Emprego da submucosa intestinal suína em uretroplastias complexas

We report the use of Porcine Intestinal Submucosa (PIS) in association with Johanson technique for urethroplasty, in the treatment of recurring urethral stenosis. The patient had obliterans xerotica balanitis and had previously undergone 15 internal uretotomies as well as various unsuccessful urethral dilations. As a result of stenotic extension, another surgery was planned using Johanson technique. During the first part of the surgery, intense local fibrosis was observed, which required greater care and protection to avoid fistulae formation. PIS was interposed to reduce the chances of the occurrence of this dreaded complication. During the second part of the surgery, a skin flap obtained from tissue parallel to the urethral plateau was used to prepare a neourethra according to the norms of this technique. PIS was fixed at its extremities, and interposed between the neourethral suture and the skin suture to prevent any contact between them. The procedure was completed with the use of meatoplasty and glandulaplasty. After 6-month follow up, clinical and urodynamic improvement could be seen. If these results can be confirmed by more extensive studies, PIS will provide new perspectives for complex urethroplasties.

Reconstrução da parede torácica nos defeitos adquiridos

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com) and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

O retalho pleural na perfuração do esôfago torácico

The thoracic esophageal perforations frequently complicate with fistula when submitted to primary suture. The use of autogenous tissues, like pleura, to reinforce the primary suture has proved to be useful in reduce the incidence of fistulas or at least the severity of the leaks in case they occur. The mortality has reduced too, consequently. A case of an extensive esophageal perforation is presented, where the use of pleural wrap to reinforce the esophagorrafy was very important to contain the leak and to permit a good evolution of the patient.

Linfoma esofágico primário

We describe the case of a 54 year old woman seen with an esophageal mass diagnosed as a primary esophageal lymphoma. The main symptom was dysphagia of seven months duration. The treatment consisted in resection of the tumor, and reconstruction of the defect with a reversed pleural flap, followed by a chemotherapy regimen that consisted of five drugs, cyclophosphamid, prednisone, doxorubicin, rituximab and vincristine (R-CHOP). The patient developed an esophageal pleural fistula treated with pleural drainage and irrigation that closed in 45 days. Two and one half years later she is doing well and disease free.

Use of local muscle flaps to cover leg bone exposures

Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure.Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit.Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41); 42 were male and 11 female. The main initial injury was trauma (84.8%), consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%). The rank of 49 patients (92.5%) was excellent or good outcome, of three (5.6%) as regular and of one (1.9%) as unsatisfactory.Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay.

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Effect of Hevea brasiliensis latex sap gel on healing of acute skin wounds induced on the back of rats

Objective : to evaluate the effect of topical delivery of latex cream-gel in acute cutaneous wounds induced on the back of rats. Methods : we subjected sixteen rats to dermo-epidermal excision of a round dorsal skin flap, with 2.5cm diameter. We divided the animals into two groups: Latex Group: application of cream-gel-based latex throughout the wound bed on postoperative days zero, three, six and nine; Control group: no treatment on the wound. Photographs of the lesions were taken on the procedure day and on the 6th and 14th postoperative days, for analyzing the area and the larger diameter of the wound. We carried out euthanasia of all animals on the 14th postoperative day, when we resected he dorsal skin and the underlying muscle layer supporting the wound for histopathological study. Results : there was no statistically significant difference in the percentage of wound closure, in the histopathological findings or in the reduction of the area and of the largest diameter of the wounds among the groups studied on the 14th postoperative day. Conclusion : according to the experimental conditions in which the study was conducted, latex cream-gel did not interfere in the healing of acute cutaneous wounds in rats.

Influência da glândula pineal sobre a ingestão de água e NaCl em ratas normais e ooforectomizadas

Objetivo: avaliar a influência da pineal sobre a ingestão de água e de NaCl em ratas normais e ooforectomizadas. Métodos: utilizaram-se 48 (n = 48) ratas adultas, divididas ao acaso em quatro grupos: GI - mantidas sem manipulação, servindo como controle (n = 20); GII - submetidas à ooforectomia bilateral (n = 8); GIII - submetidas à pinealectomia (n = 12); GIV - submetidas à ooforectomia bilateral e à pinealectomia (n = 8). A seguir, todos os animais foram mantidos em gaiolas individuais; após três semanas. Determinou-se diariamente a fase do ciclo por esfregaço vaginal e anotou-se diariamente o volume ingerido de água e NaCl a 0,25 M, por aproximadamente três meses. Resultados: 1) as ratas submetidas somente à pinealectomia apresentaram maior freqüência da fase de estro, sendo que algumas entraram em estado de estro permanente; 2) o consumo de líquidos (água e solução salina) não se alterou durante as diferentes fases do ciclo estral; 3) as ratas do grupo submetido à ooforectomia tiveram maior consumo de água, sendo que a pinealectomia nesses animais restabeleceu o consumo normal de água; 4) os animais ooforectomizados e os ooforectomizados e pinealectomizados mostraram redução do consumo médio de solução salina. Conclusões: os dados obtidos sugerem que a glândula pineal poderia modular a ação dos esteróides ovarianos sobre a ingestão de sal e água em ratas adultas.

Evaluation of a model for induction of periodontal disease in dogs

There are several methods for inducing periodontal disease in animal models, being the bone defect one of the most reported. This study aimed to evaluate this model, through clinical, radiographic, tomographic and histological analyzes, thus providing standardized data for future regenerative works. Twelve dogs were subjected to the induction protocol. In a first surgical procedure, a mucoperiosteal flap was made on the buccal aspect of the right third and fourth premolars and a defect was produced exposing the furcation and mesial and distal roots, with dimensions: 5mm coronoapical, 5mm mesiodistal, and 3mm buccolingual. Periodontal ligament and cementum were curetted and the defect was filled with molding polyester, which was removed after 21 days on new surgical procedure. Clinical and radiographic examinations were performed after the two surgeries and before the collection of parts for dental tomography and histological analysis. All animals showed grade II furcation exposure in both teeth. Clinical attachment level increased after induction. Defect size did not change for coronoapical and buccolingual measurements, while mesiodistal size was significantly higher than at the time of defect production. Radiographic analysis showed decreased radiopacity and discontinuity of lamina dura in every tooth in the furcation area. The horizontal progression of the disease was evident in micro-computed tomography and defect content in the histological analysis. Therefore, it is concluded that this method promotes the induction of periodontal disease in dogs in a standardized way, thus being a good model for future work.

O aumento em superfície em Adelia membranifolia (Müll. Arg.) Pax & K. Hoffm. e Peltophorum dubium (Spreng.) Taub., em resposta ao estresse por deficiência nutricional e alagamento do substrato

Foram estudadas as respostas plásticas em plântulas e plantas jovens de duas espécies arbóreas nativas, Adelia membranifolia (Müll. Arg.) Pax & K. Hoffm. (Euphorbiaceae) e Peltophorum dubium (Spreng.) Taub. (Leguminosae-Caesalpinoidae), submetidas ao alagamento do substrado associado ao déficit nutricional. Avaliou-se o acréscimo em superfície no módulo de expressão, definido como a região do eixo da plântula que, sob condições de estresse, sofre rediferenciação sendo considerada a hipertrofia lenticelar como a expressão morfogenética mais comum. Em A. membranifolia a associação do estresse nutricional e alagamento do substrato foi a condição mais restritiva tanto para o crescimento em altura e diâmetro do colo quanto para as expressões morfogenéticas. Já em P. dubium o estado nutricional foi mais restritivo que o alagamento para o crescimento do colo. Em geral, para ambas as espécies, plantas nutridas mantidas alagadas restabeleceram seu ritmo de crescimento a partir do terceiro mês de tratamento, além de expressarem respostas plásticas como a hipertrofia lenticelar e a formação de raízes adventícias. Quanto ao aumento em superfície, nos lotes desnutridos, verificou-se que em A. membranifolia de um total de 38% de superfície expressa, 12% corresponderam à hipertrofia lenticelar. Em P. dubium verificou-se as maiores variações de aumento em superfície expressa por hipertrofia lenticelar, elevando de 5% para 13%. Em geral a superfície modular nos lotes tratados foi o dobro em relação ao controle. É possível que o aumento em superfície, para algumas espécies, seja significativo como tendência ao aumento da estabilidade no desenvolvimento a partir de interações fisiológicas.

Alternative parameters for echocardiographic assessment of fetal diastolic function

Alternative methods to assess ventricular diastolic function in the fetus are proposed. Fetal myocardial hypertrophy in maternal diabetes was used as a model of decreased left ventricular compliance (LVC), and fetal respiratory movements as a model of increased LVC. Comparison of three groups of fetuses showed that, in 10 fetuses of diabetic mothers (FDM) with septal hypertrophy (SH), the mean excursion index of the septum primum (EISP) (ratio between the linear excursion of the flap valve and the left atrial diameter) was 0.36 ± 0.09, in 8 FDM without SH it was 0.51 ± 0.09 (P = 0.001), and in the 8 normal control fetuses (NCF) it was 0.49 ± 0.12 (P = 0.003). In another study, 28 fetuses in apnea had a mean EISP of 0.39 ± 0.05 which increased to 0.57 ± 0.07 during respiration (P < 0.001). These two studies showed that the mobility of the septum primum was reduced when LVC was decreased and was increased when LVC was enhanced. Mean pulmonary vein pulsatility was higher in 14 FDM (1.83 ± 1.21) than in 26 NCF (1.02 ± 0.31; P = 0.02). In the same fetuses, mean left atrial shortening was decreased (0.40 ± 0.11) in relation to NCF (0.51 ± 0.09; P = 0.011). These results suggest that FDM may have a higher preload than normal controls, probably as a result of increased myocardial mass and LV hypertrophy. Prenatal assessment of LV diastolic function by fetal echocardiography should include analysis of septum primum mobility, pulmonary vein pulsatility, and left atrial shortening.

Glutamate receptors as seen by light: spectroscopic studies of structure-function relationships

Ionotropic glutamate receptors are major excitatory receptors in the central nervous system and also have a far reaching influence in other areas of the body. Their modular nature has allowed for the isolation of the ligand-binding domain and for subsequent structural studies using a variety of spectroscopic techniques. This review will discuss the role of specific ligand:protein interactions in mediating activation in the a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid subtype of glutamate receptors as established by various spectroscopic investigations of the GluR2 and GluR4 subunits of this receptor. Specifically, this review will provide an introduction to the insight gained from X-ray crystallography and nuclear magnetic resonance investigations and then go on to focus on studies utilizing vibrational spectroscopy and fluorescence resonance energy transfer to study the behavior of the isolated ligand-binding domain in solution and discuss the importance of specific ligand:protein interactions in the mechanism of receptor activation.

Potential virulence of Klebsiella sp. isolates from enteral diets

We aimed to evaluate the potential virulence of Klebsiellaisolates from enteral diets in hospitals, to support nosocomial infection control measures, especially among critical-care patients. Phenotypic determination of virulence factors, such as capsular expression on the external membrane, production of aerobactin siderophore, synthesis of capsular polysaccharide, hemolytic and phospholipase activity, and resistance to antibiotics, which are used therapeutically, were investigated in strains ofKlebsiella pneumoniae and K. oxytoca. Modular industrialized enteral diets (30 samples) as used in two public hospitals were analyzed, and Klebsiella isolates were obtained from six (20%) of them. The hypermucoviscous phenotype was observed in one of the K. pneumoniae isolates (6.7%). Capsular serotypes K1 to K6 were present, namely K5 and K4. Under the conditions of this study, no aerobactin production, hemolytic activity or lecithinase activity was observed in the isolates. All isolates were resistant to amoxicillin and ampicillin and sensitive to cefetamet, imipenem, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim. Most K. pneumoniae isolates (6/7, 85.7%) from hospital B presented with a higher frequency of resistance to the antibiotics tested in this study, and multiple resistance to at least four antibiotics (3/8; 37.5%) compared with isolates from Hospital A. The variations observed in the antibiotic resistance profiles allowed us to classify theKlebsiella isolates as eight antibiotypes. No production of broad-spectrum β-lactamases was observed among the isolates. Our data favor the hypothesis that Klebsiella isolates from enteral diets are potential pathogens for nosocomial infections.