Efecto epitelizante y analgésico del sevoflurano tópico en el tratamiento de las úlceras por presión grado I-III no infectadas Hospital Obrero N°1 de La Paz Bolivia / Epithelializing and analgesic effect of topical sevoflurane in the treatment by pressure of uninfected grade I-III ulcers Hospital Obrero (workers´ Hospital) N°1 of La Paz Bolivia

INTRODUCCIÓN: las úlceras por presión constituyen un importante problema de salud por su frecuencia, carácter crónico, costes económicos y una merma en la calidad de vida en pacientes internados en las unidades de cuidados especiales. MATERIAL Y MÉTODOS: el objetivo del estudio fue evaluar el efecto epitelizante y analgésico del sevoflurano aplicado tópicamente en úlceras por presión grado I-III no infectadas de pacientes internados. El tipo de estudio fue Ensayo clínico aleatorizado. Un total de 16 pacientes fueron incluidos en el estudio y fueron divididos aleatoriamente en 2 grupos: grupo A (8 pacientes), en los que se realizó la curación con sevoflurano tópico más povidona yodada y, grupo B (8 pacientes) curación solo con yodopovidona. La valoración de la evolución de la úlcera se realizó mediante la Escala PUSH, que valora superficie, cantidad de exudado y tipo de tejido del lecho. RESULTADOS: durante la realización de la curación, el dolor manifestado por los integrantes del Grupo A (1.6 ± 0.7), fue mucho menor que el observado el Grupo B (7.2 ± 1). No se encontró diferencias significativas en la superficie de la úlcera y en la cantidad de exudado; si se encontró una diferencia significativa en el tipo de tejido existente en el lecho ulceroso, en los pacientes del Grupo A se evidenció la presencia de tejido de granulación y epitelial a partir de la tercera semana de tratamiento, lo cual, en los pacientes del Grupo B, se observó a partir de la cuarta semana.

INTRODUCTION: pressure ulcers constitute an important health problem due to their frequency, chronic nature, economic costs and a reduction in the quality of life in patients hospitalized in special care units. MATERIAL AND METHODS: the aim of the study was to evaluate the epithelializing and analgesic effect of sevoflurane applied topically in uninfected grade I-III pressure ulcers of hospitalized patients. The type of study was Randomized Clinical Trial. A total of 16 patients were included in the study and were randomly divided into 2 groups: group A (8 patients), in which the cure was performed with topical sevoflurane plus povidone iodine, and group B (8 patients) only with povidone iodine. The evaluation of the evolution of the ulcer was performed using the PUSH Scale, which assesses surface area, amount of exudate and type of bed tissue. RESULTS: during the healing, the pain manifested by the members of Group A (1.6 ± 0.7), was much lower than that observed in Group B (7.2 ± 1). No significant differences were found on the surface of the ulcer and in the amount of exudate; If a significant difference was found in the type of tissue existing in the ulcer bed, in Group A patients the presence of epithelial and granulation tissue was evidenced starting the third week of treatment, which, in Group A patients B, was observed starting the fourth week.

Avaliação clínica de pacientes com úlceras de perna acompanhados em ambulatório / Evaluación clínica de pacientes con úlceras de piernas en tratamiento ambulatorio / Clinical evaluation of patients with leg ulcers attended in outpatient clinic

RESUMO Objetivo realizar avaliação clínica e sociodemográfica de pacientes com úlceras de perna. Método estudo transversal, quantitativo, com 105 pacientes com úlceras de perna em ambulatórios da rede pública de Niterói/RJ, aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense. Os dados foram coletados no período de janeiro a agosto de 2019, analisados por estatística descritiva e dispostos em tabelas. Resultados pacientes do sexo masculino (57,1%), de 60 a 80 anos (60%), com ensino fundamental incompleto (45,7%), renda de até 1 salário mínimo (64,8%). A maioria das lesões foi de etiologia venosa (76,2%), de tempo igual ou superior a 40 meses (54,3%), com tamanho maior que 10cm2 (53,3%), apresentando exsudato seroso (91,4%) em pequena quantidade (40%) e predominância de tecido granulado (36,2%). A dor foi um achado frequente, relacionada com a posição do membro (31,4%). Conclusão e implicações para a prática o conhecimento do perfil da população acompanhada e das características clínicas das lesões favorece a otimização do tratamento, permitindo um planejamento específico da assistência de enfermagem.

RESUMEN Objetivo realizar evaluación clínica y sociodemográfica de pacientes con úlceras de piernas. Método estudio transversal, cuantitativo, con 105 pacientes con úlceras de piernas en clínicas públicas en Niterói/RJ, aprobado por el Comité de Ética en Investigación de la Facultad de Medicina de la Universidade Federal Fluminense. Los datos fueron recolectados de enero a agosto de 2019, analizados por estadística descriptiva y presentados en tablas. Resultados pacientes del sexo masculino (57.1%), de 60 a 80 años (60%), con educación primaria incompleta (45.7%), ingresos de hasta 1 salario mínimo (64.8%). La mayoría de las lesiones fueron de etiología venosa (76,2%), con una duración de 40 meses o más (54,3%), con un tamaño superior a 10 cm2 (53,3%), presentando exudado seroso (91,4%) en pequeña cantidad (40%) y predominio de tejido granulado (36,2%). El dolor fue un síntoma frecuente, relacionado con la posición del miembro (31,4%). Conclusión e implicaciones para la práctica el conocimiento del perfil de la población monitoreada y las características clínicas de las lesiones favorecen la optimización del tratamiento, lo que permite una planificación específica de la atención de enfermería.

ABSTRACT Objective to perform clinical and sociodemographic evaluation of patients with leg ulcers. Method cross-sectional study with a quantitative approach, performed with 105 patients with leg ulcers in public outpatient clinics located in Niterói/RJ, approved by the Research Ethics Committee of the Medical School of Universidade Federal Fluminense. Data were collected from January to August 2019, analyzed by descriptive statistics and organized in tables. Results most were male patients (57.1%), aged between 60-80 years (60%), with incomplete primary education (45.7%) and monthly income up to 1 minimum wage (64.8%). Most ulcers were of venous etiology (76.2%), present for 40 months or more (54.3%), with size greater than 10cm2 (53.3%), having serous exudate (91.4%) in small quantity (40%) and predominance of granulation tissue (36.2%). Pain was a frequent finding, related with the leg position (31.4%). Conclusion and implications for practice the knowledge of the population profile and clinical characteristics of wounds favors treatment optimization, allowing specific nursing care planning.

Cirurgia do periápice para remoção de lesões granulomatosas: relato de caso / Periapical surgery to remove granulomatous lesion

Periapical granuloma is a histological term that refers to the formation of a mass of granulomatous tissue around the apex of a tooth resulting from inflammation and necrosis of the pulp tissue. It consists of an infiltrate of inflammatory cells such as macrophages, plasmocytes and lymphocytes, as well as fibroblasts, collagen fibers and capillaries. Periapical surgery is an alternative for preserving the tooth in the oral cavity in cases where periapical inflammation is persistent even after treatment of root canals. The objective of this study was to report a clinical case in which the surgical technique was used to remove granulomatous lesions from a patient, female, with a history of recurrent periapical abscess without painful symptomatology in the region of the anterior 11,12 and 13 teeth. The histopathological exam demonstrated the presence of a granulomatous tissue with intense inflammatory infiltrate mixed, permeated with lymphocytes and high number of plasmocytes, confirming the diagnosis of periapical granuloma. The treatment was considered successful since the patient remained asymptomatic and there was incorporation of the inorganic bovine bone graft and initiation of bone neoformation in the periapical region.

Granuloma periapical é um termo histológico que refere-se à formação de uma massa de tecido granulomatoso ao redor do ápice de um dente, decorrente da inflamação e necrose do tecido pulpar. É constituído por um infiltrado de células inflamatórias como macrófagos, plasmócitos e linfócitos, além de fibroblastos, fibras colágenas e capilares. A cirurgia do periápice é uma alternativa para preservação do dente na cavidade bucal nos casos em que a inflamação periapical é persistente mesmo após tratamento dos canais radiculares. O objetivo desse trabalho é relatar um caso clínico no qual a técnica cirúrgica do periápice foi utilizada para remoção de lesões granulomatosas de uma paciente, do sexo feminino, com histórico de abscesso periapical recidivante sem sintomatologia dolorosa na região dos dentes anteriores superiores 11, 12 e 13. O exame histopatológico demonstrou a presença de um tecido granulomatoso com intenso infiltrado inflamatório misto, permeado com linfócitos e elevado número de plasmócitos, confirmando o diagnóstico de granuloma periapical. O tratamento foi considerado exitoso, visto que a paciente se manteve asintomática e houve incorporação do enxerto ósseo bovino inorgânico e início da neoformação óssea na região periapical.

Heberprot P en lesión grave de la mano e injerto bipediculado al abdomen. Presentación de caso / Heberprot P in serious hand injury and bipedicular graft to the abdomen. Case report

RESUMEN Fundamento: El Heberprot P es una terapia que contribuye a la reparación de tejidos dañados. Su utilización en las lesiones ortopédicas de los miembros superiores es muy reciente y de escasa publicación. Objetivo: Describir la evolución de una paciente con lesión grave del dorso de la mano derecha en el que se utilizó el Heberprot P, seguido de injerto pediculado. Presentación de caso: Paciente que sufrió accidente con lesión grave en la mano derecha. Se realizó diagnóstico clínico e imagenológico con pérdida de piel, tejido celular subcutáneo y fractura del cuarto y quinto metacarpianos, se le aplicó procedimiento quirúrgico. Evolucionó de forma tórpida con infección profunda, pérdida de tendones extensores y exposición ósea, se decidió iniciar tratamiento con Heberprot P para incentivar tejido de granulación; 21 días después se logró cubrir las estructuras óseas, se operó los tendones y cobertura cutánea con injerto bipediculado al abdomen con evolución favorable. La paciente se reincorporó a su actividad social y laboral a los 10 meses. Conclusiones: El Heberprot P aceleró la cicatrización de tejidos, asociado a colgajos a distancia facilitó una evolución satisfactoria y evitó la amputación, disminuyó estadía hospitalaria, asimismo propició la reincorporación a la vida social y laboral.

ABSTRACT Background: Heberprot P is a therapy that contributes to the repairing of damaged tissues. Its use in orthopedic injuries of the upper limbs is very recent and of little publication. Objective: To describe the evolution of a patient with a serious injury to the back of the right hand in which the Heberprot P was used, followed by a pedicle graft. Case report: Patient who suffered an accident with a serious right hand injury. Clinical and imaging diagnosis was made with skin loss, subcutaneous cellular tissue and fracture of the fourth and fifth metacarpals, a surgical procedure was applied. It evolved torpidly with deep infection, loss of extensor tendons and bone exposure, it was decided to start treatment with Heberprot P to stimulate granulation tissue; 21 days later, the bone structures were covered, the tendons and skin coverage were operated with a bipedicular graft to the abdomen with a favorable evolution. The patient returned to her social and work activity at 10 months. Conclusions: Heberprot P accelerated tissue healing, associated with remote flaps, facilitated a satisfactory evolution and avoided amputation, decreased hospital stay, and also favored return to social and work life.

Flap bipedicular no tratamento de lesão cutânea traumática em membro torácico de gato: relato de caso / Bipedicular flap in the treatment of traumatic skin injury in cat thoracic member: case report

O objetivo do presente estudo é relatar a construção de um retalho direto de bolsa bipediculada com fixação apendicular à região torácica para o tratamento de lesões extensas no membro torácico direito de um gato. Foi tratado no Hospital Veterinário Unicesumar Maringá - Paraná, um felino de 1 ano de idade, apresentando lesão no membro torácico, após história de briga com outro animal da mesma espécie. Ao exame físico, apresentava fístula e edema no membro torácico direito. O paciente foi anestesiado e foi realizado o desbridamento das áreas desvitalizadas. Como terapia inicial, a lesão foi tratada como ferida aberta, até a formação de tecido de granulação, para posterior correção do defeito empregando retalho bipediculado em bolsa direta, com fixação temporária do membro à parede torácica. Após duas semanas, o membro foi desimplantado e os pontos foram removidos 21 dias após a aplicação do retalho. O uso do retalho permitiu completa cicatrização da ferida, sem ocorrência de hematomas, necrose ou deiscência de sutura. Conclui-se que a utilização do retalho bipedicular é aplicável ao tratamento de feridas traumáticas em membro torácico de felinos.

The aim of the present study is to report the construction of a direct bipedicled pouch flap with appendicular fixation to the thoracic region for the treatment of extensive lesions in the right thoracic limb of a cat. He was treated on Hospital Veterinário Unicesumar Maringá - Paraná, a 1-year-old feline, presenting injury to the thoracic limb after a history of fighting with another animal of the same species. On physical examination, he presented fistula and edema in the right thoracic limb. The patient was anesthetized and debridement of the devitalized areas was performed. As an initial therapy, the lesion was treated as an open wound until granulation tissue was formed for subsequent correction of the defect using a direct pouch bipedicled flap, with temporary fixation of the limb to the chest wall. After two weeks, the limb was unimplanted and the stitches were removed 21 days after flap application. The use of the flap allowed complete wound healing without bruising, necrosis or suture dehiscence. It is concluded that the use of bipedicular flap is applicable to the treatment of traumatic wounds in feline thoracic limb.

Evaluación de cicatrización en zonas donantes de injerto de piel parcial con uso de xenoinjerto en comparación con sustituto dérmico sintético de celulosa / Evaluation of healing in partial skin graft donor sites using a xenograft compared to a synthetic cellulose skin substitute

Objetivo: Realizar una evaluación de la cicatrización en la zona donante de injerto de piel parcial con uso de sustituto dérmico comparado con xenoinjerto, en pacientes con lesiones diversas que requirieron injerto de piel parcial. Materiales y métodos: Se presenta el reporte de 20 pacientes entre 19 y 65 años de la Unidad de Cirugía Plástica del Hospital María Auxiliadora de Lima Metropolitana-Perú, entre diciembre 2017 y junio 2018, donde se evaluó la cicatrización en zonas donantes de injerto de piel parcial. El estudio es de tipo intervención, analítico, prospectivo y longitudinal. Emplea el diseño doble ciego para controlar posibles sesgos. Para analizar la significancia estadística se usaron pruebas no paramétricas con un nivel de confianza 95 %. Resultados: Con el uso del sustituto dérmico se aprecia una mejor calidad de cicatrización de zonas donantes de epitelización en comparación con el xenoinjerto. Ambas técnicas se evaluaron con la escala de Vancouver que considera cinco aspectos (cicatrización, vascularidad, pigmentación, flexibilidad y altura), de los cuales, la cicatrización tuvo resultados significativos (p<0,05). Al estimar el riesgo de evolución de cicatrización según el modelo de riesgos proporcionales de Cox, se obtuvo un H=0,60 (IC95% 0,46-0,78), lo cual indica que el menor tiempo de cicatrización se encontró en el grupo en que se empleó el sustituto dérmico. Conclusiones: El sustituto dérmico es una alternativa importante que favorece buena calidad de la cicatrización en las zonas donantes. El sustituto dérmico es más eficiente que el xenoinjerto convencional al ser evaluado y comparado en la escala de cicatrización de Vancouver.

Objective: To evaluate healing in partial skin graft donor sites using a skin substitute compared to a xenograft in patients with different diseases requiring partial skin grafting. Materials and methods: This paper presents a report of 20 patients between 19 and 65 years from the Plastic Surgery Unit of the Hospital María Auxiliadora in Lima Metropolitan Area, Peru, between December 2017 and June 2018, where healing was evaluated in partial skin graft donor sites. An interventional, analytical, prospective and longitudinal study was conducted using a double-blind design to control possible biases. For the statistical significance analysis, nonparametric tests with a 95 % confidence interval were used. Results: Using a skin substitute, a better healing quality of donor sites of epithelialization was seen compared with xenografting. Both techniques were evaluated with the Vancouver scale, which considers five aspects (healing, vascularity, pigmentation, flexibility and height), out of which healing showed significant results (p<0.05). Estimation of the risk in the healing process according to the Cox proportional hazards model showed that H = 0.60 (95 % CI 0.46- 0.78), which indicates that the shortest healing time was found in the skin substitute group. Conclusions: Skin substitutes are an important alternative that favors the good quality of healing in donor sites. skin substitutes proved to be more effective than conventional xenografting when evaluated and compared using the Vancouver healing scale.

Tratamiento exitoso con gel de silicona de heridas que no cicatrizan en el cuero cabelludo / Successful silicone gel treatment of wounds that do not heal on the scalp

La silicona podría tener propiedades ideales para estimular la cicatrización de heridas abiertas. Se presentan cuatro casos de heridas en el cuero cabelludo que no cicatrizaban y en todas se observaba tejido de granulación abundante y falta de migración epidérmica. La aplicación de un gel a base de silicona (Stratamed, Stratpharma, Basilea, Suiza), que forma una película directamente sobre la herida, a modo de monoterapia se asoció con una mejor cicatrización de la herida

The silicone could have ideal properties to stimulate the healing of open wounds. We present four cases of wounds on the scalp that did not heal and in all of them there was abundant granulation tissue and lack of epidermal migration. The application as a monotherapy of a silicone-based gel (Stratamed, Stratpharma, Basel, Switzerland), which forms a film directly on the wound, was associated with better wound healing

Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis

Abstract Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998-2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.

Effects of renal dysfunction on healing of colonic anastomosis: experimental study in wistar rats / Efeitos da disfunção renal na cicatrização de anastomoses colônicas: estudo experimental em ratos wistar

ABSTRACT Background: Chronic kidney disease affects more than 500 million people worldwide. In this context, the uremic toxins present are related to worsening in tissue healing. Aim: Evaluate on healing of colonic anastomosis in uremic rats, serum and anatomopathological indicators, which may be related to the change tissue repair process. Methods: Twenty Wistar rats, were randomly separated into two groups. In the sham group they were submitted to 5/6 nephrectomy simulation in left kidney, simulation right nephrectomy, median laparotomy, colotomy and colorraphy. In the uremia group, they were submitted to 5/6 nephrectomy of the left kidney, total nephrectomy of the right kidney and median laparotomy, colotomy and colorraphy. Were collected for serum urea, creatinine and CRP dosages and the colonic segments were studied for evaluation of granulation tissue, collagen maturation, microvascular and myofibroblasts density, and cell viability. Through histochemical processing, microvascular density was evaluated by anti-CD34 monoclonal antibody marking, cell viability by cell proliferation nuclear antigen screening and myofibroblasts density with monoclonal anti-α-actin antibody. Computerized histometry was used for evaluations of collagens type I and III by the coloration of picrosirius. Results: The group submitted to nephrectomy 5/6, compared to the sham group, show urea increase (p<0.0000) and higher C reactive protein (p=0.0142). Decrease of granulation tissue formation (border reepithelialization p=0,0196, angiofibroblast proliferation p=0.0379), mean collagen I (p=0,0009) and collagen III (p=0,016), microvascular density (p=0,0074), cell proliferation nuclear antigen (p<0,0000) and myofibroblasts (p<0,0001). Conclusion: The uremia induced by nephrectomy 5/6 model establishes negative impact in the colonic wound healing.

RESUMO Racional: A doença renal crônica atinge mais de 500 milhões de pessoas em todo o mundo. Neste contexto, as toxinas urêmicas estão relacionadas ao comprometimento da cicatrização tecidual. Objetivo: Avaliar, na cicatrização de anastomoses colônicas de ratos urêmicos indicadores séricos e anatomopatológicos que possam estar relacionados com alteração do processo de reparação tissular. Métodos: Utilizaram-se 20 ratos Wistar divididos aleatoriamente em dois grupos. No grupo simulação eles foram submetidos à simulação da nefrectomia 5/6 do rim esquerdo, simulação de nefrectomia total do rim direito, laparotomia mediana, colotomia e colorrafia. No grupo uremia, eles foram submetidos à nefrectomia 5/6 do rim esquerdo, nefrectomia total do rim direito, laparotomia mediana, colotomia e colorrafia. Coletaram-se amostras de sangue para dosagens séricas da ureia, creatinina e proteína C reativa, e do cólon para processamentos histológicos e histoquímicos na avaliação do tecido de granulação, maturação de colágeno, densidade microvascular e de miofibroblastos, viabilidade celular cicatricial. Empregou-se a histometria computadorizada para as avaliações de colágenos tipos I e III, densidade microvascular pela marcação com anticorpo monoclonal anti-CD34, viabilidade celular pela pesquisa do antígeno nuclear de proliferação celular e a densidade de miofibroblastos com anticorpo monoclonal anti-α-actina. Resultados: O grupo submetido à nefrectomia 5/6, em comparação ao grupo simulação, demonstraram aumentos da ureia sérica (p<0,0000) e proteína C reativa (p=0,0142), redução da formação de tecido de granulação (reepitelização de bordas p=0,0196, proliferação angiofibroblástica p=0,0379), porcentagens de colágeno I (p=0,0009) e colágeno III (p=0,016), densidade microvascular (p=0,0074) e miofibroblastos (p<0,0001) e antígeno nuclear de proliferação celular (p<0,0000). Conclusão: A uremia induzida pelo modelo de nefrectomia 5/6 determina impacto negativo no processo de cicatrização colônico.

Estudio comparativo con membranas multifuncionales y apósitos húmedos a seco, en pacientes con heridas crónicas difíciles de curar. Ensayo clínico aleatorizado / RCT of Multfunctonal Membranes vs Traditional Methods for Chronic or Hard-to-Heal Wounds

Introducción: Conocida la dificultad en el tratamiento de heridas crónicas de difícil curación, nos hemos propuesto evaluar las diferencias del progreso de la cicatrización tras intervención con métodos avanzados (Membranas Multifuncionales) y métodos tradicionales (apósitos de gasa húmedos a seco), durante un período de estudio de 12 semanas. Metodología: Un total de 380 pacientes que se presentaron a la Clínica de Curaciones de Consulta Externa del Departamento de Cirugía del Hospital Roosevelt, con heridas crónicas difíciles de curar, fueron distribuidos para su tratamiento en entorno ambulatorio a uno de dos grupos: a. con métodos avanzados (Membranas Multifuncionales) y b. con métodos tradicionales (apósitos de gasa húmedos a seco). La distribución en cada grupo se realizó mediante aleatorización simple según la secuencia de presentación: casos impares, para tratamientos avanzados con Membranas Multifuncionales y casos pares: con curas tradicionales (apósitos húmedos a secos). El principal resultado de interés fue determinar la eficacia en relación con la formación de tejido de granulación y/o tejido epitelial en el lecho de la herida con los dos métodos de tratamiento, utilizando para su valoración la escala modificada de Houghton y colaboradores (Photographic Wound Assessment Tool- PWAT por sus siglas en inglés-) Resultados: De enero a octubre de 2014, se seleccionaron 380 pacientes elegibles y se asignaron al azar a 190 pacientes en cada grupo. 129 pacientes (92 del grupo de apósito húmedo a seco y 37 de la Membrana Multifuncional), no concluyeron el ensayo por el incumplimiento/abandono del protocolo, permaneciendo en el estudio 251 pacientes para el seguimiento. El tiempo establecido para la recolección de datos fue en las semanas 4, 8 y 12. A las cuatro semanas, en la primera evaluación, el grupo tratado con la Membrana Multifuncional presentó cicatrización completa o cercana al cierre en el 50% de los casos, en comparación con el 28% de los apósitos húmedos a secos. A las ocho semanas, en la segunda evaluación, el grupo tratado con la Membrana Multifuncional presentó cicatrización completa o cercana al cierre en el 71% de los casos, en comparación con el 50% de apósitos húmedos a secos. En la evaluación final a las doce semanas, el grupo tratado con la Membrana Multifuncional presentó cicatrización completa o cercana al cierre en el 85% de los casos, en comparación con el 58% de los apósitos húmedos a secos. Conclusiones: En el presente estudio, en las heridas crónicas difíciles de curar, el grupo tratado con las membranas multifuncionales fue la alternativa que ofreció mayor éxito de cierre completo de la herida comparada con las lesiones tratadas con apósito húmedo a seco.

Introducton: Complicated chronic or difcult-to-heal wounds have led to propose the evaluaton between the diferences in progress of healing afer an interventon with advanced methods (Multfunctonal Membranes) and traditional methods (wet to dry gauze dressings), during a period of 12 weeks. Methods: From January to October 2014, 380 patents who presented at the Outpatient Wound Care Clinic of the Department of Surgery, Roosevelt Hospital, with chronic or difficult-to-heal wounds, were distributed for treatment in outpatient setting to one of two groups: a. with advanced methods (Multifunctional Membranes) and b. with traditional methods (wet-to-dry gauze dressings). The distribution in each group was made by simple randomization according to the presentation sequence: odd cases, for advanced treatments with Multifunctional Membranes and even cases: with traditional cures (wet to dry dressings). The main interest was to determine the efficacy in relation to the formation of granulation tissue and/or epithelial tissue in the wound bed with the two treatment methods, using for evaluation the modified scale of Houghton PWAT (Photographic Wound Assessment Tool). Results: 380 eligible patents were selected, and 190 patents were randomized in each group. 129 patents did not complete the trial due to noncompliance or dropout of the protocol, leaving 251 patents for follow-up. At four weeks, the group treated with the Multifunctional Membrane had completely healed or almost closed in 50% of cases, compared with 28% of wet to dry gauze dressings. At eight weeks, the group treated with the Multifunctional Membrane completely healed or almost closed in 71% of cases, compared with 50% of wet to dry gauze dressings. At twelve weeks, the group treated with the Multifunctional Membrane had completely healed or almost closed in 85% of cases, compared with 58% of wet to dry gauze dressings. Conclusions: The group treated with the multfunctonal membranes was the alternatve that ofered the greatest success of complete closure of the wound compared with the lesions treated with wet-to-dry dressing.

Efeitos do PDGF-BB na taxa de proliferação e na adesão de células derivadas da granulação óssea a fragmentos radiculares / Effects of PDGF-BB on the rate of proliferation and on the adhesion of human cells derived from bone granulation tissue to root fragments

O objetivo deste estudo foi investigar o papel do fator de crescimento derivado de plaquetas-BB (PDGF-BB) na concentração de 300ng/ml na taxa de proliferação e adesão de células derivadas da granulação óssea humana a fragmentos radiculares periodontalmente comprometidos. Na primeira etapa do estudo, foi estabelecida cultura primária de células da granulação óssea de dois pacientes adultos, sistemicamente saudáveis, não fumantes. Após a expansão celular, as células foram caracterizadas para determinação do fenótipo por meio de ensaios de viabilidade celular, MTT, ensaio de atividade de fosfatase alcalina, ensaio de mineralização e caracterização imunohistoquímica por meio de citometria de fluxo (segunda etapa). Na terceira etapa do estudo, os efeitos da adição de PDGF-BB recombinante humano na concentração de 300ng/ml na taxa de proliferação e adesão de células derivadas da granulação óssea a superfícies radiculares periodontalmente comprometidas foram investigados. A taxa de proliferação celular estimulada pelo PDGF-BB (grupo teste) ou pelo meio de cultura (grupo controle) foi investigada por meio de contagem de células viáveis nos frascos de cultura após 1, 3, 5 e 7 dias do cultivo celular. Foram obtidos 30 fragmentos dentários a partir de dentes extraídos por razões periodontais. Os fragmentos foram raspados com curetas Gracey e condicionados com solução em gel de EDTA a 24% durante 3 minutos, lavados com solução de soro fisiológico, secos e posicionados em placas de 24 poços. Foram incubadas sobre os fragmentos tratados 1x104 células GO por 24 horas, seguido por fixação e preparo para análise por microscopia eletrônica de varredura (MEV). O número de células aderidas sobre os fragmentos foi analisado nas fotomicrografias. O padrão de crescimento das células GO foi compatível com células ósseas, com modificação do padrão do crescimento com o aumento do número de passagens. Houve atividade de fosfatase alcalina em meio osteogênico e convencional, com pico máximo aos 7 dias e atividade de mineralização estimulada ou não por meio osteogênico, com pico máximo aos 21 dias. A análise por meio de citometria de fluxo demonstrou que as células GO não expressaram CD105 e CD166 na 14a passagem, indicando sua diferenciação celular avançada nesse período. A adição de rhPDGF-BB resultou em mudança na taxa de proliferação celular, observando-se pico máximo de crescimento aos 7 dias, com diferenças estatisticamente significantes (p < 0.005; ANOVA post hoc Tukey) em relação aos períodos de 1, 3 e 5 dias. O ensaio de MTT demonstrou maior viabilidade celular no período de 48 hs, comparativamente aos períodos de 24 e 72 horas, quando a densidade óptica celular diminuiu de forma significativa (p< 0.05; Friedmann pósteste Dunn). No ensaio de adesão celular, pode-se observar que a adição de rhPDGFBB aumentou significativamente o número de células aderidas aos fragmentos dentários (p< 0.05; teste t não pareado com correção Welch), com alteração da morfologia celular. Esses resultados sugerem que as células GO tem características compatíveis com linhagem de células osteoblásticas, de fenótipo mais diferenciado após a 12a passagem. A adição de rhPDGF-BB (300ng/ml) resulta em aumento da taxa de proliferação das células GO e do número de células aderidas a fragmentos radiculares, indicando que, nesta concentração, o fator de crescimento é citocompatível, favorecendo a proliferação e adesão celular.(AU)

The goal of this study was to investigate the effects of recombinant human platelet derived growth factor (rhPDGF-BB) at the concentration of 300ng/ml in the proliferation and adhesion of human bone granulation cells to periodontally diseased root fragments. At the first stage of the study, the granulation tissue existent in healing sockets (21 days after its creation) was collected from two systemically healthy nonsmoking adults to the establishment of primary culture. The in vitro properties of bone granulation (BG) cell lineage were characterized by cell viability, MTT, alkaline phosphatase activity and mineralization assays. The effects of culture medium (control) and rhPGDF-BB 300ng/ml (test) in the proliferation and adhesion of BG cells were investigated. The rate of BG cells proliferation was investigated by the number of viable cells present at 1, 3, 5 and 7 days after platting. Thirty root fragments were obtained from teeth extracted for periodontal reasons. Root fragments were scaled and root planed, conditioned with EDTA 24% for 3 minutes, rinsed in saline solution, air-dryed and positioned in 24-well plates. Each fragment was seeded with 104 BG cells, fixated after 24 hours and prepared for analysis in SEM. The number of cells adhered to the fragments was analysed in photomicrographies. BG cells growth pattern was compatible with osteogenic cell lineage, showing modification with the increasing number of cell passage. GO cells expressed alkaline phosphatase activity in conventional and osteogenic culture medium, with maximum peak at 7 days, as well as mineralization activity stimulated or not by osteogenic or non-osteogenic culture medium, with maximum peak at 21 days. The analysis by flow cytometer showed that BG cells have not expressed CD105 and CD106 at the 14th passage, indicating its advanced cell differentiation. The addition of rhPDGF-BB resulted in modification of proliferation rate, with maximum peak observed at 7 days, significantly different from 1-, 3- and 5-day periods (p< 0.005; ANOVA post hoc Tukey). MTT assay showed greater cell viability after 48 hours than after 24 and 72 hours, when optical density has significantly diminished (p< 0.05; Friedmann post hoc Dunn). At cell adhesion assay, it could be observed that the adhesion of rhPDGF-BB has significantly increased the number of cells adhered to root fragments (p< 0.05; unpaired t test with Welchs correction), and alterations in cell morphology. These results suggest that BG cells present in vitro characteristics compatible with osteoblastic cell lineages, with a more differentiated phenotype after the 12th passage. The addition of rhPDGF-BB (300 ng/ml) results in increase of the rate of BG cell proliferation and in the number of cells adhered to root fragments, indicating that, at this concentration, the growth factor is compatible with BG cells and favors cells proliferation and adhesion.(AU)

The acute effects of preoperative ozone theraphy on surgical wound healing

ABSTRACT PURPOSE: To investigate the effects of preoperative rectal ozone insufflation on surgical wound healing over the proinflammatory cytokines and histopathological changes. METHODS: Twenty one rabbits were divided into 3 groups. Sham, surgical wound, and ozone applied (6 sessions, every other day 70 µg/mL in 12 mL O2-O3 mixture rectally) surgical wound groups were created. TNF-alpha and IL-6 levels from all rabbits were studied at the basal, 24th hour, and 72nd hour. The histopathological examination was done by removing the surgical scar tissue at the end of 72nd hour. RESULTS: TNF-alfa and IL-6 levels were significantly lower compared to the control group, in the rabbits treated with ozone. The increase in angiogenesis, the decrease in the number of inflammatory cells, epidermal and dermal regeneration, better collagen deposition, and increased keratinisation in stratum corneum were observed in the histopathological examination. It was determined that the wound healing noticeably accelerated in the ozone group. CONCLUSION: Preoperative rectal ozone insufflation had a positive effect on surgical wound healing in acute period.

Low intensity ultrasound therapy induces angiogenesis and persistent inflammation in the chronic phase of the healing process of third degree burn wounds experimentally induced in diabetic and non-diabetic rats

ABSTRACT PURPOSE: To evaluate the effects of low intensity ultrasound on the healing process of third degree burn wounds in experimentally induced diabetic Wistar rats. METHODS: One hundred rats were divided into: control group; non-diabetic treated group; diabetic control group; diabetic treated group. The therapy was performed with a 3MHz ultrasound application, pulsed emission at 100Hz frequency, modulated at 20% with a dosage of 0.5W/cm2 during three minutes throughout 30 days. The surgical debridement of the wound was performed once at day 2. The wounds were morphometrically, macroscopically and microscopically evaluated at 3, 7, 14, 21 and 30 days. RESULTS: The wound contraction and collagen quantification were higher in all treated groups. Macroscopically, necrosis was higher in the diabetic control group. Granulation tissue was higher in treated groups during the proliferative and remodeling phase. Microscopically, there were greater mononuclear inflammatory infiltration, angiogenesis and fibroblast quantification in treated groups during the proliferative and remodeling phases. CONCLUSIONS: therapeutic ultrasound is beneficial in the inflammatory and proliferative phases of the healing process because it controlled the necrotic tissue, increased the granulation tissue and wound contraction. However in the remodeling phase it is not beneficial because of the continued angiogenesis and a mononuclear inflammatory infiltration.

Paronychia and granulation tissue formation during treatment with isotretinoin

Abstract This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.

Comparing open wound measuring methods popularly used in experimental studies / Estudo comparativo de métodos de avaliação de contração de feridas cutâneas abertas

Tissue repair is a response reaction to lesions and aggressions that constitutes a dynamic process to maintain the integrity of the organism. Wound healing experiments have used several approaches in order to assess and compare treatment methods, and these discrepancies hamper comparisons among assays. This study assessed three different methods of wound measurement commonly used in healing assays: clock method, graph paper method, and computer-assisted image analysis. We used 30 Wistar rats, kept in appropriate conditions for animal well-being. After anesthesia, and using an eight-millimeter punch, two lesions were made in the back region of each rat. The wounds were assessed on days four, seven, and 14 after infliction. At four days, all methods generated similar results. By day seven, the clock method had lost precision, likely due to wound shrinkage, and yielded greater means compared to the other two methods. On the last assessment, the computer-assisted method appeared to have more precise results, with the other two generating statistically higher means. Computer-assisted image analysis seems to have maintained wound measuring precision throughout this experiment, even when faced with small lesions. Considering these results, the authors recommend the use of computer-assisted measurements in future experiments.

O reparo tecidual surge em resposta às lesões e constitui-se de um processo dinâmico para manutenção da integridade do organismo. Nos estudos sobre cicatrização de feridas, tem se utilizado várias técnicas buscando-se uma avaliação da eficácia de meios de tratamento local. Sendo assim, o presente trabalho objetivou comparar três métodos de avaliação experimental de áreas de feridas, sendo eles: o método do relógio, papel milimetrado e avaliação computadorizada. Para realização do experimento, foram utilizados 30 ratos Wistar em condições de bem-estar. Após realizada a anestesia, foram confeccionadas duas lesões no dorso de cada animal com punch de 8 mm, sendo as feridas avaliadas após quatro, sete e 14 dias de tratamento. Observou-se que aos quatro dias de tratamento, todos os métodos apresentaram o mesmo desempenho, enquanto aos sete e 14 dias, o método do relógio, apresentou maior média de área, perdendo precisão, e aos 14 dias, a avaliação computadorizada apresentou resultados mais precisos em relação a ambos os outros métodos. Concluiu-se que a avaliação computadorizada através de software de áreas de feridas cutâneas apresenta resultados mais precisos em relação aos métodos do relógio e papel milimetrado, principalmente em lesões menores.

Applicability of crystalline cellulose membrane in the treatment of skin wounds induced in Wistar rats

PURPOSE: To evaluate the healing of skin wounds induced experimentally in rats using a crystalline cellulose membrane (Veloderm(r)). METHODS: Thirty-two rats were divided into two groups: control group (CG) wounds treated with a solution of 0.9% sodium chloride and Veloderm(r) group (VG) wounds treated with a crystalline cellulose membrane. The rats were evaluated at different times over twenty-six days. RESULTS: Weight loss was observed in the animals from both groups in the early stages, with greater weight in the VG animals at the end. Times of predominant hypothermia, pink color of the wound in both groups over all time points, increased granulation tissue in the CG animals, the presence of slight oozing from the wound and feature in the VG animals, more serous exudation of the bloody feature, greater wound contraction and pain in the CG animals and an absence of pain and earlier complete wound healing in the VG rats were also observed. CONCLUSION: The crystalline cellulose membrane is effective in the treatment of wounds in rats, easy to use, protects and maintains the humidity of the wound, decreases pain, eases the visualization and control of the evolution of the lesion. .

Amniotic membrane as a biological dressing in infected wound healing in rabbits

PURPOSE: To investigate amniotic membrane as a biological dressing in infected wound healing in rabbits. METHODS: The use of preserved amniotic membranes (AMs) was examined using 15 rabbits with experimentally induced wound infections on their backs. Healing was histologically evaluated during different phases including inflammation, granulation, epithelialization, and fibroplasia. The animals were distributed into three groups for histological study at seven, 14, 21, and 28 days post-wound induction. Group A did not receive treatment: the wound was left exposed and dry; Group B received a daily exposure treatment with collagenase; and Group C received one AM, which also remained exposed. RESULTS: A marked reduction of the inflammatory phase was observed in Group C at 21 days, and the granulation phase of this healing increased at 14 days. Epithelialization was similar among the three groups, and fibroplasia was more pronounced in Group C at 14 days. Furthermore, gradual collagen organization also began for the animals in Group B at 14 days. CONCLUSION: The amniotic membrane did not significantly alter the inflammation, epithelialization, or fibroplasia phases but did increase angiogenesis up to Day 14 compared with the dry dressing and collagenase treatments. .

Biocompatibility of Ricinus communis polymer with addition of calcium carbonate compared to titanium. Experimental study in guinea pigs / Biocompatibilidade do polímero de óleo de mamona com acréscimo de carbonato de cálcio comparado ao titânio. Estudo experimental em cobaias.

Objective: The aim of the present investigation was to determine whether the difference in inflammatory tissue reaction between the Riccinus communis (castor) polymer with calcium carbonate and the titanium implant is statistically significant. Methods: Thirty-two Cavia porcellus were allocated into four groups of eight animals each. We implanted the two types of materials in the retroperitoneal space of all the animals. They were euthanized at 7, 20, 30 and 40 days after surgery, and an histological study of the samples was conducted. Results: All implants showed characteristics of chronic inflammation regardless of the material and timepoint of evaluation. There was no statistically significant difference between Pm+CaCO3 and Ti with regard to the presence of granulation tissue, tissue congestion, histiocytes, lymphocytes, neutrophils, giant cells, and fibrosis (P> 0.05). Conclusion: The castor oil polymer plus calcium carbonate implant was not statistically different from the titanium implant regarding inflammatory tissue reaction. .

Objetivo: Determinar se a reação tecidual do implante retroperitoneal do polímero de óleo de mamona com acréscimo de carbonato de cálcio (Pm+CaCO3) é significativa, por meio de análise histopatológica, tendo como controle o implante de titânio não tratado (Ti). Métodos: Estudo experimental, intervencionista e randomizado com 32 cobaias. Os animais foram separados em quatro grupos iguais e eutanasiados com 7, 20, 30 e 40 dias após o ato cirúrgico. Foram confeccionadas lâminas em hematoxilina-eosina e em tricrômio de Masson. Em relação a variáveis qualitativas dicotômicas, para análise da diferença entre o Pm+CaCO3 e o Ti em cada momento de avaliação foi usado o teste binomial. Considerando os materiais separadamente, a comparação dos quatro grupos foi feita utilizandose o teste exato de Fisher. Valores de P<0,05 indicaram significância estatística. Resultados: Todos os implantes apresentaram características de inflamação crônica, independente do material e do momento de avaliação. Não houve diferença estatisticamente significativa entre o Pm+CaCO3 e o Ti considerando a presença de tecido de granulação, congestão tecidual, histiócitos, linfócitos, neutrófilos, células gigantes e fibrose (P>0,05). Conclusão: Não foi encontrada diferença significativa entre a reação tecidual do Pm+CaCO3 e a do Ti. .

A double and paradoxical role for angiogenesis

Fibrogenesis and fibrolysis are constant and important features occurring during the pathology of schistosomiasis. New findings have recently indicated that granulation tissue (angiogenesis) is a dominating feature on both occasions. This review article discusses this apparently paradoxical feature displayed by angiogenesis (granulation tissue) during the pathology of schistosomiasis...

Um duplo e paradoxal papel para a angiogêneseFibrogênese e fibrólise são características constantes e importantes que ocorrem durante a patologiada esquistossomose. Novos achados têm indicado que o tecido de granulação (angiogênese) éuma característica dominante em ambas as ocasiões. Este artigo de revisão discute este papel,aparentemente paradoxal, desempenhado pela angiogênese (tecido de granulação), durante apatologia da esquistossomose...

Alterações no reparo tecidual cutâneo em um modelo de resistência à insulina / Resistant mice cutaneous wound healing alterations in insulin

A obesidade associada às alterações metabólicas, tais como a resitência à insulina, provoca significativas modificações no decorrer do processo de cicatrização. O objetivo desse estudo foi inicialmente avaliar os efeitos da resistência à insulina induzida por uma dieta com elevado teor de gordura durante o reparo tecidual. E, em seguida, investigar o papel dos macrófagos neste processo. Observamos que os animais submetidos à dieta hiperlipídica (RHL) tornaram-se intolerantes à glicose e resistentes à insulina, além de aumentarem as taxas plasmáticas de colesterol e triglicerídeos em relação aos animais alimentados com ração padrão (RP). O grupo RHL apresentou uma menor taxa de contração da lesão e reepitelização em relação ao grupo RP. Observamos ainda maior quantidade de células inflamatórias (células NOS 2-positivas, macrófagos, e neutrófilos), menor densidade de fibras do sistema colágeno e maior densidade de miofibroblastos e vasos sanguíneos no grupo RHL. O dano oxidativo estava maior no grupo RHL bem como a expressão proteica do fator de crescimento transformante-β1 (TGF-β1) e α-actina de músculo liso (α-SMA). O grupo RHL apresentou altos níveis plasmáticos de TNF-α quando comparado com o grupo RP. Além disso, a proporção das células M1 (macrófagos ativados classicamente) e M2 (macrófagos ativados alternativamente) foi a mesma em ambos os grupos. Em relação a síntese e liberação de citocinas e fatores de crescimento avaliados através dos ensaios in vitro, observamos ainda que os níveis do fator de necrose tumoral-α (TNF-α) e interleucina-1β (IL-1β) estavam maiores no meio condicionado de macrófagos isolados dos animais do grupo RHL (MCRHL) em relacão ao meio condicionado de macrófagos isolados dos animais do grupo RP (MCRP). Além disso, os nossos resultados demonstraram claramente que os fatores solúveis produzidos por macrófagos isolados a partir de animais resistentes à insulina inibem a proliferação e a migração de fibroblastos. Através ...

Obesity associated with with metabolic alterations such as insulin resistance causes significant modifications during the healing process. Our aim was initially to analyse the effects of insulin resistance induced by a high- significant changes in skin combined fat diet during cutaneous wound healing. And then investigate the role of macrophages in this process. We observed that animals subjected to a high-fat diet (HFC) became glucose intolerant and insulin resistant and increased plasma cholesterol and triglycerides levels when compared to animals fed with a standard chow (SC). The HFC group had a lower rate of wound contraction and re-epithelialization than the SC group. Besides, HFC group presented a greater number of inflammatory cells (NOS 2- and F4/80-positive cells, and neutrophils), lower density of collagen fibers and higher density of myofibroblasts and blood vessels. Oxidative damage was greater in the HFC group as well as the protein expression of TGF-β1 and α-smooth muscle actin (α- SMA). The HFC group presented higher levels of plasma TNF-α when compared to RP group. Furthermore, the proportion of M1 cells (classically activated macrophages) and M2 (alternatively activated macrophages) was the same in both groups. Regarding to the synthesis and release of cytokines and growth factors evaluated by in vitro assays, we also observed that the levels of TNF-α and IL-1β were higher in conditioned medium of macrophages isolated from animals of HFC (MCHFC) group when compared to the conditioned medium of macrophages isolated from animals in of RP (MCSC) group. Furthermore, our results clearly demonstrate that soluble factors produced by macrophages isolated from insulin resistant animals inhibit the proliferation and migration of fibroblasts. Thus, we can show that insulin resistance delays wound healing process and suggest that the macrophages are involved in this delay