Prevalence and factors associated with dry socket following routine dental extractions.

BACKGROUND: Dry socket (DS) or fibrinolytic osteitis is a relatively common complication that can occur following tooth extraction. This study aimed to determine the prevalence of DS and identify its associated predictive and mediating variables. MATERIAL AND METHODS: This study is classified as prospective observational, cross-sectional, and multicenter. Patients were consecutively selected in accordance with established criteria for tooth extraction. Data on patient demographics, surgical procedures and postoperative outcomes were collected. Nominal variables were analyzed using the Chi-Square Test, while associations involving ordinal values or considering counts or layers were examined using the Kendall's Tau-B Test or Mantel-Haenszel Test for trend. The GLM Mediation Model was employed to investigate potential mediation or indirect effects or potential underlying mechanisms of predictive variables on the development of DS. Two-tailed significance level of p ≤0.05 was considered statistically significant. RESULTS: A total of 1,357 patients undergoing routine dental extractions were included. DS was observed in 13 patients (prevalence of 1%). DS was associated with younger patients (under 50 years old), longer procedures, and the presence of surgical accidents, but only when mediated by surgical complexity. Smoking, particularly in combination with complex surgeries and surgical accidents, was associated with DS. Postoperative pain for more than two days and reported at moderate to high levels, emerged as a potential warning sign for DS. The use of antibiotics was found to significantly reduce the risk of DS (RR reduction of 36% and absolute risk reduction of 0.63%). CONCLUSIONS: Routine dental extractions revealed a 1% prevalence of dry socket. The obtained results suggests that DS is a multifactorial condition influenced by various factors, including gender, age, smoking, antibiotic prescription and surgical factors such as length, technique and accidents, nevertheless, those associations were observed mainly considering the influence of one variable on another.

Analgesic efficacy of ketorolac associated with a tramadol/acetaminophen combination after third molar surgery - a randomized, triple-blind clinical trial.

BACKGROUND: This study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery. MATERIAL AND METHODS: A randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects. RESULTS: Significant differences in pain intensity were observed in the different times (p < 0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p < 0.001), the need of antiemetic were greater in Group K+T+A (p < 0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A. CONCLUSIONS: The current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant.

Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial.

The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia. Seventy-two volunteers completed all parts of the study. Significant differences, which indicated better effectiveness of Me2 compared to Ar4, were observed in the following tests: reduction in blood flow (larger in the Me2 group); anaesthetized area at 30min (larger in the Me2 group); pressure tests; temperature tests after 20min; fine and discriminatory proprioception tests after 20min. The volunteers' perception of anaesthesia at 30, 40, 50, and 60min was superior for Me2 at all recorded time points. The duration of anaesthesia was also superior for Me2. The overall performance of Me2 was superior to Ar4, implying that Me2 provides a more effective anaesthesia in terms of depth, extent, and duration.

Monitoring of metals, organic compounds and coliforms in water catchment points from the Sinos River basin.

Unplanned use and occupation of the land without respecting its capacity of assimilation and environmental purification leads to the degradation of the environment and of water used for human consumption. Agricultural areas, industrial plants and urban centres developed without planning and the control of effluent discharges are the main causes of water pollution in river basins that receive all the liquid effluents produced in those places. Over the last decades, environmental management has become part of governmental agendas in search of solutions for the preservation of water quality and the restoration of already degraded resources. This study evaluated the conditions of the main watercourse of the Sinos River basin by monitoring the main physical, chemical and microbiological parameters described in the CONAMA Resolution no. 357/2005.The set of parameters evaluated at five catchment points of water human consumption revealed a river that has different characteristics in each reach, as the upper reach was class 1, whereas the middle and lower reaches of the basin were class 4. Monitoring pointed to households as the main sources of pollutants in those reaches, although metals used in the industrial production of the region were found in the samples analyzed.

Monitoring of metals, organic compounds and coliforms in water catchment points from the Sinos River basin / Monitoramento de metais, compostos orgânicos e coliforms em pontos de captação de água da bacia hidrográfica do Rio dos Sinos

Unplanned use and occupation of the land without respecting its capacity of assimilation and environmental purification leads to the degradation of the environment and of water used for human consumption. Agricultural areas, industrial plants and urban centres developed without planning and the control of effluent discharges are the main causes of water pollution in river basins that receive all the liquid effluents produced in those places. Over the last decades, environmental management has become part of governmental agendas in search of solutions for the preservation of water quality and the restoration of already degraded resources. This study evaluated the conditions of the main watercourse of the Sinos River basin by monitoring the main physical, chemical and microbiological parameters described in the CONAMA Resolution no. 357/2005.The set of parameters evaluated at five catchment points of water human consumption revealed a river that has different characteristics in each reach, as the upper reach was class 1, whereas the middle and lower reaches of the basin were class 4. Monitoring pointed to households as the main sources of pollutants in those reaches, although metals used in the industrial production of the region were found in the samples analyzed.

O uso e ocupação do solo não planejados, sem respeitar sua capacidade de assimilação e de purificação ambiental, levam à degradação do ambiente e da água utilizada para consumo humano. Áreas agrícolas, plantas industriais e centros urbanos desenvolvidos sem planejamento e controle de descargas de efluentes são as principais causas de poluição da água em bacias hidrográficas que recebem todos os efluentes líquidos produzidos naqueles lugares. Nas últimas décadas, gestão ambiental tornou-se parte das agendas governamentais em busca de soluções para a preservação da qualidade da água e a restauração de recursos já degradadas. Este estudo avaliou as condições do curso de água principal da bacia do Rio dos Sinos, monitorando o principal físico, químico e microbiológicos parâmetros descritos na Resolução CONAMA n.º 357/2005. O conjunto de parâmetros avaliados em cinco pontos de captação de água para consumo humano revelou um rio que tem características diferentes em cada alcance, como o superior chegar era classe 1, Considerando que o atinge médio e inferior da bacia foram classe 4. monitoramento apontado famílias como as principais fontes de poluentes naqueles atinge, apesar de metais utilizados na produção industrial da região foram encontrados nas amostras analisadas.

Monitoring of metals, organic compounds and coliforms in water catchment points from the Sinos River basin

p>Unplanned use and occupation of the land without respecting its capacity of assimilation and environmental purification leads to the degradation of the environment and of water used for human consumption. Agricultural areas, industrial plants and urban centres developed without planning and the control of effluent discharges are the main causes of water pollution in river basins that receive all the liquid effluents produced in those places. Over the last decades, environmental management has become part of governmental agendas in search of solutions for the preservation of water quality and the restoration of already degraded resources. This study evaluated the conditions of the main watercourse of the Sinos River basin by monitoring the main physical, chemical and microbiological parameters described in the CONAMA Resolution no. 357/2005.The set of parameters evaluated at five catchment points of water human consumption revealed a river that has different characteristics in each reach, as the upper reach was class 1, whereas the middle and lower reaches of the basin were class 4. Monitoring pointed to households as the main sources of pollutants in those reaches, although metals used in the industrial production of the region were found in the samples analyzed. /p>

p>O uso e ocupação do solo não planejados, sem respeitar sua capacidade de assimilação e de purificação ambiental, levam à degradação do ambiente e da água utilizada para consumo humano. Áreas agrícolas, plantas industriais e centros urbanos desenvolvidos sem planejamento e controle de descargas de efluentes são as principais causas de poluição da água em bacias hidrográficas que recebem todos os efluentes líquidos produzidos naqueles lugares. Nas últimas décadas, gestão ambiental tornou-se parte das agendas governamentais em busca de soluções para a preservação da qualidade da água e a restauração de recursos já degradadas. Este estudo avaliou as condições do curso de água principal da bacia do Rio dos Sinos, monitorando o principal físico, químico e microbiológicos parâmetros descritos na Resolução CONAMA n.º 357/2005. O conjunto de parâmetros avaliados em cinco pontos de captação de água para consumo humano revelou um rio que tem características diferentes em cada alcance, como o superior chegar era classe 1, Considerando que o atinge médio e inferior da bacia foram classe 4. monitoramento apontado famílias como as principais fontes de poluentes naqueles atinge, apesar de metais utilizados na produção industrial da região foram encontrados nas amostras analisadas. /p>

Ultrasonic shears and bipolar vessel-sealing system for three-port laparoscopic ovariohysterectomy in dogs / Bisturi ultrassônico e sistema de selamento de vasos sanguíneos para ovário-histerectomia laparoscópica com três portais em cães

In the current experimental study, two different instruments were compared for prophylactic hemostasis during a 3-port technique of laparoscopic ovariohysterectomy (OVH) in bitches. Moreover, the need for port enlargement for specimen retrieval using 5mm or 10mm trocartes, technical difficulties and complications were assessed. Ultrasonic energy and a vascular sealing system were tested. Duration of surgery, patient weight and diameter of the uterine arteries and veins were compared among the groups. Fifteen dogs randomly divided into three groups (GI, GII, GIII) were submitted to ovariohysterectomy with hemostasis from the use of ultrasonic scalpel or vascular sealing equipment. In GI and GII the LigaSure(tm) impedance-controlled bipolar vessel-sealing device was used, differing in the size of trocartes used between groups, and in GIII Autosonix(tm) was used. Patients' weight, duration of surgery, technical difficulties and complications were compared among the groups. Statistical analysis showed no difference between the data analyzed among the groups. In conclusion, both methods of hemostasis were effective for 3-port total laparoscopic ovariohysterectomy in bitches. However, 5mm trocartes were not adequate for retrieval of the uterus and ovaries without need for enlargement of the port incision.

No presente experimento, foram comparados dois diferentes equipamentos, um com emprego de energia ultrassônica, e outro utilizando sistema de selamento vascular, como única forma de hemostasia em ovário-histerectomias laparoscópicas com três portais em cadelas. Ademais, a necessidade de ampliação da incisão do portal de 5mm ou de 10mm para a remoção dos espécimes ressecados, dificuldades técnicas e complicações foram avaliadas. Quinze cadelas aleatoriamente distribuídas em três grupos (GI, GII, GIII) foram submetidas à ovário-histerectomia com hemostasia a partir da utilização de bisturi ultrassônico ou equipamento de selamento vascular. Nos GI e GII foi utilizado um sistema de selamento vascular eletrotérmico bipolar (LigaSure(r)), diferindo-se no tamanho dos portais utilizados; em GIII foi utilizado bisturi ultrassônico (Autosonix(r)). A análise estatística não demonstrou diferença significativa entre os dados analisados nos três grupos. Conclui-se que ambos os métodos de hemostasia utilizados mostraram-se adequados e viabilizaram a realização de ovário-histerectomia laparoscópica em cadelas. Todavia, o trocarte de 5mm não foi adequado para remoção do útero e ovários sem necessidade de ampliação da incisão de acesso.

Evaluation of genotoxicity and efficacy of at-home bleaching in smokers: a single-blind controlled clinical trial.

OBJECTIVE: This single-blind controlled study evaluated the genotoxicity and efficacy of at-home bleaching in smokers and nonsmokers. METHODS: We selected 60 patients with central incisors A2 or darker: 30 smokers (experimental group) and 30 nonsmokers (control group). The bleaching was carried out with 10% carbamide peroxide for three hours a day for three weeks. The color was evaluated using a shade guide, Vita Bleachedguide 3D-Master, at baseline, during bleaching (first, second, and third weeks), and one week and one month after bleaching. Smears were obtained with a moistened wooden spatula from marginal gingiva. All the cytologic smears were stained with Giemsa solution. From each slide, 1000 cells were examined under 40× magnification and where micronuclei (MN) were located, they were examined under 100× magnification. The change in shade guide units at the different assessment periods and the frequency of MN were subjected to a two-way repeated measures analysis of variance and Tukey test (α=0.05). RESULTS: In both groups we detected a whitening of approximately 4 to 5 shade guide units, without color rebound after one month (p>0.05). The frequency of MN was significantly higher in the experimental group than in the control group, regardless of the bleaching treatment (p>0.001). CONCLUSION: The efficacy of bleaching does not appear to be affected by the smoking habit. Additionally, at-home bleaching did not induce DNA damage to the gingival tissue during the bleaching period.

Phytochemical evaluation and in vitro antioxidant and photo-protective capacity of Calendula officinalis L. leaves / Avaliação fitoquímica e capacidade antioxidante e fotoprotetora in vitro das folhas de Calendula officinalis L

ABSTRACT The plant Calendula officinalis L. is widely applied due to its medicinal properties, which are mainly dermatological and ornamental. The goal of this study is to assess the phytochemical components in a hydroethanolic extract (HECO) from the leaves of Calendula officinalis L. using UV-VIS spectrophotometry and thin layer chromatography (TLC), as well as to identify and quantify the components related to its antioxidant capacity employing high performance liquid chromatographic (HPLC). The antioxidant capacity evaluation was performed using the DPPH method for superoxide and hydroxyl radicals. The photo-protective capacity was evaluated by UVspectrophotometry in order to determine the in vitro Sun Protection Factor(SPF). The results show the plant’s strong antioxidant activity (DPPH and hydroxyl methods), which we believe to be related to the presence of flavonoids (24.67 mg/g), polyphenols (33.90 mg/g), condensed tannins (27.30 mg/g), and the amount of rutin (37.25 mg/g), and quercetin (6.09 mg/g) found during the study. The HECO presented a good antioxidant capacity, most likely due to the polyphenols, flavonoids, and tannins in its contents. However, the obtained SPF of 1.89 ± 0.05 does not allow the plant to be classified as a stand-alone sunscreen, and more studies are needed in order to test its ability to enhance sunscreens in existing cosmetic formulations.

RESUMO A Calendula officinalis L. é uma planta amplamente utilizada por suas propriedades medicinais, principalmente dermatológica e ornamental. O objetivo deste estudo é avaliar constituintes fitoquímicos do extrato hidroetanólico das folhas de Calêndula officinalis L. (HECO) por espectrofotometria UV-visível e cromatografia em camada delgada (CCD), bem como detectar e quantificar os componentes relacionados com a capacidade antioxidante por Cromatografia Líquida de Alta Eficiência (CLAE). Posteriormente, foi avaliada a capacidade antioxidante pelo método do DPPH, radicais superóxido e hidroxila. Além disso, a capacidade fotoprotetora foi avaliada através de espectrofotometria UV para determinação do Fator de Proteção Solar in vitro (FPS). Os resultados evidenciaram que a planta apresentou uma excelente atividade antioxidante para o método do DPPH e do radical hidroxila, o que pode estar relacionada com a presença de flavonoides (24,67 mg/g), polifenóis (33,90 mg/g) e taninos condensados (27,30 mg/g) e da quantidade de rutina (37,25 mg/g) e quercetina (6,09 mg/g) encontrados neste estudo. O HECO apresentou uma notável capacidade antioxidante, provavelmente devido à presença de polifenóis, flavonoides e taninos. O valor do FPS encontrado (1,89 ± 0,05), não classifica a planta como um protetor solar isolado. No entanto, mais estudos são necessários para testar a capacidade de potencializar filtros solares em formulações cosméticas.

Cross-cultural adaptation of the orthognathic quality of life questionnaire (OQLQ) in a Brazilian sample of patients with dentofacial deformities.

OBJECTIVES: The aim of this study is to translate into Portuguese-Brazilian language and adapt cross-culturally to the Brazilian population the Orthognathic Quality of Life Questionnaire (OQLQ). STUDY DESIGN: The cross-cultural adaptation process followed six stages which are; (I) initial translation, (II) synthesis of the translation, (III) back translation, (IV) expert committee and (V) test of the prefinal version. For validation process, the OQLQ results were compared with Oral Health Impact Profile Questionnaire (OHIP-49), with the generic SF-36 Quality of Life Questionnaire and a visual analogue scale. A convenience sample of 25 patients was selected in two Southern Brazilian states of Santa Catarina and Rio Grande do Sul. RESULTS: Internal consistency analysis of the OQLQ-Brazilian showed good correlation for items or domains and the test-retest reliability also presented excellent intra-class correlation coefficients. OQLQ-Brazilian exhibited a weak and negative correlation with SF-36, and good correlation with OHIP-49. CONCLUSION: The OQLQ-Brazilian preserved and reached equivalence with its original source and the findings also corroborate that there is good evidence for the construct validity. The demonstration of its reproducibility, reliability and validity makes this instrument an additional useful parameter for evaluation of the impact of dentofacial deformity over the quality of life for Brazilians.

Surgical treatment of ankyloglossia in babies--case report.

Ankyloglossia is an anomaly that is characterized by the abnormal insertion of the lingual frenulum that hinders protrusion and elevation of the tongue towards the palate, due to the short and thick composition of the frenulum. In babies it can cause inefficient nursing at the mother's breast, inadequate transfer of milk and pain in the mother's breast, resulting in early weaning and weight loss. An 8-month-old baby boy was brought to the clinic by his mother because he found it difficult to suck and consequently avoiding breast feeding, and was apparently losing weight. During the clinical exam it was observed that the patient presented little mobility of the tongue. Owing to the degree of ankyloglossia and the features of malnutrition present, it was decided to carry out complete removal of the frenulum under general anesthesia. Although this procedure might increase the risk of morbidity, the possibility of recurrence and the need to perform further procedures are avoided; the main advantage is reducing aggravation of the clinical problems.

Endovascular treatment of incoercible epistaxis and epidural cerebral hematoma. A case report.

SUMMARY: A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH.

The stomach is a source of leptin.

The circulating peptide leptin, which is the product of the ob gene, provides feedback information on the size of fat stores to central Ob receptors that control food intake and body-weight homeostasis. Leptin has so far been reported to be secreted only by adipocytes and the placenta. Here we show that leptin messenger RNA and leptin protein are present in rat gastric epithelium, and that cells in the glands of the gastric fundic mucosa are immunoreactive for leptin. The physiological function of this previously unsuspected source of leptin is unknown. However, both feeding and administration of CCK-8 (the biologically active carboxy-terminal end of cholecystokinin) result in a rapid and large decrease in both leptin cell immunoreactivity and the leptin content of the fundic epithelium, with a concomitant increase in the concentration of leptin in the plasma. These results indicate that gastric leptin may be involved in early CCK-mediated effects activated by food intake, possibly including satiety.

Potential role of Rab4 in the regulation of subcellular localization of Glut4 in adipocytes.

A role for Rab4 in the translocation of the glucose transporter Glut4 induced by insulin has been recently proposed. To study more directly the role of this small GTPase, freshly isolated adipocytes were transiently transfected with the cDNAs of both an epitope-tagged Glut4-myc and Rab4, a system which allows direct measurement of the concentration of Glut4 molecules at the cell surface. When cells were cotransfected with Glut4-myc and Rab4, the concentration of Glut4-myc at the cell surface decreased in parallel with the increased expression of Rab4, suggesting that Rab4 participates in the intracellular retention of Glut4. In parallel, the amount of Rab4 associated with the Glut4-containing vesicles increased. When Rab4 was moderately overexpressed, the number of Glut4-myc molecules recruited to the cell surface in response to insulin was similar to that observed in mock-transfected cells, and thus the insulin efficiency was increased. When Rab4 was expressed at a higher level, the amount of Glut4-myc present at the cell surface in response to insulin decreased. Since the overexpressed protein was predominantly cytosolic, this suggests that the cytosolic Rab4 might complex some factor(s) necessary for insulin action. This hypothesis was strengthened by the fact that Rab4 deltaCT, a Rab4 mutant lacking the geranylgeranylation sites, inhibited insulin-induced recruitement of Glut4-myc to the cell surface, even when moderately overexpressed. Rab3D was without effect on Glut4-myc subcellular distribution in basal or insulin-stimulated conditions. While two mutated proteins unable to bind GTP did not decrease the number of Glut4-myc molecules in basal or insulin-stimulated conditions at the plasma membrane, the behavior of a mutated Rab4 protein without GTPase activity was similar to that of the wild-type Rab4 protein, indicating that GTP binding but not its hydrolysis was required for the observed effects. Altogether, our results suggest that Rab4, but not Rab3D, participates in the molecular mechanism involved in the subcellular distribution of the Glut4 molecules both in basal and in insulin-stimulated conditions in adipocytes.

[Treatment of neonatal hyperthyroidism with calcium iopodate]. / Traitement de l'hyperthyroïdie néonatale par l'iopodate de calcium.

BACKGROUND: Treatment of hyperthyroidism in those neonates born to mothers with Grave's disease is difficult. Calcium ipodate, an agent for oral cholecystography, inhibits extra-thyroid conversion of T3 to T4 and diminishes thyroid secretion. CASE REPORTS: Two neonates with clinical manifestations and biological findings of hyperthyroidism were given calcium ipodate orally, 400 mg every 3 days, from day 26 to 50 for the first patient and from day 9 to 18 for the second in association with a beta blocker. Clinical manifestations disappeared within 2 days and circulating levels of T3 and T4 were normalized within 2-5 days. CONCLUSIONS: This treatment was effective and well-tolerated in both patients and in three others previously reported; it should be confirmed in a larger number of patients and controlled by measuring levels of antibodies directed against thyrotropin-releasing hormone receptors in order to avoid relapse after cessation of treatment as seen in our second patient.

GTPase activating protein activity for Rab4 is enriched in the plasma membrane of 3T3-L1 adipocytes. Possible involvement in the regulation of Rab4 subcellular localization.

The small guanosine 5'-triphosphate (GTP)ase Rab4 has been suggested to play a role in insulin-induced GLUT4 translocation. Under insulin stimulation, GLUT4 translocates to the plasma membranes, while Rab4 leaves the GLUT4-containing vesicles and becomes cytosolic. Rab proteins cycle between a GTP-bound active form and a guanosine 5'-diphosphate (GDP)-bound inactive form. The intrinsic GTPase activity of Rab proteins is low and the interconversion between the two forms is dependent on accessory factors. In the present work, we searched for a GTPase activating protein (GAP) for Rab4 in 3T3-L1 adipocytes. We used a glutathione-S-transferase (GST)-Rab4 protein which possesses the properties of a small GTPase (ability to bind GDP and GTP and to hydrolyse GTP) and can be isolated in a rapid and efficient way. This GAP activity was observed in 3T3-L1 adipocyte lysates, and was able to accelerate the hydrolysis of the [alpha-32P]GTP bound to GST-Rab4 into [alpha-32P]GDP. This activity, tentatively called Rab4-GAP, was also present in 3T3-L1 fibroblasts. The Rab4-GAP activity was present in total membrane fractions and nearly undetectable in cytosol. Following subcellular fractionation, Rab4-GAP was found to be enriched in plasma membranes when compared to internal microsomes. Insulin treatment of the cells had no effect on the total Rab4-GAP activity or on its subcellular localization. Taking our results together with the accepted model of Rab cycling in intracellular traffic, we propose that Rab4-GAP activity plays a role in the cycling between the GTP- and GDP-bound forms of Rab4, and thus possibly in the traffic of GLUT4-containing vesicles.

[Post-traumatic hypopituitarism after skull injury: apropos of 3 cases]. / Hypopituitarisme post-traumatisme crânien: à propos de trois cas.

BACKGROUND: Hypopituitarism is a rare but well-known complication of cranial trauma. In the absence of overt diabetes insipidus, its recognition is difficult as the onset of clinical symptoms can be very progressive, up to several years. CASE REPORTS: Three children, aged 8, 9 and 2 years, respectively, were admitted after a cranial trauma. Manifestations of diabetes insipidus occurred a few days later in two patients; one of them developed secondary growth hormone deficiency, hypothyroidism and hypogonadism, only evidenced at the age of 14 years. The third patient also developed manifestations of hypothalamic and/or pituitary hormone deficiencies without diabetes insipidus at the age of 12 years-6 months. MRI showed complete severance of the pituitary stalk in two patients and absence of posterior pituitary signal in one of the two patients with diabetes insipidus. CONCLUSION: Growth disorders and/or hypogonadism may occur many years after a trauma that may have been forgetten. Search for such an etiology and dynamic MRI are necessary in identifying heterogenous hypophyseal lesions.

Phenol injection into cisterna magna for relief of advanced intractable cancer pain in the faciocephalic area.

Between 1973 and 1980 a solution of phenol in glycerin into the cisterna magna was injected in 38 patients suffering from advanced intractable pain due to neoplasm of faciocephalic area. Owing to the poor neurological and general condition of our patients, surgical procedures were discarded. Patient's age ranged from 36 to 76 years and pain diffusion involved many cranial and cervical nerves. Follow-up studies after phenol injections were carried out in 22 patients: mean survival time proved to be 137 days. In 76% of cases, before neurolytic treatment, narcotics had been administered. In this series pain relief seemed to be poor in 50%, good in 34% while it was unclassifiable in the remaining 16% of the cases due to an incomplete follow-up. These last patients were likely to show favorable results. Complications arising immediately after phenol injections are described. Long lasting disabling neurological deficits were recorded in 18% of cases. Less severe complications were shown in 71% of the patients. The most frequent ones were impairment of sensory functions of the trigeminal area and reversible paresis of the 7th cranial nerve. Despite the poor general conditions, no fatal outcome was seen in our patients. No significant relationship between pain relief and sensory deficit was found. The pathophysiological mechanisms of pain suppression, induced by phenol injection in the faciocephalic area are discussed. The value of this simple technique is briefly assessed in comparison to other analgesic procedures.