RESUMO
Resumen Introducción Los pacientes sometidos a desconexión total con cierre al nivel del seno piriforme debido a necrosis completa del esófago y estómago después de la ingestión cáustica representan un desafío quirúrgico para restablecer la ingestión oral y la calidad de vida. Objetivo El objetivo de este trabajo es presentar la experiencia con un caso clínico con necrosis total de esófago y estómago posingestión de cáuticos por lo que fue inicialmente sometido a esofagectomía y gastrectomía total. Método La reconstrucción del tracto digestivo superior se efectuó mediante una faringo-íleo-colo anastomosis, con suplemento de irrigación sanguínea arterial y drenaje venoso mediante técnica de anastomosis microquirúrgica. Resultados No se observaron complicaciones postoperatorias mayores y en el resultado a largo plazo se logra alimentación oral normal con una recuperación nutricional adecuada y buena calidad de vida. Conclusión Esta es un procedimiento a plantear en pacientes con estenosis faríngea sin posibilidad de reemplazo esofágico con procedimientos menos complejos.
Introduction Patients submitted to total esophagectomy and gastrectomy with complete closure of pharinx due to necrosis after caustic ingestion are a challenging surgical setting for reconstruction of upper digestive transit. Objective The objective of this paper is to present a clinical case and surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy. Method Reconstruction of digestive transit was reestablished by means of a pharyngo-ileo-colonic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Results There were not major postoperative complications and at long term follow-up, normal oral nutrition and quality of life improvement was observed. Conclusion This is a surgical procedure for treatment of patients with pharyngeal strictures without any possibility to indicate other less complex procedures.
Assuntos
Humanos , Masculino , Adulto , Anastomose Cirúrgica/métodos , Colo/transplante , Procedimentos de Cirurgia Plástica/métodos , Doenças do Esôfago/cirurgia , Cáusticos , Esofagectomia/métodos , Colo/irrigação sanguínea , Doenças do Esôfago/induzido quimicamente , Microcirurgia , NecroseRESUMO
La amputación parcial traumática del pabellón auricular con preservación del pedículo inferior corresponde a una patología infrecuente. Su reconstrucción incluye el uso de diversas técnicas quirúrgicas. Presentamos dos casos de reimplante inmediato, sin uso de microcirugía, con resultados favorables y sin necesidad de reintervenciones, junto a una revisión de la literatura. La revisión bibliográfica realizada apoya el uso de esta técnica, basándose en la preservación del puente cutáneo bajo el tragus que incluye una rama de la arteria temporal superficial y que sería responsable de la irrigación del reimplante.
Partial auricle amputation with preservation of the inferior pedicle is an unusual pathology. The reconstruction in these cases includes many surgical techniques. We present two cases of immediate replantation, without the use of microsurgery, with favorable outcomes and without need of new interventions. The revision of the literature supports this technique based in the preservation of the cutaneus bridge under the tragus that includes a branch of the superficial temporal artery that is responsible of the perfusion of the reimplant.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Reimplante/métodos , Pavilhão Auricular/cirurgia , Pavilhão Auricular/lesões , Amputação Traumática/cirurgia , Procedimentos de Cirurgia PlásticaRESUMO
Background: Placental vessels are not innervated. Therefore the vasomotor activity and vascular tone is not regulated by the nervous system. Aim: To assess the existence of pacemaker mechanisms related to rhythmic motor activity of blood vessels. Material and methods: Isometric contractions of rings from umbilical and chorionic vessels of term human placentas were monitored. Results: Recordings of the circular layer of chorionic and umbilical vessels revealed rhythmic spontaneous contractions with a frequency of 1,4ñ0,05 cycles/min, the duration of each cycle was 42,8ñ0,24 s (n=12). The amplitude of contractions was larger in veins than in arteries, predominating in umbilical vein biopsies, proximal to the fetus. Both the frequency and the amplitude of contractions were relatively constant during the first 30 min. However, after an hour, the frequency declined while the amplitude increased. The absence of the endothelium neither modified the frequency nor the amplitude of the rhythmic activity. Blockage of voltage dependent sodium channels or calcium channels did not alter the frequency of spontaneous contractions, although their magnitude was reduced. Glibenclamide, an ATP-dependent K+ channel blocker or the blockade of gap junctions ablated the frequency and amplitude of spontaneous contractions. Conclusions: We propose that rhythmic contractions are triggered by pacemaker cells located in the circular layer of the smooth muscle of blood vessels and spread via gap junctions; they likely contribute to the control of blood flow