Uso de tacrolimus na terapia de resgate de rejeições agudas e crônicas no transplante de fígado

OBJETIVO: Estudar os critérios de indicação e o resultado do uso de tacrolimus na terapia de resgate de rejeições agudas ou crônicas no transplante de fígado. CASUÍSTICA E MÉTODO: Foram estudados 18 pacientes transplantados de fígado, submetidos a terapia de resgate com tacrolimus entre março de 1995 e agosto de 1999. Foram registradas a indicação do tratamento e a situação de pacientes e enxertos em 31/10/1999. Considerou-se "respondendores" pacientes vivos, com enxerto funcionante e regressão histológica da terapia de resgate de rejeições agudas, ou com bilirrubina até 2 vezes o valor normal, no caso de terapia de resgate de rejeições crônicas. RESULTADO: Observou-se resposta em 14 casos (77,8%). A taxa de resposta nas diferentes indicações foi: (1) terapia de resgate de rejeições agudas + sepse bacteriana - 0/1 caso; (2) terapia de resgate de rejeições agudas recorrente - 1/1 caso; (3) terapia de resgate de rejeições agudas resistente a OKT3 - 2/2 casos; (4) terapia de resgate de rejeições agudas resistente a corticóide + doença viral ativa - 3/3 casos; (5) terapia de resgate de rejeições crônicas - 8/11 casos (72,7% de resposta). Os quatro casos sem resposta (22,2%) evoluíram para óbito. CONCLUSÃO: O tacrolimus é eficaz na terapia de resgate da maioria dos casos de rejeição celular aguda e crônica no transplante de fígado.PURPOSE: To study the indications and results of tacrolimus as rescue therapy for acute cellular or chronic rejection in liver transplantation. PATIENTS AND METHODS: Eighteen liver transplant recipients who underwent rescue therapy with tacrolimus between March 1995 and August 1999 were retrospectively studied. The treatment indication, patients, and graft situation were recorded as of October 31st, 1999. The response to tacrolimus was defined as patient survival with a functional graft and histological reversal of acute cellular, or for chronic rejection, bilirubin serum levels decreasing to up to twice the upper normal limit. RESULTS: Fourteen cases (77.8%) presented a good response. The response rate for the different indications was: (1) acute cellular + sepsis - 0/1 case; (2) recurrent acute cellular - 1/1 case; (3) OKT3-resistant acute cellular - 2/2 cases; (4) steroid-resistant acute cellular + active viral infection - 3/3 cases; (5) chronic rejection - 8/11 cases (72.7% response rate). The 4 patients who did not respond died. CONCLUSION: Tacrolimus rescue therapy was successful in most cases of acute cellular and chronic rejection in liver transplantation

The use of bone bridges in transtibial amputations

OBJETIVO: Descrever a técnica da osteoperiosteoplastia em adultos e apresentar a variação para a utilização em crianças, procurando demonstrar sua aplicabilidade como opção nas amputações transtibiais eletivas. CASUÍSTICA E MÉTODOS: O artigo apresenta um estudo prospectivo de 15 amputações transtibiais realizadas entre 1992 e 1995 em que se utilizou a técnica da osteoperiosteoplastia. A idade dos pacientes variou de 8 a 48 anos, com média de 22,53 anos. A técnica consistiu na confecção de um cilindro de periósteo retirado da tíbia, contendo fragmentos de osso cortical presos ao mesmo, para promover uma sinostose tibiofibular na extremidade distal do coto de amputação. Observou-se que os fragmentos de osso cortical eram dispensáveis quando a técnica foi empregada em crianças, pela maior capacidade osteogênica do periósteo. Isto levou a uma variação da técnica original, que consiste numa periosteoplastia sem a utilização de fragmentos de osso cortical. RESULTADOS: O tempo médio despendido com a técnica, sem variação significativa entre adultos e crianças, foi de 171 minutos. A adaptação da prótese definitiva dos pacientes foi obtida entre 20 e 576 dias, com média de 180 dias. Revisões da técnica empregada foram necessárias em três amputações (20%). CONCLUSÃO: A técnica encontra aplicação nas amputações transtibiais em que o comprimento final do coto seja próximo da transição musculotendínea do gastrocnêmio e nas revisões de cotos de amputação de crianças onde a técnica mostrou ser efetiva na prevenção das lesões decorrentes do excessivo crescimento ósseo.We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth

Is The Ability to Perform Transurethral Resection of the Prostate Influenced by the Surgeon’s Previous Experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6%) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups

Should future cities be compact or sprawled? development of an eco-indicator to assess future urban planning strategies

Urban planning strategies can help mitigate climate change effects in cities and improve the quality of cities environment by providing a more sustainable development. However, there is still a debate on whether cities should be compact or sprawled. This study aims to develop an eco-indicator to assess parameters affected by urban morphology -air quality, urban heat fluxes, urban heat island, mobility, ecological footprint and human exposure - to evaluate the most sustainable urban planning strategies under future climate. For that, a numerical modelling approach will be applied, including the WRF-UCM-CAMx air quality modelling system, adapted to urban areas with high spatial detail, the traffic model VISUM, and a carbon balance, for the Aveiro Region case study. Three urban morphology scenarios will be developed to assess the effects of urban planning strategies. The first scenario will represent the compact city, composed of several independent cores, where commuting outside each city core is not a necessity (sustainable cities). The second scenario will represent the same cores, but in this scenario, commuting is required (polycentric city). The third scenario will represent the dispersed city, without any core areas. All the scenarios will be compared with a reference scenario, which will consider the current urban morphology. Emissions for each scenario will be estimated, based on the land use changes imposed by each urban morphology, in three main activity sectors: transportation, residential combustion and industry. All scenarios will consider the average future technological mobility changes (i.e., car-sharing) for the future medium-term. The main contribution from this research, the eco-indicator, will serve both decision maker and research communities, overcoming the existing gaps in this scientific field and supporting the best planning strategies for a healthy environment and wellbeing.publishe

The Regional Concentration of Industries and the Performance of Firms: A Multilevel Approach

This paper presents the results of a study whose objective was to understand how location within industrial concentrations, like clusters or industrial districts, affects the financial performance of firms. In its theoretical framework, this paper attempts to introduce the reasons behind the alleged superior performance of firms located in these concentrations, the base of the hypothesis formulated in this study. Analysis from a three-level hierarchical linear model applied to a sample of 509 companies located in the state of São Paulo found no evidence that industrial concentrations provide firms with superior performance, contradicting expectations generated by the theory. The decomposition of the variance of performance indicated that the location of the firms and the form with which a city interacts with an industry exerts significant influence on how they will perform. In short, location matters to the future of firms. This finding underlines the need to understand how characteristics of cities or regions can promote or retard the performance of firms

Microsurgical Testicular Denervation for the Treatment of Chronic Testicular Pain – Initial Results

INTRODUCTION: Chronic testicular pain remains an important challenge for urologists. Currently, the treatment plan is primarily empirical, with the first approach consisting of clinical measures. However, some patients remain in pain despite a conservative treatment protocol and, for them, it is possible to perform a surgical procedure that involves severing the scrotal and spermatic branches of the genitofemoral and ilioinguinal nerve fibers. METHODS: In our institution, 60 patients were evaluated and treated for idiopathic chronic testicular pain between January 2003 and July 2007. Priority was give to clinical treatment, which evolved from simple to more complex measures. Microsurgical treatment was performed on those who experienced no considerable pain relief (10 individuals in our study). RESULTS: Over a twenty-four-month follow-up period, 70% of patients showed complete remission and 20% exhibited partial relief from pain