High resolution manometric findings in patients with Chagas' disease esophagopathy

Objective: To describe high resolution manometry features of a population of symptomatic patients with Chagas' disease esophagopathy (EDE). Methods; Sixteen symptomatic dysphagic patients with EDE [mean age (54.81 +/- 13.43) years, 10 women] were included in this study. All patients underwent a high resolution manometry. Results; Mean lower esophageal sphincter (LES) extension was (3.02 +/- 1.17) cm with a mean basal pressure of (15.25 +/- 7.00) mmHg. Residual pressure was (14.31 +/- 9.19) mmHg. Aperistalsis was found in all 16 patients. Achalasia with minimal esophageal pressurization (type I) was present in 25% of patients and achalasia with esophageal compression (type 2) in 75%, according to the Chicago Classification. Upper esophageal sphincter (UES) mean brtsal pressure was (97.96 +/- 54.22) mmHg with a residual pressure of (12.95 +/- 6.42) mmHg. Conclusions: Our results show that LES was hypotensive or normotensive in the majority of the patients. Impaired relaxation was found in a minority of our patients. Aperistalsis was seen in 100% of patients. UES had impaired relaxation in a significant number of patients. Further clinical study is needed to investigate whether manometric features can predict outcomes following the studies of idiopathic achalasia..Univ Fed Sao Paulo, Dept Surg, Escola Paulista Med, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Surg, Escola Paulista Med, Sao Paulo, BrazilWeb of Scienc

High-resolution Manometry Findings in Patients After Sclerotherapy for Esophageal Varices

Background/Aims Endoscopic therapy for esophageal varices may lead to esophageal dysmotility. High-resolution manometry is probably the more adequate tool to measure esophageal motility in these patients. This study aimed to evaluate esophageal motility using high resolution manometry following eradication of esophageal varices by endoscopic sclerotherapy. Methods We studied 21 patients (11 women, age 52 [45-59] years). All patients underwent eradication of esophageal varices with endoscopic sclerotherapy and subsequent high resolution manometry. Results A significant percentage of defective lower esophageal sphincter (basal pressure 14.3 [8.0-20.0] mmHg43% hypertonic) and hypocontractility (distal esophageal amplitude 50 [31-64] mmHgproximal esophageal amplitude 40 [31-61] mmHgdistal contractile integral 617 [403-920] mmHg center dot sec center dot cm48% ineffective) was noticed. Lower sphincter basal pressure and esophageal amplitude correlated inversely with the number of sessions (P < 0.001). No manometric parameter correlated with symptoms or interval between last endoscopy and manometry. Conclusions Esophageal motility after endoscopic sclerotherapy is characterized by: (1) defective lower sphincter and (2) defective and hypotensive peristalsis. Esophageal dysmotility is associated to an increased number of endoscopic sessions, but manometric parameters do not predict symptoms.Univ Fed Sao Paulo, Escola Paulista Med, Dept Surg, Sao Paulo, BrazilUniv Chicago, Dept Surg, 5841 S Maryland Ave, Chicago, IL 60637 USAUniv Fed Sao Paulo, Escola Paulista Med, Dept Surg, Sao Paulo, BrazilWeb of Scienc

Financial cost of the admissions for simultaneous pancreas-kidney transplant in a Brazilian Hospital

PURPOSE:To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital.METHODS:Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in São Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars.RESULTS:Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was$18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%.CONCLUSION:Mortality did not affect costs, and supplies were the largest cost component.Federal University of São Paulo Department of SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of SurgeryHypertension and Kidney HospitalUniversidade Federal de São Paulo (UNIFESP) Department of Internal MedicineUniversidade Federal de São Paulo (UNIFESP) Department of PediatricUNIFESP, Department of SurgeryUNIFESP, Department of SurgeryUNIFESP, Department of Internal MedicineUNIFESP, Department of PediatricSciEL

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%)p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 +/- 102.38 mL/kg) than that in Group B (35.1 +/- 41.67 mL/kg)p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.Univ Fed São Paulo UNIFESP, Postgrad Program Interdisciplinary Surg Sci, São Paulo, BrazilUniv Fed São Paulo, Dept Surg, Div Surg Gastroenterol, São Paulo, SP, BrazilUniv Fed São Paulo, Dept Surg, Div Pediat Surg, São Paulo, SP, BrazilUniv Fed São Paulo UNIFESP, Dept Surg, Div Surg Gastroenterol, São Paulo, SP, BrazilUniv Fed São Paulo UNIFESP, Postgrad Program Interdisciplinary Surg Sci, São Paulo, BrazilUniv Fed São Paulo, Dept Surg, Div Surg Gastroenterol, São Paulo, SP, BrazilUniv Fed São Paulo, Dept Surg, Div Pediat Surg, São Paulo, SP, BrazilUniv Fed São Paulo UNIFESP, Dept Surg, Div Surg Gastroenterol, São Paulo, SP, BrazilWeb of Scienc

Comparação de transplantes hepáticos pediátricos submetidos à transecção hepática exsitu com ou sem a utilização da esponja de fibrinogênio e trombina humana

Introduction: Pediatric liver transplantation has a low number of donor, leading for a high mortality in the awaiting list. A strategy for increase the number of liver transplantation is the utilization of ex-situ liver transection (reduction or split), but this technique is not free of complications such as hemorrhage of the wound area and bile leak. The fibrinogen and thrombin human sponge, is a tool for the hemostasis in the liver surgery. The use of fibrinogen and thrombin human sponge is described in the literature for hemostasis in liver resection, and new papers reported its use in the liver transplantation field. Aims: Compare the pediatric liver transplantation with the ex-situ liver transection (reduction or split) with or without the utilization of fibrinogen and thrombin human sponge. Methods: Were analyzed prospectively 21 patients underwent liver transplantation with ex-situ liver transection (reduction or split) with the utilization of fibrinogen and thrombin human sponge in the wound area (group A), and retrospectively 59 patients underwent liver transplantation with ex-situ liver transection (reduction or split) without the sponge (group B). Results: Recipient and donor characteristics were similar in both group. In the group A 85,7% patients underwent to split liver transection and in group B 61% (p = 0,056). When we compare the number of reoperations we did not found difference in both group, but we observed a lower number of reoperation caused by hemorrhage of the wound area in the group A (14,2%) comparing to the group B (41,7%), p = 0,029. Regarding bile leak in the wound area there was no difference in both group (A: 17,6%, B: 5,1%, p = 0,14). Conclusion: Comparing both groups, in this population, there was a small number of reoperations by hemorrhage of wound area in pediatric patients underwent liver transplantation with ex-situ liver transection (reduction or split) with the fibrinogen and thrombin human sponge.Introdução: O transplante pediátrico hepático apresenta um baixo número de doadores, levando assim à uma alta taxa de mortalidade na lista de espera. Uma estratégia para aumentar o número de transplantes de fígado é a utilização da técnica de transecção hepática ex-situ (redução ou split), mas esta técnica não está livre de complicações, tais como hemorragia da área da cruenta e fístula biliar. A esponja de fibrinogênio e trombina humana é uma ferramenta para a hemostasia no campo da cirurgia hepática e seu uso é descrito na literatura para a hemostasia da ressecção hepática, sendo que novos artigos relataram a sua utilização no campo do transplante hepático. Objetivos: Comparar o transplante hepático pediátrico com a técnica de transecção hepática ex-situ (redução ou split) com ou sem a utilização da esponja de fibrinogênio e trombina humana. Métodos: Foram analisados prospectivamente 21 pacientes submetidos ao transplante hepático com transecção hepática ex-situ (redução ou split) com a utilização da esponja de fibrinogênio e trombina humana (grupo A), e, retrospectivamente, 59 pacientes que foram submetidos ao transplante hepático com transecção hepática ex-situ (redução ou split) sem a esponja (grupo B). Resultados: No grupo A 85,7% pacientes foram submetidos a técnica de split e no grupo B de 61% (p = 0,056). Características dos receptores e dos doadores foram semelhantes em ambos os grupos. Quando comparamos o número de reoperações por sangramento não encontramos diferença em ambos os grupos, porém observou-se um menor número de reoperação causada por hemorragia da área cruenta no grupo A (14,2%) em relação ao grupo B (41,7%), p = 0,029. No que diz respeito à fístula biliar na área cruenta, não houve diferença nos dois grupos (A: 17,6%, B: 5,1%, p = 0,14). Conclusão: Comparando-se os dois grupos, observamos nesta população estudada que houve um menor número de reoperações por sangramento da área cruenta do enxerto hepático quando utiliza-se a esponja de fibrinogênio e trombina humana.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016