RESUMEN
OBJECTIVE: to compare the healing by second intention under the effects of topical application of honey, copaíba oil-resin and a commercial product (fibrinolysin, deoxyribonuclease and chloramphenicol) with a control group in rats. METHODS: we carried out a skin resection, 1cm in diameter, on the back of 40 rats allocated to four groups of ten animals. All wounds were cleaned daily with 2ml of 0.9% NaCl solution. The first group (control - GC) was restricted to such procedure. In the wounds of the second (GM), third (GO) and fourth groups (GF), after cleaning, we respectively applied 1ml of honey, 1ml of copaíba oil-resin and 1ml of cream containing fibrinolysin, deoxyribonuclease and chloramphenicol. The wounds were occluded with sterile gauze. Immediately after the incision and on days three, seven and 14 of the experiment, the wounds were copied and contraction was analyzed using planimetry. After euthanasia, we histologically evaluated the inflammatory reaction and collagen in the scars. RESULTS: the reduction of the wound area of GM (p=0.003), GO (p=0.011) and GF (p=0.002) were higher than the GC. The amount of type-I collagen present in GM and GO was higher than in GC and GF groups (p<0.05). There was a predominance of chronic inflammatory stage in GM (p=0.004), GO (p<0.001) and GF (p=0.003) when compared with GC. CONCLUSION: the topical use of honey and copaíba oil-resin increases wound contraction, the presence of type-I collagen and accelerates healing.
OBJETIVO: comparar a cicatrização, por segunda intenção, sob os efeitos da aplicação tópica de mel, óleo-resina de copaíba e um produto comercial (fibrinolisina, desoxirribonuclease e cloranfenicol) a um grupo controle, em ratos. MÉTODOS: ressecção de pele, com 1cm de diâmetro, foi realizada no dorso de 40 ratos alocados em quatro grupos de dez animais. Todas as feridas foram limpas, diariamente, com 2ml de solução de NaCl 0,9%. O primeiro grupo (controle - GC) ficou restrito a tal procedimento. Nas feridas do segundo (GM), terceiro (GO) e quarto grupos (GF), após limpeza, aplicou-se, respectivamente, 1ml de mel, 1ml de óleo-resina de copaíba e 1ml de creme contendo fibrinolisina, desoxirribonuclease e cloranfenicol. Ocluíram-se as feridas com gaze estéril. Imediatamente após a incisão e nos dias três, sete e 14 do experimento, as feridas foram copiadas e, usando planimetria, analisou-se a contração. Após a eutanásia, a histologia foi utilizada para avaliação da reação inflamatória e do colágeno nas cicatrizes. RESULTADOS: a redução da área da ferida do GM (p=0,003), GO (p=0,011) e GF (p=0,002) foram superiores ao do GC. A quantidade de colágeno tipo I presente no GM e no GO foi superior aos grupos GC e GF (p<0,05). Houve predominância do estágio inflamatório crônico no GM (p=0,004), GO (p<0,001) e GF (p=0,003) quando comparados ao GC. CONCLUSÃO: o uso tópico do mel e do óleo-resina de copaíba aumenta a contração da ferida, a presença de colágeno tipo I e acelera a cicatrização.
Asunto(s)
Antiinfecciosos/administración & dosificación , Fabaceae/química , Miel , Extractos Vegetales/administración & dosificación , Aceites de Plantas/administración & dosificación , Cicatrización de Heridas/efectos de los fármacos , Administración Tópica , Animales , Cloranfenicol/administración & dosificación , Desoxirribonucleasa I/administración & dosificación , Modelos Animales de Enfermedad , Fibrinolisina/administración & dosificación , Masculino , Ratas , Ratas WistarRESUMEN
RESUMO Objetivo: comparar a cicatrização, por segunda intenção, sob os efeitos da aplicação tópica de mel, óleo-resina de copaíba e um produto comercial (fibrinolisina, desoxirribonuclease e cloranfenicol) a um grupo controle, em ratos. Métodos: ressecção de pele, com 1cm de diâmetro, foi realizada no dorso de 40 ratos alocados em quatro grupos de dez animais. Todas as feridas foram limpas, diariamente, com 2ml de solução de NaCl 0,9%. O primeiro grupo (controle - GC) ficou restrito a tal procedimento. Nas feridas do segundo (GM), terceiro (GO) e quarto grupos (GF), após limpeza, aplicou-se, respectivamente, 1ml de mel, 1ml de óleo-resina de copaíba e 1ml de creme contendo fibrinolisina, desoxirribonuclease e cloranfenicol. Ocluíram-se as feridas com gaze estéril. Imediatamente após a incisão e nos dias três, sete e 14 do experimento, as feridas foram copiadas e, usando planimetria, analisou-se a contração. Após a eutanásia, a histologia foi utilizada para avaliação da reação inflamatória e do colágeno nas cicatrizes. Resultados: a redução da área da ferida do GM (p=0,003), GO (p=0,011) e GF (p=0,002) foram superiores ao do GC. A quantidade de colágeno tipo I presente no GM e no GO foi superior aos grupos GC e GF (p<0,05). Houve predominância do estágio inflamatório crônico no GM (p=0,004), GO (p<0,001) e GF (p=0,003) quando comparados ao GC. Conclusão: o uso tópico do mel e do óleo-resina de copaíba aumenta a contração da ferida, a presença de colágeno tipo I e acelera a cicatrização.
ABSTRACT Objective: to compare the healing by second intention under the effects of topical application of honey, copaíba oil-resin and a commercial product (fibrinolysin, deoxyribonuclease and chloramphenicol) with a control group in rats. Methods: we carried out a skin resection, 1cm in diameter, on the back of 40 rats allocated to four groups of ten animals. All wounds were cleaned daily with 2ml of 0.9% NaCl solution. The first group (control - GC) was restricted to such procedure. In the wounds of the second (GM), third (GO) and fourth groups (GF), after cleaning, we respectively applied 1ml of honey, 1ml of copaíba oil-resin and 1ml of cream containing fibrinolysin, deoxyribonuclease and chloramphenicol. The wounds were occluded with sterile gauze. Immediately after the incision and on days three, seven and 14 of the experiment, the wounds were copied and contraction was analyzed using planimetry. After euthanasia, we histologically evaluated the inflammatory reaction and collagen in the scars. Results: the reduction of the wound area of GM (p=0.003), GO (p=0.011) and GF (p=0.002) were higher than the GC. The amount of type-I collagen present in GM and GO was higher than in GC and GF groups (p<0.05). There was a predominance of chronic inflammatory stage in GM (p=0.004), GO (p<0.001) and GF (p=0.003) when compared with GC. Conclusion: the topical use of honey and copaíba oil-resin increases wound contraction, the presence of type-I collagen and accelerates healing.
Asunto(s)
Animales , Masculino , Ratas , Cicatrización de Heridas/efectos de los fármacos , Aceites de Plantas/administración & dosificación , Extractos Vegetales/administración & dosificación , Miel , Fabaceae/química , Antiinfecciosos/administración & dosificación , Cloranfenicol/administración & dosificación , Administración Tópica , Ratas Wistar , Fibrinolisina/administración & dosificación , Desoxirribonucleasa I/administración & dosificación , Modelos Animales de EnfermedadRESUMEN
PURPOSE: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy. MATERIALS AND METHODS: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records. RESULTS: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6-44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented. CONCLUSIONS: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.
Asunto(s)
Oftalmopatías/cirugía , Fibrinolisina/administración & dosificación , Fibrinolíticos/administración & dosificación , Fragmentos de Péptidos/administración & dosificación , Perforaciones de la Retina/cirugía , Vitrectomía/métodos , Cuerpo Vítreo/cirugía , Anciano , Terapia Combinada , Oftalmopatías/diagnóstico por imagen , Oftalmopatías/fisiopatología , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Microcirugia , Persona de Mediana Edad , Perforaciones de la Retina/diagnóstico por imagen , Perforaciones de la Retina/fisiopatología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología , Cuerpo Vítreo/diagnóstico por imagen , Cuerpo Vítreo/fisiopatologíaRESUMEN
This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.
Asunto(s)
Fibrinolisina/uso terapéutico , Fibrinolíticos/uso terapéutico , Fragmentos de Péptidos/uso terapéutico , Desprendimiento del Vítreo/tratamiento farmacológico , Anciano , Brasil , Femenino , Fibrinolisina/administración & dosificación , Fibrinolíticos/administración & dosificación , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/administración & dosificación , Estudios Retrospectivos , Adherencias Tisulares/tratamiento farmacológico , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacos , Cuerpo Vítreo/efectos de los fármacos , Cuerpo Vítreo/patología , Desprendimiento del Vítreo/patologíaRESUMEN
ABSTRACT This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.
RESUMO O objetivo desse estudo é relatar os resultados iniciais, tanto do ponto de vista funcional quanto anatômico, no tratamento das doenças da interface vítreo-macular com a ocriplasmina em 2 serviços terciários no Brasil. Um estudo retrospectivo foi realizado através de revisão de prontuários, além de análise de achados em tomografia de coerência óptica de domínio espectral (SD-OCT) em 7 pacientes tratados com uma única injeção intravítrea de ocriplasmina. Em nosso estudo 57,14% dos pacientes apresentaram resolução da tração vítreo-macular no SD-OCT. Em relação aos resultados funcionais, 87,71% dos pacientes mantiveram, ou melhoraram sua acuidade visual durante o acompanhamento. Para nosso conhecimento, trata-se do primeiro estudo em nosso país, mostrando resultados iniciais com ocriplasmina em pacientes tratados no Brasil.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Fragmentos de Péptidos/uso terapéutico , Fibrinolisina/uso terapéutico , Desprendimiento del Vítreo/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Fragmentos de Péptidos/administración & dosificación , Cuerpo Vítreo/efectos de los fármacos , Cuerpo Vítreo/patología , Brasil , Agudeza Visual/efectos de los fármacos , Adherencias Tisulares/tratamiento farmacológico , Estudios Retrospectivos , Resultado del Tratamiento , Fibrinolisina/administración & dosificación , Desprendimiento del Vítreo/patología , Tomografía de Coherencia Óptica , Inyecciones Intravítreas , Fibrinolíticos/administración & dosificaciónRESUMEN
BACKGROUND: Current treatment of acute peripheral artery or bypass graft occlusion utilizes catheter-directed thrombolysis of a plasminogen activator (PA). Plasmin is a direct-acting thrombolytic with a striking safety advantage over PA in preclinical models. OBJECTIVES: To report the first use of purified plasmin for acute lower extremity arterial or bypass graft thrombosis in a phase I dose-escalation study of a catheter-delivered agent. METHODS: Eighty-three patients with non-embolic occlusion of infrainguinal native arteries or bypass grafts were enrolled (safety population) into seven sequential dose cohorts to receive 25-175 mg of plasmin by intrathrombus infusion over 5 h. Arteriograms were performed at baseline, 2 h, and 5 h, and subjects were monitored for 30 days for clinical outcomes and laboratory parameters of systemic fibrinolysis. RESULTS: Major bleeding occurred in four patients (4.8%), and minor bleeding alone in 13 (15.7%), with no trend towards more bleeding at higher dosages of plasmin. There was a trend towards lower plasma concentrations of fibrinogen, α(2) -antiplasmin and α(2) -macroglobulin with increasing doses of plasmin, but the nadir fibrinogen concentration was > 350 mg dL(-1) at the highest plasmin dose. Individual nadir values were above 200 mg dL(-1) in 82 of 83 subjects, and were not different in patients with or without bleeding. Thrombolysis (≥ 50%) occurred in 79% of subjects receiving 125-175 mg of plasmin, as compared with 50% who received 25-100 mg. CONCLUSIONS: Catheter-delivered plasmin can be safely administered to patients with acute lower extremity arterial occlusion at dosages of 25-175 mg.
Asunto(s)
Arteriopatías Oclusivas/tratamiento farmacológico , Cateterismo Periférico , Fibrinolisina/administración & dosificación , Fibrinolíticos/administración & dosificación , Oclusión de Injerto Vascular/tratamiento farmacológico , Extremidad Inferior/irrigación sanguínea , Terapia Trombolítica/métodos , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/diagnóstico por imagen , Biomarcadores/sangre , Brasil , Cateterismo Periférico/efectos adversos , Relación Dosis-Respuesta a Droga , Europa (Continente) , Femenino , Fibrinógeno/metabolismo , Fibrinolisina/efectos adversos , Fibrinolíticos/efectos adversos , Oclusión de Injerto Vascular/sangre , Oclusión de Injerto Vascular/diagnóstico por imagen , Hemorragia/inducido químicamente , Humanos , Infusiones Intraarteriales , Masculino , Persona de Mediana Edad , Radiografía , Sudáfrica , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Adulto Joven , alfa 2-Antiplasmina/metabolismo , alfa-Macroglobulinas/metabolismoRESUMEN
La trombosis venosa profunda aguda puede presentar dos secuelas graves: la embolia pulmonar en la primera etapa y el síndrome postrombótico como complicación tardía. Es por lo tanto comprensible que la primera preocupación sea la implementación de una terapia activa como la trombolisis. Es necesario reabrir la oclusión en pocos días. Ello es posible sólo mediante la adición de factores exógenos tales como la Estreptoquinasa, la Uroquinasa y el TPA. Dosis altas de heparina se usan para reducir notoriamente la incidencia de embolia pulmonar. El tratamiento de mantenimiento se realiza con anticoagulantes orales como los cumarínicos y la Warfarina.
Asunto(s)
Extremidades/patología , Farmacología , Embolia Pulmonar/complicaciones , Tromboflebitis/complicaciones , Tromboflebitis/epidemiología , Tromboflebitis/terapia , Fibrinolíticos/uso terapéutico , Anticoagulantes/uso terapéutico , Fibrinolisina/administración & dosificación , Heparina/administración & dosificación , Heparina/efectos adversos , Heparina/farmacología , Heparina/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estreptoquinasa/administración & dosificación , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Warfarina/uso terapéuticoRESUMEN
La trombosis venosa profunda aguda puede presentar dos secuelas graves: la embolia pulmonar en la primera etapa y el síndrome postrombótico como complicación tardía. Es por lo tanto comprensible que la primera preocupación sea la implementación de una terapia activa como la trombolisis. Es necesario reabrir la oclusión en pocos días. Ello es posible sólo mediante la adición de factores exógenos tales como la Estreptoquinasa, la Uroquinasa y el TPA. Dosis altas de heparina se usan para reducir notoriamente la incidencia de embolia pulmonar. El tratamiento de mantenimiento se realiza con anticoagulantes orales como los cumarínicos y la Warfarina. (AU)