Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy

ABSTRACT Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LN growth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusions: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.

Does displacement of lower pole stones during retrograde intrarenal surgery improves stone-free status?: a systematic review and meta-analysis

Purpose: Kidney stones are one of the most common urological diseases worldwide. The size and location of the stone are the most important factors in determining the most suitable treatment options. The aim of this review was to evaluate the displacement of lower pole stones. Methods: Three studies assessing the efficacy of translocating kidney stones from the lower pole of the kidney to other locations during retrograde intrarenal surgery published in the last 20 years were included. A systematic search was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and Web of Science databases using the following search terms: "Lower pole," "Lithotripsy." Meta-analysis was performed using Review Manager version 5.4. Results: Stone-free rates were improved through displacement (odds ratio - OR = -0.15; 95% confidence interval-95%CI -0.24--0.05; p = 0.002; I2 = 21%), but at the cost of increased surgical duration (mean difference = -12.50; 95%CI -24.06--0.95; p = 0.03; I2 = 94%). Although this represents a potentially negative outcome, the improvement in clearance rates justifies the additional investment of time and effort. Conclusions: Displacement of lower pole kidney stones for subsequent lithotripsy brings significant benefits in terms of stone-free rate, with no difference in laser energy usage. However, it results in increased surgical time. Despite these factors, the benefits to patients undergoing the procedure are substantial.

Detección molecular de estreptococos cariogénicos en saliva / Molecular detection of cariogenic streptococci in saliva

Streptococcus mutans y Streptococcus sobrinus han sido indicados como los principales agentes etiológicos de la caries dental. Sin embargo, los métodos microbiológicos y bioquímicos, disponibles actualmente en Chile, no permiten la rápida detección e identificación de estas bacterias. El objetivo de este trabajo fue implementar la metodología de reacción en cadena de la polimerasa (PCR) para detectar la presencia de S. mutans y S. sobrinus en saliva. Participaron de este estudio 51 escolares (5 a 17 años), provenientes de cinco diferentes colegios de la ciudad de Temuco; a los cuales se les realizó recuento de estreptococos del grupo mutans en saliva por método microbiológico y la diferenciación de especies por la técnica de PCR. Los resultados mostraron que la sensibilidad para la técnica de PCR fue 1000 UFC/mL de saliva, diez veces superior a la sensibilidad del método microbiológico utilizado (10.000 UFC/mL). Además, el análisis de la especificidad de la amplificación, evaluada por restricción enzimática, confirmó la presencia de las bacterias investigadas. La prevalencia de S. mutans fue de 88.2 por ciento y para S. sobrinus de 11.8 por ciento. La presencia conjunta de ambas bacterias fue observada en 7.8 por ciento de los individuos. En conclusión, podemos señalar que la metodología implementada es útil para la detección rápida de S. mutans y S. sobrinus en saliva.

Streptococcus mutans and Streptococcus sobrinus are the main causative organisms of dental caries. Nevertheless, the microbiological and biochemical methods, available at the moment in Chile, do not allow to the fast detection and identification of these bacteria. The aim of this investigation is implement the polymerase chain reaction (PCR) technique to detect the presence of S. mutans and S. sobrinus in saliva. A total of 51 schoolchildren (5 to 17 years old) from five different schools from Temuco city (Chile) participated in this study. The presence of salivary mutans streptococci was determined by microbiological method, and the species differentiation was assessed using PCR technique. The sensitivity for the PCR technique was 1000 cfu/mL of saliva, ten times superior to the sensitivity of the microbiological method used (10,000 cfu/mL). In addition, the analysis of the specificity of the amplification, evaluated by enzymatic restriction, confirmed the presence of the investigated bacteria. The prevalence of S. mutans was of 88.2 percent and for 5. sobrinus was 11.8 percent. The combined presence of both bacteria was observed in 7.8 percent of the individuals. In conclusion, the obtained results indicate that the implemented methodology is useful for the rapid detection of S. mutans and S. sobrinus in saliva.

Fallo multiorgánico secundario a sepsis posesplenectomía: presentación de 1 caso / Multiple organ failure secondary to postsplenectomy sepsis: case report

Se presentó una paciente que 2 años después de una plenectomía desarrolló un cuadro súbito de fiebre, vómitos y diarreas, acompañado de shock, coagulación intravascular diseminada e insuficiencia respiratoria aguda, que precisó ventilación mecánica, fracaso renal agudo oligúrico y lesiones tardías decamativas en palmas y plantas. Se emplearon medidas terapéuticas de soporte vital y se obtuvo una recuperación completa

Fatores anatômicos relacionados à etiologia das lesöes de furca: parte II / Anatomical factors related to the ethiology of the furcation injuries: part II

Fatores anatômicos têm sido realcionados com a etiologia das lesöes de furca. No presente relato säo estudados a entrada e o teto da furca, o septo radicular interfurca, as concavidades radiculares e o tipo de cemento radicular, os quais parecem atuar favorecendo o acúmulo de placa e dificultando sua remoçäo, Conclui-se que estes fatores podem expor os dentes multirradiculares a maior risco de doença periodontal. Deste modo, destaca-se a importância do conhecimento dos fatores etiológicos das lesöes de furca, de maneira que a açäo profissional seja direcionada para a prevençäo da ocorrência nestas lesöes

Fatores anatômicos ralacionados com a etiologia das lesöes de furca - parte I / Anatomic factors related to the etiology of the furcation lesions - part I

Fatores anatômicos têm sido relacionados com a etilogia das lesöes de furca. No presente relato säo estudados pérolas de esmalte, tronco radicular, pré-furca e projeçöes cervicais de esmalte, os quais parecem atuar como fatores que favorecem a proliferaçäo bacteriana mais rápida na regiäo de furca. Conclui-se que estes fatores podem expor os dentes multirradiculares a maior risco de doença periodontal. Assim, propöe-se que a abordagem clínica mais adequada para esses casos seja a monitorizaçäo cuidadosa dos dentes multirradiculares, de modo a se estabelecerem estratégias precisas de prevençäo e/ou pronto tratamento da doença periodontal

Nutrición en el paciente ventilado / Nutrition for the ventilated patient

Se realizó una revisión de la nutrición en el paciente ventilado teniendo en cuenta el gran número de pacientes que ingresa en la UCI en estado crítico que necesitan ventilación mecánica. Una correcta evaluación nutricional contribuye el destete precoz y a la evolución favorable de estos enfermos. Se analizaron los reajustes que deben hacerse en cuanto al aporte protéico-calórico, así como el aporte vitamínico y de oligoelementos de este tipo de paciente. Se evalúan las características de la nutrición y se plantean las yatrogenias que pueden ocurrir de no tenerse en cuenta los cambios fisiológicos relacionados con la edad y enfermedades crónicas sobreañadidas. Se señalan las diferencias en cuanto a la utilización de distintas vías de nutrición