Herniación de quiste de seno maxilar a través de fístula oroantral: reporte de un caso / Hermiation of a maxillary sinus cyst through an oroantral fistula: report of a case

Los quistes de retención mucosa y los mucoceles son las lesiones máscomunes de los senos paranasales. Éstos comparten características muysimilares y su diferencia estará determinada por su etiología. A diferencia del quiste de retención mucosa, cuyo comportamiento es mucho más sutil, el mucocele causa fenómenos infl amatorios locales, y algunas veces,reabsorción ósea de las estructuras adyacentes. El tratamiento será laenucleación quirúrgica. En el caso clínico que presentamos a continuación,se evidencia una lesión quística que se expone a través del alvéolo no cicatrizal de extracción traumática realizada semanas atrás, además se presenta la técnica que utilizamos para el cierre de fístula oroantral.

Mucus retention cysts and mucoceles are the most common lesions of the paranasal sinuses. They share very similar characteristics and the difference between them depends on their etiology. Unlike mucous reten-tion cysts, whose behavior is much more subtle, mucoceles cause local infl ammatory phenomena and sometimes bone resorption of adjacent structures. The treatment called for is surgical enucleation. The clinical case presented deals with a cystic lesion protruding through the non-cicatricial alveolus following a traumatic extraction performed weeks earlier. We also present the technique used to close the oroantral fi stula.

Discurso médico e discurso pedagógico: interfaces e suas implicações para a prática pedagógica / Medical and pedagogic discourse: interfaces and implications for pedagogic practices

O estudo investigou os efeitos do discurso médico no processo de ensino-aprendizagem escolar, particularmente, como ele tem sido apropriado pelo corpo docente e os seus efeitos nas práticas pedagógicas dos educadores. Trata-se de um estudo qualitativo realizado ao longo do período letivo de 2008. Participaram do estudo 17 educadores que trabalham com crianças com paralisia cerebral, com idade entre 6 e 12 anos e acompanhadas pela equipe de reabilitação da Rede Sarah de Hospitais, em Belém. Foram realizadas entrevistas gravadas em áudio no início e no final do período letivo, seguindo o mesmo roteiro. Ao longo do ano, foram realizadas visitas escolares, pela equipe do Sarah, com intervalos de aproximadamente dois meses e com o objetivo de dialogar com os educadores e esclarecer sobre o diagnóstico da criança, seus potenciais, limites e adaptações que favorecessem o processo de inclusão e de aprendizagem. A análise dos dados iniciais revelou a inconsistência teórica dos educadores sobre os conceitos de inclusão e de paralisia cerebral. Indicou o desconhecimento sobre o diagnóstico da criança e a elaboração de práticas pedagógicas orientadas por discursos médicos baseados no senso comum. Ao final do processo, identificou-se que as percepções, as concepções, as práticas e o discurso pedagógico dos educadores haviam se modificado. Foram observadas reelaborações de ações pedagógicas considerando o diagnóstico, aspectos individuais e coletivos da aprendizagem, além dos limites e potenciais de cada criança. Constatou-se assim, o processo de subjetivação discursiva, como resultado da interlocução entre campos de saberes diferentes, no caso, Saúde e Educação, resultando em reelaboração do discurso e das práticas pedagógicas no processo de ensino-aprendizagem das crianças com paralisia cerebral.

This study investigated the effects of medical discourse in the teaching-learning process, particularly as it has been appropriated by educators in schools and its effects on these educators' pedagogical practices. The study in question is a qualitative study undertaken during the 2008 school year. Seventeen teachers participated in this study of children diagnosed with cerebral palsy, aged between 6 and 12 years old. The children were observed by the rehabilitation team of the Sarah Hospitals Network in Belém. Using the same guidelines, audio recorded interviews were conducted at the beginning and at the end of the school year. Over the year, there were school visits by Sarah staff, at two month intervals, approximately, in order to talk to the teachers regarding the children's diagnoses, their potentials and limitations, and possible adaptations that could facilitate their inclusion and learning processes. Analysis of the initial data has shown the theoretical inconsistency of educators concerning concepts of inclusion and cerebral palsy. In addition, the analysis pointed out that teachers lacked knowledge about the children's diagnoses; they seemed to prepare pedagogical practices according to medical discourse based on common sense. Changes in perceptions, concepts, practices and pedagogical discourse of the educators were observed at the end of the study. Renewed pedagogical strategies were observed that considered the child's diagnosis, as well as individual and group learning situations, besides the limitations and potential of each child. The study demonstrated that the process of discursive subjectification can come about as a result of exchanges between fields of knowledge, in this case, Health and Education, in order to redraft discourse as well as renewed elaboration of pedagogical practices in the teaching-learning process of children with cerebral palsy.

Evaluation of the possible role of ants (Hymenoptera: Formicidae) as mechanical vectors of nematodes and protists

Nematodes and protists can be transmitted to humans in many ways and little concern has been given to the mechanical transmission by ants. This study aimed at analysing how the eggs of Ascaris lumbricoides and cysts of Entamoeba coli could be mechanically transmitted to the man by Formicidae. Through the experiments using nests of Tapinoma melanocephalum, Linepithema humile and Monomorium pharaonis reared in the laboratory allied to observations of some 17 ant species in an urban park area in Mogi das Cruzes (SP), it was found that L. humile was capable of carrying eggs of A. lumbricoides both in the field and laboratory conditions (1 worker), as well as was Camponotus rufipes (2), Solenopsis saevissima (1) and Acromyrmex niger (1). The cysts of Escherichia coli were found over three workers of C. rufipes. Although the frequency of the workers found transporting pathogens was low, the capacity of common household species in carrying pathogens like nematodes and protists was demonstrated.

Os Nematoda e Protista podem ser transmitidos ao homem de diversas maneiras, mas pouca ênfase é dada para a transmissão mecânica por intermédio de formigas. Assim, esse trabalho procurou investigar a transmissão mecânica de ovos de Ascaris lumbricoides e cistos de Entamoeba coli pelos Formicidae. Através de experimentos com espécies mantidas em ninhos no laboratório (Tapinoma melanocephalum, Linepithema humile e Monomorium pharaonis) e com 17 espécies de formigas de uma área antropizada na região de Mogi as Cruzes (SP), foi possível constar que os ovos A. lumbricoides foram transportados por L. humile, tanto no campo (1 operária) como no laboratório (1 operária), por Camponotus rufipes (2), por Solenopsis saevissima (1) e por Acromyrmrex niger (1). Em três operárias de C. rufipes foram encontrados cistos de E. coli. Apesar da baixa incidência de transporte, as três primeiras espécies pelo fato de viverem muito próximas ao ser humano, podem levar para dentro do ambiente domiciliar patógenos de Nematoda e Protista.

Reanimación del paciente quemado / Resuscitation of burned patient

Las quemaduras extensas pueden generar gran morbilidad y altas tasas de mortalidad determinadas tanto por las lesiones mismas como por la calidad de la reanimación inicial. Si esta es adecuada, puede prevenir la evolución hacia una mayor profundidad de la lesión primaria y, por ende, mejorar el pronóstico del paciente. El objetivo de esta revisión fue recopilar información que permita optimizar la atención del paciente quemado, con miras a obtener una disminución de la mortalidad y de las secuelas y complicaciones derivadas de una inadecuada reanimación. Se hizo una búsqueda en Internet, utilizando la base de datos Pubmed. Se usaron las palabras clave “Resuscitation” y “Burn”, y se limitó la búsqueda a los artículos publicados después del año 2000. Se incluyeron además algunos artículos considerados de importancia para la comprensión del tema, publicados con anterioridad a ese año.

Extensive burns can cause significant morbidity and high mortality, determined by both the injuries themselves and the quality of the initial resuscitation measures applied to the patient. If adequate, such measures can prevent the worsening of the burn and, consequently, they can improve the prognosis for the patient. The objective of this review was to compileinformation that may help resuscitation teams to improve the care of burned patients, looking for lower mortality and less frequent sequels and complications. The Pubmed database was reviewed searching for studies made on the subject from 2000 to 2007, using the key words “Resuscitation” and “Burn”. Some articles published before 2000 were also included because they wereconsidered relevant for understanding this subject.

Oral cysticercosis: a collaborative study of 16 cases.

Cysticercosis is a potentially fatal parasitic disease that rarely involves the oral region in humans. This study includes 21 lesions seen in 16 Latin American patients. There were 8 men and 8 women, with an age range from 6 to 67 years (mean 33.6 years). Most cases appeared as asymptomatic submucosal nodules that resembled mucous cysts or benign mesenchymal neoplasms. Most were found in the tongue (11 cases), followed by buccal mucosa and the lower lip (4 cases each) and upper lip (2 cases). These were well circumscribed, and ranged in size from 1 to 2.5 cm in diameter. Typical histologic features of viable cysticerci were observed in 15 cases, and the presence of colloid degeneration and granular mineralization were detected in only 1 case. In all cases, simple surgical excision was sufficient to ensure complete removal of the lesions without postoperative complications. It is important to carry out a detailed study in every case, in order to exclude the presence of the parasite in other sites.

Epidemiological and clinical profile of burn victims Hospital Universitario San Vicente de Paúl, Medellín, 1994-2004.

OBJECTIVES: To describe the clinical and epidemiological profile of the patients in the Burn Unit of the Hospital Universitario San Vicente de Paúl (HUSVP) de Medellín, Colombia, from 1994-2004. METHODS: Retrospective descriptive study of all pediatric and adult burn patients. The following were recorded: age, gender, cause, extent and severity of the burns, time in the hospital, operations, complications and death rate. Statistica 6.0 (Stafsoft Inc.) was used. RESULTS: Two thousand three hundred and nineteen patients were admitted, 66.8% were males and 62.9% were less than 15 years old. Burns caused by scalding were the most frequent (45.9%) followed by flames (38.5%) The average burn area was 26.9%. Average hospital stay was 26.9 days. In 2004, 40.4% of the patients required surgery; 13.4% of the patients had complications. 7.4% of the patients died, with an average burn area of 62%; burns caused by flames accounted for 63% of the deaths. CONCLUSIONS: There is a continuing improvement in hospital stay, survives burn sizes, with figures comparable to others without access to a tissue bank or skin cultivation.

Analysis of p53 protein by PAb240, Ki-67 expression and human papillomavirus DNA detection in different types of odontogenic keratocyst.

OBJECTIVE: To investigate the possible association between alterations in the p53 system and human papillomavirus (HPV) infection in the etiology of odontogenic keratocysts (OKCs) and to study proliferation and epithelial maturation patterns by topographic analysis of Ki-67 expression. MATERIALS AND METHODS: Eighty-three OKC samples (29 cases associated with nevoid basal cell carcinoma syndrome, 29 solitary non-recurrent cases 20 solitary recurrent cases, and 5 chondroid keratocysts) were studied by immunohistochemistry to detect p53 protein (PAb 244) and Ki-67 (MIB-1) expression, and by PCR to detect HPV DNA. RESULTS: Twelve cases (14.6%) expressed p53 protein; no case showed the presence of HPV DNA; 9 cases (11%) presented with mild epithelial dysplasia. The suprabasal expression of Ki-67 was significantly more frequent than its basal expression (p < 0.001). p53 protein expression was significantly associated with the presence of epithelial dysplasia (p = 0.023). Ki-67 expression was not associated with OKC type, the presence of dysplasia, or p53 expression. CONCLUSION: HPVs do not participate in the etiology of OKC, and it appears unlikely that a p53 gene mutation mechanism plays a major role in the genesis of OKC. OKCs show proliferation and genuine maturation behavior reminiscent of benign neoplasms with local destructive capacity.

[Antibody development and frequency of events temporarily associated with measles and rubella vaccines among university health personnel in Jalisco]. / Desarrollo de anticuerpos y frecuencia de eventos temporalmente asociados a las vacunas contra el sarampión y rubéola en personal de salud universitario de Jalisco.

OBJECTIVE: To evaluate the seroprevalence, seroconversion, anamnesic response and events temporally associated with immune status pre and post immunization with measles and rubella vaccine in health personnel from a public University in Guadalajara, Mexico. MATERIAL AND METHODS: We carried out a prospective, longitudinal and comparative study from May to June 2000 among 120 healthy volunteers. Informed consent was obtained from all participants. We administered measles (Schwarz) and rubella (RA 27/3) vaccines. Weekly phone calls during six weeks were recorded from each volunteer to assess local and systemic events temporally associated with immunization non attributable to any other disease. Serum samples were obtained before and after vaccination in 75 volunteers. Antibodies against measles and rubella were measured by an enzyme immunoassay kit (Behring) with cut-off points of 300mUI/mL 8UI/mL respectively. Statistical analysis included mean, standard deviation and paired Student's t-test (P < 0.05). RESULTS: 105/120 participants (87.5%) were followed during 6 weeks. 87.4% were health personnel and 44.6% were males. The age range was 17-71 years (median = 21). We found a prior history of measles in 57.1%. Local events included pain, heat, redness and induration and were reported by 4/105. Systemic events such as fever, exanthema, pain in joints and arthritis was reported by 9/105. The proportion of study subjects with protective antibodies against measles and rubella prior to vaccination was 90.7 and 94.7% respectively. Both groups reached 100% after vaccination. CONCLUSIONS: The proportion of non-immune health personnel was low and similar to other reports. However, the potential spread of measles and rubella virus from a non-immunized infected health care provider could be amplified by the number of patients seen daily during the peak period of 3-5 days. The vaccination of health personnel should be encouraged.

Desarrollo de anticuerpos y frecuencia de eventos temporalmente asociados a las vacunas contra el sarampión y rubéola en personal de salud universitario de Jalisco / Antibody development and frequency of events temporarily with measles and rubella vaccines among university health personnel in Jalisco

Objetivo: Evaluar el estado inmune y la seroconversión o respuesta anamnésica posterior a inmunización con vacuna de sarampión-rubéola (SR) y eventos temporalmente asociados, en personal de salud universitario. Materiales y métodos: Estudio prospectivo, longitudinal y comparativo de mayo a junio de 2000 en 120 adultos sanos de un Hospital de la Universidad Autónoma de Guadalajara. Previo consentimiento informado se aplicó la vacuna SR de sarampión (Schwarz) y rubéola (RA 27/3). Se realizó seguimiento telefónico semanal para identificar eventos locales y sistémicos temporalmente asociados a la vacunación (30 días posteriores a su aplicación, no atribuibles a otro proceso mórbido). Se tomó suero antes y seis semanas después de la vacunación. Los anticuerpos (IgG) contra sarampión y rubéola fueron cuantificados por análisis inmunoenzimático (Enzygnost®, Dade Behring) con puntos de corte de > 300mUI/mL y > 8UI/mL, respectivamente. Análisis: media, desviación estándar (DS), Prueba t de Student pareada (significancia de P < 0.05). Resultados: Se logró seguimiento en 105/120 (87.5%) durante seis semanas. El 87.4% fue personal de salud y 44.6% varones. Rango de edad 17-71 años (mediana = 21). En la historia clínica hubo antecedente de posible sarampión en 57.1%. Se obtuvo suero pareado en 75 casos. La proporción de voluntarios con anticuerpos para sarampión y rubéola antes (90.7 y 94.7%) y después (100 y 100%) de la vacuna se incrementó de manera significativa (P < 0.001). Dolor, calor, rubor e induración en el sitio de inyección se presentó en 4/105 (~4%). Fiebre, exantema, artralgias y artritis en 9/105 (~9%). Conclusiones: La proporción de susceptibles a sarampión fue alta si tomamos en consideración la potencialidad de transmisión del virus de sarampión a la población que atenderían durante el período de contagiosidad (3-5 días). La respuesta de inmunidad postvacunal fue óptima. La vacunación en personal de salud debe ser prioritaria.

Objective: To evaluate the seroprevalence, seroconversion, anamnesic response and events temporally associated with immune status pre and post immunization with measles and rubella vaccine in health personnel from a public University in Guadalajara, Mexico. Material and methods: We carried out a prospective, longitudinal and comparative study from May to June 2000 among 120 healthy volunteers. Informed consent was obtained from all participants. We administered measles (Schwarz) and rubella (RA 27/3) vaccines. Weekly phone calls during six weeks were recorded from each volunteer to assess local and systemic events temporally associated with immunization non attributable to any other disease. Serum samples were obtained before and after vaccination in 75 volunteers. Antibodies against measles and rubella were measured by an enzyme immunoassay kit (Behring) with cut-off points of ³300mUI/mL and ³8UI/mL respectively. Statistical analysis included mean, standard deviation and paired Student's t-test (P < 0.05). Results: 105/120 participants (87.5%) were followed during 6 weeks. 87.4% were health personnel and 44.6% were males. The age range was 17-71 years (median = 21). We found a prior history of measles in 57.1%. Local events included pain, heat, redness and induration and were reported by 4/105. Systemic events such as fever, exanthema, pain in joints and arthritis was reported by 9/105. The proportion of study subjects with protective antibodies against measles and rubella prior to vaccination was 90.7 and 94.7% respectively. Both groups reached 100% after vaccination. Conclusions: The proportion of non-immune health personnel was low and similar to other reports. However, the potential spread of measles and rubella virus from a non-immunized infected health care provider could be amplified by the number of patients seen daily during the peak period of 3-5 days. The vaccination of health personnel should be encouraged.

Efecto del clorhidrato de pilocarpina como estimulante de la producción salival en pacientes sometidos a radioterapia de cabeza y cuello / Effect of pilocarpine hydrochloride on salivary production in previously irradiated head and neck cancer patients

Objetivo: Estudiar los efectos del clorhidrato de pilocarpina sobre la producción salival total en pacientes mexicanos con hiposalivación secundaria a radioterapia de la región de cabeza y cuello. Diseño del estudio: Previo consentimiento informado, 20 pacientes con hiposalivación secundaria a radioterapia de la región de cabeza y cuello (> 40 Gy) fueron evaluados mediante el Test de Saliva Global (TSG) antes, durante y al final de 10 semanas de tratamiento con clorhidrato de pilocarpina (5 mg 3 veces al día). La sintomatología relacionada a la hiposalivación fue evaluada mediante un cuestionario con escala ordinal de 0 a 10. La cantidad de saliva producida al final del tratamiento se comparó con los valores obtenidos al inicio del tratamiento en cada paciente y estos datos fueron analizados mediante la prueba de t de Student pareada. La comparación de los síntomas bucales que incluyeron sensación de humedad, malestar, dificultades para hablar y para deglutir se realizó mediante una prueba de Wilcoxon pareada. Resultados: El TSG basal indicó un promedio de 0.8 cm (d.e. 0.7) de producción salival (rango de 0 a 2.9 cm). Al cabo de las diez semanas de tratamiento el promedio de saliva producido por los pacientes fue de 2.24 cm (d.e..0.7), con un rango de 1.2 a 4.0 cm. El incremento de la producción de saliva fue del 64.5% (p<0.001). Asimismo, al final del estudio se registró mejoría en cuanto a la sensación de humedad, dificultad para hablar relacionada con la falta de saliva en la cavidad bucal, deglución y molestias bucales relacionadas a la falta de saliva en comparación con los datos iniciales (p<0.01). Los trastornos colaterales detectados fueron generalmente leves, y en ningún caso fueron causa de suspensión del tratamiento. Conclusiones: El clorhidrato de pilocarpina en dosis de 5 mg 3 veces al día produjo un incremento significativo en la producción salival y mejoría clínica en cuanto a la sintomatología bucal secundaria a hiposalivación con mínimos efectos secundarios. Asimismo, el TSG representa un método rápido, técnicamente simple y de alta confiabilidad para el registro de la producción salival en estudios prospectivos (AU)

Objective: To study the effects of pilocarpine hydrochloride on whole salivary gland production in Mexican patients affected by hyposalivation secondary to radiotherapy of the head and neck region. Study design: With previous written informed consent, 20 patients affected by hyposalivation secondary to head and neck radiation therapy (> 40Gy) were evaluated through the whole saliva test (WST) before, during and after ten weeks of treatment with pilocarpine hydrochloride (5 mg t.i.d.). Hyposalivation-related symptomatology was assessed before and at every week by means of a questionnaire with an ordinal scale ranging from 0-10. Salivary production values recorded at the end of the study and those obtained before treatment were compared by means of Student ́s t test. A paired Wilcoxon test was used to compare the differences in the oral symptoms, such as oral dryness, soreness, ability for speaking and swallowing before and after treatment. Results: Initial WST had a mean salivary production of 0.8 cm (s.d. 0.7), with a range from 0 to 2.9 cm). After ten weeks of treatment salivary production increased to a mean of 2.24 cm (s.d. 0.7), with a range from 1.2 to 4.0 cm. There was a salivary flow increase of 64.5% (p<0.001). In addition, there were significant improvements in oral dryness, mouth comfort, ability to speak and ability to swallow (p<0.01). Adverse effects were usually minimal and they did not cause withdraw from the study in any case. Conclusions: Administration of 5-mg pilocarpine hydrochloride tablets three times daily significantly improved salivary production and clinical symptomatology secondary to radiation-induced hyposalivation with minimal side-effects. In addition, this study showed that WST is a fast, technically simple and highly reliable method to study salivary production in prospective studies (AU)

Effect of pilocarpine hydrochloride on salivary production in previously irradiated head and neck cancer patients.

OBJECTIVE: To study the effects of pilocarpine hydrochloride on whole salivary gland production in Mexican patients affected by hyposalivation secondary to radiotherapy of the head and neck region. STUDY DESIGN: With previous written informed consent, 20 patients affected by hyposalivation secondary to head and neck radiation therapy (>40 Gy) were evaluated through the whole saliva test (WST) before, during and after ten weeks of treatment with pilocarpine hydrochloride (5 mg t.i.d.). Hyposalivationrelated symptomatology was assessed before and at every week by means of a questionnaire with an ordinal scale ranging from 0-10. Salivary production values recorded at the end of the study and those obtained before treatment were compared by means of student's t test. A paired Wilcoxon test was used to compare the differences in the oral symptoms, such as oral dryness, soreness, ability for speaking and swallowing before and after treatment. RESULTS: Initial WST had a mean salivary production of 0.8 cm (s.d. 0.7), with a range from 0 to 2.9 cm). After ten weeks of treatment salivary production increased to a mean of 2.24 cm (s.d. 0.7), with a range from 1.2 to 4.0 cm. There was a salivary flow increase of 64.5% (p<0.001). In addition, there were significant improvements in oral dryness, mouth comfort, ability to speak and ability to swallow (p<0.01). Adverse effects were usually minimal and they did not cause withdraw from the study in any case. CONCLUSIONS: Administration of 5-mg pilocarpine hydrochloride tablets three times daily significantly improved salivary production and clinical symptomatology secondary to radiation-induced hyposalivation with minimal side-effects. In addition, this study showed that WST is a fast, technically simple and highly reliable method to study salivary production in prospective studies.

Quistes odontogénicos. Análisis de 856 casos / Odontogenic cysts. Analysis o f 856 cases

Los quistes odontogénicos (QO) representan una de las principales causas de destrucción de los maxilares. La información relativa a estas entidades en la población mexicana es escasa, por lo que el propósito de la presente investigación es el presentar la frecuencia de los distintos tipos de QO registrados en dos servicios de diagnóstico histopatológico bucal en la ciudad de México, así como comparar los hallazgos con lo reportado en otros estudios y analizar su posible asociación con el sexo de los afectados y el tipo de servicio de diagnóstico de procedencia. Se registraron 856 QO, de los cuales 449 (52,5 por ciento) se presentaron en hombres, 403 (47 por ciento) en mujeres y en 4 casos (0,5 por ciento) no se conoció el sexo. Se identificaron 8 variedades de QO de un total de 10 entidades reconocidas por la OMS. Los QO más frecuentes fueron: quiste radicular (342 casos), quiste dentígero (283 casos) y queratoquiste odontogénico (184 casos). En conjunto, estas tres entidades representaron el 94,5 por cientodel total. Tanto el sexo como el tipo de servicio de procedencia tuvieron una asociación significativa con quistes dentígeros y radiculares (p< 0,01). El conocer el origen, los aspectos clínico-patológicos y la conducta biológica de estas lesiones son aspectos fundamentales para su detección oportuna y manejo adecuado (AU)

Atlas de parasitologia: artrópodes, protozoários e helmintos / Atlas of parasitology, arthropods, protozoa and helminths

É um atlas que tem como objetivo fornecer material exclusivo àqueles que se dedicam ao estudo dos organismos que parasitam os humanos, desenvolvendo diagnósticos, pesquisas e ensinamentos aos que se lançam nesta área das ciências da saúde.

Atlas de parasitologia: artrópodes, protozoários e helmintos / Atlas of parasitology, arthropods, protozoa and helminths

É um atlas que tem como objetivo fornecer material exclusivo àqueles que se dedicam ao estudo dos organismos que parasitam os humanos, desenvolvendo diagnósticos, pesquisas e ensinamentos aos que se lançam nesta área das ciências da saúde