Prosthetic management of neuromuscular rehabilitation in hemimandibulectomy patients. A case report.

The radio-surgical treatments for carcinomas involving the oral cavity are often destructive in order to limit as much as possible the high rate of recidivism. The outcome of the combined treatment is represented by lesions on hard and soft healthy tissues besides naturally by a more or less important mandibular deviation depending on greater or lesser quantity of basal bone excised. In some cases it is possible to surgically restore the defective mandible through bone grafting; this means a quite perfect restitutio ad integrum of the mandibular arch; instead, in other cases, because of bone and soft tissue biology, general healthy state and age of the patient prosthetic management would be better as it is less invasive even if less resolutive. For a right tonsillar cavity carcinoma the patient, T. F., female, 73-year old, had undergone radical neck dissection and hemisection of the homolateral mandible. A guide-device was realized for "guiding" the residual mandible into the physiological centric occlusion position, and then a removable partial denture was realized as a definitive prosthesis. After 3 months therapy the patient was easily able to spontaneously reposition the hemimandible itself, also with considerable improvement of the masticatory function. Neuromuscular re-education of hemimandibulectomy patients via the use of a guide flange on a removable prosthesis applied to the residual mandible represents a fundamental condition for permanent prosthetic rehabilitation.

Cancer of the head and neck: general principles of radiobiology, radiotherapy and chemotherapy. Radiation damage.

The overall incidence of tumours of the head and neck area versus tumours of other areas is 10%; in other words, 1 neoplastic lesion out of 10 affecting the human body is in this area. The relative frequency places malignant tumours of the larynx in 1(st) place with 25-30%. This data relates only to the areas of competence of the dentist and ENT specialist, and thus indicates that it is now becoming increasingly frequent for the dentist to be faced with treating a cancer patient. At the same time, it is not possible to consider as "dental cancer patients" only those patients whose disease involves an anatomic structure of the oral cavity as such. Pa-tients with tumours involving any of the anatomic structures of the head and neck area (pharynx, larynx, lip, oral cavity, pa-ranasal sinuses, nasal fossae, salivary glands) must also be included. This article provides information on the epidemiology of tumours of the head and neck, the theoretical foundations of radiobiology, radiotherapy and chemotherapy, and possibilities for integration among the different possible treatment methods, i.e. radiotherapy, surgery, and chemotherapy. It looks at the most recent developments in these methods for patients with cancer of the head and neck, including the diagnostic protocol (clinical and instrumental). Lastly, irradiation damage to this anatomical area is analysed in terms of acute and delayed manifestations.

[Deciduosis of the appendix as cause of acute abdomen in pregnancy]. / Deciduosis apendicular como causa de abdomen agudo en el embarazo.

Ectopic decidua reaction or deciduosis is a physiological phenomenon of pregnancy due to a progesterone induced metaplasia of the pluripotential cells of the subcelomic mesenchyma. Usually it is an incidental finding that has not been associated with clinical symptoms. Isolated cases of ectopic decidua have been reported with symptoms simulating appendicitis. We are reporting a case of deciduosis localized in the appendix with abdominal pain during the last period of pregnancy.

Association between high serum prolactin levels and concomitant infections in HIV-infected patients.

Although prolactin (PRL) is now recognized as a cytokine and persistent immune activation is a common immunopathogenic feature of the human immunodeficiency virus infection (HIV), the circumstances associated with the onset of hyperprolactinemia during the course of this infection remain controversial. Given that PRL is able to exert not only endocrinologic effects but also immunologic influences, a study was conducted to investigate whether raised serum levels of PRL were more likely to prevail when HIV-infected patients developed concomitant infections. Serum PRL concentrations, as well as immunoglobulin isotypes, plasmatic viral burden, CD3+, CD4+, CD8+, CD19+, and natural killer (NK) cell counts were measured in 46 nonselected HIV-infected patients stratified on the basis of the presence or absence of clinically active concomitant infections. Serum PRL levels were significantly higher in patients presenting secondary infections as compared with the asymptomatic ones, with hyperprolactinemia being detected in 10/18 (55%) and 2/28 (7%) of these patient groups, respectively. Hyperprolactinemia was not related with viral burden, antiretroviral treatment, gender differences, or CD4+ cell counts. CD3+, CD4+, CD8+, and CD19+ cells were significantly lower in the group presenting active infections, whereas comparisons in NK cell counts, immunoglobulin levels and HIV viral burden revealed no differences between groups. These results provide evidence that hyperprolactinemia is more prevalent during the onset of secondary infections, which might have diagnostic and therapeutic consequences.

Deciduosis apendicular como causa de abdomen agudo en el embarazo. / [Deciduosis of the appendix as cause of acute abdomen in pregnancy]

Ectopic decidua reaction or deciduosis is a physiological phenomenon of pregnancy due to a progesterone induced metaplasia of the pluripotential cells of the subcelomic mesenchyma. Usually it is an incidental finding that has not been associated with clinical symptoms. Isolated cases of ectopic decidua have been reported with symptoms simulating appendicitis. We are reporting a case of deciduosis localized in the appendix with abdominal pain during the last period of pregnancy.

[Hyperprolactinemia is a frequent finding in HIV infection but does not correlate with viral burden]. / La hiperprolactinemia es un hallazgo frecuente en infectados por HIV pero no se correlaciona con la carga viral.

Although many authors have reported the finding of hyperprolactinemia during the course of HIV infection, the circumstances determining the rise of prolactin (PRL) concentrations in serum are poorly understood. To analyze the relationships between serum PRL and other clinical variables in HIV-infected patients, 46 HIV-infected patients and 17 seronegative controls were studied. Serum PRL concentrations were significantly higher in the HIV-infected group (p = 0.022). Furthermore, Serum PRL and serum IgG correlated positively (Rs = 0.42; p = 0.05, Spearman-Rank). On the contrary, serum PRL concentrations did not correlate with the plasmic viral burden (Rs 0.039; p = 0.841), Our data confirm that hyperprolactinemia is a frequent finding during the course of HIV infection, and that serum PRL are independent of viral replication kinetics. Considering that a positive correlation was found between serum PRL and immunoglobulins, it is possible that serum PRL might increase in response to non specific immunological activation, or even in response to immunological activation at the onset of infections.

[Immunological properties of prolactin]. / Propiedades inmunológicas de la prolactina.

A profound bi-directional interaction exists between the hormone prolactin and the immune system. Even the name "hormone" seems to be inadequate, since prolactin is clearly a growth factor and in fact it functions as an immune co-mitogenic cytokine using autocrine, paracrine and obviously endocrine mechanisms. Prolactin (PRL) stimulates lymphocyte proliferation in response to antigen and mitogens. In addition, prolactin is locally secreted by immune cells, and the pituitary production of prolactin is partially under the control of pro-inflammatory cytokines. These reciprocal influences imply the presence of specific receptors for prolactin in many immune cells, such as lymphocytes and other accessory cells. The PRL-binding to its receptor stimulates the synthesis and secretion of lymphocyte cytokines. In addition, it is a growth factor essential for at least one lymphoid cell line. The PRL-corresponding mRNA has been demonstrated in the cytoplasm of mitogen-stimulated lymphocytes, and the secretion of PRL has been well documented in lymphoid cells. Moreover, PRL acts on NK cells to induce their differentiation to prolactin-activated killer cells (PAK cells) in a dose-dependent way (activation at physiological concentrations, and cytotoxicity inhibition at tenfold higher concentrations). PRL also shows a well known capacity to induce IFN-gamma and IL-2 synthesis, suggesting their participation in the genesis of Th1-responses. These PRL immunological properties strongly support PRL as a cytokine. PRL involvement in both the normal immune response and in many pathological conditions raises important considerations regarding potential diagnostic and therapeutic applications.

La hiperprolactinemia es un hallazgo frecuente en infectados por HIV pero no se correlaciona con la carga viral. / [Hyperprolactinemia is a frequent finding in HIV infection but does not correlate with viral burden]

Although many authors have reported the finding of hyperprolactinemia during the course of HIV infection, the circumstances determining the rise of prolactin (PRL) concentrations in serum are poorly understood. To analyze the relationships between serum PRL and other clinical variables in HIV-infected patients, 46 HIV-infected patients and 17 seronegative controls were studied. Serum PRL concentrations were significantly higher in the HIV-infected group (p = 0.022). Furthermore, Serum PRL and serum IgG correlated positively (Rs = 0.42; p = 0.05, Spearman-Rank). On the contrary, serum PRL concentrations did not correlate with the plasmic viral burden (Rs 0.039; p = 0.841), Our data confirm that hyperprolactinemia is a frequent finding during the course of HIV infection, and that serum PRL are independent of viral replication kinetics. Considering that a positive correlation was found between serum PRL and immunoglobulins, it is possible that serum PRL might increase in response to non specific immunological activation, or even in response to immunological activation at the onset of infections.

Propiedades inmunológicas de la prolactina. / [Immunological properties of prolactin]

A profound bi-directional interaction exists between the hormone prolactin and the immune system. Even the name [quot ]hormone[quot ] seems to be inadequate, since prolactin is clearly a growth factor and in fact it functions as an immune co-mitogenic cytokine using autocrine, paracrine and obviously endocrine mechanisms. Prolactin (PRL) stimulates lymphocyte proliferation in response to antigen and mitogens. In addition, prolactin is locally secreted by immune cells, and the pituitary production of prolactin is partially under the control of pro-inflammatory cytokines. These reciprocal influences imply the presence of specific receptors for prolactin in many immune cells, such as lymphocytes and other accessory cells. The PRL-binding to its receptor stimulates the synthesis and secretion of lymphocyte cytokines. In addition, it is a growth factor essential for at least one lymphoid cell line. The PRL-corresponding mRNA has been demonstrated in the cytoplasm of mitogen-stimulated lymphocytes, and the secretion of PRL has been well documented in lymphoid cells. Moreover, PRL acts on NK cells to induce their differentiation to prolactin-activated killer cells (PAK cells) in a dose-dependent way (activation at physiological concentrations, and cytotoxicity inhibition at tenfold higher concentrations). PRL also shows a well known capacity to induce IFN-gamma and IL-2 synthesis, suggesting their participation in the genesis of Th1-responses. These PRL immunological properties strongly support PRL as a cytokine. PRL involvement in both the normal immune response and in many pathological conditions raises important considerations regarding potential diagnostic and therapeutic applications.

[Empirical anti-toxoplasma therapy in cerebral AIDS and Chagas disease. Presentation of 2 cases, review of the literature and proposal of an algorithm]. / Tratamiento empírico anti-toxoplasma en SIDA y Chagas cerebral. Relato de dos casos, revisión de la bibliografía y propuesta de un algoritmo.

Trypanosoma cruzi is the responsible agent of Chagas disease and is endemic in extended areas of South and Central America. There are many previous reports indicating that T. cruzi frequently involves the central nervous system in AIDS patients. Here, we present two cases illustrating that neurological involvement caused by T. cruzi frequently shows a clinical picture similar to that caused by Toxoplasma gondil. Since in neurological Chagas disease early treatment has been associated with a better outcome and considering that the diagnosis is easily reached by the detection of the agent in the cerebrospinal fluid, we propose a new algorithm for the management of AIDS patients presenting neurological focal lesions in endemic areas for T. cruzi.

Resistance to fracture of metal ceramic and all-ceramic crowns.

This study evaluated the fracture resistance of three types of all-ceramic crowns and compared these to the fracture values of metal ceramics. Uniform metal ceramic specimens; veneered, cast glass-ceramic; and porcelain fused to two different dispersion-strengthened ceramic cores (Hi-Ceram and In-Ceram) were investigated. The metal ceramic specimens demonstrated a significantly higher resistance to fracture than did the Hi-Ceram or veneered glass-ceramic units but did not significantly differ from the In-Ceram specimens. The metal ceramic crowns showed cracks only in the ceramic layer, whereas the all-ceramic specimens underwent global fracture.

[Nalbuphine. Comparison of 2 therapeutic regimens for the control of postoperative pain]. / Nalbufina. Comparación de dos regímenes terapéuticos para el control del dolor postoperatorio.

The therapeutical efficiency and the undesirable effects of Nalbuphine administered to control postoperative pain were compared. Two groups of patients were studied: one group received 10 mg endovenously every 4 h during the first 12 h of the postoperative phase and every 6 h during the following 12 h while the other group received 20 mg with the same intervals. The following variants were evaluated: pain, systolic arterial tension, cardiac frequency, respiratory frequency and undesirable effects. After statistical analysis, a similarity in both groups was confirmed for pain, systolic arterial tension, cardiac frequency, while a significant difference was found in two of the undesirable effects: sedation and sweating. In conclusion, the 10 mg dose is as effective as that of 20 mg to control pain and has less unwanted effects.

Nalbufina: comparación de los regímenes terapéuticos para el control del dolor postoperatorio / Nalbuphine: comparison of 2 therapeutic regimens for the control of postoperative pain

Se comparó la eficacia terapéutica y los efectos indeseabeles de la Nalbufina administrada para controlar el dolor postoperatorio. Se estudiaron dos grupos de enfermos: uno recibió 10 mg E.V. c/4 horas durante 12 primeiras horas del postoperatorio y cada 6 horas en las siguientes 12 horas y el otro recibió 20 mg a iguales intervalos. Se evaluaron: dolor, tensión arterial sistólica, frecuencia cardíaca, frecuencia respiratoria y efectos indeseables. Se comprobó similitud en ambos grupos con respecto a las distintas variables y diferencia significativa en dos de los efectos indesables: sedación y sudoración. Se concluye que la dosis de 10 mg es tan efectiva como la de 20 mg para el control del dolor y tiene menos efectos indeseables