and their calves were collected for 1 year and assayed for N. caninum antibodies; 23 of 29 calves were seropositive (IFAT of 1:100 or more) at 1-2 day of age. Of these 23 calves, 17 remained seropositive during the study, while six became seronegative at four (two calves), six (one calf) seven (two calves) and eight (one calf) months of age. These findings suggest a high rate of neonatal transmission of N. caninum in buffaloes.

Identification and pathogenic characterization of endophytic Fusarium species from cowpea seeds.

Isolates of Fusarium were obtained and identified from seeds of cowpea, Vigna unguiculata (L.) Walp., by means of blotter tests and slide cultures. Species were differentiated according to the morphology of the macroconidia, microconidia and their arrangement in chains or false heads, the size and type of conidiophore, and the presence or absence of chlamydospores. The species were identified as F. semitectum, F. equiseti, F. oxysporum, F. solani, F. anthophilum, F. sporotrichioides, F. moniliforme, and Fusarium sp. Among the species, F. semitectum was the most frequently detected. None of these species were pathogenic when inoculated in susceptible cowpea cultivar (BR 17-Gurgueia). But, an isolate of F. oxysporum f. sp. tracheiphilum used as a standard of comparison for pathogenicity (control) induced symptoms of yellowing, vascular wilting, and death of a susceptible cowpea cultivar under the same environmental conditions.

Shedding of Neospora caninum oocysts by dogs fed tissues from naturally infected water buffaloes (Bubalus bubalis) from Brazil.

Attempts were made to isolate Neospora caninum from naturally infected water buffaloes (Bubalus bubalis) from Brazil. Brains from six buffaloes with indirect fluorescent antibodies (>1:100) to N. caninum were used to isolate the parasite by bioassay in dogs and gerbils followed by in vitro culture. Shedding of Neospora-like oocysts was noticed in dogs fed brains from three buffaloes (isolate designation NcBrBuf-1, 2 and 4). Two more isolates (NcBrBuf-3 and 5) were obtained by in vitro culture of the brains of gerbils previously infected with brains of two other buffaloes. The identity of the isolates was confirmed by biological and molecular methods. The isolates were found to be non-pathogenic to gerbils. All five isolates amplified the gene 5 amplicons using Neospora-specific PCR assay. The sequences of gene 5 fragments and the common toxoplasmatiid ITS-1 fragments were analyzed. The dynamics of oocyst production in the dogs indicate that water buffaloes are natural intermediate hosts for N. caninum. This is the first report of isolation of N. caninum from water buffaloes.

Transplante renal em bloco de doadores-cadáveres infantis: experiência do hcfmrp-usp

The high demand for organs for transplantation has made it necessary to consider using the youngest of potential donors in order to increase the organ supply. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. This is a chart review with the objective to analyse the results achieved with transplantation of children kidneys ( 2 years) in the HCFMRP-USP from 1998 to 2000. A total of 5 pacients received en bloc renal transplants from donors aged 9 months to 2 years old, weighthing between 8 and 14 kg. Results: Only one patient lost the allograft within 8 days of transplantation due to allograft trombosis. Two patients had ureteral complications, one with ureteral necrosis and urinary fistula and the other with total ureterovesical anastomosis disrupture. Both were successfully repaired. Intra operatory complication was experienced in one pacient, with arterial anastomosis rupture. In loco reperfusion and repair was made. Another patient had inferior renal pole rupture, treated with polar nefrectomy at the 4º PO. Despite such problems, mean follow up of 20,7 months showed serum creatinine ranging from 0,9 to 2 mg/100ml, with no serious complications. Conclusion: Our data support the use of en bloc child cadaveric kidneys, even from infant donors less than two year of age, when the organ necessity supplant the higher rates of complications.

A grande procura de órgãos para transplante tornou necessária a aceitação de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicação fizeram com que cirurgiões considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis ( 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicações ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicação intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusão in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicações sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgão seja maior que o risco oferecido pelo alto índice de complicações.

Transplante renal em bloco de doadores-cadáveres infantis: experiência do HCFMRP-USP / Kidney transplantation in bloc from pediatric cadaver donors: the HCFMRP-USP experience

A grande procura de órgäos para transplante tornou necessária a aceitaçäo de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicaçäo fizeram com que cirurgiöes considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis (< 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicaçöes ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicaçäo intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusäo in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicaçöes sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgäo seja maior que o risco oferecido pelo alto índice de complicaçöes.