Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

Ethanol sclerotherapy of head and neck venous malformations / Escleroterapia com etanol em malformações venosas da cabeça e pescoço

Objective This retrospective study evaluated the results of sclerotherapy with low doses of ethanol for treatment of head and neck venous malformations. Methods We treated 51 patients, 37 females. Median age was 23 years. Patients were treated with percutaneous intralesional injection of alcohol every two weeks and followed up prospectively for a median period of 18 months. Most lesions affected the face and cosmetic disfigurement was the most frequent complaint. Results We performed a median of 7 sessions of sclerotherapy. Complete resolution or improvement was observed in 48 patients presented. Five cases of small skin ulceration, two cases of hyperpigmentation and two of paresthesia were documented; all of them were treated conservatively. Conclusion Percutaneous sclerotherapy with low doses of ethanol is a safe and effective treatment modality for venous malformations affecting the head and neck. .

Objetivo Estudo retrospectivo que analisou os resultados da escleroterapia, com doses baixas de etanol, realizada sob anestesia local para tratamento de malformações venosas na cabeça e pescoço. Métodos Foram tratados 51 pacientes, sendo 37 do gênero feminino. A mediana de idade foi de 23 anos. Os pacientes foram tratados com injeções alcoólicas nas lesões, por via percutânea, em sessões quinzenais, e acompanhados prospectivamente por um período mediano de 18 meses. A maioria das lesões acometia a face e a queixa principal mais frequente foi deformidade estética. Resultados Foram realizadas, em média, sete sessões de escleroterapia. Resolução completa ou melhora foi observada em 48 pacientes. Cinco pacientes apresentaram pequena úlcera cutânea, dois hiperpigmentação e dois parestesia, sendo todos tratados conservadoramente. Conclusão A escleroterapia percutânea com doses baixas de etanol é um método seguro e eficaz para tratar malformações venosas na cabeça e pescoço. .

Sclerotherapy of hydroceles and spermatoceles with alcohol: results and effects on the semen analysis

PURPOSE: To evaluate the success rates of sclerotherapy of the tunica vaginalis with alcohol for the treatment of hydroceles and/or spermatoceles, as well as, evaluation of pain, formation of hematomas, infection and its effects in spermatogenesis . MATERIALS AND METHODS: A total of 69 patients, with offsprings and diagnosis of hydrocele and/or spermatocele, were treated during the period from April 2003 to June 2007. Semen analysis was obtained from patients who were able to provide us with samples. The sclerotherapy with alcohol at 99.5 percent was undertaken as outpatient procedure. RESULTS: The average volume drained pre-sclerotherapy was 279.82 mL (27 to 1145). The median follow-up was 43 months (9 to 80). A total of 114 procedures were performed on 84 units, with an average of 1.35 procedures / unit and an overall success rate of 97.62 percent. Of the 69 patients, 7 (10.14 percent) reported minor pain immediately after the procedure, 3 (4.35 percent) moderate pain and 2 (2.89 percent) intense pain. Post-Sclerotherapy spermograms revealed reduction of the parameters regarding: concentration, motility and morphology up to 6 months post procedure , with return to normal parameters 12th months after procedure. CONCLUSIONS: Sclerotherapy of hydroceles and spermatoceles with 99.5 percent alcohol is an efficient procedure that can be perormed without difficulties, cost-effectiveness, with few side effects and which may be performed in patients who wish fertility.

Tratamiento del dolor quirúrgico en Buenos Aires durante la primera mitad del siglo XIX / Treatment of surgical pain in Buenos Aires during the first half of the 19th. Century. Historical Research

El tratamiento del dolor en la cirugía que se practicaba en Buenos Aires en la primera mitad del siglo XIX se basaba en la administración de opio y alcohol (usualmente vino Carlón). Además de estas sustancias, se apelaba a la sujeción, la sorpresa y el engaño, métodos ya empleados durante centurias. Importante era la rapidez del cirujano, que muchas veces operaba aun sin el auxilio de las sustancias mencionadas. Las operaciones se realizaban en los hospitales de la ciudad o en los domicilios de los pacientes.

Treating surgical pain in Buenos Aires during the first half of the 19th century was based on giving the patient opium and alcohol (usually cheap red wine). Also used were centuries-old methods such as binding the patient, taking him by surprise and lying to him. An important factor was the speed of the surgeon who frequently operated even without the help of the mentioned substances. Such surgery was done in the city's hospitals or the patient's home.

O tratamento da dor da cirurgia praticada em Buenos Aires na primeira metade do século XIX tinha como base a administração de ópio e álcool (usualmente vinho Carlón). Além dessas substancias, apelava-se para a sujeição, a surpresa e o engano, métodos já utilizados durante séculos. Era importante a rapidez do cirurgião, que muitas vezes operava até mesmo sem o auxilio das substancias mencionadas. As cirurgias eram feitas nos hospitais da cidade ou domicilios dos pacientes.

Cardiomiopatia hipertrófica tratada por técnica intervencionista de reduçäo septal / Cardiomyopaty hipertrophic treatment through technique interval the reduction septal

Mulher de 75 anos com cardiomiopatia hipertrófica obstrutiva, com dispnéia classe IV, refratária ao tratamento clínico, apresentava contra-indicaçöes relativas para abordagens cirúrgica e de implante de marcapasso. Realizou-se procedimento intervencionista para injeçäo seletiva de álcool absoluto no 1§ ramo septal da artéria interventricular anterior. O infarto septal provocado acompanhou-se de liberaçäo enzimática, elevaçäo de ST e bloqueio de ramo direito do feixe de His. Näo houve complicaçöes inesperadas, e o gradiente da via ejetiva de ventrículo esquerdo, de 66mmHg, foi imediatamente abolido. Controle ecocardiográfico evidencia manutençäo desse resultado, até o momento, dois meses após o procedimento, em correspodência a marcante alívio sintomático.

Alcoolizaçäo dos tumores inoperáveis do esôfago para paliar a disfagia: relato de 10 casos / Alcohol for unoperable esophageal tumors to lessen dysphagia: report of ten cases

Dez pacientes com disfagia causada por tumores esofágicos e da cárdia (nove com carcinomas de células escamosas e um com adenocarcinoma) foram submetidos a tratamento paliativo da disfagia pela injeçäo de álcool absoluto (95(GL), misturado ao azul de metileno a 0,5 por cento, intratumoral. O volume total injetado por via endoscópica variou de 4 a 41ml, em sessöes intervaladas de cinco dias. Avaliamos os resultados por estudo radiológico do esófago, observaçäo endoscópica e segundo os critérios de Bown, modificados. Anteriormente ao início do tratamento, o valor médio da disfagia era de 3,5 na escala de Bown. Ao fim das sessöes, essa média foi de 1,3. Todos os pacientes passaram a deglutir dieta pastosa, semi-sólida ou sólida. O tratamento era repetido quando havia recidiva da disfagia, com intervalo médio de 32,4 dias. Nao houve complicaçöes ou mortalidade em nossa casuística.