Morphological Characteristics of the Results of Experimental Modeling of Septic Peritonitis

SUMMARY: Experimental studies devoted to the study of the mechanisms of the pathogenesis of acute peritonitis and the development of new methods of medical and surgical treatment are becoming increasingly relevant. Today, experimental medicine knows many different ways to modeling septic peritonitis and eliminate it, but the role of the local immune system is underestimated, whereas it takes a direct part in inflammation. The objective of our work to study morphological features of results of experimental modeling of septic peritonitis in white rats. The study included 15 sexually mature white male rats weighing 276.75±6.56 grams. A simulation of septic peritonitis was performed by perforating the upper part of the cecum with four punctures with a G16 injection needle. As a result of the experiment, after examination of the peritoneal cavity, all 15 animals were diagnosed with omentum tamponade of perforated damage to the caecum. In 11 cases, the perforated wall of the caecum was covered by the greater omentum (73.34 %), and in the other 4 animals, tamponade was performed by one of the epididymal omentum (26.66 %). The initial stage of tamponade with the greater or epididymal omentums of a perforated caecum begins on the first day of the experiment and consists of tight interstitial consolidation between them, as well as in the invasion of blood vessels from the omentum side to the focus of infection, which ensure the delivery of the appropriate immunocompetent cells. As a result of this process, intensive lymphoid infiltrates are formed in this area, as well as the growth of adipose tissue, which isolates the inflammatory focus from the peritoneal cavity with a thick layer.

Las investigaciones experimentales dedicadas al estudio de los mecanismos de patogénesis de la peritonitis aguda y el desarrollo de nuevos métodos de tratamiento médico y quirúrgico son cada vez más relevantes. Hoy en día, la medicina experimental conoce muchas formas diferentes de modelar la peritonitis séptica y eliminarla, pero se subestima el papel del sistema inmunológico local, mientras que él participa directamente en la inflamación. El objetivo de nuestro trabajo fue estudiar las características morfológicas de los resultados del modelado experimental de peritonitis séptica en ratas blancas. El estudio incluyó 15 ratas macho blancas, sexualmente maduras que pesaban 276,75 ± 6,56 gramos. Se realizó una simulación de peritonitis séptica perforando la parte superior del ciego con cuatro punciones con una aguja de inyección G16. Como resultado del experimento, después del examen de la cavidad peritoneal, a los 15 animales se les diagnosticó taponamiento del omento o lesión perforada del ciego. En 11 casos, la pared perforada del ciego fue recubierta por el omento mayor (73,34 %), y en los otros 4 animales el taponamiento se realizó por uno de los epidídimos (26,66 %). La etapa inicial del taponamiento con omento mayor o epidídimo de un ciego perforado comienza el primer día del experimento y consiste en una estrecha consolidación intersticial entre ellos, así como en la invasión de los vasos sanguíneos desde el lado del omento hasta el foco de infección, que aseguran la entrega de las células inmunocompetentes apropiadas. Como resultado de este proceso, se forman intensos infiltrados linfoides en esta zona, así como el crecimiento de tejido adiposo, que aísla el foco inflamatorio de la cavidad peritoneal con una gruesa capa.

Tratamiento quirúrgico del linfedema de miembro superior postratamiento del cáncer de mama / Surgical treatment of lymphedema of the upper limb after breast cancer

Introducción. El linfedema de miembro superior postratamiento del cáncer de mama es una afección progresiva y crónica que compromete a una gran cantidad de pacientes causando efectos físicos, psicológicos y sociales. El linfedema secundario se da en un 20-40% de los casos luego de la cirugía del cáncer de mama con vaciamiento y radioterapia. Este es un problema desafiante. El tratamiento conservador ha demostrado no ser suficientemente exitoso por lo que su tratamiento quirúrgico es una buena opción. La transferencia microquirúrgica de nódulo linfático vascularizado (TNLV) brindó una nueva esperanza para este grupo de pacientes. Material y métodos. En el periodo comprendido entre marzo 2016 y agosto 2018 se analizaron 16 pacientes con una edad promedio de 50,25. Se realizó tratamiento quirúrgico basándose en la transferencia de nódulo linfático vascularizado (TNLV) de la ingle a la axila por medio de una anastomosis microquirúrgica de la arteria circunfleja ilíaca superficial en pacientes que presentaron linfedema secundario al tratamiento del cáncer de mama. Se realizó simultáneamente a la cirugía reconstructiva de la mama con colgajo libre DIEP y también en un segundo tiempo quirúrgico. Tiempo quirúrgico de 4,3 horas y una estadía en internación de 2,3 días. Resultados. La vitalidad de los colgajos fue 100%. Como morbilidad, se presentaron cuatro casos de seroma, una infección y una dehiscencia en la zona dadora. Con un seguimiento promedio de 10,43 meses y una reducción significativa de volumen del miembro afectado del 27.47% en comparación con el preoperatorio. La incidencia de celulitis descendió. La linfografía posoperatoria indicó una mejoría en el drenaje linfático del miembro afectado. Conclusiones. La transferencia linfática vascularizada al miembro afectado en conjunto con la cirugía reconstructiva mamaria DIEP es un procedimiento seguro y eficaz en el tratamiento del linfedema de miembro superior en pacientes mastectomizadas con vaciamiento ganglionar y radioterapia.

Purpose: Upper limb lymphedema post breast cancer treatment is a progressive and chronic condition that involves a large number of patients causing psychological, physical and social effects. The incidence of secondary lymphedema is about 20-40% before breast cancer treatment. This is a challenging problem. The conservative treatment has shown not to be successful enough so the surgery is a really good option. The vascularized lymph node transfer (VLNT) offers some hope to this group of patients. The purpose of the investigation is to demonstrate that te VLNT is an efficacious approach to treating postmastectomy upper limb lymphedema. Methods: From March 2016 to August 2018 were analyzed sixteen patients with a mean age of 50.25 years. They all have secondary lymphedema. They underwent surgical treatment based on vascularized lymph node transfer from the groin to the axially area or elbow as a recipent site. The deep inferior epigastric perforator flap was made at the same time, as a stacked flap. In only six cases, the VLNT was made on a second surgical time. The serrato's vessels were used as a recipient vessels in the axilary area and a radial artery branch and the cephalic vein were used in the elbow. Results: The flaps vitality was 100%. There were four seroma cases, one infection and one dehiscence. At a mean follow up of 10.43, the mean circumference reduction rate of the lymphedematous limb was about 27.47% between the preoperative and the postoperative groups. The postoperative lymphoscintigrapy showed a little improvement. The follow up of the vitality of the nodes was made by a lymphatic contrast tomography, and it showed all nodes survived. Conclusions: The vascularized lymph node transfer and the DIEP flap were confirmed as an effective and safe treatment to the secondary lymphedema in this type of patients, and it really improves postmastectomy upper limb lymphedema

Tuberculosis ganglionar cervical simulando una enfermedad de Kikuchi: reporte de un caso y revisión de la literatura / Cervical lymph node tuberculosis simulating Kikuchi's disease: a case report and review of the literature

La linfadenitis cervical tuberculosa es la manifestación más común de tuberculosis en cabeza y cuello. La enfermedad de Kikuchi es una enfermedad rara que consiste en una linfadenitis necrotizante histocitiaria. La presentación clínica en ambas entidades suele consistir en una o más masas cervicales dolorosas, que pueden ser duras o fluctuantes. Los hallazgos por imagen no permiten distinguir de manera absoluta la linfadenitis tuberculosa de la enfermedad de Kikuchi. Por lo tanto es imprescindible para interpretar los hallazgos por imagen no sólo conocer el origen demográfico del paciente, sino su estado inmunológico con respecto a la tuberculosis y el estudio histopatológico y microbiológico de las adenopatías.

Tuberculous cervical lymphadenitis is the most common manifestation of tuberculosis in the head and neck. Kikuchi's disease is a rare disease that is histocitiaria necrotizing lymphadenitis. The clinical presentation in both entities is usually a painful neck masses or more, which can be hard or fluctuating. The imaging findings do not distinguish in absolute tuberculous lymphadenitis Kikuchi's disease. Therefore it is essential to interpret the imaging findings not only know the origin of the patient population, but their immune status with regard to Tuberculosis and histopathological and microbiological lymphadenopathy.

Perfil da doença de Kawasaki em crianças encaminhadas para dois serviços de reumatologia pediátrica do Rio de Janeiro, Brasil / Profile of Kawasaki disease in children referred to two pediatric rheumatology services in Rio de Janeiro, Brazil

OBJETIVOS: Descrever uma população de crianças com diagnóstico de doença de Kawasaki (DK) atendida em centros de reumatologia pediátrica do Rio de Janeiro. Analisar o período de atraso no diagnóstico e início do tratamento, devido à dificuldade de distinguir DK de outras doenças febris comuns da infância; e o impacto deste atraso na frequência de sequelas coronarianas. MÉTODOS: Os dados analisados incluíram: nome, sexo, idade, data do inicio dos sintomas e da admissão no serviço especializado, sintomatologia, evolução clínica, uso de Imunoglobulina Endovenosa (IGEV) e complicações coronarianas. RESULTADOS: Dos 125 casos estudados, 63 por cento eram meninos. 40 por cento tinham menos de 2 anos no momento do diagnóstico. O intervalo médio entre o inicio dos sintomas e o diagnóstico de DK foi de 12 dias (duração média da febre = 14 dias). Dos casos estudados, 22,4 por cento receberam o diagnostico de DK antes do atendimento em serviço especializado; nos demais, as hipóteses diagnosticas iniciais incluíam: infecções bacterianas (60 por cento), virais (12 por cento), outras doenças reumatológicas (4 por cento) e reações adversas à vacinação (1,6 por cento). Em 85.6 por cento dos casos registrou-se o tratamento realizado, sendo administrada IGEV em 46,7 por cento, e a partir do 10º dia em 21,5 por cento dos casos. Dos 20 pacientes apresentando sequelas coronarianas, 9 tiveram diagnóstico tardio, incluindo 3 iniciando tratamento após o 10º dia e 6 sem tratamento. Não encontramos associação significativa entre a frequência de sequelas coronarianas e: sexo; idade; critérios clínicos; tratamento com IGEV antes ou depois do 10º dia de doença. CONCLUSÕES: O diagnóstico de DK pode ser atrasado pela dificuldade em diferenciá-lo de outras doenças febris da infância.

OBJECTIVES: To describe a population of children diagnosed with Kawasaki's disease (KD) in pediatric rheumatology centers of Rio de Janeiro, Brazil, defining the magnitude of the delay period in diagnosing KD and initiating treatment due to confusion with common childhood febrile illnesses and the impact of this delay on the frequency of coronary sequels. METHODS: Data analysis from hospital records summarized in a dedicated form, including name, gender, age, date of first recorded clinical signs, date of admission to the specialty service, information about symptoms, clinical evolution, intravenous immunoglobulin (IVIG) use and coronary sequels. RESULTS: Of 125 patients, 63 percent were males. 40 percent were under 2 years at diagnosis. Average lapse between earliest signs and KD diagnosis was 12 days (mean fever duration, 14 d). Only 22.4 percent had a diagnosis of KD before entering the specialty service. For the remainder, initial hipotheses included: bacterial (60 percent) and viral infections (12 percent), rheumatological diseases (4 percent) and adverse vaccination reactions (1.6 percent). Hence, prevalent febrile illnesses of childhood were major confounding factors. For records (85.6 percent) mentioning treatment, 46.7 percent reported IVIG treatment, beginning after day 10 in 23 cases (21.5 percent). 20 patients (16 percent) presented coronary sequels, 9 of which were diagnosed late, including 3 given IVIG after day 10, and 6 given no IVIG. We found no significant association between the frequency of coronary sequels and: a) sex; b) age; c) clinical criteria; d) initiation of IVIG treatment (before or after day 10). CONCLUSIONS: Common febrile illnesses of childhood often confound the diagnosis of KD.