RBRE-73; No. of Pages 7 r e v b r a s r e u m a t o l . 2 0 1 4;x x x(x x):xxx-xxx REVISTA BRASILEIRA DE REUMATOLOGIA w w w . r e u m a t o l o g i a . c o m . b r Available online xxx Keywords: Lidocaine Intravenous lidocaine Chronic pain a b s t r a c tBackground: pain is a public health problem, greatly impairing quality of life. Almost 80% of patients with chronic pain reported that their pain interferes with activities of daily living, and two thirds reported that the pain causes negative impact on their personal relationships.The physical and functional disability, whether temporary or permanent, compromises the professional activity and causes work absenteeism, increasing costs of health systems.Objectives: the aim of this review is to analyze, based on the literature, the analgesic effect of lidocaine administered intravenously for the treatment of chronic pain and to evaluate the reduction of pain intensity in patients with chronic pain, focusing on musculoskeletal and neuropathic etiology. Methodology: the method used was a review of the literature, consisting in searching the scientific literature on the efficacy of intravenous lidocaine infusion in the treatment of patients with chronic pain. Content: of the 19 studies reviewed, 12 had results that confirm the analgesic effect of intravenous lidocaine in patients with chronic pain. Most authors used doses of 5 mg/kg infused for 30 minutes or more, producing significant analgesia with variable duration (minutes to weeks). Conclusions: based on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted. 2 r e v b r a s r e u m a t o l . 2 0 1 4;x x x(x x):xxx-xxx A ação analgésica da lidocaína intravenosa no tratamento da dor crônica: uma revisão de literatura Palavras-chave: Lidocaína Lidocaína intravenosa Dor crônica r e s u m o Justificativa: a dor é um problema de saúde pública, comprometendo sobremaneira a qualidade de vida. Quase 80% dos pacientes com dor crônica relataram que a dor interfere em suas atividades da vida diária, e dois terços afirmaram que a dor provoca impacto negativo nas relaç ões pessoais. A incapacidade física e funcional, seja temporária ou permanente, compromete a atividade profissional e causa absenteísmo ao trabalho, elevando os custos dos sistemas de saúde. Objetivos: o objetivo desta revisão é analisar, com base na literatura, o efeito analgésico da lidocaína administrada por via intravenosa no tratamento da dor crônica e avaliar a redução da intensidade da dor em pacientes com dor crônica, focando a etiologia musculoesquelética e neuropática. Metodologia: o método adotado foi o de revisão da literatura, consistindo na busca de artigos científicos sobre a eficácia da infusão intravenosa de lidoca...

Background Although usually believed to be harmless, intestinal spirochetosis may active erosive colitis associated with intestinal spirochetosis that may mimic idiopathic chronic inflammatory bowel disease. Case presentation. A 49-year-old homosexual male patient sought medical assistance due to asthenia, rectal bleeding, tenesmus, and diarrhea for one month. He had been using corticosteroids for nine months to treat sciatic nerve pain. Colonoscopy showed rectum and distal sigmoid with diffuse erythema with many surface erosions. Rectal biopsy showed inflammatory changes including chronic changes such as architectural distortion and basal plasmacytosis, and active inflammation including crypt microabscesses. In all large bowel sample, dense colonization of intestinal spirochetosis was observed. Patient also had a positive PCR testing for Chlamydia trachomatis. The patient was treated with metronidazole for 14 days, ciprofloxacin for 14 days and azithromycin (single dose). Symptoms improved and the patient is asymptomatic after two months of follow-up. Conclusion In some high-risk groups, intestinal spirochetosis may cause colonic manifestations with overlapping features with intestinal bowel diseases. Awareness of this association is importance since proper antibiotic therapy against Brachyspira (metronidazole) is highly effective. Coinfection with other sexually transmitted infections is common and proper treatment is required.

Based on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted.

Introduction To evaluate the frequency of divergent differentiations / variant morphology in urothelial carcinoma, and their association with muscle-invasive disease at diagnosis. Methods All consecutive cases of invasive urothelial carcinoma from a busy pathology laboratory were reviewed. Clinical and pathological data were recorded including data on divergent and variant morphologies and their percentage within the invasive component. Results Among 91 cases, 46 (51%) showed some form of divergent/variant morphology. The most common divergent morphology was squamous which was present in 18/46 (39% of cases with some divergent or variant morphology) followed by micropapillary (28%), plasmacytoid (20%) and poorly differentiated (17%). Only squamous differentiation was associated with higher rate with muscularis propria invasion. Conclusions Although common, squamous differentiation should be still recognized as a feature of aggressive disease.

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Pacinian corpuscle is a low threshold mechanoreceptor involved in the sensation of pressure, touch, and vibration. Its structure comprises a capsule, flat cells (Schwann-like glial cells, or lamellar cells) arranged in a concentric pattern of about 30 lamellae and a central core with an axon terminal. 1,2 Pacinian corpuscles are commonly seen in dermis and subcutaneous tissues of the hands and feet and the digits, arm, neck, mesenteries, near joints, nipples, external genitalia, and periosteal and interosseous membranes. 3 They are exceptionally rare in other locations and have been documented in urinary bladder, pancreas, lymph nodes and thymus. 4e7 They have also been observed in developmental disorders such as meningoradiculoceles and cervical chondrocutaneous rests. 8,9 We are aware of two previous reports of Pacinian corpuscles in the prostate, 10,11 both of which were not in clear intraprostatic location.We report herein the finding of a radical prostatectomy specimen from a 64-year-old patient. It showed a prostatic adenocarcinoma, Gleason score 9 (4þ5) (Grade group 5), with extraprostatic extension (pT3a). On microscopy, the periphery of the right apex showeddin addition to extensive prostatic malignancydone bulbous onion-like formation measuring 1 mm (maximum diameter) in obvious intraprostatic location (Fig. 1). The corpuscle was located 0.5 mm deep from the external boundary of the prostate. Clinical history was unremarkable.

321 Background: Multiparametric magnetic resonance imaging (mpMRI) of the prostate has been increasingly used in the algorithm of the initial diagnosis of patients suspected to harbor prostate cancer (PCa) with the aim of improving the selection of patients who really need a biopsy. Yet patients with PI-RADS 5 lesions almost always have cancer found in their prostates, the same is not true for patients with PI-RADS 4. In this study we sought to describe pathological findings in target biopsies of PI-RADS4, and to identify clinical data that could predict those patients with benign findings. Methods: A retrospective study was conducted in a data bank collected prospectively from December 2015 through April 2022 in a single nonacademic center. The whole series consist of 547 patients, all of whom had a mpMRI of the prostate (reports as per PI-RADS version 2) followed by cognitive fusion prostate biopsy performed by a single, experienced radiologist. All biopsy specimens were read by a specialist in urological pathology. Out of these, 259 had PI-RADS 4 lesion, and 83 had PI-RADS 5. Results: We found a false positive rate of 29% and 3.7% for any cancer in PI-RADS 4 and 5 lesions, respectively. Different histologic patterns were observed among target biopsies. At multivariate analysis, PIRADS lesion ≤ 6 mm and previous negative biopsy were independent predictors of false positive PI-RADS4 lesions. The 76 cases showed normal histology (n = 22), a combination of chronic inflammation, reactive epithelium, and glandular atrophy (n = 18), glandular atrophy (n = 9), stromal proliferation consistent with nodular hyperplasia (n =7), a combination of chronic inflammation, reactive epithelium and glandular atrophy (n = 6), chronic inflammation (n = 4) and HGPIN (n = 10). The small number (n=3) of false PI-RADS5 lesions precluded further analyses. Conclusions: Benign findings are common in PI-RADS4 lesions and most of them did not show obvious glandular or stromal hypercellularity as expected in hyperplastic nodules. Size ≤ 6 mm and previous negative biopsy predict higher probability of false positive results in patients with PI-RADS 4 lesions.[Table: see text]

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