RESUMO
Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.
Assuntos
Transplante de Coração , Coração Auxiliar , Humanos , Qualidade de Vida , Transplante Heterotópico , Veia Cava SuperiorRESUMO
Abstract Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.
Assuntos
Humanos , Coração Auxiliar , Transplante de Coração , Qualidade de Vida , Veia Cava Superior , Transplante HeterotópicoRESUMO
Heterotopic and orthotopic ovarian tissue autotransplantation techniques, currently used in humans, will become promising alternative methods for fertility preservation in domestic and wild animals. Thus, this study describes for the first time the efficiency of a heterotopic ovarian tissue autotransplantation technique in a large livestock species (i.e., horses) after ovarian fragments were exposed or not to a cooling process (4°C/24 h) and/or VEGF before grafting. Ovarian fragments were collected in vivo via an ultrasound-guided biopsy pick-up method and surgically autografted in a subcutaneous site in both sides of the neck in each mare. The blood flow perfusion at the transplantation site was monitored at days 2, 4, 6, and 7 post-grafting using color-Doppler ultrasonography. Ovarian grafts were recovered 7 days post-transplantation and subjected to histological analyses. The exposure of the ovarian fragments to VEGF before grafting was not beneficial to the quality of the tissue; however, the cooling process of the fragments reduced the acute hyperemia post-grafting. Cooled grafts compared with non-cooled grafts contained similar values for normal and developing preantral follicles, vessel density, and stromal cell apoptosis; lower collagen type III fibers and follicular density; and higher stromal cell density, AgNOR, and collagen type I fibers. In conclusion, VEGF exposure before autotransplantation did not improve the quality of grafted tissues. However, cooling ovarian tissue for at least 24 h before grafting can be beneficial because satisfactory rates of follicle survival and development, stromal cell survival and proliferation, as well as vessel density, were obtained.
Assuntos
Temperatura Baixa , Folículo Ovariano/transplante , Transplante Heterotópico , Fator A de Crescimento do Endotélio Vascular/farmacologia , Animais , Apoptose/efeitos dos fármacos , Caspase 3/metabolismo , Contagem de Células , Proliferação de Células/efeitos dos fármacos , Feminino , Fibrose , Cavalos , Modelos Animais , Folículo Ovariano/irrigação sanguínea , Folículo Ovariano/efeitos dos fármacos , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Fluxo Sanguíneo Regional/efeitos dos fármacos , Células Estromais/citologia , Células Estromais/efeitos dos fármacos , Transplante AutólogoRESUMO
Acellular liver scaffolds (ALS) have arisen as potential candidates for transplantation. Until now, all reports involving ALS transplantation failed in surgical method descriptions and do not offer support to scientists to reproduce the procedures used in experimental microsurgery to make the results comparable to literature. To overcome the lack of detail information, we described surgical steps details to perform heterotopic and partial orthotopic surgical models to promote ALS transplantation. After preservation and vessel cannulation steps, the liver grafts were decellularized. In addition, ex vivo blood perfusion tests were performed to obtain a successful anticoagulation treatment prior in vivo transplantation. Then, methods of partial liver resection, combination of hand-suture and cuff techniques to complete end-to-end anastomosis between the scaffold and the recipient animal were performed. These procedures which take 30-60 min and were efficient to allow acellular liver scaffold viability and recellularization of different types of cell post-surgery. In conclusion, our methods are practical and simple promising approach that provides the opportunity to investigate ways to achieve sufficient liver function post-transplantation in vivo.
Assuntos
Transplante de Fígado/métodos , Fígado/cirurgia , Microcirurgia/métodos , Engenharia Tecidual/métodos , Alicerces Teciduais , Animais , Matriz Extracelular , Feminino , Masculino , Modelos Anatômicos , Ratos , Ratos Wistar , Transplante HeterotópicoRESUMO
STUDY OBJECTIVE: Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. DESIGN: Stepwise demonstration of the procedure with narrated video footage. SETTING: Transgender health clinic. INTERVENTIONS: A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. CONCLUSION: Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.
Assuntos
Ciclídeos , Disforia de Gênero/cirurgia , Cirurgia de Readequação Sexual/métodos , Transplante de Pele/métodos , Estruturas Criadas Cirurgicamente , Adulto , Animais , Materiais Biocompatíveis/uso terapêutico , Brasil , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Masculino , Orquiectomia , Pênis/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/veterinária , Retalhos Cirúrgicos/cirurgia , Transplante Heterólogo , Transplante Heterotópico , Transexualidade/cirurgia , Vagina/cirurgiaRESUMO
The keys to successful posterior cruciate ligament (PCL) reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, mechanical graft tensioning, secure graft fixation, and the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single and double bundle arthroscopic transtibial tunnel PCL reconstruction based upon stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements. The purpose of this article is to describe the arthroscopic transtibial tunnel PCL reconstruction surgical technique.
Assuntos
Artroscopia/métodos , Fêmur/cirurgia , Instabilidade Articular/cirurgia , Reconstrução do Ligamento Cruzado Posterior/métodos , Tíbia/cirurgia , Tendão do Calcâneo/transplante , Aloenxertos , Humanos , Músculo Esquelético/transplante , Transplante Heterotópico , Transplante HomólogoRESUMO
Mayer-Rokitansky-Küster-Hauser syndrome is the second most common cause of primary amenorrhea, trailing only to gonadal dysgenesis. Neovaginoplasty is an appropriate treatment option for patients who have failed dilation therapy. Several biomaterials have been used in this procedure, including peritoneum, amnion, skin grafts, and myocutaneous flaps. Nile Tilapia Fish Skin has noninfectious microbiota, morphologic structure comparable to human skin, and high in vivo bioresorption. In addition, it showed good outcomes when used as a xenograft for burn treatment. Thus, we suggest it as a new biologic graft for vaginal agenesis management. In this descriptive study, neovaginoplasty using Nile Tilapia Fish Skin offered 3 patients an anatomic and functional neovagina via a simple method with potential long-term effectiveness. When postsurgical dilation was performed correctly, a vaginal length greater than 6 cm was maintained at 180 days follow-up. Histologic and immunohistochemical analyses revealed the presence of stratified squamous epithelium with high expression of cytokeratins and fibroblast growth factor, matching the characteristics of normal adult vaginal tissue. We believe that further studies will show Nile Tilapia Fish Skin to be a relevant option in the therapeutic arsenal of Mayer-Rokitansky-Küster-Hauser syndrome.
Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Ciclídeos , Anormalidades Congênitas/cirurgia , Ductos Paramesonéfricos/anormalidades , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos , Vagina/anormalidades , Administração Intravaginal , Adolescente , Adulto , Animais , Produtos Biológicos/uso terapêutico , Brasil , Dilatação/métodos , Feminino , Humanos , Ductos Paramesonéfricos/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos , Transplante Heterólogo/efeitos adversos , Transplante Heterólogo/métodos , Transplante Heterotópico/efeitos adversos , Transplante Heterotópico/métodos , Resultado do Tratamento , Vagina/cirurgia , Adulto JovemRESUMO
OBJECTIVE: To evaluate the efficiency of two vitrification protocols for rat immature testicular tissue and heterotopic transplantation. METHODS: Twenty-four pre-pubertal Wistar rats were divided into three groups (n=8). After orchiectomy, testicular fragments (3mm) from Groups 1 and 2 were vitrified with different cryoprotectant concentration solutions, using sterile inoculation loops as support. After warming up, the fragments were submitted to cell viability assessment by Trypan blue and histological evaluation. Vitrified (Groups 1 and 2) and fresh (Group 3) fragments were grafted to the animals periauricular region. After 8 weeks of grafting, the implant site was histologically analyzed. RESULTS: The viability recovery rate from Group 1 (72.09%) was higher (p=0.02) than that from Group 2 (59.19%). Histological analysis showed similar tubular integrity between fresh fragments from Groups 1 and 3. Group 2 samples presented lower tubular integrity. We ran histological analyses in the grafts from the Groups. In all groups, it was possible to see the implant site, however, no fragment of testicular tissue or signs of inflammation were histologically found in most samples from Groups 1 and 3. In one sample from Group 2, we found degenerated seminiferous tubules with necrosis and signs of an inflammatory process. In another sample from Group 2, we found seminiferous tubules in the implant site. CONCLUSION: The vitrification of pre-pubertal testicular tissue of rats showed little damage to cell viability through histological analysis when we used cryoprotectants in a lower concentration. Heterotopic transplantation could not preserve the structural organization of the testicular tissue.
Assuntos
Sobrevivência Celular/fisiologia , Preservação da Fertilidade/métodos , Testículo/citologia , Transplante Heterotópico , Vitrificação , Animais , Criopreservação/métodos , Masculino , Ratos , Ratos WistarRESUMO
OBJECTIVES: To assess the viability and induction of immunotolerance of nonvascularized splenic alloimplants. The phagocytic functions of splenic implants also were studied. MATERIALS AND METHODS: Thirty-six adult female New Zealand and California rabbits were used, and these animals were divided into the following 5 groups: (n = 6 / groups 1-4) group 1 (sham operations); group 2 (total splenectomy); group 3 (implantation of autologous sliced splenic tissue in the greater omentum following splenectomy); group 4 (implantation of allogenic sliced splenic tissue in the greater omentum after splenectomy); and group 5 (n = 12) (implanting allogenic sliced splenic tissue in the greater omentum after splenectomy and receiving oral cyclosporine at a dosage of 40 mg/kg/d). All animals were followed for 120 days after the operations, then received venous injections of China ink (groups 1, 2, 3, 4, 5A) or a colloidal radiopharmaceutical (group 5B), and subsequently underwent reoperations. Hematimetric examinations were performed, and the histologic aspects and phagocytic functions of the implants were assessed. RESULTS: Spontaneous immunotolerance was not induced by sliced splenic allografts implanted in the greater omentum. The use of cyclosporine did not preserve the viabilities of the implants. All animals in group 3, which were subjected to autologous implants, exhibited viable implants that exhibited phagocytic function, although this phagocytic function was reduced compared with that of the normal spleen. CONCLUSIONS: No viable spleen alloimplants were observed regardless of the presence of cyclosporine. Spontaneous immunotolerance was not induced by sliced splenic alloimplants.