Actinic cheilitis: Proposal of a clinical index.

BACKGROUND: Actinic cheilitis is a potentially malignant lesion most commonly found in the lower lip of individuals with chronic exposure to ultraviolet radiation. The aim of this study was to develop and to test a clinical index that can be used to assess the severity of actinic cheilitis. MATERIAL AND METHODS: The clinical index of actinic cheilitis was applied to 36 patients. An incisional biopsy was obtained to grade oral epithelial dysplasias following the World Health Organization (WHO) and binary systems, and to evaluate their association with clinical characteristics by Fisher's exact test (P<0.05). The accuracy of the index was evaluated based on sensitivity, specificity, positive and negative predictive values, and receiver operating curve. RESULTS: The blurring between the border of the lip and the skin was significantly associated with cases without dysplasia/mild epithelial dysplasia (P=0.041) and with low risk of malignancy (P=0.005). Ulcers and crusts were significantly associated with moderate/severe epithelial dysplasia (P=0.002 and P=0.012, respectively) and high risk of malignancy (P=0.005 and P=0.045, respectively). Erosion showed a significant association only with high-risk cases of malignancy (P=0.024). The cut-off values of the diagnostic test showing the best performance were 10 for the WHO grading system and 11 for the binary system. CONCLUSIONS: The index cut-offs with the highest accuracy were considered indicators for a biopsy. Erosion, ulceration and crusts were associated with more severe oral epithelial dysplasias.

Clinicopathological study of oral focal mucinosis: a retrospective case series.

BACKGROUND: Oral focal mucinosis (OFM) is a rare soft tissue lesion of unknown etiology that exhibits tumor-like growth. It is considered the oral counterpart of cutaneous focal mucinosis or cutaneous myxoid cyst. This is a retrospective study of oral OFM diagnosed over a period of 42 years at an oral pathology service. MATERIAL AND METHODS: Clinical, histopathological and immunohistochemical data were analyzed. Alcian blue staining and S-100 immunohistochemistry were performed. RESULTS: Eleven cases were retrieved (4:1 female-to-male ratio). The mean age was 44 years. The gingiva was the most affected site. The main clinical presentation was sessile or pedunculated lesions of fibrous or hyperplasic appearance, most of them asymptomatic. Positive Alcian blue staining and absence of S-100 protein were observed in all specimens, which supported the histological diagnosis of OFM. Surgical excision was the treatment of choice. CONCLUSIONS: Although rare, this study supports the inclusion of OFM in the differential diagnosis of intraoral myxoid lesions.

[Benign metastasizing leiomyomas]. / Leiomiomas benignos metastizantes.

Benign metastasizing leiomyomas are rare tumours of the lung. The presenting symptoms are variable and the patients can be asymptomatic till a routine x-ray of the thorax is made (or at necropsies) and a history of uterine myomectomy is discarded. The mitotic rate is low and no cellular atypia is found but these tumours can be multiple, follow venous growth and be cause of breath inadequacy and death. Therapy has not yet been defined and can go from hysterectomy and ovariectomy to hormonal frenation with LH RH agonists. A case a benign metastasizing leiomyomas in a menopausal woman is described. A revision of literature is done.

Efeito redutor do uso de corticosteróide do diclofenaco sódico em pacientes com artrite reumatóide / The corticosteroid-sparing effect of sodium diclofenac in patients with rheumatoid arthritis

Em um ensaio duplo-cego, estudou-se o efeito redutor do uso de corticosteróide do diclofenaco sódico em 95 pacientes portadores de artrite reumatóide clássica ou definida, segundo critérios da ARA, tratados com doses variáveis de prednisolona, iguais ou superiores a 7,5mg/dia, associada ao diclofenaco sódico 50mg três vezes ao dia, ou a placebo, durante oito semanas. Observou-se melhora em ambos os grupos, segundo todos os parâmetros de eficácia terapêutica. Houve, no entanto, maior reduçäo da severidade da dor ao movimento, da duraçäo da rigidez matinal e da sensibilidade articular no grupo tratado com o diclofenaco (p<0,05). A tolerabilidade foi boa nos dois grupos de tratamento, sendo a maioria dos efeitos colaterais de natureza gastrointestinal. A dose diária de prednisolona pôde ser reduzida em 3mg no grupo tratado com o diclofenaco, permanecendo inalterada no grupo placebo. Essa diferença é estatisticamente significativa (p<0,01)