Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample.

The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

[Jejunal metastasis from choriocarcinoma. A three-case report]. / Coriocarcinoma metastásico a yeyuno. Reporte de tres casos.

Five per cent of patients presenting with choriocarcinoma develop small bowel metastasis. Tumors of the small bowel are rare and the metastases are generally from lung and breast carcinoma or from melanoma. Clinical presentation is vague and the majority of cases are autopsy findings. The main symptoms are related to the presence of abdominal tumor or hemorrhage, or bowel obstruction or perforation. We present the cases of three patients with small bowel metastasis from choriocarcinoma. A 24-year-old woman with bowel obstruction secondary to intussusception caused by a metastatic choriocarcinoma polypoid mass and two men, one 18 years old and the other 24 years old, with a history of testicular tumor, who presented with gastrointestinal bleeding due to small bowel metastasis from choriocarcinoma, 2 and 10 months after orchiectomy, respectively. Management was endoscopic in one case and surgical in the other two. Two patients died in the early postoperative period and one patient died during the first year of follow-up. Choriocarcinoma metastases are very rare and their main clinical manifestations are hemorrhage and bowel obstruction. Management can be either medical or surgical. The majority of patients with choriocarcinoma respond to chemotherapy but prognosis is worse for those patients presenting with small bowel metastasis.

Validation of the third molar maturity index (I3M): study of a Dominican Republic sample.

This retrospective study aims to test the third molar maturity index (I3M) cut-off value of 0.08 for 18 years old in Dominican Republic population. Orthopantomograms of 513 subjects (284 females and 229 males) were evaluated, intra- and inter-observer agreement, ICC (intra-class correlation coefficient) values were 0.88% (95 % CI 0.86% to 0.91%), and 0.93% (95% CI 0.90% to 0.96%), for the intra- and inter-observer reliability, respectively. Accuracy in females was 0.96 (95% CI: 0.93-0.97); the sensitivity was 0.99 (95% CI: 0.96-0.99) and specificity was 0.92 (95% CI: 0.86-0.95). In males, the accuracy was 0.96 (95% CI: 0.93-0.98); the sensitivity was 0.94 (95% CI: 0.88-0.97) and specificity was 0.99 (95% CI: 0.95-0.99). The PPV (Positive Predictive Value) was 0.93 for females and 0.99 for males. The results of this study show that I3M can be used for discriminating adults from minors in Dominican Republic subjects around the legal age of 18 years old.

[Hamartoma of the bile duct. Report of a case]. / Hamartoma de la vía biliar. Reporte de un caso.

BACKGROUND: Gallstones and neoplasms generally cause obstructions in the biliary duct. There are some infrequent problems that may lead to obstructions, such as hamartomas of the biliary duct. CASE REPORT: A 34-year-old diabetic female patient begins with abdominal pain and jaundice. The diagnostic approach initiated with hepatobiliary ultrasound that reported cholelithiasis and enlargement of the biliary ducts. Cholangiopancreatography was subsequently performed and a biliary tree lesion was discovered; the patient underwent cholecystectomy with exploration of the biliary ducts. Clinical evolution was satisfactory. Pathologic findings indicated hamartoma of the biliary duct.

[Malignant stromal tumor of the transverse colon. Case report]. / Tumor estromal maligno de colon transverso. Informe de un caso.

OBJECTIVE: Case report of a malignant stromal tumor of the transverse colon. BACKGROUND: Colon sarcomas are rare; the most frequent presentation is the leiomyosarcoma. Forty five cases of malignant stromal tumor have been reported in the international literature. The histogenesis of these mesenchymatous neoplasms is determined by ultrastructural analysis and immunohistochemical stains, nevertheless when special techniques are negative and there is uncertainty related to the cellular differentiation line (smooth muscle, neural or undifferentiated) it is preferable to call them stromal tumors of gastrointestinal tract. METHOD: A 46 year old patient with the diagnosis of malignant stromal tumor of transverse colon and the prescribed treatment was reported. RESULTS: A case of a patient with the diagnosis of malignant stromal tumor in transverse colon is presented, who had as the main clinical features abdominal pain, transanal hemorrhage and finally intestinal occlusion. He was submitted to exploratory laparotomy finding a transverse colon intussusception, which was treated with an extended right hemicolectomy and a post surgical satisfactory recovery. Follow-up to three years hasn't found tumoral activity. CONCLUSIONS: Stromal tumors are rare in colon, treatment is a wide surgical resection with curative or palliative purposes.

Tumor estromal maligno de colon transverso. Informe de un caso / Malignant stromal tumor of transverse colon

Antecedentes. Los sarcomas de colon son poco comunes, de ellos, el más frecuente es el leiomiosarcoma. A la fecha se han informado 45 casos de tumor estromal maligno en la literatura mundial. La histogénesis de estas neoplasias mesenquimatosas se determinan con análisis ultraestructural y tinciones de inmunohistoquímica, sin embargo, cuando estas técnicas especiales son negativas y existe duda en cuanto a la línea de diferenciación celular (músculo liso, neural o indiferenciado), es preferible llamarlos tumores estromales del tracto gastrointestinal (TEGI). Objetivo. Presentar un caso de tumor estromal maligno del colon transverso. Método. Se revisó el caso de un paciente de 46 años de edad con diagnóstico de tumor estromal maligno de colon transverso y el tratamiento efectuado. Resultados. Se informa el caso de un paciente con diagnóstico de tumor estromal maligno en el colon transverso, cuyas principales manifestaciones clínicas fueron dolor abdominal, hemorragia transanal, y finalmente oclusión intestinal. Se sometió a laparotomía exploradora, encontrando intusucepción del colon transverso, por lo que se hizo hemicolectomía derecha ampliada. La evolución postquirúrgica fue satisfactoria y la vigilancia a tres años no ha demostrado datos de activación tumoral. Conclusiones. Los tumores estromales de colon son raros y su tratamiento es la resección quirúrgica con fines curativos o paliativos