ABSTRACT
Abstract This study aimed to evaluate whether skeletal development of the Pantanal Caiman (Caiman yacare) is similarly influenced by temperature variation and controlled increases in embryo motility. All eggs were incubated at 90% humidity and 29 °C for the first 45 days. Thereafter, the incubation temperature was either maintained at 29 °C and embryos were treated with 4-aminopyridine (4-AP) on days 46, 47, 48, and 49 (Group I, 29 °C 4-AP, n = 15); maintained at 29 °C (n = 14; Group II); or at 33 °C (n = 14, Group III). Embryonic movement was measured using an Egg Buddy® digital monitor on days 30, 35, 42, 49, 56, and 60, at which point embryos were euthanized and samples were collected for analysis. No differences were observed between groups with varying incubation temperatures. In contrast, embryonic motility was greater in embryos treated with 4-AP (P < 0.001) on day 49, and this was associated with higher proportions of snout-vent and hand lengths. This study demonstrates for the first time that pharmacologically induced increases in embryo motility result in phenotypic changes to the proportion of elements during prenatal ontogeny, thereby effectively altering the adaptation of the species to specific environments.
Resumo Este estudo objetivou avaliar os efeitos da temperatura e motilidade embrionária sobre o desenvolvimento esquelético de jacaré-do-pantanal (Caiman yacare). Os ovos foram incubados com 90% de umidade e empregou-se a temperatura de 29°C por 45 dias. Após, para a incubação do Grupo I a temperatura continuou em 29°C, mas associou-se à injeção de 4-aminopiridina (29°C-4AP, n = 15) aplicada nos dias 46, 47, 48 e 49, do Grupo II permaneceu em 29°C (n = 14) e do Grupo III elevou-se para 33°C (n = 14). A movimentação foi mensurada através do monitor digital Egg Buddy® nos dias 30, 35, 42, 49, 56 e 60 dias. Aos 60 dias, os embriões foram eutanasiados e coletadas amostras embrionárias. Na análise estatística não foram observadas diferenças entre os grupos para o fator temperatura sobre a motilidade embrionária no desenvolvimento esquelético. Em contraste, a motilidade evidenciou diferença estatística no dia 49 para o Grupo I (P < 0,001) e apresentou maiores proporções de nariz e mão. Esses dados demonstraram pela primeira vez que o aumento na motilidade, induzidos farmacologicamente resultam em divergências fenotípicas na proporção de segmentos anatômicos durante a ontogenia pré-natal, podendo alterar efetivamente a adaptação dos animais em ambientes específicos.
Subject(s)
Animals , Alligators and Crocodiles , TemperatureABSTRACT
Abstract This study aimed to evaluate whether skeletal development of the Pantanal Caiman (Caiman yacare) is similarly influenced by temperature variation and controlled increases in embryo motility. All eggs were incubated at 90% humidity and 29 °C for the first 45 days. Thereafter, the incubation temperature was either maintained at 29 °C and embryos were treated with 4-aminopyridine (4-AP) on days 46, 47, 48, and 49 (Group I, 29 °C 4-AP, n = 15); maintained at 29 °C (n = 14; Group II); or at 33 °C (n = 14, Group III). Embryonic movement was measured using an Egg Buddy® digital monitor on days 30, 35, 42, 49, 56, and 60, at which point embryos were euthanized and samples were collected for analysis. No differences were observed between groups with varying incubation temperatures. In contrast, embryonic motility was greater in embryos treated with 4-AP (P 0.001) on day 49, and this was associated with higher proportions of snout-vent and hand lengths. This study demonstrates for the first time that pharmacologically induced increases in embryo motility result in phenotypic changes to the proportion of elements during prenatal ontogeny, thereby effectively altering the adaptation of the species to specific environments.
Resumo Este estudo objetivou avaliar os efeitos da temperatura e motilidade embrionária sobre o desenvolvimento esquelético de jacaré-do-pantanal (Caiman yacare). Os ovos foram incubados com 90% de umidade e empregou-se a temperatura de 29°C por 45 dias. Após, para a incubação do Grupo I a temperatura continuou em 29°C, mas associou-se à injeção de 4-aminopiridina (29°C-4AP, n = 15) aplicada nos dias 46, 47, 48 e 49, do Grupo II permaneceu em 29°C (n = 14) e do Grupo III elevou-se para 33°C (n = 14). A movimentação foi mensurada através do monitor digital Egg Buddy® nos dias 30, 35, 42, 49, 56 e 60 dias. Aos 60 dias, os embriões foram eutanasiados e coletadas amostras embrionárias. Na análise estatística não foram observadas diferenças entre os grupos para o fator temperatura sobre a motilidade embrionária no desenvolvimento esquelético. Em contraste, a motilidade evidenciou diferença estatística no dia 49 para o Grupo I (P 0,001) e apresentou maiores proporções de nariz e mão. Esses dados demonstraram pela primeira vez que o aumento na motilidade, induzidos farmacologicamente resultam em divergências fenotípicas na proporção de segmentos anatômicos durante a ontogenia pré-natal, podendo alterar efetivamente a adaptação dos animais em ambientes específicos.
ABSTRACT
This study aimed to evaluate whether skeletal development of the Pantanal Caiman (Caiman yacare) is similarly influenced by temperature variation and controlled increases in embryo motility. All eggs were incubated at 90% humidity and 29 °C for the first 45 days. Thereafter, the incubation temperature was either maintained at 29 °C and embryos were treated with 4-aminopyridine (4-AP) on days 46, 47, 48, and 49 (Group I, 29 °C 4-AP, n = 15); maintained at 29 °C (n = 14; Group II); or at 33 °C (n = 14, Group III). Embryonic movement was measured using an Egg Buddy® digital monitor on days 30, 35, 42, 49, 56, and 60, at which point embryos were euthanized and samples were collected for analysis. No differences were observed between groups with varying incubation temperatures. In contrast, embryonic motility was greater in embryos treated with 4-AP (P < 0.001) on day 49, and this was associated with higher proportions of snout-vent and hand lengths. This study demonstrates for the first time that pharmacologically induced increases in embryo motility result in phenotypic changes to the proportion of elements during prenatal ontogeny, thereby effectively altering the adaptation of the species to specific environments.
Subject(s)
Alligators and Crocodiles , Animals , TemperatureABSTRACT
This study aimed to evaluate the viability of using a non-invasive digital monitor to monitor heart rate (HR) and motility during the embryonic development of Pantanal alligator (Caiman yacare) using Egg Buddy ® , at different incubation temperatures. The collection of the eggs followed the Ranching system and egg identification, transportation, and incubation were performed with the required care; all eggs were incubated with 90% humidity at 29°C for the first 45 days. Thereafter, the incubation temperature was either maintained at 29°C, increased to 33°C or maintained at 29°C and embryos simultaneously treated with 4-aminopyridine on days 46, 47, 48, and 49 (29°C-4AP). Embryo movement was measured with a digital non-invasive monitor on days 30, 35, 42, 49, 56, and 60, at which point embryos were sacrificed. In the statistical analysis no differences were observed between the groups for the temperature (33°C and 29°C); for motility, a difference was observed at day 49 for the 29°C-4AP group. This revealed that the non-invasive evaluation method can be used to verify embryonic motility and HR effectively in Caiman yacare embryos.(AU)
Subject(s)
Animals , Body Temperature , Eggs/analysis , Embryo, Nonmammalian , Alligators and Crocodiles/embryology , Heart RateABSTRACT
A fenda palatina é a comunicação entre a cavidade oral e a nasal através de um orifício no palato. Tem diversas etiologias, podendo ser congênita, traumática, por deficiência mineral ou por fatores hormonais. O diagnóstico é realizado por meio de exame físico da cavidade oral, e a correção cirúrgica é o tratamento de escolha. Em animais adultos, pode ser corrigida com o auxílio de retalho mucoperiosteal, apresentando bons resultados. Já em filhotes, a correção cirúrgica é mais complicada, com prognóstico menos favorável. Este trabalho relata o caso de um canino, fêmea, sem raça definida, adulta, com histórico de fenda palatina secundária, de origem traumática, no palato mole por ingestão de osso. Para a correção cirúrgica, primeiramente foi utilizada membrana biológica de pericárdio bovino, mas não se obteve êxito. O segundo procedimento foi realizado com retalho mucoperiosteal simples autólogo e, dois meses após o procedimento, já havia cicatrização completa. A técnica de retalho mucoperiosteal simples autólogo se mostrou eficaz no tratamento da fenda palatina, aliada aos cuidados adequados no pós-operatório.(AU)
The cleft palate is the communication between the oral and nasal cavity through an aperture in the palate, it's causes include an infinitude of factors: congenital, traumatic, mineral deficiency or hormonal. Examination of the oral cavity determines if the diagnosis and treatment is surgical. Correction in adult animals is performed with mucoperiosteal flap showing good results. However, surgical correction in puppies is more complicated with less favorable prognosis. This current work reports a case of an adult, female dog of undefined breed, with a history of secondary clef palate of traumatic origin in the soft palate due to bone ingestion. For correction, a biological membrane of bovine pericardium was used, but it was not successful, requiring a second surgical procedure performed with autologous simple mucoperiosteal flap. The last technique combined with adequate postoperative care was effective.(AU)
Subject(s)
Animals , Female , Dogs , Palate, Soft/injuries , Surgical Flaps/surgery , Surgical Flaps/veterinary , Cleft Palate/surgery , Cleft Palate/rehabilitation , Cleft Palate/veterinaryABSTRACT
Although the Model for End-Stage Liver Disease (MELD) score has been used to evaluate mortality of patients on the waiting list for liver transplantation, it has not established if it correlates with post-liver transplantation prognosis. The aim of this study is to assess if there is a relationship between pretransplantation MELD and post-transplantation results, especially regarding 30-day post-LT survival rates. We analyzed data from 172 patients who underwent deceased-donor liver transplantation between February 2013 and May 2015 in a single center. The sample was divided in two groups according to their MELD scores: group 1, with MELD <25 (n = 134), and group 2, with MELD ≥25 (n = 38). The groups were compared with regard to 1-, 3-, and 12-month postoperative survival; total length of stay and in intensive care unit; and perioperative blood transfusion. The global 30-day post-liver transplantation survival rate was 87.2% (89.55% for group 1 and 78.99% for group 2 (P = .090). The evaluation of 3- and 12-month survival showed that in group 2 the mortality was higher (P = .01). Our data suggests a positive relationship between the higher MELD group and longer length of stay in intensive care unit (P = .0345), but not for total time of hospital admission (P = .524). Perioperative blood product transfusion was needed in 35.82% of patients in group 1 and 71.05% in group 2; this correlated with a higher 30- day postoperative mortality (P < .001).
Subject(s)
Liver Diseases/surgery , Liver Transplantation/mortality , Models, Statistical , Severity of Illness Index , Adult , Female , Hospitalization , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Time Factors , Waiting ListsABSTRACT
The objectives were to evaluate the efficiency of entomopathogenic fungi against Plutella xylostella (L.) and the compatibility of the most virulent isolates with some of the insecticides registered for use on cabbage crops. Pathogenicity tests used isolates of Beauveria bassiana, Metarhizium rileyi, Isaria fumosorosea, Isaria sinclairii, and Lecanicillium muscarium standardized at a concentration of 10(7) conidia/ml. Cabbage leaf discs were immersed in these suspensions, and after evaporation of the excess water, were placed 10 second-instar larvae of P. xylostella, totaling 10 leaf discs per treatment. Mortality was assessed 7 d after treatment, and the isolates that caused mortality>80% were used to estimate LC50 and LT50. The compatibilities of the most virulent isolates and the insecticides were tested from the mixture of these into the culture medium, and after solidifying, the medium was inoculated with an aliquot of the isolated suspension. The following parameters were evaluated: growth of the colony, number and viability of conidia after 7 d. The isolated IBCB01, IBCB18, IBCB66, and IBCB87 of B. bassiana, LCMAP101 of M. rileyi, and ARSEF7973 of I. sinclairii caused mortality between 80 and 100%, with LC50 and LT50 between 2.504 to 6.775×10(4) conidia/ml and 52.22 to 112.13 h, respectively. The active ingredients thiamethoxam and azadirachtin were compatible with the entomopathogenic fungi. The results suggest that the use of these isolates is an important alternative in the pesticidal management of P. xylostella, with the possible exception of the associated use of chemical controls using the active ingredients thiamethoxam or azadirachtin.
Subject(s)
Beauveria/physiology , Insecticides , Metarhizium/physiology , Moths/microbiology , Pest Control, Biological , Animals , Host-Pathogen InteractionsABSTRACT
BACKGROUND: After brain death (BD) donors usually experience cardiac dysfunction, which is responsible for a considerable number of unused organs. Causes of this cardiac dysfunction are not fully understood. Some authors argue that autonomic storm with severe hemodynamic instability leads to inflammatory activation and myocardial dysfunction. OBJECTIVES: To investigate the hypothesis that thoracic epidural anesthesia blocks autonomic storm and improves graft condition by reducing the inflammatory response. METHODS: Twenty-eight male Wistar rats (250-350 g) allocated to four groups received saline or bupivacaine via an epidural catheter at various times in relation to brain-death induction. Brain death was induced by a sudden increase in intracranial pressure by rapid inflation of a ballon catheter in the extradural space. Blood gases, electrolytes, and lactate analyses were performed at time zero, and 3 and 6 hours. Blood leukocytes were counted at 0 and 6 hours. After 6 hours of BD, we performed euthanasia to measure vascular adhesion molecule (VCAM)-1, intracellular adhesion molecule (ICAM)-1, interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, Bcl-2 and caspase-3 on cardiac tissue. RESULTS: Thoracic epidural anesthesia was effective to block the autonomic storm with a significant difference in mean arterial pressure between the untreated (saline) and the bupivacaine group before BD (P < .05). However, no significant difference was observed for the expressions of VCAM-1, ICAM-1, TNF-α, IL-1ß, Bcl-2, and caspase-3 (P > .05). CONCLUSION: Autonomic storm did not seem to be responsible for the inflammatory changes associated with BD; thoracic epidural anesthesia did not modify the expression of inflammatory mediators although it effectively blocked the autonomic storm.
Subject(s)
Anesthesia, Epidural , Autonomic Nervous System/physiopathology , Brain Death , Myocarditis/physiopathology , Animals , Male , Rats , Rats, WistarABSTRACT
Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO2/FiO2 ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-β) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO2/FiO2 ratio, neutrophil density or TGF-β expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-β expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.
Subject(s)
Animals , Male , Rats , Anti-Inflammatory Agents/pharmacology , Glucocorticoids/pharmacology , Methylprednisolone/pharmacology , Pulmonary Edema/prevention & control , Transforming Growth Factor beta/biosynthesis , Vascular Endothelial Growth Factors/biosynthesis , Analysis of Variance , Disease Models, Animal , Drug Evaluation, Preclinical , Immunohistochemistry , Lung/metabolism , Pneumonectomy/adverse effects , Pulmonary Edema/etiology , Random Allocation , Rats, Wistar , Respiratory Distress Syndrome/prevention & controlABSTRACT
Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO(2)/FiO(2) ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-ß) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO(2)/FiO(2) ratio, neutrophil density or TGF-ß expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-ß expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.
Subject(s)
Anti-Inflammatory Agents/pharmacology , Glucocorticoids/pharmacology , Methylprednisolone/pharmacology , Pulmonary Edema/prevention & control , Transforming Growth Factor beta/biosynthesis , Vascular Endothelial Growth Factors/biosynthesis , Analysis of Variance , Animals , Disease Models, Animal , Drug Evaluation, Preclinical , Immunohistochemistry , Lung/metabolism , Male , Pneumonectomy/adverse effects , Pulmonary Edema/etiology , Random Allocation , Rats , Rats, Wistar , Respiratory Distress Syndrome/prevention & controlABSTRACT
BACKGROUND: In living donor liver transplantation (LDLT), vascular complications are more frequently seen than in deceased donor transplantation. Early arterial, portal vein, or hepatic vein thromboses are complications that can lead to graft loss and patient death. The aim of this study was to assess the incidence, treatment, and outcome of vascular complications after LDLT in a single Brazilian center. METHODS: Between December 2001 and December 2010, we performed 130 LDLT. Sixty-four recipients were children (27 weighing <10 kg). RESULTS: Nine recipients had vascular complications. Hepatic artery thrombosis (HAT) occurred in 4 (3.1%), portal vein thrombosis (PVT) in 3 (2.3%), and hepatic vein thrombosis (HVT) and hepatic arterial stenosis (HAS) in 1 (0.8%) patient each. Complications were identified by Doppler and confirmed by angiography or angiotomography. Patients with HAT were listed for retransplantation. One died before retransplant. Two children were submitted to retransplantation; one is still alive, with neurologic sequelae. One adult with HAT was retransplanted with a deceased donor graft and is doing well 58 months after surgery. Two patients with PVT died as a consequence of graft malfunction. In the other case, portal vein arterialization was performed, but patient died 11 months posttransplant. HVT was detected after cardiac reanimation and was treated with an endovascular stent. This patient died 3 months after LDLT. HAS was diagnosed after liver abscess development and was successfully treated by endovascular angioplasty. No recurrence was observed after 22 months. Follow-up ranged from 9 to 117 months. CONCLUSION: Pediatric patients are more prone to develop vascular complications after LDLT. Long-term survival was statistically lower for recipients with vascular complications (33.3% vs 77.7%; P = .008).
Subject(s)
Liver Transplantation/adverse effects , Living Donors , Vascular Diseases/etiology , Adolescent , Adult , Aged , Brazil , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Reoperation , Young AdultABSTRACT
The rising demand for liver transplantation has continued to outspace the availability of deceased donor organs, leading to the need for other treatment options including living donor liver transplantation (LDLT). A precise evaluation of surgical complications is the most important issue in this setting. There are controversies about donor morbidity with reports ranging from 13%-75%. The aim of this study was to retrospectively analyze 100 LDLTs performed in a single Brazilian center from December 2002 to August 2008, stratifying the complications according to Clavien's scoring system. None of the donors experienced life-threatening complications or died. The majority of donors (n = 74) did not suffer any complication. Twenty-eight complications were observed in 26 patients. Fifty-seven hepatectomies were performed for adult and 43 for pediatric transplantations. According to the Brisbane classifications, we performed 49 right and 2 left hepatectomies as well as 49 left lateral segmentectomies. According to Clavien, the complications were as follows: grade I (n = 11; 39.2%); grade II (n = 8; 28.5%); and grade III (n = 9; 32.3%). No patient presented with grade IV or V. The most common problem a biliary tract injury, similar to other series. In this Brazilian series, hepatectomy for LDLT was a safe procedure with low morbidity, regardless of the type of liver resection. This practice will probably continue to grow to alleviate the pressure of growing waiting lists.
Subject(s)
Hepatectomy/adverse effects , Living Donors , Brazil , Humans , Length of Stay , Postoperative Complications/classification , Postoperative Complications/diagnostic imaging , Postoperative Complications/epidemiology , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
The decision to perform organ donation surgery involves a series of risks for the live donor including death. The aim of this study was to evaluate exclusion criteria for living donor liver transplantation, as well as to identify the rate of exclusion in each of the 3 process phases according to the Live Donor Evaluation Protocol for adult and child recipients. From December 2001 to December 2007, we evaluated 223 donors among whom 142 were excluded in various phases. The data were statistically evaluated. Among the 142 excluded donors, 113 (79.6%) had an adult recipient. The elimination rates for adult recipients were as follows: 68 cases in phase I, 41 cases in phase II, and 4 cases in phase III. Concerning child recipients, 29 (20.4%) donors were excluded: 17 in phase I, and 12 in phase II. Concerning adult recipients, sons and daughters were the largest part of the excluded donors, with withdrawal as the principal reason for exclusion followed by recipient death. Regarding child recipients the parents represented the largest number of excluded donors due to withdrawal followed by abnormal blood test results. Thus, 36.5% of potential donors were effective donors.
Subject(s)
Hepatectomy/methods , Liver Transplantation/methods , Living Donors , Patient Selection , Tissue and Organ Harvesting/methods , Adult , Angiography , Cadaver , Child , Female , Humans , Liver/anatomy & histology , Liver/diagnostic imaging , Liver Diseases/epidemiology , Male , Nuclear Family , Retrospective Studies , Syphilis/epidemiology , Tissue DonorsABSTRACT
BACKGROUND: Heart transplantation (OHT) has traditionally been contraindicated in the presence of severe pulmonary hypertension (PH), as detected by right heart catheterization. Noninvasive methods are still not reliably accurate to make this evaluation. OBJECTIVES: Determine the efficacy of echo Doppler analysis for the diagnosis of severe PH. METHODS: One hundred thirty patients (mean age = 42 +/- 15 years, 82 men) showed severe left ventricular dysfunction (mean ejection fraction = 29 +/- 12%; functional class III-IV). We excluded patients with atrial fibrillation, heart failure secondary to congenital disease, and valvulopathy. The pulmonary parameters defined as severe PH were: systolic pulmonary artery pressure (sPAP) >or= 60 mm Hg; a mean transpulmonary gradient >or= 15; or pulmonary vascular resistance >or= 5 Wood units. Patients underwent a right heart catheterization using a Swan-Ganz catheter to measure hemodynamic parameters and to noninvasively estimate right-sided pressures from spectral Doppler recordings of tricuspid regurgitation velocity (right ventricular systolic pressure [RVsP]). A Pearson correlation of sPAP was obtained with RVsP by; the sensitivity of RVsP for the diagnosis of PH was determined by a receiver operating characteristic (ROC) curve. RESULTS: A good correlation between sPAP and RVsP was obtained by Pearson correlation analysis (r = 0.64; 95% confidence interval [CI] 0.50-0.75; P < .001). The ROC curve analysis showed a sensitivity of 100%, a specificity of 37.2%, (95% CI 0.69-0.83, P < .0001) of a RVsP < 45 mm Hg (cutoff) on the exclusion of severe PH. CONCLUSIONS: The cutoff of RVsP < 45 mm Hg, on noninvasive echo Doppler evaluation of PH is an efficient method to replace invasive heart catheterization in OHT candidates.
Subject(s)
Endosonography/methods , Heart Transplantation/physiology , Hypertension, Pulmonary/diagnostic imaging , Stroke Volume/physiology , Adolescent , Adult , Aged , Blood Pressure , Cardiac Catheterization , Child , Contraindications , Echocardiography/methods , Female , Heart Ventricles/physiopathology , Hemodynamics , Humans , Male , Middle Aged , Reproducibility of Results , Systole , Tricuspid Valve Insufficiency/diagnostic imaging , Vascular ResistanceABSTRACT
Liver transplantation is a complex procedure that has become the treatment for some end-stage liver diseases. Some technical features are important for the success of the transplantation, including the patency of the vascular anastomoses. In cadaveric whole organ liver transplantation, a large right subphrenic space may contribute to a twist of the inferior vena cava, leading to outflow obstruction, simulating an acute Budd-Chiari syndrome. Some devices can be used to correct this drainage problem. Herein, we have described 2 cases in which the Sengstaken-Blakemore balloon was safely used, in an ectopic position, to fix drainage complications in whole liver orthotopic transplantation.
Subject(s)
Liver Transplantation/adverse effects , Adult , Angioplasty, Balloon/instrumentation , Angioplasty, Balloon/methods , Blood Flow Velocity , Budd-Chiari Syndrome/etiology , Cadaver , Hepatectomy/methods , Hepatic Veins/diagnostic imaging , Humans , Liver Cirrhosis/surgery , Male , Middle Aged , Postoperative Complications , Plastic Surgery Procedures , Tissue Donors , Torsion, Mechanical , UltrasonographyABSTRACT
Pneumonectomy is associated with high mortality and high rates of complications. Postpneumonectomy pulmonary edema is one of the leading causes of mortality. Little is known about its etiologic factors and its association with the inflammatory process. The purpose of the present study was to evaluate the role of pneumonectomy as a cause of pulmonary edema and its association with gas exchange, inflammation, nitric oxide synthase (NOS) expression and vasoconstriction. Forty-two non-specific pathogen-free Wistar rats were included in the study. Eleven animals died during or after the procedure, 21 were submitted to left pneumonectomy and 10 to sham operation. These animals were sacrificed after 48 or 72 h. Perivascular pulmonary edema was more intense in pneumonectomized rats at 72 h (P = 0.0131). Neutrophil density was lower after pneumonectomy in both groups (P = 0.0168). There was higher immunohistochemical expression of eNOS in the pneumonectomy group (P = 0.0208), but no statistically significant difference in the expression of iNOS. The lumen-wall ratio and pO2/FiO2 ratio did not differ between the operated and sham groups after pneumonectomy. Left pneumonectomy caused perivascular pulmonary edema with no elevation of immunohistochemical expression of iNOS or neutrophil density, suggesting the absence of correlation with the inflammatory process or oxidative stress. The increased expression of eNOS may suggest an intrinsic production of NO without signs of vascular reactivity.
Subject(s)
Animals , Rats , Inflammation/etiology , Nitric Oxide Synthase/metabolism , Oxidative Stress/physiology , Pneumonectomy/adverse effects , Pulmonary Circulation/physiology , Pulmonary Edema/etiology , Blood Cell Count , Cell Movement , Immunohistochemistry , Inflammation/physiopathology , Neutrophils , Pulmonary Gas Exchange , Pulmonary Edema/physiopathology , Rats, Wistar , Vasoconstriction/physiologyABSTRACT
Pneumonectomy is associated with high mortality and high rates of complications. Postpneumonectomy pulmonary edema is one of the leading causes of mortality. Little is known about its etiologic factors and its association with the inflammatory process. The purpose of the present study was to evaluate the role of pneumonectomy as a cause of pulmonary edema and its association with gas exchange, inflammation, nitric oxide synthase (NOS) expression and vasoconstriction. Forty-two non-specific pathogen-free Wistar rats were included in the study. Eleven animals died during or after the procedure, 21 were submitted to left pneumonectomy and 10 to sham operation. These animals were sacrificed after 48 or 72 h. Perivascular pulmonary edema was more intense in pneumonectomized rats at 72 h (P = 0.0131). Neutrophil density was lower after pneumonectomy in both groups (P = 0.0168). There was higher immunohistochemical expression of eNOS in the pneumonectomy group (P = 0.0208), but no statistically significant difference in the expression of iNOS. The lumen-wall ratio and pO(2)/FiO(2) ratio did not differ between the operated and sham groups after pneumonectomy. Left pneumonectomy caused perivascular pulmonary edema with no elevation of immunohistochemical expression of iNOS or neutrophil density, suggesting the absence of correlation with the inflammatory process or oxidative stress. The increased expression of eNOS may suggest an intrinsic production of NO without signs of vascular reactivity.
Subject(s)
Inflammation/etiology , Nitric Oxide Synthase/metabolism , Oxidative Stress/physiology , Pneumonectomy/adverse effects , Pulmonary Circulation/physiology , Pulmonary Edema/etiology , Animals , Blood Cell Count , Cell Movement , Immunohistochemistry , Inflammation/physiopathology , Neutrophils , Pulmonary Edema/physiopathology , Pulmonary Gas Exchange , Rats , Rats, Wistar , Vasoconstriction/physiologyABSTRACT
Cirrhosis due to hepatitis C virus (HCV) infection is the current leading indication for orthotopic liver transplantation (OLT) in the world. This series reports our program's experience with the treatment of HCV infection after the development of histological hepatitis. Between March 2002 and June 2008, patients with recurrent HCV were selected for treatment if the liver biopsy showed at least the F2 degree of Metavir score. HCV viral load was measured at 4, 12 and 24 weeks as well as at the end of treatment and at 6 months thereafter for patients who became HCV RNA negative (sustained virological response [SVR]). In this period, we performed 287 liver transplantations in 279 patients, including 117 (42%) who had HCV cirrhosis as the indication for OLT of whom 25 were eligible for antiviral treatment. Twelve patients completed treatment, 7 remain on treatment, and 6 were discontinued. The principal collateral effect was anemia. Only 1 patient had an episode of acute cellular rejection, which responded to adjustment of immunosuppression. Antiviral treatment in transplanted patients was feasible and did not seem to induce severe immunological effects. Adjuvant therapies to reduce cytopenias are frequently required, principally erythropoietin. The best results were observed with the pegylated interferon alfa (PEG) plus ribavirin (RBV) group: 38.9% of SVR. We recommend antiviral treatment of eligible patients with confirmed HCV recurrence using PEG plus RBV.
Subject(s)
Hepatitis C/drug therapy , Hepatitis C/surgery , Liver Transplantation/adverse effects , Antiviral Agents/therapeutic use , Biopsy , Female , Humans , Immunosuppressive Agents/therapeutic use , Interferon alpha-2 , Interferon-alpha/therapeutic use , Liver/pathology , Liver Cirrhosis/surgery , Liver Cirrhosis/virology , Liver Transplantation/immunology , Liver Transplantation/pathology , Male , Middle Aged , Polyethylene Glycols/therapeutic use , Postoperative Complications/drug therapy , Postoperative Complications/virology , RNA, Viral/blood , Recombinant Proteins , Recurrence , Retrospective Studies , Ribavirin/therapeutic use , Viral LoadABSTRACT
OBJECTIVE: Orthotopic liver transplantation (OLT) is the principal therapy for acute liver failure (ALF). The mortality on the waiting list for deceased donor liver transplantation (DDLT) is high, principally in countries where donation rates are low. Living donor liver transplantation (LDLT) seems an option for the treatment of ALF, although some ethical issues need to be considered. Herein we have evaluated LDLT results among patients with ALF and discussed the ethical aspects of procedures performed in emergency situations. PATIENTS AND METHODS: From March 2002 to October 2008, we performed 301 liver transplantations, including 103 from living donors. ALF was responsible for 10.6% of all transplantations; LDLT was only considered for pediatric recipients among whom 7 children displayed ALF. RESULTS: One patient died on postoperative day 33 due to hepatic artery thrombosis. One patient died at 2 months after transplantation due to biliary sepsis, resulting in an overall survival rate of 71%. The average time for donor discharge was 5 days. No mortality or major complications were observed. CONCLUSIONS: The survival of children with ALF undergoing LDLT was comparable to published data. Furthermore, despite the fact that the available time to prepare the donors was limited, no serious complications were observed in the postoperative period. Thus, using living donors for children with ALF is an effective, safe alternative that can be extremely useful in countries with low donation rates.
Subject(s)
Liver Failure, Acute/surgery , Liver Transplantation/statistics & numerical data , Living Donors , Child , Female , Follow-Up Studies , Graft Rejection/epidemiology , Humans , Liver Function Tests , Liver Transplantation/mortality , Liver Transplantation/physiology , Male , Survival Analysis , Survivors , Time FactorsABSTRACT
The aim of this study was to analyze the richness, abundance and composition of the terrestrial amphibian assemblage in a flooded riparian forest fragment in a Neotropical region in the south of Brazil over a year (2002-2003). A total of 1,265 terrestrial amphibians were captured, representing 12 species and six families. Leiuperidae represented 41.7 and 56.3 percent of the total number of species and individuals captured, respectively. The amphibian richness and abundance were higher in the Spring-Summer than in the Autumn-Winter period, and these attributes did not change after the flood events. However, the floods homogeneously distributed the amphibian species over the fragment. Our study documented the terrestrial amphibian's use in a riparian forest fragment associated to a floodplain system in the south of Brazil, showing the importance of these habitats as possible dispersal corridors among nearby wetlands.
O objetivo deste estudo foi analisar a riqueza, a abundância e a composição da comunidade de anfíbios terrestres em um fragmento de floresta ripária na região Neotropical no sul do Brasil ao longo de um ano (2002-2003). Um total de 1.265 anfíbios terrestres foi capturado, representando 12 espécies e seis famílias. A família Leiuperidae representou 41,7 e 56,3 por cento do número total de espécies e indivíduos capturados, respectivamente. A riqueza e a abundância de anfíbios foram maiores no período primavera-verão do que no período outono-inverno, e esses atributos não variaram após as inundações. Entretanto, as inundações distribuíram homogeneamente as espécies de anfíbios ao longo do fragmento. Nosso estudo verificou o uso dos anfíbios terrestres em um fragmento de floresta ripária associada a uma planície de inundação no sul do Brasil, destacando a importância desses hábitats como possíveis corredores de dispersão entre áreas úmidas próximas.
