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Introducción: Los traumatismos abdominales penetrantes son debidos generalmente a heridas de arma blanca o heridas de arma de fuego. Todas deben explorarse instrumentalmente bajo anestesia local con el objetivo de determinar la integridad del peritoneo. El ultrasonido es una herramienta muy útil utilizada en trauma, además del FAST, se lo puede utilizar en la urgencia como método de gran ayuda al realzar la exploración inicial de la herida para evaluar la integridad del peritoneo. Objetivos: Destacar la importancia del conocimiento anatómico y la correlación anatomo-clínico quirúrgica y ecográfica en la interpretación de imágenes obtenidas por ultrasonografía en la evaluación de la integridad de la pared del abdomen en heridas penetrantes por arma blanca. Material y métodos: FAST y ecografía de partes blandas instrumentándose la herida abdominal bajo anestesia local evaluando la indemnidad del peritoneo mediante la observación por ultrasonografía del abdomen y de la pared antero lateral del mismo en 14 de 42 pacientes con heridas por arma blanca en abdomen en el Servicio de Emergencias del Hospital Municipal de Morón y en el Servicio de Cirugía General del Hospital Aeronáutico Central. Período entre Febrero 2014 y Marzo 2015. Resultados: 42 (100%) pacientes con heridas de arma blanca en abdomen. 28 (66,66%) fueron inicialmente intervenidos quirúrgicamente. A 14 (33,34%) se le realizó FAST en búsqueda de líquido libre y ecografía de partes blandas instrumentándose la herida abdominal bajo anestesia local evaluando la indemnidad del peritoneo. Conclusiones: El conocimiento de las estructuras anatómicas y la disposición de las mismas que componen la pared anterolateral del abdomen permiten facilitar el reconocimiento de la indemnidad o no del peritoneo en las imágenes obtenidas por ultrasonido en pacientes con heridas abiertas por arma blanca, evitando así la realización de procedimientos quirúrgicos innecesarios.(AU)

Introduction: Penetrating abdominal trauma are usually due to stab wounds or gunshot wounds. All instrumentally be explored under local anesthesia in order to determine the integrity of the peritoneum. Ultrasound is a very useful tool used in trauma, in addition to FAST, I can use the urgency as a means of great help to enhance the initial exploration of the wound to evaluate the integrity of the peritoneum. Objectives: Highlighting the importance of the anatomical knowledge and surgical and anatomical clinical ultrasound in interpreting images obtained by ultrasonography in the evaluation of the integrity of the abdominal wall in penetrating stab wounds correlation. Material and methods: FAST ultrasound was performed and soft tissue abdominal wound became operational under local anesthesia indemnity evaluating the peritoneum through observation by ultrasound of the abdomen and the anterolateral wall thereof in 14 of the 42 patients with stab wounds in the abdomen Service Municipal Emergency Hospital of Moron and the Department of General Surgery of the Central Aeronautical Hospital, period between February 2014 and March 2015. Results: Of the 42 (100%) patients with stab wounds to the abdomen, 28 (66.66%) initially underwent surgery, and 14 (33.34%) were performed in FAST Search of free fluid and soft tissue ultrasound became operational abdominal wound under local anesthesia indemnity evaluating the peritoneum. Conclusions: Knowledge of the anatomical structures and arrangement thereof comprising the anterolateral wall of the abdomen allow easy recognition of indemnity or not the peritoneum in the ultrasound images in patients with stab wounds open, thus avoiding making unnecessary surgical procedures.

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The peritoneum is a thin membrane that covers most of the abdominal organs, composed of a monolayer of mesothelial cells and subjacent submesothelial loose connective tissue. Cells from the peritoneal wall are correlated with peritoneal fibrosis and epithelial-to-mesenchymal transition. However, the distinct involvement of mesothelial or submesothelial cells in such phenomena is still not clear. Here, we propose a new strategy to obtain stromal cells from anterior peritoneal wall explant cultures. These cells migrated from peritoneal tissues and proliferated in vitro for 4 weeks as adherent fibroblast-like cells. Optical and electronic microscopy analyses of the fragments revealed a significant submesothelial disorganization. The obtained cells were characterized as cytokeratin- vimentin+ laminin+ α-smooth muscle actin+, suggesting a connective tissue origin. Moreover, at the third passage, these stromal cells were CD90+CD73+CD29+Flk-1+CD45-, a phenotype normally attributed to cells of mesenchymal origin. These cells were able to support hematopoiesis, expressing genes involved in myelopoiesis (SCF, G-CSF, GM-CSF, IL-7 and CXCL-12), and differentiated into osteogenic and adipogenic cell lineages. The methodology demonstrated in this work can be considered an excellent experimental model to understand the physiology of the peritoneal wall in healthy and pathological processes. Moreover, this work shows for the first time that submesothelial stromal cells have properties similar to those of mesenchymal cells from other origins.

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Introdução: existem algumas dúvidas relacionadas à criptorquia, como aspectos etiofisiopatológicos do testículo críptico, e de outras estruturas adjacentes que poderiam estar relacionadas com a não descida testicular.Uma dessas estruturas seria o conduto peritônio-vaginal, presente na maioria dos casos. Com intenção de conhecer melhor a morfologia desse conduto em crianças com criptorquia, decidiu-se pelo estudo histológico. Métodos: foram colhidos 45 fragmentos de conduto peritônios-vaginais de 43 meninos com criptorquia, operados no Serviço de Cirurgia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais, durante os anos de 2001 a 2003. As amostras foram coradas pela técnica de hematotoxilina-eosina e tricrômico de Gomori e analisadas por microscopia óptica, sendo examinadas pela mesma patologista. A análise estatística dos principais achados e variáveis foi realizada pelo software Epi-Info. Calcularam-se as médias e desvios-padrão e para as proporções utilizou-se o intervalo de confiança 95 por cento, pelo método Fleiss Quadrático. Resultados: os principais achados histológicos encontrados encontrados nos CPV foram: filetes nervosos (100 por cento), tecido conjutivo (100 por cento), revestimento mesotelial (66 por cento), musculatura lisa (57 por cento) musculatura estriada (13 por cento) e remanescentes de túbulos mesonéfricos (7 por cento). Conclusões: associando os achados dessa pesquisa a dados da literatura sobre histologia de sacos herniários de criança com hérnia inguinal indireta, aventou-se a possibilidade de o CPV apresentar histologia diferente do saco herniário. Considera-se importante a realização de outros trabalhos histológicos de CPV, comparativos e com uso de métodos mais específicos – imuno-histoquímicos.

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Introducción: las metástasis peritoneales ocurren en más de la mitad de los pacientes con cáncer gástrico. Los mecanismos involucrados han sido poco estudiados y son pobremente conocidos. Experimentalmente se sabe que las células neoplásicas exfoliadas del tumor primario, sólo pueden implantarse y proliferar en áreas de peritoneo dañado o en áreas de denudación mesotelial. Objetivos: estudiar la ultraestructura peritoneal en controles y en pacientes con cáncer gástrico precoz y avanzado. Material y Método: Se estudiaron 14 pacientes con adenocarcinoma gástrico (4 mucosos/submucosos/musculares y 10 serosos) y 4 pacientes operados por patología benigna como controles. Se tomó muestra de peritoneo sano en la raíz del mesenterio (1,5 x 1,5 cm) y se obtuvo muestra de lavado peritoneal para estudio de células neoplásicas. Cada muestra fue fijada en glutaraldehido al 2,5 por ciento, deshidratada con acetona, secada y metalizada con oro-paladio. Se hizo evaluación ciega de cada muestra con Microscopia Electrónica de Barrido (10 campos con aumento de X 1250). Se excluyó pacientes con cirugía previa abdominal y con citología peritoneal (+) para células neoplásicas. Resultados: En el grupo control se encontró muy abundantes microvellosidades en la superficie y tenue definición de las uniones intercelulares (Normal). En casos con cáncer se observó disminución de las microvellosidades y pérdida de las uniones intercelulares (Patrón de Mosaico). Además se encontró pérdida de la estructura poligonal, aumento de la separación entre las células con pérdida focal de células mesoteliales dejando expuesta la lámina propia (Patrón de Denudación). Para cada grupo se encontró la siguiente distribución según patrones de normalidad, mosaico o denudación. Grupo control: 90,1 por ciento, 7,6 por ciento y 2,3 por ciento respectivamente. Grupo con cáncer mucoso/submucoso/muscular: 97,9 por ciento, 0 por ciento y 2,1 por ciento respectivamente. Grupo con cáncer...

Background: More than half of patients with gastric cancer have peritoneal metastases. Cancer cells exfoliated from the tumor can implant and proliferate in areas of damaged peritoneum or in areas of mesothelial denudation. Aim: To study peritoneal ultrastructure in patients with early and advanced gastric cancer. Material and Methods: Four patients with gastric cancer invading up to the muscular layer, 10 patients with gastric cancer invading the serosa and four patients operated for gastroesophageal reflux, were studied. A peritoneal sample from the root of the mesentery and a sample from peritoneal lavage, were obtained and analyzed by scanning electron microscopy. Patients with previous abdominal surgery or a positive peritoneal cytology for malignant cells, were excluded. Results: Among controls, abundant superficial microvilli and a faint definition on intercellular junctions was observed. In cancer patients, a reduction in microvilli and loss of intercellular junctions (mosaic pattern) or a loss of polygonal structure with focal loss of mesothelial cells, exposing the lamina propia (denudation pattern), were observed. A normal, mosaic or denudation pattern was observed in 90.1 percent, 7.6 percent and 2.3 percent of controls respectively, in 98,0 and 2 percent of patients with cancer invading up to the muscular layer respectively and 41, 42 and 17 percent of patients with cancer invading the serosa respectively (p<0.001 compared with the former two groups). Conclusions: Among patients with gastric cancer that invades the serosal surface, the visceral peritoneum experiences a loss of normal architecture and focal cellular denudation. These changes are not associated with the presence of free cancer cells in the peritoneal cavity and may precede the appearance of peritoneal metastases.

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A tuberculose peritoneal consiste num processo inflamatório crônico causado pelo Mycobacterium tuberculosis. Sua sintomatologia é inespecífica, com comprometimento sistêmico. É aqui descrito o caso de um paciente de 35 anos de idade, alcoólatra, portador de cirrose hepática. Seu diagnóstico foi definido após realização de biópsia peritoneal feita durante a laparotomia exploradora. Iniciou-se o tratamento preconizado e o paciente recebeu alta em boas condições clínicas.

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BACKGROUND: Pneumoperitoneum may be responsible for ultra-structural alterations in the mesothelium during laparoscopy. To characterize the effect of pneumoperitoneum on the mesothelial cells with CO(2) and compressed air; and to compare to laparotomy and control group (anesthesia only). MATERIALS AND METHODS: Forty C-57 mice were divided in four groups of 10 animals each: CO(2), air, laparotomy, and control group. The animals were submitted to pneumoperitoneum at 8 mmHg during 30 min (CO(2) or compressed air). Five animals of each group were sacrificed 2 and 24 h after the procedure. Fragments of parietal peritoneum were collected and processed for scanning electron microscopy. RESULTS: Control group revealed uninterrupted mesothelial cells, without any evidence of cellular limits; close contact between the cells; absence of intercellular clefts and presence of microvilli. In the laparotomy group, similar results to the control group, with decreased microvilli were noted. Air pneumoperitoneum was associated with alterations in the morphology of the mesothelial cells, clear cellular limits, and cells with spherical and fusiforme formats. CO(2) pneumoperitoneum showed mesothelial cells with clear cellular limits, predominantly spherical cellular format, and intercellular clefts that allowed the visualization of the exposed basal membrane. These alterations were more intense after 24 h. There was a statistical significance between CO(2) group (2 and 24 h) compared to the control group and laparotomy for cellular limits, intercellular clefts and microvilli, P < 0.0001. CONCLUSIONS: Pneumoperitoneum causes damage in the mesothelial ultra-structure, which differs from the laparotomy group. CO(2) pneumoperitoneum is more harmful to the mesothelium than the air.

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The lack of immunological or morphological markers makes identification of immature mast cells difficult. In the present study we have used a rat mast cell specific monoclonal antibody (mAb AA4) to immunolabel mast cells during repopulation of the peritoneal cavity. Peritoneal cells were collected six days after injection of distilled water and examined by light and electron microscopy. mAb AA4 stained immature mast cells in various stages of maturation including a population of very immature mast cells that could not be identified using conventional staining methods. These cells had virtually no cytoplasmic granules and peripherally located lobated nuclei. Thus, immunolabeling with mAb AA4 has revealed a population of very immature mast cells not previously reported during repopulation of the peritoneal cavity.

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Para visualizar los cambios ultraestructurales que produce el CINa al 33% sobre las serosas, se inyecta dicha solución en el peritoneo de ratones sacrificándolos a 3 términos: inmediato, 2 y 5 minutos. Se observa, con microscopia electrónica, la secuencia de cambios en la serosa intestinal a partir de testigos no inyectados que muestran un mesotelio normal (con microvellosidades hacia superficie libre), haces de colágeno submesoteliales y más abajo miocélulas lisas. Todos estos tejidos se modifican profundamente por el gradiente osmolar del CINa al 33% que provoca deshidratación celular y edema intersticial. En 5 desaparece el mesotelio, queda el colágeno desnudo y edematoso y se necrosan las mio-células lisas. Considerando la importancia de las funciones peritoneales y las lógicas alteraciones comprobadas a tan corto término, se apoya la tesis de que el lavaje peritoneal salino hipertónico" debe contraindicarse absolutamente en terapia humana

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Para visualizar los cambios ultraestructurales que produce el CINa al 33% sobre las serosas, se inyecta dicha solución en el peritoneo de ratones sacrificándolos a 3 términos: inmediato, 2 y 5 minutos. Se observa, con microscopia electrónica, la secuencia de cambios en la serosa intestinal a partir de testigos no inyectados que muestran un mesotelio normal (con microvellosidades hacia superficie libre), haces de colágeno submesoteliales y más abajo miocélulas lisas. Todos estos tejidos se modifican profundamente por el gradiente osmolar del CINa al 33% que provoca deshidratación celular y edema intersticial. En 5 desaparece el mesotelio, queda el colágeno desnudo y edematoso y se necrosan las mio-células lisas. Considerando la importancia de las funciones peritoneales y las lógicas alteraciones comprobadas a tan corto término, se apoya la tesis de que el lavaje peritoneal salino hipertónico" debe contraindicarse absolutamente en terapia humana (AU)

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