Intraosseous benign peripheral nerve sheath tumor of the jaws: report of 4 new cases and a comprehensive literature review.

Benign peripheral nerve sheath tumors (BPNSTs) are a vast, common, heterogeneous group of lesions that are often diagnostically challenging. The head and neck region is recognized as the second most common location for these lesions, especially the tongue. However, BPNSTs occurring centrally within the jaw bones are exceedingly rare. To date, approximately 161 cases of intraosseous BPNSTs have been reported in the jaws. This group mainly includes the relatively more common neurofibromas and schwannomas, and the less common perineuriomas and hybrid forms. Unlike soft tissues, schwannomas are the most common BPNSTs occurring within the jaws, followed by neurofibromas and perineuriomas. These neoplasms can present as a well-defined unilocular lesion or as an ill-defined multilocular image, resembling several types of benign and malignant lesions of odontogenic origin. The aim of the current study was to report 4 new cases of intraosseous BPNSTs and a comprehensive literature review.

Avaliação da interface osso-implante em tíbias de coelho irradiadas / Bone-implant interface evaluation in irradiated rabbit tibiae

O câncer de cabeça e pescoço é comumente tratado por combinação de cirurgia e radioterapia. Nesses casos, a reabilitação com próteses implanto-suportadas muito pode contribuir para restabelecimento de estética e função. A radioterapia, entretanto, pode provocar diversos problemas tais como xerostomia, alteração da microbiota oral, aumento da suscetibilidade a processos infecciosos e prejuízo generalizado para o metabolismo dos tecidos envolvidos. A despeito de todas essas alterações, os implantes, em muitos casos, representam a única opção para uma recuperação funcional adequada. Diversas substâncias, tais como o plasma rico em plaquetas (PRP), já foram avaliadas no sentido de melhorar a integração óssea dos implantes, a qual é crítica no osso irradiado. O PRP contém alta concentração de plaquetas e fibrinogênio e pode ser obtido através da centrifugação do sangue coletado do paciente. A proposta do presente trabalho foi realizar um estudo experimental em animais de modo a determinar o quanto a irradiação pode prejudicar a formação da interface osso-implante além de mensurar o quanto a utilização do PRP pode modificar a osteointegração. Foram utilizados 18 coelhos divididos em três grupos: Grupo I, implantes instalados em osso não irradiado; Grupo II, implantes instalados em osso irradiado; Grupo III, implantes instalados em osso irradiado com uso do PRP. Todos os implantes foram instalados em epífise proximal de ambas as tíbias, que foram irradiadas 40 dias antes (1727cGy). Todos os animais foram sacrificados 40 dias após a instalação dos implantes para que fossem obtidas lâminas para análise histomorfométrica ao microscópio. Foram investigadas a extensão do contato osso-implante e a área de osso neoformado entre as espiras. ...

[The EMECAS Project: Spanish multicentre study on short-term health effects of air pollution]. / El proyecto EMECAS: protocolo del estudio multicéntrico en España de los efectos a corto plazo de la contaminación atmosférica sobre la salud.

UNLABELLED: The EMECAM Project demonstrated the short-term effect of air pollution on the death rate in 14 cities in Spain throughout the 1990-1995 period. The Spanish Multicentre Study on Health Effects of Air Pollution (EMECAS) is broadening these objectives by incorporating more recent data, information on hospital disease admissions and totaling 16 Spanish cities. This is an ecological time series study in which the response variables are the daily deaths and the emergency hospitalizations due to circulatory system diseases and respiratory diseases among the residents in each city. Pollutants analyses: suspended particles, SO2, NO2, CO and O3. Control variables: meteorological, calendar, seasonality and influenza trend and incidence. STATISTICAL ANALYSIS: estimate of the association in each city by means of the construction of generalized additive Poisson regression models and metanalysis for obtaining combined estimators. The EMECAS Project began with the creation of three working groups (Exposure, Epidemiology and Analysis Methodology) which defined the protocol. The average levels of pollutants were below those established under the current regulations for sulfur dioxide, carbon monoxide and ozone. The NO2 and PM10 values were around those established under the regulations (40 mg/m3). This is the first study of the relationship between air pollution and disease rate among one group of Spanish cities. The pollution levels studied are moderate for some pollutants, although for others, especially NO2 and particles, these levels could entail a problem with regard to complying with the regulations in force.

Spatial analysis of the relationship between mortality from cardiovascular and cerebrovascular disease and drinking water hardness.

Previously published scientific papers have reported a negative correlation between drinking water hardness and cardiovascular mortality. Some ecologic and case-control studies suggest the protective effect of calcium and magnesium concentration in drinking water. In this article we present an analysis of this protective relationship in 538 municipalities of Comunidad Valenciana (Spain) from 1991-1998. We used the Spanish version of the Rapid Inquiry Facility (RIF) developed under the European Environment and Health Information System (EUROHEIS) research project. The strategy of analysis used in our study conforms to the exploratory nature of the RIF that is used as a tool to obtain quick and flexible insight into epidemiologic surveillance problems. This article describes the use of the RIF to explore possible associations between disease indicators and environmental factors. We used exposure analysis to assess the effect of both protective factors--calcium and magnesium--on mortality from cerebrovascular (ICD-9 430-438) and ischemic heart (ICD-9 410-414) diseases. This study provides statistical evidence of the relationship between mortality from cardiovascular diseases and hardness of drinking water. This relationship is stronger in cerebrovascular disease than in ischemic heart disease, is more pronounced for women than for men, and is more apparent with magnesium than with calcium concentration levels. Nevertheless, the protective nature of these two factors is not clearly established. Our results suggest the possibility of protectiveness but cannot be claimed as conclusive. The weak effects of these covariates make it difficult to separate them from the influence of socioeconomic and environmental factors. We have also performed disease mapping of standardized mortality ratios to detect clusters of municipalities with high risk. Further standardization by levels of calcium and magnesium in drinking water shows changes in the maps when we remove the effect of these covariates.

A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project.

In recent years, some epidemiologic studies have attributed adverse effects of air pollutants on health not only to particles and sulfur dioxide but also to photochemical air pollutants (nitrogen dioxide and ozone). The effects are usually small, leading to some inconsistencies in the results of the studies. Furthermore, the different methodologic approaches of the studies used has made it difficult to derive generic conclusions. We provide here a quantitative summary of the short-term effects of photochemical air pollutants on mortality in seven Spanish cities involved in the EMECAM project, using generalized additive models from analyses of single and multiple pollutants. Nitrogen dioxide and ozone data were provided by seven EMECAM cities (Barcelona, Gijón, Huelva, Madrid, Oviedo, Seville, and Valencia). Mortality indicators included daily total mortality from all causes excluding external causes, daily cardiovascular mortality, and daily respiratory mortality. Individual estimates, obtained from city-specific generalized additive Poisson autoregressive models, were combined by means of fixed effects models and, if significant heterogeneity among local estimates was found, also by random effects models. Significant positive associations were found between daily mortality (all causes and cardiovascular) and NO(2), once the rest of air pollutants were taken into account. A 10 microg/m(3) increase in the 24-hr average 1-day NO(2)level was associated with an increase in the daily number of deaths of 0.43% [95% confidence interval (CI), -0.003-0.86%] for all causes excluding external. In the case of significant relationships, relative risks for cause-specific mortality were nearly twice as much as that for total mortality for all the photochemical pollutants. Ozone was independently related only to cardiovascular daily mortality. No independent statistically significant relationship between photochemical air pollutants and respiratory mortality was found. The results in this study suggest that, given the present levels of photochemical pollutants, people living in Spanish cities are exposed to health risks derived from air pollution.

Insuficiencia hepática fulminante / Fulminant hepatic failure

La insuficiencia hepática fulminante es un síndrome clínico caracterizado por lesión o necrosis hepatocelular, o ambas. Desde el punto de vista clínico se manifiesta por encefalopatía que progresa rápidamente a disfunción orgánica múltiple y muerte. La causa más frecuente es la infección por virus de hepatitis, seguida por reacciones a medicamentos, ingestión de venenos y alteraciones en la perfusión hepática por causa local o sistémica. En este artículo se analizan las principales causas, la presentación clínica, complicaciones, tratamiento médico, indicaciones de transplante hepático, así como el pronóstico de este padecimiento.