Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment.

OBJECTIVE: To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Bilateral Peritonsillar Abscess in an Infant: An Unusual Presentation of Sore Throat.

INTRODUCTION: Peritonsillar abscess is considered a suppurative complication of acute tonsillitis. It is usually unilateral and clinically evident bilateral presentation is uncommon. The condition affects mainly children older than 10 years and young adults. Herein we present a rare case of bilateral peritonsillar abscess in an infant. PRESENTATION OF CASE: A 1-year-old boy presented with a two-day history of worsening sore throat, loss of appetite, vomiting, and fever. Examination of the oral cavity and oropharynx revealed enlarged and inflamed tonsils and a bilaterally congested and bulging soft palate. CT scan confirmed the hypothesis of bilateral peritonsillar abscess. Antibiotic therapy was instituted and after 5 days only slight regression of swelling of the soft palate was observed. He underwent a surgical procedure for draining the abscesses. After the procedure, he presented good clinical and laboratory evolution and was discharged home. DISCUSSION: Although peritonsillar abscesses are considered common complications of acute tonsillitis bilateral cases are extremely rare, especially in early childhood. The diagnosis is based on history and physical examination and the treatment remains controversial among otolaryngologists. CONCLUSION: Bilateral peritonsillar abscess should be diagnosed and treated promptly and adequately to prevent respiratory obstruction and to avoid dissemination into the deep neck spaces.

Complications of otitis media - a potentially lethal problem still present / Complicações das otites média - um problema potencialmente letal ainda presente

ABSTRACT INTRODUCTION: It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. OBJECTIVE: This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). METHODS: Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. RESULTS: 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. CONCLUSION: ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

Resumo Introdução: É uma crença comum, porém errônea, que complicações intracranianas (CICs) de otite média tanto aguda (OMA) quanto crônica (OMC) sejam doenças do passado ou de países em desenvolvimento. No entanto, esses problemas continuam, apesar de melhorias na terapia antimicrobiana. Objetivo: Analisar a ocorrência, as características clínicas e a evolução das principais CICs secundárias às otites médias (OM) Método: Estudo de coorte retrospectivo de 51 pacientes com CIC secundárias a OM, provenientes do pronto-socorro de um Hospital Universitário ao longo de um período de 22 anos. Resultado: No total, 80% dos casos de CICs foram secundários a OMC, cuja incidência foi de 0,8%, e apenas 20% foram secundárias a OMA. A letalidade foi de 7,8%, perda auditiva em 90%, com sequela neurológica permanente em 29%. Dentre os pacientes, 61% eram do sexo masculino. Na maioria, o início da doença otológica tinha ocorrido durante a infância. A demora no diagnóstico, tanto da infecção primária como da complicação secundária, foi significativa. CICs, incluindo abscesso cerebral e meningite, corresponderam a 78%, e trombose do seio lateral, empiema e hidrocefalia otítica em 13%, 8% e 1% dos casos, respectivamente. Foram realizados 27 procedimentos neurocirúrgicos e 43 cirurgias otológicas. Dois pacientes não apresentavam condições clínicas para a intervenção cirúrgica Conclusão: CICs de OM, embora incomuns, ainda ocorrem. Esses casos exigem tratamento hospitalar oneroso, complexo e de longo prazo, e frequentemente resultam em perda auditiva, sequelas neurológicas e mortalidade. É importante estar ciente dessa potencialidade especialmente em crianças com OMC e manter um alto índice de suspeita, encaminhar para avaliação otológica e antecipar a ocorrências de tais complicações.

Suppurative labyrinthitis associated with otitis media: 26 years' experience / Labirintite associada à otite média: experiência de 26 anos

ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

RESUMO INTRODUÇÃO: Labirintite permanece resultando em deficiência auditiva significativa, apesar dos esforços científicos para melhorar não só o diagnóstico, como também o tratamento. O diagnóstico definitivo é dependente de imagens da orelha interna, mas geralmente é presumido clinicamente. OBJETIVO: Analisar os fatores clínicos e os resultados auditivos em pacientes com labirintite secundária à otite média e discutir os achados dos exames de imagem. MÉTODO: Estudo de coorte retrospectivo, com base nos prontuários de pacientes diagnosticados com labirintite associada à infecção da orelha média. RESULTADOS: Foram identificados 14 pacientes, oito (57%) do sexo feminino e seis (43%) masculino. Média etária de 40 anos. Otite média crônica colesteatomatosa foi diagnosticada em seis pacientes (43%), otite média aguda em seis pacientes (43%) e otite média crônica sem colesteatoma em dois pacientes (14%). Foram identificadas 24 complicações concomitantes: seis casos (25%) de fístula labiríntica, cinco casos (21%) de meningite, cinco (21%) de paralisia facial, cinco (21%) de mastoidite, dois casos (8%) de abscesso cerebelar e um caso (4%) de abcesso temporal. Houve uma morte. Oito (57%) indivíduos tornaram-se anacústicos, enquanto seis (43%) evoluíram para perda auditiva mista. CONCLUSÃO: Labirintite foi frequentemente associada a outras complicações; RNM auxiliou no diagnóstico definitivo da labirintite na sua fase aguda; a sequela auditiva da labirintite foi significativa.

Suppurative labyrinthitis associated with otitis media: 26 years' experience.

INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

Complications of otitis media - a potentially lethal problem still present.

INTRODUCTION: It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. OBJECTIVE: This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). METHODS: Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. RESULTS: 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. CONCLUSION: ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss / Variáveis com valor prognóstico no momento da instalação da perda auditiva neurossensorial súbita idiopática

ABSTRACT INTRODUCTION: The establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice. OBJECTIVE: To establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery. METHODS: Prospective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment. RESULTS: 127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6 dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%. CONCLUSION: During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.

RESUMO Introdução: Elaborar avaliação prognóstica individualizada em pacientes com diagnóstico deperda auditiva neurossensorial súbita idiopática (PANSI) permanece tarefa árdua e imprecisa devido, em grande parte, à variedade de etiologias. A determinação de quais variáveis teriam valor prognóstico na avaliação inicial do paciente seria de extrema utilidade na prática clínica. Objetivo: Estabelecer quais variáveis, identificáveis no momento de instalação da perda auditiva neurossensorial súbita idiopática, têm valor prognóstico na recuperação auditiva final. Método: Estudo de coorte prospectivo, longitudinal. Incluídos pacientes com PANSI acompanhados pela Disciplina de Otologia-Neurotologia de um hospital quaternário. As seguintes variáveis foram avaliadas e correlacionadas com a recuperação auditiva final: idade, gênero, vertigem, zumbido, grau de perda auditiva inicial, audição na orelha contralateral, tempo para início de tratamento. Resultado: Foram avaliados 127 pacientes com PANSI. As taxas de recuperação absoluta e relativa foram 23,6 dB e 37,2% respectivamente. Apresentaram melhora completa da audição 15,7% dos pacientes; 27,6% apresentaram melhora significativa e 57,5% melhora. Conclusão: No momento da instalação da PANSI, as seguintes variáveis correlacionaram-se com pior prognóstico: vertigem, perda auditiva profunda, audição alterada na orelha contralateral e demora para início do tratamento. Presença de zumbido na instalação da PANSI correlacionou-se com melhor prognóstico.

Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss.

INTRODUCTION: The establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice. OBJECTIVE: To establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery. METHODS: Prospective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment. RESULTS: 127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%. CONCLUSION: During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.

Intratemporal complications of otitis media.

UNLABELLED: Otitis media (OM) is considered a potentially severe disease due to the risk of complications. OBJECTIVE: To establish the annual incidence of intratemporal complications (ITC) resulting from OM and to prospectively assess patients for epidemiological and clinical factors. METHOD: This prospective cohort study included patients admitted during one year at a university hospital diagnosed with intratemporal complications of OM. Patients were analyzed for age, gender, type of intratemporal complication, treatment, and clinical outcome. The overall incidence of complications and the specific incidence rates of each type of complication were determined. RESULTS: 1,816 patients were diagnosed with OM; 592 (33%) had chronic OM; 1224 (67%) had acute OM. Fifteen patients were diagnosed with OM ITC, adding up to an annual incidence of 0.8%. Nineteen diagnoses of ITC were made in 15 patients. Seven (36.8%) patients were diagnosed with labyrinthine fistula, five (26.3%) with mastoiditis, four (21.1%) with peripheral facial palsy, and three (15.8%) with labyrinthitis. CONCLUSION: The incidence of intratemporal complications remains significant when compared to the rates seen in developed countries. Chronic cholesteatomatous otitis media is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

Complicações intratemporais das otites médias / Intratemporal complications of otitis media

Otite média (OM) é considerada doença potencialmente grave em razão dos riscos de complicações que podem ocorrer em sua evolução. OBJETIVO: Estabelecer a incidência anual de complicações intratemporais de OM e avaliar prospectivamente os pacientes por meio da análise dos aspectos epidemiológicos e clínicos. MÉTODO: Estudo de coorte contemporânea. Durante o período de um ano, os pacientes admitidos em um Hospital Universitário, com diagnóstico de OM e de complicação intratemporal (CIT) de OM foram incluídos no estudo. Os dados avaliados foram: idade, sexo, tipo de complicação intratemporal, tratamento e desfecho clínico. A incidência geral das complicações e de cada complicação foi determinada. RESULTADOS: 1.816 pacientes foram diagnosticados com OM. Em 592 (33%) indivíduos, o diagnóstico foi de otite média crônica; em 1224 (67%) o diagnóstico foi de otite média aguda. CIT de OM foi diagnosticada em 15 pacientes, perfazendo uma incidência anual de CIT 0,8%. Foram identificados 19 diagnósticos de CIT em 15 pacientes. Fístula labiríntica foi diagnosticada em sete (36,8%) indivíduos, mastoidite em cinco (26,3%), paralisia facial periférica em quatro (21,1%) e labirintite em três (15,8%). CONCLUSÃO: A incidência das complicações intratemporais permanece significativa quando comparada à de países desenvolvidos. A otite média crônica colesteatomatosa é a etiologia mais frequente das complicações intratemporais. A fístula labiríntica é a complicação intratemporal mais comum.

Otitis media (OM) is considered a potentially severe disease due to the risk of complications. OBJECTIVE: To establish the annual incidence of intratemporal complications (ITC) resulting from OM and to prospectively assess patients for epidemiological and clinical factors. METHOD: This prospective cohort study included patients admitted during one year at a university hospital diagnosed with intratemporal complications of OM. Patients were analyzed for age, gender, type of intratemporal complication, treatment, and clinical outcome. The overall incidence of complications and the specific incidence rates of each type of complication were determined. RESULTS: 1,816 patients were diagnosed with OM; 592 (33%) had chronic OM; 1224 (67%) had acute OM. Fifteen patients were diagnosed with OM ITC, adding up to an annual incidence of 0.8%. Nineteen diagnoses of ITC were made in 15 patients. Seven (36.8%) patients were diagnosed with labyrinthine fistula, five (26.3%) with mastoiditis, four (21.1%) with peripheral facial palsy, and three (15.8%) with labyrinthitis. CONCLUSION: The incidence of intratemporal complications remains significant when compared to the rates seen in developed countries. Chronic cholesteatomatous otitis media is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

Mastoiditis and facial paralysis as initial manifestations of Wegener's Granulomatosis.

UNLABELLED: Wegener's Granulomatosis (WG) is characterized by necrotizing granulomas and vasculitis. If left untreated, the prognosis is poor--a 90% mortality rate within 2 years. Several authors have described the otologic manifestations of WG; these authors, however, have not mentioned the stage of the disease in which these findings present--whether as initial manifestations or subsequent to other findings. AIM: To describe three confirmed cases of WG with mastoiditis as the first manifestation, progressing to peripheral facial paralysis (PFP). MATERIAL AND METHOD: A clinical series study. Patients diagnosed with WG that initially presented with otologic findings are described. RESULTS: The three cases presented with unilateral otalgia, otorrhea, and hearing loss associated with ipsilateral PFP. None recovered in spite of the treatment; an investigation of associated diseases was therefore undertaken. Positive ANCA-C titers where detected in all patients, confirming the diagnosis of WG. Clinical improvement was seen after treatment of WG; the PFP regressed and hearing thresholds improved partially. CONCLUSION: Complications of otitis media (mastoiditis and PFP) that do not respond to the usual treatment require an investigation of associated diseases; WG should be included for an early diagnosis to change the prognosis in these patients.

Mastoidite e paralisia facial como manifestações iniciais de Granulomatose de Wegener / Mastoiditis and facial paralysis as initial manifestations of Wegener's Granulomatosis

A Granulomatose de Wegener (GW) é caracterizada por granulomas necrotizantes e vasculite. Sem tratamento a doença tem prognóstico pobre com índice de mortalidade de 90% em 2 anos. Diversos autores citam as manifestações otológicas no curso da GW, entretanto não é especificado em que momento da doença elas apareceram, isto é, se como manifestação inicial ou subsequente a outros achados. Objetivo: Descrever três casos confirmados de GW que apresentaram inicialmente mastoidite e evoluíram com paralisia facial periférica (PFP). Material e Método: Estudo de série de casos. Pacientes diagnosticados com GW que apresentaram inicialmente manifestações otológicas são descritos. Resultados: Os três casos descritos abriram o quadro com otalgia, otorreia e hipoacusia unilateral, associada a paralisia facial periférica ipsilateral. Tiveram resposta inadequada aos tratamentos instituídos o que motivou uma investigação de outras doenças associadas. Nessas circunstâncias, detectaram-se títulos positivos de ANCA-C em todos pacientes, confirmando-se o diagnóstico de GW, após período variável de investigação. Institui-se o tratamento para GW observando-se melhora do quadro clínico, regressão da PFP e melhora parcial dos limiares auditivos. Conclusão: Complicações de otites médias agudas (mastoidite e PFP) refratárias as terapêuticas habituais impõem a investigação de doenças associadas e a GW deverá ser pesquisada para que se possa fazer o diagnóstico o mais precocemente possível, alterando desta forma o prognóstico destes pacientes.

Wegener's Granulomatosis (WG) is characterized by necrotizing granulomas and vasculitis. If left untreated, the prognosis is poor - a 90% mortality rate within 2 years. Several authors have described the otologic manifestations of WG; these authors, however, have not mentioned the stage of the disease in which these findings present - whether as initial manifestations or subsequent to other findings. Aim: To describe three confirmed cases of WG with mastoiditis as the first manifestation, progressing to peripheral facial paralysis (PFP). Material and Method: A clinical series study. Patients diagnosed with WG that initially presented with otologic findings are described. Results: The three cases presented with unilateral otalgia, otorrhea, and hearing loss associated with ipsilateral PFP. None recovered in spite of the treatment; an investigation of associated diseases was therefore undertaken. Positive ANCA-C titers where detected in all patients, confirming the diagnosis of WG. Clinical improvement was seen after treatment of WG; the PFP regressed and hearing thresholds improved partially. Conclusion: Complications of otitis media (mastoiditis and PFP) that do not respond to the usual treatment require an investigation of associated diseases; WG should be included for an early diagnosis to change the prognosis in these patients.

Abdominal wall healing in reoperated rats

PURPOSE: Experimental evaluation of the abdominal wall healing in reoperations on the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar. METHODS: Twenty-four rats were selected and divided in 3 groups (G1, G2 and G3). A medium longitudinal laparotomy was performed, followed by laparorrhaphy on two synthesis planes, using an interrupted suture technique. The reoperations were performed in the same way, on the same surgical site. On the first day of the study all the 24 rats were operated, on the 30th day the 16 animals belonging to G2 and G3 were reoperated, and finally, on the 60th day, the 8 rats from G3 were operated for the third and last time. After 30 days of the last laparotomy of each group, euthanasia was performed. Complications such as adhesions were evaluated during the resection of surgical site. The breaking strength study was performed next, followed by the microscopical collagen analysis, using for that histological cuts stained with picrosirius. RESULTS: The adhesions were prevalent in G2 and G3 (16 percent each) when compared to G1. No significant difference was found in the breaking strength study. Statistically significant difference was observed in collagen concentration analysis. It was found higher mature collagen (type I) as well as total collagen concentration in the groups operated more than once (G2 and G3). The highest concentration of mature collagen (p<0,0001) and total collagen (p<0,0021) were found in G3 followed by G2 and G1 (in this sequence). CONCLUSION: The highest mature collagen concentration on the experimental groups, points out the importance of inflammatory activity in the healing process; in the resutures of the abdominal wall the surgical scar maturity is faster acquired than in the primary sutures; in relation to the primary sutures, the resutures of the abdominal wall did not influence in the resistance of the surgical scar.

OBJETIVO: Avaliar experimentalmente o processo cicatricial da parede abdominal após reoperações realizadas com o mesmo acesso cirúrgico, por meio da análise macroscópica e do estudo das características histopatológicas e tensiométricas da cicatriz cirúrgica. MÉTODOS: Vinte e quatro ratos foram selecionados e divididos, igualmente, em três grupos (G1, G2 e G3). A laparotomia consistiu em uma incisão longitudinal mediana. Após obtido o acesso à cavidade abdominal, procedeu-se a síntese da ferida cirúrgica em dois planos através de sutura interrompida. As reoperações foram realizadas pelo mesmo acesso. No primeiro dia do experimento os 24 animais (G1, G2, G3) foram operados, no trigésimo dia 16 animais (G2, G3) foram reoperados e finalmente no sexagésimo dia os 8 animais do G3 foram operados pela terceira e última vez. Decorridos 30 dias da última laparotomia de cada grupo, foi procedida a eutanásia dos animais e ressecção da parede abdominal envolvida no acesso cirúrgico. Durante a ressecção foi realizada a avaliação macroscópica da ferida cirúrgica com avaliação de aderências e de outras possíveis complicações. A peça cirúrgica foi submetida ao estudo tensiométrico e em seguida foi preparada para o estudo histopatológico com lâminas coradas com picrosírius para quantificação e qualificação do colágeno. RESULTADOS: As aderências foram prevalentes nos grupos 2 (16 por cento) e 3 (16 por cento) quando comparadas com o grupo 1. Não houve diferença significante entre os grupos no estudo tensiométrico. O estudo histopatológico demonstrou diferença estatisticamente significativa nas concentrações de colágeno. Houve maior deposição de colágeno maduro (tipo I) e colágeno total nos grupos submetidos a mais de uma laparotomia (G2 e G3). Os animais do G3 apresentaram a maior concentração de colágeno maduro (p<0,0001) e colágeno total (p<0,0021), seguidos dos animais dos grupos 2 e 1 (nessa ordem). CONCLUSÃO: A maior concentração de colágeno maduro...

Abdominal wall healing in reoperated rats.

PURPOSE: Experimental evaluation of the abdominal wall healing in reoperations on the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar. METHODS: Twenty-four rats were selected and divided in 3 groups (G1, G2 and G3). A medium longitudinal laparotomy was performed, followed by laparorrhaphy on two synthesis planes, using an interrupted suture technique. The reoperations were performed in the same way, on the same surgical site. On the first day of the study all the 24 rats were operated, on the 30th day the 16 animals belonging to G2 and G3 were reoperated, and finally, on the 60th day, the 8 rats from G3 were operated for the third and last time. After 30 days of the last laparotomy of each group, euthanasia was performed. Complications such as adhesions were evaluated during the resection of surgical site. The breaking strength study was performed next, followed by the microscopical collagen analysis, using for that histological cuts stained with picrosirius. RESULTS: The adhesions were prevalent in G2 and G3 (16% each) when compared to G1. No significant difference was found in the breaking strength study. Statistically significant difference was observed in collagen concentration analysis. It was found higher mature collagen (type I) as well as total collagen concentration in the groups operated more than once (G2 and G3). The highest concentration of mature collagen (p<0,0001) and total collagen (p<0,0021) were found in G3 followed by G2 and G1 (in this sequence). CONCLUSION: The highest mature collagen concentration on the experimental groups, points out the importance of inflammatory activity in the healing process; in the resutures of the abdominal wall the surgical scar maturity is faster acquired than in the primary sutures; in relation to the primary sutures, the resutures of the abdominal wall did not influence in the resistance of the surgical scar.