Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.(AU)

Diclofenac topical gel in excisional wounds maintain heal quality and reduce phlogistic signals1

To investigate diclofenac topical gel as an alternative to reduce phlogistic signals and maintain quality of wound repair. Fifteen Wistar rats were used in this study; four excisional wounds were performed on the dorsum of each animal. Once in a day, cranial wounds received topical diclofenac gel administration and caudal wounds were washed with isotonic saline. After seven, 14 and 21 postoperative days, five animals were randomly chosen for macroscopic and microscopic wound analysis. On the 7th day: diclofenac wounds showed significant higher scab formation, however showed less phlogistic signal; diclofenac wounds had larger area and had less neutrophil invasion. On the 14th day: No area difference was noted and diclofenac wounds showed less hyperemia and phlogistic signals; diclofenac wounds showed greater keratinocytes invasion. On the 21st day: Almost all wounds were closed and there were no difference regarding the type of scar formation; diclofenac wounds showed greater monocytes invasion and lower angiogenesis level. No difference was noted in any postoperative day regarding fibroblast invasion, collagen deposit quantity and quality. Diclofenac topical gel is capable of reducing phlogistic signals and do not cause fibroblast or keratinocyte downregulation thus do not lead to excisional wound healing impairment.(AU)

Inflammatory and oxidative stress after surgery for the small area corrections of burn sequelae / Estresse inflamatório e oxidativo após cirurgia para correção de pequenas áreas de sequela de queimaduras

PURPOSE: To compare vitamin levels, inflammatory and oxidative stress markers before and after skin autograft surgery to correct burn scar areas. METHODS: This prospective study was conducted with 8 patients with a median age of 28 years (range, 16 to 40 years) that had burn sequelae and were admitted to a Burn Unit for correction of small burn scar areas [3.3 (1.0-5.0) % of the corporal surface]. The volunteers were evaluated before and 48 hours after excision of scar tissue and skin autograft. Routine laboratory data, along with a food questionnaire and anthropometry were collected in the preoperative period. Serum vitamin A, C, E, B12 and folic acid levels, inflammatory markers (C-protein reactive, alpha-1-acid glycoprotein, ferritin) and oxidative stress markers (reduced glutathione - GSH and Thiobarbituric Acid Reactive Substances - TBARS) were determined at preoperative and postoperative phases. Data were analyzed with two-sample Wilcoxon test. RESULTS: All volunteers were clinically stable and had adequate nutritional status at admission. After surgery, C-reactive protein serum levels increased [0.4 (0.01-1.0) vs. 2.5 (0.6-4.7) mg/dL, p=0.01] and vitamin A levels decreased [3.4 (2.1-4.2) vs. 2.4 (1.6-4.1) µmol/L, p=0.01]. No changes occurred in other vitamins, ferrritin, alpha-1-acid glycoprotein, GSH and TBARS levels. CONCLUSION: Minimal metabolic changes were produced after skin autograft in small areas of well-nourished patients without active infection or inflammation.(AU)

OBJETIVO: Comparar os níveis séricos de vitaminas e dos marcadores de estresse oxidativo e inflamatório antes e após enxerto cutâneo para correção de pequenas áreas de cicatrizes hipertróficas de queimaduras. MÉTODOS: O estudo prospectivo foi conduzido com oito pacientes com mediana de idade de 28 anos (variação de 16 a 40 anos) que apresentavam cicatrizes fibróticas decorrentes de queimaduras. Todos os pacientes foram admitidos em Unidade de Queimados para serem submetidos a enxertos autólogos [3,3 (1,0 a 5,0)% da superfície corporal]. Os voluntários foram avaliados antes e 48 horas após a excisão do tecido cicatricial e do enxerto autólogo. Exames laboratoriais de rotina, além do questionário alimentar e da antropometria foram obtidos no período pré-operatório. Os níveis séricos das vitaminas A, C, E, B12 e ácido fólico, os marcadores inflamatórios (proteína C reativa, alfa-1-glicoproteína ácida e ferritina) e marcadores de estresse oxidativo (glutationa reduzida - GSH e Substâncias Reativas do Ácido Tiobarbitúrico - TBARS) foram determinados nas fases pré e pós-operatórias. Os dados foram analisados pelo teste de Wilcoxon pareado. RESULTADOS: Todos os voluntários estavam clinicamente estáveis e apresentavam estado nutricional adequado à admissão hospitalar. Após a cirurgia, houve aumento dos níveis séricos de proteína C reativa [0,4 (0,01-1,0) vs 2,5 (0,6-4,7) mg/dL, p=0,01], enquanto houve redução nos níveis de vitamina A [3,4 (2,1-4,2) vs 2,4 (1,6-4,1) µmol/L, p=0,01]. Não houve mudanças nos níveis séricos de outras vitaminas, ferritina, alfa-1-glicoproteína ácida, GSH e TBARS. CONCLUSÃO: Em pacientes com bom estado nutricional e sem evidência de atividade inflamatória ou infecciosa ocorrem mudanças metabólicas mínimas após enxerto autólogo de pequenas áreas de cicatrizes de queimadura.(AU)

Obesity and abdominal wound healing in rats / Obesidade e cicatrização da parede abdominal em ratos

INTRODUCTION: Treatment for obesity essentially has to do with weight loss, which can be achieved through surgical procedures. Despite the considerable rise in the number of such procedures, the relationship between obesity and the healing process has not been totally clarified. PURPOSE: To investigate abdominal wound healing in obese Wistar rats on the seventh and fourteenth days following a laparotomy. METHODS: Thirty-six Wistar rats were randomly distributed into two groups, the control and experiment group. The control group were fed on either a standard diet for the species and the experiment group were put on a high calorie diet. After 116 days, all the animals were submitted to a laparotomy followed by laparorrhaphy. After euthanasia on the seventh or fourteenth day, fragments of the abdominal wound containing the scar were submitted to histopathological and tensiometric analysis. RESULTS: The average weight of the animals from the experiment group was higher than that of the control group (p<0.001). The difference in the resistance of the cutaneous scars was not significant. The aponeurotic scars were more resistant in the control group after seven days (p=0.011) and fourteen days (p=0.040). There was no difference in terms of intensity of the inflammatory reaction and the collagen density was similar in both groups. CONCLUSION: In rats, obesity lowered the resistance of the aponeurotic scars but not the skin scars. It did not interfere with the delayed inflammatory response and the collagen density.(AU)

INTRODUÇÃO: O tratamento da obesidade é baseado essencialmente na perda de peso, e isto pode ser conseguido por meio de procedimentos cirúrgicos. Apesar do grande aumento no número destes procedimentos, a relação entre obesidade e o processo de cicatrização ainda não está totalmente elucidada. OBJETIVO: Investigar a cicatrização da parede abdominal de ratos Wistar obesos, sete e 14 dias após laparotomia. MÉTODOS: Ratos Wistar, em número de 36 foram alocados em dois grupos, controle e experimento. Os do grupo controle receberam dieta padrão para a espécie e os do experimento dieta hipercalórica. Depois de 116 dias, todos os animais foram submetidos à laparotomia seguida de laparorrafia. Após a eutanásia com sete ou 14 dias, fragmentos da parede abdominal contendo a cicatriz receberam análise histopatológica e tensiométrica. RESULTADOS: O peso médio dos animais do grupo experimento foi maior do que o do grupo controle (p<0,001). A diferença da resistência das cicatrizes cutâneas não foi significante. As cicatrizes aponeuróticas foram mais resistentes no grupo controle aos sete dias (p=0,011) e aos 14 dias (p=0,040). Não houve diferença quanto à intensidade da reação inflamatória e a densidade de colágeno foi semelhante nos dois grupos. CONCLUSÃO: Em ratos, a obesidade diminuiu a resistência das cicatrizes aponeuróticas, mas não a das cicatrizes da pele. Não interferiu na reação inflamatória tardia e nem na densidade do colágeno.(AU)

The influence of nicotine on the population of fibroblasts in cutaneous scars in rats / A influência da nicotina na população de fibroblastos em cicatrizes cutâneas de ratos

PURPOSE: To study the collagen density and the population of fibroblasts in cutaneous injuries in rats under the influence of nicotine. METHODS: The scars of abdominal wounds in rats were analyzed. 2 mg/kg/d of nicotine was administered to the animals in the experiment group and the solution used as a vehicle for the animals in the control group. Treatment was begun seven days prior to surgery and maintained for seven or fourteen days following surgery. The removed scars were prepared for histopathological study. Histological cuts were stained by Sirius Supra red F3BA for collagen analysis and submitted to the examination using the immunohistochemical technique, which enabled us to recognize the population of fibroblasts. RESULTS: No significant difference was found in type I collagen density after seven days (p=0.912), nor after fourteen days (p=0.211). The control group had more type III collagen after seven days (p=0.004), but after fourteen days there was no significant difference (p=0,720). The total quantification of collagen, although higher in the control group, was not significantly so at any time during the study (p=0.103 after seven days and p=0.549 after fourteen days). The average of fibroblasts per field was lower after seven days (p=0.0001) and after fourteen days (p=0.0000). CONCLUSION: Under the conditions of this experiment, nicotine reduced the fibroblast population without modifying collagen density significantly.(AU)

OBJETIVO: Estudar a densidade de colágeno e a população de fibroblastos em feridas cutâneas de ratos sob a influência da nicotina. MÉTODOS: Analisaram-se as cicatrizes de feridas abdominais de ratos. Foi administrada 2 mg/kg/d de nicotina, por via subcutânea aos animais do grupo experimento e a solução usada como veículo para os animais do grupo controle. O tratamento foi iniciado sete dias antes do ato operatório e mantido por sete ou quatorze dias no pós-operatório. As cicatrizes ressecadas foram preparadas para estudo histo-patológico. Cortes histológicos foram corados pelo Sirius Supra red F3BA para a análise do colágeno e submetidos à exame pela técnica imuno-histoquímica permitiram reconhecer a população de fibroblastos. RESULTADOS: Verificou-se que não existiu diferença significante na densidade de colágeno tipo I, na avaliação feita com sete dias (p=0,912) e com 14 dias (p=0,211). O grupo controle mostrava mais colágeno tipo III com sete dias (p=0,004), mas aos 14 dias não havia diferença significante (p=0,720). A quantificação do colágeno total, embora fosse maior no grupo controle, não o foi de forma significante em nenhum dos tempos estudados (p=0,103 aos sete dias e p=0,549 aos 14 dias). A média de fibroblastos por campo esteve diminuída na avaliação de sete dias (p=0,0001) e na de quatorze dias (p=0,0000). CONCLUSÃO: Nas condições do experimento, a nicotina promoveu diminuição da população de fibroblastos sem modificar a densidade do colágeno de forma significante.(AU)

Biópsia do miocárdio em cães: acesso minimamente invasivo por cirurgia torácica videoassistida / Myocardial biopsies in dogs: minimally invasive approach by vídeo-assisted thoracoscopy

Realizou-se uma série de biópsias cardíacas em cães para testar o acesso toracoscópico, utilizando-se oito cães sem raça definida, sob condições de manejo e alimentação adequados. A abordagem à cavidade torácica foi feita por meio de cirurgia torácica videoassistida e o instrumental utilizado para remoção do fragmento de miocárdio foi o convencional em lugar das pinças de videocirurgia. A eficácia do procedimento foi confirmada pelo tempo decorrido entre as incisões, a execução da biópsia e a sutura do tórax, com duração média de 15 minutos. A cirurgia torácica videoassistida para biópsias cardíacas foi considerada segura e adequada, minimizando o desconforto pós-operatório dos pacientes submetidos ao acesso torácico.(AU)

In order to evaluate the thoracoscopy access, biopsies were carried out in eight mongrel dogs maintained under appropriate conditions of handling and feeding. The patients were prepared to aseptic and atraumatic surgery approaching the thoracic cavity by means of video-assisted thoracic surgery (VATS). Myocardial biopsies were carried out with conventional surgical instruments as an alternative to the clamps of video surgery. The effectiveness of the procedure was confirmed by mean time (15 minutes) elapsed from thoracic approach and biopsies obtainment to thoracic wall suture. VATS is a secure and appropriate technique to carry out myocardial biopsies that minimize postoperative discomfort in patients submitted to thoracic approach.(AU)