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1.
Rev Col Bras Cir ; 46(4): e20192224, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31644721

RESUMO

OBJECTIVE: to evaluate the oral conditions and the main predisposing factors for dental treatment of patients on the waiting list for liver and simultaneous pancreas-kidney transplantation, in a single center. METHODS: we evaluated 100 patients in the waiting list, 50 candidates for liver transplantation and 50 for simultaneous kidney-pancreas transplantation, from August 2015 to February 2018. We correlated extra and intraoral examinations with pre-transplant demographic variables. RESULTS: the main oral alteration in the pancreas-kidney and liver transplant candidates were decayed, lost and filled teeth, present in 83% and 100% of the candidates, respectively (p=0.03). The need for dental treatment was equal in both groups: 71% and 70%. In liver transplant candidates, the predisposing factors for dental treatment were age, color and etiological diagnosis of liver cirrhosis. We did not identify predisposing factors for dental treatment in candidates for simultaneous pancreas-kidney transplant. CONCLUSION: candidates for liver and for simultaneous pancreas-kidney transplantation had poor oral hygiene, with cavities, residual roots, gingivitis and periodontitis, revealing that dental evaluation should be part of the transplantation waiting list.


Assuntos
Cárie Dentária , Transplante de Rim , Transplante de Fígado , Saúde Bucal , Transplante de Pâncreas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Listas de Espera
2.
Rev Col Bras Cir ; 46(1): e2096, 2019 Mar 07.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30843947

RESUMO

OBJECTIVE: considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost. METHODS: a retrospective study of hospitalization data from patients consecutively submitted to simultaneous pancreas-kidney transplantation (SPKT), from January 2008 to December 2014, at Kidney Hospital/Oswaldo Ramos Foundation (Sao Paulo, Brazil). The main studied variables were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical, and immunological ones), and hospitalization financial data for transplantation. RESULTS: the sample was composed of 179 transplanted patients. The characteristics of donors and recipients were similar in patients with and without complications. In data analysis, 58.7% of the patients presented some postoperative complication, 21.8% required reoperation, 12.3% demanded graft pancreatectomy, and 8.4% died. The need for reoperation or graft pancreatectomy increased hospitalization cost by 53.3% and 78.57%, respectively. The presence of postoperative complications significantly increased hospitalization cost. However, the presence of death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not present statistical significance in hospitalization cost (in average US$ 18,516.02). CONCLUSION: considering patients who underwent SPKT, postoperative complications, reoperation, and graft pancreatectomy, as well as surgical, infectious, clinical, and immunological complications, significantly increased the mean cost of hospitalization. However, death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not statistically interfere in hospitalization cost.


Assuntos
Hospitalização/economia , Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/economia , Reoperação/economia , Adulto , Brasil , Custos e Análise de Custo , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Transplante de Rim/economia , Masculino , Transplante de Pâncreas/economia , Pancreatectomia/economia , Estudos Retrospectivos , Adulto Jovem
3.
Rev. Col. Bras. Cir ; 46(1): e2096, 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-990365

RESUMO

RESUMO Objetivo: avaliar o impacto financeiro das complicações pós-operatórias no transplante simultâneo pâncreas-rim durante a internação hospitalar. Métodos: estudo retrospectivo dos dados da internação hospitalar dos pacientes submetidos consecutivamente ao transplante simultâneo pâncreas-rim no período de janeiro de 2008 a dezembro de 2014 no Hospital do Rim/Fundação Oswaldo Ramos. As principais variáveis estudadas foram a reoperação, pancreatectomia do enxerto, óbito, complicações pós-operatórias (cirúrgicas, infecciosas, clínicas e imunológicas) e os dados financeiros da internação para o transplante. Resultados: a amostra foi composta de 179 pacientes transplantados. As características dos doadores e receptores foram semelhantes nos pacientes com e sem complicações. Na análise dos dados, 58,7% dos pacientes apresentaram alguma complicação pós-operatória, 21,8% necessitaram de reoperação, 12,3%, de pancreatectomia do enxerto e 8,4% evoluíram para o óbito. A necessidade de reoperação ou pancreatectomia do enxerto aumentou o custo da internação em 53,3% e 78,57%, respectivamente. A presença de complicação pós-operatória aumentou significativamente o custo. Entretanto, a presença de óbito, hérnia interna, infarto agudo do miocárdio, acidente vascular cerebral e disfunção do enxerto pancreático não apresentaram significância estatística no custo, cuja média foi de US$ 18,516.02. Conclusão: complicações pós-operatórias, reoperação e pancreatectomia do enxerto aumentaram significativamente o custo médio da internação hospitalar do SPK, assim como as complicações cirúrgicas, infecciosas, clínicas e imunológicas. No entanto, o óbito durante a internação, a hérnia interna, o infarto agudo do miocárdio, o acidente vascular cerebral e a disfunção do enxerto pancreático não interferiram estatisticamente neste custo.


ABSTRACT Objective: considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost. Methods: a retrospective study of hospitalization data from patients consecutively submitted to simultaneous pancreas-kidney transplantation (SPKT), from January 2008 to December 2014, at Kidney Hospital/Oswaldo Ramos Foundation (Sao Paulo, Brazil). The main studied variables were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical, and immunological ones), and hospitalization financial data for transplantation. Results: the sample was composed of 179 transplanted patients. The characteristics of donors and recipients were similar in patients with and without complications. In data analysis, 58.7% of the patients presented some postoperative complication, 21.8% required reoperation, 12.3% demanded graft pancreatectomy, and 8.4% died. The need for reoperation or graft pancreatectomy increased hospitalization cost by 53.3% and 78.57%, respectively. The presence of postoperative complications significantly increased hospitalization cost. However, the presence of death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not present statistical significance in hospitalization cost (in average US$ 18,516.02). Conclusion: considering patients who underwent SPKT, postoperative complications, reoperation, and graft pancreatectomy, as well as surgical, infectious, clinical, and immunological complications, significantly increased the mean cost of hospitalization. However, death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not statistically interfere in hospitalization cost.

4.
Rev. Col. Bras. Cir ; 46(4): e20192224, 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-1041130

RESUMO

RESUMO Objetivo: avaliar as condições bucais e os principais fatores predisponentes para tratamento odontológico de pacientes em lista de espera para transplante simultâneo de pâncreas-rim e para transplante hepático, em um centro único. Métodos: foram avaliados 100 pacientes na fila de espera, 50 candidatos a transplante hepático e 50 a transplante simultâneo de pâncreas-rim, no período de agosto de 2015 a fevereiro de 2018. Exames extra e intrabucais foram correlacionados com variáveis demográficas pré-transplante. Resultados: a principal alteração bucal nos candidatos a transplante de pâncreas-rim e de transplante hepático foram dentes cariados, perdidos e obturados, presentes em 83% e 100% dos candidatos, respectivamente (P=0,03). A necessidade de tratamento odontológico foi igual nos dois grupos: 71% e 70%. Nos candidatos a transplante hepático, os fatores predisponentes para tratamento odontológico foram idade, cor e diagnóstico etiológico da cirrose hepática. Não identificamos fatores predisponentes para tratamento odontológico nos candidatos a transplante simultâneo pâncreas-rim. Conclusão: pacientes candidatos a transplante simultâneo de pâncreas-rim e transplante hepático apresentaram higiene bucal precária com presença de cárie, raízes residuais, gengivite e periodontite, revelando que a avaliação odontológica deve fazer parte do protocolo de atendimento dos pacientes em fila de espera para transplantes.


ABSTRACT Objective: to evaluate the oral conditions and the main predisposing factors for dental treatment of patients on the waiting list for liver and simultaneous pancreas-kidney transplantation, in a single center. Methods: we evaluated 100 patients in the waiting list, 50 candidates for liver transplantation and 50 for simultaneous kidney-pancreas transplantation, from August 2015 to February 2018. We correlated extra and intraoral examinations with pre-transplant demographic variables. Results: the main oral alteration in the pancreas-kidney and liver transplant candidates were decayed, lost and filled teeth, present in 83% and 100% of the candidates, respectively (p=0.03). The need for dental treatment was equal in both groups: 71% and 70%. In liver transplant candidates, the predisposing factors for dental treatment were age, color and etiological diagnosis of liver cirrhosis. We did not identify predisposing factors for dental treatment in candidates for simultaneous pancreas-kidney transplant. Conclusion: candidates for liver and for simultaneous pancreas-kidney transplantation had poor oral hygiene, with cavities, residual roots, gingivitis and periodontitis, revealing that dental evaluation should be part of the transplantation waiting list.

5.
Einstein (Sao Paulo) ; 15(4): 481-485, 2017.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29267429

RESUMO

OBJECTIVE: To evaluate the technique of uterine transplantation and the use of drugs used in the process of immunosuppression. METHODS: We included 12 sows, and immunosuppression was performed with minimal doses of cyclosporine, and cross-match was done to exclude the possibility of blood incompatibility. Hysterectomy was performed in the donor under general anesthesia, with the removal of the aorta and inferior vena cava in monobloc, and anastomosis of these vessels was made in the recipient. RESULTS: Six experiments were performed, and on the immediate postoperative period, five animals had good reperfusion. However, on the seventh postoperative day, histological analysis showed rejection in five animals. CONCLUSION: The experimental model of uterine transplantation is feasible, but monitoring doses of immunosuppressants is pivotal to prevent rejection episodes.


Assuntos
Ciclosporina/administração & dosagem , Procedimentos Cirúrgicos em Ginecologia/métodos , Imunossupressão , Imunossupressores/administração & dosagem , Infertilidade Feminina/cirurgia , Útero/transplante , Animais , Modelos Animais de Doenças , Feminino , Rejeição de Enxerto/imunologia , Período Pós-Operatório , Gravidez , Prenhez , Suínos
6.
Einstein (Säo Paulo) ; 15(4): 481-485, Oct.-Dec. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-891437

RESUMO

ABSTRACT Objective: To evaluate the technique of uterine transplantation and the use of drugs used in the process of immunosuppression. Methods: We included 12 sows, and immunosuppression was performed with minimal doses of cyclosporine, and cross-match was done to exclude the possibility of blood incompatibility. Hysterectomy was performed in the donor under general anesthesia, with the removal of the aorta and inferior vena cava in monobloc, and anastomosis of these vessels was made in the recipient. Results: Six experiments were performed, and on the immediate postoperative period, five animals had good reperfusion. However, on the seventh postoperative day, histological analysis showed rejection in five animals. Conclusion: The experimental model of uterine transplantation is feasible, but monitoring doses of immunosuppressants is pivotal to prevent rejection episodes.


RESUMO Objetivo: Avaliar a técnica de transplante uterino e o uso de drogas no processo de imunossupressão. Métodos: Foram incluídas 12 porcas, sendo realizada imunossupressão com doses mínimas de ciclosporina, e prova cruzada para afastar a possibilidade de incompatibilidade sanguínea. Realizou-se, na doadora, histerectomia sob anestesia geral, com a retirada, em monobloco, da aorta e da veia cava inferior, de tal forma que, na receptora, fosse possível realizar a anastomose com estes vasos. Resultados: Foram realizados seis experimentos e, no pós-operatório imediato, houve boa reperfusão em cinco animais. Entretanto, no sétimo dia de pós-operatório, as análises histológicas demonstraram rejeição em cinco deles. Conclusão: O modelo experimental de transplante uterino é factível, mas a monitorização das doses de imunossupressores é importante, a fim de impedir os episódios de rejeição.

7.
Acta cir. bras ; 32(8): 673-679, Aug. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886232

RESUMO

Abstract Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.


Assuntos
Humanos , Masculino , Feminino , Lactente , Fibrinogênio/uso terapêutico , Hemostáticos/uso terapêutico , Trombina/uso terapêutico , Tampões de Gaze Cirúrgicos , Transplante de Fígado/métodos , Hemostasia Cirúrgica/métodos , Reoperação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Perda Sanguínea Cirúrgica/prevenção & controle , Transplante de Fígado/efeitos adversos , Resultado do Tratamento , Transfusão de Eritrócitos , Estatísticas não Paramétricas , Ferida Cirúrgica/tratamento farmacológico , Hepatectomia/métodos , Fígado/cirurgia
8.
Rev. Col. Bras. Cir ; 44(4): 360-366, jul.-ago. 2017. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-896595

RESUMO

RESUMO Objetivo: comparar o resultado do transplante de fígado por hepatocarcinoma em pacientes submetidos ou não ao tratamento loco-regional e downstaging, em relação à sobrevida e risco de recidiva na fila de transplante. Métodos: estudo retrospectivo dos pacientes portadores de hepatocarcinoma submetidos a transplante hepático na região metropolitana de São Paulo, entre janeiro de 2007 e dezembro de 2011, a partir de doador falecido. A amostra foi constituída de 414 pacientes. Destes, 29 foram incluídos na lista por downstaging. Os demais 385 foram submetidos ou não ao tratamento loco-regional. Resultados: as análises dos 414 prontuários demonstraram um predomínio de pacientes do sexo masculino (79,5%) e com média de idade de 56 anos. O tratamento dos nódulos foi realizado em 56,4% dos pacientes em fila de espera para o transplante. O método mais utilizado foi a quimio-embolização (79%). Os pacientes submetidos ao tratamento loco-regional tiveram redução significativa no tamanho do maior nódulo (p<0,001). Não houve diferença estatística entre grupos com e sem tratamento loco-regional (p=0,744) e em relação à mortalidade entre pacientes incluídos no Critério de Milão ou ao downstaging (p=0,494). Conclusões: não houve diferença na sobrevida e ocorrência de recidiva associadas ao tratamento loco-regional. Os pacientes incluídos através do processo de downstaging apresentaram resultados de sobrevida comparáveis àqueles previamente classificados como Critério de Milão/Brasil.


ABSTRACT Objective: to compare the outcome of liver transplantation for hepatocarcinoma in submitted or not to locoregional treatment and downstaging regarding survival and risk of recurrence in transplant waiting list patients. Methods: retrospective study of patients with hepatocarcinoma undergoing liver transplantation in the metropolitan region of São Paulo, between January 2007 and December 2011, from a deceased donor. The sample consisted of 414 patients. Of these, 29 patients were included in the list by downstaging. The other 385 were submitted or not to locoregional treatment. Results: the analysis of 414 medical records showed a predominance of male patients (79.5%) with average age of 56 years. Treatment of the lesions was performed in 56.4% of patients on the waiting list for transplant. The most commonly used method was chemoembolization (79%). The locoregional patients undergoing treatment had a significant reduction in nodule size greater (p<0.001). There was no statistical difference between groups with and without locoregional treatment (p=0.744) and on mortality among patients enrolled in the Milan criteria or downstaging (p=0.494). Conclusion: there was no difference in survival and recurrence rate associated with locoregional treatment. Patients included by downstaging process had comparable survival results to those previously classified as Milan/Brazil criteria.

9.
Rev. Soc. Bras. Clín. Méd ; 15(1): 61-67, 2017.
Artigo em Inglês | LILACS | ID: biblio-833180

RESUMO

Pruritus represents one of the main clinical complaints in medical practice, and leads to significant impairment of life quality and some discomfort. Although the knowledge of its main primary and secondary etiologies is well-established in Internal Medicine, especially in Hepatology, its pathophysiological basis and specific therapeutic-directed approaches are still very complex and need a proper systematization for comprehension. This review aims to present the main current themes regarding the main clinical, pathophysiological, therapeutical and management aspects of cholestasis-associated pruritus. METHODS: The authors performed a wide review of practical clinical guidelines, review articles and original articles from manuscripts published and indexed in PubMed. CONCLUSIONS: Pruritus in cholestasis represents a complex symptom in clinical practice and can be secondary to different pathophysiological mechanisms; its early recognition allows a proper therapeutic approach in most cases.


O prurido representa uma das principais queixas clínicas na prática médica e origina importante comprometimento da qualidade de vida, além de desconforto. Apesar de suas principais etiologias primárias e secundárias serem de conhecimento bem estabelecido na Clínica Médica, em especial na Hepatologia, suas bases fisiopatológicas e os princípios da terapêutica específica direcionada são bastante complexos e necessitam uma sistematização adequada para sua compreensão apropriada. Esta revisão objetiva abordar os principais temas atuais referentes às bases clínicas, fisiopatológicas, terapêuticas e de manejo do prurido relacionados à colestase. Os autores realizaram ampla revisão em diretrizes clínicas práticas, artigos de revisão e publicações originais de artigos publicados e indexados na base PubMed. O prurido na colestase representa um sintoma complexo na prática clínica e pode decorrer de diferentes mecanismos fisiopatológicos secundários. Seu reconhecimento precoce possibilita a abordagem terapêutica apropriada na maioria dos casos.


Assuntos
Humanos , Antipruriginosos/uso terapêutico , Colestase/complicações , Prurido/etiologia , Prurido/terapia , Pele/inervação , Neuralgia/fisiopatologia
10.
ABCD arq. bras. cir. dig ; 29(4): 236-239, Oct.-Dec. 2016. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-837538

RESUMO

ABSTRACT Background: Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim: Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods: Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results: The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion: There was a lower number of reoperations due to bleeding of the wound area of ​​the hepatic graft when the human fibrinogen and thrombin sponge were used.


RESUMO Racional: Estratégia cirúrgica para aumentar o número de transplantes hepáticos na população pediátrica é a transecção hepática ex-situ (redução ou split). No entanto, ela está associada com complicações, tais como hemorragia e fístulas. A esponja de fibrinogênio e trombina humana é útil para melhorar a hemostasia nas operações hepáticas. Objetivo: Comparar transplantes hepáticos pediátricos com transecção hepática ex-situ (redução ou split) com ou sem a esponja de fibrinogênio e trombina humana. Métodos: Foi realizada análise prospectiva de 21 pacientes submetidos ao transplante de fígado com transecção hepática ex-situ com a aplicação da esponja de fibrinogênio e trombina humana na área cruenta (grupo A) e análise retrospectiva de 59 pacientes sem a esponja (grupo B). Resultados: As características dos receptores e doadores eram semelhantes. Observou-se menor número de reoperações devido à hemorragia na área da cruenta no grupo A (14,2%) em comparação com o grupo B (41,7%, p=0,029). Não houve diferença em relação à fístula biliar (grupo A: 17,6%, grupo B: 5,1%, p=0,14). Conclusão: Houve menor número de reoperações por sangramento da área cruenta do enxerto hepático quando a esponja de fibrinogênio e trombina humana foi utilizada.

11.
Arq Bras Cir Dig ; 29(4): 236-239, 2016.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28076477

RESUMO

Background: Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim: Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods: Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results: The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion: There was a lower number of reoperations due to bleeding of the wound area of ​​the hepatic graft when the human fibrinogen and thrombin sponge were used.


Assuntos
Fibrinogênio/administração & dosagem , Hepatectomia/métodos , Transplante de Fígado , Fígado/cirurgia , Tampões de Gaze Cirúrgicos , Ferida Cirúrgica/tratamento farmacológico , Trombina/administração & dosagem , Criança , Humanos , Estudos Prospectivos , Estudos Retrospectivos
12.
Acta Cir Bras ; 29(11): 748-51, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25424296

RESUMO

PURPOSE: To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital. METHODS: Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in Sao Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars. RESULTS: Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was $18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%. CONCLUSION: Mortality did not affect costs, and supplies were the largest cost component.


Assuntos
Custos e Análise de Custo , Transplante de Rim/economia , Transplante de Pâncreas/economia , Brasil , Feminino , Hospitalização/economia , Humanos , Unidades de Terapia Intensiva/economia , Transplante de Rim/mortalidade , Masculino , Transplante de Pâncreas/mortalidade , Estatísticas não Paramétricas , Fatores de Tempo
13.
Acta cir. bras ; 29(11): 748-751, 11/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-728646

RESUMO

PURPOSE: To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital. METHODS: Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in Sao Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars. RESULTS: Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was $18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%. CONCLUSION: Mortality did not affect costs, and supplies were the largest cost component. .


Assuntos
Feminino , Humanos , Masculino , Custos e Análise de Custo , Transplante de Rim/economia , Transplante de Pâncreas/economia , Brasil , Hospitalização/economia , Unidades de Terapia Intensiva/economia , Transplante de Rim/mortalidade , Transplante de Pâncreas/mortalidade , Estatísticas não Paramétricas , Fatores de Tempo
14.
Braz. j. infect. dis ; 15(6): 528-532, Nov.-Dec. 2011. tab
Artigo em Inglês | LILACS | ID: lil-610522

RESUMO

OBJECTIVE: To assess the presence of microorganism contamination in the preservation solution for transplant organs (kidney/pancreas). Method: Between August 2007 and March 2008, 136 samples of preservation solution were studied prior to graft implantation. Variables related to the donor and to the presence of microorganisms in the preservation solution of organs were evaluated, after which the contamination was evaluated in relation to the "recipient culture" variable. Univariate and multivariate statistical analyses were performed. RESULTS: The contamination rate of the preservation solution was 27.9 percent. Coagulase-negative Staphylococcus was the most frequently isolated microorganism. However, highly virulent agents, such as fungi and enterobacteria, were also isolated. In univariate analysis, the variable "donor antibiotic use" was significantly associated to the contamination of the preservation solution. On the other hand, multivariate analysis found statistical significance in "donor antibiotic use" and "donor's infectious complications" variables. CONCLUSIONS: In this study, 27.9 percent of the preservation solutions of transplant organs were contaminated. Infectious diseases and non-use of antibiotics by the donor were significantly related to the presence of microorganisms in organ preservation solutions. Contamination in organ preservation solutions was not associated with infection in the recipient.


Assuntos
Humanos , Contaminação de Medicamentos , Fungos/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Soluções para Preservação de Órgãos , Transplante de Rim , Transplante de Pâncreas , Estudos Prospectivos
16.
Acta cir. bras ; 26(5): 396-403, Sept.-Oct. 2011. graf, tab
Artigo em Inglês | LILACS | ID: lil-599643

RESUMO

PURPOSE: To evaluate the effects of ischemic preconditioning (IPC) associate with different preservation solutions, in the protecting of gut. METHODS: Four groups of 14 rats underwent laparotomy and collecting 20 cm of ileum, for preservation, at 4ºC, in Belzer (Belz), Ringer (RL), Celsior (Cs) and Custodiol (Cust) solutions, for 24 hours. Prior to collection, half of the animals in each group were subjected to IPC. During preservation, in the periods of zero, 12, 18 and 24 hours, were conducted evaluating the degree of mucosal injury and dosage of malondialdehyde acid (MDA). RESULTS: In all periods the RL group, with and without IPC, presented MDA values higher than the Belz and Cs. The degree of mucosal injury in the non-ipc RLgroup with 12h preservation was higher than the others; with 18 and 24h, the RL and Cust had higher degrees of damage than Cs and Belz. With IPC, in all periods, the group Cs and Belz had lower degrees of injury. CONCLUSION: The Celsior and Belzer solutions had better protective effects on the gut and these effects were enhanced by IPC.


OBJETIVO: Avaliar os efeitos do precondicionamento isquêmico (PCI) associado a diferentes soluções de preservação, na proteção do intestino delgado. MÉTODOS: Quatro grupos de 14 ratos Wistar, foram submetidos à laparotomia e coleta de 20 cm de íleo, para preservação, a 4ºC, nas soluções de Belzer (Belz), Ringer (RL), Celsior (Cs) e Custodiol (Cust) por 24 horas. Previamente à coleta, em metade dos animais de cada grupo, o intestino foi submetido ao PCI. Durante a preservação, nos períodos de Zero, 12, 18 e 24 horas, foram realizados avaliação do grau de lesão da mucosa e dosagem do ácido malondialdeído (MDA). RESULTADOS: Em todos os períodos o grupo RL, sem e com pci, apresentou valores maiores de MDA do que o Belz e Cs. O grau de lesão da mucosa nos grupos sem pci com preservação de 12h, no grupo RL, foi maior que nos demais; com 18h e 24h o grupo RL e Cust apresentaram maiores graus de lesão do que Cs e Belz. Com o pci, em todos os períodos, os grupos Belz e Cs apresentaram menores graus de lesão CONCLUSÃO: As Soluções Celsior e Belzer tiveram melhores efeitos na proteção do intestino e estes efeitos foram incrementados pelo precondicionamento isquêmico.


Assuntos
Animais , Masculino , Ratos , Mucosa Intestinal , Precondicionamento Isquêmico , Intestino Delgado/irrigação sanguínea , Soluções para Preservação de Órgãos/farmacologia , Preservação de Órgãos/métodos , Adenosina/farmacologia , Alopurinol/farmacologia , Dissacarídeos/farmacologia , Eletrólitos/farmacologia , Glucose/farmacologia , Glutamatos/farmacologia , Glutationa/farmacologia , Histidina/farmacologia , Insulina/farmacologia , Soluções Isotônicas/farmacologia , Malondialdeído/análise , Manitol/farmacologia , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Ratos Wistar , Rafinose/farmacologia , Fatores de Tempo
17.
Acta Cir Bras ; 26(5): 396-403, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21952665

RESUMO

PURPOSE: To evaluate the effects of ischemic preconditioning (IPC) associate with different preservation solutions, in the protecting of gut. METHODS: Four groups of 14 rats underwent laparotomy and collecting 20 cm of ileum, for preservation, at 4ºC, in Belzer (Belz), Ringer (RL), Celsior (Cs) and Custodiol (Cust) solutions, for 24 hours. Prior to collection, half of the animals in each group were subjected to IPC. During preservation, in the periods of zero, 12, 18 and 24 hours, were conducted evaluating the degree of mucosal injury and dosage of malondialdehyde acid (MDA). RESULTS: In all periods the RL group, with and without IPC, presented MDA values higher than the Belz and Cs. The degree of mucosal injury in the non-ipc RLgroup with 12h preservation was higher than the others; with 18 and 24h, the RL and Cust had higher degrees of damage than Cs and Belz. With IPC, in all periods, the group Cs and Belz had lower degrees of injury. CONCLUSION: The Celsior and Belzer solutions had better protective effects on the gut and these effects were enhanced by IPC.


Assuntos
Mucosa Intestinal , Intestino Delgado/irrigação sanguínea , Precondicionamento Isquêmico , Soluções para Preservação de Órgãos/farmacologia , Preservação de Órgãos/métodos , Adenosina/farmacologia , Alopurinol/farmacologia , Animais , Dissacarídeos/farmacologia , Eletrólitos/farmacologia , Glucose/farmacologia , Glutamatos/farmacologia , Glutationa/farmacologia , Histidina/farmacologia , Insulina/farmacologia , Soluções Isotônicas/farmacologia , Masculino , Malondialdeído/análise , Manitol/farmacologia , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Rafinose/farmacologia , Ratos , Ratos Wistar , Solução de Ringer , Fatores de Tempo
18.
Braz J Infect Dis ; 15(6): 528-32, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22218510

RESUMO

OBJECTIVE: To assess the presence of microorganism contamination in the preservation solution for transplant organs (kidney/pancreas). METHOD: Between August 2007 and March 2008, 136 samples of preservation solution were studied prior to graft implantation. Variables related to the donor and to the presence of microorganisms in the preservation solution of organs were evaluated, after which the contamination was evaluated in relation to the "recipient culture" variable. Univariate and multivariate statistical analyses were performed. RESULTS: The contamination rate of the preservation solution was 27.9%. Coagulase-negative Staphylococcus was the most frequently isolated microorganism. However, highly virulent agents, such as fungi and enterobacteria, were also isolated. In univariate analysis, the variable "donor antibiotic use" was significantly associated to the contamination of the preservation solution. On the other hand, multivariate analysis found statistical significance in "donor antibiotic use" and "donor's infectious complications" variables. CONCLUSIONS: In this study, 27.9% of the preservation solutions of transplant organs were contaminated. Infectious diseases and non-use of antibiotics by the donor were significantly related to the presence of microorganisms in organ preservation solutions. Contamination in organ preservation solutions was not associated with infection in the recipient.


Assuntos
Contaminação de Medicamentos , Fungos/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Soluções para Preservação de Órgãos , Humanos , Transplante de Rim , Transplante de Pâncreas , Estudos Prospectivos
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