Pneumoencéfalo intraventricular após perfuração acidental de dura-máter. Relato de caso

BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1% and 2%. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary. © Sociedade Brasileira de Anestesiologia, 2006.

Comparative Analysis of 2 Techniques of Double-Gloving Protection During Arch Bar Placement for Intermaxillary Fixation

Purpose: This study was conducted to comparatively evaluate, in a prospective and randomized manner, 2 techniques for providing double-gloving protection during arch bar placement for intermaxillary fixation. Materials and Methods: A total of 42 consecutive patients in whom application of an Erich bar was indicated for intermaxillary fixation were equally divided into 2 groups. In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove. Wilcoxon, Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to analyze the findings. Results: A total of 103 perforations were found in the outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in inner gloves in both groups (α = .01). No significant statistical difference was found between groups in terms of inner glove perforations (α = .05). The nondominant hand presented with 70.9% of the perforations, statistically significant to 1%. Conclusions: Both double-gloving techniques were found to provide effective clinician protection. The use of a nonsterile disposable glove under the surgical glove is possible for less-invasive procedures, offering the same safety as using 2 sterile surgical gloves while decreasing operational costs. This method does not eliminate the need to change gloves when a perforation is suspected or noted during the surgery, however. © 2007 American Association of Oral and Maxillofacial Surgeons.

Immunohistochemical, tomographic and histological study on onlay iliac grafts remodeling

The information concerning the molecular events taking place in onlay bone grafts are still incipient. The objective of the present study is to correlate the effects of perforation of resident bone bed on (1) the timing of onlay autogenous graft revascularization; (2) the maintenance of volume/density of the graft (assessed through tomography); and (3) the occurrence of bone remodeling proteins (using immunohistochemistry technique) delivered in the graft. Thirty-six New Zealand White rabbits were subjected to iliac crest onlay bone grafting on both sides of the mandible. The bone bed was drill-perforated on one side aiming at accelerating revascularization, whereas on the other side it was kept intact. After grafts fixation and flaps suture all animals were submitted to tomography on both mandible sites. Six animals were sacrificed, respectively, at 3, 5, 7, 10, 20 and 60 days after surgery. A second tomography was taken just before sacrifice. Histological slides were prepared from each grafted site for both immunohistochemistry analysis [osteopontin, osteocalcin, type I collagen and vascular endothelial growth factor (VEGF) anti-bodies] and histometric analysis. The values on bone volume measured on tomography showed no statistic significance (P≥0.05) between perforated and intact sites. Grafts placed on perforated beds showed higher bone density values compared with non-perforated ones at 3 days (P≤0.05). This correlation was inverted at 60 days postoperatively. The findings from VEGF labeling revealed a tendency for earlier revascularization in the perforated group. The early revascularization of bone grafts accelerated the bone remodeling process (osteocalcin, type I collagen and osteopontin) that led to an increased bone deposition at 10 days. The extended osteoblast differentiation process at intermediate stages in the perforated group cooperated for a denser bone at 60 days. © 2008 Blackwell Munksgaard.

Histopathological evaluation of different methods of experimental induction of periapical periodontitis

This study evaluated histopathologically different methods of experimental induction of periapical periodontitis. The radiographic and microbiological evaluations have been performed in a previous investigation. Fifty-seven root canals from dogs' teeth were assigned to 4 groups. In GI (n=14) and GII (n=14), the root canals were exposed to oral environment for 180 days; in GIII (n=14) and GIV (n=15) the root canals were exposed for 7 days and then the access cavities were restored and remained sealed for 53 days. The root apices of GI and GIII were perforated, whilst those of GII and GIV remained intact. After induction of periapical periodontitis, the dogs were euthanized. Serial sections were obtained and stained with hematoxylin and eosin. Data of the histopathological evaluation were submitted to Kruskal-Wallis and Dunn's tests at 5% significance level. The inflammatory periapical reaction and resorption of mineralized tissues were less intense in GII than in the other groups (p<0.05). There was no histopathological difference among the experimentally induced periapical lesions in the teeth with coronal sealing. On the other hand, when coronal sealing was not performed, greater intensity of induced periapical periodontitis was observed in the teeth with apical perforation.

Morfologia do intestino delgado de capivara - Hydrochoerus hydrochaeris (Linnaeus, 1766)

The high potential for the exploitation of capybara requires information about its digestory morphophysiology, to improve nutritional handling. In the present study, gross anatomy, light microscopy and body and intestine lengths of 25 capybaras were evaluated. The minimum and maximum small intestine lengths for females and males were, respectively, 441 cm and 1734 cm, and 355 cm and 1123 cm. These values position the capybara between canine and swine intestinal lengths. The ratio between small intestine and body length was 12:1, without differences between sexes. There were no statistically significant differences between sexes for each part of small intestine. Correlation between length of each small intestine segment and body length was positive, and statistically significant only for the duodenum. The small intestine wall was formed by mucosa, submucosa, muscular and serosa. The mucosa presented intestinal and duodenal glands, of mucosal and serosal types, respectively. The mucosa muscular layer consisted of two distinct layers in the jejunum and ileum, and a thin and single layer in the duodenum. The submucosa, formed by moderate dense connective tissue, didn't show glands. The fiber bundles of the internal layer of muscular tunic were helicoidally arranged. The gross anatomy of the capybara small intestine was similar to canine and swine intestines. Microscopically, however, subtle differences can be identified in the submucosa and internal muscular tunics.

Influência de fontes de nitrogênio no consumo e digestibilidade aparente total e parcial de novilhos alimentados com cana- deaçúcar

The objective of this work was to evaluate the effect of nitrogen sources, using sugarcane supplemented with urea, corn gluten meal-60 or soybean meal. It was evaluated Intake, total and partial apparent digestibility were evaluated using four rumen and duodenal cannulated crossbred steers. The treatments were evaluated in a 4 × 4 Latin square design. The total feces were collected to determine the apparent digestibility on the total intestinal tract. The indigestible acid detergent fiber (iADF) was used as marker of duodenal flux to determine ruminal and intestinal digestibility and dry matter daily flux. The DM, OM, CP, EE, DE, NDF, ADF and TC intakes and digestibility rates were influenced by nitrogen sources, and lower intake was observed in animals fed exclusively with cane sugar compared to animals fed the other experimental diets. Meanwhile the sources of nitrogen did not affect the total digestible nutrients (TDN) values. The RDP sources did not affect the total, ruminal, and intestinal nutrients apparent digestibility. However, the total, ruminal, and intestinal dry matter, and protein apparent digestibility were affected by the RDP sources.

Indicadores na estimativa do fluxo de digesta em bovinos de corte

single and double marker methods were compared in seven Nellore steers with average body weight 250 kg, and previously canullated in the rumen and duodenum. The animals were fitted with continuous-infusion pump that administered CoEDTA solutions intraruminally. In addition, a capsule containing Cr 2O 3, and other, containing external n-alkanes C 32, C 36 were inserted into the rumen of each steer. Internal markers indigestible neutral-detergent fiber and acid-detergent fiber (iNDF and iADF after 144 h in situ incubation) and internal n-alkanes C 31, C 33, C 35 were components of the diet. Steers were fed with palisade grass (Brachiaria brizantha cv. marandu) in two age of regrowth, 30 and 60 days. The duodenal flow experimental design was a factorial 2×2×12 while omasal experimental design was a factorial 2×2×4. Markers iNDF, CoEDTA and the combination Co+iNDF were efficacious to estimate duodenal dry matter flow whereas iNDF, iADF and the Co+iADF combination were all efficacious to predict omasal dry matter flow. In conclusion, the double marker method for estimation of omasal and duodenal dry matter flow was the most appropriate considering the ruminal fiber digestibility.

Tomographic, Histological, and Immunohistochemical Evidences on the Use of N-Butyl-2-Cyanoacrilate for Onlay Graft Fixation in Rabbits

Background: The bone tissue responses to Cyanoacrylate have been described in the literature, but none used N-butyl-2-cyanoacrilate (NB-Cn) for bone graft fixation. Purpose: The aims of the study were: (a) to analyze the bone grafts volume maintenance fixed either with NB-Cn or titanium screw; (b) to assess the incorporation of onlay grafts on perforated recipient bed; and (c) the differences of expression level of tartrate-resistant acid phosphatase (TRAP) protein involved in bone resorption. Materials and Methods: Eighteen New Zealand White rabbits were submitted to calvaria onlay grafting on both sides of the mandible. On one side, the graft was fixed with NB-Cn, while on the other hand the bone graft was secured with an osteosynthesis screw. The computed tomography (CT) was performed just after surgery and at animals sacrifice, after 1 (n=9) and 6weeks (n=9), in order to estimate the bone grafts volume along the experiments. Histological sections of the grafted areas were prepared to evaluate the healing of bone grafts and to assess the expression of TRAP protein. Results: The CT scan showed better volume maintenance of bone grafts fixed with NB-Cn (p≤0.05) compared with those fixed with screws, in both experimental times (analysis of variance). The immunohistochemical evaluation showed that the TRAP expression in a 6-week period was significantly higher compared with the 1-week period, without showing significant difference between the groups (Wilcoxon and Mann-Whitney). Histological analysis revealed that the NB-Cn caused periosteum damage, but provided bone graft stabilization and incorporation similar to the control group. Conclusion: The perforation provided by screw insertion into the graft during fixation may have triggered early revascularization and remodeling to render increased volume loss compared with the experimental group. These results indicate that the NB-Cn possesses equivalent properties to titanium screw to be used as bone fixation material in osteosynthesis. © 2010 Wiley Periodicals, Inc.

Indicadores bioquímicos séricos e do líquido peritoneal de equinos submetidos à obstrução intestinal

Twenty-four horses were distributed into four different groups, instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII) and large colon obstruction (GIV). Serum and peritoneal fluid analysis of aspartate aminotransferase, creatine kinase, lactate dehydrogenase, alkaline phosphatase, inorganic phosphorus and lactate were measured. Samples were collected one hour before the surgical procedure (T0); 3 hours after the obstruction (T3ob), 1, 3, 12, 24, 120 and 168 hours after the beginning of reperfusion/deobstruction. Duodenal (GII) and ileum (GIII) obstructions changed serum and peritoneal fluid biochemical analysis. However, only lactate, lactate dehydrogenase, creatine kinase and inorganic phosphorus concentrations were abnormal in peritoneal fluid three hours after the obstruction. The biochemical analysis of peritoneal fluid allowed a faster diagnostic of intestinal alterations than the serum analysis; hence it should be prioritized when pre-operatory colic assessment is carried out.

Digestibility, fermentation and rumen microbiota of crossbred heifers fed diets with different soybean oil availabilities in the rumen

The goal of this study was to evaluate the effects of different soybean oil availabilities on the intake and partial and total digestibility of dry matter (DM) and nutrients, rumen fermentation parameters, efficiency of microbial synthesis, and the rumen microbiota of crossbred beef heifers. Nine crossbred heifers fitted with rumen and duodenal cannulae were evaluated in a triple 3 × 3 Latin square design with three treatments and three periods in three simultaneous repetitions. Heifers approximately 18 months old, with mean initial and final body weights of 316.3±28.8 and 362.6±34.4 kg, respectively, were fed a diet containing 600. g/kg of corn silage and 400. g/kg concentrate with a 58.0. g/kg fat content in the total diet. The sources of lipids included soybean grain, rumen-protected fat, and soybean oil. The statistical analyses were conducted using PROC MIXED from SAS, and the means were compared using Tukey's test (P<0.05). Dietary lipid sources did not affect nutrient intake (P>0.05). Except the apparent digestibility of organic matter (P=0.024), the apparent digestibility of the other nutrients did not differ among the treatment groups. Regarding body nitrogen retention, the soybean grain treatment was more effective than the rumen-protected fat treatment (P=0.045); however, the soybean oil treatment did not differ from the other two treatments. In relation to the efficiency of microbial protein synthesis (g. N/kg of organic matter apparently digested in the rumen corrected for microbial organic matter), the soybean oil and soybean grain treatments were more efficient than the rumen-protected fat treatment (P=0.001). Animals fed rumen-protected fat had larger numbers of protozoa (P<0.001) and fungi (P<0.001) than those supplemented with soybean grain and soybean oil. The dietary lipid sources did not affect pH, the molar concentration of propionate and total volatile fatty acids (P>0.05), whereas the concentrations of ammonia nitrogen and acetate were higher in animals fed with rumen-protected fat than in those submitted to the other treatments. The use of different soybean oil availabilities did not affect nutrient intake; however, treatments with soybean oil and soybean grain were more efficient regarding nutrient intake than rumen-protected fat because they reduced the numbers of fungi and protozoa and consequently improved the efficiency of microbial protein synthesis. © 2013 Elsevier B.V.

Laparoscopic adhesiolysis in a mini pony

Background: Intraperitoneal adhesions are common in equines, especially following exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several advantageous aspects in human patients. The aim of the current study was to report a case of successful laparoscopic adhesiolysis in a mini pony horse. Case: A male Shetland Pony, weighing 140 kg, was admitted under complaint of right hind limb trauma and treated surgically for metatarsal fracture reduction. The patient has also had intermittent episodes of colic and was always treated clinically without major complications. The pony had no history of previous abdominal surgery and no episodes of acute abdomen were seen during hospital stay. Three months following ostheosynthesis, an exploratory laparoscopic approach was carried out to assess the possible cause or consequences of the episodes of acute abdomen. The patient was submitted to general anesthesia, positioned in dorsal recumbency and the abdomen was clipped and aseptically prepared for surgery. During the laparoscopic inspection, there were adhesions involving the ventral abdominal wall and a ventral mesogastric segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach, by gently breaking the adhesion bands using meticulous traction with a 10-mm laparoscopic atraumatic Babcock forceps. Afterwards, the intestinal loop was rinsed with heparin sodium solution diluted in normal saline. The pneumoperitoneum was completely drained and the trocars sequentially withdrawn from the abdominal wall. The synthesis of the muscular layer was carried out using an interrupted cross mattress pattern, followed by synthesis of the skin with an interrupted cushion pattern. Total surgical time was 58 min. the patient was able to recover without complications. In the early postoperative period, the surgical recovery was considered excellent. No apparent adhesion involving the previously affected intestinal loop was found during the ultrasound exam following 15 days of surgery. Furthermore, the surgical wounds had healed completely, with no complications. Discussion: In the current case report, the primary cause of the acute abdomen episodes was not determined since the patient had never undergone abdominal surgery. It was hypothesized that an acute inflammation of the duodenal loop that was involved by the adhesion bands may have triggered the adhesiogenesis. Laparoscopy was efficient and presented a short operative time, due to magnification of image and adequate observation of structures surrounded by adhesion bands. Although the use of Babcock forceps is not usually recommended for adhesiolysis in the current literature, it was both effective in manipulating the bowel and performing the adhesiolysis. The heparin solution diluted in normal saline was effective in preventing the recurrence of new adhesions, which was evidenced by ultrasonography following 15 days. The laparoscopic approach usually minimizes the new formation of adhesions as trauma to the peritoneal surfaces is minimized by the use of delicate instruments, as observed in the current study. In addition, laparoscopy reduces the possibility of contact among the peritoneal surfaces and foreign bodies, such as gauze, glove powder and room air particles. Moreover, it maintains the abdominal surfaces in adequate humidity environment.

Efeitos do refluxo gastroesofágico na cavidade oral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos do tramadol no modelo de dor induzida por obstrução intestinal em eqüinos

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

Utilização do prebiótico Flavofeed® como suplemento dietário para juvenis de tilápia do Nilo Oreochromis niloticus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)