Reservatório urinário continente. Uma alternativa para a substituição vesical

Um segmento de íleo e de cólon é utilizado para criar uma neobexiga, após a cistectomia, com uma anastomose ceco-uretral. Esta técnica cirúrgica denominada “Mainz Pouch” utiliza 15 cm de ceco e cólon ascendente e duas alças ileais do mesmo comprimento para a construção de um reservatório urinário. Esta neobexiga permite a continência urinária, um grande reservatório de baixa pressão, o esvaziamento vesical voluntário e o reimplante uretra! com técnica anti-refluxo. Quatro pacientes foram submetidos a este procedimento após a cistoprostatectomia, poupando-se, porém, a inervação responsável pela ereção. O seguimento destes pacientes variou entre oito e 14 meses. Os quatro pacientes estão continentes durante os períodos diurno e noturno. Três esvaziam sua neobexiga espontâneamente, em intervalos normais. Um paciente tem ereções e relações sexuais

NDP-α-MSH attenuates heart and liver responses to myocardial reperfusion via the vagus nerve and JAK/ERK/STAT signaling

Melanocortin peptides afford cardioprotection during myocardial ischemia/reperfusion via janus kinases (JAK), extracellular signal-regulated kinases (ERK) and signal transducers/activators of transcription (STAT) pathways. Here we investigated whether melanocortin-induced modulation of the JAK/ERK/STAT signaling occurs via the cholinergic anti-inflammatory pathway, focusing our study on cardiac and hepatic responses to prolonged myocardial ischemia/reperfusion. Ischemia was produced in rats by ligature of the left anterior descending coronary artery for 30min; effects of ischemia/reperfusion were evaluated using Western blot of heart and liver proteins. Intravenous treatment, during coronary artery occlusion, with the melanocortin analog (Nle(4), D-Phe(7))α-melanocyte-stimulating hormone (NDP-α-MSH) induced a left ventricle up-regulation of the cardioprotective transcription factors pJAK2, pERK1/2 and pTyr-STAT3 (JAK-dependent), and a reduction in the levels of the inflammatory mediators tumor necrosis factor-α (TNF-α) and pJNK (a transcription factor also involved in apoptosis), as assessed at the end of the 2-h reperfusion period. Further, these beneficial effects of NDP-α-MSH were associated with heart over-expression of the pro-survival proteins heme oxygenase-1 (HO-1) and Bcl-XL, and decrease of ventricular arrhythmias and infarct size. In the liver NDP-α-MSH induced a decrease in the pJAK2 and pTyr-STAT3 levels, and strongly reduced pERK1/2 expression. In the liver of ischemic rats NDP-α-MSH also blunted pJNK activity and TNF-α expression, and up-regulated Bcl-XL. Bilateral cervical vagotomy prevented all effects of NDP-α-MSH, both in the heart and liver. These results indicate that melanocortins inhibit heart and liver damage triggered by prolonged myocardial ischemia/reperfusion likely, as main mechanism, via the vagus nerve-mediated modulation of the JAK/STAT/ERK signaling pathways