O colágeno em fáscia transversal de pacientes com hérnia inguinal direta submetidos à videolaparoscopia
TL;DR: The direct inguinal hernia patients have less collagen in transversalis fascia either absolutely or relatively to other constitutional elements, stablishing that there are less collagenIn the hernia's wall.
Abstract: OBJETIVO: Analisar quanto a espessura, elementos constitutivos e quantificacao do colageno total amostras de fascias transversais de pacientes entre 20 e 60 anos de idade, com hernia inguinal direta, coletadas no momento da correcao videolaparoscopica, comparando-as com amostras do mesmo tecido, retiradas de cadaveres. METODOS: Biopsias de 23 pacientes e de 22 cadaveres foram analisadas e comparadas. Utilizaram-se as tecnicas de coloracao de Hematoxilina-Eosina e Picrosirius. As imagens captadas foram analisadas por tecnica videomorfometrica assistida por computador. RESULTADOS: Constatou-se uma espessura de fascia transversal nos controles, em media, de 4.5 milimetros. A espessura da fascia transversal dos pacientes com hernia foi, em media, 58 % menor (p< 0.001). Nao se evidenciou algum processo de degeneracao das fibras de colageno atribuivel a senilidade. O principal elemento constitutivo da fascia, nos dois grupos, foi o tecido conjuntivo denso, representando cerca de 75 % nos controles e sendo um terco menor nos pacientes (p< 0.001). A area media percentual de colageno no campo amostral dos pacientes encontrada foi metade da area dos controles (p< 0.001), resultando em uma menor quantidade de colageno na parede posterior herniada. CONCLUSAO: Os pacientes com hernia inguinal direta apresentam menor quantidade de colageno tanto absoluta quanto relativamente aos demais elementos constitutivos da fascia transversal.
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TL;DR: The theory linking connective tissue alterations with the etiology of hernia, and stating that these alterations include connectives tissue at locations distant from the hernia site as well, is supported, as the rectus sheath itself does not form a hernial defect.
Abstract: In the last decade, in the search for abdominal-wall hernia etiology, attention has been brought to alterations in the connective tissue ultrastructure as the probable etiological factor. These may cause weakening of connective tissue, which in turn may form ground for hernia formation. To investigate this hypothesis in depth, we compared the ultrastructure of the connective tissue in hernia patients and the control group. The study group consisted of five patients with primary inguinal hernia (Nyhus II = 4, Nyhus IIIa = 1). Another five patients posted for emergency appendectomy created the control group. Tissue specimens, harvested intraoperatively from the rectus muscle sheath (RAMS) and fixed in 4% glutaraldehyde, underwent staining by the Masson, H-E and methylene blue techniques and were assessed by microscopy (light and scanning electron). The examinations showed significant differences in the rectus sheath ultrastructure. They included altered architecture, placement and quantity of collagen and elastic fibers, differences in the caliber of individual fibers and disrupted ground matter-to-fiber ratio. In patients with hernias, chaotic arrangement of collagen fibers was seen, as well as their thinning and a decrease in the general amount of elastic fibers, replaced by ground matter. Our research has shown significant differences in the structure of the RAMS between patients with hernias and healthy individuals. This supports the theory linking connective tissue alterations with the etiology of hernia, and stating that these alterations include connective tissue at locations distant from the hernia site as well, as the rectus sheath itself does not form a hernial defect.
40 citations
TL;DR: Collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen at the last observational time point, and the prolonged healing inflammatory response and the persistence of chronic inflammation surrounding to the mesh did not affect the length of time required for fibroplasia.
Abstract: Purpose: This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. Methods: Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where the polypropylene mesh was implanted was evaluated histologically to assess inflammatory response and percentage of collagen using computer-assisted videomorphometry. Results: Total collagen was found at the mesh site on the 3rd day post-implantation, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p 0.001). Type I collagen was first found between the 7th and 21st days; it reached its highest percentage on the 21st day and then remained stable until the 30th day. The type I to type III collagen ratio increased significantly and progressively up to the 30th day (p<0.001). Neutrophils were found at the mesh site from the 1st to the 21st day post-implantation. Macrophages, giant cells and lymphocytes were seen on the 2nd day. Thirty days after mesh implantation, neutrophils disappeared, but the percentages of macrophages, giant cells and lymphocytes remained stable (p<0.001). Conclusions: This study showed that total collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen at the last observational time point. The prolonged healing inflammatory response and the persistence of chronic inflammation surrounding to the mesh did not affect the length of time required for fibroplasia.
39 citations
TL;DR: An increase in the quantity of collagen type III was found in patients with inguinal hernia and a greater quantity in those patients classified with Nyhus IIIa, and there is no significant difference in the quality of collagen in the fascia transversalis of patients compared to the controls.
Abstract: BACKGROUND: Inguinal hernia is the second most common surgical case in our field. The anatomical factors alone are not enough to explain the inguinal hernia. Studies show changes in the proportion and quantity of collagen fibers in the developing of inguinal hernia. The greater production of collagen type III compared to the type I could justify the thinning of the fascia transversalis and its weakness. AIM: To determine the quantitative and qualitative changes of collagen in the fascia transversalis in inguinal hernia patients and compare them to findings from corpses without inguinal hernia. METHOD: Prospective case-control study based on the biopsy of fascia transversalis of 27 patients and 24 corpses. The technique used was hematoxylin-eosin and picrosirius colorimetry. RESULTS: The medium percent area of collagen (types I + III) and collagen type I, in both groups, show no statistic difference. The quantity of collagen type III was greater in the patients. Patients classified with Nyhus IIIa presented greater quantity of collagen type III. CONCLUSION: There is no significant difference in the quantity of collagen in the fascia transversalis of patients compared to the controls. An increase in the quantity of collagen type III was found in patients with inguinal hernia and a greater quantity in those patients classified with Nyhus IIIa.
38 citations
Cites methods from "O colágeno em fáscia transversal de..."
...The analysis carried out by WOLWACZ et al.(27) showed an average percent collagen area in the patients, 33% smaller than in the controls....
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...The analysis carried out by WOLWACZ et al.((27)) showed an average percent collagen area in the patients, 33% smaller than in the controls....
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TL;DR: The results of this study indicate a relationship between hernias of the anterior abdominal wall and smaller amounts of total and type I collagens.
Abstract: The purpose of this study was to evaluate the amount of total and types I and III collagens of samples from the linea alba in patients with hernias (epigastric, umbilical, and incisional) on the anterior wall of the abdomen, comparing them to findings obtained from a cadaver control group without hernias. Samples of the linea alba aponeurosis from 26 patients with hernias on the anterior abdominal wall and from 32 cadavers without hernias were analyzed and compared for qualitative and quantitative evaluation of the total and the types I and III collagens. Sirius-red staining was used to evaluate the total collagen, and for types I and III collagens, immunohistochemistry was used with monoclonal antibody anticollagen types I and III, respectively. The amount of total collagen was 18.05% smaller in patients with hernias than in cadavers (p<0.05). Type I collagen was 20.50% smaller in patients than in cadavers (p<0.05). There was no significant difference in the amount of type III collagen between cases and controls (p=0.383). The results of this study indicate a relationship between hernias of the anterior abdominal wall and smaller amounts of total and type I collagens.
38 citations
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Journal Article•
TL;DR: It is concluded that this histologic, nondestructive technique can reliably quantify age-related optical properties of fibrotic collagen and that this could be used to determine the maturity of Fibrotic lesions.
Abstract: Reliable histologic methods for gauging the maturity of fibrotic lesions are limited, making interventions in the healing process difficult to assess As collagen ages there is enhanced birefringence due to increased molecular and fibrillar organization The purpose of this study was to develop a microscopal technique to quantify this process and to determine its ability to distinguish scars of varying ages Fibrosis in the rat gracilis muscle was studied 5 to 63 days after superficial injury Sections were stained with picrosirius red and illuminated with monochromatic, polarized light The microscope fields were digitized using a computer-video system yielding an image in which noncollagenous material was dark (gray level 0) and collagen was depicted by grey levels 1 to 255 In the fibrosis model used, the collagen area fraction plateaued at 80% by day 21 The median collagen grey level increased progressively as the scar aged It is concluded that this histologic, nondestructive technique can reliably quantify age-related optical properties of fibrotic collagen and that this could be used to determine the maturity of fibrotic lesions
77 citations
TL;DR: Chemical composition of rectus sheath from normal, and indirect and direct inguinal hernia patients has indicated that in inguINAL hernia the rectus heath contains decreased amount of collagen as compared to controls.
Abstract: SummaryChemical composition of rectus sheath from normal, and indirect and direct inguinal hernia patients has indicated that in inguinal hernia the rectus sheath contains decreased amount of collagen as compared to controls. Total hexose, uronic acid, and hexosamine were not significantly altered.
64 citations
Journal Article•
61 citations
TL;DR: It is reasoned that apparent deficiency of collagenous tissue in the transversalis fascia of elderly men with direct hernias may offer a clue to the missing factor in the development of indirect hernia relatively late in life.
Abstract: Classic descriptions of the pathophysiology of inguinal hernia do not account for the initial appearance of an indirect hernia after the age of forty. Moreover, structural abnormalities alone do not adequately explain repeated recurrence of inguinal hernia after physical strength has been restored by surgical procedures. Thus, some indirect inguinal hernias may be the result of factors other than the presence of a congenital abnormality such as patent tunica vaginalis, and some repeatedly recurrent direct hernias may be the result of factors other than excess strain or intra-abdomiha| pressure. The notion that factors other than the presence of a congenital patent peritoneal sac are responsible for some indirect inguinal hernias is supported by the observation that some indirect hernias do not appear until relatively late in life. In addition, analysis of autopsy and surgical statistical data suggests that as many as 20 per cent of males have a patent sac that persists well into adult years without the appearance of a typical inguinal hernia [I-6], We have reasoned that an.apparent deficiency of collagenous tissue in the transversalis fascia of elderly men with direct hernias may offer a clue to the missing factor in the development of indirect hernia relatively late in life. If decreased collagen synthesis or increased collagen degradation is a fundamental process in the development of inguinal hernia late in life, the presence or absence of a patent peritoneal sac would be of little importance except in determining the side of
58 citations
TL;DR: It is suggested that collagen synthesis is probably defective in the studied group of Saudi patients with hernia, and decreased rates of proliferation of cells derived from patients compared to controls are suggested.
Abstract: Fibroblastic cell cultures were derived from the hernial sac and some of the surrounding muscles (rectus sheath, internal oblique, and/or cremasteric muscle) of 130 Saudi patients with different types of herniation, and from 21 control subjects. The rates of cell proliferation were studied for 39 days. Results suggested decreased rates of proliferation of cells derived from patients compared to controls. In vitro studies of the rates of incorporation of 14C proline into the muscle biopsies revealed decreased rates of label incorporation in the samples derived from patients compared to controls. However, no differences were detected between rates of collagenase activities of the biopsies obtained from patients compared to those of controls. These findings suggest that collagen synthesis is probably defective in the studied group of Saudi patients with hernia.
55 citations