CRST syndrome with diffuse peri- and intra-articular calcifications. Value of x-ray computed tomography

A patient with calcinosis universalis presented extensive calcifications involving fingers, shoulders, thoracic wall and cervical spine. Computed tomography imaging appeared to be a highly valid method of investigation of calcification of soft tissues and allowed detection of an intra-articular scapulohumeral calcium-provoked effusion.     

Spindle cell lipoma of the floor of the mouth: report of a case

Spindle cell lipoma is a benign tumour composed by: (1) mature fat cells; (2) spindle cells; (3) a myxoid matrix separated by thick bands of birefringent collagen. Only 14 cases have been reported in the oral cavity. The authors present the second case located in the floor of the mouth. The treatment of the lesion consists of a local excision.     

Relationship between triple-helix content and mechanical properties of gelatin films

This paper reports a study on the influence of the renaturation level of gelatin on the mechanical and swelling properties of gelatin films. Films at different renaturation level were obtained from gelatin samples with different Bloom index. It was verified that the triple-helix content, calculated from the values of the enthalpy of denaturation associated to the endothermal transition at about 41 degrees C of gelatin, increases with the Bloom index. The d.s.c. data are further supported by the results of the X-ray diffraction investigation carried out on the same samples. The increase of triple-helix content provokes a significant reduction in the degree of swelling, and a remarkable improvement of the mechanical properties of the films. The elastic Young's modulus, E, increases linearly with the renaturation level, from 3.6 to 12.0 MPa. Crosslinking with GTA 1% remarkably reduces the degree of swelling of all the samples, and induces a further increase of the Young's modulus, which reaches values up to 27 MPa.     

Differences between 99mTc-sestamibi and 99mTc-tetrofosmin uptake in thyroid and salivary glands: comparison with 99mTc-pertechnetate in 86 subjects

Tc-tetrofosmin seems to show a prolonged thyroid retention when compared with Tc-sestamibi; this may explain its poorer performance in the dual-phase parathyroid scintigraphy. In order to verify objectively whether and to what extent Tc-sestamibi and Tc-tetrofosmin uptake and retention differ in the thyroid gland, we performed a head-to-head comparison between the tracers in 86 euthyroid subjects enrolled in five centres. Data were compared with those of Tc-pertechnetate obtained from the same subjects. For comparison purposes, quantitative data from the salivary glands were also obtained. Tc-sestamibi showed a higher early thyroid uptake (2.26+/-0.52 vs. 2.01+/-0.49, respectively; P<0.002) and a lower retention (1.4+/-0.37 vs. 1.65+/-0.58, respectively; P<0.002) when compared with Tc-tetrofosmin. This finding provides an objective basis for the poorer results of Tc-tetrofosmin in dual-phase parathyroid scintigraphy. Delayed Tc-tetrofosmin salivary gland uptake was unexpectedly high and approached the Tc-pertechnetate value (2.29+/-0.56 vs. 2.46+/-0.75, respectively; P =not significant). This finding should be kept in mind in order to avoid interpretation pitfalls in thyroid and parathyroid imaging with Tc-tetrofosmin, as well as in other oncological imaging of the neck region. This study definitely establishes that Tc-tetrofosmin and Tc-sestamibi are not twin but rather sibling tracers.     

Central granular cell odontogenic tumour: report of the first malignant case and review of the literature

Granular cell odontogenic tumours (GCOT) are rare neoplasms that usually manifest a benign clinical behaviour. We document the first case of GCOT exhibiting clinico-pathological features of malignancy that occurred in the maxilla of a 40-year-old male. The lesion appeared as an intra-oral polypoid mass and, at CT scan, as a poorly demarcated radiolucency eroding the cortical plate. Histologically, the tumour consisted of clusters of granular cells, exhibiting nuclear pleomorphism, prominent nucleoli and mitotic figures, and spindle cells in a collagenous stroma containing cementicles and strands of odontogenic epithelium. Morphologic transition from fibroblast-like to granular cells was frequently detected. The tumour cells extensively invaded the oral and respiratory mucosae and the adjacent soft tissues and exhibited vimentin and CD 68 immunoreactivity and high (21%) Ki 67 immunolabeling but not cytokeratins, E.M.A. actin, desmin, myosin or S-100 protein positivity. The patient experienced tumour recurrence 16 months after radical surgery. While the histogenesis of GCOT remains to be clarified, we document the existence of a malignant counterpart of this tumour and propose the name of malignant GCOT or granular cell odontogenic sarcoma for such entity.     

Randomised controlled trial of prophylactic etamsylate: follow up at 2 years of age

AIM: To assess the role of etamsylate in reducing the risk of haemorrhagic brain damage and its consequences. DESIGN: Follow up of babies recruited into a randomised controlled trial. METHODS: A total of 334 infants born before 33 weeks gestation in France and Greece were randomly allocated within the first four hours of birth either to receive etamsylate or to act as controls. The principal outcomes in the trial were death or impairment and/or disability at the age of 2 years. RESULTS: Fifty nine children were lost to follow up. A total of 115 (34%) either died or had some impairment or disability, and 88 (26%) either died or had severe impairment or disability at 2 years of age. These outcomes did not differ significantly between the two randomised groups: relative risks and 95% confidence intervals 1.14 (0.78 to 1.4) and 1.17 (0.82 to 1.68) respectively. The findings were similar for all the prespecified subgroup analyses stratified by key prognostic factors at trial entry: country of birth, gestational age < or >or= 29 weeks, inborn or outborn, age < or >or= 1 hour, and with or without cerebral scan abnormality. CONCLUSION: These findings do not support the use of etamsylate. Other strategies need to be evaluated for the prevention of mortality and morbidity in these vulnerable infants.     

Warty carcinoma of the oral mucosa in an HIV+ patient

The authors present the case of a 36-year-old HIV+ male patient with a 1-cm diameter papillary exophytic lesion of the right cheek. Microscopic examination showed a papillary epithelial neoplasm with invasion of the stroma in the peripheral part. Cellular and nuclear atypia were present in the superficial and in the deep layers of the neoplasm. An in situ hybridization for human papillomavirus (HPV) 6, 11, 16, 18, 31, 35 and 51 was performed. A focal positivity only for HPV 16 and 18 was present in koilocytotic cells of the most peripheral portion of the lesion. The microscopic definitive diagnosis was warty carcinoma of the cheek. No recurrence was observed at a 3-year follow-up.     

Angiomyolipoma of the palate. Report of a case

Angiomyolipoma (AML) is a tumour or an hamartomatous growth that usually affects the kidney. Only rarely has AML been described in the oral cavity. The authors report a case of AML located in the palate in a 43-year-old patient. AML is composed of smooth muscle cells, blood vessels and mature fat cells. In 50% of cases, AML presents with symptoms of tuberous sclerosis. Renal AML are often invasive, may involve regional nodes and may recur, while, on the contrary, AML are most often well circumscribed and easily resected. AML seems to follow an entire benign course.