Conservative treatment of odontogenic fibromixoma in maxilla with 11-year follow-up: case report

Introduction: Odontogenic mixomas (OMs) are a locally infiltrating slow-growing intraosseous nonmetastasizing tumors of the maxilla and the mandible that have the potential for bone des-truction and cortical expansion, showing high recurrence rates. Their frequency varies around the world, accounting for 3-20% of all odontogenic tumors, ranking third among odontogenic tumors. They predominantly affect young adults, but may occur in various age groups. Report: A 37-year-old female patient who in August 2005 sought treatment at the Maxillofacial Dental Unit at Hospital Higueras, Talcahuano, Chile, for a left maxillary bone lesion. An increase in vo-lume was observed in the left maxillary region in the clinical analysis of the oral cavity. The neo-plasm was sessile and painless, measuring approximately 3 cm, with a greater diameter in the vestibule, firm on palpation and without signs of gangliopathy. Computed cone beam tomogra-phy imaging showed an extensive infiltrating osteolytic lesion in the left maxillary sinus, with noinvolvement of the orbital bone structure. Analysis of incisional biopsy yielded the diagnosis ofOdontogenic Fibromixoma. It was proposed to perform the conservative treatment of the lesion,consisting of enucleation and surgical curettage, obtaining excellent postoperative results and absence of relapse after 11-year follow-up. Conclusion: The present case report provides eviden-ce that supports the conservative surgical approach for the treatment of odontogenic myxomas, which contributes to a better postoperative quality of life for the patient.

A snapshot of cancer in Chile: analytical frameworks for developing a cancer policy

INTRODUCTION: The South American country Chile now boasts a life expectancy of over 80 years. As a consequence, Chile now faces the increasing social and economic burden of cancer and must implement political policy to deliver equitable cancer care. Hindering the development of a national cancer policy is the lack of comprehensive analysis of cancer infrastructure and economic impact. OBJECTIVES: Evaluate existing cancer policy, the extent of national investigation and the socio-economic impact of cancer to deliver guidelines for the framing of an equitable national cancer policy. METHODS: Burden, research and care-policy systems were assessed by triangulating objective system metrics -epidemiological, economic, etc. - with political and policy analysis. Analysis of the literature and governmental databases was performed. The oncology community was interviewed and surveyed. RESULTS: Chile utilizes 1% of its gross domestic product on cancer care and treatment. We estimate that the economic impact as measured in Disability Adjusted Life Years to be US$ 3.5 billion. Persistent inequalities still occur in cancer distribution and treatment. A high quality cancer research community is expanding, however, insufficient funding is directed towards disproportionally prevalent stomach, lung and gallbladder cancers. CONCLUSIONS: Chile has a rapidly ageing population wherein 40% smoke, 67% are overweight and 18% abuse alcohol, and thus the corresponding burden of cancer will have a negative impact on an affordable health care system. We conclude that the Chilean government must develop a national cancer strategy, which the authors outline herein and believe is essential to permit equitable cancer care for the country.

Interfase neurología-psiquiatría en pacientes hospitalizados por patologías del sistema nervioso central / Neurology-psychiatry interface in central nervous system diseases

Objetivo: Las enfermedades cerebrales condicionan con frecuencia alteraciones mentales y conductuales. Para analizar el área de interfase entre la neurología y la psiquiatría, analizamos todas las interconsultas neuropsiquiátricas realizadas en los servicios de Neurología, Neurocirugía, Terapia Intensiva Neurológica y Urgencias Neurológicas, en el Instituto Nacional de Neurología y Neurocirugía de México (2007-2009). Resultados: En 506 casos, la edad promedio fue 44.24 años (DE 17 años); 240 fueron mujeres (47.4 %). Las patologías neurológicas que generaron más interconsultas fueron neoplasias del sistema nervioso central (14.2 %), encefalitis viral (8.7 %), enfermedad vascular cerebral isquémica (7.1 %), epilepsia (6.5 %) y enfermedad vascular cerebral hemorrágica (4.7 %). Los trastornos mentales más frecuentes (de acuerdo con el DSM-IV) fueron delirium (38.5 %), trastorno depresivo (15 %), demencia (7.7 %), deterioro cognoscitivo, sin criterios de demencia (6.5 %), trastorno de ansiedad (6.9 %). El delirium fue la condición neuropsiquiátrica más frecuente independientemente de las categorías etiológicas. En las infecciones cerebrales hubo mayor frecuencia del síndrome catatónico (p < 0.001). En pacientes con enfermedad vascular cerebral se manifiesta más frecuentemente la risa y el llanto patológico (p = 0.012). Conclusiones: Este estudio muestra la relevancia clínica del delirium, la depresión, la ansiedad, la demencia, los síndromes frontales y la catatonia en pacientes hospitalizados con enfermedades neurológicas y psiquiátricas.

OBJECTIVE: Brain pathologies are frequent sources of mental and behavioral disorders. In order to analyze the boundary between neurology and psychiatry, we analyzed all neuropsychiatric consultations seen at the inpatient Neurology, Neurosurgery, Critical Medicine and Neurological Emergencies clinics of the National Institute of Neurology and Neurosurgery of Mexico between 2007 and 2009. RESULTS: A total of 506 neuropsychiatric visits were included, patient mean age was 44.2 years (SD 17 years) 240 patients were female (47.4%). The main neurological disorders for which patients sought medical care at the neuropsychiatry service, were: brain tumors (14.2%), viral encephalitis (8.7%), ischaemic cerebrovascular disorders (7.1%), epilepsy (6.5%) and haemorragic cerebrovascular disorders (4.7%). The most common DSM-IV psychiatric diagnoses included: delirium (38.5%), depressive disorders (15%), dementia (7.7%), cognitive decline, without fulfilling criteria for dementia (6.5%), and anxiety disorders (6.9%). Delirium was the most common neuropsychiatric condition among the etiological groups. Catatonic syndrome was more frequent among patients with brain infections (p < 0.001), and pathological laughter and crying were more frequent among atients with cerebrovascular disorders (p = 0.012). CONCLUSIONS: Our study highlights the clinical relevance of delirium, depression, anxiety, dementia, frontal syndromes and catatonia among neurologic and neurosurgical in-patients attending a tertiary care reference center in Mexico.