RESUMO
La corrección quirúrgica de grandes asimetrías faciales son un desafío para el equipo quirúrgico. En dichos casos, los resultados de la corrección utilizando técnicas quirúrgicas convencionales son limitados, lo que hace necesario la utilización de otras herramientas terapéuticas. La distracción ósea (DO) es una de ellas, pues permite el estiramiento controlado del callo óseo previamente creado mediante osteotomías. La DO permite realizar cambios en el posicionamiento óseo de gran envergadura, favoreciendo el crecimiento óseo como mecanismo de acción. El objetivo de este artículo es describir los resultados quirúrgicos de DO intraoral del tercio medio facial utilizado en dos pacientes con severas asimetrías faciales asociadas a malformaciones de origen genético. Se relata el diagnóstico, la planificación, las herramientas tecnológicas utilizadas, técnica quirúrgica y los resultados obtenidos.
Surgical correction of major facial asymmetries is a challenge for the surgical team. In such cases, treatment results from conventional surgical techniques are limited, which requires using other therapeutic tools. Bone distraction is one of them, as it allows controlled stretching of the bone callus previously developed through osteotomies. Distraction osteogenesis allows making changes in large bone positioning, favoring bone growth as an action mechanism. This article aims to describe the surgical results of intraoral distraction osteogenesis of the midface used in two patients with severe facial asymmetries related to congenital malformations. Diagnosis, planning, technological tools, surgical techniques, and results obtained are explained.
RESUMO
BACKGROUND: Remote ischemic conditioning during cerebral ischemia (remote ischemic perconditioning, RIPerC) refers to the application of several cycles of brief ischemia and reperfusion (I/R) commonly to a limb, and it represents a new paradigm in neuroprotection with multiple mechanisms of action in ischemic stroke (IS) patients during acute phase. Some clinical trials just finished, and a few others are still ongoing; gather the current knowledge and pull it down to influence the present and future studies was the goal of this paper. METHODS: A systematic review of published research papers and/or registered clinical trials since 2000 was performed. RESULTS: Nineteen studies were identified and only four studies were completed. All of them have demonstrated that RIPerC is safe, feasible and well tolerated in IS patients. However, a high heterogeneity of clinical trial characteristics was observed: five (26.3%) randomized clinical trials (RCTs) included only thrombolytic-treated patients, three (15.8%) RCTs only thrombectomy-treated patients, and five (26.3%) RCTs required radiological confirmation of IS. Temporal inclusion criteria vary from 4 h to 48 h. Most of the clinical trials used 4 cycles of RIPerC in the upper non-affected limb. Interestingly, only three (16.7%) RCTs applied RIPerC during the transportation in the ambulance. Neuroimaging outputs were the main endpoints when endovascular therapy was applied; functional outcome is also the main endpoint in large-medium size studies. CONCLUSIONS: This review summarizes the completed and ongoing clinical trials on RIPerC in IS patients, where RIPerC has been used alone or in combination with recanalization therapies. Ongoing clinical trials will provide new information on the best RIPerC intervention strategy and potentially improve the functional outcome of IS patients; definition of new RIPerC strategies would ideally aim at enhancing tissue preservation, promoting neurological recovery, and stratify patients to improve treatment feasibility.
Assuntos
Isquemia Encefálica/prevenção & controle , Precondicionamento Isquêmico/métodos , Acidente Vascular Cerebral/prevenção & controle , Humanos , Neuroproteção , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
RESUMEN: El linfoma de Burkitt es un linfoma de células B maduras altamente agresivo, de baja incidencia. Según la Organización Mundial de la Salud presenta tres variantes: endémico, esporádico y asociado al Virus de la Inmunodeficiencia Humana. Este último representa el 30-40% de los linfomas no Hodgkin en pacientes seropositivos para virus de la inmunodeficiencia humana. El tratamiento con quimioterapia en combinación a terapia antirretroviral de gran actividad da muy buenos resultados. Se reporta caso de paciente seropositivo para virus de la inmunodeficiencia humana con linfoma de Burkitt en la cavidad oral, tratado con la terapia anteriormente mencionada.
ABSTRACT: Burkitt lymphoma is a highly aggressive mature B-cell lymphoma with a low incidence. According to the World Health Organization, it has three variants: endemic, sporadic and associated with Human Immunodeficiency Virus (HIV). The last one represents 30-40% of non-Hodgkin's lymphomas in HIV seropositive patients. Treatment with chemotherapy in combination with highly active antiretroviral therapy gives very good results. Here is the case report of a HIV seropositive patient who developed Burkitt lymphoma in the oral cavity and received this treatment.
