RESUMO
OBJECTIVES: To evaluate the effect of implanted S-nitrosoglutathione (GSNO) coating polypropylene mesh in foreign-body response of rats. METHODS: Thirty female rats underwent to subcutaneous implant of five polypropylene (PP) fragments: uncoated PP (control); PP polyvinylalcohol (PVA) coated and PP PVA + GSNO (1, 10 and 70 mMol) coated. After euthanasia (4 and 30 days), eight slides were prepared from each animal: hematoxylin-eosin (inflammatory response); unstained (birefringence collagen evaluation); TUNEL technique (apoptosis); and five for immunohistochemical processing: CD-31 (angiogenesis), IL-1 and TNF-α (proinflammatory cytokynes), iNOS (NO synthesis) and MMP-2 (collagen metabolism). The inflammation area, birefringence index, apoptotic index, immunoreactivity and vessel density were objectively measured. RESULTS: Inflammatory reaction area at 4 days was 11.3, 15.2, 25.1, 17.1 and 19.3% of pure PP, PVA, GSNO 1, 10 and 70 mM, respectively, p = 0.0006 (PP × Others). At 30 days lower inflammatory area was observed in GSNO 10 and 70 mM compared to pure PP (5.3, 5.2 and 11.1%, respectively, p = 0.0001). Vessel density was higher for GSNO 1 mM (25.5%) compared to pure PP (19.6%) at 30 days only, p = 0.0081. Apoptotic index at 4 days was lower for GSNO 1 mM (49.3%) than pure PVA (60.6%), p = 0.0124. GSNO 10 and 70 mM reduced their apoptotic index at 30 days compared to 4 days (49.9 vs. 36.9 and 59.1 vs. 47.5%, respectively, p = 0.0397). Birefringence index, IL-1, TNF, MMP-2 and iNOS were not different. CONCLUSIONS: Depending on concentrations, GSNO can increase angiogenesis, reduce inflammation and apoptosis compared to pure PP, without impact on cytokine, collagen organization/metabolism and endogenous NO synthesis.
Assuntos
Reação a Corpo Estranho , Neovascularização Fisiológica , Doadores de Óxido Nítrico/farmacologia , Óxido Nítrico/biossíntese , S-Nitrosoglutationa/farmacologia , Telas Cirúrgicas , Animais , Apoptose/efeitos dos fármacos , Feminino , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/metabolismo , Reação a Corpo Estranho/patologia , Interleucina-1/análise , Metaloproteinase 2 da Matriz/análise , Neovascularização Fisiológica/efeitos dos fármacos , Neovascularização Fisiológica/fisiologia , Óxido Nítrico Sintase Tipo II/análise , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Polipropilenos , Álcool de Polivinil/farmacologia , Ratos , Ratos Wistar , Telas Cirúrgicas/efeitos adversos , Fator de Necrose Tumoral alfa/análiseRESUMO
OBJECTIVES: To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. MATERIALS AND METHODS: Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. RESULTS: A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). CONCLUSIONS: The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.
Assuntos
Reação a Corpo Estranho/induzido quimicamente , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/patologia , Polipropilenos/efeitos adversos , Tela Subcutânea/patologia , Telas Cirúrgicas/efeitos adversos , Animais , Materiais Biocompatíveis/efeitos adversos , Birrefringência , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/patologia , Colágeno/análise , Colágeno/metabolismo , Feminino , Imuno-Histoquímica , Interleucina-1/análise , Interleucina-1/metabolismo , Teste de Materiais , Metaloproteinase 2 da Matriz/análise , Metaloproteinase 2 da Matriz/metabolismo , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismoRESUMO
ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.
Assuntos
Animais , Feminino , Polipropilenos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/induzido quimicamente , Reação a Corpo Estranho/patologia , Tela Subcutânea/patologia , Fatores de Tempo , Materiais Biocompatíveis/efeitos adversos , Birrefringência , Teste de Materiais , Imuno-Histoquímica , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/patologia , Reprodutibilidade dos Testes , Colágeno/análise , Colágeno/metabolismo , Interleucina-1/análise , Interleucina-1/metabolismo , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismo , Ratos Wistar , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Metaloproteinase 2 da Matriz/análise , Metaloproteinase 2 da Matriz/metabolismoRESUMO
The 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.
Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis , Feminino , Humanos , Invenções , Engenharia Tecidual/métodosRESUMO
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.
Assuntos
Feminino , Humanos , Materiais Revestidos Biocompatíveis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis , Invenções , Engenharia Tecidual/métodosRESUMO
Clinical complications of implantable polypropylene (PP) meshes used to repair urinary incontinence and vaginal prolapse may be associated with their low surface energy and consequent poor tissue integration. For improving tissue integration, we impregnated monofilament PP meshes with physically crosslinked poly(vinyl alcohol) (PVA), resulting in PVA deposits tightly attached inside the knot spaces of the PP knit. While preserving the mesh porosity, the PVA deposits acted as an array of hydrophilic regions leading to a great increase in the overall mesh wettability, reflected by a contact angle decrease from 111 to ca. 66°. The PVA deposits were also used as reservoirs for the local release of S-nitrosoglutathione (GSNO), a nitric oxide (NO) donor. Plain and impregnated PP meshes (1.0cm×1.0cm) were implanted in the subcutaneous tissue of 21 adult female Wistar rats. Histological analysis of the abdominal wall 21 days after the surgeries revealed lower edema and greater angiogenesis while a marked decrement of NOx concentration in the tissue surrounding the impregnated meshes was observed after 2 days. These results indicate that PVA and PVA/GSNO impregnation might be a new strategy for decreasing the frequency of mesh extrusion after PP mesh implants.
Assuntos
Parede Abdominal/irrigação sanguínea , Materiais Biocompatíveis/química , Doadores de Óxido Nítrico/química , Polipropilenos/química , Álcool de Polivinil/química , S-Nitrosoglutationa/química , Parede Abdominal/cirurgia , Animais , Materiais Biocompatíveis/farmacologia , Feminino , Microscopia Eletrônica de Varredura , Neovascularização Fisiológica , Óxido Nítrico/metabolismo , Álcool de Polivinil/farmacocinética , Ratos , Ratos Wistar , S-Nitrosoglutationa/farmacocinética , Telas Cirúrgicas , MolhabilidadeRESUMO
OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.
Assuntos
Terapia por Exercício/métodos , Esclerose Múltipla/complicações , Contração Muscular/fisiologia , Diafragma da Pelve/fisiologia , Qualidade de Vida , Transtornos Urinários/terapia , Adulto , Análise de Variância , Feminino , Humanos , Estudos Prospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Transtornos Urinários/fisiopatologiaRESUMO
INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) can occur simultaneously with anterior vaginal prolapse (AVP) in up to 30% of patients. We studied a monoprosthesis that combines prepubic and transobturator arms for simultaneous treatment of AVP and SUI. METHODS: One hundred four women with AVP underwent surgical treatment using a monoprosthesis (NAZCA TC). POP-Q was used for anatomical evaluation. Functional results were evaluated by quality of life questionnaires, stress test and Stamey score. Patients were evaluated at 1, 3, 6 and 12 months postoperatively. RESULTS: There were significant and sustained improvements in points Aa, Ba and C. Positive stress test was observed in 29.8% preoperatively and decreased to 1.9% after 12 months. There was no significant impact in sexual symptoms. Mesh exposure was noted in 5.7% of patients. CONCLUSIONS: Monoprosthesis with combined prepubic and transobturator arms presented high success rates for AVP repair and simultaneous SUI treatment. It has also been shown to be safe and appears to preserve sexual function.
Assuntos
Saúde Global , Próteses e Implantes , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/terapia , Prolapso Uterino/epidemiologia , Prolapso Uterino/terapia , Idoso , Argentina , Brasil , Comorbidade , República Tcheca , Feminino , Humanos , Itália , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Próteses e Implantes/efeitos adversos , Desenho de Prótese , Qualidade de Vida , Resultado do TratamentoRESUMO
OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.
Assuntos
Adulto , Feminino , Humanos , Terapia por Exercício/métodos , Esclerose Múltipla/complicações , Contração Muscular/fisiologia , Diafragma da Pelve/fisiologia , Qualidade de Vida , Transtornos Urinários/terapia , Análise de Variância , Estudos Prospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Transtornos Urinários/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: With the widespread early detection programs for prostate cancer, there has been a downward stage migration and a marked decrease in the percentage of men with seminal vesicle invasion (SVI) compared with previous data. We evaluated clinicopathologic findings that are associated with SVI to select patients for potential seminal vesicle-sparing surgery. PATIENTS AND METHODS: We reviewed our radical prostatectomy database from 1997 to 2006 to evaluate the incidence and clinical correlates of SVI. Variables analyzed included serum prostate-specific antigen (PSA) level, clinical stage, percentage of positive cores with cancer, Gleason score on biopsy, age, prostate weight, and urethral and vesical surgical margins. Statistical analysis included univariate and multivariate logistic regressions. RESULTS: Of 267 patients, 32 (12%) had SVI. Preoperative PSA level, biopsy Gleason score, and percentage of positive cores were highly predictive of SVI on multivariate analysis. SVI was present in only 1/98 patients (1.02 %) with biopsy Gleason score ≤6, 0/23 patients (0%) with serum PSA level <4 ng/mL, and only 1 patient with ≤12.8% of positive cores on biopsy. In all cases of distal SVI, there was proximal involvement. CONCLUSION: Serum PSA level, Gleason score, and percentage of positive cores on biopsy are statistically significant predictors of SVI on multivariate analysis. Seminal vesiculectomy does not benefit almost 99% of patients with biopsy Gleason score ≤6, PSA level <4 ng/mL, and with <12% cores with cancer. In cases of seminal vesicle-sparing surgery, frozen section of the proximal portion may be of adjunct usefulness for the triple.