ABSTRACT
El condrosarcoma es un tumor maligno de origen cartilaginoso y etiología desconocida, que se caracteriza histológicamente por un completo desarrollo de estructuras cartilaginosas maduras con nulo crecimiento de componente óseo. Supone aproximadamente el 10% de todas las neoplasias óseas. Se presenta generalmente en huesos largos, pelvis y costillas, siendo raro en localizaciones craneofaciales (menos del 5%), donde se considera de mayor agresividad debido a su rápido crecimiento y a la mayor capacidad de producir metástasis. Cuando se presenta en esta localización los sitios más afectados en orden de frecuencia son: maxila, mandíbula, tabique nasal y senos paranasales. Los rangos de edad recogidos abarcan desde los 8 meses hasta los 75 años, con una incidencia máxima entre la quinta y séptima décadas de la vida. Presentamos el caso de una niña de 7 años de edad con condrosarcoma de maxila, voluminoso y recurrente. La presentación clínica inicial fue como lesión nodular gingival derecha, asintomática, con crecimiento lento y progresivo durante 8 meses. Realizamos tomografía computarizada que mostró lesión gingival derecha de 3 x 3 cm y efectuamos resección marginal de la lesión que fue informada como condrosarcoma de II grado. La paciente presentó recurrencia tumoral aproximadamente al año, con reingreso hospitalario y recibió 9 ciclos de quimioterapia, para posteriormente efectuar maxilectomía bilateral subtotal con palatectomía y reconstrucción inicial con miniplacas de titanio y prótesis aloplástica. Presentamos imágenes de la valoración inicial, estudios complementarios, análisis histopatológico, procedimiento quirúrgico y estado postoperatorio (AU)
Chondrosarcoma is a malignant tumor of cartilaginous origin and unknown etiology, histologically characterized by a complete development of cartilaginous structures with no growth of bone. It represents approximately 10% of all bone neoplasms. It's usually presented in long bones, pelvis and ribs and it's extremely rare in craniofacial locations (less than 5%), where are considered more aggressive because of its rapid growth and a larger proportion of metastasis. When present in these locations, most affected sites in order of frequency are: maxilla, jaw, nasal septum and paranasal sinuses. The reported age ranges are 8 months to 75 years, with its peak incidence between the fifth and seventh decades of life. We present a female 7 year old patient, who presented a chondrosarcoma in the maxilla, bulky and recurrent. Her initial clinical presentation was a nodular right gingival asymptomatic lesion, with slow growth and ongoing for 8 months. Computed tomography showed a 3 x 3 cm tumor in the right maxilla that underwent limited resection; the specimen was reported as a grade II chondrosarcoma that developed recurrence in a year. She received 9 chemotherapy cycles and later, bilateral subtotal maxillectomy and pallatectomy and initial reconstruction with titanium miniplates and alloplastic prostheses. We present photographs of initial assessment, additional imaging studies, histopathology, surgical procedure and postoperative state (AU)
Subject(s)
Humans , Female , Child , Chondrosarcoma/surgery , Maxillary Neoplasms/surgery , Plastic Surgery Procedures/methods , Head and Neck Neoplasms/surgery , Neoplasm Recurrence, Local/pathologyABSTRACT
The aim of the study was to evaluate tympanic thermometry when compared with conventional glass-mercury thermometry, in 186 consecutive pediatric patients. In patients of less than 6 years of age (n = 120), there were no differences between tympanic and rectal measurements, in febrile and afebrile ranges, and significantly different when compared with axillary range. Similar data were reported in children of more than than 6 years of age (n = 65), in whom oral temperatures replace the rectal one. Using the tympanic thermometer as the standard measurement device, the accuracy of rectal, oral and axillary thermometers in determining a febrile state was examined. When tympanic temperature was 38 degrees C, a febrile state was considered, in this condition sensitivity for rectal measurement was of 73%, for oral 64%, and 23 and 29% for the axillary, according to the age group: specificity was of 100% in all the them. According to our data, tympanic measurement was consistent with glass-mercurial, rectal and oral, temperature in a pediatric population. Advantages of tympanic thermometry are its good correlation with central temperature, substantial time reduction of measurement (1 second), easy and non-invasive procedure, improved patient comfort, and lack of mercurial thermometry disadvantages. The conclusion is that tympanic thermometry becomes an acceptable option for pediatric temperature measurement.
Subject(s)
Body Temperature/physiology , Thermometers , Tympanic Membrane/physiology , Adolescent , Age Factors , Axilla , Child , Child, Preschool , Evaluation Studies as Topic , Female , Fever/diagnosis , Fever/physiopathology , Humans , Infant , Infant, Newborn , Infrared Rays , Male , Mouth , RectumABSTRACT
We present a case of acute lethal poisoning by oil of "epazote" (oil of chenopodium), in a 2 y 9 m female. The volatile oil was administered according to the advice of a "curandera" (female healer), in a total quantity of 40 ml. Clinical features of the poisoning were: vomiting, deep coma, seizures, mydriasis, apnea, metabolic acidosis, neurogenic shock and death. The EEG suggested a diffuse encephalopathy, the CT scan with an image of severe brain edema and ventricular collapse. Relevant postmortem findings were brain edema and neuronal necrosis, pneumonia, enteritis, pericholangitis, mild pancreatitis and tubular necrosis. The phytochemical analysis of volatile oil identified ascaridol, the main active compound of the chenopodium herbs, in a quantity of 39 mg/ml (1,560 mg in the dose administered), and Chenopodium graveolens as the plant employed to prepare it. According to the age of the patient, 60 mg of ascaridol would be the recommended dose formerly used in the treatment of parasitic disease. Thus 1,560 mg was 26 times higher than the recommended dose, and exceeded by 56% the dose of 1,000 mg reported as lethal in humans.
Subject(s)
Plant Oils/poisoning , Terpenes/poisoning , Child, Preschool , Fatal Outcome , Female , HumansABSTRACT
The aim of the study was to evaluate continuous administration of multiple-dose activated charcoal (MDAC) in enhancing elimination of carbamazepine (CBZ) in eight consecutive adolescent suicide attempters. Diluted charcoal was administered through a nasogastric tube at a dose of 1 g/kg every 4 h, and a saline cathartic at the same dosage was administered every 12 h. Plasma CBZ concentrations were measured at 0.0, 12, 24 and 36 h by means of a modified EMIT technique. As a measure of CBZ disappearance, half life of elimination (t1/2 beta) and exogenous total body clearance (CLB) were calculated. Clinical improvement occurred after 12 to 24 h, except in one patient who was the most severely intoxicated and who required advanced life-support therapy. Pharmacokinetic data reported a mean t1/2 beta of 9.5 h, shorter than the reference value of 18-54 h (p < 0.05), and a mean CLB of 103.13 ml/ min/kg, higher than the reference of 75.01 ml/min/ kg (p < 0.05). Initial mean CBZ levels of 27.9 decreased to 0.82 microgram/ml (97% of elimination, p < 0.05). MDAC was free from adverse side effects. In conclusion, MDAC is an effective procedure in enhancing CBZ elimination in overdosed patients as well as being relatively free from serious side effects, widely available, inexpensive and non-invasive.
Subject(s)
Anticonvulsants/poisoning , Carbamazepine/poisoning , Charcoal/therapeutic use , Drug Overdose/therapy , Suicide Prevention , Adolescent , Anticonvulsants/pharmacokinetics , Carbamazepine/pharmacokinetics , Cardiovascular System/physiopathology , Depression/therapy , Female , Half-Life , Humans , Intubation, Gastrointestinal , Suicide/psychologyABSTRACT
Twelve pediatric patients with acute poisonings caused by carbamazepine, digoxin and acetylsalicylic acid were treated with multiple doses of activated charcoal combined with a saline cathartic (adsorption surface of activated charcoal nearly 950 m2/g). This procedure was effective to shorten the plasmatic levels of the drugs, besides the clinical improvement of the poisoned patients. The average initial and final levels of the drugs were: carbamazepine 21.64 and 0.9 micrograms/ml (lowering 95.81%, p < 0.05), digoxin 5.14 and 1.1 ng/ml (lowering 78.6%, P < 0.05) and acetylsalicylic acid 418.5 and 57.5 micrograms/ml, respectively, (lowering 86.3%, p < 0.05). These results suggest the usefulness of activated charcoal in the clearance of the four overdosed drugs.
