Non Heart-Beating Donors in England

When transplantation started all organs were retrieved from patients immediately after cardio-respiratory arrest, i.e. from non-heart-beating donors. After the recognition that death resulted from irreversible damage to the brainstem, organ retrieval rapidly switched to patients certified dead after brainstem testing. These heart-beating-donors have become the principal source of organs for transplantation for the last 30 years. The number of heart-beating-donors are declining and this is likely to continue, therefore cadaveric organs from non-heart-beating donor offers a large potential of resources for organ transplantation. The aim of this study is to examine clinical outcomes of non-heart-beating donors in the past 10 years in the UK as an way of decreasing pressure in the huge waiting list for organs transplantation

Abordagem dos pedículos glissonianos no manejo do trauma hepático

AIM:  To investigate a different approach in liver trauma, that preserves as much  liver parenchyma aspossible, exposing only the injured area to ischemia and reperfusion. MATHERIAL AND METHODS:Medline and pubMed search from 1980 to 2010 about the glissonian approach , including, liver, surgery,trauma, portal vein and hepatic artery as key-words .RESULTS: The glissonian approach is feasible, nottechnically demanding, and the key for the success is the knowledge of the anatomical landmarks  in theliver surface, to facilitate the surgeon to obtain a fast control of the injured area without compromising theliver flow to the non traumatic area.  CONCLUSION: The glissonian approach represents another toolthat can be performed in liver trauma setting to minimize complications related to the non-anatomicalremoval of parenchyma and blinded-ligaturesOBJETIVO: Investigar uma abordagem diferente no manejo do trauma hepático, que consiga preservaro máximo possível o parênquima do órgão, expondo apenas a área lesada à isquemia e posteriorreperfusão. METODOLOGIA: Pesquisa de artigos publicados nas bases de dados MedLine e pubMedno período de 1980 a 2010, sobre a abordagem dos pedículos glissonianos, e usando como palavrasde busca: fígado, cirurgia, trauma, veia porta e artéria hepática. RESULTADOS: A abordagem dos pedículosglissonianos é viável, não demanda de técnica cirúrgica elaborada, e a chave para o sucesso é ter umconhecimento anatômico do órgão, incluindo pontos importantes em sua superfície para que o cirurgião consiga obter o controle rápido de toda a área lesada sem comprometer o fluxo sanguíneo para asáreas sadias.  CONCLUSÃO: A abordagem glissoniana representa uma ferramenta que pode ser utilizada com segurança no cenário de um trauma hepático, para minimizar as complicações relacionadasa ressecção não anatômica do parênquima e ligaduras realizadas às cegas

Linfoma primário do fígado tratado por hepatectomia ampliada e quimioterapia: relato de caso

Primary lymphoma of the liver is an extremely rare entity. A case of anaplastic large B-cell (both CD-20 and lambda positive) non-Hodgkin's lymphoma that was confined to the liver in a 33-year-old man is reported. The patient was treated with an extended right hepatectomy and combination chemotherapy: cyclophosphamide, adriamycin, vincristine, and prednisone. The patient was disease free 24 months after the procedure.O linfoma primário do fígado é uma entidade extremamente rara. Os autores relatam um caso de linfoma não-Hodgkin de células B grandes anaplásicas (positivo para CD-20 e Lambda) em um paciente do sexo masculino de 33 anos. O tumor estava localizado no lobo hepático direito e foi tratado por hepatectomia direita ampliada e quimioterapia pós-operatória com ciclofosfamida, adriamicina, vincristina e prednisone. Vinte quatro meses de seguimento o paciente encontra-se sem recidiva tumoral

Anterior Hepatic Transection for Caudate Lobectomy

Resection of the caudate lobe (segment I- dorsal sector, segment IX- right paracaval region, or both) is often technically difficult due to the lobe’s location deep in the hepatic parenchyma and because it is adjacent to the major hepatic vessels (e.g., the left and middle hepatic veins)

Surgical Management of Spontaneous Ruptured Hepatocellular Adenoma

AIMS: Spontaneous ruptured hepatocellular adenoma (SRHA) is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS: We reviewed medical records and radiology files of 28 patients (from 1989 to 2006) with a proven diagnosis of hepatocellular adenoma (HA). Three (10.7%) of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS: The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation), as well as intraperitoneal abscess (re-operation) and pleural effusion. CONCLUSION: Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team

A mathematical model for optimizing the indications of liver transplantation in patients with hepatocellular carcinoma

Abstract Background The criteria for organ sharing has developed a system that prioritizes liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) who have the highest risk of wait-list mortality. In some countries this model allows patients only within the Milan Criteria (MC, defined by the presence of a single nodule up to 5 cm, up to three nodules none larger than 3 cm, with no evidence of extrahepatic spread or macrovascular invasion) to be evaluated for liver transplantation. This police implies that some patients with HCC slightly more advanced than those allowed by the current strict selection criteria will be excluded, even though LT for these patients might be associated with acceptable long-term outcomes. Methods We propose a mathematical approach to study the consequences of relaxing the MC for patients with HCC that do not comply with the current rules for inclusion in the transplantation candidate list. We consider overall 5-years survival rates compatible with the ones reported in the literature. We calculate the best strategy that would minimize the total mortality of the affected population, that is, the total number of people in both groups of HCC patients that die after 5 years of the implementation of the strategy, either by post-transplantation death or by death due to the basic HCC. We illustrate the above analysis with a simulation of a theoretical population of 1,500 HCC patients with tumor size exponentially. The parameter λ obtained from the literature was equal to 0.3. As the total number of patients in these real samples was 327 patients, this implied in an average size of 3.3 cm and a 95% confidence interval of [2.9; 3.7]. The total number of available livers to be grafted was assumed to be 500. Results With 1500 patients in the waiting list and 500 grafts available we simulated the total number of deaths in both transplanted and non-transplanted HCC patients after 5 years as a function of the tumor size of transplanted patients. The total number of deaths drops down monotonically with tumor size, reaching a minimum at size equals to 7 cm, increasing from thereafter. With tumor size equals to 10 cm the total mortality is equal to the 5 cm threshold of the Milan criteria. Conclusion We concluded that it is possible to include patients with tumor size up to 10 cm without increasing the total mortality of this population

Revisão sistemática sobre alotransplantes de ilhotas de Langerhans em roedores: análise de sítio de transplante e tempo de sobrevida

Introdução. A escassez de ilhotas é uma restrição importante ao uso de ilhotas pancreáticas para o desenvolvimento do alotransplante para o tratamento do diabetes tipo I. É necessário, portanto, desenvolver fonte ilimitada de células produtoras de insulina. Objetivos. Organizar e analisar dados sobre o sítio de transplante e o tempo de sobrevida relacionados a tentativas experimentais de alotransplante em roedores, a fim de permitir elaborar um modelo mais adequado para suprir a escassez de doadores de ilhotas. Metodologia. Realizamos uma revisão sistemática usando o banco de dados Pubmed para pesquisar artigos publicados que contenham as palavras-chaves “rodent islet transplantation”. Foram incluídos estudos envolvendo experimentos alotransplante de ilhotas de roedores e analisadas as listas de referências das publicações recuperadas. Artigos relacionados a isotransplantes, autotransplantes e xenotransplantes foram excluídos do estudo. Resultados. Um total de 30 estudos relacionados a alotransplantes em diferentes sítios de enxerto foram selecionados para a revisão sistemática baseados na relevância de seus dados e em sua atualização. O fígado e a cápsula renal são sítios que possibilitaram uma maior sobrevida das ilhotas transplantadas. Conclusão. O alotransplante em roedores é promissor e continua a se desenvolver em diversos centros. As taxas de sobrevivência de aloenxertos aumentaram com a utilização de diferentes medicamentos e locais de enxerto.Introduction. The scarcity of islets is an important use of pancreatic islets for the development of allograft for the treatment of diabetes type I. It is therefore necessary to develop unlimited source of insulin-producing cells restriction. Objectives. Organize and analyze parameters related to the site of transplantation and survival time related to experimental rodent allotransplantation attempts in order to allow the elaboration of the most suitable model to supply the scarcity of islet donors. Methodology. We performed a systematic review using the PubMed database to search published articles containing the keywords “rodent islet transplantation”. We included studies involving allotransplantation experiments with rodents’ islets and we reviewed the reference lists of the publications retrieved that were eligible. We excluded articles related to isotransplantation, autotransplantation and xenotransplantation such as transplantation in other species. Articles related to isotransplantations, transplantations and xenografts were excluded from the study. Results. A total of 30 related allografts in different sites of graft studies were selected for the systematic review based on their relevance data and update. The liver and the kidney capsule are sites that showed better survival of transplanted islets. Conclusion. Allograft transplantation in rodents is promising and continues to develop in several centers. The allograft survival rates increased with the use of different drugs and graft sites

Estimating the prevalence of infectious diseases from under-reported age-dependent compulsorily notification databases.

BACKGROUND: National or local laws, norms or regulations (sometimes and in some countries) require medical providers to report notifiable diseases to public health authorities. Reporting, however, is almost always incomplete. This is due to a variety of reasons, ranging from not recognizing the diseased to failures in the technical or administrative steps leading to the final official register in the disease notification system. The reported fraction varies from 9 to 99% and is strongly associated with the disease being reported. METHODS: In this paper we propose a method to approximately estimate the full prevalence (and any other variable or parameter related to transmission intensity) of infectious diseases. The model assumes incomplete notification of incidence and allows the estimation of the non-notified number of infections and it is illustrated by the case of hepatitis C in Brazil. The method has the advantage that it can be corrected iteratively by comparing its findings with empirical results. RESULTS: The application of the model for the case of hepatitis C in Brazil resulted in a prevalence of notified cases that varied between 163,902 and 169,382 cases; a prevalence of non-notified cases that varied between 1,433,638 and 1,446,771; and a total prevalence of infections that varied between 1,597,540 and 1,616,153 cases. CONCLUSIONS: We conclude that the model proposed can be useful for estimation of the actual magnitude of endemic states of infectious diseases, particularly for those where the number of notified cases is only the tip of the iceberg. In addition, the method can be applied to other situations, such as the well-known underreported incidence of criminality (for example rape), among others