Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. / Valor de la ecografía ganglionar previa a la biopsia del ganglio centinela en 384 pacientes con melanoma: análisis de coste-efectividad.

BACKGROUND AND OBJECTIVES: Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. MATERIALS AND METHODS: We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. RESULTS: Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00). CONCLUSIONS: Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.

Local effect of titanium implant corrosion: an experimental study in rats.

The aim of this study was to evaluate histologically the biological effect of pitting corrosion and to contribute clinically relevant data on the permanence of titanium metal structures used in osteosynthesis in the body. Commercially pure titanium laminar implants (control) and commercially pure titanium laminar implants with pitting corrosion (experimental) were implanted in the tibiae of rats. At 14 days post-implantation the animals were killed. The tibiae were resected, fixed, radiographed and processed for embedding in methyl methacrylate. Percentage of bone-implant contact and peri-implant bone volume were evaluated. The histological study of the titanium implants submitted to pitting corrosion showed scarce bone-implant contact, it was only present in the areas with no pitting and/or surface alterations. There was a statistically significant lower percentage of bone-implant contact in the experimental group (6%+/-4) than in the control group (26%+/-6) (p<0.001). Products of corrosion in the peri-implant bed, especially around the blood vessels and areas of bone marrow in the metal-tissue interface, were observed. The microchemical analysis of corrosion products revealed the presence of titanium. The adverse local effects caused by pitting corrosion suggest that titanium plates and grids should be used with caution as permanent fixation structures.

A new coumarin from the fruits of Coutarea hexandra.

A new 5-O-beta-D-glucopyranosyl-4-(4-hydroxyphenyl)-7-methoxy-2H-chromen-2-one (1), together with four known compounds, one coumarin, 5-O-beta-D-galactopyranosyl-4-(4-hydroxyphenyl)-7-methoxy-2H-chromen-2-one (2) and three cucurbitacins, 23,24-dihydrocucurbitacin F (3), 23,24-dihydro-25-acetylcucurbitacin F (4) and 2-O-beta-D-glucopyranosyl-23,24-dihydrocucurbitacin F (5) have been isolated and characterised from the ethanol extract of Coutarea hexandra fruits. Their structures have been established by spectroscopic analysis (NMR and MS). Interpretation of the HMQC, HMBC, COSY-45 and NOESY experiments permitted us to establish stereochemistry of the natural products. All compounds were tested in cytotoxicity assays against the breast (MCF-7), lung (H-460), and central nervous system (SF-268) human cancer cell lines.

Analysis of inherited genetic variants in ret proto-oncogene of Brazilian patients with apparently sporadic medullary thyroid carcinoma.

Mutations in different exons of ret proto-oncogene are responsible for the development of medullary thyroid carcinoma (MTC). The mutations can occur as sporadic or as part of multiple endocrine neoplasia (MEN) type 2 hereditary syndromes. Here we report the first focused study of sporadic MTC in Brazilian patients regarding clinical and molecular analysis of ret proto-oncogene. Our study seeks to estimate the risk of hereditary MTC cases among apparently sporadic cases in a Brazilian population and describe ret genetic variants in their germinative lineage. Germinative sequence variants were screened by DNA sequencing and denaturing gradient gel electrophoresis (DGGE) analysis of exons 10, 11, 13, 14, 15, and 16 of 24 Brazilian patients with apparently sporadic MTC. We identified 1 inherited case of 24 (4%) patients with apparently sporadic MTC. Polymorphisms for the ret proto-oncogene coding region were identified in codon 769 of exon 13 (LeuCTT--> LeuCTG) at a frequency of 13% (3/24) and in codon 904 of exon 15 (SerTCC--> SerTCG) at a frequency of 16.6% (4/24). The observed frequency (4%) of inherited disease among apparent sporadic MTC strengthens routine application of ret proto-oncogene germinative DNA screening in all cases of apparently sporadic MTC ascertained at Brazilian cancer hospitals.

Taponamiento Cardiaco: cuando el corazón se encuentra bajo presión / Cardiac tamponade: when the heart is under pressure

BACKGROUND: Cardiac tamponade is a medical emergency that occurs when fluid accumulates in the pericardial space, its prompt diagnosis and treatment can prevent a fatal outcome. OBJECTIVES: We describe a case of cardiac tamponade in a medicine Ward and its subsequent resolution. CLINICAL CASE: 56-year-old male patient with dyspnoea and edematous síndrome, managed with partial response depletive therapy. Echocardiographic study reveals a large pericardial effusion with signs of cardiac tamponade. Inmediate management with ultrasound-guided pericardiocentesis and subsequent surgical resolution. DISCUSSION: The knowledge of the clinical-hemdynamic manifestations and their subsequent pathophysiological background are important in the diagnostic suspicion and management considerations. Echocardiography is a critical component for the final diagnosis, since given its sensitivity and specificity it allows to complete the characterization of the pericardial effusion. In addition, it contributes to reducing the morbidity associated with its drainage.

A quantitative method to evaluate corrosion products in tissues.

The use of odontological or orthopedic metal implants requires the availability of techniques to estimate tissue response to the corrosion processes. In previous experimental studies we showed the deposition of corrosion products not only locally (Olmedo et al., Implant Dent 2003; 12: 75-80) but also systemically (Olmedo et al., J Mater Sci: Mater in Medic 2002; 13: 793-796) in organs such as liver, spleen and lung. The aim of the present study was to propose a method to quantitatively assess the tissue deposits of the corrosion products of the materials used to manufacture implants. The samples (liver and lung) were embedded in paraffin, and the histological sections were submitted to thickness standardization. The quantitative evaluation of the deposits was performed in an MPM-800 (Carl Zeiss)* microscope. The light microscopy images were digitalized and then analyzed employing the DNA-IBAS-Kontron software that allows for the identification and evaluation of cells loaded with corrosion products (objective 20x). The following end-points were assessed: total field area, number of deposits of corrosion products, partial and total area of the deposits, and the ratio between volume of the deposits and tissue volume. The method proposed serves to quantitatively evaluate, at light microscopy level, the deposition of corrosion products in tissues.

Influence of age and gender on peri-implant osteogenesis. Age and gender on peri-implant osteogenesis.

Among the local and systemic factors affecting bone repair, great interest is focused on age and gender. The aim of this work was to perform a histomorphometric evaluation of peri-implant bone healing response in male and female rats aged 1 and 3 months. Forty Wistar rats were i.p. anesthetized with xylazine and ketamine. A c.p. Ti implant (Implant Vel, Buenos Aires-Argentina) was placed in the right tibia following the method described by Cabrini et al. (Implant Dent 1993; 2:264-267). Group I: (GI, n = 10) female rats aged 1 month; Group II: (GII, n = 10) female rats aged 3 months; Group III: (GIII, n = 10) male rats aged 1 month; Group IV: (GIV, n = 10) male rats aged 3 months. All the animals were killed by ether overdose 30 days post-implantation. The tibiae were resected, radiographed and embedded in methyl-methacrylate. Ground sections perpendicular to the longer axis of the tibia were obtained and stained with toluidine blue. Percentage of osseointegration and peri-implant bone tissue volume were evaluated. No differences in peri-implant bone tissue histology were observed among groups. No statistically significant differences in peri-implant bone volume and percentage of osseointegration were observed between GII (adult females) and GIV (adult males). Peri-implant bone volume and percentage of osseointegration were markedly greater in GIV (adult males) than in GIII (young males) (14 +/- 1 mm2 and 8 +/- 2 mm2) p < 0.01 and (49 +/- 6% and 24 +/- 9%) p < 0.01 respectively. Using this experimental model, differences in peri-implant osteogenesis (bone volume and percentage of osseointegration) associated to gender were only observed in the young rats, and differences associated to age were found between the groups of males.

An experimental model to study implant corrosion.

Corrosion phenomena would appear to play a decisive role in metallic implant long term behaviour. This study presents a method to correlate results obtained in "in vivo" and "in vitro" studies on materials used for metallic implants. Samples of titanium and copper immersed in saline solution (pH 7.4 and 5.2) were used for the "in vitro" study. Implants of these same materials were placed in rat tibiae following the method previously described by Cabrini et al. The animals were killed 14 days post-implantation, the tibiae were resected, radiographed and embedded in acrylic resin. Polarization curves revealed high corrosion in copper implants and low corrosion in titanium implants. It is important to point out that the titanium samples suffered slightly higher corrosion when immersed in a lower pH medium (pH 5.2), as in chronic inflammatory processes. A passive film was found on titanium samples as opposed to the strong corrosion observed in the copper implants. Microscopy revealed osseointegration around titanium implants and a severe inflammatory reaction with abscesses surrounding the copper implants. The method presented herein would allow to correlate "in vivo" and "in vitro" studies on corrosion in different implant materials and establish their relation with cell response.

Reactive lesions of peri-implant mucosa associated with titanium dental implants: a report of 2 cases.

The aim of this study was to report 2 novel clinical cases of reactive lesions of the peri-implant mucosa associated with titanium dental implants where metal-like particles were observed histologically. In both cases, the lesions were diagnosed as epulis, based on clinical evidence. Extirpation biopsies were carried out. Case 1 was diagnosed as pyogenic granuloma and case 2 as peripheral giant cell granuloma. The presence of metal-like particles in the tissues suggests that the etiology of the lesions might be related to the corrosion process of the metal structure. This is the first case of pyogenic granuloma to be reported in association with dental implants. All clinical cases of soft tissue lesions associated with implants should be reported to contribute to the understanding of the etiology and pathogeny of these lesions.

Desempenho e características da carcaça de novilhos terminados em pastejo rotacionado ou em confinamento / Performance and carcass characteristics of steers finished in rotational grassing or feedlot

Foram avaliados o desempenho e as características de carcaça de 36 novilhos Brahman (Bh), Brangus (Bg) e Hereford adaptado (He), terminados em pastejo com suplementação (PSu) ou em confinamento (Conf). Os animais foram abatidos quando apresentavam espessura de gordura maior do que 4mm. Na dieta do Conf, a relação volumoso:concentrado foi de 60:40 (com base na matéria seca), continha 13 por cento de proteína bruta (PB) e 62 por cento de nutrientes digestíveis totais (NDT). O capim-mombaça continha, em média, 7 por cento de PB e 54 por cento de NDT, e o suplemento 24 por cento de PB e 76 por cento de NDT. Foi observada diferença (P<0,05) no sistema de terminação para o ganho de peso médio diário, com 1,200kg/cab/dia para Conf e 0,675kg/cab/dia para Psu. Os novilhos Bh e Bg pesaram, em média, 445,8kg, e o rendimento da carcaça quente foi de 58,4 por cento, valores maiores que os 399,1kg e 55,4 por cento obtidos pelos animais He. A área de olho de Longissimus foi maior para os animais Bg, 76,42cm². A maciez, 3,71 vs 4,89, e a espessura de gordura subcutânea, 4,64 vs 3,39, foram melhores nos animais terminados em Conf do que nos animais em Psu, respectivamente.

The productive performance and carcass of the 36 Brahman (Bh), Brangus (Bg) and adapted Hereford (He) steers finished on feedlot (FD) or on rotational grazing with supplementation system (GS) were evaluated. The animals were slaughtered when the subcutaneous fat thickness was over 4mm. The feedlot diet had a forage: concentrate of 60:40 (in dry matter) 13 percent crude protein (CP), 62 percent of NDT. The mombaça gras CP level was 7 percent and 54 percent of NDT. The supplement had supplied 24 percent of CP and 76 percent of NDT. A significant difference was observed for the average daily gain, being 1,200kg/head/day for FD steers and 0.675kg/head/day for GS steers. The effect of breed on slaughter weight was observed, being 445.8kg for Bh and Bg and 399.19kg for He. The hot dressing percentage was higher for Bh and Bg than for He, 58.4 percent vs 55.4 percent. The rib eye area was higher for Bg, 76.42cm² and tenderness measured by the shear force was lower for FD steers, at 3.71 than for GS steers, at 4.89. The subcutaneous fat thickness was higher for FD steers, at 4.64 than for GS steers, at 3.39mm.

Histomorphometric study of bone healing around laminar implants in experimental diabetes.

The aim of this study was to evaluate the effects of experimental diabetes on the healing period leading to osseointegration. Wistar rats were injected with a single dose of streptozotocin (STZ); body weight and food intake were assessed every 48 hours. On days 2, 12, 26, and 42 post-STZ, glucemia, plasma hemoglobin, and urea were determined. Twelve days post-STZ, a titanium laminar implant was placed in the right tibia of each rat. Two groups of 20 rats each were killed on days 14 and 30 postimplantation, respectively. Results (ANOVA test) showed STZ-treated rats to have 1) a significant decrease in body weight; 2) an increase in food intake; 3) normal hemoglobin and plasma urea values; 4) a significant increase in glucemia; and 5) a decrease in tibiae length. Microscopic evaluation 14 days postimplantation revealed the presence of woven bone, and, at 30 days, laminar bone was in contact with the implant. Our findings show that, in this model of periimplant bone repair and under the experimental conditions stated herein, STZ-induced diabetes retards periimplant bone healing.

Plasmocitoma ganglionar primario y otras infiltraciones plasmocitarias ganglionares / Extramedullary plasmocytoma and other lymph node plasmocytomas

Se presenta un paciente de 48 años, portador de Plasmocitoma extramedular ganglionar primario (PEGP) inguinal con los propósitos de alertar sobre esta forma inusual de neoplasia de células plasmáticas y de revisar las diferencias existentes con otras infiltraciones plasmocitarias ganglionares.

Influence of age and gender on peri-implant osteogenesis. Age and gender on peri-implant osteogenesis

Among the local and systemic factors affecting bone repair, great interest is focused on age and gender. The aim of this work was to perform a histomorphometric evaluation of peri-implant bone healing response in male and female rats aged 1 and 3 months. Forty Wistar rats were i.p. anesthetized with xylazine and ketamine. A c.p. Ti implant (Implant Vel, Buenos Aires-Argentina) was placed in the right tibia following the method described by Cabrini et al. (Implant Dent 1993; 2:264-267). Group I: (GI, n = 10) female rats aged 1 month; Group II: (GII, n = 10) female rats aged 3 months; Group III: (GIII, n = 10) male rats aged 1 month; Group IV: (GIV, n = 10) male rats aged 3 months. All the animals were killed by ether overdose 30 days post-implantation. The tibiae were resected, radiographed and embedded in methyl-methacrylate. Ground sections perpendicular to the longer axis of the tibia were obtained and stained with toluidine blue. Percentage of osseointegration and peri-implant bone tissue volume were evaluated. No differences in peri-implant bone tissue histology were observed among groups. No statistically significant differences in peri-implant bone volume and percentage of osseointegration were observed between GII (adult females) and GIV (adult males). Peri-implant bone volume and percentage of osseointegration were markedly greater in GIV (adult males) than in GIII (young males) (14 +/- 1 mm2 and 8 +/- 2 mm2) p < 0.01 and (49 +/- 6

) p < 0.01 respectively. Using this experimental model, differences in peri-implant osteogenesis (bone volume and percentage of osseointegration) associated to gender were only observed in the young rats, and differences associated to age were found between the groups of males.

A quantitative method to evaluate corrosion products in tissues

The use of odontological or orthopedic metal implants requires the availability of techniques to estimate tissue response to the corrosion processes. In previous experimental studies we showed the deposition of corrosion products not only locally (Olmedo et al., Implant Dent 2003; 12: 75-80) but also systemically (Olmedo et al., J Mater Sci: Mater in Medic 2002; 13: 793-796) in organs such as liver, spleen and lung. The aim of the present study was to propose a method to quantitatively assess the tissue deposits of the corrosion products of the materials used to manufacture implants. The samples (liver and lung) were embedded in paraffin, and the histological sections were submitted to thickness standardization. The quantitative evaluation of the deposits was performed in an MPM-800 (Carl Zeiss)* microscope. The light microscopy images were digitalized and then analyzed employing the DNA-IBAS-Kontron software that allows for the identification and evaluation of cells loaded with corrosion products (objective 20x). The following end-points were assessed: total field area, number of deposits of corrosion products, partial and total area of the deposits, and the ratio between volume of the deposits and tissue volume. The method proposed serves to quantitatively evaluate, at light microscopy level, the deposition of corrosion products in tissues.

An experimental model to study implant corrosion

Corrosion phenomena would appear to play a decisive role in metallic implant long term behaviour. This study presents a method to correlate results obtained in [quot ]in vivo[quot ] and [quot ]in vitro[quot ] studies on materials used for metallic implants. Samples of titanium and copper immersed in saline solution (pH 7.4 and 5.2) were used for the [quot ]in vitro[quot ] study. Implants of these same materials were placed in rat tibiae following the method previously described by Cabrini et al. The animals were killed 14 days post-implantation, the tibiae were resected, radiographed and embedded in acrylic resin. Polarization curves revealed high corrosion in copper implants and low corrosion in titanium implants. It is important to point out that the titanium samples suffered slightly higher corrosion when immersed in a lower pH medium (pH 5.2), as in chronic inflammatory processes. A passive film was found on titanium samples as opposed to the strong corrosion observed in the copper implants. Microscopy revealed osseointegration around titanium implants and a severe inflammatory reaction with abscesses surrounding the copper implants. The method presented herein would allow to correlate [quot ]in vivo[quot ] and [quot ]in vitro[quot ] studies on corrosion in different implant materials and establish their relation with cell response.