RESUMEN
The purpose of this study was to apply decision analysis to an established practice in vascular trauma diagnosis. While exclusion arteriography has resulted in an increase in positive surgical explorations, no formal analysis that determined either the cost-effectiveness of exclusion arteriography or the cost-effectiveness ratio has been reported in the literature. We created a decision model that compared exclusion arteriography and surgical exploration, the standard used prior to the development of extremity arteriography. The decision model used predominantly literature derived estimates for the prevalence of arterial injuries and the accuracy, complications, outcomes and costs of both arteriography and exploration. Exclusion arteriography is cost-effective. This finding is robust to changes in the major model variables. Compared to surgical exploration, exclusion arteriography is a superior strategy by dominance (more effective and costs less). Therefore, a cost-effectiveness ratio cannot be calculated. Under the base case assumption of 28% prevalence of arterial injury requiring operation, exclusion arteriography saves about $2000 and adds 0.3 quality adjusted life years (QALY) for each patient. Decision analysis can be successfully applied to problems in vascular trauma diagnosis.
Asunto(s)
Angiografía/economía , Extremidades/diagnóstico por imagen , Extremidades/lesiones , Heridas y Lesiones/diagnóstico por imagen , Heridas y Lesiones/epidemiología , Angiografía/métodos , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Estudios de Seguimiento , Humanos , Prevalencia , Años de Vida Ajustados por Calidad de Vida , Sensibilidad y EspecificidadRESUMEN
PURPOSE: Many urban trauma centers have abandoned proximity arteriography, which is defined as exclusion arteriography used to evaluate the asymptomatic patient with penetrating extremity trauma near major arteries. However, decision analysis has not been applied to study proximity arteriography. MATERIALS AND METHODS: The cost-effectiveness of proximity arteriography was examined by creating a decision model that compared arteriography with observation after patient examination in the trauma unit. The model used predominantly literature-derived estimates for input variables and outcomes. The authors retrospectively reviewed arteriograms for 1 year to identify major occult injuries (requiring intervention) at their institution. After a resource-based cost analysis from the taxpayers' perspective, the cost-effectiveness ratio was calculated (incremental cost per quality-adjusted life year [QALY] gained) for proximity arteriography. RESULTS: For proximity trauma, arteriography is a dominant strategy (more effective and costs less) at a prevalence of major occult injury of 5.5% or more. Observation is a dominant strategy if the prevalence is from 0% to 0.5% or 2.0%, depending on arteriography complication assumptions. In between, arteriography is cost-effective, with a ratio of $12,100 per QALY at 2.5% prevalence (base case). Besides prevalence of occult injury, the model is sensitive to outcome assumptions for occult injuries. CONCLUSION: Proximity arteriography is a cost-effective procedure if major occult injuries equal or exceed 1.0%.
Asunto(s)
Angiografía/economía , Extremidades/lesiones , Heridas Penetrantes/diagnóstico por imagen , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Humanos , Estudios Retrospectivos , Sensibilidad y Especificidad , Heridas Penetrantes/economíaRESUMEN
PURPOSE: Transesophageal echocardiography provides detailed images of the thoracic aorta, but imaging of the abdominal aorta and its branches does not occur routinely when the transesophageal echocardiography transducer is advanced into the stomach. Transgastric aortic ultrasonography (TAUS) was investigated as an intraoperative procedure to determine whether transgastric imaging of the abdominal aortic, mesenteric, and renal arteries could be obtained and whether pathologic lesions of these arteries could be identified. METHODS: Twelve patients with diagnoses of aortic aneurysmal or occlusive disease, chronic mesenteric ischemia, or renal artery stenosis that required operative treatment were examined. Preoperative transabdominal duplex imaging was performed in all 12 patients. Transgastric B-mode and color-flow ultrasonography of the abdominal aorta and branches was performed as an intraoperative procedure with the patients under general anesthesia. After the abdomen was opened but before the vascular reconstruction was performed, the transesophageal transducer was advanced into the stomach and directed by the surgeon's hand to obtain an image of the underlying aorta and branches. TAUS images were compared with those obtained by standard transabdominal duplex imaging. RESULTS: TAUS provided high-resolution images of both aneurysmal and occlusive aortic disease. In all 12 cases the images of the aortic lumen, plaque, and thrombus obtained with TAUS had greater detail and better resolution than those obtained with transabdominal duplex imaging. The origins of the renal arteries were seen with TAUS in 23 of 24 cases, whereas transabdominal ultrasonography obtained images of the origins in only 6 of 24 cases (p < 0.01). In the five renal arteries and the one mesenteric artery with hemodynamically significant stenoses in which transabdominal ultrasonography identified the stenoses based on velocity criteria alone, TAUS visualized the occlusive plaque at the origin of the renal and mesenteric arteries. CONCLUSION: Intraoperative TAUS is feasible and may be useful for evaluating atherosclerotic disease of the abdominal aorta and renal arteries.
Asunto(s)
Aorta Abdominal/diagnóstico por imagen , Adulto , Anciano , Anestesia General , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/cirugía , Estudios de Factibilidad , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estómago , Tomografía Computarizada por Rayos X , Transductores , Ultrasonografía/instrumentación , Ultrasonografía/métodos , Ultrasonografía/estadística & datos numéricosRESUMEN
PURPOSE: Seventy-two-kilodalton type IV collagenase (MMP-2), a potent collagenase and elastase, is present in inflammatory disease states and may be important in the pathogenesis of aortic aneurysms. Alteration in expression of MMP-2 or its inhibitor, the tissue inhibitor of metalloproteinases type two (TIMP-2), could increase extracellular matrix degradation and lead to aneurysm formation. The purpose of this study is (1) to measure relative tissue levels of MMP-2 and TIMP-2 mRNA in aneurysmal, occlusive, and normal human infrarenal aorta; (2) to test for expression by cultured aneurysmal and normal vascular smooth muscle cells (VSMCs); and (3) to identify, in situ, the cells responsible for mRNA production within aneurysmal, occlusive, and normal aortic wall. METHODS: Total RNA extracted from aneurysmal (n = 8), occlusive (n = 9), and normal (n = 7) tissue was subjected to Northern analysis. Signals for MMP-2 and TIMP-2 were normalized to alpha-tubulin. Mean values +/- SE were compared by use of analysis of variance. Aneurysmal and normal VSMCs were cultured, passaged, and grown to confluence before RNA extraction and Northern analysis. In situ hybridization with digoxigenin RNA probes localized cells responsible for MMP-2 and TIMP-2 mRNA production in histologic sections of aneurysmal (n = 7), occlusive (n = 4), and normal (n = 3) aorta. RESULTS: Tissue MMP-2 mRNA levels were significantly greater in aneurysmal aorta (1.032 +/- 0.164, n = 5) than in either occlusive (0.553 +/- 0.027, n = 4, p < 0.02) or normal aorta (0.230 +/- 0.038, n = 3, p < 0.002). Differences in TIMP-2 mRNA levels were not significant (aneurysmal aorta 0.207 +/- 0.042, n = 3; occlusive aorta 0.413 +/- 0.164, n = 3; normal aorta 0.260 +/- 0.079, n = 4; p = 0.34), although numbers were small. Cultured aneurysmal and normal VSMCs constitutively expressed both MMP-2 and TIMP-2. In situ studies colocalized tissue MMP-2 and TIMP-2 expression to VSMCs and macrophages surrounding inflammation in aneurysmal adventita, but to atherosclerotic plaque in occlusive aorta. CONCLUSIONS: MMP-2 and TIMP-2 are expressed in aneurysmal, occlusive, and normal aorta. MMP-2 expression is significantly greater in aneurysmal than in either occlusive or normal aorta. Cultured aneurysmal VSMCs constitutively express both MMP-2 and TIMP-2. Differential patterns of expression seen in situ and elevated tissue MMP-2 mRNA levels in aneurysmal versus occlusive aorta suggest that MMP-2 may be responsible for localized plaque remodeling in occlusive disease and for diffuse adventitial collagen and elastin destruction in aneurysms.
Asunto(s)
Aorta Abdominal/enzimología , Aneurisma de la Aorta/enzimología , Gelatinasas/análisis , Metaloendopeptidasas/análisis , Anciano , Enfermedades de la Aorta/enzimología , Arteriopatías Oclusivas/enzimología , Northern Blotting , Células Cultivadas , Femenino , Humanos , Hibridación in Situ , Masculino , Metaloproteinasa 2 de la Matriz , Músculo Liso Vascular/enzimología , Inhibidores de Proteasas/análisis , Proteínas/análisis , ARN Mensajero/análisis , Inhibidor Tisular de Metaloproteinasa-2RESUMEN
Ninety-two-kilodalton type IV collagenase (MMP-9) is present in aortic aneurysms and may be important to the pathogenesis of this disease. Alteration in expression of MMP-9 or its inhibitor, the tissue inhibitor of metalloproteinase type 1 (TIMP-1), could increase degradation of extracellular matrix and lead to aneurysm formation. The purpose of this study was (1) to measure tissue levels of MMP-9 and TIMP-1 mRNA in aneurysmal (AAA), atherosclerotic occlusive (AOD), and normal (NL) human infrarenal aorta; (2) to test for their expression by cultured AAA and NL vascular smooth muscle cells (VSMCs); and (3) to locate in situ the cells responsible for mRNA production within AAA, AOD, and NL aortic wall. Total RNA extracted from AAA (n = 8), AOD (n = 8), and NL (n = 7) tissue was subjected to Northern analysis. Signals for MMP-9 and TIMP-1 were normalized to alpha-tubulin. Mean values +/- SEM were compared by ANOVA. NL and AAA VSMCs were cultured, passaged, and grown to confluence before RNA extraction and Northern analysis. In situ hybridization with digoxigenin-labeled RNA probes localized cells responsible for MMP-9 and TIMP-1 mRNA expression within sections of AAA (n = 5), AOD (n = 2), and NL (n = 2) aorta. MMP-9 mRNA levels were significantly greater in AAA (0.855 +/- 0.180) than NL (0.046 +/- 0.23) (P < .02), but differences between AOD (0.406 +/- 0.196) and AAA or AOD and NL were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Aorta/enzimología , Colagenasas/genética , Glicoproteínas/genética , Aneurisma/genética , Células Cultivadas , Expresión Génica , Humanos , Hibridación in Situ , Técnicas In Vitro , Metaloproteinasa 9 de la Matriz , Músculo Liso Vascular/enzimología , ARN Mensajero/genética , Inhibidores Tisulares de MetaloproteinasasRESUMEN
PURPOSE: Atheroembolization may cause limb loss or organ failure. Surgical outcome data are limited. We report the largest series of atheroembolization focusing on patterns of disease, surgical treatment and outcome. METHODS: One hundred patients (70 men), mean age 62 +/- 11 years, operated on for lower extremity, visceral, or nonthoracic outlet upper extremity atheroemboli were identified prospectively and monitored over a 12-year period. The atheroembolic source was localized by use of a combination of computed tomography scanning (n = 55), arteriography (n = 93), duplex scanning (n = 25), transesophageal echocardiography (n = 6), and magnetic resonance imaging (n = 4). Occlusive aortoiliac disease (47 patients) and small aortic aneurysms (20 patients; mean aneurysm size 3.5 +/- 0.8 cm) were the most common source of atheroemboli. Imaging studies revealed 12 patients with extensive suprarenal aortic thrombus. Correction of the embolic source was achieved with aortic bypass (n = 52), aortoiliac endarterectomy and patch (n = 11), femoral or popliteal endarterectomy and patch (n = 11), infrainguinal bypass (n = 3), extraanatomic reconstruction (n = 6), graft revision (n = 3), upper extremity bypass (n = 11), or upper extremity endarterectomy and patch (n = 3). RESULTS: All four deaths within 30 days and all seven deaths within the first 6 months after operation were among the 12 patients with suprarenal aortic thrombus. The cumulative survival probabilities for all patients at 1, 3, and 5 years were 89%, 83%, and 73%, respectively. After operation, nine patients required major leg amputations and 10 required toe amputations. Renal atheroemboli led to hemodialysis in 10 patients. Recurrent embolic events occurred in five of 97 patients monitored for a mean of 32 months. All five recurrences occurred in the first 8 months after operation. Three patients with recurrent emboli had suprarenal aortic disease, one of whom had undergone axillofemorofemoral bypass. Four of 15 patients receiving postoperative warfarin anticoagulation had development of recurrent embolism. Only one patient not receiving postoperative warfarin had a recurrent event (p < 0.05 by Fisher exact test). CONCLUSION: The atheroembolic source is the aorta or iliac arteries in two thirds of patients who underwent operation. Computed tomography scanning of the aorta is a useful diagnostic technique. The source of the emboli can be eliminated surgically with low mortality or limb loss rates except when the suprarenal aorta is involved.
Asunto(s)
Angioplastia/métodos , Embolia por Colesterol/cirugía , Endarterectomía/métodos , Extremidades/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Embolia por Colesterol/diagnóstico por imagen , Embolia por Colesterol/etiología , Embolia por Colesterol/mortalidad , Extremidades/cirugía , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Estudios Prospectivos , Recurrencia , Tasa de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos X , Warfarina/administración & dosificaciónRESUMEN
PURPOSE: Abdominal aortic aneurysms are characterized by an accelerated turnover of extracellular matrix proteins and by an inflammatory infiltrate that releases the cytokines interleukin-1 beta and tumor necrosis factor-alpha. We examined the gene expression of human aneurysmal aortic smooth muscle cells and normal aortic smooth muscle cells after treatment with interleukin-1 beta and tumor necrosis factor-alpha by measuring the changes in smooth muscle cell collagen, elastin, collagenase, and tissue inhibitor of metalloproteinase messenger ribonucleic acid levels in response to these cytokines. METHODS: Biopsy of aneurysmal aorta (n = 6) and donor normal aorta (n = 3) was obtained at operation. Medial smooth muscle cells were cultured, passaged (P2 to P4), and incubated with 0, 10, 100, or 1000 pg/ml interleukin-1 beta, tumor necrosis factor-alpha, or platelet-derived growth factor for 24 hours. Total ribonucleic acid was harvested. Percentage changes in messenger ribonucleic acid from control levels for type I and type III procollagen, elastin, collagenase, 72 kDa type IV collagenase, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 were measured by Northern hybridization. Analyses were performed with analysis of variance (p < 0.05). All comparisons between aneurysmal aortic smooth muscle cells and normal aortic smooth muscle cells represent comparisons between one aneurysmal aorta and one normal aorta. RESULTS: Added interleukin-1 beta resulted in significant, dose-dependent increases in the collagenase messenger ribonucleic acid level at all concentrations tested in both aneurysmal aorta and normal aorta. The increase in the collagenase messenger ribonucleic acid level ranged from a minimum increase of 123% for 10 pg/ml interleukin-1 beta in aneurysmal aortic smooth muscle cells to a maximum of 450% for 1000 pg/ml interleukin-1 beta in normal aortic smooth muscle cells. Interleukin-1 beta caused a significant decrease in the steady-state messenger ribonucleic acid levels for type 1 procollagen in both aneurysmal and normal aorta. The greatest reduction in type 1 procollagen messenger ribonucleic acid levels occurred at 100 pg/ml interleukin-1 beta in both aneurysmal aortic smooth muscle cells (-39%) and normal aortic smooth muscle cells (-48%). The only observed qualitative difference between aneurysmal aortic smooth muscle cells and normal aortic smooth muscle cells was the change in tissue inhibitor of metalloproteinase-1 messenger ribonucleic acid levels in response to added interleukin-1 beta. In aneurysmal aortic smooth muscle cells interleukin-1 beta at 1000 pg/ml significantly increased messenger ribonucleic acid levels by 82%, whereas levels of tissue inhibitor of metalloproteinase-1 messenger ribonucleic acid in normal aortic smooth muscle cells did not change in response to added interleukin-1 beta. Interleukin-1 beta did not alter messenger ribonucleic acid levels for type III procollagen, elastin, type IV collagenase, or tissue inhibitor of metalloproteinase-2 in aneurysmal aorta or normal aorta. When tumor necrosis factor-alpha or platelet-derived growth factor were added, this did not significantly change aneurysmal aortic smooth muscle cells messenger ribonucleic acid levels for collagenase, type IV collagenase, tissue inhibitor of metalloproteinase-1, tissue inhibitor of metalloproteinase-2, and type I and type III procollagen. CONCLUSIONS: These findings suggest that interleukin-1 beta, through its effect on smooth muscle cell collagenase and collagen gene expression, mediates the increased matrix turnover observed in aneurysms. Macrophages may induce changes in aortic smooth muscle cell gene expression in a paracrine manner that could lead to aneurysm formation.
Asunto(s)
Aorta Abdominal/metabolismo , Aneurisma de la Aorta Abdominal/metabolismo , Interleucina-1/farmacología , Músculo Liso Vascular/metabolismo , Factor de Crecimiento Derivado de Plaquetas/farmacología , ARN Mensajero/análisis , Factor de Necrosis Tumoral alfa/farmacología , Anciano , Aneurisma de la Aorta Abdominal/genética , Aneurisma de la Aorta Abdominal/patología , Colágeno/efectos de los fármacos , Colágeno/metabolismo , Colagenasas/efectos de los fármacos , Colagenasas/metabolismo , Técnicas de Cultivo , Relación Dosis-Respuesta a Droga , Elastina/efectos de los fármacos , Elastina/metabolismo , Gelatinasas/efectos de los fármacos , Gelatinasas/metabolismo , Regulación de la Expresión Génica , Genes/genética , Glicoproteínas/efectos de los fármacos , Glicoproteínas/metabolismo , Humanos , Metaloproteinasa 1 de la Matriz , Metaloproteinasa 2 de la Matriz , Inhibidores de la Metaloproteinasa de la Matriz , Metaloendopeptidasas/antagonistas & inhibidores , Metaloendopeptidasas/efectos de los fármacos , Metaloendopeptidasas/metabolismo , Persona de Mediana Edad , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/patología , Proteínas/efectos de los fármacos , Proteínas/metabolismo , Inhibidor Tisular de Metaloproteinasa-2 , Inhibidores Tisulares de MetaloproteinasasRESUMEN
Attempting proctoscopic placement of a rectosigmoid stent is proposed as a first step in treating obstructing rectosigmoid neoplasms. If stent placement is successful, elective colon resection can be performed following treatment of any coexisting medical problems that would complicate an emergency colon resection and after routine mechanical bowel preparation.
Asunto(s)
Enfermedades del Colon/terapia , Neoplasias del Colon/complicaciones , Obstrucción Intestinal/terapia , Stents , Anciano , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/etiología , Neoplasias del Colon/cirugía , Femenino , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , RadiografíaRESUMEN
OBJECTIVE: To determine whether plasma lipid hydroperoxides may be a useful marker for sepsis. DESIGN: Exploratory, open-label study. SETTING: Critical care unit at a university medical center. PATIENTS: Twelve patients with sepsis syndrome requiring hemodynamic monitoring with pulmonary artery catheters. Seven patients were diagnosed with pulmonary infections and five patients had intra-abdominal infections. INTERVENTIONS: Fatty acid hydroperoxide was measured in the fresh arterial plasma (radial artery) and mixed venous plasma (pulmonary artery) from each patient. Hydroperoxide was determined using a sensitive assay based on activating the cyclooxygenase reaction of prostaglandin H synthase. MEASUREMENTS AND MAIN RESULTS: The mean difference between the amount of fatty acid hydroperoxide measured in the plasma draining involved regions (arterial plasma for pulmonary sepsis, mixed venous plasma for intra-abdominal sepsis) compared with the paired, uninvolved regions was 0.45 +/- 0.14 microM (mean +/- SEM; p less than .005). CONCLUSIONS: Increased lipid hydroperoxides in blood-draining septic foci are markers of oxyradical release associated with severe infection, although they are not specific for infectious conditions, being released also from nonseptic regions of surgical trauma. Assays for hydroperoxides may be useful when relatively free of other tissue trauma.
Asunto(s)
Infecciones por Escherichia coli/sangre , Peróxidos Lipídicos/sangre , Infecciones por Pseudomonas/sangre , Sepsis/sangre , Infecciones Estafilocócicas/sangre , Adulto , Anciano , Anciano de 80 o más Años , Arterias , Biomarcadores/sangre , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Peritonitis/sangre , Infección de la Herida Quirúrgica/sangre , VenasRESUMEN
Autogenous vein tissue is recognized as the preferred material for extremity revascularizations that require the use of a conduit. However, the results after vascular repair of injured extremity arteries with autogenous vein interposition or bypass grafts have not been well defined. This study was done to determine both the early and late patency and limb salvage rates as well as the graft infection rate of autogenous vein repairs of injured extremity arteries. The records of 134 consecutive patients with acute extremity arterial injuries requiring repair with a reversed autogenous vein graft over a recent 5-year period were reviewed. Follow-up graft patency was defined by the presence of a palpable pulse and an extremity Doppler-derived pressure index of greater than or equal to 0.9 distal to the arterial repair. Cumulative patency was assessed by the life-table method. Acute graft thrombosis occurred in two patients, one of whom underwent successful graft thrombectomy. Four patients (3%) required extremity amputation: one patient with a thrombosed vein graft and three patients with patent vein grafts but nonsalvageable limbs as a result of myonecrosis (2) or osteomyelitis (1). No perioperative graft infections occurred. One hundred twenty-eight patients (97%) had an intact extremity and a patent vein graft at the time of hospital discharge. One hundred three patients (80%) were examined at 30 days, and all grafts were patent. Seventy-three patients (57%) were available for follow-up at intervals exceeding 6 months, and 40 patients (31%) were followed-up for periods exceeding 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Traumatismos del Brazo/cirugía , Brazo/irrigación sanguínea , Arterias/lesiones , Traumatismos de la Pierna/cirugía , Pierna/irrigación sanguínea , Vena Safena/trasplante , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos del Brazo/complicaciones , Arterias/cirugía , Niño , Estudios de Seguimiento , Humanos , Traumatismos de la Pierna/complicaciones , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Trasplante Autólogo , Grado de Desobstrucción VascularRESUMEN
Fatty acid hydroperoxides in the plasma of 18 patients who were undergoing normal postoperative periods following major thoracic or abdominal operations were measured by using a sensitive assay based upon the activation of the cyclooxygenase activity of prostaglandin H synthase. Following major thoracic operations of nine patients, the mean difference between the arterial (0.49 +/- 0.13 microM, mean +/- S.E.M.) and mixed venous (-0.09 +/- 0.12 microM) level of hydroperoxide was 0.58 +/- 0.13 microM (p less than 0.01). In marked contrast to this result, major abdominal operations of nine patients led to a mean difference between the arterial (-0.19 +/- 0.16 microM) and mixed venous (0.46 +/- 0.08 microM) hydroperoxide levels of -0.65 +/- 0.17 microM (p less than 0.01). Both pulmonary and intraabdominal tissues appear capable of generating significant amounts of fatty acid hydroperoxide in response to standard surgical procedures. The A-MV differences suggest that the blood-borne hydroperoxides were rapidly cleared from the circulation by tissue capillary beds.
Asunto(s)
Peróxido de Hidrógeno/sangre , Peróxidos Lipídicos/sangre , Periodo Posoperatorio , Abdomen/cirugía , Activación Enzimática , Radicales Libres , Humanos , Prostaglandina-Endoperóxido Sintasas/sangre , Prostaglandina-Endoperóxido Sintasas/metabolismo , Arteria Pulmonar/metabolismo , Cirugía TorácicaRESUMEN
A case of osteochondroma of the mandibular condyle has been presented. The facial and occlusal deformities produced by the tumor are described. After the surgical treatment and concomitant orthodontic treatment, satisfactory occlusion and facial contour were established.