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1.
Transpl Int ; 30(10): 1032-1040, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28605573

RESUMO

Biliary stricture is a common cause of morbidity after liver transplantation (LT). This study aimed to determine the risk factors for post-transplant biliary anastomotic strictures (BAS), focusing on perioperative platelet counts. We enrolled 771 consecutive recipients who underwent ABO-identical/compatible deceased donor LT with duct-to-duct biliary reconstruction from January 2000 to June 2012. BAS was identified in 142 cases. The median time for stricture development was 176 days. Preoperative and postoperative platelet counts within 5 days after LT were significantly lower in patients with BAS than those without BAS. Using cutoff values acquired by the receiver operating characteristic curve analysis, persistent postoperative thrombocytopenia was defined as platelet counts <41 × 1000/µl and <53 × 1000/µl on postoperative day (POD) 3 and POD 5, respectively. Multivariate analysis indicated persistent postoperative thrombocytopenia (OR = 2.38) was the only independent risk factor for BAS. No significant associations were observed in terms of donor and surgical factors. Multivariate analysis demonstrated estimated blood loss (OR = 1.01, per 100 ml) was an independent contributing factor for persistent postoperative thrombocytopenia. We demonstrated low platelet count was associated with progression of post-transplant BAS. Minimizing intraoperative blood loss potentially contributes to maintain post-transplant platelet count, which may reduce incidence of BAS.


Assuntos
Doenças dos Ductos Biliares/sangue , Transplante de Fígado , Complicações Pós-Operatórias/sangue , Trombocitopenia/complicações , Adolescente , Adulto , Idoso , Doenças dos Ductos Biliares/etiologia , Constrição Patológica/sangue , Constrição Patológica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto Jovem
2.
Clin Transplant ; 31(3)2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27992667

RESUMO

BACKGROUND: The positive impact of platelets has been recently implicated in liver transplantation (LT). The aim of this study was to determine the risk factors for graft loss and mortality after LT, focusing on perioperative platelet counts. METHODS: We reviewed all deceased donor LT from 2000 to 2012 and enrolled 975 consecutive recipients. The risk factors for graft loss and mortality were analyzed by multivariate analysis, using Cox's regression model. RESULTS: Using cutoff values acquired by receiver operating characteristics curve analysis, multivariate analyses determined that viral hepatitis C (hazard ratio [HR]=1.32), donor age >40 (HR=1.33), higher peak serum alanine aminotransferase (HR=1.01), reoperation within 30 days (HR=1.51), and platelet count <72 500/µL on postoperative day (POD) 5 (HR=1.30) were independent risk factors for graft loss. Viral hepatitis C (HR=1.33), reoperation within 30 days (HR=1.35), and platelet count <72 500/µL on POD 5 (HR=1.38) were independent risk factors for mortality. CONCLUSION: A low platelet count on POD 5 was associated with graft loss and mortality after LT. Platelet count <72 500/µL on POD 5 can be a predictor of poor graft and overall survival. Maintaining higher postoperative platelet counts could potentially improve graft and overall survival rates.


Assuntos
Rejeição de Enxerto/etiologia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias , Trombocitopenia/etiologia , Adulto , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Trombocitopenia/sangue , Trombocitopenia/patologia
3.
Spine (Phila Pa 1976) ; 39(11): E701-E704, 2014 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-24718059

RESUMO

STUDY DESIGN: Analysis of spinal cord injury patient education resources. OBJECTIVE: To assess the quality of online patient education materials written about spinal cord injury. SUMMARY OF BACKGROUND DATA: The use of online materials by health care consumers to access medical information presents unique challenges. Most Americans have access to the Internet and frequently turn to it as a first-line resource. METHODS: The quality of online patient education materials was evaluated via a readability analysis. Materials provided by the National Institute of Neurological Disorders and Stroke; Centers for Disease Control and Prevention; American Association of Neurological Surgeons; The National Spinal Cord Injury Association; Mayo Clinic; U.S. Department of Veterans Affairs; Kessler Institute for Rehabilitation; American Academy of Neurology; Paralyzed Veterans of America; and the Shepherd Center were assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. Unnecessary formatting was removed and the readability was evaluated with the spelling and grammar function. RESULTS: A total of 104 sections from 10 different Web sites were analyzed. Overall, the average values of the Flesch-Kincaid Grade Level (11.9) and Flesch Reading Ease (40.2) indicated that most Americans would not be able to fully comprehend this material. CONCLUSION: Results indicate that the language used on materials provided by the aforementioned sites is perhaps too advanced for the average American to fully comprehend. The quality of these education resources may be improved via Web site revisions, which might be beneficial for improved patient utilization. LEVEL OF EVIDENCE: 2.

4.
J Neurointerv Surg ; 5(4): e25, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22641862

RESUMO

A rare case of a persistent dorsal ophthalmic artery is reported. An elderly woman presented with subarachnoid hemorrhage and hydrocephalus. A CT angiogram revealed findings consistent with a small aneurysm and the presence of a dorsal ophthalmic artery. This was confirmed with catheter diagnostic angiography. The radiological findings, embryology and anatomy of these dual ophthalmic arteries are discussed.


Assuntos
Artéria Oftálmica/anormalidades , Artéria Oftálmica/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Idoso , Feminino , Humanos , Radiografia
5.
Neural Regen Res ; 7(23): 1812-21, 2012 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-25624806

RESUMO

Damage from spinal cord injury occurs in two phases - the trauma of the initial mechanical insult and a secondary injury to nervous tissue spared by the primary insult. Apart from damage sustained as a result of direct trauma to the spinal cord, the post-traumatic inflammatory response contributes significantly to functional motor deficits exacerbated by the secondary injury. Attenuating the detrimental aspects of the inflammatory response is a promising strategy to potentially ameliorate the secondary injury, and promote significant functional recovery. This review details how the inflammatory component of secondary injury to the spinal cord can be treated currently and in the foreseeable future.

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