Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.

Comparison among bone marrow mesenchymal stem and mononuclear cells to promote functional recovery after spinal cord injury in rabbits 1 Abstract Purpose: To investigate the efficacy of allogeneic mesenchymal stem-cells and autologous mononuclear cells to promote sensorimotor recovery and tissue rescue. Methods: Female rabbits were submitted to the epidural balloon inflation method and the intravenous cells administrations were made after 8 hours or seven days after injury induction. Sensorimotor evaluation of the hindlimbs was performed, and the euthanasia was made thirty days after the treatment. Spinal cords were stained with hematoxylin and eosin. Results: Both therapies given 8 hours after the injury promoted the sensorimotor recovery after a week. Only the group treated after a week with mononuclear cells showed no significant recovery at post-injury day 14. In the days 21 and 28, all treatments promoted significant recovery. Histopathological analysis showed no difference among the experimental groups. Our results showed that both bone marrow-derived cell types promoted significant sensorimotor recovery after injury, and the treatment made at least a week after injury is efficient. Conclusion:The possibilities of therapy with bone marrow-derived cells are large, increasing the therapeutic arsenal for the treatment of spinal cord injury.

Developing a less invasive, practical and cost-effective operative technique for obesity treatment represents a pressing need for our society. In this way, intragastric single port sleeve by endoplication was tested in six pigs during 18 weeks. Celiotomy was performed with animal placed in dorsal decubitus position. Single port gastrostomy was performed and double tobacco pouch sutures were made in fundic region, making a gastric sleeve. At the end, stomach layers and skin were closed in a conventional manner. Means and the standard deviations of surgical time were calculated. The procedure was simple and all animals survived; there were no significant blood loss and no intra and postoperative complications. The procedure was fast (67.4 minutes). The technique has the advantage of not requiring the use of mechanical sutures, making it less costly. The innovation of this procedure was the use of a single port gastrostomy device to perform an intraluminal sleeve. What made this technique less invasive were the use of a single port, nonmanipulation of the stomach intra-abdominally, ease of execution and no need of pneumoperitoneum. The new technique is acceptable and has reproducible viability, had a short procedure time without intra and postoperative complications.

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications.Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral lesions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy findings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was 1 (good dissection and visualization), with variance of zero for mediastinoscopy and 0.14 for necropsy. In the mediastinoscopy of one CC, the prosthesis crossed the tracheal bifurcation, involving the posterior vessels of this region, which was confirmed by necropsy. However, the dissection showed no vascular lesions. The integrity of the mediastinum was assessed only by mediastinoscopy. There was no impairment caused by any of the procedures performed. This resulted in a median score of 1 (integrity) with zero variance. When the positioning of the prosthesis was evaluated in relation to the tracheal bifurcation, identical values were obtained by both methods. The median score was 1, with variance of 0.62. No statistical differences were found between the two evaluation methods for the analyzed variables. This demonstrates the strong potential of the proposed evaluation techniques.Discussion: Our results show that the execution of the technique is possible, but some complications may occur. Mediastinoscopy as an evaluation procedure can pose some complications, these considerations are important, but by using technique proposed in this study, these factors are minimized due to the ease of technical implantation of the extraluminal tracheal stent, without the need for several instruments competing in the inflated mediastinal space. We concluded that the technique is viable and a safe method with minimal invasion for investigation and treatment of mediastinal diseases, presenting low impairment of the paratracheal structures, and that mediastinoscopy can be used as a transoperative evaluation method to minimize complications.

1 AbstractPurpose: To investigate the safety and clinical, hemodynamic and tissue improvement ability in mini pigs undergoing cell and gene therapy for the treatment of acute myocardial infarction. Methods: Thirty-two mini pigs Br1 lineage, 12 months old, undergoing induction of acute myocardial infarction by occlusion of the diagonal branch of the paraconal coronary. They were divided into 4 groups: one control group and 3 treatment groups (cell therapy and gene cell therapy). Echocardiography reviews were performed on three occasions and histopathological analysis was performed after 4 weeks. Analysis of variance (ANOVA), Tukey and Wilcoxon tests, were performed. Results: Association of vascular endothelial growth factor (VEGF) with angiopoietin1 (Ang1) presented satisfactory results in the improvement of ventricular function following ischemic cardiomyopathy in mini pigs when compared to the results of the other treated groups. Conclusion:The therapy with VEGF and the combination of VEGF with Ang1, promoted recovered function of the myocardium, characterized by reduced akinetic area and induction of neovascularization.

Background Ureteral obstruction is a common indication for surgical intervention, due to the small size of the ureter, specialized instrumentation is required such as operating microscope for intraoperative magnification and microsutures. The aim of this study is to evaluate and compare 3 sizes of nylon 6 − 0,8 − 0,10 − 0 for ureterorrhaphy in the ureter of rabbits, using microsurgical technique. Results A total of fifteen male, adults, New Zealand rabbits were divided in three groups: all groups were submitted ureterotomy. A 2 mm longitudinal incision was made in the medial portion of the right ureter, followed by a partial perforating simple interrupted 6 − 0, 8 − 0 and 10 − 0 sutures in each group. During the experiment ultrasound evaluations were performed to assess the kidney length and width, the presence of ureteral calculi, the renal pelvic dilation, the ureter diameter and the presence of free liquid in the abdominal cavity. At the end of the experiment all kidneys and ureters were submitted to macroscopic and histopathological evaluations. In the first ultrasound assessment, all groups had an acute increase in renal length (p < 0.048). The group with 8 − 0 suture showed a difference in ureteral diameter on the 5th day (p < 0.01) and all groups showed a reduction in diameter on the 30th day. The group with 6 − 0 suture showed a high mortality rate during the experimental period and the histopathological evaluation exhibited areas of necrosis. According to the ultrasound evaluation caliber 10 − 0 achieved better results in, macroscopic and microscopic evaluations. The finer suture diameters had better outcomes according to the ureteral inflammation scores. Conclusions The use of 10 − 0 suture resulted in lower rates of ureteral inflammation, renal changes and postoperative complications when compared to two other sizes of the same material.

The most common cause of spinal cord injury are high impact trauma, which often result in some motor impairment, sensory or autonomic a greater or lesser extent in the distal areas the level of trauma. In terms of survival and complications due to sequelae, veterinary patients have a poor prognosis unfavorable. Therefore justified the study of experimental models of spinal cord injury production that could provide more support to research potential treatments for spinal cord injuries in medicine and veterinary medicine. Preclinical studies of acute spinal cord injury require an experimental animal model easily reproducible. The most common experimental animal model is the rat, and several techniques for producing a spinal cord injury. The objective of this study was to describe and evaluate the effectiveness of acute spinal cord injury production technique through inflation of Fogarty® catheter using rabbits as an experimental model because it is a species that has fewer conclusive publications and contemplating. The main requirements of a model as low cost, handling convenience, reproducibility and uniformity. The technique was adequate for performing preclinical studies in neuro-traumatology area, effectively leading to degeneration and necrosis of the nervous tissue fostering the emergence of acute paraplegia.

Background: Orthopedic implants are commonly used for different types of surgical procedures to gain optimal function and to provide stability to both bones and tendon structures. When inserting these implants, the characteristics of the material are important for surgical success, and the ideal implant must be biocompatible and nonallergenic. However, when molding an implant to the bone structure, its resistance can change significantly. Implants can be temporary or permanent in the body, and metal possesses properties that make it acceptable for bone repair. In biomedical implants, 2 types are most common, commercially pure (CP)-Ti and Ti-6A1-4V. They both provide stable fixation and low risk of loosening. Implants made with the same material and composition can perform differently if the material has been altered by processing techniques for different scenarios. Stress, strain and elastic modulus are the primary metrics used in the description of implant materials. They can be calculated based on mechanical tests of specimens with defined geometry, most commonly tensile, bending and torsional tests. In order to better evaluate those changes, we compared the mechanical characteristics of titanium bone plates, before and after they were molded to the bone, to verify and quantify the loss of stiffness and resistance after molding the plate.Materials, Methods & Results: The study was prospective. Orthopedic implant made of commercially pure titanium (CP-Ti) were divided into 2 groups, one group without plate molding and the other with plate molding to a dog femora bone. Thirty-six plates of different sizes (5.0, 6.5, 8.0, 9.0, 10.0 and 11.0-mm diameter) were divided into 6 groups containing 6 plates of each size and submitted to the 4-point flexion test of resistance, using a piece of dog femur (weights of 5, 10, 15, 20 and 25 kg) as the bone in which the molding was performed. The evaluations were tabulated and analyzed using the program GraphPad Prism version 5.0. Corrections of the normal distribution curve were made using the Bartlett test. After the corrections, one-way analysis of variance (ANOVA) was performed with P < 0.05. Assessments were made within the group and between groups. Subsequently, the Newman-Keuls test was performed, adopting P < 0.05. For analyses in 2 groups, Student's t-test was performed as a post-test, also with P < 0.05. When the plates were compared between equal sizes of groups 1 and 2, the non-molded plate group (G1) obtained the best results in the flexural stiffness and structural flexion tests. However, in the flexural resistance test, most plates obtained similar results and the plates with diameters of 8 mm, 9 mm and 10 mm of the molded plate group (G2) obtained the best results.Discussion: Our results show that the implants had adequate mechanical characteristics, but the unmolded plates had greater flexural and structural stiffness than the molded plates. This difference was significant, thus demonstrating a large loss of stiffness in relation to the original conformation. However, when we tested the flexural resistance, no significant differences were observed, and although without significant statistical changes, there was an increase in the resistance of the plate with the new conformation obtained by molding. In the results of the mechanical tests, we observed that after the molding, the implants gained greater resistance, although the difference was not statistically significant. This suggests that the architecture of the implants should have slight curvature in the medial direction of the bone, since this would lead to a better adaptation to the anatomy of the bone, and possibly greater resistance, as indicated by the new configuration after molding.Keywords: bone implants, titanium, orthopedic implants, femur, dogs.