Comparative study of the anaesthetic efficacy of 4% articaine versus 2% mepivacaine in mandibular third molar germectomy using different anaesthetic techniques: a split-mouth clinical trial

BACKGROUND

Currently, one of the most discouraging aspects for many patients undergoing dental procedures is the administration of local anaesthesia. Therefore, there is a constant search for new techniques to avoid the invasive and painful nature of the injection. This study aimed to compare the clinical efficacy of local anaesthetics with articaine 4% or mepivacaine 2% (both with epinephrine 1:100.000), using different anaesthetic techniques to perform germectomy of lower third molars and to assess patients' feelings and pain during surgery.

METHODS

Totally 50 patients (ranged 11-16 years) who required germectomy of mandibular third molars were recruited. Each patient received local anaesthesia on one side with articaine inoculated with plexus technique while on the other side with mepivacaine using inferior alveolar nerve block technique. The patients' evaluation was performed on pre and intraoperative tactile-pressure feelings and intraoperative pain with four levels on the Visual Analogue Scale (VAS).

RESULTS

Surgical operations lasted less with more efficient analgesia when articaine was used. The additional intraosseous injection was required mainly in the mepivacaine group intraoperatively. A few patients had tactile-pressure feelings while intraoperative pain sensation was absent in 90% of cases with articaine. Significant differences were found in the cases who reported "absent" and "moderate" VAS values, favoring the use of articaine.

CONCLUSIONS

Articaine injected with a plexus anaesthetic technique seems to be more clinically manageable than mepivacaine for the mandibular third molar germectomy. The discomfort of tactile-pressure feelings and pain experienced was lower using articaine anaesthetic technique used.

Cellular neurothekeoma with neuroendocrine differentiation

We report a case of cellular neurothekeoma with unusual clinicopathological features in which neuroendocrine markers, determined by immunohistochemistry were observed. Histologically, the tumor showed a micronodular architecture with hypercellular lobules composed of slightly spindled to epithelioid cells, with nuclear atypia or pleomorphism and extension into fat, skeletal muscle. Neoplastic cells were immunoreactive for NKI/C3, CD68, CD10, and smooth-muscle actin, whereas S100 and HMB-45 staining was negative. An intriguing feature was the strong expression by tumor cells of different neuroendocrine markers. Clinical follow up showed no local recurrences after five months despite the presence of positive margins. The presence of atypical histopathological features may cause diagnostic problems with malignant mesenchymal tumors, nevo-melanocytic lesions, and fibrohistiocytic tumors. The immunohistochemical profile including the positive staining for neuroendocrine markers may suggest divergent differentiation or an origin from myofibroblast and neuroendocrine cells.

Epithelioid variant of pleomorphic liposarcoma as potential mimic of metastatic carcinoma

We report a case of epithelioid variant of pleomorphic liposarcoma (EPL) found in the the infrapatellar fat pad of Hoffa of a 31-year old male. Histologically, the predominant population was formed by epithelioid cells with eosinophilic or clear cytoplasm admixed with rare pleomorphic lipoblasts. The immunohistochemical panel was not helpful in the diagnosis. FISH analysis using the locus-specific indicator CHOP (12q13) dual color break apart was applied to representative formalin-fixed, paraffin-embedded tissue sections. The result of FISH indicated a rearranged CHOP (DDIT3) gene and confirmed the diagnosis of EPL. The EPL should be differentiated from a metastatic carcinoma or other type of sarcoma. In these cases a clinicopathological correlation and an exhaustive sampling of the specimen for demonstration of lipogenic areas or pleomorphic lipoblasts is always necessary. FISH with demonstration of CHOP gene rearrangement is useful in providing specific ancillary information for the difficult differential diagnosis of this case.

Limb body wall complex: a critical review and a nosological proposal

The analysis of the literature on limb body wall complex reveals a varied and rather confused spectrum of cases. However, we noticed the presence of at least 2 clearly distinguishable phenotypes. The first phenotype shows craniofacial defects and amniotic bands and/or adhesion; the second--without craniofacial defects--presents urogenital anomalies, anal atresia, and abdominal placental attachment, together with a persistence of the extra-embryonic coelom. We think these 2 phenotypes are the consequence of different pathogenetic mechanisms. The pathogenesis of the first type can be related to an early vascular disruption, while the pathogenesis of the second one is attributable to an intrinsic embryonal maldevelopment. Eight cases of the second phenotype were identified and the pathological findings proving this maldevelopmental origin are described.

Fine needle aspiration cytology of lipid-secreting breast carcinoma. A case report

Lipid-secreting carcinoma is a rare type of invasive carcinoma of the breast first described by Aboumrad et al in 1963. We believe lipid-secreting carcinoma to be a specific type of breast carcinoma and that it has to be differentiated from invasive lobular carcinoma. We report for the first time the fine needle aspiration cytologic features along with the histologic and electron microscopic findings.

Extraskeletal myxoid chondrosarcoma with intranuclear vacuoles and microtubular aggregates in the rough endoplasmic reticulum. Report of a case with fine needle aspiration and electron microscopy

The findings of fine needle aspiration biopsy cytology, histology, immunohistochemistry and electron microscopy in an extraskeletal myxoid chondrosarcoma of the soft tissue of the thigh detected in a 65-year-old man are described. In addition to the more usual cytologic findings of chondroblasts and pleomorphic mesenchymal cells, this tumor displayed distinctive intranuclear cytoplasmic inclusions and microtubular aggregates in the rough endoplasmic reticulum. Cytologic study made the diagnosis of malignancy, suggesting a myxoid sarcoma; the precise diagnosis was made by the subsequent studies on the resected tumor and resin-embedded samples of the aspirate. The suitability of aspirated material in the differential diagnosis of myxoid soft tissue tumors is discussed.

Myxoma of the skull and orbit

An unusual case of myxoma of the skull extending into the orbital cavity is reported. Myxoma is a benign tumour of the soft tissues and maxillary bones, which often presents infiltrating growth and recurrences. Histologically it is characterized by abundant myxoid stroma and is often confused with other tumours which can present mucoid degeneration. Although diagnosis is impossible before histological examination, the possibility of a myxoma must be considered in the presence of extradural osteolytic poorly vascularized lesions.

Carcinoma of the breast with osteoclast-like giant cells. Fine-needle aspiration cytology, histology and electron microscopy of 5 cases

Five cases of a rare peculiar type of mammary carcinoma with osteoclast-like stromal giant cells are reported. The tumors are characterized by a large number of multinucleated giant cells in intimate association with the epithelial neoplastic cells. The light and electron microscopic observations confirm the earlier reports about the origin of the giant cells from mononuclear histiocytes as a local response to some tumoral products. In 3 patients a preoperative fine-needle aspiration biopsy was carried out and the cytomorphology of these tumors is described to alert cytopathologists who encounter this entity in the routine breast mass aspiration biopsy.

Angioimmunoblastic lymphadenopathy with dysproteinemia: report of the first case in childhood evolving toward spontaneous remission

This is the first known report of a case of angioimmunoblastic lymphadenopathy, with dysproteinemia (AILD) in childhood which evolved toward a spontaneous remission. The disease had an acute onset with generalized lymphadenopathy, hepatosplenomegaly, high-grade fever and polyclonal hypergammaglobulinemia. The lymph nodes met all of the histologic criteria required for diagnosis as established by Frizzera et al. It is emphasized that AILD should be taken into consideration in the differential diagnosis of lymphadenopathy in childhood.