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Smit JM, Plat VD, Panday AN, Daams F, Negenborn VL. What are the short- and long-term abdominal consequences of an omentectomy? A systematic review. J Surg Oncol 2024; 129:1420-1429. [PMID: 38606519 DOI: 10.1002/jso.27640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
This review provides an overview regarding the abdominal effects of an omentectomy, with or without extra-peritoneal reconstructions. In general, reported complication rates were low. Short-term complications involved ileus, bowel stenosis, abdominal abscess and sepsis (range 0.0%-23%). Donor-site hernia was mainly reported as long-term complication (up to 32%) and negligible gastrointestinal complications were observed. However, the level of evidence and methodological quality are quite low with a maximum of 8.5 years follow-up.
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Affiliation(s)
- Jan Maerten Smit
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Victor D Plat
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Arvind Nannan Panday
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
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Ten-year experience with laparoscopic pedicled omental flap for cerebral revascularization in patients with Moyamoya disease. J Pediatr Surg 2022; 57:710-715. [PMID: 35197196 DOI: 10.1016/j.jpedsurg.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The omental flap has numerous extraperitoneal applications in reconstruction and revascularization given its favorable immunologic and angiogenic properties. In patients with Moyamoya disease, cerebral revascularization using a pedicled omental flap has proven to be a viable option following direct revascularization procedures. Historically, harvesting omentum involved laparotomy with the associated risk of complications; herein we describe outcomes from a 10-year experience of laparoscopic harvesting of pedicled omental flap for cerebral revascularization in Moyamoya patients. METHODS A retrospective chart review was performed of all patients with Moyamoya disease who underwent laparoscopic omental cerebral transposition between 2011 and 2021. Intraoperative and postoperative complications, length of stay (LOS), and outcomes at follow-up were analyzed. RESULTS Twenty-one patients underwent the procedure during the study period. Three intraoperative complications occurred (one segmental transverse colectomy for mesenteric injury, one converted to omental free flap, and one requiring micro anastomosis). Average overall LOS was 6 ± 6 days, with 3 ± 3.5 days in the ICU (mean±SD). Following discharge, complications included epigastric incisional hernia at the graft fascial exit site, recurrent neck pain at subcutaneous tunneling site, and partial scalp necrosis. One patient required subsequent direct bypass seven months after the initial procedure owing to the progression of the disease. All other patients had partial or complete resolution of symptoms. CONCLUSION Our retrospective observational study indicates that laparoscopic pedicled omental flap mobilization and transposition is a safe and effective method of indirect cerebral revascularization in patients with Moyamoya disease. LEVEL OF EVIDENCE N/A.
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Iizuka S, Uebayashi A, Nakamura T, Funai K. Spontaneous closure of a metachronous brochopleural fistula after omentoplasty for a preceding fistula: Case report. Ann Med Surg (Lond) 2022; 82:104645. [PMID: 36268306 PMCID: PMC9577646 DOI: 10.1016/j.amsu.2022.104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction A bronchopleural fistula (BPF) after an anatomical lung resection commonly arises singly. We report a case of a metachronous BPF, which developed after omentoplasty of a preceding fistula and subsequently closed without any intervention. Case presentation A 77-year-old patient underwent omentoplasty for a brochopleural fistula (BPF) following a right lower lobectomy. A sudden massive air leak developed from the novel BPF approximately 1 cm proximal to the preceding fistula 3 days later. The air leak resolved spontaneously without any intervention one week later. The corresponding fistula was found to be completely closed. Computed tomography showed the omental flap covered both fistulae. Conclusion The present case suggested that a metachronous BPF could develop and a harvested omental flap might migrate even after being anchored. A metachronous bronchopleural fistula (BPF) developed 3 days after an omentoplasty for a preceding fistula following a right lower lobectomy. The BPF was closed spontaneously without any subsequent intervention and a computed tomography revealed that the omental flap covered both fistulae. A metachronous BPF could develop and a harvested omental flap might migrate even after being anchored.
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4
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Wang J, Zhang B, Fan J, Cheng S, Fan S, Yin L, Li Z, Guan H, Yang K, Li X. The application of the "omental wrapping" technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures. Transl Androl Urol 2021; 10:2871-2878. [PMID: 34430389 PMCID: PMC8350257 DOI: 10.21037/tau-21-305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background To present our experience with the "omental wrapping" technique in laparoscopic and robotic ureteroplasty using onlay flaps or grafts for the management of long proximal or middle ureteral strictures. Methods This is a retrospective review of 25 patients with long proximal or middle ureteral strictures who underwent laparoscopic and robotic onlay flaps or grafts ureteroplasty using an omental flap to reinforce an anastomosis site between August 2018 and November 2019. Perioperative and follow-up data were collected. Results Sixteen laparoscopic procedures and nine robotic procedures were performed successfully. Sixteen patients underwent ureteroplasty with lingual mucosal graft (LMG), and nine patients with appendiceal onlay flap (AOF). The median stricture length was 4 cm (range, 2-6 cm). The mean operative time (OT) was 220.5±50.6 min, the estimated blood loss (EBL) was 66.0±38.9 mL, and the length of hospital stay (LHS) was 8.0±3.6 days. In the LMG group, four patients had tongue numbing and one had an oral ulcer, which relieved itself gradually without intervention. Two patients in the LMG group and four patients in the AOF group experienced urinary tract infection, and all responded well to antibiotic treatment. There were no complications attributed to "omental wrapping". The mean follow-up was 16.3±4.8 months. According to the standards regarding improvement in clinical symptoms, relief of obstruction radiologically and a stable estimate glomerular filtration rate, our surgical success rate was 100%. Conclusions The "omental wrapping" technique in laparoscopic and robotic onlay flaps or grafts ureteroplasty for long proximal or middle ureteral strictures is an efficient, safe, reproducible and simple technique.
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Affiliation(s)
- Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Baiyu Zhang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lu Yin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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Shadmani A, Razmkhah M, Jalalpoor MH, Lari SY, Eghtedari M. Autologous Activated Omental versus Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cells in Corneal Alkaline Injury: An Experimental Study. J Curr Ophthalmol 2021; 33:136-142. [PMID: 34409223 PMCID: PMC8365576 DOI: 10.4103/joco.joco_246_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To compare the effects of two types of mesenchymal stem cells (MSCs), activated omental cells (AOCs), and adipose tissue-derived stem cells (ADSCs) in the healing process of animal model of ocular surface alkali injury. Methods: An alkaline burn was induced on the ocular surfaces of eighteen rats divided randomly into three groups. The first and second groups received subconjunctival AOCs and ADSCs, respectively. The control group received normal saline subconjunctival injection. On the 90th day after the injury, the eyes were examined using slit-lamp biomicroscopy. Corneal neovascularization and scarring were graded in a masked fashion. Histological evaluation of the corneal scar was performed, and the number of inflammatory cells was evaluated. Results: Corneal neovascularization scores revealed higher neovascularization in the control (0.49 ± 0.12) than the AOC (0.80 ± 0.20, P = 0.01) and ADSC groups (0.84 ± 0.24, P = 0.007). There were no statistically significant differences between the neovascularization score of the AOC and ADSC groups (P > 0.05). According to histologic evaluation, stromal infiltration was significantly more in the control group compared to AOC and ADSC groups (P < 0.05). Conclusions: Our results suggest that MSCs, even with different sources, can be used to promote wound healing after corneal chemical burns. However, the ease of harvesting ADSC from more superficial fat sources makes this method more clinically applicable.
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Affiliation(s)
- Athar Shadmani
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Razmkhah
- Shiraz Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Masoomeh Eghtedari
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Nguyen RH, Kubes P. Bespoke brain immunity. Science 2021; 373:396-397. [PMID: 34437108 DOI: 10.1126/science.abj8183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Rita H Nguyen
- Department of Clinical Neurosciences, Division of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pharmacology and Physiology, University of Calgary, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Kubes
- Department of Pharmacology and Physiology, University of Calgary, Calgary, Alberta, Canada. .,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ishigaki K, Kumano K, Fujita K, Ueno H. Cellular basis of omentum activation and expansion revealed by single-cell RNA sequencing using a parabiosis model. Sci Rep 2021; 11:13958. [PMID: 34230565 PMCID: PMC8260800 DOI: 10.1038/s41598-021-93330-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 01/07/2023] Open
Abstract
Although the physiological function of the omentum remains elusive, it has been proposed that it plays an important role in fat storage, immune regulation, and regeneration of injured tissues and organs. Although the omentum undergoes expansion upon activation, reports on the accurate assessment of increased cell types and the origin of the increased cells remain limited. To investigate this aspect, the omenta of parabiotic mice were subjected to activation using distinct fluorescent markers and single-cell RNA sequencing (scRNA-seq) was performed to identify circulation-derived omental cells. We found that a considerable number of circulating cells contributed to the activation of the omentum. The omental cells derived from circulating cells exhibited morphological features similar to those of fibroblasts. scRNA-seq revealed the existence of a novel cell population that co-expressed macrophage and fibroblast markers in the activated omentum, suggesting that it corresponded to circulating macrophage-derived fibroblast-like cells. Lineage tracing experiments revealed that most fibroblasts in the activated omentum were not derived from WT1-positive mesenchymal progenitors. The cell cluster also expressed various chemokine genes, indicating its role in the activation and recruitment of immune cells. These results provide important information regarding the activation of the omentum.
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Affiliation(s)
- Kazuhiko Ishigaki
- Department of Stem Cell Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan
| | - Keiki Kumano
- Department of Stem Cell Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan
| | - Kyohei Fujita
- Department of Stem Cell Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan
| | - Hiroo Ueno
- Department of Stem Cell Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
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8
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Belov YV, Kosenkov AN, Vinokurov IA, Al-Yousef A. [Treatment of recurrent traumatic sternomediastinitis after cardiac surgery]. Khirurgiia (Mosk) 2021:53-57. [PMID: 33570355 DOI: 10.17116/hirurgia202102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION Omentoplasty reduces duration of treatment and risk of arrosive bleeding.
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Affiliation(s)
- Yu V Belov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A N Kosenkov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I A Vinokurov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A Al-Yousef
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
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9
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Di Nicola V. Omentum a powerful biological source in regenerative surgery. Regen Ther 2019; 11:182-191. [PMID: 31453273 PMCID: PMC6700267 DOI: 10.1016/j.reth.2019.07.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 02/06/2023] Open
Abstract
The Omentum is a large flat adipose tissue layer nestling on the surface of the intra-peritoneal organs. Besides fat storage, omentum has key biological functions in immune-regulation and tissue regeneration. Omentum biological properties include neovascularization, haemostasis, tissue healing and regeneration and as an in vivo incubator for cells and tissue cultivation. Some of these properties have long been noted in surgical practice and used empirically in several procedures. In this review article, the author tries to highlight the omentum biological properties and their application in regenerative surgery procedures. Further, he has started a process of standardisation of basic biological principles to pave the way for future surgical practice.
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Mirzaeian L, Eftekhari-Yazdi P, Esfandiari F, Eivazkhani F, Rezazadeh Valojerdi M, Moini A, Fathi R. Induction of Mouse Peritoneum Mesenchymal Stem Cells into Germ Cell-Like Cells Using Follicular Fluid and Cumulus Cells-Conditioned Media. Stem Cells Dev 2019; 28:554-564. [DOI: 10.1089/scd.2018.0149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Leila Mirzaeian
- Department of Developmental Biology, University of Science and Culture, Tehran, Iran
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Fereshteh Esfandiari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Farideh Eivazkhani
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mojtaba Rezazadeh Valojerdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Anatomy, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rouhollah Fathi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Vishwakarma SK, Lakkireddy C, Bardia A, Paspala SAB, Tripura C, Habeeb MA, Khan AA. Bioengineered functional humanized livers: An emerging supportive modality to bridge the gap of organ transplantation for management of end-stage liver diseases. World J Hepatol 2018; 10:822-836. [PMID: 30533183 PMCID: PMC6280164 DOI: 10.4254/wjh.v10.i11.822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/24/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
End stage liver diseases (ESLD) represent a major, neglected global public health crisis which requires an urgent action towards finding a proper cure. Orthotropic liver transplantation has been the only definitive treatment modality for ESLD. However, shortage of donor organs, timely unavailability, post-surgery related complications and financial burden on the patients limits the number of patients receiving the transplants. Since last two decades cell-based therapies have revolutionized the field of organ/tissue regeneration. However providing an alternative organ source to address the donor liver shortage still poses potential challenges. The developments made in this direction provide useful futuristic approaches, which could be translated into pre-clinical and clinical settings targeting appropriate applications in specific disease conditions. Earlier studies have demonstrated the applicability of this particular approach to generate functional organ in rodent system by connecting them with portal and hepatic circulatory networks. However, such strategy requires very high level of surgical expertise and also poses the technical and financial questions towards its future applicability. Hence, alternative sites for generating secondary organs are being tested in several types of disease conditions. Among different sites, omentum has been proved to be more appropriate site for implanting several kinds of functional tissue constructs without eliciting much immunological response. Hence, omentum may be considered as better site for transplanting humanized bioengineered ex vivo generated livers, thereby creating a secondary organ at intra-omental site. However, the expertise for generating such bioengineered organs are limited and only very few centres are involved for investigating the potential use of such implants in clinical practice due to gap between the clinical transplant surgeons and basic scientists working on the concept evolution. Herein we discuss the recent advances and challenges to create functional secondary organs through intra-omental transplantation of ex vivo generated bioengineered humanized livers and their further application in the management of ESLD as a supportive bridge for organ transplantation.
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Affiliation(s)
- Sandeep Kumar Vishwakarma
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Telangana, India
- Dr Habeebullah Life Sciences, Attapur, Hyderabad 500058, Telangana, India
| | - Chandrakala Lakkireddy
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Telangana, India
- Dr Habeebullah Life Sciences, Attapur, Hyderabad 500058, Telangana, India
| | - Avinash Bardia
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Telangana, India
- Dr Habeebullah Life Sciences, Attapur, Hyderabad 500058, Telangana, India
| | - Syed Ameer Basha Paspala
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Telangana, India
- Dr Habeebullah Life Sciences, Attapur, Hyderabad 500058, Telangana, India
| | - Chaturvedula Tripura
- CSIR-Centre for Cellular and Molecular Biology, Habsiguda, Hyderabad 500007, Telangana, India
| | - Md Aejaz Habeeb
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Telangana, India
- Dr Habeebullah Life Sciences, Attapur, Hyderabad 500058, Telangana, India
| | - Aleem Ahmed Khan
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Telangana, India
- Dr Habeebullah Life Sciences, Attapur, Hyderabad 500058, Telangana, India.
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12
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Harper EI, Sheedy EF, Stack MS. With Great Age Comes Great Metastatic Ability: Ovarian Cancer and the Appeal of the Aging Peritoneal Microenvironment. Cancers (Basel) 2018; 10:E230. [PMID: 29996539 PMCID: PMC6070816 DOI: 10.3390/cancers10070230] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/22/2022] Open
Abstract
Age is one of the biggest risk factors for ovarian cancer. Older women have higher rates of diagnosis and death associated with the disease. In mouse models, it was shown that aged mice had greater tumor burden than their younger counterparts when intraperitoneally injected with ovarian tumor cells. While very few papers have been published looking at the direct link between ovarian cancer metastasis and age, there is a wealth of information on how age affects metastatic microenvironments. Mesothelial cells, the peritoneal extracellular matrix (ECM), fibroblasts, adipocytes and immune cells all exhibit distinct changes with age. The aged peritoneum hosts a higher number of senescent cells than its younger counterpart, in both the mesothelium and the stroma. These senescent cells promote an inflammatory profile and overexpress Matrix Metalloproteinases (MMPs), which remodel the ECM. The aged ECM is also modified by dysregulated collagen and laminin synthesis, increases in age-related crosslinking and increasing ovarian cancer invasion into the matrix. These changes contribute to a vastly different microenvironment in young and aged models for circulating ovarian cancer cells, creating a more welcoming “soil”.
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Affiliation(s)
- Elizabeth I Harper
- Department of Chemistry and Biochemistry, University of Notre Dame, South Bend, IN 46617, USA.
- Harper Cancer Research Institute, University of Notre Dame, South Bend, IN 46617, USA.
- Integrated Biomedical Sciences Program, University of Notre Dame, South Bend, IN 46617, USA.
| | - Emma F Sheedy
- Harper Cancer Research Institute, University of Notre Dame, South Bend, IN 46617, USA.
- Department of Mathematics, University of Notre Dame, South Bend, IN 46617, USA.
| | - M Sharon Stack
- Department of Chemistry and Biochemistry, University of Notre Dame, South Bend, IN 46617, USA.
- Harper Cancer Research Institute, University of Notre Dame, South Bend, IN 46617, USA.
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13
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Affiliation(s)
- J Vernik
- Department of Medicine, Stroger Hospital of Cook County, Chicago, USA
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14
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Herrick SE, Mutsaers SE. The Potential of Mesothelial Cells in Tissue Engineering and Regenerative Medicine Applications. Int J Artif Organs 2018; 30:527-40. [PMID: 17628854 DOI: 10.1177/039139880703000611] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Injury to the serosa through injurious agents such as radiation, surgery, infection and disease results in the loss of the protective surface mesothelium and often leads to fibrous adhesion formation. Mechanisms that increase the rate of mesothialisation are therefore actively being investigated in order to reduce the formation of adhesions. These include intraperitoneal delivery of cultured mesothelial cells as well as administration of factors that are known to increase mesothelial proliferation and migration. An exciting alternative that has only recently received attention, is the possible role of mesothelial progenitor cells in the repair and regeneration of denuded serosal areas. Accumulating evidence suggests that such a population exists and under certain conditions is able to form a number of defined cell types indicating a degree of plasticity. Such properties may explain the extensive use of mesothelial cells in various tissue engineering applications including the development of vascular conduits and peripheral nerve replacements. It is likely that with the rapid explosion in the fields of tissue engineering and regenerative medicine, a greater understanding of the potential of mesothelial progenitor cells to repair, replace and possibly regenerate damaged or defective tissue will be uncovered.
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Affiliation(s)
- S E Herrick
- School of Medicine, Faculty of Medical and Human Sciences, University of Manchester, Oxford Road, Manchester, UK.
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15
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Successful Laparoscopic Harvesting of Omental Pedicle Flap for Salvage Cerebral Revascularization in 2 Adults With Moyamoya Disease: Technique and Lessons Learned. Surg Laparosc Endosc Percutan Tech 2017; 27:e111-e115. [PMID: 28708772 DOI: 10.1097/sle.0000000000000448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Moyamoya is an idiopathic and progressive disease that leads to occlusion of intracranial arteries. When other methods of revascularization fail, omentum can be used as an indirect bypass to improve cerebral perfusion. Laparoscopic mobilization of a pedicled omental flap with subcutaneous tunneling to the brain has been described in small case series in children. We report our techniques and outcomes in 2 adults with Moyamoya to undergo such a procedure. An omental flap based on the right gastroepiploic artery was created and intraoperative fluorescence imaging using indocyanine green was used to assess the viability of the flap and to guide lengthening of the pedicle. The flap was tunneled subcutaneously using skip incisions. There were no intraoperative complications and no postoperative complications related to the omental flap. Follow-up evaluation demonstrates viable omental flaps and improved cerebral vascularization. This technique is feasible in adults who require salvage cerebral revascularization for Moyamoya disease.
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Meza-Perez S, Randall TD. Immunological Functions of the Omentum. Trends Immunol 2017; 38:526-536. [PMID: 28579319 PMCID: PMC5812451 DOI: 10.1016/j.it.2017.03.002] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/28/2017] [Accepted: 03/10/2017] [Indexed: 12/25/2022]
Abstract
The omentum is a visceral adipose tissue with unique immune functions. Although it is primarily an adipose tissue, the omentum also contains lymphoid aggregates, called milky spots (MSs), that contribute to peritoneal immunity by collecting antigens, particulates, and pathogens from the peritoneal cavity and, depending on the stimuli, promoting a variety of immune responses, including inflammation, tolerance, or even fibrosis. Reciprocal interactions between cells in the MS and adipocytes regulate their immune and metabolic functions. Importantly, the omentum collects metastasizing tumor cells and supports tumor growth by immunological and metabolic mechanisms. Here we summarize our current knowledge about the development, organization, and function of the omentum in peritoneal immunity.
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Affiliation(s)
- Selene Meza-Perez
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Troy D Randall
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Bahamondes F, Flores E, Cattaneo G, Bruna F, Conget P. Omental adipose tissue is a more suitable source of canine Mesenchymal stem cells. BMC Vet Res 2017; 13:166. [PMID: 28595579 PMCID: PMC5465460 DOI: 10.1186/s12917-017-1053-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/08/2017] [Indexed: 01/08/2023] Open
Abstract
Background Mesenchymal Stem Cells (MSCs) are a promising therapeutic tool in veterinary medicine. Currently the subcutaneous adipose tissue is the leading source of MSCs in dogs. MSCs derived from distinct fat depots have shown dissimilarities in their accessibility and therapeutic potential. The aims of our work were to determine the suitability of omental adipose tissue as a source of MSCs, according to sampling success, cell yield and paracrine properties of isolated cells, and compared to subcutaneous adipose tissue. Results While sampling success of omental adipose tissue was 100% (14 collections from14 donors) for subcutaneous adipose tissue it was 71% (10 collections from 14 donors). MSCs could be isolated from both sources. Cell yield was significantly higher for omental than for subcutaneous adipose tissue (38 ± 1 vs. 30 ± 1 CFU-F/g tissue, p < 0.0001). No differences were observed between sources regarding cell proliferation potential (73 ± 1 vs. 74 ± 1 CDPL) and cell senescence (at passage 10, both cultures presented enlarged cells with cytoplasmic vacuoles and cellular debris). Omental- and subcutaneous-derived MSCs expressed at the same level bFGF, PDGF, HGF, VEGF, ANG1 and IL-10. Irrespective of the source, isolated MSCs induced proliferation, migration and vascularization of target cells, and inhibited the activation of T lymphocytes. Conclusion Compared to subcutaneous adipose tissue, omental adipose tissue is a more suitable source of MSCs in dogs. Since it can be procured from donors with any body condition, its collection procedure is always feasible, its cell yield is high and the MSCs isolated from it have desirable differentiation and paracrine potentials. Electronic supplementary material The online version of this article (doi:10.1186/s12917-017-1053-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francisca Bahamondes
- Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Av. Las Condes 12,438, Lo Barnechea, Santiago, 7710162, Chile. .,Departamento de Ciencias Clínicas, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Av. Santa Rosa 11,735, Santiago, Chile.
| | - Estefania Flores
- Departamento de Ciencias Clínicas, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Av. Santa Rosa 11,735, Santiago, Chile
| | - Gino Cattaneo
- Departamento de Ciencias Clínicas, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Av. Santa Rosa 11,735, Santiago, Chile
| | - Flavia Bruna
- Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Av. Las Condes 12,438, Lo Barnechea, Santiago, 7710162, Chile
| | - Paulette Conget
- Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Av. Las Condes 12,438, Lo Barnechea, Santiago, 7710162, Chile
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Liu J, Geng X, Li Y. Milky spots: omental functional units and hotbeds for peritoneal cancer metastasis. Tumour Biol 2016; 37:5715-26. [PMID: 26831659 PMCID: PMC4875158 DOI: 10.1007/s13277-016-4887-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
As the most common metastatic disease of abdomen pelvic cavity cancer, peritoneal carcinomatosis (PC) renders significant negative impact on patient survival and quality of life. Invasive peritoneal exfoliated cancer cells (PECCs) preferentially select the omentum as a predominant target site for cancer cell colonization and proliferation compared with other tissues in the abdominal cavity. The precise pathogenic mechanism remains to be determined. As omental milky spots (MSs) are the major implantation site for malignant cells in peritoneal dissemination, researches on mechanisms of PC have been mainly focused on MS, primitive lymphoid tissues with unique structural features, and functional characteristics. To date, extensive biophysical and biochemical methods have been manipulated to investigate the MS exact function in the peritoneal cavity. This review summarized MS as hotbeds for PECC. The anatomical distribution was briefly described first. Then, MS histology was systematically reviewed, including morphological features, cellular constituents, and histological staining methods. At last, the roles of MS in PC pathological process were summarized with special emphasis on the distinct roles of macrophages.
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Affiliation(s)
- Jiuyang Liu
- Department of Oncology, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Xiafei Geng
- Department of Oncology, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Yan Li
- Department of Oncology, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China. .,Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital Affiliated to the Capital Medical University, Tieyilu 10, Yangfangdian, Haidian District, Beijing, 100038, People's Republic of China.
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Konieczny MJ, Ri SJ, Georgiadis JR. Omental Approach to Functional Recovery After Cerebrovascular Disease. World Neurosurg 2015; 87:406-16. [PMID: 26493716 DOI: 10.1016/j.wneu.2015.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To review and synthesize the clinical literature regarding risks and benefits of omentum transplantation and transposition surgery in patients with ischemic stroke of other etiology (non-MMD) and Moyamoya disease (MMD), and to evaluate the evidence for biological underpinnings of the presumed physiologic effects of omentum transplantation and transposition on vascularization of brain parenchyma. METHODS Articles were searched on scientific databases using predefined key terms. Data abstraction was based on the clinical course as reported in the articles. For further analysis, patients were divided into groups according to their diagnosis (MMD or non-MMD). Descriptive statistics were computed for better integration of the results. RESULTS The final literature review contained 15 articles (11 case series, 4 single case studies) with data on 93 patients (29 non-MMD, 64 MMD). At post-assessment 56% of patients showed substantial gains in functional domains (24% in the non-MMD group, 71% in the MMD group) and 92% demonstrated improvements of cerebral vascularization (55% in the non-MMD group, 98% in the MMD group). Differences in improvement became apparent with regard to the initial symptomatology wherein transient ischemic attacks were related to superior recovery rates and language pathologies showed least improvement. CONCLUSIONS Surgical revascularization using omental tissue has shown good success rates, particularly for recurrent transient ischemic attacks and prevention of further strokes and should be considered as treatment option for selected patients. Experimental data on the physiologic basis for postoperative improvement delivered convincing evidence for its arteriogenic potential and recent developments in omental stem cell research suggest a role in recovery from long-standing neurological deficits.
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Affiliation(s)
- Marek J Konieczny
- Department of Molecular Neurobiology, Graduate School of Behavioural and Cognitive Neurosciences, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany.
| | - Song-Jin Ri
- Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany
| | - Janniko R Georgiadis
- Department of Neuroscience, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
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Abstract
Direct arterial bypass remains the best option in patients with terminal ischemia of the hand, if there is an adequate distal target vessel. In situ bypass is the procedure of choice in patients who are candidates for arterial bypass. Venous arterialization offers an option in patients in whom there is not adequate arterial runoff in the hand. Venous arterialization should be avoided in patients with significant wounds and/or active infection. In selected patients, microvascular omental transfer can offer an option for revascularization of the ischemic hand.
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Affiliation(s)
- William C Pederson
- The Hand Center of San Antonio, University of Texas Health Science Center at San Antonio, 21 Spurs Lane, Suite 310, San Antonio, TX 78240, USA.
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Navarro R, Chao K, Gooderham PA, Bruzoni M, Dutta S, Steinberg GK. Less invasive pedicled omental-cranial transposition in pediatric patients with moyamoya disease and failed prior revascularization. Neurosurgery 2014; 10 Suppl 1:1-14. [PMID: 23921707 DOI: 10.1227/neu.0000000000000119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with moyamoya disease and progressive neurological deterioration despite previous revascularization pose a major treatment challenge. Many have exhausted typical sources for bypass or have ischemia in areas that are difficult to reach with an indirect pedicled flap. Omental-cranial transposition has been an effective, but sparingly used technique because of its associated morbidity. OBJECTIVE We have refined a laparoscopic method of harvesting an omental flap that preserves its gastroepiploic arterial supply. METHODS The pedicled omentum can be lengthened as needed by dividing it between the vascular arcades. It is transposed to the brain via skip incisions. The flap can be trimmed or stretched to cover ischemic areas of the brain. The cranial exposure is performed in parallel with pediatric surgeons. We performed this technique in 3 pediatric patients with moyamoya disease (aged 5-12 years) with previous superficial temporal artery to middle cerebral artery bypasses and progressive ischemic symptoms. In 1 patient, we transposed omentum to both hemispheres. RESULTS Blood loss ranged from 75 to 250 mL. After surgery, patients immediately tolerated a diet and were discharged in 3 to 5 days. The ischemic symptoms of all 3 children resolved within 3 months postoperatively. Magnetic resonance imaging at 1 year showed improved perfusion and no new infarcts. Angiography showed excellent revascularization of targeted areas and patency of the donor gastroepiploic artery. CONCLUSION Laparoscopic omental harvest for cranial-omental transposition can be performed efficiently and safely. Patients with moyamoya disease appear to tolerate this technique much better than laparotomy. With this method, we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.
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Affiliation(s)
- Ramon Navarro
- *Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine and Lucile Packard Children's Hospital, Stanford, California; ‡Department of Pediatric Surgery, Stanford University School of Medicine and Lucile Packard Children's Hospital, Stanford, California
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Bu P, Vin AP, Sethupathi P, Ambrecht LA, Zhai Y, Nikolic N, Qiao L, Bouchard CS. Effects of activated omental cells on rat limbal corneal alkali injury. Exp Eye Res 2014; 121:143-6. [PMID: 24582890 DOI: 10.1016/j.exer.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/27/2014] [Accepted: 02/15/2014] [Indexed: 11/28/2022]
Abstract
Omental cells (OCs) are shown to help wound healing. The purpose of this study is to investigate if OCs improve cornea repair after alkali injury by subconjunctival injection of activated OCs in rats. Forty eight hours after limbal corneal alkali injury, fresh isolated OCs were injected subconjunctivally into the recipient rat's eye. Prior to the injury and at 0, 4 and 8 days after injury, the eyes were examined using slit lamp biomicroscopy. Corneal opacification and corneal neovascularization were graded in a masked fashion. The inflammatory response to the injury was evaluated by counting neutrophil cell numbers in the cornea under microscope. There was no significant difference in corneal opacification between the control and OCs treatment groups; however, the corneal neovascularization was significantly less in the eyes treated with OCs as compared to the controls. Also OCs treatment markedly decreased neutrophil infiltration after corneal-limbal alkali injury. Our results suggest that OCs may have a beneficial role in corneal healing after limbal corneal alkali injury by suppressing inflammatory cell infiltrates and corneal neovascularization.
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Affiliation(s)
- Ping Bu
- Department of Ophthalmology, Loyola University Chicago, Maywood, IL, USA.
| | - Anita P Vin
- Department of Ophthalmology, Loyola University Chicago, Maywood, IL, USA
| | - Periannan Sethupathi
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA
| | - Lindsay A Ambrecht
- Department of Ophthalmology, Loyola University Chicago, Maywood, IL, USA
| | - Yougang Zhai
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA
| | - Nicole Nikolic
- Department of Ophthalmology, Loyola University Chicago, Maywood, IL, USA
| | - Liang Qiao
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA
| | - Charles S Bouchard
- Department of Ophthalmology, Loyola University Chicago, Maywood, IL, USA
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Shevach M, Soffer-Tsur N, Fleischer S, Shapira A, Dvir T. Fabrication of omentum-based matrix for engineering vascularized cardiac tissues. Biofabrication 2014; 6:024101. [DOI: 10.1088/1758-5082/6/2/024101] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Eda M, Kaidoh T, Takanashi Y, Inoué T. A stone-like ovarian dermoid cyst in the Douglas' Pouch of an elderly woman. Pathol Int 2013; 62:771-3. [PMID: 23121610 DOI: 10.1111/pin.12002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Omentum in the pediatric umbilical hernia: is it a potential alarm for the appearance of complications? Case Rep Pediatr 2012; 2012:463628. [PMID: 23213589 PMCID: PMC3502821 DOI: 10.1155/2012/463628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 10/17/2012] [Indexed: 11/17/2022] Open
Abstract
Umbilical hernia is a common benign condition which resolves spontaneously during the first five years of life. However, in certain cases there are some characteristics which may be indicative of a different prognostic approach, as they increase the possibility of complications. The two cases of umbilical hernia that we describe here were treated operatively and revealed the presence of strangulated and adhered omentum, respectively. Reflecting on the adhesive properties of the omentum, we hypothesized that this may occur more often than it is believed, especially in those cases that are described as recurrent symptomatic herniations. In such cases, there should be increased alert for the possibility of complications during the period of the conservative expectance for resolution.
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Shah S, Lowery E, Braun RK, Martin A, Huang N, Medina M, Sethupathi P, Seki Y, Takami M, Byrne K, Wigfield C, Love RB, Iwashima M. Cellular basis of tissue regeneration by omentum. PLoS One 2012; 7:e38368. [PMID: 22701632 PMCID: PMC3368844 DOI: 10.1371/journal.pone.0038368] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 05/03/2012] [Indexed: 01/01/2023] Open
Abstract
The omentum is a sheet-like tissue attached to the greater curvature of the stomach and contains secondary lymphoid organs called milky spots. The omentum has been used for its healing potential for over 100 years by transposing the omental pedicle to injured organs (omental transposition), but the mechanism by which omentum helps the healing process of damaged tissues is not well understood. Omental transposition promotes expansion of pancreatic islets, hepatocytes, embryonic kidney, and neurons. Omental cells (OCs) can be activated by foreign bodies in vivo. Once activated, they become a rich source for growth factors and express pluripotent stem cell markers. Moreover, OCs become engrafted in injured tissues suggesting that they might function as stem cells. Omentum consists of a variety of phenotypically and functionally distinctive cells. To understand the mechanism of tissue repair support by the omentum in more detail, we analyzed the cell subsets derived from the omentum on immune and inflammatory responses. Our data demonstrate that the omentum contains at least two groups of cells that support tissue repair, immunomodulatory myeloid derived suppressor cells and omnipotent stem cells that are indistinguishable from mesenchymal stem cells. Based on these data, we propose that the omentum is a designated organ for tissue repair and healing in response to foreign invasion and tissue damage.
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Affiliation(s)
- Shivanee Shah
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Erin Lowery
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Rudolf K. Braun
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Alicia Martin
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Nick Huang
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Melissa Medina
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Periannan Sethupathi
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Yoichi Seki
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Mariko Takami
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Kathryn Byrne
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Christopher Wigfield
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Robert B. Love
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
| | - Makio Iwashima
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Gibly RF, Zhang X, Graham ML, Hering BJ, Kaufman DB, Lowe WL, Shea LD. Extrahepatic islet transplantation with microporous polymer scaffolds in syngeneic mouse and allogeneic porcine models. Biomaterials 2011; 32:9677-84. [PMID: 21959005 DOI: 10.1016/j.biomaterials.2011.08.084] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 08/31/2011] [Indexed: 02/03/2023]
Abstract
Intraportal transplantation of islets has successfully treated select patients with type 1 diabetes. However, intravascular infusion and the intrahepatic site contribute to significant early and late islet loss, yet a clinical alternative has remained elusive. We investigated non-encapsulating, porous, biodegradable polymer scaffolds as a vehicle for islet transplantation into extrahepatic sites, using syngeneic mouse and allogeneic porcine models. Scaffold architecture was modified to enhance cell infiltration leading to revascularization of the islets with minimal inflammatory response. In the diabetic mouse model, 125 islets seeded on scaffolds implanted into the epididymal fat pad restored normoglycemia within an average of 1.95 days and transplantation of only 75 islets required 12.1 days. Increasing the pore size to increase islet-islet interactions did not significantly impact islet function. The porcine model was used to investigate early islet engraftment. Increasing the islet seeding density led to a greater mass of engrafted islets, though the efficiency of islet survival decreased. Transplantation into the porcine omentum provided greater islet engraftment than the gastric submucosa. These results demonstrate scaffolds support murine islet transplantation with high efficiency, and feasibility studies in large animals support continued pre-clinical studies with scaffolds as a platform to control the transplant microenvironment.
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Affiliation(s)
- Romie F Gibly
- Institute of Bionanotechnology in Medicine, Northwestern University, Chicago, IL 60611, USA
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da Silva CA, Monnet E. Long-term outcome of dogs treated surgically for idiopathic chylothorax: 11 cases (1995–2009). J Am Vet Med Assoc 2011; 239:107-13. [DOI: 10.2460/javma.239.1.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Starke RM, Chwajol M, Lefton D, Sen C, Connolly ES, Berenstein A, Langer DJ. Revascularization of the Brainstem and Cerebellum. Neurosurgery 2010. [DOI: 10.1227/01.neu.0000384043.57293.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rafael H. Revascularization of the brainstem and cerebellum. Neurosurgery 2010; 67:E521; author reply E521. [PMID: 20644393 DOI: 10.1227/01.neu.0000384042.80164.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The omentum: anatomical, metabolic, and surgical aspects. J Gastrointest Surg 2009; 13:1138-46. [PMID: 19291335 DOI: 10.1007/s11605-009-0855-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 02/26/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The omentum is acknowledged to have diverse functions in the pathophysiology of intra-abdominal disease. Its angiogenic properties act as a natural defense mechanism in peritonitis and intra-abdominal sepsis. With advancing technology the omentum is revealing itself as a new player in the field of molecular surgery with special reference to cancer, obesity and tissue reconstruction. MATERIALS AND METHODS This article reviews the existing and potential surgical applications of the omentum.
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35
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Comparison of collagen biomatrix and omentum effectiveness on peripheral nerve regeneration. Neurosurg Rev 2009; 32:355-62; discussion 362. [DOI: 10.1007/s10143-009-0193-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 12/09/2008] [Accepted: 01/18/2009] [Indexed: 11/25/2022]
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Shankle WR, Hara J, Bjornsen L, Gade GF, Leport PC, Ali MB, Kim J, Raimo M, Reyes L, O'Heany T, Mena I. Omental therapy for primary progressive aphasia with tau negative histopathology: 3 year study. Neurol Res 2009; 31:766-9. [PMID: 19138468 DOI: 10.1179/174313209x382511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Omentum transposition surgery (OT) applied to various neurodegenerative disorders has produced clinically significant improvement, which may be due to omentally-derived factors. To evaluate the clinical effect of left hemisphere OT in a primary progressive aphasia (PPA) patient, 3 year follow-up data were analysed. METHODS Left hemisphere OT was performed on a 68-year-old male with PPA, characterized by moderate dementia and severe expressive aphasia with relatively preserved comprehension, object recognition and visual-spatial abilities. He was longitudinally assessed with cognitive, functional, behavioral and brain HMPAO SPECT measures pre-OT, at baseline and every 3-6 months for 34 months. RESULTS All measures improved above baseline for >20 months and persisted at or above baseline for 34 months. Cortical activity increased by a maximum of 21% underneath transposed omentum and in synaptically connected areas, and persisted in >50% of the cortex for at least 12 months. Subjectively, family members observed improved verbal and non-verbal communication. CONCLUSION OT produced a sustained, beneficial treatment effect in PPA and warrants further clinical and basic research to identify explanatory factors.
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Affiliation(s)
- William R Shankle
- Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA, USA; Department of Cognitive Science, University of California at Irvine, Irvine, CA, USA; The Shankle Clinic, Irvine, CA, USA.
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Hefty TR, Kuhr CS, Chong KT, Guinee DG, Wang W, Reems JA, Greenbaum CJ. Omental roll-up: a technique for islet engraftment in a large animal model. J Surg Res 2008; 161:134-8. [PMID: 19394649 DOI: 10.1016/j.jss.2008.11.842] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/07/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attrition of transplanted islets is significant after hepatic embolization. This study was designed to investigate a novel surgical technique for islet transplantation into the omentum. This site allows placement of the islets in a three-dimensional (3D) matrix, with growth factors, to temporarily culture the islets in vivo while revascularization progresses. MATERIALS AND METHODS Five female dogs (three partial and two total pancreatectomies) received an autologous islet transplant in the omentum. Islets were suspended in 1 mL of PBS containing 10 ug of vascular endothelial growth factor (VEGF). Fresh autologous plasma (10 mL) was mixed with the islet/VEGF suspension. The coagulum containing the islets and VEGF was then placed on the greater omentum. The leading edge of omentum was rolled up to secure the islet/VEGF/coagulum in position and to present the thin islet layer with two omental surfaces for implantation. Omentum was recovered at 2, 13, 21, 42, and 180 d. RESULTS Immunohistochemical staining for synaptophysin, glucagon, and insulin confirmed the presence of transplanted islets in all omenta. Insulin and C peptide production from the omental islets was confirmed in portal venous samples, and normalization of morning glucose levels beginning on day 7 was seen in the total pancreatectomy experiment. CONCLUSIONS Autologous islets implant in rolled-up omentum when placed as a VEGF/autologous plasma coagulum. This technique has potential benefits, including the opportunity to accelerate revascularization and to investigate local strategies for modulating the immune response.
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Affiliation(s)
- Thomas R Hefty
- Division of Renal and Pancreas Transplantation, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
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Goldsmith HS. Treatment of acute spinal cord injury by omental transposition: a new approach. J Am Coll Surg 2008; 208:289-92. [PMID: 19228541 DOI: 10.1016/j.jamcollsurg.2008.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 10/21/2008] [Accepted: 10/23/2008] [Indexed: 10/21/2022]
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Omental transposition in treatment of Alzheimer disease. J Am Coll Surg 2007; 205:800-4. [PMID: 18035264 DOI: 10.1016/j.jamcollsurg.2007.06.294] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 06/11/2007] [Accepted: 06/14/2007] [Indexed: 11/22/2022]
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Shankle WR, Hara J, Bjornsen L, Gade GF, Leport PC, Ali MB, Kim J, Raimo M, Reyes L, Amen D, Rudy L, O'Heany T. Omentum transposition surgery for patients with Alzheimer's disease: a case series. Neurol Res 2007; 30:313-25. [PMID: 17767812 DOI: 10.1179/016164107x230126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To examine effect of omentum transposition surgery (OT) in Alzheimer's disease (AD). METHODS Within-subjects design, also known as repeated-measures design, was used. OT was performed on six biopsy-confirmed AD patients (three to the left and right hemispheres each). Follow-up was conducted over 16-50 months. Outcome measures included the sum of the sub-scores of the clinical dementia rating scale (CDRSS), dementia severity rating scale (DSRS), mini-mental status exam (MMSE) and neuropsychiatric inventory (NPI), all normalized to 0-1.0. Outcomes were compared to baseline values and to expected decline with and without cholinesterase inhibitors therapy (ChEI). RESULTS Compared to baseline and to expected decline with ChEI, CDRSS scores were 22 and 39% less impaired at means of 14 and 25 months post-OT, and DSRS scores were 12 and 22% less impaired at means of 14 and 19 months post-OT (p<0.0001). Compared to baseline and expected course with and without ChEI, the MMSE scores of the left hemisphere OT patients were not significantly different for 11, 17 and 22 months respectively (p>0.49), while those of the right hemisphere OT patients more rapidly declined. The two patients with significant pre-operative behavioral problems markedly improved; NPI severity scores decreased by 23 (16%) and 78 (54%) points and were sustained for 22 and 42 months. DISCUSSION OT yielded cognitive, functional or behavioral improvement for up to 3.5 years in these AD patients. Compared to randomized ChEI clinical trials, OT was 34 times more likely to produce clinically significant improvement. Basic research to identify the mechanisms underlying the therapeutic effect of omentum is warranted.
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Affiliation(s)
- William R Shankle
- Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA 92708, USA.
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