Multiple external cervical root resorptions after home whitening treatment: a case report.

Invasive multiple cervical root resorptions after vital tooth bleaching is a rare condition. The aim of this article is to present a case of multiple external cervical root resorptions (ECRR) after a misguided home whitening treatment. A 34 year old male patient presented with slight sensitivity and mobility in several teeth. Despite the manufacturer's recommendations, the patient used a 22% carbamide peroxide-based tooth bleaching gel at home for 4 days consecutively, at night, on the upper and lower arches. Clinical examination revealed gingival swelling, probing depths ranging 5-7 mm on the buccal and proximal surfaces, and grade 2 mobility of the teeth affected by ECRR. Radiographs revealed presence of ECRR in several teeth during initial examination, and development of multiple new lesions 6 months later. The teeth were subsequently extracted. Histological analysis showed multiple dentine lacunae and areas of dentine reparation. The careful use of these products can prevent sequelae such as those reported in this clinical case. As the vital bleaching has a variable success rate, patients should be informed through a consent form of the benefits and risks of tooth bleaching treatment.

Giant prolapsed submucous leiomyoma: a surgical challenge for gynecologists.

We present a case of a 45-year-old woman who presented with irregular vaginal bleeding and menorrhagia for two months, with an episode of massive bleeding initiating 24 hours before with hemodynamic shock. Vaginal inspection showed a soft, rounded, friable mass in vaginal introitus. After hospitalization, blood transfusion and hydration, she was submitted to vaginal myomectomy with the withdrawal of a 12-cm white, solid, huge, pedunculated, leiomyoma; however, hysterectomy was performed due to persistent uterine bleeding. The postoperation period had no complications. Macroscopy showed a retraction of the myoma pedicle. Gynecologists should prioritize clamping of a pedicle before surgery, reducing its size if the tumor is large.

Retinal changes and tumorigenesis in Ramon syndrome: follow-up of a Brazilian family.

We report on the clinical evolution of the Brazilian family with Ramon syndrome described by de Pina-Neto et al. [1986, Am J Med Genet 25:441-443]. Three members (patients IV-2, IV-18, and IV-19) have developed pigmentary changes in the retina and paleness of the optic disk. Patient IV-18 also has developed giant hypertrophy of the labia minora that, when examined histopathologically, was found to be due to neoplastic fibroblast and epithelial proliferation caused by a fibromatous process similar to that reported in the gingivae of the patients with this syndrome. Audiologic function of patient IV-2 was normal, and no skin lesions were detected. The articular signs and symptoms show that the affected relatives developed rheumatoid arthritis, which is currently inactive in patient IV-18, whereas patient IV-2 did not develop these alterations.

Evaluation of staging, cytoreduction and second-look operation of 119 ovarian cancer patients.

OBJECTIVE: This study was conducted on patients with ovarian cancer in order to evaluate survival. DESIGN: A retrospective study of 119 cases of ovarian cancer from January 1977 to December 1992 with observation until 1993. LOCATION: Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, São Paulo University. PARTICIPANTS: Of the 119 cases, 70 (58.8%) presented epithelial carcinomas and 21 (17.6%) tumors of the sexual girdle/stroma. DATA SOURCE: The data were obtained from the medical records of the patients. MEASUREMENT: Statistical analysis of survival time was based on the nonparametric Mann-Whitney test with the level of significance set at P < 0.05. RESULTS: The patients with a negative second look had a mean survival of 79.4 +/- 48.5 months versus 24.2 +/- 15.1 months for patients with a positive second look (P < 0.02). CONCLUSIONS: It is concluded that patients with a negative second look present a better prognosis compared to those with residual disease.

Two methods for recommending bat weights.

Baseball players swung very light and very heavy bats through our instrument and the speed of the bat was recorded. These data were used to make mathematical models for each person. Then these models were coupled with equations of physics for bat-ball collisions to compute the Ideal Bat Weight for each individual. However, these calculations required the use of a sophisticated instrument that is not conveniently available to most people. So, we tried to find items in our database that correlated with Ideal Bat Weight. However, because many cells in the database were empty, we could not use traditional statistical techniques or even neural networks. Therefore, three new methods were used to estimate the missing data: (i) a neural network was trained using subjects that had no empty cells, then that neural network was used to predict the missing data, (ii) the data patching facility of a commercial software package was used, and (iii) the empty cells were filled with random numbers. Then, using these fully populated databases, several simple models were derived for recommending bat weights.

[The Program of External Quality Evaluation in Clinical Chemistry. An overview and evaluation after 11 years of functioning]. / Programa de Avaliação Externa da Qualidade em Química Clínica. Visão de conjunto e avaliação após 11 anos de funcionamento.

After an eleven-year period, the goals and way of functioning are remembered the External Quality Assessment Scheme in Clinical Chemistry, under the responsibility of the National Institute of Health. The authors try to evaluate the quality of results obtained at the time by the 160 participant laboratories, belonging to the public and private sectors as well as to the Portuguese reference laboratories which have to assign the expected values on the control sera to be analysed. As regards the 22 biochemical blood parameters, we came to the conclusion that there is a high performance level in what concerns the reference laboratories and a quality level of participant laboratories in accordance with their considered peer foreign laboratories.

Mono and polichemotherapy in the treatment of metastatic and invasive gestational trophoblastic disease: analysis of 50 cases.

Fifty patients with metastatic or invasive gestational trophoblastic disease (GTD) were admitted at the "Hospital das Clínicas" of the Ribeirão Preto School of Medicine of the São Paulo University between January 1980 and December 1990. Of these 50 patients, 44 (88%) had GTD following abortion, 5 (10%) after term pregnancies and one (2%) after an ectopic pregnancy. Thirty five (70%) had invasive GTD and 15 (30%) metastatic GTD. The sites of metastases were: lung, 8 (53.3%), pelvis, 4 (26.6%), central nervous system, 2 (13.3%) and right auricle, 1 (6.6%). Human chorionic gonadotropin, pelvic arteriography and ultrasonography were used in the diagnosis of invasive GTD. 25 of the 41 patients with low-risk metastatic and invasive GTD were treated with monochemotherapy. There were 6 (24%) failures and the remaining 19 patients (76%) had complete remission of the disease after 2.89 mean cycles. Sixteen patients were treated with polichemotherapy, there were 2 (12.5%) failures and the remaining 14 had complete remission after a 2.3 mean cycles. No statistical differences between the two types of chemotherapy were observed. Four (8%) deaths were recorded.

Total hysterectomy versus subtotal hysterectomy: which procedure should be performed during the pregnant-puerperal period?

A retrospective study of 40 hysterectomies due to hemorrhage performed at the "Hospital das Clínicas, Faculdade de Medicina de São Paulo", from January 1978 to August 1989 was conducted in order to determine which type of hysterectomy (total or subtotal) is better indicated during the pregnant-puerperal period. We analyzed operating time, quantity of blood derivatives transfused during the intra- and postoperative periods, time of postoperative hospitalization, number of intra- and postoperative complications, and deaths. The results did not show statistically significant differences between the two types of hysterectomy. We conclude that total hysterectomy is preferable in any clinical situation, especially in the presence of uterine atony and low implanted placenta.

Histologic changes in fibrocystic breast disease before and after treatment with bromocriptine.

Twenty-five women with fibrocystic breast disease were investigated in a double-blind study using treatment with bromocriptine (5 to 7.5 mg/day for 3 months) or placebo. Estradiol and progesterone measurements did not show any changes before, during or after treatment. Serum prolactin levels were reduced during the use of bromocriptine. Histologic evaluation demonstrated a decrease of epithelial hyperplasia and arrest of the cystic dilation picture after treatment with bromocriptine.

[Ovariectomy concomitant with hysterectomy in the pregnancy-puerperium cycle: when to indicate?]. / Ooforectomia concomitante a histerectomia no ciclo gravídico-puerperal: quando indicar?

A retrospective review of 85 hysterectomies performed during the pregnant-puerperal period was conducted at the Clinics Hospital of Medicine of Ribeirão Preto (University of São Paulo) from 1978 to August 1989 with the purpose of evaluating the number of concomitant oophorectomies. 25 oophorectomies with histological studies were performed, of which 11 (44%) presented normal ovaries; six (24%), despite the normal histological results, had adnexal hematomae requiring resection in the laparotomy; and the last eight (32%) had infection. Average age of the patients was 32.8 years. The authors concluded that there was a high number of unnecessary oophorectomies.

Pulmonary tumor embolism from squamous cell carcinoma of the vulva.

Involvement of the pulmonary vessels by tumor emboli has been described from different primary sites of malignancy. A case of pulmonary tumor embolism due to squamous cell carcinoma of the vulva is reported. This form of pulmonary involvement has not previously been described in cases of vulvar carcinoma and it is rare in gynecologic neoplasms. The development of dyspnea with rapid clinical deterioration and fatality associated with multiple pulmonary emboli and histologic signs of pulmonary hypertension is well shown by this case.

[Evaluation of different technics of uterine evacuation as a risk factor for invasive and metastatic trophoblastic neoplasms]. / Avaliação de diferentes técnicas de esvaziamento uterino como fator de risco para neoplasia trofoblástica invasora e metastática.

A study was conducted to determine the effect of the form of uterine evacuation (curettage or vacuum aspiration) and of the use of oxytocin on the incidence of invasive/metastatic gestational trophoblastic neoplasia among patients with a diagnosis of molar abortion. The study was conducted on 42 patients with a histopathological diagnosis of benign complete hydatidiform mole and with a uterine height of more than 12cm. Twenty-five patients were submitted to uterine evacuation by curettage and 17 to uterine evacuation by vacuum aspiration. Twenty-seven of the same 42 patients received oxytocin to promote dilation of the cervix and/or partial mole expulsion, and 15 were not treated with this drug. Statistical analysis showed that the use of oxytocin before uterine evacuation was a factor contributing to a higher risk of development of invasive neoplasia, especially when associated with curettage of the uterus.

Implante secundário de câmara posterior: sem cápsula / Secundary posterior chamber lens implantation

As A. A. relatam nova técnica de implante secundário de câmara posterior sem a presença de cápsula. Apresentam resultados observado em 12 olhos (10 pacientes) que submeteram a esta técnica ao invés de tentar implante de câmara anterior

Tratamento das obstrucoes venosas retinianas pelo laser de argonio. / Treatment of retinal venous obstruction with argon laser

Os autores tecem consideracoes sobre a fisiopatologia de obstrucao venosa de ramo e da veia central da retina procurando justificar o tratamento pela fotocoagulacao.Apresentam resultados observados em 154 pacientes tratados. O sexo masculino apresenta incidencia de 57% dos casos e o feminino 43%. A veia temporal superior esteve comprometida 61 (35%) vezes, a temporal inferior 31 (18%) vezes, nasal superior e inferior 6 (4%) vezes cada, veia central da retina 67 (39%) vezes. Empregaram no tratamento a unidade de fotocoagulacao laser de argonio de Coherent Radiation mod.800. Concluem que a fotocoagulacao das obstrucoes venosas justifica-se pela neo-vascularizacao e o edema retiniano melhorando as condicoes funcionais e evitando a instalacao do glaucoma pigmentar