Periodontoid Pseudotumor in Tuberous Sclerosis Associated With Neck Diffuse Lipomatosis.

Tuberous sclerosis (TS) is a genetic multisystem disorder associated with the development of benign tumors in many organs. Diffuse lipomatosis, which represents the overgrowth of fatty tissue in one part of the body, is a very rare finding reported in patients with tuberous sclerosis. We describe the case of a patient with diffuse lipomatosis in the right scapular, posterior cervical and perivertebral regions, associated with a space-occupying lesion adjacent to the odontoid process of C2 that appeared to be a pseudotumor, and discuss possible relation between these entities.

HIV-1 impact on oral health-related quality of life: a cross-sectional study.

This cross-sectional study compared the Oral-Health-Related Quality of Life (OHRQoL) in HIV negative patients (Group 1, n=129, mean age: 39.9 ± 15.6, 75 females) and HIV+ patients (Group 2, n=670, mean age: 43.2 ± 9.8, 246 females) from the same socio-economic environment using the OHIP-49 questionnaire. OHIP total score were determined by simple summing. A multiple linear regression model was carried out to predict OHIP scores in which HIV+ patients experienced a significantly (p<0.001) worst OHRQoL for total and every dimension. A general linear model was used for estimating the means in the two groups adjusted for covariates included in the previous model. Adjusted means for subscale and total OHIP scores were significantly higher for Group 2 (61.6 ± 6.26 vs. 119.8 ± 3.31) with a large effect size (0.94). HIV+ infection, decayed teeth, prosthodontic and surgical needs, care index, drug use, employment and age presented an independent effect on questionnaire scores. This study shows that HIV+ infection has an independent and negative impact on the OHRQoL while care index presents a positive impact. Additional factors like high decayed teeth, prosthodontic treatment needs and drug use are independently associated with total OHIP scores, presenting a negative effect on OHRQoL.

Labyrinthine enhancement on 3D black blood MR images of the brain as an imaging biomarker for cisplatin ototoxicity in (lung) cancer patients.

PURPOSE: Cancer patients treated with platinum-based chemotherapy can present with ototoxicity symptoms. The purpose of this work is to report the imaging features related to cisplatin ototoxicity. METHODS: Between December 2015 and March 2019, a cohort of 96 consecutive patients with lung cancer was selected. Only patients who received cisplatin chemotherapy and underwent an imaging protocol consisting of a Gd-enhanced 3D-BB and 3D-T1W sequence, as well as T2W sequence to exclude metastases, were included. Labyrinthine enhancement was assessed, and all findings regarding the auditory and vestibular function were retrieved from the clinical files. RESULTS: Twenty-one patients met the inclusion criteria. The Gd-enhanced 3D-BB images were used to divide them into the labyrinth enhancement group (LEG) and the labyrinth non-enhancement group (LNEG). None of these patients demonstrated enhancing regions on the 3D-T1W images. The labyrinthine fluid remained high on the T2 images in all patients, excluding metastases. The LEG consisted of 6 patients. The cochlea and semicircular canals were the most frequently affected regions. All the LEG patients that presented with hearing loss (4/6) had cochlear enhancement. Patients with normal hearing had no cochlear enhancement. Five patients (5/6) showed vestibular enhancement. Four of these patients had vestibular symptoms. CONCLUSION: Labyrinthine enhancement as an imaging feature related to cisplatin ototoxicity is unreported. This study demonstrates a correlation between hearing loss and cochlear enhancement and also between vestibular impairment and vestibular/semicircular enhancement on 3D-BB images, which remained invisible on the 3D-T1W images. The labyrinthine enhancement on 3D-BB images in the presence of normal signal intensity of the intralabyrinthine fluid can be used as an imaging biomarker for cisplatin toxicity in daily clinical practice and should not be mistaken for intralabyrinthine metastases.

Pseudocisto pancreático simulando lesão cística neoplásica de cabeça de pâncreas: relato de caso / Pancreatic pseudocyst simulating neoplastic pancreatic head injury: case report

Introdução: os cistos pancreáticos são diagnosticados, em sua maioria, como achados acidentais em pacientes submetidos à exame físico de rotina ou exame radiológico abdominal. As lesões neoplásicas representam 10-15% de todas as lesões pancreáticas. Relato de caso: Relatamos o caso de um paciente com 41 anos de idade apresentando pseudocisto de cabeça de pâncreas com diagnóstico pré-operatório sugestivo de neoplasia sólido-cística. Conclusão: O manejo das neoplasias císticas de pâncreas apresenta-se como um desafio. Os exames de imagem tiveram um papel essencial no diagnóstico diferencial. A ressecção cirúrgica continua sendo padrão ouro para pacientes sintomáticos e com elevada probabilidade de malignidade.

Introduction: cystic lesions of the pancreas are mostly diagnosed as accidental findings in patients undergoing routine physical examination or abdominal radiological examination. Neoplastic pancreatic cysts represent 10-15% of all pancreatic lesions. Case report: We report the case of a 41-year-old patient with a pancreatic head pseudocyst with a preoperative diagnosis suggestive of solid-cystic neoplasm. Conclusion: The management of cystic pancreatic neoplasms is a challenge. Imaging exams played an essential role in the differential diagnosis. Surgical resection remains the gold standard for symptomatic patients with high probability of malignancy.

Leigh syndrome with atypical cerebellar lesions.

Leigh Syndrome is a neurodegenerative disorder caused by mitochondrial dysfunction, with significant phenotypic and genetic heterogeneity. It usually presents in early life, with a severe prognosis. It can be caused by more than 75 different gene mutations, of nuclear and mitochondrial origin, involving all respiratory chain complexes, with less than 25% of Leigh syndrome having mitochondrial DNA mutations. The typical pathologic hallmarks are focal, bilateral, and symmetric lesions in the basal ganglia, thalamus, cerebellum, cerebral white matter and spinal cord gray matter, usually with T2WI and FLAIR hyperintensity. The basal ganglia and thalami frequently present with a pattern of cytotoxic edema. We present one case with clinical and analytical features consistent with Leigh Syndrome, with peculiar imaging features, showing dominant cerebellar edematous changes with unexpected petechial component suggestive of microangiopathy. To our knowledge, these features are unreported and suggest the existence of microvascular lesions. Based on the reported imaging findings, we propose that Leigh Syndrome should be added to the differential diagnosis of acute cerebellitis.

Complicated acute appendicitis presenting as an abscess in the abdominal wall in an elderly patient: A case report.

INTRODUCTION: Appendicitis is a common cause of acute abdomen; however, the classic clinical signs are not often present, and it has unusual presentations. Thus, its diagnosis can be challenging. PRESENTATION OF CASE: We describe the case of an elderly man who presented with right abdominal wall abscess with spontaneous drainage in the emergency department. Since we suspected a subjacent abdominal pathology, we performed surgery, and intraoperatively, we observed that the Appendix tip had invaded the abdominal wall. DISCUSSION: This patient had a challenging diagnostic process and surgical visualization of the appendicular tip invading the abdominal wall was an important characteristic in proving the cause of the abdominal wall abscess. CONCLUSION: The onset of an abdominal wall abscess without a known cause needs to be thoroughly investigated, with consideration of a subjacent abdominal cause and appendicitis necessitatis.

Muscle water control in crustaceans and fishes as a function of habitat, osmoregulatory capacity, and degree of euryhalinity.

This study aimed at detecting possible patterns in the relationship between Anisosmotic Extracellular Regulation (AER) and Isosmotic Intracellular Regulation (IIR) in crustaceans and teleost fish from different habitats and evolutionary histories in fresh water (FW), thus different osmoregulatory capabilities, and degrees of euryhalinity. Crustaceans used were the hololimnetic FW Aegla schmitti, and Macrobrachium potiuna, the diadromous FW Macrobrachium acanthurus, the estuarine Palaemon pandaliformis and the marine Hepatus pudibundus; fishes used were the FW Corydoras ehrhardti, Mimagoniates microlepis, and Geophagus brasiliensis, and the marine-estuarine Diapterus auratus. The capacity for IIR was assessed in vitro following wet weight changes of isolated muscle slices incubated in anisosmotic saline (~50% change). M. potiuna was the crustacean with the highest capacity for IIR; the euryhaline perciforms G. brasiliensis and D. auratus displayed total capacity for IIR. It is proposed that a high capacity for IIR is required for invading a new habitat, but that it is later lost after a long time of evolution in a stable habitat, such as in the FW anomuran crab A. schmitti, and the Ostariophysian fishes C. ehrhardti and M. microlepis. More recent FW invaders such as the palaemonid shrimps (M. potiuna and M. acanthurus) and the cichlid G. brasiliensis are euryhaline and still display a high capacity for IIR.