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1.
Exp Clin Transplant ; 22(Suppl 1): 102-109, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38385383

RESUMO

OBJECTIVES: Various sites have been used for parathyroid allotransplant, such as injection into the forearm, sternocleidomastoid, or deltoid muscles. However, transplant efficiency in these regions varies according to the results reported in the literature and also obtained from our previous studies. Using the omentum "as a natural incubator" for composite tissue-derived cell transplants to increase transplant success is possible. MATERIALS AND METHODS: To examine the efficiency of transplant sites for parathyroid allotransplant, we compared clinical cases from the literature and our experience with 23 cases. The omental transplant process is performed under general anesthesia by laparoscopic intervention. The abdominal cavity is visualized with an endocamera from a 5-mm trocar. With the help of a flexible catheter from another 5-mm trocar, microencapsulated or naked parathyroid cells are deposited on the omentum in approximately 30 mL of isotonic saline. The trocar sites are then sutured, and the surgery is terminated. Recipients were followed for 6 months with examination of biochemical parameters (parathormone, calcium, and phosphorus levels), medication use, and clinical scoring. RESULTS: In the 23 patients who received parathyroid allotransplants over the omentum, 7 recipients did not exhibit any changes according to the scoring system criteria. However, on average, serum calcium and phosphorus levels remained within the healthy reference range. In addition, use of oral medications among patients decreased, indicating successful transplant survival. These results were consistent with a significant decrease in hypocalcemia symptoms among patients. CONCLUSIONS: In the 23 patients, the success rate was 69.5% for the first 6-month period after transplant. Recent developments and large cohorts are needed to demonstrate the higher efficacy of parathyroid allotransplant over the omentum.


Assuntos
Cálcio , Omento , Humanos , Omento/cirurgia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo , Fósforo
2.
J Vis Exp ; (203)2024 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-38345216

RESUMO

Ovarian cancer is the deadliest gynecologic malignancy. The omentum plays a key role in providing a supportive microenvironment to metastatic ovarian cancer cells as well as immune modulatory signals that allow tumor tolerance. However, we have limited models that closely mimic the interaction between ovarian cancer cells and adipose-rich tissues. To further understand the cellular and molecular mechanisms by which the omentum provides a pro-tumoral microenvironment, we developed a unique 3D ex vivo model of cancer cell-omentum interaction. Using human omentum, we are able to grow ovarian cancer cells within this adipose-rich microenvironment and monitor the factors responsible for tumor growth and immune regulation. In addition to providing a platform for the study of this adipose-rich tumor microenvironment, the model provides an excellent platform for the development and evaluation of novel therapeutic approaches to target metastatic cancer cells in this niche. The proposed model is easy to generate, inexpensive, and applicable to translational investigations.


Assuntos
Neoplasias Ovarianas , Neoplasias Peritoneais , Humanos , Feminino , Neoplasias Peritoneais/secundário , Omento , Neoplasias Ovarianas/patologia , Tecido Adiposo/patologia , Metástase Neoplásica/patologia , Microambiente Tumoral
3.
J Biomater Appl ; 38(7): 858-865, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38165217

RESUMO

The objective of this study is to clarify whether the omental coating can effectively attenuate foreign body reaction (FBR) induced by implanted materials. Male Sprague-Dawley rats were injected with polydextran particle slurry intraperitoneally to activate the omentum. 7 days later, polyether polyurethane sponge discs were implanted subcutaneously on each side of the rat's back as the foreign implants to induce FBR. The next day, omental transposition were performed. The disc on the left side of each rat's back was wrapped with omental flap (omental group); the disc on the right side was untreated (control group). All discs were removed 21 days after implantation and assessed by determining the components of the fibrovascular tissue (angiogenesis, inflammation, foreign body giant cells (FBGCs) aggregation and fibrogenesis). In implants in omental group, micro vessel density (MVD), Hemoglobin (Hb) content and VEGF levels (pro-angiogenic cytokine) were increased when compared with implants from control group. Inflammatory parameters (IL-1ß; macrophage accumulation-NAG activity; neutrophil accumulation- MPO levels) were decreased in implants after omental coating. Also, collagen deposition, fibrous capsule thickness, and FBGCs decreased in implants from omental group. However, intra-implant levels of TNF-α and TGF-ß1 were not different after omental coating. Our findings showed for the first time that the omental coating around the implants attenuate the adverse FBR, it may be critical in developing new strategies to control FBR and improve the function and performance of the implanted materials.


Assuntos
Omento , Fator A de Crescimento do Endotélio Vascular , Ratos , Masculino , Animais , Omento/cirurgia , Ratos Sprague-Dawley , Reação a Corpo Estranho/etiologia , Inflamação/etiologia
4.
ACS Biomater Sci Eng ; 10(2): 1090-1105, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38275123

RESUMO

Nonhealing diabetic wounds are often associated with significant mortality and cause economic and clinical burdens to the healthcare system. Herein, a biomimetic hydroscaffold is developed using omentum tissue-derived decellularized-extracellular matrix (dECM) and silk fibroin (SF) proteins that associate the behavior of a collagenous fibrous scaffold and a hydrogel to reproduce all aspects of the provisional skin tissue matrix. The chemical cross-linker-free in situ gelation property of the two types of SF proteins from Bombyx mori and Antheraea assamensis ensures the adherence of dECM with surrounding tissue on the wound bed, circumventing further suturing. The physicochemical and mechanical properties of the composite hydroscaffold (SF-dECM) were thoroughly evaluated. The hydroscaffolds were found to support the growth and proliferation of human dermal fibroblasts and influence the angiogenic potential of endothelial cells under in vitro conditions. Furthermore, the healing efficacy of the composites was evaluated by generating full-thickness wounds on a streptozotocin-induced diabetic rat model. The presence of dECM components in the composite facilitated the rate of wound closure, granulation tissue formation, and re-epithelialization by providing intrinsic cues to advance the inflammatory stage and stimulating angiogenesis. Collectively, as an off-the-shelf wound dressing requiring only a single topical administration, the SF-dECM hydroscaffold is a promising, cost-effective dressing for the management of chronic diabetic wounds.


Assuntos
Diabetes Mellitus , Fibroínas , Ratos , Animais , Humanos , Fibroínas/farmacologia , Fibroínas/uso terapêutico , Células Endoteliais , Omento , Cicatrização , Matriz Extracelular/metabolismo , Diabetes Mellitus/metabolismo , Neovascularização Patológica/metabolismo
5.
Rev. colomb. cir ; 39(1): 85-93, 20240102. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1526823

RESUMO

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage


Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.


Assuntos
Humanos , Úlcera Péptica Perfurada , Complicações Pós-Operatórias , Omento , Fatores de Risco
6.
Ann Surg Oncol ; 31(2): 1358-1359, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37966705

RESUMO

BACKGROUND: The gastrohepatic ligament approach is a form of robot-assisted spleen-preserving distal pancreatectomy (SPDP).1,2 This approach does not require omentum transection, peri-splenic dissection, or stomach traction. METHODS: Considering the advantages of preserving collateral pathways around the spleen, the authors performed the gastrohepatic ligament approach in laparoscopic SPDP while preserving splenic vessels (LSPDP), with specific modifications for laparoscopic surgery. The following surgical technique was performed. First, the gastrohepatic ligament was divided extensively, and all subsequent procedures were performed through the gastrohepatic ligament route. The superior and inferior borders of the pancreas then were dissected to encircle the common hepatic and splenic arteries with vessel loops and to expose the superior mesenteric vein (SMV) and portal vein. After taping of the pancreas on the SMV, the pancreas was divided using a linear stapler. Next, the pancreas was dissected from proximal to distal with preservation of the splenic vessels. Re-taping and traction of the splenic vessels and pancreas could facilitate the dissection of the pancreas body, especially at the splenic hilum. The appropriate counter traction using traction tapes allowed efficient laparoscopic procedures. The LSPDP was performed for three patients, including one obese patient (body mass index, 36 kg/m2) and two patients with an anomalous left hepatic artery branching from the left gastric artery. RESULTS: The mean operation time was 186 min, and the intraoperative blood loss was 37 mL. CONCLUSION: The gastrohepatic ligament approach could be an option for performing LSPDP with the counter traction technique for low-grade malignant tumors.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Humanos , Baço/cirurgia , Baço/patologia , Pancreatectomia/métodos , Omento/cirurgia , Tração , Resultado do Tratamento , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Laparoscopia/métodos
7.
Microsurgery ; 44(1): e31017, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36756715

RESUMO

INTRODUCTION: The omentum has gained recent popularity in vascularized lymph node transfers (VLNT) as well as its novel use as a free flap for autologous breast reconstruction. The omentum has multiple unique advantages. It can be harvested laparoscopically or in an open fashion when utilized with abdominally-based free flaps. Additionally, it can be split into multiple flaps for simultaneous autologous breast reconstruction with VLNT or for multiple sites of VLNT. We present the safe and advantageous use of the omentum for VLNT with simultaneous autologous breast reconstruction in a series of patients. METHODS: From the years 2019-2022, patients who underwent breast reconstruction with deep inferior epigastric artery perforator (DIEP) or muscle sparing tram (MS-TRAM) flaps with concurrent omental VLNT through a mini-laparotomy or breast reconstruction with Omental Fat-Augmented Free Flap (O-FAFF) with concurrent laparoscopic harvesting of omental VLNT were studied. Patient demographics included age, gender, comorbidities, prior radiation or chemotherapy, body mass index, complications, hospital length of stay, and surgical outcomes. RESULTS: A total of seven patients underwent omental VLNT with breast reconstruction for a total of 12 breasts and eight limbs treated. Three of the patients underwent autologous breast reconstruction using omental free flap. The mean age was 52.3 (range 40-75) years and mean body mass index (BMI) was 29.3 (range 23-38) kg/m2 . The flap survival rate was 100%. All the patients had successful reduction of extremity circumference and improvement of symptoms. The range of follow-up was 5 to 19 months, with an average follow-up of 14.6 months. There was only one complication among our 7 patients: a patient with a BMI of 38 developed a post-surgical abdominal wound treated with local wound care. Otherwise, post-operative courses were uneventful, and no further complications were reported. CONCLUSION: We demonstrate here additional evidence to the growing body of literature of the versatility and safety of the omentum to be utilized as an independent tool for surgical treatment of lymphedema as well as its simultaneous use with autologous breast reconstruction.


Assuntos
Neoplasias da Mama , Retalhos de Tecido Biológico , Linfedema , Mamoplastia , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Omento/cirurgia , Mamoplastia/efeitos adversos , Linfedema/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Linfonodos/irrigação sanguínea , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Estudos Retrospectivos
9.
Arch Ital Urol Androl ; 95(4): 12049, 2023 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-38059270

RESUMO

INTRODUCTION: The role of the omentectomy procedure on Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement in pediatric patients has been differently evaluated in the literature, with some studies showing improvement while others showing no difference. Our study aims to define the advantages of omentectomy compared to a procedure without omentectomy. METHODS: The literature searching in online databases (PubMed/MEDLINE, Cochrane Library, EMBASE, Scopus, and ClinicalTrial.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, has been registered on PROSPERO (CRD42023412846). The protocol was performed through April 2023 and focused on pediatric patients treated with an omentectomy procedure and related complications. The risk of bias in each study was assessed using the risk of bias for the non-randomized control trials (ROBINS-I). The effect estimates were extracted as risk ratios with 95% confidence intervals (CI). The heterogeneity of the studies was considered as high heterogeneity if I2 values above 50% or p < 0.05. RESULTS: In the total of 676 articles identified in the database searching for screening, nine studies with 775 patients met the criteria for inclusion. The omentectomy procedure significantly showed a lower incidence of catheter obstruction compared to the control group, (OR 0.24 [95% CI, 0.12-0.49], p < 0.0001, I2 = 0%). Moreover, omentectomy demonstrated a similar trend in the rate of removal or reinsertion of the catheter with high heterogeneity, OR 0.25 [95% CI, 0.12-0.51), p = 0.0002, I2 = 70%). CONCLUSIONS: The omentectomy procedure showed a lower incidence of catheter obstruction and complications leading to removal or reinsertion of the catheter.


Assuntos
Falência Renal Crônica , Diálise Peritoneal Ambulatorial Contínua , Humanos , Criança , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/métodos , Omento/cirurgia , Falência Renal Crônica/terapia , Incidência
10.
Ann Ital Chir ; 94: 478-482, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38051514

RESUMO

BACKGROUND: The inguinal hernia is the protrusion of intra-abdominal contents through a defect of the abdominal wall. This content can be represented by omentum, most frequently intestine. Theoretically, any intraperitoneal organ can be located in the hernia sac.The inguinal hernia is distinguished by several features: it is the most common form of hernia, it can occur in any age category, the only treatment is the surgical treatment, in the absence of the treatment, severe complications can endanger the patient's life.The treatment of hernias consists either in the use of a classical ("open") surgical procedure or of a laparoscopic procedure. The objective of both procedures is to remove and treat the hernia sac and repair the defect that appeared in the posterior wall of the groin canal. OBJECTIVES: The purpose of this study is to compare the effectiveness of the two surgery types, considering the immediate postoperative pain. METHODS: This paper is a prospective study conducted between September 2019 and February 2020, including a number of 80 patients admitted in the Department of General Surgery I and II, Emergency Clinical County Hospital of Târgu Mureș. In the study were included patients with uncomplicated inguinal hernia for which a classical or laparoscopic procedure was performed. Patients with complicated inguinal hernia (strangulation, incarceration) and patients with associated comorbidities (neoplasms, autoimmune diseases, neurological disorders) were excluded. For the study group were taken into consideration: demographic data (age, gender), type of surgery and the pain assessment using the VAS scale. RESULTS: Following the study, it was statistically confirmed the prevalence of elderly patients to the detriment of young patients in both classical and laparoscopic study group. As we age, the pain sensitivity decreases, an aspect highlighted in the classical study group, the statistics showing the presence of less pain in elderly patients on the second postoperative day compared to young patients. Regarding the pain in both postoperative days, it was statistically proved that the pain tends to decrease in intensity on the second postoperative day compared to the first postoperative day. CONCLUSIONS: As seen from this paper, taking into consideration the pain aspect, the two surgeries are very similar. Regardless of the chosen type of procedure, a preponderance of elderly patients was observed. The "Open Tension Free" procedure is a modern and efficient technique due to the absence of the local tension that can generate recurrence. The laparoscopic procedure has the advantage of reducing surgical trauma and minimizing recurrences. In the end, the type of treatment should be chosen by the surgeon after taking into consideration the type of hernia, the age and the patient's comorbidities and the economic considerations. KEY WORDS: Classical procedure, Inguinal hernia, Laparoscopic procedure.


Assuntos
Hérnia Inguinal , Laparoscopia , Humanos , Idoso , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Estudos Prospectivos , Laparoscopia/métodos , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Omento/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas/efeitos adversos , Recidiva , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
12.
BMJ Case Rep ; 16(12)2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-38123316

RESUMO

A man in his early 20s presented to us in the outpatient department with a history of diarrhoea for 4 months. Investigations revealed elevated serum chromogranin levels and an intensely avid lesion in the gastrohepatic ligament in Gallium DOTATATE positron emission tomography (PET). The tumour was excised laparoscopically, and no other lesions were seen. The patient improved clinically and had a normal serum chromogranin level postoperatively. He is currently much improved at the 1year follow-up. We did an extensive workup to look for a primary tumour. It was concluded that it was a de novo tumour arising from the lesser sac. The recommended investigations in case of neuroendocrine tumour (NET) with unknown primary include blood investigations to look for the functional status of the tumour, histopathological examination, including immunohistochemistry, and radiological imaging, which must include a Gallium DOTATATE PET. An isolated NET of the lesser sac has not been reported in the literature.


Assuntos
Gálio , Tumores Neuroendócrinos , Compostos Organometálicos , Humanos , Masculino , Cromograninas , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Omento/cirurgia , Omento/patologia , Cavidade Peritoneal/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Oncoimmunology ; 12(1): 2285106, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38126032

RESUMO

Our recent research has unveiled the potential of locoregional immunotherapy. Cytokine-armored viral vectors, such as modified vaccinia virus Ankara vector encoding single-chain interleukin-12 (MVA.scIL-12), can target the omentum and elicit a robust tumor-specific immune response, all the while minimizing toxicity.


Assuntos
Neoplasias Peritoneais , Vírus Vaccinia , Humanos , Vírus Vaccinia/genética , Neoplasias Peritoneais/terapia , Omento , Vetores Genéticos , Imunoterapia/efeitos adversos
14.
BMJ Case Rep ; 16(11)2023 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-37945275

RESUMO

A previously healthy but overweight (body mass index (BMI) of 24.4) adolescent boy presented with fever and significant right-sided abdominal pain. An abdominal ultrasound scan revealed an omental infarction (OI), which was treated conservatively. OI has been described in overweight teenage children with abdominal trauma but can be missed if not considered. A missed diagnosis could result in an unnecessary laparotomy or laparoscopic surgery. Although CT is the gold standard for diagnosis, ultrasonography is an effective approach to identifying OI in children. The benefits of early diagnosis of OI by abdominal ultrasound include a shorter hospital stay and a reduction in unnecessary investigations and surgery.


Assuntos
Traumatismos Abdominais , Doenças Peritoneais , Masculino , Adolescente , Humanos , Criança , Sobrepeso , Tratamento Conservador , Infarto/diagnóstico por imagem , Infarto/etiologia , Infarto/terapia , Omento/diagnóstico por imagem , Omento/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/terapia
15.
J Immunother Cancer ; 11(11)2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37918917

RESUMO

BACKGROUND: Peritoneal carcinomatosis is an advanced stage of cancer in which the disease has spread to the peritoneal cavity. In order to restore antitumor immunity subverted by tumor cells in this location, we evaluated intraperitoneal administrations of modified vaccinia virus Ankara (MVA) engineered to express single-chain interleukin 12 (scIL-12) to increase antitumor immune responses. METHODS: MVA encoding scIL-12 (MVA.scIL-12) was evaluated against peritoneal carcinomatosis models based on intraperitoneal engraftment of tumor cells. CD8-mediated immune responses, elucidated antitumor efficacy, and safety were evaluated following intravenous, intratumoral, or intraperitoneal administration of the viral vector. The immune response was measured by ELISpot (enzyme-linked immunosorbent spot), RNA sequencing, flow cytometry, intravital microscopy, and depletion of lymphocyte subsets with monoclonal antibodies. Safety was assessed by body-weight follow-up and blood testing. Tissue tropism on intravenous or intraperitoneal administration was assessed by bioluminescence analysis using a reporter MVA encoding luciferase. RESULTS: Intraperitoneal or locoregional administration, but not other routes of administration, resulted in a potent immune response characterized by increased levels of tumor-specific CD8+ T lymphocytes with the ability to produce both interferon-γ and tumor necrosis factor-α. The antitumor immune response was detectable not only in the peritoneal cavity but also systemically. As a result of intraperitoneal treatment, a single administration of MVA.scIL-12 encoding scIL-12 completely eradicated MC38 tumors implanted in the peritoneal cavity and also protected cured mice from subsequent subcutaneous rechallenges. Bioluminescence imaging using an MVA encoding luciferase revealed that intraperitoneal administration targets transgene to the omentum. The omentum is considered a key tissue in immune protection of the peritoneal cavity. The safety profile of intraperitoneal administration was also better than that following intravenous administration since no weight loss or hematological toxicity was observed when the vector was locally delivered into the peritoneal cavity. CONCLUSION: Intraperitoneal administration of MVA vectors encoding scIL-12 targets the omentum, which is the tissue where peritoneal carcinomatosis usually begins. MVA.scIL-12 induces a potent tumor-specific immune response that often leads to the eradication of experimental tumors disseminated to the peritoneal cavity.


Assuntos
Interleucina-12 , Neoplasias Peritoneais , Animais , Camundongos , Interleucina-12/genética , Omento , Vírus Vaccinia/genética , Luciferases
17.
Urology ; 182: e262-e263, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37690546

RESUMO

OBJECTIVE: To introduce the application of the perivesical fat rotational flap as a substitute for omental interposition during several complex urologic reconstruction. We highlight our technique using a case of salvage prostatectomy after initial high-intensity focused ultrasound for recurrent high-risk prostate cancer requiring future adjuvant radiation treatment. We have also successfully used this technique in the management of recurrent vesicovaginal, colovesical, rectourethral fistulas, and postradiation salvage prostatectomy setting. MATERIALS AND METHODS: Our first patient underwent salvage radical prostatectomy after developing high-risk localized prostate cancer after initial high-intensity focused ultrasound. The prostate was radically resected after stepwise posterior and anterior dissections. A flap of perivesical fat with a wide-based pedicle overlying the bladder dome was developed until it was rotated, positioned, and tethered overlying the anterior rectal wall in a tension-free manner. This perivesical fat interposition may have protected a radiated anterior rectal wall from future complications. In the second case, a recurrent vesicovaginal fistula that persisted for 2years postabdominal hysterectomy was repaired using the robotic approach. After fistula excision, layer closure, and perivesical flap interposition, successful repair was achieved. The third patient, who had a history of colon cancer managed with partial colectomy and radiation, developed a recurrent colovesical fistula, which was successfully repaired. Postrepair, a perivesical flap was developed and secured over the site. RESULTS: In the immediate postoperative follow-up period, there were no surgical complications. Long-term follow-up ranges from 1month to 3years without evidence of complication. CONCLUSION: In cases where omentum interposition is not feasible, our novel technique of a perivesical fat flap is a successful alternative for complex reconstruction.


Assuntos
Neoplasias da Próstata , Fístula Vesicovaginal , Masculino , Feminino , Humanos , Omento/cirurgia , Retalhos Cirúrgicos , Bexiga Urinária/cirurgia , Fístula Vesicovaginal/cirurgia , Neoplasias da Próstata/cirurgia
18.
Ann Anat ; 250: 152160, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37739240

RESUMO

BACKGROUND: Aseptic peritonitis is a reaction of the local immune system aimed at rejection of a foreign body, which, having antigenic properties, does not (unlike a pathogen) counteract the immune system. The suture materials, namely catgut thread, used in intracavitary surgical operations possess xenogenic properties and can be used for antigenic stimulation of the immune system of the peritoneal cavity. Consequently, we decided to use a catgut suture for antigenic stimulation of the immune system of the peritoneal cavity and to study the morphological features of the results of experimental modeling of aseptic peritonitis in albino rats. METHOD: The study involved 15 Wistar albino male rats, weighing 286,13 ± 6,26 g. To study the dynamics of destructive changes made by the catgut implant in the peritoneal cavity of the experimental animals, the animals were assigned into three groups in accordance with the time interval of their euthanasia at 3, 7, and 14 days of the experiment. RESULTS: After modeling an aseptic peritonitis, the investigation the abdominal cavity showed that in four out of five animals of the first group, that is, on day 3 of the experiment, the catgut implant had adhered to the greater omentum. The search for the fifth implant led to an unexpected discovery: we found it conjoined with the second derivative of the visceral peritoneum, similar in structure to the greater omentum, but related to the testes. On day 7, the implant embedded into the peritoneal cavity of the animals, had adhered to the serous formations of the testes in all five cases (100%, three of them - to the left epididymal omentum, and another two - to the right one). On day 14 (n = 5) it was found that in three cases it had adhered to the serous formations of the testes (60%, one of them to the left epididymal omentum, another two - to the right one) and in two cases it had adhered to the greater omentum (40%). CONCLUSION: During the experiment on implantation of a xenogenic substrate in the form of flat bundles made from the catgut thread into the peritoneal cavity of sexually mature male rats, it was found for the first time that their acceptors were not only the greater omentum, but also two derivatives of the peritoneum, homeomorphic to it and associated with the epididymides, which we reasonably called epididymal omenta and described in details.


Assuntos
Peritônio , Peritonite , Masculino , Ratos , Animais , Ratos Wistar , Omento , Mesentério
19.
BMC Surg ; 23(1): 236, 2023 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-37573297

RESUMO

BACKGROUND: Total intersphincteric resection (ISR) is the ultimate anus-preserving surgery for patients with ultra-low rectal cancer (ULRC), which can result in various degrees of anorectal dysfunction. Known as low anterior resection syndrome (LARS), it seriously affects the postoperative quality of life of patients. The aim of this study was to discuss the value of mesorectal reconstruction with pedicled greater omental transplantation (PGOT) to relieve LARS following total ISR in patients with ULRC, hoping to provide new ideas and strategies for the prevention and improvement of LARS. METHODS: We retrospectively analyzed hospitalization data and postoperative anorectal function of 26 ULRC patients, who were met inclusion and exclusion criteria in our center from January 2015 to February 2022. And combined with the results of anorectal manometry and rectal magnetic resonance imaging (MRI) defecography of some patients, we assessed comprehensively anorectal physiological and morphological changes of the patients after surgery, and their correlation with LARS. RESULTS: In this study, 26 patients with ULRC were enrolled and divided into observation group (n = 15) and control group (n = 11) according to whether PGOT was performed. There were no significant differences in surgical results such as operative time, intraoperative blood loss and postoperative complications between the two groups (P > 0.05). Postoperative follow-up showed that patients in both groups showed severe LARS within 3 months after surgery, but from the 3rd month after surgery, LARS in both groups gradually began to decrease, especially in the observation group, which showed faster recovery and better recovery, with statistically significant difference (P < 0.001). Through anorectal manometry, the mean rectal resting pressure in the observation group was significantly lower than that in the control group (P = 0.010). In addition, the postoperative thickness of the posterior rectal mesenterium in the observation group was significantly higher than that in the control group (P = 0.001), and also higher than the preoperative level (P = 0.018). Moreover, rectal MRI defecography showed that the neo-rectum had good compliance under the matting of greater omentum, and its intestinal peristalsis was coordinated. CONCLUSIONS: ULRC patients, with the help of greater omentum, coordinated their neo-rectum peristalsis after total ISR and recovery of LARS was faster and better. PGOT is expected to be an effective strategy for LARS prevention and treatment of ULRC patients after surgery and is worthy of clinical promotion.


Assuntos
Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Síndrome de Ressecção Anterior Baixa , Complicações Pós-Operatórias , Estudos Retrospectivos , Omento/cirurgia , Qualidade de Vida , Reto/cirurgia
20.
Ginekol Pol ; 94(10): 823-830, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37599572

RESUMO

OBJECTIVES: Non-endometrioid endometrial cancers (non-EEC) have different management from endometrioid endometrial cancers. The purpose of this study was to investigate the prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer and discuss the current literature with the findings. MATERIAL AND METHODS: The study included two hundred-three patients with non-EEC who underwent surgical treatment and follow-up between January 1996 and December 2018 in a University Hospital Gynecologic Oncology Center. The patients were divided into three groups according to whether omentectomy was performed and the presence of omental metastasis. The patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion (LVSI), myometrial invasion, lymph node involvement, and survival outcomes were compared between the groups. RESULTS: The study included 203 patients. Twenty-five patients (12%) had omental metastases. LVSI was reported in 57.3%, 88.0%, and 43.2% of the non-omentectomy, no-omental metastasis, and omental metastatic groups, respectively (p = 0.001). The 5-year disease-free survival (DFS) and overall survival (OS) rates according to the tumor grade, peritoneal cytology, and lymphadenectomy were also compared and were found to be statistically similar. The five-year OS rates were 70.6% for the group without omental metastases and 16.2% for the group with omental metastases, respectively (p = 0.001). In the group of omentectomy, the five-year DFS rates were 62.2% in cases without omental metastasis and 13.0% in cases with omental metastasis (p = 0.001). The five-year OS rates of 86.3% and DFS rates of 80.0% in the group without omentectomy. CONCLUSIONS: In non-endometrioid tumors, the survival rate was better in the group that did not undergo omentectomy. Based on these results, we can say that omentectomy may not be necessary for non-endometrioid tumors whose omentum is found to be normal in intraoperative visual examination.


Assuntos
Carcinoma Endometrioide , Neoplasias do Endométrio , Neoplasias Peritoneais , Humanos , Feminino , Prognóstico , Omento/cirurgia , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Estadiamento de Neoplasias , Neoplasias Peritoneais/cirurgia , Neoplasias Peritoneais/patologia , Estudos Retrospectivos
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