Acute MI in a young hypertensive woman: could it be due to tranexamic acid?

The case report illustrates an acute myocardial infarction (MI) in a 41-year-old hypertensive woman possibly because of an intake of a combination of tranexamic acid and mefenamic acid for dysmenorrhoea and menorrhagia. There are multiple case reports of MI occurring in the setting of the use of antifibrinolytic agents including tranexamic acid. The present case serves as a warning that, even in patients with an apparently low risk for arterial thrombosis, these drugs may be implicated as a precipitant of MI.

[Implant insertion in distracted bone for reconstruction after gunshot injury]. / Pose d'implants en os distracté chez les patients reconstruits après traumatisme balistique.

Distraction osteogenesis is a tissue engineering technique with two clinical applications in maxillofacial surgery: alveolar distraction and basal bone distraction. Even if it appears to be a binding and major surgery, distraction osteogenesis applied to facial bone, and especially to the mandible, has the great advantage of producing a pluritissular reconstruction of ideal quality and quantity, suitable for the ultimate goal of dental implant rehabilitation management. This technique had some drawbacks due to technical constraints related to the material. Distraction osteogenesis is well placed in the armamentarium of reconstructive surgery techniques for bone defects caused by trauma or tumor. It allows rapid restoration of adequate physiological conditions for mandibular dental implant placement. We reviewed the various modifications of this technique.

CT scan study of the mandibular nerve intra-mandibular path.

INTRODUCTION: It is mandatory to know the anatomic path of the mandibular nerve and its intra-mandibular connections for numerous odontology, stomatology, and maxillofacial surgical procedures. We present a computed tomography study of the mandibular nerve intra-mandibular path. PATIENTS AND METHOD: The computed tomography of 14 mandibles was performed (vestibulo-lingual cross-section) and four landmarks were defined behind the mental foramen. At each landmark, we measured the distance between the alveolar canal and the two cortical layers in the vestibulo-lingual plane, and the distance between the alveolar canal and the alveolar crest, and the inferior border of the mandible in the vertical plane. RESULTS: In the vestibulo-lingual plane, the mandibular nerve is located close to the vestibular cortical layer, then to the lingual cortical before it exits. In the crestal plane, it is located at the superior third of the inferior border of the mandible. DISCUSSION: In spite of anatomical variability, there is a globally common path which means that the utmost caution should be taken by performing systematic imaging before undertaking any surgery close to the nerve.

Evolution of lipid profile, liver function, and pattern of plasma fatty acids according to the type of lipid emulsion administered in parenteral nutrition in the early postoperative period after digestive surgery.

BACKGROUND: The metabolic effects of intravenous lipid emulsions (ILEs) used in parenteral nutrition (PN) depend on their fatty acid composition. METHODS: Subjects in this prospective and randomized double-blind study were 28 adult patients post digestive surgery. PN was started after surgery and lasts for 5 days. Randomly, patients receive 1 of 4 different ILEs: medium-chain triglycerides/long-chain triglycerides (soybean oil; MCT/LCT), olive/soybean oil (oleic), long-chain triglycerides (soybean oil; LCT), and structured lipid. On days 0 and 6, serum liver function tests were analyzed for cholesterol, triglycerides, lipoproteins, and serum fatty acids. RESULTS: No differences were found in the 4 groups according to their gender, age, body mass index, diagnosis, baseline white blood cell, C-reactive protein, glucose levels, and other study parameters. Differential significant changes were not observed in any of the hepatic function parameters or plasmatic lipid levels between the groups. A significant decrease was observed in cis monounsaturated fatty acids (MUFAs) and a significant increase in omega-6 polyunsaturated fatty acids (PUFAs) and omega-3 PUFA values in LCT and structured groups compared with MCT/LCT and oleic groups, and a tendency for a decrease in trans fatty acids in the oleic and structured groups was found. CONCLUSIONS: All ILEs administered were safe and well tolerated. The changes in serum fatty acids reflected the pattern of fatty acids administered with different ILEs. The group receiving the olive oil emulsion achieved a fatty acid composition of serum lipids that could offer major therapeutic or biological advantages.

Gunshot wounds: two cases of midface reconstruction by osteogenic distraction.

BACKGROUND: Reconstruction of the midface is a surgical challenge because of the aesthetic and functional implications that are characteristic of this area. METHODS: We describe two cases of reconstruction after gunshot wounds of the midface by a customized external ostegeognic device (OBL Laboratory). These two patients had mandibular reconstruction by osteogenic distraction by the same technic. RESULTS: Gunshot wounds cause considerable cutaneous, osseous and muscular damage. Reconstruction techniques have to reconstruct all those tissues. DISCUSSION: Reconstruction by osteogenic distraction allows the bone and soft tissues to be simultaneously expanded. This expansion decreases the patchwork effect of free flap reconstruction. An other advantage of reconstructing the soft tissues at the same time by osteogenic distraction is that subsequent bone grafts can be covered, reducing the risks of their exposure.

[Computed tomography study of the lower alveolar intra-mandibular nerve path]. / Etude tomodensitométrique du trajet intra-mandibulaire du nerf alvéolaire inférieur.

INTRODUCTION: It is mandatory to know the anatomic path of the lower alveolar nerve and its intramandibular connections for numerous odontology, stomatology, and maxillofacial surgeries. We present a computed tomography study of the lower alveolar nerve intramandibular path. MATERIAL AND METHOD: The computed tomography of 14 mandibles was performed (vestibulolingual cross-section) and four landmarks were defined behind the mental foramen. At each landmark we measured the distance between the alveolar canal and the two cortical layers in the vestibulolingual plane, and the distance between the alveolar canal and the alveolar crest, and the inferior border of the mandible in the vertical plane. RESULTS: In the vestibulolingual plane, the alveolar nerve is located close to the vestibular cortical layer, then to the lingual cortical before it exits. In the crestal plane, it is located at the superior third of the inferior border of the mandible. DISCUSSION: In spite of anatomical variability, there is a globally common path which must lead to the greatest caution by performing systematic imaging before any surgery close to the nerve.

Combined therapy with rituximab plus cyclophosphamide/vincristine/prednisone for Sjogren's syndrome-associated B-cell non-Hodgkin's lymphoma.

Sjogren's syndrome (SS) is characterized by an increased risk of developing non-Hodgkin's lymphoma (NHL). Optimal treatment for NHL-complicating SS is not clearly established. NHL, which expresses the CD20 antigen on tumor cell surfaces, is a disease entity candidate to treatment with anti-CD20 monoclonal antibodies. We report clinical and immunological data of a patient with SS and NHL who was treated with a regimen consisting of cyclophosphamide/vincristine/prednisone (CVP) plus rituximab. A 68-year-old women had a 26-year history of SS and autoimmune thyroiditis. The clinical course of SS was complicated with severe splenomegaly. An increased percentage of CD19+ B cells (up to 30%) was detected in peripheral blood during follow-up. Clonal rearrangement of immunoglobulin heavy chain was detected. Low-grade B marginal zone lymphoma was diagnosed (peripheral blood immunophenotype: CD19+CD20+CD23+sIg+Kappa; bone marrow immunophenotype: 25% lymphocytes; CD19+CD20+CD79A/BCL2+). She received a total of six cycles of CVP plus rituximab (375 mg/m2). Therapy was well tolerated, and B lymphocytes were depleted from the peripheral blood. Splenomegaly normalized. No evidence of neoplastic infiltration was detected in bone marrow after completion of therapy, while certain symptoms of SS (sicca and arthralgia) improved with treatment. CVP plus rituximab proved effective in a patient with SS with NHL.

Linfoma no Hodgkin difuso de células grandes B en estadios avanzados: situación del tratamiento actual y perspectivas / No disponible

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Gunshot wounds: reconstruction of the lower face by osteogenic distraction.

BACKGROUND: Although osteogenic distraction is a well-established technique, the distraction device still needs to be improved, miniaturized, and made lighter, more flexible, and more adaptable for mandibular reconstruction in adults with gunshot wounds. The authors successively used unidirectional and bidirectional devices, followed by a bone transporter with a horseshoe-shaped trammel. The trammel system was then replaced by an endless screw, and finally by a customized endless screw. METHODS: Eleven adult patients with gunshot injuries underwent mandibular reconstruction using osteogenic distraction with an external device. RESULTS: An average bone gain of 79 mm was achieved. No infectious complications were observed. The authors encountered equipment problems during the study, requiring a change of material. The mean duration of mandibular distraction was 3.5 months. CONCLUSIONS: Distraction of bone fragments facilitates the simultaneous expansion of soft tissues, avoiding free or pedicled myocutaneous flaps, for soft-tissue reconstruction. The alveolar ridge with the attached gum is also recreated by distraction, allowing dental reconstruction by osseointegrated implants.

Triglicéridos y nutrición parenteral / Triglycerides and parenteral nutrition

Una de las complicaciones metabólicas que se asocia con relativa frecuencia con la nutrición parenteral es la hipertrigliceridemia. Su etiología se relaciona con la alteración del aclaramiento plasmático de los lípidos, bien por una disminución de la actividad de la lipoproteinlipasa, bien por un aporte excesivo. Durante la utilización de la nutrición parenteral es importante conocer el umbral de triglicéridos plasmáticos a partir del cual la administración de lípidos exógenos es ineficiente desde el punto de vista metabólico o está asociado a sobrecarga grasa. Hay diversas situaciones clínicas como la sepsis, la insuficiencia renal, la pancreatitis, así como determinados fármacos, como glucocorticoides o ciclosporina, que se asocian con hipertrigliceridemia. En estos casos, cuando se instaura una pauta de nutrición parenteral, el riesgo de desarrollar hipertrigliceridemia es especialmente elevado. En el presente trabajo se revisan las distintas causas que pueden relacionarse con hipertrigliceridemia y que pueden suponer un factor de riesgo en pacientes con nutrición parenteral (AU)

Hypertriglyceridemia is a metabolic disorder frequently correlated with the use of parenteral nutrition. The etiology of hypertriglyceridemia in patients undergoing parenteral nutrition is associated with alterations in plasma lipid clearance due to an excessive supply or to a decrease in lipoprotein lipase activity. During parenteral nutrition therapy, it is important to determine the threshold plasma triglyceride level above which exogenous lipids cannot be efficiently metabolized or would be associated with lipid overload. Several clinical and metabolic situations have been related to hypertriglyceridemia, such as sepsis, renal failure, pancreatitis and the use of certain drugs such as glucocorticoids and cyclosporine. In these cases, parenteral nutrition increases the risk of developing hypertriglyceridemia. In the present article, we review some of the risk factors for hypertriglyceridemia in patients with parenteral nutrition (AU)

The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia.

AIMS: The purpose of this study was to establish the relevance of several clinical factors associated with parenteral nutrition (PN) hypertriglyceridemia and to construct a predictive model for this complication. METHOD: This multicenter study included all patients with initial serum triglyceridemia <3 mmol and receiving a minimum of 7 days' PN therapy. The study ended for each patient when hypertriglyceridemia developed or PN was terminated. Two multivariate models were constructed, one to study the clinical factors and the second to predict plasma triglyceridemia. A total of 22 clinical factors studied as independent variables were included in the multiple-step regression models only when they showed a P-value over 0.1. Statistical significance was determined by the confidence interval of the odds ratio (OR) and the partial regression coefficient (b). RESULTS: The study included 260 patients from 14 hospitals. Lipid administration was 0.83+/-0.37 g/kg/day. Among the total, 68 patients (26.2%) showed hypertriglyceridemia. Variables included in both models were serum glucose (OR, 2.63; b, 0.06), renal failure (OR, 10.56; b, 1.70), corticoid administration >0.5 mg/kg (OR, 7.98; b, 0.97), pancreatitis (OR, 4.38; b, 0.64), sepsis (OR, 4.48; b, 0.24), lipids infused (OR, 3.03; b, 0.24) and heparin administration >3 mg/kg/day (OR, 0.11; b, -1.21). CONCLUSION: Although the rate of lipid infusion was low, certain clinical factors modified triglyceridemia. Nevertheless, relatively fast plasma clearance of lipids infused indicates that a reduction in lipid supply could be a quick, effective measure for controlling hypertriglyceridemia. Thus, careful monitoring of patients with clinical factors predicting risk in the model studied, with adjustment of lipid perfusion rates accordingly, is suggested to avoid hypertriglyceridemia.

[Idiopathic cholestasis associated with progressive ductopenia in two patients with hodgkin's disease]. / Colestasis idiopática asociada a ductopenia progresiva en dos pacientes con linfoma de Hodgkin.

INTRODUCTION: Jaundice in Hodgkin's disease can be due to several causes. Ductal lesions and ductopenia, which we describe below, have rarely been reported. CASE REPORT: We describe 2 cases of idiopathic cholestasis associated with Hodgkin's disease in which duction lesions and ductopenia were found. In one case, the ductal lesion progressed to ductopenia and the patient died from complications of her oncological disease while in the second case, outcome was favorable with improvement of cholestasis and remission of Hodgkin's lymphoma. DISCUSSION: Ductopenia should be included in the differential diagnosis of cholestasis associated with Hodgkin's disease, for which a high degree of suspicion is required. Hodgkin's disease should be suspected when ductopenia is found.

[Extra-oral implants: indications and contraindications]. / Implants extra-oraux: indications et contre-indications.

Osseointegrated facial prostheses are an interesting solution for maxillofacial rehabilitation when reconstructive surgery cannot be proposed. Progress in epithesis materials and in implantation techniques have renewed interest in maxillofacial prostheses. The best indications are for rehabilitation of nasal, auricular and orbitopalpebral defects. Another indication is complex loss of facial tissue. Endo-osseous epitheses are recommended mainly when there is no possibility of reasonable and satisfactory surgical reconstruction, when local carcinologic prognosis is uncertain, and to respond to the patient's demands. We detail here the precautions necessary when irradiation has been performed previously and finally present the contraindications against epitheses on osseointegrated implants.

[Indications for extra-oral implants: strategic methods apropos of a clinical case]. / Indication des implants extra-oraux: démarche méthodologique à propos d'un cas clinique.

We report the case of a 73-year-old man with an extensive tumor of the external ear, describing the criteria that led us to use an extra-oral implant and not reconstructive surgery. Each criteria was evaluated comparatively to another option and also on the prosthesis level.

[Localized loss of facial tissue. Criteria of use of extra-oral implants and clinical cases]. / Pertes de substance faciale localisées. Critères de recours aux implants extra-oraux et cas cliniques.

Osseointegrated maxillofacial epitheses are an interesting therapeutic response for rehabilitation after loss of facial tissue when reconstructive plastic surgery cannot be proposed. We analyzed the criteria used for deciding on this type of treatment for the loss of local areas of auricular tissue, the nasal pyramid and the orbitopalpebral region, presenting individual clinical examples.

[Permanent percutaneous connections and osteointegration]. / Connexion percutanée permanente et ostéointégration.

Passage through the skin of an abutment anchored on an implant fixed on the underlying one constitutes a Permanent Percutaneous Connection of which the principal applications are stabilization of maxillofacial prosthesis (MFP) or bone anchored hearing aid (BAHA) support. The long-term outcome of a PPC depends on a variety of different parameters. We analyzed the influence of the most important factor: osseointegration.

[From the concept of permanent percutaneous connections to that of permanent percutaneous electrical connections]. / Du concept de connexion percutanée permanente à celui de connexion électrique percutanée permanente.

Percutaneous abutment of an extra-oral implant provides two main functions: support of bone anchored hearing aid (BAHA) and fixing maxillofacial prosthesis (MFP). Further developing this concept, and using available surgical strategies and materials, leads to a new application in extra-oral implantology. We analyzed the evolution of concepts in the field of permanent percutaneous connection (PPC) to the new concept of PPEC (permanent percutaneous electric connection), presenting a clinical case.