Papiloma invertido (Papiloma Schneideriano) com envolvimento da cavidade oral: relato de caso incomum

O papiloma invertido schneideriano é uma neoplasia de origem no epitélio de revestimento que surge da mucosa respiratória revestindo a cavidade nasal e os seios paranasais. Frequentemente, surge como uma lesão unilateral no septo nasal e estende-se secundariamente para o nariz e os seios paranasais. Este trabalho relata um caso incomum desta patologia, com o envolvimento da cavidade oral em um homem branco, de 61 anos de idade, cuja avaliação clínica revelou uma massa vegetante no rebordo alveolar direito da maxila, com duração de aproximadamente 4 meses. Após avaliação radiográfica, constatouse o envolvimento do seio maxilar. A análise microscópica, hibridização in situ e análise imunoistoquímica da peça cirúrgica levaram a um diagnóstico de displasia moderada em PIS associado à infecção por HPV

Reconstrução do ligamento cruzado anterior com a técnica de duplo feixe - avaliação no laboratório de biomecânica

OBJETIVO: O objetivo deste estudo é descrever a metodologia da análise da rotação do joelho utilizando instrumentos do laboratório de biomecânica e apresentar os resultados preliminares de um estudo comparativo com pacientes submetidos à reconstrução do ligamento cruzado anterior com a técnica de duplo feixe. MÉTODOS: Descreveu-se o protocolo atualmente utilizado em nosso laboratório e realizou-se a análise cinemática tridimensional e medida da amplitude de rotação do joelho de oito pacientes normais (grupo controle) e 12 pacientes operados com a técnica de duplo feixe em três tarefas no laboratório de biomecânica. RESULTADOS: Não indicam diferenças significativas entre os lados operados e não operados em relação às amplitudes médias da marcha, da marcha com mudança de direção ou da marcha com mudança de direção ao descer a escada (p > 0,13). CONCLUSÕES: Os resultados preliminares não demonstraram diferença da técnica de reconstrução de LCA em duplo feixe em relação ao lado contralateral e ao grupo controle.

Redução da pressão arterial e do duplo produto de repouso após treinamento resistido em idosas hipertensas

FUNDAMENTO: Em razão das controvérsias existentes na literatura quanto aos possíveis benefícios do treinamento resistido (TR) sobre a pressão arterial de repouso (PA) e por causa da escassez de estudos com indivíduos idosos e hipertensos, o TR é pouco recomendado como forma de tratamento não-farmacológico da hipertensão arterial. OBJETIVO: Verificar os efeitos do TR progressivo sobre a pressão arterial de repouso (PA), a freqüência cardíaca (FC) e o duplo produto (DP) em idosas hipertensas controladas. MÉTODOS: Vinte mulheres idosas (66,8 ± 5,6 anos de idade) sedentárias, controladas com medicação anti-hipertensiva, realizaram 12 semanas de TR, compondo o grupo do treinamento resistido (GTR). Vinte e seis idosas (65,3 ± 3,4 anos de idade) hipertensas controladas não realizaram exercícios físicos durante a pesquisa, constituindo o grupo-controle. RESULTADOS: Houve redução significativa nos valores de repouso da pressão arterial sistólica (PAS), da pressão arterial média (PAM) e do DP após o TR. Não foram encontradas reduções significativas na pressão arterial diastólica (PAD) e na FC de repouso após o TR em ambos os grupos. A magnitude da queda no GTR foi de 10,5 mmHg, 6,2 mmHg e 2.218,6 mmHg x bpm para a PAS, PAM e o DP, respectivamente. CONCLUSÃO: O TR progressivo reduziu a PAS, PAM e o DP de repouso de idosas hipertensas, controladas com medicação anti-hipertensiva.

Short-Term effect of COX-2 selective inhibitor as an adjunct for the treatment of periodontal disease: a clinical double-blind study in humans

Adjunctive therapeutic strategies that modulate the inflammatory mediators can play a significant role in periodontal therapy. In this double-blind, placebo-controlled study, 60 subjects diagnosed as periodontitis patients were evaluated for 28 days after periodontal treatment combined with selective cyclooxygenase-2 (COX-2) inhibitor. The experimental group received scaling and root planning (SRP) combined with the Loxoprofen antiinflammatory drug (SRP+Loxoprofen). The control group received SRP combined with placebo (SRP+placebo). Plaque index (PI), probing pocket depth (PD) and bleeding on probing (BOP) were monitored with an electronic probe at baseline and after 14 and 28 days. Both groups displayed clinical improvement in PD, PI and BOP. They also showed statistically similar values (p>0.05) of PD reduction on day 14 (0.4 mm) and on day 28 (0.6 mm). At the baseline, few deeper sites (>7 mm) from SRP+Loxoprofen group were responsible and most PD reduction was observed after 14 days (p<0.05). The percentage of remaining deep pockets (>7 mm) after 14 days in the SRP+Loxoprofen group was significantly lower (p<0.05) than in the SRP+placebo group. Loxoprofen presents potential effect as an adjunct of periodontal disease treatment, but long-term clinical trials are necessary to confirm its efficacy.

Clinical, microscopic and imaging findings associated to Mccune-Albright syndrome: report of two cases

McCune-Albright syndrome is characterized by the triad café-au-lait cutaneous spots, polyostotic fibrous dysplasia and endocrinopathies. This article presents two cases of McCune-Albright syndrome in a middle-aged woman and a young girl. Both patients presented café-au-lait spots on the face and other parts of the body and expansion of the mandible with radiopaque-radiolucent areas with ground-glass radiographic appearance, and were diagnosed as having fibrous dysplasia and endocrine disorders. The patient of Case 1 had fibrous dysplasia on the upper and lower limbs, thorax, face and cranium, early puberty, hyperglycemia, hyperthyroidism and high serum alkaline phosphatase levels. The patient of Case 2 presented lesions on the upper limbs and evident endocrine disorders. In both cases presented in this article, the initial exam was made because of the mandibular lesion. However, a diagnosis of fibrous dysplasia must lead to investigation of the involvement of other bones, characterizing polyostotic fibrous dysplasia, which is manifested in a number of diseases. An accurate differential diagnosis is mandatory to determine the best treatment approach for each case.

Masticatory afficiency in denture wearers with bilateral balanced occlusion and canine guidance

The maintenance of masticatory function is especially important for patients wearing complete dentures due to their limitations. Thus, the bilateral balanced occlusal concept is used to achieve greater masticatory efficiency. However, a critical review of the literature reveals that there is not sufficient scientific evidence to support bilateral balanced occlusion as the most appropriate occlusal concept in complete dentures. Therefore, the aim of this study was to evaluate the masticatory efficiency in complete dentures wearers with bilateral balanced occlusion and canine guidance. A double-blinded controlled crossover clinical trial was conducted. The sample was composed by 24 edentulous patients who wore sets of complete dentures with both occlusal concepts during equal periods of 3 months. Objective data were collected through the masticatory efficiency test performed by the colorimetric method with the beads, in which capsules of a synthetic material enclosing fuchsine-containing granules were used. Subjective data were recorded by patient's ratings of their chewing function. No significant statistical difference was found for masticatory efficiency (p=0.095) between the two occlusal concepts studied. The results suggest that bilateral balanced occlusion does not improve the masticatory efficiency in complete denture wearers.

Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

Juvenile idiopathic arthritis with involvement of the temporomandibular joint: the role of image examinations

PURPOSE: Juvenile idiopathic arthritis (JIA) has unknown etiology, and the involvement of the temporomandibular joint (TMJ) is rare in the early phase of the disease. The present article describes the use of computed tomography (CT) and magnetic resonance (MRI) images for the diagnosis of affected TMJ in JIA. CASE DESCRIPTION: A 12-year-old, female, Caucasian patient, with systemic rheumathoid arthritis and involvement of multiple joints was referred to the Imaging Center for TMJ assessment. The patient reported TMJ pain and limited opening of the mouth. The helical CT examination of the TMJ region showed asymmetric mandibular condyles, erosion of the right condyle and osteophyte-like formation. The MRI examination showed erosion of the right mandibular condyle, osteophytes, displacement without reduction and disruption of the articular disc. CONCLUSION: The disorders of the TMJ as a consequence of JIA must be carefully assessed by modern imaging methods such as CT and MRI. CT is very useful for the evaluation of discrete bone changes, which are not identified by conventional radiographs in the early phase of JIA. MRI allows the evaluation of soft tissues, the identification of acute articular inflammation and the differentiation between pannus and synovial hypertrophy.

Mentors, students, and the undergraduate medical course: a virtuous circle

BACKGROUND: Mentoring Programs have been developed in several medical schools, but few studies have investigated the mentors'perspective. PURPOSES: To explore mentors'perceptions regarding their experience. METHODS: Mentors at a medical school were invited to participate in an in-depth interview including questions on satisfaction, difficulties, and perception of changes resulting from the program. RESULTS: Mentors' satisfaction and difficulties are strongly associated with students'involvement in the activity. Mentors believe changes observed in students were more related to life issues; for some mentors, there is no recognition or awareness of the program. However, most of the mentors acknowledged important changes in relation to themselves: as teachers, faculty members, and individuals. CONCLUSION: Attendance is crucial for both the mentoring relationship and strengthening of the program. Students involved in the activity motivate mentors in teaching and curriculum development, thereby creating a virtuous circle and benefiting undergraduate medical education as a whole.

Reserve carbohydrates and lipids from the seeds of four tropical tree species with different sensitivity to desiccation

Considering the importance of water content for the conservation and storage of seeds, and the involvement of soluble carbohydrates and lipids for embryo development, a comparative study was carried out among the seeds of Inga vera (ingá), Eugenia uniflora (pitanga), both classified as recalcitrant, and Caesalpinia echinata (brazilwood) and Erythrina speciosa (mulungu), considered as orthodox seeds. Low concentrations of cyclitols (0.3-0.5%), raffinose family oligosaccharides (ca. 0.05%) and unsaturated fatty acids (0-19%) were found in the seeds of ingá and pitanga, while larger amounts of cyclitols (2-3%) and raffinose (4.6-13%) were found in brazilwood and mulungu, respectively. These results, in addition to higher proportions of unsaturated fatty acids (53-71%) in orthodox seeds, suggested that sugars and lipids played important role in water movement, protecting the embryo cell membranes against injuries during dehydration.

COL18A1 is highly expressed during human adipocyte differentiation and the SNP c.1136C > T in its "frizzled" motif is associated with obesity in diabetes type 2 patients

Collagen XVIII can generate two fragments, NC11-728 containing a frizzled motif which possibly acts in Wnt signaling and Endostatin, which is cleaved from the NC1 and is a potent inhibitor of angiogenesis. Collagen XVIII and Wnt signaling have recently been associated with adipogenic differentiation and obesity in some animal models, but not in humans. In the present report, we have shown that COL18A1 expression increases during human adipogenic differentiation. We also tested if polymorphisms in the Frizzled (c.1136C>T; Thr379Met) and Endostatin (c.4349G>A; Asp1437Asn) regions contribute towards susceptibility to obesity in patients with type 2 diabetes (113 obese, BMI =30; 232 non-obese, BMI < 30) of European ancestry. No evidence of association was observed between the allele c.4349G>A and obesity, but we observed a significantly higher frequency of homozygotes c.1136TT in obese (19.5%) than in non-obese individuals (10.9%) [P = 0.02; OR = 2.0 (95%CI: 1.07-3.73)], suggesting that the allele c.1136T is associated to obesity in a recessive model. This genotype, after controlling for cholesterol, LDL cholesterol, and triglycerides, was independently associated with obesity (P = 0.048), and increases the chance of obesity in 2.8 times. Therefore, our data suggest the involvement of collagen XVIII in human adipogenesis and susceptibility to obesity.

Protector mechanisms of the association between gastroesophageal reflux disease and asthma: experimental study in rats

BACKGROUND: It is well known the association between gastroesophageal reflux disease and asthma. The hyperreactivity of the airways is a characteristic of an asthmatic. Many studies associate the increase of the airways reactivity with gastroesophageal reflux disease. AIM: In this study we have evaluated the effect of the intraluminal exposition to gastric juice of trachea on the reactivity to methacholine from rats submitted to a pulmonary allergic inflammation. METHODS: Group of rats were sensitized and challenged with ovalbumin. After 24 hours the animals were sacrificed, and their tracheae were removed to be cultured with gastric juice. The gastric juice was obtained from a donor rat. Subsequently the segments were placed into plastic plates with RPMI-1640 for incubation, under suitable atmosphere and time. After the period of incubation the segments were put into chambers for the analysis of the contractile response to methacholine. RESULTS: We observed reduction in the contractile response of trachea cultured with gastric juice from allergic rats. This result was confirmed by the pharmacological treatments with compound 48/80 and dissodium cromoglicate (mast cells blockade), L-NAME (nitric oxide inhibitor, NO), capsaicin (neuropeptides depletion) and indomethacin (ciclooxigenase inhibitor). CONCLUSIONS: Our results highlight to the existence of a complex interaction between pulmonary allergy and gastric juice in the airways. The involvement of the non-adrenergic non-cholinergic system, NO, prostanoids and mast cells are directly related to this interaction. We suggest that the reduced contractile response observed in vitro may represent a protector mechanism of the airways. Despite its presence in the human body it can not be observed due to the predominant effects of excitatory the non-adrenergic non-cholinergic system.

Cognitive control associated with irritability induction: an autobiographical recall fMRI study

OBJECTIVE: Despite the relevance of irritability emotions to the treatment, prognosis and classification of psychiatric disorders, the neurobiological basis of this emotional state has been rarely investigated to date. We assessed the brain circuitry underlying personal script-driven irritability in healthy subjects (n = 11) using functional magnetic resonance imaging. METHOD: Blood oxygen level-dependent signal changes were recorded during auditory presentation of personal scripts of irritability in contrast to scripts of happiness or neutral emotional content. Self-rated emotional measurements and skin conductance recordings were also obtained. Images were acquired using a 1,5T magnetic resonance scanner. Brain activation maps were constructed from individual images, and between-condition differences in the mean power of experimental response were identified by using cluster-wise nonparametric tests. RESULTS: Compared to neutral scripts, increased blood oxygen level-dependent signal during irritability scripts was detected in the left subgenual anterior cingulate cortex, and in the left medial, anterolateral and posterolateral dorsal prefrontal cortex (cluster-wise p-value < 0.05). While the involvement of the subgenual cingulate and dorsal anterolateral prefrontal cortices was unique to the irritability state, increased blood oxygen level-dependent signal in dorsomedial and dorsal posterolateral prefrontal regions were also present during happiness induction. CONCLUSION: Irritability induction is associated with functional changes in a limited set of brain regions previously implicated in the mediation of emotional states. Changes in prefrontal and cingulate areas may be related to effortful cognitive control aspects that gain salience during the emergence of irritability.

Ambientes inclusivos na educação infantil: possibilidades e impedimentos

Este artigo discute os resultados de uma pesquisa realizada em uma escola municipal de Educação Infantil - EMEI - da cidade de São Paulo, que teve como objetivo identificar os indicadores de envolvimento no trabalho com as crianças e aqueles que determinam a construção de um ambiente inclusivo. A coleta de dados foi feita por meio de observações dos três estágios da Educação Infantil e do levantamento da documentação pedagógica. O trabalho com as diferenças apresenta contradições importantes de serem pensadas, que se expressam como desigualdades no tratamento junto às crianças. A concepção de inclusão se restringe ao atendimento de crianças deficientes, enquanto as necessidades das demais crianças e dos profissionais que trabalham na escola são muitas vezes desconsideradas. O isolamento e o envolvimento com questões marginais do trabalho pedagógico são pontos centrais a serem considerados no enfrentamento das barreiras atitudinais para a construção de um ambiente inclusivo.

O uso de videogames, jogos de computador e internet por uma amostra de universitários da Universidade de São Paulo

OBJETIVO: Avaliar uso de jogos eletrônicos (videogames, jogos de computador e internet) em uma amostra de universitários. MÉTODO: Um questionário a respeito de comportamentos relacionados ao uso de jogos eletrônicos, contendo a escala Problem Videogame Playing (PVP), foi aplicado em 100 alunos da Universidade de São Paulo (USP). RESULTADOS: A maioria (83%) relatou ter jogado no último ano, dentre a qual 81,9% eram homens, 51,8% jogavam de 1 a 2 horas por sessão; 74,4% afirmaram que jogar não interfere em seus relacionamentos sociais e 60,5%, que o uso de jogos violentos não influencia sua agressividade. Os estudantes dividiram-se entre jogadores ocasionais e frequentes, diferenciando-se por duração de cada sessão, jogo preferido, motivação para jogar, e influência do jogo na vida social. Cerca de 5% relataram só parar de jogar quando interrompidos, normalmente jogar mais de 4 horas por sessão e se relacionar mais com amigos virtuais, sugerindo maior envolvimento com a atividade. Na escala PVP, 15,8% da amostra preencheu mais da metade dos itens, indicando consequências adversas associadas ao uso dos jogos eletrônicos. CONCLUSÃO: Observou-se que o uso de jogos eletrônicos é comum entre os estudantes da USP e que uma parcela apresenta problemas relacionados ao excesso de jogo.