Injerto Óseo Tibial en Cirugía Oral y Maxilofacial: Indicaciones y Descripción de la Técnica, Propósito De Tres Casos / Tibial graft in Oral and Maxilofacial Surgery: Indications and Description of the Technique, Regarding Three Cases

Uno de los mayores desafíos en cirugía máxilo facial, es la reconstrucción de los defectos óseos maxilares para una posterior rehabilitación funcional del sistema estomatognático. La pérdida del tejido óseo que sufren los huesos maxilares puede ser de origen congénito como las fisuras labio palatinas o adquiridas, ya sea como consecuencia de una neoplasia o lesión intra ósea que provoque algún defecto post quirúrgico, o bien un trauma o el desdentamiento de la zona (Kolerman et al., 2012). El déficit de tejido óseo que sufren los maxilares, a menudo impide o dificulta la rehabilitación dentaria, necesitando acudir a técnicas quirúrgicas que permitan corregir dichos defectos, siendo los injertos óseos la alternativa más utilizada hoy en día (Ramírez-Fernández et al., 2013). Según origen los injertos óseos se clasifican en: aloinjertos, autoinjertos, xenoinjertos y sustitutos óseos (Chappard et al., 2010). Se describen múltiples técnicas de reconstrucción mediante injertos óseos que dependen de la magnitud del defecto, de la disponibilidad de biomaterial es y de las condiciones tanto locales como sistémicas del paciente. A continuación se presenta una serie de 3 casos clínicos que requiriero n de reconstrucción ósea alveolar previo a instalación de implantes para la rehabilitación dentaria. En los tres pacientes se utiliz ó injerto óseo autólogo de tibia, siendo tratados por el equipo de cirugía máxilofacial del Hospital el Carmen Maipú, Santiago Chile. El primer caso correspondía a una paciente mujer de 65 años con una atrofia maxilar severa por pérdida de los dientes 1.4/2.4/2.5, con neumoti zación severa del seno maxilar bilateral. El segundo caso, una mujer de 30 años, portadora de una fisura alveolar unilateral, la cual no recibió injerto óseo alveolar en etapas tempranas. El tercer caso, una paciente mujer de 55 años que presentaba un odontoma compuesto m andibular en relación a las piezas dentarias 4.2 y 4.3. Para los tres casos, se utilizó injerto óseo autólogo tomado de la tibia según la técnica descrita por Catone et al. (1992) con el fin de realizar una posterior rehabilitación con implantes dentales. El objetivo de este reporte fue presentar la técnica quirúrgica utilizada y realizar una revisión breve de sus ventajas, desventajas y complicaciones asociadas.

One of the greatest challenges in maxillofacial surgery is the reconstruction of maxillary bone defects for a subsequent functional rehabilitation of the stomatognathic system. The loss of bone tissue suffered by the maxillary bones may be of congenital origin such as palatal lip fissures or acquired, either as a result of a neoplasm or intra-cè˛e injury that causes a post-surgical defect, or trauma or toothlessness of the area (Kolerman et al.). The deficit of bone tissue suffered by the jaws, often prevents or hinders dental rehabilitation, needing to resort to surgical techniques that correct these defects, with bone grafts being the most widely used alternative today (Ramírez-Fernández et al.). According to origin, bone grafts are classified as: allografts, autografts, xenografts and bone substitutes (Chappard et al.). Multiple reconstruction techniques are described using bone grafts that depend on the magnitude of the defect, the availability of biomaterials and the patient's local and systemic conditions. Below is a series of 3 clinical cases that required alveolar bone reconstruction prior to implant installation for dental rehabilitation. Autologous tibia bone graft was used in the three patients, being treated by the maxillofacial surgery team at Hospital el Carmen Maipú, Santiago Chile. The first case corresponds to a 65-year-old female patient with severe maxillary atrophy due to loss of 1.4 / 2.4 / 2.5 teeth, with severe pneumatization of the bilateral maxillary sinus. The second case was a 30-year-old woman with a unilateral alveolar fissure, who did not receive an alveolar bone graft in the early stages. The third case was a 55-year-old female patient who presented a mandibular compound odontoma in relation to teeth 4.2 and 4.3. For all three cases, an autologous bone graft taken from the tibial bone was used according to the technique described by Catone et al. (1992) in order to carry out subsequent rehabilitation with dental implants. The objective of this report is to present the surgical technique used and make a brief review of its advantages, disadvantages and associated complications.

Coleta de sêmen em Leopardus guttulus pelo método do cateterismo uretral / Leopardus guttulus semen collection using urethral catheter method

Considerando a realidade conservacionista dos animais mantidos em cativeiro, em especial os pequenos felídeos silvestres, objetivou-se, com este estudo, descrever o método de coleta de sêmen por cateterismo uretral em Leopardus guttulus cativos, anestesiados com cetamina-dexmedetomidina. Inicialmente foram utilizados 13 animais para coleta de sêmen por cateterismo mediante o uso de diferentes doses de cetamina-dexmedetomidina. Após determinação da dose anestésica ideal para coleta de sêmen nessa espécie, cinco L. guttulus machos foram submetidos a coletas seriadas de sêmen pelo método do cateterismo. A dose ideal para coleta de sêmen foi de 0,008mg/kg de dexmedetomidina e 10mg/kg de cetamina. Os valores médios para volume e concentração foram de 35,9µL e 552,8x106sptz/mL. Com média de 71% de motilidade e 3,1 de vigor, 68% dos espermatozoides apresentaram vitalidade (integridade de membrana) e 77% integridade acrossomal. Sobre as patologias espermáticas, obteve-se uma média de 28% de espermatozoides com defeitos maiores, 6% com defeitos menores e 67% normais. As vantagens do método, como a facilidade e o baixo custo, fazem recomendar sua utilização em L. guttulus, pois foram apresentados bons resultados quanto à concentração espermática, à motilidade, ao vigor, à viabilidade espermática e à integridade acrossomal, sendo uma técnica promissora para utilização em felinos selvagens.(AU)

Considering the conservationist reality of animals kept in captivity, especially the small wild felids, this study aimed to describe the semen collection method using urethral catheterization in captive Leopardus guttulus, anesthetized with ketamine-dexmedetomidine. Initially, 13 animals were used for semen collection using catheterization with different ketamine-dexmedetomidine doses. After determination of the best anesthetic dose for semen collection in this species, five male L. guttulus were submitted to serial semen collections using the catheter method. The dose for semen collection was 0.008mg/kg dexmedetomidine and 10mg/kg ketamine. The mean values for volume and concentration were 35.9µL and 552.8x106sptz/mL, with a mean of 71% motility, 3.1 vigor, and 68% of spermatozoa presented vitality and 77% presented acrosomal integrity. Sperm pathologies obtained an average of 28% of spermatozoa with major defects, 6% of spermatozoa with minor defects and 67% of normal spermatozoa. The method advantages such as ease and low cost lead us to recommend the use in L. guttulus, since it presented good results regarding sperm concentration, motility, vigor, sperm viability and acrosomal integrity, being a promising technique for use in wild cats.(AU)

Comparação dos meios de preparação e preservação de membrana amniótica humana para uso no tratamento de doenças da superfície ocular / Comparison of the preparation and preservation techniques of amniotic membrane used in the treatment of ocular surface diseases

Resumo Atualmente a membra amniótica (MA) tem obtido importância devido à comprovada capacidade de reduzir inflamação, auxiliar a cicatrização e epitelização, possuindo propriedades antimicrobianas e antivirais, além de baixa imunogenicidade. As indicações de seu uso na oftalmologia têm aumentado muito nas duas últimas décadas. Objetivo: Descrever a estrutura básica e as propriedades biológicas da MA em relação aos componentes da sua matriz extracelular e fatores de crescimento, as consequências de diferentes técnicas empregadas na sua preservação e esterilização, métodos para remoção do epitélio e a comparação dos custos dos diferentes meios de conservação atualmente empregados. Métodos: Pesquisa nas bases de dados do Portal da Biblioteca Virtual em Saúde (BVS), Pubmed, Cochrane, Scielo e Lilacs com as palavras-chave: membrana amniótica, transplante, reconstrução da córnea, doenças da conjuntiva. Resultados: A literatura é vasta na descrição dos efeitos de diversos agentes e técnicas na preparação da MA, dentre elas sua preservação, esterilização e desepitelização. A membrana desnuda tem sido a escolha para a reconstrução da superfície ocular, pois facilita a cicatrização. Em relação aos agentes conservantes, o glicerol é o meio mais utilizado mundialmente pelo baixo custo e facilidade de manuseio. Conclusão: A comparação das diversas técnicas nos guia na elaboração de protocolos de preparo da MA para uso oftalmológico. A membrana desnuda facilita a cicatrização em relação a com células epiteliais. O glicerol é o meio de conservação mais utilizado pelo baixo custo e facilidade de manuseio.

Abstract Currently, the amniotic membrane (AM) has obtained importance due to its ability to reduce inflammation, helping in the healing and epithelialization processes, having antimicrobial and antiviral properties and low immunogenicity. Its indications in ophthalmology have increased considerably in the past two decades. Objective: To describe the basic structure and biological properties of the AM, the components of the extracellular matrix and growth factors, the consequences of different techniques used in its preservation, and sterilization methods for the epithelium removal. To compare the costs of the different preservation solutions currently employed. Study design: literature review. Methods: Research in BVS databases, PubMed, Cochrane, Scielo and Lilacs with keywords: amniotic membrane transplantation, corneal reconstruction, conjunctival diseases. Results: The literature is vast in describing the effects of different agents and techniques used in the preparation of MA, including its preservation, sterilization and desepithelization. The naked membrane is the choice to reconstruct the ocular surface, as it facilitates the healing course. Regarding the preservatives, glycerol is the most used worldwide due its low cost and easy handling. Conclusion: Comparing different techniques guides us in developing a MA preparation protocol for ophthalmic use. The naked membrane facilitates the healing process compared with the presence of epithelial cells. The glycerol is the most used preservation method because of its low cost and easy handling.

Comparison of sharp dissection, electrocautery, and ultrasonic activated scalpel with regard to endothelial damage, preparation time, and postoperative bleeding during radial artery harvesting

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

El biomodelo porcino en la investigación médica traslacional: del biomodelo al humano en trasplante pulmonar / The porcine biomodel in translational medical research: From biomodel to human lung transplantation

Resumen Introducción. La anatomía humana y porcina son comparables. En consecuencia, el biomodelo porcino tiene el potencial de ser implementado para entrenar al profesional quirúrgico en áreas como el trasplante de órganos sólidos. Objetivo. Describir los procedimientos y hallazgos obtenidos mediante experimentos de medicina respiratoria traslacional con biomodelos porcinos realizados en un laboratorio de experimentación animal, y hacer una revisión comparativa entre el pulmón humano y el porcino. Materiales y métodos. El experimento se llevó a cabo en nueve cerdos de raza híbrida en un laboratorio de cirugía experimental. Se estudiaron la anatomía y la histología de las vías respiratorias mediante fibrobroncoscopia, biopsia bronquial y lavado broncoalveolar. El lavado broncoalveolar se estudió con citología en base líquida y se evaluó con las coloraciones de Papanicolau y hematoxilina y eosina. Se utilizaron técnicas de patología molecular, como inmunohistoquímica, citometría de flujo y microscopía electrónica. Los cerdos se sometieron a neumonectomía izquierda con posterior implante del injerto en otro cerdo experimental. Resultados. Los estudios histopatológicos y moleculares evidenciaron un predominio de macrófagos alveolares (98 %) y linfocitos T (2 %) en el lavado broncoalveolar porcino. En los estudios del parénquima pulmonar porcino se encontró tejido linfoide hiperplásico asociado a las paredes bronquiales. La microscopía electrónica evidenció linfocitos T dentro del epitelio y el diámetro de las cilias porcinas fue similar al de las humanas. Conclusiones. El biomodelo porcino es viable en la investigación traslacional para el entendimiento de la anatomía del sistema respiratorio y el entrenamiento en trasplante pulmonar. La implementación de este modelo experimental podría fortalecer los grupos que planean implementar un programa institucional de trasplante pulmonar en humanos.

Abstract Introduction: Human and porcine anatomy are comparable. In consequence, the porcine biomodel has the potential to be implemented in the training of surgical professionals in areas such as solid organ transplantation. Objectives: We described the procedures and findings obtained in the experiments of translational respiratory medicine with the porcine biomodel, within an experimentation animal laboratory, and we present a comparative review between human and porcine lung. Materials and methods: The experiment was done in nine pigs of hybrid race within a laboratory of experimental surgery. The anatomy and histology of the respiratory tract were studied with fibrobronchoscopy, bronchial biopsy and bronchoalveolar lavage. The bronchoalveolar lavage was studied with liquid-based cytology and assessed with Papanicolau and hematoxylin-eosin staining. Molecular pathology techniques such as immunohistochemistry, flow cytometry, and electronic microscopy were implemented. The pigs were subjected to left pneumonectomy with posterior implantation of the graft into another experimental pig. Results: Histopathologic and molecular studies evidenced predominance of alveolar macrophages (98%) and T-lymphocytes (2%) in the porcine bronchoalveolar lavage. Studies on the porcine lung parenchyma revealed hyperplasic lymphoid tissue associated with the bronchial walls. Electronic microscopy evidenced the presence of T-lymphocytes within the epithelium and the cilia diameter was similar to the human. Conclusions: The porcine biomodel is a viable tool in translational research applied to the understanding of the respiratory system anatomy and the training in lung transplantation. The implementation of this experimental model has the potential to strength the groups who plan to implement an institutional program of lung transplantation in humans.

Use of doppler ultrasound for saphenous vein mapping to obtain grafts for coronary artery bypass grafting

Abstract Introduction: The great saphenous vein is widely used as a graft in coronary artery bypass grafting surgery. Complications due to saphenous vein harvesting can be minimized when using ultrasonography mapping and marking. Objective: To analyze by clinical trial the use of vascular ultrasonography to map the saphenous vein in coronary artery bypass grafting to determine viability and dissection site. Methods: A total of 151 consecutive patients submitted to coronary artery bypass surgery with the use of the great saphenous vein as a graft were selected for this prospective study. They were divided into two groups: Group 1 - 84 patients were submitted to ultrasonographic mapping and marking of the saphenous vein; Group 2 - 67 patients had saphenous vein harvested without any previous study. Both groups were coupled with follow-up on the 1st, 5th and 30th postoperative days. Primary endpoints were need for incision of the contralateral leg and wound complications within 30 days. Results: Both legs had to be incised in 6 (8.95%) patients from Group 2 (P=0.0067). Wound complications occurred in 33 (23.4%) patients within 30 days, 21 (35%) from Group 2 e 12 (14.8%) from Group 1 (OR 3.095, 1.375-6.944, CI 95%, P=0.008). Within 30 days there were 4 (2.8%) deaths, all in Group 2 (P=0.036). Conclusion: The use of vascular ultrasonography for mapping of the great saphenous vein in coronary artery bypass surgery has properly identified and evaluated the saphenous vein, significantly reducing wound complications and unnecessary incisions. It would be advisable to use this noninvasive and easy to use method routinely in coronary artery bypass surgery.

Reactividad vascular in vitro y estudio morfométrico de venas safenas utilizadas como bypass coronario: técnica "no-touch" versus convencional / In vitro vascular reactivity and morphometric study of saphenous veins graft used as coronary bypass: "no-touch" versus conventional technique

Resumen Introducción: Prolongar la permeabilidad de los injertos utilizados en bypass coronario es un desafío constante. Objetivo: Comparar anatomofuncionalmente venas safenas humanas (VSH) extraídas con técnica convencional (TC) vs técnica "no-touch" (NT). Material y Método: Estudio experimental. Se diseccionó VSH con TC y NT en el pabellón de cirugía cardiaca del Hospital Regional de Antofagasta. Las muestras de VSH fueron seccionadas en anillos de 3 mm y conservados en cámaras de órganos aislados con solución Ringer-Krebs. Para evaluar la vasomotilidad se administró norepinefrina (10-6M), papaverina (10-4M), acetilcolina (10-6M) y nitroprusiato de sodio (10-5M). Un segmento de las muestras fue fijado en formalina al 10%, procesado con técnica histológica y analizado bajo microscopía óptica. Las muestras fueron teñidas con hematoxilina-eosina, Verhoeff y orceína. El análisis estadístico fue realizado mediante el software Prism Graphad. Resultados: Reactividad vascular: La vasoconstricción inducida por noradrenalina fue significativamente superior en anillos del grupo NT vs TC (p < 0,0001). La vasodilatación producida por papaverina y acetilcolina fue superior en el grupo NT (p < 0,004) y (p < 0,0003), respectivamente. Estudio morfométrico: El grupo NT presentó túnica muscular (0,755 vs 0,680 mm), adventicia (0,5600 vs 0,4663 mm) y pared total (1,344 vs 0,962 mm) más gruesa que el grupo TC. No hubo diferencias significativas respecto el número de vasa vasorum. Conclusión: El grupo NT responde significativamente mejor a estímulos vasoconstrictores y vasodilatadores. Los resultados se asocian con las diferencias morfométricas.

Introduction: Prolonging of the grafts permeability used in coronary bypass is a constant challenge. Objective: To compare anatomical and functional human saphenous veins (VSH) extracted "No touch" (NT) technique vs conventional technique (TC). Materials and Methods: Experimental study. VSH dissected with CT and NT in the Regional Hospital of Antofagasta cardiac surgery ward. VSH samples were sectioned into 3 mm rings and preserved in isolated organs chambers with Krebs-Ringer solution. To evaluate the vasomotor activity, norepinephrine (10-6M), papaverine (10-4M), acetylcholine (10-6M) and sodium nitroprusside (10-5M) was administered. A segment of samples was fixed in 10% formalin, processed and histological analyzed under light microscopy technique with hematoxylin-eosin, Verhoeff and orceína. Statistical analysis was performed using the Prism software Graphad. Results: Vascular Reactivity: norepinephrine-induced vasoconstriction was significantly higher in the group rings NT vs TC (p < 0.0001). Vasodilation was higher with papaverine and acetylcholine in the NT group (p < 0.004) and (p < 0.0003), respectively. Morphometric study: The NT group presented muscularis (0.755 vs 0.680 mm), adventitious (0.5600 vs 0.4663 mm), and total wall (1.344 vs 0.962 mm) thicker than the TC group. No significant differences in vasa vasorum number identified. Conclusion: The NT group vasoconstrictor and vasodilator responds significantly better. Results correlate with morphometric differences.

Manual de rotinas e procedimentos operacionais padronizados da equipe de captação de orgãos de Goiás / Manual of standardized operational routines and procedures for the organ harvesting team in Goiás

A Central de Transplantes (CET) é um orgão executivo, subordinado Secretaria de Estado da Saúde e tem como responsabilidade planejar, coordenar, acompanhar e controlar todas as atividades de transplantes, ao nível estadual, em observância à legislação vigente referente ao processo de doação, captação, distribuição e transplantes de orgãos e tecidos no Brasil. Afim de organizar as atividades da CET-GO, criou-se este manual de rotina e procedimentos operacionais da Central de Transplantes de forma a oferecer qualidade e segurança nas tarefas executadas e resultados esperados

The Transplant Center (CET) is an executive body, subordinated to the State Health Department and is responsible for planning, coordinating, monitoring and controlling all transplant activities at the state level, in compliance with current legislation regarding the donation process, capture, distribution and transplantation of organs and tissues in Brazil. In order to organize the activities of CET-GO, this manual of routine and operational procedures of the Transplant Center was created in order to offer quality and safety in the tasks performed and expected results

Laparoscopic donor nephrectomy in unusual venous anatomy - donor and recepient implications

ABSTRACT Objectives Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate. Materials and methods Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data. Results Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. Conclusion Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

Avaliação do conhecimento de médicos com especialidade em clínica médica e clínica cirúrgica sobre o processo de doação de córneas / Evaluation of knowledge of physicians with specialty in medical clinic and surgical clinic about the process of corneas donation

Resumo Objetivo: Este trabalho tem como objetivo avaliar o conhecimento de médicos com formação nas especialidades de clínica médica e cirúrgica acerca do processo de doação de córneas, bem como avaliar a segurança por parte desses profissionais neste processo e, se há insegurança, os motivos para tal. Métodos: A pesquisa se baseia na coleta de dados por meio de um questionário com dez perguntas de múltipla escolha sobre o processo de doação de córneas, sendo duas perguntas sobre segurança no processo de doação. A amostra consiste em 60 profissionais médicos do Hospital Universitário HU-UFSC selecionados por conveniência e não probabilística. Resultados: Os entrevistados obtiveram uma média de acertos de 72,2%. Em relação à segurança no processo de doação de córneas, 41 (68,66%) referem se sentir seguros quanto ao mesmo e 19 (31,33%) revelam não ter segurança para essa condição. Do total de entrevistados que revelaram insegurança no processo de doação de córneas, 13 apontaram como fator contribuinte pouca informação sobre o assunto na faculdade. Alguns temas relevantes a respeito do assunto se mostraram insuficientes e 31,66% dos entrevistados se revelaram inseguros frente a uma situação que envolva doação de córneas. Conclusão: Esses achados sugerem a necessidade de melhorar o nível de informação transmitida durante o curso de graduação acerca do processo de doação de córneas, a fim de conscientizar, melhorar o conhecimento e promover segurança frente a um potencial doador.

Abstract Objective: This study aims to evaluate the knowledge of physicians trained in Internal medicine and General surgery specialties about cornea donation process clinic, as well as to assess the confidence by these professionals in this process and, if there is uncertainty, the reasons for this. Methods: The research is based on data collected through a questionnaire with ten multiple choice questions about the process of cornea donation, in which two questions are about confidence in the donation process. The sample consists of 60 physicians of University Hospital HU-UFSC selected for convenience and non-probability. Results: Respondents had a mean score of 72.2%. Regarding confidence in the donation of corneas, 41 (68.66%) feel confident in the donation process and 19 (31.33%) did not reveal safety for this condition. From the total of respondents who revealed insecurity in cornea donation process, 13 of these indicated as a contributing factor little information on the subject in college. Some relevant themes on the subject are insufficient and 31.66% of the interviewees proved insecure against a situation involving the corneal donation. Conclusion: This finds suggest the need to improve the level of information transmitted during the undergraduate course about the process of corneal donation in order to raise awareness, improve knowledge and promote confidence when facing a potential donor.

Establishment of an anesthetic protocol for semen collection by electroejaculation in six-banded armadillos (Euphractus sexcinctus Linnaeus, 1758) / Estabelecimento de um protocolo anestésico para coleta de sêmen por eletroejaculação em tatus-peba (Euphractus sexcinctus Linnaeus, 1758)

The aim was to verify the effects of different anesthetic protocols used during electroejaculation (EEJ) in six-banded armadillos (Euphractus sexcinctus). Four sexually matured animals were physically restrained and subjected to semen collection by the EEJ following three treatments: The control group consisted of no use of anesthesia; in the others, the anesthetic combinations xylazine/ketamine/propofol or butorphanol/ ketamine/propofol were administered. For each group, twelve procedures were conducted for EEJ. Semen was evaluated for volume, color, aspect, motility, sperm concentration, morphology, viability, and functional membrane integrity. The highest efficiency (100% ejaculates) was achieved when the control group was used; the xylazine/ketamine/propofol association provided only 11 ejaculates from a total of 12 attempts (91.6% efficiency), while only 4 ejaculates (33% efficiency) were obtained with butorphanol/ketamine/propofol (P<0.05). Both protocols provided rapid induction and relaxation enough to perform the EEJ. In the use of butorphanol/ketamine/propofol, the animals recovered at 16.5±1.5min, a time shorter than in the use of xylazine/ketamine/propofol protocol, 20.7±1.0min (P>0.05). The semen volume and sperm concentration obtained in the use of xylazine/ketamine/propofol association were significantly higher than those verified for butorphanol/ketamine/propofol protocol. In conclusion, the xylazine/ketamine/propofol association is indicated for anesthesia of six-banded armadillos submitted to EEJ.(AU)

Objetivou-se verificar os efeitos de diferentes protocolos anestésicos usados durante a eletroejaculação (EEJ) em tatus-peba (Euphractus sexcinctus). Quatro animais sexualmente maduros foram contidos fisicamente e submetidos à coleta de sêmen por EEJ, seguindo três tratamentos: o grupo controle consistiu do não uso de anestesia; nos outros, foram administradas combinações anestésicas de xilazina/cetamina/propofol, ou butorfanol/cetamina/propofol. Para cada grupo, foram conduzidos 12 procedimentos de EEJ. O sêmen foi avaliado para volume, cor, aspecto, motilidade, concentração de espermatozoides, morfologia, viabilidade e integridade funcional da membrana. A mais alta eficiência (100% de ejaculados) foi alcançada quando o grupo controle foi utilizado; a associação de cetamina/xilazina/propofol forneceu apenas 11 ejaculados de um total de 12 tentativas (de eficiência 91,6%), enquanto apenas quatro ejaculados (eficiência de 33%) foram obtidos com butorfanol/cetamina/propofol (P<0,05). Ambos os protocolos forneceram rápida indução e relaxamento suficientes para executar a EEJ. Na utilização de butorfanol/cetamina/propofol, os animais se recuperaram em 16,5±1,5min, um tempo mais curto do que no uso de xilazina/cetamina/protocolo de propofol, 20,7±1,0min (P>0,05). O volume de sêmen e a concentração espermática obtidos no uso da associação xilazina/cetamina/propofol foram significativamente maiores do que os verificados para o protocolo butorfanol/cetamina/propofol. Em conclusão, a associação de cetamina/xilazina/propofol é indicada para anestesia de tatus-peba submetidos à EEJ.(AU)

Reproductive biology of Pêga Jackasses: characteristics of sperm-rich fraction collected using the split-ejaculate method / Biologia reprodutiva de jumentos da raça Pêga: características da fração rica em espermatozoides coletada de forma fracionada

The aim of this study was to evaluate the physical and morphological characteristics of the sperm-rich fraction of jackass semen. To this end, 130 ejaculates from five Pêga jackasses were collected using an open model artificial vagina. The sperm-rich fraction was collected using the split-ejaculate method and assessed for the number of mounts/ejaculate, for physical and morphological characteristics of the semen and number of doses produced/ejaculate. It was observed that all characteristics evaluated differed among the five jackasses, except for the head defect rates. The mean values obtained for the jackass sperm-rich fraction collected were: number of mounts/ejaculate - 1.27; semen volume - 20.21mL; motility - 84.53%; vigor - 4.46; motility after dilution - 80.10%; sperm concentration/mL - 894.38 x 10 6; total sperm/ejaculate - 16.14 x 10 9; number of insemination doses/ejaculate (400x10 6 motile sptz) - 33.39; number of insemination doses/ejaculate (800 x 10 6 motile sptz) - 16.69; and percentage of normal sperm - 90.46%. Thus, in the present experiment the split-ejaculate method using an open artificial vagina worked well with the jackasses, and the sperm-rich fraction of the ejaculate of Pêga jackasses had high quality and sperm concentration, allowing its use for semen processing without reducing the number of insemination doses produced per ejaculate.(AU)

Foram coletados 130 ejaculados de cinco jumentos da raça Pêga, utilizando-se vagina artificial modelo aberta, com o objetivo de se avaliar as características físicas e morfológicas da fração rica em espermatozoides do ejaculado de asininos. Para tal, a fração rica em espermatozoides, composta pelos três primeiros jatos ejaculados, foi coletada e avaliada quanto ao número de montas/ejaculado, quanto às características físicas e morfológicas do sêmen, bem como quanto ao número de doses inseminantes produzidas/ejaculado. Observou-se que todas as características avaliadas diferiram entre os cinco reprodutores avaliados, com exceção do percentual de defeitos de cabeça. Os valores médios obtidos da coleta da fração rica do ejaculado de jumentos foram: número de montas/ejaculado - 1,27; volume de sêmen - 20,21mL; motilidade - 84,53%; vigor - 4,46; motilidade pós-diluição - 80,10%; espermatozoides/mL - 894,38 x 10 6; espermatozoides/ejaculado - 16,14 x 10 9; número de doses inseminantes/ejaculado (400x10 6 sptz móveis) - 33,39; doses inseminantes/ejaculado (800 x 10 6 sptz/móveis) - 16,69; e percentual de espermatozoides normais - 90,46%. Assim, no presente experimento, observou-se boa aceitação dos reprodutores à coleta fracionada utilizando-se a vagina artificial aberta, sendo a fração rica do ejaculado de jumentos da raça Pêga caracterizada por alta qualidade e concentração espermática, o que viabilizou sua utilização para o processamento do sêmen, sem prejuízos quanto ao número de doses inseminantes produzidas/ejaculado.(AU)

Effect of lima harvesting technique on postoperative drainage in off-pump CABG

Abstract Objective: We investigated the effects of pedicled and semiskeletonized left internal mammary artery (LIMA) harvesting techniques on postoperative drainage in patients subjected to off-pump CABG, ignoring other advantages or disadvantages of those techniques. Methods: The present study comprises a total of 160 subjects that underwent coronary artery bypass surgery in our clinic. Data were collected consecutively and retrospectively. An attempt was made to have similar groups in terms of demographic characteristics. Patients that underwent off-pump coronary artery bypass surgery by two surgical teams which differed only in LIMA harvesting technique were dichotomized and compared according to these techniques. The first group (Group 1) consisted of patients in whom LIMA was harvested with surrounding tissues using the pedicled technique. The second group (Group 2) consisted of patients in whom LIMA was harvested using the semiskeletonized technique, with the veins separated from surrounding connective tissues. Results: The mean amount of drainage in the first 24 hours was 706.1±234.2 ml vs. 591±258.8 ml (Group 1 vs. Group 2; P=0.005), the mean amount of drainage in the second 24 hours was 270±133.6 ml vs. 189.4±140.4 ml (Group 1 vs. Group 2; P<0.001), and the mean amount of total drainage was determined to be 976.1±306.9 ml vs. 781.2±335.5 ml (Group 1 vs. Group 2; P<0.001). Conclusion: It was observed that semiskeletonized LIMA presents reduced amount of postoperative drainage in the first and second 24-hour periods and total amount of drainage than pedicled LIMA, independent of pleural integrity.

Alternative solution for ex vivo lung perfusion, experimental study on donated human lungs non-accepted for transplantation

PURPOSE: To evaluate a new perfusate solution to be used for ex vivo lung perfusion. METHODS: Randomized experimental study using lungs from rejected brain-dead donors harvested and submitted to 1 hour of ex vivo lung perfusion (EVLP) using mainstream solution or the alternative. RESULTS: From 16 lungs blocs tested, we found no difference on weight after EVLP: Steen group (SG) = 1,097±526g; Alternative Perfusion Solution (APS) = 743±248g, p=0.163. Edema formation, assessed by Wet/dry weigh ratio, was statistically higher on the Alternative Perfusion Solution group (APS = 3.63 ± 1.26; SG = 2.06 ± 0.28; p = 0.009). No difference on PaO2 after EVLP (SG = 498±37.53mmHg; APS = 521±55.43mmHg, p=0.348, nor on histological analyses: pulmonary injury score: SG = 4.38±1.51; APS = 4.50±1.77, p=0.881; apoptotic cells count after perfusion: SG = 2.4 ± 2.0 cells/mm2; APS = 4.8 ± 6.9 cells/mm2; p = 0.361). CONCLUSION: The ex vivo lung perfusion using the alternative perfusion solution showed no functional or histological differences, except for a higher edema formation, from the EVLP using Steen Solution(r) on lungs from rejected brain-dead donors. .

Perforator Flap versus Conventional Flap

The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. In fact, some of the flaps used by microsurgeons were perforator flaps. The only difference is the anatomical level of the blood vessels involved; the perforator concept is focused on the distal circulation, so-called 'perforator'. Therefore, thinner sections of tissue can be taken from the conventional donor sites of myocutaneous flaps. With the use of perforators, there are no longer "flap of choice" for specific reconstructions, because conventional donor sites have become universal donor sites, enabling the harvesting of a variety of flaps. Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved. Therefore, tissues can be efficiently customized and tailored into any configuration required for reconstruction. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery. No doubt the technique will continue to evolve.

Lavado vesical de bovinos com hematúria enzoótica: padronização de técnica de colheita, obtenção de amostras e avaliação citopatológica / Bovine urinary bladder washing with enzootic hematuria: standardization of harvesting technique, sample collection and cytopathological evaluation

A hematúria enzoótica bovina é uma doença crônica que causa neoplasias na bexiga, e o exame citopatológico poderia auxiliar no diagnóstico precoce. Objetivou-se padronizar a técnica de colheita, obtenção de amostras e avaliação citopatológica do lavado vesical de bovinos com hematúria enzoótica bovina. Foram utilizadas 10 vacas, adultas, distribuídas em dois grupos. No grupo A foi recuperado todo o líquido vesical infundido, no grupo B foi recuperado apenas o último lavado. Os lavados foram submetidos à avaliação citopatológica. Apesar do volume final de líquido vesical ter sido maior no grupo A, em relação ao número de células, não houve diferença significativa (p > 0,05) entre os grupos. A quantidade de células inflamatórias e células epiteliais obtidas por amostra revelou que nos dois grupos todos os animais apresentavam mais células inflamatórias do que epiteliais, entretanto, não houve diferença entre o tipo de colheita realizada. As células epiteliais foram encontradas em 60% dos casos e as alterações morfológicas observadas foram discretas, não sendo possível classificar nenhuma amostra como hiperplásica ou neoplásica. Os dados deste estudo permitiram concluir que o exame citopatológico do lavado vesical de bovinos pode auxiliar no diagnóstico da hematúria enzoótica bovina e que os dois métodos de colheita empregados mostraram-se adequados para obtenção de amostras viáveis. A avaliação citopatológica permitiu a identificação de lesões não neoplásicas predominantemente inflamatórias. Acredita-se que a utilização de técnicas moleculares com biomarcadores em amostras citológicas seria importante para detectar precocemente lesões pré-neoplásicas ou neoplásicas nesses animais.(AU)

The bovine enzootic hematuria is a chronic disease that causes tumors in the bladder, and the cytophatologic test could assist in the early diagnosis. Aimed to standardize the technique of harvesting, obtaining samples and cytophatologic evaluation of bovine urinary bladder washing with bovine enzootic hematuria, 10 adult cows were divided into two groups: A (all the liquid infused in the bladder was recovered) and B (only the latter liquid was recovered). Liquids recovered were subjected to cytophatological evaluation. It was observed that the final volume of bladder liquid was higher in group A, however, in relation to the number of cells, no significant difference (p > 0.05) was observed between groups. The amount of inflammatory cells and epithelial cells obtained per sample revealed that in both groups all animals had more inflammatory cells than epithelial cells, however, there was no difference between the type of washing done. The epithelial cells were found in 60% of cases, the alterations observed were discretes and it was not possible to classify any sample as hyperplastic or neoplastic. Data from this study showed that the cytophatological examination of bovine urinary bladder washing may aid in the diagnosis of bovine enzootic hematuria and the two harvesting methods employed were adequate for obtaining viable samples. Cytopathological evaluation allowed the identification of non-neoplastic lesions predominantly inflammatory. It is believed that the use of molecular markers in cytological samples is important for early detection of pre-neoplastic or neoplastic lesions in these animals.(AU)

Manejo del potencial donante cadáver / Management of the potential organ donor

Solid organ transplantation is limited by donor availability. The loss of brain function produces hemodynamic, respiratory, hormonal and metabolic changes that lead to hypotension and organ dysfunction. Management of a potential donor is similar to any critically ill patient. Cardiovascular stability and protective ventilatory support must be pursued, aimed at minimizing the local and systemic inflammatory response that is triggered by brain death. There is no consensus on protocols for hormonal supplementation. The administration of vasopressin analogues and steroids may be beneficial under certain conditions. Appropriate medical management helps to optimize the function of different organs prior to transplantation. This may increase the number of harvested organs and improve their functional outcome in the recipient.

O "Heart Team" para transplante cardíaco: organização e funcionamento / The \"Heart Team\" for heart transplantation: organization and operation

O transplante cardíaco é reconhecido como o melhor tratamentopara a insuficiência cardíaca refratária. O Brasil tem um grandepotencial de aumento do número de transplantes, já que atualmenteo aproveitamento dos potenciais doadores é muito baixo. Os pioresresultados do transplante aqui, quando comparados aos dadosinternacionais, decorrem, em parte, da associação de doadorespior cuidados e receptores mais graves, com limitação de acessoaos dispositivos de assistência circulatória. O desenvolvimento decentros transplantadores capazes de melhorar a condição clínicados receptores e de criar condições para aumentar a efetivaçãodos doadores pode ter um impacto positivo no número e nosresultados dos transplantes. A organização do Heart Team, umaequipe multidisciplinar envolvendo profissionais com funçõescomplementares, é essencial para o aprimoramento não só do cuidadoao receptor, mas também de todo o processo envolvido no transplantecardíaco, incluindo a captação de órgãos. A equipe deve ser compostapor cardiologistas clínicos e cirurgiões cardiovasculares dedicadosao transplante cardíaco, outros especialistas (como intensivistas,infectologistas e patologistas) fundamentais no cuidado do receptor,enfermeiros e biomédicos envolvidos na avaliação e cuidado dosdoadores e na captação do órgão, enfermeiros dedicados à assistênciados receptores e uma equipe multidisciplinar envolvida em todo oprocesso, desde a avaliação do paciente com insuficiência cardíacarefratária, potencial candidato ao transplante, até o seguimento esuporte do transplantado cardíaco e seus familiares. Esta abordagemcompleta e harmoniosa que o Heart Team possibilita é certamente ocaminho para o crescimento do transplante cardíaco no Brasil.

Heart transplant is recognized as the treatment of choice forrefractory heart failure. Brazil has a great potential to increase thenumber of heart transplants, as the use of potential donors is nowtoo low. The worst results of heart transplants in Brazil, comparedwith international data, may be, in part, due to the association ofpoor care of donors and poor conditions of recipients, with limitedaccess to circulatory assistance devices. The development of hearttransplant centers capable of improving the clinical conditions ofthe recipients and creating ways to increase the use of donors mayhave a positive impact in the number and results of transplants. Theorganization of a “Heart Team”, a multidisciplinary team evolvingprofessionals with complementary functions, is essential not only toimprove the care of recipients, but also to improve the whole processof heart transplant, including organ harvesting. The team must becomposed of cardiologists and cardiovascular surgeons dedicated toheart transplant, other specialists (such as intensivists, infectologistsand pathologists) who have a crucial role in the care of recipients;nurses and biomedicals evolved in the evaluation and care of donorsand in organ harvesting; nurses dedicated in recipients assistanceand a multidisciplinary team evolved in the whole process, sincethe evaluation of the patient with refractory heart failure, a potentialcandidate for heart transplant, up to the follow-up and support ofheart transplanted patients and their families. This complete andharmonious approach that “Heart Team” enables is certainly theway to improve heart transplant in Brazil.

Epidermal curettage technique (ECT) for tissue harvest from the donor area for melanocyte autologous grafting in cases of vitiligo

Vitiligo is a dermatosis requiring complex treatment. In clinically stable cases, melanocyte autologous grafting has shown good results, using different methodologies for obtaining the donor area: dermatomes, punches, blisters. However, these techniques are complex and require specific instruments. This study presents a simple technique for melanocyte harvest that has been performed in our service for more than ten years and includes epidermal curettage of the donor area, grafting of the obtained material, which was homogenized with saline or hyaluronic acid, on the achromic area, and the application of a semipermeable dressing that is removed 1 week later.