Hydatidiform Mole in Ectopic Pregnancy Clinical, Imaging, Pathological and Immunohistochemical Characteristics

OBJECTIVE: To determine the clinical, pathological, immunohistochemical and imaging characteristics of hydatidiform mole in ectopic pregnancy (HMEP) in all the cases admitted to the Department of Obstetrics and Gynecology, University Hospital of Caracas (HUC), Central University of Venezuela.STUDY DESIGN: Retrospective and comparative study, based on clinical records review of 2 groups: 10 cases with a diagnosis of HMEP and 20 cases with intrauterine hydatidiform mole (IUHM) admitted to the Obstetrics and Gynecology Department of HUC from 1996 to 2010. Clinical, pathological, immunohistochemical and imaging features were analyzed.RESULTS: The prevalence of HMEP in this study was 0.14:1,000 pregnancies; in this group the mean age was 28.8 years, and the mean gestational age at admission was 8.6 weeks. Both groups (HMEP and IUHM) were comparable in these last variables. Abdominal pain and genital bleeding were the most common clinical symptoms in the HMEP group, while it was vaginal bleeding in the IUHM group. Ultrasound findings were similar to those traditionally described in nonmolar ectopic pregnancy. Histology and immunohistochemistry showed that all cases of HMEP were partial mole.CONCLUSION: Although in this study the prevalence of HMEP was high, the size of the sample limits definitive conclusions. This study concludes that all cases of HMEP are partial mole. (J Reprod Med 2012;57:329-332)

Influence of Hydatidiform Mole Follow-Up Setting on Postmolar Gestational Trophoblastic Neoplasia Outcomes A Cohort Study

OBJECTIVE: To assess the influence of hydatidiform mole (HM) management setting (reference center versus other institutions) on gestational trophoblastic neoplasia (GTN) outcomes. METHODS: This cohort study included 270 HM patients attending Botucatu Trophoblastic Diseases Center (BTDC, São Paulo State University, Brazil) between January 1.990 and December 2009 (204 undergoing evacuation and entire postmolar follow-up at BTDC and 66 from other institutions [OIs]). GTN characteristics and outcomes were analyzed and compared according to HM management setting. The confounding variables assessed included age, gravidity, parity, number of abortions and HM type (complete or partial). Postmolar GTN outcomes were compared using Mann-Whitney's test, chi(2) test or Fisher's exact test.RESULTS: Postmolar GTN occurred in 34 (34/204= 16.7%) BTDC patients and in 27 (27/66=40.9%) of those initially treated in other institutions. BTDC patients showed lower metastasis rate (5.8% vs. 48%, p = 0.003) and lower median FIGO (2002) score (2.00 0.00, 3.001 vs. 4.00 [2.00, 7.00], p = 0.003]. Multiagent chemotherapy to treat postmolar GTN was required in 2 BTDC cases (5.9%) and in 8 OI cases (29.6%) (p = 0.017). Median time interval between molar evacuation and chemotherapy onset was shorter among BTDC patients (7.0 [6.0, 10.0] vs. 10.0[7.0, 16.0], p = 0.040). CONCLUSION: BTDC patients showed GTN characteristics indicative of better prognosis. This underscores the importance of GTD specialist centers. (J Reprod Med 2012;57:305-309)

Gestational Trophoblastic Neoplasia Following Molar Ectopic Pregnancy A Case Report

BACKGROUND: Ectopic molar pregnancy is a gestational trophoblastic disease (GTD) of rare occurrence and therefore not always remembered as a diagnostic possibility.CASE: We describe a case of molar ectopic pregnancy in a primiparous woman who developed gestational trophoblastic neoplasia and required chemotherapy to achieve remission.CONCLUSION This case stresses the important role of histopathologic examination in establishing a diagnosis of ectopic molar pregnancy. Moreover, close follow-up of human chorionic gonadotropin levels is required when a GTD is suspected. (J Reprod Med 2008;53:579-582)

Caring for organ donors: the intensive care unit physicians' view

This study examined the meanings that the intensive care unit (ICU) physicians attribute to their practice when caring for brain-dead organ donors. It is a phenomenological study, a qualitative method that searches for describing and understanding the experiences lived. Data were collected through recorded individual interviews made with 10 ICU physicians who work in a university hospital in the interior of São Paulo, Brazil. Three categories emerged from data: (1) providing care for brain-dead organ donors; (2) relating to donors and their families; and (3) the ethical concerns and self-awareness of the physicians. There is consensus as to-many aspects: demand of technical qualification and excellence in practice; need of investing in technology of organ transplant; and donors seen as human beings and holders of human rights. Participants understand that family participation is decisive in the donation process, although interactions between the family members and the physicians are difficult because of the sensitive nature of the situation. The physicians often felt ill-prepared to openly discuss the topic of brain death and organ donation. Educational programs for physicians and family members may assist with this difficult process.

Larynx and cervical trachea in humidification and heating of inhaled gases

To evaluate the participation of the larynx and cervical trachea in conditioning inspired gases, we randomly allocated 16 mixed-breed dogs to two groups: group TT (tracheal tube; n = 8) and group LMA (laryngeal mask airway; n = 8). The dogs were anesthetized with pentobarbital sodium and mechanically ventilated for 3 hours. The parameters studied were temperature and absolute humidities of ambient, inhaled, and tracheal air. There was a small increase in tracheal air temperature compared to inhaled air temperature, but no significant difference between groups. The absolute humidity of tracheal air was greater in group LMA than in group TT (23 mg H2O center dot L-1 and 14 mg H2O center dot L-1, respectively; p < .0001). The difference in absolute humidity between the tracheal air and the inhaled air was higher in group LMA at all times (p < .0001). We conclude that the larynx and cervical trachea of the dog participate in humidification and heating of inhaled air by means of air contact with mucosa in this airway segment.

Auditory evaluation in patients with type 1 diabetes

Objectives: We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes.Methods: Group I consisted of 40 patients with type I diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests).Results: Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group I and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group I ears. All patients of group 2 presented normal audiograms and ABR tests.Conclusions: In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group I who had normal audiometric thresholds.

Genotoxicity of antimicrobial endodontic compounds by single cell gel (comet) assay in Chinese hamster ovary (CHO) cells

Objective. In the current study, the potential DNA damage associated with exposure to a number of antimicrobial endodontic compounds was assessed by the single cell gel (comet) assay in vitro.Study design. Chinese hamster ovary (CHO) cells were exposed to formocresol, paramonochlorophenol, calcium hydroxide, or chlorhexidine at final concentration ranging from 0.01% to 1%.Results. Formocresol, paramonochlorophenol, and calcium hydroxide, as well as chlorhexidine in all concentrations tested did not contribute to the DNA damage.Conclusion. These findings are clinically relevant since they represent an important contribution to the correct evaluation of the potential health risk associated with exposure to dental agents.

Genotoxicity of corrosion eluates obtained from orthodontic brackets in vitro

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Independent clonal origin of multiple uterine leiomyomas that was determined by X chromosome inactivation and microsatellite analysis

Objective: In an attempt to clarify the clonality and genetic relationships that are involved in the tumorigenesis of uterine leiomyomas, we used a total of 43 multiple leiomyomas from 14 patients and analyzed the allelic status with 15 microsatellite markers and X chromosome inactivation analysis.Study design: We have used a set of 15 microsatellite polymorphism markers mapped on 3q, 7p, 11, and 15q by automated analysis. The X chromosome inactivation was evaluated by the methylation status of the X-linked androgen receptor gene.Results: Loss of heterozygosity analysis showed a different pattern in 7 of the 8 cases with allelic loss for at least 1 of 15 microsatellite markers that were analyzed. A similar loss of heterozygosity findings at 7p22-15 was detected in 3 samples from the same patient. X chromosome inactivation analysis demonstrated the same inactivated allele in all tumors of the 9 of 12 informative patients;. different inactivation patterns were observed in 3 cases.Conclusion: Our data support the concept that uterine leiomyomas are derived from a single cell but are generated independently in the uterus. Loss of heterozygosity findings at 7p22-15 are consistent with previous data that suggested the relevance of chromosomal aberrations at 7p that were involved in individual uterine leiomyomas. (C) 2005 Mosby, Inc. All rights reserved.

Orthodontic movement of teeth with intraosseous defects: histologic and histometric study in dogs

The purpose of this study was to evaluate histologically, in dogs, the periodontal healing of 1-walled intraosseous defects in teeth that were subjected to orthodontic movement toward the defects. The defects were surgically created bilaterally at the mesial aspects of the maxillary second premolars and distal aspects of the mandibular second premolars of 4 mongrel dogs. One week after creating the defects, an orthodontic appliance was installed, and the teeth were randomly assigned to 1 of 2 treatment groups: those in the test group received a titanium-molybdenum alloy rectangular wire spring that performed a controlled tipping root movement, and those in the control group received a passive stainless steel wire. Active orthodontic movement of the test teeth lasted 2 months and was followed by a stabilization period of another 2 months, after which the animals were killed. Throughout the study, routine daily plaque control was performed on the dogs with a topical application of a 2% chlorhexicline gel. The results showed no difference between the groups, with some regularization of the defects and periodontal regeneration limited to the apical portion of the defects. Histometric analysis showed a significant difference in bone height; on average, it was 0.53 mm smaller in the test group. It was concluded that orthodontic movement does not interfere with the healing of 1-walled intraosseous defects, with the exception of the linear extent of new bone apposition.

Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas

Objective, the objective of this study was to evaluate the reliability of in vivo staining with toluidine blue in the detection of oral epithelial dysplasia, in situ carcinoma, and invasive squamous cell carcinomas in potentially malignant epithelial lesions (PMELs) and superficial oral ulcerations suggesting malignancy.Study design. Fifty patients with PMELs and superficial oral ulcerations suggestive of malignancy were selected from those treated at the Oral Medicine Service, Faculty of Dentistry, Araraquara, Brazil. All lesions were submitted to staining with an aqueous solution of 1% toluidine blue, followed by biopsy and histologic analysis. The sensitivity, specificity, and positive and negative predictive values were calculated.Results. Histologic diagnosis revealed that 14% of the lesions analyzed were in situ carcinoma and invasive squamous cell carcinomas, 12% were epithelial dysplasias, 13% were keratosis, 40% were lichen planus, and 8% were other benign lesions. The sensitivity uf the staining was 77%, the specificity 67%, and the positive and negative predictive values 43.5% and 88.9%, respectivelyConclusions, Staining with toluidine blue was demonstrated to be highly reliable in the detection of in situ carcinoma acid invasive squamous cell carcinoma, because false-negative results for the lesions did not occur. Toluidine blue staining is an adjunct to clinical judgment and not a substitute for either judgment or biopsy.

Pixel intensity and fractal analyses: detecting osteoporosis in perimenopausal and postmenopausal women by using digital panoramic images

Objective. Pixel intensity values (PI) and fractal dimensions (FD) were compared in selected mandibular regions on digital panoramic images of normal, osteopenic, and osteoporotic perimenopausal and postmenopausal women to evaluate their relative efficacies in detecting osteoporotic-associated bone density changes.Study design. Standardized mandibular angle, body, and canine/premolar (C/PM) regions on 54 charge-coupied device (CCD) digital panoramic images of normal and potentially osteoporotic postmenopausal women were analyzed for PI and FD. Lumbar spine and femoral neck dual-energy x-ray absorptiometry QXA) on each patient served as the reference standard examination. Pearson correlation coefficients and analysis of variance (ANOVA) were performed.Results. There was significant correlation among PI measurements (P < 0.01), and no significant correlation between FD. C/PM had significantly lower PI than control C/PM (P = 0.049).Conclusions. Osteoporotic changes in mandibular C/PM cancellous bone were detected in our study population on CCD digital panoramic images by using a robust image analysis paradigm. Future automated application of such image analysis could enable widespread, cost effective screening for osteoporosis in dental settings.

Shear bond strength of metal-ceramic repair systems

Statement of problem. When clinical fractures of the ceramic veneer on metal-ceramic prostheses can be repaired, the need for remake may be eliminated or postponed. Many different ceramic repair materials are available, and bond strength data are necessary for predicting the success of a given repair system.Purpose. This study evaluated the shear bond strength of different repair systems for metal-ceramic restorations applied on metal and porcelain.Material and methods. Fifty cylindrical specimens (9 X 3 mm) were fabricated in a nickel-chromium alloy (Vera Bond 11) and 50 in feldspathic porcelain (Noritakc). Metal (M) and porcelain (P) specimens were embedded in a polyvinyl chloride (PVC) ring and received I of the following bonding and resin composite repair systems (n=10): Clearfil SE Bond/Clearfil AP-X (CL), Bistite II DC/Palfique (BT), Cojet Sand/Z100 (Q), Scotchbond Multipurpose Plus/Z100 (SB) (control group), or Cojet Sand plus Scotchbond Multipurpose Plus/Z100 (CJSB). The specimens were stored in distilled water for 24 hours at 37 degrees C, thermal cycled (1000 cycles at 5 degrees C to 55 degrees C), and stored at 37 degrees C for 8 days. Shear bond tests between the metal or ceramic specimens and repair systems were performed in a mechanical testing machine with a crosshead speed of 0.5 mm/min. Mean shear bond strength values (MPa) were submitted to 1-way ANOVA and Tukey honestly significant difference tests (alpha=.05). Each specimen was examined under a stereoscopic lens with X 30 magnification, and mode of failure was classified as adhesive, cohesive, or a combination.Results. on metal, the mean shear bond strength values for the groups were as follows: MCL, 18.40 +/- 2.88(b); MBT, 8.57 +/- 1.00(d); MCJ, 25.24 +/- 3.46(a); MSB, 16.26 +/- 3.09(bc); and MCJSB, 13.11 +/- 1.24(c). on porcelain, the mean shear bond strength values ofeach group were as follows: PCL, 16.91 +/- 2.22(b); PBT, 18.04 +/- 3.2(ab); PCJ, 19.54 +/- 3.77(ab); PSB, 21.05 +/- 3.22(a); and PCJSB, 16.18 +/- 1.71(b). Within each substrate, identical superscript letters denote no significant differences among groups.Conclusions. The bond strength for the metal substrate was significantly higher using the Q system. For porcelain, SB, Q, and BT systems showed the highest shear bond strength values, and only SB was significantly different compared to CL and CJSB (P <.05).

Effect of microwave disinfection on the hardness and adhesion of two resilient liners

Statement of problem. Microwave irradiation has been suggested for denture disinfection. However, the effect of this procedure on the hardness and bond strength between resilient liners and denture base acrylic resin is not known.Purpose. This study evaluated the effect of water storage time and microwave disinfection on the hardness and peel bond strength of 2 silicone resilient lining materials to a heat-polymerized acrylic resin.Material and methods. Acrylic resin (Lucitone 199) specimens (75 X 10 X 3 mm) were stored in water at 37 degrees C (2 or 30 days) before bonding (n = 160). The resilient lining materials (GC Reline Extra Soft and Dentusil) were bonded to the denture base and divided into the following 4 groups (n = 10): Tests performed immediately after bonding (control); specimens immersed in water (200 mL) and irradiated twice, with 650 W for 6 minutes; specimens irradiated daily for 7 total cycles of disinfection; specimens immersed in water (37 degrees C) for 7 days. Specimens were submitted to a 180-degree peel test (at a crosshead speed of 10 mm/min) and the failure values (MPa) and mode of failure were recorded. Pretreatment and posttreatment hardness measurements (Shore A) of the resilient materials were also performed. Three-way analysis of variance, followed by the Tukey HSD test, was performed (alpha=.05).Results. The analysis revealed that, for all conditions, the mean failure strengths of GC Reline Extra Soft (0.95-1.19 MPa) were significantly higher (P<.001) than those of Dentusil (0.45-0.50 MPa). The adhesion of the liners was not adversely affected by water storage time of Lucitone 199 or microwave disinfection. All peel test failures were cohesive. There was a small but significant difference (P<.001) between the pretreatment (34.33 Shore A) and posttreatment (38.69 Shore A) hardness measurements.Conclusion. Microwave disinfection did not compromise the hardness of either resilient liners or their adhesion to the denture base resin Lucitone 199.