Giant idiopathic penoscrotal lymphedema - Surgical approach with skin graft: A case report.

Lymphedema is originated from the reduced lymphatic flow, causing a volumetric increase in the affected region and is physically and emotionally uncomfortable. Surgical intervention is considered the best treatment option as it brings both functional and aesthetic benefits. This is a report from the case of a previously healthy 45-year-old man who developed idiopathic penoscrotal giant lymphedema. A surgical approach was proposed. There was resection of scrotal lymphedema followed by a classic postectomy, suprapubic advancement flaps, and use of a partial skin graft from the right thigh. The results of the therapeutic approach were aesthetically and functionally satisfactory.

IMMUNOHISTOCHEMICAL ANALYSIS OF THE EXPRESSION OF ALCAM AND ALDH1 MARKERS IN PATIENTS WITH COLORRETAL ADENOCARCINOMA AND ASSOCIATION WITH CLINICOPATHOLOGICAL OUTCOMES / ANÁLISE IMUNOISTOQUÍMICA DA EXPRESSÃO DOS MARCADORES ALCAM E ALDH1 EM PACIENTES COM ADENOCARCINOMA COLORRETAL E ASSOCIAÇÃO COM DESFECHOS CLINICOPATOLÓGICOS

Background: Colorectal cancer has a high global mortality and tumor markers have emerged as diagnostic, management and prognostic indicators. New markers are being studied. Objective: To verify if there is a correlation between the immunohistochemical expression of ALCAM and ALDH1 proteins in colorectal adenocarcinoma tissue with epidemiological and clinicopathological characteristics, in particular their impact on disease progression and death. Method: Observational, single-center, analytical, retrospective study, through the investigation of patients undergoing surgical resection for colorectal cancer. 122 patients were evaluated. Regarding progression, it was shown that in individuals with positive ALCAM (n=40), 14/40 (35%) had progression, and for positive ALDH (n=54), 22/54 (40.7%). For death, the analysis of ALCAM positive (n=40), 24/40 (60%) died, and ALDH1 positive (n=54), 33/54 (61.1%). Conclusion: The immunohistochemical expression of ALCAM and ALDH1 markers was not associated with disease progression and death; it was also not possible to observe a correspondence relationship with the evaluated markers.

Racional: O câncer colorretal apresenta alta mortalidade global e marcadores tumorais têm surgido como sinalizadores de diagnóstico, manejo e prognóstico. Novos marcadores estão sendo estudados. Objetivo: Verificar se há correlação da expressão por imunoistoquímica das proteínas ALCAM e ALDH1 em tecido com adenocarcinoma colorretal com as características epidemiológicas e clinicopatológicas, em particular o seu impacto na progressão de doença e no óbito. Método: Estudo observacional, unicêntrico, analítico, retrospectivo, através da investigação de pacientes submetidos à ressecção cirúrgica por câncer colorretal. Foram avaliados 122 pacientes. Em relação a progressão, mostrou-se que nos indivíduos com ALCAM positiva (n=40), 14/40 (35%) tiveram progressão, e para ALDH positiva (n=54), 22/54 (40,7%). Para óbito, a análise da ALCAM positiva (n=40), 24/40 (60%) morreram, e ALDH1 positivo (n=54), 33/54 (61,1%). Conclusão: A expressão imunoistoquímica dos marcadores ALCAM e ALDH1 não apresentou associação com a progressão de doença e óbito; também não foi possível observar relação de correspondência com os marcadores avaliados.

Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats / Fibroplasia após implante de tela de polipropileno para correção de hérnia da parede abdominal em ratos

PURPOSE: This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. METHODS: Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where the polypropylene mesh was implanted was evaluated histologically to assess inflammatory response and percentage of collagen using computer-assisted videomorphometry. RESULTS: Total collagen was found at the mesh site on the 3rd day post-implantation, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st days, when it reached its highest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days; it reached its highest percentage on the 21st day and then remained stable until the 30th day. The type I to type III collagen ratio increased significantly and progressively up to the 30th day (p<0.001). Neutrophils were found at the mesh site from the 1st to the 21st day post-implantation. Macrophages, giant cells and lymphocytes were seen on the 2nd day. Thirty days after mesh implantation, neutrophils disappeared, but the percentages of macrophages, giant cells and lymphocytes remained stable (p<0.001). CONCLUSIONS: This study showed that total collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen...

OBJETIVO: Avaliar o tempo de fibroplasia em tela de polipropileno na correção de hérnias incisionais da parede abdominal, em ratos, através da quantidade de colágeno, correlacionando-o com a resposta inflamatória local. MÉTODOS: Trinta e seis ratos machos da linhagem Wistar foram submetidos à ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Os animais foram distribuídos em seis grupos, de acordo com o tempo de fibroplasia a ser estudado (1, 2, 3, 7, 21 e 30 dias de pós-operatório). Após os prazos estabelecidos para estudo da fibroplasia, os animais foram submetidos à eutanásia, e a área de fixação da tela de polipropileno foi avaliada histologicamente quanto à reação inflamatória e à percentagem de colágeno pela técnica videomorfométrica assistida por computador. RESULTADOS: Houve aparecimento de colágeno total junto à tela no 3º dia pós-implante, com aumento progressivo na sua proporção em todos os dias subseqüentes até o 21º dia, quando atingiu sua proporção máxima (p<0,001). A partir do dia 3, o colágeno III sofreu um aumento progressivo até o dia 21, quando atingiu sua proporção máxima (p<0,001), e no 30º dia apresentou uma redução significativa (p<0,001). O colágeno tipo I surgiu entre o 7º e o 21º dia, apresentou sua máxima proporção no 21º dia e manteve-se inalterado até o final do período de observação. A relação colágeno tipo I/tipo III aumentou progressivamente e inverteu-se no 30º dia de observação (p<0,001). Os neutrófilos foram identificados no 1º dia pós-implante, mantendo-se junto à tela até o 21º dia. Os macrófagos, gigantócitos e linfócitos foram identificados no 2º dia. Trinta dias após a implantação da tela, desapareceram os neutrófilos e mantiveram-se estáveis as proporções de macrófagos, gigantócitos e linfócitos (p<0,001). CONCLUSÕES: Os resultados do presente estudo evidenciaram...

Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats.

PURPOSE: This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. METHODS: Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where the polypropylene mesh was implanted was evaluated histologically to assess inflammatory response and percentage of collagen using computer-assisted videomorphometry. RESULTS: Total collagen was found at the mesh site on the 3rd day post-implantation, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st days, when it reached its highest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days; it reached its highest percentage on the 21st day and then remained stable until the 30th day. The type I to type III collagen ratio increased significantly and progressively up to the 30th day (p<0.001). Neutrophils were found at the mesh site from the 1st to the 21st day post-implantation. Macrophages, giant cells and lymphocytes were seen on the 2nd day. Thirty days after mesh implantation, neutrophils disappeared, but the percentages of macrophages, giant cells and lymphocytes remained stable (p<0.001). CONCLUSIONS: This study showed that total collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen at the last observational time point. The prolonged healing inflammatory response and the persistence of chronic inflammation surrounding to the mesh did not affect the length of time required for fibroplasia.