Custo do transplante hepático no Hospital de Clínicas da Universidade Federal do Paraná Cost of liver transplantation at the Clinical Hospital of the Federal University of Parana, Brazil

OBJETIVO. Determinar o custo do transplante hepático no Hospital de Clínicas da Universidade Federal do Paraná. MÉTODO. Os dados do prontuário de 24 pacientes submetidos a 25 transplantes hepáticos foram avaliados do dia da internação para o transplante hepático até a data da alta hospitalar ou óbito para determinar o número de dias de internação, o local de internação, a quantidade de material e medicamentos usados, os exames complementares e procedimentos realizados. Honorários médicos não foram incluídos no estudo. RESULTADOS. A idade dos pacientes variou de 6 a 56 anos, tendo seis deles menos que 14 anos de idade. Cinco pacientes foram a óbito durante a internação hospitalar. Retransplante foi realizado em somente um paciente. O custo médio da retirada do fígado do doador foi de US$2,783.19. O custo total do transplante hepático variou amplamente entre os pacientes, na dependência de ocorrência de complicações pós-operatórias, do número de dias de internação hospitalar e da quantidade de transfusão de hemoderivados. O custo total variou de US$ 6,359.84 a US$75,434.18, com média de US$ 21,505.53. O item mais caro do transplante hepático foi o custo com a hemoterapia, seguido do custo com medicamentos e diária hospitalar. CONCLUSÃO. O custo do transplante hepático varia muito entre os pacientes e pode ser realizado no Brasil a um custo inferior ao relatado nos Estados Unidos e na Europa.<br>PURPOSE - To determine the cost of liver transplantation at the Clinical Hospital of the Federal University of Parana. METHODS - The data of 24 patients subjected to 25 liver transplantations were evaluated from the day of hospital admission until the day of discharge to determine the length of hospitalization, quantity of material and medications used, and exams and procedures performed. Professional fees were not included in the study. RESULTS - The age of the patients varied from 6 to 56 years. Six patients were younger than 14 years of age. Five patients died during hospitalization. Re-transplantation was performed in only one patient. The average cost for liver procurement was US$2,783.19. The total cost of the liver transplantation varied, depending on the occurrence of complications, length of hospitalization and the amount of blood products transfused. The total cost varied from US$ 6,359.84 to US$75,434.18, with an average of US$ 21,505.53. The most expensive item of the liver transplantation was blood products transfused, followed by medications, and intensive care and room charges. CONCLUSION - The cost of liver transplantation varies among the patients and may be performed in Brazil at a cost less than that reported in the United States and Europe

Sympathetic activation: a mechanism for morphine induced pain and rises in liver enzymes after cholecystectomy?

In patients with biliary type pain after cholecystectomy, morphine often precipitates pain and may induce rises in plasma concentrations of liver enzymes because of exaggerated or prolonged rises in intrabiliary pressure. In this study, changes in plasma concentrations of catecholamines and histamine were determined after the administration of morphine in patients with and without a two-fold or greater rise in the plasma concentration of aspartate aminotransferase at four hours. Those showing rises in aminotransferase had higher concentrations of noradrenaline at 40 and 60 minutes after morphine and higher concentrations of dopamine at 40 minutes after morphine. The two groups had similar concentrations of adrenaline and histamine. Attempts to inhibit rises in aminotransferase after morphine by pretreatment with histamine, serotonin and alpha-receptor blockers were largely unsuccessful, although inhibition was observed with phenoxybenzamine in two of five patients. Higher plasma concentrations of noradrenaline and dopamine before and soon after induction of pain in patients showing rises in aminotransferase are consistent with sympathetic activation but heterogeneity appears to exist in the response to alpha-receptor blockade

PNEUMOPERITÔNIO COM DIÓXIDO DE CARBONO ASSOCIADO A TRÊS POSIÇÕES PARA LAPAROSCOPIA EM CÃES PNEUMOPERITONEUM USING CARBON DIOXIDE ASSOCIATED WITH THREE POSITIONS FOR LAPAROSCOPY IN DOGS

Doze cães foram submetidos ao pneumoperitônio com dióxido de carbono, em pressão constante de 15mmHg, e posicionados em Trendelenburg, Trendelenburg reverso e decúbito horizontal. As variáveis de saturação de oxigênio na hemoglobina, freqüência cardíaca, freqüência respiratória, pressão arterial média, sistólica e diastólica, o pH, a pressão parcial de CO2 e a pressão parcial de O2 foram mensurados. Somente a freqüência cardíaca, a freqüência respiratória, o pH e a pressão parcial de CO2 apresentaram diferença estatisticamente significativa em relação ao tempo.<br>The present study evaluated the changes in abdominal insufflation with carbon dioxide, with constant pressure of 15mmHg. In this experiment 12 dogs, adult mongrels were used. After having installed the pneumoperitonium, the animals were positioned in Trendelenburg, reversed Trendelenburg and horizontal position. In each one of the mentioned positions, the dogs stayed for a period of 30 minutes, for evaluation of alterations in the variables of saturation of oxygen in the hemoglobin, heart rate, breathing rate, arterial blood pressure, pH, partial pressure of CO2 and partial pressure of O2. There was no influences of the positioning on the studied variables. The heart rate, breathing rate, pH and the partial pressure of CO2 had significant difference when compared at the time controls