Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 65
Filtrar
Mais filtros










Filtros aplicados

Base de dados
Intervalo de ano de publicação
1.
Cient. dent. (Ed. impr.) ; 16(2): 155-160, mayo-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183728

RESUMO

Las extracciones dentarias producen una pérdida ósea en sentido horizontal y vertical, que conllevan alteraciones funcionales para los pacientes, y dificultan la colocación de implantes dentales para los profesionales. Para minimizar esta pérdida ósea, se utilizan diferentes materiales de injerto, entre los cuales destaca el injerto autógeno, por cumplir las características de osteogénesis, osteoconducción y osteoinducción. En el año 2010 se describe por primera vez la utilización de dentina como material de injerto autógeno, demostrando que este material puede ser una alternativa terapéutica al resto de materiales de injerto, al permitir la osteoconducción y la osteoinducción, y mostrar la formación de hueso nuevo en un 46-87% del área con injerto de dentina autógena, 3 meses después de su utilización. La última revisión sistemática publicada en el año 2018, concluyó que los implantes colocados en áreas regeneradas en zonas en las que se empleó dentina como material de injerto, presentaron tasas de supervivencia del 97,7% después de 1 año de seguimiento, sugiriendo este nuevo material como una alternativa con resultados prometedores, aunque son necesarios más estudios al respecto


Subsequent to tooth extraction, a reduction of the length and width of alveolar ridge can be observed. It causes functional alterations to patiens, and problems to proper insertion of dental implants. In order to prevent this bone atrophy, different graft materials can be used, being considered autogenous graft the best because allows osteogenesis, osteoconduction and osteoinduction. In 2010 it was first published the use of autogenous dentine as a graft material, showing it could be an ideal graft material, as a material with excellent osteoconduction and osteoinduction. Besides, this graft material is slowly absorbed and replaced by new bone, in 46-87% of the áreas grafted with dentine, 3 months after regeneration. Last systematic review published in 2018 concluded dental implants inserted in regenerated areas with autogenous dentine had survival rates of 97,7% for over a year follow-up, so this new material is considered an alternative with good results, but there are necessary more studies with long term follow-up


Assuntos
Humanos , Animais , Cirurgia Bucal/instrumentação , Transplante Autólogo/métodos , Osteogênese , Regeneração Óssea , Dentina/metabolismo , Dentina Secundária/crescimento & desenvolvimento , Dentinogênese/fisiologia , Odontoblastos/fisiologia
2.
Cir. plást. ibero-latinoam ; 45(2): 159-168, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184223

RESUMO

Introducción y objetivo. La trigonocefalia, originada por la sinostosis prematura de la sutura metópica, en sus formas más graves presenta mayor restricción del crecimiento lateral de los huesos frontales y temporales, afectando a los rebordes supraorbitarios, limitando el crecimiento y condicionando un hipoteleorbitisimo aparente. Los principales problemas de las técnicas quirúrgicas empleadas para su tratamiento son: falta de corrección del defecto, vaciamiento temporal, daño de suturas no afectadas al hacer transposiciones que producen defectos de crecimiento (sinostosis secundarias), sobrecorrección del hipoteleorbitisimo y defectos óseos. El objetivo de este trabajo es presentar nuestra experiencia en una serie de casos tratados de forma temprana con modificaciones propias a las técnicas abiertas propuestas por Dhellemmes en Francia. Material y método. Entre 2010 y 2018 operamos 7 pacientes con trigonocefalia no sindrómica severa, con una media de 7 meses de edad. Todos fueron estudiados con tomografía computerizada de cráneo con reconstrucción ósea en tres dimensiones (TCC-3D) preoperatoria, postoperatoria inmediata y al año de evolución, electroencefalograma, valoración del neurodesarrollo y por Pediatría y Oftalmología. Resecamos la sutura metópica estenosada y efectuamos craneotomías frontales en forma de alas de escarabajo respetando la sutura coronal. Remodelamos la barra frontoorbitaria con injerto óseo para corregir la angulación y la fijamos con un injerto de hueso. Finalmente practicamos osteotomías radiadas en parietal para modificar la restricción del crecimiento de la bóveda. Resultados. Los resultados funcionales y estéticos fueron excelentes, sin defectos de osificación ni vacío de la fosa temporal, ni morbimortalidad, con cicatriz oculta por el cabello. El desarrollo neurocognitivo de los niños tuvo una mejoría notable de la irritabilidad y de la actividad e interacción con los padres. Conclusiones. En trigonocefalia, la cirugía temprana logra la corrección total del defecto en un solo tiempo quirúrgico, obteniendo una remodelación ósea y un crecimiento armónico del cráneo al respetar el crecimiento del sistema suturario. Las modificaciones a la técnica que proponemos evitan el defecto de vaciamiento temporal y permiten no utilizar material de osteosíntesis


Background and objective. The premature synostosis of the metopic suture in the most severe forms occurs with a restriction of the lateral growth of frontal and temporal bones, affecting the supraorbital rims, which limits its growth and leads to hypoteleorbitism. The triangular shape of the forehead is accentuated by the compensatory growth of the other structures of the skull. The main problem of the handling techniques are: temporal emptying, lack of defect correction, damage of unaffected sutures while making transpositions that will later produce defects in growth and cranial molding. Our aim is to show our surgical experience operated with the variations of the open technique that was conceived by Dhellemmes in France. Methods. Between 2010 and 2018 we operated 7 patients with trigonocephaly; patients' average age was 7 months. They were studied with presurgical and post operatory CBT-3D, electroencephalograms, neurodevelopmental assessment and by Pediatry and Ophthalmology. Stenosed metopic suture was resected and frontal craniotomies shaped like beetle wings were performed out without drying the coronal suture, securing them to the fronto-orbital bar with a discreet progress of the side edges. The medial osteotomy of the orbital toolbar was used to reshape it and correct its angulation fixing it with a bone graft and radiated parietal osteotomy to modify the restriction of frontoparietal growth. Results. Functional and aesthetic results were excellent, without ossification defects or vacuum the temporal fossa, morbidity or mortality, with the scar hidden by hair. Children's neuropsychological development had a noticeable improvement in irritability, activity and interaction with their rents. Conclusions. In trigonocephaly, early surgery achieves total defect correction in a single procedure and a bone remodeling and harmonic skull growth by respecting the sutures system. Our modifications to the technique avoid the temporary emptying defect and don't use osteosynthesis material


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Craniossinostoses/cirurgia , Craniotomia/métodos , Craniossinostoses/diagnóstico por imagem , Sinostose/cirurgia , Osteogênese , Remoção de Cabelo , Procedimentos Cirúrgicos Reconstrutivos/métodos , Osteotomia/métodos , Diagnóstico Diferencial
3.
Rev. osteoporos. metab. miner. (Internet) ; 11(2): 64-71, abr.-jun. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188338

RESUMO

Objetivo: Analizar el efecto de los secretomas de tumores sólidos organotrópicos hacia el hueso en células de linaje osteogénico, de tipo osteoblástico y osteocítico, en la expresión de genes relacionados con el metabolismo óseo. Material y método: Caracterizamos los cambios en expresión génica por PCR cuantitativa a tiempo real del eje OPG/RANKL, así como de otros genes relacionados con la diferenciación osteoblástica como son Runx2 y osteocalcina, inducidos por los medios condicionados de células tumorales prostáticas, mama y melanoma en pre‐osteoblastosMC3T3‐E1 y osteocitos MLO‐Y4 murinos o en osteoblastos humanos, según correspondiese por especie. Resultados: La estimulación de las células osteocíticas con medios condicionados de células de melanoma o adenocarcinoma prostático indujo un incremento en la expresión génica de OPG y también de RANKL, viéndose incrementado la ratio OPG/RANKL. Únicamente el secretoma de las células de adenocarcinoma prostático alteró la expresión de Runx2en osteocitos. Los medios condicionados de células de cáncer de mama modificaron únicamente la expresión de RANKLen células osteoblásticas, viéndose disminuido la ratioOPG/RANKL. Conclusión: Los factores solubles tumorales tienen como diana celular a las células osteocíticas, favoreciendo la inducción de un nicho pre‐metastásico óseo por modificación de la ratio OPG/RANKL en el entorno óseo, y, con ello, la progresión de tumores organotrópicos óseos como son el melanoma y adenocarcinomas prostático


Objective: To analyze the effect of the secrets of solid organotropic tumors towards bone in osteogenic, osteoblastic and osteocytic lineage cells, in the expression of genes related to bone metabolism. Material and method: We characterize the changes in gene expression by quantitative real‐time PCR of the OPG/RANKL axis, as well as other genes related to osteoblastic differentiation such as Runx2 and osteocalcin, induced by the conditioned means of prostate tumor cells, breast and melanoma in pre MC3T3‐E1 osteoblasts and murine MLO‐Y4 osteocytes or in human osteoblasts, as appropriate by species. Results: Stimulation of osteocitic cells with conditioned means of melanoma or prostate adenocarcinoma cells inducedan increase in OPG and RANKL gene expression, with the OPG/RANKL ratio being increased. Only the secretome of prostate adenocarcinoma cells altered the expression of Runx2 in osteocytes. Conditioned media of breast cancer cellsonly modified the expression of RANKL in osteoblast cells, with a decrease in OPG/RANKL ratio. Conclusion: Soluble tumor factors have osteocitic cells as their cellular target, favoring the induction of a pre‐metastatic bone niche by modifying the OPG/RANKL ratio in the bone environment, and, thus, the progression of bone organo‐tropic tumors such as melanoma and prostatic adenocarcinomas


Assuntos
Humanos , Animais , Camundongos , Osteogênese/fisiologia , Metástase Neoplásica/patologia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/metabolismo , Osteócitos/metabolismo , Osteoblastos/metabolismo , Regulação Neoplásica da Expressão Gênica , Reação em Cadeia da Polimerase em Tempo Real , Células Tumorais Cultivadas
4.
Reumatol. clin., Supl. (Barc.) ; 15(supl.1): 2-6, abr. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184207

RESUMO

Una de las características patogénicas de las espondiloartritis (EspA) es la neoformación ósea. Distintos estudios han puesto de manifiesto que el origen de este proceso está en las entesis, donde algunos factores desen cadenantes, como el estrés biomecánico, en un individuo genéticamente predispuesto producirían una compleja cascada de señales que favorecería la vasodilatación local y la activación de células inmunocompetentes residentes. Estas, a su vez, provocarían una respuesta inflamatoria caracterizada por la secreción de factor de necrosis tumoral alfa e interleucina 17 (IL-17), entre otros, y reclutamiento de otras células inmunocompetentes. Además, se ha demostrado que la IL-17 y la IL-22 favorecen la proliferación de células madre mesenquimatosas del periostio perientesítico, lo que lleva a la formación de hueso nuevo en la entesis. En las EspA, la formación de hueso nuevo es principalmente ortotópica (en continuidad con el hueso existente) y se origina a partir de la entesis y del periostio. Al parecer, la mayoría de la neoformación ósea se produce mediante osificación endocondral. En la osificación endocondral, las células progenitoras mesenquimatosas se diferencian en condrocitos, que construyen un «molde» de cartílago, en el cual las células progresivamente maduran y evolucionan hacia condrocitos hipertróficos. Esta matriz es invadida por vasos y precursores osteoblásticos que reemplazan progresivamente el modelo por hueso maduro


One of the pathogenic characteristics of spondyloarthritis (SpA) is bone neoformation. Several studies have revealed that this process originates in the enthesis, in which triggering factors such as biomechanical stress in genetically predisposed individuals may produce a complex cascade of signals favouring local vasodilation and activation of resident immune cells. These in turn induce an inflammatory response characterised by secretion of TNF-alfa and IL-17 (among other substances) and recruitment of other immune cells. In addition, it has been demonstrated that IL-17 and IL-22 favour the proliferation of mesenchymal stem cells of the peri-enthesic periosteum, leading to the formation of new bone in the enthesis. In SpA, new bone formation is mainly orthotopic (in continuity with existing bone) and arises from the enthesis and periosteum. Most bone neoformation seems to occur through endochondral ossification. In this process, mesenchymal progenitor cells differentiate towards chondrocytes, which construct a cartilaginous "mould" in which the cells progressively mature and develop towards hypertrophic chondrocytes. This matrix is invaded by vessels and osteoblastic precursors that progressively replace the model with mature bone


Assuntos
Humanos , Espondilartrite/fisiopatologia , Osteocondrodisplasias/fisiopatologia , Ossificação Heterotópica/fisiopatologia , Periósteo/fisiopatologia , Osteogênese/fisiologia
5.
Rev. int. cienc. podol. (Internet) ; 13(2): 99-113, 2019. tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-186921

RESUMO

Contexto: El pie equinovaro es una deformidad musculoesquelética congénita caracterizada por la presencia de cavo, varo, adducto y equino. Afecta a 1-7 de cada 1000 nacimientos. Un pie zambo no tratado puede generar dolor y discapacidad durante la vida de la persona. El método Ponseti se ha convertido en la principal modalidad de tratamiento para el manejo del pie zambo produciendo buenos resultados a largo plazo. El objetivo de este manuscrito fue evaluar la eficacia del método Ponseti y la evolución de los pacientes en función de las tasas de recurrencia, tenotomías y cirugías asociadas. También se determinó si la edad de los niños influía en el éxito del tratamiento. Métodos: Se realizó una estrategia de búsqueda a través de Pubmed hasta abril de 2018. Los términos de búsqueda incluyeron pie zambo, método Ponseti y pie equinovaro. Se incluyeron metaanálisis, revisiones sistemáticas, ensayos clínicos y series de casos. También se examinaron las referencias bibliográficas de los artículos seleccionados. Resultados: Veintisiete artículos fueron incluidos en esta revisión. La literatura actual muestra una tasa de éxito del 78-92% utilizando el método Ponseti. Conclusión: El método Ponseti ofrece resultados alentadores en términos funcionales y estéticos, así como disminución del grado de corrección quirúrgica cuando los resultados no sean los esperados. Se necesita más investigación para generar evidencia de mayor calidad con mayores tamaños muestrales y unificación a la hora de medir la severidad de la deformidad. Otra limitación encontrada fue la ausencia de la definición de fracaso de tratamiento y sus correspondientes motivos


Background: Clubfoot is a congenital musculoskeletal deformity characterized by heel varus, indfoot equinus, mid-foot cavus and forefoot adduction. It is the most common defect that affects between 1 and 7 births in every 1000. Left untreated, clubfoot may lead to pain and disability throughout the person ́s life. Ponseti method has become the main treatment modality for the management of clubfoot producing good long-term results. The aim of this manuscript was to determine the efficacy of the Ponseti method for the treatment of CTEV and to evaluate the evolution of patients based on the recurrence rate, tenotomies rates and surgeries. Also determine if the age of children influences the success of the treatment. Methods: A search strategy completed examined Pubmed from inception to April 2018. Search terms included clubfoot, Ponseti method and equinovarus. Meta-analysis, systematic reviews, randomized control trials and case series were included. The reference lists of the selected articles were also examined. Results: Twenty-seven articles were included in this review. The current literature shows a success of the Ponseti method of 78-92%. Conclusion: Ponseti treatment for clubfoot has encouraging results in terms of attaining a functionally and cosmetically foot and lessening the extent of surgical correction in cases in which it does not reach the expected results. Further research is needed to generate higher quality evidence with larger sample sizes hich evaluate the severity of the deformity with the same measures. Another lack was the absence of a definition of treatment failure with the reasons


Assuntos
Humanos , Pé Torto Equinovaro/epidemiologia , Índice de Gravidade de Doença , Manipulações Musculoesqueléticas/métodos , Pé Torto Equinovaro/terapia , Estética , Pé Torto Equinovaro/classificação , Osteogênese , Manipulação Ortopédica , Manipulações Musculoesqueléticas/estatística & dados numéricos , Tenotomia/métodos , Aparelhos Ortopédicos
6.
J. physiol. biochem ; 74(3): 395-402, ago. 2018. graf, ilus
Artigo em Inglês | IBECS | ID: ibc-178994

RESUMO

Bone is a dynamic organ, the bone-forming osteoblasts and bone-resorbing osteoclasts form the physiological basis of bone remodeling process. During pathological process of numerous inflammatory diseases, these two aspects are uncoupled and the balance is usually tipped in favor of bone destruction. Evidence suggests that the inflammatory destruction of bone is mainly attributed to oxidative stress and is closely related to mitochondrial dysfunction. The mechanisms underlying osteogenic dysfunction in inflammation still need further investigation. Reactive oxygen species (ROS) is associated with mitochondrial dysfunction and cellular damage. Here, we reported an unexplored role of cyclophilin D (CypD), the major modulator of mitochondrial permeability transition pore (mPTP), and the CypD-mPTP axis in inflammation-induced mitochondrial dysfunction and bone damage. And the protective effects of knocking down CypD by siRNA interference or the addition of cyclosporin A (CsA), an inhibitor of CypD, were evidenced by rescued mitochondrial function and osteogenic function of osteoblast under tumor necrosis factor-alfa (TNF-alfa) treatment. These findings provide new insights into the role of CypD-mPTP-dependent mitochondrial pathway in the inflammatory bone injury. The protective effect of CsA or other moleculars affecting the mPTP formation may hold promise as a potential novel therapeutic strategy for inflammation-induced bone damage via mitochondrial pathways


No disponible


Assuntos
Animais , Camundongos , Ciclofilinas/metabolismo , Mitocôndrias/metabolismo , Proteínas de Transporte da Membrana Mitocondrial/metabolismo , Osteíte/metabolismo , Osteoblastos/metabolismo , Osteogênese , Estresse Oxidativo , Apoptose , Transporte Biológico Ativo , Biomarcadores/metabolismo , Ciclofilinas/antagonistas & inibidores , Ciclosporina/farmacologia , Imunossupressores/farmacologia , Mitocôndrias , Proteínas de Transporte da Membrana Mitocondrial/agonistas , Proteínas de Transporte da Membrana Mitocondrial/antagonistas & inibidores , Forma das Organelas
7.
Actas dermo-sifiliogr. (Ed. impr.) ; 109(5): e33-e36, jun. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-175539

RESUMO

El síndrome de Iso-Kikuchi, onicodisplasia congénita del dedo índice, es una entidad poco frecuente caracterizada por la anoniquia total o displasia de la uña del dedo índice, acompañado, en algunas ocasiones, de alteraciones óseas subyacentes, por lo general, en ausencia de otras anomalías. Si bien se han planteado distintas hipótesis fisiopatogénicas, la etiología sigue siendo desconocida. Describimos los casos de 3 pacientes pediátricos, 2 varones y una niña, con alteraciones ungueales y óseas compatibles con el síndrome de Iso-Kikuchi. Destacamos la importancia de reconocer esta entidad tempranamente para evitar la realización de estudios complementarios y terapéuticas innecesarias


Iso-Kikuchi syndrome, or congenital onychodysplasia of the index finger, is an uncommon condition characterized by total anonychia or dysplasia of the nail of the index finger. It is occasionally accompanied by underlying bone abnormalities and is rarely associated with other conditions. Although various hypotheses have been put forward to explain the pathophysiology of the syndrome, its etiology remains unknown. We report the cases of 3 pediatric patients (2 boys and 1 girl) with nail changes and bone abnormalities consistent with Iso-Kikuchi syndrome. We highlight the importance of recognizing this entity early to avoid the need for additional tests and unnecessary treatment


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Doenças da Unha/congênito , Falanges dos Dedos da Mão/anormalidades , Doenças da Unha/diagnóstico , Síndrome , Diagnóstico Diferencial , Osteogênese
8.
Med. oral patol. oral cir. bucal (Internet) ; 23(3): e315-e319, mayo 2018. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-175883

RESUMO

Background: Odontogenic myxoma (OM) is a benign intraosseous neoplasm that exhibits local aggressiveness and high recurrence rates. Osteoclastogenesis is an important phenomenon in the tumor growth of maxillary neoplasms. RANK (Receptor Activator of Nuclear Factor κappa B) is the signaling receptor of RANK-L (Receptor activator of nuclear factor kappa-Β ligand) that activates the osteoclasts. OPG (osteoprotegerin) is a decoy receptor for RANK-L that inhibits pro-osteoclastogenesis. The RANK / RANK-L / OPG system participates in the regulation of osteolytic activity under normal conditions, and its alteration has been associated with greater bone destruction, and also with tumor growth. Objectives: To analyze the immunohistochemical expression of OPG, RANK and RANK-L proteins in odontogenic myxomas (OMs) and their relationship with the tumor size. Material and Methods: Eighteen OMs, 4 small (<3 cm) and 14 large (> 3cm) and 18 dental follicles (DF) that were included as control were studied by means of standard immunohistochemical procedure with RANK, RANK-L and OPG antibodies. For the evaluation, 5 fields (40x) of representative areas of OM and DF were selected where the expression of each antibody was determined. Descriptive and comparative statistical analyses were performed with the obtained data. Results: There are significant differences in the expression of RANK in OM samples as compared to DF (p= 0.022) and among the OMSs and OMLs (p= 0.032). Also a strong association is recognized in the expression of RANK-L and OPG in OM samples. Conclusions: Activation of the RANK / RANK-L / OPG triad seems to be involved in the mechanisms of bone balance and destruction, as well as associated with tumor growth in odontogenic myxomas


No disponible


Assuntos
Mixoma/metabolismo , Mixoma/patologia , Tumores Odontogênicos/metabolismo , Tumores Odontogênicos/patologia , Osteogênese , Ligante RANK/biossíntese , Receptor Ativador de Fator Nuclear kappa-B/biossíntese , Carga Tumoral
9.
J. physiol. biochem ; 74(1): 3-8, feb. 2018. graf
Artigo em Inglês | IBECS | ID: ibc-178912

RESUMO

The taste receptor type 1 (TAS1R) family of heterotrimeric G protein-coupled receptors participates in monitoring energy and nutrient status. TAS1R member 3 (TAS1R3) is a bi-functional protein that recognizes amino acids such as L-glycine and L-glutamate or sweet molecules such as sucrose and fructose when dimerized with TAS1R member 1 (TAS1R1) or TAS1R member 2 (TAS1R2), respectively. It was recently reported that deletion of TAS1R3 expression in Tas1R3 mutant mice leads to increased cortical bone mass but the underlying cellular mechanism leading to this phenotype remains unclear. Here, we independently corroborate the increased thickness of cortical bone in femurs of 20-week-old male Tas1R3 mutant mice and confirm that Tas1R3 is expressed in the bone environment. Tas1R3 is expressed in undifferentiated bone marrow stromal cells (BMSCs) in vitro and its expression is maintained during BMP2-induced osteogenic differentiation. However, levels of the bone formation marker procollagen type I N-terminal propeptide (PINP) are unchanged in the serum of 20-week-old Tas1R3 mutant mice as compared to controls. In contrast, levels of the bone resorption marker collagen type I C-telopeptide are reduced greater than 60% in Tas1R3 mutant mice. Consistent with this, Tas1R3 and its putative signaling partner Tas1R2 are expressed in primary osteoclasts and their expression levels positively correlate with differentiation status. Collectively, these findings suggest that high bone mass in Tas1R3 mutant mice is due to uncoupled bone remodeling with reduced osteoclast function and provide rationale for future experiments examining the cell-type-dependent role for TAS1R family members in nutrient sensing in postnatal bone remodeling


No disponible


Assuntos
Animais , Masculino , Reabsorção Óssea/metabolismo , Osso Cortical/metabolismo , Regulação da Expressão Gênica no Desenvolvimento , Células-Tronco Mesenquimais/metabolismo , Osteoblastos , Osteoclastos/metabolismo , Osteogênese , Receptores Acoplados a Proteínas-G/metabolismo , Biomarcadores/metabolismo , Reabsorção Óssea/imunologia , Reabsorção Óssea/patologia , Catepsina K , Linhagem Celular , Osso Cortical , Células-Tronco Mesenquimais/citologia , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Mutantes
10.
Cient. dent. (Ed. impr.) ; 14(3): 187-192, sept.-dic. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-170388

RESUMO

Introducción. El quiste dentígero es un quiste odontógeno del desarrollo de origen epitelial, siendo el más común después del radicular. Generalmente se asocia con la corona de dientes permanentes impactados o no erupcionados y su aparición es más frecuente en varones durante la segunda década de la vida. Los dientes que suelen verse más afectados son los terceros molares mandibulares, seguido de los caninos maxilares. A causa de su curso asintomático, el diagnóstico suele realizarse por hallazgo casual en radiografías panorámicas rutinarias. Para el diagnóstico definitivo es indispensable la realización de la anatomía patológica. Caso clínico. Se presenta el caso clínico de dos mujeres de 60 y 42 años de edad, sin antecedentes médicos de interés, remitidas al servicio de Cirugía Bucal del hospital Virgen de la Paloma, presentando una imagen radiográfica radiotransparente asociada a la corona del tercer molar inferior izquierdo sin sintomatología asociada. Tras realizar la extracción quirúrgica de los cordales afectados y la lesión quística asociada, se obtiene el diagnóstico definitivo mediante la anatomía patológica, posteriormente se realizan controles clínicos y radiográficos de la zona. Conclusiones. El quiste dentígero representa el segundo quiste odontógeno más frecuente después del quiste radicular en terceros molares retenidos. Es importante el examen radiográfico periódico de terceros molares incluidos para el diagnóstico y tratamiento de esta entidad patológica (AU)


Introduction. A dentigerous cyst or follicular cyst is defined as a developmental odontogenic cyst of an epitelial origin which represents the second most common entity after the radicular cyst. Generally it is associated with the crown of a permanent unerupted tooth (or semi-erupted) and it tends to be more frequent in males during the second decade of life. The most common location of dentigerous cyst are mandibular third molars followed by the maxillary canines. Due to its asymptomatic behaviour, the diagnosis is reached by routine panoramic radiography, however, the anatomopathologic analysis will define its nature. Case Report. A case report of a 42 and 60 year old females with no medical history of interest, referred to the Oral Surgery Service of the hospital Virgen de la Paloma with a radiotransparent images surrounding the crown of the lower left third molar without associated symptoms. After the extraction of the teeth, cystic lessions are sent for anatomopathological study, which confirm the presumption diagnosis, dentigerous cyst. Patients carried out posterior follow ups sho-wing a positive healing of the bone around the surgical area. Conclusions. Dentigerous cyst represents the second most frequent odontogenic cyst after the radicular cyst at mandibular third lower molars. It is essential to monitor retained mandibular lower third molars for the incipient approach of the pathology (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cistos Odontogênicos/complicações , Cistos Odontogênicos/cirurgia , Dente Serotino/patologia , Cisto Dentígero/cirurgia , Cisto Dentígero/diagnóstico por imagem , Boca/patologia , Cisto Dentígero/etiologia , Cisto Dentígero/patologia , Radiografia Panorâmica/métodos , Osteogênese
11.
Med. oral patol. oral cir. bucal (Internet) ; 22(4): e512-e519, jul. 2017. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-164954

RESUMO

Background: The aim of this systematic literature review was to evaluate the feasibility of topical bisphosphonate application for preserving/enhancing alveolar bone in oral implantology. Material and Methods: An electronic search was conducted in the PubMed/Medline, EMBASE, Scopus, Web of knowledge, and Google-Scholar databases for articles dated from January 2000 to December 2016. Two reviewers assessed the quality of the studies independently. Results: A total of 154 abstracts were identified, of which 18 potentially relevant articles were selected; a final total of nine papers were included for analysis. Comparison of the findings of the selected studies was made difficult by the heterogeneity of the articles, all of them animal research papers that showed heterogeneity in the methodologies used and a high or moderate risk of bias. Conclusions: The topical application of bisphosphonate solution would appear to favor new bone formation in alveolar defects, and boosts the regenerative capacities of biomaterials resulting in increased bone density (AU)


No disponible


Assuntos
Humanos , Difosfonatos/farmacocinética , Reabsorção Óssea/tratamento farmacológico , Osteogênese , Implantação Dentária/métodos , Administração Tópica , Regeneração Óssea , Materiais Biocompatíveis/uso terapêutico
13.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 60(4): 251-255, jul.-ago. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-153782

RESUMO

Las lesiones del nervio ciático asociadas a fracturas acetabulares pueden ser postraumáticas, perioperatorias o postoperatorias. Las lesiones postoperatorias tardías son extremadamente raras y pueden deberse a osificaciones heterotópicas, cicatrización hipertrófica o migración del material de osteosíntesis. Presentamos el caso de una paciente de 39 años con antecedente de una fractura transversa de acetábulo izquierdo intervenida mediante placa de reconstrucción en la columna posterior. Tras 17 años asintomática, comenzó con dolor progresivo y paresia de varios meses de evolución en territorio ciático. Tras el pertinente estudio neurofisiológico y radiológico, se decidió intervenir quirúrgicamente a la paciente, constatándose una transección del nervio ciático por compresión prolongada de uno de los tornillos de la placa de osteosíntesis. A los 4 años tras la descompresión quirúrgica, la paciente presentaba mejoría significativa del dolor neurógeno, sin parestesias. No obstante, no ha experimentado recuperación motora. Este caso clínico suscita interés dada la excepcionalidad de esta presentación tardía de lesión nerviosa, producida por la compresión prolongada del material de osteosíntesis (AU)


Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement (AU)


Assuntos
Humanos , Feminino , Adulto , Acetábulo/lesões , Acetábulo/cirurgia , Acetábulo , Nervo Isquiático/lesões , Nervo Isquiático/cirurgia , Osteogênese/fisiologia , Dor/complicações , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Lesões do Quadril , Estudos Retrospectivos
14.
Radiología (Madr., Ed. impr.) ; 58(4): 294-300, jul.-ago. 2016. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-154188

RESUMO

Objetivo. Existen pocos estudios que evalúen las características radiológicas del desarrollo de la tuberosidad tibial anterior (TTA). El presente trabajo tiene por objeto evaluar las características radiológicas de la TTA en una población pediátrica de acuerdo a grupos de edad. Material y métodos. Es un estudio llevado a cabo en 210 radiografías de rodillas de pacientes entre los 10 y 17 años, que fueron divididos por grupos de edad y sexo. Se evaluaron la presencia de osificación de la TTA, la distancia de esta a la metáfisis y la fusión con la epífisis. Resultados. A los 10 años de edad, la TTA estaba osificada en el 50% de las mujeres y solo en el 25% de los hombres. A los 11 años todas las mujeres tenían osificada la TTA, a los 12 tenían fusión de la TTA y con la epífisis, y a los 17 años la fusión era completa. En los hombres este proceso se produce un año más tarde que en las mujeres. En todos los casos se encontró un solo núcleo de osificación. Conclusión. La osificación de la TTA se inicia distalmente, posteriormente se fusiona su parte proximal con el resto de la epífisis y finalmente se fusiona en su parte distal a la tibia. Este estudio ayuda a un mejor análisis de la TTA cuando nos enfrentamos a un dolor de rodilla (AU)


Objective. Few studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups. Material and methods. We assessed 210 plain-film X-rays of the knee from patients aged from 10 to 17 years, divided into groups according to age and sex, for the presence of ossification of the anterior tibial tuberosity, the distance between the anterior tibial tuberosity and the metaphysis, and fusion with the epiphysis. Results. At 10 years of age, the anterior tibial tuberosity was ossified in 50% of the girls but in only 25% of the boys. In all the girls, the anterior tibial tuberosity was ossified at 11 years, fusion of the anterior tibial tuberosity with the epiphysis had started at 12 years, and fusion was complete by 17 years. In boys, the process is delayed by one year compared to girls. A single center of ossification was found in all cases. Conclusion. The ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Joelho/patologia , Joelho , Osteogênese/efeitos da radiação , Osteocondrose/patologia , Osteocondrose , Tíbia/patologia , Tíbia , Lâmina de Crescimento , Lâmina de Crescimento/patologia , Declaração de Helsinki , Análise Estatística
15.
Acta otorrinolaringol. esp ; 67(4): 226-232, jul.-ago. 2016. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-154420

RESUMO

Objetivos: Analizar la ontogenia del canal semicircular superior y del tegmen tympani y determinar si hay factores embriológicos comunes que expliquen la dehiscencia asociada de ambos. Métodos: Se han analizado 77 series embriológicas humanas de edades comprendidas entre las 6 semanas y recién nacidos. Las preparaciones estaban cortadas en serie y teñidas con la técnica de tricrómico de Martins. Resultados: La prolongación tegmentaria del tegmen tympani y el canal semicircular superior se originan de la misma estructura, la cápsula ótica, y poseen el mismo tipo de osificación endocondral; mientras que la prolongación escamosa del tegmen tympani se desarrolla desde la escama del temporal y su osificación es de tipo directa o intramembranosa. En la osificación de la prolongación tegmentaria colaboran los núcleos de osificación de los canales semicirculares superior, externo y accesorio del tegmen, los cuales por crecimiento se extienden hasta la prolongación tegmentaria, este hecho sumado a que ambas estructuras comparten una capa común de periostio externo podría explicar la coexistencia de falta de cobertura ósea en el tegmen y en el canal. Conclusión: El desarrollo del canal semicircular y tegmen tympani podrían explicar las causas de la asociación de ambas dehiscencias (AU)


Objectives: To analyze the ontogeny of the superior semicircular canal and tegmen tympani and determine if there are common embryological factors explaining both associated dehiscence. Methods: We analyzed 77 human embryological series aged between 6 weeks and newborn. Preparations were serially cut and stained with Masson's trichrome technique. Results: The tegmental prolongation of tegmen tympani and superior semicircular canal originate from the same structure, the otic capsule, and have the same type of endochondral ossification; while the extension of the squamous prolongation of tegmen tympani runs from the temporal squama and ossification is directly of intramembranous type. The nuclei of ossification of the superior and external semicircular canals and accessory of tegmen collaborate in the ossification of the tegmental extension and by growth extend to the tegmental prolongation. This fact plus the fact that both structures share a common layer of external periosteum could explain the coexistence of lack of bone coverage in tegmen and superior semicircular canal. Conclusion: The development of the semicircular canal and tegmen tympani could explain the causes of the association of both dehiscences (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Canais Semicirculares/anatomia & histologia , Canais Semicirculares/citologia , Embriologia/métodos , Embriologia/tendências , Osso Temporal/embriologia , Feto/embriologia , Membrana Timpânica/embriologia , Perfuração da Membrana Timpânica/embriologia , Pesquisas com Embriões , Ductos Semicirculares/anatomia & histologia , Osteogênese/fisiologia
16.
Acta otorrinolaringol. esp ; 67(1): 33-39, ene.-feb. 2016. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-148956

RESUMO

Introducción y objetivos: La cirugía endoscópica nasosinusal es la técnica de elección en la mayoría de los procesos patológicos del seno frontal, tanto inflamatorios como tumorales, quedando relegadas las indicaciones del abordaje externo mediante osteoplastia frontal para casos con dificultades por vía endoscópica. El objetivo de este trabajo es revisar las indicaciones actuales de la osteoplastia frontal en la patología del seno frontal mediante un estudio retrospectivo de pacientes intervenidos de esta técnica. Métodos: Se realiza un estudio retrospectivo de 14 pacientes intervenidos de osteoplastia frontal en el que se revisaron los criterios de las indicaciones quirúrgicas, tipo de patología del seno frontal, existencia de cirugía endoscópica previa, hallazgos quirúrgicos, complicaciones y recidiva. Resultados: La patología del seno frontal fue de un osteoma (7,1%), 3 papilomas invertidos (21,4%) y 10 mucoceles (71,4%). Nueve pacientes habían sido intervenidos previamente de cirugía endoscópica. Diez pacientes presentaron una dehiscencia orbitaria (9 casos de mucocele y un caso de papiloma). El osteoma frontal era de grado iv y los 3 casos de papilomas correspondían a un grado iii de Krouse. El 21,4% requirieron una revisión quirúrgica. Conclusiones: Las principales indicaciones son la extensión lateral y la neo-osteogénesis del receso frontal en el caso de la enfermedad inflamatoria del seno frontal, el tamaño del tumor en el caso de los osteomas, y la implantación multifocal con origen en la pared anterior y lateral en el caso de los papilomas invertidos. En todos los casos la indicación de osteoplastia frontal debe hacerse de forma individualizada (AU)


Introduction and objectives: Endoscopic sinus surgery is the technique of choice in most of the frontal sinus diseases, both inflammatory and tumour-related. This is why the external approach using osteoplastic flap (OF) would be limited to cases with a difficult endoscopic approach. Our aim was to review the current indications of the osteoplastic flap in the treatment of frontal sinus pathology, through a retrospective study of patients undergoing this technique. Methods: We performed a retrospective study of 14 patients who were treated with the osteoplastic flap procedure. All the surgical indication criteria, type of sinus disease, presence or absence of prior endoscopic surgery, surgical findings, complications and recurrence were reviewed. Results: The pathologies found were 1 osteoma (7.1%), 3 inverted papilloma (21.4%) and 10 mucoceles (71.4%). Nine patients had a prior endoscopic surgery and 10 patients had an orbital dehiscence (9 mucocele, 1 papilloma). Frontal osteoma was Grade IV and the papilloma cases were Krouse Stage III. Surgical revision was required for 21.4%. Conclusions: The main indications for an OF in patients with inflammatory disease are lateral extension and frontal recess neo-osteogenesis. In osteoma cases, it depends on the size of the tumour. In inverted papilloma cases, the indication is multifocal implantation with origin in the anterior and lateral wall. In all cases, performing the osteoplastic flap must be individualised (AU)


Assuntos
Masculino , Feminino , Adulto , Idoso , Humanos , Seio Frontal/patologia , Osteoma/cirurgia , Papiloma Invertido/cirurgia , Mucocele/cirurgia , Pólipos Nasais/cirurgia , Endoscopia , Osteogênese , Estudos Retrospectivos
17.
Arch. med. deporte ; 32(165): 32-35, ene.-feb. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-139221

RESUMO

El crecimiento óseo es un proceso complejo que se lleva a cabo en un elemento altamente especializado, que es la fisis o cartílago de crecimiento, y que puede sufrir lesiones por sobreuso igual que cualquier otro tejido del aparato locomotor. Estas lesiones suelen manifestarse por dolor sin un desencadenante evidente, aunque coincidiendo con épocas de incremento de la carga de entrenamiento y brotes de crecimiento. Las imágenes radiográfi cas pueden ser muy poco expresivas en las fases iniciales, pero la RMN muestra un ensanchamiento característico de la fi sis, que puede ser local o global, y que ayuda a realizar un diagnóstico precoz. El incremento de la actividad deportiva organizada y específica desde edades tempranas hace que sea fundamental que el médico que atiende a los deportistas en edad de crecimiento conozca estas lesiones y pueda -además de proceder a su tratamiento si ocurren- realizar la labor preventiva precisa para evitar los trastornos potenciales del crecimiento que pueden derivarse de estas lesiones. Como caso clínico típico, se presenta el de un joven paciente de 13 años de edad, practicante habitual de fútbol y fútbol sala con un cuadro de dolor de aproximadamente 1 mes de evolución en la región anterior de su tobillo derecho. El dolor había comenzado de manera progresiva, sin un evento desencadenante claro, y lo obligaba a cojear. El estudio de RMN mostraba las alteraciones típicas de una lesión pro estrés de la fisis tibial distal, por lo que se pautó un periodo de descarga tras el cual se normalizaron los hallazgos clínicos y radiológicos, y el paciente retomó su actividad deportiva de manera progresiva sin volver a presentar molestias en la zona, completando su crecimiento sin alteraciones


Growth is a complex process that takes place in a highly specialized skeletal area, the physis or growth cartilage. The physis could suffer stress injuries, as any other part of the locomotor apparatus. The injury usually starts with localized pain without a clear cause, although usually this injury happens during growing spurts and training load increase periods. Although XRay images can appear quite innocent at the beginning of the symptoms, MRI shows a characteristic physeal widening. The widening could be either local (or 'tongue-like'), or global, and helps to perform an early diagnosis. The increase in organized and specific sport activities since very young age in children makes it basic to the medical specialist who takes care after the young athletes to understand these to not only treat them once they take place but also perform the preventive task necessary to avoid the potential growth alterations that might follow these injuries. As an illustrativer typical situation, the clinical case of a 13 year old patient is presented: the young athlete (an avid football and indoor football player) was seen at the outpatient clinic complaining of pain in the anterior face of his right ankle. The pain had started one month ago, without a clear traumatic previous event, in a progressive manner. When the patient was seen, he had a limp due to pain. An MRI study of the ankle showed the typical alterations of a stress physeal injury in the distal tibialphysis, and a protected weight bearing period was prescribed, using crutches. After 3 months, pain had resolved and the radiological findings were back to normal. The patient progressively resumed his sporting activity, and has not shown new pain episodes, without growth disturbances during follow-up


Assuntos
Criança , Humanos , Masculino , Lâmina de Crescimento/fisiologia , Lâmina de Crescimento/anatomia & histologia , Lâmina de Crescimento/lesões , Traumatismos em Atletas/prevenção & controle , Futebol/lesões , Transtornos do Crescimento , Fenômenos Biomecânicos , Osteogênese , Epífises/anatomia & histologia , Osteocondrose , Medicina Esportiva
18.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 32(2): 31-40, jul.-dic. 2015.
Artigo em Espanhol | IBECS | ID: ibc-147135

RESUMO

La limitación que existe en la capacidad de diferenciación de las células madre derivadas de médula ósea ha generado la necesidad de buscar diferentes fuentes de células madre multipotenciales. Tras el estudio de la obesidad y otras enfermedades metabólicas, el tejido adiposo se ha constituido como fuente celular alternativa para la aplicación clínica, y en concreto, la célula madre derivada del tejido adiposo (ASC -adipose-derived stem cell-) se ha convertido en objetivo prioritario de investigación al destacar su capacidad de proliferación y diferenciación osteogénica. Líneas de investigación han aportado conocimiento sobre la teoría de que toda la grasa no es igual y enfatiza en la importancia de valorar el potencial osteogénico de las células mesenquimales multipotenciales residentes en el tejido adiposo teniendo en cuenta la variabilidad entre depósitos adiposos, donantes, perfil metabólico de los mismos y tiempo óptimo de cultivo. Aunque la capacidad de diferenciación a estirpe ósea de las ASCs ha sido contrastada, aún continúa siendo un desafío la generación in vitro de suficiente material óseo con las características adecuadas para uso clínico


The limitation in bone marrow mesenchymal stem cell - BMSCs - differentiation has raised up the necessity to find alternative sources of stem cells. After recent studies on obesity and some other metabolic diseases, the adipose tissue has become an alterantive cell source for clinical aplication and, particularly, adipose-derived stem cell - ASC - has emerged as a main point in this research because of their osteogenic differentiation and proliferation propierties. Current research emphasizes that all fat is not the same and points out the need to take into account fat depots variability, role of gender, donors and their metabolic profile, and time of culture in the osteogenic potential of adipose mesenchymal stem cells. Although the ability towards bone lineage differentiation of ASCs has been corroborated, the in vitro generation of bone tissue at an adequate volumen and with suitable characteristics for clinical use still remains as a challenge


Assuntos
Humanos , Masculino , Feminino , Células-Tronco/fisiologia , Tecido Adiposo/citologia , Tecido Adiposo/ultraestrutura , Osteogênese/genética , Osteogênese/fisiologia , Traumatismos Cranianos Penetrantes/congênito , Traumatismos Cranianos Penetrantes/cirurgia , Mandíbula/cirurgia , Maxila/cirurgia , Adipócitos Marrons/citologia , Adipócitos Brancos/citologia
19.
Med. oral patol. oral cir. bucal (Internet) ; 20(6): e651-e656, nov. 2015. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-144695

RESUMO

Background: The aim of this study was to evaluate the effects of long and short term systemic usage of royal jelly on bone formation in the expanded maxillary suture in a rat model. Material and Methods: Twenty eight Wistar albino rats were randomly divided into 4 equal groups: Control (C); Only Expansion (OE), Royal Jelly (RJ) group, Royal Jelly was given to rats by oral gavage only during the expansion and retention period; Royal Jelly plus Nursery (RJN) group, Royal Jelly was given to rats by oral gavage during their nursery phase of 40 days and during the retention period. After the 5 day expansion period was completed, the rats underwent 12 days of mechanical retention. All rats were sacrificed in same time. Histological examination was performed to determine the number of osteoclasts, number of osteoblasts, number of capillaries, inflammatory cell infiltration, and new bone formation. Results: New bone formation, number of osteoclasts, number of osteoblasts, and the number of capillaries in the expanded maxillary sutures were higher in the RJ and RJN groups than in the other groups. Statistical analysis also demonstrated that new bone formation and the number of osteoblasts was also highest in the RJN group. Conclusions: The systemic administration of Royal Jelly in conjunction with rapid maxillary expansion may increase the quality of regenerated bone (AU)


Assuntos
Animais , Feminino , Masculino , Ratos , Maxila/patologia , Maxila , Osteogênese/fisiologia , Modelos Animais , Mel , Oclusão Dentária , Osteoclastos/fisiologia , Reabsorção Óssea , Fenômenos Fisiológicos Dentários
20.
Eur. j. anat ; 18(4): 273-282, oct. 2014. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-131306

RESUMO

The development of the long bones at various gestational ages in the fetus has always been a subject of interest for many clinicians. Some morphometric parameters such as length, etc., are considered standard parameters for evaluation of the gestational age of the fetus. However, not much emphasis is laid upon morphometric parameters to assess the histological changes in these age groups. Therefore, the present study was undertaken to determine the histological changes occurring in a developing bone. 30 fetuses sent to the Dept. of Anatomy for routine fetal autopsy by the Dept. of Obstetrics and Gynaecology were selected for the microscopic study of the femur. Left femora were extracted, and transverse and longitudinal sections were taken and stained with hematoxylin and eosin. The epiphysis of the growing bone exhibited the formation and proliferation of different zones in different age groups. The formation and distribution of distinct cartilage canals has been evidenced as early as 13+2 weeks of gestation in the growing epiphysis. The appearance of a secondary centre of ossification in the distal femoral epiphysis was observed as early as 28+4 weeks. The diaphysis showed the formation of a cancellous bone with increasing trabeculae proliferating more on one side of the shaft. The above observations are discussed in the light of available literature


No disponible


Assuntos
Humanos , Fêmur/embriologia , Cartilagem/embriologia , Desenvolvimento Ósseo , Osteogênese/fisiologia , Condrócitos , Epífises/embriologia , Diáfises/embriologia , Feto/anatomia & histologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA