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1.
Braz J Med Biol Res ; 53(1): e9144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939600

RESUMO

Wound scarring remains a major challenge for plastic surgeons. Transforming growth factor (TGF)-ß plays a key role in the process of scar formation. Previous studies have demonstrated that truncated TGF-ß type II receptor (t-TGF-ßRII) is unable to continue signal transduction but is still capable of binding to TGF-ß, thereby blocking the TGF-ß signaling pathway. Hepatocyte growth factor (HGF) is a multifunctional growth factor that promotes tissue regeneration and wound healing. Theoretically, the combination of HGF and t-TGF-ßRII would be expected to exert a synergistic effect on promoting wound healing and reducing collagen formation. In the present study, lentivirus-mediated transfection of the two genes (t-TGF-ßRII/HGF) into fibroblasts in vitro and in a rat model in vivo was used. The results demonstrated that the expression of t-TGF-ßRII and HGF in NIH-3T3 cells was successfully induced. The expression of both molecules significantly reduced collagen I and III expression, and also inhibited fibroblast proliferation. Furthermore, histological examination and scar quantification revealed less scarring in the experimental wound in a rat model. Moreover, on macroscopic inspection, the experimental wound exhibited less visible scarring compared with the control. Therefore, the present study demonstrated that the combination gene therapy of t-TGF-ßRII and HGF promoted wound healing, with less scarring and more epithelial tissue formation, not only by suppressing the overgrowth of collagen due to its antifibrotic effect, but also by promoting tissue regeneration.


Assuntos
Cicatriz/metabolismo , Colágeno/metabolismo , Fator de Crescimento de Hepatócito/metabolismo , Transfecção , Fator de Crescimento Transformador beta2/metabolismo , Animais , Proliferação de Células , Cicatriz/patologia , Camundongos , Modelos Animais , Ratos , Ratos Sprague-Dawley
2.
Yonsei Med J ; 61(1): 85-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887804

RESUMO

PURPOSE: The aim of this study was to investigate the effect of FST gene on the inhibition of fibrosis in fibroblastic cells from scar tissue around repaired zone II flexor tendons. MATERIALS AND METHODS: Immunohistochemistry was conducted on fibroblast cells transfected with adenovirus-LacZ (Ad-LacZ) as a marker gene (control), or with adenovirus-FST (Ad-FST) as a therapeutic gene. Fibroblast cultures without adenoviral exposure served as controls. RESULTS: Fibroblastic cells transfected with Ad-FST demonstrated significant decrease in collagen type I, MMP-1, MMP2, and α-SMA mRNA expressions compared to those transfected with Ad-LacZ. In addition, fibroblastic cells transfected with Ad-FST exhibited significant decrease in MMP-1, TIMP-1, fibronectin, PAI-1, TRPV4, α-SMA, desmin, and PAX7 protein expressions. CONCLUSION: Based on these findings, we conclude that FST may be a novel therapeutic strategy for preventing scar adhesions around repaired tendons by inhibiting fibroblasts from differentiating into myofibroblasts, in addition to producing type I collagen and regulating extracellular matrix turnover via the downregulation of MMP-1 and TIMP-1. FST may also decrease contracture of the scar by inhibiting Ca2+-dependent cell contraction.


Assuntos
Diferenciação Celular/efeitos dos fármacos , Cicatriz/metabolismo , Cicatriz/patologia , Colágeno Tipo I/biossíntese , Fibroblastos/metabolismo , Folistatina/metabolismo , Miofibroblastos/patologia , Traumatismos dos Tendões/patologia , Actinas/metabolismo , Animais , Células Cultivadas , Desmina/metabolismo , Feminino , Fibronectinas/genética , Fibronectinas/metabolismo , Fibrose , Regulação da Expressão Gênica , Humanos , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 1 da Matriz/metabolismo , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Fator de Transcrição PAX7/genética , Fator de Transcrição PAX7/metabolismo , Inibidor 1 de Ativador de Plasminogênio/genética , Inibidor 1 de Ativador de Plasminogênio/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Canais de Cátion TRPV/genética , Canais de Cátion TRPV/metabolismo , Tendões/patologia
3.
Eur Radiol ; 30(1): 224-238, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350587

RESUMO

OBJECTIVES: To measure the diagnostic performance of a new radiologic pattern on restaging magnetic resonance (MR) high-resolution T2-weighted imaging (T2-WI)-the split scar sign-for the identification of sustained complete response (SCR) after neoadjuvant therapy in rectal cancer. METHODS: Institutional review board approval was obtained for this retrospective study and the informed consent requirement was waived. Fifty-eight consecutive patients with rectal cancer who underwent neoadjuvant therapy were enrolled. Two radiologists blindly and independently reviewed restaging pelvic MR imaging and recorded the presence/absence of the split scar sign (mrSSS). On a second round, they also assessed the relative proportion of intermediate signal intensity on T2-WI (mrT2) and of high signal intensity on high b-value diffusion-weighted imaging (mrDWI). Endoscopic response grading records were retrieved. Qui-square test was employed in search for associations between SCR, defined as pathologic complete response or long-term recurrence-free clinical follow-up, and mrSSS, mrT2, mrDWI and endoscopy. Interobserver agreement for imaging parameters was estimated using Cohen's kappa (k). RESULTS: mrSSS was significantly associated with SCR, with specificity = 0.97/0.97, sensitivity = 0.52/0.64, PPV = 0.93/0.94, NPV = 0.73/0.78, and AuROC = 0.78/0.83, for observers 1/2, respectively. mrDWI was significantly associated with SCR for observer 2, with specificity = 0.76, sensitivity = 0.60, PPV = 0.65, NPV = 0.71, and AuROC = 0.69. mrT2 and endoscopy were not discriminative. Interobserver agreement was substantial for mrSSS (k = 0.69), moderate for mrDWI (k = 0.46), and poor for mrT2 (k = 0.17). CONCLUSION: The split scar sign is a simple morphologic pattern visible on restaging T2-WI which, although not sensitive, is very specific for the identification of sustained complete responders after neoadjuvant therapy in rectal cancer. KEY POINTS: • The split scar sign is a morphologic pattern visible on high-resolution T2-weighted MR imaging in rectal cancer patients after neoadjuvant therapy. It therefore does not require any changes to standard protocol. • At first restaging pelvic MR imaging (mean: 9.1 weeks after the end of radiotherapy), the split scar sign identified patients who sustained a complete response with very high specificity (0.97) and positive predictive value (0.93-0.94). • The split scar sign has the potential to improve patient selection for "watch-and-wait" after neoadjuvant therapy in rectal cancer.


Assuntos
Quimiorradioterapia Adjuvante/métodos , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Retais/patologia , Adulto , Idoso , Cicatriz/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia , Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia , Indução de Remissão , Estudos Retrospectivos , Sensibilidade e Especificidade
4.
Biochem Soc Trans ; 47(6): 1679-1687, 2019 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-31724697

RESUMO

Myocardial Infarction (MI) initiates a series of wound healing events that begins with up-regulation of an inflammatory response and culminates in scar formation. The extracellular matrix (ECM) is intricately involved in all stages from initial break down of existing ECM to synthesis of new ECM to form the scar. This review will summarize our current knowledge on the processes involved in ECM remodeling after MI and identify the gaps that still need to be filled.


Assuntos
Matriz Extracelular/patologia , Infarto do Miocárdio/patologia , Remodelação Ventricular , Animais , Cicatriz/patologia , Matriz Extracelular/metabolismo , Humanos , Inflamação/metabolismo , Infarto do Miocárdio/metabolismo , Cicatrização
5.
J Drugs Dermatol ; 18(11): 1109-1114, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31741353

RESUMO

Objective: To assess the effectiveness of microfocused ultrasound with visualization (MFU-V) for treating moderate to severe atrophic acne scars. Design: Healthy subjects (N=20) seeking correction of moderate to severe atrophic acne scars on the cheeks and/or temples were enrolled. Scars were predominantly rolling- and boxcar-type, affecting an area ≥5.0cm2. Eighteen subjects completed the study. Intervention: The treatment area was marked with 14mm2 and 25mm2 squares and treated with four transducers: 7 MHz (3.0mm focal depth) and 10 MHz (1.5mm focal depth), each in 14mm and 25mm widths. During each session, MFU-V treatment lines were applied 2-3mm apart, within each treatment area, with a maximum length of 25mm. Each square received 30 treatment lines at two transducer depths (60 total lines). Subjects received three total treatments, with 30 days between each session. The primary outcome measure was improvement in baseline appearance of scars at 90 and 180 days after the final treatment. Secondary outcome measures included changes in severity using an Acne Scar Improvement Scale (ASIS) and Global Aesthetic Improvement Scale (GAIS) at 60-, 90-, and 180-days post-treatment, and a satisfaction questionnaire at 90-days post-treatment. Results: Among the 90-day images available for assessments (n=11), 100% were rated as improved by blinded reviewers, and 64% of pre- and post-treatment images were correctly selected. Among 180-day images (n=15), 100% were rated as improved, and 40% of pre- and post-treatment images were correctly selected. Most subjects were determined to have 25-50% improvement in investigator ASIS scores at 60-, 90-, and 180-days post-treatment. All subjects noted some improvement in severity at the 60-day assessment when measured using ASIS. Based on investigator GAIS scores, 100% of subjects were "Improved" or "Much Improved" at 60-, 90-, and 180-days post-treatment. Based on subject GAIS scores, all subjects noted improvement at the 60-day assessment, and 83% and 89% at the 90- and 180-day assessments, respectively. Overall, 17 subjects (94.4%) expressed some degree of satisfaction at 90-days post-treatment. Conclusions: The results of this study demonstrated that MFU-V therapy is beneficial and well tolerated for the treatment of rolling- and boxcar-type acne scars. J Drugs Dermatol. 2019;18(11):1109-1114.


Assuntos
Acne Vulgar/terapia , Cicatriz/patologia , Terapia por Ultrassom , Acne Vulgar/patologia , Adolescente , Adulto , Idoso , Atrofia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
6.
Nat Commun ; 10(1): 4866, 2019 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653830

RESUMO

Despite the success of current therapies for acute myocardial infarction (MI), many patients still develop adverse cardiac remodeling and heart failure. With the growing prevalence of heart failure, a new therapy is needed that can prevent remodeling and support tissue repair. Herein, we report on injectable recombinant human collagen type I (rHCI) and type III (rHCIII) matrices for treating MI. Injecting rHCI or rHCIII matrices in mice during the late proliferative phase post-MI restores the myocardium's mechanical properties and reduces scar size, but only the rHCI matrix maintains remote wall thickness and prevents heart enlargement. rHCI treatment increases cardiomyocyte and capillary numbers in the border zone and the presence of pro-wound healing macrophages in the ischemic area, while reducing the overall recruitment of bone marrow monocytes. Our findings show functional recovery post-MI using rHCI by promoting a healing environment, cardiomyocyte survival, and less pathological remodeling of the myocardium.


Assuntos
Colágeno Tipo III/farmacologia , Colágeno Tipo I/farmacologia , Coração/efeitos dos fármacos , Infarto do Miocárdio/patologia , Proteínas Recombinantes/farmacologia , Função Ventricular/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Animais , Capilares/efeitos dos fármacos , Carbodi-Imidas/farmacologia , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Cicatriz/patologia , Vasos Coronários/efeitos dos fármacos , Reagentes para Ligações Cruzadas/farmacologia , Dimetilaminas/farmacologia , Humanos , Macrófagos/efeitos dos fármacos , Camundongos , Monócitos/efeitos dos fármacos , Infarto do Miocárdio/fisiopatologia , Miocárdio/patologia , Miócitos Cardíacos/efeitos dos fármacos , Succinimidas/farmacologia
7.
PLoS Comput Biol ; 15(10): e1007421, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31658247

RESUMO

This paper presents a morphological analysis of fibrotic scarring in non-ischemic dilated cardiomyopathy, and its relationship to electrical instabilities which underlie reentrant arrhythmias. Two dimensional electrophysiological simulation models were constructed from a set of 699 late gadolinium enhanced cardiac magnetic resonance images originating from 157 patients. Areas of late gadolinium enhancement (LGE) in each image were assigned one of 10 possible microstructures, which modelled the details of fibrotic scarring an order of magnitude below the MRI scan resolution. A simulated programmed electrical stimulation protocol tested each model for the possibility of generating either a transmural block or a transmural reentry. The outcomes of the simulations were compared against morphological LGE features extracted from the images. Models which blocked or reentered, grouped by microstructure, were significantly different from one another in myocardial-LGE interface length, number of components and entropy, but not in relative area and transmurality. With an unknown microstructure, transmurality alone was the best predictor of block, whereas a combination of interface length, transmurality and number of components was the best predictor of reentry in linear discriminant analysis.


Assuntos
Arritmias Cardíacas/patologia , Cardiomiopatia Dilatada/fisiopatologia , Cicatriz/patologia , Arritmias Cardíacas/etiologia , Estudos de Coortes , Simulação por Computador , Humanos , Interpretação de Imagem Assistida por Computador , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Modelos Teóricos , Infarto do Miocárdio/patologia , Isquemia Miocárdica/patologia , Miocárdio/patologia
8.
Rev Prat ; 69(4): 429-431, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626501

RESUMO

Chronic pelvic pain in a woman with at least one history of caesarean should lead to the diagnosis of parietal endometrioma on a caesarean section scar, even years after. The most suggestive clinical picture is chronic cyclical pelvic pain located near the caesarean section scar associated with a pelvic wall mass. On clinical examination, this painful nodule is most often palpable. In order to support the diagnosis, it is advisable to perform a parietal ultrasound, preferably during menstruation and during the painful crisis; however, ultrasound lesions may also be typical outside menstrual period. The standard treatment consists of a large surgical resection with healthy margins, under general anesthesia.


Assuntos
Cesárea , Cicatriz , Endometriose , Cesárea/efeitos adversos , Cicatriz/patologia , Endometriose/patologia , Feminino , Humanos , Gravidez , Ultrassonografia
9.
Zhonghua Shao Shang Za Zhi ; 35(9): 701-704, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594191

RESUMO

The skin pathologic scar is a skin fibrous proliferative disease characterized by abnormal proliferation of fibroblasts and overdeposition of extracellular matrix. Unclarity of genesis and development mechanism is the main reason that restricts its diagnosis and treatment. In recent years, it has been found that microRNAs play important roles in the regulation mechanism of pathological scars. The competing endogenous RNAs (ceRNAs) have microRNA response elements which can be competitively combined with microRNAs through sponge adsorption. Through the mutual regulation of RNAs, ceRNAs regulate the expression of target gene and participate in the development of disease. Based on the ceRNA hypothesis, this paper systematically reviews the biological functions and clinical significance of ceRNAs in pathological scars of skin, and discusses the role of ceRNAs and " RNA-microRNA-RNA" regulation network in pathologic scars. The ceRNA therapy may become a new model therapy for skin scars in the future.


Assuntos
Cicatriz/patologia , Redes Reguladoras de Genes , MicroRNAs/genética , Pele/patologia , Cicatriz/genética , Humanos
10.
J Craniofac Surg ; 30(7): e655-e658, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31574788

RESUMO

A surgical approach to zygomaticomaxillary complex (ZMC) fracture has not been standardized. The authors reviewed 15 cases of ZMC fractures treated with the swinging eyelid approach and evaluated the effectiveness of the technique by an observational study of Japanese patients. Results were assessed from authentic and functional perspectives: the presence of entropion/ectropion, external canthal malposition and chemosis of the conjunctiva. After a minimum follow-up of 10 months, no patients had lower eyelid ectropion, entropion or retraction. Wounds appeared inconspicuous, and a lateral canthal shape was preserved. No post-operative chemosis of the conjunctiva was observed. Each case was evaluated based on patient satisfaction about their aesthetic outcomes. Patient self-assessment is classified into 4 groups (excellent, good, fair, and unsatisfactory). Thirteen patients were assessed to have an "excellent" outcome, and 2 patients were assessed to have a "good" outcome. No patients had "fair" or "unsatisfactory" outcomes. Avoidance of scarring is a goal of every craniofacial surgeon. The swinging eyelid approach to ZMC fractures offers a simple alternative to the conventional technique. It is versatile and provides sufficient exposure to surgical fields with less visible scar because skin incision is made along the natural crease line, "the crow's feet."


Assuntos
Pálpebras/cirurgia , Fraturas Ósseas/cirurgia , Adulto , Idoso , Cicatriz/patologia , Túnica Conjuntiva/cirurgia , Ectrópio/cirurgia , Entrópio/cirurgia , Feminino , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Satisfação do Paciente
11.
Medicine (Baltimore) ; 98(37): e17138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517854

RESUMO

RATIONAL: Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disorder. Currently, the genotype-phenotype correlations of classical EDS (cEDS) are still controversial. Hence, this study reported a case of cEDS with both clinical manifestations and COL5A2 gene mutation. PATIENT CONCERNS: A 30-year-old female presented to the plastic-surgery clinic with widen atrophic scars on forehead, elbows, knees and pretibial area that had developed since childhood. DIAGNOSIS: With the skin hyperextensibility, joint hypermobility, papyraceous scar revealed by physical examination, and the heterozygous pathogenic variant c1997G > A (p.P659P) in COL5A2 gene revealed by whole exome sequencing, the diagnosis of the classical Ehlers-Danlos syndrome was made. INTERVENTIONS: The patient underwent facial scar resection and sutured in minimizing tension and perfect apposition to avoid the post-surgery scar formation. OUTCOMES: Follow-up 6 months after surgery, the wound remained a fine line scar. LESSONS: Our findings suggested that COL5A2 gene mutation (c1997G > A p.P659P) may be associated with cEDS but did not reveal other severe complications.


Assuntos
Cicatriz/diagnóstico , Síndrome de Ehlers-Danlos/diagnóstico , Adulto , Cicatriz/genética , Cicatriz/patologia , Cicatriz/cirurgia , Diagnóstico Diferencial , Síndrome de Ehlers-Danlos/genética , Síndrome de Ehlers-Danlos/patologia , Síndrome de Ehlers-Danlos/cirurgia , Cotovelo , Feminino , Testa , Humanos , Joelho
12.
JNMA J Nepal Med Assoc ; 57(217): 209-212, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477966

RESUMO

Cesarean scar pregnancy is a rare variant of ectopic pregnancy where the fertilized ovum gets implanted in the myometrium of the previous cesarean scar. The incidence of Caesarean Scar Pregnancy among ectopic pregnancies is 6.1% and it is seen in approximately 1 in 2000 normal pregnancies. As trophoblastic invasion of the myometrium can result in uterine rupture and catastrophic hemorrhage termination of pregnancy is the treatment of choice if diagnosed in the first trimester. Expectant treatment has a poor prognosis and may lead to uterine rupture which may require hysterectomy and subsequent loss of fertility. We present a case report of a 24-year-old female G2P1L1with ruptured cesarean scar pregnancy who underwent emergency laparotomy and subsequently hysterectomy. In this case report, we aim to discuss ruptured cesarean scar pregnancy as obstetric emergency and methods by which we can make an early diagnosis that it can be managed appropriately so as to prevent maternal morbidity and mortality. Keywords: cesarean; hysterectomy; maternal mortality; pregnancy; scar; uterine rupture.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/diagnóstico , Ruptura Uterina/etiologia , Cicatriz/patologia , Feminino , Humanos , Histerectomia , Laparotomia , Gravidez , Gravidez Ectópica/cirurgia , Adulto Jovem
13.
Skinmed ; 17(3): 207-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496480

RESUMO

A 24-year-old man (Figure 1) and a 22-year-old woman (Figure 2) with atrophic acne scars were enrolled. Each patient underwent four sessions of treatment with intervals of 4 weeks consecutively, each consisting of microneedling followed by platelet-rich plasma (PRP) application on the right side of the face and microneedling alone on the left. Goodman's qualitative scale was used for the final evaluation of the results. The man had grade 4 acne scars on both sides of the face, which became grade 2 on the right side and grade 3 on the left side (Figure 3). The woman had grade 4 acne scars on both sides of the face, which diminished to grade 1 on the right side and grade 2 on the left side (Figure 4). Improvements were observed after the third treatment.


Assuntos
Cicatriz/patologia , Cicatriz/terapia , Técnicas Cosméticas , Plasma Rico em Plaquetas , Pele/patologia , Acne Vulgar/complicações , Atrofia/etiologia , Atrofia/terapia , Cicatriz/etiologia , Terapia Combinada , Feminino , Humanos , Masculino , Agulhas , Índice de Gravidade de Doença , Adulto Jovem
14.
Biomed Pharmacother ; 118: 109394, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545259

RESUMO

The renin-angiotensin system (RAS) plays an important role in scar formation. We have previously shown that oral administration of ramipril and losartan could inhibit scarring. For easier application, here we developed a series of topical ramipril and losartan creams in different concentrations and formulations to explore the effect on scar formation in a C57BL/6 mouse scar model. The harvested scar tissues were analyzed with H&E staining, Masson staining and immunohistochemical staining. We found the group treated with 0.2% losartan urea cream (Prep. 1) or 0.1% ramipril cream (Prep. 2) had significantly smaller scars compared to the negative control, while the proliferation of fibroblasts was less active and the collagen fibers were more regular; both groups showed similar efficacy with the positive control (triamcinolone acetonide urea). We also found that drug transdermalness couldn't directly determine the efficacy. Our findings indicate that local application of angiotensin converting enzyme inhibitor drugs (ACEIs) and angiotensin receptor blocker drugs (ARBs) can reduce scarring by reducing the expression of collagen I, collagen III, phosphorylated small mothers against decapentaplegic 3 (p-Smad3) and transforming growth factor-ß 1 (TGF-ß1). This may provide new insight on scar treatment in clinic.


Assuntos
Cicatriz/tratamento farmacológico , Losartan/administração & dosagem , Losartan/uso terapêutico , Ramipril/administração & dosagem , Ramipril/uso terapêutico , Creme para a Pele/uso terapêutico , Administração Tópica , Animais , Cicatriz/patologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/patologia , Losartan/farmacologia , Masculino , Camundongos Endogâmicos C57BL , Proteína Smad3/metabolismo , Suínos , Fator de Crescimento Transformador beta1/metabolismo
15.
Arch. Soc. Esp. Oftalmol ; 94(9): 453-459, sept. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186226

RESUMO

Se presenta un caso raro de una mujer caucásica de 29 años con un granuloma en una cicatriz antigua, en la región periocular derecha, como primer signo clínico de una sarcoidosis sistémica. Se procedió a una biopsia escisional de la lesión con diagnóstico anatomopatológico de inflamación crónica granulomatosa no necrosante, con características histológicas sugestivas de sarcoidosis de cicatriz. Al año, la lesión recidivó, por lo que se trató con esteroides depot intralesionales. Esta patología se produce con más frecuencia cuando existen cuerpos extraños y puede ser la primera señal de sarcoidosis sistémica


An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis


Assuntos
Humanos , Feminino , Adulto , Cicatriz/patologia , Dermatoses Faciais/diagnóstico , Granuloma de Corpo Estranho/patologia , Sarcoidose/diagnóstico , Anti-Inflamatórios/uso terapêutico , Biópsia , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/patologia , Traumatismos Faciais/complicações , Traumatismos Faciais/patologia , Granuloma de Corpo Estranho/diagnóstico por imagem , Granuloma de Corpo Estranho/etiologia , Imagem por Ressonância Magnética , Recidiva , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triancinolona Acetonida/uso terapêutico , Cicatrização
16.
Gynecol Oncol ; 155(1): 83-87, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31451293

RESUMO

BACKGROUND: Lymph node metastasis is the most important prognostic factor in patients with vulvar squamous cell carcinoma (SCC). Previous excision of the vulvar tumor may disrupt lymphatic channels and alter the accuracy of the sentinel lymph node (SLN) biopsy. The purpose of this study was to measure outcomes after SLN biopsy in patients with and without previous excision of the vulvar tumor. METHODS: Retrospective study of patients at a single institution with primary vulvar cancer, clinically negative nodes, and vulvar tumors < 4 cm treated with surgical excision who had SLN biopsy (2008-2015). RESULTS: There were 106 cases of concomitant wide local excision (WLE) and SLN biopsy and 24 additional cases of patients who had previous vulvar surgery and no visible tumor; these patients underwent scar re-excision and SLN biopsy. Median follow-up was 31 months. Patients who had previous tumor excision were more likely to be of younger age (p = 0.0001), have a smaller tumor (p = 0.002), and less depth of invasion (p = 0.02). In the wide local excision of the scar specimen, 11 patients (46%) had no residual disease left, 8 patients (33%) had only vulvar intraepithelial neoplasia (VINIII), 4 patients (17%) had carcinoma in situ with focal invasion and 1 patient (4%) had invasive carcinoma within the second specimen, resected with clear margins. There were no groin recurrences in patients who underwent scar re-excision and who had a negative SLN biopsy. CONCLUSION: SLN biopsy is feasible and safe in patients who have had previous excision of the vulvar tumor and present with a scar. When a SLN is detected by injecting the remaining scar, this accurately reflects the nodal status and does not negatively impact oncologic outcomes.


Assuntos
Carcinoma de Células Escamosas/patologia , Linfonodo Sentinela/patologia , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Cicatriz/patologia , Estudos de Coortes , Coloides , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Prognóstico , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Vulvares/diagnóstico por imagem , Neoplasias Vulvares/cirurgia
17.
J Minim Invasive Gynecol ; 26(5): 973-976, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256782

RESUMO

The first port entry in patient who underwent previous abdominal surgery. Palmer's point can be used in patients with suspected periumbilical adhesions, a history of an umbilical hernia, or multiple failed attempts of insufflations at the umbilicus. Palmer's point has its limitations in cases of left upper quadrant surgery, splenomegaly, portal hypertension, and improper nasogastric tube placement giving rise to a bloated stomach. In such cases, a new and safe point for laparoscopic entry is needed. In the present case of a patient who underwent previous upper abdominal surgery with the chevron incision obscuring Palmer's point, laparoscopic entry was made through a novel point that was found to be safe in such cases and can be used in similar cases of previously scarred abdomens.


Assuntos
Abdome/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Laparoscopia , Laparotomia/efeitos adversos , Hemorragia Uterina/cirurgia , Abdome/patologia , Cavidade Abdominal/cirurgia , Adulto , Cicatriz/patologia , Equinococose Hepática/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Instrumentos Cirúrgicos/efeitos adversos , Aderências Teciduais/cirurgia , Hemorragia Uterina/patologia
18.
Int J Mol Sci ; 20(14)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295813

RESUMO

Wound healing starts with the recruitment of inflammatory cells that secrete wound-related factors. This step is followed by fibroblast activation and tissue construction. Sphingosine-1-phosphate (S1P) is a lipid mediator that promotes angiogenesis, cell proliferation, and attracts immune cells. We investigated the roles of S1P in skin wound healing by altering the expression of its biogenic enzyme, sphingosine kinase-1 (SphK1). The murine excisional wound splinting model was used. Sphingosine kinase-1 (SphK1) was highly expressed in murine wounds and that SphK1-/- mice exhibit delayed wound closure along with less angiogenesis and inflammatory cell recruitment. Nanoparticle-mediated topical SphK1 overexpression accelerated wound closure, which associated with increased angiogenesis, inflammatory cell recruitment, and various wound-related factors. The SphK1 overexpression also led to less scarring, and the interaction between transforming growth factor (TGF)-ß1 and S1P receptor-2 (S1PR2) signaling is likely to play a key role. In summary, SphK1 play important roles to strengthen immunity, and contributes early wound healing with suppressed scarring. S1P can be a novel therapeutic molecule with anti-scarring effect in surgical, trauma, and chronic wound management.


Assuntos
Cicatriz/metabolismo , Lisofosfolipídeos/metabolismo , Neovascularização Fisiológica , Pele/metabolismo , Esfingosina/análogos & derivados , Cicatrização , Animais , Biomarcadores , Proliferação de Células , Cicatriz/genética , Cicatriz/patologia , Modelos Animais de Doenças , Expressão Gênica , Granuloma/etiologia , Granuloma/metabolismo , Granuloma/patologia , Inflamação/etiologia , Inflamação/metabolismo , Inflamação/patologia , Camundongos , Camundongos Knockout , Neovascularização Fisiológica/genética , Fosfotransferases (Aceptor do Grupo Álcool)/genética , Fosfotransferases (Aceptor do Grupo Álcool)/metabolismo , Pele/lesões , Pele/patologia , Esfingosina/metabolismo , /metabolismo , Cicatrização/genética
19.
Turk Neurosurg ; 29(3): 440-444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31270796

RESUMO

AIM: To clarify the effects of topical application of curcumin on the prevention of epidural fibrosis. MATERIAL AND METHODS: Twenty-one rats were randomly divided into three equal groups (control, spongostan, local curcumin) and a laminectomy procedure was performed between T11 and L1 in all rats. Subsequently, spongostan soaked with curcumin (100 mg/kg) was applied topically. After four weeks, the vertebral column from T9 to L3, which included the paraspinal muscles and epidural scar tissue, was removed as a single piece and the epidural fibrosis and arachnoidal scarring were graded and histopathological analysis carried out accordingly. Kruskal-Wallis and Pearson Chi-Square tests were used for statistical analysis. A p-value of less than 0.05 was considered to be significant. RESULTS: The grading of epidural fibrosis was far lower in the experimental group with curcumin compared to the control and spongostan groups, but the difference was not statistically significant. CONCLUSION: The findings of this study show that local curcumin decreases the formation of epidural fibrosis and this effect of curcumin is thought to be mediated by reducing the functions of inflammatory cells such as macrophages, neutrophils and fibroblasts, and the anti-inflammatory and antioxidant effects.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Curcumina/farmacologia , Espaço Epidural/efeitos dos fármacos , Espaço Epidural/patologia , Laminectomia/efeitos adversos , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Cicatriz/tratamento farmacológico , Cicatriz/etiologia , Cicatriz/patologia , Curcumina/uso terapêutico , Feminino , Fibrose/tratamento farmacológico , Fibrose/etiologia , Fibrose/patologia , Laminectomia/tendências , Modelos Animais , Ratos , Ratos Wistar , Resultado do Tratamento
20.
J Pediatr Ophthalmol Strabismus ; 56(4): 254-260, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322717

RESUMO

PURPOSE: To determine whether suturing to the residual muscle stump induces postoperative muscle migration after superior rectus muscle (SRM) resection in rabbit eyes. METHODS: Twenty-four eyes in 12 rabbits were randomly divided into two groups. Each group underwent a 3-mm SRM resection. The muscle stump was not removed in one randomly assigned eye in each rabbit and the resected muscle was sutured to the residual muscle stump (residual muscle stump group). In the other eye, the muscle stump was completely removed and the resected muscle was sutured to the original insertion site (control group). At postoperative weeks 1, 2, and 4, the distances between the most anterior aspect of the reattached muscle and the corneal limbus were measured. Histopathologic differences at the new attachment sites were assessed between the two groups at postoperative week 4. RESULTS: The mean distance between the corneal limbus and SRM was 2.97 ± 1.00 mm in the residual muscle stump group and 1.99 ± 0.40 mm in the control group at postoperative week 2 (P = .026) and 3.14 ± 0.78 mm in the residual muscle stump group and 1.81 ± 0.44 mm in the control group at postoperative week 4 (P = .002). Connective tissue, fibrosis, and myofibroblast proliferation in the front of the SRM were identified based on histopathologic findings. CONCLUSIONS: Postoperative loosening associated with a stretched scar frequently occurred in cases with suturing to the residual muscle during rectus muscle resection and could result from fibrosis and connective tissue proliferation in front of the rectus muscle. [J Pediatr Ophthalmol Strabismus. 2019;56(4):254-260.].


Assuntos
Cicatriz/etiologia , Músculos Oculomotores/cirurgia , Complicações Pós-Operatórias , Estrabismo/cirurgia , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos , Animais , Cicatriz/patologia , Modelos Animais de Doenças , Músculos Oculomotores/diagnóstico por imagem , Coelhos
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