Some alternatives to minimize the ischemia-reperfusion syndrome, such as the use of another vasoactive drug, use of a third pig merely for blood transfusion, presence of an anesthesia team in the operating room, and reduction of the graft, will be the next steps to enable experimental studies.
BACKGROUND
Many studies evaluated magnification endoscopy (ME) to correlate changes on the gastric mucosal surface with
Helicobacter pylori
(
H. pylori
) infection. However, few studies validated these concepts with high-definition endoscopy without ME.
AIM
To access the association between mucosal surface pattern under near focus technology and
H. pylori
infection status in a western population.
METHODS
Cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard high definition (S-HD) followed by near focus (NF-HD) examination. Presence of erythema, erosion, atrophy, and nodularity were recorded during S-HD, and surface mucosal pattern was classified using NF-HD in the gastric body. Biopsies were taken for rapid urease test and histology.
RESULTS
One hundred and eighty-seven patients were analyzed from August to November 2019. Of those, 47 (25.1%) were
H. pylori
+, and 42 (22.5%) had a previous
H. pylori
treatment. In the examination with S-HD, erythema had the best sensitivity for
H. pylori
detection (80.9%). Exudate (99.3%), nodularity (97.1%), and atrophy (95.7%) demonstrated better specificity values, but with low sensitivity (6.4%-19.1%). On the other hand, the absence of erythema was strongly associated with
H. pylori
- (negative predictive value = 92%). With NF-HD, 56.2% of patients presented type 1 pattern (regular arrangement of collecting venules, RAC), and only 5.7% of RAC+ patients were
H. pylori
+. The loss of RAC presented 87.2% sensitivity for
H. pylori
detection, 70.7% specificity, 50% positive predictive value, and 94.3% negative predictive value, indicating that loss of RAC was suboptimal to confirm
H. pylori
infection, but when RAC was seen,
H. pylori
infection was unlikely.
CONCLUSION
The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of
H. pylori
negative status. On the other hand, the loss of RAC had a suboptimal correlation with the presence of
H. pylori
.
A Hepatite Aguda Grave é uma doença de rápido desenvolvimento que causa falência do fígado com coagulopatia e encefalopatia. Devido à irreversibilidade do quadro, a maioria dos casos deve ser tratada com transplante de fígado. Entretanto, existe dificuldade na obtenção de enxertos hepáticos devido à escassez de doadores falecidos e a necessidade da urgência do transplante. Uma terapia inovadora está sendo utilizada nesses casos: o Transplante Parcial Ortotópico de Fígado Auxiliar (TPOFA). Essa técnica consiste na ressecção de parte do fígado acometido e transplante de um enxerto parcial, permitindo assim a permanência de parte do fígado original, possibilitando sua recuperação e a retirada gradual da imunossupressão. Material e Método: Revisão bibliográfica de artigos na plataforma Mesh-Medline com os descritores: “fulminant hepatitis”, “acute liver failure”, “liver transplantation” e “auxiliary partial orthotopic liver transplantation” e sítios oficiais e do governo para obtenção de dados epidemiológicos. Resultados: Técnica descrita recentemente com boa sobrevivência dos pacientes e que ainda não foi realizada no Brasil. Dentre as vantagens, há a suspensão da terapia imunossupressora mediante a recuperação do fígado original e a redução dos seus efeitos colaterais; além disso, tem-se a opção de utilizar enxertos de doadores vivos. Conclusão: A experiência em outros países do mundo mostrou a viabilidade do Transplante Parcial Ortotópico de Fígado Auxiliar. A realização por equipes devidamente treinadas e capacitadas representará uma evolução do transplante hepático no Brasil.
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