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1.
Khirurgiia (Mosk) ; (6): 121-124, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573544

RESUMO

High incidence of iatrogenic lesions of genitourinary system (during gynecological and oncogynecological operations) followed by urogenital fistulae and great percentage of recurrences after reconstructive surgery justify the need to improve surgical reconstruction of genitourinary organs and urine discharge in these patients. Stage-by-stage surgical treatment of a patient with extensive vesicovaginal fistula is reported in the article. A defect was associated with loss of 2/3 of the volume of tissues of adjacent organs. Multiple operations in various clinics were failed to eliminate the fistula and resulted decrease of bladder capacity up to microcystis.


Assuntos
Intestino Delgado/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Bexiga Urinária/cirurgia , Vagina/cirurgia , Fístula Vesicovaginal/cirurgia , Feminino , Humanos , Tamanho do Órgão , Bexiga Urinária/patologia , Doenças da Bexiga Urinária/etiologia
2.
Khirurgiia (Mosk) ; (4): 18-23, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352663

RESUMO

OBJECTIVE: To study the long-term results of reconstructive procedures for esophageal strictures and evaluate quality life after each type of esophageal repair using own criteria. MATERIAL AND METHODS: The study was conducted among patients who underwent esophageal repair with gastric transplant (172), colonic transplant (25), intestinal transplant (14) and repair of short cervical strictures (7). The age of patients ranged from 5 to 60 years. All patients underwent X-ray and endoscopic examination. Survey also included external respiration function and cardiac function, digestive function, measurement of height and weight, analysis of social aspects (work, study), female genital function. Five-score scale for quality of life assessment was developed. RESULTS: Long-term results were studied in 218 patients for the period from 3 months to 31 years (2002-2017). Excellent and good results were obtained in 180 patients. The best results were obtained after repair of short cervical strictures (4.42 scores), good results - after esophageal repair with gastric (4.14 scores) and intestinal (4.07 scores) transplants. Colonic repair was followed by satisfactory outcome (3.16 scores). CONCLUSION: Gastric and small bowel grafts are preferred for total esophageal repair due to better quality of life in long-term postoperative period.


Assuntos
Colo/transplante , Estenose Esofágica/cirurgia , Esofagoplastia/métodos , Intestino Delgado/transplante , Qualidade de Vida , Estômago/transplante , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Resultado do Tratamento , Adulto Jovem
3.
Transplantation ; 104(9): 1862-1868, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32345867

RESUMO

BACKGROUND: Intestine graft viability compromises retrieval in most brain-dead donors. Small bowel transplantation is a complex procedure with worse outcomes than transplantation of other abdominal organs. The hormone 17ß-estradiol (E2) has shown vascular protective effects in lung tissue of brain death (BD) male rats. Thus, estradiol might be a treatment option to improve the quality of intestinal grafts. METHODS: Male Wistar rats were divided into 3 groups (n = 10/group): rats that were trepanned only (sham-operated), rats subjected to rapid-onset BD, and brain-dead rats treated with E2 (280 µg/kg, intravenous) (BD-E2). Experiments performed for 180 minutes thereafter are included: (a) laser-Doppler flowmetry and intravital microscopy to evaluate mesenteric perfusion; (b) histopathological analysis; (c) real-time polymerase chain reaction of endothelial nitric oxide synthase (eNOS) and endothelin-1; (d) immunohistochemistry of eNOS, endothelin-1, P-selectin, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 expression; and (e) ELISA for cytokines and chemokines measurement. RESULTS: 17ß-Estradiol improved microcirculatory perfusion and reduced intestinal edema and hemorrhage after BD. The proportions of perfused small vessels were (mean ± scanning electron microscope) BD rats (40% ± 6%), sham-operated rats (75% ± 8%), and BD-E2 rats (67% ± 5%) (P = 0.011). 17ß-Estradiol treatment was associated with 2-fold increase in eNOS protein (P < 0.0001) and gene (P = 0.0009) expression, with no differences in endothelin-1 expression. BD-E2 rats exhibited a reduction in vascular cell adhesion molecule 1 expression and reduced cytokine-induced neutrophil chemoattractant 1 and interleukina-10 serum levels. CONCLUSIONS: 17ß-Estradiol was effective in improving mesenteric perfusion and reducing intestinal edema and hemorrhage associated with BD. The suggestion is that E2 might be considered a therapy to mitigate, at least in part, the deleterious effects of BD in small bowel donors.


Assuntos
Morte Encefálica/fisiopatologia , Estradiol/farmacologia , Intestino Delgado/transplante , Microcirculação/efeitos dos fármacos , Perfusão , Doadores de Tecidos , Animais , Citocinas/sangue , Hemorragia Gastrointestinal/prevenção & controle , Intestino Delgado/patologia , Masculino , Ratos , Ratos Wistar , Circulação Esplâncnica/efeitos dos fármacos
4.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 120-124, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32146741

RESUMO

Objective: To assess surgical outcomes of implanted porcine small intestinal submucosa (SIS) mesh in the rabbit vesicovaginal space (VVS) and explore its application value in pelvic floor reconstruction surgery. Methods: Sixteen male rabbits were randomly divided into four groups, and each group had four rabbits. All groups of rabbits were implanted with SIS mesh in the vesicovaginal space. They were humanely killed after a postoperative period of 7, 30, 90 and 180 days by group. The grafted area was removed with the surrounding bladder and vaginal tissues. The specimens were embedded in paraffin and then stained with HE and Masson's trichrome stains for visual observations, cells counts, and assessment of tissues and collagen fibers. Results: (1) After HE staining, a large number of inflammatory response cells mainly eosinophils and lymphocytes infiltrated around the SIS mesh in 7 days group, and neovascularization was observed, the infiltration area of inflammatory response cells further increased in 30 days group, the infiltration area of inflammatory response cells significantly reduced in 90 days group, while the inflammatory response basically subsided in 180 days group. (2) After Masson's trichromestaining, the collagen structure of SIS mesh in 7 days group was clear and intact. While, the collagen structure of SIS mesh was partially degraded in 30 days group, the SIS meshes of 4 rabbits were completely degraded, but the collagen fragments of SIS remained in 90 days group. In 180 days group, the SIS mesh of all rabbits was degraded, and one of them had the formation of new collagen fibers. Conclusions: SIS mesh implanted into the VVS of rabbits can lead to a transient non infective inflammatory reaction, which could be completely degraded and a small amount of new collagen fibers could be produced after 180 days of implantation. Which shown that SIS mesh should be used cautiously in pelvic floor reconstruction surgery.


Assuntos
Mucosa Intestinal/transplante , Intestino Delgado/transplante , Telas Cirúrgicas , Bexiga Urinária/cirurgia , Animais , Colágeno , Feminino , Masculino , Coelhos , Distribuição Aleatória , Suínos , Bexiga Urinária/patologia
5.
Surgery ; 168(2): 297-304, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32139142

RESUMO

BACKGROUND: Historically, adults with ultra short bowel syndrome (USBS) have been considered candidates for lifetime parenteral nutrition (PN) or are referred for visceral transplantation. We examined the surgical and nutritional outcomes of adult patients with USBS managed at a single intestinal rehabilitation center. METHODS: We retrospectively reviewed data on 588 adult patients referred to our center between January 2013 and December 2018. USBS was defined as residual small bowel (SB) length ≤ 50 cm. RESULTS: Forty-five patients (7.6%) with a mean age of 46.7 years (range 17-78) were identified. Indications for enterectomy included mesenteric ischemia (n=17) and internal hernias (n=6), followed by large intraabdominal fibroids, trauma, and allograft enterectomies, with five cases each. Median SB length was 18.0 cm; 20 patients (44.4%) had their entire SB resected. Thirteen patients had an intact colon, of which nine had preservation of the ileocecal valve. Patients who underwent autologous reconstruction of their gastrointestinal (GI) tract required a lower total PN volume (29.0 ± 7.6 vs. 40.8 ± 13.2 ml/Kg/day, p=0.002) and presented better short- and long- term survival (p=0.005). Patients with no gut had higher mortality (p=0.036). Hormonal therapy with the glucagon-like peptide-2 analog teduglutide was used in nine patients (20%) five of whom were weaned off TPN. Excluding patients with no gut (n=20), discontinuation of total PN rate for patients with an end ostomy or tube decompression (n= 6), jejunocolostomy (n= 10), and jejunoileostomy (n=9) were 0%, 40%, and 77.7%, respectively. Eleven patients (44%) with some residual small intestine achieved nutritional autonomy in an average of 20 months after GI reconstruction. Fifteen patients were listed for transplantation (33.3%). Seven patients underwent isolated SB transplantation and achieved nutritional autonomy in an average of three months after transplantation. One-year patient and graft survival were 100%. After a 37-month median follow-up period, 36 of 42 patients followed by our center were still alive (85.7%). CONCLUSION: Nutritional autonomy can be achieved in a significant number of patients with USBS in specialized centers with surgical and/or hormonal therapy. The presence of an intact colon and ileocecal valve can significantly increase the adaptation rate. Moreover, restoration of GI tract continuity has a positive impact on medical management and survival.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Síndrome do Intestino Curto/cirurgia , Adolescente , Adulto , Idoso , Algoritmos , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos , Intestino Delgado/transplante , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral Total , Peptídeos/uso terapêutico , Estudos Retrospectivos , Transplantados/estatística & dados numéricos , Adulto Jovem
6.
Fertil Steril ; 113(3): 681-682, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192600

RESUMO

OBJECTIVE: To introduce an innovation that combines single port laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with congenital cervical atresia, absence of vagina, and incomplete uterine septum (U2aC4V4). DESIGN: Video article introducing a new surgical technique. SETTING: University hospital. PATIENT(S): A 15-year-old patient with congenital cervical atresia, absence of vagina, and incomplete uterine septum had primary amenorrhea and cyclic lower abdominal pain. The magnetic resonance imaging did not show hematometra and the endometrium was 6 mm when she had lower abdominal pain. INTERVENTION(S): A neovagina (depth, 7 cm; width, 2.5 cm) was created using the Wharton-Sheares-George neovaginoplasty. By single laparoscopy, the bladder was separated from the anterior surface of the uterus. With the mold in the neovagina created by the assistant, the apex of neovagina was opened. Then the lower uterine segment was exposed and incised. A T-shaped intrauterine device was connected to an 8-cm-long catheter scissored from a 14-F Foley catheter and was inserted into the uterus to prevent cervical or vaginal stenosis. The upper end of the graft was applied onto the lower uterine segment with delayed absorbable sutures. The lower end was sutured to the high vaginal or vestibular mucosa. MAIN OUTCOME MEASURE(S): The feasibility and effect of combination single port laparoscopic with vaginal cervicovaginal reconstruction in the congenital atresia of cervix. RESULT(S): The operation was successful. The operating time was 90 minutes. Hospitalization was 3 days. There were no intraoperative and postoperative complications. The patient had resumption of menses at three cycles postoperatively, and she had no dysmenorrhea. No cervical or vaginal stenosis occurred because of the Foley catheter. CONCLUSION(S): Single port laparoscopic combined with vaginal cervicovaginal reconstruction provided a minimally invasive, safe, and effective surgical option for the young patient with congenital atresia of cervix. It was successful and without complications or cervical or vaginal stenosis.


Assuntos
Colo do Útero/anormalidades , Colo do Útero/cirurgia , Anormalidades Congênitas/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Útero/cirurgia , Vagina/anormalidades , Adolescente , Amenorreia/etiologia , Amenorreia/cirurgia , Colo do Útero/patologia , Anormalidades Congênitas/patologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/transplante , Intestino Delgado/patologia , Intestino Delgado/transplante , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Estruturas Criadas Cirurgicamente , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Vagina/patologia , Vagina/cirurgia
7.
Acta Cir Bras ; 34(11): e201901107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939503

RESUMO

PURPOSE: To establish a hypotensive brain death pig model and observe the effects of hypotension on small bowel donors. METHODS: The hypotensive brain death model was produced using the modified intracranial water sac inflation method in ten domestic crossbred pigs. Effects of hypotensive brain death on small bowel tissue morphology were evaluated through changes in intestinal tissue pathology, tight junction protein of the intestinal mucosa and plasma intestinal fatty acid-binding protein (i-FABP) levels. The pathophysiological mechanism was examined based on changes in superior mesenteric artery (SMA) blood flow and systemic hemodynamics. RESULTS: After model establishment, SMA blood flow, and the mean arterial pressure (MAP) significantly decreased, while heart rate increased rapidly and fluctuated significantly. Small bowel tissue morphology and levels of tight junction protein of the intestinal mucosa showed that after model establishment, small bowel tissue injury was gradually aggravated over time (P<0.05). Plasma i-FABP levels significantly increased after brain death (P<0.05). CONCLUSIONS: A hypotensive brain death pig model was successfully established using an improved intracranial water sac inflation method. This method offers a possibility of describing the injury mechanisms more clearly during and after brain death.


Assuntos
Morte Encefálica/fisiopatologia , Modelos Animais de Doenças , Hipotensão/fisiopatologia , Intestino Delgado/patologia , Intestino Delgado/transplante , Animais , Biópsia , Western Blotting , Ensaio de Imunoadsorção Enzimática , Proteínas de Ligação a Ácido Graxo/sangue , Feminino , Hemodinâmica , Intestino Delgado/irrigação sanguínea , Masculino , Microscopia Eletrônica de Transmissão , Reprodutibilidade dos Testes , Suínos , Fatores de Tempo , Proteína da Zônula de Oclusão-1/análise
8.
Inflamm Bowel Dis ; 26(1): 21-23, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634393

RESUMO

Small bowel transplant is an acceptable procedure for intractable Crohn's disease (CD). Some case reports and small series describe the apparent recurrence of CD in the transplanted bowel. This commentary discusses evidence in favor of and against this alleged recurrence and argues that a molecular characterization is needed to prove or disprove that inflammation emerging in the transplanted bowel is a true recurrence of the original CD.


Assuntos
Doença de Crohn/patologia , Doença de Crohn/cirurgia , Intestino Delgado/transplante , Complicações Pós-Operatórias/diagnóstico , Adulto , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recidiva , Resultado do Tratamento
9.
Transplantation ; 104(7): 1429-1436, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31651718

RESUMO

BACKGROUND: Higher incidence of posttransplant lymphoproliferative disorder (PTLD) is reported in the pediatric small bowel transplant (SBTx) population, which may be associated with more aggressive disease and poorer outcome as compared to liver transplant (LTx) recipients. We aim to compare the characteristics and outcome of PTLD in pediatric SBTx against LTx patients at a single center. METHODS: Retrospective review of pediatric SBTx and LTx patients diagnosed with PTLD from 1989 to 2016 was conducted. Diagnosis of PTLD was biopsy-proven based on World Health Organization histologic criteria. Treatment protocol consisted of reduction of immunosuppression (RIS), rituximab (from 2000), cytotoxic T-lymphocyte (CTL) therapy (available in 1999-2004 and from 2011), and chemotherapy. RESULTS: Thirty-seven PTLD patients were included following LTx (n = 23, incidence = 2.8%) and SBTx (n = 14, incidence = 14.9%). Monomorphic PTLD made up 64% of SBTx and 43% of LTx cases. RIS alone resulted in remission in 50% of LTx patients but none of the SBTx patients (P = 0.002). Poorer overall remission (57% versus 96%, P = 0.004), 2-year (46% versus 91%, P = 0.003), and 5-year survival rates (39% versus 90%, P = 0.002) were observed in the SBTx group. Risk factors associated with mortality following PTLD were SBTx (odds ratio [OR], 12.00; 95% confidence interval [CI], 2.34-61.45; P = 0.003), monomorphic histology (OR, 10.63; 95% CI, 1.88-60.25; P = 0.008), multisite involvement (OR, 6.38; 95% CI, 1.35-30.14; P = 0.019), and tumor involvement of allograft (OR, 5.33; 95% CI, 1.14-24.90; P = 0.033). Introduction of CTL therapy was associated with improved survival. CONCLUSIONS: Majority of PTLD following pediatric SBTx are of monomorphic subtype and associated with poorer outcome as compared to LTx patients. RIS is inadequate as a single strategy in managing PTLD in SBTx and prompt escalation to rituximab and CTL is recommended.


Assuntos
Infecções por Vírus Epstein-Barr/epidemiologia , Imunossupressão/efeitos adversos , Intestino Delgado/transplante , Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/epidemiologia , Adolescente , Linfócitos B/imunologia , Criança , Pré-Escolar , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/isolamento & purificação , Humanos , Incidência , Lactente , Estimativa de Kaplan-Meier , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/imunologia , Transtornos Linfoproliferativos/virologia , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Linfócitos T Citotóxicos/imunologia , Transplante Homólogo/efeitos adversos
10.
Transplantation ; 104(1): e8-e15, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31651796

RESUMO

BACKGROUND: Organs from older donors are believed to withstand ischemia worse than those from younger donors. The effect of age on the development of intestinal preservation injury (IPI) is unclear. METHODS: We compared the development of IPI in intestines from young (3 mo), adult (14 mo), and old (20 mo) rat donors and assessed if luminal preservation (LP) is effective in delaying IPI. Small intestines were perfused with, and stored in, preservation solution (Custodiol) with or without LP solution (polyethylene glycol 3350). IPI was studied using histology (Chiu score, Alcian blue staining), Western blot, and electrophysiological assessment (Ussing chamber) at 4, 8, and 14 hours. RESULTS: Intestines of old rats did not show major histological alterations, whereas their aortas and kidneys revealed typical age-related changes (arteriosclerosis and glomerulosclerosis). Intestines from old rats fared similarly to their younger counterparts at all time points regarding preservation injury and goblet cells count. Intestines undergoing LP showed fewer histological signs of damage and higher goblet cells count when compared with samples without LP, regardless of donor age. Ussing chamber experiments indicated a time-dependent deterioration of all parameters studied, which was delayed by the use of LP. CONCLUSIONS: Older intestines did not convincingly demonstrate a faster IPI compared with intestines from adult and young donors. The small differences between the age groups were nullified by the use of LP. LP significantly delayed the IPI in all age groups and may allow for longer preservation periods without an increased risk of mucosal damage.


Assuntos
Mucosa Intestinal/patologia , Intestino Delgado/transplante , Preservação de Órgãos/métodos , Traumatismo por Reperfusão/diagnóstico , Adulto , Fatores Etários , Animais , Contagem de Células , Modelos Animais de Doenças , Feminino , Células Caliciformes/citologia , Células Caliciformes/patologia , Humanos , Mucosa Intestinal/citologia , Intestino Delgado/citologia , Intestino Delgado/patologia , Pessoa de Meia-Idade , Soluções para Preservação de Órgãos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/prevenção & controle , Junções Íntimas/patologia , Fatores de Tempo , Adulto Jovem
11.
J Thorac Cardiovasc Surg ; 160(1): 102-112, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31548077

RESUMO

OBJECTIVE: The objective of our study was to investigate the feasibility of reconstructing the entire mitral valvular and subvalvular apparatus in pigs using a modified tube graft design made of 2-ply small intestinal submucosa extracellular matrix. METHODS: The reconstructions were performed in an acute 80-kg porcine model with 8 pigs, each acting as its own control. A modified tube graft was designed from a sheet of 2-ply small intestinal submucosa extracellular matrix. Before and after mitral valve reconstruction, echocardiography was used to assess mitral regurgitation, left ventricular outflow tract obstruction due to systolic anterior motion, mitral stenosis, leaflet mobility, and leaflet geometry. RESULTS: The reconstructed mitral valves were fully functional without any observable echocardiographic signs of regurgitation. We did not observe any left ventricular outflow tract obstruction due to systolic anterior motion nor any mitral valve stenosis, despite a diminished septal-lateral distance after reconstruction. The reconstruction had a reduced tenting area, a reduced coaptation length (9.6 ± 1.7 mm vs 7.9 ± 1.0 mm, P = .010, diff = -1.7 mm, 95% confidence interval, -3.1 to -0.4 mm), and atrial bending of both leaflets. CONCLUSIONS: In this acute porcine study, entire mitral valvular and subvalvular apparatus reconstruction using a modified tube graft design made from 2-ply small intestinal submucosal extracellular matrix was feasible. The 2-ply small intestinal submucosa extracellular matrix could withstand the pressure exerted by the left ventricle without any signs of tearing or rupture. These promising results warrant further assessment of both the annular geometry and the long-term durability.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Matriz Extracelular/transplante , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ecocardiografia , Feminino , Mucosa Intestinal/citologia , Mucosa Intestinal/transplante , Intestino Delgado/citologia , Intestino Delgado/transplante , Insuficiência da Valva Mitral , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Suínos , Obstrução do Fluxo Ventricular Externo
12.
J Thorac Cardiovasc Surg ; 159(2): 461-473, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30981517

RESUMO

OBJECTIVE: A hybrid small-caliber artificial vascular graft based on bilayer porcine small intestinal submucosa (SIS) with curdlan and dipyridamole mixture film serving as the so-called sandwich filler was developed for biological performance evaluation. We evaluated the performance of the graft and filler. METHODS: SIS was coated with heparin by 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide. Curdlan acted as the carrier of dipyridamole. Three types of graft tubes (2 mm internal diameter and 20 mm in length) were manufactured: bilayer SIS with 10% curdlan + 10% dipyridamole mixture film (SCD), bilayer SIS with 10% curdlan film (SC), and monolayer SIS (S). The remodeling characteristics of the grafts were evaluated by implanting them as bypass in rabbit carotid arteries for 2 and 3 months. Each group contained 16 rabbits, and 16 nonsurgical rabbits served as the control group. RESULTS: Eight rabbits of each group, including the graft occluded group, were killed at 2 months and the others were killed at 3 months. Follow-up showed that all 8 grafts in SCD group were patent at 2 months. Six of 16 grafts in the SC group and 5 of 16 grafts in the S group were occluded at 2 months. One of 8 SCD grafts were occluded at 3 months and the patent showed a confluent endothelium without intimal hyperplasia. The neointima layer was composed of circumferentially aligned vascular smooth muscle cells. At 3 months, SC and S group grafts showed incomplete endothelialization and varying degrees of mural thrombus, accompanied by occlusion in the SC group (3 of 8) and S group (2 of 8). CONCLUSIONS: The novel hybrid small caliber artificial vascular graft exhibited an improvement in revascularization resulting in high patency rate.


Assuntos
Artérias Carótidas/cirurgia , Intestino Delgado/transplante , Enxerto Vascular/instrumentação , Enxerto Vascular/métodos , Animais , Materiais Biocompatíveis/química , Materiais Biocompatíveis/metabolismo , Bioprótese , Heparina/química , Coelhos , Suínos , Grau de Desobstrução Vascular/fisiologia , beta-Glucanas/química
13.
Transplantation ; 104(1): 197-200, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205257

RESUMO

BACKGROUND: Organ transplantation (Tx) is a risk factor for Clostridium difficile infection (CDI). After intestinal transplantation (ITx), few data are available on the impact of this graft infection and the possible induction of rejection. METHODS: We included retrospectively all children after ITx in our unit, with at least 1 year of graft survival. All samples positive for Clostridium difficile (CD) and its toxin were considered. RESULTS: Among the 57 ITx recipients (60 Txs), 22 children (39%) developed culture-proven CDI, 12 after isolated small bowel Tx, 9 after liver-small bowel Tx, and 1 after multivisceral Tx. Twenty patients had diarrhea, 8 bloody stools, 4 fever, and 1 hypothermia. Nine were hospitalized for an average of 6.5 days (2-20) and 4 with severe dehydration. Nine (40%) had received antibiotics for an average of 19 days (7-60) before CDI. Two patients were asymptomatic. CDI was treated with metronidazole in 12 children, vancomycin in 6, and both in 3. Three children presented mild-to-severe rejections. Two patients presented concomitantly CDI and rejection. The third patient presented a rejection with severe complications 4 years after CDI. Recurrence of toxinogenic CD was observed in 9 children, in 7 associated with clinical symptoms. During the last follow-up, the stool number was the same as before CDI except for 1 patient with ongoing infection. CONCLUSIONS: CDI is more prevalent in children after ITx compared with other organ Tx; it is most often symptomatic but mildly or moderately severe. Standard antibiotics efficiently control the symptoms. Induction of rejection is a rare event.


Assuntos
/isolamento & purificação , Infecções por Clostridium/epidemiologia , Diarreia/epidemiologia , Intestino Delgado/transplante , Complicações Pós-Operatórias/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Estudos Transversais , Diarreia/diagnóstico , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Fezes/microbiologia , Feminino , Seguimentos , Humanos , Mucosa Intestinal/microbiologia , Intestino Delgado/microbiologia , Masculino , Metronidazol/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Prevalência , Recidiva , Estudos Retrospectivos , Fatores de Risco , Vancomicina/uso terapêutico
14.
Medicine (Baltimore) ; 98(47): e17837, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764779

RESUMO

INTRODUCTION: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare differential diagnosis for patients presenting with abdominal pain. Due to limited cases reported, surgical management strategies are poorly defined. PATIENT CONCERNS: A 54-year-old man presented to our emergency department with a 4-day history of epigastric pain combined with nausea and vomiting. The pain was dull, constant, and unbearable. It was accompanied by abdominal distention, but there was no radiating pain, chills, fever, or hematochezia. The patient did not have a history of abdominal surgeries, or tobacco or illicit drug use. DIAGNOSIS: A contrast-enhanced computerized tomography (CT) scan demonstrated an isolated and spontaneous superior mesenteric artery dissection with aneurysmal evolution of the false lumen, involving multiple side branches. The middle-lower jejunum and the whole ileum were extensively dilated, and the middle jejunum was ischemic with edema. INTERVENTIONS: Exploratory laparotomy and autologous small bowel transplantation. OUTCOMES: The patient was successfully treated using exploratory laparotomy and intestinal autotransplantation (IATx) without bowel resection and had a stable recovery without complications. CONCLUSION: For patients with severe mesenteric ischemia or those who fail to respond to initial conservative treatment, IATx may be a reasonable treatment strategy.


Assuntos
Aneurisma Dissecante/cirurgia , Intestino Delgado/transplante , Artéria Mesentérica Superior/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Procedimentos Cirúrgicos Vasculares/métodos
15.
Acta cir. bras ; 34(11): e201901107, Nov. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1054678

RESUMO

Abstract Purpose: To establish a hypotensive brain death pig model and observe the effects of hypotension on small bowel donors. Methods: The hypotensive brain death model was produced using the modified intracranial water sac inflation method in ten domestic crossbred pigs. Effects of hypotensive brain death on small bowel tissue morphology were evaluated through changes in intestinal tissue pathology, tight junction protein of the intestinal mucosa and plasma intestinal fatty acid-binding protein (i-FABP) levels. The pathophysiological mechanism was examined based on changes in superior mesenteric artery (SMA) blood flow and systemic hemodynamics. Results: After model establishment, SMA blood flow, and the mean arterial pressure (MAP) significantly decreased, while heart rate increased rapidly and fluctuated significantly. Small bowel tissue morphology and levels of tight junction protein of the intestinal mucosa showed that after model establishment, small bowel tissue injury was gradually aggravated over time (P<0.05). Plasma i-FABP levels significantly increased after brain death (P<0.05). Conclusions: A hypotensive brain death pig model was successfully established using an improved intracranial water sac inflation method. This method offers a possibility of describing the injury mechanisms more clearly during and after brain death.


Assuntos
Animais , Masculino , Feminino , Morte Encefálica/fisiopatologia , Modelos Animais de Doenças , Hipotensão/fisiopatologia , Intestino Delgado/patologia , Intestino Delgado/transplante , Suínos , Fatores de Tempo , Biópsia , Ensaio de Imunoadsorção Enzimática , Western Blotting , Reprodutibilidade dos Testes , Microscopia Eletrônica de Transmissão , Proteínas de Ligação a Ácido Graxo/sangue , Proteína da Zônula de Oclusão-1/análise , Hemodinâmica , Intestino Delgado/irrigação sanguínea
16.
Transplant Proc ; 51(9): 3178-3180, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31619344

RESUMO

We describe a unique case of a 53-year-old woman who underwent a nonrelated living donor kidney transplant 9 years after a previous small bowel transplant from her sister. The patient had suffered from short bowel syndrome secondary to volvulus after undergoing bariatric surgery for morbid obesity. Her entire small bowel had to be resected emergently, but she also developed acute kidney failure at the time. This initial kidney injury associated with long-term exposure to calcineurin-inhibitor medication eventually led to end-stage renal disease. A successful kidney transplant from a different, nonrelated adult donor was performed. Of note, the unrelated kidney donor matched exactly the 2 HLA-A and HLA-B antigens that the recipient had not matched with her sister. We discuss the unique HLA configuration between the patient and her 2 living donors, the absence of posttransplant rejection and posttransplant immunosuppressive therapy. To our knowledge this is the first published report of a successful kidney after a previous bowel transplant using (2 different) living donors.


Assuntos
Intestino Delgado/transplante , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Doadores Vivos , Cirurgia Bariátrica/efeitos adversos , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Imunossupressão/métodos , Volvo Intestinal/etiologia , Volvo Intestinal/cirurgia , Falência Renal Crônica/complicações , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Síndrome do Intestino Curto/etiologia , Síndrome do Intestino Curto/cirurgia
17.
Pediatr Transplant ; 23(7): e13563, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31471935

RESUMO

Combining HSCT with SOT is an unusual and challenging undertaking given the complexities of immune modulation, the need to balance comorbidities, and the cumulative potential for complications. Early life-threatening complications include infections and related effects, graft rejection, and GVHD can be expected to be increased especially if the HSCT is indicated for high-risk cases such as individuals with severe combined immune deficiency and SOT that includes an intestine graft. Herein, we report such a case. Our patient is unique as a long-term survivor. We review the literature and the features of our case, especially the timing of transplants and human leukocyte antigen matching for HSCT that resulted in a successful outcome and discuss how this may be applied to others in the future.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Intestino Delgado/transplante , Imunodeficiência Combinada Severa/terapia , Criança , Pré-Escolar , Terapia Combinada , Humanos , Lactente , Recém-Nascido , Masculino
19.
J Am Coll Surg ; 229(6): 541-551.e1, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31525422

RESUMO

BACKGROUND: The aim of this study was to compare primary efficacy indicators of a low-cost, electrospun, nanoscale P(LLA-CL)/fibrinogen patch with a porcine small intestine submucosa patch for hernia repair. STUDY DESIGN: A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible patients (20 to 75 years old) with primary unilateral, reducible groin hernias were randomly assigned (1:1) to electrospun nanoscale P(LLA-CL)/fibrinogen patch (experimental group) or porcine small intestine submucosa (control group) patch groups. Patients were treated with the Lichtenstein technique, and the primary endpoint was hernia recurrence at 33 months after surgery. The secondary endpoints were postoperative complications including groin pain and operative site infections. RESULTS: Between July 2014 and February 2016, 172 patients were assigned to experimental (n = 86) and control (n = 86) groups. At 6-month follow-up, postoperative complications occurred in 5 patients (5 of 86, 5.81%) and 2 (2 of 86, 2.35%) patients in the control and experimental groups, respectively (p < 0.05). At 33-month follow-up, recurrence was observed in 2 patients (2 of 79, 2.53%) in the control group vs none in the experimental group (0 of 78) (the 95% CI difference between the experimental and control groups was -0.93% to 6.00% and within the preset noninferior margin of Δ10%). No significant differences were found in the degree of chronic pain and complications 33 months after surgery between the 2 groups. CONCLUSIONS: Because the recurrence rates and postoperative complications after 33 months were not inferior in the experimental group, we believe that the P(LLA-CL)/fibrinogen patch, as a low cost alternative, has prospects for widespread clinical use.


Assuntos
Fibrinogênio/farmacologia , Hérnia Inguinal/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Adulto , Idoso , Animais , Feminino , Seguimentos , Hemostáticos/farmacologia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Método Simples-Cego , Suínos , Resultado do Tratamento , Adulto Jovem
20.
Transpl Immunol ; 57: 101246, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31526866

RESUMO

OBJECTIVE: PQA-18 (Prenylated quinolinecarboxylic acid-18) has been reported to be a novel immunosuppressant that attenuates the production of various cytokines, and the differentiation of macrophages by inhibiting PAK2. In this study, we investigated the function of this drug mainly on macrophages using a rat small intestinal transplant model. METHODS: Male Dark Agouti (DA) and Lewis rats (LEW), 7-9 weeks of age, were used as donor and recipient, respectively. Approximately 15 cm intestinal grafts were heterotopically transplanted to the recipient rats. The recipient rat was treated with PQA-18 (4 mg/kg/day) by intraperitoneal injection (ip) from postoperative day 1 for 2 weeks. The in vivo effects of this drug were evaluated based on changes in body weight, and the population of each type of blood cell. Mixed lymphocyte reaction (MLR) was also assessed, using the T cells from intestinal mesenteric lymph nodes (MLN) of the grafts on POD6. Total cells from MLN and graft Payer's patch (PP) were next collected on POD6, and the number of infiltrated macrophages was determined. RESULTS: While the survival time was 7.0 ±â€¯0.77 days for the control group (n = 9), that for the PQA-18 group was 10.7 ±â€¯1.26 days (n = 10) (p < .001). Histological examinations showed a relatively clear difference in the grafts for both groups. In addition, the MLR response was significantly lower in recipients treated with PQA-18, suggesting PQA-18 well suppressed the T cells. Moreover, while a significant increase of both MHC class II and CD11b/c positive cells, estimated as differentiated/polarized macrophages, in MLN & PP was observed in the control group, PQA-18-administration significantly suppressed the differentiation of macrophages in the MLN & PP. CONCLUSION: PQA-18 significantly prolonged the survival of the rats with intestinal grafts, and also suppressed the infiltration of lymphocytes, and macrophages to the grafts.


Assuntos
Ácidos Carboxílicos/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Intestino Delgado/patologia , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Transplante de Órgãos , Quinolinas/uso terapêutico , Linfócitos T/imunologia , Quinases Ativadas por p21/antagonistas & inibidores , Animais , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Modelos Animais de Doenças , Sobrevivência de Enxerto , Humanos , Intestino Delgado/transplante , Teste de Cultura Mista de Linfócitos , Masculino , Prenilação , Ratos , Ratos Endogâmicos Lew , Transplante Homólogo
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