Complicaciones perianales causadas por agentes modeladores inyectados en glúteos / Perianal complications caused by gluteal injection of modeling agents

En este reporte presentamos tres pacientes en quienes ocurrieron condiciones inflamatorias perianales tardías, luego de la administración de sustancias modeladoras no identificadas en los glúteos. El diagnóstico inicial y supuesto no fue correcto, ya que no se investigó durante la evaluación preliminar el antecedente de la administración de elementos modeladores. Recomendamos que los pacientes con patologías inflamatorias del ano, sobre todo aquellos cuyo curso es extraño, se les pregunte acerca de la administración de agentes modeladores en los glúteos. Esta práctica puede contribuir a la eficacia del diagnóstico de manifestaciones perianales caracterizadas por flogosis, que se presentan de forma inusual. (AU)

In this report we present three patients in which late perianal inflammatory conditions occurred after administration of unidentified modeling agents to the buttocks. The initial diagnosis was not correct because of the administration of modeling agents was not investigated during the initial eval-uation. We recommend inquiring patients with inflammatory pathologies of the anus, especially those whose course is unusual, about the adminis-tration of modeling agents to the buttocks. This approach can contribute to the efficiency of the diagnosis of perianal complaints characterized by inflammation, but rare in its appearance. (AU)

Nanosilver alleviates foreign body reaction and facilitates wound repair by regulating macrophage polarization / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Foreign body reactions induced by macrophages often cause delay or failure of wound healing in the application of tissue engineering scaffolds. This study explores the application of nanosilver (NAg) to reduce foreign body reactions during scaffold transplantation. An NAg hybrid collagen-chitosan scaffold (NAg-CCS) was prepared using the freeze-drying method. The NAg-CCS was implanted on the back of rats to evaluate the effects on foreign body reactions. Skin tissue samples were collected for histological and immunological evaluation at variable intervals. Miniature pigs were used to assess the effects of NAg on skin wound healing. The wounds were photographed, and tissue samples were collected for molecular biological analysis at different time points post-transplantation. NAg-CCS has a porous structure and the results showed that it could release NAg constantly for two weeks. The NAg-CCS group rarely developed a foreign body reaction, while the blank-CCS group showed granulomas or necrosis in the subcutaneous grafting experiment. Both matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were reduced significantly in the NAg-CCS group. The NAg-CCS group had higher interleukin (IL)-10 and lower IL-6 than the blank CCS group. In the wound healing study, M1 macrophage activation and inflammatory-related proteins (inducible nitric oxide synthase (iNOS), IL-6, and interferon-‍γ (IFN-‍γ)) were inhibited by NAg. In contrast, M2 macrophage activation and proinflammatory proteins (arginase-1, major histocompatibility complex-II (MHC-II), and found in inflammatory zone-1 (FIZZ-1)) were promoted, and this was responsible for suppressing the foreign body responses and accelerating wound healing. In conclusion, dermal scaffolds containing NAg suppressed the foreign body reaction by regulating macrophages and the expression of inflammatory cytokines, thereby promoting wound healing.

Lesiones perirradiculares persistentes: revisión narrativa / Persistent periradicular lesions: a narrative review

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)

The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)

Tercer episodio de doble contractura capsular unilateral posterior a mamoplastia de aumento / Third episode of unilateral double capsular contracture after breast augmentation

Resumen La mamoplastia de aumento consiste en insertar una prótesis dentro del tejido mamario con el fin de alterar su tamaño y forma. Actualmente, se utilizan varios tipos de implantes según su forma, tamaño y material, así como diferentes variaciones en la técnica quirúrgica. Se han descrito complicaciones asociadas por ser considerados cuerpos extraños y la más común es la contractura capsular. Se presenta el caso de una paciente de 41 años a quien se le realizó mamoplastia de aumento con implantes de silicona y de forma atípica presentó un episodio de doble contractura capsular que requirió dos intervenciones adicionales por asimetría y dolor cambiando el implante y nuevamente presentando el mismo fenómeno de manera unilateral en la mama izquierda.

Abstract Augmentation mammoplasty consists of inserting a prosthesis into the breast tissue in order to alter its size and shape. Currently, several types of implants are used according to their shape, size and material, as well as different variations in the surgical technique. Associated complications have been described because they are considered foreign bodies and the most common is capsular contracture. We present the case of a 41 year old patient who underwent augmentation mammoplasty with silicone implants and atypically presented an episode of double capsular contracture that required two additional interventions due to asymmetry and pain by changing the implant and again presenting the same phenomenon unilaterally in the left breast.

Research and development concept of barrier membranes based on “ immune microenvironment regulation” / 口腔疾病防治

@#Guided bone regeneration technology applied in alveolar bone defect regeneration is based on the barrier function and space maintenance of the barrier membrane. Therefore, traditional development strategies for barrier membranes focus on their physical barrier function, degradation characteristics and biocompatibility to avoid immunogenicity. However, not only does the barrier membrane passively block connective tissue, it is recognized as a “foreign body”that triggers a persistent host immune response, known as a foreign body reaction. The theories of osteoimmunology reveal a close relationship between the immune system and bone system and emphasize the role of immune cells in bone tissue-related pathophysiological processes. Based on these findings, we propose a novel development strategy for barrier membranes based on immune microenvironment regulation: by manipulating mechanical properties, surface properties and physiochemical properties, barrier membranes are endowed with an improved immunomodulation ability, which helps to regulate immune cell reactions to induce a favorable local immune microenvironment, thus coordinating osteogenesis and osteoclastogenesis as well as barrier membrane degradation to increase the efficiency of barrier membranes in GBR applications. In this paper, we review the development of barrier membranes and their close relationship to the immune microenvironment concerning bone regeneration and membrane degradation. Additionally, the outcomes of research on barrier membranes based on the regulation of the immune microenvironment have been summarized to improve the osteogenesis efficiency of barrier membranes and solve the problem of the regeneration and repair of bone defects, especially alveolar bone defects.

Analysis of tissue inflammatory response, fibroplasia, and foreign body reaction between the polyglactin suture of abdominal aponeurosis in rats and the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone and polyester/porcine collagen meshes

ABSTRACT Purpose To compare tissue inflammatory response, foreign body reaction, fibroplasia, and proportion of type I/III collagen between closure of abdominal wall aponeurosis using polyglactin suture and intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes to repair defects in the abdominal wall of rats. Methods Forty Wistar rats were placed in four groups, ten animals each, for the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes or suture with polyglactin (sham) after creation of defect in the abdominal wall. Twenty-one days later, histological analysis was performed after staining with hematoxylin-eosin and picrosirius red. Results The groups with meshes had a higher inflammation score (p < 0.05) and higher number of gigantocytes (p < 0.05) than the sham group, which had a better fibroplasia with a higher proportion of type I/III collagen than the tissue separating meshes (p < 0.05). There were no statistically significant differences between the three groups with meshes. Conclusions The intraperitoneal implant of polypropylene/polyglecaprone and polyester/porcine collagen meshes determined a more intense tissue inflammatory response with exuberant foreign body reaction, immature fibroplasia and low tissue proportion of type I/III collagen compared to suture with polyglactin of abdominal aponeurosis. However, there were no significant differences in relation to the polypropylene mesh group.

Relato de caso: edema tardio intermitente e persistente (ETIP) de implante de ácido hialurônico desencadeado pela Covid-19 / Case Report: Persistent, Intermittent Delayed Swelling (PIDS) of Hyaluronic Acid filler, triggered by COVID-19

O edema tardio intermitente e persistente (ETIP) por implante de ácido hialurônico é uma reação inflamatória imunomediada decorrente de fenômenos imunogênicos ao próprio preenchedor bem como de sua capacidade em reter água, configurando assim o edema local. Pode ser desencadeado após infecções virais ou bacterianas. Assim como em muitas doenças infectocontagiosas, a COVID-19 pode vir a apresentar na pele diversos sinais e sintomas que ainda não são completamente compreendidos, porém muitas manifestações cutâneas associadas já foram descritas. Vimos, por meio deste relato de caso, apresentar o ineditismo de uma reação do tipo ETIP, desencadeada pela infecção por Sars-CoV-2.

Persistent Intermittent Delayed Swelling (PIDS) due to hyaluronic acid implantation is an immune-mediated inflammatory reaction resulting from immunogenic phenomena to the filler itself, and its ability to retain water, thus configuring local edema. Viral or bacterial infections can trigger the condition. As with many infectious diseases, COVID-19 may have several signs and symptoms on the skin that are not yet fully understood, but many associated skin manifestations have already been described. Through this case report, we report the novelty of an ETIP-type reaction triggered by SARS-CoV-2 infection.

Polypropylene meshes coated with chitosan/polyethylene glycol for the reconstruction of the abdominal wall: an experimental study in rats / Telas de polipropileno revestidas com o filme de quitosana/polietilenoglicol para a reconstrução da parede abdominal: estudo experimental em ratos

The aim of this study was to characterize the tissue reactions triggered by the polypropylene mesh coated with chitosan and polyethylene glycol film, and if it's able to prevent the formation of peritoneal adhesions. Defects in the abdominal wall of rats were induced and polypropylene meshes coated with chitosan/polyethylene glycol (CPEG group, n= 12) and uncoated (PP control group, n= 12) were implanted. On the fourth and forty-fifth postoperative day the formation of adhesion and the tissue reaction to the biomaterial was evaluated through histological and histochemical analysis. The area (P= 0.01) and severity (P= 0.002) of the adhesion was significatively less in the CPEG group. On the fourth day the foreign body reaction was less intense in CPEG group (P= 0.018) and the production of collagen fibers was more intense in this group (P= 0.041). The tissue reactions caused by the biomaterials were similar on the 45th day, with the exception of the high organization of collagen fibers in the CPEG group. The CPEG meshes did not fully prevent the formation of adhesions, but minimized the severity of the process. The foreign body reaction promoted by polypropylene meshes coated with CPEG is less intense than that triggered by uncoated polypropylene meshes.(AU)

O objetivo deste estudo foi caracterizar as reações tissulares desencadeadas pela tela de polipropileno revestida com o filme de quitosana e polietilenoglicol e verificar se ela é capaz de prevenir a formação de aderências peritoneais. Um defeito na parede abdominal dos ratos foi realizado, e as telas de polipropileno revestidas com quitosana/polietilenoglicol (grupo CPEG, n= 12) e sem revestimento (grupo controle PP, n= 12) foram implantadas. No quarto e no 45º dia pós-operatório, avaliou-se a formação de aderências e a reação tecidual ao biomaterial por análise histológica e histoquímica. A área (P= 0,01) e a severidade (P= 0,002) da aderência peritoneal foram significativamente menores no grupo CPEG no 45º dia. No quarto dia, observou-se que a reação do corpo estranho foi menor no grupo CPEG (P= 0,018), e a produção de fibras de colágeno mais intensa (P= 0,041). As reações tissulares causadas pelos biomateriais implantados foram semelhantes no 45º dia, com exceção da melhor organização das fibras colágenas no grupo CPEG. As telas CPEG não impediram completamente a formação de aderências, porém minimizaram a gravidade do processo. A reação de corpo estranho promovida por telas de polipropileno revestidas com CPEG é menos intensa do que a desencadeada por telas de polipropileno não revestidas.(AU)

Research progress in the regulation of macrophages in foreign body reaction in bone tissue repair / 口腔疾病防治

@#The foreign body reaction refers to a chronic inflammatory reaction and a wound-healing reaction that mainly involve macrophages and foreign body giant cells, which occur after a biological material is implanted into the body. Since macrophages in the foreign body reaction are recruited to the surface of the material after implantation of the material, subsequent secretion of a series of inflammatory factors and fusion into foreign body giant cells may lead to the degradation of the biological materials and environmental stress cracking. Moreover, the prolongation of macrophage polarization and the influence of related receptors may also lead to the phenomenon of fiber encapsulation, resulting in poor prognosis. Some scholars are committed to reducing the response of foreign bodies from the perspective of macrophages and foreign body giant cells, specifically by regulating the secretion of related inflammatory factors, reducing the subtypes of M1 macrophages, promoting their polarization to M2 macrophages, and regulating the fusion of macrophages and selective expression of macrophage-associated receptors to regulate fibrosis. The new immunological view holds that macrophages have the potential to repair bone tissue via angioplasts and osteogenesis in foreign body reactions. Therefore, the gold standard that has long been considered in regenerative medicine, which is that an inert material does not cause a foreign body reaction, is expected to be gradually replaced by tissue engineering that regulates tissue activity and function.

Delayed formation of sterile abscess after zygomaticomaxillary complex fracture treatment with bioabsorbable plates

We present a patient who showed a sterile abscess after facial bone fixation with bioabsorbable plates and screws. He had zygomaticomaxillary complex and periorbital fracture due to falling down. The displaced bones were treated by open reduction and internal fixation successfully using bioabsorbable plate system. However, at postoperative 11 months, abrupt painless swelling was noted on the previous operation sites, left lateral eyebrow and lower eyelid. By surgical exploration, pus-like discharge and degraded materials were observed and debrided. The pathologic analysis revealed foreign body reaction with sterile abscess. This complication followed by bioabsorbable device implantation on maxillofacial bone surgery has been rarely reported in which we call attention to the maxillofacial plastic surgeons.

Ingestão acidental de broca odontológica cirúrgica durante a remoção de um terceiro molar inferior / Accidental ingestion of surgical dental drill during removal of a lower third molar

Imperícia durante a prática odontológica pode, ocasionalmente, gerar iatrogenias durante o ato transcirúrgico, tais como a deglutição ou aspiração de materiais dentários ou instrumentos de uso diário. A falta de planejamento, falhas humanas durante o tratamento, diagnóstico incorreto e acidentes podem vir a se tornar potenciais complicações ao paciente, que além da morbidade podem causar complicações secundárias, podendo até mesmo levar o indivíduo a óbito. É importante o clínico reconhecer a sintomatologia apresentada pelo paciente e tomar atitudes cabíveis no momento em que a complicação é estabelecida, desde os níveis mais baixos de suporte até os mais complexos, proporcionando conforto físico e emocional, com o intuito de evitar problemas imediatos ou futuros à saúde como um todo

Malpractice during dental practice may occasionally generate iatrogenies during the transsurgical act, such as swallowing or aspiration of dental materials or instruments for daily use. Lack of planning, human failures during treatment, incorrect diagnosis and accidents may become potential complications for the patient, which in addition to the morbidity can cause secondary complications and may even lead to death. It is important for the clinician to recognize the symptoms presented by the patient and to take appropriate actions when the complication is established from the lowest levels of support to the most complex, providing physical and emotional comfort in order to avoid immediate or future health problems as a whole

Rare chronic stridor: Case report and literature review / Estridor de extraña duración: reporte de caso y revisión

Abstract This paper reports the case of a toddler with chronic stridor of four months of evolution, treated several times by micro-nebulization (MNB) with beta 2, adrenergics, O2 and corticosteroids with partial improvement. The patient did not have complementary studies nor a clear history of foreign body aspiration (FB). During the last visit to the ER, a neck X-ray revealed a stippling sign in the upper airway. A bronchoscopy was performed, and a sharp foreign body (fishbone) was found in the upper airway, which was subsequently removed. This case is reported due to the unusual evolution of the foreign body in the upper airway, which manifested as a chronic stridor that resolved without further complications.

Resumen Se presenta el caso de una paciente prescolar con estridor crónico de 4 meses de evolución, tratada varias veces mediante micronebulizaciones (MNB) con beta 2, adrenérgicos, O2 y corticoides con mejoría parcial, sin estudios complementarios ni antecedentes claros de atoramiento con cuerpo extraño (CE). Además, se realizó una radiografía de cuello (Rx) que reveló la presencia de imagen en punta de lápiz traqueal y una broncoscopia que comprobó la existencia de un cuerpo extraño puntiagudo (espina de pescado) en la vía aérea superior. Este caso se reportó por su inusual presentación, pues es un CE en la vía aérea superior que se manifestó con estridor crónico, sin mayores complicaciones.

Bezoar metálico no trato gastrointestinal - relato de caso / Metallic bezoar in the gastrointestinal tract - case report

O objetivo deste artigo é um relatar um caso de paciente psiquiátrico atendido no Hospital Universitário Sul Fluminense (HUSF), no município de Vassouras/RJ, com quadro recidivante de bezoar metálico no trato gastrointestinal. Bezoares são corpos estranhos que podem obstruir o lúmen do aparelho digestivo a partir da ingestão continuada, prolongada e intencional de materiais não comestíveis ou de medicamentos de uso contínuo. Os bezoares podem apresentar extensão em continuidade para o intestino delgado ou fragmentação com múltiplas massas detectáveis em qualquer segmento intestinal. Neste caso foram realizadas laparotomias exploradoras para retirada dos corpos metálicos em região gástrica. Houve evasão do paciente do HUSF, o que impediu o acompanhamento do caso por equipe multidisciplinar (AU)

The purpose of this article is to describe a clinical case of relapsing metallic bezoar in the gastroinstestinal tract, observed in a psychiatric patient treated at the Hospital Universitario Sul Fluminense, located at city of Vassouras/ RJ. Bezoars are foreign bodies that impact the lumen of the digestive tract and are formed by the continued, prolonged and intentional ingestion of exotic materials or continuous use of medications. The bezoars may extend in continuity to the small intestine or could be presented as multiple masses detectable in any gut segment. By exploratory laparotomies, the metallic bodies in the gastric and intestinal region were removed. The patient evaded the Hospital and monitoring of the case by a multidisciplinary team was not possible. (AU)

Sinus Tract Formation with Chronic Inflammatory Cystic Mass after Beta Tricalcium Phosphate Insertion

Beta tricalcium phosphate (β-TCP) is one of allogenic bone substitute which is known to have interconnected pores that draws cell and nutrients for bone generation. It has been resulted in good outcomes for bone defect coverage or augmentation. However, several studies have also reported negative outcomes and associated complications including unexpected formation of cystic mass, continuous pain and secretion. We present the case of a 36-year-old man with a right cheek cystic mass who had a history of right zygomaticomaxillary (ZM) complex fracture and surgical correction with β-TCP powder insertion to ZM bone defect. Excisional biopsy under local anesthesia revealed calcified mass in a sinus tract which was found to be connected to the ZM bone defect site in postoperative computed tomography image. Further excision under general anesthesia was performed to remove the sinus tract and fine granules which filled the original defect site. Pathologic report revealed bony spicules and calcification materials with chronic foreign body reaction. Postoperative complications and recurrence were not reported.

Sinus Tract Formation with Chronic Inflammatory Cystic Mass after Beta Tricalcium Phosphate Insertion

Beta tricalcium phosphate (β-TCP) is one of allogenic bone substitute which is known to have interconnected pores that draws cell and nutrients for bone generation. It has been resulted in good outcomes for bone defect coverage or augmentation. However, several studies have also reported negative outcomes and associated complications including unexpected formation of cystic mass, continuous pain and secretion. We present the case of a 36-year-old man with a right cheek cystic mass who had a history of right zygomaticomaxillary (ZM) complex fracture and surgical correction with β-TCP powder insertion to ZM bone defect. Excisional biopsy under local anesthesia revealed calcified mass in a sinus tract which was found to be connected to the ZM bone defect site in postoperative computed tomography image. Further excision under general anesthesia was performed to remove the sinus tract and fine granules which filled the original defect site. Pathologic report revealed bony spicules and calcification materials with chronic foreign body reaction. Postoperative complications and recurrence were not reported.

Reação de corpo estranho a material de preenchimento estético: relato de quatro casos / Foreign body reaction due to aesthetic filling materials: report of four cases

Objetivo: o objetivo deste trabalho é relatar quatro casos de reações de corpo estranho a material de preenchimento estético acometendo a cavidade oral. Relato dos casos: quatro pacientes adultas do sexo feminino compareceram à consulta apresentando nódulos submucosos localizados nos lábios e sulcos nasogenianos com histórico prévio de injeção de materiais de preenchimento estético (ácido hialurônico em duas pacientes e polimetilmetacrilato em duas pacientes). O diagnóstico em três dos quatro casos foi baseado nos achados clínicos e histológicos e apenas nos achados clínicos em um caso. O tratamento consistiu de manejo cirúrgico em três pacientes e corticoterapia em uma paciente e todas se encontram bem e em acompanhamento clínico. Conclusão: os cirurgiões-dentistas devem estar atentos aos efeitos adversos provocados por materiais de preenchimento estético, considerando seus diagnósticos diferenciais e as formas mais adequadas de tratamento.

Objective: The aim of the present study is to report 4 cases of foreign body reactions to dermal fillers affecting the oral cavity. Cases report: Four adult females were referred for evaluation of submerse nodules on the lips and nasolabial folds with a previous history of injection of dermal fillers (hyaluronic acid in two cases and polymethylmethacrylate in two cases). Diagnosis was based on clinical and histological aspects in three cases and solely on clinical aspect in one case. Management consisted in surgical excision in three cases and corticosteroid therapy in one and all 4 patients are well, with no signs of recurrence and remain in clinical follow-up. Conclusion: Dental professionals should be aware of the side effects associated with the use of aesthetic fillers, considering their main differential diagnosis and the most adequate management strategy for each individual case.

Inusual hallazgo de dos monedas juntas en esófago de pacientes pediátricos: Reporte de dos casos / An unusual finding of two coins together in the esophagus of pediatric patients: Report of two cases

La ingestión de cuerpos extraños (CE) es un motivo de consulta frecuente en los Servicios de Urgencia Pediátricos. Los estudios reportan que en la edad pediátrica se presenta el 80% de los CE, siendo más frecuente entre los 6 meses y los 3 años de edad, constituyendo la segunda causa de endoscopía digestiva urgente en pediatría. En 80 a 90% de los casos el CE pasa espontáneamente a través del tracto gastrointestinal superior; sin embargo, en ocasiones se aloja en el esófago y debe ser extraído para evitar complicaciones peligrosas como obstrucción o perforación del tracto digestivo superior, sangrado, úlceras, o fístulas. La ingesta e impactación de cuerpos extraños múltiples en el esófago, es un evento muy pocas veces reportado en población infantil. La mayoría de reportes, corresponde a la ingesta de magnetos, que aunque siendo aún de presentación infrecuente, pueden causar serias complicaciones gastrointestinales debido a que la atracción entre ellos puede atrapar las paredes de múltiples asas intestinales provocando perforación, formación de fistulas, vólvulos, hemorragia intraperitoneal e incluso la muerte. Aunque las monedas son los cuerpos extraños más comúnmente encontrados en esófago en niños, el hallazgo de múltiples monedas es en evento muy pocas veces reportado. Se presentan dos casos de pacientes pediátricos atendidos en el servicio de emergencia, con el hallazgo de dos monedas juntas y alineadas a nivel esofágico.

The ingestion of foreign bodies (EB) is a frequent complaint in the Pediatric Emergency Services. Studies report that in children occurs 80% of the EC, most frequently between 6 months and 3 years old and the second held because of urgent endoscopy in pediatrics. In 80-90% of cases the CE spontaneously passes through the upper gastrointestinal tract, however occasionally staying in the esophagus and should be removed to avoid dangerous complications such as obstruction or perforation of the upper digestive tract bleeding, ulcers, or fistulas. Intake and impaction of multiple foreign bodies in the esophagus, is a few event times reported in children. Most reports, corresponds to the ingestion of magnets, although still rare even presentation, can cause serious gastrointestinal complications, because the attraction between them can trap walls causing multiple small bowel perforation, fistula formation, volvulus, intraperitoneal hemorrhage and even death. Although the coins are the most commonly found foreign bodies in esophagus in children, the discovery of multiple currencies is very few times reported event. Two cases of pediatric patients treated in the emergency, with the discovery of two coins together and aligned with esophageal level is presented.

Reacción sistémica tras la ingesta de una oruga procesionaria del pino: ¿Manejo conservador? / Systemic reaction after pine processionary caterpillar ingestion: Conservative management?

La oruga procesionaria del pino, forma larvaria de la mariposa nocturna Thaumetopoea pityocampa, es una de las principales plagas forestales del sur de Europa. Con frecuencia, estas orugas producen reacciones locales en humanos debidas a los pelillos urticantes microscópicos que las recubren. La mayoría de los síntomas ocasionados son cutáneos, como urticaria aguda, y son mucho más infrecuentes las reacciones sistémicas. Se presenta un caso de reacción sistémica, con edema orofacial, babeo y urticaria tras la ingesta de una oruga procesionaria del pino en un lactante de 11 meses, en el cual el tratamiento farmacológico fue suficiente para la resolución de los síntomas. No tuvo, en ningún momento, compromiso de la vía aérea ni otros datos de anafilaxia, por lo que se desestimaron actuaciones más agresivas, como intubación orotraqueal, endoscopía o laringoscopía.

The larval form of the moth Thaumetopoea pityocampa, known as pine processionary caterpillar, is one of the main forest pests in southern Europe. Often, these caterpillars cause local reactions in humans, due to their microscopic stinging hairs. Most symptoms affect skin, in form of acute urticaria. Systemic reactions are rare. An eleven month old infant with a systemic reaction after ingestion of a pine processionary caterpillar is presented. The boy reached the Emergency Room with orofacial edema, drooling and urticaria. Drug treatment was enough to resolve the symptoms. The patient did not present airway commitment, nor anaphylaxis data at any moment, so more aggressive actions, such as endotracheal intubation, endoscopy or laryngoscopy, were rejected.

Host inflammatory response to polypropylene implants: insights from a quantitative immunohistochemical and birefringence analysis in a rat subcutaneous model

ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.

Evaluation of diaphragmatic mobility following intra-abdominal sub-diaphragmatic fixation of a double-layered mesh in rats

PURPOSE: To evaluate the tissue integration of a double-sided mesh after fixation in diaphragm and to study the diaphragmatic mobility by ultrasound. METHODS: Twenty male Wistar rats were used. The animals were assigned into two equal groups according to the day of euthanasia. The animals were anesthetized and a 1.5 x 1.5 cm of double-layer mesh was inserted between the diaphragm and the liver. For the evaluation of the diaphragm mobility a sonographic method was used. Measurements on specific breathing parameters were taking place. Pathological evaluation took place after the animal's euthanasia. RESULTS: Extra-hepatic granuloma was not differentiated overtime, (χ2=0.04, p>0.05). Neither fibrosis was significantly differentiated, (χ2=0.04, p>0.05). Intra-hepatic granuloma was significantly differentiated overtime, (χ2=10.21, p<0.05). Concerning Te parameter, means were significantly differentiated over time, F (3, 30) = 5.12, (p<0.01). Ttot parameter, it was differentiated over time, F (3, 8)=4.79, (p<0.05). IR parameter was also longitudinally differentiated, F (3, 30)=3.73, (p<0.05). CONCLUSION: The measurements suggest a transient malfunction of diaphragmatic mobility despite the fact that inflammatory reaction, fibrosis and extra-hepatic granuloma were not significantly differentiated with the passage of time.