Drainage devices in refractory glaucoma surgery

Glaucoma is a socially sensitive disease, being one of the leading causes of irreversible visual impairment and blindness. Refractory glaucoma is one of the most severe forms of the disease as it is resistant to conservative and surgical methods of treatment. Because of pronounced postoperative fibroblastic activity of eye tissues, leading to gross scarring and obliteration of outflow paths, modern materials and methods of drainage surgery are needed. The review presents a variety of drains used today and considers in detail their main characteristics and the biocompatibility of the material used with eye tissues. Various groups of implants are presented, whose effectiveness and safety are compared and assessed. The statistics of postoperative complications and long-term results of surgical treatment are given.

Use of Mitomycin C in Ocular Surgery; A Narrative Review

Mitomycin C is an alkylating agent with an anti-proliferative activity. Because of its potent anti-fibroblastic effect, it is used in multiple ocular surgical procedures where inhibition of proliferation of fibroblasts and vascular ingrowths is required. It is dispensed in blue violet crystalline powder and it dissolves in water. MMC is stable for 2 weeks when refrigerated at 2 � 8 degrees centigrade after the powder is reconstituted for topical use. Because of its anti-fibroblastic activity, MMC is used in various ocular surgical procedures. The optimal dose of MMC is not known but is usually used in concentration of 0.1 mg/ml (0.01%) to 0.5 mg/ml (0.05%) in different clinical setups. Key Words: Mitomycin C, Fibroblasts, Ocular Surgery.

Can Sericin Prove Useful as a Pleurodesis Agent or Tissue Glue?

Background Sericin is a natural, gum-like, macromolecule protein, synthesized from silkworms for the formation of cocoon shells. The aim of the present study is to describe the effects of sericin when used for pleurodesis and/or as tissue glue. Methods Adult, male, 12-week-old Wistar albino rats, weighing 257 to 395 g were used in the present study (n = 12). The animals were randomly divided into two equal groups as the sericin and the control group. After intramuscular administration of the anesthetic agent, the rats were intubated and mechanically ventilated. A left thoracotomy was performed and 30 mg sericin powder was instilled into the thoraxes of the sericin group. The remaining rats were allocated to a sham thoracotomy group. The animals were housed in individual cages, fed ad-libitum, and sacrificed 8 days after. After sacrifice, the left hemithoraxes were removed en bloc and underwent histopathologic examination. Results Masson trichrome staining was applied on the visceral pleura sections of all the animals. Each animal specimen (n = 6, 100%) in the control group showed minimal collagen deposition, while only one rat (16.67%) in the sericin group had minimal collagen deposition. However, in the sericin group, five animals (83.33%) showed dense collagen deposition, fibroblastic activity, and fibrosis. According to the test method, independent t-test, developing fibroblastic activity and fibrosis are statistically significant between the two groups (p < 0.01). There were no foreign-body reactions and no evidence of biological glue on the specimens in the sericin group. The rats in the sericin group had lower inflammatory reactions compared with those in the control group. Emphysema was observed in two rats (33.33%) in the sericin group and in four rats (66.67%) in the control group. Therefore, sericin was found to be associated with an increase in fibroblastic activity and fibrosis in visceral pleura without exerting any adverse effect on the lung parenchyma. Conclusion Sericin is a new and researchable protein for chest diseases and thoracic surgery. To develop an effect of dense collagen deposition, fibroblastic activity, and fibrosis in the visceral pleura, without significant adverse effects, is remarkable. Therefore, sericin may be useful as a pleurodesis agent or natural biological glue in the future. Sericin treatment can add value to the disciplines of pulmonology and thoracic surgery.

Is There a Role for Acupuncture in the Treatment of Tendinopathy?

Tendinopathy is a debilitating condition in athletic and sedentary populations for which a gold standard treatment strategy does not yet exist. While the pathophysiology of tendinopathy is well understood, a debate remains as to the nature of the pain mechanism in tendinopathy which makes treatment selection challenging. This clinical discussion presents evidence to suggest that acupuncture may have a role in the treatment of tendinopathy, through the facilitation of tendon blood flow and fibroblastic activity, making recommendations for further research.

Magnetoelastic Materials as Novel Bioactive Coatings to Improve Integration of Percutaneous Implants

Fibroblastic activity is an innate function of the host response. In the presence of many percutaneous biomedical implants, this activity becomes uncontrollable, resulting in significant fibrous overgrowth at the soft tissue-implant interface [1]. The aberrant cell growth associated with pathological fibrosis can lead to extensive remodeling and excessive synthesis of extracellular matrix (ECM) components, preventing proper integration [2]. Furthermore, these areas of irregular fibrotic activity can also serve as sites for opportunistic infection [3]. In brief, interfacial fibrosis is often responsible for the ultimate failure and increased risk of infection of percutaneous biomedical implants.

The Potential Role of Cytokines in the Pathogenesis of Systemic Sclerosis (Scleroderma)

Systemic sclerosis (scleroderma) is characterized by excessive fibroblastic activity taking place through mechanisms largely unknown. It has been speculated that soluble factors, collectively categorized as lymphokines or monokines, and released by inflammatory or other differentiated cells, may modulate fibroblast multiple functions including migration, chemotaxis and protein synthesis. Vascular endothelium itself, which is deeply injured in systemic sclerosis, is acting as a target for the action of cytokines and is an important producer of polypeptide mediators that contribute to the inflammatory reaction and to the establishment of fibrosis. Thus, interactions through soluble mediators between fibroblasts, endothelial cells and immunocompetent cells appear crucial for the development of systemic sclerosis lesions. The aim of the present study is to evaluate the available information on the role of cytokines and to discuss their potential influence in the pathogenesis of systemic sclerosis.

Thickening of the Synovium of the Digital Flexor Tendons: Cause or Consequence of the Carpal Tunnel Syndrome?

Using a monofilament wire suture, the radial and ulnar edges of the flexor retinaculum were approximated in 14 white New Zealand rabbits. As a result, the volume of the carpal tunnel was diminished, and “carpal tunnel syndrome” was produced. At various intervals after this procedure the animals were sacrificed. The median nerve and all the digital flexor tendons passing through the carpal tunnel were excised “en bloc”, and sent for histological examination. Vascular proliferation with perivascular round cell infiltration and oedema, and large areas of fibroblastic activity were observed around the digital flexor tendons. This was probably due to increased vascular permeability secondary to ischaemic endothelial damage. These findings are similar to those observed in the synovium of patients operated on for carpal tunnel syndrome.