RESUMEN
Laryngeal granuloma, vocal process granuloma, or post-intubation granuloma are benign, inflammatory lesions of the arytenoid cartilage vocal process. The etiology of laryngeal granulomas is multifactorial, such as chronic irritation due to endotracheal intubation, vocal cord injury or trauma, and gastroesophageal reflux disease. They can arise postoperatively after mucosal injury due to orotracheal intubation. Clinical manifestations include voice change and dyspnea, which may start one to four months after extubation and may rarely lead to asphyxia. We presented a case of death due to glottic granuloma occurring after a surgical procedure to remove a laryngeal polyp attributed to previous laryngeal injuries by multiple intubations.
RESUMEN
ABSTRACT Laryngeal granuloma, vocal process granuloma, or post-intubation granuloma are benign, inflammatory lesions of the arytenoid cartilage vocal process. The etiology of laryngeal granulomas is multifactorial, such as chronic irritation due to endotracheal intubation, vocal cord injury or trauma, and gastroesophageal reflux disease. They can arise postoperatively after mucosal injury due to orotracheal intubation. Clinical manifestations include voice change and dyspnea, which may start one to four months after extubation and may rarely lead to asphyxia. We presented a case of death due to glottic granuloma occurring after a surgical procedure to remove a laryngeal polyp attributed to previous laryngeal injuries by multiple intubations.
RESUMEN
INTRODUCTION: To determine whether the local administration of insulin glargine compared with placebo in nondiabetic patients with venous ulcers (VUs) leads to increased wound healing. METHODS: A randomized controlled trial using a split-plot design was performed in 36 adults with leg VUs >25 cm2 and more than 3 mo of evolution. Each hemi-wound received either 10 UI insulin glargine or saline solution once a day for 7 d. Size of the wounds, thermal asymmetry, the number of blood vessels, and the percentage area of collagen content in wound biopsies were assessed at baseline and after 7 d of treatment. Blood capillary glucose was monitored once a day after the insulin injection. RESULTS: After 7 d of treatment, the hemi-wounds treated with insulin glargine were significantly smaller, had less thermal asymmetry, more blood vessels, and more collagen content than the saline-treated side. Correlation between thermal asymmetry and the number of blood vessels was also found (r2 = 66.2, P < 0.001). No patient presented capillary glucose levels ≤3.3 mmol/L nor any adverse effects. CONCLUSIONS: In nondiabetic patients with chronic VUs, the topical administration of insulin glargine seems to be safe and promotes wound healing and tissue repair after 7 d of treatment.
Asunto(s)
Úlcera Varicosa , Adulto , Glucemia , Humanos , Insulina Glargina/farmacología , Insulina Glargina/uso terapéutico , Solución Salina , Úlcera , Úlcera Varicosa/tratamiento farmacológico , Cicatrización de HeridasRESUMEN
OBJECTIVE: The aim of this study was to evaluate the effects of both testosterone depletion and supraphysiological testosterone supplementation in the early phase of an animal cutaneous wound healing model in comparison with the physiological hormonal condition. MATERIAL AND METHODS: Forty rats were distributed into the following four groups: Control, Orchiectomy (OCX), Durateston (Dura) and OCX+Dura. On day 1, the testicles were removed (OCX group) and the rats (Dura group) received a supraphysiological dose (250 mg/kg) of exogenous testosterone weekly. After 15 days a full-thickness excisional skin wound was created in all animals, which was healed by the second intention for 7 days. On day 22, the rats were euthanatized and the wounds were harvested for histopathological evaluation, immunohistochemistry analyses and multiplex immunoassay. One-way ANOVA and post-hoc Tukey tests were performed. RESULTS: It was found that the supraphysiological testosterone level increased extracellular matrix deposition, promoted higher blood vessel formation and reduced wound contraction (p < 0.05). Additionally, it also stimulated PCNA-positive fibroblasts and KGF-positive cells (p < 0.05), while orchiectomy reduced the expression of IL-6 and TNF-α and increased VEGF and PDGF (p < 0.05) . CONCLUSION: In conclusion, the results provide evidence that supraphysiological testosterone supplementation plays a positive role in the early phase of cutaneous wound healing, thus improving granulation tissue maturation through the enhancement of angiogenesis.
Asunto(s)
Testosterona , Cicatrización de Heridas , Animales , Suplementos Dietéticos , Modelos Animales de Enfermedad , Tejido de Granulación , Neovascularización Patológica , Ratas , Piel , Testosterona/farmacologíaRESUMEN
Butyrate is a short-chain fatty acid (SCFA) derived from microbiota and is involved in a range of cell processes in a concentration-dependent manner. Low concentrations of sodium butyrate (NaBu) were shown to be proangiogenic. However, the mechanisms associated with these effects are not yet fully known. Here, we investigated the contribution of the SCFA receptor GPR43 in the proangiogenic effects of local treatment with NaBu and its effects on matrix remodeling using the sponge-induced fibrovascular tissue model in mice lacking the Gpr43 gene (Gpr43-KO) and the wild-type (WT) mice. We demonstrated that NaBu (0.2 mM intraimplant) treatment enhanced the neovascularization process, blood flow, and VEGF levels in a GPR43-dependent manner in the implants. Moreover, NaBu was able to modulate matrix remodeling aspects of the granulation tissue such as proteoglycan production, collagen deposition, and α-smooth muscle actin (α-SMA) expression in vivo, besides increasing transforming growth factor (TGF)-ß1 levels in the fibrovascular tissue, in a GPR43-dependent manner. Interestingly, NaBu directly stimulated L929 murine fibroblast migration and TGF-ß1 and collagen production in vitro. GPR43 was found to be expressed in human dermal fibroblasts, myofibroblasts, and endothelial cells. Overall, our findings evidence that the metabolite-sensing receptor GPR43 contributes to the effects of low dose of NaBu in inducing angiogenesis and matrix remodeling during granulation tissue formation. These data provide important insights for the proposition of new therapeutic approaches based on NaBu, beyond the highly explored intestinal, anti-inflammatory, and anticancer purposes, as a local treatment to improve tissue repair, particularly, by modulating granulation tissue components.NEW & NOTEWORTHY Our data show the contribution of the metabolite-sensing receptor GPR43 in the effects of low dose of sodium butyrate (NaBu) on stimulating angiogenesis and extracellular matrix remodeling in a model of granulation tissue formation in mice. We also show that human dermal fibroblasts, myofibroblasts, and endothelial cells express the receptor GPR43. These data provide important insights for the use of NaBu in local therapeutic approaches applicable to tissue repair in sites other than the intestine.
Asunto(s)
Inductores de la Angiogénesis/administración & dosificación , Ácido Butírico/administración & dosificación , Matriz Extracelular/efectos de los fármacos , Fibroblastos/efectos de los fármacos , Tejido de Granulación/efectos de los fármacos , Neovascularización Fisiológica/efectos de los fármacos , Receptores Acoplados a Proteínas G/metabolismo , Animales , Línea Celular , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Colágeno/metabolismo , Modelos Animales de Enfermedad , Matriz Extracelular/metabolismo , Matriz Extracelular/patología , Fibroblastos/metabolismo , Fibroblastos/patología , Tejido de Granulación/metabolismo , Tejido de Granulación/patología , Humanos , Masculino , Ratones Endogámicos C57BL , Ratones Noqueados , Receptores Acoplados a Proteínas G/deficiencia , Receptores Acoplados a Proteínas G/genética , Tapones Quirúrgicos de Gaza , Factor de Crecimiento Transformador beta1/metabolismoRESUMEN
This study evaluated the action of autologous platelet-rich plasma (PRP) on cutaneous wounds, containing skin autografts, in the gluteal region of horses. Seven healthy horses were used. Two 6 x 6cm cutaneous wounds were produced on each side of the gluteal region. Eight days after wound induction, grafts were performed with skin fragments harvested from the neck, as well as the application of PRP, prepared by double-centrifugation protocol. Wounds with autografts on the left side received PRP (group T), and those with autografts on the right side did not receive treatment (group C). Macroscopic and microscopic evaluations were performed, considering the integration of autografts and retraction of wound edges, as well as neovascularization, inflammatory infiltrate, young fibroblasts, collagenization, reepithelization and autografts integration. There was no difference between the groups (P > 0.05) in relation to most macroscopic and microscopic variables. However, neovascularization was significantly greater (p = 0.0191) in group T, on the 14th day after grafting. It is concluded that PRP favors the process of skin repair with autografts in horses, since it increases the neovascularization in the initial phase of wound healing. Furthermore, the PRP seems to positively influence the integration of the skin autografts and the retraction of the wound edges.(AU)
Este estudo avaliou a ação do plasma rico em plaquetas (PRP) autólogo em feridas cutâneas, contendo autoenxertos de pele em equinos. Foram utilizados sete equinos hígidos, nos quais foram produzidas duas feridas cutâneas de 6 x 6cm, em cada um dos lados da região glútea. Oito dias após a indução das feridas, foram realizados enxertos com fragmentos de pele colhidos do pescoço, assim como a aplicação do PRP, preparado através de protocolo de dupla centrifugação. As feridas com autoenxertos do lado esquerdo receberam PRP (grupo T), e as com autoenxertos do lado direito não receberam tratamento (grupo C). Foram realizadas avaliações macroscópica e microscópica, considerando as variáveis integração dos autoenxertos e retração das bordas da ferida, além de neovascularização, infiltrado inflamatório, fibroblastos jovens, colagenização, reepitelização e integração dos autoenxertos. Não houve diferença entre os grupos (p > 0,05) em relação à maioria das variáveis macroscópicas e microscópicas. Contudo, a neovascularização foi significativamente maior (P = 0,0191) no grupo T, no 14º dia após a realização da enxertia. Conclui-se que o PRP favorece o processo de reparo da pele com autoenxertos em equinos, já que aumenta a neovascularização na fase inicial da cicatrização da ferida. Ainda, o PRP parece influenciar positivamente a integração dos autoenxertos de pele e a retração das bordas da ferida.(AU)
Asunto(s)
Animales , Equidae , Trasplante de Piel/rehabilitación , Trasplante de Piel/veterinaria , Plasma Rico en PlaquetasRESUMEN
This study evaluated the action of autologous platelet-rich plasma (PRP) on cutaneous wounds, containing skin autografts, in the gluteal region of horses. Seven healthy horses were used. Two 6 x 6cm cutaneous wounds were produced on each side of the gluteal region. Eight days after wound induction, grafts were performed with skin fragments harvested from the neck, as well as the application of PRP, prepared by double-centrifugation protocol. Wounds with autografts on the left side received PRP (group T), and those with autografts on the right side did not receive treatment (group C). Macroscopic and microscopic evaluations were performed, considering the integration of autografts and retraction of wound edges, as well as neovascularization, inflammatory infiltrate, young fibroblasts, collagenization, reepithelization and autografts integration. There was no difference between the groups (P > 0.05) in relation to most macroscopic and microscopic variables. However, neovascularization was significantly greater (p = 0.0191) in group T, on the 14th day after grafting. It is concluded that PRP favors the process of skin repair with autografts in horses, since it increases the neovascularization in the initial phase of wound healing. Furthermore, the PRP seems to positively influence the integration of the skin autografts and the retraction of the wound edges.
Este estudo avaliou a ação do plasma rico em plaquetas (PRP) autólogo em feridas cutâneas, contendo autoenxertos de pele em equinos. Foram utilizados sete equinos hígidos, nos quais foram produzidas duas feridas cutâneas de 6 x 6cm, em cada um dos lados da região glútea. Oito dias após a indução das feridas, foram realizados enxertos com fragmentos de pele colhidos do pescoço, assim como a aplicação do PRP, preparado através de protocolo de dupla centrifugação. As feridas com autoenxertos do lado esquerdo receberam PRP (grupo T), e as com autoenxertos do lado direito não receberam tratamento (grupo C). Foram realizadas avaliações macroscópica e microscópica, considerando as variáveis integração dos autoenxertos e retração das bordas da ferida, além de neovascularização, infiltrado inflamatório, fibroblastos jovens, colagenização, reepitelização e integração dos autoenxertos. Não houve diferença entre os grupos (p > 0,05) em relação à maioria das variáveis macroscópicas e microscópicas. Contudo, a neovascularização foi significativamente maior (P = 0,0191) no grupo T, no 14º dia após a realização da enxertia. Conclui-se que o PRP favorece o processo de reparo da pele com autoenxertos em equinos, já que aumenta a neovascularização na fase inicial da cicatrização da ferida. Ainda, o PRP parece influenciar positivamente a integração dos autoenxertos de pele e a retração das bordas da ferida.
Asunto(s)
Animales , Equidae , Plasma Rico en Plaquetas , Trasplante de Piel/rehabilitación , Trasplante de Piel/veterinariaRESUMEN
ABSTRACT Purpose: To evaluate whether using platelet-rich plasma (PRP) in the graft recipient bed after the resection of a neoplasia can influence its recurrence because this product stimulates angiogenesis, mitogenesis and chemotaxis. Methods: A study with 30 rats Wistar (Rattus norvegicus albinus), which were separated into group A (induction of carcinogenesis, PRP in the postoperative period) and group B (induction of carcinogenesis, absence of PRP in the postoperative period), with 15 animals in each. Carcinogenesis was induced on the skin of the animals' chest by the topical application of 0.5% dimethylbenzantracene (DMBA) diluted in acetone. After surgical resection of the induced neoplasia, PRP was used to stimulate angiogenesis before surgical wound synthesis. Data on the control and experimental groups and macroscopic and microscopic variables were evaluated using analysis of variance and the Tukey's test (5%). Results: It was possible to determine that the use of PRP is good in reconstructive surgeries, but it is contraindicated in patients during tumor resection, as it can cause changes in the surgical bed, in addition to stimulating recurrences and metastases. Conclusions: PRP may interact with tumour cells that were in the recipient site of the surgical wound during the resection of a neoplasia, and a local recurrence process can be triggered by applying this product.
Asunto(s)
Animales , Ratas , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/inducido químicamente , Plasma Rico en Plaquetas , Cicatrización de Heridas , Trasplante de Piel , Ratas WistarRESUMEN
ABSTRACT: This study evaluated the action of autologous platelet-rich plasma (PRP) on cutaneous wounds, containing skin autografts, in the gluteal region of horses. Seven healthy horses were used. Two 6 x 6cm cutaneous wounds were produced on each side of the gluteal region. Eight days after wound induction, grafts were performed with skin fragments harvested from the neck, as well as the application of PRP, prepared by double-centrifugation protocol. Wounds with autografts on the left side received PRP (group T), and those with autografts on the right side did not receive treatment (group C). Macroscopic and microscopic evaluations were performed, considering the integration of autografts and retraction of wound edges, as well as neovascularization, inflammatory infiltrate, young fibroblasts, collagenization, reepithelization and autografts integration. There was no difference between the groups (P > 0.05) in relation to most macroscopic and microscopic variables. However, neovascularization was significantly greater (p = 0.0191) in group T, on the 14th day after grafting. It is concluded that PRP favors the process of skin repair with autografts in horses, since it increases the neovascularization in the initial phase of wound healing. Furthermore, the PRP seems to positively influence the integration of the skin autografts and the retraction of the wound edges.
RESUMO: Este estudo avaliou a ação do plasma rico em plaquetas (PRP) autólogo em feridas cutâneas, contendo autoenxertos de pele em equinos. Foram utilizados sete equinos hígidos, nos quais foram produzidas duas feridas cutâneas de 6 x 6cm, em cada um dos lados da região glútea. Oito dias após a indução das feridas, foram realizados enxertos com fragmentos de pele colhidos do pescoço, assim como a aplicação do PRP, preparado através de protocolo de dupla centrifugação. As feridas com autoenxertos do lado esquerdo receberam PRP (grupo T), e as com autoenxertos do lado direito não receberam tratamento (grupo C). Foram realizadas avaliações macroscópica e microscópica, considerando as variáveis integração dos autoenxertos e retração das bordas da ferida, além de neovascularização, infiltrado inflamatório, fibroblastos jovens, colagenização, reepitelização e integração dos autoenxertos. Não houve diferença entre os grupos (p > 0,05) em relação à maioria das variáveis macroscópicas e microscópicas. Contudo, a neovascularização foi significativamente maior (P = 0,0191) no grupo T, no 14º dia após a realização da enxertia. Conclui-se que o PRP favorece o processo de reparo da pele com autoenxertos em equinos, já que aumenta a neovascularização na fase inicial da cicatrização da ferida. Ainda, o PRP parece influenciar positivamente a integração dos autoenxertos de pele e a retração das bordas da ferida.
RESUMEN
RESUMEN Fundamento: El Heberprot P es una terapia que contribuye a la reparación de tejidos dañados. Su utilización en las lesiones ortopédicas de los miembros superiores es muy reciente y de escasa publicación. Objetivo: Describir la evolución de una paciente con lesión grave del dorso de la mano derecha en el que se utilizó el Heberprot P, seguido de injerto pediculado. Presentación de caso: Paciente que sufrió accidente con lesión grave en la mano derecha. Se realizó diagnóstico clínico e imagenológico con pérdida de piel, tejido celular subcutáneo y fractura del cuarto y quinto metacarpianos, se le aplicó procedimiento quirúrgico. Evolucionó de forma tórpida con infección profunda, pérdida de tendones extensores y exposición ósea, se decidió iniciar tratamiento con Heberprot P para incentivar tejido de granulación; 21 días después se logró cubrir las estructuras óseas, se operó los tendones y cobertura cutánea con injerto bipediculado al abdomen con evolución favorable. La paciente se reincorporó a su actividad social y laboral a los 10 meses. Conclusiones: El Heberprot P aceleró la cicatrización de tejidos, asociado a colgajos a distancia facilitó una evolución satisfactoria y evitó la amputación, disminuyó estadía hospitalaria, asimismo propició la reincorporación a la vida social y laboral.
ABSTRACT Background: Heberprot P is a therapy that contributes to the repairing of damaged tissues. Its use in orthopedic injuries of the upper limbs is very recent and of little publication. Objective: To describe the evolution of a patient with a serious injury to the back of the right hand in which the Heberprot P was used, followed by a pedicle graft. Case report: Patient who suffered an accident with a serious right hand injury. Clinical and imaging diagnosis was made with skin loss, subcutaneous cellular tissue and fracture of the fourth and fifth metacarpals, a surgical procedure was applied. It evolved torpidly with deep infection, loss of extensor tendons and bone exposure, it was decided to start treatment with Heberprot P to stimulate granulation tissue; 21 days later, the bone structures were covered, the tendons and skin coverage were operated with a bipedicular graft to the abdomen with a favorable evolution. The patient returned to her social and work activity at 10 months. Conclusions: Heberprot P accelerated tissue healing, associated with remote flaps, facilitated a satisfactory evolution and avoided amputation, decreased hospital stay, and also favored return to social and work life.
Asunto(s)
Colgajos Quirúrgicos/trasplante , Traumatismos de los Tendones , Lesiones Accidentales , Tejido de Granulación/lesiones , Traumatismos de la ManoRESUMEN
Periapical granuloma is a histological term that refers to the formation of a mass of granulomatous tissue around the apex of a tooth resulting from inflammation and necrosis of the pulp tissue. It consists of an infiltrate of inflammatory cells such as macrophages, plasmocytes and lymphocytes, as well as fibroblasts, collagen fibers and capillaries. Periapical surgery is an alternative for preserving the tooth in the oral cavity in cases where periapical inflammation is persistent even after treatment of root canals. The objective of this study was to report a clinical case in which the surgical technique was used to remove granulomatous lesions from a patient, female, with a history of recurrent periapical abscess without painful symptomatology in the region of the anterior 11,12 and 13 teeth. The histopathological exam demonstrated the presence of a granulomatous tissue with intense inflammatory infiltrate mixed, permeated with lymphocytes and high number of plasmocytes, confirming the diagnosis of periapical granuloma. The treatment was considered successful since the patient remained asymptomatic and there was incorporation of the inorganic bovine bone graft and initiation of bone neoformation in the periapical region.
Granuloma periapical é um termo histológico que refere-se à formação de uma massa de tecido granulomatoso ao redor do ápice de um dente, decorrente da inflamação e necrose do tecido pulpar. É constituído por um infiltrado de células inflamatórias como macrófagos, plasmócitos e linfócitos, além de fibroblastos, fibras colágenas e capilares. A cirurgia do periápice é uma alternativa para preservação do dente na cavidade bucal nos casos em que a inflamação periapical é persistente mesmo após tratamento dos canais radiculares. O objetivo desse trabalho é relatar um caso clínico no qual a técnica cirúrgica do periápice foi utilizada para remoção de lesões granulomatosas de uma paciente, do sexo feminino, com histórico de abscesso periapical recidivante sem sintomatologia dolorosa na região dos dentes anteriores superiores 11, 12 e 13. O exame histopatológico demonstrou a presença de um tecido granulomatoso com intenso infiltrado inflamatório misto, permeado com linfócitos e elevado número de plasmócitos, confirmando o diagnóstico de granuloma periapical. O tratamento foi considerado exitoso, visto que a paciente se manteve asintomática e houve incorporação do enxerto ósseo bovino inorgânico e início da neoformação óssea na região periapical.
Asunto(s)
Humanos , Femenino , Adulto , Adulto Joven , Granuloma Periapical , Cirugía Bucal , Tejido de GranulaciónRESUMEN
Relata-se o tratamento alternativo de uma ferida com tecido de granulação exuberante em equino, fêmea da raça Quarto de Milha, de 23 anos, alojada em uma central de reprodução. O animal apresentou uma lesão no membro posterior direito desde meados de abril de 2018 sendo iniciado o tratamento em agosto de 2018. No início da lesão, o animal apresentou um episódio de grande edema no membro pélvico da região do calcâneo até o boleto, sensibilidade no membro e perda de condição corporal, a suspeita inicial era de um quadro de linfangite, e então foi adotado um protocolo de ducha local, massagem com pomada anti-inflamatória à base de Dimetilsulfóxido e profilaxia com enrofloxacino e fenilbutazona. Não se obteve resolução do quadro e posteriormente apareceram pontos de necrose na região do boleto, e perda total da pele na região com a exposição de tecidos moles e ineficácia na epitelização local, foi então realizada uma coleta de material biológico para a realização de cultura bacterina e antibiograma, após os resultados foi realizado tratamento sistêmico com amicacina durante 30 dias e também perfusão regional com amicacina, em dias alternados, durante 20 dias. Como não se obteve resultado com a profilaxia antibacteriana no mês de agosto de 2018 foi iniciado o tratamento alternativo para a remoção do tecido de granulação exuberante que possuía o tamanho semelhante ao de uma bola de futebol. O tratamento foi composto por sulfato de cobre, vaselina sólida, extrato de barbatimão e óleo de copaíba. A evolução da ferida foi lenta não obtendo a cicatrização total da ferida, mas é possível afirmar que cerca de 85% do tecido exuberante foi extraído com a utilização do tratamento alternativo.
Alternative treatment of a wound with lush granulation tissue in a 23-year-old Quarter Horse female housed in a breeding center is reported. The animal had an injury to the righ thind limb since mid-April 2018 and treatment was started in August 2018. At the beginning of the injury, the animal had an episode of larges welling in the pelvic limb from the calcaneal region to the boletus, tenderness in the limb and loss of body condition, the initial suspicion was Iymphangitis, and then a local shower protocol, massage with anti-inflammatory ointment based on Dimethylsulfoxide and prophylaxis with enrofloxacin and phenylbutazone were adopted. There was no resolution of the condition and later necrosis points appeared in the region of the boletus, and total loss of skin in the region with exposure of soft tissues and inefficacy in local epithelialization, was then performed a collection of biological material for bacterial culture and antibiogram, after the results a systemic treatment with amikacin was performed for 30 days and also regional infusion with amikacin, in alternate days, for 20 days. As no antibacterial prophylaxis results were obtained in August 2018, alternative treatment for the removal of lush granulation tissue that was similar in size to that of a soccer ball was started. The treatment consisted of copper sulfate, solid petroleum jelly, barbatimão extract and copaiba oil. The evolution of the wound was slow and the total healing of the wound was not achieved, but it can be said that about 85% of the lush tissue was extracted using the alternative treatment.
Se relata el tratamiento alternativo de una herida con tejido de granulación exuberante en equino, hembra de la raza Cuarto de Milla, de 23 años, alojada en una central de reproducción. El animal presentaba una lesión en el miembro posterior derecho desde mediados de abril de 2018 siendo el inicio del tratamiento en agosto de 2018. En el inicio de la sesión, el animal presentó un episodio de gran edematizacion del miembro pelviano en la región del calcáneo hasta el nudillo (articulación metatarso-falangiana) sensibilidad en el miembro y pérdida de condición corporal, Ia sospecha inicial era de un cuadro de linfangitis, y entonces fue adoptado un protocolo de ducha local, masaje con pomada antiinflamatoria a base de dimetilsulfoxido y profilaxis con enrofloxacina y fenilbutazona. No se obtuvo resolución del cuadro y posteriormente aparecen puntos de necrosis en la región del nudillo y pérdida total de lapiel de la región con exposición de tejidos blandos e ineficacia en la epitelizacion local, entonces fue realizado tratamiento sistemico con amikacina durante 30 días y también perfusión regional con amikacina, en días alternados, durante 20 días. La decisión de la amikacina fue luego de la prueba de antibiograma a partir del cultivo de la secreción proveniente de la lesión. En el mes de agosto del 2018 fue iniciado el tratamiento para la remoción del tejido de granulación exuberante que tenía un tamaño semejante a un balón de fútbol. El tratamiento alternativo con sulfato de cobre, vaselina sólida, extracto de barbatimão y aceite de copaiba. La evolución de la herida fue lenta y todavía no se obtiene cierre total, pero es posible afirmar que cerca del 85% del tejido exuberante fue extraído con la utilización de tratamiento alternativo.
Asunto(s)
Femenino , Animales , Caballos/lesiones , Cicatrización de Heridas/efectos de los fármacos , Tejido de Granulación/efectos de los fármacos , Tejido de Granulación/lesionesRESUMEN
Relata-se o tratamento alternativo de uma ferida com tecido de granulação exuberante em equino, fêmea da raça Quarto de Milha, de 23 anos, alojada em uma central de reprodução. O animal apresentou uma lesão no membro posterior direito desde meados de abril de 2018 sendo iniciado o tratamento em agosto de 2018. No início da lesão, o animal apresentou um episódio de grande edema no membro pélvico da região do calcâneo até o boleto, sensibilidade no membro e perda de condição corporal, a suspeita inicial era de um quadro de linfangite, e então foi adotado um protocolo de ducha local, massagem com pomada anti-inflamatória à base de Dimetilsulfóxido e profilaxia com enrofloxacino e fenilbutazona. Não se obteve resolução do quadro e posteriormente apareceram pontos de necrose na região do boleto, e perda total da pele na região com a exposição de tecidos moles e ineficácia na epitelização local, foi então realizada uma coleta de material biológico para a realização de cultura bacterina e antibiograma, após os resultados foi realizado tratamento sistêmico com amicacina durante 30 dias e também perfusão regional com amicacina, em dias alternados, durante 20 dias. Como não se obteve resultado com a profilaxia antibacteriana no mês de agosto de 2018 foi iniciado o tratamento alternativo para a remoção do tecido de granulação exuberante que possuía o tamanho semelhante ao de uma bola de futebol. O tratamento foi composto por sulfato de cobre, vaselina sólida, extrato de barbatimão e óleo de copaíba. A evolução da ferida foi lenta não obtendo a cicatrização total da ferida, mas é possível afirmar que cerca de 85% do tecido exuberante foi extraído com a utilização do tratamento alternativo.(AU)
Alternative treatment of a wound with lush granulation tissue in a 23-year-old Quarter Horse female housed in a breeding center is reported. The animal had an injury to the righ thind limb since mid-April 2018 and treatment was started in August 2018. At the beginning of the injury, the animal had an episode of larges welling in the pelvic limb from the calcaneal region to the boletus, tenderness in the limb and loss of body condition, the initial suspicion was Iymphangitis, and then a local shower protocol, massage with anti-inflammatory ointment based on Dimethylsulfoxide and prophylaxis with enrofloxacin and phenylbutazone were adopted. There was no resolution of the condition and later necrosis points appeared in the region of the boletus, and total loss of skin in the region with exposure of soft tissues and inefficacy in local epithelialization, was then performed a collection of biological material for bacterial culture and antibiogram, after the results a systemic treatment with amikacin was performed for 30 days and also regional infusion with amikacin, in alternate days, for 20 days. As no antibacterial prophylaxis results were obtained in August 2018, alternative treatment for the removal of lush granulation tissue that was similar in size to that of a soccer ball was started. The treatment consisted of copper sulfate, solid petroleum jelly, barbatimão extract and copaiba oil. The evolution of the wound was slow and the total healing of the wound was not achieved, but it can be said that about 85% of the lush tissue was extracted using the alternative treatment.(AU)
Se relata el tratamiento alternativo de una herida con tejido de granulación exuberante en equino, hembra de la raza Cuarto de Milla, de 23 años, alojada en una central de reproducción. El animal presentaba una lesión en el miembro posterior derecho desde mediados de abril de 2018 siendo el inicio del tratamiento en agosto de 2018. En el inicio de la sesión, el animal presentó un episodio de gran edematizacion del miembro pelviano en la región del calcáneo hasta el nudillo (articulación metatarso-falangiana) sensibilidad en el miembro y pérdida de condición corporal, Ia sospecha inicial era de un cuadro de linfangitis, y entonces fue adoptado un protocolo de ducha local, masaje con pomada antiinflamatoria a base de dimetilsulfoxido y profilaxis con enrofloxacina y fenilbutazona. No se obtuvo resolución del cuadro y posteriormente aparecen puntos de necrosis en la región del nudillo y pérdida total de lapiel de la región con exposición de tejidos blandos e ineficacia en la epitelizacion local, entonces fue realizado tratamiento sistemico con amikacina durante 30 días y también perfusión regional con amikacina, en días alternados, durante 20 días. La decisión de la amikacina fue luego de la prueba de antibiograma a partir del cultivo de la secreción proveniente de la lesión. En el mes de agosto del 2018 fue iniciado el tratamiento para la remoción del tejido de granulación exuberante que tenía un tamaño semejante a un balón de fútbol. El tratamiento alternativo con sulfato de cobre, vaselina sólida, extracto de barbatimão y aceite de copaiba. La evolución de la herida fue lenta y todavía no se obtiene cierre total, pero es posible afirmar que cerca del 85% del tejido exuberante fue extraído con la utilización de tratamiento alternativo.(AU)
Asunto(s)
Animales , Femenino , Caballos/lesiones , Tejido de Granulación/efectos de los fármacos , Tejido de Granulación/lesiones , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Abstract Introduction: In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. Objective: This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. Methods: In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n = 57) and Gelfoam patch-treated group (n = 57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. Results: Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p > 0.05). However, the total average closure time was significantly different between the two groups (26.8 ± 9.1 days in the spontaneous healing group vs. 14.7 ± 9.1 days in the Gelfoam patch-treated group, p < 0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1 ± 1.6 days vs. 12.6 ± 3.9, medium-sized perforations: 13.3 ± 2.2 days vs. 21.8 ± 4.2 days, and large perforations: 21.2 ± 4.7 days vs. 38.4 ± 5.7 days; p < 0.01). Conclusion: In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.
Resumo Introdução: Na última década, houve um uso crescente de placas biomateriais na regeneração de perfurações traumáticas da membrana timpânica. As principais vantagens das placas de biomateriais são restaurar provisoriamente a função fisiológica da orelha média, assim melhoram imediatamente os sintomas da orelha e atuam como um suporte para a migração do epitélio. No entanto, não se sabe se há efeitos clínicos adicionais na regeneração do tímpano em relação ao fragmento de material biológico. Objetivo: Avaliar a resposta de cicatrização para diferentes padrões de reparo em perfurações de membrana timpânica traumáticas humanas por meio de observação endoscópica. Método: Foram alocados 114 pacientes com perfurações de membrana timpânica traumáticas sequencialmente para dois grupos: o de cicatrização espontânea (n = 57) e o tratado com esponja de Gelfoam (n = 57). A velocidade de fechamento, o tempo de fechamento e a taxa de otorreia foram comparados entre os grupos aos três meses. Resultados: Foram analisados 107 pacientes nos dois grupos (52 no de cicatrização espontânea e 55 no tratado com esponja de Gelfoam). A velocidade global de fechamento no fim do período de seguimento de três meses foi de 90,4% no grupo de cicatrização espontânea e de 94,5% no grupo tratado com esponja de Gelfoam; a diferença não foi estatisticamente significativa (p > 0,05). No entanto, o tempo total médio de fechamento foi significativamente diferente entre os dois grupos (26,8 ± 9,1 dias no de cicatrização espontânea versus 14,7 ± 9,1 dias no tratado com esponja de Gelfoam, p < 0,01). Além disso, a velocidade de fechamento não foi significativamente diferente entre o grupo de cicatrização espontânea e o grupo tratado com esponja de Gelfoam, independentemente do tamanho da perfuração. O tempo de fechamento no grupo tratado com esponjas de Gelfoam foi significativamente menor do que no grupo de cicatrização espontânea, independentemente do tamanho da perfuração (pequenas perfurações: 7,1 ± 1,6 dias vs. 12,6 ± 3,9, perfurações de tamanho médio: 13,3 ± 2,2 dias vs. 21,8 ± 4,2 dias e grandes perfurações: 21,2 ± 4,7 dias vs. 38,4 ± 5,7 dias; p < 0,01). Conclusão: Na regeneração de PMT traumáticas, a esponja de Gelfoam não só desempenha um papel de estrutura para a migração epitelial, mas também promove edema e hiperplasia de tecido de granulação nas bordas da perfuração e acelera a cicatrização do tímpano.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Cicatrización de Heridas , Perforación de la Membrana Timpánica/diagnóstico por imagen , Estudios Prospectivos , Resultado del Tratamiento , Perforación de la Membrana Timpánica/terapia , Oído Medio , Endoscopía , Esponja de Gelatina Absorbible/uso terapéuticoRESUMEN
BACKGROUND: The granulation tissue present in surgically-created early healing sockets has been considered as a possible source of osteoprogenitor cells for periodontal regeneration, as demonstrated in animal studies. However, the in vitro osteogenic properties of tissue removed from human surgically-created early healing alveolar defects (SC-EHAD) remains to be established, being that the aim of this study. METHODS: Surgical defects were created in the edentulous ridge of two systemically healthy adults. The healing tissue present in these defects was removed 21 days later for the establishment of primary culture. The in vitro characteristics of the cultured cells were determined by Armelin method, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, immunohistochemistry, alkaline phosphatase (ALP) activity, mineralization assay, and flow cytometry for detection of stem cells/osteoprogenitor cell markers. RESULTS: Cells were able to adhere to the plastic and assumed spindle-shaped morphology at earlier passages, changing to a cuboidal one with increasing passages. Differences in the proliferation rate were observed with increasing passages, suggesting osteogenic differentiation. ALP and mineralization activities were detected in conventional and osteogenic medium. Fresh samples of SC-EHAD tissue exhibited CD34- and CD45- phenotypes. Cells at later passages (14th) exhibited CD34- , CD45- , CD105- , CD166- , and collagen type I+ phenotype. CONCLUSION: Tissue removed from SC-EHAD is a possible source of progenitor cells.
Asunto(s)
Células Madre Mesenquimatosas , Osteogénesis , Adulto , Animales , Diferenciación Celular , Células Cultivadas , Humanos , Células Madre , Cicatrización de HeridasRESUMEN
INTRODUCTION: In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. OBJECTIVE: This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. METHODS: In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n=57) and Gelfoam patch-treated group (n=57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. RESULTS: Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p>0.05). However, the total average closure time was significantly different between the two groups (26.8±9.1 days in the spontaneous healing group vs. 14.7±9.1 days in the Gelfoam patch-treated group, p<0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1±1.6 days vs. 12.6±3.9, medium-sized perforations: 13.3±2.2 days vs. 21.8±4.2 days, and large perforations: 21.2±4.7 days vs. 38.4±5.7 days; p<0.01). CONCLUSION: In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.
Asunto(s)
Perforación de la Membrana Timpánica/diagnóstico por imagen , Cicatrización de Heridas , Adolescente , Adulto , Oído Medio , Endoscopía , Femenino , Esponja de Gelatina Absorbible/uso terapéutico , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Perforación de la Membrana Timpánica/terapiaRESUMEN
Existem várias formas tópicas de auxiliar a reparação de lesões cutâneas visando a acelerar o processo complexo de epitelização, prevenindo infecções e minimizando o tempo de fechamento da ferida, uma vez que fatores tópicos e sistêmicos podem influenciar na cicatrização. O presente estudo teve como objetivo avaliar a evolução da reparação tecidual de quarenta e cinco pacientes, entre eles cães e gatos, apresentando lesões cutâneas justificáveis com o tratamento por segunda intenção, independente da região corpórea, utilizando-se pomada à base da associação de sulfanilamida, óleo de fígado de bacalhau, óxido de zinco e cânfora. A pomada de efeito antisséptico e cicatrizante mostrou-se eficaz no tratamento de feridas extensas por segunda intenção e contaminadas, apresentando boa evolução cicatricial e fácil aplicação, com tempo médio de evolução de trinta dias para atingir resultados satisfatórios para a reparação tecidual.
There are several topical strategies to repair of cutaneous lesions in order to accelerate the complex of epithelialisation process, preventing infections and minimizing wound closure time, since topical and systemic factors can influence wound healing. The present study aimed to evaluate the evolution of tissue repair of forty-five patients, including dogsand cats, with justifiable cutaneous lesions with second intention treatment, independent of the body region, using ointment based on the association of sulfanilamide, cod liver oil, zinc oxide and camphor. The antiseptic and healing ointment was effective in the treatment of extensive wounds by second intention and contaminated, presenting good healing evolution and easy application, with an average evolution time of thirty days to reach satisfactory results fortissue repair.
Asunto(s)
Animales , Gatos , Perros , Antiinfecciosos Locales/farmacología , Pomadas/farmacología , Tejido de Granulación , Integumento Común/lesiones , Cicatrización de Heridas , Drogas Veterinarias , RegeneraciónRESUMEN
Existem várias formas tópicas de auxiliar a reparação de lesões cutâneas visando a acelerar o processo complexo de epitelização, prevenindo infecções e minimizando o tempo de fechamento da ferida, uma vez que fatores tópicos e sistêmicos podem influenciar na cicatrização. O presente estudo teve como objetivo avaliar a evolução da reparação tecidual de quarenta e cinco pacientes, entre eles cães e gatos, apresentando lesões cutâneas justificáveis com o tratamento por segunda intenção, independente da região corpórea, utilizando-se pomada à base da associação de sulfanilamida, óleo de fígado de bacalhau, óxido de zinco e cânfora. A pomada de efeito antisséptico e cicatrizante mostrou-se eficaz no tratamento de feridas extensas por segunda intenção e contaminadas, apresentando boa evolução cicatricial e fácil aplicação, com tempo médio de evolução de trinta dias para atingir resultados satisfatórios para a reparação tecidual.(AU)
There are several topical strategies to repair of cutaneous lesions in order to accelerate the complex of epithelialisation process, preventing infections and minimizing wound closure time, since topical and systemic factors can influence wound healing. The present study aimed to evaluate the evolution of tissue repair of forty-five patients, including dogsand cats, with justifiable cutaneous lesions with second intention treatment, independent of the body region, using ointment based on the association of sulfanilamide, cod liver oil, zinc oxide and camphor. The antiseptic and healing ointment was effective in the treatment of extensive wounds by second intention and contaminated, presenting good healing evolution and easy application, with an average evolution time of thirty days to reach satisfactory results fortissue repair.(AU)
Asunto(s)
Animales , Gatos , Perros , Integumento Común/lesiones , Antiinfecciosos Locales/farmacología , Pomadas/farmacología , Tejido de Granulación , Cicatrización de Heridas , Regeneración , Drogas VeterinariasRESUMEN
Introdução: A criocirurgia é uma forma segura e eficaz de tratamento que utiliza o nitrogênio líquido para destruição tecidual. Objetivo: Demonstrar a eficiência da criocirurgia no tratamento do tecido de granulação hipertrófico nas feridas cutâneas. Métodos: As feridas com tecido de granulação hipertrófico foram tratadas com o nitrogênio em spray aplicado a uma distância de 5cm da área em ângulo de 90º.O tempo de congelamento foi de 02 ciclos de 05 segundos e o número de sessões variou de 01 ou 03. A avaliação dos resultados foi feita através de comparação semanal, clínica e fotográfica, alem de mensuração da área das feridas e do tecido de granulação hipertrófico, através de um planímetro, até que se completasse o processo de cicatrização. Os resultados foram analisados estatisticamente. Resultados: Foram tratados 20 pacientes com feridas cutâneas localizadas na cabeça, tronco e membros. A média do percentual de redução semanal em relação à área inicial foi de 32,5%. Os resultados tiveram significância estatística. Conclusões: A criocirurgia é um método prático, de baixo custo e pouco invasivo, podendo ser indicada para o tratamento do tecido de granulação hipertrófico nas feridas cutâneas.
Introduction: Cryosurgery is a safe and effective treatment modality that uses liquid nitrogen for tissue destruction. Objective: To demonstrate the effectiveness of cryosurgery in the treatment of hypertrophic granulation tissue in cutaneous wounds. Methods: Cutaneous wounds with hypertrophic granulation tissue were treated with the nitrogen spray applied from a distance of 5cm from the area to be treated, at a 90º angle. The freezing time was two 5-second cycles and the number of sessions ranged from 1 to 3. The assessments of results were based on weekly clinical and photographic comparisons, as well on the measurement of the wound's and hypertrophic granulation tissue's areas using a planimeter, up until the healing process was completed. The results were statistically analyzed. Results: Twenty patients with cutaneous wounds located on the head, trunk and limbs were treated. The average weekly percentage reduction compared to the baseline area was 32.5%. The results were statistically significant. Conclusions: Cryosurgery is a practical, cost effective and non-invasive method and can be indicated for the treatment of hypertrophic granulation tissue in cutaneous wounds.
RESUMEN
Abstract This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.