Role of urinary concentrating ability in the generation of toxic papillary necrosis

Role of urinary concentrating ability in the generation of toxic papillary necrosis. We studied the pathogenesis of chemically induced papillary necrosis in six groups of rats. Papillary necrosis was produced by a single injection of 2-bromoethylamine hydrobromide (BEA), 50 mg, i.v.; the animals were followed for 7 to 10 days after the administration of the compound. Following BEA, heterozygous Brattleboro rats developed all the functional and morphologic lesions of papillary necrosis that we previously described in Sprague-Dawley rats. They were unable to maintain sodium balance when dietary sodium was withdrawn. Homozygous Brattleboro rats, on the other hand, developed none of the manifestations of papillary necrosis (that is, animals with central diabetes insipidus were protected completely from the nephrotoxic effects of BEA). They adapted normally to a zero sodium diet. Chronic administration of vasopressin to homozygous Brattleboro rats fully restored the toxic effects of BEA. Lowering urinary concentrating ability by inducing a water diuresis in Sprague-Dawley rats completely protected against BEA-induced papillary necrosis. Decreasing papillary solute concentration by furosemide or increasing urine flow after abrupt withdrawal of vasopressin to homozygous Brattleboro rats did not protect against BEA-induced papillary necrosis. We conclude that the combination, but not either alone, of increased urine flow and decreased papillary solute concentration protects against the development of BEA-induced papillary necrosis.Rôle du pouvoir de concentration urinaire sur l'apparition d'une nécrose papillaire toxique. Nous avons étudié la physiopathologie d'une nécrose papillaire induite chimiquement chez six groupes de rats. La nécrose papillaire était produite par une injection unique de 2-bromoéthylamine hydrobromide (BEA), 50 mg, i.v.; les animaux étaient suivis pendant 7 à 10 jours après administration du produit. Après le BEA, des rats Brattleboro hétérozygotes ont développé toutes les lésions fonctionnelles et morphologiques d'une nécrose papillaire telles que nous les avions déjà décrites chez des rats Sprague-Dawley. Ils n'étaient pas capables d'assurer l'équilibre de la balance sodée lorsque le sodium alimentaire était supprimé. Par ailleurs, des rats Brattleboro homozygotes n'ont développé aucune des manifestations de nécrose papillaire (c'est-à-dire que les animaux ayant un diabète insipide central étaient complètement protégés des effets néphrotoxiques du BEA). Ils s'adaptaient normalement à un régime sans sodium. L'administration chronique de vasopressine à des rats Brattleboro homozygotes a totalement restauré l'effet toxique du BEA. Le fait d'abaisser la capacité de concentration des urines en induisant une diurèse aqueuse dans les rats Sprague-Dawley a complètement protégé contre la nécrose papillaire induite par le BEA. La diminution de la concentration de solutés papillaires par le furosémide ou l'augmentation du débit urinaire après arrêt brutal de la vasopressine chez des rats Brattleboro homozygotes ne protégeait pas contre la nécrose papillaire induite par le BEA. Nous concluons que la combinaison, mais non chaque facteur séparément, d'une augmentation du débit urinaire et d'une diminution de la concentration de solutés papillaires protègent contre le développement d'une nécrose papillaire induite par le BEA

The impact of prior prostatic surgery on urinary continence in patients undergoing orthotopic ileal neobladder

OBJECTIVE: To establish if previous surgery for benign prostatic hyperplasia (transurethral resection of the prostate or open prostatectomy), age, and preservation of prostatic apex can influence postoperative urinary continence in patients submitted to radical cystectomy and orthotopic ileal neobladder. PATIENTS AND METHODS: We analyzed 62 patients with bladder cancer who were treated with radical cystectomy and orthotopic ileal neobladder between 1987 and 1998 and had been followed for at least 24 months. The average age and median follow up were 61 years and 53 months, respectively. Postoperative urinary continence was correlated with 3 factors: patient age, preservation of prostatic apex during surgical excision and prior prostatic surgery for benign disease. Patients were defined as incontinent when they had to use more than 1 protective pad at the daytime. RESULTS: The overall incidence of urinary incontinence was 12.9% (8 out of 62 patients). The only statistically significant factor that impacted upon urinary continence was previous prostatic surgery, with respectively 33% versus 7% rate of incontinence for patients previously operated on and for those without previous operation (p = 0.023 odds ratio = 6.5, 95% confidence interval). Preservation of prostatic apex did not reach difference, 12% versus 13%, for those with and without preservation, and age also did not influence the postoperative continence rate. CONCLUSIONS: Prior prostatic surgery for benign prostatic hyperplasia probably can increases the risk for postcystectomy incontinence and preservation of prostate apex did not affect the continence rate. This issue deserves to be considered by the surgeon and must be discussed previously with the patients when planning an orthotopic bladder replacement.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Division of UrologyUNIFESP, EPM, Division of UrologySciEL

Effect of surface treatments with acid solutions on the surface roughness of an Yttrium-Tetragonal Zirconia Polycrystal

The purpose of this in vitro study was to evaluate the effect of conventional surface treatment with acid solutions on the surface roughness of a zirconia-based ceramic. Specimens of yttrium-tetragonal zirconia polycrystal (Y-TZP) -based ceramic were fabricated (5.0 x 5.0 x 2.0 mm, n=40). The specimens were submitted to the tested surface treatment method and divided into 4 groups (n=10): no treatment-control (GI), airborne 110 µm aluminum oxide particle abrasion for 1 minute-conventional method (GII); etching with 48% hydrofluoric acid for 2 minutes (GIII), and nitric acid/hydrofluoric acid etching for 2 minutes (GIV). The surface roughness (Ra) test was performed, followed by AFM analysis. The results were analyzed by ANOVA and the Tukey test, with the level of significance set at a=.05. The surface treatment with acid solutions (0.16 ± 0.02-GIII; 0.11 ± 0.01-GIV) promoted a significant increase in roughness, with higher mean Ra values of Y-TZP (?m) compared to control (0.06 ± 0.01-GI) (p >.05), and lower values compared to the conventional method (0.21 ± 0.06-GII). The aluminum oxide particle treatment resulted in deep microretentions forming sharp Y-TZP peaks compared to only microretentions with acid solution treatments. All Y-TZP treatments effectively promoted microretention in the ceramic. Hydrofluoric acid (48%) proved to be more effective in increasing the Ra of Y-TZP than the nitric acid/hydrofluoric acid treatment. Atomic force microscopy images revealed that both acid solutions modified the surface of the Y-TZP in a uniform manner

Erythema multiforme induced by alendronate sodium in a geriatric patient : a case report and review of the literature

Erythema multiforme is an uncommon acute inflammatory disorder caused by exposure to microbes or drugs. Erythema multiforme minor typically affects only one mucosa and can be associated with symmetrical target skin lesions on the extremities. The disease usually occurs in patients in their 3rd and 4th decade of life, but can also affect children and adolescents. Alendronate sodium has been approved for the prevention and treatment of osteoporosis in postmenopausal women, but is associated with adverse events. This study reports and discusses a case of erythema multiforme minor. In addition, a literature search of articles published in PubMed-Medline was performed. The case was a 96-year-old woman who had taken alendronate. Intraoral clinical examination demonstrated hypersalivation and macrocheilia of the lower lip, associated with an ill-defined ulcer with erythematous borders measuring 20 mm in greatest diameter and covered with serofibrinous exudates. The aging of the population in developed and developing countries has increased the use of alendronate sodium to prevent osteoporosis and clinicians should be aware of possible oral adverse events associated with this drug

Orofacial clinical features in Arnold Chiari type I malformation : a case series

Arnold Chiari malformation (ACM) is characterized by an anatomical defect at the base of the skull where the cerebellum and the spinal cord herniate through the foramen magnum into the cervical spinal canal. Among the subtypes of the condition, ACM type I (ACM-I) is particularly outstanding because of the severity of symptoms. This study aimed to analyze the orofacial clinical manifestations of patients with ACM-I, and discuss their demographic distribution and clinical features in light of the literature. A case series with patients with ACM-I treated between 2012 and 2015 was described. The sample consisted of patients who were referred by the Department of Neurosurgery to the Oral and Maxillofacial Surgery Service of Hospital da Restauração in Brazil for the assessment of facial symptomatology. A questionnaire was applied to evaluate the presence of painful orofacial findings. Data are reported using descriptive statistical methods. Mean patient age was 39.3 years and the sample consisted mostly of male patients. A high prevalence of headache (50%) and pain in the neck (66.7%) and masticatory muscles (50%) was found. Only one patient reported difficulty in performing mandibular movements and two reported jaw clicking sounds. Mean mouth opening was 40.83 mm. ACM-I patients may exhibit orofacial symptoms which may mimic temporomandibular joint disorders. This study brings interesting information that could help clinicians and oral and maxillofacial surgeons to understand this uncommon condition and also help with the diagnosis of patients with similar physical characteristics by referring them to a neurosurgeon

Clinical outcome of renal transplant patients after coronary stenting

OBJECTIVE: To assess the clinical outcome of renal transplant patients who developed coronary artery disease and were treated with coronary stenting (TCA-ST). METHODS: A total of 3,334 renal transplants were performed in our service - Hospital do Rim e Hipertensão - HRH (Kidney and Hypertension Hospital) from July, 1998 to November, 2004. During this period, 33 of the renal transplant patients underwent TCA-ST to treat 62 severe stenoses in 54 coronary arteries. A retrospective analysis was performed with renal transplant patients undergoing TCA-ST at HRH. The clinical events were registered using medical charts, medical visits and phone calls. RESULTS: During the 30-month clinical follow-up after TCA-ST, 67% of the patients remained asymptomatic, 18% presented stable angina, 6% presented acute coronary syndrome without ST-segment elevation (ACSWSTE), and 3% presented acute coronary syndrome with ST-segment elevation (ACSSTE). No strokes, CHF or cardiac deaths were observed. Three non-cardiac deaths occurred. A restenosis rate of 9% was observed, which is comparable to those found in studies on drug-eluting stents. CONCLUSION: In conclusion, renal transplant patients who developed CAD and were treated with coronary stenting had a low rate of in-stent restenosis, probably related to the immunosuppressive regimen given to prevent kidney rejection.OBJETIVO: Avaliar a evolução clínica de pacientes submetidos a transplante de rim, portadores de doença arterial coronariana, que foram tratados com implante de stent coronariano (ATC-ST). MÉTODOS: Entre julho de 1998 e novembro de 2004, foram realizados, no total, 3.334 transplantes de rim em nossa Instituição (Hospital do Rim e Hipertensão). Desse total, 33 pacientes previamente submetidos a transplante de rim fizeram ATC-ST para o tratamento de 62 estenoses graves em 54 artérias coronárias, nos quais foi realizada análise retrospectiva. O registro dos eventos clínicos foi feito por meio de análise do prontuário médico, consulta médica e ligações telefônicas. RESULTADOS: No seguimento clínico de 30 meses, após a ATC-ST, observou-se que 67% dos pacientes permaneceram assintomáticos, 18% dos pacientes apresentaram quadro de angina estável, 6% apresentaram síndrome coronariana aguda sem supra de ST e 3% apresentaram síndrome coronariana aguda com supra de ST. Não houve pacientes com acidente vascular cerebral, insuficiência cardíaca congestiva ou morte cardíaca. Houve três mortes não-cardíacas. Foi observado índice de reestenose de 9%, que é comparável ao dos estudos de stent farmacológico. CONCLUSÃO: Concluímos que pacientes submetidos a transplante de rim que desenvolveram doença arterial coronariana e que foram tratados com stent coronariano tiveram baixo porcentual de reestenose clínica, provavelmente relacionado ao regime de imunossupressão administrado para evitar rejeição renal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital do Rim e HipertensãoUNIFESP, EPM, Hospital do Rim e HipertensãoSciEL

Anxiety and pain perception in patients undergoing mandibular autogenous block bone surgery

The aim of the present study was to investigate pain perception and anxiety within the context of surgery for the placement of mandibular block bone and to evaluate the causality effect between theses variables. A total of 13 patients were recruited for the study and were submitted to mandibular autogenous block bone surgery. Demographic data were collected and the anxiety level was determined using the State-Trait Anxiety Inventory (STAI). The STAI was administered on the day of surgery and on the 14th postoperative day. Pain was determined using the visual analogue scale (VAS) and limitation of daily activities and postoperative symptoms were also reported. Data were analyzed using parametric tests (?=0.05) and cross-lagged analysis was performed to verify a causality effect. Few patients reported interference with daily activities or the presence of postoperative symptoms. A significant association of bad breath/taste with STAI-State was detected on the 14th postoperative day. No evidence of causality between STAI and VAS was detected. The patient?s self-evaluation indicates that the pain and anxiety level felt during treatment was not directly associated with the clinical aspects of the surgical procedure or with postoperative activities/symptoms limitations

Calcifying odontogenic cyst : a 26-year retrospective clinicopathological analysis and immunohistochemical study

Background: To identify the prevalence and clinicopathological profile of calcifying odontogenic cysts (COC) stored at an oral pathology service, and to analyze the immunoexpression of cyclooxygenase 2 (COX-2) and cyclin D1 (CD1) in these cysts. Material and Methods: After a retrospective analysis (1990-2016) carried out to identify cases of COC, a sample of 12 cases was selected for immunohistochemical analysis of COX-2 and CD1 by the immunoperoxidase technique. Protein expression was evaluated semiquantitatively by attributing a score of 0 to 3 (0 = no staining; 1 = 1-25%; 2 = 26-50%, and 3 = >51% immunopositive cells). Results: Twenty cases of COC were diagnosed over the study period. These cysts were more common in the posterior mandible and in men (male-to-female ratio of 1.2:1), with a mean age of 29.9 years. Among the 12 cases analyzed, immunoexpression of COX-2 was observed only in the inflammatory infiltrate in 50% of the cysts (n = 6). Protein CD1 was detected (score 1) in 66.6% of cases (n = 8), and COX-2 was negative in 50% (n = 6). Conclusions: The prevalence of COC among all odontogenic cysts was 3.5%, representing an uncommon lesion. Immunohistochemical analysis suggested that COX-2 does not participate in lesion progression. The cell proliferation index of COC was low, as demonstrated by the expression of CD1, suggesting a proliferative profile compatible with more indolent lesion

Clinical and radiographic features of pycnodysostosis : a case report

Pycnodysostosis is a rare disorder that was first described in 1962; however, it was only in 1996 that the defective gene was discovered, which led to a better understanding of this disease. This study reports and discuss a case of pycnodysostosis. In addition, a search of articles published in PubMed-Medline was performed. The case was a 13-year-old girl who was referred to a private clinic for dental treatment. Clinical examination showed midface hypoplasia, prominent cheeks, a high nasal bridge, beaked nose, spoon-shaped fingers, frontal bossing, open fontanelles and dental alterations, findings compatible with pycnodysostosis. Patients with this disease also suffer from fractures because of bone hardness with almost no elasticity, a fact that requires special care particularly in the case of children and adolescents. The diagnosis of pycnodysostosis is made based on clinical and radiographic findings. Clinicians should be aware of this disorder to provide adequate dental treatment

Oral paracoccidioidomycosis:a retrospective study of 95 cases from a single center and literature review

The ecoepidemiological panorama of paracoccidioidomycosis (PCM) is dynamic and still ongoing in Brazil. In particular, data about the oral lesions of PCM are barely explored. The aim of this study was to report the clinicopathological features of individuals diagnosed with oral PCM lesions at an oral and maxillofacial pathology service in Rio de Janeiro, Brazil, in the light of a literature review. A retrospective study was conducted on oral biopsies obtained from 1958 to 2021. Additionally, electronic searches were conducted in PubMed, Embase, Scopus, Web of Science, Latin American and Caribbean Center on Health Sciences Information, and Brazilian Library of Dentistry to gather information from large case series of oral PCM. Ninety-five cases of oral PCM were surveyed. The manifestations were more frequent among males (n=86/90.5%), middle-aged/older adults (n=54/58.7%), and white individuals (n=40/51.9%). The most commonly affected sites were the gingiva/alveolar ridge (n=40/23.4%) and lip/labial commissure (n=33/19.3%); however, one (n=40/42.1%) or multiple sites (n=55/57.9%) could also be affected. In 90 (94.7%) patients, ?mulberry-like? ulcerations/moriform appearance were observed. Data from 21 studies (1,333 cases), mostly Brazilian (90.5%), revealed that men (92.4%; male/female: 11.8:1) and individuals in the fifth and sixth decades of life were the most affected (range: 7-89 years), with the gingiva/alveolar ridge, palate, and lips/labial commissure being the sites most frequently affected. The features of oral PCM lesions are similar to those reported in previous studies from Latin America. Clinicians should be aware of the oral manifestations of PCM, with emphasis on the clinicodemographic aspects and differential diagnoses, especially considering the phenomenon of the emergence of reported cases in rural and/or urban areas of Brazil