RESUMEN
BACKGROUND: The aim was to investigate the correlation of bone tracer uptake (BTU) in SPECT/CT and changes in coronal knee alignment after total knee arthroplasty (TKA). We questioned if undercorrection of preoperative varus alignment leads to a difference in BTU compared to neutral alignment. METHODS: Consecutive 66 patients who received SPECT/CT before and after TKA were retrospectively included. Adjusted mechanical alignment was the alignment target. The alignment of the knee was measured on 3D-CT by selecting standardized landmarks. Maximum (mean ± SD) and relative BTU (ratio to the reference) were recorded using a previously validated localization scheme (p < 0.05). RESULTS: In the native group, 20 knees were aligned (30.3%) in valgus (HKA > 181.5°), 12 (18.2%) in neutral (178.5°-181.5°) and 34 (51.5%) in varus (HKA < 178°). Overall TKA changed the alignment towards neutral. 48.5% remained in the same groups, whereas 50% of native valgus and 33% of varus knees changed to neutral after TKA. In native varus alignment mean BTU was significantly higher in some medial tibial and femoral regions (fem1ia (p = 0.010), fem1ip (p = 0.002), tib1a.mid (p = 0.005), tib1a.tray (p = 0.000), tib1p.tray (p = 0.000)); in native valgus alignment mean BTU was higher in the corresponding lateral tibial and femoral regions (fem2ip (p = 0.001), tib2a.tray (p = 0.011), tib2p.tray (p = 0.002)). After TKA, a significant decrease in femoral and tibial BTU (femoral preoperative BTU 1.64 +/-0.69; femoral postoperative BTU 0.95 +/-0.42; p = 0.000// tibial preoperative BTU 1.65 +/- 0.93; tibial postoperative BTU 1.16 +/- 0.48; p = 0.000) and an increase in patellar BTU was observed (p = 0.025). Native varus alignment correlated with a higher medial BTU decrease medially. Undercorrection of preoperative varus alignment showed no higher BTU after TKA. CONCLUSION: Preoperative varus alignment correlated with a higher decrease in BTU in specific femoral and tibial medial regions. Preoperative valgus alignment correlated with a higher decrease in the corresponding lateral regions. Undercorrection of preoperative varus alignment did not lead to higher bone loading reflected by BTU after TKA.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Rótula/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Tibia/diagnóstico por imagen , Tibia/cirugíaRESUMEN
PURPOSE: The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. METHODS: Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11-30) after MOWHTO by collecting the WOMAC score. RESULTS: Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. CONCLUSION: This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Osteoartritis de la Rodilla , Tibia , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Estudios Retrospectivos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Tibia/diagnóstico por imagen , Tibia/cirugía , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
BACKGROUND: There is increasing evidence that folate, an important component of one-carbon metabolism, modulates the epigenome. Alcohol, which can disrupt folate absorption, is also known to affect the epigenome. We investigated the association of dietary folate and alcohol intake on leukocyte DNA methylation levels in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Leukocyte genome-wide DNA methylation profiles on approximately 450,000 CpG sites were acquired with Illumina HumanMethylation 450K BeadChip measured among 450 women control participants of a case-control study on breast cancer nested within the EPIC cohort. After data preprocessing using surrogate variable analysis to reduce systematic variation, associations of DNA methylation with dietary folate and alcohol intake, assessed with dietary questionnaires, were investigated using CpG site-specific linear models. Specific regions of the methylome were explored using differentially methylated region (DMR) analysis and fused lasso (FL) regressions. The DMR analysis combined results from the feature-specific analysis for a specific chromosome and using distances between features as weights whereas FL regression combined two penalties to encourage sparsity of single features and the difference between two consecutive features. RESULTS: After correction for multiple testing, intake of dietary folate was not associated with methylation level at any DNA methylation site, while weak associations were observed between alcohol intake and methylation level at CpG sites cg03199996 and cg07382687, with qval = 0.029 and qval = 0.048, respectively. Interestingly, the DMR analysis revealed a total of 24 and 90 regions associated with dietary folate and alcohol, respectively. For alcohol intake, 6 of the 15 most significant DMRs were identified through FL. CONCLUSIONS: Alcohol intake was associated with methylation levels at two CpG sites. Evidence from DMR and FL analyses indicated that dietary folate and alcohol intake may be associated with genomic regions with tumor suppressor activity such as the GSDMD and HOXA5 genes. These results were in line with the hypothesis that epigenetic mechanisms play a role in the association between folate and alcohol, although further studies are warranted to clarify the importance of these mechanisms in cancer.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Neoplasias de la Mama/genética , Metilación de ADN , Ácido Fólico/efectos adversos , Estudio de Asociación del Genoma Completo/métodos , Leucocitos/química , Adulto , Anciano , Estudios de Casos y Controles , Islas de CpG , Epigénesis Genética , Femenino , Humanos , Persona de Mediana Edad , Encuestas Nutricionales , Estudios ProspectivosRESUMEN
BACKGROUND: In order to optimally integrate the use of high-throughput sequencing (HTS) as a tool in clinical diagnostics of likely monogenic disorders, we have created a multidisciplinary "Genome Clinic Task Force" at the University Hospitals of Geneva, which is composed of clinical and molecular geneticists, bioinformaticians, technicians, bioethicists, and a coordinator. METHODS AND RESULTS: We have implemented whole exome sequencing (WES) with subsequent targeted bioinformatics analysis of gene lists for specific disorders. Clinical cases of heterogeneous Mendelian disorders that could potentially benefit from HTS are presented and discussed during the sessions of the task force. Debate concerning the interpretation of identified variants and the content of the final report constitutes a major part of the task force's work. Furthermore, issues related to bioethics, genetic counseling, quality control, and reimbursement are also addressed. CONCLUSIONS: This multidisciplinary task force has enabled us to create a platform for regular exchanges between all involved experts in order to deal with the multiple complex issues related to HTS in clinical practice and to continuously improve the diagnostic use of HTS. In addition, this task force was instrumental to formally approve the reimbursement of HTS for molecular diagnosis of Mendelian disorders in Switzerland.
Asunto(s)
Exoma/genética , Enfermedades Genéticas Congénitas/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento/normas , Técnicas de Diagnóstico Molecular/normas , Enfermedades Genéticas Congénitas/genética , Secuenciación de Nucleótidos de Alto Rendimiento/economía , Humanos , Técnicas de Diagnóstico Molecular/economía , Administración en Salud Pública , Mecanismo de Reembolso , Análisis de Secuencia de ADN , SuizaRESUMEN
BACKGROUND: Experimental and epidemiological evidence suggests that prolactin might play a role in the etiology of breast cancer. We analyzed the relationship of prediagnostic circulating prolactin levels with the risk of breast cancer by menopausal status, use of postmenopausal hormone replacement therapy (HRT) at blood donation, and by estrogen and progesterone receptor status of the breast tumors. PATIENTS AND METHODS: Conditional logistic regression was used to analyze the data from a case-control study nested within the prospective European EPIC cohort, including 2250 invasive breast cancer and their matched control subjects. RESULTS: Statistically significant heterogeneity in the association of prolactin levels with breast cancer risk between women who were either pre- or postmenopausal at the time of blood donation was observed (Phet = 0.04). Higher serum levels of prolactin were associated with significant increase in the risk of breast cancer among postmenopausal women [odds ratio (OR)Q4-Q1 = 1.29 (95% confidence interval, CI, 1.05-1.58), Ptrend = 0.09]; however, this increase in risk seemed to be confined to women who used postmenopausal HRT at blood donation [ORQ4-Q1 = 1.45 (95% CI 1.08-1.95), Ptrend = 0.01], whereas no statistically significant association was found for the non-users of HRT [ORQ4-Q1 = 1.11 (95%CI 0.83-1.49), Ptrend = 0.80] (Phet = 0.08). Among premenopausal women, a statistically non-significant inverse association was observed [ORQ4-Q1 = 0.70 (95% CI 0.48-1.03), Ptrend = 0.16]. There was no heterogeneity in the prolactin-breast cancer association by hormone receptor status of the tumor. CONCLUSION: Our study indicates that higher circulating levels of prolactin among the postmenopausal HRT users at baseline may be associated with increased breast cancer risk.
Asunto(s)
Neoplasias de la Mama/sangre , Posmenopausia , Premenopausia , Prolactina/sangre , Neoplasias de la Mama/etiología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Factores de RiesgoRESUMEN
Although the selective serotonin reuptake inhibitors (SSRIs), which are now widely used as a first-line treatment for depression and many other psychiatric conditions, are generally well tolerated, they are not devoid of side effects. Most short-term treatment-related side effects of SSRIs are transient and disappear after a few days or weeks. However, following long-term treatment with the SSRIs, some serious adverse events may occur. Some of them can be difficult to recognise because they can resemble residual symptoms of depression. The most serious can be life threatening. They all have a negative influence on the patient's quality of life and are frequently a prime reason for a lack of long-term compliance with the associated increased risk of recurrence of a depressive episode. This article is an overview of the more common adverse events, which are seen with non-acute treatment with the SSRIs.
Asunto(s)
Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Adulto , Niño , Femenino , Feto/efectos de los fármacos , Hemorragia Gastrointestinal/inducido químicamente , Humanos , Hiponatremia/inducido químicamente , Recién Nacido , Síndrome de Abstinencia Neonatal/etiología , Embarazo , Conducta Sexual/efectos de los fármacos , Trastornos del Sueño-Vigilia/inducido químicamente , SuicidioRESUMEN
The main illness of the neural pituitary is diabetes insipidus (DI). MRI is essential if DI occurs during childhood, in order to highlight malignant germinoma prognosis of which remains excellent if the diagnosis is made as early as possible. In adults, primary intracranial tumours causing DI include craniopharyngioma, or pineal tumours. Infiltrative histiocytosis is another frequent aetiology. One third of previously considered idiopathic DI is in fact auto-immune. Early MRI findings advocate for such a diagnosis. Finally, meticulous analysis of the neural pituitary imaging may avoid several pitfalls and help the analysis of adenopituitary abnormalities.
Asunto(s)
Craneofaringioma/patología , Diabetes Insípida/patología , Imagen por Resonancia Magnética/métodos , Neurohipófisis/patología , Neoplasias Hipofisarias/patología , Adenoma/patología , Neoplasias Encefálicas/patología , Niño , Diabetes Insípida/diagnóstico , Germinoma/diagnóstico , Germinoma/patología , Humanos , Tumores Neuroectodérmicos Primitivos/patología , Neurohipófisis/anatomía & histologíaRESUMEN
BACKGROUND AND PURPOSE: Germ cell tumors (GCT) of the central nervous system are rare (2% of all brain tumors in children). Although originating from germ cells, GCT cover a spectrum of different tumors with different management and prognosis, depending on whether they secrete tumor markers or not. The aim of this study is to present a series of children with GCT and comment on overall management practices. METHODS: We retrospectively reviewed 13 children under the age of 18 years (nine boys and four girls), treated in the same institution between 1986 and 2006 for one or more primitive GCT of the central nervous system. RESULTS: Median age at diagnosis is 12.9 years (7-17 years). Tumor markers (alpha foetoprotein [alphaFP], human chorionic gonadotrophin [betaHCG]) were assessed 11 times in blood as well as cerebrospinal fluid (CSF). Tumors were located as follows: pineal region (10 cases), hypothalamus (eight cases), basal ganglia (one case) and corpus callosum (one case). Six were bifocal (pineal region and hypothalamus). Clinical signs were mostly dominated by diabetes insipidus and intracranial hypertension. Seven children required surgery for hydrocephalus. Tumor markers were positive in three cases and these children subsequently received chemotherapy followed by radiotherapy, except one child. Eventually, the three patients with positive markers required surgery because of a residual lesion. The eight other patients had a stereotactic biopsy for diagnosis. At the end of follow-up, treatment morbidity appears to be low and neither death nor recurrence was observed. Mean follow-up is 8.85 years (2-20 years). CONCLUSIONS: The prognosis of cerebral GCTs in children is excellent because of their pronounced chemo- and radiosensitivity. Surgery is crucial for diagnosis in the event of negative markers, or if there is evidence of residual tumor with normalization of tumor markers at the end of chemotherapy. Tumor markers must be monitored to check the diagnosis and for follow-up. The place of tumor biopsy during endoscopic third ventriculostomy (performed if hydrocephalus is present) is still debated.
Asunto(s)
Neoplasias Encefálicas/terapia , Neoplasias del Sistema Nervioso Central/terapia , Neoplasias de Células Germinales y Embrionarias/terapia , Adolescente , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor , Biopsia , Neoplasias del Sistema Nervioso Central/diagnóstico , Neoplasias del Sistema Nervioso Central/patología , Niño , Terapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias de Células Germinales y Embrionarias/patología , Procedimientos Neuroquirúrgicos , Pronóstico , Estudios Retrospectivos , Técnicas Estereotáxicas , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , VentriculostomíaRESUMEN
A general knowledge led to the assumption that bed rest is beneficial for most illnesses and bed rest is prescribed in a large number of medical conditions. However, evidence from randomised studies and systematic reviews suggest a potentially harmful effect of bed rest. This review article discusses the utility of bed rest in some frequent medical pathologies such as myocardial infarction, pulmonary embolism, community acquired-pneumonia, and low back pain.
Asunto(s)
Reposo en Cama/efectos adversos , Pacientes Internos , Dolor de Espalda/rehabilitación , Infecciones Comunitarias Adquiridas/rehabilitación , Unidades Hospitalarias , Humanos , Medicina Interna , Infarto del Miocardio/rehabilitación , Embolia Pulmonar/rehabilitaciónRESUMEN
The authors report a case of secondary worsening of neurological symptoms in a patient 2 months after cord injury at T5 causing paraplegia. The MRI showed myeolomalacia, which appears as cord oedema, located in the grey matter, extending increasingly from the initial lesion (eighth thoracic vertebra) to the bulb. This cord lesion known as grey matter cytotoxic oedema, evolved into a syringomyelic cavity.
Asunto(s)
Edema/etiología , Edema/patología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/patología , Siringomielia/etiología , Siringomielia/patología , Adulto , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Vértebras TorácicasRESUMEN
The protozoan parasite Neospora caninum is one of the most important abortifacient organisms in cattle worldwide. The dog is known to act as definitive host although its potential role as infection source for bovines still remains unelucidated. The aim of the present study was to compile initial epidemiological data on the prevalence and incidence of N. caninum in Swiss dogs acting as definitive hosts. Thus, 249 Swiss dogs were investigated coproscopically in monthly intervals over a period of 1 year. A total of 3289 fecal samples was tested by the flotation technique. Among these, 202 were shown to contain Sarcocystis sp. (6.1%), 149 Cystoisospora sp. (=Isospora sp.; 4.5%) and 25 Hammondia/Neospora-like oocysts (HNlO) (0.7%). All but one sample containing HNlO were from different dogs; one dog shed HNlO at two subsequent time points. Calculation of the yearly incidence for HNlO resulted in the surprisingly high value of 9.2%. Farm dogs exhibited a higher incidence for HNlO than urban family dogs. Thirteen out of the 25 HNlO-samples showed sporulation after 5 days incubation at room temperature. HNlO were further differentiated by species-specific PCR. However, all HNlO-samples were negative for N. caninum, Hammondia heydorni and Toxoplasma gondii. One reason may be the low oocyst density found in most fecal samples, which did not permit us to carry out PCR under optimal conditions. Three out of the 25 HNlO-cases contained enough oocysts to allow further enrichment and purification by the flotation technique. Subsequently, twenty to fifty sporulated HNlO-oocysts were orally administered to Meriones unguiculatus. All gerbils were seronegative for N. caninum at 5 weeks p.i. A N. caninum-seroprevalence of 7.8% was determined by ELISA upon 1132 serum samples collected from dogs randomly selected by veterinarians among their clinical patients.
Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Coccidiosis/veterinaria , Enfermedades de los Perros/epidemiología , Neospora/aislamiento & purificación , Animales , Bioensayo/veterinaria , Bovinos , Coccidiosis/epidemiología , Reservorios de Enfermedades/veterinaria , Perros , Ensayo de Inmunoadsorción Enzimática/métodos , Ensayo de Inmunoadsorción Enzimática/veterinaria , Heces/parasitología , Femenino , Gerbillinae , Incidencia , Masculino , Neospora/inmunología , Oocistos/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa/veterinaria , Población Rural , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Suiza/epidemiologíaRESUMEN
Medical risk management has one main purpose: to ensure the safety of care. The law of March 2002 has generated a true cultural revolution. The radiologist is involved with new and difficult areas of medical liability due to technical advances, the increasing number of imaging techniques, the increasing complexity of imaging techniques, their efficiency and the need for multidisciplinary approach. Imaging recommendations requiring increasing levels of technical and clinical skills. The radiologist is liable with regards to the indications of imaging studies, and also with regards to informed consent. The prevention of medicolegal problems is achieved by competency, which must be combined to good liability insurance and ongoing vigilance supported by appropriate continuous medical education.
Asunto(s)
Responsabilidad Legal , Radiografía Intervencional/ética , Radiografía/ética , Radiología Intervencionista/legislación & jurisprudencia , Radiología/legislación & jurisprudencia , Francia , Humanos , RiesgoRESUMEN
BACKGROUND: Medium- and long-term prognosis of craniopharyngioma is overwhelmed by the risks of hypothalamic and visual impairment. This problem has been underestimated for a long time because the major concern for the neurosurgeon was the risk of recurrences, their best prevention being thought to be complete tumour resection. Today, we know that radical surgery not only is not an absolute guarantee against recurrences but also can cause hypothalamic and visual complications. METHODS: The authors suggest that instead of complete removal, the first choice treatment should be, when possible, a less aggressive, multistaged and personalized treatment. In this perspective they focus on other therapeutic methods: endocavity treatment of cysts with rhenium-186, triconformational radiotherapy, radiosurgery, and widespread use of the trans-sphenoidal approach. CONCLUSIONS: These simple methods should reduce the risks of visual aggravation and metabolic syndrome.
Asunto(s)
Craneofaringioma/radioterapia , Neoplasias Hipofisarias/radioterapia , Niño , Preescolar , Craneofaringioma/cirugía , Craneofaringioma/terapia , Estudios de Seguimiento , Humanos , Hipofisectomía , Isótopos/uso terapéutico , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/terapia , Complicaciones Posoperatorias , Radiocirugia/métodos , Renio/uso terapéutico , Trastornos de la Visión/etiologíaAsunto(s)
Antitoxina Botulínica/uso terapéutico , Botulismo/tratamiento farmacológico , Contaminación de Alimentos , Adulto , Botulismo/complicaciones , Botulismo/diagnóstico , Diagnóstico Diferencial , Sistema Digestivo/patología , Humanos , Masculino , Parálisis/etiología , Síndrome de Dificultad Respiratoria/etiología , Resultado del TratamientoRESUMEN
Sex steroid concentrations in urine samples from post-menopausal women have been associated with risk of various chronic diseases. The basic requirement for the assessment of risk in such large-scale epidemiological studies is that subjects be ranked accurately by their average, long-term hormone levels. We examined the reproducibility over time of measurements of urinary testosterone (T), 5alpha-androstane-3alpha, 17beta-diol (ADIOL), estrone (E1), estradiol (E2), 2-hydroxy estrone and 2-hydroxy estradiol, (2(OH)-E), 16alpha-hydroxyestrone (16alpha(OH)-E1) and the ratio of 2(OH)-E and 16alpha(OH)-E1, in a representative sub-sample of post-menopausal women (n = 43) participating in an ongoing prospective cohort study. Women collected three first morning urine voids on different occasions, with average time difference between the first and the third urine sample of 5.1 years. T, ADIOL, E1 and E2 were measured by radio immunoassay after enzymatic hydrolysis, solid-phase extraction and HPLC purification of the samples, while 2(OH)-E and 16alpha(OH)-E1 were assayed by solid-phase enzyme immunoassay after enzymatic hydrolysis. Intra-class correlation co-efficients (ICCs) over time were very good for T (r = 0.85), acceptable for E2, E1 and ADIOL (r > 0.55), but low for 2(OH)-E, 16alpha(OH)-E1 and their ratio (r < 0.46). The adjustment for creatinine concentrations did not increase these correlations.
Asunto(s)
Andrógenos/orina , Estrógenos/orina , Posmenopausia/orina , Anciano , Neoplasias de la Mama/orina , Creatinina/orina , Femenino , Humanos , Hidrólisis , Hidroxiestronas/orina , Técnicas para Inmunoenzimas/métodos , Persona de Mediana Edad , Países Bajos , Proyectos Piloto , Reproducibilidad de los Resultados , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Urinálisis/métodosRESUMEN
Cerebral venous thrombosis is an uncommon event which presents a wide spectrum of sometimes extraneurological signs different from the classical clinical presentation. We report the cases of two middle-aged women who developed thrombosis of the left lateral sinus spread-ing to the internal jugular vein from the sigmoid sinus. The time course of the symptoms suggested that intracranial thrombosis occurred first. No infectious or neoplastic local disease could be found but both women were taking oral contraceptives. Medical treatment led to good reperfusion of the intracranial sinuses but occlusion of the jugular vein persisted despite prolonged oral anticoagulants. Long-term outcome was favorable with residual benign epilepsy in one patient, and occurrence of an arteriovenous fistula in the other.
Asunto(s)
Venas Yugulares/patología , Trombosis de los Senos Intracraneales/patología , Anticoagulantes/uso terapéutico , Malformaciones Vasculares del Sistema Nervioso Central/etiología , Anticonceptivos Hormonales Orales/efectos adversos , Epilepsias Parciales/etiología , Femenino , Heparina/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Terapia Trombolítica , Acúfeno/etiologíaRESUMEN
El quiste óseo traumático es una cavidad intraósea sin recubrimiento epitelial, es considerado un pseudoquiste maxila. Este quiste, también denominado simple o hemorrágico, tiene una etiología traumática en el 25 por ciento de los casos y también puede originarse de un infarto en la médula ósea o del hueso esponjoso, degeneración quística o alteración de la osificación. Representa del 0,2 al 1 por ciento de la patología quística maxilar y se presenta generalmente de forma asintomática en la mandíbula de jóvenes entre los 5 y 25 años. El pronóstico, tras curetaje simple de la cavidad, es excelente, incluso para la vitalidad de los dientes involucrados. Se presenta un caso de quiste óseo traumático bilateral asociado a trauma por fuerzas excesivas en el tratamiento de ortodoncia, en paciente femenina de 16 años de edad. Se planificó tratamiento quirúrgico, con toma de muestra para estudio histopatológico. Se realizó seguimiento radiográfico durante 1 año, obteniéndose excelentes resultados
Asunto(s)
Humanos , Adolescente , Femenino , Quistes Maxilomandibulares , Ortodoncia Correctiva , Quistes Óseos/cirugía , Quistes Óseos/diagnóstico , Quistes Óseos/etiología , Diagnóstico Diferencial , Tercer Molar , Pronóstico , Quistes Óseos/epidemiología , Quistes Óseos , Venezuela , Organización Mundial de la SaludRESUMEN
The benzodiazepines have monopolized the acute anxiety market for about 40 years, but their potential for tolerance and dependency has stimulated an interest in alternative anxiolytics. Until recently, however, attention has focused on existing drugs such as monoamine oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors. The 5-HT1A partial agonist, buspirone (Bristol-Myers-Squibb), is one of the few compounds developed principally as an anxiolytic since the benzodiazepines. The challenge for the future is not only to find efficacious treatments with a rapid onset of action and an acceptable side effect profile but also to determine the optimal compounds for each of the different anxiety disorders.
RESUMEN
Serotonin (5-hydroxytryptamine, 5-HT) is implicated in several psychiatric diseases. Is this also true for 5-HT(1B/D) receptors? These receptors are found in high density in substantia nigra, globus pallidus, striatum and basal ganglia and in other brain regions. This ubiquity makes 5-HT(1B/D) receptors responsible for many physiological and behavioural functions. This review focuses on the role of 5-HT(1B) receptors in the regulation of 5-HT release and synthesis. Microdialysis experiments performed on freely moving animals are an interesting in vivo model to study the function of the terminal 5-HT(1B) autoreceptor. Synthesis of 5-HT, estimated by the measurement of the accumulation of 5-hydroxytryptophan (5-HTP) ex vivo or in vitro, is modulated by the 5-HT(1B) autoreceptors. Many reports have shown that chronic administration with selective serotonin reuptake inhibitors leads to the desensitisation of the terminal 5-HT(1B) autoreceptors. With the help of some animal models of depression and anxiety and with some data from clinical studies it has been hypothesised that 5-HT(1B) receptors may be supersensitive in depression, anxiety and obsessive compulsive disorder. Thus, since the dysfunction of 5-HT(1B) receptors may be involved in some pathological states, particularly in the psychiatric field, these receptors represent important potential targets for drugs to treat mental diseases.