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1.
Medicine (Baltimore) ; 99(10): e19335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150070

RESUMO

BACKGROUND: Pancreas graft quality directly affects morbidity and mortality rates after pancreas transplantation (PTx). The criteria for pancreas graft allocation are restricted, which has decreased the number of available organs. Suitable pancreatic allografts are selected based on donor demographics, medical history, and the transplant surgeon's assessment of organ quality during procurement. Quality is assessed based on macroscopic appearance, which is biased by individual experience and personal skills. Therefore, we aim to assess the histopathological quality of unallocated pancreas organs to determine how many unallocated organs are potentially of suitable quality for PTx. METHODS AND ANALYSIS: This is a multicenter cross-sectional explorative study. The demographic data and medical history of donor and cause of rejection of the allocation of graft will be recorded. Organs of included donors will be explanted and macroscopic features such as weight, color, size, and stiffness will be recorded by 2 independent transplant surgeons. A tissue sample of the organ will be fixed for further microscopic assessments. Histopathologic assessments will be performed as soon as a biopsy can be obtained. We will evaluate up to 100 pancreata in this study. RESULT: This study will evaluate the histopathological quality of unallocated pancreas organs from brain-dead donors to determine how many of these unallocated organs were potentially suitable for transplantation based on a histopathologic evaluation of organ quality. CONCLUSION: The comprehensive findings of this study could help to increase the pancreas graft pool, overcome organ shortage, reduce the waiting time, and also increase the number of PTx in the future. Registration number: ClinicalTrials.gov: NCT04127266.


Assuntos
Morte Encefálica/patologia , Pâncreas/patologia , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Distribuição de Qui-Quadrado , Protocolos Clínicos , Estudos Transversais , Alemanha , Sobrevivência de Enxerto , Humanos , Transplante de Pâncreas/métodos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/tendências
2.
J Korean Med Sci ; 35(11): e71, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32193902

RESUMO

BACKGROUND: Brain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. Based on previous reports, it is not rare for reflex and spontaneous movements to occur in patients during the process of determining brain death. However, reports of the frequency and common types of these movements vary from study to study. Thus, we evaluated adult patients with impending brain death in Korea to determine the frequency and characteristics of reflex and spontaneous movements. METHODS: Brain dead patients who were admitted to 15 hospitals in the Yeongnam region (Southeast) of Korea were recruited prospectively from January 2013 to September 2016. All patients met the criteria for brain death as established by the Korea Medical Association. All body movements occurred during the process of diagnosing brain death and were assessed by physicians and trained organ transplant coordinators. The frequency and characteristics of these movements were identified and the demographic and clinical factors of impending brain dead patients with and without these movements were compared. RESULTS: A total of 436 patients who met the criteria for brain death were enrolled during the study period. Of these patients, 74 (17.0%) exhibited either reflex or spontaneous movements. Of this subset, 45 (60.8%) exhibited reflex movements only, 18 (24.3%) exhibited spontaneous movements only, and 11 (14.9%) exhibited both reflex and spontaneous movements. The most common reflex movements were the flexor/extensor plantar response and spinal myoclonus. Of the 74 patients, 52 (70.3%) exhibited one movement of the same pattern and 22 (29.7%) exhibited two or more different movement patterns. In addition, 45 (60.8%) exhibited these movements only on a limited area of the body with the leg being most common (n = 26, 57.8%). Patients with hypoxic brain damage and a higher systolic blood pressure exhibited significantly more reflex or spontaneous movements. CONCLUSION: Movements associated with brain dead patients are not rare and thus an awareness of these movements is important to brain death diagnosis. Physicians who perform brain death examinations should understand the frequency and characteristics of these movements to reduce delays in determining brain death.


Assuntos
Morte Encefálica/diagnóstico , Movimento , Reflexo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia
7.
Acta Cir Bras ; 34(11): e201901107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939503

RESUMO

PURPOSE: To establish a hypotensive brain death pig model and observe the effects of hypotension on small bowel donors. METHODS: The hypotensive brain death model was produced using the modified intracranial water sac inflation method in ten domestic crossbred pigs. Effects of hypotensive brain death on small bowel tissue morphology were evaluated through changes in intestinal tissue pathology, tight junction protein of the intestinal mucosa and plasma intestinal fatty acid-binding protein (i-FABP) levels. The pathophysiological mechanism was examined based on changes in superior mesenteric artery (SMA) blood flow and systemic hemodynamics. RESULTS: After model establishment, SMA blood flow, and the mean arterial pressure (MAP) significantly decreased, while heart rate increased rapidly and fluctuated significantly. Small bowel tissue morphology and levels of tight junction protein of the intestinal mucosa showed that after model establishment, small bowel tissue injury was gradually aggravated over time (P<0.05). Plasma i-FABP levels significantly increased after brain death (P<0.05). CONCLUSIONS: A hypotensive brain death pig model was successfully established using an improved intracranial water sac inflation method. This method offers a possibility of describing the injury mechanisms more clearly during and after brain death.


Assuntos
Morte Encefálica/fisiopatologia , Modelos Animais de Doenças , Hipotensão/fisiopatologia , Intestino Delgado/patologia , Intestino Delgado/transplante , Animais , Biópsia , Western Blotting , Ensaio de Imunoadsorção Enzimática , Proteínas de Ligação a Ácido Graxo/sangue , Feminino , Hemodinâmica , Intestino Delgado/irrigação sanguínea , Masculino , Microscopia Eletrônica de Transmissão , Reprodutibilidade dos Testes , Suínos , Fatores de Tempo , Proteína da Zônula de Oclusão-1/análise
8.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 189-195, jan.-dez. 2020. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047755

RESUMO

Objetivo: discutir sobre a reação familiar frente ao processo de comunicação de morte encefálica e a possível doação de órgãos. Método: revisão integrativa da literatura, com busca dos artigos nas bases de dados: SciELO, BEDENF, LILACS, MEDLINE publicados entre os anos de 2008 a 2017. Selecionou-se para essa pesquisa, 14 publicações conforme os critérios de inclusão e exclusão. Resultados: o elemento principal para que o processo de doação seja satisfatório é a família. E que estes apresentam reações diversas ao receber a informação de morte encefálica e a possível doação de órgão. Dentre esses vários fatores estão a local onde a comunicação é realizada e o desconhecimento dos familiares sobre a opinião do doador. Conclusão: ao receberem o diagnóstico de morte encefálica, os familiares apresentam manifestações como tristeza, choro e revolta. O desconhecimento esse assunto, leva os familiares a uma série de questionamentos e uma possível recusa na doação


Objective: discuss about the family reaction in front of the communication process of brain death and possible organ donation. Method: integrative review of literature, with search of articles in databases: SciELO, BEDENF, LILACS, MEDLINE published between the years of 2008 to 2017. We selected for this research, 14 publications according to the criteria of inclusion and exclusion. Results: the main element for which the donation process is satisfactory is the family. And they have different reactions to receive the information of brain death and organ donation possible. Among these various factors are the place where the communication is performed and the lack of family about the opinion of the donor. Conclusion: to receive the diagnosis of brain death, the rooms feature manifestations such as sadness, crying and revolt. The lack of this subject, brings the family to a series of questions and a possible refusal in the donation


Objetivo: discutir acerca de la reacción de la familia frente al proceso de comunicación de muerte cerebral y posible la donación de órganos. Método: revisión de la literatura integradora, con búsqueda de artículos en bases de datos: BEDENF, SciELO, LILACS, MEDLINE, publicados entre los años de 2008 a 2017. Hemos seleccionado para esta investigación, 14 publicaçoes según los criterios de inclusión y exclusión. Resultados: el principal elemento para que el proceso de donación es satisfactoria es la familia. Y tienen diferentes reacciones para recibir la información de la muerte cerebral y la donación de órganos es posible. Entre estos diversos factores son el lugar donde se realiza la comunicación y de la falta de familia acerca de la opinión de los donantes. Conclusión: para recibir el diagnóstico de muerte cerebral, las habitaciones cuentan con manifestaciones como la tristeza, el llanto y la revuelta. La falta de este tema, trae a la familia a una serie de preguntas y un posible rechazo de la donación


Assuntos
Humanos , Masculino , Feminino , Relações Profissional-Família/ética , Obtenção de Tecidos e Órgãos , Morte Encefálica , Família/psicologia
9.
Enferm. foco (Brasília) ; 10(7): 141-146, dez. 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1051472

RESUMO

Objetivo: Descrever o método de desenvolvimento de uma tecnologia educacional, na modalidade de aplicativo-guia, para o manejo do potencial doador pediátrico, realizada como produto do Mestrado Profissional. Metodologia: relato de um método científico aplicado. Utilizou-se os passos propostos por Echer, com a perspectiva de apresentar o percurso para a produção da Tecnologia Educacional. Resultados: A construção está sustentada na Teoria das Necessidades Humanas Básicas, nos Diagnósticos e Intervenções de Enfermagem. Foi realizado mapeamento cruzado, dos indicadores selecionados, a partir das necessidades humanas básicas, decorrentes das alterações fisiopatológicas e as percebidas na avaliação clínica, com os Diagnósticos de Enfermagem, segundo taxonomia de NANDA-I e Intervenções de enfermagem baseadas nos diagnósticos, sob a ótica da manutenção dos órgãos a serem doados. Conclusão: O Aplicativo-guia subsidiará o Enfermeiro no planejamento da assistência de enfermagem segura e propiciará um impacto social no processo de transplantes em pediatria. (AU)


Objective: To describe the method of development of an educational technology as a guide application for the management of potential pediatric donors, carried out as a product of the Professional Master. Methodology: report of an applied scientific method. The steps proposed by Echer5 were used, with the perspective of presenting the path for the production of Educational Technology. Results: It is supported by the Theory of Basic Human Needs, Nursing Diagnoses and Interventions. Cross-mapping of selected indicators was performed based on basic human needs, resulting from pathophysiological changes and those perceived in clinical evaluation, with Nursing Diagnoses, according to NANDA-I taxonomy and Nursing interventions based on nursing diagnoses, under the optics of the maintenance of the organs to be donated. Conclusion: The Guide application will support the Nurse in the planning of safe nursing care and will provide a social impact on the process of transplantation in pediatrics. (AU)


Objetivo: Describir el método de desarrollo de una tecnología educativa como una aplicación de guía para el manejo de posibles donantes pediátricos, realizada como producto del Master Profesional. Metodología: informe de un método científico aplicado. Se utilizaron los pasos propuestos por Echer5, con la perspectiva de presentar el camino para la producción de Tecnología Educativa. Resultados: está respaldado por la Teoría de las necesidades humanas básicas, los diagnósticos e intervenciones de enfermería. El mapeo cruzado de los indicadores seleccionados se realizó con base en las necesidades humanas básicas, como resultado de los cambios fisiopatológicos y los percibidos en la evaluación clínica, con los Diagnósticos de Enfermería, de acuerdo con la taxonomía NANDA-I y las intervenciones de Enfermería basadas en diagnósticos de enfermería, bajo La óptica del mantenimiento de los órganos a donar. Conclusión: La aplicación de la Guía apoyará a la Enfermera en la planificación de la atención de enfermería segura y proporcionará un impacto social en el proceso de trasplante en pediatría. (AU)


Assuntos
Morte Encefálica , Tecnologia Educacional , Métodos , Cuidados de Enfermagem , Processo de Enfermagem
11.
Am J Forensic Med Pathol ; 40(4): 381-385, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688048

RESUMO

The authors report on the autopsy case of a 40-year-old primigravida without either coagulation disorders or anticoagulant/antiplatelet therapy, who developed a fatal intracranial subdural hematoma after spinal anesthesia (SA) for elective cesarean delivery for tocophobia.Intracranial subdural hematoma is the most dreaded complication of SA and is often misdiagnosed with postdural puncture headache.In this article, the authors discuss pathophysiological mechanisms and risk factors for the development of an intracranial subdural hematoma after SA and review the pertinent literature.


Assuntos
Raquianestesia/efeitos adversos , Cesárea , Hematoma Subdural Intracraniano/etiologia , Adulto , Morte Encefálica , Feminino , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/patologia , Humanos
17.
Biomed Res Int ; 2019: 5924101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565655

RESUMO

Deceased after circulatory death (DCD) donors offer a viable solution to the current organ shortage, particularly the Maastricht Class III (arrest subsequent to cessation of life support in the hospital). Although current results from these donors are very satisfactory, the number of included donors is too low and future expansion of inclusion criteria will likely decrease organ quality, with negative consequences on the complication rate. This donor type thus represents a priority in terms of scientific exploration, so as to study it in controlled settings and prepare for future challenges. Hence, we mimicked the DCD Class III clinical conditions a Large White pig model. Herein, we detail the different strategies attempted to attain our objectives, including technical approaches such as animal positioning and ventilator settings, as well as pharmacological intervention to modulate blood pressure and heart rate. We highlight the best combination of factors to successfully reproduce DCD Class III conditions, with perfusion pressures and functional warm ischemia (hypoperfusion) closely resembling clinical situations. Finally, we detail the functional and histological impacts of these conditions. Such a model could be of critical value to explore novel management alternative for these donors, presenting a uniquely adapted platform for such therapeutics as normothermic regional circulation and/or pharmacological intervention.


Assuntos
Morte Encefálica/fisiopatologia , Rejeição de Enxerto/fisiopatologia , Sobrevivência de Enxerto/fisiologia , Doadores de Tecidos , Animais , Morte , Humanos , Transplante de Fígado/métodos , Masculino , Suínos/fisiologia , Obtenção de Tecidos e Órgãos
18.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570361

RESUMO

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient's wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient's wish to donate organs.


Assuntos
Morte Encefálica , Viabilidade Fetal/fisiologia , Cuidados para Prolongar a Vida/ética , Doadores Vivos/ética , Mães , Defesa do Paciente/ética , Cuidado Pré-Natal/ética , Obtenção de Tecidos e Órgãos/ética , Adulto , Diretivas Antecipadas , Aconselhamento , Cuidados Críticos , Feminino , Humanos , Cuidados para Prolongar a Vida/métodos , Direitos do Paciente/ética , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos
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