Hospitales del futuro. La experiencia de Dinamarca / Hospitals of the future. The experience of Denmark

Este artículo describe la experiencia de la autora, anestesióloga, durante su estancia en Dinamarca como participante del programa Europeo de intercambio HOPE, acrónimo de ‘Hospitals for Europe’. La excepcional calidad del Sistema de Salud Danés se basa en tres pilares: a) la cultura nórdica del consenso, diálogo y aparente ausencia de jerarquía; b) la relación con el paciente al que se le ofrece un ambiente lo más cercano posible al hogar y donde el médico es visto como un compañero, y c) por último, el cuidado de las condiciones de los trabajadores, con enseñanza del idioma, actividades deportivas y espacios de descanso, entre otras muchas medidas (AU)

This article describes the experience of the author, a consultant anaesthetist, during a stay in Denmark under the European Exchange Progamme ‘Hospitals for Europe’ (HOPE). The outstanding quality of the Danish system is based on a meticulous organisation that relies on three pillars: a) the Nordic paradigms of consensus, dialogue and the apparent absence of hierarchy; b) respecting the patient, bringing about a homely atmosphere where the doctor is seen as an equal; and c) last but not least, the care of the conditions of hospital workers, with teaching of languages, sports activities and spaces to relax among many other measures (AU)

Serologic control against hepatitis B virus among dental students of the University of Granada, Spain.

BACKGROUND: To evaluate the immunological situation against hepatitis B virus (HBV) of a cohort of dentistry students, to analyze the behavior of the levels of hepatitis B surface antigen (anti-HBs) after the administration of one or three vaccine doses, and to determine the influence of age and sex on the immune response. MATERIAL AND METHODS: This retrospective cohort study included students attending the School of Dentistry of the institution where the study was performed from 2005 to 2012 who had completed the public health vaccination calendar for HBV at the age of 12-13. Data on age, sex, basal anti-HBs levels, post-vaccination anti-HBs results and final anti-HBs levels were collected. Comparisons of the basal and final levels, as well as associations regarding age and sex, were performed by means of the Student t and Chi-square tests. RESULTS: Of the 359 students, 97 (27.02%) had basal antibody concentrations <10 mIU/ml, whereas in 262 the levels of anti-HBs were ≥10 mIU/ml (72.98%). Of the 288 participating students who completed the School's protocol for immunization, 287 (99.65%) attained a level of protection ≥10 mIU/ml. Globally, there were statistically significant differences between the basal antibody levels and those achieved after administration of the vaccine and booster, but no association with age or sex was observed. CONCLUSIONS: About 70% of dental students vaccinated as pre-adolescents had serologic evidence of protection against HBV. Administering a booster is associated with the presence of an excellent immune memory. There is clearly a need to reinforce control of the antibody levels in groups at risk, such as Dentistry students.

Influencia de parámetros clínicos sobre la severidad de la recesión gingival localizada / Clinical parameters related to severity of localised gingival recession

INTRODUCCIÓN: La recesión gingival localizada es un problema de salud bucodental fundamental porque su progresión conduce a la pérdida dentaria. El propósito de este trabajo fue evaluar la influencia de distintos parámetros clínicos sobre la recesión gingival localizada. MATERIAL Y MÉTODOS: Se estudiaron 40 pacientes con recesión gingival localizada en los que se analizaron diversos parámetros clínicos relacionados con la recesión gingival. Para la comparación de variables cuantitativas se utilizó el test de Student (t-Student) y para la de variables cualitativas el test chi-cuadrado. RESULTADOS: En este estudio, según la clasificación de Miller, el 37,5% de los pacientes tenían recesiones de tipo I, el 60% de tipo II y el 2,5% restante, de tipo III. Los siguientes parámetros: edad, frecuencia de cepillado, tipo de cepillo, uso de colutorios y de seda dental, otros hábitos orales y el tratamiento de ortodoncia, no tienen influencia sobre la severidad de la recesión gingival (p > 0,05 en todos los casos). Presentan recesión gingival más severa, los varones (p = 0,03), los sujetos fumadores (p = 0,007) y los que tienen técnicas de cepillado horizontal (p = 0,02). En los cuatro momentos de seguimiento del estudio (inicial, 6, 12 y 18 meses), la profundidad de sondaje, la pérdida de inserción, el índice de placa y el índice de sangrado mejoraron a los 6 meses para luego empeorar en el resto de períodos. DISCUSIÓN: El sexo, el tabaco y la técnica de cepillado son los tres factores que tienen influencia sobre la severidad de la recesión gingival localizada en este estudio

INTRODUCTION: Localised gingival recession is a major problem of oral health because its progression leads to the dental loss. The aim of this study was to evaluate the possible influence of different clinical parameters in localised gingival recession. MATERIAL AND METHODS: Forty patients with localised gingival recession were studied. Data from several clinical parameters related to gingival recession were collected. RESULTS: In this study, 37.5% of patients had recessions of Miller's type I, 60% Miller's type II, and the remaining 2.5% of Miller's type III. Age, frequency of toothbrushing, toothbrushing technique, use of mouthwash and/or dental floss, other oral habits, and orthodontic therapy, have no influence on the severity of gingival recession (p > 0.05 in all cases). More severe gingival recession was observed in males (p = 0.03), smokers (p = 0.007) and those with horizontal toothbrushing techniques (p = 0.02). In the four follow-up periods of the study, probing depth, attachment loss, plaque index and bleeding index improved after 6 months and then got worse in the rest of the follow-up intervals. DISCUSSION: Gender, smoking and toothbrushing technique were the three factors that influenced the severity of localised gingival recession

Lesiones periapicales: diagnóstico y tratamiento / Periapical lesions. Diagnosis and treatment

Las lesiones periapicales resultado de la necrosis de la pulpa dental son las patologías que más frecuentemente ocurren encontradas en el hueso alveolar. El tratamiento consiste en la eliminación de los agentes infecciosos mediante el tratamiento del canal radicular, permitiendo la cicatrización de la lesión

Periapical lesions, which are a result of the necrosis of the dental pulp, are the most frequently occurring diseases found in the alveolar bone. The treatment involves the removal of infectious agents by treating the root canal, allowing the wound healing

Nuevas aportaciones de la mascarilla laríngea en cirugía ambulatoria. Contribución de la mascarilla laríngea Supreme / No disponible

Desde la introducción de la mascarilla laríngea, su uso se ha expandido especialmente en el contexto de la cirugía ambulatoria. La mascarilla laríngea representa el “patrón oro” de los dispositivos supraglóticos, y es la referencia con la que los nuevos dispositivos deben ser comparados. La presente revisión es una actualización de las principales indicaciones de la mascarilla laríngea en usos avanzados, incluyendo el abordaje de la vía aérea difícil en el paciente intervenido de forma ambulatoria. Así mismo se incluye una revisión de las indicaciones, aportaciones, y ventajas de la mascarilla laríngea Supreme aplicadas al contexto de la cirugía sin ingreso (AU)

Since the introduction of the original laryngeal mask airway(LMA) in the nineties in our country, its use has expanded especially in the context of outpatient surgery. The LMA remains the “gold standard” of the supraglotic devices and the standard by which all other devices should be compared. This review is an update of the main indications of the LMA in advanced applications, including addressing the difficult airway in the patient operated on an outpatient basis. Also includes a review of the information, contributions, and advantages of the LMA supreme applied to the context of day surgery (AU)

p16 Expression in squamous carcinomas of the tongue.

BACKGROUND: 81 patients with tongue carcinomas were studied to determine: 1). the proportion of carcinomas with altered p16 expression; 2). whether loss of p16 is an early carcinogenic event; 3). whether p16 expression alterations influence the prognosis. METHODS: 50/81 cases could be analysed by immunohistochemistry. RESULTS: Tumours were p16- in 32% (16/50) and p16+ in 68% (34/50) of patients; 32.3% (11/34) of p16+ tumours presented 1-10% of tumour cells as positive, 14.7% (5/34) 11-40% as positive, and 59.2% (18/34) presented 41-100% of tumour cells as positive. Adjacent nontumoural epithelium (ANTE) was available in 33 of the 50 immunohistochemically analysed specimens. ANTE was normal in 25 cases and dysplastic in 8 cases. In normal ANTE, p16 expression was positive in 16% (4/25) and negative in 84% (21/25) of cases. p16 expression was negative in all dysplastic ANTE samples (8/8). CONCLUSIONS: Changes in p16 expression are frequent in tongue cancer and can be detected at very early stages of carcinogenesis. Nevertheless, in our study neither the absence nor the degree of p16 expression influenced the survival of patients.

Lipomas en la cavidad oral. Presentación de seis casos clínicos / Lipomas of the oral cavity. Report of six cases

El lipoma es una de las neoplasias benignas más frecuentes, aunque rara en la cavidad oral. Se presentan como tumores asintomáticos, de lenta evolución, color amarillento y blandos a la palpación. Las localizaciones orales más frecuentes son la mucosa yugal, la lengua y el suelo de la boca. En la actualidad la etiología de los lipomas es desconocida aunque se jan propuesto diversas teorías que incluyen la hipertrofia y la metaplasia. Histológicamente es un tumor constituido por células adiposas maduras que se localiza en el tejido celular subcutáneo. Además del lipoma simple, se han descrito diversas variantes histológicas de lipoma entre las que se incluyen fibrolipomas, angliolipomas, lipomas mixoides y condrolipomas, siendo el fibrolipoma la más frecuente de todas. Se describe nuestra casuística de lipomas, analizando sus características clínicas, histológicas y terapeúticas (AU)

Epstein-Barr virus latent membrane protein-1 (LMP-1) expression in oral squamous cell carcinoma.

OBJECTIVES: Epstein-Barr virus (EBV) is frequently associated with malignant cell transformation through the action of the oncoprotein latent membrane protein-1 (LMP-1). The present study aimed to determine the presence of EBV in oral squamous cell carcinomas (OSCCs) and the expression of LMP-1 in neoplastic cells of EBV-positive OSCCs. STUDY DESIGN/METHODS: In a retrospective study of 78 OSCCs, we investigated the presence of the DNA of EBV by polymerase chain reaction, the expression of the oncoprotein LMP-1 by immunohistochemistry, and the presence of EBV-encoded RNA (EBER) by in situ hybridization. RESULTS: EBV DNA was detected in 19.2% of the cases. Expression of LMP-1 in neoplastic cells was found in 85.7% of the EBV-positive OSCCs. EBV presence was significantly more frequent (P <.05) in OSCCs localized on the lateral tongue. EBV-positive OSCCs more frequently presented (P <.05) greater nuclear atypia. CONCLUSION: EBV can appear in latent form in OSCC and express its main oncoprotein, LMP-1.

Nevus azul con área central despigmentada / Blue naevus with central depigmented area

El nevus azul es una lesión benigna papular o nodular con coloración que varía desde el azul-oscuro al azulnegruzco. Las localizaciones más comunes son el dorso de las manos y pies, brazos, piernas, cara y cuero cabelludo. Se presenta el caso de una mujer de 60 años con una lesión sobreelevada en el cuero cabelludo de más de 30 años de evolución, en cuyo centro apareció un área central despigmentada. Tras la toma de biopsia y posterior extirpación completa de la lesión, fue diagnosticada de nevus azul celular. La aparición de dicha área central despigmentada posiblemente está relacionada con un traumatismo continuado y repetitivo por la acción del cepillado del pelo. (AU)

P53 protein expression in oral squamous cell carcinoma. survival analysis.

BACKGROUND: The present study aimed to analyze the pattern of p53 expression and its influence on survival in patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: An immunohistochemical technique with BP53-12 antibody was performed on stored tissue from 78 patients with OSCC (intraoral cancer n=40; lip cancer n=38). The nuclear and cytoplasmic extension of p53 staining was assessed. Clinical and histopathological data were gathered and the patient survival was analyzed. RESULTS: 57.7% (n=45) of the OSCCs expressed p53, with nuclear expression in 52.6% (n=41) of cases and cytoplasmic expression in 24.4% (n=19). The OSCCs with extensive nuclear expression of p53 showed dissociated patterns of invasion of adjacent tissues (p<0.05). A greater extension of cytoplasmic expression of p53 most commonly appeared in tumors that were better-differentiated (p<0.005), more keratinized (p<0.01) and with less nuclear atypia (p<0.05). The parameters that significantly influenced survival of patients were tumor localization (p<0.01), size (p<0.0001), lymph node invasion (p<0.0001), clinical stage (p<0.0001), differentiation degree (p<0.01) and nucleargrade (p<0.01). CONCLUSION: The expression of p53 protein did not behave as a marker of prognostic value in patients with OSCC.

Suprabasal expression of Ki-67 antigen as a marker for the presence and severity of oral epithelial dysplasia.

BACKGROUND: Suprabasal expression of Ki-67 is assessed as a marker for oral dysplasia. The study involved non-neoplastic epithelium adjacent to 74 oral squamous cell carcinomas. METHODS: An immunohistochemical technique was carried out (peroxidase-antiperoxidase) with the monoclonal antibody MIB-1. Epithelial expression of Ki-67 was classified as being absent, basal, and suprabasal. The epithelium was normal in 19 cases, hyperplastic in 38 cases, and dysplastic in 37 cases. The dysplasia was slight in 20 cases, moderate in 12 cases, and severe in 5 cases. RESULTS: The results of the expression of Ki-67 were in normal epithelium, basal expression 9 cases, absent 10 cases; in hyperplastic epithelium, basal expression 18 cases, absent 20 cases; in dysplastic epithelium, basal and suprabasal expression (always jointly) 27 cases, absent 10 cases; all the severe and moderate dysplasia cases expressed suprabasal Ki-67. A significant association was observed between the presence (p <.0001) and severity (p <.007) of the dysplasia and the suprabasal expression of Ki-67.

Expression of the p53 protein in oral squamous cell carcinomas associated with Epstein-Barr virus.

The behaviour of the p53 protein has been investigated in some human carcinomas associated with Epstein-Barr virus (EBV) but not in EBV-positive oral squamous cell carcinomas (OSCC). The present study aimed to compare the p53 protein expression in EBV-positive OSCC with that in EBV-negative OSCC. The cases had been gathered in a study previously published. An immunohistochemical technique with BP53-12 monoclonal antibody was applied on 74 of the 107 OSCC from the earlier work. The nuclear or cytoplasmic expression of the p53 protein was classified as, absent (0% of neoplastic cells positive), mild (<25% positive), moderate (25-30% positive), or extensive (>50% positive). The p53 protein was expressed by 60.8% of the OSCC. Out of the fourteen EBV-positive OSCC, 57.1% (8 cases) expressed p53, always in the nucleus and never in the cytoplasm. Of the 60 EBV-negative OSCC, 61.6% (37 cases) expressed the p53 protein. Of 37 cases 33 (89.1%) showed nuclear expression of p53 and nineteen cases (51.3%) revealed cytoplasmic expression. There was a statistically significant inverse correlation between cytoplasmic expression of the p53 protein and the presence of EBV DNA (p <0.01). Thus, the EBV-positive tumours less frequently expressed p53 in the cytoplasm. No evidence of an accumulation of the p53 protein in OSCC associated with EBV was recorded.

Prognosis value of the expression of Ki-67 for squamous cell carcinoma of the oral cavity.

Ki-67 is a nuclear antigen expressed in G1, S, G2 and M phase of cell cycle and absent in quiescent cells (G0). In some neoplasms, Ki-67 expression has a prognostic value. The purpose of this study was to determine the role of Ki-67 expression like prognostic factor in oral squamous cell carcinoma (OSCC). Monoclonal antibody MIB-1 that recognizes Ki-67 antigen was used. 74 OSCCs were analyzed. 49% of OSCCs did not express Ki-67 antigen. In the Ki-67 positive tumours, the expression was slight in 36.5%, moderate in 10.8% and intense in 10.8% of the cases. In all the positive OSCCs, the distribution of the marking was patchy in different zones of the tumour, moreover, in 65% of the lesions, the positive cells were located mainly in the proximity of intraoral blood vessels. A significantly more intense expression was noted on tumours that had not been differentiated (p < 0.05), with a larger nuclear pleomorphism (p < 0.05) and in lesions that invaded in the form of disassociated neoplastic cells of in small groups of neoplastic cells (p < 0.001). However, the expression of Ki-67 did not correlate with the mitosis count and it had no influence on survival.

Increase of proliferating cell nuclear antigen (PCNA) expression in HPV-18 positive oral squamous cell carcinomas.

Several studies have established a probable relationship between HPV infections and oral neoplasia. The present study analyze the importance of the integration of DNA of HPV type 18 on the proliferative capability of oral squamous cell carcinoma (OSCC) by the study of PCNA expression. Thirty seven patients with OSCC were studied. A complete clinical history and histopathological study was performed. DNA of HPV-18 was found in 7 of the 37 oral OSCCs (19.1%). PCNA expression appeared in 75.7% of OSCCs (28 cases). 9 OSCCs (24.3%) were completely negative, whereas 13 (35.1%), 8 (21.6%) and 7 (18.9%) show minimal, moderate and intense PCNA expression. 4 HPV-18 positive OSCCs showed a intense PCNA expression, 1 OSCC showed moderate PCNA expression, whereas 2 OCSSs showed minimal PCNA expression. Statistical correlations between PCNA expression and DNA HPV-18 amplification showed a more intense PCNA expression in HPV-18 positive OSCCs (p = 0.023). Further studies are needed to establish whether the increase of cellular proliferation induced by HPV-18 has prognostic consequences.

Epithelial response to the immunitary aggression in oral lichen planus.

Oral lichen planus is an inflammatory disease with mucous and cutaneous affects caused by cellular immune reaction. Basal cell vacuolation degeneration is the result of T-cell aggression. As the clinical and histopathological alterations of OLP range from epithelial hyperplasia to epithelial atrophy and erosion, it could be that different forms of OLP finally express differences in the intensity of immune attack. The aim of the present study was to analyse the relationship between the clinical and histopathological behaviour and the intensity of the immune response to OLP by means of basal cell vacuolation and inflammatory infiltrate intensity measurement. We analysed 47 patients with OLP. Requirements for inclusion were histopathological diagnosis of OLP from an oral biopsy. Clinical and histopathological correlations were made. OLP's with an intense inflammatory infiltrate were correlated with a high grade of basal cell vacuolations (p < 0.01). A positive statistical correlation between basal cell vacuolation and epithelial atrophy (p < 0.01), and between inflammatory infiltrate intensity and epithelial atrophy (p < 0.01) were observed. An inverse statistical correlation was found when the inflammatory infiltrate intensity and the degree of basal cell vacuolation were compared with epithelial hyperplasia (p < 0.05 and p < 0.01 respectively). In the present study, OLPs with intense immune aggression frequently show epithelial atrophy and erosion on microscopic examination and vice versa.

Denture stomatitis: quantification of interleukin-2 production by mononuclear blood cells cultured with Candida albicans.

Denture stomatitis is usually associated with the presence of yeast, particularly Candida albicans, and several bacteria. In this study mononuclear blood cells were grown in the presence of Candida albicans from a single colony, and interleukin-2 production induced in T lymphocytes was measured. Blood cells were from a population of patients with denture stomatitis and a control group of denture wearers without stomatitis. Induction of interleukin-2 production was correlated with factors that condition denture stomatitis, namely, isolation of Candida albicans in selective medium, age of the denture, and diabetes. Concentrations of interleukin-2 in supernatant and serum were also compared. Significant differences in interleukin-2 production were found between patients with denture stomatitis and controls. Statistical analysis demonstrated a significant association between isolation of Candida albicans and elevated interleukin-2 production in cultures from patients with and without denture stomatitis.