Tratamiento de úlceras severas de pie diabético con factor de crecimiento epidérmico recombinante (Heberprot-P). Análisis retrospectivo de los resultados obtenidos en Argentina / Tratamento de úlceras severas de pé diabético com fator de crescimento epidérmico recombinante (Heberprot-P). Análise retrospectiva dos resultados obtidos na Argentina / Treatment of severe diabetic foot ulcers with recombinant human epidermal growth factor (Heberprot-P®. Retrospective analysis of the results obtained in Argentina

Antecedentes: Los tratamientos actualmente disponibles para aquellos pacientes que presentan úlceras severas por pie diabético incluyen distintas medidas terapéuticas, tanto médicas como quirúrgicas. Sin embargo, la tasa de amputación en los pacientes con úlceras severas continúa siendo elevada. La administración local de factor de crecimiento epidérmico humano para promover la granulación y la cicatrización de úlceras crónicas severas por pie diabético es una nueva alternativa que se ha comenzado a utilizar en la práctica médica enciertos países. El factor de crecimiento epidérmico humano recombinante es una alternativa de tratamiento actualmente disponible en Argentina.Objetivo: El objetivo del presente trabajo es evaluar los resultados del tratamiento de las úlceras severas de pie diabético (Wagner 3-4) con factor de crecimiento epidérmico (Heberprot-P) utilizado en la práctica médica habitual. Métodos: Se incluyeron en el presente análisis retrospectivo 124 pacientes (67% hombres y 33% mujeres) con diagnóstico de Pie Diabético (42% Wagner 3 y 57% Wagner 4) que fueron tratados con una dosis de 75 μg del factor de crecimiento epidérmico, Heberprot-P®, administrado por peri e intralesionalmente desde Marzo de 2009 a Diciembre de 2011. Los pacientes fueron atendidos en forma ambulatoria en los servicios de nutrición y cirugía vascular de hospitales públicos y privados de la Argentina. Resultados: El 91% de los pacientes presentó respuesta de granulación parcial. La tasa de respuesta de granulación total obtenida fue del 70.3%, con una tasa de cierre total de la úlcera en el 69.2% de los pacientes. El tiempo medio de cicatrización fue de 13 semanas. El porcentaje de pacientes amputados y con recurrencia de la lesión luego de 6 meses de seguimiento fue del 10.4% y 4.2% respectivamente. El tratamiento fue bien tolerado. Se presentaron eventos adversos (EAs) en el 29% de los pacientes. Los más frecuentes fueron escalofríos, infección local ...

Antecedentes: Os tratamentos atualmente disponíveis para pacientes que apresentam úlceras severas devido a pé diabético incluem diferentes medidas terapêuticas, tanto médicasquanto cirúrgicas. Entretanto, a taxa de amputação nos pacientes com úlceras severas continua sendo elevada. A administração local de fator de crescimento epidérmico humano para promover a granulação e a cicatrização de úlceras crônicas severas por pé diabético é uma nova alternativa que começou a ser utilizada na prática médica em alguns países. O fator de crescimento epidérmico humano recombinante é uma alternativa de tratamento atualmente disponível na Argentina. Objetivo: O objetivo do presente trabalho é avaliar os resultados do tratamento das úlcerasseveras de pé diabético (Wagner 3-4) com fator de crescimento epidérmico (Heberprot-P®) utilizado na prática médica habitual. Métodos: Incluiram-se na presente análise retrospectiva 124 pacientes (67% homens e 33% mulheres) com diagnóstico de Pé Diabético (42% Wagner 3 e 57% Wagner 4) que foram tratados com uma dose de 75 μg do fator de crescimento epidérmico, Heberprot-P®, administrado por peri e intralesionalmente de março de 2009 a dezembro de 2011. Ospacientes foram atendidos de forma ambulatória nos serviços de nutrição e cirurgia vascular dos hospitais públicos e privados da Argentina. Resultados: 91% dos pacientes apresentou resposta de granulação parcial. A taxa deresposta de granulação total obtida foi de 70.3%, com uma taxa de fechamento total da úlcera em 69.2% dos pacientes. O tempo médio de cicatrização foi de 13 semanas. A porcentagem de pacientes amputados e com recorrência da lesão depois de 6 meses de seguimento foide 10.4% e 4.2% respectivamente. O tratamento foi bem tolerado. Apresentaram-se eventos adversos (EAs) em 29% dos pacientes. Os mais frequentes foram calafrios, infecção local, dorno local de aplicação, febre e hipotensão arterial, de intensidade leve-moderados...

Background: Treatments currently available for patients with severe diabetic foot ulcers include different therapeutic alternatives as well as surgery measures. However, amputationrate in these patients is still high. Local administration of recombinant human epidermal growth factor (Heberprot-P®) to promote granulation and healing of severe chronic ulcers in diabetic foot is the new alternative that has been recently applied in some countries. Thisproduct is currently available in Argentina. Objective: The purpose of the present work is to evaluate the results of the local treatment of severe diabetic foot ulcers (Wagner 3-4) with recombinant human epidermal growth factor (Heberprot-P®) used in daily medical practice. Methods: From March 2009 to December 2011, 124 patients (67% men and 33% women) diagnosed with diabetic foot ulcer (42% Wagner 3 and 57% Wagner 4) who had receivedperi and intralesional administration of 75 μg of Heberprot-P®, were included in this retrospective analysis. These patients were outpatients seen at the nutrition, diabetes and vascular departments of argentine public and private hospitals. Results: Granulation response was shown in 91% of patients. The complete granulation response rate obtained was 70.3%, with a complete ulcer closure in 69.2% of the patients.Mean wound healing time was 13 weeks. After 6 month follow up, there were 10.4% amputations and 4.2% recurrence. The treatment was well tolerated. Adverse events (AEs)were reported in 29% of patients. The most frequent were shiver, local infection, pain in the application site, fever and arterial hypotension, all with mild to moderate intensity. Threeserious AEs (SAEs) were reported: two of them were patients with lower limb infections and the third a case of anaphylactic reaction, all with complete recovery. No deaths were reported. ...

Saccades and smooth pursuit eye movements in central vertigo.

In order to analyze the diagnostic efficiency of saccadic and pursuit eye movements compared to findings from brain magnetic resonance imaging in patients with central vertigo, 108 patients were selected from 580 dizzy patients as cases of suspected central origin; the saccadic and pursuit eye movements were evaluated by electronystagmography and findings were compared to information from magnetic resonance imaging. The study of oculomotor movements in patients suspected of having a central lesion revealed a 83.3% sensitivity and 21.2% specificity. Restricting consideration to severe alterations in eye movements as indicative of a central origin, this test gives a 71.4% sensitivity and 50.0% specificity. In conclusion, the study of alterations in oculomotor movements, in patients with suspected central lesions, proved to be a test with good sensitivity also compared with results of magnetic resonance imaging.

Obturator prostheses following palatal resection: clinical cases.

Malignant tumours of the upper gum and hard palate account for 1-5% of malignant neoplasms of the oral cavity; two thirds of the lesions which involve these areas are squamous cell carcinomas. Most of these carcinomas are diagnosed late, when they invade the underlying bone. The procedures of choice for removal are: alveolectomy, palatectomy, maxillectomy, which may be total or partial. Surgical reconstruction of the defect may be carried out using a wide range of microvascularized flaps: osteomuscolocutaneous of the internal iliac crest, an osteocutaneous flap of the fibula or scapula, fascia, or osteocutaneous radial flap, or a pedicled flap of temporal muscle. These flaps are supported by single or multiple obturator prostheses. Rehabilitation via palatal obturators is preferred in patients with a poor prognosis or in weak condition. Rehabilitation aims to: restore the separation between the oral and nasal cavities, enable the patient to swallow, maintain or provide mastication, sufficient occlusion and mandibular support, support the soft facial tissues, re-establish speech and restore an aesthetically pleasing smile. Hence, it is crucial to work in close cooperation with the staff who makes the prosthesis and who evaluates the case when the surgery is planned and obtains the necessary gnatological, anatomical and functional information. Thereafter, during the surgical stage, for the immediate obturators, or in the successive days, for the temporary obturators, work is devoted to making the prostheses. In this regard, the Odonto-prostheses Service of the Stomatological Clinic does not follow a rigid protocol but materials and techniques are selected on a personal basis, according to the features of each individual clinical case. Mobile rehabilitative systems are the systems of choice, both of which related to the traditional concepts of retention and stability and systems of self-stabilizing prostheses according to J. Dichamp, albeit modified in materials, limiting, when possible the use of prostheses which are fixed on natural teeth, on appliances or combined.