Evaluation of IL-6, FoxP3 Treg lymphocytes, intestinal barrier biomarkers and the use of synbiotics in obese adolescents: a pilot study.

Aim: This prospective pilot study evaluated inflammatory and intestinal barrier biomarkers and the effects of a synbiotic in obese adolescents. Methods: Eighteen obese and 20 eutrophic adolescents were evaluated for body composition using bioimpedance analysis (BIA), body mass index (BMI), IL-6 and lipopolysaccharide (LPS) serum levels, CD4 and FoxP3 Treg lymphocytes and monocytes. Synbiotic supplementation for 60 days was also evaluated for these parameters only in obese adolescents. Results: We observed an increase in CD4 lymphocyte (18.0 ± 12.4 vs. 8.9 ± 7.5; p < 0.01), IL-6 (0.30 ± 0.06 vs. 0.20 ± 0.06; p = 0.02) and LPS (0.18 ± 0.15 vs. 0.08 ± 0.05; p < 0.01) levels in obese compared to eutrophic adolescents. After synbiotic supplementation, FoxP3 Treg lymphocytes increased (14.0 ± 6.7 vs. 9.9 ± 5.4; p = 0.02) in obese adolescents. Conclusions: Obese adolescents presented a state of microinflammation and intestinal barrier breakdown, and synbiotic supplementation increased the expression of FoxP3 Treg lymphocytes, an anti-inflammatory regulator. Whether the increase in FoxP3 Treg lymphocytes may have an impact on inflammation and outcomes in obese adolescents deserves further evaluation.

25-vitamin D reduces inflammation in uremic environment.

Chronic kidney disease (CKD) is characterized by loss of renal function and a consequent increase of serum uremic toxins, which contribute to inflammation status. Deficiency of 25-vitamin D, often found in patients with CKD, has been included as an inflammatory factor since it might modulate the immune system. The aim of this study was to investigate the role of 25-vitamin D on inflammatory pathways in healthy and uremic environment. Toll-like receptor 4 (TLR4), oxidative stress (ROS), vitamin D receptor (VDR), 1-α hydroxylase (CYP27), 24 hydroxylase, cathelicidin, and MCP-1 were evaluated in monocytes exposed to a uremic serum pool compared with healthy pool. The human monocytes lineage (U937) was incubated with or without 25-vitamin D (50 ng/ml for 24 hours). TRL4, VDR, CYP27, CYP24, and ROS were evaluated by flow cytometry. We used ELISA to measure IL-6, TNF-α, IL-10, cathelicidin, and MCP-1 in the cell culture supernatant. We observed a higher expression of TRL-4, IL-6, TNF-α, IL-10, cathelicidin and MCP-1 in monocytes incubated with uremic serum when compared with serum from healthy individuals. Supplementation of 25-vitamin D was able to reduce the expression of TRL4, cathelicidin, and MCP-1 in the uremic environment. There was no difference in the expression of VDR, CYP27 and CYP24 intracellular enzymes. This in vitro study showed that the uremic pool activates inflammatory response in monocytes, which was reversed by 25-vitamin D supplementation; this finding suggests that 25-vitamin D has an anti-inflammatory role in the uremic environment.

Hipoplasia do músculo grande dorsal: relato de caso / Latissimus dorsi muscle hypoplasy: case report

Introdução: O músculo grande dorsal é largo, um retalho muscular muito versátil e bem vascularizado. Devido a sua confiabilidade, é frequentemente usado para reconstrução de mama após mastectomia. Ele pode também ser usado na reconstrução de cabeça, pescoço e tórax, pediculado ou como retalho livre. Relato do caso: Os autores relatam o caso de uma paciente no pós-operatório de 8 anos de uma mastectomia esquerda e reconstrução imediata com implante mamário de silicone, que após radioterapia evoluiu com radio dermite e extrusão do implante. Foi programada, então, reconstrução com o músculo grande dorsal e, durante a cirurgia, foi identificado um músculo hipoplásico, que inviabilizou a sua utilização para o procedimento proposto.

Introduction: The latissimus dorsi muscle is a wide and well vascularized flap with great versatility. Its reliance brings a very good option of reconstruction following mastectomy. It also can be used for head, neck and chest reconstruction both a pedicled or as a free flap. Case report: The authors present a case of a patient who was submitted to a left mastectomy 8 years ago and had immediate reconstruction with silicone implant that extruded due to radiotherapy. The initial surgery proposal was to perform a regular latissimus dorsi flap to rebuild the breast but during the procedure it was found a hypoplasic muscle that resulted in an impracticable proper reconstruction.

Comparação da evidenciação dos miofibroblastos marcados por imuno-histoquímica em tecido de granulação quando fixado por formol ou por álcool a 70% / Comparison of myofibroblast visualization by immunohistochemical staining in granulation tissue fixed in formaldehyde or 70% alcohol

Introdução: Para o adequado estudo anatomopatológico dos tecidos obtidos dos pacientes é crucial a boa técnica para a melhor evidenciação das células pesquisadas. É imprescindível que não só a técnica ideal de coloração/marcação seja utilizada, mas também a correta técnica de fixação da peça cirúrgica. Em trabalho prévio pesquisando miofibroblastos e contração na pele restaurada de áreas doadoras de enxertos de pele de espessura parcial, verificamos baixa densidade de miofibroblastos, ao contrário dos estudos em tecido de granulação. Investigando as causas disso, e baseando-se em artigo específico sobre a eficácia da evidenciação imuno-histoquímica com diferentes métodos de fixação tecidual, comparamos a eficácia dos diferentes fixadores, formol a 10% e álcool a 70% para a evidenciação de miofibroblastos em tecido de granulação de úlceras crônicas de 21 pacientes. Método: Estudamos 42 amostras por meio de técnica imuno-histoquímica, utilizando-se o anticorpo anti-Smooth Muscle Actin, nas quais contamos os miofibrobastos em 10 campos com aumento de 400 X. Resultados: Demonstraram-se melhores resultados qualitativo e quantitativo no material fixado em álcool, quando comparado ao fixado em formol, com densidades médias de miofibroblastos de 86,5 e 48 células/mm2, respectivamente, o que nos leva a recomendar o álcool como fixador de tecidos para estas análises imuno-histoquímicas.

Background: The use of a good visualization technique is crucial for an adequate pathological anatomy study of tissues obtained from patients. Optimal staining and fixation techniques of the surgical piece are essential. In a previous study investigating myofibroblasts and contraction in split skingraft donor sites, a low density of myofibroblasts was observed, as opposed to studies in granulation studies. To investigate the causes for this finding and based on a specific manuscript on the efficacy of immunohistochemical visualization using different tissue fixation methods, we compared the efficacy of fixation in 10% formaldehyde and 70% alcohol for the visualization of myofibroblasts in granulation tissues of chronic ulcers in 21 patients. Method: Forty-two samples were studied by immunohistochemistry, using the anti-Smooth Muscle Actin antibody, and myofibroblasts were counted in 10 fields with a magnification of 400X. Results: Better qualitative and quantitative results were observed in alcohol-fixed materials, when compared to those fixed in formaldehyde, with mean myofibroblasts densities of 86.5 and 48 cells/mm2, respectively, which encourages us to recommend the use of alcohol for tissue fixation in immunohistochemical studies.

Reconstrução da porção medial da pálpebra inferior com retalho de Imre / Reconstruction of medial portion of inferior eyelid using the Imre flap

Introdução: A reconstrução da pálpebra inferior se constitui em um importante capitulo de reconstruçãofacial, tanto por seu aspecto estético quanto por sua importância funcional, evitandocomprometimentos oculares mais graves. Dissertamos neste artigo sobre uma excelente opçãoterapêutica para esse tipo de reconstrução, especialmente em casos de defeitos extensos da pálpebra.Relato dos casos: Foram operados dois pacientes, em junho de 2008, que apresentavamdefeitos da pálpebra inferior entre 50% e 75% da mesma após ressecção de tumores de pele.Esses pacientes foram submetidos à reconstrução com retalho de Imre, descrito, em 1903, pelocirurgião Joseph Imre, seguindo sua marcação original, evoluindo com resultado efetivo quantoa sua importância funcional e estética. Os casos operados apresentaram bom posicionamento daspálpebras inferiores, sem ectrópio, apresentando apenas uma leve esclera aparente, porém semrepercussão funcional em um dos casos operados. As cicatrizes resultantes localizaram-se nossulcos naturais da face. Discussão: Consideramos que a técnica proposta por Imre se adequaàs necessidades da reconstrução palpebral inferior, proporcionando bom resultado funcionale estético, com pouca morbidade de área doadora. Conclusão: O retalho de Imre se constituiem mais uma opção para reconstrução da porção medial da pálpebra inferior, sendo de fácilexecução e reprodutível, mesmo em grandes defeitos da mesma.

Introduction: The inferior eyelid reconstruction is one of the important issues about facialreconstruction. Besides its aesthetical importance, there is its functional one, avoiding ocularproblems. In this article we present an excellent option of eyelid reconstruction - the Imreflap - especially in defects greater than 50% of extension. Cases report: In July 2008, twopatients were gone under surgery because skin cancer on inferior eyelid. The ejelid defectswere about 50 to 75% of the extension of them. The Imre flap was described first by JosephImre, in 1903. His original technique was followed and the results were functional and aestheticaleffective. Discussion: We considered that the Imre flap is applicable and useful toreconstruct the inferior eyelid, with little morbidity of the donor area and a great final result.Conclusion: The Imre flap is one more option to reconstruct the inferior eyelid portion. It’sa reproducible and an easy technique available to reconstruct large defects of inferior eyelid.

Lipoma intermuscular gigante: relato de caso / Giant intermuscular lipoma: case report

Introdução: Contrastando com o fato de que os lipomas são tumores mesenquimais muito comuns, a variante subfascial é bastante rara. Esta é subdividida em intermuscular eintramuscular. O tipo intermuscular é o menos comum. Os lipomas gigantes também são raramente encontrados e são caracterizados por medir, no mínimo, 10 centímetros em uma dasdimensões ou pesar ao menos 1000 gramas. Relato do caso: No presente artigo, relatamos o caso de uma paciente apresentando um lipoma intermuscular gigante localizado na coxa.

Introduction: Despite the fact that lipomas are very common mesenchymal tumors, the subfascial variant is quite rare. It is subdivided into intermuscular and intramuscular. The intermuscular type is less common. Giant lipomas are also rarely found and are characterizedby measuring at least 10 centimeters in one dimension or weigh at least 1000 grams. Case report: In this article, we describe the case of a patient presenting a giant intermuscular lipoma located in the thigh.

Tratamento da orelha em ponto de interrogação / Question mark ear treatment

As deformidades congênitas uni ou bilaterais da orelhaexterna com atrofia do segmento médio da concha e da escafa sãocoloquialmente chamadas de orelha em ponto de interrogação,devido ao hipodesenvolvimento deste segmento e pelo formatocaracterístico. Diversos autores publicaram suas experiências paraa correção deste tipo de deformidade congênita. Nossa experiênciabaseia-se na reconstrução de três casos, mediante a combinaçãode retalho de deslizamento e da ressecção de um triângulo decompensação na concha, ambos do tipo condro-cutâneo, natentativa de evitar ao máximo a redução do eixo maior da orelhae manter o seu contorno o mais natural possível. Método: Foramoperadas três pacientes do sexo feminino, com 17, 19 e 20 anos,sendo que na paciente de menor idade a deformidade era unilaterale nas outras duas, bilateral. Os procedimentos cirúrgicosobedeceram a mesma sistematização. Em todos os casos, o maioreixo da orelha foi medido antes e após a cirurgia, assim como otamanho do defeito a ser corrigido, para avaliações comparativas.Resultados: Os detalhes cirúrgicos descritos foram basicamentesimilares, porém as deformidades encontradas não apresentaramum padrão idêntico, mesmo numa mesma pessoa com problemabilateralmente. A extensão sendo variável determinou ressecçõesmaiores ou menores, linhas de sutura diversas na posição e naextensão, tendo como parâmetro o retalho de deslizamento e aressecção de um triângulo de compensação. Conclusões: Osprocedimentos descritos são de fácil execução, sob anestesia local,condições ambulatoriais e realizados num único tempo operatório.

The congenital external ear deformity withweakening of the medium segment of conch and of scapha isusually denominated question mark ear because of the calledminor development of that segment and by its characteristicshape. Some authors have published their experiences to correctthis kind of deformity. Our experience is based on three patientsusing a sliding flap and a compensatory triangle of the conch tobalance the reduction of the major axis of the ear and supportits shape as natural as possible. Method: Three female patientswere submitted to a surgical procedure. They were 17, 19 and 20years old; the youngest has a unilateral deformity and the others,bilateral. The procedures were systematically done. The majoraxis and the size of the defect were measured before and afterthe surgery to be compared. Results: The surgical procedures werealmost similar, however the deformities were not. They weredifferent even in the same patient. Although the same technicalprinciple of sliding flap and compensatory triangle of the conchhas been used, the extension of the defect determined minor ormajor resection and suture lines different in position and extension.Conclusions: The described procedure is not technically difficult.It can be performed under local anesthesia, ambulatorycondition and in only one operating time.

Comparative genomic hybridization analysis of abnormalities in chromosome 21 in childhood osteosarcoma.

Osteosarcomas (OS) are aggressive tumors of the bone and often have a poor prognosis. The tumors exhibit karyotypes with a high degree of complexity, which has made it difficult to determine whether any recurrent chromosomal aberrations characterize OS. To address inherent difficulties associated with classical cytogenetic analysis, comparative genomic hybridization (CGH) was applied to OS tissue. Forty-one pediatric OS specimens were analyzed by a CGH technique: 24 female and 17 male patients, with a median age of 12 years and 4 months. Chromosomal abnormalities were highly diverse and variable, including gains of chromosome 1p, 2p, 3q, 5q, 5p, and 6p and losses of 14q (50% in 14q11.2), 15q, and 16p. A high level of losses of chromosome 21 was present (26/41 cases; P = 0.008), most often loss of the 21q11.2 approximately 21 region. These novel findings in chromosome 21 of pediatric OS tumors suggest that specific sequences mapping to these chromosomal regions are likely to play a role in the development of OS.

Molecular screening of CFTR gene in Brazilian men with bilateral agenesis of the vas deferens.

Infertility is a common symptom of cystic fibrosis, especially in men (95% become sterile). It is caused by blockage of the vas deferens and the epididymis, which result in degeneration of the tubules. The purpose of this study was to verify the frequency of CFTR gene mutation in patients with bilateral agenesis of the vas deferens using SSCP and sequencing. The study population consisted of 40 white individuals with agenesis of the vas deferens as well as their 12 siblings without agenesis of the vas deferens. CTFR gene mutation was found in 22 of the 40 patients (55%) and it was possible to detect both mutating alleles in these 22 patients. The most frequent genotype found was ?F508/IVS8-5T. There was no genotype concordance in siblings. Our results show the importance of the investigation of CFTR mutation in patients with vas deferens agenesis.

Anatomical study of the superior pedicle of retroauricular skin flaps

Since the description of the flap proposed by Washio in 1969, several vascular pedicle models have been designed for the retroauricular flap, aiming chiefly to reduce the thickness of the pedicle so as to migrate the flap as an island. In spite of those advances, there are still problems such as venous stasis and partial loss of the flap.In a study in cadavers, twenty pedicles were dissected in order to find the presence or absence of veins in the region, maximum length of the pedicle and anatomical reference points for a safe dissection. All pedicles were located. The venous distribution found, that was different from that described in other studis, could account for the problems in venous drainage.

[Mutations in the methylene-tetrahydrofolate reductase gene and Down syndrome]. / Mutações no gene da metilenotetrahidrofolato redutase e síndrome de Down.

Down syndrome (DS) is a complex genetic and metabolic disorder attributed to the presence of three copies of chromosome 21. The extra chromosome derives from the mother in 93% of cases and is due to abnormal chromosome segregation during meiosis (nondisjunction). Except for advanced age at conception, maternal risk factors for meiotic nondisjunction are not well established. A recent preliminary study suggested that abnormal folate metabolism and the 677 (C-->T) mutation in the methylene-tetrahydrofolate reductase (MTHFR) gene may be maternal risk factors for DS. Frequency of the MTHFR 677 (C-->T) and 1298 (A-->C) mutations was evaluated in 36 mothers of children with DS and in 200 controls. The results are consistent with the observation that the MTHFR 677 (C-->T) and 1298 (A-->C) mutations are more prevalent among mothers of children with DS than controls. In addition, the most prevalent genotype was the combination of both mutations. The results suggest that mutations in the MTHFR gene are associated with maternal risk for DS

Polirradiculopatía desmielinizante inflamatoria crónica / Chronic inflammatory desmyelinating polyradiculoneuropathy

Se presenta un caso poco frecuente de polineuropatía periférica que debe ser tenido en cuenta entre los diagnóstico diferenciales. Se arriba al diagnóstico por los resultados del exámen de LCR y el electromiograma. Se inicia el tratamiento con prednisona de 80 mg/día. La paciente evoluciona favorablemente con recuperación de la fuerza muscular lo cual lo posibilita la deambulación.

Tratamento local das queimaduras: analise do uso de antimicrobianos / Local treatment of burn wounds: analysis of the use of antibacterial agents

Estudamos 11045 casos de tratamento local das queimaduras sendo 6063 (54,9 por cento) sem o uso de antimicrobiano topico e 4982 (45,1 por cento) com esse tipo de medicamento. Os antimicrobianos foram aplicados em 62,1 por cento dos casos pelo metodo da exposicao. Os tratamentos com antimicrobianos foram realizados em 69,5 por cento dos casos na enfermaria (no leito) sendo que os tratamentos sem medicacao topica foram realizados em 95,3 por cento dos casos no centro cirurgico. As justificacoes para o uso de entimicrobiano topico variaram nos seis anos de estudo. Inicialmente (1985-86) as justificacoes mais frequentes (79,8 por cento) nao foram relacionadas a infeccao, porem a aspectos anatomo-patologicos como exsudato, escara e ulcera; este tipo de justificacao se reduziu a 3,2 por cento no ultimo periodo do estudo, em 1992. Por outro lado as justificacoes relacionadas com a infeccao que inicialmente (1985-86) constituiram so 20,2 por cento dos casos chegaram em 1992 a 96,8 por cento.

Uso de expansores de tecidos no tratamento de sequelas de queimaduras / The use of tissue expanders in the treatment of burn sequels

É relatado um estudo sobre o uso de expansores de tecidos em seqüelas de queimaduras. Apresenta-se a experiência com o uso deste material na Divisäo de Queimados do Hospital das Clínicas, da Faculdade de Medicina da Universidade de Säo Paulo. Säo mostrados os resultados e conclusöes em 10 pacientes operados segundo este procedimento. Säo ressaltados a utilidade para o tratamento de seqüelas de queimaduras e os bons resultados obtidos