Preventing bisphosphonate induced osteonecrosis of the jaw with a polyguanidine conjugate (GuaDex): A promising new approach.

Osteonecrosis of the jaw (ONJ) is a relatively rare side effect after prolonged use of bisphosphonates, which are drugs used to treat bone resorption in osteoporosis and certain cancers. This study introduces a novel ONJ model in rats by combining exposure to bisphosphonates, oral surgery, and bacterial inoculation. Potential ONJ preventive effects of polyguanidine (GuaDex) or antibiotics were evaluated. The study consisted of twenty-four male Wistar rats were divided into four groups. Groups 1 to 3 were given weekly doses of i.v. Zoledronic acid (ZA), four weeks before and two weeks after an osteotomy procedure on their left mandibular first molar. Group 4 was a negative control. Streptococcus gordonii bacteria were introduced into the osteotomy pulp chamber and via the food for seven days. On day eight, the rats were given different treatments. Group 1 was given a GuaDex injection into the osteotomy socket, Group 2 was given an intramuscular (i.m.) injection of clindamycin, Group 3 (positive control) was given an i.m. injection of saline, and Group 4 was given an i.m. injection of saline. Blood samples were taken two weeks after the osteotomy procedure, after which the rats were euthanized. Bone healing, bone mineral density, histology, and blood status were analyzed. The results showed that Group 1 (GuaDex) had no ONJ, extensive ongoing bone regeneration, active healing activity, vascularization, and no presence of bacteria. Group 2 (clindamycin) showed early stages of ONJ, avascular areas, and bacteria. Group 3 showed stages of ONJ, inflammatory infiltrates, defective healing, and bacterial presence, and Group 4 had normal healing activity and no bacterial presence. Conclusion: ZA treatment and bacterial inoculation after tooth extraction inhibited bone remodeling/healing and induced ONJ characteristic lesions in the rats. Only GuaDex apparently prevented ONJ development, stimulated bone remodeling, and provided an antimicrobial effect.

Tumor odontogénico epitelial calcificante en la rama mandibular. Informe de un caso clínico basado en una actualización bibliográfica / Calcifying epithelial odontogenic tumor in the mandibular ramus. A case report based on a literature update

Objetivo: Presentar un caso clínico de un tumor odon- togénico epitelial calcificante (TOEC), así como una revisión de la literatura disponible sobre esta neoplasia para contribuir al análisis del mejor método de tratamiento de la patología. Caso clínico: Se presenta el caso de una paciente mujer de 35 años con un tumor odontogénico epitelial calcifican- te que recibió tratamiento de enucleación quirúrgica con una evolución favorable y seguimiento de 5 años por medio de evaluación clínica y radiológica. La elección terapéutica se basó en el resultado de un análisis exhaustivo de la literatura para determinar el mejor abordaje de la neoplasia (AU)

Aim: To present a clinical case of a calcifying epithelial odontogenic tumor (CEOT), as well as a review of the availa- ble literature on this neoplasia to contribute to the analysis of the best treatment method for the pathology. Clinical case: The case of a 35-year-old patient with a calcifying epithelial odontogenic tumor who received surgical enucleation treatment with a favorable evolution and 5-year follow-up through clinical and radiological evaluation is pre- sented. The therapeutic choice was based on the result of an exhaustive analysis of the literature to determine the best ap- proach to the neoplasia (AU))

Shaping ability of BlueShaper, TruNatomy, DC Taper and HyFlex EDM in long oval canals: An ex vivo study.

AIM: This study evaluated and compared the shaping ability of four rotary instrument systems in long-oval root canals using microcomputed tomographic (micro-CT) evaluation. Currently, there is no data available on the canal shaping abilities of BlueShaper and DC Taper instruments. METHODOLOGY: Sixty-four single-rooted mandibular premolars were matched based on similar root canal morphologic features as determined by (micro-CT) and randomly assigned to 1 of 4 experimental groups (n = 16) according to the instrument system used: BlueShaper, TruNatomy, DC Taper and HyFlex EDM One File. Changes in the root canal surface and volume, remaining dentine thickness, and number of prepared areas were assessed. RESULTS: No significant differences were found amongst the four instrument systems for the parameters evaluated (p > .05). There was a significant reduction in the number of unprepared areas and the remaining dentine thickness after each increase in size of the instruments tested (p < .05). CONCLUSIONS: The four instrument systems perform similarly in long oval root canals. Although none could prepare all canal walls, larger preparations incorporated significantly more surfaces in the final shape.

Desplazamiento de Tercer Molar Superior a Fosa Infratemporal: Reporte de Casos y Revisión de Literatura

RESUMEN: Dentro de las complicaciones transoperatorias de una cirugía de tercer molar se encuentra el desplazamiento del diente a espacios anatómicos adyacentes. Dicho accidente representa un porcentaje muy bajo de las complicaciones y se atribuye a una planeación y manejo clínico inadecuado. En este reporte se abordará específicamente el desplazamiento accidental de terceros molares superiores a la fosa infratemporal. Se realizó una búsqueda de información en la plataforma PubMed con las palabras claves "third molar displacement", obteniendo un total de 22 artículos según los criterios de inclusión. Se presentan dos casos de desplazamiento de tercer molar superior a fosa infratemporal manejados en el Centro Académico de Atención Odontológica (CAAD) del Tecnológico de Monterrey. El propósito del presente escrito es proponer un protocolo de manejo para dicha complicación.

ABSTRACT: One of the intraoperative complications of third molar surgery is the displacement of the tooth to adjacent anatomical spaces. This accident represents a small percentage of complications and is attributed to inadequate clinical planning and management. This report will specifically address the accidental displacement of upper third molars to the infratemporal fossa. A search was conducted by using the PubMed database with the keywords "third molar displacement", a total of 22 articles were included according to the inclusion criteria. Two cases of displacement of the upper third molar to the infratemporal fossa managed at the Centro Academico de Atencion Odontologica (CAAD) of the Tecnologico de Monterrey will be reported. The aim of this paper is to present a management protocol for this complication.

Evaluación de calidad en los servicios de salud: un análisis desde la percepción del usuario / Evaluation of health care services quality: An analysis from the user's perception

Resumen Objetivo: Analizar los determinantes de la evaluación en la calidad de los servicios de salud públicos y privados usando como caso de estudio el Área Metropolitana de Monterrey (AMM). Material y métodos: A partir de un estudio cuantitativo-exploratorio que utiliza la información del estudio de percepción ciudadana "Así Vamos 2018" y cuyo diseño permite la representatividad a nivel estatal, municipal y por género en la población objetivo, se utilizan dos métodos estadísticos (análisis factorial y modelo de regresión Tobit) para identificar cuales características son valoradas en la percepción de calidad para cada servicio de salud, distinguiendo entre instituciones públicas y privadas. Posteriormente, se analiza como las variables de servicio que determinan esta evaluación de calidad. Resultados: Las estimaciones sugieren diferencias significativas de los determinantes de calidad entre distintos servicios de salud: mientras para los usuarios del IMSS lo más importante es la "características de las instalaciones", "horarios de servicio" y preponderantemente "acceso a medicinas", para usuarios del Seguro Popular y servicios privados es la "atención del personal administrativo". Conclusión: Los usuarios utilizan diferentes criterios para evaluar las alternativas de servicios de salud a las que tienen acceso, y por tanto esta discrepancia es fundamental al comparar la calidad ofrecida por diferentes oferentes.

Abstract Objective: This paper studies the determinants of the quality assessment of public and private health services using the Monterrey Metropolitan Area (AMM) as a case study Material and Methods: This is a quantitative-exploratory study that uses the information from the citizen perspective study "Asi Vamos 2018" and whose design allows representativeness at the state, municipal, and gender levels in the relevant population, two statistical methods are used (factor analysis and a Tobit regression model) to identify which characteristics are valued in the perception of quality for each health service, distinguishing between public and private institutions. Subsequently, it is analyzed how service variables determine this quality evaluation. Results: The estimations suggest significant differences in the determinants of quality between health services: while for IMSS users the most important characteristics evaluated are the quality of installations, "access to more dates for medical attention", and "access to medicines" for Seguro Popular and private services users it is the "hospital managerial personnel attitude". Conclusion: Users apply different criteria to evaluate the alternatives on health service to which they have access, and therefore this discrepancy is fundamental when comparing the quality offered by different suppliers.

In Vivo Evaluation of 3 Electronic Apex Locators: Root ZX Mini, Apex ID, and Propex Pixi.

INTRODUCTION: The aim of this in vivo study was to compare the accuracy of 3 electronic apex locators (EALs) (Root ZX mini [J Morita Corp, Tokyo, Japan], Apex ID [SybronEndo, Glendora, CA], and Propex Pixi [Dentsply Maillefer, Ballaigues, Switzerland]) to determine the working length. METHODS: Thirty single-rooted human teeth that were scheduled for extraction were selected for the study. Electronic measurements were performed with the 3 EALs. After the teeth had been extracted, a #10 K-file was used to determine the actual working length, which was established at 0.5 mm short of the major foramen. The data were statistically analyzed with analysis of variance (α = 0.05). RESULTS: No significant differences were found among the experimental groups (P > .05). The mean distance from the actual working length to the file tip was 0.163 ± 0.032 mm when Root ZX mini was used, 0.343 ± 0.032 mm for Propex Pixi , and 0.012 ± 0.008 mm for Apex ID. CONCLUSIONS: Under the in vivo conditions of this study, no statistically significant differences were observed among the 3 EALs.

Quistectomía conservadora mediante trepanaciones múltiples: reporte de un caso / Conservative cystectomy by multiple trepanations: report of a case

En la actualidad los procedimientos quirúrgicos han evolucionado con la intención de ser lo más conservadores posible, dando pie a una regeneración fi siológica más rápida y completa. La extirpación de quistes de gran tamaño de los maxilares mediante descompresión y marsupialización ha demostrado obtener excelentes resultados, siendo éste un procedimiento que permite evitar un amplio abordaje quirúrgico, aunque generalmente requiere un segundo tiempo para reconstruir el defecto. La quistectomía conservadora mediante múltiples trepanaciones de acceso, permite la eliminación del cuerpo patológico por completo sin la necesidad de un segundo procedimiento quirúrgico. La excelente cicatrización ósea fi siológica y adecuado reposicionamiento y soporte de tejidos blandos sin necesidad de utilizar membranas, son logrados gracias a los puentes óseos que se mantienen entre las trepanaciones, los cuales brindan soporte además de mantener células osteoprogenitoras. Se presenta caso clínico de enucleación conservadora de quiste periapical de gran tamaño y extracción de canino retenido en paciente masculino de 12 años de edad mediante trepanaciones múltiples (AU)

Nowadays the surgical procedures have evolved aiming to be as conservative as possible, resulting in a faster physiological regeneration. The removal of large maxillary cysts using decompression and marsupialization has proved to have excellent results, is this a procedure that avoids the use of large surgical access, although a second procedure is generally needed to completely remove the lesion. Conservative cystectomy using multiple access trepanations allows the complete elimination of the cyst without the need for a second surgical intervention. Excellent physiological bone healing and adequate soft tissue reposition without the need of grafting material and membrane is achieved thanks to the osseous bridges between the multiple trepanations, which gives support for soft tissue and provides osteoprogenitor cells. A clinical case of conservative enucleation of a large radicular cyst is presented as well as the extraction of a retained canine in a 12-year-old male patient using multiple trepanations (AU)

Efectividad del uso de la bolsa adiposa de bichat para la reconstrucción de defectos en el paladar: reporte de un caso / Effectiveness of the use of the bichats fat pad for the reconstructionof defects in the palate. report a case

La bolsa adiposa de Bichat está constituida por un cuerpo y tres extensiones de tejido adiposo, se localiza dentro del espacio bucal y seextiende siguiendo el borde anterosuperior del músculo masetero. En la actualidad su uso como colgajo pediculado ha demostrado excelentesresultados en el tratamiento de reconstrucción de defectos postumorales de tejido blando en el paladar. Lo anterior se debe a su gran aporte vascular, composición histológica y a la presencia de células madre en tejido adiposo que fomentan una metaplasia del tejido, convirtiéndose en tejido fibroso y superfi cialmente con epitelio en tan sólo cinco semanas. La técnica de abordaje y reposicionamiento del colgajo pediculado en paladar fue modifi cada con la extirpación de la tuberosidad del maxilar para corregir el defecto ocasionado por un adenoma pleomorfo en el paladar. Se destacan las características y cualidades de la bolsa adiposa de Bichat para su uso en reconstrucción de defectos tumorales.

Bichat’s buccal fat pad is constituted by a body and three extensions ofadipose tissue within the buccal space and extending to the anteriorsuperiorborder of the masseter muscle. To this days, the use of thebuccal fat pad as a pedicled graft has shown excellent results onoral post tumoral reconstruction treatment. This is due to its greatvascularity, histological composition and perhaps to the presenceof stem cells that promotes a metaplasia, turning adipose tissue intofi brous and superfi cially epithelized tissue within fi ve week aftersurgery. Surgical approach and repositioning technique of the pedicledgraft was modifi ed, extirpating part of the maxillary tuberosity, topreserve vascularity and cover up a hard-soft tissue defect caused by apleomorphic adenoma on a patient’s palate. Buccal fat pad’s qualitiesand characteristics are taken into consideration to demonstrate theeff ectiveness on its surgical reconstructive uses.

Osteomielitis causante de fractura patológica: reporte de un caso / Pathological fracture resulting from osteomyelitis: report of a case

Las fracturas patológicas mandibulares son poco comunes, representanel 1 a 2% de todas las fracturas. Pueden ser defi nidas como fracturasque ocurren en regiones donde el hueso ha sido debilitado bajo un procesopatológico. Los factores de causa más comunes incluyen procesosquirúrgicos tales como extracciones de terceros molares, colocación deimplantes, osteonecrosis relacionada con bifosfonatos, osteorradionecrosisde la mandíbula, osteomielitis, infecciones, tumores o lesionesquísticas. La osteomielitis es una condición infl amatoria del hueso; estapatología es uno de los factores que puede determinar el debilitamientodel hueso mandibular y causar una subsecuente fractura patológica. Laosteomielitis mandibular se puede desarrollar si una infección primaria noes manejada adecuadamente. El tratamiento de las fracturas patológicaspuede representar un reto para el profesional de la salud y difi ere segúnla etiología de la misma. Se presenta un caso de una paciente de 54 añosde edad, con una fractura mandibular patológica causada por osteomielitis,la cual fue tratada con antibioticoterapia e intervención quirúrgica.

Pathological mandibular fractures are rare, accounting for between1 and 2% of all fractures. They can be defi ned as fractures thatoccur in regions where the bone has become weakened as a result of a pathological process. Common causal factors include surgicalprocedures such as third molar removal, implant placement, bisphosphonate-related osteonecrosis, osteoradionecrosis of the jaw,osteomyelitis, infections, tumors, and cystic lesions. Osteomyelitisis an infl ammatory condition of the bone; this pathology is one ofthe factors that may prompt weakening of the mandibular boneand cause subsequent pathological fracture. Osteomyelitis of themandible may develop if a primary infection is not properly treated.Treatment of pathological mandibular fractures can be challengingand varies according to their etiology. This article looks at the caseof a 54-year-old woman with a pathological mandibular fracture caused by osteomyelitis, which was treated by means of antibioticotherapy and surgical intervention.

Colectomía Subtotal Laparoscópica. Resultados en el Texas Endosurgery Institute / Laparoscopic subtotal colectomy: results from the Texas Endosurgery Institute

BACKGROUND: Laparoscopy is currently and progressively gaining acceptance for the management of colorectal disease. More bleeding and longer operating time were initially considered as contraindications to perform laparoscopic colon resections. Other obstacles were technical difficulties, the learning curve and the need for specialized instruments; however, improvements in surgical techniques and technological developments have allowed subtotal laparoscopic colectomy to be feasible. METHODS: This was a retrospective and descriptive study conducted from April 1992 to July 2006. Forty-four patients underwent laparoscopic subtotal colectomy at Texas Endosurgery Institute in San Antonio, TX. Measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Cancer, familial adenomatous polyposis and ulcerative colitis were the main surgical indications. The procedure was technically successful in 88% of patients. There were five conversions (11.3%). Mean operating time was 210 min. Morbidity and mortality rates were 29% and 2.2%, respectively. Mean length of hospital stay and time to resume normal diet were 11 and 4 days, respectively. CONCLUSIONS: Laparoscopic subtotal colectomy in our institute may be considered as an effective and safe method in the management of colorectal disease.

[Laparoscopic subtotal colectomy. Results from the Texas Endosurgery Institute]. / Colectomía Subtotal Laparoscópica. Resultados en el Texas Endosurgery Institute.

BACKGROUND: Laparoscopy is currently and progressively gaining acceptance for the management of colorectal disease. More bleeding and longer operating time were initially considered as contraindications to perform laparoscopic colon resections. Other obstacles were technical difficulties, the learning curve and the need for specialized instruments; however, improvements in surgical techniques and technological developments have allowed subtotal laparoscopic colectomy to be feasible. METHODS: This was a retrospective and descriptive study conducted from April 1992 to July 2006. Forty-four patients underwent laparoscopic subtotal colectomy at Texas Endosurgery Institute in San Antonio, TX. Measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Cancer, familial adenomatous polyposis and ulcerative colitis were the main surgical indications. The procedure was technically successful in 88% of patients. There were five conversions (11.3%). Mean operating time was 210 min. Morbidity and mortality rates were 29% and 2.2%, respectively. Mean length of hospital stay and time to resume normal diet were 11 and 4 days, respectively. CONCLUSIONS: Laparoscopic subtotal colectomy in our institute may be considered as an effective and safe method in the management of colorectal disease.

Esplenectomía laparoscópica: experiencia de 12 años en dos instituciones privadas / Laparoscopic splenectomy: twelve-year experience in two private institutions

Introducción: en 1991, Delaitre y colaboradores reportaron la primera esplenectomía laparoscópica exitosa. Ésta se ha convertido en el procedimiento de elección en pacientes con enfermedades hematológicas que requieren tratamiento quirúrgico. Las ventajas potenciales del abordaje laparoscópico sobre el convencional son menor estancia intrahospitalaria, retorno más rápido a la vía oral y disminución en las tasas de morbilidad y mortalidad. Material y métodos: de junio de 1993 a diciembre de 2004, 42 pacientes fueron sometidos a esplenectomía laparoscópica tanto en el Texas Endosurgery Institute como en el Hospital “San José” del Tecnológico de Monterrey. Las variables utilizadas para valorar eficacia y seguridad fueron tiempo quirúrgico, estancia intrahospitalaria, inicio de la vía oral, conversión a procedimiento abierto, morbilidad y mortalidad. Resultados: las enfermedades hematológicas representaron el diagnóstico más común. El procedimiento fue técnicamente exitoso en 95 % de los casos. Solamente hubo dos conversiones a cirugía convencional. El tiempo quirúrgico promedio fue de 120 minutos. La tasa de mortalidad fue de 2.3 % y la estancia intrahospitalaria y el inicio de la vía oral promedios, de cuatro y dos días, respectivamente. Conclusiones: nuestra serie contribuye a reafirmar que actualmente la esplenectomía laparoscópica representa un método seguro y efectivo, conservando además algunas de las ventajas de los procedimientos mínimamente invasivos.

BACKGROUND: In 1991, Delaitre et al. reported the first successful laparoscopic splenectomy. This procedure has become the best option in patients with hematological diseases and who require surgical treatment. The potential advantages of the laparoscopic approach over the conventional surgery are shorter length of hospital stay, shorter time to resume normal diet and decreased rates of morbidity and mortality. METHODS: From June 1993 to December 2004, 42 patients underwent laparoscopic splenectomy in our two surgical care centers: Texas Endosurgery Institute and Hospital San José-TEC de Monterrey. The measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Hematological diseases were the most common diagnosis. The procedure was technically successful in 95% of the patients. There were two conversions to open surgery. The mean operating time was 120 min. Mortality rate was 2.3%. The mean length of hospital stay and time to resume normal diet were 4 and 2 days, respectively. CONCLUSIONS: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method, retaining some advantages of minimally invasive techniques.

[Laparoscopic splenectomy: Twelve-year experience in two private institutions]. / Esplenectomía laparoscópica. Experiencia de 12 años en dos instituciones privadas.

BACKGROUND: In 1991, Delaitre et al. reported the first successful laparoscopic splenectomy. This procedure has become the best option in patients with hematological diseases and who require surgical treatment. The potential advantages of the laparoscopic approach over the conventional surgery are shorter length of hospital stay, shorter time to resume normal diet and decreased rates of morbidity and mortality. METHODS: From June 1993 to December 2004, 42 patients underwent laparoscopic splenectomy in our two surgical care centers: Texas Endosurgery Institute and Hospital San José-TEC de Monterrey. The measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Hematological diseases were the most common diagnosis. The procedure was technically successful in 95% of the patients. There were two conversions to open surgery. The mean operating time was 120 min. Mortality rate was 2.3%. The mean length of hospital stay and time to resume normal diet were 4 and 2 days, respectively. CONCLUSIONS: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method, retaining some advantages of minimally invasive techniques.

Laparoscopic right hemicolectomy for cancer: 11-year experience.

INTRODUCTION: Laparoscopic surgery has emerged as the gold standard for many intra-abdominal procedures. Laparoscopic colon surgery is now entering its second decade of practice, and although there are many papers focusing on surgery of the distal colon, only a few have been published regarding right sided lesion approached totally laparoscopically. OBJECTIVE: Present data collected-in a prospective manner from a single institute over an eleven year period, focusing on laparoscopic right hemicolectomy for malignancy. METHODS: Patients elected for laparoscopic right hemicolectomy for colon cancer were analyzed prospectively. From May 1991 to May 2002, 98 patients underwent attempted laparoscopic right hemicolectomy for cancer, 44 male and 54 female, with a mean age of 70.6 years, emergent and non emergent cases were included Patients who underwent a diagnostic laparoscopy and those converted immediately to open procedure were excluded from this study. RESULTS: Ninety-two patients were included in the study, eighty-two of these had a totally intracorporeal anastomosis created, and ten had an extracorporeal anastomosis performed. The mean operative time for the intracorporeal group was 136 minutes, and for the extracorporeal group was 159 minutes. The average number of lymph nodes harvested was 10.8 and the final pathologic analysis showed 26 tumors stage I, 24 stage II, 31 stage III and 17 stage IV. CONCLUSIONS: In experienced hands, laparoscopic colectomy can be performed safely and effectively for the treatment of both benign and malignant diseases of the right colon. This study reaffirms the contention that laparoscopic approach to colon cancer offers equivalent, or in some instances, greater oncologic safety when compared to the open technique.

Fascitis necrotizante postcesárea. ¿Sinergismo bacteriano o infección mixta de tejidos blandos? / Necrotizing fascitis post-cesaream section. Bacterial synergism or mixed soft tissues infection?

Recientemente se ha demostrado que la mayoría de infecciones diseminadas de la dermis, incluyendo la fascitis necrotizante, son causadas por una mezcla de bacterias que actuan sinérgicamente, tanto en estudios clínicos como experimentalmente en animales de laboratorio. El tratamiento con base en antibióticos de amplio espectro, así como la debridación temprana y extensa del tejido necrótico supervisados por un equipo multidisciplinario, han logrado disminuir la mortalidad a 10 por ciento. Se presenta el caso clínico de una paciente que desarrolló fascitis necrotizante después de una operación cesárea en ausencia de factores de riesgo. Se analizan con base en la bibliografía actual, los factores de riesgo, clasificación, etiología, diagnóstico y tratamiento