Primary Central Nervous System Lymphoma with Exclusive Leptomeningeal Involvement: The Diagnostic Challenge of a Rare Presentation of an Uncommon Disease.

Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extra-nodal non-Hodgkin lymphoma (NHL). It must be confined to the brain, eyes, spinal cord or leptomeninges without systemic involvement at the time of diagnosis. Disease confined to the cerebrospinal fluid (CSF) is a rare form of presentation and poses a particular diagnostic challenge. We present the case of an 82-year-old man admitted to hospital because of an acute confusional state, later revealed to be due to PCNSL with exclusive leptomeningeal involvement. The diagnostic process was further impaired (or, perhaps, aided?) by the onset of a COVID-19 outbreak on the ward. LEARNING POINTS: Primary central nervous system lymphoma is a rare and aggressive form of non-Hodgkin lymphoma.Exclusive involvement of the cerebrospinal fluid (CSF) is a rare form of presentation of PCNSL.The diagnosis is usually histopathological but, in the absence of a solid lesion that can be biopsied, CSF cytology and flow cytometry may be sufficient for a definitive diagnosis.

Artery of Percheron Ischaemic Stroke: A Classic Presentation of a Rare Case.

The artery of Percheron (AoP) is a rare anatomic variant, where the paramedian thalami and the rostral midbrain are supplied by an artery emerging from the P1 segment of the posterior cerebral artery. Ischaemic infarction of the artery of Percheron occurs rarely, accounting for 0.1 to 2% of all ischaemic strokes. AoP occlusion can lead to an infarction of the paramedian thalami and mesencephalon, resulting in a triad of clinical features; namely, altered mental status, vertical gaze palsy and memory impairment. A larger mesencephalon infarction can also feature oculomotor disturbances. We describe here the case of an 88-year-old patient, presenting with this triad of features. LEARNING POINTS: Neurological events such as ischaemic strokes can have a wide clinical presentation.Artery of Percheron infarction is characterized by memory impairment, vertical gaze palsy and altered mental status.Pattern recognition is fundamental for early diagnosis and optimal care.

Proteus Syndrome: A Rare Case in An Adult Ward.

Proteus syndrome is an extremely rare disorder that manifests as an asymmetric, disproportionate overgrowth of any connective tissue, such as bone, fat or epidermal nevi, in a mosaic or patchy pattern. It has an estimated prevalence of less than 1/1,000,000 live births. The diagnosis can be difficult because the phenotypes of the patients are variable. Many individuals develop cutaneous capillary malformation and prominent varicosities (large and complex vascular malformations). Thus, Proteus syndrome patients are at risk of developing deep vein thrombosis and pulmonary embolism. The authors present the case of a patient with Proteus syndrome who was admitted because of pulmonary thromboembolism and presented hypertrophy of the left arm and left hemithorax. LEARNING POINTS: Proteus syndrome is an extremely rare disorder that manifests as an asymmetric, disproportionate overgrowth of any connective tissue.The diagnosis can be difficult because the phenotypes are variable.It is important to keep in mind the importance of anticoagulation because patients are at risk of developing deep vein thrombosis and pulmonary embolism.

Light therapy modulates serotonin levels and blood flow in women with headache. A preliminary study.

In this study, we looked at the possible effects of low-level laser therapy (LLLT) on blood flow velocity, and serotonin (5-HT) and cholinesterase levels in patients with chronic headache associated with temporomandibular disorders (TMD). LLLT has been clinically applied over the past years with positive results in analgesia and without the report of any side effects. The understanding of biological mechanisms of action may improve clinical results and facilitate its indication. Ten patients presenting headache associated with TMD completed the study. An 830-nm infrared diode laser with power of 100 mW, exposure time of 34 s, and energy of 3.4 J was applied on the tender points of masseter and temporal muscle. Blood flow velocity was determined via ultrasound Doppler velocimetry before and after laser irradiation. The whole blood 5-HT and cholinesterase levels were evaluated three days before, immediately, and three days after laser irradiation. Pain score after treatment decreased to a score of 5.8 corresponding to 64% of pain reduction (P < 0.05). LLLT promoted a decrease in the blood flow velocity (P < 0.05). In addition, the 5-HT levels were significantly increased three days after LLLT (P < 0.05). The cholinesterase levels remained unchanged at the analyzed time points (P > 0.05). Our findings indicated that LLLT regulates blood flow in the temporal artery after irradiation and might control 5-HT levels in patients suffering with tension-type headache associated to TMD contributing to pain relief.

Diode laser effect on enamel microhardness after dental bleaching associated with fluoride.

OBJECTIVE: The aim of this in vitro study was to evaluate the effects of diode laser irradiation on human dental enamel treated by bleaching and acidulated phosphate fluoride gels (APF) according to microhardness analysis. BACKGROUND DATA: The high interest of patients for aesthetics in cosmetic dentistry has led to new bleaching materials and the development of new techniques. MATERIALS AND METHODS: Sixty embedded, flattened human third molar enamel fragments were randomly assigned to three groups (n=20). Group 1 received topical application of 1.23% APF photoactivated using a diode laser. Group 2 received three applications of 35% hydrogen peroxide for 5 min and was photoactivated with laser for 30 s in each application. Group 3 treated the same as group 2 plus a 1.23% APF application for 1 min after bleaching followed by 30 s of laser irradiation. Microhardness analyses were performed before and after all the treatments. RESULTS: Analysis of variance followed by Tukey and Student statistical t-tests (p<0.05) showed significantly higher microhardness values for group 1 after treatment. No significant differences were shown before and after treatments for groups 2 and 3. CONCLUSION: No change was observed in enamel microhardness after treatment with hydrogen peroxide gel photoactivated using diode laser with or without APF. There was an increase in microhardness when enamel was treated only with APF photoactivated using a laser.

Classificação de risco atribuída com o uso do Protocolo de Manchester, em um setor de Emergência, a pacientes com diagnóstico final de Acidente Vascular Cerebral Isquêmico

Este estudo teve por objetivo verificar a relação entre a classificação atribuída no protocolo Manchester no setor de emergência com casos cujo diagnóstico final foi o acidente vascular cerebral isquêmico em um hospital de alta complexidade público de Porto Alegre, RS, Brasil a fim de observar a aplicabilidade deste protocolo. Trata-se de um estudo retrospectivo e transversal, realizado a partir de dados de prontuário de pacientes que tiveram alta com os CIDs I63.0, I63.1, I63.2 I63.3, I63.4, I63.5, I63.6, I63.8, I63.9 I69.3, G46.0, G46.1, G46.2, G46.3, G46.4, G46.5, G46.6, G46.7 e G46.8 entre os meses de janeiro e junho de 2012. Resultado: mostrou-se que dos 97 pacientes analisados 56 eram do sexo masculino, média de idade de 64,88 anos e a classificação no protocolo de Manchester foram 23 verdes, 43 pacientes amarelos, 23 laranjas e 8 vermelhos. Conclusão: necessidade de protocolos de registros no prontuário do paciente e de manter a equipe de enfermagem treinada para um melhor atendimento inicial

Análise de temperatura intrapulpar no clareamento dental com laser de diodo in vitro / Intrapulpal temperature analysis in tooth whitening using a diode

O objetivo deste trabalho foi comparar a variação de temperatura no interior da câmara pulpar utilizando o laser de diodo no clareamento dental em modo contínuo ou interrompido. Para isso, foram utilizados 4 incisivos bovinos, 1 termopar, banho térmico, laser de diodo com potência de 1,5 W por 30 segundos em modo contínuo ou interrompido e peróxido de hidrogênio a 35 por cento. Os resultados mostraram que, quando o laser foi utilizado em modo contínuo, a variação de temperatura aumentou duas vezes mais que no modo interrompido