Determinant factors in an expressive increasing of liver transplant in a single center

INTRODUÇÃO: O Hospital das Clinicas da Universidade de São Paulo é o maior hospital do Brasil. Seu programa de transplante foi o pioneiro neste país e realizou seu primeiro transplante de fígado em 1968. A lista de espera para transplante de fígado tem cerca de 700 pacientes, e ultrapassou mil há alguns anos. Apesar deste fato, nosso numero de transplantes de fígado não era muito elevado (cerca de 50/ano) e tínhamos, como esperado, alta mortalidade na lista de espera. Este ano aumentamos significativamente o numero de transplantes de fígado, atingindo 3 vezes a média dos últimos anos. OBJETIVO: Nosso objetivo é explicitar os fatores determinantes neste aumento expressivo do numero de transplantes de fígado em um único centro no Brasil. MÉTODOS: Analisamos o numero de transplantes de fígado no mesmo período do ano (de janeiro a setembro) em 2008 e 2009 no Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. Foram avaliadas as razões deste aumento de transplantes de fígado em 2009 neste centro. RESULTADOS: Comparando o período de janeiro a setembro de 2008 com o mesmo período de 2009, o número de transplantes de fígado aumentou em 200% (35 para 105). A imprensa, o sistema de saúde pública, a organização da equipe transplantadora, a internação de pacientes críticos, o preparo pré-operatório, a aceitação de doadores com critérios expandidos, o programa de doadores vivos, e os fígados bipartidos foram determinantes neste aumento de transplantes de fígado nesta instituição. A sobrevida atuarial melhorou com o aumento do número de transplantes (75% para 85%). CONCLUSÃO: Ainda é possível aumentar o número de transplantes de fígado em países em desenvolvimento. O mecanismo desta transformação é multifatorial e necessita de esforço do governo, institucional e multidisciplinar. Apesar do uso de fígados marginais e bipartidos, o aumento do número de transplantes está relacionado a melhor resultado.INTRODUCTION: The Clinical Hospital of Sao Paulo University is the biggest hospital of Brazil. Its transplant program was the pioneer in this country and it performed its first liver transplant in 1968. The adult waiting list for liver transplant has about 700 patients nowadays, and it has had more than a thousand some years ago. Even though, our number of liver transplants was not so high (about 50 a year) and we had, as expected, high waiting list mortality. This year we raised significantly our liver transplant number, increasing in 3 times our past few years’ average. AIM: We would like to highlight the determinant factors in this expressive increasing number of liver transplants in a single center in Brazil. METHODS: We analyzed the number of liver transplants in the same period of the year (from January to September) in 2008 and 2009 at the Clinical Hospital of Sao Paulo University Medical School. It was evaluated the reasons of the increasing rate of liver transplants in 2009 at this center. RESULTS: Comparing the period from January to September 2008 with the same period of 2009, the liver transplant number increased 200% (35 to 105) .Mass media, public health system policy, transplant team organization, hospitalization of critical patients, preoperative prepare, acceptance of expanded criteria donors, living donor program, and split livers were determinant in this raising of liver transplants at this institution. The actuarial survival rate improved with the increasing number of liver transplants (75% to 85%). CONCLUSION: It is still possible to increase the number of liver transplants in developing countries. The mechanism of such change is multifactorial and it needs government, institutional and multidisciplinary efforts. Besides the use of marginal and split livers, the increasing rate of transplants is related to better outcome

FREQUENCY OF HEPATIC STEATOSIS IN A RADIOLOGY CLINIC IN PALMAS

ABSTRACT Introduction: Recent studies suggest that hepatic steatosis is a worldwide distribution pathology that can progress to chronic liver disease with a highly unfavorable outcome resulting in the need for liver transplantation. That’s why early diagnosis is important. The liver biopsy’s considered a "gold standard" in its diagnosis, but the use of ultrasonography helps to detect steatosis in a non-invasive manner and is a very accessible method for the population. Objectives: To evaluate the frequency of steatosis in patients treated at a radiological clinic in Palmas using abdominal ultrasonography; observing its distribution in genders and age groups and its difference between 2010 and 2016. Methods: It was used ultrasound reports of abdomen of 3.222 patients made in 2010 and of 2.346 patients made in 2016. A longitudinal analysis was performed, between these two years, regarding the frequency of hepatic steatosis at the people and also between the genders and the age groups. Results: In 2010, 25,67% of people had hepatic steatosis in the ultrasound report, while in 2016 were 31,67%. In 2010, of the total number of people with steatosis, 52,48% were women and 47,52% were men; however in 2016, 51,94% were women and 48,06% were men. Regarding the age groups, in both periods, as in men and in women, steatosis was lower at the extremes of age and more frequent around the 5th to 7th decades of life. Discussion: The frequency of hepatic steatosis has increased in the period from 2010 to 2016. It was, as seen in the literature, quite high in the 5th and 6th decades of life, besides being more frequent in females. Unlike 2010, in 2016 begins to have children under 20 with signs of steatosis. Conclusion: In the year 2010 the frequency of hepatic steatosis was 25,67%, whereas in 2016 it was 31,84%.   Keywords: Steatosis; ultrasonography; liver.Introduction: Recent studies suggest that hepatic steatosis is a worldwide distribution pathology that can progress to chronic liver disease with a highly unfavorable outcome resulting in the need for liver transplantation. That’s why early diagnosis is important. The liver biopsy’s considered a "gold standard" in its diagnosis, but the use of ultrasonography helps to detect steatosis in a non-invasive manner and is a very accessible method for the population. Objectives: To evaluate the frequency of steatosis in patients treated at a radiological clinic in Palmas using abdominal ultrasonography; observing its distribution in genders and age groups and its difference between 2010 and 2016. Methods: It was used ultrasound reports of abdomen of 3.222 patients made in 2010 and of 2.346 patients made in 2016. A longitudinal analysis was performed, between these two years, regarding the frequency of hepatic steatosis at the people and also between the genders and the age groups. Results: In 2010, 25,67% of people had hepatic steatosis in the ultrasound report, while in 2016 were 31,67%. In 2010, of the total number of people with steatosis, 52,48% were women and 47,52% were men; however in 2016, 51,94% were women and 48,06% were men. Regarding the age groups, in both periods, as in men and in women, steatosis was lower at the extremes of age and more frequent around the 5th to 7th decades of life. Discussion: The frequency of hepatic steatosis has increased in the period from 2010 to 2016. It was, as seen in the literature, quite high in the 5th and 6th decades of life, besides being more frequent in females. Unlike 2010, in 2016 begins to have children under 20 with signs of steatosis. Conclusion: In the year 2010 the frequency of hepatic steatosis was 25,67%, whereas in 2016 it was 31,84%

Agenesis of the Right Hepatic Lobe

Introduction. Agenesis of the right lobe of the liver is a rare finding and was defined as the absence of liver tissue on the right side, with preservation of the middle hepatic vein, without previous disease or surgery. It is usually an incident finding reveled by imaging exams or during abdominal surgery. Case Report. A 32-year-old male patient was admitted to the hospital for abdominal discomfort and loss of appetite. Imaging studies revealed the absence of the right hepatic lobe and hypertrophied left hepatic segments. Discussion. Anomalies of hepatic morphology are rare and correspond to developmental defects during embryogenesis, are a rare diagnosis, and are generally diagnosed incidentally based on imaging. Agenesis or hypoplasia of the right lobe may predispose the patient to the development of portal hypertension and esophageal varices. Surgical knowledge of such anatomical agenesis is necessary for surgical planning, for the appropriate identification of intraoperative surgical findings, and for the design of the postoperative approach to therapy. Conclusion. Agenesis of the right hepatic lobe is a rare condition. We want to highlight the importance of understanding the condition. Surgeons must recognize the entity in order to deal appropriately with the findings

Aumento do estresse oxidativo após hipotermia em ratos com pancreatite induzida por ceruleína

BACKGROUND: Hypothermia is a frequent event in severe acute pancreatitis (AP) and its real effects on the normal pancreas have not been well demonstrated. Moreover, neither have its effects on the outcome of acute pancreatitis been fully investigated. One hypothesis is that oxidative stress may be implicated in lesions caused or treated by hypothermia. AIM OF THE STUDY: To investigate the effect of hypothermia in cerulein-induced acute pancreatitis (CIAP) in rats and the role played by oxidative stress in this process. METHODS: Male Wistar rats were divided into hypothermic and normothermic groups. Hypothermia was induced with a cold mattress and rectal temperature was kept at 30ºC for one hour. Acute pancreatitis was induced with 2 doses of cerulein (20 ìg/kg) administered at a one-hour interval. Serum amylase, pancreas vascular permeability by Evan's blue method, pancreas wet-to-dry weight ratio and histopathology were analyzed in each group. RESULTS: When compared with normothermic rats, hypothermic animals, with cerulein-induced acute pancreatitis, showed higher levels of pancreatic vascular permeability (p < 0.05), pancreas wet-to-dry weight ratio (p = 0.03), and histologically verified edema (p < 0.05), but similar serum amylase levels. The hypothermic group showed a higher oxidized-reduced glutathione ratio than the normothermic group. CONCLUSION: Moderate hypothermia produced a greater inflammatory response in established acute pancreatitis induced by cerulein in rats. Moreover, this study suggests that oxidative stress may be one of the mechanisms responsible for the worse outcome in hypothermic rats with cerulein-induced acute pancreatitis.BACKGROUND: Hipotermia é um evento freqüente em episódios de pancreatite aguda, contudo seu efeito real sobre pâncreas normal ainda não esta bem demonstrado. Além do mais, o efeito da hipotermia no decorrer da pancreatite aguda também não está completamente esclarecido. Uma das hipóteses sobre as causas das lesões causadas ou tratadas por hipotermia aventa a implicação de estresse oxidativo. OBJETIVOS: Investigar o efeito da hipotermia em ratos com pancreatite aguda induzida por ceruleína e o papel do estresse oxidativo neste processo. MÉTODOS: Ratos Wistar machos foram divididos em grupos hipotérmicos e normotérmicos. Hipotermia foi induzida com uma bolsa gelada de forma que a temperatura retal permanecesse em 30ºC por uma hora. Pancreatite aguda foi induzida com duas aplicações de ceruleína (20 ìg/kg) administradas com intervalo de uma hora. A amilase sérica, a permeabilidade vascular do pâncreas, a razão peso seco/peso úmido do pâncreas, a histopatologia e os níveis de glutationa foram analisados em cada grupo. RESULTADOS: Ratos hipotérmicos, com pancreatite aguda induzida por ceruleína, apresentaram maiores níveis de permeabilidade vascular no pâncreas (p < 0.05), razão peso seco/peso úmido do pâncreas (p = 0.03), e edema histológico (p < 0.05), mas os níveis de amilase sérica permaneceram iguais aos níveis apresentados pelos ratos normotérmicos. O grupo hipotérmico apresentou maior relação glutationa oxidada/glutationa reduzida em relação ao grupo normotérmico. CONCLUSÃO: Hipotermia moderada produziu uma maior resposta inflamatória em ratos com pancreatite aguda estabelecida, induzida por ceruleína, sugerindo que este efeito pode estar ligado a um maior índice de estresse oxidativo em ratos com pancreatite aguda

Predictors of micro-costing components in liver transplantation

OBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards

Development of an instrument to evaluate the knowledge that the patient with hepatic cirhosis has about his disease and treatment

Introduction: hepatic cirrhosis (HC) is a disease with high morbidity and mortality in Brazil. Its treatment is complex&nbsp;and requires from lifestyle changes to large surgeries such as liver transplantation. To reach the best treatment results, it&nbsp;is necessary to guarantee a good patient’s adherence to the treatment. Studies indicate that the patient’s self-knowledge&nbsp;about his or her clinical condition is a determining factor in its adherence.Objectives: to assist in the design of an instrument that evaluates knowledge about the disease and treatment of HC. To&nbsp;improve the student knowledge on liver cirrhosis. Development of skills related to physical examination of the patient&nbsp;with HC.Methodology: The development process of the instrument will be divided into 3 stages: construction of the instrument&nbsp;(1st stage), evaluation of content validity and clarity of the instrument (2nd stage) and assessment of the reliability of the&nbsp;instrument (3 rd stage).Results: an instrument to evaluate the cirrhotic patient knowledge about the disease was made, analyzed by specialists&nbsp;and approved in the criteria proposed.Conclusions:1) The development of the instrument followed the steps described in literature.2) The suggestion of the evaluators allowed to restructure the questions making them clearer and more relevant to the&nbsp;proposal of the instrument.3) it was possible to achieve satisfactorily the proposal of the construction of the instrument.Key words: Liver cirrhosis; Self concept; Surveys and questionnaires; Health education