Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group).

BACKGROUND: The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors. METHODS: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes. RESULTS: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function. CONCLUSIONS: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.

Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group).

BACKGROUND: Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery. MATERIALS AND METHODS: In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes. RESULTS: Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality. CONCLUSIONS: The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.

Evaluation of sodium butyrate and nutrient concentration for broiler chickens.

The relation between nutrition and intestinal health is a subject with an increasing interest in research, as nutritionists need knowledge about how formulation affects different parameters in the gastrointestinal tract (GIT). That is why 4 trials were conducted to evaluate the effect of nutrient concentration and a feed additive (sodium butyrate protected with sodium salts of palm fatty acid distillates (PSB, Gustor N'RGY produced by Norel S.A., Spain, dosed at 1 kg/t), on performance, diet digestibility, intestinal morphology, volatile fatty acid concentration (VFA) in the GIT and intestinal microbiota of broiler chickens, when fed diets with different energy and amino acids concentration. Control diets, C, with the recommended metabolizable energy (ME) and ideal amino acid (AA) composition; Reduction 1, R1, C - 60 kcal ME and - 2.3% AA and Reduction 2, R2, C - 120 kcal ME and - 4.6% AA) based on different feed ingredients (Corn Soy [CS] and Wheat Barley Soy (WBS) were formulated. All trials lasted 42 d. In trials 2 and 4, the nutrient dilution decreased performance of the animals. In all trials, PSB improved animal performance (growth or FCR), despite the different situations. In trials 1 and 4, animals receiving R1 diets and PSB showed similar performance to those receiving C diets without PSB. PSB improved Gross Energy metabolizability (69.94 vs. 72.55; P: 0.02). Nutrient concentration affected histology results in T2 (ileum) and T3 (jejunum); PSB showed effects in T2 (jejunum, ileum) and in T3 (jejunum). In T1, PSB affected VFA in duodenum, jejunum, and ileum, changing the profile depending on diet nutrient concentration. PSB altered microbiology in caecum of animals in T2. It can be concluded that the dilution of ME and AA concentration of the diet impairs animal performance, influences intestinal microbiota and affects intestinal histology. PSB improves animal performance, increases gross energy metabolizability, steers intestinal microbiota and alters VFA concentrations in the intestine. The addition of PSB may help the animal to counteract the negative effects of diluted diets.

Micronucleus formation in human keratinocytes is dependent on radiation quality and tissue architecture.

The cytokinesis-block micronucleus (MN) assay was used to assess the genotoxicity of low doses of different types of space radiation. Normal human primary keratinocytes and immortalized keratinocytes grown in 2D monolayers each were exposed to graded doses of 0.3 or 1.0 GeV/n silicon ions or similar energies of iron ions. The frequencies of induced MN were determined and compared to γ-ray data. RBE(max) values ranged from 1.6 to 3.9 for primary keratinocytes and from 2.4 to 6.3 for immortalized keratinocytes. At low radiation doses ≤ 0.4 Gy, 0.3 GeV/n iron ions were the most effective at inducing MN in normal keratinocytes. An "over-kill effect" was observed for 0.3 GeV/n iron ions at higher doses, wherein 1.0 GeV/n iron ions were most efficient in inducing MN. In immortalized keratinocytes, 0.3 GeV/n iron ions produced MN with greater frequency than 1.0 GeV/n iron ions, except at the highest dose tested. MN formation was higher in immortalized keratinocytes than in normal keratinocytes for all doses and radiation qualities investigated. MN induction was also assessed in human keratinocytes cultured in 3D to simulate the complex architecture of human skin. RBE values for MN formation in 3D were reduced for normal keratinocytes exposed to iron ions, but were elevated for immortalized keratinocytes. Overall, MN induction was significantly lower in keratinocytes cultured in 3D than in 2D. Together, the results suggest that tissue architecture and immortalization status modulate the genotoxic response to space radiation, perhaps via alterations in DNA repair fidelity.

Piglet behavior as a measure of vitality and its influence on piglet survival and growth during lactation.

The aim of the study was to develop a vitality scoring method, based on piglet behavior and relate it to piglet growth and survival. From 21 sows (Sus scrofa), 287 piglets were used. After farrowing (d 0), piglets were weighed and tested for 4 behavioral parameters in a circular enclosure (55 cm diam.): movement capacity (M), udder stimulation (U), number of completed circles around the enclosure (NCC), and screaming (Sc). Piglets were weighed again on d 1, 2, 3, and 17. Piglet rectal temperature (RT) was recorded on d 0, 1, 2, and 3. Farrowing information of the sow was also recorded. Multiple regression analyses for survival and BW gain at weaning as dependent variables were performed. Piglet BW gain at weaning was influenced by BW at birth (P < 0.001), sow parity (P = 0.024), total number of piglets born alive per sow (P < 0.001), and sum of U and NCC parameters (UN; P = 0.023). Piglet survival during lactation was influenced by BW at birth (P = 0.015), UNCC parameter (P = 0.026), and RT on d 3 (P = 0.085). The sum of U and NCC parameters, in combination with BW at birth and information of the sow, might be useful to predict piglet growth survival during lactation, thus becoming a useful tool to improve piglet management during the first days of lactation. In conclusion, UNCC parameter seems to be an easy and useful way to assess piglet vitality for both scientific and commercial purposes.

Synthesis of biphenyl-based arsine ligands by Suzuki-Miyaura coupling and their application to Pd-catalyzed arsination.

A versatile and efficient approach for the synthesis of new biphenyl-based arsine ligands, by a Pd-catalyzed arsination to introduce the -AsPh(2) moiety, and then a Suzuki-Miyaura cross-coupling for biaryl construction is reported. By Pd-catalyzed arsination with n-Bu(3)SnAsPh(2) (1), (2-bromophenyl)diphenylarsine (2, 83%) was obtained. The Suzuki-Miyaura reaction between the bromoarsine 2 and aryl boronic acids bearing different substituents provided biarylarsine ligands (80-99%). The efficiency of catalysts derived from the new biarylarsine ligands was evaluated in the Pd-catalyzed arsination with perfluoroalkyl iodides (R(f)I). Outstanding activities of catalysts derived from Pd/methoxybiarylarsine ligands were found in this coupling reaction affording perfluoroalkyl arsines in very good yields (57-100%).

Uso de la regeneración ósea guiada (rog) con membranas biodegradables de co-polímeros en cirugía bucal para reparar defectos óseos: estudio clínico de 30 meses de seguimiento postquirúrgico

La regeneración ósea guiada (ROG) es frecuentemente usada para tratar defectos óseos pero muchas veces el tipo de membrana usada se degrada antes de que ocurra la adecuada cicatrización ósea y se introduce tejido blando en la zona a regenerar. El objetivo de éste estudio es evaluar la eficacia de usar el sistema de membranas y tachuelas biodegradables de co-polímeros en pacientes con defectos óseos o que necesiten levantamiento de membrana sinusal con un periódico control clínico y radiográfico. Este estudio fue realizado en 15 pacientes que tenían defectos óseos o necesitaban levantamiento de membrana sinusal, con un rango de edad entre 19 y 49 años con un promedio de 34 años de edad. 8 pacientes fueron femeninos y 7 masculinos. Se usó relleno óseo con las membranas y tachuelas biodegradables de co-polímeros en todos los casos, 7 de los casos fueron levantamiento de membrana sinusal y los otros 8 se trataron de defectos óseos. Se les realizó un seguimiento clínico y radiográfico cada 3 y 6 meses hasta 30 meses después del día de la cirugía entre los años 2005 y 2007, realizándose un análisis longitudinal. Se encontró que a 5 pacientes se les expuso la membrana, uno de ellos se mantuvo con enjuagues de clorhexidina hasta que cicatrizó por segunda intención, en 2 de los pacientes se les recortó y moldeó el borde expuesto y los otros 2 casos se tuvo que retirar la membrana y tachuelas por completo. Los 10 pacientes restantes cicatrizaron adecuadamente y no tuvieron ningún tipo de exposición, siendo el porcentaje de éxito al utilizar éste nuevo sistema de membranas y tachuelas biodegradables de co-polímeros del 66,7%. Se destaca que éste sistema de membranas y tachuelas biodegradables de co-polímeros no necesita ser retirado en una 2da cirugía. Debido al buen control postquirúrgico se pudo manejar de inmediato los casos donde hubo exposición de la membrana y sólo fracasaron 2 de 15. Se observó una adecuada cicatrización ósea tanto clínica ...

Guided bone regeneration (GBR) is frequently used to treat bone defects, however, most of the membranes degrade before bone healing has occurred permitting soft tissue invasion into the desired bone chamber. The aim of this clinical trail is to evaluate the efficacy of using a biodegradable co-polymers membrane and tacks system in patients with bone defects or need of maxillary sinus lift for implant placement with a long term clinical and radiographically follow up. All patients included in this study had the necessity of guided bone regeneration. 15 patients consisted of bone defects or the need of maxillary sinus lifting, with an age range of 19 to 49 years of age with an average of 34 years old. There were 8 females and 7 males. In all cases, we used biodegradable co-polymers membrane and tacks system that gets soft when applied but becomes rigid in-situ after approximately 15 minutes allowing the new bone cicatrization because it becomes a barrier for the bone grafting material, 7 patients underwent surgery for maxillary sinus lift and the other 8 for bone defects. Patients were followed clinical and radiographically during 3 to 6 months intervals up to 30 months between 2005 - 2007. A longitudinal study was performed by checking the patients clinical and radiographically during a continuously period of time up to 30 months postoperatively. 5 patients had partial membrane exposure, one of them was kept in clorhexidine mouth rinses and irrigation until secondary healing was accomplished. 2 patients were treated by cutting and trimming the membrane edges in order to get full mucosa coverage and it was obtained in 2 weeks after this procedure. In 2 cases the flap open totally and we had to remove the membrane. The rest 10 of the 15 patients healed uneventfully. The percentage of success using the biodegradable co-polymers membrane and tacks system was 66,7% . This biodegradable co-polymers membrane and tacks system does not require ...

Estimación del volumen orbitario mediante imágenes de TC y el principio de cavalieri / Estimation of the orbital volume with ct images and cavalieris principle

Determination of the orbital volume has significance in cases such as facial injuries and lens implants where it is necessary to restore the normal position of the structures, since providing the patient with a volume-deficient orbit may result in enophthalmos. The aim of this study is to assess the volume of the orbit by using the Cavalieri s principle supplemented with sequential analysis of CT images on the computer screen. We conducted a series of CT images with a thickness of 1mm on 10 human skulls. After selection, initially random and then sequential, images were analyzed on a computer screen with a mesh test chart to determine orbital area. Once having identifed both area and thickness, we measured the volume of segments, and the total volume of the orbit was extrapolated by using a mathematical formula based on the Cavalieri s principle. Results were compared with the actual volume obtained by the displacement of fuid from printouts of the orbits. The result of this comparison suggests that the method is statistically reliable when considering that we assessed seven images of a randomly chosen orbit and then in a known sequence with a straightforward technique for orbital volume estimation.

Conocer el volumen de la órbita es importante en traumatismos faciales o implantes oculares, donde es necesario restablecer la posición normal de las estructuras y devolver un volumen deficiente puede traducirse en enoftalmo. El objetivo del presente trabajo es realizar estimación del volumen orbitario utilizando el principio de Cavalieri complementado con análisis secuencial de imágenes de TC en la pantalla del computador. Se realizó imágenes de TC de 1mm de espesor a 10 cráneos humanos. Luego de la selección, inicialmente aleatoria y luego secuencial, las imágenes se analizaron sobre la pantalla del computador con un test de malla de puntos para determinar área orbitaria. Conociendo el área y el grosor, determinamos el volumen de los segmentos y se extrapola al volumen total de la órbita, utilizando fórmula matemática basada en el principio de Cavalieri. Los resultados fueron comparados con el volumen real obtenido por el desplazamiento de fluidos de impresiones de las órbitas. Esta comparación sugiere que el método es estadísticamente confable al evaluar 7 imágenes de una órbita escogida aleatoriamente y luego en una secuencia conocida, con una manera simple de estimación del volumen.

Tratamiento quirúrgico conservador del quiste dentígero en pacientes pediátricos atendidos en el postgrado de cirugía bucal, Facultad de Odontología de la UCV: seguimiento a largo plazo / Conservative surgical treatment of dentigerous cysts in pediatric patients assisted at the Oral Surgery Department, School of Dentistry, UCV: long-term follow-up

De acuerdo a numerosos autores el tratamiento para el quiste dentígero ha sido la eliminación total del quiste incluyendo el diente involucrado aunque si la lesión se presenta en pacientes jóvenes que están en período de erupción dentaria y las características clínicas y radiográficas sugieren la presencia de un quiste dentígero, existe una alternativa de tratamiento la cual es la de mantener el diente permanente no erupcionado y enuclear completamente la lesión, siempre que se obtenga el diagnóstico definitivo histopatológico confirmatorio de quiste dentígero. Se realizó un estudio clínico en 12 pacientes de 7 a 16 años de edad con un promedio de 9,4 años, quienes fueron tratados en el Postgrado de Cirugía Bucal de la Facultad de Odontología de la Universidad Central de Venezuela (UCV). Todos los pacientes tenían las características clínicas y radiográficas similares a las del quiste dentígero, se encontraron 5 mujeres y 7 hombres, los cuales fueron sometidos a biopsia excisional, donde se les eliminó la lesión por completo, El estudio histopatológico fue confirmatorio de quiste dentígero para cada paciente y a cada uno se les realizó un seguimiento clínico y radiográfico periódico desde 2 meses hasta 7 años, con un intervalo aproximado de cada 6 meses. (1999-2006). Tres (3) pacientes fueron seguidos por 7 años, cuatro (4) por 5 años, dos (2) por 3 años con 9 meses y tres (3) por 2 años y 6 meses. A dos (2) de los pacientes se les realizó tratamiento ortodóncico para corregir su maloclusión. Este tratamiento puede ser usado como un manejo quirúrgico conservador que permite la erupción normal de la dentición permanente. Éste estudio enfatiza la importancia del manejo multidisciplinario en equipo, Cirujano Bucal, Patólogo Bucal, Ortodoncista y Odontopediatra y el control radiográfico postquirúrgico contínuo de los pacientes para asegurarnos de que no ha habido recidiva o la aparición de alguna nueva patología asociada.

According to most authors the common treatment for the dentigerous cyst has been total elimination of the cyst including the tooth involved; however if the lesion is present in young patients during the eruption period, and the radiographic and clinical features are suggesting of dentigerous cyst, an alternative treatment is the maintenance of the permanent tooth and enucleation of the lesion alone, stating that ameloblastomatous changes or other odontogenic lesions have been ruled out after histopathological analysis, and a diagnosis of dentigerous cyst is confirmed. This study was conducted on 12 patients with an age range of 6 to 16 years with a mean age of 9.4 years that were treated at the Oral Surgery Postgraduate Department, Dental School, Central University of Venezuela. There were 5 females and 7 males. All lesions were mandibular and all of them were unilocular and well-defined radiolucencies measuring less than 2,5 cms in greatest diameter. All cases involved the coronal portion with cervical attachment of an unerupted permanent tooth. Third molars were excluded. Patients underwent surgery (excisional biopsy) of the cyst with preservation of the involved tooth. Histologic diagnosis of dentigerous cyst was confirmed in each case. Clinical and radiographic follow-up was performed at 6 months intervals up to 7 years (1999-2006). There were no recurrences of radiolucent lesions in any of the post-surgical x-rays. Three (3) patients were followed for 7 years, four (4) patients for 5 years, two (2) patients for 3 years and 9 moths and three (3) patients for 2 years and 6 months. The cases showed new bone formation surrounding the teeth involved and complete eruption of the permanent dentition. Two (2) of the patients had to use orthodontic appliances to correct their malocclusion. Preservation of the tooth involved in a Dentigerous Cyst and the enucleation of the total lesion is an alternative surgical procedure with predictable and stable clinical and radiographic results. This treatment could be used as a conservative management for the dentigerous cyst allowing the normal eruption of the permanent dentition. This clinical study emphasizes the importance of an interdisciplinary team management (Oral Surgeons, Oral Pathologists and Orthodontists) and the continuous postoperative evaluation.

Patología ultraestructural del músculo orbicular de los labios en pacientes VIH+ / Ultrastructural pathology of the lip orbicular muscle in HIV+ patients

Las complicaciones neuromusculares son muy frecuentes en pacientes VIH+. Estos últimos exhiben parestesia, adormecimiento, hormigueo, dificultad para subir escaleras, siendo más importantes estos síntomas en los miembros inferiores. Varios autores han realizado estudios con relación a miopatías como complicación del VIH y asociación con la terapia a base de AZT, no teniéndose establecido aún si es la terapia la que produce dicho desorde o éste es simplemente una complicación más de la propia infección. Se realizó un estudio en 9 pacientes VIH+ que asisten al Servicio de Enfermedades Infectocontagiosas Dra. Elsa La Corte de la Facultad de Odontología de la U.C.V, a quienes se les tomaron biopsia del músculo orbicular de los labios y se procesaron para microscopía electrónica de transmisión, encontrándose atrofia de las fibras musculares con disminución de elementos contráctiles y sarcotubulares, hipercontracción y necrosis. Asimismo, se apreció aumento de las fibrillas de colágeno, engrosamiento de la membrana basal y el plegamiento del sarcolema. Se puede concluir que el VIH tiene efectos sobre la ultraestructura de invervación craneal a la cual pertenece el orbicular de los labios, no pareciendo que las alteraciones encontradas tengan una relación directa con la medicación suministrada.

Mucoceles en cara ventral de lengua: reporte de 6 casos y manejo quirúrgico / Mucoceles in ventral aspect of the tongue: report of 6 cases and surgical management

El mucocele es un tÚrmino clÝnico que corresponde histopatológicamente a un fenómeno de retención o extravasación de moco, causado por obstrucción o ruptura del ducto de una glßndula salival menor; la localización mßs frecuente es la mucosa del labio inferior, seguida de mucosa bucal, paladar y pocas veces, lado ventral de lengua(1-2). Se estudiaron 6 pacientes con diagnóstico clÝnico de mucocele en cara ventral de lengua que acudieron al Servicio de PatologÝa ClÝnica de la Facultad de OdontologÝa de la UCV entre el año 2000 y 2001. Se les realizó biopsia a cada uno de ellos, correspondiendo el diagnóstico histopatológico a fenómeno de retención de moco. Se realizó la primera evaluación postoperatoria a los 15 dÝas, luego al mes y 3 meses respectivamente. De los 6 pacientes, al segundo control, 3 de ellos presentaron recurrencia, por lo cual se planificó realizarles marsupializacion, los otros pacientes fueron evaluados a los 3 meses sin encontrarse lesión. Los que necesitaron la segunda cirugÝa posteriormente fueron evaluados al mes y a los 3 meses, sin presentar recidiva. Los casos reportados de mucocele en cara ventral de lengua demuestran que esta localización es poco frecuente al comparar con los datos reportados en la literatura, asÝ como la revisión de 10 años de todos los mucoceles en boca estudiados en el laboratorio de HistopatologÝa Dr. Pedro Tinoco de la Facultad de OdontologÝa de la Universidad Central de Venezuela

Kinetic analysis of the general modifier mechanism of Botts and Morales involving a suicide substrate.

Suicide substrates are widely used in enzymology for studying enzyme mechanisms and designing potential drugs. The presence of a reversible modifier decreases or increases the rate of substrate-induced inactivation, with evident physiological and experimental consequences. To date, only the action of a competitive or uncompetitive inhibitor of an enzyme system involving suicide substrate has been reported. In this paper, we analyse the kinetics of enzyme-catalysed reactions which evolve in accordance with the general modifier mechanisms of Botts and Morales in which enzyme inactivation is induced by suicide substrate. Rapid equilibrium of all of the reversible reaction steps involved is assumed and the time course equations for the residual enzyme activity, the inactive enzyme forms and the reaction product are derived. Partition ratios giving the relative weight of the product and inactive enzyme concentrations, and the relative contribution to the product formation of each of the unmodified and modified catalytic routes, are studied. New indices pointing to the conditions under which the modifier acts as inhibitor or as activator are suggested. The goodness of the analytical solutions is tested by comparison with the simulated curves obtained by numerical integration. An experimental design and kinetic data analysis to evaluate the kinetic parameters from the time progress curves of the product are proposed. From these results, those corresponding to several reaction mechanisms involving both a suicide substrate and a modifier, and which can be regarded as particular cases of the general case analysed here, can be directly and easily derived.

Uso de la clindamicina oral para el tratamiento de la actinomicosis cervicofacial / Use of oral clindamycin for the treatment of cervicofacial actinomycosis

La actinomicosis cervicofacial es una enfermedad bacteriana crónica comúnmente causada por el Actinomyces Israelii, una bacteria anaeróbica gram positiva. Este organismo saprófito es una habitante normal de la cavidad bucal. La infección aparece generalmente después de un trauma, cirugía o una infección previa. La extracción del diente, la cirugía periodontal e infecciones orales son predisponentes al desarrollo de esta condición. La actinomicosis se presenta típicamente como una inflamación del maxilar inferior que puede simular un absceso. La lesión es indurada, fría al tacto y el pus que drena puede contener gránulos amarillos pequeños conocidos como "gránulos de azufre", sin un olor fétido. Este lesión tiende a recurrir generalmente. El objetivo de este estudio clínico fue probar el efecto de la clindamicina por vía oral en el tratamiento de la actinomicosis cervicofacial. Seis pacientes que presentaron actinomicosis cervicofacial fueron tratados con 1 gragea de 300 mg de clindamicina cada 6 horas por 21 días y eliminación quirúrgica de la etiología dental. Los pacientes fueron controlados por 6 meses después del tratamiento. La inflamación del maxilar inferior desapareció rápidamente, aproximadamente cuatro días después de tomar este antibiótico, el edema fue disminuyendo progresivamente. No hubo reaparición de la lesión después del tratamiento. La clindamicina oral es un antibiótico efectivo en infecciones anaeróbicas. Este antibiótico es una alternativa viable para el tratamiento eficaz de la actinomicosis cervicofacial. En nuestro estudio, no hubo recidiva

Tuberculosis, un problema que no debe ignorar el odontólogo: revisión bibliográfica / Tuberculosis, a problem that must not be ignored by the dentist: a review of the literature

La tuberculosis (TBC) es una infección bacteriana crónica de gran importancia para el odontólogo. El elevado crecimiento de la población y la deficiente aplicación de métodos para el control de esta enfermedad nos lleva a que cada día existan más enfermeos de tuberculosis. La tuberculosis es una de las enfermedades más importantes asociada al SIDA, las diferentes alteraciones inmunológicas de este síndrome facilitan las formas de TBC de reactivación y la rápida progresión de infección a enfermedad. Una compleja interacción de factores influencia el desarrollo de la misma. Existe evidencia directa e indirecta del papel del virus de inmunodeficiencia humana (VIH); sin embargo, el concepto de la reactivación antecede a los tratamientos en hospicios, ancianatos, orfanatos, prisiones y reformatorios, los que han permitido que esta enfermedad reaparezca en la historia como la plaga blanca. A continuación se muestra una revisión de la literatura sobre esta enfermedad que cada día aumenta su incidencia y como profesionales de la salud necesitamos conocer de ella

Detection and quantitation of hepatitis C virus RNA in feces of chronically infected individuals.

Hepatitis C virus (HCV) RNA was detected and quantified in human fecal specimens with the Roche COBAS AMPLICOR system adapted by us for fecal specimens. HCV RNA could be detected in the feces of four of six (67%) patients chronically infected with HCV, with loads up to about 2.8 x 10(5) copies/ml of feces. The same HCV genotypes were observed in feces and plasma as determined by direct sequencing of the 5' untranslated region.

Detection and quantitation of human cytomegalovirus DNA in faeces.

The development and performance of a robust and sensitive PCR assay are described for the detection and quantitation of human cytomegalovirus DNA in human faecal specimens. In this assay, CMV DNA was purified by an optimised DNA extraction protocol together with internal control DNA that monitored both DNA extraction efficiency and PCR efficiency. The lower detection limit of the assay was reached at about 100 CMV particles per ml of (25-50%) faecal suspension. CMV DNA could be quantitated in the range of about 300-100000 molecules per ml of faecal suspension. CMV DNA loads obtained in clinical faeces specimens suggest that the assay can be used to monitor the efficacy of antiviral treatment. Reconstruction experiments that monitored the efficiency of DNA extraction of a preliminary DNA extraction protocol, showed low DNA yields for 9% of the specimens (n = 78). In all cases, low DNA extraction efficiency seemed to be due to a component present in faeces that prevented DNA binding to silica particles, presumably by competitive binding. Choosing the right ratio of silica particles to faeces specimen solved this problem. Similarly, reconstruction experiments showed that the strong PCR inhibition that was observed in 8% of the specimens could effectively be relieved by the inclusion of alpha-casein in the PCR mixtures.

Favourable effect of chemotherapy on clinical symptoms and human herpesvirus-8 DNA load in a patient with Kaposi's sarcoma presenting with fever and anemia.

The case of a patient infected with human immunodeficiency virus type 1 (HIV-1) with Kaposi's sarcoma who presented with fever of unknown origin, severe anemia, thrombocytopenia and hypoalbuminemia but only limited involvement of the skin is presented. Chemotherapy directed at Kaposi's sarcoma resulted in resolution of these clinical signs and symptoms and was associated with a significant reduction in human herpesvirus-8 DNA load in serum, despite continued HIV-1 replication. Such a decreasing human herpesvirus-8 load following Kaposi's sarcoma-directed chemotherapy has not been reported previously. These findings suggest that Kaposi's sarcoma was indeed responsible for the clinical syndrome and that this neoplasm is a source of human herpesvirus-8 virus particle production, which can be inhibited by chemotherapy-induced reduction in tumor burden.

A highly sensitive assay for detection and quantitation of human cytomegalovirus DNA in serum and plasma by PCR and electrochemiluminescence.

We describe a diagnostic PCR assay (D-PCR) and a quantitative PCR assay (Q-PCR) for the detection of human cytomegalovirus (CMV) in plasma and serum. In the D-PCR, DNA was purified from plasma or serum together with internal control (IC) DNA, which monitored both DNA extraction efficiency and PCR efficiency. DNA was subjected to PCR with a single primer pair, and the amount of PCR products was determined by electrochemiluminescence (ECL) in the QPCR System 5000 (Perkin-Elmer) after hybridization with Tris (2,2'-bipyridine) ruthenium (II) chelate-labeled probes. The lower limit of sensitivity of the D-PCR was reached at about 25 CMV particles/ml. Even with extremely low DNA inputs (four molecules of IC DNA/200 microl of plasma), very high yields (near 100%) were reached. DNA extracted from specimens that were CMV positive by the D-PCR was subsequently used in the Q-PCR, which was similar to the D-PCR. The viral load was calculated directly from the ratio of CMV and IC signals obtained by ECL. The Q-PCR assay is quantitative in the range of 100 to 150,000 copies of CMV/ml, independent of the anticoagulant. Interassay variation, intra-assay variation, and interspecimen variation were about 25%, suggesting that the Q-PCR will reliably detect fourfold differences in viral load. Comparison of paired serum and plasma specimens from CMV-infected individuals showed that serum CMV loads were frequently more than 10-fold lower than plasma CMV loads.