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1.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372017

RESUMO

Perineal hernia with bowel gangrene is uncommon but known complication of laparoscopic extralevator abdominoperineal excision (ELAPE). We present a rare case of closed loop small bowel obstruction with bowel gangrene secondary to an incarcerated perineal hernia that developed 7 years after an ELAPE. Intraoperatively, we found a definitive transition point due to adhesions in pelvis and a closed loop obstruction of the distal small bowel at different site with gangrenous intestine. She was managed successfully surgically with adhesiolysis and fixation of defect with biological mesh. Prevalence of perineal hernias will rise in future because of the increasing cases of ELAPE, in which no repair of pelvic floor is performed. The need of follow-up of these operations and more reporting of such cases are important in increasing awareness of these complications. Patients should be made aware of such complications and should seek urgent medical care.


Assuntos
Hérnia/complicações , Obstrução Intestinal/etiologia , Laparoscopia/efeitos adversos , Períneo , Protectomia/efeitos adversos , Aderências Teciduais/etiologia , Idoso de 80 Anos ou mais , Colostomia , Feminino , Gangrena/complicações , Gangrena/cirurgia , Humanos , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Telas Cirúrgicas , Fatores de Tempo , Aderências Teciduais/patologia , Aderências Teciduais/cirurgia
2.
Nat Commun ; 11(1): 4061, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792541

RESUMO

Adhesions are fibrotic scars that form between abdominal organs following surgery or infection, and may cause bowel obstruction, chronic pain, or infertility. Our understanding of adhesion biology is limited, which explains the paucity of anti-adhesion treatments. Here we present a systematic analysis of mouse and human adhesion tissues. First, we show that adhesions derive primarily from the visceral peritoneum, consistent with our clinical experience that adhesions form primarily following laparotomy rather than laparoscopy. Second, adhesions are formed by poly-clonal proliferating tissue-resident fibroblasts. Third, using single cell RNA-sequencing, we identify heterogeneity among adhesion fibroblasts, which is more pronounced at early timepoints. Fourth, JUN promotes adhesion formation and results in upregulation of PDGFRA expression. With JUN suppression, adhesion formation is diminished. Our findings support JUN as a therapeutic target to prevent adhesions. An anti-JUN therapy that could be applied intra-operatively to prevent adhesion formation could dramatically improve the lives of surgical patients.


Assuntos
Aderências Teciduais/metabolismo , Aderências Teciduais/patologia , Animais , Benzofenonas/farmacologia , Sistemas CRISPR-Cas , Células Cultivadas , Doxiciclina/farmacologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Imunofluorescência , Gastroenteropatias/metabolismo , Gastroenteropatias/patologia , Humanos , Imuno-Histoquímica , Isoxazóis/farmacologia , Lipossomos/metabolismo , Camundongos , Células NIH 3T3 , Parabiose , RNA Mensageiro/metabolismo , Tamoxifeno/farmacologia
3.
Medicine (Baltimore) ; 99(29): e21103, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702858

RESUMO

RATIONALE: Lymphadenectomy for tongue cancer in the neck region is often accompanied by local impaired mobility, gland damage, difficult in swallowing, and postoperative complication and seriously affects patients life quality. We reported a case of subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy for tongue lesions accompanied by impaired neck mobility and difficult in swallowing was treated using Fu's subcutaneous needling (FSN) treatment. PATIENT CONCERNS: A 55-year-old male with tongue cancer received surgical intervention with lymphadenectomy 8 years ago was revealed a 15 cm-long curved surgical incision in the neck region and surrounded by numerous scar tissues. DIAGNOSIS: Post-operation subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy was diagnosed. INTERVENTIONS: FSN treatment was performed 2 to 3 times per week for 1 month to sway the affected tightened muscle and dissociate the superficial fascia beneath the scar resulted in a considerable improvement in neck movement. OUTCOMES: The Vancouver Scar Scale (VSS) was as follows: color (M) - 1; vascular distribution (V) - 0, thickness (H) - 2, and flexibility (P) - 4, with a total of 7 points before FSN treatment. The VSS after 1 month of FSN treatment was as follows: M1, V0, H2, and P2, with a total of 5 points. Neck mobility in different directions, i.e., stretching to the back of the neck and laterally bending the neck to the left and/or right side, was improved (P < .05). LESSONS: At present, treatment of chronic scar hyperplasia has certain side effects and limitations. FSN is safe and convenient, with minimal destruction of the superficial fascia, having evident effects of dissociating tissue adhesion under scars and compensating for deficiencies in scar hyperplasia treatment. It can provide new ideas for future treatments.


Assuntos
Hiperplasia/terapia , Pescoço/anormalidades , Tela Subcutânea/anormalidades , Aderências Teciduais/terapia , Humanos , Hiperplasia/patologia , Hiperplasia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pescoço/fisiopatologia , Tela Subcutânea/patologia , Tela Subcutânea/fisiopatologia , Aderências Teciduais/patologia , Aderências Teciduais/fisiopatologia , Neoplasias da Língua/complicações , Neoplasias da Língua/fisiopatologia , Neoplasias da Língua/cirurgia
4.
Surg Today ; 50(9): 1091-1098, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32239305

RESUMO

PURPOSE: A novel pharmacological mechanism of valproate was analyzed using a hamster model of adhesion. METHODS: Valproate or placebo was administered just after cecal injury and adhesion severity scores and histological were analyzed. RESULTS: The adhesion severity scores in the placebo- and valproate-treated groups were 2.67 ± 0.42 and 1.0 ± 0.37, respectively, with a significant difference between the groups. A significant increase in mast cell numbers was observed in the placebo-treated group vs. the sham-operated group; however, the mast cell number in the adhesive lesion was significantly lower in the valproate-treated group than in the placebo-treated group. The number of cells positive for chymase, an enzyme in mast cells, in the adhesive lesion was significantly higher in the placebo-treated group, but its increase was attenuated significantly by treatment with valproate. The myeloperoxidase gene expression level in the cecum was significantly higher in the placebo-treated group than in the sham-operated group, but there was no significant difference in the myeloperoxidase gene expression level between the sham-operated and valproate-treated groups in. In an in vitro experiment, valproate inhibited purified human and hamster chymases dose-dependently. CONCLUSION: The chymase inhibitory effect of valproate may contribute to prevent adhesion formation after abdominal injury.


Assuntos
Ceco/lesões , Mastócitos/patologia , Doenças Peritoneais/patologia , Doenças Peritoneais/prevenção & controle , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle , Ácido Valproico/administração & dosagem , Ácido Valproico/farmacologia , Animais , Ceco/metabolismo , Contagem de Células , Células Cultivadas , Quimases/metabolismo , Cricetinae , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Mastócitos/enzimologia , Doenças Peritoneais/etiologia , Peroxidase/genética , Peroxidase/metabolismo , Índice de Gravidade de Doença , Aderências Teciduais/etiologia
5.
Khirurgiia (Mosk) ; (3): 29-34, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271734

RESUMO

OBJECTIVE: Experimental assessment of the effect of modified and unmodified surgical suture material on abdominal adhesive process. MATERIAL AND METHODS: The study was performed on male rats of the Wistar subpopulation. There were 5 animals in each group. In all animals, midline abdominal incision was followed by suturing the parietal peritoneum with modified and unmodified suture material. All animals were euthanized with carbon dioxide vapors in 14 days after surgery. Macro- and microscopic assessment of severity of abdominal adhesive process was carried out. Two types of preparation of excised complexes 'peritoneum-suture material-adhesion' were applied for histological examination: paraffin sections and embedding in epoxy resin. Specimens were stained by Van Gieson and with methylene blue solution. Histological specimens were examined using Axio Imager A1 light microscope (Zeiss, Germany). RESULTS: Polypropylene filaments result extensive adhesions occupying about 75% of the area. Adhesions have a dense structure with signs of vascularization. Modification of suture material with solution of polyhydroxybutyrate/hydroxyvalerate and heparin reduce severity of adhesions. The use of modified suture material was followed by adhesions with more loose structure, no signs of vascularization. Adhesions occupied less than 25% of the area. Histological examination of excised complexes 'peritoneum-suture material-adhesion' revealed accumulation of inflammatory cells around the unmodified suture material, while there were no signs of tissue inflammatory process around the modified sutures. CONCLUSION: Application of polyhydroxybutyrate/hydroxyvalerate and heparin on the surface of surgical sutures is an effective method for prevention of abdominal adhesions.


Assuntos
Materiais Biocompatíveis/efeitos adversos , Heparina/administração & dosagem , Poliésteres/administração & dosagem , Polipropilenos/efeitos adversos , Suturas/efeitos adversos , Aderências Teciduais/prevenção & controle , Animais , Materiais Biocompatíveis/administração & dosagem , Materiais Revestidos Biocompatíveis/administração & dosagem , Materiais Revestidos Biocompatíveis/efeitos adversos , Modelos Animais de Doenças , Heparina/efeitos adversos , Masculino , Neovascularização Patológica/etiologia , Neovascularização Patológica/prevenção & controle , Peritônio/irrigação sanguínea , Peritônio/patologia , Peritônio/cirurgia , Poliésteres/efeitos adversos , Polipropilenos/administração & dosagem , Ratos , Ratos Wistar , Aderências Teciduais/etiologia , Aderências Teciduais/patologia
6.
J Surg Res ; 251: 152-158, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32145558

RESUMO

BACKGROUND: Adhesion formation is a common complication of abdominal surgeries. Mesna is a drug with fibrinolytic properties which has been used in surgical field to facilitate tissue dissection. The aim of this experimental animal study was to investigate the effect of mesna on prevention of intra-abdominal adhesion in rats. MATERIALS AND METHODS: Twenty-eight Wistar albino rats were used in the study. To create abdominal adhesion, cecum was abraded in all rats. No additional surgical procedure was performed other than adhesion in group 1 (only adhesion). In the other groups, rats were treated topically by administering 0.9% saline (group 2), 40 mg/kg mesna (group 3), and 400 mg/kg mesna (group 4). All rats were sacrificed on postoperative 21st day. Histopathological and macroscopic evaluations of adhesion formation were performed. RESULTS: Quantity of adhesion scores (P = 0.022), severity of adhesion scores (P = 0.041), total adhesion scores (P = 0.023), and histopathological adhesion grading scores (P < 0.001) were reduced by 400 mg/kg mesna. CONCLUSIONS: This is the first study for mesna on prevention of abdominal adhesion formation in rats. We concluded that dose-dependent reduction of adhesion was achieved by mesna. With future studies, topical administration of mesna during open abdominal surgeries may be used to prevent adhesion formation.


Assuntos
Mesna/administração & dosagem , Substâncias Protetoras/administração & dosagem , Aderências Teciduais/prevenção & controle , Abdome/patologia , Animais , Avaliação Pré-Clínica de Medicamentos , Ratos Wistar , Aderências Teciduais/patologia
8.
J Surg Res ; 249: 216-224, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32001387

RESUMO

Pericardium closure after cardiac surgery is recommended to prevent postoperative adhesions to the sternum. Synthetic materials have been used as substitutes, with limited results because of impaired remodeling and fibrotic tissue formation. Urinary bladder matrix (UBM) scaffolds promote constructive remodeling that more closely resemble the native tissue. The aim of the study is to evaluate the host response to UBM scaffolds in a porcine model of partial pericardial resection. Twelve Landrace pigs were subjected to a median sternotomy. A 5 × 7 cm pericardial defect was created and then closed with a 5 × 7 cm multilayer UBM patch (UBM group) or left as an open defect (control group). Animals were survived for 8 wk. End points included gross morphology, biomechanical testing, histology with semiquantitative score, and cardiac function. The UBM group showed mild adhesions, whereas the control group showed fibrosis at the repair site, with robust adhesions and injury to the coronary bed. Load at failure (gr) and stiffness (gr/mm) were lower in the UBM group compared with the native pericardium (199.9 ± 59.2 versus 405.3 ± 99.89 g, P = 0.0536 and 44.23 ± 15.01 versus 146.5 ± 24.38 g/mm, P = 0.0025, respectively). In the UBM group, the histology resembled native pericardial tissue, with neovascularization, neofibroblasts, and little inflammatory signs. In contrast, control group showed fibrotic tissue with mononuclear infiltrates and a lack of organized collagen fibers validated with a histologic score. Both groups had normal ultrasonography results without cardiac motility disorders. In this setting, UBM scaffolds showed appropriate features for pericardial repair, restoring tissue properties that could help reduce postsurgical adhesions and prevent its associated complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pericárdio/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Tecidos Suporte , Animais , Procedimentos Cirúrgicos Cardíacos/métodos , Modelos Animais de Doenças , Matriz Extracelular , Feminino , Humanos , Pericárdio/patologia , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Sus scrofa , Aderências Teciduais/etiologia , Aderências Teciduais/patologia , Bexiga Urinária/citologia
9.
Neurochirurgie ; 66(1): 53-55, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31953073

RESUMO

INTRODUCTION: Tumors of the spinal cord are rare and some can be confused with each other. We report a rare spinal cord solitary fibrous tumor/hemangiopericytoma (SFT/HPC), and propose keys to differentiate spinal cord tumors from each other. CASE REPORT: A 67-year-old man presented weakness with recent diffuse sensory disorders in the right lower limb. Spinal MRI revealed a T8-T9 intradural extramedullary mass with spinal cord compression. Gross total resection of a poorly vascularized intradural tumor was achieved. It was an encapsulated extramedullary tumor, which was difficult to separate from the spinal cord due to the presence of pial adhesions. Definitive diagnosis was grade 1 SFT/HPC of the spinal cord. One-year follow-up MRI revealed complete excision without any evidence of residual tumor. CONCLUSION: SFT/HPC is a very rare spinal tumor that can be extramedullary, intramedullary or both. It may perfectly mimic meningioma. The maximal resection is the best treatment, but can be challenging because of the tumor's firm consistency and pial adherences to the spinal cord. Outcome is good in case of gross total resection, but there is a risk of very late recurrence, requiring long-term follow-up.


Assuntos
Hemangiopericitoma/diagnóstico , Neoplasias da Medula Espinal/diagnóstico , Idoso , Diagnóstico Diferencial , Hemangiopericitoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Debilidade Muscular/etiologia , Procedimentos Neurocirúrgicos , Pia-Máter/diagnóstico por imagem , Pia-Máter/patologia , Transtornos das Sensações/etiologia , Tumores Fibrosos Solitários/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/patologia , Resultado do Tratamento
10.
J Clin Neurosci ; 72: 378-385, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31948884

RESUMO

INTRODUCTION: Spinal laminectomy is a common procedure performed to relieve neural compression in patients suffering from myelopathy or radiculopathy. However, up to 40% of patients suffer from persistent post-operative pain and disability, a condition known as Failed Back Surgery Syndrome (FBSS). Excessive scarring in the surgical bed is implicated as a cause. Hydrogels have been proposed to prevent adhesion formation post-laminectomy; however, their efficacy has not been proven. This study uses Chitogel complexed with the iron chelator Deferiprone (Def) to prevent adhesion formation in a sheep laminectomy model. MATERIAL & METHODS: Fifteen Adult Merino sheep (Ovis Aries, 1-5 yrs old) underwent laminectomy at lumbar levels 1-5 and had hydrated aluminum silicate (kaolin) applied to promote adhesion formation. Subjects were randomised to receive at each laminectomy level no-treatment control, Chitogel, Chitogel with Def at 20 mM or 40 mM or Carboxy-methyl-cellulose and Polyethylene oxide (CMC/PEO) gel. The animals were recovered for 3 months post-surgery, followed by assessment with Magnetic Resonance Imaging (MRI) and histopathology of the spinal tissues for evaluating the presence and extent of adhesions. RESULTS: MRI and Histology assessment indicated that Kaolin induced severe inflammation with adhesion formation. Chitogel with and without 20 mM Def decreased inflammation (p < 0.01) and trended to reduce adhesions (p < 0.1). Chitogel with Def 40 mM was not significantly dis-similar to CMC/PEO and did not reduce inflammation or adhesions compared to no-treatment control. CONCLUSION: Chitogel in combination with Def 20 mM is safe and effective in decreasing the inflammatory process and may possibly reduce post-operative adhesions following laminectomy.


Assuntos
Deferiprona/farmacologia , Laminectomia/efeitos adversos , Aderências Teciduais/prevenção & controle , Adulto , Animais , Cicatriz , Dura-Máter/patologia , Espaço Epidural/patologia , Síndrome Pós-Laminectomia , Feminino , Fibrose , Humanos , Vértebras Lombares/cirurgia , Masculino , Ovinos , Aderências Teciduais/patologia
11.
Artif Cells Nanomed Biotechnol ; 48(1): 425-434, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31916462

RESUMO

Abdominal wall defects are associated with abdominal wall surgery, infection and tumour resection. Polypropylene (PP) mesh, which has excellent mechanical strength, is currently the primary clinical repair material. In repairing the abdominal wall, the mesh can erode the bowel and cause other problems. Constructing a barrier that induces a weak inflammatory response and promotes rapid recovery of the peritoneum is important. We used electrospinning technology to construct a silk fibroin coating on the abdominal surface of a PP patch. A rat model was used to compare the inflammatory responses, regeneration of peritoneal tissue, and antiadhesion effects of electrospun regenerated silk fibroin (RSF) coatings, polycaprolactone (PCL) coatings, and noncoated PP meshes. The inflammatory responses, antiadhesion fractions, and areas of RSF and PCL were better than those of PP at 6 weeks. RSF was associated with complete peritoneal regeneration, in contrast to PCL. At 12 weeks, the structure of the PCL peritoneum was unstable, and the adhesion fraction and area were significantly higher than those of RSF. The intact peritoneum could not be effectively regenerated. The RSF group exhibited lower IL-6 levels than the PCL and PP groups but higher VEGF, IL-10 and TGF-ß levels, making RSF more conducive to the regeneration of peritoneal and abdominal wall tissues.


Assuntos
Parede Abdominal/cirurgia , Materiais Biocompatíveis/química , Fibroínas/química , Polipropilenos/química , Telas Cirúrgicas , Aderências Teciduais/prevenção & controle , Parede Abdominal/patologia , Animais , Linhagem Celular , Ratos , Ratos Sprague-Dawley , Aderências Teciduais/metabolismo , Aderências Teciduais/patologia
12.
Transplant Proc ; 52(1): 84-88, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31901325

RESUMO

BACKGROUND: The host-related risk factors for surgical difficulty of partial nephrectomy include the presence of thick and adherent adipose tissue surrounding the kidney (adherent perinephric fat [APF]). The kidney and perirenal fat must be isolated in donor nephrectomy. Thus, APF is an important surgery-related factor. We analyzed whether the Mayo adhesive probability (MAP) score is related to APF and surgical outcomes in laparoscopic single-site donor nephrectomy (LESS-DN). METHODS: Forty-six donors who underwent LESS-DN were selected. Determination of APF was based on a retrospective review of video-recorded surgical procedures during anterior perinephric fat dissection. The MAP score was evaluated from computed tomography images. Data regarding patient characteristics and operative outcomes were collected. We then examined the MAP score, APF, and related factors. RESULTS: Eleven patients (23.9%) had APF. The patients were divided into 2 groups (MAP score of 0 points and ≥ 1 point). The 2 groups showed significant differences in sex, age, body mass index, history of hypertension, and history of dyslipidemia. The operation time was significantly longer and the estimated blood loss volume was higher in patients with a MAP score of ≥ 1. Eight of 9 patients with a MAP score of ≥ 1 had APF. The only significant differences between patients with and without APF were in the body mass index, history of hypertension, and history of dyslipidemia. The operation time was significantly longer and the estimated blood loss volume was larger in patients with APF. CONCLUSIONS: The MAP score could be useful when predicting surgical difficulty in patients undergoing LESS-DN.


Assuntos
Gordura Intra-Abdominal/diagnóstico por imagem , Nefrectomia/efeitos adversos , Aderências Teciduais/diagnóstico por imagem , Coleta de Tecidos e Órgãos/efeitos adversos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Gordura Intra-Abdominal/patologia , Gordura Intra-Abdominal/cirurgia , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Aderências Teciduais/complicações , Aderências Teciduais/patologia , Coleta de Tecidos e Órgãos/métodos
13.
PLoS One ; 15(1): e0219105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31918436

RESUMO

Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3-31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55-94.9) and 65% (95% CI: 45-85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.


Assuntos
Tubas Uterinas/patologia , Laparoscopia/efeitos adversos , Ovário/patologia , Complicações Pós-Operatórias/patologia , Aderências Teciduais/patologia , Animais , Bilirrubina/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Modelos Animais de Doenças , Tubas Uterinas/metabolismo , Feminino , Fibrinogênio/metabolismo , Humanos , Ovário/metabolismo , Complicações Pós-Operatórias/sangue , Albumina Sérica/metabolismo , Índice de Gravidade de Doença , Suínos , Aderências Teciduais/sangue , Aderências Teciduais/etiologia
14.
J Surg Res ; 247: 202-210, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31753555

RESUMO

BACKGROUND: Implants used in abdominal wall reconstruction are associated with intra-abdominal inflammation that can cause complications such as adhesions, fistulae, or failure of the implant. This study analyzed the inflammatory response of human peritoneum explants when exposed to different implant materials including synthetic and biological (cross-linked and non-cross-linked). MATERIALS AND METHODS: Human peritoneum explants (parietal and visceral) were incubated in culture with implants used for abdominal wall reconstruction. Implants included Permacol (biological implant with chemical cross-linking); Biodesign and Strattice (biological implants without chemical cross-linking); Prolene (synthetic nonabsorbable); and Vicryl (synthetic absorbable). Control peritoneum samples were incubated without implant. Cytokine concentrations and corresponding gene expression were measured by enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, respectively. Further evaluation included assessment of tissue viability and implant-cytokine adsorption. RESULTS: Incubation of human peritoneal explants with Biodesign or Strattice was associated with a significant reduction in interleukin-6, interleukin-1ß, and tumour necrosis factor alpha protein and gene expression compared with control. These could not be explained by reduced cell viability or implant-cytokine adsorption. Incubation of explants in Biodesign-conditioned media displayed a similar effect to incubation of explants with Biodesign itself. CONCLUSIONS: Human peritoneal explants cultured with different mesh implant materials show an altered inflammatory cytokine response suggesting a tissue-specific response. Downregulation of key inflammatory cytokines by the peritoneum exposed to non-cross-linked biological implants may be mediated by the release of soluble factors from these implants inhibiting cytokine gene expression. This ex vivo human peritoneal system provides a novel preclinical model to investigate peritoneum-implant interactions.


Assuntos
Peritônio/imunologia , Peritonite/prevenção & controle , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Parede Abdominal/cirurgia , Citocinas/imunologia , Citocinas/metabolismo , Perfilação da Expressão Gênica , Humanos , Hérnia Incisional/cirurgia , Teste de Materiais , Peritônio/patologia , Peritonite/imunologia , Peritonite/patologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Aderências Teciduais/imunologia , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle , Técnicas de Cultura de Tecidos
15.
J Gynecol Obstet Hum Reprod ; 49(1): 101637, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520750

RESUMO

This study was undertaken to evaluate the correlation between preoperative Serum markers and pelvic adhesions in endometriosis patients and to explore the markers' clinical value for outcome prediction. Preoperative blood Serum and CA 125 results were obtained and pelvic adhesion scores were calculated. The patient group with adhesion scores less than 28 points was defined as the mild adhesion group, and those with a score of 28 or more were members of the severe adhesion group. The CA 125 level was significantly higher in the severe adhesion group than in the mild adhesion group. The CA 125 level, size of the largest cyst, and WBC count were associated with the level of pelvic adhesion. Adhesion scores were significantly higher in the CA 125 ≥ 35 U/mL group than in the CA 125 < 35 U/mL group. Patients with a preoperative CA 125 level higher than 35 U/mL are at high risk for pelvic adhesion.


Assuntos
Biomarcadores/sangue , Antígeno Ca-125/sangue , Endometriose/sangue , Adulto , Cistos/sangue , Cistos/patologia , Endometriose/patologia , Feminino , Humanos , Contagem de Leucócitos , Pessoa de Meia-Idade , Pelve , Período Pré-Operatório , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Aderências Teciduais/sangue , Aderências Teciduais/patologia , Adulto Jovem
16.
Neurosurg Rev ; 43(2): 453-472, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30043262

RESUMO

Craniopharyngioma (CP) adherence represents a most baffling problem for the neurosurgeon. The highest priority of current surgical treatment is to maximize tumor removal without compromising the patients' long-term functional outcome. Surgical damage to the hypothalamus may be avoided or at least ameliorated with a precise knowledge regarding the type of adherence for each case. This article presents a comprehensive review of the pathological, surgical, and radiological sources of evidence supporting that CP adherence, despite being heterogenous, is characterized by repeating patterns. The key underlying factors of CP adherence are also discussed. Three components define the type of adherence for each case: (i) the intracranial structures attached to the tumor, (ii) the adherence morphology, and (iii) the adhesion strength. Combination of these three components gives rise to five hierarchical levels of increased risk of hypothalamic injury during tumor removal. Tumor topography has been identified as the major predictor of the type of CP adherence. The most extensive and strongest adhesions to the hypothalamus occur in CPs originated in the suprasellar cistern that secondarily invade the third ventricle (secondary intraventricular CPs) and in those originated within the third ventricle floor itself (not-strictly intraventricular CPs). Three findings observed on preoperative conventional MRI scans have proven to be reliable predictors of adherence severity. A position of the hypothalamus around the middle portion of the tumor, an amputated pituitary stalk, and an elliptical tumor shape points to the severe and critical risk levels, and in those cases, a safer limited removal is strongly recommended.


Assuntos
Craniofaringioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Aderências Teciduais/cirurgia , Craniofaringioma/complicações , Craniofaringioma/patologia , Gliose/complicações , Gliose/patologia , Gliose/cirurgia , Humanos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Aderências Teciduais/complicações , Aderências Teciduais/etiologia , Aderências Teciduais/patologia
17.
J Gynecol Obstet Hum Reprod ; 49(1): 101619, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31430563

RESUMO

OBJECTIVE: To investigate the predictive value of the Davey Score for striae gravidarum (SG) on the presence of pelvic adhesions at repeat cesarean delivery (CD). MATERIALS AND METHODS: The current study was a cross-sectional study conducted in a tertiary university hospital between November 2016 and March 2018. All women scheduled for elective CD were included if they had at least previous one CD with pregnancy in term fetus (37-40 weeks gestation. Preoperative evaluation of SG severity using Davey score, which is a validated scoring system, was done on the examination bed. Patients with no/mild striae (score 0-2) were classified as group (I) and women with severe striae (score 3-8) were classified as group (II). During surgery, pelvic adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the difference in the rate of pelvic adhesions between both groups. RESULTS: The study included 300 women; group I included 114 women and group II included 186 women. About 90% of women with severe striae versus 82.5% of women with no/mild striae were found to have adhesions (p = 0.035). Dense adhesions were significantly present in severe striae group (57.4%) versus (41.5%) in no/mild striae group (p = 0.022). The mean Davey score in women in group (II) was significantly higher than group (I) (4.25 ± 3.36 vs. 3.09 ± 2.95, p = 0.03). Nair's score had a significant positive moderate correlation with Davey score (r = 0.541, p = 0.016). According to the results of multivariate regression analysis, Davey score >2 was the only variable associated with increased risk of pelvic adhesions (p = 0.010). CONCLUSION: Assessment of SG score in women with previous CD using Davey score might help to predict pelvic adhesions status before planning a new surgery.


Assuntos
Recesariana , Pelve/patologia , Diagnóstico Pré-Natal/métodos , Estrias de Distensão/classificação , Aderências Teciduais/diagnóstico , Adulto , Área Sob a Curva , Índice de Massa Corporal , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Gravidez , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estrias de Distensão/etiologia , Estrias de Distensão/patologia , Aderências Teciduais/classificação , Aderências Teciduais/etiologia , Aderências Teciduais/patologia
18.
Sci Rep ; 9(1): 18254, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796777

RESUMO

Today, 40-66% of elective procedures in general surgery are reoperations. During reoperations, the need for adhesiolysis results in increased operative time and a more complicated convalescence. In pre-clinical evaluation, adhesion barriers are tested for their efficacy in preventing 'de novo' adhesion formation, However, it is unknown to which extent barriers are tested for prevention of adhesion reformation. The aim of this systematic review and meta-analysis is to assess the efficacy of commercially available adhesion barriers and laparoscopic adhesiolysis in preventing adhesion reformation in animal models. Pubmed and EMBASE were searched for studies which assessed peritoneal adhesion reformation after a standardized peritoneal injury (in the absence of an intra-peritoneal mesh), and reported the incidence of adhesions, or an adhesion score as outcome. Ninety-three studies were included. No study met the criteria for low risk of bias. None of the commercially available adhesion barriers significantly reduced the incidence of adhesion reformation. Three commercially available adhesion barriers reduced the adhesion score of reformed adhesions, namely Seprafilm (SMD 1.38[95% CI]; p < 0.01), PEG (SMD 2.08[95% CI]; p < 0.01) and Icodextrin (SMD 1.85[95% CI]; p < 0.01). There was no difference between laparoscopic or open adhesiolysis with regard to the incidence of adhesion reformation (RR 1.14[95% CI]; p ≥ 0.05) or the adhesion score (SMD 0.92[95% CI]; p ≥ 0.05). Neither currently commercially available adhesion barriers, nor laparoscopic adhesiolysis without using an adhesion barrier, reduces the incidence of adhesion reformation in animal models. The methodological quality of animal studies is poor.


Assuntos
Modelos Animais de Doenças , Aderências Teciduais/prevenção & controle , Animais , Doenças Peritoneais/etiologia , Doenças Peritoneais/patologia , Doenças Peritoneais/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/etiologia , Aderências Teciduais/patologia , Pesquisa Médica Translacional
19.
Acta Cir Bras ; 34(10): e201901002, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826148

RESUMO

PURPOSE: To evaluate the effect of garlic on formation of postoperative adhesions in rats. METHODS: Twenty-four Sprague dawley rats were divided into three groups. In Group 1 (sham), laparotomy was performed and stitched up. In Group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and 2 cc of saline was intraperitoneally administered to each rat. In Group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Allium sativum derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum. RESULTS: In Group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. CONCLUSIONS: No positive outcomes indicating that Allium sativum reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, allium sativum increased the production of free oxygen radicals in the tissue.


Assuntos
Alho/química , Doenças Peritoneais/prevenção & controle , Animais , Fibrose , Radicais Livres/análise , Imuno-Histoquímica , Laparotomia , Linfonodos/efeitos dos fármacos , Linfonodos/patologia , Estresse Oxidativo/efeitos dos fármacos , Doenças Peritoneais/patologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle
20.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 635-638, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671196

RESUMO

BACKGROUND AND OBJECTIVE: There remains a low but intractable risk of rhegmatogenous retinal detachment (RRD) after surgical repair of macular holes (MHs). The purpose of this study is to identify potential causes for RRDs after MH surgery. PATIENTS AND METHODS: The authors retrospectively examined a single surgeon series of stage 3 MH repair surgeries during a 5-year period. Clinical data, including preoperative, intraoperative, and postoperative evaluations, were reviewed to determine potential causes of RRD. RESULTS: Of the 332 eyes that received MH surgery, 12 (3.6%) developed postoperative RRD. Seven RRD cases exhibited no evident precursor pathology; however, augmented posterior hyaloid adhesions (APHAs) were found intraoperatively and postoperatively. CONCLUSIONS: In MH surgery, APHA increases risk for RRD. During PPV, the vitreous typically separates to the peripheral vitreous base. Some eyes have APHAs near the equator that cannot be elevated, consistent with strong adhesion. The authors believe the high postoperative RRD rate is due to continued hyaloid elevation after surgery. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:635-638.].


Assuntos
Complicações Pós-Operatórias , Descolamento Retiniano , Perfurações Retinianas/cirurgia , Aderências Teciduais , Vitrectomia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Descolamento Retiniano/etiologia , Descolamento Retiniano/patologia , Estudos Retrospectivos , Aderências Teciduais/etiologia , Aderências Teciduais/patologia
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