Initial experience with ocriplasmin in the treatment of vitreomacular traction / Experiência inicial com ocriplasmina no tratamento da tração vitreorretiniana

ABSTRACT This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.

RESUMO O objetivo desse estudo é relatar os resultados iniciais, tanto do ponto de vista funcional quanto anatômico, no tratamento das doenças da interface vítreo-macular com a ocriplasmina em 2 serviços terciários no Brasil. Um estudo retrospectivo foi realizado através de revisão de prontuários, além de análise de achados em tomografia de coerência óptica de domínio espectral (SD-OCT) em 7 pacientes tratados com uma única injeção intravítrea de ocriplasmina. Em nosso estudo 57,14% dos pacientes apresentaram resolução da tração vítreo-macular no SD-OCT. Em relação aos resultados funcionais, 87,71% dos pacientes mantiveram, ou melhoraram sua acuidade visual durante o acompanhamento. Para nosso conhecimento, trata-se do primeiro estudo em nosso país, mostrando resultados iniciais com ocriplasmina em pacientes tratados no Brasil.

Effect of intraperitoneal curcumin instillation on postoperative peritoneal adhesions

The aim of this study was to determine the effect of curcumin on adhesion formation in a rat cecum abrasion model. Materials and Thirty Wistar rats were randomized into three groups; the control group received saline, the curcumin group received 10 mg/kg of curcumin after cecal abrasion, and in the sham group the abdominal wall was closed without any abrasion to the cecum. On day 15, adhesions were assessed blindly using a standardized scale, and histopathological samples were taken and examined. There were no incisional hernias or wound dehiscences in any animals of the three groups. A comparison of adhesion scores showed a significant difference between the curcumin [median = 1] and the control group [median = 2; p < 0.05]. The grade of inflammation of the curcumin [median = 1] and the sham [median = 0] group was significantly lower than that of the control group [median = 3; p < 0.01 and p < 0.001, respectively]. Hydroxyproline levels were significantly lower in the sham [48.3 +/- 11.8 microg/mg] and the curcumin [63.8 +/- 13.9 microg/mg] group compared to the control group [85.7 +/- 22.1 microg/mg; p < 0.05]. These data suggest that curcumin, administered intraperitoneally, was effective in the prevention of peritoneal adhesion formation

Reduction of postsurgical adhesions in a rat model: a comparative study

BACKGROUND: Adhesion formation after peritoneal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic pelvic pain. In this study, we compared the possible individual effects of phosphatidylcholine (PC), Seprafilm® II, and tissue plasminogen activator (t-PA) and the combined effects of phosphatidylcholine and t-PA on postoperative adhesion formation in a rat surgical model. MATERIALS AND METHODS: A total of 50 Wistar male rats underwent median laparotomy and standardized abrasion of the visceral and parietal peritoneum. phosphatidylcholine, Seprafilm II, and t-PA alone and phosphatidylcholine and t-PA in combination were applied intraperitoneally at the end of the surgical procedure. Seven days after surgery, a relaparotomy was performed for adhesion grading and histopathological examination. RESULTS: A comparison of adhesion stages demonstrated a significant difference between the control group and the study groups (p<0.001). The adhesion grade of the combined treatment group was statistically different from that of the other groups (p<0.05). In the t-PA group and the combined group, six and two rats, respectively, developed hematomas locally on the cecum. CONCLUSIONS: PC, t-PA, and Seprafilm II used individually reduced the adhesion grade. The t-PA and phosphatidylcholine combination was most effective in reducing adhesion formation. On the other hand, usage of t-PA alone or in combination may increase risk of bleeding. More detailed studies are needed, and future studies on the efficacy of a material for decreasing adhesion formation should include a comparison of several control materials in the same model.

Dose related effect of systemic antibiotics in prevention of postoperative intra-abdominal adhesion formation in experimental animals

Sixty hamsters weighing 100-120 g were randomly assigned to 2 equal groups. GI was injected intramuscularly with saline, half an hour preoperatively as control, and GII was injected with 50 mg/kg Cefepime HC1 and 7.5 mg/kg Metronidazole. After a midline lapparo-tomy, abdominal adhesions were induced in GI and GII Post-operration, animals in GI was divided according to the numbers of intramuscular saline injections into 2 subgroups. GIa[15] in which animals were injected every 12 hours for 2 doses and GIb [15] where animals were injected every 12 hours for 5 days. Similarly, the antibiotic group was subdivided into GIIa [15] and GIIb [15]. On the 14[th] day, the hamsters were sacrificed and the adhesion score was determined. The 5 day antibiotics course revealed significant reduction in incidence [P < 0.01], extent [P < 0.001] and severity [P < 0.01] of the postoperative peritoneal adhesions, while the short course failed

The Effects of Melatonin on Postoperative Intraabdominal Adhesion Formation

PURPOSE: Postoperative intraabdominal adhesion formation is a major clinical problem. No previous study was found, reporting the relationship between adhesion formation and melatonin administration, but melatonin, a strong antioxidant, is recognized to have certain effects on the progression of adhesion formation mechanism. It was therefore decided to investigate the effects of melatonin on postoperative adhesion formation. MATERIALS AMD METHODS: A total number of 24 Spraque-Dawley rats were utilized. Three groups, described as: Group A, sham laparatomy (n=8), Group B, rats that underwent only ischemia-reperfusion (n=8) and Group C, rats that underwent ischemia- reperfusion and were given 10 mg/kg melatonin solution i.v. (n=8). For Groups B and C, the ileocolic vessels were clamped. Blood glutathione peroxidase levels of all study groups were assessed, then microscopic and macroscopic adhesion scores were evaluated. RESULTS: Glutathione peroxidase levels of the melatonin-treated group were significantly higher and fibroblast proliferation and macroscopic adhesion scores were significantly lower, than in the melatonin-free group. CONCLUSION: The results of this study supported the hypothesis, that melatonin administration may prevent intraabdominal adhesions resulting from surgery.

Effect of oral D-penicillamine on intraperitoneal adhesions

The most common cause of intraperitoneal adhesion bands is previous abdominal surgery. Postoperative adhesion formation results from a fibroproliferative inflammatory reaction. The possibility of involvement of fibrogenic process in adhesion formation and the antifibrogenic effect of D-penicillamine led us to test the effectiveness of this drug as a possible preventive method for intraperitoneal adhesions. Eighty female rats were randomly divided into four equal groups of 20 rats. Generation of adhesion in rats introduced by intra peritoneal injection of 2.5 millilitre of a 10% sterile talc solution. The first group served as control, group 2 received oral D-penicillamine 35 milligram per kilogram per day, group 3 received oral colchicines 0.02 milligram per kilogram per day and group 4 received both drugs for three weeks. Formation of adhesion bands was then quantitatively graded in each group according to Nair classification. Severe adhesions [grade 3 and 4] were found in 20% of the D-penicilliamine administered group [group 2], whereas these types of adhesions were observed in 33% and 84% of colchicine administered groups [group 3] and the control group [group 1] respectively [p < 0.003]. Group 4 that had received both D.penicillamine and colchicine was omitted from the study due to a high mortality rate. Adhesion bands in D-penicillamine group were thinner and smoother in comparison to other groups. Lower grades of adhesions were found in the D-penicillamine group in comparison to the colchicine and control groups. Therefore it seems that D-penicillamine may be effective in the prevention of formation of adhesion bands in the rat

Efecto del allopurinol en las adherencias peritoneales postoperatorias: estudio experimental / Effect of allopurinol to prevent postsurgical adhesions: experimental study

Antecedentes: En la formación de adherencias peritoneales postoperatorias, se ha implicado a los radicales libres del oxígeno como mediadores para producir injuria tisular, asociada a reacciones inflamatorias y/o isquemia/reperfusión. Objetivo: Evaluar el efecto del allopurinol, como agente antioxidante en la prevención de las adherencias peritoneales postoperatorias. Lugar de aplicación: Instituto de Cirugía Experimental. Facultad de Ciencias Médicas. UNC. Diseño: Estudio experimental. Población: 124 ratas Sprague-Dawley. Método: Se les provocó adherencias intraperitoneales por método comprobado y fueron divididas en 6 grupos: A, control sin tratamiento y B, C, D, E, y F recibieron allopurinol en distintos esquemas terapéuticos. A los 14 días, las adherencias fueron evaluadas según la gradación de Nair y col. Se utilizó en Chi-cuadrado ensayo de 2 colas. Resultados: B recibió 50 mg/kg/día de allopurinol 5 días antes y 14 días posteriores a la cirugía, encontrándose una disminución significativa en la formación de adherencias respecto del grupo control. C recibió 50 mg/kg/día durante 14 días a partir del postoperatorio inmediato, no encontrándose diferencias significativas con el grupo B. Se utilizó los gprupos D (25 mg/kg/día), e (10 mg/kg/día) y F (5 mg/kg/día) para evaluar una curva dosis respuesta, administrado con el mismo esquema. Encontrándose diferencias estadísticamente significativas respecto al grupo control, en los grupos C (p = 0,0025), D (p = 0,0004) y E (p = 0,0080). Conclusiones: Disminución en la incidencia de adherencias postoperatorias administrando el allopurinol, tanto en el pre y post operatorio a partir de la injuria quirúrgica

Estudo comparativo entre heparina e estreptoquinase na prevençäo de aderências peritoneais: Estudo experimental em ratos / Comparative study between heparin and strptokinase in prevention of peritoneal adhesions formation: Experimental study in rats

Com o objetivo de analizar a açäo da heparina e da estreptoquinase na prevençäo da formaçäo de aderências peritoneais, 45 ratos, machos, wistar-tecpar, com idade de 120 dias e peso médio de 240 gramas, foram divididos aleatoriamente em três grupos de 15 animais. Os ratos que serviram de controle para o experimento constituíram o grupo A e receberam soluçäo salina isotônica por via intraperitoneal. Os animais do grupo B receberam 50 UI/kg de heparina e os do grupo C, 60.000UI/kg de estreptoquinase, por via intraperitoneal. As aderências foram induzidas pelo método de Ferraz Neto e col. e realizaram-se as aferições no 14 dia de pós-operatório. Com relaçäo ao número de pontos isquêmicos que originaram aderências, näo houve diferença entre os animais tratados com heparina ou estreptoquinase quando comparados ao grupo controle (p>0,05), porém quando comparados os grupos B e C entre si houve (p=0,026). O número de aderências no grupo B foi maior que no grupo A (p=0,012), enquanto que no grupo C comparado ao grupo A näo foram diferentes (p=0,21), porém comparando-se os grupos B e C, observa-se que a estreptoquinase foi mais eficiente que a heparina (p=0,026). Conclui-se que as drogas avaliadas näo säo eficientes na prevençäo da formaçäo de aderências peritoneais, em ratos, nas doses e via utilizadas

Profilaxis de las adherencias intraperitoneales posoperatorias / Prophylaxis of psotoperative intrperitoneal adhesiones

Se operaron 15 perros utilizados como patrones, a los cuales se les provocaron adherencias intraperitoneales posoperatorias por el método de Thomas, modificado por nosotros. Estos perros fueron divididos en 3 grupos: IA: Se reintervinieron a las 4 semanas; IB: Se reintervinieron a las 8 semanas; IC: La reintervención se efectuó a las 12 semanas. Se utilizó como método profiláctico el uso intraperitoneal de acetato de hidrocortisona a las dosis de 2,5 mg por Kg de peso. Como testigo se hizo otro grupo de 15 perros, divididos en igual forma que el patrón, pero fueron medicamentados. Se exponen los resultados

Efecto de la colquicina en las adherencias intraperitoneales postoperatorias: estudio experimental en ratas / Colchicine effect on intraperitoneal postoperative adherences: experimental study in rats

En este estudio se valoraron los efectos que tuvo la colquicina en la formación de adherencias intraperitoneales postoperatorias en un grupo de ratas. Para su estudio se formaron tres grupos, de diez ratas los dos primeros, a las que previamente se les crearon adherencias intrabdominales. A las del primer grupo se les administró colquicina después dela operación a dosis de 200mg/día y a las del segundo grupo de 400 mg/Kg/día; las 20 del tercer grupo quedaron sin medicamento. Posteriormente se sometió a operación de revisión de la cavidad abdominal una rata de cada grupo cada siete días. Se encontró que no hubo infección de la herida de la pared abdominal. En el grupo que recibió la dosis de 200 mg/kg/día se observó disminución significativa del número de adherencias. Los sitios afectos fueron similares en los tres grupos. El área adherida no se modificó con la administración del fármaco. Se encontró disminución dela consistencia de las adherencias en las ratas con ambas dosis de colquicina, en relación con los animales del grupo testigo. Al parecer la colquicina es eficaz, pues modifica la consistencia de las adherencias intrabdominales a dosis de 200mg/kg/día y modifica en menor grado el número de dichas adherencia