Diagnóstico y cirugía radioguiada de nódulos pulmonares / Diagnosis and radio-guided surgery of lung nodules

La detección de nódulos pulmonares se ha incrementado en las últimas décadas debido a la introducción de los programas de cribado del cáncer de pulmón y al aumento de las exploraciones rutinarias de tomografía computarizada en los pacientes con neoplasias. La biopsia percutánea de estos nódulos no siempre permite caracterizarlos, por lo que en ocasiones es necesaria la biopsia quirúrgica, que a menudo requiere de localización prequirúrgica. La resección radioguiada de lesiones ocultas (ROLL) descrita para las lesiones mamarias se aplicó por primera vez en la resección de nódulos pulmonares en el año 2000, siendo en la actualidad una alternativa a otras técnicas de localización prequirúrgica como la resección guiada por arpón. La técnica aporta elevada tasa de detección con mínima morbimortalidad, potenciando el trabajo multidisciplinar entre los especialistas en Medicina Nuclear y los especialistas de radiodiagnóstico y cirugía torácica. En este trabajo, se describen las diferentes técnicas de localización prequirúrgica disponibles, los procesos metodológicos de la técnica ROLL y los resultados acumulados en 20 años de experiencia

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massively use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy of these nodules does not always characterize them, so sometimes a surgical biopsy is necessary, which often requires a presurgical localization. The radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the collected results in 20 years of experience

Diagnosis and radio-guided surgery of lung nodules. / Diagnóstico y cirugía radioguiada de nódulos pulmonares.

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massively use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy of these nodules does not always characterize them, so sometimes a surgical biopsy is necessary, which often requires a presurgical localization. The radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the collected results in 20 years of experience.

First Report of Lettuce big-vein associated virus (Varicosavirus) Infecting Lettuce in Mexico.

Lettuce (Lactuca sativa) is a common consumed vegetable and a major source of income and nutrition for small farmers in Mexico. This crop is infected with at least nine viruses: Mirafiori lettuce big-vein virus (MiLBVV), Lettuce big-vein associated virus (LBVaV), both transmitted by the soil-borne fungus Olpidium brassicae; Tomato spotted wilt virus (TSWV), Tomato chlorotic spot virus (TCSV), Groundnut ringspot virus (GRSV), Lettuce mottle virus (LMoV), Cucumber mosaic virus (CMV), Bidens mosaic virus (BiMV), and Lettuce mosaic virus (LMV) (1). From March to May 2012, a disease on lettuce was observed in the south region of Mexico City displaying mild to severe mosaic, leaf deformation, reduced growth, slight thickening of the main vein, and plant death. At the beginning of the epidemic there were just a few plants with visible symptoms and 7 days later the entire crop was affected, causing a loss of 93% of the plants. It was estimated by counting the number of severely affected or dead plants in three plots. No thrips, aphids, or whiteflies were observed in the crop during this time. Twenty plants with similar symptoms were collected and tested by RT-PCR using the primers LBVaVF 5'-AACACTATGGGCATCCACAT-3' and LBVaVR 5'-GCATGTCAGCAATCAGAGGA-3' specific for the coat protein gene of LBVaV, amplifying a 322-bp fragment. Primers CP829F 5'-CCWACTTCATCAGTTGAGCGCTG-3' and CP1418R 5'-TATCAGCTCCCTACACTATCCTCGC-3' were used to detect MiLBVV (2). No amplification was obtained for MiLBVaV in any plants tested. PCR products of approximately 300 bp were obtained from four out of 20 symptomatic lettuce samples tested for LBVaV, but not from healthy plant and water controls. These results suggest the presence of another virus in symptomatic lettuce plants. Amplicons were gel-purified and sequenced using LBVaVF and LBVaVR primers. A consensus sequence was generated using the Bioedit v. 5 program. Both sequences of these Mexican lettuce isolates were 100% identical (Accession Nos. KC776266.1 and KC776267.1) and had identities between 94 and 99% to all sequences of LBVaV available in GenBank. Additionally, when alignments were made using ClustalW, these sequences showed identities of 99.7% to Almeria-Spanish isolate (Accession No. AY581686.1); 99.4% to Granada-Spanish isolate (AY581689.1); 99.1% to Dutch isolate (JN710441.1), Iranian isolate (JN400921.1), Australian isolate (GU220725.1), Brazilian isolate (DQ530354.1), England isolate (AY581690.1), and American isolate (AY496053.1); 96.2% to Australian isolate (GU220722.1); 96.3% to Japanese isolate (AB190527.1); and 92.8% to Murcia-Spanish isolate (AY581691.1). Twenty lettuce plants were mechanically inoculated with leaf tissue taken from the four plants collected in the field and tested positive for LBVaV by RT-PCR; 12 days after inoculation, mosaic symptoms were observed in all inoculated plants and six of them were analyzed individually by RT-PCR obtaining a fragment of the expected size. To our knowledge, this is the first report of LBVaV infecting lettuce in Mexico. Further surveys and monitoring of LBVaV incidence and distribution in the region, vector competence of olpidium species, and impact on the crop quality are in progress. References: (1) P. M. Agenor et al. Plant Viruses 2:35, 2008. (2) R. J. Hayes et al. Plant Dis. 90:233, 2006.

Esteatocistoma múltiple: relación clínico-radiológica / No disponible

El esteatocistoma múltiple es un raro trastorno cutáneo caracterizado por múltiples pequeños nódulos quísticos hamartomatosos compuestos por los diferentes tejidos de los conductos pilosebáceos situados en tórax, axilas y miembros superiores. En algunas ocasiones esta entidad pasa desapercibida observándose sólo los hallazgos en los estudios de imagen, entre los cuales se encuentra la mamografía. En la mamografía se observan múltiples nódulos hipodensos intradérmicos, bien delimitados, de paredes finas no calcificadas, bilaterales y de distribución periférica. Ecográficamente estos nódulos son hipoecoicos, bien delimitados y con refuerzo posterior. Es por esta razón que el radiólogo debe conocer esta entidad y tenerla presente para llegar al diagnóstico correcto. Presentamos un caso clínico donde la mamografía y la ecografía mostraron lesiones típicas de esta patología y posteriormente la exploración física dio el diagnóstico definitivo(AU)

Steatocystoma multiplex is a rare cutaneous syndrome characterized by multiple small intradermal yellowish nodules located in the thorax, axillae, and upper limbs. Sometimes, this entity goes unnoticed and is shown in imaging studies like mammography. The mammogram shows multiple bilateral hypodense intradermal nodules with well-defined margins and thin, non-calcified walls in the periphery of the breast. At ultrasonography, these nodules are hypoechoic with well-defined margins and posterior echogenicity. Thus, it is important for radiologists to be familiar with steatocystoma multiplex to reach the correct diagnosis. We present a case in which mammography and sonography showed typical lesions of steatocystoma multiplex and later physical examination provided the diagnosis(AU)

[Technical aspects of isolated organ perfusion devices]. / Aspectos técnicos de los dispositivos de perfusión de órgano aislado.

An aspect of capital importance in the transplant field is the maintainance and preservation of organs during the ischemic phase. Organ susceptibility and injuries secondary to ischemia, organ procurement and transportation are still nowadays one of the main causes for organ failure. Effective artificial organ perfusion has remained a main goal for researchers in this field for more than 100 years. In the second half of the XXth century these techniques have been applied to experimental and clinical organ preservation, with the aim of extending the period of an effective storage (which guarantees an early and good function after the transplant). Primary goal of any organ preservation is to maintain integrity in every cell system in order to minimize those injuries which produces graft dysfunction.

[Pharmacological preconditioning with sildenafil of warm ischemic kidneys]. / Precondicionamiento farmacológico con sildenafilo del riñón con isquemia normotérmica.

OBJECTIVES: To evaluate the preconditioning effect of sildenafil administered preoperatively in kidneys subjected to a period of warm ischemia (WI), hypothermic perfusion (HP) or cold storage (CS) and finally, autotransplant (AT). MATERIAL AND METHOD: We studied 6 groups of autotransplanted kidneys: no-WI-inmediate AT (Group A); 45 min of WI + immediate AT (Group B); 45 min of WI + 60 min of HP + autotransplant (Group C); 45 min of WI + 60 min of CS + autotransplant (Group D); 100 mg of oral sildenafil preoperatively + 45 min of WI + autotransplant (Group E); 100 mg of oral sildenafil preoperatively + 45 min of WI+60 min of HP + autotransplant (Group F). Belzer solution was used for HP; UW-Viaspan for CS. Inmediately after the autotransplant (reperfusion period), we recorded in real time for 60 min the values of Renal vascular Flow (RVF) and Renal Vascular Resistance (RVR). Nitric Oxide levels in the cava and renal graft vein were recorded every 15 min during the 60 min of the reperfusion-study period. Conventional & Electronic microscopy were completed after the process. RESULTS: We obtained significant higher values of RVF and lower values of RVR in sildenafil groups (E and F) in comparison to the other groups (A-D) (Table 1). NO levels were also significantly higher in groups E and F (Fig. 1). Groups A, B, E and F showed integrity of tubule and endothelium in comparison to groups C and D in the microscopic study. CONCLUSIONS: We showed a beneficious effect of sildenafil in inmediate post-transplant reperfusion hemodynamic and biochemical parameters of kidneys subjected to a critical period of warm-ischemia.

[Hystologic and hemodynamic aspects of warm ischemic graft in relation to the preservation method]. / Caracterización histoló6gica y hemodinámica del injerto con isquemia caliente según el método de preservación.

OBJECTIVE: The non-heart-beating donor has been proposed as a solution to donor shortage for renal transplantation. Because the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia (WI), and so potentially they may never function. Minimizing graft injury is especially important in case of transplantation form marginal donors because of a high rate of delayed graft function or primary nonfunction. The aim of this experimental study is to assess the structural and hemodynamic consequences of hypothermic perfusion (HP) versus cold storage (CS), in renal allograft after a period of WI. MATERIAL AND METHODS: We used 20 mini-pigs. WI was achieved by vascular pedicle occlusion during 45 min. We divided organs in 4 groups: A (n=5), kidneys with WI and then transplanted; group B (n=5), grafts with WI and implanted after HP with Belzer solution in our computerized perfusion system. Group C-control, (n=5) transplanted without WI and D (n=5) with WI and 60 min of CS in UW-Viaspan solution. All the procedure was recorded by a computerized data system. Renal vascular resistance (RVR) and renal vascular flow (RVF) were automatically calculated by means of mathematical formulas after renal transplantation. Subsequently histological study was completed in all cases. RESULTS: We observed two patterns after transplantation: (1). Initial increase of RVR with posterior decrease and increase of vascular flow: in organs with WI and HP prior to transplantation (group B) // organs transplanted without WI (group C-control). Electronic and conventional microscopy showed integrity of endothelial and tubule structure. (2). Initial decrease with posterior increase of RVR. Organs with WI (group A) // organs with WI and CS (group D). Structural study showed endothelial and tubule disruption. CONCLUSION: In our experimental model machine perfusion preserves endothelial and tubule structure of kidneys with WI. After transplantation the hemodynamic pattern of grafts with WI and HP is similar to the control group (without WI and direct transplantation).

[Ischemia-reperfusion syndrome and role of preservation graft technique after laparoscopic versus open nephrectomy in a experimental model of living donor kidney transplant]. / Evaluación del síndrome isquemia-reperfusión y papel de la preservación del injerto en la extracción renal laparoscópica versus abierta en un modelo experimental porcino de donante vivo.

INTRODUCTION: Delayed graft function alter living donor transplantation is a subject of debate. Delayed graft function can be partially explained by renal ischemia-reperfusion injury, when severe is associated with decreased graft survival. In this experimental living donor model study, we analyze the hemodynamic, histological and biochemical effects of laparoscopic nephrectomy. We also, analyze the effect of a pulsatile machine perfusion for kidney preservation during cold ischemia time. MATERIAL AND METHODS: Twenty large-white pigs (average weight 40-45 kgrs) were divided in 4 experimental groups: Group A: Laparoscopic nephrectomy+ immediate graft perfusion in pulsatile vacuum pump+autotransplant Group B: Laparoscopic nephrectomy+ immediate graft perfusion by gravity+autotransplant Group C: Open nephrectomy+immediate graft perfusion in pulsatile vacuum pump+autotransplant Group D: Open nephrectomy+ immediate graft perfusion by gravity+autotransplant Both laparoscopic and open nephrectomy were completed transperitoneally according to standardized technique. Hypothermic perfusion was done in a system designed in our lab. RESULTS: We observed a decreased renal artery flow in kidneys procured laparoscopically compared to open nephrectomy. We found an artery flow recovery during the first 60 minutes after revascularization. Renal machine perfusion during cold ischemia time seems to have no beneficial effect, but shows a deleterious effect on hemodynamic event for renal transplantation. Lower plasma nitric oxide level is observed in kidneys obtained by laparoscopy compared with open surgical technique. And finally, we also found higher histological damage in proximal tubular and endothelial cell, in kidneys obtained by laparoscopy compared with open surgery. CONCLUSIONS: In our experience: Laparoscopic nephrectomy versus open nephrectomy produces, in a model of living donor transplant, a lower value or renal blood flow and a higher value of renal vascular resistanse. These hemodynamic findings tend to normalize by 60 min after the reperfusion. A lower blood concentration of nitric oxide after the transplant was detected in laparoscopic group Vs open surgery group.

[Experimental renal preservation units: is this activity necessary in Spain?]. / Unidades de preservación renal experimental. Es necesaria esta actividad en España?

Renal graft preservation research is considered complementary but at the same time important activity in high-quality Kidney Transplant Programs. It provides information on limitations of kidneys to be transplanted and to discard those organs with high probability of failure. Unification of criteria in the selection of organs is essential. We think that this activity should be encouraged by Health Institutions although requires investment in staff and technology.

Unidades de preservación renal experimental. ¿Es necesaria esta actividad en España? / Experimental renal preservation units: is this activity necessary in Spain?

La investigación en preservación del injerto renal es una actividad complementaria aunque a la vez fundamental en los Programas de Trasplante Renal de calidad. Permite conocer las limitaciones de los riñones que se implantan y descartar aquellos órganos con mayor probabilidad de fracasar. La unificación de criterios en la selección de órganos es esencial. Creemos que este tipo de actividad debe ser estimulada por las instituciones sanitarias, aunque precisa de inversión para técnica y personal

Renal graft preservation research is considered complementary but at the same time important activity in high-quality Kidney Transplant Programs. It provides information on limitations of kidneys to be transplanted and to discard those organs with high probability of failure. Unification of criteria in the selection of organs is essential. We think that this activity should be encouraged by Health Institutions although requires investment in staff and technology

Aspectos técnicos de los dispositivos de perfusión de órgano aislado / Technical aspects of isolated organ perfusion devices

Un aspecto de gran importancia en el campo de los trasplantes es el mantenimiento y preservación del órgano durante la fase isquémica. La sensibilidad del órgano a ésta y la posible lesión inducida durante la extracción, preservación y transporte, siguen siendo una de las principales causas de fracaso del injerto. La perfusión artificial de órganos ha sido objetivo de investigación durante más de 100 años. En la segunda mitad del siglo XX estas técnicas han sido aplicadas a la preservación experimental y clínica, con el fin de alargar el tiempo de almacenamiento efectivo (aquél que permite una función correcta y precoz tras el trasplante del órgano preservado). La meta primaria de la preservación de cualquier órgano es el mantenimiento de la integridad de todos los sistemas celulares, de tal manera que la posibilidad de lesión que lleve a la disfunción del injerto sea mínima

An aspect of capital importance in the transplant field is the maintainance and preservation of organs during the ischemic phase. Organ susceptibility and injuries secondary to ischemia, organ procurement and transportation are still nowadays one of the main causes for organ failure. Effective artificial organ perfusion has remained a main goal for researchers in this field for more than 100 years. In the second half of the XXth century these techniques have been applied to experimental and clinical organ preservation, with the aim of extending the period of an effective storage (which guarantees an early and good function after the transplant). Primary goal of any organ preservation is to maintain integrity in every cell system in order to minimize those injuries which produces graft dysfunction

Precondicionamiento farmacológico con sildenafilo del riñón con isquemia normotérmica / Pharmacological preconditioning with sildenafil of warm ischemic kidneys

Objetivos: Evaluar el posible efecto pre-condicionador de sildenafilo en riñones sometidos a isquemia normotérmica, perfusión hipotérmica y posterior autotrasplante. Material y Métodos: Estudiamos 6 grupos de órganos autotrasplantados: control sin isquemia y autotrasplante inmediato (grupo A); control con 45 min de isquemia y autotrasplante inmediato (grupo B); isquemia + perfusión del órgano en bomba y autotrasplante (grupo C); isquemia + conservación mediante hipotermia simple en solución UW y autotrasplante (grupo D); 100 mg vo sildenafilo preoperatorio+isquemia+perfusión en bomba y autotrasplante (grupo D); 100 mg vo sildenafilo preoperatorio+ isquemia+ autotrasplante inmediato (grupo E). Evaluamos durante los 60 minutos de reperfusión postrasplante los valores medios de flujo vascular renal (FVR), resistencia vascular renal (RVR), presión arterial sistémica (PAS) y concentración de óxido nítrico en vena del injerto renal (ON). Realizamos estudio histológico mediante microscopia electrónica y convencional en todos los casos. Resultados: Obtuvimos unos valores medios de flujo vascular renal (FVR) mayores, resistencia vascular renal menor (RVR) y concentraciones de óxido nítrico en vena del injerto (ON) mayores en los primeros 60 min de reperfusión renal postrasplante en los grupos E y F frente a A,B,C y D (Tabla 1, Fig. 1). Desde el punto de vista histológico, los órganos sometidos a trasplante sin isquemia, perfundidos tras la isquemia o tratados preoperatoriamente con sildenafilo mostraron integridad túbulo-endotelial en los estudios microscópicos. Conclusiones: Mostramos, por primera vez en la literatura específica, un efecto beneficioso de sildenafilo en los parámetros obtenidos en la reperfusión postrasplante en los riñones sometidos a isquemia normotérmica durante un periodo crítico

Objectives. To evaluate the preconditioning effect of sildenafil administered preoperatively in kidneys subjected to a period of warm ischemia (WI), hypothermic perfusion (HP) or cold storage (CS) and finally, autotransplant (AT). Material and method. We studied 6 groups of autotransplanted kidneys: no-WI-inmediate AT (Group A); 45 min of WI + immediate AT (Group B); 45 min of WI + 60 min of HP + autotransplant (Group C); 45 min of WI + 60 min of CS + autotransplant (Group D); 100 mg of oral sildenafil preoperatively + 45 min of WI + autotransplant (Group E); 100 mg of oral sildenafil preoperatively + 45 min of WI+60 min of HP + autotransplant (Group F). Belzer solution was used for HP; UW-Viaspan for CS. Inmediately after the autotransplant (reperfusion period), we recorded in real time for 60 min the values of Renal vascular Flow (RVF) and Renal Vascular Resistance (RVR). Nitric Oxide levels in the cava and renal graft vein were recorded every 15 min during the 60 min of the reperfusion-study period. Conventional & Electronic microscopy were completed after the process. Results. We obtained significant higher values of RVF and lower values of RVR in sildenafil groups (E and F) in comparison to the other groups (A-D) (Table 1). NO levels were also significantly higher in groups E and F (Fig. 1). Groups A, B, E and F showed integrity of tubule and endothelium in comparison to groups C and D in the microscopic study. Conclusions. We showed a beneficious effect of sildenafil in inmediate post-transplant reperfusion hemodynamic and biochemical parameters of kidneys subjected to a critical period of warm-ischemia

Caracterización histológica y hemodinámica del injerto con isquemia caliente según el método de preservación / Hystologic and hemodynamic aspects of warm ischemic graft in relation to the preservation method

Introducción y Objetivos: Disponer de órganos de donantes a corazón parado abre una vía para solucionar la escasez de órganos para trasplante. Por la naturaleza de estos donantes los riñones sufren un periodo variable de isquemia normotérmica (IN) antes de su extracción, que puede dañar el injerto y condicionar su supervivencia. Minimizar el daño producido al riñón durante la extracción, los diferentes tipos de conservación hipotérmica y su posterior trasplante resulta clave para mejorar los resultados obtenidos con este tipo de injertos. Pretendemos evaluar mediante un modelo experimental, que somete al injerto renal a un periodo de IN, las consecuencias estructurales y hemodinámicas de la perfusión hipotérmica (PH) frente a la hipotermia simple (HS). Material y Métodos: Utilizamos 20 mini-pigs. La IN se realizó siempre mediante oclusión del pedículo vascular durante 45 min. Dividimos los órganos extraídos mediante nefrectomía transperitoneal en 4 grupos: A (n=5), riñones obtenidos tras 45 min. de IN y trasplantados; grupo B (n=5), riñones obtenidos tras IN y trasplantados tras una fase de PH en solución Belzer-gluconato a 4ºC en nuestro modelo de bomba de vacío no oclusiva. Dos grupos adicionales de órganos fueron trasplantados: sin isquemia normotérmica previa (Ccontrol) o tras IN y 60 min de conservación en HS con Viaspan-UW (D). Todo el procedimiento fue monitorizado y registrado mediante un sistema informatizado. La resistencia vascular renal (RVR) y el flujo vascular renal (FVR) fueron registrados en tiempo real tras el desclampaje. Llevamos a cabo estudio histológico mediante microscopía convencional y electrónica. Resultados: Observamos 2 patrones evolutivos post-trasplante: 1. Incremento inicial de RVR con descenso posterior e incremento del flujo vascular: órganos con IN y PH previa al trasplante (grupo B) // órganos sin isquemia previa y trasplante (grupo C-control). Microscopía convencional-electrónica: integridad túbulo-endotelial. 2. Descenso inicial de RVR con incremento posterior: órganos con IN y trasplante directo (A)//órganos con isquemia previa e HS de 60 min. (D). Alteraciones túbulo-endoteliales en micro convencional-electrónica. Conclusiones: La PH en bomba preserva mejor, a nivel experimental, la ultraestructura túbulo-endotelial de los riñones sometidos a IN prolongada. La hemodinámica post-trasplante de los órganos sometidos isquemia y PH sigue un patrón similar a la de los órganos sin IN previa y trasplantados directamente

Objective: The non-heart-beating donor has been proposed as a solution to donor shortage for renal transplantation. Because the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia (WI), and so potentially they may never function. Minimizing graft injury is especially important in case of transplantation form marginal donors because of a high rate of delayed graft function or primary nonfunction. The aim of this experimental study is to assess the structural and hemodynamic consequences of hypothermic perfusion (HP) versus cold storage (CS), in renal allograft after a period of WI. Material and Methods: We used 20 mini-pigs. WI was achieved by vascular pedicle occlusion during 45 min. We divided organs in 4 groups: A (n=5), kidneys with WI and then transplanted; group B (n=5), grafts with WI and implanted after HP with Belzer solution in our computerized perfusion system. Group C-control, (n=5) transplanted without WI and D (n=5) with WI and 60 min of CS in UW-Viaspan solution. All the procedure was recorded by a computerized data system. Renal vascular resistance (RVR) and renal vascular flow (RVF) were automatically calculated by means of mathematical formulas after renal transplantation. Subsequently histological study was completed in all cases. Results: We observed two patterns after transplantation: 1. Initial increase of RVR with posterior decrease and increase of vascular flow: in organs with WI and HP prior to transplantation (group B) // organs transplanted without WI (group C-control). Electronic and conventional microscopy showed integrity of endothelial and tubule structure. 2. Initial decrease with posterior increase of RVR. Organs with WI (group A) // organs with WI and CS (group D). Structural study showed endothelial and tubule disruption. Conclusión: In our experimental model machine perfusion preserves endothelial and tubule structure of kidneys with WI. After transplantation the hemodynamic pattern of grafts with WI and HP is similar to the control group (without WI and direct transplantation)

Evaluación del síndrome isquemia-reperfusión y papel de la preservación del injerto en la extracción renal laparoscópica versus abierta en un modelo experimental porcino de donante vivo / Ischemia-reperfusion syndrome and role of preservation graft technique after laparoscopic versus open nephrectomy in a experimental model of living donor kidney transplant

Introducción: La disfunción inicial del injerto renal extraído por laparoscopia en un donante vivo es un aspecto que, aún hoy, crea ciertas controversias. El síndrome de isquemia-reperfusión explicaría parcialmente esta disfunción inicial del injerto trasplantado que, según su intensidad, puede llegar a condicionar una menor supervivencia del riñón. Analizamos en un modelo experimental de donante vivo la repercusión hemodinámica, bioquímica e histológica de la extracción laparoscópica del injerto. Como objetivo secundario evaluamos el papel de la aplicación de una técnica de preservación (perfusión en bomba) durante los minutos de isquemia fría. Material y metodos: Utilizamos 20 cerdos tipo large-white (peso 40-45 kgrs), que fueron divididos en 4 grupos: Grupo A: Extracción laparoscópica + perfusión inmediata del injerto tras la extracción mediante bomba pulsátil + Autotrasplante Grupo B: Extracción laparoscópica + perfusión por gravedad del injerto + Autotrasplante Grupo C: Extracción por cirugía abierta + perfusión inmediata del injerto tras la extracción mediante bomba pulsátil + Autotrasplante Grupo D: Extracción por cirugía abierta + perfusión por gravedad del injerto + Autotrasplante Las extracciones laparoscópica y por cirugía abierta se realizaron por vía transperitoneal con técnica estandarizada y sistemática. La perfusión hipotérmica en bomba se llevó a cabo mediante un sistema pulsátil diseñado por nuestro grupo. Resultados. Comprobamos que el flujo arterial del riñón trasplantado que previamente fue extraído por laparoscopia, es menor que los extraídos por cirugía abierta, y existe una tendencia a recuperarse tras la primera hora post-reperfusión. La aplicación de un periodo corto de preservación del injerto durante la isquemia fría no mejora el patrón hemodinámico del injerto trasplantado, incluso resulta perjudicial. Por otro lado, la concentración de óxido nítrico en sangre venosa del injerto extraído por laparoscopia fue menor que la de los obtenidos mediante cirugía abierta. Finalmente, el estudio histológico mostró peor conservación de los elementos túbulo-glomerular y endotelial en los órganos extraídos por laparoscopia. Conclusiones: En nuestra experiencia: - La extracción laparoscópica renal en un modelo de donante vivo frente a la extracción abierta, determina un menor flujo renal y mayor resistencia vascular. - Esta alteración hemodinámica de los riñones extraídos por laparoscopia tiene tendencia a corregirse a los 60 minutos tras la reperfusión. - Existe una menor concentración sanguínea de NO en los injertos trasplantados que fueron extraídos por laparoscopia en comparación con el grupo extraídos por cirugía abierta

Introduction: Delayed graft function alter living donor transplantation is a subject of debate. Delayed graft function can be partially explained by renal ischemia-reperfusion injury, when severe is associated with decreased graft survival. In this experimental living donor model study, we analyze the hemodynamic, histological and biochemical effects of laparoscopic nephrectomy. We also, analyze the effect of a pulsatile machine perfusion for kidney preservation during cold ischemia time. Material and methods: Twenty large-white pigs (average weight 40-45 kgrs) were divided in 4 experimental groups: Group A: Laparoscopic nephrectomy+ immediate graft perfusion in pulsatile vacuum pump+autotransplant Group B: Laparoscopic nephrectomy+ immediate graft perfusion by gravity+autotransplant Group C: Open nephrectomy+immediate graft perfusion in pulsatile vacuum pump+autotransplant Group D: Open nephrectomy+ immediate graft perfusion by gravity+autotransplant Both laparoscopic and open nephrectomy were completed transperitoneally according to standardized technique. Hypothermic perfusion was done in a system designed in our lab. RESULTS. We observed a decreased renal artery flow in kidneys procured laparoscopically compared to open nephrectomy. We found an artery flow recorvery during the first 60 minutes after revascularization. Renal machine perfusion during cold ischemia time seems to have no beneficial effect, but shows a deleterious effect on hemodynamic event for renal transplantation. Lower plasma nitric oxide level is observed in kidneys obtained by laparoscopy compared with open surgical technique. And finally, we also found higher histological damage in proximal tubular and endothelial cell, in kidneys obtained by laparoscopy compared with open surgery. Conclusions: In our experience: - Laparoscopic nephrectomy versus open nephrectomy produces, in a model of living donor transplant, a lower value or renal blood flow and a higher value of renal vascular resístanse. - These hemodynamic findings tend to normalize by 60 min after the reperfusion. - A lower blood concentration of nitric oxide after the transplant was detected in laparoscopic group Vs open surgery group

[Usefulness of digestive ultrasonography in the assessment of ulcerative colitis extent]. / Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa.

INTRODUCTION: A full examination of the colon should be avoided upon finding severe endoscopic lesions in patients with ulcerative colitis. However, knowledge of the precise extent of disease is quite important for disease prognosis and the making of therapeutic decisions. Therefore, any validation of a non-invasive technique to assess the extent of ulcerative colitis gains a lot of interest and importance. MATERIAL AND METHOD: The study included patients that were previously diagnosed of having ulcerative colitis or were beginning to suffer from the disease. A prospective and blind evaluation was carried out to determine the precision of digestive ultrasonography in assessment of ulcerative colitis extent. All ultrasonography was carried out by the same person and was always performed prior to carrying out a full endoscopic study, which is used as the gold standard. The hydrocolonic ultrasonograpy technique was not used in any of the cases. RESULTS: A total of 20 patients -13 males (65%) and 7 females (35%), with an average age of 51.7 years (aged between 24-82 years)- were included in the study. Endoscopic studies revealed severe disease in 5 cases (25%), moderate disease in 12 patients (60%), and mild lesions in the 3 remaining cases (15%). A colonic ultrasonogram was considered satisfactory in 18 cases (90%), and the extent of disease as established by ultrasonography was in all cases consistent with that established through colonoscopy: 3 patients (16.6%) had ulcerative proctitis, 9 patients (50%) had left-sided ulcerative colitis, and 6 (33.3%) had extensive colitis. CONCLUSIONS: Digestive ultrasonography allows to study the colon in most patients, especially when inflammatory activity is present, and provides a greater accuracy in assessing ulcerative colitis extent, which is independent of its activity level.

Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa / Usefulness of digestive ultrasonography in assessment of ulcerative colitis extent

Introducción: el hallazgo de lesiones endoscópicas severasen un paciente con colitis ulcerosa desaconseja la realización deuna exploración completa del colon. No obstante el conocimientode la extensión precisa de la enfermedad tiene gran importanciaen las decisiones terapéuticas a tomar y también en el pronósticode la enfermedad. Por todo ello, la validación de una técnica noinvasiva para el estudio de extensión de la colitis ulcerosa cobragran interés e importancia.Material y método: se incluyen en el estudio pacientes condiagnóstico previo de colitis ulcerosa o en el debut de la enfermedady, de forma prospectiva y ciega se evalúa la precisión de laecografía digestiva en la valoración de la extensión de la colitis ulcerosa.Las exploraciones ecográficas son realizadas todas ellaspor el mismo explorador y siempre con anterioridad al estudio endoscópicocompleto, que se usa como patrón oro. No se empleala técnica hidrocolónica en ningún caso.Resultados: han sido incluidos en el estudio 20 pacientes, 13varones (65%) y 7 mujeres (35%), con una edad media de 51,7años (rango de 24 a 82 años). Los estudios endoscópicos mostraronuna afectación severa en 5 casos (25%), moderada en 12 pacientes(60%) y lesiones leves en los 3 casos restantes (15%). Elestudio ecográfico del colon fue considerado satisfactorio en 18casos (90%) y la extensión de la enfermedad establecida en el estudioecográfico coincide en todos los casos con la determinadapor la colonoscopia: 3 pacientes (16,6%) presentaban una proctitisulcerosa, 9 (50%) una colitis izquierda y 6 (33,3%) una colitisextensa.Conclusiones: la ecografía digestiva permite el estudio delmarco colónico en la mayoría de los pacientes, especialmente siexiste actividad inflamatoria, permitiendo establecer con gran precisiónla extensión de la colitis ulcerosa, independientemente delgrado de actividad de la misma

Introduction: a full examination of the colon should be avoidedupon finding severe endoscopic lesions in patients with ulcerativecolitis. However, knowledge of the precise extent of disease isquite important for disease prognosis and the making of therapeuticdecisions. Therefore, any validation of a non-invasive techniqueto assess the extent of ulcerative colitis gains a lot of interestand importance.Material and method: the study included patients that werepreviously diagnosed of having ulcerative colitis or were beginningto suffer from the disease. A prospective and blind evaluation wascarried out to determine the precision of digestive ultrasonographyin assessment of ulcerative colitis extent. All ultrasonographywas carried out by the same person and was always performedprior to carrying out a full endoscopic study, which is used as thegold standard. The hydrocolonic ultrasonograpy technique wasnot used in any of the cases.Results: a total of 20 patients –13 males (65%) and 7 females(35%), with an average age of 51.7 years (aged between 24-82years)– were included in the study. Endoscopic studies revealed severedisease in 5 cases (25%), moderate disease in 12 patients(60%), and mild lesions in the 3 remaining cases (15%). A colonicultrasonogram was considered satisfactory in 18 cases (90%), andthe extent of disease as established by ultrasonography was in allcases consistent with that established through colonoscopy: 3 patients(16.6%) had ulcerative proctitis, 9 patients (50%) had leftsidedulcerative colitis, and 6 (33.3%) had extensive colitis.Conclusions: digestive ultrasonography allows to study thecolon in most patients, especially when inflammatory activity ispresent, and provides a greater accuracy in assessing ulcerativecolitis extent, which is independent of its activity level

Sildenafil improves immediate posttransplant parameters in warm-ischemic kidney transplants: experimental study.

OBJECTIVE: To evaluate in an experimental model the effects of the PDE5 inhibitor sildenafil on kidney grafts autotransplanted after a period of 45 minutes of warm ischemia and 60 minutes of hypothermic pump perfusion. METHODS: Nine laboratory large-white pigs were divided into two groups. Group A (n = 4): oral dose of 100 mg sildenafil was administered 1 hour before the surgery. Group B (n = 5): no sildenafil given. Right single nephrectomy was completed after a 45-minute period of warm ischemia by complete vascular clamping. Before the autotransplant, all kidneys were submitted to a 60-minute period of hypothermic pulsatile perfusion. Renal flow, arterial pressure, and renal vascular resistance were recorded in real time for 60 minutes after autotransplant. Nitric oxide levels were determined in blood samples of the renal vein at predefined intervals. Optical and electronic microscopy was performed on all organs at the end of the procedure. RESULTS: Renal vascular flow was significantly higher and renal vascular resistance significantly lower in the sildenafil group compared with the non-sildenafil group. No significant differences were observed in systemic arterial pressure values between both groups. Nitric oxide levels were significantly higher for all periods in the sildenafil group. No differences were observed in histological studies. CONCLUSION: Our experimental work suggested a positive effect of sildenafil on the immediate posttransplant outcome of warm-ischemic kidneys without systemic secondary effects.

Effects of hypothermic perfusion in isolated pig kidneys after warm ischemia.

An experimental study in pigs was designed to evaluate the consequences of normothermic ischemia in hypothermic isolated renal perfusion (HP). We perfused 16 kidneys after 45 minutes of vascular occlusion. Another 16 kidneys were perfused without previous warm ischemia. The ureter was catheterized in all procedures and the output collected during HP. Creatinine was added to the perfusion solution initially in order to determine creatinine clearance (CrCl). HP hydrodynamics were recorded in real time through a computerized system. According to the results, renal vascular resistance as well as CrCl were higher in ischemic kidneys. Both facts, along with minimal differences in the microscopic study, suggested an increased vascular tone of the efferent postglomerular arteriole during HP. HP was proven to be an optimal technique to minimize the histological consequences of ischemia. Microvascular and biochemical changes produced during HP may be essentially related to dynamic causes.

[Normothermic ischemia effects in renal microcirculation]. / Caracterización de los efectos de la isquemia normotérmica en la microcirculación renal.

We report the results obtained in a experimental work designed to evaluate the consequences of warm ischemia in hypothermic isolated renal perfusion. We perfused a number of kidneys after a period of 45 min of vascular occlusion. An alternative group of kidneys were perfused without previous warm ischemia. Ureter was canulated in all the procedures and output collected during the HP. Creatinine was added to the perfusion solution initially in order to determine creatinine clearance. HP hydrodynamics was recorded on real time through a computerised system. According to the results, renal vascular resistance as well as CrCl were higher in ischemic kidneys. Both facts along with minimal differences in pathologic study suggest an increase in vascular tone of efferent-postglomerular arteriole during HP. HP was an adequate technique to minimize histologic consequences of ischemia. Mycrovascular an biochemical changes produced during HP may be produced, essentially, by dynamic causes.