Tumor nasal de músculo liso de comportamiento maligno incierto: informe de un caso / Nasal smooth muscle tumor of uncertain malignant potential: A case report

Los tumores de músculo liso que no pueden ser clasificados según su histología como leiomiomas o leiomiosarcomas se denominan tumores de músculo liso de comportamiento maligno incierto. La localización nasal de estos tumores es muy infrecuente y la extensión adecuada de la cirugía para tratar estas neoplasias no está bien definida. Se describe el caso clínico de una adolescente de 16 años, que consultó por padecer un tumor de aspecto vascular en la cavidad nasal derecha y que fue tratada con éxito mediante cirugía intranasal. El diagnóstico histológico fue tumor de músculo liso de comportamiento maligno incierto. Por la rareza de estas neoplasias, su infrecuente localización nasal y la falta de evidencia que soporte cuál debe ser la extensión de la cirugía, es relevante la descripción y discusión del caso clínico.

Smooth muscle tumors that cannot be histologically classified as leiomyomas or leiomyosarcomas are defined as smooth muscle tumors of uncertain malignant potential. The location of these tumors in the nose is very rare, and the appropriate surgical extent to manage these neoplasms has not been adequately defined. Here we describe the case of a 16-year-old female adolescent who consulted due to a vascular-like tumor in the right nasal cavity who was successfully treated with intranasal surgery. The histological diagnosis was smooth muscle tumor of uncertain malignant potential. Given that these neoplasms are rare, the uncommon location in the nose, and the lack of evidence indicating the extent of surgery, it is relevant to describe and discuss this clinical case.

Reconstrução mamária com TRAM: avaliação tomográfica abdominal / Breast reconstruction with TRAM: abdominal tomographic evaluation

Introdução: O retalho transverso do músculo reto abdominal (TRAM) é um método de reconstrução mamária com bons resultados estéticos e dispensa o uso de próteses de silicone para melhor contorno corporal. Foi originalmente descrito por Holmstrom em 1979, como uma elipse de pele e gordura com base em um músculo isolado no seu pedículo vascular. A reconstrução sistematizada do defeito da parede instalado após a transposição do retalho com o uso de tela de polipropileno foi descrita em estudo prévio por Cunha. O artigo tem como objetivo avaliar as alterações na parede abdominal, após a sistematização da colocação da tela de polipropileno durante a cirurgia de reconstrução com TRAM. Método: É um trabalho de coorte retrospectivo que avalia as possíveis alterações da parede abdominal de pacientes submetidos ao retalho TRAM com tomografia computadorizada de abdome pré e pós-operatórias. Resultados: Foi evidenciada uma redução do tamanho da cavidade abdominal de, em média, 14,5% e 14,2% na espessura da parede abdominal submetidas ao TRAM. A maior redução da espessura da parede abdominal foi de um paciente submetido ao retalho bipediculado, com 50,7%. As complicações apresentadas foram hérnia umbilical, seroma tardio, fibrose peritela e granuloma de fio. Conclusão: Nesse estudo, a tomografia após a cirurgia demonstrou a redução no volume da cavidade abdominal e espessura da parede abdominal, o que não influenciou estatisticamente no aparecimento de hérnia abdominal, abaulamentos, extrusão da malha ou outras deformidades.

Introduction: The transverse rectus abdominis muscle flap (TRAM) is a method of breast reconstruction with good aesthetic results and does not require the use of silicone implants for better body contouring. It was originally described by Holmstrom in 1979 as an ellipse of skin and fat based on an isolated muscle on its vascular pedicle. The systematic reconstruction of the wall defect installed after flap transposition using polypropylene mesh was described in a previous study by Cunha. The article aims to evaluate changes in the abdominal wall, after the systematization of polypropylene mesh placement during TRAM reconstruction surgery. Method: This is a retrospective cohort study that evaluates possible changes in the abdominal wall of patients undergoing the TRAM flap with preand postoperative abdominal computed tomography. Results: A reduction in the size of the abdominal cavity of, on average, 14.5% and 14.2% in the thickness of the abdominal wall subjected to TRAM was evidenced. The greatest reduction in abdominal wall thickness was in a patient who underwent a bipedicled flap, with 50.7%. The complications presented were umbilical hernia, late seroma, perithellal fibrosis, and thread granuloma. Conclusion: In this study, tomography after surgery demonstrated a reduction in the volume of the abdominal cavity and thickness of the abdominal wall, which did not statistically influence the appearance of abdominal hernia, bulging, mesh extrusion, or other deformities.

Experience of Medicinal Insects for Gynaecological Diseases / 中医杂志

It is believed that all kinds of gynaecological diseases are mostly related to deficiency and stagnation of qi and blood. Medicinal insects are good at running and scurrying， with the effectiveness of activating blood circulation and dispelling blood stasis， moving qi and relieving pain， searching and dredging collaterals， attacking hardness and dissipating mass， and purging foetus and resolving mass， etc. Appropriate prescriptions can enhance the effectiveness of the formula in eliminating blood stasis and eliminating stagnation. In the treatment of menstrual disorders， chronic pelvic inflammatory disease， uterine cavity disease， incomplete miscarriage， ectopic pregnancy， and other gynaecological diseases， medicinal insects including Quanxie （Scorpio）， Wugong （Scolopendra）， Tubiechong （Eupolyphaga/Steleophaga）， Jiuxiangchong （Coridius chinenses）， Shuizhi （Hirudo）， Mangchong （Tabanus）， Dilong （Pheretima） and other insects for medicinal purposes could be used， and the self-prescribed empirical formulas such as Sanhuang Decoction （三黄汤）， Hongteng Decoction （红藤汤）， Penning Decoction （盆宁方）， Shapei Decoction （杀胚方）， and Gongwaiyun Decoction （宫外孕方） and so on， were all applied medicinal insects and showed effective in clinic.

Oral health of an indigenous population in northeastern Brazil: a cross-sectional Study of the Fulni-ô ethnic group

ABSTRACT BACKGROUND: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil. OBJECTIVES: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil. DESIGN AND SETTING: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations. METHODS: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student's t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%. RESULTS: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy. CONCLUSIONS: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.

Continuous Wave of Condensation Improves the Filling of Curved Canals: a Micro-CT Study / La condensación de onda contínua mejora el selle de canales curvos: un estudio de micro-CT

Abstract The aim of this study was to compare the filling capacity in curved root canal using a new continuous wave of condensation technique (Termo Pack II, Easy Dental Equipments, Brazil) or lateral compaction. The percentage of voids in the filling of mesial root canals of mandibular molars was assessed by micro-computed tomography (micro-CT). Mesial root canals (n=24) of mandibular molars with a degree of curvature between 20° and 40° were prepared using rotary system (ProDesign Logic, Easy, Brazil) up to #35, .05 taper. The root canals were filled by using the continuous wave of condensation system or lateral compaction and AH Plus sealer (n=12). Scanning at 9 µm was performed after preparation and after filling by using micro-CT SkyScan 1176. The volumetric percentage of filling material and voids (total length and in each root canal third) were calculated. Data were analyzed using ANOVA/ Tukey and Student's t tests (α=0.05). Before the filling techniques, the root canals volume after preparation was similar (p>0.05). The root canals filled by the continuous wave of condensation technique presented the lowest percentage of voids, and the greatest percentage of filling material in total length and thirds (cervical, middle and apical) (p<0.05). Both techniques were not able of completely filling the root canals. The continuous wave of condensation technique Termo Pack II promoted better root canal filling in curved root canals, when compared with lateral compaction.

Resumen El objetivo de este estudio fue comparar la capacidad de obturación en conductos radiculares curvos utilizando una nueva técnica de condensación de onda continua (Termo Pack II, Easy Dental Equipments, Brasil) vs compactación lateral. El porcentaje de brechas en la obturación de los conductos radiculares mesiales de los molares mandibulares se evaluó mediante microtomografía computarizada (micro-CT). Se prepararon conductos radiculares mesiales (n=24) de molares mandibulares con un grado de curvatura entre 20° y 40° utilizando un sistema rotatorio (ProDesign Logic, Easy, Brasil) al #35, conicidad 0,05. Los conductos radiculares se obturaron utilizando un sistema de condensación de onda contínua o compactación lateral y cemento AH Plus (n=12). Se realizó un escaneo de 9 µm después de la preparación y después de la obturación usando el micro-CT SkyScan 1176. Se calculó el porcentaje volumétrico de material de obturación y vacíos (longitud total y en cada tercio del conducto radicular). Los datos se analizaron utilizando las pruebas ANOVA/Tukey y t de Student (α=0,05). Antes de las técnicas de obturación, el volumen de los conductos radiculares después de la preparación fue similar (p>0,05). Los conductos radiculares obturados con la técnica de condensación por onda contínua presentaron el menor porcentaje de vacíos y el mayor porcentaje de material de obturación en longitud total y en tercios (cervical, medio y apical) (p<0,05). Ambas técnicas no fueron capaces de llenar completamente los conductos radiculares. La técnica de condensación de onda contínua Termo Pack II promovió un mejor relleno del conducto radicular en conductos radiculares curvos en comparación con la compactación lateral.

Clasificación alternativa para terceros molares / Alternate classification for third molars

Resumen Introducción En el presente artículo se describen las diferentes clasificaciones de terceros molares retenidos y se recomienda una nueva clasificación que permite predecir la dificultad para la remoción respectiva. Objetivo Lo anterior tiene la finalidad servir de guía para que los estudiantes o profesionales en Odontología utilicen como clasificador el grado de dificultad de terceras molares, el cual se constituiría en un instrumento de medición del tiempo necesario para remover la pieza dental, los pasos necesarios para dicha remoción y la morbilidad relacionada.

Abstract Introduction Different literaly classifications of impacted wisdom teeth will be shown in adddition to a new categorization wich predicts their removal difficulty. Aim The goal of the above statement is to be used as a guide for students and/or collegues to classify the degree of difficulty as a tool to measure the needed time to extract the tooth and the necessary steps to remove it and the related morbility.

Trophic morphology and diet of the endangered fish Tlaloc hildebrandi (Cyprinodontiformes: Profundulidae) / Morfología trófica y dieta de Tlaloc hildebrandi (Cyprinodontiformes: Profundulidae), especie amenazada de extinción

Abstract Introduction: Tlaloc hildebrandi is a freshwater killifish, endemic to Southern Mexico and under threat of extinction; the knowledge of the trophic morphology and diet is needed by conservation managers. Objective: To analyse and describe the anatomy of the visceral skeleton, visceral musculature, digestive tract and its adjoining glands of T. hildebrandi; as well as its diet. Methods: We performed the trophic anatomy on 20 adult specimens of both sexes, through manual dissection; as well as gut content analysis in 60 individuals to describe the diet. Results: As notable characters of the visceral skeleton of T. hildebrandi we found the posterior notch of the premaxillary, the presence of the "coronoid cartilage", the tricuspid shape of the gill rakers of the first branchial arch, and the presence of the coronomeckelian bone; some outstanding characters of the visceral musculature are the origin of the retractor dorsalis muscle from the first four vertebral centra, and the division of the pharyngoclavicularis externus muscle into two sections. The notable characters of the digestive tube are the absence of stomach and pyloric caeca, and the presence of the "intestinal valve". Insects (IVI = 66.6 %) and ostracods (13 % IVI) were the dominant prey items of the Tlaloc hildebrandi diet; larvae and adults of the family Chironomidae were the most dominant insects in the diet (53 % IVI). Conclusions: The organization of the digestive system of T. hildebrandi corresponds to the general morphologic pattern of the Cyprinodontiformes; however, we register as new information for these fish, the presence of the "coronoid cartilage" and the "intestinal valve". The structures of the trophic morphology and the components of the diet, confirms us that T. hildebrandi is a carnivorous-insectivorous fish.

Resumen Introducción: Tlaloc hildebrandi es un killi de agua dulce, endémico del sur de México y bajo amenaza de extinción; el conocimiento de la morfología trófica y la dieta son necesarios para los administradores de la conservación. Objetivo: Analizar y describir la anatomía del esqueleto visceral, la musculatura visceral, el tracto digestivo y las glándulas adyacentes de T. hildebrandi; así como los componentes de su dieta. Métodos: Mediante la técnica del descarnado manual, realizamos la descripción de la anatomía trófica en 20 especímenes adultos de ambos sexos, y el análisis del contenido estomacal en 60 individuos para describir la dieta. Resultados: Como caracteres sobresalientes del esqueleto visceral de T. hildebrandi está la escotadura posterior del premaxilar, la presencia del "cartílago coronoides", la forma tricúspide de las branquiespinas del primer arco branquial y la presencia del hueso coronomeckeliano; como caracteres de la musculatura visceral sobresalen el origen del músculo retractor dorsalis de los cuatro primeros centros vertebrales, y la división del músculo pharyngoclavicularis externus en dos secciones. Los caracteres notables del tubo digestivo son la ausencia de estómago y de ciegos pilóricos y la presencia de la "válvula intestinal". Los insectos (IVI = 66.6 %) y ostrácodos (13 % IVI) fueron los componentes dominantes de la dieta de T. hildebrandi; particularmente las larvas y adultos de la familia Chironomidae fueron los insectos más abundantes en la dieta (53 % IVI). Conclusiones: La organización del sistema digestivo de T. hildebrandi corresponde al patrón morfológico general de los Cyprinodontiformes, sin embargo, se registra como nueva información para estos peces, la presencia del cartílago coronoides y la válvula intestinal. Las estructuras de la morfología trófica y los componentes de la dieta nos confirman que T. hildebrandi es un pez carnívoro-insectívoro.

A relevância da odontologia na Síndrome Treacher Collins: relato de caso / The relevance of dentistry in Treacher Collins Syndrome: case report

Treacher Collins também chamada de disostose mandibulofacial, é uma alteração genética dominante rara caracterizada pela má-formação dos ossos e tecidos da face. É uma síndrome crânio-facial que apresenta alterações bilaterais e simétricas de estruturas originadas do primeiro e segundo arcos branquiais. A maioria dos casos possui transmissão autossômica dominante e expressividade variável. O objetivo do presente estudo é realizar um relato de caso sobre o impacto do tratamento odontológico na qualidade de vida do paciente portador de Treacher Collins. Paciente, 39 anos, sexo feminino compareceu a uma clínica odontológica em Belo Horizonte, com a queixa principal de falhas dentárias e sensibilidade. Durante a anamnese a paciente relatou ter a STC, durante o exame clínico extraoral verificou a presença de hipoplasia malar e mandibular, malformação dos pavilhões auriculares com perda auditiva, obliquidade e coloboma palpebral inferior. Ao exame intraoral observou ser classe II de Angle, ausência dos dentes 11, 12, 13, 21 e 22 e extrusão do dente 41 e recessão gengival e periodontite estágio I grau A. Após exames de periodontograma e complementares foi realizado uma raspagem nas áreas com profundidade de sondagem maior que 3mm, frenectomia labial inferior, aplicação de laser para sensibilidade, enxerto gengival e colocação de prótese parcial removível. A paciente ao final do tratamento relatou ter se sentido realizada e contente com a sua conclusão, ela foi encaminhada ao Sistema único de Saúde para realizar as cirurgias para corrigir as alterações crânio-faciais. O tratamento odontológico deve ser adaptado a cada indivíduo de acordo com sua necessidade, tendo uma abordagem multidisciplinar, possibilitando uma melhora na qualidade de vida e estética do paciente(AU)

Treacher Collins syndrome is a rare dominant genetic disorder characterized by malformation of the bones and tissues of the face. It is a craniofacial syndrome that presents bilateral and symmetrical alterations of structures originating from the first and second branchial arches. The aim of the present study is to perform a case report on the impact of dental treatment on the quality of life of a patient with CTS. Patient, 39 years old, female, attended a dental clinic in Belo Horizonte, with the main complaint of dental flaws and sensitivity. During the anamnesis the patient reported having CTS, during the extraoral clinical examination she verified the presence of malar and mandibular hypoplasia, malformation of the pinnae with hearing loss, obliquity and lower eyelid coloboma. Intraoral examination revealed Angle class II, missing teeth 11, 12, 13, 21 and 22, extrusion of tooth 41, gingival recession and stage I periodontitis grade A. After periodontogram and complementary exams it was performed a scaling in areas with a probing depth greater than 3mm, lower lip frenectomy, laser application for sensitivity, gingival graft and placement of partial removable prosthesis. The patient at the end of treatment reported feeling fulfilled and happy with its completion, she was referred to the Unique Health System to undergo surgery to correct the craniofacial changes. The current treatment aims at functional and aesthetic correction and the need for psychosocial support, having the joint participation of a multidisciplinary team to achieve this goal(AU)

Effect of voxel size of Micro-CT on the assessment of root canal preparation

The aim of this study was to assess the influence of micro-computed tomography (micro-CT) voxel size on evaluation of root canal preparation using rotary heat-treated nickel-titanium files. Curved mesial root canals of mandibular molars were prepared using ProDesign Logic 30/.05 (PDL) or HyFlex EDM 25/.08 (HEDM) (n=12). The specimens were scanned using micro-CT with 5μm of voxel size before and after root canal preparation. Images with sub-resolution of 10 and 20μm voxel sizes were obtained. The percentage of volume increase, debris and uninstrumented root canal surface were analyzed in the different voxel sizes. Data were compared using unpaired Student's t-test and ANOVA statistical tests (α=0.05). No differences were observed for percentage of volume increase, debris and instrumented surface between the root canals prepared by PDL and HEDM (p>0.05). Both systems promoted higher percentage of debris in the apical third compared to the middle third (p0.05). PDL and HEDM had similar root canal preparation capacity. Micro-CT images using different voxel sizes did not influence the results of volume increase and debris evaluation. However, images at 5µm showed greater accuracy to evaluate the percentage of uninstrumented surfaces.

El objetivo de este estudio fue evaluar la influencia del tamaño de vóxel de la microtomografía computarizada (micro-CT) en la evaluación de la preparación del conducto radicular utilizando limas rotatorias de níquel-titanio tratadas térmicamente. Se prepararon conductos radiculares mesiales curvos de molares mandibulares usando ProDesign Logic 30/.05 (PDL) o HyFlex EDM 25/.08 (HEDM) (n=12). Las muestras se escanearon usando micro-CT con un tamaño de vóxel de 5μm antes y después de la preparación del conducto radicular. Se obtuvieron imágenes con subresolución de vóxeles de 10 y 20μm. Se analizó el porcentaje de aumento de volumen, residuos y superficie del conducto radicular no instrumentado en diferentes tamaños de vóxel. Los datos se compararon usando la prueba t de Student no pareada y las pruebas estadísticas ANOVA (α=0,05). No se observaron diferencias en el porcentaje de aumento de volumen, detritus y superficie instrumentada entre los conductos radiculares preparados por PDL y HEDM (p>0,05). Ambos sistemas promovieron un mayor porcentaje de detritos en el tercio apical en comparación con el tercio medio (p0,05). PDL y HEDM tenían una capacidad de preparación del conducto radicular similar. Las imágenes de micro-CT que utilizan diferentes tamaños de vóxel no influyeron en los resultados de la evaluación del volumen y los desechos. Sin embargo, las imágenes de 5µm mostraron una mayor precisión al evaluar el porcentaje de superficies no instrumentadas.

Solitary fibrous tumor: Two cases report with a focus on the differential diagnosis / Tumor Fibroso Solitário: Relato de dois casos com foco no diagnóstico diferencial

Solitary fibrous tumor (SFT) is a neoplasm of fibroblastic/myofibroblastic origin with intermediate biological behavior. We report here two cases of SFT affecting an unusual anatomical site in 58-year-old and 40-year-old female patients and discuss the differential diagnosis of this lesion. In case 01, the lesion showed the clinical appearance of an asymptomatic "blister" with normal color, rubbery consistency, measuring 0.3 cm, and affected the lower lip; while in case 02, a symptomatic red nodular lesion with a soft consistency and measuring 0.5 cm affected the floor of the mouth. Excisional biopsies were performed. Microscopically, two well-delimited benign neoplasms were observed, exhibiting the proliferation of ovoid to spindle-shaped mesenchymal cells, vascular spaces with staghorn arrangement, and the absence of mitosis figures. Immunohistochemistry was performed in case 01 to assist in the diagnosis. Weak and diffuse immunostaining was observed for α-SMA and intense and diffuse immunopositivity for Bcl-2 and CD34. Based on histopathological and immunohistochemical features, a diagnosis of SFT was rendered in both cases. The low occurrence and nonspecific clinical features of oral SFT may make its clinical diagnosis difficult. Also, morphological and immunohistochemical are essential for differential diagnosis with other mesenchymal neoplasms.(AU)

O tumor fibroso solitário (TFS) é uma neoplasia de origem fibroblástica/miofibroblastica com comportamento biológico intermediário. Nesse artigo relatamos dois casos de TFS afetando sítios anatômicos incomuns em pacientes do sexo feminino de 58 anos e 40 anos e discutir os seus diagnósticos. No caso 01 clinicamente a lesão apresentou um aspecto de "bolha" assintomática, coloração normal da mucosa, consistência borrachoide medindo 0,3 cm, em região de lábio inferior, enquanto que no caso 02, como uma lesão sintomática, vermelha, nodular com consistência mole e medindo 0,5 cm afetando o assoalho bucal. As biópsias excecionais foram realizadas. Microscopicamente, observamos duas lesões neoplásicas bem delimitadas exibindo uma proliferação de células mesenquimais variando de ovoides a fusiformes, vasos sanguíneos em formato de "chifre de veado", com ausência de figuras de mitoses. No caso 01 foi realizado análise imuno-histoquímica para auxiliar no diagnóstico. Foi observado uma marcação fraca e difusa de α-SMA e uma intensa e difusa imunopositividade para o Bcl-2 e CD34.Baseado nos achados histopatológicos e imuno-histoquímicos o diagnóstico de TFS foi estabelecido em ambos os casos. A baixa ocorrência e os achados clínicos inespecíficos do TFS oral podem dificultar o diagnóstico clínico. Além disso, as análises morfológicas e imuno-histoquimicas são essenciais para realização do diagnóstico diferencial com outras neoplasias mesenquimais.(AU)_

Rinosporidiosis humana de cavidad nasal en Argentina / Human rhinosporidiosis of the nasal cavity in Argentina

Resumen La rinosporidiosis es una enfermedad infecciosa causada por el patógeno protista acuático Rhinosporidium seeberi que habita en agua dulce de lagos o lagunas y el suelo. Es sumamente infrecuente, siendo endémica en India y Sri Lanka, aunque se han visto casos en países de Europa, África y Sudamérica. Predomina en jóvenes de sexo masculino y afecta tanto a humanos como animales. Se caracteriza por la formación de pólipos ro jizos uni o bilaterales, principalmente en cavidad nasal. Los síntomas de presentación en la vía aérea incluyen obstrucción, epistaxis, rinorrea y sensación de cuerpo extraño. Reportamos el caso de un varón de 22 años nativo de Argentina que se presentó a la consulta por insuficiencia ventilatoria nasal, rinorrea y epistaxis. La rinoscopía exhibió una formación polipoide que surgía del tabique septal y ocupaba toda la fosa nasal derecha. Microscópicamente el pólipo estaba revestido por epite lio de tipo respiratorio y pavimentoso y a nivel estromal evidenciaba proceso inflamatorio crónico granulomatoso con presencia de abundantes estructuras quísticas de pared gruesa de entre 100 y 500 μm (esporangios), que contenían en su interior abundantes endosporas. Las técnicas de ácido peryódico de Schiff y Grocott resalta ron dichas estructuras. Dado los antecedentes clínico-epidemiológicos y el cuadro morfológico se arribó al diagnóstico de rinosporidiosis.

Abstract Rhinosporidiosis is an infectious pathology caused by the aquatic protist pathogen Rhinosporidium seeberi that in habits the fresh water of lakes or lagoons and in the soil. It is extremely rare, being endemic in India and Sri Lanka, al though cases have been seen in countries in Europe, Africa and South America. It predominates in young males and affects both humans and animals. It is characterized by the formation of uni- or bilateral reddish polyps, mainly in the nasal cavity. Presenting airway symptoms include obstruc tion, epistaxis, rhinorrhea and foreign body sensation. We report the case of a 22-year-old man from Argentina who presented with nasal ventilatory insufficiency, rhinorrhea and epistaxis. Rhinoscopy revealed a polypoid formation arising from the septal septum and occupying the entire right nostril. Microscopically, the polyp was covered by respiratory and squamous epithelium, and at the stromal level it evidenced a granulomatous chronic inflammatory process with the presence of abundant thick-walled cystic structures between 100 and 500 μm (sporangia), which contained abundant endospores inside. The periodic acid Schiff and Grocott techniques highlighted these structures. Given the clinical-epidemiological background and the morphological picture, the diagnosis of rhinosporidiosis was reached.

Frecuencia de Bacilos Gram Negativos en la cavidad bucal de estudiantes de una Universidad de Asunción

Introducción: La cavidad bucal hospeda una gran cantidad de microorganismos, como los bacilos Gram negativos, y entre ellas, bacterias de gran importancia médica debido a su capacidad de producir enfermedades graves para el ser humano, especialmente en pacientes inmunodeprimidos. El objetivo de este trabajo fue determinar la presencia de Bacilos Gram Negativos y sus patrones de resistencia a antibióticos, en una población estudiantil de la ciudad de Asunción, en los años 2019 y 2020. Materiales y métodos: Se realizó un estudio observacional, descriptivo de corte transversal, donde se realizaron hisopados de la cavidad bucal a 35 alumnos de entre 18 a 24 años, de una universidad privada en la ciudad de Asunción. Se requirió consentimiento informado firmado por los participantes y fueron excluidos quienes tuvieron tratamientos antibióticos. Las muestras fueron obtenidas con un hisopo de algodón, posteriormente se colocaron en un medio de transporte para luego ser cultivadas en Agar MacConkey. El cultivo se realizó por 48 horas a 37° centígrados, luego se procedió a la identificación bacteriana. Por último, se realizó el antibiograma. Resultados: De los 35 alumnos se encontró una frecuencia de 48,57% de bacilos Gram negativos. Cepas de Klebsiella pneumoniae fueron las más frecuentes (35,29%). Se observó que las bacterias eran altamente resistentes a la Amoxicilina/Ácido Clavulánico. Conclusiones: La presencia de estos tipos de microorganismos puede ser peligrosa para la salud general de las personas, específicamente de los pacientes con algún tipo de inmunodepresión, debido a la gran la resistencia a antibióticos presentadas por algunas cepas.

Introduction: The oral cavity hosts a large number of microorganisms, such as Gram negative bacilli, and among them, bacteria of great medical importance due to their capacity to cause serious diseases for humans, especially in immunosuppressed patients. The objective of this work was to determine the presence of Gram Negative Bacilli and their patterns of resistance to antibiotics, in a student population of the city of Asunción, in the years 2019 and 2020. Materials and methods: An observational, descriptive cross-sectional study was carried out, where oral cavity swabs were made from 35 students between 18 and 24 years of age, from a private university in the city of Asunción. Informed consent signed by the participants was required and those who had antibiotic treatments were excluded. The samples were obtained with a cotton swab, later they were placed in a transport medium to later be cultured in MacConkey Agar. The culture was carried out for 48 hours at 37° Celsius, then the bacterial identification was carried out. Finally, the antibiogram was performed. Results: Of the 35 students, a frequency of 48,57% of Gram negative bacilli was found. Klebsiella pneumoniae strains were the most frequent (35.29%). The bacteria were found to be highly resistant to Amoxicillin/Clavulanic Acid. Conclusions: The presence of these types of microorganisms can be dangerous for the general health of people, specifically of patients with some type of immunosuppression, due to the great resistance to antibiotics presented by some strains.

Nasal chondrogenic tumors: Case reports of primary chondroma and recurrence of atypical cartilaginous tumor (chondrosarcoma grade I) with review of the Literature

Nasal chondromas and nasal atypical cartilaginous tumors (or chondrosarcoma grade 1) are very rare chondrogenic tumors. Approximately 150 cases of nasal chondroma and fewer than 50 cases of nasal atypical cartilaginous tumors have been described. We reported a case with nasal chondroma in the right ethmoid area and a case with a nasal atypical cartilaginous tumor of the anterior septum. No chondroma recurrence was noted for 17 years after endoscopic resection. Recurrence was noted for the nasal atypical cartilaginous tumor 36 months after wide surgical excision via midfacial degloving. Revision surgery was performed again via midfacial degloving. Recurrences of nasal chondroma and atypical cartilaginous tumors are extremely rare. The current data indicate adequate surgical excision, in some cases even radical, as the most important parameter to avoid recurrence. For inoperable recurrent cases of atypical cartilaginous tumors, observation may be followed.

THE ‘FEEDING BRONCHUS SIGN‘ IN CAVITARY LUNG LESIONS, ITS EVALUATION WITH COMPUTED TOMOGRAPHY AND A GUARDED OPINION REGARDING PHYSIOTHERAPY

BACKGROUND Bronchiectasis and cavitation are key features of acute and chronic pulmonary infections. Cavitary lesions may carry unfavourable prognosis with regard to complete restoration of pulmonary function in few patients. OBJECTIVES To evaluate type and site of bronchiectasis, its relation with cavity formation on computed tomography and providing an insight to sorting out subjects suited for physiotherapy. A radiological sign-“Feeding bronchus sign” has been discussed with reference to bronchiectasis, its origin, natural course and a suggestion of guarded future management and rehabilitation. METHODS Total 150 chest CT scans with presence of cavity and bronchiectasis were retrospectively reviewed and followed up for type, site of bronchiectasis, signs of active infection, site of cavity and presence of “feeding bronchus sign”. Final diagnosis was confirmed by sputum sample, acid-fast bacillus test or culture or polymerase chain reaction. RESULTS Out of 150 cases, 70 (46%) had chronic and 80 (53%) had active infection. 33 (22%) had solitary and 117 (78%) had multiple cavities. 37 (34.6 %) patients had cylindrical, 11 (7.3 %) had varicose, 27 (18%) had cystic bronchiectasis, 23 (15.3%) had cylindrical and varicose, 19 (12.6%) had cylindrical and cystic and 33 (22%) had all three types. “Feeding bronchus sign” was observed in 102 (68%) patients. Radiological evidence of disease progression was seen in 21 patients, improvement in 19 and no change in 17 on follow-up CT. CONCLUSION Patients with positive “Feeding bronchus sign” are at risk for increased disease transmission and secondary opportunistic infections. Improvement and maintenance of quality of life is ultimate goal of management. Apart from antibiotics, pulmonary rehabilitation also plays an important role in cavitary lung disease

Equinococosis quística peritoneal diseminada en paciente con infección Por VIH: reporte de caso / Disseminated peritoneal cystic Echinococcosis in a patient with HIV: case report

RESUMEN La equinococosis quística es una infección zoonótica producida por la larva de Echinococcus granulosus que es capaz de invadir diversos órganos desde su ubicación en el intestino humano. En los casos de coinfección con el virus de la inmunodeficiencia humana (VIH), existe una diversidad de complicaciones condicionadas por la enfermedad inmunosupresora con pronóstico reservado. El objetivo de este reporte es describir un caso de equinococosis multiquística peritoneal en una paciente en tratamiento antiviral para VIH durante casi diez años, que recibió la combinación de albendazol más cirugía, con evolución favorable. Este reporte sería el primero en el Perú en una persona con inmunosupresión por VIH y equinococosis quística.

ABSTRACT Cystic echinococcosis is a zoonotic infection caused by the larva of Echinococcus granulosus, which is capable of invading several organs starting from the human intestine. There are several complications in cases of co-infection with the human immunodeficiency virus (HIV), which are conditioned by the immunosuppressive disease and have poor prognosis. This report aims to describe a case of multi-cystic peritoneal echinococcosis in a patient under antiviral treatment for HIV for almost ten years, who received albendazole, underwent surgery and progressed favorably. This would be the first Peruvian report of a person with HIV and cystic echinococcosis.

Asociación entre las variantes anatómicas del complejo osteomeatal y patología inflamatoria sinusal: estudio de casos y controles / Association between anatomical variants of the osteomeatal complex and inflammatory sinus pathology: case-control study

Introducción: las variantes anatómicas nasosinusales pueden ser una causa frecuente de infecciones crónicas, y resulta importante identificarlas en la práctica diaria. Objetivo: determinar la asociación entre las variantes anatómicas del complejo osteomeatal (COM) y el desarrollo de patologías inflamatorias nasosinusales. Materiales y métodos: estudio de casos y controles, muestra de 226 pacientes identificando las variantes anatómicas del COM en la tomografía computada (TAC) de senos paranasales (SPN) y su correlación clínica. Resultados: el 51,9 % presentaron hallazgos imagenológicos indicativos de patología inflamatoria nasosinusal y el 19,8 % reportaron sintomatología sugestiva de sinusitis en la historia clínica. Los SPN más afectados fueron: maxilares (46,9 %) y etmoidales (23 %). Las variantes anatómicas más frecuentes fueron las celdillas de Agger Nasi (50,2 %) y la desviación septal (46,2 %). Se encontró como variable estadísticamente significativa la inserción lateral de la apófisis unciforme (p = 0,015) más frecuente del lado izquierdo (p = 0.018, odds ratio [OR] = 4,078, intervalo de confianza [IC] 95 % = 1,3-12,6). Discusión: Se confirmó la incidencia de las variantes anatómicas más frecuentes en la literatura, sin embargo, no se correlacionan con los hallazgos clínicos para la serie de pacientes estudiada en comparación con otros estudios. Existe una alta relación entre la inserción lateral de apófisis unciforme y hallazgos de rinosinusitis escasamente documentados en la literatura médica. Conclusión: se requieren más estudios sobre modelos predictivos en muestras poblacionales mayores y protocolos de lectura TAC enfocados sobre diferentes variantes anatómicas de la apófisis unciforme.

Introduction: Sinonasal anatomical variants can be a frequent cause of chronic in- fections, so it is important to identify them in daily practice. Objective: To determine the association between the anatomical variants of the osteomeatal complex (OCM) and the development of sinonasal inflammatory pathologies. Materials and methods: Case-control study, a sample of 226 patients is analyzed identifying the anatomical variants of OCM in computed tomography of the paranasal sinuses and their clinical correlation. Results: 51.9% presented imaging findings indicative of sinonasal in- flammatory disease, 19.8% reported symptoms suggestive of sinusitis in the clinical history. The most affected paranasal sinuses were: maxillary (46.9%) and ethmoid (23%). The most frequent anatomical variants were Agger Nasi cells (50.2%) and septal deviation (46.2%). The lateral insertion of the uncinate process (p=0.015) was a statistically significant variable, more frequent on the left side (p=0.018, odds ratio [OR]=4.078, 95% confidence interval [CI]=1.3-12.6). Discussion: The incidence of the most frequent anatomical variants in the literature was confirmed, however not correlated with the clinical findings for the series of patients studied in comparison with other studies. There is a high relationship between the lateral insertion of the uncinate process and rhinosinusitis findings that are scarcely documented in the medical literature. Conclusion: More studies are required on predictive models in larger population samples and tomographic reading protocols focused on different anatomical variants of the uncinate process

A Systematic Literature Study of the Sinus Septi Nasi, Crista Galli and Other Minor Pneumatizations / Estudio Bibliográfico Sistemático del Seno Septi Nasi, Crista Galli y Otras Neumatizaciones Menores

SUMMARY: Variations in the paranasal sinuses and pneumatizations originating from these structures are clinically important for surgical procedures to be performed in the nose and nasal cavity regions. No systematic review examining the sinus septi nasi, crista galli and other minor pneumatizations was found in the literature review. This study aimed to review the papers in the literature including the sinus septi nasi, crista galli and other minor pneumatizations and standardize the mean incidence, distribution by sex, age and origin of these structures. Furthermore, it was aimed to examine the height, length, and width values of sinus septi nasi and crista galli pneumatizations, determine the measurement intervals and measurement values, and standardize them. The studies involving these pneumatizations were reviewed from various databases. After being evaluated according to the inclusion and exclusion criteria, 35 articles between the years 1991-2021 were reviewed. Based on the data obtained from these articles, we examined the incidence of sinus septi nasi, crista galli, and other minor pneumatizations. Middle nasal turbinate pneumatization had the highest incidence among all these pneumatizations. Uncinate process pneumatization had the lowest incidence. Considering the distribution by sex, no difference was found. Upon examining the age range, there were people aged between 1-95 years, and the mean age range was 33.05-41.48. The length, width and height values of crista galli and sinus septi nasi could not be standardized due to the insufficient number of studies and variable data in the literature. We believe that our study will contribute to similar future studies in larger populations with the clinical procedures to be performed in and around the nasal cavity.

Las variaciones en los senos paranasales y las neumatizaciones que se originan en estas estructuras son clínicamente importantes para los procedimientos quirúrgicos que se realizan en las regiones de la nariz y la cavidad nasal. En la revisión de la literatura no se encontró ninguna revisión sistemática que examinara el seno septi nasi, la crista galli y otras neumatizaciones menores. Este estudio tuvo como objetivo revisar los trabajos en la literatura que incluyen el seno septi nasi, la crista galli y otras neumatizaciones menores y estandarizar la incidencia media, la distribución por sexo, edad y origen de estas estructuras. Además, tuvo como objetivo examinar los valores de altura, longitud y ancho de las neumatizaciones del seno septi nasi y crista galli, determinar los intervalos de medición y los valores de medición, y estandarizarlos. Los estudios relacionados con estas neumatizaciones se revisaron a partir de varias bases de datos. Luego de ser evaluados según los criterios de inclusión y exclusión, se revisaron 35 artículos entre los años 1991-2021. Sobre la base de los datos obtenidos de estos artículos, examinamos la incidencia de septi nasi nasi, crista galli y otras neumatizaciones menores. La neumatización de la concha nasal media tuvo la mayor incidencia entre todas estas neumatizaciones. La neumatización del proceso uncinado tuvo la menor incidencia. Considerando la distribución por sexo, no se encontró diferencia. Al examinar el rango de edad, había personas con edades entre 1 y 95 años, y el rango de edad promedio fue de 33,05 a 41,48. Los valores de longitud, ancho y altura de crista galli y seno septi nasi no pudieron estandarizarse debido a la cantidad insuficiente de estudios y datos variables en la literatura. Creemos que nuestro estudio contribuirá a futuras investigaciones similares en poblaciones más grandes con los procedimientos clínicos que se realizarán en y alrededor de la cavidad nasal.

Resistencia a la fractura de premolares superiores con tratamientos de endodoncia por accesos conservador y tradicional

Introducción: Las piezas dentarias luego de tratamiento de endodoncia aumentan su susceptibilidad a la fractura, lo que está asociado, principalmente, con la pérdida de la estructura dental. Objetivo: Evaluar in vitro, la resistencia a la fractura de premolares superiores con tratamientos de endodoncia mediante acceso tradicional, conservador y conservador Ninja, con restauración provisoria y final. Métodos: Estudio prospectivo de diseño experimental longitudinal con 42 premolares superiores donados, separados en 3 grupos según el tipo de acceso de endodoncia a aplicarse y luego cada uno en dos subgrupos según el tipo de restauración, y un grupo control, al cual no se le realiza endodoncia. Luego de realizar el tratamiento y la restauración, se evaluó la resistencia a la fractura mediante carga compresiva oblicua (45°), en una máquina de carga universal. Las cargas requeridas para la fractura se registraron en newtons y fueron comparadas estadísticamente. Resultados: Las piezas tratadas mediante acceso conservador Ninja con restauración provisoria y final, requirieron una carga promedio para la fractura de 513,45 N y 638,13 N, respectivamente. Fuerzas significativamente mayores a las resistencias ofrecidas por los otros tratamientos con p 0,05. Conclusiones: En la endodoncia in vitro, el diseño del acceso a la cavidad, tipo conservador Ninja, afectó significativamente la resistencia a la fractura de los premolares superiores, adquiriendo un comportamiento biomecánico similar al de las piezas control(AU)

Introduction: Tooth pieces, after endodontic treatment, increase their susceptibility to fracture, a phenomenon mainly associated with loss of tooth structure. Objective: To evaluate, in vitro, the resistance to fracture of upper premolars with endodontic treatment by traditional, conservative and conservative ninja access, with temporary and final restoration. Methods: A prospective study of longitudinal experimental design was carried out with 42 donated upper premolars, separated into three groups, according to the type of endodontic access to be applied; in turn, each was then divided into two subgroups, according to the type of restoration, and a control group, not performed endodontic treatment. After treatment and restoration, fracture resistance was evaluated using oblique compressive loading (45°) in a universal loading machine. The loads required for fracture were recorded in newtons and statistically compared. Results: The parts treated by conservative ninja access with provisional and final restoration required an average fracture load of 513.45 N and 638.13 N, respectively; this forces were significantly higher than the resistance values offered by the other treatments, with p < 0.05. Likewise, there were no significant differences in the resistance values obtained between the cases of conservative access and traditional access, nor when comparing the types of applied restoration, with P<0.05. Conclusions: In in vitro endodontics, the design of the access to the cavity of conservative ninja type significantly affected the resistance to fracture of the upper premolars, acquiring a biomechanical behavior similar to that of the control pieces(AU)

Importancia del conocimiento anatómico del espacio extraperitoneal y su utilidad en los abordajes quirúrgicos / Importance of anatomical knowledge of the extraperitoneal space and its usefulness in surgical approaches

Introducción. El espacio extraperitoneal, se define como el segmento topográfico ubicado entre el peritoneo parietal internamente y la fascia transversalis externamente. Como resultado del desarrollo y consolidación de la cirugía laparoscópica, en particular de la herniorrafia inguinal por esta vía, se ha presentado un renovado y creciente interés en esta área anatómica, debido a la importancia de su conocimiento detallado en la cirugía de mínima invasión. Métodos. Se hizo una revisión narrativa de la literatura para presentar una información actualizada y detallada sobre la anatomía del espacio extraperitoneal y su importancia en diferentes procedimientos quirúrgicos realizados actualmente. Resultados. Por fuera del espacio peritoneal, se encuentran las áreas anatómicas externas al peritoneo parietal, que incluyen la preperitoneal y la retroperitoneal. Mediante la laparoscopia, se pueden localizar en estos espacios cinco triángulos anatómicos, además de la corona mortis y el triángulo supra vesical. Conclusión. El conocimiento del espacio extraperitoneal es de gran importancia para el cirujano general, teniendo en cuenta los múltiples procedimientos que requieren el abordaje de esta área topográfica

Introduction. The extraperitoneal space is defined as the topographic segment located between the parietal peritoneum internally and the fascia transversalis externally. As a result of the development and consolidation of laparoscopic surgery, particularly inguinal herniorrhaphy by this route, there has been a renewed and growing interest in this anatomical area, due to the importance of its detailed knowledge in minimally invasive surgery. Methods. A narrative review of the literature was made to present updated and detailed information on the anatomy of the extraperitoneal space and its importance in different surgical procedures currently performed. Results. Outside the peritoneal space are the anatomical areas external to the parietal peritoneum, including the preperitoneal and extraperitoneal. Using laparoscopy, five anatomical triangles, in addition to the corona mortis and the supravesical triangle, can be located in these spaces. Conclusion. Knowledge of the extraperitoneal space is of great importance for the general surgeon, taking into account the multiple procedures that require the approach of this topographic area

Schwannoma in the nasal cavity: A benign nerve sheath tumor at an odd location

Schwannomas are neurogenic tumors arising from the Schwann cells present in the neural sheath of the myelinated nerves. These are benign tumors that can arise anywhere in the body. Schwannomas are rarely seen in the nose and paranasal sinuses representing <4% of all head-and-neck schwannomas. Surgical excision is the treatment of choice in these cases. Nasal polyps are common nasal cavity lesions which are usually inflammatory polyps. Schwannoma of the nasal cavity usually presented with headache, unilateral nasal obstruction due to mass obliterating the nasal cavity, and epistaxis. Here, we report the case of a 47-year-old female who presented with a mass in the left nasal cavity causing the nasal blockage.