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1.
Hernia ; 20(4): 517-25, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26860730

RESUMO

PURPOSE: Monitored anesthesia care with intravenous sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of oversedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes. METHODS: A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005-2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics. RESULTS: PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046). CONCLUSION AND RELEVANCE: UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.


Assuntos
Anestesia Geral , Sedação Consciente , Hérnia Umbilical/cirurgia , Herniorrafia , Monitorização Intraoperatória , Administração Intravenosa , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
5.
Rev Neurol ; 41 Suppl 3: S31-3, 2005 Oct 01.
Artigo em Espanhol | MEDLINE | ID: mdl-16299666

RESUMO

The temporal association between sleep-disordered breathing and the acute phase of cerebrovascular disease has been established. The question raised in this writing is about the clinic relevance of this association during the acute phase of stroke trying to answer questions like the relation with an excess of sleep-disordered breathing, with the characteristics of stroke and its influence in prognosis, either at short and long term.


Assuntos
Síndromes da Apneia do Sono , Acidente Vascular Cerebral
6.
Rev. neurol. (Ed. impr.) ; 41(supl.3): s31-s33, 1 oct., 2005. graf
Artigo em Espanhol | IBECS | ID: ibc-128467

RESUMO

La relación temporal entre los trastornos respiratorios del sueño y la enfermedad cerebrovascular en la fase aguda es un hecho probado. La cuestión que se plantea en el presente escrito es la relevancia clínica de esta asociación en la fase aguda del ictus, por lo que se intenta responder a cuestiones como la relación existente entre un exceso de trastornos respiratorios del sueño con las características del ictus o su influencia en el pronóstico, tanto a corto como a largo plazo (AU)


The temporal association between sleep-disordered breathing and the acute phase of cerebrovascular disease has been established. The question raised in this writing is about the clinic relevance of this association during the acute phase of stroke trying to answer questions like the relation with an excess of sleep-disordered breathing, with the characteristics of stroke and its influence in prognosis, either at short and long term (AU)


Assuntos
Humanos , Transtornos Respiratórios/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Apneia do Sono Tipo Central/fisiopatologia , Fatores de Risco
7.
Neurologia ; 20(6): 283-9, 2005.
Artigo em Espanhol | MEDLINE | ID: mdl-16007511

RESUMO

OBJECTIVE: To investigate the possible relation between the number of sleep breathing disorders (SBD) and significant extracranial carotid stenosis (ECS) in patients suffering ischemic stroke or transient ischemic attack (TIA). PATIENTS AND METHODS: Sixty-eight patients (72.2 years; 68 % males) surviving two months after ischemic stroke or TIA were studied, with the collection of general and anthropometric variables, the characteristics and repercussions of stroke, and the clinical manifestations related to sleep apnea-hypopnea syndrome (SAHS). Neurovascular status was evaluated by carotid continuous doppler flowmetry and transcraneal doppler, with cerebral MR-angio and/or arteriography when suspecting stenosis > 50 %, and respiratory polygraphy after the acute phase to assess the number and type of SBD. RESULTS: Fifteen patients (22.1 %) presented ECS. Of these, 80 % had an apnea-hypopnea index (AHI) > 30. The patients with ECS presented increased drowsiness (p = 0.01), greater AHI (36.2 vs 21.9; p = 0.003), and increased nocturnal oxygen desaturation (p = 0.01). Arterial hypertension (AHT) was also significantly more prevalent in this group of patients (p = 0.003), as was diabetes mellitus (p = 0.01) and hypercholesterolemia (p = 0.02) though logistic regression analysis only showed AHT (odds ratio [OR]: 12,7) and AHI > 30 (OR: 13,6) to exhibit independent ECS predictive capacity. CONCLUSIONS: The presence of numerous SBD is predictive of ECS, independently of the presence of AHT. Patients with ECS have more SAHS related clinical manifestations prior to stroke; as a result, SAHS could be anterior to the neurological event and act as a risk factor for the latter in this group of patients.


Assuntos
Estenose das Carótidas/fisiopatologia , Ataque Isquêmico Transitório/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Comorbidade , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polissonografia , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Acidente Vascular Cerebral/etiologia
8.
Rev Neurol ; 39(10): 929-31, 2004.
Artigo em Espanhol | MEDLINE | ID: mdl-15573308

RESUMO

INTRODUCTION: Transient global amnesia (TGA) is defined as a selective, or almost selective, deficit of the memory that appears suddenly and lasts less than 24 hours. The aetiopathogenesis of this syndrome remains unknown and different theories have been put forward about its epileptic or ischemic origin, or the relationship that exists with the neuronal depression that is produced in migraine. A number of triggering factors have been described, including the taking of distinct pharmaceutical preparations. CASE REPORT: We report the cases of two patients with a history of migraines who suffered TGA after taking ergotamine and dihydroergotamine, respectively, to treat an attack of migraine. CONCLUSIONS: Given the vasoconstriction effect of these drugs, it was concluded that in both cases the main factor that triggered the TGA was the ingestion of ergots.


Assuntos
Amnésia Global Transitória/induzido quimicamente , Di-Hidroergotamina/efeitos adversos , Ergotamina/efeitos adversos , Transtornos de Enxaqueca/tratamento farmacológico , Vasoconstritores/efeitos adversos , Idoso , Di-Hidroergotamina/uso terapêutico , Ergotamina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Vasoconstritores/uso terapêutico
9.
Eur Rev Med Pharmacol Sci ; 7(2): 57-64, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12911120

RESUMO

Urinary tract infections are often associated with urinary anomalies. An appropriate pharmacologic treatment may prevent, or may at least limit, any kidney damage due to pyelonephritis. The antibiotic prophylaxis plays a role as significant as early surgical therapy, taking into consideration also the present limitative trend for a softer therapeutic regimen. In the past few years a greater bacterial resistance has emerged against some commonly administered antibiotics. Cefixime (3rd generation cephalosporin) has been used on a wide series of patients suffering from urinary infections associated with urinary tract anomalies. A few significative results emerge from the present study. In conclusion, cefixime's effectiveness long-term prophylaxis of urinary infections associated with anomalies.


Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Cefixima/uso terapêutico , Infecções Urinárias/prevenção & controle , Anormalidades Urogenitais/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções Urinárias/etiologia , Anormalidades Urogenitais/complicações
12.
Plast Reconstr Surg ; 107(3): 668-75, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11304590

RESUMO

The authors present a cohort of 21 consecutive patients who had congenital pigmented nevi covering 15 to 65 percent of the forehead and adjacent scalp and who were treated at their institution within the last 12 years. All patients were treated with an expansion of the adjacent texture- and color-matched skin as the primary modality of treatment. The median age at presentation was approximately 1 year; mean postoperative follow-up was 4 years. Nevi were classified according to the predominant anatomic areas they occupied (temporal, hemiforehead, and midforehead/central); some of the lesions involved more than one aesthetic subunit. The authors propose the following guidelines: (1) Midforehead nevi are best treated using an expansion of bilateral normal forehead segments and advancement of the flaps medially, with scars placed along the brow and at or posterior to the hairline. (2) Hemiforehead nevi often require serial expansion of the uninvolved half of the forehead to minimize the need for a back-cut to release the advancing flap. (3) Nevi of the supraorbital and temporal forehead are preferentially treated with a transposition of a portion of the expanded normal skin medial to the nevus. (4) When the temporal scalp is minimally involved with nevus, the parietal scalp can be expanded and advanced to create the new hairline. When the temporoparietal scalp is also involved with nevus, a transposition flap (actually a combined advancement and transposition flap because the base of the pedicle moves forward as well) provides the optimal hair direction for the temporal hairline and allows significantly greater movement of the expanded flap, thereby minimizing the need for serial expansion. (5) Once the brow is significantly elevated on either the ipsilateral or contralateral side from the reconstruction, it can only be returned to the preoperative position with the interposition of additional, non-hair-bearing forehead skin. Expansion of the deficient area alone will not reliably lower the brow once a skin deficiency exists. (6) In general, one should always use the largest expander possible beneath the uninvolved forehead skin, occasionally even carrying the expander under the lesion. Expanders are often overexpanded.


Assuntos
Neoplasias Faciais/cirurgia , Nevo Pigmentado/cirurgia , Neoplasias Cutâneas/cirurgia , Expansão de Tecido , Neoplasias Faciais/congênito , Seguimentos , Testa , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Lactente , Nevo Pigmentado/congênito , Complicações Pós-Operatórias , Couro Cabeludo , Neoplasias Cutâneas/congênito , Retalhos Cirúrgicos , Expansão de Tecido/efeitos adversos , Expansão de Tecido/métodos
13.
Br J Plast Surg ; 53(6): 484-7, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10927677

RESUMO

Groin lymphorrhea is an uncommon but serious complication of vascular and cardiac surgery as well as interventional procedures that cannulate the femoral vessels. Treatment options are somewhat controversial. For lymphocutaneous fistulas, a commonly used current modality is early surgical ligation with the assistance of blue-dye staining of the lymphatic anatomy. The purpose of this case series is to give the first description of a new, less invasive, approach using subatmospheric pressure dressing therapy for the treatment of the challenging problem of lymphocutaneous fistulas of the groin.


Assuntos
Bandagens , Fístula Cutânea/cirurgia , Fístula/cirurgia , Doenças Linfáticas/cirurgia , Modalidades de Fisioterapia/métodos , Idoso , Fístula Cutânea/reabilitação , Feminino , Virilha , Humanos , Doenças Linfáticas/reabilitação , Pessoa de Meia-Idade , Pressão , Sucção , Resultado do Tratamento
14.
Rev Neurol ; 30(5): 409-11, 2000.
Artigo em Espanhol | MEDLINE | ID: mdl-10775963

RESUMO

INTRODUCTION: Hemichorea is uncommon in acute cerebrovascular accidents. Its appearance is in relation to the contralateral involvement of the basal ganglia, particularly the striate ganglion. With current neuroimaging techniques it is possible to identify the lesions responsible for these abnormal movements. Magnetic resonance (MR) is the technique of choice for detection of small sized lesions. OBJECTIVE: We have analysed our series of patients to try to relate the site of the lesion to the appearance of chorea. PATIENTS AND METHODS: We made a retrospective study of the cases of hemichorea of vascular origin admitted between January 1993 and April 1999. In all cases, cerebral CAT and/or MR had been done to find the site of the lesion. RESULTS: A total of 10 patients with an average age of 72.5 years (range: 55-85) was found. In eight of them (80%) lesions were found in the basal ganglia, half of which were of ischemic type and the other half hemorrhagic. The sites were: caudate nucleus in one case (10%), thalamus in two cases (20%) and capsulo-lenticular lesions in five cases (50%). All lesions were contralateral to the side of the body affected except in one case with a left thalamic haematoma and homolateral hemichorea. CONCLUSIONS: The lesions found were very varied in site. In 20% of the cases they were not detected by conventional neuroimaging techniques. This fact supports the concept of a functional global network of the basal ganglia which may be interrupted at several points and lead to the same clinical findings.


Assuntos
Hemorragia dos Gânglios da Base/complicações , Isquemia Encefálica/complicações , Coreia/etiologia , Idoso , Idoso de 80 Anos ou mais , Hemorragia dos Gânglios da Base/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Isquemia Encefálica/diagnóstico , Coreia/diagnóstico , Feminino , Lateralidade Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
15.
Rev. neurol. (Ed. impr.) ; 30(5): 409-411, 1 mar., 2000. tab
Artigo em Espanhol | IBECS | ID: ibc-128543

RESUMO

Introducción. La hemicorea es poco frecuente en el accidente cerebrovascular agudo, estando su aparición relacionada con la afectación contralateral de los ganglios basales, sobre todo del estriado. Las actuales técnicas de neuroimagen son capaces de identificar lesiones a las cuales se responsabiliza de estos movimientos anormales, siendo la RM la técnica de elección para la detección de las de pequeño tamaño. Objetivo. Hemos analizado nuestra serie para intentar relacionar en nuestros pacientes la localización de la lesión con la aparición de corea. Pacientes y métodos. Se han recogido de forma retrospectiva los casos de hemicorea de origen vascular ingresados entre enero de 1993 y abril de 1999. En todos ellos se había realizado TAC y/o RM cerebral para localizar la lesión. Resultados. Se han obtenido un total de 10 pacientes con edad media de 72,5 años (intervalo: 55-85). En ocho de ellos (80%) se encontró lesiones en los ganglios basales, la mitad de tipo isquémico y la otra mitad hemorrágico. Las localizaciones fueron: núcleo caudado en un caso (10%), tálamo en dos casos (20%) y lesiones cápsulo-lenticulares en cinco casos (50%). Todas las lesiones fueron contralaterales al hemicuerpo afecto salvo en un caso con hematoma talámico izquierdo y hemicorea homolateral. Conclusiones. Las lesiones halladas tienen gran variabilidad en su localización, y en el 20% de los casos no fueron detectadas con los métodos de neuroimagen convencionales. Este hecho apoyaría el concepto de red funcional global de los ganglios basales que puede ser interrumpida en varios puntos y originar la misma clínica (AU)


Introduction. Hemichorea is uncommon in acute cerebrovascular accidents. Its appearance is in relation to the contralateral involvement of the basal ganglia, particularly the striate ganglion. With current neuroimaging techniques it is possible to identify the lesions responsible for these abnormal movements. Magnetic resonance (MR) is the technique of choice for detection of small sized lesions. Objective. We have analysed our series of patients to try to relate the site of the lesion to the appearance of chorea. Patients and methods. We made a retrospective study of the cases of hemichorea of vascular origin admitted between January 1993 and April 1999. In all cases, cerebral CAT and/or MR had been done to find the site of the lesion. Results. A total of 10 patients with an average age of 72.5 years (range: 55-85) was found. In eight of them (80%) lesions were found in the basal ganglia, half of which were of ischemic type and the other half hemorrhagic. The sites were: caudate nucleus in one case (10%), thalamus in two cases (20%) and capsulo-lenticular lesions in five cases (50%). All lesions were contralateral to the side of the body affected except in one case with a left thalamic haematoma and homolateral hemichorea. Conclusions. The lesions found were very varied in site. In 20% of the cases they were not detected by conventional neuroimaging techniques. This fact supports the concept of a functional global network of the basal ganglia which may be interrupted at several points and lead to the same clinical findings (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hemorragia dos Gânglios da Base/complicações , Hemorragia dos Gânglios da Base/diagnóstico , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Coreia/diagnóstico , Coreia/etiologia , Cérebro/patologia , Cérebro , Lateralidade Funcional , Imagem por Ressonância Magnética , Fatores de Risco , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
17.
J Surg Res ; 72(2): 162-9, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9356238

RESUMO

Macrophage colony-stimulating factor (M-CSF) is produced by many cell types involved in wound repair, yet it acts specifically on monocytes and macrophages. The monocyte-derived cell is thought to be important in wound healing, but the importance of the role of tissue macrophages in wound healing has not been well defined. Dermal ulcers were created in normal and ischemic ears of young rabbits. Either rhM-CSF (17 microg/wound) or buffer was applied to each wound. Wounds were bisected and analyzed histologically at Days 7 and 10 postwounding. The amounts of epithelial growth and granulation tissue deposition were measured in all wounds. The level of increase of TGF-beta1 mRNA level in M-CSF-treated wounds was examined using competitive RT-PCR. M-CSF increased new granulation tissue formation by 37% (N = 21, P < 0.01) and 50% (P < 0.01) after single and multiple treatments, respectively, in nonischemic wounds. TGF-beta1 mRNA levels in rhM-CSF-treated wounds increased 5.01-fold (N = 8) over vehicle-treated wounds under nonischemic conditions. In contrast, no effect could be detected in ischemic wounds treated with rhM-CSF, and these wounds only showed a 1.66-fold increase in TGF-beta1 mRNA levels when compared to ischemic wounds treated with vehicle alone. GAPDH, a housekeeping gene, showed no change. As mesenchymal cells lack receptors for M-CSF, the improved healing of wounds treated with topical rhM-CSF must reflect a generalized enhancement of activation and function of tissue macrophages, as demonstrated by upregulation of TGF-beta. The lack of effect under ischemic conditions suggests that either macrophage activity and/or response to M-CSF is adversely affected under those conditions; this may suggest the pathogenesis of impaired wound healing at the cellular level.


Assuntos
Fator Estimulador de Colônias de Macrófagos/fisiologia , Macrófagos/metabolismo , RNA Mensageiro/metabolismo , Fator de Crescimento Transformador beta/genética , Regulação para Cima/fisiologia , Cicatrização/fisiologia , Animais , Sequência de Bases , Primers do DNA/análise , Primers do DNA/química , Primers do DNA/genética , Relação Dose-Resposta a Droga , Feminino , Gliceraldeído-3-Fosfato Desidrogenases/genética , Isquemia/metabolismo , Isquemia/patologia , Isquemia/fisiopatologia , Fator Estimulador de Colônias de Macrófagos/farmacologia , Macrófagos/química , Macrófagos/efeitos dos fármacos , Monócitos/química , Monócitos/efeitos dos fármacos , Monócitos/metabolismo , Reação em Cadeia da Polimerase , RNA Mensageiro/análise , RNA Mensageiro/fisiologia , Coelhos , Proteínas Recombinantes/farmacologia , Pele/irrigação sanguínea , Úlcera Cutânea/metabolismo , Úlcera Cutânea/patologia , Úlcera Cutânea/fisiopatologia , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/genética , Cicatrização/efeitos dos fármacos
18.
J Clin Invest ; 98(11): 2462-8, 1996 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-8958208

RESUMO

We have determined previously that IGF-I is dependent on the presence of IGF binding protein-1 (IGFBP-1) to act as a wound healing agent. We sought to determine the mechanism whereby IGFBP-1 is able to enhance IGF-I bioactivity. As IGFBP-1 binds both the alpha5beta1 integrin as well as IGF-I in vitro, we asked which of the following interactions were important: (a) the ability of IGFBP-1 to interact with an integrin receptor, and/or (b) the binding of IGF-I by IGFBP-1. We used an IGF-1 analogue (des(1-3)IGF-I) with a > 100-fold reduction in affinity for IGFBP-1 as well as an IGFBP-1 mutant (WGD-IGFBP-1) which does not associate with the alpha5beta1 integrin to selectively abrogate each of these interactions. We also tested the ability of IGFBP-2, a related binding protein which has an arginine-glycine-aspartate sequence but does not associate with integrin family members, to enhance IGF-I bioactivity. Full-thickness dermal wounds were created on rabbit ears; various combinations of native IGF-I, native IGFBP-1, native IGFBP-2, and their respective analogues/mutants were applied to each wound. Wounds were harvested 7 d later for analysis. Only native IGF-I in combination with native IGFBP-1 was effective as a wound healing agent, enhancing reepithelialization and granulation tissue deposition by 64+/-5 and 83+/-12% over controls (P = 0.008 and 0.016, respectively). The same doses of IGF-I/WGD-IGFBP-1, des(1-3)IGF-I/IGFBP-1, and IGF-I/IGFBP-2 were ineffective. We propose that IGF-I physically interacts with IGFBP-1 and that IGFBP-1 also binds to an integrin receptor, most likely the alpha5beta1 integrin. This interaction is unique to IGFBP-1 as the closely related IGFBP-2 had no effect, a finding consistent with its inability to bind to integrin receptors. Our results suggest that activation of both the IGF-I receptor and the alpha5beta1 integrin is required for IGF-I to stimulate wound healing.


Assuntos
Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/farmacologia , Fator de Crescimento Insulin-Like I/farmacologia , Úlcera Cutânea/fisiopatologia , Cicatrização/efeitos dos fármacos , Animais , Arginina , Células CHO , Colágeno/biossíntese , Cricetinae , Interações Medicamentosas , Matriz Extracelular/efeitos dos fármacos , Matriz Extracelular/patologia , Matriz Extracelular/fisiologia , Proteínas da Matriz Extracelular/biossíntese , Glicosaminoglicanos/biossíntese , Humanos , Proteína 2 de Ligação a Fator de Crescimento Semelhante à Insulina/farmacologia , Mutagênese Sítio-Dirigida , Oligopeptídeos , Mutação Puntual , Coelhos , Proteínas Recombinantes/farmacologia , Úlcera Cutânea/patologia , Transfecção , Triptofano , Cicatrização/fisiologia
19.
Arch Surg ; 131(6): 660-6, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8645076

RESUMO

BACKGROUND: Keratinocyte growth factor acts specifically on epithelial cells and is presumed to play an important role in tissue repair. OBJECTIVE: To examine the wound-healing effects of keratinocyte growth factor under hypoxic conditions in vivo and in vitro. DESIGN AND INTERVENTIONS: Dermal ulcers were created in the ischemic ears of 40 anesthetized young female rabbits. Either recombinant keratinocyte growth factor (rKGF) or buffer was applied to each wound. Wounds were bisected and analyzed histologically at days 7 and 10 after wounds were created. For the in vitro study, normal keratinocytes were treated with rKGF (20 ng/mL) and cultured under hypoxic (3.5% oxygen) conditions. The conditioned media were collected at 48 and 72 hours. MAIN OUTCOME MEASUREMENTS: The amount of epithelial growth and deposition of granulation tissue were measured in all wounds. The amount of transforming growth factor alpha in keratinocyte-conditioned media was measured by using a sensitive radioimmunoassay. A proliferation assay of dermal fibroblasts, treated with conditioned media, was also performed under 3.5% oxygen culture conditions. RESULTS: The rKGF (range, 5-40 micrograms per wound) that was applied significantly increased new epithelium by greater than 70% (P = .03) at days 7 and 10 after wounds were created. A significant increase in new granulation tissue formation (170%) was also observed in rKGF-treated wounds at day 10, at a dose of 40 micrograms per wound (P < .002). The amount of transforming growth factor alpha protein in the conditioned media that were treated with rKGF (20 ng/mL) increased by 26.8% and 171% at 48 and 72 hours, respectively, over that of controls. The conditioned media from rKGF-treated keratinocytes, grown for 72 hours, resulted in a 51% increase in the proliferation of primary rabbit dermal fibroblasts. CONCLUSION: Keratinocyte growth factor enhances the wound-healing process of ischemic ulcers, indicating that epithelial-mesenchymal cell interactions are critical for the healing of wounds under ischemic conditions and possibly under normal conditions as well.


Assuntos
Fatores de Crescimento de Fibroblastos , Tecido de Granulação , Substâncias de Crescimento/farmacologia , Queratinócitos/efeitos dos fármacos , Úlcera Cutânea/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Animais , Divisão Celular , Células Cultivadas , Meios de Cultura , Células Epiteliais , Feminino , Fator 10 de Crescimento de Fibroblastos , Fator 7 de Crescimento de Fibroblastos , Fibroblastos/citologia , Substâncias de Crescimento/uso terapêutico , Isquemia , Mesoderma/citologia , Coelhos , Radioimunoensaio , Fator de Crescimento Transformador alfa/análise
20.
Ann Plast Surg ; 36(6): 608-14; discussion 614-5, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8792970

RESUMO

We have previously demonstrated in a rat surgical incision model that charged dextran beads enhance wound repair in a charge-specific manner: positively charged beads increased wound breaking strength (WBS), whereas neutral or negatively charged beads were ineffective. The present work extends these observations into two models of radiation-impaired healing. One hundred five rats were divided into three groups: group 1, controls, no irradiation; group 2, total body irradiation; group 3, surface irradiation. Three days after irradiation, 0.1 ml of a suspension of either positively charged beads, neutral beads, or vehicle alone was applied to paired 6-cm incisions on the dorsum of the rats. Ten days later, wounds were excised and sample strips were harvested for determination of WBS and for histological analysis. Following total body irradiation, positively charged beads enhanced WBS 84% compared to beadless controls. When results with positively charged beads were compared to those with neutral beads, a 39% increase in WBS was noted. Healing, as measured by WBS, was more impaired in surface-irradiated animals, but when results with positively charged beads were compared with those obtained with neutral beads, a similar degree of healing (+38%) was noted. Neutral beads proved ineffective. Histology revealed that neutral beads evoked a modest foreign body response, yet there was a consistently greater clustering of giant cells around positively charged beads in wound sites. This paralleled in vitro experiments demonstrating increased monocyte aggregation around positively charged beads in tissue culture. The results suggest that positively charged ion exchangers, such as these positively charged beads, perhaps through their recruitment and/or activation of wound macrophages, may have a potential clinical role in the treatment of impaired wounds.


Assuntos
Troca Iônica , Lesões Experimentais por Radiação/terapia , Cicatrização , Animais , Agregação Celular , Monócitos , Ratos , Ratos Sprague-Dawley
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