Odontogenic Maxillofacial Infections in a High-level Hospital: Orofacial Pain and Related Conditions

ABSTRACT Objective: Odontogenic infection is a common condition in America; the aim of this research was to determine the profile of odontogenic maxillofacial infections and to identify the link between these and the pain felt by patients admitted to the emergency dental service of the Hernân Henriquez Aravena Hospital in Temuco, Chile. Methods: A cross-sectional, double-blind study analysed 49 individuals admitted for emergency dental care. Included were admissions associated with odontogenic infection identified by clinical examination, establishing a relation to pain through a survey. The diagnosis was made clinically using the fascial spaces involved in the infection, presence of self-medication prior to admission, need for surgical treatment and the patient 's systemic conditions. The data were analysed using descriptive statistics, Chi-squared, ANOVA, considering a value of p < 0.05 as significant. Results: The average pain level measured by visual analogue scale (VAS) in emergency admission was 8.1. There was no association between the diagnosis (pulp infection, periodontal infection or pericoronitis) and the VAS (p = 0.078), but there was association between age and the diagnosis (p = 0.022), and the VAS was associated with pain compared to other types of pathologies or traumas (p = 0.011). Conclusion: Odontogenic infection is frequent and linked to age and high-pain values. New public policies should be adopted based on these results. New studies are needed to assess new variables associated with these pathologies.

Abordaje de la punta nasal problemática / Approach to problematic nasal tip

Las puntas nasales globulosas, cuadradas, bífidas, hipoproyectadas, hiperproyectadas o asimétricas, son consideradas problemáticas o dificultosas. Para su tratamiento, en las rinoplastias primarias, debemos abordar los cartílagos alares a través de las incisiones intercartilaginosa y transfixiante interseptocolumelar, primero y paramarginal después. Se disecan por ambas caras y se exteriorizan por una de las narinas. Así expuestos, se les pueden realizar con mayor precisión las correcciones necesarias. Una vez repuestos los cartílagos a su nueva posición, llevaremos a cabo la síntesis de la incisión paramarginal con puntos separados. Los demás pasos de la rinoplastia se pueden efectuar según técnica de elección para cada cirujano (AU)

The nasal tips when are wide, amorphous, bulbous, bad defined, with insufficient projection, overprojection or assymetry, are considered as problematical or difficult nasals tips. At primary rhinoplasty, through a intercartilaginous, transfixion and pararim incisions, the lower lateral cartilages are dissected in both surfaces and are exteriorizated through the nostril; then, they are corrected under direct vision. After these corrections, the cartilages are placed back into their new position. The other steps of the basic aesthetic rhinoplasty can be made according to the technique of choice for each surgeon (AU)

Endobronchial tubes - a case for re-evaluation.

An endobronchial tube (Macintosh-Leatherdale) was used to secure the airway for a tracheal resection and end-to-end anastomosis. This lung separation device enabled insertion of both a fibreoptic bronchoscope and a tube exchange catheter. These were required after the trachea was transected and re-anastomosis proved surgically difficult. The airway exchange catheter allowed for jet ventilation and later a tube change when an emergency occurred. Options and management issues for tracheal surgery and lung separators are discussed. A case is made for a re-evaluation of endobronchial tubes both as a useful conduit for modern airway instruments and as an alternative to small double-lumen tubes for the increasing population of obese patients weighing > 100 kg, requiring thoracic surgery.

Anestesia troncular en rinoplastias / Troncular anesthesia in rinoplasty

Se describe la técnica de anestesia troncular para Rinoplastia en tres etapas: premedicación, aplicación tópica e infiltración. Se pretende con solamente 5 cc. de lidocaína al 2% con epinefrina más media ampolla de adrenalina, bloquear selectivamente los filetes nerviosos en sus lugares específicos, sin deformar el contorno nasal. De esta manera suprimimos las molestias durante la infiltración y logramos muy buena analgesia para la realización de la Rinoplastia, con mínimos riesgos (AU)

A 3 steps tecnique for local anesthesia in Rinoplasty is described: premedication, topical anesthesia and infiltration. With only 5 cc of 2% lidocaine plus 0,5 cc of adrenaline, nerves are specificaly blocked at the accurate emerging points, without nasal contour deformity. This way discomfrot sensation during infiltration is avoided and a very good level of analgesia for Rinoplasty is achieved (AU)

Wild manihot species do not possess C4 photosynthesis.

Cultivated cassava (Manihot esculenta) has a higher rate of photosynthesis than is usual for C3 plants and photosynthesis is not light saturated. For these reasons it has been suggested that cultivated cassava could be derived from wild species possessing C4 photosynthesis. The natural abundance of 13C and activities of phosphoenolpyruvate carboxylase and phosphoglycolate phosphatase were measured in leaves of 20 wild cassava species to test this hypothesis. All the species studied, including M. flabellifolia the potential wild progenitor of cultivated cassava, clearly exhibited C3 not C4 characteristics.

Eficacia y eficiencia del programa de control de tuberculosis en Rioja, San Martín - Perú durante el período 1996-2000 / Efficacy and efficiency of the Tuberculosis control program in Rioja, San Martin - Peru during the period 1996 - 2000

Objetivo: Evaluar la eficacia y eficiencia del Programa de Control de Tuberculosis (PCT) en la Red de Servicios de Salud Rioja (RSSR), San Martín-Perú, durante el período 1996-2000. Materiales y métodos: Estudio descriptivo longitudinal, que utiliza como fuente de información retrospectiva los libros de registro y seguimiento de pacientes con tuberculosis (TB) del PCT de la RSSP. La muestra incluyó a los pacientes diagnosticados de TB y registrado en el PCT, excluyéndose los pacientes que presentaron reacción adversa a medicamentos que motivó cambio del esquema de tratamiento o pacientes con tratamiento irregular. se realizó el análisis según año, microrred (MR) y esquema de tratamiento. Resultados: Se incluyeron 355 pacientes, La eficacia a nivel de red fue 99,7 y la eficiencia 93,0. El porcentaje de abandonados fue 2,0, fracasos 0,3 transferencias sin confirmar (TSC) 1,4 y fallecidos 2,8. No se determinó ninguna tendencia significativa a lo largo del período estudiado. A nivel de microrred, la menor eficiencia la presentaron la MR-5 y MR-3; ambas microrredes también tuvieron el mayor porcentaje de abandonos. El mayor porcentaje de fallecido de fallecidos lo presentaron la MR-5 y MR-6. Se encontró un alto porcentaje de abandonados en pacientes que recibieron Esquela III y el porcentaje de fallecidos fue mayor en los que recibieron Esquema II. Conclusiones: La eficacia y eficiencia presentaron, en general, valores adecuados en la RSSR; sin embargo, pudimos identidicar algunos microrredes y subpoblaciones de pacientes con altos porcentajes de fallecimientos, abandonos y TSC, situación que necesita ser corregida

Extraventricular cerebral anaplastic ependymomas.

BACKGROUND: Anaplastic ependymomas are considered to be uncommon cerebral tumors by most authors. We have had the opportunity to study 34 cases of such lesions in 13 years. METHODS: 34 cases of anaplastic ependymoma operated in different hospitals of Maracaibo, Venezuela, during the period of 1983-1995 were analyzed. Cases of ependymoblastoma were excluded. RESULTS: Adult patients made up most of the present series. All patients harbored supratentorial growths in locations distant from the ventricular system. The microscopic pattern was of limited value to establish prognosis, for there was no constant correlation between the histologic features and tumor relapse; only in sporadic cases in which high cell density and conspicuous mitotic activity were maximally expressed, did tumor relapse occur shortly after removal of the lesion. CONCLUSION: This type of paradoxical behavior being the rule makes all attempts at predicting prognosis in these entities a disappointing task.

[Endoscopic retrograde cholangiopancreatography and sphincterotomy in parasitic diseases]. / Pancreatocolangiografía retrógrada endoscópica y esfinterotomía en las parasitosis.

We report six patients with billary duct obstruction due to parasites (Fasciola hepatica, ascariasis and hydatid cyst) that were diagnosed and managed with the endoscopic approach. This is the first national paper which highlights the importance of endoscopic retrograde cholangiopancreatography in the management of this parasitosis. Despite choledocholithiasis as the most common cause of extrahepatic jaundice, biliary tree parasitosis must be considered in the differential diagnosis.

[Focus on risk in adolescent pregnancy]. / Un enfoque de riesgo para la maternidad temprana.

Results from the application of risk approach for the analysis of early maternity are reported. This analysis is made from the available medical records. Based on data obtained from the Registry of Deliveries of the Obstetric ward of "Madariaga de Posadas" hospital, Misiones, Argentina, a cross-sectional study of analytical observation was conducted. All records regarding deliveries occurring during the first semester of 1991, i,e, 507 cases were considered for the study and 3 characteristics were chosen: age, parity, and complications due to an inadequate prenatal monitoring. The first two characteristics, in combination, were used as an indicator of risk level and the third was crossed in a contingency table. The most significant findings were that 20% of 2 513 deliveries cared for within the aforementioned period of time corresponded to early maternity. Average age of the adolescents was 17 years ranging from 12-19 and standard deviation 1.5 years, modal parity was placed in the rank of 0. Of 507 deliveries at risk, 69 were considered high risk deliveries because of the age and 305 because of parity. Overall, 61 deliveries presented with complications due to inadequeate prenatal care. In general, it is concluded that the technique and the data source used are quite useful to quantitate the occurrence of early maternity and to design strategies for nursing intervention in the community. These women who receive medical care in the public hospital come from popular sectors and represent a well defined risk group requiring specific preventive medical care for the reproductive process as a whole.

Rhinoplasty and facial expression.

Based on the philosophical concept that facial beauty is not merely harmony of static anatomical structures but also the dynamic expression of the face (especially when one smiles), I propose that plastic surgeons approach the problem of aesthetic improvement of the human face not only in response but also when the face moves. I call this "surgery of the facial expression." I describe here the use of a new surgical procedure to correct a certain condition with which plastic surgeons are frequently confronted when patients consult and request rhinoplasty. Many patients have added defects that are exposed only when they begin to make facial movements and gestures; moreover, these added defects become even more manifest when they smile. I call this phenomenon "rhino-gingivolabial syndrome of the smile," and describe the technique I have used not only to improve the form of the nose but also to enhance the patient's smile.

Surgical lengthening of the short columella: division of the depressor septi muscles.

A new surgical procedure is described to correct the difficult problem of the short columella without resorting to cartilage grafts. The ready recourse to these grafts, so much in vogue at the present time in primary rhinoplasties, should be carefully and completely re-examined, since the final result very frequently yields no real benefits and may permanently deface the area from which the cartilage has been taken. The present technique combines trimming of the upper lateral nasal cartilages with approximation of the alar cartilages and excisions of the depressor septi muscles and/or contiguous orbicularis oris muscle.

Lateral approach in mammary implants.

The lateral approach in mammary implants is recommended, especially in patients with a marked hypomastia. In these patients, submuscular implants are mandatory. Routinely, hyaluronidase is injected in situ before implantation to favor immediate reabsorption of possible bleeding that could lead to capsular contraction. A circular pattern has been designed to reach symmetry both in incisions and the surgical pocket. Advantages of the lateral approach are described.

Aesthetic treatment of the columella.

Through a transfixion incision, a rhomboidal portion of both the depressor muscle of the nasal septum and the orbicular muscle of the mouth are excised. The remaining columellar tissues are brought nearer to each other by means of a mattress suture tied over a double-foam bolus. This simple procedure yields three advantages: (1) Tip projection, (2) nasolabial angle opening, (3) Interalar distance reduction, especially in the black population, avoiding the Weir-Joseph procedures. This simple and harmless procedure renders better results than the use of cartilage grafts or silicone implants aiming to project the tip or to open the nasolabial angle. Also, in some cases the patients' smile is enhanced.

Nuestra experiencia con los detergentes catiónicos antisépticos eficaces / Our experience with cationic detergents as efficient antiseptics

Con una experiencia de 20 años los autores destacan las bondades de los detergentes catiónicos como antisépticos eficaces siempre que se utilicen en la forma adecuada

Nuestra experiencia con los detergentes catiónicos antisépticos eficaces / Our experience with cationic detergents as efficient antiseptics

Con una experiencia de 20 años los autores destacan las bondades de los detergentes catiónicos como antisépticos eficaces siempre que se utilicen en la forma adecuada (AU)

Sphincter of Oddi pressure in chagasic patients with megaesophagus.

Autonomic denervation is found throughout the entire length of the digestive tract in Chagas' disease. Anatomic evidence of myenteric ganglia reduction in chagasic gallbladders has been noted; however, the sphincter of Oddi has not been studied. The purpose of this study is twofold: first, to determine sphincter of Oddi pressure in 11 patients with chronic Chagas' disease and megaesophagus, and to compare the results with those obtained in 27 control subjects; and second, to evaluate the effect of cholecystokinin-octapeptide on sphincter of Oddi pressure in both groups of patients. Sphincter of Oddi pressure was recorded continuously via an endoscopically placed triple-lumen catheter inserted into the papilla and directed into the common bile duct. Basal sphincter of Oddi pressure was 12.9 +/- 1.1 mmHg in controls as compared with 44.9 +/- 4.7 mmHg in chagasics with megaesophagus. Mean common bile duct/duodenum gradient pressure was 4.1 +/- 2.4 mmHg in controls as compared with 13.1 +/- 2.7 mmHg in chagasics. Amplitude of sphincter of Oddi phasic contractions in the control group was 102.4 +/- 5.5 mmHg as compared with 140.5 +/- 9.2 mmHg in the chagasic group. Pulse dose of intravenous cholecystokinin-octapeptide produced a decrease of basal sphincter of Oddi pressure with inhibition of sphincter of Oddi phasic contractions in both chagasic and control patients. In chagasic patients, a neural abnormality in the sphincter of Oddi segment could explain the observed high basal pressure and high amplitude of phasic contractions. Chagasic patients with sphincter of Oddi pressure abnormalities, demonstrating sphincter of Oddi relaxation after cholecystokinin-octapeptide, may have neural impairment limited to preganglionic fibers, while the postganglionic inhibitory nerves remain at least partially intact.