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Objective: To analyze vascular density and immunolocalization of angiogenic vascular endothelial growth factor (VEGF) and its receptor Flk-1 in the proliferative and secretory eutopic human endometrium and in three different sites of endometriosis: the ovary, bladder, and rectum., Design: Prospective study., Setting: University hospital., Patient(s): Thirty women with endometriosis (10 ovarian, 10 bladder, 10 rectal) and 32 control women (10 proliferative endometrium, 10 secretory endometrium, 4 normal ovary, 4 normal bladder, 4 normal rectum)., Intervention(s): Normal endometrial samples were obtained from women during laparoscopic ablation of subserous myoma, and biopsy specimens of endometriosis were obtained from patients undergoing surgery for the diagnosis and treatment of endometriosis. Normal tissues of ovary, bladder, and rectum were obtained from these organs beside the lesions of endometriosis., Main Outcome Measure(s): Blood vessels were quantified according to the number of von Willebrand factor-positive endothelial cells. The VEGF and Flk-1 distribution were evaluated semiquantitatively by immunohistochemical staining., Result(s): More blood vessels were found in cases of endometriosis, particularly rectal endometriosis, compared with the respective control samples and with the eutopic endometrium, and they were localized in endometrial stroma around the glands. The VEGF and Flk-1 expression levels were also higher in cases of endometriosis, especially rectal endometriosis., Conclusion(s): Vascularization and VEGF and Flk-1 expression are significantly higher in deeply infiltrating endometriosis affecting the rectum, reinforcing the hypothesis that antiangiogenesis therapy may constitute a new modality of treatment, especially in cases of deep endometriosis involving the rectum.

Context and Objective: Endometriosis is a common affliction that may affect the intestinal tract. The objective of this case report was to describe an unusual clinical presentation of this form of the disease., Case Report: The patient was a 35-year-old woman with epigastric pain that only occurred during menstruation, who had a history of bladder endometriosis. Endoscopy of the upper digestive tract showed normal results. Transvaginal ultrasound and nuclear magnetic resonance of the pelvis showed a lesion involving the ileocecal junction and appendix, measuring 30 x 22/x/13/mm, that was suggestive of endometriosis. The patient underwent laparoscopic resection of the bowel segment affected by the disease, followed by anastomosis of the ileum and ascending colon for immediate restoration of intestinal transit. Histological analysis confirmed the diagnosis of endometriosis., Conclusions: In young women, recurrent epigastric pain should be evaluated with regard to its relationship to menstruation, particularly if there is a history of endometriosis, since this may be a clinical sign that the disease is affecting the intestinal transit.

This study analyzed the antimicrobial effect of photodynamic therapy (PDT) in association with endodontic treatment. Twenty patients were selected. Microbiological samples were taken after accessing the canal, endodontic therapy, and PDT. At the end of the first session, the root canal was filled with Ca(OH)(2), and after 1 week, a second session of the therapies was performed. Endodontic therapy gave a mean reduction of 1.08 log. The combination with PDT significantly enhanced the reduction (1.83 log, p = 0.00002). The second endodontic session gave a similar diminution to the first (1.14 log), and the second PDT was significantly more effective than the first (p = 0.002). The second total reduction was significantly higher than the second endodontic therapy (p = 0.0000005). The total first + second reduction (3.19 log) was significantly different from the first combination (p = 0.00006). Results suggest that the use of PDT added to endodontic treatment leads to an enhanced decrease of bacterial load and may be an appropriate approach for the treatment of oral infections.

Objective: Studies on the influence of low-power red laser on the repair of dental structures are very scarce. This study investigated the effects of the laser therapy on the ultrastructure of the dentine-pulp interface after conservative class I cavity preparation., Design: Two female volunteers with 8 premolars indicated for extraction for orthodontic reasons were recruited. Class I cavities were prepared and the teeth were randomly divided into two groups. The first group received treatment with a GaA1As laser, lambda=660nm, power of 30mW and energy dose of 2J/cm(2), directly and perpendicularly into the cavity in a single visit. After the irradiation, the cavities were filled with composite resin. The second group received the same treatment, except by the laser therapy., Results: Twenty-eight days post-preparation, the teeth were extracted and processed for transmission electron microscopy analysis. Two sound teeth, without cavity preparation, were also studied. The irradiated group presented odontoblast process in higher contact with the extracellular matrix and the collagen fibrils appeared more aggregated and organised than those of control group. These results were also observed in the healthy teeth., Conclusion: These findings suggest that laser irradiation accelerates the recovery of the dental structures involved in the cavity preparation at the predentine region.

Background: Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagnosed before age 4, with a median age at diagnosis of 2 years., Objective: To determine characteristics and prognosis of retinoblastoma in children older than 5 years., Procedures: From 1986 to 2002, medical records of 16 patients out of 453 cases referred to Hospital do Câncer AC Camargo, São Paulo, Brazil., Results: Median age at diagnosis was 73.7 months (range 65-144) and there was an equal gender distribution. Fifteen patients presented with unilateral disease. The mean time between first symptoms and diagnosis was 9.6 months (range 0-48). Most cases were diagnosed in advanced stages and 15 eyes were enucleated. Eleven patients presented with intraocular tumor (1 Reese II and 10 Reese V) and five presented with extraocular disease (one CCG II and four CCG III). Twelve patients are still alive with a median follow-up of 92 months (range 65-199)., Conclusions: Because of its low incidence at this age, diagnosis of retinoblastoma is usually delayed due to low level of suspicion. Therefore, it is important that physicians are aware of this disease in order to perform an earlier diagnosis, and decrease treatment-related morbidity., ((c) 2006 Wiley-Liss, Inc.)

The aim of this study was to investigate the ability of malachite green (MG) combined with a low-power red laser to kill Actinobacillus actinomycetemcomitans and to investigate MG photodegradation after photodynamic therapy (PDT) by optical absorption spectroscopy. The etiology of periodontal disease is that microorganisms form a bacterial biofilm on the surface of the teeth. It is an infectious disease and A. actinomycetemcomitans is considered an important agent in biofilm ecology. Instead of using antibiotics, PDT is an alternative approach to eradicate bacteria. Cultures of A. actinomycetemcomitans were exposed to a 30 mW diode red laser, in the presence or absence of MG. A group of cultures was treated in dark conditions in the presence of MG (0.01% w/v) for 5 min. In the presence of MG, two exposure times for laser irradiation were used: t=3 min (energy dose=5.4 J/cm(2)), and t=5 min (energy dose=9 J/cm(2)). The samples were diluted and bacterial colonies were counted and converted into colony forming units. Absorption spectra of the bacterial suspensions, MG, MG-stained bacterial suspensions, and photosensitized bacterial suspensions were obtained. A. actinomycetemcomitans can be photoinactivated by a red laser in the presence of MG. Significant differences were observed between the two energy doses used (p<0.05). Red laser alone and MG alone were not able to kill bacteria. Optical absorption showed that MG is photobleached after irradiation. These results indicate that A. actinomycetemcomitans can be photosensitized by red laser combined with MG and that the dye is photodegraded following irradiation.

The purpose of the study was to evaluate at term, the effects of the association of zidovudine/ritonavir administered during the entire period of rat pregnancy. Forty pregnant EPM-1 Wistar rats were divided randomly into four groups: one control (drug vehicle control, n=10) and three experimental treated with an oral solution of zidovudine/ritonavir (Exp 1 = 10/20 mg/kg bw, n = 10; Exp 2 = 30/60 mg/kg bw, n=10; Exp 3 = 90/180 mg/kg bw, n=10) from day 0 up to day 20 of pregnancy. Maternal body weights were recorded at the start of the experiment and at the 7th, 14th and the 20th day thereafter. At term (20th day) the rats were anesthetized and, upon laparotomy and hysterotomy, the number of implantations, resorptions, living fetuses, placentae and intrauterine deaths were recorded. The collected fetuses and placentae were weighed, and the concepts were examined under a stereoscopic microscope for external malformations. The maternal body gain and the mean fetal weight at term were both significantly lower (p < 0.01 and p < 0.0001, respectively) in the experimental groups compared to the control. The recorded resorptions were higher in Exp 2 and Exp 3 groups than in the control group. The other parameters were not affected. The exposure of pregnant rats at term to a 1:2 association of zidovudine plus ritonavir resulted in a significant reduction in maternal body weight gain and increased rate of fetal resorption.

Microbial infection plays an important role in the development of pulp necrosis and formation of periapical lesions. In vitro and in vivo research in this field, traditionally microbiological culture methods using paper point sampling and quantitative culture, faces difficulties in completely removing bacteria from the root canal system and analyzing sequential procedures. This study employed genetically engineered bioluminescent bacteria and a light-sensitive imaging system to allow real-time visualization of the infection. Ten extracted teeth incubated with P. aeruginosa were treated by mechanical instrumentation with K-files (#30 K-file, #35 K-file and #40 K-file) and chemical irrigation with sodium hypochlorite and hydrogen peroxide. Irrigation alone reduced the contamination in 18%; the first chemomechanical sequence (instrumentation with a #30 K-file + irrigation) provided 41% of reduction; the second sequence (#35 K-file + irrigation) achieved 62%; and the complete therapy (#30 K-file + #35 K-file + #40 K-file + irrigation) achieved 93% of bacterial reduction. These results suggest that the endodontic treatment is dependent on the association of a chemical and mechanical approaches and that root canal enlargement improves bacterial reduction probably because the irrigation has more access to the apical third.

Objective: The purpose of this study was to investigate gingival healing after gingivectomy and adjunctive use of low-level laser therapy (LLLT)., Background Data: LLLT has been used in animal experiments to examine the influence of laser radiation on the wound healing process since the 1960s. However, clinical trials in dentistry are scarce, and most of them refer to treatment after extraction of the third molars, with only a few reports in the area of periodontics., Methods: Twenty patients with periodontal disease were selected, and treatment was planned for gingivectomy to bilateral maxillary and mandibular premolar teeth. After surgery, one side was submitted to LLLT using a 685-nm wavelength, output power of 50 mW, and energy density of 4 J/cm(2). The other side was used as the control and did not receive laser irradiation. Healing was evaluated, clinically and biometrically, immediately post-surgery and at days 3, 7, 14, 21, 28, and 35. Results were submitted to statistical analysis., Results: Biometrical evaluation indicated a significant improvement in healing for the laser group at 21 and 28 days. Clinical evaluation showed better repair for the laser group, mainly after the third day., Conclusion: LLLT was an effective adjunctive treatment that appeared to promote healing following gingivectomy.

Objective: To investigate the action of a red laser associated with a photosensitizer on the reduction of Enterococcus faecalis in dental root canal in vitro., Study Design: Thirty prepared teeth with single canals were contaminated. The chemical group was irrigated with 0.5% NaOCl and left flooded for 30 minutes. In the laser group, a paste-based photosensitizer was maintained in the root canals for 5 minutes, and then irradiated with a laser at 685 nm using an optical fiber for an E of 1.8 J during 3 minutes. After treatment, the canal content was collected, serially diluted, and cultured to determine the number of colony-forming units., Results: Photosensitizer alone or laser alone did not have any bactericidal effect. Chemical solution reduced viable bacteria in 93.25%. Laser photosensitization resulted in a reduction of 99.2%, a significantly higher bacterial reduction than NaOCl., Conclusion: Laser photosensitization was effective for reducing E. faecalis in root canals and could be an adjunct to endodontic treatment.

This study compared the long-term effects of the levonorgestrel-releasing intrauterine device with those of GnRH agonist administration on serum levels of CA-125 in patients with endometriosis. The levonorgestrel-releasing intrauterine device was found to be as efficient as GnRH agonist in reducing CA-125 serum levels.

Oral hairy leukoplakia (OHL) is an EBV (Epstein-Barr virus) opportunistic infection found in HIV-infected patients. It is an asymptomatic lesion that has an important prognostic value in AIDS. Differently from what takes place with HIV adult patients, OHL has been described in the literature as having a very small prevalence in pediatric patients. Therefore, the aim of this study was to investigate the prevalence of OHL in HIV pediatric patients using cytopathology. The sample consisted of 120 patients who were submitted to oral examination and had material scraped from both sides of their tongues. The diagnostic criterion was based on the identification of nuclear alterations. Clinical OHL was identified in two (1.67%) patients. The cytopathology revealed twenty (16.7%) cases of subclinical OHL. Our results show that in pediatric patients the prevalence of OHL may be larger than that described in the literature.

We use the optical path difference (OPD) technique to quantify the organization of collagen fibers during skin repair of full-thickness burns following low-intensity polarized laser therapy with two different polarization incidence vectors. Three burns are cryogenerated on the back of rats. Lesion L(parallel) is irradiated using the electric field vector of the polarized laser radiation aligned in parallel with the rat's occipital-caudal direction. Lesion L(perpendicular) is irradiated using the electric field vector of the polarized laser radiation aligned perpendicularly to the aforementioned orientation. Lesion C is untreated. A healthy area labeled H is also evaluated. The tissue samples are collected and processed for polarized light microscopy. The overall finding is that the OPD for collagen fibers depends on the electric field vector of the incident polarized laser radiation. No significant differences in OPDs are observed between L(parallel) and H in the center, sides, and edges of the lesion. Lesions irradiated using the electric field vector of the polarized laser radiation aligned in parallel with the rat's occipital-caudal direction show higher birefringence, indicating that collagen bundles in these lesions are more organized.

Objective: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and transcutaneous electrical neural stimulation (TENS) on the improvement of mouth opening in patients with temporomandibular disorder (TMD)., Background Data: TMDs are conditions that affect the form and/or function of the temporomandibular joint (TMJ), masticatory muscles, and dental apparatus. Often TMD is associated with pain localized in the TMJ and/or in the muscles of the face and neck., Methods: This clinical trial was performed in 10 patients, 18-56 years old, diagnosed with TMD of multiple causes. All patients received both methods of treatment in two consecutive weeks. LLLT was delivered via a 670-nm diode laser, output power 50 mW, fluence 3 J per site/4 sites (masseter muscle, temporal muscle, mandibular condyle, and intrauricular). TENS therapy was applied with a two-electrode machine at 20 W, maximum frequency of 60 Hz, adjusted by the patient according to their sensitivity. The amplitude of mouth opening was recorded before treatment and immediately after using a millimeter rule; the measurements were performed from the incisal of the upper incisors to the incisal of the lower incisors. A paired t-test was applied to verify the significance of the results., Results: A significant improvement in the range of motion for both therapies was observed immediately after treatment. Comparing the two methods, the values obtained after LLLT were significantly higher than those obtained after TENS (p < 0.01)., Conclusions: Both methods are effective to improve mouth opening. Comparing the two methods, LLLT was more effective than TENS applications.

Objective: To evaluate the advantages and disadvantages of microlaparoscopy vs. conventional laparoscopy in the management of patients with early-stage pelvic endometriosis., Study Design: In this prospective, randomized study we evaluated 54 patients with a clinical diagnosis of stage I and II pelvic endometriosis according to the classification of the American Society for Reproductive Medicine, revised in 1996. The patients were divided into 3 groups and underwent, respectively, microlaparoscopy under sedation, microlaparoscopy under general anesthesia and conventional laparoscopy for definitive diagnosis and treatment of the disease., Results: Microlaparoscopy caused less pain, required lower consumption of analgesics and permitted a faster return to daily activities. Sedation decreased the incidence of nausea, vomiting and oropharyngeal pain. Microlaparoscopy under sedation led to a shorter hospital stay and reduced cost., Conclusion: Microlaparoscopy under sedation is a viable alternative for the management of patients with suspected early-stage pelvic endometriosis.

Study Objective: To evaluate the accuracy of rectal endoscopic ultrasound and to evaluate endometriosis in the rectovaginal septum, rectum, and sigmoid walls., Design: Validation of diagnostic test (Canadian Task Force classification II-1)., Setting: Tertiary care hospital., Patients: Thirty-two consecutive women clinically suspected of having rectovaginal septum endometriosis without previous surgical treatment., Intervention: Colonoscopy, transrectal ultrasound, and rectal endoscopic ultrasound, followed by laparoscopy or laparotomy., Measurements and Main Results: The disease was classified according to 1996 standards of the American Society of Reproductive Medicine. Images obtained by colonoscopy, endoscopic ultrasound, and surgery and histologic findings were compared. In 6 patients endometriosis infiltrated bowel muscularis wall, in 20 it infiltrated rectovaginal septum, and in the remaining 6 there was no evidence of lesions. In all women in whom infiltration of the intestinal wall was suspected, rectal endoscopic ultrasound and colonoscopy confirmed the lesions (sensitivity 100%, specificity 67%)., Conclusion: Endoscopic ultrasound was useful in preoperative assessment of women with endometriosis.

Objective: This study was carried out to investigate the influence of low-intensity polarized visible laser radiation on the acceleration of skin wound healing., Background Data: Low-level laser therapy (LLLT) at adequate wavelength, intensity, and dose can accelerate tissue repair. However, there is still unclear information about light characteristics, such as coherence and polarization. Some studies indicate that linearly polarized light can survive through long propagation distance in biological tissue., Materials and Methods: Three burns about 6 mm in diameter were created on the back of rats with liquid N(2). Lesion "L(//)" was irradiated by He-Ne laser (lambda = 632.8 nm), D= 1.0 J/cm(2), with linear polarization parallel to the spinal column of the rat. Lesion "L(inverted v)" was irradiated using the same laser and dose, but the light polarization was aligned perpendicularly to the relative orientation. Lesion "C" was not irradiated in order to be considered as control. The animals were sacrificed at day 3-17 after lesion creation. Samples were collected and prepared for histological analysis., Results: Histological analysis showed that the healing of irradiated wounds was faster than that of non-irradiated wounds. Moreover, it was observed that skin wound repair is dependent on polarization orientation with respect to a referential axis as the animal's spinal column. Consequently, "L(//)" was completely healed after 17 days, whereas "L (perpendicular) " showed a moderate degree of healing after the same period., Conclusions: These results indicate that the relative direction of the laser polarization plays an important role in the wound healing process when highly coherent He-Ne laser is used.

Background: The involvement of the rectovaginal septum, of rectum and sigmoid by endometriosis leads to intense symptoms as dysmenorrhea, pelvic pain, deep dyspareunia, tenesmus and hematochezia in young and middle aged women during periods. The diagnosis can be made by tipycal history and vaginal examination, rectal examination, barium enema, proctoscopy and so on. The indications of operation include severe clinic symptoms and failed conservative therapy. The treatment of choice for this type of endometriosis is the surgical resection of affected tissue, in order to relieve patient symptoms, and avoid disease progression. The correct assessment as to the presence and extension of the endometriosis-affected sites such as the rectum, uterosacral ligaments and rectovaginal septum is extremely important to provide better results with the surgical treatment of endometriosis., Aim: To describe the main aspects related to rectovaginal septum endometriosis and offer the general surgeon some information about this enigmatic disease., Conclusion: Rectovaginal septum endometriosis is a frequent disease, with specific diagnosis and treatment.

Previous research in our laboratory has shown that the polarization component of the electrical field plays an important role on the healing process of inflammatory lesions created in the end of the spinal column of Lewis rats, using a He-Ne laser at lambda = 632.8 nm. It is well known that polarization is lost in a turbid medium, such as living tissue. However, the Nd:YLF wavelength (lambda = 1,047 nm) allows more polarization preservation than lambda = 632.8 nm, and the Nd:YLF laser beam has been used in clinical trials as a biostimulating agent. In this work, we investigated the influence of a low-intensity, linearly polarized Nd:YLF laser beam on skin wound healing, considering two orthogonal directions of polarization. We have considered a preferential axis as the animals' spinal column, and we aligned the linear laser polarization first parallel, then perpendicular to this direction. Burns of about 6 mm in diameter were created with liquid N2 on the back of the animals, and the lesions were irradiated on days 3, 7, 10, and 14 postwounding, D = 1.0 J/cm2. Lesions 1 and 2 were illuminated using Nd:YLF pulsed laser radiation. Lesion 1 was irradiated with linear polarization parallel with the rat spinal column. Lesion 2 was irradiated using the same protocol, but the light polarization was aligned with the perpendicular relative orientation. Control lesions were not irradiated. We have taken photographs from the wound areas on the 3rd, 7th, 10th, 14th, and 17th postoperative day for a biometrical analysis. The results have shown that lesion 1 healed faster than the control lesions (p < 0,05), which presented a smaller degree of healing after 14 days postwounding.