Alergia a anestesia local dentaria: Temor generalmente infundado / Dental anesthesia local allergies: fear usually unfounded

Introducción el temor a padecer accidentes anafiláticos durante la anestesia local sigue siendo elevado entre pacientes odontológicos, odontólogos y médicos no especialistas.Objetivo: Fortalecer los conceptos de nuestras comunicaciones previas en el tema y fijar pautas para el manejo clínico del mismo.Material y métodos: Pacientes que consultan a Servicios de Alergia e Inmunología de la Ciudad de Córdoba; mediante historia clínica y escala arbitraria se determina en nivel de riesgo, se realizan test intradérmicos seguidos de desafío progresivo controlado. Resultados: 424 pacientes de los que 365 (82.1%) fueron mujeres (97.7%) fueron consideradas de riesgo moderado a severo, fueron sometidas a provocación controlada. Sólo pudo demostrar se por historia clínica y prick test positivo 1 caso (0.23%) de alta probabilidad de sensibilización IgE mediada, entre los pacientes de riesgo elevado. La metodología de estudio realizada permitió una solución para la totalidad de los pacientes.Conclusiones: Existe temor infundado de reacciones alérgicas a anestésicos locales dentarios, los fenómenos adversos son, en su gran mayoría reacciones vasovagales u otros mecanismos no inmunológico. Las reacciones anafilácticas por anestesia dentaria son excepcionales. Una buena metodología de estudio permitió una solución para la totalidad de nuestros pacientes.

424 patients of which 365 (82.1%) were female and 415 (97.7%) were considered moderate to severe risk, were subjected to controlled provocation. It could only be demonstrated by medical history and positive prick test (0.23%) case high probability of IgE-mediated sensitization among patients at high-risk patients. The study methodology made possible solution for all patients.Conclusions: There is unfounded fear allergic reactions to dental local anesthetic, adverse events are mostly vasovagal reactions or other non-immunological mechanisms. Anaphylactic reactions are rare dental anesthesia. A good methodology study allowed a solution to all of our patients.

Usefulness of the QTc interval in predicting myocardial ischemia in patients undergoing exercise stress testing.

Prolongation of the QTc interval during stress testing predicts myocardial ischemia with a sensitivity of 88% and a specificity of 93%. Measurement of the QTc segment should be considered as an adjunctive electrocardiographic variable in the interpretation of stress tests and is even useful in patients who are not able to achieve the age-predicted target heart rate level.

Insulin-dependent diabetes mellitus presenting in children as frequent, medically unresponsive, partial seizures.

Severe partial seizures may be the presenting feature of nonketotic hyperglycemia in older adults, but cases in children are rare. We report three teenagers with well-controlled epilepsy who suddenly developed intractable partial seizures poorly responsive to anticonvulsants. Blood glucose levels were measured only after several days of hospitalization for frequent seizures when mild polyuria and polydipsia were first noted. Glucose levels were high with mild ketosis and acidosis in one patient and no ketosis in two. With institution of insulin, there was prompt cessation of seizures. The patients were diagnosed as having type I insulin-dependent diabetes mellitus and require ongoing insulin treatment. Hyperglycemia should be considered in children with epilepsy who develop intractable seizures.

Dose-response effect of depot leuprolide acetate on serum androgens in hirsute women.

OBJECTIVE: To determine the dose of leuprolide acetate (LA) needed to maximally suppress serum androgens in hirsute women. DESIGN: Prospective, dose-escalation study. SETTING: Outpatient endocrinology clinic. PATIENTS: Eight hyperandrogenic women with moderate to severe hirsutism. INTERVENTIONS: A LA dose-response study was done in women receiving depot LA plus estrogen-progestin replacement. MAIN OUTCOME MEASURES: Serum concentrations of T, androstenedione (A), and basal and GnRH-stimulated LH. RESULTS: The lowest LA dose (3.75 mg/mo) suppressed serum T by 62% +/- 6% and A by 56% +/- 7%. No further decrease in serum androgens was seen with doses up to 15 mg/mo. Maximal suppression of basal and stimulated LH was also seen with the lowest dose of LA. CONCLUSIONS: As opposed to results previously published in children with precocious puberty, the 3.75 mg dose of depot LA is sufficient to maximally suppress serum androgens in hyperandrogenic women.