RESUMO
Haematopoietic progenitor cell donation from bone marrow and mobilised peripheral blood obtained from related and unrelated donors is an established procedure. The donation process in general has proven to be safe, but in rare cases severe and even fatal events have been reported. The present study aimed at providing a description of the current situation of donor protection measures in Council of Europe member States. A specific questionnaire was developed to compile information on donation activities, graft sources, legal frameworks, donor protection measures, collection of donor outcome data, and long-term follow-up of paediatric and adult related and unrelated donors. The outcome of this survey served as a basis for elaborating the Recommendation CM/Rec(2020)6 of the Committee of Ministers to member States on establishing harmonised measures for the protection of haematopoietic progenitor cell donors.
Assuntos
Mobilização de Células-Tronco Hematopoéticas , Doadores de Tecidos , Adulto , Humanos , Criança , Mobilização de Células-Tronco Hematopoéticas/métodos , Células-Tronco Hematopoéticas , Doadores não Relacionados , Medula Óssea , Europa (Continente)RESUMO
Tissue-engineered human allogeneic skin grafts retrieved from a deceased donor play an important role in the therapy of extensive and deeply burned patients. However, there is a vital deficit of allogeneic skin donors, and the reserves of human allogeneic skin grafts are not sufficient. The goal of this work was to analyze the level of knowledge and attitudes of Polish society in the field of transplantation, with particular emphasis on allogeneic skin transplantation. The study used a self-made questionnaire comprised of 23 questions. 1000 respondents took part in this research. The respondents were a diverse group in terms of age, sex, education, and place of residence. The obtained results show a general positive attitude of the respondents towards the idea of transplantology. However, people with lower education presented a more negative attitude towards the donation of tissues and organs. Additionally younger people were not able to clearly declare readiness for organ procurement. What is more data analysis revealed certain gaps in more detailed knowledge and surprising attitudes. In that respect, the lack of awareness about the criteria for determining brain death could be mentioned. There was also a lack of acceptance for skin procurement in specific population groups. It can therefore be concluded that a key role in the success of the idea of transplantation in Poland is the broad and systematic education of the society.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Obtenção de Tecidos e Órgãos , Humanos , Polônia , Conhecimentos, Atitudes e Prática em Saúde , Doadores de Tecidos , Inquéritos e QuestionáriosRESUMO
In this article, we present the standpoint and recommendations of Poltransplant on the use of organs, tissues, and cells other than hematopoietic cells for transplant in connection with SARS-CoV-2 infections (January 15, 2021).
Assuntos
COVID-19 , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Humanos , Transplante de Órgãos/efeitos adversos , SARS-CoV-2 , Doadores de TecidosRESUMO
BACKGROUND: One of the important tasks of a modern hospital, in addition to treatment, prevention, and education, is the activity in the field of donating organs from deceased and living donors. In July 2010, the Polish Transplantation Coordination Center Poltransplant (the national transplantation organization and the authority responsible for organ donation and transplantation), thanks to the funds of the Ministry of Health, under the National Program for the Development of Transplant Medicine, initiated the project of building a network of coordinators by employing hospital transplantation coordinators in selected hospitals, where it is possible to identify potential deceased donors, perform the brain death diagnostic procedure, and where the conditions are met and it is possible to collect organs (they have an intensive care unit and operating theater in their structures). In Poland, these conditions are met by 388 hospitals with a donation potential. AIM: The aim of the work is to present the functioning of the system of transplant coordinators in Poland. RESULTS: The work presents the system of employment and tasks of transplant coordinators at various levels: hospital coordinators for donating organs from deceased donors, living donation and transplant coordinators, coordinators of hematopoietic cell collection and transplantation, central coordinators of Poltransplant, and organ procurement and transplant coordinators associated with transplant centers.
Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Morte Encefálica , Humanos , Doadores Vivos , Polônia , Doadores de TecidosRESUMO
In the pandemic year 2020, 634 allogeneic hematopoietic stem-cell (HSC) transplants were performed in Poland, including fully matched and haploidentical family donors (n = 248) as well as unrelated donors transplantation (n = 386). In 48 recipients (7.6%) for allogeneic transplantation, hematopoietic bone marrow cells were transplanted, and in 586 recipients (92.4%), peripheral blood hematopoietic cells. The effect of the pandemic was noticeable but not disastrous-the number of HSC transplants from unrelated donors was lower by 9% compared to 2019 and the use of haploidentical donors slightly increased compared to 2019. Out of all 386 unrelated HSC transplants, the material for 143 transplants (37%) came from international donors, whereas for 243 transplants (63%) material collected from domestic donors was used. Along with the increase in the number of potential bone marrow donors in the national resources, the share of transplants from Polish donors in the total number of transplants increased noticeably from 2006 to 2020. The total number of allogeneic transplants performed in 18 Polish transplant centers between 2006 and 2020 is 7426. Total transplant rates (cumulative number of all allogeneic HSC transplants performed from 2006 to 2020 per 1 million inhabitants) differs between regions and for regions with nonzero number of transplants varies from 520 in Mazowieckie Voivodship to 14 in Lodzkie Voivodship.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Polônia , Sistema de Registros , Transplante Homólogo , Doadores não RelacionadosRESUMO
A burn is a sudden injury which immediate or long-term consequences may be life-threatening for the patient. A mass disaster event may involve large numbers of severely burned patients. Patients of this type typically have a limited area of healthy, unburned skin from which an autologous split thickness skin graft could be collected. In a clinical situation of this type, it is necessary to use a particular skin substitute. Non-viable allogeneic human skin graft materials might be considered as the most suitable skin substitutes in the treatment of such patients. At present, Poland does not have a sufficient supply of human allogeneic skin graft materials to meet the needs arising from a sudden and unforeseen mass disaster. This study involved an analysis of selected mass disasters. From this an estimate was made from a verified casualty profile of the necessary minimum stock of human allogeneic skin graft materials. An insufficient amount of skin results from an inadequate number of skin donors, which in turn results from the current tissue donation system. Therefore, a proposal has been made for the organizational, legal and systemic changes required to improve the situation in Polish transplantology, with particular emphasis on skin donation. In order to achieve a strategic stock of human skin grafts, a tissue collecting transplantation team should be organized. The rights and obligations of the non-physician transplant team member should be extended. Proposals have been made for awareness campaigns (adverts, posters etc.) and educational schemes (educational video, lectures during transplant coordinator training, etc.). Finally, a proposal has been made for possible methods to deal with the logistic management of the allogeneic skin stock. The required, essential stock of human allogeneic skin in the event of a mass disaster has been estimated at 600,000 cm2.
Assuntos
Queimaduras , Desastres , Transplante de Células-Tronco Hematopoéticas , Humanos , Transplante de Pele/métodos , Polônia , Queimaduras/terapiaRESUMO
The nonviable allogeneic human skin grafts might be considered as the most suitable skin substitutes in the treatment of extensive and deep burns. However, in accordance to biological security such grafts require the final sterilization prior to clinical application. The aim of the study was to verify the influence of electron beam irradiation of three selected doses: 18, 25, and 35 kGy on the extracellular matrix of human skin. Prior to sterilization, the microbiological tests were conducted and revealed contamination in all examined cases. Individual groups were subjected to single electron beam radiation sterilization at proposed doses and then subjected to microbiological tests again. The results of microbiological testing performed for all irradiation doses used were negative. Only in the control group was a growth of microorganisms observed. The FTIR spectrometry tests were conducted followed by the histological evaluation and mechanical tests. In addition, cost analysis of radiation sterilization of individual doses was performed. The results of spectroscopic analysis, mechanical tests, and histological staining showed no significant changes in composition and characteristics of tested tissues after their irradiation, in comparison to control samples. The cost analysis has shown that irradiation with 18 kGy is the most cost-effective and 35 kGy is the least favorable. However, according to biological risk reduction, the recommended sterilization dose is 35 kGy, despite the higher price compared to the other doses tested.
Assuntos
Elétrons , Transplante de Células-Tronco Hematopoéticas , Matriz Extracelular , Raios gama , Humanos , Transplante de Pele , Esterilização/métodosAssuntos
Carcinoma de Células Escamosas/terapia , Perna (Membro)/efeitos da radiação , Poroceratose/terapia , Radioterapia de Intensidade Modulada/métodos , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/complicações , Humanos , Perna (Membro)/anormalidades , Masculino , Poroceratose/complicações , Radioterapia de Intensidade Modulada/estatística & dados numéricosRESUMO
Poland's Central Unrelated Potential Bone Marrow Donor and Cord Blood Registry (CBMDR Poltransplant) was established in 2011. Affiliated with the World Marrow Donor Association (WMDA) as PL5, the CBMDR is an internationally recognized hematopoietic stem cell donor registry with a large, high-quality donor database. Overall, Polish resources in this domain are the second largest in Europe and the fourth largest in the world, accounting for 4.8% of the WMDA Register of over 33.5 million records. In the last 10 years, the number of potential hematopoietic stem cell donors registered in Poland has increased more than 10-fold, from about 146,000 to 1,579,809 at the end of 2018. Such a growing number of donors in the CBMDR is contributing to an increase in overall numbers of donor searches in Polish databases, as well as in donations from Polish donors.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas , Sistema de Registros , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/organização & administração , Bancos de Sangue , Medula Óssea , Europa (Continente) , Sangue Fetal , Humanos , PolôniaRESUMO
Implant treatment is safe and predictable with sufficient amount and quality of bone tissue. In case of severely reduced bone tissue after a tooth was lost, augmentation of such tissue is necessary before implant embedment. Retrospective evaluation covered 380 alveolar ridge reconstructions. The study material consisted of human grafts prepared by the Department of Transplantology and Central Tissue Bank, Medical University of Warsaw. Presentation of laboratory procedures in the context of physical parameters of frozen, radiation sterilised, allogeneic corticocancellous material was presented. The preparation process makes it possible to obtain two types of bone material: granules and blocks. Women underwent 164 procedures with the use of bone granules and 61 augmentations with bone blocks. In case of men 122 packages of granules were used as well as 33 bone blocks. Based on the results an evaluation of usability of available allogeneic grafts was performed with reference to planned alveolar ridge augmentation procedures, which they were used for. 1. The opportunity to prepare allogeneic material of different textures allowed selection to meet augmentation requirements while providing biological safety. 2. Allogeneic granules should be used in multi-wall defects, such as a double, closed sinus lift and post-extraction socket augmentation. 3. Owing to their superior mechanical parameters, bone blocks were successfully used in extending the width and height of the alveolar ridge and in open sinus lifts with one-wall or two-wall defects and adequate location of the lamellar bone in a graft prevented substantial graft resorption.
Assuntos
Aumento do Rebordo Alveolar/métodos , Adulto , Idoso , Processo Alveolar/cirurgia , Transplante Ósseo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esterilização , Transplante Homólogo/métodos , Adulto JovemRESUMO
To avoid the risk of infectious disease transmission from donor to recipient, allografts should be terminally sterilized. In the previous paper (Kaminski et al. in Cell Tissue Bank 10:215-219, 2009) we presented the effect of various methods of preservation (deep fresh freezing, glycerolization, lyophilization), followed by irradiation with different doses of electron beam (EB), on material (intrinsic) mechanical properties of human patellar tendons cut out as for anterior cruciate ligament reconstruction, obtained in failure tensile test. As structural mechanical properties are equally important to predict the behaviour of the graft as a whole functional unit, the purpose of the present paper was to show the results for failure load and elongation, obtained in the same experiment. Paired Bone-Tendon-Bone grafts (BTB) were prepared from cadaveric human patella tendons with both patellar and tibial attachments. They were preserved by deep freezing, glycerolization or lyophilization and subsequently EB-irradiated with the doses of 25, 35, 50 or 100 kGy (fresh-frozen grafts) or a single dose of 35 kGy (glycerolized and lyophilized grafts). Each experimental (irradiated) group was provided with control (non-irradiated), donor-matched group. The specimens from all groups were subjected to mechanical failure tensile test with the use of Instron system in order to measure their structural properties (failure load and elongation). All lyophilized grafts were rehydrated before mechanical testing. In our study we did not observe significant deterioration of structural mechanical properties of BTB grafts processed by fresh-freezing and then terminal sterilized with growing doses of EB up to 100 kGy. In contrast, BTB grafts processed by glycerolization or lyophilization and irradiated with 35 kGy showed significant decrease of failure load. Obtained results suggest that deep-frozen irradiated grafts retain their initial mechanical properties to an extent which does not exclude their clinical application. However, biomechanical investigations constitute only the first step to evaluate the potential clinical usefulness of such allografts and further extensive in vivo studies are needed.
Assuntos
Enxerto Osso-Tendão Patelar-Osso/métodos , Elétrons , Preservação Biológica/métodos , Esterilização/métodos , Adolescente , Adulto , Aloenxertos/transplante , Fenômenos Biomecânicos , Humanos , Masculino , Pessoa de Meia-Idade , Resistência à Tração , Doadores de Tecidos , Suporte de Carga , Adulto JovemRESUMO
Increasingly dental surgeons face the challenge of reconstruction of the height and/or thickness of the alveolar ridge as more and more patients wish to have permanent restoration of their dental defects based on intraosseous implants. Evaluation of human allogeneic bone tissue grafts in reconstruction of atrophied alveolar ridge as a pre-implantation procedure. The material comprised 21 patients aged 19-63, treated between 2009 and 2012 by the same surgeon. Restoration of bone tissue defects was performed with allogeneic, frozen, radiation-sterilised, corticocancellous blocks. The study included 26 grafting procedures with 7 procedures consisting in reconstruction of the alveolar ridge in the mandible and 19 in the maxilla. In all the cases the atrophied alveolar ridge was successfully reconstructed, which allowed placement of intraosseous implants in compliance with the initial treatment plan. After the treatment was completed the patients reported for follow-up annually. The average time of follow-up amounted to 39 months (28-50 months). None of the implants was lost during the follow-up period. There was one case of gingival recession causing aesthetics deterioration of the prosthetic restoration. In three cases the connector became unscrewed partially, which was corrected at the same visit. Frozen, radiation-sterilised, allogeneic bone blocks constitute good and durable bone-replacement material allowing effective and long-lasting reconstruction of the atrophied alveolar ridge to support durable, implant-based, prosthetic restoration.
Assuntos
Processo Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/estatística & dados numéricos , Criopreservação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Esterilização/estatística & dados numéricos , Adulto , Atrofia/epidemiologia , Atrofia/patologia , Atrofia/cirurgia , Feminino , Raios gama , Humanos , Estudos Longitudinais , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Polônia/epidemiologia , Prevalência , Fatores de Risco , Esterilização/métodos , Transplante Homólogo , Resultado do TratamentoRESUMO
Due to atrophy of the tissue within the alveolar ridge, implantation must sometimes be preceded by bone regeneration. The use of allogeneic material allows the surgeon to prepare grafts of any shape and amount; therefore it is a good alternative to autograft reconstruction in patients with extensive atrophy of the alveolar ridge. The patient with maxillary anodontia showed insufficient width of the ridge along its entire length, which prevented implantation. Therefore, alveolar ridge reconstruction was planned. Four frozen, radiation-sterilised bone blocks processed in the Tissue Bank in Warsaw were used for reconstruction of the alveolar ridge. The blocks were grafted to the area of molars, premolars and lateral incisors bilaterally. Three months after surgery a normal union of transplants with the recipient site was achieved. Six implants were embedded and following the 6-month integration period a permanent prosthetic restoration was successfully performed. During a 38-month follow-up none of the implants were lost and the aesthetic or functional condition of the prosthetic restoration did not deteriorate. Frozen allogeneic radiation-sterilised bone blocks constitute good, efficient and safe material used in reconstruction of the alveolar ridge in extensive bone atrophy. This is only one of possible grafting materials for reconstruction of extremely atrophic alveolar ridge.
Assuntos
Aumento do Rebordo Alveolar , Transplante Ósseo , Implantes Dentários , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND PURPOSE: The upper cranial trauma of high force and wide area of application leads to fractures of calvaria, the skull base, and the viscerocranium. The aim of the study was to present eleven patients treated for severe anterior skull base and facial defects by means of three-layered osteodural plasty. MATERIALS AND METHODS: The operative tactics consisted of bicoronal incision, bifrontal craniotomy, closure of the dura mater damage with a pericranium, reconstruction of bone defects with autologous bone grafts and plasty with anteriorly pedicled pericranial flap on the supratrochlear and supraorbital vessels. RESULTS: During follow-up, which lasted 2-7 years, none of the patients developed any early or late postoperative complications. CONCLUSIONS: The three-layer osteodural plasty of severe anterior skull base injuries with the use of autologous bone grafts for the reconstruction of craniofacial skeleton resulted in a good final functional, morphological and aesthetic outcome in all patients.
Assuntos
Dura-Máter/cirurgia , Traumatismos Faciais/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Base do Crânio/lesões , Adulto , Transplante Ósseo/métodos , Concussão Encefálica/complicações , Vazamento de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/complicações , Feminino , Seguimentos , Seio Frontal/cirurgia , Hematoma Epidural Craniano/complicações , Hematoma Subdural/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
Ionizing radiation has been found to induce stable defects in the crystalline lattice of bone mineral hydroxyapatite, defined as CO(2) (-) radical ions possessing spins. The purpose of our study was to evaluate CO(2) (-) radical ions induced in non-defatted or defatted human compact bone by gamma radiation (G) and accelerated electron beam (EB), applied with two doses at different temperatures. Moreover, the potential effect of free radical ion formation on mechanical parameters of compact bone, tested under compression in the previous studies, was evaluated. Bone rings from femoral shafts of six male donors (age 51 ± 3 years) were collected and assigned to sixteen experimental groups according to different processing methods (non-defatted or defatted), G and EB irradiation dose (25 or 35 kGy), and irradiation temperature [ambient temperature (AT) or dry ice (DI)]. Untreated group served as control. Following grinding under LN2 and lyophilization, CO(2) (-) radical ions in bone powder were measured by electron paramagnetic resonance spectrometry. We have found that irradiation of bone with G and EB induces formation of enormous amounts of CO(2) (-) radical ions, absent from native tissue. Free radical ion formation was dose-dependent when irradiation was performed at AT, and significantly lower in EB as compared to G-irradiated groups. In contrast, no marked effect of dose was observed when deep-frozen (DI) bone samples were irradiated with G or EB, and free radical ion numbers seemed to be slightly higher in EB-irradiated groups. Irradiation at AT induced much higher quantities of CO(2) (-) radical ions then on DI. That effect was more pronounced in G-irradiated bone specimens, probably due to longer exposure time. Similarly, bone defatting protective effect on free radical ion formation was found only in groups irradiated for several hours with gamma radiation at ambient temperature. Ambient irradiation temperature together with exposure time seem to be key parameters promoting CO(2) (-) radical ion formation in bone mineral and may mask the opposite effect of defatting and the possible effect of irradiation type. Significant weak negative correlations between CO(2) (-) radical ion number and some mechanical properties of compact bone rings (Young's modulus and ultimate stress) were found.
Assuntos
Elétrons , Fêmur/efeitos da radiação , Raios gama , Fenômenos Biomecânicos/fisiologia , Densidade Óssea/efeitos da radiação , Espectroscopia de Ressonância de Spin Eletrônica/métodos , Fêmur/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Esterilização/métodos , TemperaturaRESUMO
There are numerous types of bone replacement materials used to regenerate atrophic alveolar processes before the elective intraosseous implantation. Properties of these materials differ one from another, therefore the choice of material should be thoroughly analysed as well as its type and texture in regard of intraoral conditions and the objective to be achieved. The study involved reconstruction of atrophic alveolar processes with allogeneic bone following unsuccessful use of synthetic and animal materials. The procedure of bone regeneration was performed with frozen bone block (case 1) and allogeneic bone granulate (cases 2, 3, 4) radiation-sterilised with 35 kGy prepared by the Tissue Bank. In all of the presented cases after 3-month implant reorganisation optimal width of the process was obtained, which allowed implant embedment (case 1) or correct implant submergence in the osseous tissue, when implantation took place at the same time (case 2, 3, 4). Allogeneic bone material both, in the form of a block as well as granulate, seems to be an adequate alternative for other materials used in order to widen the bone of the alveolar process, particularly in difficult, complicated cases, where the first regeneration procedure was not successful.
Assuntos
Processo Alveolar/cirurgia , Aumento do Rebordo Alveolar , Substitutos Ósseos/uso terapêutico , Transplante Ósseo , Implantes Dentários , Adulto , Aloenxertos , Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Humanos , Esterilização , Resultado do TratamentoRESUMO
Bone grafting allows reconstruction of the atrophied or destroyed alveolar process. In orthopaedics and traumatology allogeneic grafting has been used to restore defects of osseous tissue for over 60 years. In order to improve safety of the graft recipient, sterilized allogeneic grafts have been use. The aim of the study was to assess the direct and long-term outcomes following augmentation of atrophied alveolar processes with the use of radiation-sterilized allogeneic bone grafts. Sixty-eight patients were surgically treated between 2004 and 2011: 29 underwent open sinus floor elevation, post-extraction alveoli augmentation was performed in 16 subjects and 23 underwent reconstruction of the atrophied alveolar process. Augmentation of bone defects used bone granulate in 63 patients and bone blocks stabilized with titanium screws in 5 patients. PRF membranes collected from the patient's blood were also used in all the procedures. In each of the cases optimal dimensions of the alveolar process were obtained allowing embedment of BIOMET 3I dental implant/-s. In all the patients the defects were successfully restored with implant-supported prostheses. Radiation-sterilized allogeneic bone grafts proved to be safe and effective for the patients and manageable for the surgeon constituting a good alternative to autogeneic material.
Assuntos
Aloenxertos/efeitos da radiação , Transplante Ósseo/efeitos adversos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversos , Radiação , Esterilização/métodos , Adulto , Idoso , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Adulto JovemRESUMO
Chronic wounds are a significant socio-economic problem, thus, the improvement of the effectiveness of their treatment is an important objective for public health strategies. The predominant stage of the chronic wound is the inflammatory reaction which is associated with the damage of tissues, possibly due to the excessive secretion and activation of matrix metalloproteinases (MMPs). Several reports have suggested that amnion dressing inhibits tissue destruction and accelerates wound healing. Our recent study revealed that sterilized amnion stimulates keratinocyte proliferation in vitro, while the present study focused on the clinical application of radiation-sterilized amnion in chronic venous leg ulcers and aimed to explain the possible mechanism of its in vivo action. The study involved 25 individuals suffering from venous leg ulceration with a surface area of 10-100 cm2 and a healing rate below 10% per week, as verified during a 2-week screening period. The effectiveness of the amnion dressing was estimated following 4 weeks of treatment. The wound assessment, based on a modified Bates-Jensen Questionnaire, revealed a good and satisfactory response to the treatment in 23 of the 25 patients. The measurement of MMP-2 and MMP-9 activities in wound exudates revealed a decrease in activity in response to amnion application. This effect resulted from the presence of the potent MMP inhibitors, tissue inhibitor of metalloproteinases-1 (TIMP-1), type-1 plasminogen activator inhibitor (PAI-1) and thrombospondin-1 (TSP-1) in the amnion dressings, as shown by real-time fluorescence zymography and protein microarrays. Thus, unlike modern synthetic dressing materials, radiation-sterilized amnion dressings may have a multidirectional beneficial effect on chronic wounds.
Assuntos
Âmnio/metabolismo , Inibidores de Metaloproteinases de Matriz/uso terapêutico , Úlcera Varicosa/terapia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Bandagens , Feminino , Humanos , Masculino , Metaloproteinase 2 da Matriz/química , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/química , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/uso terapêutico , Análise Serial de Proteínas , Esterilização , Trombospondina 1/uso terapêutico , Inibidor Tecidual de Metaloproteinase-1/uso terapêutico , Úlcera Varicosa/metabolismo , Úlcera Varicosa/patologiaRESUMO
BACKGROUND: There are problems connected with the diagnosis of non-Hodgkin lymphomas of the orbit, before deciding on the correct treatment. MATERIAL AND METHODS: Six out of 22 patients with a tumour of the orbit were treated between 1995 and 2004 for orbital non-Hodgkin lymphomas (NHL). Morphological-functional and aesthetic complications regarding the eyes, the delay between onset and diagnosing the disease and concomitant conditions were evaluated. Management was always tailored individually for each patient, depending on tumour location in the orbit. Surgical procedures comprised total or subtotal removal of the tumour via a semi-coronal access and lateral orbitotomy. Histological diagnosis of the tumours was made from the surgical specimens. RESULTS: According to the REAL classification, 3 patients had a B-cell lymphoma from the MALT system with low malignancy, 2 other patients a diffuse B cell NHL and 1 patient a lymphoma from the germinal centre with intermediate malignancy. All patients had received chemotherapy. A 9-year remission was achieved in one, an 8-year in another and a 7-year remission in two more out of the total of 6 patients; one is living without relapse for 6 years. The last patient, in whom the lymphoma was diagnosed at the age of 70 years, died 4 years after the procedure without relapse due to cardiovascular and respiratory insufficiency. CONCLUSIONS: Although the treatment of choice of NHL is chemotherapy, it is felt necessary to remove the whole or possibly the major part of the tumour in case of retrobulbar location when the histological subtype is unknown prior to surgery. However, the optic nerve should always been left intact, even when such tumour encircles this cranial nerve. Only sufficient biopsy material allows determination of the lymphoma subtype and selection of appropriate chemotherapy.
Assuntos
Linfoma não Hodgkin/diagnóstico , Neoplasias Orbitárias/diagnóstico , Adulto , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Diagnóstico Diferencial , Intervalo Livre de Doença , Feminino , Humanos , Linfoma de Células B/diagnóstico , Linfoma de Células B/cirurgia , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/cirurgia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma não Hodgkin/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Orbitárias/cirurgia , Planejamento de Assistência ao Paciente , Indução de RemissãoRESUMO
OBJECTIVE: Osteomas located on the border between the anterior cranial base and the facial region are benign, often asymptomatic and usually slow growing. They may cause different complications depending on the part of the central nervous or visual systems which they affect. MATERIAL AND METHODS: Between 1997 and 2002, four patients were treated at the 1st Department of Maxillofacial Surgery of the Medical University of Warsaw for osteomas located at the border of the anterior cranial base. In all patients a radical surgical removal of the tumour was performed via bifrontal craniotomy, with an extradural approach to the anterior cranial fossa. The resulting defects were repaired with autologous bone grafts. RESULTS: The post-operative results were good regarding morphological, functional and aesthetic outcome. Two of the four patients are described to illustrate the surgical treatment.