Evidencia del síndrome neuropático en un estudio neurofisiológico e inmunohistoquímico de las fibras nerviosas en pacientes con síndrome de boca ardiente

espanolIntroduccion: El sindrome de la boca ardiente (SBA) es una enfermedad de frecuente aparicion, caracterizada para un dolor quemante y ardiente en la lengua y en la cavidad oral, en ausencia de alteraciones estructurales macroscopicas de las mucosas. La etiopatogenesis del SBA no es todavia conocida y por lo tanto no presenta un esquema diagnostico claro y bien definido. Material y metodos: Para evaluar la hipotesis que contempla una alteracion de las fibras nerviosas perifericas de pequeno calibre, asociada o no con una alteracion trofica de las mucosas, hemos seleccionados 25 pacientes (7 varones y 18 mujeres, con una edad comprendida entre 36 y 75 anos, una media de 54 anos) afectados por SBA, que llegaron a nuestra clinica para una serie de examenes que suelen realizarse de forma rutinaria en las sindromes de dolor neurologico. En todos los pacientes se ha realizado un cuidadoso examen objetivo y una ortopantomografia, con la finalidad de excluir alteraciones de las mucosas y enfermedades odontologicas. En todos los pacientes se han realizado: examenes hematoquimicos, examenes objetivos neurologicos, teletermografia de la lengua y de la cara, examen cuantitativo de la sensibilidad termica de la lengua, de las manos y de la parte dorsal del pie. Los resultados del examen cuantitativo de la sensibilidad termica de la lengua y de la muneca se confrontaban con una poblacion control homogenea. En una poblacion de 10 pacientes (3 varones y 7 mujeres; de una edad comprendida entre 34 y 53 anos, una media de 49 anos) se ha realizado un biopsia de la parte dorsal de la lengua, la biopsias se han analizado con microscopia optica e inmunofluresencia tras un tratamiento con anticuerpos activos para proteinas neuronales citoplasmaticas (protein gene product 9.5). Resultados: Los datos obtenidos evidenciaban la presencia de una polineuropatia subclinica en el 50% de los pacientes. Especialmente se apreciaban signos de baja funcionalidad de las fibras nerviosas de pequeno calibre de la lengua en casi la mitad de los pacientes examinados. El examen histologico de la mucosa lingual evidenciaba una atrofia discreta en el 70% de los pacientes, mientras que la observacion de las fibras nerviosas de pequeno calibre por medio de la inmunofluoresencia hacia suponer la presencia de alteraciones relacionadas con una polineuropatia de tipo periferico. EnglishAims. Burning pain is considered characteristic of chronic neuropathic pain condition in general, and so me recent data seem to suggest peripheral or central nervous system involvement as possible underlying factor in BMS. This study was designed to determinate if burning mouth symptoms could be originated from a peripheal neuropathy of small diameter nerve fibres. Material and methods. The material of the study consisted of 25 patients (18 female, 7 male, 30-75 years; means 54 years). In all patients there were not: oral muco membranes lesions, oral muco membranes diseases, oral correlated diseases, oral dysfunctions, dental and periodontal diseases. Besides there were: no evidence of central nervous system pathology, no evidence of peripheral nervous system pathology, no presence of organic body disfunctions. AIIpatients didn't show significant alterations of blood investigations. AII patients were undermitted to our protocol including: oral and facial clinical examinations, neurological exam, blood investigations, Mc Gill Pain Questionnaire, VAS (visual analogical scale), biopsy of tongue mucosa with hystological and immunofluorescence exams, quantitative somatosensory thermotest and teletermography examination of tongue mucosa. ResuIts. These examinations have showed subclinical polineurophaty in 50% of patients. In particular were observed a loss of function in small diameter nervous fibres in about 50% of patients. Hystological exam of mucosal tongue revealed a moderate atrophy and alterations of structures. Conclusion. Etiology, pathogenetic processes, clinical and diagnostic approaches, therapeutical resolutions and researches of burning mouth syndrome are not clear yet. The local alterations of small diameter sensitive nerve fibres could cause an increase of oral burning, without muco membranes pathologies. These locallesions could justify the bms clinical symptomatology. The hystological alteration of small diameter sensitive nerve fibres could involve meaningful alterations of thermal reactivity of oral and body surfaces. These clinical reactivities are evident in chronic peripheal neuropathy (diabetes). These conclusions and our study results are still provisory. It will be necessary to estend and to increase our results, comparing our research with other bms etio-pathogenetic hypotesis

Reining in the Web's Inconsistencies with Site Policy

Over the years, browsers have adopted an ever-increasing number of client-enforced security policies deployed through HTTP headers. Such mechanisms are fundamental for web application security, and usually deployed on a per-page basis. This, however, enables inconsistencies, as different pages within the same security boundaries (in form of origins or sites) can express conflicting security requirements. In this paper, we formalize inconsistencies for cookie security attributes, CSP, and HSTS, and then quantify the magnitude and impact of inconsistencies at scale by crawling 15,000 popular sites. We show that numerous sites endanger their own security by omission or misconfiguration of the aforementioned mechanisms, which lead to unnecessary exposure to XSS, cookie theft, and HSTS deactivation. We then use our data to analyse to which extent the recent Origin Policy proposal can fix the problem of inconsistencies. Unfortunately, we conclude that the current Origin Policy design suffers from major shortcomings which limit its practical applicability to address security inconsistencies while catering to the need of real-world sites. Based on these insights, we propose Site Policy, designed to overcome Origin Policy's shortcomings and make any insecurity explicit. We make a prototype implementation of Site Policy publicly available, along with a supporting toolchain for initial policy generation, security analysis, and test deployment

implantologia post extraccion inmediata protocolo operativo y evaluaciones oclusales periodontales y esteticas

Objetivos: Evaluar la eficacia clinica del protocolo quirurgico relativo a la colocacion inmediata del tornillo en el alveolo post-extrativo. Material y metodos: Han sido evaluados, segun los criterios de Albrekston y Buser 45 implantes colocados con la tecnica post-extractiva, a los 6 meses y a los 3 anos tras la colocacion del implante. Resultados: El protocolo aplicado se ha demostrado valido, los porcentajes de exito han sido parecidos con aquellos de la tecnica tradicional, con la ventaja de disminuir notablemente el tiempo para la rehabilitacion oclusal y con importantes ventajas esteticas para el paciente. Conclusiones: Con este nuevo protocolo quirurgico implantologico se puede garantizar un elevado porcentaje de exito con una importante disminucion de los tiempos de intervencion con mayores ventajas esteticas, funcionales y oclusales. PALABRAS CLAVE Implante, alveolo, estetica

Desmoplastic Melanoma: Report of 5 Cases

Background. The clinical presentation of desmoplastic melanoma is often challenging. We report the experience of the Melanoma Unit of Spedali Civili University Hospital of Brescia, Italy. Method. Study subjects were drawn from 1770 patients with histologica confirmed melanoma. Within this group, desmoplastic melanoma developed in 5 patients. For each diagnosed melanoma, histological characteristics, treatment, and outcomes were evaluated. Results. Of the 5 patients described in this study, 2 were males and 3 females. The average age was 62.4 years ranging from 56 to 68 years. Breslow thickness ranged from 2.1 to 12 mm with a mean thickness of 5.8 mm. Primary treatment of 5 patients included a wide local excision of their primary lesions. Conclusions. Desmoplastic melanoma is a rare neoplasm which clinically may mimic other tumours or cutaneous infiltrate of uncertain significance. The diagnosis is hiastopathological and radical resection is necessary

quality of life assessment of patients with scalp dermatitis using the italian version of the scalpdex

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Interval Sentinel Lymph Nodes: An Unusual Localization in Patients with Cutaneous Melanoma

Background. Recent studies have demonstrated that there exists a great variation in the lymphatic drainage in patients with malignant melanoma. Some patients have drainage to lymph nodes outside of conventional nodal basins. The lymph nodes that exist between a primary melanoma and its regional nodal basin are defined “interval nodes”. Interval node occurs in a small minority of patients with forearm melanoma. We report our experience of the Melanoma Unit of University Hospital Spedali Civili Brescia, Italy. Methods. Lymphatic mapping using cutaneous lymphoscintigraphy (LS) has become a standard preoperative diagnostic procedure to locate the sentinel lymph nodes (SLNs) in cutaneous melanoma. We used LS to identify sentinel lymph nodes biopsy (SLNB) in 480 patients. Results. From over 2100 patients affected by cutaneous melanoma, we identified 2 interval nodes in 480 patients with SLNB . The melanomas were both located in the left forearm. The interval nodes were also both located in the left arm. Conclusion. The combination of preoperative LS and intraoperative hand-held gamma detecting probe plays a remarkable role in identifying these uncommon lymph node locations. Knowledge of the unusual drainage patterns will help to ensure the accuracy and the completeness of sentinel nodes identification

Supernova Properties from Shock Breakout X-rays

We investigate the potential of the upcoming LOBSTER space observatory (due circa 2009) to detect soft X-ray flashes from shock breakout in supernovae, primarily from Type II events. LOBSTER should discover many SN breakout flashes, although the number is sensitive to the uncertain distribution of extragalactic gas columns. X-ray data will constrain the radii of their progenitor stars far more tightly than can be accomplished with optical observations of the SN light curve. We anticipate the appearance of blue supergiant explosions (SN 1987A analogs), which will uncover a population of these underluminous events. We consider also how the mass, explosion energy, and absorbing column can be constrained from X-ray observables alone and with the assistance of optically-determined distances. These conclusions are drawn using known scaling relations to extrapolate, from previous numerical calculations, the LOBSTER response to explosions with a broad range of parameters. We comment on a small population of flashes with 0.2 < z < 0.8 that should exist as transient background events in XMM, Chandra, and ROSAT integrations.Comment: 14 pages, 9 figures, accepted by MNRAS, presented at AAS 203rd meetin