Quantitative analysis of collagen and elastic fibers in the transversalis fascia in direct and indirect inguinal hernia

PURPOSE: Our previous studies demonstrated structural and quantitative age-related changes of the elastic fibers in transversalis fascia, which may play a role in inguinal hernia formation. To verify whether there were differences in the extracellular matrix between direct and indirect inguinal hernia, we studied the amount of collagen and elastic fibers in the transversalis fascia of 36 male patients with indirect inguinal hernia and 21 with direct inguinal hernia. MATERIAL AND METHODS: Transversalis fascia fragments were obtained during surgical intervention and underwent histological quantitative analysis of collagen by colorimetry and analysis of elastic fibers by histomorphometry. RESULTS: We demonstrated significantly lower amounts of collagen and higher amounts of elastic fibers in transversalis fascia from patients with direct inguinal hernia compared to indirect inguinal hernia patients. The transversalis fascia from direct inguinal hernia patients showed structural changes of the mature and elaunin elastic fibers, which are responsible for elasticity, and lower density of oxytalan elastic fibers, which are responsible for resistance. These changes promoted loss of resiliency of the transversalis fascia. CONCLUSION: These results improve our understanding of the participation of the extracellular matrix in the genesis of direct inguinal hernia, suggesting a relationship with genetic defects of the elastic fiber and collagen synthesis.

Avaliação histoquímica quantitativa do colágeno na fascia transversalis e na bainha anterior do músculo reto abdominal em doentes com hérnia inguinal

OBJETIVO: Avaliar a participação do colágeno na etiopatogenia das hérnias inguinais, através da análise quantitativa histoquímica do colágeno na bainha anterior do músculo reto abdominal e na fascia transversalis MÉTODO: Foram operados quarenta doentes do sexo masculino, na faixa etária entre 20 e 60 anos, portadores de hérnia inguinal tipo II e IIIA de Nyhus e realizadas autópsias em dez cadáveres frescos, na mesma faixa etária. Em ambos os grupos, amostras da bainha anterior do músculo reto abdominal e da fascia transversalis foram colhidas, coradas pela técnica histoquímica do picrocírius e submetidas a análise morfométrica quantitativa através de sistema computadorizado com a finalidade de identificar possíveis alterações quantitativas do colágeno, em cada um dos dois tipos de hérnias em comparação com indivíduos sem hérnias. RESULTADOS: Encontramos maior concentração do colágeno na bainha anterior do músculo reto abdominal, em comparação a fascia transversalis em todos os grupos estudados, embora esta diferença tenha sido estatisticamente significante apenas no grupo controle. Não encontramos diferenças na concentração do colágeno, na bainha anterior do músculo reto abdominal e na fascia transversalis, entre os doentes com hérnias tipo II e tipo IIIA de Nyhus. Não encontramos diferenças na concentração do colágeno quando comparamos os grupos com hérnias com o grupo controle. CONCLUSÃO: Não encontramos diferenças na quantidade do colágeno na bainha anterior do músculo reto abdominal e na fascia transversalis entre os pacientes portadores de hérnia inguinal tipo II e IIIA de Nyhus em comparação com indivíduos sem hérnias.

Estudo da técnica da sindesmoplastia extra-articular com fascia lata autógena: modelo em cães

OBJETIVO: Avaliar a eficácia da técnica extra-capsular para o tratamento de ruptura do ligamento cruzado anterior em cães. MÉTODOS: Foi realizada a reparação cirúrgica extra-articular, sem artrotomia do ligamento cruzado anterior, com a utilização da fáscia lata autógena para estabilização da articulação do joelho em seis animais que apresentaram claudicação grave e movimento de gaveta positivo. RESULTADOS: A técnica cirúrgica extra-articular foi eficaz com boa estabilização articular e evolução satisfatória. CONCLUSÃO: A via extra capsular com uso da fáscia lata para correção da ruptura do ligamento cruzado anterior mostrou-se útil haja vista tratar-se de um procedimento simples e de rápida execução, causando o mínimo dano tecidual e recuperação pós-operatória eficiente.

Immunohistochemical evaluation of fibrillar components of the extracellular matrix of transversalis fascia and anterior abdominal rectus sheath in men with inguinal hernia

OBJECTIVE: to evaluate the role of fibrillar extracellular matrix components in the pathogenesis of inguinal hernias. METHODS: samples of the transverse fascia and of the anterior sheath of the rectus abdominis muscle were collected from 40 men aged between 20 and 60 years with type II and IIIA Nyhus inguinal hernia and from 10 fresh male cadavers (controls) without hernia in the same age range. The staining technique was immunohistochemistry for collagen I, collagen III and elastic fibers; quantification of fibrillar components was performed with an image analysis processing software. RESULTS: no statistically significant differences were found in the amount of elastic fibers, collagen I and collagen III, and the ratio of collagen I / III among patients with inguinal hernia when compared with subjects without hernia. CONCLUSION: the amount of fibrillar extracellular matrix components did not change in patients with and without inguinal hernia.

Age related changes in the elastic fiber system of the interfoveolar ligament

In order to evaluate age related changes of the elastic fiber system in the interfoveolar ligament, we studied the deep inguinal ring from 33 male cadavers aged from stillborn to 76 years. Selective and alternated staining methods for elastic fibers were performed to differentiate oxytalan, elaunin, and mature elastic fibers. We confirmed quantitative changes of the elastic fiber system with aging. There was a significant and progressive reduction of the oxytalan fibers (responsible for tissue resistance) and a significant increment in the mature elastic and elaunin fibers (responsible for tissue elasticity). Furthermore, there were structural changes in the thickness, shortness and curling of these mature elastic fibers. These changes induced loss of the elastic fiber function and loss of the interfoveolar ligament compliance. These factors predispose individuals to the development of indirect inguinal hernias that frequently emerge in adults and aged individuals, especially above the fifth decade.

Avaliação da hernioplastia protética atensional no tratamento das hérnias inguinais

Apresentam-se 76 pacientes operados devido a hérnias inguinais, com o uso rotineiro de telas de polipropilene colocadas sobre a fascia transversalis, em correção sem tensão, através de uma inguinotomia transversa pequena (média de 6cm). Doze pacientes foram operados bilateralmente, perfazendo 88 intervenções. Entre as intervenções, cinqüenta foram sobre hérnias inguinais indiretas (56,8%), 15 sobre hérnias associadas diretas e indiretas (17,1 %), e 23 sobre hérnias diretas (26,1%). Praticamente não houve queixas de dor à exceção da dor superficial. Não houve nenhum caso de infecção ou rejeição. Nenhum paciente referiu sentir a sua presença. Após dois dias, os pacientes foram liberados de qualquer tipo de restrição física ou esportiva. Não há qualquer evidência sugestiva de recidiva. Tempo médio de seguimento de trinta meses. Discute-se a técnica empregada. A HIPA é técnica fácil, rápida, de custo baixo, não exige anestesia geral nem materiais especiais, com baixos índices de recidiva e, por não implicar suturas sob tensão, permite restabelecimento pronto, com mínima dor e sem restrições físicas.

Fasciíte necrotizante limitada a região pré-peritoneal

Our objective is to report a case of a patient with necrosis limited to the pre-peritoneal fascia and fat tissue of the abdomen and pelvis. A 34-year-old female presented with fever, chills, nausea, diarrhea and abdominal pain. She denies history of trauma, diabetes mellitus, use of immunosuppressive drugs, smoking, and drug dependence. Laboratory tests revealed hematocrit of 28.7%, white blood count of 12.200/mm3 with 49% of bands, platelets of 317.000/mm3, and sedimentation rate of 65 mm/hr. She was subjected to an abdominal ultrasonography and computed tomography that showed hepatosplenomegaly and muscular thickening on the left flank. Surgical debridment was performed. There was necrosis limited to the pre-peritoneal fascia and fat tissue extending from the pelvis to the left flank. The fascia of the superficial muscles and the subcutaneous fat were normal. The pathologic examination showed suppuration and necrosis of the tissues. Antibiotics were administered and ten debridments were performed. The patient was discharged 30 days after the admission.

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

Closure of large wounds using rubber bands in rabbits

OBJECTIVE: to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS: we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8cm long by 12cm wide. All animals were observed for 21 days. RESULTS: two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION: the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

Anti-hyperalgesic effect of electroacupuncture in a model of post-incisional pain in rats

Electroacupuncture has been proposed to be a low cost and practical method that allows effective pain management with minimal collateral effects. In this study we have examined the effect of electroacupuncture against the hyperalgesia developed in a model of post-incisional pain in rats. A 1-cm longitudinal incision was made through the skin and fascia of the plantar region of the animal hind paw. Mechanical hyperalgesia in the incision was evaluated 135 min after the surgery with von Frey filaments. The tension threshold was reduced from 75 g (upper limit of the test) to 1.36 ± 0.36 g (mean ± SEM) in control rats. It is shown that a 15-min period of electroacupuncture applied 120 min after surgery to the Zusanli (ST36) and Sanyinjiao (SP6) points, but not to non-acupoints, produces a significant and long-lasting reduction of the mechanical hyperalgesia induced by the surgical incision of the plantar surface of the ipsilateral hind paw. The tension threshold was reduced from 75 to 27.6 ± 4.2 g in animals soon after the end of electroacupuncture. The mechanical threshold in this group was about 64% less than in control. Electroacupuncture was ineffective in rats treated 10 min earlier with naloxone (1 mg/kg, ip), thus confirming the involvement of opioid mechanisms in the antinociceptive effects of such procedure. The results indicate that post-incisional pain is a useful model for studying the anti-hyperalgesic properties of electroacupuncture in laboratory animals.

Time course of training-induced microcirculatory changes and of vegf expression in skeletal muscles of spontaneously hypertensive female rats

Exercise-induced vessel changes modulate arterial pressure (AP) in male spontaneously hypertensive rats (SHR). Vascular endothelial growth factor (VEGF) is important for angiogenesis of skeletal muscle. The present study evaluated the time course of VEGF and angiogenesis after short- and long-term exercise training of female SHR and Wistar Kyoto (WKY) rats, 8-9 weeks (200-250 g). Rats were allocated to daily training or remained sedentary for 3 days (N = 23) or 13 weeks (N = 23). After training, the carotid artery was catheterized for AP measurements. Locomotor (tibialis anterior and gracilis) and non-locomotor skeletal muscles (temporalis) were harvested and prepared for histologic and protein expression analyses. Training increased treadmill performance by all groups (SHR = 28%, WKY = 64%, 3 days) and (SHR = 141%, WKY = 122%, 13 weeks). SHR had higher values of AP than WKY (174 ± 4 vs 111 ± 2 mmHg) that were not altered by training. Three days of running increased VEGF expression (SHR = 28%, WKY = 36%) simultaneously with an increase in capillary-to-fiber ratio in gracilis muscle (SHR = 19%, WKY = 15%). In contrast, 13 weeks of training increased gracilis capillary-to-fiber ratio (SHR = 18%, WKY = 19%), without simultaneous changes in VEGF expression. Training did not change VEGF expression and capillarity of temporalis muscle. We conclude that training stimulates time- and tissue-dependent VEGF protein expression, independent of pressure levels. VEGF triggers angiogenesis in locomotor skeletal muscle shortly after the exercise starts, but is not involved in the maintenance of capillarity after long-term exercise in female rats.

Effect of gallium-arsenide laser, gallium-aluminum-arsenide laser and healing ointment on cutaneous wound healing in Wistar rats

This study determined the effects of gallium-aluminum-arsenide laser (GaAlAs), gallium-arsenide laser (GaAs) and Dersani® healing ointment on skin wounds in Wistar rats. The parameters analyzed were: type I and III collagen fiber concentrations as well as the rate of wound closure. Five wounds, 12 mm in diameter, were made on the animals’ backs. The depth of the surgical incision was controlled by removing the epithelial tissue until the dorsal muscular fascia was exposed. The animals were anesthetized with ketamine and xylazine via intraperitoneal injection. The rats were randomly divided into five groups of 6 animals each, according to the treatment received. Group 1 (L4): GaAs laser (4 J/cm²); group 2 (L30): GaAlAs laser (30 J/cm²); group 3 (L60): GaAlAs laser (60 J/cm²); group 4 (D): Dersani® ointment; group 5 (control): 0.9% saline. The applications were made daily over a period of 20 days. Tissue fragments were stained with picrosirius to distinguish type I collagen from type III collagen. The collagen fibers were photo-documented and analyzed using the Quantum software based on the primary color spectrum (red, yellow and blue). Significant results for wound closing rate were obtained for group 1 (L4), 7.37 mm/day. The highest concentration of type III collagen fibers was observed in group 2 (L30; 37.80 ± 7.10%), which differed from control (29.86 ± 5.15%) on the 20th day of treatment. The type I collagen fibers of group 1 (L4; 2.67 ± 2.23%) and group 2 (L30; 2.87 ± 2.40%) differed significantly from control (1.77 ± 2.97%) on the 20th day of the experiment.

High-frequency electroacupuncture versus carprofen in an incisional pain model in rats

The objective of the present study was to compare the effect of electroacupuncture (EA) and carprofen (CP) on postoperative incisional pain using the plantar incision (PI) model in rats. A 1-cm longitudinal incision was made through skin, fascia and muscles of a hind paw of male Wistar rats and the development of mechanical and thermal hypersensitivity was determined over 4 days using the von Frey and Hargreaves methods, respectively. Based on the experimental treatments received on the third postoperative day, the animals were divided into the following groups: PI+CP (CP, 2 mg/kg, po); PI+EAST36 (100-Hz EA applied bilaterally at the Zusanli point (ST36)); PI+EANP (EA applied to a non-acupoint region); PI+IMMO (immobilization only); PI (vehicle). In the von Frey test, the PI+EAST36 group had higher withdrawal force thresholds in response to mechanical stimuli than the PI, PI+IMMO and PI+EANP groups at several times studied. Furthermore, the PI+EAST36 group showed paw withdrawal thresholds in response to mechanical stimuli that were similar to those of the PI+CP group. In the Hargreaves test, all groups had latencies higher than those observed with PI. The PI+EAST36 group was similar to the PI+IMMO, PI+EANP and PI+CP groups. We conclude that 100-Hz EA at the ST36 point, but not at non-acupoints, can reduce mechanical nociception in the rat model of incisional pain, and its effectiveness is comparable to that of carprofen.

Análise de inosina-5'-monofosfato (5'-IMP) e seus derivados em diferentes músculos de bovinos, suínos e ovinos

As concentrações de inosina-5'-monofosfato e seus derivados (adenosina monofosfato, hipoxantina e inosina) nos músculos Psoas major, Latissimus dorsi, Tensor fascia e Extensor carpi radialis de bovinos, suínos e ovinos foram determinadas através de Cromatografia Líquida de Alta Eficiência (CLAE). A Análise de Variância (ANOVA) dos dados mostraram que as concentrações de 5'-IMP e seus derivados foram significativamente diferentes entre as três espécies (p < 0,001). A maior concentração de 5'-IMP foi detectada nos músculos de ovinos (média de 108,2 mg/100g) seguida pelos de suínos (média de 97 mg/100g) e pelos de bovinos (média de 69,3 mg/100g). Houve variações significativas nas concentrações no músculo, entre os animais nas espécies bovina (p < 0,01) e ovina (p < 0,05), porém não entre os da espécie suína (p > 0,05). Não houve diferenças significativas entre os tipos de músculo em bovinos e ovinos (p > 0,05), mas em suínos (p < 0,01) observou-se variação significativa.