Cellular responses to 3D printed dental resins produced using a manufacturer recommended printer versus a third party printer.

PURPOSE: The aim of this study was to evaluate the influence of different 3D dental resins, using a manufacturer recommended printer and a third-party printer, on cellular responses of human gingival cells. MATERIALS AND METHODS: Three NextDent resins (Denture 3D+, C&B MFH and Crowntec) were used to produce specimens on printers NextDent 5100 (groups ND, NC and NT, respectively) and Phrozen Sonic Mini 4K (groups PD, PC and PT, respectively). Human gingival fibroblasts were cultured and biocompatibility was evaluated on days 1, 3 and 7. IL-6 and IL-8 concentrations were evaluated at 3 days using ELISA. Surface roughness was evaluated by a contact profilometer. SEM and fluorescence micrographs were analyzed at days 1 and 7. Statistical analyses were performed using SPSS and mean differences were tested using ANOVA and post-hoc Tukey tests (P < .05). RESULTS: There was an increase in cellular viability after 7 days in groups PC and PT, when compared to group PD. ND group resulted in higher concentration of IL-6 when compared to PT group. SEM and fluorescence micrographs showed less adhesion and thinner morphology of fibroblasts from group PD. No significant differences were found regarding surface roughness. CONCLUSION: The use of different printers or resins did not seem to influence surface roughness. NextDent 5100 and Phrozen Sonic Mini 4K produced resins with similar cellular responses in human gingival fibroblasts. However, Denture 3D+ resin resulted in significantly lower biocompatibility, when compared to C&B MFH and Crowntec resins. Further testing is required to support its long-term use, required for complete dentures.

Poorly differentiated thyroid carcinoma: molecular, clinico-pathological hallmarks and therapeutic perspectives.

Poorly differentiated thyroid carcinoma (PDTC) is a rare and extremely aggressive tumor, accounting for about 2-15% of all thyroid cancer. PDTC has a distinct biological behavior compared to well-differentiated and anaplastic thyroid carcinoma and, in last years, it has been classified as a separate entity from both anatomopathological and clinical points of view. Nevertheless, there is still a lack of consensus among clinicians regarding inclusion criteria and definition of PDTC that affects its diagnosis and clinical management. Due to its rarity and difficulty in classification compared to other tumors, very few studies are available to date and series often include different histotypes in addition to PDTC. This review focuses on main studies concerning PDTC summarizing the evolution in the definition of its diagnosis criteria, clinicopathological features, management, and outcome. The data available confirm that the pathological evaluation and classification of PDTC are crucial and should therefore be standardized. Since the clinical presentation and prognosis of PDTC may vary widely depending on the different stage of the disease at diagnosis, the patient's management may differ in treatment and should be tailored to each patient. Finally, this review discusses advances in molecular insights of PDTC that, together with the implementation of both in vitro and in vivo models, will provide valuable insights into biological mechanisms of progression, metastasis, and invasion of this aggressive thyroid carcinoma. Further studies on larger, carefully selected series are needed to better assess the peculiar features of PDTC and to better define its management by focusing on the best diagnostic and therapeutic approaches.

Outcomes of lenvatinib therapy in poorly differentiated thyroid carcinoma.

Background and objective: Lenvatinib showed promising results in a subgroup of patients with poorly differentiated thyroid carcinoma (PDTC) in the SELECT trial. Our aim was to report the effectiveness and tolerability of lenvatinib in our series of PDTC patients. Methods: Medical records of eight consecutive patients with PDTC treated with lenvatinib in a single center between January 2019 and October 2022 were retrospectively reviewed. Inclusion criteria were PDTC diagnosis based on Turin criteria and evidence of disease progression in the previous 6 months. Results: Eight PDTC patients received an average dose of lenvatinib of 18.1 mg for a median duration of treatment of 10.3 months. The baseline Eastern Cooperative Oncology Group performance status was ≥2 in 50% of patients. Two patients had unresectable primary tumor. Seven patients showed extrathyroidal disease, particularly mediastinal lymph nodes (85.7%), lung (71.4%), and bone (71.4%). The disease control rate was 100%, with partial response and stable disease in 12.5 and 87.5%, respectively. The median time to best overall response was 3 months, and the median duration of response was 7.5 months. Median progression-free survival was 12 months and median overall survival was not reached. At 6, 12, and 18 months, overall survival was 87.5, 71.4, and 57.1%, respectively. All patients experienced drug-related adverse effects (AEs). Four (50%) had dose reductions and two (25%) had temporary treatment interruptions. Lenvatinib was stopped in two patients due to grade ≥3 AEs. Conclusion: Lenvatinib is an effective treatment for real-world PDTC patients. Adequate management of comorbidities and AEs increases treatment tolerability and minimizes dose reductions.

Acromegaly-related cutis verticis gyrata.

OBJECTIVE: Acromegaly is a disorder caused by hypersecretion of growth hormone (GH), resulting in excessive levels of insulin-like growth factor 1 (IGF-1), and almost always due to a pituitary tumor. It is classically associated with acral enlargement, prominent facial features and soft tissue overgrowth. Skin manifestations include hirsutism, acne, skin tags, oily skin and acanthosis nigricans. However, other uncommon dermatological features, such as cutis verticis gyrata (CVG), may also occur. Here, we review acromegaly-related CVG aiming to raise awareness for its possible occurrence in this setting, and we discuss its pathophysiology, presentation, management and differential diagnosis. DESIGN: A comprehensive literature search regarding CVG, particularly CVG related to acromegaly, has been carried out. Case reports, original studies and review papers, were considered. RESULTS: CVG is a rare benign skin lesion characterized by thickened and folded scalp, resembling the brain gyri and sulci. The diagnosis of CVG mainly relies on clinical examination, although tissue biopsy may be necessary in case of uncertain etiology. In acromegaly, CVG appears to be driven by the trophic effects of GH and IGF-1 on skin and soft tissues. While CVG is uncommon in acromegaly, it seems to occur more frequently in male patients. The management of acromegaly-related CVG essentially relies on controlling the serum levels of GH and IGF-1. Surgical skin procedures should be reserved for patients with severe aesthetic distress, after achieving the best possible control of acromegaly. CONCLUSIONS: CVG is a rare manifestation of acromegaly that may allow an earlier diagnosis and a swifter treatment of these patients, which in turn may improve or entirely reverse such remarkable skin lesions.

PGL4 syndrome in a patient with synchronous paraganglioma-pheochromocytoma.

Pheochromocytoma and paraganglioma (PGL) are rare neuroendocrine tumours, frequently associated with genetic syndromes. We report the case of a man in his 40s with a left anterior neck mass and a history of hypertensive crisis, heavy sweating and constipation. Biochemical tests showed increased plasma and urine normetanephrines. Neck ultrasound suggested left carotid body PGL, but it was mandatory to search for other lesions. Whole-body MIBG failed to show abnormal uptake. Abdominal MRI was suggestive of another PGL, anterior to the right adrenal gland. Abdominal surgery was performed uneventfully under alpha and beta blockers. This intervention proved to be effective, as normetanephrines levels became completely normal after 1 month. Carotid body PGL was successfully excised 4-months later. Genetic study identified a large deletion in exon 1 of the SDHB gene allowing the diagnosis of paraganglioma syndrome type 4 (PGL4). After 19 months of follow-up, he is still on clinical and biochemical remission and will continue life-long surveillance.

Primary and Secondary Hypogonadism in Male Persons with Diabetes Mellitus.

AIMS: To characterize hypogonadism in male persons with diabetes mellitus. Patients and Methods. 184 consecutive male persons with diabetes were studied. Besides the usual care, total testosterone (TT), estradiol (E2), FSH, and LH were measured in the last appointment and in 40 patients, also in the next two appointments. Statistical analysis compared groups and explored factors for TT and LH levels. RESULTS: TT levels were stable and highly correlated (r > 0.750, p < 0.001) over a 6-12-month period. 20% of the patients presented secondary hypogonadism (SH) and 18% presented primary hypogonadism (PH). SH was inversely related to HbA1 (partial r (rp) = 0.229, p < 0.005), while PH was directly related to age (r = 0.356, p < 0.001). TT levels were reduced independently by metformin (364 ± 160 vs. 431 ± 242 ng/dL, t = 2.241, p < 0.05) and statins (359 ± 156 vs. 424 ± 230 ng/dl, t = 2.224, p < 0.05). TT levels were inversely related to microvascular disease (rp = -0.169, p < 0.05). Discussion. TT levels were stable over time and hypogonadism was common. SH, generally clinically, is related to the diabetic state, while PH, generally subclinically, is an age-dependent process unrelated to diabetes. Low TT levels were related to older age, poor metabolic control, metformin and statins use, and microvascular disease.

A benign cause of hyperandrogenism in a postmenopausal woman.

SUMMARY: Menopause is a relative hyperandrogenic state but the development of hirsutism or virilizing features should not be regarded as normal. We report the case of a 62-year-old woman with a 9-month history of progressive frontotemporal hair loss and hirsutism, particularly on her back, arms and forearms. Blood tests showed increased total testosterone of 5.20 nmol/L that remained elevated after an overnight dexamethasone suppression test. Free Androgen Index was 13.1 and DHEAS was repeatedly normal. Imaging examinations to study adrenals and ovaries were negative. The biochemical profile and the absence of imaging in favor of an adrenal tumor made us consider the ovarian origin as the most likely hypothesis. After informed consent, bilateral salpingectomy-oophorectomy and total hysterectomy were performed. Gross pathology revealed ovaries of increased volume and histology showed bilateral ovarian stromal hyperplasia. Testosterone levels normalized after surgery and hirsutism had completely subsided 8 months later. LEARNING POINTS: Menopause is a relative hyperandrogenic state Hirsutism and/or virilizing features, in a postmenopausal woman, should raise the hypothesis of a malignant cause In the absence of an identifiable ovarian or adrenal tumor, the ovarian origin remains the most likely Peripheral aromatization of excess androgen may conduct to high levels of estrogen increasing the risk of endometrial cancer Bilateral oophorectomy results in significant clinical improvement.

Evaluation of the influence of the impression technique, scanning direction and type of scanner on the accuracy of the final model / Avaliação da influência da técnica de impressão, direção de digitalização e tipo de scanner na precisão do modelo final

Objective: The purpose of this study is to evaluate the influence of the type of scanner and scanning direction on the accuracy of the final cast. Material and Methods: A partial master cast was used as a reference. A total of 128 scans were obtained and divided into two groups: the conventional method and the digital method. The digital group was divided into three groups: TRIOS 3, Omnicam and CS 3600. Each of these groups was subdivided according to the scanning direction, and each scan was overlaid on the digital reference cast to measure the trueness and precision of the procedures. Results: The overall precision values for the type of impression were 59.89 ± 13.08 µm for conventional and 13.42 ± 4.28 µm for digital; the values for trueness were 49.37 ± 19.13 µm for conventional and 53.53 ± 4.97 µm for digital; the scanning direction trueness values were 53.05 ± 4.36 µm for continuous and 54.03 ± 5.52 µm for segmented; and the precision values were 14.18 ± 4.67 µm for continuous and 12.67 ± 3.75 µm for segmented (p> 0.05). For the scanner type, the trueness values were 50.06 ± 2.65 µm for Trios 3, 57.45 ± 4.63 µm for Omnicam, and 52.57 ± 4.65 µm for Carestream; and those for precision were 11.7 ± 2.07 µm for Trios 3, 10.09 ± 2.24 µm for Omnicam, and 18.49 ± 2.42 µm for Carestream (p <0.05). Conclusions: The digital impression method is the most favorable method regarding precision; in terms of trueness, there are no differences between the types of impressions. (AU)

Objetivo: O objetivo deste estudo é avaliar a influência do tipo de técnica de moldagem, tipo de escâner intraoral e direção do escaneamento na precisão do modelo final. Material e Métodos: Um modelo parcial mestre foi usado como referência. Um total de 128 escaneamentos foi obtido e dividido em dois grupos: o método convencional (n = 32) e o método digital (n = 96). O grupo digital foi dividido em três grupos: TRIOS 3 (n = 32), Omnicam (n = 32) e CS 3600 (n = 32). Cada um desses grupos foi subdividido de acordo com a direção do escaneamento (n = 16), e cada escaneamento foi sobreposto ao modelo de referência digital para medir a veracidade e precisão dos procedimentos. Resultados: Os valores gerais de precisão para o tipo de impressão foram 59,89 ± 13,08 µm para convencional e 13,42 ± 4,28 µm para digital; os valores de veracidade foram 49,37 ± 19,13 µm para convencional e 53,53 ± 4,97 µm para digital; os valores de veracidade para a direção de digitalização foram 53,05 ± 4,36 µm para contínua e 54,03 ± 5,52 µm para segmentada; e os valores de precisão foram 14,18 ± 4,67 µm para contínua e 12,67 ± 3,75 µm para segmentada (p> 0,05). Para o tipo de scanner, os valores de veracidade foram 50,06 ± 2,65 µm para Trios 3, 57,45 ± 4,63 µm para Omnicam e 52,57 ± 4,65 µm para Carestream; e os de precisão foram 11,7 ± 2,07 µm para Trios 3, 10,09 ± 2,24 µm para Omnicam e 18,49 ± 2,42 µm para Carestream (p <0,05). Conclusões: O método de moldagem digital é o método mais favorável em relação à precisão; em termos de veracidade, não há diferenças entre os tipos de impressão (AU)

Influence of the background, substrate and thickness in light behaviour and colour of zirconia-reinforced lithium silicate (ZLS) glass-ceramic / Influência do fundo, substrato e espessura no comportamento da luz e cor das cerâmicas de dissilicato de lítio reforçadas com zircónia (ZLS)

Objective: To evaluate the influence of background, substrates and thickness on the color and light behaviour of two ZLS glass ceramics. Material and Methods: Standardized disc-shape specimens (12 x 1.2 mm), color A1 HT, of Celtra Duo and Vita Suprinity (n=30), were tested over a white/black background, and divided in five groups (n=6) to be tested over five substrates (polished gold alloy, white zirconia and composite, dentine and enamel A1 colour). The L*, C*, h*, a*, b* and Δ E values, were recorded in two thicknesses (1.2 and 2.4 mm). Translucency parameter (TP), contrast ratio (CR) and opalescence parameter (OP) were calculated. Data was analysed with non­parametric tests: Mann Whitney between ceramic materials for thickness, Wilcoxon for thicknesses in substrates and ceramic material and Kruskal­Wallis with Bonferroni corrections tests (p<0,01) for substrates. Results: For 2.4 mm, the Δ E values were always higher independently of ceramic material or substrates. Vita Suprinity registered lower values than Celtra Duo. Zirconia substrate registered the lower values. For 1.2 mm, dentine registered the lower values. Gold alloy and composite substrates registered the lower Δ E values for 1.2 mm Celtra Duo and 2.4 mm Vita Suprinity specimens. CT and OP higher values and TP lower values were registered for 2.4 mm Vita Suprinity. It was impossible to calculate for Celtra Duo specimens. Conclusions: Background, substrate and thickness had significant influence in light behaviour and final color of ZLS glass ceramics. Substrates Gold alloy and dentine exhibited clinical acceptable Δ E values for 1.2 mm Celtra Duo specimens. (AU)

Objetivo: Avaliar a influência do fundo, do substrato e da espessura no comportamento da luz e na cor de duas cerâmicas ZLS. Material e métodos: Discos de cerâmica (12 x 1.2 mm) de cor A1 HT, de Celtra Duo e Suprinity (n=30), foram testados sobre fundo branco/preto e cinco substratos (liga Ag-Au-Pt polida; zircónia branca; compósito, dentina e esmalte de cor A1). Os valores L*, C*, h*, a*, b* e Δ E foram registados em duas espessuras (1.2 mm e 2.4 mm). O parâmetro de translucidez (TP), o parâmetro de opalescência (OP) e o índice de contraste (CR) foram determinados. Foram realizados testes não paramétricos: Mann Whitney entre cerâmicas por espessura, Wilcoxon entre categoria de espessura por substrato e cerâmica; Kruskal­Wallis com correção de Bonferroni para substratos (p <0,01). Resultados: Para 2,4 mm, o Δ E foi sempre superior independentemente do material ou substrato. Os valores de Suprinity foram inferiores aos de Celtra Duo. O substrato zirconia obteve o Δ E mais baixo. Para 1,2 mm, a dentina obteve o Δ E mais baixo. A liga dourada e o compósito obtiveram Δ E mais baixo para Celtra Duo 1,2 mm e Suprinity 2,4 mm. Para Suprinity, CT e OP foram maiores para 2,4 mm e menores para TP. Não foi possível calcular para Celtra Duo. Conclusão: O fundo, substrato e espessura tiveram influência significativa no comportamento da luz e cor das restaurações de cerâmica ZLS. Apenas os substratos metal e dentina apresentaram valores clinicamente aceitáveis, para Celtra Duo na espessura de 1.2 mm.(AU)

Trueness and precision of the reproduction of dental casts by the conventional, milling and 3D printing techniques / Fidelidade e precisão de modelos de trabalho reproduzidos pelas técnicas convencional, de fresagem e de impressão 3D

Objective: To compare the reproduction trueness and precision of dental casts made by the conventional, milling and 3D printing techniques. Material and Methods: From an upper right side half-arch reference model (RM), 72 models were obtained and divided into three groups: conventional (CM), milled (MM) and printed (PM). All models were scanned and converted into standard tessellation language (.STL) files. The files were superimposed using 3D analysis software, and statistical analysis was performed using the root mean square (RMS) values obtained. The Shapiro-Wilk test was used to assess normality, and the Kruskal-Wallis test was used to compare groups (ρ < ⍺; ⍺ = 0.05). The Mann-Whitney U test was used for multiple comparisons among groups (ρ < ਕ; ਕ = 0.017). Results: There were significant differences in trueness (ρ = 0.000; ρ <0.001) and precision (ρ = 0.000; ρ < 0.001) among the three dental cast groups. Regarding trueness, CM presented better results, followed by MM and PM. Regarding precision, MM showed better results, followed by PM and CM, which did not show significant differences. Conclusions: For dental cast reproduction the conventional technique has the best trueness and the milling technique has the best precision.(AU)

Objetivo: Comparar a fidelidade e precisão de reprodução de modelos de trabalho pelas técnicas convencional, de fresagem e de impressão 3D. Material e Métodos: A partir de um modelo de referência (MR) de uma hemi-arcada superior direita, foram obtidos 72 modelos divididos em três grupos: convencionais (MC), fresados (MF) e impressos (MI). Todos foram digitalizados e convertidos sob a forma de ficheiros .STL (standard tesselation language). Os ficheiros foram sobrepostos utilizando um software de análise 3D, e através dos valores RMS (raiz do valor quadrático médio) obtidos foi realizada a análise estatística. Para avaliação da normalidade foi utilizado o teste Shapiro Wilk e para a comparação entre grupos foi utilizado o teste Kruskal-Wallis (ρ < ⍺; ⍺ = 0.05). Para as comparações múltiplas entre grupos, foi utilizado o teste U de Mann-Whitney (ρ < ਕ; ਕ = 0.017). Resultados:Existem diferenças significativas de fidelidade (ρ = 0.000; ρ <0.001) e precisão (ρ = 0.000; ρ < 0.001) entre os três grupos. Em relação à fidelidade, MC apresentou melhores resultados, seguido por MF e MI. Em relação à precisão, MF apresentou melhores resultados, seguido por MI e MC, que não apresentaram diferenças significativas entre si. Conclusão: Para reprodução de modelos de trabalho, a técnica convencional é a que apresenta maior fidelidade e a técnica de fresagem a que apresenta maior precisão.(AU)

Efeito do extrato da própolis e do digluconato de clorexidina sobre a formação de biofilme por Candida albicans em resina acrílica / Effect of propolis extract and chlorhexidine digluconate on the biofilm formation by Candida albicans in acrylic resin

Objetivo: avaliar in vitro a ação antimicrobiana do extrato da própolis (EP) e do digluconato de clorexidina (DCHX) na formação de biofilme por Candida albicans em resina acrílica termopolimerizada. Métodos: o efeito do EP e DCHX em biofilmes de C. albicans foi avaliado pela quantificação de Unidades Formadoras de Colônias (UFCs), pela quantificação da biomassa por cristal violeta e de polissacarídeos por safranina. Para tanto, C. albicans foram pré-aderidas em corpos de prova e somente em microplacas de poliestireno, posteriormente foi realizado o tratamento com diferentes concentrações de EP (221 µg/mL e 443 µg/mL) e DCHX (0,25% e 0,5%). Resultados: foi demonstrada uma redução significativa na formação de biofilme por C. albicans com ambas as substâncias testadas e em todas as concentrações. Conclusão: de acordo com os resultados, observou-se que ambos os tratamentos foram eficazes na redução do biofilme e que o EP, por ser um produto natural, de baixo custo e sem afeitos colaterais, representa uma alternativa inovadora para o tratamento da candidose oral em usuários de próteses removíveis.(AU)

Objective: to evaluate in vitro the antimicrobial action of propolis extract (EP) and chlorhexidine digluconate (DCHX) in the biofilm formation by Candida albicans in thermopolymerized acrylic resin. Methods: the effect of EP and DCHX on C. albicans biofilms were evaluated through the quantification of Colony Forming Units (CFU's), the quantification of biomass by violet crystal and polysaccharides by safranin. For this purpose, C. albicans were pre-adhered to specimens and only on polystyrene microplates and subsequently the treatment was performed with different concentrations of EP (221 µg/mL and 443 µg/mL) and DCHX (0.25% and 0,5%). Results: a significant reduction in the biofilm formation by C. albicans was demonstrated, with both substances tested and in all concentrations. Conclusion: according to the results, it was observed that both treatments were effective in reducing biofilm and EP, being a natural product, low cost and without side effects, represents an innovative alternative for the treatment of oral candidiasis in users removable dentures.(AU)

Zinc priming and foliar application enhances photoprotection mechanisms in drought-stressed wheat plants during anthesis.

Drought is one of most important limiting factors in wheat productivity worldwide. The need to increase drought tolerance during anthesis is of the utmost importance for high yield potentials and yield stability. Photosynthesis is one of the major physiological processes affected by drought. Damages in the photosynthetic apparatus may also arise due to non-regulated dissipation of excessive energy. Zinc (Zn) is an indispensable micronutrient for plants and is required for a wide range of physiological and biochemical processes. In this work we evaluated the stress mitigation effects of Zn seed priming alone and coupled with Zn foliar application in wheat plants submitted to severe drought during anthesis, followed by a recovery period. Under such severe drought stress, photosynthesis was constrained by both stomatal and non-stomatal limitation. Severe drought also induced an increase in non-regulated energy dissipation and hindered a full recovery of the plant's photosynthetic processes after rewatering. We also report possible activation of transposable elements due to drought stress and Zn application. Yield was severely decreased by drought and Zn treatments were unable to counteract this effect. Although unable to oppose the reduction of net photosynthesis, Zn treatments positively enhance photoprotection. At the end of drought period, Zn priming alone and coupled with Zn foliar application increased, respectively, over 2- and 3- fold the regulated dissipation of excess energy. Zn treatments lessened the non-regulated energy dissipation caused by drought, protected the plants against irreversible damages to the photosynthetic apparatus and enabled a better recovery of wheat plants after stress relief.

Repatriation Data: More than two million species occurrence records added to the Brazilian Biodiversity Information Facility Repository (SiBBr).

BACKGROUND: Primary biodiversity data records, available on-line, are essential for conservation planning. Of the mega diversity countries, Brazil have reached a high level of scientific research in describing their biodiversity. However, there still remain significant limitations in recovering, collating and organizing available information on Brazil's biological diversity and its distribution. Since the colonial period, biological material were often collected and transferred to other countries, which were characterized, stored and maintained. As a result, natural history museums worldwide possess large amounts of primary biodiversity data originally from Brazil which are then published on-line in the international Global Biodiversity Information Facility (GBIF) infrastructure. Aiming to recover these data, the Brazilian Biodiversity Information System (SiBBr) developed an automatic repatriation tool capable of retrieving all records registered in Brazil but published outside Brazilian territory in an automated manner. NEW INFORMATION: Thus, 2,459,366 records were added to SiBBr's Repository in one day. Europe and the United States hold about 80% of all records. The data set covers all life kingdoms. Animalia is the most represented group with 3 main phylum's: Chordata, Arthropoda and Mollusca, within more than 40% of all records. Plantae also comprises a large portion of the records with angiosperms having the major number of entries.

[Images in cardiology after clinical observation - aortic dissection in Marfan syndrome]. / Imagens em Cardiologia mas depois da clínica em Cardiologia - Dissecção da aorta num doente com Síndrome de Marfan.

INTRODUCTION: Stanford type A aortic dissection is a rare phenomenon with high short-term mortality and clinical manifestations that can make differential diagnosis a lengthy process requiring several diagnostic examinations. OBJECTIVES: Based on a case report, the aim is to highlight the importance of physical examination in the initial management of these patients and of rapid access to a surgical center. A brief review follows on the diagnosis and treatment of ascending aortic dissection, and its specific nature in Marfan syndrome. CASE REPORT: A 33-year-old man was admitted to the emergency department of a district hospital with chest and back pain associated with vomiting, 20 hours after symptom onset. Initial physical examination revealed an aortic systolic murmur and musculoskeletal morphological abnormalities compatible with Marfan syndrome. Given suspected aortic dissection, a transthoracic echocardiogram was immediately performed, which showed an extensive intimal flap originating at the sinotubular junction. He was transferred to the cardiothoracic surgery department of a referral hospital where he was treated by a Bentall procedure. CONCLUSION: In this case, careful physical examination during initial assessment raised the suspicion that this patient was in a high-risk group for aortic dissection, thus avoiding unnecessary and lengthy exams. This diagnosis requires emergent surgical treatment, and so direct contact in real time between those making in the diagnosis and the surgeon is essential, as well as protocols governing immediate access to a surgical center.