The impact of anti-hepatitis Be positive graft on the outcome of liver transplantion for hbv-related cirrhosis

The scarcity of organ donors requires consideration of marginal organs. The aim of this study was to evaluate the impact of anti HB core positive ( anti HBc +) graft donor status on patients transplanted for Hepatitis B HBV related cirrhosis. Recipients of first hepatic allograft from donor with antibiodies to HBV were identified retrospectively. All patients who had positive serology for HBV and were nwgative for Hepatitis C and D were included in the analysis. Kaplan meier methods were used to asses the actuarial recurrence free survival on patients with graft survival longer than 1,5 months. The Stepwise Cox Regression Model was used to identify independent predictors of HBV recurrence. 1717 first liver transplant were perfomed in our institution from September 1, 1990 to December 31, 1999. HBV was the cause of cirrhosis in 112 patients (6.5 per cents). 69 patients survived over 1,5 months. 33 patients had coexistent viral infection (23 HCB and 10 HDV). 14 donors (17.2 per cents) were positive for HBV markers, 9 anti-HBc + and 5 anti-HBc + and anti HBs +. 13 anti HBc + organ recipients met inclusion criteria. Nine (69.2 per cents) of these cases were re-infected vs. 20 (35.7 per cents) in the group that received graft from HBV negative donors (p<0.05, Fischer's Exact). The time to re-infection was briefer in the anti HBc + group (2.9 yr v 6,4 yr, p= 0.05). There were no diggerences in graft or patients survival between the two groups. HBV prophylaxis with combined lamivudine and HBIG significantly reduced the re-infection rate (p<0.03). hBeAg + recipients trenled to faster re infection (N.S). Cox Regression analysis revealed that both anti HBc graft donor status (HR 2,796, p=0.0020) and combination of lamivudine/HBIG (HR 0.249, p=0.021 are independently associated with re infection. The use of anti-HBc + liver graft does not affect graft or patient survival. However, patients who receive these organs are 2.5 times more likely to develop HBV recurrence. Lamivudine/HBIG combination decreases HBV recurrence fourfold

Anomalia isolada da artéria coronária esquerda: trajeto inusitado dentro da parede da aorta ascendente e inserçäo na artéria pulmonar direita; relato de caso / Anomalous left coronary artery without associated malformations: unusual trajectory within the wall of the ascending aorta and insertion in the right pulmonary artery; a case report

Relatamos o caso de uma criança do sexo masculino, portadora de artéria coronária esquerda originando-se da artéria pulmonar direita. Constituiu-se este relato o primeiro sem outro defeito congênito associado. Sua característica anatômica também é peculiar haja vista que, a artéria coronária esquerda antes de se inserir na artéria pulmonar direita, apresentou trajeto curioso, dentro da parede aórtica (entre as camadas média e adventicia), por cerca de 15 milímetros de extensäo dificultando sobremaneira seu diagnóstico intra-operatório mas facilitando, por outro lado, sua correçäo

Tratamento cirúrgico da hipoplasia do coração esquerdo. Apresentação de dois casos / Surgical treatment of yhypoplasia or the left heart. Report of 2 cases

Em dois pacientes de 4 e 11 dias de vida, portadores de hipoplasia do coraçäo, a técnica cirúrgica descrita por Norwood e col, foi aplicada. O segundo paciente teve boa evoluçäo, encontrando-se atualmente sem cianose evidente e assintomático