The striatum and pain modulation.

The aim of this review was to give a general aspect of the sensorial function of the striatum related to pain modulation, which was intensively studied in our laboratory. We analyse the effect of electrical and chemical stimulation of the striatum on the orofacial pain, especially that produced by tooth pulp stimulation of the lower incisors. We demonstrated specific sites within the nucleus which electrical or chemical stimulation produced inhibition of the nociceptive jaw opening reflex. This analgesic action of the striatum was mediated by activation of its dopamine D(2) receptors and transmitted through the indirect pathways of the basal ganglia and the medullary dorsal reticular nucleus (RVM) to the sensorial nuclei of the trigeminal nerve. Its mechanism of action was by inhibition of the nociceptive response of the second order neurons of the nucleus caudalis of the V par.

A CLINICAL-PATHOLOGICAL CORRELATION IN THE DIAGNOSIS OF BREAST SARCOMA / Correlação clinicopatológica no diagnóstico de sarcoma de mama

Breast sarcomas are rare tumors that are difficult to diagnose. They are characterized by a mobile and painless mass with accelerated growth. This neoplasm represents less than 1% of all breasts malignancies and less than 5% of all soft tissues sarcomas. The present publication reports the case of a 78 year old patient, who was referred to the Hospital da Cidade de Passo Fundo's Mastology Ambulatory due to a suspicious mass occupying almost the entire right breast (BI-RADS®5). The diagnosis of breast sarcoma was made through the correlation between a clinical evaluation and an anatomopathological exam, and was supplemented by an immunohistochemistry and oncologic evaluation. The patient developed lung and liver metastasis three months after surgery. This paper aimed to report an unusual case of a breast tumor and the difficulty in performing its diagnosis, even after surgery. In the end, a multidisciplinary evaluation was needed.

Sarcomas de mama são tumores raros e de difícil diagnóstico, que se apresentam como uma massa indolor, móvel e de crescimento acelerado. Essa neoplasia representa menos de 1% de todas as malignidades da mama e menos de 5% de todos os sarcomas de tecidos moles. Relata-se nesta publicação o caso de uma paciente de 78 anos, encaminhada ao Ambulatório de Mastologia do Hospital da Cidade de Passo Fundo em razão de uma massa suspeita ocupando quase a totalidade da mama direita (BI-RADS®5), que teve diagnóstico de sarcoma de mama, o qual foi obtido por meio da correlação entre avaliação clínica, exame anatomopatológico complementado por estudo imuno-histoquímico e avaliação oncológica. A paciente evoluiu com metástase pulmonar e hepática três meses após a intervenção cirúrgica. O objetivo deste trabalho foi relatar um caso inusitado de tumor de mama e a dificuldade em realizar o diagnóstico, mesmo após intervenção cirúrgica, tendo sido necessária uma avaliação multidisciplinar.

The diagnosis of GH deficiency in obese patients: a reappraisal with GHRH plus arginine testing after pharmacological blockade of lipolysis.

BACKGROUND: The diagnosis of GH deficiency (GHD) in obese patients is complicated by the reduced GH secretion associated with overweight. A GH response to GHRH+arginine lower than 4.2 microg/l is currently considered indicative of GHD in obesity. The aim of the study was to investigate the effect of acute pharmacological blockade of lipolysis on the GH response to GHRH+arginine in obese patients. PATIENTS AND METHODS: Two groups of patients were studied: 12 obese patients with proven GHD and 14 patients with essential obesity. On separate occasions, two tests were carried out in each patient: GHRH+arginine and GHRH+arginine preceded by acipimox. RESULTS: The mean GH peak after GHRH+arginine was significantly lower in hypopituitary patients than in subjects with essential obesity. Acipimox significantly increased the mean GH response in patients with essential obesity, but not in hypopituitary subjects. All hypopituitary patients and 7/14 patients with essential obesity displayed GH peaks lower than 4.2 microg/l after GHRH+arginine: the GH response to the test increased after acipimox pretreatment in five of these seven essentially obese subjects. After acipimox administration, free fatty acids (FFAs) significantly fell in both groups with comparable mean absolute decreases. All IGF1 values were normal in both groups of subjects. CONCLUSIONS: Our study has demonstrated that the acipimox-induced acute reduction of circulating FFA levels increases mean somatotropin response to GHRH+arginine in patients with essential obesity, whereas it has no effect in hypopituitary subjects. The current criterion for the diagnosis of GHD in obese patients may be misleading. Indeed, subjects affected by third degree obesity, like most of our patients, may be erroneously classified as really GH-deficient and started on an expensive unjustified treatment. It appears therefore that the current criteria for the diagnosis of GHD in obesity should be reconsidered in the light of further studies also taking into account different body mass index groups.