Hyperbaric oxygenation on adhesions prevention after laparotomy in rats

Abstract Purpose: To evaluate the effects of hyperbaric oxygenation on prevention of adhesions in the abdominal cavity after laparotomy. Methods: Fifty four rats underwent laparotomy; stitches were made in the four quadrant parietal peritoneum and abdominal cavity closure. Animals were divided into three groups: 1 - control; 2 - subjected to high pressures and oxygenation; 3 - subjected to 100% hyperbaric oxygenation. The animals in groups 2 and 3 were daily submitted to oxygenation hyperbaric chamber after surgery. On the seventh day another laparotomy, registration of procedure, assessment of adhesions and biopsies of the peritoneum were held. Professionals analyzed the videos and the biopsies. Results: Peritoneal cavity adhesions occurred in animals of three groups with no difference between them. In Group 3, the adhesions presented more fragile and vascular proliferation more pronounced, and there was no difference in comparison with the first and second groups. However, there was no significant difference in the evaluation of these parameters between the animals in groups 1 and 2. Conclusions: Postoperative hyperbaric oxygenation in rats submitted to laparotomy did not alter the frequency, but reduced the density of adhesions in the peritoneal cavity and promoted vascular proliferation. The change in atmospheric pressure alone had no influence on the results.

Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis

Intraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells -positive patients had higher rates of nodal spread (risk difference: 0.29; p<0.01), serosal invasion (risk difference: 0.43; p<0.01), recurrence (after 60 months of follow-up, risk difference: 0.44; p<0.01), and mortality (after 60 months of follow-up, risk difference: 0.34; p<0.01). Intraperitoneal free cancer cells are associated with a poor outcome in gastric cancer. This surrogate biomarker should be used to guide therapy both prior to and after surgery.

The Differential Imaging Features of Fat-Containing Tumors in the Peritoneal Cavity and Retroperitoneum: the Radiologic-Pathologic Correlation

There are a variety of fat-containing lesions that can arise in the intraperitoneal cavity and retroperitoneal space. Some of these fat-containing lesions, such as liposarcoma and retroperitoneal teratoma, have to be resected, although resection can be deferred for others, such as adrenal adenoma, myelolipoma, angiomyolipoma, ovarian teratoma, and lipoma, until the lesions become large or symptomatic. The third group tumors (i.e., mesenteric panniculitis and pseudolipoma of Glisson's capsule) require medical treatment or no treatment at all. Identifying factors such as whether the fat is macroscopic or microscopic within the lesion, the origin of the lesions, and the presence of combined calcification is important for narrowing the differential diagnosis. The development and wide-spread use of modern imaging modalities make identification of these factors easier so narrowing the differential diagnosis is possible. At the same time, lesions that do not require immediate treatment are being incidentally found at an increasing rate with these same imaging techniques. Thus, the questions about the treatment methods have become increasingly important. Classifying lesions in terms of the necessity of performing surgical treatment can provide important information to clinicians, and this is the one of a radiologist's key responsibilities.

Effects of intraperitoneal injection of phenol, glycerin and acetic acid on neoplastic ascitis in guinea pigs / Efeitos da injeção intraperitoneal de fenol, glicerina e ácido acético na ascite neoplásica em cobaias

PURPOSE: To investigate the histolytic action of a solution composed by phenol, glycerin and acetic acid on neoplastic ascitis in guinea pigs. METHODS: Thirty-two guinea pigs were used. The animals were randomly distributed in experimental and control groups, and the effects of the peritoneal injection of the testing solution were studied. Saline solution was used for the control groups. Biochemical and anatomopathological (heart, lungs, kidneys, spleen and peritoneal serous membrane) were evaluated at 24 hours and 4 weeks of development. RESULTS: It was observed that solution E, when infused into the peritoneal cavity, caused no clinical, histological or laboratory alterations in these animals when compared to those in the control group. CONCLUSION: Given our results, it would be interesting to study the effects of the proposed solution on cases with experimental neoplastic ascites with a later view to treating it in humans.

OBJETIVO: Investigar a ação hìstolítica de uma solução composta de fenol, glicerina e ácido acético na ascite neoplásica em cobaias. MÉTODOS: Foram utilizadas 32 cobaias, distribuídas por sorteio, em grupos experimentais e controles e estudados os efeitos da injeção peritonial da solução teste. Nos grupos controles empregou-se solução fisiológica. Foram estudadas alterações bioquímicas, anatomopatológicas (coração, pulmões, rins, baço e serosa peritonial), com 24 horas e 4 semanas de evolução. RESULTADOS: Verificou-se que a solução E quando instilada na cavidade peritonial não provocou nenhuma alteração clinica, histologica ou laboratorial nestes animais, quando comparados com o grupo controle. CONCLUSÃO: Frente aos resultados obtidos, consideramos interessante estudar os efeitos da solução proposta em casos de ascite neoplásica experimental em animais, com posterior estudo em seres humanos.

Solitary fibrous tumour: a diagnostic dilemma.

Solitary fibrous tumour (SFT) is a rare spindle cell neoplasm arising at pleural and extrapleural sites. Five cases of SFT diagnosed at our institution over a five year period were reviewed. Haematoxylin and eosin stained histological sections, immuno-histochemical markers including CD34 and electron microscopy were the different methods used to study these tumours. Three histological features were consistently observed in all the tumours: the tumours were composed of short spindle cells separated by dense collagen bands and arranged in alternate hypocellular and hypercellular areas. CD34 positivity was seen in all the cases. SFT's have been reported to behave in an unpredictable fashion and hence prolonged follow up is essential. Histology, CD34 positivity and electron microscopy are useful tools in diagnosing SFT. While the pleural tumours can be diagnosed based on histology, this must be substantiated by ancillary techniques in case of extrapleural tumours.

Giant lesser sac liposarcoma mimicking infected pancreatic pseudocyst.

The most common site for abdominal liposarcoma is the retroperitoneum. We report a 32-year-old man with lesser-sac myxoid liposarcoma with extensive cystic degeneration. Cystogastrostomy was attempted elsewhere with a misdiagnosis of pancreatic pseudocyst. However, the procedure was abandoned after biopsy, which showed features of liposarcoma. The patient was re-explored at our institute 2 weeks later. Complete excision of the tumor was done. Histology revealed features of myxoid liposarcoma. The patient received adjuvant radiotherapy and is doing well 12 months later.

Ventral extradural spinal meningeal cyst causing cord compression: neurosurgical treatment

Spinal extradural meningeal cysts are typically formed by a thin fibrotic membranous capsule, macroscopically similar that of an arachnoid membrane, filled by cerebro spinal fluid and related to a nerve root or to the posterior midline. Ventral location is extremely rare and when it occurs they usually cause spinal cord herniation through the ventral dural gap. A 61 year-old man who began with a two years long history of insidious tetraparesis, spasticity and hyperreflexia in lower extremities, and flaccid atrophy of upper limbs, without sensory manifestations, is presented. Investigation through magnetic resonance imaging demonstrated an extensive spinal ventral extradural cystic collection from C6 to T11. The lesion was approached through a laminectomy and a cyst-peritoneal shunt was introduced. The cyst reduced in size significantly and the patient is asymptomatic over a 48 months follow-up. This is the first reported case of a spontaneous ventral extradural spinal meningeal cyst causing cord compression. Cyst-peritoneal shunt was effective in the treatment of the case and it should be considered in cases in which complete resection of the cyst is made more difficult or risky by the need of more aggressive surgical maneuvers.

Cistos meníngeos extradurais espinhais são formados tipicamente por estreita cápsula membranosa fibrótica, macroscopicamente semelhante a uma membrana de aracnóide, repleta de líquor e relacionada com uma raiz nervosa ou com a linha média posterior. Eles são extremamente raros em posição anterior e, quando ocorrem, habitualmente causam herniação da medula espinhal pela falha dural ventral. O caso de um homem de 61 anos de idade que iniciou com tetraparesia, espasticidade e hiperreflexia em membros inferiores, e flacidez com hipotrofia nos membros superiores, sem manifestação sensitiva, é apresentado. A investigação com ressonância magnética demonstrou extensa coleção cística extradural ventral à medula de C6 a T11. A lesão foi abordada diretamente via laminectomia com introdução de derivação cisto-peritoneal, reduzindo o cisto e tornando o paciente assintomático com um seguimento de 48 meses. Este é o primeiro caso relatado de cisto meníngeo extradural ventral espontâneo causando compressão medular. A derivação cisto-peritoneal se mostrou eficaz no tratamento do caso e deve ser considerada em situações em que a ressecção completa do cisto esteja impossibilitada, ou dificultada pela necessidade de manobras cirúrgicas mais agressivas e arriscadas.

Teratoma inmaduro del ovario con implantes peritoneales de tejidos maduros: presentación de un caso y revisión de una literatura / Immature teratoma of the ovary with peritoneal implants of mature tissues: presentation of a case and review of literature

Los teratomas inmaduros de los ovarios son tumores poco frecuentes, por lo general se presentan en niñas y adolescentes. Una de las complicaciones descritas tanto en los teratomas maduros como en los inmaduros, es la presencia de implantes o metástasis de tejido glial en cavidad peritoneal, patología conocida como "gliomatosis peritoneal". Pocos son los artículos en los que se describe la presencia de otros tejidos maduros a nivel del peritoneo. Aquí presentamos el caso de una paciente de 35 años con teratoma inmaduro del ovario e implantes peritoneales constituidos por tejidos maduros, tipo cartílago, conectivo, epitelio intestinal y respiratorio.

Disruption of the intestinal barrier and bacterial translocation in an experimental model of intestinal obstruction

Clinical evidence and the use of experimental models in laboratory animals indicate that the intestine is a reservoir of microorganisms that can cause systemic infection in the human. The purpose of this work was to study the possible effect of intestinal obstruction (IO) on the mechanical and chemical barriers that bring protection against microorganisms crossing from the intestinal lumen towards the systemic tissues. We demonstrated that 24 hours after IO, histological and ultrastructural alterations do occur, seriously compromising the structure of the intestinal barrier in 100 per cent of the studies animals. Likewise, it was observed that during the same period, microorganisms translocation from intestine to the peritoneal cavity and liver (100 and 80 per cent respectively) occurred. The lungs were spared. Changes observed in the intestinal epithelium are related to a process similar to that produced by intestinal ischemia: mitochondrial destruction, with subsequent decrease of its capacity to supply eb

Exame do fluido peritoneal e hemograma de eqüinos submetidos à laparotomia e infusäo intraperitoneal de carboximetilcelulose / Peritoneal fluid exam and hemogram of horses submited to laparotomy and carboxymethylcellulose intraperitoneal infusion

A aplicaçäo intraperitoneal de carboximetilcelulose (CMC) tem sido utilizada na prevençäo de aderências peritoneais em animais e em humanos. Os objetivos deste trabalho foram avaliar a resposta do peritônio ao trauma cirúrgico e à aplicaçäo de CMC e estudar como se processa a metabolizaçäo da CMC. Dezenove eqüinos mestiços foram submetidos à laparotomia, quando se produziram lesöes no jejuno distal por abrasäo da serosa e isquemia. Nos 9 eqüinos do grupo tratamento, antes da síntese da parede abdominal, foi instilada, na cavidade peritoneal, uma soluçäo estéril de CMV, a 1 porcento na dose de 7 ml/kg. Nos eqüinos do grupo controle, nenhum medicamento foi aplicado na cavidade peritoneal. Após a cirurgia, colheram-se sangue e fluido peritoneal em 9 momentos: 4 horas após o fim da cirurgia, nos 3 primeiros dias pós-operatórios, pela manhä e a cada 48 horas nos dias subseqüentes ( no 5§, 7§, 9§, 11§ e 13§ dias pós-operatórios). Os exames laboratoriais demonstraram que todos os animais desenvolveram inflamaçäo peritoneal. Entretanto, nos animais do grupo tratamento, esta inflamaçäo foi mais intensa e com um curso mais longo. Observou-se também que a excreçäo da CMC ocorreu por fagocitose.

Peritonite infecciosa com quantitativos e qualitativos bacterianos conhecidos: estudo experimental em ratos / Infectious peritonitis with known bacterial concentration: experimental study in rats

O objetivo deste estudo é o desenvolvimento de peritonite difusa com qualitativos e quantitativos bacterianos conhecidos. Foram analisados 150 ratos, adultos, machos, da raça Wistar, com peso médio de 150 gramas. Inocularam-se, percutaneamente, na cavidade peritoneal, suspensões constituídas de Escherichia coli e Bacteoides fragilis em concentrações conhecidas, na proporção de 1ml para cada 100 gramas de peso. Os animais foram distribuídos em cinco grupos de trinta ratos. No grupo I (grupo-controle) inoculou-se solução de cloreto de sódio a 0,9 por cento. Nos demais grupos a concentração do inóculo foi a seguinte: grupo II, com suspensão a 10(9); grupo III, com suspensão a 10(8): grupo IV, suspensão a 10(7) e grupo V com suspensão a 10(6)...

Ambiente peritonial: fisiopatogenia de la endometriosis / Peritoneal environment: Pathophysiology of endometriosis

En este artículo se revisa un modelo fisiopatogénico de la endometriosis, enfocando múltiples factores dentro de un ambiente específico, el circunscrito por el peritoneo, cuya alteración repercute en las relaciones entre las propias células endometriósicas y las células de la respuesta inmune. Actuando como medidores: sustancias vasoactivas, citocinas (interleucinas y factores de crecimiento) y hormonas propias del ciclo menstrual; que son capaces de inducir distintos efectos sobre la proliferación, crecimiento y diferenciación celulares; y sobre la expresión de moléculas de adhesión y nuevos determinantes antigénicos. Interrelaciones que se manifiestan a través de respuestas inflamatoria, Inmunológica, reparación y fibrosis, formación de adherencias; y que producen un ambiente peritoneal favorable para el inicio, mantenimiento y progresión de tejido endometriósico; que finalmente llevan a manifestaciones clínicas como dolor pélvico, dismenorrea, dispareunia y esterilidad

Coelom-associated lymphomyeloid tissue (milky spots): site of lymphoid and myelomonocytic cell generation

Pleural and peritoneal milky spots (MS) are small morphofunctional structures representing subsidiary foci of coelom-associated lymphomyeloid tissue (CALT). In this paper we studied the cellular composition of CALT in normal and Schistosoma mansoni-infected mice. In the healthy mouse, CALT is mainly composed of IgM (+) B cells and presents lower numbers of CD23 and CD45R (B220) B2 lymphocytes. When activated by the infection, it may show pronounced lymphocytosis, plasmocytogenesis (IgM >IgG>IgA>IgG2a>IgG1) and myelomonocytosis. The lymphocytes were mainly of the B1 type (double positive CD5/IgM), with smaller number of T cells (TCR alpha beta (+), TCR gamma delta (+), CD3 (+) and CD5 (+)) and conventional B2 cells (B220 (+), CD23 (+)). The myeloid compartment was composed of immature and mature cells of monocyte/macrophage, eosinophil, neutrophil and megakaryocytic lineages, especially in the omental milky spots. CALT is also a favorable microenvironment for LFA-1 (+) mast cells. Thus, CALT appears to be a mixed lymphoid organ, with secondary and/or primary lymphoid organ functions, being an important site of B1 cell generation, plasma cell maturation and extramedullar hematopoiesis. CALT operates as an interface between blood and lymphatic circulation and coelomic cavities, because locally or externally produced cells have easy and ready access to the pleural and peritoneal cavities. Furthermore, MS cells can escape into blood and lymphatic vessels, providing lymphocytes to other lymphoid organs and to the mucosa-associated lymphoid tissue.

Peritonitis primaria en adultos en el Hospital Nacional Cayetano Heredia entre 1989 y 1990 / Primary peritonitis in adults at the Hospital Nacional Cayetano Heredia

La infección primaria o espontánea de la cavidad peritoneal es cada vez reconocida con mayor frecuencia en la literatura médica. Esto es el resultado de una mejor comprensión de los nmecanismos fisiopatológicos involucrados en su génesis, así como de mejores métodos para el diagnóstico. La paracentesis con cultivo de 10cc de líquido ascítico en un medio de hemocultivo, en la cabecera del paciente, es el procedimiento que se recomienda actualmente para el diagnóstico. Durante los años de 1989-1990, utilizando el procedimiento antes mencionado, hemos investigado la presencia de esta entidad en las Salas de Medicina del Hospital Nacional Cayetano Heredia. Cinco episodios en cuatro pacientes fuerin identificados, ellos grafican el amplio espectro reconocido de infección peritoneal primaria: peritonitis primaria (1), ascitis neutrocítica cultivo negativo (2) y bacterascitis monomicrobiana (2). Un alto índice de sospecha, paracentesis y cultivos adecuados, permitirán conocer la real magnitud del problema de nuestro Hospital

Orientaçäo atual em abscessos subfrênicos: contribuiçäo clínica / Up-to-date orientation in subphrenic abscesses: clinical contribution

Os traumatismos e as agressöes cirúrgicas abdominais representam, pelo menos na experiência dos autores, as causas que levam mais freqüentemente à formaçäo de abscessos na cavidade peritoneal. Näo obstante os progressos da antibioticoterapia e das técnicas de assepsia, a sua freqüência torna-se alvo de interesse. A presença de febre e leucocitose no pós-operatório ou em paciente politraumatizado devem sempre fazer suspeitar do aparecimento de tal complicaçäo. Um tratamento precose e adequado torna-se fundamental para eliminar o estado tóxico que a coleçäo purulenta produz e permitir a sobrevida do paciente

Reação granulomatosa extra-tecidual induzida por ovos de Schistosoma mansoni na cavidade peritoneal do camundongo / Granulomatous tissue reaction induced by extra-Schistosoma mansoni eggs in the peritoneal cavity of mice

A presença de ovos de Schistosoma mansoni na cavidade peritoneal de camundongos experimentalmente infectados foi constatada após a 6ê semana de infecção. Estes ovos invariavelmente mostraram-se recobertos por células inflamatórias predominantemente do tipo mononuclear. A observação sequencial à microscopia óptica e eletrônica destas estruturas, mostrou tratar-se de coleções de células macrofágicas em diferentes estádios de ativaçâo, dispostas em arranjo concêntrico, permitindo sua caracterização como reação granulomatosa. Estas estruturas foram morfologicamente comparáveis à granulomas induzidos pelo ovo do parasita em tecidos do fígado, intestino e epiplon. A injeção de ovos de S. mansoni na cavidade peritoneal de animais normais induziu respostas semelhantes, sendo possivel a visualização destas reações já 24 horas após o inóculo. Nestes granulomas foram observadas fibras colágenas distribuídas concentricamente acompanhando o padrão arquitetural do componente celular. A fibrogênese teve início nos animais infectados por volta da l0a semana e, naqueles que receberam injeção intraperitoneal de ovos após 48 horas. Com base nestes resultados é discutida a possível influência da imunidade na gênese do granuloma, bem como as relações deste com o tecido conjuntivo vascularizado.

Infecçäo peritoneal: modelo experimental em ratos / Peritoneal infection: experimental model in rats

Um modelo experimental prático de infecçäo peritoneal, em ratos, é proposto. Consiste na introduçäo, na cavidade peritoneal, de uma suspensäo de conteúdo cólico diluido em soluçäo salina. Os resultados säo analisados observando-se a mortalidade, a evoluçäo ponderal, os valores da proteína C reativa e os aspectos anátomo-patológicos. A análise dos resultados sugere que o modelo proposto pode simular a fase aguda da infecçäo peritoneal