The Prevalence of Clinical Features in Patients with Aarskog-Scott Syndrome and Assessment of Genotype-Phenotype Correlation: A Systematic Review.

Aarskog-Scott syndrome is a genetically and clinically heterogeneous rare condition caused by a pathogenic variant in the FGD1 gene. A systematic review was carried out to analyse the prevalence of clinical manifestations found in patients, as well as to evaluate the genotype-phenotype correlation. The results obtained show that clinical findings of the craniofacial, orthopaedic, and genitourinary tract correspond to the highest scores of prevalence. The authors reclassified the primary, secondary, and additional criteria based on their prevalence. Furthermore, it was possible to observe, in accordance with previous reports, that the reported phenotypes do not present a direct relation to the underlying genotypes.

Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study.

BACKGROUND: Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension. METHODS: This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis. RESULTS: Intradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m-2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m-2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m-2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001). CONCLUSION: In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.

Focal osteoporotic bone marrow defect mimicking a mandibular cystic lesion.

An unusual presentation of a focal osteoporotic bone marrow defect (FOBMD) of the mandible mimicking a cystic lesion is documented. A definitive diagnosis could be established only on the basis of the histopathologic evaluation. A 66-year-old Brazilian woman was referred by her dentist for well-defined radiolucency of the mandibular molar region suggesting a cystic lesion of odontogenic origin. The computed tomography scan confirmed that the lesion did not affect the corticals. The biopsy confirmed the diagnosis of FOBMD. The diagnostic difficulty in the current case is obvious, because FOBMD, usually exhibiting an ill-defined radiolucency, is seldom suspected preoperatively when a differential diagnosis is considered for focal well-defined radiolucent areas in the jaws.

Oral myiasis in an elderly patient.

BACKGROUND: Myiasis is the invasion of living tissue of humans and other mammals by eggs or maggots of flies of the order of Diptera. It occurs mainly in the Tropics and is associated with inadequate public and personal hygiene. Oral myiases in an older man appears to be rare. OBJECTIVE: To relate a case of oral myiases in a debilitated older man treated by mechanical removal of the maggots, identifying the adult insect that caused the infestation. METHODS: The diagnosis of oral myiasis was established by the clinical examination and it was detected that the infestation involved only soft tissue and the sinus cavity. The patient was submitted to two mechanical removal of the visible maggots. RESULTS: Total of 110 maggots was removed from the oral cavity of the patient and adult insects was identified as belonging to the Calliphoridae Family, Cochliomyia hominivorax species. The patient died two days after the second procedure by severe systemic complications. CONCLUSIONS: The mechanic removal and the identification of the maggots must be adopted as soon as possible to prevent further tissue damage and bacterial infection in cases of oral myiasis. Special attention should be given to the debilitated old patients that are particularly susceptible to oral myiasis infestation.

Floristic survey of vascular plants of a poorly known area in the Brazilian Atlantic Forest (Flona do Rio Preto, Espírito Santo).

BACKGROUND: The Atlantic Forest is one of the most threatened biomes in the world. Despite that, this biome still includes many areas that are poorly known floristically, including several protected areas, such as the "Floresta Nacional do Rio Preto" ("Flona do Rio Preto"), located in the Brazilian State of Espírito Santo. This study used a published vascular plant species list for this protected area from the "Catálogo de Plantas das Unidades de Conservação do Brasil" as the basis to synthesise the species richness, endemism, conservation and new species occurrences found in the "Flona do Rio Preto". NEW INFORMATION: The published list of vascular plants was based on field expeditions conducted between 2018 and 2020 and data obtained from herbarium collections available in online databases. Overall, 722 species were documented for the "Flona do Rio Preto", 711 of which are native to Brazil and 349 are endemic to the Atlantic Forest. In addition, 60 species are geographically disjunct between the Atlantic and the Amazon Forests. Most of the documented species are woody and more than 50% of these are trees. Twenty-three species are threatened (CR, EN and VU), while five are Data Deficient (DD). Thirty-two species are new records for the State of Espírito Santo. Our results expand the knowledge of the flora of the Atlantic Forest and provide support for the development of new conservation policies for this protected area.

Realistic simulation is associated with healthcare professionals' increased self-perception of confidence in providing acute stroke care: a before-after controlled study.

BACKGROUND: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. OBJECTIVE: To assess the impact of a stroke realistic simulation course on clinicians' self-perception of confidence in the management of acute stroke. METHODS: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees' self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. RESULTS: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. CONCLUSIONS: This stroke realistic simulation course was associated with an improvement on trainees' self-perception of confidence in providing acute stroke care.

Experience with 5% ethanolamine oleate for sclerotherapy of oral vascular anomalies: A cohort of 15 consecutive patients.

PURPOSE: To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing. MATERIALS AND METHODS: We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed. RESULTS: Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n = 7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly. CONCLUSION: The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.

Agitated saline bubble-enhanced ultrasound for the positioning of cuffed, tunneled dialysis catheters in patients with end-stage renal disease.

BACKGROUND: In patients with end-stage renal disease, the use of cuffed, tunneled dialysis catheters for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique. METHODS: From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with end-stage renal disease who required tunneled dialysis catheter placement. RESULTS: The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (±0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (±38) mL/min. The total number of catheter days was 7451, with a mean of 133 days and a range of 46-322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively. CONCLUSION: Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology. Future research should further develop and confirm these initial findings.

Prognostic ability of quick-SOFA across different age groups of patients with suspected infection outside the intensive care unit: A cohort study.

OBJECTIVES: Sepsis identification in older patients is challenging. We evaluated the performance of qSOFA across different age groups of patients with suspected infection outside the intensive care unit (ICU). METHODS: Retrospective cohort in a tertiary hospital in Brazil, from January 2016 to December 2016. Outcomes were hospital mortality, ICU admission and bacteremia. Performance of qSOFA was compared over three age groups: (1) reference: ≤65 years, (2) old: 65 to 79 years and (3) very old: ≥80 years. RESULTS: There were 420 patients in the study, of which 259 (61.7%) were ≤65 years, 80 (19%) were 65 to 79 years and 81 (19.3%) were ≥80 years. Old and very old patients had higher qSOFA scores and lower SIRS scores. Overall, qSOFA ≥2 was associated to hospital mortality [OR (95% CI) = 5.8 (3.3-10.4), p < 0.001], ICU admission [OR (95% CI) = 2.7 (1.6-4.6), p < 0.001] and bacteremia [OR (95% CI) = 3.1 (1.7-5.8), p < 0.001]. Those associations were stronger in old and very old patients. qSOFA and SIRS demonstrated overall AUROCs for hospital mortality of 0.72 and 0.50, respectively. CONCLUSION: qSOFA demonstrated good overall accuracy and was more strongly associated to outcomes in old and very old patients, when compared to younger patients.

Endogenous opioids mediate the hypoalgesia induced by selective inhibitors of cyclo-oxygenase 2 in rat paws treated with carrageenan.

Mechanical hyperalgesia induced in rat paws by carrageenan (250microg) was modified by pre-treatment with three selective inhibitors of cyclo-oxygenase-2 (COX-2); celecoxib, rofecoxib and SC236. These inhibitors raised the nociceptive threshold above the normal, non-inflamed, level, inducing a state of hypoalgesia. Such hypoalgesia was observed in different strains of rat (Holtzman, Wistar and Sprague-Dawley) and after different modes of administration of the COX-2 inhibitor (locally, in the paw, or systemically). A selective inhibitor of COX-1 (SC 560; 1-10mg kg(-1)) decreased hyperalgesia but did not induce hypoalgesia. Pre-treatment with naltrexone (3mg kg(-1)), an opioid receptor antagonist, did not affect carrageenan-induced hyperalgesia but abolished the hypoalgesic effects of COX-2 inhibitors, without diminishing the anti-hyperalgesic effect of indomethacin. In rats made tolerant to the anti-nociceptive effects of morphine, all anti-nociceptive effects of SC236 were abolished but the anti-hyperalgesic effects of indomethacin or SC 560 were unaffected. We conclude that, in our model of inflammatory hyperalgesia, the anti-nociceptive effect of selective COX-2 inhibitors involved the participation of endogenous opioids.

Remoção de fresa odontológica alojada em seio maxilar: relato de caso / Removal of dental burr localized in the maxillary sinus: case report

Introdução: O seio maxilar é um dos seios paranasais, constituído por cavidade óssea preenchida de ar, localizado bilateralmente na maxila, próximo a região dos dentes posteriores. Dada sua localização, morfologia e fisiologia, o assoalho desse seio possui íntima relação com as raízes dos dentes posteriores. Essa estrutura possui uma membrana de revestimento e que pode ser acometida em processos de exodontia de dentes posteriores no qual existe uma relação de proximidade muito evidenciada. O alvéolo pode tornar-se uma via de comunicação entre cavidade oral e seio maxilar. Relato de Caso: O objetivo desse trabalho é descrever o relato de caso de um paciente que foi encaminhado à clínica de cirurgia Bucomaxilofacial para remoção de um fresa alojada no interior do seio maxilar direito que se deslocou durante ato de odontossecção do dente 26. A remoção do fragmento foi realizada pelo alvéolo onde, inicialmente, foi realizada a cirurgia de exodontia. O paciente em questão apresentou evolução satisfatória com ausências de sinais e sintomas de complicações relacionadas ao corpo estranho. Considerações Finais: conhecer a história é fundamental na conduta de tais casos, assim como investigar as possíveis queixas relacionadas ao quadro, por exemplo, os sinais e sintomas de uma sinusite maxilar... (AU)

Introduction: The maxillary sinus is one of the paranasal sinuses, constituted by a bone cavity filled with air, located bilaterally in the maxilla, close to the region of the posterior teeth. Given its location, morphology and physiology, the floor of this sinus is closely related to the roots of the posterior teeth. This structure has a lining membrane and can be affected in processes of extraction of posterior teeth in which there is a very evident relationship of proximity. The alveolus can become a communication route between the oral cavity and the maxillary sinus. Case Report: The purpose of this paper is to describe the case report of a patient who was referred to oral and maxillofacial surgery clinic for removal of a dental burr located inside the right maxillary sinus that was displaced during the tooth 26 extraction. Removal of the fragment was performed through the socket where, initially, extraction surgery was performed. The patient in question presented a satisfactory evolution with no signs and symptoms of complications related. Final considerations: knowing the history is important in management of these cases, as well as investigating possible complaints related to the condition, for example the signs and symptoms of a maxillary sinusitis... (AU)

Realistic simulation is associated with healthcare professionals' increased self-perception of confidence in providing acute stroke care: a before-after controlled study / Simulação realística é associada a aumento na autopercepção de segurança de profissionais de saúde no atendimento a pacientes com acidente vascular cerebral agudo: um estudo antes-depois controlado

ABSTRACT Background: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. Objective: To assess the impact of a stroke realistic simulation course on clinicians' self-perception of confidence in the management of acute stroke. Methods: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees' self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. Results: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. Conclusions: This stroke realistic simulation course was associated with an improvement on trainees' self-perception of confidence in providing acute stroke care.

RESUMO Introdução: Simulações são amplamente utilizadas na educação médica, mas há pouca evidência de sua eficácia no tratamento de pacientes neurocríticos. Como o acidente vascular cerebral agudo (AVC) é uma patologia que requer atendimento imediato, o uso de simulação pode ser uma ferramenta útil no treinamento do manejo desses pacientes. Objetivo: Avaliar o impacto do uso de simulação realística na autopercepção de segurança no atendimento a pacientes vítimas de AVC agudo. Métodos: Estudo antes-depois controlado. No grupo da intervenção, 17 profissionais da área de saúde participaram de um curso de simulação realística de atendimento a pacientes com AVC. Como controles, os participantes foram escolhidos a partir de uma amostra de conveniência composta por 18 participantes do curso Emergency Neurologic Life Support (ENLS) e 20 participantes de um curso de Neurossonologia. Foram respondidos questionários antes e após o curso para avaliar a autopercepção de segurança no atendimento a pacientes vítimas de AVC agudo, variando de 10 a 50 pontos. Foi avaliada a variação entre os resultados pré- e pós-teste, para avaliar a mudança na autopercepção de confiança do trainee no manejo do AVC agudo. Análise multivariada foi realizada para controlar possíveis fatores de confusão. Resultados: Quarenta e seis (83,63%) participantes responderam aos questionários. A pontuação no questionário pós-curso foi maior do que a obtida no questionário pré-curso no grupo de participantes do curso de simulação realística em AVC [mediana do questionário pré-curso: 41,5 (36,7-46,5) e mediana do questionário pós-curso: 47,0 (44,7-48,0); p=0,033]. Essa diferença não foi observada no curso de Neurossonologia [mediana pré-curso (IQR): 46,0 (44,0-47,00), mediana pós-curso (IQR): 46,0 (44,0-47,0); p=0,739] nem no ENLS [mediana pré-curso (IQR): 46,5 (39,0-48,2) mediana pós-curso (IQR): 47,0 (40,2-49,0); p=0,317]. Esses resultados persistiram após ajuste das variáveis. Conclusão: O curso de simulação realística em AVC foi associado a um aumento na autopercepção de segurança dos participantes em atender pacientes vítimas de AVC agudo.

Evaluation of in vitro resistance of different 2.0-mm titanium plates on the mandibular angle sectioning.

OBJECTIVE: The purpose of this study was to compare, by mechanical in vitro testing, a regular 5-hole plate and a long 4-hole plate with a regular 4-hole plate, applied to stabilize a simulated mandibular angle fracture. STUDY DESIGN: The plates from the 2.0-mm titanium-based system were adapted and stabilized passively in the same site in both groups using four screws, 6 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side, first molar at the contralateral side, and between the central incisors. RESULTS: The regular 5-hole plates and longer 4-hole plates were superior to the regular 4-hole plates. Furthermore, no statistically significant difference was found between the regular 5-hole plates and long 4-hole plate. CONCLUSIONS: The length and shape of plates did not interfere with the effectiveness to stabilize the fragments. OBJECTIVE: The purpose of this study was to compare, by mechanical in vitro testing, a regular 5-hole plate and a long 4-hole plate with a regular 4-hole plate, applied to stabilize a simulated mandibular angle fracture.Study design The plates from the 2.0-mm titanium-based system were adapted and stabilized passively in the same site in both groups using four screws, 6 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side, first molar at the contralateral side, and between the central incisors. RESULTS: The regular 5-hole plates and longer 4-hole plates were superior to the regular 4-hole plates. Furthermore, no statistically significant difference was found between the regular 5-hole plates and long 4-hole plate.Conclusions The length and shape of plates did not interfere with the effectiveness to stabilize the fragments.

What is the preferred concentration of ethanolamine oleate for sclerotherapy of oral vascular anomalies?

BACKGROUND: This study compared three different concentrations of EO (1.25%, 2.5% and 5%) for the treatment of oral vascular anomalies (OVAs). MATERIAL AND METHODS: This was a retrospective comparative analysis of patients with OVAs treated with EO. Anomalies smaller than 20 mm were included. The patients were treated with 1.25% (G1), 2.5% (G2), and 5% (G3) and clinical data were obtained. The number of sessions, the final volume and dose of EO were statistically analyzed to verify effectiveness and safety of the treatment. The different concentrations of EO were compared considering the number of sessions, the final volume and total dose of EO. Analysis of covariance (ANCOVA) was used to evaluate the influence of covariates on the outcomes. A p-value < 0.05 was considered significant. RESULTS: Nineteen women and 11 men with a median age of 54 years were included. The OVAs were most frequent in the lip (n = 14) and cheek (n = 9). All lesions exhibited complete clinical healing within 28 days. Patients of G3 required fewer sessions than those of G2 (p = 0.017), a lower final volume compared to the other groups (p < 0.001), and a lower total dose than G1 (p < 0.001). Patients of G1 used a lower total dose than G2 (p = 0.003). CONCLUSIONS: The concentration of 5% EO performed better than 1.25% and 2.5% for sclerotherapy of OVAs measuring up to 20 mm. This preliminary result should be the preferred concentration of EO to provide an effective and safe treatment of OVAs

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Accidents and complications associated to third molar surgeries performed by dentistry students.

OBJECTIVE: The aim of this work is to demonstrate the accidents and complications rates on third molars surgeries performed by senior dentistry students. METHODS: A retrospective study of 122 patient charts submitted to third molars surgeries was done. Patient age, gender, dental in arch position, and accidents/complications were considered with the charts presenting incomplete dates being excluded from the study. After all, 88 patients (210 surgeries) were included. RESULTS: The majority of the patients were female (70.4 %), with the average age of 24 years. Mandibular molars represented more than half of the surgical procedures (56.2 %), with teeth at vertical position the most found (60.3 %). The cases of accidents and complications totalized 10.4 % of all performed procedures, being hemorrhage (1.9 %), root fractures (1.9 %), and maxillary tuberosity fracture (1.9 %) the most found. Suture dehiscence (1.4 %), dry socket (1.4 %), oroantral communications (0.9 %), paresthesia (0.9 %), and infection (0.4 %) were also observed. CONCLUSIONS: Surgeons' inexperience was not considered a determinant factor to modify the rates of accidents and complications at third molars surgeries when compared to previous works developed by experienced surgeons. It is important to highlight the necessity of the students' knowledge of the most adequate treatments of each of the accidents and complications.

Bite force, electromyography, and mandible mobility during the 6-month period after surgical treatment for isolated fractures of the zygomatico-orbital complex.

OBJECTIVE: The aim of this study was to identify the behavior of masticatory muscles after fractures of the zygomatico-orbital complex (ZOC) and subsequent surgical treatment, by using analyses of bite force, electromyography (EMG), and mandible mobility during a 6-month period after surgery. STUDY DESIGN: Five patients with fractured ZOCs treated surgically by using an intraoral approach and fixation exclusively in the region of the zygomaticomaxillary buttress were evaluated. The control group included 12 other patients. During postoperative follow-up, bite force, mandible mobility, and EMG analysis of the masticatory muscles were evaluated. RESULTS: There was an increase in bite force with time, but a decline in EMG activity during the same period. In the mandible mobility analysis, only maximum mouth-opening values increased significantly after the surgical treatment. CONCLUSIONS: The masticatory musculature, according to bite force and EMG, returned to its normal condition by the second month after surgery, and maximum mouth opening was observed after the first month.

Osteopetrosis complicated by osteomyelitis of the maxilla and mandible: light and electron microscopic findings.

This report presents a case of osteopetrosis in a 25-year-old male, which was complicated by the development of osteomyelitis in the maxilla and mandible following traumatic injury and tooth extractions. The osteomyelitis in the mandible was refractory to marginal resection and antibiotic therapy. Partial resection with mandible reconstruction was then carried out. Light and backscattered electron scanning microscopy revealed sclerosis of spongy bone and variations in mineral density of the bone matrix. There was also a prominent periosteal bone formation in regions affected by osteomyelitis. An 18-month follow-up showed absence of active infections in the face and oral structures, with a focal area of bone exposure in the right parasymphysis. However, development of anemia and bone marrow deficiency will likely affect prognosis. The importance of preventive oral health care and dental/periodontal managements in osteopetrosis is emphasized.

Clinical, microscopic and imaging findings associated to McCune-Albright syndrome: report of two cases.

McCune-Albright syndrome is characterized by the triad café-au-lait cutaneous spots, polyostotic fibrous dysplasia and endocrinopathies. This article presents two cases of McCune-Albright syndrome in a middle-aged woman and a young girl. Both patients presented café-au-lait spots on the face and other parts of the body and expansion of the mandible with radiopaque-radiolucent areas with ground-glass radiographic appearance, and were diagnosed as having fibrous dysplasia and endocrine disorders. The patient of Case 1 had fibrous dysplasia on the upper and lower limbs, thorax, face and cranium, early puberty, hyperglycemia, hyperthyroidism and high serum alkaline phosphatase levels. The patient of Case 2 presented lesions on the upper limbs and evident endocrine disorders. In both cases presented in this article, the initial exam was made because of the mandibular lesion. However, a diagnosis of fibrous dysplasia must lead to investigation of the involvement of other bones, characterizing polyostotic fibrous dysplasia, which is manifested in a number of diseases. An accurate differential diagnosis is mandatory to determine the best treatment approach for each case.

Acidentes e complicações associadas à cirurgia dos terceiros molares realizada por alunos de odontologia / Accidents and complications associated to third molar surgeries performed by dentistry students

O objetivo deste artigo é o de demonstrar as taxas de acidentes e complicações nas cirurgias de terceiros molares realizadas por alunos do último ano do curso de graduação em Odontologia. METODOLOGIA: a análise retropectiva do prontuário de 122 pacientes submetidos à extração dos terceiros molares foi realizada. A idade dos pacientes, o gênero, a posição do dente no arco e os acidentes e complicações decorrentes das cirurgias foram considerados. Prontuários com dados incompletos foram excluídos do estudo. Do total, 88 pacientes foram incluídos, totalizando 210 extrações. RESULTADOS: A maioria dos pacientes era do gênero feminino (70,47%), com idade média de 24 anos. Os molares inferiores corresponderam a mais da metade dos procedimentos cirúrgicos (56,2%), senda a posição vertical (60,37%) a mais encontrada. Os casos de acidentes e/ou complicações totalizaram 10,47% dos procedimentos, sendo a hemorragia (2,38%), as fraturas radiculares (1,90%) e as fraturas da tuberosidade maxilar (1,90%) as mais encontradas. Outros acidentes/complicações encontrados foram deiscência de sutura (1,45%), comunicação buco-sinusal (0,95%), parestesia (0,95%), alveolite (0,47%) e infecção (0,47%). CONCLUSÕES: a inexperiência do cirurgião não pôde ser considerada como um fator determinante para o aumento das taxas de acidentes e complicações em exodontias dos terceiros molares, tendo em vista a semelhança dos resultados deste trabalho com estudos desenvolvidos por cirurgiões experientes. É importante salientar a necessidade do conhecimento por parte dos alunos dos tratamentos mais adequados para os diferentes acidentes e complicações encontradas.

The aim of this work is to demonstrate accidents and complications rates on third molars surgeries performed by senior dentistry students. METHODS: a restrospective study of 122 patient charts submitted to third molars surgeries was done. Patient age, gender, dental in arch position, and accidents/complications were considered with the charts presenting incomplete dates being excluded from study. After all, 88 patients (210 surgeries) were included. RESULTS: the majority of the patients were female (70,47%), with average age of 24 years old. Mandibular molars represented more than half of the surgical procedures (56,2%), with teeth at vertical position the most found (60,37%). The cases of accidents and complications totalized 10,47% of all performed procedures, being bleeding (2,38%), root fractures (1,90%) and maxilar tuberosity (1,90%) the most found. Suture dehiscence (1,45%), oro-antral comunications (0,95%), paresthesia (0,95%), alveolitis (0,47%) and infection (0,47%) were also observed. CONCLUSIONS: surgeons inexperience was not considered a determinant factor to modify the rates of accidents and complications at third molars surgeries when compared to previous works developed by experienced surgeons. Is important to highlight the necessity of the students knowledge of the most adequate treatments of each of the accidents and complications.