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1.
Rozhl Chir ; 100(1): 27-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33691420

RESUMO

INTRODUCTION: Endometriosis is defined as the presence of endometrial tissue, endometrial glands or endometrial stroma outside the uterine cavity causing chronic inflammatory response. The prevalence of abdominal wall endometriosis is less than 1%. Cesarean scar endometriosis is the most common type of abdominal wall endometriosis. Chronic lower abdominal pain amplified during menstruation and palpable mass in the area of scar are the main symptoms. Generally, surgical resection with negative resection margins offers the best chance for definitive treatment of abdominal wall endometriosis. CASE REPORT: The authors present two female patients in fertile age with chronic pain in the area of Cesarean scar. The preoperatively assumed endometriosis was histologically confirmed after complete surgical excision. CONCLUSION: Abdominal wall endometriosis is rare. However, it is a possible cause of constant lower abdominal pain, impacting quality of life of the patient.


Assuntos
Parede Abdominal , Endometriose , Parede Abdominal/cirurgia , Cesárea/efeitos adversos , Cicatriz/etiologia , Cicatriz/patologia , Endometriose/etiologia , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Gravidez , Qualidade de Vida
2.
Z Geburtshilfe Neonatol ; 225(1): 55-59, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33601452

RESUMO

OBJECTIVE: Caesarean rates have increased rapidly for various reasons recently. One of the important reasons among these is medicolegal problems. Our aim with this study was to preoperatively predict abdominal adhesion density by combining the scar tissue morphology formed in the post-caesarean Pfannenstiel incision line and the skin color scoring of the patients. MATERIAL AND METHODS: Patients who had undergone one caesarean section previously, completed their terms (37-39 weeks) and were under 35 years old were included in the study. Skin color scoring of the patients was performed using the Fitzpatrick skin color scale. Intra-abdominal adhesion scoring of the participant patients was performed using Nair's adhesion scoring system. RESULTS: The change in abdominal adhesion scores was evaluated based on the Fitzpatrick color scale. Adhesion scores per the Nair intra-abdominal adhesion scoring system were found to be 0.04±0.209 in the FP1 group, 0.35±0.662 in the FP2 group, 1.58±0.923 in the FP3 group, and 2.33±0.577 in the FP4 group (p<0.05). These results showed a significant increase in adhesion density with increasing skin color darkness. Based on these results, it was observed that the abdominal adhesion scores and the frequency of depressed skin scar were significantly increased with increasing Fitzpatrick scores (p<0.05). CONCLUSION: The aim of this study was to increase the prediction rates by adding the skin color scoring to the scar tissue characteristics, which have been used in previous studies. The results of this study indicate that the combination of these two parameters may be more effective in predicting intra-abdominal adhesions. Nevertheless, there is a need for studies with a much higher number of patients and multiple parameters to be able to predict intra-abdominal adhesion density preoperatively with greater accuracy.


Assuntos
Recesariana/efeitos adversos , Cesárea/efeitos adversos , Cicatriz/etiologia , Pigmentação da Pele , Aderências Teciduais/etiologia , Adulto , Cicatriz/patologia , Feminino , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Gravidez , Aderências Teciduais/diagnóstico
4.
Khirurgiia (Mosk) ; (1): 5-14, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395506

RESUMO

OBJECTIVE: To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. MATERIAL AND METHODS: There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). RESULTS: Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. CONCLUSION: Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.


Assuntos
Cicatriz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Cicatriz/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Resultado do Tratamento
5.
Isr Med Assoc J ; 23(1): 33-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443340

RESUMO

BACKGROUND: Injuries to the anterior cruciate ligament (ACL) are common and complete tears often fail to heal. ACL reconstruction is considered the surgical gold standard of care for ACL injuries in young active patients. OBJECTIVES: To determine the corresponding morphological and histological features of the torn ACL in different time periods after injury. METHODS: The study included 28 remnant specimens of torn ACLs from patients who had ACL reconstruction surgery of the knee. The remnant pathology was evaluated by its morphology during arthroscopy and by histopathologic measurements. RESULTS: At surgery there were three progressive and distinct morphological tear patterns. The first pattern was noticed within the first 3 months from injury and showed no scar tissue. The second pattern appeared later and was characterized by the appearance of scar tissue with adhesion to the femoral wall. The third pattern was characterized by adhesion of the ACL remnant to the posterior cruciate ligament. The histological changes of the first morphological pattern showed abundance of blood vessels and lymphocytes at the torn femoral end with few irregular collagen fibers. The second and third tear patterns showed decrement in the number of blood vessels and lymphocytes with longitudinally oriented collagen fibers. CONCLUSIONS: The morphological features of the ACL remnant in the first 3 months after injury showed no scar tissue and its histological features had the characteristics of a reparative phase. This phase was followed by a prolonged remodeling phase that ended with attachment of the remnant to the posterior cruciate ligament.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Cicatriz , Articulação do Joelho , Efeitos Adversos de Longa Duração , Aderências Teciduais , Adulto , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Feminino , Tecido de Granulação/irrigação sanguínea , Tecido de Granulação/patologia , Humanos , Articulação do Joelho/irrigação sanguínea , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Efeitos Adversos de Longa Duração/diagnóstico por imagem , Efeitos Adversos de Longa Duração/etiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Fatores de Tempo , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/etiologia
6.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462003

RESUMO

Uterine scarring increases the risk of uterine rupture during labour, which can result in significant maternal and fetal morbidity and mortality. There is insufficient evidence for a clear recommendation on the safety of vaginal delivery in the context of a patient with both a uterine perforation and a previous lower uterine segment caesarean section. We present the case of a woman with a history of one previous caesarean section and uterine perforation with a uterine manipulator, who subsequently had an uncomplicated normal vaginal delivery.


Assuntos
Cesárea/efeitos adversos , Cicatriz/etiologia , Complicações Pós-Operatórias/etiologia , Perfuração Uterina/etiologia , Nascimento Vaginal Após Cesárea , Cesárea/métodos , Feminino , Humanos , Gravidez
7.
J Dermatolog Treat ; 32(1): 73-77, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31172821

RESUMO

Background: It is anticipated that the combined treatments of ablative laser and human stem cell-conditioned media produce the synergistic effects.Objectives: To investigated the effects of human stem cell-conditioned media (HSCM) as a post-procedural agent after fractional CO2 laser procedure in patients with atrophic acne scars and skin pores. Method: Both cheeks of 15 subjects were treated with a fractional CO2 laser. HSCM was randomly applied to one of the resurfacing sites (T) and normal saline was applied to the other site as a control (C). During the next six days, a solution containing 80% HSCM and hyaluronic acid (HA) was applied on the treated side (T) and HA alone was applied to the control side (C). Scar volume and erythema were objectively evaluated using an Antera 3D® CS. Result: After two months, the scar volume was reduced by 23.5% (T) versus 15.0% (C) (p = .143) and the volume of the skin pores was reduced by 37.6% (T) versus 15.9% (C) (p = .006), while the erythema was increased by 2.8% (T) versus 3.1% (C) (p = .934). Atrophic scar and the skin pores in the HSCM-applied area improved by at least 15.0% after a single treatment session, suggesting better results compared with the control side.Conclusion: HSCM may augment the regenerative effects of fractional CO2 laser.


Assuntos
Cicatriz/radioterapia , Meios de Cultivo Condicionados/farmacologia , Lasers de Gás/uso terapêutico , Pele/efeitos dos fármacos , Acne Vulgar/complicações , Adulto , Idoso , Cicatriz/etiologia , Eritema/etiologia , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Lasers de Gás/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Pessoa de Meia-Idade , Pele/patologia , Células-Tronco/citologia , Células-Tronco/metabolismo , Resultado do Tratamento , Adulto Jovem
8.
Cir. plást. ibero-latinoam ; 46(4): 475-482, oct.-dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-198735

RESUMO

INTRODUCCIÓN Y OBJETIVO: Debido a implicaciones cosméticas y funcionales, las cicatrices en los niños son una preocupación para pacientes y familiares. Existen múltiples líneas de tratamiento con efectividad variable. La transferencia de tejido adiposo es una alternativa relativamente nueva en el tratamiento de diferentes alteraciones, incluyendo las cicatrices, debido a que este tejido contiene entre otros elementos factores de crecimiento, angiogénicos y antiapoptóticos, además de una reserva de células madre mesenquimales con capacidad de replicarse indefinidamente y diferenciarse en varios tipos celulares que pueden favorecer la reorganización y regeneración de los tejidos. Mostramos los resultados del uso de lipoinjertos autólogos para el tratamiento de cicatrices patológicas en una serie de pacientes pediátricos. Basamos su empleo en los efectos satisfactorios encontrados sobre cicatrices en adultos, con la finalidad de exponer este método como alternativa en el tratamiento en niños, teniendo en cuenta que es una técnica emergente para esta condición en este grupo etario. MATERIAL Y MÉTODO: Estudio retrospectivo, observacional, no aleatorizado, en pacientes pediátricos sometidos a lipoinjertos autólogos para el manejo de cicatrices patológicas durante el periodo comprendido entre enero de 2016 y enero de 2018. Las cicatrices fueron evaluadas antes del procedimiento y en controles postoperatorios a 3 y 6 meses por medio de la escala de Vancouver. Los datos obtenidos fueron analizados estadísticamente mediante la prueba de rangos de Wilcoxon. RESULTADOS: Incluimos en el estudio 9 pacientes, 5 mujeres y 4 varones, con edades entre 2 y 17 años (media de 8.8 años). Identificamos una reducción estadísticamente significativa en los promedios de las variables vascularización, elasticidad y en la puntuación total de la escala de Vancouver (valor p <0.05) después del tratamiento con lipoinjertos. Todos los pacientes presentaron disminución de por lo menos 1 punto en el total de la escala al final del periodo de evaluación. La variable con mayor disminución a los 6 meses fue la elasticidad, y la que tuvo menor cambio fue el grosor/altura. Ningún paciente presentó complicaciones tempranas o tardías durante el seguimiento. CONCLUSIONES: Los datos obtenidos sugieren que también en pacientes pediátricos, las cicatrices presentan una mejoría clínica posterior a la aplicación de injertos grasos (especialmente en la elasticidad), basada en la disminución de puntuación en la escala de Vancouver


BACKGROUND AND OBJECTIVE: Due to the cosmetic and functional implications, scars in children represent a concern for patients and their parents. Currently, there are multiple lines of treatment with variable effectiveness. Adipose tissue transfer is a relatively new alternative in the treatment of different alterations including scars, because this tissue contains among other elements growth, angiogenic and antiapoptotic factors, in addition to a reserve of mesenchymal stem cells with the ability to replicate indefinitely and differentiate into several cell types that can promote the reorganization and regeneration of tissue. We show the results of the use of fat graft for treatment of pathological scars in a series of pediatric patients. We base its use on the satisfactory effects found on scars in adults to suggest this method as an alternative in the management in children, considering that this technique represents an emerging treatment for the management of this condition in this age group. METHODS: Retrospective, observational, non-randomized study, carried out in pediatric patients underwent to autologous fat grafts for the management of pathological scars during the period from January 2016 to January 2018. The scars were treated with autologous fat grafts and evaluated before the procedure and 3 and 6 postoperative months, using the Vancouver scale. The data obtained were statistically analyzed using the Wilcoxon rank test. RESULTS: Nine patients were included in the study (5 women and 4 men) with an age range of 2 to 17 years (average 8.8 years). A statistically significant reduction in the averages of the variables vascularization, elasticity and in total score of the Vancouver scale (p value <0.05) after treatment with fat graft was identified. All patients showed a decrease of at least 1 point in the total of the Vancouver scale at the end of the evaluated period. The variable with the greatest decrease in the score at 6 months was elasticity and the one with the least change was thickness/height. No patient presented complications early or late during the follow-up period. CONCLUSIONS: The data obtained suggest that also in pediatric patients, the scars show a clinical improvement after the application of fat grafts (especially in elasticity), based on the decrease in the score on the Vancouver scale


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Cicatriz/cirurgia , Tecido Adiposo/transplante , Cicatriz/etiologia , Cicatriz/patologia , Transplante de Tecidos , Estudos Retrospectivos , Cuidados Pós-Operatórios
9.
Int J Mol Sci ; 21(24)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33353063

RESUMO

Scars are generated in mature skin as a result of the normal repair process, but the replacement of normal tissue with scar tissue can lead to biomechanical and functional deficiencies in the skin as well as psychological and social issues for patients that negatively affect quality of life. Abnormal scars, such as hypertrophic scars and keloids, and cutaneous fibrosis that develops in diseases such as systemic sclerosis and graft-versus-host disease can be even more challenging for patients. There is a large body of literature suggesting that inflammation promotes the deposition of scar tissue by fibroblasts. Mast cells represent one inflammatory cell type in particular that has been implicated in skin scarring and fibrosis. Most published studies in this area support a pro-fibrotic role for mast cells in the skin, as many mast cell-derived mediators stimulate fibroblast activity and studies generally indicate higher numbers of mast cells and/or mast cell activation in scars and fibrotic skin. However, some studies in mast cell-deficient mice have suggested that these cells may not play a critical role in cutaneous scarring/fibrosis. Here, we will review the data for and against mast cells as key regulators of skin fibrosis and discuss scientific gaps in the field.


Assuntos
Cicatriz/etiologia , Cicatriz/metabolismo , Fibrose/etiologia , Fibrose/metabolismo , Mastócitos/imunologia , Mastócitos/metabolismo , Animais , Biomarcadores , Comunicação Celular , Cicatriz/patologia , Cicatriz Hipertrófica , Modelos Animais de Doenças , Suscetibilidade a Doenças , Fibroblastos/metabolismo , Fibrose/patologia , Humanos , Queloide , Mecanotransdução Celular
12.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(6): 657-661, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33377343

RESUMO

OBJECTIVE: To observe and compare the clinical efficacy of CO2 fractional laser in the early control of scar post-secondary repair in patients with a cleft lip. METHODS: In the treatment group, 43 patients with secondary repair of cleft lip were treated via CO2 fractional laser. The control group covered 70 patients post-cheiloplasty. The effect in the two groups after six months was compared. The duration from the beginning of the laser treatment to surgery and patient gender were analyzed to determine if they affected the efficacy of the laser treatment for scars. RESULTS: 1) The curative effect in the treatment group was better than that in the control group (P<0.000 1), the total effectiveness rate was 90.7% in the treatment group. 2) No significant statistical difference in efficacy was observed between men and women (P=0.487). Moreover, no significant statistical difference in efficacy (P=0.055) was observed among patients one year after surgery, within the duration of <3 months, and within the duration of ≥3 months. CONCLUSIONS: CO2 fractional laser had a definite effect on the treatment of scar post-secondary repair in patients with a cleft lip. No significant correlation was observed between treatment effect and patient gender, and no difference was noted among patients one year after surgery. In the beginning of the laser treatment, no difference was observed between the durations of <3 months and ≥3 months after the reconstruction, Therefore, early intervention of scars a year after secondary repair of a cleft lip can achieve good results.


Assuntos
Cicatriz , Fenda Labial , Dióxido de Carbono , Cicatriz/etiologia , Cicatriz/patologia , Fenda Labial/cirurgia , Feminino , Humanos , Lasers , Masculino , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(50): e23630, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327341

RESUMO

BACKGROUND: Previous cesarean scar defect (PCSD) is a gynecological disease that can cause bleeding after intercourse, prolonging menstrual period, intermenstrual bleeding, dysmenorrhea, and even lead to infertility. Chinese herbal medicine plays an important role in the treatment of gynecological diseases in China and East Asia. This study aims to assess the efficacy and safety of Chinese herbal medicine for PCSD. METHODS: We search the following databases: PubMed, the Cochrane Library, Chinese Biomedical Literature Database (CB), Chinese Science and Technique Journals Database (VIP), EMBASE, Chinese National Knowledge Infrastructure Database (CNKI), and the Wanfang Database. Other sources will also be searched like Google Scholar and gray literature. All databases mentioned above are searched from the start date to the latest version. Randomized controlled trials will be included which recruiting PCSD participants to assess the efficacy and safety of Chinese herbal medicines against controls (placebo or other therapeutic agents). Primary outcomes will include the size of PCSD, menstrual cycle, menstrual phase, menstrual volume, duration of disease, security index. Two authors will independently scan the searched articles, extract the data from attached articles, and import them into Endnote X8 and use Microsoft Excel 2013 to manage data and information. We will assess the risk of bias by Cochrane tool of risk of bias. Disagreements will be resolved by consensus or the participation of a third party. All analysis will be performed based on the Cochrane Handbook for Systematic Reviews of Interventions. The meta-analysis in this review will use RevMan 5.3 software. RESULTS: The study aims to evaluate the efficacy and safety of the treatment that Chinese herbal medicine for PCSD. CONCLUSION: This study of the meta-analysis could provide evidence for clinicians and help patients to make a better choice. INPLASY REGISTRATION NUMBER: INPLASY202090080.


Assuntos
Cesárea/efeitos adversos , Cicatriz/tratamento farmacológico , Cicatriz/etiologia , Medicamentos de Ervas Chinesas/uso terapêutico , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Endometriose/prevenção & controle , Feminino , Humanos , Ciclo Menstrual/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Infecção da Ferida Cirúrgica/prevenção & controle
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1298-1304, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063497

RESUMO

Objective: To explore the effect and potential mechanism of glycyrrhizin (GL) by inhibiting high mobility group box 1 (HMGB1) on glial scar formation after spinal cord injury (SCI) in rats. Methods: Seventy-two female Sprague Dawley rats were randomly divided into sham group ( n=12), SCI model group (SCI group, n=36), GL intervention group (SCI+GL group, n=12), and nuclear factor κB (NF-κB) inhibitor [pynolidine dithiocarbamate (PDTC)] intervention group (SCI+PDTC group, n=12). The SCI models of SCI group, SCI+GL group, and SCI+PDTC group were made by modified Allen's method, the sham group was only exposed the spinal cord without any injury. First of all, Basso-Beattie-Bresnahan (BBB) score of hind limbs and slope test were performed in SCI group at 1, 2, and 3 weeks after operation; Western blot was used to detect the expressions of glial fibrillary acidic protein (GFAP) and HMGB1 proteins. Compared with the sham group, the most significant time point in the SCI group was selected for subsequent experiment, in which the most significant glial scar was formed. Then, behavioral tests (BBB score of hind limbs and slope test), histological observation of spinal cord tissue structure, Western blot detection of HMGB1, GFAP, and NF-κB proteins, and immunohistochemical staining observation of GFAP and chondroitin sulfate proteoglycan (CSPG) were used to explore the effect of GL on the formation of glial scar after SCI and its potential mechanism. Results: The BBB score and slope angle of the SCI group increased gradually with time, which were significantly lower than those of the sham group at each time point ( P<0.05). Western blot detection showed that the relative expressions of HMGB1 and GFAP proteins in the SCI group at 1, 2, and 3 weeks after operation were significantly higher than those in sham group ( P<0.05). The change was most obvious at 3 weeks after SCI, therefore the spinal cord tissue was selected for subsequent experiments at this time point. At 3 weeks after operation, compared with the SCI group, BBB score and slope angle of SCI+GL group significantly increased ( P<0.05); the relative expressions of HMGB1, GFAP, and NF-κB proteins detected by Western blot and the expressions of GFAP and CSPG proteins detected by immunohistochemical staining significantly decreased ( P<0.05); the disorder of spinal cord tissue by HE staining improved, inflammatory cell infiltration reduced, and glial scar formation decreased. At 3 weeks after operation, the expressions of NF-κB, GFAP, and CSPG proteins of the SCI+PDTC group significantly reduced when compared with the SCI group ( P<0.05); and the expression of NF-κB protein significantly decreased and the expressions of GFAP and CSPG proteins significantly increased when compared with the SCI+GL group ( P<0.05). Conclusion: After SCI in rats, the application of GL to inhibit the expression of HMGB1 can reduce the expression of GFAP and CSPG in the injured spinal cord, then reduce the formation of glial scars and promote the recovery of motor function of the hind limbs, and GL may play a role in inhibiting glial scar through HMGB1/NF-κB pathway.


Assuntos
Ácido Glicirrízico , Traumatismos da Medula Espinal , Animais , Cicatriz/etiologia , Cicatriz/prevenção & controle , Feminino , Ácido Glicirrízico/farmacologia , Ácido Glicirrízico/uso terapêutico , Neuroglia , Ratos , Ratos Sprague-Dawley , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico
17.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(9): 1346-1352, 2020 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-32990236

RESUMO

OBJECTIVE: To study the effect of rapamycin on scar formation in rabbit eyes following filtering operation and explore the possible mechanism. METHODS: Ninety-six healthy adult rabbits were subjected to trabeculectomy of the left eye and subsequently randomly divided into 4 groups (n=24) for treatment with castor oil (control) or rapamycin (1%, 3%, or 5%) eye drops of the operated eyes 4 times a day. The morphology and function of the filtering blebs of the rabbits were compared at 7, 14, 21 and 28 days after the operation; at each of the time points, 6 rabbits from each group were euthanized for detection of expressions of proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) in the tissues in the surgical area using immunohistochemistry. Cultured rabbit subconjunctival fibroblasts (RTFSs) were treated with different concentrations of rapamycin (0.06, 0.25, 1, and 4 mg/L) and the cell apoptosis was detected using flow cytometry. RESULTS: In the first, second and third weeks after the operation, the rate of functional follicle formation was significantly higher in the 3 rapamycin groups than in the control group (P < 0.05), and the number of α- SMA-positive fibroblasts decreased over time in the 3 rapamycin groups. In cultured RTFSs, treatment with rapamycin at different concentrations resulted in increased apoptosis of the cells, and rapamycin above 0.25 mg/L significantly increased the cell apoptosis in a dose-dependent manner. CONCLUSIONS: Rapamycin can inhibit hyperplasia of the filtering passage tissue, helps to preserve the functional filtering blebs and prolong their life span, and induces apoptosis of RTFS.


Assuntos
Glaucoma , Animais , Cicatriz/etiologia , Cicatriz/prevenção & controle , Olho , Glaucoma/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Coelhos , Sirolimo/farmacologia
18.
Ann R Coll Surg Engl ; 102(9): 737-743, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32820638

RESUMO

INTRODUCTION: Open thyroidectomy is the most common approach to thyroid surgery. However, 'scarless' (in the neck) endoscopic thyroidectomy, consisting of endoscopic and robotic surgery, is progressively being adopted for its perceived cosmetic benefits. This study aims to determine the patient's preferred surgical approach and to identify the factors that influence their decision. MATERIALS AND METHODS: A pilot study consisting of 100 patients with a surgical thyroid disorder were prospectively recruited from a single tertiary centre. An interviewer-administered survey was conducted. Demographic, socioeconomic status, scar perception and an adapted body image scale were evaluated to identify factors that shaped the patient's perception of the surgical approach. RESULTS: The mean age of participants was 54.5 ± 13.0 years; 72% were women and 87% Chinese. Of the 100 patients, 75 patients considered scarless endoscopic thyroidectomy as their preferred surgical approach while 25 patients opted for open thyroid surgery. Improvement in scar perception score between scarless endoscopic thyroidectomy and open thyroid surgery is associated with an increased willingness to choose scarless endoscopic thyroidectomy. The mean body image scale score was 6.9 ± 2.8, indicating no statistical difference between the surgical approaches. On multivariate analysis, improvement in scar perception score (odds ratio 3.38, 95% confidence interval 1.11-10.29) and having surgeon recommendation (odds ratio 6.38, 95% confidence interval 1.80-22.63) were independently associated with interest in scarless endoscopic thyroidectomy. CONCLUSION: Patients interest in undergoing scarless endoscopic thyroidectomy is driven by improved scar perception and surgeon's recommendation compared with open thyroid surgery.


Assuntos
Cicatriz/etiologia , Endoscopia/efeitos adversos , Preferência do Paciente/estatística & dados numéricos , Tireoidectomia/efeitos adversos , Atitude Frente a Saúde , Cicatriz/prevenção & controle , Cicatriz/psicologia , Estudos Transversais , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/psicologia , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
19.
Plast Reconstr Surg ; 146(2): 156e-164e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740578

RESUMO

BACKGROUND: Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. METHODS: This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. RESULTS: A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. CONCLUSION: Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Abdominoplastia/métodos , Cicatriz/diagnóstico , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico , Tato/fisiologia , Parede Abdominal , Abdominoplastia/efeitos adversos , Adulto , Cicatriz/etiologia , Fáscia/inervação , Fasciotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Pele/inervação , Resultado do Tratamento , Adulto Jovem
20.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 516-520, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854475

RESUMO

Objective: To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP). Methods: Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed. Results: All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both P<0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml (P>0.05), the time of uterine curettage were (37±20), (42±19) minutes (P>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days (P<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Conclusion: Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.


Assuntos
Aorta Abdominal , Oclusão com Balão/métodos , Cicatriz/terapia , Embolização da Artéria Uterina/métodos , Oclusão com Balão/estatística & dados numéricos , Cesárea/efeitos adversos , Cicatriz/etiologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Embolização da Artéria Uterina/efeitos adversos , Embolização da Artéria Uterina/estatística & dados numéricos
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