Objective: To evaluate long-term efficacy and safety of melanocyte-keratinocyte cell transplantation in the management of segmental and focal vitiligo. Design: A simpler and modified method based on that of Olsson and...Objective: To evaluate long-term efficacy and safety of melanocyte-keratinocyte cell transplantation in the management of segmental and focal vitiligo. Design: A simpler and modified method based on that of Olsson and Juhlin was performed. This method uses a shaved biopsy skin sample up to one tenth the size of the recipient area. The skin sample is incubated, and the cells are mechanically separated using trypsin-EDTA solution and then centrifuged to prepare a suspension. Cell suspension is then applied to the dermabraded depigmented skin area, and a collagen dressing is applied to keep it in place. Patients: Fifty patients with segmental and 17 with focal vitiligo were treated. One patient with segmental and 2 with focal vitiligo did not attend any follow-up visits. The remaining patients were observed for a period of up to 5 years. Intervention: Autologous, noncultured melanocyte-keratinocyte cell transplantation. Main Outcome Measure: Repigmentation was graded as excellent with 95%to 100%pigmentation, good with 65%to 94%, fair with 25%to 64%, and poor with 0%to 24%of the treated area. Results: In the segmental vitiligo group, 41 patients (84%) showed excellent, 3 (6%) good, and 5 (10%) poor pigmentation, which was retained until the end of the respective follow-up period. In the focal vitiligo group, 11 patients (73%)-showed excellent, 1 (7%) fair, and 3 (20%) poor pigmentation, which was retained until the end of the respective follow-up period. Conclusions: Melanocyte-keratinocyte cell transplantation is a simple, safe, and effective surgical therapy. Patients with segmental and focal vitiligo can experience a prolonged disease-free period, which may extend through the rest of their lives.展开更多
Background/Methods: A 32- year retrospective review from 1972 to 2004 analyzed complications and long-term outcomes in children with total colonic aganglionosis (TCA) as they relate to the procedure performed. Results...Background/Methods: A 32- year retrospective review from 1972 to 2004 analyzed complications and long-term outcomes in children with total colonic aganglionosis (TCA) as they relate to the procedure performed. Results: Thirty-six patients (27 boys, 9 girls) had TCA. The level of aganglionosis was distal ileum (26), mid-small bowel (8), midjejunum (1), and entire bowel (1). Enterostomy was performed in 35 of 36. Eight developed short bowel syndrome. Twenty-nine (81% )- had a pull-through at 15± 6 months (modified Duhamel 20, Martin long Duha-mel 4, and Soave 5). Six had a Kimura patch. Postoperative complications (including enterocolitis)- were more common after long Duhamel and Soave procedures. Seven (19% ; 2 with Down’s syndrome) died (3 early, 4 late)- from pulmonary emboli (1), sepsis (1), fluid overload (1), viral illness (1), liver failure (1), arrhythmia (1), and total bowel aganglionosis (1). Mean follow-up was 11± 9 years (range, 6 months- 29 years). Twenty-four (83% ) of 29 patients exhibited growth by weight of 25% or more, 21 (91% ) of 23 older than toddler age had 4 to 6 bowel movements per day, and 17 (81% )- of 21 were continent. In 5 of 6, the Kimura patch provided functional benefit with proximal disease. Conclusion: Longterm survival was 81% . The highest morbidity occurred with long Duhamel or Soave procedures. The modified Duhamel is our procedure of choice in TCA. Bowel transplantation is an option for TCA with unadapted short bowel syndrome.展开更多
文摘Objective: To evaluate long-term efficacy and safety of melanocyte-keratinocyte cell transplantation in the management of segmental and focal vitiligo. Design: A simpler and modified method based on that of Olsson and Juhlin was performed. This method uses a shaved biopsy skin sample up to one tenth the size of the recipient area. The skin sample is incubated, and the cells are mechanically separated using trypsin-EDTA solution and then centrifuged to prepare a suspension. Cell suspension is then applied to the dermabraded depigmented skin area, and a collagen dressing is applied to keep it in place. Patients: Fifty patients with segmental and 17 with focal vitiligo were treated. One patient with segmental and 2 with focal vitiligo did not attend any follow-up visits. The remaining patients were observed for a period of up to 5 years. Intervention: Autologous, noncultured melanocyte-keratinocyte cell transplantation. Main Outcome Measure: Repigmentation was graded as excellent with 95%to 100%pigmentation, good with 65%to 94%, fair with 25%to 64%, and poor with 0%to 24%of the treated area. Results: In the segmental vitiligo group, 41 patients (84%) showed excellent, 3 (6%) good, and 5 (10%) poor pigmentation, which was retained until the end of the respective follow-up period. In the focal vitiligo group, 11 patients (73%)-showed excellent, 1 (7%) fair, and 3 (20%) poor pigmentation, which was retained until the end of the respective follow-up period. Conclusions: Melanocyte-keratinocyte cell transplantation is a simple, safe, and effective surgical therapy. Patients with segmental and focal vitiligo can experience a prolonged disease-free period, which may extend through the rest of their lives.
文摘Background/Methods: A 32- year retrospective review from 1972 to 2004 analyzed complications and long-term outcomes in children with total colonic aganglionosis (TCA) as they relate to the procedure performed. Results: Thirty-six patients (27 boys, 9 girls) had TCA. The level of aganglionosis was distal ileum (26), mid-small bowel (8), midjejunum (1), and entire bowel (1). Enterostomy was performed in 35 of 36. Eight developed short bowel syndrome. Twenty-nine (81% )- had a pull-through at 15± 6 months (modified Duhamel 20, Martin long Duha-mel 4, and Soave 5). Six had a Kimura patch. Postoperative complications (including enterocolitis)- were more common after long Duhamel and Soave procedures. Seven (19% ; 2 with Down’s syndrome) died (3 early, 4 late)- from pulmonary emboli (1), sepsis (1), fluid overload (1), viral illness (1), liver failure (1), arrhythmia (1), and total bowel aganglionosis (1). Mean follow-up was 11± 9 years (range, 6 months- 29 years). Twenty-four (83% ) of 29 patients exhibited growth by weight of 25% or more, 21 (91% ) of 23 older than toddler age had 4 to 6 bowel movements per day, and 17 (81% )- of 21 were continent. In 5 of 6, the Kimura patch provided functional benefit with proximal disease. Conclusion: Longterm survival was 81% . The highest morbidity occurred with long Duhamel or Soave procedures. The modified Duhamel is our procedure of choice in TCA. Bowel transplantation is an option for TCA with unadapted short bowel syndrome.
