omental transposition

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

omental transposition

Postby Cece » Wed Nov 06, 2013 3:29 pm

Ok if anyone even clicks on a post with a weird title like omental transposition, here is what omental transposition is:
Brain and spinal cord revascularization by omental transposition.

(PMID:7936081)

Abstract

Goldsmith HS
Department of Neurosurgery, Boston University School of Medicine, MA 02118.

Neurological Research [1994, 16(3):159-162]

It has been learned over the years that placement of the pedicled omentum onto the brain and the spinal cord results in the rapid development of blood vessels that penetrate directly, vertically and deeply into the underlying CNS structure. Rapid clinical changes in some patients following omental transposition to the CNS raised the question as to whether the changes might be due not only to increased vascular perfusion, but to neurochemicals within omental tissue. Subsequent studies have shown that the omentum incorporates in its tissue neurotransmitters, nerve growth substances, gangliosides and angiogenic factors of high activity. These neurochemical and angiogenic substances are undoubtedly involved in some manner in the ability of axons in a transected spinal cord to grow at 1 mm/day and apparently make appropriate connections with distal spinal cord target tissue.

http://europepmc.org/abstract/MED/79360 ... PtscjGI.52

It's been tried in stroke patients but I don't see any evidence of it having been tried in MS patients. It seems to be brain surgery to place a pedicled omentum onto the brain or spinal cord which causes rapid development of blood vessels and increased perfusion. This might be better than stem cells for our particular needs. First ccsvi venoplasty, then pedicled omentum surgery? Risk is probably high. Imagine though if it worked for patients with advanced MS.

It's been tried in Alzheimer's: http://www.ncbi.nlm.nih.gov/pubmed/14503017
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Re: omental transposition

Postby Cece » Wed Nov 06, 2013 3:38 pm

http://www.ncbi.nlm.nih.gov/pubmed/11547922
Neurol Res. 2001 Sep;23(6):555-64.

Role of the omentum in the treatment of Alzheimer's disease.

Goldsmith HS.

University of Nevada School of Medicine-Reno, Glenbrook 89413, USA.

Abstract

Beneficial post-operative changes in Alzheimer patients have been observed following omentum transposition to the brain. It is believed that these changes are to a certain degree due to the omentum's ability to increase cerebral blood flow (CBF). Since the omentum is known to increase CBF and to have angiogenic, neurotransmitters and nerve growth substances in its tissues, it is theorized that these biological factors favorably affect still viable but deteriorating ischemic-sensitive neurons located within the Alzheimer brain. Being able to 'rescue' these neurons by increasing CBF and adding neurotrophic factors from the omentum are mechanisms which are believed to increase neuronal energy (ATP production) which leads to cognitive improvement.

In MS, there are definitely neurons in need of rescuing.
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Re: omental transposition

Postby Cece » Wed Nov 06, 2013 3:43 pm

http://www.ncbi.nlm.nih.gov/pubmed/23921707
Neurosurgery. 2013 Aug 5. [Epub ahead of print]

Less-Invasive Pedicled Omental-Cranial Transposition in Pediatric Patients with Moyamoya Disease and Failed Prior Revascularization.

Navarro R, Chao K, Gooderham PA, Bruzoni M, Dutta S, Steinberg GK.


Source

1Departments of Neurosurgery, and Stanford Stroke Center and, Pediatric Surgery2, Stanford University School of Medicine and Lucile Packard Children's Hospital, Stanford, CA.

Abstract

BACKGROUND::

Patients with moyamoya disease and progressive neurologic 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 moyamoya patients (aged 5 to 12 years) with prior STA-MCA 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. All 3 children's ischemic symptoms resolved within 3 months postoperatively. MRI 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. Moyamoya patients appear to tolerate this technique much better than laparotomy. With this method we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.

Less invasive technique.
I feel like I should have figured out what a pedicled omentum is by now, but I haven't. I think it is a body part. LOL.
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Re: omental transposition

Postby Cece » Wed Nov 06, 2013 3:53 pm

http://www.ncbi.nlm.nih.gov/pubmed/10086501
Surg Neurol. 1999 Mar;51(3):342-5; discussion 345-6.

Omental transposition for cerebral infarction: a 13-year follow-up study.

Goldsmith HS, Sax DS.

During the past decade there has been increasing use of omental transposition to the brain of patients who experienced neurologic sequelae after a cerebral infarction. This paper reports the long-term neurologic effects seen in a patient who underwent omental transposition 31 months after a stroke. Her postoperative follow-up period has been 13 years.

CASE DESCRIPTION:

The patient had an expressive aphasia, a right hemiparesis and the inability to read which occurred immediately after her stroke. After surgery she demonstrated subjective and objective improvement in her speech and mobility. She also regained her ability to read shortly after surgery.

CONCLUSION:

The patient demonstrated that omental transposition to the brain can improve neurologic function in the presence of a long-standing cerebral infarction and that the clinical improvement can be maintained over an extended period.

A case study. Improvements in mobility, aphasia and ability to read. This was nearly three years after a stroke, so it was a long-standing neurological deficit, and the improvements remained at thirteen years follow-up.
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Re: omental transposition

Postby Cece » Wed Nov 06, 2013 4:02 pm

http://www.ncbi.nlm.nih.gov/pubmed/15072643
Neurol Res. 2004 Mar;26(2):226-9.

Current concepts on the expression of neurotrophins in the greater omentum.

Dujovny M, Ding YH, Ding Y, Agner C, Perez-Arjona E.

Department of Neurosurgery, Wayne State University, Detroit, MI, USA.

Abstract

The omentum has been utilized in Neurosurgery since the late 1960s. Its overwhelming effects on fibroblast and peripheral nerve growths were soon noticed. However, there was no direct evidence of production of any of the growth factors by the omentum, although substances were shown to be present in the omentum. Three animals were used in the study. After removal of the omentum in one, the tissue was submitted to PCR for BDNF, NT3/4 and NT5. Water was the negative control utilized. There was marked expression of all neurotrophins in the omentum, indicating local production of all those substances. The omentum has, for the first time, demonstrated to produce and not only accumulate neurotrophins. Utilization of this concept may permit transplant or transposition of parts of the omentum into the central nervous system for the management of multiple diseases, including vascular dementia, strokes, Alzheimer's disease or Moya-Moya disease.

Vascular dementia, strokes, Alzheimer's disease, Moya-Moya and why not advanced MS too?
Wayne State University...

other links
http://www.ncbi.nlm.nih.gov/pubmed/17767812
Omentum transposition surgery for patients with Alzheimer's disease: a case series.

http://www.ncbi.nlm.nih.gov/pubmed/19138468
Omental therapy for primary progressive aphasia with tau negative histopathology: 3 year study

http://www.ncbi.nlm.nih.gov/pubmed/2284990
Regional cerebral blood flow after omental transposition to the ischaemic brain in man. A five year follow-up study.

http://www.ncbi.nlm.nih.gov/pubmed/21403393
A new approach to the treatment of Alzheimer's disease: the need for a controlled study

The last article linked is by Dr. Goldsmith, who has published on this for thirty years now, and who is now a Clinical Professor of Neurosurgery at University of California, Davis. He might make an interesting speaker at ISNVD 2015...
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Re: omental transposition

Postby Anonymoose » Wed Nov 06, 2013 4:25 pm

Cece,
This is grosser than your leech idea. Lol. Pretty cool though. :)

http://ovariancancer.about.com/od/ovari ... mentum.htm
Definition: The omentum is a large fatty structure which literally hangs off the middle of your colon and drapes over the intestines inside the abdomen. It is not clear why it evolved as part of the human body, but it does reach every organ in the abdomen, draping over and attaching itself to areas of inflammation. So, as part of its function, it may act as a bandage in case of bad infection or intestinal rupture (such as appendicitis), limiting spread of infection. It is important in ovarian cancer because it has a lot of tiny blood vessels. So cancer cells that have broken away from the ovary like to implant and grow there, known as omental metastasis.
Pronunciation: oh-men-tum
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Re: omental transposition

Postby Cece » Wed Nov 06, 2013 4:35 pm

Anonymoose wrote:Cece,
This is grosser than your leech idea. Lol. Pretty cool though. :)

<grin>
Leeches was pretty out there.
Omental transposition is less so, I think? It seems like a vascular solution to a vascular problem. The patients where it's been used -- Alzheimer's, stroke -- have a lot in common with advanced MS patients.
I was not able to find anything about the risks or adverse events or risk of morbidity.
Thanks for the definition...
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Re: omental transposition

Postby Cece » Thu Nov 07, 2013 1:19 pm

http://www.jns.dergisi.org/text.php3?id=419
Omental Transplantation For Amyotrophic Lateral Sclerosis: Case report

Hernando RAFAEL1, Rafaela MEGO1, Juan Pedro AMEZCUA2, Wilfredo GARCIA2

1Sanatorio San Hipolito, Neurosurgery, Mexico city, Mexico
2Instituto Maxicano del seguro social, General surgery and anesthesiology, Mexico city, Mexico
Summary

Objective: Up to date,the cause of amyotrophic lateral sclerosis (ALS ) is not known. Several factors have been etiologically linked with this disease, but none of them with ischemia in the anterior horns of the spinal cord, in the pyramids and in bulbar nuclei of the cranial nerves.The goal of the present study was to place omentum on the medullo-spinal junction to a patient with severe ALS.

Method: A 60-year-old man with a bulbar form of ALS received an omental transplantation on the anterior and right lateral surface of the medulla oblongata.During surgery we found: 1)vascular anomalies; 2) atherosclerosis in both V4 segments of the vertebral arteries;3) several exsanguinated perforating arteries over the surface of the pyramids,and 4) hypotrophy of the anterior surface of the pyramids.

Result: Subjective and objective clinical improvement occurred beginning the first day after surgery.This improvement was better during the first days or weeks after operation than in the following months. At present,fourteen months after surgery,the bulbar symptoms have improved by 90% and he can walk at a slow pace with or without assistance.

Conclusions: These observations suggests that the bulbar form of ALS is caused by progressive ischemia in the intraparenchymal territory of the anterior-ventral spinal arteries. Because ,in contrast to this, its revascularization by means of omentum produced neurological improvement.

Omental transposition done in Mexico for an ALS patient. Improvement persisted 14 months post-surgery.
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Re: omental transposition

Postby Cece » Thu Nov 07, 2013 1:25 pm

http://www.plosone.org/article/info%3Ad ... ne.0038368
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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Re: omental transposition

Postby Cece » Thu Nov 07, 2013 1:44 pm

http://www.alstdi.org/forum/yaf_postst5 ... r-ALS.aspx
Well, I certainly get results...

I just had a pleasant talk with Dr. Goldsmith, who returned my call. He asked that I forward to him the info I get from Dr. Rafael, which I did.

Dr. Goldsmith was unaware of the work in Peru, and in an off[hand manner said that Rafael uses Omentum for lots of things, like diabetes. He also said that transport is far easier than transplant, which involves hooking up transplanted piece of omentum to a new blood supply.

He also said he thought that transport could help ALS but there was no place to do the operation in the US< and that it would be very expensive... He didn't encourage me, to say the least, and only mentioned a place(unnamed) in Singapore that he used to work with, but he hasn't ;n years.

I felt he was genuinely concerned, but had no idea how to possibly proceed.. I asked h;imp pointblank if he thought Rafael waa on the up and up, and he paused Before Demurring.

Clearly he has never performed this on someone with ALS and although he might be interested in it he had no notion of how to proceed. He said he would look at the stuff I sent and would see if ant makes sense.

Paul

Dr. Goldsmith, who published many of the articles linked above, was contacted by members of an ALS forum to ask about Dr. Rafael's published case study.

Lots of information on the ALS thread about this. At the end of the thread, there's 2 patient reports that aren't good. They had it done (I believe for ALS) and had respiratory complications and long hospital stays and worsened health. This is the omental transplantation, which is different than the transposition.
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