Gastroschisis is a full thickness abdominal wall defect, usually to the right of the umbilicus, through which a variable amount of viscera herniates, without a covering membrane. Newborns with gastroschisis present challenging problems to paediatric surgeons. The incidence of gastroschisis is rising worldwide. In developed countries, advances in neonatal intensive care have improved survival of patients with gastroschisis. In the few reported studies from Africa, mortality rates of patients with gastroschisis are high. The aim of this study was to evaluate outcome of gastroschisis from a centre in Africa with modern neonatal intensive care facilities. Methods: A retrospective analysis of all neonates admitted with the diagnosis of gastroschisis at Inkosi Albert Luthuli Central Hospital (IALCH) over a 6-year period (2002-2007). Proportions in percentages were used for categorical variables. For continuous variables the mean with standard deviation (SD) were derived. Two sampled t-test was used to show the pvalue for the time to reduction between the non-survivors and survivors with a 95% confidence interval. Results: There was a significant increase in the prevalence of gastroschisis among neonatal surgical admissions from 6.2% in 2003 to 15.2% in 2007. There were more females 53.4%, the majority (71.7% had low birth weight and 64.2% were born prematurely. Although 75% (n=79) of the mothers attended antenatal clinic, antenatal diagnosis by ultrasound was made in only 13 (n=12%)). Most of the babies 90.6% were out-born, with 70.8% delivered by normal vaginal delivery (NVD), and 57.4% of the mothers were primiparous. Primary closure was achieved in 73.5% of the patients. The overall mean (SD) time from birth to primary surgical intervention was 16 (13.04) hours and was higher 17(9.1) hours in those who died compared to survivors 15 (16.0), but the difference was not statistically significant, p=0.4465 and mortality was 43% with sepsis as the leading cause. Staged closure with a plastic silo bag was associated with more than double the mortality as compared to primary closure. Conclusion: The prevalence of gastroschisis among neonatal surgical admissions has increased in accordance with international trends. Due to lack of antenatal diagnosis, most of the babies were out-born resulting into delay in offering surgical treatment. Mortality is still high despite the presence of modern intensive care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

No description available.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-07Bitstream added on 2014-06-13T18:48:40Z : No. of bitstreams: 1 strang_r_me_botfm.pdf: 1503065 bytes, checksum: c600d4becf4eafb0269428ce7cb268b7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Foi realizado estudo experimental em ratos, visando avaliar o efeito da ablação cirúrgica dos músculos retos abdominais (MRA), nos padrões utilizados nos retalhos TRAM, sobre a resistência da parede abdominal. Utilizou-se 60 ratos machos da linhagem Wistar, divididos aleatoriamente em três grupos de 20 animais. No primeiro grupo removeu-se um dos músculos, no segundo, ambos e o terceiro grupo, controle, não foi submetido à cirurgia. Após 180 dias os animais foram sacrificados e submetidos a dois tipos de avaliação: aumento progressivo da pressão intracavitária, com o auxílio de um balão de silicone, para a observação do surgimento de abaulamentos ou hérnias, e teste de tração em dinamômetro, para quantificar a resistência da parede abdominal à tração. O segmento operado das paredes abdominais foi submetido à análise histológica. Constatou-se no primeiro teste não haver diferença significativa entre os três grupos. No teste da tração, as paredes abdominais submetidas à cirurgia apresentaram resistência significativamente maior do que as do grupo controle. A histologia evidenciou fibrose cicatricial madura, uniformemente distribuída, e fibras musculares em posição anatômica. Na análise estatística, para comparar os valores da pressão de ruptura (mmHg) e da Tração-Força Máxima (N) dos três grupos foi utilizada Análise de Variância de um fator. Quando o resultado do teste F foi estatisticamente significante, aplicou-se o Post-Hoc de Tukey para se identificar as diferenças. Concluiu-se que, no modelo utilizado, a remoção cirúrgica dos MRA não provoca redução na resistência da parede abdominal. / This experimental study was carried out in rats, with the purpose to evaluate the effect of the surgical ablation of the rectus abdominis muscles (RAM), in the patterns of the TRAM flap, on the resistance of the abdominal wall. Sixty male Wistar rats were used, divided randomly in three groups of twenty animals. In the first group, one of the muscles was removed, in the second, both and the third group, the control group, was not submitted to the surgery. After 180 days the animals were killed and submitted to two types of evaluation: an increase in the intracavitary pressure, with the help of a silicone balloon, to observe the emergence of bulge or hernia, and a test in a dynamometer to quantify the resistance of the abdominal wall to traction. The operated segment of the abdominal walls was submitted to histological analysis. In the first test, it was testified that there was no significant difference between the three groups. In the traction test, the abdominal walls submitted to the surgery showed a resistance significantly greater than the ones on the control group. Histology evidenced mature cicatricial fibrosis, evenly distributed, and muscular fibers in anatomical position. In the statistical analysis, to compare the values of rupture pressure (mmHg) and the Maximum Traction-Force (N) of the three groups it was used one-way Analysis of Variance. When the F test result showed to be statistically significant, the Tuckey test was applied to identify the differences. It was concluded that, in the used model, the surgical removal of the RAM didn’t cause a reduction in the abdominal wall resistance.

Background: Very occasionally, when a fetus is developing in the womb, problems occur with the normal processes controlling closure of the muscles of the abdominal wall and, as a result, some of the abdominal contents develop outside of the body. This is known as an abdominal wall defect. If the pregnancy continues to term, the newborn infant will need specialised surgical care. This situation occurs so infrequently that even a dedicated surgical centre will care for very few of these women and their babies in a year. Many centres have shared their experiences of managing these babies in the published literature but the majority of reports have included only a few infants. The focus of most previous studies has been to describe what happens to these newborn infants between birth and first discharge from hospital from a purely clinical perspective. Aim: To explore methodologies to holistically understand the short and longer-term outcomes of children born with abdominal wall defects and to use the information to improve the care of future affected infants. Methods: The quality of the published literature on short-term outcomes of children born with gastroschisis was scrutinised in a systematic review. The accompanying meta-analysis used published data as a means of identifying population outcome estimates. Two national population-based cohort studies were undertaken, exploring the short-term outcomes of children born with exomphalos and the outcomes at seven to ten years of children born with gastroschisis. The latter study included an assessment of childhood outcomes from the point of view of the children themselves, along with their parents. Further parental perspectives on experiences of care were explored in a qualitative analysis of in-depth interviews with parents of children born with exomphalos. Findings: Short-term outcomes of children born with gastroschisis have been published in a large number of small studies. Pooling the published data, where possible allowed the production of population estimates but heterogeneity between studies was marked. One in fourteen children born with gastroschisis died before their first birthday when managed in developed countries. Those who developed bowel complications in utero, had an increased risk of dying before one-year. The assessment of childhood outcomes for this latter group of children, who made up 11% of the population cohort, revealed a bleak outlook for many, of with one in three either dying or requiring complex surgery to gain allow them to be able to be fed via their gut, before their ninth birthday. Due to methodological limitations, the extent of neurological and gastrointestinal morbidity among survivors in the cohort is unclear, but the findings of both the highly selected responses from the parent report and those of the clinical study provide enough concern to suggest that alternative methodologies need to be explored to identify the extent of ongoing sequelae as children grow older. The live-born population of children with exomphalos is highly varied and a large burden of comorbidity was identified, however, two-thirds of infants were able to be have their abdominal wall defect surgically closed with a low-rate of early complications. A variety of techniques are employed by UK surgeons when the defect cannot be easily closed and evidence to guide management choice will be difficult to obtain using standard techniques due to the small number of these infants born annually in the UK. Parental experiences echoed the variability in management approach and in some cases highlighted a lack of respect for parental perspectives on management choice. Conclusion: Children born with abdominal wall defects represent a spectrum from those with severe comorbidity who will need ongoing care, to those who have a straightforward course and a relatively short stay in hospital. Methods of risk-stratifying infants for the purposes of outcome assessment have been explored. This approach is crucial to contextualising the progress of an individual infant and counselling their parents about their likely prognosis.

Objetivo: A proposta deste trabalho é avaliar o tempo de fibroplasia em tela de polipropileno na correção de hérnias incisionais da parede abdominal, em ratos, por meio da quantidade de colágeno, correlacionando-o com a resposta inflamatória local. Métodos: Trinta e seis ratos machos da linhagem Wistar foram submetidos à ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Os animais foram distribuídos em seis grupos, de acordo com o tempo de fibroplasia a ser estudado (um, dois, três, sete, 21 e 30 dias de pósoperatório). Após os prazos estabelecidos para estudo da fibroplasia, os animais foram submetidos à eutanásia, e a área de fixação da tela de polipropileno foi avaliada histologicamente quanto à reação inflamatória e à percentagem de colágeno pela técnica videomorfométrica assistida por computador. Resultados: O colágeno total foi identificado junto à tela no 3º dia pós-implante, apresentou aumento progressivo na sua proporção em todos os dias subseqüentes até o 21º dia, quando atingiu sua proporção máxima (p<0,001). A partir do dia 3, o colágeno III sofreu um aumento progressivo até o dia 21, quando atingiu sua proporção máxima (p<0,001), e no 30º dia apresentou uma redução significativa (p<0,001). O colágeno tipo I surgiu entre o 7º e o 21º dia, apresentou sua máxima proporção no 21º dia e manteve-se inalterado até o final do período de observação. A relação colágeno tipo I/tipo III aumentou progressivamente até o 30º dia de observação (p<0,001). Os neutrófilos foram identificados no 1º dia pós-implante, mantendo-se junto à tela até o 21º dia. Os macrófagos, gigantócitos e linfócitos foram identificados no 2º dia. Trinta dias após a implantação da tela, desapareceram os neutrófilos e mantiveram-se estáveis as proporções de macrófagos, gigantócitos e linfócitos (p<0,001). Conclusões: Os resultados do presente estudo evidenciaram colágeno total no 3º dia pós-implante, aumentando progressivamente até o 21º dia. O colágeno tipo III foi observado no 3º dia, aumentou até o 21º dia, quando reduziu significativamente. O colágeno tipo I surgiu entre o 7º e o 21º dia, e sua máxima proporção ocorreu no 21º dia, atingindo um platô. A relação do colágeno tipo I/tipo III aumentou progressivamente até o 30º dia, indicando maior proporção de colágeno tipo I ao final do período. O prolongamento da resposta inflamatória da cicatrização e a persistência do processo inflamatório crônico junto à tela não interferiram no tempo da fibroplasia. / Objective: This study assessed the amount of collagen 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 six groups according to the time points for the analysis of fibroplasia: one, two, three, seven, 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 video morphometry. Results: Total collagen was found at the mesh site on the third post-implantation day, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st day, when it reached its greatest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days, reached its greatest 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 post-implantation day. 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). Conclusion: This study showed that total collagen was fist seen on the 3rd day post-implantation, increased progressively up to the 21st day. Type III collagen was first seen on the 3rd day, increased up to the 21st day, and then decreased significantly. Type I collagen was first seen between the 7th and 21st days and reached its greatest percentage on the 21st day, after which it remained stable. The type I and type III collagen ratio progressively increased up to the 30th day, indicating a greater 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.

Made available in DSpace on 2015-07-22T20:50:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-11-24 / Introdução: O defeito na parede abdominal na área doadora do retalho musculocutâneo transverso do reto do abdome – retalho TRAM - é extenso, complexo e predispõe ao surgimento de hérnia, abaulamento e fraqueza abdominal. A reconstrução da parede abdominal deve ser anatômica e funcional, preferencialmente com tecidos autólogos, materiais de síntese resistentes e mínima tensão na sutura. As técnicas de descolamento músculo-aponeurótico seletivo da parede abdominal permitem uma reconstrução com tecido autólogo e tensão reduzida. Apesar dos relatos clínicos e avaliações em cadáveres, não foram encontrados estudos com a finalidade de comprovar, de maneira objetiva, a eficácia das manobras de descolamento músculo-aponeurótico seletivo na área doadora do retalho TRAM. Objetivo: Avaliar a resistência à tração dos componentes músculo-aponeuróticos na área doadora do retalho TRAM bipediculado. Métodos: No período de Maio de 2006 a Maio de 2008, foram estudadas 20 pacientes, com idade entre 29 e 58 anos, submetidas a reconstrução mamária com retalho TRAM bipediculado. A resistência à tração medial dos componentes músculo-aponeuróticos na área doadora do retalho TRAM foi medida, bilateralmente, com um dinamômetro analógico que foi fixado à margem lateral da lâmina anterior da bainha do músculo reto do abdome 3 cm inferior ao umbigo. Os coeficientes de tração foram comparados em três fases: Fase inicial sem qualquer incisão ou descolamento adicional na área doadora do retalho; Fase 1 incisão sobre a margem lateral da bainha do reto; Fase 2 descolamento do músculo oblíquo externo até a linha axilar anterior. Para a análise estatística foram utilizados os testes de Wilcoxon e o teste de t para dados emparelhados na comparação dos coeficientes de tração direito e esquerdo nas Fases inicial, 1 e 2. O teste de Friedman e teste post hoc de Dunn foram utilizados para comparar os coeficientes de tração das Fases inicial, 1, 2 no lado direito e no esquerdo. Resultados: Houve redução estatisticamente significante da resistência à tração após cada fase do descolamento seletivo. Conclusão: A resistência à tração medial dos componentes músculo-aponeuróticos na área doadora do retalho musculocutâneo transverso do reto do abdome diminuiu, após a incisão na margem lateral interna da bainha do músculo reto do abdome e após o descolamento do músculo oblíquo externo. / Introduction: The defect on the abdominal wall in the transverse rectus abdominis myocutaneos flap -TRAM flap- donor site is extensive, complex and predisposes the emergence of hernia, bulging and abdominal weakness. The closure of the abdominal wall must be anatomic and functional, preferably with autologous tissues, resistance synthesis material and minimal tension suture. The selective musculoaponeurotic undermining of the abdominal provide a abdominal wall closure with autologous tissue and reduced tension. Despite many clinical studies, no experimental researches prove the real efficacy of selective musculoaponeurotic undermining in the TRAM flap donor site. Objective: The aim of this study is to evaluate the resistance to medial traction of the musculoaponeurotic components in the bipedicled TRAM flap donor site. Methods: In the period of May of 2006 until May of 2008, 20 patients, with ages from 29 to 58 years old, submitted to mammary reconstruction with bipedicled TRAM flap were studied. The resistance to medial traction of the musculoaponeurotic components in the bipedicled TRAM flap donor site was measured with a dynamometer that was fixed in the lateral edge of the defect, 3 cm below the umbilicus. The traction coefficients obtained were compared in three situation: Initial Stage - with no incision or additional underminig in the flap donor site; Stage 1 - incision above the lateral edge of the rectus sheath; Stage 2 - undermining of the external oblique muscle. To the statistical analyses it was used the Wilcoxon and the t test to paired data in the comparison of the right and left traction coefficients in Initial Stage, Stage 1 and Stage 2. The Friedman test and the post hoc of Dunn test was used to compare traction coefficients in initial Stage, stage 1 and Stage 2, in the right and left sides. Results: There was a significant reduction of traction resistance after each stage of the dissection. Conclusion: The incision on the internal lateral edge of the rectus sheath and the external oblique undermining reduce the medial traction resistance of the musculoaponeurotic components in the TRAM flap donor site. / TEDE / BV UNIFESP: Teses e dissertações

Objetivo: A proposta deste trabalho é avaliar o tempo de fibroplasia em tela de polipropileno na correção de hérnias incisionais da parede abdominal, em ratos, por meio da quantidade de colágeno, correlacionando-o com a resposta inflamatória local. Métodos: Trinta e seis ratos machos da linhagem Wistar foram submetidos à ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Os animais foram distribuídos em seis grupos, de acordo com o tempo de fibroplasia a ser estudado (um, dois, três, sete, 21 e 30 dias de pósoperatório). Após os prazos estabelecidos para estudo da fibroplasia, os animais foram submetidos à eutanásia, e a área de fixação da tela de polipropileno foi avaliada histologicamente quanto à reação inflamatória e à percentagem de colágeno pela técnica videomorfométrica assistida por computador. Resultados: O colágeno total foi identificado junto à tela no 3º dia pós-implante, apresentou aumento progressivo na sua proporção em todos os dias subseqüentes até o 21º dia, quando atingiu sua proporção máxima (p<0,001). A partir do dia 3, o colágeno III sofreu um aumento progressivo até o dia 21, quando atingiu sua proporção máxima (p<0,001), e no 30º dia apresentou uma redução significativa (p<0,001). O colágeno tipo I surgiu entre o 7º e o 21º dia, apresentou sua máxima proporção no 21º dia e manteve-se inalterado até o final do período de observação. A relação colágeno tipo I/tipo III aumentou progressivamente até o 30º dia de observação (p<0,001). Os neutrófilos foram identificados no 1º dia pós-implante, mantendo-se junto à tela até o 21º dia. Os macrófagos, gigantócitos e linfócitos foram identificados no 2º dia. Trinta dias após a implantação da tela, desapareceram os neutrófilos e mantiveram-se estáveis as proporções de macrófagos, gigantócitos e linfócitos (p<0,001). Conclusões: Os resultados do presente estudo evidenciaram colágeno total no 3º dia pós-implante, aumentando progressivamente até o 21º dia. O colágeno tipo III foi observado no 3º dia, aumentou até o 21º dia, quando reduziu significativamente. O colágeno tipo I surgiu entre o 7º e o 21º dia, e sua máxima proporção ocorreu no 21º dia, atingindo um platô. A relação do colágeno tipo I/tipo III aumentou progressivamente até o 30º dia, indicando maior proporção de colágeno tipo I ao final do período. O prolongamento da resposta inflamatória da cicatrização e a persistência do processo inflamatório crônico junto à tela não interferiram no tempo da fibroplasia. / Objective: This study assessed the amount of collagen 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 six groups according to the time points for the analysis of fibroplasia: one, two, three, seven, 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 video morphometry. Results: Total collagen was found at the mesh site on the third post-implantation day, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st day, when it reached its greatest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days, reached its greatest 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 post-implantation day. 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). Conclusion: This study showed that total collagen was fist seen on the 3rd day post-implantation, increased progressively up to the 21st day. Type III collagen was first seen on the 3rd day, increased up to the 21st day, and then decreased significantly. Type I collagen was first seen between the 7th and 21st days and reached its greatest percentage on the 21st day, after which it remained stable. The type I and type III collagen ratio progressively increased up to the 30th day, indicating a greater 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.

Objetivo: A proposta deste trabalho é avaliar o tempo de fibroplasia em tela de polipropileno na correção de hérnias incisionais da parede abdominal, em ratos, por meio da quantidade de colágeno, correlacionando-o com a resposta inflamatória local. Métodos: Trinta e seis ratos machos da linhagem Wistar foram submetidos à ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Os animais foram distribuídos em seis grupos, de acordo com o tempo de fibroplasia a ser estudado (um, dois, três, sete, 21 e 30 dias de pósoperatório). Após os prazos estabelecidos para estudo da fibroplasia, os animais foram submetidos à eutanásia, e a área de fixação da tela de polipropileno foi avaliada histologicamente quanto à reação inflamatória e à percentagem de colágeno pela técnica videomorfométrica assistida por computador. Resultados: O colágeno total foi identificado junto à tela no 3º dia pós-implante, apresentou aumento progressivo na sua proporção em todos os dias subseqüentes até o 21º dia, quando atingiu sua proporção máxima (p<0,001). A partir do dia 3, o colágeno III sofreu um aumento progressivo até o dia 21, quando atingiu sua proporção máxima (p<0,001), e no 30º dia apresentou uma redução significativa (p<0,001). O colágeno tipo I surgiu entre o 7º e o 21º dia, apresentou sua máxima proporção no 21º dia e manteve-se inalterado até o final do período de observação. A relação colágeno tipo I/tipo III aumentou progressivamente até o 30º dia de observação (p<0,001). Os neutrófilos foram identificados no 1º dia pós-implante, mantendo-se junto à tela até o 21º dia. Os macrófagos, gigantócitos e linfócitos foram identificados no 2º dia. Trinta dias após a implantação da tela, desapareceram os neutrófilos e mantiveram-se estáveis as proporções de macrófagos, gigantócitos e linfócitos (p<0,001). Conclusões: Os resultados do presente estudo evidenciaram colágeno total no 3º dia pós-implante, aumentando progressivamente até o 21º dia. O colágeno tipo III foi observado no 3º dia, aumentou até o 21º dia, quando reduziu significativamente. O colágeno tipo I surgiu entre o 7º e o 21º dia, e sua máxima proporção ocorreu no 21º dia, atingindo um platô. A relação do colágeno tipo I/tipo III aumentou progressivamente até o 30º dia, indicando maior proporção de colágeno tipo I ao final do período. O prolongamento da resposta inflamatória da cicatrização e a persistência do processo inflamatório crônico junto à tela não interferiram no tempo da fibroplasia. / Objective: This study assessed the amount of collagen 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 six groups according to the time points for the analysis of fibroplasia: one, two, three, seven, 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 video morphometry. Results: Total collagen was found at the mesh site on the third post-implantation day, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st day, when it reached its greatest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days, reached its greatest 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 post-implantation day. 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). Conclusion: This study showed that total collagen was fist seen on the 3rd day post-implantation, increased progressively up to the 21st day. Type III collagen was first seen on the 3rd day, increased up to the 21st day, and then decreased significantly. Type I collagen was first seen between the 7th and 21st days and reached its greatest percentage on the 21st day, after which it remained stable. The type I and type III collagen ratio progressively increased up to the 30th day, indicating a greater 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.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-11-30T10:43:10Z No. of bitstreams: 2 Dissertação - Amanda Santos Fernandes Coelho - 2015.pdf: 1064259 bytes, checksum: 07faf1f463d60879732df56c30574e9a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-11-30T10:56:16Z (GMT) No. of bitstreams: 2 Dissertação - Amanda Santos Fernandes Coelho - 2015.pdf: 1064259 bytes, checksum: 07faf1f463d60879732df56c30574e9a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-11-30T10:56:16Z (GMT). No. of bitstreams: 2 Dissertação - Amanda Santos Fernandes Coelho - 2015.pdf: 1064259 bytes, checksum: 07faf1f463d60879732df56c30574e9a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-04-17 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Infant mortality is an important indicator of a country’s health. It is observed in several regions of the world a proportion of deaths attributable to congenital malformations. Worldwide, it is estimated that prevalence occurs in 9% of live births. Among the major abnormalities is gastroschisis, that is a congenital malformation in which there is an exteriorization of the viscera through the abdominal wall defect to the right of the umbilical cord, which is implanted in its normal position. The objective of this study was analyze the neonatal and maternal changes related to infant mortality in children with gastroschisis. This is a cross-sectional and retrospective study with a quantitative approach. It used for analysis, secondary data collected from medical records of patients treated at a public hospital in Goiânia-GO, from 2004 to 2014. The study included 123 patients diagnosed with gastroschisis, which met the criteria adopted. In relation to maternal variables, 57.7% of the women were younger than 20 years, 64.2% were first pregnancy, cesarean birth occurred in 65% of cases, there was an average of 4.8 ± 2.5 prenatal consultation. In relation to neonatal variables, 59% of the new born with gastroschisis were male. The gestational age at birth of the 123 pregnancies ranged from 29.4 to 40.4 weeks (average = 36.5 ± 1.8 weeks). The weight of the new born ranged from 890g to 3800g (average = 2351 ± 474,2g), the average of the Apgar index in the first minute was 6.6 ± 1.8. Associated malformations (not intestinal) were found in 10 (8.1%) patients and 17 (13.8%) patients had intestinal abnormalities, and at this last the most common was the intestinal atresia. By observing the eviscerated organs, 70.7% of patients had only exposed intestinal loops and about other herniated organs, the stomach has been externalized in 27.6% of cases. The general mortality rate was 41% of cases. Statistically significant association was observed between the occurrence of death and mothers who performed less monitoring in prenatal care (p = 0.027) and when there was no diagnosis of gastroschisis in prenatal care (p = 0.001). It was also observed statistically significant association between the occurrence of death and the presence of complex gastroschisis (p = 0.032) and herniation of other organs beyond just the intestine (p = 0.018). It is concluded that, in relation to maternal and neonatal profile of gastroschisis, the condition has no gender preference, particularly affecting children of young first-time mothers. Perinatal mortality of gastroschisis in this analysis seems to depend mainly on the reduced prenatal care, the absence of prior diagnosis at birth, the presence of complex gastroschisis and herniation of other organs than just the intestine. / A mortalidade infantil é um importante indicador de saúde de um país, observa-se em várias regiões do mundo, uma proporção de mortes atribuíveis às malformações congênitas. Mundialmente, estima-se que a prevalência ocorre em 9% dos nascidos vivos. Dentre as malformações graves está a gastrosquise que, é uma malformação congênita em que há exteriorização das vísceras através de defeito na parede abdominal à direita do cordão umbilical, que é implantado em sua posição habitual. O objetivo deste trabalho foi analisar as alterações neonatais e maternas relacionadas ao óbito infantil em crianças com gastrosquise. Trata-se de um estudo transversal, retrospectivo e com abordagem quantitativa. Utilizou para tanto, dados secundários coletados dos prontuários de pacientes atendidos em um Hospital Público em Goiânia-GO, no período de 2004 a 2014. Foram incluídos 123 pacientes diagnosticados com gastrosquise, os quais preencheram os critérios adotados. Em relação às variáveis maternas, 57,7% das mulheres apresentaram idade menor que 20 anos, 64,2% eram primigestas, o parto cesariano ocorreu em 65% dos casos, houve uma média de 4,8 ± 2,5 consultas de pré-natal. Em relação às variáveis neonatais, 59% dos RN com gastrosquise eram do sexo masculino, a idade gestacional ao nascimento das 123 gestações variou de 29,4 a 40,4 semanas (média = 36,5±1,8 semanas), O peso do RN variou de 890g a 3800g (média = 2351±474,2g), a média do índice de Apgar no primeiro minuto foi de 6,6±1,8. As malformações associadas (não intestinais) foram encontradas em 10 (8,1%) pacientes e 17 (13,8%) pacientes apresentaram anomalias intestinais, sendo que nesta última a mais comum foi a atresia intestinal. Ao observar os órgãos eviscerados, 70,7% dos pacientes apresentavam somente alças intestinais expostas e quanto aos outros órgãos herniados, o estômago esteve exteriorizado em 27,6% dos casos. A taxa geral de mortalidade foi de 41% dos casos. Foi observada associação estatisticamente significativa entre a ocorrência de óbito e mães que realizaram menor acompanhamento no pré-natal (p= 0,027) e quando não houve diagnóstico da gastrosquise no pré-natal (p= 0,001). Foi ainda observada associação estatisticamente significativa entre a ocorrência de óbito e a presença de gastrosquise complexa (p= 0,032) e herniação de outros órgãos que não apenas o intestino (p= 0,018). Conclui-se que em relação ao perfil materno e neonatal da gastrosquise, observa-se que a afecção não possui predileção por sexo, acometendo particularmente filhos de jovens mães primíparas. A mortalidade perinatal da gastrosquise neste trabalho, parece depender principalmente do acompanhamento pré-natal reduzido, da ausência de diagnóstico prévio ao nascimento, da presença de gastrosquise complexa e da herniação de outros órgãos que não apenas o intestino.

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