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Papers by Matheus Bertanha
Journal of Vascular Surgery, 2015
Trials, 2014
The prevalence of chronic venous disease is high and occurs more frequently in females. According... more The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be exclu...
Experimental Cell Research, 2014
Extracellular matrix a b s t r a c t Clinical experience for peripheral arterial disease treatmen... more Extracellular matrix a b s t r a c t Clinical experience for peripheral arterial disease treatment shows poor results when synthetic grafts are used to approach infrapopliteal arterial segments. However, tissue engineering may be an option to yield surrogate biocompatible neovessels. Thus, biological decellularized scaffolds could provide natural tissue architecture to use in tissue engineering, when the absence of ideal autologous veins reduces surgical options. The goal of this study was to evaluate different chemical induced decellularization protocols of the inferior vena cava of rabbits. They were decellularized with Triton X100 (TX100), sodium dodecyl sulfate (SDS) or sodium deoxycholate (DS). Afterwards, we assessed the remaining extracellular matrix (ECM) integrity, residual toxicity and the biomechanical resistance of the scaffolds. Our results showed that TX100 was not effective to remove the cells, while protocols using SDS 1% for 2 h and DS 2% for 1 h, efficiently removed the cells and were better characterized.
Jornal Vascular Brasileiro, 2014
ABSTRACT Kassabach-Merritt syndrome is a combination of capillary hemangioma and thrombocytopenia... more ABSTRACT Kassabach-Merritt syndrome is a combination of capillary hemangioma and thrombocytopenia that predisposes to bleeding with petechiae, ecchymosis and spontaneous bruising. Treatment is generally started with corticosteroids, interferon alpha or chemotherapy. We present the case of a child (aged 1 year and 9 months) with a giant hemangioma, from the root of the thigh to the knee, and thrombocytopenia. Treatment was started with corticosteroids, without improvement, and then intra-tumor and cutaneous bleeding appeared spontaneously. The patient's clinical condition precluded prescription of vincristine and interferon and emergency tumor resection was conducted because of extreme thrombocytopenia and bleeding. The child then began to develop sepsis with hypotension and ischemia of remnant tissues. This case presented a therapeutic challenge, which is the subject of this article.
Jornal Vascular Brasileiro, 2014
ABSTRACT Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for... more ABSTRACT Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.
Jornal Vascular Brasileiro, 2013
Jornal Vascular Brasileiro, 2013
O tratamento de pseudoaneurismas tem sido classicamente cirúrgico, por meio de ressecção (com ana... more O tratamento de pseudoaneurismas tem sido classicamente cirúrgico, por meio de ressecção (com anastomose término-terminal ou com enxerto venoso), sutura ou bypass . As tentativas cirúrgicas do tratamento do aneurisma da artéria subclávia são muito antigas, datando desde o ano de 1818, com Valentine Mott 2 , passando por Smyth em 1864, que realizou o primeiro tratamento com sucesso. Halsted, em 1924, descreve a dificuldade no tratamento desta lesão 3 . A cirurgia aberta envolve morbimortalidade considerável, particularmente em doentes de alto risco cirúrgico 1 e em casos de cirurgia de urgência 4 . O tratamento endovascular por via percutânea (stents recobertos ou embolização), método minimamente invasivo sem necessitar de anestesia geral, tem surgido na última década como uma alternativa terapêutica. A primeira referência ao tratamento de lesões arteriais por via endovascular surgiu em 1915, por Carrel et al. 4 . Os primeiros estudos em animais com colocação de stents endoluminais foram publicados em 1969, por Dotter et al. Em 1987, Nicholas Volodos 5 realizou a primeira correção endovascular de um aneurisma de aorta em Kharkov, na então União Soviética, mas esta técnica popularizou-se em 1991, quando Parodi et al. publicaram o primeiro estudo humano sobre a utilização de stents recobertos em aneurismas (aorta abdominal) colocados percutaneamente via femoral 6 e, em 1992, utilizaram stents recobertos na terapêutica de uma fístula arteriovenosa 7 . Em1994, surgiu o primeiro estudo sobre a utilização de stents recobertos em pseudoaneurismas, por Marin et al. 8 .
Journal of Vascular Surgery, 2014
Background: Cardiovascular diseases remain leaders as the major causes of mortality in Western so... more Background: Cardiovascular diseases remain leaders as the major causes of mortality in Western society. Restoration of the circulation through construction of bypass surgical treatment is regarded as the gold standard treatment of peripheral vascular diseases, and grafts are necessary for this purpose. The great saphenous vein is often not available and synthetic grafts have their limitations. Therefore, new techniques to produce alternative grafts have been developed and, in this sense, tissue engineering is a promising alternative to provide biocompatible grafts. This study objective was to reconstruct the endothelium layer of decellularized vein scaffolds, using mesenchymal stem cells (MSCs) and growth factors obtained from platelets. Methods: Fifteen nonpregnant female adult rabbits were used for all experiments. Adipose tissue and vena cava were obtained and subjected to MSCs isolation and tissue decellularization, respectively. MSCs were subjected to differentiation using endothelial inductor growth factor (EIGF) obtained from human platelet lysates. Immunofluorescence, histological and immunohistochemical analyses were employed for the final characterization of the obtained blood vessel substitute. Results: The scaffolds were successfully decellularized with sodium dodecyl sulfate. MSCs actively adhered at the scaffolds, and through stimulation with EIGF were differentiated into functional endothelial cells, secreting significantly higher quantities of von Willebrand factor (0.85 mg/mL; P < .05) than cells cultivated under the same conditions, without EIGF (0.085 mg/mL). Cells with evident morphologic characteristics of endothelium were seen at the lumen of the scaffolds.
Jornal Vascular Brasileiro
Journal of Vascular Surgery, 2015
Trials, 2014
The prevalence of chronic venous disease is high and occurs more frequently in females. According... more The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be exclu...
Experimental Cell Research, 2014
Extracellular matrix a b s t r a c t Clinical experience for peripheral arterial disease treatmen... more Extracellular matrix a b s t r a c t Clinical experience for peripheral arterial disease treatment shows poor results when synthetic grafts are used to approach infrapopliteal arterial segments. However, tissue engineering may be an option to yield surrogate biocompatible neovessels. Thus, biological decellularized scaffolds could provide natural tissue architecture to use in tissue engineering, when the absence of ideal autologous veins reduces surgical options. The goal of this study was to evaluate different chemical induced decellularization protocols of the inferior vena cava of rabbits. They were decellularized with Triton X100 (TX100), sodium dodecyl sulfate (SDS) or sodium deoxycholate (DS). Afterwards, we assessed the remaining extracellular matrix (ECM) integrity, residual toxicity and the biomechanical resistance of the scaffolds. Our results showed that TX100 was not effective to remove the cells, while protocols using SDS 1% for 2 h and DS 2% for 1 h, efficiently removed the cells and were better characterized.
Jornal Vascular Brasileiro, 2014
ABSTRACT Kassabach-Merritt syndrome is a combination of capillary hemangioma and thrombocytopenia... more ABSTRACT Kassabach-Merritt syndrome is a combination of capillary hemangioma and thrombocytopenia that predisposes to bleeding with petechiae, ecchymosis and spontaneous bruising. Treatment is generally started with corticosteroids, interferon alpha or chemotherapy. We present the case of a child (aged 1 year and 9 months) with a giant hemangioma, from the root of the thigh to the knee, and thrombocytopenia. Treatment was started with corticosteroids, without improvement, and then intra-tumor and cutaneous bleeding appeared spontaneously. The patient's clinical condition precluded prescription of vincristine and interferon and emergency tumor resection was conducted because of extreme thrombocytopenia and bleeding. The child then began to develop sepsis with hypotension and ischemia of remnant tissues. This case presented a therapeutic challenge, which is the subject of this article.
Jornal Vascular Brasileiro, 2014
ABSTRACT Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for... more ABSTRACT Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.
Jornal Vascular Brasileiro, 2013
Jornal Vascular Brasileiro, 2013
O tratamento de pseudoaneurismas tem sido classicamente cirúrgico, por meio de ressecção (com ana... more O tratamento de pseudoaneurismas tem sido classicamente cirúrgico, por meio de ressecção (com anastomose término-terminal ou com enxerto venoso), sutura ou bypass . As tentativas cirúrgicas do tratamento do aneurisma da artéria subclávia são muito antigas, datando desde o ano de 1818, com Valentine Mott 2 , passando por Smyth em 1864, que realizou o primeiro tratamento com sucesso. Halsted, em 1924, descreve a dificuldade no tratamento desta lesão 3 . A cirurgia aberta envolve morbimortalidade considerável, particularmente em doentes de alto risco cirúrgico 1 e em casos de cirurgia de urgência 4 . O tratamento endovascular por via percutânea (stents recobertos ou embolização), método minimamente invasivo sem necessitar de anestesia geral, tem surgido na última década como uma alternativa terapêutica. A primeira referência ao tratamento de lesões arteriais por via endovascular surgiu em 1915, por Carrel et al. 4 . Os primeiros estudos em animais com colocação de stents endoluminais foram publicados em 1969, por Dotter et al. Em 1987, Nicholas Volodos 5 realizou a primeira correção endovascular de um aneurisma de aorta em Kharkov, na então União Soviética, mas esta técnica popularizou-se em 1991, quando Parodi et al. publicaram o primeiro estudo humano sobre a utilização de stents recobertos em aneurismas (aorta abdominal) colocados percutaneamente via femoral 6 e, em 1992, utilizaram stents recobertos na terapêutica de uma fístula arteriovenosa 7 . Em1994, surgiu o primeiro estudo sobre a utilização de stents recobertos em pseudoaneurismas, por Marin et al. 8 .
Journal of Vascular Surgery, 2014
Background: Cardiovascular diseases remain leaders as the major causes of mortality in Western so... more Background: Cardiovascular diseases remain leaders as the major causes of mortality in Western society. Restoration of the circulation through construction of bypass surgical treatment is regarded as the gold standard treatment of peripheral vascular diseases, and grafts are necessary for this purpose. The great saphenous vein is often not available and synthetic grafts have their limitations. Therefore, new techniques to produce alternative grafts have been developed and, in this sense, tissue engineering is a promising alternative to provide biocompatible grafts. This study objective was to reconstruct the endothelium layer of decellularized vein scaffolds, using mesenchymal stem cells (MSCs) and growth factors obtained from platelets. Methods: Fifteen nonpregnant female adult rabbits were used for all experiments. Adipose tissue and vena cava were obtained and subjected to MSCs isolation and tissue decellularization, respectively. MSCs were subjected to differentiation using endothelial inductor growth factor (EIGF) obtained from human platelet lysates. Immunofluorescence, histological and immunohistochemical analyses were employed for the final characterization of the obtained blood vessel substitute. Results: The scaffolds were successfully decellularized with sodium dodecyl sulfate. MSCs actively adhered at the scaffolds, and through stimulation with EIGF were differentiated into functional endothelial cells, secreting significantly higher quantities of von Willebrand factor (0.85 mg/mL; P < .05) than cells cultivated under the same conditions, without EIGF (0.085 mg/mL). Cells with evident morphologic characteristics of endothelium were seen at the lumen of the scaffolds.
Jornal Vascular Brasileiro