CDM è stata sostenuta dalla American College of Surgeons (ACS) Borsa di studio Resident Research. MSH è stato sostenuto dal California Institute for Regenerative Medicine (CIRM) formazione Fellow clinica concessione TG2-01159. MSH, HPL, e MTL sono stati sostenuti dalla società americana di chirurghi maxillo-facciale (ASMS) / maxillofacciale Chirurghi Foundation (MSF) Research Grant Award. HPL è stato sostenuto da NIH concedere R01 GM087609 e un dono di Ingrid Lai e Bill Shu in onore di Anthony Shu. HPL e MTL sono stati sostenuti dal Laboratorio Hagey Pediatrica Medicina rigenerativa e la Fondazione Oak. MTL è stato sostenuto dal / Fondo Olivier Gunn.

Il seguente protocollo è stato approvato dal Comitato Istituzionale Stanford University cura degli animali e Usa (IACUC) e soddisfa tutte le linee guida etiche istituzionali per quanto riguarda l&#39;uso di animali di ricerca. 1. Creazione di addominali aderenze <ol><li> Avviare il mouse sulla dieta chow antibiotico una settimana prima della procedura. </li><li> Autoclave gli strumenti chirurgici e pre-caldo la soluzione di irrigazione salina. </li><li> Anestetizzare il mouse utilizzando 2% isoflurano per via inalatoria. </li><li> Utilizzando un tagliacapelli seguito da un breve applicazione (5 - 10 sec) di agente depilatorio, rimuovere i capelli dalla maggior parte della superficie dell&#39;addome. Rimuovere accuratamente l&#39;agente depilatorio strofinando delicatamente con una garza umida e, opzionalmente, da inzuppare con cura la parte inferiore del mouse in acqua calda. Asciugare accuratamente l&#39;animale. </li><li> Posizionare muso dell&#39;animale nel cono del naso anestetico. Durante l&#39;intero intervento chirurgico, monitorare attentamente la rtasso espiratory dell&#39;animale e titolare la portata anestetico, se necessario. </li><li> Utilizzare un dispositivo di riscaldamento, come ad esempio una piastra elettrica o una lampada di riscaldamento, per evitare l&#39;ipotermia. </li><li> Prima preparando l&#39;addome, fissare il mouse con strisce di nastro posti sopra e sotto l&#39;addome per evitare che il mouse si sposti durante l&#39;intervento chirurgico. Disinfettare l&#39;addome con betadine, poi seguire con il 70% di etanolo. Include tanta zona possibile nella preparazione, compresi i capelli sui bordi della zona rasata. Posizionare un telino sterile sopra il mouse. (Figura 1) </li><li> Sottocutanea iniettare 0,1 mg / kg buprenorfina o 3 mg di 30 g mouse. </li><li> Rendere l&#39;incisione cutanea. <ol><li> A partire dalla linea mediana addominale inferiore, afferrare la pelle con una pinza e fare un taglio verticale poco profondo nella pelle usando forbici affilate. </li><li> Effettuare il taglio superiormente al xifoidea con le forbici. Fare attenzione a inserire solo la pelle. </li></ol></li><li> Come la muscolatura addominale è nOW visibile che copre le viscere, afferrare la linea mediana della muscolatura con una pinza e con molta attenzione fare un piccolo taglio in esso usando forbici affilate. Assicurarsi di non tagliare accidentalmente in un organo addominale. </li><li> Dopo aver inserito spazio peritoneale con un piccolo taglio e vedere strato muscolare allontanarsi dagli organi addominali, estendere il taglio superiormente ed inferiormente inserendo le forbici nell&#39;apertura e accuratamente taglio in entrambe le direzioni. Estendere l&#39;incisione dal xifoidea superiormente al di sopra della vescica inferiormente. (Figura 2) </li><li> Ora che gli intestini sono esposti, individuare il cieco e delicatamente esteriorizzare esso. Evitare di afferrare il cieco con una pinza dentata o taglienti. Invece di utilizzare una pinza atraumatica come un Adson pinze dentellate. </li><li> Abrasivare il cieco con carta vetrata. <ol><li> raschiare delicatamente tutta la superficie di entrambi i lati del cieco con 100 carta abrasiva grana per 30-60 secondi fino a quando la superficie diventa meno lucida e petecchie appeaR sulla superficie. Se il chirurgo è destro, aiuta a orientare cieco con la punta rivolta verso destra e drappeggio cieco sopra il dito indice sinistro del chirurgo. (Figura 3) </li><li> Eseguire la levigatura dolcemente, come è facile provocare accidentalmente una perforazione della parete cecal sottile. Una piccola quantità di granulosità deve essere sentito come la carta vetrata viene spostato lungo la superficie cecale. Se la carta vetrata è sentita più volte prendendo piede il cieco, questo probabilmente causerà una rottura nel muro del cieco. Guarda con attenzione per assicurare che le particelle di carta vetrata non sloggiare e rimangono nell&#39;addome, in quanto ciò potrebbe causare un eccessivo reazione da corpo estraneo. </li><li> Se si verifica una rottura nel muro cecal, chiudere il procedimento e l&#39;eutanasia dell&#39;animale. </li><li> Se un vaso sanguigno del cieco viene tagliato dalla carta vetrata e provoca emorragie, mantenere la pressione per un massimo di due minuti con una garza. Tuttavia, se il sanguinamento persiste dopo questo tempo, mettere una figura di otto 7-0 monofilamento di sutura intorno alpunto di sanguinamento. Ciò affidabile fermare l&#39;emorragia in quasi tutti i casi. Fare attenzione a non incorporare una grande quantità di parete cecal nella sutura, in quanto questo rischia di provocare necrosi della parte interessata del muro. </li></ol></li><li> Ferire il diritto fianco addominale. <ol><li> Utilizzare una striscia di carta vetrata per abradere la superficie peritoneale del muscolo della parete laterale destra addominale. Sia più aggressivo con la levigatura qui che il cieco e continuare fino l&#39;intera superficie della parete laterale destra addominale appare malmenato. Evitare di levigatura così forte che la pelle è visibile attraverso le aperture nello strato muscolare. (Figura 4) </li><li> Utilizzando un driver ago Castro-Viejo, posto tra due e quattro otto figure-of-4-0 punti di sutura di seta nello strato muscolare della parete laterale addominale destra. Lasciare le code lunghe circa 5 mm. Fare attenzione a non catturare accidentalmente parete intestinale nella sutura. (Figura 5) </li></ol></li><li> Usando una siringa da 10 ml riempita wesimo riscaldato soluzione salina, irrigare gli intestini più volte. Dirigere il flusso di soluzione salina nella cavità addominale per irrigare l&#39;interno pure. Se la superficie sotto il mouse viene bagnato, spostare il mouse o sostituire la superficie, al fine di evitare l&#39;ipotermia. </li><li> Utilizzare una garza sterile posto sopra l&#39;incisione per assorbire l&#39;irrigazione in eccesso. </li><li> Prendere una presa di amido e cospargerlo sulla superficie della parete laterale addominale destra e su entrambi i lati del cieco. (Figura 6) </li><li> Assicurarsi che non vi è alcun sanguinamento attivo. Se esiste, utilizzare una garza per applicare pressione direttamente sul punto di sanguinamento fino all&#39;arresto. Se l&#39;emorragia non si ferma immediatamente, posizionare una sutura emostatica come descritto sopra. </li><li> Con l&#39;estremità smussata della pinza e un dito, spingere delicatamente l&#39;intestino nella cavità addominale. Posizionare il cieco accanto alle suture nella parete laterale addominale destra al fine di massimizzare la formazione di aderenze. </li><li> Cperdere l&#39;incisione addominale. <ol><li> Utilizzando 6-0 assorbibile sutura intrecciata, posizionare un punto in esecuzione nello strato muscolare nella parte superiore dell&#39;incisione. </li><li> Eseguire la sutura verso la parte inferiore dell&#39;incisione, riunendo strato muscolare. Viaggiare in circa 3 mm e prendere 3 morsi mm con ogni nuovo punto. Fare attenzione a non prendere accidentalmente un morso di intestino pur ponendo suture. </li><li> In fondo dell&#39;incisione, lasciare un loop sutura dal morso precedente e utilizzare questo per strumento legare la sutura. Tagliare la sutura lasciando 5 mm code. </li><li> Ripetere quanto sopra tre gradini con 6-0 monofilo di nylon di sutura per chiudere la pelle. </li></ol></li><li> Somministrare un 20 ml / kg per via sottocutanea soluzione fisiologica in bolo (circa 0,5 ml per 30 g del mouse). </li><li> Usando una garza asciutta, asciugare accuratamente l&#39;intero animale, come la pelliccia dorsale tende a bagnarsi durante l&#39;irrigazione. </li><li> Liberamente avvolgere un adesivo vestire intorno all&#39;addome per coprire l&#39;incisione. Fare attenzione a non vincolare la unaLe gambe di Nimal o la meccanica di respirazione con il condimento. </li><li> Monitorare attentamente l&#39;animale in quanto recupera da anestesia. Somministrare buprenorfina ogni 12 ore per 2-3 giorni dopo la procedura per il controllo del dolore. </li></ol> 2. La raccolta Adesione Tissue <ol><li> Aspetta un minimo di sette giorni dopo l&#39;intervento iniziale. Anche in questo caso, autoclave strumenti chirurgici e anestetizzare il mouse con isoflurano. </li><li> Sterilizzare l&#39;addome con betadine seguito da 70% di etanolo. Shave e depilare capelli supplementari dal lato destro dell&#39;addome in modo che il campione di adesione contenenti pelle non saranno coperti in capelli, che rende più difficile l&#39;istologia. </li><li> Utilizzare una incisione paramediana sinistra, dal momento intestinale è spesso bloccato per l&#39;incisione originale. Partendo all&#39;estremità inferiore dell&#39;addome, circa 5 mm a sinistra del fondo dell&#39;incisione originale, afferrare la pelle con piccole pinze dentate e tagliare nella pelle con forbici affilate. Estendere questo taglio superiorely alla cassa toracica. (Figura 7) </li><li> Utilizzando le forbici, tagliare nello strato muscolare e dopo l&#39;inserimento nello spazio peritoneale, estendere il taglio alla parte superiore e inferiore della incisione. Ci saranno tessuto adesivo causando cieco e nel piccolo intestino di aderire alla parete laterale destra dell&#39;addome ed eventualmente anche per l&#39;incisione originale. (Figura 8) </li><li> Utilizzando le forbici e iniziare sul bordo di incisione, di sopra del livello del cieco, inizia a tagliare nella parete addominale in cerchio attorno all&#39;area in cui l&#39;intestino è aderente. </li><li> Alternando sopra e sotto il livello del cieco, ridurre gradualmente tutto intorno l&#39;adesione e completare il cerchio, ottenendo un &quot;isola&quot; della pelle e aderente parete addominale per l&#39;intestino. (Figura 9) </li><li> Sempre con le forbici, tagliare nell&#39;intestino e separare la parte aderente dal resto delle viscere, ottenendo un sandwich di tessuto che consiste di pelle e parete addominaleda un lato, intestino sull&#39;altro lato, e il tessuto adesivo che li collega tra. (Figura 10) </li><li> Facoltativamente, utilizzare un paio di forbici a punta di separare nettamente la pelle dal muscolo parete addominale. Per l&#39;istologia considerare lasciando la pelle allegata, ma per la digestione e l&#39;isolamento delle cellule della pelle può essere rimosso. Se verrà utilizzato il tessuto per esame istologico, assicurarsi di rimuovere il materiale di sutura, per quanto possibile, senza disturbare troppo l&#39;interfaccia adesivo. Per la digestione e l&#39;isolamento di cellule è accettabile lasciare le suture in posizione fino a quando il tessuto digest viene filtrato. </li><li> Dopo ablazione del tessuto adesione, eutanasia il mouse mediante metodo umanitario approvati dal comitato istituzionale uso animale. </li></ol>

<ol>
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Gli autori dichiarano di non avere interessi finanziari concorrenti.

I passaggi critici di questa procedura sono: accuratamente abrasione cieco senza provocare la perforazione, suture nella parete laterale addominale, e applicando la giusta quantità di amido. applica carta vetrata Solo al cieco, o per una piccola porzione specifica dell&#39;intestino. Ampio uso di carta vetrata su grandi quantità di piccolo intestino tende a causare una significativa ileo. Fare attenzione a raschiare il cieco con forza sufficiente che la superficie diventa ruvida, ma non così tanto che le lacrime a mu...

aderenze addominali sono una forma di tessuto cicatriziale che si formano nell&#39;addome in risposta all&#39;infiammazione, di solito dopo un intervento chirurgico o infezioni intra-addominale. Le adesioni sono una delle principali cause di dolore addominale cronico ed infertilità, e sono la causa più comune di piccola occlusione intestinale 1. La presenza di aderenze fa eseguire una seconda operazione addominale più difficile e aumenta la probabilità di complicazioni 2. Nonostante anni di ricerca, i meccanismi alla base della formazione di aderenze sono ancora poco chiare. E &#39;noto che una lesione iniziale alla superficie peritoneale provoca un essudazione di liquido ricco di fibrina, che quindi forma un coagulo che lega le superfici di intestino e la parete addominale insieme 3. Successivamente, fibroblasti e altre cellule migrano nello spazio adesivo e secernono tessuto connettivo 4. Nel corso di mesi o anni l&#39;adesione matura attraverso lo sviluppo di vasi sanguigni e nervi <sup&gt; 5. Diversi prodotti commerciali esistono che sono progettati per ridurre la formazione di aderenze dopo l&#39;intervento chirurgico addominale (ad esempio, Seprafilm). Tutti questi prodotti agiscono come barriere meccaniche e interrompere la formazione di aderenze impedendo il contatto fisico tra anse intestinali e 6,7 parete addominale. Nonostante le prove da uno studio controllato che una barriera adesione chirurgica riduce la formazione di aderenze 8, molti chirurghi anecdotally sono stati delusi con l&#39;efficacia dei prodotti barriera meccanica. Attualmente non ci sono terapie anti-adesione a base di droga, che riflette il fatto che i processi precisi coinvolti nella formazione di aderenze sono poco conosciuti. Lo sviluppo di una terapia che si rivolge specificamente agenti cellulari o molecolari coinvolti nella formazione di aderenze richiederà una migliore comprensione degli eventi che sono coinvolti nella formazione di adesione. Diversi gruppos hanno identificato percorsi molecolari che possono essere importanti per la formazione di aderenze 9-11. Modelli animali forniscono un ambiente eccellente per studiare la formazione di aderenze. Molti studi sono stati pubblicati che descrive la creazione chirurgica di adesione in molti animali, soprattutto il ratto e nel topo 6,12-14. Data la nostra esperienza con lo studio della fibrosi nel topo e l&#39;ampia disponibilità di topi transgenici e gli anticorpi di topo-based, abbiamo scelto il topo come modello per lo studio di adesioni. Qui, si segnala la tecnica che abbiamo sviluppato per creare riproducibile e affidabile aderenze addominali nel topo.

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		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Micro Forceps with teeth</td>
			<td style="width:136px;">Roboz</td>
			<td style="width:116px;">RS-5150</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:152px;">Fine scissors- sharp</td>
			<td style="width:136px;">Fine Science Tools</td>
			<td style="width:116px;">14060-09</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Straight serrated forceps</td>
			<td style="width:136px;">Fine Science Tools</td>
			<td style="width:116px;">11050-10</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Castro-Viejo needle driver</td>
			<td style="width:136px;">Fine Science Tools</td>
			<td style="width:116px;">12565-14</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">100 grit 1/4 sheet sandpaper</td>
			<td style="width:136px;">ACE Hardware</td>
			<td style="width:116px;">1010446</td>
			<td style="width:208px;">Cut into strips</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">4-0 silk suture, 30&#34;, SH needle</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">K831</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:152px;">7-0 PDS II absorbable monofilament suture, 30&#34;, BV-1 needle</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">Z135</td>
			<td style="width:208px;">Usually comes double-armed. Cut the suture at the midway point to generate two usable sutures.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:152px;">Rice starch</td>
			<td style="width:136px;">MP Biomedicals</td>
			<td style="width:116px;">102955</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">0.9% Sodium Chloride Irrigation</td>
			<td style="width:136px;">Baxter</td>
			<td style="width:116px;">BHL2F7121</td>
			<td style="width:208px;">Warm to 37&#176; C prior to use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:152px;">10 mL syringe</td>
			<td style="width:136px;">Becton Dickinson</td>
			<td style="width:116px;">309604</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:152px;">6-0 Vicryl absorbable braided suture, 18&#34;, RB-1 taper needle</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">J212H</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:152px;">6-0 Ethilon nylon monofilament&#160; suture, 18&#34;, P-3 needle,&#160;</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">1698G</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:152px;">Tegaderm Transparent Film Dressing Frame Style, 6 cm x 7 cm</td>
			<td style="width:136px;">3M</td>
			<td style="width:116px;">1624W</td>
			<td style="width:208px;">Cut in half lengthwise</td>
		</tr>
	</tbody>
</table>

creation of abdominal adhesions in mice

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or intraabdominal infection. The precise mechanisms underlying adhesion formation are poorly understood. Many compounds and physical barriers have been tested for their ability to prevent adhesions after surgery with varying levels of success. The mouse and rat are important models for the study of abdominal adhesions. Several different techniques for the creation of adhesions in the mouse and rat exist in the literature. Here we describe a protocol utilizing abrasion of the cecum with sandpaper and sutures placed in the right abdominal sidewall. The mouse is anesthetized and the abdomen is prepped. A midline laparotomy is created and the cecum is identified. Sandpaper is used to gently abrade the surface of the cecum. Next, several figure-of-eight sutures are placed into the peritoneum of the right abdominal sidewall. The abdominal cavity is irrigated, a small amount of starch is applied, and the incision is closed. We have found that this technique produces the most consistent adhesions with the lowest mortality rate.

<html> A sette giorni dopo l&#39;intervento, il cieco e, eventualmente, colon ascendente, il fegato, e loop di piccolo intestino dovrebbe essere aderente alla parete addominale lato destro. (Figura 8) tessuto asportato può essere integrato e sezionato e produrrà ottimi vetrini istologici. (Figura 11, 12) Quando la procedura viene eseguita correttamente, il 100% dei topi dovrebbe avere adesion...

Watch this Scientific Journal Video about Creation of Abdominal Adhesions in Mice at JoVE.com

Creation of Abdominal Adhesions in Mice

Abdominal adhesions that form after surgery are a major cause of pain, infertility, and hospitalization and reoperation for small bowel obstruction. Our surgical procedure for creating abdominal adhesions in mice is a reliable tool to study the mechanisms underlying the formation of adhesions.

Creazione di addominali aderenze nei topi

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or ...

Research

JoVE Journal

Medicine

12.5K Views.  Stanford University School of Medicine. Abdominal adhesions that form after surgery are a major cause of pain, infertility, and hospitalization and reoperation for small bowel obstruction. Our surgical procedure for creating abdominal adhesions in mice is a reliable tool to study the mechanisms underlying the formation of adhesions.

Video: Creation of Abdominal Adhesions in Mice

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL varies between 2.5 and 20% 2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined6, 7. 
The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis8. Furthermore, some anastomoses may be insufficient from the start due to technical failure.
Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage.
The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm (figure 1). It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents.
The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage.
Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.

The C-seal is a biofragmentable drain protecting the stapled colorectal anastomosis. In this video, details of the manufacturing, deployment and use are shown.

Il C-sigillo: un drenaggio Biofragmentable Proteggere l&#39;anastomosi colorettale pinzati da dispersione

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL ...

Ricerca

Medicina

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

Ablazione termica nel trattamento dei tumori addominali

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

Creation of Reversible Cholestatic Rat Model

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and affect the nutritional status and surgical outcomes. Study of the pathophysiological changes occurring in the liver and other organs is of importance. Various studies have been done in cholestatic rat models.
We used a reversible cholestatic rat model in our recent study looking at the role of methylprednisolone in the ischemia reperfusion injury. Various techniques for creation of a reversible cholestatic model have been described. Creation of a reversible cholestatic rat model can be challenging in view of the smaller size and unique hepatopancreatobiliary anatomy in rats. This video article demonstrates the creation of a reversible cholestatic model.
This model can be used in various studies, such as looking at the changes in nutritional, physiological, pathological, histological and immunological changes in the gastrointestinal tract. This model can also be used to see the effects of cholestasis and various therapeutic interventions on major hepatic surgeries.

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Creation of a reversible cholestatic rat model can be challenging in view of the smaller size and unique hepatopancreatobiliary anatomy in rats. This video article demonstrates the creation of a reversible cholestatic model.

Creazione del Modello reversibile Rat colestatico

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and ...

Orthotopic Liver Transplantation in Rats

Clinical progress in the field of liver transplantation has been largely supported by animal models1,2. Since the publication of the first orthotopic rat liver transplantation in 1979 by Kamada et al.3, this model has remained the gold standard despite various proposed alternative techniques4. Nevertheless, its broader use is limited by its steep learning curve5.
In this video paper, we show a simple and easy-to-establish revision of Kamada's two-cuff technique. The suprahepatic vena cava anastomosis is performed manually with a running suture, and the vena porta and infrahepatic vena cava anastomoses are performed utilizing a quick-linker cuff system6. Manufacturing the quick-linker kit is shown in a separate video paper.

We present an easy-to-establish revision of the classical two-cuff technique for orthotopic liver transplantation in rat.

Trapianto di fegato in ratti

Clinical progress in the field of liver transplantation has been largely supported by animal models1,2. Since the publication of the first orthotopic rat ...

Ascending Aortic Constriction in Rats for Creation of Pressure Overload Cardiac Hypertrophy Model

Ascending aortic constriction is the most common and successful surgical model for creating pressure overload induced cardiac hypertrophy and heart failure. Here, we describe a detailed surgical procedure for creating pressure overload and cardiac hypertrophy in rats by constriction of the ascending aorta using a small metallic clip. After anesthesia, the trachea is intubated by inserting a cannula through a half way incision made between two cartilage rings of trachea. Then a skin incision is made at the level of the second intercostal space on the left chest wall and muscle layers are cleared to locate the ascending portion of aorta. The ascending aorta is constricted to 50&#8211;60% of its original diameter by application of a small sized titanium clip. Following aortic constriction, the second and third ribs are approximated with prolene sutures. The tracheal cannula is removed once spontaneous breathing was re-established. The animal is allowed to recover on the heating pad by gradually lowering anesthesia. The intensity of pressure overload created by constriction of the ascending aorta is determined by recording the pressure gradient using trans-thoracic two dimensional Doppler-echocardiography. Overall this protocol is useful to study the remodeling events and contractile properties of the heart during the gradual onset and progression from compensated cardiac hypertrophy to heart failure stage.

We describe a stepwise procedure for creating pressure overload and left ventricular hypertrophy in Wistar rats by constriction of the ascending aorta using a small metallic clip. This model is extensively used for studying remodeling changes during cardiac hypertrophy and for identifying and evaluating strategies for regression of such changes.

Crescente aortica Costrizione in ratti per la creazione di sovraccarico di pressione cardiaca Ipertrofia Modello

Ascending aortic constriction is the most common and successful surgical model for creating pressure overload induced cardiac hypertrophy and heart ...

Carotid Artery Infusions for Pharmacokinetic and Pharmacodynamic Analysis of Taxanes in Mice

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study model. As the use of mouse models are often a vital step in preclinical drug discovery and drug development1-8, it is necessary to design a system to introduce drugs into mice in a uniform, reproducible manner. Ideally, the system should permit the collection of blood samples at regular intervals over a set time course. The ability to measure drug concentrations by mass-spectrometry, has allowed investigators to follow the changes in plasma drug levels over time in individual mice1, 9, 10. In this study, paclitaxel was introduced into transgenic mice as a continuous arterial infusion over three hours, while blood samples were simultaneously taken by retro-orbital bleeds at set time points. Carotid artery infusions are a potential alternative to jugular vein infusions, when factors such as mammary tumors or other obstructions make jugular infusions impractical. Using this technique, paclitaxel concentrations in plasma and tissue achieved similar levels as compared to jugular infusion. In this tutorial, we will demonstrate how to successfully catheterize the carotid artery by preparing an optimized catheter for the individual mouse model, then show how to insert and secure the catheter into the mouse carotid artery, thread the end of the catheter out through the back of the mouse&#8217;s neck, and hook the mouse to a pump to deliver a controlled rate of drug influx. Multiple low volume retro-orbital bleeds allow for analysis of plasma drug concentrations over time.

This method was developed with the goal of delivering a steady drug solution via the carotid artery, to assess the pharmacokinetics of novel drugs in mouse models.

Infusi carotide di farmacocinetica e di farmacodinamica Analisi dei taxani nei topi

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study ...

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and fluid retention. Changes in myocardial structure, electrical conduction, and energy metabolism develop with heart failure, leading to contractile dysfunction, increased risk of arrhythmias, and sudden death. Hypertensive heart disease is one of the key contributing factors of cardiac remodeling associated with heart failure. The most commonly-used animal model mimicking hypertensive heart disease is created via surgical interventions, such as by narrowing the aorta. Abdominal aortic constriction is a useful experimental technique to induce a pressure overload, which leads to heart failure. The surgery can be easily performed, without the need for chest opening or mechanical ventilation. Abdominal aortic constriction-induced cardiac pathology progresses gradually, making this model relevant to clinical hypertensive heart failure. Cardiac injury and remodeling can be observed 10 weeks after the surgery. The method described here provides a simple and effective approach to produce a hypertensive heart disease animal model that is suitable for studying disease mechanisms and for testing novel therapeutics.

A rat model of abdominal aortic constriction that induces cardiac hypertrophy and remodeling is described. An efficient, highly-reproducible, and minimally-invasive method is used to provide a simple yet useful platform for research in myocardial hypertrophy and dysfunction.

Un modello di rimodellamento cardiaco Attraverso Costrizione del Aorta addominale in Rats

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and ...

Creation of a Rodent Model of Abdominal Aortic Aneurysm by Blocking Adventitial Vasa Vasorum Perfusion

The adventitial vasa vasorum (VV) provides oxygen and nourishment to the aortic wall. Hypoxia in the aortic wall can cause enlarged abdominal aortic aneurysms (AAAs). This article introduces and describes a standard protocol used to induce AAAs through adventitial VV hypoperfusion created with a combination of polyurethane catheter insertion into the aortic lumen and suture ligation of the infrarenal abdominal aorta.
The protocol involves the use of male rats weighing 300-400 g, which are provided food and water ad libitum. After laparotomy with a ventral midline abdominal incision, exfoliation of the aorta is performed, which blocks blood flow from the perivascular tissue. Aortotomy involving a small incision adjacent to the renal artery branches is performed, and a polyurethane catheter is inserted using an 18-gauge indwelling needle. After repairing the incision, tight ligation of the aorta over the catheter blocks VV blood flow from the proximal direction through the aortic wall without disturbing the aortic blood flow. This technique can induce an AAA with progressive aortic dilatation.
The greatest benefit of this model is that VV hypoperfusion causes tissue hypoxia and the development of an infrarenal AAA, which has morphological and pathological characteristics similar to those of a human AAA.

Polyurethane catheter insertion into the aortic lumen and suture ligation of the aorta induce chronic hypoxia due to hypoperfusion of the adventitial vasa vasorum. This article describes a novel animal model of abdominal aortic aneurysm (AAA) with characteristics similar to those of AAA in humans.

Creazione di un modello del roditore del Aneurysm aortico addominale bloccando Adventitial Vasa Vasorum perfusione

The adventitial vasa vasorum (VV) provides oxygen and nourishment to the aortic wall. Hypoxia in the aortic wall can cause enlarged abdominal aortic ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine balloon denudation model, which is comparable with established vessel injury models in large animals. The aorta denudation model with balloon catheters mimics the clinical setting and leads to comparable pathobiological and physiological changes. Briefly, after performing a horizontal incision in the aorta abdominalis, a balloon catheter will be inserted into the vessel, inflated, and introduced retrogradely. Inflation of the balloon will lead to intima injury and overdistension of the vessel. After removing the catheter, the aortic incision will be closed with single stiches. The model shown in this article is reproducible, easy to perform, and can be established quickly and reliably. It is especially suitable for evaluating expensive experimental therapeutic agents, which can be applied in an economical fashion. By using different knockout-mouse strains, the impact of different genes on MH development can be assessed.

This article demonstrates a murine model to study the development of myointimal hyperplasia (MH) after aortic balloon injury.

Basato su palloncino ferita per indurre iperplasia Myointimal nell'Aorta addominale di Mouse

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

Creation of Colonic Anastomosis in Mice

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of colonic surgeries and can occur in up to 26% of surgical anastomoses, with mortality being up to 39% for patients with such a leak. Currently, there remains a paucity of data detailing the cellular mechanisms of anastomotic healing. Devising preventative strategies and treatment modalities for anastomotic leak could be greatly potentiated by a better understanding of appropriate anastomotic healing.
A murine model is ideal as previous studies have shown that the murine anastomosis is the most clinically similar to the human case as compared with other animal models. We offer an easily reproducible murine model of colonic anastomosis in mice that will allow for further illustration of anastomotic healing.

Anastomotic leak or breakdown after surgery is a major cause of postoperative morbidity and mortality. Our surgery for creating a colonic anastomosis is a reliable and reproducible method for studying the healing mechanisms of anastomoses.

Creazione dell'anastomosi colica in topi

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of ...