Emerging technologies in organ preservation,tissue engineering and regenerative medicine: a blessing or curse for transplantation?

Since the beginning of transplant medicine in the 1950s, advances in surgical technique and immunosuppressive therapy have created the success story of modern organ transplantation. However, today more than ever, we are facing a huge discrepancy between organ supply and demand, limiting the potential for transplantation to save and improve the lives of millions. To address the current limitations and shortcomings, a variety of emerging new technologies focusing on either maximizing the availability of organs or on generating new organs and organ sources hold great potential to eventully overcoming these hurdles. These advances are mainly in the field of regenerative medicine and tissue engineering. This review gives an overview of this emerging field and its multiple sub‐disciplines and highlights recent advances and existing limitations for widespread clinical application and potential impact on the future of transplantation.     

Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind,randomised clinical trial

Wiener Medizinische Wochenschrift - The trial aimed to evaluate the efficacy and safety of Spicae aetheroleum (Spicae ae.), a phytomedicine obtained by steam distillation of the flowering...     

Relationship between enteral glucose load and adaptive mucosal growth in the small bowel

Infusion of hyperosmolar glucose solutions into small bowel will prevent mucosal atrophy or stimulate mucosal growth in rats otherwise maintained on total parenteral nutrition (TPN). It is not certain whether this growth effect is related to the osmolarity of the solution or its total molecular load. Therefore, various concentrations of glucose and sodium salt solutions were studied for comparative effects on growth of small bowel mucosa. Male Sprague-Dawley rats (240 g) were maintained on TPN and infused continuously with either glucose or sodium chloride (2 and 0.6 ml/hr) or sodium sulfate (0.6 ml/hr) via a catheter placed in the mid-small intestine. Concentrations of infusion solutions ranged in osmotic pressure from 300 to 1500 mosmol/liter. Controls were TPN rats without infusion of any solution. Over a seven-day period, TPN rats receiving mid-gut infusions of 300 mosM saline gained 18.4 g in body weight. In TPN rats receiving mid-gut infusions of progressively greater concentrations of glucose, the additional total kilocalories per day resulted in greater body weight gain compared with the saline controls. After seven days, rats were killed, the small bowel removed, and divided into eight equal segments (segment 1, duodenum; segment 8, terminal ileum). Segment weight, mucosal weight, DNA, and protein concentration per segment were measured. Mid-gut infusions of 900 and 1500 mosM glucose solutions progressively increased mucosal mass in segments downstream from the site of infusion compared with 300 mosM glucose in water or 600 mosM glucose in saline which did not differ from any of the salt solutions or TPN alone.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma

Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.     

Hepatocyte growth factor in saliva of patients with renal failure and periodontal disease

Background: Hepatocyte growth factor (HGF), endogenous cytokine with pleiotropic repairing and regeneration properties in relation to most tissues and organs, contributes to the progression of periodontal disease (PD). Furthermore, PD is a significant health problem in patients with chronic renal failure (CRF). The role of HGF in the development of PD in this specific population was not a subject of research so far. Material and methods: The following groups were enrolled in the study: (1) 26 chronic hemodialysis (HD) subjects, (2) 26 patients treated by continuous ambulatory peritoneal dialysis (CAPD), (3) 28 predialysis CRF patients, (4) 26 subjects with advanced PD (without coexisting diseases), and (5) 20 healthy subjects without PDs. HGF level in saliva was measured using the immunoenzymatic method. Gingival index, papillary bleeding index, plaque index, and the loss of clinical attachment level were evaluated. Results: The HGF level in saliva of HD patients was twice higher than in that of subjects with healthy periodontium. Direct relationships between proper HGF level in saliva and the indices GI, PBI, and PI in CAPD-treated patients and with more severe PD were shown. It was found that PD is most advanced in HD patients, moderately in CAPD-treated patients and to the smallest extent in predialysis CRF patients. Conclusions: The HGF level in mixed saliva is the index of PD progression in subjects without renal failure and in CAPD-treated patients. PD is common in renal failure patients and is a significant problem concerning general health status.     

Endothelial Function and Novel Adhesion Molecule CD44 in Kidney Allograft Recipients

Background

Disturbances in hemostasis and endothelial damage are common complications of kidney disease. Endothelial dysfunction may link these 2 processes and inflammation is closely related to endothelial dysfunction.

Patients and Methods

This cross-sectional study on serum concentrations of markers of endothelial damage and inflammation in relation to adhesion molecules was performed in 90 kidney allograft recipients and 30 healthy volunteers. We measured markers of endothelial damage—von Willebrand factor (vWF), thrombomodulin, intracellular adhesion molecule (ICAM), vascular adhesion molecule (VCAM), CD146, CD44, and CD40L; markers of inflammation—high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor alpha (TNFα), and interleukin-6 (IL-6); and other hemostatic parameters—thrombin-antithrombin complexes (TAT), plasmin-antiplasmin complexes, and thrombin activatable fibrinolysis inhibitor (TAFI) using commercially available kits.

Results

Markers of endothelial dysfunction and inflammation were significantly elevated in kidney allograft recipients compared with control subjects. CD44 was independently related to hsCRP (r = .37; P < .01), ICAM (r = .23; P < .05), eGFR (r = −.37; P < .01), thrombomodulin (r = .43; P < .001), VCAM (r = −.44; P < .001), hemoglobin (r = −.26; P < .01), red blood cell count (r = −.25; P < .05), creatinine (r = .37; P < .01), CD146 (r = .34; P < .01), and CD40L (r = .23; P < .05). Upon multiple regression analysis the predictors of elevated CD44 were hsCRP concentration (beta = .25; P < .05), CD146 (beta = .39; P < .05), creatinine (beta = .55; P < .01), and thrombomodulin (beta = .39; P < .05) with an adjusted R² = .40 (F = 4.12; P < .00028; SE of estimate = 151.19).

Conclusions

As demonstrated in multiple regression analysis, kidney function was strictly linked to the degree of inflammation and endothelial injury. Endothelial cell injury and the presence of an inflammatory state, as reflected by elevated marker concentrations, and endothelial activation/injury may play roles in the pathogenesis of atherosclerosis and cardiovascular complications among kidney allograft recipients.     

The Desire for Body Contouring Surgery after Bariatric Surgery

Background  Obesity has become far more prevalent over the last few decades. In parallel, bariatric surgery has been increasingly utilized as a method of treatment. This appears to be having an impact on the rate of body contouring surgery for hanging redundant skin after the massive weight loss that usually results from bariatric surgery. Little literature is available addressing how frequently patients who have undergone bariatric surgery receive or desire body contouring surgery or regarding how satisfied these patients are with the hanging skin in certain body areas. Methods  Seventy individuals (out of 250 who were mailed the questionnaire) who had undergone Roux-en-Y gastric bypass surgery 6–10 years previously completed a questionnaire, which obtained information regarding their experiences with as well as their desire for body contouring surgery and more general body area satisfaction. Results  Thirty three of the seventy patients reported having undergone a total of 38 body contouring procedures. The most common were abdominoplasties (24.3%), breast lifts (8.6%), and thigh lifts (7.1%). However, subjects were not uniformly satisfied with body areas that had undergone body contouring surgery; some found the areas unattractive. The majority of patients, at least to some extent, desired body contouring surgery, often in several areas, most notably the waist/abdomen, rear/buttock, upper arms, and chest/breast. Conclusion  Paralleling the increasing use of bariatric surgery is an increasing desire for body contouring surgery. Most patients desire body contouring surgery after bariatric surgery. However, third party payors usually do not reimburse for such procedures.     

Spinal epidural abscess after cervical pharyngoesophageal dilation

BACKGROUND: Esophageal perforation is an uncommon but known complication of esophageal dilation. Abscess after esophageal tear is rare, especially in the spinal epidural space. This is one case report of such an abscess. METHODS: We present a case of a spinal epidural abscess after cervical pharyngoesophageal dilation. RESULTS: After surgical decompression and abscess drainage, long-term intravenous antibiotics, and physical therapy, the patient has regained some functional use of her left upper extremity. CONCLUSIONS: Early diagnosis with a gadolinium-enhanced MRI and aggressive surgical treatment are keys to successful management with a good functional outcome after this unfortunate complication.