Exceptionally rapid recurrence of malignant meningioma: case report

Anaplastic meningioma represents less than 5% of all meningiomas. It is a neoplasm with a poor prognosis due to aggressiveness and a high rate of recurrence. Patients could remain asymptomatic but clinical characteristics of mass effect are the most common presentation. Although diagnosis is made with histological study, this method is difficult to define, with inter-observer variability. When possible, surgical resection is the primary management. We discuss a case of an adult female patient with tonic-clonic seizures and weakness attributed to an anaplastic meningioma in the occipital lobe. The patient was treated with a parietal craniotomy with complete resection. One month later the patient suffered a recurrence of the tumor with the need for further intervention with incomplete resection. Due to extent of the damage the patient deceased two weeks later.

PORT-A-CATH catheter rupture: case report

Introduction: The modern management of cancer treatment requires access to the venous system repeatedly for the passage of drugs, fluids and blood components. Peripheral veins are rapidly damaged by repeated punctures and by fluids that pass through them. To solve this problem, long-term vascular accesses avoid repeated punctures. One type of long-term venous access is the Port-A-Cath, which is an implantable device usually in the chest with a central venous catheter. Case report: Next, the case of a 34-year-old female with a diagnosis of breast cancer in the right breast is presented. It is treated with a radical mastectomy, and after the procedure a port-a-cath is placed in the left subclavian route for future treatments. The first cycle of chemotherapy is performed, later the patient reports pain at the catheter placement site with increased volume and progressive increase in pain. The patient goes to her health center for an evaluation, they decide to take a chest X-ray showing the migration of the catheter. The management used was through the seldinger technique at the femoral puncture site with a 6 Fr Amplatz GooseNeck Snare Guide, with which it was possible to extract the foreign body at the level of the left brachiocephalic vein. Conclusion: The implantation of a Port-A-Cath catheter is associated with some risks in the process. Catheter and patient care should be maintained to decrease the incidence of complications.

Nitric oxide and fibrinogen in patients with subclinical hypothyroidism and their possible relation to cardiovascular damage

Endothelial dysfunction as well as hypercoagulability have been described as the initial triggers of atherosclerosis and cardiovascular damage and have been associated with subclinical hypothyroidism (SHC). The aim of this research was to determine the concentration of nitric oxide (NO), fibrinogen and circulating lipids in patients with subclinical hypothyroidism and to correlate these variables with thyrotropin (TSH) concentration to establish their possible association with the development of cardiovascular damage. A descriptive, cross-sectional, correlational study was conducted at the IESS Hospital in Riobamba, Ecuador, in the period from January 2019 to September 2021. Ninety-five subjects were studied (65 patients with CAH and 30 controls). The concentration of total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol, TSH, free thyroxine, ON and fibrinogen were determined. Results: We found a decrease in the concentration of ON (p<0.001), accompanied by an increase in the concentration of total cholesterol (p<0.0001), LDL cholesterol (p<0.01) and fibrinogen (p<0.0001) in patients with CAH vs. controls. A negative correlation (p<0.0001; r= -0.5020) was observed between TSH and ON and a positive correlation (p<0.0001; r= 5412) between TSH and plasma fibrinogen in patients with CAH. Conclusion: patients with CAH showed a decrease in serum ON levels and an elevation in plasma fibrinogen concentration. Both measurements correlated significantly with TSH concentration. These parameters associated with an increase in total cholesterol and LDL cholesterol could favor vascular dysfunction, the development of atherosclerosis and consequent cardiovascular damage.

Forestier´s Syndrome, Diffuse idiopathic skeletal hiperostosis: Report of a case of oropharyngeal dysphagia with conservative treatment and literature review

Forestier Syndrome is a rheumatological disease of unknown origin, which consist in calcification of different areas of the body, predominantly at the level of the anterior common vertebral ligament, where osteophytes capable of producing varied symptoms of variable intensity are formed. Normally asymptomatic, although, when it affects the cervical spine, the most common symptom is dysphagia. A case of Forestier syndrome is presented who consulted for dysphagia in the Head and Neck Surgery Unit of the Otolaryngology Service of the Institute of Social Prevision, Asuncion, Paraguay. The semiology allowed to observe a submucosal bulge in the posterior wall of the oropharynx of 1,5 cm in diameter, which could be evaluated and confirmed by tomography. Due to the low intensity of the symptoms and little impact on the general state, it was decided to carry out a conservative treatment with good results, after two years of clinical follow-up. In these cases, surgery occupies a secondary place, either before the failure of this conservative behavior or the progression of the symptoms.

Applicability of the Moyers method for the estimation of the mesiodistal diameter of canines and premolars in patients of 12-18 years old

One of the most universal methods used to predict the mesiodistal width of non-erupted canines and premolars is the one designed by Dr. Edison Moyers, an American orthodontist who, taking the Anglo-Saxon population as a reference, created percentile tables to estimate these values ​​in the maxilla and mandible. During the last decade, several researchers have discovered that, when applied to various populations, there are significant differences between predictions and actual values. In Cuba, it is widely used at a 50% probability for prediction in both sexes, but there are few reports of studies that validate its reliability and those that do exist use small samples of patients. For this reason, the objective of this research is to determine the applicability of the Moyers method at 50% probabilities for estimating the mesiodistal diameter of canines and premolars in patients 12-18 years of age. A descriptive and cross-sectional study was developed from July 2019 to February 2020 with a population of 125 patients, 62 females and 63 males, between 12 and 18 years old from Cuba. Measurements were made of the mesiodistal widths of the lower incisors, all the canines and premolars. Frequency distributions were made to the variables studied and the results were presented in statistical tables. To verify the existence of significant differences, the statistical t-Student test was used. The main results obtained were that the Moyers method tends to underestimate the values ​​for the female sex between 0.4-0.5 mm, and for the male sex between 0.6 and 0.7 mm, this difference being significant for men. It is concluded that the Moyers method cannot be applied in the population studied for the prediction of the mesiodistal width of canines and premolars

Epilepsy and ADHD

Epilepsy encompasses a set of heterogeneous seizure disorders, with various clinical characteristics that exclude a unique etiological mechanism. Individuals with this disease have a significantly higher rate for the development of psychiatric and neurological conditions. Children with epilepsy have two to three times increased risk of developing ADHD when compared to healthy individuals, while one in five epileptic adults have ADHD symptoms. In children with epilepsy, the severity and frequency of seizures and an earlier age at the onset of seizures are common risk factors for ADHD. A narrative review of the literature was carried out and articles published in the period between 2003 and 2021 in digital databases of the health area (LILACS, Medline, Web of Science, SciELO and PubMed) were selected. The review showed that epilepsy can increase the risk of developing ADHD in children, and that benign rolandic epilepsy is the most diagnosed type in these children, which even has a high rate of neurobehavioral disorders with associated ADHD symptoms. Early diagnosis and appropriate management lead to a better prognosis in this group of patients.

Odontogenic keratocyst: diagnostic characteristics and conservative surgical treatment

Keratocyst is a benign odontogenic lesion with aggressive behavior, probably derived from the dental lamina. It is frequently located in the posterior part of the mandibular bone in the area of ​​the third molar, mandibular angle and can progress towards the ramus and the body, presenting a direct association with retained dental organs. There is a wide variety of techniques for the treatment of this lesion, such as decompression, marsupialization, enucleation, and en bloc resection, as well as the combination of these with adjuvant methods. The interest in this lesion stems from its high recurrence rate, which is estimated to be 20-30% in the general population, however, at present the use of conservative treatments such as marsupialization and decompression has been chosen. demonstrated greater effectiveness and less recurrence. This is why after treating the lesions it is important to give a long-term follow-up. The objective of the publication is to present the report of a clinical case of a 21-year-old male patient with a diagnosis of odontogenic keratocyst treated with a decompression technique for five months for subsequent surgical enucleation. It has been proven that decompression treatment followed by enucleation and accompanied by adjuvant methods is an adequate therapeutic management for keratocysts as it demonstrates its lower rate of recurrence and its noble behavior with neighboring vital structures. However, in all cases, regular monitoring should be carried out to prevent recurrence of the lesion.

Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

Vertebral metastasis of renal carcinoma at diagnosis. Mechanical and clinical evaluation. Surgical management

Renal cell carcinoma is among the 10 most common cancers. Metastatic disease of the spine is common and 50% of bone metastases are already present at the time of primary diagnosis. Bone metastases from renal cell carcinoma are difficult to manage, especially vertebral localization. A 48-year-old woman was diagnosed with renal cell carcinoma in the context of low back pain. The patient presented two skeleton metastases at diagnosis (T11 and 5th rib). The patient received neoadjuvant treatment with cabozantinib, followed by removal of the renal tumor. Radiotherapy was administered for the lumbar lesion. In spite of the radiotherapy treatment, increased low back pain limiting mobility and ambulation. MRI showed an occupation of the spinal canal, without neurological lesion. The SINS scale revealed a score of 14 (vertebral instability). The patient's prognosis was greater than 12 months according to the Tokuhashi score. Based on clinical and mechanical criteria, surgical treatment of the vertebral lesion was decided. T11 vertebrectomy was performed, the reconstruction was made with an expandable cage, and T8 a L2 posterior spinal arthrodesis. A partial resection of the fifth rib was performed in order to remove the whole macroscopic tumor. After 3 months, she was diagnosed with a local infection, treated by irrigation, debridement and antibiotherapy, with good evolution. At 1-year follow-up, she has no low back pain or functional limitation. Follow-up chest-abdomen-pelvis computed CT scan showed absence of disease progression, furthermore, the vertebral arthrodesis shows fusion signs. At the time of this report, there are no clinical or radiological data of infection.

Chronic subdural hematoma

does not apply