Características clínicas e implicações prognósticas do acometimento renal no mieloma múltiplo.

The renal involvement in patients with multiple myeloma has been described as a sign of poor prognosis. The influence of renal insufficiency in the clinical patterns and in the prognosis of patients with multiple myeloma was studied retrospectively in 45 patients. Patients with renal insufficiency, at first visit, more often presented weight loss, proteinuria, hypercalcemia. The means of uricemia, ESR, were higher and the hematocritic mean was lower in patients with renal insufficiency. There was no difference in edema, arterial hypertension, fractures and bone pain. The reversibility of renal insufficiency occurred in 47% of the cases, which happened more often in the first months of the follow up. The creatinine mean was lower in patients with reversible renal insufficiency. The median survival was: patients with renal insufficiency: 11 months; patients with normal renal function: 50 months. Among patients with renal insufficiency those with recuperation of renal function showed a higher median survival (24 months) than those with irreversible renal insufficiency (1 month). The renal involvement then is frequent and often reversible. Patients with impaired renal function showed a worse prognosis; normalization of the renal function was associated with a better outcome.

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts (R) total joint prostheses Part III - Pain and dysfunction outcomes

47 end-stage TMJ patients with high occlusal plane angulation, treated with TMJ custom-fitted total joint prostheses and simultaneous maxillo-mandibular counter-clockwise rotation were evaluated for pain and dysfunction presurgery (T1) and at the longest follow-up (T2). Patients subjectively rated their facial pain/headache, TMJ pain, jaw function, diet and disability. Objective functional changes were determined by measuring maximum interincisal opening (MIO) and laterotrusive movements. Patients were divided according to the number of previous failed TMJ surgeries: Group 1 (0-1), Group 2 (2 or more). Significant subjective pain and dysfunction improvements (37-52%) were observed (<0.001). MIO increased 14% but lateral excursion decreased 60%. The groups presented similar absolute changes, but Group 2 showed more dysfunction at T1 and T2. For patients who did not receive fat grafts around the prostheses and had previous failure of proplast/teflon and or silastic TMJ implants, more than half required surgery for TMJ debridement and removal of foreign body giant cell reaction and heterotopic bone formation. End-stage TMJ patients can be treated in one operation with TMJ custom-made total joint prostheses and maxillo-mandibular counter-clockwise rotation, for correction of dentofacial deformity and improvement in pain and TMJ dysfunction; Group 1 patients had better results than Group 2 patients.

P-077. Myxoma of bone. Review of 17 cases

Myxoma of bone (fibromyxoma) is a slowly growing, locally invasive tumor that almost always occurs in the facial bones. The tumor has a potential to recur, but does not metastasize. The lesion is usually painless but causes slowly progressive swelling, sometimes resulting in severe facial deformity. Aim: Review of myxoma of bone experience in two institutions. Methods: Retrospective chart review of all patients with diagnose of myxoma/fibromyxoma of bone identified in the tumor registry of two referral cancer centers: Hospital Erasto Gaerntner (HEG), Curitiba, PR Brazil and University of Sao Paulo (UNESP), Aracaatuba Campus, Sao Paulo, SP Brazil. We reviewed the age, sex, ace, presenting symptoms, topography of lesion and treatment. Results: From January 1972 to July 2000 we found 17 patients from both institutions that met the diagnostic criteria; 15 from HEG and two from UNESP. The median age was 32 years (range 10-55 years). Eleven patients were male, 14 were white and three were black. Only three patients presented with local pain, the remaining were free of symptoms, presenting only with local tumor. The tumor affected the maxilla in 11 patients (six on the right), the mandible in five and the zygomatic bone in one. All patients were treated by excisional surgery and one patient received adjuvant radiation therapy. Nine patients needed reconstruction after the tumor excision. Five of them were reconstructed with local soft tissue flaps; two received iliac crest autologous bone graft; and two had a microvascularized autologous fibula graft. Conclusion: The myxoma of bone in our experience is a rare tumor and occurs more frequently in the maxilly bone in young males. These findings are consistent with the literature data.

Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain: a literature review

The aim of the current review was to investigate the relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain. Substance P is a neuropeptide that is directly related with pain. In periodontal disease, it is expressed during the inflammatory process, and is one of the factors responsible for bone resorption. Studies have shown that Substance P levels are highest in the gingival crevicular fluid from sites with active periodontal disease and bone loss. The persistence of these substances could be sufficient to stimulate neurogenic inflammation in susceptible tissues, and cause pain. The scientific literature shows that Substance P expressed during periodontal disease can be a risk factor for patients with systemic inflammatory pathologies, such as chronic arthritis or rheumatoid arthritis. Additional research is needed to confirm the participation of this substance in the origin of some types of chronic pain.