Exames de tomografia computadorizada e cintilografia para diagnóstico e plano de tratamento de osteocondroma condilar: relato de caso

PURPOSE: To report an uncommon case of osteochondroma affecting the mandibular condyle of a young patient and to illustrate the important contributions of different imaging resources to the diagnosis and treatment planning of this lesion. CASE DESCRIPTION: A 24-year-old female patient with the chief complaint of an increasing facial asymmetry and pain in the left pre-auricular region, revealing a reduced mouth opening, mandibular deviation and posterior cross-bite over a period of 18 months. Panoramic radiography revealed an enlargement of the left condyle, whereas computed tomography (CT) sections and three-dimensional CT showed a well-defined bone growth arising from condylar neck. The scintigraphy exam showed an abnormal osteogenic activity in the left temporomandibular joint. The condyle was surgically removed and after 18 months follow-up the panoramic radiography and CT scans showed no signs of recurrence. CONCLUSION: Although osteochondroma is a benign bone tumor that rarely arises in cranial and maxillofacial region, it should be considered in the differential diagnosis of slow-growing masses of the temporomandibular area and the use of different imaging exams significantly contribute to the correct diagnosis and treatment planning of this pathological condition.OBJETIVO: Relatar um caso incomum de osteocondroma afetando o côndilo mandibular de uma paciente jovem e ilustrar as importantes contribuições dos diferentes exames por imagem para o diagnóstico e plano de tratamento desta lesão. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 24 anos, com queixa principal de uma crescente assimetria facial e dor na região pré-auricular esquerda, além de apresentar redução da abertura bucal, desvio de mandíbula e mordida cruzada posterior, por um período de 18 meses. A radiografia panorâmica revelou um aumento do côndilo esquerdo, enquanto secções de tomografia computadorizada e reconstrução 3D exibiram um crescimento ósseo bem definido originando-se do côndilo. O exame de cintilografia revelou uma atividade osteogênica anormal na região de articulação tempormandibular esquerda. O côndilo foi cirurgicamente removido e após 18 meses de acompanhamento a radiografia panorâmica e a tomografia computadorizada não revelaram nenhum sinal de recorrência. CONCLUSÃO: Apesar de o osteocondroma ser um tumor ósseo benigno que raramente surge na região crânio maxilofacial, ele deve ser considerado como diagnóstico diferencial para massas de crescimento lento na área temporomandibular e o uso de diferentes exames por imagem contribuem significativamente para o correto diagnóstico e plano de tratamento desta condição patológica

Study of the inflammatory process induced by injection of carrageenan or formalin in the rat temporomandibular joint Estudo do processo inflamatório induzido pela injeção de carragenina ou de formalina na articulação temporomandibular de ratos

The aim of this study was to evaluate the effects of the injection of two phlogistic agents, carrageenan and formalin, in the rat TMJ, and the inflammatory process induced by these substances. In this study, a total of 45 adult rats were distributed in two experimental groups and a control group. The animals were sacrificed after three hours, 24 hours, three days, seven days, and 15 days after a single injection of each substance. Histological data initially demonstrated an inflammatory process represented by acute infiltration, which later became mixed, and finally chronic in both experimental groups. Hyperplasia of the synovial membrane was observed after three days, being intense at seven days, and present after 15 days only in the formalin group. Local saline injection in the control group caused no inflammatory reaction. It was concluded that a single local injection of carrageenan or formalin was enough to induce inflammatory reaction in the TMJ and periarticular soft tissues, and that the resulting processes were similar, but more persistent in the formalin group.<br>O objetivo deste trabalho foi avaliar os efeitos da injeção de dois agentes flogísticos, ou seja, carragenina ou formalina, na ATM do rato, e a evolução do quadro inflamatório provocado por essas substâncias. Foram utilizados 45 ratos, divididos em dois grupos experimentais e um grupo controle. Os animais foram sacrificados em lotes de três de cada grupo após três horas, 24 horas, três dias, sete dias e 15 dias da injeção. Histologicamente a reação inflamatória em ambos os grupos experimentais iniciou-se com infiltrado inflamatório agudo, tornando-se misto e depois crônico. Sinais de hiperplasia da membrana sinovial foram observados aos três dias, intensos aos sete dias, estando presentes aos 15 dias somente no grupo da formalina. A injeção de solução salina (grupo controle) não provocou reação inflamatória. No presente trabalho foi concluído que uma injeção local única na região da ATM de carragenina ou de formalina foi suficiente para induzir reação inflamatória na articulação e nos tecidos moles periarticulares. As reações inflamatórias resultantes da injeção desses agentes flogísticos foram semelhantes, mas o grupo da formalina mostrou infiltrado inflamatório mais persistente

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author