In Situ Replacement for a Mycotic Aneurysm on the Porcelain Aorta Using the Superficial Femoral Artery as a Vascular Graft / 日本心臓血管外科学会雑誌

Infected thoracic aortic aneurysms are rare. Standard treatment methods have not yet been established for medical treatment, timing of surgery, or surgical techniques. In this study, we report a case in which an ascending aortic reconstruction using an autologous superficial femoral artery was successfully performed for an infected pseudoaneurysm of the thoracic aorta without the use of artificial materials. The patient was a 78-year-old man with bacteremia caused by Staphylococcus aureus and an infected pseudoaneurysm of the thoracic aorta. The patient underwent replacement of the ascending aorta and coronary artery bypass grafting. The patient was discharged from the hospital with no recurrence of infection and no abnormality of the reconstructed aorta.

Lisado plaquetario homólogo como factor estimulante de la cicatrización en la zona donante de injertos / Homologous Platelet lysate as astimulatinghealing factor for the grafts donor area

Introducción: La búsqueda de alternativas para disminuir el tiempo de cicatrización y de hospitalización constituye uno de los aspectos fundamentales de la investigación actual. Los factores de crecimiento plaquetarios son capaces de potenciar la cicatrización. Objetivo: Determinar los beneficios de la aplicación del lisado de plaquetas homólogo sobre la zona donante del injerto autólogo de piel. Método: Se realizó un estudio longitudinal prospectivo en 20 pacientes tratados en el Hospital Hermanos Ameijeiras entre agosto de 2016 y mayo de 2019, que requirieron de injerto autólogo de piel en las zonas cruentas. Se realizaron dos tomas de injerto en el mismo paciente y región anatómica; una fue tratada con lisado plaquetario (zona de intervención) y otra con tratamiento convencional (zona control). La selección de pacientes fue intencional. Para estudiar las variables cualitativas se utilizaron números absolutos y proporciones y en las cuantitativas medidas de tendencia central y dispersión. Para la comparación de los resultados se aplicó la prueba de Friedman con un nivel de significación p ≤ 0,05. Resultados: La quemadura fue la principal causa de zona cruenta (75 por ciento), el grupo de edad más afectado fue el de mayores de 55 años. El porcentaje de cicatrización fue mayor en el grupo de intervención, con un tiempo de epitelización significativamente menor (p < 0,01), y el dolor en la zona intervenida fue menor. No hubo complicaciones. Conclusiones: Los beneficios encontrados en la zona intervenida con lisado plaquetario fueron significativos con una cicatrización más rápida y menor dolor(AU)

Introduction: The search for treatment alternatives that allow reducing wound healing and hospitalization time are fundamental aspects in research nowadays. Platelet growth factors are capable of enhancing wound healing. Objective: Determine the benefits of applying homologous platelet lysate on the donor area of autologous skin graft. Methods: A prospective longitudinal-section study was conducted in 20 patients with bloody areas that required autologous skin graft at the Hospital Hermanos Ameijeiras between August 2016 and May 2019. Two graft intakes were made in the same patient and anatomical region, one of them treated with platelet lysate (intervention zone) and one with conventional treatment (control zone). Patients selection was intentional. Absolute numbers and proportions were used to study the qualitative variables, and measures of central tendency and dispersion were used in the quantitative variables. To compare de results, the Friedman test was applied, setting a level of significance p < 0,05. Results: The main cause of bloody area was burns (75 percent), the most affected age group was those over 55 years, the healing percentage was greater in the intervention group with a statistically significant shorter epithelization time (p < 0,01) and there was less pain in the intervention zone. There were no complications. Conclusions: The benefits found in the intervened area with platelet lysate were significant with faster healing and less pain(AU)

Nueva alternativa para relleno y camuflaje de dorso nasal: Injerto mixto de L-PRF y cartílago / New alternative for filling and camouflage of nasal dorsum: Mixed graft of L-PRF and cartilage

RESUMEN Introducción: Entre las alteraciones del dorso nasal puede encontrarse desde un rádix bajo hasta un aplastamiento severo del dorso nasal, siendo fundamental el uso de injertos y material de relleno. Objetivo: Proponer una nueva alternativa de relleno y camuflaje en rinoplastía mediante un injerto mixto de L-PRF más cartílago picado en una matriz de fibrina autóloga. Material y método: Evaluación de los pacientes operados de rinoseptoplastía en quienes se utilizó el injerto mixto entre febrero y septiembre del año 2016 en el Servicio de Otorrinolaringología del Hospital Regional de Concepción. Evaluación de resultados respecto a reabsorción e irregularidades del injerto y autoevaluación del grado de satisfacción. Resultados: Fueron operados 7 pacientes. Cuatro de ellos presentaban aplastamiento severo de dorso nasal y tres un rádix profundo. Se logró el relleno y camuflaje del área deseada en todos los casos. No se presentó desplazamiento ni reabsorción del injerto en ninguno de los casos. El uso de este injerto no significó mayor costo económico, y el grado de satisfacción fue alto en todos los casos. Conclusión: Primer estudio en utilizar un injerto mixto de cartílago más L-PRF en una matriz de fibrina autóloga en rinoplastía, demostrando ser una alternativa asequible, efectiva, reproducible y segura, particularmente útil en casos de revisión.

ABSTRACT Introduction: Among the alterations of the nasal dorsum there can be found from a low radix to a severe crushing of the nasal dorsum, being fundamental the use of grafts and filling materials. Aim: To propose a new filling and camouflage alternative in rhinoplasty by means of a mixed graft of L-PRF and chopped cartilage in an autologous fibrin matrix. Material and method: Evaluation of the operated patients of rhinoseptoplasty in whom the mixed graft was used between February and September 2016 in the Otorhinolaryngology unit of the Hospital Regional de Concepción. Evaluation of results regarding resorption and graft irregularities and self-assessment of degree of satisfaction. Results: Seven patients were operated. Four of them presented severe crushing of the nasal dorsum and three of them a deep radix. The filling and camouflage of desired area was achieved in all cases. There were no displacement or resorption of the graft in any case. The use of this graft did not mean greater economic cost, and the degree of satisfaction was high in all cases. Conclusions: First study to use a mixed graft of cartilage and L-PRF in an autologous fibrin matrix in rhinoplasty, proving to be an affordable, effective, reproducible and safe alternative, particularly useful in revision surgeries.

Fractura de cuña intermedia asociada a lesión de Llisfranc y escafoides tarsiano. Sustitución con injerto autólogo. Reporte de un caso / Intermedia Wedge fracture associated with Lisfranc injury and tarsal scaphoid. Substitution with autologous graft. A case report

La fractura-luxación de Lisfranc, es poco frecuente (0,2% de todas las fracturas) y pasa inadvertida; la ausencia de tratamiento puede originar una deformidad de pie plano valgo con gran incapacidad y artrosis postraumática. Las fracturas de la cuñas, generalmente están asociadas a otras lesiones, el tratamiento quirúrgico se reserva a determinados casos, y su sustitución está poco documentada en la bibliografía; en las fracturas del cuerpo del navicular es importante su correcto tratamiento por formar parte de la coxa pedis. Se presenta el caso de un paciente que sufrió traumatismo del pie derecho con afectación de las cuñas y pérdida de la integridad ósea de la cuña intermedia(AU)

The Lisfranc fracture-dislocation, are uncommon (0.2% of all fractures) go unnoticed, no treatment can cause a valgus flatfoot deformity with great disability and posttraumatic osteoarthritis (1). Fractures wedge are usually associated with other injuries, surgical treatment is reserved, for certain cases, and replacing this poorly documented in the literature, in fractures of the navicular body is important proper treatment to be part of the pedis coxa. Report the case patient who suffered trauma to the right foot, with an affectation wedges with loss of bone integrity of the intermediate wedge(AU)

Inside-out and Standard Vein Grafts, with or without Muscle Filling, in Peripheral Nerve Repair: A Histomorphometric Study.

Aim: The aim of this study was to compare two tubulization techniques, inside-out veins and standard veins, both filled with skeletal muscle or not, in sciatic nerve by morphological and histomorphometric study. Methodology: Seventy Wistar rats were divided in 4 experimental groups (IOVNF - inside-out vein with no filling; IOVSM - inside-out vein filled with skeletal muscle; SVNF - standard vein with no filling; and SVSM - standard vein filled with skeletal muscle) and a control group (Sham). The left external jugular vein was sectioned into about 14 mm segments to be used as autologous vein grafts. A 10 mm gap was then created in the sciatic nerve and the vein graft was inserted into the vein with or without filling of the right caudal tibial muscle. The animals were euthanized 12 weeks after surgery. Results: Myelinated and unmyelinated nerve fibers were observed in the histological analyses for all groups, as well as neoformation of the perineurium and intraneural organization of fascicles and blood vessels. In the morphometric analysis of the distal stump, regarding the myelin sheath area, all groups had a significant difference. The IOVNF group had the highest means for fiber, axon and myelin sheath areas. The SVSM group had the lowest means in all features measured, except for the axon area (4.95±1.72 graft; 3.71±0.90 distal stump). Conclusion: These results show that sciatic nerve repair with inside-out veins and no filling (IOVNF) had the best results, in the majority of measured variables, when compared to the other groups.

Pulmonary graft-versus-host disease after autologous hematopoietic stem cell transplantation

No abstract available.

Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone

Two case reports describing a new technique of creating a repositionable piezoelectric bony window osteotomy during apicoectomy in order to preserve bone and act as an autologous graft for the surgical site are described. Endodontic microsurgery of anterior teeth with an intact cortical plate and large periapical lesion generally involves removal of a significant amount of healthy bone in order to enucleate the diseased tissue and manage root ends. In the reported cases, apicoectomy was performed on the lateral incisors of two patients. A piezoelectric device was used to create and elevate a bony window at the surgical site, instead of drilling and destroying bone while making an osteotomy with conventional burs. Routine microsurgical procedures - lesion enucleation, root-end resection, and filling - were carried out through this window preparation. The bony window was repositioned to the original site and the soft tissue sutured. The cases were re-evaluated clinically and radiographically after a period of 12 - 24 months. At follow-up, radiographic healing was observed. No additional grafting material was needed despite the extent of the lesions. The indication for this procedure is when teeth present with an intact or near-intact buccal cortical plate and a large apical lesion to preserve the bone and use it as an autologous graft.

Corporoplasty using autologous tunica vaginalis graft for Peyronie's disease / 中华男科学杂志

<p><b>Objective</b>To assess the effect of corporoplasty with autologous tunica vaginalis graft in the treatment of Peyronie's disease.</p><p><b>METHODS</b>Ten patients with Peyronie's disease underwent plaque excision and corporoplasty with autologous tunica vaginalis graft. We obtained and compared IIEF-5 scores of the patients before and at 1 and 5 years after operation.</p><p><b>RESULTS</b>After surgery, penile curvature was obviously relieved and all the patients achieved normal penile erection and satisfactory sexual intercourse without erection-related pain or recurrent erectile dysfunction. The mean IIEF-5 score was significantly improved at 1 year (22.40±1.08) and 5 years postoperatively (23.00±1.14) as compared with the baseline, (19.20±2.28) (P<0.05 or 0.01).</p><p><b>CONCLUSIONS</b>Corporoplasty with autologous tunica vaginalis graft is a safe, simple and effective option for the treatment of Peyronie's disease, though its definite efficiency is to be further supported by large-sample clinical studies.</p>

Reconstrucción de proceso alveolar maxilar con injerto autólogo de cresta iliaca / Reconstruction of maxillary alveolar process with iliac crest autologous graft

El caso clínico que se muestra ejemplifica la conjunción de múltiples técnicas quirúrgicas con el objetivo de rehabilitar protésicamente a un paciente desdentado, para el tratamiento del maxilar superior atrófico con injerto autólogo de cresta iliaca anterior tipo onlay. Se trata de paciente del sexo femenino de 60 años de edad, la cual presenta un proceso alveolar atrófico tipo IV de Cawood y Howell, por lo que se realiza la conservación y reconstrucción de proceso alveolar con injerto autólogo de cresta iliaca.

The clinical case presented in this article illustrates the combination of multiple surgical techniques geared to the prosthetic rehabilitation of an edentulous patient for the treatment of an atrophic upper jaw with an onlay type iliac crest autologous graft. Treated patient was a 60 year old female presenting a type IV Cawood and Howell atrophic alveolar process. Therefore, treatment conducted was reconstruction of the alveolar process with an iliac crest autologous graft.

Which Graft must be Preferred in Firearm Injury of the Axillary Artery.

Aims: Interposition graft technique is used mostly in firearm wounds of axillary artery, because of excessive defect of the vessel. Autologous vein has been preferred in general application, even though there is a mild size discrepancy between native artery and autologous vein. However, in many series, prosthetic graft infection risk has been reported as low. Presentation of Case: I am presenting a patient with a gunshot wound to the right upper chest. As a first choice I preferred saphenous vein which was occluded by thrombosis at the post-repair third week in spite of anticoagulant therapy and was replaced with prosthetic graft which was patent at the eight month follow-up. Discussion: Although the theoretical risk of infection of prosthetic grafts, many previous reports have demonstrated that prosthetic grafts are nearly as safe as autologous grafts and they have high long-term patency rate. Conclusion: There is no point in insisting on autologous grafts in cases of the diameter discrepancy between native artery and autologous graft, prosthetic graft may be used more frequently in axillary artery trauma, and post-repair anticoagulants may be administered in the consequences of size discrepancy between the native artery and the graft.

Skin Graft-versus-host Disease Following Autologous Stem Cell Transplantation for Multiple Myeloma

Graft-versus-host disease (GVHD) is a common complication of allogeneic stem cell transplantation (allo-SCT). However, a similar syndrome has been reported in autologous stem cell transplantation (ASCT) as well. The target organs of GVHD in ASCT are the skin, liver and gastrointestinal (GI) tract, which are consistent with those in allo-SCT. Histologic findings from the skin and the mucosa of the GI tract also show similar features. Here we describe a case of autologous GVHD involving the skin of a patient who underwent ASCT for multiple myeloma. In this patient, the response to a total prednisone dose of 0.5 mg/kg/day was unsatisfactory, and the patient required more intensive and prolonged immunosuppressive therapy with slow tapering.

Escape tardío de la bula de filtración a propósito de un caso / Late onset of leaking filtering bleb in a case

Paciente masculino de 48 años, de color de la piel mestizo, al que se le realizó trabeculectomía con antimetabolito en su ojo derecho con daño glaucomatoso avanzado y atrofia óptica glaucomatosa en su ojo izquierdo. Tres años después acude a consulta de seguimiento con escape tardío de la ampolla de filtración, perforación escleral y ligera hipotonía ocular. Surge la disyuntiva entre realizar recubrimiento de la ampolla con trasplante conjuntival autólogo, con el riesgo de elevación posterior de la presión intraocular por encima de su valor meta, y no practicar tratamiento quirúrgico con elevada posibilidad de endoftalmitis. Se realizó el proceder y en el seguimiento se constató un injerto conjuntival bien adaptado y vascularizado, con presión intraocular inferior a 15 mmHg en cada consulta y no progresión del daño glaucomatoso

The case of a 48 years-old male patient was presented. He underwent trabeculectomy with antimetabolites to treat advanced glaucomatous damage in his right eye and optical glaucomatous atrophy in his left eye. After three years, he went to the follow-up medical service with late-onset of leaking filtering bleb, sclera perforation and slight ocular hypotony. The dilemma of covering the bleb with conjunctival autologous graft, with the risk of raised intraocular pressure over the target value o non-performance of the surgical treatment with high possibility of endophthalmitis was present. It was decided to apply the surgical procedure. The follow-up showed a well-adapted and vascularized conjunctival graft and intraocular pressure lower than 15 mm Hg in each medical appointment, without advance in glaucomatous damage

Effects of eliminating tension by means of epineural stitches: a comparative electrophysiological and histomorphometrical study using different suture techniques in an animal model / Avaliação dos efeitos da eliminação da tensão através de ancoramento epineural: estudo experimental comparando resultados eletrofisiológicos e histomorfométricos após diferentes técnicas de reparo no nervo

Epineural stitches are a means to avoid tension in a nerve suture. We evaluate this technique, relative to interposed grafts and simple neurorraphy, in a rat model. METHOD: Twenty rats were allocated to four groups. For Group 1, sectioning of the sciatic nerve was performed, a segment 4 mm long discarded, and epineural suture with distal anchoring stitches were placed resulting in slight tension neurorraphy. For Group 2, a simple neurorraphy was performed. For Group 3, a 4 mm long graft was employed and Group 4 served as control. Ninety days after, reoperation, latency of motor action potentials recording and axonal counts were performed. Inter-group comparison was done by means of ANOVA and the non-parametric Kruskal-Wallis test. RESULTS: The mean motor latency for the simple suture (2.27±0.77 ms) was lower than for the other two surgical groups, but lower than among controls (1.69±0.56 ms). Similar values were founding in both group 1 (2.66±0.71 ms) and group 3 (2.64±0.6 ms). When fibers diameters were compared a significant difference was identified between groups 2 and 3 (p=0.048). CONCLUSION: Good results can be obtained when suturing a nerve employ with epineural anchoring stitches. However, more studies are needed before extrapolating results to human nerve sutures.

A aproximação através de pontos epineurais é uma forma de se reduzir a tensão numa neurorrafia. Neste estudo esta técnica é avaliada através da sua comparação com a interposição de enxertos e neurorrafia simples num modelo experimental utilizando o rato. MÉTODO: Vinte ratos foram utilizados e divididos em 4 grupos. No Grupo 1, após a ressecção de 4 mm, os cotos do nervo foram aproximados através de pontos de ancoramento epineurais e suturados com tensão. No Grupo 2, uma neurorrafia simples foi realizada após secção do nervo. No Grupo 3, um enxerto de 4 mm foi utilizado para o reparo e o Grupo 4 foi utilizado como controle. Noventa dias após, os nervos foram novamente expostos e a medida da latência do potencial de ação motor e a contagem axonal foram realizados. A comparação entre os grupos foi realizada através da comparação entre as médias (ANOVA) e com o teste não-paramétrico de Kruskal-Wallis. RESULTADOS: A média da latência motora na sutura simples (2,27±0,77 ms) foi menor em relação aos outros dois grupos onde o nervo foi seccionado e reparado e maior que o grupo controle (1,69±0,56 ms). Resultados semelhantes foram identificados nos grupos 1 (2,66±0,71 ms) e 3 (2,64±0,6 ms). Uma diferença significativa diâmetros das fibras foi identificada quando comparados os grupos 2 e 3 (p=0,048). CONCLUSÃO: Resultados equiparáveis aos obtidos com enxerto podem ser obtidos quando a neurorrafia é realizada com pontos epineurais de ancoramento com tensão, mas estudos adicionais são necessários antes desses resultados serem extrapolados para o reparo de nervo em seres humanos.

Efectos de la eliminación de la tensión mediante puntos epineurales: estudio comparativo empleando diferentes técnicas de sutura en un modelo animal / Effects of tension elimination by using epineural anchoring stitches: a comparative study employing different techniques of suture in an experimental model

Objetivo. Documentar la utilidad de una técnica de sutura epineural bajo tensión, en comparación con la sutura mediante injerto interpuesto y la neurorrafia termino-terminal, en un estudio realizado en un modelo experimental animal (rata Wistar). Material y Método. Un lote de 20 animales, considerados como 40 unidades fisiológicas independientes a nivel del miembro inferior, fueron separados en 4 grupos de 10: en el primero se realizó una sutura bajo tensión con puntos epineurales a nivel del nervio ciático luego de resecar 4 mm de nervio. En el segundo se realizó una sutura término-terminal sin tensión, en el tercero se colocó un puente de injerto autólogo de 4 mm de extensión y el cuarto fue utilizado como control. A los 90 días de efectuados los procedimientos, se reexpusieron las zonas operadas y se documentaron las respuestas fisiológicas a los diferentes tipos de sutura mediante potenciales de acción de músculo (PAM) y nervio (PAN). Resultados. El promedio de la velocidad de conducción para la sutura simple fue el mejor de los tres grupos operados (14,60 mm/ ms), aunque peor que el control (19,31 mm/ms). La sutura a tensión mediante puntos epineurales (12,02 mm/ms) demostró resultados neurofisiológicos superiores que cuando se utilizó injerto autólogo (11,09 mm/ms). Conclusión. El presente estudio demuestra que si se logra coaptar un nervio ciático de rata mediante sutura epineural con puntos distales a la línea de neurorrafia, sus resultados son mejores que al emplear injerto. Sin embargo, estos resultados, obtenidos en un modelo de animal pequeño, deben ser cuidadosamente extrapolados a la práctica quirúrgica habitual.

Objective. To measure the utility of this technique, in comparison with interposed grafts and termino-terminal neuroraphy, all applied in an experimental model (Wistar rat).Materials and method. 20 rats were used in both sides (40 legs, each one considered as independent physiological units, were grouped in four groups: in the first one, a section of thesciatic nerve was performed, a segment 4mm long was discarded and an epineural suture with distal anchoring stitches was done under slight tension. In the second group a tensionlesstermino-terminal neuroraphy was performed after sciatic nerve section. In the third group a 4 mm long graft was employed and the fourth was used as control. 90 days after this procedure, the animals were reoperated and muscle and nerve action potentialswere recorded in both sides. Results. The mean conduction velocity for the simple suture was higher than the other two groups, but lower than the control(19,31 mm/ms). Neuroraphy with epineural stitches (12,02 mm/ms) was better than when an autologous nerve graft was employed (11,09 mm/ms).Conclusion. This study demonstrates that a good result can be obtained if a nerve is sutured under slight tension, employing epineural anchoring stitches. Nevertheless, more studies shouldbe performed before applying these results to human nerve suture.

Estudo comparativo entre enxerto autógeno e enxerto muscular coberto com tubo de veia autógeno em nervos tibiais de ratos wistar, utilizando o fluoro-gold® como marcador neuronal / Comparative study between autogenous graft and muscular graft covered with autogenous vein tube in wistar rats' tibial nerves using the fluoro-gold® as a neuronal marker

Este trabalho teve como objetivo o estudo da regeneração nervosa através da contagem de neurônios comparando duas técnicas cirúrgicas no tratamento da perda de substância nervosa nos membros inferiores em 15 ratos. Inicialmente obteve-se tubo de veia de 12mm de comprimento retirado da jugular externa esquerda. A seguir, opera-se os dois membros inferiores, expondo o nervo tibial de cada lado e ressecando um segmento de 8 mm do nervo, simulando, ao mesmo tempo, a perda de substância e a obtenção do enxerto nervoso autógeno. A reparação da perda de substância do lado esquerdo consistiu numa enxertia convencional simples para a reparação de lesão nervosa por meio de sutura microcirúrgica. A do membro inferior direito foi pela tubulização com 8 mm de enxerto de músculo quadríceps denaturado com nitrogênio líquido coberto com veia jugular. Após quatro meses, os animais foram submetidos à nova cirurgia para exposição dos nervos tibiais ao marcador neuronal Fluoro Gold®. Após 48 horas, foram perfundidos e o segmento medular entre L3 e S1 foi removido e posteriormente cortado em secções de 40 æm. Houve contagem neuronal de todos os cortes e não foram verificadas diferenças estatísticas entre as duas técnicas cirúrgicas.

The purpose of this work was to study nervous regeneration through neurons counts by comparing two surgical techniques for addressing nervous gaps on 15 rats' lower limbs. Initially, a 12-mm long vein tube from the left outer jugular was obtained, and then both lower limbs are operated, exposing the tibial nerve at each side and performing a resection of an 8-mm nerve segment, at the same time simulating a gap and an autogenous nerve graft. Left gap repair consisted of a usual conventional graft for nervous injury repair by means of microsurgical suture. The gap repair on right lower limbs was made through quadriceps muscle, treated with liquid nitrogen, covered with an 8-mm tube of jugular vein. After four months, the animals were submitted to a new surgery for exposing tibial nerves to the Fluoro-Gold® neuronal marker. After 48 hours, the rats were perfused and medullar segment between L3 and S1 was removed and subsequently cut into 40æm sections. Neurons on all sections were counted, and no statistical differences were found between both surgical techniques.