Anatomical variation of the saphenous nerve path: A case report.

INTRODUCTION: The saphenous nerve has great importance on the sensitivity of the lower limb. In its normal course, it enters the adductor canal and travels under the sartorius muscle, on the medial side of the thigh. METHODS: The anatomical variation was found accidentally during routine cadaveric dissection of the thigh at the Human Anatomy Laboratory of the Department of Morphophysiology of the Faculty of Medical Sciences of Minas Gerais (FCMMG). RESULTS: A different pattern of path of the saphenous nerve was found, which appears to perforate the sartorius muscle. DISCUSSION: Complaints of pain in the lower limbs are highly prevalent in the adult population. Saphenous neuropathy is a pathological entity that is associated with such a clinic and may have compression or trauma as its etiology. In the context of compression, it can be caused due to the unusual nerve path, as described in the present study. In trauma, knowledge of this variation is important to prevent iatrogenic damage to nervous tissue during surgical procedures. CONCLUSION: The anatomic variation presented may be related to the symptom of pain in the lower limbs and is also relevant in the surgical context, in order to prevent complications.

Wild carnivores, domestic dogs and ticks: shared parasitism in the Brazilian Cerrado.

The increase of contact between natural and rural areas is prominent in Brazil, due to agricultural activities and concern with the environmental conservation. In this context, domestic animals, wild fauna and humans are exposed to mutual exchange of parasites, microorganisms and diseases. We studied tick parasitism of wild carnivores and domestic dogs, and the environmental of questing ticks, in extensive cattle ranch areas intermingled with natural vegetation, and in a natural reserve, both in a region of Cerrado biome, Midwestern Brazil. From 2008 to 2015, we inspected 119 wild carnivores from nine species, and collected six tick species (Amblyomma sculptum, Amblyomma ovale, Amblyomma dubitatum, Amblyomma tigrinum, Dermacentor nitens and Rhipicephalus microplus). The most numerous and infested hosts were Cerdocyon thous, Lycalopex vetulus, Chrysocyon brachyurus, Puma concolor and Conepatus amazonicus. From 139 domestic dogs, we collected A. sculptum, Rhipicephalus sanguineus and R. microplus. From vegetation, samplings resulted in A. sculptum, A. dubitatum, A. ovale, Amblyomma rotundatum and R. microplus, with dominance of A. sculptum. Domestics and wild animals presented high overlapping of infestations by A. sculptum, a generalist and anthropophilic tick species. This tick is the most important vector of the Brazilian spotted fever, a lethal human disease. This fact elicits attention and requires efforts to monitor the presence of pathogens vectored by ticks circulating in this type of agroecosystem, including in other regions of the Brazil, because the most of the natural vegetation remaining have been increasingly immersed in pastures and agricultural matrix.

Catalogue of the Order Amphipoda from Brazil (Crustacea, Peracarida): Suborders Amphilochidea, Senticaudata and Order Ingolfiellida.

This catalog documents 303 species within 142 genera and 56 families distributed in the suborders Amphilochidea, Senticaudata and order Ingolfiellida that have been described or reported for the Brazilian coast and continent. Data for these species such as type material, type locality, geographic and bathymetric distribution, ecological notes and remarks, when pertinent, was given. From these, 268 species (~ 90%) are benthonic, marine and/or estuarine occurring from a diverse type of substrates as sediment, algae, sponges, cnidarians, ascideans, mangrove roots, fouling habitats, coral rubble, rodolith banks, etc. In terms of bathymetry, there are 214 species (~ 80%) reported for the Brazilian continental shelf (0-200 m) and 60 (~20%) for the deep sea zone (> 200 m, 50% from the Campos Basin area). There are 35 non-marine amphipods reported from Brazil. Hyalella is the restricted and dominant epigean group and is represented by 22 species, including some hypogean and cave species. Cave dwellers includes 15 species within 6 genera as: Hyalella (5); Megagidiella (1); Potiberaba (1); Spelaeogammarus (7), and Seborgia (1). Among the Bogidiellidae, Bogidiella neotropica Ruffo, 1952 and Marigidiella brasiliensis (Siewing, 1953) are hypogean, but not from caves. The former is the only amphipod species recorded from the Brazilian Amazon Biome, within the Tapajós River, Pará and the latter are found in marine coastal groundwater of Bahia and São Paulo. Considering the landhoppers (truly terrestrial), only two introduced species, Talitroides alluaudi (Chevreux, 1896) and Talitroides topitotum (Burt, 1934) have been found in the Atlantic forest biome, urban parks and sylviculture plantations from the southeast and south of Brazil. Moreover, several amphipod records for Brazil were noticed to be dubious or misidentifications and are listed in a table with pertinent literature.

Silent Atrial Fibrillation in Elderly Pacemaker Users: A Randomized Trial Using Home Monitoring.

BACKGROUND: Pacemaker with remote monitoring (PRM) may be useful for silent atrial fibrillation (AF) detection. The aims of this study were to evaluate the incidence of silent AF, the role of PRM, and to determine predictors of silent AF occurrence. METHODS: Three hundred elderly patients with permanent pacemaker (PPM) were randomly assigned to the remote group (RG) or control group (CG). All patients received PPM with remote monitoring capabilities. Primary end point was AF occurrence rate and the secondary end points were time to AF detection and number of days with AF. RESULTS: During the average follow-up of 15.7±7.7 months, AF episodes were detected in 21.6% (RG = 24% vs CG = 19.3%, P = 0.36]. There was no difference in the time to detect the first AF episode. However, the median time to detect AF recurrence in the RG was lower than that in the CG (54 days vs 100 days, P = 0.004). The average number of days with AF was 16.0 and 51.2 in the RG and CG, respectively (P = 0.028). Predictors of silent AF were left atrial diameter (odds ratio [OR] 1.2; 95% CI = 1.1-1.3; P < 0.001) and diastolic dysfunction (OR 4.8; 95% CI = 1.6-14.0; P = 0.005). CONCLUSIONS: The incidence of silent AF is high in elderly patients with pacemaker; left atrial diameter and diastolic dysfunction were predictors of its occurrence. AF monitoring by means of pacemaker is a valuable tool for silent AF detection and continuous remote monitoring allows early AF recurrence detection and reduces the number of days with AF.

Dynamics of chromosomal evolution in the genus Hypsiboas (Anura: Hylidae).

Hylidae is one of the most species-rich families of anurans, and 40% of representatives in this group occur in Brazil. In spite of such remarkable diversity, little is known about this family and its taxonomical and systematic features. Most hylids have 2n = 24, even though most of the cytogenetic data are mainly obtained based on the conventional chromosomal staining and are available for only 16% of Hypsiboas species, a genus accounting for about 10% of the hylid diversity. In this study, cytogenetic data of distinct species and populations of Hypsiboas were analyzed, and the evolutionary dynamics of chromosomal macro- and microstructure of these amphibians were discussed. Contrary to the conservativeness of 2n = 24, this genus is characterized by a high variation of chromosomal morphology with as much as 8 karyotype patterns. Differences in the number and location of nucleolus organizer regions and C-bands allowed the identification of geographical variants within nominal species and cytotaxonomical chromosomal markers. Comparative analyses revealed a strong phylogeographic relationship between chromosomal patterns in this group.

Seventh cervical nerve perforating the middle scalene muscle: a possible clinical and surgical application

Introduction: In most of cases, the emergency of the nervous roots of the brachial plexus in the posterior cervical triangle occur between the anterior and middle scalene muscles. However, anatomic variations in the brachial plexus are not rare. Methods: In the laboratory of Human Anatomy of the "Faculdade de Ciências Médicas de Minas Gerais" 106 cadavers were dissected. There were dissected the cervical region of all of the cadavers bilaterally. Results: In routinely dissection in the laboratory of human anatomy of the "Faculdade de Ciências Médicas de Minas Gerais" we've found in the left cervical region of a male cadaver the ventral branch of the seventh cervical nerve (C7) perforating the substance of the middle scalene muscle. Conclusion: Professionals that work with this region on the practice must pay attention to this and other variations in the constitution of the brachial plexus in the clinic and surgical procedures to avoid complications.(AU)

Sensorial differences according to sex and ages.

OBJECTIVE: To investigate age and sex differences in orofacial sensory detection. METHODS: One hundred and twenty-six (126) healthy subjects were divided into five groups according to their ages. They were assessed with a quantitative sensory testing protocol for gustative, olfactory, thermal (cold/warm), mechanical (tactile/vibration/electric), and pain (deep/superficial) detection thresholds. The corneal reflex was also evaluated. Data were analyzed with the one-way ANOVA, chi-squared, Fisher's exact, Mann-Whitney, and Kruskal-Wallis tests. RESULTS: The groups of subjects over 61 years old had higher olfactory (P < 0.001), gustative (sweet P = 0.004, salty P = 0.007, sour P = 0.006), thermal (warm P < 0.001, cold P < 0.001), and tactile (P < 0.001) detection thresholds than the others. The vibration detection threshold was high only for subjects over 75 years old (P < 0.001). The electric and deep pain detection thresholds were different for the 61-75 years old group (P ≤ 0.001). Women in all age groups had lower gustative (sweet P = 0.020, salty P = 0.002, sour P < 0.001, and bitter P = 0.002), olfactory (P = 0.010), warm (P < 0.001) and deep (P < 0.001), and superficial pain (P = 0.008) detection thresholds than men, and men from all age groups had lower vibratory detection thresholds (P = 0.006) than women. CONCLUSION: High sensory detection thresholds were observed in subjects over the 6th decade of life, and women had a more accurate sensory perception than men.

Phenotypic behavior of PBMCs from irradiated dogs based on flow cytometry.

The present paper investigates the phenotypic parameters of stimulation markers and cell immunosuppression markers in an animal model using flow cytometry analysis. Six dogs were exposed to 2, 4 or 6 Gy following a head and neck protocol. Samples of peripheral blood mononuclear cells (PBMCs) were collected before irradiation, representing standard values for all dogs (control), and at 2 h, 18 h and 30 d after irradiation. Such samples were separately assessed for surface markers with the monoclonal antibodies anti-CD5, anti-CD4 and anti-CTLA-4 by flow cytometry. A reduction in Tcell expression of CD5 and in the subpopulation expressing CD4 and an increase in CTLA-4 expression were found. No statistically significant differences were observed for the absorbed dose grouping, although the time kinetics were recorded. Radiation induced phenotypic differences between the lymphocyte lineages, reducing the CD5 and CD4 Tcell subpopulations and increasing CTLA-4 expression. The findings demonstrate the relevance of investigating the immunophenotype of irradiated subjects by examining the peripheral cell lineage.

Correlação entre as atividades antiradical, antiacetilcolinesterase e teor de fenóis totais de extratos de plantas medicinais de farmácias vivas / Correlation between the anti-radical, anti-acetylcholinesterase activities and phenolic content of some extracts of live herbal pharmacies in the Northeast of Brazil

O objetivo deste trabalho foi avaliar a correlação entre o conteúdo de fenóis de extratos de 18 plantas medicinais comuns nas Farmácias Vivas com a atividade sequestradora do radical livre DPPH e com a inibição da enzima acetilcolinesterase. Maiores conteúdos de fenóis totais foram encontrados nas plantas: Eugenia uniflora, Lippia alba, Lippia microphylla, Mentha x villosa, Ocimum gratissimum e Ocimum selloi. As espécies que apresentaram maior atividade antioxidante, semelhante a quercetina, foram: Spondias mombim, Malphigia glabra, L. alba e Croton zenhtneri,. As plantas Cecropia pachystachia, L. alba, L. microphylla, M. glabra, O. gratissimum e Plectranthus ornatus mostraram maiores halos de inibição da enzima acetilcolinesterase. Combinando as duas ações, as plantas mais ativas foram a M. glabra e a L. alba e somente a segunda correlaciona-se diretamente com o maior teor de fenóis totais. Através deste estudo, M. glabra e L. alba foram consideradas as plantas mais promissoras para estudos subsequentes a fim de encontrar novos compostos com ação potencial contra a doença de Alzheimer.

The purpose of this study was to evaluate the phenolic content of 18 medicinal plant extracts of "Live Pharmacies" and correlate them with their free radical scavenging activity and inhibition of the acetylcholinesterase enzyme. Higher amounts of phenolic compounds were found in the following plants: Eugenia uniflora, Lippia alba, Lippia microphylla, Mentha x villosa, Ocimum gatissimum, and Ocimum selloi. The species that showed higher anti-radical activity were Croton zenhtneri, Lippia alba, Malphigia glabra, and Spondias mombim, similar to quercetin. The plants Cecropia pachystachia, L. alba, L. microplylla, M. glabra, O. gratissimum, and Plectranthus ornatus showed larger inhibition zones of the acetylcholinesterase enzyme. By correlating the two actions L. alba and M. glabra are common as more active to both tests and only L. alba correlates directly with the phenolic content. Through this study, L. alba and M. glabra are considered the most promising plants for further studies to find new compounds with potential action against Alzheimer's disease.

Clinical Implications caused by the agenesis of the RectusAbdominal Muscle’s (MRA) inferior venter

The rectus abdominal muscle is part of the anterior abdominal wall, having three to six bellies. In only oneof the 106 dissections already made in the “Faculdade de Ciências Médicas de Minas Gerais” AnatomyLaboratory was found a male cadaver who did not have inferior venter of this muscle bilaterally. Instead, at theleft side, was found a tendon that measured 5.5 cm laterally and 12 cm medially, and at the right side, therewas the same variation with a 15.5 cm length tendon, rising in the upper branch of the pubis and crest pubis.Despite being a rare variation, individuals who have showed it have increased potential for physiological andsurgical complications, in case they need interventions using inferior rectus abdominis muscle venter’s snips.

Anomalous origin of the Abductor Pollicis Longus (APL): clinical and surgical applications

The Abductor Pollicis Longus (APL) is known to have a big variety in its number of insertion tendons.Because of that, studies about variations in its origin are not frequently achieved like studies about its insertionforms. This study describes an anatomic variation of the Abductor Pollicis Longus, with an anomalous venteroriginated of the inferior portion of the lateral border of the radio. Surgical and clinical implications are inrelation principally with the big number of tendons of insertion of the APL, but there are related cases inthe literature in that additional venter of this muscle also can be involved in the physiopathology of clinicalsyndromes, like the tenosynovitis of de Quervain

Disponibilidade domiciliar de lipídeos para consumo e sua relação com os lipídeos séricos de adolescentes / Household availability of lipids for consumption and its relationship with serum lipids in adolescents / Disponibilidad domiciliar de lípidos para consumo y su relación con los lípidos séricos de adolescentes

Relacionar a disponibilidade domiciliar de lipídeos para consumo e o perfil lipídico sérico de adolescentes. MÉTODOS: Estudo transversal observacional. Avaliaram-se 95 adolescentes púberes de 10 a 13 anos de escolas públicas em Viçosa, Minas Gerais. Utilizou-se uma lista de compras mensal para avaliar a disponibilidade de alimentos per capita. Coletou-se amostra de sangue dos adolescentes, adotando-se o preconizado pela Sociedade Brasileira de Cardiologia como referência para adequação do perfil lipídico. Para as variáveis categóricas realizou-se o teste do qui-quadrado e calculou-se a Odds Ratio. Para comparar os grupos, aplicaram-se os testes Mann-Whitney ou t de Student, Kruskall-Wallis ou ANOVA. Verificou-se relação entre exames bioquímicos e disponibilidade de lipídeos pelas correlações de Spearmam ou de Pearson. RESULTADOS: Da energia total disponível, 27,2% foram provenientes de lipídeos. A disponibilidade de ácidos graxos saturados, monoinsaturados e poli-insaturados esteve de acordo com a recomendação de consumo. Em relação aos lipídeos séricos, 51,9% dos meninos e 55,8% das meninas apresentaram alterações de colesterol total (p=0,66); 18,6 e 25,6%, dos meninos e das meninas, respectivamente, apresentaram elevação de triglicerídeos, (meninas>meninos; p=0,02). Em relação ao LDL, 21,2 e 32,6% dos meninos e das meninas, respectivamente, apresentaram alterações (p=0,91). A prevalência de inadequação para HDL foi de 26,9 e 30,2% (p=0,93), para meninos e meninas, respectivamente. Não houve correlação entre os lipídeos disponíveis para consumo e os lipídeos séricos. Os adolescentes que possuíam mais que 35% de lipídeos disponíveis para consumo tiveram 9,1 vezes mais chances de apresentarem alterações de colesterol total (IC95% 1,81-61,74). CONCLUSÕES: É possível que adolescentes com maior disponibilidade de lipídeos para consumo apresentem colesterol total mais elevado.

To analyze the correlation between household availability of lipids to be consumed and the serum lipid profile in adolescents. METHODS: This cross sectional study enrolled 95 adolescents aged 10-13 years, selected by random raffle in public schools of Viçosa, Southeast Brazil. A monthly shopping list was used to evaluate the availability of food per capita. A blood sample was collected from each adolescent and Brazilian Cardiology Society guideline was adopted as a reference for lipid profile adequacy. For categorical variables, the chi-square was applied and the Odds Ratio calculated. For comparison between groups, Mann-Whitney or Student's t test, Kruskall-Wallis test or ANOVA were applied. Association between biochemical parameters and lipid availability was evaluated by Spearman or Pearson correlation tests. RESULTS: 27.2% of the total available energy came from lipids. The availability of saturated fatty acids, monounsaturated and polyunsaturated agreed with the recommendation for their consumption. Regarding serum lipids, 51.9% of boys and 55.8% of girls showed alteration in total cholesterol (p=0.66); 18.6 and 25.6% of boys and girls, respectively, showed increased triglycerides level (girls>boys; p=0.02). In relation to LDL, 21.2 and 32.6% of boys and girls, respectively, showed alteration (p=0.91). The prevalence of inadequacy for HDL was of 26.9 and 30.2% of boys and girls, respectively (p=0.93). There was no correlation between the available lipids for consumption and the serum lipids. The teenagers with more than 35% of lipids to be consumed had 9.1-fold higher levels of total cholesterol (95%CI 1.81-61.74). CONCLUSIONS: It is possible that adolescents with higher lipid availability at home show higher total cholesterol.

Relacionar la disponibilidad domiciliar de lípidos para consumo y el perfil lipídico sérico de adolescentes. MÉTODOS: Estudio transversal, observacional. Se evaluó a 95 adolescentes púberes de 10 a 13 años, de escuelas públicas en Viçosa, Minas Gerais (Brasil). Se utilizó una lista de compras mensual para evaluación de la disponibilidad de alimentos per capita. Se recogió muestra de sangre de los adolescentes, adoptándose lo preconizado por la Sociedad Brasileña de Cardiología como referencia para adecuación del perfil lipídico. Para las variables categóricas, se utilizó la prueba de chi cuadrado y se calculó la Odds Ratio. Para comparar los grupos, se aplicaron las pruebas de Mann-Whitney o t de Student, Kruskall-Wallis o ANOVA. Se verificó la relación entre exámenes bioquímicos y disponibilidad de lípidos por las correlaciones de Spearman o de Pearson. RESULTADOS: De la energía total disponible, el 27,2% fue proveniente de lípidos. La disponibilidad de ácidos grasos saturados, monoinsaturados o poli-insaturados, estuvo en conformidad con la recomendación de consumo. Respecto a los lípidos séricos, 51,9% de los muchachos y 55,8% de las muchachas presentaron alteraciones de colesterol total (p=0,66); 18,6 y 25,6% de los muchachos y muchachas, respectivamente, presentaron aumento de los triglicéridos (muchachas>muchachos; p=0,02). Respecto al LDL, 21,2 y 32,6% de los muchachos y muchachas, respectivamente, presentaron alteraciones (p=0,91). La prevalencia de inadecuación para HDL fue de 26,9 y 30,2% (p=0,93) respectivamente para muchachos y muchachas. No hubo correlación entre lípidos disponibles para consumo y lípidos séricos. Los adolescentes que poseían más que 35% de lípidos disponibles para consumo tuvieron 9,1 veces más posibilidad de presentar alteraciones de colesterol total (IC95% 1,81-61,74). CONCLUSIONES: Es posible que adolescentes con mayor disponibilidad de lípidos para consumo presenten colesterol total más elevado.

Sequential dose-dense Doxorubicin and Ifosfamide in advanced soft-tissue sarcoma patients in an out-patient-basis schedule.

Aims. This phase II study explored activity/safety of front-line dose-dense chemotherapy in high-grade STS (soft tissue sarcoma) patients and tested ezrin as prognostic factor. Patients and Methods. The protocol consisted of three cycles of doxorubicin (DOXO) 30 mg/m(2) on days 1-3 every 2 weeks, followed by three cycles of ifosfamide (IFO) 2.5 g/m(2) two hours a day on days 1-5 every 3 weeks, with GCSF support. Ezrin was assessed immunohistochemically. Results. Twenty patients, 13 metastatic and 7 locally advanced, were enrolled. Median age was 39 years (25-60). Median dose intensities were 42 mg/m(2)/week and 3.6 g/m(2)/week for DOXO and IFO, respectively. Grade 3/4 toxicities occurred in 18 patients. Response rate was 15% (3 of 20) by RECIST. Patients younger than 45 years with locally advanced disease and synovial histology presented longer survival. A trend towards longer survival was observed among ezrin-positive patients. Conclusions. This dose-dense schedule should not be routinely used due to its high frequency of toxic events; however, a sequential strategy with DOXO and IFO may benefit selected patients and should be further explored with lower doses. The role of ezrin as a prognostic marker should be confirmed in a larger group of patients.

The assessment and management of pain in the demented and non-demented elderly patient / Avaliação e manejo da dor em pacientes idosos com e sem demência

Persistent pain is a frequent health problem in the elderly. Its prevalence ranges from 45 percent to 80 percent. Chronic diseases, such as depression, cardiovascular disease, cancer and osteoporosis have a higher prevalence in aged individuals and increase the risk of developing chronic pain. The presence of pain is known to be associated with sleep disorders in these patients, as well as functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs. Alzheimer's disease patients seem to have a normal pain discriminative capacity and they may probably have weaker emotional and affective experience of pain when compared to other types of dementia. Many patients have language deficits and thus cannot properly describe its characteristics. In more advanced cases, it becomes even difficult to determine whether pain is present or not. Therefore, the evaluation of these patients should be performed in a systematic way. There are three ways to measure the presence of pain: by direct questioning (self-report), by direct behavioral observation and by interviews with caregivers or informants. In recent years, many pain scales and questionnaires have been published and validated specifically for the elderly population. Some are specific to patients with cognitive decline, allowing pain evaluation to be conducted in a structured and reproducible way. The next step is to determine the type of painful syndrome and discuss the bases of the pharmacological management, the use of multiple medications and the presence of comorbidities demand the use of smaller doses and impose contra-indications against some drug classes. A multiprofessional approach is the rule in the management of these patients.

Dor persistente é um problema de saúde frequente no idoso e sua prevalência varia de 45 a 80 por cento. Doenças crônicas, como depressão, distúrbios cardiovasculares, câncer e osteoporose tem alta prevalência em indivíduos idosos e aumentam o risco de desenvolver dor crônica. Nestes indivíduos, a presença de dor está associada a distúrbios do sono, prejuízo funcional, diminuição da sociabilidade e maior procura dos serviços de saúde, com o consequente aumento dos custos de saúde. Pacientes com Alzheimer têm uma capacidade discriminativa dolorosa normal e uma experiência afetiva e emocional da dor mais atenuada quando comparados com outros tipos de demência. Muitos pacientes têm déficits de linguagem e não podem descrever adequadamente as características de sua dor. Em casos avançados, torna-se difícil determinar se a dor está realmente presente ou não. Desta forma, a avaliação destes doentes deve ser realizada de forma sistemática. Há três formas de se avaliar a dor: questionários diretos, observação direta do comportamento ou entrevistas diretas com os cuidadores ou informantes. Nos últimos anos muitas escalas e questionários para dor foram publicados e validados especificamente para a população idosa. Alguns são específicos para pacientes com declínio cognitivo, permitindo que a evolução da dor possa ser conduzida de uma forma estruturada e reprodutível. O passo seguinte é se determinar o tipo de síndrome dolorosa e se discutir as bases do manejo farmacológico. O uso de múltiplas medicações e a presença de comorbidades exige o uso de pequenas doses e impõem contra-indicações para algumas classes de drogas. A abordagem multidisciplinar é a regra no seguimento a longo prazo destes doentes.

Monostotic fibrous dysplasia of the clivus: image-guided endoscopic endonasal transsphenoidal surgery.

INTRODUCTION: Fibrous dysplasia is a non-heritable, congenital disease involving the bones. Its diagnosis relies on image examination and pathology. Treatment is usually conservative, but in cases of cranial nerve impingement or extension to the condyles, surgery should be considered. In this paper, we describe a singular case of monostotic fibrous dysplasia of the clivus in a child. CASE REPORT: A 14-year-old boy presented with chronic headache and diplopia. A neurological examination revealed palsy of the right VIth cranial nerve. The radiological findings were consistent with fibrous dysplasia, with a hypointense and isointense clival lesion on T (1)- and T (2)-weighted images, respectively. Surgical treatment was indicated by cranial nerve impairment. An endoscopic endonasal approach with an image-guided system was used. The patient was discharged four days after surgery and his diplopia improved postoperatively. DISCUSSION: A variety of surgical approaches have been used in the treatment of midline extra-axial cranial base tumors. Fibrous dysplasia of the clivus without expansion to the condylus can be removed with a transsphenoidal endonasal endoscopic approach. Preoperative imaging reveals the individual patient's anatomy and improves the intraoperative orientation. CONCLUSION: Image-guided transsphenoidal endoscopic surgery is recommended for its safety and minimal invasiveness.

Synchronous collision malignant melanoma and adenocarcinoma of the rectum.

"Collision tumors" consist of two independent but coexisting tumors. This uncommon situation might be easily mistaken for a composite tumor where one histogenetic event originates from two apparently distinct neoplasms. Colorectal collisions are particularly unusual; here, we report the exceedingly rare case of a 61-year-old man with malignant melanoma and adenocarcinoma colliding in the rectum. Collision tumors have an idiopathic pathophysiology and in fact "accidental meeting" is accepted by many authors. This article discusses the concepts about cancer development, which are overlooked by this hypothesis, another theory to explain that this rare occurrence involves microenvironment changes.

Somesthetic, gustatory, olfactory function and salivary flow in patients with neuropathic trigeminal pain.

OBJECTIVES: To determine somesthetic, olfactory, gustative and salivary abnormalities in patients with burning mouth syndrome (BMS), idiopathic trigeminal neuralgia (ITN) and trigeminal postherpetic neuralgia (PHN). SUBJECTS AND METHODS: Twenty patients from each group (BMS, ITN, PHN) and 60 healthy controls were evaluated with a systematized quantitative approach of thermal (cold and warm), mechanical, pain, gustation, olfaction and salivary flow; data were analyzed with ANOVA, Tukey, Kruskal-Wallis and Dunn tests with a level of significance of 5%. RESULTS: There were no salivary differences among the groups with matched ages; the cold perception was abnormal only at the mandibular branch of PHN (P = 0.001) and warm was abnormal in all trigeminal branches of PHN and BMS; mechanical sensitivity was altered at the mandibular branch of PHN and in all trigeminal branches of BMS. The salty, sweet and olfactory thresholds were higher in all studied groups; the sour threshold was lower and there were no differences of bitter. CONCLUSION: All groups showed abnormal thresholds of gustation and olfaction; somesthetic findings were discrete in ITN and more common in PHN and BMS; central mechanisms of balance of sensorial inputs might be underlying these observations.

Special care dentistry: Midazolam conscious sedation for patients with neurological diseases.

AIM: Midazolam is used very often to control the anxiety of patients for dental treatment, especially in patients with special needs. The objective of this study was to evaluate the efficiency of Midazolam in patients with neurological diseases referred for dental treatment. STUDY DESIGN: Descriptive study. MATERIALS AND METHODS: Forty consecutive patients with neurological disorders (encephalopathy, autism, and epilepsy) were referred to dental treatment, and 45 sedations were performed; all were sedated with Midazolam (intramuscular 0.2-0.3 mg/kg or intravenous 0.1mg/kg) and all were anesthetised with lidocaine 2% (0.5-2 mL). During the dental procedure, their behavior was analysed and classified into 3 categories: A (indifferent), B (reacted but allowed treatment), and C (did not allow treatment). Data were tabbed and statistically analysed. RESULTS: The final patients' classification was: A 22 (49%), B 18 (40%) and C 5 (11%); the patients with encephalopathy had the best results of sedation according to the proposed classification (p<0.05). CONCLUSION: Midazolam demonstrated to be effective in 89% of this sample for dental procedures in patients with neurological and behavioral disturbances, but it was less effective for patients with autism (p<0.05).

Lymphadenectomy in colorectal cancer liver metastases resection: incidence of hilar lymph nodes micrometastasis.

BACKGROUND: Liver resection is considered the best treatment for metastatic colorectal cancer. Several prognostic factors have been investigated, and many studies have shown that hepatic hilum lymph nodes involvement has a negative impact on prognosis. The present study evaluated the frequency of microscopic involvement of hilar lymph nodes, through systematic lymphadenectomy and analysis of micrometastases in patients undergoing hepatectomy due to colorectal metastasis. METHODS: A total of 28 patients underwent hepatic resection with hilar lymphadenectomy. Lymph nodes considered negative by conventional hematoxylin and eosin (H&E) staining were analyzed by serial sectioning with 100-microm intervals and immunohistochemistry (IHC) with anti-human pancytokeratin antibody AE1/AE3. RESULTS: In average, 6.18 lymph nodes were dissected per patient. No morbidity or mortality was associated to lymphadenectomy. In two patients, conventional H&E analysis showed presence of microscopic lymph node metastasis. IHC analysis allowed the identification of three other patients with lymph node micrometastases. The overall frequency of microscopic metastases, including micrometastasis, was 18%. CONCLUSIONS: Systematic lymphadenectomy allowed the detection of microscopic lymph node metastases, resulting in more accurate staging of extrahepatic disease. The inclusion of IHC increased the detection of lymph node micrometastasis.