Factor Xa inhibition and sPESI failure in intermediate-high-risk pulmonary embolism.

We report the case of a 61-year-old man who presented at the Emergency Department (ED), complaining of sudden-onset dyspnea and chest pain after a long flight from Tokyo to Houston. Considering his clinical stability and sPESI 0, enoxaparin 1 mg/kg BID was started for 24 h, and the patient was then considered for early discharge with apixaban 10 mg BID. Direct-factor Xa inhibition did not improve extensive thrombus burden and right ventricular dysfunction despite D-dimer measurement reduction. Because of the treatment failure, we considered thrombolysis. Currently, recommendations to use thrombolysis in patients under non-vitamin K antagonist oral anticoagulants (NOACs) do not exist. Hence, the one dose of apixaban was stopped, and 12 h later, we performed successful thrombolysis. A systematic review from 2007 to 2017 did not identify any cases related to NOACs failure to reduce thrombus burdens in patients with PE and persistent right ventricular dysfunction. We also did not find any evidence of cases that reported strategies for urgent thrombolysis in PE patients on NOACs. To the best of our knowledge, apixaban's failure to reduce thrombus burden, persistent right ventricular dysfunction, and a NOACs-thrombolysis bridge in patients with PE on apixaban has not been previously described. Both the bedside risk stratification and the therapeutic failures should alert clinicians in the ED to the potential limitations of low-molecular-weight heparin, NOACs therapy, and sPESI in the setting of intermediate-high-risk PE.

Aspirin desensitization in nonsteroidal anti-inflammatory exacerbated respiratory disease: The first prospective cohort in Chile.

Background: Nonsteroidal anti-inflammatory exacerbated respiratory disease (N-ERD) is characterized by the Samter triad: chronic rhinosinusitis with nasal polyps, asthma, and nonallergic hypersensitivity to NSAIDs. Its diagnosis is based on a complete clinical history and an aspirin (ASA) challenge test. Medical treatments include biological drugs and ASA desensitization. Objective: This study aims to evaluate the clinical response of patients with N-ERD undergoing functional endoscopic surgery (FES), followed by ASA desensitization and maintenance treatment, being the first prospective cohort study carried out in Chile. Methods: We conducted 1-year follow-up of 12 patients with N-ERD treated with FES, desensitization, and maintenance with ASA. For each control, the medication score, sinonasal symptomatology (SNOT-22), PEF (peak expiratory flow), nasal polyposis (Lildholdt score), and the appearance of adverse effects were recorded. Computed tomography (CT) of the paranasal cavities was performed at baseline and at the 12-month follow-up to calculate the Lund-Mackay score. Results: Patients presented a reduction of SNOT-22 after the FES, which was maintained at 12 months (p = 0.002); the symptoms that showed the greatest reduction were feeling embarrassed and nasal obstruction. The Lildholdt score was also significantly reduced (p = 0.001); in only three patients, the nasal polyps recurred, and all were small. The PEF showed a slight nonsignificant increase of 3.3%. In total, 75% of patients had an adverse effect, the most frequent being abdominal pain (66.7%), but none of the 12 patients required discontinuation of aspirin treatment in 1-year follow-up. The Lund-Mackay score had a significant reduction of 6.6 points (p < 0.001). Conclusion: ASA desensitization is safe and effective in reducing upper and lower respiratory symptoms in patients with N-ERD and delays the reappearance of nasal polyps, although it is not exempt from adverse effects, with the vast majority being mild.

Neurofibromatosis tipo 1 y manifestación en el Territorio Maxilofacial: Reporte de un caso y Revisión de la Literatura / Neurofibromatosis type 1 and manifestation in maxilofacial territory: A case report

Introducción: El neurofibroma corresponde a un tumor benigno que compromete la vaina neural del tejido nervioso, asociándose íntimamente a la neurofibromatosis. Debido al compromiso de nervios periféricos y/o centrales, su expresión clínica es muy variada producto de la compresión y/o desplazamiento de estructuras vecinas dificultando así su diagnóstico. Objetivo: El objetivo de este artículo, es el de realizar una revisión de la literatura en relación con la neurofibromatosis y sus manifestaciones en el territorio máxilofacial en conjunto con la presentación de un caso de hipercondilismo mandibular asociado a un neurofibroma en la región de la articulación temporomandibular en un paciente con antecedentes de neurofibromatosis. Métodos: Se presenta el caso de un paciente con laterognasia y antecedentes de Neurofibromatosis tipo I (NF1). Por medio de estudio imagenológico, se confirma Hipercondilismo derecho y presencia de una zona radiolúcida relacionada con el cuello del cóndilo comprometido, cuyo resultado histopatológico confirmo el diagnóstico de neurofibroma. Conclusiones: Existe una muy variada clínica en pacientes con NF1, presentando una predisposición a la formación de neurofibromas y alteraciones oseas que pudiesen comprometer el territorio máxilofacial y causar asimetrías faciales. Debido a esto, resulta imprescindible tener conocimiento y consideración de ambas patologías para una correcta planificación del tratamiento de los pacientes.

Introduction: Neurofibroma is a benign tumor that compromises the neural sheath of nerve tissue, intimately associated with Neurofibromatosis. Due to the involvement of peripheral and/or central nerves, its clinical expression is wide as a result of compression and/or displacement of neighboring structures, making its diagnosis difficult. Objective: The aim of this article is to review the literature on Neurofibromatosis and its manifestations in the maxillofacial territory, along with the presentation of a case of mandibular Hyperchondylism associated with a neurofibroma in the temporomandibular joint region in a patient with a history of Neurofibromatosis. Methods: We present the case of a patient with laterogenesis and a history of Neurofibromatosis type I (NF1). By imaging study, a right Hyperchondylism is detected along with the presence of a radiolucent area related to the neck of the compromised condyle, whose histopathological result confirmed the diagnosis of neurofibroma. Conclusions: There is a diverse clinical picture in patients with NF1, presenting a pre-disposition to neurofibromas development and bone abnormalities, leading to the compromise of the maxillofacial territory and causing facial asymmetries. Because of this, it is essential to have knowledge and consideration of both pathologies for the right planning of patient treatment.

Enfermedad de Rosai-Dorfman primario en maxilar; reporte de caso y revisión de la literatura / Primary Rosai-Dorfman disease in the maxilla; a case report and literature review

La enfermedad de Rosai-Dorfman es una enfermedad benigna, poco frecuente, de etiología desconocida, reconocida ampliamente como una histiocitosis sinusal con linfadenopatía masiva. Afecta principalmente a niños y adultos jóvenes de descendencia africana y, si bien, su tratamiento no es claro el pronóstico suele ser favorable. Presentamos una manifestación clínica rara e inusual de tumor maxilar derecho unilateral en una mujer de 59 años diagnosticada con enfermedad de Rosai-Dorfman luego de un riguroso estudio clínico, imagenológico, histológico e inmunohistoquímico. El tratamiento con corticoides sistémicos y radioterapia resultó ser exitoso en este caso, sin embargo, se requieren más estudios para comprobar su efectividad para el tratamiento de esta enfermedad.

Rosai-Dorfman is a rare benign disease of unknown etiology, recognized as sinus histiocytosis with massive lymphadenopathy. It mainly affects children and young adults of African descent and although its treatment is not clear, the prognosis is usually favorable. We present a rare and unusual clinical manifestation of a unilateral right maxillary tumor in a 59-year-old woman diagnosed with Rosai-Dorfman disease after a rigorous clinical, imaging, and histological study. The treatment with systemic corticosteroids and radiotherapy for this unusual clinical manifestation turned out to be successful in this case, however, more studies are required to verify its effectiveness.

Acuerdo Diagnóstico de Mediciones Óseas para Implantes Dentales Mediante Tomografía Computarizada de Haz Cónico / Diagnostic Agreement of Bone Measurements for Dental Implants by Cone-Beam Computed Tomography

RESUMEN: El objetivo de este estudio fue determinar el grado de concordancia entre profesionales para mediciones óseas mediante Tomografía Computarizada de Haz Cónico (CBCT). Para aquello, se realizó un estudio de Acuerdo Diagnóstico en el cual participaron 32 Cirujanos Dentistas de la Región de Los Ríos, dedicados al área de la implantología. Estos, realizaron mediciones de grosor buco-palatino, distancia mesio-distal y altura ósea en un examen de CBCT con un intervalo de 2 semanas con el fin de estimar el coeficiente de correlación intraclase (ICC). Mediante el método de BlandAltman, se realizó el análisis de las diferencias individuales para cada una de las mediciones señaladas. Finalmente, para establecer diferencias estadísticamente significativas entre las mediciones se realizó la prueba t-test para muestras pareadas, con un nivel de significancia estadística de p<0,05. El ICC para mediciones de grosor buco-palatino fue de 0,71, mientras que para las mediciones de distancia mesio-distal fue 0,79, y altura de 0,62. El ICC general para las tres mediciones fue de 0,97. No se encontraron diferencias estadísticamente significativas para las mediciones evaluadas. En conclusión, existe un alto grado de concordancia entre profesionales para mediciones óseas utilizando CBCT.

ABSTRACT: The aim of this study was to determine the degree of agreement between professionals for bone measurement analysis by Computed Beam Computed Tomography (CBCT). A diagnosis agreement study was carried out with the participation of 32 dental surgeons from the Los Ríos region, all specialists in implantology. The dental surgeons carried out measurements of bucco-palatal thickness, mesio-distal distance and height in a CBCT examination with a 2 week interval, in order to estimate intraclass correlation coefficient (ICC). Through the BlandAltman method the analysis of the individual differences for each of the indicated measurements was realized. Finally, to establish statistically significant differences between the measurements, t-test was performed for paired samples, with a statistical significance level of p <0.05. The ICC for buccopalatal thickness measurements was 0.71, while for the mesiodistal distance measurements it was 0.79, and height was 0.62. The general ICC for the three measurements was 0.97. No statistically significant differences were found in the evaluated measurements. In conclusion, there is a high level of agreement among professionals for measurements based on Cone Beam Computed Tomography (CBCT).