Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

Retrolabyrinthine approach for surgical placement of auditory brainstem implants in children

Conclusion: The extended retrolabyrinthine approach (RLA) is a safe and reliable approach for auditory brainstem placement in children. The surgical landmarks to reach cochlear nucleus are adequately exposed by this approach. Objective: To describe a new approach option for auditory brainstem implants (ABIs) in children, highlighting the anatomical landmarks to appropriately expose the foramen of Luschka. Methods: Three prelingually deafened children consecutively operated for ABIs via the RLA. Results: ABI placement via the RLA was successfully performed in all children without any further complications except multidirectional nystagmus in one child. The RLA we employed differed from that used for vestibular schwannoma only in the removal of the posterior semicircular canal. The lateral and superior semicircular canals and the vestibule remained intact, and there was no need to expose the dura of the internal auditory meatus. The jugular bulb was completely exposed to allow adequate visualization of the ninth cranial nerve and cerebellar flocculus.

Dentomaxillofacial manifestations of Gaucher's disease: preliminary clinical and radiographic findings

Objectives: A wide variety of manifestations is presented in patients with Gaucher's disease (GD), including bone, haematology and visceral disturbances. This study was conducted to ascertain the main maxillofacial abnormalities by means of clinical survey, panoramic and cone beam CT (CBCT); to compare the patient's group with an age-sex matched control group; and to correlate clinical and radiological data. Methods: Ten patients previously diagnosed with GD were submitted to clinical and radiological surveys (CBCT and panoramic radiographs). The examination consisted of anamnesis, extra- and intraoral examinations and analyses of each patient's records. Imaging data were collected from the point of view of 3 observers, and the results compared with a healthy group (20 individuals) by means of statistical analysis (Fisher's exact test). Results: Gaucher patients had significantly more manifestations than otherwise healthy carriers. The most prevalent findings were enlarged marrow spaces, generalized osteopenia and effacement of jaw structures (mandibular canal, lamina dura and mental foramen). Here we describe a case in which thickening of the maxillary sinus mucosa was observed on CBCT rather than opacification of the sinus as seen on panoramic radiographs. Pathological fractures, root resorption and delay on tooth eruption were not observed. Conclusions: A poor relationship could be observed between clinical and radiological data. Patients showed important bone manifestations, which require careful diagnostic and surgical planning whenever necessary. Although panoramic radiographs have shown significant differences, CBCT is more effective in pointing out differences between patients and a control group, thus showing it as an important tool for evaluation of Gaucher patients. Dentomaxillofacial Radiology (2012) 41, 541-547. doi: 10.1259/dmfr/143023353

Tratamento da úlcera escleral pós-cirurgia de pterígio e betaterapia por enxerto de esclera autóloga de espessura parcial

OBJETIVO: Avaliação dos resultados da utilização de enxerto de espessura parcial de esclera autóloga para o tratamento das úlceras esclerais profundas, como complicação tardia da exérese de pterígio associada à betaterapia. MÉTODOS: Foram tratados doze olhos de doze pacientes, nove femininos e três masculinos, com idade variando entre 48 e 82 anos, média 65,2 anos. RESULTADOS: Houve boa integração do enxerto em todos os casos, com resultado funcional e cosmético favorável e sem complicações. CONCLUSÃO: Várias técnicas de enxertia tem sido propostas para o tratamento da úlcera escleral: esclera e dura-máter homólogas, derme, cartilagem auricular e periósteo autólogos. No entanto, o procedimento com esclera autóloga apresenta reais vantagens em relaçâo aos enxertos empregados anteriormente. Não há referências na literatura quanto ao emprego de enxerto de esclera autóloga de espessura parcial para o tratamento da úlcera escleral.

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. RESULTS: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. CONCLUSION: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed.

Avaliação da qualidade tecnológica de snacks obtidos por extrusão de grão integral de amaranto ou de farinha de amaranto desengordurada e suas misturas com fubá de milho

Apesar dos benefícios nutricionais e de seu potencial como alimento funcional, o amaranto ainda é um alimento pouco difundido no Brasil. Para o aumento do consumo desta matéria-prima, preconiza-se a sua incorporação na formulação de produtos convencionais, como os snacks extrudados que vêm sendo elaborados com a farinha de amaranto desengordurada. Pouco tem sido pesquisado sobre a extrusão direta do grão integral de amaranto, o que permitiria eliminar as etapas de moagem e de desengorduramento. Assim, a pesquisa avaliou e comparou a qualidade tecnológica de snacks obtidos por extrusão de grão integral de amaranto e de farinha de amaranto desengordurada, e suas misturas com 25 e 50% de fubá de milho. Verificou-se que o teor de lipídeos presentes no grão de amaranto (8%) prejudicou a expansão e a textura dos extrudados. Mesmo com a adição de fubá de milho, os snacks extrudados à base de grão integral de amaranto foram rejeitados sensorialmente (aceitação global entre 3 e 4, numa escala hedônica estruturada de nove pontos), pois apresentaram baixa expansão, textura dura, cor escura e forte sabor residual. Já os snacks extrudados obtidos com farinha de amaranto desengordurada isoladamente e em combinação com fubá de milho apresentaram maior expansão, textura crocante e cor mais clara, e, por isso, maior aceitabilidade (aceitação global > 5). Conclui-se, nas condições do experimento, que não foi possível obter snacks extrudados à base de grãos de amaranto de boa aceitação e que a produção de snacks extrudados à base de farinha de amaranto desengordurada proporciona produtos com melhor aceitação por parte do consumidor.

Displasia cementária periapical: relato de dois casos

A displasia cementária periapical (DCP) é considerada uma alteração pseudotumoral de etiologia desconhecida. Essa patologia é assintomática e tem crescimento autolimitante. Os dentes afetados apresentam normalmente vitalidade pulpar e integridade da lâmina dura. Objetivo: Apresentar dois casos clínicos que demonstram a importância do conhecimento e correto diagnóstico da DCP. Relatos clínicos: Paciente M.I.S, de 61 Anos, Gênero Feminino, Leucoderma. Apresentou-se ao setor de Endodontia, para avaliação, ao exame radiográfico foi constatada imagem radiopaca nos ápices de incisivos inferiores. Ao teste de sensibilidade ao frio houve resposta negativa, então foi realizado o teste em outras áreas da mandíbula, também com resposta negativa, tornando o teste inconclusivo. Com base nas informações obtidas pelos exames clínico e radiográfico, foi diagnosticada a DCP. Realizado controle clínico e radiográfico, não houve alterações significativas. Paciente H.N.P.N, de 22 Anos, Gênero Feminino, Leucoderma. Apresentou-se ao setor de Endodontia, para avaliação, ao exame radiográfico foi constatada imagem radiopaca na região perirradicular de canino e primeiro pré-molar inferiores do lado esquerdo. Ao teste de sensibilidade ao frio, houve resposta positiva. Com base nas informações obtidas pelos exames clínico e radiográfico, foi diagnosticada a DCP. Realizado controle clínico e radiográfico, não houve alterações significativas. Conclusão: Devido as suas características radiográficas, a DCP pode ser confundida com lesões inflamatórias de origem endodôntica. Intervenções endodônticas desnecessárias podem ocorrer por isso o cirurgião-dentista deve estar atento quanto à vitalidade pulpar e a integridade da lâmina dura dos dentes envolvidos, para o correto diagnóstico.