Effects of co-administered dexamethasone and nimesulide on pain, swelling, and trismus following third molar surgery: a randomized, triple-blind, controlled clinical trial.

This study aimed to determine the effect of the co-administration of dexamethasone 8mg and nimesulide 100mg given 1h before mandibular third molar surgery. A prospective, randomized, triple-blind, split-mouth clinical trial was developed at the study institution in Pernambuco, Brazil. A pilot study was first performed (95% confidence interval, 80% test power, and 5% error), and a sample of 40 patients aged between 18 and 40 years was selected. The patients were randomized and divided into two groups: dexamethasone+placebo and dexamethasone+nimesulide. The following parameters were evaluated: pain (visual analogue scale), total number of rescue analgesics taken, time taken to first rescue analgesic consumption, oedema, trismus, and patient satisfaction. The paired t-test and the Wilcoxon test were used to compare means. Statistically significant differences were found between the groups in pain values at 2, 4, and 12h postoperative, and in the total number of rescue analgesics and time taken to first rescue analgesic ingestion (P<0.05), with results in favour of dexamethasone+nimesulide administration. Oedema and trismus were similar in the two treatment groups and decreased over time postoperatively. The co-administration of dexamethasone and nimesulide reduces pain intensity and the need for rescue medication after third molar surgery.

Heyde syndrome in a 71-year-old man who underwent chest radiotherapy at young age.

We report the case of a 71-year-old man with diagnosis of aortic valve stenosis for ten years, who came to hospital because of breathlessness during the previous two months and recent low intestinal hemorrhage. On admission, laboratory tests and upper gastrointestinal endoscopy and colonoscopy revealed anemia and bleeding cecal angiodysplasia. The echocardiography study showed a severe aortic stenosis. Classical Heyde syndrome is described as the association of aortic stenosis, bleeding gastrointestinal angiodysplasia and secondary anemia. The antecedent of mediastinal radiotherapy for treatment of Hodgkin's disease during his youth, and eventual late cardiac adverse effects that may include aortic or mitral valve disturbances are highlighted. Electrocoagulation with argonium was performed on the sites of active bleeding during the colonoscopy. In sequence, surgical replacement by bioprothesis was done on the aortic valve. The patient remains asymptomatic, under long-term outpatient surveillance, with normal control evaluations. The aim of this case study is to emphasize difficulties related to diagnosis, and to highlight the role of endoscopy and imaging studies to confirm a hypothesis of this underestimated condition.

Síndrome de Heyde en un hombre de 71 años que había recibido radioterapia en el pecho de joven / Heyde syndrome in a 71-year-old man who underwent chest radiotherapy at young age

Se presenta el caso de un varón de 71 años con estenosis aórtica diagnosticada diez años antes, que acude al hospital por disnea durante dos meses y reciente hemorragia digestiva baja. La analítica y la endoscopia oral y colonoscopia realizadas en el momento de la admisión revelaron anemia y angiodisplasia cecal con sangrado activo. El ecocardiograma mostró estenosis aórtica severa. El síndrome de Heyde clásico está descrito como asociación entre estenosis aórtica y sangrado por angiodisplasia gastrointestinal, con anemia secundaria. Se destaca el antecedente de radioterapia mediastinal para tratamiento de enfermedad de Hodgkin durante su juventud, y eventuales efectos adversos tardíos que pueden incluir trastornos de las válvulas aórtica y mitral. Durante la colonoscopia se realizó la electrocoagulación con argón del punto de sangrado activo. Posteriormente se realizó cirugía de sustitución valvular aórtica utilizando una bioprótesis. El paciente permanece asintomático, realizando un seguimiento ambulatorio a largo plazo, y con exámenes de control normales. El objetivo de este estudio es enfatizar las dificultades relacionadas al diagnóstico, y resaltar el papel de los estudios endoscópicos y de imágenes para confirmar una hipótesis de esta entidad subestimada (AU)

We report the case of a 71-year-old man with diagnosis of aortic valve stenosis for ten years, who came to hospital because of breathlessness during the previous two months and recent low intestinal hemorrhage. On admission, laboratory tests and upper gastrointestinal endoscopy and colonoscopy revealed anemia and bleeding cecal angiodysplasia. The echocardiography study showed a severe aortic stenosis. Classical Heyde syndrome is described as the association of aortic stenosis, bleeding gastrointestinal angiodysplasia and secondary anemia. The antecedent of mediastinal radiotherapy for treatment of Hodgkin’s disease during his youth, and eventual late cardiac adverse effects that may include aortic or mitral valve disturbances are highlighted. Electrocoagulation with argonium was performed on the sites of active bleeding during the colonoscopy. In sequence, surgical replacement by bioprothesis was done on the aortic valve. The patient remains asymptomatic, under long-term outpatient surveillance, with normal control evaluations. The aim of this case study is to emphasize difficulties related to diagnosis, and to highlight the role of endoscopy and imaging studies to confirm a hypothesis of this under estimated condition (AU)

Intravenous lipoma and pulmonary sarcoidosis treated with prednisone.

Corticosteroid-induced lipomatosis is not a rare condition, but lipoma in the central veins has scarcely been described. According to the databases consulted, this is the first report of a lipoma within the central veins coexistent with long-term use of corticosteroid. It involved a 47-year-old male under treatment for pulmonary sarcoidosis with prednisone. Computerized tomography of the thorax was performed and incidentally the images showed a mass within the central veins with the characteristics of lipoma. He was asymptomatic and refused surgical procedures. The intraluminal lipoma originated in the right brachiocephalic and subclavian veins. Control tomography showed a slow development of this lipoma, without obstructive effects or malignant features. Oral prednisone was changed for methotrexate. The patient is asymptomatic and under longstanding out-patient surveillance. Corticosteroid treatments for sarcoidosis can play a role in the development of intravascular lipoma, but this association is not well defined. Case reports could contribute to clarifying whether this relationship is causal or merely casual.

Solitary fibrous tumour of the pancreas: a case report.

The solitary fibrous tumour is an uncommon neoplasm of mesenchymal origin. It occasionally develops in extra pleural locations, and is very infrequent in the pancreas. A 40-year-old woman had an unsuspected solitary fibrous tumour detected by chance in the body of the pancreas. Detection of the mass occurred with imaging studies. CT and MRI images showed the well-circumscribed benign lesion, with 3 cm on its greatest diameter. Treatment consisted of partial pancreatectomy, and her postoperative recovery was uneventful.

Massive pleural effusion due to metastasis of prostate cancer.

We describe the case of a 72-year old male with pleural effusion associated with prostate cancer. There was a previous history of tobacco smoking (pack/year: 47) and of total prostatectomy followed by external beam radiation therapy seven years previously for prostate cancer. Furthermore, he was submitted to orchiectomy plus non-steroidal anti-androgen blockage, in addition to docetaxel-based chemotherapy and prednisone. After the beginning of chemotherapy, a progressive elevation in prostate specific antigen (PSA) levels was observed. On admission, he presented with fever, weight loss, and respiratory symptoms due to a massive right pleural effusion. Fluid samples obtained by needle aspiration showed haemorrhagic exudates without malignant cells. Pleural metastasis were detected by thorax imaging studies, and biopsy samples revealed prostate adenocarcinoma as the origin of his pleural effusion. Pleural fluid was drained and talc pleurodesis was performed. This report aims to describe the occurrence of massive pleural effusion due to metastasis of prostate cancer and emphasizes the role of pleural biopsy with immunohistochemical studies to characterize this diagnosis.