25 research outputs found
Ameloblastoma mandibular: revisión de la literatura y presentación de seis casos
El ameloblastoma es un tumor odontogénico benigno de origen
epitelial sin inducción en el tejido conectivo. En el tratamiento
del mismo se debe valorar el tipo clínico (sólido y multiquístico,
uniquístico, periférico), la localización y el tamaño del tumor,
así como la edad del paciente. Recientemente se han publicado
algunos artículos con el fin de actualizar los conocimientos y
actitudes terapéuticas frente al ameloblastoma.
Se presentan seis casos de pacientes afectos de ameloblastomas
localizados en la mandíbula, tratados en los últimos siete años.
Se aportan datos acerca de su aparición clínica, sus características
histológicas, el manejo terapéutico realizado que consistió
en la extirpación de la lesión, fresado perilesional del hueso o
resección en bloque, según el tipo de ameloblastoma. Finalmente
analizamos el seguimiento y la aparición de recidivas en los
pacientes presentados.
El objetivo de este artículo es revisar los conceptos respecto al
ameloblastoma que se han publicado recientemente y valorar
su influencia en la actitud del clínico a la hora de actuar frente
a esta patología, tomando como punto de partida para ilustrar
está discusión la presentación de nuestra experiencia respecto
al ameloblastoma.Ameloblastoma is a benign odontogenic tumour of epithelial
origin without induction in the connective tissue. In treating this
type of tumour, it is important to assess the clinical type (solid,
multicystic, unicystic, peripheral), localisation, and size of the
tumour as well as age of the patient. Articles have recently been
published with the purpose of providing updated knowledge
and therapeutic approaches to ameloblastoma. We present six
cases of patients with localised mandibular ameloblastoma who
were treated during the last seven years. We present data on
clinical appearance, histological characteristics, and therapeutic
approach that was used, which included excision of the lesion,
perilesional drilling of the bone, or block resection, according
to the type of ameloblastoma. Lastly, we analysed follow-up
measures and the rate of recurrence in these patients. The aim of
this paper is to review the concepts relating to ameloblastoma
that have been published recently and to assess their influence on
the clinical attitude taken when facing this pathology, using our
experience with ameloblastoma as a starting point to illustrate
this discussion
Assessment of quality of life in oral cancer
Quality of life (QL) in oral cancer patients has become one of the most important parameters to consider in the diagnosis and post-treatment follow-up. The purpose of this article has been to review the papers published that study the QL in oral cancer patients, the different QL questionnaires used, the clinical results obtained, and the systematic revisions available in the indexed literature for the last 10 years. The term QL appears as a keyword in an increasing number of articles throughout the past 10 years; however, few studies focus on oral cancer. Most of them assess all head and neck cancers, which conform to a heterogeneous group with several different features depending on location (oral cavity, oropharynx, larynx, hypopharynx, nasopharynx and salivary glands). Most studies evaluate QL in short periods of time, normally within the first year after the diagnosis. Series do not discern between different therapeutic options, and they generally center on Northern European or Northern American populations. There are few instruments translated and validated into Spanish that measure QL, a fundamental characteristic to link QL to own patients? socio-cultural parameters. Data related with QL are mostly related to patient (age, sex, co-morbidity), tumour (location, size), and treatment (surgical treatment, radiotherapy association, reconstruction, cervical dissection, and/or feeding tube). Nowadays QL?s assessment is considered an essential component of an oral cancer patient as well as the survival, morbidity and years free of disease. Although many aspects related to QL in oral cancer patients have been published throughout the past 10 years, more systematic research is needed to be able to apply it on a daily basis
Conservative management of dentigerous cysts in children
Purpose and Introduction: Dentigerous cysts are epithelial in origin and are the most commonly found cyst in
children. The majority of these lesions are usually a radiological finding and are capable of quite large before
being diagnosed. The standard treatment for these cysts is the enucleation and the extraction of the affected tooth.
However, if the patient is a child and the affected tooth is not developed, a more conservative attitude should be
considered.
Material and Methods: (Clinical case): A 7-year-old patient is presented with an eruptive backlog of the lower permanent first molars. Radiological examination reveals two radiolucid lesions in relation to them, which are compatible with a dentigerous cyst, and in relation to the inferior aveolar nerve and various germs. A partial enucleation
is carried out, maintaining all the dental germs related to the cyst in mouth and monitoring the patient until the case
study is over.
Results and Discussion: Diagnosis and early treatment of these lesions in children is of great importance, especially
in cases where the lesions enclose permanent teeth.
Conclusions: Whenever possible, a conservative attitude should be taken, one that allows for the maintenance of
the dentition and treatment of the associated cyst in order to not compromise either the occlusion or the mental state
of these patients
Cri du chat syndrome : a critical review
A new syndrome was identified in 1963, when Lejeune et al. reported a genetic disease resulting from a partial or total deletion on the short arm of chromosome 5 (5p-) and named it the cri du chat syndrome (CdCS). This term makes reference to the main clinical feature of the syndrome, a high-pitched monochromatic cat-like crying, that usually disappears in the first years of life. CdCS is one of the most common chromosomal deletion syndromes in humans, with an incidence of 1:15.000-1:50.000 live-births. Our purpose was to review different aspects of this syndrome (concept, epidemiology, aetiology, clinical features, diagnostic methods and prognosis) emphasizing both: the breakthrough in this field introduced by new cytogenetic and molecular techniques, and the orofacial manifestations most frequently reported. The main orofacial anomalies registered were mandibular microretrognathia, high palate but rarely cleft, variable malocclusion (frequently anterior open-bite), enamel hypoplasia, poor oral hygiene, generalized chronic periodontitis, and retardation of tooth eruption, although there is not enough evidence to support any clear association between these pathologies and the CdCS
Facial transplantation: a concise update
Objectives: Update on clinical results obtained by the first worldwide facial transplantation teams as well as
review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on
facial transplanted patients.
Study design: MEDLINE search of articles published on "face transplantation" until March 2012.
Results: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of
men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple
conventional surgical reconstructive procedures which had failed. Altogether 8 transplant teams belonging to 4
countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed.
Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other
tissues included, though all were grafted successfully and remained viable without significant postoperative
surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months
after transplantation.
Conclusions: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable
reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to
settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has
achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients
Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study
Background: We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. Methods: International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results: 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. Conclusions: Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized
SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome
The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome
Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection
Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19
Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III
Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2
The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality