Picrosirius-polarization staining method as an efficient histopathological tool for collagenolysis detectin in vesical prolapse lesions

The Picrosirius-polarization method has been indicated as a selective histochemical stain for collagen detection in tissue sections. This method can also be of value for studying collagen degradation given that, under polarized light, collagen displays birefringence due to its molecular order. The aim of this study is to highlight this staining method as an additional instrument for a rapid and excellent confirmatory diagnosis of the presence of collagenolysis in connective tissue in the vaginal wall with vesical prolapse lesion, in tissue sections. Dramatic changes in collagen morphology were found in vaginal mucosa in vesical prolapse disorder: they were weakly stained by Sirius red and under polarized light appeared as thin, pale (weakly birefringent), greenish, and with fibers more scattered, while the histoarchitecture of the organ showed a disrupted appearance. Thus, in the present study, we showed in vaginal mucosa in the vesicle prolapse that corroded collagenous framework appears as fragmentary and irregularly separated collagenous structures, that are weakly birefringent, corresponding to a molecular disorganization of these fibers caused by collagenolysis. (C) 2006 Elsevier Ltd. All rights reserved.

Does troncular vagotomy modify the proliferative gastric lesions induced in rats by duodenogastric reflux?

Purpose: to investigate if combining VT to DGR through the pylorus can modulate the biological behavior of PL induced by DGR and to verify if TV alone can induce morphologic lesions in the gastric mucosa. Methods: 62 male Wistar rats were assigned to four groups: 1 - Control (CT) gastrotomy; 2 - Troncular Vagotomy (TV) plus gastrotomy; 3 - Duodenogastric reflux through the pylorus (R) and 4 - Troncular vagotomy plus DGR (RTV). The animals were killed at the 54 week of the experiment. DGR was obtained by anastomosing a proximal jejunal loop to the anterior gastric wall. TV was performed through isolation and division of the vagal trunks. Gastrotomy consisted of 1 cm incision at the anterior gastric wall. PL were analyzed gross and histologically in the antral mucosa, at the gastrojejunal stoma and at the squamous portion of the gastric mucosa. Results: Groups R and RTV developed exophytic lesions in the antral mucosa (R=90.9%; RTV=100%) and at the gastrojejunal stoma (R=54.54%; RTV=63.63%). Histologically they consisted of proliferative benign lesions, without cellular atypias, diagnosed as adenomatous hyperplasia. Both groups exposed to DGR presented squamous hyperplasia at the squamous portion of the gastric mucosa (R= 54.5%; RTV= 45.4%). TV, alone, did not induce gross or histological alterations in the gastric mucosa. TV did note change the morphologic pattern of the proliferative lesions induced by DGR. Conclusions: DGR induces the development of PL in the pyloric mucosa and at the gastrojejunal stoma. TV does not change the morphologic pattern of the proliferative lesions induced by DGR. TV alone is not able to induce morphologic lesions in the gastric mucosa.

Prenatal exposure to testosterone masculinises the female gerbil and promotes the development of lesions in the prostate (Skene

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Surgical interventions for treating pectus excavatum

Background: Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual's life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined. Objectives: To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum. Search methods: With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual's condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction. Date of the most recent searches: 14 January 2014. Selection criteria: We considered randomized or quasi-randomized controlled trials that compared traditional surgery with minimally invasive surgery for treating pectus excavatum. Data collection and analysis: Two review authors independently assessed the eligibility of the trials identified and agreed trial eligibility after a consensus meeting. The authors also assessed the risk of bias of the eligible trials. Main results: Initially we located 4111 trials from the electronic searches and two further trials from other resources. All trials were added into reference management software and the duplicates were excluded, leaving 2517 studies. The titles and abstracts of these 2517 studies were independently analyzed by two authors and finally eight trials were selected for full text analysis, after which they were all excluded, as they did not fulfil the inclusion criteria. Authors' conclusions: There is no evidence from randomized controlled trials to conclude what is the best surgical option to treat people with pectus excavatum.

Experimental model of intestinal endometriosis: pilot study

Aims: The objective of this study is to create an experimental model of intestinal endometriosis in pigs, which might allow better understanding of deep infiltrating endometriosis and development of new treatment techniques. As secondary objective, we intend to create endometrial implants accessible by transrectal ultrasonography (TRUS). Study Design: Surgical experimental study in swine. Place and Duration of Study: This study was performed at the Instituto de Ensino e Pesquisa do Hospital Sírio-Libanês, São Paulo, Brazil, between January 2012 and December 2012. Methodology: Two sexually mature female minipigBR pigs underwent two laparotomies (each animal). The first laparotomy was performed to implant two fragments of autologous endometrium in the rectal wall. The second one was performed thirty days later to visualize, measure and obtain tissue of the site of the implants for histopathology study. A TRUS study was performed prior to the second surgery. The Institution’s Animal Utilization Study Committee approved the study. Results: In the first laparotomy a 5-cm segment of right uterine horn was resected. The endometrium was separated from the myometrium through sub-endometrial saline injection. Two endometrial fragments (1.0 x 2.0 cm) were dissected and sutured in the intra peritoneal anterior rectal wall of the animals. Thirty days later, all implants were identified during preoperative TRUS. “En-bloc” resection of the intestinal segment with the implants was performed during the second surgery. The autologous implants of endometrium invaded the muscular layer in one of the two animals. Conclusion: We demonstrated that the creation of an animal model of deep infiltrating endometriosis with intestinal involvement is feasible through a simple surgical technique. We believe that this model can be applied in experimental and clinical studies but further studies are necessary to refine the technique.

Surgical interventions for treating pectus excavatum

Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual’s life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined. Objectives To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum. Search methods With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual’s condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction.

Biopsias luteais em vacas Nelore

The present study describes a technique to obtain consecutive luteal samples by colpotomy. The animals received an epidural anesthesia and local anesthesia (vaginal vault) and after ten minutes the vaginal vault was incised with a scalpel blade and tissue was dissected to provide access to the pelvic cavity and to retract the ovary into the vagina. Then, a luteal biopsy was performed with a Yomann biopsy nipper. Signs indicative of pain and stress during the vaginal vault incision, traction of ovary or luteal biopsy were observed only in two collections. However, these signs were observed in ten collections during dissection of the vaginal wall and peritoneum. The occurrence of ataxia was observed in 26 collections and it was usually related to a longer duration of the procedure. Ataxia could be divided in light (15/26), moderate (6/26) and severe (5/26). The occurrence of ovarian adhesions ipsilateral to the incision was evaluated only in the initial four collections. Adhesions were present in 16 collections. The protocol described above provided a safe and efficient method to acquire luteal samples. The low incidence of adhesions allows the consecutive use of females without any interference in subsequent ovulations and collections.

Intervenções cirúrgicas para o tratamento do pectus excavatum: revisão sistemática

Pós-graduação em Bases Gerais da Cirurgia - FMB

Intervenções cirúrgicas para o tratamento do pectus excavatum: revisão sistemática

Pós-graduação em Bases Gerais da Cirurgia - FMB

Effect of shortening the barrel in contact shots from rifles and shotguns

In a suicidal gunshot fired to the chest from a carbine, the barrel of which had been shortened to half its original length, an unexpectedly large degree of destruction of the anterior thoracic wall with extensive undermining of the subcutis was found. This phenomenon was investigated for reconstructive purposes by firing test shots from two different long guns (caliber 7.92 x 57 repeating rifle with full-jacketed pointed bullet and caliber 12/70 single-barreled shotgun with shotgun slug) into blocks of soap (38 x 25 x 25 cm). The contact shots were fired before and after shortening the barrels (repeating rifle from 60 to 30 cm and single-barreled shotgun from 72 to 36 cm). The volume of the cavities in the simulant was visualized three-dimensionally with the help of a multislice computed tomography (CT) scanner and calculated sectionally. With the repeating rifle and the single-barreled shotgun, the shots from the sawed-off barrels produced significantly larger cavity diameters in the first section of the bullet track. This effect is attributable to the fact that, with a shortened barrel, the gas pressure at the muzzle is higher, thus, leading to increased expansion in the initial part of the wound track in contact shots.

Fatal contact shot to the chest caused by the gas jet from a muzzle-loading pistol discharging only black powder and no bullet: case study and experimental simulation of the wounding effect.

In modern medico-legal literature, only a small number of publications deal with fatal injuries from black powder guns. Most of them focus on the morphological features such as intense soot soiling, blast tattooing and burn effects in close-range shots or describe the wound ballistics of spherical lead bullets. Another kind of "unusual" and potentially lethal weapons are handguns destined for firing only blank cartridges such as starter and alarm pistols. The dangerousness of these guns is restricted to very close and contact range shots and results from the gas jet produced by the deflagration of the propellant. The present paper reports on a suicide committed with a muzzle-loading percussion pistol cal. 45. An unusually large stellate entrance wound was located in the precordial region, accompanied by an imprint mark from the ramrod and a faint greenish discoloration (apparently due to the formation of sulfhemoglobin). Autopsy revealed an oversized powder cavity, multiple fractures of the anterior thoracic wall as well as ruptures of the heart, the aorta, the left hepatic lobe and the diaphragm. In total, the zone of mechanical destruction had a diameter of approx. 15 cm. As there was no exit wound and no bullet lodged in the body, the injury was caused exclusively by the inrushing combustion gases of the propellant (black powder) comparable with the gas jet of a blank cartridge gun. In contact shots to ballistic gelatine using the suicide's pistol loaded with black powder but no projectile, the formation of a nearly spherical cavity could be demonstrated by means of a high-speed camera. The extent of the temporary cavity after firing with 5 g of black powder roughly corresponded to the zone of destruction found in the suicide's body.

Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation

OBJECTIVE: To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation. METHODS: Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors. RESULTS: The median follow-up was 12.5 months (range 2.5-26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83-1.00%) at 12 months and 89% (95% CI 0.55-0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64-0.96%) at 12 months and 79% (95% CI 0.51-0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from -0.1 (range -2 to 3) and 1.1 (range -1 to 8), preoperatively, to -2.6 (range -3 to -1) and -2.5 (range -3 to 0), postoperatively, respectively (P

Evaluation of the Does Reduction Potential Using a Breast Positioning Technique for Organ-based Tube Current Modulated CT Examinations

Purpose: The purpose of this work was to investigate the breast dose saving potential of a breast positioning technique (BP) for thoracic CT examinations with organ-based tube current modulation (OTCM).

Methods: The study included 13 female patient models (XCAT, age range: 27-65 y.o., weight range: 52 to 105.8 kg). Each model was modified to simulate three breast sizes in standard supine geometry. The modeled breasts were further deformed, emulating a BP that would constrain the breasts within 120° anterior tube current (mA) reduction zone. The tube current value of the CT examination was modeled using an attenuation-based program, which reduces the radiation dose to 20% in the anterior region with a corresponding increase to the posterior region. A validated Monte Carlo program was used to estimate organ doses with a typical clinical system (SOMATOM Definition Flash, Siemens Healthcare). The simulated organ doses and organ doses normalized by CTDIvol were compared between attenuation-based tube current modulation (ATCM), OTCM, and OTCM with BP (OTCMBP).

Results: On average, compared to ATCM, OTCM reduced the breast dose by 19.3±4.5%, whereas OTCMBP reduced breast dose by 36.6±6.9% (an additional 21.3±7.3%). The dose saving of OTCMBP was more significant for larger breasts (on average 32, 38, and 44% reduction for 0.5, 1.5, and 2.5 kg breasts, respectively). Compared to ATCM, OTCMBP also reduced thymus and heart dose by 12.1 ± 6.3% and 13.1 ± 5.4%, respectively.

Conclusions: In thoracic CT examinations, OTCM with a breast positioning technique can markedly reduce unnecessary exposure to the radiosensitive organs in the anterior chest wall, specifically breast tissue. The breast dose reduction is more notable for women with larger breasts.

Monoamniotic twins discordant for body stalk anomaly

Body stalk anomaly is a rare malformation. This anomaly in monozygotic twins is extremely unusual. We describe a case of monoamniotic pregnancy discordant for body stalk anomaly diagnosed at 11 weeks. Ultrasound showed a fetus with a large anterior abdominal wall defect, anomaly of the spine and no evidence of lower extremities and other with a normal morphology. As far as our concern, only three monoamniotic pregnancies discordant for this malformation were reported. Our case represents the fourth reported monoamniotic pregnancy discordant for body stalk anomaly with diagnosis made by ultrasound and the second diagnosed in the first trimester.

Tela de polipropileno versus correção sítio-especifica no tratamento do prolapso de parede vaginal anterior: resultados preliminares de ensaio clínico randômico

OBJETIVO: Comparar o uso de tela de polipropileno e correção sitio-específica no tratamento cirúrgico do prolapso vaginal anterior. MÉTODOS: Estudo prospectivo randômico comparativo em que foram operadas 32 pacientes com idades entre 50 e 75 anos, que apresentavam prolapso vaginal anterior estádio III ou IV, ou recidivado. A estática pélvica foi avaliada segundo as recomendações da International Continence Society (ICS), o sistema POP-Q e pelo Índice de Quantificação de Prolapso (POP-Q-I) Absoluto e Relativo. Para o rastreamento da incontinência urinária de esforço oculta todas as pacientes, sintomáticas ou não, foram submetidas a estudo urodinâmico em posição semi-ginecológica e semi-sentada, com redução do prolapso com pinça de Cheron. Registrou-se o tempo cirúrgico, o volume de sangramento intra-operatório e as complicações intra e pós-operatórias. O tempo de seguimento médio do estudo foi de 8,5 meses. RESULTADOS: Em relação aos resultados anatômicos ocorreu melhores resultados com a utilização de tela de polipropileno sobre o reparo sitio-específico. Em relação à morbidade cirúrgica, observou-se menor tempo cirúrgico no grupo em que utilizou-se tela. CONCLUSÃO: Houve superioridade dos resultados anatômicos obtidos com a utilização de tela de polipropileno sobre o reparo sitio-específico.