Ossificação heterotópica em saco herniário incisional

O achado de ossificação heterotópica (OH) sobre cicatriz cirúrgica abdominal é um evento raro, mas que soma morbidade ao paciente. Manifesta-se por dor, endurecimento ou desconforto na cicatriz, levando a novas abordagens cirúrgicas. Relatamos um caso de OH no saco herniário incisional com o objetivo precípuo de chamar a atenção para o potencial "totipotente" do fibroblasto, já que sua íntima relação com a OH é inegável. A partir dessa prerrogativa, qualquer forma de tratamento das hérnias incisionais deveria associar o reparo tecidual ao uso de prótese (tela), para enriquecê-lo com os fibroblastos e seus fatores de crescimento celular do próprio paciente, todos autólogos e prontos para uso. A tática é oferecer uma abordagem combinada ou mista, com menores chances de recidiva na correção dessas afecções.

Effect of alendronate on endochondral ossification in mandibular condyles of growing rats

The replacement of the calcified cartilage by bone tissue during the endochondral ossification of the mandibular condyle is dependent of the resorbing activity of osteoclats. After partial resorption, calcified cartilage septa are covered by a primary bone matrix secreted by osteoblasts. Osteoadherin (OSAD) is a small proteoglycan present in bone matrix but absent in cartilage during the endochondral ossification. The aim of this study was to analyze the effect of alendronate, a drug known to inhibit bone resorption by osteoclasts, on the endochondral ossification of the mandibular condyle of young rats, by evaluating the distribution of osteoclasts and the presence of OSAD in the bone matrix deposited. Wistar newborn rats (n = 45) received daily injections of alendronate (n = 27) or sterile saline solution as control (n = 18) from the day of birth until the ages of 4, 14 and 30 days. At the days mentioned, the mandibular condyles were collected and processed for transmission electron microscopy analysis. Specimens were also submitted to tartrate resistant acid phosphatase (TRAP) histochemistry and ultrastructural immunodetection of OSAD. Alendronate treatment did not impede the recruitment and fusion of osteoclasts at the ossification zone during condyle growth, but they presented inactivated phenotype. The trabeculae at the ossification area consisted of cartilage matrix covered by a layer of primary bone matrix that was immunopositive to OSAD at all time points studied. Apparently, alendronate impeded the removal of calcified cartilage and maturation of bone trabeculae in the mandibular ramus, while in controls they occurred normally. These findings highlight for giving attention to the potential side-effects of bisphosphonates administered to young patients once it may represent a risk of disturbing maxillofacial development.

A compound heterozygote SLC26A2 mutation resulting in robin sequence, mild limbs shortness, accelerated carpal ossification, and multiple epiphysial dysplasia in two Brazilian sisters. A new intermediate phenotype between diastrophic dysplasia and recessive multiple epiphyseal dysplasia

Mutations in solute carrier family 26 (sulfate transporter), member 2 (SLC26A2) gene result in a spectrum of autosomal recessive chondrodysplasias that range from the mildest recessive form of multiple epiphysial dysplasia (rMED) through the most common diastrophic dysplasia (DTD) to lethal atelosteogenesis type II and achondrogenesis IB. The clinical variability has been ascribed to quantitative effect of mutations of the sulfate transporter activity. Here we describe two Brazilian sisters, born to healthy and non consanguineous parents, with Robin sequence, mild shortening of upper and lower limbs, brachymetacarpalia/tarsalia, additional and accelerated carpal ossification, marked genu valgum, and multiple epiphysial dysplasia. This phenotype was intermediate between DTD and rMED, and both girls have a compound heterozygous mutations for the SLC26A2, a Finnish founder mutation (c.-26?+?2T>C), and R279W. This combination of mutations has been observed in individuals with different phenotypes, including DTD, DTD variant, and rMED. The distinct phenotype of our cases reinforces the hypothesis that other factors may be influencing the phenotype as previously suggested.

Avaliação radiográfica de quadris de pacientes lesados medulares

OBJETIVO: Os pacientes lesado-medulares passam a se submeter a uma nova conformação de forças sobre as articulações. O quadril é uma das mais afetadas, por utilizarem a cadeira de rodas como meio de locomoção. Alterações osteoarticulares, como ossificação heterotópica, podem ser encontradas nesses pacientes, sendo evidenciadas por estudos radiográficos. Este estudo visa identificar a incidência das alterações radiográficas em quadris de paciente lesados medulares. MÉTODOS: Foram avaliados 15 pacientes (30 quadris) acompanhados no Laboratório de Reabilitação Biomecânica do Aparelho Locomotor do HC-Unicamp, analisando-se radiografias da bacia em posições antero-posterior e lowenstein. RESULTADOS: Dos quadris avaliados, apenas sete (23%) não possuíam alguma evidência de dano à superfície articular. A prevalência de ossificação heterotópica encontrada (16,6%) aproximou-se a da literatura. CONCLUSÃO: Devido à prevalência de alterações articulares encontradas, justifica-se o acompanhamento radiográfico dos quadris destes pacientes. Nível de Evidência II. Desenvolvimento de critérios diagnósticos em pacientes consecutivo. (com padrão de referência "ouro" aplicado).

Developmental basis of limb homology in Pleurodiran turtles, and the identity of the hooked element in the chelonian tarsus

Although Pleurodiran turtles represent an important component of extant turtle radiation, our knowledge of the development and homology of limb bones in turtles rests mostly upon observations made on derived members of the Cryptodiran clade. Herein, we describe limb development in three pleurodirans: Podocnemis unifilis Troschel, 1848, Podocnemis sextuberculata Cornalia, 1849 and Phrynops hilarii (Dumeril and Bibron, 1835), in an effort to contribute to filling this anatomical gap. For earlier stages of limb development, we described the Y-shaped condensation that gave rise to the zeugopodial cartilages, and differentiation of the primary axis/digital arch that reveals the invariant pattern common to tetrapods. There are up to four central cartilaginous foci in the carpus, and the proximal tarsale is formed by the fusion of the fibulare, intermedium, and centrale 4. Digital development is similar for the five digits. Changes in toe V occur predominantly in the distal tarsale 5. Ontogenetic reduction of phalanges is observed in toe V of Podocnemis. Based on these results, we suggest that the hooked element present in the chelonian tarsus, and traditionally recognized as a modified fifth metatarsale, is actually the fifth distal tarsale. Additionally, our data on limb development of pleurodiran turtles supply more taxonomically comprehensive information to interpret limb configuration within the chelonian clade. (C) 2009 The Linnean Society of London, Zoological Journal of the Linnean Society, 2009, 155, 845-866.

A new species of Trachycephalus (Amphibia, Anura, Hylidae) from the State of Goias, Brazil

A new species of Trachycephalus is described for the Cerrado biome of Goias, Brazil. Trachycephalus mambaiensis sp. nov. is distinguished from the other ten species of the genus by the skin co-ossified with the skull, heavy cranial ossification, frontoparietal that fails to articulate with squamosal, absence of a crista occipitalis and secreting glands of milky and viscous substances. The skull of the new species shows an intermediary condition between species of Trachycephalus with a well ossified skull (Casque-headed frogs) and those without cranial ossification.

Prenatal detection and postnatal management of an intranasal glioma

Nasal gliomas are rare benign congenital midline tumors composed of heterotopic neuroglial tissue. They have potential for intracranial extension through a bony defect in the skull base. Neuroimaging is essential for identifying nasal lesions and for determining their exact location and any possible intracranial extension. Computed tomography is often the initial imaging study obtained because it provides good visualization of the bony landmarks of the skull base; it is not, however, well suited for soft tissue imaging. Magnetic resonance imaging has better soft tissue resolution and may be the best initial study in patients seen early in life because the anterior skull base consists of an unossified cartilage and may falsely appear as if there is a bony dehiscence on computed tomography. A frontal craniotomy approach is recommended if intracranial extension is identified, followed by a transnasal endoscopic approach for intranasal glioma. A case is presented of a huge fetal facial mass that was shown by ultrasound that protruded through the left nostril at 33 weeks of gestation. Computed tomography of the neonate suggested a transethmoidal encephalocele. Magnetic resonance imaging showed a huge mass occupying the nasopharynx and the nasal cavity and protruding externally to the face but ruled out bony discontinuity in the skull base and, therefore, any intracranial connection. The infant underwent an endoscopic resection of the mass via oral and nasal routes and pathologic examination revealed intranasal glioma. (C) 2012 Elsevier Inc. All rights reserved.

LIMB REPLANTATION AFTER AVULSION INJURIES: TECHNIQUES AND TACTICS FOR SUCCESS

Objectives: Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results. Methods: Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries. Results: The majority of the cases were young men. The most common injury was to the thumbs. The surgical techniques and tactics used were: nerve grafting, vein grafting, transposition of the digital vessels, limb shortening, and heterotopic replantation. The most commonly used technique was vein graft. The limb survival rate was high (93%), as was patient satisfaction. Conclusion: Replantation after avulsion injury depends on the correct diagnosis of the limb viability and the use of appropriate surgical techniques and tactics for each case. The experience of the team of surgeons and a good hospital structure are essential for good results. There are few articles in medical literature about the indications, techniques and results of limb replantation after avulsion injuries. We believe that this retrospective evaluation can bring new information and contributions to the correct management of this highly complex situation. Level of evidence IV, Case Series.

Dental anomalies in Richieri-Costa-Pereira syndrome

Objective. The objective of this study was to investigate the prevalence of dental anomalies in individuals with Richieri-Costa-Pereira syndrome. Study Design. A total of 13 individuals with Richieri-Costa-Pereira syndrome who were older than 8 years with at least 1 available panoramic radiograph were assessed. Dental anomalies were evaluated clinically and radiographically and classified as hyperplastic, hypoplastic, or heterotopic and as alterations of shape, number, position, and structure. Enamel alterations were classified by the DDE index. Results. All individuals exhibited anomalies, with predominance of hypoplastic disorders, mainly agenesis of mandibular incisors and second premolars and demarcated creamy-white enamel opacities primarily affecting the maxillary premolars. Conclusions. Individuals with Richieri-Costa Pereira syndrome exhibit high prevalence of tooth agenesis, especially mandibular incisors and premolars, as well as high frequency of enamel opacities. These findings are compatible with the mandibular cleft observed in all individuals and also reflect the hypoplastic characteristic of the syndrome. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:99-106)

Crenicichla chicha, a new species of pike cichlid (Teleostei: Cichlidae) from the rio Papagaio, upper rio Tapajos basin, Mato Grosso, Brazil

Crenicichla chicha, new species, occurs in clear, fast-running waters with rocky substrates in the rio Papagaio and tributaries. It is distinguished from all other Crenicichla species by the combination of two character states: infraorbitals 3 and 4 co-ossified (vs. separated) and 66-75 scales in the row immediately above to that containing the lower lateral line (E1 row scales). Crenicichla chicha shares a smooth preopercular margin, co-ossification of infraorbitals 3 and 4, and some color features with C. hemera from the adjacent rio Aripuana drainage, rio Madeira basin. It differs from Crenicichla hemera in more E1 scales (6675 vs. 58-65) and presence of a conspicuous black narrow stripe running from infraorbital 3 obliquely caudoventrad toward the preopercular margin vs. a rounded and faint suborbital marking present on infraorbitals 3-4. Examination of the type series and additional material from the rio Aripuana confirms that Crenicichla guentheri Ploeg, 1991 is a junior subjective synonym of C. hemera Kullander, 1990.

Auditory brainstem implant outcomes and MAP parameters: Report of experiences in adults and children

The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (Cl). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention. Objective: The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center. Methods: Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate. Results: The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 mu s. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores. Conclusion: We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Osseous metaplasia of the endometrium associated with infertility: a case report and review of the literature

Abstract Introduction Endometrial ossification is an uncommon disease related to secondary infertility and its etiology and pathogenesis are controversial. More than 80% of reported cases occur after pregnancy. Case presentation A 33-year-old Caucasian woman was admitted with a history of secondary infertility and with a regular menstrual cycle. She reported a miscarriage at 12 weeks of gestation 7 years previously and subsequent dilatation and curettage in another medical facility. Vaginal ultrasound was performed and showed an intrauterine structure described as a hyperechogenic image suggesting calcification related to chronic endometritis. Office hysteroscopy revealed a wide endometrial cavity and proliferative endometrium, with a coral-like white plaque 1.5 cm in length on the right horn and posterior wall of the uterus. The lesion was treated by hysteroscopy without complications. Microscopic examination showed endometrial tissue with osseous metaplasia in the stroma. Nine months after the procedure, the patient became pregnant spontaneously. Conclusion In our patient, hysteroscopy was effective in the diagnosis and treatment of osseous metaplasia of the endometrium associated with infertility.

Crenicichla chicha, a new species of pike cichlid (Teleostei: Cichlidae) from the rio Papagaio, upper rio Tapajós basin, Mato Grosso, Brazil

Crenicichla chicha, new species, occurs in clear, fast-running waters with rocky substrates in the rio Papagaio and tributaries. It is distinguished from all other Crenicichla species by the combination of two character states: infraorbitals 3 and 4 co-ossified (vs. separated) and 66-75 scales in the row immediately above to that containing the lower lateral line (E1 row scales). Crenicichla chicha shares a smooth preopercular margin, co-ossification of infraorbitals 3 and 4, and some color features with C. hemera from the adjacent rio Aripuanã drainage, rio Madeira basin. It differs from Crenicichla hemera in more E1 scales (66-75 vs. 58-65) and presence of a conspicuous black narrow stripe running from infraorbital 3 obliquely caudoventrad toward the preopercular margin vs. a rounded and faint suborbital marking present on infraorbitals 3-4. Examination of the type series and additional material from the rio Aripuanã confirms that Crenicichla guentheri Ploeg, 1991 is a junior subjective synonym of C. hemera Kullander, 1990.

Dental age as indicator of adolescence

AIM: The purpose of the present study was to analyze the relationship between root formation of the first premolars and skeletal maturation stages identified in hand-wrist radiographs. METHODS: A cross-sectional study was carried out involving the panoramic and hand-wrist radiographs obtained on the same date of 232 patients, 123 boys and 109 girls aged 4 years and 5 months to 17 years and 12 months. Root formation stages of the first premolars were related to the ossification stages of the sesamoid bone, epiphyseal stages of the phalanx of the thumb and epiphyseal stages of the radius. RESULTS: The studied variables demonstrated statistically significant correlations. CONCLUSION: Roots of the lower first premolars do not reach 2/3 of their complete length before adolescence.