Patient-centered outcomes after surgical treatment of peri-implantitis: a prospective clinical study.

BACKGROUND: Peri-implantitis is an inflammatory process affecting soft and hard tissues surrounding dental implants, causing progressive marginal bone loss. Peri-implant surgery is the treatment of choice. However, evidence about its impact on patients' quality of life (QoL) is limited. This study aimed to assess pain and QoL in the first seven post-operative days and measure patient satisfaction at the end of this period. MATERIAL AND METHODS: A prospective cohort study was conducted in patients with peri-implantitis. Patients reported pain on a visual analogue scale (VAS) ranging from 0 to 100mm every day during the first week after surgery. They then completed the OHIP-14sp questionnaire. A descriptive and inferential data analysis was used to assess the effect of surgical approach (resective, regenerative or combined), gender and working status on pain, satisfaction and QoL. RESULTS: Forty-one patients (93,2%) completed the daily pain VAS; scores ranged from 0 to 95 mm. Gender, occupation, or type of surgery had no significant effect upon its evolution. The mean total OHIP-14sp score was 16.7 (range = 5 to 33), indicating low to moderate deterioration in perceived oral health. Postoperative OHRQoL was significantly higher in working patients (mean difference (MD): 3.94; P = 0.042), and with the regenerative (MD: 6.34; P = 0.044) or the combined approach (MD: 5.41; P = 0.027). CONCLUSIONS: Considering the limitations of this study, postoperative pain was mild to moderate and decreased after the third day. Surgical treatment of peri-implantitis has an impact on QoL, especially when augmentation procedures are involved. This impact is higher in working patients.

Milk production responses, rumen fermentation, and blood metabolites of dairy cows fed increasing concentrations of forage rape (Brassica napus ssp. Biennis).

The aim of this study was to determine animal performance, rumen fermentation, and health-related blood metabolites of dairy cows in mid lactation fed with increasing levels (30 and 45%) of forage rape (FR) in the diet. Twelve pregnant multiparous lactating Holstein-Friesian dairy cows were randomly allocated to 1 of 3 dietary treatments in a replicated 3 × 3 Latin square design. The experiment was divided into three 21-d periods. For the control diet, 13.0 kg (dry matter, DM) of grass silage, 3.0 kg DM of commercial concentrate, 2.7 kg of DM cold-pressed extracted canola meal, and 0.45 kg DM of solvent-extracted soybean meal were offered daily. For the other two treatments, 30 and 45% of the DM from silage, canola meal, and commercial concentrate were replaced in equal proportions with FR. Data were analyzed individually using linear and quadratic orthogonal polynomials. Ingestive behavior was altered by the inclusion of FR. We observed a linear increase in eating time at the expense of rumination time. Nevertheless, total DM intake was not affected by dietary treatments, averaging 19.5 ± 0.24 kg of DM/d. Milk yield increased linearly with increasing concentration of FR in the diet. Thus, feed efficiency of cows (kg of milk/kg of DM intake) increased linearly with the percentage of FR in the diet. Inclusion of FR in the diet had no effect on milk composition or milk sensory characteristics. Mean rumen pH of cows decreased linearly from the control to the 45% FR diet; however, dietary treatments had no effect on the daily amount of time that rumen pH was below 5.8 (252 ± 71.4), indicating no risk of subacute ruminal acidosis. Concentrations of total volatile fatty acids in the rumen and molar proportions of acetate and butyrate were increased with FR inclusion, whereas the proportion of propionate was linearly reduced. Excretion of uric acid and total purine derivatives tended to be greater for cows fed FR, which resulted in a trend toward a linear increase in estimated microbial N flow. However, N use efficiency was not affected by FR inclusion. Although differences for some hematological measures (increased white blood cell and neutrophils counts) and a quadratic response for glutamate dehydrogenase for cows fed FR in the diet (decreased with inclusion of 30% and increased with 45% in the diet) were observed, all values were within appropriate ranges for dairy cows. These results indicated that including FR to dairy cow diets, up to 45% of diet DM, improved milk production due to changes in volatile fatty acids and predicted microbial N flow and had no negative effects on dairy cow health or sensory characteristics of milk.

Influence of information concerning a computerized anesthesia system on dental anxiety: a randomized controlled clinical trial.

BACKGROUND: A single-blinded randomized controlled trial among patients requiring an upper third molar extraction was performed to evaluate the anxiety degree after receiving information or not about the functioning of The Wand system. Secondarily, perceived pain and the need of re-anesthesia were assessed. MATERIAL AND METHODS: Patients were randomly assigned to the experimental group (detailed explanation about The Wand) or control group (no specific information). Local anesthesia with The Wand consisted in a supraperiosteal infiltrative technique injection 1.6 mL at the buccal and 0.2 mL at the palatal side. Distinct questionnaires for assessing dental anxiety and 100-mm visual analog scales to assess pain were delivered. Demographic data, radiological parameters, operative time and type of intervention were also registered. A descriptive bivariate analysis by non-parametric tests to detect differences in anxiety, pain and re-anesthesia was performed by SPSS 22.0 (SPPS Inc. Chicago, USA). RESULTS: A total of 85 patients were assessed for eligibility but 17 participants were lost due to the cancellation of the visit for the surgical intervention. Finally, sixty-eight patients were included (34 participants in each group), 47 women (69.1%) and 21 men (30.9%), with an average age of 28.8 (± 9.3) years. CONCLUSIONS: Patients that received a detailed explanation of The Wand did not have a significant reduction of the anxiety degree and perceived pain during the anesthetic act compared to patients that received no information. The need of re-anesthesia was not related to the anxiety level but was significantly related to increasing operative time.

Influence of key factors on ammonia and nitrous oxide emission factors for excreta deposited by livestock and land-applied manure.

Ammonia (NH3) and nitrous oxide (N2O) emissions from livestock manure management have a significant impact on air quality and climate change. There is an increasing urgency to improve our understanding of drivers influencing these emissions. We analysed the DATAMAN ("DATAbase for MANaging greenhouse gas and ammonia emissions factors") database to identify key factors influencing (i) NH3 emission factors (EFs) for cattle and swine manure applied to land and (ii) N2O EFs for cattle and swine manure applied to land, and (iii) cattle urine, dung and sheep urine deposited during grazing. Slurry dry matter (DM) content, total ammoniacal nitrogen (TAN) concentration and method of application were significant drivers of NH3 EFs from cattle and swine slurry. Mixed effect models explained 14-59 % of the variance in NH3 EFs. Apart from the method of application, the significant influence of manure DM, manure TAN concentration or pH on NH3 EFs suggests mitigation strategies should focus on these. Identifying key factors influencing N2O EFs from manures and livestock grazing was more challenging, likely because of the complexities associated with microbial processes and soil physical properties impacting N2O production and emissions. Generally, significant factors were soil-related e.g. soil water content, pH, clay content, suggesting mitigations may need to consider the conditions of the receiving environment for manure spreading and grazing deposition. Total variability explained by terms in mixed effect model was on average 66 %, with the random effect 'experiment identification number' explaining, on average, 41 % of the total variability in the models. We suspect this term captured the effect of non-measured manure, soil and climate factors and any biases in application and measurement technique effects associated with individual experiments. This analysis has helped to improve our understanding of key factors of NH3 and N2O EFs for inclusion within models. With more studies over time, insights into the underlying processes influencing emissions will be further improved.

Comparison between Accelerated Partial Breast Irradiation with multicatheter interstitial brachytherapy and Whole Breast Irradiation, in clinical practice.

PURPOSE: The aim of this study was to compare accelerated partial breast irradiation (APBI) with multicatheter interstitial brachytherapy (BT) and whole breast irradiation (WBI), in terms of toxicity, aesthetic result, quality of life and survival, in clinical practice. MATERIALS AND METHODS: A comparative study of two prospectively recorded cohorts of 76 breast cancer patients who complied with the recommendations of GEC-ESTRO for APBI was conducted. The main objective was toxicity, quality of life measured through validated questionnaires and the aesthetic results. Secondary objectives were overall survival and disease-free survival. RESULTS: Seventy-six stage I/II breast cancer patients, with a mean age of 66 years entered the study. APBI group showed less acute G1-2 dermatitis (51.4 vs 94.9%, p < 0.001) and late hyperpigmentation (0 vs 17.9%, p = 0.04). There were no differences in aesthetic results, both assessed by the patient herself and by the doctor. Statistically significant differences in measures of quality of life were observed in favour of the APBI, both in EORTC QLQ-BR23 and body image scale questionnaires. With a median follow-up of 72 months (6 years), the estimated overall survival at 5 and 10 years was 96.8 and 77.7%, respectively, and disease-free survival at 5 and 10 years was 91.1 and 69.4%, respectively, without statistically significant differences between groups. DISCUSSION: APBI is an attractive alternative in candidate patients with initial breast cancer, with benefits in acute toxicity and quality of life and fewer visits to the hospital, without compromising tumor control or survival.

One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients. / Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes.

INTRODUCTION: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. METHODS: We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. RESULTS: The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. CONCLUSIONS: The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.

[Lacunar infarct and deep cerebral hemorrhage: a comparison of the risk factors]. / Infarto lacunar y hemorragia cerebral profunda: comparación de factores de riesgo.

INTRODUCTION: Lacunar infarcts (LI) and deep cerebral hemorrhages (DCH) have the same localization and a vasculopathy which appears to be similar, at the level of the small perforating arteries, classically attributed to arterial hypertension (AHT). OBJECTIVES: To compare the vascular risk factors of patients with lacunar ictus (LIc) and those with DCH, to try to determine how these may affect the appearance of one type of stroke or another. PATIENTS AND METHODS: We analyzed a prospective consecutive series of patients with cerebral vascular accidents (CVA), selecting 1,540 patients in the first 1,155 with a first CVA. We recorded demographic data and the following risk factors: previous transient ischemic accident (TIA), AHT, diabetes mellitus (DM), hypercholesterolemia, ischemic cardiopathy, atrial fibrillation and the presence of silent infarcts on CT. RESULTS: Two hundred and four patients had LIc and 163 had DCH. There was a significant dissociation between LIc and a history of TIA, DM, hypercholesterolemia and the presence of silent lacunar-type infarcts on CT. However, after multivariant analysis, DM did not continue to be an independent variable. Arterial blood pressure was found to be greater in the DCH group. CONCLUSIONS: The presence of different risk factors for LIc and DCH may be the key to understanding the mechanism which leads to one type or other of CVA.

[Transitory episode of laughter as the initial symptom of an ischemic stroke]. / Episodio transitorio de risa como síntoma inicial de ictus isquémico.

INTRODUCTION: Pathological laughter occurs in pseudobulbar paralysis, in psychiatric disorders and as a sign of convulsions (gelastic crisis). An extremely rare form is the "fou rire prodromique' a pathological episode of laughter preceding a stroke. The pathogenesis is unknown and classically differentiated from gelastic crises. "Fou rire prodromique' has been described in subcortical ischaemic or haemorrhagic strokes, not in cortical strokes. CLINICAL CASE: We describe a patient with an ischaemic cerebrovascular accident due to embolism of the left Sylvian artery. The clinical picture started with a short episode of pathological laughter which preceded sensitive aphasia and weakness of the right limbs. CONCLUSIONS: We suggest that in the case described it is impossible to differentiate between the "fou rire prodromique' and a gelastic crisis as a first sign of an embolic cerebrovascular accident.

[Analytical epidemiological study of multiple sclerosis in Alcoi]. / Estudio epidemiológico analítico sobre la esclerosis múltiple en Alcoi.

INTRODUCTION: Multiple sclerosis (MS) is a disease of controversial epidemiology, which has frequently been studied. The results of an epidemiological descriptive study in the Alcoi area led to a first case-control study to give information about the factors associated with the illness in this area. It was seen from this that migration, contact with dogs and with cloth might be related to it. OBJECTIVE: To carry out a second analytical study, maintaining the migration factor stable to avoid the possible confounding effect with other associated factors. MATERIAL AND METHODS: For this case-control study we grouped one case with four controls from the population according to age, sex and place of birth. All cases fulfilled criteria defined for MS and the controls were randomly selected from the census. We also classified the cases and controls into three groups, according to whether or not migration was involved (group A: Autochthonous; group B: Immigrants who arrived before the age of 13, and group C: Immigrants who arrived after the age of 13). RESULTS: We analyzed 40 patients and 160 controls. We obtained significant values for 'social group'. The cases belonged to the less favored social group both on overall analysis and in the autochthonous group. Pneumonia was the only infection with significant figures in patients over 15. Contact with dogs gave new statistically significant figures, together with cloth and cloth products. CONCLUSIONS: Persistence of positive correlation of MS with contact with dogs and cloth suggest the possible influence of these two factors in the increase in incidence of MS in this area.

[Atherosclerosis and brain circulation]. / Aterosclerosis y circulación cerebral.

INTRODUCTION: Atherosclerosis affects the vascular system in a diffuse way and its is clearly implicated in some of the most prevalent diseases in western countries such as cerebrovascular and cardiovascular diseases. Knowing more about the underlying pathogenic mechanisms may contribute to a better understanding of this entities and the development of therapies for both its treatment and prevention. DEVELOPMENT: We review herein the concepts included in the term atherosclerosis, the growth of the atheromatous plaque and its complications and the cellular mechanisms which intervene in its development. We analyze how it influences brain hemodynamics and its implication in cerebrovascular ischemic disease paying attention to the dissimilarities with other vascular territories and the clinical syndromes which derive from its development on different vascular structures. CONCLUSIONS: Under the concept of ischemic cerebrovascular disease we can find a group of heterogeneous clinical syndromes, usually associated to different etiopathogenic mechanisms: cardioembolic, atherothrombotic or hemodynamic. Although their risk factors may be common, these processes are clearly different form each other. Therefore including ischemic brain infarctions all together without attending to their etiology may produce important methodological biases when interpreting the results in clinical trials or other studies, and may also be a suitable explanation for differences between authors.

[A case-control study of multiple sclerosis in Alcoi]. / Estudio caso-control sobre la esclerosis múltiple en Alcoi.

INTRODUCTION: Multiple sclerosis (EM) is a neurological disorder of great epidemiological interest. Considerable variations have been described regarding the initial description of geographical distribution. In the Alcoi health district an epidemiological study showed more cases than would be expected from the latitude. Objective. To care out an analytical study to determine which factors influence this situation. MATERIAL AND METHODS: We carried out a case-control study, pairing one case with four controls from the population, as regards age, sex and place of residence. Only current cases were included, under the control of the only Neurology Unit in the area, and which fulfilled criteria defined by EM. The control group was randomly selected from the census. RESULTS: We analyzed 37 patients and 148 controls. There were no significant differences between the cases and the controls regarding socio-educational level, order of birth within the family, blood group, toxic habits and family history. We found a significantly greater frequency of urinary infections before the age of 15, and of cystitis and pneumonia after reaching the age of 15. Contact with textiles, their finished products and dogs reached significant values. In the patient group there was a significantly higher number of immigrants than in the control group. CONCLUSIONS: The correlation found between certain factors such as contact with textiles, their finished products and dogs should be evaluated in further studies in which the immigration factor is controlled.

[Multiple sclerosis incidence in the Alcoi Health district. 12-year-long study (1986-1997)]. / Incidencia de la esclerosis múltiple en el área sanitaria de Alcoi. Estudio de 12 años (1986-1997).

INTRODUCTION: To date, epidemiological studies on multiple sclerosis in Spain have been basically prevalence studies, and the data on incidence recorded have been the result of different methodologies, with no definition of the criteria for inclusion. OBJECTIVE: To carry out a study of incidence with prospective collection/review of cases over a prolonged period of time. PATIENTS AND METHODS: Over 12 years, between 1 March 1986 and 31 December 1997, we collected data prospectively for patients with a definite diagnosis of multiple sclerosis. The year of incidence was considered to be when the patient fulfilled clinical criteria for diagnosis of the disease. RESULTS: On 31 December 1997 in the Alcoi Health District there were 54 patients with clinically defined multiple sclerosis (a prevalence of 41.28 cases per 100,000 inhabitants). Of these, 45 patients were diagnosed during the period studied, with an average incidence of 2.82 cases per 100,000 inhabitants per year. Only 15 patients were confirmed before 1986. CONCLUSIONS: This is the most prolonged study of the incidence of multiple sclerosis carried out in Spain. The figures found for incidence are in contrast to those found in previous years for prevalence and incidence. Analysis of the data suggests that the incidence of multiple sclerosis in the Alcoi district has changed and has increased since the second half of the 1980s.

[The prevalence of multiple sclerosis in the Alcoi Health district]. / Prevalencia de la esclerosis múltiple en el área sanitaria de Alcoi.

INTRODUCTION: The epidemiological studies done in Spain in recent years show higher figures for the prevalence of multiple sclerosis than before. Spain is therefore now in the area with a high risk of contracting the disease. OBJECTIVE: We have made a new study to confirm the current prevalence of the disorder in the Alcoi Health District. PATIENTS AND METHODS: Between 1 March 1986 and the prevalence day, 31 December 1997 we recorded the patients with definite or probable multiple sclerosis, as defined on Poser's criteria, after intensive fieldwork and reevaluation of all possible patients by a neurologist from the Neurology Unit. On the prevalence day there were 130,786 inhabitants in the district. RESULTS: On the prevalence day we found 54 patients with definite multiple sclerosis and no patient with probable multiple sclerosis. The rate of prevalence was 41.28 cases per 100,000 inhabitants (95% CI: 31-53.6). During the study we counted an incidence of 45 cases with an average rate of 2.82 cases per 100,000 inhabitants per year. We also describe the clinical characteristics of the patients. CONCLUSIONS: The rate of prevalence found is much higher than that described for the district in studies using similar methodology. This increase, together with the discrepancy between the incidence found and the prevalence, makes us consider that possibly the prevalence has increased in recent years.

[Wegener granulomatosis. 5 clinical case reports]. / Granulomatosis de Wegener. A propósito de cinco casos clínicos.

Wegener's granulomatosis has progressively acquired more significance from the otolaryngologist point of view. Its usual debut at ENT-territory, the occurrence of limited forms to the upper airway and the conviction that the nose is the best site for biopsies, makes the otolaryngologist the first line specialist for the actual diagnosis. We report the last 5 cases seen at our Department and furthermore review the nowadays knowledges on the Syndrome.

[Epidemiological notes on nasal bleeding]. / Notas epidemiológicas sobre el sangrado nasal.

The incidence of epistaxis is difficult to calculate because only a 10% of them look for medical attention. In this study the nasal bleeding means the 13.3% of the ENT emergencies (279 patients). Its incidence was 6 cases/10,000/year. The majority were over 50 years old (57.3%). There was season variations. The anterior epistaxis were more frequent but he posterior ones increased over the 40. An 18% had rebleeding more significatively with age and localization. We discuss the mechanisms that can explain the male dominance, the season incidence, and the old ages of the patients with hospital epistaxis.

[Tympanic chemodectoma. A report of 2 cases]. / Quemodectoma timpánico. A propósito de dos casos.

Report of 2 chemodectoma cases diagnosed in the ENT-Department (Prof. Labella) at C.H.U.S. The condition could be suspected because a tinnitus aurium and the transtympanic reddish image by otoscopy. And diagnosis settled through imaging techniques (computed tomography, magnetic resonance and selective angiography). Surgical treatment.

[Treatment of epidermoid carcinoma of the oral cavity and oropharynx: our result (1991-1995)]. / Tratamiento de los carcinomas epidermoides de cavidad oral y orofaringe: nuestros resultados (1991-1995).

In a study of 79 patients diagnosed as squamous cell carcinoma of the oropharynx and oral cavity, we compared the results obtained with two different types of initial treatment (surgery versus irradiation). Patients were grouped by tumor size: small tumors (T1 and T2) and bigger tumors (T3 and T4). Thirty-one patients had T1-T2 tumors:17 treated surgically with an 83% cure rate, 14 treated by irradiation with a 71% cure rate. Forty-three patients had T3-T4 tumors: 38 treated by irradiation with an 32.5% cure rate and 5 treated by surgery, with a 25% cure rate.

[Possible factors influencing rehabilitation of the total laryngectomy patient using esophageal speech]. / Estudio de posibles factores que influyen en la rehabilitación del laringuectomizado total mediante voz esofágica.

One of the handicaps of patients that have had a total laryngectomy is the loss of oral speech. There are three possibilities to rehabilitate these patients; surgery, voice prosthesis or esophageal speech. This last one appears as an inexpensive, non-invasive rehabilitation method; it does not need a complex learning and in spite of new technics, it continues to be an effective method in the social rehabilitation of laryngectomized patients. We have made a retrospective study of patients who underwent TL between 1992-1998 and that were rehabilitated by esophageal voice learning. Three factors have been evaluated: first, those related to the patient (gender, age, study level...); second, those related to the treatment itself [TL, pharyngolaryngectomy (PTL), TL plus radiotherapy...] and third, those related to the rehabilitation (technics, delayed on starting, number of sessions...). Data were compared with rehabilitation outcome: good (usually using esophageal voice), medium (speaking sometimes) and bad (not speaking). 74.1% had an acceptable outcome and they use esophageal voice with more or less difficulty to communicate, and this outcome increases to 95.8% when we do not take into account 7 patients who gave-up rehabilitation before finishing the first five sessions.

[Epistaxis: prospective study on emergency care at the hospital level]. / Epistaxis: estudio prospectivo sobre la atención urgente a nivel hospitalario.

We prospectively studied 279 patients with epistaxis referred to ENT specialist from emergency room in our hospital in one year. Masculine sex (62%), medium or old ages (median 56 year), and associated diseases (HBP 22.9%, anticoagulants or antiplatelet drugs 11.1%), were the most common. Predominant local etiologic factors were trauma (12.9%) and inflammation (14%). Epistaxis had been essential in 36.9%. The most frequent location in all ages was the anterior one, especially located in the Kiesselbach's area, although the incidence of the posterior epistaxis increases in characteristic way from fourth decade, affecting more to men. Most of epistaxis (> 99%) were treated successfully by conservative approach and only two patients required surgical or interventional therapy. Patients between 30-59 year and the posterior epistaxis was the most refractory to the treatment. Hospitalized patients were older than ambulatory ones and had more associated diseases. Their average hospital stay was 9.2 days.

[Carcinoma of small neuroendocrine cells in major salivary glands. Presentation of two clinical cases and literature review]. / Carcinoma de células pequeñas neuroendocrino de glándulas salivares mayores. Presentación de dos casos clínicos y revisión de la literatura.

To date, only 45 cases of oat cell carcinoma of the major salivary glands have been reported in the literature, which represents less than 1% of primary malignant tumors of the parotid glands. Two subtypes exist: ductal and neuroendocrine. We report two new cases of neuroendocrine oat cell carcinoma of the parotid gland which were treated by surgery associated with radiation therapy and chemotherapy. The literature review showed a predominance of males (61.7%), age 50-70 years, and location in parotid gland (83%). Treatment consists of radical surgery of the tumor associated with radiation therapy and chemotherapy. The prognosis is poor, with survivals at one, three and five years of 77.7%, 40.7%, and 29.6%, respectively, although this is better than the prognosis for other sites.