Nasal Lobular Capillary Hemangioma During Pregnancy: A Systematic Review.

Objective: To perform a systematic review of published cases of nasal lobular capillary hemangioma (LCH) during pregnancy. Data Source: PubMed, Embase, Scopus, Web of Science, and LILACS. Review Methods: We searched electronic databases from inception to June 30, 2022. Case report and case series that reported clinical data on nasal LCH during pregnancy were included. Categorical variables were expressed as proportions and numerical variables as mean ± standard deviation or median (interquartile range). Results: Twenty-three studies (20 case reports and 3 case series) involving 29 patients were included. The mean age was 30.5 ± 5.3 years. A total of 62% cases were diagnosed in the third trimester of pregnancy. The most frequent (62%) location of LCH was the nasal septum. All cases presented with epistaxis. A total of 48% cases were treated by surgical excision after delivery and the recurrence was 11%. Conclusion: Our review shows that nasal LCH during pregnancy usually manifests in the third trimester. This lesion can be treated by surgical excision with a relatively low risk of recurrence.

Oral Pyogenic Granuloma: A Narrative Review.

Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.

Diagnosis and management of exuberant palatal pyogenic granuloma in a systemically compromised patient - Case report.

AIM: To discuss the diagnosis and treatment of an exuberant oral pyogenic granuloma (OPG) in the palatal region in a systemically compromised patient. METHODS AND RESULTS: A 50-year-old woman presented with extensive and painless nodular mass that extended throughout the palatal region, with difficulty speaking, swallowing and spontaneous bleeding for 6 months. Her medical history showed poorly controlled type II diabetes mellitus and hypertension. The intraoral physical examination also revealed poor oral hygiene and periodontal disease. After clinical and radiographic evaluation, the presumptive diagnosis of OPG was made and complete excision of the lesion was performed. Local hemostatic measures were employed to control bleeding. Microscopic evaluation showed a lobulated lesion composed of many blood capillaries confirming the diagnostic hypothesis. CONCLUSIONS: In summary, individuals with severe periodontal disease and systemic disorders may present exacerbated clinical presentations of OPG.

Angioleiomioma oral mimetizando um granuloma piogênico: relato de caso raro / Oral Angioleiomyoma mimetizing a pyogenic granuloma: A rare case report

Angioleiomioma (AL) é um tumor benigno de origem perivascular que raramente é observado na cavidade oral, principalmente em localizações como a gengiva. Devido sua apresentação clínica inespecífica, os ALs podem mimetizar outras lesões orais, como tumores benignos de glândulas salivares e lesões reacionais, como o granuloma piogênico. O presente artigo objetiva relatar um caso raro de AL localizado em gengiva, em uma paciente de 19 anos. Clinicamente, a lesão apresentava-se como um tumor assintomático, oval, pedunculado, bem definido, com superfície lisa, consistência fibrosa e cor eritematosa, semelhante a um granuloma piogênico, Uma biópsia excisional foi realizada e o fragmento foi encaminhado para análise histopatológica, que revelou uma proliferação vascular de diversos calibres, contendo paredes musculares espessas e proliferação muscular adjacente, além de infiltrado inflamatório, predominantemente crônico, hemácias extravasadas e área de ulceração, consistente com o diagnóstico de AL inflamado. A histopatologia desempenha um papel importante no diagnóstico final de lesões raras e com características clínicas inespecíficas. A excisão cirúrgica da lesão é o tratamento de escolha mais eficaz para os ALs orais. (AU)

Angioleiomyoma (AL) is a benign tumor of smooth muscle of perivascular origin that is rarely seen in the oral cavity, mainly in locations like the gingiva. Due to their nonspecific clinical presentation, ALs can mimic other oral lesions, such as benign salivary gland tumors and reactional lesions, as a pyogenic granuloma. We reported a case of an AL located in the gingiva in a 19-year-old female patient. In clinical terms, the lesion was presented as an asymptomatic, oval, pedunculated, well-defined nodule with a smooth surface, fibrous consistency and erythematous color, similar to a pyogenic granuloma. An excisional biopsy was performed and the fragment was sent for histopathological analysis that revealed a vascular proliferation of different calibers, containing thick muscle walls and adjacent muscle proliferation, in addition to an inflammatory infiltrate, predominantly chronic, extravasated red blood cells and an area of ulceration, consistent with the diagnosis of inflamed AL. The histopathology plays an important role in the final diagnosis of rare lesions and with nonspecific clinical characteristics. The surgical excision of the lesion is the most effective treatment of choice for oral ALs. (AU)

Granuloma piogénico oral de comportamiento agresivo: Reporte de un caso / Oral pyogenic granuloma with aggressive behavior: A case report

El granuloma piogénico es una lesión vascular reactiva benigna del tejido blando que surge en respuesta a irritantes crónicos de bajo grado. Rara vez crece más de 2 cm de diámetro y por lo general, no provoca cambios en el hueso alveolar. Presentamos un caso inusual de granuloma piógeno en una mujer de 19 años, de extenso tamaño y comportamiento agresivo, asociado a resorción ósea severa, movilidad dentaria, hemorragia, anemia ferropénica y recurrencias.

Pyogenic granuloma is a benign reactive vascular lesion of the soft tissue that arises in response to chronic low-grade irritants. It rarely grows more than 2 cm in diameter and usually does not cause changes in the alveolar bone. We present the case of a 19-year-old woman with an unusual pyogenic granuloma of extensive size and aggressive behavior, associated with severe bone resorption, tooth mobility, hemorrhage, iron deficiency anemia and recurrences.

Unusual clinical presentation of oral pyogenic granuloma with severe alveolar bone loss: A case report and review of literature.

BACKGROUND: Pyogenic granuloma (PG) is a localized, reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity. In most cases, the presence of this lesion does not show alveolar bone resorption. The pathology is diagnosed clinically with some caution. However, the diagnosis and treatment are usually corroborated with histopathological evidence. CASE SUMMARY: Three clinical cases of PG associated with bone loss were described in this study. The three patients presented tumor-like growth which bled on touch, and were associated with local irritant factors. Radiographs showed bone loss. All cases were treated with conservative surgical excision. The scarring was satisfactory, and there was no case of recurrence. The diagnoses were based on clinical findings, and were confirmed histopathologically. CONCLUSION: The occurrence of oral PG with bone loss is unusual. Therefore, clinical and radiographic evaluations are important for the diagnosis.

Sacroileítis piógena en pediatría: reporte de caso y revisión de la literatura / Pediatric Pyogenic Sacroiliitis: Case Report and Literature Review / Sacroileíte piogênica em pediatria: relato de caso e revisão da literatura

Resumen: Las infecciones osteoarticulares en pacientes pediátricos están asociadas a morbilidad significativa y riesgo de secuelas funcionales o anatómicas, que requieren intervenciones quirúrgicas, en ciertas ocasiones. La sacroileítis piógena (SP) es una infección bacteriana osteoarticular que abarca un pequeño porcentaje del total de las artritis sépticas. La sintomatología es imprecisa, lo que hace retrasar el diagnóstico de la enfermedad y, consecuentemente, llevar a posibles complicaciones como abscesos, sepsis y deformación de las articulaciones. En la actualidad, la resonancia magnética nuclear (RMN) es el método diagnóstico más útil en razón a su relativamente fácil acceso y alta sensibilidad. El inicio del manejo antibiótico adecuado implica una rápida regresión de los síntomas. Presentamos el caso clínico de una paciente escolar atendida en un hospital de Bogotá, Colombia, quien presentó un cuadro de SP, sospechado con base en la anamnesis y examen físico para finalmente ser confirmado por imagenología y cultivo microbiológico.

Abstract: Osteoarticular infections in pediatric patients are associated with significant morbidity and the risk of functional and/or anatomical sequelae, often requiring surgical interventions. Pyogenic sacroiliitis is a rare bacterial infection affecting the osteoarticular region, accounting for a small percentage of all septic arthritis cases. The symptomatology is imprecise, leading to delayed diagnosis and potential complications such as abscesses, sepsis and joint deformities. Currently, nuclear magnetic resonance is the most useful diagnostic method due to its relatively easy accessibility and high sensitivity. Initiating appropriate antibiotic treatment results in a rapid regression of symptoms. We present the clinical case of a school- aged patient treated at a hospital in Bogotá, Colombia. The patient exhibited symptoms indicative of pyogenic sacroiliitis, suspected based on the anamnesis and physical examination, and later confirmed through imaging and microbiological culture.

Resumo: As infecções osteoarticulares em pacientes pediátricos estão associadas a morbidade significativa e risco de sequelas funcionais ou anatômicas, que podem requerer intervenções cirúrgicas em certas ocasiões. A sacroileíte piogênica (SP) é uma infecção bacteriana osteoarticular que abrange uma pequena porcentagem do total de artrites sépticas. A sintomatologia é imprecisa, o que pode atrasar o diagnóstico da doença e, consequentemente, levar a complicações como abscessos, sepse e deformação das articulações. Atualmente, a ressonância magnética nuclear (RMN) é o método diagnóstico mais útil devido ao seu acesso relativamente fácil e alta sensibilidade. O início do manejo antibiótico adequado implica uma rápida regressão dos sintomas. Apresentamos o caso clínico de uma paciente escolar atendida em um hospital em Bogotá, Colômbia, que apresentou um quadro de SP, suspeito com base na anamnese e exame físico, sendo posteriormente confirmado por imagem e cultura microbiológica.

How I do it: brainwashing for purulent ventriculitis.

BACKGROUND: The management of ventriculitis remains controversial, with no single management strategy that can provide a good outcome. There are few articles describing the brainwashing technique, and most for neonatal intraventricular hemorrhage. This technical note is important because it describes a practical way to perform brainwashing in case of ventriculitis, and it is more feasible compared to endoscopic lavage in developing countries. METHOD: We describe in a stepwise fashion the surgical technique of ventricular lavage. CONCLUSION: Ventricular lavage is a neglected technique that can help to improve ventricular infection and hemorrhage prognosis.

Hemangioma lobular capilar inusual en un paciente pediátrico. Reporte de caso y revisión de literatura / Unusual capillary lobular hemangioma in a pediatric patient. Case report and literature review

Lobular capillary hemangioma or pyogenic granuloma is a benign non-neoplastic lesion that is mainly presented as a tissue growth in response to irritation or trauma. It is located on the skin or on the mucous membrane, with the oral mucosa being the most frequent, with the gingiva standing out, but also appearing in other places such as the lips, buccal mucosa, palate and tongue, the latter being a very unusual location. This is a report of the case of a pediatric patient who underwent a surgical procedure of frenotomy, and who subsequently presented a lesion due to trauma possibly as a consequence of local anes-thesia, which forced an excisional biopsy, the histopathological diagnosis being capillary lobular hemangioma or pyogenic granuloma. Likewise, a literature review of this type of pathology is presented, with emphasis on its location in the tongue.

Point­of­care ultrasound for the diagnosis of liver abscess in a patient with HIV in the emergency department: A case report.

A liver abscess is an entity that is rarely observed in the emergency department; therefore, it requires timely diagnosis by the clinicians who support this service. The early diagnosis of a liver abscess is challenging as variable and non-specific symptoms are present; furthermore, symptoms may differ in patients with human immunodeficiency virus (HIV) infection. To date, reports on the presentation of diagnostic ultrasound with point-of-care ultrasonography (PoCUS) are limited. The present case report study describes a patient diagnosed with HIV and the presence of a liver abscess confirmed by PoCUS performed in an emergency department. The patient presented with abdominal pain upon palpation in the right hypochondrium and in the thoracoabdominal area, which became more severe with inspiration. PoCUS revealed a hypodense intrahepatic image observed between segments VII and VI, with internal echoes suggestive of a liver abscess. Moreover, it was decided to perform tomography-guided percutaneous drainage of the liver abscess. Antibiotic treatment with ampicillin/sulbactam and IV metronidazole was also commenced. The patient presented clinical improvement and was discharged on the third day.

Liver abscess due to Granulicatella adiacens in an immunocompetent patient: Case report / Absceso hepático por Granulicatella adiacens

Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.

Los abscesos hepáticos piógenos por Granulicatella adiacens son infecciones asociadas a una alta mortalidad, principalmente en pacientes inmunocomprometidos. Los principales microorganismos asociados a los abscesos hepáticos son Klebsiella pneumoniae y Escherichia coli, aunque pueden ser polimicrobianos. Sin embargo, los informes de casos que describen la infección hepática por G. adiacens son muy escasos. Se presenta el caso de un paciente adulto inmunocompetente que presentó 15 días de evolución de picos febriles cuantificados asociados a astenia, adinamia, escalofríos, ictericia y coluria. El examen clínico inicial reveló un tinte ictérico generalizado sin dolor abdominal, y presión arterial con tendencia a la hipotensión. Se sospechó neoplasia biliopancreática confluente, colangitis secundaria y sepsis de origen biliar, y se inició reanimación con líquidos y antibioterapia. Se tomaron hemocultivos y estudios diagnósticos complementarios. En el ultrasonido hepatobiliar, se observó un absceso de 73 x 62 mm en el segmento IV; la vía biliar y el páncreas se encontraron dentro de los límites normales. Se realizaron múltiples pruebas moleculares de detección de microorganismos (FilmArray), y se identificó a G. adiacens como el principal agente patógeno. El paciente completó el manejo antibiótico con ciprofloxacina, vancomicina y metronidazol en buenas condiciones y fue dado de alta con éxito. Este es el primer absceso hepático piógeno reportado causado por G. adiacens en un paciente inmunocompetente, en quien el diagnóstico microbiológico temprano en conjunto con el tratamiento antibiótico dirigido y el drenaje percutáneo de la lesión fueron determinantes en el resultado clínico.

Pyogenic spinal infections in patients with chronic liver disease: illustrative case and systematic review.

BACKGROUND: Pyogenic spinal infections (PSIs) are a group of uncommon but serious infectious diseases that are characterized by inflammation of the endplate-disc unit. PSIs are considered more prevalent and aggressive among patients with chronic immunocompromised states. Association between PSIs and liver disease has not been systematically analyzed. The authors performed a systematic review to study baseline characteristics, clinical presentation, and mortality of patients with PSI in the setting of chronic liver disease. OBSERVATIONS: The authors presented the case of a 72-year-old female patient with chronic liver disease who presented with severe low back pain and bilateral lower weakness. Imaging studies showed T10-11 spondylodiscitis. The patient received decompression and fusion surgery with partial neurological improvement. The authors performed a systematic literature search of spondylodiscitis and liver disease, and eight published articles met the studies inclusion and exclusion criteria. These studies featured a total of 144 patients, of whom 129 met inclusion criteria (mean age, 60.5 years, range 40 to 83 years; 62% males). Lumbar infection was the most common report (67%), with Staphylococcus aureus (48%) as the main causative microorganism. Neurological compromise was present in 69% of patients. Surgical intervention occurred in 70.5% of patients, and the average duration of antibiotic treatment was 69.4 days. Postoperative complication rate was 28.5%, with a 30- and 90-day mortality of 17.2% and 24.8%, respectively. LESSONS: Pyogenic spondylodiscitis in patients with liver disease was associated with a high rate of neurological compromise, postoperative complications, and mortality.

Hemangioma capilar lobular: granuloma piógeno en lengua / Lobular capillary hemangioma: pyogenic granuloma of tongue

El granuloma piógeno es una lesión benigna, reactiva y multifactorial que resulta de le- siones repetitivas, microtraumatismos e irritación local en piel o mucosas y cambio hormonal. Cuando aparece en la cavidad oral tiene predilección por la encía vestibular, pero es importante que el odontólogo esté consciente y familiarizado con el hecho de que puede estar localizado en otras áreas anatómicas. Clínicamente se presenta como lesión hiperplásica altamente vascularizada, de tamaño generalmente no mayor a 2 cm, pediculada en la base o sésil y de lento crecimiento. Sin mostrar preferencia por edad o sexo, tiende a aparecer principalmente en encías, labios y mucosa oral, siendo muy pocos los casos reportados en el área lingual. Es por ello que, en este artículo, nos referimos a un caso de ubicación inusual, en conjunto con una revisión de la literatura (AU)

Pyogenic granuloma is a benign, reactive, and multifactorial lesion caused by repetitive injuries, microtrauma and local irritation on the skin or mucous membranes, and hormonal change. When it appears in the oral cavity, it has a predilection for the vestibular gingiva, but the dentist must be aware and familiar with the fact that it can be present in other anatomi- cal areas. Clinically, it is presented as a hyperplasic injury highly vascular-related, with a size generally no bigger than 2 cm, pedunculated in base or sessile, and slow in growth. Without showing any preference in age or gender, it tends to appear mainly on the gums, lips, and oral mucosae, with very few, reported cases in the lingual area. Therefore, in this study, we refer to a case of unusual localization with a literature review (AU)

Intravascular lobular capillary hemangioma of the temporal artery.

Lobular capillary hemangiomas (LCHs) are a common form of benign vascular tumors originating from the skin and subcutaneous tissues. We have described the case of a 47-year-old man who had presented with a 1-month history of a tender swelling to the right temporal region. Biopsy was performed to rule out temporal arteritis and demonstrated a subset of LCH, now formally known as intravascular LCH. We have described the occurrence of a rare subtype of LCH arising from the intravascular wall of the temporal artery. To the best of our knowledge, this is the only reported case of an intravascular LCH in the Caribbean.

Granuloma telangiectásico de cavidad oral en zona anterior

Introducción: El granuloma telangiectásico es una neoplasia benigna de origen epitelial y contenido vascular que se presenta en cavidad oral, de crecimiento lento. Su etiología es atribuible a trauma físico, alteraciones hormonales y al uso de medicamentos, además es inducido por presencia de cálculos y deficiente higiene oral. Objetivo: Describir las características clínicas y patológicas de un granuloma telangiectásico presente en cavidad oral, su patogénesis y el manejo de terapéutico del caso. Presentación del caso: Paciente de 35 años que acude a consulta por presentar una lesión tumoral, en sector anterosuperior derecho, afectando la estética de la paciente. Se efectuó excisión quirúrgica y al realizar el estudio histopatológico se confirmó diagnóstico de granuloma telangiectásico. Conclusión: Los profesionales de la odontología deben conocer todos los aspectos relacionados con el granuloma telangiectásico, etiopatogenia, características clínicas e histológicas, con el objeto de identificar esta patología, establecer diagnósticos diferenciales y poder brindar un diagnóstico adecuado y, por consiguiente, un plan de tratamiento específico para cada caso.

Introduction: The granuloma telangiectásico is a benign neoplasia of epithelial origin and vascular content that occurs in oral cavity with greater predilection in gum, of slow growth. Its etiology is attributable to physical trauma, hormonal alterations and the use of medicines, and is induced by the presence of stones and poor oral hygiene. Objective: to describe the clinical and pathological characteristics of a telangiectatic granuloma present in oral cavity, its pathogenesis and the therapeutic management of the case. Presentation of the case: A 35-year-old patient who attended a dental consultation for presenting a tumor lesion of a soft consistency, located in the right anterior superior sector, affecting the aesthetics of the patient. Surgical excision was performed, detoxification of the exposed area with citric acid, and the histopathological study confirmed the diagnosis of telangiectatic granuloma. Conclusion: Dental professionals must know all the aspects related to telangiectatic granuloma, etiopathogenesis, clinical and histological characteristics, in order to identify this pathology, establish differential diagnoses and be able to provide an adequate diagnosis and therefore a specific treatment plan for each case.

Granuloma piógeno por picadura de insecto

RESUMEN Introducción: El hemangioma lobular capilar es un tumor de tejidos blandos relativamente frecuente. Se conoce que es un desarrollo reactivo focal de tejido fibrovascular o de granulación con proliferación endotelial, que no tiene relación con ninguna bacteria. Se desarrolla rápidamente, sangra con facilidad y se ulcera causando la impresión clínica errónea de un tumor maligno. Objetivo: Contribuir al conocimiento de esta afección para su detección precoz y tratamiento oportuno. Presentación de caso: Paciente masculino, de 6 años de edad, con antecedentes de buena salud, que es traído a consulta porque su madre refiere que desde hace más de un mes, comenzó con una pequeña lesión en la cara después de la picadura de un insecto que creció y sangra con facilidad de manera espontánea o después de algún traumatismo. Al examen dermatológico se constata cuadro cutáneo localizado constituido por lesión única en forma de tumor, de aproximadamente 0,5 cm, de color rojo intenso, que sangra con facilidad con el mínimo roce localizada en la cara. Se trató con criocirugía y se logró eliminación de la lesión casi sin cicatriz aparente. Conclusiones: La extirpación quirúrgica completa se considera el tratamiento de primera línea porque se evitan las recidivas y, al mismo tiempo, puede obtenerse material suficiente para el estudio histopatológico. En los casos con diagnóstico de certeza es útil el uso de criocirugía y electrofulguración para impedir las alteraciones estéticas provocadas por la cirugía.

ABSTRACT Introduction: Capillary lobe hemangioma is a relatively common soft tissue tumor. It is known to be a focal reactive development of fibrovascular or granulation tissue with endothelial proliferation, which is not related to any bacteria. It develops rapidly, bleeds easily and ulcerates causing the clinical erroneous impression of a malignant tumor. Objective: Contribute to the knowledge of this condition for its early detection and timely treatment. Case presentation: Male patient, 6 years old, with a health history, who is brought to consultation because his mother reports that for more than a month he presented a small lesion on the face after the bite of an insect that grew and bleeds easily, spontaneously or after some trauma. The dermatological examination shows a localized skin condition consisting of a single lesion in the form of a tumor, approximately 0.5 cm, of intense red color, which bleeds easily with the minimum friction, and it was located on the face. It was treated with cryosurgery and the removal of the lesion was achieved with almost no apparent scar. Conclusions: Complete surgical removal is considered the first-line treatment because recurrences are avoided and, at the same time, sufficient material can be obtained for histopathological study. In cases with a diagnosis of certainty, the use of cryosurgery and electrofulguration is useful to prevent the aesthetic alterations caused by surgery.

An inter- and intra-rater agreement assessment of a novel classification of pyogenic spinal infections.

PURPOSE: Pola et al. described a clinical-radiological classification of pyogenic spinal infections (PSI) based on magnetic resonance imaging (MRI) features including vertebral destruction, soft tissue involvement, and epidural abscess, along with the neurological status. We performed an inter- and intra-observer agreement evaluation of this classification. METHODS: Complete MRI studies of 80 patients with PSI were selected and classified using the scheme described by Pola et al. by seven evaluators. After a four-week interval, all cases were presented to the same assessors in a random sequence for repeat assessment. We used the weighted kappa statistics (wκ) to establish the inter- and intra-observer agreement. RESULTS: The inter-observer agreement was substantial considering the main categories (wκ = 0.77; 0.71-0.82), but moderate considering the subtypes (wκ = 0.51; 0.45-0.58). The intra-observer agreement was substantial considering the main types (wκ = 0.65; 0.59-0.71), and moderate considering the subtypes (wκ = 0.58; 0.54-0.63). CONCLUSION: The agreement at the main type level indicates that this classification allows adequate communication and may be used in clinical practice; at the subtypes level, the agreement is only moderate.

Maintenance of the buccal fat pad (Bichat) as a resource for regional grafting: A case report and literature review

Objective: Report a case of pyogenic granuloma with two years of evolution, three previous removals with external oral and maxillofacial surgeons, and new recurrences. Case Report: A 25-year-old male patient with a history of a pyogenic granuloma with two years of evolution had three previous removals with external maxillofacial and had relapses. The treatment indicated after these relapses were the extraction of the involved teeth and the lesion, performing the closure with a buccal fat pad flap. The lesion underwent metaplasia, transforming into mucosa.Conclusion: This case emphasizes keeping the buccal fat pad as a possible future resource for regional grafting. (AU)

Anti-synthetase Syndrome Complicated by Pyogenic Myositis.

BACKGROUND: Anti-synthetase syndrome is a rare autoimmune disorder characterized by autoantibodies against aminoacyl-tRNA-synthetases. Inflammatory myopathy and interstitial lung disease could be present among other manifestations. Anti-Jo-1 is the most common antisynthetase antibody and is the most likely to present with the classic triad (interstitial lung disease, myositis, and arthritis), and includes more muscle and joint involvement than patients with other antisynthetase antibodies. CASE REPORT: Here, we present a case of a 60-year-old female patient with a previous diagnosis of myositis, secondary to the anti-synthetase syndrome, a complication of pyogenic myositis. CONCLUSION: The diagnosis of anti-synthetase syndrome is made by a multidisciplinary approach, and occasionally, muscle and/or lung biopsy is needed. Imaging studies, especially magnetic resonance imaging, based on findings such as muscle and fascial edema, and fatty tissue replacement, allow an optimal approach.