Tratamiento quirúrgico de la endocarditis infecciosa / Surgical treatment of infective endocarditis

La cirugía constituye un ataque vigoroso a la incompetencia valvular que ocasiona las graves complicaciones hemodinámicas que se observan en la endocarditis infecciosa. Se presenta una breve revisión de las diferentes técnicas quirúrgicas que se emplean para el tratamiento de la endocarditis infecciosa de la válvula mitral nativa, utilización de homoinjertos mitrales, tratamiento quirúrgico de la endocarditis infecciosa de la válvula aórtica y de la endocarditis infecciosa de prótesis valvular aórtica, homoinjertos criopreservados, prótesis sin soporte valvular y otros tipos de prótesis, así como de otras técnicas que se pueden emplear en caso de no contar con homoinjertos. Se revisan las técnicas que se utilizan en la endocarditis infecciosa de la válvula tricúspide y la conducta quirúrgica en la endocarditis por cables de marcapasos o desfibriladores automáticos implantables(AU)

Surgery is a strong attack to valvular incompetence causing the severe hemodynamic complications seen in infective endocarditis. This is a brief review of the different surgical techniques used in the treatment of infective endocarditis of native mitral valve, utilization of mitral homografts, surgical treatment of the infective endocarditis of the aortic valve and the infective endocarditis of the aortic valvular prosthesis, cryopreservation of the homografts, prosthesis without valvular support and other types of prostheses, as well as of other techniques that could be used if the homografts are not available. Techniques used in the infective endocarditis of tricuspid valve are reviewed and the surgical behavior in the endocarditis provoked by the pacemakers cables or implanted automated defibrillators(AU)

Enxerto homólogo congelado de diafragma na correção dos defeitos da parede abdominal de ratos / Diaphragma frozen homograft for rats' abdominal wall defects repair

OBJETIVOS: Análise morfológica e biomecânica do enxerto homólogo congelado de diafragma para correção de defeito da parede abdominal em ratos. MÉTODOS: Os animais foram distribuidos em controle (20 ratos Wistar) e experimento (30 ratos Wistar). Os do grupo controle foram submetidos à laparotomia mediana e sutura da parede abdominal; já os do grupo experimento, à ressecção da parede abdominal e reconstrução com enxerto homólogo congelado de diafragma. Os animais foram submetidos à eutanásia no 3° e 6° mês de pós-operatório e avaliados quanto à presença de complicações pós-operatórias, integridade do enxerto, presença de aderências, avaliação tensiométrica, avaliação histopatológica com H/E e com sirius-red (colágeno tipo I e III). RESULTADOS: Houve integração do enxerto em todos os animais sem complicações. Aderências foram semehantes entre os grupos controle e experimento após três e seis meses. Observaram-se maior força máxima, força de ruptura e tensão nos animais do grupo experimento aos três meses de pós-operatório (p=0,001; p=0,012 e p=0,001, respectivamente). Na correlação entre as diferentes variáveis estudadas houve correlação estatisticamente significante entre força máxima e tensão nos grupos controle e experimento (p=0,001 e p= 0,001), e nos subgrupos três e seis meses (p=0,002 e p=0,001). Correlacionaram-se força máxima e colágeno tipo I (p=0,04) e Índice de Maturação do Colágeno (IMaC) e força máxima (p=0,03) ambos somente no grupo controle, mas nos subgrupos 3 e 6 meses (p=0,045 e p=0,038). O número de monomorfonucleares e força máxima também apresentou significância estatística tanto para o grupo controle quanto para o experimento (p=0,005 e p=0,004, respectivamente). CONCLUSÃO: O enxerto homólogo congelado de diafragma mostrou ser boa alternativa no reparo de grandes defeitos da parede abdominal em ratos.

OBJECTIVE: To analyse the morphology and biomechanics of diaphragma frozen homografts used for rats' abdominal wall defects repair. METHOD: Thirty wistar rats with abdominal wall resection and reconstruction using frozen diaphragma homografts were compared to twenty other rats submitted to abdominal wall incision and closure (control). Animals were euthanized after 3 and 6 months and abdominal walls were avaliated histologically with H/E and Picrosiriud Red staining and tensiometric evaluation. RESULTS: The tensiometric parameters were greater in the experimental group at 3 months after surgery. The percentage of mature collagen was significantly greater at 6 months after surgery in control and experimental groups. Tensiometric parameters and type I collagen as well maturation collagen index and rupture maximal strength were statistically correlated after 3 and 6 months. CONCLUSION: Frozen diaphragma homograft can be an alternative to repair the defects of abdominal wall.

Treatment of Partial Thickness Burn Wounds with Cultured Epidermal Homografts

PURPOSE: Since Rheinwald and Green laid the foundation of epidermal cell culture technology in 1975, many clinicians and scientists have attempted to prove the effectiveness of cultured epidermal autologous(CEA) or homogenetic(CEH) grafts in the wound healing process. In contrast to CEA which cultured from a patient's skin on demand, Cultured Epidermal Homograft (CEH) can be readily available to use on cleaned wounds. In this study, we conducted a controlled clinical trial in order to confirm the effectiveness of CEH in treating partial-thickness 2nd degree burn wounds. METHODS: From July 2003 to January 2004 at Hangang Sacred Heart Hospital, we performed a clinical trial in which 35 patients who suffered from 2nd degree burns were enrolled. Wounds were randomly divided into two parts, control and test sites. Test sites were treated with allogeneic keratinocyte sheets (Kaloderm(R), Tegoscience Inc.), a CEH commercialized in Korea. RESULTS: All wounds healed completely without any major complication. The complete healing took 8.3+/- 2.8(mean+/-S.D.) days in the test sites as opposed to 11.7+/-3.3 days in the control sites. CONCLUSION: Based on these results, we concluded that CEH accelerates re-epithelialization of partial thickness burn wounds and CEH can be an safe alternative to skin grafts for 2nd degree burns.

An Experimental Study of Histological Changes of Scleral Homograft

Transplantation of the scleral homograft was performed with 6 rabbits in order to evaluate its usefulness as a material for frontalis sling operation. Scleral homografts which were surrounded by connective tissue maintained normal scleral architecture until the 12th week of subcutaneous implantation. Under the electronmicroscopic examination, sclenl homografts maintained their proper collagen fiber type I architecture until the 12th week. With these results we considered that homologous scleral shell could be a promising material for frontalis sling operation.