Abordaje Transoral para la Extracción de un Diente Supernumerario Intranasal. Presentación de un Caso y Revisión de la Literatura

RESUMEN: El diente supernumerario de ubicación nasal es una patología de baja prevalencia en la población con diferentes formas y sintomatología clínica. Es importante establecer un diagnóstico respecto a sus características clínicas y radiológicas para realizar una planificación de tratamiento quirúrgica adecuada, con nula o escasas complicaciones post intervención. Presentación del caso: En el presente estudio se reporta el caso de un niño de 10 años de edad, sin antecedentes mórbidos, que recurre al servicio por presentar un diente supernumerario en la línea media hallado radiográficamente. El CBCT demuestra un mesiodens en el septum nasal, palatal inclinado e invertido, parcialmente erupcionado cubierto por mucosa nasal, con su corona en sentido a la cavidad nasal en relación a las fosas nasales. El diente fue extraído con anestesia general mediante un abordaje transoral a través de una vestibulotomía. El diente supernumerario nasal es una patología poco prevalente. Es importante conocer sus características clínicas y radiográficas ya que determinarán el tipo de abordaje a realizar. El grado de erupción, la distancia a la espina nasal anterior y su sintomatología asociada son fundamentales para determinar si el abordaje quirúrgico es intraoral o extraoral.

ABSTRACT: The supernumerary tooth of nasal location is a pathology of low prevalence in the population with different forms and clinical symptoms. It is important to establish a diagnosis regarding its clinical and radiological characteristics in order to carry out adequate surgical treatment planning, with few or no post-intervention complications. Case presentation: This study reports the case of a 10-year-old boy, with no morbid history, who presented a supernumerary tooth, found radiographically in the midline. CBCT showed a mesiodens in the nasal septum, tilted and inverted palatal, partially erupted covered by nasal mucosa, with its crown facing the nasal cavity in relation to the nostrils. The tooth was extracted under general anesthesia using a transoral approach through a vestibulotomy. The nasal supernumerary tooth is a rare pathology. It is important to know its clinical and radiographic characteristics since they will determine the type of approach to be used. The degree of eruption, the distance to the anterior nasal spine and its associated symptoms are essential to determine whether the surgical approach is intraoral or extraoral.

Cost-effectiveness of Cladribine Tablets and fingolimod in the treatment of relapsing multiple sclerosis with high disease activity in Spain.

OBJECTIVE: To estimate the cost-effectiveness of Cladribine Tablets in the treatment of relapsing multiple sclerosis (RMS) with high disease activity compared with fingolimod, from the perspective of the National Health System (NHS) in Spain. METHODS: A Markov model was developed. The annual transition probabilities, were adjusted to patients with RMS with high disease activity. The effect of the treatments compared on the Expanded Disability Status Scale (EDSS) was modeled by hazard ratios for the confirmed progression of disability. The annual relapse rate and the probability of suffering adverse reactions were obtained from a meta-analysis and the literature. The derived costs were calculated from Spanish unit costs. The utilities were obtained from the CLARITY clinical trial and the literature. Deterministic and probabilistic sensitivity analyzes were performed. RESULTS: Cladribine tablets was the dominant treatment: lower costs (-86,536 €) and more effective (+1.11 quality-adjusted life years - QALYs) compared to fingolimod. The probability that Cladribine Tablets was cost-effective compared to fingolimod ranged between 94.6% and 96.1% for willingness to pay from € 20,000 to € 30,000 per QALY gained. CONCLUSIONS: Cladribine Tablets is a cost-effective treatment, compared to fingolimod, for the treatment of RMS with high disease activity. EXPERT OPINION: According to the present study, compared to fingolimod, treatment with Cladribine Tablets of relapsing multiple sclerosis with high disease activity is an option that could generate savings for the Spanish National Health System, with a considerable gain in QALYs. Cladribine Tablets is considered cost-effective and dominant (less costs and more effectiveness) than fingolimod treatment option in this population.

Safety of elective laparoscopic cholecystectomy in patients on dialysis: an analysis of the ACS NSQIP database.

BACKGROUND: Laparoscopic cholecystectomy (LC) remains one of the most frequently performed surgical procedures. The safety of LC in patients with renal disease is unclear. The postoperative outcomes of elective LC in patients on dialysis were studied and risk factors associated with longer length of stay and mortality were sought. METHODS: Patients who underwent LC between the dates of 1 January 2007 and 31 December 2010 at all hospitals in North America participating in the American College of Surgeons National Surgical Quality Improvement Project were reviewed. Data from 80,995 patients were collected, and the patients on dialysis (N = 512) were separated and compared with those of patients not on dialysis (N = 80,483). RESULTS: Postoperative complications for patients on and not on dialysis, respectively, included mortality (4.1 vs. 0.2%, p < 0.001), myocardial infarction (0.8 vs. 0.1%, p = 0.002), pneumonia (2.3 vs. 0.4%, p < 0.001), sepsis (3.1 vs. 0.4%, p < 0.001), and return to operating room (4.3 vs. 1.0%, p < 0.001). In patients on dialysis, multivariate analysis was used to identify risk factors, including congestive heart failure and prior cardiac surgery as significant independent predictors of longer length of stay and mortality. CONCLUSION: Patients on dialysis who undergo LC should be carefully selected due to the significantly higher complication and mortality rate. Several predictors of longer length of stay and mortality were identified that can determine which patients on dialysis are good candidates for LC.

The methyl ester of rosuvastatin elicited an endothelium-independent and 3-hydroxy-3-methylglutaryl coenzyme A reductase-independent relaxant effect in rat aorta

The relaxant effect of the methyl ester of rosuvastatin was evaluated on aortic rings from male Wistar rats (250-300 g, 6 rats for each experimental group) with and without endothelium precontracted with 1.0 µM phenylephrine. The methyl ester presented a slightly greater potency than rosuvastatin in relaxing aortic rings, with log IC50 values of -6.88 and -6.07 M, respectively. Unlike rosuvastatin, the effect of its methyl ester was endothelium-independent. Pretreatment with 10 µM indomethacin did not inhibit, and pretreatment with 1 mM mevalonate only modestly inhibited the relaxant effect of the methyl ester. Nω-nitro-L-arginine methyl ester (L-NAME, 10 µM), the selective nitric oxide-2 (NO-2) inhibitor 1400 W (10 µM), tetraethylammonium (TEA, 10 mM), and cycloheximide (10 µM) partially inhibited the relaxant effect of the methyl ester on endothelium-denuded aortic rings. However, the combination of TEA plus either L-NAME or cycloheximide completely inhibited the relaxant effect. Inducible NO synthase (NOS-2) was only present in endothelium-denuded aortic rings, as demonstrated by immunoblot with methyl ester-treated rings. In conclusion, whereas rosuvastatin was associated with a relaxant effect dependent on endothelium and hydroxymethylglutaryl coenzyme A reductase in rat aorta, the methyl ester of rosuvastatin exhibited an endothelium-independent and only slightly hydroxymethylglutaryl coenzyme A reductase-dependent relaxant effect. Both NO produced by NOS-2 and K+ channels are involved in the relaxant effect of the methyl ester of rosuvastatin.

The methyl ester of rosuvastatin elicited an endothelium-independent and 3-hydroxy-3-methylglutaryl coenzyme A reductase-independent relaxant effect in rat aorta.

The relaxant effect of the methyl ester of rosuvastatin was evaluated on aortic rings from male Wistar rats (250-300 g, 6 rats for each experimental group) with and without endothelium precontracted with 1.0 µM phenylephrine. The methyl ester presented a slightly greater potency than rosuvastatin in relaxing aortic rings, with log IC50 values of -6.88 and -6.07 M, respectively. Unlike rosuvastatin, the effect of its methyl ester was endothelium-independent. Pretreatment with 10 µM indomethacin did not inhibit, and pretreatment with 1 mM mevalonate only modestly inhibited the relaxant effect of the methyl ester. Nω-nitro-L-arginine methyl ester (L-NAME, 10 µM), the selective nitric oxide-2 (NO-2) inhibitor 1400 W (10 µM), tetraethylammonium (TEA, 10 mM), and cycloheximide (10 µM) partially inhibited the relaxant effect of the methyl ester on endothelium-denuded aortic rings. However, the combination of TEA plus either L-NAME or cycloheximide completely inhibited the relaxant effect. Inducible NO synthase (NOS-2) was only present in endothelium-denuded aortic rings, as demonstrated by immunoblot with methyl ester-treated rings. In conclusion, whereas rosuvastatin was associated with a relaxant effect dependent on endothelium and hydroxymethylglutaryl coenzyme A reductase in rat aorta, the methyl ester of rosuvastatin exhibited an endothelium-independent and only slightly hydroxymethylglutaryl coenzyme A reductase-dependent relaxant effect. Both NO produced by NOS-2 and K+ channels are involved in the relaxant effect of the methyl ester of rosuvastatin.

Detection of Candida albicans in blood by PCR in a rabbit animal model of disseminated candidiasis.

A model of acute disseminated Candida albicans infection in New Zealand rabbits was developed to determine the sensitivity and accuracy of polymerase chain reaction (PCR) assay compared with the lysis-centrifugation blood culture method. Primers used amplify a DNA fragment from the multicopy gene coding for the small subunit rRNA, highly conserved in fungi. The sensitivity of PCR achieved in rabbit blood samples spiked with Candida albicans was 10-50 CFU/100 microL. A nested-PCR increased the limit of detection 10-fold. The sensitivity achieved exclusively with the lysis-centrifugation method (37.5%) was higher than that obtained with PCR (25%), but lower than nested PCR (52.5%). The combination of both techniques, lysis-centrifugation and nested PCR, increased the overall sensitivity rate to 62.5%. These results have demonstrated that, globally, the nested PCR was more sensitive than both single PCR and lysis-centrifugation culture in detecting C. albicans in blood from immunecompetent rabbits with acute disseminated candidosis. PCR could be a useful complementary technique to traditional methods in the early diagnosis of candidemia.

Mitral valve replacement under video assistance through a minithoracotomy.

Minimally invasive techniques for mitral valve replacement offer an alternative for selected patients. In this report we present a woman with recurrent mitral valve stenosis, after mitral valve repair 10 years ago, who underwent mitral valve replacement through a minithoracotomy using stereo video assistance in combination with direct vision.

Correlation between in vitro resistance to fluconazole and clinical outcome of oropharyngeal candidiasis in HIV-infected patients.

Fifty episodes of oropharyngeal candidiasis in HIV-infected patients were analyzed prospectively in order to evaluate the clinical response to fluconazole. The minimum inhibitory concentrations (MICs) of fluconazole for the Candida strains isolated from the pharynx were correlated with the clinical response. Treatment with fluconazole (100 mg/day) was successful in 86% of the cases. A good clinical outcome followed in 97% of the cases when a strain sensitive to fluconazole was isolated. This figure fell to 22% when the strain was resistant to fluconazole (p < 0.001). The rate of post-treatment colonization was high (87%), and selection of non-albicans Candida species occurred in 23% of the cases. In conclusion, fluconazole treatment for oropharyngeal candidiasis of HIV-infected patients was useful in most cases, but less sensitive non-albicans species can be selected. Most treatment failures were associated with increased MICs of fluconazole for the strains isolated before treatment; therefore, susceptibility testing is recommended as an aid in clinical decision-making for the use of the azole group of drugs.

Detection of pathogenic fungi in human blood by the polymerase chain reaction.

The ability of the polymerase chain reaction (PCR) to detect pathogenic fungi in human blood was investigated. A DNA fragment of about 300 bp from the 18S rDNA, highly conserved in all fungi, was amplified with target DNA from 18 different species of fungi commonly isolated from clinical samples. The presence of PCR products was confirmed by hybridization with a fluorescein-labelled internal probe (21-mer). The PCR assay described is sensitive enough to detect 125 fg of purified Candida albicans DNA and 10 to 100 yeast cells per millilitre of blood.

Improved method of determining the susceptibility of Candida albicans to fluconazole.

The MICs of fluconazole for four reference strains of Candida albicans were determined in one laboratory by the macrobroth dilution method recommended by the National Committee for Clinical Laboratory Standards (NCCLS) and by a modified version of the method which incorporated microbroth dilution, RPMI 1640 medium supplemented with glucose and the reading of MIC endpoints by spectrophotometry. The results obtained by the two methods were within one two-fold dilution. In addition, the susceptibilities of 58 clinical isolates of C. albicans to fluconazole were determined in two laboratories by the modified NCCLS method. Close interlaboratory agreement was observed, 98.2% of MICs varying by no more than one two-fold dilution.

[Primary choriocarcinoma of the bladder. A case report with immunohistochemical and ultrastructural study]. / Coriocarcinoma primario de vejiga urinaria. Aportación de un caso con estudio inmunohistoquímico y ultraestructural.

Some tumors frequently encountered in other organs and usually with a high grade of malignancy and a poor prognosis have been recently described in the urinary bladder, very often in close relationship with a pre-existing transitional cell carcinoma. Of these, primary choriocarcinoma of the urinary bladder is one of the most uncommon and its histogenesis much discussed. It is important to identify this tumor type, since a change in the oncologic treatment may be warranted. We report an additional case of this rare bladder tumor with clinicopathologic study and discuss the histogenetic and therapeutic aspects.

Spontaneous bacterial peritonitis caused by Listeria monocytogenes: two case reports and literature review.

Two new cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes are reported. Listeria monocytogenes was recovered from the ascitic fluid but not from the blood cultures of two adult diabetic inpatients with hepatic cirrhosis and SBP that had been treated empirically with cefotaxime. These two cases add to the 17 cases of Listeria monocytogenes SBP reported previously, stressing the relevance of this microorganism to this clinical condition. The recovery of Listeria monocytogenes from blood has been achieved in only half of the cases reported, suggesting the possibility of a direct translocation mechanism. Combinations of amino- or ureidopenicillins with beta-lactamase inhibitors or carbapenems might be more effective as empiric therapy of SBP in cirrhotic patients.

[Signet ring cell adenocarcinoma of the bladder]. / Adenocarcinoma vesical de células en anillo de sello.

A case of primary signet-ring cell adenocarcinoma of the urinary bladder is described. The etiopathogenesis, pathological and clinical features, prognosis and treatment of this tumor type are discussed and the literature reviewed.