Effect of application of fibrin glue on vocal fold healing after surgical manipulation in rabbits / Efeito da aplicação de cola de fibrina na cicatrização de pregas vocais após manipulação cirúrgica em coelhos

Abstract Introduction A challenge in phonosurgery is achieving good vocal quality with minimal vocal fold fibrosis. Fibrin glue can be applied to minimize fibrosis; however, its use in the larynx is based primarily on clinical experience, particularly in extensive lesions. Objective The objective of this study was to evaluate the effect of application of fibrin glue on collagen concentration at the late phase of the healing process after detaching a pedicled flap of the vocal fold cover in rabbits. Methods In this prospective animal study, twelve adult male rabbits underwent laryngeal microsurgery, in which an incision was made along the entire length of both vocal folds, followed by extensive mucosal detachment and section of the incision ends. Fibrin glue was applied in the left vocal fold, and the mucosa was repositioned. In the right vocal fold, the mucosa was repositioned without treatment with fibrin glue. After 3-months, the rabbits were euthanized. Histological analyses were performed, and the data collected were subjected to statistical analysis. Results Vocal folds treated with fibrin glue presented higher collagen concentration in Masson trichrome staining and significantly higher (p< 0.05) collagen concentration in picrosirius red staining compared to control vocal folds. Conclusion Treatment with fibrin glue led to greater vocal fold fibrogenesis in the present study. Nonetheless, further studies are necessary to determine the prophylactic effect of sealants in laryngeal surgeries that require extensive detachment of the vocal fold cover.

Resumo Introdução Um desafio na fonocirurgia é conseguir uma boa qualidade vocal com o mínimo de fibrose das pregas vocais. A cola de fibrina pode ser aplicada para minimizar a fibrose; porém, seu uso na laringe é baseado principalmente na experiência clínica, particularmente em lesões extensas. Objetivo Avaliar o efeito da aplicação da cola de fibrina na concentração de colágeno na fase tardia do processo de cicatrização, após o descolamento do retalho pediculado da cobertura da prega vocal em coelhos. Método Neste estudo prospectivo com animais, 12 coelhos adultos machos foram submetidos à microcirurgia de laringe, na qual uma incisão foi feita em toda a extensão de ambas as pregas vocais, seguida de extenso descolamento da mucosa e secção das extremidades da incisão. A cola de fibrina foi aplicada na prega vocal esquerda e a mucosa foi reposicionada. Na prega vocal direita, a mucosa foi reposicionada sem tratamento com cola de fibrina. Após três meses, os coelhos foram sacrificados. Análises histológicas foram feitas e os dados coletados foram submetidos à análise estatística. Resultados As pregas vocais tratadas com cola de fibrina apresentaram maior concentração de colágeno na coloração tricrômica de Masson e concentração significativamente maior de colágeno (p < 0,05) na coloração com picrosirius red comparadas às pregas vocais controle. Conclusão O tratamento com cola de fibrina resultou em maior fibrogênese das pregas vocais no presente estudo. Contudo, novos estudos são necessários para determinar o efeito profilático dos selantes em cirurgias de laringe que requerem extenso descolamento da cobertura das pregas vocais.

Estrogen receptor mRNA determined by Quantitative Real-Time PCR in the nasal mucosa of women taking oral contraceptives / Receptor ARNm de estrógeno determinado por PCR Cuantitativa en Tiempo Real en la mucosa nasal de mujeres tratadas con anticonceptivos orales

SUMMARY: Estrogen receptors (ER) have been identified in human nasal mucosa, but its physiologic and pathologic impacts are not totally established. ER have been demonstrated in nasal mucosa by several authors, mainly by immunohistochemical method in nasal mucosa samples surgically removed. The present study aimed to quantify ERα and ERβ mRNA concentration by using an absolute quantitative real-time PCR in cells from nasal mucosa smear of women under oral contraceptive therapy. Nasal epithelium smear samples were collected from 110 patients divided in two groups: 55 women who present regular menstrual cycle without using contraceptives and 55 women who present regular menstrual cycle and have been using oral contraceptives for more than 3 months. All the patients answered a rhinitis symptoms questionnaire. The current study showed the potential usefulness of nasal turbinate mucosa cell sourcing, collected through swab, for extracting useful RNA for gene expression. We have identified the predominant expression of ERα isoform in a ratio 10-15 times higher compared to ERβ isoform. There is a tendency for positive correlation between the ERb isoform and the rhinitis severity score.

RESUMEN: Se han identificado receptores de estrógeno (RE) en la mucosa nasal humana, sin embargo sus impactos fisiológicos y patológicos aún no están totalmente establecidos. Varios autores han demostrado RE en la mucosa nasal, principalmente por método inmunohistoquímico en muestras obtenidas quirúrgicamente. El presente estudio tuvo como objetivo cuantificar la concentración de ARNm de REa y REb mediante el uso de una PCR cuantitativa absoluta en tiempo real en células de frotis de mucosa nasal de mujeres bajo terapia anticonceptiva oral. Se recolectaron muestras de frotis de epitelio nasal de 110 pacientes divididas en dos grupos: 55 mujeres que presentan ciclo menstrual regular sin uso de anticonceptivos y 55 mujeres que presentan ciclo menstrual regular con uso de anticonceptivos orales durante más de 3 meses. Todas las pacientes respondieron un cuestionario de síntomas de rinitis. El estudio actual mostró la utilidad de la obtención de células de la mucosa de la concha nasal, recolectadas a través de un hisopo, para extraer ARN para la expresión génica. Hemos identificado la expresión predominante de la isoforma REμ en una proporción de 10 a 15 veces mayor en comparación con la isoforma REß. Hemos identificado la expresión predominante de la isoforma REα en una proporción de 10 a 15 veces mayor en comparación con la isoforma REß. Existe una tendencia a una correlación positiva entre la isoforma REß y la puntuación de gravedad de la rinitis.

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.

Anatomic study of the optical radiation and its relationship in the temporal lobe: definition of a secure approach for amigdalohipocampectomy in epilepsy surgery / Estudio anatómico de la radiación óptica y su relación en el lóbulo temporal: definición de un abordaje seguro para amigdalohipocampectomía en cirugía de la epilepsia

Introducción/Objetivos: El lóbulo temporal anterior tiene importantes estructuras subcorticales, especialmente fibras blancas que llevan la información visual. La comprensión de esta región anatómica, importantes para la práctica microquirúrgica, se basa en técnicas de disección de fibras. Ellos proporcionan perspectiva tridimensional de esta región y añaden un enfoque quirúrgico exitoso para el tratamiento de las lesiones temporales mesiales. El propósito de este trabajo es el estudio de la anatomía de la pared lateral del ventrículo lateral con el fin de determinar una zona libre de la radiación óptica. Métodos: Se diseccionaron diez hemisferios cerebrales, preparados de acuerdo con técnicas de Klingler. Se utilizan espátulas de madera con puntas de diferentes tamaños. La radiación óptica fue delimitada y las medidas se tomaron a partir de esta estructura para el polo temporal, que se utiliza como punto de referencia. Resultados: Abordajes para el cuerno temporal superior a 27 mm más allá del polo temporal pueden cruzar asa de Meyer y determinar un perjuicio a la radiación óptica con los consiguientes déficits en los campos visuales. Conclusión: La determinación de la zona de libre de fibras de radiación óptica es factible. En este trabajo se podría inferir que el área libre de la radiación óptica se encuentra en la región anterioinferior del lóbulo temporal a una distancia de hasta 2,7 centímetros desde el polo temporal y permite el acceso a el hipocampo y la amígdala durante la cirugía de la epilepsia. Resecciones más grandes que estas medidas permiten aclarar de una lesión a la radiación óptica con los consiguientes déficits en los campos visuales.

Introduction/Objective: The anterior temporal lobe has important subcortical structures, especially white fibers that lead visual information. Understanding this anatomical region, important for microsurgical practice, is based on fibers dissection techniques. They provide three-dimensional perspective for this region and add a successful surgical approach for the treatment of mesial temporal lesions. The purpose of this paper is to study the anatomy of the lateral wall of the lateral ventricle in order to determine a free area of the optical radiation. Methods: Ten cerebral hemispheres were dissected, prepared according to Klingler´s techniques. Wooden spatulas with tips of various sizes were used. The optical radiation was delimited and measures were taken from this structure to the temporal pole, used as a reference point. Results: Approaches to the temporal horn larger than 27 mm beyond the temporal pole can cross Meyer´s loop and determine injury to the optical radiation with consequent postoperatively deficits in visual fields. Conclusion: The determination of free area of optical radiation fibers is feasible. In this work we could infer that free area of optical radiation is located in the anterioinferior region of the temporal lobe at a distance of up to 2.7 centimeters from the temporal pole and allows access to the hippocampus and amygdala during epilepsy surgery. Larger resections than these measures can possibly determine injury to the optical radiation with consequent deficits in visual fields.

Anatomical study of sensory anastomoses in the hand

Objective: The aim of this study is to evaluate the prevalence, topography and morphometry of sensitive nervous anastomoses in the hand. Methods: Thirty anatomic parts irrespective of race, gender and age have been dissected. Measurements of anastomoses' length, origin and terminus regarding the transverse carpal ligament were noted. The anastomoses were classified according to the scheme proposed by Meals & Shaner and modified by Bas & Kleinert. Results: Type 1 anastomosis was the most prevalent. The distance between the origin of the anastomosis to the distal limit of the transverse carpal ligament was 0.7 cm in average. Conclusion: This study showed that Berretini anastomosis is high prevalent, usually beginning in the ulnar and distal nerve until the transverse carpal ligament. Level of Evidence IV, Case Series. .

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.

Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications / Ausência do nervo musculocutâneo: uma rara variação anatômica com possíveis implicações clínico-cirúrgicas

CONTEXT: The musculocutaneous nerve is one of the terminal branches of the lateral fasciculus of the brachial plexus, and is responsible for innervation of the flexor musculature of the elbow and for skin sensitivity on the lateral surface of the forearm. Its absence has been described previously, but its real prevalence is unknown. CASE REPORT: A case of absence of the musculocutaneous nerve that was observed during the dissection of the right arm of a male cadaver is described. The area of innervation was supplied by the median nerve. From this, three branches emerged: one to the coracobrachialis muscle, another to the biceps brachii muscle and the third to the brachialis muscle. This last branch continued as a lateral antebrachial cutaneous nerve. This is an anatomical variation that has clinical-surgical implications, considering that injury to the median nerve in this case would have caused unexpected paralysis of the flexor musculature of the elbow and hypoesthesia of the lateral surface of the forearm.

CONTEXTO: O nervo musculocutâneo é um dos ramos terminais do fascículo lateral do plexo braquial, sendo responsável pela inervação da musculatura flexora do cotovelo e pela sensibilidade cutânea da face lateral do antebraço. Sua ausência já foi descrita previamente, mas a sua real prevalência é desconhecida. RELATO DE CASO: Este é um relato de caso da ausência do nervo musculocutâneo observada durante a dissecção do membro superior direito de um cadáver do sexo masculino, sendo o seu território de inervação suprido pelo nervo mediano. Deste emergiam três ramos, um para o músculo coracobraquial, outro para o músculo bíceps braquial e o terceiro para o músculo braquial. Este último ramo continuava-se como nervo cutâneo lateral do antebraço. Trata-se de variação anatômica que tem implicações clínico-cirúrgicas, já que a lesão do nervo mediano, neste caso, acarretaria inesperada paralisia da musculatura flexora do cotovelo e hipoestesia da face lateral do antebraço.

Study on the morphology and frequency of the vomeronasal organ in humans / Estudio sobre la morfología y la frecuencia del órgano vomeronasal en los seres humanos

The vomeronasal organ was first described in humans in the seventeenth century. It has a chemosensory function and is found in the mucosa of the nasal septum of mammals and consists of an opening in the mucosa at the base of the nasal septum. For this study, 143 individuals undergoing nasofibrolaryngoscopy were studied, and presence of the vomeronasal organ was considered to be a finding from the examination. Three morphological types of vomeronasal organ were observed: fissure, fossette and circular. The total prevalence of the vomeronasal organ among these patients was 28 percent (40 individuals ). The prevalence of the vomeronasal organ in this study population is compatible with what has been reported in other studies. The forms of the vomeronasal organ can be characterized: fissure, fossette and circular. The fossette type is commonest in males and the fissure among females.

El órgano vomeronasal se describió por primera vez en seres humanos en el siglo XVII. Tiene una función quimiosensorial y se encuentra en la mucosa del tabique nasal de los mamíferos, y consta de una abertura en la mucosa en la base del tabique nasal. Para este estudio, 143 individuos fueron estudiados mediante nasofibrolaringoscopía, y la presencia del órgano vomeronasal se consideró un hallazgo del examen. Tres tipos morfológicos de órgano vomeronasal se observaron: fisura, foseta y circular, siendo el tipo foseta es más común en los hombres y las fisuras entre las mujeres. La prevalencia total del órgano vomeronasal entre estos pacientes fue de 28 por ciento (40 pacientes). La prevalencia del órgano vomeronasal de la población en estudio es compatible con lo que ha sido reportado en otros estudios.

Anatomical Study of the Digastric Muscle: Variations in the Anterior Belly / Estudio Anatómico del Músculo Digástrico: Variación en el Vientre Anterior

The digastric muscle is formed by two muscle bellies: one anterior and one posterior, joined by an intermediate tendon. It is localized in the anterior cervical region. The anterior belly divides the region between the hyoid bone and the mandible into two: laterally the submandibular triangle, and medially the submental triangle. The anatomical variations described in the literature relate to the anterior belly and consist of differences in shape and muscle attachment. This cross-sectional cohort study had the objective of describing anatomical variations in the anterior belly of the digastric muscle. The neck regions of 10 cadavers of male adults were dissected in the Department of Morphology, between June 2004 and June 2006. The digastric muscles that presented anatomical variations were photographed using a Sony Cyber-shot DSC-T1 camera, with a Carl Zeiss Vario-Tessar lens and their bellies were measured using a universal pachymeter. Anatomical variations in the anterior bellies of the digastric muscle were observed in four individuals. Cases 1 and 4 presented a unilateral right variation, with an anomalous anterior belly. Cases 2 and 3 presented bilateral variation, with the presence of two supernumerary bellies. The anatomical variations observed on this study related only to the anterior belly, as previously described by other authors. It is important to consider the occurrence of these variations in the digastric muscle when differentiating between cervical masses and during surgical procedures on the anterior region of the neck.

El músculo digástrico está formado por dos vientres musculares: uno anterior y otro posterior, unidos por un tendón intermedio. Está localizado en la región cervical anterior. El vientre anterior divide en dos la región entre el hueso hiodes y la mandíbula: lateralmente el trígono sub mandibular y medialmente el trígono submentoniano. Las variaciones anatómicas descritas en la literatura se refieren al vientre anterior y consisten en diferencias en la forma e inserción muscular. Este estudio de cohorte transversal tiene el objetivo de describir las variaciones anatómicas del vientre anterior del músculo digástrico. Diez regiones cervicales de cadáveres adultos masculinos fueron disecadas en el Departamento de Morfología entre junio de 2004 y junio de 2006. Los músculos digástricos que presentaron variaciones anatómicas fueron fotografiados usando una cámara Sony Cyber-shot DSC-T1 con un lente Cari Zeiss Vario-Tessar y sus vientres fueron medidos con un cáliper. Variaciones anatómicas en el vientre anterior del músculo digástrico se observaron en cuatro individuos. Los casos 1 y 4 presentaron variación unilateral derecha, con un vientre anterior anómalo. Los casos 2 y 3 presentaron variación bilateral, con presencia de dos vientres supernumerarios. Las variaciones anatómicas observadas en este estudio se refieren solamente el vientre anterior, el cual ha sido descrito previamente por otros autores. Es importante considerar la ocurrencia de estas variaciones en el músculo digástrico cuando se diferencian masas cervicales y durante los procedimientos quirúrgicos de la región anterior del cuello.

Benign Inclusions in Lymph Nodes / Inclusiones Benignas en Linfonodos

Benign inclusions are foci of non-neoplastic ectopic tissue in lymph nodes. They are classified into three types: epithelial, nevomelanocytic and decidual. It is important to identify them for the differential diagnosis with lymph node metastases, particularly among patients who present proliferative benign lesions. In general, epithelial inclusions are presented inside lymph nodes as epithelial cysts or as numerous structures resembling ducts. The cells of these structures may originate from the cells of paramesonephricus ducts, salivary glands, breast tissue, thyroid follicles, squamous epithelium or mesothelium. Paramesonephricus -type inclusions are almost exclusively found in pelvic lymph nodes and, in appearance, they resemble the epithelium of the uterine tube. Inclusions of breast tissue are composed predominantly of ectopic mammary glands and ducts that present diverse morphological characteristics that still have obscure etiology. Thyroid-type inclusions are frequently found in cervical and axillary lymph nodes, and it is believed that, embryologically, they arise from the mixing of tissues from which lymph nodes and the thyroid gland originate. Mesothelial inclusions occur preferentially in the mediastinal lymph nodes of patients who are affected by pleural or pericardial effusions. Aggregates of melanocytic cells are generally found in the lymph node capsule. The explanation for this occurrence is uncertain, but it is believed to be a consequence of incorrect migration of neural crest cells, or because of "benign metastases" of nevi present in the skin. Studies on benign inclusions in lymph nodes take on importance through assisting in correctly diagnosing the presence of metastases.

Las inclusiones benignas son focos de tejido ectópico no neoplásico en los linfonodos. Ellos son clasificados en tres grupos: epitelial, nevomelanocítico y decidual. Es importante identificarlos para el diagnóstico diferencial con metástasis de linfonodos, particularmente en aquellos pacientes que presentan lesiones proliferativas benignas. En general, las inclusiones epiteliales se presentan dentro de los linfonodos como quistes epiteliales o como numerosas estructuras que parecen conductos. Las células de estas estructuras se pueden originar a partir de las células del conducto paramesonéfrico, glándulas salivales, tejido mamario, folículos tiroideos, epitelio escamoso o mesotelio. Las inclusiones tipo paramesonéfrico son exclusivamente encontradas en los linfonodos pélvicos y su apariencia recuerda el epitelio de la tuba uterina. Las inclusiones del tejido mamario están compuestas predominantemente de tejido mamario glandular ectópico y los ductos presentan diversas características morfológicas las que no tienen una clara etiología. Las inclusiones del tipo tiroideas son frecuentemente encontradas en los linfonodos cervicales y axilares y se cree que embriológicamene, se originan de una mezcla de tejidos de que origina linfonodos y tejido glandular tiroideo. Las inclusiones mesoteliales ocurren preferentemente en los linfonodos mediastínicos de pacientes que son afectados por dilataciones pleurales y pericárdicas. Los agregados de células melanocíticas son generalmente encontrados en la cápsula de los linfonodos. La explicación para este hecho es incierta, pero se cree que es una consecuencia incorrecta de la migración de células de la cresta neural o por metástasis benignas de nevos presentes en la piel. Los estudios de las inclusiones benignas en linfonodos toma importancia ya que a través de ellos se puede ayudar a un correcto diagnóstico de la presencia de metástasis.

Cardia: al fin de cuentas ¿qué es? / Cardia: at the end of the day, what is it?

There is no consensus about the precise definition of what the cardia is. Although this term is often utilized in the medical literature, it takes on a variety of meanings, depending on the context. For histologists and endoscopists, the cardia is a region of the stomach immediately below the gastroesophageal junction. However, the concepts of gastroesophageal junction used by histologists and endoscopists are not the same as used by anatomists. This junction is histologically defined as the abrupt transition from the nonkeratinized stratified squamous epithelium of the esophagus to simple columnar epithelium and corresponds to the endoscopically defined Z-line. Nevertheless, this epithelial change does not occur exactly in the anatomical transition between the esophagus and stomach, but is situated in the esophagus, 1 or 2 cm above the anatomical transition. Surgeons usually use the term cardia as synonymous with lower esophageal sphincter. From a strictly oncological point of view, the cardia is the region that includes the most distal 5 cm of the esophagus and the most proximal 5 cm of the stomach. Thus, it is easy to see that there is no uniform concept of the cardia. The term cardia needs to be revised as a matter of urgency.

No existe concenso sobre una definición precisa de lo que es el cardia. Aunque este término es a menudo utilizado en la literatura médica ha tomado una variedad de significados dependiendo del contexto. Para histólogos y endoscopistas, el cardia es una región del estómago inmediatamente bajo la unión gastroesofágica. Sin embargo, los conceptos de unión gastroesofágica usado por éstos es diferente al de los anatomistas. Esta unión es histológicamente definida como la abrupta transición del epitelio escamoso estratificado no queratinizada del esófago, a un epitelio columnar simple y corresponde a lo que endoscópicamente se define como línea Z. Sin embargo, este cambio epitelial no ocurre exactamente en la transición anatómica entre el esófago y el estómago, pero está situado en el esófago, 1 a 2 cm por encima de la transición anatómica. Generalmente, los cirujanos usan el término cardia como sinónimo de esfínter esofágico inferior. Desde un estricto punto de vista oncológico, el cardia es la región que incluye los más distales 5 cm del esófago y los más proximales 5 cm del estómago. Así, es fácil afirmar que no hay un concepto uniforme del cardia. El término necesita ser urgentemente revisado.

Minor salivary glands morphology in xerostomia patients / Morfología de las Glándulas Salivales Menores en Pacientes Xerostomizados

Las glándulas salivales menores son encontradas distribuidas a través de la mucosa oral, especialmente en los labios y en la mucosa del paladar blando. Varios factores pueden causar xerostomía, donde las características histológicas de las glándulas salivales son también consideradas como factores para definir la etiología. Así, las biopsias de las glándulas salivales menores representan una herramienta fundamental para alcanzar los criterios diagnósticos requeridos en la clasificación de pacientes con síndrome de Sjõgren, ya que no representa riesgo para los pacientes. El objetivo de este estudio es determinar las características histológicas de las glándulas mencionadas, obtenidas de biopsias de pacientes con xerostomía y clasificar los aspectos histológicos de las glándulas en el síndrome de Sjõgren. Estudiamos 40 láminas de pacientes con xerostomía, cuyas glándulas salivales menores fueron sometidas a biopsia en el Servicio de Estomatología de la Santa Casa de São Paulo, Brasil. Se observaron las variaciones de su aspecto histológico, desde la normalidad hasta la presencia de focos inflamatorios, los cambios del tejido conjuntivo entre los acinos y conductos, como también el parénquima. En 15 casos, el infltrado de células inflamatorias invadió el foco, es decir, grupos de al menos 50 células inflamatorias alrededor de acinos o conductos, lo cual es un aspecto característico del síndrome de Sjõgren. Por lo tanto, el hallazgo de al menos un foco inflamatorio de 4 mm2 de tejido glandular, representa un buen criterio, aunque no es uno de los criterios a considerar cuando se trata de clasificar a los pacientes con el Síndrome de Sjõgren.

The minor salivary glands are found scattered throughout the oral mucosa, especially in the lips and soft palate mucosa. Several factors can cause xerostomia, whereas the salivary glands histological characteristics are also considered as factors for defining the etiology. Thus, the minor salivary glands biopsy represents an essential tool for attending the required diagnosis criterion in the classification of Sjögren's Syndrome patients, since it does not present risk for the patient. The objective of this study is to determine the histological description of the minor salivary glands obtained from the biopsies of xerostomia patients and to classify the minor salivary gland histological aspect as the Sjögren's Syndrome. Forty laminas of xerostomia patients that were submitted to minor salivary glands biopsy at the Santa Casa de Sao Paulo Stomatology ambulatory were retrospectively studied. The variation in the glands histological aspect was observed, from the normality up to the presence of inflammatory focus, replacing the conjunctive between acini and ducts, as well as the parenchyma. In 15 cases, the infiltrated inflammatory cells amounted to focus, that is to say, groups of at least 50 inflammatory cells around the acini or ducts, which is a characteristic aspect of the Sjögren's Syndrome. Therefore, the finding of at least one inflammatory focus of 4 mm2 of glandular tissue represents a set criterion, although, not the only one in order to classify this patient as having the Sjögren's Syndrome.

Doenças mitocondriais: uma revisão / Mitochondrial diseases: a review

As mitocôndrias são organelas responsáveis pela produção da maior parte de energia do organismo através do processo de fosforilação oxidativa (OXPHOS). Possui um DNA de fita dupla de herança exclusivamente materna (DNAmit), com cerca de 16.500pb e 37 genes que codificam dois RNAmit ribossômicos, 22 RNAmit transportadores e 13 cadeias polipeptídicas. Mutações no DNAmit podem acarretar a síntese insuficiente de ATP, resultando em um grupo de distúrbios multissistêmicos denominado doenças mitocondriais. Com o comprometimento da produção de energia nas mitocôndrias, tecidos que exigem maior demanda de ATP e maior turnover oxidativo são mais afetados. Assim, as doenças mitocondriais envolvem comumente distúrbios dos músculos estriados esqueléticos (miopatias mitocondriais), cérebro (neuropatias como MELAS, MERRF, LHON e NARP), fígado, rins (síndrome de Fanconi), coração e glândulas endócrinas (síndromede Pearson), podendo haver ainda envolvimento secundário de outros órgãos e tecidos. A partir de 1962, quando se descreveu pela primeira vez um caso de doença mitocondrial e mais especificamente a partir do final da década de 80, quando se verificou pela primeira vez associação entre mutações específicas no DNAmit e doenças humanas, puderam ser identificadas cerca de 150 alterações no genoma mitocondrial capazes de gerar disfunções metabólicas, justificando o importante significado clínico deste grupo de doenças genéticas. Atualmente não há um protocolo totalmente aceito para o diagnóstico das síndromes mitocondriais, dada a amplitude de suas manifestações clínicas. Em pacientes com sintomas compatíveis com alteração do funcionamento mitocondrial, dados clínicos e exames laboratoriais, bioquímicos e morfológicos devem ser combinados para avaliar a atividade da cadeia respiratória e a integridade do genoma nuclear e mitocondrial. Não existe tratamento efetivo para os distúrbios mitocondriais, sendo a terapêutica atual fundamentalmente paliativa.