The effect of Lactiplantibacillus plantarum on cutaneous surgical wound healing in rats

Introduction: While oral probiotic administration is a well-established therapeutic modality, its topical application remains relatively unexplored, despite suggestive evidence of its potential benefit. This study aims to investigate the impact of topical application of the probiotic Lactiplantibacillus plantarum on cutaneous wound healing in rats. Thus, a comprehensive evaluation was conducted, encompassing photographic documentation, histopathological examination, and immunohistochemical analysis. The resulting data were subjected to comparative analysis. Materials and Methods: Four circular excisional wounds were created on the dorsum of 32 male Wistar rats, by an 8 mm biopsy punch. The animals were randomly assigned to two groups of 16: a control group and a group receiving topical application of L. plantarum. At predetermined time points (2, 4, 8, and 16 days), the wounds were photographed, tissue samples were obtained for histology. Wound healing was assessed by analyzing photographic and histopathological data. Immunohistochemical techniques were employed to quantify and compare the presence of inflammatory cells (neutrophils, lymphocytes, plasma cells, mast cells, and fibroblasts) at each stage of wound healing. Additionally, angiogenesis was evaluated. Results: Across all indicators used to measure wound healing, the probiotic group demonstrated statistically significant superiority over the control group, evident as early as day 2. Neutrophil infiltration analysis revealed a lower overall influx of neutrophils into wounds treated with the probiotic, with a shorter duration of stay. Although fibroblast numbers were lower in the probiotic group, their recruitment was significantly accelerated compared to the control group. Lymphocyte counts were significantly higher at all stages in the control group. No statistically significant differences were observed for plasmacyte or mast cell populations. Neovascularization was initiated earlier in the probiotic group. Conclusions: The findings unequivocally demonstrate that the topical application of probiotics significantly accelerates the wound healing process. In the present study, L. plantarum appeared to exert its beneficial effects by attenuating inflammation during the initial phases of healing. This anti-inflammatory action likely facilitated the timely migration of fibroblasts and the initiation of angiogenesis, resulting in a more expeditious wound closure.Εισαγωγή: Παρότι η χορήγηση των προβιοτικών από το στόμα έχει καθιερωθεί σαν θεραπευτική επιλογή κλινικά και η αποτελεσματικότητά τους είναι αδιαμφισβήτητη, η τοπική εφαρμογή τους δεν έχει διερευνηθεί επαρκώς, αν και υπάρχουν ενδείξεις περί της χρησιμότητάς τους. Στην παρούσα μελέτη διερευνάται η επίδραση της τοπικής χορήγησης του προβιοτικού Lactiplantibacillus plantarum σε δερματικά τραύματα επίμυων. Για το σκοπό αυτό διεξήχθη φωτογραφική, ιστολογική και ανοσοϊστοχημική μελέτη και συγκρίθηκαν τα κυτταρικά δεδομένα που προέκυψαν. Υλικό και Μέθοδος: Πραγματοποιήθηκαν 4 κυκλικά τραύματα εκτομής διαμέτρου 8 χιλιοστών στη ράχη 32 αρρένων επίμυων τύπου Wistar που τυχαιοποιήθηκαν σε 2 ομάδες των 16, oμάδα ελέγχου και ομάδα τοπικής εφαρμογής L. plantarum. Στις χρονικές φάσεις 2, 4, 8 και 16 ημερών πραγματοποιήθηκε φωτογράφηση των ελκών, ιστοληψία και θανάτωση τεσσάρων επίμυων κάθε ομάδας. Από τη φωτογραφική και ιστολογική μελέτη των ελκών υπολογίστηκε η ταχύτητα και η ποιότητα της επούλωσης στην κάθε ομάδα, ενώ με ανοσοϊστοχημία μετρήθηκαν και συγκρίθηκαν τα κύτταρα φλεγμονής (ουδετερόφιλα, λεμφοκύτταρα, πλασματοκύτταρα, μαστοκύτταρα, ινοβλάστες) σε κάθε φάση της επούλωσης, καθώς και η αγγειογένεση. Αποτελέσματα: Σε κάθε δείκτη που χρησιμοποιήθηκε για να μετρηθεί η ταχύτητα της επούλωσης, η ομάδα που έλαβε προβιοτικό υπερτερούσε στατιστικά σημαντικά της ομάδας ελέγχου, ήδη από την ημέρα 2. Η μέτρηση των ουδετερόφιλων έδειξε πως συνολικά στα τραύματα της ομάδα του προβιοτικού μετανάστευσαν λιγότερα και παρέμειναν για συντομότερο διάστημα. Οι ινοβλάστες, παρόλο που ο αριθμός τους ήταν μικρότερος στην ομάδα του προβιοτικού, στρατολογήθηκαν σημαντικά νωρίτερα από ότι στην ομάδα ελέγχου. Τα λεμφοκύτταρα ήταν σημαντικά πολυπληθέστερα σε όλες τις φάσεις στην ομάδα ελέγχου. Για τα πλασματοκύτταρα και τα μαστοκύτταρα δεν εξήχθη στατιστικά σημαντικό αποτέλεσμα. Η νεοαγγείωση προήχθη νωρίτερα στην ομάδα του προβιοτικού. Συμπεράσματα: Τα αποτελέσματα δείχνουν με τρόπο καθοριστικό ότι η χρήση τοπικών προβιοτικών επάγει σημαντικά τη διαδικασία της επούλωσης. Η δράση του L. plantarum στην παρούσα μελέτη φάνηκε να περιορίζει τη φλεγμονή στα αρχικά στάδια της επούλωσης, επιτρέποντας με αυτόν τον τρόπο την έγκαιρη μετανάστευση ινοβλαστών και την έναρξη της αγγειογένεσης σε συντομότερο χρόνο

Massive subgaleal hematoma in a 62-year-old man treated with apixaban as a consequence of mild head trauma

Subgaleal hematoma, accumulation of blood in the loose areolar tissue of the subgaleal space of the skull, is considered the most catastrophic complication of instrumental delivery. It is a rare finding in older ages, usually associated with coagulation disorders, severe head trauma leading to skull base fractures and accidental or abusive hair pulling. Complications include periorbital necrotising fasciitis, permanent blindness, infections and, in extreme rare cases, airway obstruction. Most cases of subgaleal hematoma resolve spontaneously, without the need of aspiration or drainage.We present here the case of a 62-year-old male on anticoagulant therapy with apixaban for chronic atrial fibrillation, who came to the emergency department after a car accident suffering from mild head trauma. The patient was complaining of a diffuse headache and physical examination showed a large ecchymosis and edema on the frontal area of the head. His neurological examination was unremarkable. Full-body computed tomography (CT) revealed a fracture of the third right rib. Twelve hours after admission, due to an excessive decrease of hematocrit, a second CT was performed. Although the images didn’t show intracranial hemorrhage or skull base fractures, a large and diffuse hematoma of the subaponeurotic space was observed and the diagnosis of subgaleal hematoma was confirmed.Massive subgaleal hematoma after mild head trauma is rather infrequent. Early diagnosis improves outcomes and can avert serious complications. Therapeutic strategy should be based on the severity of each case. In our case, conservative treatment appeared to be a valid alternative to surgery, as hematoma resolved spontaneously within 10 days. It is noteworthy that the use of anticoagulation is the only evident factor that could have been the precipitating factor for the development of the hematoma in our patient

Massive subgaleal hematoma in a 62-year-old man treated with apixaban as a consequence of mild head trauma

Subgaleal hematoma, accumulation of blood in the loose areolar tissue of the subgaleal space of the skull, is considered the most catastrophic complication of instrumental delivery. It is a rare finding in older ages, usually associated with coagulation disorders, severe head trauma leading to skull base fractures and accidental or abusive hair pulling. Complications include periorbital necrotising fasciitis, permanent blindness, infections and, in extreme rare cases, airway obstruction. Most cases of subgaleal hematoma resolve spontaneously, without the need of aspiration or drainage.We present here the case of a 62-year-old male on anticoagulant therapy with apixaban for chronic atrial fibrillation, who came to the emergency department after a car accident suffering from mild head trauma. The patient was complaining of a diffuse headache and physical examination showed a large ecchymosis and edema on the frontal area of the head. His neurological examination was unremarkable. Full-body computed tomography (CT) revealed a fracture of the third right rib. Twelve hours after admission, due to an excessive decrease of hematocrit, a second CT was performed. Although the images didn’t show intracranial hemorrhage or skull base fractures, a large and diffuse hematoma of the subaponeurotic space was observed and the diagnosis of subgaleal hematoma was confirmed.Massive subgaleal hematoma after mild head trauma is rather infrequent. Early diagnosis improves outcomes and can avert serious complications. Therapeutic strategy should be based on the severity of each case. In our case, conservative treatment appeared to be a valid alternative to surgery, as hematoma resolved spontaneously within 10 days. It is noteworthy that the use of anticoagulation is the only evident factor that could have been the precipitating factor for the development of the hematoma in our patient

Massive subgaleal hematoma in a 62-year-old man treated with apixaban as a consequence of mild head trauma

Subgaleal hematoma, accumulation of blood in the loose areolar tissue of the subgaleal space of the skull, is considered the most catastrophic complication of instrumental delivery. It is a rare finding in older ages, usually associated with coagulation disorders, severe head trauma leading to skull base fractures and accidental or abusive hair pulling. Complications include periorbital necrotising fasciitis, permanent blindness, infections and, in extreme rare cases, airway obstruction. Most cases of subgaleal hematoma resolve spontaneously, without the need of aspiration or drainage. We present here the case of a 62-year-old male on anticoagulant therapy with apixaban for chronic atrial fibrillation, who came to the emergency department after a car accident suffering from mild head trauma. The patient was complaining of a diffuse headache and physical examination showed a large ecchymosis and edema on the frontal area of the head. His neurological examination was unremarkable. Full-body computed tomography (CT) revealed a fracture of the third right rib. Twelve hours after admission, due to an excessive decrease of hematocrit, a second CT was performed. Although the images didn&amp;rsquo;t show intracranial hemorrhage or skull base fractures, a large and diffuse hematoma of the subaponeurotic space was observed and the diagnosis of subgaleal hematoma was confirmed. Massive subgaleal hematoma after mild head trauma is rather infrequent. Early diagnosis improves outcomes and can avert serious complications. Therapeutic strategy should be based on the severity of each case. In our case, conservative treatment appeared to be a valid alternative to surgery, as hematoma resolved spontaneously within 10 days. It is noteworthy that the use of anticoagulation is the only evident factor that could have been the precipitating factor for the development of the hematoma in our patient.</jats:p

External Oblique Muscle Schwannoma: A Rare Anatomical Presentation

Introduction. Schwannomas or neurilemmomas are rare, benign, and usually solitary lesions that arise from the nerve sheath. In the majority of cases, these tumors involve the extremities, head, neck, and trunk. Case Presentation. In the present study, a 52-year-old man presented to our surgical department for the evaluation of a symptomatic lump in his left lateral abdominal wall. CT and MRI confirmed the presence of a cystic mass located between the external and internal oblique muscles. Histopathology and immunohistochemistry confirmed it to be benign schwannoma. Discussion. Schwannomas have rarely been reported in the abdominal wall. To the best of our knowledge, this is the first case of schwannoma located in the left upper abdominal wall and the fifth case of abdominal wall schwannoma reported according to the reviewed medical literature. Conclusion. Benign schwannoma should be included in the differential diagnosis of cystic and symptomatic lesions of the abdominal wall. The treatment of choice is surgical excision, and recurrence is extremely rare.</jats:p

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed

External Oblique Muscle Schwannoma: A Rare Anatomical Presentation

Introduction. Schwannomas or neurilemmomas are rare, benign, and usually solitary lesions that arise from the nerve sheath. In the majority of cases, these tumors involve the extremities, head, neck, and trunk. Case Presentation. In the present study, a 52-year-old man presented to our surgical department for the evaluation of a symptomatic lump in his left lateral abdominal wall. CT and MRI confirmed the presence of a cystic mass located between the external and internal oblique muscles. Histopathology and immunohistochemistry confirmed it to be benign schwannoma. Discussion. Schwannomas have rarely been reported in the abdominal wall. To the best of our knowledge, this is the first case of schwannoma located in the left upper abdominal wall and the fifth case of abdominal wall schwannoma reported according to the reviewed medical literature. Conclusion. Benign schwannoma should be included in the differential diagnosis of cystic and symptomatic lesions of the abdominal wall. The treatment of choice is surgical excision, and recurrence is extremely rare

The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

Abstract Background The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy. Case presentation We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home. Conclusions Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions. </jats:sec

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.</jats:p