Clinical, microscopic and imaging findings associated to Mccune-Albright syndrome: report of two cases

McCune-Albright syndrome is characterized by the triad café-au-lait cutaneous spots, polyostotic fibrous dysplasia and endocrinopathies. This article presents two cases of McCune-Albright syndrome in a middle-aged woman and a young girl. Both patients presented café-au-lait spots on the face and other parts of the body and expansion of the mandible with radiopaque-radiolucent areas with ground-glass radiographic appearance, and were diagnosed as having fibrous dysplasia and endocrine disorders. The patient of Case 1 had fibrous dysplasia on the upper and lower limbs, thorax, face and cranium, early puberty, hyperglycemia, hyperthyroidism and high serum alkaline phosphatase levels. The patient of Case 2 presented lesions on the upper limbs and evident endocrine disorders. In both cases presented in this article, the initial exam was made because of the mandibular lesion. However, a diagnosis of fibrous dysplasia must lead to investigation of the involvement of other bones, characterizing polyostotic fibrous dysplasia, which is manifested in a number of diseases. An accurate differential diagnosis is mandatory to determine the best treatment approach for each case.A Síndrome de McCune-Albright é caracterizada pela tríade manchas café-com-leite na pele, displasia fibrosa poliostótica e endocrinopatias. Este artigo apresenta dois casos de Síndrome de McCune-Albright em uma mulher de meia idade e em uma menina. Ambos apresentavam manchas café-com-leite na face e em outras partes do corpo, expansão da mandíbula com área radiopaca-radiolúcida com aspecto de vidro despolido na radiografia, com o diagnóstico de displasia fibrosa, e desordens endócrinas. O paciente do Caso 1 apresentava displasia fibrosa nos membros inferiores e superiores, tórax, face e crânio, puberdade precoce, hiperglicemia, hipertireoidismo e elevação da fosfatase alcalina no sangue. O paciente do Caso 2 apresentava lesões nos membros superiores e desordem endócrina evidente. Em ambos os casos apresentados neste artigo, o exame inicial foi realizado devido à lesão mandibular. Contudo, o diagnóstico de displasia fibrosa deve conduzir a pesquisa de envolvimento de outros ossos, caracterizando a displasia fibrosa poliostótica, que se manifesta em um grande número de doenças. O diagnóstico diferencial preciso é fundamental para determinar o tratamento adequado a cada caso

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health

Bone quality associated with daily intake of coffee: a biochemical, radiographic and histometric study

Caffeine induces loss of calcium and influences the normal development of bone. This study investigated the effects of coffee on bone metabolism in rats by biochemical measurement of calcium, bone densitometry and histometry. Male rats, born of female treated daily with coffee and with coffee intake since born, were anesthetized, subjected to extraction of the upper right incisor, and sacrificed 7, 21 and 42 days after surgery. Blood and urine samples were taken, and their maxilla radiographed and processed to obtain 5-µm-thick semi-serial sections stained with hematoxylin and eosin. The volume and bone quality were estimated using an image-analysis software. The results showed significantly greater amount of calcium in the plasma (9.40 ± 1.73 versus 9.80 ± 2.05 mg%) and urine (1.00 ± 0.50 versus 1.25 ± 0.70 mg/24 h) and significantly less amount in bone (90.0 ± 1.94 versus 86.0 ± 2.12 mg/mg bone), reduced bone mineral density (1.05 ± 0.11 versus 0.65 ± 0.15 mmAL), and lower amount of bone (76.19 ± 1.6 versus 53.41 ± 2.1 %) (ANOVA; p≤0.01) in animals treated with coffee sacrificed after 42 days. It may be concluded that coffee/caffeine intake caused serious adverse effects on calcium metabolism in rats, including increased levels of calcium in the urine and plasma, decreased bone mineral density and lower volume of bone, thus delaying the bone repair process.A cafeína induz perda de cálcio e influencia no desenvolvimento ósseo normal. Este estudo investiga os efeitos do café sobre o metabolismo ósseo em ratos através de avaliações bioquímicas do cálcio, densitometria e histometria óssea. Ratos machos, nascidos de fêmeas tratadas diariamente com café, e com ingestão de café desde o nascimento, foram anestesiados, submetidos à extração do incisivo superior direito e sacrificados 7, 21 e 42 dias após a cirurgia. Amostras de sangue e urina foram colhidas, suas maxilas radiografadas e processadas para se obter cortes semi seriados (5 µm) e corados pela hematoxilina-eosina. Através de um programa de análise de imagens, o volume e a qualidade do osso foram avaliados. Os resultados demonstraram maior quantidade de cálcio no sangue (9,40 ± 1,73 versus 9,80 ± 2,05 mg%) e urina (1,00 ± 0,50 versus 1,25 ± 0,70 mg/24 h) e menor no osso (90,0 ± 1,94 versus 86,0 ± 2,12 mg/mg osso), densidade mineral óssea menor (1,05 ± 0,11 versus 0,65 ± 0,15 mmAL), e menor quantidade de osso (76,19 ± 1,6 versus 53,41 ± 2,1 %) estatisticamente significante (ANOVA p≤0,01) nos animais tratados com café sacrificados após 42 dias. Conclui-se que a ingestão de café/cafeína causou sérios efeitos adversos no metabolismo de cálcio em ratos, incluindo aumento dos níveis de cálcio na urina e no plasma, diminuição da densidade mineral óssea e menor volume de osso atrasando o processo de reparo ósseo

Implante de um floculado de resina de mamona em alvéolo dental de rato

The purposes of the present study were: 1) to investigate the biocompatibility of a natural resin (made of fatty acids extracted from Ricinus communis) implanted in the dental alveolus of rats and 2) to verify any possible interference of that material in the osseous healing following tooth extraction. The resin (AUG-EX, Poliquil Araraquara Polímeros Químicos LTDA, Araraquara - SP) was placed inside de alveoli immediately after extraction of the upper right incisors. The animals were sacrificed 1, 2, 3 and 6 weeks after extraction or extraction + implantation. The hemi-maxillae were decalcified and processed for paraffin embedding. Longitudinal 6-micrometer-thick semi-serial sections stained with hematoxylin and eosin were obtained. Histologic examination showed particles of irregular shape and variable size (700-1200 mum) localized in the medium/cervical alveolar thirds, with a scanty but persistent foreign body reaction. From the second week on, as the relative volume of bone trabeculae increased, it was seen in close contact with the surface of the implanted material in some regions. Histometric analysis (differential point counting method), used to quantify the healing process in the apical third, showed a small but significant decrease (13%-20%) in new bone formation in the implanted rats. In conclusion, the results show that, in spite of its biocompatible nature, the studied resin hinders the post-extration healing process.Os objetivos do presente trabalho foram: 1) testar a biocompatibilidade de uma resina natural, derivada do óleo de mamona, implantada na cavidade de extração dental de ratos, e 2) estudar a possível interferência do material na cronologia do reparo alveolar. O material (AUG-EX, Poliquil Araraquara Polímeros Químicos Ltda., Araraquara - SP) foi implantado no alvéolo imediatamente após a extração do incisivo superior direito e os ratos foram sacrificados de 1 a 6 semanas após a extração ou extração + implante. As hemimaxilas foram descalcificadas e processadas para inclusão em parafina e obtenção de cortes semi-seriados, corados com hematoxilina-eosina. Os flocos da resina, de forma irregular e tamanho variável, localizaram-se entre os terços alveolares médio e cervical, inicialmente circundados por tecido de granulação e a seguir por quantidade progressivamente maior de tecido ósseo, no geral com a presença de um tecido conjuntivo interposto, mas em algumas áreas estabelecendo aparente osseointegração direta. Não houve persistência da reação inflamatória, mas observou-se pequena quantidade de células gigantes aderidas à superfície do material, em todos os períodos. A análise histométrica (contagem diferencial de pontos) do terço apical mostrou um atraso de 13% a 20% no reparo alveolar dos ratos implantados, com menor neoformação óssea associada a maiores volumes percentuais de tecido conjuntivo e de remanescentes do coágulo sangüíneo

Eruption sequestrum - case report and histopathological findings

Eruption sequestrum is an uncommon disturbance in eruption and consists of small fragments of calcified tissue overlying the crowns of erupting permanent molar teeth, especially at the time of eruption of the mandibular first molars. This paper reports a case of unilateral eruption sequestrum in a 7-year-old Brazilian boy and describes its histopathological findings. A white small fragment, 0.5 cm in diameter, with hard consistency, irregular shape and located on the occlusal surface of the erupting mandibular left first molar was excised. Microscopic examination revealed large trabeculae with empty lacunae and a minimal amount of existing spongy bone consisting of acute inflammatory cells (neutrophils). Signs of necrosis were found on the periphery. The histological analysis was consistent with non-vital bone and the diagnosis of eruption sequestrum was established. Clinical and radiographic follow-up visits scheduled at short intervals and then every 6 months revealed normal postoperative conditions

Comparison of rat bone healing following intra-alveolar grafting with organic or inorganic bovine bone particles

Aim: This study compared, histometrically, the alveolar bone healing after grafting rats extraction socket with particles of organic or inorganic bovine bone. Method: The volume fraction of grafted materials and bone trabeculae was estimated in histologic images at the end of the 2nd and 9th weeks post-operatively by a differential point-counting method. Results: Particles of both materials were observed partially filling the cervical alveolar third and the volume fraction of inorganic graft was larger than that of organic graft 2 and 9 weeks following implantation. Although evoking neither a foreign-body reaction nor a persisting inflammatory response, both materials delayed bone healing. By the 2nd week, the delay was more pronounced in the animals grafted with inorganic than in those grafted with organic bone, but only in the animals whose inorganic graft occupied more than 50% of the cervical third. By the 9th week, despite the greater volume fraction of inorganic graft the percent of bone healing was similar to that observed in the animals grafted with organic bone. Conclusion: The degree of impairment of bone healing resulted from combination of factors such as type of material, its relative amount and the phase of the reparational process

Comparison of rat bone healing following intra-alveolar grafting with organic or inorganic bovine bone particles

Aim: This study compared, histometrically, the alveolar bone healing after grafting rats extraction socket with particles of organic or inorganic bovine bone. Method: The volume fraction of grafted materials and bone trabeculae was estimated in histologic images at the end of the 2nd and 9th weeks post-operatively by a differential point-counting method. Results: Particles of both materials were observed partially filling the cervical alveolar third and the volume fraction of inorganic graft was larger than that of organic graft 2 and 9 weeks following implantation. Although evoking neither a foreign-body reaction nor a persisting inflammatory response, both materials delayed bone healing. By the 2nd week, the delay was more pronounced in the animals grafted with inorganic than in those grafted with organic bone, but only in the animals whose inorganic graft occupied more than 50% of the cervical third. By the 9th week, despite the greater volume fraction of inorganic graft the percent of bone healing was similar to that observed in the animals grafted with organic bone. Conclusion: The degree of impairment of bone healing resulted from combination of factors such as type of material, its relative amount and the phase of the reparational process