Caso de desafío diagnóstico: fístula dural / Diagnostic challenge case: dural fistula

Se presenta el caso de una paciente de sexo femenino, de 69 años, que refiere tinnitus pulsátil de dos meses de evolución percibido en la región retroauricular derecha. Se presentan los hallazgos en estudios de imágenes, diagnóstico y se presenta una corta revisión del tema.

We present the case of a female patient, 69 years old, who reported pulsatile tinnitus since two months ago perceived in the right retroauricular region. We present the findings in image studies, diagnosis and a short review about the topic.

Type II diabetes and oral health: perceptions among adults with diabetes and oral/health care providers in Ghana.

OBJECTIVE: This study sought to examine oral health beliefs and attitudes, and utilisation of oral health care services among individuals with diabetes and health professionals who serve them in Ghana. BASIC RESEARCH DESIGN: A qualitative study using grounded theory was conducted. CLINICAL SETTING: University of Ghana Dental School at Korle Bu, University of Ghana School of Public Health, National Diabetes Research and Management Centre at Korle Bu, and New York University College of Dentistry. PARTICIPANTS: A convenience sample of 59 patients comprised 7 focus groups conducted in either Twi or English. Seven key informant interviews with healthcare professionals and one spiritual leader were completed. RESULTS: Data from the focus groups and interviews reveal: 1, half of the participants with diabetes have oral manifestations (e.g., bleeding gums) and participants are generally unaware of interrelationship between diabetes and oral health; 2, dental treatment utilisation is minimal and associated almost exclusively with reparative and emergency care; and 3, medical health providers do not acknowledge the interrelationship between oral health and diabetes nor do they incorporate oral health issues into diabetes screening/treatment. CONCLUSION: Oral health knowledge and practices are limited among patients with diabetes in Accra, Ghana. Collaborative efforts for in-service education and training for oral health and medical professionals may be beneficial in serving the oral and general health care needs as well as improving the oral health-related quality of life of Ghanaians with diabetes.

The long-term psychosocial effects of infertility.

OBJECTIVE: To explore the psychosocial effects of infertility and the role that social support plays over time. The major hypothesis was that although infertile persons report less contentment, lower levels of marital and sexual satisfaction, and lower self-esteem over time, those with higher levels of social support will be less affected. DESIGN/SETTING: Four questionnaires were completed in subjects' own homes, one every 9 months. PARTICIPANTS: Subjects, all of whom perceived themselves as infertile, were recruited through the national newsletter for an infertility support group. Ninety-four subjects entered the study, and 41% of the sample completed it. MAIN OUTCOME MEASURES: Contentment, marital satisfaction, sexual satisfaction, self-esteem, sex-role identity, press (the measure of perceived internal and external pressures), and social support. RESULTS: Perceived support (F[3, 111] = 4.77, p < 0.004), as well as contentment and self-esteem, significantly increased over time (F[3, 111] = 12.03, p < 0.0001, and F[3, 111] = 5.378, p < 0.002, respectively). Social support was positively correlated with all dependent measures. CONCLUSIONS: Contrary to what was hypothesized, infertile persons experienced increased social support and greater contentment over time. As hypothesized, there was a significant positive relationship between social support and all dependent measures. The positive impact of social support, counseling, and the adoption of strategies to deal with the stress of infertility lends credence to the crucial role nurses can play in helping infertile couples cope.

Dental implant esthetics.

As dental implants have become an increasingly popular restorative therapy and their stability and functional benefits have become widely acknowledged, newly applied surgical and prosthetic techniques are enabling dentists to approach patients' esthetic expectations. Esthetic results of implant-supported fixed bridges, retrievable bridges, and overdentures are influenced by the amount of soft and bone tissue as well as by the placement of the implants themselves. Tissue augmentation procedures that restore normal tissue contour and allow more ideal implant placement help minimize esthetic compromises. The use of modified abutments that are angulated and placed directly in the implant can offset weak implant placement. Finally, overdentures should be constructed if these techniques cannot be used or if their use still results in compromised esthetic results.

Nucleolar organizer regions in squamous cell carcinoma of the head and neck.

Nucleolar organizer regions are collections of nucleolar proteins associated with ribosomal genes that can be visualized in histologic sections using a silver colloid stain, thus the term silver-staining nucleolar organizer region (AgNOR). In some tissues, the number of AgNORs per nucleus correlates with cellular proliferation and, independently, with malignant change. AgNORs were studied in 66 paraffin-embedded head and neck squamous cell carcinomas and in 12 samples of normal tonsillar squamous epithelium. Carcinomas had a significantly higher mean AgNOR count than the benign epithelium (P less than .0001). Among carcinomas, mean AgNOR count increased with stage of the disease (P less than .001), but there was no significant correlation with histologic grade or DNA ploidy as determined by flow cytometry. These data suggest that AgNOR count should be evaluated as a possible aid in differentiating benign from malignant squamous epithelial proliferations in the head and neck, and also possibly as a prognostic marker in these carcinomas.

Concomitant chemotherapy and split-course radiation for cure and preservation of speech and swallowing in head and neck cancer.

To assess the ability of simultaneous cisplatin, 5-Fluorouracil, and radiation to substitute for surgery and radiation in advanced head and neck cancer, we have retrospectively selected from our phase II study a subgroup of 29 patients having primary disease requiring either more than a hemiglossectomy or a laryngectomy for control. Patients included 22 with stage IV and 7 with stage III disease, 12 tongue, 10 hypopharynx, and 7 larynx primaries. The treatment consisted of concurrent cisplatin, 5-Fluorouracil, and split-course radiation every other week for a total of 7 cycles within 13 weeks. With a median follow-up of 5 years, 86% of patients had preservation of speech and/or swallowing function. Median survival was 45 months, with 14 (48%) patients currently alive and disease free, 11 (38%) dead from their cancer, and 4 (14%) dead of other causes. The overall failure rate was 38%. Advanced-stage presence of N3 nodal disease and fewer than 7 cycles of chemotherapy received were significantly associated with increasing failure rates. This program of concomitant cisplatin, 5-Fluorouracil, and radiation produced control rates quite competitive with surgery and radiation and is appropriate for definitive testing in a randomized trial.

The effect of infertility on marriage and self-concept.

Two groups of subjects (couples seeking medical treatment for infertility and couples not yet attempting to conceive) completed questionnaires assessing the impact of infertility on their marriages and self-concept. Infertile individuals experienced greater dissatisfaction with themselves and their marriages. Females experienced greater discontent over time and had greater emotional investment than males. Infertile couples, labeled noncommunicators, were found to be affected even more by infertility. Nurses can play vital roles in counseling infertile couples.

Vocal restorative surgery: why wait?

The case histories of 36 laryngectomees with vocal restorative surgery from the Department of Otolaryngology were reviewed to determine the patient's current mode of speech and number and type of complications to recovery and rehabilitation. The patients comprised two groups: 21 with tracheoesophageal fistula (tef) at the time of laryngectomy (primary) and 15 with tef subsequent to laryngectomy (secondary). Results of the review indicated that while approximately 10% fewer patients in the primary group were using a surgically restored voice, none of the surviving primary group remained aphonic. In contrast, 27% of the surviving secondary group failed to develop some form of verbal communication. When the complication rate is identified, vocal restorative surgery at the time of laryngectomy appeared to be very successful in initiating the rehabilitation process without compromising sound oncological procedures.

The effect of proximal cavity design on the cementation of Class II inlays.

This article indicates that the gingival opening of a two-surface cast restoration after cementation is minimized by the use of a preparation with proximal grooves.

Survey research and the silent majority.

A survey conducted at the New York University Dental Center demonstrated that significant differences exist between patients who are ready participants in research efforts and those who require the more persistent attention of the researcher. In addition, patients who were questioned while in treatment emphasized different reasons for selecting a dental school for treatment than did those patients who were interviewed prior to beginning treatment. The importance of collecting data from a truly random sample of patients is stressed and elaborated with reference to the marketing implications of the results. Strategies for patient recruitment and retention require knowledge that is complete and does not suffer from systematic absences in the data base. Careful data collection methods are described and advocated.