Correction of chin ptosis.

Chin ptosis is described as a descent of the soft tissue from the symphyseal region to a position under the lower contour of the mandible. Given its multifactorial causes, treatment must be determined on a patient-by-patient basis. While augmentation of the submental crease is a versatile option for the correction of chin ptosis, this only corrects the soft tissue component. A technical modification to treat dynamic chin ptosis, associated with bone reduction in the mandibular symphysis, is presented here.

Sinusitis maxilar por osteonecrosis asociada a bisfosfonatos en pacientes con cáncer de mama: serie de casos / Maxillary sinusitis associated to bisphosphonate-related osteonecrosis in patients with breast cancer: case series

Los bisfosfonatos (BF) son fármacos ampliamente utilizados como estabilizadores óseos en el tratamiento de metástasis óseas, osteoporosis, enfermedad de Paget, entre otras patologías, debido a sus efectos anti-tumorales y a la característica de inhibir la actividad osteoclástica. La osteonecrosis maxilar asociada a BF, hoy en día osteonecrosis maxilar asociada a fármacos (ONMF) es definida como la presencia de hueso expuesto, no-vascularizado y necrótico en la cavidad oral por un periodo mayor a ocho semanas, con una historia positiva de tratamiento con fármacos anti-reabsorción ósea (BP, inhibidores del ligando RANKL) y/o anti-angiogénicos y sin antecedentes de tratamiento con radiación o metástasis obvia en los maxilares. La frecuencia de ONMF es incierta. La mandíbula es más frecuentemente afectada por ONMF que el maxilar. Pocos casos de ONMF en el maxilar han sido descritos con un diagnostico de sinusitis maxilar simultáneo. Tres casos con sinusitis maxilar asociada a ONMF son presentados en este trabajo. Todos los pacientes fueron mujeres con una historia positiva de cáncer de mama y tratamiento con bisfosfonatos. Los primeros dos casos, desarrollaron ONMF después de una extracción del tercer molar maxilar. El tercer caso con ONMF en el maxilar, sólo tenía antecedentes de curetaje periodontal. Una tomografía computada fue realizada y mostró compromiso del seno maxilar en todos los pacientes. Modalidades diagnósticas para evaluar la extensión de la necrosis y el compromiso del seno, como también alternativas de tratamiento son descritas en este estudio. Finalmente, una revisión actualizada de la literatura es presentada.

Bisphosphonates are widely used as bone-stabilizers in the treatment of osseous metastases, osteoporosis, Paget's disease and others,due to their ability to inhibit osteoclast activity and anti-tumor effects. Bisphosphonate-related osteonecrosis of the jaw, nowadays medication-related osteonecrosis of the jaw (MRONJ), is defined as the presence of exposed, non-vascularized and necrotic bone tissue in the oral cavity over a period of 8 weeks with a current or previous history of treatment with antiresorptive (bisphosphonates, RANKL ligand inhibitor) and/or antiangiogenic agents, and no history of radiation therapy to the jaws or obvious metastatic disease to the jaws. The frequency of MRONJ is unclear. The mandible appears to be more frequently affected by MRONJ than the maxilla. Isolated cases of maxillary MRONJ have been described in wich a simultaneous sinusitis maxillaris was diagnosed. Three cases of MRONJ associated with maxillaris sinusitis are presented. All cases were females with a positive history of breast cancer and bisphosphonate therapy. The first two, developed MRONJ after a third molar upper extraction. The third case with MRONJ, had a history of periodontal curettage. A computed tomography was performed and showed a maxillary sinus compromise in all patients. Imaging modalities to evaluate the extent of the necrosis and the sinus compromise, as also treatment options were described in this study. Finally, an updated literature review is presented.

Musca domestica como vector mecánico de bacterias enteropatógenas en mercados y basurales de Lima y Callao / Musca domestica as a mechanic vector of enteropathogenic bacteria in markets and junkyards in Lima and Callao

Objetivos: Demostrar que la mosca doméstica (Musca domestica) es un vector mecánico de bacterias enteropatógenas en distritos de Lima y Callao. Materiales y Métodos: Estudio de tipo descriptivo transversal. Unidad de estudio: Musca domestica. Entre mayo de 2004 y julio de 2005 se realizó un muestreo en diferentes distritos de las provincias de Lima y el Callao teniendo en cuenta el índice de infestación de cada zona elegida. Se recolectaron moscas de mercados, periferia y basurales aledaños. En el laboratorio fueron procesadas en medios de cultivo para aislamientode enterobacterias y su identificación. Resultados: De un total de 780 moscas domésticas se aisló Escherichia coli enteropatógena, Salmonella typhi, Shigella flexneri y Yersinia enterocolitica. Se estableció una relación directa entre el hallazgo de bacterias enteropatógenas y las zonas de mayor grado de infestación (>20 moscas/hora de observación). Conclusión: El aislamiento de bacterias enteropatógenas en Musca domestica permitió demostrar su papel vector

Objectives: To prove that domestic fly (Musca domestica) is a mechanic vector for enteropathogenic bacteria in Lima and Callao districts. Materials and methods: Cross sectional descriptive study. Between May 2004 and July 2005 a sampling was performed in different districts in Lima and Callao, considering the infestation index in each selected area. Flies from markets, peripheral areas and surrounding junkyards were collected. The insects were later processed in the laboratory for isolation and identification of enterobacteria. Results: Out of 780 flies, enteropathogenic Escherichia coli, Salmonella typhi, Shigella flexneri, and Yersinia enterocolitica were isolated. A direct relationship between finding enteropathogenic bacteria and the areas with greatest infestation indexes (>20 flies/hour in observation). Conclusion: The isolation of enteropathogenic bacteria in Musca domestica allowed us to prove its role as a vector.

[The use of resources. Unnecessary stays in pediatric surgical services]. / Utilización de recursos. Estancias innecesarias en un servicio de cirugía infantil.

BACKGROUND: There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard. OBJECTIVE: The main aim of this work is to determine the percentage of inadequate stays in a pediatric surgery service and to identify the causes that provoke them. METHOD: It was a concurrent study in pediatric patients entered, at least 24 hours, by different disease for surgery, observation or study. Revising trained applied the pediatric version of the Appropriateness Evaluation Protocol on the medical records of these patients. It has been measured if the stay was appropriated or not, and the cause. RESULTS: The studied patients (279) caused a total of 1,001 stays of those which 373 (37.3%) were deemed to be unnecessary. The diseases with greater number of inappropriate stays were cryptorchidia (97.3%), hernia (88.9%), hypertrophic pyloric stenosis (50%), and soft tissues surgery (43.1%). A 68.2% of the unnecessary stays were responsibility of the hospital-service-surgeon, a 22.6% to the associated environment-familiar, and a 9.2% to the lack of alternative resources to the hospital. CONCLUSIONS: A meaningful proportion by day of hospital stay would be avoided. The unnecessary stays search facilitates the weak points identification on those which to develop improvement actions.

[Activity and costs of diagnosis-related groups (DRG) of neurological services at the Virgen de las Nieves Hospital of Granada]. / Actividad y costes por GRD del Servicio de Neurología del Hospital Universitario Virgen de las Nieves de Granada.

INTRODUCTION: The influence on health costs of variations in the clinical practice of doctors makes it necessary for them to be involved in the administration of resources so as to increase the efficacy, effectiveness and efficiency of clinical units. OBJECTIVES: To analyze the activity of the Neurology Department of the Virgen de las Nieves Hospital of Granada and to determine its costs per GRD. PATIENTS AND METHODS: Activity during 1996 was compared with that of the previous year and with a standard using measurements of cases, efficiency in administration of beds, quality of data and quality of care. The GRD costs of the service were found. RESULTS: Ninety percent of the discharges were grouped in 20 GRD, and GRD 014 and 015 represented 44% of the productivity. Complexity of the cases was 5% more than in 1995, similar to that of Rule IV [20]. Extreme cases led to a third of all admissions. Mortality was less than expected (3.13%). Hospital stays made up 82% of the total cost. The cost of one stay in hospital was 463.686 pesetas. CONCLUSIONS: It is essential to improve the structure and procedures related to hospital care of patients with cerebral vacular pathology. Those with uncomplicated conditions should be attended as outpatients or in smaller hospitals. The GRD costs obtained are not comparable to those of other authors. Hospital activity should be measured homogeneously and use should be made of analytical accounting systems with common operators and standardized applications so as to obtain reliable, comparable data.

Effect of policosanol on hyperlipidemia and coronary heart disease in middle-aged patients. A 14-month pilot study.

To find out the long-term lipid-lowering efficacy of policosanol in low dose and its influence in the evolution of coronary heart disease (CHD), a pilot clinical randomized single-blind, placebo-controlled trial was conducted on 23 middle-aged outpatients, with well documented diagnosis of chronic CHD and primary or marginal hyperlipidemia. Twelve patients received policosanol tablets of 1 mg twice daily, and 11 patients placebo in the same fashion, followed with rest and stress electrocardiogram (ECG), and serum lipid blood samples by 14 months. The treated group showed significant reduction of total cholesterol in 14.8% (p < or = 0.001) and of low density lipoprotein (LDL) in 15.6% (p < or = 0.05), against non significant increase of 3% and 5.5%, respectively, in the placebo group. No patient had new coronary events in both groups, but 5 of 12 treated patients exhibited a clinical tendency to improve their CHD, in comparison with no one in the placebo group (p < or = 0.05). These findings show the effectiveness of low dose of policosanol lowering total cholesterol and LDL levels and suggest a CHD improvement in middle-aged patients with primary or marginal hyperlipidemia.

Disminución del ausentismo laboral asociado a la terapia de reemplazo hormonal en mujeres postmenopáusicas / Dicrease of work absenteeism related to hormone replacement therapy in postmenopausal women

Absenteeism affects efficiency and costs of health care. Most of health workers are middle age women, whose climateric symptoms may reduce their work capacity. We studied absenteeism rates due to medical causes in 444 women of 40 years old or more, working at a public hospitalñ in Santiago during 1992. Fifty-eight percent were postmenopausal and 34.8 percent of these were receiving hormone replacement therapy. Global absenteeism rate was 17.1 days/year. These figures were 14.8 days-year for premenopausal and 17.8 days/year for the postmenopausal women (NS). Among the later, those women receiving hormone replacement therapy had a significantly lower absenteeism rate (9.4 days/year compared to 20.4 days/year among those not receiving hormones). Osteoarticular diseases were responsible for 44.3 percent and psychiatric diseases for 18.1 percent of sick leaves. No differences in absenteeism were observed between different professional levels. We conclude that hormone replacement therapy is associated with a better working capacity in postmenopausal women

Citologia general

Reimpresion 1957

Citologia general

Reimpresion 1957

Formas de presentación y procedimientos diagnósticos de Trece Hemangiomas Hepáticos

Presentamos una serie de trece pacientes diagnosticados de Hemangioma Hepático Gigante, en los últimos veinte años. La edad media de los pacientes era 48 años y nueve de ellos eran mujeres. Sólo cinco referían sintomatología de dolor abdominal. Se encontraron alteraciones de la bioquímica hepática en 8 pacientes, pero dos de ellos tenían otra hepatopatía de base sinendo el hallazgo más constante, la elevación de la fosfatasa alcalina. Hemos revisado los diferentes medios diagnósticos utilizados: Gammagrafía hepática etiquetada con sulfuro coloide de Tc99, gammgrafía hepática con hematíes marcados, ecografía abdominal, tomografía computarizada, arteriografía hepática, laparoscopia, laparotomía y biopsia hepática. Generalmente se utilizó más de uno de los mencionados medios para llegar al diagnóstico. Habiéndose observado una evolución hacia métodos menos invasivos. El diagnóstico se confirmó en todos los pacientes de la presente revisión, a excepción de uno, mediante laparotomía o laparoscopia