Patch Testing with Dental Screening Series in Oral Disease

BACKGROUND: The oral mucosa is constantly exposed to several irritants and allergens including dental materials, but the role of contact allergy in oral disease is obscure. OBJECTIVE: To analyze positive patch test results in patients with oral diseases and evaluate the clinical relevance of oral diseases with contact allergy to dental materials. METHODS: We retrospectively analyzed patch test results with dental screening series in 44 patients with oral disease from 2004~2011. RESULTS: Oral diseases included oral lichen planus (54.5%), cheilitis (27.3%), burning mouth syndrome (9.1%), and others (9.1%). Thirty-one of 44 patients (70.5%) had positive reactions to one or more allergens. The most commonly detected allergens were gold sodium thiosulfate (25.0%) and nickel sulfate (25.0%), followed by potassium dichromate (22.7%), cobalt (15.9%), palladium (6.8%), mercury (4.5%), copper (4.5%), and methylhydroquinone (4.5%). Six of 24 patients with oral lichen planus had a symptom in areas adjacent to dental materials and positive patch test reactions to allergens contained in the suspected dental materials. CONCLUSION: Patch tests with dental screening series are worth considering for oral diseases, especially for oral lichen planus.

Long-lasting Allergic Patch Test Reaction / 대한피부과학회지

A long-lasting allergic patch test reaction (LLAPTR) is generally defined as a positive patch test reaction that persists for weeks or months, at least 2 weeks after application of the allergen. Several allergens, including gold sodium thiosulfate, have been reported as causes of LLAPTR, however, it has never been described in the Korean dermatologic literature. We report a case of LLAPTR to Cl+Me-Isothiazolinone (Kathon CG) and p-tert-butylphenol formaldehyde resin (PTBP-FR) in a 45-year-old woman with suspected allergic contact dermatitis.

Dexmedetomidina para sedación durante intubación difícil con Fibrobroncoscopia / Dexmedetomidina for sedation during intubación difficult with Fibrobroncoscopia

Paciente de 48 años de sexo femenino, con diagnóstico de bocio gigante, valorada en consulta preanestésica que presenta una gran masa en cuello que ya había sido operada previamente y que se extendía al pulmón derecho. Al evaluar la vía aérea se encontró una desviación traqueal importante, con Mallampati III y se programó como intubación difícil con fibrobroncoscopia. El día de la cirugía, se decidió colocar un tubo doble lumen No. 37, previa anestesia tópica con lidocaina spray, 2 mg de midazolam y un bolo de Dexmedetomidina (DXM) 0,7 microgr/kg en 10 minutos, seguido por una infusión continua de 0,25-0,3 microgr/Kg. Se midió el nivel de sedacion mediante la escala de Ramsay, considerando adecuado un nivel 2 y 3 y se procedió a la intubación nasotraqueal con fibrobroncoscopia. Una vez confirmada se le colocó tiopental sódico 3 mg/kg más Rocuronio 0,5 mg/kg y Fentanyl 2 microgr/kg IV. Se continúo con DXM durante todo el procedimiento y se adicionó Isorane a 1 MAC. Se realizó cervicotomía y esternotomía para extraer la masa, se suspendió la DXM 15 minutos antes de finalizar el procedimiento y se extubó a la paciente despierta; hemodinámicamente estable, se llevó a UCI donde evolucionó satisfactoriamente y fue dada de alta a los 3 días...