Glandular odontogenic cyst: report of an unusual case in the posterior mandible / Cisto odontogênico glandular: relato de um caso incomum na região posterior de mandíbula

ABSTRACT The glandular odontogenic cyst (GOC) is an uncommon developmental cyst that presents glandular differentiation and has potential for recurrence. Clinically, it is asymptomatic and it has slow growing. This report proposes to describe a clinical case of GOC diagnosed at the Service of Pathological Anatomy of a university in the northeast of Brazil, in the posterior region of the mandible, which was treated with mandibular resection and bone graft with iliac crest. One may conclude that clinical, microscopic and radiographic parameters were crucial tools for treatment choice.

RESUMEN El quiste odontogénico glandular (QOG) es un quiste del desarrollo poco frecuente que presenta diferenciación glandular y es propenso a la recurrencia. Clinicamente, es asintomático y de crecimiento lento. El presente trabajo tiene como objetivo describir un caso clinico de QOG diagnosticado en la región posterior de la mandíbula en un paciente masculino de 36 anos de edad, atendido en el servicio de Anatomia Patológica de una universidad en el nordeste de Brasil. Se decidió tratarlo por resección mandibular e injerto óseo de la cresta ilíaca. La conclusión a que podemos llegar es que los parâmetros clínicos, microscópicos y radiográficos fueran herramientas esencialespara la elección del tratamiento.

RESUMO O cisto odontogênico glandular (COG) é um cisto de desenvolvimento incomum que apresenta diferenciação glandular e tem potencial de recidiva. Clinicamente, é assintomático e de crescimento lento. Este relato propõe-se a descrever um caso clínico de COG diagnosticado em região posterior de mandíbula em um paciente do gênero masculino, 36 anos de idade, atendido no Serviço de Anatomia Patológica de uma universidade no nordeste do Brasil. Como tratamento, optou-se por ressecção mandibular e enxerto ósseo da crista ilíaca. Conclui-se que os parâmetros clínicos, microscópicos e radiográficos foram ferramentas essenciais na escolha do tratamento realizado.

Update of dental and maxillofacial alterations in patients with pycnodysostosis / Atualização das alterações dentárias e dos ossos gnáticos em pacientes com picnodisostose

ABSTRACT Pycnodysostosis is a rare, autosomal recessive genetic condition, which causes a decrease in bone remodeling, resulting in different clinical and radiographic manifestations. This case series aims to describe two clinical cases diagnosed at the Department of Oral and Maxillofacial Surgery and Traumatology of a University on the Northeast of Brazil. There are two complex cases involving osteomyelitis and dental and bone alterations of the jaws. It is concluded that the knowledge of oral and maxillofacial characteristics of this syndrome are required to plan appropriate treatment for patient in order to avoid complications of dental treatments due to inadequate bone remodeling.

RESUMEN La picnodisostosis es una enfermedad genética rara autosómica, recesiva, con disminución de la remodelación ósea, que ocasiona varias manifestaciones clínicas y radiográficas. Este estudio describe dos casos clínicos diagnosticados en el servicio de cirugía y traumatología bucomaxilofacial de una universidad en el nordeste de Brasil. Los casos son complejos y envuelven osteomielitis, alteraciones dentales y óseas de las mandíbulas. Es necesario conocer las características orales y maxilofaciales de este síndrome para planear el tratamiento adecuado al paciente, con la intención de evitar complicaciones de tratamientos dentales debido a la remodelación ósea inadecuada.

RESUMO A picnodisostose é uma condição genética rara, autossômica recessiva, que ocasiona diminuição da remodelação óssea, resultando em várias manifestações clínicas e radiográficas. Este estudo pretende descrever dois casos clínicos diagnosticados no Serviço de Cirurgia e Traumatologia Bucomaxilofacial de uma universidade no nordeste do Brasil. São dois casos complexos que envolvem osteomielite e alterações dentárias e ósseas dos maxilares. É necessário o conhecimento das características orais e maxilofaciais dessa síndrome para planejar o tratamento adequado para o paciente, a fim de se evitar complicações de tratamentos dentários em virtude do remodelamento ósseo inadequado.

Insulin action is severely impaired in adipocytes of apparently healthy overweight and obese subjects.

OBJECTIVE: Many overweight/obese subjects appear metabolically healthy with normal in vivo insulin sensitivity. Still, they have increased long-term risk of developing type 2 diabetes. We hypothesized that adipose tissue dysfunction involving decreased insulin action in adipocytes is present in apparently healthy overweight/obese subjects. DESIGN/METHODS: Subjects with normal metabolic health according to Adult Treatment Panel-III or Framingham risk score criteria were subdivided into 67 lean, 32 overweight and 37 obese according to body mass index. They were compared with 200 obese individuals with metabolic syndrome. Insulin sensitivity and maximum action on inhibition of lipolysis and stimulation of lipogenesis was determined in subcutaneous adipocytes. Gene expression was determined by micro-array and qPCR. DNA methylation was assessed by array, pyrosequencing and reporter assays. RESULTS: Compared with lean, adipocytes in overweight/obese displayed marked reductions in insulin sensitivity in both antilipolysis and lipogenesis as well as an attenuated maximum lipogenic response. Among these, only antilipolysis sensitivity correlated with whole-body insulin sensitivity. These differences were already evident in the overweight state, were only slightly worse in the unhealthy obese state and were not related to fat cell size. Adipose tissue analyses linked this to reduced expression of the insulin signalling protein AKT2, which associated with increased methylation at regulatory sites in the AKT2 promoter. CONCLUSIONS: Apparently healthy subjects have severely disturbed adipocyte insulin signalling already in the overweight state which involves epigenetic dysregulation of AKT2. This may constitute an early defect in insulin action that appears even upon modest increases in fat mass.

Depot-specific differences in fatty acid composition and distinct associations with lipogenic gene expression in abdominal adipose tissue of obese women.

Cardiometabolic diseases are primarily linked to enlarged visceral adipose tissue (VAT). However, some data suggest heterogeneity within the subcutaneous adipose tissue (SAT) depot with potential metabolic differences between the superficial SAT (sSAT) and deep SAT (dSAT) compartments. We aimed to investigate the heterogeneity of these three depots with regard to fatty acid (FA) composition and gene expression. Adipose tissue biopsies were collected from 75 obese women undergoing laparoscopic gastric bypass surgery. FA composition and gene expression were determined with gas chromatography and quantitative real-time-PCR, respectively. Stearoyl CoA desaturase-1 (SCD-1) activity was estimated by product-to-precursor FA ratios. All polyunsaturated FAs (PUFA) with 20 carbons were consistently lower in VAT than either SAT depots, whereas essential PUFA (linoleic acid, 18:2n-6 and α-linolenic acid, 18:3n-3) were similar between all three depots. Lauric and palmitic acid were higher and lower in VAT, respectively. The SCD-1 product palmitoleic acid as well as estimated SCD-1 activity was higher in VAT than SAT. Overall, there was a distinct association pattern between lipid metabolizing genes and individual FAs in VAT. In conclusion, SAT and VAT are two distinct depots with regard to FA composition and expression of key lipogenic genes. However, the small differences between sSAT and dSAT suggest that FA metabolism of SAT is rather homogenous.

Cognitive-perceptual deficits and symptom correlates in first-episode schizophrenia.

BACKGROUND: Thought disorder and visual-perceptual deficits have been well documented, but their relationships with clinical symptoms and cognitive function remain unclear. Cognitive-perceptual deficits may underscore clinical symptoms in schizophrenia patients. AIM: This study aimed to explore how thought disorder and form perception are related with clinical symptoms and cognitive dysfunction in first-episode schizophrenia. SETTING: Forty-two patients with a first-episode of schizophrenia, schizophreniform or schizoaffective disorder were recruited from community clinics and state hospitals in the Cape Town area. METHODS: Patients were assessed at baseline with the Rorschach Perceptual Thinking Index (PTI), the Positive and Negative Syndrome Scale (PANSS) and the MATRICS Cognitive Consensus Battery (MCCB). Spearman correlational analyses were conducted to investigate relationships between PTI scores, PANSS factor analysis-derived domain scores and MCCB composite and subscale scores. Multiple regression models explored these relationships further. RESULTS: Unexpectedly, poor form perception (X- %) was inversely correlated with the severity of PANSS positive symptoms (r = -0.42, p = 0.02). Good form perception (XA%) correlated significantly with speed of processing (r = 0.59, p < 0.01), working memory (r = 0.48, p < 0.01) and visual learning (r = 0.55, p < 0.01). PTI measures of thought disorder did not correlate significantly with PANSS symptom scores or cognitive performance. CONCLUSIONS: Form perception is associated with positive symptoms and impairment in executive function during acute psychosis. These findings suggest that there may be clinical value in including sensory-perceptual processing tasks in cognitive remediation and social cognitive training programmes for schizophrenia patients.

Impaired atrial natriuretic peptide-mediated lipolysis in obesity.

BACKGROUND: Catecholamines and natriuretic peptides (NPs) are the only hormones with pronounced lipolytic effects in human white adipose tissue. Although catecholamine-induced lipolysis is well known to be impaired in obesity and insulin resistance, it is not known whether the effect of NPs is also altered. METHODS: Catecholamine- and atrial NP (ANP)-induced lipolysis was investigated in abdominal subcutaneous adipocytes in vitro and in situ by microdialysis. RESULTS: In a cohort of 122 women, both catecholamine- and ANP-induced lipolysis in vitro was markedly attenuated in obesity (n=87), but normalized after substantial body weight loss (n=52). The impairment of lipolysis differed between the two hormones when expressing lipolysis per lipid weight, the ratio of stimulated over basal (spontaneous) lipolysis rate or per number of adipocytes. Thus, while the response to catecholamines was lower when expressed as the former two measures, it was higher when expressed per cell number, a consequence of the significantly larger fat cell size in obesity. In contrast, although ANP-induced lipolysis was also attenuated when expressed per lipid weight or the ratio stimulated/basal, it was similar between non-obese and obese subjects when expressed per cell number suggesting that the lipolytic effect of ANP may be even more sensitive to the effects of obesity than catecholamines. Obesity was characterized by a decrease in the protein expression of the signaling NP A receptor (NPRA) and a trend toward increased levels of the clearance receptor NPRC. The impairment in ANP-induced lipolysis observed in vitro was corroborated by microdialysis experiments in situ in a smaller cohort of lean and overweight men. CONCLUSIONS: ANP- and catecholamine-induced lipolysis is reversibly attenuated in obesity. The pro-lipolytic effects of ANP are relatively more impaired compared with that of catecholamines, which may in part be due to specific changes in NP receptor expression.

Efficacy assessment of two antibiotic prophylaxis regimens in oral and maxillofacial trauma surgery: preliminary results.

The study set out to evaluate the efficacy of two antibiotic prophylaxis regimens in patients with facial fractures admitted to the Oral and Maxillofacial Surgery and Traumatology services of the Onofre Lopes University Hospital attached to the Federal University of Rio Grande do Norte in the period from December 2011 to December 2012. The sample consisted of 74 patients divided into two groups, GI with forty-three patients and GII with 32. Both groups received 2 g of cefazolin, 20 minutes before surgery. The postoperative protocol for each group was randomly determined; group I (single dose) received no antibiotics after surgery but group II (24 h dosage) received 1 g of cefazolin every 6 hours for 24 hours. Postoperative infection incidence was 9.3% (seven patients), six patients in Group I and one in Group II. 85% of the infections were in mandibular fractures. Results were presented qualitatively and quantitatively and the Chi square test (taking the value for p to be < 0.05) showed no statistically significant differences in the efficacies of the two regimens in the comparisons made between the cases of fractures in the upper and middle thirds of the face with those in the lower third (mandibular fractures). Considering mandibular fractures alone, Group II proved to be more efficacious with a p value of 0.02. However, to confirm the tendency shown in the mandibular fracture treatments whereby prolonging antibiotic administration for 24 hours appeared to be beneficial, research needs to be done with much larger sample groups.

Low early B-cell factor 1 (EBF1) activity in human subcutaneous adipose tissue is linked to a pernicious metabolic profile.

AIM: Recently, in both human and murine white adipose tissue (WAT), transcription factor early B-cell factor 1 (EBF1) has been shown to regulate adipocyte differentiation, adipose morphology and triglyceride hydrolysis (lipolysis). This study investigated whether EBF1 expression and biological activity in WAT is related to different metabolic parameters. METHODS: In this cross-sectional study of abdominal subcutaneous WAT, EBF1 protein levels were examined in 18 non-obese subjects, while biological activity was determined in 56 obese and non-obese subjects. Results were assessed by anthropometric measures and blood pressure as well as by plasma lipid levels and insulin sensitivity. RESULTS: EBF1 protein levels were negatively associated with waist circumference (r=-0.56; P=0.015), but not with body mass index (BMI) or body fat (P=0.10-0.29). Biological activity of EBF1 correlated negatively with plasma triglycerides (r=-0.46; P=0.0005) and plasma insulin (r=-0.39; P=0.0027), but positively with plasma HDL cholesterol (r=0.48; P=0.0002) and insulin sensitivity, as assessed by intravenous insulin tolerance test (r=0.64; P<0.0001). These relationships, except for plasma insulin, remained statistically significant after adjusting for BMI and adipose morphology. EBF1 activity was not associated with age, systolic/diastolic blood pressure or total plasma cholesterol (P=0.17-0.48). In contrast to EBF1 activity, after adjusting for BMI, EBF1 mRNA levels displayed only an association with plasma triglycerides. CONCLUSION: Low EBF1 protein expression and activity in abdominal subcutaneous WAT is a BMI-independent marker for several traits associated with the metabolic syndrome. However, whether EBF1 constitutes a novel treatment target remains to be demonstrated.

Symptom recurrence following intermittent treatment in first-episode schizophrenia successfully treated for 2 years: a 3-year open-label clinical study.

OBJECTIVE: An unanswered question in the management of schizophrenia is how long antipsychotic treatment should be continued after a single psychotic episode. In this study, we assessed the rates of symptom recurrence with intermittent treatment in patients with a first episode of DSM-IV-defined schizophrenia or related illness after 2 years of successful continuous treatment. We also investigated antecedents of recurrence, as well as demographic and baseline clinical predictors of early recurrence, and we compared the psychopathology of the recurrence episode with that of the first episode. METHOD: Outpatients in an academic psychiatric hospital setting (single site) who had responded well in an open-label study with risperidone long-acting injection were recruited for this intermittent treatment trial, and those who participated had their treatment tapered and discontinued over a period of up to 6 weeks, with follow-up for 3 years or until reemergence of symptoms. Open-label treatment with oral risperidone and risperidone long-acting injection was immediately reinstituted in the event of recurrence of symptoms. The study was conducted between February 2004 and March 2010. The primary outcome measure was symptom recurrence rate at 3 years. RESULTS: Participants (N = 33) had a mean age ± SD of 28 ± 7.9 years and a mean baseline Positive and Negative Syndrome Scale total score ± SD of 44.8 ± 7.4 at study entry. Symptom recurrence rates were 79% at 12 months, 94% at 24 months, and 97% at 36 months. Onset of recurrence symptoms was fairly abrupt, and symptom severity returned to levels close to those of the first episode. No significant predictors of early recurrence were identified. CONCLUSIONS: Intermittent antipsychotic treatment, even after 2 years of successful treatment, may not be in the best interest of patients who have experienced a single psychotic episode. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00378092.

Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients: results from a randomized, placebo-controlled trial.

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA), are increasingly being used by psychiatric patients. Most studies have concentrated on efficacy aspects, while little is known about their safety and tolerability in psychiatric populations. This study aimed to assess the effects of EPA treatment on body mass, glucose metabolism, lipid profiles, prolactin secretion, bleeding time, haematology and liver functions. Eighty-four subjects with schizophrenia were treated with either EPA 2 g/day or placebo in addition to their antipsychotic medication for 12 weeks, in a randomized, controlled trial. Forty-seven entered a 40-week open-label extension phase of EPA 2 g/day. Seventy-four patients were included in the analysis. Six patients discontinued from the EPA group and 14 in the placebo group. Adverse event reporting was similar for the two groups. While there were no significant between-group differences, in the blinded phase the EPA group showed a significant increase in body mass index (BMI) and bleeding time. In the open-label extension, there was again a modest increase in BMI. Total cholesterol and HDL levels were significantly decreased. EPA 2 g/day is generally well tolerated. Clinicians should be aware of possible increases in bleeding time, as well as changes in weight and lipid metabolism.

Predictors of abnormal involuntary movement in an african schizophrenia population.

As little is known about the risk factors for abnormal involuntary movements in African patients with schizophrenia, 170 Xhosa participants with schizophrenia were rated with the abnormal involuntary movement scale. Abnormal involuntary movements occurred in 19.4% of this group. Modeling of the data set showed that combining age at interview, age-squared, cannabis use or abuse, and anhedonia successfully identified 82.35% of cases of involuntary movements overall. Abnormal involuntary movements increased with increasing age (in a nonlinear manner), the presence of a cannabis use or abuse history seems to be protective against involuntary movements, and anhedonia is associated with the group that displayed fewer involuntary movements.

Cranioplasty for midline metopic suture defects in adults with cleidocranial dysplasia.

OBJECTIVE: Patients with cleidocranial dysplasia often express concerns related to their perception of an undesirable esthetic appearance of their forehead and skull because of a combination of the persistence of metopic suture defects and frontal bossing. This case series reviews the use of a cranioplasty technique that has been developed to address such concerns. STUDY DESIGN: A series of 7 adult patients with cleidocranial dysplasia were treated using a cranioplasty technique to correct visible metopic suture defects in the forehead region. The patients were 4 males and 3 females with a mean age of 29.0 years. All 7 patients underwent identical cranioplasty procedures. RESULTS: The metopic suture cranial defects were found to range in size from 0.6 to 2.4 cm in diameter and were present as full-thickness osseous defects in 4 of the 7 patients. All postoperative complications resolved spontaneously. Inpatient admission times ranged from 1 to 3 days. Follow-up ranged from 9 to 48 months with satisfactory subjective esthetic outcomes. The patients were content in all cases. CONCLUSION: This cranioplasty procedure successfully addresses the specific esthetic concerns of a rare and unique group of individuals. The procedure can be offered to cleidocranial dysplasia patients as part of their overall comprehensive craniomaxillofacial management.

Congenital epulis: a surprise in the neonate.

A newborn infant with congenital epulis can be a striking sight for both parents and health care professionals involved in neonatal care. These tumours of the infant mouth can be remarkably large, occupying much of the oral cavity and posing a risk of airway obstruction or interfering with feeding. Dentists should be able to recognize these swellings as they may be asked to consult and provide information to parents and other practitioners regarding treatment of these lesions.

Fractures of the supraorbital rim: principles and management.

Dentists may be asked to provide consultations for patients who have sustained trauma to their facial structures. Supraorbital rim fractures, although uncommon, must be recognized and promptly referred to an oral and maxillofacial surgeon or other specialist skilled in the management of facial bone fractures. Supraorbital rim fractures commonly coexist with other craniomaxillofacial injuries, especially with fractures of the anterior table of the frontal sinus. In this article, we review the frequency, management and complications associated with the treatment of supraorbital rim fractures in adults. A series of 5 cases was reviewed; 4 of the 5 patients were male, with a mean age of 21.6 years (range 17-28 years). All injuries involved the supraorbital rim and the anterior table of the frontal sinus and occurred concurrently with other facial injuries. Treatment ranged from conservative observation to open reduction and internal fixation of the fractures. No associated perioperative or postoperative complications occurred. The follow-up ranged from 6 months to 26 years, with satisfactory subjective esthetic outcomes in all cases.

Apparent prevalence of dourine in the Khomas region of Namibia.

A 15-year record of the results of horse sera from the Khomas region of Namibia tested by the complement fixation test for dourine at the Central Veterinary Laboratory in Windhoek before clearing the respective animals for export and competitive sport were subjected to statistical analysis. The range of percentage positive, taken as the apparent prevalence of dourine for the region, during the period of study, was 0-29.09%; the average regional level of apparent prevalence was 8.33%. These figures were thought to be lower than the real situation due to some bias in the sampling criteria. For more accurate results, the more reliable enzyme-linked immunosorbent assay techniques are recommended for use in sero-surveys for dourine in Khomas and other regions of Namibia to provide a basis for development of effective control strategies against the disease.