[Mammal bite management]. / Manejo de las mordeduras por mamíferos.

BACKGROUND: Animal bites are a major public health problem, it is estimated that 2% of the population is bitten each year. Most bites are by dogs and the risk factors include young children, men, certain breeds of dogs and untrained dogs. The risk of infection after bites differs between animal species and depends on the animal teeth and oral flora. CONCLUSIONS: Animal bites are still a major cause of morbidity in patients of all ages and have caused several preventable childhood deaths. These wounds often become infected. If the wound requires it, early surgical evaluation must be performed. The use of antibiotics is only recommended for high risk bite wounds.

Extensor tendon injuries in athletes.

Extensor tendon injuries of the hand and wrist in high-level athletes can cause a delay in return to play and permanently affect their performance. Given the inherent demand for a speedy and complete recovery, orthopedic surgeons must have an understanding of how to best direct an athlete's treatment for these injuries. The extensor anatomy is very intricate and a thorough understanding of the anatomy can help with both diagnosis and treatment. However, untreated or poorly managed injuries are at risk of leading to chronic deformities. We will discuss the diagnosis and management of the most common extensor tendon injuries and tendinopathies of the hand found in athletes: mallet fingers, swan-neck deformities, boutonniere deformities, central slip ruptures, sagittal band ruptures, intersection syndrome, extensor carpi ulnaris tendinitis, and extensor carpi ulnaris subluxation.

[Bacteriological study of oral cavity of people of Mexican origin to determine etiology agents of human infections in hand bite]. / Estudio bacteriológico de la cavidad oral de personas de origen Mexicano para determinar agentes causales de infecciones por mordedura humana en la mano.

INTRODUCTION: Hand infections secondary to human bites often leave serious consequences on the functioning of the hand. Such infections are caused by different bacteria. Most bacteriological studies have been made to people of Anglo-Saxon origin or descent, and based on these findings; provide treatment to patients of different origins which may not always be as effective. METHODS: Descriptive, internal stratified 17 patients were isolated samples of oral cavity and dental plaque bacterial species to identify and define the possible treatment according to the species identified. RESULTS: Microorganisms were isolated Gram (+) and Gram (-) belonging to the normal flora of the oral cavity and dental plaque in all the cases studied, presenting a variable number of microorganisms according to age but not by sex. The group of Gram-positive bacteria isolated showed sensitivity to: erythromycin, chloramphenicol and ciprofloxacin. In the group of Gram negative: kanamycin, amoxicillin + clavulanic acid, ciprofloxacin and norfloxacin, E. Corrodens sensitive to the group of quinolones as ciprofloxacin, norfloxacin as well as ceftriaxone and cefoperazone sulbactam. CONCLUSIONS: The bacterial species that are commonly found in normal flora of the oral cavity and dental plaque may be potential pathogens in a hand injury where to find the appropriate conditions for their development.

Traumatic lesions from congenital insensitivity to pain with anhidrosis in a pediatric patient: dental management.

Congenital insensitivity to pain with anhidrosis is a rare autosomal-recessive disorder characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and mental retardation. The lack of sensitivity to pain results in traumatic lesions, such as ulcers, fractures, burns, bites, scars, and digital amputations. Several methods have been suggested to treat these patients; however, appropriate management is difficult, especially when the mutilation is particularly severe. This report describes the case of a 2-year-old female patient who had severe self-mutilating injuries to her tongue, hands, lips, and oral mucosa caused by biting. The patient presented digital amputation and also a premature loss of a permanent tooth germ during the treatment. The dental management is described and discussed. It is important to include the dentist on the multidisciplinary team to reduce the frequency and severity of the self-inflicted lesions in these patients, also to prevent complications.

Oral mucosal conditions in chronic hepatitis C Brazilian patients: a cross-sectional study.

OBJECTIVE: Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C. METHODS: A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality. RESULTS: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant (P = 0.002). The most frequent variations of normality included Fordyce's spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent). CONCLUSION: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.

Mordeduras y mordidas / Bites and bites

Las mordeduras que presentan mayor interés para los cirujanos son las ocasionadas por animales domésticos, principalmente por los perros y gatos. Estos traumatismos poseen alto índice de contaminación y pueden provocar, además de infecciones locales graves, algunas dolencias sistemáticas causadas por bacterias, virus, rickettsias, protozoarios y parásitos. Las mordidas, ocasionadas por humanos, son notoriamente las que llevan a mayores índices de contaminación de tejidos lesionados a cuadros infecciosos graves, siendo consideradas las más peligrosas producidas por los mamíferos. Las heridas por mordeduras son tratadas de forma un poco diferente de las demás, ya que estas poseen saliva rica en microbiota, siendo altamente propicia a infección haciendo que su tratamiento sea bastante controvertido, principalmente no que se refieren sutura primaria y a profilaxia de dolencias infectocontagiosas originadas a partir de contacto con la mucosa oral con la herida del paciente. Este trabajo, con base en algunos casos clínicos, tiene por objetivo aclarar y explicar posibles divergencias respecto al tratamiento de estas lesiones, dando énfasis al tratamiento adoptado por nuestro servicio de cirugía y traumatología Buco-Maxilo-Facial del Hospital da Restauração (Pronto Socorro) en Recife-Pe, los días martes y viernes en las noches.

The bites that present more frequent interest for the surgeon are the caused for domestic animals, mainly for the dogs and cats. These traumas possess high index of contamination and can provoke, beyond serious local infections, some systematic illnesses caused by bacteria, virus, rickettsias, protozoan and parasites. The bites, caused for human beings, are notably the ones that take the biggest indices of contamination of injured fabrics and serious the infectious pictures, being considered most dangerous of the produced ones for mammals. Bite wounds are dealt with short while different from of excessively, since these possess rich saliva in microbial, being highly propitious to the infection, this becoming its treatment sufficiently controverter, mainly in that if it relates to the primary suture and the Prophylaxis of originated infectum – contagious illnesses from the contact of the oral mucosa with the wound of the patient. This work, on the basis of some clinical cases, has for objective to elucidate and to explain possible divergences regarding the treatment for us adopted in the Service of Surgery and Maxillofacial Traumatology of the Hospital da Restauração (Emergency) in Recife-PE, on Tuesdays (day) and Fridays (night) duties.

Tratamiento quirúrgico precoz en osteomielitis de mano por mordeduras humanas / Early surgical treatment in hand osteomyelitis by human bites

Hemos visto, que las mordeduras humanas poseen ciertas características particulares, que pueden interferir en su manejo; y son responsables de su morbilidad, de ahí la importancia de nuestro tema. Nuestros objetivos, consisten en la identificación del tratamiento más eficiente, en el manejo inicial de las osteomielitis de mano por mordeduras humanas y su rehabilitación; y la presentación de casos clínicos del Servicio. La metodología que utilizamos, está constituída por una revisión bibliográfica sobre el manejo de estas lesiones. De las conclusiones ha las que hemos arribamos, destacamos que la mayoría de los autores enfatizan la importancia del tratamiento temprano, con administración antibiótica enérgica y cirugía precoz. As feridas produzidas pelas mordidas dos humanos, possuem particularidades que podem intervir no seu tratamento e na evolução das suas proprias feridas, além de ser as responsavels do seus danos e complicações. Encontra-se aqui à importança do nosso tema. Os nossos objetivos são: identificar o tratamento que seja mais eficaz na precocidade do tratamento da “ostemyelitis” das mãos, pelas mordidas humanas, e a sua reabilitação aliás da apresentação de casos clínicos do nosso serviço. A metodología escolhida foi uma revisão da bibliografia sobre o tratamento de estas feridas. Concluímos que, o maior numero de autores ressaltao a importância da precocidade do tratamento, com atibióticos enèrgicos e uma cirugia precoce.

We have seen that human bites have some features which may interfere in their treatment, are responsible for their morbility and show the importance of our topic. Our objectives are discovering the best treatment for hand osteomielitys caused by human bites, its rehabilitation and showing some of our cases. Our methodology si based in a bilbliografhy revision of the treatment for this illness. From our conlusions, we spotlight that the mayority of the authors emphasize the importance of early treatment using properly antibiótics and sugery.

Mordedura humana: apresentaçäo de um caso clínico com complicaçäo infecciosa / Human bite: report of a case with infectious complication

Os autores relatam um caso de mordedura humana complicada com infecçäo local regional. Destacam as conseqüências da mordedura, especialmente as referentes às complicaçöes infecciosas, e discutem a terapêutica e a profilaxia. A mordedura humana apesar da sua importância clínica tem sido pouco estudada, o que faz com que profissionais médicos dos Serviços de Emergência tenham dificuldade em prestar um atendimento adequado a esse tipo de paciente. A conduta correta é a lavagem mesticulosa da ferida com soro fisiológico a 0,9 por cento e a retirada do tecido desvitalizado. Se necessário, deve ser feita a vacina ou a antitoxina antitetânica. O uso de antibiótico profilático deve visar os principais agentes causadores de complicaçöes infecciosas, que säo os estreptococos, cocos anaeróbios, a Eikenella corrodens e o Staphylococcus aureus. Por isso recomenda-se o emprego da associaçäo amoxicilina + ácido clavulânico ou de tetraciclinas por três dias. Nos casos com lesäo extensa ou múltipla acometendo o tecido celular subcutâneo, indicamos o uso da penicilina G por via I.V. associada à oxacilina por três a cinco dias. Baseados nesta conduta terapêutica, os autores propöem evitar complicaçöes infecciosas como celulites, abscessos, mionecrose, osteomielite, artrite séptica e septicemias.