Malignant transformation of pleomorphic xanthoastrocytoma: Case report

We report a case of a pleomorphic xantoastrocytoma which manifested itself as a cystic isodense lesion in the right fronto-temporal lobe in a 26 year-old woman. It appeared as a soft yellow tumor with cystic cavities on surgery. Five months after this surgery, the patient was submitted to a new operation, which revealed a friable tumor, easily differentiated from the normal parenchyma, with cystic components. The histopathological examination demonstrated pleomorphic xanthoastrocytoma with malignant transformation. Histologically, the tumor at first procedure was composed of pleomorphic astrocytes with multinucleated and foamy cells. A rare case of malignant transformation in pleomorphic xanthoastrocytoma is presented, discussed and illustrated in this paper.

Surgical treatment of metachronous metastases in different organs following radical nephrectomy

Renal clear cell carcinoma (RCCC) is a neoplasia resistant to radio and chemotherapy, with surgical treatment being the procedure that is recognized for its curative treatment. This case report demonstrates the success of an aggressive surgical treatment for consecutive and late metachronous metastases following radical nephrectomy. Case report: Asymptomatic 50-year old man. During a routine examination, an incidental mass was found by renal ultrasonography. He underwent right radical nephrectomy due to RCCC in June 1992. During the follow-up metastases were evidenced in cerebellum on the seventh year, and in left lung and pancreas on the eighth year following the radical nephrectomy, with all of them successfully treated by surgical excision. Comments: The surgical excision of consecutive and late metachronous metastases in different organs arising from RCCC is feasible, being a good therapeutic alternative in selected cases.

Morphometric study by image analysis of Ag-stained nucleoli in thyroids bearing proliferating lesions

The Ag-NOR staining technique and image analysis were used to evaluate morphological parameters (area, perimeter and axis ratio) in nucleoli from normal thyroids and from thyroids bearing proliferating lesions (carcinomas, adenomas and hyperplasias). Regions with normal appearance located close to adenomatous and carcinomatous regions, in the thyroid of every patient, were also analyzed for comparison with the respective pathological regions and with normal thyroids. Statistical analysis of data for the nucleolar area and perimeter allowed the separation of adenomas and carcinomas from hyperplasias and normal tissue but not the two components in each of these two groups. However, if we look at the numbers, a sequence of increasing nucleolar mean areas in the order: normal, hyperplasia, adenoma and carcinoma may be observed, indicating the sequence of increasing rRNA requirements in these different kinds of cells. The axis ratio that denotes the nucleolar shape (round or oblong) did not show significant differences among tissues, suggesting that shape is not important in the characterization of these pathologies. Differences in nucleolar areas and perimeter between normal and affected regions from each patient were statistically significant for adenomas and carcinomas. When these normal regions were compared with the normal thyroids, significant differences were not obtained in the three evaluated parameters. The observations and their importance for histopathological diagnosis are discussed.

Influence of age on combined effects of cyclosporin and nifedipine on rat alveolar bone

Background: There is some evidence showing that cyclosporin A (CsA) and nifedipine (NIF) affect bone metabolism. The purpose of this work was to study the effects of CsA and NIF, given alone or concurrently, on alveolar bone of rats of different ages. Methods: Rats 15, 30, 60, and 90 days old were treated daily with 10 mg/kg body weight of CsA subcutaneously injected and/or 50 mg/kg body weight of NIF/day given orally for 60 days. Alveolar bone of the first lower molars was morphologically and stereologically evaluated in serial 5 μm bucco-lingual paraffin sections, stained with hematoxylin and eosin. Serum calcium and alkaline phosphatase levels were measured in all animals at the end of the experimental period. Results: Rats treated with CsA or NIF alone or CsA and NIF concurrently showed decreased alveolar bone density. CsA was more effective than NIF. A significant decrease in serum calcium was found only in animals treated with CsA or CsA/NIF. The results were similar regardless of age. Conclusions: These results indicate that the decrease in the alveolar bone volume in rats caused by CsA and NIF alone or concurrently is not age dependent. Furthermore, NIF (50 mg/kg) did not further increase the loss of alveolar bone volume induced by CsA (10 mg/kg).

Juxtaglomerular cell tumor as a rare cause of hypertension in adults

The juxtaglomerular cell tumor is a cause of secondary hypertension in adults. A 35-year-old female patient suffering from hypertension and low serum potassium had a 3 × 3 cm solid mass at the lower pole of left kidney diagnosed by abdominal sonography. Partial nephrectomy was performed and the postoperatory was uneventful. Normalization of blood pressure was observed within the first month.

Diagnostic agreement of conventional and inverted scanned panoramic radiographs in the detection of the mandibular canal and the mental foramen.

The aim of this study was to evaluate the diagnostic agreement of conventional panoramic radiographs and their inverted scanned images in the detection of the mandibular canal and mental foramen. A total of 77 panoramic radiographs obtained from the files of totally edentulous patients were used. Digitization was done by means of a scanner with brightness and contrast adjustment, as well as image inversion. The extension of mandibular canal was divided into anterior, middle, and posterior regions, and the presence of a radiopaque line that characterized the mandibular canal was classified according to a 5-point confidence scale. The mental foramen was classified in 4 types: continuous, separated, diffuse, and unidentified. Both conventional and inverted scanned panoramic radiographs were evaluated by 3 calibrated implantologists at 2 distinct moments with a minimum interval of 10 days between them. Intraexaminer agreement was evaluated by Kappa statistics by point and by 95% confidence interval. Because the intraexaminer level of agreement was low, interexaminer agreements could not be carried out. The results showed a substantial (in 2 situations), moderate (in 16 situations), and fair (in 18 situations) intraexaminer agreement for mandibular canal and a substantial (in 1 situation), fair (in 1 situation), and moderate (in 10 situations) intraeaminer agreement for mental foramen. There were no statistically significant differences in most instances. In conclusion, the diagnostic agreement of conventional and inverted scanned panoramic radiographs for detection of mandibular canal and mental foramen was low.

Surface roughness of packable composite resins polished with various systems

Purpose: The aim of this study was to evaluate the surface roughness of four packable composite resins, SureFil™ (Dentsply, Petrópolis, Rio de Janeiro, Brazil), Prodigy Condensable™ (Kerr Co., Orange, CA, USA), Filtek P60™ (3M do Brasil, São Paulo, Brazil), and ALERT® (Jeneric/Pentron, Inc., Wallingford, CT, USA) and one microhybrid composite resin (Filtek Z250™, 3M do Brasil) after polishing with four finishing systems. Materials and Methods: Twenty specimens were made of each material (5 mm in diameter and 4 mm high) and were analyzed with a profilometer (Perthometer® S8P, Perthen, Mahr, Germany) to measure the mean surface roughness (Ra). The specimens were then divided into four groups according to the polishing system: group 1 - Sof-Lex™ (3M do Brasil), group 2 - Enhance™ (Dentsply), group 3 - Composite Finishing Kit (KG Sorensen, Barueri, São Paulo, Brazil), and group 4 - Jiffy Polisher Cups® (Ultradent Products, Inc., South Jordan, UT, USA). The specimens were polished and then evaluated for Ra, and the data were subjected to analysis of variance, analysis of covariance, and Tukey's test (p = .05). Results: The mean Ra of SureFil polished with Sof-Lex was significantly lower than that of KG points. Prodigy Condensable polished with Enhance showed a significantly less rough surface than when polished with Sof-Lex. Filtek P60 did not exhibit a significant difference with the various polishing systems. For ALERT the lowest mean Ra was obtained with Sof-Lex and the highest mean Ra with KG points. Regarding Filtek Z250, polishing with KG and Jiffy points resulted in a significantly lower mean Ra than when polished with Enhance. Conclusions: Packable composite resins display variable roughness depending on the polishing system used; the Sof-Lex disks and Jiffy points resulted in the best Ra values for the majority of the materials tested.

Evaluation of systems for timing of fungicide sprays for control of postbloom fruit drop of citrus in Brazil

Postbloom fruit drop (PFD) of citrus, caused by Colletotrichum acutatum, infects petals of citrus flowers and produces orange-brown lesions that induce the abscission of young fruitlets and the retention of calyces. Proper timing of fungicide applications is essential for good disease control. Different systems for timing of fungicide applications for control of PFD in a major citrus-growing region in southern São Paulo state in Brazil were evaluated from 1999 to 2002. The following programs were compared to an unsprayed control using counts of diseased flowers, persistent calyces, or fruit: (i) a phenology-based program currently recommended in Brazil with one application at early and another at peak bloom; (ii) the Florida PFD model; (iii) the postbloom fruit drop-fungicide application decision system (PFD-FAD), a new computer-assisted decision method; and (iv) grower's choice. In 1999, no disease developed, sprays applied with the phenology-based program had no effect, and the Florida PFD model saved two sprays compared with the phenology-based program. In 2000, PFD was moderate and the phenology-based and growers' choice treatments had a significantly lower number of persistent calyces and higher fruit numbers than the control, but no differences were found between those treatments and the PFD model. In 2001, PFD was severe with considerable yield loss. The PFD model, the phenology-based program, and the grower's choice reduced flower blight and the number of persistent calyces, and improved fruit yields with two to three applications, but the PFD-FAD achieved comparable yields with only one spray. In 2002, the disease was mild, with no yield loss, and the Florida PFD model and the PFD-FAD saved one spray compared with the other systems. The PFD model and the PFD-FAD were equally effective for timing fungicide applications to control PFD in Brazil. Scouting of trees is simpler with PFD-FAD; therefore, this system is recommended and should eliminate unnecessary sprays and reduce costs for growers.

Injeção subaracnóidea inadvertida de corticoíde em tratamento de dor crônica da coluna lombar. Relato de caso

BACKGROUND AND OBJECTIVES: Before epídural steroids were used in chronic lumbar pain, subarachnoid injection of these agents was the treatment of choice. Although still preconized by some authors, this technique may lead to severe complications with neurological sequelae. This report aimed at describing a case of accidental subarachnoid injection of steroid associated to local anesthetics during epidural puncture to treat lumbar pain. CASE REPORT: Male patient, 46 years old, followed byneuro-surgery for presenting right sciatic pain for 9 month, refractory to clinical treatment due to L 4-L 5 disk protrusion confirmed by CT scan, without neurological deficit. Epidural puncture for pain treatment was performed in L 4-L 5 with 17G needle and 10 mL solution were injected containing 4 mL of 0.25% bupivacaine, 80 mg methylprednisolone and 4 mL of 0.9% saline. Although there has not been CSF reflux, 5 minutes after injection there were sensory block in T 4 and motor block in T 6, associated to blood pressure and heart rate decrease. CONCLUSIONS: Accidental subarachnoid injections with the association of steroids for pain relief may cause adverse effects. There are several risks, varying from mild transient symptoms to nervous injuries, including spinal cord injuries. Our patient had no sequelae from the accidental subarachnoid injection, probably because it has been a single injection.

Oral manifestations during chemotherapy for acute lymphoblastic leukemia: A case report

A 14-year-old, male patient was referred for the treatment of mucositis, idiopathic facial asymmetry, and candidiasis. The patient had been undergoing chemotherapy for 5 years for acute lymphoblastic leukemia. He presented with a swollen face, fever, and generalized symptomatology in the mouth with burning. On physical examination, general signs of poor health, paleness, malnutrition, and jaundice were observed. The extraoral clinical examination showed edema on the right side of the face and cutaneous erythema. On intraoral clinical examination, generalized ulcers with extensive necrosis on the hard palate mucosa were observed, extending to the posterior region. Both free and attached gingivae were ulcerated and edematous with exudation and spontaneous bleeding, mainly in the superior and inferior anterior teeth region. The tongue had no papillae and was coated, due to poor oral hygiene. The patient also presented with carious white lesions and enamel hypoplasia, mouth opening limitation, and foul odor. After exfoliative cytology of the affected areas, the diagnosis was mixed infection by Candida albicans and bacteria. Recommended treatment was antibiotics and antifungal administration, periodontal prophylaxis, topical application of fluor 1.23%, and orientation on and control of proper oral hygiene and diet during the remission phase of the disease.

Isolated Richter's syndrome in central nervous system: Case report

Diffuse large cell non Hodgkin's lymphoma associated with chronic lymphoid leukemia (CLL), or Richter's syndrome, is a rare and serious complication. Isolated Richter's syndrome in the central nervous system is very rare; only 12 cases have been reported. We describe a 74-year-old patient with diffuse large cell non Hodgkin's lymphoma in the right frontal region with the appearance of multiform glioblastoma.

A new way of analyzing occlusion 3 dimensionally

This article introduces a new method for 3-dimensional dental cast analysis, by using a mechanical 3-dimensional digitizer, MicroScribe 3DX (Immersion, San Jose, Calif), and TIGARO software (not yet released, but available from the author at hayasaki@dent.kyushu-u.ac.jp). By digitizing points on the model, multiple measurements can be made, including tooth dimensions; arch length, width, and perimeter; curve of Spee; overjet and overbite; and anteroposterior discrepancy. The bias of the system can be evaluated by comparing the distance between 2 points as determined by the new system and as measured with digital calipers. Fifteen pairs of models were measured digitally and manually, and the bias was evaluated by comparing the variances of both methods and checking for the type of error obtained by each method. No systematic errors were found. The results showed that the method is accurate, and it can be applied to both clinical practice and research. Copyright © 2005 by the American Association of Orthodontists.

Abordagem diagnóstica dos pacientes com suspeita de trombose venosa profunda dos membros inferiores

Deep venous thrombosis is a relatively common disease, which can present pulmonary embolism as a complication in its acute phase, and later the post-thrombotic syndrome. Thus, diagnosis should be made as soon as possible, in order to prevent or minimize such complications. Several studies have shown that the symptoms and the clinical signs are inaccurate for the deep venous thrombosis diagnosis and that complementary exams are necessary. As an attempt to simplify the patients' assessment, Well et al., in 1997, developed a clinical prediction index that combines symptoms, signs and risk factors for deep venous thrombosis and managed to make a simpler approach through an association of this index with the complementary exams. Phlebography has been considered the gold standard of complementary exams. However, since it is an invasive exam and thus subject to complications, other diagnostic methods were introduced aiming at making the diagnostic approach simpler and less invasive. Doppler ultrasound, duplex scan, impedance plethysmography, computed tomography, and blood tests such as the D-dimer are some of the available methods for assessing the patient with suspicion of deep venous thrombosis. Among them, duplex scan has shown excellent accuracy and it is currently widely accepted as the first choice test for approaching the patient with deep venous thrombosis. Several authors have suggested an association of diagnostic methods to simplify and make the assessment of such patients more cost-effective, leading to the introduction of a wide range of diagnostic strategies. The different diagnostic methods used for assessing deep venous thrombosis are discussed, as well as a review of the literature on the accuracy, advantages and disadvantages of these methods. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.

Spontaneous eye blink analysis in the normal individual

Purpose: Spontaneous eye blink activity in the primary eye position and its relationship to age and gender were assessed using digital image processing techniques to quantify blink opening and closing time. Methods: One hundred-and-eighty healthy volunteers (90 males and 90 females), divided into the age groups 0-3, 4-12, 13-20, 21-40, 41-60 and ≥60 years old, were evaluated prospectively. They were videotaped digitally in a standard setting and the images were transferred to a personal computer (Macintosh 400) and processed with the iMovie software. Blink opening and closing time were measured at 30 frames/second. The data were then subjected to statistical analysis. Results: The closing time was significantly longer than the opening time for all ages and both genders. Elderly individuals (≥41 years old) and women had significantly longer closing times. Conclusion: Image processing techniques made possible the observation of differences in spontaneous eye blink opening and closing time in relation to age and gender. Copyright © 2005 Taylor & Francis LLC.