RESUMEN
We report a case of an 80-year-old Caucasian woman on maintenance hemodialysis for almost three years through a right-tunneled jugular catheter. She presented with recurrent epistaxis for which she was periodically blood transfused despite erythropoietin therapy. She continued manifesting epistaxis, which was progressively emerging as a sign related to superior vena cava syndrome due to mediastinal mass. Laboratory investigations revealed active immunological abnormalities thereafter. Malignant superior vena syndrome remains an uncommon com-plication in this population related to a history of or ongoing central vein catheterization. Prolonged oozing from the vascular site was the first alerting sign of the existence of this syndrome. We conclude that sometimes the transformation of undifferentiated connective tissue disease in the presence of epidermoid carcinoma of the superior mediastinum may be revealed during the use of catheters in dialysis.
Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Epistaxis/etiología , Fallo Renal Crónico/terapia , Neoplasias del Mediastino/complicaciones , Diálisis Renal , Síndrome de la Vena Cava Superior/etiología , Anciano de 80 o más Años , Transfusión Sanguínea , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Diferenciación Celular , Epistaxis/diagnóstico , Epistaxis/terapia , Eritropoyetina/uso terapéutico , Femenino , Hematínicos/uso terapéutico , Humanos , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/terapia , Recurrencia , Factores de Riesgo , Síndrome de la Vena Cava Superior/diagnóstico , Síndrome de la Vena Cava Superior/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: Traditionally, tobacco is considered as part of the military culture. A cross-sectional survey was designed to clarify if smoking habit increases the caries risk in a sample of Italian adults attending a Military Academy. METHODS: Clinical examinations including dental caries and presence of bleeding at probing were carried out following WHO criteria. Related socio-behavioural factors were collected. Four calibrated examiners observed 763 subjects (men = 722; 94.6% and women = 41; 5.4%). RESULTS: One of the 763 subjects did not declare the smoking status and was excluded from the analysis. Hundred twenty-six (16.5%) subjects claimed to have never smoked, 200 (26.3%) were coded as light smokers and 436 (57.2%) as heavy tobacco users. Statistically significant linear trend across the educational level (p = 0.03), self-satisfaction with the appearance of teeth and gums (p = 0.04) and dental check-up in the past 6 months (p = 0.02) was found among the 3 subgroups. Almost the entire sample showed caries experience (84.1%). Mean DS ranged from 0.6 in the nonsmokers subgroup to 1.1 in the heavy smokers. Differences among means were statistically significant for DS, DMFS and Significant Caries Index (p = 0.01, 0.04 and 0.03, respectively). The zero-inflated regression model showed that caries severity was significantly associated with smoking habit (p = 0.02), dental check-up in the past 6 months (p = 0.01), self-satisfaction with the appearance of teeth and gums (p < 0.01) and healthy gums (p = 0.04). CONCLUSION: Heavy smokers attending a Military Academy showed a higher prevalence of caries, confirming a correlation between the disease and tobacco use.