Techniques of intestinal transplantation in rat

Two surgical models of intestinal transplantation in the rat are described. One is the implantation of fetal and newborn intestine as free grafts into the omentum of adult recipients, the other the adult intestine transplantation as an accessory graft using vascular anastomoses. A hundred and sixteen small-bowel transplantations were done; 36 of which were fetal intestine (group I), 40 of newborn intestine (group II), and 40 of adult intestine (group III). In the fetal and newborn intestinal transplantation, we emphasize the practices that allowed us to avoid ischemic and traumatic injury to the graft. In the adult intestine transplantation with vascular anastomoses, we heighten the modifications in the surgical technique that made the operation easier and the strategies used to prevent hypothermia and hypovolemic shock. Once experienced with the two chosen surgical techniques, transplantation using an avascular segment became much easier and quicker than transplantation with vascular anastomose

Exercise-Induced Intraventricular Obstruction in a Child with Near Syncope and Chest Pain During Exercise

We report the case of a 10-year-old girl with two episodes of light-headedness and chest pain during exercise. She had an unremarkable clinical record, physical examination, ECG, and echocardiogram. Noninvasive ischemia tests were positive, but coronary angiography was normal. Exercise stress echocardiogram revealed an exercise-induced intra-left-ventricular obstruction with a peak gradient of 78 mmHg and replicated her symptoms. After starting beta-blocker therapy her clinical status improved and no residual obstruction was detected. The authors review this unsuspected clinical condition, seldom reported in the adult population and, to our knowledge, never before in a child

Juvenile polyposis of infancy in a child with deletion of BMPR1A and PTEN genes: Surgical approach

Juvenile polyposis of infancy is the most severe and life-threatening form of juvenile polyposis. This disease typically presents in the first two years of life with gastrointestinal bleeding, diarrhea, inanition, and exudative enteropathy. In very few reports concerning this entity, a large deletion in the long arm of chromosome 10 (10q23), encompassing the PTEN and BMPR1A genes, was found. The authors report a case of delayed diagnosis of juvenile polyposis of infancy at 6years of age. A 3.34Mb long de novo deletion was identified at 10q23.1q23.31, encompassing the PTEN and BMPR1A genes. The disease course was severe with diarrhea, abdominal pain, inanition, refractory anemia, rectal bleeding, hypoalbuminemia, and exudative enteropathy. A sub-total colectomy, combined with intraoperative endoscopic removal of ileal and rectal stump polyps, was required for palliative disease control

Effect of hydroxyethyl starch on acute renal injury in a model of hepatic ischemia-reperfusion

BACKGROUND: Hepatic vascular control techniques employed during liver surgery are usually associated with ischemia-reperfusion injury, which could cause acute renal dysfunction. The murine model has been used in the study of this injury. Hydroxyethyl starch has recognized anti-inflammatory properties and improves microcirculation. Third generation hydroxyethyl starches, namely 130/0.4, show a better safety profile than previous molecules. OBJECTIVES: Evaluation of renal injury in a murine model of partial normothermic hepatic ischemia-reperfusion injury and assessment of hydroxyethyl starch 130/0.4 effect on this injury. METHODS: Seventy-two male Wistar rats were randomized into six groups with identical characteristics (n = 12 x 6). In three of them, the ischemia-reperfusion injury groups, we placed a clamp in the vascular pedicle of the median and left liver lobes, inducing hepatic ischemia (70%), and removed the clamp 60 minutes later (IRI + HES and IRI + HS groups, with HES or hypertonic saline (7.5%) administration during reperfusion, respectively, and IRI group, without fluid therapy). The control groups were sham-operated without hepatic ischemia and treated likewise (sham + HES, sham + HS and sham groups). After 120 minutes of reperfusion in the ischemia-reperfusion injury groups and 180 minutes in the controls we drew blood from the aorta artery for creatinine, urea and alanine aminotransferase quantification and removed kidney and liver samples for histopathological analysis. RESULTS: As already published by our group, the partial hepatic ischemia-reperfusion injury model showed liver injury. In the present work, the IRI group had higher creatinine, urea and histopathological score than sham (p < 0.05). Creatinine and urea mean concentrations were significantly lower both in IRI+HES (23.08 µmol/L and 8.38 mmol/L, respectively) and IRI + HS (26.59 µmol/L and 7.82 mmol/L) when compared to IRI (40.101 µmol/L and 11.25 mmol/L). There was no significant difference between IRI + HES and IRI + HS groups (serum markers and histopathology).Conclusion: The hepatic ischemia-reperfusion injury murine model was effective in producing kidney injury. Both the hydroxyethyl starch 130/0.4 and the hypertonic saline protected the kidney in this context and were not harmful for this organ in the controls. Further studies are necessary to assess clinical implications of hydroxyethyl starch 130/0.4 administration in liver surgery

Stenosis of the Branches of the Neopulmonary Artery after the Arterial Switch Operation: a Cardiac Magnetic Resonance Imaging Study

Background : The neonatal arterial switch operation (ASO) is now the standard of care for children born with transposition of the great arteries. Stenosis of the neopulmonary artery on long‑term follow up is a known complication. Methods : We performed a retrospective analysis of eleven patients who underwent a cardiac magnetic resonance imaging (MRI) due to echocardiographic evidence suggestive of stenosis of the neopulmonary artery or its branches (mean estimated Doppler gradient 48 mmHg, min 30 mmHg, max 70 mmHg). A comprehensive evaluation of anatomy and perfusion was done by cardiac MRI. Results : The branches of the neopulmonary artery (neo PA) showed decreased caliber in three patients unilaterally and in two patients, bilaterally. Magnetic resonance (MR) perfusion studies showed concomitant decreased flow, with discrepancy between the two lungs of 35/65% or worse, only in the three patients with unilateral obstruction, by two different MR perfusion methods. Conclusions : Cardiac MR can be used as a comprehensive non‑invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making

Patent Foramen Ovale Closure with the BioSTAR Bioabsorbable Implant

Os autores apresentam o caso clínico de uma doente de 35 anos, sexo feminino, que recorreu ao hospital da área da residência por parésia do membro superior direito, tendo sido diagnosticado AVC isquémico por Ressonância Magnética Nuclear Cranio-Encefálica (RMN-CE). A investigação da fonte embólica levou ao diagnóstico, por ecocardiograma transesofágico, de foramen oval patente (FOP), com shunt direito-esquerdo espontâneo. Em Maio de 2009 foi efectuado encerramento percutâneo do FOP com dispositivo bioreabsorvível “BioSTAR®”, sob controlo ecocardiográfico. Efectuou ecocardiograma transtorácico após o primeiro, terceiro e sexto mês pós-procedimento e ecocardiograma transesofágico aos nove meses, mostrando sempre adequada colocação do dispositivo, sem presença de shunt residual, sem qualquer intercorrência clínica durante este período. Os autores discutem a importância do desenvolvimento de dispositivos bioabsorvíveis para encerramento de FOP, e as suas vantagens em comparação com os dispositivos sintéticos previamente utilizados

Influence of P53 on the radiotherapy response of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and it has a poor prognosis and few therapeutic options. Radiotherapy is one of the most effective forms of cancer treatment, and P53 protein is one of the key molecules determining how a cell responds to radiotherapy. The aim of this study was to determine the therapeutic efficacy of iodine-131 in three human HCC cell lines

A fixed point formula for the index of multi-centered N=2 black holes

We propose a formula for computing the (moduli-dependent) contribution of multi-centered solutions to the total BPS index in terms of the (moduli-independent) indices associated to single-centered solutions. The main tool in our analysis is the computation of the refined index Tr(-y)^{2J_3} of configurational degrees of freedom of multi-centered BPS black hole solutions in N=2 supergravity by localization methods. When the charges carried by the centers do not allow for scaling solutions (i.e. solutions where a subset of the centers can come arbitrarily close to each other), the phase space of classical BPS solutions is compact and the refined index localizes to a finite set of isolated fixed points under rotations, corresponding to collinear solutions. When the charges allow for scaling solutions, the phase space is non-compact but appears to admit a compactification with finite volume and additional non-isolated fixed points. We give a prescription for determining the contributions of these fixed submanifolds by means of a `minimal modification hypothesis', which we prove in the special case of dipole halo configurations.Comment: 61 pages, 3 figure

Occupational and leisure time physical activity in contrasting relation to ambulatory blood pressure

Background: While moderate and vigorous leisure time physical activities are well documented to decrease the risk for cardiovascular disease, several studies have demonstrated an increased risk for cardiovascular disease in workers with high occupational activity. Research on the underlying causes to the contrasting effects of occupational and leisure time physical activity on cardiovascular health is lacking. The aim of this study was to examine the relation of objective and self-report measures of occupational and leisure time physical activity with 24-h ambulatory systolic blood pressure (BP). Methods: Results for self-reported physical activity are based on observations in 182 workers (60% male, mean age 51 years), while valid objective physical activity data were available in 151 participants. The usual level of physical activity was assessed by 5 items from the Job Content Questionnaire (high physical effort, lifting heavy loads, rapid physical activity, awkward body positions and awkward positions of head or arms at work) and one item asking about the general level of physical activity during non-working time. On a regular working day, participants wore an ambulatory BP monitor and an accelerometer physical activity monitor during 24 h. Associations were examined by means of Analysis of Covariance. Results: Workers with an overall high level of self-reported occupational physical activity as well as those who reported to often lift heavy loads at work had a higher mean systolic BP at work, at home and during sleep. However, no associations were observed between objectively measured occupational physical activity and BP. In contrast, those with objectively measured high proportion of moderate and vigorous leisure time physical activity had a significantly lower mean systolic BP during daytime, while no differences were observed according to self-reported level of leisure time physical activity. Conclusions: These findings suggest that workers reporting static occupational physical activities, unlike general physically demanding tasks characterized by dynamic movements of large muscle groups, are related to a higher daily systolic BP, while high objective levels of moderate and vigorous leisure time physical activity are related to lower daytime systolic BP. Ambulatory systolic BP may be a physiological explanatory factor for the contrasting effects of occupational and leisure time physical activity