Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.006
Filtrar
1.
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
2.
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
3.
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
4.
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
5.
Expert Rev Gastroenterol Hepatol ; 13(8): 785-796, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282770

RESUMO

Introduction: Short bowel syndrome represents the leading etiology that causes intestinal failure both in children and adults. Total parenteral nutrition support has dramatically improved the prognosis for these patients but, if related irreversible complications occur, the alternative is represented by surgery and/or transplantation. Areas covered: Autologous gastrointestinal reconstructive procedures are a feasible, alternative approach with good long-term outcome data inexperienced surgical centers. Expert opinion: Ongoing innovative efforts have driven the surgical options for successful autologous reconstructive surgery: bowel elongation/tapering techniques (LILT, STEP, and the new SILT) together with the 'reversed bowel segment' procedure are now recognized procedures and all must be tailored to the individual patient needs to obtain the optimal result in terms of enteral autonomy. Background laboratory experimentation with new procedures e.g. options for bowel dilation techniques and distraction-induced enterogenesis, may provide additional management and treatment modalities.


Assuntos
Intestino Delgado/fisiopatologia , Intestino Delgado/transplante , Intestinos/fisiopatologia , Intestinos/transplante , Síndrome do Intestino Curto/fisiopatologia , Síndrome do Intestino Curto/cirurgia , Tecnologia Biomédica , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Transferência de Tecnologia , Transplante Autólogo
7.
Int J Mol Med ; 43(5): 2086-2102, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30864680

RESUMO

The purpose of the present study was to investigate whether bone marrow mesenchymal stem cells (BMMSCs) modified by CXC­chemokine receptor type 3 (CXCR3) and heme oxygenase­1 (HO­1) genes can repair damaged intestinal epithelial cells in vitro, and the role of the p38 mitogen­activated protein kinase (p38­MAPK) pathway in this process. A model of intestinal epithelial crypt cell line­6 (IEC­6) damage was created, and BMMSCs were transfected with either the CXCR3 and/or HO­1 gene in vitro. There were nine experimental groups in which the damaged IEC­6 cells were co­cultured with differentially­treated BMMSCs and lymphocytes for 24 h. Reverse transcription­quantitative polymerase chain reaction analysis, immunohistochemistry and a western blot analysis were performed to detect stem cell transfection, the repair of damaged intestinal epithelial cells and the expression of related molecules in the P38­MAPK pathway, respectively. Crystal violet staining and live cell imaging were used to detect the chemotaxis of BMMSCs. Flow cytometry was used to detect T lymphocyte activity and the surface markers expressed on BMMSCs. An ELISA was used to quantify cytokine production. The adenovirus (Ad)­CXCR3/MSCs exhibited the characteristics of stem cells and exhibited chemotaxis. The Ad­CXCR3/MSCs and Ad­(CXCR3 + HO)/MSCs exhibited increased expression of tight junction protein zonula occludens­1 (ZO­1) and anti­proliferating cell nuclear antigen in the damaged IEC­6 cells, and apoptosis of the damaged IEC­6 cells was decreased. BMMSCs inhibited the phosphorylation of p38, in addition to downstream molecules of the p38MAPK signaling pathway. The Ad­CXCR3/MSCs and Ad­(CXCR3 + HO)/MSCs exhibited significantly decreased expression levels of downstream molecules, including phosphorylated (p)­p38, p­activated transcription factor 2, p­C/EBP homologous protein­10, and p­myocyte enhancer factor 2C, and target molecules (e.g., apoptotic bodies). The effects of Ad­(CXCR3 + HO)/MSCs on the repair of the damaged intestinal tract and inhibition of the p38­MAPK pathway was more marked than those in other groups on day 7 post­surgery in the rejection model for small bowel transplantation. BMMSCs modified by the CXCR3 and HO­1 genes exhibited superior ability to repair damaged intestinal epithelial cells and served this role via the p38­MAPK pathway.


Assuntos
Enterócitos/metabolismo , Enterócitos/patologia , Heme Oxigenase-1/genética , Sistema de Sinalização das MAP Quinases , Células-Tronco Mesenquimais/metabolismo , Substâncias Protetoras/metabolismo , Receptores CXCR3/genética , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Animais , Apoptose , Linhagem Celular , Sobrevivência Celular , Quimiotaxia , Heme Oxigenase-1/metabolismo , Intestino Delgado/transplante , Linfócitos/metabolismo , Masculino , Transplante de Células-Tronco Mesenquimais , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Reprodutibilidade dos Testes , Proteínas de Junções Íntimas/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
9.
Cardiovasc Pathol ; 39: 54-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30660869

RESUMO

The search for an ideal material for cardiac tissue repair has led to utilization of porcine small intestinal submucosa extracellular matrix (CorMatrix). Here, we examine the histologic features of CorMatrix and the associated cellular growth at a variety of time intervals. Tissues with CorMatrix from ten patients (4 male, 6 female) with ages ranging from 2 weeks to 2 years, and implant duration ranging from 1 week to 2 years were included in this study. Samples for analysis were collected at autopsy. Surgical repair sites included great vessel repair (n=9), atrial septum defect (n=1), coronary vessels (n=1), as well as aortic (n=1) and mitral valve (n=2) leaflets. In all specimens, CorMatrix was composed of dense laminated regions of collagen, without appreciable elastin staining. In most grafts, especially those implanted for extended periods of time, tissue with luminal CD31 positivity covered the intimal surface of the CorMatrix graft. This tissue (neo-intima) consisted of spindled myofibroblasts (SMA) and small CD31 positive vessels with occasional mononuclear cells in a matrix composed of collagen, glycosaminoglycans, and rarely elastin, after extended periods of implantation. These features were readily identified in patients as early as 1 month after CorMatrix implantation. The matrix comprising the CorMatrix itself remained largely acellular, despite implantation times up to 2 years, with degradation of the graft material. We provide a framework for histologic expectations when evaluating explanted CorMatrix grafts. In this regard, the CorMatrix matrix is likely to remain acellular without significant elastin deposition, whereas the intimal and adventitial surfaces become coated by proliferating cells in a novel matrix of collagen and glycosaminoglycans.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Proliferação de Células , Matriz Extracelular/transplante , Cardiopatias Congênitas/cirurgia , Intestino Delgado/transplante , Animais , Autopsia , Biópsia , Pré-Escolar , Colágeno/metabolismo , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Feminino , Glicosaminoglicanos/metabolismo , Cardiopatias Congênitas/metabolismo , Cardiopatias Congênitas/patologia , Xenoenxertos , Humanos , Lactente , Intestino Delgado/metabolismo , Intestino Delgado/patologia , Masculino , Propriedades de Superfície , Sus scrofa , Fatores de Tempo , Resultado do Tratamento
10.
J Minim Invasive Gynecol ; 26(3): 396-397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29890355

RESUMO

STUDY OBJECTIVE: To introduce a creation that combines laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who had a rudimentary cavity (U5aC4V4) [1]. DESIGN: A video article introducing a new surgical technique. SETTING: A university hospital. PATIENTS: A 24-year-old patient had primary amenorrhea and irregular lower abdominal pain for 9 years. The patient was Tanner stage 3 for pubic hair and Tanner stage 4 for breast development. The physical examination revealed no vagina. A primordial uterus and a uterus with a rudimentary cavity were detected by magnetic resonance imaging [2,3]. However, the rudimentary cavity had no hematometra. Magnetic resonance imaging also found a left solitary kidney. The diagnosis was MRKH syndrome with a rudimentary cavity (U5aC4V4) [4]. The patient desired resumption of menses and possible future fertility. INTERVENTIONS: Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft was performed. MEASUREMENTS AND MAIN RESULTS: With the Wharton-Sheares-George neovaginoplasty, a vaginal mold with a surrounding SIS graft was inserted into the newly created cavity [5]. Using laparoscopy, the lower uterine segment was incised by shape dissection. The proximal segment of the SIS graft to the lower uterine segment was sutured. A T-shaped intrauterine device with a Foley catheter was fixed in the uterine cavity by the delay of absorbed sutures to prevent cervical or vaginal stenosis. The distal segment of the SIS graft was sutured with the high vaginal or vestibular mucosa vaginally. The operation was successfully completed. The operating time was 2 hours. Hospitalization was 4 days. There were no blood transfusions or complications. The patient had resumption of menses for 2 cycles postoperatively, and she had no dysmenorrhea. The patient did not have sexual intercourse because of the mode in the vagina to prevent vagina stenosis. No cervical stenosis occurred because of the Foley catheter. CONCLUSION: In the past, a uterus with a rudimentary cavity in patients with MRKH was always excised, and patients lost the chance of menstrual onset and fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft provided a minimally invasive, safe, and effective surgical option for the young patient with MRKH syndrome with a rudimentary cavity. The technique is not complex, is easy to learn and perform, and provided a result with functional and anatomic satisfaction. No special surgical apparatus is needed with this technique.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Anormalidades Congênitas/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Laparoscopia/métodos , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia , Amenorreia/etiologia , Amenorreia/cirurgia , Animais , Colo do Útero/anormalidades , Colo do Útero/cirurgia , Terapia Combinada , Feminino , Humanos , Ductos Paramesonéfricos/cirurgia , Suínos , Tecidos Suporte , Transplante Heterólogo , Anormalidades Urogenitais/cirurgia , Vagina/anormalidades , Adulto Jovem
11.
Eur J Pediatr Surg ; 29(3): 253-259, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29475213

RESUMO

BACKGROUND: Modified multivisceral transplantation (MMVTx) refers to the use of a graft that includes all abdominal organs except the liver. The use of this type of transplant in children and adults expanded over the last years with good results. However, long-term survival in experimental models has not been reported. Our aim is to describe in detail some technical modifications of MMVTx to obtain long-term survival. MATERIALS AND METHODS: Syngeneic (Lewis-Lewis) heterotopic MMVTx was performed in 16 male rats (180-250 g). All procedures were performed under isoflurane anesthesia. The graft consisted of stomach, duodenopancreatic axis, spleen, and small bowel. The vascular pedicle consisted of a conduit of aorta, including the celiac trunk and the superior mesenteric artery (SMA), and the portal vein (PV). The engraftment was performed by end-to-side anastomosis to the infra-renal cava vein and aorta. After reperfusion, the graft was accommodated in the right side of the abdomen, and a terminal ileostomy performed. The native spleen was removed. RESULTS: Donor and recipient time was 39 ± 4.4 minutes and 69 ± 7 minutes, respectively; venous and arterial anastomosis time was 14 ± 1 minutes and 12.3 ± 1 minutes, respectively. Total ischemia time was 77.2 ± 7.9 minutes. Survival was 75% (12/16), six were sacrificed after 2 hours, and six were kept alive for long-term evaluation (more than 1 week). CONCLUSION: Long-term survival is reported after heterotopic MMVTx in rats. The heterotopic MMVTx with native spleen removal would potentially improve the existent models for transplant research. The usefulness of this model warrants further confirmation in allogeneic experiments.


Assuntos
Intestino Delgado/transplante , Transplante de Pâncreas/métodos , Baço/transplante , Estômago/transplante , Alotransplante de Tecidos Compostos Vascularizados/métodos , Animais , Masculino , Transplante de Pâncreas/mortalidade , Ratos , Ratos Endogâmicos Lew , Taxa de Sobrevida , Transplante Heterotópico , Alotransplante de Tecidos Compostos Vascularizados/mortalidade
13.
Surg Clin North Am ; 99(1): 103-116, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30471736

RESUMO

Intestinal and multivisceral transplants are complex technical procedures that present unique challenges in the field of solid organ transplantation. This review aims to highlight the indications, techniques, outcomes, and complications specific to intestinal transplantation.


Assuntos
Intestino Delgado/transplante , Transplante de Órgãos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Humanos , Transplante de Órgãos/métodos , Nutrição Parenteral Total , Seleção de Pacientes , Resultado do Tratamento
14.
Int J Impot Res ; 31(4): 256-262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30194372

RESUMO

Advanced Peyronie's disease (PD) with severe penile curvature requires grafting following plaque incision or partial plaque excision. So far, the ideal graft material has not been identified although various grafts have been studied. In this first matched pair analysis we compared the outcome after grafting with small intestinal submucosa (SIS) and self-adhesive collagen fleece (CF). We retrospectively identified 43 patients after SIS grafting with complete follow-up data sets to be eligible for the present study. A total of 43 patients after CF grafting were matched case by case to the SIS group using the degree of preoperative penile curvature as the primary matching factor. Postoperative outcome was compared with the focus on penile straightening, penile length, potency, relapse rates and long-term complications. Median degree of curvature was 80° in each group. Mean follow-up periods were 31 months after SIS and 39 months after CF grafting. The CF grafting procedure was significantly faster than SIS grafting (80 vs. 104 min, p < 0.001). No major short-term complications were observed. Both techniques gained good long-term penile straightening rates. Relapse of penile curvature was observed after SIS grafting only. Postoperative penile shortening occurred more often after SIS grafting (28% vs. 5%, p = 0.007). With a mean preoperative IIEF-5 score of 16, the SIS cohort significantly differed from the CF cohort with a mean IIEF-5 score of 19 (p = 0.016). The median IIEF-5 score improvement was higher after SIS grafting (+4.5 vs. +1, p = 0.002). Diminished penile sensation was the main long-term side effect with low rates after both procedures (9% and 7% in the SIS and CF group respectively, p = 0.100). In this first matched pair analysis both techniques showed promising long-term results. CF seems to have advantages regarding duration of surgery and preserving penile length. More comparative studies with larger collectives are desirable.


Assuntos
Colágeno , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Induração Peniana/cirurgia , Pênis/cirurgia , Estudos de Coortes , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Satisfação do Paciente , Ereção Peniana , Pênis/anatomia & histologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Sensação , Resultado do Tratamento
15.
J Clin Neurosci ; 58: 187-191, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30454688

RESUMO

This study aimed to evaluate the safety and effectiveness of an alternative dural substitute using a porcine pericardial graft for duraplasty in a large animal model. Six pigs underwent bilateral craniectomy followed by bilateral duraplasty using either a porcine pericardium patch or a Biodesign® Dural Repair Graft. Intraoperative workability was evaluated for each type of graft. Pigs were euthanized after 1 and 3 months (n = 3 per group). Histological analysis was performed for each case. The Biodesign® Dural Repair Graft showed better workability than the porcine pericardial patch, which was more transparent (p = 0.002). Histological analyses at 1 and 3 months showed no differences between the types of graft. There was no postoperative leakage of cerebrospinal fluid in any case. No grafts showed any adverse reactions in the underlying brain tissues. The porcine pericardial patch as a dural substitute seems to be an acceptable alternative graft to duraplasty using a small intestinal submucosal graft (Biodesign®). Further studies are needed to determine whether porcine pericardial patches provide workable alternatives in clinical practice.


Assuntos
Craniotomia/métodos , Modelos Animais de Doenças , Dura-Máter/cirurgia , Pericárdio/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Produtos Biológicos/administração & dosagem , Craniotomia/normas , Dura-Máter/patologia , Intestino Delgado/citologia , Intestino Delgado/transplante , Masculino , Pericárdio/citologia , Procedimentos Cirúrgicos Reconstrutivos/normas , Suínos , Resultado do Tratamento
16.
Transplant Proc ; 50(9): 2771-2774, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30401395

RESUMO

OBJECTIVES: The small intestine is the primary site for absorption of dietary zinc. Intestinal transplant recipients are at high risk for zinc deficiency because of the long process of posttransplant adaptation. We initiated an intestinal transplant program in Taiwan in 2007. In this study, we aimed to retrospectively investigate the incidence of zinc deficiency in recipients after intestinal transplantation. METHODS: Twenty-one isolated intestinal transplants were performed in 20 patients with 1 retransplantation. The level of serum zinc was monitored periodically, and zinc supplements were administered when zinc level was below 700 ng/mL. Twelve patients with graft above 1-year survival and with available related data were enrolled for the analysis of zinc deficiency. The levels of serum zinc were tracked, and the protocol of zinc supplementation is discussed herein. RESULTS: The survival rates of 20 transplant recipients for 1 year, 3 years, and 5 years were 85%, 75%, and 65%, respectively. In the 12 grafts that survived longer than 1 year, we found that zinc deficiency was highest during the third (41.7%) to sixth (50%) month after transplantation. Sustained supplementation of zinc was required for over 70% of patients throughout the 3-year period to maintain their zinc level around the lower normal limit. CONCLUSION: The outcome of isolated small bowel transplantation is promising. Periodical monitoring and sufficient dosing of zinc supplements should be considered into the posttransplant protocol to prevent zinc deficiency after intestinal transplantation.


Assuntos
Intestino Delgado/transplante , Complicações Pós-Operatórias/epidemiologia , Zinco/deficiência , Adolescente , Adulto , Criança , Pré-Escolar , Suplementos Nutricionais , Feminino , Humanos , Incidência , Intestino Delgado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Taxa de Sobrevida , Taiwan , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem , Zinco/administração & dosagem
18.
Congenit Heart Dis ; 13(6): 997-1004, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30242970

RESUMO

BACKGROUND: Congenital heart defects affect nearly 1% of all children born per year in the United States, and complete atrioventricular canal (CAVC) accounts for 2%-9%. While several patch materials have been used for septal defect closure during CAVC repair, clear superiority of one material over another has yet to be established. METHODS: A retrospective review of clinical outcomes following CAVC repair at Morgan Stanley Children's Hospital/Columbia University was performed on operations conducted from March 2010 to September 2017. Univariate and Kaplan-Meir survival analyses were utilized to evaluate primary outcomes of interest following CAVC repair in the modern surgical era. RESULTS: A total of 73 patients were analyzed, with an average operative age of 22 weeks. The majority (71%) of the patients underwent a 2-patch repair. A CorMatrix patch was used for ventricular septal defect(VSD) closure in 77% of the patients, and/or in 75% of atrial septal defect closures. There was one in-hospital mortality (1.4%) due to respiratory failure. One patient required a pacemaker. At mid-term follow-up (1.6 years), a total of 7 patients required 8 reoperations due to cardiac-related indications, including 5 for left atrioventricular valve (LAVV) repair, 1 for LAVV replacement, and 2 isolated residual VSDs. CONCLUSION: A standardized repair for CAVC results in excellent outcomes in the current era, with low rates of reoperations. CorMatrix for the closure of CAVC has proven to produce good results with equivalent outcomes to other patch materials. Its ease of use and pliability make it an attractive alternative for consideration.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Defeitos dos Septos Cardíacos/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Animais , Feminino , Defeitos dos Septos Cardíacos/mortalidade , Humanos , Lactente , Recém-Nascido , Intestino Delgado/citologia , Masculino , New York/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Suínos , Resultado do Tratamento
19.
Andrology ; 6(6): 909-915, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30076677

RESUMO

BACKGROUND: Peyronie's Disease (PD) is an acquired connective tissue disorder that often leads to penile curvature (PC) and sexual dysfunction. Penile lengthening procedures (PLP) with four-layered porcine small intestinal submucosa graft (Surgisis® ES; Cook) have been widely used in patients with severe PC when erectile function is preserved. However, complications such as erectile dysfunction (ED) may limit treatment satisfaction. OBJECTIVES: Focusing on patients perspective, our study aims to evaluate longterm patient-reported outcomes, satisfaction, and dissatisfaction predictors after PLP. MATERIAL AND METHODS: This prospective study included 32 patients affected by PD with severe PC submitted to PLP with Surgisis® ES between 2011 and 2014. All patients were submitted to a standardized protocol with regular clinical evaluation at 3, 6 and 12 months, and yearly thereafter. After the third year follow-up, IIEF-5, modified EDITS and an additional non-validated questionnaire were completed. RESULTS: Concerning the surgical procedure, the mean tunical defect area (TDA) was 15.9 ± 6.9 cm2 . The mean follow-up time were 49.6 ± 12.7 months and there was a significant increase in stretched penile length (p = 0.01). Postoperative erectile function as assessed by IIEF-5 was positively correlated with overall treatment satisfaction evaluated through EDITS (p = 0.01). TDA was negatively correlated with postoperative IIEF-5 (R = -0.56, p < 0.001). TDA ≥ 14.375 cm2 can predict ED with 76.9% sensibility and 58.3% specificity. Moreover, TDA ≥ 21.875 cm2 can predict clinically significant ED (IIEF-5 score ≤17) with 80% sensibility and 95.2% specificity. Patient-reported longterm complications were 65.6% decreased penile length, 56.5% diminished rigidity and 25% curvature recurrence. CONCLUSION: PLP using a Surgisis® ES is a valuable surgical option for the treatment of PD with severe PC. Although it results in high rates of long-term patient-reported overall satisfaction, possible outcomes such as postoperative ED must be acknowledged. TDA is a strong predictor for postoperative ED and should be considered in clinical practice to classify patients in low- or high-risk for postoperative ED.


Assuntos
Disfunção Erétil/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Satisfação do Paciente , Ereção Peniana , Induração Peniana/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Animais , Disfunção Erétil/patologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/patologia , Induração Peniana/fisiopatologia , Induração Peniana/psicologia , Pênis/patologia , Pênis/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Inquéritos e Questionários , Sus scrofa , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
20.
Transplantation ; 102(10): 1666-1673, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29994982

RESUMO

BACKGROUND: The small bowel is prone to ischemic injury during transport before transplantation, an injury that endangers the recipient patient. The small-bowel mucosal microcirculation in particular appears to be highly sensitive to injury. Current preservation solutions such as histidine-tryptophan-ketoglutarate (HTK) solution provide some protection to the graft. However, these were developed decades ago and do not address several critical processes, such as hypoxia-induced membrane pores and free radical-mediated hypothermic injury. METHODS: To protect the graft from cold ischemic injury, we implemented a modified HTK solution here, including glycine, alanine, and iron chelators in a heterotopic, syngeneic small-bowel transplantation model of the rat. The effects of the modified solution and its major components were compared against the conventional HTK solution using intravital microscopy in the early reperfusion period. RESULTS: The amino acid glycine, added to HTK solution, slightly improved mucosal perfusion. Both, the modified base solution (without iron chelators) and iron chelators increased functional capillary density of the mucosa during the early reperfusion period. The complete modified solution (with glycine, alanine, and iron chelators) significantly increased the perfusion index, functional capillary density of the mucosa, and red blood cell velocity in the grafts after reperfusion in comparison with the grafts preserved with HTK. CONCLUSIONS: The modified preservation solution improved the microcirculation of the transplants and needs detailed evaluation in further models of small-bowel transplantation.


Assuntos
Isquemia Fria/efeitos adversos , Intestino Delgado/transplante , Soluções para Preservação de Órgãos/uso terapêutico , Preservação de Órgãos/métodos , Traumatismo por Reperfusão/prevenção & controle , Alanina/farmacologia , Alanina/uso terapêutico , Animais , Hipóxia Celular/efeitos dos fármacos , Modelos Animais de Doenças , Glucose/química , Glucose/farmacologia , Glucose/uso terapêutico , Glicina/farmacologia , Glicina/uso terapêutico , Humanos , Intestino Delgado/irrigação sanguínea , Intestino Delgado/efeitos dos fármacos , Intestino Delgado/patologia , Quelantes de Ferro/farmacologia , Quelantes de Ferro/uso terapêutico , Masculino , Manitol/química , Manitol/farmacologia , Manitol/uso terapêutico , Microcirculação/efeitos dos fármacos , Soluções para Preservação de Órgãos/química , Soluções para Preservação de Órgãos/farmacologia , Perfusão/métodos , Cloreto de Potássio/química , Cloreto de Potássio/farmacologia , Cloreto de Potássio/uso terapêutico , Procaína/química , Procaína/farmacologia , Procaína/uso terapêutico , Ratos , Ratos Endogâmicos Lew , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Transplantes/irrigação sanguínea , Transplantes/efeitos dos fármacos , Transplantes/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA