ABSTRACT Bronchial anastomotic complications are a cause of grave concern for surgeons that perform lung transplantations. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding adequate exposure and manipulation of the bronchial stump and anastomosis. Here we report the use of Octopus™ Tissue Stabilizer as a mean to allow for a better exposure of the stump and facilitate a “no-touch” approach towards anastomosis. Systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of bronchial anastomotic complications. transplantations complication them anastomosis Octopus notouch no touch “no-touch

ABSTRACT BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients’ demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

Objetivo: Avaliar o nível de conhecimento dos acadêmicos de Medicina sobre transplante e morte encefálica. Métodos: Questionário autoaplicado não identificado respondido pelos alunos do curso de Medicina do primeiro ao sexto ano, com base em informações da Associação Brasileira de Transplante de Órgãos e Tecidos, Registro Brasileiro de Transplantes e pela resolução que define os critérios para morte encefálica. Resultados: Dos 677 alunos do curso de Medicina, 310 (45,8%) concordaram em responder. Foram excluídos 22 (7,0%) pacientes. Dos que participaram, 41,3% informaram que já assistiram à aula sobre transplante de órgãos e 33% sobre morte encefálica; 9,7% se sentiram aptos a diagnosticar morte encefálica (p<0,01); apenas 66,8% responderam o rim como o órgão sólido mais transplantado no Brasil. Conclusão: O nível de conhecimento sobre morte encefálica e transplantes dos alunos de Medicina da instituição é limitado, o que pode ser resultado de uma abordagem inadequada durante o curso de Medicina.

Objective: To evaluate the level of knowledge of medical students about transplantation and brain death. Methods: An anonymous self-administered questionnaire answered by medical students from the first through the sixth year that was based on information from the Associação Brasileira de Transplante de Órgãos e Tecidos, the Registro Brasileiro de Transplantes and the resolution that defines the criteria for brain death. Results: Of the 677 medical students asked, 310 (45.8%) agreed to answer the questionnaire. In total, 22 (7.0%) subjects were excluded. Of the students who participated, 41.3% reported having already attended a class on organ transplantation and 33% on brain death; 9.7% felt able to diagnose brain death (p<0.01); only 66.8% indicated the kidney as the most transplanted solid organ in Brazil. Conclusion: The level of knowledge of medical students at this institution regarding brain death and transplantation is limited, which may be the result of an inadequate approach during medical school.

PURPOSE: To investigate the effect of chronic experimental diabetes on skin allografts in rats as a simple model that could clarify some basic aspects and mechanisms involved in transplant rejection in diabetes compared to normal animals. METHODS: Skin grafting was performed with fragments of tail skin from sex matched non diabetic Wistar rats engrafted onto the thoracic area of diabetic and non diabetic recipients. Grafts were scored for rejection every other day and were removed on day 14. Skin grafts were graded according to the following itens: no rejection; or rejection including: acute, chronic and humoral and/or cellular rejection. Statistical analysis was performed using JMP 5.1 software with ANOVA test. Diabetes was induced with IV injection of alloxan 40 mg/kg. RESULTS: Inflammatory vascular infiltrate compromising the endothelium with areas of fibrinoid necrosis and thrombosis characteristics of acute humoral rejection and subendothelial lymphocyte infiltrate typical of acute cellular rejection were significantly (p<0.003) higher in diabetic than in non diabetic recipients as the inflammatory infiltrate in the epidermis (p<0.002). CONCLUSION: Skin transplant acute rejection from chronic alloxan diabetic rats to normal tissue was significantly more intense than the acute rejection between normal rats.