Survival of dental implants in oncology patients versus non-oncology patients: a 5-year retrospective study

Abstract Patients with a history of cancer are increasingly common in the dental office. Treating cancer patients requires a multidisciplinary team, which should include the dentist, in order to control the complications that occur in the oral cavity and also to recover the patient undergoing treatment in any of its types: surgical, medical, radiotherapeutic, or its possible combinations. Dental implants can be a safe and predictable treatment option for prosthetic rehabilitation. The aim of this paper is to describe in retrospect the success rate of osseointegrated implants in oncology and non-oncology patients placed by the Master of Dentistry in Oncology and Immunocompromised Patients, as well as the Master of Medicine, Surgery and Oral Implantology of the University of Barcelona Dental Hospital, between July 2011 and March 2016. 466 patients were reviewed, with a total of 1405 implants placed, considering the oncological history of the patients and the implant success rate. The total success rate in the concerned period was 96.65%. When comparing cancer patients with healthy ones, the success rate has been 93.02% in the first case, and 97.16% in the latter. According to the literature review, our results encourage implant placement in cancer patients, it is important to recognize that this is an analysis of a complex care pathway with a large number of confounding variables. However, the findings should not be considered as generalizable.

Resumo Pacientes com histórico de câncer são cada vez mais comuns no consultório odontológico. O tratamento de pacientes com câncer requer uma equipe multidisciplinar, que deve incluir o dentista, a fim de controlar as complicações que ocorrem na cavidade oral e também para tratar o paciente com qualquer uma das modalidades de tratamento: cirúrgica, médica, radioterápica ou suas possíveis combinações. Os implantes dentários podem ser uma opção de tratamento segura e previsível para reabilitação protética. O objetivo deste artigo é propor um estudo retrospectivo sobre a taxa de sucesso de implantes osseointegrados em pacientes oncológicos e não oncológicos atendidos no Mestrado em Odontologia em Pacientes Oncológicos e Imunodeprimidos, bem como no Mestrado em Medicina, Cirurgia e Implantodontia Oral do Hospital Odontológico da Universidade de Barcelona, entre julho de 2011 e março de 2016. Foram revisados 466 pacientes, com um total de 1405 implantes instalados, considerando o histórico oncológico dos pacientes e a taxa de sucesso do implante. Resultados: A taxa de sucesso total no período em questão foi de 96,65%. Na comparação entre pacientes com câncer e saudáveis, a taxa de sucesso foi de 93,02% no primeiro caso e 97,16% no segundo. Conclusão: De acordo com a revisão da literatura, nossos resultados encorajam a colocação de implantes em pacientes com câncer, é importante reconhecer que esta é uma análise complexa que requer cuidado devido ao grande número de variáveis. No entanto, os resultados não devem ser considerados de forma generalizada.

Control y tratamiento de la hipertensión arterial: Programa 20-20 / Control and treatment of arterial hypertension; Program 20-20

Resumen Las enfermedades cardiovasculares son la primera causa de muerte prematura en el mundo y entre los factores de riesgo modificables más prevalentes se encuentra la hipertensión arterial, que es la tercera causa de muerte en el mundo, atribuyéndosele una de cada ocho muertes a nivel global. La hipertensión arterial se identifica fácilmente a través de métodos no invasivos; estudios poblacionales mundiales han mostrado que la prevalencia de hipertensión arterial en adultos mayores de 35 años es de 41%, de los cuales solamente el 46,5% son conscientes de ser hipertensos y de aquellos que son conscientes el 87,9% está recibiendo tratamiento farmacológico, pero solo el 32.5% de los que reciben tratamiento está bien controlado para una cifra de control global de apenas el 18%. En este artículo se revisan los factores que explican esta situación, entre ellos dificultades asociadas a la disponibilidad y al acceso a los servicios de salud y a los medicamentos antihipertensivos, educación de los equipos de salud y falta de consciencia de los pacientes respecto a su enfermedad, lo que determina una baja adherencia a las intervenciones de cambios de estilos de vida y a la terapia farmacológica. Así mismo, se revisan una serie de iniciativas y estrategias que están siendo desarrolladas por diferentes organizaciones en pro de mejorar la detección, el diagnóstico, el tratamiento y el control adecuado de la hipertensión arterial, de tal manera que se contribuya a disminuir sustancialmente la morbimortalidad por enfermedades cardiovasculares.

Abstract Cardiovascular diseases are the first cause of premature death in the world. Arterial hypertension is among the most prevalent modifiable diseases, and is the third cause of death in the world, with one in every eight deaths worldwide being attributed to it. Arterial hypertension is easily to identify using non-invasive methods. World population studies have shown that the prevalence of arterial hypertension in adults greater than 35 years is 41%, and only 46.5% are aware of being hypertensive. In those that are aware, 87.9% are receiving pharmacological treatment, but only 32.5% of those that receive treatment are well-controlled, with an overall control worldwide of just 18%. In this article, the factors that explain this situation are reviewed, including the difficulties associated with the availability and access to health services and anti-hypertensive medication, education of the health teams, and lack of awareness by the patients as regards their illness. This is reflected by a low adherence to the interventions on changes in life style and the pharmacological treatment. Furthermore, a review is carried out on a series of initiatives and strategies that are being developed by different organisations in order to improve the adequate detection, treatment, and control of arterial hypertension, as such that it contributes to substantially decrease the morbidity and mortality due to cardiovascualar diseases.

Xerostomia y radioterapia de cabeza y cuello: actualización / Radiation-induced xerostomia: update

Resumen En la radioterapia de cabeza y cuello las glándulas salivales suelen recibir una dosis elevada de radiación, lo que provoca una disminución progresiva y, a partir de determinada dosis, irreversible de la secreción salival, entre otros efectos. La xerostomía o sensación de boca seca es el efecto secundario más frecuente tras la radioterapia de cabeza y cuello, el cual disminuye la calidad de vida de los pacientes al dificultar funciones como la fonación y la deglución. Dada la complejidad y la temprana aparición de este síntoma, su prevención es la solución más eficaz. Los avances de las últimas décadas tienen un papel imprescindible: la radioterapia de intensidad modulada, la administración de sustancias citoprotectoras y el autotransplante de glándula submandibular parecen limitar en cierta medida el efecto de la radiación y disminuir así la sensación de sequedad bucal.

Abstract Radiation therapy is a key component in the multidisciplinary treatment of head-and-neck malignancies. In these cases, salivary glands are irradiated with high-level doses, which, among other side effects, results in a progressive and irreversible decrease in the salivary output. Radiation-induced xerostomia is the most common side effect of the head and neck region after radiotherapy treatment, and highly impairs the patients' long-term quality of life, threatening physiological functions, essentially speaking and swallowing. Given the complexity and early appearance of this symptom, its prevention is the most effective solution. In the past decades, the development of new radiation delivery techniques, such as intensity-modulated radiotherapy (IMRT), along with the administration of radioprotective drugs and autologous submandibular gland transplantation, seem to reduce the dose reaching the salivary glands, which in turn improves the patients' perception of dry mouth.

¿Existe un espacio para los análogos de la incretina como terapia para el sobrepeso, la obesidad y la prevención de la enfermedad cardio-metabólica? / Is there a space for incretin mimetics as a therapy for excess weight, obesity and cardiometabolic disease prevention?

Introducción: En las últimas décadas se ha producido un aumento progresivo de la enfermedad cardiovascular, convirtiéndose en la principal causa de mortalidad en el mundo y especialmente en los países de Latinoamérica, a pesar de haberse identificado los factores de riesgo cardiovascular prevenibles y que explican alrededor del 90% de la causalidad de un infarto de miocardio y de un accidente cerebrovascular. Por tanto, es necesario implementar las acciones que permitan controlar los factores de riesgo cardiovascular incluyendo sobrepeso y obesidad. Objetivo: Revisar el efecto que tienen los análogos de los receptores del GLP-1, entre ellos la liraglutida, en el control de factores de riesgo cardiovascular, particularmente del sobrepeso y la obesidad y en la consecuente prevención de la enfermedad cardiovascular. Métodos: Se realizó una búsqueda de la evidencia con operadores booleanos y referencias cruzadas en base de datos MEDLINE, LILACS y Google Scholar. Conclusiones: Los análogos de los receptores de GLP-1 pueden ser una alternativa farmacológica para el manejo del sobrepeso, la obesidad y contribuir en la prevención de la enfermedad cardiovascular, aunque todavía quedan interrogantes sobre el beneficio de su uso en nuestro medio.

Introduction: During the last decades there has been a gradual increase of cardiovascular diseases, who have become the main cause of death in the world and especially in Latin American countries, despite having identified preventable cardiovascular risk factors that explain around 90% of myocardial infarctions and cerebrovascular accidents. Therefore, it is require to implement actions that will allow to control cardiovascular risk factors, including being overweight or obese. Motivation: To review the effect of GLP-1 receptor agonists, including liraglutide, in controlling cardiovascular risk factors, particularly excess weight and obesity and the subsequent prevention of cardiovascular diseases. Methods: Evidence were searched by means of boolean operators and cross references in databases MEDLINE, LILACS and Google Scholar. Conclusions: GLP-1 receptor agonists can be a pharmacological alternative to control excess weight and obesity, and may help in preventing cardiovascular disease, though some questions remain regarding the benefits of its use in our field.

Autofluorescence and Diagnostic Accuracy of Lesions of Oral Mucosa: A Pilot Study

The purpose of this study was to determine the accuracy of autofluorescence techniques for diagnosing oral mucosa lesions, using as reference pattern for comparison the visual diagnosis made by a clinical specialist. A pilot study was conducted with 60 patients divided in a control group without mucosal pathology and a study group with known clinical history for mucosal pathology. Both groups were examined by an oral medicine specialist and by a general dentist who used VELscope(r) system, which applies tissue fluorescence visualization to identify oral mucosal abnormalities. Using the VELscope(r) system, the general dentist made overdiagnosis in two cases and underdiagnosis in one case. The sensitivity and specificity for the oral medicine specialist were 1 (95% CI: 0.884 to 1). For the general dentist, the sensitivity did not improve significantly with the use of VELscope(r) system [0.53 (95% CI: 0.343 to 0.717) versus 0.49 (95% CI: 0.406 to 0.773)] and the specificity was 0.80 (95% CI: 0.614 to 0.923). A limitation of the study is the small sample size, which does not fully represent a population and extrapolation of the data should be done carefully. Based on the obtained results, no clinical benefits were obtained using this VELscope(r) system.

Resumo O objetivo deste estudo foi determinar a precisão das técnicas de autofluorescência para o diagnóstico de lesões da mucosa oral, utilizando como padrão de referência para comparação o diagnóstico visual feito por um especialista clínico. Um estudo piloto foi realizado com 60 pacientes, divididos em um grupo controle sem patologia da mucosa oral e um grupo de estudo com história clínica conhecida de patologia da mucosa oral. Ambos os grupos foram examinados por um especialista em medicina oral e por um dentista clínico geral que usou o sistema VELscope(r), que aplica a visualização por fluorescência para identificar anormalidades do tecido da mucosa oral. Usando o sistema VELscope(r), o dentista geral realizou sobrediagnóstico em dois casos e subdiagnóstico em um caso. A sensibilidade e especificidade para o especialista em medicina oral foi 1 (IC 95%: 0,884 a 1). Para o dentista geral, a sensibilidade não melhorou significativamente com o uso do sistema de VELscope(r) [0,53 (95% CI: 0,343 to 0,717) versus 0,49 (95% CI: 0,406 to 0,773)], e a especificidade foi de 0,80 (IC de 95% : 0,614-0,923). Uma limitação do estudo é o pequeno tamanho da amostra, que não representa totalmente a população e a extrapolação dos dados deve ser feita com cuidado. Com base nos resultados obtidos, não houve benefícios clínicos com o uso do sistema VELscope(r).

Virus en Endodoncia / Viruses in Endodontics

La infección endodóntica es la infección que afecta al sistema de conductos radiculares y, sin duda, es el principal agente etiológico de las periodontitis apicales. Además, de las bacterias patógenas endodónticas, se ha buscado en los últimos años asociar la presencia de virus en distintos tipos de patología endodóntica. Los virus que más se han buscado y asociado son los pertenecientes a la familia herpesvirus, los cuales se han encontrado presentes en patologías periapicales principalmente. Se ha buscado además, relacionar su presencia a patologías que cursan con mayor sintomatología, o que presentan a la imagen radiográfica destrucciones óseas periapicales mayores. El rol de los virus en las lesiones apicales de origen endodóntico está aún poco claro, se habla de efectos acumulativos a los de las bacterias, además de posibles inmunosupresiones locales que favorecerían el crecimiento y el efecto de estas últimas.

Endodontic infection is an infection of the root canal system and undoubtedly is the main etiological agent of apical periodontitis. In recent years, research has aimed to associate the presence of virus and endodontic bacterial pathogens in the different types of endodontic disease. The most common viruses that have been researched and associated are members of the herpesvirus family, which are mainly present in periapical pathologies. Furthermore, research has been carried out relating their presence to pathologies with important symptoms, or those where radiographic imaging shows extensive apical bone reabsorption. The role of viruses in apical lesions of endodontic origin are still unclear, it hypothesizes the cumulative effect with bacteria, in addition to possible local immunosuppression that favors the growth and the effect of bacteria.

Sobrepeso y obesidad en indígenas nahuas de Ixtaczoquitlán, Veracruz, México / Overweight and obesity in indigenous nahuas from Ixtaczoquitlán, Veracruz, Mexico

El estudio tuvo como objetivo determinar la frecuencia de sobrepeso y obesidad en indígenas nahuas de Ixtaczoquitlán, Veracruz, México. Para ello, se realizó un estudio transversal entre los años 2010-2011; donde se calculó el índice de masa corporal (IMC). Para la definición de sobrepeso y obesidad se emplearon las categorías de la Organización Mundial de la Salud (OMS) y los de la Norma Oficial Mexicana (NOM). Se incluyó 227 nahuas (77,5% mujeres). Según los lineamientos de la OMS, la proporción de nahuas con sobrepeso fue de 41%, y de obesidad 36,5%; y según la NOM fue de 11,4 y 69,2% respectivamente. En conclusión, la frecuencia de sobrepeso y obesidad en indígenas nahuas es alta. Deben realizarse estudios enfocados a determinar la prevalencia y factores de riesgo y, con ello, desarrollar estrategias de prevención que mejoren la calidad de salud de estas poblaciones.

The study was aimed at determining the prevalence of overweight and obesity in indigenous nahuas from Ixtaczoquitlán, Veracruz, Mexico. For this purpose, a cross-cut study was conducted between 2010 and 2011, in which the body mass index (BMI) was calculated. To define overweight and obesity, the categories of the World Health Organization (WHO) and the Mexican Official Standard (NOM, Spanish acronym) were used. 227 nahuas (77,5% women) were included. According to WHO’s guidelines, the rate for overweight among nahuas was 41%, and 36.5% for obesity; according to NOM, it was 11.4 and 69.2% respectively. In conclusion, the prevalence of overweight and obesity among indigenous nahuas is high. Studies should be conducted to determine the prevalence and risk factors in order to develop prevention strategies based on this information to improve the health quality of these populations.

Oral tongue squamous cell carcinoma (OTSCC): alcohol and tobacco consumption versus non-consumption. A study in a Portuguese population

There has been an increase in the incidence of carcinoma of the tongue, particularly among alcohol and tobacco non-users. However, the number of studies that would allow a better understanding of etiological factors and clinical features, particularly in the Portuguese population, is very limited. This study was based on patients with squamous cell carcinoma of the anterior two thirds of the tongue that were treated at the Department of Head and Neck Surgery of the “Instituto Portugues de Oncologia de Lisboa - Francisco Gentil” (IPOLFG) in Lisbon, Portugal, between January 1, 2001 and December 31, 2009. The patients were divided in alcohol and tobacco users and non-users in order to evaluate the differences between these 2 groups based on gender, age, tumor location, denture use, and tumor size, metastasis and stage. Of the 354 cases, 208 were users and 146 were non-users. The main location in both groups was the lateral border of the tongue. Denture use showed no significant effect in both study groups. It was possible to conclude that patients who did not drink or smoke were older and presented with smaller tumor size, lower incidence of ganglion metastasis and lower tumor stage compared with alcohol and tobacco users.

Um aumento do carcinoma da língua, particularmente entre os não consumidores de álcool e tabaco tem se verificado recentemente. No entanto, o número de estudos que permitam uma melhor compreensão dos fatores etiológicos e características clínicas, particularmente na população Portuguesa, é muito limitado. Este estudo foi baseado em pacientes com carcinoma de dois terços anteriores da lingual que foram atendidos e tratados no Departamento de Cabeça e Pescoço do “Instituto Portugues de Oncologia de Lisboa, Francisco Gentil” (IPOLFG), Portugal, entre 1 de janeiro de 2001 e 31 de dezembro de 2009. Eles foram divididos em usuários de álcool e tabaco e não usuários, a fim de avaliar as diferenças entre estes 2 grupos com base no sexo, idade, localização do tumor, o uso de prótese dentária, tamanho do tumor, metástase e estágio. Dos 354 casos estudados, 208 eram usuários de álcool e tabaco e 146 eram não-usuários. A localização principal, em ambos os grupos, foram a bordos laterais da língua. O uso de prótese dentária mostrou não ter um efeito significativo em ambos os grupos de estudo. Pode-se concluir que os não-usuários de álcool e tabaco eram mais velhos e apresentaram carcinoma de menores dimensões, menor incidência de metástases ganglionares e um estágio mais inicial da doença do que os etilistas e fumantes.

Relationship between squamous cell carcinoma of the anterior two thirds of the tongue and removable denture use: a pioneer study in a Portuguese population

The aim of the study was to determine whether there is any relationship between the presence of removable dentures and squamous cell carcinoma of the anterior two thirds of the tongue in a Portuguese population. A retrospective cross-sectional study was conducted on patients with a biopsy-proven diagnosis of squamous cell carcinoma of the tongue, who were seen and treated at the Department of Head and Neck Surgery of the Portuguese Institute of Oncology 'Francisco Gentil', Lisbon, Portugal, during a 3-year period. Several factors were examined: gender, use of removable dentures, age, location of the lesion, and alcohol and tobacco consumption. One hundred and six cases were selected from the initial 151 cases, with a male:female ratio of 3:1 and the lateral borders being the most commonly affected site. The prevalence in both genders was between the sixth and seventh decade of life. Men were more likely to consume alcohol and tobacco than women, and no relationship was observed between denture use and presence of carcinoma of the tongue. In light of the data obtained, it may be considered that female use of a denture plays an important role, but it cannot be identified as a remarkable etiologic factor.

O objetivo deste estudo foi determinar se existe alguma relação entre o uso de prótese removível e o carcinoma escamoso dos dois terços anteriores na população portuguesa estudada. Um estudo retrospectivo foi conduzido em paciente com diagnóstico anatomopatologico de carcinoma escamoso dos dois terços anteriores, diagnosticados no Instituto Português de Oncologia, Francisco Gentil, Lisboa desde 1 de Janeiro de 2001 até 31 de Dezembro de 2003. Diferentes fatores foram analisados: o gênero, uso de prótese removível, idade, localização, álcool e tabaco. Dos 151 casos iniciais de carcinoma, foram selecionados 106 casos mostrando numa proporção de 3:1 (masculino/feminino). Os bordos laterais foram a localização mais comum e a prevalência em ambos os sexos sitou-se entre a sexta e a sétima década. A presença de álcool e tabaco foi significativamente mais comum nos homens não se observando relação entre o uso de prótese e a presença do carcinoma na língua. Não se observou relação estatística entre o uso de prótese removível e o carcinoma escomoso dos dois terços anteriores da língua. Face aos resultados, o uso de prótese no sexo feminino desempenha um papel importante ainda que não possa ser considerado um fator etiológico significativo.

Lecciones aprendidas de dos grandes estudios epidemiológicos de enfermedades cardio-cerebro-vasculares en las que ha participado Colombia: [editoriales] / Lessons learned from two large epidemiological studies of cardiovascular and cerebrovascular diseases in which Colombia took part: [editorial]

Dos recientes estudios epidemiológicos de gran envergadura en los que participó Colombia, el INTERHEART y el INTERSTROKE, demostraron que en Latinoamérica en general y en Colombia en particular, el principal factor de riesgo para la presentación de infarto agudo del miocardio y accidente cerebro vascular isquémico y hemorrágico es la obesidad abdominal, a diferencia del resto del mundo donde el principal factor de riesgo fue el aumento en las concentraciones plasmáticas del colesterol total y del colesterol LDL, en el primer caso, y la hipertensión arterial, en el segundo. Estos datos dan soporte a la propuesta de que en Latinoamérica la transición rápida de los modelos económicos experimentados en los últimos años junto con la urbanización acelerada son la causa del explosivo aumento de la obesidad abdominal, la diabetes mellitus tipo 2 y las enfermedades cardio-cerebro-vasculares.

Two recent large-scale epidemiological studies, INTERHEART and INTERSTROKE in which Colombia took part, demonstrated that in Latin America in general and particularly in Colombia, the main risk factor for the presentation of acute myocardial infarction and ischemic, and hemorrhagic stroke was the abdominal obesity in contrast to the rest of the world where the main risk factor was increase in plasma concentrations of total cholesterol and LDL-cholesterol for myocardial infarction, and hypertension for stroke . These data give support to the proposal that in Latin America the rapid transition in economic models experienced in the last years together with the fast urbanization has led to an explosive increase in abdominal obesity, diabetes mellitus type 2, and cardiovascular and cerebrovascular diseases.

Estudio histomorfológico de la capacidad de regeneración ósea del plasma rico en plaquetas, médula ósea y fosfato tricálcico: estudio experimental en cerdos "regeneración ósea en cirugía experimental en cerdos" / Histomorphological study of the bone regeneration capacity of platelet-rich plasma, bone marrow and tricalcium phosphate experimental study on pigs

Objetivo: Se valora histomorfológicamente la capacidad de regeneración ósea del plasma rico en plaquetas, a distintas concentraciones,y el extracto de médula ósea rico en plaquetas, en comparación con -fosfato tricálcico. Material y Metodo: Se realiza un trabajo experimental en 8 cerdos, a los que se les practican trepanaciones mandibulares para colocar los materiales a estudio. Las muestras obtenidas se observan mediante microscopio electrónico y se realizan fotografías sistemáticas para analizarlas mediante un sistema de histograma de grises. Resultados: Los fenómenos de osificación se aprecian en el 96% de los defectos practicados, con independencia del material empleado para rellenarlo. Se aprecia que el plasma rico en plaquetas (PRP) y la médula ósea (M) muestran un grado de osteogénesis equivalente, 12,3 y 13,4 respectivamente más potencia que el control. El plasma pobre en plaquetas (PPP) presenta una capacidad semejante a los controles (C) con una media de sustracción de 14,03 y 14,12 respectivamente. El fosfato tricálcico (FT) se muestra efectivo como elemento inductor de osificación, 3,03 veces más potente que el control. Conclusiones: La osificación se presenta en la mayor parte de los defectos practicados. El PRP y la M son los elementos con máscapacidad osteogénica y el PPP no se muestra más efectivo que el control.

Objetive: On numerous occasions after the oral surgery bone defects occur which may be difficult to repair. Objective: We assessed the histomorphologic bone regeneration capacity of platelet-rich plasma at different concentrations, and extract bone marrow platelet-rich, compared with -tricalcium phosphate. Material and Methods: We performed an experimental study in 8 pigs, who are practicing trepanaciones jaw to move the materials to study. The samples obtained were observed through electronic microscope and systematic photographs were made to analyse them through a system of gray histogram. Results: Ossification Phenomena were seen in 96% of the defaults practiced with independance of the material used to fill them. It is appreciated that the platelet-rich plasma (PRP) and bone marrow (M) show an equivalent degree of osteogenesis, 12.3 and 13.4 respectively, more power than the control. The platelet-poor plasma (PPP) provides a capability similar to controls (C) with an average of 14.03 and 14.12 abduction respectively. Tricalcium phosphate (FT) is effective as an inducer of ossification, 3.03 times more potent than the control. Conclusions: The ossification occurs in most of the charged defects. The PRP and the M are the most osteogenic capacity and the PPP is no more effective than control.

Proceso de atención de enfermería (PAE) en cuidados progresivos / Nursing care process (NCP) in progressive care

Se realizó un estudio descriptivo de corte con 50 casos ingresados en el Servicio de Terapia Intermedia del hospital provincial clinicoquirúrgico docente "Dr. Gustavo Aldereguía Lima", con diagnóstico de enfermedad cerebrovascular y casos quirúrgicos a los que se realizó proceso de atención de enfermería. Se aplicó anexo para la obtención de datos de interés como: movilización, ejercicios, baño en cama, alteraciones del balance hidromineral y apoyo psicológico, así como desarrollo de bronconeumonía, escaras, flebitis, secuela motora y desequilibrio hidromineral. Los datos fueron procesados por sistema computadorizado y se comprobó que los procederes de atención de enfermería más realizados fueron el baño en cama y la vigilancia de la hidratación, seguido de movilización, apoyo psicológico y ejercicios pasivos. Las principales complicaciones de los pacientes fueron: flebitis (38 porciento), secuela motora (34 porciento), desequilibrio hidromineral (22 porciento), y en menor número se presentó la bronconeumonía (20 porciento) y escaras (12 porciento)

Funcionamiento del anciano y anestesia / Elderly function and anesthesia

Se estudiaron 103 pacientes mayores de 65 años de edad, los cuales fueron sometidos a diferentes procedimientos anestésico-quirúrgicos en el Hospital Lic. Adolfo López Mateos del Instituto de Seguridad y Servicio de los Trabajadores del Estado, durante el periodo comprendido entre el primero de marzo de 1994 y el 31 de septiembre del mismo año a todos los pacientes se les realizo historia clínica, biometría hemática, tiempo de protrombina, tiempo parcial de tromboplastina, electrocardiograma y tele de tórax. Así mismo se utilizo la valoración de ASA, Goldman y Caldera y la escala de funcionalidad de Crichton. Se tomaron en cuenta las enfermedades asociadas, la técnica anestésica y las complicaciones transanestésicas, al igual que el tiempo quirúrgico y anestésico. Se llego a la conclusión de que la valoración preoperatoria y el tratamiento de las enfermedades asociadas, pueden disminuir la mortalidad y la morbilidad perioperatoria en el paciente geriátrico. También puede asegurarse que a mayor edad biológica, menor funcionalidad en el anciano y que los factores patológicos contribuyen a aumentar la mortalidad

Queratinofagia: un nuevo término / Keratinofagia: a terminal new

Se propone un nuevo término en dermatología: Queratinofagia; definiéndola como la manía de morder y/o comerse las porciones superficiales de la epidermis, alrededor de los dedos, manos o labios. Se describen 11 casos con este problema, ocho de los cuales se asociaban a onicofagia. La totalidad de los casos se relacionaban con ansiedad

Diagnostico precoz gineco-obstétrico mediante historia clínica sucinta e integral / Gineco-obstetric early diagnosis by means of sucint and integral clinical history

Estudio de 500 pacientes de las emergencias de los Hospitales Belén, Regional y Zonal de la ciudad de Trujillo (Peru), utilizando "Historia Clínica - Obstetrica de Emergencia, sucinta e integral", con la finalidad de proporcionar diagnósticos y tratamientos precoces y correctos. Se comprueba que de las pacientes que concurren a la emergencia el 74% son obstétricas y el 25% con patología ginecológica; la edad promedio fue de 28 años y la pridad promedio de 4 hijos, con menarca promedio de 13.2 años. La historia clínica fue realizada aceptadamente por el 86.8% de los estudiantes médicos, con mejores resultados en manos más expertas, permitiendo establecer diagnósticos correctos en el 86.8%. En el 75.2% el diagnóstico y tratamiento fue realizado antes de los 10 minutos. El análisis estadístico demuestra alata significación, por lo que se infiere que esta historia sea un medio de ayuda eficaz, para facilitar la labor asistencial, docente y de investigación gineco-obstétrica