BackgroundThe purpose of this study was to evaluate collagen deposition, mRNA collagen synthesis and TGF-beta expression in the lung tissue in an experimental model of scleroderma after collagen V-induced nasal tolerance.MethodsFemale New Zealand rabbits (N = 12) were immunized with 1 mg/ml of collagen V in Freund's adjuvant (IM). After 150 days, six immunized animals were tolerated by nasal administration of collagen V (25 μg/day) (IM-TOL) daily for 60 days. The collagen content was determined by morphometry, and mRNA expressions of types I, III and V collagen were determined by Real-time PCR. The TGF-beta expression was evaluated by immunostaining and quantified by point counting methods. To statistic analysis ANOVA with Bonferroni test were employed for multiple comparison when appropriate and the level of significance was determined to be p < 0.05.ResultsIM-TOL, when compared to IM, showed significant reduction in total collagen content around the vessels (0.371 ± 0.118 vs. 0.874 ± 0.282, p < 0.001), bronchioles (0.294 ± 0.139 vs. 0.646 ± 0.172, p < 0.001) and in the septal interstitium (0.027 ± 0.014 vs. 0.067 ± 0.039, p = 0.026). The lung tissue of IM-TOL, when compared to IM, showed decreased immunostaining of types I, III and V collagen, reduced mRNA expression of types I (0.10 ± 0.07 vs. 1.0 ± 0.528, p = 0.002) and V (1.12 ± 0.42 vs. 4.74 ± 2.25, p = 0.009) collagen, in addition to decreased TGF-beta expression (p < 0.0001).ConclusionsCollagen V-induced nasal tolerance in the experimental model of SSc regulated the pulmonary remodeling process, inhibiting collagen deposition and collagen I and V mRNA synthesis. Additionally, it decreased TGF-beta expression, suggesting a promising therapeutic option for scleroderma treatment.

Lateral thoracic flap is a feasible flap with low donor area morbidity in a concealed region that can be harvested with upper LTLN for transplantation.

Well-vascularized composite tissue offers improved outcomes for complex head and neck reconstruction. Patients with vessel-depleted necks and failed reconstructions require alternative reconstructive options. We describe a pedicled internal mammary artery osteomyocutaneous chimeric flap (PIMOC) for salvage head and neck reconstruction. Bilateral dissections of 35 fresh cadavers were performed to study individual tissue components and vascular pedicles to develop the PIMOC technique. The flap was then utilized in a series of patients with vessel-depleted neck anatomy. The PIMOC was dissected bilaterally in all cadavers and there were no statistical differences in vascular pedicle caliber or length with regards to laterality or gender. Five patients subsequently underwent this procedure. The flaps included a vertical rectus abdominis myocutaneous component and a 6th or 7th rib with adjacent muscle and skin to restore bone defects, internal lining, and external coverage. All donor sites were closed primarily. There were no flap losses and all patients gained improvements in facial contour, speech and swallow. Although technically complex, the PIMOC is reproducible and provides a safe and reliable option for salvage head and neck reconstruction. The harvest of the 6th or 7th rib and rectus abdominis muscle renders an acceptable donor site.

RESUMO: Os pacientes com derrame pleural maligno (DPM) têm neoplasias em fase avançada com mau prognóstico e baixa resposta a tratamento sistêmico. Devido à curta expectativa de vida e ao controle muitas vezes ineficaz pela quimioterapia, quando se apresentam muito sintomáticos alguma terapêutica paliativa efetiva é necessária para oferecer conforto e qualidade de vida a estes pacientes. Porém, visto a grande variedade de apresentações clínicas, a terapêutica ideal não deve ser generalizada para todos os pacientes com DPM, como é pode ser observado em muitos ensaios clínicos sobre o assunto. Esta deve ser individualizada considerando principalmente a performance status e as condições clínicas do paciente. Revisamos as várias opções terapêuticas descritas na literatura para o tratamento de pacientes com DPM, propondo uma abordagem individualizada destes pacientes, de acordo com a suas apresentações clínicas. DESCRITORES: Derrame pleural maligno/diagnóstico. Derrame pleural maligno/terapia. Pleurodese. Qualidade de vida. Prognóstico.

RESUMO:A estenose traqueobrônquica é uma condição que cursa com dispnéia, estridor e pneumonia obstrutiva, causada por diversas condições como tumores, compressão extrínseca e traqueobroncomalacia, porém a causa mais freqüente é a complicação resultante de intubação prolongada, sendo que ocorre em aproximadamente 1% das intubações. O tratamento de escolha para esta condição é a ressecção cirúrgica do segmento atingido, entretanto este procedimento não é possível em todos os pacientes e isto levou à adoção de técnicas endoscópicas paliativas. O uso de endopróteses para manter uma via aérea pérvia está entre as técnicas endoscópicas com melhores resultados. As endopróteses utilizadas atualmente dividem-se, principalmente, em próteses de silicone e metálicas expansíveis, cada uma com vantagens e desvantagens específi cas. A presente monografi a visa apresentar os principais modelos de endopróteses, comparando suas vantagens e desvantagens e índices de complicações, procurando sistematizar as indicações ideais para cada tipo de prótese. DESCRITORES: Constrição patológica. Traquéia/cirurgia. Implante de prótese. Dispnéia/ etiologia.