Diagnóstico de la discinecia ciliar primaria / Diagnosis of the primary ciliary dyskinesia

Primary ciliary dyskinesia is a congenital disorder due to abnormal motile ciliary function, especially in the airway epithelium. The mucociliary clearance is impaired, producing reoccurring respiratory tract infections, usually resulting in bronchiectasis as an adult. Patients also have frequent ear and sinus infections and almost 50% of them have situs inversus. Diagnosis of primary ciliary dyskinesia is difficult because there is not a single gold standard test, resulting in the need of a multi-test approach. Until recently in our country we only had transmission electron microscopy, but nasal nitric oxide and high speed video microscopy are now available. In this article we will detail the most important clinical characteristics that make us suspect the presence of primary ciliary dyskinesia at different ages and the methods available for its diagnosis.

La discinesia ciliar primaria es una enfermedad congénita debida a una alteración del movimiento normal de los cilios, especialmente a nivel del epitelio respiratorio. Esto se traduce en una alteración del clearance mucociliar lo que predispone al paciente a tener infecciones respiratorias repetidas, terminando en la aparición de bronquiectasias en la edad adulta. También son frecuentes las infecciones repetidas de oídos y cavidades perinasales. La presencia de situs inverso puede verse en hasta en 50% de los pacientes con esta enfermedad. El diagnóstico de discinesia ciliar primaria es difícil ya que no existe un examen que sea considerado patrón de oro, por lo que se requiere la realización de distintos exámenes. En nuestro país hasta hace poco tiempo solo contábamos con la microscopía electrónica, pero recientemente se ha sumado la medición de óxido nítrico nasal y la videomicroscopía de alta velocidad. En el presente artículo se detallarán las características clínicas más importantes que hacen sospechar la presencia de DCP en las distintas edades y los métodos disponibles para su diagnóstico.

Factores predictivos de conversión en la apendicectomía videolaparoscópica / Predictive factors of conversion in the videolaparoscopic appendectomy

Introducción para el tratamiento de pacientes con apendicitis aguda, la vía videolaparoscópica se ha convertido en la técnica de elección. Desafortunadamente, en ocasiones es necesario convertir el procedimiento a cirugía convencional. Objetivo: identificar los factores predictivos de conversión en la apendicectomía videolaparoscópica. Métodos: se realizó un estudio longitudinal, prospectivo, de cohorte, en 131 pacientes operados de apendicitis aguda mediante cirugía videolaparoscópica en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2010 hasta diciembre del 2014. Para identificar dichos factores, el análisis de los datos se basó en la construcción de un modelo multivariado (regresión logística multivariable). Resultados: se halló predominio de los pacientes jóvenes del sexo masculino. La construcción del modelo de regresión logística estuvo sustentado por 8 variables posiblemente predictoras de conversión, de las cuales 4 resultaron altamente influyentes. Se estimó una sensibilidad de 70,6, una especificidad de 97,4 y un porcentaje global predictivo de 93,9 del modelo de regresión calculado. Conclusiones: los factores de mayor influencia para la conversión de cirugía videolaparoscópica a convencional fueron: laparotomía previa en hemiabdomen inferior, presencia de adherencias diagnosticadas por laparoscopia, ubicación retrocecal y apendicitis perforada

Introduction: the videolaparoscopic procedure has become the election technique for the treatment of patients with acute appendicitis. Unfortunately, in occasions it is necessary to convert the procedure to conventional surgery. Objective: to identify the predictive factors of conversion in the videolaparoscopic appendectomy. Methods: a longitudinal, prospective, cohort study was carried out in 131 patients operated on for acute appendicitis by means of videolaparoscopic surgery in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2010 to December, 2014. The analysis of the data was based on the construction of a multivaried model to identify these factors (multivariable logistical regression). Results: there was a prevalence of young male patients. The construction of the pattern of logistical regression was sustained by 8 possibly predictive variables of conversion, 4 of which were highly influential. Sensibility of 70.6, a specificity of 97.4 and a predictive global percentage of 93.9 of the calculated regression pattern were considered. Conclusions: the most influencial factors for the conversion of videolaparoscopic surgery to conventional surgery were: previous laparotomy in lower hemiabdomen, presence of adherences diagnosed by laparoscopy, retrocaecal location and perforated appendicitis

Ventajas de la microscopia holográfica digital para el estudio de muestras biológicas / Advantages of the digital holographic microscopy for the study of biological samples

Se efectuó una revisión bibliográfica exhaustiva sobre la microscopia holográfica digital y se ofrece una información actualizada sobre esta novedosa técnica de registro óptico en el país, así como de sus fundamentos teóricos y principales aplicaciones en el campo de la biología, para que pueda ser consultada por estudiantes y profesionales de la medicina y ciencias afines, con vistas a promover la realización de futuras investigaciones relacionadas con dicha técnica

An exhaustive literature review on the digital holographic microscopy was carried out and an updated information on this novel technique of optic record, its theoretical foundations and main uses in the field of biology in the country is offered, so that it can be consulted by students and professionals of medicine and similar sciences, aimed at promoting the realization of future investigations related to this technique

Evaluación de la microcirculación con sidestream dark field (SDF) Microscan® como método de monitorización en microcirugía en modelo porcino / Microcirculation assessment with sidestream dark field (SDF) Microscan® as flap monitoring method in microsurgery in a porcine model

Objetivo: Determinar la factibilidad de la monitorización en microcirugía por medio de la evaluación no invasiva de la microcirculación con sidestream dark field (SDF) y compararla con otros métodos. Materiales y métodos: Estudio experimental. En 8 cerdos se elevó colgajo pectoral y se disecó pedículo. Se llevó a cabo una instalación sucesiva de dispositivos cutáneos para la evaluación de la microcirculación: SDF para evaluar flujo, y near infrared spectroscopy (NIRS) para evaluar saturación de O2 (SatO2). Posteriormente se evaluó la oclusión venosa, arterial y total con pinzamiento durante 180 s. Resultados: SDF en oclusión venosa: disminución del flujo: 51 s (59-62); SDF en oclusión arterial: disminución del flujo: 3 s (1-5); SDF en oclusión vascular total: disminución del flujo: 3,5 s (2-5). NIRS en oclusión venosa: disminución de la SatO2:15,2 ± 5,3%; NIRS en oclusión arterial: disminución de la SatO2 23,9 ± 13,8%; NIRS en oclusión vascular total: disminución de la SatO2 23,85 ± 13,9%. Doppler en oclusión venosa: no desapareció; Doppler en oclusión arterial y oclusión vascular total: desapareció a los 2 s. En cada una de las mediciones, los cambios clínicos fueron más tardíos que los observados con SDF. Conclusión: Es factible la monitorización en microcirugía por medio de la evaluación de la microcirculación con Microscan®. Este método permite realizar el diagnóstico de oclusión vascular más tempranamente que con NIRS y evaluación clínica.

Aim: Determine the feasibility of using SDF Microscan® as a non-invasive method for monitoring free flap microcirculation, and compare it to other methods. Materials and methods: Experimental study. In 8 pigs a pectoral myocutaneous flap was raised. Microcirculation was evaluated using: SDF Microscan®, near infrared spectroscopy (NIRS), clinical examination and Doppler. Venous, arterial and total occlusion was performed by clamping the vascular pedicle. Mean time to blood flow impairment diagnosis was measured. Results: SDF in venous occlusion: reduced microcirculatory flow index at: 51 s (59-62). SDF in arterial occlusion: reduced microcirculatory flow index at: 3 s (1-5). SDF in total vascular occlusion: reduced microcirculatory flow index at: 3.5 s (2-5). NIRS in venous occlusion: SatO2 decrease was 15.2 ± 5.3%. NIRS in arterial occlusion: SatO2 decrease was 23.9 ± 13.8%. NIRS in total vascular occlusion: SatO2 decrease was 23.85 ± 13.9%. Doppler in venous occlusion: The signal did not disappear. Doppler arterial and total vascular occlusion disappears at 2 s. The clinical changes were later than SDF. Conclusion: Microcirculation monitoring is feasible using SDF Microscan® in a pig model. This method allows to detect blood flow disruption earlier than NIRS and clinical evaluation.

Presencia de patrón esclerodérmico capilaroscópico en pacientes sin conectivopatías: descripción de dos casos clínicos / Scleroderma pattern in patients without connective tissue disorders: cases reports

Videocapillaroscopy (VCP) is a consolidated imaging technique that helps the clinician in the assessment of connective tissue disorders (CTD). Their findings have demonstrated predictive value, and a potential role in the differential diagnosis and treatment monitoring of CTD. To date, the scleroderma pattern has been described mainly in CTD. We describe two cases in which the presence of scleroderma pattern, evidenced by ATP, is not only present in CTD.

La videocapilaroscopia (VCP) es una técnica de imagen fácil, inocua y sencilla que se ha consolidado como ayuda diagnóstica para las enfermedades del tejido conectivo. Los hallazgos de VCP demostraron tener valor predictivo de patología microangiopática, siendo útil para el diagnóstico diferencial, seguimiento y monitoreo de respuesta al tratamiento. La presencia de patrón esclerodérmico hasta ahora ha sido descrita en patologías asociadas al tejido conectivo. Presentamos dos casos clínicos en los cuales la presencia de patrón esclerodérmico evidenciado por medio de la VCP no es exclusiva de las enfermedades del tejido conectivo.

Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in Stroke / Associação entre presença de resíduos faríngeos e escape oral posterior e a ocorrência de penetração e aspiração no Acidente Vascular Encefálico

PURPOSE: This study aimed at showing association between the posterior oral spillage and pharyngeal residue with tracheal aspiration and/or laryngeal penetration in stroke. METHODS: Clinical cross-sectional retrospective multicenter study. The study included 63 videofluoroscopic tests of post-ischemic stroke individuals and oropharyngeal dysphagia data of the three reference centers providing care for patients with dysphagia (43 men and 20 women; age range: from 40 to 90 years). These individuals were divided into two groups. Group I consisted of 35 participants with the presence of penetration and/or laryngotracheal aspiration, and Group II consisted of 28 individuals with no penetration and/or aspiration. Videofluoroscopic swallowing test results were analyzed to divide the groups, and the presence of posterior oral spillage and pharyngeal residue was observed. RESULTS: No association was found between the groups with posterior oral spillage (χ2=1.65; p=0.30; φ2=0.02), but there was statistical difference for the association between pharyngeal residue (χ2=12.86; p=0.003; φ2=0.20) and the groups. CONCLUSION: There is an association between pharyngeal residue and penetration with tracheal aspiration in post-stroke individuals. .

OBJETIVO: Este estudo teve por objetivo verificar a associação entre a ocorrência de escape oral posterior e a presença de resíduos faríngeos com penetração laríngea e/ou aspiração laringotraqueal no acidente vascular encefálico (AVE). MÉTODOS: Estudo clínico transversal, retrospectivo e multicêntrico. Foram incluídos neste estudo 63 exames videofluoroscópicos de indivíduos pós-AVE isquêmico e disfagia orofaríngea do banco de dados dos serviços de três centros públicos de referência no atendimento do indivíduo disfágico, sendo 43 do gênero masculino e 20 do gênero feminino, faixa etária variando de 40 a 90 anos. Estes foram divididos em dois grupos. O Grupo I foi composto por exames de 35 indivíduos com presença de penetração e/ou aspiração laringotraqueal e o Grupo II, por exames de 28 indivíduos com ausência de penetração e/ou aspiração. Foram analisados exames de videofluoroscopia da deglutição para dividir os grupos e observou-se a presença de escape posterior e resíduos faríngeos. RESULTADOS: Não houve associação entre os grupos com o escape oral posterior (χ2=1,65; p=0,30; φ2=0,02), porém houve associação entre resíduos faríngeos (χ2=12,86; p=0,003; φ2=0,20) e os grupos. CONCLUSÃO: Diante dos resultados obtidos, concluiu-se que há associação entre a presença de resíduos faríngeos com a ocorrência de penetração com aspiração laringotraqueal em indivíduos pós-AVE. .

Dynamics of tear fluid desiccation on a glass surface: a contribution to tear quality assessment

BACKGROUND: Fern-like crystalloids form when a microvolume of tear is allowed to dry out at ambient conditions on a glass surface. Presence of crystalloids in tear "microdesiccates" is used to evaluate patients with Dry-Eye disease. This study aims to examine morphologically the desiccation process of normal tear fluid and to identify changes associated with accelerated tear evaporation. Tear microdesiccates from healthy (Non-Dry Eye) and Dry Eye subjects were produced at ambient conditions. Microdesiccate formation was monitored continuously by dark-field video microscopy. Additionally, accelerated desiccation of tear samples from healthy subjects was conducted under controlled experimental conditions. Particular morphological domains of tear microdesiccates and their progressive appearance during desiccation were compared. RESULTS: In normal tear microdesiccates, four distinctive morphological domains (zones I, II, III and transition band) were recognized. Stepwise formation of those domains is now described. Experimentally accelerated desiccation resulted in marked changes in some of those zones, particularly involving either disappearance or size reduction of fern-like crystalloids of zones II and III. Tear microdesiccates from Dry Eye subjects may also display those differences and be the expression of a more synchronous formation of microdesiccate domains. CONCLUSION: Morphological characteristics of tear microdesiccates can provide insights into the relative rate of tear evaporation.

Herramientas en el diagnóstico y tratamiento de enfermedades dermatológicas, una actualización / Tools in dermatologic's diagnosis and treatment: an update

Para lograr acercarnos a diagnósticos más certeros en nuestra práctica dermatológica, hoy en día contamos con dispositivos que proveen imágenes de alta resolución. La videomicroscopía y microscopía confocal permiten realizar diagnósticos confiables en forma no invasiva, sobre todo en lesiones pigmentadas y tumorales. Por otro lado, como herramienta terapéutica, contamos con equipos que otorgan los efectos benéficos de la luz. Esta puede ser usada en forma aislada o combinada con agentes fotosensibilizantes, lo que se conoce como fototerapia (UVA, UVB o PUVA) y terapia fotodinámica. Cuando la luz es amplificada a través de lásers, puede usarse en distintas longitudes de onda para tratar diferentes células blanco, como son lesiones pigmentadas, vasculares y rejuvenecimiento, entre otras. Se comentan algunas de éstas técnicas y sus principales indicaciones.

In order to get more accurate diagnosis in our dermatological practice, today we have access to high-resolution-images producing devices. Videomicroscopy and confocal microscopy allow us to reach more trustable decisions via non-invasive procedures. This is especially true for pigmented and tumoral lesions. From the therapeutic point of view, we count with equipment that bring light beneficial effects. Light can be used alone or combined with photo sensitizing agents, this is what is known as phototherapy (UVA, UVB, PUVA) and photodynamic therapy. When light is amplified through lasers it wavelength could be modified in order to select specific target cells like those involved in pigmented, vascular and age related processes, among many. Some of these techniques and it's applications are commented in the present document.

Enteroscopia doble balón y videocápsula endoscópica en el diagnóstico de patologías del intestino delgado: hospital universitario de maracaibo. 2007-2010 / Double-balloon enteroscopy and endoscopic video capsule in the diagnosis of diseases of the small intestine: maracaibo university hospital. 2007-2010

Introducción: La Enteroscopia Doble Balón (EDB) y la Videocápsula Endoscópica (VCE) se introdujeron en el Hospital Universitario de Maracaibo desde 2007 y 2008, respectivamente. Se analizó y comparó el desempeño de estas pruebas para diagnosticar enfermedades del intestino delgado. Pacientes y Métodos: Se revisaron retrospectivamente los casos sometidos a EDB superior (EDBS), EDB inferior (EDBI) y/o VCE, desde su implementación hasta enero de 2010. Resultados: En 94 casos (55 ♂ y 39 ♀; 10-89 años) se realizaron 155 procedimientos: 52 EDBS, 8 EDBI, 16 VCE y 79 procedimientos combinados. Indicaciones predominantes: Hemorragia de origen oscuro, hemorragia digestiva superior o inferior, anemia, diarrea crónica y sospecha de tumoración intestinal. Visualización completa del tracto entérico: 86,7% (EDBS), 57,7% (EDBI) y 100% (VCE). Biopsias, terapias y/o cromomarcaje: 58,2% (EDBS) y 23,1% (EDBI). Diagnósticos endoscópicos predominantes: Malformaciones vasculares, enteropatías de aspecto parasitario, neoplasias malignas, enteropatías ulcerosas y erosivas. Concordancia indicación/diagnóstico: 74,3% (EDBS), 57,7% (EDBI) y 70% (VCE). Conclusiones: La EDB y la VCE constituyen herramientas eficientes con ventajas particulares para diagnosticar patologías del intestino delgado: La EDB permite realizar procedimientos adicionales; la VCE ofrece mayor probabilidad de visualizar todo el tracto entérico. En casos concretos, combinar estar pruebas podría aumentar su eficiencia diagnóstica y terapéutica.

Introduction: Double Balloon Enteroscopy (DBE) and Endoscopic Viocapsule (EVC) were introduced in the University Hospital of Maracaibo since 2007 and 2008, respectively. Their performance in diagnosing small bowel diseases were analyzed and compared. Patients and Methods: Cases undergoing upper DBE (UDBE), lower DBE (LDBE) and/or CE, were retrospectively reviewed since the introduction of these techniques, until January 2010. Results: In 94 cases (♂: 55; ♀:39; Ages: 10 to 89), 155 diagnostic procedures were performed: 52 UDBE, 8 LDBE, 16 EVC and 79 combined procedures. Predominating indications: obscure gastrointestinal bleeding, upper and/or lower gastrointestinal bleeding, anemia, chronic diarrhea, and suspicion of an intestinal tumor. Full visualization of small bowel: 86.7% (UDBE), 57.7% (DBUE) and 100% (EVC). Biopsies, therapies and/or India ink tattooing: 58.2% (UDBE) and 23.1% (DBLE). Predominant endoscopic diagnoses: vascular malformations, parasitic enteropathies, malign tumor, ulcerative enteropathies and erosive enteropathies. Agreement indication/diagnosis: 74.3% (UDBE), 57.7% (LDBE) and 70% (EVC). Conclusions: DBE and EVC constitute efficient methods with particular advantages for diagnosing small bowel pathologies: DBE allows additional procedures; EVC provides a greater chance of full visualization of small intestine. In specific cases, combination of these tests could improve their diagnostic and therapeutic efficiency.

Uso ou não uso do torniquete na videoartroscopia do joelho: estudo clínico multicêntrico, prospectivo, duplo-cego e aleatório / Tourniquet versus no tourniquet use in knee videoarthroscopy: a multicentric, prospective, double-blind, randomized clinical trial

OBJETIVO: Avaliar se com o uso da artrobomba (equipo de irrigação com sensor de pressão), o uso do torniquete pneumático poderia interferir no tempo cirúrgico, na recuperação de movimentos e no volume articular em pacientes submetidos à videoartroscopia do joelho para meniscectomia parcial. MÉTODOS: Foram avaliados em cinco diferentes centros e com sete diferentes cirurgiões, 103 pacientes divididos de forma aleatória em dois grupos quanto à utilização ou não do torniquete pneumático. As variáveis foram avaliadas durante a cirurgia e com sete dias de pós-operatório. RESULTADOS: Não se encontrou diferença estatisticamente significativa entre nenhuma das variáveis estudadas. CONCLUSÃO: Não existem razões que justifiquem ou desabonem o uso do torniquete nessa situação específica.

OBJECTIVE: To evaluate if by using a pressure sensitive pump, tourniquet use could affect surgical time, range of motion recovery, and joint volume in patients who underwent knee arthroscopy for medial partial meniscectomy. METHODS: Two groups of 103 patients operated in five different centers by seven different surgeons were evaluated after a random selection to use or not use a pneumatic tourniquet. The variables were evaluated during surgery and seven days post-operation. RESULTS: No statistically significant differences were found among any of the variables studied. CONCLUSION: There is no reason to justify or disapprove tourniquet use in this specific situation.

Utilidad y seguridad del 17-alfa-estradiol 0, 025 por ciento versus minoxidil 2 por ciento en el tratamiento de la alopecia androgenética / Usefulness and safety of 0.025 percent 17-alpha-estradiol versus 2 percent minoxidil in the treatment of androgenetic alopecia

Introducción: La calvicie más común es la alopecia androgenética, la cual consiste en una pérdida progresiva del cabello inducida por la acción de los andrógenos a nivel del folículo piloso. Objetivos: Evaluar la utilidad y seguridad del 17-alfa-estradiol al 0,025 por ciento en el tratamiento de la alopecia androgenética. Material y Métodos: Uso de una solución tópica capilar de 17-alfa-estradiol al 0,025 por ciento versus minoxidil al 2 por ciento en solución tópica capilar, durante 12 semanas, en pacientes chilenos con diagnóstico de alopecia androgenética mediante el análisis cuantitativo del videotricograma. Resultados: Se observó una tendencia al aumento de los cabellos en anágeno y disminución de los cabellos en telógeno en los pacientes tratados con 17-alfa-estradiol al 0,025 por ciento en la zona frontoparietal sin aparición de efectos adversos.

Introduction: Androgenetic alopecia is the most common cause of baldness. It consists of progressive hair loss induced by the action of androgens in the hair follicle. Aim: To evaluate usefulness and safety of 0.025 percent 17-alpha-estradiol in the treatment of androgenetic alopecia. Material and Methods: Use of a topic hair solution of 0.025 percent 17-alpha-estradiol versus 2 percent minoxidil topic hair solution for twelve weeks in Chilean patients with clinically diagnosed androgenetic alopecia through quantitative analysis with videotrichogram. Results: Patients treated with 0.025 percent 17-alpha-estradiol showed a tendency to increase the number of hair follicles in anagen phase and a decrease in telogen phase in the frontoparietal zone with no adverse events.

Evaluación de la microcirculación sublingual en un paciente en shock séptico refractario tratado con hemofiltración de alto volumen / Evaluation of sublingual microcirculation in septic shock: report of one patient treated with high volume hemofiltration

Microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. These alterations have important prognostic implications, being more severe in non-survivors to septic shock. Today microcirculation may be assessed bedside, non-invasively usingpolarized light videomicroscopy a technique known as SDF (side dark field). We report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fascitis associated to septic shock, in whom microcirculation was periodically assessed during his management. The patient was treated with Buids, vasoactive drugs, antibiotics and was operated for exploration and debridement. As the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. Before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. Physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear inflammatory mediators. Since microcirculatory alterations are in part secondary to these mediators, their removal is beneficial. Like other authors, we found no relation between microcirculation and other haemodynamic and perfusion variables.

Utilização do programa Cells Analyser® no estudo comparativo entre imagens do endotélio de córneas obtidas por microscopia especular / Using of Cells Analyser® software in the study of image of corneal specular microscope endothelial samples

OBJETIVOS: Conhecer diferenças entre o número de células, área endotelial avaliada e erro amostral, comparando amostras endoteliais de uma única imagem endotelial, com amostras endoteliais constituídas pelo número de células e imagens, orientadas por software específico. MÉTODOS: Foi realizado estudo transversal, comparando as amostras endoteliais com e sem a intervenção do software. A amostra foi composta de 157 olhos. Foram criados 2 grupos: Grupo 1: composto pelos dados amostrais da primeira imagem dos exames; Grupo 2: composto pelos dados amostrais que consideram o número de imagens necessárias para que o exame seja considerado completo pelo software Cells Analyzer PAT. REC. (Grau de confiança 95 por cento e erro relativo 0,05). Os dados amostrais comparados foram número de células contadas, área da amostra endotelial e erro amostral. Utilizou-se o teste t Student bicaudal, para amostras pareadas, com nível de 99 por cento (p<0,01). RESULTADOS: 157 (52,69 por cento) exames necessitaram de mais de uma imagem endotelial para que se superasse o número mínimo de células endoteliais necessárias. Evidenciou-se diferença estatisticamente significativa, do número de células das amostras endoteliais (p= 4x10-24), da área endotelial avaliada (p= 2x10-18) e do erro amostral (p= 1x10-21) entre o Grupo 1 e o Grupo 2. CONCLUSÃO: O estudo dos dados amostrais sem e com a intervenção do software Cells Analyser®, mostraram-se estatisticamente diferentes, com amostras maiores e erros amostrais menores, o que evidencia a importância do seu uso para se obter exames de microscopia especular de córnea com baixos erros (menor que 5%), conferindo-lhes representatividade e reprodutibilidade.

PURPOSE: To describe differences between number of cells, evaluated endothelial area and relative error comparing endothelial samples from one endothelial image with endothelial samples obtained by guidance of a specific software, with number of cells and images as many as necessary. METHODS: A transversal study was performed, comparing the endothelial samples with and without intervention of the software. The sample consisted of 157 eyes. They were divided into 2 groups. Group 1 consisted of data of the first image and group 2 consisted of data from as many images as necessary for a complete examination guided by the Cells Analyser software (95 percent confidence interval and 0.05 relative error). The evaluated data were number of counted cells, equivalent evaluated field (mm²) and relative error. Student's t test with 99 percent confidence interval (p<0.01) was used. RESULTS: The compared data showed statistically significant differences between groups 1 and 2 in cell count (p=4x10-24), evaluated endothelial field (p=2x10-18) and relative error (p=1x10-21). CONCLUSION: The study of the sample data with and without intervention of the Cells Analyzer® software showed them to be statistically different with greater samples and smaller sample errors, evidencing the importance of their use in order to obtain specular microscopic cornea tests with small errors (less than 5%), giving them representativeness and reproducibility.

Glycol methacrylate-embedding medium to study morphological alterations of saphenous vein under brief and crescent pressurizations / Inclusão em glicol metacrilato para estudar alterações morfológicas de veias safenas humanas submetidas a pressurizações breves e crescentes

PURPOSE: This study sought to evaluate the efficiency of glycol methacrylate-embedding medium to detect morphological alterations of human saphenous vein submitted to brief and crescent pressurizations. METHODS: Saphenous veins of 20 CABG patients were randomly distributed into four experimental groups (control, 100, 200 and 300 mmHg pressures during 15 seconds). To quantify the percentage of endothelium spread over vein surface a microscope magnification of 100x was used for measurements. Morphometric analysis was performed using videomicroscopy with the Leica Qwin software in conjunction with a Leica microscope, videocamera, and an on-line computer. RESULTS: A slight tendency of quantitative increase was observed in all parameters including percentage of endothelium spread over vein surface and thickness of saphenous vein walls (intima and media layers). CONCLUSIONS: The glycol methacrylate-embedding allowed sections with adequate resolution of structural details and revealed to be an extremely useful method to study pressurized human saphenous veins.

OBJETIVO: Avaliar a inclusão em glicol metacrilato para estudar alterações morfológicas de veias safenas humanas submetidas a pressurizações breves e crescentes. MÉTODOS: Veias safena de 20 pacientes submetidos a cirurgia de revascularização do miocárdio foram distribuídas ao acaso em quatro grupos experimentais (controle, pressões de 100, 200 e 300 mmHg durante 15 segundos). Para quantificar a percentagem da superfície venosa recoberta por endotélio utilizou-se o aumento de 100x. A análise morfométrica foi realizada utilizando-se videomicroscopia com auxílio do software Leica Qwin em conjunto com um microscópio Leica e videocâmera, acoplados a um computador. RESULTADOS: Observou-se uma leve tendência de aumento quantitativo de todos os parâmetros avaliados, incluindo a percentagem de superfície recoberta por endotélio e a espessura das paredes das veias safenas. CONCLUSÕES: A inclusão em glicol metracrilato permitiu secções com adequada resolução dos detalhes estruturais, revelando-se um método extremamente útil para o estudo de veias safenas humanas pressurizadas.

Experiencia clínica: análisis cuantitativo del cambio de videotricograma en pacientes chilenas con alopecia androgenética en respuesta a la utilización de una formulación a base de aminexil SP94® / Effect of a formulation using Aminexil SP94® in 48 chilean patients with androgenetic alopecia

Durante un período de 12 semanas se realizó un estudio clínico abierto, de tipo prospectivo, con el fin de evaluar la acción de una formulación a base de Aminexil SP94® en 48 pacientes con alopecia androgenética, diagnosticada clínicamente. Fue posible evaluar los efectos de la formulación sobre la fase anágena y telógena mediante la realización de videotricogramas, y conjuntamente se analizaron los efectos de la formulación sobre densidad capilar, sebumetría y presencia de halo-pericapilar. Se observó una mejoría significativa en cada uno de los parámetros medidos. Los efectos adversos se limitaron a la aparición de ardor en sólo un 4 por ciento de las pacientes, lo cual no derivó en la suspensión del tratamiento ni la eliminación del estudio. Se confirma la eficacia y seguridad de la formulación en el tratamiento de alopecia androgenética.

During twelve weeks, an open and prospective clinical study was performed in order to analyze the effect of a formulation using Aminexil SP94® in 48 patients with clinically diagnosed androgenetic alopecia. We evaluated effects during the telogen and anagen phase with video trichogram, and hair density, sebumetry and pericapillary halo were measured as well. There was a significant improvement in each of the parameters studied. Adverse effects were limited to mild itching in 4 percent of the patients. The efficacy and safety of the formulation in the treatment of androgenetic alopecia was confirmed.

Dimensões geométricas das fibras do músculo sóleo de ratos exercitados em esteira rolante: a importância da análise por meio de imagens digitalizadas / Geographical dimensions of fibers from the soleum muscle in rats exercised on treadmill: the importance of the analysis by means of digitalized images

O objetivo deste trabalho foi avaliar uma nova metodologia para análise de imagens digitalizadas de cortes transversais de fibras musculares esqueléticas de ratos submetidos ao exercício físico em esteira rolante. Foram utilizados segmentos do músculo sóleo de ratos obtidos de cortes histológicos e corados com hematoxilina e eosina (HE). Foram avaliadas 100 fibras musculares para cada animal e medidos o perímetro, a área e os diâmetros máximo, médio e mínimo por meio do processo de segmentação de imagens digitalizadas das seções das fibras usando o programa computacional Image-Pro-Plus. As dimensões geométricas como a área, perímetro e os diâmetros mínimos, médios das seções transversais das fibras musculares revelaram-se adequados para a análise do efeito do treinamento dos ratos. A análise revelou a existência de interação entre os grupos de ratos e a duração do exercício físico. O coeficiente de correlação de Pearson foi maior entre diâmetro médio e a área das fibras (0,97) seguida pela correlação entre os diâmetros máximo e médio com o perímetro (0,93). Concluiu-se que a mensuração do grau de hipertrofia das fibras musculares pode ser feita através da determinação do diâmetro médio ou da área da seção transversal da fibra, constituindo uma metodologia adequada e eficiente especialmente para as fibras musculares com acentuado polimorfismo.

The purpose of this paper was to assess a new methodology to analyze digitalized cross sectional images from the skeletal muscular fibers in rats submitted to physical exercise on treadmill. It was used portions of the soleum muscle of rats attained from histological cuts and tinted with hematoxylin and eosin (HE). 100 muscular fibers were assessed from each animal, and their perimeter, the area, and the maximal, medium and minimal diameters were measured by means of the segmentation process from digitalized images of the fibers' sections using the software Image-Pro Plus. The geometrical dimensions such as the area, the perimeter and the medium and minimal diameters of the cross section of muscular fibers revealed to be adequate to analyze the effect of the training in rats. The analysis revealed the existence of an interaction between the group of rats and the duration of the physical exercise. The Pearson's correlation coefficient was higher between the medium diameter and the area of the fibers (0.97), followed by the correlation between the maximal and medium diameter with the perimeter (0.93). It can be concluded that the measurement of the grade of the hypertrophy of the muscular fibers can be performed by determining the medium diameter or the cross sectional area of the fiber, and thus constituting an adequate and effective methodology especially for muscular fibers with accentuated polymorphism.

El objetivo de este trabajo era evaluar una nueva metodología para el análisis digitalizado de las imágenes de cortes transversales de fibras musculares esqueléticas de ratones sometidos al ejercicio físico en la cinta rodante. Los segmentos del músculo sóleo de ratones obtenidos por cortes histológicos y fueron coloreados con Hematoxilina y Eosina (ÉL). Se estimaron 100 fibras musculares para cada animal, y se midión el perímetro moderado, el área, y el máximo de los diámetros, medio y mínimo a través del proceso de segmentación de digitalizacións de las imágenes de las secciones de las fibras usando un programa computarizado Image Pro-Plus. Las dimensiones geométricas como el perímetro área y los diámetros mínimos, medio de las secciones atravesado de las fibras musculares que ellos se revelaron apropiado para el análisis del efecto del entrenamiento de los ratones. El análisis reveló la existencia de la interacción entre los grupos de ratones y la duración del ejercicio físico. El coeficiente de correlación de Pearson era más grande entre el diámetro elemento y el área de las fibras (0,97) siguiendo para la correlación entre el máximo de los diámetros y medio con el perímetro (0,93). fue Acabado que pueden hacerse las medidas del grado de hipertrofia de las fibras musculares a través de la determinación del diámetro elemento o del área de la sección atravesado de la fibra, constituyendo una metodología apropiada y eficaz sobre todo para las fibras musculares con haber acentuado el polimorfismo.

TNFa increases in vitro migration of human HPV18-positive SW756 cervical carcinoma cells

TNFa has been associated with both, tumor survival and apoptosis. This cytokine is also involved in promoting cell migration during wound healing and tumorigenesis. SW756 is a HPV18-positive cervical carcinoma cell line, which has been used to study different mechanisms of cervical cancer progression. An in vitro assay of scratch wound healing onto monolayers of SW756 cells was used to assess the effect of TNFa on cell migration into a wound space. It was found that SW756 cells have the ability to migrate, but not proliferate in response to scratch wounding in a serum-free medium supplemented with TNFa. RT-PCR analysis showed that SW756 cells express TNFa mRNA when incubated in medium with and without serum. Wound closure and migration rate of SW756 cells were significantly increased in the presence of serum-free media supplemented with TNFa (10 ng/mL) as compared to serum-free media, and media supplemented with either anti-TNFa antibody or both TNFa and anti-TNFa antibody (p<0.05). The results showed a stimulatory effect of TNFa on the migration of SW756 cervical carcinoma cells, suggesting a novel and important role for TNFa in cervical cancer progression.

Telepatologia: nova ferramenta diagnóstica para lesões do aparelho respiratório e importante elo tecnológico entre as áreas da patologia, clínica cirúrgica e pneumologia / Telepathology: a new diagnostic tool for respiratory lesions and important technological link between pathology, surgery and pneumology

Telepatologia é a prática da Patologia à distância, utilizando computadores, videomicroscopia remota e redes digitais integradas (intra-hospitalar ou internet). Os autores têm por objetivo demonstrar a importância daTelepatologia nos procedimentos diagnósticos derotina para lesões do aparelho respiratório, principalmente as pulmonares, além de ressaltar as vantagens do uso de estações de trabalho telepatológicas relatadas na literatura internacional.