Kidney Autotransplantation: Between the Past and the Future.

PURPOSE OF REVIEW: The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords "autologous transplantation" and "kidney." RECENT FINDINGS: Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency. KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.

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The evolution of acute burn care - retiring the split skin graft.

The skin graft was born in 1869 and since then, surgeons have been using split skin grafts for wound repair. Nevertheless, this asset fails the big burn patient, who deserves an elastic, mobile and robust outcome but who receives the poorest possible outcome based on donor site paucity. Negating the need for the skin graft requires an autologous composite cultured skin and a material capable of temporising the burn wound for four weeks until the composite is produced. A novel, biodegradable polyurethane chemistry has been used to create two such products. This paper describes the design, production, optimisation and evaluation of several iterations of these products. The evaluation has occurred in a variety of models, both in vitro and in vivo, employing Hunterian scientific principles, and embracing Hunter's love and appreciation of comparative anatomy. The process has culminated in significant human experience in complex wounds and extensive burn injury. Used serially, the products offer robust and elastic healing in deep burns of any size within 6 weeks of injury.

History of synthetic materials in alloplastic cranioplasty.

When faced with calvarial defects, surgeons have long searched for repair materials. General criteria include ease of use, low cost, availability, cosmetic shape, and osteointegrative potential. While autologous bone is widely used and favored in contemporary reconstructive procedures, synthetic alternatives have been used throughout history and are necessary in current practice for select cases when autograft reconstruction is not an option (such as cases with severe bony comminution, bone graft resorption, infection, and limited donor site options). For centuries, surgeons have experimented with metals, ceramics, plastics, and later, resorbable polymers. This paper provides a tour of the materials that have been used and experimented with throughout the history of alloplastic cranioplasty.

High-dose therapy with autologous stem cell support for lymphoma--from experimental to standard treatment.

High-dose therapy with autologous stem cell support (HDT) has been a therapeutic option for lymphomas in Norway since as far back as 1987. By restoring bone marrow function through reinfusion of the patient's own stem cells, it is possible to administer cancer treatment in higher and otherwise lethal doses, and thereby achieve better treatment results. Originally stem cells were harvested from bone marrow and the high-dose therapy included total body irradiation, but since the mid 1990s stem cells have been harvested by apheresis and the high-dose therapy has consisted of chemotherapy alone (BEAM chemotherapy). In 1995 the treatment was regionalised and since then it has been performed in all health regions. The HDT procedure was introduced as an experimental treatment in clinical studies with international collaboration. The indications have changed over time, and this is now established treatment for a number of types of lymphoma.

The reconstructive microsurgery ladder in orthopaedics.

Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. The concept of the reconstructive ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article.

The history of autologous fat graft use for prevention of cerebrospinal fluid rhinorrhea after transsphenoidal approaches.

Presented herein is a review of the history of fat graft use in preventing iatrogenic cerebrospinal fluid (CSF) rhinorrhea after transsphenoidal surgery. Since the first transsphenoidal surgeries were described in the early 1900s, the techniques of sellar packing to prevent CSF leak have evolved. Kanavel, Halstead, and Cushing used bismuth- or iodine-soaked gauze. Under Dandy's influence, fascia lata was the first autologous material to be used for the repair and prevention of CSF rhinorrhea. The use of autologous fat graft for this purpose has only been reported in recent decades. Montgomery was the first to use abdominal fat to obliterate the middle ear cavity in 1964, and Collins reported the first transsphenoidal application of fat graft in 1973. Other reports by Kirchner, Tindall, and Wilson followed.

Cryopreservation of ovarian tissue for a decade in Denmark: a view of the technique.

This paper presents the Danish 10-year experience (1999-2009) with cryopreservation (n=386) and autotransplantation of ovarian tissue (n=18). Before applying the technique to humans, the method was thoroughly tested and validated. The cryoprotectant solution was chosen after histological evaluation of mouse and human ovarian tissue after freezing with four different combinations of cryoprotectants. Viability was confirmed by transplantation of frozen-thawed human ovarian tissue (n=49) to oophorectomized Nude mice. Viability after transport of fresh tissue 4-5h prior to freezing had previously been validated. Overnight transport of fresh ovarian tissue prior to cryopreservation was evaluated when human ovarian tissue was kept on ice for 20h and then cryopreserved. The thawed ovarian tissue was transplanted to an oophorectomized Nude mouse and histology confirmed viability. In Denmark 12 women have received a total of 18 autotransplantations of ovarian tissue. All women resumed ovarian function and three healthy babies were born to two women. In both women, the tissue was transported on ice for 4-5h prior to cryopreservation. Ovarian tissue cryopreservation is an important method for fertility preservation; however, before applying the method clinically, each laboratory should perform thorough validation of their technique.

[Pioneers and martyrs: Delpech, Guinard, Pozzi]. / Pionniers et martyrs : Delpech, Guinard, Pozzi.

Jacques Mathieu Delpech, Aimé Guinard Samuel Pozzi, three famous surgeons of the 19th and early 20th century were murdered by patients. All three contributed to the history of plastic surgery. Delpech (1777-1832) carried out the first plastic surgery in France using a forehead flap to replace a loss of substance on the face, Guinard (1856-1911) did the first reduction mammaplasty. Pozzi (1846-1918) was probably the first to perform an operation of face lift on one of his patients but did not publish it. These three surgeons were killed by unbalanced patients they had operated of benign lesions.

George (1830-72) and his son James Hogarth (1863-1941) Pringle: unsung surgical pioneers.

The achievements of the Hogarth Pringles, father and son, represent a remarkable story of surgical innovation; remarkable not only for the range and significance of their contributions but also because neither of them has been given appropriate recognition for their pioneering work. George Hogarth Pringle introduced antiseptic surgery to Australia. His son James performed the first autologous vein graft in Britain and the first excision with en bloc nodal dissection for malignant melanoma, both of which procedures were successful. He was also one of the earliest exponents of hindquarter amputation, was a national authority on fracture management and an early supporter of women in medicine.

Activity survey and historical perspective of autologous stem cell transplantation in Europe.

Autologous hematopoietic stem cell transplantation (HSCT) has a long tradition in Europe. Initially developed as a tool to restore rapid remission or chronic phase in patients with advanced leukemia without a sibling donor, it evolved over the last three decades to be used as a standard tool in patients with malignancies that are responsive to high-dose chemoradiotherapy. Autologous HSCTs are the standard of care for defined patients with lymphoid malignancies and for certain solid tumors of childhood. They continue to be evaluated in acute myeloid leukemia and are being investigated in phase II and III studies for defined severe autoimmune disorders. More than 15,000 such procedures, mainly peripheral blood stem cell transplants, are performed annually in Europe, which corresponds to double the number of allogeneic HSCTs. These numbers emphasize the important role of this type of therapy at its current stage.

Trasplante de tejido vascular: recuento histórico y utilización clínica / Vascular tissue transplant: review and clinical utilization

Se realiza un recuento histórico y se muestra nuestra experiencia clínica en el trasplante de tejido vascular. Desde febrero de 1986 a febrero de 2003, se han implantado aloinjertos arteriales a 13 enfermos, obtenidos de donante cadáver en muerte encefálica. Las indicaciones operatorias fueron diversas y la localización de los injertos fue múltiple. El comportamiento biológico de los aloinjertos se evaluó regularmente desde el punto de vista clínico y ecográfico, la trombosis del injerto resultó la complicación más frecuente. Los aloinjertos son altamente resistente a la infección y sustitutos arteriales con perspectiva de utilización a corto y mediano plazo