Flap and abdominal wall washing and debridement using dressings to prevent seromas and hematomas in abdominoplasty / Lavagem e desbridamento do retalho e da parede abdominal com compressas como prevenção de seromas e hematomas em abdominoplastia

Seroma formation remains a common complication of abdominoplasty. The use of drain, flap fixation points, and fibrin glue has been described to reduce the incidence of seroma formation. The authors present herein an easyto- reproduce technique to decrease the risk of bleeding and eliminate the devitalized tissue caused by the detachment. The proposed strategy consists of washing and debridement, which was conducted with mechanical friction using moist flap and abdominal wall dressings.

A formação de seroma após uma abdominoplastia continua sendo uma complicação frequente. O uso de dreno, os pontos de fixação do retalho e o uso da cola de fibrina foram descritos com a finalidade de diminuir a sua incidência. Os autores apresentam uma técnica de fácil reprodução para reduzir o risco de sangramento, bem como para eliminar o tecido desvitalizado decorrente do descolamento. A tática proposta constitui-se de lavagem e desbridamento por meio da fricção mecânica com compressas umedecidas do retalho e da parede abdominal.

Surgical item left in the abdomen six years after abdominoplasty: case report / Corpo estranho retido cirurgicamente em abdômen seis anos após abdominoplastia: relato de caso

The retained surgical item in patients after closure of the wound is a situation that although rare is preventable and requires specific care such as institutional protocols for prevention. We report a case of removal of an already encapsulated pads by fibrin tissue (textiloma) from a patient six years after an abdominoplasty, which formed a palpable mass in her abdomen. The retained surgical items lead to variable symptoms such as palpable masses, compressions, non-absorptive loss and, sometimes, severe complications. The diversity of manifestations combined with their few frequency, most of the times, lead to underdiagnosis. Treatment should be individualized for each case, although in case of symptoms removal is indicated in most cases. Surgical removal is associated with complications as longer as objects remain in patient's body.

A permanência de corpos estranhos em pacientes após o fechamento da ferida operatória é uma situação que, embora rara, é evitável e demanda cuidados específicos como protocolos institucionais de prevenção. O caso relata a retirada de uma compressa já encapsulada por tecido de fibrina (textiloma) de uma paciente seis anos após abdominoplastia, formando uma massa palpável em seu abdômen. A permanência desses itens cirúrgicos leva a sintomas variáveis como massas palpáveis, compressões, síndromes disabsortivas e, algumas vezes, graves complicações. A diversidade de manifestações combinada a sua pouca frequência levam, muitas vezes, ao subdiagnóstico. O tratamento deve ser individualizado para cada caso, embora na presença de sintomas a retirada é indicada na grande maioria das vezes. A cirurgia de retirada está mais associada a complicações quanto maior tempo de permanência dos objetos no corpo do paciente.

Estimation of the use of fibrin and collagen membranes as carriers for platelet-derived growth factor-BB (PDGF-BB) in the presence of amoxicillin.

The effect of homogeneous fibrin (Fb), collagen (Coll) and composite fibrin-heparin (Fb-Hp), fibrin-collagen (Fb-Coll) membranes on in vitro release of platelet-derived growth factor (PDGF-BB) was evaluated in the presence or absence of amoxicillin using of the ELISA immunoassay test. Amoxicillin concentration was determined spectrophotometrically at 272 nm. The process of the PDGF-BB growth factor and amoxicillin release from the studied membranes was of a two-phase nature in the majority of the systems analysed. The PDGF-BB was released in the highest amount from the Coll membrane (M7) without the presence of amoxicillin – 546.2 ±7.47 pg, t0.5 = 0.88 h and 202.5 ± 6.83 pg, t0.5 = 26.65 h during the first phase and second phase, respectively. The lowest PDGF-BB release was observed from composite M4 (Fb-Hp) membrane – 5.88 ± 0.81 pg, t0.5 = 1.69 h; and 110.2 ± 6.48 pg, t0.5 = 855.6 h during first and second phase respectively. An optimal release of amoxicillin was observed in the case of the composite M6 (Fb-Coll) membrane – only in the second phase: 64.2 ± 7.8 mg, t0.5 = 83.5 h. The lowest and delayed amoxicillin release was achieved for M4 membrane (approx. 17.1 ± 1.12 mg, t0.5 = 46.5 h). The results of the PDGF-BB release and amoxicillin from membranes indicated a correlation between the level of release and composition of the film. Our results suggested that fibrin and collagen membranes may be beneficial to enhance periodontal bone regeneration.

Aumento no material fibrinoide perivilositário nas placentas de gestações com pré-eclâmpsia / Increase in perivillous fibrinoid material in placentas from pregnancies with preeclampsia

INTRODUÇÃO: A pré-eclâmpsia responde por alta morbimortalidade no Brasil e no mundo. A sua etiologia ainda não foi totalmente esclarecida. Entre as alterações placentárias na pré-eclâmpsia citam-se: infartos, aumento de nós sinciciais, hipotrofia vilositária, espessamento da membrana basal trofoblástica e deposição de material fibrinoide. OBJETIVO: Analisar quantitativamente imagens do material fibrinoide perivilositário presente em placentas de gestações com e sem pré-eclâmpsia. MATERIAL E MÉTODOS: Foi realizado estudo de caso-controle no Serviço de Anatomia Patológica do Hospital Universitário Professor Alberto Antunes (HUPAA). Realizou-se análise histomorfométrica de 840 imagens provenientes de 14 placentas de gestações com pré-eclâmpsia (casos) e 14 placentas de gestações sem pré-eclâmpsia (controles). RESULTADOS: A média da área do material fibrinoide no grupo pré-eclâmpsia foi de 168,46 pixels, e no grupo sem pré-eclâmpsia, de 89,63 pixels. Foi observada uma quantidade menor da área total dos núcleos na pré-eclâmpsia, 89,51 pixels, do que no grupo controle, 113,34 pixels. CONCLUSÃO: Nas placentas de gestações com pré-eclâmpsia a área ocupada pelo material fibrinoide está aumentada em 1,8 vez em comparação com as placentas de gestações normais. As áreas dos núcleos e citoplasmas foram maiores no grupo controle. Não houve diferença estatisticamente significativa quanto à área do estroma. Observou-se também redução do espaço ocupado pelas vilosidades na pré-eclâmpsia, sendo este fato compatível com hipotrofia vilositária.

INTRODUCTION: Preeclampsia is responsible for high maternal mortality in Brazil and worldwide. Its etiology has not been fully elucidated. Placental changes in preeclampsia include: infarcts, increase in syncytial knots, villous hypotrophy, thickening of trophoblastic basement membrane and fibrin deposition. OBJECTIVE: To analyze quantitatively images of perivillous fibrinoid material present in placentas from pregnancies with and without preeclampsia. MATERIAL AND METHODS: A case-control study was carried out at the Anatomical Pathological Service of Professor Alberto Antunes University Hospital. It was performed the histomorphometric analysis of 840 images comprising 14 placenta samples from pregnancies with preeclampsia (cases) and 14 placenta samples from pregnancies without preeclampsia (controls). RESULTS: In the preeclampsia group the mean area of fibrinoid material was 168.46 pixels and in the group without preeclampsia it was 89.63 pixels. The nuclei total area was smaller in preeclampsia (89.51 pixels) in comparison with the control group (113.34 pixels). CONCLUSION: In placentas from preeclampsia pregnancies the fibrinoid material area is larger (1.8x) compared to normal pregnancies. Nuclei and cytoplasm areas were larger in the control group. There was no statistical difference regarding the stromal area. There was also a reduction in villous space in preeclampsia, which is consistent with villous hypotrophy.

Preliminary study of the fibrin structure in hypertensive, dyslipidemic and type 2 diabetic patients

Individuals with hypertension, dyslipidemia or diabetes are at a higher risk to suffer cardiovascular disease than other people; while impaired fibrin structure/function may contribute to further raise the cardiovascular risk in the former. The purpose of this work was to study the fibrin network and fibrin degradation properties in hypertensive (HT) patients, pharmacologically treated, 124 ± 11 mmHg, systolic blood pressure, and 70 ± 10 mmHg, diastolic blood pressure, n = 12; metabolic dyslipidemic patients (DL), cholesterol: 5.7 ± 1.5 mmol/L, n = 10; patients with type 2 diabetes mellitus (T2D), fasting plasma glucose: 8.8 ± 2.2 mmol/L, n = 10; and a control group of healthy individuals, n = 9. The fibrinogen concentration was determined by the gravimetric method. Fibrin network formation and porosity were assessed by turbidity and permeation techniques, respectively; fibrin elastic properties were evaluated by compaction and fibrin lysis, by turbidity after addition of external tPA prior to plasma clotting. Fibrinogen concentration was significantly higher only in T2D patients (p = 0.004), compared to the control group. The fibrin polymerization and lysis processes were similar for all patient and control groups. Permeation was significantly slower in DL and T2D patients, p = 0.022 and 0.0002, respectively, whereas the compaction coefficient was significantly smaller in T2D patients, p = 0.0015. Our results suggest that the fibrin structure was altered in DL and T2D patients, probably due to the increased cholesterol and glycation, respectively.

Individuos hipertensos, con dislipidemia o diabetes tipo 2 tienen un mayor riesgo de sufrir enfermedades cardiovasculares, y la alteración en la estructura/función de la malla de fibrina aumenta su riesgo. El propósito del presente trabajo fue estudiar la estructura de la malla de fibrina y su degradación en pacientes hipertensos (HT), tratados farmacológicamente, con una presión arterial sistólica de 124 ± 11 mmHg y una presión arterial diastólica de 70 ± 10 mmHg, n = 12; pacientes con dislipidemia metabólica (DL), colesterol 5,7 ± 1,5 mmoles/L, n = 10; pacientes con diabetes mellitus tipo 2 (DT2), glicemia en ayunas: 8,8 ± 2,2 mmoles/L, n = 10; y un grupo control de individuos sanos, n = 9. Se determinó la concentración de fibrinógeno por el método de la pesada. La formación de la malla de fibrina y su porosidad fue estudiada mediante las técnicas de turbidimetría y permeabilidad, respectivamente; las propiedades elásticas por compactación y la degradación de la fibrina por turbidimetría, añadiendo externamente el activador tisular del plasminógeno (tPA) antes de la coagulación del plasma. Se encontró que la concentración de fibrinógeno fue significativamente mayor solamente en los pacientes DT2 (p = 0,004), en comparación con el grupo control. El proceso de polimerización y degradación de la fibrina de los pacientes fue similar a la del grupo control. La permeabilidad estuvo disminuída significativamente en los pacientes DL y DT2, p = 0,022 and 0,0002, respectivamente, mientras que la compactación fue significativamente mayor solamente en los pacientes DT2, p=0,0015. Nuestros resultados sugieren que la estructura de la malla de fibrina estuvo alterada en los pacientes DL y DT2, probablemente debido al aumento en los valores de colesterol y glicemia, respectivamente.

Histological and radiographic evaluation of the muscle tissue of rats after implantation of bone morphogenic protein (rhBMP-2) in a scaffold of inorganic bone and after stimulation with low-power laser light.

Objective: The present study histologically and radiologically evaluates the muscle tissue of rats after implantation of bone morphogenic protein (rhBMP-2) in a natural inorganic bone mineral scaffold from a bull calf femur and irradiation with low-power light laser. Materials and Methods: The right and left hind limbs of 16 rats were shaved and an incision was made in the muscle on the face corresponding to the median portion of the tibia, into which rhBMP-2 in a scaffold of inorganic bone was implanted. Two groups of limbs were formed: control (G1) and laser irradiation (G2). G2 received diode laser light applied in the direction of the implant, at a dose of 8 J/cm2 for three minutes. On the 7th, 21st, 40th and 112th days after implantation, hind limbs of 4 animals were radiographed and their implants removed together with the surrounding tissue for study under the microscope. The histological results were graded as 0=absence, 1=slight presence, 2=representative and 3=very representative, with regard to the following events: formation of osteoid structure, acute inflammation, chronic inflammation, fibrin deposition, neovascularization, foreign-body granuloma and fibrosis. Results: There were no statistically significant differences in these events at each evaluation times, between the two groups (P>0.05; Mann-Whitney test). Nevertheless, it could be concluded that the natural inorganic bone matrix with rhBMP-2, from the femur of a bull calf, is a biocompatible combination. Conclusions: Under these conditions, the inductive capacity of rhBMP-2 for cell differentiation was inhibited. There was a slight acceleration in tissue healing in the group that received irradiation with low-power laser light.

Comparative scanning electron microscopy of platelets and fibrin networks of human and differents animals / Microscopía electrónica de barrido comparativa de plaquetas y redes de fibrina de humano y de diferentes animales

The purpose of the present study was to compare the platelet and fibrin network ultrastructure of humans to eight different animal species in order to determine the differences between human and animal platelet and fibrin morphology, and to determine whether the animals studied differ in their platelet and fibrin morphology, and whether these differences can be observed by scanning electron microscopy. Platelets and fibrin networks play an important role both in the coagulation process as well as physiologically in allergic processes and immunological mechanisms. The thickness of human fibrin networks were compared to mouse (Mus musculus), equine (Equus caballus), vervet monkey (Chlorocebus aethiops previously Cercopithecus aethiops), oryx (Oryx gazella), ovine (Ovis aries), penguin (Spheniscus demersus), rabbit (Oryctolagus cuniculus) and sea turtle (Caretta caretta). Fibers were measured and divided into thin (minor) fibers, intermediate fibers and thick (major) fibers. The results obtained indicated that for each of the three fibrin classes, the size ranges of the monkey, oryx and equine were not significantly different to one another, and the human, penguin, oryx and ovine not significantly different to one other. From these results it can be concluded that mammals and aves possess a distinct tri-modal fibrin fiber distribution, different from that of the studied reptilian species where the sea turtle possesses a distinct bimodal fibrin fiber distribution and it can be suggested that the utilization of mammalian and avian models, in terms of fibrin fiber distribution patterns, might be a suitable alternative for ultrastructural studies.

El propósito del presente estudio fue comparar la ultraestructura de plaquetas y las redes de fibrina de los seres humanos y de ocho diferentes especies de animales, con el fin de determinar las diferencias morfológicas de estas estructuras y si las diferencias pueden ser observadas por microscopía electrónica de barrido. Las plaquetas y las redes de fibrina desempeñan un papel importante tanto en el proceso de coagulación como, fisiológicamente en procesos alérgicos y mecanismos inmunológicos. Elgrosor de las redes de fibrina humana fue comparado con las del ratón (Mus musculus), equino (Equus caballus), mono vervet (Chlorocebus aethiops, anteriormente Cercopithecus aethiops, antílope Africano (Oryx gazella), ovino (Ovis aries), pingüino (Spheniscus demersus), conejo (Oryctolagus cuniculus) y tortuga marina (Caretta caretta). Las fibras fueron medidas y agrupadas en fibras delgadas (menor), fibras intermedias y fibras gruesas (grandes). Los resultados obtenidos indicaron que para cada una de las tres clases de fibrina, los rangos de su tamaño en el mono, antílope africano y en equino no fueron significativamente diferentes entre sí, mientras que en humano, pingüino, antílope africano y ovino no fueron significativamente diferentes entre éstos. De estos resultados se pudo concluir que mamíferos y aves poseen una distribución tri-modal de fibras de fibrina, distinta a la de las especies de reptiles estudiadas, donde la tortuga de mar posee una distribución bimodal de fibras de fibrina. Se puede sugerir que la utilización de los modelos mamíferos y aviar, en términos de patrones de distribución de fibras de fibrina, pueden ser una alternativa adecuada para los estudios ultraestructurales.

Bone Marrow Fibrin-Ring Granuloma: Review of 24 Cases / 대한진단검사의학회지

BACKGROUND: Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma. METHODS: We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group. RESULTS: The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05). CONCLUSIONS: Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.

Autopsy study of patients dying of bleeding diathesis.

Ten thousand & thirty seven autopsies performed from the year 1982 to 1992 were studied retrospectively, to find out the number of deaths due to bleeding diathesis. Eighty-seven (0.87%) patients died due to bleeding diathesis, out of which haemolytic uraemic syndrome (HUS) was seen in 9 cases (10.34%), disseminated intravascular coagulation (DIC) in 67 cases (77.01%) & 11 cases were grouped as miscellaneous. Martius scarlet blue stain was carried out to demonstrate fibrin & depending on the number of thrombi in the glomerulus & blood vessels, the lesions were graded as mild, moderate or severe. Kidney was the most common organ involved in all groups of bleeding diathesis. In DIC kidney & lung involvement was almost equal.

Implante da associaçäo esponja de fibrina (Fibrinol R) adesivo fibrínico (Tissucol R) em cavidade cirúrgica preparada em tíbia de rato: estudo histológico / Use of an implant of fibrin sponge (Fibrinol R) with fibrin adhesive material (Tissucol R) in the healing process of experimental rat tibial lesions: histologic study

Estudaram-se os efeitos da associaçäo esponja de fibrina (Fibrinol R)/adesivo fibrínico (Tissucol R) no reparo ósseo, comparando-a com o adesivo fibrínico (Tissucol R). Cavidades cirúrgicas foram preparadas em ambas as tíbias de 25 ratos. Os materiais testados foram implantados nas tíbias direitas, enquanto que as tíbias esquerdas serviram como controle. Em grupos de cinco, os animais foram sacrificados aos 1, 3, 7, 14 e 21 dias pós-operatórios. Os resultados histológicos mostraram que: a) os tecidos conjuntivo e ósseo se desenvolveram na intimidade da associaçäo esponja de fibrina (Fibrinol R)/adesivo fibrínico (Tissucol R); b) a associaçäo esponja de fibrina (Fibrinol R)/adesivo fibrínico (Tissucol R) é paulativamente absorvida ao longo da reparaçäo óssea; c) a associaçäo esponja de fibrina (Fibrinol R)/adesivo fibrínico (Tissucol R) é completamente absorvida e o material está aos 21 dias pós-operatórios; d) a associaçäo esponja de fibrina (Fibrinol R)/adesivo fibrínico (Tissucol R) estimula a formaçäo de tecidos reparacionais qualitativamente semelhantes àqueles formados em resposta ao implante fibrínico (Tissucol R) ao longo dos períodos estudados

Measurement of plasma fibrin D-Dimer using monoclonal antibody-coated latex particles: a new approach for screening of DIC in newborns

30 newborns with neonatal infection from the NICU of Banha University Hospitals were studied for early detection of DIC despite absence of clinical evidence of this condition. 10 normal newborns were also studied to serve as controls. D-Dimer latex agglutination test was employed in addition to PTT, platelet count and FDP. 18 of 30 cases [60%] showed laboratory evidence of DIC despite lack of clinical evidence. FDP is recommended as the screening test for cases of DIC due to its high sensitivity and D-Dimer is recommended as a confirmatory test for cases with high FDP due to its high specificity