Chin augmentation with conchal cartilage

Profile enhancement most frequently involves mentoplasty. For this purpose, the author performs conchal grafts to the chin. A total of 28 women aged 15 to 76 years (mean age, 38.11 ± 15.11 years) requested mentoplasty by itself or combined with rhinoplasty, rhytidoplasty, or submental lipoplasty. The conchal cartilage was harvested subperichondrally through a posterior 3-cm incision. The specimen measured 3 x 1 cm, which was sufficient to project the chin 2 to 3 mm. For 4 to 5 mm of projection, both cartilages were used. The graft was positioned under the periosteum and held with two 5-0 nylon sutures. In these cases, the conchal cartilage graft was a suitable option for chin augmentations up to 5 mm.

Estudo da estabilidade da cirurgia do tipo sagital da mandíbula com vista a correção de deformidades faciais

This research evaluated the surgical stabilily in patients with mandibular prognathism and retrognathism in which was used sagital split technic to correct those detormities. Twelve patients were selected from the clinic of only one experienced surgeon. Six patients presenter a Class III 6 a Class II molar relationship. A comparative cefalometric analysis using linear and angular measurements was performed of pre-surgery, imediate pós-surgery and 1 year follow-up. The following conclusions were obtained. 1 The Dal Pont sagital split technic modified by Epker to correct mandibular prognathisn and retroghnatism is a stable technic and must be indicated to correct those deformities. 2 Small relapses are easily corrected by the post-surgical orthodontic treatment. 3 A small over correction is advised in cases of large mandibular advancements or set bascks. 4 In those cases which a large amount of mandibular retrusion on advancement need to be performed, a combination of maxillary and mandibular surgery should be used. Rigid fixation technic is also indicated in those cases

Organização da demanda de um Centro de Especialidades Odontológicas

Introduction: Secondary care in oral health in Brazil is still a little researched topic. Objective: The aim of this study was to analyze the resolution of dental services in SUS based on the referral to secondary attention and backreferral to primary attention. Methodology: It’s a descriptive, quantitative study that used secondary data collected from dental records of patients seen at Centre of Dental Specialties (Ceo) in a city of São Paulo State. Result: It was analyzed 1030 dental records. Just 1236 proceedings received referral to Ceo and among then, 86.4% showed the first attendance on Basic Health Unity (UBS) through spontaneous demand and 50.4% (n=623) received referral to endodontic treatment. There was evasion of 2.27% of studied population (n=28) on the first specialized consultation. Among 1208 proceedings that started the treatment in Ceo, 62.6% (n=757) were finalized and received back-referral to primary attention, that finalized 61.1% (n=463) of proceedings. To conclude the treatment, considering the time spent in Ceo and primary attention, there was variation according to specialty: periodontics – 62 days (sd ±68) and endodontics – 71 days (sd ±51.8), requiring 3 consultations in average, regardless specialty. Conclusion: The Centre of Dental Specialties gave referral and attention to the majority of demand, regardless specialty. However, there are many cases of evasion during dental treatment, alerting managers to develop methods to entice these patients, reducing service expenses and raising solvability of dental procedures previously initiated.

Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Considerações sobre o sucesso do tratamento endodôntico

The follow up after endodontic treatment is the most effective tool for evaluating the quality of treatments performed, as well as, it lets to examine the procedures used at different stages of endodontic therapy. Clinical and radiographic findings must be taken into consideration to determine the percentage of endodontic success. Clinical findings include: absence of pain or positive examinations for percussion and palpation, swelling, tooth mobility and fistula. Regarding the radiographic findings it is possible to report absence of periapical radiolucent areas suggestive of periapical lesions and presence of bone cortical. Thus the aim of this study was to perform a bibliographic revision and a discussion about the factors of endodontic treatment follow up.

Avaliação da neutralização dos efeitos citotóxicos do ácido lipoteicóico em canais radiculares

Pós-graduação em Odontologia Restauradora - ICT

Influência da hipertensão arterial no padrão fenotípico da lesão periapical, na diferenciação dos osteoclastos, na resposta teciduale na capacidade de mineralização do cimento reparador MTA

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Atividade proteolítica e resistência da união cimento resinoso-dentina radicular produzida na presença de agentes promotores de ligações cruzadas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Surgical treatment of gynaecomastia in a Saanen goat

Background: Gynaecomastia in male goats is characterized by abnormal development of the mammary gland. Enlarged udder may be observed cranially to the scrotum, which can occasionally reach the size of the testicles. The udder may carry functional glands and impair the animal's reproductive performance and welfare. The case of a successful surgical treatment of gynaecomastia in a high reproductive performance Saanen buck-goat is reported in the present study.Material, Methods & Results: The animal was admitted presenting significant augmentation of the mammary glands, which was clinically diagnosed as gynaecomastia. The male goat owned optimal phenotypic characteristics for the Saanen breed, which had been producing high performance descendents. The mammary glands had been impairing the goat's locomotion and sexual performance. Manual milking resulted in great amount of milk secretion. The animal presented anorexia and impaired sexual performance. After clinical and laboratorial evaluation, the animal was submitted to radical mastectomy. An elliptic skin incision was performed around each mammary gland. Subcuticular blunt dissection was accomplished to isolate the mammarian tissue from the abdominal muscular layer and the spermatic chord. The excised mass was sampled for histological assessment. Subcuticular layer and skin closure was carried in a routine fashion. Hygienization of the surgical wound was performed with 2,5% PVP-I solution for ten days. Additionally, an association of penicillin G benzathine and streptomycin, and fluxinin meglumine were also given. The surgical procedure was successfully accomplished without any peroperative complication. The excised mass was sampled for anatomic/histological assessment. Macroscopically, the left mammary gland presented 22 cm in length, 12 cm wide and 26 cm in diameter. The right gland presented 16 cm in length, 7 cm wide and 13,5 cm in diameter. The microscopic assessment revealed hyperplasia of the glandular ducts. No abnormalities resembling malignant mammary neoplasms or degeneration were observed. At the end of the treatment, the animal was completely recovered. The animal convalesced satisfactorily and surgical wound healed completely within the first 10 days post-op. The goat was not culled and returned to normal reproductive activity. Within 12 months of follow-up, the animal was able to produce high milk yield performance progenies.Discussion: This case report presented relevant aspects of the surgical management of gynaecomastia, especially to veterinary practitioners dealing with milk goats. Gynaecomastia is not as common as other reproductive disorders in domestic animals. In opposition to the findings of the present study, other trials revealed that gynaecomastia usually does not affect fertility, libido, ejaculate parameters and sexual performance of goats. However, it is important to consider that neoplasic disorders such as mammary adenocarcinoma may be present, even though these are rare complications. Last but not least, the decision making on mastectomy in the present study was crucial in order to reestablish the animal's welfare and its functionality in the farms reproduction program.

Wear resistance of nickel-titanium endodontic files after surface treatment

Objectives The purpose of this work was to submit the Nitinol files to plasma immersion ion implantation (PIII) and evaluate the effects of the surface treatment. Materials and Methods Wear resistance was determined in vitro by using an equipment for the application of horizontal movements on previously prepared notched plates made of resin. Vickers microhardness was measured in plates and files, before and after surface treatment and the surface chemical composition of the instruments was determined by X-rays photoelectron spectroscopy. Results The hardness values found for the treated Nitinol files were significantly lower than the hardness values measured before the implantation process. The comparison of commercially available instruments shows that the wear resistance of the stainless steel file is higher than the resistance of the Nitinol. Conclusions The results found led to the conclusion that the surface treatment significantly increased the Nitinol files wear resistance.

Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies

PURPOSE: To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05). CONCLUSION: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.

Treatment of venous ulcers with surgical adhesives derived from snake venom

A Brazilian dictionary states that "ulcer", from the Latin word ulcuserise, is a superficial lesion on skin or mucous membrane characterized by an inflammatory process and loss of tissue. Ulcers are a relatively frequent problem that may be worsen by infection or long-time duration. In these cases, they can represent a serious public health issue, since the increased case number contributes to the burden on the public health service. In recent decades, wound treatment has advanced in technological and scientific aspects regarding both development of new products and techniques. Ongoing research in this area is providing new products for wound treatment. Among newly tested substances that have presented successful results is fibrin glue, a snake venom derivative that promotes reduction of infection and edema as well as bleeding control and pain decrease. Thus, the present study aimed to evaluate fibrin glue effects on ulcers of venous origin in 24 patients that were divided into two groups. The first one (G1) consisted of 11 patients treated without the adhesive while the second group (G2) was composed of 13 persons who were under therapy with the adhesive. The results of this study revealed that patients treated with fibrin glue evolved to a satisfactory healing when compared to the other group. Therefore, fibrin glue is an appropriate alternative for treating leg ulcers with several advantages: easy application, less pain, early hospital discharge, not transmiting diseases, lower cost than the adhesive currently available in Brazil and, finally, it is a Brazilian technology.

Quality of life in women with vulvar cancer submitted to surgical treatment: a comparative study

Objectives: To investigate the occurrence and severity of lymphoedema of the lower extremities (LLE), quality of life (QoL), and urinary and sexual dysfunction in women with vulvar cancer submitted to surgical treatment.Study design: Twenty-eight patients with vulvar cancer submitted to vulvectomy and inguinofemoral lymphadenectomy and 28 healthy, age-matched women (control group) were evaluated. The occurrence and severity of LLE were determined by Miller's Clinical Evaluation. QoL, urinary function and sexual function were assessed by the EORTC QLQ-C30, SF-ICIQ and FSFI questionnaires, respectively. The differences between groups and correlations were assessed using Student's r-test, Chi-squared test, Mann-Whitney U-test and Spearman's rho test.Results: The groups were similar in terms of marital status, educational status, menopausal status, hormone therapy and height. The occurrence and severity of LLE were higher in women with vulvar cancer compared with the control group (p < 0.001 and p = 0.003, respectively). A significant association was found between the severity of LLE and advanced age (p = 0.04), and the severity of LLE and higher body mass index (BMI; p = 0.04) in patients with vulvar cancer. In the patients with vulvar cancer, there was a significant correlation between the severity of LLE and worse QoL in the following domains: physical, cognitive, emotional, social, fatigue, pain, sleep and financial questions (p < 0.05). There was no difference in urinary function between the two groups (p = 0.113). Age and number of deliveries were the only variables associated with the occurrence of urinary incontinence (p = 0.01). Urinary incontinence was present in women with a mean age of 74.9 +/- 4.6 years and a mean of 7.3 +/- 1.3 normal deliveries. There was no difference between the groups in terms of the sexual function. Multivariate analysis showed an association between sexual function and age (p = 0.01), and sexual function and being in a stable relationship (p = 0.02).Conclusion: Patients submitted to vulvectomy or inguinofemoral lymphadenectomy for vulvar cancer are at higher risk of developing LLE compared with healthy, age-matched women. This has a negative effect on QoL, but does not interfere with urinary or sexual function. (C) 2012 Elsevier B.V. All rights reserved.

Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy

CONTEXTO: A recorrência local única do carcinoma renal de células claras em seu leito renal após nefrectomia radical é um evento raro. Estima-se que essa situação ocorra em 0,8% a 3,6% do total de procedimentos. Comumente, seu diagnóstico é realizado através de tomografia computadorizada de abdômen ou ultra-som renal usados no acompanhamento desses pacientes. É polêmico qual o melhor tratamento dessa rara condição entre urologistas e oncologistas devido aos poucos relatos em literatura. RELATO DE CASO: Relatamos um caso de recidiva neoplásica única no leito renal após quatro anos e meio da nefrectomia radical por adenocarcinoma de células claras, sem evidência de metástases a distância em outros órgãos. O diagnóstico foi realizado por meio de tomografia abdominal em acompanhamento ambulatorial, observando-se massa retroperitoneal em topografia renal. A massa foi retirada por meio de uma incisão subcostal ampliada, em cirurgia sem intercorrências. O paciente evoluiu bem no pós-operatório. Após um ano e meio do procedimento, foi evidenciada uma metástase no pulmão esquerdo, e seis meses após, outra recorrência metastática na nona costela anterior à direita, mesmo com paciente totalmente assintomático. O tratamento cirúrgico agressivo em recorrência local única é um bom método para controlar essa rara doença. Tomografia computadorizada de abdômen deve ser feita em acompanhamento de carcinoma renal por longos períodos após a nefrectomia radical para o diagnóstico de recorrências tardias e o tratamento deve ser feito como o de uma metástase recorrente única.