Successful Regenerative Therapy of Periodontal Defects Associated With Tongue Piercing: A Clinical Report.

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework.

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional / Thoracoscopy in children with complicated parapneumonic pleural effusion at the fibrinopurulent stage: a multi-institutional study

Objetivo: Determinar a eficácia da toracoscopia em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças submetidas à toracoscopia paratratamento de DPPC na fase fibrinopurulenta entre novembro de 1995 e julho de 2005. A média de idade foi de 2,6 anos (variação, 0,4-12 anos) e 60% eram do sexo masculino. A toracoscopia foi realizada em três hospitais diferentes utilizando-se o mesmo algoritmo de tratamento. Resultados: A toracoscopia foi eficaz em 87 crianças (88%) e 12 (12%) necessitaram de outro procedimento cirúrgico: nova toracoscopia (n = 6) ou toracotomia/pleurostomia (n = 6). O tempo médio de drenagem torácica foi de 3 dias nas crianças em que a toracoscopia foi efetiva e de 10 dias naquelas que precisaram de outro procedimento (p < 0,001). A infecção pleural de todas as crianças foi debelada após o tratamento. As complicações da toracoscopia foram fuga aérea (30%) e sangramento pelo dreno torácico (12%), enfisema subcutâneo na inserção do trocarte (2%) e infecção da ferida operatória (2%). Nenhuma criança necessitou de reoperação devido às complicações. Conclusões: A efetividade da toracoscopia em criançascom DPPC na fase fibrinopurulenta foi de 88%. O procedimento mostrou-se seguro, com baixa taxa de complicaçõesgraves, devendo ser considerado como primeira opção em crianças com DPPC na fase fibrinopurulenta.

Objective: To determine the efficacy of thoracoscopy in the management of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage. Methods: Retrospective study of 99 children submitted to thoracoscopy for the treatment of complicated parapneumonic pleural effusion at the fibrinopurulent stage between Novemberof 1995 and July of 2005. The mean age was 2.6 years (range, 0.4-12 years), and 60% were males. Thoracoscopywas performed at three different hospitals following the same treatment algorithm. Results: Thoracoscopy waseffective for 87 children (88%). In 12 (12%), a second surgical procedure was required: another thoracoscopy (n = 6) or thoracotomy/thoracostomy (n = 6). Mean duration of chest tube drainage following successful thoracoscopy was 3 days vs. 10 days in patients submitted to a second procedure (p < 0.001). In all of the children, the pleural infection resolved after treatment. Thoracoscopy-related complications included air leak (30%), chest tube bleeding (12%), subcutaneous emphysema associated with trocar insertion (2%) and surgical wound infection (2%). None of the children required additional surgical procedures due to the complications. Conclusions: The effectiveness of thoracoscopy in children with parapneumonic pleural effusion at the fibrinopurulent stage was 88%. Theprocedure was safe, with a low rate of severe complications. Thoracoscopy should be the first-choice treatment forchildren with parapneumonic pleural effusion at the fibrinopurulent stage.

Drenaje retroperitoneal abierto (pancreatostomía) en el manejo de la supuración pancreática / Open retroperitoneal drenage (pancreatostomy) in supurated pancreas management

Se analiza prospectivamente el manejo de 21 pacientes portadores de una supuración pancreática secundaria a pancreatitis aguda necrohemorrágica grave, con drenaje retroperitoneal abierto (pancreatostomía). La cirugía incluyó procedimientos sobre la vía biliar, ostomías digestivas y el mencionado drenaje. Las complicaciones más frecuentes fueron las fístulas intestinales (23,8%), las lesiones isquémicas de intestino (19%) y los abscesos residuales (14,2%). La mortalidad fue del 9,5%, lo que representa un descenso importante en relación a series nacionales y extranjeras

Absceso hepático piógeno: experiencia en 50 casos / Pyogenic liver abscess: experience in 50 cases

During the last years the diagnosis and treatment of pyogenic liver abscess has changed substantially. The aim of this work is to report a retrospective analysis of 50 patients aged 24 to 87 years old, that presented with a pyogenic liver abscess and were treated in the last 13 years. The sensitivity for diagnosis of ultrasound examination, CAT scan and angiography was 68, 89 and 75 percent respectively. The origin of the abscess was detected at the biliary tree in 46 percent and remained unknown in 38 percent. 31 patients were operated, 13 were subjected to percutneous drainage and 5 were treated only with antimicrobials. 40 percent of patients had a septic complication and 4 (8 percent) died. Mean hospital stay was 31 days for operated patients and 21 for the rest. The abscess recurred in 7 patients and 2 of these had a gallbladder carcinoma. It is concluded that percutaneous g=drainage is an alternative to surgical treatment that must be accompanied by a careful diagnosis workup

Evolución clínica de los pacientes con angina de Ludwing sometidos a sedacion consciente y otras maniobras anestésicas / Patients' clinical evolution with angina of subjected Ludwing to conscious sedation and other anesthetic maneuvers

Objetivo: Conocer a los pacientes con diagnóstico de Angina de Ludwig (A. L.) drenados bajo técnica de anestesia. Material y método: estudio descriptivo, retrospectivo de corte transversal. La recolección de la información fue obtenida del expediente clínico del paciente evaluándose a través de una ficha de recolección de datos las características clínicas examen de laboratorio tiempo de drenaje quirúrgico, complicaciones días de estancia intra-hospitalaria, al aplicar diferentes técnicas de anestesia para el drenaje de A. L. Resultados: fueron revisados 47 expedientes con diagnóstico de A. L., estos se agruparon de acuerdo a la técnica anestésica administrada: la sedación consciente se utilizó en un 53 porciento, seguida de intubación y máscara laríngea con un 17 porciento respectivamente. Este tipo de patología se observó en hombres en un 57 porciento, de los cuales el 76.5 porciento provenía de Managua, con una edad promedio de 34.51±16.9 años. La mayoría de los pacientes presentaban disnea, disfagia y trismos. Las complicaciones más letales se observaron al usarse la intubación y la máscara laríngea en un 25 porciento cada una y en un 100 porciento con traqueostomía; y en los pacientes que tenían comprometidos 6 y 8 espacios. Conclusiones En pacientes con diagnóstico de A. L. sometidos a drenaje quirúrgico recibieron sedación consciente, Independientemente de los espacios ocupados y presentaron complicaciones manejables con tratamiento medico, sin incrementar el tiempo de estancia intra-hospitalaria. Con la traqueostomía la intubación y la máscara laríngea, se observaron complicaciones letales...