Lack of IgG antibody seropositivity to Borrelia burgdorferi in patients with Parry-Romberg syndrome and linear morphea en coup de sabre in Mexico.

BACKGROUND: Progressive hemifacial atrophy or Parry-Romberg Syndrome (PRS) is a rare, acquired, progressive dysplasia of subcutaneous tissue and bone characterized by unilateral facial involvement. Its etiology is unknown, but theories about its pathogenesis include infectious, degenerative, autoimmune, and traumatic causes among others. The causal relationship of PRS and linear morphea en coup de sabre (LMCS) with Borrelia burgdorferi infection remains controversial. Our goal was to serologically determine anti-B. burgdorferi antibodies in patients diagnosed with PRS and LMCS to establish a possible association as a causative agent. METHODS: We conducted a serology study with patients belonging to a group of 21 individuals diagnosed with PRS, six with LMCS, and 21 matched controls. Anti-Borrelia IgG antibodies were determined by ELISA. A descriptive statistical analysis and Fischer's exact test were done. RESULTS: In serological tests, only two cases had borderline values and were further analyzed by Western blot with non-confirmatory results. For both the PRS and LMCS group, the association test was not significant, suggesting a lack of association between PRS or LMCS and the presence of anti-Borrelia antibodies. CONCLUSION: In Mexico there are no previous studies on Borrelia infection and its relationship between PRS or LMCS. Our result showed a lack of association of either clinical entities with anti-Borrelia-antibodies. Former reports of this association may suggest coincidental findings without causal relationship.

[Jejunal intussusceptions as a lead point ectopic pancreatic tissue in a 1-year-old male. Case report]. / Invaginación yeyuno-yeyunal secundaria a tejido pancreático ectópico en un lactante de un año de edad. Reporte de caso.

BACKGROUND: intussusception is the most common cause of acute bowel obstruction in infants and young children. Incidence has been reported as 1.5 to 4 cases per 1,000 live births. Most intussusceptions are ileocecocolic; jejunal intussusceptions in children is extremely rare. CLINICAL CASE: a 1-year-old male was admitted to the emergency department with diarrheal evacuations, without mucus or blood, crying and irritable. Previously he had melaena in one occasion. The abdomen was found soft and depressible and low pain. He was treated with ceftriaxone, omeprazole and metoclopramide. Two days after admission he had melaena and rectal bleeding. Plain abdominal radiography showed air fluid levels. Abdominal surgery was performed finding jejunal intussusceptions which were reduced. Demonstrable lesion as a lead point was a small tumor that was removed. The pathologist's report showed pancreatic islets cells. CONCLUSIONS: jejunal intussusceptions in children are extremely rare and occur at any age. Main symptoms are intermittent abdominal pain and vomiting. Ultrasonography is the study of choice. Often a lesion is demonstrable as a lead point for the intussusceptions and therefore requires open or laparoscopic surgery. In this case, it was unusual to have the presence of ectopic pancreatic tissue as a lead point.

Congenital stenosis of the colon with foreign bodies. Case report.

BACKGROUND: Colonic stenosis is rarely seen in pediatric practice. Its incidence has been reported as 1/40,000 births. Ascending and transverse colon are the most common sites affected. Symptoms may be present at birth. CLINICAL CASE: We present the case of a 2 year, 11 month old male. Since birth, the patient had symptoms of constipation, abdominal pain and abdominal distension. X-ray of the abdomen showed a dilated colon and foreign bodies on the right side. Barium enema was normal. The stenotic segment was resected. Foreign bodies were removed and alimentary continuity was restored by end-to-end anastomosis. The pathologist found a 5-cm lumen at the stenosis. Histological ganglion cells were present throughout the specimen. The patient evolved favorably postoperatively and was discharged 1 week after surgery. The patient has been in good health for 2 years. CONCLUSIONS: Colonic stenosis is uncommon. Abu-Judeh reported on one case and a review of the literature revealed eight cases of congenital colonic stenosis since 1941. Symptoms are abdominal distension, vomiting and constipation with symptom remission, making diagnosis difficult. This is the first report involving foreign bodies. Barium enema and colonoscopy are necessary for diagnosis. Resection of the stenotic segment with end-to-end anastomosis or colostomy is the treatment of choice. Laparoscopy is an alternative procedure.

Estenosis congénita de colon con retención de cuerpos extraños: informe de un caso / Congenital stenosis of the colon with foreign bodies: case report

Introducción: La estenosis del colon es rara, con una incidencia de uno entre 40 mil nacimientos. El colon ascendente y transverso son los más afectados. Las manifestaciones clínicas pueden aparecer desde el nacimiento. Caso clínico: Niño de dos años 11 meses de edad, con cuadros periódicos de estreñimiento, dolor tipo cólico y distensión abdominal. La radiografía simple de abdomen mostró dilatación de asas y cuerpos extraños. El colon por enema fue normal. Por laparotomía exploradora se identificó estenosis en el colon transverso. Se practicó resección, extracción de cuerpos extraños y anastomosis término-terminal. El examen histopatológico mostró estenosis con lumen de 0.5 cm; las células ganglionares estuvieron presentes entre las capas musculares. A dos años de la cirugía, el paciente se encontraba asintomático. Conclusiones: La estenosis congénita de colon es poco frecuente. Abdu-Judeh informa un caso y refiere ocho descritos desde 1941. Las manifestaciones clínicas son estreñimiento, vómito y distensión abdominal, sin embargo, los pacientes pueden permanecer asintomáticos por periodos variables, lo que dificulta y retrasa el diagnóstico. No existe informe previo acerca de la retención de cuerpos extraños. El colon por enema y la colonoscopia son necesarios para el diagnóstico oportuno. El tratamiento electivo es la resección quirúrgica con anastomosis primaria o colostomía; una opción es la cirugía laparoscópica.

BACKGROUND: Colonic stenosis is rarely seen in pediatric practice. Its incidence has been reported as 1/40,000 births. Ascending and transverse colon are the most common sites affected. Symptoms may be present at birth. CLINICAL CASE: We present the case of a 2 year, 11 month old male. Since birth, the patient had symptoms of constipation, abdominal pain and abdominal distension. X-ray of the abdomen showed a dilated colon and foreign bodies on the right side. Barium enema was normal. The stenotic segment was resected. Foreign bodies were removed and alimentary continuity was restored by end-to-end anastomosis. The pathologist found a 5-cm lumen at the stenosis. Histological ganglion cells were present throughout the specimen. The patient evolved favorably postoperatively and was discharged 1 week after surgery. The patient has been in good health for 2 years. CONCLUSIONS: Colonic stenosis is uncommon. Abu-Judeh reported on one case and a review of the literature revealed eight cases of congenital colonic stenosis since 1941. Symptoms are abdominal distension, vomiting and constipation with symptom remission, making diagnosis difficult. This is the first report involving foreign bodies. Barium enema and colonoscopy are necessary for diagnosis. Resection of the stenotic segment with end-to-end anastomosis or colostomy is the treatment of choice. Laparoscopy is an alternative procedure.

Subhepatic appendicitis with subdiaphragmatic abscess in a pediatric patient without intestinal malrotation: case report.

BACKGROUND: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. When these conditions are met, accurate diagnosis and early management decisions are delayed. CLINICAL CASE: We present the case of a 10-year-old male who had diarrhea without mucus or blood for 5 days. He was treated with antibiotics. Afterwards, he presented with vomiting, abdominal pain, and fever. Physical examination of the abdomen demonstrated a soft and depressible mass and pain in the lower right abdomen. Abdominal ultrasound and tomography reported image of subdiaphragmatic abscess. Percutaneous puncture and drainage were performed without results. Exploratory laparotomy was then performed, revealing a subhepatic perforation of the appendix. The patient evolved with abdominal sepsis and septic shock, resulting in a new surgical intervention for drainage of serohematic fluid. The patient improved and was discharged on day 40. DISCUSSION: It is very important to consider the position of the anatomic appendix during appendicitis because it contributes to the various clinical symptoms, of which 30% are atypical. Diagnosis is masked, leading to complications such as perforations and/or abscesses that extend the hospital stay. CONCLUSIONS: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. Delay in treatment due to atypical symptoms caused by the abnormal position of the appendix conditioned complications that implied a prolonged hospital stay, with the risk of increasing morbidity and mortality of the patient.

Apendicitis subhepática con absceso subdiafragmático en paciente pediátrico sin malrotación intestinal: informe de un caso / Subhepatic appendicitis with subdiaphragmatic abscess in a pediatric patient without intestinal malrotation: case report

Introducción: Los cuadros de apendicitis aguda subhepática en niños son raros y no siempre se acompañan de malrotación intestinal, lo que dificulta el diagnóstico y manejo temprano. Caso clínico: Niño de 10 años de edad, con padecimiento de cinco días de evolución caracterizado por evacuaciones diarreicas, tratado con antibióticos. Posteriormente presentó vómito, dolor abdominal tipo cólico y fiebre de 39 °C. El abdomen se encontró blando y depresible, con escaso dolor en flanco derecho. El ultrasonido y la tomografía mostraron imagen compatible con absceso subdiafragmático. Se manejó con drenaje externo. Al no obtener respuesta se realizó laparotomía exploradora, encontrando apéndice inflamada, de 10 cm de longitud, en posición ascendente sobre la corredera parietocólica derecha y perforación del extremo distal a nivel subhepático. El paciente evolucionó con sepsis abdominal y choque séptico, requiriendo nueva intervención quirúrgica para drenaje de líquido serohemático. A los 40 días el paciente fue dado de alta. Conclusiones: La consideración anatómica del apéndice es importante, por las múltiples presentaciones clínicas, de las cuales 30 % son atípicas y el diagnóstico se enmascara ocasionando complicaciones como perforación y abscesos. Los casos de apendicitis aguda de localización subhepática son raros y por lo general se asocian a malrotación del intestino. El retraso del tratamiento relacionado con el cuadro atípico, ocasionado por la posición poco habitual del apéndice, implica estancia hospitalaria más prolongada y riesgo de incrementar la morbilidad y mortalidad.

BACKGROUND: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. When these conditions are met, accurate diagnosis and early management decisions are delayed. CLINICAL CASE: We present the case of a 10-year-old male who had diarrhea without mucus or blood for 5 days. He was treated with antibiotics. Afterwards, he presented with vomiting, abdominal pain, and fever. Physical examination of the abdomen demonstrated a soft and depressible mass and pain in the lower right abdomen. Abdominal ultrasound and tomography reported image of subdiaphragmatic abscess. Percutaneous puncture and drainage were performed without results. Exploratory laparotomy was then performed, revealing a subhepatic perforation of the appendix. The patient evolved with abdominal sepsis and septic shock, resulting in a new surgical intervention for drainage of serohematic fluid. The patient improved and was discharged on day 40. DISCUSSION: It is very important to consider the position of the anatomic appendix during appendicitis because it contributes to the various clinical symptoms, of which 30% are atypical. Diagnosis is masked, leading to complications such as perforations and/or abscesses that extend the hospital stay. CONCLUSIONS: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. Delay in treatment due to atypical symptoms caused by the abnormal position of the appendix conditioned complications that implied a prolonged hospital stay, with the risk of increasing morbidity and mortality of the patient.

Effective analgesic between acetominophen + B vitamins vs. acetominophen in pediatric ambulatory surgery.

BACKGROUND: analgesics in pediatric ambulatory surgery must be safe and effective. Acetominophen is safe with moderate efficacy; therefore, we searched for other drugs. In preclinical trials, improved efficacy was reported with the combination of acetaminophen + B vitamins. The aim of this study was to determine the analgesic efficacy of acetaminophen + B vitamins in pediatric ambulatory surgery. METHODS: we conducted a clinical, comparative, randomized, double-blind study. We included 56 patients who were divided into four groups of 14 patients for each surgery (circumcision, tonsillectomy, inguinal hernioraphy, orchiopexy). Half of the patients received acetaminophen + B vitamins, and the remaining patients received acetaminophen alone. Variables were drugs, visual analogue scale and time of discharge. χ(2), Student t-test and analysis of variance (ANOVA) were used for statistical analysis. RESULTS: in children who received acetaminophen + B vitamins during the immediate postoperative period, 58% had a pain score <2 and 89% were discharged with a pain score %lt;1. Both schedules were effective and safe but acetaminophen + B vitamins showed a better pain score. CONCLUSIONS: the adjuvant effect of B vitamins was demonstrated with a better pain score in the immediate postoperative period and at the time of discharge.

Interventions for central giant cell granuloma (CGCG) of the jaws.

BACKGROUND: Central giant cell granuloma (CGCG) of the jaws is a rare benign tumour with an unknown aetiology accounting for up to 7% of tumours in the mandible (lower jaw) and the maxilla (upper jaw). OBJECTIVES: This systematic review focused on assessing the effects of primary non-surgical versus primary surgical interventions or any other treatment or placebo for treating central giant cell granuloma of the jaws. SEARCH STRATEGY: Relevant randomised controlled trials (RCTs) were identified from the Cochrane Oral Health Group's Trials Register (July 2009); CENTRAL (The Cochrane Library 2009, Issue 3); MEDLINE (1950 to July 2009); EMBASE (1980 to July 2009); and LILACS (1982 to July 2009). We scanned bibliographies of relevant studies for possible references to additional trials as well as prospective clinical trial registries. Eligible RCTs were included regardless of the language of publication. SELECTION CRITERIA: Randomised controlled trials involving a comparison of primary non-surgical interventions with primary surgical interventions or any other treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility, risk of bias and extracted data. The Cochrane Collaboration statistical guidelines were followed. MAIN RESULTS: We did not find any study evaluating the effects of primary surgical versus primary non-surgical interventions for central giant cell granuloma of the jaws. However, we included and analysed one RCT with unclear risk of bias, evaluating the effects of calcitonin versus placebo for central giant cell granuloma of the jaws. No significant difference was found in the proportion of patients with increased volume of more than 10% of the lesion compared to the pretreatment measurement at 3 months of follow-up (one RCT, 14 participants; risk ratio (RR) 3.00, 95% confidence interval (CI) 0.40 to 22.30). AUTHORS' CONCLUSIONS: We did not find RCTs evaluating the effects of primary surgical versus primary non-surgical interventions for central giant cell granuloma of the jaws. Although a number of non-surgical therapies have been proposed for treating central giant cell granuloma of the jaws, our review did not identify evidence from RCTs to support their use. More research is needed on this topic.

Solitary fibrous tumor of the parotid region. Report of a case and review of the literature.

Solitary fibrous tumor is a well-recognized entity that most commonly involves the pleura; however, it has been recently described in other locations including the head and neck region, where it occurs as a slowly growing and well-circumscribed lesion. Due to its low frequency it may be confused with other neoplasms, and for this reason microscopic, ultrastructural and immunohistochemical features are necessary to establish its diagnosis. Prognosis of this tumor depends on its location and size. We present a 20-year-old woman with a well circumscribed, rapidly enlarging solitary fibrous tumor located in the parotid region, which protruded into the oral cavity, measured 10 x 8.5 x 5.5 cm and exhibited benign histological features and positive immunoreactivity to CD34.

Tumor fibroso solitario de la región parotidea. Reporte de un caso y revisión de la literatura / Solitary fibrous tumor of the parotid region. Report of a case and review of the Literature

El tumor fibroso solitario es una entidad bien establecida, comúnmente localizada en la pleura, aunque recientemente se ha descrito en otras localizaciones, incluyendo la región de cabeza y cuello, en donde se presenta como una lesión bien circunscrita y de crecimiento lento. Debido a su baja frecuencia se puede confundir con otras neoplasias de esta área, por lo que las características microscópicas, ultraestructurales y de inmunohistoquimica ayudan a establecer su diagnóstico. El pronóstico esta relacionado con la localización y el tamaño del tumor.. Se presenta un caso en una mujer de 20 años de edad, localizado en la región parotidea con protrusión a cavidad oral, de crecimiento rápido y con un tamaño de 10x8.5x5.5cm, bien circunscrita, y con características histológicas benignas e inmunoreactividad para CD34 (AU)

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Malignant odontogenic tumors. A retrospective and collaborative study of seven cases.

The frequency, clinico-pathologic features and outcome of malignant odontogenic tumors diagnosed according to the current WHO classification in three pathology services in Mexico City are presented. There were seven cases (5 male and 2 female patients), which represent less than 4% of all odontogenic tumors diagnosed in these services. There were six odontogenic carcinomas (two malignant ameloblastomas, two clear cell odontogenic carcinomas, one primary intraosseous carcinoma and one carcinoma arising in an odontogenic cyst) and one ameloblastic fibrosarcoma. Age ranged from 25 to 72 years (mean: 43.8). Clear cell odontogenic carcinomas occurred in the canine-premolar region, one in the maxilla and one in the mandible (one ia a man and one in a woman), while the remaining lesions affected the posterior region of the mandible, with a male predominance (4:1), which agrees with previously reported cases. Surgical resection was the treatment employed in all carcinomas, while the ameloblastic fibrosarcoma was treated with chemotherapy due to its large extension, but without favorable response. The patient with primary intraosseous carcinoma had submaxillary and cervical metastases and the neoplasm was the cause of death. In spite of their extremely low frequency, malignant odontogenic tumors are an important cause of extensive surgical procedures in the oral and maxillofacial region.

Síndrome de Gorlin (síndrome de carcinoma basocelular nevoide). Presentación de dos casos y revisión de la literatura / Gorlin's symdrome (nevoid basal cell carcinoma syndrome). Presentation of two cases and review of the literature

El síndrome de carcinoma basocelular nevoide fue descrito hace cuatro décadas por Gorlin y Goltz; ha sido caracterizado por múltiples carcinoma basocelulares en áreas expuestas o no al sol. Además, los pacientes con este síndrome cursan con quistes mandibulares, alteraciones esqueléticas (costilla bífida), puntilleo palmoplantar y calcificaciones ectópicas. Este síndrome está asociado con otras alteraciones de cara, de piel y de los sistemas musculoesquelético, genitourinario, neurológico y oftalmológico, así como algunas neoplasias, incluyendo, linfoma de Hodgkin, no-Hodgkin, meduloblastoma, fibromas de ovario y fibrosarcomas, melanoma y rabdomioma fetal. Se ha establecido que para el diagnóstico de síndrome de Gorlin, se requiere de dos características principales, consideradas como criterios mayores, o bien de una alteración mayor y dos menores. Algunos estudios han demostrado que este síndrome es una alteración autosómica dominante en el cromosoma 9, lo cual es relevante como un evento temprano en la carcinogénesis. Esta serie presenta dos casos de síndrome basocelular nevoide. En uno de ellos se efectuó estudio completo familiar y se detecto que había ocho miembros más de la familia que padecían esta enfermedad

Efecto del piroxicam sobre la microflora local en el complejo pulpoperiapical posterior a la exposición pulpar / Effect of piroxicam on local microflora on the pulp-periapical complex, after pulp exposure

El objetivo de este reporte fue determinar el efecto del piroxicam (antiinflamatorio no esteroide) sobre las bacterias en el complejo pulpoperiapical, cuando se administra para inhibir el desarrollo de lesiones periapicales experimentales. A 12 ratas cepa long Evans se les provocó exposición pulpar previo a la administración de piroxicam, administrando el medicamento cada 24 horas durante 15 días. Se encontró que el porcentaje de bacterias decrece de la cámara pulpar hacia el periápice observándolos escasos en la lesión periapical en ambos grupos, sin embargo se encuentran incrementados con respecto a porcentajes en el grupo al cual se le administró el piroxicam, lo que sugiere que si bien el piroxicam disminuye el desarrollo de lesiones periapicales, favorece el desarrollo de bacterias incrementando su número en el complejo pulpoperiapical

Detección de células cebadas y basófilos en lesiones periapicales experimentales tratadas con piroxicam / Detection of mast cells and basophils in experimental periapical lesions treated with piroxicam

En este estudio, se reportó la respuesta del tejido periapical ante la exposición prolongada del tejido pulpar y el efecto de la administración de un antiinflamatorio no esteroide (piroxicam), sobre dos tipos celulares involucrados en la respuesta inflamatoria e inmunológica local como son las células cebadas y los basófilos, utilizando ratas Long Evans a las cuales se les provocó exposición pulpar previo a la administración del piroxicam. Los hallazgos fueron: en el área de los abscesos en el grupo experimental, a los 8 días las células cebadas se encontraron en un porcentaje del 50.0 disminuyendo a 16.6 por ciento a los 15 días, mientras que en el grupo control a los 8 días se presentaron en 11.1 por ciento, aumentando a 22.2 por ciento a los 15 días en el total de los animales. Con respecto a los basófilos en la misma zona se observó en el grupo control a los 8 días un porcentaje de 61.1 disminuyendo a 33.3 por ciento a los 15 días, siendo lo contrario en el grupo experimental, donde de 16.6 por ciento aumentó a 33.3 por ciento en el transcurso del tratamiento; la degranulación fue raramente observada en ambos tipos celulares probablemente por efecto del antiinflamatorio en estudio