Patient perception after oral biopsies: an observational outpatient study.

OBJECTIVE: The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient's perception variables potentially correlated to poor healing. SUBJECTS AND METHODS: Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy. RESULTS: Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson's correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes. CONCLUSIONS: The clinical evaluation was correlated with the patient's perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools. CLINICAL RELEVANCE: Patient perception can be a predictor of the healing of biopsied tissues.

New head-mounted miniaturized microscope in hypospadia surgical correction.

AIM: The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications. METHODS: Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes. RESULTS: In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10). CONCLUSION: In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.

PSA and second-line therapy of hormone refractory prostate carcinoma.

The aim of the present study was to correlate PSA response with subjective response (bone pain and performance status), in patients treated for hormone refractory carcinoma of the prostate. Twenty-four patients were introduced into the study. Median PSA was 198 ng/ml. Symptom score, performance status and PSA were monitored monthly for 3 months and then 3-monthly. Sixteen patients (66%) showed a PSA response (median value 10 ng/ml). In 8 patients (33%) PSA was <4 ng/ml. Eight patients (33%) only had a subjective response. However, 75% of the patients with a PSA value <4 ng/ml had a subjective improvement. On the other hand, subjective response was 25% only in patients in whom PSA value decreased to <50% of the initial value but >4 ng/ml. In conclusion, PSA response is not always related to subjective improvement and does not always implicate a beneficial effect of the therapy for the patient.

Urinary BTA-stat, BTA-trak and NMP22 in surveillance after TUR of recurrent superficial transitional cell carcinoma of the bladder.

OBJECTIVES: To evaluate NMP22, BTA-Stat and BTA-Trak tests in monitoring recurrent transitional cell carcinoma of the bladder. METHODS: The tests were performed in 179 selected patients being followed up for recurrent superficial bladder tumors: 55 patients had bladder recurrence and 124 patients were recurrence free. The NMP22 test was obtained in all patients; BTA-Stat and BTA-Trak in the last 96 and 74 patients, respectively. Sixty-four patients (51.6%) were undergoing adjuvant intravesical chemotherapy. RESULTS: Sensitivity was 74, 57 and 62% and specificity was 55, 62 and 79% for NMP22, BTA-Stat and BTA-Trak, respectively. A high percentage of patients submitted to intravesical chemotherapy had false-positive tests. Positive predictive values of the NMP22, BTA-Stat and BTA-Trak tests were 42.2, 40 and 45.4%, and negative predictive values were 82.9, 76.9 and 88.4%, respectively. CONCLUSIONS: NMP22, BTA-Stat and BTA-Trak tests cannot replace cystoscopy and cannot be adopted as routine tools in surveillance after TUR in patients with superficial bladder cancer.

[Type I neurofibromatosis presenting as a progressive cervical myelopathy. The first case reported in Kaxinawa Indians]. / Neurofibromatosis tipo I manifestada como mielopatía cervical progresiva. Primer caso descrito entre los indios Kaxinawa.

INTRODUCTION: Type I neurofibromatosis is an autosomal dominant disorder with an estimated prevalence of 1/3,000. Half of the new cases are due to mutations; their penetration is complete in adults and may affect any ethnic group. We describe the first reported case of type I neurofibromatosis in a Kaxinawa Indian from the state of Acre, Brazil, in whom the presenting symptoms were of progressive tetraparesis due to multiple paraspinal neurofibromata. CLINICAL CASE: A 16 year old indigenous Kaxinawa boy presented with progressive myelopathy for the past six months. On neurological examination he had hyperreflexive spastic tetraparesia, predominantly on the right side, with the sensory level at C3/C4, multiple medullary automatisms and respiratory difficulty. He also had diffuse café-au-lait stains, including one particularly prominent one measuring 15 cm on his right buttock. MR of the spine showed many hypo-intense lesions at T1 and hyperintense lesions at T2, which took up contrast and were present at all the conjugation foramens bilaterally. These lesions originated at the roots and were suggestive of neurofibromata. On mediastinal tomography there were several neurofibromata in the mediastinum. The patient had a surgical operation for spinal decompression, with a laminectomy at C1/C2 and removal of the neurofibromata on the spinal cord at C1 and C2. The patient has a sister with multiple café-au-lait stains. CONCLUSIONS: Because of the traditional isolation of the Kaxinawa Indians, with whom contact was made at the beginning of the twentieth century, this first case reported of type I neurofibromatosis may be due to a new mutation which presented as a florid form of the disease with multiple spinal neurofibromata.

Neurofibromatosis tipo I manifestada como mielopatía cervical progresiva. Primer caso descrito entre los indios kaxinawa / Type I neurofibromatosis presenting as progressive cervical myelopathy. The first case reported in kaxinawa indians

Introducción. La neurofibromatosis tipo I es un trastorno autosómico dominante cuya prevalencia se estima en 1/3.000. La mitad de los casos nuevos se deben a mutaciones; su penetrancia es completa en adultos y puede afectar a cualquier grupo étnico. Presentamos el primer caso descrito de neurofibromatosis tipo I entre los indios Kaxinawa del estado de Acre, Brasil, cuya manifestación clínica inicial fue una tetraparesia progresiva por compresión de múltiples neurofibromas paraespinales. Caso clínico. Varón indígena Kaxinawa de 16 años de edad, afecto de mielopatía progresiva de seis meses de evolución. Neurológicamente se objetivaba tetraparesia espástica con hiperreflexia de predominio derecho, nivel sensitivo C3/C4, numerosos automatismos medulares y compromiso respiratorio. Presentaba manchas color café con leche difusas, entre las que destacaba una especialmente prominente, de 15 centímetros, situada en la nalga derecha. La resonancia magnética de columna total mostró numerosas lesiones hipointensas en T1, hiperintensas en T2, captantes de contraste y presentes en todos los forámenes de conjugación bilateralmente. Dichas lesiones se originaban en las raíces y sugerían neurofibromas. La tomografía de mediastino mostró diversos neurofibromas. El paciente fue sometido a una intervención quirúrgica para descompresión medular, mediante laminectomía C1/C2 y exéresis de los neurofibromas extrarraquianos en C1 y C2. Una hermana del enfermo presentaba también numerosas manchas café con leche. Conclusiones. Debido al tradicional aislamiento de los indios Kaxinawa, contactados a comienzo del siglo XX, este primer caso descrito de neurofibromatosis tipo I puede deberse a una mutación nueva, que se manifiesta como una forma florida de la enfermedad con varios neurofibromas espinales (AU)

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[Cerebellar syndrome and peripheral neuropathy as manifestations of infection by HTLV-1 human T-cell lymphotropic virus]. / Síndrome cerebelar y neuropatía periférica como manifestación de la infección por el virus linfotrópico humano de células T, HTLV-I.

INTRODUCTION: Type I human T-cell lymphotropic virus (HTLV-I) is a retrovirus with affinity for CD4 cells. This infection may give rise to a broad spectrum of disorders including T-cell leucemia/lymphoma, the myelopathy/tropical spastic paraparesis complex (M/TSP), and to a lesser extent, uveitis, arthritis, polymyositis and peripheral neuropathy. M/TSP is a progressive, chronic myelopathy characterized by spasticity, hypereflexia, muscle weakness and sphincter disorders. Much less frequently it may precede, or give rise to, a cerebellar syndrome with ataxia and intention tremor. CLINICAL CASE: We describe the case of a 13 year old adolescent girl who presented with a neurological syndrome which had started with tremor of the head and limbs, ataxia, dysmetria, frequent falls and sphincter disorders. During the two and a half years that she had had this illness she had developed spastic paraparesis of the legs and had repeated urinary infections. Serology of blood and CSF was positive for HTLV-I using the ELISA technique and confirmed by Western-blot. EMG showed predominantly axonal sensomotor neuropathy. A neurogenic bladder was detected on functional urodynamic studies. On MR there was moderate atrophy of the thoracic spinal cord and slight alterations of the subcortical white matter. CONCLUSIONS: The presence of a cerebellar syndrome or neuropathy of uncertain origin, in endemic areas, should lead to the inclusion of HTLV-I infection in the differential diagnosis, even in the absence of pyramidal symptoms or defined M/TSP. Maternal seropositivity supports the hypothesis of mother-daughter transmission during lactation.

Fungal and aflatoxin contamination of medicinal herbs.

Since the consumption of aromatic and medicinal herbs has been increasing in the last years, the Argentinian Health Authorities are concerned to control the quality and security of them. Fungal and aflatoxin contamination are two parameters to be taken into account, to ensure the harmlessness of the phytomedicinal products. In 81 different samples, grouped in end products (EP), raw material (RM) and at harvest (SH), fungal flora (enumeration and identification) as well as naturalAspergillus flavus and aflatoxin occurrence were investigated. In all samples fungal counts fulfilled the international general recommendation limits (maximum 10(5) cfu/g). Predominant flora was made up by xerophilic species ofAspergillus(100%), byPeniciIlium (< 50%) and in less percentage byFusarium (5.6%). Among the Aspergilli, A.flavus was present in all the three groups of samples. Using a TLC method, 47% of A. flavus isolates were toxinogenic, producing aflatoxin B1 and B2. In herbs, 4.7% of RM samples were naturally contaminated with aflatoxins B1 and B2. Considering the carcinogenic activity of aflatoxins it is essential to regulate them in the raw material (vegetal drug).

Macrocyclic trichothecenes in Baccharis coridifolia plants and endophytes and Baccharis artemisioides plants.

Toxic disease in livestock caused by the shrubs Baccharis coridifolia and Baccharis artemisioides is very common in Argentina. The toxicity of Argentinian and Brazilian B. coridifolia plants and of Argentinian B. artemisioides was investigated. The toxicogenic capacity of 15 endothyte isolates of Ceratopicnidium baccharidicola from B. coridifolia was determined. Roridins and verrucarins were analyzed by thin-layer chromatography using a modified Jarvis method. One-hundred per cent of Argentinian B. coridifolia plants were positive for roridins (RA and RE) and verrucarins (VA and VJ), 16.2% for RD and 2.7% for RH. All of the Brazilian B. coridifolia plants were positive only for roridins. In B. artemisioides plants, RA, RE and RD were present in higher concentrations than VA and VJ, and all of them were more concentrated than in B. coridifolia. One-third of the endophyte isolates were toxicogenic for the same roridins and verrucarins, but in very low concentrations. This is the first report of macrocyclic trichothecenes in B. artemisioides, and a new report of B. coridifolia macrocyclic trichothecenes in Argentina.

Sanitary factors and mycotoxin contamination in the argentinian wheat crop 1993/94.

In Argentina, due to climatic conditions, Fusarium head blight (FHB) caused by Fusarium graminearum, affected the 1993/94 wheat crop. To evaluate the severity of this disease, samples of wheat where gathered from four zones of the wheat area. Sanitary conditions and mycotoxin contamination were determined. One zone (IIN) was intensely affected by FHB with 90% of samples in grade III (bad quality). No samples were grade I (good quality). The other zones were less affected falling into grade I or II (moderate quality). In all samples tested F. graminearum was the most prevalent species singly or in combination with others. Zone II N, with a DON mean level of I1.26 ppm, did not fulfil aceptability limits, whereas zones IIS, III and IV with overall means of 2.12, 1.57 and 1.0 ppm, respectively, did. Statistical analysis showed a close relation between percentage FHB and DON contamination (r:-0.71, p<0.01) in infected samples.

Incidence of aflatoxin, zearalenone, and deoxynivalenol on corn in Argentina.

The study of the incidence of aflatoxins, zearalenone, and deoxynivalenol was the aim of this work. This investigation was carried out upon recently harvested corn samples collected in the Departamento of Rio Cuarto, Province of Córdoba, Argentina. 150 samples of corn were analized to investigate aflatoxins B1, G1, and zearalenone contamination. Out of these 150 samples 58 were selected and deoxynivalenol was examined.The incidence value for aflatoxin B1 was of 3.3% (5 samples), aflatoxin G1 1.3 % (2 samples), and zearalenone 6 % (9 samples).The analysis of the 58 samples showed that 24% of them were contaminated with deoxynivalenol.

[Microbiological quality of dehydrated and instant products for infants and children ]. / Calidad microbiológica de productos deshidratados e instantáneos para lactantes y niños.

A total of 23 lots of dehydrated and instant products for babies and children were analyzed. Neither Salmonella, C. perfringens, B. cereus, St. aureus, Group A beta-hemolytic streptococci, fecal coliforms, E. coli nor aflatoxins could be detected in the 115 samples studied. With the exception of the cereals, results obtained for the Aerobic Plate Count (RAP), the Moulds and Yeast Count (RHL) and the Total Coliforms Count (RCT) were, respectively, 91% equal of lower then 3 per gram, and 92% lower than 100 per gram. The results obtained justify the proposition of consultants of FAO/WHO, to limit determination to RAP, RCT, and investigation of Salmonella. According to specifications of FAO/WHO, 10,5% of the lots examined would be considered non acceptable. With regard to the cereals, the lower sensitivity of the used techniques, due to the physical sample characteristics, makes it advisable to adopt RHL here, too.

Calidad microbiológica de productos deshidratados e instantáneos para lactantes y niños. / [Microbiological quality of dehydrated and instant products for infants and children ]

A total of 23 lots of dehydrated and instant products for babies and children were analyzed. Neither Salmonella, C. perfringens, B. cereus, St. aureus, Group A beta-hemolytic streptococci, fecal coliforms, E. coli nor aflatoxins could be detected in the 115 samples studied. With the exception of the cereals, results obtained for the Aerobic Plate Count (RAP), the Moulds and Yeast Count (RHL) and the Total Coliforms Count (RCT) were, respectively, 91

equal of lower then 3 per gram, and 92

lower than 100 per gram. The results obtained justify the proposition of consultants of FAO/WHO, to limit determination to RAP, RCT, and investigation of Salmonella. According to specifications of FAO/WHO, 10,5

of the lots examined would be considered non acceptable. With regard to the cereals, the lower sensitivity of the used techniques, due to the physical sample characteristics, makes it advisable to adopt RHL here, too.