ASIA syndrome: Adverse reaction or autoimmunity?

Introduction: Adjuvant-Induced Autoimmune / Auto-inflammatory Syndrome (ASIA) is an immune-mediated condition by the exposure of material previously considered inert, such as silicone, aluminum salts, mineral oils, hyaluronic acid and metallic implants. In addition to a genetic component, there is a risk of development of an undifferentiated connective tissue disease, which varies clinically and laboratorially depending on the adjuvant material used. Patients and methods: This paper addresses two cases reported, in caucasian subjects, born and residents in Madeira Island, Portugal. In this article are described two different histological patterns occurring in ASIA patients, due to mammoplasty with silicone. Conclusion: Although ASIA does not meet the diagnostic requirements for connective tissue disease, there is a close relationship with the development of autoimmune conditions. These cases aim to alert the medical community to the existence of this entity, encourage the notification of situations arising from exposure to adjuvants and investigate the presence of a genetic predisposition and a suggestive histological pattern in excisional biopsies of satellite adenomegalies.

Benign metastasizing leiomyoma - a case of benign metastasis.

Leiomyomas are benign tumours of smooth muscle cells that most often affect the female genital tract, but their metastasis to extra-uterine locations represent rare, yet misunderstood phenomena. The authors present a clinical case of a 42-year-old woman, who underwent a hysterectomy 15 years ago due to myomas, admitted with multiple pulmonary nodules and abdominal mass, diagnosed by imaging tests, in the context of haemoptysis. The anatomopathological exams of the pulmonary and abdominal lesions were compatible with the diagnosis of benign metastatic leiomyoma. Benign metastatic leiomyoma is a rare condition that particularly affects women of childbearing age, with a history of hysterectomy for uterine fibroids. Hence, this entity must be considered in the differential diagnosis of women with pulmonary nodules of uncertain aetiology.

Heart Dissemination: A Clinical Case of Melanoma.

Introduction. Primitive malignant heart tumours are rare, specific cases. The presence of cardiac metastases, often in the pericardium, besides indicating disseminated oncological disease, represents a diagnostic challenge since they tend to be asymptomatic. Malignant cutaneous melanoma (MCM) is the neoplasm that most often affects the heart. Patients and Methods. The authors describe a case report of a 59-year-old female patient with a history of non-insulin-treated diabetes mellitus, arterial hypertension, dyslipidemia, and remitting cutaneous malignant melanoma who underwent skin excision, lymphadenectomy, and adjuvant chemotherapy in 1996. In April 2014, she resorted to emergency service due to epigastric pain and progressive tiredness. Due to the persistence of the complaints, abdominal ultrasound was performed, which showed a large pericardial effusion, corroborated later by teleradiography and echocardiography. The patient underwent pericardiocentesis, which isolated neoplastic cells. A computed tomography study of the chest, abdomen, and pelvis revealed bilateral and pericardial pleural effusion, as well as alterations suggestive of pericardial and pulmonary metastasis. Later, fine-needle aspiration puncture of the left posterior cervical nodule confirmed histologically malignant melanoma metastasis. Discussion. Given the natural history of melanoma that when metastasized has an overall survival of 15-20% for 5 years, its metastatic spread may occur several years after its surgical excision. Thus, patients with a history of melanoma and heart failure who develop new cardiac symptoms of unknown aetiology should undergo imaging studies such as echocardiography, computed tomography, and magnetic resonance imaging.

Acute Iatrogenic Agranulocytosis: A Rare and Dire Case of an Adverse Drug Reaction to Be Aware.

BACKGROUND: Iatrogenic agranulocytosis (IA), by nonchemotherapeutic drugs, is a rare adverse event, resulting in a neutrophil count under 0.5 × 109 cells/L with fever or other suggestive signs of infection. METHODS: This paper discusses the possible mechanisms responsible for agranulocytosis induced by nonchemotherapeutic drugs. It also describes three cases as well as potential ways to handle such iatrogenic situations. CONCLUSION: Neutropenia under 0.1 × 109 cells/L predispose patients to potentially fatal infections. Empiric broad-spectrum antibiotic and hematopoietic growth factors may be helpful in shortening hospitalization and prevent further infectious complications. Not all drugs associated with IA require frequent hematological monitoring, except medications such as clozapine, ticlopidine, and antithyroids.

Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines.

UNLABELLED: Benign Paroxysmal Positional Vertigo (BPPV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. AIM: the aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. STUDY DESIGN: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS) and the other by the American Academy of Neurology (AAN). The similarities were presented in different tables. RESULTS: Those guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. CONCLUSIONS: Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.

Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines / Vertigem Posicional Paroxística Benigna: comparação de duas recentes diretrizes internacionais

Benign Paroxysmal Positional Vertigo (BPPV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. AIM: the aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. METHOD: Study design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS) and the other by the American Academy of Neurology (AAN). The similarities were presented in different tables. RESULTS: Those guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. CONCLUSIONS: Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.

A Vertigem Posicional Paroxística Benigna (VPPB) é caracterizada por tontura rotatória com duração de segundos e tratada com manobras cefálicas. Para sistematizar a conduta e conduzir os clínicos no atual conhecimento no seu controle, sociedades internacionais desenvolveram diretrizes. OBJETIVO: Discutir de forma prática e didática o estado da arte da abordagem atualmente disponível para VPPB. MATERIAL E MÉTODOS: Revisão assistemática com análise crítica comparando os resultados de duas recentes diretrizes internacionais a respeito da avaliação e controle da VPPB. Uma pesquisa foi elaborada pela American Academy of Otolaryngology (AAO-HNS) e a outra preparada pela American Academy of Neurology (AAN). Os tópicos em comum foram separados em tabelas comparativas. RESULTADOS: As diretrizes apresentaram diferenças quanto à metodologia. Apenas o artigo da AAO-HNS abordou sobre diagnóstico, recomendando o teste de Dix-Hallpike. Quanto aos tratamentos abordados, apenas a Reposição Canalítica, Manobra de Semont e a Reabilitação Vestibular tiveram estudos suficientes para receber recomendações. CONCLUSÃO: As duas diretrizes apresentaram os respaldos científicos necessários para os profissionais que atuam no diagnóstico e controle da VPPB, porém o resultado do grupo multidisciplinar da AAO-HNS foi mais abrangente e com qualidade superior.

Intrinsic bent DNA sites in the developmentally amplified C3-22 gene promoter of Rhynchosciara americana (Diptera: Sciaridae).

The Rhynchosciara americana C3-22 gene is located in an amplified domain and is developmentally expressed. The aim of the present work was to identify intrinsically bent DNA sites in a segment containing the gene promoter and downstream sequence. The results indicated that this gene is flanked by intrinsically bent DNA sites. Three bent DNA sites (b(-3), b(-2), and b(-1)) were localized in the promoter, and one was localized downstream of the gene (b(+1)). These sites had helical parameters that confirmed the curved structure, as well as segments with left-handed superhelical writhe. In silico analysis of the promoters of four other insect genes, which encode secreted polypeptides, showed that they all had curved structures and similar helical parameters. Correlation with other results indicates that the detected intrinsically bent DNA sites that flank the C3-22 gene might be a consensus feature of the gene structure in the amplified domains.

DNA bending in the replication zone of the C3 DNA puff amplicon of Rhynchosciara americana (Diptera: Sciaridae).

Intrinsic bent DNA sites were identified in the 4289 bp segment encompassing the replication zone which directs DNA amplification and transcription of the C3-22 gene of Rhynchosciara americana. Restriction fragments showed reduced electrophoretic mobility in polyacrylamide gels. The 2D modeling of the 3D DNA path and the ENDS ratio values obtained from the dinucleotide wedge model of Trifonov revealed the presence of four major bent sites, positioned at nucleotides -6753, -5433, -5133 and -4757. Sequence analysis showed that these bends are composed of 2-6 bp dA.dT tracts in phase with the DNA helical repeat. The circular permutation analysis permitted the verification that the fragments containing the bending sites promote curvature in other sequence contexts. Computer analyses of the 4289 bp sequence revealed low helical stability (DeltaG values), negative roll angles indicating a narrow minor groove and a putative matrix attachment region. The data presented in this paper add to information about the structural features involved in this amplified segment.

The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: a preliminary study.

BACKGROUND: Swelling, pain and trismus are undesirable consequences of impacted mandibular third-molar extraction. The authors conducted a study to evaluate the effectiveness of cryotherapy, the therapeutic use of cold, in reducing undesirable consequences after surgery. METHODS: Fourteen patients aged 20 to 28 years comprised the sample. The authors extracted two impacted mandibular third molars at different times from each patient. Immediately after surgery, the patient underwent cryotherapy on one side for 30 minutes every one and one-half hours for 48 hours when he or she was awake. The patient did not receive cryotherapy on the other side. The authors performed clinical examinations to measure trismus and swelling before surgery, immediately after surgery and 24 and 48 hours after surgery. RESULTS: The authors compared both sides for differences in swelling, pain and trismus in each patient. The results showed significant statistical differences in two of the five points that were used to measure the swelling (Wilcoxon nonparametric signed rank test of linear distances between the angle of the mandible to the pogonion and to the tragus). They found statistical differences between the two sides in relation to the pain; however, they found no significant differences in relation to trismus. CONCLUSIONS: Cryotherapy was effective in reducing swelling and pain in this sample. Despite playing no role in the reduction of trismus, cryotherapy was effective in reducing swelling and pain in this sample, and the authors still recommend it be used. CLINICAL IMPLICATIONS: Cryotherapy is helpful after third-molar extraction. Further studies need to be conducted that use larger samples of patients and other types of therapy, such as low-level laser therapy.