RESUMO
Los bisfosfonatos (BF) son fármacos ampliamente utilizados como estabilizadores óseos en el tratamiento de metástasis óseas, osteoporosis, enfermedad de Paget, entre otras patologías, debido a sus efectos anti-tumorales y a la característica de inhibir la actividad osteoclástica. La osteonecrosis maxilar asociada a BF, hoy en día osteonecrosis maxilar asociada a fármacos (ONMF) es definida como la presencia de hueso expuesto, no-vascularizado y necrótico en la cavidad oral por un periodo mayor a ocho semanas, con una historia positiva de tratamiento con fármacos anti-reabsorción ósea (BP, inhibidores del ligando RANKL) y/o anti-angiogénicos y sin antecedentes de tratamiento con radiación o metástasis obvia en los maxilares. La frecuencia de ONMF es incierta. La mandíbula es más frecuentemente afectada por ONMF que el maxilar. Pocos casos de ONMF en el maxilar han sido descritos con un diagnostico de sinusitis maxilar simultáneo. Tres casos con sinusitis maxilar asociada a ONMF son presentados en este trabajo. Todos los pacientes fueron mujeres con una historia positiva de cáncer de mama y tratamiento con bisfosfonatos. Los primeros dos casos, desarrollaron ONMF después de una extracción del tercer molar maxilar. El tercer caso con ONMF en el maxilar, sólo tenía antecedentes de curetaje periodontal. Una tomografía computada fue realizada y mostró compromiso del seno maxilar en todos los pacientes. Modalidades diagnósticas para evaluar la extensión de la necrosis y el compromiso del seno, como también alternativas de tratamiento son descritas en este estudio. Finalmente, una revisión actualizada de la literatura es presentada.
Bisphosphonates are widely used as bone-stabilizers in the treatment of osseous metastases, osteoporosis, Paget's disease and others,due to their ability to inhibit osteoclast activity and anti-tumor effects. Bisphosphonate-related osteonecrosis of the jaw, nowadays medication-related osteonecrosis of the jaw (MRONJ), is defined as the presence of exposed, non-vascularized and necrotic bone tissue in the oral cavity over a period of 8 weeks with a current or previous history of treatment with antiresorptive (bisphosphonates, RANKL ligand inhibitor) and/or antiangiogenic agents, and no history of radiation therapy to the jaws or obvious metastatic disease to the jaws. The frequency of MRONJ is unclear. The mandible appears to be more frequently affected by MRONJ than the maxilla. Isolated cases of maxillary MRONJ have been described in wich a simultaneous sinusitis maxillaris was diagnosed. Three cases of MRONJ associated with maxillaris sinusitis are presented. All cases were females with a positive history of breast cancer and bisphosphonate therapy. The first two, developed MRONJ after a third molar upper extraction. The third case with MRONJ, had a history of periodontal curettage. A computed tomography was performed and showed a maxillary sinus compromise in all patients. Imaging modalities to evaluate the extent of the necrosis and the sinus compromise, as also treatment options were described in this study. Finally, an updated literature review is presented.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Sinusite Maxilar/induzido quimicamente , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Neoplasias da Mama/tratamento farmacológico , Sinusite Maxilar/terapia , Sinusite Maxilar/diagnóstico por imagem , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagemRESUMO
Objetivo: Comparar la utilidad del CRE en etapa aguda versus el CRE diferido para predecir la presencia y/o ausencia de RVU en niños con primer episodio de ITU febril. Material y métodos: Estudio retrospectivo donde se analizaron 95 pacientes con primer episodio deITU febril, a los cuales se les realizó dentro de los primeros 15 días de evolución del cuadro un CRE control y luego un CRE diferido después de 6 meses del primer episodio. Se correlacionó la presencia de alteración cintigráfica en el CRE agudo y en el CRE diferido con la existencia RVU diagnosticado mediante UCG. Resultados: La edad promedio fue de 17 meses, con 72 (75,8 por ciento) pacientes menores de 2 años de edad. Cuarenta y nueve pacientes eran de sexo femenino. Se encontró RVU en 41 de los 95 pacientes (43,2 por ciento). En la etapa aguda 93,7 por ciento de los pacientes tuvo un CRE alterado, 46,1 por ciento de los cuales tenía RVU. Ninguno de los 6 pacientes con CRE normal tuvo RVU (VPN de 100 por ciento). En el CRE diferido persistieron con alteraciones cintigráficas el 40,4 por ciento de los niños, de los cuales la mitad presentaba RVU. De los 59 niños sin alteraciones cintigráficas el 61 por ciento no tenía RVU (VPN 60 por ciento).Conclusión: El CRE diferido no es un buen predictor de RVU en niños con primer episodio de ITU febril, a diferencia del CRE realizado en etapa aguda, el cual tiene un excelente VPN para RVU.
Objective: To compare the usefulness of static renal scintigraphy done in the acute phase of febrile UTI versus late static renal scintigraphy to predicit the presence and/or absence of VUR in children with first episode of febrile UTI. Materials and methods: Retrospective study that analized 95 patients with first episode of febrile UTI, to whom a control static renal scintigraphy was done in the first 15 days of the UTI and then late static renal scintigraphy was performed after 6 months of the first episode of UTI. A correlation was made between the presence of scintigraphic abnormalities in the acute phase static renal scintigraphy and late static renal scintigraphy with the existence of VUR diagnosed by VUG. Results: The mean age was 17 months, with 72 (75.8 percent) patients younger than 2 years. Forty-nine patients were girls. VUR was found in 41 of the 95 patients (43.2 percent). In the acute phase 93.7 percent of the patients had an abnormal static renal scintigraphy, 46.1 percent of which had VUR. None of the 6 patients with a normal static renal scintigraphy had VUR (NVP de 100 percent). In the late static renal scintigraphy 40.4 percent of the patients persisted with scintigraphic alterations, the presence of VUR in this group of patients was of 50 percent. Of the 59 patients without scintigraphic abnormalities 61 percent did not have VUR (PPV 60 percent).Conclusion: The late static renal scintigraphy is not a good predictor of VUR in children with first episode of febrile UTI, unlike the static renal scintigraphy done in the acute phase of the illness, which has an excelent NPV for VUR.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Cintilografia/métodos , Infecções Urinárias , Infecções Urinárias/complicações , Refluxo Vesicoureteral , Refluxo Vesicoureteral/etiologia , Estudos Retrospectivos , Fatores de Tempo , Febre , Rim , Rim/patologia , Valor Preditivo dos TestesRESUMO
La encefalitis herpética es la causa más frecuente de encefalitis esporádica en el mundo occidental. Para conocer las principales características clínicas de esta enfermedad en nuestro medio, se efectuó un análisis de casos confirmados por reacción de polimerasa en cadena en dos hospitales universitarios de Santiago. Un total de 15 casos pudo ser identificado con un promedio de edad de 41 años (5-78 años) y 80% ³ 30 años, el primero de ellos el año 1998. La mayor parte se presentó con fiebre y compromiso de conciencia (80% cada uno) o cefalea (67%). Las convulsiones y la focalización fueron infrecuentes (£ 15%) y sólo 2 casos (13%) tuvieron además una manifestación herpética extracerebral. La duración promedio de los síntomas fue de 3,8 días. La mayor parte estuvo asociada al serotipo 1 (86,7%). El 91,7% de los casos evaluados presentó alteraciones electroencefalográficas, 81,8% alteraciones en la resonancia magnética y sólo 13,3% en la tomografía axial computarizada. La totalidad de los pacientes fue tratada con aciclovir y la letalidad fue de 13,3%, aunque el deceso en un paciente con SIDA y linfoma del SNC no pudo ser atribuido a la infección herpética. Seis pacientes (40%) presentaban secuelas neurológicas al momento del egreso. La muerte o alteraciones neurológicas al alta estuvieron asociadas significativamente a un inicio del tratamiento > 3 días desde el inicio de los síntomas. (p = 0,01 prueba bilateral de Fisher).
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encefalite por Herpes Simples/diagnóstico , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Encefalite por Herpes Simples/líquido cefalorraquidiano , Encefalite por Herpes Simples/tratamento farmacológico , Herpesvirus Humano 1/isolamento & purificação , /isolamento & purificação , Reação em Cadeia da PolimeraseRESUMO
Aquaporin-2 (AQP-2) is the vasopressin-regulated water channel expressed in the apical membrane of principal cells in the collecting duct and is involved in the urinary concentrating mechanism. In the rat distal colon, vasopressin stimulates water absorption through an unknown mechanism. With the hypothesis that AQP-2 could contribute to this vasopressin effect, we studied its presence in rat colonic epithelium. We used RT-PCR, in situ hybridization, immunoblotting, and immunocytochemistry to probe for AQP-2 expression. An AQP-2 amplicon was obtained through RT-PCR of colon epithelium RNA, and in situ hybridization revealed AQP-2 mRNA in colonic crypts and, to a lesser extent, in surface absorptive epithelial cells. AQP-2 protein was localized to the apical membrane of surface absorptive epithelial cells, where it colocalized with H(+)-K(+)-ATPase but not with Na(+)-K(+)-ATPase. AQP-2 was absent from the small intestine, stomach, and liver. Water deprivation increased the hybridization signal and the protein level (assessed by Western blot analysis) for AQP-2 in distal colon. This was accompanied by increased p-chloromercuriphenylsulfonic acid-sensitive water absorption. These results indicate that AQP-2 is present in the rat distal colon, where it might be involved in a water-sparing mechanism. In addition, these results support the idea that AQP-2, and probably other aquaporins, are involved in water absorption in the colon.
Assuntos
Aquaporinas/biossíntese , Membrana Celular/metabolismo , Colo/metabolismo , Mucosa Intestinal/metabolismo , Animais , Aquaporina 2 , Aquaporina 6 , Aquaporinas/antagonistas & inibidores , Aquaporinas/genética , Western Blotting , Colo/citologia , Regulação da Expressão Gênica/fisiologia , Imuno-Histoquímica , Hibridização In Situ , Mucosa Intestinal/citologia , Masculino , RNA Mensageiro/análise , RNA Mensageiro/biossíntese , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Água/metabolismo , Privação de Água/fisiologiaRESUMO
BACKGROUND: Scleritis and episcleritis may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. AIM: To evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. PATIENTS AND METHODS: Forty six patients with refractory scleritis and episcleritis were studied and treated during the period 1991 to 1998. RESULTS: Necrotizing type was the most common and severe category in the scleritis group of patients. A decrease in vision occurred in 58.3% of patients with scleritis v/s a 23.5% of patients with epiescleritis (p < 0.05). Uveitis was present in 35.4% of patients with scleritis and scleromalacia was present in 33.3% (p < 0.05). A specific disease association was uncovered in 51% of scleritis and in 38% of episcleritis patients. Rheumatoid arthritis, primary systemic vasculitic disease and Sjögren syndrome with vasculitis were the most common associated systemic diseases. Three patients with scleritis had tuberculosis. CONCLUSIONS: Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information. A meticulous approach for the detection of a specific associated disease must be undertaken. Scleritis associated with vasculitis has a worse ocular prognosis than other non infectious diseases. Cyclophosphamide is the most effective immunosuppressive treatment to control severe ocular involvement.
Assuntos
Esclerite/tratamento farmacológico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Recidiva , Esclerite/complicações , Esclerite/diagnóstico por imagem , Resultado do TratamentoRESUMO
Milk urea determination is being used as a broad indicator of protein/energy imbalance in dairy herds. The main purpose of this study was to compare blood and bulk milk urea values in grazing herds, to evaluate their seasonal variation under South Chilean conditions, and to examine their potential relationships with herd fertility. The association between herd blood urea concentration (mean of seven lactating cows) and bulk milk urea concentration (tank containing milk from the previous 24 h) was determined in 21 diary herds. Reference values, seasonal and herd variance, and the frequency of herds with values outside a range of 2.5 to 7.3 mmol/l were determined in bulk milk samples obtained monthly for a period of one year from 82 suppliers at two creameries located in southern Chile. Finally, bulk milk urea was measured every two weeks in samples from 24 herds, and the first service conception rate (FSCR) from 2153 dairy cows was determined. Mean bulk urea concentration was highly correlated with mean herd blood urea concentration (r = 0.95; p < 0.01). Mean urea concentration in the bulk milk samples obtained during one year from 82 herds was 4.9 +/- 1.2 mmol/l, with a range of 1.5 to 11.6 mmol/l. The highest values were found during spring and the lowest values during the summer. There was a high seasonal variation (CV = 13-47%) and between-herd variation (CV = 20-31%). Out of a total of 984 samples, 5.4% had urea values > 7.3 mmol/l and 3.8% had values < 2.5 mmol/l. Of the 82 herds, 27% had values outside the reference interval (2.5-7.3 mmol/l) on two or more occasions. FSCR was lower in herds when the bulk milk urea was > 7.3 mmol/l (50.7%) than in cows, where the urea concentration was < 5.0 mmol/l (73.8%) at the time of insemination. The study concluded that bulk milk urea concentrations provided information similar to herd blood urea concentrations in local grazing dairy herds. There was a high frequency of herds with abnormal values, with large variations between herds and between seasons. Increased milk urea concentrations during spring were associated with lower conception rates.
Assuntos
Bovinos/metabolismo , Fertilidade/fisiologia , Leite/química , Ureia/análise , Ureia/sangue , Animais , Chile , Indústria de Laticínios , Feminino , Estações do AnoRESUMO
Los aneurismas de las arterias carótidas extracraneales son lesiones muy poco frecuentes. En Chile sólo se han reportado cinco casos: dos ateroescleróticos, dos congénitos y uno secundario a extirpación de tumor del cuerpo carotídeo. Aunque obedecen a diferentes causas, aquellos secundarios a endarterectomía carotídea son bastante infrecuentes, reportándose una incidencia de 0,30 por ciento en la literatura mundial, por lo que el objetivo de esta presentación es reportar un caso clínico de esta patología. Se presenta un caso de aneurisma postendarterectomía carotídea, de aparición tardía, que, aparte de presentar un aumento de volumen pulsátil en la región cervical, refiere varios episodios transitorios de isquemia cerebral. Su diagnóstico fue hecho en base a eco Doppler y angiografía, siendo operada con shunt para mantener la circulación cerebral, efectuándose una reparación de la arteria con parche de vena safena. Se concluye que el tratamiento de esta patología radica en un minucioso estudio preoperatorio, y en cuanto a su tratamiento es importante la utilización de shunt intraoperatorio, donde la reparación debe ser simple y efectiva a fin de prevenir nuevos episodios de isquemia cerebral
Assuntos
Humanos , Feminino , Idoso , Aneurisma/etiologia , Endarterectomia das Carótidas/efeitos adversos , Isquemia Encefálica/prevenção & controle , Angiografia Cerebral/estatística & dados numéricos , Ecocardiografia Doppler/estatística & dados numéricosRESUMO
Si bien el falso aneurisma es una formación que no posee todas las capas de la pared arterial, su tratamiento quirúrgico es similar a los aneurismas. Se presenta nuestra experiencia quirúrgica en el tratamiento de esta patología. Se revisan en forma retrospectiva 9 pacientes operados en 53 meses. Como etiología, 6 son del tipo traumático y 3 son del tipo iatrogénico. De estos últimos, 2 son anastomáticos y uno es por punción arterial. La localización más frecuente correspondió a la arteria femoral común. El diagnóstico se confirmó con angiografía y Eco Doppler. El tratamiento quirúrgico en la mayoría fue el reemplazo arterial con vena prótesis vascular. Hubo un paciente complicado que presentó una infección de prótesis tratado sólo con antibioterapia. No hubo mortalidad. Finalmente, se concluye que esta patología es evitable a través de un equipo entrenado en trauma vascular, el evitar el uso de prótesis vascular y una buena técnica quirúrgica
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Falso Aneurisma/cirurgia , Artéria Femoral/cirurgia , Implante de Prótese Vascular/métodos , Distribuição por Idade , Falso Aneurisma , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Estudos Retrospectivos , Veia Safena/cirurgia , Distribuição por SexoRESUMO
Se presenta un caso de tumor del cuerpo carotídeo. El tratamiento de estos tumores es de preferencia quirúrgico. El ecodoppler color, la tomografía computarizada y/o la resonancia nuclear magnética son importantes en el diagnóstico de esta enfermedad. Sin embargo, la angiografía de los vasos carotídeos es esencial en la evaluación preoperatoria. En manejo quirúrgico incluye la identificación y preservación de estructuras vasculares y nerviosas adyacentes al tumor. Algunos tumores estarán íntimamente adheridos a la circunferencia de la bifurcación carotídea, por lo que será necesario resecar el tumor con la porción de carotídea interna, que será reconstruida con vena safena. En los grandes tumores debiera considerarse la embolización preoperatoria para facilitar su resección.
Assuntos
Humanos , Masculino , Adulto , Artéria Carótida Interna/cirurgia , Tumor do Corpo Carotídeo/cirurgia , Angiografia , Embolização Terapêutica , Tomografia Computadorizada de Emissão , Tumor do Corpo Carotídeo/patologia , Tumor do Corpo CarotídeoRESUMO
The light-dark cycle exerts an influence over the lipostatic mechanism in the superior vertebrate animals promoting an acceleration in the lipid synthesis rate during the dark period (in the case of rodents) and a higher lipolitic rate during the day. This cycle, the feeding habits, and the awake-sleep cycle are syncronized. The Growth Hormone is a molecule that facilitates the lipolysis and the protein synthesis. This hormone is released, by the pituitary gland, during the puberty and during the short wave sleep period. Modifying the light-dark cycle and in consequence the sleep-awake cycle and the food consumption, we pretend to study its influence over the growth rate in weight and length in animals that consume 100% of its nutritional requirements. Also want to dilucidate if an alteration of the cycle (18 h light 6 h dark) in the malnourished animals can revert the deficiency of the growth rate expected in these animals. Male Wistar rats (160); 21 days old, adapted to the temperature and to the light-dark cycle (12 h-12 h) during a week. Then, four groups were formed; Group I: Well nourished rats with a light-dark (12 h-12 h) cycle; Group II: Well nourished rats with a light-dark (18 h-6 h) cycle; Group III: Malnourished rats with a light-dark (12 h-12 h) cycle; Group IV: Malnourished rats with a light-dark (18 h-6 h) cycle. Its length and weight were registered weekly, obtained its growth rates, and the results were analysed by the ONE-WAY ANOVA and orthogonal contrasts. It was found a significant difference in the growth rate in weight between the Groups I and II; the growth rate in weight in the Group III had a higher slope than the rate in the Group IV but we did not find a significant difference. The growth rate in length did not show a significant difference between the Groups III and IV. The last weight in the malnourished animals represented 55% of the control animals last weight; and 47% of the Group IV. The last length of the animals of the Group III represented 90% of the control value, and the last length in the Group IV represented 82% of the control animals value. The feeding habits are modified changing the cycle to 18 h light and 6 h dark. Modifying the light-dark cycle appears an accelerating rate in the growth rate in weight in the well nourished animals, but not in the malnourished ones.
Assuntos
Escuridão , Luz , Estado Nutricional , Ratos/crescimento & desenvolvimento , Análise de Variância , Animais , Biometria , Peso Corporal , Ingestão de Alimentos , Comportamento Alimentar , Masculino , Ratos/anatomia & histologia , Ratos Wistar , Sono , VigíliaAssuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Apendicite , Diagnóstico DiferencialRESUMO
La enfermedad de Behcet es una patología poco frecuente en Chile que afecta principalmente a adultos jóvenes de países Mediterráneos y Japón. Se caracteriza por compromiso multisistémico siendo las manifestaciones cardiovasculares inusuales. Presentamos el caso de un paciente portador de Enfermedad de Behcet, quien es hospitalizado por dolor y aumento de volumen pulsátil inguinal derecho. El estudio angiográfico revela falso aneurisma femoral común de 5 cm de diámetro. Luego de destacar compromiso arterial en otra localización es intervenido demostrándose que el falso aneurisma se origina desde un defecto posterolateral el cual es reparado con parche de vena safena. No se presentaron complicaciones postoperatorias. El estudio histopatológico no demostró fragmentación o disminución en el número de fibras elásticas ni el depósito de inmunoglobulinas o complemento
Assuntos
Adulto , Humanos , Masculino , Aneurisma , Artéria Femoral , Síndrome de Behçet/cirurgiaAssuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Drenagem , Abscesso/terapia , Abdome , Abscesso Subfrênico/terapia , Idoso de 80 Anos ou mais , Cateteres de Demora , Drenagem/instrumentação , Estudos Retrospectivos , Abscesso Hepático/terapiaRESUMO
Rio Negro Country (40 degrees 48'-40 degrees 50' South lat.; 73 degrees 12'-73 degrees 13' West long.), is located in the province of Osorno, South of Chile. It has a population of 18,031 inhabitants, with 39% in rural areas. The basic economic activity is cattle raising (cows, pigs). According to reports, prevalence of human hydatidosis in 1988 was 11.1 per 100,000. In order to contribute to a better knowledge of human hydatidosis in Rio Negro County, an indirect hemagglutination test (IHAT) was performed to 509 randomized persons. Five (1.0%) individuals resulted positive.