Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms.

To explore the relationship between sleep bruxism (SB), painful temporomandibular disorders (TMD) and psychologic status in a cross-sectional study. The sample consisted of 272 individuals. The Research Diagnostic Criteria for TMD (RDC/TMD) was used to diagnose TMD; SB was diagnosed by clinical criteria proposed by The American Academy of Sleep Medicine. The sample was divided into four groups: (1) patients without painful TMD and without SB, (2) patients without painful TMD and with SB, (3) patients with painful TMD and without SB and (4) patients with painful TMD and with SB. Data were analysed by Odds Ratio test with a 95% confidence interval. Patients with SB had an increased risk for the occurrence of myofascial pain (OR = 5·93, 95% CI: 3·19-11·02) and arthralgia (2·34, 1·58-3·46). Group 3 had an increased risk for moderate/severe depression and non-specific physical symptoms (10·1, 3·67-27·79; 14·7, 5·39-39·92, respectively), and this risk increased in the presence of SB (25·0, 9·65-64·77; 35·8, 13·94-91·90, respectively). SB seems to be a risk factor for painful TMD, and this in turn is a risk factor for the occurrence of higher depression and non-specific physical symptoms levels, but a cause-effect relationship could not be established.

Condrossarcoma primário de língua em cão / Primary chondrosarcoma in the tongue of a dog

A 10 year old female Boxer was taken dead to veterinary hospital for a necropsy without any clinical history, showing a growth on the dorsal part of the tongue. Based on the histopathological findings mesenchymal chondrosarcoma was diagnosed. This report describes the first case of chondrosarcoma on the base of the tongue in veterinary medicine.

Panlitiasis del colédoco: tratamiento laparoscópico, ¿en qué va la discusión? / Common bile duct panlithiasis: Laparoscopic management

La colecistectomia laparoscopica (CL) reemplazó la colecistectomia abierta como el procedimiento de eleccion para la colelitiasis sintomática en esta decada. Para la gran mayoria de cirujanos generates, la exploracion laparoscopica del coledoco (ELC) parece como un procedimiento indebido, complejo y demandante. Desde la aparición de la CL casi todos los cirujanos prefieren realizar previamente CPER/EE como la unica opcion para tratar los cálculos del coledoco y no tener que manejar en cirugia laparoscopica una via biliar dilatada y con cálculos. La CPER es más especifica si es usada despues de cirugia, pero no hay que olvidar su morbilidad, y tiene la desventaja de requerir un tercer procedimiento (cirugia abierta) para tratar los cálculos del coledoco en caso de fracaso (1).

[The patient-physician relationship: towards humanization of medical practice]. / A Relação paciente-médico: para uma humanizaçáo da prática médica.

Based on a literature review, this article discusses the physician-patient relationship by presenting anthropological and communicational approaches, physicians' experiences as patients, key concepts showing the need for humanization of the patient-physician relationship, and some theoretical-philosophical reflections relating primarily to hermeneutics. Based on this framework, one can already identify a series of possibilities for implementing humanizing proposals. The challenge now is to classify, publish, and evaluate these proposals.

Exploración laparoscópica del colédoco / Laparoscopic exploration of the common bile duct

Se presenta la experiencia inicial de los autores con la exploracion laparoscopica del coledoco, teniendo en cuenta, que esta tecnica debe convertirse en la operacion inicial para el tratamiento de la coledocolitiasis concomitante con la colelitiasis, y como una extension directa y natural de la colecistectomia laparoscopica. Además, se hace una revision del tema, se anotan los principales detalles tecnicos del procedimiento y de las vias de acceso a la via biliar principal y se discute la interaccion e indicaciones actuates de la colangiopancreatografia endoscopica retrograda y de la esfinterotomia endoscopica en la epoca de la cirugia minimamente invasora. Durante un periodo de 32 meses se practicó exploracion laparoscopica del coledoco en 35 pacientes durante la colecistectomia laparoscopica. A la gran mayoria de pacientes se le efectuo previamente colangiogarfia intraoperatoria con un porcentaje de exito en su ejecucion de 90 por ciento. Se utilizaron diferentes metodos para hacer la exploracion de la via biliar, trancistica fluoroscopica, trancistica coledocoscopica y coledocoscopica directa. Se usaron varias alternativas para limpiar de cálculos el coledoco: retiro con canastilla de Dormia, barrido con solucion salina y avance hasta el duodeno de los cálculos. Se encontraron cálculos en el coledoco en 25 pacientes de los 35 a los que se les efectuo exploracion laparoscopica del coledoco. Se obtuvo un porcentaje de exito en la limpieza de la via biliar de 60 por ciento con muy baja morbilidad y sin mortalidad. El porcentaje de cálculos residuales fue del 6.6 por ciento. De los 10 pacientes a quienes no se les pudo extraer los cálculos, se efectuo la conversion a cirugia abierta a 6, y a los 4 restantes se les dejo sonda trancistica para una posterior colangiopancreatografia endoscopica retrograda y esfinterotomia endoscopica. La exploracion laparoscopica del coledoco es un metodo posible, seguro y efectivo para limpiar de cálculos la via biliar. Demanda mayor capacidad por parte del cirujano y mayor recurso tecnologico, pero con la ventaja de tratar el problema de la colecistocoledocolitiasis en un solo tiempo.

Laparoscopic repair of paraesophageal hernia. New access, old technique.

Large paraesophageal hernias are generally repaired by reduction of the stomach into the abdomen, sac excision, crural closure, and gastropexy or fundoplication. After gaining experience performing laparoscopic repair of sliding hiatal hernias and Nissen fundoplication we combined laparoscopic access with traditional surgical technique in treating patients with complex paraesophageal hernias. Ten adults, six males and four females, with type III paraesophageal hernias underwent laparoscopic repair between February 1993 and April 1994. The average age of the patients was 60.4 years (range 38-81). Using five ports (three 10 mm and two 5 mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with pledgeted horizontal mattress sutures. In addition, nine patients had a Nissen fundoplication performed and one patient had a diaphragmatic gastropexy. The procedure was completed laparoscopically in all ten cases and the median operating time was 282 min (range 165-430). Two complications occurred, an intraoperative gastric laceration, and a postoperative mediastinal seroma. All patients were discharged on the 2nd or 3rd postoperative day. Eight of nine patients were asymptomatic at last follow-up (mean 8.9 months postop). One patient has mild dysphagia and heartburn from partial migration of the fundoplication into the chest. One patient died 3 months postoperatively of unrelated causes. Paraesophageal hernia can be reduced and repaired safely with laparoscopic access using standard surgical techniques.