ABSTRACT
The high demand for organs for transplantation has made it necessary to consider using the youngest of potential donors in order to increase the organ supply. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. This is a chart review with the objective to analyse the results achieved with transplantation of children kidneys ( 2 years) in the HCFMRP-USP from 1998 to 2000. A total of 5 pacients received en bloc renal transplants from donors aged 9 months to 2 years old, weighthing between 8 and 14 kg. Results: Only one patient lost the allograft within 8 days of transplantation due to allograft trombosis. Two patients had ureteral complications, one with ureteral necrosis and urinary fistula and the other with total ureterovesical anastomosis disrupture. Both were successfully repaired. Intra operatory complication was experienced in one pacient, with arterial anastomosis rupture. In loco reperfusion and repair was made. Another patient had inferior renal pole rupture, treated with polar nefrectomy at the 4º PO. Despite such problems, mean follow up of 20,7 months showed serum creatinine ranging from 0,9 to 2 mg/100ml, with no serious complications. Conclusion: Our data support the use of en bloc child cadaveric kidneys, even from infant donors less than two year of age, when the organ necessity supplant the higher rates of complications.
A grande procura de órgãos para transplante tornou necessária a aceitação de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicação fizeram com que cirurgiões considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis ( 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicações ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicação intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusão in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicações sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgão seja maior que o risco oferecido pelo alto índice de complicações.
ABSTRACT
A grande procura de órgäos para transplante tornou necessária a aceitaçäo de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicaçäo fizeram com que cirurgiöes considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis (< 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicaçöes ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicaçäo intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusäo in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicaçöes sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgäo seja maior que o risco oferecido pelo alto índice de complicaçöes.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adult , Middle Aged , Kidney Transplantation , Tissue Donors , Anastomosis, Surgical/methods , Cadaver , Intraoperative Complications , Postoperative Complications , Retrospective StudiesABSTRACT
It has been suggested that erythma nodosum leprosum (ENL) is associated with enhanced production of TNF-alpha resulting in increased inflammation of the skin and nerve function impairment. Thalidomide and steroids are the major drugs used in the treatment of ENL, but due to the serious problems associated with their use, alternative therapeutic interventions are being considered. In the present retrospective study, the authors report their clinical observations on the effect of pentoxifylline (PTX) in the treatment of ENL. Parameters, such as the clinical involution of reactional lesions, the regression of the inflammatory symptoms associated with the lesions, and the impact on the systemic symptoms common to ENL were assessed at regular intervals during PTX therapy. It was found that PTX therapy led to total elimination of systemic symptoms within the first week of treatment. This improvement was maintained until the end of the study (60 days of treatment). Moreover, the evolution of nodular lesions showed a 100% improvement within the first 14 days of treatment. However, by the 60th day, worsening of the lesions was noted in 20% of the cases. The impression is that PTX is well tolerated, and it may be used for improving patient's clinical condition during ENL reaction. Nevertheless, a randomized, double blind, controlled trial to compare the effects of the widely-accepted thalidomide and the yet untested pentoxifylline for treatment of type 2 reaction is still necessary.
Subject(s)
Adult , Aged , Erythema Nodosum/drug therapy , Female , Humans , Leprosy/drug therapy , Male , Middle Aged , Pentoxifylline/therapeutic use , Retrospective Studies , Treatment OutcomeABSTRACT
A retrospective serologic study was carried out in Fortaleza, State of Ceará, Brazil, in order to detect the dengue virus activity before recognizing the epidemic of 1994. Mac-Elisa was performed by using a mixture of specific DEN-1 and DEN-2 antigens on serum samples from the Emilio Ribas Laboratory collection. Samples were obtained from 1,224 patients with exanthematic febrile disease and negative serological results for rubella. All specimens were taken during November 1993 to May 1994. The results confirmed dengue infections in Fortaleza by November 1993, approximately six months before the beginning of the epidemic, proving how misleading diagnosis of dengue infection are still troublesome, in spite of the strong dengue activity in Ceará. The authors stress the urgent necessity to implement the active surveillance system in order to prevent another extensive fever epidemics in the state. Epidemiological background of the dengue activity in the State of Ceará is also described.