Effect of the platelet-rich plasma covering of polypropylene mesh on oxidative stress, inflammation, and adhesions.

INTRODUCTION AND HYPOTHESIS: Polypropylene mesh (PPM) is often used for urogynecological repair; however, it can cause complications. An approach to reduce complications is to coat PPM with anti-inflammatory and wound-healing molecules. Platelet-rich plasma (PRP) is inexpensive and improves wound healing. Therefore, we evaluated whether covering PPM with PRP could reduce inflammation, adhesion, and oxidative stress (OS) in rabbits. METHODS: The primary objective was to evaluate OS, and the secondary objectives were to evaluate inflammation and adhesion. PRP-coated PPM was implanted on the right side of the abdominal cavity of 12 female New Zealand rabbits, in the interface between the hypodermis and peritoneum. An uncoverated PPM was implanted in the other side. Twelve rabbits served as the sham group; all animals were euthanized after 30 or 60 days. Inflammatory parameters were myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) activities. OS was evaluated by measuring the ferric-reducing antioxidant power, the free-radical-reducing ability of 3-ethylbenzothiazoline-6-sulfonic acid [2,2'-azino-bis (ABTS)], reduced glutathione levels, and superoxide anion production. Adhesion was measured using tenacity and Diamond scales (the latter of which grades adhesions according to their extent) Inflammation and OS were analyzed by analysis of variance (ANOVA), followed by Tukey's test. The Mann-Whitney test was used to evaluate adhesions, and analysis of the sham group was conducted using Kruskal-Wallis test. RESULTS: No significant differences were observed in parameters of adhesions. After 60 days, PRP-coverated PPM presented a decrease in MPO and NAG activities. Furthermore, decreased OS and increased antioxidant levels were observed in PRP-coverated PPM samples. CONCLUSIONS: The reduction of OS and inflammatory responses indicates that PRP-covered PPM is a promising therapeutic approach.

Hepatectomy: a critical analysis on expansion of the indications.

BACKGROUND: Hepatic resection has evolved to become safer, thereby making it possible to expand the indications. Aim : To assess the results from a group of patients presenting these expanded indications. METHOD: Were prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs). RESULTS: Were operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery. CONCLUSION: The indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion.

Hepatectomy: a critical analysis on expansion of the indications / Hepatectomia: uma analise critica da ampliacao das indicacoes

Background: Hepatic resection has evolved to become safer, thereby making it possible to expand the indications. Aim : To assess the results from a group of patients presenting these expanded indications. Method: Were prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs). Results: Were operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery. Conclusion: The indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion. .

Racional: As ressecções hepáticas evoluíram, tornando-se mais seguras, permitindo ampliação das indicações. Objetivo : Avaliar os resultados com ampliação da indicação. Método : Estudo prospectivo de todas as hepatectomias realizadas para ressecção de tumores hepáticos. Foram incluídos pacientes com tumores primários e secundários, benignos e malignos e anotados idade, gênero, diagnóstico pré-operatório, tratamento realizado no pré-operatório, tipo de operação realizada, necessidade de transfusão, exame anatomopatológico final e evolução pós-operatória. Os pacientes foram divididos em dois grupos: grupo A, aqueles com indicação tradicional de hepatectomia e grupo B, com indicação ampliada (tumor nos dois lobos hepáticos, ressecções extensas de cinco ou mais segmentos, fígados cirróticos e pós-quimioterapia com drogas hepatotóxicas). Resultados: Foram operados 38 pacientes e realizadas 40 operações, 28 no grupo A e 10 no B. A média de idade foi 57,7 anos, sendo 25 mulheres. Três do grupo B foram operados em dois tempos. Os grupos A e B receberam em média 1,46 e 5,5 concentrados de hemácias por operação, respectivamente. Os pacientes do grupo A tiveram três complicações (10,7%) e os do B seis (60%). A mortalidade no grupo A foi de 3,5% (n=1) e no grupo B ocorreram quatro óbitos (40%). Os exames de imagem foram sensíveis para presença de tumor, mas não para definir o tipo. As transfusões, a morbidade e a mortalidade foram maiores no grupo com ampliação das indicações e operações mais extensas. Conclusão: Deve-se indicar a biópsia hepática com maior frequência no pré-operatório, ...