Breno Bezerra Gomes de Pinho Pessoa

Amitriptyline, clomipramine, and maprotiline attenuate the inflammatory response by inhibiting neutrophil migration and mast cell degranulation

OBJECTIVE Despite the recognized anti-inflammatory potential of heterocyclic antidepressants, the mechanisms concerning their modulating effects are not completely known. Thus, we evaluated the anti-inflammatory effect of amitriptyline, clomipramine, and maprotiline and the possible modulating properties of these drugs on neutrophil migration and mast cell degranulation. METHODS The hind paw edema and air-pouch models of inflammation were used. Male Wistar rats were treated with saline, amitriptyline, clomipramine or maprotiline (10, 30, or 90 mg/kg, per os [p.o.]) 1 h before the injection of carrageenan (300 μg/0.1 mL/paw) or dextran (500 μg/0.1 mL/paw). Then, edema formation was measured hourly. Neutrophil migration to carrageenan (500 μg/pouch) and N-formyl-methionyl-leucyl-phenylalanine (fMLP) (10-6 M/mL/pouch) was also investigated in 6-day-old air-pouch cavities. Compound 48/80-induced mast cell degranulation was assessed in the mesenteric tissues of antidepressant-treated rats. RESULTS All tested antidepressants prevented both carrageenan- and dextran-induced edema. The anti-inflammatory effect of these drugs partially depends on the modulation of neutrophil migration, since they significantly counteracted the chemotactic response of both carrageenan and fMLP (p < 0.01). Furthermore, amitriptyline, clomipramine and maprotiline inhibited compound 48/80-induced mast cell degranulation (p < 0.001). CONCLUSIONS These results suggest an important anti-inflammatory role of heterocyclic antidepressants, which is dependent on the modulation of neutrophil migration and mast cell stabilization.

Long-term ethanol intoxication reduces inflammatory responses in rats

The anti-inflammatory effects of long-term ethanol intoxication were determined during ethanol treatment and withdrawal on the basis of neutrophil and eosinophil migration, hind paw edema and mast cell degranulation. Male Wistar rats (180-200 g, around 2 months of age) were exposed to increasing concentrations of ethanol vapor over a 10-day period. One group was evaluated immediately after exposure (treated group - intoxicated), and another was studied 7 h later (withdrawal group). Ethanol inhalation treatment significantly inhibited carrageenan--(62% for the intoxicated group, N = 5, and 35% for the withdrawal group, N = 6) and dextran-induced paw edema (32% for intoxicated rats and 26% for withdrawal rats, N = 5 per group). Ethanol inhalation significantly reduced carrageenan-induced neutrophil migration (95% for intoxicated rats and 41% for withdrawn rats, N = 6 per group) into a subcutaneous 6-day-old air pouch, and Sephadex-induced eosinophil migration to the rat peritoneal cavity (100% for intoxicated rats and 64% for withdrawn rats, N = 6 per group). A significant decrease of mast cell degranulation was also demonstrated (control, 82%; intoxicated, 49%; withdrawn, 51%, N = 6, 6 and 8, respectively). Total leukocyte and neutrophil counts in venous blood increased significantly during the 10 days of ethanol inhalation (leukocytes, 13, 27 and 40%; neutrophils, 42, 238 and 252%, respectively, on days 5, 9 and 10, N = 7, 6 and 6). The cell counts decreased during withdrawal, but were still significantly elevated (leukocytes, 10%; neutrophils, 246%, N = 6). These findings indicate that both the cellular and vascular components of the inflammatory response are compromised by long-term ethanol intoxication and remain reduced during the withdrawal period.

O retalho hipogástrico cutâneo no cão: modelo para o aprendizado experimental de microcirurgia

Microsurgical clinical training is done in several stages, including the practice in animals. Description of dog skin flaps for microsurgery are not often found in the literature. Objective: The authors propose a model of hypogastric cutaneous flap based on the lateral circumflex vessels in the dog. Methods: Nine dogs of unknown age and race were used, their weight ranging from 8 to 15 kg. The procedures for raising the flaps are described in details. Aanastomosis patency was demonstrated by means of empty-and-refill testing just after the completion of the anastomosis, after one hour of the procedure, by vascular doppler and by clinical evaluation (color and bleeding after prick with needle). Results: All flaps came out successfully. Conclusion: The authors believe that this model is valuable for those who want to learn microsurgery on their own.

Treinamento em microanastomoses utilizando tubos de látex

Introduction: Practice in inanimate materials are necessary for laboratorial and clinical microsurgical technique use. A new approach to microsurgical training is now propose. Methods: Rubber tubes from latex surgical gloves were made in different diameter (the smaller with 0.5mm) where end-to-end and end-to-side microanastomosis were done using 9, 10 and 11-0 Nylon microsurgical thread. Conclusions: The model is a contribution to the traditionals models of training in microsurgery as it diminish costs and spare experimentation animals.

Strategies in complex reconstructions of the scalp and forehead: a series of 22 cases

Introduction: The cephalic region is exposed to various insults from the environment. Extensive lesions in the scalp are a great challenge for plastic surgeons, because the low mobility of the skin in this region hampers its closure. A great variety of techniques have been used to close defects on the scalp and forehead. Ideally, scalp closure should provide a better functional and aesthetic outcome, as well as low morbidity at the donor site. Methods: From January 2006 to December 2014, we performed a retrospective clinical study involving a series of 22 patients with advanced tumors of the scalp or forehead, or with extensive post-trauma skin loss. Results: Reconstructive surgeries with 11 local scalp flaps (bior tri-pedicled), three coronal forehead flaps, and eight free flaps were performed. One patient experienced late partial loss of a free flap after radiotherapy. Conclusion: Various techniques can be used to reconstruct the scalp and forehead; each case should be assessed individually. The present study indicated that flaps are safe and that they confer low morbidity at the donor area. These results were satisfactory and in agreement with the literature analyzed. ■ ABSTRACT

Transplant of the greater omentum for reconstruction of a complex hand injury

The greater omentum, a large fold of the peritoneum, can be used as a free flap in numerous procedures due to the extensive network of its broad vascular pedicle and its versatility when manipulated. In this case report, we present a patient with a complex degloving injury, in which an omental flap was the best therapeutic option for reconstruction of the hand. The greater omental flap is a viable option for complex lesions of the hand, and provides good coverage of the lesion and good functional and aesthetic results. ■ ABSTRACT

Complex reconstruction of the upper and lower limbs by using reverse-flow flaps: a series of 32 cases

Introduction: Reconstruction of the soft tissues after loss of substance in the distal third of the upper and lower limbs, in particular when associated with the exposure of noble structures (bone, tendon, nerves, or blood vessels), remains a challenge in plastic surgery. Fasciocutaneous reverse flow flaps are an efficient surgical option for covering small and medium lesions in this location. Method: A retrospective clinical study was performed on a series of 32 cases of complex trauma of the upper and lower limbs treated between January 2013 and December 2014. Results: A total of 24 reverse-flow flaps were performed in the lower limbs and eight in the upper limbs, resulting in efficient coverage of the defects. Conclusion: Reverseflow flaps are reliable and present rotation arcs that allow coverage of a variety of lesions in the distal third of the upper and lower limbs. ■ ABSTRACT

Strategies for chest reconstruction following extensive resection of locally advanced breast tumors: an 11-case series

Introduction: Breast cancer is a major cause of mortality among women in Brazil. Locally advanced breast tumors are classified as stage III because they compromise the breast tissue in all or almost all of its extensions and regional lymph nodes, without distant metastases. Surgical treatment of these advanced tumors includes modified radical mastectomy, which involves axillary dissection and large skin resection, leading to major defects in the chest cavity that require complex reconstruction. Method: A retrospective clinical study including a series of 11 cases diagnosed with locally advanced breast tumors was performed from January 2006 to March 2014. Results: The chest cavity reconstruction methods performed after resection of advanced breast tumors included three fasciocutaneous flaps, two skin grafts, and six reconstructions with muscle flaps. These procedures resulted in effective coverage of extensive chest defects. Conclusion: Aggressive surgical treatment is feasible in these tumors; although numerous reconstruction options are available, individual case assessment is necessary to determine the optimal technique to reduce surgical trauma and lower morbidity in order to avoid delays in adjuvant treatment in these patients. The reconstructions were safe, with satisfactory results similar to those reported in the literature.

Surgical correction of constrictive bands in Vohwinkel syndrome

Vohwinkel syndrome, also known as hereditary mutilating keratoderma, is a rare palmoplantar keratoderma that manifests in childhood and becomes more evident in adolescence and adulthood. This preferential autosomal dominant disease affects more women and Caucasians. Its clinical features are diffuse palmoplantar keratoderma with the appearance of honeycomblike constricting rings in the fingers and toes known as pseudo-ainhum, and starfish-shaped keratotic plaques on the dorsal aspect of the hands and feet that can affect the elbows and knees. The present report describes a case report of a patient with Vohwinkel syndrome and surgical correction of the constrictive bands.

Program for theoretical and practical training insuture techniques for medical students in the field of plastic surgery at the Federal University of Ceará (UFC)

289 1 General Surgeon Resident in the Plastic Surgery and Reconstructive Microsurgery Service at University Hospital Walter Cantídio/Federal University of Ceará, Fortaleza, Brazil; Aspirant Member of the Brazilian Society of Plastic Surgery (SBCP). 2 Member of the Brazilian Society of Plastic Surgery Regent of the Plastic Surgery and Reconstructive Microsurgery Service at University Hospital Walter Cantídio/Federal University of Ceará, Fortaleza, Brazil. 3 Member of the Brazilian Society of Plastic Surgery (SBCP) Plastic Surgery Preceptor in the Plastic Surgery and Reconstructive Microsurgery Service at University Hospital Walter Cantídio/Federal University of Ceará, Fortaleza, Brazil. 4 Specialist Member of the Brazilian Society of Plastic Surgery (SBCP) Plastic Surgery Preceptor in the Plastic Surgery and Reconstructive Microsurgery Service at University Hospital Walter Cantídio/Federal University of Ceará, Fortaleza, Brazil. 5 Medical Student at the Federal University of Ceará, Fortaleza, Brazil Member of the League of Plastic Surgery and Reconstructive Microsurgery Dr. German Riquet. 6 Medical Student at the Federal University of Ceará, Fortaleza, Brazil. -Member of the League of Plastic Surgery and Reconstructive Microsurgery Dr. German Riquet. Program for theoretical and practical training in suture techniques for medical students in the field of plastic surgery at the Federal University of Ceará (UFC)