Estatística geral de doação e transplantes de orgãos - Goiás - 2023 (Janeiro a setembro) / General statistics on organ donation and transplants - Goiás - 2023 (January to September)

Estatística geral de doação e transplantes de orgãos - Goiás que tem como objetivo transcrever em números os resultados de todo o trabalho executado pela Gerência de Transplantes em Goiás

General statistics on organ donation and transplants - Goiás which aims to transcribe into numbers the results of all the work carried out by the Transplant Management in Goiás

Estatística geral de doação de orgãos - Goiás - 2023 (Janeiro a julho) / General organ donation statistics - Goiás - 2023 (January to July)

Estatística geral de doação de orgãos e transplantes de orgãos - Goiás tem como objetivo transcrever em números os resultados de todo o trabalho executado pela Gerência de Transplantes em Goiás

General statistics of organ donation and organ transplants - Goiás aims to transcribe in numbers the results of all the work carried out by the Transplant Management in Goiás

Trasplante hepático en Chile: pasado, presente y futuro / Hepatic transplantation in Chile: past, present and future

Resumen La donación de órganos en Chile es insuficiente, con una tasa histórica de alrededor de seis donantes por millón de habitantes. Las reformas legales, mejoras organizacionales y campañas comunicacionales han permitido hacer del año 2019 el más exitoso en cuanto a donación de órganos y trasplantes. El trasplante hepático en Chile fue realizado por primera vez en el año 1969 en el Hospital Naval de Valparaíso, falleciendo el receptor precozmente. El primer trasplante exitoso fue realizado en el año 1985 en el Hospital Militar de Santiago. Desde esa fecha hasta la actualidad se han realizado 1.812 trasplantes de hígado, el 43,6% en hospitales universitarios, el 35,1% en clínicas privadas y un 21,5% en hospitales estatales. El 23,1% en la Pontificia Universidad Católica (PUC), el 20,6% en el Hospital Clínico de la Universidad de Chile (HCUCH), el 15,9% en el Hospital Luis Calvo Mackenna (HLCM), el 15,9% en Clínica Las Condes (CLC), el 14,3% en Clínica Alemana de Santiago (CA), el 5,6% en el Hospital del Salvador (HdS), 2% en Clínica Dávila (CD), 2% en el Sanatorio Alemán de Concepción (SA) y 0,9% en Clínica Santa María (CSM) De este total, 455 son en pacientes pediátricos, de ellos 63,3% en Hospital Luis Calvo Mackenna el 21,1% en la Clínica Las Condes el 7,7% en la Pontificia Universidad Católica de Chile, el 6,4% en la Clínica Alemana y 1,5% en el Sanatorio Alemán. Desde el 2015, aproximadamente el 80% de los trasplantes pediátricos se realizan en el HLCM. Sobrevidas reportadas en adultos van del 75% a 85% al año y de 75% a 92% al año en pacientes pediátricos dependiendo el período. Hay centros que nunca han reportado sus resultados. Se espera mejorar la educación en pro de una sociedad proclive en la donación, mejorar la organización de detección, mantención y procuramiento, aumentar la utilización de órganos, potenciar la utilización los de donantes cadáveres, con técnica Split o hígado dividido y, mientras no tengamos un sistema de donación que dé cuenta de las necesidades del país, mantener los programas de donante vivo. Finalmente debe motivarse a generaciones jóvenes para que se dediquen a esta importante actividad.

Organ donation in Chile is insufficient, with a historical rate of six donors per million inhabitants. Legal reforms, organizational improvements, and communications campaigns have made 2019 the most successful year in terms of organ donations and transplants. The first liver transplant in Chile was performed in 1969 at the Naval Hospital in Valparaíso. However, the patient passed away shortly after. The first successful transplant was performed in 1985 at the Militar Hospital in Santiago. As of that date to present day, 1.812 liver transplants have been performed: 43.6% of these in university hospitals, 35.1% in private clinics, and 21.5% in state hospitals. Of these, 23.1% were performed at the Pontificia Universidad Católica de Chile (PUC), 20.6% at the Universidad de Chile Clinical Hospital (HCUCH), 15.9% at the Luis Calvo Mackenna Hospital (HLCM), 15.9% at the Las Condes Clinic (CLC), 14.3% at the Alemana Clinic in Santiago (CA), 5.6% at the del Salvador Hospital (HdS), 2% at the Dávila Clinic (CD), 2% at the Alemán Sanatorium in Concepción (SA), and 0.9% at the Santa María Clinic (CSM). Of this total, 455 correspond to pediatric patients. Of these patients, 63.3% were at the Luis Calvo Mackenna Hospital, 21.1% at the Las Condes Clinic, 7.7% at the Pontificia Universidad Católica de Chile, 6.4% at the Alemana Clinic, and 1.5% at the Alemán Sanatorium. Since 2015, approximately 80% of pediatric transplants are performed at the HLCM. Reported one-year survival range from 75% to 85% in adults and 75% to 92% in pediatric patients per year, depending on the period. Some centers have never reported their results. It is expected that education of a society prone to organ donation improves, as well as improving the detection, maintenance, and procurement of potential donors, increasing the utilization of organs, enhancing the utilization of organs from deceased donors with Split technique, and, while we are building towards a donation system that responds to the needs of the nation, upholding live donor programs. Finally, younger generations are to be motivated so that they dedicate themselves to this important activity.

Situação atual dos transplantes em Goiás / Current status of transplants in Goiás

A Secretaria de Estado da Saúde de Goiás (SES-GO) por meio da Central Estadual de Transplantes de Goiás/ Superintendência de Acesso a Serviços Hospitalares e Ambulatoriais ­ SUPRASS, deu um salto qualitativo em favor das pessoas que necessitam da realização de transplantes de órgãos e tecidos para ter mais qualidade de vida ou mesmo para sobreviver. Em 2017, comparada ao ano anterior, a taxa de doadores efetivos aumentou 32,3%, tendo passado de 7,2 pmp para 10,7 pmp. Esse crescimento foi decorrente do aumento da taxa de notificação de potenciais doadores de 8,5%(56,5 pmp) e da taxa de efetivação da doação de 5% (19%). Mas, apesar do progressivo aumento de doações efetivas, ainda apresentamos uma alta taxa de não consentimento familiar (61,7%), muito acima da média nacional, 43%, segundo Registro Brasileiro de Transplantes da Associação Brasileira de Transplantes de Órgãos, referente ao primeiro semestre de 2017

The Goiás State Health Department (SES-GO) through the Goiás State Transplant Center / Superintendence for Access to Hospital and Outpatient Services - SUPRASS, made a qualitative leap in favor of people who need organ transplants. and fabrics to have a better quality of life or even to survive. In 2017, compared to the previous year, the effective donor rate increased by 32.3%, from 7.2 pmp to 10.7 pmp. This growth was due to the increase in the rate of notification of potential donors of 8.5% (56.5 pmp) and the rate of effective donation of 5% (19%). However, despite the progressive increase in effective donations, we still have a high rate of family non-consent (61.7%), well above the national average, 43%, according to the Brazilian Transplant Registry of the Brazilian Association of Organ Transplants, referring to the first semester from 2017

Anatomical and functional graft survival, 10 years after epikeratoplasty in keratoconus.

Purpose: To report outcomes of epikeratoplasty in keratoconus (KC), utilizing manually-prepared plano donor lenticules in terms of flattening of the cone, reduction in astigmatism and improvement in the visual acuity. Materials and Methods: Patients with KC, having visual acuity <20/200, astigmatism >12 diopters (D) but without corneal opacity underwent epikeratoplasty, using manually prepared plano donor lenticules from fresh or M.K preserved corneas, between 1990 - 2000 and followed for 10 years, were included in this report. Visual acuity slit-lamp-biomicroscopy, keratometry, and refraction were performed at 8 weeks, 12 weeks, and 6 months for all 59 patients. The same were carried out at 1 year, 5 years, and 10 years depending upon the availability of the patient for that period. Results: Of the 59 patients, only 26 were available for follow-up after 10 years. At 3 months, 1 year and 5 years, best corrected visual acuity of (BCVA) ≥20/60 were achieved in 84.7%, 84.4% and 80.3% of eyes, respectively. BCVA was 73% at 10-year follow- up, which was due to the presence of posterior subcapsular cataract (PSC). The average keratometric astigmatism and average flattening in diopters stabilized at the end of 3 months, which remained constant at 1, 5, and 10-year follow-up. The average diopter of myopia was stabilized by 1 year, which was almost same at 10 year. Graft was clear in all but 1 eye at 10 year follow-up. Conclusion: Epikeratoplasty is a useful technique for keratoconic eyes without apical scarring who fail or unable to use contact lenses.

Conhecimento dos enfermeiros sobre condutas na prevenção, manutenção e no controle da temperatura de potenciais doadores de órgãos / Knowledge of the nurses on behaviors in the prevention, maintenance and in the control of the temperature of potential givers of agencies

Objetivo - Verificar o conhecimento dos enfermeiros da Unidade de Terapia Intensiva (UTI) do Hospital de Urgências de Goiânia-GO (HUGO), sobre condutas de enfermagem a serem tomadas no manejo do potencial doador de órgãos, no que se refere à prevenção, manutenção e controle da temperatura. O indivíduo em morte encefálica está sujeito a alterações térmicas. Cabe ao enfermeiro traçar plano de cuidados para prevenção e controle da hipotermia, considerando que complicações inerentes a esta condição podem inviabilizar a doação. Métodos - Realizou-se uma pesquisa quantitativa, do tipo exploratório e descritivo, no Hospital de Urgências de Goiânia, Goiás. Participaram 10 enfermeiros atuantes em Unidade de Terapia Intensiva. Resultados - Constatou-se que os enfermeiros participantes conhecem diversas estratégias no manejo da queda de temperatura que acomete o paciente em morte encefálica, o que contribui paraa otimização do processo de transplantes. Identificou-se as condutas de enfermagem utilizadas na manutenção da temperatura corporal do potencial doador de órgãos. Conclusão - Diante dos resultados apresentados verificou-se que o enfermeiro conhece a importância da manutenção da temperatura corporal para o potencial doador de órgãos e também a necessidade de se prevenir complicações que podem contribuir para inviabilizar a doação.

Objective - To verify the knowledge of the nurses of the Intensive Care Unit (UTI) of the Emergency Hospital of Goiânia (HUGO), on behavior of nursing be taken in the handling of the potential giver of agencies, as for the prevention, maintenance and control of the temperature. The individual in encephalic death is subject to thermal alterations. It fits to the nurse to trace plan of cares for prevention and control of the hypothermia, being considered that inherent complications to this condition can make impraticable the donation. Methods - It was carried out a quantitative research, of the exploratory and descriptive type, at the Emergency Hospital of Goiânia, Goiás. Ten operating nurses participated in Intensive Care Unit. Results - One evidenced that the participant nurses know diverse strategies in the handling of the temperature fall that event the patient in encephalic death, what he contributes for to facilitate of the process of transplants. One identified the used behaviors of nursing in the maintenance of the body temperature of the potential giver of agencies. Conclusion - Ahead of the presented results it was verified that the nurse also knows the importance of the maintenance of the body temperature for the potential giver of agencies and the necessity of preventing complications that they can contribute to make impracticable the donation.

El donante: elemento básico en el proceso de donación y trasplante / The donor: a basic element in the donation-transplant process

En la actualidad la mayor limitación del trasplante es la escasez de donantes, con aumento de la cifra de pacientes que mueren en listas de espera de órganos. El objetivo fundamental del estudio fue conocer la distribución de los donantes en el país y las causas que motivaron la ocurrencia de casos en que no se extrajeron los órganos. Se realizó un estudio descriptivo, de corte longitudinal, prospectivo y observacional del proceso de donación-extracción de órganos en 87 donantes cadavéricos con muerte encefálica y corazón latiente, ofertados por la Oficina Nacional Coordinadora de Trasplantes al Grupo de Extracción Multiorgánica del Centro de Investigaciones Medicoquirúrgicas en el cuatrienio de 2002 a 2005. Las provincias que más donantes ofrecieron fueron Ciudad de La Habana, Camagüey y Holguín. Las causas más frecuentes de muerte encefálica fueron accidentes cerebrovasculares (43 casos) y traumas craneales (33 pacientes). Los pacientes permanecieron menos de 3 días en unidades de cuidados intensivos, como donantes potenciales. Se consiguió realizar la extracción múltiple de órganos en 78 de las 87 alertas recibidas (90 por ciento). La causa más frecuente de la no extracción es la negativa familiar. Es enfáticamente necesario cuidar a los donantes potenciales en las unidades de cuidados intensivos y velar por el tratamiento adecuado de la familia.

Nowadays, the highest limitation of transplantation is the lack of donors with an increase of the figure of patients that die waiting for an organ. The main objective of the study was to know the distribution of donors in the country and why organs were not extracted in some cases. A descriptive longitudinal, prospective and observational study of the donation-organ extraction process was conducted in 87 cadaveric donors with encephalic death and beating heart that were given to the Multiorgan Extraction Group of the Medicosurgical Research Center by the National Transplant Coordinating Office between 2002 and 2005. Havana City, Camagüey and Holguin were the provinces with the highest number of donors. The most frequent causes of encephalic death were cerebrovascular accident (43 cases) and cranial traumas (33 patients). The patients stayed less than 3 days at the intensive care unit as potential donors. Multiple organ extraction was possible in 78 of the 87 alerts received (90 percent). Family refusal was the most common cause of the non-extraction of organs. It is very important to take care of the donors at the intensive care units and to match over the adequate treatment of the family.

Success rate of long implants inserted in fresh frozen bone

To evaluate the clinical out come on a series of long implants inserted into homologue Fresh Frozen Bone [FFB]. This retrospective study was conducted in the period between December 2003 and December 2006, 33 patients were operated on at the Civil Hospital, Castelfranco Veneto, Italy and 85 LIs inserted. The mean follow-up period was 28 months. Implant diameter and length ranged from 3.3 to 5.0 mm and from 14 to 16 mm, respectively. No implants were lost [i.e. SRV = 100%] and no differences were detected among the studied variables, On the contrary, Cox regression showed that implant diameter [i.e. narrow - implants, diameter 3, 75 mm] and prosthetic restoration [i.e. removable dentures] correlated with a statistically significant lower delta IAJ [i.e. reduced crestal bone loss] and thus a better clinical outcome. FFB is a good material to be used in pre-prosthetic surgery. LIs inserted into FFB can be considered reliable, although a higher marginal bone loss has to be expected when wider implants and fixed prosthetic restorations are used

Experiencia en el manejo de la gangrena de fournier: Servico de Cirugía I / Experience in the management of fournier's gangrene: Servico de Cirugía I

Presentar la experiencia de nuestro servicio en el manejo de la gangrena de Fournier entre los años 1996 a 2006. Estudio retrospectivo y descriptivo. Se estudiaron a todos los pacientes ingresados por gangrena de Fournier en el Servicio de Cirugía Uno del Hospital Vargas de Caracas, entre enero de 1996 y diciembre 2006. Se estudiaron un total de 10 pacientes que habían presentado gangrena de Fournier, todos pertenecían al género masculino. El grupo etario más afectado fue el grupo entre 51 y 60 años con un 40 por ciento (cuatro casos). En cuanto al foco primario se observó con más frecuencia el de origen anorrectal con un 50 por (cinco casos). El número de limpiezas realizadas fue entre uno y cinco, con promedio de 2,7 limpiezas quirúrgicas por pacientes. Se realizaron colostomías derivativas al 80 por ciento de los pacientes, cistostomías al 30 por ciento, se manejo la vía urinaria al 70 por ciento con sonda de Foley, se realizaron injertos al 70 por ciento de los enfermos. No hubo decesos en esta serie de pacientes. La gangrena de Fournier debe ser diagnósticada en forma rápida, manejada en forma agresiva y con medidas de soporte que permitan un adecuado control metabólico e infeccioso.

MR Imaging of Stable Posterior Cruciate Ligament Grafts in 21 Arthroscopically Proven Cases

OBJECTIVE: To describe the magnetic resonance (MR) appearance of intact posterior cruciate ligament (PCL) grafts. MATERIALS AND METHODS: Thirty-one postoperative MR examinations were performed in 21 grafts of 20 patients after PCL reconstruction. All 21 grafts were proven to be intact on second-look arthroscopic examination. Two musculoskeletal radiologists retrospectively analyzed the MR findings and reached decisions by consensus. The signal intensity (SI) of the graft on proton density-weighted and T2-weighted images, as well as the shapes, locations, and segments of increased SI were recorded. The graft thickness was also recorded and correlated to elapsed time since reconstructive surgery. RESULTS: The SI of the graft was high (15/31, 48%), intermediate (10/31, 32%), or low (6/31, 19%) on proton density-weighted images, and high (9/31, 29%), intermediate (6/31, 19%), or low (16/31, 52%) on T2-weighted images. The graft SI decreased significantly as postoperative time elapsed. The shape of the increased SI within the grafts was band-like (14/25, 56%) or focal (11/25, 44%). The increased SI was located in the proximal (18/25, 72%), middle (21/25, 82%), and distal (12/25, 48%) segments. In the axial plane, the location of increased SI was intrasubstance (19/25, 76%) or peripheral (10/25, 40%). A 'focal' shape of increased SI was found significantly more in Achilles tendon allografts, while a band-like shape was more frequent in autogenous double-loop hamstring tendon grafts. Graft thickness ranged from 5-15 mm. The difference in graft thickness relative to postoperative time was not statistically significant (p = 0.79). CONCLUSION: Stable PCL grafts commonly showed an increased SI at any segment or location, even though they were stable. The shape of increased SI differed according to allograft donor sites. However, SI tended to decrease as time elapsed.

One stage hybrid repair of aortic arch aneurysms with antegrade endovascular graft deployment

Despite advances in surgical technique and intensive care medicine, the mortality and morbidity of standard single or two staged approaches for the management of arch aortic aneurysms remain extremely high. With the elephant trunk technique, some patients never proceed to completion of treatment either because of worsening co-morbidity or interim rupture. Retrograde thoracic endografting is not always feasible and its complications are well known. This study examines the use of a hybrid approach for treating arch aneurysms in one stage. The technique combines open aortic arch debranching with antegrade stent repair of these aneurysms. In this series three women and nine men with aneurysms involving the arch, ascending and descending thoracic aorta were treated. Their median age was 66 years. Most aneurysms were degenerative in aetiology [50%. The rest were either dissecting or secondary to Marfan's disease. One patient had the ascending aorta replaced prior to presenting with the arch problem. All other patients were put on cardiopulmonary bypass and had their ascending aorta replaced with or without further concomitant cardiac procedures. Cerebral perfusion was maintained antegrade at 24[degree sign] C through right axillary artery cannulation. This was followed by debranching of the arch of aorta and closure of the origins of the innominate, left common carotid and left sub-clavian arteries. The thoracic endografts were then introduced antegrade through a side arm connected to the body of the main aortic graft. No attempt was made to revascularise the left sublcavian artery. All patients were followed-up with CT scans. No patients was lost to follow-up. It was possible to complete the procedure in a single stage in all patients. The mean operative time was 5.7 hours. There was no intraoperative mortality. There were no intra or postoperative coagulation problems. Two patients had immediate type II endoleak that disappeared completely in one month. One patient died postoperatively having developed acute renal failure and chest infection. Acute renal failure requiring temporary dialysis occurred in three other patients. One patient developed delayed paraparesis that recovered with CSF drainage. One patient suffered with lower medial quadranopia in the right eye. There were no strokes or permanent spinal neurological deficits. Two patients with history of COPD required prolonged respiratory support. They were no long term complications secondary to occlusion of the left subclavian artery. The median length of ITU stay was 5.1 days. The mean length of hospital stay was 15.8 days. During a median follow-up duration of 8.8 months two patients were successfully treated for type II endoleak and one patient developed type 1 endoleak that required extension of the bottom end of the endografts. All aortic debranching grafts remain patent to last follow-up. One stage hybrid repair of aneurysms involving the aortic arch is a feasible technique. The preliminary results of this series show low mortality and complications rate. Larger series with longer follow-ups are underway

Um estudo sobre as filas para transplantes no Sistema Unico de Saúde brasileiro / A study on organ transplantation waiting lines in Brazil's Unified National Health System

Este trabalho estuda as filas para transplantes no Sistema Unico de Saúde, estabelecendo um quadro geral da situação deste problema no Brasil. Os tempos de espera para transplantes de diversos órgãos sólidos são estimados, em cenários alternativos, com o auxílio de um modelo de teoria das filas (queueing theory). O modelo permite estimar as elasticidades dos tempos de espera em relação às taxas de chegada de pacientes de prestação de serviços do sistema. Os prazos de espera são longos e bastante sensíveis às variações na demanda e na oferta de órgãos. Existem possibilidades significativas de redução dos prazos de espera nas filas.

Management of pediatric temporomand bular joint ankylosis: use of costochondral rib graft with interpositiona, temporalis myofacial flap

The posttraumatic ankylosis of the temporomandibular joint [TMJ] is frequently seen in children in Pakistan. The factors which favour in the development of this condition are; the children exhibit much more liability to emergency management, greater difficulty in clinical and radiological examination, state of mixed dentition, faster rate of healing, non-availability of specialists and low socioeconomic status of the patient. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. All patients were presented at Punjab Dental and Children Complex Hospitals Lahore. Twenty-three children [age 1 to 15years] with 28 joints underwent costochondral arthroplasty with interpositional temporalis myofacial flap, out of which 6 were of re-ankylosis after surgery at other centres. The costochondral graft was fixed by tripod screws with remaining ramus condylar unit. The surgery was planned after caref ul examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. The surgical protocol is used to achieve the desirable interincisal jaw opening [>30mm] that was also the postoperative criteria for successful surgery. Five patients with bilateral ankylosis were operated and one patient with additional ipsilateral coronoidectomy. Less than 30mm interincisal opening was considered as unsatisfactory jaw opening. The overall success rate was 96% with only one patient was observed with less than 30mm opening. The lateral and protrusive jaw movements were assessed as excellent, good and poor. The immediate postoperative complications were transient. The ankylosis develops mainly after damage to mandibular condyles or TMJ at a growing age. Results with the procedure were encouraging without noticeable complications during an average follow up of one year

El donante pulmonar: criterios de evaluación y selección / The lung donor: assesment and selection criteria

El trasplante pulmonar es una alternativa adicional de tratamiento para algunos grupos de pacientes seleccionados quienes padecen de enfermedades pulmonares no malignas que comprometen los vasos, las vías aéreas o el parenquima. En la medida que aumentan los centros con capacidad para realizar el trasplante crece también la lista de candidatos para el procedimieto, lo que hace más notorio el inconveniente derivado de la limitación en el número de donantes, situación que ha conducido a un replanteamiento de los rígidos criterios iniciales para su selección. Ahora se describen tres categorías: donante perfecto, aceptable y marginal. En este último grupo se incluyen los pacientes en el límite de los requisitos exigidos. En esta revisión se conparan los antiguos y actuales para la selección de los donantes, con énfasis en el exclusión de aquellos con neoplasias y enfermedades virales trasmisibles, aunque se mantienen reservas y se destaca el tema de los portadores del virus de la hepatitis C. Se revisan aspectos particulares del estudio inmunológico, aspectos técnicos como la diferencia en el tamaño corporal entre el donante y el receptor, problemas infecciosos como el citomegalovirus y se otorga especial atención a las técnicas de manejo del donante vivo, considerado este último como un procedimiento todavía restringido

Reconstrucción de hueso malar mediante injerto de calota / Reconstruction of cigomatic bone by calvarian bone graft

Realizando una revisión bibliográfica de las diferentes técnicas quirúrgicas de injertos e implantes para la reconstrucción del hueso malar se presenta un caso clínico con la aplicación de injerto de hueso de calota en un paciente masculino de cuarenta y nueve años de edad con fractura antigua de hueso malar derecho con hundimiento y deformidad facial