Conducted healing to treat large skin wounds.

BACKGROUND: Improvement of the healing process to provide better aesthetical and functional results continues to be a surgical challenge. This study compared the treatment of skin wounds by means of conducted healing (an original method of treatment by secondary healing) and by the use of autogenous skin grafts. METHOD: Two skin segments, one on each side of the dorsum,were removed from 17 rabbits. The side that served as a graft donor site was left open as to undergo conducted healing (A)and was submitted only to debridement and local care with dressings. The skin removed from the side mentioned above was implanted as a graft (B) to cover the wound on the other side. Thus, each animal received the two types of treatment on its dorsum (A and B). The rabbits were divided into two groups according to the size of the wounds: Group 1 - A and B (4 cm2)and Group 2 - A and B (25 cm2). The healing time was 19 days for Group 1 and 35 days for Group 2. The final macro- and microscopic aspects of the healing process were analysed comparatively among all subgroups. The presence of inflammatory cells, epidermal cysts and of giant cells was evaluated. RESULTS: No macro- or microscopic differences were observed while comparing the wounds that underwent conducted healing and those in which grafting was employed, although the wounds submitted to conducted healing healed more rapidly. CONCLUSIONS: Conducted wound healing was effective for the treatment of skin wounds.

Enhanced Eu3+ emission in aqueous phosphotungstate colloidal systems: stabilization of polyoxometalate nanostructures.

Luminescent Eu(3+)-containing polyphosphate-tungstate aqueous colloidal systems were prepared and studied as a function of the relative polyphosphate-tungstate content. In polyphosphate-rich solutions, Eu(3+) ions occupy cagelike sites composed of phosphate groups from the metaphosphate chains. In these sites, an average number of 0.5 water molecule coordinates to an Eu(3+) ion and the (5)D(0) emission quantum efficiency is 0.22. Tungstate addition leads to important modifications in neighboring Eu(3+) leading to coordination sites in the aqueous medium where metal ions are completely hidden from interactions with solvent molecules. Transmission electron microscopy results clearly show W-rich nanoparticles with sizes between 5 and 10 nm for all tungstate relative concentrations. For high tungstate relative contents (above 30 mol %), spectroscopic results suggest the presence of Eu(3+) in polyoxometalate (POM)-like sites by comparison with the well-known decatungstoeuropate [EuW(10)O(36)](9-) structure. These new aqueous colloids display surprisingly high (5)D(0) emission quantum efficiencies of ca 80% because of the strong ligand field provided by tungstate POM ligands and the complete absence of water molecules from the Eu(3+) first coordination shell.

Ghrelin plasma levels, gastric ghrelin cell density and bone mineral density in women with rheumatoid arthritis.

Generalized bone loss can be considered an extra-articular manifestation of rheumatoid arthritis (RA) that may lead to the occurrence of fractures, resulting in decreased quality of life and increased healthcare costs. The peptide ghrelin has demonstrated to positively affect osteoblasts in vitro and has anti-inflammatory actions, but the studies that correlate ghrelin plasma levels and RA have contradictory results. We aimed to evaluate the correlation between total ghrelin plasma levels, density of ghrelin-immunoreactive cells in the gastric mucosa, and bone mineral density (BMD) in twenty adult women with established RA with 6 months or more of symptoms (mean age of 52.70±11.40 years). Patients with RA presented higher ghrelin-immunoreactive cells density in gastric mucosa (P=0.008) compared with healthy females. There was a positive relationship between femoral neck BMD and gastric ghrelin cell density (P=0.007). However, these same patients presented a negative correlation between plasma ghrelin levels and total femoral BMD (P=0.03). The present results indicate that ghrelin may be involved in bone metabolism of patients with RA. However, the higher density of ghrelin-producing cells in the gastric mucosa of these patients does not seem to induce a corresponding elevation in the plasma levels of this peptide.

Coconut water solutions for the preservation of spleen, ovary, and skin autotransplants in rats.

BACKGROUND: The purpose of this study was to evaluate the efficacy of coconut water in the preservation of spleen, ovary, and skin autotransplantations in rats. METHODS: Fifty female Wistar rats were divided randomly into 5 groups on the basis of the following tissue graft preservation solutions: group 1, lactated Ringer's; group 2, Belzer's solution; group 3, mature coconut water; group 4, green coconut water; and group 5, modified green coconut water. In group 5, the green coconut water solution was modified to obtain the same electrolyte composition as Belzer's solution. The spleen, ovaries, and a skin fragment were removed from each animal, stored for 6 hours in one of the solutions, and then re-implanted. The recoveries of tissue functions were assessed 90 days after surgery by means of spleen scintigraphy and blood tests. The implanted tissues were collected for histological analyses. RESULTS: Higher immunoglobulin G levels were observed in the animals of group 5 than in the animals of group 1. Differences in follicle-stimulating hormone levels were observed between groups 1 and 2 (P < .001), between groups 4 and 2 (P = .03), and between groups 5 and 2 (P = .01). The spleen scintigraphy results did not differ among the groups. The ovarian tissue was better preserved in the mature coconut water group (P < .007). CONCLUSIONS: Solutions containing coconut water allowed for the preservation of the spleen, ovaries, and skin for 6 hours, and the normal functions of these tissues were maintained in rats.

Carcinoid tumors frequently display genetic abnormalities involving chromosome 11.

Carcinoid tumors are neuroendocrine neoplasms that are encountered either sporadically or as part of a familial syndrome, most notably-multiple endocrine neoplasia type 1 (MEN1). The MEN1 gene localizes to chromosome 11 (11q13) and presumably functions as a tumor suppressor gene. The molecular mechanisms underlying carcinoid tumor development and their clonal composition remain largely unknown. To establish whether carcinoid tumors develop via a mechanism similar to other MEN1-associated tumors, and indirectly determine their clonal composition, we analyzed 36 sporadically occurring carcinoid tumors with 16 chromosome 11 microsatellite markers, mostly from around the MEN1 region for loss of heterozygosity (LOH). Twenty one tumors (58%) displayed LOH of at least three markers, five lost almost an entire allele and the rest displayed a discontinuous pattern. Similar, but less extensive analysis was also carried out for 10 additional carcinoid tumors from Brazil, 6 of the 10 showed LOH with at least one marker. Overall, 36 of 46 tumors (78%) displayed LOH. In addition, 20 of 46 (43%) tumors exhibited a pattern of genomic instability. Thus, the majority of sporadically occurring carcinoid tumors are monoclonal whose tumorigenesis involves inactivation of a tumor suppressor gene on chromosome 11 and DNA mismatch repair genes mutations.

Topical application of benzalkonium chloride to the stomach serosa increases gastric emptying time, acid secretion, serum gastrin and size of the mucosa.

AIM: In the present study we evaluated the effects of gastric myenteric denervation using benzalkonium chloride (BAC) on the time for gastric emptying, as well as gastric secretion, and mucosal epithelial cell size and population in rats. METHODS AND RESULTS: Wistar rats were treated with topical serosal application of BAC to the stomach. Control animals received saline. Ninety days after surgery, gastric emptying time, gastric acid secretion and serum gastrin levels were studied. Next, the animals were sacrificed and the stomachs were removed, fixed in formalin and histologically processed for histomorphometry of the height, area and volume of the glandular portion, and volume and population of mucous, chief, parietal, G- and labelled cells. BAC animals showed a significant delay in gastric emptying and an increase in gastric acid secretion and serum gastrin levels. These animals also presented a significant reduction of myenteric neuron number, hypertrophy of parietal and chief cells, hyperplasia of G cells and an increase in the gastric mucosa area. CONCLUSION: The absence of the myenteric plexus seems to protect the stomach from the hyperplastic effects of hypergastrinemia. Gastric food stasis may act as a factor triggering morphological and functional alterations of the gastric epithelium. Although gastric food stasis is a common finding in medical practice, its physiopathological consequences are poorly understood and have not been frequently discussed in the literature.

Prevalence of Helicobacter pylori in Brazilian patients with gastric carcinoma.

Investigators have speculated on the role of Helicobacter pylori in gastric carcinogenesis. The current study was performed to evaluate prospectively the prevalence of H. pylori infection in the stomachs of Brazilian patients with gastric carcinoma. Forty patients receiving gastrectomy for gastric carcinoma were studied. H. pylori was examined in four areas without atrophy or with minor atrophic changes. Mucosal fragments were obtained for microbiologic studies in 19 cases. H. pylori was detected in 82.5% of the cases. Of the cases evaluated by histologic and microbiologic methods, 94% had positive results by at least one method. In most cases there were small numbers of microorganisms. There was no correlation between the site and histologic type of neoplasia and the presence of H. pylori. The use of more than one diagnostic method improves H. pylori detection in gastric carcinoma. The small number of microorganisms observed in gastric carcinoma cases may lead to an underestimate of H. pylori in histologic sections. This might explain the variation in H. pylori infection rates reported for patients with gastric carcinoma.

Helicobacter pylori and gastric histamine concentrations.

An enzyme isotopic assay was used to determine the histamine concentration in the gastric mucosa of patients positive for Helicobacter pylori with (n = 11) and without duodenal ulceration (n = 9) and in negative controls (n = 7). A significant difference was observed when the histamine content of H pylori negative subjects was compared with that of positive patients. On the other hand, there was no significant difference in histamine concentration between H pylori positive patients with duodenal ulceration and those without duodenal ulceration. H pylori positive patients with and without duodenal ulceration had significantly lower gastric histamine concentrations than H pylori negative subjects. The lower gastric histamine concentration observed in H pylori positive patients might be due to increased histamine release which could in turn induce increased gastric acid secretion.

Experimental infection of Wistar rats with 'Gastrospirillum suis'.

In order to develop a model for the study of gastric spiral bacteria, and based on the observation that Wistar rats do not carry urease-positive spiral bacteria in their gastric mucosa, mucus from a pig naturally colonised by 'Gastrospirillum suis' (an organism with I6S rDNA 99.5% similar to that of 'G. hominis' type 1), was inoculated into 35 Wistar rats (test group). Fourteen rats were given mucus taken from 'G. suis'-negative swine (control group). Five test animals and two controls were killed 1, 2, 4, 8, 12, 26, and 52 weeks after inoculation. 'G. suis' was observed in the antral mucosa of all test rats but not in the gastric mucosa of any control animal. The number of organisms was high from the beginning of the infection and increased over the period of observation. The bacteria were seen deep in the gastric antral glands, especially in the advanced stages of infection. Histological study of two test rats killed 1 week after inoculation and of all rats killed from the second week after infection revealed the presence of a mild inflammatory response characterised by the infiltration of small numbers of mononuclear cells and scarce polymorphonuclear cells in the subglandular region of the antral mucosa. Lymphoid aggregates were observed in the antral mucosa of rats killed from 1 month onwards, and increased in size and number over the period of infection. Control animals did not have any histological changes in the gastric mucosa. The natural transmission of the bacterium from rat to rat was also investigated. Five non-inoculated animals (contact group) and rats of the test group were maintained in the same cage and killed after 12 weeks. Two animals of the contact group showed slight infiltration of mononuclear cells in the antral mucosa, although they were not colonised by 'G. suis', a finding that supports the hypothesis of faecal-oral transmission of gastric Helicobacter spp. This animal model could be used not only to understand different aspects of the relationship between spiral bacteria and the gastric mucosa but also to obtain large numbers of the organism, free from other spiral bacteria to study some of its properties.

Histopathological study of porcine gastric mucosa with and without a spiral bacterium ("Gastrospirillum suis").

Tightly spiralled bacteria ("Gastrospirillum suis") were seen in the pyloric mucosa of the stomach of 13 (10.8%) of 120 pigs that appeared clinically healthy at slaughter and in the fundic mucosa of three (5.0%) out of 60 pigs. The spiral organism could not be cultured from any pig. Chronic gastritis was observed in the pyloric mucosa of 53 (44.2%) of 120 pigs and in the fundic mucosa of 7 (11.7%) of 60 pigs. The 13 pigs with spiral bacteria in the pyloric region comprised one animal (7.7%) with normal pyloric mucosa, two (15.4%) with "borderline gastritis", and 10 (76.9%) with chronic gastritis--in one instance accompanied by signs of activity (numerous polymorphonuclear cells). The three pigs with spiral bacteria in the fundic mucosa comprised two animals with a normal fundic region and one with "borderline gastritis". The presence of the spiral bacterium was significantly associated with pyloric gastritis (p = 0.013) and with numbers of lymphoid follicles (p = 0.014).

Scorpion sting-induced pulmonary oedema: evidence of increased alveolocapillary membrane permeability.

A 16-year-old boy died with acute pulmonary oedema and shock after Tityus serrulatus scorpion sting. The patient showed evidence of cardiac dysfunction and damage, an increase in tracheobronchial aspirate/plasma protein concentration, light microscopic features of the lung compatible with the adult respiratory distress syndrome and electron microscopic findings compatible with acute lung injury and increased alveolocapillary membrane permeability.

A spiral microorganism in the stomach of pigs.

Light and electron microscopic and microbiologic evaluations were performed on mucosa of stomachs from 120 healthy slaughtered pigs. Helicobacter pylori was not found, but a tightly spiralled bacterium, not previously described, was seen in histological sections and/or in carbol fuchsin stained smears in 13 (10.8%) stomachs. In paraffin sections stained with carbol fuchsin, the bacteria were seen in the mucus of the lumen of the antral pits and in the mucosa surface within and beneath the mucus. In this sections of Polilyte embedded tissue the bacteria had three to eight spiral turns per cell (mean = five), flattened ends, a Gram-negative cell-wall structure and a sheathed flagella. The urease test was positive in gastric mucosa of 13 bacteria-positive pigs (10.8%). The microorganism was not cultured and did not cross-react with polyclonal antibodies raised in rabbits against H. pylori. Superficial chronic gastritis and "borderline" gastritis were observed in antral mucosa of 10 (76.9%) and of two (15.4%) spiral bacteria-positive pigs, respectively.

Experimental reconstruction of anterior and circumferential defects of the cervical trachea.

Despite the variety of materials employable in the rehabilitation of the cervical trachea, long-term success is rarely achieved. Both gross and microscopic postoperative developments were studied on 45 dogs submitted to nine different types of reconstruction of anterior and circumferential defects. In the majority of cases, the grafts and prostheses used for repairs, enveloped by connective and inflammatory tissue, were either absorbed or expelled. Only pedicled autologous grafts survived rejection. Failure of tracheal replacements appears to be confined to tracheal and local phenomena. Such events impaired the incorporation of any type of graft or prosthesis.

Immunocytochemical identification of Campylobacter pylori in gastritis and correlation with culture.

Endoscopic biopsy specimens of antral mucosa from 25 patients presenting with gastric complaints were obtained for culture and histologic and immunocytochemical studies. The histopathologic study revealed chronic gastritis in 22 patients and borderline chronic gastritis in three patients. The unlabeled-antibody peroxidase-antiperoxidase (PAP) method was applied for the detection of Campylobacter pylori, and its results were compared with those obtained with the culture technique. Strongly positive immunoperoxidase staining was localized in spiral, curved bacteria that were present in the mucus layer adjacent to the gastric epithelial cell surface. The microorganisms were frequently congregated in clumps and were sectioned in several directions. The PAP stains were positive in 19 specimens (76%), and the cultures were positive in 20 (80%). All results negative by culture were also negative by PAP method. Compared with the cultures, the sensitivity and positive predictive value of the PAP method for identification of C pylori in antral mucosa obtained from endoscopic biopsy specimens were 95% and 100%, respectively.

Ganglion cell number in hypertrophic colon above experimental stenosis.

In order to determine the number of ganglia and ganglion cells of the myenteric plexus in a hypertrophic segment of the gut a partial surgical obstruction was carried out in the colon of 10 adult rats. The myenteric plexus was studied in "spread" preparations in which the circular and longitudinal muscle layers were intact. With the colon distended and stretched above the surgical obstruction, the muscle layers became intensely hypertrophic and, as a consequence, the surface of the hypertrophic colon increased by 39%. The decrease in number of ganglia and ganglion cells per area in the hypertrophic colon was 37.6% and 36.4%, respectively. The increase of the surface of the hypertrophic colon was proportional to the decrease In number of ganglia and ganglion cells per area. Therefore there was no change in the absolute number of ganglia and neurons in the colon above the partial obstruction. The results of the present study do not support the view that immature cells develop into ganglion cells in the hypertrophic intestine above a surgical obstruction.

Morphology and viability of the spleen after subtotal splenectomy.

1. Postsplenectomy complications have stimulated surgeons to opt for partial splenectomy as a more desirable technique for several diseases and in some cases for trauma to the spleen. 2. We studied spleen viability in 15 dogs submitted to subtotal splenectomy while maintaining the upper pole and upper splenogastric vessels. Macro- and microscopic histological studies as well as Tc99m-labeled heat-damaged erythrocyte scintigraphic analysis of splenic blood irrigation were carried out. 3. We conclude that: a) the splenogastric vessels are sufficient for the maintenance of spleen irrigation and drainage; b) the spleen remnants develop increased cellularity of the splenic cords and lymphoid folliculi; c) the length of the spleen remnants does not change for at least 2 months after surgery.

Antral gastrin cell population in patients with chagasic megaesophagus and megacolon.

1. Patients with chronic Chagas' disease have abnormally low gastric acid secretion and increased gastrin release both during fasting and after different stimuli. Regardless of the relationship between intragastric acidity and gastrin secretion, it is uncertain whether hypergastrinemia in Chagas' disease is caused by an increased population of antral gastrin (G) cells (hyperplasia) or by enhanced cell activity (hyperfunction). 2. We therefore estimated G cell number in antral biopsies from 16 chagasic patients and 13 control subjects using a peroxidase-anti-peroxidase immunohistochemical technique. All subjects underwent a gastric secretion test to determine peak acid output following intravenous pentagastrin instillation. 3. Antral G cell number in Chagas' disease patients was not significantly different from that observed in the control group (number of cells/mm2, median and (range): 128 (44-284) vs 138 (65-285)). 4. In chagasic patients, peak acid output was significantly lower than in controls (mmol/h, median and (range): 9.819 (3.024-21.564) vs 17.490 (9.423-25.848)). 5. These results suggest that the increase in gastrin release associated with reduced gastric acid secretion in Chagas' disease is mediated by antral G cell hyperfunction rather than by hyperplasia.

Effect of sodium carboxymethylcellulose and methylprednisolone on the healing of jejunal anastomoses in rats.

Sodium carboxymethylcellulose (SCMC) has been effective in reducing adhesion formation and corticosteroids reduce the inflammatory process. The objective of this study was to define the intraperitoneal (ip) effects of SCMC combined with intramuscular (im) methylprednisolone on peritoneal adhesion formation and on jejunal anastomosis healing in rats. Twenty Wistar rats (200-350 g) were divided into four groups (N = 5): groups I and III (controls) 5 and 21 days of treatment before sacrifice, respectively; groups II and IV (experimental groups) 5 and 21 days of treatment, respectively. SCMC (1%) was infused into the abdominal cavity and methylprednisolone (10 mg kg-1 day-1) was injected im daily from the day before surgery for animals of groups II and IV. All rats were submitted to a jejunal anastomosis. Sections of the anastomosis were prepared for routine histopathological analysis. The abdominal adhesion of group IV was less intense when compared with group III (P<0.0008). Anastomotic resistance was higher in groups II and IV when compared with groups I and III, respectively (P<0.05). There was no histological difference between groups I and II (exuberant granulation tissue on the serosal surface). Group III presented little peritoneal fibrinous tissue, with numerous thick collagen fibers. Group IV presented extensive although immature young fibrous tissue with rare thick collagen fibers. Sodium carboxymethylcellulose combined with corticosteroids seemed to diminish peritoneal adhesion but did not reduce anastomotic resistance.

Influence of acute renal failure on the mononuclear phagocytic system.

Several studies show the ability of macrophages to remove particles injected into the bloodstream. This function seems to be increased in the presence of acute renal failure. The objective of the present study was to assess the phagocytic function of the main organs (spleen, liver and lung) of the mononuclear phagocytic system in renal and postrenal failures. Fifteen rats (250-350 g) were divided into three groups (N = 5): group I - control; group II - ligature of both ureters, and group III - bilateral nephrectomy. On the third postoperative day, all animals received an iv injection of 1 ml/kg 99mTc sulfur colloid. Blood samples were collected for the assessment of plasma urea, creatinine, sodium, and potassium concentrations and arterial gasometry. Samples of liver, spleen, lung and blood clots were obtained and radioactivity was measured. Samples of liver, spleen, lung and kidney were prepared for routine histopathological analysis. Plasma urea, creatinine and potassium concentrations in groups II and III were higher than in group I (P<0.05). Plasma sodium concentrations in groups II and III were lower than in group I (P<0.05). Compensated metabolic acidosis was observed in the presence of postrenal failure. Group II animals showed a lower level of radioactivity in the spleen (0.98) and lung (2.63), and a higher level in the liver (105.51) than control. Group III animals showed a lower level of radioactivity in the spleen (11.94) and a higher level in the liver (61.80), lung (11.30) and blood clot (5.13) than control. In groups II and III liver steatosis and bronchopneumonia were observed. Renal and postrenal failures seem to interfere with blood clearance by the mononuclear phagocytic system.

Lower density of antral somatostatin-immunoreactive cells in the digestive form of chronic Chagas' disease.

Patients with the digestive form of chronic Chagas' disease exhibit abnormally increased gastrin release, possibly caused by antral gastrin cell (G cell) hyperfunction. In order to identify the mechanisms underlying this abnormality, we used an immunohistochemical method to assess the population of antral somatostatin-producing cells (D cells) in chagasic patients, since somatostatin is known to be the main inhibitory factor of gastrin secretion. Samples (N = 11) of endoscopic antral biopsies taken from 16 Chagas' disease patients and 13 control subjects were studied. Antral D and G cell populations were determined by an immunohistochemical technique using highly specific antibodies against somatostatin and gastrin. There was no significant difference between Chagas' disease and control groups regarding G cell population (number of cells/mm reported as median (range): 70.0 (23.7-247.0) vs 98.1 (52.7-169.4), P > 0.10). In contrast, the number of antral D cells in Chagas' disease patients was significantly lower than in controls (16.4 (6.9-54.4) vs 59.3 (29.6-113.8), P < 0.05). Chronic superficial gastritis and infection with Helicobacter pylori were more frequent in chagasic patients than in controls, but there was no demonstrable association between these factors and the reduction of the number of antral D cells. These data suggest that reduction in the number of antral somatostatin-producing cells, which should lead to reduced inhibition of gastrin cell activity, may play a role in the increased gastrin secretion observed in Chagas' disease patients.