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BACKGROUND Neurilemmomas are rare tumors derived from the Schwann cells that comprise the peripheral nerve sheaths. They have a slow growth and rarely display malignancy. Early diagnosis is rare, and the treatment consists by surgical resection. Although robotic-assisted surgery is commonly used for treating retroperitoneal diseases, there are few reports of resection of retroperitoneal and pelvic schwannoma through robotic-assisted surgery. In the present study, we reported a case of complete excision of a benign retroperitoneal schwannoma of the obturator nerve by robotic-assisted surgery. CASE REPORT A 51-year-old woman was referred by her gynecologist for left pelvic discomfort of a 3-month duration. The physical examination was normal, but a computerized tomography scan of the abdomen and pelvis showed an expansive pelvic lesion in the topography of the left iliac vessels, a hypodense contrast enhancement measuring 4.6×3.4 cm. Magnetic resonance imaging showed an extraperitoneal lesion located medially and inferiorly to the left external iliac vessels, with a size of 4.9×3.7 cm, and of probable neural etiology. Surgical resection of the tumor was recommended because of the diagnostic hypothesis of obturator nerve schwannoma. CONCLUSIONS This case showed that retroperitoneal neurilemmomas are difficult to diagnose owing to a lack of specific symptoms, and the best treatment is complete tumor resection. The use of robotic techniques gives greater dexterity to the surgeon, since it provides high-definition 3-dimensional vision, which can make the removal of retroperitoneal tumors susceptible to minimally invasive resection in a safe and effective way.

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To investigate the effect of ELVAX polymer subgingival implants incorporated with echistatin peptide on incisor reimplanted tooth in rats. Forty-two male Wistars rats were divided into two groups: echistatin-treated rats (E) and control rats (C). The animals had their right maxillary incisors extracted and treated according to the International Association of Dental Traumatology replantation protocol. The extra-alveolar dry period was 30 and 60 min, and the post-surgical experimental periods were 15, 60, and 90 days. The samples were stained with H&E and analyzed for the presence of an inflammatory response, incidence of resorptions, and dental ankylosis. Results were statistically analyzed (p < 0.05). The presence of inflammatory resorption was significantly higher in group C at 30 and 60 min extra-alveolar time, in the 15-day postoperative period as compared with the E group (p < 0.05). Dental ankylosis was significantly more prevalent in group E in 30 min extra-alveolar time and 15 days postoperative period (p < 0.05). However, in 60 min extra-alveolar time and 60 days postoperative period, dental ankylosis was more prevalent in C group (p < 0.05). The use of ELVAX subgingival implants with echistatin demonstrated therapeutic potential in preventing the experimental resorption process after replantation of maxillary incisors in rats.

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Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

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Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.

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ABSTRACT Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.

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ABSTRACT Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

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The current research aims to perform a comparative evaluation of vegetable matter involved lesions with oral parasitic infections found in oral mucosa, presenting histochemical methods to differentiate their microscopic similarities. Eight cases were selected out of a sample of 1.975 reports from a single Oral and Maxillofacial Pathology Service of the author's institution from 2012 to 2019. Specimens were examined by hematoxylin and eosin staining (HE), periodic acid-Schiff (PAS) staining, Gomori-Grocott staining, Ziehl-Neelsen staining, Giemsa, and mucicarmine staining. Microscopic analysis included fluorescence, polarized light, and confocal microscopy. Microscopically, in HE coloration, hookworm eggs showed as eosinophilic. Inflammatory multinucleated giant cells and lymphocytes, were usually related to the nematode eggs, forming an intense inflammatory infiltrate. Biofluorescent properties of eggs and larvae revealed to be sensitive in the detection of parasitic structures contrasting with the inflamed connective tissue. Vegetable presence was confirmed by polarized light microscopy and it was found to be associated with microbial biofilms. Confocal microscopy has showed to be an excellent method for morphotype differentiation of parasitic eggs. Parasitic infection and vegetable matter displayed similarities in the inflammatory response, but the latter can rot and agglomerate biofilms. The microscopic diagnosis of such infections requires the interpretation of challenging morphological features since the parasites are usually sectioned and mixed with an inflammatory reaction. These histochemical approaches proved to be excellent to distinguish both lesions.

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Sialolithiasis is a disorder of the salivary glands characterized by the presence of mineralized structures. The aim of this article is to contribute to the understanding of the etiopathogenesis of sialolithiasis based on data reported in the literature and the interpretation of scanning electron microscopic (SEM), histopathologic, fluorescence, and energy-dispersive X-ray spectroscopic (EDX) studies. The results of these analyses in a single case are presented. Fluorescence microscopy captured saliva flowing inside a giant sialolith, EDX analysis enabled the quantification of samples of minerals and characterized the chemical composition in the internal areas of the sialolith, and SEM images captured the external communications of the sialolith (ostia). Many theories have been proposed to explain sialolithiasis development, but few consider the role of saliva in its dynamic form. The authors propose that the triple synergism of microbiota, biofilm, and salivary dynamics plays a fundamental role in the development and intrinsic architecture of sialoliths, creating a cyclic sialolithic mineralization. This hypothesis is supported by the results of the laboratory studies in the present case.

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Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.

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Pediatric mandibular tumors present an aggressive biological behavior and difficult diagnosis. A wide range of odontogenic and nonodontogenic tumors comprise the spectrum of these lesions. We report a case of a 1-year-old male child patient showing facial asymmetry symptomatic of an expansive lesion extending throughout the body and ramus of the left hemimandible with a diameter of 8 cm. The histopathological report suggested a high-grade mucoepidermoid carcinoma (MEC), recommending further immunohistochemical investigation of the ectomesenchymal or neuroectodermal origin of the tumor cells. The patient evolved with extensive bilateral pleural effusion followed by metastasis in the middle third of the right humerus, and died 2 months after the first biopsy procedure by acute renal failure with tubular necrosis, before a final inconclusive immunohistochemical report was reached. The lack of resources for less-favored regions of Brazil impairs rapid biomolecular examinations such as immunohistochemical resulting in delay of appropriate therapeutic procedures.

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PURPOSE: Areal bone mineral density (aBMD) by DXA is underestimated in those with smaller bones and overestimated in those with larger bones. Trabecular bone score (TBS) predicts fracture risk, and is not influenced by bone size. The aim of this study was to evaluate TBS and BMD in women with short stature. METHODS: We retrospectively analyzed DXA scans of all women aged 50-90 years with short stature (<144 cm) obtained in a single center, from 2006 to 2016. The comparison group comprised women >161 cm in height, matched for age and LS BMD, selected from the same database. RESULTS: The study population included 342 women. The two groups were similar in age, and aBMD at the LS and total hip. Femoral neck aBMD was lower in cases than in taller women. In contrast, TBS was higher in women with short stature than in their taller counterparts (1.347 ± 0.102 vs. 1.250 ± 0.110; p < 0.001). Bone mineral apparent density (BMAD) and the LS TBS-adjusted BMD T-score were also significantly higher in shorter than in taller women. From the entire cohort, 121 women (67 cases) were osteoporotic by aBMD determinations. Among these subjects, TBS was also greater in cases (1.303 ± 0.103) than in women with standard height (1.190 ± 0.099; p < 0.001). Despite being considered osteoporotic, 36% of short women, but none of the taller ones, had a normal TBS. CONCLUSIONS: TBS can be a useful adjunct to aBMD for assessing bone quality in short women, in whom aBMD measurement tends to read lower, and, thus could overestimate fracture risk.

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Star jasmine (Jasminum multiflorum) plants growing in Hawaii expressing a diverse array of virus-like foliar symptoms were examined for the presence of a causal agent. Symptomatic tissues collected from three locations on the island of Oahu, Hawaii consistently harbored double-stranded (ds)RNAs approximately 4.2 and 1.7 kbp in size. Sanger and high-throughput sequencing approaches revealed these dsRNAs were from two distinct virus species co-infecting the same host plant. One of these two viruses was the recently characterized Jasmine virus H (JaVH), and the second we designated as Jasmine mosaic-associated virus (JMaV). Both viruses were subsequently found, by high-throughput sequencing, in a single angelwing jasmine (J. nitidum) plant exhibiting similar ringspot symptoms and growing at the U.S. National Arboretum in Washington, DC. Phylogenetic placement, genome organization, and sequence comparisons indicate these two viruses are classifiable as members of the genus Pelarspovirus (family Tombusviridae). To determine if either of these viruses were associated with the observed symptoms, a PCR-based detection assay was developed to detect and distinguish these two viruses in several Hawaii-grown plants. All 32 samples collected from four Oahu locations displayed symptoms. All 32 samples were positive for JaVH, and 16 were positive for JMaV. An asymptomatic star jasmine plant from the island of Hawaii was negative for both JaVH and JMaV. Both viruses were also found in a symptomatic J. sambac sample from Maryland while only JMaV was detected in a symptomatic Jasminum sp. sample from California.

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RESUMO Objetivos Descrever a utilização da contenção física em um hospital psiquiátrico público e analisar os fatores de risco associados com seu uso, no contexto da implantação de um protocolo clínico. Métodos Em um hospital psiquiátrico público de Belo Horizonte-MG, os formulários de registro e monitoramento de contenção física (2011-2012) foram analisados e comparados com os registros das demais internações englobadas no mesmo período. Neste estudo transversal, além das análises descritivas das características clínicas e demográficas dos pacientes contidos, das técnicas utilizadas e das complicações reportadas, os fatores de risco associados com o uso da contenção foram analisados por meio de regressão logística múltipla. Resultados A contenção foi utilizada em 13,4% das internações, sendo mais comum em pacientes jovens, do sexo masculino, portadores de psicoses não orgânicas, apresentando agitação/agressividade. A técnica foi geralmente de quatro pontos, durando entre 61-240 minutos. Os únicos fatores de risco significativos para o uso da contenção incluíram a idade (OR = 0,98; p = 0,008) e o tempo de permanência (OR = 1,01; p < 0,001). Conclusões A contenção física foi utilizada usualmente na abordagem aguda do paciente agitado/agressivo inabordável verbalmente, no contexto de um transtorno psicótico. O registro dos dados vitais e dos efeitos adversos foram os itens menos aderentes aos protocolos vigentes.

ABSTRACT Objectives To describe the use of physical restraint in a public psychiatric hospital and analyze the risk factors associated with its use in the context of the implementation of a clinical protocol. Methods In a public psychiatric hospital of Belo Horizonte-MG, registration forms for monitoring physical restraint (2011-2012) were analyzed and compared with the records of other admissions in the same period. In this cross-sectional study, the clinical and demographic characteristics of the restrained patients, the techniques used and the reported complications were described. Also, risk factors associated with the use of physical restraints were analyzed using multiple logistic regression. Results Physical restraint was used in 13.4% of admissions, was more common in young male patients, with a non-organic psychoses diagnosis, presenting agitation/aggressive behavior. Usually, a four-points restraint technique was performed, lasting between 61-240 minutes. The only significant risk factors for the use of restraints included age (OR = 0.98, p = 0.008) and length of stay (OR = 1.01, p < 0.001). Conclusions Physical restraint was used in the approach of the acutely agitated, aggressive, and non-responsive to verbal de-escalation patient, in the context of a psychotic disorder. The registration of vital signs and adverse effects were the items less frequently compliant to current protocols.

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Este artigo tem como objetivo descrever as características sociodemográficas,história penal e assistência ao pré-natal e puerpério em mulheres detentas. Estudo transversalcom aplicação de questionário estruturado para nove gestantes e três puérperas de umpresídio feminino em Campo Grande, Mato Grosso do Sul. Nas puérperas, também seinvestigou a atenção à saúde no perinatal e puerpério. Os dados foram expressos comofrequências absolutas e relativas. Foi constatada média de idade de 27,6±5,9 anos;predominância da cor parda (n=8); não utilização de condom pela maioria (n=6); históriaprévia de doenças sexualmente transmissíveis e vírus da imunodeficiência adquirida (n=3);acompanhamento pré-natal a partir do 1º trimestre de gravidez em cinco participantes, apartir do 2º trimestre em apenas uma e a partir do 3º em quatro; realização de colpocitologiaoncótica em uma. No pós-parto, uma puérpera não foi consultada até o dia da entrevista;duas o foram. A assistência pré-natal e puerperal disponível no presídio revelou-seinadequada em relação aos critérios estabelecidos pelo Programa Nacional de Humanizaçãodo Pré-Natal e Nascimento...

This paper aims to describe the socio-demographic profile, criminal history, andprenatal and postpartum care provision among female inmates. A cross-sectional study of ninepregnant and three postpartum women in a women’s prison in Campo Grande, Mato Grossodo Sul, Brazil, was conducted using structured questionnaires. The healthcare provisionduring perinatal and postpartum periods were also investigated in postpartum women.Data were expressed as absolute and relative frequencies. Mean age was 27.6±5.9 years.Most participants were of mixed black and white ancestry (n=8) and did not use condoms(n=6). Three had a history of sexually transmitted diseases and human immunodeficiencyvirus. Prenatal care from the 1st trimester onwards was provided to 5 subjects; from the 2nd,to only 1; from the 3rd trimester, to 4 individuals. Pap smear testing was performed on oneparticipant. Guidance on breastfeeding and breast care was provided to 2 women. Up to theday of interview, one participant had not been seen by a physician since delivery. The prenatalcare and postpartum assistance available at the correctional facility investigated in CampoGrande proved to be inadequate, considering the criteria established by the Brazilian Programfor the Humanization of Prenatal Care and Birth...

Es significativo el aumento de la población femenina en el sistema carcelario.Este estudio objetivó describir las características sociodemográficas, la historia penal y laasistencia prenatal y puerperal de las detenidas. Es una investigación transversal con cuestionarioestructurado para 9 gestantes y 3 puérperas de un presidio femenino de Campo Grande, MatoGrosso do Sul, Brasil, analizadas mediante estadística descriptiva. En las puérperas también seestudió la atención de la salud perinatal y puerperal. Los datos se expresaron como frecuenciasabsolutas y relativas. Se constató un promedio de edad de 27,6 ± 5,9 años; predominancia decolor pardo (8); no utilización de preservativos por parte de la mayoría (6); historia previa de ETS y VIH en 3 participantes; seguimiento prenatal desde el 1er trimestre de embarazo en 5, a partir del 2.º trimestre en una y del 3.º en 4, y realización de colpocitología oncótica en una.En el posparto, una puérpera no fue consultada hasta la entrevista; a dos sí se las consultó. Laasistencia prenatal y puerperal disponible se mostró inadecuada en relación con los criterios delPrograma Nacional de Humanización del Prenatal y el Nacimiento...

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Este artigo tem como objetivo descrever as características sociodemográficas, história penal e assistência ao pré-natal e puerpério em mulheres detentas. Estudo transversal com aplicação de questionário estruturado para nove gestantes e três puérperas de um presídio feminino em Campo Grande, Mato Grosso do Sul. Nas puérperas, também se investigou a atenção à saúde no perinatal e puerpério. Os dados foram expressos como frequências absolutas e relativas. Foi constatada média de idade de 27,6±5,9 anos; predominância da cor parda (n=8); não utilização de condom pela maioria (n=6); história prévia de doenças sexualmente transmissíveis e vírus da imunodeficiência adquirida (n=3); acompanhamento pré-natal a partir do 1º trimestre de gravidez em cinco participantes, a partir do 2º trimestre em apenas uma e a partir do 3º em quatro; realização de colpocitologia oncótica em uma. No pós-parto, uma puérpera não foi consultada até o dia da entrevista; duas o foram. A assistência pré-natal e puerperal disponível no presídio revelou-se inadequada em relação aos critérios estabelecidos pelo Programa Nacional de Humanização do Pré-Natal e Nascimento.

This paper aims to describe the socio-demographic profile, criminal history, and prenatal and postpartum care provision among female inmates. A cross-sectional study of nine pregnant and three postpartum women in a women's prison in Campo Grande, Mato Grosso do Sul, Brazil, was conducted using structured questionnaires. The healthcare provision during perinatal and postpartum periods were also investigated in postpartum women. Data were expressed as absolute and relative frequencies. Mean age was 27.6±5.9 years. Most participants were of mixed black and white ancestry (n=8) and did not use condoms (n=6). Three had a history of sexually transmitted diseases and human immunodeficiency virus. Prenatal care from the 1st trimester onwards was provided to 5 subjects; from the 2nd, to only 1; from the 3rd trimester, to 4 individuals. Pap smear testing was performed on one participant. Guidance on breastfeeding and breast care was provided to 2 women. Up to the day of interview, one participant had not been seen by a physician since delivery. The prenatal care and postpartum assistance available at the correctional facility investigated in Campo Grande proved to be inadequate, considering the criteria established by the Brazilian Program for the Humanization of Prenatal Care and Birth.

Es significativo el aumento de la población femenina en el sistema carcelario. Este estudio objetivó describir las características sociodemográficas, la historia penal y la asistencia prenatal y puerperal de las detenidas. Es una investigación transversal con cuestionario estructurado para 9 gestantes y 3 puérperas de un presidio femenino de Campo Grande, Mato Grosso do Sul, Brasil, analizadas mediante estadística descriptiva. En las puérperas también se estudió la atención de la salud perinatal y puerperal. Los datos se expresaron como frecuencias absolutas y relativas. Se constató un promedio de edad de 27,6 ± 5,9 años; predominancia de color pardo (8); no utilización de preservativos por parte de la mayoría (6); historia previa de ETS y VIH en 3 participantes; seguimiento prenatal desde el 1er trimestre de embarazo en 5, a partir del 2.º trimestre en una y del 3.º en 4, y realización de colpocitología oncótica en una. En el posparto, una puérpera no fue consultada hasta la entrevista; a dos sí se las consultó. La asistencia prenatal y puerperal disponible se mostró inadecuada en relación con los criterios del Programa Nacional de Humanización del Prenatal y el Nacimiento.

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