Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis.

BACKGROUND: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. MATERIAL AND METHODS: A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. RESULTS: Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. CONCLUSIONS: TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis.

Estudio experimental sobre la regeneración ósea mandibular de la rata con diferentes biomateriales / Experimental study in rats of mandibular bone regeneration with different biomaterials

Objetivo. Los defectos óseos mandibulares resultantes de infecciones,traumatismos o resecciones oncológicas, van a producir severos problemas funcionalesy/o estéticos, que van a precisar de un tratamiento complejo. Durante losúltimos años, las aportaciones al terreno de la reconstrucción ósea se han debatidoentre métodos tan dispares como la distracción ósea o la utilización de colgajos libresmicrovascularizados, pasando por un sin fin de biomateriales. El objetivo de este estudiofue comparar la formación de hueso nuevo tras la aplicación de una membranareabsorbible y dos tipos de sustitutivos óseos. Material y método. Se utilizaron 24ratas adultas macho tipo Wistar, en las que se crearon defectos circulares de 4 mmde diámetro en ambos lados de la mandíbula. Se formaron 4 grupos, un grupo controly 3 grupos experimentales. Los animales fueron sacrificados a las 3 y 6 semanasde la cirugía, realizándose un análisis radiológico e histológico. Resultados. Los defectoscontrol no mostraron formación ósea, apareciendo una reparación por tejidofibroso. La membrana de hueso utilizada de forma aislada, actuó como una barreraeficaz excluyendo los tejidos no osteogénicos, pero no se produjo reparación totaldel defecto en ningún caso. El grupo de Colloss® y membrana, mostró una regeneraciónósea completa del defecto a las 6 semanas. El grupo de NovaBone® y membrana,no mostró formación ósea, apareciendo las partículas del biomaterial ocupandoel defecto. Conclusiones. La regeneración ósea fue significativamente mayoren los defectos rellenos con Colloss® y cubiertos con la membrana de Lambone®,comparado con los otros grupos experimentales(AU)

Objective. Mandibular bone defects can occur as a resultof trauma, neoplasm, or infectious conditions. Such conditions oftenare associated with severe funtional and esthetic problems. Correctivetreatment often is complicated by limitations in tissue adaptation.The aim of this study was to compare new bone formation followingapplication of a bioabsorbable membrane and two types of bonesubstitutes. Material and method. In the present study, 24 fourmonth-old male Wistar rats were used. Standardized round throughand-through bone defects (4 mm in diameter) were made in bothmandibles and the rats were divided into four groups: one controlgroup and 3 experimental groups. Animals were killed 3 and 6 weeksafter surgery. Bone defect healing was assessed by radiologic andhistologic analysis. Results. The control defects showed no boneformation; holes were filled with fibrous connective tissue. Bonemembrane alone was an efficient barrier, excluding nonosteogenictissue. However, new bone formation underneath the membranewas incomplete. The Colloss® + membrane group showed completehealing after 6 weeks. The NovaBone® + membrane group showedno bone formation and particles appeared in the defect. Conclusions.The percentage bone regeneration was significantly better in thedefects filled with Colloss® and covered with Lambone® than theother experimental groups(AU)

Osteonecrosis de los maxilares inducida por bifosfonatos: prevención y actitud terapéutica / Bisphosphonate induced osteonecrosis of the jaws: prevention and therapeutic approach

Introducción. La osteonecrosis maxilar o mandibular por bifosfonatospuede convertirse en una epidemia debido a la amplia difusión deestos fármacos entre la población.Material y método. Se muestra un protocolo para la prevención y el tratamientode esta enfermedad. Se presentan tres casos de osteonecrosismaxilar/mandibular.Resultados. Es difícil lograr una curación completa; sin embargo es posibledetener la progresión de la enfermedad.Discusión. La cirugía y la suspensión de la terapia con bifosfonatos handemostrado poca utilidad. Los antibióticos y los enjuagues con clorhexidinason las únicas medidas eficaces.Conclusiones. Es imprescindible una planificación adecuada previa a la instauracióndel tratamiento con bifosfonatos. Ante una osteonecrosis establecida,la actitud debe ser conservadora (AU)

Introduction. Bisphosphonate-induced osteonecrosis of the jaws might reach epidemic proportions due tothe widespread use of this therapy.Materials and methods. A protocol for prevention and treatmentof this pathology is shown. Three clinical cases arereported.Results. It is quite difficult to reach restitutio ad integrum,but stopping the progress of the disease is possible.Discussion. Surgical treatment and cessation of bisphosphonatetherapy are of no use. Only antibiotics and oral chlorhexidinehave shown some benefits.Conclusions. An accurate preventive attitude is mandatoryprior to undergoing bisphosphonate therapy. If osteonecrosisof the jaws is present, management should be conservative (AU)

Estudio epidemiológico de las urgencias en cirugía oral y maxilofacial en un hospital general / Epidemiological study of oral and maxillofacial emergencies in a general hospital

Objetivo. La demanda de asistencia en los Servicios de Urgencias Hospitalarias está en constante crecimiento desde hace varias décadas y en especial en la Cirugía Maxilofacial. El objetivo de este estudio es realizar un análisis epidemiológico de las urgencias que se producen en dicha especialidad.Diseño del estudio. Estudio transversal y observacional de pacientes atendidos por Cirugía Maxilofacial en el Servicio de Urgencias del Hospital Río Hortega de Valladolid durante el año 2002. Se analizaron 1.970 pacientes y 10 variables. Resultados. Se atendieron 1.970 pacientes, de los cuales el 55,8 por ciento fueron hombres. La mayor presión asistencial se produjo en domingo (15,8 por ciento) y en el mes de junio (10,9 por ciento). El rango de edad con mayor demanda asistencial fue de los 0 a los 10 años (22,6 por ciento). La etiología más común por la que los pacientes fueron atendidos resultaron ser los accidentes (55,1 por ciento) y el grupo diagnóstico los traumatismos (55,6 por ciento). El tipo de tratamiento inmediato más frecuente fue el médico (58,5 por ciento). Fueron ingresados el 9,4 por ciento de los pacientes y revisados en consulta un 33,1 por ciento. El 90,3 por ciento de los pacientes pertenecían al área del hospital. Conclusiones. El rango de edad más frecuente de los pacientes atendidos es de 0 a 10 años y la mayoría de los pacientes que acuden a urgencias son hombres. El día con mayor presión asistencial es el domingo y el mes con mayor número de urgencias y de ingresos es junio. La etiología por la que acuden más frecuentemente a urgencias son los accidentes y la traumatología configura la patología maxilofacial con mayor demanda de atención urgente en nuestro hospital. El tratamiento más frecuente es el médico (AU)

Quiste hemático crónico orbitario / Chronic hematic cyst of the orbit

No disponible

Carcinoma de glándulas sebáceas de párpado superior

No disponible

Fístula de segundo arco branquial

No disponible

Invasive maxillary aspergillosis: report of a case and review of the literature.

A case of invasive aspergillosis of the maxillary sinus in an immunocompromised patient is presented. Aspergillosis of the paranasal sinuses is uncommon, however, its incidence has shown a marked increase in number in the recent years. It has been classified into four types: allergic, noninvasive, invasive and fulminant. Immunocompromised patients are particularly at the risk of fulminant invasive aspergillosis. Early diagnosis is essential in order to avoid the high morbidity and mortality associated with the destructive disease and to instigate treatment before irreversible conditions arise.

[Maxillary ameloblastoma: report of two cases]. / Ameloblastomas maxilares: a propósito de dos casos clínicos.

The ameloblastomas are benign odontogenic tumors locally aggressive that between 15-20% are located in the upper maxillary. The maxillary ameloblastomas have worse forecast than their mandibular homologous upon presenting greater index of postsurgery relapses and a greater percentage of malignancy. Their proximity to nasal cavity, orbit and skull base suppose a risk added by the probability of extension to these structures.

Ameloblastomas maxilares: a propósito de dos casos clínicos / Maxillary amelobastoma: report of two cases

Los ameloblastomas son tumores odontogénicos benignos localmente agresivos que entre un 15-20 por ciento se localizan en el maxilar superior. Éstos tienen peor pronóstico que sus homólogos mandibulares al presentar mayor índice de recidivas postquirúrgicas y un mayor porcentaje de malignización. Su proximidad a fosas nasales, órbita y base de cráneo les hace presentar un riesgo añadido por la probabilidad de extensión a estas estructuras (AU)

The ameloblastomas are benign odontogenic tumors locally aggressive that between 15-20% are located in the upper maxillary. The maxillary ameloblastomas have worse forecast than their mandibular homologous upon presenting greater index of postsurgery relapses and a greater percentage of malignancy. Their proximity to nasal cavity, orbit and skull base suppose a risk added by the probability of extension to these structures (AU)

Fístula cutánea parotídea de origen litiásico / Cutaneus fistulae of the parotid gland of litiasic origin

Presentamos el caso clínico de un varón de 63 años con fístula cutánea en la región parotídea izquierda secundaria a un cálculo intraparotídeo de gran tamaño. Los cálculos salivares son más frecuentes en la glándula submaxilar, y en su mayoría son de pequeño tamaño; la presencia de una fístula cutánea en su diagnóstico y tratamiento de la litiasis parotídea (AU)

[Tularemia in the differential diagnosis of cervical lymph node enlargement. An outbreak of tularemia in Castilla-León, Spain]. / La turalemia en el diagnóstico diferencial de las adenopatías cervicales. A propósito de un brote tularémico en Castilla-León.

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region.

La turalemia en el diagnóstico diferencial de las adenopatías cervicales. A proposito de un brote tularémico en Castilla-León / Tularemia in the differential diagnosis of cervical lymph node enlargernent. An outbreak of tularemia in Castilla-León, Spain

La presencia de adenopatías cervicales plantea un reto diagnóstico en la patología de cabeza y cuello. Estas pueden ser secundarias a procesos infecciosos locales o generales, a enfermedades sistémicas no infecciosas o deberse a la diseminación metastásica linfática de procesos tumorales. Entre los múltiples cuadros infecciosos que pueden desarrollar adenopatías cervicales se encuentra el de la Tularemia. Esta enfermedad, rara en nuestro medio, se ha presentado con inusitada incidencia en Castilla-León en los últimos meses de 1997, alcanzando los 136 casos diagnosticados en nuestro Hospital, de los cuales 13 desarrollaron adenopatías en la región de cabeza y cuello. El propósito de este artículo es presentar a la Turalemia como una enfermedad a tener en cuenta en el diagnóstico diferencial de las adenopatías cervicales en nuestro medio (AU)

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region (AU)

[Gold weights for the treatment of lagophthalmos caused by facial paralysis. Our experience and review of the literature]. / Pesas de oro en el tratamiento de lagoftalmos por parálisis facial. Experiencia y revisión de la literatura.

Paralysis of the orbicularis oculi muscle in patients with facial palsy can originate serious functional and esthetic problems. The implantation of a gold weight in the upper eyelid is one of the many surgical techniques that have been described for the correction of lagophthalmos in these patients. In this article we review the literature and present our experience with gold weight implantation for eyelid reanimation in patients with facial palsy. This procedure is technically simple to perform, produces good functional and cosmetic results, has a relatively low complication rate and is reversible should facial function return.

Repair of experimental mandibular defects in rats with autogenous, demineralised, frozen and fresh bone.

This prospective experimental study aimed to assess the regenerative capability of demineralised bone autografts resected and replaced orthotopically, compared with traditional fresh and deep frozen mandibular autografts in rats. In 60 adult Wistar rats, a bone defect 4 x 4 mm was created at the left ascending mandibular ramus and the removed bone was used as a fresh (n = 20), deep frozen (n = 20), or demineralised (n = 20) graft which was implanted orthotopically 2 weeks later. Ten rats in each group were killed at 2 and 6 weeks later. Outcome was measured by cellular proliferation on histological examination. The number of mesenchymal cells was significantly greater (P < 0.05) at both 2 and 6 weeks in the demineralised grafts than in the other two groups. There were no differences between the 2- and 6-week examinations of deep frozen bone, nor between the medullary and peripheral aspects. It was concluded that demineralised bony autografts cause greater osteoinduction both in the short (2 weeks) and the medium (6 weeks) term.

Oral sarcoidosis with tongue involvement.

A case of oral sarcoidosis involving the tongue and buccal region is reported in a 56-year-old woman. Intraoral presentations of sarcoidosis are uncommon, and sarcoidosis of the tongue is particularly rare. In this case the tongue lesion was asymptomatic, and unusual clinical behavior. In this article, we review the clinical manifestations, diagnostic procedures, differential diagnosis and treatments of oral sarcoidosis.

Effect of particulate porous hydroxyapatite on osteoinduction of demineralized bone autografts in experimental reconstruction of the rat mandible.

In an experimental model in the rat, a nonhealing bone defect was created in the left ascending mandibular ramus to test the effect of particulate porous hydroxyapatite (HA) on osteoinduction of demineralized bone autografts. The bone fragment removed was demineralized in HCl and used as an autograft for mandibular reconstruction. Granules of HA were added to the lingual and vestibular surfaces of the graft. The effect of this material was evaluated by determining the number of mesenchymal cells induced in the biomaterial and the central and peripheral zones of the bone graft, at 2-and 6-week intervals. The results show that the sites containing HA showed inhibition of osteoinduction by the bone matrix. In all groups, a proliferative gradient from the peripheral zone toward the center of the bone was observed. Similarly, the HA experienced a greater cellular increase in the regions in contact with the demineralized bone matrix.

Immunoregulation with methisoprinol in Sjögren's syndrome.

In this work, we studied the therapeutic clinical efficacy and the immunoregulating effect of methisoprinol in 4 cases of primary SS and one case of secondary SS. After 12 weeks of treatment, no significant clinical improvement was detected in the glandular histology, in Schirmer's test and sialography. On the other hand, we have observed the following alterations: immunological changes characterized by an increase in the total population of T-lymphocytes (OKT3), a normalization and thereby a diminution in IgM, an increase in T-helper subpopulation (OKT4) in four cases and in T-suppressor subpopulation in one case. A noticeable fact was the best immunological response of the patient showing a negative histology, a functional alteration of the parotid and a short evolution of the syndrome. These findings support the hypothesis that methisoprinol can be an efficient coadjuvant in the treatment of primary Sjögren's syndrome in early stages when there is only functional alteration but no glandular atrophy.