ABSTRACT
El microscopio es un instrumento, que desde hace muchos años es herramienta diagnóstica en Dermatología. La evolución del microscopio ha ido en sinergia con el avance de la tecnología, siendo el desarrollo de imágenes microscópicas digitalizadas, fuente de estudio en la época actual. El uso de estas imágenes en Dermatología ha permitido realizar diagnósticos en tiempo real; situación que vence la celeridad diagnóstica y aminora tanto para el médico como para el paciente, la lentitud de otras técnicas. El conocimiento sobre los diferentes métodos que se utilizan actualmente, para confirmar diagnósticos de enfermedades cutáneas, como: la dermatoscopía, la dermatoscopía multiespectral y la microscopía confocal de reflectancia, son imprescindibles para la formación del dermatólogo de hoy en día, ya que, con ellos se resumen pasos para el manejo definitivo de los pacientes. Con esta disertación, realizaremos un breve análisis de la historia de la microscopía, desde sus inicios hasta la era digital y los beneficios que se obtienen, con el uso de cada una de estas técnicas diagnósticas.
The microscope, is an instrument that for many years is used as a diagnostic tool in Dermatology. The evolution of the microscope has gone in synergy with the advancement of technology, being the development of digitized microscopic images a source of study and research in the present time. The use of these images in Dermatology has carried out diagnoses in real time; situation that overcomes the diagnostic speed and reduces for both the doctor and the patient the slowness of other techniques. The knowledge about the different methods currently used to confirm skin diseases, such as dermatoscopy, multispectral dermoscopy and confocal reflectance microscopy, is essential for the formation of today's dermatologist, since they summarize the steps for the definitive management of patients. With this dissertation, we will make a brief analysis of the history of microscopy from its beginnings to the digital age, and the benefits obtained with the use of each of these diagnostic techniques.
ABSTRACT
Introducción: El Microscopio Láser Confocal de Reflectancia (MCR) es una técnica no invasiva, con resolución cuasi histológica, que permite la visualización de células y estructuras de la piel. Esta tecnología es especialmente útil en el diagnóstico de lesiones tumorales. Material y métodos: Se trata de un estudio retrospectivo que busca medir la sensibilidad y especificidad del MCR en el diagnóstico de lesiones tumorales de la piel. Luego de obtener imágenes con el MCR de las lesiones, éstas se resecaron y se enviaron a estudio histopatológico, observando la correlación entre ambas técnicas. Resultados: Encontramos un 98 por ciento de concordancia entre el diagnóstico por MCR y el diagnóstico histopatológico para el total de tumores. El MCR mostró una sensibilidad y especificidad de 100 por ciento paramelanomas y sensibilidad de 93 por ciento y especificidad de 100 por ciento para carcinoma basocelular. En el caso de nevus atípico, la sensibilidad fue de 100 por ciento y la especificidad de 97 por ciento. Sólo dos lesiones que en la histopatología demostraron ser carcinomas basocelulares superficial y nodular fueron confundidas conqueratosis liquenoide y nevus atípico respectivamente. Discusión: Este estudio demostró una alta concordancia entre el MCR y la histopatología en tumores malignos. Sin duda que el MCR es y seguirá siendo un pilar fundamental en el diagnóstico de las lesiones tumorales de la piel, así como en la investigación y seguimiento in vivo de diversas lesiones de la piel.
Introduction: The Reflectance Confocal Laser Microscope (RCLM) is a new non-invasive technology, with quasi-histological resolution, which allows visualization of cells and skin structures and is particularly useful in the diagnosis of skin tumors. Material and methods: This is a retrospective study aimed to determine the diagnostic sensitivity and specificity of the RCLM in tumors of the skin using conventional histology as the gold standard for diagnosis. The images were obtained from patients with tumors of the skin using the RCLM, which were subsequently excised and sent to histopathological analysis. Results: We found a 98 percent concordance between the previous diagnosis by RCLM and pathology results. Diagnosis by confocal microscopy showed a sensitivity and specificity of 100 percent for melanomas, 93 percent sensitivity and 100 percent specificity for basal cell carcinoma and a sensitivity of 100 percent and specificity of 97 percent for atypical nevi. Only 2 lesions on histopathology proved to be superficial and nodular basal cell carcinomas were confused with lichenoid keratosis and atypical nevi, respectively. Discussion: We believe that RCLM is and will remain a really useful tool in the diagnosis of tumours of the skin as well as in research and in vivo monitoring of various types of skin lesion.
Subject(s)
Humans , Male , Female , Microscopy, Confocal , Skin Neoplasms/diagnosis , Carcinoma, Basal Cell/diagnosis , Diagnosis, Differential , Melanoma/diagnosis , Skin Neoplasms/pathology , Keratosis/diagnosis , Retrospective Studies , Sensitivity and SpecificityABSTRACT
O propósito deste trabalho foi avaliar a interação de matriz óssea bovina inorgânica, (Gen-ox®) como material de enxerto e implantes de titânio em mandíbula de coelhos. A amostra constituiu-se de 32 coelhos da raça Botucatu de aproximadamente 4kg. Os incisivos inferiores destes animais foram extraídos e foi realizada um defeito de aproximadamente 4mm de diâmetro. Um dos lados foi mantido apenas com coágulo (grupo controle) e o outro lado (grupo experimental) recebeu o enxerto do material proposto. Após 60 dias foram instalados implantes bilateralmente na região do defeito. Os animais foram eutanaziados imediatamente após a instalação dos implantes e após 1, 2 e 6 meses (n=6) para o grupo microscópico a após 2 e 6 meses para o grupo do teste biomecânico (n=4). A análise constituiu de medidas da distância da crista óssea alveolar à plataforma do implante, da densidade radiográfica em valores de pixel ma região do alvéolo, de teste biomecânico de torque de remoção e microscópico através de medidas de contato osso-implante (BIC) (em µm e %) e área de osso (em µm2 e %). Os resultados demonstraram que não houve diferenças significantes nem durante o tempo e nem entre os grupos na analise de distancia entre crista óssea alveolar e plataforma do implante. Na medida de densidade óssea, não houve variação significante ao longo do tempo, mas houve diferença estatisticamente significante entre os grupos, sendo maior no grupo experimental. Para o teste biomecânico também não houve variação significante do torque de remoção ao longo do tempo e nem houve diferença significante entre os grupos. Na análise de contato osso implante (BIC) não houve variação significante ao longo do tempo, mas houve diferença estatisticamente significante entre os ...
The aim of this study was to evaluate the interaction of an inorganic bovine bone matrix (Gen-ox®) as bone graft and titanium implants in rabbits mandible. Thirty-two Botucatu rabbits weighting about 4kg were used on this experiment. The mandible incisives were extracted and a defect of 4 mm of diameter was performed. One socket and defect was filled with experimental material. The opposite site was left to heal naturally and served as control. After 60 days, the implants were installed on the defect region. The animals were killed immediately after the implant installation and after 1, 2 and 6 months. Vertical bone height, bone density, biomechanical test, bone implant contact (BIC) and bone area near to implant threads were evaluated. The results showed that there was no significant differences on the distance between the alveolar bone crest to the implant platform (vertical bone height) along the time, neither between groups. On the bone density (pixel value) there was no significant difference along the time, but there was significant difference between groups, being the experimental group higher. For the biomechanical test there was no significant difference along the time, neither between groups. There was no significant differences on the bone implant contact (BIC) measures along the time, but there was significant difference between groups, being the experimental groups higher and there was interaction between time and groups. On bone area evaluation, there was no significant difference along the time, neither between the groups during the analyzed time. The graft behavior observed by the authors was similar to that of the control group, suggesting high acceptance of the material as graft option associated to titanium implants.