ABSTRACT
INTRODUCTION: The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor. OBJECTIVE: This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death. METHOD: These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence. RESULTS: Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines? CONCLUSIONS: This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.
Subject(s)
Brain Death , Critical Care/standards , Organ Transplantation/standards , Tissue Donors/supply & distribution , Tissue and Organ Harvesting/standards , Tissue and Organ Procurement/standards , Adult , Biomarkers/blood , Blood Pressure , Blood Pressure Determination/standards , Blood Volume , Body Temperature , Brain Death/blood , Brain Death/diagnosis , Brain Death/physiopathology , Brazil , Carbon Dioxide/blood , Cardiotonic Agents/therapeutic use , Echocardiography/standards , Erythrocyte Transfusion/standards , Evidence-Based Medicine , Fluid Therapy/standards , Humans , Intracranial Pressure , Lactic Acid/blood , Oxygen/blood , Rewarming/standards , Time Factors , Tissue Survival , Vasoconstrictor Agents/therapeutic useABSTRACT
In Brazil, the incidence of IPF due to alcohol-induced CP seems to be higher than in other countries. The authors analysed some general, epidemiologic, laboratory and radiologic features in 98 patients with CP, all of them alcoholics, divided in two groups: 49 patients without IPF (I) and 49 patients with IPF (II). The authors first analysed the following parameters in each group and then comparatively in both groups: age, sex, race, smokers and daily consumption of cigarettes, daily consumption of alcoholic beverages, years of alcohol consumption, and mortality. The authors concluded that pancreatic fistula plays in effusions the main role, secondary to cysts disruption or necrosis of the main pancreatic duct.
Subject(s)
Pancreatic Cyst/complications , Pancreatic Fistula/complications , Pancreatitis/complications , Adult , Age Factors , Alcoholism/complications , Chronic Disease , Female , Humans , Male , Middle Aged , Necrosis , Pancreatic Cyst/epidemiology , Pancreatic Ducts/pathology , Pancreatic Fistula/epidemiology , Pancreatitis/epidemiology , Sex Factors , Time FactorsABSTRACT
Desde a primeira descricao de uma estrutura esfincteriana no ducto biliar terminal, em 1681, por Glisson, inumeras publicacoes contribuiram para melhor compreensao da funcao do esfincter de Oddi. Estudos manometricos do esfincter de Oddi abriram novas perspectivas para redefinicao de velhos conceitos como a discinesia biliar e a sindrome pos-colecistectomia, e permitiram uma avaliacao mais racional dos resultados obtidos apos esfincterotomia. Os autores realizaram revisao da literatura no que se refere aos aspectos fisiologicos, farmacologicos, diagnosticos e terapeuticos das disfuncoes do esfincter de Oddi.
Subject(s)
Humans , Female , Adult , Middle Aged , Common Bile Duct Diseases/physiopathology , Sphincter of Oddi/physiopathology , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/therapyABSTRACT
Since the first description by Glisson in 1681 many papers about the sphincter of Oddi have been published contributing to the understanding of its physiology. Sphincter manometry has brought to light new facts that allow a better understanding of old concepts such as the biliary dyskinesia and the post-cholecystectomy syndrome as well as a more rational evaluation of the clinical results of the sphincterectomy. A review of the physiologic, pharmacologic, diagnostic and therapeutic aspects of the dysfunction of the sphincter of Oddi is presented.
Subject(s)
Common Bile Duct Diseases/physiopathology , Sphincter of Oddi/physiopathology , Adult , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/therapy , Female , Humans , Middle AgedABSTRACT
Few data on chronic non-A, non-B hepatitis (NANB-CH) have been published so far in our country. We have studied 85 patients classified into four groups: I. post-transfusional (PT), 35 patients (41.2%); II. risk group (GR), including health professionals and drug addicts, 11 (12.9%); III. sporadic with a well defined beginning (EBD), 19 (22.4%) and IV. sporadic with ill-defined beginning (END), 20 (23.5%). The mean age in group I was significantly higher than in groups II and III. A polyphasic pattern of serum aminotransferases and severe histological forms were observed in all groups. It is concluded that the way of infection has probably no prognostic importance.
Subject(s)
Hepatitis C , Hepatitis, Viral, Human , Adolescent , Adult , Aged , Child , Chronic Disease , Female , Hepatitis C/enzymology , Hepatitis C/etiology , Hepatitis C/pathology , Hepatitis, Viral, Human/enzymology , Hepatitis, Viral, Human/etiology , Hepatitis, Viral, Human/pathology , Humans , Male , Middle Aged , Retrospective Studies , Transaminases/bloodABSTRACT
The etiology of chronic pancreatitis was investigated in 407 patients: 381 (93.6%) had a history of heavy alcoholic ingestion (average = 295.3 +/- 171.3 g of ethanol) during a time of 19.2 +/- 8.0 years: five patients (1.0%) had familial background of pancreatitis, two (0.5%) had the obstructive form, and two (0.5%) presented history of malnutrition. In 18 patients (4.4%) it was not possible to determine the etiology. Patients with the alcoholic form started the alcohol abuse at the age of 19.4 +/- 6.0 years. A careful dietetic inquiry showed that patients with chronic pancreatitis lived on a diet which was significantly richer in protein than that of patients of the control group (p less than 0.01). Attention is called to the high incidence of chronic alcohol abuse in patients with chronic pancreatitis.
Subject(s)
Alcoholism/complications , Pancreatitis/etiology , Adolescent , Adult , Aged , Brazil , Cholelithiasis/complications , Chronic Disease , Feeding Behavior , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
The clinical aspects, complications and association with other diseases were investigated in 407 patients with chronic pancreatitis. The most frequent symptoms were abdominal pain (93.6%), weight loss (91.6%), diabetes (37.8%) and malabsorption (31.7%). Pancreatic cysts (32.6%), ascites and/or pleural effusion (12.5%), pancreatic necrosis (11.2%), gastrointestinal bleeding (12.8%) and pancreatic abscess (7.3%) were the most frequent complications. The symptoms and complications observed are discussed and their incidences compared to those reported from other countries.
Subject(s)
Pancreatitis/complications , Chronic Disease , Female , Humans , MaleABSTRACT
Os autores apresentam 4 casos de sindrome de Kluver Bucy parcial e completa comentam sobre o quadro clinico, a etiologia e associacao com atrofia de lobos temporais.Chamam atencao sobre a possibilidade de ocorrer casos cujo diagnostico passaria desapercebido
Subject(s)
Infant , Child, Preschool , Child , Humans , Male , Female , Behavior , Psychosurgery , Temporal LobeABSTRACT
Os autores estudam 5 criancas de uma familia, portadoras de ataxia-telangiectasia, uma das quais com a doenca em sua expressao completa. Sao ressaltados os aspectos clinicos. As anormalidades geneticas, imunologicas e a avaliacao psicologica, sao comentadas
