Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

A Síndrome da Apnéia-Hipopnéia do Sono Obstrutiva (SAHSO) é um doença de fisiopatologia complexa, e sua etiologia é multifatorial e não entendida completamente. Cirurgia com avanço do músculo genioglosso é indicado em obstrução na região de hipofaringe. OBJETIVO: Avaliar a eficácia e complicações da técnica de mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva (SAHSO). MÉTODOS: Polissonografia, exame físico e análise cefalométrica foram realizados em 10 pacientes não-obesos, que apresentavam SAHSO leve ou moderada, índice de apnéia-hipopnéia (IAH) entre 5 e 30, obstrução de hipofaringe e retrognatismo mandibular. RESULTADOS: IAH pré-operatório médio foi de 12,4±4,6 diminuindo a média pós-operatória para 4,4±5,7 (p < 0,001). Quando 50% de redução do IAH pré-operatório foram escolhidos como parâmetro, o índice de sucesso foi de 70%. A análise cefalométrica revelou um aumento do espaço aéreo posterior (EAP) em todos os pacientes, a média pré-operatória foi de 7,9±2,3mm para uma média pós-operatória de 10,8±2,5mm (p < 0,001). CONCLUSÃO: Mentoplastia para avanço do músculo genioglosso parece reduzir os sinais da SAHSO, podendo ser considerada uma opção com tratamento cirúrgico em pacientes com obstrução na hipofaringe. Os dados coletados indicam esse procedimento como opção em pacientes com SAHSO e retrognatismo mandibular.

Anquilose da articulação têmporo-mandibular

A anquilose pode ser definida como sendo a fusão das superfícies articulares e seu tratamento é um verdadeiro desafio devido à alta taxa de recorrência. OBJETIVO: Descrever seis casos clínicos tratados pela técnica da reconstrução articular, avaliar os resultados dessas cirurgias e fazer uma revisão da literatura. METODOLOGIA: A população estudada neste estudo retrospectivo foi obtida dos prontuários do hospital universitário e tinha que ter sido submetida a cirurgia para tratamento de anquilose por reconstrução aloplástica ou autógena entre os períodos de março de 2001 e outubro de 2005. Dados como a máxima abertura de boca (MAB), etiologia, tipo de anquilose e tratamento, e ocorrência de recidiva e lesão do nervo facial foram coletados no pré-operatório, através dos prontuários, e no pós-operatório, através de entrevista. RESULTADOS: A média da MAB no pré-operatório foi de 9,6mm (0 a 17mm) e no pós-operatório foi de 31,33mm (14mm a 41mm), não houve lesão do nervo facial e apenas em um caso houve recidiva da anquilose. CONCLUSÃO: A reconstrução da articulação com material autógeno ou alógeno, para o tratamento da anquilose da ATM se mostrou eficaz em relação à MAB pós-operatória, recidiva e função da articulação.

Ameloblastoma mandibular tratado por ressecção óssea e reconstrução imediata

O ameloblastoma multicístico acomete principalmente pacientes adultos, entre a terceira e a sétima década de vida, freqüentemente na região posterior de mandíbula. A ressecção de um segmento mandibular, sem reconstrução adequada, produz grave seqüela estética e funcional levando a uma perda da qualidade de vida. O objetivo desta apresentação é mostrar que o tratamento multidisciplinar do ameloblastoma possibilita radicalidade oncológica associada à completa reconstrução da área lesada. Apresentamos um paciente de 47 anos, acometido por um ameloblastoma em região posterior de mandíbula tratado com ressecção completa de um segmento mandibular. A reconstrução no mesmo tempo operatório utilizou enxerto ósseo de crista ilíaca fixado com placas e parafusos de titânio. Após oito meses completou-se a reabilitação com implantes de elementos dentários na área do enxerto. As vantagens deste procedimento incluem a diminuição do risco de recidivas pelo uso da ressecção segmentar, reconstrução mandibular confiável e diminuição do número de procedimentos cirúrgicos, permitindo completa reabilitação em um período mais curto de tempo.

Multiple skin neoplasms in subjects under 40 years of age in Goiania, Brazil

OBJECTIVE To describe the trend for malignant skin neoplasms in subjects under 40 years of age in a region with high ultraviolet radiation indices.METHODS A descriptive epidemiological study on melanoma and nonmelanoma skin cancers that was conducted in Goiania, Midwest Brazil, with 1,688 people under 40 years of age, between 1988 and 2009. Cases were obtained fromRegistro de Câncer de Base Populacional de Goiânia(Goiania’s Population-Based Cancer File). Frequency, trends, and incidence of cases with single and multiple lesions were analyzed; transplants and genetic skin diseases were found in cases with multiple lesions.RESULTS Over the period, 1,995 skin cancer cases were observed to found, of which 1,524 (90.3%) cases had single lesions and 164 (9.7%) had multiple lesions. Regarding single lesions, incidence on men was observed to have risen from 2.4 to 3.1/100,000 inhabitants; it differed significantly for women, shifting from 2.3 to 5.3/100,000 (Annual percentage change – [APC] 3.0%, p = 0.006). Regarding multiple lesions, incidence on men was observed to have risen from 0.30 to 0.98/100,000 inhabitants; for women, it rose from 0.43 to 1.16/100,000 (APC 8.6%, p = 0.003). Genetic skin diseases or transplants were found to have been correlated with 10.0% of cases with multiple lesions – an average of 5.1 lesions per patient. The average was 2.5 in cases without that correlation.CONCLUSIONS Skin cancer on women under 40 years of age has been observed to be increasing for both cases with single and multiple lesions. It is not unusual to find multiple tumors in young people – in most cases, they are not associated with genetic skin diseases or transplants. It is necessary to avoid excessive exposure to ultraviolet radiation from childhood.

Primary neoplasms of the heart. Clinical and histological presentation of 50 cases

OBJECTIVE: To analyze clinical and histologic findings of 50 patients with primary neoplams of the heart in a tertiary referral center. METHODS: From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16±18 years). RESULTS: Most tumors were located in the left side of the heart (72%), myxoma being the most common (84%) histologic type. The other histologic types found were as follows: fibroma (4%), lipoma (2%), rhabdomyosarcoma (2%), hemangioma (2%), sarcoma (2%), angiosarcoma (2%), and lymphoma (2%). Diagnosis was established by echocardiography in 94% of the cases. Clinical findings were as follows: dyspnea (36%), weight loss (20%), palpitations (18%), chest pain (16%), fever (8%), and arthralgia (6%). All patients with thromboembolic phenomena (10%) had left atrial myxoma. Approximately 20% of the patients were asymptomatic at the initial clinical assessment. CONCLUSION: Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion.

Avaliação da prevalência do tratamento das fraturas de côndilo mandibular

OBJETIVO: Realizar um estudo do tratamento das fraturas do côndilo mandibular e discutir a terapêutica conservadora versus a cirúrgica. MÉTODOS: Foram examinados 892 prontuários de traumatismo bucofacial, e selecionados aqueles em que haviam: relatos de fraturas condilares isoladas ou associadas a outros ossos da face, dados relativos à identificação, a história médico-odontológica, e o tratamento para a fratura de côndilo. Os dados foram analisados através de estatística descritiva e comparados a~ terapêuticas conservadora e cirúrgica. RESULTADOS: As fraturas de côndilo perfizeram um total de 124 casos. O sexo masculino representou 72,0% da amostra, e a faixa etária mais acometida foi aquela dos 21 a 30 anos. O tratamento conservador foi empregado em 61,0% dos pacientes. CONCLUSÃO: O tratamento cirúrgico foi utilizado em pacientes acima de dez anos de idade, vítimas de acidentes de trânsito e quedas, predominantemente, seguido de agressões, armas de fogo e acidente esportivo.

Tobacco experimental model to induce urinary bladder neoplasms

OBJECTIVE: to develop an experimental model of exposure to tobacco burning (cigarette) products to assess the effects of its chronic use in relation to cancers of the bladder. METHODS: the animals were chronically exposed to the burning tobacco products in a semi-open chamber to simulate smoking. Thirty young Wistar rats were divided into two groups: one with 20 animals simulating smoking for six months, and ten not exposed control animals for the same period. After exposure by inhalation of cigarette smoke, animals were euthanized and subjected to histopathological study of the bladder wall. RESULTS: no tumor was found but mild and non significant alterations. The studies of hemo-oximetry (carboxyhemoglobin and methemoglobin) and the concentration of carbon dioxide (CO2) confirm that the animals were exposed to high concentrations of tobacco smoke and its derivatives. CONCLUSION: no bladder mucosal neoplasia was found in the pathological study of animals. The developed experimental models were highly efficient, practical and easy to use and can be used in other similar studies to determine the harmful effects caused by smoking.

Submandibular gland excision

OBJECTIVE: to analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS: we analyzed the records of patients treated with resection of the gland from January 1995 to December 2008. The data collected included age, gender, findings on clinical history, surgical procedure, results of fine needle aspiration (FNA), pathological diagnosis and complications. RESULTS: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. CONCLUSION: resection of the submandibular gland is a safe procedure, with low complication rates.

Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

Objective: to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. Methods: twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. Results: the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. Conclusion: the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life

Expression of the Immunohistochemical Markers p16 and Ki-67 and Their Usefulness in the Diagnosis of Cervical Intraepithelial Neoplasms

Objective The aim of this study was to determine the expression of the immunohistochemical markers p16 and Ki-67 in cervical intraepithelial neoplasms and their influence on the level of agreement among different observers and for the same observer. Methods The study included 184 patients with cervical intraepithelial neoplasms previously confirmed through biopsies performed between 2005 and 2006. Three pathologists reviewed the biopsies by using hematoxylin-eosin staining to reach a consensus on the diagnosis. Subsequently, an immunohistochemical study analyzed the expression of p16 and Ki-67 in such cases. Results The comparison among the reviewing pathologists revealed only moderate agreement (kappa = 0.44). The agreement improved when the differentiation of highgrade lesions (cervical intraepithelial neoplasm - CIN - 3) was analyzed (kappa = 0.59). p16 staining exhibited a high negative predictive value and sensitivity; however, the specificity was low. Overall, both qualitative and quantitative analyses of p16 and a quantitative analysis Ki-67 exhibited low accuracy. The agreement among diagnoses before immunohistochemistry was 0.47. The use of immunohistochemistry increased the agreement to 0.68. Conclusion Our study showed that the agreement among observers using traditional diagnostic criteria of cervical intraepithelial lesions can improve with the use of immunohistochemistry.

Surto de abscesso mandibular por Pseudomonas aeruginosa em ovinos

Descreve-se um surto de abscesso mandibular em ovelhas da raça Bergamácia no município de Botucatu, estado de São Paulo. Do rebanho de 120 animais, 35 apresentaram aumento de volume mandibular com a presença de nódulos únicos, de consistência pétrea, de diferentes tamanhos, fistulados ou não e sem indicativos de inflamação dos tecidos moles adjacentes. Os animais eram criados em pasto de Panicum maximum cv. Tanzânia com água e sal mineral ad libitum e everminados, via oral, com pistolas dosificadoras. O material para diagnóstico microbiológico e antibiograma foi coletado de cinco animais acometidos, por punção e aspiração dos nódulos. Dos 35 animais acometidos, 19 foram submetidos ao exame radiográfico, um ao exame tomográfico e outro à biópsia óssea da região submandibular. O único ovino que morreu, encontrava-se em estado de caquexia provavelmente devido à localização do aumento de volume que afetou a implantação dos dentes molares daquela região impedindo a apreensão e mastigação adequadas levando a perda da condição corporal e morte. Ao exame necroscópico, observaram-se áreas de necrose caseosa na mandíbula direita de onde isolou-se Pseudomonas aeruginosa. O tratamento utilizado foi baseado na aplicação de iodeto de sódio a 10% por via intramuscular e antibioticoterapia segundo antibiograma com enrofloxacina por via intramuscular, porém com pouca eficácia. Diante do quadro clínico, dos dados de anamnese, da localização das lesões no tecido ósseo mandibular, do resultado do cultivo microbiológico, das alterações radiográficas e tomográficas foi feito o diagnóstico de abscesso mandibular causado por Pseudomonas aeruginosa.

Primary bone neoplasms in dogs: 90 cases

A retrospective study of necropsy and biopsy cases of 90 primary bone tumors (89 malignant and one benign) in dogs received over a period of 22 years at the Laboratório de Patologia Veterinária, Universidade Federal de Santa Maria, was performed. Osteosarcoma was the most prevalent bone tumor, accounting for 86.7% of all malignant primary bone neoplasms diagnosed. Most cases occurred in dogs of large and giant breeds with ages between 6 and 10-years-old. The neoplasms involved mainly the appendicular skeleton, and were 3.5 times more prevalent in the forelimbs than in the hindlimbs. Osteoblastic osteosarcoma was the predominant histological subtype. Epidemiological and pathological findings of osteosarcomas are reported and discussed.

Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin®) when compared with 20 mg piroxicam alone (Feldene®) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.