RESUMOO sucesso dos transplantes de fígado certamente seria comprometido se a avaliação pré-operatória dos pacientes não fosse realizada de forma adequada. Isto se justifica devido ao reconhecimento de que o sucesso da cirurgia depende, em princípio, do diagnóstico da doença de base, da determinação de sua extensão e do grau de repercussão sistêmica. No final das décadas de setenta a noventa os progressos da hepatologia na identificação das hepatites virais e no manejo da ascite e da síndrome hepatorrenal melhoraram sobremaneira a expectativa de vida do doente portador de doença hepática crônica. Mas, sem dúvida o transplante ortotópico do fígado (TOF) foi o espetacular avanço da hepatologia moderna. Atualmente o transplante é um tratamento eficaz das hepatopatias crônicas, e o índice de sobrevivência global aos 3 anos é ao redor de 80%. É, portanto, uma alternativa de tratamento indicada nos casos terminais, onde a mortalidade com tratamentos conservadores pode atingir até 70% ao final de 12 meses. Neste artigo, os autores comentam aspectos do TOF, relacionados à indicação e a sobrevida. Disponível em URL: http://www.scielo.br/acb Descritores -Transplante de fígado; Doadores; Receptores; Hepatopatias crônicas. ABSTRACTThe success of liver transplantation would be certainly compromised if the pre-operative evaluation was not adequately performed. The success of the liver transplantation depends on the diagnosis of the underlying hepatic disease, the determination of its extension and the degree of systemic repercussion. In the last 30 years, the progress in hepatology, the identification of viral hepatitis and the better management of ascitis and hepatorenal syndrome have increased the life expectancy of patients with chronic liver failure. Undoubtedly, orthotopic liver transplantation represents a great advance in modern hepatology. Nowadays, liver transplantation represents a valid therapeutic option for chronic liver diseases with (and presents) a mean survival rate of about 80% in 3 years. Thus, it is an indicated treatment in situations where the conservative treatment (would) could lead to a (incur) mortality rate as high as 70% in one year. In this article the authors comment (on) various aspects of Orthotopic Liver
BackgroundScreening tests have been used for cognitive deficits in Parkinson's disease (PD).ObjectiveThis study compared the Montreal Cognitive Assessment (MoCA) test, the Mini-Mental State Examination (MMSE) and the clock drawing test for this purpose.MethodsA total of 50 patients with PD were selected, 41 (82%) were diagnosed with dementia by the criteria of the Movement Disorder Society. The test Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) was used as the gold standard in comparison with the screening tests.ResultsThe MoCA test (AUC=0.906) had a sensitivity of 87.80% and specificity of 88.89%. When the MMSE was associated with the clock drawing test (AUC=0.936), it had a specificity of 66.67% and sensitivity of up to 97.56%.ConclusionThe study suggests that the MoCA test can be a good screening test in PD. However, MMSE associated with the clock drawing test may be more effective than the MoCA test.
BackgroundAtrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence.ObjectiveTo compare post-CABG AF incidence, following two CVP control strategies.MethodsInterventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively.Results70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups.ConclusionKeeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG.
The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery was created to assess cognitive impairment in Alzheimer's disease (AD) but it is widely-used for various dementias. The aim of this study was to analyze the efficacy of using the CERAD battery in the assessment of patients with Parkinson's disease. Forty-nine patients with Parkinson's disease were divided into two groups (one with dementia and one without) using the Movement Disorder Society criteria for Parkinson's disease dementia. Cognitive deficits were assessed with the Clinical Dementia Rating Scale as the gold standard, and the CERAD. The ROC curve for the CERAD battery had an area under the curve = 0.989 (95% CI = 0.967 - 1, p<0.0001). Among the CERAD subtests, verbal fluency had the worst accuracy, and word list learning had the best accuracy. Despite the limits of this study, the CERAD battery can be efficient for assessment of cognitive deficits in Parkinson's disease patients.
BackgroundVenous arterialization has been adopted as a strategy for salvage of limbs in critical ischemia without the distal arterial bed, with successful outcomes, but the mechanisms by which irrigation of the extremities takes place are still unknown.ObjectivesTo develop an experimental model to test hypotheses that could explain the mechanisms of blood supply in venous arterialization.MethodsEleven pigs underwent a period of hind limb ischemia followed by reperfusion achieved by venous arterialization, after interposition of conduits filled with 10 ml (5 animals – group 1) or 1 ml (6 animals – group 2) of China Ink. After euthanasia, the limbs were amputated and underwent histological analysis.ResultsUnder optical microscopy, ink staining was observed in the arteriolar lumen of six (55%) of the eleven pigs used in the experiment; four (80%) out of five from group 1 and two (33%) out of six from group 2.ConclusionsThe experimental model was capable of testing the hypothesis. The presence of China Ink in the arteriolar lumen shows that it is possible to supply the arterial vessels by means of venous arterialization.
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