Actitud terapéutica ante los terceros molares: ¿exodoncia o vigilancia? / Therapeutic approach to third molars ¿Extraction or surveillance?

Uno de los desafíos a los que se enfrenta a diario un cirujano bucal o maxilofacial es el manejo terapéutico de los terceros molares asintomáticos y libres de patología. Hasta la fecha existe una falta de información concluyente, problemas en la interpretación de la bibliografía reciente, así como diferentes puntos de vista entre profesionales a la horade responder si es mejor realizar la exodoncia a tiempo o mantener una actitud expectante. El objetivo de este trabajo es revisar la bibliografía reciente referente a la toma de decisiones terapéuticas en estos casos y discutir sobre los aspectos de consenso y las controversias. Además, buscar evidencia científica que justifique la exodoncia profiláctica del tercer molar. A día de hoy continúala controversia sobre el manejo terapéutico óptimo de un tercer molar asintomático y libre de patología. En la presente revisión no se ha encontrado evidencia científica que justifique la exodoncia profiláctica del tercermolar. Se necesita mucha más evidencia científica, así como el diseño de estudios clínicos aleatorizados que permitan compararlas consecuencias a corto y largo plazo de la vigilancia activa y de la exodoncia de los terceros molares

The therapeutic management of asymptomatic and disease free third molars is one of the challenges faced daily by an oral and maxillofacial surgeon. To date there is a lack of conclusive information, problems in the interpretation of the recent literature, as well as different views among professionals when asked if it is better to perform a prophylacticor maintain an expectant attitude. The objective is to review the recent literature on the therapeutic decisions in these cases and discuss aspects of consensus and controversies. Search scientific evidence to support prophylactic third molar extraction. At present controversy continues regarding the optimal therapeutic management of an asymptomatic and disease free third molar. Conclusive evidence has not been found to justify prophylactic third molar extraction in the present review. Much more scientific evidence as well as the design of randomized clinical studies comparing the short-and long-term active surveillance and the extraction of third molars is needed

Bacteriemia por Flavimonas oryzihabitans en un paciente no neutropénico con enfermedad cardiaca / Flavimonas oryzihabitans bacteriemia in a non-neutropenic patient with cardiac illness

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[Diarrhea caused by adenovirus and astrovirus in hospitalized immunodeficient patients]. / Diarrea por adenovirus y astrovirus en pacientes inmunodeficientes hospitalizados.

BACKGROUND: Acute or chronic diarrheal illness are common complications in immunosuppressed patients such as human immunodeficiency virus (HIV)-infected, bone marrow or solid organ transplanted patients and those with leukaemias or other immune deficiency disorders. Due to the importance of recognizing the feasible etiologies of diarrhea in order to give the proper antimicrobial chemotherapy or to avoid a misdiagnosis of rejection in the case of transplanted patients, we have investigated adenovirus and astrovirus antigen in faeces from different immunosuppressed patients. PATIENTS AND METHODS: Stool samples from 258 immunodeficient patients hospitalized at University Hospital Complex of Santiago of Compostela with acute or persistent diarrhea were collected between 1997-99 and assayed for astrovirus and adenovirus antigen. Viral antigen was detected by EIA. Other common enteric pathogens were also assayed. RESULTS: Adenovirus antigen was positive in 5 cases (2%) and astrovirus antigen in 12 cases (5%). The most commonly patients infected was those with haematologic disorders and premature infants. HIV-infected patients were positive for astrovirus antigen in 3 cases. The majority of the cases were related with intestinal bacterial diseases or other circumstances, such as Clostridium difficile infection, both associated with prolonged antimicrobial therapy. CONCLUSIONS: Astrovirus and adenovirus have to be considered as enteropathogens specially in immunocompromised hospitalized patients. An accurate diagnosis about diarrhea etiology is advisable in order to give a specific antimicrobial therapy, when it be necessary, or to avoid a misdiagnosis of rejection, in transplanted patients.

Stomatococcus mucilaginosus septicemia in a patient with acute lymphoblastic leukaemia.

A 16-year-old patient with acute lymphoblastic leukaemia which had relapsed for the third time developed clinical signs and symptoms of septicemia during a period of neutropenia. The patient had signs of oral mucositis, and Stomatococcus mucilaginosus was isolated from blood cultures. The patient responded well to antibiotic therapy. The biochemical characteristics and antimicrobial susceptibility patterns of 68 other pharyngeal isolates of Stomatococcus mucilaginosus from immunocompromised patients are presented.