HIV-associated oral plasmablastic lymphoma and role of adherence to highly active antiretroviral therapy.

Plasmablastic lymphoma (PBL) is an HIV-associated non-Hodgkin's lymphoma that primarily affects the oral cavity. We describe the case of an HIV patient with a lesion in the maxilla that lasted four months. He was diagnosed with PBL and received highly active antiretroviral therapy as well as chemotherapy and local radiotherapy. The lesion regressed after the third cycle of chemotherapy. The patient interrupted antiretroviral treatment and the lesion recurred. The immune reconstitution secondary to the use of antiretroviral therapy seems to participate in the regression of PBL and maintains the remission of the tumour, but it might not be enough to prevent the development of PBL.

The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia.

AIM: This study evaluated the effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia. METHODS: Twelve patients with severe xerostomia were treated with acupuncture after radiation therapy. The baseline data were obtained preceding acupuncture treatment, and used as reference values. Acupuncture was performed in 12 sessions, 20 min each, twice a week, during a 6-week period. Clinical response was evaluated objectively by saliva collection measuring resting and stimulated whole salivary flow rates, and subjectively by a visual analogue scale patients' self-evaluation questionnaire. Statistical analyses were performed with a repeated-measures analysis of variance by using a mixed-effect modeling procedure. RESULTS: The results showed a statistically significant improvement for salivary flow rates on both objective and subjective evaluations (P<0.05). On objective evaluation there was an increase for resting salivary flow of 142.2% (mean=0.04 mL/min to 0.12 mL/min) and of 73.5% (mean=0.09 mL/min to 0.21 mL/min) for stimulated salivary flow. On subjective evaluation, visual analogue scale raised 36 points (mean=18.4 to 53.8) for sensation of more saliva production. CONCLUSION: According to the results of the present study, acupuncture showed a significant effect on saliva production, suggesting this therapy as a useful treatment for patients suffering from radiation-induced xerostomia.

Peroxiredoxin I is differentially expressed in multiple myelomas and in plasmablastic lymphomas.

BACKGROUND: Plasmablastic lymphoma (PBL) and multiple myeloma (MM) are B cell-derived malignancies that share many morphologic and immunophenotypic traits, making the differential diagnosis particularly complicated. We have recently demonstrated that peroxiredoxin I (PrdxI) is expressed in plasma cells but not in B lymphocytes, suggesting that its expression is development-associated. AIM: To analyze PrdxI expression in PBL and in MM in order to study its utilization as an additional diagnostic molecular tool. METHODS AND RESULTS: Eight cases of PBL and nine of MM were studied by immunohistochemistry. We have demonstrated that PrdxI expression is closely connected with the immunoglobulin production capacity of the cells, which means high in MM, but absent in PBL cases, except one, wherein few cells were stained. CONCLUSIONS: We hypothesize PrdxI as a component of the unfolded protein response (UPR), an adaptive pathway essential for plasma cell differentiation. As we have not detected immunoglobulin in our PBL cases, we suggest that UPR was not activated in the cells, accounting for the impediment of the developmental process, and for the inhibition of PrdxI expression observed. PrdxI could be considered an additional plasma cell functional marker and could also be speculated as a therapeutic target in the treatment of MM.

Effect of a topical antimicrobial paste on healing after extraction of molars in HIV positive patients: randomised controlled clinical trial.

AIM: To assess the efficacy of a medicated dressing in the socket on the healing after dental extractions in HIV positive patients. PATIENTS AND METHODS: Forty HIV positive patients with CD4 counts below 200 cells/mm(3) who were to have molar teeth extracted were randomly allocated to have the socket dressed with a medicated paste (Rifocort) with camphorated parachlorophenol and iodoform) and sutured (treated group), or merely sutured (control group). RESULTS: The sockets in the treated group healed more quickly than in the control group.

Polymorphous low grade adenocarcinoma presenting an uncommon radiographic aspect.

The aim of this study was to present clinical, histological and immunohistochemical aspects of a polymorphous low grade adenocarcinoma occurring in the mandible. A radiolucent tumour, located in the right mandible, was removed from a 40-year-old woman. Radiographic and CT exams revealed that the lesion expanded bucco-lingual cortical plates and presented an irregular scalloping of the bone. The surrounding lining mucosa was intact. The patient underwent total surgical removal of the lesion with an intraoperative biopsy. Histological diagnosis was polymorphous low-grade adenocarcinoma confirmed by immunohistochemical study. One-year follow up was uneventful. The accurate diagnosis of lesions presenting unusual clinical aspects, as the one presented here, is critical for correctly handling treatment.

Radon-222 in Brazil: an outline of indoor and outdoor measurements.

This study discusses the methodology for measuring and assessing the radon concentration in indoor and outdoor environments. A research study was developed to investigate the long-term behavior of the diurnal and seasonal fluctuations of radon (222)Rn EEC (Equilibrium-Equivalent Concentration) and the influence of temperature and other climatic aspects on this behavior. The study was performed by means of both integrated and instantaneous measurements of radon and its short-lived daughter products for a period of 1 year in an indoor environment in Rio de Janeiro city, Brazil (reference environment), with continuous measurement, using a radon monitor with an alpha spectrometry detector. For a single day, a variability of about 50% could be observed in the (222)Rn EEC values measured on a hourly basis, with a maximum occurring early in the morning and a minimum in the afternoon. For the long-term period, seasonality is responsible for a two order of magnitude variability, with a maximum of 50 Bq.m(-3) in winter (dry season) and a minimum of 0.5 Bq.m(-3) in the summer months (wet season), outdoors. A negative correlation with temperature was observed. The conclusions of this experiment led to a survey of radon gas concentration in dwellings in Rio de Janeiro city, Brazil, in urban area with nearly 7 million inhabitants, through integrated sampling methods, using a Solid State Nuclear Track Detectors Technique (SSNTD). The study was conducted in different geomorphological locations in town. The radon gas concentration in Rio de Janeiro dwellings ranged from 5 Bq.m(-3) to 200 Bq.m(-3). A good correlation between indoor radon gas concentration and location of dwellings was observed. The seashore areas presented the lowest levels of indoor radon concentration, whereas the highest levels were found close to the mountains.

Moebius syndrome with oral involvement.

The oral findings of 12 patients with Moebius syndrome are described. Facial weakness, hypoplastic upper lip, microstomia, mouth-angle drooping, hypoplasia of mandible, gothic palate, tongue weakness, fissured tongue, tongue atrophy and open bite were found. In addition to describing the oral findings, this report discusses some implications for dental treatment of patients with this syndrome.

Prevalence of numeric anomalies in the permanent dentition of patients with Down syndrome.

The purpose of this study was to evaluate the prevalence of numeric anomalies in the permanent dentition of patients with Down syndrome by means of panoramic radiographs. The sample consisted of panoramic radiographs from 70 subjects. We examined the radiographs to detect hypodontia as well as supernumerary teeth. Our results confirm the high prevalence of hypodontia among patients with Down syndrome (60%), mostly with mild expression. The teeth most often missing were the upper lateral incisors, usually bilaterally, followed by the lower second premolars and upper second premolars. Supernumerary teeth were seen in 6% of the subjects, and the concomitant occurrence of hypodontia and supernumerary teeth occurred in one patient.

Langerhans cell histiocytosis: recurrent lesions affecting mandible in a 10-year-old patient.

Hand-Schuller-Christian disease is a multifocal variant of eosinophilic granuloma, characterised by the classical triad of bony lesions, exophthalmos and diabetes insipidus. This case relates recurrent Langerhans' cell histiocytosis lesions presented as destruction of periodontal support associated with diabetes in a 10-year-old patient. Medical history suggests that the case represents a case of Hand-Schuller Christian disease.

Paracoccidioidomycosis in an HIV-positive patient: a case report with gingival aspects.

Paracoccidioidomycosis is an important deep mycosis, endemic in some areas of the South American countryside, with great incidence in males bearing rural activities, being unusual in urban developed centres. Cell-mediated immunity is the main host defence against the P. brasiliensis, and HIV-positive patients have been increasingly affected by the disease, although only a few reports are available in the literature. We present a case of paracoccidiodomicosis in an HIV-positive female, with unusual clinical history and histopathological aspects.

[A hierarchical model for analysis of socio-economic variables and water contact patterns associated with the hepatosplenic form of schistosomiasis]. / Um modelo hierárquico de análise das variáveis sócio-econômicas e dos padrões de contatos com águas associados à forma hepatoesplênica da esquistossomose.

A study of factors associated with the hepatosplenic clinical form of schistosomiasis was carried out in an endemic area (Comercinho, Minas Gerais) where prevalence of Schistosoma mansoni infection was 70.4%. Of the 1,408 inhabitants aged two years and over, 1,162 (82.5%) participated in the study. Socio-demographic characteristics and reasons for water contacts of individuals with the hepatosplenic form (n = 73) were compared to those who did not present splenomegaly and eliminated (positive controls; n + 804) or did not eliminate S. mansoni eggs in stools (negative controls; n = 285). Multivariate analysis was performed, considering the existence of colinearity among socio-economic status of the family, running water in the household, and bathing in streams. The hepatosplenic form in children was strongly associated with occupation of the head of the family (manual workers) (OR = 11.4; 95% CI = 1.4 - 91.8), absence of running water in the household (OR = 7.7; 95% CI = 2.6 - 23.1), and bathing in streams (OR and 95% CI 7.6; 2.5-22.9 and 5.7; 1.3-25.5 for frequencies > weekly and <= weekly, respectively); bathing in streams, which implies intense contacts, was a consequence of the first two factors. Our results suggest that running water in the household can decrease morbidity from schistosomiasis because it reduces the need for intense contacts with streams.

[Anatomic study of the aortic ring position in relation to the mitral ring]. / Estudo anatômico do posicionamento do anel aórtico em relação ao anel mitral.

PURPOSE: Evaluate the relations between aortic and mitral rings. METHODS: One hundred hearts were studied, in 84% men, 61% white and 85% were between 11 and 40 years old. The commissure between non coronary/left coronary sinus in the aortic ring and the middle point between anterior (AT) and posterior trigone (PT) in the mitral ring were used as references. When these points were coincident the position was middle; when the aortic point (AP) was closer the PT the position was posterior and when the AP was closer the AT the position was anterior or much anterior. RESULTS: Forty seven (47%) showed middle position, twenty seven (27%) much anterior, twenty two (22%) anterior and only four (4%) posterior. These aren't related to sex and age. The hearts of black people showed more posterior position than the others. CONCLUSION: Variations in aortic/mitral rings relations may be observed in normal hearts.

[Preservation of hearts by perfusion under pressure]. / Técnica de preservação de corações através de perfusão sob pressão.

PURPOSE: Development of method used to fix hearts in a reduced time, with preservation of their structures and characteristics. METHODS: Fifty normal human hearts were fixed in a system with four reservoirs, a roller pump, PVC tubes and a plastic recipient. This system was used to maintain the continuous injection by pressure of formaldehyde solution, to the interior of the heart. RESULTS: The fixation was satisfactory, pré-fixation time (13.93 +/- 5.13 min) and fixation time (60.53 +/- 12.50 min) were reduced related to previously utilized methods. CONCLUSION: The method was good, with decrease of fixation time and obtention of fixed hearts, with preservation of their structures and characteristics.

Anthropometric measures in relation to Schistosomiasis mansoni and socioeconomic variables.

A cross-sectional study of anthropometric measures and their association with socioeconomic variables, infection by Schistosoma mansoni, intensity of infection and splenomegaly was carried out in an endemic area for schistosomiasis in Brazil (Comercinho), using multiple logistic regression methods. Eighty-seven per cent of all 1.5-14.4 year-old children in the area participated in the study. Children below the 5th percentile (USA Ten State Survey) for height-for-age, weight-for-age and arm muscle area-for-age were compared to those greater than the 5th percentile. There was no association between low anthropometric measures and schistosomiasis or socioeconomic variables in children under five years of age. For the 4.4-14.4 year-old children, poor condition of the heads of family and poorer housing were independently associated with low height and arm muscle area. Heavy excretion of S. mansoni eggs (greater than or equal to 500 epg) was related to low height, and splenomegaly was the variable which showed the strongest association with low height, weight and arm muscle area (odds ratios adjusted for socioeconomic variables were 6.4, 3.5 and 3.7 respectively). This indicates that there is a biological component for low anthropometric measures in the severe form of schistosomiasis and this reinforces the need for public health measures to prevent the development of splenomegalies in endemic areas.

Water-contact patterns and socioeconomic variables in the epidemiology of schistosomiasis mansoni in an endemic area in Brazil.

A study was carried out in Comercinho in south-east Brazil where information relating to socioeconomic factors and water contacts was obtained from 290 (99% of the total) households and 1208 (82% of the total) inhabitants, respectively. Stool examinations and physical examinations were performed on 90% and 82% of the population, respectively. The rates of Schistosoma mansoni infection and splenomegaly were higher in families whose heads were manual workers, in individuals living in houses without piped water and of poor construction, and in those who were born in Comercinho. A total of 1017 (84%) individuals reported water contact; 75% of these contacts were for household activities or bathing and 21% for leisure. The faecal egg counts decreased in persons over 15 years of age, while the degree (intensity) of water contact did not. The mean degree of water contact was higher in individuals without than with piped water in the household (96.8+/-0.6 v. 25.7+/-0.6). The main risk factors for splenomegaly weer no piped water, intense water contact, bathing in streams, and daily contact (odds ratio=7.3, 5.1, 4.5 and 3.6, respectively). These results indicate that the extension of piped water to houses should decrease the incidence of splenomegaly in this endemic area.

A clinico-epidemiological survey of schistosomiasis mansoni in a hyperendemic area in Minas Gerais State (Comercinho, Brazil). I. Differences in the manifestations of schistosomiasis in the town centre and in the environs.

A cross-sectional survey of schistosomiasis was done in Comercinho (Minas Gerais State, Brazil). Faecal (Kato-Katz technique) and physical examinations were performed on 90% and 79% of the population (1474 inhabitants), respectively. The rate of infection with Schistosoma mansoni was 70%, the geometric mean of eggs was 334/g of faeces and 7% of the infected individuals had splenomegaly. The rate of infection, faecal egg counts and the rate of splenomegaly were significantly higher in the environs (zones 3 and 4) of the town than in the central areas (zones 1 and 2) of Comercinho. This difference seemed to be determined by the social differences existing between the population in the central area and the environs; in the environs the heads of families were predominantly manual workers (73 and 94% respectively), only 10 and 3% of the houses had piped water supply and less than 14% were of better quality.