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Introducción: El presente artículo ahonda en las teorías más aceptadas sobre el proceso de erupción dental en la literatura de hoy en día y, desde este enfoque, expone el caso clínico de una paciente de 12 años de edad que presentaba retención de caninos y molares temporales. A dicha paciente se le trató clínicamente mediante exodoncias seriadas y se muestra su evolución posterior al tratamiento dental. Objetivos: Lograr entender de mejor manera el proceso de la erupción dental en base a la actual bibliografía. Materiales y métodos: Se realizó una revisión bibliográfica con palabras claves: "erupción dental", "extracciones seriadas", "retención dental" y "evolución dental". La paciente fue evaluada y tratada ortodóncicamente, mediante extracciones seriadas y se realizaron controles dentales periódicos con toma de radiografía panorámica para evaluar su evolución. Conclusión: El folículo dental y el retículo estrellado son las estructuras encargadas de generar el proceso eruptivo del diente mediante la interacción de diversas moléculas. Estas moléculas deben encajar dentro de un contexto para que cada diente erupcione de manera independiente.
Introduction: This article delves into the most accepted theories about the dental eruption process in today's literature and, from this perspective, presents the clinical case of a 12-year-old patient who presented retention of temporary canines and molars. This patient was treated clinically by means of serial extractions and her evolution after dental treatment is shown. Objectives: This article delves into the most accepted theories about the dental eruption process in today's literature and, from this perspective, presents the clinical case of a 12-year-old patient who presented retention of temporary canines and molars. This patient was treated clinically by means of serial extractions and her evolution after dental treatment is shown. Materials and methods: A bibliographic review was carried out with key words: "dental eruption", "serial extractions", "dental retention" and "dental evolution". The patient was evaluated and treated orthodontically by serial extractions and periodic dental check-ups were carried out with panoramic radiography to evaluate her evolution. Conclusion: The dental follicle and the stellate reticulum are the structures responsible for generating the eruptive process of the tooth through the interaction of various molecules. These molecules must fit into a context for each tooth to erupt independently.
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Erupción Dental , DienteRESUMEN
Observational studies with long-term follow-up of patients with primary central nervous system lymphoma (PCNSL) are scarce. Patient data over a period of four decades were retrospectively analysed from databases at Nottingham University Hospitals Trust, UK. The cohort was delineated by two distinct therapeutic eras; the first from 01/01/1982 to 31/12/2010 (n = 147) and the second 01/01/2011 to 31/07/2020 (n = 125). The median age at diagnosis was significantly older in the second era compared to the first (69 and 65 years respectively, P = 0·003). The 3-, 6- and 12-month overall survival (OS) rates in the second era were significantly higher compared to the first, at 85%, 77%, 62% versus 56%, 49%, 38% respectively (log-rank test P < 0·0001). On multivariate analysis, high-dose methotrexate (HD-MTX)-based induction protocols employed in the second era were associated with improved OS compared to those used in the first [hazard ratio (HR) 0·40, 95% confidence interval (CI) 0·28-0·57]. Within the second era, superior OS rates were seen with the use of intensive HD-MTX protocols (including consolidation with high-dose chemotherapy and autologous stem cell transplantation) compared to non-intensive HD-MTX schedules (HR 0·47, 95% CI 0·22-0·99). Initiating chemotherapy within 14 days of biopsy and use of rituximab were independently associated with improved OS and progression-free survival during the second era. These data suggest that prompt treatment initiation and use of intensive HD-MTX- and rituximab-based protocols have resulted in improved survival outcomes for patients.
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Neoplasias del Sistema Nervioso Central/mortalidad , Linfoma no Hodgkin/mortalidad , Factores de Edad , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carmustina/administración & dosificación , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/terapia , Ciclofosfamida/administración & dosificación , Citarabina/administración & dosificación , Dexametasona/administración & dosificación , Doxorrubicina/administración & dosificación , Esquema de Medicación , Femenino , Trasplante de Células Madre Hematopoyéticas , Hospitales Universitarios , Humanos , Estimación de Kaplan-Meier , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/terapia , Masculino , Metotrexato/administración & dosificación , Persona de Mediana Edad , Mortalidad/tendencias , Supervivencia sin Progresión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Trasplante Autólogo , Resultado del Tratamiento , Reino Unido/epidemiología , Vincristina/administración & dosificaciónRESUMEN
Hospitalized cancer patients are at high risk of venous thromboembolism (VTE). Despite current recommendations in clinical guidelines, thromboprophylaxis with low molecular weight heparin (LMWH) is underused. We performed an observational prospective study to analyse factors influencing prophylaxis use, VTE events and mortality in cancer-hospitalized patients. 1072 consecutive adult cancer patients were included in an University Hospital from April 2014 to February 2017, and followed-up for 30 days after discharge. The rate of LMWH prophylaxis was 67.6% (95% confidence interval [CI] 64.7% to 70.4%), with a 2.8% rate of VTE events (95% CI 1.9% to 3.9%) and 3.5% rate of major bleeding events (95% CI 2.5% to 4.8%). 80% of VTE events occurred despite appropriate thromboprophylaxis. Overall, 30-day mortality rate was 13.2% (95% CI 11.2% to 15.3%). Active chemotherapy treatment, hospital stay ≥ 4 days, and metastatic disease were associated with a higher use of LMWH. On the contrary, patients with hematologic malignancies, anemia or thrombocytopenia were less prone to receive thromboprophylaxis. The main reasons for not prescribing LMWH prophylaxis were thrombocytopenia (23.9%) and active/recent bleeding (21.8%). The PRETEMED score, used for VTE risk stratification, correlated with 30-day mortality. There is room for improvement in thromboprophylaxis use among hospitalized-cancer patients, especially among those with hematologic malignancies. A relevant number of VTE events occurred despite prophylaxis with LMWH. Therefore, identification of risk factors for thromboprophylaxis failure is needed.
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Neoplasias/patología , Tromboembolia Venosa/prevención & control , Anciano , Anticoagulantes/uso terapéutico , Antineoplásicos/uso terapéutico , Plaquetas/citología , Femenino , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/patología , Heparina de Bajo-Peso-Molecular/uso terapéutico , Hospitales Universitarios , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/mortalidad , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trombocitopenia/complicaciones , Tromboembolia Venosa/etiologíaRESUMEN
Background: Recent meta-analyses suggest that higher removal of beta-2 microglobulin (ß2M) with either high-flux (HFD) dialysis or hemodiafiltration (HDF) may be associated with decreased total and cardiovascular mortality in dialysis patients. However, there are limited data about the performance of high flux dialyzers and/or convective therapies in removing ß2M. Methods: This is a random effects meta-analysis and meta-regression of data extracted from randomized controlled trials and observational studies in hemodialysis, hemofiltration and HDF regarding the efficiency of high flux dialyzers to remove ß2M. Studies were searched using ProQuest in SCOPUS, EMBASE and MEDLINE. Results: We included 69 studies from 1 January 2001 to 12 June 2017 on 1879 patients with 6771 available measurements. Average ß2M clearance was 48.75 mL/min [95% confidence interval (CI) 42.50-55.21] for conventional HF dialysis, and 87.06 mL/min (95% CI 75.08-99.03) for convective therapies (hemofiltration and HDF) with substantial heterogeneity among studies [P (Q) ≤ 0.001]. In multivariable meta-regression analyses, we found significantly higher ß2M clearance for polyarylethersulfone dialyzers when used for HFD and polysulfone membranes in convective therapies. However, the mass of ß2M removed into the dialysate did not depend on membrane material. Adjusted dialysate-side (-22.279, 95% CI -9.8 to -34.757, P < 0.001) ß2M clearances were significantly lower than whole blood clearances, suggesting that adsorption contributes substantially to ß2M removal. Higher Kuf, blood flow and substitution fluid rates but not dialysate flow rates were associated with statistically significant and clinically meaningful elevation in ß2M clearance from the body independent of the dialysis modality. Conclusions: Membrane composition and characteristics, modality (convective versus diffusive), blood flow rates and substitution fluid rates in HDF play a significant role in the efficient removal of ß2M from the body in both diffusive and convective dialysis.
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Hemodiafiltración/métodos , Fallo Renal Crónico/terapia , Diálisis Renal/clasificación , Diálisis Renal/métodos , Microglobulina beta-2/metabolismo , Convección , Soluciones para Diálisis , Difusión , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND AND OBJECTIVES: Prognostic uncertainty is one barrier that impedes providers in engaging patients with CKD in shared decision making and advance care planning. The surprise question has been shown to identify patients at increased risk of dying. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In our prospective observational study, 488 patients ≥60 years of age with CKD stage 4 or 5 were enrolled. Binary surprise question (i.e., "Would you be surprised if this patient died in the next 12 months?") responses were recorded, and dialysis planning preferences, presence of advance care planning documentation, and care preceding death were abstracted. RESULTS: The median patient age was 71 (65-77) years old. Providers responded no and yes to the surprise question for 171 (35%) and 317 (65%) patients, respectively. Median follow-up was 1.9 (1.5-2.1) years, during which 18% of patients died (33% of surprise question no, 10% of surprise question yes; P<0.001). In patients with a known RRT preference (58%), 13% of surprise question no participants had a preference for conservative management (versus 2% of yes counterparts; P<0.001). A medical order (i.e., physician order for life-sustaining treatment) was documented in 13% of surprise question no patients versus 5% of yes patients (P=0.004). Among surprise question no decedents, 41% died at home or hospice, 38% used hospice services, and 54% were hospitalized in the month before death. In surprise question yes decedents, 39% died at home or hospice (P=0.90 versus no), 26% used hospice services (P=0.50 versus no), and 67% were hospitalized in the month before death (P=0.40 versus surprise question no). CONCLUSIONS: Nephrologists' prognostic perceptions were associated with modest changes in care, highlighting a critical gap in conservative management discussions, advance care planning, and end of life care among older adults with CKD stages 4 and 5 and high-risk clinical characteristics. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_09_18_CJASNPodcast_17_11.mp3.
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Planificación Anticipada de Atención , Fallo Renal Crónico/terapia , Nefrología , Prioridad del Paciente/estadística & datos numéricos , Diálisis Renal , Anciano , Anciano de 80 o más Años , Tratamiento Conservador , Toma de Decisiones , Femenino , Estudios de Seguimiento , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Fallo Renal Crónico/fisiopatología , Masculino , Participación del Paciente , Percepción , Pronóstico , Estudios Prospectivos , Cuidado TerminalRESUMEN
BACKGROUND: Prognostic uncertainty is one barrier to engaging in goals-of-care discussions in chronic kidney disease (CKD). The surprise question ("Would you be surprised if this patient died in the next 12 months?") is a tool to assist in prognostication. However, it has not been studied in non-dialysis-dependent CKD and its reliability is unknown. STUDY DESIGN: Observational study. SETTING & PARTICIPANTS: 388 patients at least 60 years of age with non-dialysis-dependent CKD stages 4 to 5 who were seen at an outpatient nephrology clinic. PREDICTOR: Trinary (ie, Yes, Neutral, or No) and binary (Yes or No) surprise question response. OUTCOMES: Mortality, test-retest reliability, and blinded inter-rater reliability. MEASUREMENTS: Baseline comorbid conditions, Charlson Comorbidity Index, cause of CKD, and baseline laboratory values (ie, serum creatinine/estimated glomerular filtration rate, serum albumin, and hemoglobin). RESULTS: Median patient age was 71 years with median follow-up of 1.4 years, during which time 52 (13%) patients died. Using the trinary surprise question, providers responded Yes, Neutral, and No for 202 (52%), 80 (21%), and 106 (27%) patients, respectively. About 5%, 15%, and 27% of Yes, Neutral, and No patients died, respectively (P<0.001). Trinary surprise question inter-rater reliability was 0.58 (95% CI, 0.42-0.72), and test-retest reliability was 0.63 (95% CI, 0.54-0.72). The trinary surprise question No response had sensitivity and specificity of 55% and 76%, respectively (95% CIs, 38%-71% and 71%-80%, respectively). The binary surprise question had sensitivity of 66% (95% CI, 49%-80%; P=0.3 vs trinary), but lower specificity of 68% (95% CI, 63%-73%; P=0.02 vs trinary). LIMITATIONS: Single center, small number of deaths. CONCLUSIONS: The surprise question associates with mortality in CKD stages 4 to 5 and demonstrates moderate to good reliability. Future studies should examine how best to deploy the surprise question to facilitate advance care planning in advanced non-dialysis-dependent CKD.
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Insuficiencia Renal Crónica/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Insuficiencia Renal Crónica/diagnóstico , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Impaired nitric oxide (NO) vasodilation (endothelial dysfunction) is associated with obesity and thought to be a factor in the development of hypertension. We previously found that NO synthesis inhibition had similar pressor effects in obese hypertensives compared with healthy control during autonomic blockade, suggesting that impaired NO vasodilation is secondary to sympathetic activation. We tested this hypothesis by determining the effect of autonomic blockade (trimethaphan 4 mg/min IV) on NO-mediated vasodilation (increase in forearm blood flow to intrabrachial acetylcholine) compared with endothelial-independent vasodilation (intrabrachial sodium nitroprusside) in obese hypertensive subjects (30
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Bloqueo Nervioso Autónomo/métodos , Endotelio Vascular/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Nitroprusiato/administración & dosificación , Obesidad/epidemiología , Determinación de la Presión Sanguínea , Índice de Masa Corporal , Comorbilidad , Estudios Cruzados , Progresión de la Enfermedad , Endotelio Vascular/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Óxido Nítrico/metabolismo , Obesidad/fisiopatología , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: The objective of this study was to determine the effect of inspiratory resistance through an impedance threshold device (ITD) on orthostatic tolerance in patients with postural tachycardia syndrome. We hypothesized that the ITD would result in a greater negative intrathoracic pressure to enhance cardiac venous return, improve stroke volume, and reduce heart rate in these patients. METHODS AND RESULTS: We compared the effect of a sham device (sham, no resistance) versus an ITD (increased inspiratory resistance) in 26 patients with postural tachycardia syndrome in a randomized, single-blind, crossover study. Hemodynamic assessments were performed at baseline while supine and during head-up tilt to 70° for 10 minutes. We did not find differences in baseline hemodynamic parameters between the ITD and the sham devices. After 10 minutes of head-up tilt, the heart rate was lower with the ITD versus sham device (102±4 versus 109±4 beat/min, respectively; P=0.003). The ITD also improved stroke volume compared with the sham device (35±2 versus 26±1 mL; P=0.006). CONCLUSIONS: These findings suggest that increasing negative intrathoracic pressure with ITD breathing improves heart rate control in patients with postural tachycardia syndrome during upright posture. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov; Unique Identifier: NCT00962728.
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Resistencia de las Vías Respiratorias , Inhalación , Síndrome de Taquicardia Postural Ortostática/terapia , Adulto , Estudios Cruzados , Diseño de Equipo , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Posicionamiento del Paciente , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Síndrome de Taquicardia Postural Ortostática/fisiopatología , Presión , Método Simple Ciego , Volumen Sistólico , Succión/instrumentación , Posición Supina , Tennessee , Pruebas de Mesa Inclinada , Factores de Tiempo , Resultado del TratamientoRESUMEN
Postural tachycardia syndrome (POTS) is associated with exercise intolerance, hypovolemia, and cardiac atrophy, which may contribute to reduced stroke volume and compensatory exaggerated heart rate (HR) increases. Acute volume loading with intravenous (iv) saline reduces HR and improves orthostatic tolerance and symptoms in POTS, but its effect on exercise capacity is unknown. In this study, we determined the effect of iv saline infusion on peak exercise capacity (VO2peak) in POTS. Nineteen patients with POTS participated in a sequential study. VO2peak was measured on two separate study days, following administration of placebo or 1 liter of i.v. saline (NaCl 0.9%). Patients exercised on a semirecumbent bicycle with resistance increased by 25 W every 2 min until maximal effort was achieved. Patients exhibited blood volume deficits (-13.4 ± 1.4% ideal volume), consistent with mild to moderate hypovolemia. At baseline, saline significantly increased stroke volume (saline 80 ± 8 ml vs. placebo 64 ± 4 ml; P = 0.010), increased cardiac output (saline 6.9 ± 0.5 liter/min vs. placebo 5.7 ± 0.2 liter/min; P = 0.021), and reduced systemic vascular resistance (saline 992.6 ± 70.0 dyn-s/cm(5) vs. placebo 1,184.0 ± 50.8 dyn-s/cm(5); P = 0.011), with no effect on HR or blood pressure. During exercise, saline did not produce differences in VO2peak (saline 26.3 ± 1.2 mg·kg(-1)·min(-1) vs. placebo 27.7 ± 1.8 mg·kg(-1)·min(-1); P = 0.615), peak HR [saline 174 ± 4 beats per minute (bpm) vs. placebo 175 ± 3 bpm; P = 0.672] or other cardiovascular parameters. These findings suggest that acute volume loading with saline does not improve VO2peak or cardiovascular responses to exercise in POTS, despite improvements in resting hemodynamic function.
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Volumen Sanguíneo/efectos de los fármacos , Tolerancia al Ejercicio , Ejercicio Físico , Síndrome de Taquicardia Postural Ortostática/fisiopatología , Adolescente , Adulto , Anciano , Umbral Anaerobio/efectos de los fármacos , Presión Sanguínea , Prueba de Esfuerzo , Femenino , Humanos , Infusiones Intravenosas , Soluciones Isotónicas , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Adulto JovenRESUMEN
Obesity is an important risk factor for the development of insulin resistance. Initial compensatory mechanisms include an increase in insulin levels, which are thought to induce sympathetic activation in an attempt to restore energy balance. We have previously shown, however, that sympathetic activity has no beneficial effect on resting energy expenditure in obesity. On the contrary, we hypothesize that sympathetic activation contributes to insulin resistance. To test this hypothesis, we determined insulin sensitivity using a standard hyperinsulinemic euglycemic clamp protocol in obese subjects randomly assigned in a crossover design 1 month apart to receive saline (intact day) or trimetaphan (4 mg/min IV, autonomic blocked day). Whole-body glucose uptake (MBW in mg/kg per minute) was used as index of maximal muscle glucose use. During autonomic blockade, we clamped blood pressure with a concomitant titrated intravenous infusion of the nitric oxide synthase inhibitor N-monomethyl-L-arginine. Of the 21 obese subjects (43±2 years; 35±2 kg/m(2) body mass index) studied, 14 were insulin resistant; they were more obese, had higher plasma glucose and insulin, and had higher muscle sympathetic nerve activity (23.3±1.5 versus 17.2±2.1 burst/min; P=0.03) when compared with insulin-sensitive subjects. Glucose use improved during autonomic blockade in insulin-resistant subjects (MBW 3.8±0.3 blocked versus 3.1±0.3 mg/kg per minute intact; P=0.025), with no effect in the insulin-sensitive group. These findings support the concept that sympathetic activation contributes to insulin resistance in obesity and may result in a feedback loop whereby the compensatory increase in insulin levels contributes to greater sympathetic activation.
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Sistema Nervioso Autónomo/efectos de los fármacos , Bloqueadores Ganglionares/farmacología , Resistencia a la Insulina/fisiología , Obesidad/fisiopatología , Trimetafan/farmacología , Adulto , Sistema Nervioso Autónomo/fisiopatología , Glucemia/metabolismo , Presión Sanguínea/efectos de los fármacos , Estudios Cruzados , Inhibidores Enzimáticos/farmacología , Femenino , Técnica de Clampeo de la Glucosa/métodos , Humanos , Insulina/administración & dosificación , Insulina/sangre , Masculino , Persona de Mediana Edad , Músculos/inervación , Óxido Nítrico Sintasa/antagonistas & inhibidores , Óxido Nítrico Sintasa/metabolismo , Obesidad/sangre , omega-N-Metilarginina/farmacologíaRESUMEN
Se estudió la cantidad y distribución de las fibras colágenas y elásticas de los distintos tejidos que conforman la articulación témporomandibular humana (ATM). Se utilizaron diecisiete ATMs humanas. Las muestras fueron procesadas con técnicas histológicas e histoquímicas. Al evaluar la morfología articular, ocho presentaron características histológicas normales y nueve alteradas. La cantidad y distribución de fibras elásticas varió para cada tejido articular en estudio, siendo notable la cantidad de fibras elásticas en la zona anterior y retrodiscal. Se determinó gran cantidad de fibras colágenas tipo I en todos los tejidos articulares. Entre los manojos de colágeno I se encontraron fibras de colágeno tipo III. Estos hallazgos nos indican que la cantidad y distribución de estas fibras están relacionadas con el rol funcional de los tejidos articulares donde ellas se encuentran. No se encontraron diferencias significativas en la cantidad de fibras elásticas, colágenas tipo I y III entre los tejidos conectivos evaluados en articulaciones sanas y enfermas.
The quantity and distribution of collagen and elastic fibers of seventeen human TMJ tissues were studied. Histological and histochemical methods were used. The histological evaluation showed eight TMJs with normal morphology and nine with joint tissue alterations. Elastic fibers amount and distribution was different in every analyzed articular tissue, noting the amount of elastic fibers in the anterior and retrodiscal zones. A great quantity of type I collagen fibers was found in all the joint tissues. Type III collagen fibers were found among the type I collagen bundles. These findings suggest a relationship between function and the amount and distribution of these fibers. No significant difference was found in the quantity of elastic, collagen type I and III fibers among the connective tissues in healthy and sick joints.
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Humanos , Articulación Temporomandibular/anatomía & histología , Colágeno , Tejido Elástico/anatomía & histología , Disco de la Articulación Temporomandibular/anatomía & histología , HistocitoquímicaRESUMEN
El desarrollo embrionario es un conjunto de procesos que dan origen al organismo y en particular al macizo craneofacial. Se pueden producir múltiples alteraciones del desarrollo, dentro de las cuales está el Síndrome de Goltz. Se realiza el estudio de una paciente de sexo femenino de 21 años de edad, portadora de este síndrome, la que presenta alteraciones cutáneas, óseas y musculares. Estas se manifiestan principalmente por la falta de desarrollo del macizo craneofacial en el lado izquierdo (gran asimetría facial). A nivel dental se observa microdoncia, hipoplasia del esmalte, y una gingivitis generalizada. Asociado a este síndrome la paciente presentaba un trastorno temporomandibular severo, dolor de cabeza, dolor de oídos, mareos, sordera en el oído izquierdo y mala calidad de sueño. Es tratada durante seis meses con un plano oclusal con mayor altura de trabajo en el lado izquierdo, para estimular el trabajo muscular y descomprimir los tejidos de la ATM. Posteriormente se realiza un tratamiento de rehabilitación dental integral para lograr una estabilidad oclusal y mantener la posición mandibular. Con el tratamiento se logra un desarrollo músculo esqueletal del lado izquierdo, compensando la asimetría facial, mejoran los síntomas asociados a la patología témporomandibular, como el dolor de cabeza, la sordera izquierda y el funcionamiento articular. Podemos concluir que el Síndrome de Goltz afecta estructuras corporales y craneofaciales, provocando en esta paciente alteraciones cutáneas, esqueletales y un trastorno témporomandibular severo. El tratamiento con un aparato ortopédico permitió equilibrar el trabajo muscular del sistema craneocervicomandibular, mejorando la patología témporomandibular y los síntomas asociados.
The origin of craniofacial structures is a complex embryonary process. There could be different growth alterations of it; one of them is Goltz Syndrome. We report a case of a female patient, 21 years old who present skin, bone and muscular alterations. This alteration is mainly in the left craniofacial structures, resulting in facial asymmetry. She also presented microdontia, enamel hypoplasia, and generalized gingivitis. A severe Temporomandibular disorder (TMD) was also associated with headaches, earaches, dizziness, deafness in the left ear and poor sleep quality. She was treated for 6 months with an occlusal splint, higher in the left side to stimulate the muscular activity and give some relief to the left TMJtissues. Subsequently, a complete oral rehabilitation treatment was performed to achieve occusal stability and to perpetuate the mandibular position. After the treatment, the patient presented more development in the left muscular and skeletal structures, improving the facial symmetry, and eliminating headaches, earaches, dizziness, deafness in the left ear and poorsleep quality.
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Humanos , Adulto , Femenino , Hipoplasia Dérmica Focal/complicaciones , Procedimientos Ortopédicos , Trastornos de la Articulación Temporomandibular/terapia , Asimetría Facial/etiología , Hipoplasia Dérmica Focal/terapia , Síndrome , Resultado del Tratamiento , Trastornos de la Articulación Temporomandibular/etiologíaRESUMEN
UNLABELLED: The presence of Herpes Simplex Virus (HSV) has been a frequent detection in gingivitis and ulcerations of oral mucosa in patients undergoing oncologic therapy. In these patients, lesions tend to show atypical clinical patterns, leading to misdiagnosis. OBJECTIVES: To detect HSV, using an ELISA test, in oral lesions of patients under oncologic therapy, to determine localization of these lesions in the oral cavity, to relate their presence with the general diagnosis of the patient and to compare the test results with the previous clinical diagnosis of the lesions. STUDY DESIGN: Thirty lesions where examined in nineteen pediatric patients under oncologic therapy. Direct samples of all lesions were taken and an ELISA test for HSV type I and II was applied to them. General diagnosis of the patients was consigned, as well as localization of the lesions in the oral cavity and clinical diagnosis of them. A database was elaborated with all the information. RESULTS: 33% of lesions were positive to the test, most of them in patients with acute myeloid leukemia. Localization of lesions was not restricted to areas of mucosa attached to periosteum, but also in areas like the dorsum of the tongue. Positive predictivity of clinical diagnosis was 56,25% and negative predictive index was 92,86%. Sensitivity of the test was 90% and specificity was 65%. CONCLUSIONS: It is very important to corroborate clinical diagnosis of gingivitis and ulcerative lesions of the oral cavity of patients under oncologic therapy with laboratory tests, because of the atypical clinical presentation that can lead to misdiagnosis.
Asunto(s)
Mucosa Bucal/virología , Neoplasias/tratamiento farmacológico , Neoplasias/virología , Simplexvirus/aislamiento & purificación , Niño , HumanosRESUMEN
La presencia de Virus Herpes Simple (VHS) ha sido una detección frecuente en gingivitis y ulceraciones de a mucosa oral en pacientes bajo terapia oncológica. En estos pacientes las lesiones se presentan con patrones clínicos atípicos, lo que lleva a un diagnóstico erróneo.Objetivos: Detectar VHS utilizando un test de ELISA, en lesiones orales de pacientes: sometidos a terapia oncológica, determinar la localización de las Iesiones en la cavidad oral, relacionar su presencia con el diagnóstico general del paciente y comparar los resultados del test con el diagnóstico clínico previo de Ia lesión.Diseño de estudio. Se examinaron 30 lesiones en 19 pacientes pediátricos bajo terapia oncológica. Se tomaron muestras directas de todas las lesiones y se aplicó el test dé ELISA para VHS tipo I y II. Se consignó el diagnóstico general del paciente, ubicación de las lesiones en la cavidad bucal"y el diagnóstico clínico de las lesiones. Se confeccionó una base de datos y estos se relacionaron entre sí.Resultados: Un 33 por ciento de las lesiones fueron pós tivas al test, la mayoría en pacientes can leucemia mieloide aguda. La localización de las lesiones no se limitó a áreas de mucosa adherida a per ostio, ya qué se observaron también en otras zonas como el dorso de la lengua. La predictividad positiva del diagnóstico clínico fue de 56,25 por ciento y el índice predictivo negativo fue de 92,86 por ciento. La sensibilidad del test fue de 90 por ciento y Ia especificidad de 65 por ciento.Conclusiones: Es muy importante corroborar mediante tests de laboratorio el diagnóstico clínico de gingivitis Y lesiones ulcerativas de la cavidad bucal en pacientes con terapia oncológica, ya que la presentación clínica atípica que éstas presentan puede llevar a falsos diagnósticos (AU)
Asunto(s)
Niño , Humanos , Simplexvirus , Mucosa Bucal , NeoplasiasRESUMEN
Las neoplasias malignas y su tratamiento producen complicaciones bucales que comprometen al paciente en su estado general. Objetivos: El objetivo de este estudio fue registrar las manifestaciones orales más frecuentes en pacientes pediátricos con patología oncológica, bajo tratamiento. Diseño de estudio: Se realizó un estudio descriptivo de las lesiones bucales registradas en pacientes que se encontraban en período de hospitalización en la Unidad de Oncohematología del Servicio de Pediatría del Hospital Regional de Concepción, Chile, durante un período de dos años. El diagnóstico se realizó en base a un examen clínico, realizado en visitas semanales, con luz artificial, siempre por el mismo operador. Los datos fueron registrados en fichas personales. Se excluyó la patología de tejidos duros. De un total de 127 pacientes, el 59 por ciento era de sexo masculino y el 41 por ciento de sexo femenino. El rango de edad fue de 5 meses a 16 años. El 57 por ciento de los pacientes eran portadores de leucemias o linfomas y el 43 por ciento de otras neoplasias malignas. Resultados: El 65 por ciento de ellos presentó algún tipo de patología bucal. El grupo que presentó mayor porcentaje de patología oral fue el de pacientes portadores de leucemia mieloide aguda (95 por ciento), seguido por los pacientes con linfomas (73 por ciento) y los que padecían de leucemia linfoblástica aguda (71 por ciento). La patología que presentó mayor cantidad de episodios fue la candidiasis (38 por ciento), seguida de mucositis (19 por ciento), lesiones herpéticas (14 por ciento) y síndromes hemorragíparos (10 por ciento). Las candidiasis, lesiones herpéticas y síndromes hemorragíparos fueron más frecuentes en los pacientes con leucemia mieloide aguda y las mucositis en los pacientes con linfomas. Conclusiones: Con estos datos se concluye que es necesaria la incorporación del odontólogo al equipo oncológico en el tratamiento integral de estos pacientes (AU)