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Rev. chil. reumatol ; 35(2): 44-54, 2019. ilus
Article in Spanish | LILACS | ID: biblio-1281801


Miopatía Necrotizante Autoinmune (MNA) fue reconocida como nuevo sub-grupo de miositis luego de observar en biopsias musculares la presencia de necro-sis con escaso o ausente infiltrado inflamatorio, sumado a la expresión de dos an-ticuerpos específicos de miositis (Anticuerpo anti Partícula de Reconocimiento de Señal, anti-SRP; y Anticuerpo anti Hidroxi-3-metilglutaril-CoA reductasa, anti-HM-GCR), ambos fuertemente asociados al hallazgo histológico descrito y a fenotipos clínicos característicos a cada anticuerpo, los cuales comparten importantes simi-litudes representadas por severa debilidad muscular proximal, gran elevación de creatinkinasa (CK), escasa manifestación de síntomas y signos extramusculares, y resistencia al uso de inmunosupresión habitual. Si bien en primera instancia los criterios de clasificación propuestos estaban basados en la histología, la obser-vación de necrosis en otros subgrupos de miositis, sumado a la homogeneidad del comportamiento clínico de pacientes que expresaban anticuerpos anti-SRP o anti-HMGCR independiente de la histología presentada, llevó en el año 2016 al Grupo de Trabajo del Centro Europeo Neuromuscular (ENMC) a establecer crite-rios diagnósticos de MNA basados en el comportamiento clínico (debilidad mus-cular proximal con CK total elevada) más la presencia del anticuerpo respectivo (anti-SRP o anti-HMGCR), reservando la necesidad de realizar biopsia muscular en el caso que la serología resulte negativa, siendo así reconocidas tres entidades distintas de MNA: Miopatía anti-SRP, Miopatía anti-HMGCR y Miopatía Necroti-zante seronegativa. La presente revisión expresa el actual conocimiento de MNA y sus subtipos, refiriéndose a aspectos históricos, clínicos, histológicos, inmuno-patológicos, y de pronóstico y tratamiento.

Necrotizing autoinmune myopathy (NAM) was recognized as a new sub-group of myositis after the observation of necrosis with mild or absent inflam-matory infiltrates in muscle biopsies, in addition of expression of two specific myositis antibodies (antiSRP and antiHMGCR), which are strongly associated to the mentioned hystologic findings, with different clinical phenotypes depending on the presence of each antibody, but sharing some features like severe proximal muscle weakness, significant elevation of creatin phosphokinase (CK), mild ex-tramuscular involvement and resistance to commonly used immunosupressants. The first proposed approach to classification criteria was hystology-based, none-theless the observation of necrosis in some other types of myositis and the homo-geneity of clinical features in patients expressing antiSRP or antiHMGCR despite the hystologic findings led to a new classification scheme leaded by the European Neuromuscular Center in 2016, which recognizes thre different clinical entities of NAM, based on the antibody expression plus the presence of proximal muscle weakness, relying hystology to a secondary place thus eliminating the need for immediate biopsy to stablish a diagnosis: those are antiSRP myopathy, antiHMG-CR myopathy and seronegative necrotizing myopathy, being the last one the only needing muscle biopsy. The present review shows the actual knowledge about NAM and its subtypes, referring to hystoric, clinical, hystologic, immunopatholog-ic, prognostic and therapeutic issues.

Humans , Autoimmune Diseases/pathology , Myositis/pathology , Autoimmune Diseases/immunology , Muscular Diseases , Myositis/diagnosis , Myositis/physiopathology , Myositis/therapy , Myositis/epidemiology , Necrosis/immunology , Necrosis/pathology
Braz. j. med. biol. res ; 52(1): e7844, 2019. tab, graf
Article in English | LILACS | ID: biblio-974274


Necroptosis is a regulated cell death mechanism. However, it is unknown whether necroptosis is involved in the death of tumor necrosis factor-α (TNF-α)-treated osteoblasts. Therefore, we conducted the study with TNF-α, Nec-1 (a specific inhibitor of necroptosis), and Z-IETD-FMK (a specific inhibitor of apoptosis) to determine whether necroptosis plays a role in the death of TNF-α-treated osteoblast cell line MC3T3-E1. Cell viability, cell death, and lactate dehydrogenase (LDH) release were assayed to evaluate cytotoxicity. Specific marker proteins receptor interacting protein kinase (RIPK3) and phosphorylated mixed lineage kinase domain-like protein (p-MLKL) for necroptosis, and cleaved caspase 3 for apoptosis were detected by western blot, and mRNA was measured by quantitative real-time polymerase chain reaction (qRT-PCR). We found that TNF-α inhibited cell proliferation in a dose- and time-dependent manner. Nec-1 plus Z-IETD-FMK restored cell viability and significantly decreased LDH release. In addition, TNF-α alone increased the cell population of AV+PI−, while Z-IETD-FMK caused a shift in the cell population from AV+PI− to AV+PI+. Furthermore, TNF-α significantly increased protein cleaved caspase 3. TNF-α plus Z-IETD-FMK significantly increased the proteins RIPK3 and MLKL phosphorylation in MC3T3-E1 cells, while the changes in mRNA levels of RIPK3, MLKL, and caspase 3 were not consistent with the changes in the corresponding protein expression levels. In conclusion, TNF-α induced preferentially apoptosis in osteoblast cell line and necroptosis played a decisive role when TNF-α-induced death was inhibited by the inhibitor of apoptosis. Combined treatment with Nec-1 and Z-IETD-FMK protected mouse osteoblasts from death induced by TNF-α.

Animals , Rabbits , Osteoblasts/pathology , Tumor Necrosis Factor-alpha/pharmacology , Caspase 8/drug effects , Caspase Inhibitors/pharmacology , Necrosis/pathology , Oligopeptides/pharmacology , Osteoblasts/drug effects , Phosphorylation , Cell Survival/drug effects , Imidazoles/pharmacology , Indoles/pharmacology , L-Lactate Dehydrogenase/pharmacology
An. acad. bras. ciênc ; 89(3,supl): 2433-2443, 2017. tab, graf
Article in English | LILACS | ID: biblio-886814


ABSTRACT The focus of this study was to test the hypothesis that there would be no difference between the biocompatibility of resin-modified glass ionomer cements. Sixty male Wistar rats were selected and divided into four groups: Control Group; Crosslink Group; RMO Group and Transbond Group. The materials were inserted into rat subcutaneous tissue. After time intervals of 7, 15 and 30 days morphological analyses were performed. The histological parameters assessed were: inflammatory infiltrate intensity; reaction of multinucleated giant cells; edema; necrosis; granulation reaction; young fibroblasts and collagenization. The results obtained were statistically analyzed by the Kruskal-Wallis and Dunn test (P<0.05). After 7 days, Groups RMO and Transbond showed intense inflammatory infiltrate (P=0.004), only Group RMO presented greater expression of multinucleated giant cell reaction (P=0.003) compared with the control group. After the time intervals of 15 and 30 days, there was evidence of light/moderate inflammatory infiltrate, lower level of multinucleated giant cell reaction and thicker areas of young fibroblasts in all the groups. The hypothesis was rejected. The Crosslink cement provided good tissue response, since it demonstrated a lower level of inflammatory infiltrate and higher degree of collagenization, while RMO demonstrated the lowest level of biocompatibility.

Animals , Male , Rats , Biocompatible Materials/pharmacology , Materials Testing , Subcutaneous Tissue/drug effects , Glass Ionomer Cements/pharmacology , Time Factors , Double-Blind Method , Rats, Wistar , Subcutaneous Tissue/pathology , Edema/pathology , Fibroblasts/drug effects , Necrosis/pathology
Article in English | LILACS | ID: biblio-842776


ABSTRACT Chronic necrotizing pulmonary aspergillosis (CNPA), a form of chronic pulmonary aspergillosis (CPA), affects immunocompetent or mildly immunocompromised persons with underlying pulmonary disease. These conditions are associated with high morbidity and mortality and often require long-term antifungal treatment. The long-term prognosis for patients with CNPA and the potential complications of CNPA have not been well documented. The aim of this study was to review published papers that report cases of CNPA complications and to highlight risk factors for development of CNPA. The complications in conjunction associated with CNPA are as follows: pseudomembranous necrotizing tracheobronchial aspergillosis, ankylosing spondylarthritis, pulmonary silicosis, acute respiratory distress syndrome, pulmonary Mycobacterium avium complex (MAC) disease, superinfection with Mycobacterium tuberculosis, and and pneumothorax. The diagnosis of CNPA is still a challenge. Culture and histologic examinations of bronchoscopically identified tracheobronchial mucus plugs and necrotic material should be performed in all immunocompromised individuals, even when the radiographic findings are unchanged. Early detection of intraluminal growth of Aspergillus and prompt antifungal therapy may facilitate the management of these patients and prevent development of complications.

Humans , Invasive Pulmonary Aspergillosis/complications , Medical Records , Chronic Disease , Invasive Pulmonary Aspergillosis/pathology , Invasive Pulmonary Aspergillosis/diagnostic imaging , Necrosis/pathology , Necrosis/diagnostic imaging
An. bras. dermatol ; 91(5,supl.1): 76-78, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-837916


Abstract Cutaneous reactions associated with interferons (IFNs) treatment are either localized or generalized. The most common presentation of localized reactions at IFNs injection site is usually an erythematous patch or plaque. Local leukocytoclastic vasculitis presenting with cutaneous necrosis is extremely rare. We report a 19-year-old man with hepatitis B who had local leukocytoclastic vasculitis induced by interferon-gama injection at the injection site. After changing the injection sites and using the combined treatment of prednisone and colchicine, the previous lesion healed and no other cutaneous lesion occurred. We also made a mini review of such cases.

Humans , Male , Young Adult , Skin/pathology , Interferon-gamma/adverse effects , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , Skin/drug effects , Prednisone/therapeutic use , Colchicine/therapeutic use , Treatment Outcome , Vasculitis, Leukocytoclastic, Cutaneous/pathology , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy , Erythema/chemically induced , Erythema/pathology , Injections, Subcutaneous/adverse effects , Anti-Inflammatory Agents/therapeutic use , Necrosis/chemically induced , Necrosis/pathology
Acta cir. bras ; 31(7): 463-471, tab, graf
Article in English | LILACS | ID: lil-787263


ABSTRACT PURPOSE: To evaluate the effects of low intensity ultrasound on the healing process of third degree burn wounds in experimentally induced diabetic Wistar rats. METHODS: One hundred rats were divided into: control group; non-diabetic treated group; diabetic control group; diabetic treated group. The therapy was performed with a 3MHz ultrasound application, pulsed emission at 100Hz frequency, modulated at 20% with a dosage of 0.5W/cm2 during three minutes throughout 30 days. The surgical debridement of the wound was performed once at day 2. The wounds were morphometrically, macroscopically and microscopically evaluated at 3, 7, 14, 21 and 30 days. RESULTS: The wound contraction and collagen quantification were higher in all treated groups. Macroscopically, necrosis was higher in the diabetic control group. Granulation tissue was higher in treated groups during the proliferative and remodeling phase. Microscopically, there were greater mononuclear inflammatory infiltration, angiogenesis and fibroblast quantification in treated groups during the proliferative and remodeling phases. CONCLUSIONS: therapeutic ultrasound is beneficial in the inflammatory and proliferative phases of the healing process because it controlled the necrotic tissue, increased the granulation tissue and wound contraction. However in the remodeling phase it is not beneficial because of the continued angiogenesis and a mononuclear inflammatory infiltration.

Animals , Female , Skin/injuries , Ultrasonic Therapy/methods , Wound Healing/physiology , Burns/therapy , Angiogenesis Inducing Agents/therapeutic use , Diabetes Mellitus, Experimental , Burns/pathology , Collagen/analysis , Rats, Wistar , Models, Animal , Diabetes Mellitus, Experimental/complications , Diabetes Mellitus, Experimental/therapy , Fibroblasts/pathology , Granulation Tissue , Necrosis/pathology , Necrosis/rehabilitation
Rev. cuba. oftalmol ; 29(1): 0-0, ene.-mar. 2016.
Article in Spanish | LILACS | ID: lil-781209


La apoptosis es un término relativamente reciente mediante el cual se denomina a un tipo de muerte celular programada, que se encuentra ligada a diferentes procesos patológicos (cáncer, enfermedades inflamatorias y degenerativas). Actualmente se considera otro tipo de muerte celular no programada, que es la necrosis, la cual ocurre por mecanismos no modulados y se menciona una variedad de esta última: la necroptosis. Ambos procesos (apoptosis y necroptosis) se encuentran presentes en la fisiopatología de algunas enfermedades oftalmológicas, lo que nos motivó a realizar una revisión bibliográfica renovada acerca del tema, con el objetivo de acrecentar el conocimiento sobre el tema y su relación con algunas enfermedades oftalmológicas en las que participan. Se revisaron textos básicos de Oftalmología y se localizaron artículos sobre el tema de los últimos 5 años a través Google como motor de búsqueda, el directorio LILACS y la consulta de las bases de datos PubMed y Hinari. Aún queda mucho por recorrer en el estudio de estos procesos que ocurren a nivel celular y que en ocasiones solo se han podido constatar a través de estudios de laboratorio y con modelos de animales. Su mayor comprensión puede constituir una vía para el surgimiento de nuevas terapéuticas antiapoptóticas y antinecroptóticas(AU)

Apoptosis is a relatively recent term to define a process of programmed cellular death related to different pathological processes (cancer, inflammatory and degenerative diseases). There is currently another process of non-programmed cellular death named necrosis, which occurs through non-modulated mechanisms and a variety is called necroptosis. Both processes (apoptosis and necroptosis) can be found in the physiopathology of some ophthalmological disorders, which prompted us to carry out an updated literature review on this topic. The objective was to increase the amount of knowledge on the topic and its relation to some of the ophthalmological disorders in which it is involved. Basic texts of ophthalmology were reviewed and articles published in the last five years were tracked down using Google as search engine, the LILACS directory and the consultation of the PubMed and Hinari databases. There is still much to be studied on these processes that take place at the cell level and that have only been verified through lab studies and with animal models. Better understanding of this process may pave the way for the emergence of new anti-apoptosis and anti-necroptosis therapies(AU)

Humans , Apoptosis/physiology , Eye Diseases/physiopathology , Glaucoma/pathology , Databases, Bibliographic , Necrosis/pathology , Review
Rev. bras. cir. plást ; 31(2): 178-185, 2016. ilus
Article in English, Portuguese | LILACS | ID: biblio-1557


INTRODUÇÃO: A abdominoplastia é o terceiro procedimento mais realizado em cirurgia plástica. Na intenção de evitar complicações cirúrgicas, foi feito o estudo da artéria ilíaca circunflexa superficial do abdome (AICS), investigando a importância da sua preservação nestas cirurgias, como um dos fatores de alta importância na prevenção das necroses. MÉTODOS: O presente estudo anatômico prospectivo foi realizado no Serviço de Cirurgia Plástica do Hospital Agamenon Magalhães. Trinta e três pacientes foram submetidos à dermolipectomia abdominal à Pitanguy, com os retalhos cirúrgicos ressecados sendo submetidos a estudos hemodinâmicos para análise do território anatômico irrigado pela AICS. RESULTADOS: Foram operados 82 pacientes, sendo selecionados 33 que preencheram os critérios de inclusão para este estudo, seis (18,9%) foram excluídos por motivos técnicos. O grupo de pacientes em estudo apresentou faixa etária entre 23 e 49 anos (36,6 ± 7,5). O Índice de Massa Corporal variou de 22,0 a 30,5 (24,9 ± 2,1). O peso das peças cirúrgicas ressecadas variou de 450 a 1010 gramas (623,1 ± 141,5), o teste de Pearson entre IMC e peso das peças demonstrou importante correlação r = 0,91 e r2 = 0,83. Trinta e dois eram femininos (97%) e um masculino (3%). Uma paciente era portadora de hipertensão arterial sistêmica (3%). Vinte e sete eram pardos (81,8%), dois brancos (6,1%), três negros (9,1%) e um da raça indígena (3,0%). Nos estudos hemodinâmicos, as imagens e filmes obtidos demonstraram que a injeção do contraste iodado na AICS foi considerada adequada, compatível com o objetivo do trabalho em 25 (92%) pacientes e inadequada em dois (8%) pacientes. CONCLUSÃO: Os resultados hemodinâmicos deste estudo levam à conclusão que a preservação da AICS do abdome nas miniabdominoplastias tem relevante importância na prevenção das necroses da parede abdominal.

complications, a study of the superficial circumflex iliac artery of the abdomen (SCIA) was carried out to investigate the importance of this artery preservation in abdominoplasties as one of the high importance factors to prevent necrosis. METHODS: This prospective study was carried out at the Plastic Surgery Service of the Agamenon Magalhaes Hospital. We included 33 patients who underwent abdominoplasty using Pitanguy's technique where the resected surgical flaps underwent hemodynamic studies to analyze the anatomical area irrigated by SCIA. RESULTS: A total of 82 patients underwent surgery, of them 33 met the study inclusion criteria, and 6 (18.9%) were excluded for technical reasons. Patients' age ranged from 23 and 49 years (36.6±7.5), their body mass index (BMI) ranged from 22.0 to 30.5 (24.9 ± 2.1), and weight of resected surgical specimens ranged from 450 to 1010 grams (623.1 ± 141.5). Pearson's test between BMI and weight of surgical specimens showed significant correlation r = 0.91 and r2 = 0,83. We included in the study 32 women (97%) and 1 man (3%). One patient had hypertension (3%). Of the sample, 27 patients were pardo (81.8%), 2 white (6.1%), 3 black (9.1%) and 1 native south American (3.0%). In hemodynamic studies, images and videos obtained showed that injection of iodinated contrast in SCIA were considered adequate, and consistent with the objective of this study in 25 (92%) patients and inadequate for 2 (8%) patients. CONCLUSION: Hemodynamic results of our study indicated that preservation of SCIA of the abdomen in mini-abdominoplasties is important to prevent necrosis of abdominal wall.

Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Surgery, Plastic , Surgical Flaps , Prospective Studies , Evaluation Study , Abdominal Wall , Abdomen , Abdominoplasty , Hemodynamics , Iliac Artery , Anatomy , Necrosis , Surgery, Plastic/methods , Surgical Flaps/surgery , Abdominal Wall/anatomy & histology , Abdominal Wall/surgery , Abdominal Wall/pathology , Abdominoplasty/methods , Abdomen/anatomy & histology , Abdomen/surgery , Iliac Artery/anatomy & histology , Iliac Artery/surgery , Iliac Artery/pathology , Anatomy/methods , Necrosis/pathology , Necrosis/prevention & control
Acta cir. bras ; 30(7): 452-460, 07/2015. graf
Article in English | LILACS | ID: lil-754977


PURPOSE: To study the effect of remote ischemic preconditioning (RIPC) in ischemia-reperfusion (I/R) liver injury and in the expression of IL-6 and IL-10 in a rat model. METHODS: Thirty-six male rats were divided in three groups: Sham; I/R injury, a 45 minutes lobar liver ischemia and reperfusion; and RIPC, six cycles of four minutes of ischemia and four minutes of reperfusion on the right hindlimb followed by a 45 minutes lobar liver ischemia and reperfusion. Tissue and blood samples were collected after 1h and 3h of reperfusion for histopathological study, plasma cytokines and alanine aminotransferase (ALT) measurement. RESULTS: The histopathological study demonstrated a significant reduction in liver necrosis in the RIPC group (p<0,001). The ALT levels were also significant lower in the RIPC group (p<0.01). The cytokines assessment showed that IL-6 levels were increased in the RIPC group after 1h of reperfusion, in comparison to the I/R group (p<0.05). Interleukin-10 levels in RIPC groups did not differ significantly from I/R group. CONCLUSIONS: Remote ischemic preconditioning is effective in decreasing liver necrosis in a rat model of ischemia-reperfusion. The IL-6 expression is up-regulated and peaked at 60 min of reperfusion. There was no difference in IL-10 expression between the groups. .

Animals , Male , Disease Models, Animal , /blood , /blood , Ischemic Preconditioning/methods , Liver/blood supply , Reperfusion Injury/blood , Alanine Transaminase/blood , Enzyme-Linked Immunosorbent Assay , Liver/pathology , Necrosis/pathology , Necrosis/prevention & control , Rats, Sprague-Dawley , Reproducibility of Results , Time Factors
Acta cir. bras ; 30(7): 497-502, 07/2015. tab, graf
Article in English | LILACS | ID: lil-754981


PURPOSE: To evaluate the effects of isoxsuprine and nicotine on TRAM. METHODS: Forty eight 48 Wistar rats distributed into four Groups (n=12). All rats received medication managed daily for 20 days: saline solution (SA), nicotine solution (NI), isoxsuprine solution (IS) and nicotine solution (NI) + isoxsuprine solution (IS). On day 21st the rats were submitted to the caudally based, right unipedicled TRAM flap and after 48 hours, made the macroscopic evaluation of the surface of the flap, photographic documentation and collection of material for histology. Data from macroscopic evaluation were analyzed by ANOVA and microscopic evaluation by Kruskal-Wallis test, with significance level of 5%. RESULTS: In the macroscopic evaluation of isoxsuprine Group retail presented absolute numbers: final area (p=0.001*) and viable area (p=0.006*) with the highest values; necrosis (p=0.001*) had the lowest value. Microscopic examination revealed no significant findings in the study of TRAM under the action of isoxsuprine and nicotine to the percentage of necrosis in the left and right cranial and caudal regions. CONCLUSIONS: There was significant improvement in viability of TRAM using the isoxsuprine solution alone. No influence using nicotine alone and in association with isoxsuprine. .

Animals , Female , Isoxsuprine/pharmacology , Myocutaneous Flap , Nicotine/adverse effects , Nicotinic Agonists/adverse effects , Rectus Abdominis/transplantation , Vasodilator Agents/pharmacology , Graft Survival/drug effects , Models, Animal , Myocutaneous Flap/pathology , Necrosis/pathology , Prospective Studies , Rats, Wistar , Reproducibility of Results , Rectus Abdominis/drug effects , Rectus Abdominis/pathology , Smoking/adverse effects , Tissue Survival/drug effects
Acta cir. bras ; 30(7): 461-469, 07/2015. tab, graf
Article in English | LILACS | ID: lil-754983


PURPOSE: To investigate the vitality of the spleen lower pole after subtotal splenectomy with suture to the stomach and after posterior peritoneal gastro-splenic membrane section, using macro and microscopic evaluations. METHODS: Sixty Wistar rats were used in this study and were randomly distributed in the three groups: Group 1: (n=20), subtotal splenectomy with lower pole preservation, Group 2: (n=20) subtotal splenectomy with lower pole preservation and suture to the stomach, Group 3: subtotal splenectomy with lower pole preservation and posterior peritoneal gastrosplenic ligament section. The animals were sacrificed 45 days after the surgery and the spleen lower poles were removed for macroscopic and microscopic examination. RESULTS: All animals in this series survived. No macroscopic differences were encountered between the groups. Microscopic evaluation observed statistic difference concerning fibrosis between group 1 and 3 (p≤0.05), but the analysis for necrosis and inflammation presented no differences. CONCLUSION: Vitality of the spleen lower pole after subtotal splenectomy is minimally modified when it is fixed to the stomach or when the posterior peritoneal gastrosplenic ligament is resected. .

Animals , Male , Peritoneum/surgery , Spleen/surgery , Splenectomy/methods , Stomach/surgery , Feasibility Studies , Fibrosis/pathology , Necrosis/pathology , Organ Size , Postoperative Period , Peritoneum/pathology , Random Allocation , Rats, Wistar , Reproducibility of Results , Spleen/pathology , Treatment Outcome
An. bras. dermatol ; 90(3,supl.1): 101-103, May-June 2015. ilus
Article in English | LILACS | ID: lil-755746



The granulomatosis with polyangiitis, initially known as Wegener's granulomatosis, is a small and medium vessels vasculitis. It's classic form presents a triad: necrotizing granuloma of respiratory tract, necrotizing cutaneous vasculitis and glomerulonephritis. This vasculitis has cytoplasmic antineutrophil antibodies as signal. This work illustrates a case, of multisystemic rare disease, in which the segment and treatment were considered satisfactory for symptoms remission.


Adolescent , Female , Humans , Granulomatosis with Polyangiitis/pathology , Skin Ulcer/pathology , Adrenal Cortex Hormones/administration & dosage , Facial Dermatoses/drug therapy , Facial Dermatoses/pathology , Granulomatosis with Polyangiitis/drug therapy , Leg Dermatoses/drug therapy , Leg Dermatoses/pathology , Necrosis/pathology , Skin Ulcer/drug therapy , Terminology as Topic
Int. braz. j. urol ; 41(2): 304-311, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-748285


Objective: To investigate the clinical characteristics, prognosis, survival and diagnosis of high-grade primary renal leiomyosarcoma. Materials and Methods: From January 2003 to April 2013, 10 cases of high-grade primary renal leiomyosarcoma were retrospectively reviewed. We analyzed clinical manifestations, treatment and prognosis of our group and correlated to the literature. Results: Ten cases (five male and five female patients; age range 43­77 years, mean=57±std d:12.3 ) were enrolled. The mean diameter of the tumor masses was 9.35±4.5 cm (range 3-18 cm). 40% of the patients were asymptomatic while the major symptom of 60% patients was lumbar pain. Nephrectomy was performed in 90% of patients. Partial nephrectomy surgery was preferred for only one patient. Pleomorphism and necrosis with high-grade, pink spindle cell cytoplasm were viewed in all patients. All patients were high-grade, pink spindle cell cytoplasm and pleomorfism and necrosis were observed in all. In an immunohistochemical examination, vimentin was seen in 100%, desmin in 90% and smooth muscle actin in 80% of the patients. CD117 was negative in all patients. All of the cases were followed-up, and the time of survival varied from 6 to 68 months (mean 23.9±std d:20.1). No patient received adjuvant CTx and/or RTx. Conclusion: High-grade primary renal leiomyosarcomas (LMSs) are rare and highly malignant and the prognosis is poor. Early diagnosis and radical nephrectomy can prolong the patient's life. Surgery is the main treatment modality for renal (leiomyosarcoma) LMS

Humans , Male , Female , Adult , Aged , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Leiomyosarcoma/surgery , Leiomyosarcoma/pathology , Prognosis , Immunohistochemistry , Magnetic Resonance Imaging , Retrospective Studies , Tumor Burden , Kidney/surgery , Kidney/pathology , Kidney Neoplasms/mortality , Leiomyosarcoma/mortality , Middle Aged , Necrosis/pathology , Nephrectomy/methods
Acta cir. bras ; 30(4): 235-241, 04/2015. tab, graf
Article in English | LILACS | ID: lil-744275


PURPOSE: To evaluate the morphology, necrotic area and collagen content in skin flaps of rats subjected to hyperbaric oxygenation (HBO). METHODS: Forty adult rats were divided into four groups: GEC - epilated; GE/HBO - epilated subjected to HBO; GER - epilated submitted to skin flap (2 cm in width /8 cm length in the dorsal area) and GER/HBO - epilated, subjected to skin flap and HBO. HBO (2.4 ATA) was performed for two hours during seven consecutive days. In the eighth day, the rats were anesthetized and the skin flaps were removed and separated into three portions, relative to pedicle fixation. The material fixed in 10% formalin was processed for paraffin embedding; sections were stained by H.E and subjected to picrosirius-red method. The slides examined under light microscopy for evaluation of the collagen content in polarized light microscope and ImageLab(r) software (Bio-Rad). RESULTS: The data showed larger area of necrosis and lower levels of collagen in the three regions of the GER group, whereas in the GER/HBO group the collagen content was similar to the GEC and GE/HBO groups. CONCLUSION: Hyperbaric oxygenation reduced the area of necrosis and preserved the morphology and collagen content in skin flaps of rats. .

Animals , Rats , Collagen/analysis , Hyperbaric Oxygenation/methods , Skin Transplantation/methods , Skin/pathology , Surgical Flaps/pathology , Surgical Flaps/physiology , Biopsy , Necrosis/pathology , Random Allocation , Reproducibility of Results , Time Factors , Treatment Outcome , Wound Healing
Acta cir. bras ; 30(4): 247-252, 04/2015. tab, graf
Article in English | LILACS | ID: lil-744281


PURPOSE: To determine the antioxidant and anti-inflammatory effects of alfa lipoic acid (ALA) on the liver injury induced by methotrexate (MTX) in rats. METHODS: Thirty two rats were randomly assigned into four equal groups; control, ALA, MTX and MTX with ALA groups. Liver injury was performed with a single dose of MTX (20 mg/kg) to groups 3 and 4. The ALA was administered intraperitonealy for five days in groups 2 and 4. The other rats received saline injection. At the sixth day the rats decapitated, blood and liver tissue samples were removed for TNF-α, IL-1β, malondialdehyde, glutathione, myeloperoxidase and sodium potassium-adenosine triphosphatase levels measurement and histological examination. RESULTS: MTX administration caused a significant decrease in tissue GSH, and tissue Na+, K+ ATPase activity and which was accompanied with significant increases in tissue MDA and MPO activity. Moreover the pro-inflammatory cytokines (TNF-α, IL- β) were significantly increased in the MTX group. On the other hand, ALA treatment reversed all these biochemical indices as well as histopathological alterations induced by MTX. CONCLUSION: Alfa lipoic acid ameliorates methotrexate induced oxidative damage of liver in rats with its anti-inflammatory and antioxidant effects. .

Animals , Female , Male , Antimetabolites, Antineoplastic/toxicity , Antioxidants/therapeutic use , Chemical and Drug Induced Liver Injury/prevention & control , Methotrexate/toxicity , Thioctic Acid/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Chemical and Drug Induced Liver Injury/pathology , Enzyme-Linked Immunosorbent Assay , Glutathione/analysis , Interleukin-1beta/blood , Liver/drug effects , Liver/pathology , Malondialdehyde/analysis , Necrosis/pathology , Peroxidase/analysis , Random Allocation , Rats, Wistar , Reproducibility of Results , Treatment Outcome , Tumor Necrosis Factor-alpha/blood
Rev. bras. cir. plást ; 30(2): 182-189, 2015. tab
Article in English, Portuguese | LILACS | ID: biblio-1000


Introdução: A reconstrução da mama imediata pós-mastectomia, com implante de silicone é um método simples, porém, pode evoluir com complicações e remoção do implante. O objetivo do estudo foi analisar as complicações pós-operatórias e buscar relação entre estas e a remoção do implante. Método: No período de 4 anos, foram estudados retrospectivamente 323 casos de reconstrução de mama imediata com implante de silicone após mastectomia total realizados no Institut Gustave-Roussy, França. Resultados: A complicação mais frequente foi a linfocele (34,9%), seguida da necrose cutânea com 22,9%, da infecção com 19,3% e do hematoma, com 13,3% dos casos. A remoção do implante foi mais frequente quando ocorreu algum tipo de complicação cirúrgica e maior quando ocorreu mais de um tipo de complicação. A complicação mais frequente nos casos de remoção do implante foi a infecção (75,0%). O expansor foi o implante que mais teve relação com remoção do implante. O uso de implantes de volume acima de 300 ml teve significativamente mais risco de remoção do implante. Conclusões: 1) A presença de complicação pós-operatória foi fator de risco para a remoção do implante. 2) O risco de remoção foi maior na presença de mais de um tipo de complicação 3) A infecção foi o principal tipo de complicação que se relacionou com a remoção 4) O expansor apresentou maior risco de complicações e de remoção do implante. 5) A utilização de implantes de volume maior do que 300 ml apresentou maior risco de remoção.

Introduction: Immediate breast reconstruction with silicone implants following mastectomy is a simple method, but can develop complications culminating in implant removal. The aim of this study was to analyze postoperative complications and evaluate their correlation with implant removal. Method: In a period of 4 years, 323 cases of immediate breast reconstruction with silicone implants following total mastectomy were retrospectively studied in the Institut Gustave-Roussy, France. Results: The most frequent complication was lymphocele (34.9%), followed by cutaneous necrosis (22.9%), infection (19.3%), and hematoma (13.3%). Implant removal was more frequent when a surgical complication occurred, and even more frequent when there was more than one type of complication. The most frequent complication leading to implant removal was infection (75.0%). The expander was the implant that had the highest correlation with implant removal. The use of implants with a volume greater than 300 ml was associated with a significantly higher risk of implant removal. Conclusions: 1) The presence of postoperative complications was a risk factor for implant removal. 2) The risk of removal was higher when more than one complication was present. 3) Infection was the main type of complication associated with implant removal. 4) The expander presented a higher risk of complications and implant removal. 5) The use of implants with a volume greater than 300 ml had a greater risk of need for removal.

Humans , Female , Adult , Middle Aged , Aged , History, 21st Century , Postoperative Complications , Prostheses and Implants , Skin Neoplasms , Lymphocele , Retrospective Studies , Mammaplasty , Breast Implants , Reconstructive Surgical Procedures , Evaluation Study , Mammary Glands, Human , Necrosis , Postoperative Complications/surgery , Prostheses and Implants/adverse effects , Prostheses and Implants/standards , Skin Neoplasms/surgery , Skin Neoplasms/complications , Breast , Breast/surgery , Lymphocele/surgery , Lymphocele/complications , Lymphocele/pathology , Mammaplasty/adverse effects , Mammaplasty/methods , Breast Implants/adverse effects , Reconstructive Surgical Procedures/methods , Mammary Glands, Human/surgery , Necrosis/surgery , Necrosis/pathology
Article in English | WPRIM | ID: wpr-22494


OBJECTIVE: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. MATERIALS AND METHODS: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. RESULTS: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. CONCLUSION: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

Adolescent , Adult , Aged , Aged, 80 and over , Asian Continental Ancestry Group , Biopsy , Calcinosis/pathology , Child , Child, Preschool , Female , Histiocytic Necrotizing Lymphadenitis/pathology , Humans , Lymph Nodes/pathology , Male , Middle Aged , Neck/diagnostic imaging , Necrosis/pathology , Sensitivity and Specificity , Tuberculosis, Lymph Node/pathology , Ultrasonography, Doppler , Young Adult
Article in English | IMSEAR | ID: sea-157090


Background & objectives: General anaesthetics may induce apoptosis. The pro-apoptotic/necrotic markers M30 (caspase-cleaved cytokeratin-18) and M65 (intact cytokeratin-18) have been used to identify early apoptosis in liver disease. The aim of this study was to detect the effect of propofol and sevoflurane anaesthesia on these markers and blood transaminase levels in female patients undergoing elective surgery. Methods: Sixty-seven women undergoing mastectomy or thyroidectomy under general anaesthesia were randomly allocated to the propofol or sevoflurane groups. Venous blood samples for measuring the apoptotic and necrotic markers M30 and M65 as well as for measuring the alanine aminotransferase (ALT) and the aspartate aminotransferase (AST) liver enzymes were collected before induction of anaesthesia, immediately after completion of surgery, and 24 and 48 h postoperatively. Results. The M30 values preoperatively and 0, 24 and 48 h postoperatively were 280±229, 300±244, 267±198 and 254±189 U/l in the propofol group and 237±95, 242±109, 231±94 and 234±127 U/l in the sevoflurane group, respectively. The M30 values did not differ within or between the groups. The M65 levels at the same time intervals were 470±262, 478±271, 456±339 and 485±273 in the propofol group and 427±226, 481±227, 389±158 and 404±144 U/l in the sevoflurane group, respectively. No significant changes were found in the M65 either within or between the propofol and the sevoflurane groups. The ALT and AST levels did not change at these time intervals. Interpretation & conclusions: Under the present study design propofol or sevoflurane anaesthesia did not induce apoptosis or affected the liver function as assessed by the M30, M65 markers and liver enzymes in patients undergoing mastectomy or thyroidectomy under general anaesthesia.

Aged , Alanine Transaminase/metabolism , Anesthesia/adverse effects , Anesthesia/methods , Apoptosis/drug effects , Aspartate Aminotransferases/metabolism , Female , Humans , Keratin-18/blood , Liver/drug effects , Liver/enzymology , Mastectomy/methods , Methyl Ethers/administration & dosage , Methyl Ethers/adverse effects , Middle Aged , Necrosis/chemically induced , Necrosis/enzymology , Necrosis/pathology , Peptide Fragments/blood , Propofol/administration & dosage , Propofol/adverse effects , Thyroidectomy/methods