Comparative efficacy of Belzer or Euro-Collins solutions for pancreatic preservation during cold ischemic storage in rats

PURPOSE:To compare the efficacy of different types of solutions (Belzer or Euro-Collins) for the preservation of rat pancreas during cold ischemia. METHODS:Thirty Wistar rats were divided into three groups according to the perfusion or storage solution: Group E (perfusion and storage in Euro-Collins solution); Group B (perfusion and storage in Belzer solution) and Group BE (Perfusion in Belzer solution and storage in Euro-Collins solution). After perfusion, the pancreas was excised and stored at 4˚C for 18 hours. Amylase was measured at 6, 12 and 18h, and histological analysis of the pancreas was performed after 18h of cold storage.RESULTS:Amylase was elevated and comparable in Groups E and BE after 12 and 18 hours of ischemia (p<0.05). In the exocrine pancreas, histological differences in the amount of necrosis (p=0.049), lymphocytic infiltrate (p<0.001) and neutrophilic infiltrate (p=0.004) were observed, with more favorable features present in Group B. In the endocrine pancreas, Group B showed less edema (p<0.001), but other parameters were similar among all groups. CONCLUSION:The Euro-Collins solution is inferior to the Belzer solution for the preservation of rat pancreas during cold ischemia.São Paulo Federal UniversityUNIFESP Paulista School of Medicine Department of SurgeryUNIFESP-EPM Department of SurgerySão Paulo Federal UniversityUNIFESP, Paulista School of Medicine Department of SurgeryUNIFESP, EPM Department of SurgerySciEL

Efeitos do precondicionamento isquêmico associado a diferentes soluções de preservação na proteção do enxerto intestinal

PURPOSE: To evaluate the effects of ischemic preconditioning (IPC) associate with different preservation solutions, in the protecting of gut. METHODS: Four groups of 14 rats underwent laparotomy and collecting 20 cm of ileum, for preservation, at 4ºC, in Belzer (Belz), Ringer (RL), Celsior (Cs) and Custodiol (Cust) solutions, for 24 hours. Prior to collection, half of the animals in each group were subjected to IPC. During preservation, in the periods of zero, 12, 18 and 24 hours, were conducted evaluating the degree of mucosal injury and dosage of malondialdehyde acid (MDA). RESULTS: In all periods the RL group, with and without IPC, presented MDA values higher than the Belz and Cs. The degree of mucosal injury in the non-ipc RLgroup with 12h preservation was higher than the others; with 18 and 24h, the RL and Cust had higher degrees of damage than Cs and Belz. With IPC, in all periods, the group Cs and Belz had lower degrees of injury. CONCLUSION: The Celsior and Belzer solutions had better protective effects on the gut and these effects were enhanced by IPC.OBJETIVO: Avaliar os efeitos do precondicionamento isquêmico (PCI) associado a diferentes soluções de preservação, na proteção do intestino delgado. MÉTODOS: Quatro grupos de 14 ratos Wistar, foram submetidos à laparotomia e coleta de 20 cm de íleo, para preservação, a 4ºC, nas soluções de Belzer (Belz), Ringer (RL), Celsior (Cs) e Custodiol (Cust) por 24 horas. Previamente à coleta, em metade dos animais de cada grupo, o intestino foi submetido ao PCI. Durante a preservação, nos períodos de Zero, 12, 18 e 24 horas, foram realizados avaliação do grau de lesão da mucosa e dosagem do ácido malondialdeído (MDA). RESULTADOS: Em todos os períodos o grupo RL, sem e com pci, apresentou valores maiores de MDA do que o Belz e Cs. O grau de lesão da mucosa nos grupos sem pci com preservação de 12h, no grupo RL, foi maior que nos demais; com 18h e 24h o grupo RL e Cust apresentaram maiores graus de lesão do que Cs e Belz. Com o pci, em todos os períodos, os grupos Belz e Cs apresentaram menores graus de lesão CONCLUSÃO: As Soluções Celsior e Belzer tiveram melhores efeitos na proteção do intestino e estes efeitos foram incrementados pelo precondicionamento isquêmico.University of Mato Grosso Department of SurgeryUNIFESP Division of Experimental SurgeryUNIFESP Division of Pediatric SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of SurgeryUNIFESP, Division of Experimental SurgeryUNIFESP, Division of Pediatric SurgeryUNIFESP, Department of SurgerySciEL

Farmacoalegría

Sección Deptal. de Historia del Arte III (Contemporáneo)Fac. de Bellas ArtesFALSEsubmitte

Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting

<p>Abstract</p> <p>Background</p> <p>HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.</p> <p>Methods</p> <p>A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.</p> <p>Results</p> <p>The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to$97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to$20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to$14.93.</p> <p>Conclusions</p> <p>The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.</p

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

Relevamiento florístico preliminar de especies frutales de árboles nativos del Campo Anexo Manuel Belgrano, INTA San Antonio, Misiones = Preliminary floristic survey of arboreal native fruit species in Campo Anexo Manuel Belgrano, INTA San Antonio, Misiones

Se evaluaron los parámetros fitosociológicos de las especies frutales nativas mediante el relevamiento florístico en un sector remanente de bosque nativo en la localidad de San Antonio, Misiones. El relevamiento fitosociológico se realizó en 13 parcelas de 10.000 m2 cada una, ubicadas en diferentes sectores del remanente boscoso. Los datos relevados se analizaron mediante el cálculo de parámetros fitosociológicos y procedimientos estadísticos no paramétricos. El análisis de cluster clasificó a las parcelas en tres grupos diferenciados por la composición, frecuencia y densidad de especies frutales nativas como consecuencia de disturbios antrópicos y variación ambiental. En base a los resultados se recomienda una evaluación previa del recurso al momento de planificar su uso con fines agroalimentarios para asegurar la viabilidad de las iniciativas proyectadas.The phytosociological parameters of the native tree fruit species were evaluated a floristic survey in a remnant sector of native forest in San Antonio town, Misiones. The phytosociological survey was carried out in 13 plots of 10.000 m2 each one, situated in different sectors of the remnant forest. The collected data were analyzed by calculating phytosociological parameters and nonparametric statistical procedures. The cluster analysis classified the plots into three groups differentiated by composition of species, frequency and density of native fruit species as a consequence of anthropic disturbances and environmental variation. Based on the results, a prior evaluation of the resource is recommended at the moment to plan its for agrifood purposes to ensure the viability of the undertaken/ planned initiatives.EEA MontecarloFil: Barth, Sara Regina. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Montecarlo; Argentina.Fil: Pinazo, Martin Alcides. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Montecarlo; ArgentinaFil: Gonzalez, Paola Analia. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Montecarlo; ArgentinaFil: Gonzalez, Paola Analía. Universidad Nacional de Misiones. Facultad de Ciencias Forestales; Argentina.Fil: Dohman, Romario Andrés. Universidad Nacional de Misiones. Facultad de Ciencias Forestales; Argentina.Fil: Knebel, Otto Eduardo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Montecarlo. Campo Anexo Manuel Belgrano; Argentina.Fil: Alcaraz, Ramón. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Montecarlo. Campo Anexo Manuel Belgrano; Argentina

Acompanhamento de longo prazo após a ressecção de metástases na tiroide de carcinoma hepatocelular em fígado cirrótico

Thyroid metastasis from hepatocellular carcinoma (HCC) is rare, and has poor prognosis. We report the case of a 62-year-old woman seen at our clinic because of the occurrence of a slightly painful abdominal mass. At that time, alpha-fetoprotein concentration was very high, reaching 49,831.7 ng/mL. Abdominal ultrasound showed a heterogeneous mass in segment IV of the liver, which was diagnosed as HCC upon MRI. The patient underwent surgical resection and histological analysis of the specimen confirmed HCC. Metastases to the thyroid were detected 17 months after liver resection. Although the presence of metastases indicates advanced disease, thyroidectomy was performed, since no other distant metastases were detected. In fact, the patient is doing well 3 years after thyroidectomy and regular imaging exams showed no tumor recurrence. Current alpha-fetoprotein concentration is 8 ng/mL. In conclusion, thyroid metastasis from HCC is uncommon and short-term survival is expected. However, surgical resection should be encouraged, especially in the case of solitary metastases.As metástases de carcinoma hepatocelular (CHC) em tiroide são raras e o prognóstico é ruim. Relatamos o caso de uma paciente de 62 anos de idade atendida em nossa clínica devido a uma massa abdominal levemente dolorida. Naquele momento, a concentração de alta-fetoproteína era muito alta, chegando a 49.831,7 ng/mL. O ultrassom de abdômen mostrou uma massa heterogênea no segmento IV do fígado, que foi diagnosticada como CHC por meio de ressonância magnética. A paciente foi submetida a uma ressecção cirúrgica, e a análise histológica do espécime confirmou o CHC. As metástases na tiroide foram detectadas 17 meses após a ressecção do fígado. Embora a presença de metástases indique doença avançada, a tiroidectomia foi feita porque não foram detectadas outras metástases distantes. De fato, três anos após a tiroidectomia, a paciente está bem e os exames de rotina mostraram não haver recorrência do tumor. A concentração atual de alfa-fetoproteína é de 8 ng/mL. Concluiu-se que as metástases de CHC em tiroide não são comuns e espera-se uma sobrevida curta. Entretanto, deve-se encorajar a ressecção cirúrgica, especialmente no caso de metástases solitárias.Universidade Federal de São Paulo (UNIFESP) Hepatology Unit Department of GastroenterologyUNIFESP Liver Transplant Unit Department of SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Pediatric SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Diagnostic RadiologyUniversidade Federal de São Paulo (UNIFESP) Department of PathologyUNIFESP, Hepatology Unit Department of GastroenterologyUNIFESP, Liver Transplant Unit Department of SurgeryUNIFESP, Department of Pediatric SurgeryUNIFESP, Department of Diagnostic RadiologyUNIFESP, Department of PathologySciEL

Estudo da eficácia e da reprodutibilidade da colangiopancreatografia por ressonância magnética na detecção das complicações biliares pós-transplantes hepáticos

PURPOSE: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP) in the detection of biliary complications in liver transplanted patients. METHODS: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6% and 82.1% of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100% of the exams, by both observers. Six biliary complications were detected (21.4%), all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804) for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000) for the detection of biliary complications. MRCP achieved 100% sensitivity, 95.45% specificity, 85.7% positive predictive value and 100% negative predictive value for the detection of biliary complications. CONCLUSIONS: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients.OBJETIVO: Medir a acurácia e reprodutibilidade da colangiopancreatografia por ressonância magnética (CPRM) na avaliação da visibilização de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos. MÉTODOS: Realizado estudo retrospectivo de 28 exames de CPRM de 24 pacientes submetidos a transplantes hepáticos. Os exames foram interpretados por dois observadores independentes, em dois momentos distintos, quanto ao grau de visibilização das estruturas estudadas e quanto à presença ou ausência de alterações nas vias biliares. Os resultados da CPRM foram comparados, nos casos de CPRM negativa, à evolução clínico-laboratorial por pelo menos 3 meses e, nos casos de CPRM alterada, aos achados de colangiopancreatografia retrógrada endoscópica (CPRE) e cirurgia, quando indicados. RESULTADOS: A visibilização das vias biliares intra-hepáticas foi considerada boa ou excelente em 78,6% e 82,1% dos exames pelos dois observadores. A visibilização da via biliar extra-hepática do doador e do receptor, bem como da anastomose biliar, foi considerada boa ou excelente em 100% dos casos por ambos os observadores. Foram detectadas seis complicações biliares (21,4% dos casos), todas elas estenoses anastomóticas. A concordância intra e intra-observador foi substancial ou quase perfeita (índices de kappa- k de 0,611 a 0,804) para a visualização das estruturas estudadas e quase perfeita (k de 0,900 a 1,000) para a detecção das complicações biliares. A CPRM apresentou sensibilidade de 100%, especificidade de 95,45%, valor preditivo positivo de 85,7% e valor preditivo negativo de 100% para a detecção de complicações biliares. CONCLUSÕES: A colangiopancreatografia por ressonância magnética (CPRM) é um exame acurado para a detecção de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos por CPRM. Este exame configura-se como um método eficiente e altamente reprodutível para detecção de complicações biliares pós-transplantes hepáticos ortotópicos.Universidade Federal de São Paulo (UNIFESP) Department of SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Image DiagnosticUniversidade Federal de São Paulo (UNIFESP) Department of MedicineUniversidade Federal de São Paulo (UNIFESP) Department of Surgery Division of Liver TransplantationUniversidade Federal de São Paulo (UNIFESP) Department of Surgery Division of Surgical GastroenterologyUNIFESP, Department of SurgeryUNIFESP, Department of Image DiagnosticUNIFESP, Department of MedicineUNIFESP, Department of Surgery Division of Liver TransplantationUNIFESP, Department of Surgery Division of Surgical GastroenterologySciEL

O Transplante Hepático Por Hepatocarcinoma Na Era Meld Em São Paulo: Análise De 414 Casos Transplantados Pelo Critério De Milão/Brasil

Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules 2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p2 cm (p2 cm (p=0,028) associaram-se com recidiva. A idade (p=0,001), sexo feminino (p2 cm (p<0,014) estiveram associados com a piora na sobrevida. Conclusões: O CMB aumentou em 8,6% as indicações de TxH e apresentou índices de sobrevida semelhantes ao CM.Univ Fed Sao Paulo, Postgrad Program Interdisciplinary Surg Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Sect Liver Transplantat, Discipline Surg Gastroenterol, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Dept Surg, Sect Liver Transplantat, Sao Paulo, SP, BrazilPrograma de Pós-Graduação em Ciência Cirúrgica Interdisciplinar, Universidade Federal de São Paulo, São Paulo, SP, BrasilSetor de Transplante Hepático, Disciplina de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo, SP, BrasilWeb of Scienc