Intraoperative topical administration of mitomycin C, in different concentrations, on the cicatrization of mioplasties of the dorsal rectus of rabbits / Administração tópica per-operatória da mitomicina C, em diferentes concentrações, sobre a cicatrização de mioplastias do reto dorsal de coelhos

Myoplasties of the extraocular muscle may cause adhesions between the operated muscle and the adjacent tissues, commonly generating cicatricial strabismus. With the purpose of reducing to a minimum the occurrence of adhesion, the effects of mitomycin C, an antifibrotic agent, were studied in concentrations of 0.008 percent, 0.02 percent, and 0.04 percent applied during intraoperative of myoplasties of the superior rectus muscle of rabbits. Fifty six animals were divided in five groups. During the postoperative, the operated areas were washed with physiological solution. Eye drop instillation to prevent inflammation and bacterial infection were used. The method to analyze the results consisted of clinical and histological evaluation and statistical analyzes. We also evaluated at the same time the amount of basic fibroblast growth factor (FGF-2) by immunohistochemical study. Clinically, more adhesions were found in the eyes of the control group than in the groups of treated eyes. However there was no significant statistics difference between the two groups (P>0.05). Histologically, mitomycin C caused a delayed cicatrization in the mioplastic areas, specially in the group who received the 0.02 percent concentration. The immunohistochemical showed FGF-2 marking in fibroblasts and macrophages, but between the groups there wasn't no difference. Based on those results, mitomycin C in the utilized concentrations was capable of delaying the cicatrization and consequently avoid the secondary strabismus without undesirable side effects.

Mioplastias da musculatura extra-ocular podem ensejar aderências entre o músculo operado e os tecidos adjacentes, produzindo, não raro, estrabismos cicatriciais. Com intuito de se minimizar a ocorrência de aderências, investigaram-se os efeitos da mitomicina C, como agente antifibrótico, em concentrações ascendentes de 0,008, 0,02 e 0,04 por cento, aplicada no per-operatório de mioplastias do reto superior do bulbo do olho de coelhos. Operaram-se 56 animais, que compuseram cinco grupos. No pós-operatório, instituíram-se limpeza com solução fisiológica das áreas operadas e profilaxia antimicrobiana e antiinflamatória, na forma de colírio. Avaliações clínica, histológica e imunoistoquímica, em que se estudou o fator de crescimento fibroblástico-básico (FGF-2), e estatística compuseram os métodos de análise dos resultados. Encontraram-se, clinicamente, mais aderências nos olhos-controle, comparativamente aos tratados, embora sem diferença estatística (P>0,05). À histologia, verificou-se que a mitomicina C ensejou retardo da cicatrização junto às áreas das mioplastias, notadamente no grupo que a recebeu, à concentração de 0,02 por cento. A imunoistoquímica revelou marcação do FGF-2 em fibroblastos e macrófagos indistintamente entre os grupos. Com base nos resultados, permite-se admitir que a mitomicina C, nas concentrações em que foi empregada, retardou a cicatrização e, por conseguinte, o estrabismo secundário, sem ensejar efeitos colaterais.

Procedimientos quirúrgicos en 156 casos de derrame pleural: resultados inmediatos / Surgical procedures in 156 cases of pleural effusion: immediate results

Introducción: el derrame pleural es una entidad clínica frecuente, su estudio y manejo son importantes para resolverlo. El objetivo fue evaluar los resultados inmediatos de los procedimientos diagnósticos y terapéuticos en casos consecutivos de derrame pleural. Material y métodos: durante un periodo de 12 meses, de 787 pacientes hospitalizados, 156 (19.8 %) presentaron derrame pleural. También se evaluaron 22 casos de neumotórax considerados como derrame gaseoso y 10 con empiema crónico. Resultados y discusión: en 23 casos no neoplásicos, la toracentesis diagnóstica y evacuadora resolvió el derrame. El drenaje con sonda intrapleural conectada a sello de agua se practicó en 133: en 109 (81.9 %) se resolvió el derrame y en 24 se practicaron otros procedimientos. En este grupo el derrame fue neoplásico en 35 y no neoplásico en 98, incluidos 36 iatrogénicos; 22 casos de neumotórax se consideraron como derrame gaseoso y fueron tratados con sonda intrapleural; 10 casos de empiema crónico fueron estudiados como secuelas de derrames, no fueron resueltos con los procedimientos mencionados. Hubo diferencia significativa entre derrames neoplásicos y no neoplásicos (p = 0.001), y entre casos manejados con procedimientos de invasión mínima y sonda intrapleural (p = 0.001), por comparación de proporciones. Se comenta la utilidad de la pleurodesis y la toracoscopia en el tratamiento del derrame. En casos crónicos la toracostomía en ventana y mioplastia consecutiva tienen indicación precisa. Conclusiones: el diagnóstico y tratamiento oportunos del derrame pleural son importantes. La colocación de sonda pleural resuelve la mayoría de los casos (89.9 %). El neumotórax debe ser igualmente manejado. El empiema crónico requiere toracostomía en ventana y mioplastia. Las maniobras descuidadas o inadecuadas provocan derrames de naturaleza iatrogénica.

BACKGROUND: Pleural effusion is a common clinical entity. Proper diagnosis and management are important for successful treatment. We undertook this study to evaluate immediate results of the procedures used in a group of cases with pleural effusion. METHODS: Of 2589 patients at first consultation, 787 were hospitalized and 156 had pleural effusion. Diagnostic and therapeutic procedures used were evaluated. RESULTS: With thoracentesis and evacuation of liquid, 23 nonneoplastic cases had resolution. Chest tube drainage with water seal was performed in 133 patients. This procedure suppressed the effusion in 109 patients, but in 24 patients another approach was necessary. In this group there were 35 neoplastic and 96 nonmalignant cases, the latter 36 were provoked by iatrogenic management. Twenty two cases of pneumothorax considered as gaseous effusion and 10 cases of chronic empyema sequelae of pleural effusions were also studied. Proportion comparison demonstrated significant differences between neoplastic and nonneoplastic effusions (p =0.001) and in cases managed with minimally invasive procedures and chest tube drainage (p =0.001). The performance of pleurodesis and thoracoscopy is discussed. In chronic cases, indications of open window thoracostomy and myoplasty are elucidated. CONCLUSIONS: In pleural effusion, opportune diagnosis and proper management are essential. Drainage tube can solve the majority of cases. Pneumothorax must be treated in the same way. In chronic empyema, open window thoracostomy and myoplasty are indicated. Careless patient management and poor treatment lead to iatrogenic complications.

Aspergillus thoracic empyema treated with single stage cavernostomy and myoplasty / 中国医师进修杂志

Objective To investigate the therapeutic effect of single stage cavernostomy and myoplasty on the aspergillus thoracic empyema. Method Four patients suffering from aspergillus thoracic empyema were treated with single stage cavernostomy and myoplasty. They got the inflammation of aspergillus after the operation for tuberculosis in 2, bronchiectasis in 1 and lung cyst in 1. They were performed rib resection, cavernostomy, closure of the bronchial openings and total/partial obliteration of the cavity with a muscle flap as a single stage technique. Pectoralis major muscle was used for the myoplasty in 1, latissimus dorsi in 1 and intercostal muscle in 2. All patients were given the therapy of nutritional support, local pressure dressing and oral anti-fungus drugs. Result Two patients got the primary healing, the chest tube were pulled out 2 days later and they were discharged 12 days after the operation. One patient′s cavity became little and there was pus drained from the chest tube, he cured after prolonged draining and washed with the anti-fungus drugs. One patient dead for pneumonia 67 days after the operation. Conclusion Cavernostomy and myoplasty as a single stage technique is safe and reliable in the management of patients with aspergillus thoracic empyema.

Development of Descending Thoracic Aortomyoplasty for Cardiac Bioassist / 대한흉부외과학회지

BACKGROUND: Thoracic aortomyoplasty is one of the surgical treatment for heart failure and has advantages over artificial heart or intraaortic balloon pumps. It uses autogenous skeletal muscles and solves problems such as energy source. However its use in clinical settings has been limited. This preliminary study was designed to develop surgical technique and to determine the effect of acute descending thoracic aortomyoplsty. MATERIAL AND METHOD: Thirteen adult Mongrel dogs were used. The left latissimus dorsi muscle was wrapped around the descending aorta under general anesthesis. Swan-Ganz and microtipped Millar catheter were used for the hemodynamics and endocaridial viability ratio. Data were collected with myostimulator on and off in normal hearts and the ischemic hearts. RESULT: In normal hearts, the mean aortic diastolic pressure increased from 72+/-15mmHg at baseline to 78+/-13mmHg with stimulator on. Coronary perfusion pressure increased from 61+/-11mmHg to 65+/-9mmHg. Diastolic time increased from 0.288+/-0.003 msec to 0.290+/-0.003msec. Systolic time decreased from 0.164+/-0.002msec to 0.160+/-0.002 msec. Endocardial viability ratio increased from 1.21+/-0.22 to 1.40+/-0.18. In ischemic hearts, mean aortic diastolic pressure incrased from 56+/-21mmHg at baseline to 61+/-15mmHg with stimulator on. Coronary perfusion pressure increased from 48+/-17mmHg to 52+/-15mmHg. Diastolic time increased from 0.290+/-0.003 msec to 0.313+/-0.004msec. Systolic time decreased from 0.180+/-0.002 msec to 0.177+/-0.003 msec. Endovascular viability ratio increased from 0.9+/-0.31 to 1.1+/-0.31. The limited number of cases ruled out the statistic significance. CONCLUSIONS: Descending thoracic aortomyoplasty is a simple operation designed to use patient's own skeletal muscles. It trends to increase diastolic augmentation and coronary perfusion pressure. Modification of surgical technique and stimulator protocol would maximize the effect to assist the heart.