Poster Session : PS 0012 ; Immunology : Retroperitoneal Fibrosis Related to Periaortitis - When to Think of It?

( Helena Lobo Martns ),( Nadejda Potlog ),( Antonio Marinho ),( Isabel Almeida ),( Carlos Vasconcelos ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Retroperitoneal fi brosis (RF) is a rare condition characterized by the presence of infl ammatory and fi brous retroperitoneal tissue that may be idiopathic or secondary to other causes. Idiopathic RF is part of the spectrum of chronic periaortitis, a condition characterized by infl ammation and fi brosis surrounding the aorta and iliac arteries. The pathogenesis of idiopathic retroperitoneal fi brosis is unclear. The authors report the case of a 66 year-old woman with RF diagnosis related to infrarenal infl ammatory aortitis in 2009, following the study of a hypochromic microcytic anemia and increased infl ammatory parameters, confi rmed by imaging. She has a history of stenosing ileal Crohn`s disease, underwent surgery in 2006, with recurrence of ileal disease two years ago, treated and currently stable. As other relevant pathological antecedents, she contacted patients with pulmonary tuberculosis. She starting anti-tuberculosis therapeutic in September 2009 for nine months, because she has positive Mantoux test. The patient began high-dose corticosteroids with clinical benefi t, however with reduction in dose to about 20mg/day clinical worsening was observed with marked increase in infl ammatory parameters. Azathioprine was added during a short period due to myelosuppression. Subsequently started methotrexate with good response at an early stage but with need to change to cyclosporine due to worsening of infl ammatory parameters. Although there was an initial response to this drug, a sustained analytical and clinical response could only be achieved through the introduction of anti-TNF-alpha (Infl iximab). It was systematically excluded neoplastic, infectious, autoimmune and other infl ammatory diseases. The authors argue the importance of knowing and diagnosing rare diseases such as retroperitoneal fi brosis. It presents insidiously, often making the diagnosis diffi cult, thus you need to think about these diseases for successful diagnose. We point out the importance of knowing the biological drugs as potential therapeutic weapons in these cases.

Poster Session : PS 0731 ; Rheumatology ; Miller Fisher Syndrome Secondary to Primary Sjogren s Syndrome - Anti-CD 20 Responsive

( Helena Lobo Martins ),( Tomas Abrantes Da Fonseca ),( Teresa Sequeira ),( Isabel Almeida ),( Antonio Marinho ),( Carlos Vasconcelos ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Neuropathy seems to be the most specific neurological complication of primary Sjogren`s syndrome (SS). Miller-fisher syndrome (MFS) characterized by acute onset of ataxia, external ophthalmoplegia and arefi exia, is considered a variant form of Guillain Barre syndrome (GBS). GBS is linked to SS by case reports only. We present a case of 70-year-old woman with classifi cation criteria for primary SS: dry syndrome (xerostomia and xerophthalmia; Schirmer test = 5, Normal > 10), biopsy and scintigraphy of salivary glands compatible with SS, elevated SSa/Ro autoantibodies and polyclonal hypergammaglobulinemia. In 2007, presents paresthesias of both feet, takes Gabapentin with poor response. In March 2009, admitted with diplopia and diffi culty in gait by ataxia; physical examination showed decrease in pain and vibratory hypoesthesia of the lower limbs (LL) with absence of osteo-tendon refi exes; lumbar puncture with increased protein (0. 63) without cells; treated with intravenous Immunoglobulins (IV Ig) with signifi cant clinical improvement, except paresthesias in both feet. In the last three years, LL paresthesias worsened and spreaded to legs bilaterally under IV Ig, with relapse of diplopia and severe ataxia when extending dosage interval of IV Ig. Electromyography and nerve biopsy inconsistent, performed under IV Ig. Thus, SS with neurological involvement characterized by diplopia, severe gait ataxia, severe sensory polyneuropathy with absent vibratory sensibilities and arefi exia - MFS like. Refractory and dependent of IV Ig treatment. Performed two perfusions of Rituximab 1 gram in December and January 2014, without new episodes of diplopia and ataxia and no further use of IV Ig until July 2014. This patient demonstrated clinical improvement after high dose of IV Ig, although dose dependent and refractory to treatment in the last three years. However, when the underlying disease was treated with anti-CD 20 therapy a complete response was observed.

Poster Session : PS 0767 ; Rheumatology ; Arthritis in Older Man: Don`t Forget Paraneoplastic Syndromes

( Helena Martins ),( Tomas Abrantes Da Fonseca ),( Teresa Sequeira ),( Isabel Almeida ),( Antonio Marinho ),( Carlos Vasconcelos ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

The association of rheumatic manifestations with cancer is now well established. There are various rheumatological diseases that can be manifested as paraneoplastic syndromes, i. e. precede or occur simultaneously with different types of tumors, without local evidence of malignancy and regress after effective treatment of the tumor. In fact, the recognition of rheumatic symptoms as the fi rst translation of malignancy is essential for early treatment of the underlying tumor. The authors present a case of a 66 year-old man with no history of relevant disease nor family history of psoriasisor rheumatic diseases, with initial manifestation of chronic oligoarticular frame of the knees with severe systemic infi ammatory component associated with B symptoms, which evolved into symmetric infiammatory polyarthritis and morning stiffness. Analytically, without anemia or lymphopenia, increased infiammatory parameters, hemosedimentation velocity and C-reactive protein; Negative immunological study, including RF and anti-CCP, interpreted as probable seronegative rheumatoid arthritis. Excluded tuberculosis. Initially treated with NSAIDs, corticosteroids and methotrexate (MTX) without much articular benefi t, subsequently conducted infi ltrations and began salazopyrin (SSZ), with some clinical improvement. Onset of oral ulcers, whose biopsy revealed epidermoid carcinoma. Tumor with lymph node metastasis, requiring dissection, radiotherapy and chemotherapy, with clear improvement of the arthritis afterwards. Assumed paraneoplastic arthritis. Disease currently in remission, sporadically medicated only with NSAIDs. The relationship between malignancy and rheumatic manifestations is not simple. It is often diffi cult to identify the underlying tumor if not thinking about it, since the rheumatic paraneoplastic syndromes mimic well the idiopathic situations. On the other hand, the exhaustive search for a neoplasm in the initial assessment of rheumatic diseases is not recommended unless it is a high risk patient. Additionally, paraneoplastic arthritis may have independent natural history of tumors, thus the diagnosis is always a challenge.

Poster Session : PS 0753 ; Rheumatology ; Sporadic Inclusion Body Myositis - A Rare Genetic Myopathies Impersonator

( Helena Lobo Martins ),( Tomas Abrantes Da Fonseca ),( Teresa Sequeira ),( Isabel Almeida ),( Antonio Marinho ),( Carlos Vasconcelos ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Sporadic inclusion body myositis (IBM) is classifi ed as one of the idiopathic infi ammatory myopathies, as well as polymyositis and dermatomyositis. However, despite some histologic similarities, the clinicopathologic manifestations of IBM are clearly distinct from the other two disorders. The recognition of amyloid deposits in IBM was helpful in further differentiating this disorder from other idiopathic infi ammatory myopathies. The authors present the case of a 65 year-old woman with a history of hypertension and vertiginous syndrome, with about 10 years of evolution of an important proximal muscle weakness interpreted as possible dystrophy, with inconclusive muscle biopsy. Conducted physical and occupational therapy without any benefi t, having evolved to neuromyopathy with distal and asymmetrical involvement and persistence of elevated CPK. At physical examination, muscle strength has grade 4+ / 5 in all muscle proximal segments, absence of fi exor and extensor muscles against gravity in hands and feet. No cervical, respiratory and swallowing muscles involvement. No weakness of the pelvic girdle. Hypothesized inclusion body myopathy and repeated muscle biopsy that confi rmed diagnosis. Proposed for treatment with intravenous immunoglobulins (IgIV) and low-dose corticosteroids. IBM is a rare disorder, whose proximal muscle weakness is present initially, but distal weakness may be an early feature in some patients. The clinical diagnosis of IBM is suspected on the basis of a combination of muscle weakness, elevated plasma levels of muscle enzymes, myopathic features observed on clinical electrophysiologic studies and a conclusive muscle biopsy. The authors emphasize that the initial biopsy may be inconclusive with respect to the diagnostic histopathologic features of IBM. Therefore, in these cases it is important to repeat the biopsy.

Poster Session : PS 0703 ; Rheumatology ; Remission of Sweet Syndrome Secondary to Rheumatoid Arthritis Treated with Etanercept

( Helena Lobo Martins ),( Tomas Abrantes Da Fonseca ),( Teresa Sequeira ),( Isabel Almeida ),( Antonio Marinho ),( Carlos Vasconcelos ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Sweet`s syndrome (SS) is the most common acute neutrophilic dermatosis (ND), often idiopathic although it is associated with a wide range of diseases, especially neoplastic, infi ammatory and infectious. We report the case of SS occurring on a 43-year-old woman with a known seronegative rheumatoid arthritis (RA) since 20 year-old. After diagnosis, was treated by NSAIDs, methotrexate (MTX) and gold salts with complete remission. Medication was suspended. In 2002, develops disabling symmetric polyarthritis, unresponsive to corticosteroids, NSAIDs and sulfasalazine. MTX was avoided due to chronic cholestasis (autoantibodies to primary biliary cirrhosis were negative, IRM excluded primary sclerosing cholangitis and liver biopsy without cirrhosis or interface hepatitis). Initiated Anti-TNF alpha monotherapy (Adalimumab) in 2004 with complete remission. Suspended due to pregnancy in 2007 and stayed in remission without drugs until 2014. In 2012, she presented widespread painful mucocutaneous lesions involving the neck, trunk and upper limbs, with fever, arthralgia and deterioration of general condition, compatible with SS. Biopsy confi rmed diagnosis. Systematically excluded tuberculosis, lympho/myeloproliferative and other autoimmune diseases. Executed corticotherapy unsuccessfully, having developed iatrogenic diabetes. Improvement of lesions with dapsone, maintaining tolerable oral lesions. In 2014, worsening cutaneous lesions and initiates cyclosporine without any benefit. Under cyclosporine, progression to disabling oral lesions, and severe polyarthritis with DAS 28 5. 02 (high activity disease). The authors assumed SS secondary to RA and started anti-TNF alpha etanercept. Skin lesions improved within few days, with complete regression of all clinical and laboratory abnormalities. The authors argue the importance to consider SS in differential diagnosis of new mucocutaneus lesions in patients with known autoimmune diseases, including RA. The diagnosis should be based on clinical,laboratory and histological fi ndings of an acute febril neutrophilic dermatosis without vasculitis. In these cases, the treatment with anti-TNF alpha is an option.

Brazilian young dental practitioners' use and acceptance of digital radiographic examinations

Rovaris, Karla,de Faria Vasconcelos, Karla,do Nascimento, Eduarda Helena Leandro,Oliveira, Matheus Lima,Freitas, Deborah Queiroz,Haiter-Neto, Francisco Korean Academy of Oral and Maxillofacial Radiology 2016 Imaging Science in Dentistry Vol.46 No.4

Purpose: The aim of this study was to investigate the use and acceptance of digital radiographic examinations by Brazilian dental practitioners in daily practice and to evaluate the advances that have occurred over the past 5 years. Materials and Methods: Dental practitioners enrolled in extension courses at the Piracicaba Dental School, University of Campinas, Brazil, responded to a self­administered questionnaire in the years 2011 and 2015. They were asked about sociodemographic factors and their knowledge and use of digital radiographic examinations. Descriptive analysis was performed, as well as the chi-square and Fisher exact tests, with a significance level of 5% (${\alpha}=0.05$). results: A total of 181 participants responded to the questionnaire in the years 2011 and 2015. Most of the respondents worked in private practice, had graduated within the last 5 years, and were between 20 and 30 years old. In 2011, 55.6% of respondents reported having ever used digital radiographic examinations, while in 2015 this number increased significantly to 85.4% (p<.0001), out of which 71.4% preferred it to conventional images. Moreover, 21.4% of respondents reported having used digital radiographic examinations for more than 3 years. A significant increase in use of intraoral digital radiography (p = 0.0316) was observed in 2015. In both years, image quality and high cost were indicated, respectively, as the main advantage and disadvantage of digital radiographic examinations. conclusion: This study showed that digital radiology has become more common in Brazil over the past 5 years. Most of the Brazilian dental practitioners evaluated in 2015 used digital radiographic examinations.

Influence of kilovoltage-peak and the metal artifact reduction tool in cone-beam computed tomography on the detection of bone defects around titanium-zirconia and zirconia implants

Fontenele Rocharles Cavalcante,Nascimento Eduarda Helena Leandro,Imbelloni-Vasconcelos Ana Catarina,Martins Luciano Augusto Cano,Pontual Andrea dos Anjos,Ramos-Perez Flávia Maria Moraes,Freitas Debora 대한영상치의학회 2022 Imaging Science in Dentistry Vol.52 No.3

Purpose: The aim of this study was to assess the influence of kilovoltage- peak (kVp) and the metal artifact reduction (MAR) tool on the detection of buccal and lingual peri-implant dehiscence in the presence of titanium-zirconia (Ti-Zr) and zirconia (Zr) implants in cone-beam computed tomography (CBCT) images. Materials and Methods: Twenty implant sites were created in the posterior region of human mandibles, including control sites (without dehiscence) and experimental sites (with dehiscence). Individually, a Ti-Zr or Zr implant was placed in each implant site. CBCT scans were performed using a Picasso Trio device, with variation in the kVp setting (70 or 90 kVp) and whether the MAR tool was used. Three oral radiologists scored the detection of dehiscence using a 5-point scale. The area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity were calculated and compared by multi-way analysis of variance (α=0.05). Results: The kVp, cortical plate involved (buccal or lingual cortices), and MAR did not influence any diagnostic values (P>0.05). The material of the implant did not influence the ROC curve values(P>0.05). In contrast, the sensitivity and specificity were statistically significantly influenced by the implant material (P<0.05) with Zr implants showing higher sensitivity values and lower specificity values than Ti-Zr implants. Conclusion: The detection of peri-implant dehiscence was not influenced by kVp, use of the MAR tool, or the cortical plate. Greater sensitivity and lower specificity were shown for the detection of peri-implant dehiscence in the presence of a Zr implant.

Brazilian young dental practitioners’ use and acceptance of digital radiographic examinations

Karla Rovaris,Karla de Faria Vasconcelos,Eduarda Helena Leandro do Nascimento,Matheus Lima Oliveira,Deborah Queiroz Freitas,Francisco Haiter-Neto 대한영상치의학회 2016 Imaging Science in Dentistry Vol.46 No.4

Purpose: The aim of this study was to investigate the use and acceptance of digital radiographic examinations by Brazilian dental practitioners in daily practice and to evaluate the advances that have occurred over the past 5 years. Materials and Methods: Dental practitioners enrolled in extension courses at the Piracicaba Dental School, University of Campinas, Brazil, responded to a self-administered questionnaire in the years 2011 and 2015. They were asked about sociodemographic factors and their knowledge and use of digital radiographic examinations. Descriptive analysis was performed, as well as the chi-square and Fisher exact tests, with a significance level of 5% (α=0.05). Results: A total of 181 participants responded to the questionnaire in the years 2011 and 2015. Most of the respondents worked in private practice, had graduated within the last 5 years, and were between 20 and 30 years old. In 2011, 55.6% of respondents reported having ever used digital radiographic examinations, while in 2015 this number increased significantly to 85.4% (p<.0001), out of which 71.4% preferred it to conventional images. Moreover, 21.4% of respondents reported having used digital radiographic examinations for more than 3 years. A significant increase in use of intraoral digital radiography (p=0.0316) was observed in 2015. In both years, image quality and high cost were indicated, respectively, as the main advantage and disadvantage of digital radiographic examinations. Conclusion: This study showed that digital radiology has become more common in Brazil over the past 5 years. Most of the Brazilian dental practitioners evaluated in 2015 used digital radiographic examinations.

Influence of kilovoltage- peak and the metal artifact reduction tool in cone-beam computed tomography on the detection of bone defects around titanium-zirconia and zirconia implants

Fontenele, Rocharles Cavalcante,Nascimento, Eduarda Helena Leandro,Imbelloni-Vasconcelos, Ana Catarina,Martins, Luciano Augusto Cano,Pontual, Andrea dos Anjos,Ramos-Perez, Flavia Maria Moraes,Freitas, Korean Academy of Oral and Maxillofacial Radiology 2022 Imaging Science in Dentistry Vol.52 No.-

Purpose: The aim of this study was to assess the influence of kilovoltage- peak (kVp) and the metal artifact reduction (MAR) tool on the detection of buccal and lingual peri-implant dehiscence in the presence of titanium-zirconia (Ti-Zr) and zirconia (Zr) implants in cone-beam computed tomography (CBCT) images. Materials and Methods: Twenty implant sites were created in the posterior region of human mandibles, including control sites (without dehiscence) and experimental sites (with dehiscence). Individually, a Ti-Zr or Zr implant was placed in each implant site. CBCT scans were performed using a Picasso Trio device, with variation in the kVp setting (70 or 90 kVp) and whether the MAR tool was used. Three oral radiologists scored the detection of dehiscence using a 5-point scale. The area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity were calculated and compared by multi-way analysis of variance (α=0.05). Results: The kVp, cortical plate involved (buccal or lingual cortices), and MAR did not influence any diagnostic values (P>0.05). The material of the implant did not influence the ROC curve values(P>0.05). In contrast, the sensitivity and specificity were statistically significantly influenced by the implant material (P<0.05) with Zr implants showing higher sensitivity values and lower specificity values than Ti-Zr implants. Conclusion: The detection of peri-implant dehiscence was not influenced by kVp, use of the MAR tool, or the cortical plate. Greater sensitivity and lower specificity were shown for the detection of peri-implant dehiscence in the presence of a Zr implant.

Black Anal Canal: Acute Necrosis

Sandra Barbeiro,Catarina Martins,Cláudia Gonçalves,Paulo Alves,Inês Gil,Manuela Canhoto,Filipe Silva,Isabel Cotrim,Cristina Amado,Liliana Eliseu,Helena Vasconcelos 대한대장항문학회 2016 Annals of Coloproctolgy Vol.32 No.4

Acute ischemia of the rectum or anal canal resulting in necrosis is extremely uncommon because both the rectum and the anal canal have excellent blood supplies. We present a case with spontaneous necrosis of the anal canal without rectal involvement. Surgical debridement was accomplished, and the recovery was uneventful. The patient was elderly, with probable atherosclerotic arterial disease, and presented with hypotension. Due to the lack of other precipitating factors, the hypoperfusion hypothesis seems to be the most suitable in this case. To the best of our knowledge, no similar cases have been reported in the literature on this subject.