Influence of microbiology on endodontic failure. Literature review.

BACKGROUND: The main cause of endodontic failure is the persistence of microorganisms that cause an intraradicular or extratradicular infection and that become resistant to disinfection measures. The objective of this review is to identify the microbiota associated with endodontic failure, as well as the reasons why these microorganisms are capable of surviving basic disinfection measures. MATERIAL AND METHODS: Systematic search of scientific articles in the databases PubMed with the following keywords "Endodontic Infections", "Endodontic Microbiology", "Endodontic Failure", "Enterococcus Faecalis", "Endodontics Retreatment" was carried out. Case reports and articles with publication date prior to 2000 were not included in this review. RESULTS: Most authors highlight E. faecalis as the main microorganism associated with endodontic failure, nevertheless there are recent studies that isolate, to a greater extent, other bacteria such as Fusobacterium nucleatum and Propionibacterium. DISCUSSION: These microorganisms have in common the following proprieties, which make them able to escape the disinfection measures: the ability to form a biofilm, to locate in areas unreachable to root canal instrumentation techniques, synergism, the ability to express survival genes and activate alternative metabolic pathways.

Improving the quality of care in the molecular era for children and adolescents with medulloblastoma.

PURPOSE: Elevated mortality and morbidity rates persist in pediatric patients with medulloblastoma. We present a clinical audit of a real-world cohort of patients in search for pragmatic measures to improve their management and outcome. METHODS/PATIENTS: All pediatric patients with medulloblastoma treated between 2003 and 2016 at a Spanish reference center were reviewed. In the absence of internationally accepted quality indicators (QIs) for pediatric CNS tumors, diagnostic, therapeutic, survival, and time QIs were defined and assessed. RESULTS: Fifty-eight patients were included, 24% were younger children (< 3 years), 36% high risk (anaplastic, metastasis, or surgical residue > 1.5 cm2), and 40% standard risk. Five-year OS was 59.2% (95% CI 47-75); 5-year PFS 36.4% (95% CI 25-53). Five main areas of quality assurance were identified: diagnosis, global strategy, frontline treatment modalities, outcomes, and long-term and end-of-life care. A set of 34 QIs was developed and applied. Lack of central pathology review, delay in the incorporation of novel molecular markers, and absence of a neurocognitive and quality-of-life evaluation program were some of the audit findings. CONCLUSIONS: This real-world research study resulted in the development of a pragmatic set of QIs, aimed to improve clinical audits and quality of care given to children and adolescents with medulloblastoma. We hope that our findings will serve as a reference to further develop a quality assurance system with specific QIs for pediatric CNS tumors in the future and that this will ultimately improve the survival and quality of life of these patients.

[Brain-stem tumors in children]. / Tumores de tronco cerebral en la población pediátrica.

We report a large series of brain-stem tumors seen during 18 years of at our hospital. We diagnosed and treated a total of 42 patients between 1988 and 2006; 36 of them were operated with partial resection in most cases. Brain-stem tumors constitute a rare condition with very bad prognosis. A surgical complete resection of the mass is not possible in most cases, so the principal surgical objective is reduction and decompression. The best prognosis is seen in patients with low grade tumors with minimal neurologic deficit. Most of these tumors cause death in a short period, usually one year or less.

Triggering receptor expressed in myeloid cells 2 (TREM2) trafficking in microglial cells: continuous shuttling to and from the plasma membrane regulated by cell stimulation.

Cell biology of triggering receptor expressed in myeloid cells 2, a receptor expressed in brain cells (microglia and possibly neurons and oligodendrocytes) which is responsible for a neurological and psychiatric genetic disease, polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy otherwise called the Nasu-Hakola disease, is still largely unknown. Using immortalized mouse N9 microglial cells we demonstrate that triggering receptor expressed in myeloid cells 2 is mostly distributed intracellularly in two pools: a deposit in the Golgi complex and a population of exocytic vesicles, distinct from endosomes and lysosomes, which is continuously translocated to, and recycled from the cell surface. Results with ionomycin and gamma-interferon, showing rapid and slow increases, respectively, of triggering receptor expressed in myeloid cells 2 surface density, documented that the exocytosis of the receptor-rich vesicles is regulated. Pulse labeling in the cold of surface triggering receptor expressed in myeloid cells 2 with its antibody (or Fab fragment) followed by chase at 37 degrees C showed internalization, with recovery of the antibody in endosomes and lysosomes. However, part of the receptor/antibody complex, internalized for up to 30 min chase, was recycled to the cell surface within 2 min of ionomycin stimulation, together with a fraction of the total biotinylated surface protein chased in parallel. The internalized receptor appears therefore to get access to exocytic organelles distinct from lysosomes which may resemble the exocytic vesicles of resting cells. These results document that, in microglial cells, the surface density of the triggering receptor expressed in myeloid cells 2 and thus, presumably, the response to its activation, is continuously adapted and can be greatly increased, even at rapid rate, as a function of cell activation.

[The validation of checklists for the inhalation technic for the pressurized cartridge and the Turbuhaler]. / Validación de listas de comprobación de la técnica de inhalación para cartucho presurizado y Turbuhaler.

OBJECTIVE: To determine the intra- and interobserver validity and reliability of two checklists for inhalation technique with a pressurized inhaler (PI) and the Turbuhaler. MATERIAL AND METHODS: Transversal descriptive study performed at an urban health clinic in Gijón (Spain). Thirty-four patients, over 14 years of age but younger than 65, who used a PI and 35 who used a Turbuhaler were chosen randomly from among patients in our health clinic practice. The results obtained with each list by two observers were compared with those obtained by electronic monitors (test pattern). Each patient performed 3 inhalation maneuvers. RESULTS: Comparison with the test pattern showed that, between 35.2% and 47% of patients used the PI technique correctly, whereas 74.2% inhaled correctly using the Turbuhaler. The sensitivity of the PI checklist ranged from 62.5 to 91.6 and specificity ranged from 88.8 to 94.4. The sensitivity of the Turbuhaler checklist ranged from 50 to 76.9 specificity ranged from 66.6 to 88.8. Intra-observer agreement (Kappa index) was 0.62 to 0.74 for the PI checklist and between 0.77 and 0.81 for the Turbuhaler list. Interobserver agreement (Kappa index) was 0.68 to 0.81 for the PI list and 0.53 to 0.60 for the Turbuhaler list. CONCLUSIONS: The two checklists are valid instruments and offer good intra- and interobserver reliability, permitting easy identification of patients who perform the inhalation technique incorrectly.

Morphology and innervation of the diaphragma of Myrmecophaga tridactyla.

The diaphragma of 4 "Myrmecophaga tridactyla" was described. The diaphragma follows the general pattern of EDENTATA, but it has special features which make it possible to differentiate it from that of "Bradypus tridactylus.

[Signet-ring cell colorectal carcinoma. Study of 2 cases]. / Carcinoma de células en anillo de sello colorrectal. Estudio de dos casos.

The signet-ring cell colorectal carcinoma is very uncommon. During the period 1985-89, we have diagnosed two cases among 1,135 adenocarcinomata located in the same place. They are the two first cases described in Spain, according to a computerized bibliographic search. We have to point up as clinical features of the tumor, the occurrence of its first signs in advanced stages of the disease and the small survival of the patients suffering from this tumor. Its great content of mucin facilitates the thromboembolic disease which was the first sign and the cause of legth in one of our patients. This type of tumor has worse prognosis than the usual colorectal carcinomata, including the mucinous one, and it is similar to the one of the poorly differentiated carcinoma.

[Cystic lymphangioma of the colon: endoscopic treatment and diagnosis]. / Linfangioma quístico de colon: diagnóstico y tratamiento endoscópico.

We present a case of cavernomatous cystic lymphangioma in the hepatic angle of the colon, a extremely rare benign tumor developed in a patient under continued radiologic and endoscopic surveillance because of multiple polyps and colon carcinoma. The lesion was asymptomatic and was diagnosed in a routine follow-up colonoscopy. The endoscopic appearance was similar to that of an adenomatous polyp and was safely resected by polypectomy without evidence of relapse to the present time. Trends in the treatment of lymphangioma have been changing since the development of snare polypectomy; thus before 1980 it was treated mainly by surgery, while at present lymphangiomas less than 2 cm have been removed more frequently by polypectomy.

[Idiopathic ductopenia in adults as a cause of cryptogenic cirrhosis and complications of portal hypertension]. / Ductopenia idiopática del adulto como causa de cirrosis criptogenética y complicaciones de la hipertensión portal.

We describe a 56 years old male patient with long-term chronic liver disease of unknown etiology presenting with esophageal varices rupture. Prophylaxis of re-bleeding with propranolol and endoscopic sclerotherapy failed to prevent further haemorrhagic events and the placement of a transjugular intrahepatic portosystemic shunt (TIPS) was needed. The portal hemodynamic data revealed sinusoidal portal hypertension and the liver biopsy displayed ductopenic cholestasis. The patient met all criteria of idiopathic ductopenia. Subsequently, the jaundice worsened and the patient required liver transplantation.

[Sympathetic nervous activity in cirrhosis: the relationship between peripheral hemodynamics and renal function changes]. / Actividad nerviosa simpática en la cirrosis: relación con la hemodinámica periférica y cambios en la función renal.

The relationship between the activity of the sympathetic nervous system and the systemic and peripheral hemodynamic and renal function changes and the antinatriuretic activity in a group of 30 cirrhotic patients and 8 healthy subjects (control group) was investigated. Plasma catecholamines (noradrenaline, adrenaline and dopamine), plasma renin activity, plasma aldosterone concentrations, mean arterial pressure, cardiac output, blood volume, right femoral arterial flow (RFAF) and renal function parameters were determined in all the participants. Cyclic GMP urinary excretion (cV-UGMP) was used as an indirect index of systemic nitric oxide production. The plasma concentration of noradrenaline was greater in the patients than in the control group and was directly correlated with other vasopressor and antinatriuretic systems, RFAF, cV-UGMP, the degree of hepatic failure studied by the Pugh score and was inversely correlated with creatinine clearance and urinary sodium excretion. On Cox regression analysis, only the RFAF, creatinine clearance and plasma adrenaline concentration remained independently associated with plasma noradrenaline levels. Furthermore, plasma noradrenaline was significantly higher in patients with greater hyperdynamic circulation. These results indicate that extrasplanchnic vasodilatation substantially contributes to sympathetic nervous hyperactivity which may significantly influence in the renal function changes observed in these patients.

[Localized Castleman's disease associated with high-grade lymphoma]. / Enfermedad de Castleman localizada asociada a linfoma de alto grado.

Castleman's disease is a rare entity which is characterized by its histologic features: hyperplasia of lymph nodes and capillary proliferation. Two distinct histological patterns has been described: hyaline vascular type and plasma-cell type. Two different clinical course has been identified. While localized type is usually a benign disease in which surgical resection is curative, multicentric type has a poor prognosis regarded to the appearance of severe infection or neoplasm (Kaposi's sarcoma or malignant lymphoma. We present a rare association of localized Castleman's disease that presents synchronously with a diffuse large-cell lymphoma.

[Intramuscular juvenile xantogranuloma]. / Xantogranuloma juvenil intramuscular.

Deep or intramuscular juvenile xanthogranuloma (JXG) is very rare. There are, however, some clinical and histological similarities between the case we present and the few cases that have been published in the literature. Although most of them will need histologic confirmation to establish the final diagnosis, surgeons who are operating tumors of infancy should consider it in the differential diagnosis of well circumscribed, rapidly growing dorsal masses in children under 3 years of age. Macroscopic appearance upon excision can help to support the diagnosis. Knowledge of this variant of JXG may avoid aggressive diagnostic or therapeutic procedures.

[Tumours in the pineal region in the paediatric age. Reports of 23 cases and a review of the literature]. / Tumores de la region pineal en la edad pediatrica. Presentacion de 23 casos y revision de la bibliografia.

INTRODUCTION: Tumours in the pineal region are located at a meeting point of several neurovascular structures that are difficult to reach surgically and for which the possibility of resection is limited; as a result the management of these lesions usually requires associated adjunctive treatment with radiotherapy and/or chemotherapy. PATIENTS AND METHODS: This study is a retrospective analysis of the epidemiological, clinical, neuroimaging and pathological characteristics of 23 patients with tumours in the pineal region who were treated between the years 1997 and 2010 in the Hospital Infantil Niño Jesús. The factors involved in the prognosis of this cohort following surgical or adjunctive treatment are also discussed. RESULTS: Subjects included in the study were 6 girls and 17 boys with ages ranging from 4 months to 18 years. It was found that the initial symptoms in 95% of the patients were signs of acute or subacute hydrocephalus, which required the placement of a ventriculoperitoneal shunt (82%). A histological sample of the tumour tissue was collected in all cases. Biopsy samples were taken in the case of five patients and 18 underwent surgery involving a craniotomy. Germinoma (eight cases) and mature teratoma (one case) were the tumours with the longest survival times; non-germinomatous tumours (three cases), those of the pineal parenchyma (four cases) and gliomas (five cases) presented the highest rates of recurrence and a poorer prognosis. CONCLUSIONS: The study of tumour markers can be used to guide the diagnosis of certain tumours of the pineal region. At present, the recommended procedure involves taking a histological sample of the tumour in order to establish an accurate diagnosis and a specific oncological treatment.

Pediatric giant cell glioblastoma: a case report and review of the literature.

INTRODUCTION: Giant cell glioblastoma is a subtype of glioblastoma multiforme (GM) whose most characteristic histology is the presence of plentiful multinucleated giant cells. These tumours are very rare and account for only 5% of GM. They do not have specific localization, although normally they are supratentorial and affect mostly the temporal lobe. They may occur at any age, but mostly they occur in younger people than GM. They are infrequent in childhood, but they have longer survival in paediatric age. CASE REPORT: We present an 11-year-old girl that was operated but whose tumour recurred in a month after apparent total removal. DISCUSSION: We review in the literature the clinical, histological, immuno-histochemical and genetic characteristics, as well the prognosis of this tumour.

Diaphyseal chondroblastoma in a long bone: first report.

Chondroblastoma is a rare benign bone tumor typically located in the epiphysis. We describe the first case of chondroblastoma arising in the diaphysis of a long bone. The patient was a 13-year-old girl who presented with pain over her right thigh. Radiographs showed a lytic lesion in the diaphysis of her right femur. A core biopsy and a subsequent surgical resection were performed.

Congenital melanotic macules and Sebaceous Choristoma arising on the tongue of a newborn: epidermal choristoma?

Oral hyperpigmentation is a common event in older individuals, however, is exceptional in neonates (congenital melanotic macules). Conversely, 70-80% of people have sebaceous glands in the oral mucosa, with the tongue representing an ectopic location and termed sebaceous choristoma by some authors. We report a case that fulfills both conditions in a tongue lesion. A 1-month-old boy presented with a pigmented macula on his tongue noted at birth. An excisional biopsy was performed showing a lesion lined by an epidermal-like epithelium with basal pigmentation, under which, sebaceous glands, abortive hair follicles and ductal structures mimicking apocrine glands were found. Seven cases of congenital melanotic macules of the tongue have been reported, however, none of them showed sebaceous glands under the lesion. Furthermore, there has not been a reported case of sebaceous choristoma of the tongue present at birth. We present a case that shares clinical and histological features of both conditions and propose the name 'epidermal choristoma'.

Scanning electron microscopy of the choroid plexus of the lateral ventricle of the horse.

The present study examined the ultrastructure of the choroid plexus of the lateral ventricle of the horse. The material was fixed in 2.5% glutaraldehyde in 0.1 m sodium phosphate buffer, pH 7.3, processed and analysed by scanning electron microscopy. The choroid plexus was characterized by regions with a predominance of villi, which resembled finger-like projections or bunches of grapes, and others where straight and uniform folds predominated. Epithelial cells projected into the ventricle and large amounts of cilia and microvilli were observed on their surface. The choroid glomus corresponded to a dilatation of the choroid plexus and was characterized by blood vessels of different calibres surrounded by connective tissue.

Linear childhood cutaneous lupus erythematosus following Blaschko lines.

We report a case of a 3-year-old Spanish boy with linear cutaneous lupus erythematosus following the lines of Blaschko on his face and neck. Histological examination established the diagnosis. Only eight cases of discoid lupus erythematosus following the lines of Blaschko have been reported previously.

About the arterial blood vessels pelvic opossum's (Didelphis albiventris) behaviour.

The work consists of the study of 20 opossums (Didelphis albiventris); 7 females and 13 males, adults, natives of Jaboticabal county proceeding to a cannulation and injection of the arterial system with neoprene latex-650 in the aorta artery (full-blooded). Right away the preparations were fixed by a 10% formaldehyde aqueous solution and afterwards dissected and formed a scheme. The analysis of the pieces showed that in the opossum, the end of the aorta always divides in the common iliac artery, right and left sides, both originating the external and internal iliac artery, on the right and left sides. The medium sacral artery results, medianly, from the aorta division's angle in 2 common iliac arteries in 8 cases (40%-6 males and 2 females); this vessel comes from the left common iliac artery in 7 animals (35%-5 males and 2 females) or comes from the right common iliac artery, in 5 preparations (25%-3 females and 2 males). The deep iliac circumflex artery is born by the common iliac artery from the right side in 10 preparations (50%-6 males and 4 females); can appear as well, concomitantly with the external and internal iliac artery, from the right side in 9 pieces (45%-6 males and 3 females) and further from the right this vessels can emerge from the external iliac artery, in 1 case only (5%-1 male).