RESUMEN
Chest wall resection is performed for a variety of conditions and has been a complex problem in the past due to intraoperative technical difficulties, surgical complications, and respiratory failure. Advances in the fields of surgery and anaesthesia and the team effort of the involved thoracic and plastic surgeons result in more aggressive resections with good results. The surgical technique of sternal excision and reconstruction with a Marlex methacrylate composite prosthesis as a part of chest wall resection and reconstruction series is described here in this chapter.
RESUMEN
OBJECTIVE: Chest wall resection and reconstruction is a demanding operation involving a dedicated team. It can be performed with minimal mortality with excellent cosmetic and functional results using various substitutes. However, reconstructing the lower costal margin with diaphragmatic resection is a challenging prospect needing special techniques. METHODS: We describe a technique of reconstructing the chest wall defect involving the lower costal margin and diaphragm with an Inverted Y Marlex Methylmethacrylate Sandwich Flap. RESULTS: There were no intra operative or postoperative complications and immediate extubation was possible in all six patients without the need for postoperative ventilation. There was a good functional and cosmetic result in all the patients. CONCLUSIONS: This is an easy and safe technique resulting in a stable and satisfactory reconstruction after large antero-lateral full-thickness chest wall resections involving the diaphragm.
Asunto(s)
Diafragma/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Pared Torácica/cirugía , Adulto , Femenino , Humanos , Masculino , Metilmetacrilato , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Mallas QuirúrgicasAsunto(s)
Enfisema Pulmonar/complicaciones , Anciano , Drenaje , Hernia/diagnóstico por imagen , Hernia/etiología , Hernia/terapia , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/terapia , Masculino , Neumotórax/diagnóstico por imagen , Neumotórax/terapia , Enfisema Pulmonar/diagnóstico por imagen , Radiografía , Costillas , Técnicas de SuturaRESUMEN
A differential distribution of sialyltransferase (ST) in different regions of intestine has been shown. Jejunum and ileum homogenates from rats showed almost exclusive presence of alpha-2-3 ST (to Gal in Gal beta-1-4GlcNAc and/or to Gal in Gal beta-1-3GalNAc). In contrast, colon homogenates showed the presence of both alpha-2-3 ST (as above) and alpha-2-6 ST. Incubation of intestinal slices in presence of heat-inactivated horse serum (HHS) showed a time- and temperature-dependent secretion of soluble ST into the medium. Both jejunum and ileum slices showed high rates of secretion of alpha-2-3 ST. Colon slices, though rich in alpha-2-6 ST, secreted only alpha-2-3 ST. Colchicine, an anti-mitotic drug, injected into rats caused about 10-fold increase of the serum ST level. Jejunum slices from colchicine-treated rats showed an increased secretion of alpha-2-6 ST, suggesting that intestine undergoes a change in the expression of normal secretion of alpha-2-3 ST to a secretion of alpha-2-6 ST. The secretion of ST from incubated intestinal slices was inhibited by heparin. Certain protein factors (anti-proteases) in HHS bind to heparin-sepharose column and these protein factors are responsible for causing the secretion of ST into the medium. It has also been found that a supernatant fraction of the colon homogenate activated ST. Gel chromatography on HPLC produced 3-4 protein fractions from the colon cytosol and one of this fraction bearing high molecular weight proteins produced the maximum activation of ST.(ABSTRACT TRUNCATED AT 250 WORDS)