Quantifying the potential of morphological parameters for human dental identification: part 1-proof of concept.

In forensic identification, lack of eccentric characteristics of intact dentitions hinders correct ante-mortem/post-mortem (AM/PM) matching. It remains unclear which morphological dental parameters hold strong potential as identifiers. This study aimed to establish a method to quantify and rank the identifying potential of one (or a combination of) continuous morphological parameter(s), and to provide a proof of concept. First, a statistic was defined that quantifies the identifying potential: the mean potential set (MPS). The MPS is derived from inter-observer agreement data and it indicates the percentage of subjects in the AM reference dataset who at least need to be considered to detect the correct PM subject. This was calculated in a univariate and a multivariate setting. Second, the method was validated on maxillary first molar crowns of 82 3D-digitally scanned cast models. Standardized measurements were registered using 3D modeling software (3-Matic Medical 12.0, Materialise N.V., Leuven, Belgium): tooth depth, angles between cusps, distances between cusps, distances between the cusps, and the mesial pit. A random sample of 40 first molars was measured by a second examiner. Quantifying and ranking the parameters allowed selecting those with the strongest identifying potential. This was found for the tooth depth (1 measurement, MPS = 17.1%, ICC = 0.879) in the univariate setting, and the angles between cusps (4 measurements, MPS = 3.9%) in the multivariate setting. As expected, the multivariate approach held significantly stronger identifying potential, but more measurements were needed (i.e., more time-consuming). Our method allows quantifying and ranking the potential of dental morphological parameters as identifiers using a clear-cut statistic.

Dilemas en el manejo de glioblastoma espinal primario durante el embarazo / Dilemmas in primary spinal glioblastoma management during pregnancyi

El glioblastoma espinal primario (GBM) es una entidad clínicamente rara, con progresión rápida y resultado inevitable, a pesar de su manejo intensivo. En una mujer embarazada, esta neoplasia es particularmente grave, ya que los beneficios potenciales para la madre que ofrece el tratamiento estándar para GBM deben sopesarse frente a los riesgos para el feto. Existen pocas directrices en la literatura sobre cómo manejar a las pacientes embarazadas con tumores neuroaxiales malignos y, en opinión de los autores, no se han publicado informes hasta la fecha sobre este neoplasma específico en dicha población. Este caso clínico describe el manejo de una paciente embarazada con GBM no diagnosticado previamente, con rápida progresión intramedular, a la que se realizó cesárea electiva para permitir el inicio de tratamiento oncológico. Debatimos los dilemas a los que se enfrentan los anestesistas, con esperanza de aportar directrices ante las futuras decisiones y de optimizar los resultados

Primary spinal glioblastoma (GBM) is a clinically rare entity with rapid progression and a dismal outcome despite aggressive treatment. In a pregnant woman, this malignancy is particularly dramatic because the potential benefits to the mother offered by standard GBM treatment must be balanced against the risks to the fetus. There is little guidance in the literature on how to manage pregnant patients with malignant neuraxial tumours and, to the authors' knowledge, no reports have been published so far regarding this specific neoplasm in such population. This case report describes the management of a pregnant patient with a previously undiagnosed and rapidly progressive intramedullary GBM submitted to an elective caesarean delivery to allow subsequent onset of oncological treatment. Dilemmas faced by anaesthetists are discussed in hope to provide guidance for future decisions and optimize outcomes

Dilemmas in primary spinal glioblastoma management during pregnancy. / Dilemas en el manejo de glioblastoma espinal primario durante el embarazo.

Primary spinal glioblastoma (GBM) is a clinically rare entity with rapid progression and a dismal outcome despite aggressive treatment. In a pregnant woman, this malignancy is particularly dramatic because the potential benefits to the mother offered by standard GBM treatment must be balanced against the risks to the fetus. There is little guidance in the literature on how to manage pregnant patients with malignant neuraxial tumours and, to the authors' knowledge, no reports have been published so far regarding this specific neoplasm in such population. This case report describes the management of a pregnant patient with a previously undiagnosed and rapidly progressive intramedullary GBM submitted to an elective caesarean delivery to allow subsequent onset of oncological treatment. Dilemmas faced by anaesthetists are discussed in hope to provide guidance for future decisions and optimize outcomes.

Phaeohyphomycosis due to Cladosporium cladosporioides.

Phaeohyphomycosis is a clinical entity caused by dematiaceous fungi. We describe a clinical case of phaeohyphomycosis due to Cladosporium cladosporioides in a 45-year-old white male, apparently healthy, human immunodeficiency virus-negative. The patient was treated with terbinafine for 9 months, with regression of a skin lesion. Three months after discontinuation of the therapy, there was a clinical and mycological relapse. After progression of the disease with inadequate treatment, there was no response to amphotericin B and flucytosine. Finally, we obtained a clinical response with itraconazole oral solution at 600 mg day(-1) for a 6-month period.

[Hematuria]. / Hematúria.

Patients referred for hematuria work-up are frequently seen in the urologic practice. The initial evaluation does not require the participation of a urologist or nephrologist, due to the false sense of security in the evaluation of an asymptomatic and persistent hematuria. In fact, an adequate history and physical followed by urinalysis and radiologic tests, such as IVP and ultrasonography, must be made in the initial evaluation to exclude any serious urologic/nephrologic disease.

[Pelvic lipomatosis]. / Lipomatosis pélvica.

Pelvian lipomatosis is a proliferative process of fatty tissue in the perivesical and perirectal pelvian space. The etiology is unknown and some authors consider that in reality is a localized form of obesity. Diagnosis can be incidental, or be part of a sequence within a study for unspecific symptoms such as pelvian complains or perineal problems. As part of the presentation of a clinical case report, the authors make a revision of this disease, focusing in several particular aspects, like diagnostic methods, treatment, etc.

[Changes in lung function after cholecystectomy--open versus laparoscopic cholecystectomy]. / Veränderungen der Lungenfunktion nach Cholezystektomie--Offene versus laparoskopische Cholezystektomie.

Impairment of respiratory function after open cholecystectomy may cause atelectasis and hypoxemia. Clinical experience shows evidence for easier recovery after laparoscopic operation. Postoperative respiratory function using spirometric tests was assessed in 50 patients with simple symptomatic cholecystolithiasis submitted either to open or laparoscopic cholecystectomy and revealed less impairment of respiratory function in the laparoscopic group.

Pulmonary function after laparoscopic cholecystectomy in the elderly.

The results of laparoscopic cholecystectomy in a group of 52 patients older than 69 years (group 1) were compared with the results of the same operation in a group of 338 younger patients (group 2). In group 1, 23 per cent of patients had acute cholecystitis and 13 per cent were operated on after an episode of acute pancreatitis. In group 2, 8 per cent of patients had acute cholecystitis and 4 per cent were operated on after acute pancreatitis. Pulmonary function was assessed prospectively before operation, 24 h after surgery and on the seventh day after operation, in 20 patients in group 1 and 30 in group 2. In group 1 there was one death (2 per cent); the morbidity rate was 14 per cent and conversion to laparotomy was required in 15 per cent. In group 2 there were no deaths, the morbidity rate was 11 per cent and the conversion rate 4 per cent. No significant differences were found between the two groups in mortality and morbidity rates. Preoperative values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were significantly lower in group 1 than in group 2 (P < 0.05); the values of FVC, FEV1 and forced expiratory flow at 50 per cent 24 h after surgery were less depressed in group 1 (P < 0.01) and also recovered more quickly in these patients 7 days after operation. Laparoscopic cholecystectomy gives excellent results in geriatric patients and can be recommended as the treatment of choice for symptomatic cholelithiasis in the elderly.

[Prophylaxis of postoperative thromboembolism. Randomized prospective study]. / Profilaxia da tromboembolia pós-operatória. Estudo prospectivo randomizado.

The difference between a non fractioned heparin (Liquemine) and another of low molecular weight (Fraxiparine) was compared through: hemostasis difficulties, during and after surgery; the use of transfusions; clinical signs of inferior limb vein thrombosis or pulmonary emboli; laboratory results of blood (hemogramme, biochemistry, coagulation) and urine. The results observed in 500 patients, (250 of each heparin) statistically treated, show that no difference was found between the two groups of patients, which lead us to conclude that both heparins have the same effect. Low molecular weight has the advantage of being administrated only once a day.

[Acute pancreatitis. An analysis of 91 consecutive cases (1988-1991) with a brief review of the literature)]. / Pancreatite aguda. Análise de 91 casos consecutivos (1988-1991) com breve revisão da literatura.

Acute pancreatitis (AP) remains a subject of great controversy from the standpoint of its aetiology, pathogeny and treatment. We present a study of 91 patients with AP consecutively admitted to a surgical ward. 50 Women and 41 men with a mean age of 59 +/- 19 years were treated. The aetiology of AP was attributed to gallstones in 54 patients, alcohol in 22, ERPC and trauma; in 14 patients the aetiology was considered idiopathic. The most frequent signs and symptoms were pain, vomiting, abdominal tenderness, jaundice and fever. The mean number of Ranson's prognostic criteria was 3 +/- 1.5 and 29 patients (31%) had more than three. Initial management was conservative in 84 patients (92.3%) and seven were operated on admission (acute abdomen in four, septic shock in two and common duct obstruction in another). Mortality rate was 11% (n = 10) and in 24 patients (26.3%) there were complications of AP. Most of the patients (80%) began oral feeding a week after admission. The mean number of Ranson's criteria of patients deceased was 5.4 +/- 1.6 and of those who survived was 2.8 +/- 1.3 (p < 0.001). Follow-up of patients allowed us to see that in five (5.5%) there was a relapse of AP.

Metabolic responses to cholecystectomy: open vs. laparoscopic approach.

Laparoscopic cholecystectomy is considered a minor surgical procedure. In a prospective, randomized study, we compared the metabolic responses to surgery in two groups of patients submitted to open or laparoscopic cholecystectomy. The aim of the study was to verify if the latter caused less metabolic changes. Blood samples were drawn before the operation (basal), 1 h and 2 h after skin incision, and on the first and second postoperative days. The following parameters were studied: cortisol, renin, and leukocytes, including subpopulations. The mean values for age, weight, height, basal neutrophil and lymphocyte counts, basal values of cortisol and renin of patients, and sex distribution of group 1 patients (open, n = 20) matched with those for group 2 (laparoscopic, n = 20), with the exception of age (p < 0.05). No differences were detected between the two groups in terms of cortisol and renin values. However, the neutrophil count 1 h after skin incision was statistically significantly higher with the laparoscopic approach (p < 0.05). The lymphocyte count on the second postoperative day was also statistically significantly higher in group 2 (p < 0.05). We conclude that when a cholecystectomy is performed, the laparoscopic approach has no advantage over the open approach from the standpoint of the metabolic responses we studied. It appears that leukocytes have a more rapid return to normal values after laparoscopic cholecystectomy. Although pneumoperitoneum is known to be responsible for important cardiorespiratory changes, no worse response was found in the laparoscopic group than in the open group.

[Esophageal perforations]. / Perfurações do esófago.

The opportunity of having successfully treated a patient with intrathoracic perforation of the Oesophagus and many surgical complications, led us to review the literature on the subject. We then discussed the advantages and disadvantages of the various technical options, concluding that immediate Oesophagectomy is the best solution for this type of perforation, with several hours of evolution and serious mediastinite, to reduce surgical complications and mortality.