Colour-duplex ultrasonography of the temporal and ophthalmic arteries in the diagnosis and follow-up of giant cell arteritis.

OBJECTIVE: To evaluate the diagnostic value of colour-duplex ultrasonography (CDU) of the temporal and ophthalmic arteries in the diagnosis of giant cell arteritis (GCA) and its usefulness in the follow-up of the disease. Furthermore, to examine the relationship between CDU abnormalities in ophthalmic arteries and blindness. METHODS: This is a prospective study of all patients with clinical suspicion of GCA or polymyalgia rheumatica (PMR) seen consecutively at the Internal Medicine Department at Vall d'Hebron University Hospital, Spain, between March 2003 and July 2006. Patients were evaluated with regard to the sensitivity and specificity of the dark halo sign in the temporal artery for the diagnosis of GCA, as well as the sensitivity and specificity of the presence of stenosis in temporal and/or ophthalmic arteries. Additionally, the usefulness of the dark halo sign in the follow-up of GCA was addressed. RESULTS: Forty-seven patients (30 with GCA, 17 with PMR) and 13 controls were included in the study. The sensitivity and specificity for the diagnosis of biopsy-proven GCA were higher for the temporal halo (72% in both cases) than for temporal artery stenosis (41% and 89%, respectively), or for ophthalmic artery stenosis (58% and 89%, respectively). Disappearance of the halo was observed in 50% of patients six months after diagnosis, although all patients were in clinical remission, and laboratory parameters were within normal values. CONCLUSION: CDU of the temporal arteries may be a valid tool in the diagnosis of GCA. However, its role in the follow up of the disease deserves re-evaluation. CDU of the ophthalmic arteries is less useful for CGA diagnosis and no relationship with blindness is suspected.

Tumor de Pindborg (tumor odontogénico epitelial calcificante) / Pindborg tumor (Calcifying epithelial odontogenic tumor)

El objetivo del presente artículo es realizar una revisión de laliteratura del tumor de Pindborg a propósito de un caso. El interés radicaen su baja frecuencia y a la importancia de la anatomía patológica para sudiagnóstico y correcto tratamiento ya que puede confundirse en algunoscasos con otras tumoraciones benignas, a diferencia de las cuales, en estetumor debe realizarse una resección con márgenes de seguridad paradisminuir la probabilidad de recidiva(AU)

The aim of this article is to review the literatureon Pindborg tumor based on a case. In view of its low frequencyand the importance of histology for its correct diagnosisand treatment as it can be confused with other benigntumors, appropriate resection is necessary with tumor-freemargins in order to reduce the probability of local recurrence(AU)

Proposal to decrease the number of negative temporal artery biopsies.

OBJECTIVE: The percentage of negative temporal artery biopsies (TABs) remains very high in patients with suspected giant cell arteritis (GCA). The aim of our study was to identify the clinical predictors of TAB results to improve the effectiveness of this diagnostic procedure. METHODS: We performed a cross-sectional study of 125 consecutive patients who underwent TAB in the Department of Internal Medicine of a public tertiary hospital, from January 1997 to March 2002. We compared patients with a positive and a negative biopsy result. RESULTS: Forty-six of the 125 biopsies (36.8%) were positive for GCA and 79 (63.2%) negative. Temporal artery (TA) thickening (8.01), decreased pulse (5.58), jaw claudication (4.87), and scalp tenderness (4.29) presented the highest positive likelihood ratios (LR+). Erythrocyte sedimentation rate (ESR) (0.11), headache (0.39), TA thickening (0.42), and decreased pulse (0.48) had the lowest negative likelihood ratios (LR-). Only TA abnormalities [odds ratio (OR) 12.3] and scalp tenderness (OR 6) were independent predictors of biopsy results. By excluding patients with no evidence of TA abnormalities, scalp tenderness, or jaw claudication, only 48% of the 125 biopsies would have been performed; 59 negative biopsies would have been prevented, but six positive biopsies would have been missed. CONCLUSION: Careful assessment of patients with clinically suspected GCA to rule out artery abnormalities, scalp tenderness, and jaw claudication can lead to a dramatic decrease in the percentage of negative biopsies. This observation may contribute to improving the physician's decision-making process when contemplating TAB.

Gingival squamous cell carcinoma: a clinical case and differential diagnosis.

A 59-year-old woman presented with a tumor of the gums located in the second quadrant for the past 6 weeks. The histopathological findings are presented and the most likely differential diagnoses are commented (pyogenic granuloma, squamous cell carcinoma and gingival metastases), along with the importance of the radiological features. The definitive diagnosis requires concordance among the clinical, radiological and histopathological characteristics of the lesion.