Angulação do osso hioide e segurança da deglutição pós-laringectomia parcial horizontal supracricóidea e cricohioidoepiglotopexia / Hyoid bone angle and swallowing safety post supracricoid horizontal partial laryngectomy and cricohyoidoepiglottopexy

RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.

ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.

Estrogen receptors in immunohistochemically stained slides: comparing subjective and computerized evaluation methods / Receptores de estrógeno en cortes teñidos inmunohistoquímicamente: comparación de métodos de evaluación subjetivos y computarizados

Immunohistochemistry is a specific and sensitive staining method for detection of several proteins. One important function of this method is to help us on the diagnosis of the presence of specific receptors as the estrogen receptors. The aim of this study was to compare two different methods to evaluate immunohistochemical staining intensity to detect the presence of ER in the nasal mucosa tissue: one using a digital system and the other through conventional direct microscopy observation. Sixty two stained samples were observed and analyzed under optic microscopy by three specialized professionals, who have graded intensity from: absent, mild, moderate and intense staining. Afterwards, an objective measurement was obtained by a relative optical density (ROD) reading, through the MCID 7.0 system of densitometric digital analysis (Inter Focus Imaging LTDA, Linton, England). Subjective and objective classifications were compared under statistical analysis (Kolmogorov-Smirnov and Spearman Correlation Test, p<0.05). We found a positive correlation between the subjective findings of observers and digital analysis in all the categories of beta receptor. For the alpha receptor, there was a correlation only in extreme categories. The subjective evaluations by observers and digital method by measuring the relative optical density show statistically significant correlations in quantifying the estrogen receptors by immunohistochemistry staining. This indicates that both methods show accuracy for the proposed study.

La inmunohistoquímica es un método de tinción específico para la detección de varias proteínas. Este método es importante en el diagnóstico de la presencia de receptores específicos, tales como los receptores de estrógeno. El objetivo de este estudio fue comparar dos métodos diferentes para evaluar la intensidad de la tinción inmunohistoquímica para detectar la presencia de RE en el tejido de la mucosa nasal: el primero utilizando un sistema digital y el segundo a través de la observación directa de microscopía convencional. Tres profesionales especializados observaron sesenta y dos muestras teñidas las que fueron analizadas con microscopio óptico con la siguiente intensidad de tinción: ausente, leve, moderada e intensa. Posteriormente, se obtuvo una medición objetiva a través de lectura de densidad óptica relativa (DOR) del sistema MCID 7.0 de análisis de densitometría digital (Inter Enfoque de imágenes LTDA, Linton, Inglaterra). Clasificaciones subjetivas y objetivas fueron comparadas bajo análisis estadístico (Kolmogorov-Smirnov y prueba de correlación de Spearman, p<0,05). Encontramos una correlación positiva entre los resultados subjetivos de los observadores y el análisis digital en todas las categorías de los receptores beta. Para el receptor alfa, hubo una correlación solamente en categorías extremas. Las evaluaciones subjetivas de los observadores y método digital midiendo la densidad óptica relativa muestran correlaciones estadísticamente significativas en la cuantificación de los receptores de estrógeno por tinción inmunohistoquímica. Por tanto ambos métodos demostraron ser correctos para el estudio propuesto.

Integrative learning in morphology: philosophical grounds of thefounding educators of the Santa Casa School of Medical Sciences,Sao Paulo, Brazil

This aim of this paper is to briefly report the education methodology employed at the Santa Casa School of Medical Sciences’ undergraduate program, founded in 1963, Sao Paulo, Brazil. Some relevant historical aspects are also brought out in order to provide readers with a glimpse of the social scenario that have yielded such successful model, based on integrative, practice-based strategies. Developed from simple concepts, innovative at that time, the educational system, the building structure of the hospital-university facilities and the pedagogical method remains modern and still inspires educators nowadays. The Department of Morphology is in alignment with these principles, working with the minimum possible lectures and exploring practical experience to the maximum. The disciplines of anatomy, histology and embryology comprise the curricular unit, elaborated per organ system, in a pedagogical program based on: timeline organization of the disciplines, strong theory-practice linkage, and a proactive learning system. The faculty members are trained in multiple areas to be as versatile as possible, delivering lectures and assisting in the practical training. New teaching methods may aggregate value to this model. We believe that such didactic approach can provide students with a realistic perspective of the main purpose and applicability of the basic sciences.