RESUMO
Neutrophils form neutrophil extracellular traps (NETs) of decondensed DNA and histones that trap and immobilize particulate matter and microbial pathogens like bacteria. NET aggregates reportedly surround and isolate large objects like monosodium urate crystals, which cannot be sufficiently cleared from tissues. In the setting of acute necrotizing pancreatitis, massive tissue necrosis occurs, which is organized as pancreatic pseudocysts (1). In contrast to regular cysts, these pseudocysts are not surrounded by epithelial layers. We hypothesize that, instead, the necrotic areas observed in necrotizing pancreatitis are isolated from the surrounding healthy tissues by aggregated NETs. These may form an alternative, putatively transient barrier, separating necrotic areas from viable tissue. To test this hypothesis, we investigated histological samples from the necropsy material of internal organs of two patients with necrotizing pancreatitis and peritonitis accompanied by multiple organ failure. Tissues including the inflammatory zone were stained with hematoxylin and eosin and evaluated for signs of inflammation. Infiltrating neutrophils and NETs were detected by immunohistochemistry for DNA, neutrophil elastase (NE), and citrullinated histone H3. Interestingly, in severely affected areas of pancreatic necrosis or peritonitis, chromatin stained positive for NE and citrullinated histone H3, and may, therefore, be considered NET-derived. These NET structures formed a layer, which separated the necrotic core from the areas of viable tissue remains. A condensed layer of aggregated NETs, thus, spatially shields and isolates the site of necrosis, thereby limiting the spread of necrosis-associated proinflammatory mediators. We propose that necrotic debris may initiate and/or facilitate the formation of the NET-based surrogate barrier.
RESUMO
INTRODUCTION: At the same time even laparoscopic adrenalectomy can become the source or the causing factor of a number of complications. In the following report we present the clinic case of diagnostic complications during postsurgical period of "rapid" development and signs of tuberculosis after laparoscopic adrenalectomy. PRESENTATION OF CASE: The patient underwent ultrasonography and CT was found out: the tumor of right adrenal gland. Operational treatment: right laparoscopy adrenalectomy. Pathologistological conclusion: clear cell adenoma. On the fourth day there was a high temperature rise noted 38-39°C. On the 10th day the CT, where there were no signs of free liquid abscess formation. Relaparoscopic: small amount of serous-hemorrhagic liquid in small pelvis, hyperemated peritoneum, in both - left and right liver lobes tight knots of white color. After, the patient still had hyperthermia 38°C. Phthisiatrician consulted the patient and diagnosed abdominal tuberculosis. After six-month treatment the patient in satisfactory condition was discharged home. DISCUSSION: But in case of our patient's case such visual diagnostic methods, such as CT and ultrasonography of abdominal cavity appeared to be non-informative in lymph system diagnostics due to the number of reasons.The described clinical case and literature data prove the fact, that crucial in abdominal tuberculosis form management treatment is a diagnostic laparoscopy with tissue biopsy. CONCLUSION: Labors, as well as adrenalectomy are possible factors which decrease the immunity and can cause the activation of tuberculosis process. Diagnostic laparoscopy and intraoperative histological tissue study of abdominal cavity are the main points in prescribing diagnosis of abdominal tuberculosis form.
