Effect of the intra-alveolar administration of dexamethasone on swelling, trismus, and pain after impacted lower third molar extraction: a randomized, double-blind clinical trial.

BACKGROUND: To evaluate the efficacy of intra-alveolar administration of dexamethasone 4 mg in the control of edema, trismus, and pain resulting from the extraction of impacted lower third molars and the drug permeability through the oral mucosa by in silico prediction. MATERIAL AND METHODS: The randomized, double-blind, split-mouth clinical trial included patients who had both impacted lower third molars in equivalent positions. Hemiarches were divided into control side when dexamethasone was administered orally and experimental side when dexamethasone was administered using the intra-alveolar route. Patients were evaluated considering edema, trismus, and pain. The permeability of dexamethasone through the oral mucosa was assessed by in silico prediction. Student's t-test was selected for comparative analysis of edema and trismus, and the chi-square test analyzed the distribution of postoperative pain between the sides. RESULTS: There were no significant differences between the routes of administration in measuring symptoms between the pre and postoperative times (p>0.05). In silico prediction suggested that dexamethasone molecular characteristics facilitate intra-alveolar administration. CONCLUSIONS: Intra-alveolar administration had similar efficacy to oral administration in controlling symptoms of post-surgical inflammation of impacted lower third molars.

Paracoccidioidomicose: caso clínico / Paracoccidioidiomycosis: case report

Os autores reportam o caso clínico de um homem, 43 anos de idade, natural e residente na ilha da Madeira, emigrado na Venezuela até há 6 anos. Em Março 2009, observado por aparecimento de lesão pápulo-crostosa de bordos regulares eritematosos, indolor, pruriginosa, com dimensões de 4,5 x 3cm, localizada no dorso, com 2 meses de evolução. Como antecedentes, refere história de lesão da mucosa bucal, com exame histopatológico compatível com paracoccidioidomicose (PCM). Foram efectuadas duas biópsias da lesão cutânea para avaliação histopatológica e micológica. O exame histopatológico revelou a presença de múltiplas células circulares, sugerindo distribuição característica de "roda de leme". O estudo micológicos revelou,no exame directo, a presença de leveduras - algumas em gemulação. As culturas permitiram isolar o Paracoccidioides brasiliensis. A radiografia pulmonar apresentava infiltrado bilateral e simétrico, nos lobos centrais e basais. A Tomografia Axial Computadorizada torácica demonstrou múltiplosnódulos espiculados, áreas de opacidade e bronquiectasias.Foi efectuada broncofibroscopia (sem alterações) e simultaneamente foi obtido o lavado broncoalveolar (LBA). A cultura, a 25º C, revelou a presença de hifas e clamidósporos (forma filamentosa). Na cultura, a 37º C, não se obteve a forma leveduriforme.O tratamento efectuado foi o itraconazol 200 mg/dia, durante 6 meses, com regressão da lesão.Até à actualidade, nenhum caso de PCM foi reportado na ilha da Madeira, Portugal. Embora não seja frequente, fora das áreas endémicas, os dermatologistas devem ser capazes de reconhecer e diagnosticar micoses sistémicas, como a PCM (AU)

We report a case of a 43 years-old portuguese man, natural and resident in Madeira island, who was emigrated in Venezuela until 6 years ago. He was observed on March 2008 for a crusted papulo-nodular lesion with erythematous regular borders, pruritic and sized 4,5 x 3,0 cm, located on the dorsum, with a 2 month history. There was no palpable lymphadenopathy. He denied other simptomatology. On March of 1999, the patient had a mouthlesion which was compatible with paracoccidioidomycosis on histopathological examination. He was not aware of any associated pathologies. We performed two punch biopsies of the cutaneous lesion for histopathological and mycological examination. The histopathology showed the presence of multiple round cells of different size (yeast cells) in a narrow base suggesting the classic “pilot’s wheels”, on Hematoxiline & Eosine stain. On direct microscopic examination the mycology revealed yeast of different sizes - some of them on gemulation. The cultures, at 24º and 37º, isolated Paracoccidioides brasiliensis. The thoracic x-ray revealed a heterogeneous, bilateral and symmetric pattern located towards the central and basal portions. The CT scan of the chest showed multiple, micronodular and striated lesions (some of them with small cavities), with tendency to coalesce. To characterize better these lung abnormalities, the patient performed a fibrobronchoscopy of the respiratory tract which was normal. The culture, at 25 ºC, obtained from the sputum of the bronchoalveolar lavage fluid (BAL) showed Paracoccidioides brasiliensis. Routine laboratory studies were normal and serology negative for HIV and tuberculosis. The treatment of choice was itraconazol 200 mg/day, for 6months. As far as we know no case of PCM has been reported in Madeira. Although it is not a frequent disease outside the endemic areas, dermatologists should be able to recognise and diagnose systemic mycosis like PCM (AU)