Clinical evaluation and treatment in men with low testosterone levels and prostate cancer.

INTRODUCTION: A high prevalence of low testosterone levels has been reported in men with prostate cancer. The use of testosterone therapy in men with a history of prostate cancer is still controversial, and there is uncertainty regarding the management of these patients. METHODS: We analyzed the European and American guidelines on this topic and presented the clinical experience in the management of patients with low testosterone levels and a history of prostate cancer in one of the world's leading cancer centers. RESULTS: According to the published evidence to date, testosterone therapy in men with prostate cancer does not increase the risk of prostate cancer recurrence in the short and medium term, but there is a lack of data on the long term. Symptomatic men with low testosterone levels who are candidates for this therapy need a thorough clinical evaluation before commencing testosterone therapy. Evaluation of prostate cancer history including type of treatment administered, pathologic stage of prostate cancer and prostate specific antigen should be requested before and during testosterone treatment to assess its trend. CONCLUSION: Prostate-specific antigen should remain undetectable after radical prostatectomy or stable after radiotherapy. Otherwise, it would be a sign of uncontrolled prostate cancer, and the patient may require cessation of testosterone therapy and referral to oncology for further evaluation.

Manejo odontológico del paciente en tratamiento de anticoagulante oral sometido a cirugía oral: una revisión narrativa / Stomatological management of anticoagulated patients undergoing oral surgery: a narrative review

Resumen Los pacientes que se encuentran bajo tratamiento de anticoagulantes orales, presentan alteraciones en distintas etapas de la hemostasia, lo que conlleva a tener implicancias y consideraciones médico/quirúrgicas durante su atención. En la actualidad, no existe un consenso en relación con el manejo odontológico de estos pacientes que serán sometidos a procedimientos quirúrgicos, llevando a protocolos clínicos que siguen diversas posturas, como la de disminuir la ingesta farmacológica del anticoagulante, sustituir con heparina y la de mantener el tratamiento bajo control. Objetivo Establecer el manejo estomatológico del paciente que se encuentra en tratamiento de anticoagulante oral mediante una revisión profunda de la literatura Materiales y método Se realizó una búsqueda de revisión bibliográfica manualmente de artículos indexados a las bases de datos de PUBMED y EBSCO que correspondiesen a las palabras "cirugía bucal", "anticoagulantes", "atención dental" y "hemorragia oral". En cuanto a los criterios de inclusión, se consideraron revisiones bibliográficas, estudios observacionales, ensayos clínicos, guías, revisiones sistemáticas y metaanálisis publicados entre noviembre de 2005 y 2022, en idiomas inglés o español. Conclusiones Existen múltiples protocolos para la atención del paciente anticoagulado que será sometido bajo procedimiento de cirugía oral menor. Es importante considerar el anticoagulante utilizado, motivo, control de este, el procedimiento a realizar en el paciente y medidas hemostáticas tanto intra como postoperatorias por realizar, tras analizar lo anterior, se advierte que disminuir la ingesta del fármaco para realizar el procedimiento, puede ser más perjudicial al paciente como al clínico, por lo tanto se sugiere mantener el tratamiento antitrombótico y realizar un correcto manejo médico/quirúrgico.

Abstract Patients undertaking oral anticoagulant treatment may experience alterations in different stages of hemostasis, which lead to medical/surgical implications and considerations during their care. Currently, there is no consensus regarding the dental management of these patients, as they go through surgical procedures. This leads to clinical protocols that follow numerous approaches, such as reducing the pharmacological intake of the anticoagulant, replacing it with heparin, and maintaining the controlled treatment. Objective: To establish the stomatological management of the patient undergoing oral anticoagulant treatment through an in depth review of the literature. Materials and Method: A manual bibliographic review search of articles indexed to the PUBMED and EBSCO databases corresponding to the words "oral surgery", "oral bleeding", "anticoagulants" and "dental management" was performed. Regarding the inclusion criteria: bibliographic reviews, observational studies, clinical trials, guidelines, systematic reviews, and meta-analyses published between November 2005 and 2022, in English or Spanish, were considered. Conclusion: There are multiple protocols for the care of the anticoagulated patient who will undergo a minor oral surgery procedure. It is important to reflect on the anticoagulant used, the reason for it, its supervision, the surgical procedure that will be undertaken by the patient, and both intraoperative and postoperative hemostatic measures to be implemented. After analyzing the above, it is noted that reducing the intake of the drug to perform the surgical procedure may be harmful to the patient and to the clinician, therefore it is suggested to maintain the antithrombotic treatment and carry out a correct medical/surgical management.

Latencia y violencia / Latency and violence

La autora desarrolla las características de la latencia y su relación con la violencia. Este es un período precario, donde la turbulencia emocional se esconde detrás de paredes muy finas y frágiles. Los primeros vínculos son fundamentales para un tránsito satisfactorio por este etapa, pues ofrece al niño la posibilidad de adquirir y ampliar sus áreas de satisfación y conocimiento, permitiéndole una inserción más amplia en el mundo y en la cultura. La violencia en la latencia surge cuando las condiciones para su desarrollo no se alcanzan, y el niño permanece aprisionado en las cuestiones de la primera infancia, desde las narcisistas primarias hasta las complejas cuestiones pulsionales. Se ilustran estas ideas con la presentación de dos casos clínicos en los cuales muestra cómo el fracaso en la adquisición de sublimaciones exitosas y el pasado extremadamente presente no permiten vivir el presente ni ocuparse del futuro.

The author exposes the characteristics of latency and its relation with violence. This is a precarious period in which emotional turbulence hides behind thin a fragile walls. First bonds are fundamental for a satisfactory transit through this stage, offering the child the possibility of acquiring and expanding its satisfaction and knowledge, allowing a broader insertion in the world and its culture. Violence in latency appears when the conditions for its development aren't reached, and the child remains imprisoned in early childhood matters, from the primary narcissistic ones to the complex "pulsiona" matters. The author illustrates this ideas with the presentation of two clinical cases in which she shows how failure in the acquisition of successful sublimation and the past being extremely present do not allow them to enjoy the present nor take care of the future.

Histopathologic evaluation following chronic implantation of chromium and steel based metal alloys in the rabbit central nervous system.

Histopathologic evaluation of three metal alloys for chronic implantation in the central nervous system (CNS) was undertaken in rabbits. Throughout the 8 month evaluation period the inflammatory response to the alloys was bland. Two of the alloys tested (chromium based MP35N, Trademark of the Standard Pressed Steel Company, and a stainless steel alloy, BG42 VacArc, Trademark of Latrobe Steel) appeared suitable as CNS implants. The third alloy (stainless steel 440C, Carpenter Steel Company) showed more corrosion than the other alloys, and may be less suitable for implantation. While E. cuniculi infection was found in four rabbits, the infection did not directly interfere with the assessment of the histologic changes directly due to the implants. Autoantibodies to a brain constituent were not observed.