Abordaje Transoral para la Extracción de un Diente Supernumerario Intranasal. Presentación de un Caso y Revisión de la Literatura

RESUMEN: El diente supernumerario de ubicación nasal es una patología de baja prevalencia en la población con diferentes formas y sintomatología clínica. Es importante establecer un diagnóstico respecto a sus características clínicas y radiológicas para realizar una planificación de tratamiento quirúrgica adecuada, con nula o escasas complicaciones post intervención. Presentación del caso: En el presente estudio se reporta el caso de un niño de 10 años de edad, sin antecedentes mórbidos, que recurre al servicio por presentar un diente supernumerario en la línea media hallado radiográficamente. El CBCT demuestra un mesiodens en el septum nasal, palatal inclinado e invertido, parcialmente erupcionado cubierto por mucosa nasal, con su corona en sentido a la cavidad nasal en relación a las fosas nasales. El diente fue extraído con anestesia general mediante un abordaje transoral a través de una vestibulotomía. El diente supernumerario nasal es una patología poco prevalente. Es importante conocer sus características clínicas y radiográficas ya que determinarán el tipo de abordaje a realizar. El grado de erupción, la distancia a la espina nasal anterior y su sintomatología asociada son fundamentales para determinar si el abordaje quirúrgico es intraoral o extraoral.

ABSTRACT: The supernumerary tooth of nasal location is a pathology of low prevalence in the population with different forms and clinical symptoms. It is important to establish a diagnosis regarding its clinical and radiological characteristics in order to carry out adequate surgical treatment planning, with few or no post-intervention complications. Case presentation: This study reports the case of a 10-year-old boy, with no morbid history, who presented a supernumerary tooth, found radiographically in the midline. CBCT showed a mesiodens in the nasal septum, tilted and inverted palatal, partially erupted covered by nasal mucosa, with its crown facing the nasal cavity in relation to the nostrils. The tooth was extracted under general anesthesia using a transoral approach through a vestibulotomy. The nasal supernumerary tooth is a rare pathology. It is important to know its clinical and radiographic characteristics since they will determine the type of approach to be used. The degree of eruption, the distance to the anterior nasal spine and its associated symptoms are essential to determine whether the surgical approach is intraoral or extraoral.

Milk production responses, rumen fermentation, and blood metabolites of dairy cows fed increasing concentrations of forage rape (Brassica napus ssp. Biennis).

The aim of this study was to determine animal performance, rumen fermentation, and health-related blood metabolites of dairy cows in mid lactation fed with increasing levels (30 and 45%) of forage rape (FR) in the diet. Twelve pregnant multiparous lactating Holstein-Friesian dairy cows were randomly allocated to 1 of 3 dietary treatments in a replicated 3 × 3 Latin square design. The experiment was divided into three 21-d periods. For the control diet, 13.0 kg (dry matter, DM) of grass silage, 3.0 kg DM of commercial concentrate, 2.7 kg of DM cold-pressed extracted canola meal, and 0.45 kg DM of solvent-extracted soybean meal were offered daily. For the other two treatments, 30 and 45% of the DM from silage, canola meal, and commercial concentrate were replaced in equal proportions with FR. Data were analyzed individually using linear and quadratic orthogonal polynomials. Ingestive behavior was altered by the inclusion of FR. We observed a linear increase in eating time at the expense of rumination time. Nevertheless, total DM intake was not affected by dietary treatments, averaging 19.5 ± 0.24 kg of DM/d. Milk yield increased linearly with increasing concentration of FR in the diet. Thus, feed efficiency of cows (kg of milk/kg of DM intake) increased linearly with the percentage of FR in the diet. Inclusion of FR in the diet had no effect on milk composition or milk sensory characteristics. Mean rumen pH of cows decreased linearly from the control to the 45% FR diet; however, dietary treatments had no effect on the daily amount of time that rumen pH was below 5.8 (252 ± 71.4), indicating no risk of subacute ruminal acidosis. Concentrations of total volatile fatty acids in the rumen and molar proportions of acetate and butyrate were increased with FR inclusion, whereas the proportion of propionate was linearly reduced. Excretion of uric acid and total purine derivatives tended to be greater for cows fed FR, which resulted in a trend toward a linear increase in estimated microbial N flow. However, N use efficiency was not affected by FR inclusion. Although differences for some hematological measures (increased white blood cell and neutrophils counts) and a quadratic response for glutamate dehydrogenase for cows fed FR in the diet (decreased with inclusion of 30% and increased with 45% in the diet) were observed, all values were within appropriate ranges for dairy cows. These results indicated that including FR to dairy cow diets, up to 45% of diet DM, improved milk production due to changes in volatile fatty acids and predicted microbial N flow and had no negative effects on dairy cow health or sensory characteristics of milk.

Usefulness of autocidal gravid ovitraps for the surveillance and control of Aedes (Stegomyia) aegypti (Diptera: Culicidae) in eastern Colombia.

In the past decade, new strategies have been developed to control the Aedes aegypti (Diptera: Culicidae) mosquito vector, as well as a broad range of arboviral agents. Vector control surveillance programmes in Puerto Rico and Australia have implemented the Centers for Disease Control and Prevention autocidal gravid ovitrap (AGO), which has had an impact on vector density and, consequently, the epidemiology of arboviral infections. Colombia intends to establish the AGO as a new tool for the surveillance and control of the A. aegypti vector. AGOs were evaluated in a hyperendemic area for dengue virus during an 8-week period in Villavicencio city, eastern Colombia. The results indicated that the AGOs detect a high density of A. aegypti, with positive results for these traps of over 80% and an average catch of six individuals per trap per week. Acceptance of AGOs in the community exceeded 95%, and adherence was around 89%. This study's results demonstrate, for the first time in Colombia, that traps are a useful tool for the surveillance of A. aegypti. Future studies must consider the implementation of AGOs in the region.

Gender Differences in Dose of Erythropoietin to Maintain Hemoglobin Target in Hemodialysis Patients.

Dialysis patients receiving erythropoietin (EPO) for anemia management are a challenge due to the significant interindividual variability in erythropoietic response. Our objective was to determine if there is a gender-dependent difference in the EPO doses required to maintain the hemoglobin (Hb) targets in adult patients undergoing hemodialysis. We conducted a historic cohort study with a 12-month follow-up. We include patients with the Hb target, normal serum albumin, and normal transferrin saturation index. Monthly data were gathered for the following: Hb level, EPO doses, and intravenous iron doses. In the 11 hemodialysis facilities included, 1844 patients were on hemodialysis. We considered 389 patients for follow-up, 190 of which were excluded mainly for failing to keep the Hb level in the established range. The final cohort for analysis included 141 men (70.9%) and 58 women (29.1%). At baseline, men weighed more than women (P < 0.001). At the end of the follow-up period, the EPO required to maintain Hb level between 10 and 13 g/dl was significantly higher in women in the monthly dose, weekly dose, and weekly EPO dose/patient weight, with no difference in the monthly iron dose. There was a significant association between female gender and the use of high EPO doses (odds ratio, 4.1; 95% confidence interval, 1.4-12.2; P = 0.01). Our study demonstrates that women require higher doses of EPO to achieve Hb targets.

Dynamic nucleotide mutation gradients and control region usage in squamate reptile mitochondrial genomes.

Gradients of nucleotide bias and substitution rates occur in vertebrate mitochondrial genomes due to the asymmetric nature of the replication process. The evolution of these gradients has previously been studied in detail in primates, but not in other vertebrate groups. From the primate study, the strengths of these gradients are known to evolve in ways that can substantially alter the substitution process, but it is unclear how rapidly they evolve over evolutionary time or how different they may be in different lineages or groups of vertebrates. Given the importance of mitochondrial genomes in phylogenetics and molecular evolutionary research, a better understanding of how asymmetric mitochondrial substitution gradients evolve would contribute key insights into how this gradient evolution may mislead evolutionary inferences, and how it may also be incorporated into new evolutionary models. Most snake mitochondrial genomes have an additional interesting feature, 2 nearly identical control regions, which vary among different species in the extent that they are used as origins of replication. Given the expanded sampling of complete snake genomes currently available, together with 2 additional snakes sequenced in this study, we reexamined gradient strength and CR usage in alethinophidian snakes as well as several lizards that possess dual CRs. Our results suggest that nucleotide substitution gradients (and corresponding nucleotide bias) and CR usage is highly labile over the approximately 200 m.y. of squamate evolution, and demonstrates greater overall variability than previously shown in primates. The evidence for the existence of such gradients, and their ability to evolve rapidly and converge among unrelated species suggests that gradient dynamics could easily mislead phylogenetic and molecular evolutionary inferences, and argues strongly that these dynamics should be incorporated into phylogenetic models.

Cloning, expression and characterization of mugwort pollen allergen Art v 2, a pathogenesis-related protein from family group 1.

Mugwort (Artemisia vulgaris) belongs to the Compositae family, and is one of the main causes of allergy in late summer and autumn. The aim of the study was to characterize the allergen Art v 2 from mugwort pollen. Skin prick tests, performed in 19 patients allergic to mugwort and 10 control patients, showed an Art v 2 sensitization prevalence of 58%, whereas none false-positives were detected among control patients. Art v 2 was purified by standard chromatography and binding to Concanavalin A column and had an apparent molecular mass of 33 and 20 kDa, calculated by gel permeation and SDS-PAGE under denaturing conditions, respectively, showing that the allergen is composed of two identical subunits. Art v 2-encoding cDNA was amplified by PCR using degenerate primers based on reported partial amino acid sequences. Cloned cDNA encoding Art v 2 contains 140 bp that codify for a polypeptide of 15.8 kDa, with a predicted pI value of 5.2, and one potential N-glycosylation site. Protein homology search demonstrated that Art v 2 share 55-42% identical residues with pathogenesis-related protein PR-1 of tomato, potato, rape, wheat and rice. Homology was also found to Ves v 5 (41% identical residues). Bacterial-expressed recombinant Art v 2 was recognized only by 21% of mugwort-allergic patients. In conclusion, Art v 2 from mugwort is the first weed pollen allergen that belongs to the pathogenesis-related protein PR-1 and its recombinant form could help molecular diagnosis of mugwort associated allergy.

Pulmonary artery dissection and conservative medical management.

Pulmonary artery dissection is a rare clinical entity, which has been related to pulmonary arterial hypertension. It is frequently presented as cardiogenic shock or sudden death, so diagnosis is often made at autopsy. The management with best results is surgery. We report a case of pulmonary artery dissection associated with previous aortic valve replacement with a favourable outcome, using conservative medical therapy.

Prosthetic mitral valve endocarditis due to Ochrobactrum anthropi: case report.

We describe a case of infective endocarditis in a prosthetic mitral valve due to Ochrobactrum anthropi. Although O. anthropi is an emerging pathogen in immunocompromised patients, infections with the bacterium have very rarely been documented in healthy hosts, and endocarditis is rare. To our knowledge, only two cases of O. anthropi endocarditis have been reported in the medical literature.

Immunotherapy with a depigmented, polymerized vaccine of Olea europaea pollen allergens. Significantly reduces specific bronchial and skin test reactivity in sensitized patients after one year of treatment.

Clinical manifestations after the inhalation of Olea europaea pollen are very frequent in Spain. Forty-five patients with a clinical history of asthma and sensitivity to O. europaea pollen were included in a randomized trial to evaluate the safety and the clinical efficacy of immunotherapy with a new chemically modified extract (depigmented and glutaraldehyde-polymerized) of Olea europaea. The study was conducted following good clinical practices and appropriate consent forms were signed. Patients were divided into three groups of 15 individuals: Group A received a maximum concentration of 44 micrograms/ml of the depigmented, polymerized allergen extract (equivalent to 100 HEPL of the native unmodified extract). Group B received 10 times less; Group C did not receive any specific immunotherapy. Any adverse event was recorded to assess safety. Efficacy was evaluated by measuring the amount of allergen needed to elicit a positive response in specific bronchial challenges before and after 12 months of immunotherapy. The treatment schedule consisted of an incremental phase of five injections and a maintenance dosage of 0.5 ml per month. Each patient received a total of 14 injections during this period. No moderate or serious adverse events related to immunotherapy were recorded. At the beginning of the study, no significant differences were observed between the three groups in specific bronchial hyperreactivity (p > 0.05). A significant difference (p < 0.05) was obtained after 12 months. Patients in Group A needed four times more native unmodified allergen than Group C to elicit the same degree of bronchoconstriction. The analysis of the individual groups before and after 12 months of treatment showed that patients in Groups B and C did not improve. Patients in Group A showed a significant improvement (p < 0.05) in specific bronchial hyperreactivity, and at the end of the study needed 5.5 times more native unmodified allergen to obtain the same degree of bronchial response as in the beginning. Depigmented and glutaraldehyde-polymerized vaccines of Olea europaea pollen are very safe for treating patients with asthma and clinical sensitivity to allergens of this pollen. The clinical efficacy of this new allergen vaccine seems to be dose-dependent as shown by specific bronchial challenges as well as by symptom and medication scores. These modified extracts induce protection against unmodified native allergens.

Camuflaje ortopédico-ortodóncico de una clase IIIsevera en un paciente adulto / Orthopedic-orthodontic camouflage in adults patient with a severe class III

En este artículo presentamos un tratamiento de camuflaje ortopédico-ortodóncico incluido dentro de los cinco casos que se presentaron para el acceso a miembro diplomado de la SEDO. Se trata de un varón adulto con una maloclusión ósea de clase III muy grave que afecta a los 3 planos del espacio. Por un lado, tenemos un crecimiento vertical muy acusado con mordida abierta anterior. Por otro, una compresión maxilar que afecta al plano anteroposterior y al transversal y que produce una relación ósea y dental de clase III. A esto se le suma apiñamiento en ambas arcadas, más acusado en la superior. Aunque la primera opción de tratamiento era la quirúrgica ha sido abordado mediante camuflaje ortopédico-ortodóncico. Hemos utilizado disyuntor, quadhelix y aparatos fijos multibrackets. También ha sido necesaria la extracción de 4 premolares. (AU)

[Multivisceral infarcts are complication of invasive aspergillosis]. / Infartos viscerales múltiples detectados por TAC en la aspergilosis invasiva.

Aspergillus fumigatus is one of the species of Aspergillus that causes aspergillosis. The clinical picture of invasive-disseminated aspergillosis is generally characterized by fever and respiratory distress that usually follows a fatal course. This form of intensive aspergillosis is suffered by severely immunossuppressed patients. There is another clinical form of severe aspergillosis, aortic aspergillosis, that appears after cardiac surgery. We present two cases of invasive aspergillosis complicated by multiple visceral infarcts involving the liver, spleen, kidneys, pancreas, thiroid and brain. Infarcts were confirmed in necropsy and appeared to be caused by an overwhelming amount of intravascular hiphae, which were observed in the infarcted areas acting forming septic embolus. We believe that multi-visceral infarcts are an underestimated complication of invasive aspergillosis. Given the progressive increase in the population of immunossuppressed patients, clinicians have to aware of all the possible presentations of invasive aspergillosis.

Lesiones específicas del hombro del deportista / Shoulder specifics injuries in athletes

Las lesiones del hombro producidas por la práctica deportiva han aumentado en los últimos años, ello ha originado la descripción de nuevas patologías, estudiamos en este trabajo algunas de ellas. El síndrome subacromial ha pasado de ser una patología estática a concebirse como un problema funcional, que puede producirse por solicitaciones repetidas en rotación externa y elevación, se ha descrito una patología específica de la inserción del tendón del bíceps (lesiones SLAP), y en el fondo de todas estas lesiones puede existir una inestabilidad subclínica, que deberemos reconocer. La articulación acromioclavicular puede afectarse también y existen también lesiones neurológicas de vecindad. Damos pautas para el diagnóstico y orientación terapéutica de todas ellas. (AU)

Infartos viscerales múltiples detectados por TAC en la aspergilosis invasiva / Multivisceral infarcts are complication of invasive aspergillosis

La aspergilosis es una infección causada por el hongo Aspergillus fumigatus. En la aspergilosis invasiva y diseminada se produce un cuadro muy grave caracterizado por fiebre, síndrome respiratorio y generalmen te muerte. Estas formas aparecen en la inmunosupresión severa. Pero hay además una forma grave de aspergilosis, la aspergilosis aórtica, que se presenta en enfermos que, sin defecto inmunológico alguno, han sido sometidos a reemplazamiento valvular o cirugía coronaria. Damos a conocer dos casos de aspergilosis invasiva que cursaron con infartos viscerales múltiples: hepático, esplénico, renales, pancreáticos, tiroideos y cerebrales. Estos infartos fueron confirmados en la autopsia y parecían producidos por la ingente cantidad de hifas intravasculares, observadas en las áreas infárticas, que pudieron actuar a modo de émbolos sépticos, sin descartar una vasculitis aspergilar. Pensamos que los infartos multiviscerales constituyen una complicación subestimada en la aspergilosis invasiva. Es necesario que aprendamos a reconocer estas formas emergentes de aspergilosis invasiva, que serán más frecuentes cada día por el aumento de enfermos inmunodeprimidos (AU)

Aspergillus fumigatus is one of the species of Aspergillus that causes aspergillosis. The clinical picture of invasive-disseminated aspergillosis is generally charactericed by fever and respiratory distress that usually follows a fatal course. This form of invesive aspergillosis is suffered by severely immunossupressed patients. There is another clinical form of severe aspergillosis, aortic aspergillosis, that appears after cardiac surgery. We present two cases of invasive aspergillosis complicated by multiple visceral infarcts involving the liver, spleen, kidneys, pancreas, thiroid and brain. Infarcts were confirmed in necropsy and appeared to be caused by an overwhelming amount of intravascular hiphae, wich were observed in the infarcted areas acting forming septic embolus. We believe that multi-visceral infarcts are an underestimed complication of invasive aspergillosis. Given the progressive increse in the population of immunossupressed patients, clinicians have to aware of all the possible presentations of invasive aspergillosis (AU)

Revisión sobre la posición condilar estudiadacon técnicas radiográficas / Review on the condyle position studied with radiographics technical

Existe un gran desacuerdo en el ámbito científico actual en conceptos tan básicos como la posición condilar ideal en relación céntrica (RCM) y si su localización fuera de la misma cuando los dientes contactan en máxima intercuspidación (IOP) se puede relacionar o no con los desórdenes temporomandibulares (DTM). Existen básicamente dos técnicas para determinar la posición condilar en su fosa: una, a través de técnicas radiográficas (destacando la tomografía entre ellas) y la otra, mediante articuladores con algún aditamento que registre las diferencias entre las diversas localizaciones condilares. En este artículo hemos realizado una revisión de las investigaciones que utilizan la primera. (AU)

Estudio sobre la relación entre morbilidad psiquiátrica y absentismo por incapacidad temporal en una gran empresa / Analysis on the relationship between psychiatric morbidity and time-off work in a large company in Spain

Objetivo: El objetivo del estudio es evaluar la relación de 'caso' psiquiátrico -y número de procesos y días de absentismo en la población laboral de trabajadores en situación de Incapacidad Temporal en una empresa de la provincia de Cádiz. Métodos: Se realizó un estudio observacional de prevalencia semestre de 'casos' mediante el GHQ-28 y una entrevista psiquiátrica semiestructurada (Clinical Interview Schedule), con la inclusión de una variable longitudinal de seguimiento de la muestra durante los dos años posteriores al inicio del estudio. Resultados: De los 114 sujetos en situación de IT (5,4 por ciento), 88 aceptaron participar en el estudio. Treinta y tres sujetos (37,5 por ciento) presentaron un diagnóstico psiquiátrico, en su mayoría trastornos afectivos (30,68 por ciento). Los días totales de absentismo por IT durante los dos años de seguimiento fueron significativamente superiores en el grupo de 'casos'. Conclusiones: La prevalencia de morbilidad psiquiátrica en el grupo es superior a la referida en la población general y en unidades de asistencia orimaria, y resulta similar a la de poblaciones médicas con enfermedades graves. Existe una relación entre 'caso' y la duración del absentismo por enfermedad común, lo que pone de relieve la importancia de realización de estudios de detección de patologías psiquiátrica en población laboral junto con el resto de exploraciones físicas habituales (AU)

[Ventricular fibrillation secondary to radiofrequency application in ventricular tachycardia ablation]. / Fibrilación ventricular secundaria a la aplicación de radiofrecuencia en la ablación de una taquicardia ventricular.

Radiofrequency catheter ablation has become a first line therapy for several types of tachycardias because of its high efficacy and low complication rate. The development of proarrhythmic complications due to a direct effect of radiofrequency is very unusual. We describe a patient with previous myocardial infarction and well tolerated sustained monomorphic ventricular tachycardia who underwent catheter ablation of the tachycardia substrate. During two of the radiofrequency applications, ventricular fibrillation developed and external defibrillation was required.

Validez de un sistema de evaluación psiquiátrica estandarizada en la detección de "casos" en población laboral: la escala gh0-28 y la entrevista cis / Validity in a standarized psychiatric assessment system for "cases" identification in a worker population: the General Health Questionnaire and the Clinical Interview Schedule

El objetivo del presente estudio es la optimización de un sistema de detección de 'casos' psiquiátricos, ya validado en población general y en unidades de asistencia primaria, en una población laboral de una gran empresa de la provincia de Cádiz, con el objetivo de establecer protocolos que contemplen las variables psicosociales como factores moderadores de la salud integral de los trabajadores. Para ello se ha realizado un estudio de la utilidad de los ítems de la entrevista CIS y de la validez predictiva del cuestionario GHQ-28. Los resultados encontrados sugieren la adecuación del sistema de evaluación propuesto (GHQ-28 y CIS) para su uso sistemático en la población analizada (AU)

[Proarrhythmic effect following radiofrequency catheter ablation of repetitive monomorphic ventricular arrhythmia]. / Efecto proarrítmico tras la ablación con radiofrecuencia de una arritmia ventricular monomórfica repetitiva.

Radiofrequency catheter ablation is a first line therapy for many supraventricular and some ventricular tachycardias due to a high success rate and a low probability of complications. Although the majority of them are related to the catheterization technique, some are due to a direct effect of radiofrequency application. We report a patient with a nonsustained, repetitive, monomorphic ventricular arrhythmia that presented, after a successful radiofrequency ablation, an incessant sustained monomorphic ventricular tachycardia requiring a new ablation procedure.

[Congenital dysplasia of tricuspid valve (Ebstein like) in a 73-year-old male with severe tricuspid insufficiency]. / Displasia congénita de la válvula tricúspide (Ebstein like) en un varón de 73 años con insuficiencia tricuspídea severa.

Multiple congenital abnormalities in the structure of the tricuspid valve have been described and, the majority of cases could be considered as variations of Ebstein's anomaly. The onset of the symptoms and the diagnosis depend on the severity of the valve dysfunction and the right ventricular function and size. The age at diagnosis ranges from birth to adulthood, but a delayed diagnosis is rare when tricuspid regurgitation is severe. We cite as an example the case of a 73 year-old male classified as class I of the NYHA up to 5 months before, since then he developed progressive ascitis and edema on his legs. The physical examination suggested severe tricuspid regurgitation. We performed a transtoracic and transesophageal ecocardiogram that showed severe dysplasia in the tricuspid leaflets, severe regurgitation because of lack of adequate joining, dilatation of right chambers and right ventricular systolic dysfunction.