Résumé
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.
Sujets)
Animaux , Femelle , Lapins , Hernie abdominale/chirurgie , Polyéthylène glycols/effets indésirables , Polypropylènes/usage thérapeutique , Filet chirurgical/effets indésirables , Collagène/analyse , Modèles animaux de maladie humaine , Fibrose/anatomopathologie , Fibrose/prévention et contrôle , Réaction à corps étranger/anatomopathologie , Réaction à corps étranger/prévention et contrôle , Herniorraphie/méthodes , Laparoscopie , Test de matériaux , Complications postopératoires/anatomopathologie , Complications postopératoires/prévention et contrôle , Reproductibilité des résultats , Facteurs temps , Résultat thérapeutique , Adhérences tissulaires/anatomopathologie , Adhérences tissulaires/prévention et contrôleRésumé
Mulher idosa apresentou psoríase em placas do tipo grave, com tendência eritrodérmica, e foi submetida a tratamento de acordo com o algoritmo consensual (fototerapia, acitretina, ciclosporina). Resultados clínicos insuficientes, recorrência e agravamento do quadro laboratorial orientaram no sentido da introdução de terapia biológica. A avaliação preliminar revelou PPD de 30mm. A resolução completa das lesões se verificou quando realizada profilaxia antituberculose e administrado antidepressivo.
An 83 year old woman, exhibiting severe psoriasis, was treated conventionally (phototherapy, acitretin, and cyclosporine). After poor clinical results and significant changes in laboratory procedures, those treatments were suspended. She was then being prepared to be submitted to biological treatment, when preliminary results disclosed a 30mm PPD. Complete improvement occurred [only] after introducing prophylactic therapy for tuberculosis and anti-depressive medication.