Comparative study of two autogenous graft techniques using piezosurgery for sinus lifting

PURPOSE: Maxillary sinus lifting is a technique, in which, a possible complication is sinus membrane perforation. The aim of this study was to compare two techniques using ultrasound surgery to perform autogenous graft for maxillary sinus lifting. METHODS: Ten rabbits were used in the study, one of them did not undergo surgery. The other nine rabbits had their maxillary sinuses filled with autogenous bone grafts collected from the external skull diploe in particulate form on the right side, and shaved on the left side, both with ultrasonic device. Data on bone density in left and right maxillary sinus, obtained by computed tomography in transverse and longitudinal sections, recorded 90 days after the grafts, were statistically compared. RESULTS: There were no statistically significant differences between the two techniques that used shaved and particulate bone collected by means of ultrasonic device from rabbit skulls. CONCLUSION: Assessment of operative procedures led to the conclusion that piezoelectric ultrasound was shown to be a safe tool in the surgical approach to the maxillary sinus of rabbits, allowing sinus membrane integrity to be maintained during surgical procedures.

Evaluation of the dental structure loss produced during maintenance and replacement of occlusal amalgam restorations

The aim of this in vitro study was to evaluate four different approaches to the decision of changing or not defective amalgam restorations in first primary molar teeth concerning the loss of dental structure. Ditched amalgam restorations (n = 11) were submitted to four different treatments, as follows: Control group - polishing and finishing of the restorations were carried out; Amalgam group - the ditched amalgam restorations were replaced by new amalgam restorations; Composite resin group - the initial amalgam restorations were replaced by composite resin restorations; Flowable resin group - the ditching around the amalgam restorations was filled with flowable resin. Images of the sectioned teeth were made and the area of the cavities before and after the procedures was determined by image analysis software to assess structural loss. The data were submitted to ANOVA complemented by the Student Newman Keuls test (p < 0.05). The cavities in all the groups presented significantly greater areas after the procedures. However, the amalgam group showed more substantial dental loss. The other three groups presented no statistically significant difference in dental structure loss after the re-treatments. Thus, replacing ditched amalgam restorations by other similar restorations resulted in a significant dental structure loss while maintaining them or replacing them by resin restorations did not result in significant loss.

Fatal adenoviral necrotizing bronchiolitis case in a post-cardiac surgery intensive care unit

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.

Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur

A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural), CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma), CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1) e CON (anestesia epidural com lidocaína 2%). Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur.

Caracterização da fala de indivíduos submetidos à palatoplastia primária

OBJETIVOS: Descrever as características de fala de indivíduos submetidos à palatoplastia primária; relacioná-las com tipo de fissura, técnica cirúrgica e idade na ocasião da cirurgia; e descrever as condutas fonoaudiológicas após a cirurgia. MÉTODOS: Estudo retrospectivo de 167 casos, de ambos os gêneros, com fissura labiopalatina, submetidos à palatoplastia primária. Foram coletadas informações relativas ao tipo de fissura, idade na palatoplastia, técnica cirúrgica, e as análises subjetivas sobre as características da fala, realizadas por fonoaudiólogas. RESULTADOS: Na avaliação perceptiva da fala após a cirurgia, encontrou-se inteligibilidade de fala alterada (46%), ressonância hipernasal (33%), articulações compensatórias (26%), emissão de ar nasal (14%), mímica facial (11%) e fraca pressão aérea intra-oral (8%). Na associação entre a ressonância e as articulações compensatórias com tipo de fissura, técnica cirúrgica e faixa etária, não houve diferença significativa. A conduta mais frequentemente tomada foi a de terapia fonoaudiológica (38%), para correção das articulações compensatórias e/ou outras alterações. CONCLUSÃO: A maioria dos indivíduos apresentou ressonância equilibrada ou hipernasalidade aceitável e ausência de articulações compensatória, independente do tipo de fissura, da técnica cirúrgica e da faixa etária, embora não tenha ocorrido diferença significativa. Dentre as condutas adotadas após a primeira avaliação pós-palatoplastia primária, a terapia fonoaudiológica foi a mais frequente.

Grupos de aprendizagem nas aulas de física: as interações entre professor e alunos

Em nosso trabalho buscamos entender a dinâmica que se estabelece na sala de aula quando são introduzidas atividades de grupos, analisando o processo grupal e sua relação com o ensino-aprendizagem da Física. Por isso, optamos por um estudo das relações estabelecidas no grupo entre os seus membros (alunos e professor) e das estratégias criadas em conjunto para a resolução da atividade. Como referencial teórico, utilizamos as concepções de grupo operativo de Pichon-Rivière, que focaliza a tarefa do grupo e o vínculo entre os membros como elementos essenciais do desenvolvimento grupal. O nosso trabalho consistiu em uma análise diacrônica e sincrônica das interações dos alunos de um dos grupos que compunha a classe em duas aulas diferentes: a primeira antes de uma intervenção institucional do professor, que atribuiu funções para cada um dos membros do grupo; e a segunda depois desta intervenção.

Physical analysis of compost from composting plants in Brazil

Nowadays the composting process has shown itself to be an alternative in the treatment of municipal solid wastes by composting plants. However, although more than 50% of the waste generated by the Brazilian population is composed of matter susceptible to organic composting, this process is, still today, insufficiently developed in Brazil, due to low compost quality and lack of investments in the sector. The objective of this work was to use physical analyses to evaluate the quality of the compost produced at 14 operative composting plants in the Sao Paulo State in Brazil. For this purpose, size distribution and total inert content tests were done. The results were analyzed by grouping the plants according to their productive processes: plants with a rotating drum, plants with shredders or mills, and plants without treatment after the sorting conveyor belt. Compost quality was analyzed considering the limits imposed by the Brazilian Legislation and the European standards for inert contents. The size distribution tests showed the influence of the machinery after the sorting conveyer on the granule sizes as well as the inert content, which contributes to the presence of materials that reduce the quality of the final product

Robotic Resection of Intraductal Neoplasm of the Pancreas

Background: Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional open surgery. Computer-assisted surgical devices have recently been approved for general surgical use. Aim: The aim of this study was to report the first known case of pancreatic resection with the use of a computer-assisted, or robotic, surgical device in Latin America. Patient and Methods: A 37-year-old female with a previous history of radical mastectomy for bilateral breast cancer due to a BRCA2 mutation presented with an acute pancreatitis episode. Radiologic investigation disclosed an intraductal pancreatic neoplasm located in the neck of the pancreas with atrophy of the body and tail. The main pancreatic duct was enlarged. The surgical decision was to perform a laparoscopic subtotal pancreatectomy, using the da Vinci (R) robotic system (Intuitive Surgical, Sunnyvale, CA). Five trocars were used. Pancreatic transection was achieved with vascular endoscopic stapler. The surgical specimen was removed without an additional incision. Results: Operative time was 240 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions: The subtotal laparoscopic pancreatic resection can safely be performed. The da Vinci robotic system allowed for technical refinements of laparoscopic pancreatic resection. Robotic assistance improved the dissection and control of major blood vessels due to three-dimensional visualization of the operative field and instruments with wrist-type end-effectors.

Laparoscopic nephrectomy outside gerota fascia for management of inflammatory kidney

Background and Purpose: A nonfunctioning inflammatory kidney is a challenging surgical condition for urologists. Some investigators recommend open surgery because of the surgical difficulties caused by the inflammatory process, whereas others try to apply the advantages of a ""simple"" non-hand-assisted laparoscopic approach. We report our experience with simple laparoscopic nephrectomy for inflammatory kidney management. Patients and Methods: From July 2002 through December 2006, 50 pure laparoscopic nephrectomies were performed for inflammatory kidney ( 43 because of pyelonephritis, 5 for xanthogranulomatous pyelonephritis (XGP), and 2 for pyonephrosis). Histopathologic analysis was the criterion used for inflammatory kidney diagnosis. Pain or recurrent urinary tract infection associated with a nonfunctioning excluded kidney was the eligibility criterion for the procedure. Preoperatively, all patients underwent complete image and functional renal assessment. Morcellation was used to remove surgical specimens. Conversion index, surgical difficulties, operative time, and postoperative complications were evaluated. Results: Conversion was performed in 14 of 50 (28%) patients, including two with XGP and one with pyonephrosis. Adhesions, vascular (two inferior vena cava) lesions, and intestinal lesions (two colon) were the main causes of conversion. Acute pancreatitis developed in one patient, and one patient had a wound infection. Reoperations were unnecessary, and no deaths occurred. Conclusion: Pure laparoscopic nephrectomy was successful in 72% of patients with inflammatory kidneys. The laparoscopic dissection was useful even in those cases converted to open surgery. This is a high-risk procedure, however, and both surgeon and patient must be aware of that before the decision is made for this approach.

Combined Retrograde Flexible Ureteroscopic Lithotripsy with Holmium YAG Laser for Renal Calculi Associated with Ipsilateral Ureteral Stones

Purpose: The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones. Materials and Methods: Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II). Results: Mean ureteral stone size was 8.0 +/- 2.6 mm and 8.1 +/- 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 +/- 29.5 minutes and for group 2 was 49.3 +/- 13.2 minutes (p < 0.001). Flexible ureteroscopic therapy for renal calculi increased 18 minutes in the mean operative time. The overall complication rate was 3.1% and 2.5% for groups I and II, respectively (p = 0.87). Mean renal stone size was 10.7 +/- 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p = 0.03; r = -0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR = 13.5; p = 0.01). Conclusion: Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.

Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?

AIM: To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis. Prognostic factors, especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed. METHODS: Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection. Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct (> 2 cm). Late results and risk factors for recurrence of symptoms or stones were evaluated. RESULTS: There was no operative mortality. After a mean follow-up of 50.3 mo, good late results were observed in 82.9% of patients; all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms (P = 0.0006). Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%, respectively (P < 0.001). CONCLUSION: Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution. Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct. (C) 2010 Baishideng. All rights reserved.

Intrahepatic Glissonian Approach for Pure Laparoscopic Left Hemihepatectomy

Background: Recent advances in laparoscopic devices and experience with advanced techniques have increased the indications for laparoscopic liver. Aim: The aim of this work was to present a video with technical aspects of a pure laparoscopic left hemi-hepatectomy (segments 2, 3, and 4) by using the intrahepatic Glissonian approach and control of venous outflow without hilar dissection or the Pringle maneuver. Patient and Method: A 63-year-old woman with a 5-cm solitary liver metastasis was referred for treatment. Four trocars were used. The left lobe was pulled upward and the lesser omentum was divided, exposing Arantius' ligament. This ligament is a useful landmark for the identification of the main left Glissonian pedicle. A small anterior incision was made in front of the hilum, and a large clamp was introduced behind the Arantius' ligament toward the anterior incision, allowing control of the left main sheath. Ischemic discoloration of the left liver was achieved and marked with cautery. The vascular clamp was replaced by a stapler. If ischemic delineation was coincident with a previously marked area, the stapler was fired. The left hepatic vein was dissected and encircled. Parenchymal transection and vascular control of the hepatic veins were accomplished with a Harmonic scalpel and an endoscopic stapling device, as appropriate. All these steps were performed without the Pringle maneuver and without hand assistance. Results: Operative time was 220 minutes with minimum blood loss. Hospital stay was 4 days. Pathology showed free surgical margins. The patient is alive with no signs of recurrence 18 months after the operation. Conclusion: Totally laparoscopic left hemihepatectomy is safe and feasible in selected patients and should be considered for patients with benign or malignant liver neoplasms. The described technique, with the use of the intrahepatic Glissonian approach and control of venous outflow, may facilitate laparoscopic left hemihepatectomy by reducing the technical difficulties in pedicle control and may decrease bleeding during liver transection.

Cortisol plasmático como indicador de estresse em colopexias laparoscópicas com implante de tela de polipropileno em cães

The realization of conventional surgical procedures, even using the recommended doses of analgesics drugs, generally are associated with a long recovery period, post-surgical trauma, stress and pain in animals. That can vary according with the procedure, extension and time of the surgery. Considering the increased interest in procedures that minimize surgical stress and the recovery period after the surgical procedure in dogs, this present work was developed to evaluate a new technique of laparoscopic colopexy with the alterations of cortisol levels, heart rate and respiratory frequencies in dogs. For this study, nine female dogs were submitted to a colopexy. Blood samples and data of heart rate and respiratory frequency were sampled in intervals of 10min. from the preoperative period until the end of the procedure. After, these parameters were assessed every three hours for 12 hours. Cortisol levels were measured using an ELISA Kit for cortisol. Results were analyzed by ANOVA and comparisons were made using Tukey's test. Significance levels was set at p <= 0.05. The increase of the heart rate, respiratory frequency and cortisol levels were mainly observed in the period after shaving and after the end of the anesthesia. Values were kept stable during all the surgery, and coming to the basal conditions after nine hours in the post-operative period. The laparoscopic colopexy is a stress-associated surgery, but it produces lower increasing of cortisol levels returning to normal in 9 hours after the surgery.

Spin Hall effect due to intersubband-induced spin-orbit interaction in symmetric quantum wells

We investigate the intrinsic spin Hall effect in two-dimensional electron gases in quantum wells with two subbands, where a new intersubband-induced spin-orbit coupling is operative. The bulk spin Hall conductivity sigma(z)(xy) is calculated in the ballistic limit within the standard Kubo formalism in the presence of a magnetic field B and is found to remain finite in the B=0 limit, as long as only the lowest subband is occupied. Our calculated sigma(z)(xy) exhibits a nonmonotonic behavior and can change its sign as the Fermi energy (the carrier areal density n(2D)) is varied between the subband edges. We determine the magnitude of sigma(z)(xy) for realistic InSb quantum wells by performing a self-consistent calculation of the intersubband-induced spin-orbit coupling.

Effect of Oxalate Desensitizer on the Durability of Resin-Bonded Interfaces

Potassium oxalate desensitizers were previously shown to effectively reduce the immediate permeability of resin-bonded dentin. The current study evaluated whether the effect of the combined application of oxalate with etch-and-rinse adhesives interferes with the durability of resin-dentin bonds when using etch-and-rinse adhesives. The bond strength of resin-bonded dentin specimens composed of two-step or three-step etch-and-rinse adhesives (Single Bond, One-Step and Scotchbond Multi-Purpose, respectively) was tested immediately (24 hours) and after 12 months of water storage. The adhesives were used either according to the manufacturers` instructions (control groups) or after treating acid-etched dentin with a potassium oxalate gel (BisBlock, BISCO, Inc). The treatment of dentin with potassium oxalate was shown to negatively affect the baseline bond strength of resin-bonded dentin specimens, regardless of the adhesive used (p<0.05). After storage, the bond strength of the resin-bonded interfaces was significantly reduced for all the tested groups (p<0.001). Nevertheless, the rate of decreasing bond strength was significantly lower for oxalate-treated specimens than for the controls (p<0.05).