RESUMO
We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral subcostal incision revealed a large right side anterior diaphragmatic defect with a hernia containing the ascending colon, the majority of the transverse colon and a huge amount of omentum. Also a second smaller defect was found on the left side with no hernia inside. After large bowel and omentum had been taken down to the peritoneal cavity, both defects were primarily closed using interrupted nylon sutures without the use of a mesh. The patient recovered very well, had an uneventful postoperative course and was released on the 5th postoperative day. 15-month follow-up failed to reveal any signs of recurrence.
RESUMO
Hyaluronan accumulates at sites of inflammation, which affects the organization of matrix and thereby the proliferation, migration, and adherence of cells. In this study we investigated possible beneficial effects of the hyaluronan-degrading enzyme hyaluronidase on rat liver graft viability. Orthotopic rat liver transplantation was performed using a cuff technique in Wistar AL Bacharach Glaxo (WAG) rats grafted with WAG livers, which had been stored in the University of Wisconsin (UW) solution or in UW solution enriched with testicular hyaluronidase. Liver tissue architecture, as well as tissue and serum hyaluronan levels, were determined using immunohistochemistry and biochemical assays. Addition of testicular hyaluronidase (0.4 mg/mL) to livers preserved for 24 hours in cold UW solution followed by brief exposure to Ringer's lactate both prolonged the function of the grafted livers and improved their viability (4 of 10 grafts survived, compared with 0 of 10 in the control group). Hyaluronidase treatment did not damage the liver tissue architecture, and a reduced edema was observed in the survivors. Furthermore, 10 minutes after restoration of circulation, higher serum hyaluronan levels were observed in nonsuccessful compared with successful transplantations, whereas no differences in the levels of other serum viability markers were detected. We conclude that addition of testicular hyaluronidase to storage UW solution limits liver cell damage and considerably improves graft function. Furthermore, our data suggest that serum hyaluronan level is a better marker than other serum markers for early evaluation of postoperative graft function.
