ABSTRACT
Portal vein thrombosis (PVT) may occur at any time following liver transplantation. We describe our experience with portal vein recanalization in cases of thrombosis after liver transplantation. Twenty-eight children (5%) out of 566 liver transplant recipients underwent portal vein recanalization using a transmesenteric approach. All children received left hepatic segments, developed PVT, and had symptoms or signs of portal hypertension. Portal vein recanalization was performed via the transmesenteric route in all cases. Twenty-two (78.6%) patients underwent successful recanalization and stent placement. They received oral anticoagulants after the procedure, and clinical symptoms subsided. Symptoms recurred due to portal vein restenosis/thrombosis in seven patients. On an intention-to-treat basis, the success rate of the proposed treatment was 60.7%. Only 17 out of 28 children with posttransplant chronic PVT retained stent patency (primary + assisted) at the end of the study period. In cases of portal vein obstruction, the transmesenteric approach via minilaparotomy is technically feasible with good clinical and hemodynamic results. It is an alternative procedure to reestablish the portal flow to the liver graft that can be performed in selected cases and a therapeutic addition to other treatment strategies currently used to treat chronic PVT.
Subject(s)
Graft Rejection/prevention & control , Liver Diseases/surgery , Liver Regeneration , Liver Transplantation/adverse effects , Portal Vein/surgery , Venous Thrombosis/surgery , Child , Child, Preschool , Female , Follow-Up Studies , Graft Rejection/etiology , Graft Survival , Humans , Infant , Male , Portal Vein/pathology , Prognosis , Retrospective Studies , Risk Factors , Survival Rate , Venous Thrombosis/etiologyABSTRACT
According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of São Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non-recyclable materials (11%) and increase the volume of recyclable materials (4%). It was also possible to segregate organic waste (7%), which was forwarded for production of compost. The rate of infectious waste generation in critical areas decreased from 0.021 to 0.018 kg/procedure. Many improvements have been observed, and now the PHC complies with most of legal requirements, offers periodic training and better biosafety conditions to workers, has reduced the volume of waste sent to sanitary landfills, and has introduced indicators for monitoring its own performance. This evaluation method might subsidize the creation and evaluation of medical waste management plans in similar heath institutions.
Subject(s)
Ambulatory Care Facilities , Medical Waste Disposal , BrazilABSTRACT
Os autores apresentam dois casos de tumor do corpo carotídeo diagnosticados pelo Serviço de Angiologia e Cirurgia Vascular da Casa de Saúde Santa Marcelina. Aproveitam a oportunidade para comentar o diagnóstico clínico, angiológico e o tratamento desta doença.
Subject(s)
Humans , Female , Male , Adult , Carotid Body Tumor/surgery , Carotid Body Tumor/pathologySubject(s)
Herpes Zoster , Polyradiculoneuropathy/virology , Herpes Zoster/diagnosis , Herpesvirus 3, Human , Humans , Male , Middle AgedABSTRACT
Neste trabalho e apresentada uma nova formulaçao para opreparo do tampao alcalino empregado no Metodo de Heinegard-Tiderstrom modificado por LOPES et alii, 1984, para a dosagem de creatinina no sangue e urina. A modificaçao foi proposta com a finalidade de se obter uma metodologia que facilitasse o preparo do tampao alcalino, garantindo a nao precipitaçao em baixas temperaturas, alem da reduçao do custo. A nova formulaçao do tampao alcalino foi avaliada em comparaçao com o reagente de Heinegard-Tiderstrom mod.(8), atraves da dosagem de 100 (cem) amostras de soro com variadas concentraçoes de creatinina. A analise dos resultados demonstrou uma excelente correlaçao linear, sugerindo que este reagente preenche todos os requisitos necessarios ao seu emprego na dosagem de creatinina, apresentando ainda as vantagens acima citadas
Subject(s)
Humans , Buffers , Creatinine/administration & dosageABSTRACT
Apresentamos um metodo colorimetrico direto, simples, sensivel, preciso e exato para a determinaçao do fosfato inorganico em amostras de soro e urina. Os reagentes sao estaveis, facilmente preparados e economicos. A reaçao se passa entre o fosfato e a soluçao molibdico-sulfurica para formar o complexo de fosfomolibdato, que e reduzido a azul de molibdenio pelo sulfato de p-metilaminofenol (ELON) na presença de dietanolamina, um potente solubilizante do precipitado formado. Os resultados de dosagens obtidos com o novo metodo apresentam excelente correlaçao com os do metodo de desproteinizaçao de GOMORY (6-7) e com 2 tecnicas diretas industrializadas
Subject(s)
Humans , Phosphates/adverse effects , Urine/analysisABSTRACT
Na etapa inicial desta pesquisa, os autores compararam a analise de uma instituicao nao-escolar para criancas de seis a catorze anos com os resultados de duas aplicacoes da prova de Rorschach com intervalo de um ano. Neste intervalo detectaram a evasao de quarenta das setenta criancas da amostragem inicial. Na presente etapa, propoem a pesquisa dos fatores que ponderam esse fenomeno. Apresentam os dados obtidos junto as familias da populacao evadida (que se mostram possiveis de explicar o fenomeno) bem como discutem aplicacao da prova de Rorschach junto as criancas desta segunda populacao
Subject(s)
Child , Adolescent , Humans , Child, Institutionalized , Personality Development , Rorschach Test , FamilyABSTRACT
Os autores descrevem a etapa inicial de uma experiencia em que compararam os resultados da analise de uma instituicao nao-escolar para criancas de 6 a 14 anos, com os resultados de duas aplicacoes de prova de Rorschach (com intervalo de um ano) em uma parcela de sua clientela. Levam em consideracao o estudo das familias dos probandos. Concluem nessa etapa que a interacao entre a instituicao e sua clientela apresenta resultantes positivas reciprocas, e que a aplicacao de dois metodos distintos (estudo da Instituicao e prova de Rorschach) foi eficaz para avaliacao dessas resultantes
Subject(s)
Child , Adolescent , Humans , Child, Institutionalized , Family , Personality Development , Rorschach TestABSTRACT
Os autores expoem o seu conceito de Psiquiatria Social e sua importancia dentro do curriculo para a formacao de psiquiatras. Descrevem a situacao atual do fenomeno migratorio, dando enfase neste assunto na regiao de Sao Paulo. E ressaltada a resultante pragmatica para a atividade psiquiatrica com essa populacao atraves de exemplos colhidos em um trabalho de campo que vem se desenvolvendo ha tres anos
