RESUMO
BACKGROUND: Patients who underwent primary inguinal hernia repair still report a high rate of postoperative pain after operation due to the effect of mesh fixation by suture.An alternative is the use of human fibrin glue. We compared the two techniques. METHODS: 468 patients randomly underwent primary inguinal hernia Lichtenstein repair fixing the mesh by suture or by human fibrin glue (HFG); in both cases the mesh was fixed to the posterior wall of the inguinal canal and to the inguinal ligament. RESULTS: No significant differences were recorded between the two groups in terms of complications, while the sutureless technique reduces the operative time and the postoperative pain. CONCLUSIONS: A widespread technique for the treatment of inguinal hernia is the application of a mesh using Lichtenstein procedure. The prosthesis can be fixed by traditional suture or using a new method of sutureless fixation with adhesive materials that shows an excellent local tolerability and lack of adverse effects and contraindications.
Assuntos
Adesivo Tecidual de Fibrina/administração & dosagem , Hérnia Inguinal/cirurgia , Herniorrafia , Telas Cirúrgicas , Técnicas de Sutura , Adesivos Teciduais/administração & dosagem , Feminino , Seguimentos , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Polipropilenos , Estudos Prospectivos , Implantação de Prótese/métodos , Fatores de Risco , Telas Cirúrgicas/efeitos adversos , Resultado do TratamentoRESUMO
Inflammatory bowel disease (IBD) consists of two distinct clinical forms, ulcerative colitis (UC) and Crohn's disease (CD), with unknown aetiology, which nevertheless are considered to share almost identical pathophysiological backgrounds. Up to date, a full coherent mechanistic explanation for IBD is still lacking, but people start to realize that the pathogenesis of IBD involves four fundamental components: the environment, gut microbiota, the immune system and the genome. As a consequence, IBD development might be due to an altered immune response and a disrupted mechanism of host tolerance to the non-pathogenic resident microbiota, leading to an elevated inflammatory response. Considering the available data arising from the scientific literature, here reviewed, in CD, a benefit of probiotics remains unproven; in UC, a benefit of probiotics remains unproven, even if E. coli Nissle 1917 seems promising in maintaining remission and it could be considered an alternative in patients intolerant or resistant to 5-ASA preparations; in pouchitis, small controlled trials suggest a benefit from VSL no. 3 in the primary and secondary prevention of pouchitis; in IBD-associated conditions, a benefit of probiotics remains unproven. However, well-designed randomized control clinical trials are necessary to understand the undoubted role of these agents in the management of gut physiology in health and disease.
Assuntos
Doenças Inflamatórias Intestinais/tratamento farmacológico , Prebióticos , Probióticos/uso terapêutico , Humanos , Doenças Inflamatórias Intestinais/etiologia , Doenças Inflamatórias Intestinais/microbiologia , MicrobiotaRESUMO
OBJECTIVE: To describe our experience with ultrasonic-guided instillation of povidone-iodine to treat post-kidney transplantation lymphocele. Patients and methods. We studied the safety and efficacy of this procedure for treatment of lymphocele in 6 male kidney transplanted recipients in which we assisted a progressive increase of creatinine and urinary proteins levels and color-Doppler ultrasonography demonstrated an increase (25,4%) of index of resistence (IR) Using eco-colorDoppler, the related-graft lymphocele location and the distance to the anterior abdominal wall were determined; then, a radiopaque double-lumen catheter was used to instillate 5% povidone-iodine 10 ml. Results. Percutaneous drainage achieved a resolution rate of 100%. Studying the rate of peripheral and internal vascularization of the kidney before and after treatment, eco-colorDoppler showed a significant decrease of the IR (24,6%). Conclusions. The US-guided povidone-iodine instillation for treatment of lymphocele following renal transplantation may be considered as first choice therapy in such disease.
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Transplante de Rim/efeitos adversos , Linfocele/terapia , Povidona-Iodo/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Adulto , Humanos , Instilação de Medicamentos , Linfocele/diagnóstico por imagem , Linfocele/etiologia , Masculino , Pessoa de Meia-Idade , Escleroterapia , UltrassonografiaRESUMO
ABSTRACT: Tertiary hyperparathyroidism (HPT III) occurs when an excess of parathyroid hormone (PTH) is secreted by parathyroid glands, usually after longstanding secondary hyperparathyroidism. Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantation. Long-standing chronic kidney disease (CKD) is associated with several metabolic disturbances that lead to increased secretion of PTH, including hyperphosphatemia, calcit-riol deficiency, and hypocalcaemia. Hyperphosphatemia has a direct stimulatory effect on the parathyroid gland cell resulting in nodular hyperplasia and increased PTH secretion. Prolonged hypocalcaemia also causes parathyroid chief cell hyperplasia and excess PTH. Af-ter correction of the primary disorder CKD by renal transplant, the hypertrophied parathyroid tissue fails to resolute, enlarge over and continues to oversecrete PTH, despite serum calcium levels that are within the reference range or even elevated. They also may become resistant to calcimimetic treatment. The main indication for treatment is persistent hypercalcemia and/or an increased PTH, and the primary treatment is surgery. Three procedures are commonly performed: total parathyroidectomy with or without autotransplantation, subtotal parathyroidectomy, and limited parathyroidectomy. It is important to remove superior parts of thymus as well. The most appropriate surgical procedure, whether it be total, subtotal, or anything less than subtotal including "limited" or "focused" parathyroidectomies, continues to be unclear and controversial. Surgical complications are rare, and para-thyroidectomy appears to be a safe and feasible treatment option for HPT III.
Assuntos
Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia/métodos , Humanos , Hiperfosfatemia/etiologia , Hiperplasia/patologia , Hipocalcemia/etiologia , Transplante de Rim , Glândulas Paratireoides/patologia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/metabolismo , Insuficiência Renal Crônica/complicações , Transplante AutólogoRESUMO
INTRODUCTION: Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet found. In 1995, Doppler-guided haemorrhoidal artery ligation was introduced, aiming to reduce postoperative pain and complications. In this work, an evolu-tion of the aforementioned surgical technique was described. MATERIALS AND METHODS: 183 patients treated with standard Doppler-Guided Haemorrhoidal Artery Ligation were statistically compared with 225 patients dealt with Colour Doppler-Guided Haemorrhoidal Artery Ligation. The procedures were performed under local anaes-thesia with patients in lithotomy position. A special proctoscope and a dedicated Colourdoppler US probe were employed in the second group. Superior haemorrhoidal artery terminal branches were con-secutively ligated according to provided technique in the first group and under vision in the second. In all cases, each ligation was followed by mucopexy. RESULTS: No significant differences between the two groups, in terms of post-operative pain, early complications (bleeding, urinary retention, incontinence) or patient satisfaction, were demonstrated. Recurrence rate was significantly higher in patients treated with stan-dard DG-HAL. No late complications (after one-year follow-up) were registered in both groups. CONCLUSIONS: Colour Doppler-Guided Haemorrhoidal Artery Li-gation represents an ideal management for 1-day surgery, and fulfils the requirements of minimally invasive surgery in patients with III-IV grade haemorrhoids. The absence of complications and the evidence of significant wellness of patients are the best advantages. Colour Doppler-Guided Haemorrhoidal Artery Ligation is a safe and easy procedure with good results and a very short-time training. It could be considered an easy and reliable method to treat symptomatic haemorrhoids.
Assuntos
Ecocardiografia Doppler em Cores/métodos , Hemorroidectomia/métodos , Hemorroidas/cirurgia , Ligadura/métodos , Artéria Mesentérica Inferior/cirurgia , Ultrassonografia Doppler/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
ABSTRACT: Bleedings occurring during a surgical intervention can be caused by haemostatic defects, but they are generally due to ineffective local haemostasis. Current coagulation systems may not be sufficient to achieve a good haemostasis, causing, at the same time, tissue dama-ge. Furthermore, the availability of such devices does not eliminate difficulties linked to the isolation of vessels, a crucial step of surgical procedures that require the removal of an organ or part of it, in case of inflammation or neoplasm. This difficulty is even more evident, and weighs more on operative times, when the surgeon engages with video-assisted surgery, where anatomical structures are difficult to detect and the manoeuvres of dissection and separation become more complex. The use of pre-operative radio-guided embolization of organ main arterial vessels with different embolic agents, could represent a great advantage, especially for mini-invasive procedures, such as laparoscopy in patients with high bleeding risk.
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Embolização Terapêutica , Laparoscopia , Hemorragia , Humanos , Radiologia IntervencionistaRESUMO
BACKGROUND: Esophagogastroduodenoscopy (EGDS) is the gold standard exam for upper gastrointestinal diseases. EGDS is very important in Early Gastric Cancer diagnosis and treatment but it is an operator-dependent exam and there are lots of factors that reduce its visibility (mucus, bubbles and foam). AIM: The aim of our study is to evaluate if the use of Lumevis™ improves mucosa visualization during EGDS without increasing the examination time and complications' rate and comparing the differences in patients prepared with water or no intervention. MATERIALS AND METHODS: we recruited 50 patients from 01/08/2020 to 31/08/2020 who came to our observation for epigastric pain, dyspepsia and gastroesophageal reflux (GERD). For each patient we evaluate the satisfaction of the procedure, vision quality, EGDS duration and the presence of bubbles following the administration of: nothing (group 1); 50 ml of water alone (W) (group 2); W + simethicone (S) 150 mg+N-acetylcysteine (NAC) 250 mg+10% acetic acid 2.5 ml (group 3); W+S 100 mg + NAC 300 mg + 10% acetic acid 2 ml (group 4); W + S 100 mg + NAC 200 mg + 10% acetic acid 1.5 ml (group 5). RESULTS: Our results suggest that the lesion detection rate improves with the use of simethicone, acetylcysteine and acetic acid prior to EGDS, although this needs to be studied prospectively. CONCLUSIONS: Lumevis™ is proposed as a new product in the routine preparation of all patients who have to undergo an EGDS, raising the level in the quality of the exam.
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Endoscopia do Sistema Digestório/métodos , Gastroenteropatias/diagnóstico por imagem , Pré-Medicação/métodos , Ácido Acético/química , Acetilcisteína/química , Adulto , Dispepsia/diagnóstico por imagem , Feminino , Refluxo Gastroesofágico/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Simeticone/química , Neoplasias Gástricas/diagnóstico por imagemRESUMO
CONCLUSION: High suspicion of scar endometriosis are painful no-dule in the abdominal scar. Wide surgical excision is the treatment of choice. INTRODUCTION: Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018. METHODS: We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nodules at US was 26,8 ± 13,8 mm. RESULTS: All patients underwent surgery. Seven patients (15,2%) needed mesh implantation, while 39 patients (84,8%) underwent local resection with reconstruction of muscle fascia. Mean follow-up was 31,6 ± 14 months and no patients reported local recurrence of disease.
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Cicatriz/patologia , Endometriose/patologia , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adulto , Cesárea/efeitos adversos , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND: Abdominal compartment syndrome (ACS) is a clinical condition caused by an increase in intra-abdominal pressure. The incidence is variable, based on the type of patients taken into consideration, increasing exponentially in critical conditions, such as traumatized, burned patients in shock. The syndrome can also follow surgical procedures like transplantation of abdominal organs, for example configuring rare pictures such as RACS (post-transplant kidney syndrome). In most cases the symptoms are non-specific and varied according to the different etiology of the ACS, therefore the diagnosis may not be immediate. AIM: The aim of this work is to evaluate the best therapeutic approach based on the evidence in the literature. RESULTS: An early diagnosis, which can also identify the stages of intra-abdominal hypertension, is necessary to ensure the survival of the patient, implementing an integrated multidisciplinary treatment, expecially in the early stages of the development of the ACS. CONCLUSIONS: The definitive treatment is surgical and is based on the decompression of the abdomen.
Assuntos
Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/cirurgia , Descompressão Cirúrgica , Diagnóstico Precoce , Humanos , Incidência , Hipertensão Intra-Abdominal/epidemiologiaRESUMO
Primary perianal fistulous pathology represents a painful condition often noticeable in patients affected by Crohn's disease or Ulcerative colitis. It causes difficult defecation and can evolve in perianal abscess that should be urgently ascertained and drained. The present work aims to propose Argentum-Quartz® as valid non-surgical therapeutic treatment in order to reach a more comfortable perianal fistula healing. In fact, our preliminary data allow us to consider Argentum Quartz® ideally employable for treatment of perianal fistulas associated or not with IBDs, representing a reliable sphincter-sparing solution.
Assuntos
Canal Anal/patologia , Doença de Crohn/terapia , Quartzo/administração & dosagem , Fístula Retal/terapia , Adulto , Colite Ulcerativa/complicações , Doença de Crohn/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Resultado do Tratamento , Cicatrização/efeitos dos fármacosRESUMO
INTRODUCTION: Post-Endoscopic Retrograde Cholangio-Pancreatography pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac) have shown promising prophylactic activity in PEP. The aim of our prospective study is to report whether prophylactic oral versus rectal suppository versus intramuscular diclofenac versus placebo are able to reduce the incidence and the severity of ERCP-induced pancreatitis. MATERIALS AND METHODS: In this randomized, double-blinded, prospective study, 100 patients (49 male, 51 female), similar with regard to indication for ERCP, were enrolled between January 2016 and November 2017 to undergo ERCP in the Section of General and Thoracic Surgery of University Hospital of Palermo. They were randomized into five groups, respectively 20 patients with placebo by mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs were administered 30 to 90 minutes before ERCP. All clinical data were collected one day before and 2, 12 and 24 hour after ERCP. RESULT: Data were prospectively collected and to demonstrate the preventive effect of rectal diclofenac on PEP, a two-by-two table and chi-square test with Yates correction were used: the incidence of PEP was significantly lower (p < 0.001) in the rectal diclofenac group respect to other groups and, in the same way, the incidence of post-ERCP pain was significantly lower in the rectal diclofenac group than in the other groups (p = 0.001) and patients discharge was consequently earlier (p < 0.01). CONCLUSION: 100 mg dose rectal diclofenac administered 30-60 minutes before ERCP can effectively prevent PEP.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Diclofenaco/administração & dosagem , Pancreatite/prevenção & controle , Doença Aguda , Administração Retal , Adulto , Colangiopancreatografia Retrógrada Endoscópica/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic plane and dangerous for the underlying presence of the graft. MATERIALS AND METHODS: A case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface. RESULTS: The patient was discharged after 4 days. The 6-month follow-up did not show mesh displacement or recurrence of hernia. CONCLUSIONS: The laparoscopic mesh repair may become the criterion standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients.
Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Transplante de Rim , Laparoscopia/métodos , Telas Cirúrgicas , Idoso , Feminino , Herniorrafia/instrumentação , Humanos , Masculino , Próteses e ImplantesRESUMO
AIMS: The radio-cephalic arteriovenous fistula (RCAVF) is the first choice treatment in end-stage renal disease patients. In the last few years, the hemodialysis population has shown a high percentage of elderly patients (> 65 year old) with comorbidities, mainly vascular diseases, which may adversely affect their vascular access success. The aim of this study was to evaluate the effectiveness of a loup-assisted technique to create RCAVFs in over 65 patients. PATIENTS AND METHODS: 98 consecutive patients with renal failure were prospectively observed. The patient were divided in relation to their age (> 65 year old; < 65 year old). In both groups, a microsurgical distal RCAVF was created. Statistics included the prevalence of distal RCAVF created, the incidence of immediate failure, the primary and secondary patency rate at one year. RESULTS: Distal RCAVF was created in 82.60% of patients younger than 65 years and in 73.07% of patients older than 65 years, with no statistically significant difference. The incidence of immediate failure, the primary and secondary patency at one year were not statistically significant between the two groups. CONCLUSIONS: Distal RCAVF should be the first choice vascular access even in ESRD elderly patients. The loup-assisted microsurgical fistula creation, allows to perform distal RCAVF with success, even in patients older than 65 years old, achieving similar results to younger patients.
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Derivação Arteriovenosa Cirúrgica/métodos , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Diálise Renal , Resultado do TratamentoRESUMO
BACKGROUND: Pancoast's syndrome is caused by malignant neoplasm of superior sulcus of the lung which produces destructive lesions of thoracic inlet and comes along with the involvement of brachial plexus and stellate ganglion. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can detect early lesions otherwise missed by routine radiographs and can also define the local extent or metastatic progression of the disease. Protocols involving combinations of irradiation, chemotherapy, and surgery are currently being under investigation to determine the best management. AIMS: This work reviewed the current diagnostic and therapeutic approaches to Pancoast's tumors. DISCUSSION: Patients with lung superior sulcus carcinoma should be considered for surgery only after an appropriate diagnostic assessment. The perfect candidate for surgery should have a confined to the chest disease with T3N0M0 staging. Inoperable patient with severe pain after irradiation therapy may benefit from palliative surgical resection. Medical therapy plays only a secondary role in lung cancers, patients with disseminated lung cancer might require palliative treatment and medical management of paraneoplastic syndrome symptoms. Following surgery, radiation and chemotherapy may improve local and systemic control by addressing individual adverse findings. CONCLUSIONS: The cooperation of surgeons, clinicians and radiologists represents the gold standard today and a multidisciplinary approach is essential to achieve the best outcome possible. Further studies are advisable in order to define the best surgical approach and the real advantage of mini-invasive surgery by comparison with open surgery.
Assuntos
Síndrome de Pancoast/diagnóstico , Síndrome de Pancoast/terapia , HumanosAssuntos
Hemorroidas/diagnóstico por imagem , Hemorroidas/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Ultrassonografia Doppler em Cores/métodos , Endossonografia/métodos , Seguimentos , Hemorroidectomia/métodos , Humanos , Ligadura/métodos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Reto/irrigação sanguínea , Técnicas de Sutura , Resultado do TratamentoRESUMO
AIM: The aim of this study is to assess, retrospectively, the incidence of secondary hypoparathyroidism after total thyroidectomy in patients with retrosternal goitre. MATERIAL AND METHODS: From January 2009 to September 2015, 622 patients who undergone total thyroidectomy for goitre, were retrospectively observed. The patients were divided into two group: Group A, including 58 patients with retrosternal goitre and Group B, including 562 patients with in situ goitre. Those patients with diseases of the parathyroid glands, assumption of drugs modifying calcium metabolism and who received blood transfusions before or after surgery, were excluded from the study. In both groups, a total thyroidectomy was performed under general anaesthesia. The upper and lower parathyroid glands in both groups were observed in situ as well. All surgical specimens underwent histological examination. RESULTS: Transient hypocalcaemia was observed in a higher percentage in group A (15% vs 7%, P <0.05). The mean hospital stay was greater in group A (P <0.05). There were no statistically differences between the two groups in terms of permanent hypocalcaemia and post-operative blood ionized calcium (72hours and 1 month). CONCLUSIONS: Many efforts should be made to respect parathyroids during total thyroidectomy in retrosternal goitre; greater attention should be given to inferior parathyroid glands that should be displayed, respecting the vasculature and performing a terminal lower thyroid artery ligation in order to reduce the risk of transient hypocalcaemia and - as a consequence - the average hospital stay.
Assuntos
Cálcio/sangue , Bócio/cirurgia , Hipocalcemia/sangue , Hipoparatireoidismo/etiologia , Tempo de Internação/estatística & dados numéricos , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Doença Iatrogênica , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tireoidectomia/métodosRESUMO
OBJECTIVES: Port-a-cath catheterization is often required for those patients who need long-term therapies (malnutrition, neoplasm, renal failure, other severe diseases). The use of ports for a wide range of indications is not exempt from complications. Ultrasound-guided central venous catheterization (CVC) is a safe and fast technique for the introduction of the catheter inside a central vein. This retrospective study reports our experience with US-guided CVC in patient eligible for port-a-cath implantation. MATERIALS AND METHODS: From January 2007 to March 2017, 108 CVC (out of 770 procedures), were positioned using an ultrasound guide, with the new "one-shoot technique" (group 1) and the classic Seldinger technique (group 2). RESULTS: One-shoot techniques showed a reduced operative time, in comparison to Seldinger technique, with a negligible minor complication rate. No major complication were evidenced. CONCLUSIONS: CVC is a safe procedure, although not free from complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts and complications; it is helpful in patients with vascular anatomical variations, with no visualized or palpable landmarks or for patients with coagulation disorders.
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Cateterismo Venoso Central/métodos , Ultrassonografia de Intervenção , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
In this study, mesenchymal stem cells were isolated from rat adipose tissue (AD-MSCs) to characterize and differentiate them into endothelial-like cells. AD-MSCs were isolated by mechanical and enzymatic treatments, and their identity was verified by colony-forming units (CFU) test and by differentiation into cells of mesodermal lineages. The endothelial differentiation was induced by plating another aliquot of cells in EGM-2 medium, enriched with specific endothelial growth factors. Five subcultures were performed. The expression of stemness genes (OCT4, SOX2 and NANOG) was investigated. The presence of CD90 and the absence of the CD45 were evaluated by flow cytometry. The endothelial-like cells were characterized by the evaluation of morphological changes and gene expression analysis for endothelial markers (CD31, CD144, CD146). Characterization of AD-MSCs showed their ability to form clones, to differentiate in vitro and the OCT-4, SOX-2, NANOG genes expression. Immunophenotypic characterization showed the CD90 presence and the CD45 absence. The endothelial-like cells showed morphological changes, the expression of CD31, CD144, CD146 genes and the presence of CD31 membrane receptor. Matrigel assay showed their ability to form network and vessels-like structures. This study lays the foundations for future evaluation of the potential AD-MSCs pro-angiogenic and therapeutic role.
Assuntos
Tecido Adiposo/citologia , Diferenciação Celular/fisiologia , Células Endoteliais/citologia , Células-Tronco Mesenquimais/citologia , Ratos Wistar/anatomia & histologia , Animais , Antígenos CD/genética , Antígenos CD/metabolismo , Antígeno CD146/genética , Antígeno CD146/metabolismo , Caderinas/genética , Caderinas/metabolismo , Colágeno , Meios de Cultura , Regulação para Baixo , Combinação de Medicamentos , Citometria de Fluxo , Perfilação da Expressão Gênica , Laminina , Antígenos Comuns de Leucócito/metabolismo , Proteína Homeobox Nanog/genética , Proteína Homeobox Nanog/metabolismo , Fator 3 de Transcrição de Octâmero/genética , Fator 3 de Transcrição de Octâmero/metabolismo , Molécula-1 de Adesão Celular Endotelial a Plaquetas/genética , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Proteoglicanas , Ratos , Fatores de Transcrição SOXB1/genética , Fatores de Transcrição SOXB1/metabolismo , Antígenos Thy-1/metabolismo , Regulação para CimaRESUMO
Perineal hernia is the protrusion of an intra-abdominal structure into the perineal area, that could be primitive or secondary to trauma or abdominoperineal resection. Main treatment could be transabdominal, transperineal or combined. Here is a rare case of anterior perineal hernia in a young saxophone male patient, treated with a mininvasive perineal approach. A 25-year-old Caucasian male patient referred 1-year history of perineal pain. The pain was more severe when he played his saxophone. Local exam was negative but a dynamic perineal ultrasonography revealed a small anterior perineal hernia. The defect was repaired with a polypropylene plug and the patient was discharged the day after. At one year, no signs of remission have been signalled. Perineal mesh hernioplasty of primary perineal hernia is technically feasible, is associated with rapid recovery and minimal complications, and has a good long-term outcome. The use of ultrasonography to detect the hernia could be considered the best choice whenever it is of small size. Ultrasonography allow to identify weakness areas, reducing diagnostic time and avoiding further costs.
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Hérnia/etiologia , Herniorrafia/métodos , Abdome/patologia , Adulto , Humanos , Masculino , Períneo/patologia , Telas CirúrgicasRESUMO
BACKGROUND: There is increasing interest in the development of vessel substitutes, and many studies are currently focusing on the development of biodegradable scaffolds capable of fostering vascular regeneration. We tested a new biocompatible and biodegradable material with mechanical properties similar to those of blood vessels. METHODS: The material used comprises a mixture of α,ß-poly(N-2-hydroxyethyl)-d,l-aspartamide (PHEA) and polylactic acid (PLA), combined with polycaprolactone (PCL) by means of electrospinning technique. Low-molecular-weight heparin was also linked to the copolymer. A tubular PHEA-PLA/PCL sample was used to create an arteriovenous fistula in a pig model with the use of the external iliac vessels. The flow was assessed by means of Doppler ultrasound examination weekly, and 1 month after the implantation we removed the scaffold for histopathologic evaluation. RESULTS: The implants showed a perfect leak-proof seal and adequate elastic tension to blood pressure. About â¼3 weeks after the implantation, Doppler examination revealed thrombosis of the graft, so we proceeded to its removal. Histologic examination showed chronic inflammation, with the presence of foreign body cells and marked neovascularization. The material had been largely absorbed, leaving some isolated spot residues. CONCLUSIONS: The biocompatibility of PHEA-PLA/PCL and its physical properties make it suitable for the replacement of vessels. In the future, the possibility of functionalizing the material with a variety of molecules, to modulate the inflammatory and coagulative responses, will allow obtaining devices suitable for the replacement of native vessels.