RESUMEN
Anorectal melanoma is a very rare tumor with poor prognosis because of delay in diagnosis. It is often mistaken for benign conditions such as hemorrhoids or rectal polyps. Surgical treatment ranges from local excision to radical abdominoperinal resection. Herein, we report 2 cases of anorectal malignant melanoma and further review the diagnostic and therapeutic approaches in light of the pertinent literature.
Asunto(s)
Melanoma/secundario , Neoplasias del Recto/patología , Anciano , Colonoscopía , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Neoplasias del Recto/cirugíaRESUMEN
One possible way to expand the human heart donor pool is to include non-heart-beating human donors. To begin validating this approach, we developed an ex vivo cardiac perfusion circuit to support large mammalian hearts in Langendorff mode and beating-ejecting mode and to assess and improve their ischemic tolerance. In vivo hemodynamic data and heparinized blood (4.0 +/- 0.5 L) were collected from 6 anesthetized pigs. Hearts were isolated and connected to a recirculating perfusion circuit primed with autologous buffered blood (pH, 7.40). After retrograde aortic perfusion in Langendorff mode, the left atrium was gravity-filled at 10-20 mmHg, and the left ventricle began to eject against a compliance chamber in series with a systemic reservoir set to a hydraulic afterload of 100-120 mmHg. Left ventricular function was restored and maintained in all 6 hearts for 30 min. Cardiac output, myocardial oxygen consumption, stroke work, aortic pressure, left atrial pressure, and heart rate were measured. The mean myocardial oxygen consumption was 4.8 +/- 2.7 mL/min/100 g (95.8% of in vivo value); and mean stroke work, 5.3 +/- 1.1 g x m/100 g (58.95% of in vivo value). One resuscitated heart was exposed to 30 min of normothermic ischemic arrest, then flushed with Celsior and re-resuscitated. The ex vivo perfusion method described herein restored left ventricular ejection function and allowed assessment of ischemic tolerance in large mammalian hearts, potentially a 1st step toward including non-heart-beating human donors in the human donor pool.
