Estudio de las alteraciones del esmalte en la enfermedad celiaca

La enfermedad celiaca (EC) es una enteropatía caracterizada por una intolerancia permanente al gluten, proteína existente en el trigo, centeno, cebada y avena que provoca una lesión severa de las vellosidades intestinales, y se normaliza tras su retirada de la dieta. La sintomatología varía de un paciente a otro dependiendo del daño de la mucosa intestinal. La presentación típica incluye diarrea, pérdida de peso, fatiga, distensión abdominal, vómitos, deficiencias nutricionales y anemia por deficiencia de hierro. La hipoplasia del esmalte es el defecto más común en el desarrollo y mineralización de la dentición humana. Diferentes autores han descrito una mayor prevalencia de estas lesiones en pacientes afectos de EC. Dentro de estas lesiones existen diferentes grados de alteración que van desde mínimas lesiones a lesiones severas estructurales. Las alteraciones estructurales del esmalte en pacientes con EC son simétricas y cronológicamente distribuidas en los cuatro cuadrantes de la dentición, mientras que en la población general las lesiones son aisladas e inespecíficas. Diferentes estudios, han relacionado los antígenos del Complejo Mayor de Histocompatibilidad y las alteraciones del esmalte, comprobando que si existe una asociación entre ellos. Se ha postulado que las alteraciones dentales en estos pacientes pueden ser un dato de sospecha de la enfermedad en sus vertientes más difíciles de diagnosticar. La dermatitis herpetiforme (DH) y la diabetes son las enfermedades que más claramente se han asociado con la EC, la prevalencia de los antígenos de histocompatibilidad de los tipos DR3 y DQW2 y anticuerpos antigliadina circulantes en este grupo de pacientes es paralelo a la EC. Las alteraciones más destacadas que encontramos en boca son los defectos del esmalte dental en un 50-80% de los pacientes adultos, úlceras y la queilitis angular. El estudio realizado demuestra que existió un mayor número de pacientes con defectos en el esmalte en el grupo celiaco que en el grupo control, los pacientes celiacos presentaron una mayor afectación del grupo incisivo y molar, esto pudo estar relacionado con la edad de diagnóstico de la EC y la retirada del gluten de la dieta, coincidiendo con el periodo de calcificación de estos grupos dentales.Los pacientes celiacos portadores de los antígenos DR3 y DQ2 presentaron mayor número de defectos en el esmalte

Pediatric oral ranula : clinical follow-up study of 57 cases

Objective: To present 57 cases of oral ranula in children, analyzing the clinical characteristics, treatment and outcome of these lesions. Methods: The clinical histories of patients diagnosed with oral ranula, seen between 1998 and 2008 at the Oral and Maxillofacial Surgery Unit of a reference Children?s Hospital (0-14 years) were reviewed. All patients with clinical diagnosis of oral ranula were included. Results: Fifty-seven patients, 21 boys and 36 girls, with a mean age of 5.1 years were included in the study. Thirtytwo cases were located on the left side of the floor of the mouth. The lesion diameter varied between 1 and 3 cm in 27 cases, 22 were less than 1 cm, and 8 were larger than 3 cm. Fifty-four cases were asymptomatic and 3 ranulas had pain on swallowing. Twenty-two cases were resolved by opening with a tract dilator and 35 by marsupialization. Seven cases recurred at a mean of 12 months after treatment, three of these from the marsupialization group. Conclusion: The majority of the oral ranulas occurred in females, asymptomatic, on the left side of the floor of the mouth, with a mean size of 1 to 3 cm; all lesions were treated by surgery, of which 7 recurred

Orofacial dermoid cysts in pediatric patients : a review of 8 cases

Objective: The aim was to analyze the clinical characteristics, treatment and outcome of 8 orofacial dermoid cysts (DC) in pediatric patients. Material and Methods: A retrospective observational study was made, reviewing the medical records with clinical diagnosis of dermoid cyst between 1987 and 2006 in the Children?s Maxillofacial Surgery Department of the Hospital Universitario La Fe, Valencia, Spain. The following data were collected: sex, age, location, size and duration of the lesion, treatment, length of follow-up, and recurrence. Results: Eight patients (3 girls and 5 boys) with a mean age of 2.7 years (range 0-12 years). Four DC were located in the oral area (3 sublingual and 1 lingual), one in the periorbital and three in the nasal areas. The size ranged from 0.8 cm to 4 cm. The mean duration of the lesion was 13.7 months (range 4 days to 2 years). All DC were diagnosed pathologically following surgical removal of the lesion. There were no recurrences. Conclusion: The appearance of DC in the maxillofacial region of pediatric patients is uncommon. The floor of the mouth is the most frequently affected area in the oral cavity. Treatment is surgical removal of the lesion. Recurrence is unusual

Clinical characteristics, treatment and outcome of 28 oral haemangiomas in paediatric patients

Objective: To present a large series of oral haemangiomas in children, analyzing the clinical characteristics, treatment and outcome of oral haemangiomas in 28 children. Material and Methods: We conducted an observational retrospective study, reviewing medical records with clinical diagnosis of haemangioma between 1990 and 2006 at the Children?s Maxillofacial Surgery Service of the Hospital Universitario la Fe, Valencia. All patients with a clinical, radiographic, pathologically confirmed diagnosis of oral haemangioma were included. Results: The study included 28 patients (19 females and 9 males) with a mean age of 4.27 years (range 0-14 years). Nine were congenital haemangioma. The most frequent location of oral haemangioma was in the lip with 23 cases, followed by three cases in the tongue and 2 in the buccal mucosa. The mean diameter of the lesion was 1.67 cm (range 1-3cm). The mean duration of the lesion was 6.3 months (range 1 month to 5 years). Of the 28 haemangiomas, 13 were surgically removed, 2 were treated with embolization and 13 disappeared spontaneously. The mean follow up was 2.7 months (1-8 months). There were no cases of recurrence. Conclusions: Haemangiomas usually present in children, and can be seen from birth. They have a predilection for females. They are uncommon in the oral cavity. In the oral region, the most common location is the lip. Most congenital haemangioma regress spontaneously without treatment. The treatment of choice is surgical excision of the lesion

Oral mucocele: review of the literature

Mucocele is a common lesion of the oral mucosa that results from an alteration of minor salivary glands due to a mucous accumulation. Mucocele involves mucin accumulation causing limited swelling. Two histological types exist - extravasation and retention. Mucoceles can appear at any site of the oral mucosa where minor salivary glands are present. Diagnosis is principally clinical; therefore, the anamnesis should be carried out correctly, looking for previous trauma. The most common location of the extravasation mucocele is the lower lip, while retention mu- coceles can be found at any other site. Mucoceles can affect the general population, but most commonly young patients (20-30 years old). Clinically they consist of a soft, bluish and transparent cystic swelling which normally resolves spontaneously. Treatment frequently involves surgical removal. Never-theless micro marsupialization, cryosurgery, steroid injections and CO2 laser are also described. Mucocele is a common lesion and affects the general population. For this reason we felt it would be interesting review the clinical characteristics of mucoceles, and their treatment and evolution in order to aid decision-making in daily clinical practice

The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes

Up to 50-60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR. We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan-Meier and Cox regression analyses. Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P <.0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P <.0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85-3.31], P <.001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26-2.62), P =.001]. DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD

Risk factors for non-diabetic renal disease in diabetic patients

Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 6 12.8 years, creatinine was 2.8 6 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n ¼ 329) of patients had DN, 49.6% (n ¼ 413) NDRD and 10.8% (n ¼ 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n ¼ 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) ¼ 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR ¼ 1.51, 95% CI: 1.03–2.21, P ¼ 0.033) and absence of diabetic retinopathy (DR) (OR ¼ 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P ¼ 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P ¼ 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P ¼ 0.002), higher creatinine (P ¼ 0.01) and DN (P ¼ 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis

Lesões bucais na infância: revisão sistemática de interesse da fonoaudiologia

RESUMO Este estudo tem como tema, fonoaudiólogos, médicos e dentistas que são profissionais que, frequentemente, em suas ações profissionais, realizam exames intrabucais em seus pacientes. Muitas crianças, desde seu nascimento, apresentam o acometimento por lesões bucais que podem trazer transtornos temporários ao cotidiano. O objetivo é apresentar aos profissionais de saúde uma revisão sistemática acerca das lesões bucais mais frequentes em crianças e de interesse da fonoaudiologia. Os profissionais de saúde devem buscar sempre aumentar seus conhecimentos melhorando a atenção à saúde de seus pacientes