Acute systemic response to intraperitoneal implantation of polypropylene mesh/chitosan-based film composite in pigs

PURPOSE:To assess the systemic response of pigs to the intraperitoneal implantation of polypropylene mesh associated with chitosan-based film with a degree of deacetylation of 95%.METHODS:Blood samples were collected 24 hours before, and two and seven days after surgery. Systemic reactions were evaluated based on white blood cell count, C-reactive protein, and total serum protein, albumin and globulin levels.RESULTS:The systemic response was proportional to the composite response induced by polypropylene mesh, and the tissue inflammatory response was higher in the PP group (p=0.0033).CONCLUSION:The polypropylene mesh/chitosan-based film composite did not elicit a systemic response in pigs.

New strategies to improve results of mesh surgeries for vaginal prolapses repair – an update

ABSTRACTThe use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.

Abdominal wall healing in incisional hernia using different biomaterials in rabbits

PURPOSE: To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS: Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL), ULTRAPRO® (UP), PROCEED® (PCD) or repairing without mesh (TRANSPALB). After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS: Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). PPL groups (p = 0.032) and PCD (p <0.001) showed greater meshes shrinkages when compared to UP. Microscopic: neutrophils: PCD> PPL, UP and TRANSPALB (p = 0.010); eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010); granulation tissue: PPL and PCD> UP and TRANSPALB (p <0.001); macrophages : PPL, UP and PCD> TRANSPALB (p <0.001); lymphocytes: PPL and PCD> UP (p = 0.009) and TRANSPALB (p <0.001); giant cells: PPL, UP and PCD> TRANSPALB (p <0.001); viscera adhered: PPL and UP> PCD and TRANSPALB (p <0.001). CONCLUSION: All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.

Análise angiográfica e ultra-sonográfica do stent liberador de novolimus para o tratamento de lesões coronárias de novo: resultados do estudo EXCELLA I / Preliminary results from the first-in-man study EXCELLA

A reestenose intra-stent coronário sofreu marcante redução com o surgimento dos stents liberadores de medicamentos, alcançando níveis de 10 por cento na maioria dos cenários clínicos e angiográficos. Desde então, novos dispositivos com diferentes fármacos vêm sendo testados com a finalidade de se obter perfil de eficácia pelo menos equivalente ao dos stents farmacológicos de primeira geração (Cypher e Taxus), mas com maior segurança tardia. Objetivo: Avaliar a segurança e a eficácia na inibição da proliferação neointimal com implante de stent liberador de novolimus. Método: Estudo unicêntrico, tipo first-in-man, com inclusão de 15 pacientes portadores de angina pectoris submetidos a implante de stent liberador de novolimus. Resultados: Análise por meio de angiografia coronária quantitativa (ACQ) e ultra-som intracoronário (USIC), realizada imediatamente após implante do stent e aos quatro meses, revelou perda tardia intra-stent de 0,15 mais ou menos 0,29 mm e no segmento, de 0,07 mais ou menos 0,3 mm. O volume de obstrução intra stent foi de 2,6 mais ou menos 2,6 por cento. Não foram observados casos de reestenose binária. O seguimento clínico aos seis meses foi obtido em todos os pacientes, não sendo observados eventos cardíacos adversos...

Background: Stent restenosis suffered a marked reduction with drug-eluting stents (DES) reaching levels below 10% in most clinical and angiographic scenarios. Since then, new devices with different drugs have been tested in order to obtain an efficiency equivalent to first generation DES (Cypher® and Taxus®), although with better long-term safety. Our objective was to evaluate safety and neointimal proliferation inhibition with novolimuseluting stent through clinical and angiographic endpoints. Methods: Single-center, first-in-man study, including 15 patients with angina pectoris submitted to novolimuseluting stent implantation. Results: Angiographic analysis with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) performed immediately after stent implantation and at 4-month follow-up revealed instent and in-segment late loss of 0.15 mm ± 0.29 mm and 0.07 mm ± 0.3 mm, respectively. In-stent volume obstruction was 2.6 ± 2.6%. No cases of binary restenosis were observed. The six-month clinical follow-up revealedno major acute cardiovascular events (MACE). Conclusion: The new novolimus-eluting stent proved to be efficient in reducing late loss and supressing neointimal proliferation. Late results in more complex group of patients are needed to confirm the safety of this new device...

Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent

OBJECTIVE: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. MATERIALS AND METHODS: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks). RESULTS: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. CONCLUSION: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

Superfície de titânio modificada por jateamento mecânico e/ou tratamento ácido / Titanium surface modified by mechanical blasting and/or acid treatment

Foram preparadas amostras de chapas de titânio com nove condiçöes de superfície, sendo três lixadas até lixa 600 e seis jateadas com óxido de alumínio (alumina com granulometria 65mm e 250mm). Seis condiçöes foram entäo submetidas a tratamento ácido com soluçäo de ácido sulfúrico/clorídico ou soluçäo contendo ácido fluorídrico. Essas superfícies foram caracterizadas por meio de técnicas, como microscopia eletrônica de varredura (MEV/EDS), espectroscopia de fotoelétrons por raio X (XPS) e medidas de rugosidade média. A soluçäo contendo ácido fluorídrico foi eletiva na remoçäo das partículas de alunina, provenientes do jateamento mecânico, e na criaçäo de uma microscopia homogeneamente rugorosa