Schwanoma palatino en paciente pediátrico de 12 años: una rara presentación clínica

El schwanoma es un tumor neural que se origina en las células de Schwann presentes en la vaina nerviosa cuya localización más frecuente a nivel oral es el dorso de lengua, siendo mucho más frecuente en adultos. En población pediátrica la presentación es muy rara siendo lengua su ubicación más frecuente, mientras que a nivel palatino solo se conocen 11 reportes en menores de 16 años. El objetivo de este reporte es presentar un caso clínico inusual de schwanoma palatino en un niño chileno de 12 años de edad, quien fue derivado con diagnóstico clínico presuntivo de carcinoma mucoepidermoide. El caso se complementó con radiografía panorámica, Conebeam, y luego biopsia incisional. Finalmente, se diagnosticó schwanoma palatino variedad sólida. Es importante considerar al schwanoma como diagnóstico diferencial en casos de tumores palatinos, en especial en casos pediátricos ya que se pueden presentar similares características clínicas a tumores de glándula salival.

The Schwannoma or neurilemmoma tumor originates from Schwann cells present in nerve sheaths. At oral level, its most frequent location is at the back of the tongue, being much more frequent in adults. In the pediatric population, this occurrence is rare and most frequently found in the tongue. At palatal level, only 11 reports are known in children under 16 years of age. The aim of this report is to present an unusual clinical case of palatal schwannoma in a 12-year-old Chilean boy, referred with a clinical diagnosis of mucoepidermoid carcinoma. The case was complemented with panoramic radiography and Cone beam, for its subsequent incisional biopsy. Finally, a solid palatal schwannoma was diagnosed. It is important to consider schwannoma as a differential diagnosis in cases of palatal tumors, especially in pediatric cases, since they can present similar clinical characteristics to salivary gland tumors.

Prevalencia y morfología del segundo conducto en la raíz mesiovestibular de primeros molares superiores en base a cuatro técnicas ex vivo / Prevalence and morphology of second mesiobuccal canal in maxillary first molars based on four ex vivo techniques

Los objetivos principales del tratamiento de endodoncia no quirúrgico son la prevención y/o tratamiento de periodontitis apical junto con la resolución de signos y síntomas de las lesiones pulpares irreversibles. Debido a la compleja morfología del sistema de conductos radicular, la persistencia de un conducto no tratado puede mantener la contaminación y sintomatología pulpar y periapical. La prevalencia para MV2 reportado a nivel mundial para el primer molar superior varía ampliamente según las técnicas in vivo o ex vivo empleadas en cada estudio, es por esto que el presente trabajo tiene por objetivo evaluar la prevalencia de MV2 en primeros molares superiores en base a cuatro técnicas diagnósticas aplicadas ex vivo. Se realizó un estudio transversal observacional en 101 primeros molares superiores extraídos bajo consentimiento informado para determinar la prevalencia del conducto MV2 y su morfología en base a las técnicas de radiografía ortoradial, tomografía Cone Beam, apertura coronaria con microscopio quirúrgico (16x) y cortes radiculares axiales de aplicación ex vivo. La prevalencia encontrada para MV2 por cada técnica fue de 81,1 % para cortes radiculares y tomografía Cone Beam, 59,4 % para la apertura coronal con microscopio (16x) y 32,6 % con radiografía ortoradial. En el 3,96 % de la muestra se encontró un tercer conducto mesiovestibular en base a la técnica de corte radicular. La morfología interna del sistema de conductos radiculares fue de 36 % clase II, 19 % clase I y 16 % clase IV de Vertucci. Los resultados del presente estudio están en concordancia con lo reportado en la literatura y confirman la mayor prevalencia reportada en estudios ex vivo para esta situación. La presencia de MV2 en el primer molar superior es una condición frecuente que el endodoncista debe considerar, empleando técnicas imagenológicas y tecnologías de magnificación para asegurar el éxito terapéutico en estos dientes.

The main objectives of non-surgical endodontic treatment are the prevention and / or treatment of apical periodontitis, as well as resolving signs and symptoms of irreversible pulpal lesions. Considering the complex morphology of the root canal system, the a canal left untreated, can generate contamination, pulp and periapical symptoms. The prevalence for MV2 reported worldwide for the upper first molar, varies depending on the ex vivo or ex vivo techniques used in each study. Consequently, the present work aims to assess the prevalence of MV2 in first upper molars based on four ex vivo diagnostic techniques applied. An observational crosssectional study was performed in 101 upper first molars extracted under informed consent to determine the prevalence of the MV2 duct and its morphology based on orthoradial radiography, Cone Beam tomography, coronary opening with a surgical microscope (16x), and axial root cuts applied ex vivo. The prevalence found for MV2 by each technique was 81.1 % for root cuts and Cone Beam tomography, 59.4 % for coronal opening with a microscope (16x) and 32.6 % with orthoradial radiography. In 3.96 % of the sample, a third mesiovestibular canal was found based on the root cutting technique. The internal morphology of the root canal system was 36 % Vertucci´s class II, 19 % class I and 16 % class IV. The results of the present study coincide with that reported in the literature, and confirm the higher prevalence reported in ex vivo studies for this situation. The presence of MV2 in the upper first molar is a frequent condition that the endodontist must consider, using imaging techniques and magnification technology to ensure therapeutic success in these teeth.

Evaluation of Bias Associated with Capture Maps Derived from Nonlinear Groundwater Flow Models.

The impact of groundwater withdrawal on surface water is a concern of water users and water managers, particularly in the arid western United States. Capture maps are useful tools to spatially assess the impact of groundwater pumping on water sources (e.g., streamflow depletion) and are being used more frequently for conjunctive management of surface water and groundwater. Capture maps have been derived using linear groundwater flow models and rely on the principle of superposition to demonstrate the effects of pumping in various locations on resources of interest. However, nonlinear models are often necessary to simulate head-dependent boundary conditions and unconfined aquifers. Capture maps developed using nonlinear models with the principle of superposition may over- or underestimate capture magnitude and spatial extent. This paper presents new methods for generating capture difference maps, which assess spatial effects of model nonlinearity on capture fraction sensitivity to pumping rate, and for calculating the bias associated with capture maps. The sensitivity of capture map bias to selected parameters related to model design and conceptualization for the arid western United States is explored. This study finds that the simulation of stream continuity, pumping rates, stream incision, well proximity to capture sources, aquifer hydraulic conductivity, and groundwater evapotranspiration extinction depth substantially affect capture map bias. Capture difference maps demonstrate that regions with large capture fraction differences are indicative of greater potential capture map bias. Understanding both spatial and temporal bias in capture maps derived from nonlinear groundwater flow models improves their utility and defensibility as conjunctive-use management tools.

Association of 25-hydroxyvitamin D with metabolic syndrome in patients with psoriasis: a case-control study.

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

Palmar filiform parakeratotic hyperkeratosis: A report of 2 cases.

Palmar filiform parakeratotic hyperkeratosis (PFPH) is a rare dermatosis; hyperkeratotic lesions appear as small spines on the palms and/or soles. Palmar filiform parakeratotic hyperkeratosis has been associated with a variety of malignant tumors and endocrine disorders, although these associations have not been fully demonstrated. We report two new cases of this entity without systemic pathology associated.

Pyoderma gangrenosum in an infant.

Pyoderma gangrenosum is rare in children and very rare in infants less than 1 year of age. We report Pyoderma gangrenosum in a 6-month-old girl without any associated disorders, which was well controlled with oral prednisone. This entity in infants usually presents with multiple lesions, mainly located on the face, buttocks, thighs, and extremities, which in some instances are associated with pathergy. Pyoderma gangrenosum in infants has a good response to therapy, and healing is usually achieved.

[Genital artefact ulcers appearing simultaneously in a couple]. / Ulceras genitales artefactas de aparición simultánea en pareja.

Genital ulcers may be due to a number of causes, with the most frequent ones being of infectious, tumorous and physical etiology. The coexistence of genital lesions in a couple makes it necessary to rule out sexual transmission as a first option, as it is not always the cause. We present the case of a 78 and 73-year-old couple, both of whom presented with genital ulcers which had been developing for months and which began to manifest simultaneously. The negative results in the tests performed, the exclusion of other likely causes and the favorable evolution of the lesions suggest self-inflicted ulcers as a probable diagnosis, an infrequent form of presentation of "folie à deux". Despite its infrequent occurrence, dermatitis artefacta is a cause that should always be included in the differential diagnosis of any skin lesion, as it often goes unnoticed because of its many clinical presentations.

Úlceras genitales artefactas de aparición simultánea en pareja / Genital artefact ulcers appearing simultaneously in a couple

Las úlceras genitales pueden deberse a múltiples causas, siendo las más frecuentes las de etiología infecciosa, tumoral y física. La coexistencia de lesiones genitales en una pareja obliga a descartar como primera opción la transmisión sexual, que no siempre es la causa. Presentamos el caso de un pareja, de 78 y 73 años de edad, en la que ambos presentaban úlceras genitales de meses de evolución, que comenzaron a manifestarse de forma simultánea. La negatividad de las pruebas realizadas, la exclusión de otras causas probables y la evolución favorable de las lesiones, sugieren como diagnóstico probable úlceras autoprovocadas, tratándose de una forma de presentación poco frecuente de «locura compartida». La dermatitis artefacta, a pesar de su baja frecuencia, es una causa que siempre debemos incluir en el diagnóstico diferencial de cualquier lesión cutánea, ya que pasa muchas veces desapercibida por su gran heterogeneidad clínica

Genital ulcers may be due to a number of causes, with the most frequent ones being of infectious, tumorous and physical etiology. The coexistence of genital lesions in a couple makes it necessary to rule out sexual transmission as a first option, as it is not always the cause. We present the case of a 78 and 73-year-old couple, both of whom presented with genital ulcers which had been developing for months and which began to manifest simultaneously. The negative results in the tests performed, the exclusion of other likely causes and the favorable evolution of the lesions suggest self-inflicted ulcers as a probable diagnosis, an infrequent form of presentation of «folie à deux». Despite its infrequent occurrence, dermatitis artefacta is a cause that should always be included in the differential diagnosis of any skin lesion, as it often goes unnoticed because of its many clinical presentations

Eritema necrolítico migratorio asociado a glucagonoma / Necrolytic migratory erythema associated with glucagonoma

El glucagonoma es un raro tumor pancreático que habitualmente se asocia a un síndrome que incluye diabetes, anemia, pérdida de peso y lesiones cutáneas en forma de eritema necrolítico migratorio. Se presenta el caso de una paciente con un glucagonoma maligno tratado con cirugía y octreótida que se manifestó con lesiones cutáneas. Se revisa la fisiopatología, las otras causas de eritema necrolítico, el diagnóstico y diagnóstico diferencial y el tratamiento

Glucagonoma is a rare pancreatic tumor that isusually associated with a syndrome that includes diabetes, anemia, weight loss and skin lesions in the form of necrolyticmigratory erythema. We present the case of a patient with malignant glucagonoma treated with surgery and octreotide, which manifested with skin lesions. The discussion will review the physiopathology, other causes of necrolytic erythema, diagnosis and differential diagnosis and treatment

Nódulos y placas violáceas en escroto y muslo / Nodules and violaceous plaques on the scrotum and thigh

No disponible

[Necrolytic migratory erythema associated with glucagonoma]. / Eritema necrolítico migratorio asociado a glucagonoma.

Glucagonoma is a rare pancreatic tumor that is usually associated with a syndrome that includes diabetes, anemia, weight loss and skin lesions in the form of necrolytic migratory erythema. We present the case of a patient with malignant glucagonoma treated with surgery and octreotide, which manifested with skin lesions. The discussion will review the physiopathology, other causes of necrolytic erythema, diagnosis and differential diagnosis and treatment.

Carcinoma de células de Merkel. Presentación de seis casos / Merkel cell carcinoma. A casses series of five patients

El carcinoma de células de Merkel es una neoplasia cutánea primaria de comportamiento biológico agresivo que se localiza sobre todo en cabeza y cuello de personas de edad avanzada. Generalmente se presenta como enfermedad cutánea localizada, aunque, en determinadas ocasiones, existe evidencia de enfermedad linfática regional o bien, la existencia de metástasis a distancia en el momento del diagnóstico inicial. Se realiza un análisis retrospectivo de los 6 casos diagnosticados de carcinoma de células de Merkel en el Hospital Clínico San Cecilio de Granada en el período comprendido entre 1997-2001 (AU)

Mucinosis pápulo-nodular o síndrome de Gold, en el contexto de lupus eritematoso sistémico: a propósito de un caso y revisión de la literatura / Papulo-nodular mucinosis or Gold s syndrome in systemic lupus erythematosus: a clinical care and literature review

Las manifestaciones cutáneas del lupus son a menudo el primer signo de la enfermedad. Una de ellas, de presentación esporádica y no muy frecuente es la mucinosis pápulo-nodular o Síndrome de Gold, mucinosis primaria asociada al LES con características clínicas e histológicas bien definidas. Asimísmo se discute de su papel como marcador de afectación visceral lúpica. (AU)

A cirurgia refrativa na América latina: análise atualizada / Overview of refractive surgery in Latin America

Objetivo: avaliar o estágio atual da cirurgia refrativa na América Latina. Material e método: questionário analisando aspectos demográficos de cada país, técnicas realizadas, custo de equipamentos e preços cobrados por serviços säo estudados. Também säo analisadas as sugestöes e críticas ao estado atual da cirurgia refrativa em diferentes regiöes. Os questionários foram respondidos pelos representantes da International Society of Refractive Surgery. A data de término da pesquisa foi de 30/03/97. Resultados: Duas centenas de Excimer Lasers funcionam na América Latina. Os preços dos serviços variam de 200 a 2200 USD com variaçöes regionais. Queixas como comportamento antiético, alto preço dos equipamentos e baixo preço dos serviços se constituem nos ..