alexandre cerqueira | Universidade Federal do Rio de Janeiro (UFRJ) (original) (raw)

Papers by alexandre cerqueira

Acta Cirurgica Brasileira, 2004

OBJETIVO: Investigar a área de necrose focal induzida pela injeção intra-hepática de quatro difer... more OBJETIVO: Investigar a área de necrose focal induzida pela injeção intra-hepática de quatro diferentes substâncias no fígado de ratos. MÉTODOS: Foram utilizados 25 ratos Wistar, com peso variando entre 200 a 250 g, distribuidos em 5 grupos, que receberam 0,1cc das seguintes substâncias: Grupo I (Gr. I) - soro fisiológico a 0,9% (controle). Grupo II (Gr. II) - glicose hipertônica a 50%. Grupo III (Gr. III) - NaCl a 20%. Grupo IV (Gr. IV) - formol a 10%. Grupo V (Gr. V) - etanol. Os animais foram submetidos a laparotomia para que a punção fosse realizada no lobo hepático médio sob visão direta. Todos os animais foram sacrificados após 24 horas da injeção.. Os fígados foram avaliados histologicamente, com o intuito de mensurar a área do tecido necrótico. RESULTADOS: Nos cinco grupos estudados observou-se: Gr. I - 2829mm² (controle); Gr. II - 3805mm² (glicose hipertônica); Gr. III - 3930mm² (NaCl); Gr. IV - 4532mm² (formol) e Gr. V - 6432mm² (etanol). A análise estatística destes valore...

Clinical Radiology Extra, 2004

Radiologia Brasileira, 2005

Liver Transplantation, 2003

I n patients who underwent transplantation for familial amyloidotic polyneuropathy (FAP) type I, ... more I n patients who underwent transplantation for familial amyloidotic polyneuropathy (FAP) type I, the explanted liver is normal except for the production of transthyretin met-30. In 1997, a new modality of liver transplantation was introduced: the sequential or domino liver transplantation. 1 In this kind of transplantation, the FAP patients' livers are used as grafts especially for recipients older than age 60 years. The obvious inconvenience is that the FAP liver will continue to produce variant transthyretin, with the potential for later development of neuropathy in the new recipient. The original technique used for transplantation in FAP patients has been changed to promote sequential transplantation. During the hepatectomy of FAP patients, the inferior vena cava (IVC) is not preserved, 1,2 and in many cases, the venovenous bypass is used. 2 Some investigators also report that the pericardium may be sectioned to lengthen the vena cava stumps. 2 Recently, some complications of IVC anastomosis in domino liver transplantation were reported. The Achilles heel of domino transplantation remains the IVC length for both patients, the FAP patient and the domino recipient.

Pediatric Transplantation, 2006

Abstract: The selection of donors for living donor liver transplantation (LDLT) is one of the mos... more Abstract: The selection of donors for living donor liver transplantation (LDLT) is one of the most important features in this kind of surgery. The aim of this study is to describe our initial experience in the donor evaluation process. From December 2001 to January 2005, 104 donors were evaluated for 70 recipients (65 potential donors were evaluated for 39 adult recipients, and 39 donors for 31 pediatric recipients). Only 30 donors were able to donate: 13 for the adult group, and 17 for the pediatric one. In general, the utilization rate of potential donors was 28.8% (30/104). For the adult patients, 65 potential donors were seen to perform 13 LDLT, which represents a utilization rate of potential donors of 20%. For the pediatric patients, this rate was 43.6%. The exclusion criteria were clinical in 22 cases (21%), anatomical in 13 cases (13%), psychosocial in nine cases (9%), and others in 12 (12%). Death of recipients led to excludsion 18 of donors (17%). Thirty-three percent of adults and 55% of pediatric recipients who had at least one potential donor to start the evaluation process were able to identify a living donor. In conclusion, the first limit for LDLT is the rigorous donor evaluation.

Pediatric Transplantation, 2004

Abstract: The shortage of organ donors for low-weight liver transplant recipients, especially fo... more Abstract: The shortage of organ donors for low-weight liver transplant recipients, especially for small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg. We report here the case of an 8-month-old boy, weighing 6.1 kg, who received a monosegmental graft (segment III) from his grandmother weighing 68 kg. The graft was reduced at the donor surgery, before clamping of the vessels. The donor was discharged on the fourth post-operative day; the recipient had an uneventful post-operative period and was discharged after 22 days.

Liver Transplantation, 2005

The shortage of organ donors for low-weight liver transplant recipients, especially small childre... more The shortage of organ donors for low-weight liver transplant recipients, especially small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg, and further reduction could be necessary. Few articles address the issue of monosegmental liver transplantation. Available articles are with small sample sizes or even case reports, which makes it difficult to draw conclusions about indication and outcome for monosegmental grafts. A search of the MEDLINE databases using the terms “Liver Transplantation” and “Monosegmental” or “Monosegments” limited to title or abstract with publication in the English language was conducted. The data from each study were selected and analyzed, regarding donor status (living or cadaveric), donor weight, surgical techniques used in left lateral further reduction, recipient indication for liver transplantation, age and recipient weight, graft-to-recipient body weight ratio, segment utilized, type of abdominal closure, postoperative complications, and survival. Seven publications were identified from 1995 to 2004 and fulfilled the criteria. A total of 27 pediatric patients who received a monosegment transplant were identified, median age 211 days (range, 27 to 454 days) and median weight 4.6 kg (range, 2.45 to 7.4 kg). Segment III was utilized in 21 (78%) and segment II in 6 (22%). Patient survival was 85.2%. In conclusion, monosegment liver transplantation appears to be a satisfactory option for infants weighing less than 10 kg who require a liver transplant. (Liver Transpl 2005;11:564–569.)

Pediatric Transplantation, 2010

Enne M, Pacheco-Moreira L, Balbi E, Cerqueira A, Alves J, Valladares MA, Santalucia G, Martinho J... more Enne M, Pacheco-Moreira L, Balbi E, Cerqueira A, Alves J, Valladares MA, Santalucia G, Martinho J-M. Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use. Pediatr Transplantation 2010: 14: 48–51. © 2009 John Wiley & Sons A/S.Abstract: Arterial reconstructions are pivotal, particularly in pediatric LDLT. We describe microsurgical reconstruction technique with 6× loupes and the clinical course of the first 23 less than 10 kg recipients in an initial LDLT program at a developing country. From March 2002 to October 2008, 286 liver transplantation were performed in 279 patients at our unit. There were 73 children and 206 adults. Among the children, 23 weighing less than 10 kg were recipients from living donors. Arterial reconstructions were with end-to-end interrupted suture using a 6× magnification loupe, according to the untied suture technique. All patients were prospectively followed by color Doppler ultrasound protocol. In our initial experience there were no arterial complications. With mean 24 months of follow-up, 19 patients (82%) are alive with good graft function. Hepatic artery in LDLT can be safely reconstructed with microsurgical techniques without microscope using, with 6× loupe magnification, and can achieve good results in patients under 10 kg.

Liver Transplantation, 2006

In 1997, a new modality of liver transplantation was introduced: the sequential, or domino, liver... more In 1997, a new modality of liver transplantation was introduced: the sequential, or domino, liver transplantation.