Made available in DSpace on 2015-07-22T20:49:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-25 / Objetivo: Avaliar histologicamente e através da imuno-histoquímica as alterações celulares decorrentes do tratamento com Luz Intensa Pulsada (LIP) na região cervical de portadores de poiquilodermia de Civatte (PC). Métodos: Foram estudados 14 pacientes com poiquilodermia de Civatte na região cervical. Os pacientes foram submetidos a três sessões mensais de Luz Intensa Pulsada (LIP). Foi feita uma biópsia prévia e outra após o término do tratamento. Para cada paciente foram confeccionadas cinco lâminas, perfazendo um total de 70 lâminas para exame histopatológico e imuno-histoquímica. Foram estudadas com as seguintes colorações: Hematoxilina-Eosina (HE), Tricrômio de Masson (para o colágeno), Verhoeff-van-Gieson (para as fibras elásticas), Fontana-Masson (para a melanina) e a imuno-histoquímica com o CD 34. Resultados: Observamos melhoria tanto da pigmentação quanto da textura da pele de todos os pacientes. Verificamos na coloração pelo Tricrômio de Masson a proliferação e compactação (neocolagenese), bem evidente de fibras colágenas na derme papilar fato também confirmado pela análise de imagem digital. Pela coloração Fontana-Masson observou-se regularização na distribuição do pigmento melânico; o padrão mosqueado melhorou. Verificamos pela coloração Verhoeffvan Gieson que as fibras elásticas aumentaram em número, sobretudo nos casos onde a densidade do colágeno aumentou. Na imuno-histoquímica também observamos que não houve alterações significativas nos vasos, após tratamento com a Luz Intensa Pulsada (LIP). Conclusões: Evidenciamos aumento significativo na densidade e intensidade das fibras de colágeno, aumento do número de fibras elásticas e redistribuição do pigmento melânico, quando comparamos os grupos antes e depois do tratamento com a Luz Intensa Pulsada (LIP). Em relação aos vasos, houve diminuição do diâmetro vascular em cinco pacientes (35,7%). / Objective: To assess through histological and immunohistochemical analyses the cell changes after Intense Pulsed Light therapy in the cervical region of patients with poikiloderma of Civatte. Methods: Fourteen patients with poikiloderma of Civatte in the cervical region were studied. They were submitted to three monthly sessions of Intense Pulsed Light. Biopsies were performed before and after treatment. Five slides were prepared for each patient summing up 70 slides for histological and immunohistochemical analyses. The slides were stained with hematoxilyn-eosin (HE), Masson trichrome (for colagen), Verhoeffvan- Gieson (for elastic fibers), Fontana-Masson (for melanin) and CD 34 immunohistochemistry. Results: Improvement in both skin pigmentation and texture was observed in all patients in Masson Trichrome staining, showed evident proliferation and compaction (neocollagenesis) of collagen fibers in the papillary dermis, which was confirmed by digital imaging analysis. By Fontana- Masson staining even distribution of melanin pigment was found; the mottled pattern improved. In slides stained by Verhoeff-van-Gieson, the elastic fibers increase in number, mainly in the cases with higher collagen density. In Immunohistochemistry, there were no significant alterations in vessels after Intense Pulsed Light therapy. Conclusions: A significant increase in density and intensity of collagen fibers, increase in number of elastic was observed in papillary dermis and redistribution of melanin when comparing the groups before and after treatment with Intense Pulsed Light. The vessel diameter was smaller in five patients (35,7%). / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Ramon Santana (ramon.souza@ufpe.br) on 2015-03-05T17:08:13Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertaçao Leslie Araujo.pdf: 2142115 bytes, checksum: 7236db401aab88bc9de98a2de67c457b (MD5) / Made available in DSpace on 2015-03-05T17:08:13Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertaçao Leslie Araujo.pdf: 2142115 bytes, checksum: 7236db401aab88bc9de98a2de67c457b (MD5) Previous issue date: 2013-11 / O tabagismo é um importante fator de risco para diversas patologias, afetando o sistema arterial, pele e sistema urogenital onde inclui a estenose do colo vesical, seu efeito no colo vesical ainda não foi descrito. Avaliar possíveis alterações morfológicas ocasionadas pela nicotina no colo vesical. Foram avaliados estereologicamente fragmentos do colo vesical de 16 paciente divididos em dois grupos, um tabagista e um não tabagista com respectivamente, 7 e 9 pacientes, após 90 dias da cirurgia foram submetidos a urofluxometria livre e tendo dados analisados por teste T não pareado, obtendo significância estatística com p<0,05. Foram observados aumento de 63,26% na quantidade de fibras do sistema elástico no grupo tabagista e diminuição da espessura das artérias em 35,96%, bem como aumento do IPSS e queda do fluxo máximo à urofluxometria todos com significância estatística. As alterações laboratoriais são semelhantes às encontradas em outros trabalhos em diferentes tipos de tecidos, tais como a pele, onde estes achados estão relacionados ao envelhecimento precoce. Os resultados clínicos, embora estatisticamente significativos, não possuem consistência clínica devido ao desenho do estudo ter sido para análise morfológica. O tabagismo aumenta a quantidade de fibras do sistema elástico e diminui a espessura das artérias do colo vesical.

In the present study samples were collected from abdominal linea alba aponeurosis of 30 patients (15 males and 15 females) aged from twenty to sixty years [30-59], (Mean=44.9±SD=7.3), with hernia of the anterior abdominal wall to evaluate the immunohistochemistry expression and morphometry of the elastic fibers. Nine of the patients were submitted to surgery at the Hospital de Clínicas in Porto Alegre (HCPA), ten of then at the Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), seven of them at the author’s private clinic (CA) in Caxias do Sul, and four of them at the Hospital Pompeia (HP) in Caxias do Sul. All patients had a hernia of the anterior abdominal wall. Fourteen of these cases were umbilical hernias, ten epigastric hernias and six incisional hernias. Specimens were collected from the midline three centimeters above the umbilical scar and from two centimeters below it. At the laboratory, the specimens were subdivided in two parts. One of these specimens was stained with orcein and the elastic fibers were counted by digital analysis using the applicative Image Pro Plus (Media Cybernetics, Silver Spring, USA). The other specimen was submitted to evaluation through immunohistochemistry analysis utilizing monoclonal anti-Emilin Antibody to EMILIN1 GP115 Elastin microfibril interface located protein TNF (Proteintech Group), in 1:100 dilution. Findings obtained from these patients were compared to findings obtained in a control group of non formolized cadavers from the Medical Examiner’s Office of Caxias do Sul. In this cadaver control group without hernias, aged from twenty to sixty years [20-59] (Mean= 40.5±SD=11.8), the same studies were carried out as in the surgical group with hernias to evaluate the differences in quantity and morphometry of elastic fibers between the two groups. Results show that the total amount of elastic fibers was 35% higher in patients with hernia of the anterior wall of the abdomen than in the cadaver control group with no hernias (p<.05). / In the present study samples were collected from abdominal linea alba aponeurosis of 30 patients (15 males and 15 females) aged from twenty to sixty years [30-59], (Mean=44.9±SD=7.3), with hernia of the anterior abdominal wall to evaluate the immunohistochemistry expression and morphometry of the elastic fibers. Nine of the patients were submitted to surgery at the Hospital de Clínicas in Porto Alegre (HCPA), ten of then at the Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), seven of them at the author’s private clinic (CA) in Caxias do Sul, and four of them at the Hospital Pompeia (HP) in Caxias do Sul. All patients had a hernia of the anterior abdominal wall. Fourteen of these cases were umbilical hernias, ten epigastric hernias and six incisional hernias. Specimens were collected from the midline three centimeters above the umbilical scar and from two centimeters below it. At the laboratory, the specimens were subdivided in two parts. One of these specimens was stained with orcein and the elastic fibers were counted by digital analysis using the applicative Image Pro Plus (Media Cybernetics, Silver Spring, USA). The other specimen was submitted to evaluation through immunohistochemistry analysis utilizing monoclonal anti-Emilin Antibody to EMILIN1 GP115 Elastin microfibril interface located protein TNF (Proteintech Group), in 1:100 dilution. Findings obtained from these patients were compared to findings obtained in a control group of non formolized cadavers from the Medical Examiner’s Office of Caxias do Sul. In this cadaver control group without hernias, aged from twenty to sixty years [20-59] (Mean= 40.5±SD=11.8), the same studies were carried out as in the surgical group with hernias to evaluate the differences in quantity and morphometry of elastic fibers between the two groups. Results show that the total amount of elastic fibers was 35% higher in patients with hernia of the anterior wall of the abdomen than in the cadaver control group with no hernias (p<.05).

In the present study samples were collected from abdominal linea alba aponeurosis of 30 patients (15 males and 15 females) aged from twenty to sixty years [30-59], (Mean=44.9±SD=7.3), with hernia of the anterior abdominal wall to evaluate the immunohistochemistry expression and morphometry of the elastic fibers. Nine of the patients were submitted to surgery at the Hospital de Clínicas in Porto Alegre (HCPA), ten of then at the Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), seven of them at the author’s private clinic (CA) in Caxias do Sul, and four of them at the Hospital Pompeia (HP) in Caxias do Sul. All patients had a hernia of the anterior abdominal wall. Fourteen of these cases were umbilical hernias, ten epigastric hernias and six incisional hernias. Specimens were collected from the midline three centimeters above the umbilical scar and from two centimeters below it. At the laboratory, the specimens were subdivided in two parts. One of these specimens was stained with orcein and the elastic fibers were counted by digital analysis using the applicative Image Pro Plus (Media Cybernetics, Silver Spring, USA). The other specimen was submitted to evaluation through immunohistochemistry analysis utilizing monoclonal anti-Emilin Antibody to EMILIN1 GP115 Elastin microfibril interface located protein TNF (Proteintech Group), in 1:100 dilution. Findings obtained from these patients were compared to findings obtained in a control group of non formolized cadavers from the Medical Examiner’s Office of Caxias do Sul. In this cadaver control group without hernias, aged from twenty to sixty years [20-59] (Mean= 40.5±SD=11.8), the same studies were carried out as in the surgical group with hernias to evaluate the differences in quantity and morphometry of elastic fibers between the two groups. Results show that the total amount of elastic fibers was 35% higher in patients with hernia of the anterior wall of the abdomen than in the cadaver control group with no hernias (p<.05). / In the present study samples were collected from abdominal linea alba aponeurosis of 30 patients (15 males and 15 females) aged from twenty to sixty years [30-59], (Mean=44.9±SD=7.3), with hernia of the anterior abdominal wall to evaluate the immunohistochemistry expression and morphometry of the elastic fibers. Nine of the patients were submitted to surgery at the Hospital de Clínicas in Porto Alegre (HCPA), ten of then at the Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), seven of them at the author’s private clinic (CA) in Caxias do Sul, and four of them at the Hospital Pompeia (HP) in Caxias do Sul. All patients had a hernia of the anterior abdominal wall. Fourteen of these cases were umbilical hernias, ten epigastric hernias and six incisional hernias. Specimens were collected from the midline three centimeters above the umbilical scar and from two centimeters below it. At the laboratory, the specimens were subdivided in two parts. One of these specimens was stained with orcein and the elastic fibers were counted by digital analysis using the applicative Image Pro Plus (Media Cybernetics, Silver Spring, USA). The other specimen was submitted to evaluation through immunohistochemistry analysis utilizing monoclonal anti-Emilin Antibody to EMILIN1 GP115 Elastin microfibril interface located protein TNF (Proteintech Group), in 1:100 dilution. Findings obtained from these patients were compared to findings obtained in a control group of non formolized cadavers from the Medical Examiner’s Office of Caxias do Sul. In this cadaver control group without hernias, aged from twenty to sixty years [20-59] (Mean= 40.5±SD=11.8), the same studies were carried out as in the surgical group with hernias to evaluate the differences in quantity and morphometry of elastic fibers between the two groups. Results show that the total amount of elastic fibers was 35% higher in patients with hernia of the anterior wall of the abdomen than in the cadaver control group with no hernias (p<.05).

In the present study samples were collected from abdominal linea alba aponeurosis of 30 patients (15 males and 15 females) aged from twenty to sixty years [30-59], (Mean=44.9±SD=7.3), with hernia of the anterior abdominal wall to evaluate the immunohistochemistry expression and morphometry of the elastic fibers. Nine of the patients were submitted to surgery at the Hospital de Clínicas in Porto Alegre (HCPA), ten of then at the Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), seven of them at the author’s private clinic (CA) in Caxias do Sul, and four of them at the Hospital Pompeia (HP) in Caxias do Sul. All patients had a hernia of the anterior abdominal wall. Fourteen of these cases were umbilical hernias, ten epigastric hernias and six incisional hernias. Specimens were collected from the midline three centimeters above the umbilical scar and from two centimeters below it. At the laboratory, the specimens were subdivided in two parts. One of these specimens was stained with orcein and the elastic fibers were counted by digital analysis using the applicative Image Pro Plus (Media Cybernetics, Silver Spring, USA). The other specimen was submitted to evaluation through immunohistochemistry analysis utilizing monoclonal anti-Emilin Antibody to EMILIN1 GP115 Elastin microfibril interface located protein TNF (Proteintech Group), in 1:100 dilution. Findings obtained from these patients were compared to findings obtained in a control group of non formolized cadavers from the Medical Examiner’s Office of Caxias do Sul. In this cadaver control group without hernias, aged from twenty to sixty years [20-59] (Mean= 40.5±SD=11.8), the same studies were carried out as in the surgical group with hernias to evaluate the differences in quantity and morphometry of elastic fibers between the two groups. Results show that the total amount of elastic fibers was 35% higher in patients with hernia of the anterior wall of the abdomen than in the cadaver control group with no hernias (p<.05). / In the present study samples were collected from abdominal linea alba aponeurosis of 30 patients (15 males and 15 females) aged from twenty to sixty years [30-59], (Mean=44.9±SD=7.3), with hernia of the anterior abdominal wall to evaluate the immunohistochemistry expression and morphometry of the elastic fibers. Nine of the patients were submitted to surgery at the Hospital de Clínicas in Porto Alegre (HCPA), ten of then at the Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), seven of them at the author’s private clinic (CA) in Caxias do Sul, and four of them at the Hospital Pompeia (HP) in Caxias do Sul. All patients had a hernia of the anterior abdominal wall. Fourteen of these cases were umbilical hernias, ten epigastric hernias and six incisional hernias. Specimens were collected from the midline three centimeters above the umbilical scar and from two centimeters below it. At the laboratory, the specimens were subdivided in two parts. One of these specimens was stained with orcein and the elastic fibers were counted by digital analysis using the applicative Image Pro Plus (Media Cybernetics, Silver Spring, USA). The other specimen was submitted to evaluation through immunohistochemistry analysis utilizing monoclonal anti-Emilin Antibody to EMILIN1 GP115 Elastin microfibril interface located protein TNF (Proteintech Group), in 1:100 dilution. Findings obtained from these patients were compared to findings obtained in a control group of non formolized cadavers from the Medical Examiner’s Office of Caxias do Sul. In this cadaver control group without hernias, aged from twenty to sixty years [20-59] (Mean= 40.5±SD=11.8), the same studies were carried out as in the surgical group with hernias to evaluate the differences in quantity and morphometry of elastic fibers between the two groups. Results show that the total amount of elastic fibers was 35% higher in patients with hernia of the anterior wall of the abdomen than in the cadaver control group with no hernias (p<.05).

Introdução: A luz intensa pulsada(LIP) tem sido muito utilizada no tratamento do fotoenvelhecimento sem completo conhecimento de seu mecanismo de ação. Métodos: Foram acompanhados 26 pacientes apresentando fotoenvelhecimento grau II-III (GLOGAU, 1994), os quais foram submetidas à avaliação clínica , histológica e imunoistoquímica 6 e 12 meses após o término do tratamento com LIP. Foram realizadas cinco sessões com intervalos de trinta dias. Além da quantificação histomorfométrica das fibras colágenas e elásticas na derme, foram avaliados CD1, CD4, CD8 e ICAM-1. Resultados: Após 6 meses houve melhora clínica moderada e intensa em 76,92% dos casos e a nota média de satisfação foi 8,57 correspondendo à melhora moderada. Após 12 meses do término do tratamento observou-se que 51,52% das pacientes apresentaram uma melhora clínica moderada em relação à clínica inicial. Os efeitos colaterais foram eritema (11/26), edema (10/26), ardência (7/26) e crostas (8/26). A quantificação das fibras colágenas mostrou aumento médio de 51,33% proporção média de fibra colágena na derme após 6 meses de tratamento e o aumento em relação a 12 meses do término do tratamento foi 30,17%; as fibras elásticas mostraram aumento de 44,13% após 6 meses e aumento de 143,19% após 12 meses do término do tratamento. Na análise imunoistoquímica não houve alteração de CD1 e CD8. Em relação ao CD4 houve redução significante após 12 meses do término do tratamento. Quanto ao ICAM-1 houve aumento em 6 meses com retorno aos níveis normais após 12 meses do término do tratamento. Conclusão: A melhora clínica observada foi comprovada pelo estudo histopatológico, que mostrou aumento das fibras colágenas e elásticas na derme. Após 12 meses do término do tratamento observou-se discreta redução do aspecto clínico da pele correlacionado ao histopatológico. Poucos efeitos colaterais foram observados, sendo todos reversíveis. Desta forma, a LIP constitui boa opção de tratamento para o fotoenvelhecimento cutâneo, sendo uma técnica não ablativa, segura e eficaz. / Introduction: The intense pulsed light has been used in the treatment of photoaging without full knowledge of its mechanism of action. Material and Methods: 26 patients were followed-up presenting photoaging grade II-III (GLOGAU, 1994), who were submitted to clinical evaluation, histological and immunohistochemistry 6 and 12 months after the treatment termination with LIP. Five sessions were made with 30-day intervals. In addition to histomorphometric quantification of collagen and elastic fibers in the dermis, CD1, CD4, CD8 and ICAM-1 were evaluated. Results: After 6 months there were moderate and intense clinical improvement on 76.92% of the cases and the mean score of satisfaction was 8.57 corresponding to moderate improvement. After 12 months of the treatment termination, it was observed that 51.52% of the patients presented a moderate clinical improvement in relation to initial clinic. The side effects were erythema (11/26), edema (10/26), burning (7/26) and crusts (8/26). The quantification of collagen fibers has shown mean increase of 51.33% in the dermis after 6 months of treatment and the increase regarding to 12 months of the treatment termination was of 30.17%; the elastic fibers has shown an increase of 44.13% after 6 months and increase of 143.19% after 12 months of the treatment termination. In the immunohistochemistry analysis there was no alteration of CD1 and CD8. In relation to CD4, there was a significant reduction after 12 months of treatment termination. Regarding the ICAM-1, there was an increase in 6 months with return to normal levels after 12 months of treatment termination. Conclusion: The observed clinical improvement was verified by the histopathologic study, which showed increase in the elastic and collagen fibers in the dermis. After 12 months of treatment termination, it was observed a discrete reduction of clinical aspect of skin correlated to histopathology. A few side effects were observed, being all reversible. Thus, LIP constitutes good option of treatment for skin photoageing, being a non-ablative, safe and effective technique.

Introdução: A luz intensa pulsada(LIP) tem sido muito utilizada no tratamento do fotoenvelhecimento sem completo conhecimento de seu mecanismo de ação. Métodos: Foram acompanhados 26 pacientes apresentando fotoenvelhecimento grau II-III (GLOGAU, 1994), os quais foram submetidas à avaliação clínica , histológica e imunoistoquímica 6 e 12 meses após o término do tratamento com LIP. Foram realizadas cinco sessões com intervalos de trinta dias. Além da quantificação histomorfométrica das fibras colágenas e elásticas na derme, foram avaliados CD1, CD4, CD8 e ICAM-1. Resultados: Após 6 meses houve melhora clínica moderada e intensa em 76,92% dos casos e a nota média de satisfação foi 8,57 correspondendo à melhora moderada. Após 12 meses do término do tratamento observou-se que 51,52% das pacientes apresentaram uma melhora clínica moderada em relação à clínica inicial. Os efeitos colaterais foram eritema (11/26), edema (10/26), ardência (7/26) e crostas (8/26). A quantificação das fibras colágenas mostrou aumento médio de 51,33% proporção média de fibra colágena na derme após 6 meses de tratamento e o aumento em relação a 12 meses do término do tratamento foi 30,17%; as fibras elásticas mostraram aumento de 44,13% após 6 meses e aumento de 143,19% após 12 meses do término do tratamento. Na análise imunoistoquímica não houve alteração de CD1 e CD8. Em relação ao CD4 houve redução significante após 12 meses do término do tratamento. Quanto ao ICAM-1 houve aumento em 6 meses com retorno aos níveis normais após 12 meses do término do tratamento. Conclusão: A melhora clínica observada foi comprovada pelo estudo histopatológico, que mostrou aumento das fibras colágenas e elásticas na derme. Após 12 meses do término do tratamento observou-se discreta redução do aspecto clínico da pele correlacionado ao histopatológico. Poucos efeitos colaterais foram observados, sendo todos reversíveis. Desta forma, a LIP constitui boa opção de tratamento para o fotoenvelhecimento cutâneo, sendo uma técnica não ablativa, segura e eficaz. / Introduction: The intense pulsed light has been used in the treatment of photoaging without full knowledge of its mechanism of action. Material and Methods: 26 patients were followed-up presenting photoaging grade II-III (GLOGAU, 1994), who were submitted to clinical evaluation, histological and immunohistochemistry 6 and 12 months after the treatment termination with LIP. Five sessions were made with 30-day intervals. In addition to histomorphometric quantification of collagen and elastic fibers in the dermis, CD1, CD4, CD8 and ICAM-1 were evaluated. Results: After 6 months there were moderate and intense clinical improvement on 76.92% of the cases and the mean score of satisfaction was 8.57 corresponding to moderate improvement. After 12 months of the treatment termination, it was observed that 51.52% of the patients presented a moderate clinical improvement in relation to initial clinic. The side effects were erythema (11/26), edema (10/26), burning (7/26) and crusts (8/26). The quantification of collagen fibers has shown mean increase of 51.33% in the dermis after 6 months of treatment and the increase regarding to 12 months of the treatment termination was of 30.17%; the elastic fibers has shown an increase of 44.13% after 6 months and increase of 143.19% after 12 months of the treatment termination. In the immunohistochemistry analysis there was no alteration of CD1 and CD8. In relation to CD4, there was a significant reduction after 12 months of treatment termination. Regarding the ICAM-1, there was an increase in 6 months with return to normal levels after 12 months of treatment termination. Conclusion: The observed clinical improvement was verified by the histopathologic study, which showed increase in the elastic and collagen fibers in the dermis. After 12 months of treatment termination, it was observed a discrete reduction of clinical aspect of skin correlated to histopathology. A few side effects were observed, being all reversible. Thus, LIP constitutes good option of treatment for skin photoageing, being a non-ablative, safe and effective technique.

A fisiopatologia do edema de Reinke ainda permanece desconhecida e poucos estudos abordam sobre as alterações das proteínas fibrosas, colágeno e elastina, na matriz extracelular da prega vocal com edema de Reinke. Por isso, este estudo foi idealizado para descrever a distribuição das fibras colágenas e do sistema de fibras elásticas do espaço de Reinke com edema de Reinke comparando com a prega vocal normal e com a severidade do edema. Foram obtidas 20 amostras de pregas vocais de indivíduos com edema de Reinke, sendo nove casos com edema de Reinke grau II e 11 casos grau III. Dezessete indivíduos eram do sexo feminino e três do sexo masculino, com idade variando de 47 a 62 anos (55 ± 4,4 anos). Quinze pacientes eram tabagistas e cinco ex-tabagistas, média e desvio padrão de 22 ± 10,7 maço/ano. O tempo de disfonia apresentou média e desvio padrão de 36 ± 16,6 meses. Dez pregas vocais normais de laringes humanas excisadas foram utilizadas como controles. Os métodos da Picrossírius-polarização e da Resorcina-fucsina de Weigert com oxidação prévia pelo oxone 10% foram empregados para visualização das fibras colágenas e do sistema de fibras elásticas, respectivamente. Uma avaliação semiquantitativa foi utilizada para categorizar os resultados histológicos que foram correlacionados com a idade, consumo de cigarro, tempo de disfonia e com a severidade do edema. Evidenciou-se que o arranjo entrelaçado das fibras colágenas semelhante a uma cesta de vime observado em pregas vocais normais estava desestruturado no edema de Reinke. A desestruturação foi caracterizada por um afastamento das fibras, fragmentação, formando áreas esparsas e tomadas por um estroma mixóide de quantidade variável. Todos os casos de edema de Reinke mostraram uma maior preservação do arranjo das fibras colágenas próximo ao epitélio da prega comparada com as fibras da camada mais profunda do espaço de Reinke. O arranjo do sistema de fibras elásticas formado por fibras finas e onduladas paralelas à membrana basal do epitélio e uma rede de fibras mais finas, logo abaixo da membrana basal do epitélio observado em pregas vocais normais estava desestruturado no edema de Reinke. Na avaliação semiquantitativa observou-se que moderada e intensa desestruturação ocorreram em 90% dos casos com relação às fibras colágenas e em todos os casos para o sistema de fibras elásticas. Houve uma correlação estatisticamente significante entre a idade e o grau de desestruturação das fibras colágenas (r=0,47, p=0,037). Houve diferenças estatisticamente significantes entre os edemas grau II e III quanto à desestruturação das fibras colágenas (p=0,007) e quanto à idade (p=0,036). Observamos com este estudo que as alterações nas proteínas fibrosas presentes no edema de Reinke podem contribuir com a deformidade da prega vocal / The physiopathological mechanisms underlying Reinkes edema are still unknown and few studies addressed alterations in the fibrillar proteins, collagen and elastin, in extracellular matrix with Reinkes edema. This study was idealized to describe the distribution of collagen fibers and elastic system fibers in Reinkes space with Reinkes edema, comparing with normal vocal fold and with the severity of Reinkes edema. Twenty surgical vocal fold specimens were obtained from patients with Reinkes edema, nine cases presented grade II severity and 11 cases grade III. Seventeen subjects were females and three were males, ranging in age from 47 to 62 years (mean±SD 55 ± 4.4 years). Fifteen patients were smokers and five ex-smokers, mean±SD of 22 ± 10.7 pack-years. The duration of dysphonia ranged from 6 to 60 months (mean of 36 ± 16.6 months). Ten vocal folds from human larynges of nonsmokers cadavers were used as normal controls. The Picrosirius polarization method and the Weigerts resorcin-fuchsin stain after oxidation with 10% aqueous oxone were used for visualization of collagen fibers and the elastic system fibers, respectively. Findings were categorized semiquantitatively and correlated with age, cigarette smoking, duration of dysphonia and Reinkes edema severity. The intertwined network of collagen fibers resembling a wicker-basket found in normal vocal folds was disarranged in Reinkes edema. Disarrangement of collagen fibers was characterized by loosely arranged and fragmented fibers intermixed with varying amounts of myxoid stroma. All cases showed a better preservation of collagen fibers arrangement closer to the epithelium compared to fibers of the deeper of the Reinkes space. The elastic system fibers arrangement formed by a delicate network of thin and undulated fibers arranged in parallel to the epithelial basement membrane and a network of thinner fibers immediately below the basement membrane was disarranged. The semiquantitatively analysis showed that moderate and large areas of disarrangement of collagen fibers were found in 90% of cases and in all cases for elastic fibers. Age was significantly correlated with collagen fiber disarrangement (r=0.47, p=0.037). There was a statistical difference in collagen disarrangement (p = 0,007) and age (p=0,036) between grade II and grade III severity. In our study, the alterations in the fibrillar proteins observed in Reinkes edema may contribute to the vocal fold deformity

INTRODUÇÃO: A cicatriz em prega vocal que ocorre após injúria constitui causa importante de disfonia. A fonocirurgia ideal é aquela em que a lesão efetivamente removida com o menor dano possível ao tecido adjacente, a fim de reestabelecer a função da prega vocal ao mesmo tempo em que a sua ultraestrutura sua ultraestrutura é preservada. Tanto o bisturi frio quanto lasers em geral são aceitos como instrumentos para fonocirurgia. O laser de diodo tem sido usado no tratamento de doenças laríngeas. Entretanto, não há consenso quanto os parâmetros ideais desse aparelho para tal finalidade. Inexistem trabalhos que mostrem a forma ou a extensão da lesão provocada com laser de diodo em laringe e tampouco as reações histológicas e cicatriciais provocadas por ele. OBJETIVO: O objetivo desta pesquisa é estudar as alterações morfométricas e histopatológicas observadas nas pregas vocais de coelhos, sete dias após a lesão provocada com o laser de diodo, comparando diferentes configurações do dispositivo. MÉTODO: Vinte e um coelhos machos albinos da raça New Zealand foram distribuídos aleatoriamente em três grupos com sete animais por grupo. Foi realizada uma lesão única durante 20 segundos em cada prega vocal com a ponta da fibra em contato superficial com o tecido. Duas frequências de pulso foram comparadas no Grupo I (10Hz versus 1000Hz), diferentes potências no Grupo II (3W versus 5W) e modos de radiação distintos no Grupo III (pulsado versus contínuo). Após sete dias, as laringes foram excisadas e submetidas à coloração com hematoxilina-eosina, além de coloração histoquímica para colágeno e elastina. Foi realizada análise histológica quantitativa e subjetiva. RESULTADOS: o laser de diodo provocou: exocitose de células inflamatórias; edema de mucosa e submucosa; infiltrado celular extenso em torno da úlcera, composto por polimorfonucleares (especialmente eosinófilos), linfócitos e histiócitos; tecido de granulação com a presença de fibroblastos e vasos neoformados e áreas de necrose do tipo coagulativa. A extensão do processo inflamatório e a extensão linear da úlcera apresentaram diferença significativa entre as duas potências, e foi maior com uso do laser ajustado para 5W. A extensão do processo inflamatório, extensão linear da úlcera, profundidade da úlcera e profundidade do processo inflamatório apresentaram diferença significativa entre os dois modos de emissão do laser, isto é, maior no modo contínuo. A densidade das fibras colágenas apresentaram-se elevadas apenas ao uso do laser no modo contínuo, quando comparado ao modo pulsado. Não houve diferença estatística quanto à densidade de fibras elásticas. CONCLUSÃO: O uso do laser de diodo ajustado em potência de 5W ao invés 3W e o uso do modo contínuo ao invés do pulsado são capazes de aumentar significativamente a injúria térmica nas pregas vocais de coelhos / INTRODUCTION. Scarring of the vocal folds is a relevant cause of dysphonia after injury. The ideal phonomicrosurgery would be the one that removes the vocal fold disease in order to restore the biomechanical function, while providing minimal disruption to the surrounding vocal fold layered structure. Steel scalpel and laser systems are widely accepted tools for vocal fold surgical procedures. The diode laser technique has been used in the treatment of laryngeal diseases. However, there is great variability among surgeons with regard to the use of the diode laser for laryngeal surgery and the ideal parameters for this procedure remain unclear. No description of the lesion extent or the vocal fold healing after injury with this device have been reported to date. OBJECTIVE: The aim of this research was to study the morphometric and histopathological changes seen in the vocal fold seven days after injury with the diode laser in a rabbit model, comparing different settings of the device. METHODS: Twenty-one male New Zealand white rabbits were randomized into three groups with seven animals per group. A single spot injury during 20 seconds was performed in each vocal fold with the fiber tip in superficially contact with the tissue. Two pulse frequency were compared in group I (10Hz versus 1000Hz), different powers in group II (3W versus 5W) and distinct wave mode of radiation in group III (pulsed versus continuous). After seven days, the larynges were harvested and subjected to H&E staining, histochemical staining for collagen and elastin, with quantitative and subjective histological analysis. RESULTS: the diode laser provoked exocytosis of inflammatory cells; edema of mucosa and submucosa; extensive cell infiltrate around the ulcer with polymorphonuclear cells (especially eosinophils), lymphocytes and histiocytes; granulation tissue with the presence of fibroblasts and neoformed vessels and areas of coagulative necrosis. The extent of the inflammatory infiltrate and the extent of the ablation crater showed to be greater with the 5W power use. The analyzes of extension of the extent of the inflammatory infiltrate, the extent of the ablation crater, the depth of the ablation crater and depth of the inflammatory process presented greater measurements with the continuous mode. The density of collagen fibers was higher when the laser was used in continuous wave mode. There was no statistically significant difference in elastic fiber density. CONCLUSION: Increasing power from 3W to 5W and using continuous wave rather than pulsed wave mode of the diode laser significantly increased the extent of thermal injury in the rabbit vocal folds

INTRODUÇÃO: A cicatriz em prega vocal que ocorre após injúria constitui causa importante de disfonia. A fonocirurgia ideal é aquela em que a lesão efetivamente removida com o menor dano possível ao tecido adjacente, a fim de reestabelecer a função da prega vocal ao mesmo tempo em que a sua ultraestrutura sua ultraestrutura é preservada. Tanto o bisturi frio quanto lasers em geral são aceitos como instrumentos para fonocirurgia. O laser de diodo tem sido usado no tratamento de doenças laríngeas. Entretanto, não há consenso quanto os parâmetros ideais desse aparelho para tal finalidade. Inexistem trabalhos que mostrem a forma ou a extensão da lesão provocada com laser de diodo em laringe e tampouco as reações histológicas e cicatriciais provocadas por ele. OBJETIVO: O objetivo desta pesquisa é estudar as alterações morfométricas e histopatológicas observadas nas pregas vocais de coelhos, sete dias após a lesão provocada com o laser de diodo, comparando diferentes configurações do dispositivo. MÉTODO: Vinte e um coelhos machos albinos da raça New Zealand foram distribuídos aleatoriamente em três grupos com sete animais por grupo. Foi realizada uma lesão única durante 20 segundos em cada prega vocal com a ponta da fibra em contato superficial com o tecido. Duas frequências de pulso foram comparadas no Grupo I (10Hz versus 1000Hz), diferentes potências no Grupo II (3W versus 5W) e modos de radiação distintos no Grupo III (pulsado versus contínuo). Após sete dias, as laringes foram excisadas e submetidas à coloração com hematoxilina-eosina, além de coloração histoquímica para colágeno e elastina. Foi realizada análise histológica quantitativa e subjetiva. RESULTADOS: o laser de diodo provocou: exocitose de células inflamatórias; edema de mucosa e submucosa; infiltrado celular extenso em torno da úlcera, composto por polimorfonucleares (especialmente eosinófilos), linfócitos e histiócitos; tecido de granulação com a presença de fibroblastos e vasos neoformados e áreas de necrose do tipo coagulativa. A extensão do processo inflamatório e a extensão linear da úlcera apresentaram diferença significativa entre as duas potências, e foi maior com uso do laser ajustado para 5W. A extensão do processo inflamatório, extensão linear da úlcera, profundidade da úlcera e profundidade do processo inflamatório apresentaram diferença significativa entre os dois modos de emissão do laser, isto é, maior no modo contínuo. A densidade das fibras colágenas apresentaram-se elevadas apenas ao uso do laser no modo contínuo, quando comparado ao modo pulsado. Não houve diferença estatística quanto à densidade de fibras elásticas. CONCLUSÃO: O uso do laser de diodo ajustado em potência de 5W ao invés 3W e o uso do modo contínuo ao invés do pulsado são capazes de aumentar significativamente a injúria térmica nas pregas vocais de coelhos / INTRODUCTION. Scarring of the vocal folds is a relevant cause of dysphonia after injury. The ideal phonomicrosurgery would be the one that removes the vocal fold disease in order to restore the biomechanical function, while providing minimal disruption to the surrounding vocal fold layered structure. Steel scalpel and laser systems are widely accepted tools for vocal fold surgical procedures. The diode laser technique has been used in the treatment of laryngeal diseases. However, there is great variability among surgeons with regard to the use of the diode laser for laryngeal surgery and the ideal parameters for this procedure remain unclear. No description of the lesion extent or the vocal fold healing after injury with this device have been reported to date. OBJECTIVE: The aim of this research was to study the morphometric and histopathological changes seen in the vocal fold seven days after injury with the diode laser in a rabbit model, comparing different settings of the device. METHODS: Twenty-one male New Zealand white rabbits were randomized into three groups with seven animals per group. A single spot injury during 20 seconds was performed in each vocal fold with the fiber tip in superficially contact with the tissue. Two pulse frequency were compared in group I (10Hz versus 1000Hz), different powers in group II (3W versus 5W) and distinct wave mode of radiation in group III (pulsed versus continuous). After seven days, the larynges were harvested and subjected to H&E staining, histochemical staining for collagen and elastin, with quantitative and subjective histological analysis. RESULTS: the diode laser provoked exocytosis of inflammatory cells; edema of mucosa and submucosa; extensive cell infiltrate around the ulcer with polymorphonuclear cells (especially eosinophils), lymphocytes and histiocytes; granulation tissue with the presence of fibroblasts and neoformed vessels and areas of coagulative necrosis. The extent of the inflammatory infiltrate and the extent of the ablation crater showed to be greater with the 5W power use. The analyzes of extension of the extent of the inflammatory infiltrate, the extent of the ablation crater, the depth of the ablation crater and depth of the inflammatory process presented greater measurements with the continuous mode. The density of collagen fibers was higher when the laser was used in continuous wave mode. There was no statistically significant difference in elastic fiber density. CONCLUSION: Increasing power from 3W to 5W and using continuous wave rather than pulsed wave mode of the diode laser significantly increased the extent of thermal injury in the rabbit vocal folds