OBJECTIVE: Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation. METHODS: Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1) the control group, recipients of open donor nephrectomy (n = 29), and 2) the study group, recipients of laparoscopic donor nephrectomy (n = 26). Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor. RESULTS: The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047) and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01). CONCLUSION: The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure laparoscopic donor nephrectomy utilization in renal transplantation.

PURPOSE: We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery. MATERIALS AND METHODS: From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83%) with a single renal artery and 22 (17%) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. RESULTS: The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6% vs 4.5%, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23% vs 12%, respectively, p = 0.18). Five patients in the single artery group (4.6%) and one patient in the multiple arteries group (4.5%) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9% vs 18.1%, respectively, p = 0.51). CONCLUSION: Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.

OBJETIVO: Propor um novo modelo de pseudoartrose em animais de pequeno porte e investigar o potencial de parâmetros de retroespalhamento de ultrassônico em diferenciar osso normal e com pseudoartrose. MÉTODOS: Doze Rattus norvegicus albinus (SPF) foram distribuídos aleatoriamente em dois grupos, tendo cada grupo seis animais. No grupo Controle realizou-se uma abordagem cirúrgica ao fêmur, seguida da síntese por planos do músculo e da pele. O grupo Experimental foi submetido à osteotomia do fêmur aduzida da confecção de um retalho pediculado de fascia lata para interposição entre os segmentos resultantes da fratura induzida cirurgicamente. Prosseguiu-se com o alinhamento e estabilização óssea, mediante a confecção de um nó com fio de náilon em formato de U, introduzido em orifícios efetuados nas extremidades proximal e distal à fratura. As amostras ósseas foram irradiadas pelo ultrassom e sinais foram coletados para cada uma no intuito de analisar o parâmetro Retroespalhamento Integrado Aparente - AIB. RESULTADOS: Estudos radiológicos e anatomopatológicos evidenciaram a ausência de consolidação óssea com persistência de tecido fibro-osteóide. Os valores de AIB para ossos normais foram estatisticamente diferentes em relação aos ossos com pseudoartrose. CONCLUSÃO: O modelo experimental apresentou-se adequado para a formação de pseudoartrose em ratos e o parâmetro de retroespalhamento de ultrassom foi capaz de detectar tal doença óssea, in vitro.

PURPOSE: To propose a novel model of pseudarthrosis in a small animal and to investigate the ability of backscatter parameters from ultrasound signals in differentiating normal bone from those ones with pseudarthorsis. METHODS: Twelve Rattus norvegicus albinus free from pathogenic species (SPF) were randomly divided in two groups, with six animals each. In the Control group a surgical approach to the femur was made, followed by the synthesis of the muscle and skin layers. The Experimental group was submitted to an osteotomy of the femur and a vascularized flap of the fascia lata was interposed in the line of the fractured bone. Then the alignment and bone stabilization were accomplished, by using nylon stitch in U shape introduced in holes made in the proximal and distal fractured bone. Bone samples were scanned with ultrasound and signals were collected for each one to analyze the parameter Apparent Integrated Backscatter - AIB. RESULTS: Radiological and anatomopathologic studies revealed the absence of bone consolidation with persistence of fiber-osteoid tissue. Values of the ultrasound parameter AIB from normal bones were statistically different from those with pseudarthrosis. CONCLUSION: The experimental model was suitable for pseudarthrosis development in rats and the ultrasound backscatter parameters were able to identify such a bone disease in vitro.

OBJETIVO: Estudar os efeitos da nicotina sobre as células inflamatórias, deposição de colágeno e sua interferência sobre a força tecidual em suturas vesicais de coelhos. MÉTODOS: Foram utilizados 20 coelhos Nova Zelândia, divididos de maneira aleatória em dois grupos: grupo N, composto de 10 animais, no qual foi administrada nicotina na dose de 2mg/Kg de peso por via subcutânea, diluída em 1ml de solução fisiológica a 0,9% em 1 aplicação diária por 28 dias prévios à cirurgia; e grupo C, composto por 10 animais, no qual foi administrada solução fisiológica a 0,9% nas mesmas condições e intervalos de tempo do grupo nicotina. Todos os animais foram submetidos à cistotomia com sutura da parede vesical após 28 dias da administração de nicotina ou solução fisiológica. As aferições foram realizadas no 4º e 7º dia em cada grupo após cistectomia e eutanásia dos animais. Uma parte da bexiga foi submetida a teste de tração para avaliar a força tecidual da sutura e outro fragmento foi submetido à análise histológica de processo inflamatório e deposição de colágeno. RESULTADOS: Houve uma diminuição de neutrófilos no 4º dia pós-operatório (p=0,079) e aumento de plasmócitos no 7º dia após a cirurgia (p=0,053) nos animais que receberam nicotina, sem diferença estatística em relação ao grupo controle. Na análise de proliferação de fibroblastos, deposição de colágeno e teste de tração tecidual, não houve diferença estatística em relação ao grupo controle. CONCLUSÃO: A administração de nicotina em coelhos não influenciou no processo de cicatrização de sutura vesicais em relação às células inflamatórias, depósito de colágeno e força tecidual da sutura.

PURPOSE: To study the effects of nicotine on inflammatory cells, deposition of collagen and its interference on the strength of tissue in vesical sutures in rabbits. METHODS: Twenty New Zealand rabbits were used, randomized into two groups: group N, consisting of 10 animals, to which nicotine was administered in the dose of 2mg/kg of weight as a subcutaneous injection, diluted in 1ml of saline solution at 0.9% in a daily administration during the 28 days prior to the surgery; and group C, consisting of 10 animals, to which saline solution at 0.9% was administered in the same conditions and time intervals of the nicotine group. All the animals underwent cystotomy and suture of the bladder wall 28 days after the administration of nicotine or saline solution. The measurements were performed on the fourth and seventh day in each group after cystectomy and euthanasia of the animals. A fragment of bladder was removed and sent for a tensile strength test to evaluate the tissue strength and another fragment underwent a histological analysis of inflammatory process and deposition of collagen. RESULTS: There was a decrease of neutrophils on the fourth postoperative day (p=0.079) and an increase of plasmocytes on the seventh postoperative day (p=0.053) in the animals that were given nicotine, without statistical difference in relation to the control group. In the analysis of the proliferation of fibroblasts, deposition of collagen and tensile strength test, there was no statistical difference in relation to the control group. CONCLUSION: The administration of nicotine in rabbits did not influence the healing process of vesical suture in relation to the inflammatory cells, deposit of collagen and tissue strength of the suture.