ABSTRACT
The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.
Subject(s)
Arthralgia/etiology , Hypertension, Pulmonary/etiology , Lung Diseases, Interstitial/etiology , Raynaud Disease/etiology , Scleroderma, Systemic/diagnosis , Adult , Aged , Female , Humans , Male , Middle Aged , Prognosis , Registries , Retrospective Studies , Scleroderma, Systemic/complications , Scleroderma, Systemic/physiopathology , Severity of Illness Index , Symptom AssessmentABSTRACT
Introducción. El quiste dentígero es un quiste odontógeno del desarrollo de origen epitelial, siendo el más común después del radicular. Generalmente se asocia con la corona de dientes permanentes impactados o no erupcionados y su aparición es más frecuente en varones durante la segunda década de la vida. Los dientes que suelen verse más afectados son los terceros molares mandibulares, seguido de los caninos maxilares. A causa de su curso asintomático, el diagnóstico suele realizarse por hallazgo casual en radiografías panorámicas rutinarias. Para el diagnóstico definitivo es indispensable la realización de la anatomía patológica. Caso clínico. Se presenta el caso clínico de dos mujeres de 60 y 42 años de edad, sin antecedentes médicos de interés, remitidas al servicio de Cirugía Bucal del hospital Virgen de la Paloma, presentando una imagen radiográfica radiotransparente asociada a la corona del tercer molar inferior izquierdo sin sintomatología asociada. Tras realizar la extracción quirúrgica de los cordales afectados y la lesión quística asociada, se obtiene el diagnóstico definitivo mediante la anatomía patológica, posteriormente se realizan controles clínicos y radiográficos de la zona. Conclusiones. El quiste dentígero representa el segundo quiste odontógeno más frecuente después del quiste radicular en terceros molares retenidos. Es importante el examen radiográfico periódico de terceros molares incluidos para el diagnóstico y tratamiento de esta entidad patológica (AU)
Introduction. A dentigerous cyst or follicular cyst is defined as a developmental odontogenic cyst of an epitelial origin which represents the second most common entity after the radicular cyst. Generally it is associated with the crown of a permanent unerupted tooth (or semi-erupted) and it tends to be more frequent in males during the second decade of life. The most common location of dentigerous cyst are mandibular third molars followed by the maxillary canines. Due to its asymptomatic behaviour, the diagnosis is reached by routine panoramic radiography, however, the anatomopathologic analysis will define its nature. Case Report. A case report of a 42 and 60 year old females with no medical history of interest, referred to the Oral Surgery Service of the hospital Virgen de la Paloma with a radiotransparent images surrounding the crown of the lower left third molar without associated symptoms. After the extraction of the teeth, cystic lessions are sent for anatomopathological study, which confirm the presumption diagnosis, dentigerous cyst. Patients carried out posterior follow ups sho-wing a positive healing of the bone around the surgical area. Conclusions. Dentigerous cyst represents the second most frequent odontogenic cyst after the radicular cyst at mandibular third lower molars. It is essential to monitor retained mandibular lower third molars for the incipient approach of the pathology (AU)
