Transplantation practices

Operational techniques used in the global transplantation practices at the fence of the pancreas (pancreatic) necessitate exposure to two factors that make up the so-called "phenomenon of graft exclusion, in particular, vascular (including lymphatic), and nervous decentralization, as a result of a complete interruption anatomical connections to the body of the donor phase. The immediate effects of vascular decentralization in organ transplantation are well known - is ischemia and interstitial gland tissue lymphostasis. The question about the negative impact of denervation of the pancreas transplant for a long time remained open, but after the pathogenetic involvement of denervation and the so-called "neurodystrophic process" in all solid organs of the allograft to the mechanisms of implementation and reasons for the irreversibility of chronic rejection gave the subject that the original lack of importance, as a result that this problem a long time remained in the shadow of unresolvable problems of modern transplant [1,2,5,7].

The purpose of the work - to develop and prove experimentally neyrosohranyayuschie operational methods of preparing and allotransplantation pancreatoduodenal complex (MAC).
Materials and Methods: We studied bezporodnyh pankreatektomirovannyh dogs (= 30) weighing 18-21kg, were divided into 3 groups (10 animals in each group). For group 1 (control) - the fence of the graft was performed using a modified technique J.-M. Dubernard with preservation of duodenal segment: after opening the abdomen dissected gastrocolic ligament, mobilizing the spleen while tied up and cross the gastro-splenic ligament from the left gastro-omental artery and short gastric arteries, stomach divert upwards isolated celiac trunk, while from the aorta separated and crossed diaphragmatic feet, and from the celiac trunk was separated nervous and lymphatic tissues. Then ligated and cross the left gastric and common hepatic artery, and then pulling up for the spleen, pancreas, together with the splenic vessels removed from the retroperitoneal space, ligated and cross the inferior mesenteric vein. RV mobilized to the level of the superior mesenteric and portal veins, and superior mesenteric vein is isolated and crossed to the cranial hepatoduodenal ligament. Celiac trunk cut off from the aorta with its disk-shaped platform and then transplant pancreas is placed in cold intracellular solution was separated spleen and begin washing the graft [3]. For 2 and 3 of the fence MPC carried out according to our in INVH technique [2.4]: abdomen dissected cross-cut, then the transverse colon relegated downward and the greater omentum up and ripped up the gastrocolic ligament, were part of the omental bursa. By traction spleen anteriorly and downward, stretched gastro-splenic, splenic, renal, phrenicolienal and colonic-splenic ligament, which was dissected, and passing them previously ligated vessels at the time. Next up and assigned the spleen and anterior parietal peritoneum was dissected along the lower edge of the pancreas, away from the latter to 0,5 cm After that mobilized the pancreas to the posterior surface, the superior mesenteric artery and vein were ligated and crossed following a discharge from the last - lower pancreatoduodenal artery vein. Shaped segment of the duodenum - by cutting off the last of the stomach just below the pyloric sphincter and at 3 cm below the opening in the intestine of large and small papillary. In the hepatoduodenal conjunction isolated common bile duct and common hepatic artery, which crossed and tied, and the portal vein, which took taped. Then isolated organocomplexes with abdominal aorta (Fig.2-3) and in vitro began washing of the graft. Pancreas transplants in each group withdrew from the body of a living donor, and washed with a solution Eurocollins at +40 C with the addition of 5000ED heparin at the time of cold ischemia 1-1,5 hours. Blood flow in the graft was reduced formation mezhsosudistyh aortic anastomoses sites, including the celiac trunk, superior mesenteric artery (in group 1) and ganglionic artery (in 2 and 3 group), with the infrarenal aorta of the recipient-type end-to-side. " Between duodenal segment of the graft, namely the distal end and the small intestine of the recipient shaped anastomosis end-to-side. " And in Group 3 was carried out by the roots gangiopeksiyu mesentery of the small intestine of the recipient.

Duodenal segment of the MAC function was brand viagra evaluated after 20 and 60 minutes after turning into the bloodstream, as well as 12 and 30 days after surgery during relaparotomy using electromyography. RV function was assessed by measuring apparatus Waldman pressure in the pancreatic duct (GD) pancreas, as well as indicators of activity of amylase in urine by Wohlgemuth and blood glucose. Pancreatic endocrine function was studied 30 days after transplantation using a test with insulin: insulin intravenously at the rate of 0.1 IU per 1 kg and measured blood glucose levels at 30, 120, 180, 240 minutes [6]. When processing the histological material used silver impregnation Bilshovskomu Gros, hematoxylin and eosin staining. Mediator activity of adrenergic components of nerve tissue graft gistoflyuorestsentnym investigated the detection of the method of Falk. Aksonotransportnuyu function of nerve grafts was assessed examining the retrograde movement in neurons injected into a body of highly purified preparation of horseradish peroxidase ..
Results and discussion: In group 1 after 20 minutes after turning into the blood stream segment of duodenal ulcer (DU) was atonichen, pressure to PP RV does not exceed 5-8 mm water column After 60 minutes of gut visually clearly not peristaltirovala, but recorded low-amplitude electromyographic ostsilyatsii, the pressure in the EP RV was 130 10 mm water column In Groups 2 and 3 in 20 minutes. KDP is clearly diminished, and asynchronously, electromyography recorded low ostsilyatsii, pressure to PP RV does not exceed 110 mm water column 5 After 60 minutes peristalsis in the duodenum is insignificant (p> 0.05) differed according to the electromyography of ostsilyatsy emanating from his own duodenal recipient, pressure to PP RV equal to 140 15 mm water column, which corresponded to close to baseline setting in PCB RV intact animal. After 12 days in group 1 ostsilyatsii not actually recorded, in group 2 recorded the ostsilyatsii electromyograph amplitude, which is 4-5 times decreased as compared with 60 min in Group 3 distinct differences between the indices shot after 60 minutes, and 12 days did not was. After 30 days in group 1 - PDK completely atonic, in group 2 - electromyograph recorded the ostsilyatsii who 1,5-2 times the amplitude decreased as compared with the shot in 12 days and in Group 3 - no change.
Evaluation of the results of biochemical analysis of blood and urine of animals at different times after transplantation are presented in Table 1.

Monitoring the concentration of glucose in the blood of animals after insulin load displayed in Figure 1. The data obtained show that using the autonomic nerve centers as "centers of the local nervous regulation" allow more finely regulate the function of the pancreas transplant, which is improved by using directional surgical gangliomezenterikopeksii, compared with the classical technique of transplantation of the MPC.
Histological examination after 8-10 days was observed destruction of almost all nerve cells of celiac nodes in group 1, while in groups 2 and 3 on the light-optical levels are found structurally Intact nerve tissue with reactive changes, suggesting that a necessary condition for preserving the viability of a neyrogangliev adequate blood supply. After 30 days in group 2 were found degenerative changes in nervous tissue of vegetative nodes and pancreas, and in Group 3 with no dynamics. Also in Group 3 remained retrograde axonal transport, which is confirmed by horseradish Viagra limit opportunities peroxidase stain. In the study by Falk slices into 3 groups determined by the glow of granules of norepinephrine.
Conclusions: The data analysis revealed that the use of operational techniques neyrosohranyayuschih MPC allotransplantation positive impact on the structural and functional status of the transplanted pancreas in the MAC and increases the physiological quality, in particular, the myogenic tone and peristaltic activity of duodenal segment. Preservation of ganglion arteries and implementation gangliopeksii is a prerequisite for the viability of vegetative nodes, which respectively provide an improved and longer-term graft function. This allows us to reasonably recommend the use of techniques developed neyrosohranyayuschih transplant pancreas in clinical transplantation.

Culture method
hormonal agents
Swimming pool