A 57-year-old woman was diagnosed with an anterior cervical mass (figure 1). No peripheral neurop... more A 57-year-old woman was diagnosed with an anterior cervical mass (figure 1). No peripheral neuropathy or cervical lymph nodes were detected from the physical examination. The mass has slowly and painlessly grown for 30 years with no dyspnea or dysphagia. She had a history of chronic alcohol consumption and heavy tobacco use for 25 years. No standard medications were taken. Multiple symmetric lipomatosis is a disease characterized by the accumulation of multiple, benign, symmetric, and nonencapsulated fatty tissue masses. This is more common in males (15:1) and in the Mediterranean population. Malignancy is rarely observed in this case. Masses can be found on the head and neck, including the upper trunk, shoulders, upper back, mediastinum, perineum, scrotum, and tongue. Besides the aesthetic effects, masses can cause airways or digestive compressive symptoms, as well as limitations in head or neck movements, urinating, or sexual intercourse. The involvement of peripheral nerves can c...
Estudo retrospectivo de dois casos de hemorragia craniana de localização atípica em 777 recém-nat... more Estudo retrospectivo de dois casos de hemorragia craniana de localização atípica em 777 recém-natos internados na unidade de terapia intensiva neonatal da Casa de Saúde São José, Rio de Janeiro, RJ. Foram avaliados os aspectos clínicos e o diagnóstico por métodos de imagem. Verificamos que a ultrassonografia foi diagnóstica nos dois casos quando comparada com a ressonância magnética. Em relação à etiologia, esta foi multifatorial, e a manifestação clínica silenciosa independente da localização. Até o presente momento, a avaliação neurológica tem tido curso satisfatório, embora os pacientes ainda tenham baixa idade para a avaliação neurológica definitiva.
Purpose: The aim of this study is to analyze a ten-year single center experience in liver transpl... more Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year r...
Background Medical students’ skills in radiographic image interpretation is neither known nor ass... more Background Medical students’ skills in radiographic image interpretation is neither known nor assessed in the case of most medical schools in Brazil. Objective The purpose of this study was to assess intern students’ performance in the interpretation of radiographic images of the chest and abdomen. Methods A 10-item test was developed using non-contrasted radiological images from the chest and abdomen. Internship students from two public medical schools (Classroom Group, n=50) and doctors (Control Group, n=20) answered the test. A third group (Online Group, n=38) composed of students from different medical schools answered a web-based form with the same 10-item test. Results Doctors and students were able to accurately interpret only 30% of the radiographic images; 50% of the students and 30% of the doctors performed poorly. The rest produced average levels of performance. There were minimal differences between the Classroom and Online Groups. A point-by-point analysis of their answ...
Management of small-bowel fistulas which are in an open abdomen and have no soft tissue overlay o... more Management of small-bowel fistulas which are in an open abdomen and have no soft tissue overlay or a fistula tract involves many complications and challenges. Controlling the local leakage of enteric contents has a central role in the success of medical treatment. There are several methods to deal with fistula discharge but unfortunately, the technical solutions only partially address such problems and a definitive management of fistula discharge still remains an insoluble challenge. We describe a simple and cheap method to control fistula leakage by using a percutaneous endoscopic gastrostomy tube.
Interruption of blood flow and subsequent organ reperfusion lead to significant tissue damage. Th... more Interruption of blood flow and subsequent organ reperfusion lead to significant tissue damage. This well-studied phenomenon is recognized as ischemia/reperfusion injury. Ischemic preconditioning refers to a mechanism in which a prior, short, ischemic period induces some protection against a subsequent prolonged ischemic and reperfusion damage. The mechanisms involved in ischemic preconditioning and its applications for clinical and basic research are discussed in this paper.
Mitochondrial respiratory activity is associated with hepatic ischemia/reperfusion injury. To det... more Mitochondrial respiratory activity is associated with hepatic ischemia/reperfusion injury. To determine in vitro whether hepatic ischemia/reperfusion injury may be detected regardless mitochondrial respiratory activity. Twenty-four heartworm-free mongrel dogs of either sex were randomized in the following groups: control, sham-operated dogs; I60, dogs subjected to 60 min of liver ischemia; I30/R60, dogs subjected to 30 min of ischemia e 60 min of reperfusion of liver; I45/R120 animals subjected to 45 min of ischemia and 120 min of reperfusion of liver. Blood and liver samples were taken after surgery to be processed. Mitochondrial respiratory activity was measured with a Clark-type oxygen electrode and mitochondrial membrane potential was calculated. lactic dehydrogenase, aspartate amino transferase and alanine aminotrasferase activities were determinated using laboratory kits, and malondialdehyde content in liver samples was estimated. The group I45/R120 showed increases of serum a...
This study aim was to investigate an association between donor age and lower recipient survival i... more This study aim was to investigate an association between donor age and lower recipient survival in liver transplantation. A total of 178 consecutive patients underwent liver transplantation between 1999 and 2007. Among these patients, 172 liver transplants (donor age: 32.04 +/- 16.66) and 167 recipients were included in the analysis. Mean recipient age was 39.16 +/- 21.61 years (range: 6 mo-71 years) and 90 (53.89%) were males. Among 172 transplants, 32.9% recipients died during follow-up. Mean follow-up time was 34.37 +/- 20.50 mo. A lower mean recipient survival prevailed from donors older than 50 years (p = .01) at 7-year patient survival. At 6-month and 1-year recipient survival, cut-offs were 50 and 55 years, respectively (p < .05). A significant difference was observed in graft survival from donors older than 30 years (p = .02) and at 6-month and 1-year, cutoffs were 35 and 50 years, respectively (p < .05). Although the utilization of donors with increased age in liver t...
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2010
To investigate an association between short-term mortality and donor age-associated worst outcome... more To investigate an association between short-term mortality and donor age-associated worst outcomes in liver transplant. A total of 178 consecutive patients underwent a liver transplant between 1999 and 2007. Among these patients, there were 172 liver transplants (donor age, 32.04 +/- 16.66; range, 2-65 years) and 167 recipients. Mean recipient age was 39.16 +/- 21.61 years (range, 6 months to 71 years), and 90 were males (53.8%). Among 172 transplants, 32.9% recipients died during follow-up (mean, 34.37 +/- 20.50 months). A lower mean recipient and graft survival occurred in donors older than 50 years (P = .01) and 30 years (P = .02) at 7-year patient survival. At 6- month and 1-year recipient survival, cutoffs were 50 and 55 years (P < .05). Log-rank test showed no statistical difference among recipients, and graft survival from donors older/younger 50 and 30 years 1.5 years after liver transplant (P < .565 and P < .259). Donor age is a key factor in liver transplant that ...
O transplante hepático tornou-se o procedimento de escolha para o tratamento da doença hepática t... more O transplante hepático tornou-se o procedimento de escolha para o tratamento da doença hepática terminal. Não obstante o sucesso da cirurgia, a disfunção pós-operatória do fígado enxertado ainda representa importante causa de morbidade e mortalidade. O restabelecimento do fluxo sangüíneo ao fígado recém transplantado impõe a ele nova agressão, agravando a lesão causada pelo período de isquemia. Este fenômeno pouco compreendido é conhecido como lesão por isquemia e reperfusão e envolve disfunção endotelial, seqüestro de leucócitos e agregação de plaquetas, lesão por radicais livre de oxigênio, e distúrbios da microcirculação hepática. Essa revisão discute os vários aspectos fisiopatológicos que estão envolvidos na lesão por isquemia e reperfusão do fígado.
OBJETIVO: Relatar a experiência inicial do Grupo de Transplante de Fígado do Hospital Universitár... more OBJETIVO: Relatar a experiência inicial do Grupo de Transplante de Fígado do Hospital Universitário Oswaldo Cruz, Recife - PE, com doadores de fígado em assistolia. MÉTODO: Foram revistos os dados referentes a seis transplantes hepáticos, realizados entre outubro de 2002 e setembro de 2004, com órgãos obtidos de doadores em assistolia. RESULTADOS: Não houve disfunção primária do enxerto. Complicações biliares e vasculares não foram observadas. Todos os pacientes receberam alta hospitalar em boas condições clínicas. CONCLUSÕES: Embora se trate de uma experiência pequena, bons resultados iniciais foram obtidos com transplante hepáticos realizados a partir de doadores em assitolia.
A 57-year-old woman was diagnosed with an anterior cervical mass (figure 1). No peripheral neurop... more A 57-year-old woman was diagnosed with an anterior cervical mass (figure 1). No peripheral neuropathy or cervical lymph nodes were detected from the physical examination. The mass has slowly and painlessly grown for 30 years with no dyspnea or dysphagia. She had a history of chronic alcohol consumption and heavy tobacco use for 25 years. No standard medications were taken. Multiple symmetric lipomatosis is a disease characterized by the accumulation of multiple, benign, symmetric, and nonencapsulated fatty tissue masses. This is more common in males (15:1) and in the Mediterranean population. Malignancy is rarely observed in this case. Masses can be found on the head and neck, including the upper trunk, shoulders, upper back, mediastinum, perineum, scrotum, and tongue. Besides the aesthetic effects, masses can cause airways or digestive compressive symptoms, as well as limitations in head or neck movements, urinating, or sexual intercourse. The involvement of peripheral nerves can c...
Estudo retrospectivo de dois casos de hemorragia craniana de localização atípica em 777 recém-nat... more Estudo retrospectivo de dois casos de hemorragia craniana de localização atípica em 777 recém-natos internados na unidade de terapia intensiva neonatal da Casa de Saúde São José, Rio de Janeiro, RJ. Foram avaliados os aspectos clínicos e o diagnóstico por métodos de imagem. Verificamos que a ultrassonografia foi diagnóstica nos dois casos quando comparada com a ressonância magnética. Em relação à etiologia, esta foi multifatorial, e a manifestação clínica silenciosa independente da localização. Até o presente momento, a avaliação neurológica tem tido curso satisfatório, embora os pacientes ainda tenham baixa idade para a avaliação neurológica definitiva.
Purpose: The aim of this study is to analyze a ten-year single center experience in liver transpl... more Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year r...
Background Medical students’ skills in radiographic image interpretation is neither known nor ass... more Background Medical students’ skills in radiographic image interpretation is neither known nor assessed in the case of most medical schools in Brazil. Objective The purpose of this study was to assess intern students’ performance in the interpretation of radiographic images of the chest and abdomen. Methods A 10-item test was developed using non-contrasted radiological images from the chest and abdomen. Internship students from two public medical schools (Classroom Group, n=50) and doctors (Control Group, n=20) answered the test. A third group (Online Group, n=38) composed of students from different medical schools answered a web-based form with the same 10-item test. Results Doctors and students were able to accurately interpret only 30% of the radiographic images; 50% of the students and 30% of the doctors performed poorly. The rest produced average levels of performance. There were minimal differences between the Classroom and Online Groups. A point-by-point analysis of their answ...
Management of small-bowel fistulas which are in an open abdomen and have no soft tissue overlay o... more Management of small-bowel fistulas which are in an open abdomen and have no soft tissue overlay or a fistula tract involves many complications and challenges. Controlling the local leakage of enteric contents has a central role in the success of medical treatment. There are several methods to deal with fistula discharge but unfortunately, the technical solutions only partially address such problems and a definitive management of fistula discharge still remains an insoluble challenge. We describe a simple and cheap method to control fistula leakage by using a percutaneous endoscopic gastrostomy tube.
Interruption of blood flow and subsequent organ reperfusion lead to significant tissue damage. Th... more Interruption of blood flow and subsequent organ reperfusion lead to significant tissue damage. This well-studied phenomenon is recognized as ischemia/reperfusion injury. Ischemic preconditioning refers to a mechanism in which a prior, short, ischemic period induces some protection against a subsequent prolonged ischemic and reperfusion damage. The mechanisms involved in ischemic preconditioning and its applications for clinical and basic research are discussed in this paper.
Mitochondrial respiratory activity is associated with hepatic ischemia/reperfusion injury. To det... more Mitochondrial respiratory activity is associated with hepatic ischemia/reperfusion injury. To determine in vitro whether hepatic ischemia/reperfusion injury may be detected regardless mitochondrial respiratory activity. Twenty-four heartworm-free mongrel dogs of either sex were randomized in the following groups: control, sham-operated dogs; I60, dogs subjected to 60 min of liver ischemia; I30/R60, dogs subjected to 30 min of ischemia e 60 min of reperfusion of liver; I45/R120 animals subjected to 45 min of ischemia and 120 min of reperfusion of liver. Blood and liver samples were taken after surgery to be processed. Mitochondrial respiratory activity was measured with a Clark-type oxygen electrode and mitochondrial membrane potential was calculated. lactic dehydrogenase, aspartate amino transferase and alanine aminotrasferase activities were determinated using laboratory kits, and malondialdehyde content in liver samples was estimated. The group I45/R120 showed increases of serum a...
This study aim was to investigate an association between donor age and lower recipient survival i... more This study aim was to investigate an association between donor age and lower recipient survival in liver transplantation. A total of 178 consecutive patients underwent liver transplantation between 1999 and 2007. Among these patients, 172 liver transplants (donor age: 32.04 +/- 16.66) and 167 recipients were included in the analysis. Mean recipient age was 39.16 +/- 21.61 years (range: 6 mo-71 years) and 90 (53.89%) were males. Among 172 transplants, 32.9% recipients died during follow-up. Mean follow-up time was 34.37 +/- 20.50 mo. A lower mean recipient survival prevailed from donors older than 50 years (p = .01) at 7-year patient survival. At 6-month and 1-year recipient survival, cut-offs were 50 and 55 years, respectively (p < .05). A significant difference was observed in graft survival from donors older than 30 years (p = .02) and at 6-month and 1-year, cutoffs were 35 and 50 years, respectively (p < .05). Although the utilization of donors with increased age in liver t...
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2010
To investigate an association between short-term mortality and donor age-associated worst outcome... more To investigate an association between short-term mortality and donor age-associated worst outcomes in liver transplant. A total of 178 consecutive patients underwent a liver transplant between 1999 and 2007. Among these patients, there were 172 liver transplants (donor age, 32.04 +/- 16.66; range, 2-65 years) and 167 recipients. Mean recipient age was 39.16 +/- 21.61 years (range, 6 months to 71 years), and 90 were males (53.8%). Among 172 transplants, 32.9% recipients died during follow-up (mean, 34.37 +/- 20.50 months). A lower mean recipient and graft survival occurred in donors older than 50 years (P = .01) and 30 years (P = .02) at 7-year patient survival. At 6- month and 1-year recipient survival, cutoffs were 50 and 55 years (P < .05). Log-rank test showed no statistical difference among recipients, and graft survival from donors older/younger 50 and 30 years 1.5 years after liver transplant (P < .565 and P < .259). Donor age is a key factor in liver transplant that ...
O transplante hepático tornou-se o procedimento de escolha para o tratamento da doença hepática t... more O transplante hepático tornou-se o procedimento de escolha para o tratamento da doença hepática terminal. Não obstante o sucesso da cirurgia, a disfunção pós-operatória do fígado enxertado ainda representa importante causa de morbidade e mortalidade. O restabelecimento do fluxo sangüíneo ao fígado recém transplantado impõe a ele nova agressão, agravando a lesão causada pelo período de isquemia. Este fenômeno pouco compreendido é conhecido como lesão por isquemia e reperfusão e envolve disfunção endotelial, seqüestro de leucócitos e agregação de plaquetas, lesão por radicais livre de oxigênio, e distúrbios da microcirculação hepática. Essa revisão discute os vários aspectos fisiopatológicos que estão envolvidos na lesão por isquemia e reperfusão do fígado.
OBJETIVO: Relatar a experiência inicial do Grupo de Transplante de Fígado do Hospital Universitár... more OBJETIVO: Relatar a experiência inicial do Grupo de Transplante de Fígado do Hospital Universitário Oswaldo Cruz, Recife - PE, com doadores de fígado em assistolia. MÉTODO: Foram revistos os dados referentes a seis transplantes hepáticos, realizados entre outubro de 2002 e setembro de 2004, com órgãos obtidos de doadores em assistolia. RESULTADOS: Não houve disfunção primária do enxerto. Complicações biliares e vasculares não foram observadas. Todos os pacientes receberam alta hospitalar em boas condições clínicas. CONCLUSÕES: Embora se trate de uma experiência pequena, bons resultados iniciais foram obtidos com transplante hepáticos realizados a partir de doadores em assitolia.
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