ABSTRACT
El linfoma de células T/NK tiene una frecuencia de presentación inusual, caracterizado por una progresión rápida y de mal pronóstico. Ocurrencia aludida a regiones de Asia y Latinoamérica por la fuerte incidencia de infección por el virus de Epstein- Barr. Su presentación puede ser nasal o en otra localización. Los esquemas de tratamiento suelen conllevar respuestas insuficientes, empero protocolos con base en L-Asparaginasa reflejarían mejores resultados. El presente reporte corresponde a 4 casos de este tipo de linfoma, 2 de tipo nasal y 2 de diversa presentación. Todos evolucionaron desfavorablemente, en parte por el mal pronóstico atribuido y también por el diagnóstico suscitado en etapas avanzadas de enfermedad concatenadas a dificultades económicas para sostener el tratamiento, factores intervinientes en nuestro medio.
NK/T cell lymphoma is an unusual neoplasm, characterized by fast progression and poor prognosis. It is present in regions of Asia and Latin America associated to a high incidence of Epstein-Barr virus infection. Its presentation can be nasal or in another location. Treatment schemes usually lead to insufficient responses, however protocols based on L-Asparaginase would reflect better results. This report concerns 4 cases of this lymphoma, 2 nasal type and 2 of a different presentation. Patients responses were unfavorable, partly due to the poor prognosis att r ibuted and also due to the diagnosis raised in advanced stages of the disease as well as to economic difficulties to sustain treatment, intervening factors in our country.
ABSTRACT
Objective: Compare the clinical effectiveness of custom thermoformed occlusal splints (OS) alongside behavioral and self-care therapy (BST) in the management of myalgia of the masticatory muscles. Material and methods:A controlled clinical trial was conducted with a total of 46 subjects with a diagnosis of myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). All subjects were treated with BST at the beginning of the study and were then randomized into four groups: behavioral and self-care control group; Thermoformed Tough-elastic splint group; Thermoformed Soft-elastic splint group, and non-occlusive splint group. Follow-ups were carried out at 2, 6, and 10 weeks, where it was evaluated: pain in the masticatory muscles, mandibular range of motion, mandibular functional limitation, and occlusal discomfort. Data were analyzed with Doornik and Hansen, ShapiroWilk, and ANOVA at p=0.05. Results: All the variables showed significant improvement (p<0.05) from the first follow-up and were maintained later. BST control group, as well as groups with BST associated with OS, were able to reduce pain and increase the mandibular range of motion without significant differences between them (p>0.05), while the Thermoformed Tough-elastic splint was the most efficient in terms of the mandibular functional limitation. The occlusal discomfort decreased over time, but without statistically significant differences in terms of time and design of OS. Conclusion: The addition of thermoformed OS to behavioral and self-care therapy does not have a significant impact on myalgia of the masticatory muscles. (AU)
Objetivo: Comparar a eficácia clínica das Placas Oclusais (PO) termoplásticas personalizadas associadas à Terapia Cognitiva Comportamental (TCC) na condução da mialgia dos músculos mastigatórios. Material e Métodos: Foi realizado um ensaio clínico controlado randomizado com um total de 46 participantes com um diagnóstico de mialgia de acordo com os Critérios de Diagnóstico das Desordens Temporomandibulares (DC/TMD). Todos os participantes foram tratados com a TCC, no início do estudo, e foram, depois, randomizados em quatro grupos: grupo controle Terapia Congnitivo Comportamental; grupo de placa termoplástica dura-soft, grupo de placa termoplástica soft, e grupo de placa sem cobertura oclusal. Foram realizados controles com 2, 6, e 10 semanas, onde foi avaliado: dor nos músculos mastigatórios, amplitude de movimento mandibular, limitação funcional mandibular, e desconforto oclusal. Os dados foram analisados com Doornik e Hansen, Shapiro-Wilk, e ANOVA a p=0,05. Resultados: Todas as variáveis mostraram melhora significativa (p<0,05) desde o primeiro controle e se mantiveram posteriormente. O grupo de controlo da TCC, bem como os grupos com TCC associada a PO, foram capazes de reduzir a dor e aumentar a amplitude de movimento mandibular sem diferenças significativas entre eles (p>0,05), enquanto que, a placa termoplástica dura-soft, foi a mais eficiente em termos da limitação mandibular funcional. O desconforto oclusal diminuiu ao longo do tempo, mas, sem diferenças estatisticamente significativas em termos de tempo e design da PO. Conclusão: A inclusão da Terapia Cognitivo Comportamental à PO termoplástica não tem um impacto significativo na mialgia dos músculos mastigatórios.(AU)