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1.
Can J Surg ; 63(5): E451-E453, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33026312

RESUMO

SUMMARY: "Never let a good crisis go to waste." - Sir Winston Churchill.The value of Canada's Kidney Paired Donation program to the population cannot be overstated. Its greatest challenge as a national program, however, is the geographic separation of recipient and matched donor. Representatives from every transplant program in the country have been working toward increased use of kidney shipping in order to diminish the disincentive of donor travel. With transplantation program and travel restrictions in place to minimize the risk of coronavirus disease 2019 (COVID-19), the time to make a full transition from donor travel to the shipment of donor kidneys has clearly arrived.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transplante de Rim/métodos , Doadores Vivos/provisão & distribução , Pandemias , Pneumonia Viral/epidemiologia , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Canadá , Humanos
2.
Plast Reconstr Surg ; 146(3): 265e-275e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842099

RESUMO

BACKGROUND: Total extraperitoneal laparoscopically assisted harvest of the deep inferior epigastric vessels permits a decrease in myofascial dissection in deep inferior epigastric artery perforator flap breast reconstruction. The authors present a reliable technique that further decreases donor-site morbidity in autologous breast reconstruction. METHODS: The authors conducted a retrospective cohort study of female subjects presenting to the senior surgeon (S.K.K.) from March of 2018 to March of 2019 for autologous breast reconstruction after a newly diagnosed breast cancer. The operative technique is summarized as follows: a supraumbilical camera port is placed at the medial edge of the rectus muscle to enter the retrorectus space; the extraperitoneal plane is developed using a balloon dissector and insufflation; two ports are placed through the linea alba below the umbilicus to introduce dissection instruments; the deep inferior epigastric vessels are dissected from the underside of the rectus muscle; muscle branches and the superior epigastric are ligated using a Ligasure; and the deep inferior epigastric pedicle is ligated and the vessels are delivered through a minimal fascial incision. The flap(s) is transferred to the chest for completion of the reconstruction. RESULTS: Thirty-three subjects totaling 57 flaps were included. All flaps were single-perforator deep inferior epigastric artery perforator flaps. Mean fascial incision length was 2.0 cm. Sixty percent of subjects recovered without narcotics. Mean length of stay was 2.5 days. Flap salvage occurred in one subject after venous congestion. Two pedicle transections occurred during harvest that required perforator-to-pedicle anastomosis. CONCLUSION: Total extraperitoneal laparoscopically assisted harvest of the deep inferior epigastric pedicle is a reliable method that decreases the donor-site morbidity of autologous breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias da Mama/cirurgia , Laparoscopia , Mamoplastia/métodos , Retalho Perfurante/irrigação sanguínea , Coleta de Tecidos e Órgãos/métodos , Adulto , Estudos de Coortes , Artérias Epigástricas , Fasciotomia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Med Sci (Paris) ; 36(6-7): 600-606, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32614311

RESUMO

In inherited retinal diseases such retinitis pigmentosa, characterized by progressive loss of light sensitive neurons (photoreceptors), cell therapy is now considered as an attractive strategy. Photoreceptor cell replacement would be valuable for restoring function to retinas in a way that is independent from the cause of the disease. With advances in stem cell biology, considerable strides have been made towards the generation of retinal cells, in particular with the development of 3D culture systems allowing the generation of retinal organoids from pluripotent stem cells. In this review, we present a state-of-the art of preclinical strategies conducted in animal models for photoreceptor replacement from stem cell-derived photoreceptors and we discuss the important obstacles to overcome in the future.


Assuntos
Células Fotorreceptoras/transplante , Retinite Pigmentosa/terapia , Terapias em Estudo/métodos , Terapias em Estudo/tendências , Animais , Humanos , Células-Tronco Pluripotentes Induzidas/citologia , Células-Tronco Pluripotentes Induzidas/transplante , Organoides/citologia , Organoides/fisiologia , Células Fotorreceptoras/citologia , Células Fotorreceptoras/fisiologia , Células-Tronco Pluripotentes/citologia , Células-Tronco Pluripotentes/transplante , Retina/citologia , Retina/embriologia , Retina/transplante , Degeneração Retiniana/terapia , Retinite Pigmentosa/patologia , Índice de Gravidade de Doença , Técnicas de Cultura de Tecidos , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/normas , Coleta de Tecidos e Órgãos/tendências
4.
BMC Surg ; 20(1): 119, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493278

RESUMO

BACKGROUND: Donor safety is the top priority in living-donor liver transplantation. Splenic hypertrophy and platelet count decrease after donor surgery are reported to correlate with the extent of hepatectomy, but other aftereffects of donor surgeries are unclear. In this study, we evaluated the surgical effects of donor hepatectomy on skeletal muscle depletion and their potential sex differences. METHODS: Among a total of 450 consecutive donor hepatectomies performed from April 2001 through March 2017, 277 donors who completed both preoperative and postoperative (60-119 days postsurgery) evaluation by computed tomography were the subjects of this study. Donors aged 45 years or older were considered elderly donors. Postoperative skeletal muscle depletion was assessed on the basis of the cross-sectional area of the psoas major muscle. Postoperative changes in the spleen volume and platelet count ratios were also analysed to evaluate the effects of major hepatectomy. RESULTS: The decrease in the postoperative skeletal muscle mass in the overall donor population was slight (99.4 ± 6.3%). Of the 277 donors, 59 (21.3%) exhibited skeletal muscle depletion (i.e., < 95% of the preoperative value). Multivariate analysis revealed that elderly donor (OR:2.30, 95% C.I.: 1.27-4.24) and female donor (OR: 1.94, 95% C.I. 1.04-3.59) were independent risk factors for postoperative skeletal muscle depletion. Stratification of the subjects into four groups by age and sex revealed that the elderly female donor group had significantly less skeletal muscle mass postoperatively compared with the preoperative values (95.6 ± 6.8%), while the other three groups showed no significant decrease. Due to their smaller physical characteristics, right liver donation was significantly more prevalent in the female groups than in the male groups (112/144, 77.8% vs 65/133, 48.9%; p < 0.001). The estimated liver resection rate correlated significantly with the splenic hypertrophy ratio (r = 0.528, p < 0.001) and the extent of the platelet count decrease (r = - 0.314, p < 0.001), but donor age and sex did not affect these parameters. CONCLUSION: Elderly female donors have a higher risk of postoperative skeletal muscle depletion. Additionally, female donors are more likely to donate a right liver graft, whose potential subclinical risks include postoperative splenic enlargement and a platelet count decrease.


Assuntos
Hepatectomia/métodos , Transplante de Fígado/métodos , Doadores Vivos , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Fígado/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/metabolismo , Contagem de Plaquetas , Período Pós-Operatório , Estudos Retrospectivos , Trombocitopenia/epidemiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
Plast Reconstr Surg ; 146(1): 37e-42e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590648

RESUMO

When septal cartilage is lacking, commercially available costal cartilage allograft can be used. Such allografts have "off-the-shelf" accessibility, are available in multiple sizes, are aseptically processed to meet sterility, and are screened to minimize infectious risks. The purpose of this study was to evaluate the effect of donor age, storage temperature, and orientation of a bilayered construct on the degree of warping of a commercialized fresh frozen costal cartilage allograft in vitro over time. A total of 140 fresh frozen costal cartilage cadaveric specimens were separated into three donor age groups. These were allocated into three harvesting subgroups: group a, single pieces (cephalocaudal segments); group b, two laminated pieces of the same rib sutured together in anatomical position (laminated group); and group c, two pieces from the same rib reversed onto each other and sutured together (oppositional group). Photographs were examined and analyzed to determine the degree of cartilaginous warping. Decreased rates of warping were seen in commercially available, aseptically processed costal cartilage allografts procured from older cadavers. Warping was also decreased when oppositional suturing techniques were used as a way to address those intrinsic cartilage forces.


Assuntos
Fenômenos Biomecânicos/fisiologia , Cartilagem Costal , Rinoplastia/métodos , Adulto , Fatores Etários , Cartilagem Costal/fisiologia , Cartilagem Costal/transplante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Doadores de Tecidos , Coleta de Tecidos e Órgãos/métodos , Transplante Homólogo , Adulto Jovem
7.
Nat Commun ; 11(1): 2939, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546694

RESUMO

There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.


Assuntos
Sobrevivência de Enxerto/fisiologia , Testes de Função Hepática/métodos , Transplante de Fígado/métodos , Fígado/fisiologia , Preservação de Órgãos/métodos , Doadores de Tecidos/estatística & dados numéricos , Idoso , Feminino , Humanos , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Preservação de Órgãos/estatística & dados numéricos , Perfusão/métodos , Estudos Prospectivos , Análise de Sobrevida , Temperatura , Fatores de Tempo , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/estatística & dados numéricos
8.
Acta Chir Orthop Traumatol Cech ; 87(2): 108-113, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32396511

RESUMO

PURPOSE OF THE STUDY The clinical prospective study presents the results of minimally invasive harvesting of cancellous bone tissue in trauma indications. We focused on evaluating the clinical outcomes of this technique, particularly on the amount of cancellous bone harvested, the effectiveness of its use and complications. The pain in the bone graft harvest site is evaluated and compared with the pain after a standard harvest from the iliac crest. MATERIAL AND METHODS All the patients aged 18-90 years, in whom cancellous bone was harvested by minimally invasive technique using a bone cutter were included prospectively in the study. It was used to fill the defect in treating a fracture or in surgical treatment of non-union. The patients, in whom the grafts harvested in this manner were combined with another substitute, were not included in the study. Thus, 57 adult patients (40 men, 17 women) were included in the group in the period from March 2012 to March 2016. 37 patients, i.e. 65% of the total number of 57 patients, arrived for the evaluation of the clinical outcome. The minimally invasive graft harvesting was performed using the Aesculap® cutters. The graft was harvested either from the skeleton directly in the area of surgical wound or by a mini incision above the harvest site in the area under surgical drapes. The diameter of the cutter was selected based on the planned necessary number of grafts and with account taken of the harvest site. There were 6 harvest sites selected - proximal humerus, proximal ulna, iliac crest, greater trochanter of femur, distal femur and proximal tibia. The age and gender of patients, harvest site, type of the used cutter and the total number of harvested grafts were recorded in the study. The patients underwent a clinical follow-up at 6 weeks, 3 months, 6 months and 1 year postoperatively. The healing of the fracture or non-union was assessed on radiographs and in case of any doubt a CT scan was indicated. The pain at the graft harvest site was quantified with the use of the VAS score. A possible correlation between the age and the harvest site pain was explored by means of the Pearson s correlation coefficient. RESULTS In surgical management of fractures, 10.98 cm³ of bone marrow (σ 5.32) was harvested on average, in non-unions it was 10.85 cm³ (σ 5.52). With the above described technique, the mean healing time of lower extremity fractures was 26 weeks, in upper extremity it was 22 weeks. The non-unions of lower extremity and upper extremity healed after 28 weeks and 19 weeks, respectively. The average pain at the harvest site was 4.08 (σ 2.21, p ˂ 0.001). By calculating the Pearson's correlation coefficient it was confirmed that there is no correlation between the age and pain VAS score at the harvest site (r = -0.05). No early complications at the graft harvest site were observed in our group of patients. DISCUSSION On average, 10.98 cm³ of bone marrow was harvested in treated fractures, which in comparison to standard harvests from the iliac crest offers sufficient amount of tissue to treat complicated fractures and non-unions. Technically, the standard harvest site of cancellous bone tissue from the iliac crest is replaceable. The harvesting technique offers an interesting alternative also in terms of the duration of surgery and material. CONCLUSIONS Our study confirmed that by the minimally invasive technique of bone graft harvesting adequate amount of tissue to treat defect fractures and non-unions can be harvested. Spongioplasty using grafts harvested in this manner is effective, with a minimum percentage of non-unions. The advantage of this technique is the proximity of the harvest site and the operative field and low level of pain. The minimally invasive graft harvesting represents a technique with a low risk of postoperative and late complications. Key words: bone graft, autografts, minimally invasive surgery, ilium, pain.


Assuntos
Transplante Ósseo/métodos , Osso Esponjoso/transplante , Fraturas Ósseas/cirurgia , Coleta de Tecidos e Órgãos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Adulto Jovem
9.
J Fr Ophtalmol ; 43(6): 477-483, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32444133

RESUMO

BACKGROUND AND PURPOSE: The purpose of this study is to compare two alternative methods of collecting and transporting media for the diagnosis of corneal ulcers, as not all clinical settings have conventional culture materials and transport media available. METHODS: In this open-label, prospective, comparative, and randomized study, patients with clinical suspicion of infectious keratitis with high risk of loss of vision had corneal specimens collected using two methods and transport media: Eswab scraping with Amies transport medium and 23-gauge needle scraping in BACTEC Peds broth. The order of each collection method was randomized. The samples were processed by standard methods, comparing the positivity frequencies for both by parametric and nonparametric tests, according to normality criteria. RESULTS: Corneal infiltrates from 40 eyes of 40 patients were analyzed. Culture positivity rate was 50% for Eswab and 35% for 23-gauge needle (P=0.258). The overall growth rate of the two methods combined was not higher than with the swab alone. The results obtained with a swab were not influenced by the collection sequence (P=0.112); however, the positivity rate was significantly higher when the sample taken with the needle was performed first (P=0.046). CONCLUSIONS: The single sample Eswab method of collection and transportation for the diagnosis of high risk corneal ulcers is a valid alternative and can be used in cases in which, for various reasons, there is no access to the full set of traditional culture materials.


Assuntos
Córnea , Úlcera da Córnea/patologia , Infecções Oculares Bacterianas/patologia , Ceratite/patologia , Manejo de Espécimes/métodos , Coleta de Tecidos e Órgãos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Córnea/patologia , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/microbiologia , Meios de Cultura/química , Meios de Cultura/farmacologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/microbiologia , Masculino , Pessoa de Meia-Idade , Técnicas de Cultura de Tecidos/métodos , Transportes , Adulto Jovem
11.
Ann Palliat Med ; 9(2): 359-367, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233631

RESUMO

BACKGROUND: To establish a stable ex vivo lung perfusion (EVLP) model and determine the preservation effect of the EVLP technique on donor lungs in vitro. METHODS: EVLP was performed on nonacceptable human donor and porcine lungs, and during perfusion, the oxygenation index was assessed and blood gas analysis was performed. RESULTS: After 4 h of EVLP of nonacceptable human donor and porcine lungs, lung function parameters remained stable, and lung energy metabolism was improved to a certain extent. CONCLUSIONS: EVLP can suitably maintain donor lungs in vitro for transplantation and is an effective method for ex vivo preservation of donor lungs.


Assuntos
Transplante de Pulmão/métodos , Perfusão/métodos , Obtenção de Tecidos e Órgãos/métodos , Animais , Humanos , Soluções para Preservação de Órgãos , Preservação Biológica , Suínos , Coleta de Tecidos e Órgãos/métodos
12.
Ann R Coll Surg Engl ; 102(6): 422-428, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326723

RESUMO

INTRODUCTION: Endoscopic vein harvest is the technique of choice in North America, where it constitutes 80% of conduit harvest for coronary artery bypass grafting. The UK has much lower rates, despite demonstrable perioperative benefits. Concerns about patency and long-term survival are often cited as reasons for poor uptake and evidence in the literature thus far has only addressed mid-term outcomes. We sought to identify the long-term survival of patients undergoing endoscopic vein harvest compared with a contemporaneous cohort of open vein harvest. MATERIALS AND METHODS: This was a retrospective cohort study of all consecutive patients undergoing isolated coronary artery bypass grafting at a single institution between 2007 and 2017. All-cause long-term mortality was compared using Kaplan-Meier curves and log-rank analysis. RESULTS: A total of 7,527 patients undergoing coronary artery bypass grafting (1,029 receiving endoscopic vein harvest) were studied. The groups were well matched for preoperative characteristics, except that there were more patients with triple-vessel disease and good left-ventricular function in the endoscopic vein harvest group. There was no statistically significant difference in the long-term survival (p = 0.23). At five years (median follow-up), survival was 86.1% (95% confidence interval 85.3-87.0) in the open vein harvest group compared with 85.5% (95% confidence interval 82.8-88.2) in the endoscopic vein harvest group. DISCUSSION AND CONCLUSION: Endoscopic vein harvest does not affect long-term survival in an unselected population. The contraindications for minimally invasive vein harvest in coronary artery bypass grafting are increasingly diminishing.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/mortalidade , Endoscopia/métodos , Veia Safena/transplante , Infecção da Ferida Cirúrgica/epidemiologia , Coleta de Tecidos e Órgãos/métodos , Idoso , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Endoscopia/efeitos adversos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Resultado do Tratamento , Grau de Desobstrução Vascular
13.
PLoS One ; 15(4): e0227546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343697

RESUMO

We developed a preoperative assessment system to predict surgical workload in hand-assisted laparoscopic donor nephrectomy (HALDNx) using the normal-based linear discriminant rule (NLDR). A total of 128 cases of left HALDNx performed by a single operator were used as training data. Surgical workload was measured by operative time. The optimized model had 9 explanatory variables: age, total protein, total cholesterol, number of renal arteries (numberRA), 4 variables of perinephric fat (PNF), and thickness of subcutaneous fat. This model was validated using cross-validation and the .632 estimator to estimate discrimination rates with future test data. PNF and numberRA were the predominant factors affecting workload followed by the computed tomography value of PNF, body weight, and male sex. The estimated accuracy of the prediction system was 94.6%. The complication rate was 9.38% and did not correlate with surgical workload. We also made our program available online for constructing assessment functions from other cohort data. In conclusion, the surgical workload of HALDNx could be predicted with PNF and numberRA as the dominant risk factors.


Assuntos
Laparoscopia Assistida com a Mão/efeitos adversos , Modelos Estatísticos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Índice de Massa Corporal , Análise Discriminante , Feminino , Laparoscopia Assistida com a Mão/estatística & dados numéricos , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Rim/cirurgia , Curva de Aprendizado , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Duração da Cirurgia , Segurança do Paciente , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Medição de Risco/métodos , Fatores de Risco , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
14.
Plast Reconstr Surg ; 145(5): 1267-1274, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332551

RESUMO

BACKGROUND: The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap. METHODS: All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. RESULTS: A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS: The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Retalhos de Tecido Biológico/transplante , Retalho Perfurante/transplante , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço/irrigação sanguínea , Antebraço/fisiopatologia , Antebraço/cirurgia , Retalhos de Tecido Biológico/efeitos adversos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Perfurante/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Artéria Radial/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante/fisiopatologia , Sítio Doador de Transplante/cirurgia , Artéria Ulnar/cirurgia
15.
Am Heart J ; 224: 17-24, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32272256

RESUMO

The SWEDEGRAFT study (ClinicalTrials.gov Identifier: NCT03501303) tests the hypothesis that saphenous vein grafts (SVGs) harvested with the "no-touch" technique improves patency of coronary artery bypass grafts compared with the conventional open skeletonized technique. This article describes the rationale and design of the randomized trial and baseline characteristics of the population enrolled during the first 9 months of enrollment. The SWEDEGRAFT study is a prospective, binational multicenter, open-label, registry-based trial in patients undergoing first isolated nonemergent coronary artery bypass grafting (CABG), randomized 1:1 to no-touch or conventional open skeletonized vein harvesting technique, with a planned enrollment of 900 patients. The primary end point is the proportion of patients with graft failure defined as SVGs occluded or stenosed >50% on coronary computed tomography angiography at 2 years after CABG, earlier clinically driven coronary angiography demonstrating an occluded or stenosed >50% vein graft, or death within 2 years. High-quality health registries and coronary computed tomography angiography are used to assess the primary end point. The secondary end points include wound healing in the vein graft sites and the composite outcome of major adverse cardiac events during the first 2 years based on registry data. Demographics of the first 200 patients enrolled in the trial and other CABG patients operated in Sweden during the same time period are comparable when the exclusion criteria are taken into consideration. RCT# NCT03501303.


Assuntos
Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/prevenção & controle , Sistema de Registros , Veia Safena/transplante , Coleta de Tecidos e Órgãos/métodos , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Oclusão de Enxerto Vascular/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
16.
J Card Surg ; 35(5): 1082-1084, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32176354

RESUMO

BACKGROUND: The right gastroepiploic artery (RGEA) is a useful in-situ graft, and skeletonization is effective to prevent spasm and achieve good patency. To harvest the skeletonized RGEA easily, ultrasonic scalpel has been widely used, but the tip shape of conventional ultrasonic device was not optimal for this procedure. Recently, a novel hybrid ultrasonic/bipolar energy device (THUNDERBEAT Open Fine Jaw [TOFJ]) has been developed and is widely used in general surgery. SURGICAL TECHNIQUE: The operator holds forceps in left hand and TOFJ in right hand, incises the anterior layer of the omentum, and extends the incision distally along the RGEA. The side branches and satellite veins were sealed and cut. Because the tip of the TOFJ is well-designed to easily grasp and peel off the tissue, there is no need to change instruments throughout the procedure. After the dissection was advanced distally, the proximal side was subsequently dissected. CONCLUSIONS: This novel device is useful for harvesting skeletonized RGEA.


Assuntos
Artéria Gastroepiploica/cirurgia , Artéria Gastroepiploica/transplante , Coleta de Tecidos e Órgãos/instrumentação , Transplantes , Desenho de Equipamento , Humanos , Coleta de Tecidos e Órgãos/métodos , Grau de Desobstrução Vascular
17.
Fertil Steril ; 113(3): 679-680, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32111474

RESUMO

OBJECTIVE: To introduce an effective approach using a self-made retrieval bag during laparoscopic myomectomy to contain tissue extraction. DESIGN: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. SETTING: University hospital. PATIENT(S): A 32-year-old woman diagnosed with a uterine myoma (diameter, 6 cm). She had endured 5 years of intermittent lower abdominal pain and 2 years of infertility. INTERVENTION(S): A self-made retrieval bag during laparoscopic myomectomy was used (consists of four steps) to contain tissue extraction. 1. Self-made retrieval bag using a sterile medical bag. 2. Inspect the pelvic cavity, evaluate and determine the location and number of myomas. 3. Resect the myoma. 4. Morcellate the myoma into pieces inside the retrieval bag using laparoscopic power morcellation. MAIN OUTCOME MEASURE(S): Value and feasibility of using a self-made retrieval bag in laparoscopic myomectomy. RESULT(S): The myoma was successfully and completely resected by laparoscopy using a self-made retrieval bag to contain tissue extraction. Operative time was 93 minutes. In the follow-up period, the patient did not report any symptom of iatrogenic parasitic myoma. The woman had a pregnancy at month 26 after operation and underwent a cesarean section. This resulted in a full-term baby. CONCLUSION(S): Our surgical approach demonstrated a number of noteworthy advantages. The use of retrieval bag to contain tissue extraction during laparoscopic morcellation can avoid the risk of iatrogenic parasitic myoma. The retrieval bag is self-made using a sterile packing bag, which is cost free and also reduces operative expenses.


Assuntos
Laparoscopia , Leiomioma/cirurgia , Instrumentos Cirúrgicos , Coleta de Tecidos e Órgãos/instrumentação , Miomectomia Uterina , Neoplasias Uterinas/cirurgia , Adulto , Desenho de Equipamento , Feminino , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Leiomioma/patologia , Morcelação/instrumentação , Morcelação/métodos , Coleta de Tecidos e Órgãos/métodos , Miomectomia Uterina/instrumentação , Miomectomia Uterina/métodos , Neoplasias Uterinas/patologia
18.
Fertil Steril ; 113(3): 609-617.e3, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192593

RESUMO

OBJECTIVE: To evaluate whether specific ovarian decortication techniques vary in promoting ovarian cortex cryopreservation and transplant outcomes. DESIGN: Experimental design. SETTING: University hospital. ANIMAL(S): Nonobese diabetic (NOD)/severe combined immunodeficiency (SCID) female mice. INTERVENTION(S): Human ovarian biopsy samples allocated to one of the following decortication procedures: scratching with scalpel blade (B), cutting with microsurgical scissors (M), separation with slicer (S), or no-separation (control, C). Parallel, in vivo experiment: decortication techniques combined with slow freezing (SF) and vitrification (VT) before xenograft into immunodeficient mice. MAIN OUTCOME MEASURE(S): Follicular counts, apoptosis, shear stress, Hippo pathway and inflammation. In vivo: recovered grafts analyzed for follicular counts, angiogenesis, proliferation, and fibrosis. RESULT(S): There were no differences in follicular density or number of damaged follicles between the decortication techniques in the in vitro study. Nevertheless, the M samples showed statistically significantly increased stromal damage compared with the controls and S samples, and up-regulation of Hsp60 shear stress gene expression. Decortication by both M and S inhibited the Hippo pathway, promoting gene expression changes. In the 21-day xenograft, total follicular density statistically significantly decreased compared with the nongrafted controls in all groups. Nevertheless, no differences were observed between the decortication techniques. Ovarian stroma vascularization was increased in the vitrified samples, but among the slow-freezing samples, the B samples had the lowest microvessel density. The M decorticated xenografts had increased fibrosis. CONCLUSION(S): Decortication with a slicer causes less damage to ovarian tissue than other commonly used methods although microsurgical scissors seem to preserve slightly increased follicular numbers. Nevertheless, blade decortication seems to be a reliable technique for maintaining acceptable follicular conditions without inducing serious stromal impairment.


Assuntos
Separação Celular/normas , Criopreservação/normas , Folículo Ovariano/fisiologia , Ovário , Células Estromais/citologia , Coleta de Tecidos e Órgãos/normas , Adolescente , Adulto , Animais , Calibragem , Separação Celular/métodos , Sobrevivência Celular , Criopreservação/métodos , Feminino , Humanos , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Folículo Ovariano/citologia , Controle de Qualidade , Coleta de Tecidos e Órgãos/métodos , Adulto Jovem
19.
Transplant Proc ; 52(4): 1081-1086, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32192742

RESUMO

BACKGROUND: The transverse abdominal plane (TAP) block is sensitive and encompasses peripheral nerves of the anterior abdominal wall. It decreases 27% of the forced vital capacity, 58% of maximum inspiratory, and 51% of the maximum expiratory pressure on the first postoperative day. It is a postoperative analgesic alternative. OBJECTIVE: The researchers sought to evaluate the effectiveness and safety of the TAP block compared with continuous epidural analgesia in donor nephroureterectomy. MATERIAL AND METHODS: A controlled clinical trial of 30 randomized patients in 2 groups-TAP and continuous epidural analgesia-was used. In the TAP group, a catheter was installed in the transverse abdominal plane and ropivacaine, 0.375% 20 mL, and ropivacaine, 0.2%, were deposited in an elastomeric infuser. The other group was installed with an epidural catheter; at the end of the surgery, 10mL of ropivacaine 0.2% was administered and connected to an elastomeric infuser. Adverse effects and pain intensity were evaluated in the first 36 hours; Student t test and the χ2 test were applied. RESULTS: The study showed similar analgesia in both groups at 6 hours after the procedure (P = .256); better analgesia was seen in the TAP group in the next 30 hours (P = .000). Researchers also found time for bladder catheter removal, ambulation, and minor hospital discharge in the TAP vs the epidural group as follows: 18.2 ± 3.6 vs 21.7 ± 4.4 hours (P = .028), 20 ± 3.5 vs 23.5 ± 4.2 hours (P = .019), and 51.2 ± 8.4 vs 62.4 ± 17.6 hours (P = .035), respectively. CONCLUSIONS: Continuous TAP blockade is an effective and safe technique. It favors early recovery, early removal of the bladder catheter, ambulation, and discharge.


Assuntos
Analgesia Epidural/métodos , Nefroureterectomia/métodos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Coleta de Tecidos e Órgãos/métodos , Músculos Abdominais/efeitos dos fármacos , Adulto , Anestésicos Locais/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefroureterectomia/efeitos adversos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Ropivacaina/uso terapêutico
20.
Plast Reconstr Surg ; 145(4): 1089-1097, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221240

RESUMO

Currently, fat transplantation occurs immediately after harvesting procedures. Because low rates of fat graft take are well reported in the literature, many patients require multiple surgical procedures for fat graft harvest. These subsequent procedures lead to increased cost, donor-site morbidity, and patient discomfort in the long term. The ability to preserve our patients' own adipose aspirate would allow us to counteract these shortcomings and ultimately improve the clinical outcome after fat grafting. Unfortunately, there is no optimal and practical adipose tissue cryopreservation protocol for use by the plastic surgeon at the present time. Because of this dilemma, the senior author (L.L.Q.P.) has investigated this concept in an effort to create a protocol that is both technically sound and clinically achievable to allow for the long-term preservation of adipose tissue. In this article, the authors aim to outline this effort, review current clinical applications that have been reported in the literature, and detail exciting future perspectives in the use of preserved lipoaspirates for repeated fat grafting procedures or in the form of cell-based therapy engineered for reconstructive endeavors for their patients.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/métodos , Criopreservação/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Coleta de Tecidos e Órgãos/métodos , Tecido Adiposo/citologia , Sobrevivência de Enxerto , Humanos , Transplante Autólogo/métodos
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