RESUMO
Las contenciones fijas en ortodoncia han demostrado tener excelentes resultados para la estabilidad y durabilidad del tratamiento. A pesar de esto, se ha observado que existen ciertos movimientos dentarios indeseados totalmente diferentes a una recidiva a su posición inicial previa al tratamiento de ortodoncia. El llamado "efecto giro" es uno de ellos, y se caracteriza por ser una inclinación en sentidos opuestos de los caninos contralaterales, en donde uno presenta una inclinación hacia vestibular y el otro hacia lingual o palatino. Se presenta principalmente en la mandíbula, a pesar de que la contención permanece perfectamente adherida a los dientes. El objetivo de esta revisión bibliográfica es evaluar los distintos factores reportados en la literatura que puedan estar relacionados con la aparición del "efecto giro" y qué tan relevantes pueden ser en su desarrollo. Como conclusión es importante considerar el carácter multifactorial de este tipo de complicaciones, en donde el tipo y calidad del alambre que se utilice para la contención, junto con las características periodontales del paciente demostraron tener cierta participación en la génesis de este, por lo tanto, resulta fundamental concientizar a los pacientes de la importancia de los controles ortodóncicos periódicos posteriores al retiro de los aparatos fijos para monitorear y controlar los resultados oclusales logrados y el estado de los dispositivos de contención instalados.
As contenções fixas em ortodontia têm demonstrado excelentes resultados para a estabilidade e durabilidade do tratamento. Apesar disso, observou-se que existem certos movimentos dentários indesejados totalmente diferentes de uma recorrência à sua posição inicial anterior ao tratamento ortodôntico. O chamado "efeito de torção" é um deles, e se caracteriza por uma inclinação em sentidos opostos dos caninos contralaterais, onde um apresenta uma inclinação para vestibular e outro para lingual ou palatino. Ocorre principalmente na mandíbula, apesar do retentor permanecer perfeitamente preso aos dentes. O objetivo desta revisão bibliográfica é avaliar os diferentes fatores relatados na literatura que podem estar relacionados ao aparecimento do "efeito turn" e quão relevantes podem ser no seu desenvolvimento. Em conclusão, é importante considerar a natureza multifatorial deste tipo de complicações, onde o tipo e a qualidade do fio utilizado para contenção, juntamente com as características periodontais do paciente, mostraram algum envolvimento na sua génese, pelo que é essencial conscientizar os pacientes sobre a importância de check-ups ortodônticos periódicos após a remoção dos aparelhos fixos para monitorar e controlar os resultados oclusais alcançados e o estado dos dispositivos de contenção instalados.
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Resumen Introducción: El neumomediastino se define como la presencia de aire o gas dentro de los planos fasciales del mediastino. Por lo general, es un fenómeno secundario a perforaciones traumáticas del tracto aerodigestivo. El neumomediastino secundario a una fractura orbitaria es un evento raro. Se asocia a complicaciones potencialmente mortales como el neumotórax, el neumopericardio y la mediastinitis. Objetivo: Describir un caso de neumomediastino secundario a una fractura aislada de piso orbitario y su manejo médico-quirúrgico. Caso clínico: Paciente de sexo femenino de 42 años que sufre traumatismo en regiones facial, cervical y torácica desarrollando secundariamente un enfisema subcutáneo panfacial y un neumomediastino, el cual se resuelve exitosamente. Discusión: El neumomediastino secundario a una fractura aislada de piso orbitario es un evento muy raro. El aire puede descender a lo largo de los espacios fasciales hasta el mediastino. En este sentido, sonarse la nariz es un factor de riesgo para desarrollar esta pa-tología. Conclusión: Ocurrido un trauma maxilofacial puede presentarse enfisemas de espacios profundos de la cabeza, cuello e incluso el mediastino.
Introduction: Pneumomediastinum is defined as the presence of air or gas within the fascial planes of the mediastinum. It is usually a phenomenon secondary to traumatic perforations of the aerodigestive tract. Pneumomediastinum secondary to an orbital fracture is a rare event. And it is related to life-threatening complications such as pneumothorax, pneumopericardium and mediastinitis. Aim: To describe a case of pneumomediastinum secondary to an isolated orbital floor fracture and its medical-surgical management. Clinical case: A 42-year-old female patient who suffers trauma to the facial, cervical and thoracic regions, secondary development of a subcutaneous panfacial emphysema and pneumomediastinum, which resolves successfully. Discussion: Pneumomediastinum following an isolated orbital floor fracture is a very rare event. The air can descend along the fascial spaces to the mediastinum. In this sense, blowing your nose is a risk factor to develop this pathology. Conclusion: After a maxillofacial trauma, emphysema of the deep spaces of the head, neck and even the mediastinum can occur
Assuntos
Humanos , Feminino , Adulto , Fraturas Orbitárias/cirurgia , Fraturas Orbitárias/complicações , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Órbita/lesões , Fraturas Orbitárias/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fixação de Fratura , Enfisema Mediastínico/diagnóstico por imagemRESUMO
Resumen Introducción: El tratamiento inoportuno e ineficaz de las infecciones odontogénicas puede causar complicaciones potencialmente mortales como la mediastinitis necrotizante descendente (MND). La MDN es una infección grave que afecta al cuello-tórax, con una alta tasa de mortalidad por sepsis e insuficiencia orgánica si no se trata de manera rápida y efectiva. Objetivo: Describir un caso de MND de origen odontogénico y su manejo médico-quirúrgico. Caso clínico: Presentamos un paciente de sexo masculino de 34 años que ingresa con un cuadro infeccioso agudo de origen odontogénico, que compromete espacios de la cabeza, cuello y tórax (mediastino superior), el cual se trata exitosamente. Discusión: Las infecciones odontogénicas son generalmente localizadas y que se pueden tratar mediante terapias convencionales. A pesar de esto, si estas infecciones no pueden controlarse, ya sea por no realización de tratamientos oportunos o por estados inmunosuprimidos del paciente, se pueden desarrollar diferentes complicaciones como la MND. Conclusión: Un diagnóstico rápido, el tratamiento quirúrgico agresivo, la terapia antibiótica adecuada y la atención de apoyo son los pilares fundamentales para el manejo de la MND.
Introduction: Inappropriate and ineffective treatment of odontogenic infections can cause life-threatening complications such as Descending Necrotizing Mediastinitis (MND). MDN is a serious infection that affects the neck-thorax, with a high mortality rate from sepsis and organ failure if it is not treated quickly and effectively. Aim: To describe a case of MND of odontogenic origin and its medical-surgical management. Case report: We present a 34-year-old male patient who is admitted with an acute infectious condition of odontogenic origin, which compromises spaces of the head, neck and thorax (upper mediastinum), which is treated successfully. Discussion: Odontogenic infections are generally localized and can be treated by conventional therapies. In spite of this, if these infections cannot be controlled, either by not carrying out appropriate treatments or by immunosuppressed states of the patient, different complications such as MND can develop. Conclusion: A rapid diagnosis, aggressive surgical treatment, adequate antibiotic therapy and supportive care are the fundamental pillars for the management of MND.
Assuntos
Humanos , Masculino , Adulto , Infecção Focal Dentária/cirurgia , Infecção Focal Dentária/complicações , Mediastinite/cirurgia , Mediastinite/etiologia , Necrose/terapia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Infecção Focal Dentária/diagnóstico por imagem , Mediastinite/diagnóstico por imagem , Pescoço/cirurgiaRESUMO
Microaeration can be used to cost-effectively remove in-situ H2S from the biogas generated in anaerobic digesters. This study is aimed at developing and validating an extension of the Anaerobic Digestion Model n°1 capable of incorporating the main phenomena which occurs during microaeration. This innovative model was implemented and tested with data from a pilot scale digester microaerated for â¼ 200 d. The results showed that despite the model's initial ability to predict the digester's behavior, its predicted performance was improved by calibrating the most influential parameters. The model's prediction potential was largely enhanced by adding retention parameters that account for the activity of sulfide oxidizing bacteria retained inside the anaerobic digester, which have been consistently shown to be responsible for a large share of the H2S removed.
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RESUMEN: La sialometaplasia necrotizante (SN) es una rara enfermedad benigna, inflamatoria, autolimitante, que afecta más frecuentemente a las glándulas salivales menores y que comúnmente se asocia a las ubicadas en la porción más posterior del paladar duro. Su etiología no esta clara, la mayoría de los autores sugieren que una lesión química, física o biológica de los vasos sanguíneos produciría cambios isquémicos, que provocarían infarto del tejido glandular con necrosis, inflamación e intento de reparación. Clínicamente puede presentarse como una úlcera de márgenes irregulares, ligeramente elevados y lecho necrótico, mientras que histopatológicamente se caracteriza por presentar metaplasia escamosa de conductos y acinos e hiperplasia pseudoepiteliomatosa del epitelio mucoso. La similitud de sus características clínicas e histopatológicas con algunas lesiones glandulares malignas de la cavidad oral, puede resultar en tratamientos innecesarios, considerando que la SN se trata de una patología autoresolutiva, por lo que es fundamental realizar un correcto diagnóstico clínico e histopatológico para evitar tratamientos quirúrgicos mutilantes o innecesarios. En el presente trabajo se presenta un caso de una mujer joven, con diagnóstico de SN, con sus características clínicas, histopatológicas y la evolución de la lesión.
ABSTRACT: The Necrotizing Sialometaplazia (NS) it's a rare self-limiting, inflammatory, benign disease, that most frequently affects the minor salivary glands and it is commonly associated to the glands located at the most posterior portion of the hard palate. Its etiology is not clear. Most authors suggest that a chemical, physical or biological lesion of the blood vessels would produce ischemic changes, which lead to infarction of muscle tissue with necrosis, inflammation and attempts to repair. Clinically it can present as a slightly elevated ulcer with irregular edges and necrotic bed, while histopathologically it is characterized for present squamous metaplasia of ducts and acini and pseudoepitheliomatous hyperplasia of mucosal epithelium. The similarity of its clinical and histopathological characteristics with some malignant glandular lesions of the oral cavity, can result in unnecessary treatments, considering that NS is a self-sustaining pathology, it is therefore essential to perform a correct clinical and histopathological diagnosis to avoid mutilating or unnecessary surgical treatments. In the present work we present the case of a young woman, with diagnosis of NS, with its clinical and histopathological characteristics and the evolution of the lesion.
Assuntos
Humanos , Feminino , Adulto , Sialometaplasia Necrosante/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Glândulas Salivares/patologia , Biópsia , Tomografia Computadorizada de Emissão , Palato Duro , Diagnóstico DiferencialRESUMO
Partition coefficients serve in various areas as pharmacology and environmental sciences to predict the hydrophobicity of different substances. Recently, they have also been used to address the accuracy of force fields for various organic compounds and specifically the methylated DNA bases. In this study, atomic charges were derived by different partitioning methods (Hirshfeld and Minimal Basis Iterative Stockholder) directly from the electron density obtained by electronic structure calculations in a vacuum, with an implicit solvation model or with explicit solvation taking the dynamics of the solute and the solvent into account. To test the ability of these charges to describe electrostatic interactions in force fields for condensed phases, the original atomic charges of the AMBER99 force field were replaced with the new atomic charges and combined with different solvent models to obtain the hydration and chloroform solvation free energies by molecular dynamics simulations. Chloroform-water partition coefficients derived from the obtained free energies were compared to experimental and previously reported values obtained with the GAFF or the AMBER-99 force field. The results show that good agreement with experimental data is obtained when the polarization of the electron density by the solvent has been taken into account, and when the energy needed to polarize the electron density of the solute has been considered in the transfer free energy. These results were further confirmed by hydration free energies of polar and aromatic amino acid side chain analogs. Comparison of the two partitioning methods, Hirshfeld-I and Minimal Basis Iterative Stockholder (MBIS), revealed some deficiencies in the Hirshfeld-I method related to the unstable isolated anionic nitrogen pro-atom used in the method. Hydration free energies and partitioning coefficients obtained with atomic charges from the MBIS partitioning method accounting for polarization by the implicit solvation model are in good agreement with the experimental values. © 2018 Wiley Periodicals, Inc.
Assuntos
Metilação de DNA , DNA/química , Elétrons , Simulação de Dinâmica Molecular , Termodinâmica , Pareamento de Bases , Clorofórmio/química , Água/químicaRESUMO
Noninvasive ventilation (NIV) frequently involves the development of facial pressure ulcers (FPU). Its prevention considers the empirical use of protective patches between skin and mask, in order to reduce the pressure exerted by it. OBJECTIVES: To evaluate the effect of protective patches on the pressure exerted by the facial mask, and its impact on the programmed ventilatory parameters. METHOD: Bilevel NIV simulated model using full face mask in phantom with a physiological airway (ALS PRO +) in supine position. Forehead, chin and cheekbones pressure were measured using 3 types of standard protective patches versus a control group using pressure sensors (Interlinks Electronics®). The values obtained with the protective patches-mask model were evaluated in the programmed variables maximum inspiratory flow (MIF)), expired tidal volume (Vte) and positive inspiratory pressure (IPAP), with Trilogy 100 ventilator, Respironics®. The programming and recording of the variables was carried out in 8 opportunities in each group by independent operators. RESULTS: There was no decrease in facial pressure with any of the protective patches compared to the control group. Moltopren increased facial pressure at all support points (p < 0.001), increased leakage, it decreased MIF, Vte and IPAP (p < 0.001). Hydrocolloid patches increased facial pressure only in the left cheekbone, increased leakage and decreased MIF. Polyurethane patches did not produce changes in facial pressure or ventilatory variables. CONCLUSION: The use of protective patches of moltopren, hydrocolloid and polyurethane transparent did not contribute to the decrease of the facial pressure. A deleterious effect of the moltopren and hydrocolloid patches was observed on the administration of ventilatory variables, concluding that the non-use of the protective patches allowed a better administration of the programmed parameters.
Assuntos
Bandagens , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Máscaras/efeitos adversos , Ventilação não Invasiva/instrumentação , Úlcera por Pressão/prevenção & controle , Pressão/efeitos adversos , Face , Humanos , Manequins , Úlcera por Pressão/etiologiaRESUMO
La ventilación mecánica no invasiva (VMNI) tiene como complicación frecuente el desarrollo de úlceras faciales por presión (UPP). Su prevención considera el uso empírico de parches protectores entre piel y mascarilla, para disminuir la presión ejercida por ésta. Objetivos: Evaluar el efecto de los parches protectores sobre la presión ejercida por la mascarilla facial, y su impacto en los parámetros ventilatorios programados. Método: Modelo simulado de VMNI binivelada usando mascarilla facial total en fantoma con vía aérea fisiológica (ALS PRO+) en posición supina. Se midió la presión en frente, mentón y pómulos, usando 3 tipos de parches protectores de uso habitual versus un grupo control, utilizando sensores de presión (Interlinks Electronics®). Se evaluaron los valores obtenidos con el modelo de mascarilla-parches protectores en las variables programadas flujo máximo inspiratorio (FMI), volumen corriente espirado (Vte) y presión positiva inspiratoria (IPAP), con ventilador Trilogy 100, Respironics®. La programación y registro de las variables fue efectuada en 8 oportunidades en cada grupo por operadores independientes. Resultados: No se observó disminución de la presión facial con ninguno de los parches protectores respecto al grupo control. Moltoprén aumentó la presión facial en todos los puntos de apoyo (p < 0,001), aumentó fuga, disminuyó FMI, Vte e IPAP (p < 0,001). Parches de hidrocoloide aumentaron la presión facial sólo en pómulo izquierdo, aumentaron la fuga y disminuyeron FMI. Parches de poliuretano no generaron cambios en la presión facial ni en variables ventilatorias. Conclusión: El uso de parches protectores de moltoprén, hidrocoloide y poliuretano transparente no contribuyó a la disminución de la presión facial. Se observó un efecto deletéreo de los parches de moltoprén e hidrocoloide sobre la administración de variables ventilatorias, concluyendo que el no uso de los parches protectores permitió una mejor administración de los parámetros programados.
Noninvasive ventilation (NIV) frequently involves the development of facial pressure ulcers (FPU). Its prevention considers the empirical use of protective patches between skin and mask, in order to reduce the pressure exerted by it. Objectives: To evaluate the effect of protective patches on the pressure exerted by the facial mask, and its impact on the programmed ventilatory parameters. Method: Bilevel NIV simulated model using full face mask in phantom with a physiological airway (ALS PRO +) in supine position. Forehead, chin and cheekbones pressure were measured using 3 types of standard protective patches versus a control group using pressure sensors (Interlinks Electronics®). The values obtained with the protective patches-mask model were evaluated in the programmed variables maximum inspiratory flow (MIF)), expired tidal volume (Vte) and positive inspiratory pressure (IPAP), with Trilogy 100 ventilator, Respironics®. The programming and recording of the variables was carried out in 8 opportunities in each group by independent operators. Results: There was no decrease in facial pressure with any of the protective patches compared to the control group. Moltopren increased facial pressure at all support points (p < 0.001), increased leakage, it decreased MIF, Vte and IPAP (p < 0.001). Hydrocolloid patches increased facial pressure only in the left cheekbone, increased leakage and decreased MIF. Polyurethane patches did not produce changes in facial pressure or ventilatory variables. Conclusion: The use of protective patches of moltopren, hydrocolloid and polyurethane transparent did not contribute to the decrease of the facial pressure. A deleterious effect of the moltopren and hydrocolloid patches was observed on the administration of ventilatory variables, concluding that the non-use of the protective patches allowed a better administration of the programmed parameters.
Assuntos
Humanos , Pressão/efeitos adversos , Bandagens , Úlcera por Pressão/prevenção & controle , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Ventilação não Invasiva/instrumentação , Máscaras/efeitos adversos , Úlcera por Pressão/etiologia , Face , ManequinsRESUMO
INTRODUCTION: The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. OBJECTIVE: To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. PATIENTS AND METHOD: An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P≤.05. RESULTS: The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7kg (2-10kg); 95 percentile: 3.7 months and 5.7kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P=.013), radiography (P=018), connection context (P<.0001), pCO2 (median 40.7mmHg [15.4-67 mmHg] versus 47.3mmHg [28.6-71.3mmHg], P=.004) and hours on HFNC (median 60.75hrs [5-621.5 hrs] versus 10.5hrs [1-29 hrs], P<.0001). The OR of the PCO2 ≥ 55mmHg for failure was 2.97 (95% CI; 1.08-8.17; P=.035). No patient died and no complications were recorded. CONCLUSION: The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.
Assuntos
Cateterismo/métodos , Cuidados Críticos/métodos , Pneumopatias/terapia , Oxigenoterapia/métodos , Administração Intranasal , Gasometria , Bronquiolite/epidemiologia , Bronquiolite/terapia , Dióxido de Carbono/sangue , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Modelos Logísticos , Estudos Longitudinais , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Doenças Pulmonares Intersticiais/epidemiologia , Doenças Pulmonares Intersticiais/terapia , Masculino , Falha de Tratamento , Resultado do TratamentoRESUMO
Introducción: La cánula nasal de alto flujo (CNAF) es un método de soporte respiratorio cada vez más utilizado en pediatría por sus resultados y seguridad. Objetivo: Determinar la efectividad de la CNAF, evaluar factores asociados a fracaso y complicaciones relacionadas con su uso en lactantes. Pacientes y método: Se analizaron los datos demográficos, clínicos, gasométricos, radiológicos y complicaciones de los pacientes conectados a CNAF en una unidad crítica entre junio de 2012 y septiembre de 2014. Se compararon los pacientes que fracasaron con los respondedores a CNAF, considerándose fracaso la necesidad de un mayor soporte respiratorio durante las primeras 48 h de conexión. Se utilizó test de Kolmogorov Smirnov, U de Mann-Whitney, Chi cuadrado, test exacto de Fisher, correlaciones y Modelo de regresión logística binaria para p ≤ 0,05. Resultados: Un total de 109 pacientes. Mediana de edad y peso: 1 mes (0,2-20 meses) y 3,7 kg (2-10 kg); percentil 95: 3,7 meses y 5,7 kg respectivamente. El diagnóstico y patrón radiológico más frecuente fue bronquiolitis (53,2%) e infiltrado intersticial (56%). Un 70,6% respondió. Hubo diferencia significativa entre fracaso y respuesta en el diagnóstico (p = 0,013), radiografía (p = 0,018), contexto de conexión (p < 0,0001), pCO2 (mediana 40,7 mm Hg [15,4-67 mm Hg] versus 47,3 mm Hg [28,6-71,3 mm Hg], p = 0,004) y horas de CNAF (mediana 60,75 h [5-621,5 h] versus 10,5 h [1-29 h], p < 0,0001). El OR de PCO2 ≥ 55 mm Hg para fracaso fue 2,97 (IC 95%: 1,08-8,17; p = 0,035). Ningún paciente falleció ni registró complicaciones. Conclusión: El porcentaje de éxito observado fue similar a lo publicado. En esta muestra el fracaso de CNAF solo se asoció a una pCO2 inicial ≥ 55 mm Hg. Su uso se consideró seguro al no reportarse complicaciones relacionadas a su utilización. Se requiere de un estudio multicéntrico, aleatorizado y controlado para contrastar estos resultados.
Introduction: The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. Objective: To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. Patients and method: An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48 hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P ≤ .05. Results: The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7 kg (2-10 kg); 95 percentile: 3.7 months and 5.7 kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P = .013), radiography (P = 018), connection context (P < .0001), pCO2 (median 40.7 mmHg [15.4-67 mmHg] versus 47.3 mmHg [28.6-71.3 mmHg], P = .004) and hours on HFNC (median 60.75 hrs [5-621.5 hrs] versus 10.5 hrs [1-29 hrs], P < .0001). The OR of the PCO2 ≥ 55 mmHg for failure was 2.97 (95% CI; 1.08-8.17; P = .035). No patient died and no complications were recorded. Conclusion: The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55 mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Oxigenoterapia/métodos , Cateterismo/métodos , Cuidados Críticos/métodos , Pneumopatias/terapia , Gasometria , Administração Intranasal , Dióxido de Carbono/sangue , Bronquiolite/terapia , Bronquiolite/epidemiologia , Unidades de Terapia Intensiva Pediátrica , Modelos Logísticos , Estudos Longitudinais , Resultado do Tratamento , Falha de Tratamento , Doenças Pulmonares Intersticiais/terapia , Doenças Pulmonares Intersticiais/epidemiologia , Pneumopatias/fisiopatologia , Pneumopatias/epidemiologiaAssuntos
Pavilhão Auricular/cirurgia , Doenças do Cabelo/cirurgia , Pilomatrixoma/cirurgia , Neoplasias Cutâneas/cirurgia , Adolescente , Diagnóstico Diferencial , Pavilhão Auricular/patologia , Doenças do Cabelo/diagnóstico , Doenças do Cabelo/patologia , Humanos , Masculino , Pilomatrixoma/diagnóstico , Pilomatrixoma/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologiaRESUMO
Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.
La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.
Assuntos
Feminino , Artrite Juvenil/terapia , Rênio/uso terapêutico , Sinovite/terapia , Ultrassom/métodos , Artrite Juvenil/complicações , Injeções Intra-Articulares , Punho , Compostos Radiofarmacêuticos/uso terapêutico , Seleção de Pacientes , Sinovite/etiologia , Terapia CombinadaRESUMO
BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality. METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.
Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/mortalidade , Pneumonia Viral/mortalidade , Adulto , Idoso , Estudos de Coortes , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Previsões , Hospitalização , Humanos , Influenza Humana/complicações , Influenza Humana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Sons Respiratórios/fisiopatologia , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
The current concept of Parkinsons disease comprises a group of non-motor symptoms: neuropsychiatric disorders, sleep disturbances and dysautonomia, among others. Orthostatic hypotension is a frequent problem that impairs the patients quality of life. We review the symptoms of this disorder, its pathogeny and the available diagnostic tools. We emphasize the early suspicion and show the treatment options, based on the available evidence and our experience.
Assuntos
Humanos , Masculino , Idoso , Doença de Parkinson/complicações , Hipotensão OrtostáticaRESUMO
As the pandemic of 2009 H1N1 influenza A virus progressed, more patients required hospitalisation. The objective of this study is to describe the characteristics and clinical course of hospitalised patients with 2009 H1N1 virus infection in Chile. This was a prospective, observational study of 100 consecutive hospitalised patients with RT-PCR-confirmed 2009 H1N1 influenza A, admitted to Puerto Montt General Hospital (Puerto Montt, Chile). Information was obtained regarding contact history, demographics, laboratory values and clinical course. The primary reason for hospitalisation was pneumonia, in 75% of patients. Rapid influenza A test was positive in 51% of patients. Prior exposure to 2009 H1N1 virus was documented in 21% of patients. Clinical failure, documented in 18% of cases, was characterised by respiratory failure and acute respiratory distress syndrome. Failure was more common in patients with obesity, tachypnoea, confusion and multilobar infiltrates. When evaluating a patient hospitalised with influenza-like illness, a negative rapid test for influenza A or negative contact with a suspected case should not alter physicians' considerations regarding the likelihood of 2009 H1N1 virus infection. Patients with 2009 H1N1 virus infection with obesity, tachypnoea, confusion and multilobar infiltrates should be closely monitored since they are at high risk for clinical failure.
Assuntos
Vírus da Influenza A Subtipo H1N1/metabolismo , Influenza Humana/epidemiologia , Influenza Humana/virologia , Adulto , Antibacterianos/farmacologia , Antivirais/farmacologia , Chile , Feminino , Humanos , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pandemias , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
The mesentery is a frequent site for abdominal diseases, since it constitutes the intestinal scaffolding and pathway for many structures. Nowadays, computed tomography (CT) is the imaging modality of choice for evaluating mesenteric masses and their origin. An isolated mesenteric mass (primary) is an unexpected and rare tomographic finding in the context of patients with nonspecific clinical signs. The identification of a primary mesenteric mass requires an effort to exelude the possibility of being a secondary source. Thus, knowledge of the spectrum of mesenteric disease (neoplastic, infectious, inflammatory, vascular, traumatic, congenital) and its computed tomographic appearance is the key for proper diagnosis and treatment.
El mesenterio es un sitio frecuente de enfermedades abdominales, ya que constituye el soporte intestinal y una vía de paso para muchas estructuras. Hoy en día, la tomografía computada (TC) es la modalidad de imagen de elección para evaluar las masas mesentéricas y su origen. Una masa aislada (primaria) es un hallazgo tomográfico raro e inesperado de encontrar en el contexto de pacientes con signos clínicos inespecíficos. La identificación de una masa mesentérica primaria requiere un esfuerzo para descartar la posibilidad de un origen secundario. Así pues, el conocimiento del espectro de la enfermedad mesentérica (neoplásicas, infecciosas, inflamatorias, vasculares, traumáticas y congénitas procesos) y su apariencia tomográfica es clave para el diagnóstico y el tratamiento adecuado.
Assuntos
Humanos , Doenças Peritoneais , Mesentério , Neoplasias Peritoneais , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Doença de Crohn , Fibromatose Abdominal , Linfangioma , Linfoma , Neoplasias Peritoneais/secundário , Cisto Mesentérico , Teratoma , Tuberculose GastrointestinalRESUMO
BACKGROUND: There are few reports in the literature on the use of a laparoscopic approach for duodenal obstruction, particularly for duodenal atresia. We report here the results of 4 cases treated laparoscopically, and discuss the safety, feasibility and long-term results of this approach. PATIENTS AND METHODS: Four pediatric patients presented with duodenal obstruction, one with duodenal atresia, one with annular pancreas, and two with duodenal obstruction due to Ladd's bands but without malrotation. Diagnosis was made by clinical evaluation, simple X-ray film in the Ladd's patients, and contrast gastroduodenal X-ray series for the annular pancreas. All procedures were performed using 3-mm instruments and 3 trocars. Two duodeno-duodenal anastomoses were performed and two lyses of Ladd's bands; all procedures were carried out laparoscopically. RESULTS: An upper GI contrast excluded obstruction or leakage in all patients 5 - 7 days after surgery and feedings were started. The patient with annular pancreas died of cardiovascular complications after one months. The other 3 patients are asymptomatic and tolerating feedings after a follow-up of 36 months. CONCLUSIONS: We conclude that a laparoscopic approach for duodenal obstruction can be performed safely and effectively and achieves a short hospital stay. Laparoscopic lysis of Ladd's bands is easy to perform, but duodenoduodenostomy requires advanced laparoscopic skills.