Mamoplastia pós-cirurgia bariátrica usando suporte protético complementar de contenção glandular / Breast augmentation after bariatric surgery by using complementary prosthetic support for glandular containment

INTRODUÇÃO: A pele de pacientes emagrecidas pós-cirurgia bariátrica apresenta alterações estruturais e proteômicas e não resiste ao peso das mamas, levando-as à flacidez residual precoce, exigindo suporte auxiliar. O objetivo é aplicar suporte auxiliar de lâmina de polipropileno não absorvível mais poliglecaprone absorvível ou lâmina de silicone de bustos, em forma de "soutien interno" como auxiliar de sustentação da pele, para manutenção da forma das mamas, e flacidez no mínimo comparável a outras pacientes sem emagrecimento pela cirurgia bariátrica. MÉTODOS: Nove pacientes foram submetidas à mamoplastia em T invertido com modelagem dos tecidos mamários, com redução do volume e envolvidos com lâmina de sustentação auxiliar. RESULTADOS: Não houve flacidez precoce e em observação de até 4 anos ela era aceitável. Uma delas apresentou seroma, drenado com boa resolução. Serão operadas outras 24 pacientes dentro do protocolo, acompanhadas e observadas por 2 anos com controle mamográfico, ultrassônico e ressonância magnética. CONCLUSÃO: A mamoplastia redutora pós-cirurgia bariátrica requer suporte extra à glândula mamária. A pele estruturalmente alterada não suporta o seu peso e haverá flacidez precoce.

INTRODUCTION: The skin presents structural and proteomic changes after bariatric surgery and cannot withstand the weight of the breasts, which leads to early residual flaccidity, requiring auxiliary support. The goal is to apply a nonabsorbable polypropylene-poliglecaprone absorbable auxiliary mesh support or Bustos silicone sheet, in the form of an "internal brassiere," to support the skin in order to maintain the shape and flaccidity of the breasts comparable with those of normal breasts. METHODS: Nine patients underwent mammoplasty in inverted T with modeling of tissue implants, reduction of breast volume, and wrapping with an auxiliary support mesh. RESULTS: Flaccidity was not observed at an early stage and the condition was acceptable for up to 4 years of follow-up. One of the patients had a seroma, which was drained with good resolution. Another 24 patients will be operated according to the protocol and observed for 2 years by using mammography, ultrasonography, and magnetic resonance imaging. CONCLUSION: Reduction mammoplasty after bariatric surgery requires additional support for the mammary gland. The structurally altered skin could not support the weight of the breasts, resulting in early flaccidity.

Characterization and evaluation of amphotericin B loaded MDP conjugated poly(propylene imine) dendrimers.

This paper describes a novel strategy for targeted delivery of amphotericin B (AmB) to macrophages with muramyl dipeptide (MDP) conjugated multimeric poly(propyleneimine) (PPI) dendrimers. Synergistic antiparasitic activity due to immunostimulation by multimeric presentation of MDP on dendrimers was anticipated. MDP conjugated 5.0G PPI (MdPPI) dendrimers were synthesized and characterized. Therapeutic activity and toxicity of dendrimeric formulation of AmB (MdPPIA) were compared with marketed formulations of AmB. Highly significant (P<0.01) reduction in toxicity was observed in hemolytic toxicity and cytotoxicity studies in erythrocytes and J774A.1 macrophage cells, respectively. Formulation MdPPIA showed appreciable macrophage targeting potential and higher or equivalent antiparasitic activity against parasite infected macrophage cell lines and in vivo infection in Balb/c mice. These results suggest the developed MDP conjugated dendrimeric formulation of AmB as a promising immunostimulant targeted drug delivery system and a safer alternative to marketed formulations. From the clinical editor: Parasitic infections remain a significant issue in the clinical setting. The authors in this article studied the use of ligand anchored dendrimeric formulation of Amphotericin B to target infected macrophages and showed reduced toxicity, high anti-leishmanial activity. This may add another treatment option to available formulations in the future.

In vivo reactions in mice and in vitro reactions in feline cells to implantable microchip transponders with different surface materials.

Tissues of mice that had had microchip transponders with surfaces made of bioglass, bioglass with a polypropylene cap, parylene C, titanium or aluminium oxide inserted were examined histologically, and the growth of two lines of feline fibroblastoid cells around these transponders was examined in vitro. The results for bioglass and aluminium oxide were similar. In vitro, there were almost no cells around or on the transponders; in vivo, there was often granulomatous inflammation in the surrounding tissue. In the case of the bioglass, this reaction seemed to be induced by petrolatum, which was added by the manufacturer for technical reasons, rather than by the bioglass itself. In some of the mice, polypropylene caused a proliferation of granulation tissue. In vitro, the cellularity around the transponders was high, but only a moderate number of cells were found on the material. In vivo, around the parylene C transponders, there were occasionally small fragments of foreign material, surrounded by a foreign body reaction; in vitro, the results for parylene C resembled those for polypropylene. In vivo, particles of titanium were sometimes visible in the connective tissue adjacent to the titanium transponders, and sometimes accompanied by a foreign body reaction; in vitro, a confluent layer of cells developed on the transponders, with a high cellularity around them.

Unusual complications of preperitoneal mesh implantation in the treatment of inguinal hernia.

More and more prosthetic materials are being used in the treatment of inguinal hernia. This report deals with some unusual but devastating complications, occurring after preperitoneal mesh implantation. A 56-year old male patient underwent a Stoppa-repair for a bilateral inguinal hernia. Two years postoperatively, a localized abdominal wall abscess was treated with antibiotics and drainage. A barium enema and a CT-scan of the abdomen were performed to rule out an enteric fistula; the CT-scan unexpectedly revealed a tumoral mass involving the sigmoid colon, and an explorative laparotomy was done. Peroperatively, part of the mesh was found to penetrate the bowel wall and a sigmoidectomy with removal of the mesh was performed. Two years later, ingrowth of the urinary bladder by the remains of the mesh was the unfortunate peroperative finding when the patient was operated on for an inflammatory mass, involving the bladder wall. The patient needed two more interventions for persisting wound fistulas. All the remains of the mesh have been removed and all fistulas have been widely excised. Nowadays, the patient is recovering well with complete healing of all wounds. Although infection of prostheses used in the treatment of hernias has been described, late and serious complications related to mesh implantation, such as perforation of the colon and the bladder, have seldom been reported.