Prevalence of horizontal alveolar changes in edentulous patients: a retrospective tomographic study

Abstract Horizontal bone loss after tooth extraction is a common finding that demands bone reconstruction in various cases. The aim of this study was to assess the horizontal alveolar status in partially and completely edentulous patients using cone-beam computed tomography (CBCT). In total, 1516 CBCT scans of 1404 adult patients were analyzed. Assessment of the images was performed in accordance with the previously published horizontal alveolar change (HAC) classification, which categorizes horizontal bone defects into four classes: HAC 1, HAC 2, HAC 3 and HAC 4 (from the least severe to the most severe condition). Analysis of 1048 scans from partially edentulous patients presented a distribution of 63.55%, 22.14%, 13.36% and 0.95% in HAC 1, HAC 2, HAC 3 and HAC 4, respectively. Analysis of 468 scans from completely edentulous patient images presented a distribution of 19.87%, 28.63%, 41.67% and 9.83% in HAC 1, HAC 2, HAC 3 and HAC 4, respectively. Based on these results, as in HAC 4, no cancellous bone was found between the cortical buccal and lingual/palatal bone plates, it seems reasonable to state that the absence of cancellous bone is higher in completely edentulous patients than in partially edentulous patients. Therefore, the absence of cancellous bone seems to be higher in completely edentulous than in partially edentulous patients.

Horizontal Bone Reconstruction on sites with different amounts of native bone: a retrospective study

Abstract: The lack of guidelines for bone augmentation procedures might compromise decision making in implantology. The objective of this study was to perform a retrospective study to verify the outcomes of horizontal bone reconstruction in implant dentistry with different types of materials and amounts of native bone in the recipient bed to allow for a new guideline for horizontal bone reconstruction. One hundred preoperative CT scans were retrospectively evaluated and categorized in accordance to horizontal bone defects as presence (Group P) or absence (Group A) of cancellous bone in the recipient bed. Different approaches were used to treat the edentulous ridge and the outcomes were defined either as satisfactory or unsatisfactory regarding the possibility of implant placement. The percentage distribution of the patients according to the presence or absence of cancellous bone was 92% for Group P and 8% for Group A. In Group P, 98% of the patients had satisfactory outcomes, and the use of autografts had 100% of satisfactory outcomes in this group. In Group A, 37.5% of the patients had satisfactory outcomes, and the use of autografts also yielded 100% of satisfactory outcomes. The use of allografts and xenografts in Group A had 0% and 33.3% of satisfactory outcomes, respectively. Therefore, it seems reasonable to speculate that the presence of cancellous bone might be predictive and predictable when the decision includes bone substitutes. In cases of absence of cancellous bone in the recipient bed, the use of a vitalized graft seems to be mandatory.

Complex regional pain syndrome: new concepts regarding diagnosis and treatment

Antecedentes: Los autores presentan una revisión crítica sobre el cuadro clínico, el diagnóstico, clasificación y tratamientodel síndrome de dolor regional complejo, discutiendo todos los métodos de tratamiento y haciendo hincapié en que la reabilitación debe ser empleada con el fin de obtener un mejor resultado. Aspecto psicológico debe ser discutido en el tratamiento y también se anima equipo multidisciplinario para participar en él.

Background: The authors presented a critical review about the clinical picture, diagnosis, classification and treatment ofcomplex regional pain syndrome, discussing all methods of treatment and emphasizing that the reabiltation must be employed in order to obtain a better result. Psychological aspect must be involved in the treatment and also multidisciplinary team is encouraged to take part on it.

¿Existe sarcopenia en pacientes menores de 30 años por criterio de bioimpedanciometría? / Is there sarcopenia in patients under 30 years by bioelectrical impedance criteria?

La sarcopenia es una patología detectada principalmente en ancianos, se desconoce la prevalencia en personas jóvenes. Este estudio pretende determinar la prevalencia de sarcopenia en pacientes menores de 30 años mediante bioimpedanciometría y determinar sus factores asociados; en pacientes que acuden a consulta de endocrinología del Centro de Especialistas de Colsubsidio, Bogotá. Metodología: estudio de corte transversal. Se estableció la correlación entre músculo corporal total y otros parámetros antropométricos como peso, talla, grasa corporal total, grasa visceral, sexo y edad. Determinó los factores asociados a sarcopenia mediante análisis multivariado. Resultados: se incluyeron 501 pacientes, 315 mujeres (62.87%) y 186 hombres (37.13%) y se encontró una prevalencia de sarcopenia en pacientes menores de 30 años, clasificada como moderada 60.53% (n=46) y severa 22.37% (n=17) p<0.001; con 31.75% asociado a problemas de sobrepeso u obesidad p<0.001. Además una correlación inversa entre el porcentaje de músculo total y edad, peso, grasa corporal total y grasa visceral tanto para mujeres y hombres respectivamente p<0.01. Los factores independientes asociados a sarcopenia fue el sexo masculino OR = 1.09 x 10(16) (IC 95% 7.37 x 10(11) -1.62 x 10(20)) p<0.001; edad OR=1.15 (IC 95% 1.085-1.22) p<0.001 y grasa corporaltotal OR=1.9(IC 95% 1.59-2.26) p<0.001. Conclusión: la definición de sarcopenia se enfoca en pacientes ancianos y es interesante cómo se aprecia pérdida de la masa muscular desde edades tempranas, asociados a problemas de sobrepeso u obesidad que podría corresponder a "obesidad sarcopénica". Consideramos que se debe realizar una definición de sarcopenia donde se incluya pacientes jóvenes. (Acta Med Colomb 2015; 40: 132-137).

Sarcopenia is a disease detected mainly in the elderly, and its prevalence in young people is unknown. This study aims to determine the prevalence of sarcopenia in patients under 30 years by bioelectrical impedance and determine its associated factors in patients attending endocrinology consultation of Specialists Center Colsubsidio Bogota. Methodology: cross sectional study. The correlation between total body muscle and other anthropometric parameters such as weight, height, total body fat, visceral fat, sex and age was established. Factors associated with sarcopenia were determined by multivariate analysis. Results: 501 patients, 315 women (62.87%) and 186 men (37.13%). Prevalence of sarcopenia found in patients under 30 years was classified as moderate in 60.53% (n = 46) and severe 22.37% (n = 17) p <0.001; 31.75% was associated with overweight or obesity p <0.001. Besides, there was an inverse correlation between the percent of total muscle and age, weight, total body fat and visceral fat for both women and men respectively p <0.01. Independent factors associated with sarcopenia were male gender OR = 1.09x 10(16) (95% CI 7.37 x 10(11) -1,62 x 10(20)) p <0.001; age OR = 1.15 (95% CI 1,085-1.22) p <0.001 and total body fat OR = 1.9 (95% CI 1.59-2,26) p <0.001. Conclusion: the definition of sarcopenia focuses on elderly patients, and it is interesting how loss of muscle mass can be seen from an early age, associated with overweight or obesity that might correspond to "sarcopenic obesity." We believe that a definition of sarcopenia where young patients be included should be made. (Acta Med Colomb 2015; 40: 132-137).

Atrofia hemifacial progresiva o Síndrome Parry Romberg asociado a inmunodeficiencia / Progressive Hemifacial Atrophy or Parry Romberg Syndrome associated with immunodeficiency

La Atrofia Hemifacial Progresiva (AHP) o Síndrome Parry Romberg, es una enfermedad degenerativa rara, caracterizada por una lenta y progresiva atrofia facial unilateral que afecta al tejido celular subcutáneo, cartílago, tejido graso y estructuras óseas subyacentes, que frecuentemente se solapa con una condición conocida como esclerodermia lineal en corte de sable. Hasta donde se conoce no se ha reportado en la literatura la asociación de este síndrome a algún tipo de inmunodeficiencia. Se presenta el caso de un niño de 5 años con AHP, con historia de procesos infecciosos recurrentes, algunos graves, desde que tenía 7 meses de nacido. En el estudio inmunológico se observó la presencia de anticuerpos antinucleares con patrón homogéneo y de anticuerpos anti-DNA de doble cadena. La cuantificación de las subpoblaciones linfocitarias mostró una disminución de los valores de células T/CD3+ y T/CD4+, con valor normal de células B/CD19+. Se diagnosticó una inmunodeficiencia de células T. El hallazgo de una inmunodeficiencia celular en un paciente con AHP es expresión de la gran variabilidad clínica de esta enfermedad y de la importancia que tiene su diagnóstico temprano

The progressive hemifacial atrophy (AHP) or Parry Romberg syndrome, is a rare degenerative disease, characterized by slowly progressive unilateral facial atrophy involving the subcutaneous tissue, cartilage, fat tissue and underlying bone structures, which often overlaps with a condition known as linear scleroderma en coup of sabre. To our knowledge has not been reported the association between immunodeficiency and this syndrome. We report the case of a child of 5 years with AHP, with a history of recurrent infectious processes, some serious, since he was 7 months old. The immunological study showed T cell immunodeficiency, lymphocyte subpopulations showed T/CD4 T/CD3 + cells values decreased and normal value B/CD19 + cells. The presence of antinuclear homogeneous pattern and anti-dsDNA antibodies confirm de autoimmune disorders described in these patients. The cellular immunodeficiency with AHP is an expression of great clinical variability of this disease and the importance of early diagnosis

Atrofia cerebelosa y uso crónico de fenitoína: revisión de la literatura y presentación de un caso clínico / Cerebellar atrophy and long-term phenytoin therapy: literature review and case presentation

Introduction: The most important chronic toxic adverse effect caused by phenytoin takes place in the cerebellum and may lead to irreversible cerebellar atrophy. Objective: Draw attention to the occurrence of cerebellar atrophy in patients undergoing long-term phenitoyn therapy Emphasize the need for and feasibility of early diagnosis. Update pathogenetic hypotheses. Development: Brief history of Phenytoin since it was first used in the treatment of epileptic seizures; acute, subacute, and chronic adverse effects, with emphasis on cerebellar atrophy. The case presented developed during long-term phenytoin treatment of an epileptic patient. The hypotheses so far raised on pathophysiological mechanisms involved in causing atrophy are described. Complete current review of literature is included and most relevant authors are listed. Conclusions: Cerebellar atrophy following long-term phenytoin therapy takes place in a minor, as yet indeterminate, number of patients; its occurrence, however, must be borne in mind in the case of patients under long-term therapy. CT and MR contributions to early diagnosis are underlined, as well as the current and potential support of new neuroimaging techniques. Recent hypotheses regarding pathophysiological mechanisms involved, direct toxic action, anoxia, and dysafferentation are discussed. The debate on future use of phenytoin as first-line drug is supported.

Introducción: El efecto adverso tóxico crónico más relevante que puede ocasionar la fenitoína es producido sobre el cerebelo pudiendo causar una atrofia cerebelosa irreversible. Objetivo: Llamar la atención sobre la ocurrencia de atrofia cerebelosa en pacientes expuestos a la fenitoína en forma crónica. Resaltar la importancia y posibilidad de efectuar un diagnóstico precoz. Actualizar las hipótesis planteadas en su patogenia. Desarrollo: Breve síntesis histórica de la fenitoína desde su incorporación a la terapéutica de las crisis epilépticas, sus efectos adversos agudos, sub-agudos y crónicos, haciendo énfasis en la atrofia cerebelosa. Se presenta un caso clínico desarrollado durante el tratamiento a largo plazo con fenitoína en una paciente epiléptica. Describimos las hipótesis planteadas hasta ahora sobre los mecanismos fisiopatológicos involucrados en la producción de la atrofia. Se realiza una revisión actualizada y completa de la bibliografía y se citan los autores más pertinentes. Conclusiones: La Atrofia cerebelosa causada por el uso crónico de la fenitoína se produce en un porcentaje bajo de pacientes, aún no determinado; sin embargo, su ocurrencia se debe tener siempre presente en las personas tratadas con fenitoína en forma prolongada. Muy demostrativos de atrofia cerebelosa son algunos exámenes como la TAC y la RNM, cuyos hallazgos pueden preceder a las manifestaciones clínicas, lo que permite realizar un diagnóstico precoz, La aparición de nuevas técnicas neuroradiológicas, como la RNM con tensor de difusión (RNM-DT) prometen contribuir a dilucidar los mecanismos fisiopatológicos involucrados. Se revisan las hipótesis actuales postuladas en la patogenia, como acción toxica directa, anoxia y desaferentación.