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2.
Int J Mol Sci ; 22(16)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34445347

RESUMO

Clostridium collagenase has provided superior clinical results in achieving digestion of immediate and accumulating devitalized collagen tissue. Recent studies suggest that debridement via Clostridium collagenase modulates a cellular response to foster an anti-inflammatory microenvironment milieu, allowing for a more coordinated healing response. In an effort to better understand its role in burn wounds, we evaluated Clostridium collagenase's ability to effectively minimize burn progression using the classic burn comb model in pigs. Following burn injury, wounds were treated with Clostridium collagenase or control vehicle daily and biopsied at various time points. Biopsies were evaluated for factors associated with progressing necrosis as well as inflammatory response associated with treatment. Data presented herein showed that Clostridium collagenase treatment prevented destruction of dermal collagen. Additionally, treatment with collagenase reduced necrosis (HMGB1) and apoptosis (CC3a) early in burn injuries, allowing for increased infiltration of cells and protecting tissue from conversion. Furthermore, early epidermal separation and epidermal loss with a clearly defined basement membrane was observed in the treated wounds. We also show that collagenase treatment provided an early and improved inflammatory response followed by faster resolution in neutrophils. In assessing the inflammatory response, collagenase-treated wounds exhibited significantly greater neutrophil influx at day 1, with macrophage recruitment throughout days 2 and 4. In further evaluation, macrophage polarization to MHC II and vascular network maintenance were significantly increased in collagenase-treated wounds, indicative of a pro-resolving macrophage environment. Taken together, these data validate the impact of clostridial collagenases in the pathophysiology of burn wounds and that they complement patient outcomes in the clinical scenario.


Assuntos
Queimaduras , Colagenases/uso terapêutico , Desbridamento/métodos , Cicatrização/efeitos dos fármacos , Animais , Queimaduras/tratamento farmacológico , Queimaduras/patologia , Clostridium/enzimologia , Colagenases/farmacologia , Modelos Animais de Doenças , Feminino , Necrose/tratamento farmacológico , Necrose/etiologia , Pele/efeitos dos fármacos , Pele/patologia , Suínos
3.
Nat Commun ; 12(1): 4402, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285231

RESUMO

Acute kidney injury (AKI) is morphologically characterized by a synchronized plasma membrane rupture of cells in a specific section of a nephron, referred to as acute tubular necrosis (ATN). Whereas the involvement of necroptosis is well characterized, genetic evidence supporting the contribution of ferroptosis is lacking. Here, we demonstrate that the loss of ferroptosis suppressor protein 1 (Fsp1) or the targeted manipulation of the active center of the selenoprotein glutathione peroxidase 4 (Gpx4cys/-) sensitize kidneys to tubular ferroptosis, resulting in a unique morphological pattern of tubular necrosis. Given the unmet medical need to clinically inhibit AKI, we generated a combined small molecule inhibitor (Nec-1f) that simultaneously targets receptor interacting protein kinase 1 (RIPK1) and ferroptosis in cell lines, in freshly isolated primary kidney tubules and in mouse models of cardiac transplantation and of AKI and improved survival in models of ischemia-reperfusion injury. Based on genetic and pharmacological evidence, we conclude that GPX4 dysfunction hypersensitizes mice to ATN during AKI. Additionally, we introduce Nec-1f, a solid inhibitor of RIPK1 and weak inhibitor of ferroptosis.


Assuntos
Injúria Renal Aguda/patologia , Ferroptose/fisiologia , Túbulos Renais/patologia , Traumatismo por Reperfusão/patologia , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/etiologia , Animais , Proteínas Reguladoras de Apoptose/genética , Proteínas Reguladoras de Apoptose/metabolismo , Cisplatino/administração & dosagem , Cisplatino/toxicidade , Modelos Animais de Doenças , Células Epiteliais , Feminino , Ferroptose/efeitos dos fármacos , Técnicas de Silenciamento de Genes , Células HT29 , Transplante de Coração/efeitos adversos , Humanos , Imidazóis/química , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Indóis/química , Indóis/farmacologia , Indóis/uso terapêutico , Masculino , Camundongos , Camundongos Transgênicos , Microssomos Hepáticos , Proteínas Mitocondriais/metabolismo , Células NIH 3T3 , Necrose/tratamento farmacológico , Necrose/etiologia , Necrose/patologia , Oxirredutases/genética , Oxirredutases/metabolismo , Fosfolipídeo Hidroperóxido Glutationa Peroxidase/antagonistas & inibidores , Fosfolipídeo Hidroperóxido Glutationa Peroxidase/metabolismo , Cultura Primária de Células , Proteína Serina-Treonina Quinases de Interação com Receptores/antagonistas & inibidores , Proteína Serina-Treonina Quinases de Interação com Receptores/metabolismo , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/etiologia
4.
Microsurgery ; 41(7): 671-675, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34156111

RESUMO

The medial tarsal area is a commonly used donor site for skin grafts to the digits and toes, with good color and texture match as well as a concealable donor site scar. Yet, there has been no report as a perforator free flap donor site. The purpose of this report is to present a new perforator flap harvested from medial tarsal region. We present a case of a soft tissue defect of the fifth toe due to essential thrombocythemia (ET), successfully treated with a free medialis tarsus flap (MTF) transfer. A 62-year-old male with ET suffered from the right fifth toe necrosis caused by digital artery thrombosis. After the manifestation of the necrosis, necrotic tissue was completely debrided, which resulted in a 3 × 1.5 cm skin defect with exposure of the tendon and the phalangeal bone. Sixth days after debridement, a 4.5 × 1.7 cm MTF was harvested transversely and inferiorly to the right medial ankle, locating the preoperatively detected posterior tibial artery perforator (PTAP) in the flap. Perforator-to-perforator anastomosis was done using the dorsal metatarsal artery perforator and the subcutaneous vein as recipient vessels. The donor site was closed primarily. Postoperative course was uneventful, and the reconstruction preserved the toe length and functions of extension and flexion at 9 months postoperatively. The patient could walk with conventional shoes by himself. MTF may be an option for small skin defect in the digits and toes where skin graft is not indicated.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Tornozelo , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/cirurgia , Lesões dos Tecidos Moles/cirurgia , Dedos do Pé/cirurgia
5.
Toxins (Basel) ; 13(5)2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-34067062

RESUMO

Local tissue swelling, inflammation, and wound necrosis are observed in Taiwan cobra bites. Knowledge of the factors influencing local tissue necrosis after cobra bites might improve the cobra bite treatment strategy. Therefore, we aimed to explore the factors influencing local tissue necrosis after cobra bites. This was a retrospective observational cohort study. All patients clinical presentations including serum venom levels for determining the influential factors in this study were obtained from Hung et al.'s previous study. Clinical features, such as bite information, initial swelling, patient presentation time, serum venom levels, and antivenom, use were extracted. The measurement outcome was the development of wound necrosis. The factors influencing wound necrosis were investigated using univariate and logistic regression analyses. The influential factors of local tissue necrosis and their areas under the curve were: initial limb swelling, 0.88; presentation time × serum level, 0.80; initial necrosis, 0.75; patient presentation time, 0.70. Serum venom level alone cannot be used as a predictive factor. The development of tissue necrosis might be associated with the venom factor, time factor, and their interaction. These influential factors can be used in future studies to evaluate antivenom efficacy.


Assuntos
Antivenenos/administração & dosagem , Venenos Elapídicos/toxicidade , Mordeduras de Serpentes/complicações , Adulto , Animais , Estudos de Coortes , Elapidae , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Estudos Retrospectivos , Mordeduras de Serpentes/patologia , Mordeduras de Serpentes/terapia , Taiwan
6.
Facial Plast Surg ; 37(4): 543-549, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34082455

RESUMO

Vascular compromise leading to cutaneous loss following surgical rhinoplasty is a devastating complication. The objective of this review is to identify all reported cases in literature published in English and summarize the current evidence to identify the patients at risk of this complication following surgery. A comprehensive literature review using Medline and Embase databases was performed to capture all reported cases of cutaneous vascular compromise following rhinoplasty from database inception through September 2020. Nonsurgical rhinoplasty cases were excluded. We identified eight studies that featured vascular cutaneous compromise following surgical rhinoplasty. A total of 18 patients were included in the analysis. The majority of the patients were females with a mean age of 30.9. Risk factors included smoking in 23.5% patients and revision setting. Extensive tip thinning, tight splinting and taping with dorsal onlay grafting, or combining extended alar base excision with revision open rhinoplasty were among surgical techniques associated with vascular compromise. The most commonly affected aesthetic nasal subunit in our review was the dorsum followed by the nasal tip. Conservative management primarily was utilized in 72.2% of patients, allowing the defect to heal by secondary intention. Studies reporting on cutaneous vascular compromise following surgical rhinoplasty are of low level of evidence. This review is the largest summary reporting on this complication to date, aiming to caution surgeons about associated techniques and management options. We also share an expert opinion on preoperative assessment of nasal skin to guide surgeons to potentially avoid rhinoplasty surgery in this subset of patients.


Assuntos
Rinoplastia , Estética Dentária , Feminino , Humanos , Necrose/etiologia , Nariz/cirurgia , Reoperação , Rinoplastia/efeitos adversos
7.
Isr Med Assoc J ; 23(6): 373-375, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34155851

RESUMO

BACKGROUND: Surgical interventions in patients with systemic sclerosis (SSc), in particular plastic procedures, might cause undesired consequences. Notably, liposuction seems to possess greater risk as adipose tissue has been shown to play an important role in treating wounds and ulcers in patients with SSc. While anticentromere antibodies were found to be correlated with vasculopathy in SSc, patients with SSc and anticentromere antibodies might be more vulnerable to surgical wound complications following liposuction. A 46-year-old female patient, who had been diagnosed with SSc at the age of 31 years, had antinuclear as well as anticentromere antibodies. She underwent abdominoplasty with liposuction and developed severe skin necrosis of the abdomen following the procedure and at the site of liposuction. The correlation with anticentromere and the role of liposuction in skin necrosis in SSc are presented.


Assuntos
Abdominoplastia , Tecido Adiposo/imunologia , Obesidade Abdominal/cirurgia , Escleroderma Sistêmico , Pele/patologia , Deiscência da Ferida Operatória , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Anticorpos Antinucleares/sangue , Cicatriz/diagnóstico , Cicatriz/etiologia , Contraindicações de Procedimentos , Feminino , Humanos , Lipectomia/efeitos adversos , Lipectomia/métodos , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/imunologia , Necrose/cirurgia , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico , Reoperação/efeitos adversos , Reoperação/métodos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/imunologia , Escleroderma Sistêmico/cirurgia , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Resultado do Tratamento
9.
Plast Reconstr Surg ; 148(1): 100-107, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34014864

RESUMO

BACKGROUND: Near-infrared spectroscopy can detect changes in tissue oxygenation postoperatively that predict flap necrosis. The authors hypothesized that this technology can be applied along with topical nitroglycerin to measure an improvement in tissue oxygenation that correlates with tissue salvage. METHODS: Dorsal, random pattern flaps measuring 10 × 3 cm were raised using Sprague-Dawley rats. Tissue oxygenation was measured after flap elevation in 10 locations using the ViOptix Intra.Ox. Animals were divided into three groups that received 30 mg of topical nitroglycerin daily, twice-daily, or not at all. Oxygenation measurements were repeated on postoperative day 1 and animals were euthanized on day 7 and evaluated for tissue necrosis. RESULTS: Tissue necrosis was greatest in controls (51.3 mm) compared to daily (28.8 mm) and twice-daily nitroglycerin (18.8 mm; p = 0.035). Three flap perfusion zones were identified: healthy (proximal, 50 mm), necrotic (distal, 20 mm), and watershed. Immediate postoperative tissue oxygenation was highest in healthy tissue (57.2 percent) and decreased to 33.0 and 19.3 percent in the watershed and necrotic zones, respectively (p < 0.001). One day after treatment with nitroglycerin, oxygenation in the healthy zone did not increase significantly (mean difference, -1.5 percent). The watershed (17.8 percent; p < 0.001) and necrotic zones (16.3 percent; p <0.001) did exhibit significant improvements that were greater than those measured in control tissues (7.9 percent; both p < 0.001). CONCLUSIONS: Serial perfusion assessment using the ViOptix Intra.Ox measured a significant improvement in flap oxygenation after treatment with topical nitroglycerin. Within the watershed area of the flap, this increase in tissue oxygenation was associated with the salvage of ischemic tissue.


Assuntos
Sobrevivência de Enxerto/efeitos dos fármacos , Nitroglicerina/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Terapia de Salvação/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Animais , Modelos Animais de Doenças , Humanos , Necrose/diagnóstico , Necrose/tratamento farmacológico , Necrose/etiologia , Oxigênio/análise , Oxigênio/metabolismo , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Ratos , Fluxo Sanguíneo Regional/efeitos dos fármacos , Espectroscopia de Luz Próxima ao Infravermelho , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos/transplante
12.
Medicine (Baltimore) ; 100(20): e25659, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011027

RESUMO

ABSTRACT: Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.


Assuntos
Amputação/estatística & dados numéricos , Dedos/irrigação sanguínea , Isquemia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolia/complicações , Embolia/epidemiologia , Feminino , Dedos/patologia , Dedos/cirurgia , Seguimentos , Humanos , Doença Iatrogênica/epidemiologia , Isquemia/epidemiologia , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/epidemiologia , Pessoa de Meia-Idade , Necrose/epidemiologia , Necrose/etiologia , Necrose/cirurgia , Neoplasias/complicações , Neoplasias/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Taxa de Sobrevida , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/epidemiologia , Trombose/complicações , Trombose/epidemiologia , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia
14.
BMC Pregnancy Childbirth ; 21(1): 296, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845786

RESUMO

BACKGROUND: Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF is characterized by yellow-white bands running parallel to the umbilical blood vessels. These bands consist of inflammatory cells, necrotic debris, and calcium deposits. Calcification is visible in ultrasonography, which makes it possible to suspect NF when umbilical vascular wall calcification is detected by prenatal ultrasonography. CASE PRESENTATION: Ultrasonography revealed calcification of the umbilical venous wall in an expectant 31-year-old woman who was gravida 1, para 0. The woman required emergency cesarean section because of fetal distress and suspected umbilical cord torsion at 31 weeks gestation. The root of the umbilical cord was quite fragile and broke during the operation. The pathological results on the placenta showed histologic chorioamnionitis and NF. The infant was diagnosed to have neonatal sepsis and acidosis after delivery but was discharged without severe complications after a one-month hospitalization that included antibiotic and supportive therapy. CONCLUSION: NF is a rare and severe inflammation of the umbilical cord. Umbilical vascular wall calcification discovered in prenatal ultrasonography is diagnostically helpful.


Assuntos
Corioamnionite/diagnóstico , Cordão Umbilical/patologia , Calcificação Vascular/diagnóstico , Adulto , Cesárea , Corioamnionite/patologia , Corioamnionite/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Necrose/diagnóstico , Necrose/etiologia , Gravidez , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Cordão Umbilical/irrigação sanguínea , Cordão Umbilical/diagnóstico por imagem , Veias Umbilicais/diagnóstico por imagem , Veias Umbilicais/patologia , Calcificação Vascular/complicações
16.
Anaesth Intensive Care ; 49(2): 133-139, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33832336

RESUMO

Published reports of uvular necrosis are uncommon and it is possibly an under-reported complication of oropharyngeal manipulation. Uvular necrosis is thought to develop due to ischaemia secondary to mechanical compression of the uvula from oropharyngeal devices. Patients typically present with symptoms of a sore throat within 48 hours postoperatively. It is unclear whether there are any preventable factors, or any specific management strategies that might reduce this complication. Treatment is most commonly conservative management, including observation and simple analgesia. We present 13 cases of uvular injury that were reported to a web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand. While the postoperative findings varied, sore throat was the most frequent symptom. Most of the cases resolved spontaneously; the remainder with supportive treatment only. The findings suggest that patients who sustain a uvular injury can be reassured, but they should be advised to seek review early if sore throat persists or any difficulty with breathing develops.


Assuntos
Anestesia , Máscaras Laríngeas , Faringite , Austrália , Humanos , Doença Iatrogênica , Internet , Necrose/etiologia , Nova Zelândia , Faringite/etiologia , Complicações Pós-Operatórias , Gestão de Riscos , Úvula
18.
Wounds ; 33(4): 99-105, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33872203

RESUMO

INTRODUCTION: The COVID-19 virus is caused by the new coronavirus, SARS-CoV-2. COVID-19 has drastically changed the medical landscape. Although predominantly impacting the respiratory system, COVID-19 has several non-respiratory symptoms associated with its presentation and course. Among these are gastrointestinal symptoms and thromboembolic events with stroke. Increasingly recognized, but often overlooked, are the coagulopathy phenomena occurring with COVID-19. The severe respiratory symptoms are the primary focus of clinical management. However, close inspection of patients demonstrates that patients often exhibit both thromboembolic and bleeding events, ranging from simple skin lesions to overt emergencies. CASE REPORT: The author presents a case of COVID-19-associated coagulopathy resulting in compartment syndrome of the arm with volar forearm necrosis, requiring flap reconstruction and tendon transfer to salvage the upper extremity. CONCLUSIONS: Massive rhabdomyolysis resulted in acute tubular necrosis with renal failure requiring hemodialysis. The timing of reconstruction of the sequelae of compartment syndrome in an acutely ill patient is challenging, but optimal timing can result in a successful outcome.


Assuntos
COVID-19/complicações , Síndromes Compartimentais/cirurgia , Pandemias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , COVID-19/epidemiologia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Antebraço , Humanos , Masculino , Necrose/diagnóstico , Necrose/etiologia , Necrose/cirurgia , SARS-CoV-2
19.
BMJ Case Rep ; 14(3)2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692050

RESUMO

We report a case of walled off pancreatic necrosis in a patient with alcoholic pancreatitis who underwent endoscopic ultrasound-guided multiple pigtail catheter drainage. 10 days later patient presented with massive haemorrhage likely due to erosion of portal vein pseudoaneurysm caused by decubitus of pigtails. Patient required emergent portal venorrhaphy to arrest haemorrhage.


Assuntos
Falso Aneurisma , Pancreatite Necrosante Aguda , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Drenagem , Endossonografia , Humanos , Necrose/etiologia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Stents
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