RESUMO
El envejecimiento progresivo de la población española puede incrementar el riesgo de padecer diversas patologías óseas como la osteoporosis, que junto con distintos procesos oncológicos suelen conllevar el consumo de fármacos como los bisfosfonatos.La toma de este tipo de medicamentos puede ocasionar efectos secundarios, como la osteonecrosis de los maxilares. Se presenta un caso clínico atendido en el Servicio de Prácticas Odontológicas de la Universidad de Zaragoza, donde tras la toma de bisfosfonatos apareció osteonecrosis mandibular. El abordaje de estos pacientes se realiza desde un punto de vista multidisciplinar, por lo que el manejo clínico fue realizado en coordinación con el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Miguel Servet de Zaragoza. (AU)
The progressive aging of the Spanish population may increase the risk of suffering from various bone pathologies such as osteoporosis, which together with different oncological processes usually lead to the consumption of drugs such as bisphosphonates.Taking these types of drugs can cause side effects, such as osteonecrosis of the jaws. A clinical case treated in the Dental Practice Service of the University of Saragossa is presented, where after taking bisphosphonates, osteonecrosis of the jaw appeared. These patients are approached from a multidisciplinary point of view, so the clinical management was carried out in coordination with the Oral and Maxillofacial Surgery Service of the Miguel Servet University Hospital in Saragossa. (AU)
Assuntos
Humanos , Feminino , Idoso , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Envelhecimento , Osteoporose/tratamento farmacológico , Osteoporose/diagnóstico por imagem , DifosfonatosRESUMO
Phlegmasia Caerulea Dolens is a rare complication of deep vein thrombosis. It presents with a sudden onset of pain, swelling, discoloration and arterial compromise of the affected limb. Theres usually history of prothrombotic events such as malignancy, femoral vein catheterism, antiphospholipid syndrome, recent surgery, pregnancy, etc. Left without treatment, it can evolvein to gangrene, septic shock and death. Diagnosis usually only requires clinical appreciation.Confirmation can be done with ultrasonographic studies with doppler. Treatment can be both medical and surgically based. Medical therapy can be done with heparin and elevation of the affected limb or the use of thrombolytic, whilst surgical therapy can be either venous thrombectomy or amputation. We present the case of a 57-year old smoker, diabetic, and with systemic lupus erythematosus history female patient, that goes to the emergency room with sudden left leg pain, with cyanosis and absence of distal pulses. Besides she presented with lower respiratory symptoms. Diagnosis was confirmed with ultrasound and CT pulmonary angiography was performed showing pulmonary embolism. Medical treatment was initiated with good response.
Assuntos
Humanos , Masculino , Adulto , Feminino , Trombose/classificação , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Trombose/patologiaRESUMO
Objetivos. Estudiar la variación en la pérdida de masa ósea que se produce en la columna lumbar y cadera durante los años previos a la aparición de la menopausia y durante la misma. Material y método. Análisis prospectivo de la masa ósea mediante densitometría ósea a mujeres sin medicación previa. Resultados. Estudio de 316 mujeres, el 81,6% con menopausia. Existe relación lineal negativa significativa entre la masa ósea y la menopausia en la columna lumbar y la cadera, con una fuerza de relación homogénea en la columna lumbar, siendo ésta más intensa en la cadera. Al nivel lumbar se aprecia una pérdida de hueso global del 17,6%, siendo más rápida en los 10 primeros años; en la cadera el porcentaje de pérdida es mayor. Discusión. Existe importante pérdida de masa ósea con la menopausia, mayor que la esperable sólo por la edad, más intensa en triángulo de Ward seguido del cuello, trocánter y columna lumbar; esto mismo aunque en menor intensidad ocurre en la época de la premenopausia
Objectives. To study the variation in bone loss in the lumbar spine and hip during pre- and postmenopausal periods. Material and method. Prospective analysis of the bone mass assessing the bone mineral density in women without previous medication. Results. Three hundred-sixteen women were studied, 81.6% of them were menopausal. We found a statistically significant negative linear correlation at lumbar spine and hip in all locations, with a homogenous force in lumbar spine, this being the most intense in the hip. On the lumbar level there was a decrease of 17.6% of the global bone mass, this loss being faster during the first ten years. The loss was greater in the hip. Conclusions. There is a clear loss of bone mass during the menopause, greater than that expected only due to age. The location with the most bone loss is the Ward's triangle, followed by the neck and the trocanter of the hip and the lumbar spine. The same, although on a smaller scale, was found during premenopause
Assuntos
Feminino , Idoso , Pessoa de Meia-Idade , Humanos , Osteoporose Pós-Menopausa/fisiopatologia , Densidade Óssea/fisiologia , Fatores Etários , Menopausa/fisiologia , Quadril/fisiopatologia , Coluna Vertebral/fisiopatologiaRESUMO
Children with chronic diseases have to undergo numerous and repeated painful medical procedures. Psychological interventions have produced good results in the treatment of this kind of pediatric pain and, although they have not been routinely incorporated into pediatric practice, they provide an effective complement to physical and pharmacological therapies. The present article reviews research into cognitive-behavioral treatment of the distress, pain and anxiety associated with medical procedures in pediatric oncology. We present the possible benefits of these interventions and suggest uses for cognitive-behavioral techniques when performing painful medical procedures.
Assuntos
Adaptação Psicológica , Terapia Comportamental , Neoplasias/psicologia , Manejo da Dor , Dor/psicologia , Criança , Humanos , Neoplasias/diagnóstico , Neoplasias/terapia , Dor/etiologiaRESUMO
BACKGROUND: Psychological treatments for procedural distress have shown good results in pediatric oncology and several institutions recommend their implementation to reduce the procedural distress, anxiety and pain associated with painful medical procedures. OBJECTIVES: To assess the results of a psychological intervention in the first child participating in the study "Prospective Analysis of a Psychological Program for Coping with Medical Procedures in Pediatric Oncology". METHODS: We performed a single-case study, using pain and anxiety self-reports by the child and an observational scale in a psychological intervention with the following components: Breathing exercises, imagery, reinforcement, and behavioral rehearsal. RESULTS: The psychological intervention decreased procedural distress, anticipatory anxiety and pain. The 3-year-old child was able to give pain and anxiety self-reports using appropiate tools. CONCLUSIONS: The potential benefits of this kind of intervention are discussed, and some recommendations for future research are proposed.
Assuntos
Adaptação Psicológica , Terapia Comportamental , Neoplasias/psicologia , Manejo da Dor , Dor/psicologia , Ansiedade , Pré-Escolar , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/terapia , Dor/etiologia , Medição da DorRESUMO
Los niños con enfermedades crónicas tienen que padecer numerosos y repetidos procedimientos médicos dolorosos. Las intervenciones psicológicas han conseguido buenos resultados en el tratamiento de este tipo de dolor pediátrico y resultan ser un buen complemento para las terapias físicas y farmacológicas, aunque este tipo de intervenciones no se han aplicado de manera sistemática en la práctica pediátrica. En este artículo se revisan algunos trabajos de investigación sobre el tratamiento cognitivoconductual del estrés, del dolor y de la ansiedad asociados a procedimientos médicos en la población oncológica pediátrica. Se exponen los posibles beneficios derivados de este tipo de intervenciones, además de sugerencias para la realización de procedimientos médicos dolorosos utilizando técnicas cognitivo-conductuales (AU)
Assuntos
Criança , Humanos , Terapia Comportamental , Adaptação Psicológica , Dor , NeoplasiasRESUMO
Antecedentes: Los tratamientos psicológicos para el estrés en la realización de un procedimiento han demostrado tener buenos resultados en oncología pediátrica y numerosas instituciones recomiendan su implantación para reducir el estrés procedimental, la ansiedad y el dolor del niño asociados a procedimientos médicos dolorosos. Objetivos: Valorar los resultados de la intervención psicológica en el primer niño que participa en el estudio "Análisis prospectivo de un programa psicológico para el afrontamiento de procedimientos médicos en oncología pediátrica". Métodos: Estudio de caso único, utilizando autoinformes de dolor y ansiedad y una escala observacional, de una intervención psicológica que consta de los siguientes componentes: ejercicios de respiración, imaginación emotiva, refuerzo y ensayo conductual. Resultados: El estrés procedimental, la ansiedad anticipatoria y el dolor disminuyeron con la intervención psicológica. El niño de 3 años de edad fue capaz de proporcionar autoinformes de dolor y de ansiedad anticipatoria utilizando los instrumentos apropiados. Conclusiones: Se discuten los beneficios potenciales de este tipo de intervenciones y se proponen mejoras para futuras investigaciones. (AU)
Assuntos
Pré-Escolar , Masculino , Humanos , Terapia Comportamental , Adaptação Psicológica , Dor , Medição da Dor , Ansiedade , NeoplasiasRESUMO
No disponible
Assuntos
Criança , Masculino , Humanos , Doenças da Glândula Submandibular , Cálculos das Glândulas Salivares , Remissão Espontânea , Hepatite , Anemia AplásticaRESUMO
Candida spp. colonization in neonates occurs due to vertical or horizontal transmission. Preliminary studies determined that Candida albicans is the principal agent of these infections. In order to establish nosocomial transmission, 26 Candida albicans strains isolated from patients with candidosis hospitalized during a 18-month period in 2 neonatal intensive care units (NICU) from a pediatric hospital were studied. Fourteen isolates from patients and health care workers, involved in possible outbreaks of an intensive care unit (UCI) and a NICU from another pediatric hospital were also studied. All Candida albicans strains were genotyped by Southern blot hybridization with 27A. Isolates for outbreak confirmation were also hybridized with another specific Candida albicans probe, Ca3. Hybridization patterns demonstrated horizontal transmission in all the units studied. In a NICU, transmission among 4 patients during a 10-month period could be established and in the other NICU, 3 cases of transmission among 2 patients each were demonstrated in periods of 2 to 20 days. The outbreak studies showed the same strain isolated from 2 nurses and from one patient at the NICU and at the ICU identical strains were found in 3 patients. In this study, hybridization with Ca3 in addition to 27A probe did not increase discrimination power among isolates. Genotypic analysis allows, not only, determination of transmission and persistence of strains during prolonged periods or in sporadic outbreaks, but also facilitates necessary epidemiological decisions for optimizing nosocomial fungal infection control measures.(AU)
Assuntos
Humanos , Recém-Nascido , RESEARCH SUPPORT, NON-U.S. GOVT , Candidíase/transmissão , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Candida albicans/isolamento & purificação , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Unidades de Terapia Intensiva NeonatalRESUMO
Candida spp. colonization in neonates occurs due to vertical or horizontal transmission. Preliminary studies determined that Candida albicans is the principal agent of these infections. In order to establish nosocomial transmission, 26 Candida albicans strains isolated from patients with candidosis hospitalized during a 18-month period in 2 neonatal intensive care units (NICU) from a pediatric hospital were studied. Fourteen isolates from patients and health care workers, involved in possible outbreaks of an intensive care unit (UCI) and a NICU from another pediatric hospital were also studied. All Candida albicans strains were genotyped by Southern blot hybridization with 27A. Isolates for outbreak confirmation were also hybridized with another specific Candida albicans probe, Ca3. Hybridization patterns demonstrated horizontal transmission in all the units studied. In a NICU, transmission among 4 patients during a 10-month period could be established and in the other NICU, 3 cases of transmission among 2 patients each were demonstrated in periods of 2 to 20 days. The outbreak studies showed the same strain isolated from 2 nurses and from one patient at the NICU and at the ICU identical strains were found in 3 patients. In this study, hybridization with Ca3 in addition to 27A probe did not increase discrimination power among isolates. Genotypic analysis allows, not only, determination of transmission and persistence of strains during prolonged periods or in sporadic outbreaks, but also facilitates necessary epidemiological decisions for optimizing nosocomial fungal infection control measures.
Assuntos
Humanos , Recém-Nascido , Candidíase/transmissão , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Candida albicans , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Unidades de Terapia Intensiva NeonatalRESUMO
Candida spp. colonization in neonates occurs due to vertical or horizontal transmission. Preliminary studies determined that Candida albicans is the principal agent of these infections. In order to establish nosocomial transmission, 26 Candida albicans strains isolated from patients with candidosis hospitalized during a 18-month period in 2 neonatal intensive care units (NICU) from a pediatric hospital were studied. Fourteen isolates from patients and health care workers, involved in possible outbreaks of an intensive care unit (UCI) and a NICU from another pediatric hospital were also studied. All Candida albicans strains were genotyped by Southern blot hybridization with 27A. Isolates for outbreak confirmation were also hybridized with another specific Candida albicans probe, Ca3. Hybridization patterns demonstrated horizontal transmission in all the units studied. In a NICU, transmission among 4 patients during a 10-month period could be established and in the other NICU, 3 cases of transmission among 2 patients each were demonstrated in periods of 2 to 20 days. The outbreak studies showed the same strain isolated from 2 nurses and from one patient at the NICU and at the ICU identical strains were found in 3 patients. In this study, hybridization with Ca3 in addition to 27A probe did not increase discrimination power among isolates. Genotypic analysis allows, not only, determination of transmission and persistence of strains during prolonged periods or in sporadic outbreaks, but also facilitates necessary epidemiological decisions for optimizing nosocomial fungal infection control measures.
Assuntos
Candidíase/transmissão , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Candida albicans/isolamento & purificação , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva NeonatalRESUMO
Candida spp. colonization in neonates occurs due to vertical or horizontal transmission. Preliminary studies determined that Candida albicans is the principal agent of these infections. In order to establish nosocomial transmission, 26 Candida albicans strains isolated from patients with candidosis hospitalized during a 18-month period in 2 neonatal intensive care units (NICU) from a pediatric hospital were studied. Fourteen isolates from patients and health care workers, involved in possible outbreaks of an intensive care unit (UCI) and a NICU from another pediatric hospital were also studied. All Candida albicans strains were genotyped by Southern blot hybridization with 27A. Isolates for outbreak confirmation were also hybridized with another specific Candida albicans probe, Ca3. Hybridization patterns demonstrated horizontal transmission in all the units studied. In a NICU, transmission among 4 patients during a 10-month period could be established and in the other NICU, 3 cases of transmission among 2 patients each were demonstrated in periods of 2 to 20 days. The outbreak studies showed the same strain isolated from 2 nurses and from one patient at the NICU and at the ICU identical strains were found in 3 patients. In this study, hybridization with Ca3 in addition to 27A probe did not increase discrimination power among isolates. Genotypic analysis allows, not only, determination of transmission and persistence of strains during prolonged periods or in sporadic outbreaks, but also facilitates necessary epidemiological decisions for optimizing nosocomial fungal infection control measures.
RESUMO
OBJECTIVE: To evaluate the usefulness of magnetic resonance (MR) for investigating bone involvement in Gaucher disease type 1 (GD). METHODS: Ten adult patients with the diagnosis of GD type 1 were studied. Weighted sequences were performed in spin-echo (SE) T1 and T2 of 4 body areas: spine, pelvis, hips, and femurs. The patterns of bone infiltration proposed for the study were: homogeneous infiltration (H), non-homogeneous infiltration (NH), and normality (N). Four patients were receiving enzyme replacement therapy. RESULTS: All patients (100%) showed changes associated with infiltration with Gaucher cells. The distribution of patterns was as follows: the homogeneous pattern predominated (60 and 50%, respectively) in spine (6H/2NH/2N) and pelvis (5H/3NH/2N), whereas the non-homogeneous pattern predominated (60% and 80%, respectively) in hips (1H/6NH/3N) and femurs (1H/8NH/1N). As bone complications two cases of hip avascular necrosis were noted, one of them with bilateral involvement, one case with infarcts in femur diaphysis and other case with medullar edema in a bone crisis. CONCLUSION: MR is an excellent technique for detecting medullar bone infiltration and complications in GD type 1.
Assuntos
Doenças Ósseas/diagnóstico , Doença de Gaucher/diagnóstico , Imageamento por Ressonância Magnética , Adolescente , Adulto , Idoso , Doenças Ósseas/etiologia , Doenças da Medula Óssea/diagnóstico , Doenças da Medula Óssea/etiologia , Feminino , Doença de Gaucher/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Osteonecrose/etiologiaRESUMO
In this study we report the cases of 22 pediatric patients with nodal erythema. The predominance of this condition in male patients was clear. Etiological factors were determined in 77% of the patients. In our series, the principal cause was tuberculosis (36%). We would like to point out the etiological diversity in this small series of children: streptococcal infection, gastrointestinal infection with Salmonella enteritidis or Campylobacter jejuni, cat scratch disease, infectious mononucleosis, chronic hepatitis B, Crohn's disease and pharmacological (amoxycillin). In 22% of the cases no cause was found.
Assuntos
Eritema Nodoso/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Eritema Nodoso/complicações , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologiaRESUMO
A case of oesophageal neurofibroma is reported; its low incidence among the benign tumours of the oesophagus is pointed out. The clinical, radiologic and histologic features of this very rare tumour are described.
Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Esôfago/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neurofibroma/patologia , RadiografiaRESUMO
A case of undifferentiated pancreatic carcinoma is described. The first symptoms were due to brain metastases and was then diagnosed as malignant glioma. The appearance of a sudden obstructive jaundice and pneumoperitoneum without any apparent cause led to the diagnosis of undifferentiated pancreatic carcinoma and peritoneal carcinomatosis, that was confirmed by the anatomicopathological study.