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The number of patients waiting for transplants has increased despite the constant growth of the number of transplants performed. This is the reason why the possibility of using animal organ donors is taken into consideration. Since 2002, the problems concerning xenotrasplantation have been investigated in Poland in the frame of the project: Application of trangenesis in genetic modification of pigs in order to gain organs for transplantation in humans. In the presented paper the possibility of use of transgenic pig kidneys for allogenic and heterogenic transplantation in clinical aspect was evaluated, with the special compliance of surgical methods. The proposed surgical technique of kidney transplantation in pigs derived from the methods used in human medicine and consisted of three stages: the operation of collecting the kidneys en-block, preservation of collected organs and their transplantation. The aim of the first stage was the isolation of the both donor kidneys as fast as possible in a manner not causing the injury of kidney parenchyma, with the maintenance of all anatomical and functional structures and blood vessels. In the study, 3 non-transgenic and 6 transgenic sows with the block of the gene á1,3GT were evaluated. In the presented studies the modification of the routine technique of kidney collection used in human transplantology was performed with the possibility of application of the method for allo- and xenotranplantation in pigs. The maintenance of the defined conditions of perfusion and storage of the collected organs is the requirement of the preservation of viability of the transplant for the time necessary for preparing the organ and the recipient for the transplantation.
In the conducted study the possibility of using the transgenic pig kidneys for allogenic and heterogenic transplantation was evaluated with regards to the clinical context. There were 3 nontransgenic and 6 transgenic pig donors with a human α1.3-fukosylotransferase gene. The recipient of the kidneys were 6 nontransgenic and 3 transgenic pigs. The kidneys were heterotopic transplantated to intraperitoneal space. The kidney was transplanted to the left side at the level of 4-5 lumbar vertebra with end-to-side anastomosis of the renal vein and artery with vena cava caudale and aorta, respectively. The proposed surgical model of homological transplantation of kidneys in pigs allows for rapid organ collection without disturbing the structure, with continuous and tight vessel. The immunological response on the base of the changed levels of IL-1, IL-4 IL-6 IL-10 TNF-α and INF-γ in the serum were investigated. The acute immunological rejection of the graft was found on cell and humoral bases. There was a weaker immunological response after the transplantation of transgenic kidneys in comparison to nontransgenic ograns. Transgenesis has a positive effect on the immunological response.
Inguinal hernia repairs are very common yet fairly complex surgical procedures. Variations in the anatomical course of the inguinal nerves require that diligence is taken in their proper recognition. Inadvertent surgical injury to these nerves is associated with long term postoperative pain and complications. The aim of the present study was to highlight the complexity and variation in the innervation of the inguinal region in order to increase proper nerve identification during surgical interventions. Bilateral dissection of the inguinal and posterior abdominal regions in one human male cadaver revealed an atypical anatomic topography of the groin innervation. This unusual case was observed at the Jagiellonian University Anatomy Department during routine cadaveric preparations. The left ilioinguinal nerve was absent. The left genital branch of the genitofemoral nerve arose higher than expected from the lumbar plexus and supplied the groin region, which is typically innervated by the ilioinguinal nerve. Furthermore, the left lateral cutaneous femoral nerve and the right genital branch of the genitofemoral nerve also followed uncharacteristic courses. Awareness of topographical nerve variations during inguinal hernia repair will help surgeons identify and preserve important nerves, thus decreasing the incidence of chronic postoperative pain. (Folia Morphol 2013; 72, 3: 267–270)
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