Evidencia del síndrome neuropático en un estudio neurofisiológico e inmunohistoquímico de las fibras nerviosas en pacientes con síndrome de boca ardiente

espanolIntroduccion: El sindrome de la boca ardiente (SBA) es una enfermedad de frecuente aparicion, caracterizada para un dolor quemante y ardiente en la lengua y en la cavidad oral, en ausencia de alteraciones estructurales macroscopicas de las mucosas. La etiopatogenesis del SBA no es todavia conocida y por lo tanto no presenta un esquema diagnostico claro y bien definido. Material y metodos: Para evaluar la hipotesis que contempla una alteracion de las fibras nerviosas perifericas de pequeno calibre, asociada o no con una alteracion trofica de las mucosas, hemos seleccionados 25 pacientes (7 varones y 18 mujeres, con una edad comprendida entre 36 y 75 anos, una media de 54 anos) afectados por SBA, que llegaron a nuestra clinica para una serie de examenes que suelen realizarse de forma rutinaria en las sindromes de dolor neurologico. En todos los pacientes se ha realizado un cuidadoso examen objetivo y una ortopantomografia, con la finalidad de excluir alteraciones de las mucosas y enfermedades odontologicas. En todos los pacientes se han realizado: examenes hematoquimicos, examenes objetivos neurologicos, teletermografia de la lengua y de la cara, examen cuantitativo de la sensibilidad termica de la lengua, de las manos y de la parte dorsal del pie. Los resultados del examen cuantitativo de la sensibilidad termica de la lengua y de la muneca se confrontaban con una poblacion control homogenea. En una poblacion de 10 pacientes (3 varones y 7 mujeres; de una edad comprendida entre 34 y 53 anos, una media de 49 anos) se ha realizado un biopsia de la parte dorsal de la lengua, la biopsias se han analizado con microscopia optica e inmunofluresencia tras un tratamiento con anticuerpos activos para proteinas neuronales citoplasmaticas (protein gene product 9.5). Resultados: Los datos obtenidos evidenciaban la presencia de una polineuropatia subclinica en el 50% de los pacientes. Especialmente se apreciaban signos de baja funcionalidad de las fibras nerviosas de pequeno calibre de la lengua en casi la mitad de los pacientes examinados. El examen histologico de la mucosa lingual evidenciaba una atrofia discreta en el 70% de los pacientes, mientras que la observacion de las fibras nerviosas de pequeno calibre por medio de la inmunofluoresencia hacia suponer la presencia de alteraciones relacionadas con una polineuropatia de tipo periferico. EnglishAims. Burning pain is considered characteristic of chronic neuropathic pain condition in general, and so me recent data seem to suggest peripheral or central nervous system involvement as possible underlying factor in BMS. This study was designed to determinate if burning mouth symptoms could be originated from a peripheal neuropathy of small diameter nerve fibres. Material and methods. The material of the study consisted of 25 patients (18 female, 7 male, 30-75 years; means 54 years). In all patients there were not: oral muco membranes lesions, oral muco membranes diseases, oral correlated diseases, oral dysfunctions, dental and periodontal diseases. Besides there were: no evidence of central nervous system pathology, no evidence of peripheral nervous system pathology, no presence of organic body disfunctions. AIIpatients didn't show significant alterations of blood investigations. AII patients were undermitted to our protocol including: oral and facial clinical examinations, neurological exam, blood investigations, Mc Gill Pain Questionnaire, VAS (visual analogical scale), biopsy of tongue mucosa with hystological and immunofluorescence exams, quantitative somatosensory thermotest and teletermography examination of tongue mucosa. ResuIts. These examinations have showed subclinical polineurophaty in 50% of patients. In particular were observed a loss of function in small diameter nervous fibres in about 50% of patients. Hystological exam of mucosal tongue revealed a moderate atrophy and alterations of structures. Conclusion. Etiology, pathogenetic processes, clinical and diagnostic approaches, therapeutical resolutions and researches of burning mouth syndrome are not clear yet. The local alterations of small diameter sensitive nerve fibres could cause an increase of oral burning, without muco membranes pathologies. These locallesions could justify the bms clinical symptomatology. The hystological alteration of small diameter sensitive nerve fibres could involve meaningful alterations of thermal reactivity of oral and body surfaces. These clinical reactivities are evident in chronic peripheal neuropathy (diabetes). These conclusions and our study results are still provisory. It will be necessary to estend and to increase our results, comparing our research with other bms etio-pathogenetic hypotesis

In search of social support in the NICU: features, benefits and antecedents of parents' tendency to share with others the premature birth of their baby.

Objective: to investigate social sharing among 40 parents (20 couples) of hospitalized premature newborns, the social network of addressees with whom they shared their experience, the perceived benefits of this activity and the sources of individual differences. Methods: emotional reaction and attachment status were assessed within seven days and between 30 and 45 days from birth, respectively. At three months of infant's corrected age, parents completed a self-report assessing retrospectively their social sharing. Results: over 80% of the parents felt the need to share the event and actually did within one week; one's own partner was the most preferred addressee. The extent of father's social sharing was mainly related to the newborn's medical risk, while mother's to her own emotional reaction. Guilt and anger were found to lengthen the latency of sharing in mothers and fathers, respectively. Secure attachment status, compared to insecure ones, was found to be the most effective in promoting social sharing. Conclusions: These findings help to understand why parents differ from each other in their use of social support in the NICU; from a practical standpoint, they highlight important factors which require attention when implementing intervention program in the NICU directed to parents of premature newborns

Oral surgery in patients treated with anticoagulating therapy: experimental model for evaluation of fibrin glue efficiency

espanolIntroduccion: En la practica de cirugia oral en los pacientes bajo terapia anti coagulante, el empleo de un sistema eficaz de accion hemostatica es de extrema relevancia, porque puede evitar la alteracion del regimen terapeutico anticoagulante y el riesgo de un exceso de sangrado. En el presente trabajo se investiga la capacidad hemostatica de la cola de fibrina como presidio hemostatico en los pacientes bajo terapia anticoagulante, exponiendo los resultados de la experimentacion sobre la base de un Standard de referencia del trauma quirurgico y de la intensidad de la terapia anticoagulante. Materiales y metodos: Han sido seleccionados 20 pacientes en terapia anticoagulante con una edad comprendida entre los 44 y 79 anos, se han realizado, segun las modalidades apropiadas, simples exodoncias o mas complejas de dientes mono-, bi- y tri-radiculares. Tras la alveoloplastia se ha colocado una esponja de fibrina reabsorbible en forma de gel (Gingistat®) y se ha realizado la sutura. El trauma quirurgico ha sido clasificado por medio de una escala cuantitativa que puede expresar de forma univoca el grado de trauma. La categoria de trauma por cada paciente se establece por la suma de los valores obtenidos de cada uno de los procedimientos unitarios. Ha sido posible evaluar el coeficiente de relacion entre la intensidad del efecto anticoagulante (medido por medio del lNR) y numero de complicaciones hemorragicas que se han verificado, ademas de entre el grado de trauma quirurgico y el numero de complicaciones que se han presentado. Resultados y Conclusiones: Se demuestra que el utilizo terapeutico de la cola de fibrina puede ser considerado como un valido soporte por la optimizacion de la hemostasis en los pacientes con alteraciones de la coagulacion inducidas farmacologica mente EnglishAim of the work: The authors emphasize how an effective emostatic method is extremely important in patients treated with anticoagulating therapy during oral surgery: it can avoid the risk of an excessive emorrhage and the necessity to alter the anticoagu- lating therapeutic regimen. The present study examines the fibrin glue emostatic ability as emostatic support in patients treated with anticoagulating therapy. It expresses the experiment results, based on standards of reference of surgical trauma and considers the anticoagulating therapy intensity. Materials and methods: 20 patients with anticoagulation therapy have been selected within the age of 44 and 79. Following the appropriate techniques extractions of teeth with one, two or three roots have been practiced. After the alveoloplasty a reabsorbable sponge of fibrine is placed and the suture is done. The surgical trauma has been classified by means of a quantitative scale which can express it without inaccuracy. The category of trauma for each patient is established by the total of the values obtained from each of the single procedures. It has been possible to evaluate the coefficient of relationship between the intensity of the anticoagulating effect (measured by the lNR) and the number of verified hemorrhagic complications; and also between the grade of surgical trauma and the number of complications. Results and conclusions: The authors demonstrate how the therapeutical usage of fibrin glue can be considered a valid support for the optimization of the haemostatis in patients with induced alterations of the coagulatio